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Low-cost do-it-yourself (DIY) kit for glaucoma procedures. 用于青光眼手术的低成本 DIY 套件。
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2024-08-14 DOI: 10.4103/IJO.IJO_950_24
Indira Pegu, Rengaraj Venkatesh, Swati Upadhyaya

Surgical skill training in ophthalmology is pivotal for ensuring optimal and safe patient outcomes. Access to traditional training resources such as cadaveric or animal eyes, as well as modern alternatives such as silicone eyeballs and simulators, remains limited, especially in resource-constrained settings. We present a series of innovative and low-cost do-it-yourself (DIY) models for glaucoma training using readily available hospital waste materials. These models allow ophthalmic assistants, fellows, and junior consultants to practice various procedures before transitioning to live patients, thereby enhancing surgical proficiency and minimizing the financial burden on both trainees and training institutions. We were able to practice procedures such as tonometry, central corneal thickness measurement, laser suture lysis, laser iridotomy, anterior chamber decompression, bleb needling, trabeculectomy flap construction, and suturing. By providing a practical and easy training solution, these models have the potential to boost confidence among glaucoma trainees and thus address the growing demand for skilled glaucoma surgeons.

摘要:眼科手术技能培训对于确保患者获得最佳和安全的治疗效果至关重要。传统的培训资源(如尸体或动物眼睛)以及现代的替代品(如硅胶眼球和模拟器)仍然有限,尤其是在资源有限的环境中。我们介绍了一系列创新的、低成本的 DIY 模型,用于利用医院废弃材料进行青光眼培训。这些模型可让眼科助理、研究员和初级顾问在接触活体患者之前练习各种手术,从而提高手术熟练程度,并最大限度地减轻受训人员和培训机构的经济负担。我们能够练习的程序包括眼压测量、中央角膜厚度测量、激光缝线裂解、激光虹膜切开术、前房减压、眼裂针刺、小梁切除术瓣构建和缝合。通过提供实用、简便的培训解决方案,这些模型有望增强青光眼学员的信心,从而满足对技术熟练的青光眼外科医生日益增长的需求。
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引用次数: 0
Comparative evaluation of OCT with OCTA changes at the optic disc and macula in glaucoma suspect and early glaucoma. 比较评估青光眼疑似患者和早期青光眼患者视盘和黄斑的 OCT 与 OCTA 变化。
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2024-10-25 DOI: 10.4103/IJO.IJO_2575_23
Dewang Angmo, Anirudh Kapoor, Gazella B Warjri, Shorya Vardhan Azad, Rohan Chawla, Viney Gupta, Tanuj Dada

Purpose: To compare the diagnostic ability of macular ganglion cell inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on optical coherence tomography (OCT) and macular and peripapillary perfusion changes using OCT angiography (OCTA) in glaucoma suspect and early primary open angle glaucoma (POAG).

Methods: Ninety patients (30 normal, 30 glaucoma suspects, and 30 early POAG) were recruited in this cross-sectional, prospective study. The average thickness of mGCIPL and pRNFL on spectral domain-OCT and macular vessel density (VD), optic nerve head (ONH) perfusion, and ONH flux index (FI) on OCTA were evaluated for early diagnosis of glaucoma.

Results: Macular VD, ONH perfusion, and ONH FI were significantly reduced in early POAG eyes compared to normal. The best correlation was observed between ONH FI and the average RNFL in both glaucoma suspects ( r = 0.47, P < 0.01) and early POAG patients ( r = 0.53, P < 0.01). Out of all the measured OCTA parameters, only ONH perfusion was significantly lower in glaucomatous eyes compared to glaucoma suspects ( P < 0.001). Average GCIPL (0.82) and macular VD (0.76) had the highest area under the receiver operating characteristic (AUROC) curve value among all the OCT and OCTA parameters, respectively, for differentiating glaucoma suspects from controls. Rim area (0.92) and ONH FI (0.81) had the highest AUROC value among all the OCT and OCTA parameters for differentiating early POAG patients from controls.

Conclusion: OCTA vascular parameters had a good correlation with structural damage both at the disc and the macula. OCT parameters were superior to OCTA parameters for diagnosis of glaucoma, although OCTA parameters are deranged very early in the disease.

目的:比较光学相干断层扫描(OCT)显示的黄斑神经节细胞丛状内层(mGCIPL)和毛细血管周围视网膜神经纤维层(pRNFL)厚度,以及 OCT 血管造影(OCTA)显示的黄斑和毛细血管周围灌注变化对青光眼疑似患者和早期原发性开角型青光眼(POAG)的诊断能力:这项横断面前瞻性研究共招募了 90 名患者(30 名正常、30 名青光眼疑似患者和 30 名早期原发性开角型青光眼患者)。结果:黄斑血管密度(VD)、视神经头(ONH)灌注和ONH通量指数(FI)在OCTA上的平均值均可用于青光眼的早期诊断:结果:与正常人相比,POAG 早期患者的黄斑血管密度、视神经头灌注和视神经头通量指数明显降低。青光眼疑似患者(r = 0.47,P < 0.01)和早期 POAG 患者(r = 0.53,P < 0.01)的 ONH FI 与平均 RNFL 之间的相关性最好。在所有测量的OCTA参数中,只有青光眼眼的ONH灌注显著低于青光眼疑似患者(P < 0.001)。在所有 OCT 和 OCTA 参数中,平均 GCIPL(0.82)和黄斑 VD(0.76)的接收者操作特征曲线下面积(AUROC)值最高,分别用于区分青光眼疑似患者和对照组。在区分早期 POAG 患者和对照组的所有 OCT 和 OCTA 参数中,边缘面积(0.92)和 ONH FI(0.81)的接收者操作特征曲线面积值最高:结论:OCTA血管参数与椎间盘和黄斑的结构损伤有很好的相关性。在诊断青光眼方面,OCT参数优于OCTA参数,尽管OCTA参数在青光眼发病早期就会出现失常。
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引用次数: 0
Early outcomes of bent ab interno needle goniectomy and Espaillat goniotomy with phacoemulsification in open-angle glaucoma.
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.4103/IJO.IJO_2078_24
Devendra Maheshwari, Madhavi Ramanatha Pillai, Shweta Ranjiv Dev, Nimrita Gyanchand Nagdev, Rengappa Ramakrishnan
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引用次数: 0
Bleb resuscitation of failing, leaking and dysfunctional blebs: A review. 失败、渗漏和功能障碍出血点的出血点复苏:综述。
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.4103/IJO.IJO_1233_24
Arshi Singh, Kirti Singh, Aastha Singh

The success of trabeculectomy surgery depends on the longevity of the filtering bleb. Bleb failure can be categorized into two types: the scarred bleb with high intraocular pressure or the over-filtering and leaking bleb with low intraocular pressure. Bleb scarring is an insidious process over time as a consequence of excessive subconjunctival fibrosis. Timely recognition and early intervention utilizing a stepped-up approach are important for resuscitating the bleb and salvaging the trabeculectomy. Over-filtration and leaky bleb on the other end of the spectrum lead to failure of optimal bleb function and require a different management approach. This review discusses in detail various surgical techniques to revive dysfunctional blebs with a special focus on bleb needling. Timely identification and multifaceted management of bleb-related complications is the key to ultimately improving long-term success rates and patient outcomes.

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引用次数: 0
Modified ab-externo scleral fixation method for dislocated scleral fixated intraocular lenses.
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-26 DOI: 10.4103/IJO.IJO_1315_24
Ayushi Choudhary, Gaurang Sehgal, Chaitra Jayadev, Nagesha C Krishnappa

Sutured scleral fixation of intraocular lenses (SSFIOL) is a stable technique with a low risk of dislocation either from suture dehiscence (suture breakage or loosening) or suture erosion (suture degradation or wear), making it a reliable and durable option for intraocular lenses (IOL) fixation. Dislocation of rigid IOLs is managed conventionally by removing the IOL through a large sclerocorneal section and refixing the same lens or tucking another IOL into the sclera. The procedure described here is a modified ab-externo 4-exit 2-knot technique, wherein the dislocated SSFIOL can be refixated with a closed globe maneuver without removing the entire IOL. The eyelet of the haptic is exteriorized through a small limbal incision, and sutures are replaced at both ends. The IOLs refixated using this technique showed good centration postoperatively. Closed globe refixation of rigid IOLs can be easily performed with minimal or no complications. Minimal tissue handling and early postoperative recovery are advantages over conventional IOL removal and re-surgery.

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引用次数: 0
Comment on "Outcomes of bent ab interno needle goniectomy with phacoemulsification in moderate to severe primary open angle glaucoma".
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.4103/IJO.IJO_2258_24
Zeba Khanam, Bhawesh Chandra Saha, Aditya Rajan
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引用次数: 0
Intraoperative tube placement in opaque corneas: The illuminated tube.
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.4103/IJO.IJO_2943_24
Arnav Panigrahi, Viney Gupta, Shikha Gupta

The role of glaucoma drainage devices (GDDs) for refractory glaucoma is well established because of certain advantages offered over conventional filtering surgeries. However, the correct plane of placement of the GDD tube inside an eye with an opaque cornea can be challenging, due to poor intra-operative visualization. These cases are also challenging if they undergo subsequent corneal grafting. In cases with presence of totally opaque cornea precluding tube visualization within the anterior chamber, we describe a novel technique for ensuring the correct positioning of a GDD tube.

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引用次数: 0
Outcomes of non-penetrating deep sclerectomy combined with mitomycin C in advanced open-angle glaucoma in Indian eyes. 非穿透性深巩膜切除术联合丝裂霉素C治疗印度眼晚期开角型青光眼的疗效。
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-27 DOI: 10.4103/IJO.IJO_1257_24
Devendra Maheshwari, Rinkal Goyal, Madhavi Ramanatha Pillai, Shivam Gupta, Drishti Chautani, Rengappa Ramakrishnan

Purpose: To assess the safety and efficacy of non-penetrating deep sclerectomy (NPDS) in advanced open-angle glaucoma patients.

Design: Retrospective observational study.

Methods: Forty-two eyes of 38 patients with advanced glaucoma who underwent NPDS surgery combined with mitomycin-C with or without phacoemulsification were evaluated for up to 12 months at a tertiary eye care center in South India. Patients with intraoperative perforation of the trabeculo-Descemet membrane who did not meet the follow-up criteria were excluded. The primary outcome measured was intraocular pressure (IOP) reduction postoperatively on day 1, week 2, and months 1, 3, 6, and 12. The secondary outcomes measured were the need for antiglaucoma medications (AGMs), postoperative complications, and interventions.

Results: Patients enrolled had a mean age of 61.08 ± 10.2 years. There was a statistically significant reduction ( P < 0.001) of IOP from 29.48 ± 10.89 mmHg (baseline) to 11.58 ± 6.29, 11.90 ± 5.99, 13.60 ± 7.06, 14.03 ± 8.00, 13.94 ± 4.65, and 13.19 ± 3.29 mmHg at day 1, week 2, and months 1, 3, 6, and 12, respectively. The number of AGMs reduced from 3.14 ± 1.03 preoperatively to 1.85 ± 0.83 at 12 months postoperatively ( P < 0.001). Nd: YAG laser goniopuncture was done in 21.4%, bleb needling in 11.9%, and one patient underwent 260° trabeculotomy after NPDS. There were no cases of choroidal detachment or wipeout.

Conclusion: NPDS with or without phacoemulsification has good safety for managing advanced open-angle glaucoma.

目的:评价非穿透性深巩膜切除术(NPDS)治疗晚期开角型青光眼的安全性和有效性。设计:回顾性观察性研究。方法:在印度南部的一家三级眼科保健中心对38例晚期青光眼患者的42只眼睛进行了长达12个月的评估,这些患者接受了NPDS手术联合丝裂霉素c合并或不合并超声乳化术。术中小梁-后网膜穿孔不符合随访标准的患者被排除在外。测量的主要结果是术后第1天、第2周和第1、3、6和12个月的眼压(IOP)降低。测量的次要结果是抗青光眼药物(AGMs)的需求、术后并发症和干预措施。结果:入组患者平均年龄为61.08±10.2岁。在第1天、第2周和第1、3、6、12个月时,IOP分别从29.48±10.89 mmHg(基线)降至11.58±6.29、11.90±5.99、13.60±7.06、14.03±8.00、13.94±4.65和13.19±3.29 mmHg,差异有统计学意义(P < 0.001)。术后12个月agm数由术前的3.14±1.03个减少到1.85±0.83个(P < 0.001)。Nd: YAG激光巩膜穿刺占21.4%,泡针占11.9%,1例患者在NPDS后行260°小梁切开术。无一例脉络膜脱离或脱落。结论:NPDS联合或不联合超声乳化术治疗晚期开角型青光眼具有良好的安全性。
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引用次数: 0
Commentary on: Role of selective laser trabeculoplasty in India. 评论:选择性激光小梁成形术在印度的作用选择性激光小梁成形术在印度的作用。
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.4103/IJO.IJO_2575_24
Geeta Behera, Karthikeyan Mahalingam, Subashini Kaliaperumal
{"title":"Commentary on: Role of selective laser trabeculoplasty in India.","authors":"Geeta Behera, Karthikeyan Mahalingam, Subashini Kaliaperumal","doi":"10.4103/IJO.IJO_2575_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2575_24","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S225-S226"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Goniodysgenesis and glaucoma: A perspective worth revisiting. 性腺发育异常与青光眼:值得重新审视的观点。
IF 2.1 4区 医学 Q2 OPHTHALMOLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.4103/IJO.IJO_2538_24
Viney Gupta
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引用次数: 0
期刊
Indian Journal of Ophthalmology
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