Journal of Current Glaucoma Practice最新文献

Aim: Comparing intraocular pressure (IOP) measurements using Goldmann applanation prism and TonoSafe® in the population without signs of glaucoma.

Material and methods: Patients with no ocular pathologies, except ametropia (until ± 4 D) or IOP of <30 mm Hg without signs of glaucoma by optic disc structural analysis by fundus biomicroscopy. The IOP was measured sequentially using the traditional cone and the TonoSafe®, according to a randomization list to determine which device would be used first. The measurements from the right and left eyes were compared separately. Since there was no statistical difference, both eyes were considered in this study.

Results: A total of 385 eyes of 194 patients with a mean age of 66.4 ± 11.2 years old were included. The mean IOP with conventional prism was 14.2 ± 3.6 and 14.3 ± 3.6 mm Hg with TonoSafe^®. Differences were not statistically significant by the Wilcoxon test (p = 0.3). The median was 14.0 mm Hg for both groups. The mean difference between measurements was 0.04 mm Hg, with the median equal to zero. There was no statistical difference in IOP readings according to which device was the first measurement.

Conclusion: No statistical difference was found in IOP was measured with conventional prism or TonoSafe® in the population without signs of glaucoma.

Clinical significance: The data provided by our study support the efficacy and safety of the disposable tonometer compared to the Goldman tonometer in measuring IOP in patients without glaucoma.

How to cite this article: Soares PHA, Santos RDO, Filho CRADM, et al. Goldmann Applanation Tonometry: Comparison of Intraocular Pressure Values Obtained with Disposable Tip and Conventional Applanation Prism in the Population without Clinical Signs of Glaucoma. J Curr Glaucoma Pract 2023;17(2):75-78.

Aim: Minimally invasive glaucoma surgery (MIGS) is not typically used in patients with advanced-stage glaucoma. This study describes the outcomes and complications of patients with advanced open-angle glaucoma (OAG) who underwent XEN implantation with cataract surgery or gonioscopy-assisted transluminal trabeculotomy (GATT) with cataract surgery.

Methods: This retrospective study identified patients who had undergone XEN implantation or GATT for the management of advanced OAG. Outcomes included surgical success, intraocular pressure (IOP) reduction, number of topical IOP-lowering drops, visual field mean deviation (MD), best-corrected visual acuity (BCVA), and complications. Surgical success was defined as an IOP of <14 mm Hg and a 20% reduction at 12 months without topical IOP-lowering drops (complete success) or with topical IOP-lowering drops (qualified success).

Results: Exactly 70 eyes were enrolled in this study, including 35 who had undergone XEN implantation and 35 who had undergone GATT. The overall surgical success rate was 74.3% (26 of 35) for eyes that underwent XEN implantation and 71.4% (25 of 35) for eyes that underwent GATT. Percent IOP reduction from baseline to 12 months postoperatively was 48% in the XEN cohort and 32% in the GATT cohort. Significant reduction in the use of topical IOP-lowering drops was demonstrated for both XEN (3.26 ± 1.15-1.23 ± 1.28) (p < 0.001) and GATT (2.46 ± 1.12-0.43 ± 0.78) (p < 0.001) cohorts at 12 months postoperatively. The only complication reported was transient hyphema, which occurred in three patients from the XEN group and four from the GATT group, and resolved spontaneously.

Conclusions: Both XEN implantation and GATT may be safe and effective management options when treating patients with advanced OAG. However, larger sample sizes are required to make direct statistical comparisons between these techniques.

Clinical significance: In this study, XEN implantation and GATT combined with cataract surgery were each associated with favorable outcomes in patients with advanced OAG.

How to cite this article: Ruparelia S, Sharif M, Shoham-Hazon N. Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma. J Curr Glaucoma Pract 2023;17(2):63-67.

How to cite this article: Au L, Bhartiya S. Can We Ever Win with a Suprachoroidal Implant? J Curr Glaucoma Pract 2023;17(2):55-57.

Purpose: To compare Ahmed glaucoma valve (AGV) outcomes in neovascular glaucoma (NVG) eyes with and without a postoperative (PO) hypertensive (HTN) phase.

Design: Retrospective study at a single tertiary care center of patients who underwent AGV implantation for NVG treatment with ≥6-month follow-up.

Methods: Main outcome measures included intraocular pressure (IOP), number of glaucoma medications (GM), and failure at month 6 or at the most recent visit. Failure was defined as decline to no light perception (NLP) vision, IOP >21 mm Hg, or need for glaucoma reoperations (all with GM).

Results: A total of 76 eyes of 74 patients (37 without HTN phase and 39 with HTN phase) with a mean follow-up duration of 28.9 ± 25.7 months (p = 0.602) were included. Both groups had similar demographics, visual acuity (VA), number of GM, etiology of NVG, and retina treatment perioperatively. Baseline IOP was significantly higher in the HTN phase group (p = 0.001). Compared to eyes without an HTN phase, HTN phase eyes more commonly met failure criteria at month 6 (33.3 vs 9.1%; p = 0.01), but both groups had a comparable cumulative failure for the entire follow-up period (p = 0.180). At the most recent visit, the number of GM was higher in the HTN phase group (p = 0.019), but IOP was similar in both groups. PO complications were comparable and uncommon in both groups.

Conclusion: Hypertensive (HTN) phase following AGV implantation for NVG is associated with higher preoperative IOP and greater failure by PO month (POM) 6. However, eyes with and without the HTN phase had similar needs for GM and failure rates over the long term.

How to cite this article: Ramesh S, Shalaby WS, Myers JS, et al. Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma. J Curr Glaucoma Pract 2023;17(2):91-97.

Purpose: To assess the optic nerve head (ONH) parameters in normal male Saudi eyes using swept-source optical coherence tomography (SS-OCT).

Materials and methods: The study included 86 healthy men with a mean age of 23.6 ± 4.82 years. The metrics collected using SS-OCT from each individual was disk area (DA), rim area (RA), cup volume (CV), linear cup-disk ratio (LCDR), vertical cup-disk ratio (VCDR), and total retinal nerve fiber layer (RNFL) thickness, superior RNFL thickness, and inferior RNFL thickness. All the metrics were correlated with the DA. The right eye data were used for the correlation analysis.

Results: The mean DA in OD was 1.78 mm² (range 1.09-2.70 mm²). The mean RA was 1.28 mm² (range 0.72-2.47 mm²). The DA showed a significant positive correlation (p < 0.05) with RA, cup area (CA), CV, VCDR, LCDR, and total RNFL thickness.

Conclusion: For the first time, using sweeping source OCT (DRI OCT Triton, Topcon Corporation), a normative database of ONH parameters was made accessible to the Saudi male population. While assessing the optic disk for progressive optic neuropathies like glaucoma, disk size should be taken into consideration since the optic DA affects ONH topography, especially in Saudi eyes.

How to cite this article: Challa NK. Optic Nerve Head Parameters in Saudi Male Young Adults Using Swept-source Optical Coherence Tomography. J Curr Glaucoma Pract 2023;17(2):58-62.

Objective: To compare anterior segment biometry parameters in progress and non-progress primary angle closure glaucoma (PACG) among Malay and Chinese patients.

Materials and methods: A cross-sectional study was conducted between November 2015 and December 2016 involving 75 patients with PACG (43 Malays and 32 Chinese) who were recruited from a single glaucoma center in Malaysia. Ocular examination included anterior segment biometry measurements on the selected eye. Axial length (AL) and anterior chamber depth (ACD) measurement was done using a noncontact partial coherence interferometer (IOL Master, Carl Zeiss, Germany). Anterior chamber angle (ACA) was measured by Anterior Segment-OCT (Spectralis Heidelberg, Germany). Humphrey visual field (HVF) 24-2 analysis of the same eye was conducted and compared with the HVF when diagnosis was made. Progression of PACG patients was assessed according to the Hodapp, Parrish and Anderson's (HPA) classification, they were then divided into progress and non-progress groups. Comparison of anterior segment biometry parameters between Malay and Chinese PACG patients with and without progression was analyzed using independent T test. Multivariate ANOVA analysis was used to compare the anterior segment parameters between progress and non-progress PACG patients, with adjustment for age, gender, lens status, family history and presence of diabetes mellitus.

Results: Chinese PACG patients have significant shorter AL (22.18 mm ± 0.76) and narrower ACA (11.96° ± 6.00) compared to Malay PACG patients. Among the progress group, Chinese PACG patients have significant shorter AL, shallower ACD and narrower ACA compared to Malays. However, after controlling for confounding factors, there was significant difference in ACA between Malay and Chinese PACG. There was also no significant difference of ocular biometry measurement between Chinese and Malay patients in progress and non-progress group.

Conclusion: There was racial influence in ocular biometry measurement in PACG patients. Chinese have significant narrower ACA compared to Malays. Serial AS-OCT monitoring is important in management of PACG.

How to cite this article: Neoh FP, Azhany Y, Siti-Azrin AH, et al. Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese. J Curr Glaucoma Pract 2023;17(1):3-8.

How to cite this article: Kanadani FN, F Campos LD, Dorairaj S, et al. Transscleral Cyclophotocoagulation: New Perspectives for Uncontrolled Glaucoma Management. J Curr Glaucoma Pract 2023;17(1):1-2.

Aim: We report on an 88-year-old female patient who presented with a relapse in aqueous misdirection 15 years after being treated with pars plana vitrectomy (PPV) with hyaloidotomy-zonulectomy-iridotomy (HZI) for the same cause.

Case description: A 73-year-old pseudophakic woman with a history of pseudoexfoliation underwent a trabeculectomy in the left eye in our institution because of uncontrolled intraocular pressure. Days after trabeculectomy, the patient developed aqueous misdirection and was treated with PPV combined with HZI. In the following years, the patient had regular follow-up appointments in our instruction, and she had normal intraocular pressures in the left eye without any treatment. A total of 15 years after the vitrectomy, the patient developed gradual swallowing in the anterior chamber and increased intraocular pressure. Neodymium (Nd): yttrium aluminum garnet (YAG) laser hyaloidotomy through the iridectomy opening was performed, the anterior chamber was immediately deepened, and the intraocular pressure was reduced to normal limits. The anterior chamber remained deep, and the intraocular pressure remained normal through the 36 months of follow-up.

Conclusion: Relapse of aqueous misdirection may occur many years after vitrectomy, even when HZI is performed. An Nd: YAG- laser hyaloidotomy should be attempted before a second HZI is considered.

Clinical relevance: A close and long-lasting follow-up of patients with aqueous misdirection is warranted, especially if the patients are treated not with complete PPV but by a limited disruption of the anterior hyaloid face along with HIZ.

How to cite this article: Halkiadakis I, Tzimis V, Markopoulos I, et al. Late-onset Relapse of Aqueous Misdirection after Pars Plana Vitrectomy: Case Report and Literature Review. J Curr Glaucoma Pract 2023;17(1):49-51.

Aim: To describe a unique finding in a patient with Sturge-Weber syndrome (SWS) accompanied by glaucoma.

Background: Cases with SWS may have an associated choroidal angioma and glaucoma. The localized retinal nerve fiber layer (RNFL) defects induced by the associated glaucoma are better detected against the red background of the associated choroidal angioma.

Case description: A 15-year-old boy was presented with left-side SWS. The case was subjected to full clinical examination, intraocular pressure (IOP) measurements, color fundus photography, ultrasonography, visual field assessment, and optical coherence tomography (OCT) of the peripapillary RNFL and ganglion cell layer (GCC) analysis. The main clinical finding was the enhanced detection of defects of the RNFL against the red color of associated choroidal angioma in this glaucomatous eye.

Conclusion: There is enhanced clinical visibility of RNFL defects in presence of associated diffuse choroidal angioma in Sturge-Weber glaucoma.

Clinical significance: Easier clinical detection of RNFL defects in SWS glaucoma associated with diffuse choroidal angioma.

How to cite this article: Abdelrahman AM. Enhanced Visibility of the Retinal Nerve Fiber Layer Defects by the underlying Diffuse Choroidal Angioma in Sturge Weber Syndrome with Glaucoma. J Curr Glaucoma Pract 2023;17(1):52-54.

Aim: This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period.

Methods: Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm² and a duty cycle of 31.3%.

Results: A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028).

Conclusions: Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis.

How to cite this article: Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.