Journal of Current Glaucoma Practice最新文献

Background: This article contains two cases with accompanying surgical videos, illustrating the use of a Tutoplast plug to create a watertight seal in the corneoscleral fistula formed after tube shunt removal.

Case description: These cases demonstrate that Tutoplast can be cut into a strategic geometric shape to both plug the fistula formed at the tube entry site and reinforce adjacent areas of scleral thinning during tube removal or repositioning surgery. Specifically, a piece of dehydrated scleral Tutoplast was shaped into a small rectangle with an attached larger rectangle. The smaller rectangle or "head" would plug the fistula, while the attached larger rectangle or "body" could be used to reinforce the adjacent area of scleral thinning. The patch graft was sutured to the sclera at the four corners and resembled a turtle with four sutures for legs, with its head in the fistula. Hence, this technique is called the scleral "Turtle-Plast."

Conclusion and clinical significance: This "Turtle-Plast" technique is advantageous over direct suturing of the tube track because the head of the turtle provides an astigmatically neutral, watertight seal for the short anterior fistula, which can often be technically challenging to secure. Meanwhile, the body of the turtle can serve as a more substantive piece of patch graft to suture down to the underlying sclera that may be susceptible to thinning.

How to cite this article: Edoigiawerie S, Weber P, Gorla M, et al. Glaucoma Tube Shunt Revision with Scleral "Turtle-Plast". J Curr Glaucoma Pract 2024;18(4):171-173.

Aims and background: To evaluate the safety and efficacy of MicroPulse^® transscleral laser therapy (MP-TLT) using the revised MicroPulse P3^® (MP3) probe compared to the original probe.

Materials and methods: A retrospective study of 122 consecutive eyes of 99 glaucoma patients who received MP-TLT with a minimum of 12 months follow-up. The primary outcome was success at 12 months, defined as final IOP <18 mm Hg and either IOP reduction of >20% or any medication reduction, without any adverse events or secondary surgical interventions (SSIs) within 12 months.

Results: Ninety-five eyes in 75 patients were treated with the original probe, and 27 eyes of 24 patients were treated with the revised probe. The mean total energy and fluence used were 113.6 joules (J) and 54.3 J/cm² for the original probe, and 79.9 J and 140.1 J/cm² for the revised probe. Subjects were mostly white with primary open-angle glaucoma and a mean age of 70.3 years. Significantly more eyes with advanced glaucoma were treated with the revised probe compared to the original probe (p < 0.001). At baseline, mean IOP was 23.0 ± 7.5 on 2.94 ± 1.19 medications for the original probe compared to 22.6 ± 6.9 (p = 0.799) on 3.15 ± 1.32 medications (p = 0.429) for the revised probe. At 12 months, mean IOP was 17.9 ± 5.9 mm Hg (21.4% reduction) on 2.55 ± 1.40 medications (13.0% reduction) for the original probe compared to 14.8 ± 5.7 mm Hg (29.7% reduction, p = 0.063) on 3.07 ± 1.49 medications (2.2% reduction, p = 0.279) for the revised probe. Thirty-one of 95 eyes (32.6%) and 11 of 27 eyes (40.7%) treated with original and revised MP-TLT, respectively, achieved success at 12 months (p = 0.435). The rate of SSIs was 12% and similar between groups (p = 0.833). Significantly more eyes treated with the original probe underwent repeat MP-TLT within 12 months (44.2 vs 22.2%, p = 0.049). No adverse events occurred in either group.

Conclusion and clinical significance: The revised probe for the MP3 device may result in an improved and longer-lasting IOP-lowering effect compared to the original probe, while maintaining an excellent safety profile.

How to cite this article: Ramachandran M, Voss J, Ferrell J, et al. Outcomes of MicroPulse^® Transscleral Laser Therapy Using the Revised MicroPulse P3^® Delivery Device. J Curr Glaucoma Pract 2024;18(4):147-154.

Aims and background: The objective of this study is to determine the prevalence of female sexual dysfunction (FSD) in older adults with primary open-angle glaucoma (POAG) and its correlation with the severity of visual field (VF) defects. Additionally, potential associated factors with FSD were identified.

Materials and methods: This cross-sectional study included a total of 210 female patients with POAG, aged between 40 and 80 years, from three tertiary centers in two states of Malaysia, conducted between September 2019 and 2020. FSD was assessed using the self-administered Bahasa Malaysia version of the Female Sexual Function Index-6 (MvFSFI-6), with scores of ≤19 indicating FSD. The severity of POAG was evaluated using the modified Advanced Glaucoma Intervention Study (AGIS) scoring system, predicated on two reliable consecutive VFs evaluated by two masked investigators, categorizing the condition as mild, moderate, or severe. Medical records were reviewed for POAG management and other systemic comorbidities. Sociodemographic data, including education and living status, were obtained from the participants.

Results: The participants' average age was 66.7 (7.9) years. The prevalence of FSD is 78.5%. MvFSFI-6 scores decreased with age (r = -0.88; p < 0.001) and revealed an exponential decline with increasing AGIS scores (r = -0.238, p = 0.010). Higher education was correlated with a 67% decreased possibility of experiencing FSD (OR = 0.33, 95% CI 0.12-0.88).

Conclusion: FSD is common among female patients with POAG. Sexual well-being is a crucial factor for women with POAG, particularly those with severe VF defects and lower education levels. Ophthalmologists, gerontologists, and women's health experts need to address this issue to ensure a better quality of life (QoL) for older adults.

Clinical significance: Sexual dysfunction (SD) among women with POAG increases with the severity of the disease, especially among those with lower education levels. To ensure a good QoL for these women, sexual function should be included in the comprehensive management of POAG.

How to cite this article: Chee CC, Sabah H, Yaakub A, et al. Severity of Primary Open-angle Glaucoma and Female Sexual Dysfunction among Older Adults in Malaysia. J Curr Glaucoma Pract 2024;18(4):155-161.

Aim and background: To assess the efficacy of 2% dorzolamide/0.5% timolol/0.2% brimonidine tartrate fixed combination (DTB-FC) eye drops in patients with intermediate glaucoma stage.

Materials and methods: A retrospective case series study was performed, including eyes diagnosed with primary open-angle (POAG) or chronic angle-closure glaucoma (CACG), which were at intermediate stage of the illness according to the Brusini grading system and were initially treated with 2% dorzolamide/0.5% timolol fixed combination (DT-FC), and switched at baseline to DTB-FC. Main outcome was intraocular pressure (IOP) baseline measured, as well as at weeks 1 and 2, months 1, 3, and 6, and 1 year after switching. IOP differences were analyzed using analysis of variance (ANOVA) repeated measures.

Results: A total of 36 eyes from 22 patients were included in the study. The median age of the participants was 61 years [interquartile range (IQR) 53-71], with 59.1% (n = 13) being female. At baseline, 1, 2 weeks, 1, 3, 6 months, and 1 year after switching to DTB-FC, the mean IOP values were 20.3 (95% CI, 19.5-21.1), 15.3 (95% CI, 14.5-16.1), 15.5 (95% CI, 14.7-16.2), 15.5 (95% CI, 14.8-16.0), 15.5 (95% CI, 14.9-16.2), 15.5 (95% CI, 14.8-16.2) and 15.3 (95% CI, 14.7-15.9) mm Hg, respectively (p > 0.001). The mean IOP reduction after 1 year of treatment was -5.0 ± (4.2-5.8) mm Hg. Treatment success rates were 86.1, 80.6, 80.6, 77.8, 72.2, and 66.7%, respectively. When stratified by diagnosis, there were no statistically significant differences in the treatment success rates between POAG and CACG (p > 0.05).

Conclusion: Therapy switching from DT-FC to DTB-FC was shown to be effective in reducing IOP of eyes with POAG or CACG during 6-12 months.

Clinical significance: The DTB-FC therapy improved the therapeutic management of POAG or CACG previously treated with DT-FC therapy, which may be relevant to prevent its progression in the future.

How to cite this article: Justiniano JM, Rodríguez GM, Passerini MS. Triple-fixed Combination of Dorzolamide/Timolol/Brimonidine: Efficacy Study in Bolivian Population. J Curr Glaucoma Pract 2024;18(4):137-141.