Central corneal thickness in Iranian congenital glaucoma patients

To compare central corneal thickness [CCT] in subjects with controlled primary congenital glaucoma [PCG] and nonglaucomatous subjects and to investigate the correlation between CCT and intraocular pressure [IOP] in the study population. Twenty-three consecutive PCG cases with controlled IOP and no clinical evidence of corneal edema comprised the Study Group. There was an interval of at least 2 months between last intraocular surgery and inclusion in the study. Twenty-one subjects with strabismus or lacrimal drainage insufficiency who did not have glaucoma or any history of intraocular surgery or ocular trauma comprised the control group. The Control Group was age and sex-matched. Data from ultrasonic pachymetry and applanation tonometry were analyzed for differences between groups. Correlation of the study parameters was investigated. A P-value less than 0.05 was statistically significant. Data from both eyes of subjects in the Study Group and Control Group were included in the original analysis. Mean CCT was statistically significantly higher in the Study Group compared to the Control Group [589.42 +/- 53.44 æm vs. 556.14 +/- 30.51 æm, respectively; P=0.001]. There was a significant correlation between CCT and IOP [r=0.63; P<0.0001]. Similar statistically significant outcomes were observed when only one eye per subject was used in a reanalysis of the data for the Study and Control Groups. Patients with PCG who had controlled IOP have statistically significantly thicker corneas than nonglaucomatous age and sex-matched subjects The thicker cornea could significantly alter IOP measurement with applanation tonometry. Pachymetry should be considered an essential part of the evaluation for PCG

Office-based slit-lamp needle revision with adjunctive Mitomycin-C for late failed or encapsulated filtering blebs

The purpose of this study was to assess the results of bleb needling in glaucomatous patients with late failed filtering blebs. A retrospective case series of 27 eyes of 27 patients was considered. All patients underwent needle bleb revision with adjuvant mitomycin-C performed at the slit lamp, during an office visit. Complete success was defined as postneedling intraocular pressure [IOP]=21 mmHg without any antiglaucoma medications and qualified success was IOP=21 mmHg with topical antiglaucoma medications. There were 12 eyes with encapsulated blebs and 15 eyes with flat blebs. The mean interval between index filtering surgery and bleb revision was 32.74 +/- 15.36 months. Mean IOP was 25.07 +/- 4.80 mmHg before surgery and 19.66 +/- 4.97 mmHg at last postoperative follow-up. The mean follow-up was 20.31 +/- 15.63 months. Complete and qualified successes were 7.4% and 51.9%, respectively. Cumulative rates of success at 1, 2, 3, and 4 years were 76%, 65%, 49%, and 37%, respectively. The mean number of antiglaucoma medications was reduced from 3.15 +/- 0.36 preoperatively to 2.33 +/- 1.21 postoperatively [P<0.001]. Slit-lamp needle revision in office is a simple and effective method for treating late encapsulated or flat filtering blebs without significant complications even for late bleb failure

Sex bias in primary congenital glaucoma patients with and without CYP1B1 mutations

To investigate variations in sex ratio among Iranian primary congenital glaucoma [PCG] patients with and without mutations in the CYP1B1 gene and to evaluate possible clinical variations associated with sex in these two groups. Phenotypical data on 104 unrelated Iranian PCG patients who had previously been screened for CYP1B1 mutations were analyzed. Emphasis was placed on analysis of sex ratios among patients with and without CYP1B1 mutations. In addition to sex, familial and sporadic incidence and clinical features including age at onset, bilateral/unilateral involvement, corneal diameter, intraocular pressure, and cup-disc ratios were compared between these two groups. Information on phenotypical parameters was available for most but not all patients. Among the 93 PCG patients whose sex was recorded, 57 were male [61.3%] and 36 were female [38.7%] [P=0.03]. Patients with CYP1B1 mutations included 37 male [66.1%] and 29 female [43.9%] subjects [P=0.30], while patients without the mutation included 20 [74.1%] male and 7 [25.9%] female individuals [P=0.013]. Our data did not provide conclusive evidence on difference in severity of the disease between those with and without CYP1B1 mutations, nor between the two sexes. Consistent with data on PCG patients from other populations, the overall incidence of PCG in Iran seems to be higher among male subjects. The difference in incidence between the two sexes was not significant among patients whose disease was due to mutations in CYP1B1. The overall higher incidence of PCG among male subjects seems to be attributable to a higher incidence in male patients not harboring CYP1B1 mutations, suggesting that other genes or factors may be involved in manifestation of PCG phenotypes in a sex dependent manner

Outcomes of single-plate molteno implants in refractory glaucoma

To evaluate the success rate and complications of single-plate Molteno tube implantation in patients with intractable glaucoma. We reviewed the records of patients who had undergone single-plate Molteno tube implantation from 1995 to 2000 with at least 18 months of follow up. Thirty-six eyes of 35 [20 male and 15 female] patients with mean age of 29.7 +/- 25.3 [range 3-77] years were enrolled in the study. Preoperative intraocular pressure [LOP] was 34.5 +/- 10,4 mmHg with a mean of 2.3 +/- 0.8 medications which decreased to 18.0 +/- 7.6 mmHg with 1.9 +/- 1.2 medications after 32.8 +/- 161 months of follow up [P<0.0001]. Complete success [IOP: 7-21 mmHg without medications], incomplete success [IOP: 7-21 mmHg with medication] and total success [sum of complete and incomplete success] rates were 19.5%, 55.6%, and 75%, respectively. At final follow up, visual acuity improved 1 line in 10 [27.8%], decreased >/= 1 line in 8 [22.2%] and remained unchanged in 18[50%] eyes. Postoperative complications occurred in 20 eyes [55.6%] including encapsulated bleb in 10 eyes [27.8%], tube-iris touch in 4 [11%], flat anterior chamber in 3 [8.4%], tube-cornea touch in 2 [5.6%], and retinal detachment, tube-lens touch, and tube blockage, each in 1 [2.8%]. IOP dropped to zero in one eye resulting in visual loss. In eyes at high risk for trabeculectomy failure, implantation of the Molteno tube can be considered as a procedure with acceptable success for control of IOP and preservation of vision. Long term follow-up is recommended to ensure timely management of the frequent complications of this procedure