Clinical profile and demographics of glaucoma patients managed in a Philippine tertiary hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the demographic and clinical profile of glaucoma patients seen in a Philippine tertiary hospital from 2011 to 2014.<br /><br /><strong>METHOD:</strong> Medical records of glaucoma patients managed at the outpatient ophthalmology clinic from October 2010 to August 2014 were reviewed. Diagnosis of glaucoma was based on the International Society of Geographic and Epidemiological Ophthalmology (ISGEO) guidelines. The demographics, clinical profile, functional severity scoring, and initial management of patients were described.<br /><br /><strong>RESULT:</strong> Majority of the 570 patients were females (60.17%), with a mean age of 56.23 years. Eighty-five percent claimed to have no family history of glaucoma. The mean best-corrected visual acuity (BCVA) was 0.40, the mean intraocular pressure (IOP) was 23.56 mmHg, and the mean cup-to-disc (CD) ratio was 0.69. There were more primary type of glaucoma (55.48%) than secondary glaucoma. Mixed pattern was the most common type of visual field pattern at initial presentation. Majority of the defects were under GSS 2 stage 2 of mean deviation (MD) and loss variance (LV). Medical treatment was the most common initial management given to glaucoma patients.<br /><br /><strong>CONCLUSION:</strong> The primary glaucomas were more common than the secondary glaucomas seen in a private tertiary hospital. Most had moderate visual field damage (mixed type pattern) and the most common initial management given was medical treatment.<br /><br /><strong>KEYWORD:</strong> Glaucoma, Epidemiology, Primary open angle glaucoma, Primary angle closure glaucoma, Secondary glaucoma, Normal tension glaucoma, ISGEO guidelines</p>

Correlation of average RNFL thickness using the STRATUS OCT with the perimetric staging of glaucoma

Objective@#To determine the correlation between average peripapillary retinal nerve fiber layer (RNFL) thickness measured with time domain optical coherence tomography (TD-OCT) in normal and glaucoma eyes. @*Methods@#This was a cross-sectional study of 281 eyes randomly selected from a previous study. Assessment of glaucomatous damage was done by glaucoma specialists who based their diagnosis on the visual field tests and optic disc photos, independent of OCT results. Eyes were classified into the following groups: normal, mild, moderate, or severe glaucoma. Severity of glaucoma was based on visual field abnormalities following a modified HodappAnderson-Parish criteria for staging. Average RNFL thickness of normal and glaucoma subgroups, as measured with STRATUS–OCT, were analyzed using single ANOVA test. Association between average RNFL thickness and severity of glaucomatous visual field loss was evaluated using the Pearson’s correlation coefficient analysis. @*Results@#183 eyes had no glaucoma; 27 had mild, 32 had moderate, and 39 had severe glaucoma. Mean average peripapillary RNFL thickness (μm) in the normal, mild, moderate, and severe glaucoma groups were 98.05(±13.46), 76.27(±11.79), 76.42(±16.01), and 56.17(±14.92) respectively. Significant differences were seen in the average RNFL thickness among the groups (P<0.05), except in eyes with mild to moderate glaucoma. A moderately strong correlation of -0.57 (P<0.05) was observed between average RNFL thickness and the stage of glaucoma. @*Conclusion@#TD-OCT showed moderately strong correlation between the average RNFL thickness and perimetric stages of glaucoma. Average RNFL thickness is a good parameter to discriminate normal from glaucoma eyes.

Effect of topical ketorolac tromethamine and topical nepafenac on maintaining pupillary dilation during phacoemulsification

Objective@#This study compared the effectiveness of prophylactic administration of topical ketorolac tromethamine 0.5% and nepafenac 0.1% on maintaining mydriasis during phacomulsification.@*Methods@#This is a prospective, randomized, double-masked comparative study involving adult cataract patients given topical NSAIDs (ketorolac or nepafenac) or balanced salt solution (control) prior to phacoemulsification and capsular bag intraocular-lens (IOL) implantation at a tertiary hospital. Horizontal and vertical diameters of pupil were measured at different stages of cataract surgery and the mean values were compared across the three groups.@*Results@#A total of 47 eyes of 44 cataract surgery patients, 13 males and 34 females, with a mean age of 66.04 ± 8.87 years, were included in the study. The mean horizontal and vertical diameters of the three groups were similar at the start of surgery. Significant differences were seen after IOL implantation, with the nepafenac group having the largest mean diameters in both horizontal (p = 0.012) and vertical (p = 0.012) pupil measurements.@*Conclusion@#Topical nepafenac has been shown to be a more effective inhibitor of miosis during phacoemulsification and provides a more stable mydriatic effect throughout the surgical procedure compared to topical ketorolac and placebo.