ABSTRACT
Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single?center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ?6 months of follow?up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 � 0.8 vs. 1.9 � 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant. Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.
ABSTRACT
Purpose: To describe the variables that may be utilized in the optimization of three?dimensional heads?up surgeries (3D?HUS) for achieving better ergonomics among ophthalmic surgeons. Methods: A cross?sectional study was conducted at the operating room of a tertiary eye care center, equipped with an ARTEVO 800 3D surgical microscope and display monitor. The parameters noted were monitor height (MH), surgeon eye?to?floor distance (ETFD), surgeon eye?to?monitor distance (ETMD) and viewing tilt (VT) angle. The neck and eye strain of the surgeon and assistant were scored as per Borg’s CR?10 scale, before and after surgeries. Results: Thirty (13 right, 17 left) eye surgeries were analyzed. The minimum ETMD was 51 inches (in) and the eye strain reduced with shorter ETMD (within the range 51 inches to 83 inches). The VT and ETFD were higher for right eye surgeries. The optimum MH was between 50 and 55 in. Overall, the neck strain and eye strain were in the range of 0–3 and 0–1, respectively. Conclusion: The various parameters affecting the 3D image quality, neck and eye strain are chair height, VT angle, eye centration, monitor distance, laterality of the eye, and room illumination.