A case of neovascular glaucoma secondary to ocular ischemia

Objective@#To present a case of neovascular glaucoma secondary to ocular ischemic syndrome following an uncomplicated phacoemulsification@*Methods@#This is a case description of a 74-year-old male who developed blurred vision and increased intraocular pressure (IOP) two months after an uncomplicated phacoemulsification cataract surgery with posterior chamber lens implantation of the left eye. There was iris neovascularization with absence of retinal dot/blot hemorrhages or neovascularization. The fluorescein angiogram (FA) showed delayed choroidal fluorescence and arteriovenous time. IOP-lowering medications and intravitreal injection of aflibercept were given. Carotid doppler test showed 70% stenosis of the ipsilateral artery but a subsequent magnetic resonance angiography (MRA) did not show evidence of significant stenosis. @*Results@#At his last consultation, visual acuity improved to counting fingers. IOP was maintained at 12 mmHg with one anti-glaucoma medication.@*Conclusion@#Ocular ischemia can confound the outcome of an uncomplicated cataract surgery. Doppler scans are usually chosen as the first-line exam for those suspected of carotid stenosis but, at times, may have contradictory results with MRA.

Comparative analysis of meibomian gland dysfunction in eyes with and without eyelid margin tattoos

@#OBJECTIVE: To compare the presence and severity of meibomian gland (MG) dysfunction among eyes of female subjects with and without eyelid margin tattoos using infrared meibography and colored photographs. METHODS: This is a cross-sectional, descriptive study that involved 38 Filipino females with and without eyelid margin tattoos. Infrared meibography was performed on the upper and lower eyelids of each eye to assess total or partial MG dropout. Colored photographs were taken to evaluate vascularity, irregularity, thickening of the lid margins, and plugging of MG orifices. Severity of MG dysfunction (MGD) was assessed using Arita’s MGD proposed grading scale. Independent t-test was used to compare MG dropout and other lid margin parameters between the two groups. Prevalence ratio and prevalence odds ratio were calculated to measure the likelihood of MGD among eyes with eyelid tattoos. RESULTS: Seventy-four (74) eyes were included in the study (36 in the tattoo group and 38 in the control group). Scores for abnormal vascularity, irregularity, and thickening of the lid margins were significantly higher in the tattoo group compared to the control group (p<0.0000001). However, plugging of gland orifices scores between the two groups were found to be similar (upper eyelid: p=0.65; lower eyelid: p=0.91). Total MG dropout was significantly greater in the tattoo group (upper eyelid: -1.11 ± 0.82; lower eyelid: 1.37 ± 0.75) compared to the control group (upper eyelid: 0.53 ± 0.83; lower eyelid: 0.45 ± 0.76) (upper eyelid: p=0.003; lower eyelid: p=0.000001) for the upper and lower eyelid, respectively). Analysis of total MG dropout between the two groups showed a prevalence ratio of 2.13. CONCLUSION: Eyelid margin tattoos are associated with several eyelid margin abnormalities and increase the risk of meibomian gland droupout.

Determination of iridotrabecular contact using the anterior segment optical coherence tomography in lights-on and lights-off conditions

Objective@#To determine the presence of iridotrabecular contact (ITC) and compare the changes in anterior chamber angle (ACA) measurements in room lights-on and lights-off conditions using the anterior segment optical coherence tomography (AS-OCT) in eyes diagnosed as primary angle closure suspects (PACS) by gonioscopy.@*Methods@#This is a retrospective review of 144 eyes of 79 patients (70 females, 9 males) with PACS. All eyes were imaged using the Visante® time-domain AS-OCT (Carl Zeiss Meditec, Dublin, CA). Each eye was imaged twice; the first scan was done with the room lights on followed by a second scan done after turning the room lights off for 2 minutes. The principal outcome measure was the presence of ITC in either lighting condition. Other angle metrics that were assessed included anterior chamber depth (ACD), angle opening distance (AOD), trabecular-iris space area (TISA), and scleral spur angle (SSA). Presence of ITC and differences in the angle metrics between the 2 lighting conditions were then analyzed using the t-tests and logistic regression.@*Results@# ITC was present in 36.8% (53) of the study eyes. Twenty percent (20%) of the study eyes (29) did not initially exhibit ITC in the lights-on phase but developed ITC when imaged with the lights off. Persistent ITC was seen in 16.6% (24 eyes) in both lighting conditions. ITC occurred in 52.2% of the eyes with ACD less than 2.18 mm. Logistic regression showed that there is a 91% decrease in the odds of having ITC in lights-off condition for every millimeter of ACD increase. Age was not associated with the occurrence of ITC in the lights-off condition. All other analyzed parameters decreased significantly in the lights-off condition (p<0.05) except for the ACD, nasal TISA-500, and temporal SSA.@*Conclusions@#The presence of ITC is a well-established characteristic of eyes with angle closure. In eyes with PACS, detection of ITC may be enhanced with AS-OCT imaging in lights-off condition.

Risk factors for conjunctival tube erosion in eyes implanted with Ahmed glaucoma valve in a private eye institution in the Philippines

Objective@#To identify the risk factors for conjunctival tube erosion (CTE) in eyes implanted with Ahmed® glaucoma valve (AGV) device@*Method@#This is a retrospective study conducted at a private eye institution. Medical records of patients who underwent AGV implantation surgery from January 2004 to December 2013 were reviewed. Eyes with at least 24 months of follow-up and complete records were included. Several variables from the pre-, intra-, and postoperative periods were collected. The primary outcome was development of CTE after AGV surgery. Univariable logistic regression and multivariable analysis were employed.@*Results@#Forty-six (46) eyes of 45 patients were included in the study. The mean follow-up was 50.2 months (range: 24-140 months). Eight (8) eyes developed CTE (17.4%). Univariable logistic regression analysis identified female gender (P =0.064), presence of diabetes (P =0.083), prior intraocular surgeries (P =0.09), and postoperative use of antiglaucoma medications (P =0.086) to be marginally significant risk factors for CTE. On multivariable analysis, only female gender (OR=15.4, P =0.033) and diabetes (OR=14.1, P =0.031) were found to be significantly associated with CTE.@*Conclusion@#Risk factors for CTE following AGV implantation include female gender and presence of diabetes.

Should anterior segment imaging devices replace gonioscopy?

@#Glaucoma will continue to be the leading cause of irreversible blindness worldwide.1,2 A recent metaanalysis done by Tham and coworkers projected an increase of 74% in the total number of people with glaucoma, from 64.3 million in 2013 to 76 million by 2020, and to 111.8 million by the year 2040.2 With this recent forecast, Asia will have the greatest number of both primary open angle glaucoma and primary angle closure glaucoma (PACG), comprising 18.8 million (79.8%) and 9 million (58.4%) respectively.2 Since half of the world’s PACG will come from Asia, an effective reduction in the real incidence and prevention of visual loss from this devastating disease will depend on the accurate assessment of the anterior chamber angle and early detection of appositional closure