Incidence, outcomes, and risk of surgical failure after development of early hypotony following Aurolab aqueous drainage implant surgery

Purpose: To report the incidence, outcomes, and risk of surgical failure after early postoperative hypotony following Aurolab Aqueous Drainage Implant (AADI) surgery for adult and pediatric refractory glaucoma. Methods: Medical records of patients who underwent AADI between January 2013 and March 2017 with a minimum of 2?years follow?up were retrospectively reviewed. Early postoperative hypotony was defined as IOP ?5 mmHg within the first 3 months after AADI. Surgical failure of AADI was defined as IOP >21 mmHg or reduced <20% below baseline on two consecutive follow?up visits after 3 months, IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision. Results: Early postoperative hypotony was seen in 15/213 eyes (7%) in the adult group and in 6/101 eyes (6%) in the pediatric group. The onset of hypotony was significantly earlier in the pediatric group (median = 39 days post AADI, IQR = 20–58 days) compared with adult eyes (median = 51 days post AADI, IQR = 30–72 days) (P = 0.02). Eyes with early postoperative hypotony did not have an increased risk of cumulative surgical failure as compared with eyes without hypotony in both adult (33.3% vs. 23.7%; P = 0.48) and pediatric (33.3% vs. 13.7%; P = 0.16) refractory glaucoma. All eyes recovered from hypotony, though one adult eye developed retinal detachment and one pediatric eye developed corneal decompensation and lost vision. Conclusion: Early postoperative hypotony was an infrequent complication post AADI and occurred earlier in pediatric eyes. Early postoperative hypotony did not increase risk of surgical failure up to 2 years.

Short-term surgical outcomes of twin-site combined phaco-emulsification and mitomycin-C augmented trabeculectomy in pseudo-exfoliation glaucoma versus primary open-angle glaucoma

Purpose: To compare the short?term outcomes of combined phaco?emulsification with posterior chamber intra?ocular lens and mitomycin augmented trabeculectomy in patients with pseudo?exfoliation glaucoma (PXFG) versus primary open?angle glaucoma (POAG). Methods: A total of 144 eyes of 144 patients were enrolled in this prospective interventional comparative study, 72 each of which had PXFG and POAG, respectively. All patients underwent twin?site combined phaco?trabeculectomy at a tertiary eye center in India between December 2017 and December 2018 and were followed up for a period of 12 months. The main outcome measures were intra?ocular pressure (IOP), best corrected visual acuity (BCVA), total surgical time, rate of intra?operative and post?operative complications, and the number of ocular hypotensive medications needed. Success rates were determined via Kaplan–Meier survival analysis. Results: The mean age was 63.9 ± 7.9 years in the POAG group and 66.4 ± 6.8 years in the PXFG group (P ? 0.04). The baseline BCVA, IOP, and cup?disc ratio were comparable between two groups. Intra?operative complications and post?operative outcomes were comparable between the two groups. There was a significant drop in anti?glaucoma medications in both groups. Six patients, three (4.2%) in each group, were lost to follow?up after 6 months. Three patients (4.2%) in PXFG needed additional glaucoma intervention for controlling IOP, one patient needed a non?valved glaucoma drainage device, and two patients required diode cyclo?photocoagulation within the follow?up period. Conclusion: Patients with PXFG had a longer surgical time than POAG. Similar success and complication rates were observed following combined twin?site phaco?trabeculectomy in both POAG and PXFG at 1 year. Combined glaucoma surgery resulted in good IOP control, improvement in BCVA, and lower requirement of ocular hypotensives in both the groups.

Retinal detachment in eyes treated with Aurolab aqueous drainage implant for refractory glaucoma - Incidence and outcomes

Purpose: To analyze the incidence of rhegmatogenous retinal detachment (RRD) in patients who have undergone prior Aurolab aqueous drainage implant (AADI) surgery and report outcomes in terms of anatomic, visual acuity, and intraocular pressure (IOP) findings. Methods: Case records of all patients who underwent RRD repair after AADI surgery from 2013 to 2019 were retrospectively analyzed. Data collected included patient demographics, ocular examination findings at all visits including IOP and best?corrected visual acuity (BCVA) and clinical findings related to RRD both at baseline and postoperatively. Results: Ten eyes of nine patients were included in study. The mean age of patients was 28.2 years (median: 15 years, range: 6� years). Mean duration between AADI and RRD was 14 months (median 2.5 months; range 2 days?72 months). All eyes underwent pars plana vitrectomy with silicon oil injection. The preoperative LogMAR BCVA (logarithm of the minimum angle of resolution) was 2.52 � 0.15 which improved to 2.29 � 0.58 at final follow?up; however, only one eye had vision ? 20/400 largely due to recurrent RRD and advanced glaucomatous disc damage. Postoperatively retina was attached in 6 eyes (60%) and IOP was ? 21 mmHg in 5 out of 6 eyes with anatomic success. Conclusion: The incidence of RRD following AADI was found to be 0.86% in our study. Pars plana vitrectomy (PPV) with silicon oil tamponade was the preferred approach in the management of these eyes with IOP being well controlled post PPV. However, visual acuity outcomes were largely unsatisfactory due to recurrent RRD and preexisting advanced glaucoma

Can novel Apo A-I polymorphisms be responsible for low HDL in South Asian immigrants.

Coronary artery disease (CAD) is the leading cause of death in the world. Even though its rates have decreased worldwide over the past 30 years, event rates are still high in South Asians. South Asians are known to have low high-density lipoprotein (HDL) levels. The objective of this study was to identify Apolipoprotein A-I (Apo A-I) polymorphisms, the main protein component of HDL and explore its association with low HDL levels in South Asians. A pilot study on 30 South Asians was conducted and 12-h fasting samples for C-reactive protein, total cholesterol, HDL, low-density lipoprotein (LDL), triglycerides, Lipoprotein (a), Insulin, glucose levels, DNA extraction, and sequencing of Apo A-I gene were done. DNA sequencing revealed six novel Apo A-I single nucleotide polymorphisms (SNPs) in South Asians, one of which (rs 35293760, C938T) was significantly associated with low (<40 mg/dl) HDL levels (P = 0.004). The association was also seen with total cholesterol (P = 0.026) and LDL levels (P = 0.032). This pilot work has highlighted some of the gene-environment associations that could be responsible for low HDL and may be excess CAD in South Asians. Further larger studies are required to explore and uncover these associations that could be responsible for excess CAD risk in South Asians.

Occult penetrating foreign body in hypopharynx

An unusual presentation of a foreign body in the hypopharynx is reported. A high index of clinical suspicion along with radiological assessment is helpful in the diagnosis of foreign bodies in the aero-digestive tract

Functional endoscopic sinus surgery results after 1 year

This is a report on the results of functional endoscopic sinus surgery [FESS] after its introduction in our hospital. From a total of 17 patients who were operated from October 1997 to November 1998, response to queries regarding symptom improvement was compared with that before surgery. The study showed that excellent subjective results following FESS could be maintained with appropriate postoperative management