Bilateral Iridocorneal Endothelial Syndrome

Objectives@#We presented a case of bilateral iridocorneal endothelial (ICE) syndrome with secondary glaucoma and discussed its clinical presentation and management.@*Study design@#This is a case report.@*Results@#A 12-year old female consulted for a one-year history of progressive blurring of vision in both eyes associated with abnormal pupils and occasional eye pain. Polycoria, shallow anterior chambers, increased intraocular pressures (IOP), areas of closed angles on gonioscopy, and increased cup-to-disc ratio in both eyes indicative of ICE syndrome were present. Management included anti-glaucoma medications and implantation of glaucoma drainage devices (GDD).@*Conclusion@#Early detection with regular follow-ups leading to prompt management of the ICE syndrome are necessary. IOP control may be challenging due to the nature of the disease and may require multiple surgeries including GDD implantation to achieve successful outcomes. Early use of GDD may be beneficial for pediatric patients with ICE and glaucoma, and may require additional surgeries to adequately manage the IOP.

Comparison of trabeculectomy with mitomycin-C and glaucoma drainage device implantation in glaucoma management after penetrating keratoplasty

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the intraocular pressure control of trabeculectomy with mitomycin-C (Trab MMC) versus glaucoma drainage device (GDD) implantation in glaucoma management after penetrating keratoplasty (PKP).<br /><strong>METHODS:</strong> A review of medical records of patients who developed glaucoma after penetrating keratoplasty and underwent either trabeculectomy with mitomycin-C augmentation or glaucoma drainage device implantation between October 2006 to June 2012 at a tertiary referral eye center was done. The following information were obtained for each patient: age, gender, corneal diagnosis before keratoplasty, details of keratoplasty in terms of graft versus donor size, other simultaneous operations, visual acuity (VA), intraocular pressure (IOP), number of glaucoma medications before and after PKP, graft status before glaucoma treatment and at the final visit, type of glaucoma before treatment, and the glaucoma procedure performed and its complications if any. Three primary outcomes were evaluated: graft status, postoperative IOP, and VA. Controlled IOP with or without medications was defined as IOP greater than 6 but less than 20. Paired t-test determined the significant decrease in the mean IOP control and the number of medications before and after keratoplasty. Single-factor analysis of variance (ANOVA) determined if there were significant differences in the mean between the two surgeries. Kaplan-Meier survival analysis compared the surgeries in their effects on graft clarity.<br /><strong>RESULTS:</strong> Out of the 222 medical records reviewed, 23 patients met the inclusion criteria. Twelve (52.2%) eyes had clear grafts after glaucoma surgery; 8 (72.7%) in the Trab MMC and 4 (33.3%) in the GDD groups. Twenty-one (91.3%) eyes had controlled IOP; 9 (81.8%) had Trab MMC, 12 had GDD surgeries. There was no difference (p = 0.07) in percentage of patients with controlled IOP between the 2 groups. Mean IOP in the Trab MMC (32.6 ± 4.3 to 15.1 ± 4.0, p = 0.004) and GDD (23.6 ± 4.6 to 12.5 ± 0.8, p = 0.04) groups significantly decreased after the procedures. The decrease in mean IOP was not different (p = 0.55) between the 2 groups. The number of patients with controlled IOP increased significantly (p = 0.02) in the Trab MMC group. There were no differences in the mean number of glaucoma medications between both groups before (p = 0.92) and after (p = 0.18) glaucoma surgery. There was no difference (p = 0.17) in the survival distribution of controlled IOP between the 2 surgeries.<br /><strong>CONCLUSION:</strong> Trabeculectomy with mitomycin-C augmentation and glaucoma drainage device implantation are effective methods of controlling IOP post penetrating keratoplasty. There was no difference between the two groups in controlling the IOP and in reducing the number of glaucoma medication postoperatively.</p>

Translation and validation of a Filipino version of the glaucoma quality-of-life questionnaire

Objective@#This study validated the functionality and value of a Filipino version of the Glaucoma Quality-of-Life 15 Questionnaire (GQL 15) as a tool in managing glaucoma among Filipinos.@*Methods@#The GQL 15 was translated using the forward-backward-forward translation method. Discrepancies were reconciled by the research group, producing a final forward translation (FFT). The FFT was pretested on patients from the University of the Philippines–Philippine General Hospital, along with the GQL 15. A multidisciplinary group of ophthalmologists and healthsocial-science experts analyzed the results of the pretest to determine the functionality and necessity of the FFT. The FFT was used on glaucoma patients composed of 1 set with glaucomatous automated visual fields, 1 set with glaucomatous disc photos, and a control group. The results were analyzed via an independent t-test.@*Results@#The pretest in 9 patients showed that the FFT was functional. Majority preferred answering the FFT to the GQL 15. Differences were noted in the answers to FFT vs. GQL 15. A Filipino translation was deemed necessary. The answers of patients in the glaucomatous automated visual-field group (n = 14) and the glaucomatous disc photo group (n = 9) were significantly higher than those of the control group (n = 16) (p = 0.05). These results were similar to those of the GQL 15.@*Conclusions@#The Filipino version of the GQL 15 is a necessary and valid tool in managing glaucoma among Filipinos.

Correlation of structure and function in glaucoma

Objective@#This study assessed the relationship of two structural tests, optic-disc photography and optical coherence tomography (OCT), and a functional test, standard achromatic perimetry (SAP), in the diagnosis of glaucoma.@*Methods@#A retrospective review of charts from the database of a private glaucoma specialist and the glaucoma clinic of a tertiary hospital was done. The participants were longitudinally evaluated and had comprehensive eye examination, imaging, and functional testing. Optic-disc photographs, OCTs, and SAPs were interpreted and evaluated separately, and then correlated with each other by two glaucoma experts working individually. Sensitivities, specificities, and predictive values were obtained for each diagnostic test and in combination. Kappa statistics were used for interobserver agreement.@*Results@#Three hundred sixty-seven eyes of 188 patients were included in the study. Fifty-eight patients were diagnosed as normal, 130 had glaucoma. OCT had the highest sensitivity and specificity at 70.7% and 76.6%, followed by SAP at 72.4% and 53.5% respectively. Optic-disc photos had the lowest sensitivity and specificity at 55.8% and 54.4% respectively, and the lowest interobserver agreement (kappa = 0.50-0.61). The predictive values of the 3 tests increased to 82% with good interobserver agreement (kappa = 0.68-0.78) when correlated with each other.@*Conclusion@#The correlation of structural and functional tests increased the accuracy of diagnosing glaucoma. These examinations offered complementary information and, when used in conjunction with comprehensive clinical evaluation, guided the clinician in the proper management of patients with glaucoma.

Reliability analyses of the GDx nerve-fiber analyzer

Objectives: The scanning laser polarimetry, exemplified by the GDx 400 (Laser Diagnostic Technologies, San Diego, CA, USA) nerve-fiber analyzer, allows noninvasive quantitative assessment of the retinal nerve-fiber layer. This study determined the reliability of the GDx 400 in taking repeat measurements by different operators and at different sessions in a sample of normal and glaucoma patients Methods: Patients with and without glaucoma underwent a complete eye evaluation, automated achromatic perimetry, scanning laser polarimetry, and optic-disc photography. Retinal nerve-fiber layer (RNFL) measurements were obtained for each group of patients by two trained operators who were masked as to the status of the study eye. Four measurements were obtained for each study eye in the same session and in another session. Reliability measures using intraclass correlation coefficient of five preselected GDx parameters were obtained Results: The study recruited 355 patients (171 normal, 184 glaucomatous) ages 30 to 78 years. Intraclass correlation coefficients within operator same session (0.84-0.95), within operator different sessions (0.78-0.93), between operators same session (0.79-0.94), and between operators different sessions (0.80-0.94) were excellent. The reliability measures for the second session (0.79-0.94) were higher than for the first session (0.79-0.87) even for measurements taken by the same operator Conclusion: The GDx 400 nerve-fiber analyzer has good reliability measures and can be used to monitor changes in the RNFL thickness over time. Change in measurements exceeding 20 percent from baseline should be considered as possible progression. (Author)