Scanning laser polarimetry in glaucoma.

Glaucoma is an acquired progressive optic neuropathy which is characterized by changes in the optic nerve head and retinal nerve fiber layer (RNFL). White‑on‑white perimetry is the gold standard for the diagnosis of glaucoma. However, it can detect defects in the visual field only after the loss of as many as 40% of the ganglion cells. Hence, the measurement of RNFL thickness has come up. Optical coherence tomography and scanning laser polarimetry (SLP) are the techniques that utilize the evaluation of RNFL for the evaluation of glaucoma. SLP provides RNFL thickness measurements based upon the birefringence of the retinal ganglion cell axons. We have reviewed the published literature on the use of SLP in glaucoma. This review elucidates the technological principles, recent developments and the role of SLP in the diagnosis and monitoring of glaucomatous optic neuropathy, in the light of scientific evidence so far.

Novel occurrence of Axenfeld: Rieger syndrome in a patient with blepharophimosis ptosis epicanthus inversus syndrome.

is a complex eyelid malformation characterized by the classical tetrad of blepharophimosis, telecanthus, ptosis, and epicanthus inversus. It has been reported to be associated with other ocular anomalies such as euryblepharon, strabismus, nystagmus, amblyopia, microphthalmos, lacrimal drainage apparatus abnormality, extra ocular muscle abnormalities, microcornea, trabecular dysgenesis, optic nerve hypoplasias, and colobomas of the optic disk. We describe a case of BPES with Axenfeld–Rieger syndrome, a neurocristopathy characterized by maldevelopment of the anterior segment with predisposition to development of glaucoma. Interestingly, both syndromes are caused by mutations in the same class of genes, namely the winged‑helix/ forked transcription factors (FOX) involved in a variety of developmental processes.

Test retest variability of TonoPen AVIA.

The study was conducted to evaluate the intra-session repeatability of Tonopen AVIA (TPA). 180 eyes of 180 patients (50 eyes with glaucoma, 130 eyes of controls) were recruited for this observational study. The mean age of patients enrolled in the study was 43.9 ± 16.7 yrs (84 males, 96 females). Mean IOP recorded with Tonopen AVIA was 19.5 ± 9.5 mmHg, 19.4 ± 9.6 mmHg and 19.3 ± 9.2 mmHg, respectively in the first, second and third instances (P = 0.656). The intraclass correlation coefficient (ICC) ranged from 0.996 (95% CI: 0.956 - 0.998) for glaucoma subjects to 0.958 (95% CI: 0.934 - 0.975) for controls. The coefficient of variation in the study population ranged from 3.47% (glaucoma patients) to 8.10% (healthy controls), being 6.07% overall. The coefficient of repeatability varied between 2.96 (glaucoma patients), 3.35 (healthy controls) to 3.24 (overall). Thus, the Tonopen Avia shows good intrasessional repeatability of IOP in both glaucomatous patients and healthy subjects.

Surgical management of glaucoma: Evolving paradigms.

Surgical intervention is mandatory in the case of documentation of the progression of glaucomatous optic neuropathy despite the administration of maximal tolerated medical therapy, and in cases where compliance is poor. Minimal complications, good long-term intraocular pressure (IOP) control, and precisely titrated target IOPs resulting in avoidance of visual impairment are the primary goals of surgical intervention. This article is an attempt to provide a broad overview of the therapeutic options available to the glaucoma surgeon. The available surgical modalities have undergone modifications and refinements over time, with a view to improve patient outcomes and visual recovery, yet are fraught with intra- and postoperative complications. The risk and benefits of each of the available surgical options must be critically evaluated and customized to fit the needs of the particular patient. There is insufficient evidence at present to establish the superiority of any of these surgeries over the other.

Pars plana Ahmed glaucoma valve implantation with triamcinolone-assisted vitrectomy in refractory glaucomas.

Glaucoma drainage devices are an option in refractory glaucomas for control of intraocular pressure (IOP). We evaluated the outcome of pars plana Ahmed glaucoma valve along with triamcinolone-assisted vitrectomy in 11 eyes with uncontrolled IOP on maximum tolerable antiglaucoma therapy. The mean preoperative IOP of 33.64 ± 5.99 (range 26 to 44 mmHg) decreased to 17.09 ± 2.26 (range 14 to 20 mmHg) and 17.45 ± 1.81mm of Hg (range 14 to 24 mmHg) at 6 and 12 months following surgery. The mean number of antiglaucoma medications decreased from 3.27 ± 0.05 to 0.64 ± 0.67 and 0.55 ± 0.6 at 6 and 12 months following surgery.

Fibrin glue in ophthalmology.

Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.