Consensual eye intra-ocular pressure rise following unilateral glaucoma surgery

Purpose: Consensual eye intra?ocular pressure (IOP) increase has been reported following ipsilateral glaucoma surgery. The study evaluated the need for increase in anti?glaucoma medications (AGM) ± glaucoma surgery to control the IOP in consensual eye following unilateral glaucoma surgery. Methods: Data of 187 consecutive patients who underwent either trabeculectomy or AGV implant were collected. Index (IE) and fellow eye (FE) IOP (baseline, follow?up day 1, week 1, months 1 and 3), acetazolamide and AGM use, FE surgery, glaucoma status, and relevant ophthalmological data were collected. Results: A significant increase from a baseline IOP of 14.4 mmHg was noted at week 1 (15.8 mmHg, p?0.005) and month 1 (15.62 mmHg, p?0.007) in FE (n?187). Among the 61 patients (33%, n?187) who needed additional intervention to reduce FE IOP, 27 (14.4%) underwent FE trabeculectomy. In the IE trabeculectomy group (n?164), significant increase in FE IOP was noted in week 1 (15.87 mmHg, p?0.014) and month 1 (15.61 mmHg, p?0.02), and in the IE AGV group (n?23) at day 1 (15.91 mmHg, p?0.06). Pre?operative acetazolamide resulted in significant increase in FE IOP at week 1 and month 1. Maximum increase in FE IOP of nearly 3.5 mm Hg was noted when IE IOP was persistently <5 mmHg at one month following surgery. Mean FE IOP remained elevated at all visits. Conclusion: An increase in fellow eye IOP needing any additional intervention in a third and surgical intervention in nearly a sixth meant that FE IOP be strictly monitored and addressed following unilateral glaucoma surgery

Outcomes of ab-interno irrigating goniectomy with trabectome in primary and secondary glaucoma from a single center in India

Purpose: This study was done to report intermediate?term outcomes of irrigating goniectomy with trabectome (trabectome) surgery among different types of glaucoma eyes from a single center in India using a cross?sectional, longitudinal, observational study design. Methods: Fifty?three patients (58 eyes) with glaucoma who underwent irrigating goniectomy with trabectome between January 2019 and February 2020 were included. Pre?operative data included age, gender, eye laterality, specific diagnosis, number of anti?glaucoma medications (AGMs), prior glaucoma surgeries, visual acuity, and intraocular pressure (IOP) on medical treatment. Post?operative data included IOP changes during the follow?up till 1?year, number of AGMs, any complications, or additional surgical intervention required. Success was defined as IOP ? 21 mmHg and ? 20% reduction of IOP from pre?operative IOP with no additional glaucoma surgery. Results: The cohort included 58 eyes (male 53.4% and female 46.6%) ranging from 0.6 to 81 years of age. The average baseline IOP was 23.4 ± 10.2 mmHg and reduced significantly with surgery to 14.1 ± 5.3 mmHg at 1?year follow?up. The AGMs reduced from 2.4 ± 1.4 pre?surgery to 1.6 ± 1.4 at 1?year follow?up. Four eyes required additional glaucoma surgeries for IOP control. The success rate of trabectome with phacoemulsification (88%) was discernibly higher than with trabectome alone (67%). Intra?operatively, significant blood reflux was noticed in 27 eyes, of which only one required tamponading with a viscoelastic agent. Conclusion: This study concludes that irrigating goniectomy with trabectome has good efficacy and safety in both pediatric and adult cases of glaucoma in terms of IOP control, reduction in AGMs, and low incidence of complications in the Indian population.

Association of primary angle-closure disease in patients with retinal vein occlusion in North Indian population

Purpose: To determine the association of primary angle-closure disease (PACD) in patients with retinal vein occlusion (RVO) at a tertiary eye care center in North India. Methods: It is a cross-sectional, observational study. Sixty consecutive patients with retinal vein occlusion within a period of one year from a single tertiary eye care center were enrolled. Detailed history, slit-lamp examination of the anterior segment, intraocular pressure measurement by applanation tonometry, gonioscopy and fundus examination were done. Anterior chamber depth and axial length were also measured. Results: Among the 60 patients, 29 were males (48.3%) and 31 females (51.6%). Twenty-seven (45%) of them had central retinal vein occlusion (CRVO) and 33 (55%) had branch retinal vein occlusion (BRVO). Forty percent of patients with RVO had PACD. Relative risk of PACD was 1.71 times in patients with CRVO as compared to BRVO. Risk of glaucoma was 49% more in CRVO than BRVO. Probability of PACD was more in patients of RVO who had diabetes and CAD as comorbidity. Conclusion: The association between PACD and RVO is less known. PACD can be one of the risk factors for the development of RVO. A comprehensive examination and detailed angle evaluation of both of the eyes should be done in all cases of RVO, in addition to investigating for systemic risk factors. However, larger population-based studies would be required to prove it as an independent risk factor.

Correlation between choroidal thickness and intraocular pressure control in primary angle-closure glaucoma

Purpose: To study the correlation between choroidal thickness (CT) and IOP control in primary angle?closure glaucoma (PACG). Methods: In total, 61 patients (102 eyes) with PACG underwent subfoveal CT (SFCT) scanning using enhanced depth imaging–optical coherence tomography. The subjects with PACG were further grouped as controlled IOP (?21 mm Hg on maximal medical therapy) and uncontrolled IOP (>21 mm Hg on maximal medical therapy). The average CT of the PACG eyes was calculated and compared between both groups. A correlation analysis was done between CT and intereye difference in CT with the disease parameters. Results: The mean CT was 274.38 ± 42.10 ?m in 102 PACG eyes. SFCT was significantly increased in the uncontrolled IOP group as compared with the controlled IOP group. The mean SFCT was 245.57 ± 62.10 ?m in the controlled group and 294.46 ± 51.05 ?m in the uncontrolled group (P < 0.01). Factors associated with a thicker choroid were younger age, high IOP, and higher optic nerve head cupping (P < 0.001). Neither the visual field?mean deviation (VF?MD) nor pattern standard deviation (PSD) was found to be associated with overall CT. The intereye asymmetry between CT was significantly associated with poor VF?MD and PSD. Conclusion: PACG eyes with thicker choroid may be a risk factor for poor IOP control on medical anti?glaucoma therapy. Thicker choroid as compared to the fellow eye is a poor prognostic sign and these eyes should be monitored closely

Conjunctival erosion after glaucoma drainage device surgery: A feasible option.

Glaucoma drainage devices (GDDs) have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evidence to prove that any of these methods is superior to another for providing tectonic durability in the long term. In this report, we present a case of neovascular glaucoma, who developed conjunctival melting over the tube of an Ahmed Glaucoma Valve implant and was successfully managed with Cap Doxycycline.