Incidence, efficacy and safety of YAG laser goniopuncture following nonpenetrating deep sclerectomy at a university hospital in Riyadh, Saudi Arabia

Assessing the frequency and evaluating the efficacy and safety of Neodymium:Yttrium Aluminum Garnet [Nd:YAG] Laser goniopuncture [LGP] following nonpenetrating deep sclerectomy [NPDS]. Retrospective cohort study. We retrospectively reviewed the outcome of 197 eyes of 153 patients with open angle glaucoma who underwent either NPDS or NPDS combined with cataract extraction between January 2005 and September 2010 at King Abdulaziz University Hospital [KAUH]. Both demographic and clinical data were retrieved and analysed. Goniopuncture [GP] was needed in 48 [24.4%] of the eyes which had NPDS or NPDS with cataract extraction after a mean post operative interval of 9.78 [ +/- 11.16] months. The mean IOP had significantly decreased from 23.3 [ +/- 5.9] mmHg prior to Nd:YAG LGP procedure to 14.6 [ +/- 4.4] mmHg at the last post-procedure assessment. At the last follow-up; Nd:YAG LGP was successful in controlling IOP in 27 eyes [56.3%]. Mean Nd:YAG LGP failure time was 6.04 [ +/- 5.80] months. Young age [<50 years] [p = 0.001]; type of glaucoma [secondary versus primary open angle, p = 0.0258] and the use of drainage implant [p = 0.038] were the identified predicting factors for the need of Nd:YAG LGP. Complications following Nd:YAG LGP occurred in 5 eyes [iris touch to TDM [4.2%], Hyphema [2.1%], hypotony maculopathy [2.1%] and choroidal detachment [2.1%]. LGP is an efficient IOP lowering procedure after NPDS, when it is indicated. It is a simple and noninvasive procedure. However, certain precautions should be taken to avoid complications

profile of glaucoma in a tertiary ophthalmic university center in Riyadh, Saudi Arabia

To report the pattern of glaucoma among Saudi patients who were presented to King Abdul Aziz University Hospital [KAUH]. All glaucoma or glaucoma suspect patients who were presented to KAUH from 2006 to 2008 were included; medical files of all patients were retrieved and evaluated through standardized international guidelines. Collected data included: age, sex, laterality, intraocular pressure, and cup/disk ratio. Prevalence of different glaucoma types [including 95% CI] was calculated, ANOVA and post hoc tests were applied to evaluate the difference in indices across different types. A total of 2296 eyes of 1236 patients were included. Primary angle closure glaucoma [PACG] was the predominant type [46.6%] followed by primary angle closure [PAC] [17.2%], then primary open angle glaucoma [POAG] [12.8%], and secondary glaucoma [13%]. Other types including [normal tension glaucoma [5.9%], childhood glaucoma [2.6%], and juvenile glaucoma [1.9%]] were also present but of lower prevalence. Primary angle closure glaucoma was the predominant form of glaucoma followed by PAC, and POAG suggesting that the pattern in Saudi Arabia could be quite different from that reported for primary glaucomas in the Western literature. In addition, pseudoexfoliation was the most common form of secondary open and closed angle glaucoma. These results indicate the need for a national intervention program for early detection and referral of glaucoma cases in order to prevent significant visual loss. There is also a need for a community based assessment to determine the prevalence of glaucoma as a baseline for future intervention

Controlled Cyclophotocoagulation with diode laser in refractory glaucoma and long term follow up at King Abdulaziz University Hospital, Riyadh

To evaluate the clinical efficacy and safety of controlled contact transscleral diode laser Cyclophotocoagulation [COCO] procedure in reducing the Intraocular Pressure [IOP] among patients with refractory glaucoma. Thirty two patients [35 eyes] with refractory glaucoma in prospective clinical studies were treated with trans-sclera diode laser in a controlled manner. The energy power used was 5 W in adults and 3 W in children, exposure time was 0.5 s, a total of 16 shots were applied over ciliary body and four shots in each quadrant. Pre and postoperative IOP were measured at different postoperative visits. Snellen visual acuity, the number of anti-glaucoma medications and associated complications were also recorded. Student Ttest was used to compare the pre and post intervention lOPs, while Wilcoxon Signed Ranks test was used, to detect significance change in medication dependency. The mean [SD] follow up time was 80.2[ +/- 9.6] months, range [36-84] m, where the mean IOP was significantly reduced from 35.1 mm Hg [ +/- 10.7] before intervention to 18.8 mm Hg [ +/- 7.3] after intervention, in the final visit [P < 0.0001]. Complete success was achieved in seven eyes [20%], 22 eyes [62.8%] showed qualified successes and complete failure was reported in six eyes [17.1%]. The overall success rate was 82.8% [95% CI: 70.4-95.3]. Visual acuity improved