Ultrasound cyclo plasty in advanced glaucoma: Intermediate-term success, predictors for failure and complications.

PURPOSE: To report the intermediate-term success rate of ultrasound cyclo plasty (UCP), predictors for failure and complications in advanced glaucoma. METHODS: This study included patients with advanced glaucoma who underwent UCP. The main outcome measures were intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of complications. Success was defined as an IOP reduction ≥30% and IOP between 6 mmHg and 18 mmHg with no vision-threatening complications. Cox proportional hazard regression analysis was performed to identify possible predictors for failure. RESULTS: We included 65 eyes of 58 patients in the study. The mean IOP and number of antiglaucoma medications decreased significantly from 27.60 ± 5.5 mmHg and 3.40 ± 0.9 at baseline to 17.80 ± 8.0 mmHg (35.51% reduction) and 2.43 ± 1.3 at 12 months and 17.10 ± 8.2 mmHg (38.04% reduction) and 2.41 ± 1.5 at 24 months, respectively (p < 0.01 for both). The success rates were 66.2% (43/65) and 72.4% (21/29), while the failure rates were 33.8% (22/65) and 27.6% (8/29) at 12 and 24 months postoperatively, respectively. The cumulative probabilities of overall success were 67.7 ± 5.8% and 33.8 ± 5.9% at 12 and 24 months, respectively. High baseline IOP and history of old glaucoma surgery were associated with a higher risk for failure (Hazard ratio = 1.10 and 5.82, p = 0.03 and p < 0.01, respectively). The most common complications were anterior chamber reaction (18.5%) and cataract development/progression (15.4%). Two eyes (3.1%) developed phthisis bulbi. CONCLUSIONS: Although UCP is effective in lowering IOP in eyes with advanced glaucoma, the intermediate-term success rates were moderate.

Outcomes of Ultrasound Cyclo Plasty in Primary Angle Closure Glaucoma.

PRCIS: Ultrasound cyclo plasty (UCP) can be useful in decreasing the intraocular pressure (IOP) and burden of antiglaucoma medications in eyes with primary angle closure glaucoma (PACG). Nevertheless, baselines IOP was an important determinant for failure. PURPOSE: To evaluate the intermediate-term outcomes of UCP in PACG. METHODS: This retrospective cohort study included patients with PACG who underwent UCP. The main outcome measures were IOP, number of antiglaucoma medications, visual acuity, and presence of complications. The surgical outcomes of each eye were classified as a complete success, qualified success, or failure based on the main outcome measures. Cox regression analysis was performed to identify possible predictors for failure. RESULTS: Sixty-two eyes of 56 patients were included in the study. The mean follow-up period was 28.81 months (±18.2). The IOP and number of antiglaucoma medications decreased from a mean of 23.03 (±6.4) mmHg and 3.42 (±0.9) to 15.57 (±6.4) mmHg and 2.04 (±1.3), respectively, in the 12 th month and to 14.22 (±5.0) mmHg and 1.91 (±1.5) in the 24 th month ( P <0.01 for all). The cumulative probabilities of overall success were 72.6±5.7% and 54.8±6.3% at 12 and 24 months, respectively. A high baseline IOP was associated with a higher risk of failure (hazard ratio=1.10, P =0.03). The most common complications were cataract development or progression (30.6%), rebound or prolonged anterior chamber reaction (8.1%), hypotony with choroidal detachment (3.2%), and phthisis bulbi (3.2%). CONCLUSIONS: UCP offers reasonable 2-year IOP control and reduction of the antiglaucoma medication burden. However, counseling on possible postoperative complications is needed.

Two-Year Outcomes of Ultrasound Cyclo Plasty as a First Procedure in Glaucoma.

PURPOSE: To evaluate the 2-year outcomes of ultrasound cyclo plasty (UCP) as a first procedure in glaucoma. METHODS: This retrospective cohort study included patients with uncontrolled glaucoma who underwent UCP as an initial glaucoma procedure. The main outcome measures were intraocular pressure (IOP), the number of antiglaucoma medications, visual acuity, and the presence of vision-threatening complications. Surgical outcomes of each eye were classified as either complete success, qualified success, or failure based on the main outcome measures. Differences in IOP control and success rates were compared in eyes with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). RESULTS: We included 98 eyes of 88 patients in the study. The mean follow-up period was 27.25 ± 10.1 months. At 12 and 24 months, mean IOP decreased significantly from 23.16 ± 6.4 mmHg to 16.57 ± 6.0 mmHg and 16.18 ± 5.2 mmHg, respectively, and the number of antiglaucoma medications decreased from 3.27 ± 0.9 to 1.86 ± 1.4 and 1.70 ± 1.7, respectively (p < .01 for all). There were no changes in visual acuity throughout the follow-up compared with preoperative levels. The cumulative probabilities of success were 64.3% (±4.8) [78.9% (±9.4) complete success, and 72.9% (±6.4) qualified success], and 42.9% (±5.0) [52.6% (±11.5) complete success, and 56.3% (±7.2) qualified success] at 12 and 24 months, respectively. The most common complications were cataract development/progression, anterior chamber inflammation, and macular edema. There were no significant differences in IOP, number of antiglaucoma medications, or survival rates between POAG and PACG groups. CONCLUSIONS: UCP can be used as an initial glaucoma procedure for reducing IOP and the number of antiglaucoma medications and offers comparable outcomes in POAG and PACG.

Outcomes and Predictors of Failure of Ultrasound Cyclo Plasty for Primary Open-Angle Glaucoma.

Aims: To evaluate the outcomes of ultrasound cyclo plasty (UCP) for primary open-angle glaucoma (POAG) and identify the predictors of failure. Methods: This retrospective cohort study included patients with POAG who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were the intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures. Cox proportional hazard regression analysis was performed to identify the possible predictors of UCP failure. Results: Sixty-six eyes of fifty-five patients were included herein. The mean follow-up period was 28.95 (±16.9) months. The mean IOP decreased significantly from 23.02 (±6.1) to 18.22 (±7.0) and 16.44 (±5.3) mm Hg on the 12th and 24th months, respectively; the mean number of antiglaucoma medications decreased significantly from 3.23 (±0.9) to 2.15 (±1.5) and 2.09 (±1.6), respectively. The cumulative probabilities of overall success were 71.2 ± 5.6% and 40.9 ± 6.1% on the 12th and 24th months, respectively. High baseline IOP and the number of antiglaucoma medications were associated with a higher risk of failure (hazard ratio = 1.10 and 3.01, p = 0.04 and p < 0.01, respectively). The most common complications were cataract development or progression (30.8%) and prolonged or rebound anterior chamber reaction (10.6%). Conclusions: UCP reasonably controls the IOP and reduces the antiglaucoma medication burden in eyes with POAG. Nevertheless, the success rate is modest, with a high baseline IOP and number of medications.

Ultrasound Cyclo Plasty in Glaucoma: 2-Year Outcomes.

PRCIS: UCP offers reasonable IOP control and reduction of the antiglaucoma medication burden. PURPOSE: The purpose of this study is to evaluate the 2-year outcomes of Ultrasound Cyclo Plasty (UCP) in uncontrolled glaucoma. MATERIALS AND METHODS: A retrospective cohort study included patients with uncontrolled primary or secondary glaucoma who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, and presence of vision-threatening complications. The surgical outcome of each eye was classified as complete success, qualified success, or failure based on the main outcome measures. RESULTS: One hundred and eighty-two eyes of 158 patients were included in the study. The mean follow-up period was 29.71 months (±18.1). The IOP and the number of antiglaucoma medications decreased significantly from a mean of 23.46 mm Hg (±6.3) and 3.33 (±0.9) to 17.33 (±7.1) and 2.14 (±1.4), and 16.24 (±6.3) and 1.90 (±1.5) on the 12th and 24 months, respectively. The overall success rates were 78.0% (143/182) and 85.6% (95/111), and the failure rates were 21.4% (39/182) and 14.4% (16/111) on the 12th and 24th months, respectively. The most common complications were cataract development/progression and anterior chamber reaction. CONCLUSIONS: UCP offers reasonable IOP control and reduction of the antiglaucoma medication burden.

Ultrasound Cyclo Plasty After Failed Glaucoma Surgery: Outcomes and Complications.

INTRODUCTION: The purpose of this study is to report the outcomes and complications of ultrasound cyclo plasty (UCP) after failed glaucoma surgery. METHODS: A retrospective case series included patients with previously failed glaucoma surgery who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were: intraocular pressure (IOP), number of antiglaucoma medications and presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures. RESULTS: Seventy eyes of 70 patients were included in the study. The mean follow-up period was 31.89 months (± 17.5). The IOP and the number of antiglaucoma medications decreased significantly from a mean of 23.91 mmHg (± 6.3) and 3.43 (± 0.8) to 17.88 mmHg (± 8.1) and 2.48 (± 1.3) and of 16.74 (± 7.9) and 2.11 (± 1.3) at the 12th and 24th months postoperatively, respectively (p < 0.01 for both). The success rates were 77.1% (54/70) and 48.6% (34/70), while the failure rates were 22.9% (16/70) and 2.9% (2/70) at the 12th and 24th months postoperatively, respectively. The cumulative probabilities of success were 70.0% (± 5.5%) and 47.1% (± 6.0%) at the 12th and 24th months postoperatively, respectively. The most common complications were anterior chamber reaction (24.3%), cataract development/progression (18.6%), hypotony/choroidal detachment (4.3%), phthisis bulbi (1.4%) and aqueous misdirection (1.4%). CONCLUSIONS: UCP is an effective treatment modality to control IOP and decrease the burden of antiglaucoma medications in eyes with previously failed glaucoma surgery. Monitoring and counseling of possible postoperative complications are needed.

Coronary artery rupture in blunt thoracic trauma: a case report and review of literature.

BACKGROUND: Blunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare. CASE PRESENTATION: We present a case of a young male who sustained a blunt thoracic trauma in a motor vehicle collision, that resulted in rupture of the left anterior descending (LAD) coronary artery and subsequent cardiac tamponade. Prompt surgical intervention with pericardiotomy and ligation of the artery has resulted in survival of the patient. CONCLUSIONS: In cases of traumatic coronary artery rupture, early surgical intervention is crucial to avoid mortality. Ligation of the injured coronary is a viable option in selected cases, and can be the most expeditious option in patients in extremis.