The outcomes of a low-cost, non-valved glaucoma drainage device using mitomycin-C: 1-year results.

PURPOSE: To evaluate the indications, outcomes, and complications of the usage of Aurolab Aqueous Drainage Implant (AADI) using mitomycin-C. METHODS: A retrospective case series of patients who underwent AADI placement using mitomycin-C between April 2018 and June 2020 at Ain Shams University Hospitals, Cairo, Egypt. The data was extracted from the records of the patients with a minimum of 1 year of follow-up. Complete success was defined as IOP ≥ 5 mmHg and ≤ 21 mmHg or reduction of IOP by ≥ 20% from baseline without antiglaucoma medications (AGMs). Qualified success was defined as reaching the same IOP range with the aid of AGM. RESULTS: A total of 50 eyes of 48 patients were included. Neovascular glaucoma represented the commonest indication (13 patients, 26%). The mean preoperative IOP was 34.0 ± 7.1 mmHg, with a median number of AGM of 3 (mean ± SD = 2.84 ± 1), while the mean IOP after 12 months was 14.3 ± 4 with a median number of AGM of 0. (mean ± SD = 0.52 ± 0.89) (p < 0.001). Complete success was achieved in 33 patients (66%). Qualified success was achieved in 14 patients (28%). Thirteen eyes (26%) had variable postoperative complications; none of them required explantation of the device or affected the visual acuity (except one patient). CONCLUSION: AADI with using mitomycin-C and ripcord during the surgery is an effective and relatively safe method of control of IOP in refractory and advanced cases of glaucoma, with an overall success rate of 94%.

Angle Kappa agreement between Scheimpflug tomography, combined placido Scheimpflug and combined slit scanning placido systems.

PURPOSE: To compare the measured or calculated angle Kappa using Oculus pentacam HR, Sirius and Orbscan III devices. PATIENTS AND METHODS: A prospective randomized cohort study, conducted on 47 eyes of 47 healthy orthotropic individuals, with an age range of 18-50 years and a corrected Snellen's distance visual acuity (CDVA) of 0.8 decimal or better. Angle Kappa is assessed directly using Orbscan® III software version 1.8.165.1. (Bausch and Lomb Rochester, New York, United States), while Pentacam® HR 1.21r.65 (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Sirius device (CSO, version 3.2.1.60, Costruzione Strumenti Oftalmici, Florence, Italy) were used to calculate angle kappa indirectly. RESULTS: Least mean difference of estimated angle Kappa was between Orbscan and Pentacam devices (- 0.18° ± 1.8), and it was statistically insignificant (p value = 0.1294). Differences between both Orbscan and Sirius, and Pentacam and Sirius were statistically significant (p value = 0.0004 and < 0.0001 consecutively). Bland Altman analysis showed a 95% confidence interval between Orbscan III and Pentacam of - 3.76 to 3.4 and between Orbscan III and Sirius of - 3.79 to 2.26. CONCLUSION: Pentacam parameters can be used as a reliable method to calculate angle kappa indirectly, without usage of any additional measurements from other machine. Sirius device parameters could also be used, but with less accurate results. A simple modification to those devices' software to calculate it, and incorporate it in the printout is possible, and highly recommended.

Transepithelial Laser versus Alcohol Assisted Photorefractive Keratectomy Safety and Efficacy: 1-Year Follow-up of a Contralateral Eye Study.

PURPOSE: To compare single-step transepithelial photorefractive keratectomy (TPRK) to conventional alcohol assisted epithelial removal then photorefractive keratectomy (AAPRK) regarding pain, epithelial healing, visual acuity, corneal haze measured subjectively and objectively, higher order aberrations changes, contrast sensitivity and vector analysis of astigmatic correction with one year follow-up. METHODS: A prospective double-blind randomized study of 29 subjects (58 eyes) who underwent myopic aberration-free laser correction by smart pulse technology using Schwind Amaris 1050 Hz with 1-year follow-up. Right eye was randomly treated by AAPRK or TPRK. Postoperative assessment was performed on day 1 and 3, at 1st week, and 1st, 3rd, 6th, and 12th months. Patients were assessed for pain, epithelial healing, visual acuity, corneal haze, astigmatic correction, higher order aberrations and contrast sensitivity. RESULTS: Epithelial healing was complete by the 3rd day in 62.1% of AAPRK eyes and in 89.7% of TPRK eyes. First day postoperative pain was higher in TPRK group (p = 0.0134). The decimal uncorrected visual acuity at 12 months was 1.47 ± 0.39 and 1.57 ± 0.38 in the AAPRK and TPRK groups respectively (p = 0.3719). Post-photorefractive keratectomy haze reached a final level of 0.04 ± 0.14 and 0.02 ± 0.1 in AAPRK and TPRK groups respectively (p = 0.5607). Contrast sensitivity was comparable in low and high frequency cycles per degree. Vector analysis of astigmatic correction showed correction index at one year of 0.99 and 1.05 for AAPRK and TPRK groups respectively. CONCLUSIONS: Alcohol assisted and transepithelial photorefractive keratectomy have comparable results regarding safety and efficacy.

Visual disability among patients attending glaucoma clinic in a tertiary hospital.

PURPOSE: To report visual impairment and blindness among the patients attending a glaucoma clinic in a tertiary university hospital and highlight the possible risk factors that could be addressed later. METHODS: A retrospective analysis of the medical records of the patients attending the glaucoma clinic in Ain Shams University Hospitals over a period of one year was conducted. Visual impairment classification was done according to the International Classification of Diseases and Related Health Problems (ICD-11) based on the best-corrected visual acuity in the better-seeing eye. Data including diagnosis, history of previous surgery, and duration of glaucoma were extracted and analyzed. RESULTS: The medical records of the first visit of 118 patients (58 males and 60 females) were included in this study. Secondary glaucoma was the most common type presented (38 patients, 32.2%), followed by primary open-angle glaucoma (35 patients, 29.6%). Sixty-seven patients (56.7%) were considered visually impaired, while seven patients (5.9%) were considered blind. Forty-one patients (34.7%) were considered mono-ocular blind. CONCLUSION: There is a high incidence of visual impairment and blindness among glaucoma patients presented to the glaucoma clinic in the  tertiary hospital. A further nation-wide study and possibly, an early surveillance program for glaucoma are needed.