Globe rupture with aphakia, aniridia, secondary glaucoma and late corneal decompensation: A multi-staged approach to management.

Severe blunt ocular trauma may result in immediate and delayed complications requiring appropriate management algorithms. We hereby report a case of globe rupture, aphakia, traumatic aniridia, and secondary glaucoma in a 33-year-old male following road traffic accident. He was treated initially by primary repair followed by novel combined approach of aniridia IOL with Ahmed glaucoma valve implantation. Delayed corneal decompensation required deferred penetrating keratoplasty. After a follow-up of 3.5 years after last surgery, patient maintains good functional vision with stable IOL, clear corneal graft and controlled intraocular pressure. A meticulously planned and staged management approach appears better suited in complex ocular trauma in such scenarios giving a good structural and functional outcome.

A deep dive into the latest European Glaucoma Society and Asia-Pacific Glaucoma Society guidelines and their relevance to India.

Glaucoma is the second leading cause of blindness in India. Despite advances in diagnosing and managing glaucoma, there is a lack of India-specific clinical guidelines on glaucoma. Ophthalmologists often refer to the European Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines. A group of glaucoma experts was convened to review the recently released EGS guideline (fifth edition) and the APGS guideline and explore their relevance to the Indian context. This review provides the salient features of EGS and APGS guidelines and their utility in Indian scenario. Glaucoma diagnosis should be based on visual acuity and refractive errors, slit-lamp examination, gonioscopy, tonometry, visual field (VF) testing, and clinical assessment of optic nerve head, retinal nerve fiber layer (RNFL), and macula. The intraocular pressure target must be individualized to the eye and revised at every visit. Prostaglandin analogues are the most effective medications and are recommended as the first choice in open-angle glaucoma (OAG). In patients with cataract and primary angle-closure glaucoma (PACG), phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Trabeculectomy augmented with antifibrotic agents is recommended as the initial surgical treatment for OAG. Laser peripheral iridotomy and surgery in combination with medical treatment should be considered in high-risk individuals aged <50 years. In patients with phakic and PACG, phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Visual acuity, VF testing, clinical assessment of the optic disc and RNFL, and tonometry are strongly recommended for monitoring glaucoma progression.

Visual Field Plots: A Comparison Study Between Standard Automated Perimetry and Eye Movement Perimetry.

PRéCIS:: This eye movement perimetry (EMP) study describes the development of saccadic reaction time (SRT)-based visual field plots, which could effectively display the presence, location, and extent of glaucomatous defects and support clinical decision-making. PURPOSE: EMP is capable of discriminating normal from glaucomatous visual field defects on the basis of average delays in SRTs. To classify the presence and extent of age-corrected visual field defects, it is required to create SRT-based probability maps. AIM: The aim of this study was to create visual field probability plots based on SRTs and to evaluate their clinical applicability by 2 glaucoma specialists. MATERIALS AND METHODS: The development phase included 95 controls segregated into 5 age-bins to estimate normative limits of SRT. Next, for the testing phase, a set of 28 healthy subjects and 24 glaucoma patients were recruited who underwent standard automated perimetry (SAP) and EMP visual field testing. Fifty-two SAP and EMP plots were presented to 2 glaucoma specialists to classify them as normal or abnormal and to identify the defect location and pattern as 1 or more of 7 predefined categories. RESULTS: The glaucoma specialists showed a sensitivity of 100% and a specificity of 93% and 96% for identifying normal versus abnormal visual field. For specialists 1 and 2, 85% and 92%, respectively, of EMP reports were assigned to the same category as SAP. The reports that did not agree with SAP were graded to a higher defect pattern. The intermethod agreement for specialists 1 and 2 was κ 0.92 and 0.96, respectively. CONCLUSION: SRT-based visual field probability plots provided a comprehensive summary of an individual's visual field status and showed comparable clinical applicability to that of SAP plots.

Effect of Age, Sex, Stimulus Intensity, and Eccentricity on Saccadic Reaction Time in Eye Movement Perimetry.

PURPOSE: In eye movement perimetry (EMP), the extent of the visual field is tested by assessing the saccades using an eye tracker. The aim of the present study was to determine the effects of age and sex of the subjects, the eccentricity and intensity of the peripheral stimuli on saccadic reaction time (SRT), and the interaction between these parameters in healthy participants. METHODS: Healthy participants aged between 20 to 70 years underwent a complete ophthalmic examination and an EMP test. SRT was determined from detected peripheral stimuli of four intensity levels. A multilevel mixed-model analysis was used to verify the influence of subject and stimulus characteristics on SRT within the tested visual field. RESULTS: Ninety-five subjects (mean age 43.0 [15.0] years) were included. Age, stimulus intensity, and eccentricity had a statistically significant effect on SRT, not sex. SRTs were significantly faster with increasing stimulus intensity and decreasing eccentricity (P < 0.001). At the lowest stimulus intensity of 192 cd/m2, a significant interaction was found between age and eccentricity. CONCLUSIONS: The current study demonstrated significant SRT dependence across the visual field measured up to 27°, irrespective of sex. The presented SRT values may serve as a first normative guide for EMP. TRANSLATIONAL RELEVANCE: This report of SRT interaction can aid in refining its use as a measure of visual field responsiveness.

Eye Movement Perimetry and Frequency Doubling Perimetry: clinical performance and patient preference during glaucoma screening.

PURPOSE: To evaluate the screening accuracy of an Eye Movement Perimetry (EMP) in comparison with Frequency Doubling Perimetry (FDP) and to investigate the patient preference and perception towards these visual field screening methods. METHODS: A total of 104 healthy subjects (mean age (SD) of 48 (14) years) and 73 glaucoma patients (mean age (SD) of 52 (13) years) were recruited. All the participants underwent a comprehensive ophthalmic evaluation including the 24-2 SITA standard protocol on the Humphrey Field Analyzer (HFA). This was followed by the 26-point protocol in EMP and the C-20-1 protocol in FDP. During EMP, all subjects were instructed to fixate a central target and to look at the detected peripheral target, followed by refixation of the central target and Saccadic Reaction Time (SRT) towards each of the "seen" stimuli was calculated. Next, a questionnaire was administered to evaluate the patient preference and perception towards the perimetry techniques. Mean SRTs and Robin scores were used to plot Receiver Operating Characteristics (ROC) curves to determine the screening accuracies. From the questionnaire survey, the frequency distributions of the responses were calculated. RESULTS: Robin score and SRT were significantly increased in glaucoma patients in comparison with the age-matched healthy subjects (p < 0.001). The ROC analysis revealed comparable Area Under the Curve (AUC) values (0.95, p = 0.81) with a specificity of 95.2% for FDP and 96.2% for EMP with a sensitivity of 87.7%. Thirty-seven percent of the older age group (≥ 40 years) and 65% of severe glaucoma patients showed preference for EMP over FDP. CONCLUSIONS: This study results indicate that the customized protocol in EMP provides efficient and rapid means of screening visual field defects in glaucoma, which compared well with FDP. Elderly healthy participants and patients with moderate and severe glaucomatous defects preferred EMP as it permitted natural reflexive eye movements thereby resembling a real-life test setting.

Detection of Proteins Associated with Extracellular Matrix Regulation in the Aqueous Humour of Patients with Primary Glaucoma.

Purpose: The protein composition of aqueous humour (AH) has held significant relevance and remains to be the prime sample in the discovery of biomarkers in glaucoma. The purpose of this study is to analyze the AH protein concentrations in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) and further examine the proteome changes compared to cataract control. Methods: AH was collected from 90 POAG, 72 PACG, 78 cataracts (controls) in this study. The total protein was quantified using Bradford's assay. Samples were subjected to trypsin digestion followed by liquid chromatography-mass spectrometry (LC-MS) for proteomic studies (n = 3 per group). The extracellular matrix has a major influence on the AH outflow, and the regulator proteins osteopontin (OPN), cathepsin D, and cystatin C detected by mass spectrometry are validated in AH samples by Western blot and turbidimetric immunoassay. Results: We observed a significant increase in protein levels of POAG (p = .0009); interestingly, a similar increase in PACG compared to cataract (p < .0001) and POAG (p = .02). Proteomics analysis identified 184, 190, and 299 proteins in control, POAG and PACG. OPN was increased in POAG (p = .0319) and PACG (p = .0103) compared to control. The precursor form of cathepsin D was increased in POAG and decreased in PACG, though not significant compared to control. Cystatin C was also increased in both POAG (p = .0310) and PACG (p = .0125) compared to control. Conclusion: In this study, we report for the first time that PACG cohort had higher total protein compared to controls. A qualitative comparison of proteomes revealed increased numbers of proteins identified in PACG. We assume that elevated levels of OPN and cystatin C in POAG and PACG along with altered cathepsin levels may contribute to ECM aberration in glaucoma.

Is prophylactic laser peripheral iridotomy for primary angle closure suspects a risk factor for cataract progression? The Chennai Eye Disease Incidence Study.

BACKGROUND: To report the risk of cataract progression among primary angle closure suspects (PACS) 6 years after they underwent laser peripheral iridotomy (LPI). METHODS: In the Chennai Eye Disease Incidence Study, 6 years after their baseline evaluation, 4421 subjects were examined again. As part of a detailed evaluation cataract was graded using the Lens Opacities Classification System II; progression was defined as change of cataract by two or more grades or history of cataract surgery in the 6-year period. Only bilaterally phakic subjects with less than N2 or C2 or P2 cataract at baseline with no history of any form of glaucoma, primary angle closure and pseudoexfoliation were included. RESULTS: There were 3205 eligible subjects. Of these, 190 had undergone LPI for PACS. In comparison to the study population, they were significantly older (p<0.001), female (p=0.008), urban residents (p=0.001) and patients with hypertension (p<0.001). During the intervening period, 53 subjects had undergone cataract surgery. The cataract progression rate was significantly greater (OR 1.7, 95% CI 1.3 to 2.4, p<0.001) in those who had undergone LPI. For the study population the baseline risk factors for progression of cataract were age (p<0.001), female gender (p=0.01), diabetes (p<0.001) and LPI (p<0.001). Diabetes and female gender were significant risk factors for nuclear and cortical cataract progression; LPI was a risk factor only for cortical cataract (OR 1.6, 95% CI 1.1 to 2.3, p=0.007). CONCLUSIONS: There was significant cataract progression in 6 years following LPI for PACS.

Six-year incidence of visually significant age-related cataract: the Chennai eye disease incidence study.

BACKGROUND: The aim of this study is to report the 6-year incidence of age-related cataract in a population-based study. DESIGN: The design used is a population-based cohort study. PARTICIPANTS: A cohort of 2484 phakic subjects, aged 40 years and above at baseline, from a south Indian population was included in the study. METHODS: Bilateral phakics with visual acuity of 6/12 or better and cataract less than N2, C2 and P2 on the Lens Opacities Classification System II at baseline were included. Subjects with glaucoma and corneal or retinal diseases were excluded. Incident visually significant cataract was defined as visual acuity of less than 6/18 with a corresponding one grade or greater change in Lens Opacities Classification System II or history of having undergone cataract surgery with evidence of pseudophakia or aphakia at the 6-year follow-up. MAIN OUTCOME MEASURES: Six-year incidence of visually significant cataract and associated risk factors data were collected. RESULTS: Incident visually significant cataract at 6 years was seen in 158 subjects (6.36%, 95% CI: 5.40-7.32, phakics:pseudophakics/aphakics 70:88). Incidence was higher in the rural cohort as compared with the urban cohort (P < 0.001). Incidence increased with age and was highest in the ≥70 years age group (odds ratio (OR):31.23, 95% CI: 15.20-64.16, P < 0.001). Other associated risk factors included illiteracy (OR 1.75, 95% CI: 1.17-2.61, P = 0.007) and smoking (OR 1.77, 95% CI: 1.08-2.88, P = 0.02). CONCLUSIONS: A significant proportion of the population developed visually significant age-related cataract at 6 years. Incident visually significant cataract was significantly greater for the rural cohort between 50 and 69 years old.

The Prevalence of Pseudoexfoliation and the Long-term Changes in Eyes With Pseudoexfoliation in a South Indian Population.

PURPOSE: To report the prevalence, long-term changes and associated factors for pseudoexfoliation (PEX) in a population aged 40 years and above from rural and urban south India. MATERIALS AND METHODS: At baseline (the Chennai Glaucoma Study), 7774 subjects were examined. After 6 years, as a part of the incidence study, 133 of the 290 subjects diagnosed with PEX at baseline were reexamined for long-term changes. Participants had detailed examination at base hospital. RESULTS: At baseline PEX was noted in 290 [3.73%, 95% confidence interval (CI), 3.3-4.2] subjects. It was associated with glaucoma in 24 (8.3%), ocular hypertension (OHT) in 21 (7.2%), and occludable angles in 24 (8.3%) subjects. The age-adjusted and sex-adjusted prevalence was 3.41% (95% CI, 3.39-3.43). Increasing age was a significant associated factor. Using the 40- to 49-year age group as a reference, the odds ratio increased from 8.4 (95% CI, 4.1-17.1) for the 50- to 59-year age group to 51.2 (95% CI, 25.8-101.6) for the 70 years and above age group. Other associated factors were rural residence (P<0.001), higher intraocular pressure (P<0.001), cataract (P<0.001), being underweight (P=0.01), manual labor (P=0.03), and aphakia (P<0.001). Of the 133 subjects reexamined, 8 (6.0%) subjects developed glaucoma and all had OHT at baseline. Rates of cataract surgery were (P<0.001) higher in subjects with PEX. CONCLUSION: Prevalence of PEX was higher in rural population and baseline OHT was a significant factor for conversion to glaucoma.

Six-Year Incidence and Baseline Risk Factors for Pseudoexfoliation in a South Indian Population: The Chennai Eye Disease Incidence Study.

OBJECTIVE: To estimate the 6-year incidence of pseudoexfoliation and its risk factors in a South Indian population. DESIGN: Longitudinal population-based study. PARTICIPANTS: Subjects 40 years of age or older without pseudoexfoliation at baseline. METHODS: Participants were examined at baseline and after a 6-year interval. The presence of pseudoexfoliation was looked for after pupillary dilation in either or both eyes at 1 or more locations. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification. Logistic regression was performed to identify the baseline risk factors that could predict the incident pseudoexfoliation. MAIN OUTCOME MEASURES: Six-year incidence, associated risk factors, and rural-versus-urban differences. RESULTS: From the study cohort of 4228 subjects, 87 subjects (male-to-female ratio, 48:39; rural-to-urban ratio, 69:18) demonstrated incident pseudoexfoliation (2.03%; 95% confidence interval [CI], 1.6-2.5; rural: -2.86%; 95% CI, 1.6-2.5; urban: 0.96%; 95% CI, 0.5-1.4). Pseudoexfoliation was associated with glaucoma in 1 subject (1.1%), with primary angle-closure suspicion in 10 subjects (11.5%), and with ocular hypertension in 2 subjects (2.2%). Significant predictive baseline risk factors were older age (P < 0.001), rural residence (P < 0.001), illiteracy (P = 0.02), pseudophakia (P = 0.04), and nuclear cataract (P = 0.05). With reference to the 40-to-49-year age group, the risk of incidence increased from 4.7 (95% CI, 2.4-9.4) for the 50-to-59-year age group to 12.9 (95% CI, 6.1-27.2) for 70 years of age and older group. CONCLUSIONS: In 6 years, pseudoexfoliation developed in 2.03% of the population. Rural and urban incidence was significantly different.

Six-year incidence of ocular hypertension in a South Indian population: the Chennai eye disease incidence study.

AIMS: To report the 6-year incidence and risk factors for ocular hypertension (OHT) in a population-based study in southern India. METHODS: 6 years after baseline evaluation, 56.9% subjects (participants:non-participants, 4421:3353) were re-examined at the base hospital. Incident OHT was defined as an intraocular pressure above the 97.5th centile for the population with no evidence of glaucoma in the 2852 phakic subjects, 40 years or older. Subjects with trauma, laser or incisional surgery at baseline or follow-up were excluded (total exclusions: 1569). RESULTS: Incidence of OHT at 6 years was 62/2852 subjects (2.17% (95% CI 1.64% to 2.71%, men:women, 36:26)). Incidence was higher in the rural cohort as compared with the urban cohort (80.6% vs 19.4%, p<0.001). A higher baseline intraocular pressure (with increasing OR: 16-18 mm Hg (OR 4.0, 95% CI 2.1 to 7.9), 19-21 mm Hg (OR 11.4, 95% CI 5.7 to 22.9), 22-24 mm Hg (OR 42.6, 95% CI 11.0 to 164.8, in the urban cohort)) and increasing age (50-59 years (OR 1.9, 95% CI 1.1 to 3.3), 70 years and above (OR 3.6, 95% CI 1.2 to 10.6)) were significantly associated risk factors for incident OHT. CONCLUSIONS: A significant proportion of this normal population converted to OHT. A higher incidence of conversion was seen in the rural population.

Baseline risk factors for incidence of blindness in a South Indian population: the chennai eye disease incidence study.

PURPOSE: To report the baseline risk factors and causes for incident blindness. METHODS: Six years after the baseline study, 4419 subjects from the cohort underwent a detailed examination at the base hospital. Incident blindness was defined by World Health Organization criteria as visual acuity of less than 6/120 (3/60) and/or a visual field of less than 10° in the better-seeing eye at the 6-year follow-up, provided that the eye had a visual acuity of better than or equal to 6/120 (3/60) and visual field greater than 10° at baseline. For incident monocular blindness, both eyes should have visual acuity of more than 6/120 (3/60) at baseline and developed visual acuity of less than 6/120 (3/60) in one eye at 6-year follow-up. RESULTS: For incident blindness, 21 participants (0.48%, 95% confidence interval [CI], 0.3-0.7) became blind; significant baseline risk factors were increasing age (P = 0.001), smokeless tobacco use (P < 0.001), and no history of cataract surgery (P = 0.02). Incident monocular blindness was found in 132 participants (3.8%, 95% CI, 3.7-3.8); it was significantly more (P < 0.001) in the rural population (5.4%, 95% CI, 5.4-5.5) than in the urban population (1.9%, 95% CI, 1.8-1.9). Baseline risk factors (P < 0.001) were increasing age and rural residence, and no history of cataract surgery was a protective factor (P = 0.03). CONCLUSIONS: Increasing age was a significant risk factor for blindness and monocular blindness. No history of cataract surgery was a risk factor for blindness and a protective factor for monocular blindness.

Predictors for incidence of primary open-angle glaucoma in a South Indian population: the Chennai eye disease incidence study.

OBJECTIVE: To determine the 6-year incidence of primary open-angle glaucoma (POAG) and its associated predictors. DESIGN: Population-based cohort study. PARTICIPANTS: A total of 4316 subjects without POAG at baseline who were 40 years of age and older from a south Indian population. METHODS: Participants were examined at baseline and after a 6-year interval. Detailed ophthalmic examination included applanation tonometry, gonioscopy, pachymetry, optic disc evaluation, and automated perimetry. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification. Multivariable logistic regression was performed to identify the baseline risk factors that could predict the incident POAG. MAIN OUTCOME MEASURES: Six-year incidence of POAG and its associated risk factors. RESULTS: In 6 years, incident POAG developed in 129 subjects (2.9%; 95% confidence interval [CI], 2.4-3.4; male-to-female ratio, 65:64). Baseline age was a risk factor. In reference to the group 40 to 49 years of age, the incidence increased from 2.3 (95% CI, 1.4-3.7) for the group 50 to 59 years of age to 3.5 (95% CI, 2.2-5.7) for the group 60 to 69 years of age (P<0.001). Other baseline risk predictors were urban residence (odds ratio [OR], 1.6; 95% CI, 1.1-2.2; P = 0.01), higher intraocular pressure (IOP; OR, 2.0; 95% CI, 1.5-2.6 per 10 mmHg; P<0.001), myopia (OR, 1.7; 95%, CI, 1.1-2.5; P<0.001), and axial length (OR, 1.5; 95% CI, 1.0-2.2 per millimeter; P = 0.03). Thinner corneas with higher IOP at baseline had the highest incidence of POAG. In 80% of the urban population and 100% of the rural population, incident glaucoma was previously undetected. CONCLUSIONS: A significant proportion of this population demonstrated incident POAG. The baseline risk factors could help in identifying those at highest risk of disease.

Prospective evaluation of early visual loss following glaucoma-filtering surgery in eyes with split fixation.

PURPOSE: The aim of this study was to evaluate the incidence and etiology of loss of vision in the early postoperative period after glaucoma-filtration surgery in eyes with split fixation. METHODS: This was a prospective, interventional cohort study. Sixty-five eyes of 65 patients with advanced glaucomatous optic nerve damage with split fixation were included. Thirty-four eyes underwent trabeculectomy (group A) and 31 eyes underwent combined cataract and glaucoma surgery (group B). Main outcome measures included the incidence and etiology of visual loss and changes in intraocular pressure, visual acuity, and visual field indices during the first 2 months after surgery. RESULTS: No significant changes were seen in the mean deviation in group A [mean difference, -0.53±2.23; 95% confidence interval (CI): -1.32, 0.25; P=0.59] and in group B (mean difference, -0.75±2.9; 95% CI: -1.81, 0.31; P=0.16). There was a significant drop in the intraocular pressure from a baseline of 36.87±2.86 to 10.2±3.47 mm Hg (P<0.001) in group A, and from a baseline of 27.74±15.5 to 13.41±5.5 mm Hg in group B (P<0.001). At the end of 2 months, visual loss of 2 lines or more occurred in 2 eyes (3%; 95% CI: 0%, 7%) because of choroidal detachment with increase in lens changes in one eye (group A) and no apparent cause in the other (group B). None of the eyes developed a loss of central vision ("0" dB sensitivity in 4 test points abutting fixation). CONCLUSIONS: Visual loss after surgery in advanced glaucoma is rare and most often because of reversible causes.

Comparison of saccadic reaction time between normal and glaucoma using an eye movement perimeter.

AIM: To compare the saccadic reaction time (SRT) in both the central and peripheral visual field in normal and glaucomatous eyes using eye movement perimetery (EMP). MATERIALS AND METHODS: Fifty-four normal and 25 glaucoma subjects underwent EMP and visual field testing on the Humphrey Field Analyser (HFA) 24-2 program. The EMP is based on infrared tracking of the corneal reflex. Fifty-four test locations corresponding to the locations on the 24-2 HFA program were tested. SRTs at different eccentricities and for different severities of glaucoma were compared between normal and glaucoma subjects. RESULTS: Mean SRT was calculated for both normal and glaucoma subjects. Mann-Whitney U test showed statistically significant (P < 0.001) differences in SRT's between normal and glaucoma subjects in all zones. CONCLUSION: SRT was prolonged in eyes with glaucoma across different eccentricities.

Six-year incidence of angle-closure disease in a South Indian population: the Chennai Eye Disease Incidence Study.

PURPOSE: To estimate the 6-year incidence of primary angle-closure (PAC) disease among adult population aged 40 years and older from rural and urban south India. DESIGN: Population-based longitudinal study. METHODS: A complete ophthalmologic examination, including applanation tonometry, gonioscopy, biometry, stereoscopic fundus examination, and automated perimetry was performed at both baseline and at the 6-year follow up at base hospital. Incident PAC disease was defined as the development of PAC disease during the 6-year follow-up in phakic subjects without PAC disease at baseline. Diagnosis was made using the International Society Geographical and Epidemiological Ophthalmology classification. RESULTS: The data were analyzed for 3350 subjects (mean age, 56.4 ± 8.9 years; 1547 males, 1803 females) for a diagnosis of PAC disease at baseline and at follow-up examinations. The incidence of PAC disease was identified in 134 subjects (6-year incidence rate, 4.0%; 95% confidence interval (CI), 3.3-4.7). Among the 134 subjects, 88 subjects (2.6%, 95% CI, 2.1-3.2) were primary angle-closure suspects; 37 subjects (1.1%, 95% CI, 0.7-1.5) had primary angle closure, and 9 subjects (0.3%, 95% CI, 0.1-0.4) had primary angle-closure glaucoma. There was an inverse relationship between the incidence of PAC disease and the cataract surgery rates. Significant risk factors for PAC disease on logistic regressions were higher intraocular pressure, increased lens thickness, shorter axial length, shallow anterior chamber depth, anteriorly positioned lens, and hyperopia. CONCLUSIONS: The average incidence of PAC disease per year was 0.7%. All biometric parameters were found to be strong predictors for the incidence of PAC disease.

Outcomes of bleb excision with free autologous conjunctival patch grafting for bleb leak and hypotony after glaucoma filtering surgery.

PURPOSE: To determine the outcomes of bleb excision with free autologous conjunctival patch grafting for bleb leak and hypotony after glaucoma filtering surgery. PATIENTS AND METHODS: Retrospective, consecutive, noncomparative case series. Outcome measures were closure of bleb leak, intraocular pressure (IOP), and best corrected visual acuity after patch grafting and complications from intervention. Complete success was defined as resolution of the bleb leak or hypotony, with IOP between 6 and 18 mm Hg. RESULTS: Fifty-eight eyes (57 patients) were included: 51 with bleb leaks and 7 with hypotonous maculopathy without a bleb leak. Eight eyes required scleral flap resuturing and 2 required scleral patch grafts in addition to free conjunctival patch grafting. The mean postoperative follow-up period was 112.65 ± 128.74 weeks (median 80.0 wk). At 6 weeks and final follow-up, the IOP increased from baseline of 4.41 ± 4.61 mm Hg (median 4.00 mm Hg) to 11.98 ± 6.25 mm Hg (median 11.50 mm Hg) (P<0.001) and 12.67 ± 4.83 mm Hg (median 12.00) (P<0.001), respectively. Visual acuity increased from baseline of 0.87 ± 0.95 logMAR (median 0.60) to 0.65 ± 0.80 logMAR (median 0.48) (P=0.001) and 0.76 ± 0.93 logMAR (median 0.48) (P=0.35) at 6 weeks and last follow-up, respectively. The complete and qualified success rates at the final follow-up were 75.8% and 79.3%, respectively. Failure events occurred in 12 (20.6%) eyes, including 2 eyes with hypotony, 5 with raised IOP, and 3 with postoperative bleb leaks. CONCLUSIONS: Free conjunctival patch grafting is a successful procedure for bleb repair and hypotony providing moderate IOP control with minimal postoperative complications in majority of patients.