Effect of beta blockers on optical coherence tomography angiography in normal, suspect, and glaucomatous eyes: A prospective study.

PURPOSE: The study aimed to assess the effect of hypertension, and use of systemic beta blockers (BB) and other antihypertensives on ocular perfusion by optical coherence tomography angiography (OCTA) in normal, suspect, and glaucomatous eyes. METHODS: Cross-sectional study in tertiary eye care center. Prospectively recruited consenting subjects between 18 and 90 years with or without glaucoma. Measured the optic nerve peripapillary perfusion and flux and macular vessel density (MVD: 6 × 6 and 3 × 3 mm) in the superficial retinal layer using OCTA. RESULTS: Included 200 eyes (112 patients). Compared to nonhypertensives or those on non-BB antihypertensives (NBB), hypertensives on BB had lower peripapillary perfusion (43.45,43.40, 42.05%, P = 0.003), and MVD (6 × 6 mm: 16.65, 16.70,15.75 mm/mm 2 , P = 0.002; 3 × 3 mm: 18.70, 18.50, 18.00 mm/mm 2 , P = 0.025). Those on systemic BB with vasodilatory properties had similar perfusion parameters as nonhypertensives and NBB. Those on systemic BB without vasodilating properties had significantly lower peripapillary perfusion (42.05 vs 43.30%, P = 0.011) and MVD (6 × 6 mm: 15.15 vs 16.60 mm/mm 2 , P < 0.001; 3 × 3 mm: 17.40 vs 18.70 mm/mm 2 , P = 0.005) compared to nonhypertensives. On multivariate analysis, peripapillary perfusion increased with increase in diastolic blood pressure (ß:0.051, p: 0.04) and increasing age was the only factor found to be significantly associated with decreased peripapillary and macular perfusion parameters. CONCLUSION: Systemic BB users have worse ocular perfusion parameters compared to those on other medications or nonhypertensives on univariate analysis but similar perfusion on multivariate analysis. Those on BB with vasodilation have better ocular perfusion parameters. All BB cannot be considered equally detrimental to ocular perfusion. Further well-controlled prospective studies are needed to reassess the effects of BB with or without vasodilation on ocular perfusion.

Neovascular glaucoma - A review.

Neovascular glaucoma (NVG) is a sight-threatening secondary glaucoma characterized by appearance of new vessels over the iris and proliferation of fibrovascular tissue in the anterior chamber angle. Retinal ischemia is the common driving factor and common causes are central retinal vein occlusion, proliferative diabetic retinopathy, and ocular ischemic syndrome. The current rise in the prevalence of NVG is partly related to increase in people with diabetes. A high index of suspicion and a thorough anterior segment evaluation to identify the early new vessels on the iris surface or angle are essential for early diagnosis of NVG. With newer imaging modalities such as the optical coherence tomography angiography and newer treatment options such as the anti-vascular endothelial growth factor, it is possible to detect retinal ischemia early, tailor appropriate treatment, monitor disease progression, and treatment response. The management strategies are aimed at reducing the posterior segment ischemia, reduce the neovascular drive, and control the elevated intraocular pressure. This review summarizes the causes, pathogenesis, and differential diagnoses of NVG, and the management guidelines. We also propose a treatment algorithm of neovascular glaucoma.

INTRAOCULAR PRESSURE OUTCOMES AFTER SURGERY FOR RHEGMATOGENOUS RETINAL DETACHMENT IN SCHWARTZ SYNDROME.

PURPOSE: To study intraocular pressure (IOP) outcomes after surgery for rhegmatogenous retinal detachment in Schwartz syndrome. METHODS: We reviewed records of 32 eyes of 32 patients with Schwartz syndrome (patients with rhegmatogenous retinal detachment, IOP above 21 mmHg, and open angles without angle recession, chronic steroid use or other secondary causes of increased IOP) who had undergone surgical treatment consisting of scleral buckling or vitrectomy. Intraocular pressure, number of medication, best-corrected visual acuity were compared at baseline and postsurgery visits and also studied association of various factors on long-term IOP. RESULTS: The median duration of rhegmatogenous retinal detachment was 2 months, and the inter quartile range was 1 to 12 months. Follow-up was 15 months (inter quartile range: 7-33 months). Sixteen (50%) had prior ocular trauma. Baseline IOP was 35 ± 8 mmHg, and 12% (4/32) of patients were on IOP-lowering medication at presentation. At the final visit, mean IOP was 17 ± 6 mmHg and 59% patients (19/32) required additional IOP-lowering medication or surgery for IOP control. CONCLUSION: Surgical management of rhegmatogenous retinal detachment resulted in significant reduction in IOP. At the final visit, 41% did not require any IOP-lowering medication or surgical intervention for IOP control.