Short term outcome of Ahmed glaucoma valve implantation in management of refractory glaucoma in a tertiary hospital in Oman.

BACKGROUND: We present outcomes of Ahmed Glaucoma Valve (AGV) implantation in treating refractory glaucoma in a tertiary hospital in Oman. Refractory glaucoma was defined as previously failed conventional glaucoma surgery and an uncontrolled intraocular pressure (IOP) of more than 21 mm Hg despite treatment with three topical and/or oral therapy. MATERIALS AND METHODS: This historical cohort study was conducted in 2010. Details of medical and surgical treatment were recorded. Ophthalmologists examined eyes and performed glaucoma surgeries using AGV. The best corrected distant vision, IOP, and glaucoma medications were prospectively reviewed on 1(st) day, 1(st), 6(th), 12(th) week postoperatively, and at the last follow up. RESULT: Glaucoma specialists examined and treated 40 eyes with refractory glaucoma of 39 patients (20 males + 19 females). Neo-vascular glaucoma was present in 23 eyes. Vision before surgery was <3/60 in 21 eyes. At 12 weeks, one eye had vision better than 6/12, seven eyes had vision 6/18 to 6/60, and eight eyes had vision 6/60 to 3/60. Mean IOP was reduced from 42.9 (SD 16) to 14.2 (SD 8) and 19.1 (SD 7.8) mmHg at one and 12 weeks after surgery, respectively. At 12 weeks, five (12.5%) eyes had IOP controlled without medication. In 33 (77.5%) eyes, pressure was controlled by using one or two eye drops. The mean number of preoperative anti-glaucoma medications (2.38; SD 1.1) was reduced compared to the mean number of postoperative medications (1.92; SD 0.9) at 12 weeks. CONCLUSION: We succeeded in reducing visual disabilities and the number of anti-glaucoma medications used to treat refractory glaucoma by AGV surgery.

Influence of diabetes on the validity glaucoma screening by frequency doubling perimetry: a hospital-based study in Oman.

BACKGROUND: A hospital-based study was conducted in 2007 in Oman to determine the validity of frequency doubling perimetry (FDP). The authors have compared the ability of FDP to detect glaucoma among patients with and without diabetes. METHODS: This was a validity study of the screening procedure. An ophthalmologist and an optometrist examined Omani persons >30 years of age with and without diabetes. They determined glaucomatous field changes by using FDP. The glaucoma specialist labeled the eye and the person as suffering from glaucoma if two criteria were present: (1) optic cup disc and other retinal changes suggestive of glaucoma and (2) field changes on automated perimeter suggestive of glaucoma. Ocular pressure was measured with a Tono-Pen (Medtronic Ophthalmics, Jacksonville, FL). We calculated the validity of glaucoma screening by FDP among persons both with diabetes and without diabetes. RESULTS: We examined 111 eyes of 56 Omani patients (55 eyes of 28 patients with diabetes and 56 eyes of 28 persons without diabetes). Two persons had a history of glaucoma in both eyes. Glaucoma screening by FDP detected five eyes (two eyes of patients with diabetes and three eyes of persons without diabetes) with glaucoma. The specificity of glaucoma screening among those with and without diabetes was 97.4% and 97.3%, respectively. The sensitivity was 6% and 11%, respectively, in these two groups. CONCLUSIONS: Validity of glaucoma screening by FDP is not different among those with and without diabetes. In countries with high rates of diabetes, FDP could be used as a first-level screening tool for glaucoma.

Glaucoma in oman: a review.

PURPOSE: Glaucoma is one of the priority eye diseases in Oman in its VISION 2020 Plan. A review of available data is presented on the basis of situation analysis carried out in 2002. METHODS: The General demography, morbidity and management of eye diseases reported by different eye institutions. Predefined parameters and definitions were used to calculate incidence and coverage of glaucoma. RESULTS: The rate of glaucoma cases reported by ophthalmologists was 1.14/1000. 11.5% of estimated blindness in Oman in 1997 was due to glaucoma. Primary Open angle glaucoma constituted 63.5% of the total glaucoma cases. In spite of free and easy access to the eye treatment, coverage of glaucoma surgery was 25% of the reported cases. Evidence based information on glaucoma in the community is needed in Oman. The health facilities for eye care of glaucoma cases are available in different health regions of Oman. CONCLUSIONS: Glaucoma should be addressed through a program approach both to reduce/delay visual disabilities and improve quality of life of glaucoma patients.

Endonasal carbon-dioxide laser assisted dacryocystorhinostomy verses external dacryocystorhinostomy.

This is a prospective, non-randomized study to evaluate and compare the results, morbidity and surgical time for endonasal carbon-dioxide laser assisted dacryocystorhinostomy and external dacryocystorhinostomy. 70 consecutive patients of chronic dacryocystitis with nasolacrimal duct obstruction were selected for the study. 36 patients under went endonasal CO2 laser assisted dacryocystorhinostomy and 34 had external dacryocystorhinostomy. Selection of the type of operation was left to the patient's choice. All the patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Patients not willing for the external incision were selected for endonasal laser assisted dacryocystorhinostomy and others were operated via external approach. Silicone tubes were put in all the patients for three months after surgery. The final follow up was 12 months after the removal of silicone tubes. The patency of the lacrimal passage was confirmed by irrigation, and patients were questioned about their symptoms.The success rates, 12 months after removal of silicone tubes were 100% in endonasal CO2 laser assisted dacryocystorhinostomy and 88.24% in external dacryocystorhinostomy. The surgical time of endonasal laser assisted dacryocystorhinostomy was 38 minutes as compared to 62 in external dacryocystorhinostomy. Complication rate in both groups was almost equal.Thus, we came to the conclusion that Endonasal CO2 laser assisted dacryocystorhinostomy is a better surgical option to external dacryocystorhinostomy in cases of chronic dacryocystitis with nasolacrimal duct obstruction, with shorter surgical time.