Primary Transscleral Diode Laser Cyclophotocoagulation for Management of Glaucoma in Nanophthalmic Eyes.

PURPOSE: The aim of this study was to assess the efficacy and safety of double-row transscleral cyclophotocoagulation in controlling intraocular pressure in patients with secondary angle closure glaucoma due to nanophthalmos, not being controlled by medical therapy. PATIENTS AND METHODS: A prospective case series study that included 13 eyes of 8 patients diagnosed with secondary angle closure glaucoma due to nanophthalmos at the Giza Eye Subspeciality Center, treated by 24 cyclodiode applications in a double-row technique. Success was defined as complete success by control of intraocular pressure <21 mm Hg without medication and qualified success in which control of pressure <21 mm Hg achieved with 1 or 2 medications. RESULTS: The average reduction in intraocular pressure at 3 months was 57.3±20.14% and at 6 months 44.5±32%, with an average eye drop intake of 1.3±0.8 drops. There was a significant reduction of intraocular pressure at 6 months compared with the preprocedure pressure ( P =0.01). Complete success achieved in 3 eyes, pressure controlled without any medication, and qualified success in 9 eyes. CONCLUSION: Transscleral cyclophotocoagulation is a safe and effective primary therapy for managing glaucoma in nanophthalmic eyes.

Enhanced Visibility of the Retinal Nerve Fiber Layer Defects by the Underlying Diffuse Choroidal Angioma in Sturge Weber Syndrome with Glaucoma.

Aim: To describe a unique finding in a patient with Sturge-Weber syndrome (SWS) accompanied by glaucoma. Background: Cases with SWS may have an associated choroidal angioma and glaucoma. The localized retinal nerve fiber layer (RNFL) defects induced by the associated glaucoma are better detected against the red background of the associated choroidal angioma. Case description: A 15-year-old boy was presented with left-side SWS. The case was subjected to full clinical examination, intraocular pressure (IOP) measurements, color fundus photography, ultrasonography, visual field assessment, and optical coherence tomography (OCT) of the peripapillary RNFL and ganglion cell layer (GCC) analysis. The main clinical finding was the enhanced detection of defects of the RNFL against the red color of associated choroidal angioma in this glaucomatous eye. Conclusion: There is enhanced clinical visibility of RNFL defects in presence of associated diffuse choroidal angioma in Sturge-Weber glaucoma. Clinical significance: Easier clinical detection of RNFL defects in SWS glaucoma associated with diffuse choroidal angioma. How to cite this article: Abdelrahman AM. Enhanced Visibility of the Retinal Nerve Fiber Layer Defects by the underlying Diffuse Choroidal Angioma in Sturge Weber Syndrome with Glaucoma. J Curr Glaucoma Pract 2023;17(1):52-54.

Don't overlook flank pain in apparently asymptomatic COVID-19 cases: A case report and literature review.

An outbreak of novel coronavirus disease-2019 (COVID-19) was reported in Wuhan, China, in December 2019, which was later declared a global pandemic by the World Health Organization (WHO) in March 2020. It is a life-threatening contagious infection with infected patients usually presenting with respiratory tract symptoms, although the disease can affect other multiple organs. Coronavirus disease-2019 infection is a hypercoagulable state associated with serious thrombotic complications, particularly in critically ill patients. However, these thrombotic complications are also being reported as a presenting symptom in asymptomatic and mildly symptomatic cases of COVID-19 infection in the absence of any other predisposing risk factors. Renal infarction is one of these thrombotic complications and can present with ambiguous abdominal symptoms leading to irreversible organ damage and other thromboembolic complications, if not diagnosed in time. Physicians must be aware of such uncommon presenting complaints of COVID-19 infection and include it in the differential diagnosis of patients presenting with abdominal symptoms.

Juvenile Open-angle Glaucoma With Waardenburg Syndrome: A Case Report.

Waardenburg syndrome (WS) is a genetic disorder resulting in anomalies of derivatives of neural crest cells during development. Patients tend to have variable degrees of pigmentary defects affecting skin, hair, and irides in addition to hearing loss and possible systemic neurological associations. Elevation of the intraocular pressure has been reported in several adult patients with WS. We report the first case of WS to be associated with juvenile open-angle glaucoma in a 20-year-old Egyptian man thus expanding the spectrum of the types of glaucoma that can coexist with the syndrome.

Optical coherence tomography angiography in juvenile open angle glaucoma: correlation between structure and perfusion.

PURPOSE: Juvenile open angle glaucoma (JOAG) is a type of glaucoma that occurs in patients younger than 40 years. Only a few studies have assessed vascular perfusion in JOAG and correlated it with structural damage. The aim of this study is to investigate vascular perfusion in JOAG by optical coherence tomography angiography (OCTA) and correlate it with structural damage, represented by retinal nerve fiber layer (RNFL) thinning. METHODS: This is a cross-sectional observational study of 25 eyes of patients with JOAG. All patients underwent full ocular examination and scanning by OCTA to measure parameters such as RNFL thickness, peripapillary and disk vascular density. RESULTS: Average superior and inferior RNFL thicknesses were 69.4 (± 22.1) and 70.4 (± 25.6) µm, whereas peripapillary and disk vascular densities were 38.2(± 10), and 39.1(± 12) % and superior and inferior vascular densities were 38.1(± 10.5) and 38.2(± 9.7) %. A strong positive correlation was found between the superior and inferior RNFL thickness and the vascular density of the peripapillary region, the disk and the superior and inferior vascular densities (p < 0.001 for all). CONCLUSION: OCTA parameters are strongly correlated with structural damage in JOAG patients. OCTA can serve as a helpful tool in the diagnosis and assessment of progression in JOAG and be utilized as a prognostic indicator, thus filling the defects and gaps present in other methods of assessment.

Sub-flap Mattress Suture With Deep Sclerectomy: A Novel Step.

The study was a prospective interventional clinical trial enrolling 29 eyes from 20 patients with uncontrolled open-angle glaucoma to evaluate the effect of adding a novel simple economical step to nonpenetrating deep sclerectomy. We obtained an additional 12.5% reduction in the intraocular pressure compared with the standard surgery.

Safety and Efficacy of Oral Melatonin When Combined with Thoracic Epidural Analgesia in Patients with Bilateral Multiple Fracture Ribs.

BACKGROUND: The purpose of this study is to evaluate the safety and efficacy of oral melatonin administered with thoracic epidural analgesia in patients with multiple bilateral fractured ribs. PATIENTS AND METHODS: A prospective, double-blind randomized control study was carried out on 80 patients of either sex, American Society of Anesthesiologists (ASA) Grade I and II, aged above 18 years, presenting with multiple bilateral fractured ribs. They were randomly divided into two groups, 40 patients each. Placebo group patients received oral placebo tablets and melatonin group (TEA and melatonin) patients received oral melatonin tablets (5 mg), about 1 hour before epidural infusion of local anesthetics and then every 12 hours till the cessation of bupivacaine infusion. RESULTS: Melatonin administration was associated with a significant decrease in total morphine analgesia consumption, from 31.8 ± 1.41 mg in the TE group to 13.03 ± 0.85 mg in the melatonin group (P < 0.001), with a significant decrease (P < 0.001) in the mean infusion rate of bupivacaine required for controlling the pain, from 0.17 ± 0.014 mL/kg/hour in the TE group to 0.12 ± 0.001 mL/kg/hour in the melatonin group. The duration of bupivacaine infusion in the melatonin group was also significantly shorter than in the TE group (96.48 ± 1.87 and 100.05 ± 3.39 hours, resp., P < 0.001). CONCLUSION: We conclude that premedication of patients with 5 mg melatonin is associated with significant prolongation of thoracic epidural analgesic effects compared to placebo. REGISTRATION: This clinical study was registered at Pan African Clinical Trial Registry with no. "PACTR 201711002741378" on 02-11-2017.

Efficacy and safety of using topical cyclosporine A for treatment of moderate to severe dry eye disease.

OBJECTIVE: To investigate and evaluate the efficacy and safety of topical cyclosporine A for treatment of moderate to severe dry eye disease. MATERIALS AND METHODS: This is a prospective study of patients with moderate to severe dry eye syndrome were recruited. All cases were selected from patients attending the ophthalmic outpatient clinic of Research institute of ophthalmology. Eligible patients were at least 21 years of age with a confirmed diagnosis of keratoconjunctivitis sicca with or without Sjogren's syndrome refractory to conventional management.The medication used in this study were unit dose vials of unpreserved cyclosporine A 0.05% used twice daily.The protocol was composed of a 2-week washout phase, a 12-week treatment phase, and a 4-week post treatment phase. Patients were evaluated at weeks 4, 8, 12 during the treatment phase. During these visits patients were evaluated for changes from base line in Schirmer test, rose Bengal staining, superficial punctuate erosions, BUT, impression cytology, symptoms of ocular discomfort and visual acuity. After completion of the treatment phase, patients were also evaluated at post treatment week 4, during this visit patients were assessed for Schirmer test, rose Bengal staining, superficial punctuate erosion, BUT, impression cytology, symptoms of ocular discomfort and visual acuity. RESULTS: Thirty two cases in the mean age of 47 (12.9), range [20-67] years; four (13%) male and 28 (87%) female were recruited in the current study. Out of them, 12 (38%) cases had Sjogren syndrome. Visual acuity improved significantly (p = 0.012), BUT (p < 0.0001) for both eyes, Schirmer measurements (p < 0.0001 and p = 0.029 for OD and OS, respectively). CONCLUSIONS: Cyclosporine A ophthalmic emulsion 0.05% has been demonstrated to be effective and safe in human clinical trials. It reduces signs and symptoms of dry eye disease, with the fact that its effect continued to occur significantly within the treatment periods as well as improvement of ocular condition kept on, actually more slowly towards stability, despite the drug has already stopped.

Micropulse Versus Continuous Wave Transscleral Cyclophotocoagulation in Refractory Pediatric Glaucoma.

PURPOSE: The aim of this study was to compare the safety and efficacy of micropulse cyclophotocoagulation (MP-CPC) and transscleral continuous wave cyclophotocoagulation (CW-CPC) for the treatment of refractory glaucoma in the pediatric age group. METHODS: This prospective study included 45 eyes of 36 children requiring transscleral cyclophotocoagulation, in the period spanning from September 2016 to August 2017, using micropulse (MP-CPC) or continuous wave (CW-CPC) modes. The intraocular pressure (IOP) reduction, success rates, and complications were compared for both groups. Success was defined as an IOP of 5 to 21 mm Hg, in the absence of vision-threatening complications at 6 months. RESULTS: The MP-CPC group included 17 eyes, in patients aged 67.8±48 months, and the CW-CPC group included 28 eyes, in patients aged 61.3±38.3 months. There was a tendency toward lower IOP in the MP-CPC group at all follow-ups, almost reaching statistical significance at 2 weeks and 3 months (P=0.05). IOP reduction was 63% in the MP-CPC group and 67% in the CW-CPC group (P=0.6). The success rate was higher in the MP-CPC group (71% vs. 46% in the CW-CPC group), but the difference was not significant (P=0.1). No significant complications were noted in the MP-CPC group whereas, in the CW-CPC group, 1 eye developed phthisis bulbi, and 2 eyes had severe pain and uveitis (P=0.3). CONCLUSIONS: Both the MP-CPC and CW-CPC are effective in lowering the IOP in children with refractory glaucoma. However, the rate of complications, pain, and inflammation seem to be lower with the micropulse mode, making it a safer alternative for cyclophotocoagulation, especially since retreatments are often needed.

Sutureless Deep Sclerectomy: A Preliminary Report.

This study describes a modification of deep sclerectomy, making it completely sutureless, with a 6-month follow-up period. This was a prospective pilot phase that included 24 eyes of 16 patients, 13 male individuals and 3 female individuals, with medically uncontrolled open-angle glaucomas despite maximally tolerated medical therapy. After excising the deep flap, no sutures are added to the superficial scleral flap or to the conjunctiva. A statistically significant reduction of the intraocular pressure was reported during all the follow-up visits without serious complications.

A New Ultrasound Biomicroscopic Sign seen after Deep Sclerectomy (Dolphin Head Sign).

PURPOSE: To describe a new ultrasound biomicroscopic (UBM) sign seen in patients who underwent deep sclerectomy (DS) as a surgical procedure for the management of uncontrolled primary open-angle glaucoma (POAG). The presence of this sign in ultrasound biomicroscopy is suggested to be an indicator of successful surgery. We would like to name this sign as the "dolphin head sign." DESIGN: Prospective interventional study. MATERIALS AND METHODS: Twenty-eight eyes of 17 patients with POAG underwent DS with intraoperative mitomycin C (MMC) 0.3% applied for 2 minutes under the superficial scleral flap. Patients were followed up for a minimum of 6 months. Ultrasound biomicroscopy was done at the third postoperative month to evaluate the surgical area in both successful and failed cases. RESULTS: The study included 28 eyes of 17 patients. The mean age of the study group was 42.90 ± 14.37 years (20-64 years). The study included 10 females and 7 males. The mean preoperative intraocular pressure (IOP) was 24.57 ± 6.37 mm Hg (20-38 mm Hg). The mean best corrected visual acuity (BCVA) was 0.57 ± 0.3 (0.05-1.00). Complete success has been achieved in 21 eyes (75%) during the follow-up period, with a mean IOP of 12.00 ± 3.86 mm Hg (6-20 mm Hg). The dolphin head sign was demonstrated only in successful cases, whereas the unsuccessful cases failed to show the typical sign. CONCLUSION: The presence of a "dolphin head" configuration in UBM images could be taken as an indicator of successful DS. How to cite this article: Abdelrahman AM, El Cheweikh HM, El-Fayoumi DMS, Allam RSHM. A New Ultrasound Biomicroscopic Sign seen after Deep Sclerectomy (Dolphin Head Sign). J Curr Glaucoma Pract 2016;10(2):56-59.

Noninvasive glaucoma procedures: current options and future innovations.

Noninvasive glaucoma procedures (NIGPs) represent a new dawn in the management of glaucoma. They try to fill the gap between the shortcoming of invasive glaucoma surgeries and antiglaucoma medications. NIGPs were introduced as an adjunct or alternative treatments for glaucoma. Some of these procedures have shown good efficacy with few serious complications. Hence, they are now used as both primary and adjunctive therapy for glaucoma. The most common NIGPS involve laser and ultrasound technologies. Currently, the portfolio of NIGPs includes argon laser trabeculoplasty, selective laser trabeculoplasty, and micropulse diode laser trabeculoplasty. More recent innovations include therapeutic ultrasound for glaucoma, ultrasonic circular cyclocoagulation, and deep wave trabeculoplasty.

Selective laser trabeculoplasty in Egyptian patients with primary open-angle glaucoma.

PURPOSE: To assess the change in intraocular pressure (IOP) in Egyptian patients after selective laser trabeculoplasty (SLT) as a primary or adjunctive treatment for primary open-angle glaucoma (POAG). MATERIALS AND METHODS: One hundred and six eyes with POAG were enrolled in this prospective study. Patients were divided into two groups: recently diagnosed cases with no preoperative medications (group 1) and; patients with confirmed glaucoma on medical therapy (group 2). All patients underwent 360° SLT. Patients were evaluated to 18 months postoperatively. Data were analyzed on postoperative changes in IOP, number of medications and complications. A P-value less than 0.05 was statistically significant. RESULTS: A statistically significant drop in IOP occurred, from 19.55 ± 4.8 mmHg preoperatively, to 16.03 ± 2.8 mmHg postoperatively (P < 0.001). Each group had a statistically significant drop in IOP (P < 0.001). There was a statistically significant decrease in the number of medications in group 2 from 2.25 ± 0.97 medications preoperatively to 1.0 ± 1.3 medications postoperatively (P = 0.004). No serious complications occurred for the duration of the study. CONCLUSION: SLT can be safely and effectively used as primary or adjunctive therapy for the treatment of POAG.

Phaco Prechop versus Divide and Conquer Phacoemulsification: A Prospective Comparative Interventional Study.

PURPOSE: To compare two phaco techniques, namely Phaco Prechop and Divide and conquer, basically during their early learning curves. PATIENTS AND METHODS: The study included 50 patients divided into 2 groups, each including 25 patients; group (A) where phaco Prechop was performed, and group (B) in which divide and conquer was performed. The mean effective ultrasound time, mean endothelial cell count, mean endothelial cell loss, corneal thickness, intraoperative complications, and the best corrected visual acuity were reported in the two groups both preoperative and postoperative. RESULTS: The mean effective ultrasound time in group A was 19.36 ± 8.51 seconds, and in group B, it was 24.44 ± 7.86 seconds with a statistically significant difference between the two groups (P = 0.033). The mean endothelial cell count 3 months postoperative in group A was 2139.88 cells/mm(2). In group B, the mean endothelial cell count 3 months postoperative was 2087.08 cells/mm(2). The difference between the two groups was statistically insignificant (P = 0.558), however The difference in endothelial cell loss 3 months postoperatively between the two groups was statistically significant. (P = 0.001). Four cases in groups A (16%) had posterior capsular rents compared to three cases (12 %) in group B. Postoperative best corrected visual acuity in group B was 6/12 or better in 88% of cases as compared to 92% in group A with no statistical difference. CONCLUSION: Early cataract surgical cases performed with the Phaco Prechop and divide and conquer techniques showed comparable results and complications. However the former technique utilized less phaco time and energy without significant effect on the final surgical outcome.

Trabeculotome-guided deep sclerectomy. A pilot Study.

PURPOSE: To describe and evaluate a new technique that helps identification and unroofing of Schlemm's canal during deep sclerectomy. DESIGN: A prospective, interventional case series. METHODS: This pilot study was conducted on 15 eyes with various types of glaucoma. After dissecting the superficial scleral flap, the trabeculotome was inserted inside the Schlemm's canal. During deep flap dissection, a direct incision was made over the trabeculotomy to open and unroof Schlemm's canal. Five of the excised deep flaps were submitted for histologic examination. RESULTS: In 13 of the 15 eyes, the Schlemm's canal was properly identified and unroofed. Schlemm's canal endothelium was identified in all the examined specimens. The mean intraocular pressure was reduced from 26.66 +/- 4.54 mm Hg to 12.2 +/- 3.5 mm Hg at the end of a mean follow-up of 9.4 +/- 2.9 months. CONCLUSION: The insertion of the trabeculotome inside Schlemm's canal before dissection of the deep flap helped Schlemm's canal unroofing.