Clinical profile and long term outcomes of eyes with choroidal detachment following trabeculectomy.

Purpose: To assess the long-term outcomes of choroidal detachments (CDs) in eyes following trabeculectomy. Methods: Retrospective comparative case series. Data of patients with CDs following trabeculectomy (5-year period) with or without cataract surgery with a minimum of 3 months of follow-up were included. Results: In total, 45 patients with CDs following trabeculectomy were included. The mean age was 63.27 ± 8.68 years, (M:F = 2:1); 29 of 45 eyes (64.4%) had a baseline IOP of >24 mm Hg. Patients had a median follow-up of 22.2 (IQR: 16.2-30.5) months. Further, 10 of 45 eyes (22.2%) had CDs following suture lysis. The median onset of choroidal detachment from the time of surgery was 16.0 (IQR: 11-36) days. The mean BCVA improved from 0.62 ± 0.28 to 0.24 ± 0.27 (P < 0.001) and mean IOP increased from 4.07 ± 2.66 to 11.20 ± 5.31 (P < 0.001) at last visit. The cumulative success rates were 76.4% (95% CI: 48.4-90.5) in POAG eyes and 79.3% (95% CI: 62.8-89.1) in PACG eyes (P = 0.547). Medical management was the mainstay in all patients. Four of 45 (8.88%) patients underwent subsequent choroidal drainage. Conclusion: Choroidal detachment following modern-day trabeculectomy has favorable long-term visual acuity and IOP outcomes. There was no difference in the long-term surgical success of trabeculectomy with choroidal detachments in primary angle-closure and open-angle glaucoma eyes. Long-term follow-up is essential to prevent chronic hypotony and trabeculectomy failure.

Early outcomes of 21-gauge needle-guided ab interno tube sulcus placement of a non-valved implant in pseudophakic eyes.

We report the early outcomes and describe an ab interno 21-G needle technique of sulcus placement of the Aurolab aqueous drainage implant (AADI) tube in nine pseudophakic eyes. IOP reduced from a preoperative mean (SD) of 28.33 (9.80) to 11.56 (2.65) mm Hg and the mean (SD) number of preoperative medications reduced from 3.0 (0.7) to 0.4 (0.9) at 3 months. There were no intraoperative complications noted. This technique of sulcus placement of the AADI tube is a precise technique of tube insertion. It may be an alternative to existing ab externo procedures of tube sulcus placement, limiting multiple blind entries.

An Infectious Cause of Congenital Pupillary-Iris-Lens Membrane With Secondary Angle Closure Glaucoma in an Infant.

PURPOSE: The aim of the study was to report an infectious cause of congenital pupillary-iris-lens membrane with secondary angle closure glaucoma in an infant. DESIGN: This was a case report. METHODS: Institutional review board exemption for this report was obtained from the Institutional Ethics Committee, Aravind Eye Hospital, Tirunelveli. Informed consent was obtained.A 3-month-old female infant presented to us with congenital pupillary-iris-lens membrane, iris bombe and raised intraocular pressure in the left eye. She underwent trabeculotomy and trabeculectomy along with membranectomy for the same. An aqueous tap performed a month later was suggestive of coexisting Toxoplasma gondii infection detected by polymerase chain reaction. RESULT: The study provides a description of the course of management of angle closure glaucoma secondary to congenital pupillary-iris-lens membrane with an associated infection. Intraocular pressure reduced from 40 to 20 mm Hg in the left eye. CONCLUSION: This condition is a rare entity of unknown etiology with an increased risk of glaucoma and visual loss. A multidisciplinary approach is needed for the management of these eyes. Infectious associations with these membranes should be ruled out by an aqueous tap with polymerase chain reaction and a close postoperative follow-up is mandatory.

A Case of Annular Iris Cyst Diagnosed With the Help of Ultrasound Biomicroscopy.

PURPOSE: To report a case of annular iris cyst presenting as a secondary angle closure managed with Nd:YAG laser iridotomy. DESIGN: Case report. METHODS: Institutional review board exemption for this case report was obtained from the institutional ethics committee, Aravind eye hospital, Tirunelveli. All research adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained.A 45-year-old woman presented with a 2-week history of sudden onset of pain and redness in the right eye. Slit-lamp biomicroscopy showed corneal edema, with the shallow anterior chamber, convex bowing of iris, irregular shape of the pupil, and glaucomflecken on the clear lens. Ultrasound biomicroscopy revealed an annular iris cyst of the iris pigment epithelium. Nd:YAG laser iridotomy was done to drain the cyst and relieve the angle closure. RESULTS: Laser treatment resulted in the collapse of the cyst, confirmed by ultrasound biomicroscopy and disappearance of the subject symptoms. CONCLUSION: Iris cysts are usually benign in nature. An annular iris cyst is a rare presentation. They can present with a secondary angle closure as in our report. Correct diagnosis and timely intervention bring about a desirable result. With this report, the authors aim to catalog and familiarize ophthalmologists with a rare ocular pathology and its management.

Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber.

Purpose: To evaluate the outcome of a nonvalved Aurolab aqueous drainage implant (AADI) in the management of refractory glaucoma. Methods: Retrospective case series of patients with refractory glaucoma underwent AADI implantation in posterior segment (PS group) or anterior chamber (AC group) with minimum follow-up of 1 year. Primary outcome criterion was success, defined as intraocular pressure (IOP) <18 or >6 mm Hg or IOP reduced to <20% from baseline, for two consecutive visits after 3 months. Failure was defined as inability to meet IOP criteria, any additional glaucoma surgery, loss of light perception, and implant explantation. Secondary outcome criteria compared groups based on mean IOP, mean glaucoma medication use, best-corrected visual acuity, and complications at each postoperative visit. Results: In the AC and PS group of 64 patients, 32 tubes each were placed. Preoperative mean IOP was 37.41 ± 8.6 and 43.38 ± 10.3 mm Hg in AC and PS, respectively. Postoperatively IOP reduced to 14.22 ± 4.9 and 15.21 ± 8.1 mm Hg in AC and PS groups, respectively (P < 0.001). Preoperative mean antiglaucoma medication changed from 2.56 ± 0.9 and 3.44 ± 0.5 to 1.03 ± 0.9 and 1.67 ± 0.5 in AC and PS, respectively, postoperatively (P < 0.001). No significant change in VA was noted in either group. At 12 months, success rate was 84% in AC group and 72% in PS group, with PS group having 2.63 times higher hazard (risk) of failure than AC group. Conclusion: AADI implantation in PS or AC is a safe and effective method for IOP control in refractory glaucoma with its low cost being of significance in developing countries.

Midterm outcome of mitomycin C augmented trabeculectomy in open angle glaucoma versus angle closure glaucoma.

Purpose: The purpose of this study is to evaluate the efficacy and safety of Trabeculectomy with Mitomycin C in Open angle glaucoma versus Angle closure glaucoma. Methods: The medical records of patients who underwent Trabeculectomy with Mitomycin C were reviewed and followed for three years, divided into two groups: group 1: Open Angle Glaucoma (n = 41) and group 2: Angle Closure Glaucoma (n = 67). Success criterion was measured as Intraocular Pressure ≤21 mmHg with (qualified) or without (complete) use of Antiglaucoma medications. Results: A total number of 108 eyes of 137 patients were undertaken. Mean preoperative Intraocular pressure in group 1 was 31.4 ± 10.5 mmHg and in group 2 was 33.1 ± 9.4, which reduced to 10.5 ± 3.4, 10.5 ± 2.6, 11.6 ± 3.6, 11.0 ± 2.7, 11.0 ± 2.7 in group 1 and 10.9 ± 2.8, 12.0 ± 3.8, 12.8 ± 4.9, 12.4 ± 3.9, 12.4 ± 3.7 in group 2 with P value = 0.566, 0.032, 0.168, 0.049, 0.049 at three, six months, one, two, three years, respectively, with P < 0.001 at each visit. The number of Antiglaucoma medications was reduced from 0.75 ± 0.89 to 0.43 ± 0.55 at 3 yrs (P = 0.002). At 36 months follow-up, overall, 50.0% and 48.2% of eyes achieved complete and qualified success, respectively. Sub-group analysis showed that the success rate was higher in group 1 (68.3%) compared to group 2 (55.2%). Overall, complications such as hypotony (1.8%), choroidal detachment (2.8%), encapsulated bleb (2.8%), and bleb leakage (1.8%) were encountered. Conclusion: Primary Trabeculectomy with Mitomycin C is a safe and effective means of controlling Intraocular Pressure in both groups with good success and low rates of sight-threatening complications.