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BackgroundTo assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG).MethodsA retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications.ResultsMean patient age (mean±SD) was 49±16 years (range: 18–79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up.ConclusionGATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.

Background/Aims To evaluate the supraciliary space (SCS) with anterior segment optical coherence tomography (OCT) imaging after CyPass Micro-Stent implantation. Methods The SCS was imaged with OCT after microstent implantation at 1, 6 months, and 1 year. Images were graded on a scale of 0–4 for morphological features indicative of fluid presence within, or drainage through, the SCS. Results 35 patients underwent ab-interno microstent implantation. Mean age was 68.6±10.2 years. Baseline mean intraocular pressure (IOP) was 21.9±6.1 mm Hg on average of 3.0 topical medications. At 1 month, the fluid space grade was ≥1 for 96% (24/25) of patients for tenting, 79% (15/19) for fluid posterior to the microstent, and 89% (8/9) for fluid surrounding the microstent. The mean (composite) score for all features was 2.5±0.99. The majority of patients maintained aqueous fluid through 12 months. Conclusions OCT imaging provides adequate visualisation of the angle, the SCS and aqueous fluid drainage after implantation of a suprachoroidal microstent into the SCS.

Introduction A primary objective of healthcare services is to improve patients9 health and health-related quality of life (HRQoL). Glaucoma, which affects a substantial proportion of the world population, has a significant detrimental impact on HRQoL. Although there are a number of glaucoma-specific questionnaires to measure HRQoL, none is preference-based which prevent them from being used in health economic evaluation. The proposed study is aimed to develop a preference-based instrument that is capable of capturing important effects specific to glaucoma and treatments on HRQoL and is scored based on the patients9 preferences. Methods A sequential, exploratory mixed methods design will be used to guide the development and evaluation of the HRQoL instrument. The study consists of several stages to be implemented sequentially: item identification, item selection, validation and valuation. The instrument items will be identified and selected through a literature review and the conduct of a qualitative study. Validation will be conducted to establish psychometric properties of the instrument followed by a valuation exercise to derive utility scores for the health states described. Ethics and dissemination This study has been approved by the Trillium Health Partners Research Ethics Board (ID number 753). All personal information will be de-identified with the identification code kept in a secured location including the rest of the study data. Only qualified and study-related personnel will be allowed to access the data. The results of the study will be distributed widely through peer-reviewed journals, conferences and internal meetings.

Aims To highlight possible and may be fatal complications of Varicella Zoster virus (VZV) infection. Method We report a case of an infant with VZV infection who developed meningeococcal sepsi, meningeococcal meningitis, VZV encephalitis and subdural empyema. Results A 3 month, previously well and developmentally normal male child was admitted with skin rash. He had contact with varicella zoster infection. His initial inflammatory markers were high. He was treated as Chicken pox. His blood culture grew Nisseria Meningitidis, treated with intravenous antibiotics. He remained unwell with poor response to antibiotics. A lumbar puncture was then performed. This revealed a picture consistent with bacterial meningitis. CSF PCR was positive for N. Meningitidis as well as for VZV.A week after admission he started to have seizures. This required intubation and PICU admission. A brain CT showed to bilateral subdural collection. He was assessed at 10 month of age and found to have no residual disabilities. Conclusion VZV infection complicated by meningococcal sepsis and meningitis is well reported in the literature; subdural empyema is reported on few occasions; however we found no report with all these complications in a single patient nor in an infant.