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Purpose: To compare the intraocular pressure (lOP) diurnal fluctuations of glaucoma patients treated with latanoprost 0.005% once a day with patients with controlled lOP after deep sclerectomy or trabeculectomy. Methods: The trial included 60 prospectively recruited subjects with primary open-angle glaucoma. The medical group consisted of 20 patients with controlled lOP (<18 mm Hg) under latanoprost 0.005% monotherapy and with no history of previous intraocular surgery or argon laser trabeculoplasty; the surgical groups included 20 patients after trabeculectomy, and 20 patients after deep sclerectomy with collagen implant (DSCI). The patients in the surgical groups had a controlled lOP without any ocular hypotensive medications. All patients underwent a diurnal tension curve (08:00-17:00/three- hour intervals), followed by a water-drinking test (WDT) with the last lOP measurement taken at 21:00 hours. The between-group differences were tested for significance by means of analysis of variance (ANOVA). Results: Baseline lOP was significantly different between the trabeculectomy group (10.1 mm Hg (3.4 SD)), the DSCI group (13.9 mm Hg (2.8)) and the latanoprost group (15.5 mm Hg (2.0); p = 0.005). The average lOP during the diurnal tension curve (10.1, 13.7, and 15.7 mm Hg, respectively, for the trabeculectomy, DSCI, and latano-prost groups) differed significantly between groups (ANOVA; p'

AIM: To identify the value of using collagen implant in deep sclerectomy. METHODS: A prospective randomised trial of 104 eyes (104 patients) with medically uncontrolled primary and secondary open angle glaucoma. All patients had deep sclerectomy (DS), half of them with and the other half without a collagen implant (CI) sutured in the scleral bed. The main outcome measures were intraocular pressure (IOP), visual acuity, number of treatments preoperative and postoperative, and Nd:YAG goniopunctures. RESULTS: Mean follow up period was 44.5 (SD 21) months for the DS group and 43.9 (SD 14) months for the deep sclerectomy with a collagen implant (DSCI) group. The mean preoperative IOP was 23.3 (SD 7.2) mm Hg for the DS group and 25.6 (SD 4.9) mm Hg for the DSCI group. The mean IOP at the first postoperative day was 6.1 (SD 4.21) mm Hg for the DS group and 5.1 (SD 3.3) mm Hg for the DSCI group. At 48 months IOP was reduced by 40% (14 versus 23.3 mm Hg) for the DS group and by 50% (12.7 versus 25.6 mm Hg) for the DSCI group. Complete success rate, defined as IOP lower than 21 mm Hg without medication, was 34.6% (18/52 patients) at 48 months for the DS group, and 63.4% (33/52 patients) for the DSCI group. Qualified success rate; patients who achieved IOP below 21 mm Hg with or without medication, was 78.8% (41/52 patients) at 48 months and 94% (49/52 patients) for the DSCI group. The mean number of medications was reduced from 2.1 (SD 0.8) to 1.0 (SD 1) after DS, and was reduced from 2.2 (SD 0.7) to 0.4 (SD 0.6) in the DSCI group (p = 0.001) CONCLUSION: The use of a collagen implant in DS enhances the success rates and lowers the need for postoperative medication. [ABSTRACT FROM AUTHOR]

Aim: The use of an animal model to study the aqueous dynamic and the histological findings after deep sclerectomy with (DSCI) and without collagen implant. METHODS: Deep sclerectomy was performed on rabbits'' eyes. Eyes were randomly assigned to receive collagen implants. Measurements of intraocular pressure (IOP) and aqueous outflow facility using the constant pressure method through cannulation of the anterior chamber were performed. The system was filled with BSS and cationised ferritin. Histological assessment of the operative site was performed. Sections were stained with haematoxylin and eosin and with Prussian blue. Aqueous drainage vessels were identified by the reaction between ferritin and Prussian blue. All eyes were coded so that the investigator was blind to the type of surgery until the evaluation was completed. RESULTS: A significant decrease in IOP (p<0.05) was observed during the first 6 weeks after DSCI (mean IOP was 13.07 (2.95) mm Hg preoperatively and 9.08 (2.25) mm Hg at 6 weeks); DS without collagen implant revealed a significant decrease in IOP at weeks 4 and 8 after surgery (mean IOP 12.57 (3.52) mm Hg preoperatively, 9.45 (3.38) mm Hg at 4 weeks, and 9.22 (3.39) mm Hg at 8 weeks). Outflow facility was significantly increased throughout the 9 months of follow up in both DSCI and DS groups (p<0.05). The preoperative outflow facility (OF) was 0.15 (0.02) micro l/min/mm Hg. At 9 months, OF was 0.52 (0.28) micro l/min/mm Hg and 0.46 (0.07) micro l/min/mm Hg for DSCI and DS respectively. Light microscopy studies showed the appearance of new aqueous drainage vessels in the sclera adjacent to the dissection site in DSCI and DS and the apparition of spindle cells lining the collagen implant in DSCI after 2 months. CONCLUSION: A significant IOP decrease was observed during the first weeks after DSCI and DS. DS with or without collagen implant provided a significant increase in outflow facility throughout the 9 months of follow up. This might be partly explained by new drainage vessels in the sclera surrounding the operated site. Microscopic studies revealed the appearance of spindle cells lining the collagen implant in DSCI after 2 months. [ABSTRACT FROM AUTHOR]

Aim: To prospectively study the success rate and complications of viscocanalostomy, a non-penetrating glaucoma surgery. Methods: Prospective non-randomised consecutive case series of 57 eyes (57 patients) with medically uncontrolled primary and secondary open angle glaucoma. Viscocanalostomy was performed on all participants with injection of viscoelastic in the surgically created ostia of Schlemm's canal as well as in the scleral bed, the superficial scleral flap was loosely sutured. Intraocular pressure, visual acuity, and number of goniopunctures were measured. Results: The mean follow up period was 34.1 months. The mean preoperative intraocular pressure (IOP) was 24.6 mm Hg; while the mean postoperative lOP was 5.6 mm Hg at day 1 and 13.9 mm Hg at 36 month. Patients who achieved lOP below 21 mm Hg with or without medication were 90% at 60 months, complete success rate (IOP<21 mm Hg without medication) was 60% at 60 months. 21 patients (37%) needed Nd:YAG goniopuncture postoperatively to control raised IOP, mean time for goniopuncture application was 9.4 months, mean pre-goniopuncture IOP was 20.4 mm Hg and mean postgoniopuncture lOP was 12.6 mm Hg (p <0.0001). Conclusion: Viscocanalostomy appears to be a promising modification of filtering surgery. [ABSTRACT FROM AUTHOR]

Aim: To assess intraocular pressure (lOP) changes of the contralateral eyes of eyes undergoing trabeculectomy with mitomycin C (MMC). Methods: Non-comparative retrospective study of 24 consecutive patients who underwent trabeculectomy with MMC that led to more than 45% reduction in IOP. In the contralateral eyes, IOP before surgery was compared with IOP 1 day and 1 month after surgery. 11 fellow eyes: were under topical hypotensive therapy while 13 contralateral eyes were not (12 contralateral. eyes had previous filtering surgery and one had normal tension glaucoma). No patients had systemic ocular hypotensive therapy. Results: Mean IOP in all contralateral eyes decreased from 15.5 (SD 5.5) mmHg to 12.5 (3.8) mm Hg (p<0.001), and 13.0 (4.7) mm Hg (p<0.001) 1 day and 1 month after surgery, respectively. In: the 11 fellow eyes under topical ocular hypotensive therapy mean IOP was reduced from 19.5 (4.0) mm Hg to 13.5 (2.2) mm Hg (p<0.01), and 16.5 (2.8) mm Hg (p<0.05) 1 day and 1 month alter surgery, respectively. In the 13 fellow eyes not under topical ocular hypotensive therapy mean lOP was reduced from 12.1(4.2) mm Hg to 11.6 (4.7) mm Hg (p not: significant) and 9.8 (3.8) mm Hg (p0.01) 1 day and 1 month after surgery, respectively. Conclusions: In the present population, a month after trabeculectomy, mean IOP in the contralateral eyes decreased independently of whether these contralateral eyes were undergoing topical ocular hypotensive therapy or not. [ABSTRACT FROM AUTHOR]

Purpose: To investigate, in vitro, the influence of non- penetrating glaucoma surgery (NPGS) and the influence of tightly suturing the superficial scleral flap on the aqueous outflow facility of isolated porcine eyes. Materials and methods: The anterior chambers of 1 2 enucleated porcine cadaver eyes were cannulated and perfused. NPGS was performed by the same surgeon. The overall ocular aqueous outflow facilities were assessed before and after the surgical interventions of NPGS, as well as after scleral Hap closure. Results: The mean (SD) aqueous outflow facility, which was 0.164 (0.014) μl/min/mm Hg before surgery, increased significantly after NPGS to 1.584 (0.217) μl/min/mm Hg, p<0.001. When the superficial Hap was closed, the aqueous outflow facility significantly decreased (0.754 (0.107) μl/min/mm Hg, p<0.001) but remained significantly higher than preoperatively (p<0.01). After suturing the superficial flap, the overall resistance increased to 1.625 (0.210) μl/min/mm Hg. The difference in the resistance to outflow before and after flap closure was 0.848 (0.169) μl/min/ mm Hg. Conclusion: After NPGS suturing the scieral flap can modulate aqueous outflow resistance. The experimental set up described might provide an efficient model for the technical training of glaucoma surgeries. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented concerning the case evaluation of a pseudophakic pupillary block with an anterior segment optical coherence tomography in a 60-year-old female patient.

The article comments on a study on the socioeconomic impact of glaucoma on patients in Egypt. 20 percent of the population in Egypt fall below the poverty line. The country serves as a model of how glaucoma is managed in a developing country. Its ratio of physicians per 1,000 people is indicative of its investment in health services, which is six percent of the gross domestic product.

Comments on an article by Tan and Hitchings that tackles the issue of sclerectomy with collagen implant. Failure to cite a landmark study comparing deep sclerectomy without an implant with trabeculectomy in the two eyes of the same patient.