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To evaluate the severity of primary open angle glaucoma (POAG) at presentation using visual field analysis and its relationship to demographic and ocular factors in patients presenting to a tertiary eye care centre. Cross-sectional study. Newly diagnosed POAG patients were classified as early, moderate, or severe stage in the worse eye based on the Humphrey visual field testing using Hodapp–Parrish–Andersons criteria. The groups were compared for differences in demographics and ocular characteristics. Statistical analysis was done using STATA 14.1 (Texas, USA). The average age of 71 eligible patients was 60.04 ± 9.53 years, and the cohort had 29.5% females. Among the subjects, 19 (26.7%) had early, 24 (33.3%) had moderate and 28 (38.89%) had severe POAG at presentation. There was no statistically significant difference among different stages of glaucoma with respect to age and sex groups. No statistical association was found with education, occupation status, presenting complaints, family history of glaucoma, or systemic diseases between the different stages of severity. 5.6% with severe disease presented with a relative afferent pupillary defect (RAPD). The mean intraocular pressure (IOP) in the severe stage was 22.54 ± 5.27 mmHg, which was not statistically higher than the other groups (P = 0.726). Newly diagnosed POAG patients predominantly present at moderate or severe stage of disease, reflecting either the asymptomatic nature of the disease or a lack of access to vision care services. Existing screening programmes need to be improved, with special attention to women and individuals less than 50 years of age.

A 42-year-old female patient has been referred for high intraocular pressure (IOP) in both eyes (BE). Examination revealed dilated, tortuous conjunctival, and episcleral vessels in BE with no apparent cause, also the patient had advanced glaucomatous damage in the left eye (LE). A diagnosis of bilateral idiopathic elevated episcleral venous pressure with secondary open-angle glaucoma (Radius Maumenee syndrome) was made. She was treated with aqueous suppressants in BE and underwent Partial diode cyclophotocoagulation in LE for control of high IOP. Nearly 50–55 cases have been reported till now. We publish here as this is a rare entity; also we discuss certain management controversies and provide literature review about this entity.

Juvenile open-angle glaucoma (JOAG) is a subset of primary open-angle glaucoma, which affects individuals aged 5 to 35 years. Keratoconus is a bilateral progressive ectatic disorder of the cornea that results in a reduction of vision due to irregular astigmatism. The exact cause and the underlying pathological mechanism are unknown, but both environmental and genetic factors are thought to contribute to the development of the disorder. The association between keratoconus and normal-tension glaucoma has been widely published in literature, whereas the association between keratoconus and JOAG has been reported rarely. This is the third case report pointing toward the possible association of juvenile glaucoma with keratoconus, which emphasizes the importance of thorough glaucoma evaluation among keratoconus patients.

Pseudoexfoliation (PXF) syndrome is an age-related systemic disease having ocular manifestations characterised by deposition of a white fluffy amyloid-like proteinaceous material in the eye. A 73-year elderly man, a known case of PXF glaucoma, who underwent combined trabeculectomy with posterior

Glaucoma drainage devices are commonly used nowadays in cases of secondary glaucoma, especially silicone oil (SO) glaucoma. Even after removal of SO from the vitreous and anterior chamber, due to remnant droplets in the drainage tube, intractable glaucoma can occur. We hereby report one such case.

Purpose: COVID-19 pandemic has affected the healthcare system worldwide hindering the continuum of treatment of chronic disease patients. The objective of the study is to analyze the barriers encountered by the glaucoma patients for the follow-up visit and medication adherence during the pandemic. Methods: This cross-sectional study included glaucoma patients who did not attend the scheduled appointment from April 1, 2020 to July 31, 2020 in a tertiary eye care center (88.21%). Eligible patients of age >18 years and advised antiglaucoma medication in Madurai Zone were interviewed with validated questionnaire through telephonic call. Results: 363 patients answered the questionnaire through telephonic interview. 57.3% of the patients were found to be non-adherent to medication. The main barriers for glaucoma follow-up visit during the pandemic were lockdown restriction, transport problem, and financial difficulties. The top barriers for medication adherence were non availability of medication (54.81%), financial difficulties (30.29%), did not feel much improvement with eye drops (20.19%). On multiple regression analysis, longer distance to hospital, low socioeconomic status, more than one antiglaucoma medication use, lack of awareness of glaucoma, non-complaint before COVID-19 and stress due to the pandemic were found to be significant factors for medication non adherence. Conclusion: COVID-19 pandemic has emphasized the need for reformation in health care system for accessibility of medical care to patients in rural areas. Decentralization of health system to primary care level and utilization of teleophthalmology should be considered by health care planners in future.

Purpose: To present a selected case series of advanced glaucoma-associated peripapillary and macular retinoschisis and response to various treatment strategies with a comprehensive literature review. Methods: Retrospective observational case series. Retrospective review of five selected cases of advanced glaucoma with peripapillary and macular retinoschisis. Results: All five patients had advanced glaucomatous damage with macular and peripapillary retinoschisis, three (patients 2, 3, and 5) had a neurosensory detachment of the macula. Increased intraocular pressure was managed with maximal antiglaucoma medications and G6 micropulse diode laser treatment in the first patient, transscleral diode laser in the second patient, mitomycin-C augmented trabeculectomy in the third patient, maximal antiglaucoma medications alone in the fourth patient, pars plana vitrectomy followed by trabeculectomy in the fifth patient. Conclusion: We speculate that peripapillary and macular retinoschisis may indicate a vision-threatening sequelae of advanced glaucoma. The probable inciting factor for this vision-threatening pathology being elevated intraocular pressure, fluctuations in intraocular pressure, and chronic glaucoma with advanced cupping. We emphasize that meticulous examination of the macula in patients with advanced glaucoma is mandatory. It is imperative to do OCT macula in patients with advanced glaucoma to diagnose this distinct entity at an earlier stage and preserve the existing visual potential.