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Glaucoma may develop or worsen after ocular surface transplantation and often requires surgical management for adequate intraocular pressure control. Traditional glaucoma filtering procedures in patients with prior ocular surface transplant may be problematic for several reasons, which include mechanical disruption of the pre-existing graft, epithelial and stem cell toxicity induced by antifibrotic agents, and increased risk of future corneal transplantation failure. We describe the implantation of a glaucoma drainage implant via a limbal-based conjunctival incision with tube placement in the ciliary sulcus in three eyes of two patients with prior ocular surface transplantation. At a follow-up interval of 3-7 months, all three eyes have excellent postoperative control of intraocular pressure, stable vision, and healthy ocular surface grafts. [ABSTRACT FROM AUTHOR]

Glaucoma represents a leading cause of preventable vision loss in Sub-Saharan Africa. Recent studies evaluating outcomes of glaucoma drainage implant (GDI) surgery suggest an important role for this approach in the African patient population. The Tube Versus Trabeculectomy study demonstrated a higher success rate with non-valved GDI surgery compared to trabeculectomy with mitomycin C after five years. The Ahmed Baerveldt Comparison study showed no difference in surgical failure rates between the Ahmed Glaucoma Valve and the Baerveldt Glaucoma Implant (BGI) but better intraocular pressure outcomes with the BGI at one year. The Ahmed Versus Baerveldt study demonstrated a lower failure rate for the BGI, but also a requirement for more post-operative interventions. Further study of GDI surgery in the Sub-Saharan Africa is necessary to determine its optimal place in the treatment paradigm for glaucoma patients in the region. [ABSTRACT FROM AUTHOR]

The article discusses the use of a Tube Extender and a 22-gauge angiocatheter tubing segment in the management of tubal retraction associated with glaucoma drainage implants (GDI). According to ophthalmologist Ahmad A. Aref, an alternative method to address tubal retraction is to lengthen the silicone tube of the glaucoma draining device. The Tube Extender, consisting of silicone tubing is connected to an accessory plate, may be used for the lengthening of any GDI type.

The article describes the case of a 41-year-old Caucasian man presented to the ophthalmology emergency room with complaint of decreasing vision in his right eye. Leukocoria of the right eye was shown in the external ocular examination, while diffuse keratic precipitates of the right eye were revealed in the slit-lamp examination. The Western blot analysis for human immunodeficiency virus (HIV) antibody was positive. Toxoplasmosis and acute retinal necrosis are included in the differential diagnosis of retinitis in patients with AIDS.

A 62-year-old woman with stable unilateral glaucoma in the left eye presented for a cataract consultation. In 2010, laser peripheral iridotomies (LPI) were performed on both eyes by a different provider. Her postoperative course was complicated by a recalcitrant steroid response with a highest intraocular pressure (IOP) of 65 mm Hg in the left eye. A trabeculectomy with a glaucoma minishunt (EX-PRESS, Alcon) was then performed by that provider (Supplemental Figure 1, http://links.lww.com/JRS/A603). Thereafter, IOP control of the left eye was normalized and maintained without topical antiglaucoma medications. Historically, her right eye has been always her better eye. Recently, she noticed metamorphopsia in her left eye. Her ocular history was also notable for high refractive errors requiring continuous spectacles wear, possible mild refractive amblyopia of the left eye, history of submacular choroidal nevus with drusen in the right eye, and an epiretinal membrane (ERM) with macular pucker in the left eye. Her husband is an optician. Both inquire about refractive cataract surgery options to correct astigmatism and presbyopia; both have reservations regarding cost and visual quality associated with diffractive optic intraocular lenses (IOLs). Her deteriorating visual acuity in both eyes affects her ability to work. Her corrected distance visual acuity was 20/40 in both eyes (pinhole, no help) while wearing spectacles according to a prescription of -8.50 diopters (D) +1.50 D × 106 for the right eye and -13.00 D +3.25 D × 057 for the left eye. Her corrected near visual acuity was 14/14 in both eyes with the abovementioned prescription and a +3.00 D add. Central corneal thickness was 618 µm in the right eye and 631 µm in the left eye. IOP was 20 mm Hg in the right eye and 10 mm Hg in the left eye on no antiglaucoma medications. Pertinent findings on slitlamp examination included bilateral dermatochalasis, a shallow diffuse thick bleb superiorly in the left eye only, patent LPI superiorly in both eyes, nuclear sclerotic and cortical cataracts in both eyes (with prominent focal spoke superiorly left eye only) (Figure 1, A-C). Fundus photos show posterior vitreous detachment in both eyes, ERM with macular pucker in the left eye, and submacular choroidal nevus (2.5 × 3.0 disc diameter size) with overlying drusen in the right eye (Supplemental Figure 2, A, http://links.lww.com/JRS/A604). Gonioscopy revealed open angles in both eyes, albeit with focal narrowing without synechiae superiorly in the left eye only (Figure 1, D-FJOURNAL/jcrs/04.03/02158034-202207000-00020/figure1/v/2022-06-24T130746Z/r/image-tiff). Most importantly, however, the distal tip of the minishunt was not positioned as expected in the anterior chamber; rather, it was noted to pierce the peripheral iris near the iris root superiorly. Most of the minishunt shaft and spur were positioned in the posterior chamber with the distal tip penetrating into the superior aspect of the capsular bag and cataract in the left eye-like a deadbolt. Visual field testing showed a full field in the right eye and an inferior nasal step in the left eye (Supplemental Figure 2, B, http://links.lww.com/JRS/A604). In addition to slitlamp, gonioscopic, and fundus photos, we also obtained optical coherence tomography of the macula and nerve (Supplemental Figure 2, C, http://links.lww.com/JRS/A604), optical biometry, ultrasound biomicroscopy, endothelial cell counts, and corneal topography (Supplemental Figure 3, http://links.lww.com/JRS/A605). How would you counsel this patient regarding her glaucoma condition, the misplanted minishunt, and her cataract surgery and IOL options? How would you manage the misplanted minishunt? What surgical approaches or specific techniques would you consider for cataract removal and visual rehabilitation?, (Copyright © 2022 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To evaluate medication and follow-up adherence in incarcerated patients examined at an academic glaucoma clinic, in comparison to nonincarcerated controls., Methods: Retrospective, case-control study. Consecutive prisoners presenting for initial visits in the Glaucoma Clinic at the Illinois Eye and Ear Infirmary between December 2015 and December 2017 were included in the study. Nonincarcerated patients seen in the same Glaucoma Clinic with similar initial visit dates, age, race, sex, and disease severity were selected as controls. Glaucoma Clinic visits from each patient were reviewed until December 2018. Examination information, surgical intervention, follow-up and treatment recommendations, and patient-reported medication usage were recorded for each visit. Number of visits, loss to follow-up, follow-up delays, and medication nonadherence were studied as primary outcome measures., Results: Twenty-four prisoners and 24 nonincarcerated controls were included. Prisoners had an average of 2.46 ± 2.38 visits during the study period, compared to 5.04 ± 3.25 for controls ( P = 0.001). Follow-up visits occurred more than 30 days after the recommended follow-up time in 57.4% (95% confidence interval [CI]: 44.2%-70.6%) of prisoners, compared to 17.9% (95% CI: 10.2%-25.6%) of controls ( P < 0.00001). 70.8% of prisoners (95% CI: 66.3-74.5%) were lost to follow-up, compared to 29.2% of controls (95% CI: 25.5%-32.9%; P < 0.01). Medication nonadherence rates were similar between prisoners (13.6%; 95% CI: 12.1%-15.2%) and controls (12.0%; 95% CI: 11.4%-12.6%; P = 0.78)., Conclusions: Glaucoma follow-up adherence was significantly worse in prisoners compared to a nonincarcerated control population. Further study into causative factors is needed., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Current Ophthalmology.)

Selective laser trabeculoplasty (SLT) has been widely used in the clinical management of glaucoma, both as primary and adjunctive treatment. As new evidence continues to arise, we review the current literature in terms of indications and efficacy, surgical technique, postoperative care, repeatability, and complications of this therapy. SLT has been shown to be effective in various glaucomas, including primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), steroid-induced glaucoma, pseudoexfoliation glaucoma (PXFG), and primary angle-closure glaucoma (PACG), as well as other glaucoma subtypes. Relatively high preoperative intraocular pressure (IOP) may predict surgical success, while other parameters that have been studied do not seem to affect the outcome. Different techniques for performing the procedure have recently been explored, revealing that minor modifications may lead to a more favorable or safer clinical outcome. The utilization of postoperative medications remains controversial based on the current evidence. A short-term IOP increase may complicate SLT and can also persist in certain cases such as in exfoliation glaucoma. The efficacy and safety of repeat SLT are shown in multiple studies, and the timing of repeat procedures may affect the success rate.

Purpose of Review: Sustained drug delivery has been recognized as a need for patients with ocular hypertension or glaucomatous optic neuropathy. Several sustained drug delivery systems and devices are currently on the horizon. This review aims to summarize initial results with these platforms, as reported in the literature, and also provide insight into their possible role in the glaucoma treatment paradigm., Recent Findings: Sustained drug delivery systems currently on the horizon include the topical bimatoprost ocular insert, travoprost and latanoprost punctal plugs, latanoprost-eluting contact lenses, bimatoprost and travoprost intraocular implants, as well as several other therapies in earlier stages of development. Delivery strategies differ with respect to ocular site of implantation, ocular hypotensive agent, and duration of efficacy. Efficacy and safety outcomes with these devices are favorable thus far., Summary: The glaucoma treatment paradigm is currently in a state of flux as sustained drug delivery systems bring promise to individuals suffering from ocular hypertension or glaucoma. Several options will likely become available in the near future to ease the burden of daily administration of chronic therapy with intraocular pressure-lowering agents.

Glaucoma drainage implant (GDI) surgery represents a significant advance in the treatment of refractory glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of implant are currently available and differ in surface area, shape, composition, and the presence or absence of a flow-restricting valve. Two separate prospective, randomized clinical trials comparing 2 types of GDI have reported results after 5 years of follow-up. GDIs may be placed in the anterior chamber, ciliary sulcus, or pars plana. Several types of patch graft material may be utilized to prevent tube erosion. Potential complications of GDI surgery may relate to immediate or late-onset hypotony, motility disturbances, corneal decompensation, or tube erosion., (© 2017 S. Karger AG, Basel.)

Introduction: This study is a retrospective case series to evaluate the outcomes and complications of Baerveldt glaucoma implant surgery (BGI) in patients without prior cataract or incisional glaucoma surgery., Methods: Patients who underwent 350-mm 2 BGI through the Glaucoma Service of the University of Illinois at Chicago between 2010 and 2015 were included in this study. Outcome measures included age, sex, ethnicity, operated eye, preoperative diagnosis, preoperative, and sequential postoperative intraocular pressure (IOP), visual acuity, glaucoma medications, and postoperative complication and interventions. Statistical analyses were performed using the two-sided Student t test for continuous variables., Results: Thirty-seven patients were studied. IOP was consistently and statistically significantly lower at 3 months (17.4 ± 6.4, p = 3 × 10 -7 ), 6 months (13.9 ± 5.1, p = 2 × 10 -11 ), 1 year (12.2 ± 4.0, p = 9 × 10 -10 ), and 2 years (14.6 ± 3.3, p = 0.0004) postoperatively compared to IOP at baseline (27.5 ± 8.1). Fewer glaucoma medications were used at 3 months (2.8 ± 1.3, p = 0.04), 6 months (2.6 ± 1.2, p = 0.02), 1 year (2.7 ± 1.7, p = 0.04), and 2 years (2.0 ± 1.2, p = 0.03) postoperatively compared to baseline (3.4 ± 1.1). A total of six cases (16%) had failure. A total of five patients (15%) had postoperative complications. Mean Snellen visual acuity was not statistically different at 6 months (0.5 ± 0.6, p = 0.88) or 1 year (0.4 ± 0.4, p = 0.57) postoperatively from baseline (0.5 ± 0.6)., Conclusions: Primary BGI is effective at reducing IOP and the medication burden in patients suffering glaucomatous optic neuropathy. Further randomized prospective studies are needed to compare various procedures in the primary surgical management of patients with uncontrolled glaucoma., Funding: This study was funded by an unrestricted grant from Research to Prevent Blindness.

Glaucoma remains a prevalent disorder and visual limiting factor after Boston keratoprosthesis type 1 implantation. Patients with glaucoma have worse initial and late visual acuity outcomes after otherwise successful keratoprosthesis implantation. Management of glaucoma in the setting of a keratoprosthesis is challenging because of relatively rapid progression and an inability to accurately measure intraocular pressure (IOP). In addition, there are no standard guidelines for glaucoma surveillance and monitoring after keratoprosthesis surgery. This report provides a review of the current literature and offers innovative strategies that will overcome the challenges in managing glaucoma in the setting of a Boston keratoprosthesis type 1 implant. The topics that will be discussed in this section include alternative methods for IOP measurement, rationales and surgical techniques for a pars plana tube placement for glaucoma drainage device, effective medical and laser treatment, the risk for IOP elevations after YAG laser, and practical guides to glaucoma surveillance and monitoring., Competing Interests: Conflict of Interest Tharasat Vajaranant, Jacob Wilensky, Jessica Liu, Ahmad Aref and Soledad Cortina declare no conflict of interest.

Introduction: Hypotony maculopathy is ocular hypotony complicated by papilledema and/or folding of the retina and choroid in the posterior pole. Our objective was to examine the current literature regarding hypotony maculopathy and treatment methods., Methods: A systematic review of the English-language literature was conducted by performing a broad search of PubMed from 1972 through 2015 using the keywords hypotony maculopathy and hypotony. Additional articles were identified from bibliographies of relevant articles., Results: Hypotony maculopathy was infrequent before the introduction of antimetabolite agents in glaucoma-filtering surgery, and the incidence of this entity is now up to 20%. Risk factors for developing hypotony maculopathy include male gender, young age, myopia, and primary filtering surgery. Correctly identifying the etiology of hypotony is essential for successful treatment. Treatment of hypotony maculopathy includes procedures to elevate the intraocular pressure, thus reversing the collapse of the scleral wall and chorioretinal wrinkling., Conclusion: This review discusses the definition, clinical presentation, pathophysiology, incidence and risk factors, prevention and treatment of hypotony maculopathy.

Purpose: To evaluate current practices of refractive surgeons in terms of performing elective refractive surgery in persons with human immunodeficiency virus (HIV) positivity or acquired immune deficiency syndrome (AIDS)., Setting: Penn State University College of Medicine, Hershey, Pennsylvania, USA., Methods: A link to an anonymous web-based survey was e-mailed to members of the International Society of Refractive Surgery. Surgeons were asked whether they considered persons with HIV or AIDS to be acceptable candidates for elective refractive surgery and specific precautions, if any, taken when operating on these individuals., Results: Of 1123 surgeons sent the link, 285 (25.4%) responded. Of respondents, 143 (50.2%) said they consider persons with HIV acceptable candidates for elective refractive surgery and 35 (12.5%) said they consider persons with AIDS acceptable candidates for elective refractive surgery. One hundred sixty-five (72.7%) respondents who perform elective refractive surgery in persons with HIV or AIDS said they take additional precautions when operating on these patients; precautions included performing unilateral surgery, scheduling the patient last on the surgery schedule for a given day, wearing a double layer of gloves, and evacuating the laser plume immediately after surgery., Conclusions: Approximately half of refractive surgeons said they consider HIV-positive persons acceptable candidates for elective refractive surgery; a much lower proportion considered patients with AIDS acceptable candidates. The majority of the surgeons recommended additional precautions when performing refractive surgery on patients with HIV or AIDS., (Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)