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Hazem Helmy Glaucoma and Optic Nerve Disease Department, Research Institute of Ophthalmology, Giza, EgyptCorrespondence: Hazem HelmyGlaucoma and Optic Nerve Disease Department, Research Institute of Ophthalmology, 2 El Ahram Street, Giza, 12577, EgyptTel +201224004991; +2022315228Email hazem.helmy@yahoo.comPurpose: To assess the 10-year effects of early phacoemulsification with intraocular lens (IOL) implantation in primary angle closure glaucoma (PACG) patients with cataract.Patients and Methods: This prospective cohort study included 102 eyes of 102 patients with PACG. All patients had coexisting cataracts compromising vision. Patients underwent phacoemulsification and foldable IOL implantation. The main outcome measures were anterior chamber depth (ACD), angle width, value of intraocular pressure (IOP), and number of medications needed postoperatively and during follow-up.Results: Half (53%) of the patients were female, with ages ranging from 55 to 73 with a mean of 59.82± 5.19 years. Mean IOP decreased significantly from 22.15± 2.08 mmHg at baseline to 14.08± 2.13 mmHg postoperatively (p˂ 0.05). The ACD increased from 2.2± 0.21 preoperatively to 3.73± 0.25 postoperatively (p˂0.001). Nasal angle width increased postoperatively to 40.05± 2.09 compared to the preoperative value of 16.02± 2.08 (p˂0.001). Temporal angle width increased from 13.05± 2.07 to 41.9600± 1.94 (p˂0.001). Anti-glaucoma treatment significantly decreased postoperatively (p˂0.001). A significant positive correlation was detected between ACD and angle width, while a negative correlation was detected between IOP and both ACD and angle width (p˂0.001). There was also a significant negative correlation between postoperative angle width and IOP (p˂0.001). Preoperative lens thickness was positively correlated with preoperative IOP and number of medications, while it was negatively correlated with preoperative AC depth and angle width. Preoperative lens thickness positively correlated with postoperative IOP and medications. Complete and qualified success was achieved in 69.65% and 30.4% of cases, respectively, while 2.9% failed to be controlled. Visual acuity significantly improved from 0.17± 0.1 to 0.9± 0.08 (p˂0.001). All parameters showed high stability throughout the follow-up period.Conclusion: Phacoemulsification with IOL implantation is a safe and effective early modality for long-term control of IOP in PACG patients with coexisting cataract. The effects can persist for at least 10 years.Keywords: primary angle closure glaucoma, early phacoemulsification, anterior chamber depth, angle width, UBM

Hazem Helmy Glaucoma Unit, Glaucoma and Optic Nerve Disease Department, Research Institute of Ophthalmology; RIO, Giza, EgyptCorrespondence: Hazem Helmy 48, Palm City Katameya, EgyptTel +20 201288882616Email hazem.helmy@yahoo.comIntroduction: Primary congenital glaucoma (PCG) is a challenging disease that needs to be surgically managed with more innovative methods. Conventional incisional surgery, such as goniotomy and trabeculotomy, has a primary high success rate, but does not seem to be a very effective treatment in advanced stages.Design: A prospective clinical case study.Purpose: To qualify the outcome, in terms of success rate, of goniotomy combined with trabeculotomy as a surgical option to treat eyes affected by PCG with a corneal diameter larger than 14 mm.Patients and Methods: This study included 50 eyes of 50 patients diagnosed with PCG with corneal diameter larger than 14 mm who underwent ab interno goniotomy combined with ab externo trabeculotomy. Intraocular pressure (IOP) was measured preoperatively and 24 months postoperatively. A statistical analysis was performed to detect correlations between the success rate and corneal diameter, preoperative IOP, age of onset, axial length, and consanguinity. The main outcome was reduction in IOP; secondary outcomes were factors affecting the success rate, complications, and the need for additional surgical intervention to control IOP.Results: The mean age of the patients was 18.86± 9.94 months. Males made up 52% of cases and females 48% of cases. Positive consanguinity was present in 38% of cases. Axial length ranged between 20 and 22 mm, with a mean of 20.98± 0.8 mm. Mean preoperative IOP was 29.56± 3.36 mmHg, which decreased postoperatively to 12.6± 2.5, 14.1± 3.2, 16.8± 5.5, 14.4± 2.3, 14.3± 1.6, 14.3± 1.6, 14.3± 1.6, 14.3± 1.7, and 14.3± 1.7 mmHg at 1, 3, 6, 9, 12, 15, 18, 21, and 24 months respectively (p˂0.001). Use of medical treatment was decreased from 2.7± 0.4 preoperatively to 1.4± 0.7 postoperatively (p˂0.001). Hyphema was the only complication that appeared, occurring in 47% of cases. The success rate was 94%. Complete success (IOP < 21 mmHg without treatment) was achieved in 70% of cases, 24% were considered a qualified success (IOP < 21 mmHg with treatment), while failure was documented in 6% of cases (IOP > 21 mmHg with treatment). The success rate was significantly related to preoperative IOP, corneal diameter, axial length, consanguinity, and age of onset (p˂0.001). All cases were followed for 24 months.Conclusion: Ab interno goniotomy combined with ab externo trabeculotomy improves the success rate of buphthalmos surgery. A significant correlation was detected between success rate and preoperative IOP, corneal diameter, axial length, consanguinity, and age of onset.Keywords: primary congenital glaucoma, intraocular pressure, corneal diameter, trabeculotomy, goniotomy

Hazem Helmy,1 Omar Hashem2 1Glaucoma and Optic Nerve Disease Department, Research Institute of Ophthalmology, Giza, Egypt; 2Cornea and Refractive Surgery Department, Research Institute of Ophthalmology, Giza, EgyptCorrespondence: Hazem Helmy Email hazem.helmy@yahoo.comBackground: Corneal refractive surgery is widely used worldwide. Myopia is the most common reason for laser-assisted corneal refractive surgery (LASIK) and one of therisk factors for glaucoma. Intraocular pressure (IOP) measurement becomes variable postoperatively as the results are affected by thedecrease in corneal thickness and biomechanics.This prospective clinical case studyattempted to establish a simple correction formula for the calculation of IOP in post-LASIK myopic patients.Methods: This study included 300 eyes of 150 patients with myopia and myopic astigmatism as a refractive error whounderwent LASIK. IOP was measured preoperatively and 6 months postoperatively. Preoperative and postoperative corneal thickness as well as ablation depth were measured. Statistical analysis was performed to detect the relationship between ablation depth and change in IOP. An attempt was made to construct a correction formula for thecalculation of post-LASIK IOP.Results: The age of the patientsranged between 18 and 50 (mean ± SD 34.78± 8.8) years. The spherical equivalent of refractive error ranged between − 1.5 and − 10 diopters. The mean IOP decreased significantly from 15.72± 2.37 mmHg preoperatively to 11.71± 2.24 mmHg postoperatively, with a mean difference of 4± 1.75 mmHg (p˂0.001). A positive correlation was detected between corneal thickness and IOP difference among patients both preoperatively and postoperatively (p˂0.001). A positive correlation was identified between ablation depth and IOP change (p˂0.001).The correction formula for IOP was established: Real IOP=4+0.7(preoperative IOP)− 0.3(ablation depth).Conclusion: IOP measurements change after corneal refractive surgery with LASIK. A corrected formula may be a good option for theproper calculation of post-LASIK IOP.Keywords: intraocular pressure calculation, post-LASIK glaucoma, Goldmann applanation tonometry, glaucoma, laser in situ keratomileusis