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Purpose Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. Methods Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. Results The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62 mmHg (3.05,12.18) in the MMC group and 8.15 mmHg (−0.64,16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93,58.17) and 36.08% (5.16,67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was −0.92 medications (−3.38, +1.54)) for the MMC group and −1 medication (−3.12, +1.12). Both groups had a statistically significant decline in mean IOP over the follow-up period (p Conclusions The use of PVP during trabeculectomy achieves and maintains a statistically significant IOP reduction from baseline to 36 months and decreases the number of glaucoma medications. Secondary outcome measures showed a lower incidence of adverse events in the PVP group.

Purpose To report our experience using a Tenon's cyst autograft in the management of tube exposure post Ahmed Glaucoma Valve implantation. Methods This is a retrospective case series. Results Four patients who underwent tube exposure repair using Tenon's cyst autograft were identified in our tertiary care center. The duration between initial Ahmed Glaucoma Valve implantation and tube exposure ranged between 3 and 36 months with a mean of 16 months (+/-14.35). All patients were followed post-operatively for a range of 4 to 24 months with a mean of 11.75 months (+/-9.03) and all remain exposure free at last follow-up. Conclusion The use of a Tenon's cyst autograft for the surgical repair of a tube exposure is valuable, as it involves using autologous scar tissue that is available in eyes that have undergone Ahmed Glaucoma Valve implantation. The patch autograft is technically easy to harvest, and represents a significantly lower cost when compared to other available options.

PReCIS:: In this article, the authors concluded that an additional Ahmed glaucoma valve (AGV) implantation after the failure of an initial AGV, even with the addition of glaucoma medications, maybe a good surgical treatment option for refractory glaucoma. PURPOSE To evaluate the surgical outcomes of a second AGV implant in Hispanic patients with refractory glaucoma. MATERIALS AND METHODS The medical records of patients who underwent a second AGV implant were reviewed retrospectively. Clinical outcome measures including intraocular pressure (IOP), visual acuity, and glaucoma medication use were collected from the preoperative visit and all follow-up visits up to 18 months after surgery. Failure was defined as one of the following: loss of light perception, sustained IOP >21 or

Purpose Self-administration of topical ophthalmic therapies remains challenging for many patients as errors due to improper technique are common. The aim of the current studies was to evaluate a novel electromechanical topical ocular drug delivery device designed to facilitate precise dosing and accurate delivery with substantially lower drug exposure than conventional eye drops. Patients and methods Two randomized Phase 1 studies were performed to evaluate the efficacy and safety of a single dose of a topical ophthalmic solution administered as a ~9 μL microfluid stream via the test device compared with a ~30-40 μL drop delivered via conventional dropper in healthy subjects (Trial 1) and glaucoma patients (Trial 2). In Trial 1, a 1% tropicamide/2.5% phenylephrine solution was administered via the test device in one eye and by conventional dropper in the contralateral eye. Pupil dilation was measured at 30 min intervals post-instillation and subject comfort was assessed using a visual analogue scale (range, 0-100). In Trial 2, patients were randomized to receive latanoprost 0.005% via the test device or conventional dropper. Intraocular pressure was measured at baseline and 4-8 hrs post-instillation. Results In Trial 1 (N=20), mean (SD) pupil diameter 30 mins post-instillation increased by 3.4 (0.9) and 3.5 (1.0) mm in the test and control eyes, respectively. The mean comfort score was 81.7 for the test device versus 57.3 for conventional dropper delivery. In Trial 2 (N=18), the mean change in intraocular pressure following administration of latanoprost was -5.0 (1.8) and -4.3 (3.3) mm Hg in the test and control groups, respectively. No serious adverse events were observed in either study. Conclusion Administration of a single dose of topical ophthalmic therapy via an electromechanical drug delivery device resulted in comparable effects on pupil dilation and intraocular pressure with lower drug exposure and increased patient comfort compared with conventional dropper delivery.

Purpose To assess the short and long-term changes in Visual Field (VF) Mean Deviation (MD), Visual Field Index (VFI), and intraocular pressure (IOP) after femtosecond laser-assisted cataract surgery (FLACS) in glaucomatous eyes. Materials and methods Interventional, prospective case series. Patients with glaucoma, who required cataract surgery were included. All patients underwent a complete ophthalmologic assessment and Visual Fields. FLACS was performed in all patients by a single experienced surgeon. IOP was measured during surgery immediately before and after pretreatment suction docking. Changes from baseline in VF MD and VFI, IOP, visual acuity (VA), and number of glaucoma medications were evaluated up to one-year follow-up. Results Fourteen eyes of 11 patients were included. Eighty-five percent were female, with a mean age of 74.2 ± 7.9 years. Nine (64.3%) and 5 (35.7%) were diagnosed with primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG), respectively. We found a slight IOP reduction after the docking phase during FLACS in both glaucoma subtype groups. No significant changes in visual field mean deviation (MD) and visual field index (VFI) were found from baseline to 12 months after surgery in both groups. A significant reduction in IOP values was found in all cases from baseline up to one year follow up. No significant changes were observed in BCVA and number of topical glaucoma medications after one year in both groups. Conclusion In our patients, there was an IOP reduction immediately after suction docking FLACS pretreatment. Mean IOP at final follow-up showed a reduction from baseline. There was no change in VF MD and VFI from baseline to final one-year follow-up. FLACS appears to be well tolerated in early and moderate glaucoma and appears to be a safe tool for glaucoma patients undergoing cataract surgery. Similar results to traditional surgery can be obtained with the advantages of femtosecond laser precision.

To describe the efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma.This retrospective multicentre case series reports on 40 eyes with severe or refractory open-angle glaucoma that underwent standalone or combined KDB goniotomy and were followed for 12 months post-operatively in the United-States, Mexico and Switzerland. Surgical success was defined as an intraocular pressure (IOP) reduction ≥20% from baseline at 12 months, with fewer medications than preoperatively. Mean IOP and antiglaucoma medication reduction, probabilities of achieving an IOP ≤16 or 18 mmHg, and adverse events were also analysed.Mean IOP decreased from 18.1 ± 5.0 mmHg at baseline to 14.8 ± 3.7 mmHg at 12 months (18.2% reduction, P 0.001). Concomitantly, the mean number of glaucoma medications decreased from 2.5 ± 1.4 to 1.7 ± 1.2 (32% reduction, P = 0.002). The proportion of eyes achieving an IOP reduction of more than 20% from baseline was 37.5% (n = 15) at 12 months. At 12 months, 67.5% and 82.5% achieved a medicated IOP ≤ 16 and ≤18 mmHg, respectively. No severe complications were reported.Excisional goniotomy with KDB achieves a statistically significant IOP and antiglaucoma medication reduction in severe or refractory glaucoma over a period of 12 months. While its efficacy decreases with time, its favourable safety profile makes it a potentially useful primary or adjunctive procedure in high-risk eyes.

PRECIS Surgeons that perform cataract surgery combined with endocyclophotocoagulation (ECP) should rely on their preferred intraocular lens (IOL) calculation formula. There is no need to perform any correction to the IOL power, as this procedure does not modify the refractive outcome. PURPOSE The purpose of this study was to compare postoperative refractive outcomes in patients with glaucoma who underwent phacoemulsification and IOL implantation with or without ECP and the change in intraocular pressure (IOP) and number of antiglaucoma medications between groups. METHODS A cross-sectional study in which the medical records of the patients with any type of glaucoma, who underwent phacoemulsification with IOL implantation in the capsular bag in addition to ECP or as a standalone procedure from June 2016 to August 2019 were analyzed. Clinical data collected included axial length, steep, flat, and mean keratometry values, target spherical equivalent (SE) estimated by the SRK/T formula, manifest refraction SE at the 1-month follow-up, IOP, and number of antiglaucoma medications before and 12 months after surgery. Primary and secondary outcome measures were the mean predictive error (MPE), the postoperative SE, and the change in IOP after surgery in both groups, respectively. Significance was assessed using the Student t test for all variables between groups according to data distribution. P-values

BackgroundWe aim to describe the short-term effect of femtosecond laser-assisted cataract surgery (FLACS) in intraocular pressure (IOP), visual acuity (VA), number of hypotensive medications, and visual fields (VF) in glaucomatous eyes.MethodsSingle-center consecutive case series study included patients with a previous glaucoma diagnosis that needed cataract surgery alone or combined with incisional glaucoma procedure. IOP was measured during surgery immediately before and after pretreatment docking with an indentation tonometer. Changes in visual acuity (VA), IOP, number of medications, and VF were evaluated with a 90 day follow up.ResultsTwenty-seven eyes of 27 patients were included. Mean patient age was 70 years, 70% (n = 19) were female. Glaucoma diagnoses were: twelve patients with primary open-angle glaucoma, 13 with angle-closure glaucoma, and 2 with pseudoexfoliation glaucoma. Twenty-one patients underwent cataract surgery alone and 6 combined with an incisional glaucoma procedure (trabeculectomy or glaucoma drainage device implantation). We found no significant differences between pre-docking IOP (17.59 mmHg ± 6.25 SD) and post-docking IOP (17.23 mmHg ± 7.74 SD) p = 0.7. No surgical complications were recorded. The 90-day postoperative follow up revealed no changes from baseline regarding VF mean deviation, mean IOP, and the number of glaucoma medications decreased in both groups.ConclusionFLACS appears to perform well in the short-term in eyes with glaucoma undergoing cataract surgery alone or with an incisional glaucoma procedure. Comparable outcomes to manual phacoemulsification were obtained regarding IOP, VA, and postoperative period evolution.Clinical SignificanceSafety and efficacy of FLACS have not been properly studied in the glaucoma population, we present a case series with different glaucoma diagnoses who underwent FLACS alone or with an incisional glaucoma procedure.

Precis The prevalence of depression in Mexican patients with glaucoma is higher than that reported in the general population. Depression prevalence and severity are directly associated with glaucoma severity and lower adherence to medical treatment. Purpose To determine the prevalence of depression in patients with glaucoma and to describe the correlation between the severity of depression, glaucoma, and treatment adherence. Patients and methods This cross-sectional study included 111 patients with glaucoma who answered the Beck Depression Inventory (BDI)-II and the Morisky-Green questionnaire that evaluated their depression severity and medical treatment adherence. Low treatment adherence was defined as having a score of >2 on the Morisky-Green questionnaire. Analysis of variance, Fisher exact test, and linear regression models were used for statistical analyses. The main outcomes were prevalence of depression, prevalence of depression according to glaucoma damage, and the association between depression severity, medical treatment adherence, and glaucoma damage. Results The average patient age was 67.6±13.8 years. The prevalence of depression was 50.4%. Analysis of variance revealed a statistically significant association between glaucoma severity of the "worse eye" and the BDI raw score. In the "better eye," there was no statistically significant difference in mean BDI raw scores across glaucoma severity categories. There was a statistically significant association between the presence of depression and the level of treatment adherence after adjusting for age, sex, type of glaucoma, and the glaucoma severity in both eyes. The risk of low treatment adherence in patients with depression was 38 times that of patients with no depression. Conclusion Glaucoma is associated with a prevalence of depression nearly 10 times higher than that in the general population. Glaucoma, depression severity, and lower adherence to medical treatment are associated.

PURPOSE The purpose of the study is to describe short-term efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma. METHOD Retrospective multicentric case series of 53 eyes with severe or refractory glaucoma as defined by ICD-10 conducted in the United States, Mexico, and Switzerland. Primary efficacy outcome was a ≥20% decrease in intraocular pressure (IOP) from baseline at 6 months. Secondary efficacy outcome measures were probability of achieving an IOP≤14 or 18 mm Hg at 6 months and the mean IOP change from baseline at 6 months. Medication use required to obtain target IOP at last follow up and adverse effects were analyzed. RESULTS The proportion of eyes achieving an IOP reduction of >20% from preoperative baseline at 6 months was 57.7% (n=30). The mean IOP decreased from 18.4±6.1 mm Hg at baseline to 13.9±3.5 mm Hg at month 6 (23.9% reduction; P

Introduction The aim of this prospective crossover study was to evaluate the non-inferiority of PRO-122 (a preservative-free fixed combination) compared with 0.5% timolol + 0.2% brimonidine + 2.0% dorzolamide fixed combination (KOF) by evaluating its efficacy, tolerability and safety in subjects with controlled primary open-angle glaucoma (POAG) previously treated with KOF for at least 2 months. Methods In a prospective, crossover, randomized, double-masked multicenter study, patients previously treated with KOF were randomly assigned to receive either PRO-122 or KOF for 30 days. On day 31, the A sequence changed to KOF, while the B sequence received PRO-122. All patients remained in the protocol for 30 additional days for a total of 60 days. The main efficacy endpoint was maintaining the controlled intraocular pressure (IOP). The safety and tolerability of both products were assessed by the presence of adverse events (AEs), ocular findings, a questionnaire on ocular comfort and the VF-14 index. Results A total of 51 patients participated. After application of PRO-122 twice a day, its efficacy was demonstrated through maintenance of the controlled IOP in patients previously controlled with KOF. The crossover between PRO-122 and KOF and vice versa, after 30 days of use, did not affect IOP control. PRO-122 was shown not to be inferior to KOF in maintaining IOP at control levels. The safety of both drugs is similar, as neither presented drug-related AEs or differences regarding safety issues. The tolerability of the two medications—evaluated by ocular findings, the questionnaire on ocular comfort and the VF-14 index—was also determined to be similar. Conclusions The controlled IOP in patients with controlled POAG treated with PRO-122 was maintained both in relation to the initial controlled IOP of the study and when compared with KOF in the B sequence. Finally, the treatment with PRO-122 demonstrated similar safety and tolerability to KOF. Funding Laboratorios Sophia, S.A. de C.V. (Zapopan, Jalisco, México). Trial Registration ClinicalTrials.gov identifier: NCT03257813 (registered retrospectively).

Aim To describe the demographic characteristics, ocular comorbidities, and clinical outcomes of patients with neovascular glaucoma (NVG) and to determine the number of patients who returned for a follow-up eye examination. Materials and methods We examined the clinical data of patients with NVG, who attended a glaucoma clinic between July 2010 and November 2014. We collected information on the demographic characteristics of the patients to include the level of education, ocular comorbidities, NVG stage, visual acuity, glaucoma medications, intraocular pressure (IOP), and the number of patients who had a follow-up ocular examination at month 1, 3, 6, and 12. Results Data from 350 patients (473 eyes) with NVG were collected. We found 91% of the cohort had proliferative diabetic retinopathy (PDR). We found blindness in both or one eye in 14% and 31% of the cohort respectively. Low vision was found in both or one eye in 14% and 32% of the eyes respectively. By 6 months follow-up, only 32% of the patients were seen at our clinic and by 12 months follow-up, this number decreased to 15%. Around 60% of the patients were on no IOP lowering drugs at the first visit. We found 53% of the cohort had an incomplete elementary school education. Conclusion The results suggest that advanced NVG is a significant ocular problem for patients referred to our clinic with just over half of the patients presenting as blind. We also found that several socioeconomic factors that had an important role in the development of PDR and NVG, specifically, educational status. Clinical significance We described the characteristics of a large cohort of patients with very advanced NVG, reflecting the fact that the strict control of the underlying disease must be the main goal of the Mexican national health system. How to cite this article Lazcano-Gomez G, Soohoo JR, Lynch A, Bonell LN, Martinez K, Turati M, Gonzalez-Salinas R, Jimenez-Roman J, Kahook MY. Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico. J Curr Glaucoma Pract 2017;11(2):48-51.

Objective To prospectively evaluate the safety and efficacy of the Ahmed glaucoma valve model M4 (high density porous polyethylene plate; Medpor) compared with the model S2 (polypropylene plate). Method Mexican patients with neovascular glaucoma were randomly included for each group (M4 and S2). They were operated on using conventional techniques and creating a sub-episcleral tunnel to place the valve tube in the anterior chamber. After one year of follow-up, the results were evaluated with respect to a post-operative reduction in pressure, changes in visual acuity, the need for drugs, and complications, as well as the demographic characteristics of each group. Each operation using the M4 valve was performed by a single surgeon (FGC). Those operated on using the S2 model had their surgery performed by the staff surgeons at the Glaucoma Department of the Mexican Association to Prevent Blindness (APEC). Results Each group (M4 and S2) contained 21 eyes of 21 Mexican patients with a diagnosis of neovascular glaucoma, leading to a total of 42 patients undergoing surgery. The mean preoperative intraocular pressure (IOP) was 43.5 (±11.8), and 42.24 (±12.84) mmHg for the M4 and S2 groups, respectively. After one year of follow-up, the IOP reported was 18.9 (±9.7) mmHg for the final 18 patients in the M4 group, and 16.38 (±9.76) mmHg for the 21 patients in the S2 group. Discussion The design of a drainage valve device such as that of Ahmed has characteristics such as moderate control of IOP, thanks to the valve component in the immediate post-operative period, which makes them safer than other non-valve devices. This avoids an excess of flat chambers and the presence of low IOPs, which can lead to bleeding in the early post-operative period due to the weak desmosomal junctions of the newly formed vessels, with the advantage of maintaining suitable control of IOP from the first day after surgery. Conclusion Further studies with longer follow-up with a larger number of patients are needed to evaluate the effectiveness of this porous coating in the control of neovascular glaucoma.

Resumen Objetivo El objetivo de este estudio fue evaluar de forma prospectiva la seguridad y eficacia del dispositivo valvulado de Ahmed modelo M4 (sistema valvular convencional en plato de polietileno poroso de alta densidad, Medpor) comparado con el modelo S2 (plato de polipropileno). Metodo Se formaron 2 grupos de pacientes con glaucoma neovascular. Un grupo en el que se implanto el dispositivo M4 y el grupo en el que se implanto el dispositivo S2. En ambos grupos (M4 y S2) se incluyo a pacientes mestizos mexicanos. Dichos pacientes fueron intervenidos quirurgicamente, utilizando la tecnica convencional consistente en la fijacion escleral del cuerpo valvular en el cuadrante temporal superior a 8 mm del limbo y realizando un tunel subepiescleral para colocar el tubo del dispositivo dentro de la camara anterior, de acuerdo con la tecnica descrita por nuestro grupo en forma previa. Despues de un ano de seguimiento los resultados fueron evaluados tomando en cuenta la reduccion de la presion intraocular (PIO), los cambios en la agudeza visual, el uso de hipotensores oculares complementarios y las complicaciones aparecidas, asi como las caracteristicas demograficas de cada grupo. En el caso del modelo M4, los procedimientos quirurgicos fueron realizados por el mismo cirujano (FGC). Los pacientes en los que se implanto el modelo S2 fueron operados por diversos cirujanos, incluyendo a FGC, del Servicio de Glaucoma del Hospital Dr. Luis Sanchez Bulnes de la Asociacion para Evitar la Ceguera en Mexico (APEC). Resultados En cada uno de los 2 grupos se operaron 21 ojos de 21 pacientes con diagnostico de glaucoma neovascular, conformando los 42 ojos incluidos en este estudio. La PIO promedio en el preoperatorio fue de 43,5 mmHg (±11,8) para el grupo de M4 y de 42,24 mmHg (±12,84) para el grupo de S2. Despues de un ano de seguimiento, la PIO reportada fue 18,9 mmHg (±9,7) para el grupo de M4 y 16,38 mmHg (±9,76) para el grupo de S2. Conclusiones Creemos que es necesario efectuar un mayor numero de estudios a largo plazo con un numero mayor de pacientes, para poder evaluar la ayuda de esta cubierta porosa en el control tensional de los pacientes con el diagnostico de GNV.

Prostaglandin analogues (PGAs) have become the first-line therapy for patients with glaucoma.1 PGAs promote aqueous humor outflow by the uveoscleral pathway and, to a lesser extent, through the trabecular meshwork and Schlemm’s canal, which are part of the conventional pathway.2 This effect is due to connective tissue remodeling by active metalloproteinases in the ciliary body and trabecular meshwork.3 Recent studies suggest that corneal biomechanical properties may provide important information about glaucoma progression, such as increased deformation of the optic nerve surface.4 Corneal hysteresis (CH) is considered to be a direct measurement of corneal biomechanical properties, with central corneal thickness (CCT) being one of the factors directly related to it.5 Corneal resistance factor (CRF) is also believed to be useful in predicting glaucoma progression and may be correlated with CCT.6,7 Recently Tsikripis et al8 prospectively analyzed the effect of latanoprost and latanoprost/timolol combination on corneal biomechanical properties and CCT and concluded that low CH and a thin cornea may lead to underestimation of intraocular pressure (IOP); they suggested that the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Depew, NY) be used in combination with Goldmann applanation tonometry (GAT) to obtain more accurate and reliable IOP values. Multiple articles have analyzed the effects on corneal biomechanics of specific PGAs, including latanoprost or bimatoprost.9 Agarwal et al10 retrospectively compared the relationship between CH and the magnitude of IOP reduction with PGA, and they found that baseline CH is independently associated with the magnitude of IOP reduction with PGA therapy. Experimental studies have demonstrated that PGAs alter corneal collagen structure and affect CCT.10 These changes imply that results of GAT could be affected by PGA treatment.11–13 In a study of 136 human eyes, Schlote et al12 found that topical therapy with travoprost was accompanied by a significant reduction of CCT within 1 year of treatment. In a study with F2α prostaglandin, Viestenz et al found that CCT in PGA-treated eyes decreased significantly, suggesting that these changes might be attributed to effects of F2α PGA on the extracellular matrix of corneal stroma via upregulation of matrix metalloproteinases.13 It is not known whether PGAs induce changes in corneal biomechanical structure or, subsequently, affect GAT measures, which assume that there is minimal variation due to the biomechanical properties of the cornea and to CCT. However, in clinical practice, corneal thinning under local effect of PGA treatment could result in underestimation of IOP levels as measured by applanation tonometry.14,15 Bergonzi et al16 used A-scan laser confocal microscopy to analyze 52 eyes that had only been on PGA therapy for 3 years and concluded that PGA therapy increased the keratocyte density in each layer of corneal stroma but more significantly in the anterior stroma than in the midstroma or the posterior stroma. The increased keratocyte density might be the result of diminished extracellular matrix, possibly owing to the activation of matrix metalloproteinases and inhibition of their tissue inhibitors.17 The current interest in improving methods of IOP measurement has led to study of the influence of corneal biomechanical properties on the development of glaucoma. The Ocular Response Analyzer performs measurements of corneal properties such as corneal hysteresis (CH) and corneal resistance factor (CRF) and incorporates both Goldmann-correlated IOP (IOPg) and corneal-corrected IOP (IOPcc), a measurement that is minimally influenced by corneal properties.17 CH is defined as the difference between the air-jet pressure at inward and outward applanation and is considered to be a measure of corneal viscous damping and thus the cornea’s resistance to deformation.18–20 Lower CH values have been linked with progression of visual fields in primary open-angle glaucoma (POAG); lower CH values, with worse visual field damage in patients with asymmetric POAG.11 The purpose of the present study was to determine whether topical application of travoprost 0.004% induces changes in corneal structure and biomechanical properties affecting intraocular pressure measures in rabbits.

Introduction To describe the 12-month efficacy and safety of goniotomy performed using the Kahook Dual Blade (KDB) in combination with cataract surgery in eyes with medically treated open-angle glaucoma (OAG). Methods This was a prospective, interventional case series conducted at seven centers in North America. Consecutive patients with medically treated OAG and visually significant cataract underwent phacoemulsification combined with goniotomy (PE + goniotomy) using KDB. Indications for glaucoma surgery included reduction of intraocular pressure (IOP) and reduction of IOP-lowering medications. De-identified data were collected and included pre-, intra-, and postoperative data on IOP, the use of IOP-lowering medications, and adverse events through 12 months of follow-up. Results Among 52 eyes undergoing surgery, mean IOP was reduced from 16.8 ± 0.6 mmHg at baseline to 12.4 ± 0.3 mmHg at month 12 (P 10 mmHg (n = 2, 3.8%). Conclusion PE + goniotomy using the KDB significantly lowers both IOP and dependence on IOP-lowering medications in eyes with OAG. Adverse events were not sight-threatening and typically resolved spontaneously. Funding New World Medical, Inc.

The objective of this study is to evaluate the efficacy and safety of a second Ahmed glaucoma valve (AGV) in eyes with refractory glaucoma that had undergone prior Ahmed device implantation. This multicenter, retrospective study evaluated 58 eyes (58 patients) that underwent a second AGV (model S2-n = 50, model FP7-n = 8) due to uncontrolled IOP under maximal medical therapy. Outcome measures included IOP, visual acuity, number of glaucoma medications, and postoperative complications. Success was defined as IOP

Purpose: To assess the effect of patient education on videotaped topical instillation of artificial tear drops on subsequent topical instillation. Materials and methods: Forty-five patients, who had been using glaucoma drops for at least 6 months and with a best-corrected visual acuity of 20/100 or better, were studied. The patients were asked to instill an artificial tear drop using their accustomed technique while being video recorded. The patients viewed the recordings, and the errors in their drop instillation method were pointed out. This was followed by an educational session on proper drop instillation technique. After 30 minutes, patients were videotaped instilling drops to ascertain the effect of the educational session. The variables compared were: number of drops instilled, number of drops reaching the ocular surface, and the number of times the tip of the medication bottle touched the eye or ocular adnexa. Results: Before the instruction session, patients squeezed an average of 1.5 ± 0.9 drops from the bottle, and the average number of drops reaching the conjunctival fornix was 0.9 ± 0.7. The tip of the bottle touched the ocular adnexa in 29/45 (64.4%) patients. After the education session, the patients squeezed an average of 1.2 ± 0.5 drops and an average of 1.2 ± 0.4 drops reached the conjunctival fornix. The tip of the bottle touched the ocular adnexa in 13/45 (28.9%) patients. With proper instructions, the percentage of patients that instilled just one drop on the eye increased from 66 to 82%. Conclusion: A single educational session on the proper use of topical drops improves the successful instillation of eye drops. However, it was not determined whether the patients will retain the improved instillation technique for long-term or if the intervention results in only a short-term improvement. How to cite this article: Lazcano-Gomez G, Castillejos A, Kahook M, Jimenez-Roman J, Gonzalez-Salinas R. Video-graphic Assessment of Glaucoma Drop Instillation. J Curr Glaucoma Pract 2015;9(2):47-50.

Purpose: To describe clinical results of Ahmed glaucoma valve implantation in Mexican patients with neovascular glaucoma (NVG). Materials and methods: We reviewed records of 60 eyes of 60 patients with NVG who underwent Ahmed valve implantation, with a follow-up period of 1 year. We identified successful and failed cases and compared baseline and follow-up characteristics to identify possible differences between both groups. Results: We classified 36 eyes (60%) as successful and 24 (40%) as failed cases. We found a significant difference in success rate in patients who had a hypertensive phase at any time during the follow-up period (OR = 5.15, CI = 1.49-20.15, p = 0.004). Patients in the success group showed a statistically significant decrease in the number of glaucoma medications 1 year after surgery (p

AIM: To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS: The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P

Aim To determine the glaucoma specialists' preferences for the different brands of topical glaucoma medications available in Mexico. Materials and methods A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice. Results Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists' preferences. Conclusion Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option. Clinical significance This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition. How to cite this article Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez-Arroyo J, Castañeda-Diez R, Castillejos-Chevez A, Gonzalez-Salinas R, Dominguez-Dueñas F, Jimenez-Roman J. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico. J Curr Glaucoma Pract 2017;11(3):97-100.

ResumenLa ciclodiálisis resulta de la separación del cuerpo ciliar del espolón escleral, permitiendo la comunicación entre la cámara anterior y el espacio supracoroideo. Es un padecimiento raro que puede causar disminución grave de visión, secundaria a hipotonía crónica. Se presenta principalmente como consecuencia de traumatismos accidentales o quirúrgicos.El diagnóstico como el manejo de estos casos resulta difícil, requiriendo tener un alto nivel de sospecha y un seguimiento estrecho. La gonioscopía detallada logra el diagnóstico la mayor de las veces, sin embargo ésta puede resultar difícil por la presencia de cámara plana, hipema u otras alteraciones anatómicas secundarias al evento traumático o bien que contraindiquen la exploración gonioscópica como la presencia de sangrado reciente en cámara anterior. La ultrabiomicroscopía y la tomografía de coherencia óptica (oCT) del segmento anterior permiten un diagnóstico preciso con mínima invasión.Existen muchas posibilidades terapéuticas desde las menos invasivas como son el tratamiento médico con ciclopléjicos, ciclofotocoagulación, criopexia, hasta las más invasivas como ciclopexia con sutura, indentación escleral anterior, vitrectomía y tamponamiento con gas.Tanto el diagnóstico como el tratamiento de la ciclodiálisis resultan complejos, debido a la rareza de esta entidad aún no se cuenta con el tratamiento de elección para estos casos. Por lo general son pacientes con riesgo de disminución irreversible de la visión, por lo que se deben agotar todas las alternativas terapéuticas para poder ofrecer el mejor tratamiento y seguimiento posible, como se observa en los siguientes casos clínicos.AbstractCiclodyalisis results from detachement of ciliary body to scleral spur enabling communication between the anterior chamber and the suprachoroidal space. it is a rare condition that can cause severe vision loss secondary to chronic hypotony. it occurs mainly as a result of accidental or surgical trauma. The diagnosis and management is difficult, needing a high level of suspicion and close monitoring.Detailed gonioscopy achieves diagnosis most of the time, however it can be difficult to perform by the presence of flat chamber, hyphema or other anatomical abnormalities secondary to the traumatic event or other causes that contraindicate gonioscopy as the presence of recent bleeding of the anterior chamber. The ultrabiomicroscopy and optical coherence tomography (oCT) of the anterior segment allow an accurate diagnosis with minimal invasion.There are many possibilities from least invasive treatment such as medical treatment with cycloplegic, cyclophotocoagulation, criociclopexy to the more invasive as cyclopexy suture, anterior scleral buckling, vitrectomy and gas tamponade.Both the diagnosis and treatment of cyclodialysis is complex, due to the rarity of this entity is still no gold standard treatment for these cases. They are usually patients with increased risk of irreversible vision loss needing exhaust all treatment options to offer the best possible treatment and monitoring, as you can review in the next clinical cases.

Aim To compare the 24 h intraocular pressure (IOP), blood pressure (BP), and perfusion pressure (PP) of primary open-angle glaucoma (POAG) patients and healthy individuals. Methods 24 healthy individuals and 29 POAG patients underwent IOP and BP measurements every 2 h, starting at 08:00 until 06:00 of the next morning. IOP measurements were made by a masked observer with a Goldmann tonometer at the slit-lamp from 08:00 to 22:00 and with the Perkins tonometer in supine position from 24:00 to 06:00. Systolic and diastolic BP (SBP and DBP) measurements were performed with an automated device. Results Mean IOPs in POAG patients were significantly higher at all time intervals (p

Fixed-combination ocular hypotensives have multiple advantages, but triple-therapy dorzolamide/brimonidine/timolol (dorz/brim/tim) is only available in Latin and South America, and information on its relative efficacy is limited. This study compares the efficacy and tolerability of fixed-combination bimatoprost/timolol (bim/tim) and dorz/brim/tim in Mexican patients with primary open-angle glaucoma or ocular hypertension. In this investigator-masked, crossover study, patients with unmet target intraocular pressure (IOP) on once-daily bim/tim or twice-daily dorz/brim/tim received the opposite medication for 3 months before returning to their pre-baseline medication for 3 months. IOP was evaluated before and after morning instillation at months 2, 3, 5 and 6. Primary endpoints were mean IOP change and Ocular Surface Disease Index© (OSDI) score at each visit. The intent-to-treat population was the a priori analysis population, but due to the number of discontinuations, the per-protocol and intent-to-treat populations were used for the primary efficacy and sensitivity analyses, respectively. Seventy-eight and 56 patients were included in the intent-to-treat and per-protocol populations, respectively. At month 3, statistically significant IOP reductions from baseline were observed in the bim/tim (P

The aim of the study was to disclose a realistic estimate of primary open-angle glaucoma treatment, follow-up costs, and patients’ monthly glaucoma-economic burden in an ophthalmology hospital in Mexico City. Prospective survey of 462 primary open-angle glaucoma patients from 2007 to 2012 was carried out. Costs from visits, glaucoma follow-up studies, laser, and glaucoma surgical procedures were obtained from hospital pricings. Education, employment, and monthly income were interrogated. Total cost was divided into hypotensive treatment cost, nonpharmacologic treatment cost (laser and surgeries), and follow-up studies and consults. Average wholesale price for drugs analyzed was obtained from IMS Health data; monthly cost was calculated using: Monthly cost = ([average wholesale price/number of drops per eye dropper] × number of daily applications) × 30 days. Patients were classified according to their glaucoma severity, and data were analyzed based on monthly income (average annual exchange rate: 12.85 Mexican pesos = 1 USD). The mean age was 70 ± 10 years, women = 81%, elementary school = 39%, and unemployed = 53%. Low-income group = 266 patients (57%), 146 with mild glaucoma; moderate-income group = 176 patients (38%), 81 with mild glaucoma; high-income group = 20 patients (4.3%), 10 with mild glaucoma. Patients’ monthly average economic burden in glaucoma treatment: low-income patients = 61.5%, moderate-income patients = 19.5%, and high-income patients = 7.9%. Glaucoma-economic burden is substantial not only for health systems, but for the family and the patient. Therefore, screening plans for earlier diagnosis, and health policies that lessen the cost of disease management and increase adherence to treatment, and reduce the prevalence of blindness attributed to glaucoma are essential. These would improve quality of life, reduce personal and national expenditure, and help increase national economy.

Recently, a new latanoprost ophthalmic solution containing cyclodextrins was developed. The purpose of the present work was to compare the stability, clinical efficacy, and adverse effect profile of this formulation with the innovator product. The innovator formulation was stable at 4 degrees C but exhibited degradation at higher temperatures, whereas the cyclodextrin-containing formulation was stable at temperatures up to 40 degrees C. Formulations were assayed in a randomized double-blind clinical study in patients with primary open-angle glaucoma and/or ocular hypertension. Both latanoprost ophthalmic solutions produced comparable reduction of intraocular pressure. Conjunctival hyperemia was observed in 11.9% and 11.3% of the patients treated with the innovator and the cyclodextrin-containing formulations, respectively. There were no significant differences between the 2 ophthalmic solutions in efficacy or in the measured adverse effect. It is concluded that these 2 latanoprost ophthalmic solutions yield comparable efficacy and adverse effect outcomes. The cyclodextrin-containing formulation, however, has an improved stability.

ResumenObjetivoEvaluar la eficacia y la seguridad de la cirugía de catarata con láser de femtosegundo en pacientes con glaucoma.MétodosSe realizó un estudio retrospectivo en los pacientes sometidos a cirugía de catarata mediante láser de femtosegundo. El estudio incluyó de forma consecutiva aquellos pacientes con glaucoma, sometidos a cirugía de catarata asistida por láser de femtosegundo entre enero de 2012 y diciembre de 2013 por un cirujano con experiencia. Se recogieron datos demográficos del paciente, datos preoperatorios, datos postoperatorios y las complicaciones postoperatorias. La agudeza visual se midió mediante el test de logarithm of the minimum angle resolution (logMAR).ResultadosVeinticuatro pacientes, 6 (25%) varones y 18 (75%) mujeres, fueron incluidos en el estudio. La agudeza visual media (desviación estándar) mejoró significativamente de 1.3 (0.78) a 0.55 (0.59), p=0.010. El acontecimiento adverso más frecuentemente observado fue la hemorragia subconjuntival en 7 (29%) pacientes. Un paciente presentó una rotura de la cápsula posterior que requirió una vitrectomía.ConclusiónLos resultados de nuestro estudio sugieren que la cirugía de catarata asistida con láser de femtosegundo puede ser una opción eficaz y segura en los pacientes con glaucoma. Una selección adecuada de los pacientes es esencial para el resultado de la técnica.AbstractObjectiveTo evaluate the efficacy and safety of femtosecond laser-assisted cataract surgery in patients with glaucoma.MethodsA retrospective study was conducted on patients with glaucoma underwent cataract surgery by means of a femtosecond laser-assisted surgery. The study included consecutive glaucoma patients undergoing femtosecond Laser-assisted cataract surgery between January 2012 and December 2013 by one experienced surgeon. Data were collected about patient demographics, preoperative investigations, postoperative data, and postoperative complications. Visual acuity was assessed with the logarithm of the minimum angle resolution [logMAR]) test.Results24 subjects, 6 (25%) men and 18 (75%) women, were included in the study. Mean (Standard deviation) visual acuity significantly improve from 1.3 (0.78) to 0.55 (0.59), P=0.010. The most frequently observed adverse event was subconjuctival hemorrhage in 7 (29%) patients. One patient had a posterior capsular rupture that required vitrectomy.ConclusionThe results of our study suggest that femtosecond laser-assisted cataract surgery may be an effective and safe option in glaucoma patients. Appropriate patient selection is essential to the outcome of the technique.

ResumenObjetivoDeterminar el astigmatismo corneal que se induce en pacientes postoperados de facoemulsificación con implante de lente intraocular y trabeculectomía.MétodosEstudio retrospectivo de pacientes operados por un mismo cirujano, se evaluaron los cambios en las queratometrías a los 6 meses y al año mediante análisis escalar y vectorial.ResultadosSe incluyeron en el estudio a 28 pacientes, 4 (14.3%) varones y 24 (85.7%) mujeres. La media de edad fue de 75.6 años (±6.8). En la evaluación de astigmatismos corneales prequirúrgicos se encontraron: 64.3% de los pacientes con astigmatismo contra la regla, 28.6% con astigmatismo con la regla y 7.1% con astigmatismo oblicuo. En el análisis escalar el astigmatismo quirúrgico inducido a los 6 meses fue –0.437 dioptrías (D) (±0.35) y al año fue –0.434 D (±0.43). Tanto a los 6 meses, como al año el valor máximo de astigmatismo inducido fue –1.5 D. Mediante análisis vectorial la media del astigmatismo quirúrgicamente inducido fue –0.83 D (±0.73) a 81.07° a los 6 meses y –0.86 D (±0.71) a 89.3° al año. Los valores máximos de astigmatismo inducido fueron –2.83 y –2.26 a los 6 meses y al año, respectivamente. Se observó que se indujo un cambio del astigmatismo con la regla.ConclusionesLos cambios detectados en la curvatura corneal posteriores a la cirugía de facoemulsificación con microincisión y trabeculectomía, por diferentes puertos corresponden a casi una D queratométrica de cambio con dirección a la incisión de la trabeculectomía.AbstractObjectiveTo determine the corneal astigmatism induced in patients after phacoemulsification with intraocular lens implantation and trabeculectomy. Keratometric changes were measured with an automated keratometer, patients were evaluated for a period of one year follow-up.MethodsObservational retrospective study. Changes in keratometry were evaluated at 6 months and 1 year using scalar and vector analysis. All surgeries were performed by the same expert surgeon.Results28 patients were included in this study, 4 (14.3%) men and 24 (85.7%) women. The mean age was 75.6 years (±6.8). Preoperative evaluation of corneal astigmatism revealed that 64.3% against-therule, 28.6% of patients had a with-the-rule, and 7.1% had an oblique astigmatism. In the scalar analysis, surgical induced astigmatism at 6 months was –0.437 diopters (D) (±0.35) and –0.434 D at 1 year (±0.43). Both at 6 months and 1 year, the maximum value of induced astigmatism was –1.5 D. Through vector analysis, the average of the surgically induced astigmatism was –0.83 D (±0.73) and the axis was 81.07° at 6 months and –0.86 D (±0.71) and the axis was 89.3° at 1 year. The maximum values of induced astigmatism were –2.83 and –2.26 at 6 months and 1 year respectively.ConclusionsThe changes detected in astigmatism following microincisional phacoemulsification and trabeculectomy correspond to about one diopter keratometric change the direction of the incisión trabeculectomy.

La medicación tópica continúa siendo la primera línea de tratamiento para glaucoma, sin embargo, la liberación sostenida de fármacos por vía tópica es difícil de lograr. La mayoría de los fármacos tienen pobre penetración de la córnea y son degradados rápidamente. En cambio, la administración de fármacos de manera sostenida mediante el uso de estructuras como liposomas, puede proveer al paciente una dosis óptima de fármaco, con una mínima toxicidad local y evitar inconvenientes como alergias debidas a la administración diaria del fármaco. Este proyecto de tesis se centró en la obtención de liposomas de fosfatidilcolina (PC) con polietilenglicol (PEG) y Travoprost (fármaco) por la técnica de rehidratación seguida de extrusión. Para lo cual se evaluaron tres relaciones molares (fármaco/fosfolípido) de 0.04, 0.1 y 0.18 en la obtención de los liposomas. Así mismo re realizó las caracterización de los liposomas pegilados (morfología, tamaño, carga de superficie, estabilidad y eficiencia de encapsulación del fármaco) mediante el usos de las técnicas experimentales como Microscopía Óptica de Contraste de Interferencia Diferencial (DIC), Microscopía Electrónica de Transmisión (TEM) con tinción negativa, Dispersión Dinámica de la Luz (DLS), velocimetría Doppler (potencial Z) y Cromatografía líquida de alta resolución (HPLC). En base a los resultados se notó que la técnica de obtención de los liposomas (rehidratación–extrusión) permite controlar el tamaño de éstos. También se observó que la incorporación de PEG (peso molecular de 2000 g/mol) estabiliza xi el sistema liposoma-Travoprost, permitiendo que su tamaño y forma permanezcan sin cambios significativos durante un periodo de 4 semanas. Así mismo se logró un porcentaje promedio de incorporación del fármaco (Travoprost) del 90% (en base al inicial) en la membrana del liposoma pegilado. La relación molar fármaco/fosfolípido de 0.1 fue la más estable y se propone ésta para la obtención de liposomas para estudios posteriores en modelos animales.