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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

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.

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.

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.

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.

ResumenObjetivosEvaluar los resultados de las pruebas de sobrecarga hídrica (SH) y estimación de presión intraocular o prueba de Borrone, en pacientes con glaucoma primario de ángulo abierto comparándolos con el estudio de curva tensional horaria.Material y métodoA un mismo grupo de pacientes con diagnóstico de glaucoma primario de ángulo abierto se les realizó curva tensional horaria y se compararon los resultados de variabilidad de la presión intraocular con los obtenidos mediante la prueba de sobrecarga hídrica y con la prueba de Borrone.ResultadosLa variación promedio de la presión intraocular en la curva horaria tensional fue de 4.05±1.57mmHg, en la prueba de SH fue de 3.55±1.5mmHg y en el método de Borrone de 2.55±2.83mmHg. La diferencia entre la variación medida con curva diurna y Borrone fue estadísticamente significativa (p=0.025). La diferencia entre la variación medida con la curva horaria y SH no fue estadísticamente significativa (p=0.374). Los resultados de las pruebas de Borrone y SH concordaron con la curva tensional horaria solamente en un 40% de los ojos cada una.AbstractObjetivesTo evaluate de results of the water drinking test and Borrone test in patients with primary open angle glaucoma, comparing it with 24hr tensional curve.Material and methodsTo the same group of patients a 24hr tensional curve was perfomed and the results were compared with the Borrone test and the water drinking test.ResultsThe average of intraocular pressure fluctuation was 4.05±1.57mmHg in the 24hr tensional curve, for the water drinking test was 3.55±1.5mmHg and for Borrone test was 2.55±2.83mmHg. The difference of the results between the 24hr tensional curve and Borrone test were statistically significant. The difference of the results between the 24hr tensional curve and water drinking test were not statistically significant. We observed just a 40% of concordance between both the Borrone test and water drinking test with the 24hr tensional curve.ConclusionsIn the present study the Borrone test and the water drinking test obtained a low correlation with the 24hr tensional curve which is considered the gold standard.