Search

Refractory Glaucoma is a kind of intractable eye disease with strong destruction and high blindness rate, the failure rate of which is very high.The mainly reason is fibroblasts hyperplasia and scarring on filtration mouth that hindered the drainage and diffusion of aqueous. Combined trabeculectomy, glaucoma drainage device implantation, and cyclophotocoagulation are the common surgical procedures for refractory glaucoma. So far, glaucoma drainage device implantation is regarded as the first-line choice. The authors focus on the clinical efficacy and prospect of the surgery way for refractory glaucoma.

Purpose To study primary congenital glaucoma characteristics and surgery in a University-based practice in Egypt. Patients and methods The present study was a retrospective chart review of 165 eyes of 112 children who presented and were operated upon between 2005 and 2012 at Alexandria Main University Hospital in Egypt. The charts were reviewed for demographics as well as clinical data. Postoperative data were retrieved till the end of the follow-up period. Complications were noted, and success rates were studied. Results The mean age±SD (range) of the study population at presentation was 6.1±4.4 (1–24) months, and of the follow-up period was 32.3±21.7 (6–78) months. The average (range) number of glaucoma procedures performed for each eye was 1.3 (1–4). The most common primary glaucoma surgical procedure performed was combined trabeculotomy–trabeculectomy with mitomycin C (143 procedures). The mean values (range) of preoperative intraocular pressure (on no intraocular pressure lowering therapy), corneal diameter and thickness, cup/disc ratio and axial length of the study eyes were 18.7±5.9 (5–36) mmHg, 12.8±0.9 (10–17) mm and 619.5±95.2 (433–784) μm, 0.6±0.2 (0–1) and 22.99±1.82 (17.0–30.59) mm, respectively, and postoperatively at last follow-up were 7.4±6.6 (0–46) mmHg, 13.0±0.9 (10–18) mm and 530.6±75.1 (425–823) μm, 0.3±0.3 (0–1) and 24.06±2.13 (20.55–30.75) mm, respectively. Cumulative success by Kaplan–Meier analysis was 0.97, 0.89, 0.83, 0.73 and 0.61 at 1, 2, 3, 4 and 5 years, respectively. Complications included corneal scarring, cataract, intraretinal haemorrhages, hypotony disc oedema, rhegmatogenous retinal detachment and endophthalmitis. Conclusion Combined trabeculotomy–trabeculectomy with mitomycin C is a successful treatment for primary congenital glaucoma. Meticulous, continuous and prolonged follow-up is mandatory for all operated cases to ensure long-term success.

Introduction: Optical coherence tomography (OCT) is a commonly used imaging modality that provides detailed cross-sectional retinal images. This has revolutionised management of neovascular age-related macular degeneration. The need for repeated anti-vascular endothelial growth factor injections has led to therapy being delivered using OCT-guided retreatment strategies with both qualitative OCT features of disease activity (e.g. macular fluid) and changes in retinal thickness as triggers for retreatment The purpose of this study is to determine the intra-session repeatability of retinal thickness and volume measurements using the Topcon 3DOCT-1000 spectral-domain optical coherence tomography (SDOCT) device in patients with neovascular age-related macular degeneration (nAMD). This is the largest study to date looking specifically at the Topcon 3DOCT-1000. Materials and Methods: Two SDOCT raster scans were performed by the same blinded observer in the same sitting in consecutive patients attending for nAMD treatment as part of standard validation of a new device. Retrospective analysis was undertaken, with retinal thickness and volume measurements automatically calculated by the onboard software for each Early Treatment of Diabetic Retinopathy Study subfield for each scan. Bland-Altman methods of analysis were used to assess repeatability. Results: Data from the 73 patients were analyzed with a mean age of 78 years (standard deviation 8). The 95% coefficient of repeatability (CR) was 64 μm and 0.050 mm 3 for retinal thickness and volume respectively in the central 1 mm macular subfield. The CR did not exceed 85 μm (0.30 mm 3 ) in any subfield. The revised CR for retinal thickness and volume for the subgroup of 37 patients with no segmentation error in the central 1 mm subfield was 53 μm and 0.050 mm 3 respectively. Discussion : We report relatively modest intra-sessional repeatability of SDOCT retinal thickness and volume metrics in patients with nAMD in a clinical setting. Though useful in detecting clinical change from measurement variability in clinical practice, these results suggest the precision of macular thickness measurement does not approach the theoretical resolution of SDOCT.

Aims: To compare the consistency and accuracy in ocular biometric measurements and intraocular lens (IOL) power calculations using the new optical low-coherence reflectometry and partial coherence interferometry. Subjects and Methods: The clinical data of 122 eyes of 72 cataract patients were analyzed retrospectively. All patients were measured with a new optical low-coherence reflectometry system, using the LENSTAR LS 900 (Haag Streit AG)/ALLEGRO BioGraph biometer (Wavelight., AG), and partial coherence interferometry (IOLMaster V.5.4 [Carl Zeiss., Meditec, AG]) before phacoemulsification and IOL implantation. Repeated measurements, as recommended by the manufacturers, were performed by the same examiner with both devices. Using the parameters of axial length (AL), corneal refractive power (K1 and K2), and anterior chamber depth (ACD), power calculations for AcrySof SA60AT IOL were compared between the two devices using five formulas. The target was emmetropia. Statistical analysis was performed using Statistical Package for the Social Sciences software (SPSS 13.0) with t-test as well as linear regression. A P value < 0.05 was considered to be statistically significant. Results: The mean age of 72 cataract patients was 64.6 years ± 13.4 [standard deviation]. Of the biometry parameters, K1, K2 and [K1 + K2]/2 values were significantly different between the two devices (mean difference, K1: −0.05 ± 0.21 D; K2: −0.12 ± 0.20 D; [K1 + K2]/2: −0.08 ± 0.14 D. P

A 2-year 7-month-old girl born out of a consanguineous marriage, presented at our facility with clinical features characterized by the eyelid triad of blepharophimosis, blepharoptosis and epicanthus inversus in association with hypertelorism, cleft palate and craniosynostosis. This constellation of features is suggestive of Michels syndrome. At the time of writing this report, there were only ten reported cases worldwide and to the best of our knowledge, there have been no published reports from India.

Purpose: The purpose was to investigate the efficacy and complications of nonvalved glaucoma drainage implant (GDI) surgery and GDI combined with trabeculectomy. Subjects and Methods: Serial Japanese patients who received GDI were retrospectively investigated. The survival rate of eyes was analyzed using the Kaplan-Meier method, defining death as: (1) Intraocular pressure (IOP)

Aims: To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives. Design: Cross-sectional observational study. Materials and Methods: A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey′s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2. Statistical Analysis: Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect. Results: There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1΍ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13-45%, P = 0.001) and glaucoma suspect (95% CI = 2-21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP. Conclusion: Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.

Aim: To study the safety and efficacy of sutureless femtosecond anterior lamellar keratoplasty (FALK) in patients with corneal stromal opacities. Materials and Methods: Eleven eyes of 11 consecutive patients with corneal stromal opacities involving < 250 μ due to various pathologies were included in the study. Preoperatively, all underwent anterior segment imaging with spectral domain optical coherence tomography (SD-OCT) (Bioptigen Inc., Durham, North Carolina, USA) to measure the depth of the stromal opacity. All patients underwent FALK, and bandage contact lens was placed for a period of 2 weeks. Postoperatively, uncorrected visual acuity, best corrected visual acuity (BCVA), and SD-OCT evaluation were performed. Results: All patients showed significant improvement in BCVA. The mean postoperative BCVA (in decimals) improved from 0.11 ± 0.06 preoperatively to 0.59 ± 0.08. There were no intraoperative or significant postoperative complications that were noticed. Conclusion: FALK is a safe and effective alternative to deep anterior lamellar keratoplasty or penetrating keratoplasty in the treatment of anterior stromal opacities.

Background: Both cataract surgery and anesthesia techniques are rapidly evolving to become more patient friendly. However, comparison of topical anesthesia (TA) and peribulbar anesthesia (PA) for phacoemulsification and cataract surgery is limited. We evaluated the clinical outcomes and patient and surgeon satisfaction between anesthetic techniques. Materials and Methods: This randomized clinical trial was conducted between January and June 2012. Patients were randomly assigned to TA and PA groups for surgery. Visual acuity at 4 weeks postoperatively, status of the cornea and the wound and intraoperative complications were compared between groups at day 1, and 1 and 4 weeks after surgery. Patients and the surgeon completed a close-ended questionnaire on satisfaction with analgesia and comfort. The relative risk (RR) with 95% confidence intervals (CI) was calculated. Result: There were 500 patients in each group. There were no significant differences between groups preoperatively. Complications at 1-day postoperatively were significantly greater in the TA group (RR = 1.36, 95% CI: 1.17-1.58). Satisfaction with the mitigation of pain was statistically significantly greater in the PA group compared to the TA group (χ2 = 10.9, df = 3, P = 0.001). Surgeons were more satisfied with PA compared to TA (RR = 1.4, 95% CI: 1.34-1.63). There were more anesthesia-related complications in the PA group compared to the TA group. Conclusions: Patients who underwent surgery with topical anesthetic experienced lower complications by more pain compared to patients who underwent PA. Topical anesthetic supplemented with analgesic medications could help the patient and surgeon during cataract surgery.

Purpose: The purpose of this study is to analyze the donor and tissue profile of a community eye bank in Eastern India. Materials and Methods: Eye bank records were analyzed for the period July 2007-June 2011. Variables analyzed included donor demographics (age, gender, and ethnicity), donor cause of death, consent for recovery, death-to-preservation interval, preservation-to-utilization interval, endothelial cell density (ECD), corneal suitability for transplantation, and corneal tissue utilization. Results: During this study period, 743 corneal tissues were retrieved from 373 donors (male:female = 263:110). The mean age of donors was 52 ± 21 years (range: 3-95 years). The most common donor age group was 41-50 and 71-80 years. Most of the donors belonged to one religious faith (99%). The most common causes of death were cardiorespiratory failure (34%) followed by road traffic accident (30%). Majority donors were motivated (n = 320; 86%), and remaining (n = 53; 14%) were voluntary. Most of the consents were given by sons or daughters of the deceased (45%) followed by siblings (18%). Mean death-to-preservation interval was 3.9 ± 1.9 h. Mean preservation-to-utilization interval was 56.0 ± 24.4 h. The mean ECD of donor corneal tissue was 2857 ± 551 cells/mm 2 and the median value was 2898 cells/mm 2 . Of harvested corneas 556 (75%) corneal tissues were utilized. The most common causes of nonutilization were septicemia in donor (n = 56; 30%) and poor quality of tissue (n = 55; 30%). Conclusions: Although, there is significant corneal tissue utilization, there is a need for increased awareness among people in order to augment voluntary donations.

We report a case of blebitis that occurred 3 years later following a combined glaucoma and cataract surgery. It was an atypical presentation, as patient had no classical fiery looking signs of blebitis despite the isolated organism being Pseudomonas aeruginosa. Improvized surgical techniques like use of Mitomycin C, releasable flap sutures though considered as part of the recommended procedure for better surgical outcomes, their role as potential risk factors for visually blinding complications like endophthalmitis are often overlooked. This case report throws light on such risk factors for bleb associated infections and recommends removal or trimming of all releasable sutures and the need for a regular postoperative follow-up.

We report a case of a 15-year-old boy who presented with profound visual loss and complete ophthalmoplegia after an uneventful spinal surgery for removal of cervical osteoblastoma. Postoperative visual loss following nonocular surgery is, fortunately rare, yet a devastating complication. The most common cause is ischemic optic neuropathy, but it can also be due to central retinal occlusion or cortical blindness. Visual loss in conjunction with ophthalmoplegia is rarely seen, and there are very few reports in the literature. We also review the related literature and highlight the mechanism and preventive measures.

In this paper, we report two cases of a 62-year-old patient presented with blurred vision and a 45-year-old male diagnosed with multiple myeloma who was referred from the Department of Oncology. Slit-lamp examination, in vivo confocal microscopy (IVCM), systemic work-up and serum protein electrophoresis were obtained. In both patients, slit-lamp findings revealed bilateral diffuse subepithelial and anterior stromal crystals and IVCM showed highly reflective deposits in the corneal epithelium and stroma. The first patient was eventually diagnosed with monoclonal gammopathy of undetermined significance following bone marrow biopsy and systemic evaluation. Unusual corneal deposits may constitute the first sign of monoclonal gammopathies. IVCM may be helpful in showing the crystalline nature of the corneal deposits and guiding the clinician to the diagnosis of gammopathies. Both ophthalmologists and oncologists should be aware that corneal deposits may herald a life-threatening hematologic disease.

Fundus imaging with a fundus camera is an essential part of ophthalmic practice. A mobile phone with its in-built camera and flash can be used to obtain fundus images of reasonable quality. The mobile phone can be used as an indirect ophthalmoscope when coupled with a condensing lens. It can be used as a direct ophthalmoscope after minimal modification, wherein the fundus can be viewed without an intervening lens in young patients with dilated pupils. Employing the ubiquitous mobile phone to obtain fundus images has the potential for mass screening, enables ophthalmologists without a fundus camera to document and share findings, is a tool for telemedicine and is rather inexpensive.

We report a case of large histopathologically proven melanocytoma of the ciliary body in a 15-year-old male, presented with rapid extraocular growth following incisional biopsy with scleral patch graft. We chose brachytherapy with Ruthenium 106 plaque over enucleation as the later was refused by the parents. The initial apical height of the tumor was 14.2 mm on ultrasonography. Two weeks after brachytherapy, the mass regressed to a size of 8.1 mm and 1 year later to 6.7 mm. This is the first case report showing the response of brachytherapy to ciliary body melanocytoma, which results in ocular and visual acuity salvation with considerable decreased in size of the tumor. The authors conclude that brachytherapy is an option in the management of non-resectable melanocytoma of the ciliary body.

Purpose To study primary congenital glaucoma characteristics and surgery in a University-based practice in Egypt. Patients and methods The present study was a retrospective chart review of 165 eyes of 112 children who presented and were operated upon between 2005 and 2012 at Alexandria Main University Hospital in Egypt. The charts were reviewed for demographics as well as clinical data. Postoperative data were retrieved till the end of the follow-up period. Complications were noted, and success rates were studied. Results The mean age±SD (range) of the study population at presentation was 6.1±4.4 (1-24) months, and of the follow-up period was 32.3±21.7 (6-78) months. The average (range) number of glaucoma procedures performed for each eye was 1.3 (1-4). The most common primary glaucoma surgical procedure performed was combined trabeculotomy-trabeculectomy with mitomycin C (143 procedures). The mean values (range) of preoperative intraocular pressure (on no intraocular pressure lowering therapy), corneal diameter and thickness, cup/disc ratio and axial length of the study eyes were 18.7±5.9 (5-36) mmHg, 12.8±0.9 (10-17) mm and 619.5±95.2 (433-784) µm, 0.6±0.2 (0-1) and 22.99±1.82 (17.0-30.59) mm, respectively, and postoperatively at last follow-up were 7.4±6.6 (0-46) mmHg, 13.0±0.9 (10-18)mm and 530.6±75.1 (425-823) µm, 0.3±0.3 (0-1) and 24.06±2.13 (20.55-30.75) mm, respectively. Cumulative success by Kaplan-Meier analysis was 0.97, 0.89, 0.83, 0.73 and 0.61 at 1, 2, 3, 4 and 5 years, respectively. Complications included corneal scarring, cataract, intraretinal haemorrhages, hypotony disc oedema, rhegmatogenous retinal detachment and endophthalmitis. Conclusion Combined trabeculotomy-trabeculectomy with mitomycinCisa successful treatment for primary congenital glaucoma. Meticulous, continuous and prolonged follow-up is mandatory for all operated cases to ensure long-term success. [ABSTRACT FROM AUTHOR]

AIM: To observe the clinical effect of bio-amnion implantation used in combined trabeculectomy for refractory glaucoma METHODS: Totally 86 eyes of 80 glaucoma patients were randomly divided into 2 groups. In experimental group, 43 eyes underwent trabeculectomy combined with bio-amnion implantation. In control group, 43 eyes only underwent trabeculectomy combined. The intraocular pressure(IOP), filtrative bleb and complications were observed. RESULTS: Following-up for 12 months, IOP: there was significant difference between the average IOP(15.5±1.1mmHg)in experimental group and the average IOP(19.7±2.5mmHg)in control group(P

A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF.

A 49-year-old woman developed a dark brown nodular mass in the lower eyelid. The lesion had grown fast for 2 months and then had remained stable in size. Excisional biopsy was performed. Histopathological examination of an excisional biopsy specimen pointed to proliferative vessels lined by increased endothelial cells without nuclear atypism. The nodular mass evaluated as a capillary hemangioma.