Safety and efficacy of Ahmed glaucoma valve implantation in refractory glaucomas in Northern Indian eyes

AbstractPurposeTo evaluate the safety and efficacy of Ahmed glaucoma valve (AGV) implantation in refractory glaucoma in Northern Indian eyes.BackgroundThe success rate of trabeculectomy remains low in cases of refractory glaucoma even with the use of antifibrotics. Glaucoma drainage devices have proven to be more efficacious in reducing intraocular pressure (IOP) in these glaucomas.MethodsRetrospective records of 55 consecutive patients who underwent AGV implantation at Dr. Shroff’s Charity Eye Hospital, New Delhi, India from January 2003 to December 2012 were reviewed. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications, number of prior incisional surgeries, visual acuity and IOP on medical treatment. Postoperative data included visual acuity and IOP on day one, 1week, 1month, 3months, 6months, 1year and yearly thereafter, number of anti-glaucoma medications, any complication or additional surgical intervention required. Success was defined as IOP >5 and <22mmHg with or without treatment.ResultsMean IOP decreased from 39.71±8.99 pre-operatively to 17.52±5.72mmHg at last follow-up (p<0.001) and number of medications reduced from 3.27±0.84 to 1.25±0.88 (p<0.001). Visual acuity remained within one Snellen line or improved at last follow-up in 47 cases (85.4%). The cumulative probability of success was 85.45% at 1year and 79.63% at 3years. The incidence of post-operative complications was 25.45%.ConclusionAGV implantation has proven to be safe and is effective in controlling IOP in refractory glaucoma in Northern Indian eyes

Management of Secondary Glaucoma, a Rising Challenge

Secondary glaucoma has increased exponentially in recent times. This is partially due to the increase in complex eye surgeries like corneal transplantation and vitreoretinal surgery and partly due to the increase in life style related diseases like diabetes causing an increase in the prevalence of neovascular glaucoma. The other leading causes of secondary glaucoma are post-trauma, post-cataract surgery, and lens-induced glaucoma. Secondary glaucoma is an important cause of visual morbidity. The management of this complex glaucoma is difficult as they are mostly intractable and do not respond to anti-glaucoma medications. Many patients who are not managed by medical management may require surgical intervention along with vigilant control of their primary pathology. This course would address the stepwise approach to the management of these glaucomas and the tips and tricks to tackle the nuances during management. This chapter would specifically address the management of neovascular glaucoma, Post-PK glaucoma, lens-induced glaucoma, traumatic glaucoma, and uveitic glaucoma

Cost-effectiveness of glaucoma screening in cataract camps versus opportunistic and passive screening in urban India: A study protocol [version 3; peer review: 2 approved]

India has an estimated 12 million people affected with glaucoma; however, no organised screening programme exists. Cases are usually detected opportunistically. This study documents the protocol for detecting glaucoma in suspects in cataract camps conducted by Shroff Charity Eye Hospital in North India. We report a cost-effectiveness alongside prospective study design of patients attending cataract camps where glaucoma screening will be integrated. The eligible population for glaucoma screening is non-cataract patients. Patients will undergo glaucoma screening by a trained optometrist using a pre-determined glaucoma screening algorithm. Specific diagnostic cut-off points will be used to identify glaucoma suspects. Suspected patients will be referred to the main hospital for confirmatory diagnosis and treatment. This group will be compared to a cohort of patients arriving from cataract camps conducted by the institute in similar areas and undergoing examination in the hospital. The third arm of the study includes patients arriving directly to the hospital for the first time. Cost data will be captured from both the screening components of cataract-only and glaucoma screening-integrated camps for screening invitation and screening costs. For all three arms, examination and treatment costs will be captured using bottom-up costing methods at the hospital. Detection rates will be calculated by dividing the number of new cases identified during the study by total number of cases examined. Median, average and range of costs across the three arms will be calculated for cost comparisons. Finally, cost-effectiveness analysis will be conducted comparing cost per case detected across the three arms from a quasi-societal perspective with a time horizon of 1 year. Ethics approval for the study has been obtained from the institutional ethics committee of the hospital. The study protocol will be useful for researchers and practitioners for conducting similar economic evaluation studies in their context

A unique case of bilateral nanophthalmos and pigmentary retinal abnormality with unilateral angle closure glaucoma and optic disc pit

Abstract Background Microophthalmos or ‘dwarf eye’ is characterized by an axial length 2 standard deviation less than age-matched controls. It is classified into nanophthalmos, relative anterior microphthalmos, and posterior microphthalmos based on the anterior segment: posterior segment ratio. Nanophthalmos can occur in association with optic disc drusen, foveoschisis, and retinitis pigmentosa, as an autosomal recessive syndrome linked to mutations in the MFRP gene. We report a case of bilateral nanophthalmos and pigmentary retinopathy with angle closure glaucoma and optic disc pit in one eye. We believe this to be the first case presenting with optic disc pit in association with nanophthalmos. Case presentation A 56-year-old female presented with bilateral small eyes, high hypermetropia, shallow anterior chamber depth, increased lens thickness, mid-peripheral retinal flecks, and macular edema. She also had high intraocular pressure in the right eye, with a disc cupping of 0.9 with an Optic disc pit. The macular edema in the right eye was found to occur in association with the Optic disc pit, whereas, in the left eye, it was associated with intra-retinal hemorrhages and diagnosed as macular branch retinal vein occlusion secondary to hypertension. She was started on anti-glaucoma medications in both eyes and planned for Anti-VEGF injection in the left eye. Conclusion This case report is unique as it reports an association of Nanophthalmos with Optic Disc pit, with an associated angle closure glaucoma in the same eye, an association which has never been previously reported in the literature

Acquired ectropion uveae: A case series

Acquired ectropion uveae (AEU) is a common sequela to various inflammatory and ischemic conditions, though it is not well recognized. There is a paucity of literature describing AEU. So here, we present five cases where we documented ectropion uveae following chronic inflammation. Patients with ectropion uveae following chronic inflammation and ischemia were retrospectively reviewed. Their medical records and clinical findings were analyzed. Five patients of various ages were found to have AEU, of which 1 was post trabeculectomy with phacoemulsification and posterior chamber intraocular lens, 1 following neovascular glaucoma (NVG), 1 following uveitic glaucoma, and 2 following iridocorneal endothelial syndrome. Patients with NVG and uveitic glaucoma also had undergone glaucoma filtration surgeries. AEU may be seen secondary to inflammatory and ischemic processes and should be looked for carefully as they may cause progressive glaucoma

Causes for Postponement of Cataract Surgery in a Peripheral Eye Hospital

Objective: To study the common causes leading to postponement of cataract surgery in a peripheral eye hospital.Design: Retrospective secondary data analysis of patients who underwent cataract surgery from 1 January 2015 to 31 December 2017.Method: All adult patients diagnosed with cataract and posted for cataract surgery from 1 January 2015 to 31 December 2017 and were cancelled on the day or 24 hours before the intended procedure were included in the study. The causes for cancellation were retrieved from the patient files. Pareto analysis was done to find out the most common causes for the cancellation.Results: 14113 patients were posted for cataract surgery from 1st January 2015 to 31st December 2017, of which 13265 patient underwent cataract surgery while 848 patients were cancelled within 24 hours of scheduled start time due to different causes. The cancellation rate for on the day cancellation of cataract surgery for a peripheral eye hospital is found to be 6%.Conclusion: Systemic illnesses especially uncontrolled diabetes and hypertension are the most common causes for on the day cancellation of cataract surgery in a peripheral eye hospital

Detection of Ganglion Cell Loss in Preperimetric Glaucoma by Fourier-Domain Optical Coherence Tomography

Background: Glaucoma is a multi-factorial optic neuropathy characterized by a loss of retinal ganglion cells with subsequent loss of the retinal nerve fibers ultimately resulting in visual impairment. The macula region has a high density of retinal ganglion cells thereby being a likely region to detect early cell loss .Since glaucoma affects mainly the inner layers of the retina, Ganglion Cell Complex (GCC) mapping can help to detect glaucomatous damage early as compared to the total retinal thickness. Purpose: To map GCC thickness and average Macular Retinal (MR) thickness with high-speed Fourier-Domain Optical Coherence Tomography (FD-OCT) and correlate it with the Retinal Nerve fiber layer (RNFL) thickness in preperimetric glaucoma. Design: Observational cross-sectional study. Methods: Forty four eyes diagnosed as preperimetric glaucoma were studied. GCC, MR thickness and RNFL thickness was mapped using the RTVue FD-OCT system. The GCC thickness map, the deviation map and the significance map were obtained in all cases. Average GCC thickness and MR thickness were correlated with the RNFL thickness. Results: Average GCC of patients was 85.99&plusmn;6.9 &micro;m. There was GCC loss in 35 (87.5%) eyes which correlated well with areas of RNFL loss (r=0.408, p&lt;0.001). Nine (22.5%) eyes were seen to have decreased MR thickness. GCC loss correlated well with the loss of average RNFL thickness and MR thickness. Further GCC loss was also seen in 23 (74.19 %) eyes with a normal MR thickness. Conclusion: GCC analysis may prove to be a robust diagnostic parameter and is complementary to RNFL analysis in preperimetric glaucoma

Conjunctival erosion after glaucoma drainage device surgery: A feasible option

Glaucoma drainage devices (GDDs) have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evidence to prove that any of these methods is superior to another for providing tectonic durability in the long term. In this report, we present a case of neovascular glaucoma, who developed conjunctival melting over the tube of an Ahmed Glaucoma Valve implant and was successfully managed with Cap Doxycycline