Peripapillary and macular choroidal thickness in glaucoma.

PurposeTo compare choroidal thickness (CT) between individuals with and without glaucomatous damage and to explore the association of peripapillary and submacular CT with glaucoma severity using spectral domain optical coherence tomography (SD-OCT).MethodsNinety-one eyes of 20 normal subjects and 43 glaucoma patients from the UCLA SD-OCT Imaging Study were enrolled. Imaging was performed using Cirrus HD-OCT. Choroidal thickness was measured at four predetermined points in the macular and peripapillary regions, and compared between glaucoma and control groups before and after adjusting for potential confounding variables.ResultsThe average (± standard deviation) mean deviation (MD) on visual fields was -0.3 (±2.0) dB in controls and -3.5 (±3.5) dB in glaucoma patients. Age, axial length and their interaction were the most significant factors affecting CT on multivariate analysis. Adjusted average CT (corrected for age, axial length, their interaction, gender and lens status) however, was not different between glaucoma patients and the control group (P=0.083) except in the temporal parafoveal region (P=0.037); nor was choroidal thickness related to glaucoma severity (r=-0.187, P=0.176 for correlation with MD, r=-0.151, P=0.275 for correlation with average nerve fiber layer thickness).ConclusionsChoroidal thickness of the macular and peripapillary regions is not decreased in glaucoma. Anatomical measurements with SD-OCT do not support the possible influence of the choroid on the pathophysiology of glaucoma

Demographics of ocular myasthenia gra

Among patients with generalized myasthenia gravis (GMG), women are more likely than men to present during early adulthood, with men typically developing GMG after 50 years of age. We investigated the incidence of ocular myasthenia gravis (OMG) by age, race and gender

Pars Plana Anterior Vitrectomy, Hyaloido-Zonulectomy, and Iridectomy for Aqueous Humor Misdirection

PURPOSE: To report a surgical technique for aqueous misdirection refractory to medical treatment consisting of combined pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. DESIGN: Noncomparative case series. METHODS: The charts of 5 pseudophakic patients who sought treatment for aqueous humor misdirection refractory to medical treatment from May 2008 trough February 2009 were reviewed. All 5 patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy with an anterior vitrector through a pars plana incision. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination results, and fundus findings. RESULTS: Five female patients (age range, 23 to 89 years) had increased intraocular pressure and shallowing of the anterior chamber after cataract extraction or trabeculectomy, and none responded to conventional medical therapy. After surgery, prompt resolution of the aqueous misdirection was achieved in all cases. The follow-up was 7.6 months (range, 1 to 13 months). CONCLUSIONS: Aqueous misdirection refractory to medical treatment can be treated successfully with surgery consisting of partial pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. (Am J Ophthalmol 2010;150:82-87. (C) 2010 by Elsevier Inc. All rights reserved.

Glaucoma secondary to cosmetic iris implants in congenital iris coloboma

Introduction:To report a case of angle closure and corneal decompensation requiring surgical intervention secondary to BrightOcular cosmetic iris implantation in a patient with a history of congenital bilateral iris coloboma.Patient and Clinical Findings:A 40-year-old male patient with a history of bilateral congenital coloboma presented to the emergency department with reduced visual acuity to count fingers and moderate pain in the left eye 4 months after bilateral BrightOcular iris implant surgery in Mexico. Intraocular pressure (IOP) was 70 mm Hg with little response to maximal medical therapy. Gonioscopy revealed dense pigment obstructing angle inferiorly.Diagnosis, Interventions, and Outcomes:The patient was diagnosed with angle closure, pigment dispersion syndrome, and corneal decompensation secondary to bilateral cosmetic iris implants. IOP stabilized after emergency Ahmed valve and Baerveldt shunt placement. Corneal decompensation addressed first with endothelial keratoplasty, however ultimately failed leading to penetrating keratoplasty in the left eye. Fellow eye required glaucoma shunt placement 4 years after initial presentation due to persistent glaucoma not controlled with laser and medical therapy.Conclusions:The use of iris implants for cosmetic reasons can have serious ocular morbidity in patients with iris coloboma. Close monitoring and explantation should be strongly recommended at the earliest sign of complication

Repair of Iridodialysis with Sewing Machine Technique and Pupilloplasty Using Four-Throw Method: A Low Invasive Approach to Iris Reconstruction

Iris damage from trauma, congenital anomalies, or iatrogenic injuries can result in iridodialysis and pupillary defects, leading to visual impairment and aesthetic issues. This chapter discusses two surgical techniques for iris reconstruction: the Sewing Machine Technique for iridodialysis repair and the single-pass four-throw (SFT) method for pupilloplasty. The Sewing Machine Technique allows for quick suturing of large iridodialysis defects with minimal tissue manipulation, but it may not restore the pupil’s shape or function. Pupilloplasty, using the SFT method, corrects pupillary distortion by creating a self-retaining knot with minimal anterior chamber manipulation. Both techniques are often performed alongside cataract surgery, with the use of iris hooks or viscoelastic agents for better surgical access and to prevent iris prolapse. The chapter provides a detailed step-by-step description of both procedures, emphasising their effectiveness in restoring both iris function and aesthetics in patients with iris defects. These low-invasive approaches offer reliable solutions for managing complex iris injuries

Steroid-Induced Ocular Hypertension in Children: A Review on Risk Factors

Steroid-induced ocular hypertension is poorly understood in children, despite its frequent occurrence. Significant knowledge voids exist in steroid responsiveness, especially in the pediatric population. Therefore, highlighting the most critical risk factors in pediatric patients can help ophthalmologists identify who is at increased risk of developing a high steroid response. A manual search was conducted in PubMed and Google Scholar in search of relevant articles on the steroid-induced glaucoma subtopic. Key risk factors for high steroid response include glaucoma family history, previous glaucoma diagnosis, young age, steroid type, administration route, and diseases such as vernal keratoconjunctivitis (VKC) and uveitis. Clinically, it presents similarly to primary glaucoma, except for steroid usage history. Steroid cessation or reduction can normalize intraocular pressure (IOP) levels; however, in some cases, pressure-lowering drugs are necessary for treatment. Topical ocular steroids are frequently used by pediatricians and ophthalmologists alike. Understanding the importance of risk factors allows for a timely diagnosis of steroid response and adequate treatment before glaucomatous vision loss can occur