Wound dehiscence and device migration after subconjunctival bevacizumab injection with Ahmed glaucoma valve implantation

Purpose: To report a complication pertaining to subconjunctival bevacizumab injection as an adjunct to Ahmed Glaucoma Valve (AGV) implantation. Case Report: A 54-year-old woman with history of complicated cataract surgery was referred for advanced intractable glaucoma. AGV implantation with adjunctive subconjunctival bevacizumab (1.25 mg) was performed with satisfactory results during the first postoperative week. However, 10 days after surgery, she developed wound dehiscence and tube exposure. The second case was a 33-year-old man with history of congenital glaucoma and uncontrolled IOP who developed AGV exposure and wound dehiscence after surgery. In both cases, for prevention of endophthalmitis and corneal damage by the unstable tube, the shunt was removed and the conjunctiva was re-sutured. Conclusion: The potential adverse effect of subconjunctival bevacizumab injection on wound healing should be considered in AGV surgery. © 2016 Journal of Ophthalmic and Vision Research

Selective laser trabeculoplasty in patients with pseudoexfoliative glaucoma VS primary open angle glaucoma: A one-year comparative study

Aim: To compare the efficacy of single-session 360-degree selective laser trabeculoplasty (SLT) for reduction of intraocular pressure (IOP) in patients with pseudoexfoliative glaucoma (PXFG) and primary open angle glaucoma (POAG).Methods: This is a single-center, prospective, nonrandomized comparative study. Patients older than 18 years of age with uncontrolled PXFG or POAG eyes requiring additional therapy while on maximally tolerated IOP-lowering medications were included. The primary outcome measure changed in IOP from baseline. Success was defined as IOP reduction �20 from baseline without any additional IOP-lowering medication. All patients were examined at 1d, 1wk, 1, 3, 6, 9, 12mo after SLT.Results: Nineteen patients (20 eyes) with PXFG and 27 patients (28 eyes) with POAG were included in the study. In the visual fields mean deviation was -2.88 (±1.67) in the POAG and -3.1 (±1.69) in the PXFG groups (P=0.3). The mean (±SD) IOP was 22.9 (±3.7) mm Hg in the POAG group and 25.7 (±4.4)?mm Hg in the PXFG group at baseline and decreased to 18.4 (±3.2) and 18.0 (±3.9) mm Hg in the POAG group (P<0.001 and P=0.02), and to 17.9 (±4.0) and 21.0 (±6.6) mm Hg in the PXFG group (P<0.001 and P=0.47) at 6 and 12mo, respectively. The number of medications was 2.6 (±0.8) in the POAG group and 2.5 (±0.8) in the PXFG group at baseline, and did not change at all follow-up visits in both groups (P=0.16 in POAG and 0.57 in PXFG). Based on Kaplan-Meier survival analysis, the success rate was 75 in the POAG group compared to 94.1 in the PXFG group (P=0.08; log rank test) at 6mo, and 29.1 and 25.0 at 12mo, respectively (P=0.9; log rank).Conclusion: The 360-degree SLT is an effective and well-tolerated therapeutic modality in patients with POAG and PXFG by reducing IOP without any change in number of medications. The response was more pronounced early in the postoperative period in patients with PXFG whereas there was no statistically significant difference at 12-month follow-up. © 2016, International Journal of Ophthalmology (c/o Editorial Office). All rights reserved

Selenium and selenoprotein P1 levels are related to primary open-angle glaucoma

Background Glaucoma is a highly prevalent eye disease related to optic nerve lesions and visual field defects. Primary Open-Angle Glaucoma (POAG) is a type of glaucoma that occurs frequently with unknown etiology. In this study, we investigated the serum levels of selenium, selenoprotein P1, glutathione, hemolysate glutathione peroxidase1 (GPx1) activity and aqueous humour selenium in POAG patients. Methods Ninety sex- and age-matched subjects (POAG patients; n=45 and, controls; n=45) with the controlled confounders (smoking, hypertension and alcohol beverages) were recruited on clinical histories and exams. The serum and aqueous humour selenium levels were measured using GFAAS technique. The serum selenoprotein P1 level was assayed with the ELISA method. The hemolysate GPx1 activity and serum reduced glutathione level were also measured using known colorimetric techniques. Results The serum selenium (P=0.01) and selenoprotein P1 (P<0.001) levels were significantly high in POAG patients. Furthermore, the aqueous humour selenium level was significantly high among patients as compared to controls (64.68±13.07 vs. 58.36±13.76 ng/mL, P=0.02). The results did not show a significant difference (P=0.36) in the hemolysate GPx1 activity between the groups. The cutoff points for intraocular pressure (IOP) and serum selenoprotein P1 parameters were estimated to be 39 mmHg (sensitivity 97.5; 1-specificity 6.5) and 188 mg/mL (sensitivity 93.5; 1-specificity 14), respectively

Effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve implantation: A randomized control trial

Importance: The effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve (AGV) implantation. Background: Evaluation of efficacy and safety of subconjunctival Bevacizumab injection adjunctive to AGV implantation. Design: Prospective and randomized clinical trial. Participants: Fifty eyes of 50 patients with diagnosis of glaucoma that were candidate for AGV surgery were included. Methods: In 25 eyes, conventional AGV surgery (group 1) and in 25 eyes AGV surgery with subconjunctival Bevacizumab (group 2) was performed by block randomization Main Outcome Measures: The primary outcome measure was surgical success. Outcome measures were compared at postoperative month 3, 6 and 12. Results: Mean age of patients was 58.76 ± 12.11 and 51.36 ± 15.44 years in group 1 and 2 respectively (P = 0.06). Mean intraocular pressure (IOP) at baseline was 24.88± 7.62mmHg in group 1 and 27.52± 8.57mmHg in group 2 which decreased to15.4 ± 4.4 mmHg in group 1 and 13.42± 2.9 mmHg in group 2 (P < 0.00) at last follow up. Surgical success was defined in two level: postoperative IOP �21mmHg with at least 20 reduction in IOP (Criterion A), either with no medication (complete success) or with no more than two medications (qualified success) and criterion B with the same definition but the IOP �18mmHg The cumulative success according to criterion A and B was 77.8, 72.2 in group 1 and 89.5 in group 2, respectively, at the end of follow-up. Conclusions and Relevance: Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow-up. © 2018 Royal Australian and New Zealand College of Ophthalmologists

Local variability of macular thickness measurements with SD-OCT and influencing factors

Purpose: To compare the intrasession variability of spectral-domain optical coherence tomography (SD-OCT)-derived local macular thickness measures and explore influencing factors. Methods: One hundred two glaucomatous eyes (102 patients) and 21 healthy eyes (21 subjects) with three good quality macular images during the same session were enrolled. Thickness measurements were calculated for 3° superpixels for the inner plexiform (IPL), ganglion cell (GCL), or retinal nerve fiber layers (mRNFL), GC/IPL, ganglion cell complex, and full macular thickness. Spatial distribution and magnitude of measurement errors (ME; differences between the 3 individual superpixel values and their mean) and association between MEs and thickness, age, axial length, and image quality were explored. Results: MEs had a normal distribution with mostly random noise along with a small fraction of outliers (1.2�6.6; highest variability in mRNFL and on the nasal border) based on M-estimation. Boundaries of 95 prediction intervals for variability reached a maximum of 3 µm for all layers and diagnostic groups after exclusion of outliers. Correlation between proportion of outliers and thickness measures varied among various parameters. Age, axial length, or image quality did not influence MEs (P > 0.05 for both groups). Conclusions: Local variability of macular SD-OCT measurements is low and uniform across the macula. The relationship between superpixel thickness and outlier proportion varied as a function of the parameter of interest. Translational Relevance: Given the low and uniform variability within and across eyes, definition of an individualized �variability space� seems unnecessary. The variability measurements from this study could be used for designing algorithms for detection of glaucoma progression. © 2016, Association for Research in Vision and Ophthalmology Inc. All rights reserved

The prevalence of glaucoma in Tehran, Iran

Purpose: To determine the prevalence of glaucoma in adults 40 years of age or older in Tehran, Iran. Methods: This stratified random-sampling cross-sectional population survey was performed on residents of Tehran, the capital of Iran, aged 40 years and older in the year 2001. Refraction, best-corrected visual acuity, slitlamp biomicroscopy, Goldmann applanation tonometry, funduscopy, and gonioscopy were performed in all subjects. Automated perimetry was performed in selected cases. Results: Out of 4418 sampled subjects, 2184 individuals (49.4) participated in the survey. Eventually data from 2160 individuals including 814 (38) male and 1346 (62) female subjects with mean age of 55.1±10.2 (range 40-92) years were analyzed. The overall prevalence of glaucoma was 1.44 (95 confidence interval, 0.94-1.94) including primary open angle glaucoma 0.46, chronic angle closure glaucoma 0.33, normal tension glaucoma 0.28, pseudoexfoliation glaucoma 0.23, and other types of glaucoma 0.14. More than 80 of affected subjects were unaware of their condition. Conclusion: The prevalence of glaucoma in adults 40 years of age or older in Tehran is 1.44, which is in the lower range reported in other populations. The large majority of cases are unaware of their condition

Effects of Beetroot Juice Supplementation on Cognitive Function, Aerobic and Anaerobic Performances of Trained Male Taekwondo Athletes: A Pilot Study

Studies have shown that nitrate (NO3−)-rich beetroot juice (BJ) supplementation improves endurance and high-intensity intermittent exercise. The dose–response effects on taekwondo following BJ supplementation are yet to be determined. This study aimed to investigate two acute doses of 400 mg of NO3− (BJ-400) and 800 mg of NO3− (BJ-800) on taekwondo-specific performance and cognitive function tests compared with a placebo (PL) and control (CON) conditions. Eight trained male taekwondo athletes (age: 20 ± 4 years, height: 180 ± 2 cm, body mass: 64.8 ± 4.0 kg) completed four experimental trials using a randomized, double-blind placebo-controlled design: BJ-400, BJ-800, PL, and CON. Participants consumed two doses of BJ-400 and BJ-800 or nitrate-depleted PL at 2.5 h prior to performing the Multiple Frequency Speed of Kick Test (FSKT). Countermovement jump (CMJ) was performed before the (FSKT) and PSTT, whereas cognitive function was assessed (via the Stroop test) before and after supplementation and 10 min following PSTT. Blood lactate was collected before the CMJ tests immediately and 3 min after the FSKT and PSST; rating of perceived exertion (RPE) was recorded during and after both specific taekwondo tests. No significant differences (p > 0.05), with moderate and large effect sizes, between conditions were observed for PSTT and FSKT performances. In addition, blood lactate, RPE, heart rate, and CMJ height were not significantly different among conditions (p > 0.05). However, after the PSTT test, cognitive function was higher in BJ-400 compared to other treatments (p 0.05). It was concluded that acute intake of 400 and 800 mg of NO3−rich BJ reported a moderate to large effect size in anaerobic and aerobic; however, no statistical differences were found in taekwondo-specific performance

Variability of antioxidant defense enzymes in primary angle closure glaucoma patients in comparison with healthy subjects

Abstract Background: Oxidative stress and antioxidant status may be associated with glaucomatous damage. The purpose of this study was comparison of the serum antioxidant status between primary angle closure glaucoma patients and healthy subjects. Materials and Methods: In this case- control study 66 primary angle closure glaucoma patients and 80 controls were enrolled. Peripheral blood sample obtained from patients .Superoxide dismutase(SOD) was assayed by inhibition the rate of adrenochrome formation. Catalase (CAT) was evaluated by decrease of H2O2 absorbance. Glutathione peroxidase (GPx) and Glutathione reductase (GR) were determined following NADP oxidation or reduction. Glutathione S-transferase (GST) was measured by increase in the absorbance of CDNB and glutathione conjugation. Results: Antioxidant defense enzymes were significantly decreased in glaucoma patients over those of control groups. CAT (p<0.006), SOD (p<0.020) and GPX (p<0.004). A relative insignificant decrease of GR and GST activities was observed in glaucoma patients compared with healthy subjects. Conclusion: The present study supports the hypothesis that oxidative stress is an important factor in the pathogenesis of glaucoma. Although primary angle closure glaucoma has an anathomical basis but decrease in antioxidant defense enzymes activities may have a role in pathogenesis of this type of glaucoma

Ocular biometric changes after Ahmed glaucoma valve implantation

Purpose: To investigate the ocular biometric changes after uneventful Ahmed glaucoma valve implantation. Methods: Patients with refractory glaucoma who were candidate for Ahmed valve surgery were prospectively included in this study. Patients with a history of any kinds of corneal surgery were excluded. Refractive status, intraocular pressure, axial length, anterior chamber parameters including anterior and posterior mean keratometry, central corneal thicknesses, and anterior chamber depth, anterior chamber volume, and anterior chamber angle were evaluated at baseline and 1 and 3 months after surgery. Results: A total of 20 eyes from 20 patients were included. Mean intraocular pressure at baseline was 33.4 ± 12.3 mm Hg that significantly decreased to 14.6 ± 6.2 mm Hg at 1 month and 13.5 ± 4.3 mm Hg at 3 months after Ahmed glaucoma valve implantation (p 0.05 in all). Conclusion: Ahmed glaucoma valve implantation had a significant effect on axial length at 3 months after surgery but its effect on keratometry and other anterior chamber parameters was not significant. © The Author(s) 2019