Cost analysis of childhood glaucoma surgeries using the US Medicaire allowable costs

AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure (IOP) reduction ($/mm Hg). METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction ($/mm Hg) at 1y postoperatively. RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy,$284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy,$338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant,$351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy. CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method

When My Green Eye Turns Brown: Uveitis-Glaucoma-Hyphema Syndrome Causing Transient Monocular Heterochromia and Vision Loss

Transient monocular vision loss (TMVL) can be due to multiple etiologies. The causes could be vascular, neurologic, or ophthalmic. We report a unique case of recurrent transient monocular iris heterochromia, and transient monocular vision loss (TMVL) due to UGH syndrome

Clinical outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation laser for treatment of glaucoma

The complications and inadequate efficacy of prior cyclodestructive procedures limited their role in glaucoma management. Recent advances in treatment techniques and parameters for laser cyclophotocoagulation has expanded its role in today's glaucoma practice. In this review, we discuss the treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) as a glaucoma surgical procedure for multiple types of glaucoma in lowering intraocular pressure (IOP). Slow-coagulation TSCPC is a relatively new technique for CW-TSCPC that, unlike the 'pop' power titration technique of laser energy delivery, aims to avoid the production of the 'pop' sound that signals explosive inflammatory energy delivery to the ciliary body and nearby tissue. In slow-coagulation TSCPC, laser energy is applied in a fixed and lower amount over a longer duration, compared with the conventional pop technique. This laser energy approach leads to more stable, reliable, titratable, and selective ciliary body ablation for control of IOP, especially relative to the controversial current use of micropulse TSCPC. Slow-coagulation CW-TSCPC can be used safely, efficiently, reproducibly, and efficaciously in wide range of glaucoma types including those with no history of incisional surgeries, good visual acuity, and medically refractory glaucomas

Slow-coagulation transscleral cyclophotocoagulation laser treatment for medically uncontrolled secondary aphakic adult glaucoma

This study evaluates the outcomes of slow-coagulation continuous wave transscleral cyclophotocoagulation (CW-TSCPC) laser for treating secondary aphakic adult glaucoma after complicated cataract surgery as a primary surgical intervention. Retrospective chart review of adult aphakic eyes with medically uncontrolled glaucoma underwent slow-coagulation CW-TSCPC as a primary surgical glaucoma intervention was performed. Surgical success was the primary outcome measure. Success was defined as intraocular pressure (IOP) between 6 - 21 mmHg with ≥20% reduction compared to baseline and no need for further glaucoma surgeries or development of vision-threatening complications at 1-year follow-up. The secondary outcomes included changes in IOP, glaucoma medication numbers, visual acuity, and postoperative complications 1 year after laser treatment. This study included forty-one eyes of 41 patients. The mean age of study participants was 66.7±13.1 years, with a mean follow-up duration of 19±3.5 months. At one year, the success rate was 63.4%. A statistically significant reduction of the IOP was observed, with the mean IOP decreasing from 29.6±5.8 mmHg with a mean of 3.9±1.0 medications at baseline to a mean of 19.0±6.4 mmHg with a mean of 2.5±1.2 medications at 12 months (P<0.001). Four eyes received CW-TSCPC retreatment, and two eyes required incisional glaucoma surgeries. Reported postoperative complications included: visual acuity decline ≥2 lines in 7 eyes, iritis in 6 eyes, hyphema in 5 eyes, cystoid macular edema in 2 eyes, and transient hypotony in 1 eye. Slow-coagulation CW-TSCPC is an efficacious, relatively safe, and non-incisional laser treatment option as an initial surgical glaucoma management choice with secondary aphakic adult glaucoma that is medically uncontrolled

The role of monocytes in optic nerve injury

Monocytes, including monocyte-derived macrophages and resident microglia, mediate many phases of optic nerve injury pathogenesis. Resident microglia respond first, followed by infiltrating macrophages which regulate neuronal inflammation, cell proliferation and differentiation, scar formation and tissue remodeling following optic nerve injury. However, microglia and macrophages have distinct functions which can be either beneficial or detrimental to the optic nerve depending on the spatial context and temporal sequence of their activity. These divergent effects are attributed to pro- and anti-inflammatory cytokines expressed by monocytes, crosstalk between monocyte and glial cells and even microglia-macrophage communication. In this review, we describe the dynamics and functions of microglia and macrophages in neuronal inflammation and regeneration following optic nerve injury, and their possible role as therapeutic targets for axonal regeneration

Morning Glory Disc Anomaly Associated With Moyamoya Disease and Pituitary Stalk Duplication

Morning glory disc anomaly (MGDA) is a rare congenital anomaly of the optic nerve head. Detection of the associated systemic anomalies is crucial and sometimes lifesaving in those patients. We present a unique case of MGDA associated with hypophyseal stalk duplication and moyamoya disease