Progressive optic neuropathy in congenital glaucoma associated with the Sirsasana yoga posture

The authors describe a case of progressive optic neuropathy in a patient with congenital glaucoma who had routinely practiced the Sirsasana (headstand) yoga posture for several years. Ophthalmic examination included best-corrected visual acuity, anterior segment examination, indirect oplithalmoscopy, ultrasound pachymetry for central corneal thickness, and intraocular pressure before, during, and after maintaining the Sirsasana posture for 5 minutes. Intraocular pressure increased significantly during the Sirsasana posture. Transient elevation in intraocular pressure during yoga exercises may lead to progressive glaucomatous optic neuropathy, especially in susceptible patients with congenital glaucoma

Ahmed vs Baerveldt Glaucoma Drainage Device in Uveitic Glaucoma

Introduction: Uveitis is an inflammatory eye disorder which may elevate intraocular pressure (IOP), causing sight-threatening glaucoma. Treatment of refractory uveitic glaucoma involves implantation of a glaucoma drainage device (GDD). Uveitic glaucoma has been a minority diagnosis in prior studies comparing the valved Ahmed GDD and non-valved Baerveldt GDD. Here we compare the safety and efficacy of the Ahmed and Baerveldt GDD in uveitic glaucoma. Methods: This retrospective comparative study was conducted on patients with uveitic glaucoma (≥14 years old) who underwent Ahmed or Baerveldt GDD implantation between 2006–2018 with a minimum follow-up of 3 months. Success was defined as IOP of 6-21 mmHg with (complete success) or without (qualified success) medications, with at least light perception vision and no further glaucoma surgery. Pearson Chi-squared test, independent t test, and Kaplan-Meier survival model were utilized for statistical analysis. Results: 137 eyes of 122 patients (67 Ahmed and 70 Baerveldt) were included. Baseline characteristics were comparable in both groups. The Baerveldt group experienced greater IOP reduction (60.3% vs. 44.5%), higher complete success rate (28.6% vs. 10.4%), higher complication rate (44.3% vs. 20.9%), and higher hypotony rate (10% vs. 0%) than the Ahmed group (all p values \u3c0.05). Discussion: Our results are in line with pooled analysis of previous GDD comparison studies on various types of glaucoma. For patients with uveitic glaucoma, the Baerveldt implant provided a significantly higher success rate and greater IOP reduction with fewer medications, but was associated with a higher complication rate, compared to the Ahmed implant