The Impact of the COVID-19 Pandemic on Ophthalmology Residency Training

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Risk factors for Ahmed Glaucoma Valve (AGV) Failure in Glaucoma Patients

Background: To investigate the Risk factors for AGV ( Ahmed glaucoma valve) failure. Material and Methods: A retrospective review was conducted on the medical records of patients with varying causes of glaucoma who had undergone AGV implantation. The primary measure of success was the cumulative achievement of an intraocular pressure (IOP) between 5 and 21 mmHg, with a 20 % reduction from baseline, with or without medication to lower IOP. The secondary measures of success were the IOP levels and the number of medications used for glaucoma treatment. Results: The study enrolled a total of 120 participants, with an average age of 48.9 ± 19.6 years and an average follow-up period of 4.5 ± 1.4 years. The mean survival duration was 5.3 ± 0.5 years in patients with high pressure (HP), which was significantly shorter than the 6.4 ± 0.2 years in those without HP. The likelihood of surgical failure increased with higher baseline IOP, with an odds ratio of 1.07 (95 % confidence interval: 1.02-1.12). In a logistic regression model, neovascular glaucoma was the only factor significantly associated with the occurrence of HP, with an odds ratio of 3.14 (95 % confidence interval: 1.2-8.1). Conclusion :Neovascular glaucoma and a Higher Baseline IOP are risk factors for AGV failure

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

Evaluation of Asymptomatic Cardiac Disease in Patients with Ocular Pseudoexfoliation

Purpose: To evaluate asymptomatic cardiac disease in patients with ocular pseudoexfoliation.Patients and Method: Forty-two patients with ocular pseudoexfoliation (with or without glaucoma) and 40 patients without pseudoexfoliation, who had no positive signs or symptoms of cardiac ­­­­­­diseases, were enrolled in this study. For each participant a standard treadmill exercise test, as a noninvasive and reliable method for detecting ischemic heart disease, was performed under supervision of a cardiologist. The prevalence of ischemic heart disease was compared in the case and control groups.Results: The mean age of participants was 68.38 ± 8.10 years in the case and 62.45 ± 8.40 years in the control group. There was no statistically significant difference between the two groups in terms of diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. Twenty patients (47.6 %) with pseudoexfoliation and 9 participants (22.5 %) without pseudoexfoliation had hypertension (P = 0.02). There were 10 (23.8 %) positive exercise tests in the pseudoexfoliation group and 8 (20 %) positive exercise tests in participants without pseudoexfoliation (P = 0.78). Conclusion: Based on our findings ocular pseudoexfoliation was not associated with increased risk of asymptomatic ischemic heart disease as evaluated by a treadmill exercise test. Keywords: Pseudoexfoliation syndrome; Exercise test; Myocardial ischemia; Iran

The Effects of Macular Photocoagulation on Visual Field

Purpose: To evaluate visual field and nerve fiber layer thickness changes after Macular photocoagulation for treatment of diabetic macular edema. Setting: Rassoul Akram Hospital, Tehran, Iran. Material and method: Twenty six eyes with history of diabetes and clinically significant macular edema candidate for Macular photocoagulation were included in this prospective interventional case series. All patients underwent 10-2 and 24-2 Humphrey Visual Field Test with Swedish Interactive Thresholding Algorithm (SITA) standard strategy and also optic nerve and macular optical coherence tomography (OCT), before and 6 months after macular laser photocoagulation. Then visual field, peripapillary and macular nerve fiber layer thickness of each eye were compared before and after photocoagulation. Results: The mean age of patients was 57.60 ± 8.99 (range 33-73) years. There was no statistically significant change after photocoagulation compared to before the procedure regarding the mean deviation, pattern standard deviation and foveal threshold in visual field 10-2 and 24-2 tests except for pattern standard deviation in 10-2 test. Conclusion: Based on our results it seems that visual field is not affected by macular laser photocoagulation

Decision Support System for Age-Related Macular Degeneration Using Convolutional Neural Networks

Introduction: Age-related macular degeneration (AMD) is one of the major causes of visual loss among the elderly. It causes degeneration of cells in the macula. Early diagnosis can be helpful in preventing blindness. Drusen are the initial symptoms of AMD. Since drusen have a wide variety, locating them in screening images is difficult and time-consuming. An automated digital fundus photography-based screening system help overcome such drawbacks. The main objective of this study was to suggest a novel method to classify AMD and normal retinal fundus images. Materials and Methods: The suggested system was developed using convolutional neural networks. Several methods were adopted for increasing data such as horizontal reflection, random crop, as well as transfer and combination of such methods. The suggested system was evaluated using images obtained from STARE database and a local dataset. Results: The local dataset contained 3195 images (2070 images of AMD suspects and 1125 images of healthy retina) and the STARE dataset comprised of 201 images (105 images of AMD suspects and 96 images of healthy retina). According to the results, the accuracies of the local and standard datasets were 0.95 and 0.81, respectively. Conclusion: Diagnosis and screening of AMD is a time-consuming task for specialists. To overcome this limitation, we attempted to design an intelligent decision support system for the diagnosis of AMD fundus using retina images. The proposed system is an important step toward providing a reliable tool for supervising patients. Early diagnosis of AMD can lead to timely access to treatment

Transient Myopia and Ciliochoroidal Effusion following Influenza Vaccination

Introduction: The aim of the study was to report a case of ocular adverse events following influenza vaccination which involved bilateral myopic shift, ciliochoroidal effusion, and fine retinal folds in a middle-aged woman. Case Presentation: A 42-year-old female presented with sudden-onset painless binocular decreased distance vision. She had received a quadrivalent influenza vaccine (Influvac Tetra) injection 10 days prior, a few days after which she experienced blurred vision. Her initial uncorrected visual acuity and refraction were 20/200 and −3.00/−1.00 × 180 in the right eye, 20/100 and −3.00/−0.50 × 50 in the left eye. Intraocular pressure was within normal limits bilaterally. Anterior segment examination was significant for bilateral shallow anterior chambers (AC) and narrow iridocorneal angles with no cells or flare. Fundus examination was notable for bilateral fine chorioretinal folds radiating from the macula and bilateral low-lying choroidal effusion in the far periphery. Ultrasound biomicroscopy confirmed bilateral ciliochoroidal effusions, shallow AC, and anterior rotation of the ciliary bodies. The patient was started on oral and topical corticosteroids plus atropine and timolol eye drops after which prompt improvement was observed. Restoration of visual acuity and complete resolution of the symptoms without any further complication were observed after 2 weeks. Conclusion: The temporal association between the onset of the patient’s symptoms and influenza vaccination, in the absence of any pertinent medical conditions or medications, significantly implicates causality. Future research and case reports can help in corroborating this ocular adverse event attributed to influenza vaccination

Comparison of the long-term outcomes of resident versus attending performed trabeculectomy

Purpose: To compare the long-term outcomes obtained by residents and attending surgeons performing trabeculectomy. Methods: After reviewing medical records of the patients, 41 residents performing trabeculectomy under supervision of attendings were compared to 41 attendings performing trabeculectomy. The primary outcome measure was the surgical success defined in terms of intraocular pressure (IOP) ≤ 21 mmHg (criterion A) and IOP ≤ 16 mmHg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than 2 medications (qualified success). IOP, number of glaucoma medications, surgical complications, and visual acuity were analyzed as secondary outcome measures. Results: Mean age of the patients was 59.5 ± 8.6 years in the resident group and 59.6 ± 12.31 years in the attending group (P = 0.96). Furthermore, mean duration of the follow-up was 62.34 ± 5.51 months in the resident group and 64.80 ± 7.80 months in the attending group (P = 0.10). The cumulative success according to criterion A was 87.8% in the resident group and 85.3% in the attending group (P = 0.50). Moreover, according to criterion B, it was 87.8% and 83% in the resident and attending groups, respectively (P = 0.62). Repeated glaucoma surgery was required in 12.2% and 2.4% of the patients in the resident and attending groups, respectively (P = 0.09). Rate of complications was 12.2% and 4.8% in the resident and attending groups, respectively (P = 0.23). Conclusion: There were comparable results with respect to success rates and complications between residents and attending surgeons performing trabeculectomy in the long-term follow-up. Keywords: Glaucoma, Trabeculectomy, Intraocular pressur

Surgical management of glaucoma in Fuchs uveitis syndrome: Trabeculectomy or Ahmed glaucoma valve

Purpose: To evaluate the outcome of trabeculectomy versus Ahmed glaucoma valve (AGV) surgery in patients with Fuchs uveitis Syndrome (FUS). Methods: Twenty-eight eyes with uncontrolled glaucoma and at least 6 months of follow-up were enrolled. In 16 eyes trabeculectomy and in 12 eyes AGV implant were performed. The primary outcome measure was surgical success defined as 5 < intraocular pressure (IOP) ≤ 21 mmHg (criterion A) and 5 < IOP ≤ 16 mmHg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than preoperative medications (qualified success). The sum of complete and qualified success was defined as cumulative success. Results: The mean age of the patients in the trabeculectomy group and the AGV group was 44.92 ± 9.02 and 45.76 ± 7.10 years, respectively (P = 0.79). The mean duration of follow-up was 23.06 ± 12.03 months in the trabeculectomy group and 22.83 ± 13.63 months in the AGV group (P = 0.96). The baseline mean IOP in trabeculectomy was 26.81 ± 6.69 mmHg which decreased to 11.61 ± 4.15 mmHg at last visit (P < 0.001). In the AGV group, mean IOP was 31.41 ± 6.76 at baseline that changed to 22.41 ± 5.09 at last visit (P = 0.005). According to criterion A, cumulative success rates were 100% and 91% at 6 months and 76% and 9% at 36 months in the trabeculectomy and the AGV group, respectively. Cumulative success rates at 6 months were 93% and 58% and 65% and 7% at 36 months according to criterion B in the trabeculectomy and the AGV group, respectively.Kaplan-Meier survival analysis revealed a significant association between surgical method and cumulative success rate over 36 months (based on criteria A: P = 0.02, and based on criteria B: P = 0.007). Conclusion: The success rate of trabeculectomy was higher than AGV in the surgical management of glaucoma in FUS during a medium-term follow-up. Keywords: Fuchs uveitis syndrome, Ahmed glaucoma valve, Trabeculectomy, Glaucom