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

This is a Letter to the Editor and does not have an abstract. Please download the PDF or view the article HTML

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

Peripapillary nerve fiber layer thickness changes after macular photocoagulation for clinically significant diabetic macular edema

Purpose: To evaluate the effect of macular photocoagulation (MPC) on peripapillary nerve fiber layer (PNFL) thickness measurement in patients with clinically significant diabetic macular edema (CSME). Methods: This study was a prospective interventional case series. Patients with CSME underwent MPC. Optical coherence tomography (OCT) was used to measure the PNFL and central macular thicknesses before and 3. months after MPC. Results: Thirty-three eyes of 25 patients with a mean age of 59.4. ±. 7.2. years were included. There was no statistically significant difference between pre- and post-MPC mean best corrected visual acuity (0.35. ±. 0.29 and 0.40. ±. 0.23 LogMAR, respectively, P= 0.2). Mean baseline and 3. months central macular subfield thickness was 305.9. ±. 90.7 and 317.5. ±. 112.4 microns, respectively (P= 0.1). Peripapillary nerve fiber layer thickness was 105.7. ±. 10.0 before and 106.1. ±. 9.9 three months after MPC (P= 0.7). No significant differences were found between pre and post MPC measurements in temporal, nasal, inferior and superior nerve fiber layer thickness in each quadrant around optic nerve head (P>. 0.05). Conclusions: Macular photocoagulation has no statistically significant effect on PNFL thickness measurements in patients with CSME. © 2014 The Authors

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

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. © 2018 Iranian Society of Ophthalmolog

Cefixime-induced angle closure and transient myopic shift in a healthy individual; A case report

Purpose: To report a case of Acute bilateral angle closure and Myopia following oral Cefixime therapy for pharyngitis. Observation: A 49-year-old man presented to the clinic with a history of aggravating ocular pain and blurry vision in both eyes from 5 days ago. He was under treatment with oral Cefixime 400 mg twice a day for acute bacterial pharyngitis since last week. His refractive error was �3.75 and �4.25 diopters in the right and left eye respectively. Intraocular pressure (IOP) was 32 mm Hg in the right eye and 40 mm Hg in the left eye. Slit lamp examination and gonioscopy showed shallow anterior chamber with 360° appositional angle closure. Ultrasound biomicroscopy revealed shallow anterior chamber, narrow angle, supraciliary effusion and anterior rotation of ciliary body in both eyes. With diagnosis of drug-induced acute angle closure, oral Cefixime was discontinued and eye drops Betamethasone every 4 hours, Cosopt and Brimonidine twice a day, and Atropine 1 twice a day were started. Few days after starting treatment all ocular symptoms and signs were resolved. Conclusions and importance: Systemic Cefixime can induce acute angle closure disease with myopic shift and elevated IOP secondary to supraciliary effusion and ciliary body rotation. © 202

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

Cataract surgery for congenital cataract: Endothelial cell characteristics, corneal thickness, and impact on intraocular pressure

Purpose: To investigate whether central corneal thickness (CCT), endothelial cell characteristics, and intraocular pressure (IOP) are affected in patients with previous congenital cataract surgery and to focus on their clinical significance. Methods: CCT and IOP measurements and specular microscopy were performed in 31 eyes of 17 cases of extracted congenital cataracts and 40 eyes of 20 age- and sex-matched participants as control group. The mean of three pachymetry measurements of the central cornea was taken as CCT. IOP was checked using an applanation tonometer. Results: The mean corneal thickness of the eyes with extracted congenital cataract (632 ± 45 μm) was significantly greater than that of the control eyes (546 ± 33 μm; p < 0.001). There was no significant difference in the corneal endothelial cell count, coefficient of variation (CV), and mean cell area (AVG) of endothelial cells between operated eyes and the control group. The mean measured IOP in the operated group (22.8 ± 3.3 mm Hg) was significantly greater than IOP in controls (14.1±1.8 mm Hg, p < 0.001). Conclusions: Although the corneas were clinically clear and there was no significant difference in endothelial characteristics of eyes with extracted congenital cataract and controls, central corneas of operated eyes were significantly thicker than those of controls. To differentiate the actual glaucoma from ocular hypertension in these patients, the central corneal thickness measurement should strongly be considered. © 2007 American Association for Pediatric Ophthalmology and Strabismus