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

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

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

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

Central corneal thickness, corneal endothelial characteristics and intraocular pressure after pediatric cataract surgery

To investigate central corneal thickness (CCT), endothelial cell characteristics and intraocular pressure (IOP) in eyes with prior pediatric cataract surgery and to compare them with eyes of normal age and sex matched controls. Methods: Specular microscopy CCT and IOP measurements were performed in 31 eyes of 17 patients with prior congenital cataract extraction and 40 eyes of 20 age and sex matched subjects. The mean of three pachymetric and specular microscopic measurements were recorded. IOP was measured using Goldmann applanation tonometry. Results: Mean CCT was 632±45 μm in eyes with prior pediatric cataract surgery vs 546±33 μm in control eyes (P<0.001, independent t test and Mann Whitney U-test). Mean IOP was 22.1±3.9 mmHg in eyes with prior pediatric cataract surgery and 14.0±1.6 mmHg in the control group (P<0.001, independent t-test). There was no significant difference between the two groups in cell count, polymegethism and mean cell area of corneal endothelial cells. Conclusions: Although the corneas were clinically clear and there was no significant difference in endothelial characteristics in eyes with prior pediatric cataract surgery as compared to normal controls, central corneal thickness in the operated eyes was significantly greater. To differentiate actual glaucoma from artifactual IOP increase, CCT measurement should be performed in these patients

Postoperative Blepharoptosis After Modern Phacoemulsification Procedure

Purpose: To investigate the frequency of transient (1 month) and persistent (at least 6 months) postoperative ptosis following clear corneal sutureless phacoemulsification and to analyze the factors affecting them. Design: Cohort study. Methods: Patients who underwent phacoemulsification cataract surgery from October 2016 to June 2018 in a tertiary center were enrolled. Margin reflex distance 1 (MRD1), MRD2, and levator function were measured and facial photography was taken before, 1 month, and at least 6 months after the surgery. Clinical ptosis was defined as any postoperative drop of MRD1 and clinically significant ptosis as MRD1 drop of �2 mm. Photo-based ptosis was assessed by a masked oculofacial plastic surgeon at the end of the study. Results: A total of 234 patients (313 eyelids) were included. The majority of surgeries were performed by senior residents (65.5, 205/313) and under topical anesthesia (78.0, 244/313). Persistent clinical, clinically significant, and photo-based ptosis were 25.4 (71/279), 3.2 (9/279), and 3.3 (9/276). Eyelids with persistent postoperative ptosis showed a significantly (P = .03) lower preoperative levator function (13.9 vs 15.8 mm). No other factor was significantly different between the eyelids with and without postoperative ptosis. Conclusion: Persistent clinically significant ptosis was observed in more than 3 of patients undergoing clear corneal sutureless phacoemulsification cataract surgery. It should be counseled preoperatively. Lower preoperative levator function was significantly associated with a higher frequency of postoperative ptosis. Duration of surgery, level of surgeons, and other variables did not have any significant effect on the frequency of postoperative ptosis. © 2020 Elsevier Inc

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