Glaucoma Surgery and Aqueous Dynamics

Reduction in intraocular pressure is the only proven method to treat glaucoma. When medical treatment does not achieve adequate intraocular pressure reduction with acceptable adverse effects, laser or incisional surgeries are introduced. In this chapter, we discuss the physiological basis for the established surgical procedures as well as the newer surgical procedures. Most new surgical innovations have been designed according to natural physiology by routing aqueous as nature intended, through the Schlemm’s canal. This has been possible because of better understanding of the outflow system and the availability of micro-technology to manipulate it

Efficacy, safety and tolerability of combination therapy with timolol and dorzolamide in glaucoma and ocular hypertension

Combination pharmacotherapy has simplified and improved glaucoma medication regimens. This update focuses on the previous and recent studies on efficacy and tolerability profile of dorzolamide–timolol in adult ocular hypertension and open angle glaucoma patients. Dorzolamide–timolol has been shown to be efficacious and well tolerated in clinical trials and the adverse effects reflect those of the individual components

Intellectual System Diagnostics Glaucoma

Glaucoma is a chronic eye disease that can lead to permanent vision loss. However, glaucoma is a difficult disease to diagnose because there is no pattern in the distribution of nerve fibers in the ocular fundus. Spectral analysis of the ocular fundus images was performed using the Eidos intelligent system. From the ACRIMA eye image database, 90.7% of healthy eye images were recognized with an average similarity score of 0.588 and 74.42% of glaucoma eye images with an average similarity score of 0.558. The reliability of eye image recognition can be achieved by increasing the number of digitized parameters of eye images obtained, for example, by optical coherence tomography. The research contribution is the digital processing of fundus graphic images by the intelligent system “Eidos”. The scientific contribution lies in the automation of the glaucoma diagnosis process using digitized data. The results of the study can be used at medical faculties of universities to carry out automated diagnostics of glaucoma

Ideal Illumination for Smartphone-based Trabeculectomy Bleb Photography

Purpose: Ophthalmology has seen numerous novel uses for smartphones over the years including fundus photography, telemedicine, and operative videography. However, anterior segment photography for assessing and documenting trabeculectomy bleb morphology using a smartphone has not been explored in detail. With the current study, we aim to characterize ideal illumination for the anterior segment smartphone photography in trabeculectomy patients. Methods: Thirty status post-trabeculectomy patients were enrolled in this study. Native camera application and FiLMiC pro camera application were used on iPhone X to compare bleb images using yellow and white pen-torches as illumination source. Measured bleb area was compared using ImageJ software from the two apps in different illumination settings by charting boxplots and using one-way ANOVA test using R software to establish consistency. Bland-Altman interoperability for repeatability of blebarea measurements was analyzed by plotting Bland-Altman plots. Signal-to-noise ratio was calculated using ImageJ for native camera images using slit-lamp camera images as reference. Subjective rating of these images was then performed by two experienced ophthalmologists and kappa coefficient was calculated for inter-operator repeatability. Statistical analysis was performed. Results: The measured bleb area from images taken from both apps showed no significant difference, thereby establishing consistency, and Bland-Altman analysis indicated good repeatability and reproducibility. It was noted that SNR was lower for images shot in close illumination as compared to the ones shot in intermediate and distant illumination. Cohen’s kappa coefficient was 0.7 for images with distant illumination using white light and 0.65 for images clicked with illumination at an intermediate distance using yellow light, suggesting substantial agreement between the observers. Conclusion: Smartphone photography is a reliable tool for morphological assessment trabeculectomy blebs. Optimal illumination helps achieve results free from digital noise and better delineation of specific morphological features. Intermediate illumination and distant illumination provides much better results in terms of high SNR while avoiding overexposure and clipping of highlight information in the images

Intracameral Recombinant Tissue Plasminogen Activator for Refractory Glaucoma Secondary to a Fungal Corneal Abscess

We present a 78-year-old patient who developed refractory glaucoma following a fungal infection of the corneal incision after cataract extraction with posterior chamber intraocular lens implantation. An anterior chamber injection of 0.1 ml recombinant tissue plasminogen activator (25 mcg/0.1 mL) was performed to improve the trabecular meshwork outflow facility compromised secondary to fibrin blockade. The intraocular pressure dropped dramatically from 48 mmHg to 10 mmHg postoperatively, negating the need for glaucoma surgery

Intellectual System Diagnostics Glaucoma

Glaucoma is a chronic eye disease that can lead to permanent vision loss. However, glaucoma is a difficult disease to diagnose because there is no pattern in the distribution of nerve fibers in the ocular fundus. Spectral analysis of the ocular fundus images was performed using the Eidos intelligent system. From the ACRIMA eye image database, 90.7% of healthy eye images were recognized with an average similarity score of 0.588 and 74.42% of glaucoma eye images with an average similarity score of 0.558. The reliability of eye image recognition can be achieved by increasing the number of digitized parameters of eye images obtained, for example, by optical coherence tomography. The research contribution is the digital processing of fundus graphic images by the intelligent system “Eidos”. The scientific contribution lies in the automation of the glaucoma diagnosis process using digitized data. The results of the study can be used at medical faculties of universities to carry out automated diagnostics of glaucoma

Eidos System Prediction of Myopia in Children in Early Education Stages

This study used a database containing factors that, when processed using the Eidos intellectual system, detect myopia in children of primary school age. The database includes parameters that take into account the properties of the visual system, as well as factors that determine the duration of the performance of the main functions of the cognitive and entertaining nature of the students. The results obtained allow us to determine those factors that are more conducive to the appearance of myopia. The negative impact of some factors that cause myopia can be removed, such as, limiting the screen time spent, increasing outdoor activities/sports. A retrospective training sample can be used for automated processing using the Eidos intellectual system of the results obtained during the preventive examination of schoolchildren by an ophthalmologist. Early intervention towards myopia management in students, improves the chances of maintaining vision and slows myopia progression. The contribution of this research includes factors of a social nature that could be influenced at school in the process of education, increasing the attention towards childent, awareness of maintaining vision and slows down the progression of myopia

Glaucoma - Intraocular Pressure and Aqueous Dynamics

Written for ophthalmology residents and practitioners, this book provides the most comprehensive resource covering all the major aspects of aqueous humor and intraocular pressure dynamics. In addition to chapters on the conventional and new technologies for intraocular pressure assessment, there is a novel chapter on the engineering perspectives of continuous monitoring of the intraocular pressure. Based on the newer insights in aqueous outflow, this text offers a rational approach to the medical and surgical management of glaucoma