Changes to Glaucoma Surgery Patterns during the COVID-19 Pandemic: A Shift Toward Less Invasive Procedures

Glaucoma is a leading cause of blindness. Surgical and pharmacological treatment of glaucoma aims to lower the intraocular pressure (IOP) and preserve visual function. The severe acute res-piratory syndrome coronavirus 2 pandemic has placed a strain on the healthcare system. We aimed to compare the quantity, type of anti-glaucoma surgeries, and the disease stage before and during the coronavirus disease pandemic. We analyzed 362 eyes of 306 patients and 172 eyes of 149 patients from the pre-pandemic and pandemic groups, respectively. The number of an-ti-glaucoma surgeries was halved during the pandemic compared to a similar pre-pandemic pe-riod, with a significant difference in the procedural structures between the two groups (p<0.001). The most common procedures in the pre-pandemic group were Ex-Press implantation (33.7%) and trabeculectomy (31.5%). Within the pandemic group, half of the eyes underwent tra-beculectomy (50.0%), followed by Preserflo microshunt (11.6%). A significant difference in the average IOPs was revealed among patients who qualified for surgery 22.21 ± 7.83 mmHg in the pre-pandemic group and 25.16 ± 9.48 mmHg in the pandemic group; p<0.001). There was no significant difference in the best corrected visual acuity between the groups (p=0.263). Glaucoma treatment remained relatively accessible during the pandemic.

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Safety and Efficacy of 25G vitrectomy surgery for malignant glaucoma in pseudophakia

10.21203/rs.2.13438/v1 ◽

2019 ◽

Author(s):

fei you

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Cataract Surgery ◽

Anterior Chamber ◽

Safety And Efficacy ◽

Corrected Visual Acuity ◽

Malignant Glaucoma ◽

Intraocular Hemorrhage ◽

Significant Difference ◽

Best Corrected Visual Acuity

Abstract Background: malignant glaucoma after cataract surgery is still one of the serious complications, if not handled properly，it may lead to serious consequences. It is notoriously difficult to treat. 25G vitrectomy was performed to evaluate the safety and efficacy for the treatment of malignant glaucoma in pseudophakia. Methods: This is a retrospective, comparative case series study. A total of 20 eyes of 20 patients with malignant glaucoma after phacoemulsification were analyzed retrospectively in The First Affiliated Hospital Of Anhui Medical University from May 2015 to January 2018. All Medical Data including the best corrected visual acuity (BCVA), Change of intraocular pressure (IOP), the length of eye axis, and the depth of anterior chamber were recorded. SPSS 17.0 statistical software was used for analysis .Before surgery, the best corrected visual acuity (BCVA) was 1.8±0.6. The intraocular pressure was between 18-57mmHg, with an average of 35.2±10.4mmHg.The depth of anterior chamber was between 0.9-1.9mm, with an average of 1.3±0.2mm.The length of eye axis was 19.7-22.5mm,with an average of 20.6±0.5mm.All the patients were accomplished with 25G vitrectomy. Besides, anterior chamber inflammatory reaction and other complications were also observed postoperation. Results: The patients were followed up for 6-12 months with an average of 9 months. BCVA at the last follow up improved to 0.8±0.1, and there was significant difference compared to that before operation (P<0.01).IOP was from 12-19mmHg, an average of 16.1±2.5mmHg, there was significant difference compared to that before operation (t=7.6, p<0.01).Only one patient occurred low IOP (6mmHg) after surgery, IOP returned to normal level (14mmHg) after conservative treatment. No serious complications including corneal endothelium decompensation, intraocular lens (IOL) capture, intraocular hemorrhage, endophthalmitis and uncontrolled IOP were observed. Conclusions: 25G minimally invasive vitrectomy can treat malignant glaucoma after cataract surgery safely and effectively

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Estimation of the Level of Glycosylated Hemoglobin as a Predictor Factor to Bevacizumab Injection in Diabetic Macular Edema in a Sample of Iraqi Patients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7273 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1480-1483

Author(s):

Hasanain Hasan Attar ◽

Farooq Mohammed Abbas ◽

Haider Layikh

Keyword(s):

Diabetes Mellitus ◽

Visual Acuity ◽

Intraocular Pressure ◽

Macular Edema ◽

Glycosylated Hemoglobin ◽

Study Groups ◽

Corrected Visual Acuity ◽

Significant Difference ◽

Best Corrected Visual Acuity

Abstract Background: clinically significant macular edema ( CSME) consider as one of the most critical complications of poorly controlled diabetes and it’s the main reason for decreased vision in that kind of patients, we try in this article to find the relation between glycosylated hemoglobin level and the response to bevacizumab injections in people with macular edema Materials and methods: Ninety-five patients (55 male:40 female) were recruited in this study, all of them had diabetes type2, age of the participants ranging from 42 to 70 years old, Complete ophthalmic examination was done for all the participants including (best-corrected visual acuity), (intraocular pressure) checking, fundus evaluation, and central macular thickness measurement, serum glycosylated hemoglobin (HbA1C) was also measured, Patients were given 0.05ml(1.25mg) of bevacizumab (Avastin) intravitreally for three successive months, Follow up visit was at 4,8,12 week post-injection. On each follow up detailed examination was done including the( best-corrected visual acuity) examination, (Intraocular pressure), both fundus examination, and OCT of the macula. Results: This study included 111 patients who had type 2 diabetes mellitus who were classified according to HbA1c into two sub-groups, HbA1c ≤ 7 % (n = 45) and HbA1c > 7 % (n = 66) we found no significant difference in mean age and frequency distribution according to gender between study groups (p > 0.05), but, there was a highly significant difference in mean HbA1c % (p < 0.001). when we compare mean OCT and mean VA before and after the intervention in patients who had diabetes mellitus classified according to HbA1c into (HbA1c ≤ 7 % and HbA1c > 7 %) we found that before the intervention, there was no significant difference in mean OCT between study groups (p > 0.05), but after the intervention, there was a reduction in mean OCT and the reduction was more pronounced in the group of HbA1c of less than 7 % (p < 0.001). About visual acuity, we found no significant difference before the intervention and after the intervention, the changes were comparable between both study groups (p > 0.05). Conclusion: intra-vitreal injections of bevacizumab result in anatomical (macular thickness) and functional (vision ) improvement in those patients who had diabetic macular edema and strict glycemic control affecting the outcome of the treatment where strict regulation of glucose level have yield maximum benefit from the given therapy

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The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension

European Journal of Ophthalmology ◽

10.1177/1120672118785280 ◽

2018 ◽

Vol 29 (2) ◽

pp. 210-215 ◽

Cited By ~ 6

Author(s):

Marta Misiuk-Hojlo ◽

Maria Pomorska ◽

Malgorzata Mulak ◽

Marek Rekas ◽

Joanna Wierzbowska ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Standard Deviation ◽

Ocular Hypertension ◽

Benzalkonium Chloride ◽

Tear Film ◽

Corrected Visual Acuity ◽

Break Up ◽

Preservative Free ◽

Best Corrected Visual Acuity

Purpose: To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension. Methods: A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability. Results: Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001). Conclusion: Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.

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Effect of phacoemulsification with intraocular lens implantation in eyes with cataract and functioning filtering blebs

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v13i2.44 ◽

2013 ◽

Vol 13 (2) ◽

pp. 33-41

Author(s):

Devendra Maheshwari ◽

Rengappa Ramakrishanan ◽

Mohideen Abdul Kader ◽

Neelam Pawar ◽

Ankit Gupta

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Intraocular Lens ◽

Intraocular Lens Implantation ◽

Corrected Visual Acuity ◽

Lens Implantation ◽

The Mean ◽

One Year ◽

Best Corrected Visual Acuity

Aim: To evaluate the effect of phacoemulsification with intraocular lens implantation in eyes with pre-existing trabeculectomy.Methods: This prospective single-center clinical study evaluated intraocular pressure in 60 eyes of 60 patients who underwent phacoemulsification and implantation of a foldable intraocular lens after a previous successful trabeculectomy. Patients who had a trabeculectomy more than one year prior to the study were included. Intraocular pressure, number of antiglaucoma medications, bleb appearance, and visual acuity were recorded preoperatively, and at each follow-up examination and 12 months after phacoemulsification.Results: The mean intraocular pressure before phacoemulsification was 12.42 mmHg (SD, 4.60 mmHg), which increased to 14.98 mmHg (SD, 4.18 mmHg), 14.47 mmHg (SD, 3.58 mmHg), 15.44 mmHg (SD, 3.60 mmHg), and 15.71 mmHg (SD, 3.47 mmHg) after one, three, six, and 12 months, respectively. At each follow-up visit, the mean IOP was significantly higher than the preoperative value (p < 0.001, p = 0.015, p ≤ 0.001, and p = 0.001 at month one, three, six, and 12, respectively). The mean preoperative best-corrected visual acuity was 0.98 logMAR (SD, 0.44 logMAR) and the mean postoperative best-corrected visual acuity at 12 months was 0.20 logMAR (SD, 0.21 logMAR) [p = 0.0001]. The mean preoperative number of antiglaucoma medications used was 0.57 (SD, 0.63), which increased to 0.65 (SD, 0.63 ), 0.70 (SD, 0.72 ) 0.68, (SD, 0.70), and 0.67 (SD, 0.77 ) at one, three, six, and 12 months, respectively, but there were no statistically significant differences. Bleb size decreased clinically after phacoemulsification. Nineteen of 60 eyes (32%) developed fibrosis of bleb with decreased bleb size.Conclusion: Phacoemulsification with intraocular lens implantation significantly increased intraocular pressure and increased the number of antiglaucoma medications in eyes with pre-existing functioning filtering blebs.

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Short-term anterior chamber inflammation in phacoemulsification with and without Ex-Press glaucoma implant

European Journal of Ophthalmology ◽

10.1177/1120672119839300 ◽

2019 ◽

Vol 30 (3) ◽

pp. 533-537

Author(s):

Shmuel Graffi ◽

Beatrice Tiosano ◽

Modi Naftali ◽

Nakhoul Nakhoul ◽

Michael Mimouni ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Medical Center ◽

Glaucoma Surgery ◽

Consecutive Series ◽

Device Implantation ◽

Significant Difference ◽

Clinically Significant ◽

Retrospective Comparative Study

Purpose: The aim of this study was to investigate the incidence of clinically significant anterior chamber inflammation in a combined surgery, namely, phacoemulsification and Ex-Press miniature glaucoma device implantation, compared to phacoemulsification alone. Methods: A retrospective comparative study of a consecutive series of 210 participants above 18 years of age diagnosed with significant cataract and who required glaucoma surgery, namely, Ex-Press miniature glaucoma device implantation or cataract alone in one or both eyes. All were operated on by a single experienced glaucoma surgeon in a single medical center. A total of 231 eyes were included in this study. All cases underwent an uneventful surgery and were examined the day following the surgery for visual acuity, intraocular pressure, and signs of excessive anterior chamber inflammation (Standardization of Uveitis Nomenclature grading ⩾ 3). Results: The combined group included 55 eyes of 51 patients, of whom 15 (27.3%) demonstrated excessive anterior chamber inflammation. The phacoemulsification group included 176 eyes of 159 patients, of whom 12 (6.7%) demonstrated excessive anterior chamber inflammation. Visual acuity and intraocular pressure measurements showed no statistically significant difference between the two groups. Conclusion: The Ex-Press glaucoma device is efficient, safe, and known for its inert nature. However, combination of this procedure with phacoemulsification surgery might result in a condition encouraging excessive inflammation, which eventually could lead to excessive anterior chamber inflammations if not treated vigorously. Emphasizing and recognizing the risks, especially in glaucoma patients, is important.

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Examining the effect and safety of orthokeratology in controlling the development of myopia: Based on fluorosilicone acrylic breathable material

Materials Express ◽

10.1166/mex.2020.1690 ◽

2020 ◽

Vol 10 (5) ◽

pp. 740-747

Author(s):

Yanxia Song ◽

Haixia Tian ◽

Suling Yang ◽

Feifan Du ◽

Huihui Sun ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Axial Length ◽

Corneal Endothelium ◽

Clinical Effect ◽

Naked Eye ◽

Corrected Visual Acuity ◽

Significant Difference ◽

Before And After

We aimed to evaluate the clinical effect and safety of orthokeratology in controlling the development of myopia. We assessed the changes in visual acuity, diopter change, axial length, corneal endothelium count, intraocular pressure, and corneal Q value in 30 adolescents with 60 years of wearing an orthokeratology lens. In this study, no significant difference was observed between the naked eye vision and corrected visual acuity before wearing the lens (t = –0.23, P = 0.59); furthermore, no significant difference was observed in diopter, axial length, corneal endothelium count, and intraocular pressure 1 year before and after wearing the lens (t = 1.24, P = 0.45; t = –0.89, P = 0.25; t = –0.43, P = 0.57; t = 1.43, P = 0.61); by contrast, there was a significant difference in the corneal Q value before and after wearing the lens (t = –8.37, P = 0.001). These results suggest that the fluorosilicone acrylic breathable material corneal orthopedic lens is safe and effective in controlling myopia, and has little effect on the physiology of the eye.

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Single-pass four-throw pupilloplasty for Urrets-Zavalia syndrome

European Journal of Ophthalmology ◽

10.1177/1120672117747038 ◽

2018 ◽

Vol 28 (5) ◽

pp. 552-558 ◽

Cited By ~ 1

Author(s):

Priya Narang ◽

Amar Agarwal ◽

Dhivya Ashok Kumar

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Segment ◽

Anterior Chamber Angle ◽

Single Pass ◽

Corrected Visual Acuity ◽

The Mean ◽

Chamber Angle ◽

Best Corrected Visual Acuity

Purpose: To demonstrate the efficacy and initial results of single-pass four-throw pupilloplasty in cases of Urrets-Zavalia syndrome. Methods: In this prospective interventional study, single-pass four-throw was performed to reconstruct the pupil in all symptomatic cases with Urrets-Zavalia syndrome. Applanation tonometry, indentation gonioscopy, and anterior segment optical coherence tomography for anterior chamber angle assessment were performed in all the cases. Results: Out of 10 cases that were identified with Urrets-Zavalia syndrome, the procedure was performed in 7 cases, whereas 3 cases were left untreated, as they did not have any visual complaints. Five out of seven eyes had preoperative raised intraocular pressure with appositional closure of the angle. Postoperatively, intraocular pressure was controlled in all the eyes, whereas one eye required antiglaucoma medications to control the intraocular pressure. The mean preoperative and postoperative best-corrected visual acuity was 1.1 ± 1.2 and 0.4 ± 0.4 LogMar, respectively. There was a significant improvement in the best-corrected visual acuity (p = 0.0169) in the postoperative period. The mean preoperative and postoperative intraocular pressure was 26.6 ± 11.23 and 16.3 ± 2.98 mm Hg, respectively (p = 0.0168). All the patients had a minimum of 6-month follow-up period (range = 6–8 months). Conclusion: Single-pass four-throw can be employed for cases with Urrets-Zavalia syndrome, and single-pass four-throw helps to prevent the postoperative glare and narrows down the pupil size effectively. Single-pass four-throw helps to alleviate the anterior chamber angle apposition in patients with Urrets-Zavalia syndrome by mechanically pulling the peripheral iris centrally as demonstrated on anterior segment optical coherence tomography. The study also reports the occurrence of Urrets-Zavalia syndrome after glued intraocular lens surgery.

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Retro-pupillary iris fixated intraocular lens: A boon to aphakia

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.082 ◽

2021 ◽

Vol 7 (2) ◽

pp. 415-418

Author(s):

Subramanya K Giliyar ◽

Ravi Bypareddy ◽

Kamakshi N Moger ◽

Vinutha Moger ◽

Deeksha Bekal

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Intraocular Lens ◽

Simple Procedure ◽

Visual Outcome ◽

Secondary Outcome ◽

Corrected Visual Acuity ◽

Corneal Decompensation ◽

Best Corrected Visual Acuity ◽

Capsular Support

To evaluate post operative visual outcome and complications of retro-pupillary iris fixated Intracoular lens (IOL) in aphakia. This is a prospective interventional case study conducted at our tertiary eye care centre from March 2018 to February 2019 All monocular aphakias secondary to any cause with no capsular support, good iris diaphragm support and BCVA of better than 6/60 were included. Patients who required combined procedures like trabeculectomy and retinal procedure were excluded. Patients with poor endothelial count/ corneal decompensation, any posterior segment pathologies, pre existing glaucoma and any form of uveitis were also excluded from the study. Pre operative visual acuity, slit lamp examination and fundus examination were carried out. Anterior vitrectomy and retropupillary fixation of iris claw lens were done. The primary outcome was to assess the post operative visual acuity and secondary outcome was to analyse post operative complications at various intervals up to 6 months after surgery. Our study comprised of thirty eyes of 30 aphakic patients. RPIFIOL was inserted as primary intraocular lens in 18 patients (%) and secondary intraocular lens in 12 patients(%). Baseline best corrected visual acuity was 0.831±0.66 logMAR. Four patients had light perception at baseline. The mean best corrected visual acuity was 0.77±0.35 logMAR at month 1, 0.64±0.36logmAR at month 3 and 0.53±0.33logmAR at month 6 respectively. Mean intraocular pressure at baseline was 16mmHg. Mean intraocular pressure at month 1, 3 and 6 were 17mmHg, 16mmHg, and 16mmHg. Among the complications, twelve eyes (40%) had significant ovalisation of pupil at post operative month 1 which persisted at month 6, two eyes(6.66%) had transient ocular hypertension (OHT), and none of the eyes progressed to glaucoma. Choroidal detachment was noted in 2 eyes (6.66%), CME in 3 eyes (9.99%), 1 eye (3.33%) had retinal detachment and 2 eyes (6.66%) had one haptic disenclavation. Among the complications, ovalisation of pupil was the most common observed one. Retro-pupillary Iris fixated IOL is an effective, safe and simple procedure for management of aphakia in eyes with no posterior capsular support.

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Dynamics choroidal thickness in anterior uveitis without visible retinal changes

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-204-207 ◽

2021 ◽

pp. 204-207

Author(s):

E.V. Udovichenko ◽

◽

E.L. Sorokin ◽

L.P. Danilova ◽

◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Uveitis ◽

Choroidal Thickness ◽

Main Group ◽

Hla B27 ◽

Acute Anterior Uveitis ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Purpose. To assess the state of the choroid in patients with HLA-B27-associated anterior uveitis without detectable lesions of the macular zone by ophthalmoscopy. Material and methods. 22 patients with HLA-B27-associated acute anterior uveitis without detectable changes in the macular zone by ophthalmoscopy – the main group. Age: 39.02±13.76 years, men – 16 and women – 8. Best corrected visual acuity varied from 0.1 to 0.5 (average 0.3). The level of intraocular pressure according to Maklakov in all eyes varied from 15 to 22 mm Hg. The parameters of paired intact eyes of patients served as a control. The subfoveal choroid thickness (CT) was determined using optical coherence tomography in comparison with paired intact eyes before treatment and 2 weeks after its initiation. Results. The initial values of the CT indexes in the main group varied from 337 to 371 μm, averaging 354±8 μm. This is statistically significantly higher than in intact paired eyes 255±7 μm (from 246 to 268 μm), p <0.001. 2 weeks after the start of treatment CT indexes in the main group were 268±10 μm, which was statistically significantly lower than the initial indexes in this group, p<0.001. In paired eyes, they were 254±6 μm. Conclusion. A statistically significant increase in CT was revealed in the eyes of patients with acute anterior uveitis, which statistically significantly exceeded the values of the paired intact eye on average on 100 μm. 2 weeks after the start of treatment, the CT indexes statistically significantly decreased to 268±10 μm, which did not differ statistically significantly from the CT indexes of the intact eye. Key words: anterior uveitis, HLA-B27, choroidal thickness.

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Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis

European Journal of Ophthalmology ◽

10.1177/1120672117750059 ◽

2018 ◽

Vol 29 (1) ◽

pp. 69-74 ◽

Cited By ~ 6

Author(s):

Mohammed Mamdouh Elwan ◽

Ayman Elsayed Abd Elghafar ◽

Sherein Mahmoud Hagras ◽

Waleed Ali Abou Samra ◽

Sameh Mohamed Saleh

Keyword(s):

Visual Acuity ◽

Internal Limiting Membrane ◽

Foveal Thickness ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Myopic Foveoschisis ◽

Central Foveal Thickness ◽

Corrected Visual Acuity ◽

Significant Difference ◽

Best Corrected Visual Acuity

Purpose: To compare between vitrectomy with internal limiting membrane peeling over the whole macula and preservation of the epi-foveal internal limiting membrane in myopic foveoschisis. Patients and methods: A prospective controlled non- randomized comparative study included patients with myopic foveoschisis recruited between 2013 and 2017. Patients were allocated into two groups: group A included patients who underwent vitrectomy with complete macular internal limiting membrane peeling and group B included those who underwent preservation of the epi-foveal membrane. Pre- and postoperative best corrected visual acuity and macular optical coherence tomography were obtained and compared. Results: There was no statistically significant difference between the two groups regarding the preoperative baseline data. The difference between the two groups was insignificant as regard postoperative best corrected visual acuity (p = 0.18) and central foveal thickness (p =0.504). There was statistically significant improvement in final best corrected visual acuity within each group (p < 0.0001). Central foveal thickness significantly decreased postoperatively within each group (p < 0.001). No macular holes or other visual-threatening complications were recorded in either group. Conclusion: Vitrectomy with complete internal limiting membrane peeling resulted in comparable outcomes to those achieved with preservation of the epi-foveal membrane in treating cases with myopic foveoschisis. There was no statistically significant difference in final visual acuity between the two groups. No macular holes were recorded in either group.

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