OCULAR CLINICAL PROFILE OF PATIENTS WITH PSEUDOEXFOLIATION SYNDROME AND PSEUDOEXFOLIATION GLAUCOMA AT TERTIARY CARE CENTRE IN KASHMIR

Aim: To study the clinical profile of pseudoexfoliation (PEX) syndrome and Pseudoexfoliation glaucoma at tertiary care centre in Kashmir. Materials and Methods: A cross sectional study consisting of 100 PEX and 100 PEXG patiens, attending the general ophthalmology clinic of a tertiary care center in kashmir. All patients underwent a complete ophthalmologic evaluation including recording IOP,gonioscopy and Central Corneal Thickness(CCT). Results: The study cohort comprised 200 patients(100 with PEX and 100 with PEXG). There were 145(72.5) males and 55(27.5%) females. The highest number of patients (120 patients) were from the age group between 61 and 70years. 145(72.5%) patients were involved in outdoor activities.153(76.5%) patients had bilateral involvement of pseudoexfoliationand pseudoexfoliative material was present at anterior lens capsule in 175(49.58%) eyes. Nuclear cataract was predominant type of cataract and was present in 188(48.2%)eyes. Mean IOP was 17.26±7.634mmHg in PEX group and 24.39±4.456mmHg in PEXG group. Gonioscopyshowed open angles in 96.5% of eyes and occludable in 3.5% eyes . Mean central corneal thickness was 531.80±19.127μm. Conclusion: The prevalence of PEX is found to increase with age. Patients with PXG had more severity of optic nerve damage at presentation. Therefore a careful assessment for detection of PEX is warranted and regular follow-up of patients is desired to minimize the extent of optic nerve damage.

Aqueous misdirection syndrome masking as myopic surprise following phacoemulsification surgery

Aqueous misdirection syndrome is a rare but serious condition that can present after routine phacoemulsification surgery. This report examines a case of myopic surprise following an uncomplicated left eye (LE) phacoemulsification surgery. The patient had previous bilateral peripheral iridotomies for narrow anterior chamber angles. Repeat biometry measurement of the pseudophakic LE did not show shallow anterior chamber, and intraocular pressure (IOP) was normal at initial presentation. However, approximately 3 years postoperatively, LE IOP was raised. Surgical management was considered as medical and laser procedures did not stop deterioration. Clinical presentation of aqueous misdirection syndrome may be subtle and can occur weeks to years after routine uncomplicated phacoemulsification surgery. Myopic surprise may be the only initial presenting sign. Patients who are at risk of aqueous misdirection syndrome should be followed up closely after cataract surgery with accurate gonioscopic assessments for early diagnosis and treatment to prevent optic nerve damage.

Atypical presentations of non-familial anterior megalophthalmos: a rare disease

Anterior megalophthalmos usually presents early in life with megalocornea, deep anterior chamber, raised intraocular pressure, glaucomatous optic nerve damage and iridodonesis/stromal thinning with positive family history. We report atypical features and presentations in two patients (four eyes) with non-familial megalophthalmos. While the first patient, a male, presented at 51 years of age with megalocornea, cataract, phacodonesis, normal pupillary dilatation/normal iris and advanced glaucoma, the second patient presented with iridodonesis with stromal thinning, aphakia and advanced glaucoma. The family history was negative in both patients. The vitreous index was unusually high, >70% in all four eyes, owing to aphakia in the second patient and possible late presentation/variant phenotype in the first patient. Thus, atypical features such as greater vitreous length, absent iris involvement and late-onset adult presentation are common in non-familial anterior megalophthalmos. Clinical surprises due to varied phenotypes should be kept in mind in such cases.

Glaucoma Progressing Stage Estimated from Visual Field Test Data with Glaucoma Patient; and Zinc(Ⅱ) Induced Regenerative Ativity from Optic Nerve Damage

Glaucoma progressing stages (Stages 1～5) estimated from Visual Field Index (VFI); Mean Deviation (MD); and Pattern Standard Deviation (PSD) data has been elucidated; in which the glaucomatous pathology is in the proceeding stage 2-3 with T. Ishida's glaucoma patient compared with referring with VFI; MD; and PSD values to the literatures. Zinc(Ⅱ) induced VFI improvement should be taken into account when interpreting rates of VFI change over time that zinc promotes Retinal Ganglion Cells (RGCs) survival; in which zinc intake in RGCs survival may be zinc acetate 25-50 mg/day. Zinc(Ⅱ) induced recovery activity from optic nerve damage of the eye consists of four processes as follows. (1) Intraocular inflammatory stimulation process; Zinc concentrations 123-292 μg/g inhibit intraocular inflammation with atypical growth factor oncomodulin (Ocm) binding to its cognate receptor on RGCs. (2) RGC survival process; Zn2+ chelators enhance RGC survival and promote axon regeneration through the optic nerve. (3) Neural axon regeneration process; Zn2+ chelation promotes axon regeneration. Norepinephrine Transporters (Net) inhibitor promotes RGCs survival and axonal regeneration. (4) Eye to brain pathway process; Zn2+ chelator TPEN promotes both enduring RGC survival and considerable axon regeneration. Zinc induced recovery for NO production in RGCs that the NO conveys from the eye to the brain through the axons of RGCs; in which zinc concentration 100 μM may be suited for the optic nerve recovery. Accordingly; Zinc(Ⅱ) could enhance optic nerve damage recovery that Zn2+ may be bound with optic nerve damage proteins; in which Zn2+ ions may bind with intraocular protein; RGC survival protein; axonal protein; and optic nerve disorder proteins during recovery process by Zn2+ ions-centered tetrahedrally binding proteins molecular coordination pattern.

A Prospective Study of Patients with Pseudoexfoliation Glaucoma and Its Management in a Tertiary Care Centre in South India

BACKGROUND Pseudoexfoliation syndrome is the most common identifiable cause of open angle glaucoma worldwide. Pseudoexfoliation glaucoma develops in 50 % of patients with pseudoexfoliation syndrome. The purpose of this study was to assess the clinical profile, intraocular pressure (IOP), gonioscopic findings, disc changes and need for medical or surgical line of management for the control of pseudoexfoliation glaucoma. METHODS It was a prospective hospital based interventional study of 68 consecutive patients diagnosed with pseudoexfoliation glaucoma, who presented to the glaucoma clinic at a tertiary care centre from Nov 2017 to Mar 2019. RESULTS 68 patients diagnosed with pseudoexfoliation glaucoma were evaluated during the study period from November 2017 to March 2019. Male predominance of 43 (63 %) was noticed. Mean age group of study population was 68 years with 44 (65 %) of patients in age group of 61 – 75 years. 55 cases had bilateral pseudoexfoliation. 85 (69 %) eyes had a pressure of > 21 mm of Hg. 97 (79 %) eyes had open angles, 4 (3 %) occludable angles, 22 (18 %) had closed angles. 4 (3 %) of eyes had cup disc ratio < 0.5, 49 (40 %) eyes had cup disc ratio of 0.5 - 0.7, 64 (52 %) had > 0.7 cupping. 38 (31 %) eyes were controlled on medical therapy with topical antiglaucoma medications. In 14 (11 %), eyes were treated with Nd: YAG PI (neodymium-doped yttrium aluminium garnet peripheral laser iridotomy) with medical treatment, 59 (48 %) eyes were taken up for triple procedure. 10 (8 %) eyes could not be controlled using medical therapy and had to be taken for surgical treatment. CONCLUSIONS Pseudoexfoliation glaucoma leads to irreversible visual loss if high IOP is not treated leading to glaucomatous optic nerve damage and visual field loss. The response to medical therapy is poor and needs surgical intervention. KEYWORDS Pseudoexfoliation Glaucoma, Intraocular Pressure, Optic Nerve Damage, Dandruff Like Material

Diagnosis and Management of Wooden Foreign Bodies in the Orbit: A Case Report

The diagnosis and management of intraorbital foreign bodies are challenging for surgeons. Foreign bodies made of wood and those located close to the optic nerve are especially difficult to manage. Herein, we report our experience with the diagnosis and management of intraorbital wooden foreign bodies utilizing magnetic resonance imaging (MRI). A 50-year-old man presented to the emergency room with a laceration on his left upper eyelid. No foreign bodies were visible through the laceration, and computed tomography findings showed only evidence of cellulitis with abscess formation. Despite drainage and antibiotics, the cellulitis worsened; subsequently, we found multiple wooden foreign bodies on MRI. Surgical removal was performed, excluding those in the intraconal space to avoid optic nerve damage. The patient recovered well and has not experienced any ophthalmic complications at 1 year of follow-up.

Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data

Background Uveitic glaucoma commonly leads to a more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC). Methods Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow up was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopuncture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classified as a failure. Results A total of 16 patients with uveitic glaucoma were reviewed. Complete success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries. Conclusion There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.