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CONTEXT: Glaucoma is the leading cause of blindness and vision loss worldwide and hasa major impact on quality of life. As glaucoma is a multifactorial disease, it is important to identify the association between its ocular and systemic risk factors. AIMS: To assess the demographic profile, type of glaucoma, grade, risk factors and severity of same in first time diagnosed patients of glaucoma. SETTINGS AND DESIGNS: Primary open angel and Primary close angle glaucoma patients were selected according to inclusion criteria and cross-sectional observational study was carried out. METHODS: This analysis includes study of 200 patients diagnosed with glaucoma for the first time at a Western Regional Institute of Ophthalmology in Western India. Patients visual BCVA, age, intraocular pressure, corneal pachymetry, gonioscopy, central disc ratio, visual field findings and optical coherence tomography (OCT) were analysed. STATISTICAL ANALYSIS USED: Data were analysed using independent t test and statistical software Spss 26.0 version and Microsoft excel. P < 0.05 was considered stastically significant. Results: The study revealed that the mean age of patient of POAG was 60 and PACG was 57 years. POAG mean IOP was 20.98 ± 2.78 and PACG mean IOP was 28.37 ± 5.33. We observed 11.5% patients with advanced glaucomatous damage clinically and on perimetry report. POAG patients were more aged than POCG patients and also had advanced glaucomatous damage clinically and on perimetry report. Hypertension and diabetes were most commonly observed risk factors. CONCLUSIONS: this study undermines the utmost importance of raising awareness about glaucoma and the significance of early screening before irreversible glaucomatous damage occurs. [ABSTRACT FROM AUTHOR]

Background: Pseudoexfoliation glaucoma (PXG) is more aggressive than Primary open angle glaucoma; Intraocular pressure (IOP) is higher, IOP fluctuations are excessive, and there is substantial damage to the optic nerve and visual field. Resistance to medical management, aggressive nature, and increased intraoperative complications of PXG make it distinct entity from primary open angle glaucoma. So, this study was conducted to analyze the prevalence of glaucoma in Pseudoexfoliation syndrome (PXS) and its clinical spectrum. Methodology: This was a hospital based, descriptive study done between February 2021 to August 2022, where patients satisfying the inclusion criteria were recruited for the study. Detailed history was taken. Visual acuity, anterior segment examination, IOP, gonioscopy, fundus examination visual field analysis, contrast sensitivity were evaluated. PXG was diagnosed based on pseudoexfoliative material on slit lamp examination, IOP>21 mm Hg, glaucomatous cupping, pigmentation of trabecular meshwork and visual field defects. Results: Prevalence of glaucoma in patients with PXS was 35.2%. Prevalence and laterality of PXS increases with increase in age and more common in males. Iris and lens were the most common sites for Pseudoexfoliation (PXF) material. Nuclear cataract was predominant in PXS. Central corneal thickness (CCT) in patients with PXG was found to be thinner that patients with PXS. Mean IOP in PXG was higher than in PXS. High-pressure glaucoma, Open angle glaucoma and unilateral glaucoma was most common type of glaucoma in PXG, which showed increased severity of optic disc damage and advanced field defects. Interpretation & conclusion: Thus, in view of high prevalence of glaucoma and aggressive nature of glaucoma in PXS leading to blindness, all elderly patients should be screened for PXS and patients with PXS should undergo complete glaucoma evaluation and follow up and treatment to prevent blindness. [ABSTRACT FROM AUTHOR]

Background: Glaucoma is a collection of eye diseases that affect the optic nerve, which is essential for proper vision. An unusually high pressure in the eye is often the source of this injury. Glaucoma is the second leading cause of blindness in the world. It is a serious worldwide problem that causes severe ocular morbidity and impairment as a consequence of its progressive nature, which results in permanent vision loss. Material and Methods: This is a prospective and observational study was conducted in the Department of Ophthalmology at Subbaiah Institute of Medical Sciences, Shivamogga from November 2022 to December 2023. Total 74 (Due to COVID pandemic the study subjects was reduced from 100 to 74). Data was collected from patients of primary open angle glaucoma with systemic hypertension presenting to ophthalmology department. Patients with systemic hypertension meeting the criteria mentioned above were included in the study after taking informed consent. A detailed history regarding past medical illness including hypertension, duration of hypertension, family history of glaucoma was taken. Details regarding antihypertensive medications and any other medications that the patient was on were also obtained. Results: Among study participants, about 66 % were males & 34% were females Demonstrating that out of 74 patients, 31 patients i.e., 42% had high IOP & remaining 58% had normal IOP. The mean values of IOP in right & left eyes were 21 mm of Hg & 20.80 mm of Hg respectively; clearly showing that mean IOP is slightly higher in Right eye of patients. Median values were 21 for right eye & 20.50 for left eye. Standard deviation for right eye was 3.664 & left eye was 3.188. Maximum value for right eye was 34 & minimum was 14 and for left eye maximum & minimum values were 30 & 14 respectively. The mean value for Central Corneal Thickness in Right eye as 511.36 with a standard deviation of 15.431 & median lies at 510. Conclusion: Even though, many studies reported that higher systemic blood pressure is having higher risk of developing POAG & few studies reported that hypotension is also a risk factor for developing POAG. But, in the current study there was a statistically significant association found between Systemic hypertension & POAG and also IOP is positively correlated with SBP. Thus, with this study, it can be concluded that systemic hypertension is one of the risk factors for developing POAG. [ABSTRACT FROM AUTHOR]

Glaucoma is one of the leading causes of irreversible blindness globally and is characterized by the gradual loss of retinal ganglion cells. The primary risk factor for the development and progression of glaucoma is increased intraocular pressure (IOP). Numerous surgical interventions exist to lower IOP should conservative therapy fail. One trend in recent years has been minimally invasive glaucoma surgery (MIGS) as an alternative to traditional methods. The ISTENT inject® is an ab interno trabecular micro-bypass implant designed to be implanted through the trabecular meshwork into the Schlemm's canal to lower IOP. The aim of the study was the postoperative visualization and description of the positioning of the ISTENT inject® using automated circumferential goniophotography. Patients with symptomatic cataracts and mild to moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigment-dispersion glaucoma were included who underwent combined cataract surgery with the ISTENT inject® and received postoperative automated gonioscopy with the NIDEK Gonioscope GS-1 to visualize the location of the implant. Twenty-four implants of 14 eyes in 11 patients could be visualized. Out of the implants, 14.3% were in the trabecular meshwork, 46.4% were at the border between the trabecular meshwork and scleral spur, 25% were below the trabecular meshwork, and 14.3% of the implants were not detectable in the gonioscopy. In the overall cohort, a statistically significant IOP reduction was found over the 12-month postoperative observation period. Even in three eyes, in each of which both stents were located below the trabecular meshwork, an IOP reduction over 12 months was observed compared to the baseline IOP. In this study, vertical two-dimensional positioning of the ISTENT inject® was performed for the first time using NIDKE GS-1 automated 360° goniophotography. The method is suitable for postoperative visualization, control, and documentation of positioning after ISTENT inject® implantation. Further studies are needed to analyze the correlation between positioning of the ISTENT inject® in the chamber angle and postoperative IOP reduction. [ABSTRACT FROM AUTHOR]

Purpose: To find the diagnostic accuracy of Disc Damage Likelihood Scale (DDLS) and cup-to-disc ratio (CDR) for diagnosis of glaucoma taking central corneal thickness (CCT) adjusted intraocular pressure (IOP) and characteristic visual filed defects with corresponding OCT-ONH changes as standard. Study Design: Comparative, cross-sectional. Place and Duration of Study: Department of Ophthalmology, Mayo Hospital, Lahore, from August 2020 to February 2021. Methods: Three hundred and nine patients were enrolled after taking informed consent. Demographic data was obtained and patients underwent complete ocular exam including DDLS and CDR, Slit-lamp biomicroscopy, gonioscopy and IOP. CCT, visual fields and OCT ONH was done. The patient was said to have glaucoma if his CCT adjusted IOP was greater than 21 mmHg, visual field defects and OCT changes. It was compared with CDR and DDLS, which was taken as suggestive of glaucoma with scores greater than 5. Results: Mean age of patients was 54.82 ± 9.29 years, 108 (34.95%) were males. The sensitivity, specificity and diagnostic accuracy of DDLS for detection of glaucoma was 78.57%, 84.97% and 80.91% and the sensitivity, specificity and diagnostic accuracy of CDR for detection of glaucoma was 82.14%, 49.56% & 70.23% taking CCT adjusted IOP and characteristic visual field defects with corresponding OCT changes as standard. Conclusion: DDLS is useful, cost effective and has higher accuracy to detect glaucomatous damage as compared to CDR for diagnosis of glaucoma taking CCT adjusted IOP and characteristic visual field defects with corresponding OCT changes as standard. [ABSTRACT FROM AUTHOR]

Introduction: diagnosing and managing highly myopic patients who might have or willdevelop glaucoma stillappears to be challenging and genuine diagnostic dilemma. This is due to the fact that high myopia is associated with elongation of the eye and resulting in tilting and torsion of the optic disc, causing visual filed defects that may resemble glaucomatous damage. This is why we are constantly asking ourselves is it glaucoma or just myopia? Or even both. Allophthalmologists assessing high myopic patients often encounter this dilemma. By 2050, about half the world's population will have myopia and in some parts of the world, these rates are already approaching 90%. Aim: early diagnosis assessment in myopic patients with changes in the visual field that might indicate glaucoma is the main goal of our research. Structural and functional defects in myopic eyes are difficult to distinguish from those caused by glaucoma. Materials and methods: this was prospective-retrospective randomized, clinical research. In order to make a scientifically valuable statistical comparison, a total of 300 eyes has been examined, i.e. 100 eyes in 3 groups of respondents of both gender: I group - patients with glaucoma, II group - patients with myopia and glaucoma, III group - patients only with myopia. Each group was also divided regarding the size of the optic disc diameter into 3 categories: small (<1.30 mm), medium (1.31-2.09 mm) and large (>2.10 mm). The following ophthalmological examinations were performed on all patients: natural visual acuity and best-corrected visualacuity, Goldman applanation tonometry, biomicroscopy examination, autorefractometry, gonioscopy, fundus examination - direct ophthalmoscopy (Volk lens +90D), spectral three-dimensional optical coherence tomography (SOCT 3D), static computerized perimetry. Results: our research results showed that respondents with progressive visual field loss have accordingly a higher numeric value of Disc Damage Likelihood Scale (DDLS). There is a statistically significant difference in the quality of the visual field in relation to the size of the disc in respondents diagnosed with glaucoma with and without the associated diagnosis of myopia. Conclusion: analyzing the comorbidity of glaucoma and myopia, it is possible to create a diagnostic algorithm technique and procedure with emphasis and aim in early detection of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the gonioscopic changes in patients receiving Descemet's stripping endothelial keratoplasty (DSEK) without pre-existing ocular hypertension (OHT) and to report its correlation with post-surgery OHT, graft survival, and visual outcomes.Methods: Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow-up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post-DSEK OHT details were documented.Results: A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra-ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid-induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre-operative best corrected visual acuity was 1.62 logMAR (range 1.17-1.77), which gradually improved to 0.79 logMAR (range 0.3-1.77) after 2 years (p < 0.00001).Conclusion: PAS was found to be an important factor associated with post-DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also. [ABSTRACT FROM AUTHOR]

Objective: To evaluate efficacy of gonioscopy-assisted transluminal trabeculotomy and relate to severity of glaucoma. Methods: A retrospective analysis of medical records of patients submitted to gonioscopy-assisted transluminal trabeculotomy, at a private hospital, from 2019 to 2021. Results: A total of 20 were submitted to gonioscopy-assisted transluminal trabeculotomy (2 eyes) or facectomy and gonioscopy-assisted transluminal trabeculotomy (18 eyes). Patients with advanced-stage disease achieved a decrease by 5 mmHg (26.5%) in IOP, with a reduction of 2.3 drugs, and eyes with mild or moderate glaucoma showed a drop by 8 mmHg (40%) in mean IOP and of 2.1 drugs. Half of the operated eyes had hyphema in the first days as the main surgical complication. Conclusion: Gonioscopy-assisted transluminal trabeculotomy is an effective procedure to reduce IOP and the number of drugs being used, with greater IOP decrease in eyes with mild/moderate glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether gonioscopic examination using a four-mirror goniolens affects intraocular pressure (IOP). Materials and Methods: This cross-sectional study included one randomly selected eye of 30 patients with primary open-angle glaucoma (POAG) under medical treatment and 27 healthy controls. IOP was measured using a noncontact tonometer (NT), then with a Tono-pen, followed by gonioscopic examination using a four-mirror goniolens (without gel), and finally a second IOP measurement by Tono-pen. We compared NT and Tono-pen measurements obtained before gonioscopic examination, and Tono-pen measurements obtained before and after gonioscopic examination. We evaluated the relationship between the difference in Tono-pen measurements before and after gonioscopy and central corneal thickness (CCT) and palpebral fissure height (PFH). Results: Mean IOPs in the POAG and control groups were 15.7±3.2 and 16±2.7 mmHg with NT before gonioscopy, 15.3±2.6 and 14.8Ü2.27 mmHg with Tono-pen before gonioscopy, and 14.9±3.1 and 14.37±2.13 mmHg with Tono-pen after gonioscopy, respectively. In pre-gonioscopic measurements, NT and Tono-pen measurements did not differ significantly in the POAG group (p>0.05), whereas NT measurements were higher than Tono-pen measurements in controls (p<0.05). The mean change in IOP after gonioscopy was -0.32±1.60 and -0.44±1.69 mmHg in the POAG and control groups, respectively (p>0.05). There was no difference in CCT between groups (p>0.05), whereas PFH was smaller in controls (9.67±0.73 vs. 10.Ü0.55 mm; p<0.05). Change in IOP was not correlated with CCT or PFH in either group (p>0.05). Conclusions: Our results indicate that gonioscopic examination using a four-mirror goniolens has no significant effect on IOP in open-angle eyes. [ABSTRACT FROM AUTHOR]

To develop and evaluate the performance of a 3-dimensional (3D) deep-learning–based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans. International, cross-sectional, multicenter study. A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively). For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference. The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated. In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933–0.953), 0.867 (0.838–0.895), and 0.878 (0.859–0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818–0.985), 0.900 (0.714–1.000), and 0.890 (0.841–0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836–0.933), 0.912 (0.816–1.000), and 0.700 (0.660–0.741), respectively, on the external testing set at clock-hour level. The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to review the literature that compares the accuracy of Anterior Segment-Optical Coherence Tomography (AS-OCT) against gonioscopy in detecting eyes with angle closure. It is currently unclear how AS-OCT fits into clinical practice for detecting angle closure. This is a systematic review and meta-analysis. Methods: A literature search was performed on Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials to identify studies that investigated the diagnostic accuracy of AS-OCT in detecting eyes with angle closure as diagnosed by gonioscopy. Eligible studies included in the analysis met stringent inclusion criteria determining the sensitivity and specificity of AS-OCT. Results: The initial search identified 727 studies, of which 23 were included in the final analysis. We found substantial variation in the parameters being studied and methodologies. The sensitivity of AS-OCT ranged from 46 to 100% (median 87%). Twenty-one studies identified parameters that showed sensitivity above 80%. The specificity ranged from 55.3 to 100% (median 84%). Conclusion: AS-OCT demonstrates good sensitivity for detecting angle closure. It may provide an avenue to address high rates of undiagnosed angle closure, such as found in developing Asian countries. However, AS-OCT is not yet able to replace gonioscopy. Clinicians should consider whether the diagnostic accuracy of AS-OCT is acceptable for their specific clinical use before adopting it. More studies are needed to determine the utility of AS-OCT, including longitudinal studies to determine the significance of eyes classified to have closed angles by AS-OCT but open on gonioscopy. [ABSTRACT FROM AUTHOR]

To assess anatomic changes after laser peripheral iridotomy (LPI) and predictors of angle widening based on anterior segment (AS) OCT and angle opening based on gonioscopy. Prospective observational study. Primary angle-closure suspects (PACSs) 50 to 70 years of age. Participants of the Zhongshan Angle Closure Prevention (ZAP) Trial underwent gonioscopy and AS-OCT imaging at baseline and 2 weeks after LPI. Primary angle-closure suspect was defined as the inability to visualize pigmented trabecular meshwork in 2 or more quadrants on static gonioscopy. Laser peripheral iridotomy was performed on 1 eye per patient in superior (between 11 and 1 o'clock) or temporal or nasal locations (at or below 10:30 or 1:30 o'clock). Biometric parameters in horizontal and vertical AS-OCT scans were measured and averaged. Linear and logistic regression modeling were performed to determine predictors of angle widening, defined as change in mean angle opening distance measured at 750 μm from the scleral spur (AOD 750); poor angle widening, defined as the lowest quintile of change in mean AOD 750 ; and poor angle opening, defined as residual PACS after LPI based on gonioscopy. Anatomic changes and predictors of angle widening and opening after LPI. Four hundred fifty-four patients were included in the analysis. Two hundred nineteen underwent superior LPI and 235 underwent temporal or nasal LPI. Significant changes were found among most biometric parameters (P < 0.006) after LPI, including greater AOD 750 (P < 0.001). One hundred twenty eyes (26.4%) showed residual PACS after LPI. In multivariate regression analysis, superior LPI location (P = 0.004), smaller AOD 750 (P < 0.001), and greater iris curvature (P < 0.001), were predictive of greater angle widening. Temporal or nasal LPI locations (odds ratio [OR], 2.60, P < 0.001) was predictive of poor angle widening. Smaller mean gonioscopy grade (OR, 0.34, 1-grade increment) was predictive of poor angle opening. Superior LPI location results in significantly greater angle widening compared with temporal or nasal locations in a Chinese population with PACS. This supports consideration of superior LPI locations to optimize anatomic changes after LPI. [ABSTRACT FROM AUTHOR]

Objective: To assess whether preoperative gonioscopy status is associated with the development of postoperative glaucoma after phacoemulsification. Procedure: Eligible dogs and eyes were selected from medical records (2007‐2017), and each eye was classified as having normal or abnormal gonioscopy status. Records were examined for postoperative glaucoma, and data were collected for baseline variables including patient signalment, surgical factors, and pre, intra, and postoperative medications. Results: Of 305 dogs (505 eyes) selected for review in this study, 111 dogs (163 eyes) had abnormal gonioscopy findings, and 194 dogs (342 eyes) had normal gonioscopy findings. Postoperative glaucoma occurred in 24% (39/163) of eyes with abnormal gonioscopy and in 14% (49/342) eyes with normal gonioscopy. Eyes with abnormal gonioscopy status were at higher risk of postoperative glaucoma compared to normal eyes (P =.025). There was no important confounding due to the numerous baseline variables summarised above. Regardless of gonioscopy status, the risk of glaucoma was highest during the first 2 months after surgery. Conclusions: Eyes with abnormal gonioscopy findings are at increased risk of postoperative glaucoma compared with eyes with normal gonioscopy findings. Gonioscopy is recommended as a part of presurgical assessment in all dogs prior to phacoemulsification. Further study is needed to assess whether the incidence of postoperative glaucoma can be reduced by increased monitoring or altered treatment protocols in cases that are known to have abnormal gonioscopy findings prior to cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between gonioscopic iridocorneal angle (ICA) morphology and the incidence of postoperative ocular hypertension (POH) and postoperative glaucoma in dogs undergoing cataract surgery. Animals studied: Retrospective analysis of 138 eyes of 78 canine patients who underwent phacoemulsification at North Carolina State University from December 1, 2015 through April 30, 2017. Methods: Medical records of all phacoemulsification patients with preoperative RetCam gonioscopic images were reviewed for preoperative, intraoperative, and postoperative variables. Gonioscopic angle indices were calculated using a novel (ZibWest) angle grading system, and these indices were analyzed for outcome‐related significance. Results: Increased surgeon experience was associated with increased probability of POH and vision loss. Higher average ZibWest Angle indices (ie, more open angles with less pectinate ligament dysplasia/ abnormality) were associated with a significantly decreased probability of medically unresponsive glaucoma. Increased patient age was significantly associated with an increased probability of both postoperative glaucoma and vision loss. Female dogs were significantly more likely to experience postoperative glaucoma compared to male dogs. Increased surgery time was significantly associated with increased probability of vision loss. Conclusions: The ZibWest angle index may predict increased risk for developing medically unresponsive glaucoma with cataract surgery. Female sex, and increased patient age, surgical time, and surgeon experience were associated with increased postoperative morbidity. [ABSTRACT FROM AUTHOR]

Beside the examination of optic nerve head and retinal nerve fibre bundles, gonioscopy is the most important examinations we have to perform when performing structure analysis. The differentiation of angle closure, angle closure suspect and open angle is essential not only for the correct diagnosis, but as well to draw the best therapeutic consequences out of these findings. In addition to grading systems that help us to classify the types of glaucoma, we can find pathological changes like abnormal vessels, inflammatory induced changes, pigmentations, clefts etc. that help us to make the right diagnosis and therapy. Nowadays As‐OCT is a big help and makes it a lot easier, but there are still essential deficits, that do not allow to replace gonioscopy by this new examination. In the presentation we will show, what we can see in normal and pathological eyes and which findings can be seen in AS‐OCT and which ones cannot been seen. [ABSTRACT FROM AUTHOR]

Gonioscopy is an indispensable part of work up in the context of glaucoma. Its value lies not only in differentiation between open angle and angle closure glaucoma. It is also providing essential clues for other specific glaucoma diagnoses, like pseudoexfoliation, pigment dispersion, neovascularization, goniodysgenesis and post‐traumatic changes. Examples will be shown. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify acute angle closure (AAC) risk following pharmacologic mydriasis and the factors affecting post-mydriatic intraocular pressure (IOP) in a population with a high prevalence of angle closure disease. Methods: In total, 460 individuals aged ≥ 72 years were enrolled in this cross-sectional community-based screening program. IOP was measured at baseline and 1 hour after mydriasis. Individuals with post-mydriatic IOP spike > 6 mmHg received indentation gonioscopy and IOP-lowering medication. Linear regression analysis was used to identify ocular parameters associated with post-mydriatic IOP elevation. Results: The mean age of participants was 77.8 ± 4.1 years, and 65.4% of them were men. In total, 21 eyes of 16 participants (3.48%) had post-mydriatic IOP spikes (range: 6–13.7 mmHg); among them, 15 eyes had an IOP of > 21 mmHg. None of the participants developed AAC. All eyes with IOP spikes were phakic, except for one with pseudophakic angle closure. Analysis of 381 participants with at least one phakic eye revealed that higher post-mydriatic IOP and IOP changes were associated with narrower angle grading, more extensive peripheral anterior synechiae, shallower central anterior chamber, and thicker lens. According to multiple linear regression analysis, post-mydriatic IOP was independently associated with baseline IOP and factors suggestive of crowded anterior chamber based on gonioscopic findings and central or peripheral anterior chamber depth evaluation in conjunction with lens thickness. Conclusion: Post-mydriatic IOP should be measured in phakic eyes with a crowded anterior chamber. Post-mydriatic IOP spikes can be effectively blunted with intervention to prevent AAC. [ABSTRACT FROM AUTHOR]

Objectives: To describe the signalment, ophthalmic examination findings, and follow‐up of dogs affected with a previously unreported retrocorneal pigmentary lesion. Materials and Methods: Retrospective record evaluation spanning 2009‐2019. Results: Retrocorneal pigmentary lesions were described in 34 patients (46 eyes). German Shepherds (n = 7), Jack Russel terriers (n = 5), and terrier crosses (n = 4) made up 16/34 (47.1%) of the cases. The mean age was 13.5 years (range 1.4‐14.2 years), and 16/30 (53.3%) dogs were female. Most dogs were affected unilaterally (22/34 (64.7%)), the others bilaterally, and 5/34 (14.7%) were referred for it while the others were incidentally diagnosed. The lesions affected the ventral, peripheral, inner cornea and had a round/undulated leading edge. The number of corneal clock hours affected was known for 41/46 (89.1%) eyes and involved 1‐3 clock hours in 32/41 (78.1%) eyes, 4‐6 in 6/41 (14.6%), 7‐9 in 2/41 (4.9%), and 10 in 1/41 (2.4%). The central cornea was affected in 9/46 (19.6%) eyes, and in 5/9 (55.6%), the median corneal clarity score was G2 (scale: G0‐G4). The commonest additional findings included free‐floating uveal cysts (11/34 dogs, 32.4%), cataracts (6/34 dogs, 17.6%), and primary glaucoma (5/34 dogs, 14.7%). Gonioscopy was available in 16/34 (47.1%) dogs and was normal except in primary glaucoma cases. Follow‐up was documented in 13/34 (38.2%) dogs with a mean follow‐up of 17 months (range: 5‐26 months). Lesion progression was documented in 6/13 (46.2%) dogs. Conclusions: Retrocorneal pigmentation occurs as a slowly progressive lesion of older dogs that could impact vision. Histological studies of affected eyes are warranted. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of the study was to report a small case series of patients with iridoschisis seen at our hospital over a period of 5 years. METHODS: Retrospective review of all those files over the past 5 years whereby the diagnosis of iridoschisis/iris atrophy/iris fibrils in anterior chamber (AC) was made. RESULTS: In our case series, the average age at presentation was 49 years (range: 23–85 years). The pathology was bilateral in 57% of patients in our series. Our most common presentations were angle closure glaucoma and cataract. Younger individuals can also manifest iridoschisis. CONCLUSION: The iridoschisis can be an incidental finding, and gonioscopy should be performed in all the cases, as occludable or synechiael angle closure may be present in these cases. [ABSTRACT FROM AUTHOR]

Purpose: Studies examining the anterior chamber angle and angle closure disease often compare quantitative angle information obtained using anterior segment optical coherence tomography (ASOCT) with one of several ordinal scales derived using gonioscopy. We test the assumption that the ordinal gonioscopic angle grades have equal step sizes and can be analysed using metric statistics. Methods: The medical records of 214 consecutive patients who were referred for assessment of the anterior chamber angle were prospectively examined using gonioscopy and ASOCT (Spectralis Optical Coherence Tomography, OCT, www.heidelbergengineering.com). Anterior chamber angle parameters (angle opening distance, AOD, and trabecular‐iris space area, TISA at 500 and 750 microns) were extracted from ASOCT images using a semi‐automated segmentation algorithm written on MATLAB (www.mathworks.com). We first matched the quantitative values for each gonioscopic grade (0–4, from no structures visible to ciliary body visible) and described the frequency distributions to determine separability. We then applied a grade‐agnostic clustering algorithm to determine the concordance between algorithm‐clustered groups (using solely quantitative data) and those obtained using gonioscopy. Results: The frequency distributions of the quantitative ASOCT parameters for each angle grade were mostly non‐parametric and displayed unique distribution characteristics, with a floor effect seen for grade 0 and the lack of a ceiling effect seen for grades 3 and 4. Although we found significant differences in quantitative values across the five angle grades using the frequency distributions, some pairwise comparisons were indistinguishable (such as grades 0 and 1, and grades 3 and 4) due to the overlaps in distributions. On average, differences in quantitative values were consistent between gonioscopic grade steps, but there remained substantial variability that confounds prediction of change between ordinal steps. The clustering algorithm showed approximately 10% of cases with the same group assignment as that of the gonioscopic grade, improving slightly to 30% when the top 5% of quantitative data were excluded from analysis. Conclusions: Our results do not necessarily support the assumption that the ordinal scales used in gonioscopy can be interpreted using an interval scale. We highlight the need for better methods of describing the course and risk of angle closure spectrum disease to identify disease progression and conversion, where gonioscopy remains the gold standard. [ABSTRACT FROM AUTHOR]

Background: Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease.Methods: The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted.Results: Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non-angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001).Conclusions: The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities. [ABSTRACT FROM AUTHOR]

Purpose: To assess the quality and accuracy of glaucoma referrals from ophthalmologist.Methods: Retrospective review of patients chart with referral letter to a tertiary glaucoma center between January and December 2017. Patients aged <16 years, lens-induced glaucoma, uveitic glaucoma, and glaucoma following retinal and corneal surgery were excluded.Results: A total of 184 patients referred by 55 ophthalmologists were included. Mean patient age (SD) was 57.8 ± 14 years. Intraocular pressure was not documented in the referral letter in 113 (61%) patients, gonioscopy in 174 (95%) patients, disc findings in 149 (81%) patients, and visual fields in 175 (95%) patients. Thirteen (37%) of the 35 patients referred as open angle glaucoma were found to have angle closure glaucoma. Pseudoexfoliation glaucoma was diagnosed in 29 (16%) patients, of which 18 were missed by the referring ophthalmologist.Conclusion: In our study >90% of referral letter did not have the essential parameters. A standard template for glaucoma referral is suggested, which will help the patient to get better transfer of care. [ABSTRACT FROM AUTHOR]

Purpose: Glaucoma is the leading cause of irreversible blindness in the world. The current study aims to estimate prevalence, features, and associations of open angle glaucoma (OAG) in a rural and urban East Indian population.Methods: This is a population based cross sectional study with two arms, rural (28 contiguous villages from 13 Gram Panchayats in Balagarh Police Station, Hooghly district) and urban (Kolkata). Individuals residing in the study area aged 40 years and above were included using multistage random cluster sampling. All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. The primary outcome was the prevalence of POAG (95% CI). Age and gender specific prevalence estimates were calculated. Multiple logistic regressions were used to analyze the risk factors.Results: Data from 7128 and 6964 subjects aged 40 years or older from Kolkata city and Hooghly district, respectively were analyzed. In the urban population, 2.10% (95% CI: 1.99-2.21%) had POAG and 0.15% (95% CI: 0.13-0.17%) had secondary OAG. In the rural population, 1.45% (95% CI: 0.59-2.31%) had POAG and 0.10 ± 0.03% (95% CI: 0.07-0.13%) had secondary OAG.Conclusion: The study concludes that higher age, higher vertical cup disc ratio (VCDR), and lower central corneal thickness (CCT) are important independent predictors of OAG and emphasizes that increased intraocular pressure (IOP) is not POAG. Gonioscopy, disc evaluation, and screening perimetry need to be incorporated in the detection protocol for glaucoma if we intend to lighten the burden of blindness due to glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: We performed a retrospective, comparative study to determine if patients with aniridia and glaucoma had open angles on high-resolution anterior segment optical coherence tomography (OCT) and clinical gonioscopy. Patients and methods: Forty-three patients (86 eyes) with aniridia had recorded anterior segment OCTs, gonioscopy, or both. Of these patients, 27 (54 eyes) were diagnosed with glaucoma and 16 (32 eyes) had no evidence of glaucoma. All patients had either anterior segment OCT, gonioscopy, or both. Results: The 43 patients with aniridia had average age of 32±17 years, and 27 (62%) were female. Anterior segment OCT and gonioscopy were recorded in 25 (58%) of the patients and 18 (42%) of the patients had gonioscopy alone. Of the 54 eyes with aniridia and glaucoma, 4 (7%) eyes in 3 patients (11%) had partial or completely closed angles. Of the 32 eyes without glaucoma, all (100%) had open angles. The proportion of open angles in the aniridia with glaucoma eyes was not significantly different compared with the aniridia without glaucoma eyes (P=0.32). Of the 4 eyes with closed angles, all had a history of prior surgery for cataract, glaucoma, and/or keratopathy. The proportion of eyes with prior surgery was significantly higher in eyes with open-angle glaucoma and angle-closure glaucoma compared with eyes without glaucoma (P<0.001 and P=0.002, respectively). Conclusion: The majority of eyes with aniridia and glaucoma have open anterior chamber angles, similar to patients with aniridia without glaucoma. All eyes with aniridia and glaucoma that had closed angles had a prior history of ocular surgery. [ABSTRACT FROM AUTHOR]

Purpose/Aim: To evaluate the best formula to predict intraocular pressure (IOP) reduction after cataract surgery. Materials and methods: In this prospective longitudinal study, we included consecutive patients with or without glaucoma, either with open or with narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Clinical factors and anterior segment parameters measured with optical biometry and optical coherence tomography were evaluated as preoperative predictors for IOP reduction at 6 months postoperatively. To find the best combinations of predictors, model selection was conducted using least absolute selection and shrinkage operator regression with cross-validation. Results: A total of 156 eyes from 109 patients were enrolled. The mean age of the patients was 74.89 (±8.54) years and the average preoperative IOP was 15.6 (±3.68) mmHg with 0.7 (range 0–4) glaucoma medications. The mean IOP reduction after phaco was 3.1 (±2.49) mmHg at postoperative month 6. After multivariate analysis, preoperative IOP (β = 0.49 [0.4–0.59] P <.0001), gonioscopy score (β = −0.14 [−0.23 to −0.06] P =.0001), anterior chamber depth (β = −0.85 [−1.64 to −0.07] P = 0.033), lens thickness (LT) (β = 0.87 [0.12–1.62] P =.024), and angle open distance 750 (β = −2.2 [−3.96 to −0.44] P = 0.014) were associated with IOP reduction. The best formula to correlate with IOP reduction was −4.76 + (0.46 × preoperative IOP) – (0.42 × LT) – (0.1 × gonioscopy score) – (0.66 × glaucoma status). Conclusion: Different formulas were developed and were able to improve the predictive value of the preoperative IOP. When used in combination, these formulas may help the clinician to know how much IOP reduction to expect after cataract surgery at 6 months postoperatively. [ABSTRACT FROM AUTHOR]

Aim: To examine the accuracy of referrals by community optometrists for suspected primary angle closure, including primary angle closure suspects, primary angle closure and primary angle closure glaucoma. Methods: A retrospective review of 769 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital in Scotland. Ninety‐five of 715 eligible subjects (13%) were referred due to suspected angle closure. All subjects had a comprehensive eye examination in the glaucoma clinic, including gonioscopy, with angle closure defined according to the International Society of Geographical and Epidemiological Ophthalmology classification as iridotrabecular contact over at least 270 degrees. Results: Fifty‐nine of 95 subjects referred due to suspected angle closure were confirmed to have an occludable angle, while 36 of 95 (38%) had open angles (positive predictive value = 62%). Of 620 patients referred to the glaucoma clinic for reasons other than narrow angles, 601 (97%) had open angles on gonioscopy and 19 (3%) had narrow angles. Using the 620 patients referred with 'open angles' as a control group, sensitivity was estimated as 76% and specificity 94%. Eleven of 95 (12%) patients referred for possible angle closure were discharged at the first visit compared to 156 of 620 (25%) referred to the glaucoma clinic for other reasons (p = 0.003). In a multivariable model, suspect angle closure detected by the optometrist (OR = 56.0, 95% CI 35.2–89.2, p < 0.001) and female gender (OR = 1.9, 95% CI 1.2–3.1, p = 0.008) were associated with increased odds of angle closure on gonioscopy. Conclusion: Community optometrists had good ability to detect eyes at risk of angle closure. There was also greater accuracy of referrals for suspected angle closure than for other glaucoma referrals. [ABSTRACT FROM AUTHOR]

Abstract The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management. [ABSTRACT FROM AUTHOR]

Purpose: Primary adult glaucomas that have an occludable angle with peripheral anterior synechiae which are too few to account for the chronically raised IOP, or the glaucomatous optic neuropathy, do not fit the definition of either POAG or PACG and can be considered as combined mechanism glaucoma (CMG). We aimed to compare the clinical features and anatomical parameters of combined mechanism glaucoma with age, sex, and refraction-matched POAG and chronic PACG eyes.Methods: Consecutive adult patients with definitive optic nerve head and perimetric changes of glaucoma were screened at a tertiary care center. All glaucomatous eyes having an IOP > 22 mmHg on at least three separate occasions and glaucomatous optic neuropathy consistent with moderate visual field loss in the eye were divided as POAG, PACG, and CMG. Eyes with occludable angles having < 90° of goniosynechiae were diagnosed as CMG. A detailed clinical examination, ocular biometry, and ASOCT were performed in the better eye of all individuals.Results: A total of 93 patients with similar visual field index or pattern standard deviation on perimetry were evaluated: 32 POAG, 31 CMG, and 30 PACG. The mean anterior chamber depth was 3.47 ± 0.37 mm in POAG, 2.81 ± 0.32 mm in PACG, and 3.06 ± 0.26 mm in CMG (p < 0.0001). Mean lens thickness was 4.22 ± 0.27 mm in POAG, 4.53 ± 0.35 mm in PACG, and 4.44 ± 0.29 mm in CMG (p = 0.0004). Iridotrabecular contact on ASOCT was nil in POAG, a mean of 87.60 ± 12.802% in PACG eyes, and 15.23 ± 14.19% in CMG eyes, p < 0.0001. CMG was similar to PACG in terms of corneal diameters and lens thickness and had an axial length in between PACG and POAG. On ASOCT, all parameters had highest values in POAG eyes and the least in PACG eyes, with CMG eyes having values in between the other two groups, p value of < 0.0001 between each group for all parameters.Conclusion: This study has demonstrated significantly different anatomical parameters in eyes with CMG, in addition to the differences on gonioscopy and iridotrabecular contact, indicating that CMG is discernibly dissimilar to PACG and POAG. [ABSTRACT FROM AUTHOR]

BACKGROUND: Glaucoma is the leading cause of blindness after penetrating keratoplasty (PK) and its early diagnosis and management is mandatory to salvage the graft. AIMS: This study aimed to evaluate the incidence and risk factors for post penetrating keratoplasty glaucoma (PKG). METHODS: Data of 155 eyes of 155 patients were reviewed retrospectively who underwent PK from March 2013 to February 2016. Data were analyzed from recipient records for recipient age, sex, indications, type of PK, lens status, recipient graft size or any additional procedure. Detailed ophthalmological examination was recorded for all cases including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) by applanation tonometry or tonopen, central corneal thickness (CCT) and gonioscopy. IOP measurement records were reviewed at each visit of one week, two weeks,one, three and six months and if IOP was elevated (>22 mmHg) medical management was initiated. Uncontrolled IOP with antiglaucoma medication (AGM) required surgical management. RESULTS: Overall incidence of raised IOP after PK was 32.25%. Increase in IOP post PK was reported mainly in 32 (64%) among age group >40 years. Raised IOP showed significant association with age group, indications of PK, recipient size and CCT (P value 0.00, 0.01, 0.00, 0.00) respectively. Two weeks after PK 46 (29.67%) patients reported an increase in IOP ,47(30.32 %) after 1 months, 33 (21.29%) at 3 months and 30 (19.35%) at 6 months. In 11 (39.28%) cases cataract was major long term complication seen in PKG cases. 35 (70%) cases of PKG were treated medically and 15 (30%) patients required surgical treatment. CONCLUSION: Subjects with age group >40 years, corneal opacity, increased recepient size and increased CCT are risk factors for PKG. IOP monitoring in early post operative period especially one month after PK is mandatory to avoid graft failure due to PKG which is difficult to diagnose otherwise. [ABSTRACT FROM AUTHOR]

Pigment dispersion syndrome predominantly affects young myopes. It is not uncommon for such patients to seek refractive surgery. It may also be encountered after an uneventful refractive surgery. We report a case of a young myopic male who presented with bilateral pigment dispersion syndrome 9 months after an uneventful photorefractive keratectomy. A meticulous ocular examination is the cornerstone of a successful refractive surgery. Through this report, we highlight the need for gonioscopy to be included as a routine examination in screening for refractive surgery. [ABSTRACT FROM AUTHOR]

Purpose: To classify subjects with primary angle closure into clusters based on features from anterior segment optical coherence tomography (ASOCT) imaging and to explore how these clusters correspond to disease subtypes, including primary angle closure suspect (PACS), primary angle closure glaucoma(PACG), acute primary angle closure (APAC) and fellow eyes of APAC and reveal the factors that become more predominant in each subtype of angle closure. Method: A cross-sectional study of 248 eyes of 198 subjects(88 PACS eyes, 53 PACG eyes, 54 APAC eyes and 53 fellow eyes of APAC) that underwent complete examination including gonioscopy, A-scan biometry, and ASOCT. An agglomerative hierarchical clustering method was used to classify eyes based on ASOCT parameters. Results: Statistical clustering analysis produced three clusters among which the anterior segment parameters were significantly different. Cluster 1(43 eyes) had the smallest anterior chamber depth(ACD) and area, as well as the greatest lens vault (p<0.001 for all). Cluster 2(113 eyes) had the thickest iris at 2000 microns(p = 0.048), and largest iris area(p<0.001), and the deepest ACD (p<0.001). Cluster 3(92 eyes) was characterized by elements of both clusters 1 and 2 and a higher iris curvature(p<0.001). There was a statistically significant difference in the distribution of clusters among subtypes of angle closure eyes(p<0.001). Although the patterns of clusters were similar in PACS and PACG eyes, with the majority of the eyes classified into cluster 2(55%, and 62%, respectively), the highest proportion of APAC and fellow eyes were assigned to clusters 1(44%) and 3 (51%), respectively. Conclusion: Hierarchical cluster analysis identified three clusters with different features. Predominant anatomical components are different among subtypes of primary angle closure. [ABSTRACT FROM AUTHOR]

The objective was to assess the effect of high intensity focused ultrasound (HIFU) on intraocular pressure (IOP) in dogs with primary glaucoma (PG). Seven dogs (13 eyes) presenting with PG as diagnosed by a raised IOP (> 20 mm Hg) associated with consistent gonioscopy and ultrasound biomicroscopy of the ciliary cleft, with no other ocular disease. Patients were divided into 3 groups, corresponding to their pre-operative IOP (group 1 ranging from 21 to 30 mm Hg, group 2 from 31 to 40 and group 3 for 40 and above). Ciliary process sonication was achieved with a probe containing one high-frequency transducer operating at 21 MHz during 5 seconds. Six sites were treated in patients from group 1, 8 in group 2, 10 in group 3, under general anesthesia. Post-operative treatment consisted of systemic meloxicam and topical carbonic anhydrase inhibitors, beta-blockers and prostaglandins analogues. No intraoperative complications were observed. Conjunctival hyperaemia occurred in eyes from group 2 (66%) and 3 (100%). Conjunctival burns were visible in 2 patients from group 3. One patient from group 3 experienced a hypertensive spike during the first hours post-op with associated pain. The hypotensive effect of HIFU was observed in all groups. Normotensive IOP (=20 mm Hg) was reached in all patients until the last recheck at 6 months post op. Despite the small number of patients included in the study, HIFU appears to be a promising option for the management of PG in dogs. [ABSTRACT FROM AUTHOR]

Introduction: To introduce a trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT) procedure and to report preliminary results.Materials and Methods: A preliminary case series of eight patients who have undergone the newly proposed TIGATT procedure is presented. TIGATT is a new concept that modifies established techniques by replacing the initial goniotomy incision of gonioscopy-assisted transluminal trabeculotomy (GATT) with an ab interno trabeculectomy ablation utilizing the trabectome. All surgeries were performed by a single surgeon (W.I.K.) between November 2014 and October 2015 in adults with primary open-angle glaucoma. Recorded outcome measures were intraocular pressure (IOP), number of medications, and complications.Results: Eight patients with an age range of 63-93 yr underwent TIGATT with at least 3 mo of follow-up. Five of the eight initial patients had follow-up to 2 yr. The mean pre-operative IOP was 25 mmHg (standard deviation [SD] 7.0) on four medications (SD 1.1). The mean post-operative IOP at 3 mo was 14 mmHg (SD 1.8) on two medications (SD 1.3). The average decrease in IOP was 9.9 mmHg (SD 7.5) with an average decrease in medications of two (SD 1.4) at 3 mo. At 2 yr, the mean post-operative IOP was 14 mmHg (SD 3.2) on one medication (SD 1.1). The average decrease in IOP was 7.8 mmHg (SD 3.1) with an average decrease in medications of two (SD 1.8). There were two treatment failures that required further glaucoma surgery and one patient was lost to follow-up.Conclusions: The preliminary results and safety profile for TIGATT are promising and appear at least comparable with previously published results for both GATT and trabectome. Initiating the transluminal trabeculotomy with trabectome clearly exposes Schlemm's canal and facilitates threading the microcatheter into the canal. Additionally, if the 360-degree trabeculotomy cannot be completed because of an incompletely patent Schlemm's canal, the patient will at least have a trabectome ablation that can serve as their glaucoma surgery. [ABSTRACT FROM AUTHOR]

Abstract: This article aims to review the published literature pertaining to the use of anterior segment optical coherence tomography (AS‐OCT) in the evaluation of angle‐closure disease. Searches on the available published literature were last conducted on 15 June 2017. Rated as Level I evidence, we found that AS‐OCT has shown good sensitivity and moderate diagnostic accuracy to detect narrow angles when compared with gonioscopy. AS‐OCT quantitative and qualitative parameters demonstrated strong association with the presence of gonioscopically closed angles. This technology provides an objective non‐contact method of assessing the angle that is well tolerated by the patient and correlates well with the information provided by gonioscopy. [ABSTRACT FROM AUTHOR]

Importance The role of the filtration bleb for IOP management following trabeculectomy (TRAB) and deep sclerectomy (DS) in glaucoma is highlighted in this study. Background This study serves to analyse the bleb morphology and IOP using the Indiana Bleb Appearance Grading Scale (IBAGS) and the anterior-segment optical coherence tomography (AS-OCT) postoperatively and at 3 months. Design The retrospective study was performed by a single surgeon. Participants Twenty-eight patients with open-angle glaucoma were recruited into the study, 14 in each of the TRAB (fornix) and DS groups. Methods The surgical intervention was dependent on the irido-corneal angle configuration on gonioscopy. Main Outcome Measures Pre-operatively, we collected visual acuity, medications and IOP. Three months postoperatively, we used the IBAGS to assess bleb morphology, including bleb height, extent, vascularity and leak. AS-OCT was also used to assess bleb height, thickness, cyst presence and posterior and intrascleral fluid. Results Central corneal thickness and mean IOP at 3 months postoperatively were significantly lower in the TRAB group (7.75 vs. 12.27 mmHg; P = 0.005). Blebs that were significantly higher, broader and less vascular compared with DS were displayed by TRAB eyes. The AS-OCT measurements confirmed TRAB eyes had significantly higher blebs and increased intrascleral fluid compared with DS eyes. Conclusions and Relevance Significant differences in bleb morphology, correlating with improved IOP outcomes in TRAB eyes compared with DS eyes in patients with open-angle glaucoma, were showed by both the IBAGS and AS-OCT. Despite the limitations of each classification system, a higher bleb with an increased aqueous reservoir is associated with optimal IOP results. [ABSTRACT FROM AUTHOR]

Background: Trabeculotomy with the Trabectome® is an effective surgical procedure to lower intraocular pressure (IOP). However, in some patients it does not lead to a significant IOP reduction despite a gonioscopically well visible opening of Schlemm's canal. This study investigated whether the size of the trabeculotomy opening and other parameters, including anterior chamber depth (ACD) are related to IOP reduction. Methods: Retrospective observational case series with 93 eyes of 93 patients who underwent Trabectome surgery. Trabeculotomy opening and ACD were measured with an anterior segment swept source OCT. IOP was taken pre-operatively and at a single follow-up visit [follow-up time 125 ± 66 days (mean ± SD)]. The relationship between IOP reduction and OCT parameters and possible confounding factors was analyzed in a multiple linear regression model. Results: The trabeculotomy opening size did not correlate with IOP reduction (slope of regression line = 0.0016; 95% confidence interval of slope: −0.025 to 0.028). The same applied for all other parameters tested, including ACD, which showed a tendency towards better IOP reduction with a deeper AC (slope = −1.9; 95% confidence interval: −5.54 to 1.73). Comparison between the 1st and 4th quartile of the trabeculotomy opening showed a significantly higher ACD in the largest trabeculotomy opening quartile (3.32 ± 0.05 mm vs. 3.16 ± 0.04 mm; p = 0.031). Conclusions: The fact that the trabeculotomy opening size did not correlate with IOP reduction points to the poorly understood role of the intrascleral aqueous outflow pathway in glaucomatous IOP elevation. A deeper AC might be a factor promoting a larger trabeculotomy opening. [ABSTRACT FROM AUTHOR]

Purpose To evaluate visual field (VF) progression and rate of glaucomatous VF loss in patients with primary angle-closure glaucoma (PACG) using pointwise linear regression (PLR) trend analysis. Design Clinic-based retrospective study. Participants Primary angle-closure glaucoma patients with 5 or more reliable VF tests and with 5 years or more of follow-up. Methods Visual field progression was assessed by PROGRESSOR software version 3.7 (Medisoft, Leeds, United Kingdom) and was defined by the presence of at least 2 adjacent testing points located within the same hemifield that showed progression with a change of –1 dB/year or more ( P < 0.01) for inner points or –2 dB/year or more ( P < 0.01) for edge points. We also performed a logistic regression analysis to determine the variables associated with rapid progression (defined as mean slope of progressing points ≥–1.5 dB/year). Main Outcome Measures Visual field progression and rate of VF loss. Results Of the 1296 patients who were assessed, 398 (30.7%) fulfilled the inclusion criteria of 5 or more VFs and 5 years or more of follow-up. Visual field progression was observed in 63 of 398 eyes (15.8%) according to the PLR criteria. The overall mean rate of VF change for these patients was –0.12±0.51 dB/year over a mean follow-up period of 10.4±3.7 years. There were no significant differences in the age, gender distribution, follow-up duration, or number of VFs between those who showed progression and those who did not (all P > 0.05). The most common sector of VF progression was the superior arcuate area (65%). Rapid progression was found in 36 patients (57%). Multiple logistic regression analysis revealed older age and higher vertical cup-to-disc ratio (VCDR) at presentation as predictors of rapid progression (all P < 0.005) in the progressing group (n = 63). Conclusions In patients with PACG being managed in a hospital setting, VF progression was noted in 15.8%, and the overall rate of VF loss was –0.12±0.51 dB/year. The superior arcuate was the most common sector of progression. Older age and higher VCDR at presentation were associated with rapid progression. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of inadvertent bleb formation presenting 18 months after pars plana M3 Molteno implant tube obstruction in a patient with mixed mechanism glaucoma. Materials and Methods: An 84-year-old Caucasian male with mixed mechanism glaucoma underwent slit-lamp examination, gonioscopy, colour anterior segment photography and anterior segment optical coherence tomography (AS-OCT). Results: An inadvertent bleb developed 18 months after pars plana implant tube re-positioning with a 6/0 Vicryl tie ligature. The bleb was located in the area anterior to the implant plate; it was characterised by a thin, transparent, avascular and multi-cystic wall, with a visible stoma at the posterior edge of the bleb. The bleb was functioning as demonstrated by an intraocular pressure of 6 mm Hg at presentation and a punctate fluorescein uptake pattern of the bleb wall. The bleb over the plate of the Molteno implant was non-functioning, likely secondary to tube obstruction by vitreous in the early postoperative period. AS-OCT showed a tract from the anterior chamber commencing at an entry wound through a corneal tunnel to the posterior stoma at the base of the inadvertent bleb. Conclusions: We hypothesise that the pathophysiologic factors resulting in an inadvertent bleb are a result of a combination of apoptosis, late-onset wound dehiscence and internal gaping of a centrally placed corneal wound. In addition, aqueous hydrodynamic factors may play a role. [ABSTRACT FROM AUTHOR]

The visualization capabilities of various ocular imaging instruments can generally be categorized into photographic (e.g. gonioscopy, Pentacam, RetCam) and optical tomographic (e.g. optical coherence tomography (OCT), photoacoustic (PA) imaging, ultrasound biomicriscopy (UBM)) methods. These imaging instruments allow vision researchers and clinicians to visualize the iridocorneal angle, and are essential in the diagnosis and management of glaucoma. Each of these imaging modalities has particular benefits and associated drawbacks in obtaining repeatable and reliable measurement in the evaluation of the angle. This review article in this context summarized recent progresses in anterior chamber imaging techniques in glaucoma diagnosis and follow-up procedures. [ABSTRACT FROM AUTHOR]

Purpose: To compare the prevalence of angle closure disease (ACD) diagnoses in a glaucoma department of an ophthalmology teaching hospital at two cut points, before and after encouragement of a supervised, mandatory gonioscopy for all patients, during all visits as well as to profile patients with angle closure disease in terms of age, gender, intraocular pressure, visual acuity, cup-to-disc ratio and refractive error parameters when divided by Foster's classification. Study design: Retrospective, two cut-point observational study. Material and methods: A 1-month sample of electronic medical records from 2010 and from 2013 was analyzed. Between those two cut points, gonioscopy was encouraged as a mandatory procedure and execution was supervised systematically. The prevalence of angle closure disease was obtained from the diagnosis of electronic medical records and patients with ACD were divided according to Foster's ACD classification in order to profile them. Results: A total of 2112 medical records from 2010 and 2549 medical records from 2013 were included. Angle closure disease prevalence went from 7.29% (n=154) in 2010 to 20.36% (n=519) in 2013. Prevalence of primary open angle glaucoma (POAG) decreased from 23.20% to 10.84% in the same time period. Conclusions: A comparison between the prevalence of angle closure disease between these two cut points showed a considerable increase. Angle closure disease was diagnosed 1.79 times more as opposed to when gonioscopy was not previously encouraged or supervised. ACD patients are generally women, with decreasing low hyperopia and intraocular pressure within normal ranges. [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence of pectinate ligament dysplasia ( PLD) in UK Leonbergers and identify cases affected by glaucoma. Also, to define the spectrum of pectinate ligament ( PL) appearance in this breed and determine whether gonioscopic monitoring should be recommended. Animals studied Data were compiled from 78 prospective gonioscopy examinations performed by one author ( GF) and retrospective analysis of 233 UK eye scheme certificates (2009-2014). Clinical cases of glaucoma in Leonbergers diagnosed by UK veterinary ophthalmologists, where gonioscopy of the fellow eyes or histology of affected eyes had been performed, were also reviewed. Procedure In the prospective study, intraocular pressure was recorded prior to gonioscopy using a rebound tonometer. Gonioscopy was performed using a slit-lamp biomicroscope with a Koeppe goniolens. PLD was categorized according to the percentage of the iridocorneal drainage angle affected (grade 0 = <25% affected; grade 1 = 25-50% affected; grade 2 = 51-75% affected; and grade 3 = >75% affected), and the degree of narrowing of the angle was noted. Results Of 78 dogs examined prospectively, 64/78 (82%) were grade 0, 7/78 (9%) were grade 1, 3/78 (4%) were grade 2, and 4/78 (5%) were grade 3. A large phenotypic variation was observed. Spearman's rank correlation showed a positive correlation between age and severity of PLD ( P < 0.0055). 52 (22%) of Leonbergers examined under the UK eye scheme 2009-2014 were affected by PLD. Five clinical cases of glaucoma were reviewed where gonioscopy had been performed and one where histology was performed. All individuals had grade 3 PLD with gonioscopy of the contralateral eye or severe goniodysgenesis with histological sections of the affected eye. Conclusion This survey suggests the prevalence of PLD is sufficient to justify ongoing screening of Leonbergers. [ABSTRACT FROM AUTHOR]

Context: Glaucoma is the leading cause of global irreversible blindness. No recent study with adequate sample size has been carried out to estimate glaucoma prevalence in Eastern India.Aims: The aim of this study was to assess and compare the prevalence and types of glaucoma in a rural and urban East Indian population.Settings and Design: The Hooghly River Glaucoma Study (HRGS) is a population-based cross-sectional study from West Bengal. A tertiary hospital in Kolkata was our urban study center. Our rural study area included 28 contiguous villages from the district of Hooghly surrounding the rural base hospital located at Dhobapara in village Bakulia. Individuals aged 40 years and above were included in this study.Subjects and Methods: All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. Glaucoma was defined using modified International Society of Geographical and Epidemiological Ophthalmology criteria.Statistical Analysis Used: Analysis was performed using Chi-square test and multiple logistic regression using SPSS.Results: Totally, 14,092 individuals participated; 2.7% were detected to have glaucoma in rural arm and 3.23% in urban arm (P < 0.001). In urban population, 2.10% had primary open angle glaucoma (POAG), 0.97% had primary angle closure glaucoma (PACG), and 0.15% had secondary glaucoma. In rural population, 1.45% had POAG, 1.15% had ACG, and 0.10% had secondary glaucoma.Conclusions: HRGS is the largest population-based glaucoma study in India to date with glaucoma prevalence comparable to other landmark Indian studies. POAG was the most common form of glaucoma in our study population as well. PACG was more common in this region than previously thought. [ABSTRACT FROM AUTHOR]

Purpose: To report on the safety and efficacy of Nd: YAG laser goniopuncture (LGP) for postsurgical intraocular pressure increase after deep sclerectomy (DS) in a consecutive cohort of open-angle glaucoma patients. Methods: This case series included 56 eyes from 49 consecutive patients who underwent LGP between November 2008 and March 2015. Prior to LGP, patients had undergone DS augmented with mitomycin C and injectable cross-linked hyaluronic acid implant between October 2008 and May 2014. Demographic variables, type of glaucoma, prior phacoemulsification, intraocular pressure (IOP), best-corrected visual acuity, execution of post-LGP maneuvres, and post-LGP complications were analyzed. The success rate of the procedure was analyzed using the Kaplan-Meier survival curve. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model in order to highlight variables associated with a failure to achieve surgical success. Results: Mean IOP was 23.0 mmHg prior to LGP, and 12.5, 11.8, and 10.5 mmHg at 6, 12, and 24 months after LGP respectively. Post-laser IOP was significantly lower than pre-laser IOP at every time point. For an IOP ≤ 15 mmHg, success rates were 85 % at 6 months, 76 % at 1 year, and 62 % at 2 years. Thirty-eight eyes underwent prophylactic iridotomy and iridoplasty prior to LGP. Iris prolapse into the trabeculo-descemetic window following LGP occurred in 6/18 eyes (33.3 %) of the non-pretreated and in 1/38 eyes (2.6 %) of the pretreated group. One case of choroidal detachment and one delayed suprachoroidal hemorrhage occurred after LGP execution in two non-pretreated eyes. Conclusions: LGP is a relatively safe and effective complementary adjunct to deep sclerectomy that makes it possible to further lower IOP and avoid additional filtering surgery. Prophylactic iridotomy and localized iridoplasty may permit the frequency of post-LGP complications to be reduced. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate intra-session repeatability of measurements of the iridocorneal angle at different meridians in the nasal and temporal areas in healthy eyes using the Sirius Scheimpflug photography-based system in glaucoma analysis mode. Methods: A total of 43 eyes of 43 patients ranging in age from 36 to 79 years were enrolled in the study. All eyes received a comprehensive ophthalmologic examination including a complete anterior segment analysis with the Costruzione Strumenti Oftalmici [CSO] Sirius system. Three consecutive measurements of nasal and temporal angles at 0°, ±10°, ±20°, and ±30° meridians were obtained in order to assess the intra-session repeatability of iridocorneal angle measurements provided by the device using the glaucoma analysis mode. Within-subject standard deviation (S), coefficient of variation (CV), and intraclass correlation coefficient (ICC) values were calculated. Results: The mean S was 1.07 ± 1.09°, 1.22 ± 1.53°, 0.66 ± 0.51°, 0.86 ± 0.57°, 0.68 ± 0.65°, 0.84 ± 0.68°, and 0.91 ± 0.70° at the temporal 30°, 20°, 10°, 0°, −10°, −20°, and −30° positions, respectively. Mean S was 3.13 ± 3.15°, 3.43 ± 3.63°, 2.75 ± 2.29°, 2.19 ± 1.55°, 1.90 ± 1.49°, 2.14 ± 1.74°, and 2.24 ± 2.06° at the temporal −30°, −20°, −10°, 0°, 10°, 20°, and 30° positions, respectively. Mean CV ranged from 1.36 ± 1.05 % (nasal 0° position) to 10.92 ± 13.95 % (nasal −20° position). ICC values ranged from 0.778 to 0.972. Conclusions: The glaucoma analysis mode of the Sirius system provides consistent measurements of the iridocorneal angle at different meridians in healthy eyes, with slightly less consistency for nasal measurements. It may be considered a clinically useful non-invasive technique for the detection of potentially occludable angles. [ABSTRACT FROM AUTHOR]

Glaucoma is one of the leading causes of visual impairment worldwide. Classically, clinicians have evaluated patients through a full ophthalmological examination including gonioscopy, measurement of intraocular pressure (IOP), and assessment of the optic nerve. New imaging modalities have further enhanced our ability to evaluate glaucoma; however, our treatments have not evolved as much. Whether one uses medical treatment with topical ocular antihypertensives, laser trabeculoplasty, or filtering surgery, the mainstay of treatment is to lower IOP. However, as our understanding of the disease evolves, mechanisms other than elevated IOP have been implicated in glaucoma pathogenesis. Recent animal model studies have shown a possible role of the immune system in the pathophysiology of glaucoma. This article explores the current understanding of immune reactions in glaucoma, which could lead to a new paradigm of treatment for human disease. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the baseline anterior segment (AS) parameters determined by AS optical coherence tomography (AS OCT) in the prediction of long-term outcome of laser peripheral iridotomy (LPI) in primary angle closure suspect (PACS) eyes Methods: Participants were imaged at pre-LPI and at 2 weeks and 3 years post-LPI using AS OCT. Based on these images, anterior chamber depth (ACD), iris curvature (IC), anterior chamber width (ACW), iris thickness at 750 µm from the scleral spur (IT750), lens vault (LV), and iris area (IA) were estimated using the Image J software (version 1.46). Proportional change (%) in angle opening distance at 750 µm from the scleral spur (AOD750) was used as an outcome measure for LPI. Univariate and multivariate regression analyses were performed to evaluate baseline AS parameters associated with changes in AOD750. Results: A total of 39 PACS eyes were included. At 2 weeks post-LPI, thinner IT750(p = 0.006) and less AOD750(p < 0.001) at baseline were related to a greater AOD750change. When assessed at 3 years post-LPI, thinner IT750(p = 0.039) and less AOD750(p = 0.003) at baseline were associated with a greater AOD750change. Conclusions: Thin peripheral iris and less AOD750at baseline were associated with greater changes in longitudinal assessment after LPI. PACS eyes with thick peripheral iris at baseline showed less AOD750change at both early and late follow up after LPI; therefore, such eyes should be followed with caution despite successful LPI. [ABSTRACT FROM PUBLISHER]

Purpose: To compare intraocular pressure (IOP) measurements obtained using the Icare Pro rebound tonometer and Tono-Pen XL tonometer in supine and lateral decubitus body positions. Methods: One-hundred eyes of 50 subjects (normal volunteers or glaucoma suspects) were enrolled in this prospective observational study. IOP was measured in both eyes using the Icare Pro and Tono-Pen XL in the sitting position and the recumbent positions including supine, right lateral decubitus and left lateral decubitus. IOP was measured five minutes after assuming each of the recumbent postures in a randomized sequence. The eye on the lower side in the lateral decubitus position was termed as the dependent eye. Agreement of IOP readings between the Icare Pro and Tono-Pen was assessed in all recumbent positions. Differences of IOP readings (ΔIOP) between the two tonometers and their correlations with ocular parameters were also assessed in all positions. Results: The IOP readings obtained using Icare Pro and Tono-Pen showed good correlations in supine and lateral decubitus positions (allr > 0.7,p < 0.005), although Icare Pro readings were higher than Tono-Pen readings (allp < 0.001) in all positions. The ΔIOP showed a weakly positive correlation with central corneal thickness in both eyes, whereas such a positive correlation was found only in the dependent eye in the lateral decubitus positions (r = 0.307–0.531, allp < 0.005). Both the spherical equivalents and axial lengths were not correlated with ΔIOP in all positions. Conclusion: IOP readings obtained with Tono-Pen and Icare Pro tonometers showed good agreement in supine as well as in lateral decubitus positions, although Icare readings were higher than Tono-Pen readings in all positions. Such differences in IOP readings between the different tonometers need to be considered when measuring IOPs in various body positions. [ABSTRACT FROM AUTHOR]

Topiramate is an oral sulfamate medication used primarily for epilepsy and migraine. The tolerability profile with its lack of significant metabolic side effects makes it a favorable drug for patients with comorbid lifestyle illnesses. Topiramate-induced angle closure is an idiosyncratic reaction and can occur in otherwise normal eyes with normal anterior chamber angles. Ocular examination before starting topiramate cannot identify eyes at risk. Prompt cessation of therapy alone can result in rapid resolution of most of these adverse effects, whereas failure to recognize can lead to permanent visual problems. The internists should be aware of the documented side effects of topiramate, particularly when presented with simultaneous bilateral acute angle-closure glaucoma. Neurologists initiating therapy with topiramate should also educate the patients of its potential side effects and importance of reporting back immediately in case of any visual disturbance. Prompt cessation of topiramate is the mainstay of treatment. Supportive treatment in the form of oral and topical antiglaucoma drugs to reduce the intraocular pressure (IOP), topical steroids to bring down the inflammation, and topical cycloplegics to retract the ciliary processes thus bringing down the IOP has been recommended, but a few would warrant laser iridotomy or surgical iridectomy. We report a case of topiramate-induced angle closure glaucoma in a young female being managed as a case of chronic migraine, highlighting the importance of increasing the awareness of this rare, idiosyncratic adverse effect of topiramate and the need for timely intervention to avoid irreversible visual loss. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the reproducibility of anterior chamber angle measurements obtained by the Zeiss Visante anterior segment optical coherence tomography (AS-OCT). Methods: Twenty eyes from 20 normal subjects with open anterior chamber angles were studied. The anterior chamber angle was imaged using the Visante AS-OCT. The angle-opening distance (AOD 500, AOD 750), trabercular iris space area (TISA 500, TISA 750) and scleral spur angle (SS angle) at the inferior angle location were measured. All the subjects underwent imaging in a darkened room (1 foot candles measured at the eye). Images were graded in a masked fashion by certified Doheny Image Reading Center graders. For intra-grader reproducibility assessments, images were re-graded by the same grader 1 week later after random sorting of images. For inter-grader assessments, a second masked grader independently reviewed the images. Intraclass correlation coefficients (ICC) were used to assess reproducibility. Results: Inferior angle measurements of AOD (500, 750), TISA (500, 750) and SS angle for 20 normal eyes were calculated. The intra-observer ICC calculations showed excellent reproducibility for all measurements (AOD 500 = 0.95, AOD 750 = 0.97, TISA 500 = 0.93, TISA 750 = 0.94, SS = 0.96; p < 0.001 for all). The inter-observer ICC calculations showed lower reproducibility for all measurements (AOD 500 = 0.71, p < 0.001; AOD 750 = 0.82, p < 0.001; TISA 500 = 0.49, p = 0.08; TISA 750 = 0.61, p = 0.02; SS = 0.75). Conclusion: Determination of anterior chamber angle measurements was possible with the time-domain AS-OCT, but only modest inter-observer reproducibility was found even among experienced graders. [ABSTRACT FROM AUTHOR]