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Aim: To evaluate refractive outcomes of cataract surgery with intraocular lens (IOL) implantation in operated eyes of primary congenital glaucoma (PCG)., Design: A retrospective case-control study., Methods: Patients of PCG who developed cataract following trabeculectomy with trabeculotomy were recruited. Preoperative biometry was recorded and refractive outcomes of the patients in terms of spherical equivalent (SE) and prediction error were noted at 3 and at 12 months following surgery. The refractive outcomes were compared with non-glaucomatous eyes of children in similar age group who underwent lens aspiration with IOL implantation (controls)., Results: The median age of the children with PCG (n = 31) at the time of cataract surgery was 60 months, similar to controls (n = 29); 48 months (p = 0.3). The SE in PCG eyes at 12 months was comparable to controls (p = 0.18). The prediction error (postoperative SE - predicted SE) at 3 months (p = 0.018) and at 12 months (p = 0.03) among PCG eyes was higher and more myopic compared with controls. The range of prediction error at 12 months in PCG eyes was - 8.6 to + 5.8 D (median - 2.0 D), whereas in controls it was - 4.2 to + 6.3 D (median + 0.5 D). For each mmHg intraocular pressure (IOP) increase there was 0.42 mm increase in axial length among PCG eyes and a 0.24 mm increase among controls (p < 0.001)., Conclusions: After IOL implantation there was a greater prediction error and a greater myopic shift among PCG eyes. Eyes of children with PCG are more prone to refractive surprises as their axial length changes are more sensitive to IOP fluctuation.

Competing Interests: None

Aim: To determine the prevalence, risk factors and the severity of visual loss caused by steroid-induced glaucoma (SIG) among children., Methods: Five-year records of all paediatric glaucoma cases presenting to the glaucoma services of our tertiary care centre were evaluated. Data of children presenting with SIG were recorded with respect to their visual acuity, highest baseline intraocular pressure, cup:disc ratio, perimetry and need of glaucoma filtering surgery. Parents were interviewed to assess the indication of steroid use, type of steroid used, person prescribing it and the duration of use. The prevalence of visual impairment was calculated based on WHO criteria., Results: Of 1259 cases of paediatric glaucoma presenting at our centre over 5 years, 59 children (4.7%) were diagnosed with SIG. Of these, 51 (87%) had been prescribed topical steroids for vernal keratoconjunctivitis (VKC). The median duration of steroid use was 18 months (range 1 month to 8 years). Also, 82% of children with VKC had been prescribed steroids by the treating ophthalmologist and 52% had been on topical steroids for >1 year. Glaucomatous optic neuropathy was the cause of blindness in 37.3% (22/59) and low vision in 23.7% (14/59) children. And 27% (16/59) were unilaterally blind at presentation., Conclusions: A third of the children presenting with SIG to our tertiary care centre were bilaterally blind at presentation. Ophthalmologists need to consider steroid-sparing agents to treat VKC and monitor these children closely for glaucoma if they prescribe topical steroids in order to prevent unnecessary childhood blindness., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Aim: The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV) in post-penetrating-keratoplasty glaucoma (PKPG)., Materials and Methods: In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP) >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7) implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 < IOP < 21 mmHg and qualified success as 5 < IOP < 21 mmHg with medications or minor procedures., Results: The mean IOP decreased from 42.95 ± 10.24 to 17.69 ± 3.64 mmHg (P < 0.001) and the use of medications dropped from 2.92 to 0.39 (P < 0.001) after AGV implantation. The absolute success was achieved in 11 eyes and qualified success in 9. There was no significant change in best corrected visual acuity, graft clarity, or graft thickness. Six device-related complications occurred after AGV implantations which were successfully managed with medical or minor surgical therapy., Conclusions: Postkeratoplasty refractory glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up.