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Purpose: To describe the incidence, risk factors, clinical characteristics, and long-term outcomes of a hypertensive phase (HP) after glaucoma drainage device (GDD) implantation., Design: Retrospective cohort study., Participants: Eyes that underwent implantation of their first GDD from January 2010 to October 2020 at a tertiary care center., Methods: Hypertensive phase was defined as intraocular pressure (IOP) >21 mmHg occurring at 2 consecutive visits in the first 90 days after the date of surgery for Ahmed Glaucoma Valve (AGV) or in the first 90 days after tube opening for Baerveldt Glaucoma Implant (BGI). Generalized estimating equations and Fisher exact tests were used to evaluate risk factors for HP and risk factors for failure of GDD surgery after occurrence of a HP., Main Outcome Measures: Incidence and risk factors for HP. Overall surgical success rates, defined as the absence of failure criteria: IOP >21 mmHg, ≤5 mmHg, or <20% reduction below baseline IOP after 3 months for 2 consecutive visits, with or without adjunctive ocular hypotensive therapy; additional glaucoma surgery; or loss of light perception., Results: Among 419 eyes of 360 patients that underwent GDD implantation, 42 (10.0%) eyes developed HP. Onset of HP was 20.8 ± 10.5 days after AGV and 11.7 ± 20.3 days from the date of tube opening after BGI. Mean IOP during HP was 26.5 ± 3.2 mmHg with peak IOP of 30.0 ± 5.9 mmHg. Median follow-up duration was 21.5 months after onset of HP. Younger age and neovascular glaucoma were significant risk factors for HP occurrence in a multivariable model. Resolution of HP occurred in 32 eyes (76.2%) after a mean duration of 48.0 ± 53.0 days. Additional surgery with a second GDD or cyclophotocoagulation was performed for 12 eyes (28.6%). The overall success rate among eyes with a HP was 52.6% at 2 years, which was significantly lower than that observed among control eyes that did not experience HP (76.3%), P < 0.01., Conclusions: The incidence of HP was 10.0%. Younger age and neovascular glaucoma were significant risk factors for HP in the multivariable model. The risk of surgical failure after HP is significantly higher compared to eyes that did not experience HP., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare outcomes of early aqueous suppression (EAS) and standard therapy (ST) after Ahmed Glaucoma Valve (AGV) implantation for uveitic glaucoma., Design: Retrospective comparative cohort study., Participants: All patients with uveitic glaucoma underwent AGV implantation from January 2010 to October 2020 at Northwestern Medicine., Methods: Excluding the first postoperative day 1 (POD1), only eyes with IOP 10-15 mmHg at their first visit with IOP ≥ 10 mmHg were included in the main analysis. Early aqueous suppression (EAS) was defined as initiation of ocular hypotensive therapy when IOP was first 10-15 mmHg. Standard therapy was initiation of therapy at any later time. Failure was defined as IOP > 21 mmHg, < 5 mmHg, or < 20% reduction in IOP from baseline after 3 months, for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥ 2 visits. Hypertensive phase was defined as IOP > 21 mmHg for 2 consecutive visits in the first 3 months., Main Outcome Measures: Proportion achieving overall success; incidence of hypotony and hypertensive phase., Results: Twenty-eight eyes of 26 patients were in the EAS group and 20 eyes of 19 patients were in the ST group, with a mean follow-up of 17.7 and 28.2 months, respectively. Baseline IOP was similar in the EAS (31.2 ± 10.1 mmHg) and ST (34.6 ± 12.2 mmHg) groups; P = 0.18. Final IOP was lower in the EAS group (12.9 ± 4.6 mmHg) than the ST group (16.4 ± 5.7 mmHg; P = 0.02) on 2.6 ± 0.9 medications in the EAS group and 1.8 ± 1.5 in the ST group (P = 0.07). Overall success was achieved in 87% of EAS eyes and 74% of ST eyes (P = 0.43). There were no statistically significant differences in the occurrence of additional glaucoma surgery (4% for EAS, 20% for ST; P = 0.11), hypotony (7% for EAS, 0% for ST; P = 0.50), or hypertensive phase (4% for EAS, 21% for ST; P = 0.09)., Conclusions: EAS was associated with a lower final IOP after AGV in uveitic glaucoma eyes; however, more medications were in use at the final visit. No statistically significant differences in overall success or the incidence of adverse events were observed., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT) showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery.

Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT) showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery. [ABSTRACT FROM AUTHOR]

Introduction: Optical coherence tomography (OCT) is a commonly used imaging modality that provides detailed cross-sectional retinal images. This has revolutionised management of neovascular age-related macular degeneration. The need for repeated anti-vascular endothelial growth factor injections has led to therapy being delivered using OCT-guided retreatment strategies with both qualitative OCT features of disease activity (e.g. macular fluid) and changes in retinal thickness as triggers for retreatment The purpose of this study is to determine the intra-session repeatability of retinal thickness and volume measurements using the Topcon 3DOCT-1000 spectral-domain optical coherence tomography (SDOCT) device in patients with neovascular age-related macular degeneration (nAMD). This is the largest study to date looking specifically at the Topcon 3DOCT-1000. Materials and Methods: Two SDOCT raster scans were performed by the same blinded observer in the same sitting in consecutive patients attending for nAMD treatment as part of standard validation of a new device. Retrospective analysis was undertaken, with retinal thickness and volume measurements automatically calculated by the onboard software for each Early Treatment of Diabetic Retinopathy Study subfield for each scan. Bland-Altman methods of analysis were used to assess repeatability. Results: Data from the 73 patients were analyzed with a mean age of 78 years (standard deviation 8). The 95% coefficient of repeatability (CR) was 64 μm and 0.050 mm 3 for retinal thickness and volume respectively in the central 1 mm macular subfield. The CR did not exceed 85 μm (0.30 mm 3 ) in any subfield. The revised CR for retinal thickness and volume for the subgroup of 37 patients with no segmentation error in the central 1 mm subfield was 53 μm and 0.050 mm 3 respectively. Discussion : We report relatively modest intra-sessional repeatability of SDOCT retinal thickness and volume metrics in patients with nAMD in a clinical setting. Though useful in detecting clinical change from measurement variability in clinical practice, these results suggest the precision of macular thickness measurement does not approach the theoretical resolution of SDOCT.

Aims: To compare the consistency and accuracy in ocular biometric measurements and intraocular lens (IOL) power calculations using the new optical low-coherence reflectometry and partial coherence interferometry. Subjects and Methods: The clinical data of 122 eyes of 72 cataract patients were analyzed retrospectively. All patients were measured with a new optical low-coherence reflectometry system, using the LENSTAR LS 900 (Haag Streit AG)/ALLEGRO BioGraph biometer (Wavelight., AG), and partial coherence interferometry (IOLMaster V.5.4 [Carl Zeiss., Meditec, AG]) before phacoemulsification and IOL implantation. Repeated measurements, as recommended by the manufacturers, were performed by the same examiner with both devices. Using the parameters of axial length (AL), corneal refractive power (K1 and K2), and anterior chamber depth (ACD), power calculations for AcrySof SA60AT IOL were compared between the two devices using five formulas. The target was emmetropia. Statistical analysis was performed using Statistical Package for the Social Sciences software (SPSS 13.0) with t-test as well as linear regression. A P value < 0.05 was considered to be statistically significant. Results: The mean age of 72 cataract patients was 64.6 years ± 13.4 [standard deviation]. Of the biometry parameters, K1, K2 and [K1 + K2]/2 values were significantly different between the two devices (mean difference, K1: −0.05 ± 0.21 D; K2: −0.12 ± 0.20 D; [K1 + K2]/2: −0.08 ± 0.14 D. P

A 2-year 7-month-old girl born out of a consanguineous marriage, presented at our facility with clinical features characterized by the eyelid triad of blepharophimosis, blepharoptosis and epicanthus inversus in association with hypertelorism, cleft palate and craniosynostosis. This constellation of features is suggestive of Michels syndrome. At the time of writing this report, there were only ten reported cases worldwide and to the best of our knowledge, there have been no published reports from India.

Purpose: The purpose was to investigate the efficacy and complications of nonvalved glaucoma drainage implant (GDI) surgery and GDI combined with trabeculectomy. Subjects and Methods: Serial Japanese patients who received GDI were retrospectively investigated. The survival rate of eyes was analyzed using the Kaplan-Meier method, defining death as: (1) Intraocular pressure (IOP)

Aims: To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives. Design: Cross-sectional observational study. Materials and Methods: A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey′s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2. Statistical Analysis: Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect. Results: There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1΍ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13-45%, P = 0.001) and glaucoma suspect (95% CI = 2-21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP. Conclusion: Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.

Aim: To study the safety and efficacy of sutureless femtosecond anterior lamellar keratoplasty (FALK) in patients with corneal stromal opacities. Materials and Methods: Eleven eyes of 11 consecutive patients with corneal stromal opacities involving < 250 μ due to various pathologies were included in the study. Preoperatively, all underwent anterior segment imaging with spectral domain optical coherence tomography (SD-OCT) (Bioptigen Inc., Durham, North Carolina, USA) to measure the depth of the stromal opacity. All patients underwent FALK, and bandage contact lens was placed for a period of 2 weeks. Postoperatively, uncorrected visual acuity, best corrected visual acuity (BCVA), and SD-OCT evaluation were performed. Results: All patients showed significant improvement in BCVA. The mean postoperative BCVA (in decimals) improved from 0.11 ± 0.06 preoperatively to 0.59 ± 0.08. There were no intraoperative or significant postoperative complications that were noticed. Conclusion: FALK is a safe and effective alternative to deep anterior lamellar keratoplasty or penetrating keratoplasty in the treatment of anterior stromal opacities.

Background: Both cataract surgery and anesthesia techniques are rapidly evolving to become more patient friendly. However, comparison of topical anesthesia (TA) and peribulbar anesthesia (PA) for phacoemulsification and cataract surgery is limited. We evaluated the clinical outcomes and patient and surgeon satisfaction between anesthetic techniques. Materials and Methods: This randomized clinical trial was conducted between January and June 2012. Patients were randomly assigned to TA and PA groups for surgery. Visual acuity at 4 weeks postoperatively, status of the cornea and the wound and intraoperative complications were compared between groups at day 1, and 1 and 4 weeks after surgery. Patients and the surgeon completed a close-ended questionnaire on satisfaction with analgesia and comfort. The relative risk (RR) with 95% confidence intervals (CI) was calculated. Result: There were 500 patients in each group. There were no significant differences between groups preoperatively. Complications at 1-day postoperatively were significantly greater in the TA group (RR = 1.36, 95% CI: 1.17-1.58). Satisfaction with the mitigation of pain was statistically significantly greater in the PA group compared to the TA group (χ2 = 10.9, df = 3, P = 0.001). Surgeons were more satisfied with PA compared to TA (RR = 1.4, 95% CI: 1.34-1.63). There were more anesthesia-related complications in the PA group compared to the TA group. Conclusions: Patients who underwent surgery with topical anesthetic experienced lower complications by more pain compared to patients who underwent PA. Topical anesthetic supplemented with analgesic medications could help the patient and surgeon during cataract surgery.

Purpose: The purpose of this study is to analyze the donor and tissue profile of a community eye bank in Eastern India. Materials and Methods: Eye bank records were analyzed for the period July 2007-June 2011. Variables analyzed included donor demographics (age, gender, and ethnicity), donor cause of death, consent for recovery, death-to-preservation interval, preservation-to-utilization interval, endothelial cell density (ECD), corneal suitability for transplantation, and corneal tissue utilization. Results: During this study period, 743 corneal tissues were retrieved from 373 donors (male:female = 263:110). The mean age of donors was 52 ± 21 years (range: 3-95 years). The most common donor age group was 41-50 and 71-80 years. Most of the donors belonged to one religious faith (99%). The most common causes of death were cardiorespiratory failure (34%) followed by road traffic accident (30%). Majority donors were motivated (n = 320; 86%), and remaining (n = 53; 14%) were voluntary. Most of the consents were given by sons or daughters of the deceased (45%) followed by siblings (18%). Mean death-to-preservation interval was 3.9 ± 1.9 h. Mean preservation-to-utilization interval was 56.0 ± 24.4 h. The mean ECD of donor corneal tissue was 2857 ± 551 cells/mm 2 and the median value was 2898 cells/mm 2 . Of harvested corneas 556 (75%) corneal tissues were utilized. The most common causes of nonutilization were septicemia in donor (n = 56; 30%) and poor quality of tissue (n = 55; 30%). Conclusions: Although, there is significant corneal tissue utilization, there is a need for increased awareness among people in order to augment voluntary donations.

We report a case of blebitis that occurred 3 years later following a combined glaucoma and cataract surgery. It was an atypical presentation, as patient had no classical fiery looking signs of blebitis despite the isolated organism being Pseudomonas aeruginosa. Improvized surgical techniques like use of Mitomycin C, releasable flap sutures though considered as part of the recommended procedure for better surgical outcomes, their role as potential risk factors for visually blinding complications like endophthalmitis are often overlooked. This case report throws light on such risk factors for bleb associated infections and recommends removal or trimming of all releasable sutures and the need for a regular postoperative follow-up.

We report a case of a 15-year-old boy who presented with profound visual loss and complete ophthalmoplegia after an uneventful spinal surgery for removal of cervical osteoblastoma. Postoperative visual loss following nonocular surgery is, fortunately rare, yet a devastating complication. The most common cause is ischemic optic neuropathy, but it can also be due to central retinal occlusion or cortical blindness. Visual loss in conjunction with ophthalmoplegia is rarely seen, and there are very few reports in the literature. We also review the related literature and highlight the mechanism and preventive measures.

In this paper, we report two cases of a 62-year-old patient presented with blurred vision and a 45-year-old male diagnosed with multiple myeloma who was referred from the Department of Oncology. Slit-lamp examination, in vivo confocal microscopy (IVCM), systemic work-up and serum protein electrophoresis were obtained. In both patients, slit-lamp findings revealed bilateral diffuse subepithelial and anterior stromal crystals and IVCM showed highly reflective deposits in the corneal epithelium and stroma. The first patient was eventually diagnosed with monoclonal gammopathy of undetermined significance following bone marrow biopsy and systemic evaluation. Unusual corneal deposits may constitute the first sign of monoclonal gammopathies. IVCM may be helpful in showing the crystalline nature of the corneal deposits and guiding the clinician to the diagnosis of gammopathies. Both ophthalmologists and oncologists should be aware that corneal deposits may herald a life-threatening hematologic disease.

Fundus imaging with a fundus camera is an essential part of ophthalmic practice. A mobile phone with its in-built camera and flash can be used to obtain fundus images of reasonable quality. The mobile phone can be used as an indirect ophthalmoscope when coupled with a condensing lens. It can be used as a direct ophthalmoscope after minimal modification, wherein the fundus can be viewed without an intervening lens in young patients with dilated pupils. Employing the ubiquitous mobile phone to obtain fundus images has the potential for mass screening, enables ophthalmologists without a fundus camera to document and share findings, is a tool for telemedicine and is rather inexpensive.

We report a case of large histopathologically proven melanocytoma of the ciliary body in a 15-year-old male, presented with rapid extraocular growth following incisional biopsy with scleral patch graft. We chose brachytherapy with Ruthenium 106 plaque over enucleation as the later was refused by the parents. The initial apical height of the tumor was 14.2 mm on ultrasonography. Two weeks after brachytherapy, the mass regressed to a size of 8.1 mm and 1 year later to 6.7 mm. This is the first case report showing the response of brachytherapy to ciliary body melanocytoma, which results in ocular and visual acuity salvation with considerable decreased in size of the tumor. The authors conclude that brachytherapy is an option in the management of non-resectable melanocytoma of the ciliary body.

A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF.

A 49-year-old woman developed a dark brown nodular mass in the lower eyelid. The lesion had grown fast for 2 months and then had remained stable in size. Excisional biopsy was performed. Histopathological examination of an excisional biopsy specimen pointed to proliferative vessels lined by increased endothelial cells without nuclear atypism. The nodular mass evaluated as a capillary hemangioma.