THE HISTOLOGICAL STUDY OF CON- JONCTIVA AFTER SHORT AND LONG - TERM TOPICAL ANTI-GLAUCOMA TREA-TMENT

Long-term-use of topical drugs can induce changes in the con-jonctiva. To determin the conjonctival changes resulting from topical glaucoma medication, patient with glaucoma were selected and classified into two groups,according to the medication received. The patients of group one, had received two type of topical anti-glaucoma drug ( Timolol & Trusopt) during for at least     

Efficacy of combined cataract extraction and endoscopic cyclophotocoagulation for the reduction of intraocular pressure and medication burden

AIM: To report on the efficacy of combined endoscopic cyclophotocoagulation (ECP) and phacoemulsification cataract extraction (PCE) with intraocular lens placement for reduction of intraocular pressure (IOP) and medication burden in glaucoma. METHODS: A retrospective case review of 91 eyes (73 patients) with glaucoma and cataract that underwent combined PCE/ECP surgery was performed. Baseline demographic and ocular characteristics were recorded, as well as intraocular pressure, number of glaucoma medications, and visual acuity postoperatively with 12-month follow-up. Treatment failure was defined as less than 20% reduction in IOP from baseline on two consecutive visits (at 1, 3, 6, or 12mo postoperatively), IOP ≥21 mm Hg or ≤5 mm Hg on two consecutive visits, or additional glaucoma surgery performed within 12mo after PCE/ECP. RESULTS: Overall, mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12mo (P<0.0001). Mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12mo (P=0.0003). At 3mo postoperatively, the success rate was 73.6% (95%CI: 63.3, 81.5), 57.1% at 6mo (95% CI: 46.3, 66.6), and 49.7% at 12mo (95%CI: 38.9, 59.6). Patient demographic characteristics were not associated with treatment success. The only ocular characteristic associated with treatment success was a higher baseline IOP. CONCLUSION: Combined PCE/ECP surgery is an effective surgical option for the reduction of IOP and medication burden in glaucoma patients. Patients with higher baseline IOP levels are most likely to benefit from this procedure.     

Clinical Analysis of Steroid Glaucoma

Purpose:The authors accumulated 15 cases (26 eyes) of steroid glaucoma due to topical administration of dexamethasone or prednisolone.Methods: From 1970 to 1990,26 eyes in 15 cases were observed (bilateral 11 cases,unilateral 4 cases) including 12 right eyes and 14 left eyes. 10 cases were male and 5 cases female with age ranging from 14 to 52 years averaging 28 years. 25 eyes had the manifestation of chronic open angle glaucoma in the clinical course, and 1 eye simulated an acute glaucoma attack.Results: All patients had taken antiglaucoma medication before coming to our hospital,but the IOP was over 6. 7 kPa in 9 eyes. The C/D ratio was equal to or over 0. 6 in 9 cases (16 eyes),and the values were inconsistent between both eyes in 55% of the patients. Treatment for glaucoma was immediate discontinuation of the steroids with antiglaucoma medication if necessary. Three eyes received filtering operations and 2 eyes had the removal of subconjunctival residual steroid. Normal IOP was restored in months up     

How to improve Iranians’ vision health: on the national policy of preventing Iranians’ blindness

AIM: To review vision health situation of Iranian community, analyze its determinants, and discuss the adopted improvement strategies by the Iran Ministry of Health and Medical Education (MOHME). METHODS: This was a rapid situation analysis with a qualitative approach in three parts of recognition, orientation and implementation. The data were gathered via review of upstream documents, national and international experiences, and experts and stakeholders’ opinions. RESULTS: Eradicating trachoma, increasing human resources, increasing educational and research centers and promotion of ophthalmic technologies were important achievements in the field of vision health in Iran. Through these achievements, it seemed that the pattern of causes of blindness and low vision was similar to that of the developed countries. However, the review of Iranians’ vision health indicators showed that a considerable percent of the blindness and low vision was avoidable through a national program demanding 3 types of interventions in social determinants of health (SDH), community education, and increasing the access to health care services by integrating the necessary services in primary health care system. CONCLUSION: Managing the issue requires attentions from a national committee for preventing blindness with participation of all stakeholders, implementing a national survey on vision health, preparation of the primary level health centers including employment and education of community health workers (Behvarzes), optometrists and general practitioners, fair distribution of specialized human resources and establishing at least one specialized center in each province for referring patients from the primary levels.     

TOPICAL CARTEOLOL WITH AND WITHOUT BENZALKONIUM CHLORIDE：EFFECT ON THE OCULAR SURFACE AND INTRAOCULAR PRESSURE

Purpose: Long term use of antiglaucoma medication may induce changes in both tear film and ocular surface. The purpose of this study was to evaluate the effect on ocular surface of carteolol with and without 0.004% benzalkonium chloride (BAC). Methods: Forty-three patients (age 61 ±11, m±SD) with primary open angle glaucoma (POAG) or ocular hypertension (OHT)     

Efficacy and safety of deep sclerectomy with uveoscleral implant plus collagen matrix implant overcoming the superficial scleral flap in glaucoma surgery

AIM: To assess the efficacy and safety of non-penetrating deep sclerectomy (NPDS) with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips (modified deep sclerectomy technique, DS) and minimal use of mitomycin C in glaucoma surgery. METHODS: A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018. Best-corrected visual acuity, intraocular pressure (IOP), post-operative need for glaucoma medications, visual field mean deviation (MD), re-interventions, needling revisions and laser goniopuncture were noted. Absolute success was defined as IOP≤18 mm Hg without topical medication. Relative success was defined as the same criteria but with the addition of any antihypertensive medication. IOP over 18 mm Hg on two consecutive follow-up visits was considered as a failure. RESULTS: Fifty-two eyes of 47 patients were evaluated. Mean preoperative IOP was 25.37±6.47 mm Hg, and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo (all P<0.0001). Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo (all P<0.0001). No medications were required in 45.5% of patients after 24mo. Relative and absolute success rate at 24mo were 85.5%±5% and 48.5%±7.4%, respectively. CONCLUSION: DS is a safe and effective non-penetrating glaucoma surgery variation. It aims to retain the patency of all pathways created for aqueous humor drainage: the intrascleral bleb, the supraciliary space and the open communication between intrascleral and subconjunctival compartments.     

[In Press] Effect of phacoemulsification on intraocular pressure in patients with primary open-angle glaucoma and pseudoexfoliation glaucoma

AIM: To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association for Preventing Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with IOL implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, month 1, 3, 6 and 12 postoperatively. RESULTS: The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in intraocular pressure) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION: In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12-month follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.     

ACCURACY OF CLINICAL ESTIMATES OF INTRA OCULAR PRESSURE (IOP) WITH REGARD TO PACHIMETRY

Purpose of the study is to investigate the validity of clinical estimates of intra ocular pressure with regard to pachimetry in a prospective hospital based in vivo study on twentyeight patients schedule for routine phacoemulsification on topical anestesia Intra ocular pressure was measured with Tonopen, Perkins and solid state hemodinamic monitor trough cannula in the Anterior Chamber before starting the case. Pachimetry was measured be-     

Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

AIM: To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS: The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION: In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.     

Determination of the location of the fovea on the fundus

PURPOSE: To evaluate whether the distance between optic nerve head and fovea in healthy eyes determined by scanning laser ophthalmoscope may facilitate estimation of the location of the fovea relative to the optic disc in patients with macular disease. METHODS: The angular distance was measured, in horizontal and vertical directions, between the center of the optic nerve head and the fovea in 104 eyes of 104 healthy probands. For additional evaluation of intraindividual variation in 70 of these persons the contralateral eye was measured as well. RESULTS: The distance between the optic disc and the fovea differed vertically more than horizontally (-1.5 +/- 0.9 degrees [-3.65 to +0.65 degrees ] vs. 15.5 +/- 1.1 degrees [13.0-17.9 degrees ]). There was a mean angle between the fovea and the center of the optic disc versus the horizon of -5.6 +/- 3.3 degrees. The intraindividual difference between right and left eyes was markedly lower, with average angles being 0.2 +/- 1.3 degrees vertically and 0.0 +/- 1.1 degrees horizontally. CONCLUSIONS: The distance between the optic nerve head and the fovea does not allow for a meaningful determination of the location of the fovea in eyes in which morphologic changes have occurred. The angle of rotation of the fovea relatively to the center of the optic nerve head is relatively stable. Therefore, the size of a central scotoma can be determined by movement of the blind spot according to the change of the preferred retinal locus (PRL). In addition, the knowledge of the location of the fovea enables determination of the position in the contralateral eye of the same patient.