Surinder S. Pandav

Description:To report the long-term outcomes of trabeculectomy with collagen implant as bevacizumab depot in eyes with uncontrolled glaucoma. In this retrospective non-comparative interventional study, medical records of patients (age ≥18 years) who underwent trabeculectomy with Ologen implant as bevacizumab depot for uncontrolled glaucoma with ≥ 2 years follow-up were reviewed. The underlying etiology, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of anti-glaucoma medications (AGM) were recorded at baseline. Postoperatively, BCVA, IOP, AGMs, complications, and re-surgery were noted on day 1, 1-week, 1-, 3-, 6- months, 1-, 2-, 3-, 4-, 5-years and at final follow-up after 24 months. The main outcomes measured were IOP, number of AGM, and cumulative probability of overall success after 2 years. Forty-three eyes of 43 patients with a mean age of 54.79 ± 17.27 years were included. The mean follow-up was 62.9 ± 27.42 (24-108) months. The mean pre-operative IOP was 29.23 ± 10.09 mmHg with an average of 4.3 ± 1.2 AGM. The mean IOP and number of AGM were significantly reduced in all follow-up visits (p < .0001) following surgery. The complete success was 48.8% and 48.5% at 2-year and 5-year respectively. The cumulative probability of overall success was 95%, 85%, 80%, and 71% at 2-5-, 7-, and 9-years respectively. A total of 24 complications were noted in 15 eyes in early postoperative days, and all were managed conservatively. The failure was noticed in 6 (17.2%) eyes at 5-year study visits. The use of ologen implant as a drug depot for bevacizumab in trabeculectomy was safe and had a good long-term outcome.

Description:Early-onset childhood glaucoma usually is diagnosed based on signs and symptoms (such as a cloudy cornea, buphthalmos, or excessive lacrimation). However, the signs and symptoms can overlap with other congenital conditions, making differentiation important. Swept-source anterior-segment optical coherence tomography (SS-ASOCT) may offer a rapid, noninvasive alternative to assess the trabecular meshwork (TM) structures, providing an additional tool to aid diagnosis. To evaluate use of SS-ASOCT in diagnosing pediatric patients as having early-onset childhood glaucoma vs not having glaucoma. A prospective, comparative study including pediatric patients younger than 2 years of age who were referred to a tertiary care research and referral center in Northern India between June 2023 and July 2024. A diagnosis of early-onset childhood glaucoma was based on the clinical appearance of corneal clarity, intraocular pressure, buphthalmos, and optic disc evaluation. Imaging was performed using SS-ASOCT with the "flying baby" technique to analyze the visibility of the TM structures, the angle opening distance (500 mm or 250 mm), and the angle recess area (250 mm2 or 500 mm2). Comparisons were made using analysis of variance. The area under the receiver operating characteristic curve was used to determine the discriminators for the nonglaucomatous angles. The best discriminatory parameters studied were subsequently tested in age-matched infants (controls) with congenital cloudy corneas without glaucoma based on an eye examination using an ophthalmoscope. The SS-ASOCT features were compared between 23 pediatric patients without and 30 pediatric patients with early-onset childhood glaucoma; the 30 patients were diagnosed as having glaucoma based on an eye examination using an ophthalmoscope. At the time of SS-ASOCT imaging, the pediatric patients without glaucoma had a mean age of 17.3 (SD, 4.4) months and the pediatric patients with glaucoma had a mean age of 18.6 (SD, 14.2) months. The TM shadow was clearly visible in 23 patients without glaucomatous eyes (100%), whereas the TM shadow was clearly visible in only 8 patients with glaucomatous eyes (26.7%) (sensitivity of 73.3% and specificity of 100%). To diagnose pediatric patients as not having early-onset childhood glaucoma, the highest area under the receiver operating characteristic curve of 0.87 (95% CI, 0.77-0.97; P < .001) was used for a clearly visible TM structure. The pediatric patients with glaucoma had greater anterior chamber angle measurement values than the pediatric patients without glaucoma. The TM structure was visualized in all young children with corneal opacity but who did not have glaucoma, and all 23 patients were correctly diagnosed as not having glaucoma using SS-ASOCT. A noninvasive imaging tool, SS-ASOCT can be used to assess the anterior chamber angles in children. The findings suggest the use of SS-ASOCT offers the potential for distinguishing early-onset childhood glaucoma from other conditions. No visibility of the TM structure was the most specific sign for glaucomatous eyes in this relatively small cohort.

Description:PurposeTo compare the effect of delayed postoperative mitomycin C (MMC) application on surgical outcome and bleb morphology with intra-operative application in trabeculectomy.MethodThis monocentric, unmasked randomized control trial recruited primary glaucoma patients between 18-70 years of age. They were randomized into Group I (intraoperative MMC group) and Group II (postoperative MMC group). All patients underwent standard fornix-based trabeculectomy with differences only in the MMC application step. In Group I, 0.2 mg/ml MMC was applied intraoperatively for two minutes, while in Group II, 0.01 mg (0.25 ml of 0.04 mg/ml) of MMC was injected 7-14 days postoperatively above the bleb. The primary outcome was surgical success, whereas the secondary outcome measures were rate of complications and bleb morphology. Complete and qualified success was defined as intraocular pressure (IOP) between 6-21 mm Hg without and with ≤2 anti-glaucoma medications (AGMs).ResultsFifty-six eyes (31 in Group I and 25 in Group II) were analyzed for the outcome at 18 months follow-up. Surgical success was comparable (70.9% vs 68%) (p = 0.811) between the groups. There were higher incidences of hypotony (41.9% vs 36%) in Group I. Incidences of persistent-hypotony (p = 0.032) and late-hypotony (p = 0.127) were higher in Group I. Two eyes developed hypotony maculopathy in Group I, while none in Group II. The blebs in Group I were more avascular, cystic and developed thinning, while those in Group II were diffuse and shallow.ConclusionsDelayed postoperative MMC application may be as effective as standard trabeculectomy with MMC in lowering IOP with a lower rate of complications.

Description:Conclusions: Intraocular pressure (IOP) decreases as preterms mature and in moderate retinopathy of prematurity, IOP is initially low and transiently rises after laser treatment. Objective: This study aimed to measure intraocular pressure (IOP) in preterm infants with and without retinopathy of prematurity (ROP) and evaluate the effect of laser treatment on IOP. Methods: This prospective non-randomized comparative study included infants born before 34 weeks of gestation weighing less than 2000 grams at a tertiary care research and referral institute. Those with ocular or systemic conditions or requiring surgical intervention for ROP were excluded. Infants were divided into three groups: Group 1 (no ROP), Group 2 (ROP without treatment), and Group 3 (ROP requiring peripheral retinal ablation by laser photocoagulation). IOP was measured using a Perkins tonometer at presentation and one and three months. The primary outcome was IOP in preterm infants with and without ROP; and the secondary outcome was change in IOP post-laser treatment. Results: Of 107 infants, 40 (37.38%) had no ROP (Group 1), 25 (23.36%) had untreated ROP (Group 2), and 42 (39.25%) required laser treatment (Group 3). Average post-menstrual ages were 37.89±2.74 weeks 36.98±3.38 and 35.47±2.84 weeks respectively. A moderate negative correlation between IOP and post-menstrual age was found in Group 1 (r2=-0.382; P=0.01) and Group 2 (r2= -0.6; P=0.001). Baseline IOP was significantly lower in Group 3 compared to the other groups, with a transient increase post-laser treatment that typically normalized without needing IOP treatment. Conclusions: IOP decreases as preterm infants mature. Infants with ROP requiring laser treatment exhibit significantly low IOP at presentation, but have a post-laser spike which generally normalises without treatment.

Description:The management of a severely contracted socket necessitates the restoration of fornix depth, the meticulous release of fibrotic components without compromising the already limited conjunctival tissue, and the replacement of lost volume. In this case series of four patients, the authors employed mucous membrane placement using the lid-splitting approach to address the deficit in fornix conjunctiva. This approach involved releasing posterior lamellar tension and repositioning the retractors at the fornix, followed by augmentation with a dermis-fat graft to restore volume.