1. J Glaucoma. 2015 Nov 17. [Epub ahead of print]

Automated Detection of Glaucoma From Topographic Features of the Optic Nerve Head
in Color Fundus Photographs.

Chakrabarty L(1), Joshi GD, Chakravarty A, Raman GV, Krishnadas SR, Sivaswamy J.

Author information: 
(1)*Aravind Eye Care System, Madurai, Tamil Nadu †International Institute of
Information Technology, Hyderabad, India.

OBJECTIVE: To describe and evaluate the performance of an automated CAD system
for detection of glaucoma from color fundus photographs.
DESIGN AND SETTING: Color fundus photographs of 2252 eyes from 1126 subjects were
collected from 2 centers: Aravind Eye Hospital, Madurai and Coimbatore, India.
The images of 1926 eyes (963 subjects) were used to train an automated image
analysis-based system, which was developed to provide a decision on a given
fundus image. A total of 163 subjects were clinically examined by 2
ophthalmologists independently and their diagnostic decisions were recorded. The 
consensus decision was defined to be the clinical reference (gold standard).
Fundus images of eyes with disagreement in diagnosis were excluded from the
study. The fundus images of the remaining 314 eyes (157 subjects) were presented 
to 4 graders and their diagnostic decisions on the same were collected. The
performance of the system was evaluated on the 314 images, using the reference
standard. The sensitivity and specificity of the system and 4 independent graders
were determined against the clinical reference standard.
RESULTS: The system achieved an area under receiver operating characteristic
curve of 0.792 with a sensitivity of 0.716 and specificity of 0.717 at a selected
threshold for the detection of glaucoma. The agreement with the clinical
reference standard as determined by Cohen κ is 0.45 for the proposed system. This
is comparable to that of the image-based decisions of 4 ophthalmologists.
CONCLUSIONS AND RELEVANCE: An automated system was presented for glaucoma
detection from color fundus photographs. The overall evaluation results indicated
that the presented system was comparable in performance to glaucoma
classification by a manual grader solely based on fundus image examination.

PMID: 26580479   [PubMed - as supplied by publisher]


2. J Glaucoma. 2015 Nov 10. [Epub ahead of print]

Do Intraocular Pressure Measurements Under Anesthesia Reflect the Awake
Condition?

Gofman N(1), Cohen B, Matot I, Cattan A, Dotan G, Stolovitch C, Ela-Dalman N.

Author information: 
(1)*Division of Anesthesia, Pain and Critical Care †Department of Ophthalmology, 
Tel-Aviv Medical Center Affiliated with Sackler Medical School, Tel-Aviv
University, Tel-Aviv, Israel.

BACKGROUND: Anesthesia or sedation is needed when intraocular pressure (IOP)
measurement is required in certain circumstances. The effect of different
anesthetic regimens on the IOP is still debatable. We aimed to evaluate
alterations in the IOP under anesthesia with either propofol or different
end-tidal concentrations of sevoflurane, when compared with the awake state.
METHODS: The IOP was measured in both eyes of 20 adult patients undergoing
extraocular ophthalmic surgeries at 5 timepoints: before the induction of general
anesthesia (under topical anesthesia), after the induction using propofol
target-controlled infusion, and under 3 end-tidal concentrations of sevoflurane
(0.5%, 2%, and 5%), either in a decreasing (group A) or an increasing (group B)
concentration order.
RESULTS: With either propofol or sevoflurane anesthesia, the IOP did not differ
significantly from the measurement performed during the awake state (no
anesthesia), regardless of the concentration of sevoflurane used (in the range of
0.5% to 5%) or the order of sevoflurane administration (from low to high
concentration or vice versa).
CONCLUSIONS: These data suggest that propofol and sevoflurane are valid
anesthetic agents for the evaluation of IOP in adults when anesthesia is needed.

PMID: 26561424   [PubMed - as supplied by publisher]


3. J Glaucoma. 2015 Nov 10. [Epub ahead of print]

Modified 360-degree Suture Trabeculotomy for Pseudoexfoliation Glaucoma: 12-Month
Results.

Hepşen İF(1), Güler E, Yalçin NG, Kumova D, Aktaş ZP.

Author information: 
(1)*Department of Ophthalmology, Gazi University, Medical School, Ankara †Erciş
State Hospital, Eye Clinic, Van ‡Viranşehir State Hospital, Eye Clinic, Urfa,
Turkey.

PURPOSE: We aimed to evaluate the 12-month results of a modified 360-degree
suture trabeculotomy (ST) technique in patients with pseudoexfoliation glaucoma
(XFG).
PATIENTS AND METHODS: The modified 360-degree ST was performed on 20 eyes of 20
consecutive patients with XFG resistant to maximal topical treatment. In 8
patients, ST was combined with phacoemulsification. The main outcome measures
were the surgical success rate, the mean postoperative intraocular pressure
(IOP), the number of antiglaucoma medications, and the operative complications.
RESULTS: The baseline IOP (26.55±8.91) and medications (3.15±0.81) decreased
significantly to 10.90±2.73 mm Hg and 0.30±0.80, respectively, at 12 months
postoperatively (P<0.001). The magnitude of IOP reduction was 58.9%. Complete and
qualified success rates were 68.4% and 94.7%, respectively. The entire
circumference of Schlemm's canal was opened successfully in all cases. Hyphema,
perforation of the trabeculodesmetic window, posterior synechia, peripheral
anterior synechia, and a transient elevation of the IOP were noted. The results
are comparable to our 6-month results and other previously published results for 
circumferential trabeculotomy.
CONCLUSIONS: The modified 360-degree ST provides a feasible choice in patients
with XFG with a reasonable rate of complications. The 12-month success rates are 
promising. It can also be combined effectively with the current cataract surgery.

PMID: 26561423   [PubMed - as supplied by publisher]


4. J Glaucoma. 2015 Nov 10. [Epub ahead of print]

Meta-Analysis of Association of Obstructive Sleep Apnea With Glaucoma.

Liu S(1), Lin Y, Liu X.

Author information: 
(1)*Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, The First
Affiliated Hospital of Chongqing Medical University Departments of †Traditional
Chinese Medicine ‡Clinical Pharmacy, Chongqing Medical University, Chongqing,
China.

OBJECTIVES: Previous studies suggested that obstructive sleep apnea (OSA) was
associated with glaucoma. However, data on this issue are controversial. This
study aims to use meta-analysis to determine whether OSA is related to glaucoma.
MATERIALS AND METHODS: We searched PubMed, Embase, the Cochrane library, the Web 
of Science, and the Chinese BioMedical Literature Database disk databases up to
November 20, 2014 for related literature. The association of OSA with glaucoma
was assessed by odds ratio (OR) with 95% confidence interval (CI) as the effect
size. Then subgroup analysis was performed according to area and glaucoma type.
RESULTS: Six primary studies (3 cohort study and 3 case-control studies) were
included in this meta-analysis involving 2,288,701 participants. There was a
significant association between OSA and glaucoma (adjusted-effect summary for
case-control studies OR=2.46; 95% CI, 1.32-4.59, P=0.005) (adjusted-effect
summary for cohort studies OR=1.43; 95% CI, 1.21-1.69, P=0.000). There was no
significant publication bias.
CONCLUSION: OSA was a risk factor for glaucoma. A large number of studies is
needed to explore the mechanisms that link OSA with glaucoma.

PMID: 26561422   [PubMed - as supplied by publisher]


5. J Glaucoma. 2015 Nov 10. [Epub ahead of print]

The Influence of Scleral Flap Thickness, Shape, and Sutures on Intraocular
Pressure (IOP) and Aqueous Humor Flow Direction in a Trabeculectomy Model.

Samsudin A(1), Eames I, Brocchini S, Khaw PT.

Author information: 
(1)*Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
†UCL Department of Mechanical Engineering ‡NIHR Biomedical Research Centre at
Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology
§UCL School of Pharmacy, London, UK.

PURPOSE: Intraocular pressure and aqueous humor flow direction determined by the 
scleral flap immediately after trabeculectomy are critical determinants of the
surgical outcome. We used a large-scale model to objectively measure the
influence of flap thickness and shape, and suture number and position on pressure
difference across the flap and flow of fluid underneath it.
METHODS: The model exploits the principle of dynamic and geometric similarity, so
while dimensions were up to 30× greater than actual, the flow had similar
properties. Scleral flaps were represented by transparent 0.8- and 1.6-mm-thick
silicone sheets on an acrylic plate. Dyed 98% glycerin, representing the aqueous 
humor was pumped between the sheet and plate, and the equilibrium pressure
measured with a pressure transducer. Image analysis based on the principle of dye
dilution was performed using MATLAB software.
RESULTS: The pressure drop across the flap was larger with thinner flaps, due to 
reduced rigidity and resistance. Doubling the surface area of flaps and reducing 
the number of sutures from 5 to 3 or 2 also resulted in larger pressure drops.
Flow direction was affected mainly by suture number and position, it was less
toward the sutures and more toward the nearest free edge of the flap. Posterior
flow of aqueous humor was promoted by placing sutures along the sides while
leaving the posterior edge free.
CONCLUSION: We demonstrate a new physical model which shows how changes in
scleral flap thickness and shape, and suture number and position affect pressure 
and flow in a trabeculectomy.

PMID: 26561421   [PubMed - as supplied by publisher]


6. J Glaucoma. 2015 Nov 10. [Epub ahead of print]

Early Clinical Results of a Novel Ab Interno Gel Stent for the Surgical Treatment
of Open-angle Glaucoma.

Sheybani A(1), Dick B, Ahmed II.

Author information: 
(1)*Department of Ophthalmology and Visual Sciences, Washington University School
of Medicine in St. Louis, St. Louis, MO †Institute for Vision Science, Ruhr
University Eye Hospital, Bochum, Germany ‡Department of Ophthalmology and Vision 
Sciences, University of Toronto, Toronto §Credit Valley Eye Care ∥Trillium Health
Partners, Mississauga, ON, Canada.

PURPOSE: To evaluate the intraocular pressure (IOP) lowering effect of the XEN140
microfistula gel stent implant for the surgical treatment of open-angle glaucoma.
PATIENTS AND METHODS: Forty-nine eyes of 49 patients with an IOP>18 mm Hg and ≤35
mm Hg were studied in a prospective nonrandomized multicenter cohort trial of the
surgical implantation of the XEN140 implant in patients with open-angle glaucoma.
Complete success was defined as a postoperative IOP≤18 mm Hg with ≥20% reduction 
in IOP at 12 months without any glaucoma medications. Failure was defined as
vision loss of light perceptions vision or worse, need for additional glaucoma
surgery, or <20% reduction of IOP from baseline.
RESULTS: The average age was 64.3 (28.1 to 86.9) years old. Twenty-one eyes had
prior failed trabeculectomy with mitomycin C surgery. IOP at 12 months decreased 
from a mean of 23.1 (±4.1) mm Hg to 14.7 (±3.7) mm Hg for a 36.4% reduction in
IOP from baseline. The number of patients at 12 months who achieved an IOP≤18 mm 
Hg and ≥20% reduction in IOP was 40 (89%). The number of patients who achieved an
IOP≤18 mm Hg and ≥20% reduction in IOP without antiglaucoma medications was 18
(40%).
CONCLUSIONS: The XEN140 gel stent lowers IOP with few complications when
implanted for the surgical treatment of open-angle glaucoma.

PMID: 26561420   [PubMed - as supplied by publisher]


7. J Glaucoma. 2015 Nov 10. [Epub ahead of print]

Glaucoma Severity and Participation in Diverse Social Roles: Does Visual Field
Loss Matter?

Yang Y(1), Trope GE, Buys YM, Badley EM, Gignac MA, Shen C, Jin YP.

Author information: 
(1)*Faculty of Medicine, University of Ottawa, Ottawa †Department of
Ophthalmology and Vision Sciences §Dalla Lana School of Public Health, University
of Toronto ‡Health Care and Outcomes Research, Toronto Western Research Institute
∥Institute for Work and Health, Toronto, ON, Canada.

PURPOSE: To assess the association between glaucoma severity and participation in
diverse social roles.
DESIGN: Cross-sectional survey.
PATIENTS AND METHODS: Individuals with glaucoma, 50+, with visual acuity in the
better eye >20/50 were enrolled. They were classified into 3 groups based on
visual field loss in the better eye: mild [mean deviation (MD)>-6 dB], moderate
(MD, -6 to -12 dB), and severe (MD<-12 dB). The validated Social Role
Participation Questionnaire assessed respondents' perceptions of the importance, 
difficulty, and satisfaction with participation in 11 social role domains (eg,
community events, travel). Differences between groups were examined using
multivariate linear regression analyses.
RESULTS: A total of 118 participants (52% female) were included: 60 mild, 29
moderate, and 29 severe. All social role domains were rated as important by all
participants except for education and employment. Women (P<0.01), those with a
partner (P<0.01), and those who were less depressed (P=0.03) reported higher
scores of perceived importance of participating in social activities. Compared
with those with mild glaucoma, individuals with severe glaucoma reported
significantly more difficulty participating in community/religious/cultural
events (P<0.01), travelling (P<0.01), and relationships with family members
(P=0.01). They also reported less satisfaction with travelling (P=0.01) and
social events (P=0.04).
CONCLUSIONS: Participation in diverse social roles is valued by individuals with 
glaucoma. Severe visual field loss impedes involvement in and satisfaction with
activities in community/religious/cultural events, travelling, and relationships 
with family members. Appropriate community and targeted interventions are needed 
to allow people with severe glaucoma to maintain active social participation-a
key component to successful aging.

PMID: 26561419   [PubMed - as supplied by publisher]


8. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Assessing the Role of the Family/Support System Perspective in Patients With
Glaucoma.

Shtein RM(1), Newman-Casey PA, Herndon L, Coleman AL, Lee PP.

Author information: 
(1)*Kellogg Eye Center, University of Michigan, Ann Arbor, MI †Duke Eye Center,
Duke University, Raleigh, NC ‡Jules Stein Eye Institute, UCLA, Los Angeles, CA.

PURPOSE: To investigate the role of the family/friends support system for
patients with glaucoma and their perspective on barriers to effective glaucoma
management.
METHODS: Six focus groups were conducted in 3 geographically and ethnically
diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC)
that included 31 participants; 68% (21/31) were family members and friends of
glaucoma patients with poor vision and 32% (10/31) were support system
individuals of patients with good vision. Content analysis was used to identify
important themes. Semiquantitative analysis was used to measure the frequency of 
each theme.
RESULTS: A total of 134 relevant comments were made in the 6 focus groups and 72%
of relevant comments were made by individuals providing support for patients with
poor vision. Family members and friends mentioned the following areas of concern 
regarding patients' glaucoma care: patient education (19.4%), doctor-patient
relationship (17.9%), their own lack of involvement in the patient's medical care
(17.2%), frustration with glaucoma and with the patient (14.9%), patient
dependency on caregivers (14.9%), patient frustration with the disease (10.4%),
and sex differences in coping mechanisms (5.2%).
CONCLUSIONS: Support system individuals tend to be minimally involved in the
patient's glaucoma status and care. This is especially true for support system
members of patients with glaucoma who maintain good vision and those who do not
have any other personal experiences with difficulties from glaucoma. Many of
these family members express an interest in acquiring more education about
glaucoma and becoming more involved in the patient's glaucoma care.

PMID: 26550982   [PubMed - as supplied by publisher]


9. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Effect of Laser in Situ Keratomileusis on Schiøtz, Goldmann, and Dynamic Contour 
Tonometric Measurements.

Sales-Sanz M(1), Arranz-Marquez E, Piñero DP, Arruabarrena C, Mikropoulos DG,
Teus MA.

Author information: 
(1)*Ramón y Cajal Universitary Hospital †Novovision ‡Rey Juan Carlos Universitary
Hospital, Móstoles ¶Príncipe de Asturias Universitary Hospital **University of
Alcalá, Madrid §Department of Optics, Pharmacology and Anatomy, University of
Alicante ∥Foundation for the Visual Quality, Alicante, Spain #3rd University
Department of Ophthalmology, Aristotle University, Thessaloniki, Greece.

PURPOSE: To assess the effect of laser in situ keratomileusis (LASIK) on ocular
rigidity and compare its effect on intraocular pressure (IOP) readings with
Goldmann applanation tonometry (GAT), Schiøtz indentation tonometry (ST), and
dynamic contour tonometry (DCT).
PATIENTS AND METHODS: Prospective, observational, single-masked study. Eighty-one
patients who underwent myopic LASIK and 108 unoperated myopic control patients
were included in the study. The IOP was measured using GAT, DCT, and ST. The
coefficient of ocular rigidity (Ko) was obtained from the regression analysis of 
the 3 readings obtained with each weight of the ST. Linear multiple regression
analysis was performed with dummy variables to assess the effects of age, central
corneal thickness (CCT), and refractive surgery on measured IOP values.
RESULTS: Age, CCT, and previous LASIK explained 39.41% of the IOP readings with
GAT, 25.31% with DCT, and 3.28% with ST. LASIK caused a mean decrease of -2.51 mm
Hg in IOP readings (P=0.000) with GAT, -1.29 mm Hg (P=0.036) with DCT, and no
significant change in IOP readings with ST (P=0.299). Significant differences in 
the Ko were observed between the LASIK and control groups. The Ko values were
unrelated to age and CCT in the LASIK and control groups.
CONCLUSIONS: ST seems to be less affected by previous LASIK procedures. There is 
a difference in the ocular rigidity between the unoperated and LASIK eyes that is
not correlated with the CCT. Therefore, ST seems to measure changes in the
biomechanical behavior of corneas that underwent LASIK surgery.

PMID: 26550981   [PubMed - as supplied by publisher]


10. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Outcomes of Nd: YAG Goniopuncture After Viscocanalostomy/Phacoviscocanalostomy.

Mathews D(1), Shirodkar AL, Ahnood D, Garrick A.

Author information: 
(1)*Stanley Eye Unit, Abergele Hospital, Abergele, Conwy †University Hospital of 
Wales, Heath Park, Cardiff ‡Royal Gwent Hospital, Newport, UK.

PURPOSE: The aim of this study is to evaluate the safety and efficacy of laser
goniopuncture (LGP) to lower intraocular pressure (IOP) post-viscocanalostomy
(VC)/phacoviscocanalostomy (PVC). Outcomes include: IOP reduction from pre-LGP
levels and the need for further topical antiglaucomatous medication or surgery.
PATIENTS AND METHODS: A total of 541 eyes that underwent VC/PVC between 2009 and 
2012, at the Stanley eye unit in Abergele were included in the study.
INCLUSION CRITERIA: All patients who had LGP at any timepoint after VC/PVC when
target IOP was not achieved +/- progression in visual field with at least 6
months of follow-up data.Statistical analysis was performed on IOP values pre-
and post-LGP, involving χ, Fischer exact, Mann-Whitney U, and Wilcoxon tests. A
P-value of <0.05 was accepted as the level of significance.
RESULTS: Of the 515 included eyes, 136 (26%) required LGP after a mean of
15.11±9.73 months after surgery (95% confidence interval, 13.46-16.76 mo),
ranging from 1 to 42 months. LGP reduced IOP significantly from a mean of
22.92±5.80 to 17.08±5.30 mm Hg immediately for all eyes, a reduction of 5.84 mm
Hg (or a 25% reduction) (P<0.0001). IOP significantly reduced in the VC group
with a mean reduction of 7.60 mm Hg compared with 4.85 mm Hg in the PVC group
immediately after the procedure (P=0.0038). LGP was required sooner in the VC
group compared with PVC, 11.35 and 14.57 months, respectively (P=0.0393). A total
of 69 (62%) eyes were commenced on topical IOP-lowering medications, mean
7.26±6.41 months after LGP.
CONCLUSIONS: This study supports previous evidence that LGP enhances the
IOP-lowering success of VC/PVC. The advantages of LGP are that it is a minimally 
invasive clinic-based procedure with a low complication rate.

PMID: 26550980   [PubMed - as supplied by publisher]


11. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Uveal Effusion: Clinical Features, Management, and Visual Outcomes in a
Retrospective Case Series.

Shah PR(1), Yohendran J, Hunyor AP, Grigg JR, McCluskey PJ.

Author information: 
(1)*Sydney Eye Hospital †Save Sight Institute, The University of Sydney, Sydney, 
NSW Australia.

PURPOSE: To present the experience of a tertiary care ophthalmic institution in
the assessment and management of uncommon causes of uveal effusion and related
complications.
MATERIALS AND METHODS: A retrospective chart review was conducted of 12 patients 
diagnosed with uveal effusion and managed at our institution between 1996 and
2012. The presenting features, investigations, management, and outcomes were
analyzed for each case.
RESULTS: The case series encompasses a variety of clinical conditions that cause 
uveal effusion including inflammatory, hydrostatic, and idiopathic mechanisms.
Two thirds of the patients presented with secondary angle closure. Half of the
patients had serous retinal detachment. Modern imaging techniques including
ultrasound biomicroscopy and high-resolution magnetic resonance imaging were
critical in making the diagnosis. Seven of the 12 patients responded to medical
treatment and 4 required scleral surgery. Uveal effusions resolved in all
patients after treatment.
CONCLUSIONS: Uveal effusion is a complex and poorly understood clinical entity
with significant visual morbidity and is caused by a range of ocular and systemic
diseases. Effective management is critically dependent on the underlying cause.

PMID: 26550979   [PubMed - as supplied by publisher]


12. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Long-term Surgical Outcomes of 180-Degree Suture Trabeculotomy in Korean Patients
With Primary Congenital Glaucoma.

Park JH(1), Yoo C, Yoo E, Kim YY.

Author information: 
(1)Department of Ophthalmology, Korea University College of Medicine, Guro-gu,
Seoul, Korea.

PURPOSE: To investigate the surgical outcomes of 180-degree suture trabeculotomy 
in Korean patients with primary congenital glaucoma (PCG).
PATIENTS AND METHODS: This retrospective study included 21 eyes of 17 children
with PCG who underwent 180-degree suture trabeculotomy as a first surgical
procedure. Surgical success was defined as (1) an intraocular pressure (IOP)<22
mm Hg with or without medication; (2) no additional intraocular surgery; and (3) 
no evidence of progressive optic disc cupping. The main outcome measure was the
success rate of 180-degree suture trabeculotomy. Secondary outcome measures were 
IOP, number of glaucoma medications, and occurrence of complications.
RESULTS: Of the 21 eyes included, 18 (85.7%) were classified as having achieved
success at the final visit (mean last follow-up or failure time, 54.91±45.68 mo).
Median age at surgery was 11.97 months with mean IOP 29.8±9.6 mm Hg, on average
of 1.52 medications. The mean IOP at the final visit was 16.9±5.6 mm Hg on an
average of 0.38 medications. The surgical success rate of 180-degree suture
trabeculotomy at 1, 3, and 5 years was 95.0%, 87.7%, and 78.9%, respectively
(Kaplan-Meier analysis). Three eyes underwent second operations and the mean time
to failure was 29.39±19.75 months. Hyphema was observed in 10 eyes, but it
cleared up within 7.6 days.
CONCLUSION: The 180-degree suture trabeculotomy performed for PCG had a
significant IOP-lowering effect and caused no remarkable complications.

PMID: 26550978   [PubMed - as supplied by publisher]


13. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Adherence With the Use of Target Intraocular Pressure for Glaucoma Patients in a 
Large University Practice.

Solano-Moncada F(1), Dymerska M, Jefferys JL, Quigley HA.

Author information: 
(1)Glaucoma Center of Excellence, Wilmer Ophthalmological Institute, Johns
Hopkins University School of Medicine, Baltimore, MD.

PURPOSE: To determine how often glaucoma specialists set a target intraocular
pressure (IOP) and how they respond when the target is not achieved.
METHODS: We reviewed 250 randomly selected charts of glaucoma patients seen by 5 
glaucoma specialists to identify whether a target IOP was specifically set and to
detail the plan of action when the target was exceeded.
RESULTS: A target IOP was present for at least 1 eye in 66% of patients
(165/250). Among the patients of 5 physicians, the percentage with a target IOP
for both eyes ranged from 90% to 34%. Half of eyes with no target had an
explaining feature, whereas the other half did not. The study visit IOP exceeded 
the target in at least 1 eye in 29% (50/173) of patients. When the target was not
met, 66% (33/50) had a notation of action taken, with no significant difference
among physicians in whether any action was taken (P=0.64). The significant
differences among the 5 physicians in the use of target IOP were potentially
associated with patient demographic and clinical features, such as age, race,
treatment intensity, and visual field damage, which differed among the 5
practices (all P<0.05).
CONCLUSIONS: Target IOP was recorded in the large majority of patient charts, but
its use varied by physician and patient characteristics. On nearly one third of
visits, IOP exceeded the target, indicating the need for active decision-making
and management changes.

PMID: 26550977   [PubMed - as supplied by publisher]


14. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Shared Care in Monitoring Stable Glaucoma Patients: A Randomized Controlled
Trial.

Holtzer-Goor KM(1), van Vliet EJ, van Sprundel E, Plochg T, Koopmanschap MA,
Klazinga NS, Lemij HG.

Author information: 
(1)*Department of Health Policy and Management, Institute for Medical Technology 
Assessment, Erasmus University Rotterdam †Rotterdam Ophthalmic Institute,
Rotterdam Eye Hospital, Rotterdam §Department of Social Medicine, Academic
Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands ‡School
of Public Health, KULeuven, University of Leuven, Leuven, Belgium.

PURPOSE: Comparing the quality of care provided by a hospital-based shared care
glaucoma follow-up unit with care as usual.
PATIENTS AND METHODS: This randomized controlled trial included stable glaucoma
patients and patients at risk for developing glaucoma. Patients in the Usual Care
group (n=410) were seen by glaucoma specialists. In the glaucoma follow-up unit
group (n=405), patients visited the glaucoma follow-up unit twice followed by a
visit to a glaucoma specialist. The main outcome measures were: compliance to the
working protocol by glaucoma follow-up unit employees; difference in intraocular 
pressure between baseline and at ≥18 months; and patient satisfaction.
RESULTS: Glaucoma follow-up unit employees closely adhered to the working
protocol for the measurement of intraocular pressure, visual acuity and GDx
(≥97.5% of all visits). Humphrey Field Analyzer examinations were not performed
as frequently as prescribed by the working protocol, but more often than in the
Usual Care group. In a small minority of patients that required back-referral,
the protocol was disregarded, notably when criteria were only slightly exceeded. 
There was no statistically significant difference in changes in intraocular
pressure between the 2 treatment groups (P=0.854). Patients were slightly more
satisfied with the glaucoma follow-up unit employees than with the glaucoma
specialists (scores: 8.56 vs. 8.40; P=0.006).
CONCLUSIONS: In general, the hospital-based shared care glaucoma follow-up
closely observed its working protocol and patients preferred it slightly over the
usual care provided by medical doctors. The glaucoma follow-up unit operated
satisfactorily and might serve as a model for shared care strategies elsewhere.

PMID: 26550976   [PubMed - as supplied by publisher]


15. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Segmental Analysis of Macular Layers in Patients With Unilateral Primary
Open-Angle Glaucoma.

Zangalli CS(1), Ahmed OM, Waisbourd M, H Ali M, Cvintal V, Affel E, Gupta L, Katz
LJ, C Sergott R.

Author information: 
(1)*Glaucoma Research Center †Diagnostic Center ‡Neuro-ophthalmology Service,
Wills Eye Hospital, Philadelphia, PA.

PURPOSE: To measure the thicknesses of the inner layers of the macula in both
eyes of patients with unilateral primary open-angle glaucoma (POAG) and compare
them with normal control eyes.
METHODS: This prospective, cross-sectional pilot study enrolled patients with
unilateral POAG, who had visual field defect in only 1 eye, and controls with a
normal eye examination. Horizontal and vertical B-scan images centered on the
fovea were obtained using spectral domain optical coherence. Semiautomatic
delineation and segmentation of the inner layers of the retina were performed to 
evaluate macular retinal nerve fiber layer (mRNFL), ganglion cell complex (GCC)
and ganglion cell-inner plexiform layer (GC-IPL) thicknesses. Mean, superior,
inferior, nasal, and temporal inner macular layer thicknesses were compared
between affected eyes, fellow eyes without visual field defect, and control eyes.
RESULTS: Nineteen patients with unilateral POAG and 14 normal control eyes were
enrolled. In the affected POAG eyes, thinning of the mRNFL, GCC, and GC-IPL
layers on horizontal and vertical scans were significant when compared with
controls (P<0.05), particularly on vertical scans (P<0.001). The mean regional
macular GCC and GC-IPL were most severely thinned in the inferior and temporal
perifoveal regions. The unaffected eye of patients with unilateral POAG showed
significant thinning of the mRNFL only in the vertical scan when compared with
normal controls (P<0.05).
CONCLUSIONS: Spectral domain optical coherence tomography detected significant
thinning of the mRNFL, GCC, and GC-IPL in the affected eyes of patients with
unilateral POAG. Fellow eyes showed early structural changes only in the vertical
mRNFL scans when compared with normal controls.

PMID: 26550975   [PubMed - as supplied by publisher]


16. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

CYP1B1 and MYOC Mutations in Vietnamese Primary Congenital Glaucoma Patients.

Do T(1), Shei W, Chau PT, Trang DL, Yong VH, Ng XY, Chen YM, Aung T, Vithana EN.

Author information: 
(1)*Vietnam National Institute of Ophthalmology, Hanoi, Vietnam †Singapore Eye
Research Institute ‡Department of Ophthalmology, National University Health
System & National University of Singapore §Singapore National Eye Centre
∥Neuroscience and Behavioral Disorders (NBD) Program, Duke-NUS Graduate Medical
School, Singapore, Singapore.

PURPOSE: Primary congenital glaucoma (PCG, OMIM 231300), the most common glaucoma
in infancy, is caused by developmental defects in the anterior chamber angle. The
3 implicated genes are cytochrome P450 family I subfamily B polypeptide 1
(CYP1B1), latent transforming growth factor β-binding protein 2 (LTBP2), and
myocilin (MYOC). In this study, we sought to determine CYP1B1 and MYOC sequence
variations in a Vietnamese cohort of index cases with PCG and their families.
METHODS: Thirty Vietnamese subjects with PCG and 120 normal Vietnamese subjects
were recruited. PCG was defined by the presence of at least 2 of the following
clinical manifestations: increased corneal diameter (>10 mm at birth), corneal
edema, Haab's striae, optic disc changes, and absence of other ocular or systemic
diseases associated with childhood glaucoma. The coding exons, intron and exon
boundaries, and untranslated regions of CYP1B1 and MYOC genes were PCR amplified 
and subjected to bidirectional sequencing in all subjects.
RESULTS: We identified 2 homozygous and 3 heterozygous CYP1B1 sequence
alterations in our study subjects. Among the 5 mutations identified, 2 (p.H279L
and p.L283F) were novel mutations, whereas 3 (p.A121_S122insDRPAFA, p.L107V, and 
p.V320L) had been previously reported in PCG cases. None of these mutations was
observed in any of the 120 controls. Haplotypes generated with 6
non-disease-causing intragenic single nucleotide polymorphisms detected in CYP1B1
indicated that the most common haplotype in Vietnamese population is similar to
that found in Chinese and Japanese. The genotype-phenotype correlation showed no 
significant difference between mutation and no-mutation groups for quantitative
clinical features (presenting intraocular pressure, corneal diameter, number of
surgeries performed, the cup-to-disc ratio) as well as for qualitative factors
(bilateral cases, phenotype severity, and the prognosis) (P>0.05).
CONCLUSIONS: Five out of 30 families with PCG (16.7%) had disease attributable to
CYP1B1 alterations suggesting that CYP1B1 is not the major gene causing PCG in
Vietnamese unlike in the case of Arab or Romany patients. This percentage is
similar to that detected in studies of Japanese and Chinese patients with
sporadic PCG. PCG has proven to be an ocular disease of genetic heterogeneity,
calling for further studies to identify novel genes causing this disease.

PMID: 26550974   [PubMed - as supplied by publisher]


17. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Management of Elevated Intraocular Pressure Associated With Subluxated/Dislocated
Lenses by Combining Trabeculectomy With Adjunctive Mitomycin C With Lensectomy,
Vitrectomy, and Scleral Fixation of Intraocular Lens.

David RL(1), Balekudaru S, George RJ, Sen P, Lingam V.

Author information: 
(1)Sankara Nethralaya, Chennai, Tamil Nadu, India.

AIM: To evaluate the short-term outcomes of lensectomy, combined with vitrectomy,
scleral-fixated intraocular lens (SFIOL), and trabeculectomy with adjunctive
mitomycin C (MMC) in patients with subluxated/dislocated crystalline lenses with 
associated elevated intraocular pressure (IOP).
MATERIALS AND METHODS: This retrospective case series included 51 eyes of 51
patients who underwent lensectomy, vitrectomy, and SFIOL combined with
trabeculectomy with MMC between 2003 and 2012. The main outcome measures assessed
were IOP, change in visual acuity, IOP-lowering medications, and the
complications and reoperation rates.
RESULTS: The most common etiology observed was blunt trauma in 35 eyes (68.6%).
Glaucomatous optic neuropathy was detected in 13 eyes (25.49%) preoperatively.
The IOP reduced significantly from a preoperative mean of 26.3±11.5 mm Hg to
13±4.6 mm Hg (P<0.001) at the final visit. The mean preoperative number of
IOP-lowering medications of 2.9±0.8 reduced to 0.3±0.7 at last follow-up
(P<0.001). The best-corrected visual acuity (Snellens) improved significantly
from 20/600 to 20/60 (P<0.001). Complete success defined as IOP≤21 mm Hg without 
medications was achieved in 93%±5% and 80%±13% at 1 and 2 years, respectively.
Major postoperative complications included retinal detachment in one eye and
SFIOL dislocation in another.
CONCLUSIONS: The technique of combining SFIOLs with trabeculectomy with
adjunctive MMC in the management of subluxated/dislocated lenses resulted in good
IOP control and improvement in visual acuity.

PMID: 26550973   [PubMed - as supplied by publisher]


18. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Effect of Axial Length on Macular Ganglion Cell Complex Thickness and on Early
Glaucoma Diagnosis by Spectral-Domain Optical Coherence Tomography.

Nakanishi H(1), Akagi T, Hangai M, Kimura Y, Suda K, Hasegawa T, Yamada H,
Yoshikawa M, Morooka S, Ikeda HO, Yoshimura N.

Author information: 
(1)*Department of Ophthalmology and Visual Sciences, Kyoto University Graduate
School of Medicine, Sakyo-ku, Kyoto †Department of Ophthalmology, Saitama Medical
University, Moroyama, Saitama, Japan.

PURPOSE: To investigate the effects of the axial length (AL)-related ocular
magnification on the thickness of the macular ganglion cell complex (mGCC), and
the diagnostic accuracy of the built-in normative database of the spectral-domain
optical coherence tomographic (SD-OCT) instrument for early glaucoma detection.
METHODS: This retrospective study included 41 eyes with early primary open-angle 
glaucoma and 36 normal eyes. The mGCC thickness within a 20-degree circle,
equivalent to a 6 mm diameter in the Gullstrand model eye, was measured in the
SD-OCT images. The magnification effect was corrected using Bennett formula, and 
the mGCC thickness within the actual 6 mm diameter circle was determined.
RESULTS: In normal eyes, the inferior corrected mGCC was significantly correlated
with the AL (β=-0.40, P=0.028), but correction for the magnification reduced the 
correlation. In 38 nonhighly myopic eyes, the sensitivity and specificity of the 
SD-OCT's significance maps for distinguishing early glaucoma were 95.0% and 94.4%
when using either the uncorrected or the corrected mGCC. In 39 highly myopic
eyes, the diagnostic accuracy was lower when using the uncorrected mGCC thickness
(sensitivity was 95.2% and specificity was 44.4%), and was not improved when
using the corrected mGCC (81.0% and 61.1%, respectively).
CONCLUSIONS: The inferior mGCC was thinner in eyes with longer AL. The accuracy
of the diagnosis with the SD-OCT built-in normative database for early glaucoma
was not improved significantly by the correction of the AL-associated
magnification in highly myopic eyes. Evaluation of highly myopic eyes with the
nonhighly myopic normative database can lead to misdiagnosis.

PMID: 26550972   [PubMed - as supplied by publisher]


19. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Dual Endotemponade for Extensive Long-standing Cyclodialysis Using Sulcus-fixated
Cionni Ring and PCIOL.

Gupta S(1), Sagar P, Gogia V, Khokhar S, Dada T.

Author information: 
(1)Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, New Delhi, India.

A young patient presented with visual acuity of hand movements only, unrecordable
intraocular pressure, and total cataract after trauma 12 months ago. She reported
failure to improve with conservative therapy as well as a direct cycloplexy
elsewhere. After cleft localization on preoperative gonioscopy, ultrasound
biomicroscopy (UBM), and intraoperative gonioscopy, a partial-thickness scleral
flap was fashioned at the site of maximum cleft height. Following
phacoaspiration, a multipiece intraocular lens was implanted in the sulcus; its
haptics aligned to the axis with maximum height of cyclodialysis. A Cionni ring
placed in sulcus was sutured to sclera under the flap to provide additional
tamponading effect. Postoperative UBM and gonioscopy confirmed cleft closure.
Normalization of intraocular pressure was found on repeated follow-ups till 1
year (12 to 14 mm Hg). UBM showed increase in sulcus diameter, and "double
indentation sign" on the ciliary body.

PMID: 26550971   [PubMed - as supplied by publisher]


20. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Obstructive Sleep Apnea and Retinal Nerve Fiber Layer Thickness: A Meta-analysis.

Zhao XJ(1), Yang CC, Zhang JC, Zheng H, Liu PP, Li Q.

Author information: 
(1)*Department of Ophthalmology, The Fifth Affiliated Hospital, Sun Yat-sen
University †Department of Cardiology, Zhuhai People's Hospital, Zhuhai, China.

STUDY OBJECTIVES: The association between obstructive sleep apnea syndrome (OSAS)
and retinal nerve fiber layer (RNFL) thickness has been examined in many studies.
However, the findings are inconsistent. Our goal is to evaluate the association
between OSAS and RNFL thickness by performing a meta-analysis.
METHODS: We conducted a PubMed database search in November 2014 to identify
studies on OSAS and RNFL. Reference lists of retrieved articles were also
reviewed. A fixed-effects model was used to compute the summary mean difference
(MD).
RESULTS: Six studies involving 1034 eyes were included in the meta-analysis. The 
overall combined MD of RNFL in OSAS patients compared with control participants
was -2.03 µm [95% confidence interval (CI), -3.67 to -0.4; P=0.01]. The overall
combined MDs of RNFL thickness in relation to moderate OSAS and severe OSAS were 
-2.49 µm (95% CI: -4.54 to -0.44; P=0.02) and -6.36 µm (95% CI: -8.4 to -4.32;
P<0.001). But no significant difference was observed in mild OSAS; the combined
MD was -2.05 µm (95% CI: -4.23 to 0.13; P=0.07). Association was also observed in
OSAS and RNFL thickness of the inferior quadrant, with a combined MD of -3.31 µm 
(95% CI: -6.19 to -0.42; P=0.02).
CONCLUSIONS: This meta-analysis provides evidence that OSAS is associated with
RNFL thickness. Furthermore, it was observed that the greater the severity of
OSAS, the greater the loss of RNFL. Among the 4 quadrants observed, the most
affected quadrant was the inferior quadrant, and the least affected was the
temporal quadrant. OSAS may have an impact on changes in RNFL and therefore more 
attention should be paid to patients with this condition.

PMID: 26550970   [PubMed - as supplied by publisher]


21. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Intraocular Pressure Spike and Corneal Decompensation Following Selective Laser
Trabeculoplasty in Patients With Exfoliation Glaucoma.

Bettis DI(1), Whitehead JJ, Farhi P, Zabriskie NA.

Author information: 
(1)Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center,
University of Utah, Salt Lake City, UT.

PURPOSE: To report 5 cases of intractable intraocular pressure (IOP) elevation
and 2 cases of corneal failure in patients with exfoliation glaucoma after
undergoing selective laser trabeculoplasty (SLT).
METHODS: SLT was performed for the treatment of exfoliation glaucoma in 5
patients, all of whom subsequently developed significant IOP elevation within 1
to 5 weeks following treatment. Two patients went on to develop corneal
endothelial failure requiring transplantation within 9 to 11 months.
RESULTS: All 5 patients failed to respond adequately to topical antiglaucoma
therapy and required trabeculectomy. Two patients required secondary implantation
of a glaucoma drainage device. Two patients suffered significant endothelial
injury requiring corneal transplantation (one receiving penetrating keratoplasty 
and another receiving Descemet stripping automated endothelial keratoplasty).
CONCLUSIONS: Significant and persistent IOP spikes requiring surgical
intervention following SLT are extremely rare, with only 1 other case series of 4
patients (all with heavily pigmented angles) reported in the literature.
Exfoliation patients, and likely all patients with heavily pigmented angles,
should be considered at higher risk for developing this complication. Corneal
endothelial failure is similarly rare. Nine cases have been reported in the
literature, none requiring corneal transplantation. Further clinical attention
and research is needed to help elucidate what factors (both pressure-dependent
and pressure-independent) may predispose patients to corneal changes following
SLT.

PMID: 26550969   [PubMed - as supplied by publisher]


22. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Immunohistochemical Characterization of the Ectopic Epithelium Devoid of Goblet
Cells From a Posttraumatic Iris Cyst Causing Mucogenic Glaucoma.

Wakae H(1), Higashide T, Tsuneyama K, Nakamura T, Takahashi K, Sugiyama K.

Author information: 
(1)*Department of Ophthalmology and Visual Science, Kanazawa University Graduate 
School of Medical Science, Kanazawa †Department of Pathology and Laboratory
Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School,
Tokushima ‡Department of Frontier Medical Science and Technology for
Ophthalmology Kyoto Prefectural University of Medicine, Kyoto §Department of
Ophthalmology, Kansai Medical University, Hirakata, Japan.

PURPOSE: Mucogenic glaucoma is an unusual form of secondary open-angle glaucoma
caused by intracameral ectopic mucus-producing epithelium. To date, only 3 cases 
have been described in detail. Numerous goblet cells in the specimens indicated a
possible conjunctival origin. We immunohistochemically characterized the
implanted epithelium from an iris cyst responsible for mucogenic glaucoma.
METHODS: A series of immunostaining analyses were performed on a
sector-iridectomy specimen derived from an eye with mucogenic glaucoma and a
history of limbal penetrating injury. An iris cyst was present in the inferonasal
quadrant of the right eye of a 58-year-old man. The anterior chamber was filled
with hazy, translucent material, and the chamber angle was gonioscopically open. 
The cyst was resected due to medically uncontrollable high intraocular pressure.
RESULTS: The ectopic epithelium was mostly positive for CK19, a corneal and
conjunctival epithelial marker. Negative staining for MUC5AC, a secretory mucin, 
and positive staining for MUC1, a membrane-bound mucin, corroborated the absence 
of goblet cells. Ectopic epithelial cells were abundantly positive for CK15, a
limbal basal cell marker, but there was patchy immunostaining of CK13, a
conjunctival epithelial marker, and sparse labeling with CK12, a corneal
epithelial marker. Immunostaining patterns of CK15, CK13, and CK12 were nearly
mutually exclusive.
CONCLUSIONS: The ectopic epithelium of an iris cyst causing mucogenic glaucoma
was most likely to originate from limbal basal cells, which showed dual direction
of differentiation toward both the conjunctival and corneal epithelia. The
membrane-bound mucin may have caused mucogenic glaucoma in the absence of goblet 
cells.

PMID: 26550968   [PubMed - as supplied by publisher]


23. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Risk Factors of Disease Progression After Cataract Surgery in Chronic
Angle-closure Glaucoma Patients.

Lee CK(1), Lee NE, Hong S, Kang E, Rho SS, Seong GJ, Hong YJ, Kim CY.

Author information: 
(1)*Department of Ophthalmology, Maryknoll Hospital, Busan †Department of
Ophthalmology, Institute of Vision Research, Yonsei University College of
Medicine §Nune Eye Hospital, Seoul ‡Department of Ophthalmology, CHA Bundang
Medical Center, CHA University, Seongnam, Republic of Korea.

PURPOSE: To evaluate clinical risk factors of disease progression after cataract 
surgery using phacoemulsification with posterior chamber intraocular lens
implantation, in eyes with chronic angle-closure glaucoma (CACG) and coexisting
cataract.
DESIGN: Retrospective study.
METHODS: The data of 56 eyes of 45 CACG patients who had undergone uncomplicated 
phacoemulsification with posterior chamber intraocular lens implantation were
retrospectively analyzed. Disease progression was defined as glaucomatous optic
nerve change or visual field (VF) deterioration according to the European
Glaucoma Society guideline. Correlations between VF progression and various
preoperative and postoperative factors were determined by χ and independent t
tests. Linear regression analysis [(odds ratio (OR)] was used to determine
predictive risk factors for disease progression using univariate and multivariate
analyses.
RESULTS: The mean postoperative follow-up period was 45.13±17.54 (24 to 84)
months. Fourteen eyes (25%) with cataracts diagnosed with CACG progressed after
phacoemulsification, but the remaining 42 eyes (75%) did not. According to
univariate analysis, disease progression was significantly associated with older 
age, more number of preoperative/postoperative antiglaucoma drugs, higher scores 
of preoperative pattern standard deviation, and lower scores of preoperative and 
postoperative visual field index (VFI) (P<0.05). Using multivariate analysis, a
lower score of preoperative VFI (OR: 0.86, P=0.044) and lower postoperative
intraocular pressure (IOP) reduction, which was not sustained below 20% less than
the preoperative mean IOP, were significantly correlated with disease progression
after cataract surgery (OR: 8.44, P=0.048).
CONCLUSIONS: CACG patients with low preoperative VFI and high postoperative IOP
are at risk for disease progression even after uncomplicated cataract surgery.

PMID: 26550967   [PubMed - as supplied by publisher]


24. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Bleb-like Finding Caused by Idiopathic Scleral Thinning in an Eye With Absolute
Glaucoma.

Matsumura R(1), Inoue T, Tanihara H.

Author information: 
(1)Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University,
Kumamoto, Japan.

PURPOSE: To evaluate a bleb-like finding in an eye with absolute glaucoma using
anterior-segment optical coherence tomography (AS-OCT).
METHODS: A 35-year-old woman complained of sudden-onset pain in the right eye.
She had been diagnosed with keratitis at 1.5 years old and the onset of secondary
glaucoma was identified at 13 years old. At the age of 26 years, transscleral
contact diode laser cyclophotocoagulation therapy was performed, except for the
upper quadrant, because scleral thinning was noted at that time. At the age of 35
years, she was blind in her right eye and corneal opacity and a bleb-like
structure in the upper conjunctiva was seen with a slit-lamp examination. This
bleb-like structure was removed surgically at bulbar exenteration, and the
pathology was examined.
RESULTS: AS-OCT showed a bleb-like internal structure with a single large empty
space and thin scleral tissue and relatively thin walls with high optical
density. Pathology indicated that the high optical density bleb wall was
connective tissue. On AS-OCT, the internal surface of the empty space was very
smooth, which matched the pathology. Histochemically, there were goblet cells, as
in normal conjunctiva, but not in the conjunctiva over the aqueous space.
CONCLUSIONS: AS-OCT images found that the intrableb structure was in good
agreement with the pathology results; these conjunctival changes were very
similar to those after a standard trabeculectomy.

PMID: 26550966   [PubMed - as supplied by publisher]


25. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Comparison of Eye Drop Instillation Before and After Use of Drop Application
Strips in Glaucoma Patients on Chronic Topical Therapy.

Sharma R(1), Singhal D, Shashni A, Agarwal E, Wadhwani M, Dada T.

Author information: 
(1)Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, New Delhi, India.

PURPOSE: To evaluate the impact of using drop application strips on eye drop
instillation in glaucoma patients on chronic topical ocular hypotensive therapy.
METHODS: A total of 72 patients with primary open-angle glaucoma with an
uncorrected visual acuity of 3/60 or more, self-administering topical
antiglaucoma medication for >1 year were evaluated. One eye of each patient was
included in the study. Patients were instructed to instill 0.5% carboxymethyl
cellulose drop in 1 eye. They were then instructed to instill the same drop using
the drop application strips.
RESULTS: Mean age of the patients included in the study was 50.39±12.04 years.
Before assistance of drop application strips, 35 (48.61%) patients placed the
drop into the eye without any contact of the dropper nozzle, and, after
application of the drop application strips, 66 (91.67%) patients placed the drop 
in the eye without any contact (P=0.025). The number of patients putting the
first drop of drug into the eye without spilling over the adenexae increased from
30 (41.67%) to 45 (62.5%) after application of the strip (P<0.001). The mean
number of drops instilled to get 1 drop into the eye decreased from 2±0.95 to
1.56±0.78 when the drop application strip was used (P<0.001).
CONCLUSIONS: Use of a drop application strip causes a significant decrease in
contact of the eye drop bottle nozzle with the eyeball and eyelid, decreases the 
number of drops instilled to get 1 drop into the eye, and is associated with an
overall improvement in eye drop instillation.

PMID: 26550965   [PubMed - as supplied by publisher]


26. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Persistence of Glaucoma Therapy and Visual Field Progression.

de Leon JM(1), Quek DT, Htoon HM, Tun TA, Perera SA, Lamoureux EL, Aung T.

Author information: 
(1)*Singapore and Singapore National Eye Centre, Singapore Eye Research Institute
‡Duke-NUS Medical School §Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore †Cardinal Santos Medical Center, San Juan City,
Metro Manila, Philippines.

PURPOSE: To determine the association of visual field (VF) progression with
medication persistence in a cohort on glaucoma therapy.
PATIENTS AND METHODS: Pharmacy records were examined over 3 years for patients
started on glaucoma monotherapy. A patient was persistent if a prescription was
refilled for the same medication <90 days after the previous prescription had
lapsed; otherwise was nonpersistent. Only patients with >5 reliable VFs within
1-year pretherapy and 6-year posttherapy were included. Progression was analyzed 
with pointwise linear regression and defined using 2 criteria: (A) ≥2 adjacent
progressing points (slope P<0.01) in 1 hemifield; and (B) ≥3 progressing points
(slope P<0.01). The mean number and mean slope of progressing points and the mean
global slopes were determined.
RESULTS: Of 1206 patient eyes (131 persistent, 1075 nonpersistent), 941 were
excluded leaving 175 (47 persistent and 128 nonpersistent) for analysis. The mean
follow-up durations were 59.3±10.9 and 58.2±9.7 months (P=0.07) for persistent
and nonpersistent eyes, respectively. Overall, 2/47 (4.3%) and 10/128 (7.8%) eyes
progressed among persistent and nonpersistent patients, respectively (P=0.52)
using criterion A and 1/47 (2.1%) and 12/128 (9.4%; P=0.19) eyes using criterion 
B. Mean number of progressing points (0.3±0.9 vs. 0.7±1.8; P=0.17), mean slope of
progressing points (-2.2±1.1 vs. -2.8±1.3 dB/y; P=0.27), and mean global slope
(0.7±0.5 vs. -0.1±0.8 dB/y; P=0.07) were similar for persistent and nonpersistent
patients, respectively.
CONCLUSION: There were small but appreciable differences in VF progression rates 
between persistent and nonpersistent patient eyes on glaucoma drops, but
differences were not significant.

PMID: 26550964   [PubMed - as supplied by publisher]


27. J Glaucoma. 2015 Nov 6. [Epub ahead of print]

Seasonal Variation in the Incidence of Late-onset Bleb-related Infection After
Filtering Surgery in Japan: The Japan Glaucoma Society Survey of Bleb-related
Infection Report 3.

Sagara H(1), Yamamoto T, Sekiryu T, Ogasawara M, Tango T.

Author information: 
(1)*The Marui Eye Clinic, Minamisouma †Department of Ophthalmology, Fukushima
Medical University School of Medicine, Fukushima ‡Department of Ophthalmology,
Gifu University Graduate School of Medicine, Gifu §Center for Medical Statistics,
Tokyo, Japan.

PURPOSE: To investigate seasonal variations in the incidence of late-onset
bleb-related infection after filtering surgery in Japan and the relationship
between season and other factors.
PATIENTS AND METHODS: This multicenter, prospective study is part of a
5-year-long Japan Glaucoma Society survey of bleb-related infection. We analyzed 
156 cases of first-time infections (106 men, 50 women) encountered over 5 years
to determine the seasonal variation using the Roger test and the relationships
between season, sex, and age by logistic regression analysis.
RESULTS: We noted significant monthly seasonal variation in the incidence of
infection, which was the highest in January and February (23 and 18 infections,
respectively; P=0.018) and lowest from August to November (9, 9, 11, and 8
infections, in that order). Multiple logistic regression analysis revealed that
infections were most frequent among women in spring (odds ratio, 8.43; P=0.005). 
Staphylococcus aureus and Streptococcus spp. infections were more frequent in
warmer seasons than in winter. Less virulent species, namely, coagulase-negative 
Staphylococcus spp., Corynebacterium spp., and Enterococcus spp., were frequently
detected in winter. Coagulase-negative Staphylococcus spp. and Haemophilus
influenzae were more frequent in women and men, respectively.
CONCLUSIONS: The incidence of late-onset bleb-related infection showed
significant seasonal variation and sex differences. The climate in Japan may
influence the incidence of bleb-related infection. Moreover, besides climate,
physical activity level and lifestyle may contribute to the seasonal variation in
the incidence and sex differences in the involved bacterial agents of
bleb-related infections in Japan.This is an open-access article distributed under
the terms of the Creative Commons Attribution-Non Commercial-No Derivatives
License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work 
provided it is properly cited. The work cannot be changed in any way or used
commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.

PMID: 26550963   [PubMed - as supplied by publisher]