1.Should anterior segment imaging devices replace gonioscopy?
Jovell Ian M. Peregrino ; Edgar U. Leuenberger
Philippine Journal of Ophthalmology 2014;39(2):94-96
Glaucoma will continue to be the leading cause
of irreversible blindness worldwide.1,2 A recent metaanalysis done by Tham and coworkers projected an
increase of 74% in the total number of people with
glaucoma, from 64.3 million in 2013 to 76 million by
2020, and to 111.8 million by the year 2040.2
With this
recent forecast, Asia will have the greatest number of
both primary open angle glaucoma and primary angle
closure glaucoma (PACG), comprising 18.8 million
(79.8%) and 9 million (58.4%) respectively.2
Since half
of the world’s PACG will come from Asia, an effective
reduction in the real incidence and prevention of
visual loss from this devastating disease will depend
on the accurate assessment of the anterior chamber
angle and early detection of appositional closure
Gonioscopy
2.Risk factors for conjunctival tube erosion in eyes implanted with Ahmed glaucoma valve in a private eye institution in the Philippines.
Jovell Ian M. PEREGRINO ; Edgar U. LEUENBERGER ; Ma. Imelda Y. VELOSO
Philippine Journal of Ophthalmology 2018;43(2):51-59
Objective:
To identify the risk factors for conjunctival tube erosion (CTE) in eyes implanted with Ahmed®
glaucoma valve (AGV) device
Method:
This is a retrospective study conducted at a private eye institution. Medical records of patients who
underwent AGV implantation surgery from January 2004 to December 2013 were reviewed. Eyes with at least 24
months of follow-up and complete records were included. Several variables from the pre-, intra-, and postoperative
periods were collected. The primary outcome was development of CTE after AGV surgery. Univariable logistic
regression and multivariable analysis were employed.
Results:
Forty-six (46) eyes of 45 patients were included in the study. The mean follow-up was 50.2 months
(range: 24-140 months). Eight (8) eyes developed CTE (17.4%). Univariable logistic regression analysis identified
female gender (P =0.064), presence of diabetes (P =0.083), prior intraocular surgeries (P =0.09), and postoperative
use of antiglaucoma medications (P =0.086) to be marginally significant risk factors for CTE. On multivariable
analysis, only female gender (OR=15.4, P =0.033) and diabetes (OR=14.1, P =0.031) were found to be significantly
associated with CTE.
Conclusion
Risk factors for CTE following AGV implantation include female gender and presence of diabetes.
Human
;
Glaucoma
3.A case of neovascular glaucoma secondary to ocular ischemia
James Paul S. Gomez ; Amadeo A. Veloso ; Edgar U. Leuenberger
Philippine Journal of Ophthalmology 2022;47(2):106-110
Objective:
To present a case of neovascular glaucoma secondary to ocular ischemic syndrome
following an uncomplicated phacoemulsification
Methods:
This is a case description of a 74-year-old male who developed blurred vision and increased
intraocular pressure (IOP) two months after an uncomplicated phacoemulsification cataract surgery
with posterior chamber lens implantation of the left eye. There was iris neovascularization with
absence of retinal dot/blot hemorrhages or neovascularization. The fluorescein angiogram (FA)
showed delayed choroidal fluorescence and arteriovenous time. IOP-lowering medications and
intravitreal injection of aflibercept were given. Carotid doppler test showed 70% stenosis of the
ipsilateral artery but a subsequent magnetic resonance angiography (MRA) did not show evidence of
significant stenosis.
Results:
At his last consultation, visual acuity improved to counting fingers. IOP was maintained at
12 mmHg with one anti-glaucoma medication.
Conclusion
Ocular ischemia can confound the outcome of an uncomplicated cataract surgery.
Doppler scans are usually chosen as the first-line exam for those suspected of carotid stenosis but, at
times, may have contradictory results with MRA.
Glaucoma, Neovascular
;
Phacoemulsification
4.Determination of iridotrabecular contact using the anterior segment optical coherence tomography in lights-on and lights-off conditions
James Paul S. Gomez ; Edgar U. Leuenberger
Philippine Journal of Ophthalmology 2019;44(1):19-24
Objective:
To determine the presence of iridotrabecular contact (ITC) and compare the changes in anterior
chamber angle (ACA) measurements in room lights-on and lights-off conditions using the anterior segment
optical coherence tomography (AS-OCT) in eyes diagnosed as primary angle closure suspects (PACS) by
gonioscopy.
Methods:
This is a retrospective review of 144 eyes of 79 patients (70 females, 9 males) with PACS. All eyes
were imaged using the Visante® time-domain AS-OCT (Carl Zeiss Meditec, Dublin, CA). Each eye was
imaged twice; the first scan was done with the room lights on followed by a second scan done after turning
the room lights off for 2 minutes. The principal outcome measure was the presence of ITC in either lighting
condition. Other angle metrics that were assessed included anterior chamber depth (ACD), angle opening
distance (AOD), trabecular-iris space area (TISA), and scleral spur angle (SSA). Presence of ITC and differences
in the angle metrics between the 2 lighting conditions were then analyzed using the t-tests and logistic
regression.
Results:
ITC was present in 36.8% (53) of the study eyes. Twenty percent (20%) of the study eyes (29) did not
initially exhibit ITC in the lights-on phase but developed ITC when imaged with the lights off. Persistent ITC was
seen in 16.6% (24 eyes) in both lighting conditions. ITC occurred in 52.2% of the eyes with ACD less than 2.18
mm. Logistic regression showed that there is a 91% decrease in the odds of having ITC in lights-off condition for
every millimeter of ACD increase. Age was not associated with the occurrence of ITC in the lights-off condition. All other analyzed parameters decreased significantly in the lights-off condition (p<0.05) except for the ACD, nasal
TISA-500, and temporal SSA.
Conclusions
The presence of ITC is a well-established characteristic of eyes with angle closure. In eyes with
PACS, detection of ITC may be enhanced with AS-OCT imaging in lights-off condition.
Tomography, Optical Coherence
6.Survey of glaucoma practice patterns among members of The Philippine Glaucoma Society
Edgar Felipe U. Leuenberger ; James Paul S. Gomez ; Karlo Paolo L. Alejo ; Robert Edward T. Ang ; Maria Zita Zagala-Meriales ; Pamela C. Allarey ; Aldo Mar B. Cariaga ; John Mark S. De Leon ; Sammy L. Ang ; ; ;
Philippine Journal of Ophthalmology 2020;45(1):9-18
OBJECTIVE: To identify the glaucoma clinical practice patterns among the members of the Philippine Glaucoma Society (PGS) from 2015 to 2016 using an online survey.
METHODS: An online link was sent to each consenting PGS member which directed them to two poll sites. These sites asked questions about demographics and their preferred clinical practice patterns. Frequency and percent distributions were used to analyze the data.
RESULTS: There was a high response rate from PGS members at 97% (42 out of 43 members). More than half of respondents (51%, n=22) defined glaucoma as glaucomatous optic neuropathy with an evident visual field loss. IOP was routinely measured by 90% (n=38) of the respondents with majority preferring to use the Goldmann applanation tonometer (GAT) (98%, n=41). Gonioscopy was done on all new patients by all PGS members but only 62% did regular gonioscopy on follow-up consultations. Most of the respondents relied on the 90D lens (88%) to assess the optic nerve. Visual field examination (VFE) was routinely requested by all respondents. Pachymetry and anterior segment optical coherence tomography (AS-OCT) were used sparingly at only 43% and 12% respectively. Appositional angle closure was addressed by performing laser iridotomy with majority of the respondents preferring a site that is covered by the upper eyelid (57%). Prostaglandin analogues were the top choice as first-line monotherapy for eyes with open-angle glaucoma. Majority of the respondents (55%) opted to do laser trabeculoplasty (LTP) as an adjunct to medical therapy. Mitomycin-C was the preferred intraoperative antimetabolite for trabeculectomy by 98% (n=41). Ahmed (71%, n=30) was the more favored glaucoma drainage device (GDD) by our respondents over Baerveldt (19%, n=8).
CONCLUSION: This survey showed majority of the glaucoma practices of PGS members appear to adhere to the current clinical practice guidelines.
Philippines
;
Glaucoma
;
Tetrahymenina
;
Surveys and Questionnaires
7.Comparative analysis of meibomian gland dysfunction in eyes with and without eyelid margin tattoos
Ma. Joanna Carla Z. Garcia ; Edgar U. Leuenberger ; James Paul S. Gomez ; Tommee Lynne T. Tiu ; Sharlene I. Noguera
Philippine Journal of Ophthalmology 2020;45(1):41-47
OBJECTIVE: To compare the presence and severity of meibomian gland (MG) dysfunction among eyes of female subjects with and without eyelid margin tattoos using infrared meibography and colored photographs.
METHODS: This is a cross-sectional, descriptive study that involved 38 Filipino females with and without eyelid margin tattoos. Infrared meibography was performed on the upper and lower eyelids of each eye to assess total or partial MG dropout. Colored photographs were taken to evaluate vascularity, irregularity, thickening of the lid margins, and plugging of MG orifices. Severity of MG dysfunction (MGD) was assessed using Arita’s MGD proposed grading scale. Independent t-test was used to compare MG dropout and other lid margin parameters between the two groups. Prevalence ratio and prevalence odds ratio were calculated to measure the likelihood of MGD among eyes with eyelid tattoos.
RESULTS: Seventy-four (74) eyes were included in the study (36 in the tattoo group and 38 in the control group). Scores for abnormal vascularity, irregularity, and thickening of the lid margins were significantly higher in the tattoo group compared to the control group (p<0.0000001). However, plugging of gland orifices scores between the two groups were found to be similar (upper eyelid: p=0.65; lower eyelid: p=0.91). Total MG dropout was significantly greater in the tattoo group (upper eyelid: -1.11 ± 0.82; lower eyelid: 1.37 ± 0.75) compared to the control group (upper eyelid: 0.53 ± 0.83; lower eyelid: 0.45 ± 0.76) (upper eyelid: p=0.003; lower eyelid: p=0.000001) for the upper and lower eyelid, respectively). Analysis of total MG dropout between the two groups showed a prevalence ratio of 2.13.
CONCLUSION: Eyelid margin tattoos are associated with several eyelid margin abnormalities and increase the risk of meibomian gland droupout.
Meibomian Gland Dysfunction
;
Tattooing
;
Margins of Excision
8.Comparison of the clinical profile of patients with glaucoma between private and government clinics in the Philippines.
Edgar Felipe U LEUENBERGER ; James Paul S GOMEZ ; Robert Edward T ANG ; Maria Imelda YAP-VELOSO ; Joseph Anthony J TUMBOCON ; Jose Maria D MARTINEZ ; John Mark S DE LEON ; Nilo Vincent FLORCRUZ ; Rainier Victor A COVAR ; Irene R FELARCA ; Denise Polly CHAO-PO ; Shalam SIAO-MARIANO ; Marie Joan Therese D BALGOS ; Noel D ATIENZA
Philippine Journal of Ophthalmology 2019;44(2):45-53
OBJECTIVE: To describe the demographic and clinical characteristics of patients with glaucoma managed at private and government institutions in the Philippines between 2009 and 2014.
METHODS: A research team from two private and two government institutions in the Philippines reviewed the case records of 1246 patients seen who met the following criteria: intraocular pressure of >21 mmHg, optic nerve and nerve fiber layer abnormalities, and visual field defects. For bilateral cases, we selected the eye with worse glaucoma parameters.
RESULTS: There were 600 and 646 patients in the private and government groups (mean age at presentation, 60.51 and 55.88 years), respectively, with the majority being Filipino (91%). Patients with visual acuity (VA) of 20/20 to 20/40 were more frequently observed in private centers (58.7% vs. 41.3%), while a VA worse than counting fingers was more frequently observed in government centers (66.1% vs. 33.9%). Within-group analysis showed that primary angle-closure glaucoma was the most frequent glaucoma subtype in both private (27.3%) and government institutions (37.8%). In between-group analysis showed the following to be more common in private than government centers: primary open-angle glaucoma (61.3% vs. 38.7%), normal-tension glaucoma (63.9% vs. 36.1%), ocular hypertension (92.3% vs. 7.7%), and glaucoma suspects (80.4% vs. 19.6%) while government institutions registered a larger number of primary angle-closure glaucoma (59.8% vs. 40.2%) and secondary glaucoma (70.3% vs. 29.7%) cases. Medical treatment using a single drug and multiple drugs was employed for 245 (23%) and 825 (77%) patients, respectively. Within-group analysis showed that laser iridotomy and trabeculectomy were the most commonly performed laser and surgical procedures in both institution types.
CONCLUSION: There is a contrasting profile of glaucoma between clinical institutions in the Philippines with openangle glaucoma being more predominant in private centers while closed-angle glaucoma and secondary glaucoma being more frequent in government centers. Our findings may provide important preliminary information that can aid future health studies or training programs.
Human ; Glaucoma ; Patients