OBJECTIVE: Since cataract and glaucoma often coexist, and there is no agreement as to their optimal management, a review of the surgical strategies for coexisting I cataract and glaucoma is necessary. The latest evidence-based findings from various studies are presented. METHODS: A literature search of the latest full articles (up to September 2006) was conducted on the surgical management of coexisting cataract and glaucoma. The results of the 2001 Johns Hopkins milestone study were also included for analysis and comparison. RESULTS: Evidence is strong that trabeculectomy is associated with increased risk of postoperative cataract. Though cataract surgery alone may be appropriate for some glaucoma patients, combined cataract and glaucoma surgery lower long-term intraocular pressure (IOP) more than cataract extraction alone. Use of intraoperative mitomycin-C is beneficial in combined surgery. Limbu and fornix-based conjunctival flaps are equally effective for lowering IOP combined surgery. Trabeculectomy alone lowers long-term IOP more tha combined extracapsular cataract extraction (ECCE) and trabeculectomy. Evidence is weak that combined surgery with phacoemulsification rather than ECCE results in lower long-term IOP, as does two-site compared to single-site combined surgery. CONCLUSION: The literature does not point to an optimal strategy for controlling in patients with coexisting cataract and glaucoma needing surgery. There is a continued need for high-quality studies of longer duration and more information on the optic nerve and visual field.
GLAUCOMA ; CATARACT ; INTRAOCULAR PRESSURE ; OCULAR HYPERTENSION ; OCULAR HYPOTENSION ; SURGERY ; PHACOEMULSIFICATION ; TRABECULECTOMY

This study aims to determine the average span of time for Nd:YAG Capsulotomy for posterior capsular opacification after phacoemulsification using four (4) different posterior chamber intraocular lens (IOL) materials (acrylic, polymethylmethacrylate, silicone and hydrogel). This is a retrospective, cohort study wherein data from the charts of 46 patients of a single surgeon were tabulated. All the patients underwent a standardized and an uncomplicated phacoemulsification for senile cataracts with posterior chamber IOL insertion. There were a total of 50 IOLs in this study, 8 acrylic, 16 polymethylmethacrylate (PMMA), 24 silicone and 2 hydrogel. The average duration before Nd: YAG capsulotomy was necessary for each IOL material were: acrylic 11.91 months, PMMA 14.50 months, silicone 18.25 months and hydrogel 8.125 months. This study revealed that each of the four (4) different IOL materials had no influence on the span of time before the necessity for Nd: YAG capsulotomy. (Author)
SURGERY

Human ; Adult ; GLAUCOMA-OPEN-ANGLE ; GLAUCOMA,SIMPLEX ; GLAUCOMA, COMPENSATED ; IRIDOCORNEAL ENDOTHELIAL SYNDROME ; FILTERING SURGERY ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY

PURPOSE:To determine the cup and disc areas using computer-aided imaging. METHODOLOGY:Case-control study using the computer-aided imaging as a screening test in a given population. RESULTS:There is a wide variability in cup and disc areas among glaucoma suspects and normal. CONCLUSION:C:D alone has a poor predictive value for diagnosing glaucoma.Optic disc size with C:D is just as sensitive and specific in screening for glaucoma.Cup and disc areas are positively correlated for normal and glaucoma suspects.
Human ; Aged ; Middle Aged ; Adult ; GLAUCOMA

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.
GLAUCOMA ; OPTIC NERVE ; VISUAL FIELDS ; VISUAL FIELD TESTS ; OPTIC DISK

Objective: This study compared the peripapillary retinal nerve fiber layer (pRNFL) microangiographic properties [vessel area density (VAD) and blood flux index (BFI)] of unilateral open-angle glaucomatous eyes to contralateral eyes-at-risk, and to eyes of healthy age- and sex-matched subjects. Methods: This was a single-center, case-control study of Filipinos diagnosed with unilateral primary openangle glaucoma (POAG) or normal-tension glaucoma (NTG). Mean overall and quadrantal VAD and BFI of the three groups were measured with optical coherence tomography- angiography (OCT-A). Area under the receiver operating characteristic (AROC) was used to measure diagnostic ability. Results: Twenty-two (22) glaucomatous subjects (15 POAG and 7 NTG eyes), 22 contralateral eyes-at-risk, and 22 normal eyes from age- and sex-matched control subjects completed the study. Eyes with glaucoma showed lower mean overall VAD (40%) and BFI (0.37) compared to eyes-at-risk (44.4% and 0.42, respectively; p <0.001) and control eyes (45.6% and 0.44, respectively; p <0.001). Mean VAD and BFI values of eyes-at-risk and control groups did not significantly differ from each other. Overall pRNFL thickness showed highest diagnostic accuracy for glaucoma (AROC = 0.97), followed by VAD (0.94), and BFI (0.88) (p=0.46). Conclusion VAD and BFI were significantly diminished in unilateral open-angle glaucoma, suggesting that the utility of OCT-A in the detection of glaucoma is comparable to pRNFL thickness.
Microcirculation ; Glaucoma ; Angiography

Introduction: To determine the structure-function correlations of glaucoma in Filipinos using the average peripapillary retinal nerve fiber layer (RNFL) thickness and rim area (RA) of the spectral-domain optical coherence tomography (SD-OCT) and mean defect (MD), pattern standard deviation (PSD), and visual field (VF) clusters of standard automated perimetry (SAP) Methods: Consecutive tests consisting of SD-OCT, SAP, and disc photos were reviewed and selected based on abnormalities in VFs or OCTs or both. Each set of tests was classified as to VF defect type and severity. Mean threshold of VF clusters, MD, and PSD were correlated with average and sectoral RNFL thicknesses and RA. Results: One hundred eighty-six (168) eyes of 121 patients with mean age of 60.2 ± 14.7 years had an average MD, PSD, RNFL thickness, RA of -9.5 ± 8.5 dB, 5.4 ± 3.3 dB, 75.9 ± 15.9 μm, and 0.9 ± 0.4 mm2, respectively. Among VF tests, 23.1% were normal, 16.5% had early, 9.1% moderate, 12.4% advanced, and 8.3% severe glaucoma damage. Most common VF defect types were central islands, combined, and paracentral (16.5%, 14.4%, and 12.2%, respectively). The most commonly affected RNFL segments were inferior, followed by superior, and combined superior and inferior (51.2%, 47.1, and 34%, respectively). Among the OCT parameters, RNFL thickness and RA were strongly correlated (p<0.0001). Between the VF and OCT parameters, the strongest correlation was between the clusters of superior VF defects and the 6-8 o’clock RNFL thinning, followed by the inferior VF defects and the 12-1 o’clock RNFL thinning. Inferior RNFL thinning was strongly correlated with MD and PSD. Conclusion Among Filipino glaucomatous eyes monitored with SD-OCT and SAP, correlation was strongest between the superior VF defects and the infero-temporal RNFL thinning.
Visual Fields ; Tomography, Optical Coherence ; Glaucoma

This document offers guidance to help the ophthalmologist plan for the safe resumption of elective surgical care. There are 4 sections: (I) COVID-19 Awareness, (II) Preparedness, (III) Patient Issues, and (IV) Delivery of Safe and High-Quality Care. Each section contains key issues to be addressed before elective surgery may be safely reinstituted. Understanding the capabilities of health facilities (e.g., testing, operating rooms) as well as the potential limitations in manpower and supplies will remain important, while keeping an eye out on subsequent waves of COVID-19.
COVID-19

With the resumption of elective surgeries during this COVID-19 pandemic, surgeons and facilities should implement infection prevention and control measures to ensure the safety of patients and health care workers. This advisory highlights the key principles, risk stratification considerations, and recommended approach regarding Covid-19 testing prior to elective ophthalmic surgeries.
COVID-19

Objective: To report the clinical profile and treatment outcomes of neovascular glaucoma (NVG). Methods: A retrospective cohort study was done in a single tertiary hospital. Medical records of patients diagnosed with NVG from January 2000 to August 2018 were reviewed and pertinent data were collected. Study outcomes included visual acuity (VA) and intraocular pressure (IOP) and were analyzed for eyes that received any of the following: intravitreal bevacizumab (IVBe), pan-retinal photocoagulation (PRP), trabeculectomy with mitomycin (trab-MMC), or diode laser cyclophotocoagulation (DLCP) with at least 1 month of follow-up. Results: There were 162 patients (181 eyes) diagnosed with NVG. Mean age at the time of diagnosis was 55.6 ± 14 years. Diabetic retinopathy (DR) was observed in 81 (45%) eyes and central retinal vein occlusion (CRVO) in 48 (27%) eyes. Baseline VA was hand movement in 67 (37%) eyes and no light perception (NLP) in 49 (27%) eyes. Only 60 (33%) eyes had ≥1 month of follow up (mean of 73 ± 119.1 weeks) after procedures were done. IVBe was done in 22 (37%) eyes, trab-MMC in 20 (33%), PRP in 22 (37%), and DLCP in 24 (40%) eyes. IOP decreased from 45 to 20 mmHg (p<0.001) but VA decreased from LogMAR 1.7 to 2.1 (p<0.01). There was significant VA decrease in eyes that underwent a single procedure (p<0.02) but none in eyes that underwent 2 or 3 procedures. Nonetheless, there was significant IOP decrease (p<0.05) when one procedure was done. Of the 49 eyes that had baseline sight, 19 (41%) converted to NLP (p<0.01). Conclusion Most patients presenting with advanced NVG had DR and CRVO. Procedures led to better IOP but not VA and some lost vision. Aggressive screening for NVG among high-risk groups is warranted to institute treatment early.
Bevacizumab ; Retinal Vein Occlusion ; Diabetic Retinopathy ; Glaucoma, Neovascular ; Trabeculectomy