PURPOSE: To evaluate outcomes and factors associated with surgical failure in patients who underwent combined phacoemulsification and Ahmed glaucoma valve (AGV) implantation. METHODS: This retrospective and longitudinal study enrolled 40 eyes (38 patients) that underwent combined phacoemulsification and AGV implantation. Visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as a last follow-up IOP of 6 to 21 mmHg without medication, qualified success as an IOP of 6 to 21 mmHg with medication, and failure as an IOP of >21 or <6 mmHg. RESULTS: The mean follow-up period was 18 ± 10 months. Preoperative diagnoses were chronic angle closure glaucoma (35.0%), neovascular glaucoma (22.5%), uveitic glaucoma (17.5%), primary open-angle glaucoma (15.0%), and other (10.0%). IOP decreased from a mean of 30.5 ± 8.7 to 14.5 ± 3.7 mmHg at the last follow-up visit (p < 0.001). Treatment was classified as qualified success in 18 eyes (45%), complete success in 15 (37.5%), and failure in seven (17.5%). Twenty-two eyes (55%) showed improvement in visual acuity. The most common postoperative complication was a transient hypertensive phase (five eyes, 12.5%). Tube-iris touch was associated with surgical failure (hazard ratio, 8.615; p = 0.008). CONCLUSIONS: Combined phacoemulsification and AGV implantation is an effective and safe surgical option for patients with refractory glaucoma and cataract. Postoperative tube-iris touch is an indicator of poor prognosis.
Cataract ; Diagnosis ; Follow-Up Studies ; Glaucoma Drainage Implants ; Glaucoma* ; Glaucoma, Angle-Closure ; Glaucoma, Neovascular ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Longitudinal Studies ; Phacoemulsification* ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Visual Acuity

Blepharoplasty is one of the most commonly performed aesthetic procedures. Surgical complications are rare, but can have severe consequences, such as permanent vision loss. In this report, we describe a patient who developed primary angle-closure glaucoma (ACG) with associated vision loss after a oculoplastic procedure using local anesthesia. So far, six similar cases have been described in the literature. It is believed that acute ACG is triggered by the surgical procedure in patients with predisposing risk factors such as a cataract. Surgical triggering factors include the use of buffered lidocaine/xylocaine with adrenaline/epinephrine, stress, and coverage of the eyes postoperatively. Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay. Acute ACG should therefore be excluded in each patient with postoperative complaints by assessing pupillary reactions. If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss.
Anesthesia, Local ; Blepharoplasty* ; Blindness ; Cataract ; Glaucoma ; Glaucoma, Angle-Closure* ; Humans ; Ophthalmology ; Postoperative Complications ; Pupil ; Referral and Consultation ; Risk Factors ; Surgeons

PURPOSE: To evaluate the influence of biometric variables on refractive outcomes after cataract surgery in angle-closure glaucoma (ACG) patients. METHODS: In this case-control study, 42 ACG patients, 40 open-angle glaucoma (OAG) patients, and 35 controls without glaucoma who had undergone conventional cataract surgery were enrolled consecutively. Electronic medical records, including preoperative biometric variables (keratometric diopter, axial length, anterior chamber depth, and lens thickness), the refractive change (RC), and the absolute value of refractive change (ARC) were reviewed. RESULTS: In the control and OAG patients, the anterior chamber depth was negatively correlated with the ARC (r = -0.344, p = 0.043 and r = -0.431, p = 0.006, respectively), whereas there was no correlation in the ACG patients. Lens thickness was positively correlated with the RC, but not with the ARC, in the control and OAG groups (r = 0.391, p = 0.020 and r = 0.501, p = 0.001, respectively). In contrast, lens thickness in the ACG group was not correlated with the RC but was positively correlated with the ARC (r = 0.331, p = 0.032). CONCLUSIONS: In contrast with the anterior chamber depth, preoperatively measured lens thickness may be a useful predictor of the direction of the RC after cataract surgery in control and OAG patients. However, in ACG patients, a thicker lens was correlated with a larger RC, regardless of the direction of the shift (hyperopic or myopic).
Aged ; Anterior Chamber/*diagnostic imaging ; Biometry/*methods ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/*complications/diagnosis/surgery ; Glaucoma, Open-Angle/*complications/diagnosis/surgery ; Humans ; *Intraocular Pressure ; Male ; Middle Aged ; *Phacoemulsification ; Refraction, Ocular/*physiology ; Retrospective Studies ; Tomography, Optical Coherence

PURPOSE: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. METHODS: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. RESULTS: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). CONCLUSIONS: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.
Acute Disease ; Adolescent ; Adult ; Animals ; Antivenins/therapeutic use ; *Elapidae ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/diagnosis/*etiology/therapy ; Humans ; Male ; Middle Aged ; Ophthalmoplegia/diagnosis/*etiology/therapy ; Prospective Studies ; Snake Bites/*complications/diagnosis/therapy ; Snake Venoms/*poisoning ; Tertiary Healthcare ; Time Factors ; Uveitis, Anterior/diagnosis/*etiology/therapy ; *Viperidae ; Young Adult

PURPOSE: In this study we evaluated the safety and efficacy of combined phacoemulsification and synechiolysis without aid of gonioprism lens and intraoperative intracameral tissue plasminogen activator (tPA) injection for angle-closure glaucoma. METHODS: The method used in this study was synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection following cataract surgery. RESULTS: A total of 20 patients with a mean age of 71.4 +/- 5.4 years were treated. Mean follow-up time was 31.3 +/- 24.3 months. Mean preoperative and last visit intraocular pressures (IOPs) were 21.70 +/- 9.50 mm Hg and 12.40 +/- 2.30 mm Hg, respectively (p < 0.0001). The mean number of glaucoma medications decreased from 2.40 to 0.30 (p < 0.0001). IOP was maintained below 16 mm Hg in all cases. No significant intraoperative and postoperative complications, hyphema, or fibrin reaction occurred. CONCLUSIONS: Combined phacoemulsification and peripheral anterior synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection is an effective and safe surgical procedure.
Cataract ; Fibrin ; Follow-Up Studies ; Glaucoma ; Glaucoma, Angle-Closure* ; Humans ; Hyphema ; Intraocular Pressure ; Phacoemulsification* ; Postoperative Complications ; Tissue Plasminogen Activator*

No abstract available.
Female ; Glaucoma, Angle-Closure/complications/surgery ; Humans ; Middle Aged ; Optic Neuropathy, Ischemic/complications/*diagnosis

No abstract available.
Female ; Glaucoma, Angle-Closure/complications/surgery ; Humans ; Middle Aged ; Optic Neuropathy, Ischemic/complications/*diagnosis

BACKGROUNDTrabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.

METHODSThis is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.

RESULTSAfter 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59 ± 7.94) vs. (24.85 ± 14.39) mmHg, P = 0.614), complete success rate (88% vs. 71%, P = 0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P = 0.094), and complications (41% (7/17) vs. 57% (8/14), P = 0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.

CONCLUSIONPhacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

Aged ; Cataract Extraction ; Female ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Phacoemulsification ; adverse effects ; methods ; Postoperative Complications ; etiology ; Trabeculectomy ; adverse effects ; methods ; Visual Acuity

PURPOSE: To compare the accuracy of intraocular lens (IOL) power calculation formulas in eyes with primary angle closure glaucoma (ACG). METHODS: This retrospective study compared the refractive outcomes of 63 eyes with primary ACG with the results of 93 eyes with normal open angles undergoing uneventful cataract surgery. Anterior segment biometry including anterior chamber depth, axial length, and anterior chamber depth to axial length ratio were compared by the IOL Master. Third generation formulas (Hoffer Q and SRK/T) and a fourth generation formula (Haigis) were used to predict IOL powers in both groups. The predictive accuracy of the formulas was analyzed by comparison of the mean error and the mean absolute error (MAE). RESULTS: In ACG patients, anterior chamber depth and the anterior chamber depth to axial length ratio were smaller than normal controls (all p < 0.05). The MAEs from the ACG group were larger than that from the control group in the Haigis formula. The mean absolute error from the Haigis formula was the largest and the mean absolute error from the Hoffer Q formula was the smallest. CONCLUSIONS: IOL power prediction may be inaccurate in ACG patients. The Haigis formula produced more inaccurate results in ACG patients, and it is more appropriate to use the Hoffer Q formula to predict IOL powers in eyes with primary ACG.
Aged ; Biometry ; Cataract Extraction ; Glaucoma, Angle-Closure/*complications ; Glaucoma, Open-Angle/complications ; Humans ; *Lens Implantation, Intraocular ; *Lenses, Intraocular ; Middle Aged ; *Optics and Photonics ; Reproducibility of Results ; Retrospective Studies

PURPOSE: To evaluate the intraoperative and postoperative complications and outcomes of phacoemulsification of cataract in eyes with prior iriodotomy for acute angle closure glaucoma. METHODS: This retrospective case-control study included 30 eyes which underwent phacoemulsification. All 30 eyes had prior acute angle closure treated by laser iridotomy (ACG group). A second group that had phacoemusification for cataract only served as control (Control group). RESULTS: The ACG group showed significantly shallow anterior chamber (1.56+/-0.18 mm) and short axial length (22.32+/-0.60 mm). At 2 months after surgery, visual acuity was improved in both groups and IOP was significantly decreased in the ACG group. Posterior synechiae, small pupil and zonulysis were more commonly found in the ACG group than the control group. Intraoperative iris trauma and postoperative persistent mydriasis were also more common in the ACG group. CONCLUSIONS: During cataract surgery in eyes with prior iriodotomy for acute angle closure glaucoma, there are many preoperative risk factors such as shallow anterior chamber, zonulysis, and small pupil. These increase the risk of posterior capsule rupture and bullous keratopathy. To reduce the complications and improve the visual acuity, a careful preoperative examination and proper intra- and post-operative management by skillful surgeons are needed.
Anterior Chamber ; Case-Control Studies ; Cataract ; Eye ; Glaucoma, Angle-Closure ; Growth Hormone ; Iris ; Miosis ; Mydriasis ; Peptide Fragments ; Phacoemulsification ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Rupture ; Visual Acuity