Ilgaz Sagdic Yalvac

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma Three-year prospective randomized clinical trial

Purpose: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open‐angle glaucoma (POAG). Setting: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. Methods: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. Results: At 3 years, the mean IOP was 16.0 mm Hg ± 7.07 (SD) in the trabeculectomy group and 17.8 ± 4.6 mm Hg in the viscocanalostomy group (P = .694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mm Hg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P = .002). Conclusions: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.

Long-term results of Ahmed glaucoma valve and Molteno implant in neovascular glaucoma

AimsTo evaluate the surgical success results of Ahmed glaucoma valve (AGV) and Molteno single-plate implant (MSPI) in cases of neovascular glaucoma (NVG).MethodsBetween May 1997 and May 2002, 38 of 38 NVG patients that underwent implantation of AGV and 27 eyes of 27 NVG patients that underwent MSPI (a total 65 eyes of 65 patients) included to the study.ResultsThe cumulative probabilities of success were 63.2% at 1 year, 56.2% at 2 years, 43.2% at 3 years, 37.8% at 4 years, and 25.2% at 5 years in AGV group whereas the cumulative probabilities of success were 37.0% at 1 year, 29.6% at 2 years, 29.6% at 3 years, 29.6% at 4 years, and 29.6% at 5 years in MSPI group (P=0.141). Preoperative visual acuity <2/200 (P=0.003), diagnosis of diabetes mellitius (P=0.050), and preoperative IOP≥35 mmHg (P=0.038) were found to be poor prognostic factors for surgical success.ConclusionsBoth AGV and single plate MSPI were successful for early and intermediate-term of IOP control but in long term both implants were failed to achieve control of IOP in patients with NVG.

Conjunctival impression cytology and tear-film changes in patients with psoriasis.

PURPOSE In this study, we evaluated ocular-surface changes and tear-film functions in patients with plaque-type psoriasis. METHODS This study was performed on two groups. Group I included 100 eyes of 50 subjects with chronic plaque-type psoriasis whose diagnoses were confirmed with skin biopsy. Group II included 100 eyes of 50 healthy volunteers who were in the same age and sex distribution. Ocular-surface changes were evaluated on the cell content of the surface conjunctival epithelium by conjunctival impression cytology and tear-film functions by the Schirmer I test and break-up time (BUT). RESULTS Of the patients with psoriasis, 50% had a grade 0, 30% had a grade I, and 20% had a grade II conjunctival impression cytology differentiation compared with 95, 3, and 2%, respectively in the control group (p < 0.001). Snake-like appearance of nuclear chromatin in conjunctival epithelial cells was demonstrated in 12% of eyes in group I but in 2% of eyes in group II. The Schirmers test results showed that average values were 10.1 +/- 5.8 mm in group I and 12.6 +/- 5.5 mm in group II (p > 0.001). The mean break-up time was 7.8 +/- 3.7 s in group I and 12.5 +/- 4.6 s in group II (p < 0.001). CONCLUSIONS We showed the early conjunctival changes in patients with psoriasis. According to these results, primary etiologic factors may contribute to ocular lesions in psoriasis.

Trabeculectomy with mitomycin-C in uveitic glaucoma associated with Behcet disease

Purpose:To determine the effect of intraoperative application of Mitomycin-C (MMC) with trabeculectomy in uveitic glaucoma associated with Behçet disease. Materials and Methods:Twenty-six eyes of 26 patients with uveitic glaucoma associated with Behçet disease who underwent trabeculectomy with MMC between 1996 and 2001 were reviewed in this retrospective, noncomparative study. Trabeculectomy + MMC in concentration of 0.4 mg/mL for 3 minutes was performed to all patients. Main outcome measures were control of IOP, the number of antiglaucoma medications required to achieve the desired IOP, visual acuity and complications. The surgical success was defined as IOP less than 22 mm Hg and greater than 5 mm Hg without additional further glaucoma surgery or loss of light perception. Results:The cumulative probability of success was 83.3% at 1 year, 76.2% at 2 years, 70% at 3 years, 66.7% at 4 years and 62.5% at 5 years after surgery. The mean follow-up was 40.0±18.0 months. At last follow-up 23% of the patients required no antiglaucoma medications. Best-corrected visual acuity improved or remained within two lines of preoperative visual acuity in 19 eyes (73.1%). Glaucomatous (1 eye 3.8%) and nonglaucomatous optic atrophy (3 eyes 11.5%) was the most frequent reason for visual decrease (total 4 eyes 15.2%). The most common complications were cataract formation in 6 eyes (23.1%), bleb leakage in 4 eyes (15.3%) and choroidal effusion in 3 eyes (11.5%). Phthisis bulbi was found in one (3.8%) patient. Conclusion:Trabeculectomy and intraoperative application of MMC appears to provide long term safety and effectiveness in uveitic glaucoma associated with Behçet disease.

A comparative study between diode laser cyclophotocoagulation and the Ahmed glaucoma valve implant in neovascular glaucoma: a long-term follow-up.

BackgroundTo compare the efficacy, safety, and long-term results of intraocular pressure (IOP) reduction by diode laser contact cyclophotocoagulation (DCPC) and Ahmed glaucoma valve (AGV) implant in cases of neovascular glaucoma. MethodsA total of 66 eyes of 66 patients with neovascular glaucoma were prospectively assigned to either DCPC or AGV implantation. All patients underwent a baseline complete ophthalmologic examination and IOP measurement by Goldmann applanation tonometry before and after 1,3, 6, 12, and 24 months follow-up. Complications and the number of medications were recorded. ResultsMean age of the patients was 60.0±11.7 years (range: 20 to 85) in the DCPC group and 57.2±10.3 years (range: 20 to 85) in the AGV group. The preoperative IOP was 43.4±11.9 mm Hg and 43.3±7.4 mm Hg for the DCPC and AGV group, respectively (P>0.05). The postoperative IOP was 16.5±11.3 mm Hg and 22.09±7.6 mm Hg for the DCPC and AGV groups, respectively (P>0.05) at the last visit. Kaplan-Meier survival analysis showed a probability of success at 24 months of 61.18% and 59.26% for the DCPC and AGV groups (P>0.05). All the patients had a visual acuity of hand movement or worse preoperatively. Visual acuity decreased in 6 eyes (24%) in the DCPC group and 9 eyes (27%) in AGV group. Complications included anterior segment inflammation in 5 eyes (20%), neurotrophic keratitis in 2 eyes (8%), and hypotony in 3 eyes (15%) in the DCPC group and hyphema in 5 eyes (15%) and tube occlusion in 3 eyes (9%) in AGV group. ConclusionsThere was no significant difference in the success rate between the DCPC and AGV implantation in neovascular glaucoma treatment. However, DCPC is less time consuming and easier method for lowering IOP in patients with neovascular glaucoma.

Management of glaucoma in patients with nanophthalmos

AimsIn this retrospective study, we aimed to evaluate the results of glaucoma surgery in patients with nanophthalmos.MethodsTwenty-eight bilateral nanophthalmic patients, of whom 20 patients underwent trabeculectomy+Mitomycin-C (MMC)+inferior sclerotomy between 1996 and 2004, were included in this study. Records of patients with nanophthalmos were reviewed. Intraocular pressure (IOP), glaucoma medications, surgical success, visual acuity and complications were analyzed.ResultsThe mean IOP was 34.6±5.3 mm Hg preoperatively. At the final follow-up visit, the mean IOP dropped to 21.41±7.34 mm Hg (P<0.05). The cumulative probability of success was 85% at 1 year, 78.5% at 2 years, 76.9% at 3 years, 70.6% at 4 years and 47% at 5 years after surgery. Visual acuity decreased in 13 (65%) patients but no eye lost vision. Sequels of choroidal detachment (five patients 25%) and retinal folds (four patients 20%) were the most frequent reason for visual decrease. Uveal effusion (10 patients 50%) and cataract formation (seven patients 35%) were major late postoperative complications.ConclusionsResults indicate that trabeculectomy+MMC+inferior sclerotomy procedure was effective and safe for glaucoma control in patients with nanophthalmos, but uveal effusion is a major problem and cataract surgery is expected in the long run.

Success of trabeculotomy in patients with congenital glaucoma operated on within 3 months of birth.

AimsTo determine the efficacy and safety of trabeculotomy in congenital glaucoma patients operated on within first 3 months of birth.MethodsA total of 36 eyes of 24 patients with congenital glaucoma, who underwent primary trabeculotomy within first 3 months of birth were included. Preoperative and postoperative intraocular pressures (IOP), corneal clarity, diameter, axial length, success rates, and complications were evaluated in this study.ResultsThe mean follow-up was 38.38±11.77 months (range 12–48 months). Mean IOP was 33.16±7.28 mmHg (range 23–50 mmHg) preoperatively. At the final follow-up visit, the mean IOP was 21.41±7.34 mmHg (range 8–38 mmHg). Pre-and postoperative IOP differences were statistically significant at all examination periods (P<0.001). A12-, 24-, and 36-month success rates were 92, 82, and 74%, respectively. Survival analysis regarding to gender, preoperative corneal diameter and consaguinity were not statistically significant. Only preoperative axial length was a statistically significant parameter (P=0.024) for success. Postoperatively normal corneal clarity was achieved in 29 eyes (80.5%). The main complications were shallow anterior chamber in one (4.2%) eye and detachment of Descements membrane in two (8.4%) eyes.ConclusionsPrimary trabeculotomy is a safe and effective procedure for congenital glaucoma patients when operated within 3 months of birth. It has a favourable IOP control and a low rate of complications in three year period.

Assessment of anterior chamber angle using Visante OCT, slit-lamp OCT, and Pentacam.

Purpose. To assess and compare the anterior chamber angle (ACA) by different anterior segment imaging techniques. Methods. Forty healthy eyes of 40 normal subjects were recruited and 3 consecutive measurements of ACA were determined prospectively utilizing Visante optical coherence tomography (OCT), slit-lamp OCT (SL-OCT), and Pentacam. Statistical significance of interdevice differences between measurements was evaluated by Wilcoxon signed rank test and Bland-Altman analysis. The repeatability of 3 consecutive measurements was analyzed by repeated measured analysis of variance. Results. Mean nasal and temporal ACA were detected as 31.2±8.7 and 32.1±8.5 degrees by Visante OCT; 41.6±5.9 and 41.8±5.2 degrees by Pentacam; and 42.9±10.0 and 43.3±10.1 degrees by SL-OCT. All devices displayed a high intrasession repeatability (Scheffe multiple comparison, p>0.05). ACA detected by Visante OCT were found significantly different from ACA calculated by Pentacam and SL-OCT (p<0.05). On the other hand, ACA data obtained by Pentacam and SL-OCT were found to be statistically similar (p>0.05). Conclusions. Although noncontact ACA measurements using all modalities were easy to handle and demonstrated good repeatability in healthy participants, the tested devices were not regarded as comparable. Hence, the clinician should take the different modalities into consideration during ACA assessment using various devices.

Clinical and demographic evaluation of Behçet disease among different paediatric age groups

Aim: The aim of the study is to describe the demographic and clinical features of Behçet disease (BD) in paediatric patients. Methods: The study included 62 patients who presented to the Department of Ophthalmology at Ankara Education and Research Hospital, Ankara, Turkey and diagnosed as having BD. These patients were placed into three age groups based on the age at the time of BD presentation: group 1, birth to 10 years old; group 2, 11–15 years old; group 3, 16–20 years old. Among these three age groups, the objective was to identify the ocular and extraocular clinical findings and complications of BD, and to uncover the role of gender, if exists, in the aetiology of the disease. Results: The findings indicated that gender played no significant role in the aetiology of BD. In group 1, a family history of BD was more prevalent, and the most common ocular finding was bilateral anterior uveitis. The most frequent form of ocular involvement in groups 2 and 3 was bilateral panuveitis with retinal vasculitis and retinitis. The majority of disease complications were glaucoma, maculopathy and cataract formation. Conclusion: Patient age appeared to define the type of ocular involvement in BD. While anterior uveitis was the most frequent ocular finding in BD patients younger than 10 years, panuveitis was the most frequent in patients older than 10 years. As a family history of BD was more frequent among patients younger than 10 years, family screening for BD is considered critical for early and accurate diagnosis of BD, as well as for the control of its complications.

Hemorrhagic descemet’s membrane detachment after viscocanalostomy

We report a case of hemorrhagic detachment of Descemets membrane after viscocanalostomy. A 60-year-old man with pseudoexfoliative glaucoma had an uneventful viscocanalostomy in the right eye. On the first postoperative day, a 5.0 mm x 5.0 mm Descemets membrane detachment was present in the superior nasal quadrant. The space between Descemets membrane and the stroma was filled with a hemorrhage. The hemorrhage resorbed by 6 months postoperatively, and Descemets membrane completely reattached without surgical manipulation. The final visual acuity dropped from 20/40 to 20/100, final intraocular pressure was 20 mm Hg with 1 medication, and a paracentral fibrinoid scar persisted 18 months after surgery. Hemorrhagic detachment of Descemets membrane can cause visual acuity deterioration and should be recognized as a rare complication of viscocanalostomy.