Purpose: The aim of this study was to report the incidence of presumed steroid response in contralateral eye of patients who underwent glaucoma filtration surgery. Methods: We reviewed records of 298 ...glaucoma patients (147 PACG primary angle-closure glaucoma, 129 POAG primary open-angle glaucoma, and 22 JOAG juvenile open-angle glaucoma) who underwent either trabeculectomy alone or trabeculectomy with cataract extraction. All patients received prednisolone acetate 1% eye drop postoperatively in the operated eye for up to 6 to 8 weeks. The contralateral eye received the same antiglaucoma medications as before. Information collected included age, sex, number of antiglaucoma medications in the fellow eye preoperatively, and VFI (visual field index). The preoperative intraocular pressure (IOP) in the contralateral eye was taken as the baseline. The maximum IOP recorded postoperatively up to a follow-up period of 6 to 8 weeks was noted. A steroid response was defined as rise in the IOP by ≥6 mmHg. Results: In this study, 298 eyes of 298 glaucoma patients were included. The mean age of patients was 60.1 ± 13.7 years. The mean number of antiglaucoma medications in the fellow eye pre-operatively was 2.4 ± 1.2. Mean preoperative and postoperative IOP in the fellow eye were 17.46 ± 7 and 19.37 ± 7.1 mmHg, respectively. Sixty-three eyes out of 298 eyes (21.14%) showed a rise in IOP by 6 mmHg. The maximum IOP difference noted was 15 mmHg. The average time interval to the defined steroid response was 16.13 days. The majority showed a steroid response within 19 days. Conclusion: Steroid response is a significant factor leading to elevated IOP postoperatively in the contralateral eye as well.
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Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published ...data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020.
In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014. We identified population-based studies published before July 8, 2014, by searching online databases with no language restrictions (MEDLINE from Jan 1, 1946, and Embase from Jan 1, 1974, and the WHO Library Database). We fitted a series of regression models to estimate the proportion of moderate or severe vision impairment (defined as presenting visual acuity of <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity of <3/60 in the better eye) by cause, age, region, and year.
We identified 288 studies of 3 983 541 participants contributing data from 98 countries. Among the global population with moderate or severe vision impairment in 2015 (216·6 million 80% uncertainty interval 98·5 million to 359·1 million), the leading causes were uncorrected refractive error (116·3 million 49·4 million to 202·1 million), cataract (52·6 million 18·2 million to 109·6 million), age-related macular degeneration (8·4 million 0·9 million to 29·5 million), glaucoma (4·0 million 0·6 million to 13·3 million), and diabetic retinopathy (2·6 million 0·2 million to 9·9 million). Among the global population who were blind in 2015 (36·0 million 12·9 million to 65·4 million), the leading causes were cataract (12·6 million 3·4 million to 28·7 million), uncorrected refractive error (7·4 million 2·4 million to 14·8 million), and glaucoma (2·9 million 0·4 million to 9·9 million). By 2020, among the global population with moderate or severe vision impairment (237·1 million 101·5 million to 399·0 million), the number of people affected by uncorrected refractive error is anticipated to rise to 127·7 million (51·0 million to 225·3 million), by cataract to 57·1 million (17·9 million to 124·1 million), by age-related macular degeneration to 8·8 million (0·8 million to 32·1 million), by glaucoma to 4·5 million (0·5 million to 15·4 million), and by diabetic retinopathy to 3·2 million (0·2 million to 12·9 million). By 2020, among the global population who are blind (38·5 million 13·2 million to 70·9 million), the number of patients blind because of cataract is anticipated to rise to 13·4 million (3·3 million to 31·6 million), because of uncorrected refractive error to 8·0 million (2·5 million to 16·3 million), and because of glaucoma to 3·2 million (0·4 million to 11·0 million). Cataract and uncorrected refractive error combined contributed to 55% of blindness and 77% of vision impairment in adults aged 50 years and older in 2015. World regions varied markedly in the causes of blindness and vision impairment in this age group, with a low prevalence of cataract (<22% for blindness and 14·1–15·9% for vision impairment) and a high prevalence of age-related macular degeneration (>14% of blindness) as causes in the high-income subregions. Blindness and vision impairment at all ages in 2015 due to diabetic retinopathy (odds ratio 2·52 1·48–3·73) and cataract (1·21 1·17–1·25) were more common among women than among men, whereas blindness and vision impairment due to glaucoma (0·71 0·57–0·86) and corneal opacity (0·54 0·43–0·66) were more common among men than among women, with no sex difference related to age-related macular degeneration (0·91 0·70–1·14).
The number of people affected by the common causes of vision loss has increased substantially as the population increases and ages. Preventable vision loss due to cataract (reversible with surgery) and refractive error (reversible with spectacle correction) continue to cause most cases of blindness and moderate or severe vision impairment in adults aged 50 years and older. A large scale-up of eye care provision to cope with the increasing numbers is needed to address avoidable vision loss.
Brien Holden Vision Institute.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose: To evaluate the incidence of shallow anterior chamber in the early postoperative period following Ahmed glaucoma valve (AGV) implantation and its effect on the hypertensive phase (HP), ...intermediate-term intraocular pressure (IOP) control, and success rate. Methods: A retrospective analysis of 369 eyes of 360 patients who underwent AGV implantation between January 2005 and January 2020 with a minimum follow-up of 2 months was performed. Twenty-six patients developed shallow anterior chamber (AC) within 8 weeks following surgery (cases). They were compared with 39 randomly selected controls (no shallow AC post AGV). HP (IOP spike >21 mmHg), use of ocular hypotensive medications, and other associations were compared. Results: Incidence of shallow AC post AGV was 7% (95% confidence interval CI 4, 9). The onset of shallow AC was 3 ± 2.1 days and resolved within 6 ± 4.7 days. Hypotony (12 47% vs. 1 2.5%, P 0.0001) and choroidal detachment (CD; 7 27% vs. 3 8%, P 0.03) were more common in cases compared to controls. The HP occurred in 11 (43%) cases versus 13 (34%) controls (P 0.4). Cases required more ocular hypotensive medications than controls at the end of 8 weeks (1.1 ± 1 vs. 0.5 ± 0.5, P 0.01). There was no significant difference in the qualified success between the groups at 1 year. Conclusion: The development of postoperative shallow AC post AGV implantation was not detrimental to IOP control at 1 year. However, there is a need to monitor the occurrence of HP in these eyes.
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Global and regional prevalence estimates for blindness and vision impairment are important for the development of public health policies. We aimed to provide global estimates, trends, and projections ...of global blindness and vision impairment.
We did a systematic review and meta-analysis of population-based datasets relevant to global vision impairment and blindness that were published between 1980 and 2015. We fitted hierarchical models to estimate the prevalence (by age, country, and sex), in 2015, of mild visual impairment (presenting visual acuity worse than 6/12 to 6/18 inclusive), moderate to severe visual impairment (presenting visual acuity worse than 6/18 to 3/60 inclusive), blindness (presenting visual acuity worse than 3/60), and functional presbyopia (defined as presenting near vision worse than N6 or N8 at 40 cm when best-corrected distance visual acuity was better than 6/12).
Globally, of the 7·33 billion people alive in 2015, an estimated 36·0 million (80% uncertainty interval UI 12·9–65·4) were blind (crude prevalence 0·48%; 80% UI 0·17–0·87; 56% female), 216·6 million (80% UI 98·5–359·1) people had moderate to severe visual impairment (2·95%, 80% UI 1·34–4·89; 55% female), and 188·5 million (80% UI 64·5–350·2) had mild visual impairment (2·57%, 80% UI 0·88–4·77; 54% female). Functional presbyopia affected an estimated 1094·7 million (80% UI 581·1–1686·5) people aged 35 years and older, with 666·7 million (80% UI 364·9–997·6) being aged 50 years or older. The estimated number of blind people increased by 17·6%, from 30·6 million (80% UI 9·9–57·3) in 1990 to 36·0 million (80% UI 12·9–65·4) in 2015. This change was attributable to three factors, namely an increase because of population growth (38·4%), population ageing after accounting for population growth (34·6%), and reduction in age-specific prevalence (−36·7%). The number of people with moderate and severe visual impairment also increased, from 159·9 million (80% UI 68·3–270·0) in 1990 to 216·6 million (80% UI 98·5–359·1) in 2015.
There is an ongoing reduction in the age-standardised prevalence of blindness and visual impairment, yet the growth and ageing of the world's population is causing a substantial increase in number of people affected. These observations, plus a very large contribution from uncorrected presbyopia, highlight the need to scale up vision impairment alleviation efforts at all levels.
Brien Holden Vision Institute.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose: Idiopathic elevated episcleral venous pressure (IEEVP) is a rare cause of secondary glaucoma and is a diagnosis of exclusion. The aim of this study was to describe the clinical presentation ...and analyze the outcomes of medical and surgical management in eyes diagnosed with idiopathic elevated episcleral venous pressure. Methods: A retrospective analysis of eyes diagnosed with IEEVP over a 5-year period between April 2012 and March 2016 was performed. The demographic details, medical history, and clinical course of the cases were obtained from the medical records. Data pertaining to the severity of glaucomatous damage, response to medical management, need for surgical intervention, and their outcomes were analyzed. Results: Fifteen eyes of 13 patients were included. Thirteen eyes (86.6%) had open angle configuration. Among the 13 eyes that had glaucoma, eight eyes (61.5%) had severe glaucoma, four eyes (30.7%) had moderate glaucoma, and one eye (7.6%) had mild glaucoma. The median follow-up was 210 days. Seven of the 15 eyes (46.6%) required a glaucoma filtration procedure, and three underwent prophylactic sclerotomies. 71.4% of these eyes had complete success. One out of the seven operated eyes required choroidal drainage post-operatively. Conclusion: IEEVP is an extremely rare condition and presents with raised intra-ocular pressure and tortuous episcleral vessels. The management of IEEVP is similar to that of primary open angle glaucoma. Uveal effusion is to be anticipated, and hence, combining trabeculectomy with prophylactic sclerotomies is advisable.
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To report the risk of cataract progression among primary angle closure suspects (PACS) 6 years after they underwent laser peripheral iridotomy (LPI).
In the Chennai Eye Disease Incidence Study, 6 ...years after their baseline evaluation, 4421 subjects were examined again. As part of a detailed evaluation cataract was graded using the Lens Opacities Classification System II; progression was defined as change of cataract by two or more grades or history of cataract surgery in the 6-year period. Only bilaterally phakic subjects with less than N2 or C2 or P2 cataract at baseline with no history of any form of glaucoma, primary angle closure and pseudoexfoliation were included.
There were 3205 eligible subjects. Of these, 190 had undergone LPI for PACS. In comparison to the study population, they were significantly older (p<0.001), female (p=0.008), urban residents (p=0.001) and patients with hypertension (p<0.001). During the intervening period, 53 subjects had undergone cataract surgery. The cataract progression rate was significantly greater (OR 1.7, 95% CI 1.3 to 2.4, p<0.001) in those who had undergone LPI. For the study population the baseline risk factors for progression of cataract were age (p<0.001), female gender (p=0.01), diabetes (p<0.001) and LPI (p<0.001). Diabetes and female gender were significant risk factors for nuclear and cortical cataract progression; LPI was a risk factor only for cortical cataract (OR 1.6, 95% CI 1.1 to 2.3, p=0.007).
There was significant cataract progression in 6 years following LPI for PACS.
Angle closure disease was present in 59.3% of eyes with long anterior zonules (LAZ). The cause is multifactorial including a thick anteriorly positioned crystalline lens, shorter axial length, and ...increased lens thickness to axial length factor.
To study the profile of eyes with LAZ presenting in a glaucoma clinic in a tertiary eye care centre and understand the pathogenesis of angle closure disease in these eyes.
This was a retrospective cross-sectional study.All patients with LAZ seen from January 2014 to December 2018 were included. Demographic and clinical characteristics were noted. LAZ eyes (177 eyes of 177 patients) were compared with an equal number of age and sex-matched controls. LAZ was defined as radially oriented zonular fibers (both pigmented and nonpigmented), extending central to the normal zonular termination zone on the anterior lens surface >1 mm beyond their usual insertion of 1.42±0.24 mm from the lens equator onto the mid peripheral zone or central to it, as seen on slit-lamp examination, following pupillary dilation by a single examiner. Glaucoma was defined according to the International Society for Geographical and Epidemiological Ophthalmology classification. The following biometric parameters were compared: anterior chamber depth (ACD), axial length (AXL), lens thickness (LT), lens position (LP=ACD+0.5×LT), relative lens position (RLP=LP/AXL); lens thickness to axial length factor (LAF=(LT/AXL)×10). LAZ eyes without angle closure disease were also compared with controls.
Mean age of patients with LAZ was 64.8±8.1 years. Of these, 63.3% were females. Angle closure disease was present in 59.3% (105/177) patients. Majority of these eyes were primary angle closure suspects (PACS) (53.3%, n=56). Significant differences were found between LAZ eyes and controls for LT (4.8±0.38 mm vs. 4.49±0.40 mm, P<0.0001), ACD (2.68±0.39 mm vs. 3.0±0.32 mm, P<0.0001), AXL (22.37±0.79 mm vs. 22.94±1.1, P<0.0001), LAF (2.14±0.19 vs. 1.96±0.21, P<0.0001), and LP (5.07±0.37 vs. 5.3±0.25, P<0.0001).
Angle closure was present in more than half the eyes with LAZ. Majority of these eyes were PACS or had primary angle closure. LAZ eyes had a thicker lens, shallow AC, a shorter axial length and an increased LAF as compared with age and sex matched normal controls. The presence of LAZ may be an indicator of increased risk for angle closure.
Purpose: Comparison of the conjunctiva related complication rates and success rates among eyes with Ahmed glaucoma valve (AGV) implantation in which eye bank derived scleral and corneal patch grafts ...had been used to cover the tube. Methods: Retrospective comparative study. Patients who underwent AGV implantation between January 2000 to December 2016 were included. Demographic, clinical data, intra and post operative data was obtained from electronic medical records. Conjunctiva related complications were divided into two groups: with and without implant exposure. Conjunctiva related complication rates, success rate, risk factors among eyes with corneal and scleral patch graft were compared. Results: Three hundred and twenty three eyes of 316 patients underwent AGV implantation. Scleral patch graft was used in 214 eyes of 210 patients (65.9%) and corneal patch graft was used in 109 eyes of 107 patients (34%). Median follow up was 14 months. There was no significant difference in the conjunctiva related complication rate (7.3 % in corneal patch graft versus 7.0% in scleral patch graft;p=0.5) and conjunctival dehiscence rate (3.7% versus 4.6%, P = 0.7) among the two groups. Success rate was significantly higher in the corneal patch graft group versus the scleral patch graft group (98% versus 72%; p=0.001). Eyes with corneal patch graft had a higher survival rate (P = 0.01). Conclusion: There was no significant difference in the rate of conjunctiva related complications following corneal and scleral patch grafts used to cover the AGV tube. Eyes with corneal patch graft had a higher success rate and survival rate.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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