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Glaucoma
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Zhi Da Soh, Victor Koh, Ching-Yu Cheng
In clinic, glaucoma is classified according to the configuration of the anterior-chamber angle, and the presence of an identifiable cause (Figure 11.1).4 Glaucoma is classified as open angle in cases where the anterior-chamber angle space is unobstructed, and aqueous humor can flow freely into the trabecular meshwork. In contrast, angle closure is diagnosed when there is a physical impediment to aqueous outflow (e.g., irido-trabecular contact). In open-angle glaucoma, raised IOP is commonly attributed to outflow resistance from within the trabecular meshwork itself. Primary glaucoma is used to describe cases with no discernible cause, and vice versa for secondary. Secondary glaucoma often results as a sequela to neovascularization, uveitis, trauma, or lens-related complications.4 Angle closure is further classified into primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG) (Table 11.1).
Medical and Mathematical Background
Published in Arwa Ahmed Gasm Elseid, Alnazier Osman Mohammed Hamza, Computer-Aided Glaucoma Diagnosis System, 2020
Arwa Ahmed Gasm Elseid, Alnazier Osman Mohammed Hamza
Glaucoma is a collection of optic neuropathies. It is a chronic disease that has various types, the most common of which is open-angle glaucoma. It is differentiated from ACG by the appearance of the iridocorneal angle. In the OAG, the iridocorneal angle is open and has a normal form. On the other hand, the iridocorneal angle is closed in ACG. Glaucoma is further divided into primary and secondary. Primary glaucoma is characterized by the absence of additional ocular/systemic impairments. Regardless of the common features between primary and secondary glaucoma, however, secondary glaucoma might proceed differently. In addition, secondary glaucoma is accompanied by ocular/systemic diseases which could lead to the initiation of glaucoma.
Surgical removal of subretinal hemorrhage
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Postoperatively, vitreous hemorrhage and even hyphema may occur from continued drainage of the submacular space or conceivably from an effect of the residual rtPA within the eye, although this is conjectural. Depending upon the severity of the rebleed, observation, outpatient gas–fluid exchange, or repeat vitrectomy are options. Secondary glaucoma may accompany the postoperative rebleed and should be treated appropriately. Secondary retinal breaks and retinal detachment should be diagnosed and treated immediately, as should proliferative changes inducing traction upon the retinotomy site.
Ophthalmic Complications in Pediatric Uveitis
Published in Ocular Immunology and Inflammation, 2021
Natasha Gautam Seth, Savleen Kaur, Sonam Yangzes, Deepak Jugran, Reema Bansal, Vishali Gupta, Mangat Ram Dogra, Deepti Suri, Surjit Singh, Ramandeep Singh
The new finding from our study was the raised intraocular pressure occurring more commonly at follow-up than at baseline. The rise in IOP could be due to disease per se or to the treatment. We know that persistent steroid-induced ocular hypertension over time can lead to irreversible disc damage and glaucoma. Due to the chronicity of our cases; the low frequency of topical steroids given as a maintenance therapy might have been responsible for the raised intraocular pressure in these cases. Although we couldn’t differentiate secondary glaucoma into ocular hypertension and glaucoma at the presentation in our study, still the high numbers of raised intraocular pressures in these patients are a cause of concern. A high percentage of these patients with raised intraocular pressure needed surgery to control the IOP (58%). Hence, it is not only that raised intraocular pressure occurred more in these patients, but most children required surgical intervention for IOP control. Kanski et al18 reported that one-third of the glaucomatous eyes in JIA ended with no light perception, attributing it to low success rate of glaucoma surgery which was also seen by De Boer et al.12 The cumulative probability of survival (control with IOP limit of 21 mmHg) was 86.6% at 5 years using Kaplan- Meier survival analysis in patients who had pediatric uveitic glaucoma in a previous study by our department.19 We found favorable outcomes in patients with secondary glaucoma if managed appropriately and aggressively.
Intravitreal Ziv-Aflibercept : Safety Analysis in Eyes Receiving More Than Ten Intravitreal Injections
Published in Seminars in Ophthalmology, 2020
Sumit Randhir Singh, Goura Chattannavar, Apoorva Ayachit, Miguel Cruz Pimentel, Alex Alfaro, Sarvesh Tiwari, Abhishek Heranjal, Anand Subramanyam, Imoro Zeba Braimah, Abhinav Dhami, Parineeta Sachdev, Ahmad Mansour, Jay Chhablani
A patient with n-AMD and no known systemic illness developed acute endophthalmitis 2 weeks after the 6th intravitreal injection. Vitreous biopsy along with intravitreal antibiotics injection was performed. Culture failed to show any growth. Pars plana vitrectomy and lensectomy were performed subsequently in view of the dense vitreous opacities and cataract respectively. Patient developed secondary glaucoma during the follow up which was treated with topical anti glaucoma medications initially. Later on, he underwent secondary intraocular lens (IOL) implantation and a tube shunt procedure in view of uncontrolled IOP. BCVA at baseline was 0.3 logMAR(20/40) and declined on followup to 0.78 logMAR (20/120). The patient received additional 8 IVZ injections during subsequent follows up visits with no adverse effects.
Needling with 5-fluorouracil for encapsulated blebs after Ahmed glaucoma valve implantation
Published in Cutaneous and Ocular Toxicology, 2019
Burak Erdem, Serhat Imamoglu, Nimet Yesim Ercalik
The success rates of bleb needling after a trabeculectomy operation were found to be between 49% and 96%, depending on different criteria in classification and differences in follow-up times25. Number of previous operations, ethnicity, etiology of glaucoma, and surgical techniques are the main factors affecting the success of the bleb needling procedure performed after trabeculectomy surgery25,26. To our knowledge, there are limited data in the literature evaluating bleb needling effectiveness for EBs after GDDs implantation. In this regard, Quaranta et al.13 found that 5-FU needling improved aqueous outflow in the IOP control after AGV implantation in cases with primary open-angle glaucoma (POAG). The success rates were 75% and 72.2% at postoperative 1 and 2 years, respectively13. Our 1-year success rate is consistent with Quaranta et al.’s13 study, although our 2nd year success rate was lower. This might be due to poorer prognosis of the secondary glaucoma cases than primary glaucoma cases13. High aqueous levels of proinflammatory cytokines and increased IOP values were determined in eyes complicated with EBs22. Our study consisted of secondary glaucoma cases which were more prone to developing an inflammatory response over time. We assumed that the use of 5-FU in our study might have prevented excess fibroblast proliferation and reduced the likelihood of developing recurrent EBs in these cases. In addition, the male gender is defined as a risk factor in the Quaranta et al.13 study. In our study, there was no significant difference regarding gender distribution (p = 0.452).