Development Of Secondary Glaucoma Research Articles

Long-term surgical outcomes of pediatric cataract—multivariate analysis of prognostic factors

We assessed the 10-year postoperative outcomes of pediatric cataract patients who underwent surgery at the age of 6 years or younger. A retrospective review of medical charts was conducted for 457 eyes of 277 patients, with the age at surgery averaging 1.3 ± 1.5 years (mean ± SD) and the follow-up duration averaging 12.8 ± 2.4 years (ranging from 10 to 17 years). The cohort included 250 eyes of 125 cases with bilateral aphakia (age at surgery 0.5 ± 0.8 years), 110 eyes of 55 cases with bilateral pseudophakia (1.9 ± 1.6 years), 42 cases with unilateral aphakia (1.1 ± 1.3 years), and 55 cases with unilateral pseudophakia (2.6 ± 1.7). A forward stepwise multiple regression analysis revealed that the best-corrected visual acuity at the final visit was significantly associated with laterality of cataract (with bilateral cases showing better results compared to unilateral cases), presence of systemic comorbidities, presence of ocular comorbidities, development of glaucoma, and phakic status (with better results in the pseudophakia group than the aphakia group). The age at surgery did not significantly affect visual acuity outcomes. A multiple logistic regression analysis demonstrated that the incidence of secondary glaucoma was significantly linked to younger age at surgery, phakic status (higher in aphakic than pseudophakic eyes), and presence of systemic comorbidities. In conclusion, after pediatric cataract surgery, final visual acuity was better in patients with bilateral cataracts, those treated with an intraocular lens, and cases without systemic or ocular comorbidities and secondary glaucoma. The development of secondary glaucoma was linked to younger age at surgery, aphakic status, and presence of systemic comorbidities.

Exploring the Relationship between Anti-VEGF Therapy and Glaucoma: Implications for Management Strategies.

A short-term increase in intraocular pressure (IOP) is a common side effect after intravitreal anti-VEGF therapy, but a sustained increase in IOP with the development of secondary glaucoma has also been reported in some studies after repeated intravitreal anti-VEGF injections. The aim of this review is to present and discuss the possible pathophysiological mechanisms and factors contributing to a sustained rise in IOP, as well as treatment strategies for patients at risk. Close monitoring and adjustable IOP-lowering treatment are recommended for high-risk patients, including those with glaucoma, angle-closure anomalies, ocular hypertension or family history of glaucoma; patients receiving a high number of injections or at shorter intervals; and patients with capsulotomy. Strategies are needed to identify patients at risk in a timely manner and to prevent sustained elevation of IOP.

Prevalence of Glaucoma Following Paediatric Cataract Surgery in an Australian Tertiary Referral Centre.

Secondary glaucoma following childhood cataract surgery remains the most common complication in the paediatric population. This study aimed to determine the incidence, time to progression and risk factors associated with the development of secondary glaucoma following childhood cataract surgery in a paediatric population. Outcome measures were the detection of secondary glaucoma, postoperative time frame to development of glaucoma and risk factors in its development. A retrospective case series was conducted between 2003 and 2017 at a tertiary children's hospital in Sydney. The patient population included those 16 years or less of age who underwent congenital cataract extraction, with or without an intraocular lens implantation and who had been followed up for a minimum of six months following surgery. Patients were excluded if they had cataract aetiology other than congenital idiopathic cataract. Multivariate Cox Regression analysis was used to determine relevant risk factors. A total of 320 eyes in 216 patients were included in the study. Secondary glaucoma developed in 11.9% of eyes. In those that developed secondary glaucoma, the average time to onset from surgery was 3.2 years (median 2.75 years). The mean age of diagnosis of secondary glaucoma was 4.58 years (median 3.5 years, range 2.5 months to 13.23 years). Microcornea was the only adverse characteristic significantly associated with an increased risk of secondary glaucoma (HR 6.30, p 0.003). Despite modern surgical techniques, glaucoma remains a significant long-term sequela in children following cataract surgery.

Surgical Rehabilitation of a Posttraumatic Iris Cyst, Cataract and Astigmatism Patient. Clinical Case

Injuries cause serious disturbance of the form and function of the organ of vision due to the damage and accompanying or remote complications and therefore have a high proportion to the structure of low vision, blindness and disability. One of the complications of penetrating wounds of the eye is iris cysts. Iris cyst can increase and cause pupillary block, secondary glaucoma, uveitis, corneal dystrophy, and therefore it requires surgical intervention. The goal of surgical treatment of an iris cyst is to ensure complete removal of the cyst.Objective: to estimate the clinical and functional results of treatment in a posttraumatic iris cyst, posterior subcapsular cataract and myopic astigmatism patient.Patient and methods. Patient B., 49 years old with posttraumatic retention iris cyst, posterior subcapsular cataract, compound myopic high astigmatism was examined. To determine the tactics of surgical treatment of the patient, a complex of General ophthalmology was perfomed (visometry, IOP measurement, autorefractometry, biomicroscopy, ophthalmoscopy), as well as special (B-scanning, optical coherence tomography of the retina) research methods. The follow-up period was 1 year.Results and discussion. To improve visual functions and prevent the development of secondary glaucoma, the patient was offered surgery - excision of the iris cyst and cataract phacoemulsification with toric intraocular lens. Simultaneous carrying out of two stages of the operation reduced the risks of postoperative complications and shorten the rehabilitation period.Conclusion. Positive optical and therapeutic effects were achieved as a result of the surgical treatment 44 years after an open eye injury: the eye is calm, the iris cyst is not detected, visual acuity has increased. The postoperative period showed the saving the stable and high visual and functional result with no recurrence of the iris cyst.

Pseudoexfoliation Syndrome

Pseudoexfoliation Syndrome (PEX) is a systemic disease characterised by the deposition of extracellular fibrillary material in the anterior segment of the eye. It is often identified incidentally on slit lamp examination because patients are typically asymptomatic during initial stages. It is associated with raised intraocular pressure and development of secondary glaucoma. Due to the increased disposition of PEG, patients with PEG should be routinely monitored so that early interventions could be introduced to slow down the progression of glaucomatous changes.

Клинический случай впервые выявленной в семье мезенхимальной дисплазии радужки

Frank-Kamenetsky syndrome is a rather rare ocular anomaly, which is characterized by hypoplasia of the iris stroma with exposure of its pigment layer and the development of secondary glaucoma, more often in the 2-3rd decade of life. Gonioscopy reveals goniodysgenesis in the form of "dentate" and anterior attachment of the root of the iris of a dirty gray color, as well as the inclusion of mesodermal tissue in the trabecular zone. The severity of the course of glaucoma is determined by the age of onset and is often malignant, gradually leading to blindness. Frank-Kamenetsky syndrome is observed in men and refers to a recessive disease linked to the X chromosome. The article presents a clinical case of mesenchymal iris dysplasia, first identified in a family, similar to the clinical picture of Frank-Kamenetsky syndrome. Previously, retinal pigment degeneration was observed in the male line of the family. Key words: Frank-Kamenetsky syndrome, glaucoma, congenital glaucoma.

Современный взгляд на использование гониоассоцированной трабекулотомии

Purpose. Provide data on the use of gonioscopy-assisted transluminal trabeculotomy (GATT), reflecting its effectiveness and safety when using this technique in various patient models. Material and methods. To perform the review, literature sources which were searched through the PubMed and Scopus databases up to and including 2021, using the keywords "gonioassociated trabeculotomy", "minimally invasive glaucoma surgery", "primary open-angle glaucoma", "glaucoma", "secondary glaucoma". A total of 19 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 2013. Results. GATT can be used at various stages of glaucoma, but at the same time, the maximum effect of lowering intraocular pressure (IOP) is achieved in patients with an early or middle stage of glaucoma. There are also good results of using the GATT technique after vitreoretinal surgery, with the development of secondary glaucoma or ophthalmic hypertension. One of the advantages of GATT is that all manipulations are performed in the anterior chamber, which in turn makes it possible, if necessary, to perform reoperation after an unsuccessful ad-externo trabeculotomy without re-traumatizing the sclera and conjunctiva. It should be noted that the main complication in all studies is the hyphema, which is completely absorbed within a few days. Conclusion. Based on these studies, it can be concluded that the proposed GATT technique is relevant, and meets all modern standards of minimally invasive glaucoma surgery (MIGS): micro-incision, minimal trauma, is able to effectively reduce IOP, has a high level of safety and quick recovery. Key words: glaucoma, primary open-angle glaucoma, secondary glaucoma, gonioassociated trabeculotomy, minimally invasive glaucoma surgery, surgical treatment of glaucoma

Хирургия катаракты у детей с врожденной аниридией

Purpose. Analysis of clinical and functional results of cataract surgery in children with congenital aniridia. Material and methods. Retrospective analysis of treatment results of 46 children and adolescents up to 18 years (92 eyes), whose average age was 6.2±5 years. In the postoperative period, the dynamics of visual functions, the state of the corneal surface and changes in intraocular pressure were assessed. Results. The average age of surgical interventions for lens opacities was 14±3 years. The improvement in visometry data, observed in the first years after the removal of lens opacity, decreased 4 years after surgery, and visual acuity indices did not significantly differ from preoperative values (p=0.07). Regardless of the method of correcting postoperative aphakia, cataract surgery in children was associated with the risks of progression of keratopathy (45%), development of secondary glaucoma (15%) and retinal detachment (10%). In 70% of cases, regardless of the choice of the method of intraocular correction, the debut of the glaucomatous process occurred on average 13.7±5.25 years after cataract surgery. Conclusion. Cataract surgery is not a routine procedure and carries postoperative risks associated with the features of the aniridic eye (development of keratopathy, secondary glaucoma, aniridic fibrosis syndrome), which worsen the long-term functional results of surgery. Key words: congenital cataract, aniridia, keratopathy.

Optical reconstructive treatment of a patient with essential mesodermal dystrophy of the iris

Essentially mesodermal iris dystrophy (EMID) is a type of iridocorneal endothelial syndrome and has a chronic progressing character. It is observable after a local fibrosis is formed in the outer border of the iris, which subsequently causes the peripheral iris to pull up and leads to pupil deformation.Purpose: to evaluate the outcome of modern high-tech surgical treatment, which improves visual functions, prevents the decompensation of intraocular pressure and ensures a cosmetic effect.Materials and methods. Patient R., 48 yrs, was diagnosed with OU EMID, low hyperopia, astigmatism, and presbyopia. In order to prevent the development of secondary glaucoma and correct refractive anomalies, the patient was subjected to phacoemulsification with implantation of a multifocal toric IOL, synechiotomy, and iris plastic surgery. MTIOL was calculated using the VERION™ Image Guided System navigation computing complex (Alcon, USA) and the IOLMaster® 700 optical biometer (Carl ZEISS, Germany).Results. In early post-surgery period, the patient noted an increase in visual acuity, stabilized by the 6th month, a significant decrease of undesirable optical phenomena (glare, halo) and was satisfied with the postoperative cosmetic result. The level of intraocular pressure also stabilized by the 6th month after surgery and remained within the reference range by the 9th month. No intraoperative complications were observed. Control UBM scans showed transparent OU cornea, anterior chamber being shallower than the average depth, exfoliated stroma of the iris, moderate anterior chamber angle, intact ciliary body, centrally located pupil, IOL in capsule bag.Conclusion. The case describes a successful outcome of surgical treatment of a rare variety of iridocorneal endothelial syndrome, increase in visual functions, achievement of the desired cosmetic effect, and improvement in the quality of life of the working age patient.

Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery.

To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. This retrospective case series included all children aged 0-2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. One hundred and sixty-one eyes of 110 patients aged 0-2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure (p = 0.62) was found, but age at cataract surgery differed significantly (p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months).Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus (p = 0.81), strabismus (p = 0.98) and amblyopia (p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group (p = 0.036). Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2-3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.

Increased Hydrostatic Pressure Promotes Primary M1 Reaction and Secondary M2 Polarization in Macrophages.

Patients with chronic anterior uveitis are at particularly high risk of developing secondary glaucoma when corticosteroids [e.g., dexamethasone (Dex)] are used or when inflammatory activity has regressed. Macrophage migration into the eye increases when secondary glaucoma develops and may play an important role in the development of secondary glaucoma. Our aim was to evaluate in vitro if increased hydrostatic pressure and corticosteroids could induce changes in macrophages phenotype. By using a pressure chamber cell culture system, we assessed the effect of increased hydrostatic pressure (HP), inflammation, and immunosuppression (Dex) on the M1/M2 phenotype of macrophages. Bone marrow-derived macrophages (BMDMs) were stimulated with medium, lipopolysaccharide (LPS, 100 ng/ml), Dex (200 ng/ml), or LPS + Dex and incubated with different HP (0, 20, or 60 mmHg) for 2 or 7 days. The numbers of CD86+/CD206− (M1 phenotype), CD86–/CD206+ (M2 phenotype), CD86+/CD206+ (intermediate phenotype), F4/80+/TNF-α+, and F4/80+/IL-10+ macrophages were determined by flow cytometry. TNF-α and IL-10 levels in cell culture supernatants were quantified by ELISA. TNF-α, IL-10, fibronectin, and collagen IV expression in BMDMs were detected by immunofluorescence microscopy. Higher HP polarizes macrophages primarily to an M1 phenotype (LPS, 60 vs. 0 mmHg, d2: p = 0.0034) with less extra cellular matrix (ECM) production and secondary to an M2 phenotype (medium, 60 vs. 0 mmHg, d7: p = 0.0089) (medium, 60 vs. 20 mmHg, d7: p = 0.0433) with enhanced ECM production. Dex induces an M2 phenotype (Dex, medium vs. Dex, d2: p < 0.0001; d7: p < 0.0001) with more ECM production. Higher HP further increased M2 polarization of Dex-treated macrophages (Dex, 60 vs. 0 mmHg, d2: p = 0.0417; d7: p = 0.0454). These changes in the M1/M2 phenotype by high HP or Dex treatment may play a role in the pathogenesis of secondary uveitic glaucoma- or glucocorticoid (GC)-induced glaucoma.

Оптико-реконструктивное лечение пациента с эссенциально-мезодермальной дистрофией радужки

Essentially mesodermal dystrophy of the iris is a type of iridocorneal endothelial syndrome and has a chronic progressive course. It stems from the local fibrosis in the outer border of the iris, which subsequently leads the peripheral iris to pull up and the pupil to deform. Purpose. To evaluate outcome of the modern high-tech surgical treatment, which allows to increase visual functions, prevent decompensation of intraocular pressure and achieve the desired cosmetic effect. Material and methods. Patient R., 48 y.o., with diagnosed OU Essential-mesodermal dystrophy of the iris, low hyperopia, astigmatism, presbyopia. In order to prevent the development of secondary glaucoma and to correct refractive anomalies, phacoemulsification with implantation of a multifocal toric IOL, synechiotomy, and iris plastic surgery were performed. The calculation of MTIOL was performed using the data from the VERION™ Image Guided System navigation computing complex (Alcon, USA) and IOLMaster® 700 optical biometer (Carl Zeiss, Germany). Results. During follow-up examinations the patient noticed an increase in visual acuity with stabilization by the 6th month, a significant decrease in undesirable optical phenomena (glare, halo) and was satisfied with the postoperative cosmetic result. The level of intraocular pressure stabilized by the 6th month after surgery and was within the reference range by the 9th month. No intraoperative complications were observed. Control UBM scans showed OU transparent cornea, anterior chamber shallower than the average depth, stratified stroma of the iris, moderate anterior chamber angle, intact ciliary body, pupil in the center, IOL in capsule bag. Conclusion. The case describes outcome of successful surgical treatment of rare variety of iridocorneal endothelial syndrome, increase in visual functions, achievement of the desired cosmetic effect, and improvement in the quality of life of the working age patient.

Risk factors for occurrence and development of ulcerative keratitis in dogs

Ulcerative keratitis (corneal ulcer) is an inflammatory infected condition of the cornea with a violation of its epithelial layer, affecting the stroma. Due to the fact that the cornea is a tightly innervated tissue of the body, its damage is associated with the appearance of symptoms of varying intensity: hyperemia of the conjunctiva, blepharospasm, the corneal vascularization, a decrease or increase in tear production, the formation of superficial or deep sections of corneal epithelialization, depending on the severity and the duration of the pathological process. The causes of ulcerative keratitis are also diverse: corneal injuries, chronic conjunctivitis, dry keratoconjunctivitis, anomalies of the eyelids, brachiocephalic syndrome. The danger of ulcerative lesions of the cornea is due to their necrotic effect on eye tissue, possible perforation of the eyeball, the development of secondary glaucoma or uveitis, as well as panophthalmitis. It is necessary to establish risk factors for the occurrence and development of ulcerative keratitis in dogs to prevent this pathology in the future, since in the absence of timely diagnosis and treatment, the disease can progress and lead to impaired vision of the animal, thereby lowering the level of their quality of life. Determining the root cause of corneal ulcerative lesions is necessary to understand the possible outcome and relapse of the pathology, as well as the appointment of adequate treatment. Prevention and relief of the etiological factor of the disease and timely prescribed therapy lead to a decrease in the risk of development and complications of ulcerative keratitis.

GWAS links variants in neuronal development and actin remodeling related loci with pseudoexfoliation syndrome without glaucoma

Pseudoexfoliation syndrome (PEXS) is an age-related elastosis, strongly associated with the development of secondary glaucoma. It is clearly suggested that PEXS has a genetic component, but this has not been extensively studied. Here, a genome-wide association study (GWAS) using a DNA-pooling approach was conducted to explore the potential association of genetic variants with PEXS in a Polish population, including 103 PEXS patients without glaucoma and 106 perfectly (age- and gender-) matched controls. Individual sample TaqMan genotyping was used to validate GWAS-selected single-nucleotide polymorphism (SNP) associations. Multivariate binary logistic regression analysis was applied to develop a prediction model for PEXS. In total, 15 SNPs representing independent PEXS susceptibility loci were selected for further validation in individual samples. For 14 of these variants, significant differences in the allele and genotype frequencies between cases and controls were identified, of which 12 remained significant after Benjamini–Hochberg adjustment. The minor allele of five SNPs was associated with an increased risk of PEXS development, while for nine SNPs, it showed a protective effect. Beyond the known LOXL1 variant rs2165241, nine other SNPs were located within gene regions, including in OR11L1, CD80, TNIK, CADM2, SORBS2, RNF180, FGF14, FMN1, and RBFOX1 genes. None of these associations with PEXS has previously been reported. Selected SNPs were found to explain nearly 69% of the total risk of PEXS development. The overall risk prediction accuracy for PEXS, expressed by the area under the ROC curve (AUC) value, increased by 0.218, from 0.672 for LOXL1 rs2165241 alone to 0.89 when seven additional SNPs were included in the proposed 8-SNP prediction model. In conclusion, several new susceptibility loci for PEXS without glaucoma suggested that neuronal development and actin remodeling are potentially involved in either PEXS onset or inhibition or delay of its conversion to glaucoma.

The relationship between inflammatory mediator expression in the aqueous humor and secondary glaucoma incidence after silicone oil tamponade.

The expression of inflammatory mediators in the aqueous humor and the incidence of secondary glaucoma after vitreous body resection combined with silicone oil tamponade for patients with retinal detachment were inestigated, and the roles of IL-17, IL-6 and TNF-α in secondary glaucoma after silicone oil tamponade were analyzed. Fifty-eight cases of retinal detachment treated by vitrectomy combined with silicone oil tamponade were examined at the time of silicone oil removal surgery. All patients underwent unilateral surgery. Patients were divided into observation (19 cases with) and control (39 cases without) groups depending on development of secondary glaucoma. Prior to silicone oil removal, expression levels of IL-17, IL-6 and TNF-α in the aqueous humor were examined. IL-17, IL-6 and TNF-α levels in the aqueous humor in the observation group were 204.2±18.3, 351.1±28.4 and 850.0±51.7 pg/ml, respectively, vs. 152.3±22.2, 254.4±26.8 and 625.6±61.2 pg/ml, respectively in the control group (P<0.001). The expression of IL-17 was positively correlated with those of IL-6 and TNF-α (r=0.687, 0.745; P<0.001). IL-17, IL-6 and TNF-α presented good diagnostic values for glaucoma. The receiver operating characteristic (ROC) areas were 0.957, 0.980 and 0.975, respectively (P<0.001). The expression of inflammatory mediators such as IL-17, IL-6 and TNF-α in the aqueous humor of patients with secondary glaucoma after silicone oil tamponade significantly increased relative to patients without secondary glaucoma. The resultant inflammation may be involved in the development of secondary glaucoma.

Potential Predictors of Poor Visual Outcome in Human Leukocyte Antigen-B27–Associated Uveitis

To identify potential predictors of permanent vision loss in patients with human leukocyte antigen (HLA)-B27-associated uveitis in a tertiary referral center. Retrospective case-control study. The charts of 212 patients (338 eyes) with HLA-B27-associated uveitis that visited the University Medical Center Utrecht with a follow-up of at least 6months were retrospectively studied. Clinical features at presentation and during follow-up were compared to final visual outcome in quiescent state. Eyes with (sub-) normal vision (>20/50) were compared with visually impaired (≤20/50) and blind (≤5/50, or a visual field of <10 degrees) eyes, using survival analysis. A multivariate Cox proportional hazards analysis was performed to analyze potential predictors for permanent vision loss. Median follow-up was 10.4 years (range, 0.5-44.7 years). During follow-up 226 eyes (66%) experienced vision loss up to 20/50, but most recovered. Twenty patients (9%) became permanently visually impaired or blind in at least 1 eye because of uveitis, after a median of 9.7 years (range, 0-20.9 years). The main cause was secondary glaucoma or related to glaucoma surgery (12/22 eyes, 55%). Survival analysis showed, after adjustment for age and sex, an ocular pressure of >21mm Hg, hypotony, and panuveitis to be potential predictors at presentation, and the development of secondary glaucoma or hypotony to be predictors of blindness or visual impairment during follow-up. The long-term visual prognosis of HLA-B27-associated uveitis is relatively good, but the true incidence of permanent vision loss is probably still underestimated. Our findings highlight the importance of proper control of intraocular pressure.

Glaucoma drainage device surgery after vitreoretinal surgery: incidence and risk factors

The initial success of vitreoretinal surgery can be annihilated by an acceleration of preexisting glaucoma or the development of secondary glaucoma. Aim of this study was to determine the incidence of and risk factors for medically uncontrollable glaucoma after vitreoretinal surgery. Case-control study amongst patients who underwent vitreoretinal surgery at the University Medical Center Groningen between 1991 and 2011 (in total 14,942 interventions). Cases were all patients who received a glaucoma drainage device after vitreoretinal surgery. Controls were a subset of the patients who underwent vitreoretinal surgery without a subsequent drainage device. Cases and controls were matched (three controls per case) with regard to the year of the (first) vitreoretinal intervention. The incidence rate was calculated from the number of cases and the number of person-years corresponding to all vitreoretinal interventions performed in the study period. Risk factors were analysed with logistic regression. Ninety-five cases were identified after a follow-up of 101,961 person-years (one per 1000 person-years). Cases were younger (p = 0.017), were more often men (p = 0.035), underwent more interventions (p < 0.001) or were treated with silicone oil (p = 0.021), had a higher intra-ocular pressure 1 week after the intervention (p < 0.001) and had more often a history of glaucoma or ocular hypertension (p < 0.001). Glaucoma after vitreoretinal surgery that requires a glaucoma drainage device is not very common and patients who need a device differ from those who do not. This gives the opportunity to monitor certain subgroups more closely.

Unilateral Orbital Proptosis Secondary To A Carotico- Cavernous Fistula: A Case Report

CaroticoCavernous Fistulas (CCF) are caused by the laceration of the intercavernous portion of the carotid artery, or one of its intercavernous branches resulting in arterialisation of blood within the cavernous sinus. There are four types (A,B,C,D) of CCF out which type A (Direct type) and types B, C, and D (Indirect types) occur spontaneously. Prompt diagnosis and treatment of this condition can prevent visual loss, development of secondary glaucoma and intracranial hemorrhages.A unilateral orbital proptosis associated with sinusitis is an indication for endoscopic decompression. In our case even though there was unilateral orbital proptosis along with sinusitis, endoscopic surgery was unnecessary and did not significantly effect the course of patients illness. We present a case of unilateral orbital proptosis in a middle aged male with an indirect type of CCF detected on Magnetic Resonance Angiogram. The role of MR imaging and indications for endoscopic surgery in a unilateral orbital proptosis with review of relevant literature is discussed in this paper.

Silicone oil induced glaucoma: A review

Silicone oil has been an important adjunct for internal tamponade in the treatment of complicated retinal detachment for the past 4 decades. A known complication of its use has been the development of secondary glaucoma. This article reviews the current body of literature documenting the different pathogeneses, predisposing factors and management of silicone oil induced pressure elevation and optic neuropathy. Categorization is clarified for the different types of secondary glaucomas due to silicone oil. Four different mechanisms have been proposed for the pathogenesis of glaucoma that require different therapeutic strategies: (1) overfill with total anterior chamber fill leads to an open-angle glaucoma due to mechanical obstruction of outflow, (2) pupillary block with silicone oil incites angle closure glaucoma, (3) denaturation of silicone oil into microdroplets may sweep into the trabecular meshwork with the development of secondary open angle glaucoma, or (4) finally, inflammation or exacerbation of pre-existing glaucoma. Understanding the risk factors and the pathogenesis of secondary glaucoma when using silicone oil helps guide the timely and appropriate course of treatment.

Secondary Glaucoma Associated With Advanced Acanthamoeba Keratitis

To describe the association of acanthamoeba keratitis and glaucoma, to establish an incidence of glaucoma in patients with acanthamoeba keratitis, to discuss treatment options and outcomes in these patients, and to describe the histopathologic findings and pathogenesis of glaucoma secondary to acanthamoeba keratitis. After Institutional Review Board approval, the charts of all patients suspected of having acanthamoeba keratitis at Aston Ambulatory Center at The University of Texas Southwestern Medical Center were reviewed. Inclusion criteria were as follows: diagnosis of acanthamoeba keratitis by positive confocal microscopy or culture, diagnosis of glaucoma or ocular hypertension secondary to acanthamoeba keratitis, and at least 6 months of follow-up. Exclusion criteria included a previous diagnosis of glaucoma or ocular hypertension and any history of intraocular surgery before the development of glaucoma. The date of keratitis development, pneumotonometry on initial and follow-up examinations, glaucoma medications used, and surgical procedures performed were tabulated. Twenty patients (20 eyes) were included. Six (30%) eyes developed secondary glaucoma during the review period. Of the patients treated for glaucoma with medication alone, the visual acuity of three (75%) of four became light perception or no light perception. Three of six patients required glaucoma drainage device implantation for intraocular pressure control. Of these, the vision of one eye became no light perception, and the other two eyes maintained better than 20/100 vision. Histopathologic examination showed chronic inflammation of the trabecular meshwork and angle closure. No acanthamoeba organisms were found in the angle structures. The development of secondary glaucoma is not uncommon in acanthamoeba keratitis and is a poor prognostic sign in patients with acanthamoeba keratitis, because most progress to light perception or no light perception vision. Histopathologic findings suggest an inflammatory angle-closure mechanism, apparently without direct infiltration of the organism. The glaucoma associated with acanthamoeba keratitis is often severe and frequently requires surgical intervention for intraocular pressure control and vision preservation.