Congenital Glaucoma Research Articles

DEVELOPMENT AND VALIDATION OF SPECTROPHOTOMETRIC DETERMINATION OF PROPRANOLOL IN EXTEMPORANEOUS POWDERS OF MANUFACTURE FOR CHILDREN

Introduction. Propranolol, a non-selective beta-blocker, is included in Russian and international treatment protocols for various cardiovascular diseas-es in children and adults. It has also demonstrated efficacy in the treatment of infantile hemangiomas, migraines, glaucoma and other diseases. The pharmaceutical industry produces propranolol in tablets of 10 and 40 mg. However, for pediatric treatment, dosages of 0.5–2.5 mg/kg/day are re-quired. Extemporaneous pharmaceutical powders for internal use allow for individual dosing. This study aims were to develop method for the quantitative determination of propranolol by spectrophotometric method in powders containing dex-trose or lactose and to carry out validation assessment of this method. Material and methods. The pharmaceutical substances propranolol hydrochloride was purchased from (Changzhou Yabang Pharmaceutical Co., Ltd, China), dextrose monohydrate – from (Weifang Shengtai Medicine Co., Ltd, China) and lactose monohydrate – from (DFE Pharma GmbH&Co. KG, Goch, Germany). The optical density of propranolol solutions was measured on a UNICO 2802 spectrophotometer (Russia) at a wavelength of 290 nm in cu-vettes with a layer thickness of 10 mm. Weighing of the samples was carried out on an analytical balance ADV-200M (Russia). Results. The method has been developed for the spectrophotometric quantitative determination of propranolol in powders containing dextrose or lac-tose. The validation of the method was carried out by the requirements of OFS.1.1.0012 “Validation of analytical methods” of the Russian State Phar-macopoeia of the XV edition, confirmed its specificity, linearity in the range from 12 to 28 µg/mL (r=0,9995 for dextrose powder и r=0,9997 for lactose powder), intermediate (intra-laboratory) precision and accuracy. The results are not burdened by systematic error. The relative standard deviation (RSD) does not exceed 2.0%. Conclusions. A validation evaluation of a spectrophotometric method for the quantitative determination of propranolol in powders with dextrose or lac-tose has been developed and carried out. The proposed method can be used to control the quality of extemporal medicines.

Conversion to Glaucoma After Ocular Trauma in Pediatric Patients

Background: The outcomes of pediatric glaucoma suspects with a history of ocular trauma remains unknown; we describe the rate of conversion to glaucoma of this population of patients at a research-intensive academic center. Methods: We conducted a retrospective case series of pediatric patients with a history of open- or closed-globe trauma who were being monitored as pediatric glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016. Results: A total of 62 eyes from 62 patients with a history of ocular trauma were identified with a median age at presentation of 9.7 years (7.8 years) and a median follow-up of 2.7 (5.8 years). There were 29 eyes (46.8%) with open-globe injuries and 33 eyes (53.2%) with closed-globe injuries. A higher proportion of eyes that sustained closed-globe injuries were started on topical therapy for persistent ocular hypertension than eyes that sustained open-globe injuries (36.4% versus 10.3%, X2 = 5.6976, p = 0.017). Five eyes (8.1%) developed glaucoma during the follow-up period, all of which had a history of closed-globe injury (15.2%, X2 = 4.7794, p = 0.029). Four eyes of these eyes underwent glaucoma-related surgical intervention. Most eyes (3/5, 60%) that went on to develop post-traumatic glaucoma had undergone additional and/or concurrent intraocular surgical interventions to address sequelae of ocular trauma, such as traumatic cataract and retinal detachment. Conclusions: All eyes that developed glaucomatous damage or underwent glaucoma-related surgical intervention in this cohort of patients with a history of ocular trauma were those that had sustained close-globe injuries. No eyes that sustained open-globe injury progressed to glaucoma.

TREATMENT OF EARLY POSTOPERATIVE COMPLICATIONS IN CHILDREN WITH PRIMARY CONGENITAL GLAUCOMA

Purpose – to study the nature of early postoperative complications in children with primary congenital glaucoma and methods of their correction after antiglaucoma surgery using a combined method with a simultaneous effect on three outflow tracts. Material and methods The total number of children who underwent antiglaucoma surgery using the combined method (simultaneous impact on the outflow tracts in three directions: sinus trabeculectomy according to Burian in the scleral sinus, cyclodialysis-cycloretraction with autoscleral pedicle into the suprachoroidal space, basal iridectomy with sclerectomy beneath the scleral flap into the episcleral venous system) was 151 (270 eyes). Results On the first postoperative day following antiglaucoma surgery, the incidence of early postoperative complications was 62.6%, which increased to 67.4% by the third day. Among these, the highest proportion of patients presented with severe hypotony – 33.3%, hyphema – 10.0%, and ocular hypertension – 6.7%. After conservative treatment, the incidence of complications in children decreased to 10% by the seventh postoperative day. Conclusion Thus, following conservative treatment, the incidence of complications in the early postoperative period decreased by 52.6%. There was no need for repeated surgical intervention in these patients. Patients were discharged home under the supervision of an ophthalmologist at their place of residence. Key words: primary congenital glaucoma, glaucoma surgery, early postoperative complications

A New Ocular Phenotype Combining Juvenile Glaucoma and Doyne Honeycomb Retinal Dystrophy (Malattia Leventinese) due to a Novel EFEMP1 Pathogenic Variant.

Doyne honeycomb retinal dystrophy (DHRD), also termed malattia leventinese (MLVT), is a dominantly inherited ocular disease characterized by the progressive accumulation of macular and peripapillary drusenoid material beneath the retinal pigment epithelium in the Bruch membrane. In all affected individuals genetically characterized to date, DHRD/MLVT is caused by a single heterozygous p.Arg345Trp missense variant in the EGF-containing fibulin-like extracellular matrix protein 1, EFEMP1. Recently, pathogenic variants in the EFEMP1 gene have also been demonstrated in several families with juvenile or adult-onset hereditary isolated glaucoma. Here, we describe a family featuring a unique phenotype of juvenile glaucoma and DHRD/MLVT caused by a novel EFEMP1 variant. Our results expand both the ocular phenotype associated with EFEMP1 variants and the molecular spectrum causing DHRD by describing the first non-p.Arg345Trp EFEMP1 pathogenic allele.

Bilateral Primary Congenital Glaucoma in a Newborn

Bilateral Primary Congenital Glaucoma in a Newborn

ULTRASOUND AS A SCREENING TOOL FOR FETAL GLAUCOMA: A CLINICAL APPROACH

The World Health Organization's VISION 2020 initiative has recognised paediatric glaucoma as the third leading cause of significant visual impairment and blindness in children in low- and middle-income countries, accounting for 5% of global childhood blindness. Childhood glaucoma is a critical condition in paediatric ophthalmology, causing damage to the optic nerve and ganglion cells. The objective of the study was to assess the feasibility of ultrasonography screening in pregnant women for the early identification of probable congenital glaucoma in the fetus. Material and methods of the study. To achieve this, we conducted a comprehensive ultrasound examination of 500 pregnant women at the Republican Centre for Mother and Child Screening in 2022-2024. The article was prepared on the basis of the results of the planned dissertation research (Registration code B2023.3.DSc/Tib902; due dates: 2022 -2025). Results: Ultrasound scans of pregnant women provide important information for ophthalmologists. Ultrasound screening of pregnant women, monitoring the orbits and eyeballs of the fetuses, was performed from 20 to 40 weeks of gestation. Of the total, data were analysed for 2 (0.4%) cases of fetal eye pathology in which echographic indicators of glaucoma, known as buphthalmos, were identified. After birth, the suspected diagnosis of congenital glaucoma was confirmed in the children, requiring emergency hospitalisation and surgical intervention. This is particularly important in children with congenital glaucoma to prevent blindness and visual impairment in the future. Conclusions: This imaging could serve as a cost-effective and safe screening technique that provides important information to ophthalmologists. Comprehensive ultrasound assessment of embryonic ocular structures may provide significant information and identify congenital glaucoma in infants. Accurate diagnosis and verification of congenital glaucoma typically requires more specialised ophthalmological assessment postnatally.

Micropulse cyclophotocoagulation in the treatment of primary open-angle glaucoma and congenital glaucoma. Part 1: hypotensive effect mechanisms, modern procedure protocol

Micropulse cyclophotocoagulation (MP-CPC) refers to interventions that reduce intraocular pressure by laser exposure on the ciliary body, while the term “coagulation” in its name does not reflect the essence of the procedure, but is inherited from the previous continuous laser version. Unlike other methods that target ciliary body, MP-CPC is considered the safest procedure due to its special laser action mode and the absence of a coagulative effect. In the first part of our review, we would like to focus on the history, mechanisms of action and procedure protocol of micropulse cyclophotocoagulation.

Outcomes of Second Trabeculectomy Versus Glaucoma Drainage Device in Juvenile Open-angle Glaucoma After Primary Trabeculectomy Failure.

Second trabeculectomy and glaucoma drainage device implantation offer similar success rates for juvenile open angle glaucoma after initial trabeculectomy failure. However, second trabeculectomies required fewer medications. A quarter of patients in both groups required a third operation after 2.5±2.3 years. To compare outcomes between second trabeculectomy surgery versus glaucoma drainage device (GDD) insertion in juvenile open-angle glaucoma (JOAG) patients after primary trabeculectomy failure. A retrospective review was performed on all JOAG patients who underwent a second glaucoma surgery after primary trabeculectomy failure across two tertiary hospitals in Bangkok, Thailand between 2009 and 2020. Demographics, intraoperative reports, and clinical findings were collected. The primary outcomes were complete and qualified success rates at 5 years; secondary outcomes included differences in intraocular pressures and number of glaucoma medications post-operatively. Fifty-two eyes of 38 patients underwent a second glaucoma surgery after primary trabeculectomy: 30 had a second trabeculectomy, 17 received a GDD (10 valved, 7 non-valved), and 5 underwent cyclophotocoagulation. Prior to surgery, there were no significant differences except in mean refractive error. Average follow-up length was 66.9±53.7 months. Qualified success rates were 81.5% and 63.2% at 3 and 5 years (complete success: 55.6% and 42.1%) for the second trabeculectomy group and 80.0% and 70.0% (complete success: 53.3% and 50.0%) for the GDD group, respectively. There were no significant differences in group success or IOP post-operatively. The GDD group required more medications at 5 years (1.3±1.9 vs. 2.3±1.5, P=0.03). Two cases of tube exposure in the GDD group resulted in implant removal. About a quarter of patients in both groups required a third operation after 2.5±2.3 years. Both second trabeculectomy and GDD insertion are effective treatments for JOAG after trabeculectomy failure. Second trabeculectomy required fewer medications for IOP control.

Glaucoma drainage devices: Indications, intraoperative management and postoperative follow-up

Glaucoma drainage devices (GDD) are used for patients with secondary glaucoma, such as uveitic or neovascular glaucoma, which is uncontrolled under local therapy. They are also used in patients with conjunctival scarring, for example after a previous vitrectomy or after unsuccessful previous glaucoma surgery, such as trabeculectomy. They are also a treatment option for congenital glaucoma, aphakic glaucoma or for the treatment of iridocorneoendothelial syndromes. The conventional GDD were the Baerveldt, Molteno or Ahmed glaucoma implant, whereby the first two were valveless and the latter had a valve. Newer GDD include the PAUL glaucoma implant, the Ahmed Clear Path and the EyeWatch system. Hypotony is a feared complication after GDD surgery, and there are various options for avoiding it: external ligation of the tube or intraluminal suture obstruction. However, low IOP may still occur postoperatively. If early postoperative hypotension occurs in combination with a shallow anterior chamber, the injection of a viscoelastic can be helpful. Late hypotension is usually treated with permanent occlusion or removal of the tube. Furthermore, GDD erosion and migration can occur postoperatively, in such cases a surgical revision is required. Corneal decompensation can also occur after GDD; Descemet's membrane endothelial keratoplasty (DMEK) is the treatment of choice in many centers and is performed more frequently than a penetrating keratoplasty. Finally, double vision is a possible complication after GDI. Most patients have short-term, self-limited diplopia or can be adequately treated with prism glasses; a few require strabologic surgery.

Cup-to-disc ratio measured clinically and via OCT in pediatric patients being monitored as glaucoma suspects for suspicious optic discs.

Compare cup-to-disc ratio (CDR) measured by clinical assessment and optical coherence tomography (OCT) in pediatric eyes being monitored as glaucoma suspects for suspicious optic disc appearance. Retrospective cross-sectional study. An institutional study following 221 eyes from 122 unique pediatric glaucoma suspects being monitored due to increased or asymmetric appearance of CDR. Ophthalmologic findings, including visual acuity, intraocular pressure, CDR measured by clinical assessment, average retinal nerve fiber layer thickness, and average CDR measured by OCT, were recorded for each participant's initial and final examinations. CDRs measured clinically and by OCT were compared at both initial and final presentations. Average age at presentation was 9.0 years old (95% CI: 8.0-9.9), and mean length of follow-up was 5.0 years (95% CI: 5.4-4.5). At initial presentation, 53 eyes had CDRs recorded by both clinical assessment and OCT, and at final presentation, 93 eyes had CDRs measured by both modalities. CDR measured by OCT was significantly larger than CDR measured clinically on initial and final presentation (p=0.002, p<0.001). Measurements of CDR by clinician assessment were significantly smaller than measurements obtained via OCT imaging. However, the average difference between CDR measured clinically and by OCT was <0.1. Thus, OCT may be a suitable way to measure CDR in pediatric glaucoma suspects, especially when clinical exam proves difficult. Further research is needed to assess CDR in glaucoma suspects using OCT longitudinally and in the context of other optic disc measurements, such as disc area.

Rigid Probe Trabeculotomy Versus 360-Degree Catheter Trabeculotomy in Childhood Glaucoma.

Background/Objectives: This study aims to compare the effectiveness of traditional rigid probe trabeculotomy and 360-degree catheter trabeculotomy in treating childhood glaucoma, underlining the necessity of early surgical intervention. Methods: This retrospective cohort study, conducted at the University Eye Hospital Mainz, Germany, included 109 patients under 18 years with childhood glaucoma who underwent rigid probe trabeculotomy or 360-degree catheter trabeculotomy between January 2015 and February 2021. Results: A total of 151 eyes from 109 patients were included. The average IOP decreased significantly in both groups, with a greater reduction seen in the 360-degree catheter trabeculotomy group (mean reduction: 10.1 ± 8.7 mmHg; p < 0.001). In the rigid probe trabeculotomy group, the IOP reduction was 8.1 ± 9.0 mmHg (p < 0.001). The need for revision surgeries was lower in the 360-degree catheter trabeculotomy group. Conclusions: Both trabeculotomy techniques effectively reduced the intraocular pressure in childhood glaucoma. The 360-degree catheter trabeculotomy group demonstrated fewer revision surgeries compared to the rigid probe trabeculotomy group. However, there was no statistically significant difference in the IOP reduction between the groups. These findings indicate that while both methods are effective in managing the IOP in childhood glaucoma, the 360-degree catheter trabeculotomy may provide more favorable long-term results.

Ahmed Glaucoma Valve Implantation in Jordan: Indications and Complications.

The main indications for Ahmed glaucoma valve (AGV) include neovascular glaucoma, congenital glaucoma, primary open angle glaucoma and patients with failed previous trabeculectomy. This article aims to investigate the complications of AGV in Jordanian glaucoma patients and to justify the main risk factors. Retrospectively, we report 87 eyes of 83 patients who underwent AGV implantation for different indications. The database included demographic data, past ocular and medical history, the indication for surgery, the perioperative outcome parameters at different follow-up visits, and the developed complications at each post-operative visit. More than half of the patients (54%) were males. The mean age of the patients was 47.4 years. Neovascular glaucoma was the most common indication for AGV implantation. Valve encapsulation was the most encountered complication. About one quarter of the eyes at one time underwent valve revision. Younger patients, neovascular glaucoma and congenital glaucoma were associated significantly with AGV failure and for the need for revision surgery. AGV is the predominant glaucoma surgery performed in Jordan. Valve encapsulation is the most common complication for AGV implant in Jordanian patients which may be related to racial and genetic factors. Neovascular glaucoma has a high burden in Jordan and secondary causes should be controlled adequately.

Clinical characteristics and ultrasound biomicroscopic evaluation of anterior segment dysgenesis: a retrospective cross-sectional study.

Anterior segment dysgenesis (ASD) encompasses a range of congenital disorders affecting the development of the eye's anterior segment, often leading to significant visual impairment and glaucoma. Although numerous studies have focused on the genetic basis of ASD, few have comprehensively compared the clinical features across ASD subtypes. This study aims to address this gap by describing and comparing the clinical characteristics and ultrasound biomicroscopy (UBM) imaging features of various ASD subtypes in a Chinese tertiary medical center. A retrospective review of medical records was conducted for hospitalized patients diagnosed with ASD in the Eye & ENT Hospital, Fudan University between January 2013 and December 2022. Patients were enrolled consecutively. Demographic data, clinical manifestations, and UBM images of various ASD subtypes were analyzed. A total of 1,031 patients were included in the analysis. Primary congenital glaucoma (PCG) was the most prevalent, affecting 396 patients (625 eyes), whereas congenital ectropion uveae (CEU) was the rarest, affecting 8 patients (13 eyes). All subtypes exhibited a spectrum of characteristic clinical manifestations. UBM imaging revealed distinct anterior segment abnormalities characteristic of each subtype. Trabeculodysgenesis was implicated in glaucoma pathogenesis across multiple ASDs, including PCG, aniridia, Axenfeld-Rieger syndrome, Peters anomaly, CEU, iris coloboma, and microcornea, whereas persistent fetal vasculature and congenital fibrovascular pupillary membrane exhibited completely closed angles in glaucomatous eyes. Our study provides comprehensive insights into the clinical features and UBM characteristics of ASD subtypes, enhancing diagnostic accuracy and guiding appropriate interventions.

Effects of 0.024% latanoprostene bunod on intraocular pressure and pupil diameter in normal cats and cats with congenital glaucoma.

To evaluate the effects of latanoprostene bunod on intraocular pressure (IOP) and pupil diameter (PD) in normal cats and cats with feline congenital glaucoma (FCG). Five normal and 5 FCG cats. This masked, controlled crossover study comprised a 1-day Pre-treatment phase followed by two 10-day Treatment phases, each followed by a 10-day Recovery phase. During treatment, all cats received twice daily 0.005% latanoprost (LAT) or 0.024% latanoprostene bunod (LBN) in a randomized eye. Following Recovery, the same eye was treated with the opposite drug. Contralateral eyes served as saline-treated controls. Intraocular pressure and PD measurements were performed three times daily during all study phases. Data were analyzed via constrained longitudinal data analysis models. Neither drug significantly reduced IOP in normal cats. In FCG cats, statistically significant reductions in mean (95% CI) IOP were observed relative to controls 4 h after LAT and LBN treatment (-5.5 mmHg [-8.4, -2.5], p < .001, -7.2 mmHg [-10.2, -4.3], p < .001, respectively). These differences represented 28.4% and 37.9% IOP reductions, respectively. Mean IOP reduction after 4 h was significantly greater with LBN treatment compared to LAT (-1.8 mmHg [-3.2, -0.4], p = .012). However, these IOP reductions were not considered clinically significant. Both drugs similarly reduced PD in normal and FCG cats. Transient IOP reduction was observed after topical administration of LAT and LBN in FCG cats; and mean IOP difference was statistically significantly greater in LBN-treated eyes. However, the apparent enhanced hypotensive effect of LBN is not clinically significant.

Identification of mutation of MYOC (c.1099G>A), a pedigree pathogenic gene of juvenile open angle glaucoma (JOAG): A case report.

The MYOC gene is associated with juvenile open-angle glaucoma (JOAG). This study aims to provide genetic counseling for a Chinese JOAG family by detecting MYOC mutations to identify high-risk individuals for early JOAG intervention. It also supplements the clinical characteristics of glaucoma patients with MYOC gene mutations. A 43-year-old presented sought medical attention in a local hospital due to a 6-month decline in binocular vision. He was diagnosed as JOAG and underwent glaucoma surgery. The patient also had 11 family members with a history of JOAG. After sequencing the polymerase chain reaction products of the patient, MYOC c.1099 G > A (p.G367R) mutation was observed. That is consistent with a diagnosis of JOAG. Polymerase chain reaction analyses of 9 patients and 42 healthy family members were performed to explore potential mutations associated with familial JOAG. JOAG assisted in diagnosing the III-5 proband. Genetic detection indicated that III-5 was exposed to a novel heterozygous missense mutation of MYOC (c.1099 G > A [p.G367R]). The co-segregation of this gene with the trait observed in the pedigree was verified. All 10 participants exhibiting this mutation had JOAG phenotypes, whereas other participants did not show this mutation. In terms of MYOC mutation c.1099 G > A (p.G367R), this mutation occurred when the 1099th nucleotide in the encoding zone of MYOC changed from G to A. Moreover, the 367th amino acid coded by this base got mutated from glycine to arginine. DNAMAN sequence homology results showed that the G residues of MYOC: 367 were significantly conserved among different species. In addition, 3D protein conformation predicted that these mutations could decrease protein stability. MYOC c.1099 G > A was identified as a pathogenic gene of JOAG in this pedigree. The addition of the MYOC mutant spectrum to JOAG in the Chinese population facilitates a complete understanding of the molecular pathogenesis and clinical diagnosis of MYOC.

Establishment of a CPAMD8-GFP reporter human embryonic stem cell line, IBBDe001-B, using CRISPR/Cas9 editing

The human CPAMD8 gene encodes proteins in the A2M/C3 (alpha-2-macroglobulin/complement 3) family, predominantly expressed in the distal tips of the retinal neuroepithelium that form the iris and ciliary body. Mutations in CPAMD8 have been linked to anterior segment dysplasia and congenital glaucoma. Using CRISPR/Cas9 editing, we inserted a 3*EAAAK-EGFP fluorescent tag into the CPAMD8 gene, enabling real-time observation of its expression and providing insights into its biological functions. The resulting gene-edited cell line retained normal stem cell morphology and karyotype, expressed essential pluripotency markers, and exhibited differentiation potential.

Guardian Knowledge in Primary Congenital Glaucoma: A Cross-Sectional Study.

Guardian education level and frequency of surgical interventions are key determinants of knowledge in primary congenital glaucoma, highlighting the need for targeted educational strategies. Management of congenital glaucoma poses unique challenges, particularly concerning the patient guardians' understanding of the condition, which is crucial for treatment adherence and follow-up compliance. This study aimed to assess guardians' knowledge levels and identify the influencing factors. This cross-sectional study included 103 guardians of pediatric patients with PCG. Participants with missing data were excluded from the study. The participants were assessed using a 20-question survey covering various aspects of glaucoma. Descriptive and inferential statistics were used for analysis. The sample included 96 guardians, primarily females (80.2%). The children's ages varied significantly, averaging approximately 44 months (SD = 39.8). The guardians predominantly had secondary education (34.4%) and most were housewives (77.1%). There was a positive correlation between higher education levels and the overall knowledge score of guardians (P = 0.006). Similarly, the guardian's locality showed a positive correlation with knowledge scores, with urban guardians having higher scores than rural guardians. Additionally, there was a positive correlation between the number of surgical operations performed on the child and the guardians' knowledge. For the subtotals, variables such as the child order among siblings and age of the child showed significant positive correlations, emphasizing the multifaceted influences on guardians' understanding. In the multivariate analysis, the guardian's education level showed a significant positive correlation for the Overall Score, as did the number of operations performed on the patient. The study revealed gaps in guardian knowledge, irrespective of educational level or other demographic factors. Guardians' education level and the number of operations performed on the child are critical determinants of guardians' understanding of congenital glaucoma. Traditional approaches to educational interventions may require re-evaluation, and there is a pressing need for targeted educational interventions.

Outcomes of microcatheter-assisted trabeculotomy in adult patients with primary congenital glaucoma and juvenile open-angle glaucoma: A case series

Abstract Trabeculotomy is conventionally performed using a rigid probe, allowing for 180° trabeculotomy. More recently, microcatheter-assisted 360° trabeculotomy (MCAT) has shown safe and effective results in pediatric glaucoma cases, particularly in primary congenital glaucoma (PCG) and to a lesser extent in juvenile open-angle glaucoma (JOAG). This case report highlights the successful intraocular pressure (IOP) control following iTrack®-assisted trabeculotomy in one adult with PCG and two with JOAG. Four eyes of three adults, aged 50, 28, and 45 years, underwent MCAT for uncontrolled PCG or JOAG, with no prior surgical history. No major complications were observed. Postoperatively, IOP ranging from 11 to 15 mmHg was achieved without the need for topical therapy or reoperation during a follow-up period of 12–14 months. These cases suggest that MCAT is both effective and safe for adults with PCG or JOAG requiring surgery.

Clinical profile and etiological spectrum of patients presenting with corneal hydrops over a 12-year period.

To describe the demographics, clinical characteristics, and management of corneal hydrops in patients presenting to a multi-tier ophthalmology hospital network in India. Cross-sectional hospital-based study. Of the total of 3,140,941 new patients presenting between October 2010 and March 2022, patients with a clinical diagnosis of corneal hydrops in at least one eye were included in the study. All the data was collected using an electronic medical record system. 1291 eyes of 1110 patients were diagnosed with corneal hydrops and included in the study and 961 patients (83.69%) had a unilateral affliction. Corneal hydrops was noted to be significantly more common in males (62.43%) and adults (62.7%). The most common age group at presentation was during the second decade of life with 472 (42.52%) patients. They were more commonly from the higher socio-economic status (77.3%) and from the urban geography (44.23%). In the 1291 eyes, 567 (43.92%) eyes had a visual impairment of blindness (> 20/400-20/1200) followed by moderate visual impairment (> 20/70-20/200) in 166 (12.86%) eyes. Overall, the most common etiology was keratoconus in 1,082 (83.81%) eyes followed by primary congenital glaucoma (PCG) in 91 (7.05%) eyes. Surgical intervention to hasten the recovery of hydrops was performed in 7.82% of eyes with ectasia and as a definite management in 7.05% eyes with PCG. Visual rehabilitation was with contact lenses in 29.1% eyes and keratoplasty in 13.94% eyes. Corneal hydrops is predominantly unilateral and is more common in males. Keratoconus was the commonest etiological condition; however, the risk of hydrops was highest in keratoglobus, followed by PMD. Most affected age was the second decade of life and visual impairment was severe in majority (60%). A surgical intervention was performed in a third of the cases.

Initial Results of the Paul Ahmed Comparison (PAC) Study in Refractory Childhood Glaucoma

PurposeTo compare the effectiveness and safety of the Paul Glaucoma Implant (PGI) to the Ahmed Glaucoma Valve (AGV) in managing refractory childhood glaucoma. DesignRandomized controlled trial. SettingTwo clinical centers. MethodsAn ongoing randomized controlled trial including patients ≤18 years with refractory childhood glaucoma in whom glaucoma drainage implant surgery was planned. Patients were randomized to receive either PGI or AGV. The primary outcome was the intraocular pressure (IOP) reduction. Secondary outcomes included glaucoma medication reduction, success rate, and complications rate. The success rate was defined as achieving a postoperative IOP between 6-21 mmHg without or with glaucoma medications (up to three topical glaucoma medications), without the need for additional glaucoma surgeries, and without the occurrence of vision-threatening complications or evidence of disease progression. The use of oral glaucoma medications, such as acetazolamide, was considered a failure. ResultsThe current report included 44 patients (44 eyes) who completed the one-year postoperative follow-up (25 in the PGI group versus 19 in the AGV group). The mean age at the time of surgery was 96.9±59.1 months (90.5±60.04 months in the PGI group and 105.4±58.5 months in the AGV group. Preoperatively, the mean IOP was 32.6±6.1 mmHg with a mean of 3.6±0.6 glaucoma medications in the PGI group, compared with 29.8±6.1 mmHg (p=0.1) with a mean of 3.4±0.7 glaucoma medications (p=0.35) in the AGV group. At one year, there were no statistically significant differences in the mean IOP (14.9±4.1 mmHg in the PGI group versus 15.5±3.5 in the AGV group, p=0.6) and number of glaucoma medications (1.1±1 in the PGI group versus 1.6±1.03 in the AGV group, p=0.1). The success rate of PGI was 80% vs. 73.6% in the AGV (p=0.2). The postoperative complications rate was comparable in both groups (three eyes in each group). Conclusion/RelevanceAt one year postoperatively, the IOP reduction, reduction of glaucoma medications, success rates, and rate of complications were comparable between both groups.