OBJECTIVE: The aim of this study was to retrospectively evaluate vision outcomes of dogs with primary angle closure glaucoma (PACG) that underwent Ahmed valve gonioimplantation (AVG) followed by lensectomy and endolaser cyclophotocoagulation (ECP) with or without bleb resection after AVG failure.
METHODS: Medical records from 2008 to April 2022 were reviewed. All patients selected had an AVG performed first. Following valve failure, lensectomy-ECP was performed in addition to bleb resection as indicated. Additional ECP and AVG replacement surgeries were performed as deemed medically necessary. Main outcomes evaluated included vision preservation, average IOP reduction, and the number of glaucoma medications (both oral and topical) at 6, 12, 24, and 36 months.
RESULTS: Fourteen eyes from 13 patients were included in the study. Females were predominant (n = 9) compared with males (n = 4). Mean age at initial glaucoma diagnosis was 6.82 years. Following AVG and lensectomy-ECP, vision was preserved in 93%, 84%, 60%, and 48% of eyes at 1, 2, 3, and 4 years respectively. Following lensectomy-ECP, there was a significant reduction in mean IOP of 9.64 mmHg (p = .015) and 9.71 mmHg (p = .016) at 2 and 6 months, respectively. There was a reduction in mean IOP of 2.45, 7.25, and 12.25 mmHg at 12, 24, and 36 months, respectively, which was not statistically significant. There was a significant decrease in the number of glaucoma medications at all evaluated time points except 24 months.
CONCLUSIONS: Combined AVG and lensectomy-ECP is successful in maintaining vision long term as well as decreasing IOP, and the number of glaucoma medications administered.

UNASSIGNED: To compare visual field progression in severity-matched pseudoexfoliation glaucoma (XFG) and primary glaucoma after intraocular pressure (IOP) reduction by filtering surgery.
UNASSIGNED: Patients with XFG (n=32), primary open-angle glaucoma (POAG, n=33) or primary angle closure glaucoma (PACG, n=28) that underwent routine cataract and glaucoma filtering surgery by the same surgeon (APR) between May 2017 and September 2021, were included for this prospective study. Rate of progression (ROP) was determined using guided progression analysis and compared between XFG and primary glaucoma. Multivariate regression was done to analyse the factors responsible for progression in each group.
UNASSIGNED: Visual field progression after surgery was noted in 48 eyes (n=11 XFG, 18 POAG and 19 PACG eyes) at a mean follow-up of 10±5.6 months after surgery with RVI seen in 18 of 48 eyes. The final IOP (p=0.8) and mean ROP (p=0.09) were not significantly different between XFG and primary glaucoma. The XFG eyes had a greater number of eyes (36%) showing an ROP worse than -5dB/yr, with 45% of eyes showing an IOP spike >5mm Hg, and a higher mean IOP spike between visits. The ROP in eyes with RVO and >5mm Hg IOP spikes was greater in XFG than in POAG or PACG. In the multivariate analysis, higher IOP fluctuations >5mm Hg, and associated retinal vein occlusions (RVO) were significant factors for visual progression greater than -5dB/year (R2=53.5%) in POAG and XFG eyes. Age, gender, baseline MD, and number of medications before surgery or at final follow-up did not influence visual progression rates in either group.
UNASSIGNED: A higher IOP fluctuation >5mm Hg and associated RVO were the significant factors predicting visual field progression after filtering surgery in XFG and POAG eyes. Control of both IOP-dependent and -independent mechanisms of VF progression is therefore essential in these eyes.

OBJECTIVE: The aim is to determine the magnitude of glaucomatous damage in the asymptomatic subjects identified with primary glaucoma for the first time and thus to evaluate the significance and efficacy of screening measures for glaucoma.
METHODS: An observational retrospective cohort study of 100 asymptomatic patients of age more than 40 years, diagnosed with and under treatment for primary glaucoma was performed. Patients were categorized into having early, moderate, and severe glaucoma, according to standard automated perimetry (SAP) mean deviation (MD) in the worse eye (<-6, -6 to -12 and >-12 dB, respectively). Risk factors were correlated with the severity of glaucoma at presentation and statistically analyzed.
RESULTS: About 32%, 33%, and 35% of patients were found to have early, moderate, and severe stages of glaucoma with average MD of -3.51 ±1.53, -8.65 ±1.64, -17.15 ± 5.13 on SAP, respectively. The association of risk factors such as age (P = 0.006) and glaucoma awareness (P = 0.044) with the severity of glaucoma was statistically significant. There was no direct statistical correlation found between gender, history of diabetes mellitus, family history of glaucoma, intraocular pressure, central corneal thickness, the angle width, and the severity of glaucoma in our study.
CONCLUSIONS: Majority of cases with primary glaucoma show no symptoms until advanced irreversible stages. Early screening and proper treatment are the only ways to halt its progression. In spite of available facilities, 68% of patients in our study were found to have moderate-to-severe stages of glaucoma. This indicates that our screening measures should reach the masses at the primary level, with a focus on awareness programs.

OBJECTIVE: To assess whether gonioscopy performed on Samoyed puppies (6-14 weeks of age) is a reliable predictor of their gonioscopy results as adults (>11 months of age).
METHODS: A retrospective medical record search was performed to identify Samoyed dogs that had undergone gonioscopy as a puppy (6-14 weeks of age). A second prospective gonioscopy examination was performed as an adult (>11 months of age) and the results were compared. Gonioscopy was assessed on two characteristics: percent of iridocorneal angle (ICA) unaffected by pectinate ligament abnormalities (PLA) and ICA width, with PLA results categorized into unaffected ( ≥ 75% open), moderately affected (50%-74% open), and severely affected (<50% open) and the width categorized into wide, moderate, narrow, and closed groups. A multivariate model was created that considered factors such as PLA, angle width, sex, puppy age, neuter status, and time between examinations.
RESULTS: The eyes of 77 Samoyed dogs (154 eyes) met inclusion criteria. When assessing PLA, 90% of dogs had the same categorization as a puppy and as an adult. When assessing ICA width, 53.2% of dogs had the same width classification as a puppy and as an adult. There is strong evidence that variation between puppy and adult results increases with time between examination (p = .03).
CONCLUSIONS: Puppies unaffected by PLA and with a wide ICA angle, are likely to retain these features as adults. Selection of puppies with desirable gonioscopic traits may help breeders to choose dogs likely to retain these traits as adults for breeding. This may reduce the incidence of glaucoma in the breed. Puppy examinations should be performed in both eyes. Examination of adults prior to breeding remains prudent.

UNASSIGNED: To ascertain the prevalence and clinical features of the various types of childhood glaucoma at a tertiary eye care hospital in Northern India.
UNASSIGNED: Retrospective chart review of all children less than 16 years of age with childhood glaucoma who presented from 1st April 2014 to 31st March 2019, who was diagnosed to have any subtype of childhood glaucoma as per Childhood Glaucoma Research Network (CGRN) classification and advised appropriate management.
UNASSIGNED: Out of 405 children with childhood glaucoma, 36% had primary glaucoma, whereas the rest had secondary glaucoma. Primary congenital glaucoma (PCG) was the most common form of primary glaucoma. Glaucoma associated with acquired conditions was the most common cause of secondary glaucoma. Primary glaucoma was mostly bilateral in contrast to secondary glaucoma. The most common age of presentation with primary glaucoma was <1 year of age, and in children with secondary glaucoma was 11-16 years. On presentation, 80% of eyes had intraocular pressure (IOP) of >20 mm Hg and 70% had cupping of >0.7. Eyes with PCG were primarily managed surgically.
UNASSIGNED: In our cohort, PCG was the most common primary childhood glaucoma. Traumatic glaucoma was the most common secondary glaucoma. Since childhood glaucoma is an important cause of visual morbidity in children, its timely diagnosis and prompt management are essential to prevent irreversible visual loss.
UNASSIGNED: Understanding the disease pattern, their presenting features, and the proportion of different types of childhood glaucoma can help in planning appropriate eye care services, create awareness and better allocate resources to plan appropriate management strategies. Screening programs and counseling of parents should also be strengthened.
UNASSIGNED: Dubey S, Jain K, Pegu J, et al. Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India. J Curr Glaucoma Pract 2023;17(2):68-74.

UNASSIGNED: To study the surgical outcomes of glaucoma drainage device (GDD) implantation in refractory glaucoma patients.
UNASSIGNED: Retrospective chart review of glaucoma patients undergoing GDD implantation, Ahmed glaucoma valve (AGV), Baerveldt glaucoma implants (BGI), and Aurolab aqueous drainage implantation (AADI) from January 2012 to June 2021. Glaucoma patients were classified into two groups: primary glaucoma including: primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG) and juvenile open angle glaucoma (JOAG) and secondary glaucoma including: neovascular glaucoma (NVG), ocular surgery (vitreoretinal surgery, scleral buckling procedure, postoperative extra capsular cataract extraction, scleral fixation intraocular lens, penetrating keratoplasty), intraocular trauma, uveitis glaucoma, lens-induced glaucoma, pseudoexfoliation glaucoma (PXG), iridocorneal endothelial (ICE) syndromes and Axenfeld Rieger Syndrome. Surgical outcomes were studied.
UNASSIGNED: Primary glaucoma included 57 eyes from 49 patients. Secondary glaucoma included 87 eyes from 85 patients. The cumulative probability of complete or qualified success of refractory glaucoma patients at five years were 53.4% (95%CI: 38.4%, 66.3%). Higher success rate was discovered in primary glaucoma at 65.8% (95%CI: 38.4%, 83.3%) than 45.2% (95%CI: 26.9%, 61.9%) in secondary glaucoma group significantly with p=0.003. While the results among success rate, adverse events and complications was not different between types of GDD. Predictors for failure were neovascular glaucoma with unadjusted hazard ratio (HR) 3.62 (95%CI: 1.45, 9.04) with p=0.006, and lens-induced glaucoma with adjusted HR 4.19 (95%CI: 1.10, 15.86) with p=0.035 in multivariable analysis. Tube malposition and occlusion were the most frequent adverse events at 11.11%, corneal decompensation at 5.5%, hypotony at 2% in the nonvalved group, and endophthalmitis at 0.69%.
UNASSIGNED: Surgical success in refractory primary glaucoma was superior to secondary glaucoma with no difference between nonvalved and valved GDD implantation. Lens-induced glaucoma was a strong predictor for failure in GDD implantation.

UNASSIGNED: To analyze ischemia-modified albumin (IMA) levels in aqueous humor and serum, and their correlation to RNFL thinning in primary glaucoma patients.
UNASSIGNED: Cross-sectional study.
UNASSIGNED: Patients were divided into the control and glaucoma groups. The control group was patients with senile cataracts. The glaucoma group consisted of patients diagnosed for the first time as primary open-angle glaucoma (POAG) or primary angle closure glaucoma (PACG). Exclusion criteria were secondary glaucoma and patients with systemic disease. A complete cataract examination was done for all patients, and glaucoma examinations for the glaucoma group. In both groups, the IMA aqueous humor was obtained during cataract and glaucoma procedure. Serum levels of IMA, malondialdehyde (MDA), and tumor necrosis factor alpha (TNF-α) were examined during preoperative examinations.
UNASSIGNED: Control group comprised 33 participants, and glaucoma group 41 patients (21 PACG and 20 POAG). Mean IMA aqueous humor (AQH) levels found in cataract group 6.039±3.16 ng/mL, glaucoma group 14.89±6.08 ng/mL, PACG group 12.69±6.25 ng/mL and POAG group 17.33±4.988 mg/mL. Mean IMA serum levels in cataract group 14.75±6.53 ng/mL, glaucoma group 13.89±6.53 ng/mL, PACG group 12.79±6.46 ng/mL± and POAG group 14.93±10.74 ng/mL. Glaucoma group had significant higher level of IMA in aqueous humor compared to control group, but opposite findings in serum IMA levels between groups. POAG patients had a higher aqueous IMA level compared to PACG group and correlated significantly with IOP. IMA AQH also negatively correlated to the RNFL thickness in both POAG and PACG group. Cut off 9.5 ng/mL was considered as a normal limit value to differentiate between control and glaucoma group.
UNASSIGNED: Primary glaucoma patients showed a significantly increased level of IMA AQH as a local ischemic biomarker compared to the control group. Systemic oxidative activity is not a representation of local ocular oxidative stress in both cataract and glaucoma group.

OBJECTIVE: To determine the 5-year incidence of primary glaucoma and its associated risk factors in rural northern China.
METHODS: Population-based cohort study. A total of 5184 participants aged 30 years and older, without glaucoma at baseline, were subjected to comprehensive standardized interviews and ophthalmic and systemic examinations at baseline and after a 5-year interval in the Handan Eye Study. Incident glaucoma was diagnosed by a consensus panel of five senior glaucoma specialists. Univariate and multivariable logistic regression analyses were performed to identify the baseline risk factors that could predict the incidence of glaucoma.
RESULTS: During the 5-year follow-up, incident primary glaucoma developed in 82 subjects (1.6%; 95% confidence interval [CI], 1.2%-1.9%). The age- and gender-standardized incidence of glaucoma among subjects ≥40 years old was 2.1% (0.4% annually), calculated according to the 2010 Chinese census. A higher age (odds ratio [OR], 1.06; 95% CI, 1.04-1.09; p < 0.001), higher intraocular pressure (IOP) (OR, 1.11; 95% CI, 1.02-1.20; p = 0.017), and vertical cup disc ratio (VCDR) ≥ 0.60 (OR, 5.30; 95% CI, 3.22-8.73; p < 0.001) were found to be associated with an increased risk of incident glaucoma. For each year, older age and each mmHg higher IOP, the risks of primary glaucoma increased by 1.2% and 2.0% per year, respectively.
CONCLUSIONS: We reported the 5-year incidence of primary glaucoma in a rural Chinese population and found that older age, higher IOP, and VCDR ≥ 0.60 at baseline could help in identifying those at highest risk of disease development.

Secondary glaucoma is a typical normal tissue complication following radiation therapy involving ocular radiation exposure at high fractionated dose (several tens of Gy). In contrast, recent studies in acutely exposed Japanese atomic bomb survivors showed a significantly increased risk for normal-tension glaucoma (NTG, a subtype of primary open-angle glaucoma) at much lower dose, but such information is not available in any other cohorts. We therefore set out to evaluate the incidence of risk for primary glaucoma and its subtypes in a Russian cohort of Mayak Production Association nuclear workers who received chronic radiation exposure over many years. Of these, we found a significantly increased relative risk (RR) of NTG incidence (RR = 1.88 95% confidence intervals (CI): 1.01, 3.51; p = 0.047) in workers exposed to gamma rays at cumulative brain absorbed dose above >1 Gy. We observed the linear relationship between NTG incidence and brain absorbed gamma dose with an excess relative risk per unit brain absorbed dose of 0.53 (95% CI: 0.01, 1.68; p < 0.05), but not for any other subtypes nor for total primary glaucoma. Such elevated risk of radiogenic NTG incidence, if confirmed in other cohorts, has significant implications for normal tissue complications in radiotherapy patients receiving ocular radiation exposure, and for ocular radiation protection in radiation workers.

OBJECTIVE: This study aims to determine the 5-year visual field progression and identify the prognostic factors for progression in Malay patients with primary glaucoma.
METHODS: A retrospective cohort record review study was conducted among 222 patients (222 eyes) with primary glaucoma who were selected from a glaucoma research database of a tertiary center in Malaysia. The patients were Malays and diagnosed with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Patients who were followed up regularly for at least 6 months between 1 January 2009 and 31 December 2014 and completed another 1-year follow-up after recruitment (between 1 January 2015 and 31 December 2015) were selected. Multiple prognostic factors that influence visual field progression were identified. Progression of visual field loss was based on the Advanced Glaucoma Intervention Study and Hodapp-Parrish-Anderson scores. Kaplan-Meier survival and Cox proportional hazard regression analyses were performed.
RESULTS: Sixty-three patients (28.4%) developed visual field progression after a mean (SD) follow-up of 6.9 (3.3) years. Those with POAG progressed faster (mean time, 10.6 years; 95% confidence interval [CI], 9.3, 11.9) than those with PACG (17.3 years; 95% CI, 14.8, 19.9) but not statistically significant. Disc hemorrhage and history of eye pain increased the risk of progression by 2.8-folds (95% CI, 1.6, 4.8) and 2.5-folds (1.4, 4.4), respectively.
CONCLUSIONS: The 5-year survival of the Malay primary glaucoma patients with visual field progression was similar with that of other Asian populations. However, aggressive management is required for those with disc hemorrhages and eye pain related to increased intraocular pressure.