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Tanuj Dada - One of the best experts on this subject based on the ideXlab platform.

  • Evaluating target intraocular pressures in primary Congenital Glaucoma
    'Medknow', 2021
    Co-Authors: Ramanjit Sihota, Talvir Sidhu, Tanuj Dada, Rinky Agarwal, Ajay Sharma, Amisha Gupta, Anin Sethi, Veena Pandey
    Abstract:

    Purpose: The aim of this study was to evaluate long-term intraocular pressures that provide stabilization/reversal of Glaucomatous neuropathy after surgery in primary Congenital Glaucoma (PCG). Methods: Prospective evaluation of consecutive PCG patients who underwent trabeculectomy-trabeculotomy and followed up for ≥2 years. Records of regularly performed examination under anesthesia were maintained to ascertain intraocular pressure, (IOP), fundus, refraction and corneal diameter. Outcomes – Primary: cup: disc ratio and intraocular pressure, Secondary: corneal changes and refractive error Results: A total of 174 eyes of 108 children with PCG had a preoperative IOP of 22.44 ± 9.5 mm Hg. Postoperative review IOP was 11.8 ± 4.5 mm Hg, cup-disc-ratio was 0.52 ± 0.23 and corneal diameter was 12.75 ± 0.9 mm. Primary outcomes: Linear regression analysis showed a significant positive correlation of review IOP with cup disc ratio, P = 0.004. 67.9%, of eyes at a review IOP range of 6-12 mm Hg showed reversal, 14.1%, were stable, at 6-15 mm Hg, while 3.84% showed an increase in cup: disc ratio 16-22 mm Hg. Patients operated before 6 months of age had a significantly smaller final cup-disc ratio, P = 0.0013. Patients with a final cup: disc ratio of >0.9 were significantly older at surgery, P < 0.001. Secondary outcomes: There was a positive correlation of final myopia with review IOP on linear regression analysis, P = 0.012. The final spherical error in eyes having cup disc ratio of ≤ 0.5 was –0.96 ± 4.5 diopters, as against -3.45 ± 7.7 diopters in eyes having cup-disc ratio of 0.6-0.8 and -3.8 ± 6.9 diopters in eyes with cup disc ratio of ≥0.9, P = 0.015. There was no significant change in corneal diameter. Conclusion: Patients operated after 6 months of age had a larger final cup: disc ratio, while postoperative review intraocular pressures over 2 years of at least ≤15 mm Hg in primary Congenital Glaucoma eyes, commonly lead to reversal/stability of the neuropathy, and a lower incidence and degree of myopia

  • randomized trial on illuminated microcatheter circumferential trabeculotomy versus conventional trabeculotomy in Congenital Glaucoma
    American Journal of Ophthalmology, 2017
    Co-Authors: Jyoti Shakrawal, Shveta Bali, Talvir Sidhu, Saurabh Verma, Ramanjit Sihota, Tanuj Dada
    Abstract:

    Purpose To compare 1-year outcomes of illuminated microcatheter–assisted circumferential trabeculotomy (IMCT) vs conventional partial trabeculotomy (CPT) for primary Congenital Glaucoma (PCG). Design Randomized clinical trial. Methods Forty eyes of 31 patients with unilateral or bilateral primary Congenital Glaucoma aged less than 2 years were randomized to undergo IMCT (20 eyes) or CPT (20 eyes). Primary outcome measure was intraocular pressure (IOP) reduction. The success criterion was defined as IOP ≤ 12 mm Hg without and with antiGlaucoma medications (absolute success and qualified success, respectively). Results The mean age of our study population was 8.35 ± 1.2 months. The mean preoperative IOP was 24.70 ± 3.90 mm Hg in the IMCT group and 24.60 ± 3.31 mm Hg in the CPT group. Both groups were comparable with respect to preoperative IOP, corneal clarity, corneal diameter, vertical cup-to-disc ratio, and refractive error. In the IMCT group, 360-degree cannulation was achieved in 80% (16/20) of eyes. For the IMCT group and CPT groups, respectively, the absolute success rates were 80% (16/20) and 60% (12/20) ( P P P Conclusion In primary congential Glaucoma, illuminated microcatheter–assisted 360-degree circumferential trabeculotomy performed better than conventional partial trabeculotomy at 1 year follow-up and resulted in significantly lower IOP measurements.

  • illuminated microcatheter circumferential trabeculotomy versus combined trabeculotomy trabeculectomy for primary Congenital Glaucoma a randomized controlled trial
    American Journal of Ophthalmology, 2015
    Co-Authors: Shreyas Temkar, Reetika Sharma, Amar Pujari, Dewang Angmo, Shikha Gupta, Ramanjit Sihota, Tanuj Dada
    Abstract:

    Purpose To compare outcomes of illuminated microcatheter–assisted circumferential trabeculotomy vs combined mitomycin C–augmented trabeculotomy-trabeculectomy for primary Congenital Glaucoma. Design Prospective, randomized trial. Methods Of the 30 patients (60 eyes) analyzed with bilateral primary Congenital Glaucoma aged ≤2 years, 1 eye of each patient was randomized to: illuminated microcatheter–assisted trabeculotomy (Group I) or combined trabeculotomy with trabeculectomy augmented with mitomycin C (Group II). Primary outcome measure was intraocular pressure (IOP) reduction. Categorization into absolute success (IOP ≤15 mm Hg without medication) and qualified success (IOP ≤15 mm Hg with medication) was done. Secondary outcomes included change in corneal diameter and clarity, optic disc status, refraction, need for anti-Glaucoma therapy, and occurrence of complications. Results Mean age of patients was 6.63 ± 5.74 months. IOP fell by 49.3% (22.25 ± 10.88 to 11.56 ± 3.33 mm Hg) in Group I and 46.6% in Group II (21.73 ± 8.89 to 11.60 ± 3.03 mm Hg) ( P P  >.99) and qualified success in 93.3% (28/30) in both groups ( P  = 1). There was significant improvement in corneal clarity ( P P ≤ .01) in both groups at 1 year. Though incidence of hyphema was significantly more in Group I ( P  = .0001), no vision-threatening complications occurred in either group. Conclusions Illuminated microcatheter–assisted circumferential trabeculotomy achieved comparable surgical outcomes to mitomycin C–augmented combined trabeculotomy-trabeculectomy and may be recommended as the initial surgical procedure for primary Congenital Glaucoma.

Deepak P Edward - One of the best experts on this subject based on the ideXlab platform.

  • pigmented lesion in the anterior chamber angle following multiple trans scleral diode laser photocoagulation for Congenital Glaucoma
    American Journal of Ophthalmology Case Reports, 2019
    Co-Authors: Mamdouh Altamimi, Rizwan Malik, Deepak P Edward
    Abstract:

    Abstract Purpose To describe a child with primary Congenital Glaucoma found to have pigment tissue proliferation in the angle following multiple applications of trans-scleral cyclophotocoagulation. Observations During examination under anaesthesia, a 4-year-old girl was found to have pigmented tissue overlying the trabecular meshwork. Anterior segment ocular coherence tomography confirmed mounds of abnormal tissue in the angle. Conclusion Trans-scleral cyclodiode may cause iris root damage, and predispose to proliferation of pigmented tissue which covers the angle structures.

  • Pigmented lesion in the anterior chamber angle following multiple trans-scleral diode laser photocoagulation for Congenital Glaucoma
    'Elsevier BV', 2019
    Co-Authors: Mamdouh Al-tamimi, Rizwan Malik, Deepak P Edward
    Abstract:

    Purpose: To describe a child with primary Congenital Glaucoma found to have pigment tissue proliferation in the angle following multiple applications of trans-scleral cyclophotocoagulation. Observations: During examination under anaesthesia, a 4-year-old girl was found to have pigmented tissue overlying the trabecular meshwork. Anterior segment ocular coherence tomography confirmed mounds of abnormal tissue in the angle. Conclusion: Trans-scleral cyclodiode may cause iris root damage, and predispose to proliferation of pigmented tissue which covers the angle structures. Keywords: Congenital Glaucoma, Trabecular meshwork, Pigment proliferation, Cyclophotocoagulatio

  • Eradicating primary Congenital Glaucoma from Saudi Arabia: The case for a national screening program
    Elsevier, 2017
    Co-Authors: Rizwan Malik, Deepak P Edward, Rajiv Khandekar, Trishal Boodhna, Zuhair Rahbeeni, Abdul Elah Al Towerki, Khaled Abu-amero
    Abstract:

    The prevalence of primary Congenital Glaucoma (PCG) in Saudi Arabia is high and the condition is a cause of childhood blindness in the country. Children often present with severe disease, requiring multiple procedures and a lifetime of medical care. The social and economic burden of the condition is substantial. Presently, the mainstay of management is early diagnosis and treatment of PCG. Premarital screening, especially in recessive diseases, such as PCG can be immensely useful by detecting the presence of a defect in the causative gene, followed by genetic counseling to potential couples that will lead to eradication of the disease in future generations. The introduction of a national screening program similar to the one already functioning for thalassemia, could potentially eliminate childhood blindness from PCG in Saudi Arabia and is likely to prove cost-effective. Keywords: Primary Congenital Glaucoma, Genetic screening, Childhood blindness, Disease preventio

  • primary and secondary Congenital Glaucoma baseline features from a registry at king khaled eye specialist hospital riyadh saudi arabia
    American Journal of Ophthalmology, 2013
    Co-Authors: Farhan F Alanazi, Jonathan C Song, Ahmed Mousa, Jose Manuel Morales, Sami Al Shahwan, Sami Alodhayb, Ibrahim Al Jadaan, Shahira Alturkmani, Deepak P Edward
    Abstract:

    Purpose To compare the demographic and clinical distribution of primary and secondary Congenital Glaucoma from a registry at King Khaled Eye Specialist Hospital. Design Registry-based cohort study. Methods Review of registry data that included new patients with Congenital Glaucoma seen between 2001 and 2003 (29 months); analysis of the demographic data and clinical features of primary and secondary Congenital Glaucoma at presentation. Results A total of 325 eyes of 180 patients were included. Most patients had primary Congenital Glaucoma (80%). The mean (± SD) age at presentation for primary Congenital Glaucoma was 3.8 ± 10.7 months and for secondary Congenital Glaucoma was 4.3 ± 7.9 months. Most primary Congenital Glaucoma and secondary Congenital Glaucoma patients had bilateral disease (82.6%; 74.3%). Primary Congenital Glaucoma was equally distributed by sex but secondary Congenital Glaucoma was 1.5-fold more common in male patients. A positive family history was elicited in 30%, and almost 60% had a history of consanguinity in both groups. The mean intraocular pressure and corneal diameter were comparable in both groups but the axial length was significantly longer in primary Congenital Glaucoma and cup-to-disc (C/D) ratio greater in secondary Congenital Glaucoma. In the primary Congenital Glaucoma group, corneal haze showed a significant relationship with most clinical parameters. In primary Congenital Glaucoma, a positive correlation was noted between age at presentation and increasing corneal diameter and axial length but a negative relationship was noted with C/D ratio and corneal haze, whereas for secondary Congenital Glaucoma only axial length was positively correlated. Conclusion The Congenital Glaucoma registry provides unique baseline data on primary Congenital Glaucoma and secondary Congenital Glaucoma in Saudi Arabia that will enable us to better understand the disease in the Kingdom and region.

Franz Grehn - One of the best experts on this subject based on the ideXlab platform.

  • catheter assisted 360 degree trabeculotomy for Congenital Glaucoma
    Journal of Glaucoma, 2018
    Co-Authors: Anani P Toshev, Esther M Hoffmann, Martin M Much, Thomas Klink, Norbert Pfeiffer, Franz Grehn
    Abstract:

    PURPOSE: To determine feasibility, efficacy, and safety of ab externo 360-degree trabeculotomy with illuminated microcatheter for Congenital Glaucoma. PATIENTS AND METHODS: The postoperative results of 36 eyes in 23 consecutive patients who underwent 360-degree trabeculotomy for primary Congenital Glaucoma (PCG) or secondary Congenital Glaucoma using an illuminated microcatheter were retrospectively analyzed. Success criteria were defined as intraocular pressure (IOP) ≤18 mm Hg without (complete success) and with medication (qualified success). RESULTS: In all previously nonoperated eyes with PCG (group 1), the Schlemm's canal was identified and circumferentially cannulated for 360-degree trabeculotomy. In group 2 comprising of operated eyes with PCG and eyes with secondary Congenital Glaucoma, the performance of 360-degree trabeculotomy failed in 4 eyes because of the Schlemm's canal occlusion or high tissue resistance of the trabecular meshwork. Mean preoperative IOP was 28.6±5 and 29.6±9 mm Hg with 7 of 20 eyes and 7 of 9 eyes receiving IOP-lowering medication in group 1 and group 2, respectively. Mean postoperative IOP was reduced to 13±2.7 and 20.2±7.1 mm Hg after a mean follow-up of 15.3 and 12.7 months with 4 of 20 eyes and 5 of 9 eyes receiving medication in group 1 and group 2, respectively. Four eyes underwent further surgery. Complete success was achieved in 16 and 3 eyes, whereas qualified success was achieved in 20 and 4 eyes from group 1 and group 2, respectively. In all eyes, a mild to moderate postoperative hyphema was observed. CONCLUSIONS: Ab externo catheter-assisted 360-degree trabeculotomy controls IOP in a majority of patients with Congenital Glaucoma after a single operation. Moderate blood reflux in the anterior chamber is considered as a common postoperative finding. We did not observe hypotony or other severe complications in our series. In 1 patient, we experienced catheter misdirection in an eye that had previously undergone trabeculotomy.

  • correlation of postoperative axial length growth and intraocular pressure in Congenital Glaucoma a retrospective study in trabeculotomy and goniotomy
    Graefes Archive for Clinical and Experimental Ophthalmology, 2001
    Co-Authors: Gesine Kiefer, Oliver Schwenn, Franz Grehn
    Abstract:

    Background: This paper investigates the correlation of postoperative intraocular pressure (IOP) with axial length growth in children who underwent either trabeculotomy (TO) or goniotomy (GO) as primary surgery for Congenital Glaucoma. Methods: Thirty-seven eyes of 21 children with Congenital Glaucoma who underwent one or two TOs from 1992 to 1997 and 26 eyes of 16 children with Congenital Glaucoma who underwent one or more GOs from 1974 to 1993 were retrospectively analyzed. None of the eyes had undergone other surgery previously. Thirteen of the TOs were combined with a small trabeculectomy. IOP was measured by handheld applanation tonometry (Perkins). Axial length was measured by ultrasound. The data were analyzed for correlation of postoperative IOP reduction with postoperative axial length growth. Results: Mean duration of follow-up was 27.3 months in the TO eyes and 37.1 months in the GO eyes. Mean pretreatment IOP before surgery was 28.4±6.9 mmHg in the TO eyes and 30.8±8.5 mmHg in the GO eyes. Mean IOP at the end of follow-up was 17.5±5.8 mmHg in the TO eyes and 17.4±10.2 mmHg in the GO eyes. Axial length growth was normalized (proportional or slowed down compared with the nomogram of axial length growth) in 31 of the 37 TO eyes and in 20 of the 26 GO eyes, and was increased in 6 of the TO eyes and 6 of the GO eyes at the end of follow-up. Regarding axial length growth, 6 of 37 TO eyes had increased axial length growth at the end of follow-up. Three of these eyes also did not fulfill the IOP success criterion; 2 of the 3 eyes with normalized IOP had only borderline increased axial length growth. Six of 26 GO eyes had increased axial length growth at the end of follow-up. Five of these eyes did not fulfill the IOP success criterion; 1 eye with normalized IOP had only borderline increased axial length growth. Conclusion: The data show remarkably good correlation of postoperative IOP with postoperative axial length growth. Axial length measurements can therefore help to ascertain halting or progression of Congenital Glaucoma and thus are considered an important parameter for Congenital Glaucoma follow-up.

  • trabeculotomy in Congenital Glaucoma
    Graefes Archive for Clinical and Experimental Ophthalmology, 2000
    Co-Authors: Gesine Meyer, Norbert Pfeiffer, Oliver Schwenn, Franz Grehn
    Abstract:

    Background: Congenital Glaucoma is a potentially blinding disease that requires surgical therapy. This paper describes the outcome of trabeculotomy in primary Congenital Glaucoma. Methods: Thirty-nine eyes of 22 children with Congenital Glaucoma who underwent trabeculotomy with or without a simultaneous trabeculectomy between 1992 and 1997 were retrospectively analyzed. Results: Mean follow-up was 24.7±17.9 months. A mean of 1.3 operations per eye were performed. The mean IOP at the end of follow-up (n=39) was 17.7±6.0 mmHg; in 8 eyes (20.5%) the IOP was >21 mmHg, in 31 eyes (79.5%) it was ≤21 mmHg. The mean difference between pretreatment IOP and IOP at the end of follow-up (n=39) was –10.5±9.4 mmHg (–37.2%). Success rates were calculated: IOP was ≤21 mmHg in 36/39 eyes (92.3%) after 1/2 year of follow-up, in 25/27 eyes (92.6%) after 1 year, in 15/18 eyes (83.3%) after 2 years, in 8/12 (66.7%) eyes after 3 years, in 4/8 eyes (50%) after 4 years and in 4/4 (100%) eyes after 5 years of follow-up. Complications included hypotony (three eyes), subchoroidal bleeding (one eye ), detachment of Descemet’s membrane (one eye) and macular pucker (one eye in which later mitomycin C was used). Visual acuity (VA) was tested with various methods in 35 eyes. VA was within the normal nomogram range in 12 eyes and below the normal range in 23 eyes at the end of follow-up. Axial length measurements showed normalization according to the age nomogram in 22 of 35 eyes. Conclusion: This study shows that trabeculotomy is an effective surgical procedure in Congenital Glaucoma with satisfactory success rates up to 5 years of follow-up.

Abdullah A Altorbak - One of the best experts on this subject based on the ideXlab platform.

  • outcome of combined ahmed Glaucoma valve implant and penetrating keratoplasty in refractory Congenital Glaucoma with corneal opacity
    Cornea, 2004
    Co-Authors: Abdullah A Altorbak
    Abstract:

    Purpose: To investigate surgical outcomes following simultaneous Ahmed Glaucoma valve implant and penetrating keratoplasty (PKP) in the management of refractory Congenital Glaucoma with corneal opacity. Methods: A retrospective review was undertaken of pediatric patients who underwent simultaneous Ahmed Glaucoma valve implant and PKP at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, between January 1994 and September 1999. Results: Twenty eyes of 17 patients were included in the study. Cumulative probabilities of success by Kaplan-Meier analysis showed 85%, 44%, and 33% TOP control and 85%, 43%, and 17% graft success at 2, 24, and 48 months. The most common cause of Glaucoma failure that required subsequent surgery was subconjunctival scarring, which resulted in loss of long-term IOP control. Main graft-related complications included failure (13/20) and graft ulceration (6/20), and in 4/6 ulcerated grafts, Streptococcus pneumoniae was cultured positively. Subsequent surgery was the only significant clinical factor associated with poor outcome of Glaucoma. However, low graft survival rate was significantly associated with delinquency of follow-ups, corneal ulcer, subsequent surgery, and postoperative complications. Conclusions: The long-term success of simultaneous Ahmed Glaucoma valve implant and PKP in refractory Congenital Glaucoma associated with corneal opacity is low, and the complication rate is high.

  • outcome of combined ahmed Glaucoma valve implant and penetrating keratoplasty in refractory Congenital Glaucoma with corneal opacity
    Cornea, 2004
    Co-Authors: Abdullah A Altorbak
    Abstract:

    Purpose:To investigate surgical outcomes following simultaneous Ahmed Glaucoma valve implant and penetrating keratoplasty (PKP) in the management of refractory Congenital Glaucoma with corneal opacity.Methods:A retrospective review was undertaken of pediatric patients who underwent simultaneous Ahme

Ningli Wang - One of the best experts on this subject based on the ideXlab platform.

  • ab interno versus ab externo microcatheter assisted trabeculotomy for primary Congenital Glaucoma with clear cornea
    Clinical and Experimental Ophthalmology, 2020
    Co-Authors: Yan Shi, Huaizhou Wang, Julius T Oatts, Kai Cao, Chen Xin, Xintong Liang, Jiaxin Tian, Ningli Wang, Ying Han
    Abstract:

    IMPORTANCE This is the first comprehensive comparison between ab interno approach and ab externo approach for microcatheter-assisted trabeculotomy in primary Congenital Glaucoma with clear cornea. BACKGROUND Ab externo microcatheter-assisted trabeculotomy is considered to be the gold standard for primary Congenital Glaucoma. The novel ab interno approach would intuitively be similar to ab externo approach for microcatheter-assisted trabeculotomy in eyes with clear cornea, however, there is no evidence yet. DESIGN non-contemporary comparison of retrospective case series. PARTICIPANTS Fifty-eight and fifty-seven consecutive primary Congenital Glaucoma eyes with clear corneas underwent ab interno and ab externo microcatheter-assisted trabeculotomy, respectively. METHODS retrospective comparison of clinical outcomes MAIN OUTCOME MEASURES: Surgical success was defined as a post-operative intraocular pressure of ≤21 mmHg with at least a 30% reduction from pre-operative IOP with or without the use of anti-Glaucoma medication (qualified and complete success, respectively). RESULTS The qualified success rate (87.9% versus 82.2%, P=0.40) and complete success rates (81.0% versus 73.3%, P=0.32) were comparable between groups. Complications were minimal and comparable. Less than 360 degree trabeculotomy (P=0.009) and a higher number of previous surgeries (p=0.03) were both associated with worse surgical outcomes. CONCLUSIONS AND RELEVANCE Ab interno approach provide good and comparable outcomes as ab externo approach for microcatheter-assisted trabeculotomy in primary Congenital Glaucoma eyes with clear cornea. It should be considered as the initial choice in these patients with the benefit of sparing conjunctiva. Successful trabeculotomy with either technique during the first attempt is critical to overall success and underscores the need for proficiency before independent practice.

  • microcatheter assisted trabeculotomy for primary Congenital Glaucoma after failed Glaucoma surgeries
    Journal of Glaucoma, 2019
    Co-Authors: Man Hu, Huaizhou Wang, Alex S Huang, Li Li, Yongli Xu, Ningli Wang
    Abstract:

    PURPOSE: To evaluate the effectiveness of microcatheter-assisted trabeculotomy (MAT) to treat primary Congenital Glaucoma after failed previous Glaucoma surgeries. MATERIALS AND METHODS: Retrospective, noncomparative, interventional case series conducted at Beijing Tongren Eye Center, China. Outcome measures were compared between 3 groups: successful and complete (≥330 degrees) MAT; successful and partial ( 180 degrees. Success was defined as final intraocular pressure ≤21 mm Hg, with (qualified success) or without (complete success) Glaucoma medications. RESULTS: In total, 74 eyes of 63 consecutive patients were included. MAT was performed in 50 eyes (67.6%). Postoperative intraocular pressure and number of Glaucoma drops (17.7±8.6 mm Hg, 0.6±1.2 medications) was significantly less than the preoperative values (35.3±7.2 mm Hg, 2.7±0.8 medications; P<0.001). Cumulative probabilities of qualified and complete success were 84.0% and 80.0% at 3-year follow-up with no difference between complete and partial trabeculotomies. MAT was not successfully performed in 24 eyes (32.4%), requiring conversion to traditional trabeculotomy and associated with greater incidence of previous surgeries (P<0.001), earlier age of disease onset (P=0.024) and worse corneal transparency (P=0.010). Cumulative probabilities of qualified and complete success were 37.0% and 29.2% at 3-year follow-up. CONCLUSIONS: Both complete and partial MAT achieved significant pressure reduction in cases of primary Congenital Glaucoma with previous failed Glaucoma surgeries in intermediate term.