A 40-year-old man was referred for unilateral Glaucoma in his left eye. Medical history was unremarkable for systemic disorders and medications. The patient had undergone uneventful phacoemulsification and posterior chamber intraocular lens (PCIOL) implantation in the same eye two years ago. Six months postoperatively intraocular pressure (IOP) was inadequately controlled with topical medications ….

Purpose: To evaluate the efficacy and safety of Ahmed Glaucoma Valve (AGV) implantation with adjunctive use of preserved amniotic membrane for surgical management of refractory Glaucoma.Methods: Seven patients (5 female subjects) with refractory Glaucoma were included in the study. An AGV (model FP7) was implanted in the usual manner and was covered with two layers of cryopreserved human amniotic membrane. Intraocular pressure (IOP) and number of Glaucoma medications before and after surgery, and complications were evaluated.Results: Mean duration of follow-up was 16.8±4.6 months. Mean preoperative IOP was 31.7±4.4 mmHg which was reduced to 17.7±6.1 mmHg at final follow-up (P=0.01, Wilcox on U test). Although the number of topical medications was also reduced (mean decrease of 0.85 drops), this decrease was not significant (P=0.10, Wilcox on U test). None of the eyes developed encapsulation after surgery; only one case was complicated by posterior migration of the implant resulting in failure.Conclusion: Glaucoma shunt surgery using the AGV with adjunctive amniotic membrane seems to be a safe and effective procedure which may reduce the risk of bleb encapsulation in refractory Glaucoma’s.

The prostaglandin-related topical medications include latanoprost, unoprostone, travoprost, and bimatoprost. They are the new class of Glaucoma medications. Prostaglandin analogs reduce intraocular pressure (IOP) by improving uveoscleral outflow primarily by altering the extracellular matrix. These prostaglandin-related agents or hypotensive lipids have a potent ocular antihypertensive agent when given once daily, with the exception of unoprostone, which is prescribed twice a day.Monotherapy with prostoglandins can reduce IOP levels by 29-32% over 1-12 months.Prostaglandins are quickly becoming important first-line agents in the treatment of Glaucoma. They are well-tolerated and lack significant systemic side effects. They have the added benefit of once daily dosing.At high doses, these produce ocular inflammation and hypertension, but in smaller amounts, they reduce IOP.Prostaglandin analogs are contraindicated in any patient who is allergic or sensitive to these drugs, those with multiple risk factors, with iritis, herpes simplex keratitis or in the immediate postoperative period following intraocular surgery and patients with a history of uveitis and ocular herpes infection.

Purpose: To compare the serum homocysteine (Hcy) level in healthy control individuals and in patient with primary open angle Glaucoma (POAG) and pseudoexfoliative Glaucoma (PEXG) Methods: In this cross sectional study, 79 subjects including 36 patients with PEXG, 23 patients with POAG, and 20 matched healthy control individuals were recruited. Those who used alcohol and mediations affecting Hcy levels were excluded. The level of serum Hcy was measured by Enzyme Immunoassay (EIA) method. Analysis of variance (ANOVA) was used to compare Hcy levels among PEXG, POAG and control groups.Results: The mean ages were 68.9, 63.3, and 64.7 years in PEXG, POAG, and control groups, respectively (P=0.053), and 64%, 52%, and 60% were male in three study groups, respectively (P=0.67). The mean Hcy levels in PEXG, POAG and control groups were 12.21±4.93, 10.20±5.25, and 11.59±3.87 mmol/l, respectively (P=0.293, ANOVA). There was not a significant correlation between Hcy levels and diabetes, hyperlipidemia (HLP), hypertension (HTN), and cigarette smoking among diagnostic groups.Conclusion: No significant difference was found in Hcy levels among PEXG, POAG, and normal control group.

Background and Aim: The aim of this study was to evaluate the success rate and complications of Ahmed Glaucoma Valve (AGV) insertion during a follow up of at least 5 years. Materials and Methods: In this retrospective case series study, patients with 5 years of follow up after AGV insertion were enrolled. Success was defined as intraocular pressure (IOP) < 21 mm Hg (criterion A) and IOP < 16 mm Hg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than preoperative medication (qualified success). Cumulative success was defined as sum of qualified and complete success. Findings: This study included 40 eyes of 40 patients with mean age of 40. 63± 22. 91years, (range 1 to 88). Cumulative survival success rates were 90%, 73% at 1 and 5 years after surgery according to criterion A and 42%, 25% based on criterion B with the median survival time of 60 months and 22. 36 months, respectively. Complications were observed in 4 eyes of 4 patients (10%) and included wound dehiscence, choroidal detachment, encapsulated bleb and lid retraction. There were not any early complications such as hypotonia or hyphema. Conclusion: The present study was one of the largest series that reported the long-term outcome of AGV implantation in Asian patients with refractory Glaucoma, and showed the wide difference of success rate between criterion A and B.

Purpose: To compare the prevalence of open-angle Glaucoma (OAG), Glaucoma suspect (GS), and ocular hypertension (OHT) among patients with Graves' orbitopathy (GO) admitted to a private endocrinology clinic and a control group.Methods: This analytic study with convenience sampling was conducted on patients with GO verified by complete systemic and paraclinic examinations by an endocrinologist (A.F.), and a matched control group from companions of patients admitted to the general ophthalmology clinic of Imam Hossein Hospital without any history of documented thyroid disease or orbitopathy and with negative systemic and paraclinic examinations at the time of study. Complete ophthalmologic examinations and intraocular pressure (IOP) measurements in primary position of gaze were performed at least at two different times of day. In case of any type of optic nerve defect or dysfunction, visual field testing by Humphery automated achromatic static perimetry and to rule out compressive optic neuropathy (CON), CT-scan or MRI were performed. OAG, OHT, and (GS) were diagnosed based on characteristic findings and after ruling out the other causes. Classification of Graves' orbitopathy was performed by NOSPECS system and phases of disease activity. Fisher's exact test or chi-square test for qualitative and ANOVA or Hest for quantitative data were used in statistical analysis.Result: We assessed 233 eyes of 117 patients with GO and 240 eyes of 120 persons in the control group. Mean age ± SD was 39.9±13.4years and 39±14.2years in GO group and control group, respectively. OAG was diagnosed in 6 eyes (2.5%), GS in 5 eyes (2.1%), and OHT in 20 (8.5%) eyes of GO group. From the control group, 2 eyes (0.8%) had OAG. Prevalence of OAG was not statistically different between the two groups, but prevalence of OAG and GS altogether was statistically more in GO than control group (P< 0.02). Prevalence of ocular hypertension with or without optic nerve damage also was statistically more in GO than control group (p<0.001). In GO group, 10 eyes (4.3%) had CON, of these, 5 (2.1%) had also OHT. All OAG and GS eyes were in class 3 or higher of NOSPECS classification. Active phase of GO was observed more in eyes with OHT (p< 0.001), but not for eyes with OAG or GS in GO group.Conclusion: The prevalence of OAG, GS, and OHT in Graves' orbitopathy is more than the general population. Also the results of this study suggest routine and periodic ophthalmologic examination in patients with GO especially in higher classes of NOSPECS classification and/or active phase of disease.

Purpose: To compare the outcomes and complications of mitomycin-C trabeculectomy (MMC-T) versus the Ahmed Glaucoma implant (AGI) for treatment of pediatric aphakic Glaucoma.Methods: In a randomized clinical trial, 30 eyes of 28 children <16 years of age who had undergone anterior lensectomy-vitrectomy for congenital cataract were assigned to MMC-T (15 eyes of 13 children) or AGI (15 eyes of 15 children). Surgical success was classified as complete (IOP 6-21 mmHg without any antiGlaucoma medication) and partial (IOP 6-21 mmHg with £2 topical antiGlaucoma agents) in the absence of any sight-threatening complication or need for further Glaucoma surgery, stable cup/disc ratios and visual loss £2 Snellen lines. Overall success was defined as the sum of complete and partial success.Results: Mean patient age was 9.1±4.1 and 10.9±5.1 years in the MMC-T and AGI groups, respectively (P=0.29). After a mean follow up of 14.8±11 and 13.1±9.7 months; complete, partial and overall success rates were 33.3%, 40% and 73.3% in the MMC-T vs 20%, 66.7% and 86.7% in the AGI groups, respectively (P= 0.361). Complication and failure rates were 40% and 26.7% in the MMC-T group vs 26.7% and 13.3% in the AGI group, respectively (P= 0.439).Conclusion: MMC-T and AGI seem to be comparable in terms of success and complications as the initial surgical procedure in pediatric aphakic Glaucoma. Choice of either technique depends on surgeon’s experience and conjunctival quality and mobility.

Purpose: Viscocanalostomy represents an alternative to standard penetrating Glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle Glaucoma (POAG) versus eyes with pseudoexfoliation Glaucoma (PEXG). Methods: In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre-and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiGlaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication. Results: Fifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23. 36 ± 8. 8 months (range, 6– 40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14. 7 ± 8. 9 vs 10. 1 ± 7. 7 mmHg) (P = 0. 05). At the final follow-up visit, the mean postoperative IOP was 14. 1 ± 2. 1 and 16. 6 ± 3. 5 mmHg in the PEXG and POAG eyes, respectively (P = 0. 001). A complete success rate of 88. 9% and 75. 9% was achieved in PEXG and POAG eyes, respectively (P = 0. 07). The qualified success rate was 100% in the PEXG and 85. 2% in POAG groups (P = 0. 03). Conclusion: Phacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG.