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Fard AM, Patel SP, Nader ND. The efficacy of 2 different phakic intraocular lens implant in keratoconus as an isolated procedure or combined with collagen crosslinking and intra-stromal corneal ring segments: a systematic review and meta-analysis. Int Ophthalmol 2023; 43:4383-4393. [PMID: 37470861 DOI: 10.1007/s10792-023-02813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To compare the efficacy of phakic intra-ocular lenses in isolation or in combination with corneal crosslinking (CXL) and/or intra-stromal corneal ring segments (ICRS) in keratoconus. METHODS Data extracted from the publications meeting the selection. The outcome parameters included mean pre- and post-operative uncorrected distance visual acuity, corrected distance visual acuity (CDVA), sphere and cylinder of refraction and complications. Available data analyzed with Cochrane Review Manager. RESULTS A total of 23 studies including 464 eyes were included. All the parameters showed significant improvement in all subgroups other than CDVA in ACPIOL + CXL subgroup and cylinder in PIOL + CXL subgroups. There was not a significant difference between PCPIOL and ACPIOL in the outcomes, exception was more improvement of CDVA in "ACPIOL only" than" PCPIOL only" subgroup. CONCLUSION Both PCPIOLs and ACPIOLs are comparably safe and efficient options in management of KCN and their efficacy significantly improves when combined with CXL/ICRS.
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Affiliation(s)
- Ali Mahdavi Fard
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Ophthalmology, Doheny Eye Center of UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sangita P Patel
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Research and Ophthalmology Services, Veterans Administration of Western New York Healthcare System, Buffalo, NY, USA
| | - Nader D Nader
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
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Moshirfar M, Tukan AN, Bundogji N, Liu HY, McCabe SE, Ronquillo YC, Hoopes PC. Ectasia After Corneal Refractive Surgery: A Systematic Review. Ophthalmol Ther 2021; 10:753-776. [PMID: 34417707 PMCID: PMC8589911 DOI: 10.1007/s40123-021-00383-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/02/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The incidence of ectasia following refractive surgery is unclear. This review sought to determine the worldwide rates of ectasia after photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) based on reports in the literature. METHODS A systematic review was conducted according to modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications were identified by a search of eight electronic databases for relevant terms between 1984 and 2021. Patient characteristics and preoperative values including manifest refractive spherical refractive equivalent (MRSE), central corneal thickness (CCT), anterior keratometry, postoperative residual stromal bed (RSB), and percent tissue altered (PTA) were summarized. In addition, annual rates of each refractive surgery were determined, and incidence of post-refractive ectasia for each type was calculated using the number of ectatic eyes identified in the literature. RESULTS In total, 57 eyes (70 eyes including those with preoperative risk factors for ectasia) were identified to have post-PRK ectasia, while 1453 eyes (1681 eyes including risk factors) had post-LASIK ectasia, and 11 eyes (19 eyes including risk factors) had post-SMILE ectasia. Cases of refractive surgery performed annually were estimated as 283,920 for PRK, 1,608,880 for LASIK, and 96,750 for SMILE. Reported post-refractive ectasia in eyes without preoperative identifiable risk factors occurred with the following incidences: 20 per 100,000 eyes in PRK, 90 per 100,000 eyes in LASIK, and 11 per 100,000 eyes in SMILE. The rate of ectasia in LASIK was found to be 4.5 times higher than that of PRK. CONCLUSION Post-refractive ectasia occurs at lower rates in eyes undergoing PRK than LASIK. Although SMILE appears to have the lowest rate of ectasia, the number of cases already reported since its recent approval suggests that post-SMILE ectasia may become a concern. Considering that keratoconus is a spectrum of disease, pre-existing keratoconus may play a larger role in postoperative ectasia than previously accounted for in the literature.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA.
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
| | - Alyson N Tukan
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Nour Bundogji
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Harry Y Liu
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
- Mission Hills Eye Center, Pleasant Hill, CA, USA
| | - Yasmyne C Ronquillo
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
| | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
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Barbara A, Barbara R, Barua A, Alio J, Bandello F. Why a dedicated section on keratoconus in the European Journal of Ophthalmology? Eur J Ophthalmol 2021; 31:1513-1516. [PMID: 34176308 DOI: 10.1177/11206721211026096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Keratoconus is emerging as a new subspecialty in ophthalmology. The literature is booming with publications on the topic as we have better understanding of the pathophysiology, treatment and prognosis of the disease over the past two decades. Advances in diagnostic tools as well as genuine increase in prevalence have shifted perspective of the disease from being a rare one. Early diagnosis is of public health interest as early treatment arrests progression. With the view to encourage research, increase awareness and to reflect the evolution of knowledge related to keratoconus, the European Journal of Ophthalmology has dedicate a special section on keratoconus in its journal.
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Affiliation(s)
- Adel Barbara
- IVISION Cornea and Refractive Surgery Center, Haifa, Israel
| | - Ramez Barbara
- Ophthalmology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham, UK
| | - Jorge Alio
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Ormonde S. Refractive surgery for keratoconus. Clin Exp Optom 2021; 96:173-82. [DOI: 10.1111/cxo.12051] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sue Ormonde
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand,
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5
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Valdez-García JE, Hernandez-Camarena JC, Loya-García D, Lopez-Montemayor P, Ortiz-Morales G, Merayo-Lloves J. Safety and Efficacy of Myopic LASIK performed on Thin Corneas. Open Ophthalmol J 2020. [DOI: 10.2174/1874364102014010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
The aim was to report on the visual outcomes and safety of myopic LASIK performed in patients with corneas of central thickness below average(<540μm) and normal topography.
Methods:
This is a retrospective cohort study conducted at a private practice setting on Mexican Hispanic patients who underwent myopic LASIK between January 2014 and January 2015. An analysis of records of patients >18 years-old with previous normal topography, stable refraction, corrected visual acuity ≥ 20/20 (Snellen), Central Corneal Thickness (CCT) < 540μm and at least 12 months follow up after surgery was conducted. The main outcome measures were standard visual outcomes (efficacy, safety, refractive stability) and Percent Tissue Altered (PTA) analysis was conducted.
Results:
A total of 51 patients (102 eyes) were included; 56% (n=57) were female. The mean age was 26.52 ± 8.06 (range 18-55 years) with a mean follow up of 13.9 ± 1.2 months. Preoperative CCT was 515.44 ± 17.87μm (range 452- 540μm), with a mean refractive spherical equivalent (SEQ): -4.08 ± 2.17 D (range -0.75 to -9.75 D), and mean refractive cylinder: -1.44 ± 1.29 D (range 0.00 to -6.00 D). Mean predictability of postoperative SEQ was -0.20 ± 0.40 D (range -1.25 to +1.25). Postoperative SEQ was ±0.50 D in 71%, ±1.00 D in 93% of the eyes. Postoperative uncorrected distance visual acuity was ≥20/20 in 78% and ≥20/25 in 95%. One line of CDVA was lost in 3% of the eyes, no eyes lost ≥2 lines. No ectasia cases were observed during follow-up.
Conclusion:
LASIK surgery in Mexican Hispanic patients with thinner than “normal” corneas (<540 μm) is safe, efficient and predictable at 1 year follow up for myopic refractive corrections with no evidence of postoperative keratectasia.
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Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality. J Ophthalmol 2017; 2017:7589816. [PMID: 29403662 PMCID: PMC5748308 DOI: 10.1155/2017/7589816] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/28/2017] [Indexed: 01/14/2023] Open
Abstract
Keratoconus provides a decrease of quality of life to the patients who suffer from it. The treatment used as well as the method to correct the refractive error of these patients may influence on the impact of the disease on their quality of life. The purpose of this review is to describe the evidence about the conservative surgical treatment for keratoconus aiming to therapeutic and refractive effect. The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. Cross-linking can halt the disease progression, intrastromal corneal ring segments can improve the corneal shape and hence the visual quality and reduce the refractive error, PRK can correct mild-moderate refractive error, and intraocular lenses can correct from low to high refractive error associated with keratoconus. Any of these surgical options can be performed alone or combined with the other techniques depending on what the case requires. Although it could be considered that the surgical option for the refracto-therapeutic treatment of the keratoconus is a reality, controlled, randomized studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case.
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7
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Giacomin NT, Mello GR, Medeiros CS, Kiliç A, Serpe CC, Almeida HG, Kara-Junior N, Santhiago MR. Intracorneal Ring Segments Implantation for Corneal Ectasia. J Refract Surg 2016; 32:829-839. [DOI: 10.3928/1081597x-20160822-01] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/05/2016] [Indexed: 12/20/2022]
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9
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Tomita M, Watabe M, Mita M, Waring GO. Long-term observation and evaluation of femtosecond laser-assisted thin-flap laser in situ keratomileusis in eyes with thin corneas but normal topography. J Cataract Refract Surg 2014; 40:239-50. [PMID: 24461499 DOI: 10.1016/j.jcrs.2013.07.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 07/04/2013] [Accepted: 07/26/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of thin-flap laser in situ keratomileusis (LASIK) in eyes with thin corneas (central corneal thickness [CCT] <500 μm) but normal topography. SETTING Private center, Tokyo, Japan. DESIGN Retrospective randomized comparative study. METHOD The efficacy, safety, predictability, and topography of LASIK were evaluated in eyes with a CCT of less than 500 μm but with normal topography (thin-cornea group) to 6 years postoperatively. The LASIK outcomes in the thin-cornea group were compared with those in eyes with a CCT of 500 μm or greater (control group). Analysis was performed to determine whether there were differences between the groups at the last checkup 3 to 4 years postoperatively. RESULTS In the thin-cornea group (291 eyes; 146 patients), no significant differences were observed in LASIK outcomes when eyes were subdivided by the time of final checkup (3, 4, and ≥ 5 years). There was a significant difference in visual and refractive outcomes between 3 months postoperatively and the last checkup in the thin-cornea group and the control group (371 eyes; 193 patients). No significant difference in visual, refractive, or topography outcomes was observed between the 2 groups at the last checkup. CONCLUSIONS Laser in situ keratomileusis in eyes with thin corneas was as safe and effective as and showed similar long-term stability in eyes with a CCT of 500 μm or greater. No eye in either group had a postoperative complication. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Minoru Tomita
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA.
| | - Miyuki Watabe
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA
| | - Mariko Mita
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA
| | - George O Waring
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA
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10
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Ferreira TB, Güell JL, Manero F. Combined Intracorneal Ring Segments and Iris-Fixated Phakic Intraocular Lens for Keratoconus Refractive and Visual Improvement. J Refract Surg 2014; 30:336-41. [DOI: 10.3928/1081597x-20140319-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022]
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11
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Comparison of iris-claw and posterior chamber collagen copolymer phakic intraocular lenses in keratoconus. J Cataract Refract Surg 2014; 40:383-94. [DOI: 10.1016/j.jcrs.2013.07.052] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 07/25/2013] [Accepted: 07/30/2013] [Indexed: 02/07/2023]
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12
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Jaimes M, Ramirez-Miranda A, Graue-Hernández EO, Navas A. Keratoconus therapeutics advances. World J Ophthalmol 2013; 3:20-31. [DOI: 10.5318/wjo.v3.i3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023] Open
Abstract
Keratoconus is a progressive, usually bilateral disease of the cornea that significantly diminishes visual acuity, secondary to a progressive corneal deformity which is characterized by corneal thinning, variable degrees of irregular astigmatism and specific abnormal topographic patterns. Normally it initiates during puberty and is progressive until the third or fourth decade of life, when normally the progression rate is diminished or waned. There are multiple scales to clinically classify keratoconus. One of the most commonly used is Amsler-Krumeich and recently with the development of morphometric and aberrometric techniques, additional scales have been created that allow keratoconus to be classified according to its severity. Despite certain etiology of keratoconus remains unknown, current treatment options are available in patients with ectatic corneas and they vary depending on the severity of the disease and they include spectacles, contact lenses, intrastromal rings, keratoplasty both penetrant or lamellar, cross-linking, refractive lens exchange with intraocular lens implant, phakic intraocular lenses and the combination of these alternatives. Some authors have been using excimer laser in patients with keratoconus but the safety of the procedure is controversial. Currently, the techniques for the management of keratoconus can be classified in 3 types: corneal strengthening techniques, optical optimization techniques and combined techniques.
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13
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14
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Abstract
Pre-2000, the clinical management of keratoconus centred on rigid contact lens fitting when spectacle corrected acuity was no longer adequate, and transplantation where contact lens wear failed. Over the last decade, outcome data have accumulated for new interventions including corneal collagen crosslinking, intracorneal ring implantation, topographic phototherapeutic keratectomy, and phakic intraocular lens implantation. We review the current evidence base for these interventions and their place in new management pathways for keratoconus under two key headings: corneal shape stabilisation and visual rehabilitation.
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Affiliation(s)
- D M Gore
- Moorfields Eye Hospital, London, UK.
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15
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He M, Wang D, Jiang Y. Overview of Ultrasound Biomicroscopy. J Curr Glaucoma Pract 2012; 6:25-53. [PMID: 27990069 PMCID: PMC5159457 DOI: 10.5005/jp-journals-10008-1105] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/09/2011] [Indexed: 11/23/2022] Open
Abstract
Ultrasound biomicroscopy (UBM) is a high-resolution ultrasound technique that allows noninvasive in vivo imaging of structural details of the anterior ocular segment at near light microscopic resolution and provides detailed assessment of anterior segment structures, including those obscured by normal anatomic and pathologic relations. This review gives an overview regarding the instrument, technique and its applications.
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Affiliation(s)
- Mingguang He
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dandan Wang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuzheng Jiang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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16
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Abstract
Until recently, corneal biomechanical properties could not be measured in vivo. The ocular response analyzer is a new, noninvasive device that analyses corneal biomechanical properties simply and rapidly. The ORA allows cornea compensated IOP measurements and can estimate corneal hysteresis (CH) and corneal resistance factor (CRF). It is designed to improve the accuracy of IOP measurement by using corneal biomechanical data to calculate a biomechanically adjusted estimate of intraocular pressure. This review critically evaluates the technology and its implications in current day glaucoma management.
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Affiliation(s)
- Sushmita Kaushik
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Pandav
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Khurana AK, Khurana B, Khurana AK. Drug-induced Angle-Closure Glaucoma. J Curr Glaucoma Pract 2012; 6:6-8. [PMID: 27990064 PMCID: PMC5159452 DOI: 10.5005/jp-journals-10008-1100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 11/02/2011] [Indexed: 11/23/2022] Open
Abstract
Drug-induced angle-closure glaucoma is an important entity for the ophthalmologist as well as the general physician as it represents a preventable cause of potential blindness. This brief review highlights the fact that a high index of suspicion, in a susceptible individual followed by confirmation on appropriate imaging modality (UBM, ultrasound or anterior segment OCT) can alleviate the threat to sight and also help to institute appropriate therapy.
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Affiliation(s)
- Aruj K Khurana
- Senior Professor, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Bhawna Khurana
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashok K Khurana
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Navas A, Tapia-Herrera G, Jaimes M, Graue-Hernández EO, Gomez-Bastar A, Ramirez-Luquín T, Ramirez-Miranda A. Implantable collamer lenses after intracorneal ring segments for keratoconus. Int Ophthalmol 2012; 32:423-9. [DOI: 10.1007/s10792-012-9582-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/21/2012] [Indexed: 11/27/2022]
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19
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Kaur D, Gupta A, Singh G. Perspectives on Quality of Life in Glaucoma. J Curr Glaucoma Pract 2012; 6:9-12. [PMID: 27990065 PMCID: PMC5159453 DOI: 10.5005/jp-journals-10008-1101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/28/2011] [Indexed: 11/23/2022] Open
Abstract
Chronic diseases are invariably associated with decreased functioning ability of the individual in one form or the other depending upon the system/organ involved. Disability consequent to the disease is the major factor affecting the patient's physical and psychosocial well-being; in other words, the 'Quality of Life (QOL)'. Besides the disease itself, the treatment and its consequences are also major determinants of QOL of the patients. Globally, glaucoma, which is emerging as one of the leading causes of blindness, is one such chronic ophthalmic disease characterized by a progressive loss of visual function and a potential to cause irreversible blindness, if not treated at an early stage. Patients of glaucoma need to take lifelong medications in order to keep their intraocular pressure within limits. It's impact on the daily life of patients cannot be overexpressed and compounded by the fact that it remains asymptomatic for a considerable time after the disease has set in; has led to new imperatives in diagnosis, treatment and epidemiological and outcome studies. Assessment of the debilitating effect of glaucoma and side effects of its treatment on the emotional and physical QOL of the patient is therefore an important criterion for arriving at the treatment regimen. An extensive literature search was done on Pubmed Central, Pubmed and Google Scholar using the keywords 'glaucoma', 'quality of life in glaucoma', 'management in POAG' and 'QOL assessment tools'. Various tools available for the assessment of QOL, and their advantages and limitations have been reviewed in this article.
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Affiliation(s)
- Divjyot Kaur
- Junior Resident, Department of Pharmacology, Government Medical College, Patiala, Punjab, India
| | - Anita Gupta
- Professor and Head, Department of Pharmacology, Government Medical College, Patiala, Punjab, India
| | - Gursatinder Singh
- Associate Professor, Department of Pharmacology, Government Medical College, Patiala, Punjab, India
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Abstract
A large number of glaucoma patients suffer from vision impairments that qualify as low vision. Additional difficulties associated with low vision include problems with glare, lighting, and contrast, which can make daily activities extremely challenging. This article elaborates on how low vision aids can help with various tasks that visually impaired glaucoma patients need to do each day, to take care of themselves and to lead an independent life.
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Affiliation(s)
- Anjani Khanna
- Glaucoma Services, Government Medical College and Hospital, Chandigarh, India
| | - Parul Ichhpujani
- Glaucoma Services, Government Medical College and Hospital, Chandigarh, India
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21
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Sathyan P, Shilpa S, Anitha A. Optical Coherence Tomography in Glaucoma. J Curr Glaucoma Pract 2012; 6:1-5. [PMID: 27990063 PMCID: PMC5159451 DOI: 10.5005/jp-journals-10008-1099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/20/2011] [Indexed: 11/30/2022] Open
Abstract
The optic disk and the RNFL are the principal sites of apparent glaucomatous damage which precedes glaucomatous visual field alterations. RNFL defects are known to precede detection of visual field defects by approximately 6 years. Accurate early detection and monitoring of ONH and RNFL defects has become the prime focus of effective management of glaucoma. Optical coherence tomography employs low-coherence interferometry to obtain cross-sectional images of the ocular tissues. This review attempts to critically analyse the applications of both, anterior and posterior segment OCT in glaucoma management.
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Affiliation(s)
- P Sathyan
- Glaucoma Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Shilpa Shilpa
- Glaucoma Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Anitha Anitha
- Glaucoma Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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22
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Angmo D, Sobti A, Panda A. The Surgical Treatment of Neovascular Glaucoma with Ex-PRESS P-50 Miniature Glaucoma Shunt. J Curr Glaucoma Pract 2012; 6:13-16. [PMID: 27990066 PMCID: PMC5159454 DOI: 10.5005/jp-journals-10008-1102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 10/18/2011] [Indexed: 11/27/2022] Open
Abstract
Surgical treatment for neovascular glaucoma has evolved from cyclodestructive procedures to full-thickness filtration surgery, to trabeculectomy with antifibrosis drugs and glaucoma drainage implant surgery. The choice of a surgical approach may be influenced by several factors, including the stage of the disease. Many surgeons favor drainage implants when the disease is more advanced or when severe inflammation is present, which would be associated with a poorer prognosis if trabeculectomy were chosen. New devices are being developed to allow surgeons increased control with more predictable postoperative results. One such device, the Ex-PRESS™ mini glaucoma shunt, has undergone changes in design and method of insertion making it more appealing for use in patients requiring IOP-lowering surgery. This report highlights the use of Ex-PRESS mini glaucoma shunt in neovascular glaucoma, surgical technique and summarize pertinent literature on the role of this device in glaucoma surgery.
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Affiliation(s)
- Dewang Angmo
- Department of Glaucoma Services, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Sobti
- Department of Glaucoma Services, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Panda
- Department of Glaucoma Services, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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