JAMA Ophthalmology: Glaucoma Topic Collection

Inadvertent Implantation of Aqueous Tube Shunts in Glaucomatous Eyes With Unrecognized Intraocular Neoplasms: Report of 5 Cases

Kaliki S, Eagle RC, Grossniklaus HE, et al. — Thu, 09 May 2013 00:00:00 GMT

Intraocular tumors are a recognized cause of secondary glaucoma. Mechanisms of tumor-related glaucoma include direct tumor invasion or infiltration of the anterior chamber angle, pupillary block caused by anterior displacement of iris-lens diaphragm in the eyes with tumors located posterior to the iris, melanomalytic or melanocytomalytic glaucoma, tumor-induced neovascular glaucoma, inflammatory glaucoma secondary to tumor necrosis, hemolytic glaucoma, and glaucoma due to elevated episcleral venous pressure secondary to extraocular tumor extension. A survey of 2704 eyes with intraocular tumors revealed tumor-related glaucoma in 126 eyes (5%) including uveal melanoma (55 of 2111 [3%]), uveal metastases (12 of 256 [5%]), retinoblastoma (51 of 303 [17%]), intraocular lymphoma (3 of 11 [27%]), intraocular leukemia (1 of 11 [9%]), ciliary body medulloepithelioma (2 of 2 [100%]), iris melanocytoma (1 of 1 [100%]), and iris pigment epithelial adenoma (1 of 2 [50%]).

Prevalence of Glaucoma in an Urban West African Population The Tema Eye Survey Glaucoma in West Africa

Budenz DL, Barton K, Whiteside-de Vos J, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Multiple studies have found an increased prevalence, younger age at onset, and more severe course of glaucoma in people of African descent, but these findings are based on studies conducted outside Africa.

Objective

To determine the prevalence of glaucoma in an urban West African population of adults.

Design and Setting

A population-based, cross-sectional study of adults 40 years and older conducted from September 1, 2006, through December 31, 2008, from 5 communities in Tema, Ghana.

Participants

Participants from randomly selected clusters underwent a screening examination that consisted of visual acuity, frequency doubling perimetry, applanation tonometry, and optic disc photography. Participants who failed any of these tests were referred for complete examination, including gonioscopy, standard automated perimetry, and stereoscopic optic disc photography.

Results

A total of 6806 eligible participants were identified, and 5603 (82.3%) were enrolled in the study. The field examination referred 1869 participants (33.3%) to the clinic examination, and 1538 (82.2%) came for complete examination. A total of 362 participants were identified as having glaucoma of any type and category. Primary open-angle glaucoma was the underlying diagnosis in 342 participants (94.5%). The prevalence of primary open-angle glaucoma was 6.8% overall, increasing from 3.7% among those 40 to 49 years old to 14.6% among those 80 years and older, and was higher in men than in women in all age groups, with an overall male-female prevalence ratio of 1.5. Of the participants with glaucoma, 9 (2.5%) were blind using World Health Organization criteria, and only 12 (3.3%) were aware that they had glaucoma.

Conclusions and Relevance

The prevalence of glaucoma is higher in this urban West African population than in previous studies of people of East or South African and of non-African descent. Strategies to identify affected persons and effectively manage the burden of glaucoma are needed in West Africa.

Forniceal Conjunctival Pedicle Flap for the Treatment of Complex Glaucoma Drainage Device Tube Erosion Forniceal Conjunctival Flap for GDD Erosion

Grover DS, Merritt J, Godfrey DG, et al. — Wed, 01 May 2013 00:00:00 GMT

This retrospective study evaluated the safety and efficacy of the forniceal conjunctival pedicle flap for repair of conjunctival-deficient tube erosions. Additionally, we report the split-lid technique, a procedural improvement if fornix access is difficult. We identified 15 eyes of 14 consecutive patients with complex tube erosions. The mean age was 72.8 years and 33.3% had diabetes mellitus. Most patients were functionally monocular and 80% had undergone 4 or more prior ocular surgical procedures. There was no difference between the following preoperative and postoperative values: visual acuity, intraocular pressure, or number of glaucoma medications. The mean follow-up time after pedicle flap repair was 49 months. There were no recurrent erosions allowing for preservation of the drainage implant with excellent intraocular pressure control. This study demonstrates the relative long-term safety and success of this novel technique.