Glaucoma is a primary cause of irreversible blindness worldwide, it kills the vision silently, having a financial burden on society regarding therapy expenses and loss of valuable hours of the day. Objective: To compare the choroidal filling time and grade the status and pattern of optic nerve head (ONH) perfusion by fundus fluorescein angiography (FFA) in glaucoma patients Methods: Patients with various types of glaucoma were enrolled and compared them with healthy volunteers with no history and findings of glaucoma. Perfusion status using FFA was studied and analyzed corresponding visual fields (VF) and optical coherence tomography (OCT) findings Results: There were 70 participants in the study, including 48 glaucoma patients and 22 healthy controls. Choroidal filling time (CFT) was 9-12, 13-17, 15-22, and 20-33 seconds in healthy individuals and patients with ocular hypertension (OH), primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG), respectively. In OH, inferonasal and inferotemporal hypofluorescence pattern of ONH perfusion was noted, whereas POAG showed an inferonasal, patchy, and undefined pattern of hypofluorescence. In contrast with the healthy volunteers that showed uniform fluorescence, patients with NTG showed inferonasal hypofluorescence. CFT was significantly delayed in NTG patients (p<0.05). We found a strong correlation between findings of FFA, OCT, and corresponding VF defects in glaucoma patients Conclusions: The choroidal filling time is prolonged in patients with various types of glaucoma, especially in cases of normal-tension glaucoma. FFA reveals perfusion defects in the form of areas of hypofluorescence and multiple characteristic optic nerve head perfusion patterns in cases of POAG, NTG, and OH.
Glaucoma is characterized by an optic neuropathy associated with raised intraocular pressure (IOP) and visual field defect Objective: To determine the efficacy and outcome of trabeculectomy augmented with anti-metabolite mitomycin-C in children with childhood glaucoma. Methods: A total of 40 eyes of 22 diagnosed cases of congenital glaucoma were studied. All these children underwent mitomycin-C augmented trabeculectomy from July 2017 to August 2020. The primary outcome was control of postoperative intraocular pressure (IOP) at the end of one year. A target pressure of <15mmHg was set as target pressure to label a successful surgical outcome. Results: The mean age of the patients enrolled in the study was 26.8± 12.2 years (range: 8 – 32 months) with a male to female ratio of 7:4. The mean ± SD IOP before trabeculectomy surgery was (31.5± 8.6) (range: 21 – 53) mmHg. At the one-year follow-up, the mean postoperative IOP was (19.4± 7.9) (range: 9 – 48) mmHg. Target IOP < 15 mmHg was successfully achieved in 27 (67.5%), 24 (60.0%) and 22 (55.0%) eyes at postoperative 1, 6 and 12 months respectively. Repeat trabeculectomy was required in 5 (12.5%) eyes, while 5 (12.5%) eyes developed corneal perforations and 3 (7.5%) eyes developed phthisis bulbi. Conclusion: Trabeculectomy with mitomycin C can be a primary surgical intervention in congenital glaucoma. However, repeat surgery may be required and other related surgical complications can occur after this surgery in patients with uncontrolled IOP.
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