Visual vertigo is a disorder characterised by symptoms of dizziness, vertigo, unsteadiness, disorientation, and general discomfort induced by visual triggers. It is currently treated with vestibular rehabilitation therapy, with no effective pharmacotherapy available for treatment-resistant cases. The objective of this study was to evaluate the efficacy of oral acetazolamide in improving symptoms of visual vertigo. A comparative case series of adult patients clinically diagnosed with visual vertigo was conducted from January 1992 to May 2015. Patients without a full neurologic or otorhinolaryngologic work-up, negative magnetic resonance imaging (MRI), and an organic cause for their symptoms were excluded. The identified patients were then contacted by phone to complete a voluntary symptom survey. Main outcome was the subjective reported percentage in symptom improvement. Secondary outcomes were subjective improvement by symptom triggers. The participants were retrospectively divided into three groups based on their treatment with acetazolamide: currently on acetazolamide, terminated acetazolamide, or never initiated acetazolamide. Fifty-seven patients met the inclusion criteria and were willing to complete the phone survey (19 currently on acetazolamide, 27 terminated acetazolamide, and 11 never initiated therapy). Overall symptomatic improvement was reported by 18 (94.7%) patients currently on acetazolamide, 18 (66.7 %) who terminated acetazolamide, and 5 (45.5%) who never initiated therapy, varying significantly by group ( = 0.0061). Greatest improvement was reported in symptoms triggered by being a passenger in a car. These results show that acetazolamide has a positive association with improvement of symptoms of visual vertigo.
AimTo evaluate the safety and efficacy of the M4 (porous polyethylene plate) Ahmed Glaucoma Valve (AGV) drainage implant in a multicenter retrospective study.Materials and methodsA retrospective chart review of medical records of patients who had undergone the M4 Ahmed valve was performed from January 2013 to April 2015. The primary outcome measure was surgical failure defined as: Less than a 20% reduction in baseline intraocular pressure (IOP) to last follow-up visit, final IOP less than 5 mm Hg or greater than 18 mm Hg, reoperation for glaucoma, or loss of light perception vision. All eyes not meeting the above criteria were defined as success.ResultsA total of 291 eyes met all study inclusion criteria. The average follow-up in the study was 6 months (±7.6 months) with 112 patients achieving 12-month follow-up (38.5%). 208 eyes (71.5%) met the study success criteria at final follow-up. No statistically significant spikes in postoperative IOP at 1 and 4 months were detected. The average preoperative IOP was 26.0 on an average of 2.8 medications. At 6 months, the average IOP dropped to 16.7 on 0.9 medications and stayed relatively stable at 15.8 on 1.2 medications at 12-month follow-up.ConclusionThe M4 valve appears to have less of a hypertensive phase compared with the other Ahmed class valves with a similar safety profile. While 71.5% success rate was achieved at final follow-up, the failure rate steadily increased over time.Clinical significanceWhile the M4 production has been discontinued, the porous design of the M4 may avoid a pressure spike in the Ahmed valve class and warrants future investigation for valve design.How to cite this article: Sluch I, Gudgel B, Dvorak J, Ahluwalia MA, Ding K, Vold S, Sarkisian S. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant. J Curr Glaucoma Pract 2017;11(3):92-96.
Efficacy of selective laser trabeculoplasty after canaloplastyGlaucoma is a family of diseases of multi-factorial aetiology, which typically lead to a slow and progressive degeneration of the optic nerve resulting in blindness. Canaloplasty (CP) is a relatively new technique that attempts to restore the natural trabeculocanalicular flow through dilation of Schlemm's canal and the collector channels. 1 Selective laser trabeculoplasty (SLT) is a non-invasive procedure used to lower the intraocular pressure (IOP) by improving the outflow through the trabecular meshwork, which is thought to act by stimulating the inflammatory cytokines of the trabecular meshwork with laser energy resulting in improved outflow. 2 A wide range in the overall decrease of IOP after SLT has been reported in the literature ranging from 3-7 mm Hg (11-40% decrease from baseline). [2][3][4] To this date, no studies have looked at the utilization of SLT in patients who have had a CP. Because of the dilation of Schlemm's canal after CP, the distal aqueous outflow from the trabecular meshwork would be more patent and may be more responsive to SLT.A retrospective chart review of patients who had undergone SLT after CP by two surgeons from January 2010 to August 2014 was performed. Patients were excluded if they had undergone a trabeculectomy or a drainage device prior to SLT. This study received institutional review board approval from the University of Oklahoma with accordance to the Declaration of Helsinki.The decision for performing SLT was left to the individual surgeon based on the patients IOP and medications. Success of treatment was defined as a greater than 20% drop in IOP at 2-4 weeks or a decrease in the number of medications 3 months after SLT. The patients were then separated into 'responders' and 'nonresponders' and compared based on age, ethnicity, sex, medical diagnosis, ocular medical history, ocular surgical history, laterality of eye involved, surgeon, pre-operative IOP, pre-operative visual acuity, preoperative IOP medications, post-operative pressure, post-operative visual acuity and post-operative IOP medications at (2-4 weeks, 4-6 months, 8-12 months and 18-24 months). Statistical significance was measured using a 2-sample T-Test and Fisher's Exact Test.A total of 19 eyes of 16 patients met the inclusion criteria. Of the 3 patients with both eyes meeting inclusion criteria, all eyes were non-responders. The average time between CP and SLT was 17 months for the non-responders group and 18 months for the responders (P < 0.81). The earliest SLT was performed 204 days after CP. Three patients were found to have a greater than 20% response rate to SLT at 2-4 weeks, and two patients were able to stop one of their medications. The follow up rate was 68% at 8-12 months.Of the 19 eyes, 15 were on a prostaglandin analog prior to SLT (4/5 responders and 11/14 non-responders), which was not statistically significant. 5 Older age was the only statistically significant factor between the two groups (P < 0.044), which showed older patient...
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