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Combined phacotrabeculectomy with adjunctive mitomycin C is more effective than phacoemulsification alone in controlling IOP in medically uncontrolled CACG eyes with coexisting cataract. Combined phacotrabeculectomy is associated with more postoperative complications.

Citation: You QS, Chan JCH, Ng ALK, et al. Macular vessel density measured with optical coherence tomography angiography and its associations in a large population-based study. Invest Ophthalmol Vis Sci. 2019;60:4830-4837. https://doi.org/10.1167/ iovs.19-28137PURPOSE. We investigate macular perfusion and the systemic and ocular associations in a population-based setting. METHODS.In this cross-sectional study, 2018 adults residing in Hong Kong underwent detailed ophthalmic examinations after consenting to participate. Macular perfusion was measured with optical coherence tomography angiography (OCTA) using the split-spectrum amplitude decorrelation angiography algorithm. The parafoveal flow index and vessel area density were quantified using automated custom-built software. RESULTS.Of the 2018 participants, the OCTA measurements were available for 1940, and 1631 (84.1%) had good quality scans. The right eyes of these 1631 participants (43.1% men) were included for final analysis. Mean age was 49.8 years (range, 18-92 years). Mean global macular vessel density was 47.3% and 55.1% for the superficial and deep retinal layers, respectively. In multivariate analysis, lower superficial vessel density remained significantly associated with lower signal strength index (SSI; P < 0.001, standardized b ¼ 0.607) and male sex (P < 0.001, b ¼ 0.162), and borderline associated with older age (P ¼ 0.09, b ¼ À0.045) and longer axial length (AL; P ¼ 0.09, b ¼ À0.037), while lower deep layer vessel density was significantly associated with lower SSI (P < 0.001, standardized b ¼ 0.667), longer AL (P < 0.001, b ¼ À0.097), and higher creatinine (P < 0.001, b ¼ À0.072).CONCLUSIONS. This large population-based study provided normative OCTA data of macular vessel density and demonstrated that a lower superficial retinal vessel density was significantly associated with lower SSI and male sex, while a lower deep layer retinal vessel density was significantly associated with lower SSI, longer AL, and higher level of creatinine. These associations must be considered when interpreting clinical quantitative OCTA data.

Purpose: To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. Materials and Methods:Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity.Results: Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (6 SD) was 73.7 6 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 6 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 6 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 6 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 6 0.77 (range, 1-3) to 0.52 6 0.87 (range, 0-3) at final follow-up (P , 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 6 0.2 (range, 0.3-0.9) preoperatively, and 0.7 6 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). Conclusions:In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.

BackgroundNormal tension glaucoma (NTG) is commonly treated with anti-glaucoma medications. Recently, selective laser trabeculoplasty (SLT) has been demonstrated to lower the intraocular pressure (IOP) and medication use in NTG. The purpose of this study was to investigate the efficacy of a single session of SLT for NTG at 1 year.MethodsThis prospective cohort study recruited NTG patients taking anti-glaucoma medication. Potential subjects were excluded if they had had previous glaucoma surgery or laser and also if intraocular surgery or additional SLT procedures were performed after the first treatment. All subjects underwent a 1-month washout. A 30% IOP reduction was set as the target IOP. A single session of SLT was performed to 360 degrees of the trabecular meshwork. At 1-month after SLT, medication was resumed to achieve the target IOP. The IOP was measured every 3 months, and the number of medications was recorded at 3, 6, and 12 months. Only the right eye was used for statistical analysis.ResultsIn 41 right eyes, the mean pre-study IOP was 14.3 ± 3.4 mmHg while on 1.5 ± 0.8 eye drops. The post-washout IOP was 16.2 ± 2.2 mmHg. A mean of 191.1 ± 26.3 SLT shots at 1.0 ± 0.07 mJ were applied. There was significant IOP reduction at all time intervals following SLT when compared to the post-washout IOP (P < 0.0001). The number of medications was significantly reduced at all time intervals following SLT when compared to the pre-study level (P < 0.0001). At 12 months, the mean IOP was 12.2 ± 2.2 mmHg while on 1.1 ± 0.9 eye drops.ConclusionsA single session of SLT for NTG achieved an additional 15% IOP reduction while using 27% less medication at 1 year compared to pre-study levels.Trial registrationThe Clinical Trials Register of the University of Hong Kong HKCTR1847The European Clinical Trials Database 2014-003305-15 (August 11, 2014) (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-003305-15)

Despite advances in artificial intelligence-based diagnostics, ophthalmic clinical skills remain an important acquisition during medical school. Simple ophthalmic examination techniques allow future non-ophthalmic physicians to make timely referrals to ophthalmologists for sight-threatening diseases. Currently, the coronavirus disease 2019 (COVID-19) pandemic poses a serious public health crisis worldwide and an immediate challenge to traditional methods of medical education. With the present threat of disease transmission, face to face small group tutorials are not feasible, especially in the context of ophthalmic clinical skills, which requires close contact between the examiner and the patient.Prior to the outbreak, we introduced ophthalmic clinical skills to second-year pre-clinical undergraduate medical students in the form of face to face demonstrations of techniques by a clinical tutor. A recent published study reported that, video-based materials and written materials were synergistic in enhancing ophthalmic clinical skills and knowledge acquisition in an undergraduate medical programme. 1The objective of our adaption was to introduce video-based and written materials to precede and complement Zoom™ (Zoom Video Communications Inc., San Jose, CA, USA) platform-based small group tutorials. Our aim was to identify advantages and difficulties with this new approach as a necessary replacement for traditional face to face small group clinical demonstrations during the COVID-19 pandemic. | WHAT WA S TRIED?We taught ophthalmic clinical skills to second-year undergraduate medical students, including the visual acuity assessment with near Snellen chart, pupil examination, confrontation test for visual field, extraocular movement examination and direct ophthalmoscope examination. In order to replace face to face 2-hour group tutorials during the COVID-19 outbreak, we devised a three-pronged approach to provide an effective learning experience for our undergraduate medical students. First, for each examination technique, we included written information regarding: (a) technique; (b) physical signs demonstrated; (c) common mistakes by medical students, and (d) clinical relevance. Second, we recorded a video of a clinical teacher demonstrating the techniques on a surrogate patient. We uploaded both written material and videos on the e-learning platform of our medical school. Third, after going through the online materials, the students were split into small groups of 30 students for a single 60-minute tutorial with a clinical teacher on the Zoom cloud-based video conference platform. During the tutorial, the teacher went through each key ophthalmic clinical skill and highlighted important points, pitfalls and clinical knowledge. The last 10 minutes were reserved for questions from students. Using the private message function, students were able to send live questions as they maintained anonymity. Assessment was conducted at the end of the block in the form of objective structured clinical examination (OSCE) stations. | ...

The benefits of physical exercise on health and well-being have been studied in a wide range of systemic and ocular diseases, including glaucoma, a progressive optic neuropathy characterized by accelerated apoptosis of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP) and insufficient ocular perfusion have been postulated to be the two main theories in glaucoma development and progression. The effects of exercise in these two aspects have been demonstrated by numerous researches. A review in 2009 focusing on these two theories concluded that exercise results in transient IOP reduction but an inconsistent elevation in ocular perfusion. However, the majority of the studies had been conducted in healthy subjects. Over the past decade, technological advancement has brought forth new and more detailed evidence regarding the effects of exercise. Moreover, the neuroprotective effect of exercise by upregulation of neurotrophin and enhancement of mitochondrial function has been a focus of interest. Apart from visual impairment, the mental health issues in patients with glaucoma, which include anxiety and depression, should also be addressed. In this review, we mainly focus on publications from the recent years, so as to provide a comprehensive review on the impact of physical exercise on IOP, ocular perfusion, neuroprotection and mental health in patients with glaucoma.