PurposeThe aim of this study was to detect the clinical and histological effects of preoperative subconjunctival injection of both bevacizumab and mitomycin C (MMC) 1 month before the surgical excision of primary pterygium using a bare sclera technique.Patients and methodsA total of 20 patients with primary pterygium underwent subconjunctival combined injection of 0.1 mL of MMC (0.1 mg/mL) and 0.1 mL of bevacizumab (1.25 mg/0.1 mL) 1 month before bare sclera excision of the pterygium. The excised pterygium tissues were examined histologically and immunohistologically by CD31 staining, and the patients were followed up clinically for at least 2 years. The excised pterygia of two patients without preoperative injection were used for histological comparison.ResultsClinically, there were no intraoperative or postoperative complications. No recurrence was noted during the follow-up period. Histologically, the previously injected pterygia showed a decreased number of epithelial cells and stromal fibroblasts. The latter were rounded or oval and swollen rather than spindle shaped, and some were degenerating or apoptotic. Collagen and elastic fibers were degenerated, distorted, and decreased in density, while blood capillaries were obliterated. There was a significant decrease in CD31-positive cells in previously injected pterygia.ConclusionPreoperative subpterygium combined injection of bevacizumab and MMC is safe and effective in reducing the postoperative recurrence of primary pterygium. Histological and immunohistological changes in the form of decreased fibrovascular activity and degeneration of the extracellular matrix and nerve axons were noted.

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Purpose: evaluation of the role of the ExPRESS device implantation in the management of pseudophakic glaucoma. Design: non-comparative case series study. Patients and methods: 6 eyes with pseudophakic glaucoma scheduled to undergo ExPRESS glaucoma filtration device. Each study patient underwent a complete ophthalmic examination preoperatively including full clinical history taking, VA measurement, autorefraction examination, slit lamp biomicroscopy of the anterior segment, IOP measurement using Goldmann applanation tonometer, gonioscopic examination to evaluate of the angle of AC, and ophthalmoscopy of the posterior segment using a direct ophthalmoscopy. All the patients were subjected to functional and structural evaluation by SAP (HFA 745i) for central 30-2 threshold test, endothelial cell evaluation by non-contact specular microscopy (Topcon specular microscope; SP-1P Version 1.20) for endothelial cell count and OCT scans (Topcon 3D OCT-2000) for peripapillary RNFL thickness measurements, ONH analysis and GCA. All patients included were having pseudophakic OAG. Patients were excluded if they were under 18 years old. All eyes underwent ExPRESS device implantation performed by the same surgeon for consistency, using the standardized technique for the procedure. A complete ophthalmologic follow-up examination included IOP measurement using Goldmann applanation tonometry, number of drugs required to attain IOP control and any associated complications was carried out postoperatively at the 1st and 3rd days, the end of 1st week, every month till the end of the 6th month and the end of 1st year. Best-corrected visual acuity (BCVA) was tested using Snellen chart, which was converted to LogMAR for statistical analysis. Criteria for success were defined as follows; Absolute success: IOP ≤21 mmHg without any medication, qualified success: IOP ≤21 mmHg with ocular hypotensive medications. VF test with SAP, specular microscopy and ONH analysis and GCA assessed with OCT were carried out one year postoperatively. Results: There were 4 eyes (80%) showed complete success (IOP <21mmHg without treatment) and 1 eyes (20%) showed qualified success (IOP <21 mmHg with anti-glaucoma medical treatment). There is a statistically significant reduction in IOP 1, 3, 6 months and one year postoperatively (P<0.001) with the most reduction in IOP observed at 6 months after surgery due to controlling all cases with IOP >21 mmHg using anti-glaucoma medications by this time. There is a statistically significant improvement of postoperative BCVA (P=0.002). Moreover, there is a statistically significant reduction of number of anti-glaucoma medications used postoperatively (P<0.001). For VF indices, there is a statistically significant improvement in both MD and PSD postoperatively (MD; P<0.001) (PSD; P=0.002). However; There is no significant improvement in the staging of glaucoma according to GSS2 (P=327). For OCT parameter, there is a statistically significant increase in the thickness of both RNFL and GCC (P<0.001). Furthermore, endothelial CD...

Purpose: evaluation of the role of the Ex-PRESS device implantation in IOP reduction of neovascular glaucoma.Design: non-comparative case series study. Patients and methods: 5 eyes with neovascular glaucoma scheduled to undergo Ex-PRESS glaucoma filtration device. Each study patient underwent a complete ophthalmic examination preoperatively including full clinical history taking, VA measurement, autorefraction examination, slit lamp biomicroscopy of the anterior segment, IOP measurement using Goldmann applanation tonometer, gonioscopic examination to evaluate of the angle of AC, and ophthalmoscopy of the posterior segment using a direct ophthalmoscopy. All patients included were having neovascular OAG (angle grade 3 and 4 on Shaffer classification). Patients were excluded if they were under 18 years old. All eyes underwent Ex-PRESS device implantation performed by the same surgeon for consistency, using the standardized technique for the procedure. A complete ophthalmologic follow-up examination included IOP measurement using Goldmann applanation tonometry, number of drugs required to attain IOP control and any associated complications was carried out postoperatively at the 1st and 3rd days, the end of 1st week, every month till the end of the 6th month and the end of 1st year. Best-corrected visual acuity (BCVA) was tested using Snellen chart, which was converted to LogMAR for statistical analysis. Criteria for success were defined as follows; Absolute success: IOP ≤21 mmHg without any medication, qualified success: IOP ≤21 mmHg with ocular hypotensive medications.

Purpose: To evaluate the efficacy and safety of Alahmady ring implantation in the management of neovascular glaucoma. Methods: A total of 15 eyes of 15 patients with intractable neovascular glaucoma with intraocular pressure (IOP) $28 mmHg not responding to medical treatment were retrospectively analyzed. All patients had poor visual acuity and underwent Alahmady ring implantation. The ring was designed from fenestrated silicon tube used in lacrimal surgeries and was implanted subsclerally after passing it through the anterior chamber. Patients were followed up for at least 24 months. Success in this study was defined based on IOP $8 mmHg and ,21 mmHg, with not more than 1 glaucoma drug, and improvement of patient symptoms and signs with maximum use of beta blocker as antiglaucoma drug. Results: A total of 15 eyes of 15 patients (9 males [60%] and 6 females [40%]) were analyzed in this study. The mean IOP before surgery was 38.6 mmHg (standard deviation [SD]: 6.98) and it was 14.05 mmHg (SD =7.57) after surgery. The follow-up range was 24-36 months. Success of silicon drainage device was defined as an IOP ,21 mmHg on the last follow-up visit. Medications included only beta-blockers and topical steroids for those who were without severe complications or for those who were not in a condition to undergo a further glaucoma surgery. Conclusion: Alahmady ring implantation proves to be a good surgical option for neovascular glaucoma; however, a longer follow-up period is recommended.