Management of Advanced Glaucoma

Nathan M. Radcliffe, MD; Blake Williamson, MD, MPH; and Gary Wörtz, MD

Eyetube

Nathan M. Radcliffe, MD, joins Blake Williamson, MD, MPH, and Gary Wörtz, MD, to share his experiences managing complex patients with advanced-stage glaucoma. He shares a specific case of an 83-year-old man with a cataract and exfoliation glaucoma with an IOP of 56 mm Hg. Dr. Radcliffe walks through how he managed complications he encountered during the combined cataract and glaucoma surgery, including vitreous prolapse and suprachoroidal hemorrhage. The surgeons also discuss how to educate and counsel patients with advanced-stage disease to help them understand realistic surgical outcomes.

Keratoconus and Visual Rehabilitation

Two studies provide insight into current modalities.

Dimitrios Kyroudis, MD, FWCRS, and Michael Tsatsos, MD, PhD, FEBOS-CR, FWCRS, MRCOphth

Cataract and Refractive Surgery Today

Comparison of Long-Term Outcomes of Simultaneous Accelerated Corneal Cross-Linking Combined With Intracorneal Ring Segment or Topography-Guided Photorefractive Keratectomy Cohen E, Tone SO, Mimouni M, et al1Industry support: None ABSTRACT SUMMARY A prospective, nonrandomized, interventional study compared the long-term outcomes of simultaneous accelerated CXL combined with either intrastromal corneal ring segments (CXL-ICRS) or topography-guided PRK (CXL-TG-PRK) in eyes that had progressive keratoconus. The research builds upon an earlier study with 1 year of follow-up by the same group.2 Of the original 248 eyes, 57 (CXL-ICRS, n = 32; CXL-TG-PRK, n = 25) were included. The mean follow-up duration was 51.28 months for the CXL-ICRS group and 54.57 months for the CXL-TG-PRK group. Study in Brief A prospective, nonrandomized, interventional study compared the 5-year clinical outcomes of CXL with two adjunctive modalities—intrastromal corneal ring segments (ICRSs) and topography-guided PRK (TG-PRK)—for the treatment of progressive keratoconus. Only patients in the CXL-ICRS group experienced an improvement in visual parameters. Both treatment groups achieved an improvement in topographic parameters, although the change was greater in the CXL-TG-PRK group. The improvement in topography remained stable over the long term in the CXL-ICRS group but regressed in the CXL-TG-PRK group. Safety was excellent in both groups. WHY IT MATTERS The study offers insight into the long-term efficacy of ICRS implantation and TG-PRK when these procedures are combined with CXL for the visual rehabilitation of patients with keratoconus. At the final follow-up visit, the change (improvement) in patients’ logMAR uncorrected distance visual acuity (UDVA) compared to preoperative values was significant in the CXL-ICRS group (-0.31 ±0.27, P < .001; equivalent to approximately 3 lines) but not the CXL-TG-PRK group (-0.06 ±0.42, P = .43; < 1 line).

Acute-Onset Vogt-Koyanagi-Harada Syndrome

This autoimmune condition may present with only ocular findings early in the disease course.

Steven Scheidt, MS, and Heeral R. Shah, MD

Retina Today

Vogt-Koyanagi-Harada (VKH) syndrome is a rare autoimmune and granulomatous inflammatory condition that affects the central nervous system. VKH has a vast range of presentations, which may involve cerebrospinal fluid, skin, hair, and eyes. VKH syndrome mainly occurs in adults, but there is a case report of a 3-year-old girl with VKH.1 VKH syndrome has an idiosyncratic phenotype and may present with early or late physical manifestations. Although the pathophysiology is not completely understood, VKH syndrome can be subdivided into a prodrome, an acute, and a chronic phase. The prodrome phase is characterized by nonspecific features such as fever, malaise, headache, and dizziness, which last for a few days. The acute phase lasts for a few weeks and is characterized by bilateral posterior uveitis and other ocular findings. In rare cases, the posterior uveitis may not occur at the same time in the contralateral eye but will have a short delay.2 The chronic stage can last a few months to years and involves depigmentation of the skin and uvea. At this point vitiligo is most often seen, commonly affecting the eyelashes, face, and trunk. Other symptoms such as alopecia may occur, and patients may present with changes in the color of the choroid to bright orange with a pale optic nerve.3 CASE PRESENTATION A 26-year-old woman presented to the emergency department with an acute onset of progressive worsening bilateral eye pain and blurry vision. She denied any discharge from the eyes and stated that she had been having headaches, nausea, and fever for a few days.