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Editorial

Current trends in surgical ophthalmology

Natarajan, Sundaram

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Indian Journal of Ophthalmology: September 2014 - Volume 62 - Issue 9 - p 905-906
doi: 10.4103/0301-4738.143923
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Dear Friends

Season's Greetings!!

Glaucoma, a chronic progressive optic neuropathy is one of the leading causes for blindness worldwide.[1] Various studies have shown obesity, family history of glaucoma, smoking and drugs (corticosteroids, statins, alpha blockers) as major contributing factors.[234] However, studies evaluating the association between hypertension and glaucoma are inconclusive and a recently conducted meta-analysis on 16 studies in around 60,000 patients has found a mild increase in the risk of glaucoma amongst hypertensive patients (odds ratio - 1.22 with 95% confidence intervals - 1.09, 1.36).[5] Deb et al. in this issue has published a cross-sectional study on patients with systemic hypertension compared with age-matched controls. The authors found that the presence of systemic hypertension alone did not increase the risk of glaucoma, corroborating an earlier study from a similar population.[6] Furthermore, individuals on antihypertensive drugs were found to be at an increased risk of developing glaucoma or glaucoma suspect supporting the vascular hypothesis of glaucoma where the nocturnal drop in blood pressure with antihypertensive medicines reduces the mean ocular perfusion pressure resulting in glaucomatous cupping and visual field loss.[7] Despite the study being snapshot in time, it suggests the avoidance of nighttime administration of antihypertensive drugs at least in individuals with suspected glaucoma. Additionally, central corneal thickness has been attributed as an important risk factor for open-angle glaucoma but studies are limited in associating this with the disease severity.[8] Franco et al. in this issue has published a study evaluating the association of pressure to cornea index (PCI) in patients with primary open-angle glaucoma in around 70 eyes. The authors found a correlation between PCI with a mean diameter of the automated perimetry and cup to disc ratio suggestive of its utility in staging the glaucoma severity. Conventional ways of glaucoma treatment include drugs lowering intra-ocular pressure and trabeculectomy. In the case of resistant cases of primary glaucoma, congenital glaucoma, neovascular glaucoma and those following eye injuries, the so-called “glaucoma devices” or “implants” is considered more appropriate.[9] Sparse literature exists regarding the outcomes of glaucoma implant surgery amongst Asians. Hamanaka et al. in this issue has published a study evaluating the long-term efficacy and complications of glaucoma drainage implant surgery and its combination with trabeculectomy in Japanese. The authors have found the implants to be highly effective and hypotony and corneal endothelial loss as the most serious complications.

Femtosecond laser surgery has surpassed the traditional penetrating keratoplasty and deep anterior lamellar keratoplasty in being more accurate, safe and efficacious.[1011] Since the procedure is sutureless and requires short-term administration of corticosteroids, the associated complication rate is less. However, studies that assessed long-term safety and efficacy are limited. Shetty et al. in this issue has published a study wherein they have assessed the outcomes in 11 patients with corneal stromal opacities not exceeding 250 μg. Although the authors never observed 20/20 visual acuity, none of them experienced deterioration in the visual acuity or an increase in the interface haze even at 12 months follow-up. The promising results of this study calls for the use of femtosecond laser surgery over the conventional procedures for corneal stromal disorders. Similarly, another ophthalmological area where newer techniques are often being tried is cataract. Recent reports related to administration of anesthetic drugs have shown topical superior to peribulbar route.[12] As any technique or treatment procedure is patient-centric, it is important to assess the satisfaction of patients operated upon. Dole et al. in this issue has published a randomized controlled trial on topical versus peribulbar anesthesia comparing the clinical outcomes and satisfaction of patients and surgeons. Although topical anesthesia was found to cause more pain and so patients were found to be less satisfied than peribulbar, the rate of complications was significantly lower. Considering the fact that topical is now-a-days a preferred route, one shall concomitantly administer analgesic to alleviate pain, thereby contributing to patient satisfaction.

Hope this issue unrolls some of the unknown aspects of newer surgical techniques in ophthalmology.

Happy reading!!

1. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: A review JAMA. 2014;311:1901–11
2. Klein BE, Klein R, Linton KL. Intraocular pressure in an American community. The Beaver Dam Eye Study Invest Ophthalmol Vis Sci. 1992;33:2224–8
3. Perkins ES, Phelps CD. Open angle glaucoma, ocular hypertension, low-tension glaucoma, and refraction Arch Ophthalmol. 1982;100:1464–7
4. Mitchell P, Lee AJ, Rochtchina E, Wang JJ. Open-angle glaucoma and systemic hypertension: The blue mountains eye study J Glaucoma. 2004;13:319–26
5. Bae HW, Lee N, Lee HS, Hong S, Seong GJ, Kim CY. Systemic hypertension as a risk factor for open-angle glaucoma: A meta-analysis of population-based studies PLoS One. 2014;9:e108226
6. Vijaya L, George R, Baskaran M, Arvind H, Raju P, Ramesh SV, et al Prevalence of primary open-angle glaucoma in an urban south Indian population and comparison with a rural population. The Chennai Glaucoma Study Ophthalmology. 2008;115:648–54.e1
7. Omoti AE, Enock ME, Okeigbemen VW, Akpe BA, Fuh UC. Vascular risk factors for open angle glaucoma in african eyes Middle East Afr J Ophthalmol. 2009;16:146–50
8. Francis BA, Varma R, Chopra V, Lai MY, Shtir C, Azen SP, et al Intraocular pressure, central corneal thickness, and prevalence of open-angle glaucoma: The Los Angeles Latino Eye Study Am J Ophthalmol. 2008;146:741–6
9. . Glaucoma Implant SurgeryLast accessed on 2014 Oct 08 Available from: http://www.glaucoma.org/treatment/glaucoma-implants.php
10. Kezirian GM, Stonecipher KG. Comparison of the IntraLase femtosecond laser and mechanical keratomes for laser in situ keratomileusis J Cataract Refract Surg. 2004;30:804–11
11. Durrie DS, Kezirian GM. Femtosecond laser versus mechanical keratome flaps in wavefront-guided laser in situ keratomileusis: Prospective contralateral eye study J Cataract Refract Surg. 2005;31:120–6
12. Zhao LQ, Zhu H, Zhao PQ, Wu QR, Hu YQ. Topical anesthesia versus regional anesthesia for cataract surgery: A meta-analysis of randomized controlled trials Ophthalmology. 2012;119:659–67
© 2014 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow