Purpose: To study the effect of injection bevacizumab on iris neovascularization (NVI) and angle neovascularization (NVA) and compare its efficacy in terms of visual outcome, NVI, NVA, and intraocular pressure (IOP) control between intracameral, intravitreal, and combined use.Materials and methods: This was a prospective study conducted at a tertiary center for patients of neovascular glaucoma (NVG), including 20 eyes of 20 patients. After thorough evaluation, patients were divided into three groups: Intracameral, intravitreal, or combined, according to the route of injection bevacizumab required.Results: About 30% of patients belonged to the age group 51 to 60 years of which 80% were female. In 50%, vein occlusion was the cause of NVG, and 50% needed intravitreal injection bevacizumab. After 4th week of injection 90% and after 12th week 60% were found to have absence of NVI. Patients who had IOP in the range of 11 to 20 mm Hg and 21 to 30 mm Hg showed lower IOP as compared to other groups. But no significant difference was noted in higher IOP groups. Only two patients required antiglaucoma surgery.There was no statistically significant difference in visual outcomes in any groups. In all routes, there were statistically significant changes in NVI and NVG in the 1st and 4th weeks.Conclusion: The effect of injection in all routes deteriorates after 8 weeks. Intracameral route of injection is found to be most effective in terms of control of IOP. There was no statistically significant difference in terms of improvement in best corrected visual acuity (BCVA) in any route. Injection bevacizumab is effective and statistically significant in reducing the need of antiglaucoma surgery for NVG patients.How to cite this article: Bhagat PR, Agrawal KU, Tandel D. Study of the Effect of Injection Bevacizumab through Various Routes in Neovascular Glaucoma. J Curr Glaucoma Pract 2016;10(2):39-48.

Purpose: To determine the importance of ganglion cell complex (GCC) analysis as a parameter for early diagnosis of glaucoma and for following glaucoma progression and to compare glaucoma progression with conventional visual field analysis using a different type of spectral-domain optical coherence tomography (SD-OCT).Materials and methods: Two hundred eyes including 68 normal eyes, 70 eyes with pre-perimetric glaucoma and 62 eyes with perimetric glaucoma were analyzed in this prospective study undertaken during Jan 2013 to Dec 2013 in a tertiary ophthalmology institute. Automated visual field examination was done to group the subjects in above three categories. The thicknesses of the GCC and retinal nerve fiber layer (pRNFL) were measured using Topcon model 2000 version 7.1 SD-OCT images and compared. The statistical analysis was carried out by z-test.Results: The average GCC was thickest in the normal group and the thickness decreased as the severity of glaucoma increased. The mean macular GCC at the start and end of the study in pre-perimetric (94.86 ± 8.31, 90.74 ± 8.46) and perimetric (82.48 ± 13.21, 79.80 ± 12.88) eyes was lower than those in normals (102.70 ± 7.19, 101.82 ± 7.42).Conclusion: Majority of the studies done on GCC analysis have used the Cirrus OCT (Zeiss). Our study has used the Topcon model 2000 version 7.1 to show that irrespective of the machine used, GCC analysis definitely plays an important role. To detect pre-perimetric glaucoma and may show progression earlier than pRNFL in pre-perimetric glaucoma.How to cite this article: Bhagat PR, Deshpande KV, Natu B. Utility of Ganglion Cell Complex Analysis in Early Diagnosis and Monitoring of Glaucoma using a Different Spectral Domain Optical Coherence Tomography. J Curr Glaucoma Pract 2014;8(3):101-106.

IntroductionBenzalkonium chloride (BAK), included as a preservative in many topical treatments for glaucoma, induces significant toxicity and alters tear breakup time (TBUT). BAK-containing latanoprost, an ester prodrug of prostaglandin F2α, can cause ocular adverse events (AEs) associated with BAK. The purpose of this study was to evaluate the efficacy and safety of BAK-free latanoprost.Patients and methodsA prospective, open-label, single-arm, multicenter, 8-week study in patients with primary open-angle glaucoma or ocular hypertension taking BAK-containing latanoprost for ≥12 months was performed. Patients were switched to BAK-free latanoprost ophthalmic solution 0.005% administered once daily, and eyes were assessed after 28 and 56 days. Primary efficacy and safety variables were TBUT and treatment-emergent AEs, respectively.ResultsAt day 56, 40 eyes were evaluable. Mean TBUT increased significantly from baseline (3.67±1.60 seconds) to 5.03±2.64 and 6.06±3.39 seconds after 28 and 56 days of treatment with BAK-free latanoprost (P<0.0001). Ocular Surface Disease Index© (OSDI©) score also decreased significantly to 12.06±13.40 and 7.06±10.75 at 28 and 56 days, respectively, versus baseline (18.09±18.61, P<0.0001). In addition, inferior corneal staining score decreased significantly to 0.53 from baseline (0.85, P=0.0033). A reduction in conjunctival hyperemia and intraocular pressure was observed at both time points. No treatment-related serious AEs were evident and 12 (26.08%) treatment-emergent AEs occurred in seven patients, with eye pain and irritation being the most frequent. No clinically significant changes in vital signs or slit lamp examinations were observed.ConclusionResults indicate that switching from BAK-containing latanoprost to BAK-free latanoprost resulted in significant improvements in TBUT, OSDI© score, and inferior corneal staining score, and measurable reductions in conjunctival hyperemia score. Furthermore, BAK-free latanoprost was well tolerated with only mild-to-moderate and self-limiting AEs. BAK-free latanoprost appears to be effective in protecting ocular surface integrity in glaucoma patients but further studies are needed to confirm this beneficial effect.

Purpose:Effective communication lies at the heart of a patient--doctor relationship. Communication skills (CS) teaching and assessment is not a part of the postgraduate (PG) curriculum. Lack of effective CS in current PG students’ results in patient distrust and dissatisfaction, conflicts, and compromised healthcare. The regulatory authorities of medical education have recognized the need to inculcate soft skills among medical graduates, one of which is CS. The purpose of this study was to assess the need for teaching CS to ophthalmology PG students and develop and introduce a module for the same.Methods:In this prospective, interventional study done at the ophthalmology department of a tertiary hospital, a validated 8 day CS workshop was conducted for 60 PG students through interactive lectures, observations, video sessions, and role plays. Feedbacks were obtained through narratives, validated Google survey, reflections and verbal method and analyzed.Results:In the needs assessment done on 27 departmental faculties, 20 faculties found poor communication to be a major reason for patient complaints. All faculties agreed that CS should be taught to medical students. Statistically significant improvement in CS awareness was noted among students after the workshop. Lack of CS training, work burden, and language were identified as main barriers to effective communication. All the students were satisfied with the workshop and wanted it to be conducted regularly.Conclusion:This study establishes that CS training is essential to improve patient satisfaction and patient-doctor relationships. Barriers to effective CS could be identified, for which possible solutions could be found.