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Background: Pars plana vitrectomy with implantation of an Ahmed glaucoma valve in the vitreous cavity has been reported with a success rate in the management of refractory and neovascular glaucoma. This study aimed to present the outcomes of pars plana Ahmed glaucoma valve (PPAV) surgical implantation in cases with refractory glaucoma. Methods: In this single-center, retrospective, comparative study, 87 consecutive patients diagnosed with refractory glaucoma who underwent PPAV surgical implantation between October 2015 and October 2019 were evaluated. A successful post-op outcome was defined as postoperative intraocular pressure (IOP) less than or equal to 21 mmHg upon examination and a reduction in the number of anti-glaucoma agents used at the latest follow-up. Results: As a final count, 81 eyes of 78 patients with refractory glaucoma were included; 54 (66.66%) of the eyes had neovascular glaucoma. The mean follow-up was 20.65 ± 12.17 months (range: 2?52 months). The mean pre-op IOP was 40.01 ± 1.19 mmHg and reduced significantly to 16.73 ± 0.82 mmHg at the latest follow-up (P < 0.001); thus, a successful IOP outcome was achieved in 88.89% of eyes. The mean number of anti-glaucoma agents decreased significantly from 2.86 ± 0.09 pre-operatively to 1.46 ± 0.11 at the latest follow-up (P < 0.001); while 61 (75.31%) of eyes had a reduction in the number of IOP lowering eye drops, and 14 (17.28%) had no need for IOP lowering eye drops. Conclusions: PPAV surgery is a successful procedure for IOP reduction in patients with refractory glaucoma. Our study demonstrated either elimination or reduction of IOP, lowering eye drops postoperatively. Large scale studies with a comparison group, a longer follow-up, and having various subtypes of glaucoma are required as future research to confirm these outcomes.

Purpose: To discuss a case of shared optometric-ophthalmic (O-O) approach in objectively refracting and examining a paediatric high myope under general anaesthesia. Methods: A paediatric high myope was cyclopleged then underwent objective retinoscopy under general anaesthesia within a surgical theatre setting. Corneal diameter, interpupillary distance, immersion biometry axial lengths, intraocular pressures, keratometry readings, A-scan and B-scan ultrasound images were all subsequently obtained. Lastly, binocular indirect ophthalmoscopic examination with 360º scleral indentation was carried out. A comprehensive O-O report was dispensed with all collated parameters. Results: A refractive error of -11.00DS bilaterally was measured. Ocular health assessment showed no significant myopic abnormalities. The patient was dispensed spectacles and adapted well with improved comfort. Low dose atropine myopia control was commenced. Conclusion: O-O shared care in refracting and examining difficult and highly myopic paediatric cases under general anaesthesia is a useful and effective tool.