Purpose: To compare the outcomes of iStent vs. iStent inject implantation combined with phacoemulsification. Methods: This single center retrospective comparative case series included subjects with open angle glaucoma who underwent iStent or iStent inject implantation combined with phacoemulsification with ≥1 year follow-up. The main outcome measures were in-group and between-group changes in intraocular pressure (IOP) and medication number, proportion of eyes that achieved IOP ≤15 mmHg, and surgical success defined as 20% IOP reduction from baseline at 6/12 months. Univariate/multivariate regression analyses were done to identify predictors of surgical failure. Results: One hundred ninety-seven eyes of 148 patients were included (122 iStent, 75 iStent inject). Both groups achieved significant IOP and medication reduction at months 6/12 (P < 0.05). At month 6, IOP was significantly lower in iStent inject vs. iStent eyes (P = 0.003), but the difference was insignificant by month 12 (P = 0.172). Medication number was comparable in both groups at months 6/12 (P > 0.05). More iStent inject eyes achieved IOP ≤15 mmHg at month 6 (P = 0.003) and 12 (P = 0.047). Surgical success was comparable in both groups at months 6/12 (P > 0.05). Kaplan–Meier survival analysis showed similar cumulative rate of surgical failure at year-1 in both groups (P = 0.644). The multivariate model identified older age (P = 0.017) and lower baseline IOP (P = 0.002) as the strongest predictors of surgical failure. Conclusion: Compared to iStent, iStent inject achieved lower IOP at month 6 and higher proportion of eyes achieved IOP ≤15 mmHg at month 6/12. However, surgical success was similar in both groups. Predictors of surgical failure were older age and lower baseline IOP rather than the stent type.

PurposeStudying the role of ultrasound biomicroscopy (UBM) in detection of anterior segment changes in infants with primary congenital glaucoma (PCG).MethodsCross-sectional study that included 25 eyes of 15 patients suffering from PCG and a control group of 15 eyes of ten age- and sex-matched participants. Diagnosis of PCG was based on clinical data (intraocular pressure, corneal diameter, fundus examination and amplitude-modulation scan measurement of axial length). UBM examination was done for all participants for measurement of central corneal thickness, anterior chamber depth, lens thickness, iris thickness (measured 2 mm from the iris root and again at the thickest point near the pupil), zonular length, posterior chamber depth, and angle of anterior chamber. Qualitative evaluation was done for abnormal angle membranes, iris insertion level, and ciliary processes position and configuration.ResultsMean age ± standard deviation was 10.32±3.59 months in the study group and 14.54±5.9 months in the control group. The central corneal thickness, anterior chamber depth, zonular length, and angle of anterior chamber were significantly larger in the study group than in the control group, with mean values 700±190 μm, 3.55±0.32 mm, 1.02±0.15 mm, and 58.47°±5.57°, respectively. The posterior chamber depth had a mean of 0.33±0.06 mm, which was significantly smaller than that of the control group. In the study group, the mean iris thickness 2 mm from the iris root was 0.32±0.04 mm, the mean iris thickness at the thickest point near the pupil was 0.38±0.08 mm, and the mean lens thickness was 3.32±0.18 mm. These three parameters were smaller than the control group but the difference was insignificant. Loss of normal iris configuration was detected in all eyes of the study group. Anterior iris insertion was detected in 56% of the eyes in the study group, and abnormal angle membrane was found in 12%.ConclusionUBM is a useful tool for detection of anterior segment changes in PCG, which is helpful especially in cases with opaque cornea or cases with borderline clinical findings.

Purpose To determine the distribution and the anatomical characteristics of plateau iris (PI) in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). Methods Fifty UBM images of PACG cases were studied over one year by retrospective analysis. The data from UBM images including angle opening distance at 500 and 750 μm (AOD500 and AOD750), trabecular-iris angle (TIA), angle recess area at 750 μm (ARA750), maximum ciliary body thickness (CBTmax), anterior placement of ciliary processes (APCP), central anterior chamber depth (CACD), axial lens thickness (ALT), and ciliary sulcus status were analyzed and compared between the PI and non-PI cases. Results Eighteen cases had PI (36%). The mean AOD500, AOD750, and TIA were significantly smaller in PI than in non-PI eyes ( P = 0.01; P = 0.046; and P = 0.026). Values of the ARA750 and CBTmax were not significantly different between the two groups ( P = 0.208 and P = 0.368). CACD was deeper in the PI group ( P = 0.011). ALT was higher in the non-PI group ( P = 0.001). The mean APCP of the PI group was more than those of the non-PI group ( P < 0.001). The number of cases with obliterated ciliary sulcus in more than two quadrants was significantly more in the PI group ( P < 0.001). Conclusion Around one-third of PACG eyes were found to have PI on UBM imaging. The number of obliterated ciliary sulcus and APCP were important UBM parameters that help in PI diagnosis.

Background: ‎On examining the RNFL thickness by OCT, the media opacity caused ‎by cataract will increase light scattering and absorption, so the RNFL thickness measurement can be increased after uncomplicated cataract surgery also, inflammatory reaction by mechanical injury of phacoemulsification ‎surgery, traction reaction of optic nerve head induced by parts of vitreous liquefaction in ultrasonic emulsification process, with the addition of optic ‎neuropathy from ultrasonic energy. For all above, these factors could increase NFL thickness.‎ Aim: Evaluation of retinal nerve fiber layer thickness in axial high myopic ‎patients after uncomplicated phacoemulsification.‎ Patients and Methods: Our patients collected from outpatient clinic of Ophthalmology ‎department; Tanta University and outpatient clinic at Ophthalmology ‎department of Matarya Teaching Hospital during the period from December 2019 to June 2020 and extended to December 2020 due to Covid_19 ‎pandemic.‎ ‎Results: This study including 20 eyes of high axial myopic  cataracts patients (group Ⅰ) and 10 eyes of normal cataracts patients (group II)  from which age range between (50-70) years old , males were (30%) and females were (70%) in group Ⅰand males (50%) were equal to female (50%) in group II. Conclusion: There is a significant increase in thickness of peripapillary RNFL measured by OCT after 1 week of uncomplicated phacoemulsification cataract surgery. ‎This increase in thickness occurs as the media opacity caused by cataracts increases the light scattering and absorption thus affects the quality ‎of measurements which improves after cataract extraction.‎