Publications by authors named "Faisal A Almobarak"

32 Publications

Ultrasound Cyclo Plasty in Glaucoma: Two-Year Outcomes.

J Glaucoma 2022 Jul 18. Epub 2022 Jul 18.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Purpose: To evaluate the two-year outcomes of Ultrasound Cyclo Plasty (UCP) in uncontrolled glaucoma.

Methods: A retrospective cohort study included patients with uncontrolled primary or secondary glaucoma who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia between 2016 and 2021. The main outcome measures were: intraocular pressure (IOP), number of antiglaucoma medications, and presence of vision-threatening complications. The surgical outcome of each eye was classified as complete success, qualified success, or failure, based on the main outcome measures.

Results: One hundred and eighty-two eyes of 158 patients were included in the study. The mean follow-up period was 29.71 months (±18.1). The IOP and number of antiglaucoma medications decreased significantly from a mean of 23.46 mm Hg (±6.3) and 3.33 (±0.9) to 17.33 (±7.1) and 2.14 (±1.4), and 16.24 (±6.3) and 1.90 (±1.5) on the 12th and 24th months respectively. The overall success rates were 78.0% (143/182) and 85.6% (95/111), and the failure rates were 21.4% (39/182) and 14.4% (16/111) on the 12th and 24th months respectively. The most common complications were cataract development/progression and anterior chamber reaction.

Conclusions: UCP offers a reasonable IOP control and reduction of the antiglaucoma medications burden.
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http://dx.doi.org/10.1097/IJG.0000000000002078DOI Listing
July 2022

Ultrasound Cyclo Plasty After Failed Glaucoma Surgery: Outcomes and Complications.

Ophthalmol Ther 2022 Aug 25;11(4):1601-1610. Epub 2022 Jun 25.

Department of Ophthalmology, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia.

Introduction: The purpose of this study is to report the outcomes and complications of ultrasound cyclo plasty (UCP) after failed glaucoma surgery.

Methods: A retrospective case series included patients with previously failed glaucoma surgery who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were: intraocular pressure (IOP), number of antiglaucoma medications and presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures.

Results: Seventy eyes of 70 patients were included in the study. The mean follow-up period was 31.89 months (± 17.5). The IOP and the number of antiglaucoma medications decreased significantly from a mean of 23.91 mmHg (± 6.3) and 3.43 (± 0.8) to 17.88 mmHg (± 8.1) and 2.48 (± 1.3) and of 16.74 (± 7.9) and 2.11 (± 1.3) at the 12th and 24th months postoperatively, respectively (p < 0.01 for both). The success rates were 77.1% (54/70) and 48.6% (34/70), while the failure rates were 22.9% (16/70) and 2.9% (2/70) at the 12th and 24th months postoperatively, respectively. The cumulative probabilities of success were 70.0% (± 5.5%) and 47.1% (± 6.0%) at the 12th and 24th months postoperatively, respectively. The most common complications were anterior chamber reaction (24.3%), cataract development/progression (18.6%), hypotony/choroidal detachment (4.3%), phthisis bulbi (1.4%) and aqueous misdirection (1.4%).

Conclusions: UCP is an effective treatment modality to control IOP and decrease the burden of antiglaucoma medications in eyes with previously failed glaucoma surgery. Monitoring and counseling of possible postoperative complications are needed.
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http://dx.doi.org/10.1007/s40123-022-00538-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253205PMC
August 2022

Evaluation of ABCA1 and FNDC3B Gene Polymorphisms Associated With Pseudoexfoliation Glaucoma and Primary Angle-Closure Glaucoma in a Saudi Cohort.

Front Genet 2022 1;13:877174. Epub 2022 Jun 1.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

It is plausible that common disease mechanisms exist in glaucoma pathophysiology. Accordingly, we investigated the genetic association of two previously reported primary open-angle glaucoma (POAG)-related gene polymorphisms, rs2472493 (A > G) in and rs7636836 (C > T) in FNDC3B, in primary angle-closure glaucoma (PACG) and pseudoexfoliation glaucoma (PXG). TaqMan genotyping was performed in a total of 442 subjects consisting of 246 healthy controls, 102 PACG patients, and 94 PXG patients. Statistical evaluations were performed to detect allelic and genotype association of the variants with the disease and clinical variables such as intraocular pressure (IOP) and cup/disc ratio. Overall, there was no allelic or genotype association of these variants in PACG and PXG. However, rs7636836[T] allele significantly increased the risk of PXG among men ( = 0.029, odds ratio [OR] = 2.69, 95% confidence interval = 1.11-6.51). Similarly, rs2472493 and rs7636836 genotypes also showed significant association with PXG among men in over-dominant model ( = 0.031, OR = 1.98, 95% CI = 1.06-3.71) and co-dominant model ( = 0.029, OR = 2.69, 95% CI = 1.11-6.51), respectively. However, none survived Bonferroni's correction. Besides, the synergic presence of rs2472493[G] and rs7636836[T] alleles (G-T) was found to significantly increase the risk of PACG ( = 0.026, OR = 2.85, 95% CI = 1.09-7.46). No significant genotype influence was observed on IOP and cup/disc ratio. : Our results suggest that the polymorphisms rs2472493 in ABCA1 and rs7636836 in FNDC3B genes may be associated with PXG among men, and a G-T allelic combination may confer an increased risk of PACG in the middle-eastern Saudi cohort. Further research in a larger population-based sample is needed to validate these findings.
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http://dx.doi.org/10.3389/fgene.2022.877174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198278PMC
June 2022

Phacoemulsification after trabeculectomy in uveitis associated with Vogt-Koyanagi-Harada disease: intermediate-term visual outcome, IOP control and trabeculectomy survival.

BMC Ophthalmol 2022 May 9;22(1):210. Epub 2022 May 9.

Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: To evaluate the visual outcome, intraocular pressure control and trabeculectomy survival after phacoemulsification in eyes with prior trabeculectomy in uveitis associated with Vogt-Koyanagi-Harada disease (VKH).

Design: Retrospective comparative study.

Methods: Eyes with uveitic glaucoma associated with VKH who underwent mitomycin C (MMC)-enhanced trabeculectomy were included. Eyes were divided into two groups: the first study group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second control group included eyes that did not have cataract surgery. The main outcome measures were changes in the visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications, IOP control and trabeculectomy survival.

Results: There were no significant differences in the final visual acuity (0.78 (±0.9) and 0.92 (±1.1), p = 0.80)) nor IOP (14.21 mmHg (±5.8) and 12.16 mmHg (±6.1), p = 0.29), but there was a difference in the antiglaucoma medications (1.58 (±1.5) and 0.53 (±1.0), p = 0.02) between the study and control group, respectively. There was no difference in the overall trabeculectomy survival (p = 0.381, Log Rank), but more eyes in the study group converted to qualified success after phacoemulsification and required more medications to control the IOP.

Conclusion: Phacoemulsification after trabeculectomy seems to be a safe procedure in eyes with combined vision threatening complications of VKH, although the visual improvement was limited. Nevertheless, more medications were required to control the IOP, resulting in less absolute and more qualified trabeculectomy success. Therefore, patient counseling before surgery is essential.
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http://dx.doi.org/10.1186/s12886-022-02438-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9087941PMC
May 2022

Polymorphism rs3742330 in microRNA Biogenesis Gene Is Associated with Pseudoexfoliation Glaucoma in Saudi Cohort.

Genes (Basel) 2022 03 10;13(3). Epub 2022 Mar 10.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia.

We investigated the association between (rs3742330) and (rs10719) polymorphisms and pseudoexfoliation glaucoma (PXG) and related clinical phenotypes in a Saudi cohort. In a retrospective case-control study, TaqMan real-time, PCR-based genotyping was performed in 340 participants with 246 controls and 94 PXG cases. The minor (G) allele frequency of rs3742330 in PXG (0.03) was significantly different from that in the controls (0.08) and protective against PXG (odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.16-0.92), = 0.017). Similarly, the rs3742330 genotypes showed a significant protective association with PXG in dominant ( = 0.019, OR = 0.38, 95% CI = 0.15-0.92), over-dominant ( = 0.024, OR = 0.39, 95% CI = 0.16-0.95), and log-additive models ( = 0.017, OR = 0.38, 95% CI = 0.16-0.92). However, none remained significant after an adjustment for age, sex, and multiple testing. Rs10719 in DROSHA did not show any significant allelic or genotype association with PXG. However, a protective effect of the GA haplotype in and and PXG ( = 0.034) was observed. Both polymorphisms showed no significant effect on intraocular pressure and the cup-disk ratio. In conclusion, we report a significant genetic association between variant rs3742330 in , a gene involved in miRNA biogenesis, and PXG. Further investigation in a larger group of patients of different ethnicities and functional studies are warranted to replicate and validate its potential role in PXG.
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http://dx.doi.org/10.3390/genes13030489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8956095PMC
March 2022

Successful Pars Plana Vitrectomy with Zonulo-hyaloidectomy Performed 4 Years after the Onset of Chronic Low-Grade Aqueous Misdirection.

Middle East Afr J Ophthalmol 2021 Apr-Jun;28(2):137-139. Epub 2021 Sep 25.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

In aqueous misdirection, the interval between diagnosis and surgical intervention is inversely proportional to the success of the surgery. Here, we report a successful outcome of pars plana vitrectomy (PPV) with irido-zonulo-hyaloidectomy 4 years after the onset of the disease. A 34-year-old female, known to have primary angle closure glaucoma, underwent trabeculectomy with mitomycin C in the right eye for uncontrolled intraocular pressure (IOP). Six weeks after the surgery, the patient presented with a shallow anterior chamber centrally and peripheral iridocorneal touch along with a patent peripheral iridectomy. Ultrasound biomicroscopy showed a shallow AC centrally with peripheral iridocorneal touch, and the ciliary body was rotated forward confirming the diagnosis of aqueous misdirection. The patient refused surgical management and was managed medically, which was unsuccessful. Four years after the diagnosis, the patient underwent PPV with irido-zonulo-hyaloidectomy because of progressive shallowing of the AC and corneal edema. One month postoperatively, visual acuity improved from 20/200 to 20/60, and the AC maintained appropriate depth. In conclusion, PPV with irido-zonulo-hyaloidectomy may result in a complete resolution of a chronic low-grade form of aqueous misdirection.
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http://dx.doi.org/10.4103/meajo.meajo_19_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547664PMC
November 2021

Association analysis of variants rs35934224 in and rs6478746 in in primary angle-closure and pseudoexfoliation glaucoma.

Eur J Ophthalmol 2022 Jul 31;32(4):2249-2258. Epub 2021 Aug 31.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Objective: Previous genome-wide studies have demonstrated significant pathogenic association between variants rs35934224 within and rs6478746 near in primary open-angle glaucoma. We investigated the association between these variants in primary angle-closure glaucoma (PACG) and pseudoexfoliation glaucoma (PXG) patients of Saudi origin.

Methods: In a case-control study, DNA samples from 249 controls (135 men and 114 women), 100 PACG cases (44 men and 56 women), and 95 PXG cases (61 men and 34 women) were genotyped by TaqMan based real-time PCR. Statistical tests were performed to evaluate genetic association with glaucoma types and related clinical indices.

Results: The allele frequencies of rs35934224 and rs6478746 did not show significant variation in PACG and PXG than controls, except that the rs35934224[T] allele was found to be significantly low among PXG women (0.10) as compared to controls (0.21) (odds ratio = 0.38, 95% confidence interval = 0.16-0.94,  = 0.024). Rs35934224 genotypes showed a nominal-to-borderline protective association with PACG and PXG among women in different genetic models. However, except for the over-dominant model in PACG ( = 0.0095), none of the effects survived Bonferroni's correction ( < 0.01). Rs6478746 showed no significant genotype or allelic association with PACG and PXG. Regression analysis showed no influence on disease outcome, and neither showed any correlation with intraocular pressure and cup/disk ratio in both PACG and PXG.

Conclusions: Variants rs35934224 in and rs6478746 near are not associated with PACG and PXG in the Saudi cohort, but rs35934224 may confer modest protection among women. Further population-based studies are needed to validate these results.
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http://dx.doi.org/10.1177/11206721211042547DOI Listing
July 2022

Lack of Association Between Polymorphisms in and and Primary Open-Angle Glaucoma in a Saudi Cohort.

Front Genet 2021 2;12:690780. Epub 2021 Aug 2.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Recent studies have demonstrated an association of single nucleotide polymorphisms (SNPs) rs35934224 in and rs6478746 near genes in primary open-angle glaucoma (POAG) among Europeans. We performed a retrospective, case-control study to investigate the association between the rs35934224 () and rs6478746 () and POAG in a middle-eastern population from Saudi Arabia. DNA from 399 participants consisting of 150 POAG cases (83 males and 67 females) and 249 controls (135 males and 114 females) were genotyped using TaqMan® real-time PCR. Statistical tests were performed to evaluate genetic association with POAG and related clinical indices. The minor allele frequency (MAF) of rs35934224[T] was 0.19 and 0.20 in POAG and controls, respectively. The difference was non-significant (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.75-1.55, = 0.663). Likewise, rs6478746[G] MAF was 0.12 in both cases and controls with no statistical significance (OR = 1.02, 95% CI = 0.67-1.56, = 0.910). Genotype analysis showed no association with POAG for both the SNPs in combined and gender-stratified groups. Regression analysis showed no significant effect of risk factors such as age, sex, rs35934224, and rs6478746 genotypes on POAG outcome. Furthermore, both the SNPs showed no significant genotype effect on clinical indices such as intraocular pressure (IOP) and cup/disc ratio in POAG patients. Rs35934224 in and rs6478746 near genes are not associated with POAG or related clinical indices such as IOP and cup/disc ratio in a Saudi cohort. Since the study is limited by sample size further investigations are needed to confirm these results in a larger cohort.
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http://dx.doi.org/10.3389/fgene.2021.690780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365832PMC
August 2021

Long-term outcomes of initial trabeculectomy in glaucoma associated with granulomatous and non-granulomatous uveitis.

Int Ophthalmol 2021 Oct 7;41(10):3459-3470. Epub 2021 Jun 7.

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: To evaluate the outcomes of initial trabeculectomy in granulomatous and non-granulomatous uveitis.

Methods: Retrospective comparative study of 68 eyes that underwent an initial trabeculectomy.

Results: The mean follow-up was 74.18 and 74.86 months in both groups (p = 0.95). The intraocular pressure decreased from 40.03 mmHg ( ± 7.2) and 36.48 mmHg ( ± 11.3) to 14.00 mmHg ( ± 6.2) and 13.48 mmHg ( ± 5.7), the number of medications decreased from 3.73 ( ± 0.7) and 3.58 ( ± 0.9) to 1.00 ( ± 1.4) and 1.13 ( ± 1.4) on the last follow-up (p < 0.01) in the granulomatous and non-granulomatous groups, respectively. More eyes in the granulomatous uveitis group developed delayed postoperative complications like cataract, transient hypotony and glaucoma progression. Success rates were 64.9 and 71.0%, while failure rates were 35.1 and 29.0% in both groups (p = 0.84).

Conclusions: Trabeculectomy seems to have comparable IOP control and survival in granulomatous and non-granulomatous uveitis. Nevertheless, more eyes in the granulomatous uveitis group developed late-onset complications.
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http://dx.doi.org/10.1007/s10792-021-01910-1DOI Listing
October 2021

Aqueous misdirection after Nd:YAG goniopuncture in deep sclerectomy treated with Nd:YAG irido-zonulo-hyaloidotomy.

Eur J Ophthalmol 2021 May 20:11206721211019556. Epub 2021 May 20.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: To report a case of aqueous misdirection after goniopuncture in deep sclerectomy treated with Nd:YAG laser irido-zonulo-hyaloidotomy.

Case Presentation: About 72 years old patient with pseudoexfoliation glaucoma who underwent deep sclerectomy, developed aqueous misdirection after Nd:YAG laser goniopuncture. Medical management failed and subsequent peripheral Yag laser iridotomy to expose the zonules coupled with laser zonulo-hyaloidotomy was done and an instant gush of aqueous and vitreous substance prolapse through the iridotomy was noticed. Later, the anterior chamber was deep and the pressure was controlled.

Conclusions: Aqueous misdirection can occur after Nd:YAG laser goniopuncture. Nd:YAG laser irido-zonulo-hyaloidotomy can be effective in breaking the attack.
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http://dx.doi.org/10.1177/11206721211019556DOI Listing
May 2021

Assessing patient cosmetic satisfaction after glaucoma drainage device surgery for different patch grafts.

BMC Ophthalmol 2021 Feb 23;21(1):99. Epub 2021 Feb 23.

Glaucoma Division, King Khaled Eye Specialist Hospital Riyadh, Al Arubah Branch Rd, Riyadh, 11462, Saudi Arabia.

Background: The use of a tissue patch graft is common practice with a glaucoma drainage device (GDD). Patch grafts can be visible in the palpebral fissure and may be cosmetically displeasing for some patients. The aim of this study was to report the cosmetic satisfaction of pericardial, scleral, and corneal patch grafts related to superior GDD surgery.

Methods: Baseline clinical data were collected for consecutive patients with glaucoma operated between 2014 and 2019 at two tertiary eye care institutions (for superiorly-placed) Ahmad glaucoma valve implant using sclera, cornea and pericardium patch graft. A patient questionnaire that contained 4 concise questions, with a Likert-scale grading relating to cosmetic satisfaction was administered by a telephone-based interview. Responses and scores for each question were compared across patients who received the three different types of graft. A binominal logistic regression analysis was used to assess the effects of age, gender, type of graft, number of previous ocular surgeries, and final visual acuity to explain differences.

Results: We included 92 patients who met our inclusion criteria (24 patients received a corneal patch graft, 30 who received sclera and 38 who received pericardium). The mean (±SD) age was 50 (±17.5) years, and the average follow up was 20.7 (± 18.6) months. Regardless of the type of patch graft, most (67-84%) of patients were satisfied with the appearance of their eyes. Patients who received cornea or sclera were more likely to report that their eye looked 'abnormal' by others. Younger age was significantly associated with the response to this question.

Conclusion: Patients are generally satisfied with the appearance of their eye following GDD surgery with each of the patch grafts for superiorly-placed GDDs. Younger patients with cornea or sclera were more likely to report that their eyes looked abnormal.
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http://dx.doi.org/10.1186/s12886-021-01864-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903744PMC
February 2021

Association of rs12997 variant in the gene: a member of bone morphogenic protein signaling pathway with primary open-angle glaucoma in a Saudi cohort.

J Investig Med 2021 02 21;69(2):402-407. Epub 2020 Dec 21.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

We investigated the association between variants rs12997 in activin A receptor type I () and rs1043784 in located in the 3' untranslated region, and primary open-angle glaucoma (POAG). The retrospective case-control study used TaqMan real-time PCR assay to genotype 400 subjects, including 150 patients with POAG and 250 controls. The minor 'G' allele of rs12997 in showed significant association with POAG (p=0.027, OR=1.39, 95% CI=1.03 to 1.87). Likewise, rs12997 genotypes showed moderate association with POAG in recessive (p=0.048, OR=1.80, 95% CI=1.01 to 3.20) and log-additive models (p=0.030, OR=1.39, 95% CI=1.03 to 1.87), but did not survive Bonferroni correction. Rs1043784 in showed no associations. Furthermore, rs12997 G/G genotype significantly (p=0.033) increased the risk of POAG (twofolds) independent of age, sex and rs1043784 genotypes in regression analysis. However, clinical variables such as intraocular pressure and cup/disc ratio showed no association with both the polymorphisms. To conclude, the study shows a modest association between rs12997 in the gene, a member of the bone morphogenic protein signaling pathway and POAG. However, the results need further replication in large population-based cohorts and different ethnicities to validate its role as an important genetic biomarker.
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http://dx.doi.org/10.1136/jim-2020-001596DOI Listing
February 2021

Association analysis of polymorphisms rs12997 in ACVR1 and rs1043784 in BMP6 genes involved in bone morphogenic protein signaling pathway in primary angle-closure and pseudoexfoliation glaucoma patients of Saudi origin.

BMC Med Genet 2020 07 8;21(1):145. Epub 2020 Jul 8.

Department of Ophthalmology, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia.

Background: Glaucoma is a polygenic neurodegenerative disease and the second most common cause of blindness in Saudi Arabia. To test the hypothesis that genetic variants in the genes involved in the bone morphogenic protein (BMP) signaling pathway may be associated with glaucoma, we investigated the association between 3' untranslated region variants, rs12997 in ACVR1 and rs1043784 in BMP6, and primary angle-closure glaucoma (PACG) and pseudoexfoliation glaucoma (PXG).

Methods: In a case-control study, TaqMan® real-time PCR-based genotyping was done in 444 subjects consisting of 250 controls, 101 PACG and 95 PXG cases, and tested for genetic association with glaucoma-types and other clinical phenotypes.

Results: Rs12997[G] allele in ACVR1 exhibited significant 2-fold increased risk of PACG (p = 0.005) in women but not in men. Similarly, genotype analysis also showed that subjects carrying rs12997[G/G] genotype were at > 2-fold risk of PACG that remained significant after adjustment for age, sex, and Bonferroni correction in the recessive model. Furthermore, this effect was also significant in women only. In PXG, the rs12997[G/G] genotype showed a significant trend towards increased risk of the disease (OR = 2.04, 95% CI = 0.99-4.18, p = 0.049) but did not survive the Bonferroni correction. Regression analysis showed that rs12997[G/G] genotype was a significant predictor of PACG independent of age, sex, and rs1043784 genotypes. Likewise, age and rs12997[G/G] genotype showed significant effect on PXG outcome. The rs12997[A/G] genotype showed significant association with cup/disc ratio as compared to wild-type (p = 0.005) in PXG. Genotype and allele frequencies of rs1043784 in BMP6 did not show any significant association either with PACG or PXG.

Conclusions: Our results suggest that the polymorphism rs12997 in the ACVR1 gene involved in the BMP signaling pathway is significantly associated with PACG and PXG in a Saudi cohort. This is the first study to associate this variant/gene with PACG and PXG. However, further studies would be needed to replicate these findings in a large population-based cohort.
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http://dx.doi.org/10.1186/s12881-020-01076-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346469PMC
July 2020

Elevated Plasma Level of 8-Hydroxy-2'-deoxyguanosine Is Associated with Primary Open-Angle Glaucoma.

J Ophthalmol 2020 25;2020:6571413. Epub 2020 Apr 25.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Purpose: To determine the association between plasma 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels, a marker for oxidative DNA damage, and patients with primary open-angle glaucoma (POAG) or its clinical phenotypes. Furthermore, we also examined the utility of plasma 8-OHdG as a potential biomarker in POAG.

Materials And Methods: In a retrospective case-control study, plasma samples were obtained from 50 POAG cases and 45 glaucoma-free controls matched for age, sex, and ethnicity. 8-OHdG levels were measured in duplicate using an enzyme-linked immunosorbent assay (ELISA) on an automated ELISA analyzer.

Results: There was no significant difference in age, sex, and systemic disease distribution between POAG cases and controls. Both mean and median 8-OHdG levels were significantly elevated in POAG cases and male subjects. The area under the receiver operating characteristic (ROC) curve value for plasma 8-OHdG was 0.653 (95% confidence interval = 0.54-0.76, = 0.010). The cutoff values based on quartile distribution and ROC curve analysis showed that elevated plasma 8-OHdG significantly increased the risk of POAG by more than 4-folds. Plasma 8-OHdG had a sensitivity of 78% and specificity of 53%. In logistic regression analysis, 8-OHdG showed a significant effect on POAG outcome ( = 0.016) independent of age, sex, smoking, and systemic diseases. However, no significant correlation was observed between 8-OHdG and specific clinical markers of glaucoma such as intraocular pressure ( = 0.699), cup/disc ratio ( = 0.213), and the number of antiglaucoma medications ( = 0.603).

Conclusion: The study shows that there is a significant association between elevated plasma 8-OHdG and POAG, supporting the role of systemic oxidative stress-induced DNA damage in POAG pathogenesis. However, with a high rate of false-positivity, plasma 8-OHdG may lack the ability to serve as a potential biomarker in POAG. Further studies in a much larger cohort are needed to confirm these findings.
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http://dx.doi.org/10.1155/2020/6571413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201519PMC
April 2020

Genetic variant rs613872 in transcription factor 4 (TCF4) is not associated with primary open-angle glaucoma.

Eye (Lond) 2021 02 30;35(2):696-697. Epub 2020 Apr 30.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

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http://dx.doi.org/10.1038/s41433-020-0924-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026605PMC
February 2021

Association of endothelial nitric oxide synthase (NOS3) gene polymorphisms with primary open-angle glaucoma in a Saudi cohort.

PLoS One 2020 8;15(1):e0227417. Epub 2020 Jan 8.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Aim: To investigate the association of endothelial nitric oxide synthase (NOS3) gene polymorphisms in patients with primary open-angle glaucoma (POAG) of Saudi origin.

Methods: This case-control study included 173 patients with POAG (94 men and 79 women) and 171 controls (98 men and 73 women). Genotyping of rs2070744 (T-786C) and rs1799983 (G894T) variants of the NOS3 gene was performed using TaqMan® assay.

Results: Rs1799983 genotypes showed a significant association with POAG but did not survive Bonferroni correction (pcorrection = 0.01). The minor 'T' allele was significantly associated with the risk of POAG among men (p = 0.025, odds ratio (OR) = 1.77, 95% confidence interval (CI) = 1.07-2.94). Likewise, the genotypes were significantly associated with POAG among men in dominant (p = 0.030, OR = 1.92, 95% CI = 1.06-3.48) and log-additive models (p = 0.022, OR = 1.82, 95% CI = 1.08-3.07), and after adjustment for age and smoking. Genotype and allele frequencies of rs2070744 were not significantly different between POAG cases and controls, and after sex stratification. CG haplotype was significantly protective (p = 0.011, OR = 0.52, 95% CI = 0.32-0.87) and CT haplotype conferred significantly increased risk of POAG (p = 0.016, OR = 2.60, 95% CI = 1.16-5.82) among men. Rs1799983 showed trend (p = 0.054) towards risk of POAG independent of age, gender, smoking, and rs2070744 polymorphism in logistic regression analysis. Both the polymorphisms showed no association with POAG phenotypes such as intraocular pressure and cup/disc ratio.

Conclusion: Our results suggest that the polymorphism rs1799983 and the haplotypes of rs20707440 and rs1799983 in the NOS3 gene may significantly modulate the risk of POAG in Saudi's, particularly among men. Further larger studies are needed to confirm these findings.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227417PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948740PMC
April 2020

Polymorphism rs7961953 in TMTC2 gene is not associated with primary open-angle glaucoma in a Saudi cohort.

Ophthalmic Genet 2019 02 7;40(1):74-76. Epub 2019 Feb 7.

a Department of Ophthalmology, Glaucoma Research Chair, College of Medicine , King Saud University , Riyadh , Saudi Arabia.

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http://dx.doi.org/10.1080/13816810.2019.1576210DOI Listing
February 2019

Lack of Association between Variant rs7916697 in and Primary Open Angle Glaucoma in a Saudi Cohort.

Genet Res Int 2018 1;2018:2148056. Epub 2018 Nov 1.

Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

A case-control genetic association study was performed to investigate whether variant rs7916697 in (), which has been previously reported to be associated with optic disc parameters and primary open angle glaucoma (POAG) in different ethnic groups, is a risk factor for POAG or any of its clinical phenotypes in a Saudi cohort. Genotyping of rs7916697 (G>A) variant was performed in 186 unrelated POAG cases and 171 unrelated nonglaucomatous controls of Saudi origin using real-time Taq-Man® assay. Genotypic and allelic association with POAG and its related clinical indices were evaluated. Demographic and systemic disease status did not differ significantly between POAG cases and controls. Association analysis between POAG cases and controls showed no significant genotype effect under additive (p=0.707), dominant (p=0.458), and recessive (p=0.554) models. Besides, the minor 'A' allele frequency was 0.39 in POAG cases and 0.36 in controls with no significant distribution (p=0.406). In addition, there was no significant difference between genotypes and clinical phenotypes such as intraocular pressure and cup/disc ratio within the POAG group, or any age and sex adjusted genotype effect on the disease outcome in regression analysis. Variant rs7916697 in is not associated with POAG or its clinical indices such as IOP and cup/disc ratio in a Saudi cohort.
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http://dx.doi.org/10.1155/2018/2148056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241241PMC
November 2018

Plexin domain containing 2 (PLXDC2) gene polymorphism rs7081455 may not influence POAG risk in a Saudi cohort.

BMC Res Notes 2018 Oct 16;11(1):733. Epub 2018 Oct 16.

Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia.

Objective: Plexin domain containing 2 (PLXDC2), a cell surface transmembrane protein receptor for pigment epithelium derived factor, is expressed in many tissues including the eye. Polymorphism rs7081455 flanking PLXDC2 has been associated with primary open angle glaucoma (POAG) and its clinical phenotypes and may have a role in POAG. Rs7081455 was genotyped in POAG cases (n = 188) and non-glaucomatous controls (n = 164) of Saudi origin using Taq-Man to determine any association of this variant with POAG and its endophenotypes.

Results: The risk variant, 'G' allele, frequency was 0.56 and 0.52 in controls and POAG cases, respectively (p = 0.197) with was no significant deviation from Hardy-Weinberg equilibrium. Genotype analysis between cases and controls revealed no significant distribution under additive (p = 0.482), dominant (p = 0.590) and recessive models (p = 0.228). In addition, glaucoma specific phenotypic traits such as intraocular pressure (IOP) and cup/disc ratio; and number of anti-glaucoma medications, used to assess severity of the disease, were also statistically non-significant. Furthermore, regression analysis showed no significant effect of age, sex and genotype on disease outcome. Rs7081455 was not associated with POAG or its clinical phenotypes such as IOP and cup/disc ratio and hence may not be a significant risk factor for POAG patients of Saudi origin.
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http://dx.doi.org/10.1186/s13104-018-3848-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192173PMC
October 2018

Association of increased levels of plasma tumor necrosis factor alpha with primary open-angle glaucoma.

Clin Ophthalmol 2018 12;12:701-706. Epub 2018 Apr 12.

Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Purpose: Retinal ganglion cell (RGC) death is a key feature of glaucoma. Elevated levels of tumor necrosis factor alpha (TNF-α), a pro-inflammatory cytokine, can induce RGC apoptosis and play a critical role in glaucomatous neurodegeneration. Based on the possible role of inflammation and oxidative stress in the pathogenesis of primary open-angle glaucoma (POAG), we investigated the association between plasma levels of TNF-α and POAG or its clinical indices in comparison to non-glaucomatous controls.

Patients And Methods: In a case-control retrospective cohort of 51 POAG cases and 88 controls, plasma TNF-α levels were measured using an enzyme-linked immunosorbent assay (ELISA). The assay was performed in duplicates on an automated ELISA analyzer.

Results: Mean TNF-α level was significantly elevated in POAG cases (1.88 ± 2.17 pg/mL) than the controls (0.93 ± 1.49 pg/mL; = 0.003). The overall dose-response trend was significant ( = 6.12, df = 2; = 0.047). No statistical difference was seen in age, gender and systemic disease distribution. A modest negative and significant correlation was seen between TNF-α level and number of antiglaucoma medications, an important clinical index of POAG severity. Moreover, logistic regression analysis showed that the risk of POAG was most significantly affected by TNF-α level and not by age and sex.

Conclusion: High systemic level of an inflammatory cytokine, TNF-α, is associated with POAG; however, its possible use as a biomarker for early glaucoma diagnosis and/or disease severity needs further investigation.
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http://dx.doi.org/10.2147/OPTH.S162999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905466PMC
April 2018

Elevated levels of plasma tumor necrosis factor alpha in patients with pseudoexfoliation glaucoma.

Clin Ophthalmol 2018 17;12:153-159. Epub 2018 Jan 17.

Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine, which plays a role in glaucomatous neurodegeneration. Based on the plausible role of inflammation in the pathogenesis of pseudoexfoliation glaucoma (PEG), we investigated whether there is any relationship between the levels of plasma TNF-α and PEG or any of its clinical indices in comparison to normal controls.

Methods: The study was designed as a retrospective analysis. Plasma samples from 49 PEG patients and 88 non-glaucomatous controls were evaluated for TNF-α levels using an enzyme-linked immunosorbent assay (ELISA). The assay was performed in duplicates on a biochemical/ELISA analyzer.

Results: The two study groups were similar in age, sex and systemic disease distribution. The mean TNF-α concentration was significantly higher in the PEG patients (5.54±4.58 pg/mL) than in the control subjects (0.93±1.49 pg/mL; 95% confidence interval [CI] =3.50-5.72; =0.000). The overall dose-response trend was significant (=57.07, df=2; =0.000). A moderate positive and significant correlation was seen between TNF-α level and cup/disc ratio, an important clinical index for PEG. Besides, binary logistic regression analysis showed that the risk of PEG was most significantly affected by TNF-α level as compared to no association with age and sex. In receiver operating characteristic analysis, the area under the curve was 0.777 (95% CI =0.682-0.872) and statistically significant (=0.000).

Conclusion: Elevated systemic levels of inflammatory marker, TNF-α, are associated with PEG and may possibly serve as a biomarker for undiagnosed early glaucoma and/or as a marker for disease progression.
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http://dx.doi.org/10.2147/OPTH.S155168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775737PMC
January 2018

Polymorphism rs10483727 in the SIX1/SIX6 Gene Locus Is a Risk Factor for Primary Open Angle Glaucoma in a Saudi Cohort.

Genet Test Mol Biomarkers 2018 Jan 30;22(1):74-78. Epub 2017 Nov 30.

1 Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University , Riyadh, Saudi Arabia .

Aims: Variant rs10483727 in the SIX1/SIX6 locus has been significantly associated with primary open angle glaucoma (POAG) in multiple ethnic groups. We conducted a case-control study to investigate the association between this variant and POAG in a Saudi cohort.

Materials And Methods: Polymorphism rs10483727 was genotyped by using a TaqMan assay in 186 subjects comprising 92 unrelated POAG cases and 94 controls all of Saudi origin.

Results: The "C" allele frequency was 0.33 and 0.45 among POAG cases and controls, respectively (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.38-0.89; p = 0.013), suggesting a protective effect; and the "T" allele was associated with increased susceptibility to POAG (OR = 1.7, 95% CI = 1.11-2.58; p = 0.013). Genotype distribution was also significantly associated with POAG (χ = 6.41, df = 2, p = 0.041). Endophenotype traits such as intraocular pressure and cup/disk ratio did not show any significant genotype distribution in POAG cases. A binary logistic regression analysis used to evaluate the effects of age, gender, and genotype on the likelihood of having POAG showed that genotype distribution (p = 0.012) significantly affected the disease outcome as compared with age (p = 0.055) and sex (p = 0.432).

Conclusion: The "T" allele of the rs10483727 polymorphism is an independent significant risk factor for POAG in the Saudi population.
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http://dx.doi.org/10.1089/gtmb.2017.0159DOI Listing
January 2018

The influence of mitomycin C concentration on the outcome of trabeculectomy in uveitic glaucoma.

Int Ophthalmol 2018 Dec 14;38(6):2371-2379. Epub 2017 Oct 14.

Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: To evaluate the influence of mitomycin C (MMC) concentration on the outcome of trabeculectomy in uveitic glaucoma.

Methods: Retrospective comparative study included 50 patients who underwent MMC-enhanced trabeculectomy for uncontrolled uveitic glaucoma. Patients were divided into two groups based on the concentration of MMC used during trabeculectomy (high [0.04%] or low [0.02%]). The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the need for further glaucoma surgeries, and trabeculectomy success.

Results: There were no differences in the IOP nor antiglaucoma medications. The success rates were 76.0 and 68.0%, while the failure rates were 24.0 and 32.0% in the 0.02 and 0.04% MMC groups, respectively.

Conclusion: Trabeculectomy augmented with low (0.02%) MMC concentration seems to have comparable outcomes in uveitic glaucoma compared with high (0.04%) concentration.
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http://dx.doi.org/10.1007/s10792-017-0737-6DOI Listing
December 2018

Polymorphism rs11656696 in GAS7 Is Not Associated with Primary Open Angle Glaucoma in a Saudi Cohort.

Genet Test Mol Biomarkers 2017 Dec 12;21(12):754-758. Epub 2017 Oct 12.

1 Department of Ophthalmology, College of Medicine, King Saud University , Riyadh, Saudi Arabia .

Aims: To conduct a case-control study to investigate the association between the polymorphism rs11656696 located in the growth arrest-specific 7 gene (GAS7)on human chromosome 17p13.1 and primary open angle glaucoma (POAG).

Methods: The polymorphism rs11656696 was genotyped using the TaqMan assay in 187 subjects comprising 92 unrelated POAG cases and 95 controls of Saudi Arabian origin.

Results: Association analysis between cases and controls revealed no significant genotype distribution under additive (p = 0.225), dominant (p = 0.635), or recessive (p = 0.085) models. Moreover, the allele frequency distribution was also nonsignificant (p = 0.70). The minor "A" allele frequency was 0.35 and 0.41 among POAG cases and controls, respectively. In addition, specific clinical indices used to assess severity of glaucoma such as intraocular pressure (IOP), cup/disk ratio, and number of antiglaucoma medications also did not show any significant genotype distribution in POAG cases. Moreover, a binary logistic regression analysis did not show any significant effect of age, sex, or genotype on disease outcome.

Conclusion: Polymorphism rs11656696 is not associated with POAG nor any of its endophenotypic traits such as IOP and cup/disk ratio and is thus not a risk factor for POAG in this Saudi cohort.
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http://dx.doi.org/10.1089/gtmb.2017.0147DOI Listing
December 2017

Intermediate and Long-term Outcomes of Mitomycin C-enhanced Trabeculectomy as a First Glaucoma Procedure in Uveitic Glaucoma.

J Glaucoma 2017 May;26(5):478-485

*Department of Ophthalmology, College of Medicine ‡Glaucoma Research Chair, King Saud University †Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh §King Abdullah Medical City, Makkah, Saudi Arabia.

Objectives: To evaluate the intermediate and long-term outcomes of mitomycin C-enhanced trabeculectomy as a first glaucoma procedure in uveitic glaucoma.

Materials And Methods: Retrospective cohort study included 70 eyes of 50 patients with uveitic glaucoma who underwent mitomycin C-enhanced trabeculectomy as a first glaucoma procedure at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1996 and 2014. The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the presence of visually threatening complications, and the need for further surgeries to control the IOP. Surgical outcome of each eye was classified as an absolute success, qualified success, or failure, based on the main outcome measures.

Results: The mean follow-up period was 77.0 months (±40.9). The IOP and number of antiglaucoma medications decreased significantly from a mean of 39.5 mm Hg (±8.9) and 3.7 (±0.8) to 14.4 mm Hg (±6.9) and 1 (±1.3) at the last follow-up, respectively (P<0.001 for both). The cumulative probabilities of success were 60% and 35.7% at 36 and 60 months postoperatively, respectively. The most common complications were cataract development and progression (45.3%), hypotony (IOP ≤5 mm Hg) (30%) and IOP spike≥30 mm Hg (10%). Eighteen eyes (25.7%) needed a second procedure to control the IOP.

Conclusions: Although mitomycin C-enhanced trabeculectomy offers reasonable intermediate and long-term IOP control and safety in uveitic glaucoma, a significant number of patients needed further procedures to control the pressure. Thus, continuous monitoring of the pressure and inflammation are crucial.
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http://dx.doi.org/10.1097/IJG.0000000000000653DOI Listing
May 2017

The Influence of Phacoemulsification on Intraocular Pressure Control and Trabeculectomy Survival in Uveitic Glaucoma.

J Glaucoma 2017 May;26(5):444-449

*Department of Ophthalmology, College of Medicine ‡Glaucoma Research Chair, King Saud University †Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh §King Abdullah Medical City, Makkah, Saudi Arabia.

Objectives: To evaluate the influence of phacoemulsification on intraocular pressure (IOP) control and survival of mitomycin C (MMC)-enhanced trabeculectomy in uveitic glaucoma (UG).

Materials And Methods: Retrospective case-control study included 54 eyes from 40 patients with UG who underwent MMC-enhanced trabeculectomy as an initial procedure to treat glaucoma at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 2002 and 2014. Eyes were divided into 2 groups: the first group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second group included eyes that did not have cataract surgery. The main outcome measures were changes in the IOP, the number of antiglaucoma medications, IOP control, and trabeculectomy survival.

Results: There were no differences in the overall trabeculectomy survival of eyes that underwent cataract surgery and those that did not (P=0.681, log-rank) nor the final IOP [15.54 mm Hg (±6.3) in the study group and 13.34 mm Hg (±5.6) in the control group, P=0.247]. However, more antiglaucoma medications were needed to control the IOP after cataract surgery at the last follow-up [1.59 medications (±1.4) in the study group and 0.50 medications (±0.7) in the control group; P=0.009].

Conclusions: UG eyes that underwent phacoemulsification following MMC-enhanced trabeculectomy required more medications to control the IOP than those that did not undergo cataract surgery and therefore less IOP control. Such changes in IOP control did not affect the overall trabeculectomy survival rate.
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http://dx.doi.org/10.1097/IJG.0000000000000646DOI Listing
May 2017

Analysis of Cyclin-Dependent Kinase Inhibitor-2B rs1063192 Polymorphism in Saudi Patients with Primary Open-Angle Glaucoma.

Genet Test Mol Biomarkers 2016 Oct 19;20(10):637-641. Epub 2016 Aug 19.

1 Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University , Riyadh, Saudi Arabia .

Aims: To investigate whether the polymorphism rs1063192 (A>G) in the cyclin-dependent kinase Inhibitor-2B (CDKN2B) gene is a risk factor for primary open-angle glaucoma (POAG).

Method: A case-control study was conducted wherein we genotyped 87 unrelated POAG cases and 94 control subjects from Saudi Arabia using the Taq-Man assay.

Results: The minor allele frequency was 0.20 in POAG cases and 0.21 in controls. Both the genotype and allele frequencies were not significantly different between cases and controls. No significant association was found between genotypes and glaucoma clinical indices, except that the mutant homozygous genotype (G/G) was associated with the family history of glaucoma (p = 0.024).

Conclusion: Polymorphism rs1063192 in CDKN2B is not a risk factor for POAG in Saudi cohort.
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http://dx.doi.org/10.1089/gtmb.2016.0140DOI Listing
October 2016

Analysis of Polymorphism rs1900004 in Atonal bHLH Transcription Factor 7 in Saudi Patients with Primary Open Angle Glaucoma.

Genet Test Mol Biomarkers 2016 Nov 12;20(11):715-718. Epub 2016 Sep 12.

1 Department of Ophthalmology, College of Medicine, King Saud University , Riyadh, Saudi Arabia .

Aims: To investigate the association between the rs1900004 polymorphism in the atonal bHLH transcription factor 7 (ATOH7) gene and primary open angle glaucoma (POAG) in Saudi patients.

Methods: Eighty-seven unrelated POAG cases and 94 unrelated control subjects of Saudi origin were genotyped utilizing a TaqMan assay. The association between mutant genotypes and POAG and its related clinical indices was investigated.

Results: The genotype and allele frequencies of the polymorphism in ATOH7 did not show any statistically significant association with POAG compared to controls. The minor allele frequency was 0.32 in both cases and controls. None of the demographic, systemic diseases nor glaucoma-specific clinical indices such as intraocular pressure (IOP), cup/disc ratio, and number of antiglaucoma medication, showed any significant association with genotypes. Binary logistic regression analysis (adjusted for age and gender) showed that age was a marginally significant risk factor for the development of glaucoma (adjusted odds ratio = 1.1; 95% confidence interval = 1.079-1.158; p < 0.0001).

Conclusions: The study did not detect any direct link between genotype/allele frequency of rs1900004 in ATOH7 and POAG or its related clinical indices such as IOP and cup/disc ratio indicating that this polymorphism is not a risk factor for POAG in a Saudi cohort.
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http://dx.doi.org/10.1089/gtmb.2016.0209DOI Listing
November 2016

Outcomes of Trabeculectomy With Mitomycin-C in Uveitis Associated With Vogt-Koyanagi-Harada Disease.

J Glaucoma 2016 06;25(6):528-32

*Department of Ophthalmology, College of Medicine, King Saud University †Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh ‡King Abdullah Medical City, Makkah, Saudi Arabia.

Objectives: To evaluate the outcomes of trabeculectomy with mitomycin-C (MMC) in uveitis associated with Vogt-Koyanagi-Harada disease (VKH).

Methods: Retrospective cohort study included 27 eyes of 15 patients with uveitic glaucoma associated with VKH disease who underwent trabeculectomy with MMC as a first glaucoma procedure at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1992 and 2011. The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the presence of visually threatening complications, and the need for further surgeries to control the IOP.

Results: The mean follow-up was 78.19 months. The IOP decreased significantly from a mean of 40.15±7.0 to 13.12±6.9 mm Hg on the last follow-up (P<0.01) as well as during the whole follow-up period. The number of medications needed to control the IOP also decreased significantly from 3.89±0.6 to 1.04±1.3. The cumulative probabilities of success were 77.8%, 74.1%, 63.0%, and 51.9% at 12, 24, 36, and 48 months postoperatively, respectively. The most common complications were cataract development and progression (53.8%), hypotony (IOP≤5 mm Hg) (33.3%), choroidal effusion (7.4%), and decompressive retinopathy (7.4%). Eight eyes (29.6%) needed a second procedure to control the IOP.

Conclusions: Trabeculectomy with MMC offers an acceptable intermediate term success and IOP control in uveitic glaucoma associated with VKH. However, significant number of eyes needed further procedures to control the pressure. Therefore, continuous monitoring of the pressure is important.
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http://dx.doi.org/10.1097/IJG.0000000000000384DOI Listing
June 2016

Incidence and management of haemorrhagic Descemet membrane detachment in canaloplasty and phacocanaloplasty.

Acta Ophthalmol 2016 Aug 21;94(5):e298-304. Epub 2015 Dec 21.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Purpose: To report the incidence and management of haemorrhagic Descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty.

Methods: This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD, best corrected visual acuity, recovery time after Descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of antiglaucoma medications. Each eye was managed according to the time of development, type and extent of DMD.

Results: Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intracameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1 day post-procedure.

Conclusion: HDMD occurred in up to 6.7% in canaloplasty and phacocanaloplasty procedures, mostly during catheter withdrawal and the viscodilation step. Early recognition and management prevented further manipulation.
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http://dx.doi.org/10.1111/aos.12936DOI Listing
August 2016
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