Methods: A cross-sectional study was conducted involving 114 Malay patients with POAG seen at the eye clinic of Hospital Universiti Sains Malaysia. Patients aged between 40 and 80 years who were diagnosed with other types of glaucoma, previous glaucoma filtering surgery or other surgeries except uncomplicated cataract surgery and pterygium surgery were excluded. A total of 101 patients who were followed up for dry eyes, age-related cataracts or post cataracts extraction surgery were recruited as control subjects. Those with family history of glaucoma or glaucoma suspect were excluded. Microvascular endothelial function was assessed using laser Doppler fluximetry and the process of iontophoresis. Iontophoresis with acetylcholine (ACh) and sodium nitroprusside (SNP) was used to measure microvascular endothelium-dependent and endothelium-independent vasodilatations, respectively.
Results: In general, POAG patients demonstrated lower ACh% and AChmax values compared with controls. There was significant difference in microvascular endothelial function [ACh%: mean, 95% confidence interval = 503.1 (378.0, 628.3), and AChmax: mean, 95% confidence interval = 36.8 (30.2, 43.5)] between primary open angle glaucoma cases (p
METHODS: This was a cross-sectional comparative study comparing primary angle closure glaucoma (PACG) patients (Group A) with primary angle closure and primary angle closure suspect (Group B). Group A was treated with topical pressure-lowering drugs; Group B was not. Data on ocular diagnosis and details of treatment were obtained from medical records. Ocular surface disease incidence was assessed using the Ocular Surface Disease Index (OSDI) questionnaire and from clinical signs using Schirmer's test, tear break-up time and corneal fluorescein stain. Predictive Analytic Software 20 and STATA analysis software were used for statistical analyses.
RESULTS: Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer's test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer's test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer's test. There was a significant difference in mean score of OSDI (p=0.004), TBUT (p=0.008) and cornea staining (p<0.001) between two groups. Primary angle closure glaucoma treated with more than two medications and for more than three years had worse ocular surface disease parameters but without statistical significant difference.
CONCLUSION: Ocular surface disease is common in PACG patients treated with topical pressure-lowering drugs. Topical pressure-lowering drugs caused significant OSD symptoms and signs except for tear production in PACG patients. Thorough evaluation of ocular surface disease is important to ensure appropriate treatment and intervention in PACG patients.
METHODS: A retrospective, non-comparative, analytical case series of all patients who received SL-TSCPC treatment from October 2018 to April 2019 at Hospital Tengku Ampuan Afzan, Pahang, Malaysia. Data was collected during the second week, sixth week, third month and sixth month follow-up. The primary outcome measure gave success rate at six months post-treatment. Secondary measures were changes in visual acuity, mean IOP reduction, mean number of IOP lowering medications reduced and ocular side effects noted during follow-up.
RESULTS: The success rate was 43.8% (seven eyes out of sixteen eyes) at six months post-treatment. The mean IOP reduced from 43.0mmHg±14.8mmHg pre-treatment to 24.7mmHg±12.0mmHg at two weeks post treatment with 42.6% reduction. Subsequently, mean IOP at sixth week, third month and sixth month were 33.8mmHg±16.9mmHg, 35.2mmHg±14.9mmHg, and 29.0mmHg±16.2mmHg respectively. Vision maintained in 13 patients, two patients had improvement in vision however, five patients had deterioration in vision. No serious ocular side effects were noted.
CONCLUSION: Subliminal TSCPC is a safe and alternative method of lowering IOP in moderate to advanced glaucoma over 6 months duration of follow-up. As it has good safety profile and repeatability, it is a good treatment option for patients with uncontrolled glaucoma.
METHODS: Seventeen POAG patients with suboptimal IOP control despite pre-existing topical medications were subjected to adjunct SLT (50 applications 180 degrees) or second line medical therapy. Current medications were continued, and patients were followed up for 6 months for degree of intraocular pressure (IOP) lowering. HRQoL was assessed using Glaucoma Quality of Life 36-item (GlauQoL-36), Assessment of Quality of Life-7D (AQoL-7D) and Vision related Quality of Life (VisQoL). Costs involved were calculated and compared to the effect (IOP reduction) achieved in each arm.
RESULTS: Ten patients were in the SLT group and 7 in the topical medication (MED) group. Mean baseline intraocular pressure (IOP) was 18.90±3.48mmHg in SLT group and 15.57±2.23mmHg in MED group. Mean reduction of IOP was 4.30±1.64mmHg in SLT group and 2.71±2.56 mmHg in MED group at 6 months which was not statistically significant (p=0.14) between two groups. All the HRQoL questionnaires did not show significant changes in the groups or between groups when compared baseline with 6-month post treatment (p-values ranging from 0.247 to 0.987). For every 1mmHg reduction in IOP, cost involved in MED group (RM53.61) was 165% of the cost involved in SLT group (RM32.56).
DISCUSSION AND CONCLUSION: This study has shown that SLT was as effective clinically and tolerable as topical anti glaucoma medications and was possibly more cost effective in the step-up treatment of patients with POAG at 6 months follow- up.
METHODS: This cross-sectional study was conducted between December 2020 and March 2021 at Sarawak General Hospital, Malaysia. Convenience sampling was used to recruit patients with glaucoma who self-administered their eye drops. Participants' background information were obtained using an investigator-administered questionnaire before their eye drop instillation technique was assessed. Those with imperfect techniques were counselled by a pharmacist before being reassessed. Differences in eye drop instillation competency were determined using paired T-test.
KEY FINDINGS: A total of 138 participants were recruited. Participants were on a median of two eye drops (IQR 2-4) for a median of five years (IQR 2-8). Prior to being counselled, they demonstrated a mean total of 8.4/13 steps (SD 2.33) correctly. A statistically significant improvement in eye drop instillation technique was observed post-pharmacists' counselling, with a mean increase of 4.3 steps demonstrated correctly (95% CI, 4.0 to 4.7, P < 0.001). The majority of participants agreed that pharmacists are knowledgeable in providing counselling on eye drop administration techniques.
CONCLUSIONS: Patients with glaucoma treated at Sarawak General Hospital had imperfect eye drop instillation techniques, despite most having used their eye drops for several years. Interventions by pharmacists to improve eye drop instillation are crucial to optimise the medical treatment of patients with glaucoma.