The Tube Versus Trabeculectomy (TVT) Study is a multicenter randomized clinical trial comparing the safety and efficacy of tube shunt surgery to trabeculectomy with mitomycin (MMC) in eyes with previous cataract and/or failed glaucoma surgery. Tube shunt surgery was more likely to maintain intraocular pressure (IOP) control and avoid persistent hypotony, reoperation for glaucoma, or loss of light perception vision than trabeculectomy with MMC during the first year of follow-up. Both surgical procedures had similar IOP reduction at 1 year, but less supplemental medical therapy was used following trabeculectomy. The incidence of postoperative complications was higher after trabeculectomy with MMC relative to tube shunt surgery, but serious complications associated with vision loss and/or reoperation developed with similar frequency after both of the procedures. There was no significant difference in the rate of vision loss following trabeculectomy with MMC and tube shunt surgery after 1 year of follow-up. Cataract progression was common, but occurred with similar frequency with both of the surgical procedures.

This review presents the 'Moorfields Safer Surgery System', which is designed to improve the consistency and outcomes of trabeculectomy surgery. Evidence-based recommendations are made for each step of the surgery. This system requires a minimum of equipment and can be easily implemented by most surgeons. The system is ultimately designed to preserve the vision in our patients by minimising complications while maintaining a desired intraocular pressure.

Newer techniques of Laser Trabeculoplasty have revived the procedure and gained widespread acceptance by the ophthalmic community. This review was undertaken to address the evolution of different laser trabeculoplaty techniques, proposed mechanisms of action as well as review current studies of the therapeutic effects of these interventions.

Cataract and glaucoma are common co morbidities. Cataract surgery is frequently performed in patients with glaucoma. In this study, a review of literature with search terms of cataract, glaucoma and intraocular pressure is followed by evaluation and synthesis of data to determine the effect of cataract surgery on intraocular pressure. Cataract surgery seems to lower intraocular pressure on a sustained basis, especially in patients with higher preoperative intraocular pressure. The mechanism of action of these finds remains speculative.

Deep Sclerectomy is a non penetrating surgical procedure for the treatment of open angle glaucoma. In this article we will describe the surgical technique, the indications for surgery and will review the scientific literature on surgical outcome following this procedure. We will also discuss the important role played by antimetabolites, implants and the use of gonipuncture to achieve the desired IOP reduction.

Open angle glaucoma (OAG) necessitating surgery has traditionally been treated with filtering procedures using antifibrotics. Unfortunately, such filtering procedures are not without the risk of postsurgical complications. Increasing interest in blebless surgery has led to innovative surgical procedures aimed at rejuvenating the natural trabeculo canalicular outflow pathway. Circumferential catheterization with suture tensioning of Schlemm's canal has emerged as a safe and effective way to surgically treat OAG.

Endocyclophotocoagulation is becoming a widely accepted and popular treatment of refractory glaucoma and as an adjunct to cataract surgery in both medically controlled and uncontrolled glaucoma. We present a brief review of the indications, technique, safety and efficacy of endoscopic photococylocoagulation.

The Ex-Press Mini Glaucoma Shunt has been available internationally for almost a decade with almost 35,000 implantations world wide. The device shunts aqueous from the anterior chamber to a subconjunctival reservoir in a similar fashion as trabeculectomy, without removal of any sclera or iris tissue. Developments in ophthalmic surgery have been focused on smaller incisions to improve patient outcomes and visual recovery. The Ex-Press is an example of these developments. This article will review the surgical technique for implanting the Ex-Press Mini Glaucoma Shunt and will highlight the clinical experience with the device.

The iStent trabecular micro-bypass system (Glaukos Corp. Laguna Hills, CA) was developed to address the limitations of current medical and surgical therapies for glaucoma treatment. The iStent^; is inserted ab interno through a small temporal clear corneal incision, bypassing the trabecular meshwork and placed in Schlemm's canal at the lower nasal quadrant. Implantation of this stent into Schlemm's canal allows aqueous humor to drain directly from the anterior chamber into Schlemm's canal bypassing the obstructed trabecular meshwork. For this review, a Medline search was performed using the terms "trabecular micro-bypass stent" and "trabecular bypass stent." The online abstract database for the American Academy of Ophthalmology was also reviewed. Abstracts which duplicated published articles were excluded. All relevant papers (n is equal to three) and abstracts (n is equal to one) were included in this review. Multiple, prospective multi-country, clinical trials have demonstrated the safety and efficacy of iStent in reducing IOP, when compared to traditional treatment modalities, while reducing/ eliminating the need for ocular antihypertensive drugs when implanted in OAG patients during combined cataract surgery or in patients with glaucoma refractory to traditional treatment modalities.

Purpose : To detect early glaucomatous changes in pseudo exfoliative patients with normal intraocular pressure (IOP), visual field and optic nerve head appearance; by measuring retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT). Design : A prospective observational case-control study. Participants : Twenty non-glaucomatous (normal IOP, fundus and visual field) pseudo exfoliative patients and 20 age matched healthy control subjects. Materials and Methods : The RNFL thickness (global and four quadrants) was assessed using combined imaging system OTI (OCT/SLO) and compared with age matched normal control subjects. Results : The RNFL in patients with pseudo exfoliation syndrome (PXS) was significantly thinner in all quadrants except the nasal quadrant compared to the control group (p less than 0.05). Conclusion : Measurement of RNFL thickness by OCT is useful in detecting early RNFL damage which in turn provides clinically relevant information in detecting early glaucomatous changes in pseudo exfoliative patients.

Context : The exact patho physiological mechanizm of optic nerve damage in glaucoma is not fully understood. Aim : To assess the vascular risk factors in open angle glaucoma in African eyes. Settings and Design : Prospective multicenter hospital-based study in Edo State, Nigeria. Materials and Methods : Three hundred and twenty-two glaucoma patients and 184 control subjects were included in the study comprising 200 male glaucoma patients (62.11%) and 122 females (37.89%). A cohort of consecutive patients with a diagnosis of primary open angle glaucoma and age and sex matched control subjects were included in this prospective, cross-sectional, and multicenter hospital-based study conducted during the period January-June 2008. Blood pressure (BP), pulse and intraocular pressure findings were recorded and mean BP, pulse and perfusion pressure for each eye calculated. Statistical Analysis Used : Mean, standard deviations, 95% confidence intervals, Welch's t test, and Fisher's exact test were calculated. Results : The mean IOP in the 644 eyes of the 322 glaucoma patients was 22.65 mmHg (SD plus/minus 11.06). The systolic blood pressure (P < 0.0001), diastolic blood pressure (P < 0.0001), mean arterial blood pressure (P < 0.0001), pulse pressure (P < 0.01), systolic perfusion pressure (P < 0.01) were all significantly higher in glaucoma patients than in control. Conclusions : Higher systolic, diastolic, mean arterial BP and pulse pressure was found in Black African patients with open angle glaucoma.

Purpose : To describe short term outcomes of Ahmed Glaucoma Valve [AGV] implantation in East African patients. Materials and Methods : In this multi-center retrospective case series we reviewed eyes of Black African patients with refractory glaucoma, treated consecutively with Ahmed Glaucoma Valve implantation, in two centers in Kenya between January 2006 and October 2007. Results : About 25 cases including 18 [72%] pediatric eyes and seven [28%] adult eyes were identified. Results have been presented with a median follow-up of two months with inter-quartile range [IQR] of one to 12 months. intraocular pressure [IOP] was reduced from a mean of 36.4 mmHg preoperatively to 16.7 mmHg and glaucoma medications were lowered from a mean of 1.32 before surgery to 0.2 after surgery. The success rate during short term follow-up was 79%. The mean visual acuity dropped slightly from 6/18 pre-operatively to 6/24. There was only one major complication of an extruded, infected valve in a child. Conclusions : The Ahmed Valve Implant is safe and effective in lowering IOP for the short term in pediatric and adult East African patients with refractory glaucoma. Further studies with more patients and longer term follow-up are needed in this population.