Advanced Glaucoma Research Articles

CORRELATION OF VISUAL FIELD CHANGES WITH OPTICAL COHERENCE TOMOGRAPHY IN PRIMARY OPEN ANGLE GLAUCOMA

PURPOSE: To detect morphological changes in Optic Nerve Head (ONH), macula and Retinal nerve fibre layer (RNFL) using spectral domain optical coherence tomography (SDOCT) and to correlate them with functional loss (Visual field changes) using 24-2 and 10-2 standard automated perimetry in Primary open angle glaucoma patients. RESULTS: Mean value of 90D cup to disc ratio (CDR) of study subjects was 0.64 ± 0.13 with median (25th-75th percentile) of 0.7(0.6-0.7). Mean value of average RNFL thickness(microns), superior quadrant thickness (micron), inferior quadrant thickness (micron), nasal quadrant thickness (micron) and temporal quadrant thickness (micron) of study subjects was 62.35 ± 14.43, 77.96 ± 14.29, 81.41 ± 22.84, 51.33 ± 21.14 and 50.71 ± 17.71 with median(25th-75th percentile) of 63(52-75), 78(66.25-89), 81.5(64.25-93.75), 54(46-63) and 50.5(39-57.75) respectively. Mean value of average macular thickness (micron), macular GCL-IPL thickness -Superior quadrant (micron) and macular GCL-IPL thickness -Inferior quadrant (micron) of study subjects was 65.6 ± 11.7, 76.49 ± 11.63 and 76.76 ± 16.86 with median (25th-75th percentile) of 64(56-75), 75(67-87.75) and 75.5(65.25-93) respectively. Mean value of MD and PSD of study subjects was -7.34 ± 4.47 and 6.8 ± 3.11 with median (25th-75th percentile) of -7.65(-11--3.1) and 6.9(3.9-9.1) respectively. 57(41.3%) eyes had early glaucoma, 51(37%) eyes had moderate glaucoma and 30(21.7%) eyes had advanced glaucoma. CONCLUSION: In present study, ONH parameters (rim area), RNFL parameter (inferior quadrant thickness) and macula parameters (average macular GCLIPL thickness) showed statistically significant correlation with VF MD. Correlation between VF parameters i.e. MD and PSD with OCT parameters shown that there was a relation between Macular GCLIPL thickness ,RNFL thickness and ONH with the changes in the results of VF.

Establishing target intraocular pressure in newly diagnosed exfoliation glaucoma patients

ABSTRACT Background This study aimed to determine the appropriate target intraocular pressure (IOP) for patients newly diagnosed with exfoliation glaucoma. Research design and methods The study followed a prospective cohort of newly diagnosed exfoliation patients for three years. The target IOP was defined using three methods to measure visual field deterioration, mean deviation (MD), visual field index (VFI), and guided progression analysis (GPA). Results Over the three years, the mean deviation (MD) values declined by an average of −3.84 (±2.61) dB, while the visual field index (VFI) values dropped by an average of 9.66 (±6.25) %. The untreated IOP at inclusion was 32.52 ± 5.54 mmHg. At the end of the study (due to treatment), it was 17.94 ± 1.82 mmHg, resulting in a reduction of 14.58 mmHg (45% reduction). Based on the MD and VFI methods, the target IOP for the whole cohort was around 14–15 mmHg, while the target IOP based on GPA was around 15 mmHg. For advanced glaucoma cases, the target IOP was around 13 mmHg. Conclusions The study concludes that the traditional reported IOP reduction of 20% and/or IOP 18–20 mmHg may not be sufficient for patients newly diagnosed with exfoliation glaucoma. Instead, the study recommends a target IOP of 14–15 mmHg for these patients. Clinical Trial Registration The study was registered in the www.clinicaltrials.gov website with the number NCT06237764.

Treadmill-walking impairs visual function in early glaucoma and elderly controls

Abstract Aims Impaired vision is an additional risk factor in elderly for falls. We investigated the hypothesis that treadmill (TM) walking affects visual function in both healthy elderly and those with early-moderate visual dysfunction due to glaucoma. Methods Thirty healthy controls (HC) aged 64–83 years and 18 glaucoma patients (GLA) aged 62–82 years participated in this cross-sectional study. The impact of TM-walking on visual function was assessed binocularly for (i) best-corrected visual acuity (BCVA) with and without crowding effect, (ii) contrast sensitivity (CS), and (iii) and visual field (mean deviation, VF-MD). Visual function was tested while participants were standing or during TM-walking for 2 speed conditions: (i) fast walking at their preferred speed and (ii) walking at a fixed speed of 3.5 km/h. Results GLA, most with early-moderate VF loss, performed equally well as HC. Independent of GROUP, an impact of SPEED on visual functions was statistically evident with large statistical effect size for (i) both types of BCVA with a mean loss of 0.02–0.05 logMAR (η2 = 0.41) and (ii) VF-MD with mean loss of 1 dB (η2 = 0.70), but not for CS. Conclusions Here, we introduce a paradigm for the assessment of visual function during walking. We provide proof-of-concept that our approach allows for the identification of walking induced visual function loss, i.e., a deterioration of BCVA and VF-sensitivity during TM-walking in both groups. It is therefore of promise for the investigation of the relation of vision impairment and mobility, ultimately the increased frequency of falls in advanced glaucoma.

Matched case-control comparison of surgical success after XEN45 Gel Stent and PRESERFLO MicroShunt implantation in a Caucasian population.

The aim of this study was to compare the outcome of implantation of a XEN45 Gel Stent with the outcome of implantation of a Preserflo MicroShunt in a matched-pair analysis in eyes being naïve to filtering surgery. In this comparative, retrospective study, 50 eyes that had undergone XEN45 Gel Stent implantation were compared with 50 eyes after Preserflo implantation. Follow-up was at least 6 months, and surgical success was measured by criteria A (IOP < 21 mmHg, IOP reduction >20%, no repeat surgery); criteria B (IOP < 18 mmHg, IOP reduction >20%, no repeat surgery); and criteria C (IOP ≤15 mmHg, IOP reduction ≥40%, no repeat surgery). After a follow-up period of 12 months, mean IOP had decreased from preoperative 25.2 ± 4.8 mmHg in the XEN group to 14.5 ± 4.0 (n = 35) and from 25.3 ± 6.8 mmHg to 11.9 ± 2.9 (n = 41) in the Preserflo group, respectively. The IOP at the last follow-up of the two groups differed significantly (p < 0.01). The probability of surgical success did not differ concerning Criteria A and B, but surgical success was significantly higher in the Preserflo group for Criteria C (60%, p < 0.01). Both the Preserflo and XEN45 Gel Stent provide an effective and safe treatment option for advanced glaucoma and have a high potential to reduce intraocular pressure. Absolute IOP levels of <16 mmHg after 12 months were significantly more frequent in the Preserflo group.

Visual Outcome after Cataract Surgery in a South-Eastern Nigerian Tertiary Hospital

Background: Cataract is the leading cause of reversible blindness worldwide. Aim: To evaluate the visual outcome of cataract surgeries done in a South-Eastern tertiary hospital. Methodology: The study is a 2-year retrospective study from January 2021 to December 2022. Case notes of all eligible patients that had cataract surgery within the study period were pulled out and relevant information extracted from them. Collected data was analyzed using SPSS version 21. Results were presented in percentages, tables and pie charts. Results: One hundred and eighty-two eyes were analyzed. Visual outcome continued to improve postoperatively in majority of the patients from first day to 3 months and was even better in some when corrected with glasses or with pinhole. The overall visual outcome was good in 70.3% and poor in 10.4% at 3 months. The major causes of poor visual outcome were aphakia and advanced glaucoma. Conclusion: The overall visual outcome after cataract surgery in these patients did not meet the WHO standard. Thus, there is need for training and re-training of the cataract surgeons, good patients’ selection, in-depth pre-operative work up as well as centre-based provision of needed equipments/ consumables in other to improve the visual outcome.

Association Between Primary Open Angle Glaucoma and Type II Diabetes Mellitus in Benghazi, Libya

Glaucoma, a leading cause of permanent blindness in the world, primarily affects older adults and is classified into four types, with diabetes mellitus potentially influencing the condition. The study aims to identify the link between Diabetes mellitus type two and Primary open angle Glaucoma. Subject and method A case-control study at Benghazi Educational Eye Hospital from December 2023 to February 2024. examined diabetic patients with and without glaucoma. Participants underwent ophthalmic examinations, including visual acuity, and gonioscopy. Patients with history of type two diabetes were included. The mean age of cases was significantly higher than controls [P=0.001]. There were significant differences in best corrected visual acuity between the two groups [P=0.035], Participants with high a [HbA1c] were more likely to have an advanced primary open angle glaucoma type. Participants with uncontrolled diabetes mellitus had higher intraocular pressure levels compared to the control group, [p=0.013]. There was a statistically significant difference in Retinal nerve fibers layers thickness in right eye, and Retinal nerve fibers layer thickness in left eye, between the case and control groups, [P= 0.041, 0.005 respectively. The age 66-75 years had a significantly higher risk of primary open angle glaucoma. A negative correlation between the duration of diabetes and Pattern standard deviation in left eye [ P = 0.051], as well as Visual Field left [P = 0.002]. The study reveals a significant link between diabetes mellitus type two and primary open angle glaucoma, with factors like higher intraocular pressure and older age causing higher incidence. early detection and management of risk factors could prevent or delay glaucoma onset.

Efficacy and Safety of Surgical Peripheral Iridectomy, Goniosynechialysis, and Goniotomy for Advanced Primary Angle Closure Glaucoma Without Cataract: 1-Year Results of a Multicenter Study.

The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract. To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract. A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18mmHg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression. A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8mmHg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P =0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P =0.036) reduced success rate. The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.

Values of macular ganglion cell-inner plexiform layer and 10-2 visual field measurements in detecting and evaluating glaucoma.

To assess the performance of macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and 10-2 visual field (VF) parameters in detecting early glaucoma and evaluating the severity of advanced glaucoma. Totally 127 eyes from 89 participants (36 eyes of 19 healthy participants, 45 eyes of 31 early glaucoma patients and 46 eyes of 39 advanced glaucoma patients) were included. The relationships between the optical coherence tomography (OCT)-derived parameters and VF sensitivity were determined. Patients with early glaucoma were divided into eyes with or without central 10° of the VF damages (CVFDs), and the diagnostic performances of OCT-derived parameters were assessed. In early glaucoma, the mGCIPLT was significantly correlated with 10-2 VF pattern standard deviation (PSD; with average mGCIPLT: β=-0.046, 95%CI, -0.067 to -0.024, P<0.001). In advanced glaucoma, the mGCIPLT was related to the 24-2 VF mean deviation (MD; with average mGCIPLT: β=0.397, 95%CI, 0.199 to 0.595, P<0.001), 10-2 VF MD (with average mGCIPLT: β=0.762, 95%CI, 0.485 to 1.038, P<0.001) and 24-2 VF PSD (with average mGCIPLT: β=0.244, 95%CI, 0.124 to 0.364, P<0.001). Except for the minimum and superotemporal mGCIPLT, the decrease of mGCIPLT in early glaucomatous eyes with CVFDs was more severe than that of early glaucomatous eyes without CVFDs. The area under the curve (AUC) of the average mGCIPLT (AUC=0.949, 95%CI, 0.868 to 0.982) was greater than that of the average circumpapillary retinal nerve fiber layer thickness (cpRNFLT; AUC=0.827, 95%CI, 0.674 to 0.918) and rim area (AUC=0.799, 95%CI, 0.610 to 0.907) in early glaucomatous eyes with CVFDs versus normal eyes. The 10-2 VF and mGCIPLT parameters are complementary to 24-2 VF, cpRNFLT and ONH parameters, especially in detecting early glaucoma with CVFDs and evaluating the severity of advanced glaucoma in group level.

Morphometric analysis of the anterior chamber in patients with refractory glaucoma after micropulse cyclophotocoagulation

PURPOSE. To evaluate the anatomical-topographic parameters of the anterior chamber of the eye before and after micropulse cyclophotocoagulation (mCPC) in patients with refractory glaucoma in pseudophakic and phakic eyes.METHODS. The study included 60 patients (62 eyes) with moderate (7 eyes) and advanced (55 eyes) refractory glaucoma. Study groups were formed as follows: the 1st group consisted of 31 pseudophakic eyes (32 patients), the 2nd group included 31 phakic eyes (30 patients). All patients underwent mCPC according to a modified technique. To assess anatomical parameters patients underwent optical coherence tomography of the anterior segment (AS-OCT). Anterior chamber angle (ACA) and anterior chamber depth (ACD) were measured at specific follow-up time points after mCPC.RESULTS. Hypotensive effect by the end of 12-month follow-up was achieved in the patients of the first group in 83.1% of cases, in the second group — in 80.6% of cases (p&lt;0.05). According to OCT findings, anterior chamber depth in patients with phakic eyes during the 12-month follow-up remained the same as before surgery — 2.43±0.21 (mm). In the other group with pseudophakic eyes, anterior chamber depth also did not change during the observation period, with an average value of 3.27±0.12 (mm). No significant changes (p&gt;0.05) were found in the irido-corneal angle measurements in the 4 meridians over the entire follow-up period in both groups.CONCLUSION. Micropulse cyclophotocoagulation performed at fluence rate F=121 J/cm2 does not result in changes of structures of the anterior segment of the eye. The stability of anterior chamber anatomy as well as the absence of postoperative complications in early and longterm follow-up proved the minimal traumatic effect of this surgery in patients with refractory glaucoma.

Glue-Assisted Retinopexy for Retinal Detachments Study Report 2: Fibrin Glue As a Surgical Adjunct in Complex Rhegmatogenous Retinal Detachment.

Purpose: To present the successful application of fibrin glue as a surgical adjunct in the management of complex rhegmatogenous retinal detachment (RRD). Methods: In this retrospective case series, fibrin glue was used as a surgical adjunct in 5 cases of complex RRD. In each case, standard pars plana vitrectomy and laser retinopexy were performed by the same surgeon. Fibrin glue was used intraoperatively as a tamponade to seal the breaks because the isolated use of conventional tamponade agents was not feasible given the variable nature of the complex RRDs, the anatomy of the eye, or an inability to maintain postoperative positioning. Results: In 1 patient previously treated for a large corneoscleral tear, fibrin glue was used to seal a large iatrogenic retinal break caused by a fragmatome-related surge that led to a quadrantic RD. In 2 patients treated for combined RRD, fibrin glue was used with silicone oil to manage recurrent RRD with incompletely drained thick subretinal fluid and blood. In 2 other cases, fibrin glue was applied to manage RRD in congenital aniridia with advanced glaucoma and aphakia. In all cases, retinal attachment without serious adverse effects was attained over a follow-up ranging from 4 to 6 months. Conclusions: Fibrin glue is an effective, safe surgical adjunct in complex RRD. It can be used to transiently seal a retinal break when use of a conventional tamponade agent is not possible or not sufficient alone.

Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma.

To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.

The need for more pragmatic trials in glaucoma research.

There have been a number of clinical trials in glaucoma research published in the past two decades. Most of these trials were designed to evaluate very specific issues in selected populations placing them in the explanatory end of the pragmatic-explanatory continuum. The purpose of this study was to assess the level of pragmatism of published randomized controlled trials in glaucoma. A PubMed search using 'glaucoma' from 1995 to 2022 and randomized controlled trial (RCT) article type was done. Each study was assessed by three independent examiners using the Pragmatic-Explanatory Continuum Indicator Summary version 2 (PRECIS-2) toolkit. Scores were calculated for each study to determine the level of pragmatism. A summed score ≥36 was indicative of a very pragmatic study. Thirty-two different articles were included in the analysis. These papers represented 13 different landmark trials. The median PRECIS-2 score was 32 (range, 25 for the Early Manifest Glaucoma Trial (EMGT) to 34 to the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Ocular Hypertension Treatment Study). The Treatment of Advanced Glaucoma Study (TAGS), was considered very pragmatic and scored 33 points. Despite the number of RCTs in glaucoma, there is still a need for more pragmatic studies.

Understanding Patterns of Preserved Retinal Ganglion Cell Layer in Advanced Glaucoma as Seen With Optical Coherence Tomography.

Using optical coherence tomography (OCT), eyes with advanced glaucoma were found to have a wide range of patterns of damage that were consistent with the natural history of progression based on a model of macular progression. To understand the patterns of preserved retinal ganglion cells in eyes with advanced glaucoma using OCT and a model of progression of the central macula. OCT GCL thickness was measured in 94 eyes with advanced glaucoma, defined as glaucomatous eyes with a 24-2 MD (mean deviation) worse than -12dB. A commercial report supplied the GCL thickness in 6 sectors of the thick, donut-shaped GCL region around the fovea. For each eye, the 6 sectors were coded as green (within normal limits, WNL), yellow (≤5th, ≥1st percentile), or red (<1st percentile). In all 94 eyes, one or more of the 6 sectors of the donut were abnormal (red or yellow), while all 6 sectors were red in 52 (55%) of the eyes. On the other hand, 33 eyes had one or more sectors WNL (green). While the pattern of donut damage varied widely across these 33 eyes, 61 of the 66 hemiretinas were consistent with a temporal-to-nasal progression of damage within each hemiretina as predicted by our model. All eyes with advanced glaucoma had damage to the critically important central, donut-shaped GCL region. This region showed a wide range of patterns of damage, but these patterns were consistent with the natural history of progression based on a model of macular progression. These results have implications for the clinical identification of macular progression, as well as for inclusion criteria for clinical trials seeking to preserve central macular function.

Correlation of retrobulbar perfusion deficits with glaucomatous visual field defects.

This study is to evaluate the correlation between retrobulbar perfusion deficits and glaucomatous visual field defects. Eighty-four patients with glaucoma and 17 normal subjects serving as controls were selected. Color Doppler imaging (CDI) was used to measure the changes in blood flow parameters in the retrobulbar ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs). Visual field testing was performed using a Humphrey perimeter, categorizing the visual field deficits into four stages according to the Advanced Glaucoma Intervention Study (AGIS) scoring method. Subsequently, the correlation of retrobulbar hemodynamic parameter alterations among glaucomatous patients with varying visual field defects was examined. The higher the visual field stage, the lower the peak systolic velocity (PSV) of the OA, CRA, and SPCAs in glaucomatous patients. The CRA had the highest sensitivity to changes in its PSV. The PSV of the temporal SPCA (TSPCA-PSV) was lower in advanced glaucoma than in early-stage glaucoma. The PSVs of the OA, CRA, and TSPCA, as well as the resistance index of the CRA (CRA-RI), were positively correlated with the visual field index and the mean deviation. Except for that of OA, the PSV of the retrobulbar vessels was negatively correlated with the pattern standard deviation (PSD). The OA-PSV and end-diastolic velocity (EDV) of the CRA and TSPCA were lower in patients with superior visual field defects than in those with inferior visual field defects. Greater severity of visual field defects corresponded to poorer retrobulbar blood flow in glaucomatous patients. Patients suffered significant perfusion impairments in the CRA at the early stage, accompanied by SPCA perfusion disorder at the advanced stage. The presence of a bow-shaped defect in the superior or inferior region of the visual field in moderate-stage glaucoma was closely correlated with retrobulbar vascular EDV. ChiCTR2200059048 (2022-04-23).

Association of Long-Term Intraocular Pressure Variability and Rate of Ganglion Complex Thinning in Patients With Glaucoma

To evaluate the association of mean intraocular pressure (IOP) and IOP variability (IOP fluctuation [SD of IOP] and the IOP range) with the rate of ganglion cell complex (GCC) layer thinning over time in patients with glaucoma. Prospective cohort study. Participants with at least 4 visits and 2 years of follow-up of optical coherence tomography tests were included. A linear mixed-effect model was used to investigate the association of IOP parameters with the rates of GCC thinning. Subgroup analyses were conducted for eyes with early (MD ≥ -6 dB), and moderate to advanced stage (MD < -6 dB) at baseline. The cohort consisted of 369 eyes of 249 glaucoma patients (282 early glaucoma and 87 moderate to advanced glaucoma) with mean (standard deviation [SD]) age of 68.2 (10.7) years over 5.1 years of follow-up. The mean rate of GCC change was -0.59 (95% confidence interval [CI], -0.67 to -0.52) µm per year. In multivariable models, faster annual rate of GCC thinning was associated with a higher IOP fluctuation (-0.17 [95% CI, -0.23 to -0.11] µm per 1-mmHg higher, P < .001) or higher IOP range (-0.07 [95% CI, -0.09 to -0.05] µm per 1-mmHg higher, P < .001) after adjustment for mean IOP and other confounding factors. Similar results were found for early and moderate to advanced stages of glaucoma. IOP variability showed an independent association with macular change in patients with glaucoma regardless of severity at baseline, even after adjustment for mean IOP, supporting its potential value as a therapeutic target for clinical decision-making.

Current Status and Future Perspectives of Optic Nerve Imaging in Glaucoma.

Being the primary site of degeneration, the optic nerve has always been the focus of structural glaucoma assessment. The technical advancements, mainly of optical coherence tomography (OCT), now allow for a very precise quantification of the optic nerve head and peripapillary retina morphology. By far the most commonly used structural optic nerve parameter is the thickness of the parapapillary retinal nerve fiber, which has great clinical utility but also suffers from significant limitations, mainly in advanced glaucoma. Emerging novel imaging technologies, such as OCT angiography, polarization-sensitive or visible-light OCT and adaptive optics, offer new biomarkers that have the potential to significantly improve structural glaucoma diagnostics. Another great potential lies in the processing of the data already available. Artificial intelligence does not only help increase the reliability of current biomarkers but can also integrate data from various imaging modalities and other clinical measures to increase diagnostic accuracy. And it can, in a more efficient way, draw information from available datasets, such as an OCT scan, compared to the current concept of biomarkers, which only use a fraction of the whole dataset.

The effectiveness of combined laser treatment technology in patients with glaucoma

Purpose: to study the effectiveness of combined laser treatment in patients with the advanced primary open-angle glaucoma (POAG).Material and methods: the present study included 63 patients with POAG. They were divided into the studied group (32 eyes) and control group (31 eye). Patients age ranged from 65 to 78 years (mean 70.68 ± 4.39 years in the studied group and 69.48 ± 3.82 in the control group). Intraocular pressure (IOP) in all patients was compensated with antihypertensive drops, and in average was 20.36 ± 1.27 mm Hg in the studied group and 20.02 ± 1.43 mm Hg in the control group. The number of antihypertensive drugs used before surgery ranged from 2 to 3 (average 2.40 ± 0.49 in the studied group and 2.51 ± 0.50 in the control group). YAG-LAT was performed with Lightlas YAG Nd-YAG laser (Lightmed, USA). Microimpulse transcleral cyclophotocoagulation (mTS-CPC) was performed with Cyclo G6 Glaucoma Laser System (IRIDEX, USA). In the studied group, all patients had YAG-LAT with mTS-CPC; in the control group – mTS-CPC. Patients were examined on days 1 and 7; and then in 1, 3 and 6 months after the treatment. The obtained results were summarized in a table and were statistically processed.Results: in the studied group, on day 1 after the intervention IOP was (mm Hg): 19.36 ± 1.36, in the control group – 19.45 ± 1.15; on day 7: studied group – 20.59 ± 1.5, control group – 19.9 ± 2.68; in one month: studied group – 13.95 ± 1.67, control group – 15.8 ± 1.5; in three months: studied group – 15.04 ± 1.13, control group – 16.48 ± 1.12; in 6 months: studied group – 15.27 ± 1.77, control group – 16.23 ± 1.41.Conclusion: the combined laser technology which includes YAG-laser activation of the trabecula and mTS-CPC is an effective and safe method for lowering intraocular pressure in patients with glaucoma

Case Report: Temporary management of delayed postoperative hypotony with Baerveldt tube: Ab Interno stenting using 3-0 nylon suture

Background To describe the management of delayed postoperative hypotony and choroidal detachment in a 79-year-old female patient with advanced pseudoexfoliative open-angle glaucoma. Case The patient, refractory to maximal medical therapy, underwent Baerveldt tube implantation with a ripcord using a 4-0 nylon suture. Ripcord removal and the reintroduction of antiglaucoma medication were initiated in response to a hypertensive phase. Delayed postoperative hypotony and choroidal effusions were managed through ab interno stenting of the tube, employing a 3-0 nylon suture. Ab interno stenting of the tube, employing a short segment of 3-0 nylon suture, initially addressed delayed postoperative hypotony and choroidal effusions. However, recurrence of hypotony and choroidal detachment occurred as the short stent descended into the anterior chamber. To manage the recurrent hypotony, Baerveldt tube truncation was performed, along with re-stenting of the tube using a longer 3-0 Nylon ripcord. Conclusions While ab interno occlusion with a short segment of 3-0 nylon suture may offer temporary hypotony control, the risk of segment descent warranted the use of a longer ripcord to enhance efficacy and stability.

Novel Technologies in Artificial Intelligence and Telemedicine for Glaucoma Screening.

To provide an overview of novel technologies in telemedicine and artificial intelligence (AI) approaches for cost-effective glaucoma screening. A narrative review was performed by summarizing research results, recent developments in glaucoma detection and care, and considerations related to telemedicine and AI in glaucoma screening. Telemedicine and AI approaches provide the opportunity for novel glaucoma screening programs in primary care, optometry, portable, and home-based settings. These approaches offer several advantages for glaucoma screening, including increasing access to care, lowering costs, identifying patients in need of urgent treatment, and enabling timely diagnosis and early intervention. However, challenges remain in implementing these systems, including integration into existing clinical workflows, ensuring equity for patients, and meeting ethical and regulatory requirements. Leveraging recent work towards standardized data acquisition as well as tools and techniques developed for automated diabetic retinopathy screening programs may provide a model for a cost-effective approach to glaucoma screening. Leveraging novel technologies and advances in telemedicine and AI-based approaches to glaucoma detection show promise for improving our ability to detect moderate and advanced glaucoma in primary care settings and target higher individuals at high risk for having the disease.

The influence of post-COVID-19 syndrome on microcirculation of the optic nerve head among patients with primary open-angle glaucoma

BACKGROUND: Glaucoma is one of the leading causes of blindness in the world. This is a multifactorial ophthalmopathology, which also results from impaired microcirculation in the optic nerve. One of the diseases affecting ocular blood flow is acute coronavirus infection (COVID-19). AIM: The aim of this study is the assessment of blood flow parameters of the optic nerve head in patients with primary open-angle glaucoma (POAG) against the background of post-COVID-19 syndrome using laser speckle flowgraphy. MATERIALS AND METHODS: The study included 40 patients with advanced stage primary open-angle glaucoma who had COVID-19 within the previous 3 months. Patients were divided into 2 subgroups depending on the severity of the disease. The comparison group consisted of 20 individuals with an advanced stage of primary open-angle glaucoma who did not have COVID-19. All subjects were over 60 years old and had normal blood pressure parameters. Optic nerve head blood flow was measured using the LSFG-NAVI device (Japan) and assessed by LSFG Analyzer software. MBR parameters (MA, MV and MT), as well as pulse wave indicators (Skew, BOS, BOT, RR, FR, FAI, ATI and RI) were analyzed. RESULTS: The most significant decrease was found for the MV and MT parameters, reflecting the blood flow in large vessels and the microvasculature of the optic disc. MV decrease by 20%, MT — by 23%, MA — by 16% were noted, as well as pulse wave parameter changes, in patients with an advanced stage of primary open-angle glaucoma, post-COVID syndrome after moderate COVID-19 compared with patients with an advanced stage of primary open-angle glaucoma who did not have COVID-19 (p ≤ 0.05). CONCLUSIONS: Laser speckle flowgraphy allows rapid and effective assessment of ocular blood flow. Parameters estimated at the examination may be considered as new biomarkers for the detection and evaluation of vascular diseases.