Advanced Glaucoma Research Articles

No Strong Association between the Apolipoprotein E E4 Allele and Glaucoma: A Multicohort Study.

To elucidate a potential association between the apolipoprotein E (APOE) E4 allele and glaucoma prevalence in large cohorts. A cross-sectional analysis of baseline and prospectively collected cohort data. UK Biobank (UKBB) participants of genetically determined European ancestry (n= 438 711). Replication analyses were performed using clinical and genotyping data collected from European participants recruited to the Canadian Longitudinal Study of Aging (CLSA; n= 18 199), the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG; n= 1970), and the Blue Mountains Eye Study (BMES; n= 2440). Apolipoprotein E alleles and genotypes were determined, and their distributions were compared on the basis of glaucoma status. Similar analyses were performed using positive control outcomes associated with the APOE E4 allele (death, dementia, age-related macular degeneration) and negative control outcomes not associated with the APOE E4 allele (cataract, diabetic eye disease). Outcome phenotypes were also correlated with Alzheimer's dementia (AD), a clinical outcome highly associated with the APOE E4 allele. Results of APOE E4 genotype-phenotype comparisons were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Replication analyses investigated APOE E4 associations in 2 replication cohorts (CLSA and ANZRAG/BMES). The APOE E4 allele was inversely associated with glaucoma (OR, 0.96; 95% CI, 0.93-0.99; P= 0.016) and both negative controls (cataract: OR, 0.98; 95% CI, 0.96-0.99; P= 0.015; diabetic eye disease: OR, 0.92; 95% CI, 0.87-0.97; P= 0.003) in the UKBB cohort. A paradoxical positive association was observed between AD and both glaucoma (OR, 1.30; 95% CI, 1.08-1.54; P < 0.01) and cataract (OR, 1.15; 1.04-1.28; P= 0.018). No association between the APOE E4 allele and glaucoma was observed in either replication cohort (CLSA: OR, 1.03; 95% CI, 0.89-1.19; P= 0.66; ANZRAG/BMES: OR, 0.97; 95% CI, 0.84-1.12; P= 0.65). A small negative association observed between APOE E4 and glaucoma within the UKBB was not evident in either replication cohort and may represent an artifact of glaucoma underdiagnosis in APOE E4 carriers. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Bilateral Angle Recession and Chronic Post-Traumatic Glaucoma: A Review of the Literature and a Case Report.

Ocular trauma affects millions of people worldwide and is a leading cause of secondary glaucoma. Angle recession is the main cause of post-traumatic glaucoma after blunt eye trauma, and it is usually unilateral. The aim of this paper is to investigate the possible causes of angle recession with a bilateral presentation. Airbag activation during traffic accidents is a likely cause to be ruled out, along with repeated head or eye trauma, due to contact sports or a history of physical abuse. These aspects can aid in early detection, appropriate management, and improved outcomes for patients with ocular trauma. Finally, we report the case of a 75-year-old Caucasian man who developed a bilateral angle recession after an airbag impact, with advanced glaucoma in the right eye and ocular hypertension in the left eye. To our knowledge, this is the first case in the literature of chronic post-traumatic glaucoma probably caused by an airbag.

The impact of visual function on staircase use performance in glaucoma.

This cross-sectional study aimed to investigate the relationship between visual function and staircase use in glaucoma. Overall, 181 patients with glaucoma with a best-corrected visual acuity ≥20/400 were classified into mild to moderate (mean deviation [MD] ≥ -12 dB) and advanced (MD < -12 dB) groups, according to 24-2 VF of the worse eye. Staircase use evaluation included stair descent and ascent time (SDT/SAT) and self-reported stair difficulty. Correlations between staircase use and visual function were analysed, including binocular visual acuity, integrated visual field (IVF), and binocular contrast sensitivity (CS). Linear and logistic regression adjusted by age, sex, and comorbidities inspected the effect of visual parameters on SDT/ SAT and stair difficulty. Visual function best correlated with SDT among staircase use. In mild to moderate glaucoma, area under the log CS function (AULCSF) (β = -1.648, P = 0.031) was the only visual factor significant for SDT (adjusted R2 = 0.106), whereas AULCSF (β = -1.641, P = 0.048) and MD of IVFINF0-24 (β = -0.089, P = 0.013) were associated with SDT in advanced glaucoma (adjusted R2 = 0.589). The AULCSF was the only significant visual parameter related to SAT (β = -1.125, P = 0.019) and stair difficulty (adjusted odds ratio = 0.003; 95% confidence interval, 0-0.302; P = 0.013). SDT provides a higher correlation with visual function than self-reported stair difficulty. Patients with impaired CS or inferior IVF defects should be advised on stair safety and referred to low-vision services.

Three-Dimensional Structural Phenotype of the Optic Nerve Head as a Function of Glaucoma Severity

The 3-dimensional (3-D) structural phenotype of glaucoma as a function of severity was thoroughly described and analyzed, enhancing understanding of its intricate pathology beyond current clinical knowledge. To describe the 3-D structural differences in both connective and neural tissues of the optic nerve head (ONH) between different glaucoma stages using traditional and artificial intelligence-driven approaches. This cross-sectional, clinic-based study recruited 541 Chinese individuals receiving standard clinical care at Singapore National Eye Centre, Singapore, and 112 White participants of a prospective observational study at Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania. The study was conducted from May 2022 to January 2023. All participants had their ONH imaged using spectral-domain optical coherence tomography and had their visual field assessed by standard automated perimetry. (1) Clinician-defined 3-D structural parameters of the ONH and (2) 3-D structural landmarks identified by geometric deep learning that differentiated ONHs among 4 groups: no glaucoma, mild glaucoma (mean deviation [MD], ≥-6.00 dB), moderate glaucoma (MD, -6.01 to -12.00 dB), and advanced glaucoma (MD, <-12.00 dB). Study participants included 213 individuals without glaucoma (mean age, 63.4 years; 95% CI, 62.5-64.3 years; 126 females [59.2%]; 213 Chinese [100%] and 0 White individuals), 204 with mild glaucoma (mean age, 66.9 years; 95% CI, 66.0-67.8 years; 91 females [44.6%]; 178 Chinese [87.3%] and 26 White [12.7%] individuals), 118 with moderate glaucoma (mean age, 68.1 years; 95% CI, 66.8-69.4 years; 49 females [41.5%]; 97 Chinese [82.2%] and 21 White [17.8%] individuals), and 118 with advanced glaucoma (mean age, 68.5 years; 95% CI, 67.1-69.9 years; 43 females [36.4%]; 53 Chinese [44.9%] and 65 White [55.1%] individuals). The majority of ONH structural differences occurred in the early glaucoma stage, followed by a plateau effect in the later stages. Using a deep neural network, 3-D ONH structural differences were found to be present in both neural and connective tissues. Specifically, a mean of 57.4% (95% CI, 54.9%-59.9%, for no to mild glaucoma), 38.7% (95% CI, 36.9%-40.5%, for mild to moderate glaucoma), and 53.1 (95% CI, 50.8%-55.4%, for moderate to advanced glaucoma) of ONH landmarks that showed major structural differences were located in neural tissues with the remaining located in connective tissues. This study uncovered complex 3-D structural differences of the ONH in both neural and connective tissues as a function of glaucoma severity. Future longitudinal studies should seek to establish a connection between specific 3-D ONH structural changes and fast visual field deterioration and aim to improve the early detection of patients with rapid visual field loss in routine clinical care.

Effect of Phacoemulsification Cataract Surgery on the Clinical Outcomes of Advanced Glaucoma Patients

Purpose: To identify the clinical outcomes of cataract surgery in patients with advanced glaucoma.Methods: A retrospective chart review of open-angle glaucoma patients who underwent cataract surgery and were followed-up for 1 year was conducted. Advanced glaucoma was defined as a mean deviation (MD) &lt; -12 dB on the preoperative visual field test. A group with mild-to-moderate glaucoma (MD ≥ -12 dB) served as the control group. Changes in intraocular pressure (IOP) at 1, 3, 6, and 12 months, and in the postoperative visual acuity (VA) as well as in the visual field indices (MD and the pattern standard deviation), and the number of antiglaucoma medications were compared.Results: Eighty-seven eyes (87 patients) of the advanced group and 109 eyes (109 patients) of the mild-to-moderate group were finally included. From 1 week to 24 months postoperatively, both groups evidenced IOP decreases compared to the preoperative values (both &lt;i&gt;p&lt;/i&gt; &lt; 0.05). The IOP spike prevalence was similar in the two groups (11% vs. 13%, &lt;i&gt;p&lt;/i&gt; = 0.199). The mean IOP difference between the two groups was not significant at months 1, 3, 6, 12, or 24 postoperatively (all &lt;i&gt;p&lt;/i&gt; &gt; 0.05). Both groups evidenced VA improvements at 1 year postoperatively and the visual field (VF) indices did not differ from those before surgery. The numbers of antiglaucoma medications used decreased after surgery, but the decrease was significant only in the advanced glaucoma group (&lt;i&gt;p&lt;/i&gt; = 0.030).Conclusions: The advanced and mild-to-moderate glaucoma groups evidenced similar IOP and VF changes after cataract surgery. The VA improved and the number of antiglaucoma medications decreased. Our findings suggest that cataract surgery for patients with advanced glaucoma may afford similar clinical outcomes compared to other less severe glaucoma groups.

Gonioscopy-assisted transluminal trabeculotomy in patients with advanced glaucoma.

To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with advanced glaucoma. Records of 46 patients with advanced glaucoma were reviewed retrospectively in this single-center chart review. The main outcome measure was surgical success; intra-ocular pressure (IOP) and IOP lowering medication use were secondary outcome measures. Success was defined as an IOP of 18 mmHg or lower (criterion A) or 14 mmHg or lower (criterion B) and one of the following: IOP reduction >30% from baseline on the same or fewer medications or IOP ≤ of baseline on fewer medications as compared to baseline. Forty-seven eyes were included in the analysis. The average mean deviation was -17.5 ± 7.2 dB (range -8.0 to -33.0). The average follow-up was 6.8 months (range 3.2-22.3). Success at 6 months was 91% for criterion A and 75% for criterion B (n = 33). Mean IOP was reduced from 19.3 ± 6 mmHg (12-40) on 3.7 ± 1.4 medications to 13.2 ± 5.8 mmHg on 1.6 ± 1.4 medications at the 6th post-operative month (P < 0.001 for both IOP and medications). At the last follow-up visit, 37 patients (78%) had an IOP of 14 mmHg or lower, and ten of these patients were unmedicated. Transient hyphema and IOP spikes were the most prevalent adverse events following surgery. Three eyes required further surgery for IOP control. None of the patients lost vision because of surgery. GATT is a viable surgical option in cases of advanced glaucoma. Careful patient selection and attentive post-operative management are imperative.

Outcomes of non-penetrating deep sclerectomy in the control of intraocular pressure in patients with advanced glaucoma

Outcomes of non-penetrating deep sclerectomy in the control of intraocular pressure in patients with advanced glaucoma

Selective Laser Trabeculoplasty-What Do We Know So Far? Review

Abstract Selective laser trabeculoplasty (SLT) has been used for lowering intraocular pressure (IOP) in patients with different types of glaucoma. It is a safe and effective procedure as initial or additional therapy when target IOP could not be achieved with medical therapy. SLT could specifically target pigmented cells in trabecular meshwork (TM) leaving nonpigmented cells unaffected, which may allow repeat treatments and thus has lower complication rate. It can be successfully used for IOP reduction in primary open angle glaucoma (POAG), normotensive glaucoma (NTG), pigmentary glaucoma (PG), pseudoexfoliation glaucoma (PXFG), primary angle closure glaucoma (PACG), silicone-oil-induced glaucoma, and high IOP after failed trabeculectomy. SLT could also be used in all stages of open agle glaucoma but failure of SLT in advanced glaucoma patients should go to immediate filtering surgery to avoid postoperative fibrosis. SLT reduces IOP fluctuation. IOP-lowering effect of SLT diminishes over time, but it can be repeated in order to achieve additional or recurrent IOP reduction. Higher baseline IOP up to a certain level is the strongest predictor of success after SLT.

Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature

PurposeTo describe imaging characteristics of severe macular complications occurring in glaucoma and discuss available treatments.MethodsRetrospective case series of glaucomatous patients with macular retinoschisis (MR) and/or serous retinal detachment (SRD). Patients underwent a complete ophthalmological examination and multimodal imaging including retinography, SD-OCT, fluorescein and indocyanine green angiography (FA & ICGA) and adaptive optics (AO).ResultsTen eyes (8 patients) were included. Initial BCVA was 1.04 ± 1.12 logMAR and IOP was 24.0 ± 9.3mmHg. All eyes presented with MR while SRD was present in 5 eyes (5 patients), with a central macular thickness of 573 ± 152 μm. FA and ICGA allowed to exclude leakage in all cases. A focal lamina cribrosa defect (LCD) was found in four eyes (4 patients) using OCT, with AO providing en-face visualization of the defect in one eye. Outer retinal hole was present in 3 eyes (3 patients). No visual improvement or resolution of the macular retinoschisis was observed in eyes with medical or surgical IOP control (N = 9). Vitrectomy with internal membrane limiting peeling and gas tamponade was performed in one eye with good visual results.ConclusionsMultimodal high-resolution imaging is essential to diagnose severe macular complications associated with advanced glaucoma.

Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma.

Minimally invasive glaucoma surgery (MIGS) is not typically used in patients with advanced-stage glaucoma. This study describes the outcomes and complications of patients with advanced open-angle glaucoma (OAG) who underwent XEN implantation with cataract surgery or gonioscopy-assisted transluminal trabeculotomy (GATT) with cataract surgery. This retrospective study identified patients who had undergone XEN implantation or GATT for the management of advanced OAG. Outcomes included surgical success, intraocular pressure (IOP) reduction, number of topical IOP-lowering drops, visual field mean deviation (MD), best-corrected visual acuity (BCVA), and complications. Surgical success was defined as an IOP of <14 mm Hg and a 20% reduction at 12 months without topical IOP-lowering drops (complete success) or with topical IOP-lowering drops (qualified success). Exactly 70 eyes were enrolled in this study, including 35 who had undergone XEN implantation and 35 who had undergone GATT. The overall surgical success rate was 74.3% (26 of 35) for eyes that underwent XEN implantation and 71.4% (25 of 35) for eyes that underwent GATT. Percent IOP reduction from baseline to 12 months postoperatively was 48% in the XEN cohort and 32% in the GATT cohort. Significant reduction in the use of topical IOP-lowering drops was demonstrated for both XEN (3.26 ± 1.15-1.23 ± 1.28) (p < 0.001) and GATT (2.46 ± 1.12-0.43 ± 0.78) (p < 0.001) cohorts at 12 months postoperatively. The only complication reported was transient hyphema, which occurred in three patients from the XEN group and four from the GATT group, and resolved spontaneously. Both XEN implantation and GATT may be safe and effective management options when treating patients with advanced OAG. However, larger sample sizes are required to make direct statistical comparisons between these techniques. In this study, XEN implantation and GATT combined with cataract surgery were each associated with favorable outcomes in patients with advanced OAG. Ruparelia S, Sharif M, Shoham-Hazon N. Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma. J Curr Glaucoma Pract 2023;17(2):63-67.

Bilateral Fixed Dilated Pupils after MicroPulse Transscleral Cyclophotocoagulation: A Case Report and Review of Urrets-Zavalia Syndrome

MicroPulse transscleral cyclophotocoagulation (MP-TSCPC) is a relatively new procedure for treating refractory advanced glaucoma. It uses repetitive micropulses of diode laser in an "on-off" cyclic manner, delivered with the Cyclo G6 Glaucoma Laser System (IRIDEX Corp., Mountain View, CA). In this unique case, we report the only instance of bilateral Urrets Zavalia Syndrome (UZS) in medical literature following MP-TSCPC in a 33-year-old Asian female with refractory angle-closure glaucoma. The patient developed bilateral fixed dilated pupils (UZS) after the treatment. The treatment settings included 100 seconds of laser application (50 seconds superiorly and 50 seconds inferiorly). Treated areas were the superior and inferior 180 degrees of the eye, excluding the 3 and 9 o'clock positions. On the first postoperative day, vision and intraocular pressure (IOP) were stable. Six weeks postoperatively, the patient presented with fixed mid-dilated pupils bilaterally and a visual acuity (VA) of 20/200 and 20/300, despite discontinuing Atropine 1% for 42 days. The patient was given pilocarpine 2% for ten days without response; however, vision improved to 20/125 and 20/160 with refraction and a +4.50 add for near vision. One and a half years postoperatively, the patient showed spontaneous partial recovery of the fixed dilated pupils in both eyes, with sectoral paralytic iris superiorly. The overall pupils' size was smaller in both eyes compared to previous visits. This case outlines the patient's symptoms, treatment, and outcome while discussing the potential risk of UZS following MP-TSCPC in specific populations. Further research is needed to better understand and mitigate the UZS complication after MP-TSCPC.

Suprathreshold Approaches to Mapping the Visual Field in Advanced Glaucoma.

Measuring the spatial extent of defects may be advantageous in advanced glaucoma where conventional perimetric sensitivity measurements are unreliable. We test whether suprathreshold tests on a higher density grid can more efficiently map advanced visual field loss. Data from 97 patients with mean deviation < -10 dB were used in simulations comparing two suprathreshold procedures (on a high-density 1.5° grid) to interpolated Full Threshold 24-2. Spatial binary search (SpaBS) presented 20-dB stimuli at locations bisecting seen/unseen points until the seen status of all neighbors matched or until tested points were adjacent. The SupraThreshold Adaptive Mapping Procedure (STAMP) presented 20-dB stimuli where entropy was maximal and modified the status of all points after each presentation, stopping after a fixed number of presentations (estimated as 50%-100% of the presentation number of a current procedure). With typical response errors, SpaBS had worse mean accuracy and repeatability than Full Threshold (both P < 0.0001). Compared to Full Threshold, mean accuracy (Full Threshold: median, 91%; interquartile range [IQR], 87%-94%) was slightly better with STAMP for all stopping criteria, although this was not statistically significant until 100% of conventional test presentations were used. Mean repeatability for STAMP was similar for all stopping criteria (P ≥ 0.02) compared to Full Threshold (Full Threshold: median, 89%; IQR, 82%-93%). STAMP accurately and repeatably maps the spatial extent of advanced visual field defects in as few as 50% of conventional perimetric test presentations. Further work is needed to test STAMP in human observers and in progressive loss. New perimetric approaches may improve information available for advanced glaucoma management and may potentially be more acceptable to patients.

Uniocular Primary Open Angle Glaucoma: An Unusual Case Report from Bangladesh

Purpose: To describe the case of a uniocular patient with advanced primary open-angle glaucoma (POAG) and age-related cataract in the right eye and microphthalmic left eye. Methods: A 73-year-old one-eyed man presented with four years of painless, progressive dimness of vision in the right eye. The vision was 6/18 in the right eye, whereas the left eye had no light perception (NLP). In the left eye, severe ptosis and microphthalmos were detected, while the right eye had age-related cataracts, an open anterior chamber angle, intraocular pressure (IOP) of 30 mmHg, and progressive glaucomatous optic neuropathy. The IOP was dropped to 22 mmHg after a topical timolol maleate (0.5%), brimonidine tartrate (0.2%), and brinzolamide (1%). As the patient had mature cataract, advanced glaucomatous optic nerve damage, target IOP was not reached, and adherence issues with antiglaucoma medications (AGM), the decision was made to proceed with cataract extraction combined with augmented trabeculectomy with mitomycin-C (MMC). Results: There were no intraoperative complications. Over one year, the IOP was maintained in the 12–14 mmHg range without AGM. Conclusion: In advanced glaucoma patients, combined phaco-trabeculectomy operations can considerably lower IOP and drug load or compliance concerns with antiglaucoma drugs. This case represented an efficient and safe surgical technique for uniocular advanced POAG, particularly in a developing country like Bangladesh.

Estimating the rate of severe visual loss (wipe-out) following cataract surgery, a British Ophthalmological Surveillance Unit (BOSU) study.

A sudden, irreversible reduction in visual acuity ('wipe-out') is a feared complication of cataract surgery. Current literature on wipe-out is limited in quantity and quality, and largely predates modern cataract surgery and imaging techniques. The objectives of our study were to estimate the incidence of wipe-out and to identify potential risk factors. We prospectively collated cases of wipe-out occurring in the UK during a 25-month study period using the British Ophthalmic Surveillance Unit reporting system. A total of 21 potential cases of wipe-out were reported, 5 of which met all inclusion and exclusion criteria. The estimated incidence of wipe-out during the study period was 0.00000298, or approximately 3 cases per million cataract operations. All cases of wipe-out occurred exclusively in patients with advanced glaucoma (mean deviation -21.0 decibels or worse in the operated eye), with an over-representation of black people (40%) in our case series. A prior diagnosis of retinal vein occlusion (60%) and elevated post-operative IOP (40%) were more common among individuals suffering from wipe-out compared to the general population, suggesting these factors may contribute to the pathogenesis of wipe-out. Our study shows that wipe-out is a rare complication, affecting approximately 3 per million undergoing cataract surgery. Patients with advanced glaucoma, black patients, and those with previous retinal vein occlusions may be at greater risk of wipe-out. We hope that the findings of our study will be used to help inform treatment decision-making and the cataract surgery consent process.

Outcomes of iStent Inject Versus Kahook Dual Blade Surgery in Glaucoma Patients Undergoing Cataract Surgery.

iStent Inject implantation (iStent) or Kahook Dual Blade goniotomy (KDB) in combination with phacoemulsification have a similar IOP-lowering effect in all stages of glaucoma, and medications are significantly reduced, especially after KDB. To compare the 2-year efficacy and safety of iStent or KDB in combination with phacoemulsification in eyes with mild to advanced open angle glaucoma. A retrospective chart review of 153 patients that received iStent or KDB in combination with phacoemulsification at a single center between March 2019 and August 2020. The main outcome parameters at 2 years were: (1) intraocular pressure (IOP)-reduction ≥20%, with a postoperative IOP ≤18mmHg, and (2) a reduction of ≥1 medication. Results were stratified by glaucoma grade. After 2 years, mean IOP was reduced from 20.3±6.1 to 14.2±4.1mmHg in the phaco-iStent group ( P <0.001) and from 20.1±6.1 to 14.7±3.6mmHg in the phaco-KDB group ( P <0.001). The mean number of medications was reduced from 3.0±0.9 to 2.6±1.1 in the Phaco-iStent group ( P =0.001) and from 2.3±1.0 to 1.5±1.3 in the Phaco-KDB group ( P <0.001). Success regarding IOP-reduction ≥20% with a postoperative IOP ≤18mmHg was met by 46% in the phaco-iStent group and by 51% in the phaco-KDB group. A reduction of ≥1 medication was met by 32% in the phaco-iStent group and by 53% in the phaco-KDB group ( P =0.013). Eyes with mild to moderate and advanced glaucoma responded equally well to the success criteria. iStent and KDB, in combination with phacoemulsification, both lowered IOP effectively in all stages of glaucoma. More medications were reduced after KDB, suggesting that it may be a more effective procedure compared with iStent.

Impact of cataract surgery on the quality of life of patients with advanced glaucoma

Aim: To describe changes in the quality of life and visual performance of advanced glaucoma patients after lensectomy. Materials and methods: Retrospective cohort study of patients with advanced glaucoma requiring cataract surgery between March and September 2018 at the Glaucoma Service of Hospital Oftalmológico Santa Lucía. Advanced glaucoma was defined as present when there was a cup/disc ratio &gt; 0.8, visual field damage within 10 degrees of central fixation or a temporal visual field remnant. Standard phacoemulsification surgery with intraocular lens implantation was performed. An adapted low-vision quality of life questionnaire was administered before surgery and one month postoperatively. Results: A total of 9 patients (6 women and 3 men) were included. The age range was 29 to 88 (mean: 71 years). Visual acuity improved in most cases and there was an improvement of sensitivity in mean deviation and model standard deviation, as well as in the areas of quality of life evaluated. Conclusion: Cataract surgery should be considered as an alternative in cases of advanced glaucoma and stable intraocular pressure, since a substantial benefit in the function and quality of life of patients has been observed.

Outcomes of microPulse transscleral laser therapy in eyes with prior glaucoma aqueous tube shunt.

To evaluate the outcomes of micropulse transscleral laser therapy (MP-TLT) in patients with uncontrolled glaucoma and prior glaucoma aqueous tube shunt. In this single‑center, retrospective, interventional case series, eyes that underwent MP-TLT and had prior glaucoma aqueous tube shunt surgeries were included. The Cyclo Glaucoma Laser System (IRIDEX Corporation, Mountain View, CA, USA) with the MicroPulse P3 probe (version 1) was used. Post‑operative data were collected at day 1, week 1, and months 1, 3, 6, 12, 18, 24, 30 and 36. A total of 84 eyes (84 patients) with mean age of 65.8 ± 15.2years and with advanced glaucoma (baseline mean deviation -16.25 ± 6.80dB and best-corrected visual acuity 0.82 ± 0.83 logMar) were included in the study. Baseline mean IOP was 19.95 ± 5.6mm Hg with a mean number of medications 3.39 ± 1.02. There were statistically significant differences in IOP between baseline and all follow-up visits (p < 0.01 for all). The mean percentage of IOP reduction between baseline and different follow-up visits ranged from 23.4% to 35.5% (p < 0.01). There was a significant reduction of visual acuity (≥ 2-lines) at 1year (30.3%) and 2years (76.78%). There was a statistically significant reduction in the number of glaucoma medications between baseline and all follow-up visits after postoperative week 1 (p < 0.05 for all). No severe complications including persistent hypotony and related complications were observed. At the last follow-up visit, only 24 (28%) eyes out of 84 eyes remained in the study. MP-TLT is an effective treatment for reducing IOP and decreasing the number of medications in patients with advanced glaucoma and prior glaucoma aqueous tube shunt.

PHACOEMULSIFICATION OF IRIS AS A TREATMENT FOR PATIENTS WITH CLOSED-ANGLE GLAUCOMA

We examined 55 patients (62 eyes) with primary closed-angle glaucoma. All of them were operated by ultrasonic phacoemulsification with IOL implantation. The patients' age ranged from 55 to 75 years (mean age 65 years). There were 42 (78.7%) women and 13 (21.3%) men. The initial stage of glaucoma was detected in 29 eyes, advanced glaucoma in 47 eyes, and advanced glaucoma in 45 eyes. The operation was performed in 42 patients against the background of acute and subacute glaucoma attack. Intraocular pressure level was decreased in 51 eyes (36.4 %) before the planned operation. In the remaining patients the level remained elevated and high. Refraction in patients was mostly hyperopic. Complicated cataract of various degrees was detected in 127 (77,9%) eyes, preoperative visual acuity was 0,01 to 0,8, which averaged 0,31 to 0,09.

Factors Associated with Visual Acuity in Advanced Glaucoma.

This study aimed to comprehensively analyze various parameters in advanced glaucoma patients to identify the factors that can affect best-corrected visual acuity (BCVA) in advanced glaucoma. This cross-sectional retrospective study included 113 patients (mean age, 61.66 ± 13.26 years; males, 67) who had advanced glaucomatous damage (113 eyes; mean BCVA, 0.18 ± 0.38 logMAR; mean deviation of 30-2 visual field [VF], -19.08 ± 6.23 dB). Peripapillary retinal nerve fiber layer (RNFL) and total and segmented macular thickness (RNFL, ganglion cell layer (GCL), and inner plexiform layer (GCL)) were measured using Spectralis optical coherence tomography (OCT). Correlations between BCVA and OCT parameters or 30-2 VF parameters were assessed using Pearson correlation analysis. Multivariate regression analysis was performed to determine the factors associated with BCVA in advanced glaucoma patients. Peripapillary RNFL thickness, subfoveal choroidal thickness, and global macular RNFL, GCL, IPL, and total thickness were found to be significantly correlated with BCVA and central visual function. Multivariate analysis showed a significant correlation between subfoveal choroidal thickness and BCVA. In addition, central VF mean sensitivity, especially inferior hemifield, showed a significant relationship with BCVA. In conclusion, subfoveal choroidal thickness and central VF sensitivity, especially the inferior hemifield area, are factors that affect BCVA in advanced glaucoma.

Treatment expectations in glaucoma: what matters most to patients?

Background/ObjectivesRecent clinical trials in glaucoma have used patient-reported outcome measures (PROMs) of health-related quality of life to evaluate interventions. However, existing PROMs may not be sufficiently sensitive to capture changes in health status. This study aims to determine what really matters to patients by directly exploring their treatment expectations and preferences.Subjects/MethodsWe conducted a qualitative study using one-to-one semi-structured interviews to elicit patients’ preferences. Participants were recruited from two NHS clinics serving urban, suburban and rural populations in the UK. To be relevant across glaucoma patients under NHS care, participants were sampled to include a full range of demographic profiles, disease severities and treatment histories. Interview transcripts were evaluated using thematic analysis until no new themes emerged (saturation). Saturation was established when 25 participants with ocular hypertension, mild, moderate and advanced glaucoma had been interviewed.ResultsThemes identified were: Patients’ experiences of living with glaucoma, patients’ experiences of having glaucoma treatment, most important outcomes to patients, and COVID-related concerns. Participants specifically expressed their most important concerns, which were (i) disease-related outcomes (intraocular pressure control, maintaining vision, and being independent); and (ii) treatment-related outcomes (treatment that does not change, drop-freedom, and one-time treatment). Both disease-related and treatment-related experiences were covered prominently in interviews with patients across the spectrum of glaucoma severity.ConclusionsOutcomes related both to the disease and its treatment are important to patients with different severities of glaucoma. To accurately evaluate quality of life in glaucoma, PROMs may need to assess both disease-related and treatment-related outcomes.