Antiglaucoma Treatment Research Articles

Latanoprost drops without added detergent in the treatment of glaucoma

Chronic nature of both the disease and its therapy forces ophthalmologists to choose the treatment with the lowest potential for adverse reactions, which may be caused by the active substance, excipient or preservative. Detergents used in ophthalmic drops include a derivative of macrogolglycerol hydroxystearate-40 (MGHS-40), which in in vitro tests showed pro-inflammatory and cytotoxic properties towards corneal epithelial cells, and this effect increased with increasing concentration and time. The analyzed observational study showed that latanoprost without MGHS-40 effectively reduces intraocular pressure, and the factors encouraging ophthalmologists to choose this preparation were good local tolerance and a simple composition (without detergents, preservatives and antioxidants), improving compliance. In the observational study, 82.3% received latanoprost without MGHS-40, and almost 60% started antiglaucoma treatment with this preparation.

Exploring the Benefits of Preservative-Free Ophthalmic Solutions in the Management of Glaucoma: A Comprehensive Review

Glaucoma is a worldwide major cause of vision loss; it is mainly caused due to the degeneration of retinal cells. Its symptoms usually appear at a later stage and thus chances of vision loss are high. Ophthalmic formulations have vast applications in the treatment of several ocular disorders such as glaucoma, dry eye syndrome, and many more. Conventional dosage forms such as eye drops have been used for the treatment of glaucoma for several years but they need to be sterile, especially multi-dose formulations. Ophthalmic dosage forms generally include preservatives such as Benzalkonium chloride (BAK) to maintain the sterility of the formulations which in some cases, were reported with severe ocular irritation and toxicity including corneal damage, ocular inflammation, and conjunctival injury even though used in minute concentration. Thus, there is a dire need to review the preservative-free ophthalmic formulations (PFOF) for the treatment and management of glaucoma to overcome the side effects associated with preserved formulations and to eliminate the irritation and toxicity caused by the preservatives. This article details the current research progress and development of PFOFs for the treatment of glaucoma. Moreover, a brief on preservative-free options of ophthalmic solutions and their applications in glaucoma, with a special focus on factors limiting their development has also been presented. In addition, this review also provides up-to-date information regarding the use of preservative-free antiglaucoma treatment.

In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography Findings of Patients with Iridocorneal Endothelial Syndrome

This case report aims to present the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in three patients with iridocorneal endothelial (ICE) syndrome. Three female patients 37, 50, and 57 years of age presented with complaints of unilateral visual impairment and elevated intraocular pressure (IOP). Biomicroscopy revealed unilateral pupil irregularities and anterior synechiae, and gonioscopy demonstrated synechiae in the iridocorneal angle. IOP was within normal limits with medical treatment in two patients, while one patient had an IOP of 44 mmHg despite maximal antiglaucomatous treatment. IVCM revealed large, polymorphic, and hyperreflective cells in the corneal endothelial layer of the affected eyes and normal corneal epithelium, stroma, and endothelium in the fellow eyes. AS-OCT findings were normal in healthy eyes, while the affected eye showed synechiae in the iridocorneal angle and a hyperreflective, thickened endothelial layer. The patient with refractory glaucoma underwent trabeculectomy surgery with 5-fluorouracil. In conclusion, IVCM and AS-OCT allow a detailed examination of endothelial cell abnormalities and iridocorneal membranes in ICE syndrome, which is characterized by unilateral pupil and iris irregularities and anterior synechiae mainly in women.

A rare case of Radius Maumenee syndrome with unilateral open angle glaucoma

Elevated episcleral venous pressure (EEVP) is a rare but important cause of raised intraocular pressure. The resultant glaucoma is often severe and refractory to routine anti glaucoma treatment. Usually it occurs due to arteriovenous fistulas or venous congestion. This entity is important to detect as it may be associated with serious pathologies like retrobulbar tumor, cavernous sinus thrombosis, mediastinal tumor to name a few. EEVP is considered idiopathic after ruling out such disorders. Here, we have described idiopathic EEVP also known as Radius-Maumenee syndrome along with a detailed diagnostic and therapeutic approach of management.

SECONDARY GLAUCOMA AFTER VITREORETINAL SURGERY: A RETROSPECTIVE OBSERVASIONAL STUDY

Introduction & ObjectivesSecondary glaucoma is the most common complication after vitreoretinal surgery. Pars PlanaVitrectomy (PPV) is a common surgical procedure aimed at removing vitreous gel and replacing itwith variety of substances denominated tamponades. Vitreous removal and replacement may causeincreased intraocular pressure (IOP). The IOP can be reduced with medical treatment or surgery.The purpose of this study is to describe the characteristics of secondary glaucoma after vitreoretinalsurgery in National Eye Center Cicendo Hospital from January 2019 - December 2020.
 MethodsThis study was a retrospective descriptive study which data were obtained from medical records.Data such as age, gender, vitrectomy tamponades, IOP, onset of glaucoma, and glaucoma treatmentwere collected.
 ResultsOne hundred fifty-three eyes were referred to Glaucoma Unit with increasing IOP after vitreoretinalsurgery. PPV with tamponade was done in 141 eyes (92.16%) and silicone oil (SO) 1000 centistokes(cSt) was the most used tamponade in 101 eyes (66.07%). Secondary glaucoma with open angle wasthe most common type in 124 eyes (81.04%). Secondary glaucoma developed in 4-7 weeks aftersurgery, with the highest IOP recorded at 31-40 mmHg. The IOP decreased after SO evacuation withinitial glaucoma treatment in 121 eyes (79.09%), and glaucoma surgery was performed in 32 eyes(20.91%).
 ConclusionSilicon oil as a tamponade agent after PPV may cause rise IOP in the post-operative period.Evacuation SO needs to be done after retinal adhesion to prevent secondary glaucoma. Therefore,timely detection and anti-glaucoma treatment are important to decreased IOP, or filtration surgerycan be performed.

Steroid induced glaucoma in the paediatric population

Aims/Purpose: Steroid induced glaucoma is an iatrogenic pathology secondary to the prolonged use of corticosteroids, it is a serious pathology with a high risk of blindness. The aim of this study is to evaluate the epidemiological, clinical, therapeutic and evolutionary profile of steroid induced glaucoma in children.Methods: It is a retrospective study of cases treated between November 2007 and February 2022, including patients followed in the paediatric ophthalmology department of Casablanca for steroid induced glaucoma.Results: Our study involved́ 35 children (60 eyes), including 20 boys and 15 girls, with an average age of 12 years. The involvement was bilateral in 25 eyes. All the patients had a history of discontinuous self‐medication with local corticosteroids for a mean period of 5 years. The initial condition that led to the use of steroids was in 19 cases allergic conjunctivitis, in 10 cases it was used for recurrent meibomian cysts, 3 cases of uveitis, 2 cases of blepharitis and one episcleritis. 60% eyes had visual acuity raging between 0.1 to 0.3. Mean Intraocular pressure was 36 ± 1 2 mmHg. Mean vertical cup disc ratio was 0.68 ± 0.25. all our patients had an open angle on gonioscopy and severe perimetric deficits were noted in all our patients. 19 eyes (32%) had an associated cataract. IOP was controlled after the withdrawal of steroids in 8 eyes, associated to antiglaucoma treatment in 22 eyes. The surgical management consisted of a Trabeculectomy + IP + 5 F.U in 30 eyes. Cyclophotocoagulation was not required in any of the patients. On a follow up of 24 months, the average final visual acuity was <2/10th and the tonometric results were globally good with a stabilization of the papillary excavation and visual field in 82% of the cases.Conclusions: Steroid induced glaucoma is a condition in which the functional prognosis is at risk, especially in young patients. It shows the importance of regular monitoring of the IOP in patients undergoing corticosteroid treatment. The first line of treatment consist of the prevention: awareness of the risks of self‐medication by steroids.

XEN®-45 implantation for refractory uveitic glaucoma

PurposeTo evaluate the efficacy of XEN®-45 gel stent ab interno implantation for medically uncontrolled uveitic glaucoma.MethodsRetrospective analysis of 25 eyes receiving XEN® gel stent for medically uncontrolled uveitic glaucoma from February 2019 to February 2023 with recording of intraocular pressure (IOP) values, ocular hypotensive medication, requirement for revision or secondary surgery and complications. Prerequisites for XEN® implantation were a clear cornea, an open iridocorneal angle and an unscarred, mobile conjunctiva at the implantation site. Minimum follow-up required for inclusion was 3 months. The primary outcome measure was IOP compared to baseline. Complete and qualified success were defined as final IOP of ≤ 18 mmHg without or with topical antiglaucomatous treatment, respectively. Failure was defined as IOP > 18 mmHg on two consecutive visits, IOP reduction < 20%, persisting complications from hypotony and open conjunctival bleb revision. Further glaucoma surgical intervention was defined as complete failure.ResultsMean preoperative IOP was 35.3 ± 10.9 mmHg on 2.9 ± 0.9 topical antiglaucomatous agents. 19 of 25 patients (76%) received additional oral acetazolamide. 19 eyes were pseudophakic, 5 eyes phakic and 1 aphakic.Early postoperatively, mean IOP reduced to 7.7 ± 3.0 mmHg (75.8% reduction). At final follow-up (mean 17.7 months) mean IOP was 12.0 ± 3.8 mmHg (62.5% reduction) on 0.2 ± 0.6 medications.Six eyes (24%) required bleb revision at mean 28 weeks and therefore were categorized as failure. One eye failed despite bleb revision and restart of topical ocular hypotensive medication. Three other eyes (12%) had IOP spikes with uveitis flare-ups. Transient hypotony complications occurred in 32%. At final follow-up, 18 eyes (72%) achieved complete success and one eye (4%) qualified success.ConclusionThe XEN® gel stent effectively reduced IOP in uncontrolled uveitic glaucoma, with 72% complete success. Bleb revision was required in 24%. IOP spikes occurred in 12% despite functioning blebs. Further follow-up is needed to determine long-term outcomes.

The Relationship between Intraocular Pressure and Estimated Intracranial Pressure in Patients with Normal Tension Glaucoma

This study aims to determine the relationship between intracranial pressure (ICP) and intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG) who were already on anti-glaucoma treatment using an estimated ICP (estICP) and translaminar pressure difference (estTPD) formula. A cross-sectional comparative study consisted of 66 subjects (66 eyes) who were divided into NTG (n=33) and normal (n=33) group was conducted from 1st November 2017 until 31st May 2020 at a tertiary hospital in Malaysia. After obtaining consent from subjects, ocular and systemic data including IOP, visual field testing, axial length, central corneal thickness (CCT), peripapillary and macular retinal nerve fibre layer evaluation as well as blood pressure (BP) and body mass index (BMI) were collected. The estICP (mm Hg) was calculated as 0.44 x BMI (kg/m2) + 0.16 x diastolic blood pressure (mmHg) – 0.18 x age (years) – 1.91. The estTPD was derived from this calculated value, where estTPD (mm Hg) = IOP – estICP. Analysis showed there was no significant difference in estimated ICP between NTG and normal subjects [mean difference (95% CI): 0.37 (-1.39, 2.12), p=0.679]. The difference in estTPD between NTG and normal subjects were found to be statistically insignificant too [mean difference (95% CI): -1.24 (-2.95, 0.47), p=0.149]. The variables significant in multivariate model included best corrected visual acuity (p=0.028), retinal nerve fiber layer (RNFL) (p=0.003), average macular (p=0.002) and estTPD (p=0.008). The EstTPD was found to be protective towards NTG, which the unit increased in estTPD will decreased the odds of having NTG by 26.5% [Adj. OR (95% CI): 0.735 (0.586, 0.922), p=0.008]. In conclusion, ICP was correlated in increased in IOP. A higher TPD may be associated with a lower chance of developing NTG.

The Prevalence of Ocular Surface Disease in Glaucoma Patients

Introduction: Glaucoma is the third cause of blindness in developed countries after age-related macular degeneration (AMD) and diabetic retinopathy. The aim of this study was to determine the prevalence of ocular surface disease in patients treated for glaucoma or ocular hypertonia. Patients and methods: We conducted a one-year observational study including glaucoma patients older than 15 years, diagnosed and treated for more than six months. The impact of anti-glaucoma treatment on the ocular surface was assessed by a questionnaire derived from the Ocular Surface Disease Index (OSDI). Results: Antiglaucoma treatment caused an alteration of the ocular surface in 59% of patients. 61.7% of patients had a mean epithelial thickness below normal. Discussion: Several observational studies have shown a high prevalence of ocular surface disease in glaucoma patients. The prevalence of surface involvement in our study is close to most studies in the literature. The strong correlation between the number of eye drops prescribed and the severity of ocular surface involvement has been proven. This correlation is attributed to the preservative benzalkonium chloride (BAK). Among the cellular alterations, we noted a decrease in mucus cells with a decrease and instability of the thickness of the tear film, which was more important in patients under BAK preserved eye drops than in those without BAK. Conclusion: Our study allowed us to determine the frequency of ocular surface damage in patients treated long-term with hypotonizing eye drops. The mechanisms of this damage are multiple. Preservatives seem to play a central role in the genesis of these reactions.

When Diabetes Interferes with Medical Treatment of Glaucoma in Ocular Surface Involvement

Glaucoma is a common blinding disease. Many of the currently available hypotonating eye drops are associated with adverse effects, such as ocular surface damage, which sometimes lead to discontinuation of treatment. We report the case of a 60-year-old man with glaucoma under hypotonizing treatment and unbalanced diabetes with diabetic retinopathy and diabetic peripheral neuropathy. The patient presented a severe damage of the ocular surface most probably shared between two components; the antiglaucoma treatment and their conservative on the one hand and the badly balanced diabetes with neuropathy on the other hand.

Visual field progression in open-angle glaucoma after refractive corneal ablation surgery.

This study aimed to investigate visual field (VF) progression in open-angle glaucoma (OAG) subjects who had a history of refractive corneal ablation surgery (RCAS). Retrospective study. The medical records of 21 subjects who had a history of refractive corneal ablation surgery (RCAS group) and 36 patients who had myopia without a history of RCAS (non-RCAS group) were reviewed. VF progression was determined by the non-parametric progression analysis (NPA) method. VF progression and clinical characteristics were compared between the two groups. For the RCAS group, refractive regressions were analysed. The mean follow-up periods were 4.5years and 5.5years for the RCAS and non-RCAS groups, respectively. More glaucoma subjects in the RCAS group (57.1%) had likely VF progression than in the non-RCAS group (25.0%) (p = 0.01). The RCAS group had a significantly lower percentage of IOP reduction with anti-glaucoma medication than the non-RCAS group (p = 0.037). Eyes with likely VF progression had a higher incidence of refractive regression (91.7%, 11/12) than eyes without it (33.3%, 3/9). Among subjects whose eyes had refractive regression, 78.6% (11/14) had likely VF progression, and 21.4% (3/14) did not (p = 0.016). The VF progression in OAG after RCAS was faster than that of myopic OAG without RCAS. Anti-glaucoma treatment should be actively enhanced in clinical practice.

The Effect of High Molecular Weight Hyaluronic Acid and Latanoprost Eyedrops on Tear Functions and Ocular Surface Status in C57/BL6 Mice.

Anti-glaucoma eye drop treatment often induces ocular surface problems, including dry eyes, and may be associated with poor medication compliance. This study aimed to investigate the effects of a novel high molecular weight hyaluronic acid and Latanoprost eye drop on intraocular pressure, as well as the tear function and ocular surface alterations in wild type mice, comparing the results with the mice receiving commercially available Latanoprost eye drops and mice receiving no treatment. The mice were divided into three groups: Group I, control group (no treatment group); Group II, commercial Latanoprost eye drop (LP); and Group III, Comfort Shield (CS) + Latanoprost (LP) eye drop (CS + LP). The CS + LP eye drop group had an IOP lowering effect comparable to the commercial LP eye drop group. The mice receiving LP eye drops had significantly worse corneal staining scores, lesser goblet cell density(GCD), higher numbers of CD45+ staining cells, significantly higher tear film concentrations of IL-6 and IL1-b, and a significantly lower expression of corneal ZO-1 mRNA compared with the mice receiving CS + LP 7 days after eye drop instillations (p &lt; 0.05). In conclusion, the new CS + LP formulation appeared to induce less inflammation, less corneal vital staining, and a better barrier status with an IOP lowering effect comparable to the commercial LP eye drops.

Study of Comparison of Effect and Complications of Intravitreal Triamcinolone Injection of 1 mg, 2 mg and 4 mg in Macular Edema of Vascular Origin

Introduction: The present study aimed to compare the efficacy and safety of different doses (1 mg, 2 mg and 4 mg) of triamcinolone acetonide (IVTA) in treatment of eyes with macular edema of vascular origin. Methods: Using simple random sampling among patients attending our tertiary healthcare referral centre, 60 patients fulfilling selection criteria were divided into 3 groups and were followed up for a period of 16 weeks. Following IVTA injections of different doses, patients were observed for changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT) on optical coherence tomography (OCT), intraocular pressure (IOP) and cataract occurrence/ progression in all three groups at 1 week , 4 weeks, 12 weeks and 16 weeks. Results: Following IVTA injection in all three groups (1 mg, 2 mg and 4 mg), mean BCVA improved from baseline but no statistically significant difference was observed in mean BCVA at different follow ups between the three groups. Mean CFT significantly improved from baseline in all three groups but no statistically significant difference was observed at different follow ups between groups. Mean IOP increased from baseline in all three groups but no statistically significant difference was observed among groups at different follow ups. Anti glaucoma treatment was required at end of 16 weeks postoperatively in 0, 1 and 3 eyes receiving 1 mg, 2 mg and 4 mg IVTA respectively. Lenticular changes at the end of 16 weeks postoperatively were found in 0, 1 and 2 eyes with 1 mg, 2 mg and 4 mg IVTA respectively. Conclusion: 4 mg dose of IVTA improves the functional and anatomical outcome in macular edema of vascular origin in most patients followed by 2 mg dose. 1 mg and 2 mg dose of IVTA has less incidence of steroid induced elevation of IOP and lenticular opacity development or progression. Further large scale studies are recommended to compare the effectiveness and safety of different doses of IVTA. Keywords: Triamcinolone Acetonide, Macular edema, diabetic retinopathy, retinal vein occlusion

Study of comparison of effect and complications of intravitreal triamcinolone injection of 1 mg, 2 mg and 4 mg in macular edema of vascular origin

Introduction: The present study aimed to compare the efficacy and safety of different doses (1 mg, 2 mg and 4 mg) of triamcinolone acetonide (IVTA) in treatment of eyes with macular edema of vascular origin.Methods: Using simple random sampling among patients attending our tertiary healthcare referral centre, 60 patients fulfilling selection criteria were divided into 3 groups and were followed up for a period of 16 weeks. Following IVTA injections of different doses, patients were observed for changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT) on optical coherence tomography (OCT), intraocular pressure (IOP) and cataract occurrence/ progression in all three groups at 1 week , 4 weeks, 12 weeks and 16 weeks. Results: Following IVTA injection in all three groups (1 mg, 2 mg and 4 mg), mean BCVA improvedfrom baseline but no statistically significant difference was observed in mean BCVA at different follow ups betweenthe three groups. Mean CFT significantly improved from baseline in all threegroups but no statistically significant difference was observed at different follow ups between groups. MeanIOP increasedfrom baseline in all three groupsbut no statistically significant difference was observed among groups at different follow ups. Anti glaucoma treatment was required at end of 16 weeks postoperatively in 0, 1 and 3 eyes receiving 1 mg, 2 mg and 4 mg IVTA respectively. Lenticular changes at the end of 16 weeks postoperatively were found in 0, 1 and 2 eyes with 1 mg, 2 mg and 4 mg IVTA respectively.Conclusion: 4 mg dose of IVTA improves the functional and anatomical outcome in macular edema of vascular origin in most patients followed by 2 mg dose. 1 mg and 2 mg dose of IVTA has less incidence of steroid induced elevation of IOP and lenticular opacity development or progression. Further large scale studies are recommended to compare the effectiveness and safety of different doses of IVTA. Keywords: Triamcinolone Acetonide, Macular edema, diabetic retinopathy, retinal vein occlusion

In vitro evaluation of sodium hyaluronate protective effect against benzalkonium chloride toxicity

AbstractPurpose: To evaluate the protective effect of different concentrations of sodium hyaluronate (SH) on the Benzalkonium chloride (BAK)‐induced toxicity using an in vitro model.Methods: The NAV14 cell line (SV40‐immortalized murine conjunctival epithelium) was used. Cell monolayers were exposed to different combinations of BAK (0.001%; 0.005%; 0.01%) and SH (0.2%; 0.3%; 0.4%) for 15 minutes; then cells were washed, and fresh culture media was added. Cell viability was evaluated after 2 h by resazurin reduction and lactate dehydrogenase (LDH) release. Also, cell migration and proliferation over 24 hours were determined by the scratch wound‐healing assay. Data were analysed by two‐way ANOVA and are shown as mean ± SD of two independent experiment with 4–6 replicates each.Results: BAK induced a concentration‐dependent decrease on cell viability (BAK 0.001%: 91 ± 14%, BAK 0.005%: 45 ± 9% and BAK 0.01%: 22 ± 10% of control cells, p &lt; 0.001) and an increase in LDH release (no BAK:0.22 ± 0.02, BAK 0.001%: 0.31 ± 0.02, BAK 0.005%: 1.14 ± 0.05 and BAK 0.01%: 1.21 ± 0.05, p &lt; 0.001). Conversely, SH neutralized these effects also in a concentration‐dependent manner (p &lt; 0.001). In the presence of SH 0.4% (highest effect), cell viability was BAK 0.001%: 104 ± 22%, BAK 0.005%: 109 ± 9% and BAK 0.01%: 75 ± 13% of control cells (p &lt; 0.001 for BAK 0.005–0.01%) while LDH release was no BAK: 0.24 ± 0.03, BAK 0.001%: 0.26 ± 0.01, BAK 0.005%: 0.37 ± 0.02 and BAK 0.01%: 0.49 ± 0.22, (vs. no SH: p &lt; 0.001 for BAK 0.005–0.01%). BAK also reduced wound closure in vitro (after 24 h, no BAK: 76 ± 14%, BAK 0.001%: 42 ± 12%, BAK 0.005%: 17 ± 16% and BAK 0.01%: 0.0% wound closure, p &lt; 0.001 for all BAK). Conversely, SH neutralized this effect in a concentration‐dependent fashion (p &lt; 0.001). In the presence of SH 0.4% (highest effect), wound closure at 24 h was: no BAK: 81 ± 15%, BAK 0.001%: 58 ± 6%, BAK 0.005%: 63 ± 10%, BAK 0.01%: 60 ± 8% (vs no SH: p &lt; 0.001 for BAK 0.005–0.01%).Conclusions: Sodium hyaluronate neutralized BAK toxicity on conjunctival epithelial cells in a concentration‐dependent manner. SH 0.4% was even protective at the highest preservative concentrations. These findings support the use of SH to mitigate BAK toxicity in long‐term antiglaucomatous treatment, although more studies are needed.

Clinical applications of molecular genetics research in glaucoma daily practice

AbstractPersonalized medicine using genetic information to predict disease development and tailor preventive interventions is an evolving field. In the last decade, molecular genetic studies in glaucoma have experienced a great advance, partly due to the appearance of new diagnostic technologies such as high‐efficiency and rapid next‐generation sequencing (NGS) that allows the sequencing of gene panels in a short time, exomes or complete genomes. With these advances, the list of candidate genes associated with the diagnosis of POAG has greatly increased and there is increasing information about the molecular mechanisms underlying POAG. The new genes involved in the pathology of glaucoma are mainly related to oxidative stress, DNA repair mechanisms, mitochondrial DNA, sex hormones, etc. The study of loci associated with quantitative endophenotypic traits has also been proposed that would act as risk factors for the disease (pachymetry, axial length, anterior chamber depth, diameter of the retinal vessels, papillary excavation, etc.) that, when added together, would increase the risk of developing POAG.On the other hand, exome sequencing can be useful for the detection of polymorphisms in genes associated with the individual response to medical treatment of glaucoma (pharmacogenic bases of glaucoma) and the possible success of filtering surgery in these patients (genetic bases of glaucoma). Early fibrosis in individuals with glaucoma.Recent studies have described the existence of polymorphisms against the ocular pharmacological receptors of the drugs commonly used to treat glaucoma that would cause an absence of pharmacological response. These would be polymorphisms in genes encoding drug receptors for prostaglandin analogs (rs3766355; rs3753380) and topical beta‐blockers (rs1042714) and would provide valuable information on whether the patient will respond well to these drugs or will be resistant them and thus plan their antiglaucomatous treatment in a personalized and early manner. The main cause of surgical failure in patients with glaucoma is fibrosis of the conjunctival bleb. This may be due to acquired factors (prolonged use of topical medication causing inflammation of the ocular surface, eye drops with preservatives, dry eye, etc.), or genetic factors that would cause individual susceptibility to early fibrosis of the conjunctival bleb. In recent years, genes that present an overexpression at the conjunctival level in cases of early surgical failure have been described and studies have also been published on the existence of systemic and genetic humoral factors responsible for an individual hyperfibrosing genetic profile. Definitely. the study of exomes by means of NGS would allow us to quickly and effectively discover different aspects of the glaucomatous pathology of our patients: molecular diagnosis, detection of asymptomatic relatives, genetic counselling, type of appropriate hypotensive treatment and type of surgical technique that would increase surgical success. And so in the near future we will be able to personalize and administer early treatment that is key to stopping the destruction of the optic nerve in these patients.

Dry Eye Disease among Patients with Glaucoma under Topical Antiglaucoma Agents in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Dry eye disease is a disorder of the tears and ocular surface that results in various symptoms, such as dryness, grittiness, burning and itching sensation in the eye, excessive tearing, and fluctuating vision. The prevalence of dry eye disease symptoms is increased with long-term topical anti-glaucoma medicine treatment. The objective of this study was to find out the prevalence of dry eye disease in glaucoma patients under topical anti-glaucoma agents in a tertiary care centre. A descriptive cross-sectional study was conducted from 9 February 2022 to 5 June 2022 among glaucoma patients under topical anti-glaucoma agents at a tertiary care centre after receiving ethical approval from the Institutional Review Committee (Reference number: UCMS/IRC/028/22). Data were collected using a standard ocular surface disease index questionnaire. The dry eye disease was clinically diagnosed if the ocular surface disease index score was equal to or more than 13. Point estimate and 95% Confidence Interval were calculated. Among 250 glaucoma patients, dry eye disease was found in 180 (72%) (66.43-77.57, 95% Confidence Interval). Mild, moderate, and severe symptoms were present in 50 (27.78%), 68 (37.78%), and 62 (34.44%) of the patients, respectively. The most frequently observed dry eye symptoms were itching and irritation seen in 56 (31.11%), followed by pain in the eye in 41 (22.77%) and redness in the eye in 32 (17.77%) patients. The prevalence of dry eye disease was higher than other clinical studies done in similar setting. It is extremely concerning and calls for increased focus on managing glaucoma and concurrent dry eye disease.

Clinical Practice Management of Primary Open-Angle Glaucoma in the United States: An Analysis of Real-World Evidence.

PurposeTo investigate clinical management of primary open-angle glaucoma (POAG) in the United States using real-world evidence and to examine healthcare resource utilization (HCRU), medication adherence/persistence, and procedure use.DesignA cross-sectional, retrospective analysis of Optum’s de-identified Market Clarity Dataset (July 1, 2013–December 31, 2019).Patients and MethodsPatients ≥18 years with POAG diagnosis and continuous enrollment for 1-year pre- and post-index were eligible and categorized into four mutually exclusive cohorts: CH1, treated with antiglaucoma medication(s) only; CH2, underwent glaucoma procedure(s) only; CH3, treated with antiglaucoma medication(s) and underwent procedure(s); and CH4, received no treatment for POAG. Adherence and persistence with antiglaucoma medications, and disease-specific HCRU were analyzed. Pairwise two-sample comparisons and multivariate regressions were conducted.ResultsExamined 232,572 eligible patients (CH1=60,895; CH2=4330; CH3=6027; CH4=161,320). Prostaglandin analogs were most prescribed antiglaucoma medications (CH1: 69.7%; CH3: 62.7%), of which latanoprost was most common (CH1: 51.3%; CH3: 46.1%). Disease-specific office visits occurred in 26.3%, 78.2%, 75.0%, 23.8%, and surgical services visits occurred in 3.8%, 36.3%, 42.5%, 3.3%, in CH1-CH4, respectively. Adherence was higher (medication possession ratio: 47.1% vs 39.4%; P<0.0001), and more patients remained persistent across 1-year post-index period in CH1 vs CH3 (25.4% vs 16.1%; P<0.0001). Positive predictors of medication persistence included being female, ≥55 years, and history of dyslipidemia or thyroid disease (all P≤0.0003).ConclusionOverall, 70% POAG patients might not have received antiglaucoma treatment. Since POAG is a slowly progressive blinding disease, the lack of antiglaucoma treatment and suboptimal adherence/persistence with medications are of major concerns. Targeted screening and educational approaches are needed to improve POAG management.

Outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma eyes

Introduction: Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) is a new treatment for glaucoma claiming to have lower levels of complications while having comparable efficacy relative to its predecessor, traditional Transscleral Continuous-wave Cyclophotocoagulation (TC-CPC).Objective: To evaluate the clinical efficacy and safety of MPTSCPC in the treatment of refractory glaucoma eyes.Methods: This uncontrolled interventional study was conducted at the Northampton General Hospital, UK. Patients who were selected to undergo MP-TSCPC due to uncontrolled intraocular pressure (IOP) or visual field progression despite maximum tolerable anti-glaucoma treatment were recruited for the study from February to September 2020. Data related to the patients were collected pre procedure and up to three months post procedure.Results: Of the 37 patients included in the study, 59.5% were females. The mean age of participants was 75.35 (SD=10.37) years. The most common types of glaucoma seen in the sample were primary open angle glaucoma and pseudoexfoliation glaucoma with 67.6% and 16.2% respectively. Mean pretreatment IOP was 26.62 (SD=8.36) mmHg. Three-month post-treatment mean IOP of 18.47 (SD=7.92) mmHg was a statistically significant (p&gt;0.001) reduction of 7.10 mm Hg. The drop in mean number of anti-glaucoma medications from 2.38 to 2.22 was not significant. Except for four patients with prolonged ocular inflammation and one patient with macular oedema, there were no significant complications following the procedure.Conclusion: MP-TSCPC is an effective and safe treatment option for refractory glaucoma over a 3 month follow up period. More extensive studies with larger sample sizes and longer follow up durations are recommended.

Detection of Intraocular Hypertension during Opportunity Screening (Check-Up Medical Inspections).

The aim of the study is the early detection of OHT (Ocular hypertension) in patients, in the activity of secondary prophylaxis (opportunity screening-medical check-up), to prevent blindness caused by POAG (Primary Open Angle Glaucoma). In Romania, medical examination of personnel with responsibilities in Transport Safety (TS) is legally regulated, being mandatory as a result of the internal transposition of European legislation in the field. The addressability of the patients for examination was determined by personal choice, depending on the accessibility of the medical service on the profile market (availability and price). The design of the study is epidemiological, observational, descriptive and retrospective. The standardized medical protocol included: personal medical history (anamnesis), physical ophthalmological examination, Intraocular pressure (IOP) measurement and Visual Field (VF) performance, with Automated Perimeter “Optopol PTS 910” through “Fast Threshold” strategy. The specialized medical research was completed with a dichotomous questionnaire entitled “Symptom Inventory”, made according to the recommendations of patients resulting from “Focus group” research. The study was carried out within the “Check-up” type medical controls upon request, only for personnel with positions in Transport Safety (TS), during January–December 2021 at S.C. ARTIMED S.R.L. Oradea, Bihor County. Health analysis was performed for 820 people, of whom 71 people (8.65%) tested positive for IOP > 21 mmHg, (suspected OHT) compared to 749 (91.35%) with normal values (Normal intraocular pressure-NIOP); the two lots being statistically significantly different (x2 = 560.590, df = 1, p = 0.000). The study involved 754 men (92.0%) and 66 women (8.0%), the sex ratio is 11.42 (Exp (B) = 0.782, Sig = 0.558, 95% CI = 0.343–1783; sex is not a significant predictor at the 5% level). The prevalence of OHT was 8.66% for the whole group, 8.48% for men and 10.60% for women. In the screening action for the whole group of patients the following was determined: IOP reference = 20.85 mmHg, Sensitivity (Se) = 91.5% and 1-Specificity (Sp) = 0.073, (Sp = 92.7%). The predictive value of the screening test was: Positive Predictive Value (PPV) = 90.1% and Negative Predictive Value (NPV) = 91.7%; Area under the ROC Curve (Receiver Operating Characteristic) = 0.986, Sig. = 0.000, CI95% = 0.979–0.993. A binary logistical model of a questionnaire was developed to determine the screening parameters which significantly predicted OHT: IOP (OR = 4.154, 95% CI: 3.155–5.469), Age < 40 years (OR = 0.408, 95% CI: 0.239–0.698) and Pattern Defect (PD) (OR = 1.475% CI: 1.130–1.925). The results of this study assess health status through regular medical examinations, and highlight their importance and usefulness in secondary prevention activity. The particularity of this “check-up” type for personnel with attributions in transport safety is based on two essential aspects: the legal obligation to perform it and the fact it is financed by the beneficiary (the employer). In patients suspected of OHT after antiglaucoma treatment, IOP statistically significantly decreased.