Antiglaucoma Medications Research Articles

Retrospective evaluation of surgical outcomes in canine patients with primary and secondary glaucoma following diode endoscopic cyclophotocoagulation.

To evaluate the long-term outcome of endoscopic cyclophotocoagulation (ECP) for the treatment of primary and secondary glaucoma in dogs. Retrospective review of dogs that underwent ECP at two referral centers from 2004 to 2023. Medical records of 389 eyes (301 dogs) following ECP were reviewed. Outcomes evaluated included follow-up time, intraocular pressure (IOP), vision status, additional ECP procedures performed, number of medications, and complications. Patient and surgical variables and their association with IOP control and vision maintenance were evaluated. Median follow-up time was 18 months. IOP remained controlled in 90% and 95% of patients at 1 and 2 years, respectively, following ECP. IOP was controlled long-term (2 years) in cases with primary (88%) and secondary (99%) glaucoma. Post-operative vision was maintained in 63% and 49% of eyes at approximately 1 and 2 years, respectively. Median time to vision loss was 6.5 months. Repeat ECP was required in 15.4% of eyes at a median of 19 days post-operatively. Eyes that underwent more than one ECP surgery had a significantly longer median time to blindness (13.8 months) than those that underwent a single ECP procedure (3.6 months; p = .0003). The median number of anti-glaucoma medications decreased from three pre-operatively to one at 1- and 2-year post-operatively. Complications included corneal ulceration (28%), blinding hypotony (11%), retinal detachment (11%), and hyphema (10%). Endolaser cyclophotocoagulation is an effective surgery for maintaining long-term IOP control and extending vision in canine patients with glaucoma refractory to medical management.

Extraocular muscle bridle traction suture assisted Paul glaucoma implant surgery for severe conjunctival scarring

Abstract: Glaucoma drainage device implantation can be complex and challenging, particularly in patients with conjunctival scarring. However, in this case, involving a young man with refractory glaucoma who had undergone multiple ocular surgeries, the implantation of a Paul glaucoma drainage device was successfully performed after the application of extraocular muscle bridle sutures. The patient exhibited a stable intraocular pressure ranging from 12 to 18 mmHg without antiglaucoma medication during the 3-month follow-up period. Thus, this surgical technique improves the accuracy and ease of inferior-temporal quadrant glaucoma drainage implantation, resulting in good treatment outcomes.

The use of anti-glaucoma medications following pediatric glaucoma surgery: a report on efficacy and trends in Cairo University

Purpose To identify the pattern(s) in using antiglaucoma medications following glaucoma surgery in children and compare their efficacies. Methods Retrospective chart review of patients (≤12 years) receiving glaucoma surgery from January 2013 to December 2020. Partially responsive patients needing antiglaucoma medications to attain an Intraocular pressure (IOP) of at least 18 mmHg were divided into three groups: (A) received beta-blocker (β-Blockers); (B) received Prostaglandin analogues and (C) received fixed β-Blocker+ Carbonic anhydrase inhibitor (CAI) preparation. Data included demographics, clinical characteristics, IOP (before, after 1 month, and at last follow-up), and surgeries. Successful treatment attained IOP less than or equal to 18 mmHg on last follow-up. Side effects were recorded. Results Totally 200 eyes of 152 patients were included, (61%) presented within the first month of life, 54% were males, 31.6% had bilateral disease and (82.2%) had primary congenital glaucoma (PCG). Pre-treatment IOP was significantly higher in group C (P=0.009). The most common procedure performed was trabeculotomy (P=0.014). After a mean follow-up period of 20.12 months, all three groups showed a significant reduction in the IOP (P≤0.001), with the highest percent reduction attained in group C (43.7% vs. 33.4% and 33.1% in groups A and B, respectively) P=0.001. Final success rates were 41.2%, 83.3%, and 82.2% for groups A, B, and C, respectively. Dry eye was the most common side effect (32 eyes) mainly occurring in group A (21.6%). Conclusions The most frequently used antiglaucoma medications following partially successful surgery are CAI+β-Blocker combinations. They seem to have the most potent effect and are usually used as a first line the higher the initial IOP is.

Change in Intraocular Pressure after Selective Laser Trabeculoplasty in North Indian Primary Open Angle Glaucoma Patients: A Prospective Analytical Study

Introduction: Glaucoma is the second leading cause of blindness in the world. The only known modifiable risk factor for the onset and progression of glaucoma is Intraocular Pressure (IOP). There are a limited number of studies documenting the IOP-lowering effect of Selective Laser Trabeculoplasty (SLT) in Primary Open Angle Glaucoma (POAG) patients, especially within the North Indian population. Understanding the effect of SLT on IOP reduction in this population is crucial for the proper management of glaucoma patients. Aim: To study the IOP-lowering effect of SLT in North Indian POAG patients (who had not achieved target IOP on two or more antiglaucoma drugs) after a period of six months. Materials and Methods: A hospital-based, single-arm, prepost type of prospective analytical study was conducted at Lady Hardinge Medical College and associated hospitals in New Delhi, India, from January 2021 to June 2022. POAG patients aged 18 years or older, who had not achieved the target IOP while on two or more Antiglaucoma Medications (AGM), were given the option of treatment with SLT. A total of 33 eyes were considered for the study as per sample size calculations. PreSLT, IOP was recorded along with other baseline parameters. The SLT procedure was carried out according to the standard protocol. IOP was recorded during follow-ups at one week, one month, three months, and six months. The Friedman test was used to compare IOP values, with a significance level set at 0.05. Spearman correlation was employed to explore the correlation between baseline IOP and the change in IOP at six months. Results: A total of 33 eyes were included in the study. Of these, 28 (84.8%) eyes had advanced glaucoma, while 5 (15.2%) eyes had moderate glaucoma according to International Classification of Diseases, Tenth Revision (ICD-10) staging. Patients were on two or more commonly used AGMs, including prostaglandin analogues, beta blockers, alpha agonists, topical carbonic anhydrase inhibitors, and rho kinase inhibitors. The mean number of topical AGMs that patients were using was 3.03. The number and type of AGMs for each patient remained consistent pre and post-SLT throughout the study period. The mean IOP (baseline) was 16.39±2.73 mmHg, and after six months, the mean IOP was 13.86±1.99 mmHg. The mean IOP reduced by 2.53 mm Hg (15.44%). There was a strong negative correlation between baseline IOP and the change in IOP at six months, which was statistically significant (rho=-0.78, p-value<0.001). Conclusion: The present study indicates that SLT can be considered an adjunctive treatment for lowering IOP in North Indian POAG patients. A strong negative correlation was found between baseline IOP and IOP at six months post-SLT, suggesting that a higher reduction can be expected in patients with elevated baseline IOP.

Raised Intraocular Pressure Secondary to Vitreoretinal Procedures: A Literature Review

The anatomical proximity of anterior and posterior segment structures and the familiar microcirculatory milieu make both susceptible to arduous complications when either is surgically handled. Because of the complex haemodynamic reciprocity between vitreous, retina, choroid, and aqueous humour, any trivial alteration in one can present a catastrophic consequence in the other. A good number of evidence.based studies have already substantiated that postoperative rise in intraocular pressure (IOP) is a well-recognised complication after vitreoretinal surgeries like scleral buckling, pars plana vitrectomy (PPV), intravitreal gas and silicon oil injection as well as intravitreal steroid and antivascular endothelial growth factor (VEGF) injection. The cause is multifactorial. Determining the cardinal pathophysiological mechanism is very decisive as it provides the ultimate guide to opting for the suitable treatment modality. The superimposing clinical features mystify the diagnosis, and pre.existing conjunctival scars and episcleral explants make any further surgical management very tough. In many cases, anti-glaucoma medications are beneficial for managing the temporary rise in IOP. However, the options of laser treatment and filtration surgeries can be considered in resistant cases, and glaucoma drainage devices are the last resort for refractory patients where filtration surgeries fail. In this review, we provide fundamental insight into the possible pathogenic mechanisms, specifically focusing on how to discriminate among them and strategically approach the management with secondary elevation in IOP following vitreoretinal surgeries.

A Systematic Review of Cyclophotocoagulation Techniques: Continuous Wave Versus Micropulse for Glaucoma Treatment.

Micro-pulse cyclophotocoagulation (MP-CPC) represents the latest iteration of minimally invasive laser procedures aimed at reducing intraocular pressure (IOP) through the disruption of pigmented ciliary body epithelium. This systematic review aims to assess the efficacy and safety profile of the MP-CPC procedure in comparison to CW-CPC for the treatment of glaucoma. We initiated a search on PubMed, ScienceDirect, and the Cochrane Library databases for studies that compared micro-pulse and traditional CW-CPC in terms of their efficacy and safety profiles. We employed medical subject headings terms and keywords such as "cyclophotocoagulation," "cyclodestructive," "photocoagulation," "CPC," "micropulse," "micro-pulse," and "glaucoma" within the timeframe from 2015 to 2023. We assessed the success rate, IOP reduction, antiglaucoma medications, and complications of MP-CPC and CW-CPC. We included six articles in this study, comprising two randomized controlled trials, three retrospective, and one prospective cohort, published between 2015 and 2023. Five out of six reported a significant reduction in IOP for both procedures with comparable success rates observed in MP-CPC compared to CW-CPC. One article reported an increase in IOP in MP-CPC. Both groups reported a decrease in the number of antiglaucoma medications, while one study reported an increase in medications in both MP-CPC and CW-CPC groups. Complication rates were lower in the MP-CPC group with two articles reporting a significant decrease compared to the CW-CPC group. MP-CPC has shown promising results in the treatment of glaucoma in the adult population. With comparable results in IOP reduction and fewer instances of serious ocular complications, MP-CPC may open new possibilities for the use of cyclophotocoagulation procedures in the earlier stages of glaucoma. However, its efficacy in the pediatric population and for neovascular glaucoma remains less defined, thus warranting further studies to establish optimal laser parameters for different types of glaucoma and specific populations of glaucoma patients.

Analysis of the impact of different schemes of preparation to trabeculectomy on the healing markers using in vitro model of the Tenon fibroblast cultures isolated directly from the patient

Aims/Purpose: The aim of the study was to assess the influence of different regimes of patient's preparation before trabeculectomy on the markers of healing process in Tenon's fibroblast cultures.Methods: The studied group consisted of 66 patients with open angle glaucoma undergoing primary trabeculectomy. The patients were divided into 5 groups with different regimes of preparation before the surgery based on application or withdrawal of topical antiglaucoma medications and steroids. During trabeculectomy the samples of Tenon's capsule were obtained. Tenon fibroblasts were isolated directly from the explants to test their proliferation ability and the level of released healing markers. Following factors typical of healing process were evaluated using commercially available ELISA kits: IL 1‐β, IL‐6, IL‐8, VEGF‐A, TGF‐ β1 and MMP‐9.Results: Concentrations of IL‐1β, IL‐6 and TGF‐ β1 were significantly higher in the group obtaining antiglaucoma drops. Additionally, in this group the fibroblasts revealed the highest proliferation potential, indicating the active healing process. The levels of IL‐8, VEGF‐A and MMP‐9 were similar between the groups.Conclusions: Our study shows that for the best conjunctival anti‐inflammatory control, the most influential factor is the withdrawal of antiglaucoma medications.

Cyclophotocoagulation versus Ahmed Glaucoma Implant in Neovascular Glaucoma with Poor Vision at Presentation.

To evaluate the outcomes of surgical intervention in eyes with neovascular glaucoma (NVG) and poor vision, comparing the Ahmed glaucoma implant with cyclophotocoagulation (CPC). This study is a double-armed cohort retrospective review of medical records of patients with NVG who had a visual acuity of 20/200 or less and underwent one of the two procedures as a primary intervention: Ahmed glaucoma valve (AGV) or cyclophotocoagulation (CPC). The study was conducted at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, from January 2014 to June 2019, with a total study period of 1 year. The main outcome measures included the surgical success rate, changes in intraocular pressure (IOP), the number of antiglaucoma medications, corrected distance visual acuity, and the reoperation rate for glaucoma. The preoperative IOP was 40.4 ± 10.6 mmHg (Median 40) in the CPC group and 39.4 ± 10.2 mmHg (Median 40) in the AGV group (P = 0.6). At 1 year, the IOP ranged from 12.5 to 28 mmHg (Median 18) in the CPC group and 14 to 21.5 mmHg (Median 17) in the AGV group (P = 0.016). Survival analysis showed a 51% success rate in the CPC group and an 89% success rate at 1 year in the AGV group (p>0.0001). CPC and AGV procedures yielded good outcomes with similar IOP levels 12 months after the surgery. However, AGV demonstrated a higher overall success rate and a lower medication requirement than CPC.

An Unusual Case of Unilateral Iridocorneal Endothelial Syndrome with Keratoconus and Secondary Angle Closure Glaucoma: A Case Report

We report an unusual association of unilateral keratoconus–Iridocorneal endothelial syndrome with secondary angle closure glaucoma in a 22-year-old female. The patient was advised glaucoma drainage device as she was a breastfeeding mother with limited options for antiglaucoma medications. This case highlights the ophthalmologists need to look for multiple entities linked to keratoconus.

Surgical Outcomes of Ahmed Glaucoma Valve and Aurolab Aqueous Drainage Implant in Nepalese Eyes: Comparison in the First Year.

Glaucoma is the leading cause of irreversible blindness worldwide. Though trabeculectomy still remains the surgical modality of choice for the management of glaucoma, the outcome of glaucoma drainage devices (GDDs) too has been encouraging in recent years. To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. We retrospectively studied the charts of the patients with refractory glaucoma who had undergone GDD implantation at Tilganga Institute of Ophthalmology (TIO), Kathmandu, Nepal. Depending on which GDD was implanted, the eyes of the patients were divided into: AGV group and AADI group. The outcome measures of the study were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs), surgical success and complications. There were 24 eyes of 23 patients in AGV group and 31 eyes of 30 patients in AADI group with a median (quartiles) follow-up of 12 (12,12) months. In the final visit, IOP and AGMs were both significantly lower than the baseline in both the groups (P <0.001). The median IOP in mmHg and AGMs were both significantly lower in the AADI group compared to AGV group in the final visit, p <0.001 and p=0.002, respectively. The overall success was similar in both the groups: AGV (n=22, 91.67%) and AADI (n=29, 93.55%), p=1.0. However, complete success was significantly more in AADI group (n=16, 51.61%) compared to AGV group (n=6, 25%), p=0.046. Complications and their rates were comparable between the two groups (p=0.4). Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.

Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors.

This study aims to report the disparity between the ideal and actual quantities of eyedrops prescribed to individual glaucoma patients. This retrospective observational study included 676 patients receiving treatment with antiglaucoma topical medication(s) in at least one eye. These patients had follow-up appointments scheduled at mean intervals of 3.4 ± 1.4 months and were actively using antiglaucoma medication. The mean age was 70.4 ± 11.9 years, with 372 (55%) being male. The over-prescription volume was 1.4 ± 1.7 bottles per month for each medication when prescribed for both eyes. Multiple regression analysis revealed that older age (p = 0.03), hyperopic refractive error (p < 0.0001), and the use of multiple medications (p = 0.03) were associated with a larger over-prescription volume, while the use of unit-dose medication only (p < 0.0001) was associated with a smaller over-prescription volume. Factors such as sex, Mini-Cog cognitive function score, best-corrected visual acuity, intraocular pressure, glaucoma type, and a history of cataract surgery were not significantly associated. This study revealed a significant over-prescription of eyedrops for glaucoma patients, with actual prescriptions often exceeding the theoretically ideal amount by 2.4 times, influenced by factors like age and the format of prescriptions, where unit-dose eyedrops show promise in reducing excess.

Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting.

This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.

Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India.

To describe the clinical profile, demographics, and management of Posner-Schlossman syndrome (PSS) in patients presenting to a multitier ophthalmology hospital network in India. This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PSS in at least one eye were included as cases. The data were collected using an electronic medical record system. Overall, 130 eyes of 126 (0.004%) patients were diagnosed with PSS. The majority of the patients were male (81.75%) and had unilateral (96.83%) affliction. The most common age group at presentation was during the fourth decade of life, with 46 (36.5%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.005%) presenting from the metropolitan geography (0.008%) and in professionals (0.014%). A significant number of patients (108; 83.08%) had a raised intraocular pressure of >30 mm of Hg. The majority of the eyes had mild or no visual impairment (better than 20/70) in 99 (76.15%) eyes. Keratic precipitates were found in 59 (45.38%) eyes, anterior chamber cells in 43 (33.08%) eyes, and iris atrophy in seven (5.38%) eyes. The majority of eyes (127; 97.69%) had open angles on gonioscopy. The average duration of use of topical steroids was 1.70 ± 0.76 months, and the average duration of use of topical antiglaucoma medications (AGMs) was 1.66 ± 0.81 months, with 35 eyes (26.92%) requiring continued AGMs. Among the surgical interventions, trabeculectomy was performed in nine (6.92%) eyes and cataract surgery in five (3.85%) eyes. PSS more commonly affects males presenting during the fourth decade of life from higher socioeconomic status and is predominantly unilateral. The majority of the eyes have mild or no visual impairment, open angles, and require surgical intervention in a tenth of the eyes.

Results of Combined Phacoemulsification and Goniosynechialysis in the Management of Refractory Acute Angle Closure Glaucoma in Ratchaburi Hospital

Objective: To assess the effectiveness of combined phacoemulsification and goniosynechialysis (PE-GSL) of angle closure glaucoma in patients with uncontrolled intraocular pressure (IOP) and persistent peripheral anterior synechiae (PAS) initially presented with acute angle closure attack. Materials and Methods: The present study was a retrospective cohort study of medical records of Thai glaucoma patients comprising 19 eyes of 19 patients (13 females and 6 males) with acute angle closure attacks. All patients were performed with PE-GSL Results: There were statistically significant differences between preoperative and postoperative IOP, PAS, and the number of medications required for IOP control. Postoperative visual acuities were improved. At the final examination for each patient, IOP was 12.15±1.57 mmHg (range 10 to 16). The extent of recurrent PAS was 66.32±40.72° (range 0 to 90), and the number of antiglaucoma medications was 0 (range 0 to 2). IOP was less than 20 mmHg in 16 eyes (80%) without medications. Three eyes were controlled with medications. In the 16 eyes with successful PE-GSL, the mean time between the angle closure attack and surgery was 7.5±5.6 weeks. Conclusion: PE-GSL are effective in decreasing IOP, PAS, and medications, as well as improvement of visual acuity in eyes with uncontrolled IOP and persistent PAS in patients who initially presented with acute angle closure attacks. Keywords: Angle-closure glaucoma; Phacoemulsification; Goniosynechialysis; Cataract; IOP

Clinical Efficacy of Preoperative and Intraoperative Intravitreal Ranibizumab as Adjuvant Therapy of Ahmed Glaucoma Valve Implantation Combined with Vitrectomy in the Management of Neovascular Glaucoma with Diabetic Vitreous Hemorrhage.

Neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) is a devastating ocular disease with poor prognosis. Intravitreal ranibizumab injection (IVR) has been used as adjuvant therapy of surgical interventions preoperatively or intraoperatively. This study aimed to determine the efficacy and safety of combined IVR as adjuvant therapy in treating NVG with vitreous hemorrhage (VH) in PDR. A total of 39 NVG patients with VH (39 eyes) received IVR 3 to 5 days before surgery, and then they were assigned to either pars plana vitrectomy (PPV) + Ahmed glaucoma valve (AGV) implantation (Group 1, n = 22) or PPV + AGV implantation + intraoperative IVR (Group 2, n = 17). Patients were followed up for at least 9 months. Intraocular pressure (IOP), anti-glaucoma medications, best corrected visual acuity (BCVA), surgical success rates and postoperative complications were compared. Results showed that IOP decreased promptly after surgery and was notably maintained at a mid-term follow-up in both groups, and no significant differences were observed (all p > 0.05). Additional intraoperative IVR significantly reduced postoperative recurrent VH and iris neovascularization (p = 0.047, p = 0.025, respectively). There was no remarkable difference in postoperative anti-glaucoma medications, BCVA and complications between two groups (all p > 0.05). In conclusion, preoperative and intraoperative IVR as adjuvant therapy of AGV implantation combined with PPV could be a safe and effective treatment for NVG with VH in PDR. An additional intraoperative anti-VEGF injection could significantly reduce postoperative VH and iris neovascularization.

Selective Laser Trabeculoplasty – The First-line Treatment For Open-Aangle Glaucoma?!

The purpose of this nonrandomized study conducted at the Eye Clinic "Akhali Mzera" between October 2011 and November 2022 was to evaluate the intraocular pressure (IOP) reduction and side effects following selective laser trabeculoplasty (SLT). A total of 867 eyes of 558 patients with early to moderate primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PXG) phakic and pseudophakic were included in the study. The patients were treated with laser as primary therapy or adjunct laser with medication. The mean age of the study participants was 54.3 ± 5.2 years (range, 40 to 78 years) and 362 (64.9%) were males. The glaucoma diagnosis was POAG in 726 (83.7%) eyes and PXG in 141 (16.3%) eyes. Diabetes mellitus in 8% and systemic hypertension in 30% were noted. 736 eyes (84.9%) were on medications, and 130 (14.9%) eyes were treated with laser as primary therapy. Overall, the mean IOP after SLT was 17.8 ± 3.2mmHg, 18.8 ± 2.3 mmHg, and 23.4 ± 2.5 mmHg in the 12th month, 24th month, and 36th month respectively. About 20% of patients with POAG lost efficacy in 18 months post-treatment and in these eyes, the second SLT procedure was more effective than the first one. The number of drugs reduced from an average of 1.3 to an average of 1.0 was statistically significant with the inter-eye correlation. Those patients who were treated with laser as primary therapy with a baseline IOP of 25.4 mmHg ±2.9 mmHg had IOP reduction of 7.5 ± 3.1 mmHg at the last visit, and those who were on antiglaucoma medication with baseline IOP 23.9 ± 2.2 mmHg had IOP reduction of 4.8 ± 2.8 mmHg. IOP reduction at the last visit between POAG, and PXG was 6.5 mmHg and 7.9 mmHg, respectively. It was concluded that SLT is a safe and innovative technology that uses lasers to target only certain cells of the trabecular meshwork of the eye.

Clinical Characteristics and Surgical Outcomes of Turkish Patients With Pediatric Glaucoma Who Underwent Glaucoma Surgery in a University Hospital.

To describe the clinical characteristics and outcomes of a pediatric cohort surgically treated for primary or secondary pediatric glaucoma (PPG/SPG). A retrospective chart review was conducted of all patients with pediatric glaucoma who had surgery between 2013 and 2021. Relevant demographic and clinical data were cumulated and analyzed. Forty-two eyes of 29 patients (18 girls and 11 boys) were included: 22 (52.4%) primary congenital glaucoma (PCG), 7 (16.7%) juvenile open-angle glaucoma, and 13 (30.9%) SPG. Mean ages at presentation were 2.57 ± 2.87, 131.96 ± 27.71, and 62.09 ± 65.12 months, respectively. In this study, eyes with PCG presented the earliest, with the highest intraocular pressure (IOP) and thickest central corneal thickness (CCT). The mean number of glaucoma surgeries was 1.48 ± 0.71, with 38.1% of the eyes needing two or more glaucoma surgeries; trabeculectomy was the most frequent glaucoma surgery in this cohort. After surgical intervention, the overall mean IOP dropped from 32.25 ± 12.97 to 18.10 ± 9.23 mm Hg (P < .001). Moreover, the percentage using antiglaucoma medications decreased from 100% to 35.7% at the final visit, as did the number of medications prescribed per eye (2.69 ± 0.92 vs 1.05 ± 1.46, P ≤ .001). Mean best corrected visual acuity (BCVA), in patients who could have their BCVA measured, improved from 0.61 ± 0.61 to 0.53 ± 0.51 logMAR at final follow-up. Surgical intervention was shown to provide a well-controlled IOP, decrease dependance on glaucoma medications, and improve BCVA in both PPG and SPG. Multiple surgical interventions may be necessary in the treatment of some pediatric patients with glaucoma. Prognostically, thicker CCT was significantly associated with worse IOP control, more glaucoma surgeries, and more antiglaucoma medications at the final visit. Initial BCVA correlated significantly with BCVA at the final visit. [J Pediatr Ophthalmol Strabismus. 2024;61(3):188-197.].

Clinical significance of episcleral venous fluid wave in gonioscopy-assisted transluminal trabeculotomy.

To evaluate the clinical significance of checking episcleral venous fluid wave (EVFW) during gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open angle glaucoma (OAG). This retrospective case series study comprised 30 patients (45 eyes) with OAG underwent GATT. The location and extent of EVFW were examined and graded after intraoperative compression flushing of the anterior chamber angle during the operation. Patients were followed up for 1y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) <18 mm Hg without any anti-glaucoma medication. IOP<18 mm Hg with less than two anti-glaucoma medications is defined as qualified success, while the control of IOP requiring three anti-glaucoma medications is considered as unsuccess. The mean IOP was 35.38±7.16 mm Hg before surgery and 15.52±4.22 mm Hg 1y after surgery (P<0.01). The average number of anti-glaucoma medication was 2.8±1.2 (2-4) preoperation and 0.6±1.3 (0-3) 1y postoperation (P<0.01). The success rate of the operation was 93.33%. Complete success rate was 66.67%, qualified success rate was 26.67%, and 6.66% of unsuccessful cases required reoperation. EVFW of all cases was grade 2-4, and the percentages of grade 2, 3 and 4 were 33.33%, 40.0% and 26.67%, respectively. The distribution and percentage of EVFW were inferior (36%), nasal (28%), superior (20%), and temporal (16%). The EVFW grade of complete success patients was 3.4±0.6 (3-4), and that of qualified success patients was 2.6±1.0 (2-4). The larger the range of EVFW, the lower the IOP, and the better the IOP reduction effect. During GATT surgery, pressurized irrigation of anterior chamber to check EVFW can reduce the outflow resistance of aqueous humor and increase the effect of postoperative IOP. The range of EVFW is negatively correlated with postoperative IOP. Therefore, EVFW may be a valuable prognostic indicator for the success of GATT surgery.

Ocular surface changes in primary open-angle glaucoma on anti-glaucoma medications versus treatment-naïve patients.

To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment. A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer's test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up. On presentation, TBUT, Schirmer's test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer's test, TMH, and TMD had better values in group I in comparison to group II on follow-up. The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.

Trabeculectomy with collagen implant for the treatment of glaucoma

The goal is to assess the effectiveness and safety of trabeculectomy with collagen implants for glaucoma patients who cannot be managed medically. This research is a case series that intervenes without randomization and focuses on potential outcomes. The study consisted of 76 treated eyes of 76 patients with uncontrollable glaucoma. A thorough examination of the eyes was performed on all patients, and the results were documented. Each patient underwent conventional trabeculectomy surgery using the fornix-based approach. Additionally, a subconjunctival collagen implant known as Ologen was also utilized. We recorded preoperative data such as age, gender, best-corrected visual acuity, intraocular pressure, glaucoma type, and a few preoperative antiglaucoma medications. We recorded the intraocular pressure after surgery, the number of glaucoma medications given after surgery, and any complications that occurred during the postoperative period. Each patient was monitored for a minimum of six months. Before the operation, the average intraocular pressure (IOP) was 34.21 ± 12.5, and the patient took at least two IOP-lowering medications (average 2.3). The postoperative IOP was measured after three months and found to be 13.85±5.42mm Hg, with a p-value of 0.060. On average, the blood pressure decreased by 16.42±6.42 mmHg after six months, with a p-value of 0.056. After six months, it was observed that the medication significantly reduced 1.22 in intraocular pressure (P=&amp;#60;0.001), leading to a notable decrease of 17.79 mmHg. The success rate stood at a commendable 97.36% at the three-month mark, but it reduced to an alarming 88.15% by the last visit. Within just one month after the operation, several complications arose, including three cases of hyphaema, one case of the shallow anterior chamber, and two cases of wound leak. All patients showed gradual improvement with conservative management. However, three of them developed cataracts within three months. For patients who have not responded to topical antiglaucoma medications, to manage intraocular pressure is a dependable and safe surgical procedure that offers an efficient treatment option.