Glaucoma Research Articles

Short-term efficacy and safety of PreserFlo MicroShunt in Japanese patients with medically treated primary open-angle glaucoma.

To assess the efficacy and safety of PreserFlo MicroShunt (PMS) combined with mitomycin C in patients with medically treated primary open-angle glaucoma (POAG). A retrospective observational study. The study examined 83 eyes from 83 patients with medically treated glaucoma surgery naive POAG. Preoperative intraocular pressure (IOP) was stratified into three groups: IOP < 15 mmHg (group 1), 15 ≤ IOP < 21 mmHg (group 2), and IOP ≥ 21 mmHg (group 3). IOP levels at week 1, month 1, month 3, and month 6 were evaluated using a linear mixed model, and Kaplan-Meier survival analysis was employed to assess the complete success rate (30% IOP reduction without any medications or interventions) of IOP management. The postoperative complications and interventions were also evaluated. Overall, the mean IOP decreased from 19.2 ± 7.4 mmHg to 11.3 ± 3.1 mmHg, representing a 41% IOP reduction. Especially, in group 1 (mean IOP of 12.8 mmHg), IOP decreased to 10.3 mmHg, achieving a reduction rate of 20%. Overall, 51% (95% confidence interval [CI] 41-62%) of the patients maintained a ≥ 30% IOP reduction (complete success). Minor complications included hypotony (n = 10) and hyphema (n = 30). Needling was performed in 12 eyes, bleb revision in 2, tube re-insertion in 2, and insertion of a second tube in 1. PMS demonstrated significant efficacy in reducing IOP in patients with POAG reagrdless of its preoperative IOP levels. No serious complications affecting the VA were observed.

The repeatability of macular and peripapillary vessel density in participants with different severities of glaucoma.

To investigate the repeatability of optical coherence tomography angiography (OCTA) parameters in participants with different severities of glaucoma. Subjects with open-angle glaucoma were enrolled prospectively and categorised into mild (mean deviation [MD] of 24-2 visual field test ≥ -6 dB), moderate to advanced (-6 > MD ≥ -20 dB) and severe glaucoma groups (MD < -20 dB). OCTA was performed three times within a single visit to obtain superficial and deep macular vessel density (VD) and peripapillary vessel and capillary density. The association between the coefficient of variation (CoV) and intraclass correlation coefficient (ICC) of these OCTA parameters and glaucoma severity (MD, the thickness of the retinal nerve fibre layer and the ganglion cell complex) was analysed, along with factors associated with the CoV of OCTA parameters. A total of 57 mild, 92 moderate to advanced and 39 severe glaucomatous eyes were included. CoV for superficial (p < 0.001) and deep macular VD (p < 0.001) and peripapillary VD (p = 0.004) increased with glaucoma severity. Greater CoV for superficial and deep macular VD and peripapillary VD was associated with worse MD and scan quality index in multivariable analysis. The association between a higher CoV of superficial and deep macular VD and worse MD was only noticeable in participants with a scan quality index <7. The relationship between the CoV of peripapillary VD and MD was consistent across varying image qualities. The intrasession variability of OCTA parameters was greater in glaucoma participants with advanced disease, especially in those with suboptimal scan quality.

Structural reversal of disc cupping measured in Bruch’s membrane opening-based OCT morphometry after PRESERFLO microshunt implantation for open-angle glaucoma

Background/ AimsTo analyze the longitudinal change in Bruch’s membrane opening minimal rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (pRNFL) thickness using optical coherence tomography (OCT) after implantation of a PRESERFLO® microshunt for surgical glaucoma management in adult glaucoma patients.MethodsRetrospective data analysis of 59 eyes of 59 participants undergoing implantation of a PRESERFLO microshunt between 2019 and 2022 at a tertiary center for glaucoma management. Surgical management included primary temporary occlusion of the glaucoma shunt to prevent early hypotony. Pre- and post-operative OCT examinations of the optic nerve head (ONH) and intraocular pressure (IOP) were assessed. Longitudinal change in morphometric spectral domain OCT parameters of the ONH was correlated to change in IOP.ResultsBMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first three months after surgery (BL = 171.15 ± 66.80 μm; FU = 180.78 ± 70.394 μm; p = 0.034). For the same postoperative period, the mean preoperative IOP of 24.97 ± 7.22mmHg was lowered after surgery to 13.70 ± 5.09 mmHg. Eighteen months after surgery, there was no significant change in BMO-MRW compared to baseline (BL = 169.83 ± 52.69 μm; FU = 164.98 ± 55.85 μm; p = 0.271), while mean IOP was 13.08 ± 4.48 mmHg. A decrease in IOP correlated significantly with a change in BMO-MRW (r = 0.453, p < 0.05) three months after surgery. Peripapillary RNFL thickness was unchanged in follow-up after three months (p > 0.16) and significantly decreased in later follow-up (p = 0.009).ConclusionPRESERFLO® microshunt implantation with primary temporary occlusion leads to a significant transient increase in BMO-MRW. This phenomenon is also known as structural reversal of disc cupping (SRDC). The effect seems to be less pronounced and of shorter duration when compared to previous data after trabeculectomy with comparable pre- and postoperative IOP levels.

Vascular Density and Retinal Structure Relationships Across Sectors and Regions of the Optic Nerve in Patients with Primary Open Angle Glaucoma

Précis: The relationship between structural and hemodynamic parameters in patients with primary open angle glaucoma is strongest in the temporal region of the optic nerve. Purpose: To investigate the relationship between radial peripapillary capillary (RPC) vessel density (VD) and retinal nerve fiber layer (RNFL) thickness in quadrants and sectors of the optic nerve head (ONH) in patients with and without primary open angle glaucoma (POAG). Methods: In a cross-sectional prospective analysis, 191 subjects (80 early-stage POAG; 111 non-glaucomatous controls) were assessed for RNFL thickness and RPC VD in each quadrant [superior (S), inferior (I), nasal (N) and temporal (T)] and sector [inferior-temporal (IT), temporo-inferior (TI), temporo-superior (TS), superior-temporal (ST), inferior-nasal (IN), naso-inferior (NI), naso-superior (NS), and superior-nasal (SN) sectors] of the ONH via optical coherence tomography angiography (OCTA, Avanti, Optovue). Pearson correlations were used to test for associations between measurements, with P&lt;0.05 considered statistically significant. Results: Significantly stronger positive correlations were found between RPC VD and RNFL thickness in the S, I, and T quadrants in POAG patients compared to non-glaucomatous controls (all P&lt;0.05). The temporal quadrant in POAG patients displayed the largest difference in correlation compared to controls. A stronger positive correlation was also found between RPC VD and RNFL thickness in the temporal sectors of the ONH in POAG patients compared to controls, with the largest difference in the TS sector (all P&lt;0.05). Conclusion: Early-stage POAG patients have a stronger relationship between RPC VD and RNFL in the temporal regions of the ONH compared to non-glaucomatous controls, with the TS sector demonstrating the largest difference between groups. Temporal sector VD loss may represent an early-stage biomarker for vascular-linked POAG disease.

Aqueous Angiography Guided Bent Ab Interno Needle Goniectomy in High versus Low Aqueous Humor Outflow Regions in POAG: A Pilot RCT.

Trabecular cutting minimally invasive glaucoma surgery like bent ab interno needle goniectomy (BANG) when performed in baseline aqueous angiography identified low aqueous humor outflow regions, results in greater success of intraocular pressure reduction. To study the efficacy of Bent Ab Interno Needle Goniectomy (BANG) in high versus low aqueous humor outflow (AHO) regions as determined by Aqueous Angiography(AA) in patients with primary open angle glaucoma (POAG). A prospective, single-centre, pilot, randomized control trial recruited 30 eyes of 30 patients of POAG and visually significant cataract (45-80y) and were randomised into two groups ("A": BANG performed in the high-flow regions and "B": BANG performed in the low-flow regions) of 15 each. AA was performed using indocyanine green dye (0.1%) to identify baseline high- and low-flow regions of the AHO pathways followed by BANG in these respective regions as per randomisation. Preoperative and postoperative data on IOP, number of antiglaucoma medications (AGMs) and any complications were noted over 6 months. Overall success was defined as achieving an IOP ≤15mm Hg and ≥6mm Hg at 6 months of follow-up with AGMs (qualified success) or without AGMs (complete success). AA revealed high-flow regions of AHO pathways in the nasal quadrant and low-flow regions of AHO pathways in the temporal quadrant in all 30 patients. Both groups had comparable demographic composition [group A age: 65.3±6.48y and male: female (14:1) and group B age: 64.6±7.08y and male: female (13:2)]. The mean preoperative IOPs [group A (17.27±3.43mm Hg); group B (17.60±5.42mm Hg)] (P=0.842) and mean postoperative IOP at 6 months [group A (15.6±4.98mm Hg); group B (13.13±2.29mm Hg)] (P=0.09) were similar. However, lower qualified success was seen in group A (40.00%) compared to group B (86.67%; P=0.021). Survival in Kaplan-Meier analysis was higher in group B (P=0.021). Complications were comparable in both groups. Short-term results of BANG in low-flow AHO regions show enhanced success compared to those in high-flow AHO regions. This study suggests that trabecular cutting minimally invasive glaucoma surgeries (like BANG) may be performed in baseline low-flow AHO regions (temporal quadrant) instead of the high-flow AHO (nasal quadrant) regions.

A Systematic Review of Micropulse Laser Trabeculoplasty (MLT) in Primary Open-Angle Glaucoma (POAG) Management: Efficacy, Safety, and Future Perspectives

Background/Objectives: Micropulse laser trabeculoplasty (MLT) is gaining attention as a non-invasive treatment option for primary open-angle glaucoma (POAG), offering an alternative to traditional surgeries and medications. This systematic review evaluates the effectiveness, safety, and potential of MLT in glaucoma management. Methods: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, following the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. Results: We identified 79 articles, and after removing duplicates and screening abstracts, 56 articles were eligible for further review. A detailed full-text analysis was conducted on 26 articles, of which 15 met the predefined inclusion criteria. Conclusions: MLT shows promise as a primary or adjunctive treatment for reducing intraocular pressure (IOP) in glaucoma and ocular hypertension patients. Current evidence supports its efficacy and safety; however, additional long-term studies are needed to confirm its durability and compare its effectiveness with traditional surgical and pharmacological approaches. Standardizing treatment protocols and refining patient selection criteria could enhance MLT’s clinical value and support its broader adoption in glaucoma care.

Aging-enhanced autophagy activity promotes fibrotic progression via the TGF-β2/Smad signaling pathway in trabecular meshwork cells—a new insight from POAG

IntroductionGlaucoma, a leading cause of irreversible blindness, is characterized by optic neuropathy and retinopathy, with primary open-angle glaucoma (POAG) being the most prevalent form. The primary pathogenic mechanism of POAG involves elevated intraocular pressure caused by chronic fibrosis of the trabecular meshwork (TM). Autophagy, a critical process for maintaining cellular homeostasis, has been implicated in fibrosis across various organs. However, its precise role in the fibrosis associated with POAG pathogenesis remains unclear. This study investigates the involvement of autophagy in TM fibrosis and explores its potential impact on POAG development, aiming to provide insights into new therapeutic targets.MethodsTo assess autophagy activity and its relationship with fibrosis, we analyzed TM tissues from POAG patients and healthy donors. Autophagic activity in human TM tissues was measured through immunohistochemical analyses. An in vitro aging model using chronic H2O2 treatment was established to investigate the change of fibrosis in TM cells. Additionally, we used dexamethasone-treated TM cells as a POAG model to explore the role of autophagy in fibrotic progression. The involvement of the TGF-β2/Smad signaling pathway was investigated through western blot analysis and quantitative real-time PCR.ResultsThis study reveals increased autophagic activity in tissues from POAG patients and an age-related upregulation of autophagy in healthy human TM tissues. In the H2O2-induced aging model, TM cells displayed both elevated autophagic activity and fibrosis. Further investigation showed that enhanced autophagy activity promoted fibrotic progression via activation of the TGF-β2/Smad signaling pathway. Similarly, in the dexamethasone-treated TM cell model, autophagy was found to exacerbate fibrosis, aligning with observations in the aging model.DiscussionIn this study, we uncover the interplay between autophagy and the TGF-β2/Smad pathway in the pathogenesis of POAG. We observed increased autophagic activity in TM tissues from POAG patients and in TM tissues of aging healthy individuals. In human primary TM cells, we confirmed that autophagy becomes activated in the context of cellular senescence and the development of POAG, which further facilitates fibrotic progression via the TGF-β2/Smad signaling pathway. These findings underscore the important role of autophagy in POAG pathogenesis and confirm senescence as a pivotal risk factor.

Relationship of Angle Kappa with Ocular Parameters using Swept-Source Ocular Coherence Tomography in Cataract Surgery Patients

Purpose To assess the relationship between angle kappa (apparent chord mu) and ocular parameters in cataract patients. Methods In this cross-sectional study, the data on apparent chord mu, age, axial length, anterior chamber depth, anterior and posterior mean keratometry, mean total keratometry, white-to-white, central corneal thickness and lens thickness were collected for consecutive cataract patients. Correlation (Pearson) between chord mu and the other ocular parameters was calculated. A stepwise backward multiple regression analysis was performed to identify the combination of ocular parameters strongly correlating to chord mu. Results Two thousand four hundred and sixty-four eyes (1232 patients) were included in this study. The mean age was 72.7 ± 12.7 years (18–97 years). Univariate analysis showed a significant positive correlation of chord mu to age (R = 0.06, p = .01), lens thickness (R = 0.12, p < .01), mean keratometry (R = 0.08, p < .01), and mean total keratometry (R = 0.08, p < .01). Whereas there was a significant negative correlation with white-to-white (R = −0.04, p = .03), axial length (R = −0.19, p < .01), and anterior chamber depth (R = −0.2, p < .01). Male gender (R = −0.04, p = .05) and central corneal thickness (R = 0.04, p = .06) were not significantly correlated. Multivariate stepwise backward regression analysis showed a combination of four factors (female sex, reduced axial length and anterior chamber depth and steep mean keratometry) significantly related to chord mu (angle kappa). Conclusion Female gender, reduced axial length and anterior chamber depth, and higher mean keratometry correlate to apparent chord mu (angle kappa) in cataract patients. These findings can help identify vulnerable patients who can have appropriate counseling on the prognosis of postoperative optical and visual outcomes.

Third-Generation Trabecular Micro-Bypass Implantation with Phacoemulsification for Glaucoma.

This retrospective, consecutive, real-world case series assessed the efficacy and safety of third-generation trabecular micro-bypass stent implantation (iStent infinite) with phacoemulsification in patients with mild-to-moderate primary open-angle glaucoma (POAG). Patients underwent phacoemulsification combined with implantation of iStent infinite (containing three stents) by a single U.S. glaucoma surgeon. Outcomes through 12months included mean intraocular pressure (IOP) and medications; proportions of eyes with IOP ≤ 18mmHg, ≤ 15mmHg, or ≤ 12mmHg; proportions of eyes on 0, 1, 2, or ≥ 3 topical glaucoma medications; adverse events; and secondary glaucoma procedures. Data are presented for the observed cohort of all available eyes at each time point and the consistent cohort of eyes with data at 12months postoperative. A total of 121 eyes with mild (66.1%) or moderate (33.9%) POAG underwent iStent infinite implantation between February 2023 and June 2024. In eyes with 12-month follow-up data (n = 32), mean IOP reduced from 18.1 ± 3.3mmHg preoperatively to 13.8 ± 3.4mmHg at 12months (23.8% reduction, p < 0.001), while mean number of medications reduced from 1.38 ± 0.91 to 1.06 ± 1.13 medications (23.2% reduction, p = 0.023). The proportions of eyes achieving IOP ≤ 18/15/12mmHg increased from 53.1%/21.9%/3.1% preoperatively to 87.5%/75.0%/43.8% at 12months, respectively (all p < 0.01). Adverse events were largely mild and transient; three eyes (< 3%) had secondary laser or micro-invasive glaucoma interventions due to IOP and/or medications above goal. iStent infinite implantation with cataract surgery resulted in clinically and statistically significant IOP and medication reductions through 12months postoperative, with favorable safety. This cohort constitutes one of the first and largest published datasets for this device in combination with cataract surgery in real-world usage.

FABP5 regulates ROS-NLRP3 inflammasome in glutamate-induced retinal excitotoxic glaucomatous model.

Fatty acid binding proteins (FABPs) are a class of small molecular mass intracellular lipid chaperone proteins that bind to hydrophobic ligands, such as long-chain fatty acids. FABP5 expression was significantly upregulated in the N-methyl-d-aspartic acid (NMDA) model, the microbead-induced chronic glaucoma model, and the DBA/2J mice. Previous studies have demonstrated that FABP5 can mediate mitochondrial dysfunction and oxidative stress in ischemic neurons, but the role of FABP5 in oxidative stress and cell death in retina NMDA injury models is unclear. In this study, we found that FABP5 is significantly altered in a model of glutamate excitotoxicity and is regulated by Stat3. Inhibition of FABP5 alleviated oxidative stress imbalance and activation of NLRP3 inflammasome, reduced the release of inflammatory factors, and ultimately attenuated glutamate excitotoxicity-induced retinal ganglion cell loss. Meanwhile, caspase1 inhibitors could alleviate the retinal ganglion cell loss induced by glutamate excitotoxicity. In conclusion, FABP5 inhibition protects retina ganglion cells from excitotoxic damage by suppressing the ROS-NLRP3 inflammasome pathway. FABP5 maybe a promising new target for glaucoma diagnosis and treatment.

Nationwide cohort study of primary open angle glaucoma risk and cardiovascular factors among in Korean glaucoma suspects

This retrospective study investigated the risk of primary open-angle glaucoma (POAG) among individuals identified as glaucoma suspects and examined associated cardiovascular risk factors. We conducted a longitudinal, nationwide cohort study using data from the Korean National Health Insurance Service (KNHIS) and included 362,285 participants aged ≥ 40 years from the Korean National Health Screening Program (NHSP) without pre-existing POAG in 2009 and 2010. Of these, glaucoma suspects (n = 32,220) were defined as individuals with at least two recorded instances of the KCD code H400 for glaucoma suspect and no prior antiglaucoma medication prescriptions before health screening. The primary outcome was the diagnosis of POAG and the prescription of antiglaucoma medications. Over a 6-year follow-up, 4.92% of glaucoma suspects developed POAG. Through multivariate Cox regression analysis, glaucoma suspects with diabetes, hypertension, dyslipidemia, or coronary heart disease exhibited a greater risk of conversion to POAG than those without these comorbidities ([HR, 1.354; 95%CI, 1.201 to 1.527] for diabetes, [HR, 1.139; 95%CI, 1.019 to 1.273] for systemic hypertension, [HR, 1.128; 95%CI, 1.013 to 1.26] for dyslipidemia, [HR, 1.124, 95%CI, 1.007 to 1.254] for coronary heart disease).This nationwide study observed that among glaucoma suspects, having cardiovascular risk factors/disease was associated with higher risk of developing POAG.

Refractive Changes and Corneal Thickness in Healthy Mountaineers at High Altitude: The Korzhenevskoi Experience (7105 m).

The purpose of this study was to investigate the effect of hypoxia and hypobaric conditions on refraction and central corneal thickness on healthy corneas during an ascent without oxygen supplementation above 7000 m (23 000 ft). Twelve multinational mountaineers were included in a prospective observational cohort study during an expedition to the Korzhenevskoi Peak (7105 m). The two patients excluded from the study had a history with keratoconus or were current wearers of rigid contact lenses. None had a history of refractive surgery or ocular disease. The central corneal thickness (CCT), the oxygen saturation, and the refraction have been recorded for each patient using portable equipment. The highest measurement has been taken at 6356 m of altitude which is the highest ophthalmologic measurement ever done. Longitudinal analysis revealed a significant increase of CCT during altitude exposure (CCTbaseline = 542± 36 μm; CCTC3 = 633 ± 30 μm) due to stromal edema reversible upon descent. The amount of decrease in oxygen saturation paralleled the increase in CCT. The refraction measurements showed a myopic shift (-1.14D) with the altitude (RBaseline = -0.41 ±2.25D; RC3 = -1.55 ± 2.41D P < 0.05). Significant stromal edema was found during exposure to high altitude in healthy mountaineers. This is due to hypoxia and decreased atmospheric pressure leading to a deficiency of adenosine triphosphate. A significant and clinically relevant myopic shift, due to the stroma edema, appears above 6500 m which can explained the blurry far vision in high altitude for mountaineers without oxygen supplementation.

In vivo imaging of mitochondrial function in normal, glaucoma suspect, and glaucoma eyes.

To investigate macula and optic nerve head (ONH) mitochondrial metabolic activity using flavoprotein fluorescence (FPF) in normal, glaucoma suspect (GS), and open-angle glaucoma (OAG) eyes we performed a cross-sectional, observational study of FPF in normal, GS, and OAG eyes. The macula and ONH of each eye was scanned and analyzed with a commercially available FPF measuring device (OcuMet Beacon, OcuSciences Inc., Ann Arbor, MI). One-way analysis of variance was used to compare macula and ONH FPF scores between groups. Linear regression models investigated the correlation between FPF scores and structural and functional parameters. We included 25 normal, 16 GS, and 54 OAG eyes. The average age in years ± SD for normal, GS, and OAG groups was 60.6 ±17.4, 67.8 ± 10.3, and 67.9 ± 11.6, respectively (P = 0.064). There was no significant difference in gender, race/ethnicity, visual acuity, and intraocular pressure between groups. OAG eyes had larger cup-to-disc ratio, thinner retinal nerve fiber and macula thicknesses, and worse visual field indices compared to normal and GS eyes (P ≤ 0.018). There was no significant difference in any FPF metric between the study groups in either the macula or the ONH, despite normalizing FPF data for structural differences between groups (e.g. retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness). In conclusion, no significant differences in metabolic activity as measured by FPF were found in macula and ONH FPF scores using the integrated clinician report generator between normal, GS, and OAG eyes. Further research is needed to evaluate the role of mitochondrial metabolic activity measurements in glaucoma.

In Vivo Confocal Microscopy Findings in Corneal Stromal Dystrophies

Background/Objectives: In this study, we aim to evaluate in vivo confocal microscopy (IVCM) findings of corneal stromal dystrophies (CSDs) including granular, macular and lattice corneal dystrophy that can be used for differential diagnosis and monitoring recurrences after surgical interventions. Methods: Patients diagnosed with CSD who were followed-up in the cornea and ocular surface unit were included in this study. IVCM was performed using the Heidelberg Retina Tomograph 3, Rostock Cornea Module (Heidelberg Engineering, Germany) and anterior segment optical coherence tomography (AS-OCT) imaging was performed using the Spectralis OCT (Heidelberg Engineering, Germany). The morphological structure, size and location of deposits, epithelial involvement and presence of inflammatory and dentritic cells were compared among the three stromal dystrophies. Results: A total of 72 eyes from 36 participants were included in this study. Twelve patients (33.33%) had granular corneal dystrophy (GCD), ten (27.77%) had macular corneal dystrophy (MCD) and fourteen (38.88%) had lattice corneal dystrophy (LCD). In GCD, highly reflective deposits varying in size (20 µm–300 µm) were observed. In MCD, diffuse hyperreflective stroma with dark striae, dentritic cells around deposits and abnormal keratocytes were observed. In LCD, there were branching, lattice-like and granular deposits with epithelial cell disruption in some of the eyes. In MCD, the central corneal thickness was thinner (449.44 ± 65.45 µm) compared to GCD and LCD (565.16 ± 49.62 µm and 569.91 ± 39.32 µm p &lt; 0.001). Recurrence was observed in five patients following penetrating keratoplasty. Conclusions: IVCM is a valuable tool for distinguishing CSD subtypes and monitoring recurrence following surgical interventions.

Longitudinal corneal hysteresis changes predict structural progression in medically controlled, early-to-moderate, open-angle glaucoma with a history of refractive surgery

BackgroundThe present study aims to identify the relationship between longitudinal changes in corneal hysteresis (CH) and progressive retinal nerve fibre layer (RNFL) thinning in a cohort of medically controlled, early-to-moderate...

4.5-Year Follow-up with a Novel Corneal Endothelial Prosthesis.

Refractory corneal edema is the foremost reason for endothelial corneal transplantation (EK) in the world. Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) offer good clinical outcomes. However, human donor tissue is limited in availability and has a complex logistical chain. Many patients in need do not have access to EK. Success of the human donor tissue depends on its quality, the number of rebubbles, repeat keratoplasties, and patient-related risk factors. The use of an endothelial corneal keratoprosthesis could benefit patients with a high risk for graft failure and human graft rejection, and patients in underserved areas where tissue banking is unavailable. Case cohort series of 10 eyes of 10 patients implanted with the EndoArt, with a follow-up of up to 4.5 years. Outcome measures are device adherence, central corneal thickness, visual acuity, and incidence of adverse events. In the first seven eyes, the EndoArt was implanted in eyes with low visual potential within the first-in-human (FIH) trial, and in the three remaining eyes, implantation was performed because of either guarded posterior or anterior segment prognosis or the patient's wishes. In 9/10 eyes, device adherence was obtained and maintained throughout the follow-up period. Mean corneal thickness decreased from 927 + SD 241 microns to 621 + SD 140 microns. In 6/10 eyes, visual acuity improved from a mean preoperative value of logMAR 1.94 + 0.63 to a mean postoperative value of logMAR 0.8 + 0.64. No pathological thinning or corneal metabolic changes were seen. The surgical technique was developed during the follow-up period. The EndoArt provided a stable decrease in central corneal thickness, improved vision in 60% of eyes, and had no device-related adverse events. The EndoArt is an additional treatment modality for special cases like repeat corneal graft failure in the population of the Western world, or as a primary procedure in underserved areas worldwide.

Impact of orthokeratology and low-dose atropine on corneal biomechanics and myopia progression in children.

This study evaluated the effects of orthokeratology and 0.01% atropine on corneal biomechanical properties (CBPs) and myopia progression in children, focusing on their association with axial length (AL) changes and treatment outcomes. In this 1-year prospective study, 53 children (aged 8-17 years) were enrolled, with 30 undergoing orthokeratology and 23 receiving 0.01% atropine. CBP parameters, including the Corvis Biomechanical Index (CBI), central corneal thickness (CCT), biomechanically corrected intraocular pressure (bIOP) and stress-strain index (SSI), were assessed at baseline and during follow-ups at 1, 3, 6, 9 and 12 months. The orthokeratology group was further stratified into good and poor responders based on early myopia reduction. The orthokeratology group exhibited a significant increase in CBI over time, particularly among good responders, while CCT, bIOP and SSI remained stable. In contrast, no significant changes in CBPs were observed in the atropine group. AL elongation showed no significant correlation with CBP changes in either group. The orthokeratology group achieved superior control of myopia progression compared to the atropine group at 12 months, with poor responders exhibiting better long-term AL control. Both orthokeratology and 0.01% atropine were effective in controlling myopia. While atropine had no impact on CBPs, the increase in CBI with orthokeratology may predict early treatment outcomes. However, the initial response to orthokeratology did not guarantee long-term effectiveness, highlighting the need for individualised treatment monitoring.

Bisphosphonates increase risk of acute angle closure glaucoma

Bisphosphonates increase risk of acute angle closure glaucoma

Xen 63 versus Preserflo MicroShunt implant in patients with primary open-angle glaucoma

This study compared the efficacy safety profiles of the Xen 63 and Preserflo MicroShunt devices, both standalone, in patients with primary open-angle glaucoma (POAG). It is a retrospective and single-center study conducted on consecutive on patients with medically uncontrolled POAG who underwent either a standalone Xen 63 or a standalone Preserflo and had a 12-month follow-up visit. The primary outcome was the mean IOP at month-12. Sixty eyes were included, 30 eyes in each Xen 63 and Preserflo groups, respectively. Preoperative IOP was significantly lowered from 20.8 ± 3.6 mmHg and 19.1 ± 3.8 mmHg to 14.2 ± 4.5 mmHg and 12.8 ± 2.3 mmHg in the Xen 63 and Preserflo groups, respectively (p < 0.0001 each, respectively); without significant differences between groups (p = 0.1346). Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.6 to 0.2 ± 06 drugs and from 2.3 ± 0.7 to 0.3 ± 0.6 drugs, in the Xen 63 and Preserflo groups, respectively (p < 0.0001 each, respectively); without significant differences between groups (p = 0.5212). Regarding safety, one (3.3%) eye in the Preserflo group required a device removal due to maculopathy. Three (10.0%) eyes in the Xen 63 group underwent needling. In conclusion, both the Xen 63 and the Preserflo devices effectively and safely reduced IOP and the requirement for IOP-lowering medications, exhibiting comparable IOP levels after 12 months.

The Effect of Blood Pressure on Rates of Progression in Focal Ischemic versus Generalized Cup Enlargement Glaucoma Phenotypes.

To investigate the impact of blood pressure (BP) on rates of retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes with focal ischemic (FI) versus generalized enlargement (GE) optic disc phenotypes. Prospective cohort study. The study included 122 eyes from 101 patients diagnosed with primary open-angle glaucoma. Eyes were classified as FI (n=31, 25%) or GE (n=91, 75%) based on masked grading of stereophotographs at baseline. Subjects underwent comprehensive ophthalmic examinations, including intraocular pressure (IOP) measurement and spectral-domain optical coherence tomography (SD-OCT) scans, every 6 months for an overall mean follow-up of 4.2 years ± 1.5 years. Brachial artery BP was measured concurrently, and mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) were calculated. Rates of global RNFL thickness change over time were assessed using linear mixed models, evaluating the impact of BP parameters in each optic disc phenotype, adjusting for IOP and other confounders. Interaction terms were used to test for differences in the effects of BP and IOP between the FI and GE phenotypes. Effect of MAP, SAP and DAP on rates of RNFL loss over time in FI and GE optic disc phenotypes. In the adjusted FI group models, each 10-mmHg decrease in MAP, SAP, and DAP was associated with -0.397 μm/year (p=0.006), -0.211 μm/year (p=0.029), and -0.471 μm/year (p=0.005) faster RNFL thinning, respectively. In contrast, BP parameters were not significantly associated with RNFL loss in the GE group. In the multivariable model with interaction terms, the interaction between DAP and phenotype was statistically significant (p=0.019), indicating the FI phenotype exhibited greater sensitivity to lower diastolic pressure compared to GE eyes. In contrast, interaction terms between IOP and optic disc phenotype were not significant in any of the models, suggesting a similar effect of IOP in both phenotypes. Lower systemic BP levels were associated with faster RNFL thinning in the FI optic disc phenotype, but not in the GE phenotype. These findings highlight the importance of considering both IOP and systemic BP when managing patients with the FI optic disc phenotype.