Decrease In Intraocular Pressure Research Articles

Outcomes of Phacoemulsification With or Without Kahook Dual Blade Goniotomy for Glaucoma Patients with Cataract.

This meta-analysis examines the comparative efficacy of phacoemulsification with and without Kahook Dual Blade Goniotomy in individuals with glaucoma and cataract, aiming to elucidate optimal surgical approaches for coexisting conditions. The purpose of this current study is to compare the effect of combining Kahook Dual Blade (KDB) goniotomy with phacoemulsification versus phacoemulsification alone on intraocular pressure (IOP) and medication reduction in patients with glaucoma and cataract. We conducted a systematic review and meta-analysis utilizing computer databases, including Embase (OVID), MEDLINE (OVID and PubMed), CINHAL (EBSCO), and the Cochrane Library (Wiley). We included studies examining the IOP-lowering effect of KDB goniotomy combined with phacoemulsification and studies that examined the IOP-lowering effect of phacoemulsification alone in patients with open angle glaucoma or ocular hypertension. The mean reduction of IOP and the reduction in topical glaucoma eye drops after surgery were determined. A total of 26 studies were included reporting on 1659 patients, 684 patients underwent phacoemulsification alone and 975 underwent combined phacoemulsification and KDB goniotomy. A 9.62% IOP reduction from baseline occurred following phacoemulsification as a solo procedure compared to 22.74% following combined KDB goniotomy with phacoemulsification. Similarly, the combination of the procedures caused a significant drop in the mean number of glaucoma eye drops used (mean reduction=1.35, 95% CI [1.08, 1.61]) compared to phacoemulsification alone (mean reduction=0.36, 95% CI [0.06, 0.66]). Funnel plots suggested the absence of publication bias. Both phacoemulsification alone or combined with KDB goniotomy result in a significant decrease in post-op IOP and topical glaucoma eye drops. The combination of these two procedures outperforms phacoemulsification alone in terms of both parameters.

[Comparison of surgical outcomes between Kahook Dual Blade goniotomy and Trabectome surgery in patients with open-angle glaucoma].

Objective: To compare the medium-term therapeutic effects of Kahook Dual Blade (KDB) goniotomy and Trabectome surgery in the treatment of patients with primary open-angle glaucoma (POAG). Methods: This study was a non-randomized prospective interventional controlled clinical study. POAG patients who underwent KDB goniotomy or Trabectome surgery at Beijing Tongren Hospital from May 2017 to April 2022 were enrolled. The definition of successful surgery was postoperative average intraocular pressure (IOP)≤21 mmHg (1 mmHg=0.133 kPa) and IOP decrease≥20%. Follow-up visits were conducted on the 1st day, 1st week, 1st, 3rd and 6th month after surgery. The IOP value, the number of IOP-lowering medications, the proportion of surgical success (average IOP≤21 mmHg at 6 months), and complications were evaluated. Statistical methods included independent sample t-test, Mann-Whitney rank sum test, χ2 test, repeated measures two-factor analysis of variance, Bonferroni, Friedman M test, Wilcoxon, and Log-rank. The Kaplan-Meier method was used to calculate the cumulative success rate of each group. Results: Seventeen male patients (17 eyes) and 10 female patients (10 eyes) were included. The mean age was (39.9±17.7) years old. There were 11 patients in the KDB group and 16 patients in the Trabectome group. There was no significant difference in clinical baseline conditions between the two groups (P>0.05). The IOPs in the KDB and Trabectome groups at postoperative 1 week [(16.6±6.3) and (16.4±4.1) mmHg) and 6 months [(17.8±5.3) and (19.9±4.4) mmHg) were lower than those before surgery [(25.1±9.3) and (27.4±9.1) mmHg) (all P<0.05). There was no significant difference in the overall IOP between groups (P>0.05). The IOP reduction rates in the KDB and Trabectome groups were 23.4% and 19.0%, with no significant difference (P=0.674). The numbers of IOP-lowering medications used in the KDB and Trabectome groups at 3 months [2.0 (1.0, 4.0) and 2.0 (1.0, 2.3)] and 6 months [2.0 (0.0, 4.0) and 2.0 (1.0, 3.0)] after surgery were not significantly different from those before surgery [4.0 (2.0, 4.0) and 3.0 (2.0, 4.0)] (both P>0.05). There was no statistical significance in the overall number of IOP-lowering medications used between the two groups (P>0.05). There was also no statistically significant difference in the proportion of patients with an IOP decrease of≥20% and the proportion of patients whose mean postoperative IOP was≤21 mmHg (all P>0.05). The proportions of IOP≤21 mmHg in the KDB group and the Trabectome group at 6 months after surgery were 81.8% and 68.8% (P>0.05). Serious intraoperative or postoperative complications occurred in neither group. Conclusions: Both KDB trabeculotomy and Trabectome surgery can effectively reduce IOP and have a good safety profile in treating POAG, with the same number of IOP-lowering medications.

No Changes in Keratometry Readings and Anterior Chamber Depth after XEN Gel Implantation in Patients with Glaucoma.

Background: This study aimed to compare keratometry and anterior chamber depth (ACD) changes after XEN implantation in primary open-angle glaucoma (POAG) cases over a 3-month follow-up period. Methods: Twenty patients with POAG who underwent XEN63 implantation, either standalone or combined with cataract surgery, were included. Preoperative data, including best-corrected visual acuity (BCVA), refraction, gonioscopy, ophthalmoscopy, intraocular pressure (IOP) evaluation, and axial length, were collected. Corneal topography and ACD measurements were assessed preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Each patient's eye that underwent XEN surgery was included in the study group, with the fellow eye serving as a control. Results: In the study group, there was a significant decrease in IOP after XEN stent implantation at all investigated time intervals (p < 0.05). However, changes in mean ACD did not show statistically significant differences at any follow-up examination in both the study and control groups. Additionally, keratometry readings revealed no significant changes in total astigmatism or steep keratometry values in either group. Conclusions: XEN implantation in POAG cases resulted in a significant decrease in IOP over the 3-month follow-up period. However, there were no significant changes observed in mean ACD or keratometry readings, indicating stability in these parameters post-XEN implantation. These findings suggest that XEN implantation may be an effective option for IOP reduction without affecting corneal curvature or ACD in POAG patients.

Selective laser trabeculoplasty in the treatment of juvenile open angle glaucoma patients under 25years of age.

To retrospectively evaluate the effectiveness and reliability of selective laser trabeculoplasty (SLT) treatment in juvenile open angle glaucoma (JOAG) cases. The 46 eyes of 28 cases that had undergone SLT for JOAG and had a follow-up of at least one month were included in the study. The pre-SLT, month 1, month 6, year 1, year 2, and final follow-up intraocular pressure (IOP); the number of drugs before and after the SLT procedure; and the complications caused by the SLT were recorded. An IOP below 21mmHg without any additional medication or glaucoma surgery and an IOP decrease of 20% or more compared to the baseline were considered successful. There were 18 females and 10 males with a mean age of 17.52 ± 2.7 (13-22) years. The cases were followed-up for a mean duration of 39 (5-59) months. The mean IOP was 23.93 ± 0.52mmHg before SLT and decreased to 17.15 ± 0.57mmHg at month 1 after the procedure, 17.17 ± 0.52mmHg at month 6, 18.02 ± 0.77mmHg at year 1, 18.12 ± 0.48mmHg at year 2, and 20.93 ± 0.69mmHg at the final follow-up. The post-SLT IOP measurements at all times were found to be significantly lower than the pre-SLT values (p < 0.001). The mean number of drugs was 1.5 before the SLT and 0.59 afterwards (p < 0.001). The most common complications after SLT were anterior chamber inflammation in 29 cases (63.04%), hyperemia in 20 (43.40%) cases (4.34%), an early period IOP increase of 5mmHg or more in 11 cases (23.91%), and mild ocular pain in 2 cases (4.34%). SLT is an effective and reliable method for JOAG treatment.

The Efficacy of Phacotrabeculectomy in Reducing Intraocular Pressure

Background: Primary open angle glaucoma and age related cataract are ocular comorbidities which can occur in some individuals at different times. Phacoemulsification is carried out for restoration of vision decreased by cataract while trabeculectomy is a procedure to decrease the intra ocular pressure. To save the time, money and stay in the hospital, phacotrabeculectomy is a single procedure which can fulfill both the restoration of vision and decrease intraocular pressure. Objectives: To determine the efficacy of phacotrabeculectomy in decreasing the intraocular pressure in patients having both primary open angle glaucoma and age related cataract.Materials and Methods: This study was conducted at the Eye department, Hayatabad Medical Complex, Peshawar, from 1st August, 2022 to 1st February 2023 after getting the permission from Ethical Committee to do this study. Patients both males and females, from 40-80 years of age, who had coexisting age related cataract (ARC) and Primary open angle glaucoma (POAG), whose intraocular pressures (IOP) was 21mm Hg or above, with and without using anti-glaucoma treatment.Patients who had secondary or rosette shaped cataract, past ocular trauma (including ocular surgery along with its intraoperative or post-operative complications) and trauma after phacotrabeculectomy procedure during the follow up period were excluded from this study.Results: All 121 patients underwent Phacotrabeculectomy. Follow up was done for 5 months. Preoperative mean intraocular pressure (IOP) was 23.53 ± 4.22SD which reduced to 12.90 ± 2.09SD postoperatively which was highly significant with p- value=0.001Conclusion: Phacotrabeculectomy reduced Intraocular pressure by &gt;10 mm Hg in our study which showed that this procedure is very effective in coexisting age related cataract and primary open angle glaucoma.Keywords: Age related cataract, Angle closure glaucoma, Combined phaco-trabeculectomy, Glaucoma, Intraocular pressure, Open angle glaucoma, Trabeculectomy.

Understanding the treatment paradigm and the sequencing of antiglaucoma fixed-dose combinations in a tertiary center in South India.

To analyze the medical management of primary open-angle glaucoma (POAG) and ocular hypertension (OHT) and the placement of fixed-drug combination drugs (FDC) in the treatment paradigm at a tertiary eye care center in South India. Retrospective study (January 2011-December 2015) of newly diagnosed POAG and OHT patients (≥18 years) with ≥5 years follow-up. Primary outcome included percentage use of different antiglaucoma drugs (at initiation) and FDCs at the first, second, and third progression (sequencing). Secondary outcomes: Percentage discontinuation for different FDCs, efficacy parameters (decrease in intraocular pressure (IOP)/visual field), adverse events, and the median number of antiglaucoma medications (AGMs) after 5 years. Three hundred and seventy eyes (198 patients) were analyzed; 84% of them had POAG. Prostaglandin analogs (PGAs) were the most common (66.2%). FDCs were started in 48 eyes (12.9%), with brimonidine + timolol combination being the most common. FDC usage at subsequent modifications was 10.1%, 24.04%, and 30.0%. Beta-blockers and PGAs were the most frequently prescribed AGMs in our practice pattern, with b-blockers being the most consistent one. This study is a fairly large study with a minimum of a 5-year follow-up of patients with POAG and OHT and gives insights into the treatment patterns, use of FDCs, and the need for multiple medications over time.

Effect of treatment with carteolol and latanoprost in newly diagnosed primary open-angle glaucoma on peripapillary vessel density.

In a previous follow-up of glaucoma patients taking carteolol or latanoprost, we found a greater progression of visual field changes with the prostaglandin than the betablocker. In the present study we compared the impact of carteolol and latanoprost on peripapillary vessel density in newly diagnosed primary open-angle glaucoma (POAG) patients. The study consisted of two groups of POAG patients. There were 46 patient eyes treated with carteolol (Carteol LP 2%) in the first group and 52 eyes treated with latanoprost (Xalatan 0.005%) in the second. Intraocular pressure (IOP), vessel density (VD) and visual field were assessed in all patients. VD was measured peripapillary by optical coherence tomography angiography (OCTA) with the Avanti RTVue XR in eight segments: Inferior Temporal - IT (1); Temporal Inferior -TI (2); Temporal Superior - TS (3); Superior Temporal - ST (4); Superior Nasal - SN (5); Nasal Superior - NS (6); Nasal Inferior - NI (7) and Inferior Nasal - IN (8). The measurements were compared before and after three months of treatment. The visual field was examined with a fast threshold glaucoma program using a Medmont M 700 instrument from Medmont International Pty Ltd. and only when a diagnosis of POAG was done. The overall defect (OD) was assessed. Before treatment, there was no difference between groups in either OD or VD. After treatment, there was a decrease in IOP in both groups. In the carteolol-treated group, the mean decrease was 5.8 mmHg and in the latanoprost-treated eyes, the mean decrease was 7 mmHg. The difference was not statistically significant (P=0.133). After treatment with carteolol, there was a statistically significant increase in VD in segments 4, 5 and 6. After latanoprost treatment, VD was statistically significantly improved only in segment 5. A greater increase in VD values was found in eyes treated with carteolol than in eyes treated with latanoprost. Carteolol had a better effect on vessel density than latanoprost.

Профилактика роговичных осложнений послеоперационного адъювантного применения антиметаболитов после непроникающей глубокой склерэктомии

Original article Prevention of corneal complications after post-operative application of antimetabolites following nonpenetrating deep sclerectomy S.N. Svetozarskii, A.N. Andreev, A.V. Shvaikin, S.V. Scherbakova, I.G. Smetankin Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation Privolzhsky Research Medical University under the Ministr y of Health of Russia, Nizhny Novgorod, Russian Federation Purpose. To evaluate the clinical and functional effectiveness of the developed method for prevention of corneal complications of nonpenetrating deep sclerectomy (NPDS) with postoperative adjuvant use of 5-fluorouracil in comparison with the control group. Material and methods. Retrospective comparative study in 2 groups included patients with open angle glaucoma who were initially underwent NPDS and received at least 1 subconjunctival injection of 5-fluorouracil in the postoperative period. 1st group included 101 patients (101 eyes) who underwent subconjunctival injection of 5-fluorouracil after surgery using standard technique, 2nd group included 176 patients (176 eyes) who underwent subconjunctival injection of 5-fluorouracil with prophylaxis of corneal complications. Best corrected visual acuity (BCVA), intraocular pressure (IOP), frequency of corneal complications and number of visits to the doctor during the first 4 weeks after surgery were analyzed as criteria of efficacy and safety. Results. Comparison groups did not differ in demographic characteristics and preoperative BCVA and IOP parameters. Fluorescein stained corneal epithelium defects were statistically significantly more frequently observed in 1st group (38.6%) in comparison with 2nd group (7.4%) (p&lt;0.001). Four weeks after NPDS, IOP decrease was 25.5% in 1st group and 31.5% in 2nd group (p=0.042). Mean BCVA loss was 1.9 lines in 1st group and 1.3 lines in 2nd group (p&lt;0.001). The number of follow-up visits during the first month after surgery was 0.6 less in 2nd group than in 1st group (p=0.002). Conclusion. Prevention of corneal complications simply and effectively reduces the risk of corneal epithelial defects after subconjunctival injection of 5-fluorouracil as well as markedly improves the clinical and functional results of NPDS and reduces the need for outpatient visits. Key words: antimetabolites, open-angle glaucoma, corneal erosion, toxicity, prevention of complications

Gonioscopy-assisted Transluminal Trabeculotomy in Uveitis-related Ocular Hypertension and Glaucoma.

Gonioscopy-assisted Transluminal Trabeculotomy may be an effective first line surgery for decreasing intraocular pressure and medication burden in patients with uveitis-related ocular hypertension or glaucoma. The purpose of the study is to determine the efficacy of Gonioscopy-assisted transluminal trabeculotomy (GATT) to lower the intraocular pressure (IOP) in uveitis-related ocular hypertension (OHT) or glaucoma. Retrospective case series that included patients with uveitis-related OHT or glaucoma that underwent GATT with or without concomitant cataract extraction and intraocular lens implantation at two Canadian academic centres from July 2018 to May 2022. Primary outcomes were : complete (no medications) and qualified success (with medication), and failure defined as (1) IOP > 21mmHg with maximal medical therapy, (2) the need of additional glaucoma procedure, (3) loss of light perception secondary to glaucoma, (4) IOP < 6mmHg for 3 months. Twenty-one eyes from 18 patients were included with a mean preoperative IOP of 26.2±7.3mmHg on 4.3±0.7 classes of glaucoma drops. Average follow-up was 29.2±17.6 months and 76% of eyes (n=16) had reached at least 12 months of follow-up. At the 12 month follow-up visit, there was a significant decrease in average IOP by 9.9±7.9mmHg (38%, P=0.005) and a decrease of 1.9 in glaucoma medication classes (P=0.002). Fourteen percent of eyes achieved complete success while 80% of eyes achieved qualified success. Six eyes failed (29%) and five patients (24%) required an additional glaucoma surgery. The most common postoperative complication was hyphema (n=9; 43%). This small case series suggests that GATT may be an effective first line surgery for decreasing IOP and medication burden in patients with uveitis-related OHT or glaucoma. Further studies with longer follow-up should be conducted to assess its long-term outcomes.

Real-World Analysis of the Efficacy of Bimatoprost Sustained-Release Glaucoma Implant Where American Indians Comprise the Largest Minority Population.

To assess the effectiveness and safety of bimatoprost sustained release (SR) glaucoma implant as a treatment for open-angle glaucoma and ocular hypertension in a real-world private practice setting with a significant American Indian population. This retrospective study included 156 eyes from adult patients who received a single injection of bimatoprost implant between June 2020 and May 2022 at the Oklahoma Eye Surgeons. Patients were stratified by baseline intraocular pressure (IOP) (≥21 mmHg versus IOP<21 mmHg). The co-primary endpoints were changes in the mean IOP and the number of topical IOP-lowering medications from baseline to Month 6. At 6 months, eyes with baseline IOP≥21 mmHg had a significantly lower mean IOP (19.85±8.01 versus 26.25±4.84 mmHg; p<0.0001) and the mean number of IOP-lowering medications (1.04±1.44 versus 1.38±1.50; p=0.048) compared with baseline. One year after implantation, 73.58% of eyes had a ≥20% reduction in IOP, 41.51% were medication-free and 30.19% were receiving at least one fewer medication. Among eyes with baseline IOP<21 mmHg, there was a significant reduction in the mean number of IOP-lowering medicines by Month 6 (0.61±1.03 versus 1.93±1.21 at baseline; p<0.0001), with no change in IOP. At 12 months, 24.27% of eyes had a ≥20% decrease in IOP, 43.69% of eyes did not require any medications and 63.11% had at least one fewer medication compared with baseline. An analysis using Welch's two-sample t-test showed no significant differences in the outcomes between the overall population and the American Indian population (number of eyes, 23). Bimatoprost SR glaucoma implant lowered IOP in eyes with high, uncontrolled baseline IOP, while it reduced the number of medications in eyes with a controlled baseline IOP. No clinically meaningful and statistically significant differences in the efficacy of bimatoprost were observed in patients of American Indian descent.

Comparative efficacy and safety of different anti-VEGF agents combined with different delivery methods for neovascular glaucoma: a systematic review and Bayesian network meta-analysis

ObjectiveTo compare the efficacy and safety of different anti-vascular endothelial growth factor (VEGF) agents combined with different delivery methods for neovascular glaucoma (NVG).DesignSystematic review and Bayesian network meta-analysis (NMA).Data sourcesPubMed,...

Longitudinal Rates of Change in Structural Parameters of Optical Coherence Tomography in Primary Angle Closure Glaucoma following Laser Iridotomy along with Peripheral Iridoplasty.

This study aimed to investigate longitudinal rates of change (LRCs) of structural parameters from optical coherence tomography (OCT) in patients with primary angle closure glaucoma (PACG) after laser iridotomy (LI) along with laser peripheral iridoplasty (PI). Among 146 patients diagnosed with PACG, thirty-two subjects (32 eyes) who underwent LI plus PI and accomplished more than five times of reliable OCT tests were included in the current retrospective study. Retinal nerve fiber layer (RNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured by spectral-domain OCT with three month interval. LRCs of global and six Garway-Heath sectors were investigated using the linear mixed-effects model which adjusted BMO area, sex, and age. Imaging of dual Scheimpflug analyzer was performed before and at 1 week after LI with PI and yearly thereafter. The mean follow-up period was 32.28 ± 13.34 months with a mean number of 10.18 ± 3.33 OCT images. Baseline characteristics are as follows: age, 63 ± 7.9 years; female, 62.5%; intraocular pressure(IOP), 15.48 ± 4.79 mmHg; anterior chamber depth, 2.09 ± 0.18 mm; and mean deviation, -7.97 ± 8.48 dB. Global LRC of BMO-MRW was 0.86 ± 1.34 μm/yr and RNFL was -0.64 ± 0.22 μm/yr. IOP decreased significantly to 13.06 ± 2.21 mmHg (p=0.001) while anterior chamber volume (p=0.011) and mean anterior chamber angle (p=0.022) increased significantly after LI along with PI compared to the baseline at the final visit. LRC of a new parameter, BMO-MRW, and LRC of RNFL were relatively low in patients with PACG, following LI along with PI. After widening of the anterior chamber angle and decrease of IOP due to LI plus PI, PACG might show stable structural prognosis assessed by OCT.

The Effects of Lens Extraction Surgery on Intraocular Pressure and Anterior Segment Parameters in Primary Angle-Closure Glaucoma.

To investigate the effects of phacoemulsification with intraocular lens implantation (phaco+IOL) surgery on intraocular pressure (IOP) and anterior segment parameters in patients with cataract and primary angle-closure glaucoma (PACG). Fifty-five patients with PACG undergoing phaco+IOL surgery were evaluated in terms of best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), aqueous depth (AD), and lens thickness (LT) measured by optical biometry preoperatively and at the 6-month postoperative visit. They were compared with 34 healthy age-and gender-matched cataract patients who underwent phaco+IOL surgery. Preoperative evaluation revealed higher IOP, shorter axial length, shallower ACD and AD, and greater LT in the PACG group (p<0.001 for all). Postoperative evaluation in the PACG group showed an increase in BCVA, a significant decrease in IOP, an increase in ACD and AD, and a decrease in LT (p<0.001 for all). Additionally, a reduction in the average number of antiglaucomatous medications used postoperatively was observed in the PACG group (p<0.001). The changes in IOP, ACD, AD, and LT between preoperative and postoperative assessments were significantly greater in the PACG group compared to the control group (p<0.0001 for all). Phaco+IOL surgery in PACG patients leads to a significant increase in ACD compared to the control group and allows better control of IOP with fewer antiglaucomatous medications after surgery.

Influence of the calcium voltage-gated channel auxiliary subunit (CACNA2D1) absence on intraocular pressure in mice

The etiology of elevated intraocular pressure (IOP), a major risk factor for glaucoma (optic nerve atrophy), is poorly understood despite continued efforts. Although the gene variant of CACNA2D1 (encoding α2δ1), a calcium voltage-gated channel auxiliary subunit, has been reported to be associated with primary open-angle glaucoma, and the pharmacological mitigation of α2δ1 activity by pregabalin lowers IOP, the cellular basis for α2δ1 role in the modulation of IOP remains unclear. Our recent findings reveled readily detectable levels of α2δ1 and its ligand thrombospondin in the cytoskeletome fraction of human trabecular meshwork (TM) cells. To understand the direct role of α2δ1 in the modulation of IOP, we evaluated α2δ1 null mice for changes in IOP and found a moderate (∼10%) but significant decrease in IOP compared to littermate wild type control mice. Additionally, to gain cellular insights into α2δ1 antagonist (pregabalin) induced IOP changes, we assessed pregabalin's effects on human TM cell actin cytoskeletal organization and cell adhesive interactions in comparison with a Rho kinase inhibitor (Y27632), a known ocular hypotensive agent. Unlike Y27632, pregabalin did not have overt effects on cell morphology, actin cytoskeletal organization, or cell adhesion in human TM cells. These results reveal a modest but significant decrease in IOP in α2δ1 deficient mice, and this response appears to be not associated with the contractile and cell adhesive characteristics of TM cells based on the findings of pregabalin effects on isolated TM cells. Therefore, the mechanism by which pregabalin lowers IOP remains elusive.

SUCCESS RATE OF GLAUCOMA DRAINAGE DEVICE IMPLANTATION IN KARIADI GENERAL HOSPITAL SEMARANG 2020 – 2022

Introduction: Glaucoma is a leading cause of irreversible blindness, and implantation of drainage devices is an effective treatment option for patients with advanced glaucoma. The purpose of this study was to investigate the success rate of glaucoma drainage devices implantation in Kariadi Hospital. Methods: This was an observational analytic study with a retrospective design. All patients who received Virna implantation between January 2020 and December 2022 were included. Intraocular pressure (IOP) examination was performed at the baseline and at the first day, at the seventh day, at the first month, and at the third month after surgery. The success rate was divided into three groups: complete success if IOP was &lt;21mmHg without medication, qualified success if IOP was &lt;21mmHg with medication, and failure if IOP was &gt;21mmHg with medication. Results: This study included 42 patients (42 eyes) with an average age of 43.3 years. There were 16 male (38%) and 26 female (62%) patients in the group. From these patients, 11 (26.2%) had primary glaucoma and 31 (73.8%) had secondary glaucoma. There was a significant decrease in IOP from preoperative measurement (37.1±10.1mmHg) compared to IOP on the first day (13.0±6.0mmHg), on the seventh day (15.4±3.8mmHg), on the first month (18.2±4.4mmHg), and on the third month (23.4±8.9mmHg) after surgery (p&lt;0.05). At three-month follow-up, the complete success was 14.29%, the qualified success was 50%, and the failure was 35.71%. Conclusion: Glaucoma drainage device implantation was found to successfully reduce IOP in patients with advanced glaucoma. The qualified success rate was higher than complete success rate, suggesting that some patients may require medication to achieve target IOP levels.

A Watchful Eye: A Case Report on The Management of Hypotony Maculopathy after Non-Valved Glaucoma Drainage Device Implantation

Introduction : Low intraocular pressure (IOP) and reduced visual acuity following glaucoma surgery have been linked to a serious complication known as hypotony maculopathy. Here, we report a case of hypotony maculopathy following glaucoma drainage implant which was successfully managed by a conservative approach utilizing oral and topical steroids, resulting in favorable outcomes.&#x0D; Case Illustration : A 25-year-old female with juvenile glaucoma presented with low IOP in the right eye (RE) following glaucoma drainage surgery using non-valved implant four months prior. Ophthalmic examination revealed a decrease of IOP (9mmHg to 4mmHg) and visual acuity (6/6 to 6/24). Fundus examination and optical coherence tomography (OCT) of macula was indicating hypotony maculopathy. All glaucoma medications were discontinued and the patient was given oral methylprednisolone 3x8 mg and topical prednisolone acetate three hourly for two months. Subsequent follow-up revealed an increase in IOP to 37mmHg and visual acuity improvement to 6/6. The patient was then given oral and topical antiglaucoma medications to maintain IOP control.&#x0D; Discussion : Hypotony and its related sequelae are more common with the non-valved drainage devices. Prompt intervention is crucial for improving visual outcomes. Treatment options include surgical and conservative approach. Closely monitored conservative therapy may also give favorable outcomes similar to surgical approach.&#x0D; Conclusion : In advanced cases of glaucoma, extremely low IOP is just as risky as a high IOP. Conservative therapy, including topical and oral corticosteroids, can be employed to reverse hypotony, at the expense of transient IOP rise, in corticosteroid-responsive patients. Restoring normal IOP in a timely manner may improve retinal function.

Comparison Between Results of Trabeculectomy With or Without Anti- Vascular Endothelilal Growth Factor in Patients With Neovascular Glaucoma at Undaan Eye Hospital Surabaya, Indonesia

Introduction &amp; ObjectivesNew intraocular medication, Anti-vascular endothelial growth factor (Anti-VEGF) agents has beendeveloped in the management of neovascular glaucoma and in glaucoma surgery. But there are nostudies comparing trabeculectomy with Anti-VEGF to no Anti-VEGF treatment in patients withneovascular glaucoma. This study aims to compare decrease of intraocular pressure (IOP) betweentrabeculectomy with Anti-VEGF and without Anti-VEGF in neovascular glaucoma.&#x0D; MethodsThis observational retrospective study comprised 30 medical records of neovascular glaucoma,divided to 15 medical records of patients with anti-VEGF before trabeculectomy and medical recordsof patients operated with trabeculectomy without anti-VEGF, monitored between January 2021 toDecember 2021. Patients with incomplete medical records were excluded. Data collected are age,gender, risk factor, intraocular pressure pre operative, and during 6 months follow-up IOP postoperative. Data analysis uses an Independent T test.&#x0D; ResultsFrom 30 samples, mean IOP in trabeculectomy with anti-VEGF group generally is 12,26 mmHg.Meanwhile, mean IOP in trabeculectomy without anti-VEGF group generally is 16,74 mmHg. Tindependent test between 2 groups shows that there are significant mean difference between themduring 1-5 months follow-up (1 month: p = 0,022; 2 months: p = 0,007; 3 months: p = 0,007; 4months: p = 0,042; 5 months: p = 0,029).&#x0D; ConclusionTrabeculectomy with prior administration of intravitreal anti-VEGF shows good IOP reduction andcan be implemented in NVG patients.

Changes in confocal microscopy in glaucoma patients after intraocular pressure reduction with medical therapy.

Topical glaucoma medication is the first line of management to reduce intraocular pressure (IOP) in patients with glaucoma. In this study, we intended to compare the ultrastructural findings of the cornea in patients with glaucoma before and after the reduction of the IOP through confocal microscopy. Ten patients (19 eyes) with newly diagnosed glaucoma were recruited from the glaucoma services of our tertiary care center. Demographic parameters were noted, and basic ocular examination, specular microscopy (Topcon SP3000P, Tokyo, Japan), and ultrasonic pachymetry (300 AP, Sonomed Escalon, Stoneham, MA, USA) were performed. In vivo confocal microscopy of corneal sections was performed using the z-ring Confoscan 4.0 (Nidek, Inc., Freemont, CA) at baseline and after 3 months of starting glaucoma medications. The mean age of the patients was 53.53 ± 9.34 years. There was a statistically significant reduction (P < 0.0001) of IOP from 30.21 ± 7.42 mmHg (baseline) to 16.42 ± 4.14 mmHg (3 months). The mean central corneal thickness at baseline was 533.42 ± 3.96 μm, and it further decreased to 521.94 ± 42.45 μm at the end of 3 months (P = 0.006). No significant change was noted in the mean epithelial cell density, mean keratocyte density in anterior and posterior stroma, and the mean endothelial cell density and cell area (P >0.5). There was no significant percentage change in these parameters before and after the lowering of the IOP. A short-term (3 months) decrease in IOP using topical glaucoma medications caused a significant reduction in corneal thickness but did not have any significant ultrastructural changes in cornea measured using confocal microscopy.

A Noninvasive Clinical Method to Measure in Vivo Mechanical Strains of the Lamina Cribrosa by OCT

To measure mechanical strain of the lamina cribrosa (LC) after intraocular pressure (IOP) change produced 1 week after a change in glaucoma medication. Cohort study. Adult glaucoma patients (23 eyes, 15 patients) prescribed a change in IOP-lowering medication. Noninvasive OCT imaging of the eye. Deformation calculated by digital volume correlation of OCT scans of the LC before and after IOP lowering by medication. Among 23 eyes, 17 eyes of 12 persons had IOP lowering ≥ 3 mmHg (reduced IOP group) with tensile anterior-posterior Ezz strain= 1.0% ± 1.1% (P= 0.003) and compressive radial strain (Err)=-0.3% ± 0.5% (P= 0.012; random effects models accounting inclusion of both eyes in some persons). Maximum in-plane principal (tensile) strain and maximum shear strain in the reduced-IOP group were as follows: Emax= 1.7% ± 1.0% and Γmax= 1.4% ± 0.7%, respectively (both P < 0.0001 vs. zero). Reduced-IOP group strains Emax and Γmax were significantly larger with greater % IOP decrease (P < 0.0001 and P < 0.0001, respectively). The compliances of the Ezz, Emax, and Γmax strain responses, defined as strain normalized by the IOP decrease, were larger with more abnormal perimetric mean deviation or visual field index values (all P ≤ 0.02). Strains were unrelated to age (all P ≥ 0.088). In reduced-IOP eyes, mean LC anterior border posterior movement was only 2.05 μm posteriorly (P= 0.052) and not related to % IOP change (P= 0.94, random effects models). Only Err was significantly related to anterior lamina depth change, becoming more negative with greater posterior LC border change (P= 0.015). Lamina cribrosa mechanical strains can be effectively measured by changes in eye drop medication using OCT and are related to degree of visual function loss in glaucoma. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Success of Endoscopic Laser Cyclophotocoagulation vs Repeat Transscleral Treatment after Prior Transscleral Cycloablation.

To compare the efficacy of endoscopic cyclophotocoagulation (ECP) vs repeat transscleral cyclophotocoagulation (TCP) in eyes with persistent glaucoma despite prior treatment with TCP. This was a retrospective chart review of glaucoma patients at the American University of Beirut Medical Center over 10 years who underwent ECP or repeat TCP. We reported qualified and complete success; success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, with (qualified) or without medications (complete) and without procedure-related complications. This study included 23 eyes of 21 patients with various forms of uncontrolled glaucoma who had failed TCP. A total of 13 eyes of 12 patients underwent ECP with a mean age of 39.9 ± 23.2 years, and 10 eyes of nine patients underwent repeat TCP with a mean age of 27.2 ± 22.6 years. A significant decrease in IOP was observed from 38.5 ± 7.9 mm Hg preoperatively to 25.2 ± 8.8 mm Hg postrepeat TCP (p = 0.006) and from 33.0 ± 9.5 to 12.8 ± 3.9 mm Hg post-ECP (p < 0.001), noted at a mean follow-up time of 39.2 ± 44.4 and 41.5 ± 37.4 months, respectively. The mean number of antiglaucoma medications decreased in the two groups (from 3.8 ± 1.0 preoperatively to 1.8 ± 0.9 postoperatively for ECP and from 3.5 ± 1.3 to 3.1 ± 0.9 postoperatively for TCP); however, the drop was only statistically significant post-ECP. Qualified success was significantly higher after ECP vs repeat TCP (91.7 vs 40%, respectively). Complete success was achieved only in 1/12 (8.3%) eyes in the ECP group. Endoscopic cyclophotocoagulation (ECP) performed in glaucomatous eyes previously treated with transscleral cycloablation provided more IOP control as compared to repeat TCP by directly treating viable tissue in previously skipped ciliary processes and in between processes. In glaucomatous eyes previously treated with transscleral cycloablation, ECP attained better IOP control than repeat transscleral cycloablation. Al-Haddad C, Barikian A, Moussawi ZE, et al. Success of Endoscopic Laser Cyclophotocoagulation vs Repeat Transscleral Treatment after Prior Transscleral Cycloablation. J Curr Glaucoma Pract 2023;17(4):191-196.