Decrease In IOP Research Articles

Adjunctive use of netarsudil 0.02% in the treatment of refractory glaucoma: a one year analysis

PurposeThis study evaluates the long-term adjunctive use of netarsudil ophthalmic solution 0.02% in lowering IOP in patients with refractory glaucoma.MethodsThis retrospective chart review study was conducted at a tertiary care center. Patients who were prescribed add-on netarsudil therapy and on ≥ 3 topical glaucoma medications from 01/01/2018 to 08/31/2020 were reviewed. 47 patients (69 eyes) met the inclusion criteria. Baseline IOPs prior to the addition of netarsudil were compared to IOPs measured at 3-, 6-, and 12-month intervals. Any patients with inadequate follow-up or who had glaucoma surgery after netarsudil initiation were excluded.ResultsMedian baseline IOP (± SD) was 21 ± 5.8 mmHg (median of 2 visits prior to initiation of netarsudil). At 3-month follow-up, 64 eyes had a median IOP of 16 ± 6.7 mmHg (p < 0.01). At 6-month follow-up, 56 eyes had a median IOP of 18 ± 4.6 mmHg (p < 0.01). At 12-month follow-up, 44 eyes had a median IOP of 15 ± 6.8 mmHg (p < 0.01). At the conclusion of the study, 64% of eyes reached 1 year follow-up due to several reasons.ConclusionsPatients with refractory glaucoma showed statistically and clinically significant IOP reductions on netarsudil. IOP reduction was stable long-term with the largest decrease in IOP seen at 12 months. Although some patients will still go on to require further laser or incisional surgery, for most patients netarsudil is an effective treatment for adjunctive use in refractory glaucoma.

Evaluation of the Effectiveness of Using a Fixed Combination of Dorzolamide 2.0 % and Timolol 0.5 % in Primary Open-­Angle Glaucoma

The purpose of the work was to evaluate the effectiveness of the drug Domizia Duo® (OTCPharm JSC), which is a fixed combination (dorzolamide 20 mg/ml and timolol 5 mg/ml) in the treatment of patients diagnosed with primary open­angle glaucoma. The multicenter study involved 156 patients (280 eyes) with primary open­angle glaucoma (POAG) (136 patients — 243 eyes), primary angle­closure glaucoma (PACG) (8 patients — 15 eyes), ocular hypertension (12 patients — 22 eyes). 37 doctors from 22 medical institutions took part in the study. Patients aged 55–75 years with first­time POAG stages I–III, PAOG, ocular hypertension, as well as with abnormal intraocular pressure, patients with pseudophakia, if the diagnosis of glaucoma was made before cataract extraction and at least 6 months before the study, were included. According to the study results, intraocular pressure decreased significantly in all groups of patients and at all stages of treatment: primary open­angle glaucoma, primary angle­closure glaucoma, ocular hypertension. In 136 patients (243 eyes) with POAG, a 28 % reduction in IOP was achieved at an initial level of 25 (22–28) mm Hg. In the group of patients with PCOG (8 patients, 15 eyes), a decrease in IOP by 19 % was shown with an initial intraocular pressure of 20.1 (19.1–23.0) mm Hg. The high effectiveness of the drug Domizia Duo® (OTCPharm JSC) was established at all stages of POAG, so at stage I of newly diagnosed POAG, the reduction in IOP was 35.5 % within a month after the start of therapy, at stage II of newly diagnosed POAG by 28 %, at stage III by 44.4 %, in the group of patients with ocular hypertension, the degree of reduction in intraocular pressure was 27 % at an initial level of 26 (23–27) mm Hg. The data obtained from the study prove the high effectiveness of the fixed combination (FC) Domizia Duo® (OTCPharm JSC) against the background of good tolerability in patients with primary open­angle glaucoma (POAG) at stages I–III. The drug was also highly effective not only when prescribed as monotherapy, but also when switching from another drug or adding Domizia Duo® to treatment.

Aphakia treatment with sutureless scleral fixation or retropupillary iris-claw intraocular lens implantation: visual acuity, anterior segment and keratometry outcomes

PurposeEvaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation.MethodsA total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior–posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany).ResultsThere was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively).ConclusionIn this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.

Evaluation of anterior segment parameters between pregnancy trimesters and postpartum with pentacam scheimflug ımaging: a prospective study

PurposeTo evaluate the effect of pregnancy on the anterior chamber, corneal parameter, and intraocular pressure measurements; and compare the results between trimesters, postpartum and non-pregnant healthy age-matched women.MethodsThis prospective study included 41 pregnant women and 53 non-pregnant women. Four measurements were taken from the pregnant women, in each trimester and postpartum third month, and once from the control group. Of the individuals included in the study, anterior chamber depth (ACD), anterior chamber volume (ACV), K1 (flat keratometry), K2 (steep keratometry), Kmean (mean value of K1 and K2), anterior chamber angle (ACA), central corneal thickness (CCT), thinnest corneal thickness (TCT), astigmatism value (AST), corneal volume (CV), biometry, axial length (AL), spherical equivalent (SFEQ), intraocular lens power (ILP), VA (visual acuity) datas were recorded.ResultsWe observed a statistically significant decrease in K2, CCT, ACD, AL and CV in the postpartum period (p = 0.025, p < 0.001, p = 0.029, p = 0.005, p = 0.004 respectively) and a statistically significant increase in ACV, CCT, and TCT as the gestational week progressed in the pregnant group (p = 0.007, p < 0.001, p = 0.025, respectively). A statistically significant decrease in IOP towards to the third trimester, and an increase in the postpartum period was observed (p < 0.001). We did not observe statistically significant changes in K1, Kmean, AST, ACA, VA, ILP, and SFEQ values.ConclusionIt is important to investigate the physiological changes that may occur during pregnancy, distinguish them from pathological changes, and avoid unnecessary treatment. We consider that it’s also important to guide the timing of anterior segment surgeries such as cataract and refractive surgery and to prescribe glasses/contact lenses.

Minimally invasive bleb surgery versus minimally invasive glaucoma surgery: a 12-month retrospective study

This study aimed to compare the IOP-lowering effectiveness and safety of standalone Preserflo MicroShunt and iStent 1st generation implantation combined with phacoemulsification in Caucasian patients with a 12-month follow-up period. This retrospective study analyzed the medical histories of patients undergoing antiglaucoma surgery at the Department of Ophthalmology, Medical University of Bialystok, between January 2019 and January 2022. The main outcome measures were success rates (complete: proportion of eyes with IOP < 18 mmHg (criterion A) and < 15 mmHg (criterion B) or 20% reduction in IOP without any glaucoma medication; qualified: proportion of eyes achieving IOPs < 18 mmHg and < 15 mmHg or 20% reduction in IOP from baseline with or without medications), mean reduction (%) in IOP, medication burden, number of complications and additional interventions. In both groups, a significant decrease in IOP and medication burden were observed at 6 and 12 months when compared with baseline. At 12 months, qualified surgical success in criterion A was recorded in 67.4% and 85.7% of patients in the Preserfo and iStent groups, respectively (p = 0.045). Complete surgical success in criterion B at 12 months accounted to 61.4% of patients from Prserflo group and 32.7% patients in iStent group (p = 0.04). Surgical failure at 12 months was documented in 30.2% and 6.3% of patients, respectively (p = 0.003). There was a significant difference between groups in %IOP reduction after 12 months. Greater reduction was observed in Preserflo group, MD = − 8.41 CI95 [− 15.88; − 0.95], p = 0.028, (− 33.49% ± 21.59 vs − 25.07% ± 14.15 in iStent group). Both procedures effectively reduced IOP and postoperative use of antiglaucoma medications in glaucoma patients.

Outcomes of a Second Ahmed Glaucoma Implant With Mitomycin-C in Pediatric Glaucoma After Initial Valve Failure.

After the failure of a glaucoma drainage device in children, implantation of a second Ahmed glaucoma valve with mitomycin-C allows a significant reduction of intraocular pressure and number of medications with good medium-term and long-term survival. The effectiveness of glaucoma drainage devices (GDD) is limited in time. There is little literature regarding the optimal management strategy after failure of a GDD in pediatric glaucoma. To report the outcomes of Ahmed glaucoma valve implantation (AGV) with mitomycin-C (MMC) after failure of a GDD in children. Retrospective chart review of patients with a history of at least 1 GDD receiving an AGV implantation with MMC between 2000 and 2019. We defined complete success as an IOP of 5-21mmHg without glaucoma medication and qualified success as a final IOP of 5-21mmHg with one or more glaucoma medication, without loss of vision. Twenty-one patients (22 eyes) met the inclusion criteria. The intraocular pressure and number of medications were significantly reduced. The probability of complete success was 47% [95% CI: 29%-75%] at 2 years and 34% [95% CI: 18%-65%] at 4 years. The probability of qualified success was 74% [95% CI: 56%-97%] at 2 years, and 54% [95% CI: 34%-84%] at 5 years. Failure happened in 10 eyes after a mean time of 4.3 years ±3.6 (6mo to 15y), 5 of which (23%) for severe complications or loss of vision. This study of implantation of a second valve with MMC reports a significant decrease in IOP and medications with medium-term and long-term success rates close to those reported for first valve implantation, although with a high risk of complications.

Long-term efficacy and safety of posterior endoscopic cyclophotocoagulation in refractory glaucoma: A 5-year follow-up study at a tertiary eye center

PurposeTo evaluate the long-term efficacy of endoscopic cyclophotocoagulation (ECP) via a pars plana approach in a large cohort of refractory glaucoma patients DesignSingle-center, retrospective, longitudinal, cohort study. MethodsThis study recruited patients who underwent ECP and consecutively visited and were followed up for at least 5 years at Beijing Tongren Eye Center, China from January 2013 to December 2017. All patients underwent a complete ophthalmic examination. Treatment success was defined as 6 mmHg ≤ IOP ≤ 21 mmHg with or without anti-glaucoma medications. ResultsA total of 121 eyes of 105 patients including 51 children and 54 adults were enrolled. The mean follow-up was 7.2 ± 1.3 years. The most common glaucoma diagnoses were secondary glaucoma (74 eyes, 61.1 %) and primary congenital glaucoma (19 eyes 15.7 %). The mean extent of the first ECP was 259 degrees. There was an overall decrease in IOP of 38.3 % from 33.3 ± 9.0 mmHg preoperatively to 20.5 ± 7.5 mmHg after surgery, which was statistically significant (P < 0.001). The success rate after 1 or more ECP surgery was 65.3 %. After adjusting for sex, number of prior TCP surgeries and the extent of ECP degree, the failure of ECP was associated with being children (as compared with adults; P = 0.028; OR = 2.549) and higher preoperative IOP (P = 0.001; OR = 1.084). ConclusionECP is an effective procedure for lowing IOP in refractory glaucoma, particularly in patients who are also candidates for vitreoretinal interventions. Hence, a collaborative approach between glaucoma and retinal specialists is of utmost importance in devising an optimal management strategy for glaucoma treatment.

Comparison of Nd: YAG Laser Iridotomy Alone Versus Sequential Argon-Nd: YAG Laser Iridotomy in Patients with Primary Angle Closure Spectrum

Purpose: To compare the mean Nd: YAG energy used and mean decrease in IOP 3-hours post-laser, in Nd: YAG Laser iridotomyalone versus sequential Argon-Nd:YAGiridotomy in patients with primary angle closure spectrum. Study Design: Quasi experimental Study. Place and Duration of Study: Department of Ophthalmology, Allied Hospital, Faisalabad from March 2022 to August 2022. Methods: After taking approval from Ethical review board, 70 patients with angle closure spectrumwere included in the study. Out of 70, 25 patients were primary angle closure suspect (PACS), 28 had primary angle closure (PAC) and 17 patients had primary angle closure glaucoma (PACG). We sorted patients into Group A (those who underwent sequential Argon-Nd: YAG Laser peripheral iridotomy) and Group B (those who underwent Nd: YAG laser alone). Mean Nd: YAG energy used was noted in each group and compared using SPSS version 25.0. Mean decrease in IOP 3-hours post-laser was also noted and compared. Results: Mean decrease in IOP 3 hours post-laser was 5.46 ± 3.70 mmHg for sequential Argon-Nd: YAG LPI versus 3.46 ± 2.38 mmHg for Nd: YAG LPI alone (p-value = 0.009). Mean Nd: YAG energy used in sequential Argon-Nd: YAG LPI group was significantly lesser when compared to Nd: YAG LPI alone group (32.70 ± 38.87 versus 139.37 ± 62.32 mJ) which was found to be statistically significant (p = 0.0001). Conclusion: Sequential Argon-Nd-YAG laser iridotomy uses significantly less Nd:YAG energy than conventional Nd:YAG only method with better IOP control.

Первые результаты микроимпульсной циклофотокоагуляции при вторичной глаукоме у пациентов после витреоретинальной хирургии с использованием силиконового масла

Quite often, the use of silicone oil (SO) in routine vitrectomy can lead to increased IOP. Silicone-induced glaucoma is classified as refractory. It is difficult to treat with hypotensive drops or surgical treatment. The introduction of MicroPulse cyclophotocoagulation (MP-CPC) significantly contributed to reducing the number of side effects of laser operations by reducing the operating cycle to 31.3 %. Purpose. To analyze the first results of MP-CPC for secondary glaucoma that developed after vitrectomy using SO. Material and methods. A retrospective analysis of data from 22 patients was performed: 13 eyes were avitreal and 9 eyes had SO. IOP monitoring was carried out on first day, after 2 weeks, 1, 3 and 6 months. Results. On the first day after MP-CPC, a significant decrease in IOP was noted by 28 % compared to the baseline and averaged 19.2 ± 4.2 mmHg (p &lt; 0.05). There was no statistically significant difference between the groups of patients with avitria and with SO. Over the next 3 months, the average IOP level after MP-CPC remained within the range of 19–21 mmHg. By the 6th month of observation, there was a tendency to increase IOP, which required to repeat MP-CPC. Conclusion. MP-CPC for secondary silicone-induced glaucoma that developed after vitrectomy has shown high efficiency and safety in patients with both avitria and the presence of silicone. Considering the compensation of IOP, which persists for up to 6 months after MP-CPC, it is possible to perform a repeat laser procedure without changing the hypotensive therapy regimen. Keywords: micropulse cyclophotocoagulation; secondary glaucoma; silicon oil

Предикторы офтальмогипертензии в раннем послеоперационном периоде после витрэктомии

In vitreoretinal surgery, the problem of increasing intraocular pressure in the early postoperative period remains urgent. This complication occurs despite the constant improvement of surgical techniques and monitoring of patients after interventions. Given the variety of risk factors for ophthalmic hypertension, the study of its causes and their elimination is an urgent problem. Objective. Study the dynamics of the increase in intraocular pressure, determine the factors influencing this indicator and analyze the ways of measuring it. Material and methods. 36 patients (36 eyes) were included in the study. As a medical postoperative support, patients were divided into 2 groups: the first group included 20 eyes receiving instillation of 0.1 % dexamethasone solution in the postoperative period, and the second group included 16 eyes receiving instillation of 0.1 % fluorometholone solution. In addition, the distribution of patients was carried out depending on the agent tamponing the vitreal cavity. Results. A statistically significant difference was revealed between the values of ophthalmotonus using various diagnostic devices the next day after surgery. In the eyes with silicone and gas tamponade in the early postoperative period, there was a significantly more significant increase in IOP compared with tamponade with BSS solution and sterile air. A month after surgical interventions, a faster decrease in IOP was revealed against the background of instillations of 0.1 % fluorometholone solution than in patients who were instilled with 0.1 % dexamethasone solution. Keywords: vitreoretinal surgery, intraocular pressure, ophthalmic hypertension, silicone tamponade

The effect of the intercellular adhesion molecule-1 and glycated haemoglobin on the management of diabetic neovascular glaucoma.

Introduction: The study hypothesizes that some patients with diabetic neovascular glaucoma (NVG) do not fully respond to transscleral (TSC) cyclophotocoagulation (CPC) due to significant inflammation and insufficient glucose control. Objective: The study aimed to determine the effect of baseline blood levels of intercellular adhesion molecule-1 (ICAM-1) and glycated haemoglobin (HbA1c) on the management of patients with diabetic NVG by TSC CPC. Methods: This open prospective study included 70 diabetic patients (75 eyes; aged Ме 63.0 years) with painful NVG and 20 healthy individuals (aged Ме 61.5 years) as an immunological control. All patients underwent TSC СPC with a diode laser. Baseline HbA1c levels and ICAM-1 expression in blood samples were determined. Follow-up was 12 months. Results: One month after TSC CPC, IOP decreased by 28% compared to baseline. The effectiveness of laser treatment after 12 months of follow-up was 63% with IOP decrease by 46%. In patients with NVG, the initial level of ICAM-1 was 2.5 times higher than in the control group. Patients who did not fully respond to the first TSC CPC (30 eyes) and required additional laser procedure, had high initial HbA1c (9.5%) and high expression values of the ICAM-1 (609.0 cells/μL). Conclusions: Repeated procedures of TSC CPC at high IOP in diabetic patients with NVG are associated with high initial values of expression of ICAM-1 in peripheral blood and high HbA1c. The strategy of management of patients with diabetic NVG should be aimed at intensive glucose control and local anti-inflammatory treatment. Abbreviations: PDR = proliferative diabetic retinopathy, DR = diabetic retinopathy, NVG = neovascular glaucoma, TSC CPC = transscleral cyclophotocoagulation, ICAM-1 = intercellular adhesion molecule-1, HbA1c = glycated haemoglobin, IOP = intraocular pressure.

Mid-term real world outcomes of the Hydrus® Microstent in open angle glaucoma.

To evaluate the mid-term clinical results and the safety aspects of the Hydrus® Microstent (Ivantis, Inc, Irvine, CA) in a real-life setting. Retrospective case series. Hydrus® Microstent was implanted in phakic eyes (88 eyes, 87.1%) and in pseudophakic eyes (13 eyes, 12.9%), respectively. Mean follow-up time was 16 ± 9 months with 27 eyes having a follow-up time of more than 24 months. The primary endpoint was reduction in IOP compared to baseline. Target IOP levels were set at ≤20 mmHg, ≤18 mmHg and ≤15 mmHg. Kaplan-Meier survival was defined as a reduction in IOP of ≥20% compared to baseline. Secondary endpoints were reduction in number of glaucoma medications and safety assessments addressing visual acuity, adverse events, re-surgery rate and identification of factors that made the implantation more difficult. 101 eyes underwent Hydrus® implantation. The mean preoperative IOP was 21.60 mmHg (SD 6.6) on 2.18 (SD 1.3) medications. After a mean follow up time of 16 months, the mean IOP was reduced to 14.61 ± 3.7 mmHg on 1.12 (SD 1.1) medication classes (p < 0.001). Mean decrease in IOP was 26.7%. Analysis of the target IOP levels showed that in 29%, 34% and 35% of cases an IOP of ≤15 mmHg, ≤18 mmHg and ≤20 mmHg respectively could be achieved. BCVA improved from 0.56 ± 0.3 at baseline to 0.85 ± 0.3 more than 24 months after surgery (p < 0.001). The rate of re-operation was low at <3%. Adverse events occurred in 4 eyes (<4%). This study underlines the effectiveness and the safety of the Hydrus® Microstent in an elective setting, but it also demonstrates certain limits and risk factors of this procedure.

Topical application of hypotensive drugs for the prevention of intraocular pressure elevation after intravitreal injections of anti-VEGF drugs

This study evaluates the effect of topical hypotensive drugs on the short-term IOP rise after IVI of anti-VEGF drugs in patients with nAMD. The prospective study included 80 patients with newly diagnosed nAMD. Before the start of treatment, the patients were divided into 4 groups of 20 people each: 1st - controls, who received no prophylactic drugs, in the 2nd, 3rd and 4th groups local instillations of one drop of hypotensive drugs brinzolamide 1%, brinzolamide-timolol, brimonidine-timolol were performed in the conjunctival sac twice: 1 day before the injection (at 20:00) and on the day of the injection 2 hours before the manipulation (at 08:00), respectively. IOP was measured in each patient using ICare Pro non-contact tonometer before injection, as well as 1 min, 30 and 60 min after injection. Prophylactic use of hypotensive drugs was associated with a significant decrease in IOP immediately after IVI compared to the same parameter in the 1st group (p<0.001), the maximum decrease in IOP values was observed when using a fixed combination of brimonidine-timolol by 12.1 mm Hg compared to the controls (p<0.001), the combination of brinzolamide-timolol reduced IOP by 8.5 mm Hg (p<0.001), brinzolamide 1% led to the smallest decrease in IOP - by 5.1 mm Hg (p<0.001). Study patients that received instillations of brimonidine-timolol combination of one drop into the conjunctival sac 1 day before the injection and on the day of the injection showed the maximum decrease in IOP compared to patients of the other groups.

Efficiency and safety of the fixed latanoprost/ dorzolamide combination in open-angle glaucoma hypotensive treatment

Purpose: to determine the efficacy and safety of fixed latanoprost/dorzolamide combination Dorzoprost in hypotensive treatment of primary open-angle glaucoma (POAG) patients previously treated with latanoprost.Material and methods. An observational study included 30 patients (37 eyes) with moderate and advanced POAG who had uncompensated elevated IOP receiving latanoprost monotherapy. During the screening visit, latanoprost was switched to Dorzoprost instilled once in the evening. The targets were IOP, visual acuity, MD and PSD perimetry indices, retinal nerve fiber layer thickness, minimum width of the neuroretinal rim, macula retinal nerve fiber layer thickness, and adverse events. The observation period lasted 12 weeks. IOP was measured at weeks 4 and 12.Results. After 4 weeks, a statistically significant decrease in IOP was noted, which remained stable at 12 weeks. The average additional IOP decrease of those treated with Dorzoprost was 17%. Statistically insignificant positive changes were registered in visual acuity, static perimetry and optical coherence tomography. By the end of the observation period, 6 cases revealed a decrease in the degree of conjunctival hyperemia, while all dry eye syndrome cases (5 patients) showed a decrease in the severity of the signs of the syndrome.Conclusion. Dorzoprost has a significant additive hypotensive effect and a favorable safety profile.

Модифицированный способ субконъюнктивального введения антиметаболитов в хирургии глаукомы

Purpose. Comparative evaluation of the clinical and functional results of post-operative adjuvant subconjunctival administration of 5-fluororacil after a non-penetrating deep sclerectomy (npdS) compared to the control group. Material and methods. A retrospective study was conducted of two groups of patients with primary open-angle glaucoma who had undergone npdS and received at least 1 subconjunctival injection of 5-fluorouracil in the postoperative period. Group 1 is patients who have received post-surgical 5-fluoride injection using a standard procedure. group 2 — patients who received the injection according to the proposed method. The comparison included: best correction visual acuity (BcVa), intraocular pressure (Iop), frequency of corneal complications. Results. Demographic characteristics and preoperative BcVa and Iop parameters did not differ between the compared groups. Corneal epithelial defects stained with fluorescein were statistically significantly more common in group 1 compared to group 2, p &lt; 0.001. The highest decrease of Iop (p = 0.042) and lower loss of BcVa (p &lt; 0.001) 4 weeks after npdS was observed in group 2. Conclusions. The use of the modified method provides greater safety and efficacy of 5-fluorouracil administration in the postoperative period of npdS compared to the control group. Keywords: 5-fluorouracil, glaucoma, corneal erosion, toxicity, prevention of complications, injection

The Combination of Treatment for Glaucoma

Glaucoma is the leading cause of permanent vision loss worldwide. Because the disease may be asymptomatic until an advanced stage, diagnosis is often delayed.1 An estimated 57.5 million people worldwide develop primary open-angle glaucoma (POAG). The purpose of this study was to determine the comparison of intraocular pressure reduction in open-angle primary glaucoma patients between monotherapy, double therapy, and triple combination therapy. This study is a type of observational analytical research with a cross sectional approach. Which is a research design in which data collection of both independent and dependent variables and factors that influence them are collected at the same time. The research was conducted at the Eye Clinic of RSPAL dr. Ramelan Surabaya. The population taken was a 53-year-old female patient diagnosed with open-angle primary glaucoma at the Eye Clinic of RSPAL dr. Ramelan Surabaya. The results showed that trabeculectomy had a statistically significant result that was very high on IOP reduction and decrease in the number of antiglaucoma drops. Untreated glaucoma can lead to permanent vision loss or blindness that occurs more quickly. The earlier treatment is given, the more vision loss can be delayed or reduced.

Intraocular Pressure Changes in Myopic Patients Undergoing Laser In-Situ Keratomileusis and Photorefractive Keratectomy.

To assess the variation in intraocular pressure measurements between Ocular Response Analyzer (ORA) and Goldmann Applanation Tonometer (GAT) in myopic patients undergoing laser assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), National University of Medical Sciences, Rawalpindi, Pakistan, between September 2020 and 2021. Myopic patients undergoing LASIK and PRK during the study period were selected. Baseline examinations and postoperative follow-ups were carried out to measure intraocular pressure at 1, 3, and 6 months after LASIK or PRK, using Goldmann Applanation Tonometer (GAT) and Ocular Response Analyzer, corneal compensated IOP (ORA IOPcc). One hundred and thirteen eyes underwent myopic refractive surgery, LASIK (n = 60) or PRK (n = 53). Mean age of patients was 23.6 ± 4.11 years in the PRK group and 24.4 ± 5.94 years in LASIK group. For the PKR group, the GAT IOP value increased at 1-month (p <0.001), decreased at 3-month (p <0.001) and further decreased at 6-month (p <0.001) follow-up postoperatively. In the LASIK group, the GAT IOP value decreased at all time points (p <0.001). In both groups, the mean ORA IOPcc value increased at 1 month (p <0.001), decreased at 3-month (p <0.001) and further decreased at 6-month (p <0.001) follow-up postoperatively. The IOP mean values were generally found to be higher when measured using ORA as compared with GAT. Corneal refractive surgery markedly decreased IOP. This decrease in IOP was observed more after LASIK than after PRK. ORA was less likely to underestimate the intraocular pressure than GAT. Myopia, Laser in-situ keratomileusis, Photorefractive keratectomy, Tonometery ocular, Intraocular pressure.

Baerveldt-350 with 3-0 Prolene Ripcord to Minimize Hypotony-Associated Complications after Spontaneous Ligature Dissolution

To describe the technique and demonstrate the utility and outcomes of using a thick 3-0 Prolene ripcord in the lumen of a Baerveldt-350 aqueous shunt until after the ligature suture dissolves. Single-center, noncontrolled, retrospective case series. A total of 50 eyes from 50 patients with glaucoma undergoing placement of Baerveldt-350 aqueous shunts with 3-0 Prolene ripcords. A retrospective chart review was performed for all eyes of adult patients that had undergone a Baerveldt-350 aqueous shunt placement by a single surgeon at a single academic center between October 1, 2019 and June 30,2022. Data collected included demographic and clinical characteristics of the patients, preoperative and postoperative clinical data including intraocular pressure (IOP) and glaucoma medications, postoperative timepoints of ligature suture dissolution, and timepoints of 3-0 Prolene ripcord removal or whether they were permanently left in place. In total, 50 eyes from 50 patients were included; mean age was 69.5 years, 54.0% of patients were female, 92% of patients were Black, and 66% of eyes had primary open-angle glaucoma. Twenty-six of 50 (52%) eyes had ripcord removal at the soonest postoperative visit after spontaneous ligature dissolution, 19/50 (38%) eyes had delayed ripcord removal, and 5/50 (10%) eyes had no ripcord removal. There were no cases of hypotony-associated complications (shallow anterior chamber, hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage) in this subgroup of eyes that underwent no ripcord removal. Our results demonstrate that routine use of a 3-0 Prolene ripcord to partially occlude the lumen of a Baerveldt-350 is a useful strategy to minimize sudden hypotony-associated complications when the ligature suture dissolves. This strategy allows for a more controlled postoperative course and a safe 2-step decrease in IOP (1: when the ligature dissolves, and 2: when the ripcord is removed). The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Микроимпульсная лазерная трабекулопластика как метод лечения первичной открытоугольной глаукомы

Purpose. Analysis of the results of treatment of primary open-angle glaucoma by the method of microimpulse laser trabeculoplasty with a power of 1000 mW and different operating cycles. Material and methods. 33 patients (36 eyes) who underwent microimpulse laser trabeculoplasty were included in the study: in the 1st month, MLT with a power of 1000 mW and a duty cycle of 15% was performed in 19 patients (21 eyes), in the 2nd month MLT s rabochim cyclom 10% 14 patients (15 glasses). Criterion of inclusion of development of patients with primary open glaucoma and pigmented angular anterior camera. Observation and measurement of VGD is carried out an hour after the laser procedure, after 10 days, and after 1; 3, 6 months. Results. In the MLT group with 15% duty cycle, at 6-month follow-up, we noted a decrease in IOP by more than 20% of baseline or more than 3 mmHg, in 78% of cases, however, in the MLT group with a 10% duty cycle, this figure was only 33%. Also, in the MLT group with 15% workers, there was a decrease in the number of antihypertensive drugs used by 32%, while in the MLT group with a 10% work cycle, this figure was 9%. Conclusions. Treatment with micropulse laser trabeculoplasty for primary open-angle glaucoma is a new method that affects pigmented cells without thermal damage. However, to achieve a hypotensive effect, the laser power should be 1000 mW, and the duty cycle is 15%, since with a duty cycle of 10%, no hypotensive effect is observed in the long-term observation period. Keywords: glaucoma, laser trabeculoplasty, pigmented anterior chamber angle

The Beneficial Effects of Photobiomodulation to Reduce Intraocular Pressure in Primary Open-Angle Glaucoma

Purpose: The aim of this trail was to study the efficacy of photobiomodulation (PBM) treatment to reduce the intraocular pressure in subjects with primary open angle glaucoma disease.&#x0D; Methods: Twenty eyes suffering from open angle glaucoma with high IOP level were selected, examined and treated with Thera-RED light diode system. The subjects were divided into two groups (n=10); treated and placebo group respectively; this system provide two lights (red at 660n.m continue and Near IR light micro-pulsed at 850 n.m), the patients received two series of treatment (ten per month within three months between every series of sessions) over five months and follow up taking ocular pressure measurements after every diode delivery session.&#x0D; Results: A significant decrease in IOP has been observed from the first month of the treatment compared to the placebo group (from 22.6mmHg before treatment to 15 mmHg after the tenth session) this amelioration has been also remarked during the second session of treatment (fifth month) to attempt 14.2 mmHg. &#x0D; Conclusion: Thera-RED light diode system treatment shows a significant decrease of IOP and remained to be stable under 14.2 mmHg in all the follow up, which confirm that photobiomodulation help in reducing the intraocular pressure in glaucomatous patients .