Stages Of Glaucoma Research Articles

OPTIMIZATION OF THE METHOD OF SURGICAL TREATMENT OF PRIMARY INFANTILE CONGENITAL GLAUCOMA IN CHILDREN

Pediatric glaucoma is a term that encompasses several forms of congenital glaucoma and types of secondary glaucoma thatdiff er in etiology, pathogenesis, and clinical presentation. Surgical treatment is the main method of IOP reduction in pediatricglaucoma. To date, no uniform method of surgical treatment of infantile glaucoma has been proposed, which makes the searchfor adequate methods of surgical intervention in this pathology most urgent.The aim of this work was to evaluate the effi cacy of surgical treatment of primary congenital infantile glaucoma in children.Material and methods. In the eye department of the clinic of the Tashkent Pediatric Medical Institute, the eff ectiveness of themethod of surgical intervention in children from 3 to 10 years old with primary congenital infantile glaucoma was evaluated.Examined – 20 patients (40 eyes). Of these, 5 patients (10 eyes) entered the advanced stage, 10 patients (20 eyes) entered the far advanced stage, and 5 patients (10 eyes) entered the terminal stage, respectively. The patients underwent standard ophthalmological examination. The state of the optic nerve was investigated by optical coherence tomography Stratus OCT-3000 (Carl Zeiss Meditec), the visual fi elds – in 10 (20 eyes) patients aged over 8 years using standard automated and computer perimetry (SAP).Conclusions of the bioethical commission: This article evaluates the eff ectiveness of the method of surgical treatment ofprimary congenital infantile glaucoma in children. And gives specifi c results of diff erent operations at diff erent stages of primary congenital infantile glaucoma. Surgical treatment was chosen according to the degree of goniodysgenesis and the stage of the disease, which showed a satisfactory result in stabilizing the glaucoma process.Statistical analysis method using Microsoft Excel and SPSS programs was used for processing the results of theophthalmological study. Diff erences between the mean values (M±σ) were considered reliable at P≤0.05.Results and Discussion. All patients underwent surgical treatment, depending on the severity of morphometric changesin the anterior chamber angle, and in the postoperative period with an interval of 6 months – a course of neuroprotectivetherapy. According to the examinations, children with primary infantile glaucoma in advanced stage underwent non-penetrating deep sclerectomy in 10 eyes, with extensive – in 20 eyes and with terminal – in 10 eyes – sinusotrabeculotomy ab externo, sinusotrabeculectomy. In 2 eyes in the terminal stage, fi ltering surgery was performed according to the proposed method. Thus, the above methods of surgery reduce the number of intra- and postoperative complications by 12.5%, avoid reoperations, reduce IOP in 12.3% of cases, increase visual acuity by 0.15 compared to the original.Conclusion. The above methods of surgical treatment were chosen according to the degree of goniodisgenesis and the stageof the disease, which showed a satisfactory result in stabilizing the glaucoma process

Местное хроническое асептическое воспаление в патогенезе первичной открытоугольной глаукомы (пОУГ), роль дисбаланса биологически активных молекул

Purpose. Purpose: to study the content of pro-inflammatory cytokines and matrix metalloproteinases in the intraocular fluid in patients with advanced stage of primary open-angle glaucoma. Material and methods. 50 patients were examined with a verified diagnosis of the advanced stage of poag. the control group consisted of 30 patients with a diagnosis of uncomplicated cataract. the concentration of the determined biologically active molecules was carried out by the method of flow fluorimetry on a two-beam laser analyzer -Bio-plex 200, Bio-rad, USA. Results. A statistically significant increase in the concentrations of Il-6, 8, 12, 17, mIp-1β matrix metalloproteinase-2 was found in the intraocular fluid of patients with poag. Conclusion. The data obtained indicate the significance of the local inflammatory process, as well as disturbances in the structure of the extracellular matrix in the mechanisms of poag development. Keywords: primary open-angle glaucoma, intraocular fluid, cytokines, matrix metalloproteinases

Genetic risk of glaucoma is associated with vascular and retinal nerve fibre wedge defects.

To evaluate the association between localised vascular and retinal nerve fibre layer (RNFL) loss and genetic risk for glaucoma and cardiovascular disease using polygenic risk scores (PRS). 858 eyes were included from 455 individuals with suspect and early manifest primary open angle glaucoma. Eyes were characterised as having localised vascular and/or RNFL wedge-shaped defects by scrutiny of optical coherence tomography angiography (OCTA) and OCT images, respectively. Investigations included associations with pre-established scores for genetic risk of glaucoma and cardiovascular disease in the context of glaucoma risk factors and systemic vascular disease outcomes. Higher genetic risk for glaucoma was associated with both vascular wedge defects and RNFL defects (p < 0.001 and p = 0.020, respectively). A greater genetic risk of glaucoma was associated with the presence of multiple vascular wedges per eye (p = 0.005). Glaucoma progression based on global RNFL loss was associated with vascular and RNFL wedge defects (p ≤ 0.001 and p = 0.008, respectively). The glaucoma PRS was significantly associated with vascular, but not RNFL, wedge defects after controlling for disc haemorrhage (p = 0.007 and p = 0.070, respectively). Vascular wedge defects were not related to the cardiovascular PRS. Individuals with a higher genetic risk of glaucoma based on the PRS were more likely to have retinal vascular defects, as well as structural glaucomatous loss, but this did not relate to systemic cardiovascular risk. This possibly implies a local pathophysiology for the vascular defects in some cases, which may have clinical relevance in the early stages of glaucoma and in individuals at high genetic risk.

Additive Therapy for Advanced Stages of Glaucoma

Purpose of the study: to evaluate the efficacy and feasibility of using brimonidine 0.2 % in the additive therapy of patients with advanced stages of glaucoma. Materials and methods. There were 59 patients (77 eyes) with advanced stages of primary open-angle, glaucoma (POAG) aged 68 to 83 years in the study. Patients were randomized into 2 groups depending on the received antihypertensive therapy. The first group (I) included 32 people (41 eyes) who used a fixed combination of a prostaglandin analogue (APG) or a carbonic anhydrase inhibitor (CAI) with a beta-blocker (BB) for the treatment of POAG. The second group (II) consisted of 27 patients (36 eyes) who had the α2-adrenergic agonist brimonidine — S3 added to the previously available combination of APG or ICA with BB. The observation period was 6 months. Results. Application of brimonidine — SZ in the additive therapy of advanced stages of glaucoma led to an additional hypotensive effect. By the end of the observation period in the group of patients treated with brimonidine, intraocular pressure decreased by an additional 10 % from the initial level. A good hypotensive effect contributed to an increase in functional parameters. Analysis of the results of static automatic perimetry showed a positive trend in the mean deviation (MD) and standard deviation pattern (PSD), which may indicate a neuroprotective effect of the drug. All patients noted good tolerability of treatment. Throughout the observation period, patients maintained a high level of adherence and performance.

Optical Coherence Tomography Angiography (OCTA) Differences in Vessel Perfusion Density and Flux Index of the Optic Nerve and Peri-Papillary Area in Healthy, Glaucoma Suspect and Glaucomatous Eyes.

To assess the ability of vascular perfusion parameters determined by optical coherence tomography angiography (OCTA) to detect and monitor glaucoma. This prospective study included healthy, glaucoma suspect and glaucomatous eyes. All eyes underwent comprehensive glaucoma examination, including visual field tests and ocular imaging scans by OCTA. Parameters measured included retinal nerve fiber layer (RNFL) thickness, ganglion cell analysis (GCA), vascular perfusion density (VPD) and flux index (FI) of the optic nerve and peri-papillary area. Ocular parameters in healthy, glaucoma suspect, and glaucomatous eyes were compared by generalized estimating equations (GEE) with adjustments for age, with their relationships analyzed by Pearson's correlation coefficient. Rates of change per year were compared in glaucomatous eyes with and without glaucoma progression. This study enrolled 238 eyes, including 56 healthy, 79 glaucoma suspect, and 103 glaucomatous eyes. After adjustments for age, the average VPD (45.40 ± 0.19% vs 45.05 ± 0.22% vs 42.89 ± 0.32%, p < 0.001) and FI (0.4210 ± 0.0055 vs 0.4105 ± 0.0039 vs 0.3801 ± 0.0048, p < 0.001) in these three groups differed significantly. Average VPD in the glaucoma group was inversely associated with the severity of glaucoma, being 43.99 ± 0.32%, 42.63 ± 0.43% and 39.27 ± 0.48% in eyes with early, moderate and severe glaucoma, respectively (p < 0.001). Average VPD, as well as VPD in the superior and inferior quadrants correlated well with both OCT determined RNFL and visual field parameters. The decreases per year in both superior (-0.012 vs -0.001, p = 0.002) and inferior (-0.008 vs -0.003, p = 0.007) FI were significantly greater in glaucomatous eyes with than without glaucoma progression. Both VPD and FI as measured by OCTA are promising ocular parameters that can distinguish between normal and glaucomatous eyes. VPD is sensitive in comparing eyes at different glaucoma stages, whereas FI can detect rates of glaucoma progression. Thai Clinical Trial Registry, TCTR20181031002.

Topical hypotensive therapy preceding surgical treatment of glaucoma

PURPOSE. To analyze specific clinical and epidemiological parameters of patients with primary open-angle glaucoma (POAG) who were admitted for surgical treatment to the ophthalmological hospital of a multi-specialty in-patient medical center in the period of 2021–2022 years.METHODS. The retrospective elective study analyzed data from 95 patients (95 eyes) with different stages of primary open-angle glaucoma (mean age 73 [67; 80] years old) who were hospitalized for surgical treatment of the disease in 2021–2022. In addition to standard ophthalmological examination, several clinical and epidemiologic characteristics were analyzed in detail, including the prevalence of prescriptions for antiglaucoma hypotensive drugs. Comparison of the obtained results with the data of similar procedures performed in the period from 2005 to 2016 was carried out.RESULTS. The number of main comorbid somatic diseases was on average 3 (2; 4), and comparison of conditions by disease stage revealed no significant differences (p&gt;0.05). Mean duration of the disease (according to anamnesis) was 8 (4; 13) years and was longer in comparison with similar results from 2005–2006 presented in a previous study. The period preceding the first surgical intervention was 5 (2; 10) years and was statistically significantly longer in those with moderate stage of POAG (9 [3; 14] years) compared to those with early stage of POAG (4 [3; 5] years, p&lt;0.05) and advanced stage of POAG (6 [0; 10] years, p&lt;0.04). The average number of drugs at the time of hospitalization for surgical treatment has increased significantly in comparison with the data of the early-mid 2000s and amounted to 4 (3; 4) units (stage I glaucoma — 3 [3; 4]; stage II — 4 [3; 4]; stage III — 4 [3; 4] units), with no statistically significant difference (p1,2=0.64; p1,3=0.21; p2,3=0.42, respectively).CONCLUSION. Unwarranted long-term use of a large number of antiglaucoma drugs ("maximal medication therapy adherence") is a significant problem in modern glaucomatology and can evidently affect future prognosis of the disease.

Effectiveness and tolerability of the fixed combination of preservative-free drugs timolol and travoprost in glaucoma patients after cataract surgery

PURPOSE. The aim of the study was to evaluate the tolerability and effectiveness of the preservative-free combination eye drops timolol 0,5%/travoprost (Travapress Duo, ROMPHARM Company) when changing therapy in patients with initial and moderate stages of glaucoma after phacoemulsification of age-related cataract.METHODS. The study included 38 patients with disorders of the ocular surface with specific complaints, initial and moderate stages of glaucoma compensated for therapy with β-blockers and prostaglandin F2-α analogues. The patients were using monodrugs of these groups, or their fixed combinations. All patients had previously undergone phacoemulsification of age-related cataract with implantation of a monofocal aspherical intraocular lens. The main group consisted of 18 patients who underwent a change in antiglaucoma therapy to a preservative-free combination eye drops timolol 0,5%/travoprost (Travapress Duo, ROMPHARM Company) with once-per-day instillation regimen. Participants included in the control group (20 patients) remained on the treatment they had been using. All patients completed a questionnaire survey of subjective complaints and their condition, underwent assessment of the level of intraocular pressure (IOP), visual functions, parameters of the state of ocular surface (Schirmer test, epitheliopathy according to the Oxford scale), perimetric data on Humphrey 860 (Humphrey Field Analyzer III 860, Zeiss, USA), as well as morphometric parameters and indicators of retinal blood flow and optic nerve on OCT Cirrus 5000 Angioplex (Zeiss, USA) over three months of observation.RESULTS. After switching the drug all patients of the main group experienced a significant improvement in their subjective condition and gave less complaints about the ocular surface. At the same time, stable IOP compensation and no changes in retinal light sensitivity were achieved according to the results of perimetry, the morphometric data and indicators of retinal and optic nerve blood flow.CONCLUSION. The combined preservative-free eye drops timolol 0,5%/travoprost (Travapress Duo, ROMPHARM Company) is well tolerated by patients and is an effective antiglaucoma drug that allows achieving target IOP level with stabilization of morphological and functional parameters in patients with initial and moderate stages of glaucoma after previous cataract phacoemulsification.

Методы оптимизации комплексного лечения больных глаукомой после лазерной трабекулопластики

Aim. To evaluate the results of complex treatment of advanced stage POAG (stage III) with the use of Retinalamin. Methods.In a hospital under observation there were 67 patients (67 eyes) with stage III POAG, including 37 men and 28 women. The age of the patients varied from 53 to 78 years. Depending on the therapy, the patients were divided into two groups. The first (main group) after laser trabeculoplasty received Retinalamin in subconjunctival injections for 10 days and patients in the control group received Retinalamin in peribulbar injections. A comprehensive examination included general ophthalmological studies: visometry, perimetry, gonioscopy, biomicroscopy, ophthalmoscopy, tonometry, tonography, as well as dopplerography of retinal vessels. Results. A year later, stabilization of the glaucoma process in the main group was achieved in 89 % of cases, in the control group – in 68 %. Conclusion. In the late stages of glaucoma, in the complex of conservative treatment, it is pathogenetically justified to use laser trabeculoplasty followed by subconjunctival injection of Retinalamin for 10 days. Key words: POAG; laser trabeculoplasty; Retinalamin.

Disc damage likelihood scale: its correlation with field indices and its accuracy in diagnosis of glaucoma

: To find a correlation of the disc damage likelihood scale (DDLS) scale with visual field indices and its diagnostic power in cases of glaucoma.: The study enrolled 198 patients suffering from primary open angle glaucoma. The patients were investigated using Humphreys perimetry and ocular coherence tomography (OCT). The DDLS scoring for each patient was done which was then correlated with visual field indices and the accuracy of DDLS in scoring different stages of glaucoma was studied. Single center, prospective, observational study.: The DDLS showed a strong correlation with cup-disc ratio, a good correlation with visual field index and mean deviation values and a weak correlation with foveal sensitivity. Also, the scale showed 68.9%, 82.6% and 100% diagnostic accuracy in cases of mild, moderate and severe glaucoma respectively.: The DDLS is a strong adjunctive diagnostic tool that has helped in the diagnosis of glaucoma.

Utility of targeted mean total deviation trend analysis for detecting progressive visual field changes in early-to-moderate stage glaucoma.

To evaluate the clinical utility of trend-based analysis of the targeted mean total deviation (TMTD) by comparing its rates of visual field (VF) change and sensitivities of detecting VF progression with those of the mean total deviation (mTD) in the global and hemifield VF area in early to-moderate glaucoma patients. A single eye from 139 open-angle glaucoma patients with hemifield VF defects and a minimum two year follow-up were retrospectively evaluated. The TMTD was estimated by averaging the total deviation (TD) values after excluding VF points that had a threshold sensitivity of <0 dB in three baseline tests, and the mTD by averaging the entire VF TD values. The study patients were classified as VF progressors vs. non-progressors using both event- and trend-based analysis. The rates of change and ratios of progression detection were compared between TMTD and mTD. This study included 49 VF progressors and 90 non-progressors. Slopes for the global and VF-affected hemifield TMTD were significantly faster than those for the mTD in each subgroup and in the entire cohort (P < 0.001). Trend-based TMTD analysis detected VF progression in greater proportion than either trend-based mTD or event-based analysis (38.1% vs. 30.2% vs. 27.3%, respectively: VF affected hemifields). The rates of change in the TMTD are significantly faster than those for the mTD globally and in the VF-affected hemifields. Trend-based TMTD analysis shows greater sensitivity for detecting VF progression than trend-based mTD or event-based analysis in early-to-moderate glaucoma patients with hemifield VF loss.

Relationships of Macular Functional Impairment With Structural and Vascular Changes According to Glaucoma Severity.

To determine the pointwise relationships of central visual field (VF) defects with macular ganglion cell loss and macular vessel density (VD) loss during various stages of glaucoma. Eyes with primary open-angle glaucoma (POAG) were subjected to optical coherence tomography (OCT) and OCT angiography (OCTA) to evaluate macular ganglion cell layer (GCL) thickness and macular VD in the superficial and deep vascular complexes (SVC and DVC). OCT, OCTA, and VF locations were matched after correcting for retinal ganglion cell (RGC) displacement. Pointwise correlations of GCL thickness and VDs of the SVC and DVC with central VF sensitivity (VFS) were evaluated by Pearson's correlation analysis and compared in eyes with early and advanced POAG by Meng's test. Of the 100 eyes, 52 and 48 were classified as early and advanced POAG. Macular VD showed overall better correlation with central VFS than GCL thickness in both the early and advanced groups. SVC density showed the strongest correlation with central VFS in all groups (R = 0.327 in early group, R = 0.325 in advanced group, all P < 0.001). Although DVC density showed better correlation with VFS (R = 0.311) than GCL thickness (R = 0.212) in the early group (P < 0.001), the correlation was comparable in the advanced group (R = 0.199 and 0.176, respectively, P = 0.254). After adjustment for RGC displacement, macular SVC density was better correlated with central VFS than macular GCL thickness in both early and advanced POAG. Macular DVC density showed better correlation with VFS than GCL thickness in early but not in advanced POAG, indicating that DVC loss may be involved in early central VF loss.

Real-World Outcomes of Canaloplasty and Trabeculotomy Combined with Cataract Surgery in Eyes with All Stages of Open-Angle Glaucoma.

To evaluate the long-term safety and efficacy of sequential canaloplasty and trabeculotomy combined with cataract surgery in patients with mild, moderate, and advanced open-angle glaucoma. Case records of 171 consecutive patients (171 eyes) who had undergone cataract surgery followed by canaloplasty (≥180°) and trabeculotomy (≥90°) for mild, moderate, or advanced open-angle glaucoma (Shaffer grade ≥3) using the OMNI Surgical System (Sight Sciences, Inc., Menlo Park, CA) were analyzed retrospectively. Efficacy endpoints included change in mean IOP and number of medications from baseline to postoperative 12- and 24-months for the overall dataset and stratified by each stage of glaucoma. Kaplan-Meier survival analysis of success (eyes that did not require secondary surgical interventions (SSI)) by postoperative 24 months was also performed. Postoperatively, there was a statistically significant reduction in IOP (baseline of 17.2 mmHg on 1.3 medicines reduced to 14.3 on 0.8 medicines (12 months) and 14.0 on 0.9 medicines (24 months), p<0.001 for both time points). Eyes with advanced glaucoma (N=63) maintained significant IOP reduction (17.8 mmHg on 1.6 medicines at baseline reduced to 13.6 mmHg on 1.3 medicines (12 months) and 13.0 on 1.5 medicines (24 months), p<0.001). Kaplan-Meier analysis showed a 93.0% survival probability for the avoidance of SSI at 2 years after surgery. Canaloplasty and trabeculotomy combined with cataract surgery provided effective IOP reduction for eyes with all stages of glaucoma at postoperative 12 and 24 months, and the procedure yielded a 93% survival rate for SSI avoidance at 2 years.

Retinal OCT speckle as a biomarker for glaucoma diagnosis and staging.

This paper presents a novel image analysis strategy that increases the potential of macular Optical Coherence Tomography (OCT) by using speckle features as biomarkers in different stages of glaucoma. A large pool of features (480) were computed for a subset of macular OCT volumes of the Leuven eye study cohort. The dataset contained 258 subjects that were divided into four groups based on their glaucoma severity: Healthy (56), Mild (94), Moderate (48), and Severe (60). The OCT speckle features were categorized as statistical properties, statistical distributions, contrast, spatial gray-level dependence matrices, and frequency domain features. The averaged thicknesses of ten retinal layers were also collected. Kruskal-Wallis H test and multivariable regression models were used to infer the most significant features related to glaucoma severity classification and to the correlation with visual field mean deviation. Four features were selected as being the most relevant: the ganglion cell layer (GCL) and the inner plexiform layer (IPL) thicknesses, and two OCT speckle features, the data skewness computed on the retinal nerve fiber layer (RNFL) and the scale parameter (a) of the generalized gamma distribution fitted to the GCL data. Based on a significance level of 0.05, the regression models revealed that RNFL skewness exhibited the highest significance among the features considered for glaucoma severity staging (p-values of 8.6×10-6 for the logistic model and 2.8×10-7 for the linear model). Furthermore, it demonstrated a strong negative correlation with the visual field mean deviation (ρ=-0.64). The post hoc analysis revealed that, when distinguishing healthy controls from glaucoma subjects, GCL thickness is the most relevant feature (p-value of 8.7×10-5). Conversely, when comparing the Mild versus Moderate stages of glaucoma, RNFL skewness emerged as the only feature exhibiting statistical significance (p-value = 0.001). This work shows that macular OCT speckle contains information that is currently not used in clinical practice, and not only complements structural measurements (thickness) but also has a potential for glaucoma staging.

Development and Validation of the Low Vision Severely Constricted Peripheral Eyesight (LV-SCOPE) Questionnaire

To develop and validate a novel patient-reported outcome (PRO) measure to assess vision-related functioning in individuals with severe peripheral field loss (PFL). Prospective outcome measure development/validation study. A 127-item questionnaire was developed based on a prior qualitative interview study. A total of 116 participants with severe PFL due to retinitis pigmentosa (RP) or glaucoma were recruited at the Kellogg Eye Center and completed the Likert-scaled telephone-administered questionnaire. Included participants had a horizontal extent of their visual field <20 degrees (RP) or a mixed or generalized stage 4 to 5 defect using the Enhanced Glaucoma Staging System (glaucoma) in the better seeing eye (or in 1 eye if the fellow eye visual acuity was <20/200). Response data were analyzed using exploratory factor analysis and Rasch modeling. Poorly functioning items were eliminated, confirmatory factor analysis was used to ensure scale unidimensionality, and the model was refit to produce the final instrument. The final Low Vision Severely Constricted Peripheral Eyesight (LV-SCOPE) Questionnaire contains 53 items across 6 domains: mobility, object localization, object recognition, reading, social functioning, and technology. There were 74 items removed because of high missingness, poor factor loadings, low internal consistency, high local dependency, low item information, item redundancy, or differential item functioning. Using Rasch item calibrations, person ability scores could be calculated for each of the 6 unidimensional LV-SCOPE domains with good test-retest stability. The LV-SCOPE Questionnaire provides a valid and reliable measure of vision-related functioning across 6 key domains relevant to individuals with severe PFL. Findings support the clinical utility of this psychometrically valid instrument.

Three-Dimensional Structural Phenotype of the Optic Nerve Head as a Function of Glaucoma Severity

The 3-dimensional (3-D) structural phenotype of glaucoma as a function of severity was thoroughly described and analyzed, enhancing understanding of its intricate pathology beyond current clinical knowledge. To describe the 3-D structural differences in both connective and neural tissues of the optic nerve head (ONH) between different glaucoma stages using traditional and artificial intelligence-driven approaches. This cross-sectional, clinic-based study recruited 541 Chinese individuals receiving standard clinical care at Singapore National Eye Centre, Singapore, and 112 White participants of a prospective observational study at Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania. The study was conducted from May 2022 to January 2023. All participants had their ONH imaged using spectral-domain optical coherence tomography and had their visual field assessed by standard automated perimetry. (1) Clinician-defined 3-D structural parameters of the ONH and (2) 3-D structural landmarks identified by geometric deep learning that differentiated ONHs among 4 groups: no glaucoma, mild glaucoma (mean deviation [MD], ≥-6.00 dB), moderate glaucoma (MD, -6.01 to -12.00 dB), and advanced glaucoma (MD, <-12.00 dB). Study participants included 213 individuals without glaucoma (mean age, 63.4 years; 95% CI, 62.5-64.3 years; 126 females [59.2%]; 213 Chinese [100%] and 0 White individuals), 204 with mild glaucoma (mean age, 66.9 years; 95% CI, 66.0-67.8 years; 91 females [44.6%]; 178 Chinese [87.3%] and 26 White [12.7%] individuals), 118 with moderate glaucoma (mean age, 68.1 years; 95% CI, 66.8-69.4 years; 49 females [41.5%]; 97 Chinese [82.2%] and 21 White [17.8%] individuals), and 118 with advanced glaucoma (mean age, 68.5 years; 95% CI, 67.1-69.9 years; 43 females [36.4%]; 53 Chinese [44.9%] and 65 White [55.1%] individuals). The majority of ONH structural differences occurred in the early glaucoma stage, followed by a plateau effect in the later stages. Using a deep neural network, 3-D ONH structural differences were found to be present in both neural and connective tissues. Specifically, a mean of 57.4% (95% CI, 54.9%-59.9%, for no to mild glaucoma), 38.7% (95% CI, 36.9%-40.5%, for mild to moderate glaucoma), and 53.1 (95% CI, 50.8%-55.4%, for moderate to advanced glaucoma) of ONH landmarks that showed major structural differences were located in neural tissues with the remaining located in connective tissues. This study uncovered complex 3-D structural differences of the ONH in both neural and connective tissues as a function of glaucoma severity. Future longitudinal studies should seek to establish a connection between specific 3-D ONH structural changes and fast visual field deterioration and aim to improve the early detection of patients with rapid visual field loss in routine clinical care.

Fungal endophthalmitis following transscleral cyclophotocoagulation

Most cases of refractory glaucoma not amenable to filtration surgery or glaucoma drainage device are managed by cyclodestructive procedures. An 84-year-old female had undergone oculus sinister (OS) transscleral cyclophotocoagulation (TSCPC) after a diagnosis of OS closed angle stage of neovascular glaucoma was made. On the 1st week post-TSCPC, discharge on the conjunctival surface was noted along with a 6 mm hypopyon in the anterior chamber and associated vitritis. Treatment on the lines of fungal endophthalmitis was initiated. At 1 month review, the reaction had reduced significantly. Cases with significant reaction and vitritis post-TSCPC must be treated aggressively on the lines of endophthalmitis to salvage the globe. A rather safe approach to the management of such cases, TSCPC does have rare complications such as inadvertent sclerostomy or panophthalmitis, being reported as isolated case reports. To the best of our knowledge, this is the first case of fungal endophthalmitis being reported post-TSCPC.

Evaluation of inner retinal function at different stages of primary open angle glaucoma using the photopic negative response (PhNR) measured by RETeval electroretinography.

To investigate the objective function of the inner retinal layer in each stage of primary open angle glaucoma (POAG) using the photopic negative response (PhNR) measured by RETeval full-field electroretinography (ERG), and to identify which PhNR parameter is the most useful. Ninety eyes of 90 patients with POAG (30 with mild POAG (mean deviation (MD) ≥ -6dB) and 60 with moderate-to-advanced POAG (MD < -6dB)) and 76 eyes of 76 control cases were examined. We investigated six PhNR parameters and their relationships with the results of the Humphrey 30-2 visual field test and the thickness of the circumpapillary retinal nerve fiber layer (cpRNFL) obtained from optical coherence tomography. The following PhNR parameters were assessed: base-to-trough (BT), peak-to-trough (PT), 72msPhNR, the W-ratio, P-ratio, implicit time (IT), and a-wave and b-wave amplitudes on ERG. All PhNR parameters other than IT significantly differed between the all POAG (all stages) and control groups and between the moderate-to-advanced POAG and control groups. BT and 72msPhNR in the mild POAG group, significantly differed from those in the control group. Regarding the relationships between PhNR parameters and the visual field and between these parameters and cpRNFL thickness, correlations were observed between all PhNR parameters, except PT and IT, and both the visual field and cpRNFL thickness in the all and moderate-to-advanced POAG groups. 72msPhNR correlated with cpRNFL thickness in the mild POAG group. The area under the receiver operating characteristic curve was greater for BT than for the other PhNR parameters in both the mild and moderate-to-advanced POAG groups. The discriminant linear function for examining the presence or absence of POAG and the threshold for diagnosis were quantitatively obtained as follows. Regarding BT: discriminant = 0.505 × BT + 2.017; threshold = positive for POAG, negative for no POAG; correct answer rate = 80.7%. Concerning 72msPhNR: discriminant = 0.533 × 72msPhNR + 1.553; threshold = positive for POAG and negative for no POAG; correct answer rate = 77.1%. RETeval-measured PhNR parameters were useful for an objective evaluation of visual function in moderate-to-advanced POAG. BT appeared to be the most diagnostically useful parameter.

Neurofilament Light Chain in Aqueous Humor as a Marker of Neurodegeneration in Glaucoma.

Neurofilament light chain (NfL) is a neuronal cytoskeletal protein that has been identified as a marker of neurodegeneration in diseases of the central nervous system. In this study, we investigated whether NfL in the aqueous humor (AH) can serve as a marker of neurodegeneration in glaucoma in a racially diverse North American population. Single-center, case-control study. We enrolled patients with various types and stages of glaucoma undergoing planned ophthalmic surgery as part of their routine care and compared them with patients without glaucoma undergoing phacoemulsification for age-related cataract. We collected AH from 39 glaucoma patients and 10 patients without glaucoma. AH NfL was quantified using the Single-Molecule Array (Simoa)® NF-light assay (Quanterix). Demographic information, such as age, body mass index, sex, and self-reported race, as well as clinical information, such as pre-operative intraocular pressure (IOP), maximum IOP, and number of pre-operative glaucoma medications, was obtained by reviewing the medical record. Levels of AH NfL. In a model controlling for age and body mass index (BMI), NfL was significantly elevated in AH from glaucoma patients (mean: 429 pg/mL; standard deviation [SD]: 1136 pg/mL) compared to AH from patients without glaucoma (mean: 3.1 pg/mL; SD: 1.9 pg/mg): P = 0.002. Higher AH NfL was associated with higher maximum IOP (R = 0.44, P = 0.005), higher pre-operative IOP (R = 0.46, P = 0.003), and more pre-operative glaucoma medications (Rs = 0.61, P < 0.001). There was no association between AH NfL and Humphrey visual field mean deviation (R = -0.20, P = 0.220), retinal nerve fiber layer thickness as measured with optical coherence tomography (R = 0.07, P = 0.694), or glaucoma stage (Rs = 0.015, P = 0.935). Our findings suggest that AH NfL may have clinical utility as a marker of glaucomatous neurodegeneration.

Optical Coherence Tomography and Optical Coherence Tomography Angiography: Essential Tools for Detecting Glaucoma and Disease Progression.

Early diagnosis and detection of disease progression are critical to successful therapeutic intervention in glaucoma, the leading cause of irreversible blindness worldwide. Optical coherence tomography (OCT) is a non-invasive imaging technique that allows objective quantification in vivo of key glaucomatous structural changes in the retina and the optic nerve head (ONH). Advances in OCT technology have increased the scan speed and enhanced image quality, contributing to early glaucoma diagnosis and monitoring, as well as the visualization of critically important structures deep within the ONH, such as the lamina cribrosa. OCT angiography (OCTA) is a dye-free technique for noninvasively assessing ocular microvasculature, including capillaries within each plexus serving the macula, peripapillary retina and ONH regions, as well as the deeper vessels of the choroid. This layer-specific assessment of the microvasculature has provided evidence that retinal and choroidal vascular impairments can occur during early stages of glaucoma, suggesting that OCTA-derived measurements could be used as biomarkers for enhancing detection of glaucoma and its progression, as well as to reveal novel insights about pathophysiology. Moreover, these innovations have demonstrated that damage to the macula, a critical region for the vision-related quality of life, can be observed in the early stages of glaucomatous eyes, leading to a paradigm shift in glaucoma monitoring. Other advances in software and hardware, such as artificial intelligence-based algorithms, adaptive optics, and visible-light OCT, may further benefit clinical management of glaucoma in the future. This article reviews the utility of OCT and OCTA for glaucoma diagnosis and disease progression detection, emphasizes the importance of detecting macula damage in glaucoma, and highlights the future perspective of OCT and OCTA. We conclude that the OCT and OCTA are essential glaucoma detection and monitoring tools, leading to clinical and economic benefits for patients and society.

Selective Laser Trabeculoplasty-What Do We Know So Far? Review

Abstract Selective laser trabeculoplasty (SLT) has been used for lowering intraocular pressure (IOP) in patients with different types of glaucoma. It is a safe and effective procedure as initial or additional therapy when target IOP could not be achieved with medical therapy. SLT could specifically target pigmented cells in trabecular meshwork (TM) leaving nonpigmented cells unaffected, which may allow repeat treatments and thus has lower complication rate. It can be successfully used for IOP reduction in primary open angle glaucoma (POAG), normotensive glaucoma (NTG), pigmentary glaucoma (PG), pseudoexfoliation glaucoma (PXFG), primary angle closure glaucoma (PACG), silicone-oil-induced glaucoma, and high IOP after failed trabeculectomy. SLT could also be used in all stages of open agle glaucoma but failure of SLT in advanced glaucoma patients should go to immediate filtering surgery to avoid postoperative fibrosis. SLT reduces IOP fluctuation. IOP-lowering effect of SLT diminishes over time, but it can be repeated in order to achieve additional or recurrent IOP reduction. Higher baseline IOP up to a certain level is the strongest predictor of success after SLT.