Glaucoma Subtypes Research Articles

PREVALENCE OF GLAUCOMA IN NORTH COSTAL ANDHRA PRADESH

Aim: To study the prevalence of Glaucoma and its sub types in North costal Andhra Pradesh in South India. Results: Among the total number of 2,98,971 General ophthalmic OPD individuals, 4836 individuals referred to Glaucoma clinic on suspicion of glaucoma and 4320 patients are confirmed to have glaucoma after doing relevant investigations. 1884 primary open angle glaucoma (POAG), 1057 Primary Angle closure disease (PACD), 702 glaucoma suspect or at risk, 82 Juvenile Open angle glaucoma, 43 Normal Tension Glaucoma, 41 Ocular hypertension, 489 Secondary glaucoma, 22 congenital & Developmental Glaucoma are identified. Conclusion: This study revealed the prevalence of various subtypes of glaucoma which varies ethnic wise. The prevalence of POAG is more (43.6%), followed by PACG (24.5%), secondary glaucoma (11.3%), Juvenile Open angle glaucoma (1.9%), Normal Tension Glaucoma (1%), ocular hypertension (0.9%), congenital glaucoma (0.5%).

Effectiveness of Microinvasive Glaucoma Surgery in the United States: Intelligent Research in Sight Registry Analysis 2013–2019

To evaluate the effectiveness of microinvasive glaucoma surgery (MIGS) with and without concurrent phacoemulsification. Multicenter, retrospective cohort study. Patients in the Intelligent Research in Sight (IRIS®) Registry who underwent Xen gel stent (ab interno) implantation, endoscopic cyclophotocoagulation (ECP), or goniotomy or canaloplasty from 2013 through2019. Kaplan-Meier survival analysis was used to assess reoperation rates. We defined reoperation as any subsequent glaucoma surgery occurring 1 month to 3 years after the initial procedure. Multivariable Cox proportional hazard models were used to determine factors predictive of reoperation. Reoperation rate, mean intraocular pressure (IOP) and visual acuity (VA), postoperative complications, predictors of reoperation, and reoperation procedure type. A total of 79 363 eyes from 57 561 patients were included, with 15 118 eyes (19%) receiving stand-alone MIGS and 64 245 eyes (81%) receiving MIGS concurrent with phacoemulsification. Overall, patients who underwent MIGS concurrently with phacoemulsification showed lower reoperation rates compared with stand-alone MIGS, most pronounced in ECP and goniotomy or canaloplasty. At postoperative year 2, the cumulative reoperation rate for stand-alone procedures was 15% for ECP, 24% for Xen implantation, and 24% for goniotomy or canaloplasty compared with 3% for ECP, 19% for Xen implantation, and 6% for goniotomy or canaloplasty concurrent with phacoemulsification (P < 0.001 for each stand-alone MIGS vs. MIGS with phacoemulsification). Black race, older age, moderate and severe glaucoma, higher baseline IOP, and glaucoma subtype were associated with higher reoperation risk. Although IOP decreased in all groups, stand-alone MIGS showed a more substantial decrease in mean IOP. Complication rates from MIGS were low overall: 1% for ECP, 1% for Xen implantation, and 2% for goniotomy or canaloplasty. In current United States clinical practice, MIGS has substantially lower reoperation rates when performed with phacoemulsification, especially for ECP and goniotomy or canaloplasty. Approximately one-sixth of patients undergoing stand-alone ECP and one-quarter of patients undergoing stand-alone Xen implantation or goniotomy or canaloplasty require reoperation by 2 years. Black race, diagnosis coding of moderate to severe glaucoma, and higher baseline IOP were associated with higher risk of reoperation after MIGS procedures. Proprietary or commercial disclosure may be found after the references.

Micropulse diode laser therapy in refractory glaucoma

PurposeDescription of safety and efficacy of micropulse Transscleral cyclophotocoagulation as a treatment option for refractory glaucoma. MethodsThis is a prospective study including 39 eyes of 31 patients followed for refractory glaucoma, who benefited from transscleral cyclophotocoagulation using a microplused laser. The main indication for the procedure was increased ocular pressure refractory to quadritherapy in various types of glaucoma. The patients were treated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 ​nm. The parameters for the procedure were a duration of 90 ​s per hemisphere with a power of 2000 mW and an energy of 180 ​J. Both the upper and lower hemispheres were treated in the same procedure, sparing the 3 o'clock and 9 o'clock meridians, and all the patients benefited from a single treatment session. The following parameters were evaluated: ocular pain and overall tolerance; visual acuity; and the evolution of IOP postoperatively up to 9 months. ResultsThe glaucoma subtypes treated are as follows: primary open-angle glaucoma (n ​= ​05), chronic angle-closure glaucoma (n ​= ​13), neovascular glaucoma (n ​= ​07), aphakic glaucoma (n ​= ​06), malignant glaucoma (n ​= ​04), post-traumatic angle recession (n ​= ​02), and inflammatory glaucoma (n ​= ​02). The mean pre-operative intraocular pressure was 42.3 ​± ​5.2 ​mmHg and the mean post-operative intraocular pressure at 9 months was 16.9 ​± ​1.9 ​mmHg. The reduction in IOP was 49.9%. The average number of intraocular pressure-lowering medications used prior to surgery was four, and the average number of medications used at the 9-month post-operative visit was 2.0 ​± ​1.2 (70.3% of patients were on dual therapy). The overall success rate was 60.5%. ConclusionsMicropulse transscleral cyclophotocoagulation appears to be a safe and efficient treatment for refractory glaucoma. Its indications should therefore be broadened and proposed early in various situations.

The safety and validity of contact lens sensor (Triggerfish) in measuring diurnal variation of intraocular pressure (IOP)

With the current understanding of pathophysiology of glaucoma, the reduction of intraocular pressure (IOP) is the main evidence-based treatment which can prevent the progression of visual field defect (1). Several studies have shown that IOP varies throughout the day and night and patients with different glaucoma subtypes can have different circadian IOP patterns (2-4). In clinical practice, most ophthalmologists rely on the single measurement of IOP in clinic at each patient visit to monitor the control of IOP and thereby monitor the control of glaucoma. The peak IOP during after-hours is frequently underestimated by this form of measurement because it can only provide a single temporal value. Therefore, it is clear that in order to better manage glaucomatous patients, it is necessary to keep track of how their IOP changes over time.

Comparing corneal biomechanics and intraocular pressure between healthy individuals and glaucoma subtypes: A cross-sectional study.

BackgroundThe utilization of corneal biomechanical features in evaluating glaucoma and its progression has received particular attention. The severity of corneal biomechanical changes can play an essential role in response to medical or surgical treatment. The present study evaluated the biomechanical features of the cornea in glaucoma patients in different subtypes and compared them with the normal condition.MethodsIn this cross-sectional study, glaucoma patients and healthy individuals were referred to the tertiary hospital in 2021. Both eyes underwent a complete ophthalmologic examination, intraocular pressure measurement, and corneal biomechanical parameters using Corvis and ORA devices. Finally, data from both groups were compared.ResultsBased on the ORA evaluation, Lower CRF and CH were seen in glaucoma patients. In the Corvis evaluation, minor differences were observed in glaucoma as increased pachy, radius, and pachy slope, and decreased HC deformation amplitude, HC deflection amplitude, HC deflection area, deflection amplitude max, dArc length max, max inverse radius, and integrated radius. Lower ACD and higher CCT differentiated PACG from others. Lower CCT and higher C/D and WTW indicated NTG. Based on ORA, the highest CRF and CH were related to PACG and the lowest related to PEXG. In contrast, based on Corvis, higher pachy and radius and lower max inverse radius and integrated radius were specified for PACG. PEXG also had the highest values of the last two parameters.ConclusionEvaluation of corneal biomechanical parameters and other indicators can be beneficial in assessing the status and severity of glaucoma and distinguishing between disease subtypes.

Multicenter Effectiveness and Disease Stability Through 3 Years After iStentTrabecular Micro-Bypass with Phacoemulsification in Glaucoma and Ocular Hypertension.

PurposeTo evaluate 3-year safety and efficacy of two second-generation trabecular micro-bypass stents. (iStent inject®) with phacoemulsification.Materials and MethodsThis multicenter retrospective study of iStent inject implantation with phacoemulsification included data from eight surgeons across Australia. Eyes with cataract and mild to advanced glaucoma [predominantly primary open-angle (POAG), primary angle closure (PAC), or normal-tension (NTG) glaucoma] or ocular hypertension (OHT) were included. Study assessments included intraocular pressure (IOP); number of ocular hypotensive medications; proportions of eyes with 0, 1, 2, or ≥3 IOP-lowering medications; IOP ≤15 mmHg or ≤18 mmHg; visual fields (VF); retinal nerve fiber layer thickness (RNFL); central corneal thickness (CCT); intraoperative complications; adverse events; and secondary surgeries.ResultsA total of 273 eyes underwent surgery and had 36-month follow-up. At 36 months versus preoperative, mean IOP decreased by 15.5% (16.4±4.6 mmHg to 13.9±3.5 mmHg; p<0.001), and 70.3% of eyes achieved IOP of ≤15 mmHg (versus 49.1% preoperatively; p<0.001). The mean medication burden decreased by 68.5% (from 1.51±1.17 to 0.48±0.89 medications; p<0.001); 71.4% of eyes were medication-free (versus 21.6% preoperatively; p<0.001), while 6.2% of eyes were on ≥3 medications (versus 22.3% preoperatively; p<0.001); 96.3% of eyes maintained or reduced medications vs preoperative. Significant IOP and medication reductions occurred across glaucoma subtypes (POAG, PAC, NTG, OHT): 13–22% for IOP (p<0.05 for all) and 42–94% for medication (p<0.05 for all). Favorable safety included few adverse events; stable VF, RNFL, and CCT; and filtering surgery in only 8 eyes (2.9%) over 3 years.ConclusionIn this multicenter cohort from 8 surgeons across Australia, significant IOP and medication reductions were sustained through 3 years after iStent inject implantation with phacoemulsification. Results were favorable across different glaucoma subtypes (including POAG, PAC, NTG, OHT), severities, and surgeons, thereby underscoring the real-world relevance and efficacy of iStent inject implantation for glaucoma treatment.

Medium-term Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma.

AimTo describe our first experience with the efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) procedure in the treatment of different glaucoma subtypes refractory to topical medication using a standard protocol.Materials and methodsRetrospective, interventional study in a series of 35 eyes of 34 patients with refractory glaucoma who underwent MP-TSCPC. Treatment success was defined as an intraocular pressure (IOP) reduction of at least 20% compared to baseline with or without IOP-lowering medication or eventual retreatment.ResultsMean age was 78.0 years. The glaucoma subtypes included pseudoexfoliative (PSXG) (16), neovascular (NVG) (9), primary open-angle (POAG) (7), congenital (1), aphakic (1), and secondary glaucoma (1). The mean preoperative IOP was 31.8 ± 10.5 mm Hg and at month 12 was 21.9 ± 10.6 mm Hg (p < 0.05). The average baseline number of glaucoma medications pretreatment was 3.0 ± 1.0 and at month 12 was 2.3 ± 1.2 (p = 0.114). At month 12, success was achieved in 15 eyes (42.9%) with an IOP-lowering effect of 31.1%. PSXG was correlated with IOP reduction (p = 0.037) and had a higher likelihood of success (p = 0.031). As complications, there was one case of prolonged hypotony and another case of developed postoperative neurotrophic keratopathy.ConclusionUsing our standardized protocol, MP-TSCPC seems a safe and relatively effective treatment in the medium-term for refractory glaucoma, achieving good results in PSXG.Clinical significanceThere are few studies published about MP-TSCPC. The results of our study contribute to expanding on the short evidence reported at present, emphasizing our considerable percentage of PSGX.How to cite this articleValle IT, Bazarra SP, Taboas MF, et al. Medium-term Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma. J Curr Glaucoma Pract 2022;16(2):91-95.

Cognitive Performance on the Montreal Cognitive Assessment Test and Retinal Structural and Functional Measures in Glaucoma.

Background: Glaucoma, the leading cause of irreversible blindness, is classified as a neurodegenerative disease, and its incidence increases with age. Pathophysiological changes, such as the deposition of amyloid-beta plaques in the retinal ganglion cell layer, as well as neuropsychological changes, including cognitive decline, have been reported in glaucoma. However, the association between cognitive ability and retinal functional and structural measures in glaucoma, particularly glaucoma subtypes, has not been studied. We studied the association between cognitive ability and the visual field reliability indices as well as the retinal ganglion cell (RGC) count estimates in a cohort of glaucoma patients. Methods: A total of 95 eyes from 61 glaucoma patients were included. From these, 20 were normal-tension glaucoma (NTG), 25 were primary open-angle glaucoma (POAG), and 16 were glaucoma suspects. All the participants had a computerised Humphrey visual field (HVF) assessment and optical coherence tomography (OCT) scan and were administered the written Montreal Cognitive Assessment (MoCA) test. RGC count estimates were derived based on established formulas using the HVF and OCT results. A MoCA cut-off score of 25 and less was designated as cognitive impairment. Student’s t-test was used to assess differences between the groups. The Pearson correlation coefficient was used to assess the association between MoCA scores and retinal structural and functional measures. Results: Significant associations were found between MoCA scores and the false-negative and pattern standard deviation indices recorded on the HVF (r = −0.19, r = −0.22, p < 0.05). The mean IOP was significantly lower in the cognitively impaired group (i.e., MOCA ≤ 25) (13.7 ± 3.6 vs. 15.7 ± 4.5, p < 0.05). No significant association was found between RGC count estimates and MoCA scores. Analysis of these parameters in individual glaucoma subtypes did not reveal any group-specific significant associations either.

Differing Associations between Optic Nerve Head Strains and Visual Field Loss in Patients with Normal- and High-Tension Glaucoma

To study the associations between optic nerve head (ONH) strains under intraocular pressure (IOP) elevation with retinal sensitivity in patients with glaucoma. Clinic-based cross-sectional study. Two hundred twenty-nine patients with primary open-angle glaucoma (subdivided into 115 patients with high-tension glaucoma [HTG] and 114 patients with normal-tension glaucoma [NTG]). For 1 eye of each patient, we imaged the ONH using spectral-domain OCT under the following conditions: (1) primary gaze and (2) primary gaze with acute IOP elevation (to approximately 35 mmHg) achieved through ophthalmodynamometry. A 3-dimensional strain-mapping algorithm was applied to quantify IOP-induced ONH tissue strain (i.e., deformation) in each ONH. Strains in the prelaminar tissue (PLT), the retina, the choroid, the sclera, and the lamina cribrosa (LC) were associated (using linear regression) with measures of retinal sensitivity from the 24-2 Humphrey visual field test (Carl Zeiss Meditec). This was performed globally, then locally according to a previously published regionalization scheme. Associations between ONH strains and values of retinal sensitivity from visual field testing. For patients with HTG, we found (1) significant negative linear associations between ONH strains and retinal sensitivity (P < 0.001; on average, a 1% increase in ONH strains corresponded to a decrease in retinal sensitivity of 1.1 decibels [dB]), (2) that high-strain regions colocalized with anatomically mapped regions of high visual field loss, and (3) that the strongest negative associations were observed in the superior region and in the PLT. In contrast, for patients with NTG, no significant associations between strains and retinal sensitivity were observed except in the superotemporal region of the LC. We found significant negative associations between IOP-induced ONH strains and retinal sensitivity in a relatively large glaucoma cohort. Specifically, patients with HTG who experienced higher ONH strains were more likely to exhibit lower retinal sensitivities. Interestingly, this trend in general was less pronounced in patients with NTG, which could suggest a distinct pathophysiologic relationship between the two glaucoma subtypes.

IStent Trabecular Micro-bypass Stent Implantation Combined with Phacoemulsification for Open-Angle Glaucoma: A 2-Year Post-marketing Surveillance Study in Japan.

IntroductionWe report 2-year outcomes after implantation of iStent trabecular micro-bypass stent with phacoemulsification, in Japanese patients with mild–moderate open-angle glaucoma (OAG).MethodsThis was a 24-month, prospective, longitudinal, observational, post-marketing study conducted between July 2017 and September 2020. Patients consisted of adults with OAG on antiglaucoma medications who had cataract surgery combined with one iStent implantation. Outcome measures included intraocular pressure (IOP), antiglaucoma medications, treatment success rates (defined as eyes having lower IOP with same or reduced number of medications from baseline, or same IOP with reduced number of medications from baseline, and not requiring secondary glaucoma surgeries postoperatively), and safety. Outcomes were analyzed in the overall cohort and in glaucoma subtypes: primary OAG, normal-tension glaucoma, and exfoliative glaucoma.ResultsOverall, 232 eyes were enrolled. At 24 months, mean ± standard deviation IOP decreased from 17.6 ± 4.0 mmHg preoperatively to 14.3 ± 3.0 mmHg (p < 0.05), and mean number of medications reduced from 2.2 ± 1.2 preoperatively to 0.7 ± 1.2 (p < 0.05). Similar trends were observed across glaucoma subtypes. In the overall cohort, 96.7%, 95.3%, and 93.7% of patients achieved treatment success at 6, 12, and 24 months, respectively. There were 67.6% medication-free eyes at 24 months compared to 3.2% medication-free eyes preoperatively (p < 0.0001). Safety profile was favorable over the 2-year period.ConclusionsFollowing iStent implantation with phacoemulsification, clinically relevant and statistically significant reductions in IOP and number of medications were observed in Japanese eyes with OAG over 2 years, with favorable safety profile. These reductions were observed across all glaucoma subtypes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02207-0.

Efficacy and safety of trabeculectomy versus peripheral iridectomy plus goniotomy in advanced primary angle-closure glaucoma: study protocol for a multicentre, non-inferiority, randomised controlled trial (the TVG study)

IntroductionPrimary angle-closure glaucoma (PACG) is a major subtype of glaucoma that accounts for most bilateral glaucoma-related blindness globally. Filtering surgery is a conventional strategy for PACG, yet it has a...

The Prevalence of Glaucoma in the Jirel Ethnic Group of Nepal.

Glaucoma is one of the leading causes of blindness worldwide with individuals in Asia disproportionately affected. Using a cross-sectional study design as part of the Jiri Eye Study, we assessed the prevalence of glaucoma in the Jirel population of Nepal and provide new information on the occurrence of glaucoma in south central Asia. Over a four-year period, 2,042 members of the Jirel population, aged 18 years and older, underwent a detailed ocular examination. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology criteria. The mean (SD) age at exam was 42.3 (16.7) years and 54.1% of the sample was female. In the total sample, the mean (SD) intraocular pressure (IOP) and vertical cup-to-disc ratio (VCDR) was 14.55 (2.42) mmHg and 0.31 (0.15), respectively. The 97.5th and 99.5th percentile for IOP and VCDR was 20 mmHg and 22 mmHg, and 0.7 and 0.8, respectively. The overall prevalence of glaucoma in the population was 2.30% (n = 47). Of these 47 individuals, 37 (78.7%) had primary open angle glaucoma, 6 (12.8%) had primary angle closure glaucoma, and 4 (8.5%) had secondary glaucoma. There was a significant (p = 5.86×10-6) increase in the prevalence of glaucoma with increasing age overall and across glaucoma subtypes. Six individuals with glaucoma (12.8%) were blind in at least one eye. Of the individuals with glaucoma, 93.6% were previously undiagnosed. In individuals aged 40 years or older (n=1057, 51.4% female), the mean (SD) IOP and VCDR was 14.39 (2.63) mmHg and 0.34 (0.16), respectively, and glaucoma prevalence was 4.16% (n = 44). The prevalence of glaucoma and undiagnosed disease is high in the Jirel population of Nepal. This study will inform strategies to minimize glaucoma-associated burden in Nepal.

Bioinformatic Prioritization and Functional Annotation of GWAS-Based Candidate Genes for Primary Open-Angle Glaucoma.

Background: Primary open-angle glaucoma (POAG) is the most prevalent glaucoma subtype, but its exact etiology is still unknown. In this study, we aimed to prioritize the most likely ‘causal’ genes and identify functional characteristics and underlying biological pathways of POAG candidate genes. Methods: We used the results of a large POAG genome-wide association analysis study from GERA and UK Biobank cohorts. First, we performed systematic gene-prioritization analyses based on: (i) nearest genes; (ii) nonsynonymous single-nucleotide polymorphisms; (iii) co-regulation analysis; (iv) transcriptome-wide association studies; and (v) epigenomic data. Next, we performed functional enrichment analyses to find overrepresented functional pathways and tissues. Results: We identified 142 prioritized genes, of which 64 were novel for POAG. BICC1, AFAP1, and ABCA1 were the most highly prioritized genes based on four or more lines of evidence. The most significant pathways were related to extracellular matrix turnover, transforming growth factor-β, blood vessel development, and retinoic acid receptor signaling. Ocular tissues such as sclera and trabecular meshwork showed enrichment in prioritized gene expression (>1.5 fold). We found pleiotropy of POAG with intraocular pressure and optic-disc parameters, as well as genetic correlation with hypertension and diabetes-related eye disease. Conclusions: Our findings contribute to a better understanding of the molecular mechanisms underlying glaucoma pathogenesis and have prioritized many novel candidate genes for functional follow-up studies.

Rho kinase inhibitor for primary open-angle glaucoma and ocular hypertension.

Rho kinase inhibitor for primary open-angle glaucoma and ocular hypertension.

Long-term outcomes of pars plana Ahmed valve implant and vitrectomy in eyes with refractory glaucoma.

Pars plana vitrectomy with implantation of an Ahmed glaucoma valve in the vitreous cavity has been reported with a success rate in the management of refractory and neovascular glaucoma. This study aimed to present the outcomes of pars plana Ahmed glaucoma valve (PPAV) surgical implantation in cases with refractory glaucoma. In this single-center, retrospective, comparative study, 87 consecutive patients diagnosed with refractory glaucoma who underwent PPAV surgical implantation between October 2015 and October 2019 were evaluated. A successful postoperative outcome was defined as intraocular pressure (IOP) ≤ 21 mmHg upon examination and a reduction in the number of anti-glaucoma agents used at the latest follow-up. Finally, 81 eyes of 78 patients with refractory glaucoma were included; 54 (66.66%) of the eyes had neovascular glaucoma. The mean follow-up was 20.65 ± 12.17 months (range: 2-52 months). The mean preoperative IOP was 40.01 ± 1.19 mmHg and reduced significantly to 16.73 ± 0.82 mmHg at the latest follow-up (P < 0.001); a successful IOP outcome was achieved in 88.89% of eyes. The mean number of anti-glaucoma agents decreased significantly from 2.86 ± 0.09 preoperatively to 1.46 ± 0.11 at the latest follow-up (P < 0.001); while 61 (75.31%) of eyes had a reduction in the number of IOP lowering eye drops, and 14 (17.28%) had no need for IOP lowering eye drops. PPAV surgery is a successful procedure for IOP reduction in patients with refractory glaucoma. Our study demonstrated either reduction or elimination of IOP lowering eye drops postoperatively. Large scale studies with a comparison group, a longer follow-up, and having various subtypes of glaucoma are required as future research to confirm these outcomes.

Efficacy of ab-interno gelatin microstent implantation in primary and refractory glaucoma

ObjectifÉvaluer les résultats de l'implantation ab interno d'une micro-endoprothèse en gélatine seule ou en association avec la phacoémulsification, en vue de réduire la pression intraoculaire (PIO). NatureÉtude de cohorte rétrospective. ParticipantsOnt été inclus 141 yeux de 141 patients (peu importe le type de glaucome, y compris le glaucome réfractaire) qui ont fait l'objet d'une chirurgie au Centre hospitalier de l'Université de Montréal (CHUM) entre 2015 et 2018. Les patients ont été admis à l’étude s'ils avaient plus de 40 ans et si leur PIO préopératoire était > 18 mm Hg sous l'effet du traitement médicamenteux maximal toléré. MéthodesTous les patients ont fait l'objet de l'implantation ab interno d'une micro-endoprothèse (XEN-45, Allergan, Madison, NJ) sous couvert de mitomycine C avec ou sans phacoémulsification. Le paramètre principal était la réussite chirurgicale complète (PIO : 6-18 mm Hg et baisse < 20 % par rapport aux valeurs de départ, sans prise de médicament permettant d'abaisser la PIO ni nouvelle intervention ou cyclophotocoagulation); au nombre des paramètres secondaires, mentionnons les suivants : succès mitigé s'accompagnant de la prise de médicaments, réduction en pourcentage de la PIO moyenne et du nombre de médicaments administrés, et baisse du nombre de complications, d'interventions et de nouvelles chirurgies. RésultatsLa durée moyenne du suivi a été de 30,5 ± 10,2 mois (± é.-t.). La PIO moyenne se chiffrait à 23,3 ± 7,0 mm Hg malgré la prise de 3,4 ± 0,8 médicaments au départ et à 13,3 ± 4,7 mm Hg malgré la prise de 1,9 ± 1,5 médicament lors du suivi à 24 mois (p < 0,001). Selon l'analyse de survie à 24 mois, on estime que 34,1 % des yeux qui ont reçu une micro-endoprothèse ont bénéficié d'une réussite complète, comparativement à 20,7 % pour le groupe avec phacoémulsification (p = 0,02); le succès a été mitigé dans 79,1 % des yeux qui ont reçu une micro-endoprothèse, comparativement à 75,1 % dans le groupe avec phacoémulsification (p = 0,86). Le taux d’échec a été plus élevé dans le groupe avec phacoémulsification (rapport de risque [RR] = 1,6; intervalle de confiance [IC] à 95 %: 1,1–2,3; p = 0,02). On a dû recourir à un aiguilletage de mitomycine C ou de 5-fluorouracil en période postopératoire dans 54 yeux (38,3 %). L'hypotonie transitoire (10,6 %), l'hyphéma transitoire (6,4 %), l’œdème maculaire (4,3 %) et l'extrusion de la micro-endoprothèse (2,8 %) comptaient au nombre des complications. On a dû opérer à nouveau 33 yeux (23,4 %), et 14 yeux (9,9 %) ont dû par la suite faire l'objet d'une cyclophotocoagulation au laser. ConclusionsDans la plupart des cas, l'implantation d'une micro-endoprothèse a dû être complétée d'un traitement topique dans les 24 mois suivant la chirurgie visant le traitement d'un glaucome primaire et réfractaire. Qui plus est, l'ajout d'une phacoémulsification s'accompagnait d'un risque plus élevé d’échec.

The Retinal Renin-Angiotensin-Aldosterone System: Implications for Glaucoma.

Aldosterone is one of the main effectors of the renin-angiotensin-aldosterone system (RAAS) along with having roles in hypertension, and cardiovascular and renal diseases. Recent evidence has also shown the presence of an active local RAAS within the human eye. It has been shown that at 12 h after a retinal ischemia-reperfusion injury, there is an upregulation of the protein levels of angiotensin II type 1 receptor (AT1-R) in the retina. Furthermore, at 12 h after reperfusion, there is an increase in reactive oxygen species (ROS) production in the retina that is mediated via an NADPH oxidase pathway. This ischemia-reperfusion injury-induced increase of retinal ROS levels and NADPH oxidase expression can be prevented by the administration of an AT1-R antagonist. This suggests that one of the main retinal ischemic injury pathways is via the local RAAS. It has also been reported that progressive retinal ganglion cell loss and glaucomatous optic nerve degeneration without elevated intraocular pressure occur after administration of local or systemic aldosterone. Elucidation of glaucoma pathogenesis, especially normal-tension glaucoma (NTG) subtype by our current animal model can be used for identifying potential therapeutic targets. Based on these results, we are further evaluating NTG prevalence among primary aldosteronism patients.

Management of Childhood Glaucoma Following Cataract Surgery.

Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for ‘glaucoma following cataract surgery’ (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to propose a clinical management strategy for GFCS cases. A literature search was conducted in four large databases (Cochrane, PubMed, Embase, and Web of Science), from 1995 up to December 2021. Thirty-nine studies—presenting (1) eyes with GFCS; a disease entity as defined by the Childhood Glaucoma Research Network Classification, (2) data on treatment outcomes, and (3) follow-up data of at least 6 months—were included. Included papers report on GFCS treated with angle surgery, trabeculectomy, glaucoma drainage device implantation (GDD), and cyclodestructive procedures. Medical therapy is the first-line treatment in GFCS, possibly to bridge time to surgery. Multiple surgical procedures are often required to adequately control GFCS. Angle surgery (360 degree) may be considered before proceeding to GDD implantation, since this technique offers good results and is less invasive. Literature suggests that GDD implantation gives the best chance for long-term IOP control in childhood GFCS and some studies put this technique forward as a good choice for primary surgery. Cyclodestruction seems to be effective in some cases with uncontrolled IOP. Trabeculectomy should be avoided, especially in children under the age of one year and children that are left aphakic. The authors provide a flowchart to guide the management of individual GFCS cases.

The Incidence Risk for Primary Glaucoma and Its Subtypes following Chronic Exposure to Ionizing Radiation in the Russian Cohort of Mayak Nuclear Workers.

Simple SummaryGlaucoma is a leading cause of irreversible blindness worldwide and also represents one of the normal tissue complications following radiation therapy involving ocular radiation exposure. It has widely been considered that such secondary glaucoma occurs at fractionated high dose (several tens of Gy). In contrast, this study is the first to report that normal-tension glaucoma (a subtype of primary open-angle glaucoma) occurs in radiation workers at a chronic dose of >1 Gy. Such elevated risk of radiogenic normal-tension glaucoma, if confirmed in other cohorts, has significant implications for normal tissue complications in radiotherapy patients receiving ocular radiation exposure, and for ocular radiation protection in radiation workers.Secondary glaucoma is a typical normal tissue complication following radiation therapy involving ocular radiation exposure at high fractionated dose (several tens of Gy). In contrast, recent studies in acutely exposed Japanese atomic bomb survivors showed a significantly increased risk for normal-tension glaucoma (NTG, a subtype of primary open-angle glaucoma) at much lower dose, but such information is not available in any other cohorts. We therefore set out to evaluate the incidence of risk for primary glaucoma and its subtypes in a Russian cohort of Mayak Production Association nuclear workers who received chronic radiation exposure over many years. Of these, we found a significantly increased relative risk (RR) of NTG incidence (RR = 1.88 95% confidence intervals (CI): 1.01, 3.51; p = 0.047) in workers exposed to gamma rays at cumulative brain absorbed dose above >1 Gy. We observed the linear relationship between NTG incidence and brain absorbed gamma dose with an excess relative risk per unit brain absorbed dose of 0.53 (95% CI: 0.01, 1.68; p < 0.05), but not for any other subtypes nor for total primary glaucoma. Such elevated risk of radiogenic NTG incidence, if confirmed in other cohorts, has significant implications for normal tissue complications in radiotherapy patients receiving ocular radiation exposure, and for ocular radiation protection in radiation workers.

Effect of peripheral iridectomy on VEGF-A and TGF-\u03b2 levels in rabbit aqueous humour

BackgroundPeripheral iridectomy (PI), routinely performed during glaucoma filtration surgery, may contribute to scarring. This study aims to determine whether PI alters the concentrations of VEGF-A and TGF-β isoforms in the rabbit aqueous humour.MethodsAnterior chamber paracentesis (ACP) was performed in both eyes of six New Zealand white rabbits, with additional surgical PI performed in the right eyes. Eyes were examined on postoperative days (PODs) 1, 7, 30 and 60 by means of the tonopen, slit-lamp biomicroscopy, and bead-based cytokine assays for TGF-β and VEGF-A concentrations in the aqueous humor.ResultsACP caused a significant reduction in intraocular pressure (IOP) from mean preoperative 11.47 ± 1.01 mmHg to 5.67 ± 1.63 mmHg on POD 1 while PI did not cause further IOP reduction. Limbal conjunctival vasculature appeared slightly increased on POD 1 in both ACP and PI eyes with PI also causing mild bleeding from damaged iris vessels. Two PI eyes developed fibrinous anterior chamber reaction and/ or peripheral anterior synechiae. Aqueous VEGF-A levels were not significantly different between eyes treated with ACP and PI. Aqueous TGF-β concentrations distributed in the ratio of 4:800:1 for TGF-β1:TGF-β2:TGF-β3 respectively. While aqueous TGF-β2 was not significantly induced by either procedure at any time point, TGF-β1 and TGF-β3 were significantly induced above baseline levels by PI on POD 1.ConclusionPI increases the risk of inflammation. The combined induction of aqueous TGF-β1 and TGF-β3 by PI in glaucoma surgery may impact surgery success in glaucoma subtypes sensitive to these isoforms.