Glaucoma Surgery Research Articles

Severe Case Of Delayed Diagnosed Of >10 Years Untreated Newborn Congenital Glaucoma

Introduction : Though cases of newborn primary congenital glaucoma (PCG) had poor prognosis, we couldn’t simply ignore that early proper diagnostic and treatment can still improves quality of one’s sight, which’s absent in this case. Presented with delayed diagnosed highly suspected case of newborn PCG, physician was compelled to make the best in condition of the already given poor prognosis to begin with.
 Case Illustration : A 13 years old female patient came to eye clinic with a very disturbing chronic condition of visual loss. Accompanied by her family, who also claimed had witnessed both the patient’s eyes appeared whitish since birth. Eye examination revealed visual acuity of 1/~ for right eye and no light perception for left eye, along with significant signs of buphthalmos, epiphora, nystagmus, megalocornea (diameter of 9x14mm right eye and 9x13.3mm left eye), cloudy cornea, leukocoria, and Schiotz tonometry of 60-100mmHg in both eyes. Patient then received oral Acetazolamide, Levofloxacin eye drop, and Timolol Maleate 0,5% eye drop; then advised to return for one week evaluation also to bring her siblings to be subjected to glaucoma screening.
 Discussion : The decision to perform surgical intervention in cases of newborn PCG commonly require further thoughts. This case immediately shifted our focus towards palliative care of the patient whilst continuing monitoring IOP, as glaucoma surgery possessed a more menacing risk to be performed this patient.
 Conclusion : All cases of pediatric glaucoma require a life time of comprehensive management that requires heedfulness especially from caregivers as it is a very challenging disease.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma.

To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18mmHg, and (3) IOP ≤ 15mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4mmHg and 32.3 ± 8.4mmHg, respectively, which significantly reduced to 14.5 ± 0.7mmHg and 11.6 ± 0.6mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Powikłania po trabekulektomii, aktualne strategie działania – przegląd piśmiennictwa

Glaucoma is the first cause of blindness in Europe and over the world. The purposes of its treatment are lowering intraocular pressure. For patients who have visual potential, conventional glaucoma surgery such as trabeculectomy is frequently performed. The most common failures of it are associated with functioning of the filtering bleb, which causes inappropriate filtration and ultimately hypotony or increased intraocular pressure. Prevention or good treatment of complications after trabeculectomy is necessary to achieve long-term success of anti-glaucoma surgery.

Comparative evaluation of iStent versus iStent inject W combined with phacoemulsification in open angle glaucoma.

The study aimed to compare the 12-month post-operative outcomes of iStent and iStent inject W (inject W), and the factors associated with their success in open-angle glaucoma. This single-center, retrospective comparative case series evaluated the medical records of patients who underwent iStent (comprising 1 stent) or inject W (comprising 2 stents) implantation with cataract surgery for primary open-angle glaucoma and normal tension glaucoma between January 2019 and March 2022. The 12-month post-operative efficacy outcomes included intraocular pressure (IOP), glaucoma medications, and survival analysis of the probability of success. "Failure" was defined as any of the following conditions compared to baseline: 1) IOP elevation, 2) increased glaucoma medication, or 3) IOP decline not exceeding 20% when glaucoma medication scores were comparable, and 4) need for additional glaucoma surgery. The safety outcomes included intra- and post-operative adverse events and changes in the best-corrected visual acuity and visual field. The study comprised 55 eyes in the iStent and 105 in the inject W groups. At 12 months, treatment success was achieved in 66.0% of iStent and 78.4% of inject W eyes. The mean IOP was lower, and the percent reduction from baseline was equal in iStent-treated eyes (8.0% reduction, 14.8 mmHg to 13.7 mmHg, P<0.01) and inject W-treated eyes (11.9% reduction, 15.0 mmHg to 13.8 mmHg, P<0.01) (between-group comparison, P = 0.23). The mean medication burden decreased significantly from 2.5 to 1.1 for iStent (55.0% reduction, P<0.01) and 2.9 to 1.7 for iStent inject (46.8% reduction, P<0.01), with no significant differences between the two groups (P = 0.17). Both devices exhibited excellent safety. Both devices significantly reduced IOP and glaucoma medication 12 months post-operatively. The outcome measures did not differ significantly between the two groups, and lower baseline IOP was predictive of surgical failure.

Ten-Year Outcome of Boston Type I Keratoprosthesis Surgery at a Tertiary Care Center.

The aim of this study was to report long-term outcomes of patients who have undergone Boston type I keratoprosthesis (KPro) surgery. This study was a retrospective review. Inclusion criteria were KPro surgery between 2006 and 2012 and at least 10 years of follow-up. Demographics, ocular history, surgery indication, clinical variables, and postsurgical outcomes were recorded. Descriptive statistical analysis was performed. We identified 75 patients with KPro implantation, and 17 patients with at least 10 years of follow-up (median = 11.1 years; range, 10.0-12.8 years) were included. Of 17 eyes, 11 (64.8%) had their original device in situ, 3 (17.6%) had their second device in situ, 1 (5.9%) had the device removed and replaced with a donor keratoplasty, and 2 (11.8%) were enucleated. At the last follow-up, 11 eyes (64.7%) were able to maintain improvement in vision, 5 (29.4%) had worsened vision, 1 (5.9%) had stable vision, and 9 (52.9%) had visual acuity <Snellen 20/200. Major complications included infectious keratitis (n = 5, 29.4%), hypotony (n = 4, 23.5%), retinal detachment (n = 4, 23.5%), endophthalmitis (n = 2, 11.8%), and retroprosthetic membrane (n = 7, 50%). In addition, 15 eyes (88.2%) required glaucoma surgery. All but 1 eye lost best-ever visual acuity with 9 eyes (52.9%) because of glaucoma progression. KPro had an acceptable retention proportion and remains a viable option for eyes at high risk of failure with donor keratoplasty. However, subsequent surgeries are commonly performed postoperatively to manage complications. Glaucoma seems to be the main etiology of irreversible vision loss.

Characteristics of ocular hypertension and uveitic glaucoma among patients with noninfectious uveitis

ObjectiveOcular hypertension and uveitic glaucoma are important downstream sequela of noninfectious uveitis (NIU). Herein, we describe the clinical outcomes of NIU cases with ocular hypertension and uveitic glaucoma. DesignRetrospective cohort study. ParticipantsAll adults (≥18 years) with NIU under the care of uveitis subspecialty tertiary care clinics between 2010 and 2021 were included. MethodsThe primary outcomes were baseline and final visual acuity. ResultsA total of 216 patients out of 914 (23.6%) cases with NIU had ocular hypertension or uveitic glaucoma over the study period. Of all patients with ocular hypertension or uveitic glaucoma, 46% were corticosteroid responders. Baseline and last median visual acuities were better for the ocular hypertension patients compared with patients with uveitic glaucoma (p < 0.001). A higher proportion of patients with uveitic glaucoma than patients with ocular hypertension required glaucoma surgery (p < 0.001). The regression analyses suggested that baseline visual acuity and anatomical classification are significant predictors of last visual acuity, whereas diagnosis of ocular hypertension versus uveitic glaucoma were significant predictors of requirement for glaucoma surgery (p < 0.001). ConclusionA quarter of patients with NIU in this study developed ocular hypertension or uveitic glaucoma. Approximately half of the patients with ocular hypertension or uveitic glaucoma were deemed to be corticosteroid responders. Baseline and last visual acuity outcomes are better amongst ocular hypertension patients compared with those with uveitic glaucoma. Poor baseline visual acuity and panuveitis are predictors of worse vision at last follow-up. Additionally, diagnosis of uveitic glaucoma was a significant predictor of requirement for glaucoma surgery.

Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis

Background/aimWhile intraocular pressure (IOP) remains the only modifiable risk factor for glaucoma progression, the ultimate goal of glaucoma management is to preserve patients’ functional vision and quality of life. To...

Donor Corneal Endothelial Cell Maturity and Its Impact on Graft Survival in Glaucoma Patients Undergoing Corneal Transplantation

To examine corneal graft survival via corneal endothelial cell density (ECD) and corneal endothelial cell loss (ECL) at 5 years post-transplantation in the eyes of patients with and without a history of undergoing glaucoma surgery according to the maturity of the donor corneal endothelial cells. Prospective cohort study. This prospective cohort study included 17 patients with glaucoma and 51 patients without glaucoma who underwent Descemet's stripping automated endothelial keratoplasty or penetrating keratoplasty at the Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. Human corneal endothelial cells were cultured from residual peripheral donor cornea tissue, and the maturity of the cells was evaluated by cell surface markers (ie, CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Kaplan-Meier analysis or the chi-square test was used to assess the rate of successful corneal graft survival post-transplantation. At 36 months postoperatively, the mean ECD and ECL in the glaucoma-bleb eyes were 1197 ± 352 cells/mm2 and 55.5% ± 13.9% in the high-maturity group and 853 ± 430 cells/mm2 and 67.7% ± 18.1% in the low-maturity group, respectively. Kaplan-Meier analysis revealed that at 5 years postoperatively, the overall rate of survival was 45%, that is, 100% in the high-maturity group and 25% in the low-maturity group (P < .05). The findings in this prospective cohort study revealed that the use of donor corneal grafts containing mature-differentiated corneal endothelial cells could maintain the survival of the transplanted graft for a long-term period, even in patients with a history of undergoing glaucoma surgery.

A Review of Canaloplasty in the Treatment and Management of Glaucoma.

To review the published literature evaluating the safety and efficacy outcomes of canaloplasty performed in the treatment of glaucoma. Canaloplasty is a nonpenetrating glaucoma procedure involving combined 360° circumnavigation and viscodilation of Schlemm's canal. The procedure may be performed under an ab externo (with tensioning suture) or ab-interno (conjunctiva-sparing) approach. Given the wide variety of glaucoma procedure types and approaches, further investigation into the role of canaloplasty in ophthalmological practice is warranted. The objectives of this narrative review are to synthesize the existing literature in order to investigate indications, safety and efficacy outcomes, and the optimal place of canaloplasty in glaucoma treatment and management. A total of 60 articles were included in this review. Both ab externo and ab-interno canaloplasty (ABiC) were found to be significantly effective at reducing intraocular pressure (IOP) and glaucoma medication burdens in patients with mild-to-moderate open-angle glaucoma (OAG). These findings remained consistent regardless of phacoemulsification status. ABiC was found to exhibit a safety profile favorable compared to trabeculectomy and comparable to minimally invasive trabecular bypass implants. Canaloplasty is a nonpenetrating surgical intervention that is highly effective in treating patients with mild-to-moderate OAG across a large variety of clinical scenarios. These findings support the clinical use of canaloplasty in ophthalmological practice, clarify its patient profile, and compare procedural outcomes to other minimally invasive glaucoma surgery (MIGS) devices on the market. Wagner IV, Towne C, Saade MC, et al. A Review of Canaloplasty in the Treatment and Management of Glaucoma. J Curr Glaucoma Pract 2024;18(2):79-85.

Two-Photon and Multiphoton Microscopy in Anterior Segment Diseases of the Eye.

Two-photon excitation microscopy (TPM) and multiphoton fluorescence microscopy (MPM) are advanced forms of intravital high-resolution functional microscopy techniques that allow for the imaging of dynamic molecular processes and resolve features of the biological tissues of interest. Due to the cornea's optical properties and the uniquely accessible position of the globe, it is possible to image cells and tissues longitudinally to investigate ocular surface physiology and disease. MPM can also be used for the in vitro investigation of biological processes and drug kinetics in ocular tissues. In corneal immunology, performed via the use of TPM, cells thought to be intraepithelial dendritic cells are found to resemble tissue-resident memory T cells, and reporter mice with labeled plasmacytoid dendritic cells are imaged to understand the protective antiviral defenses of the eye. In mice with limbal progenitor cells labeled by reporters, the kinetics and localization of corneal epithelial replenishment are evaluated to advance stem cell biology. In studies of the conjunctiva and sclera, the use of such imaging together with second harmonic generation allows for the delineation of matrix wound healing, especially following glaucoma surgery. In conclusion, these imaging models play a pivotal role in the progress of ocular surface science and translational research.

Factors limiting glaucoma care among glaucoma patients in Nigeria: A scoping review.

Glaucoma currently accounts for 11% of irreversible visual loss worldwide. Due to many factors, patients do not access the glaucoma care pathway and present late with poor vision, while many are undiagnosed or untreated. These factors may be personal-level dispositions or Institutional-level dispositions, limiting the awareness, diagnosis, and treatment of glaucoma or adherence to medications or follow-up clinic visits. This scoping review followed the JBI methodology for scoping reviews and was pre-registered on the open science platform (https://osf.io/wqx57/?view_only=727eb6c803764509a2809e5d0794e214). The PUBMED, EMBASE, WEB OF SCIENCE, AJOL, and GOOGLE SCHOLAR databases were systematically searched for studies published in English between 1990 and June 2023. Data were extracted and analysed along a conceptualised framework of factors limiting access to glaucoma care in Nigeria. Of the 336 records retrieved, 13 studies were included in this scoping review. These included one (1) mixed method (quantitative/qualitative) study, three qualitative studies, and nine quantitative studies spanning 2008-2022 covering eight states and 2,643 sampled respondents. Nine studies reported personal-level dispositions limiting glaucoma care, including low levels of education, unemployment, gender, living distance from the hospital, cost of care, and faith/religion. Four reported institutional-level dispositions, including the lack of proper equipment and expertise to diagnose or manage glaucoma. The factors limiting Glaucoma care in Nigeria are varied and may act alone or combined with other elements to determine the awareness or knowledge of glaucoma, uptake of glaucoma surgery, medication adherence, or clinic follow-up. While most of these factors limiting glaucoma care in Nigeria may be amenable to policy, a bottom-up approach is needed to improve the community's awareness and uptake of glaucoma services. A shift from the over-dependence and reliance on tertiary hospitals, which are often far away from the people who need them, is required to bridge the information and service gap currently being witnessed.

Consensual eye intraocular pressure rise following unilateral glaucoma surgery.

Consensual eye intraocular pressure rise following unilateral glaucoma surgery.

Long-Term Surgical Outcomes of Glaucoma Drainage Implants in Eyes with Preoperative Intraocular Pressure Less than 19 mmHg.

This retrospective review reports on patients who underwent glaucoma drainage implant (GDI) surgery and had baseline intraocular pressure (IOP) of ≤18 mmHg with at least one year of follow-up. Clinical data of 67 eyes of 67 patients were collected from patients' charts, and the outcomes of GDI were evaluated until 7 years. GDI failure was defined as IOP reduction of less than 20% from the baseline at two consecutive visits three months after surgery, decline to no light perception, or if additional glaucoma surgery was performed. The average age was 65.9 ± 13.2 years. Most cases were male (52.2%), White (53.7%), and had primary open-angle glaucoma (62.7%). Forty-four eyes had prior glaucoma surgery (68.6%) and 46 (68.6%) had severe glaucoma. Though postoperative (postop) IOP changes were insignificant, the average postop number of medications dropped from 2.4 ± 1.4 to 1.9 ± 1.2 medications two years after surgery (p = 0.0451). Postop complications (23.9%) included GDI exposure (7.5%), inflammation (4.5%), shallow anterior chamber (4.5%), and strabismus (1.5%). Hypotony was observed in 4 eyes (5.9%), none of which developed hypotony maculopathy. The cumulative one-year failure rate was 56.7%, most of which were due to failure to lower IOP. In patients with baseline IOP ≤18 mmHg who had GDI surgery, though the change in IOP was not statistically significant, the number of medications dropped and visual field progression slowed in a subset of patients with adequate perimetric data. Due to a relatively high rate of complications and limited effectiveness in lowering IOP, GDI should be cautiously used in these eyes.

Glaucoma Tube Outcomes with and without Anti-VEGF in Patients with Age-related Macular Degeneration

PurposeTo compare glaucoma tube outcomes of wet age-related macular degeneration (AMD) eyes receiving anti-vascular endothelial growth factors (VEGF) injections versus dry AMD eyes and no anti-VEGF. DesignRetrospective clinical cohort study. ParticipantsPatients with wet AMD and a history of anti-VEGF within a year prior or after stand-alone glaucoma tube surgery and eyes with dry AMD and no history of anti-VEGF with at least 6 months of follow-up. Eyes with neovascular glaucoma or anti-VEGF for reason other than wet AMD were excluded. MethodsA Kaplan-Meier analysis compared survival for wet versus dry AMD eyes. Failure was defined as intraocular pressure (IOP) >21 mmHg or <20% IOP reduction from baseline or IOP ≤5 mm Hg for two consecutive post-operative visits starting at month three, additional glaucoma surgery, or no light perception. Complete success was defined as no failure or medications at final follow-up. Hypertensive phase was defined for valved tubes as IOP >21 mmHg within three months of surgery after a reduction to <22 mmHg during the first post-operative week. Intraocular pressure, percent reduction in IOP, number of glaucoma medications, and early (<1 year) and late (>1 year) complications were compared through five years. Main Outcome MeasuresSurvival analysis, IOP, number of medications ResultsBaseline IOP, number of medications, or tube type were not significantly different between wet (n=24) and dry AMD eyes (n=54). No wet AMD eyes failed versus 10 (18%) dry AMD eyes (P=0.03). Five-year survival was estimated as 100% for wet AMD and 72% for dry AMD (P=0.04). Wet AMD eyes had lower IOP (10.6 vs 12.7 mmHg, P=0.05), greater IOP reduction (60% vs 49%, P=0.04), fewer medications (1.2 vs 2.1, P=0.02), and more complete success (50% vs 15%, P=0.001) at final follow-up (32 versus 36 months, P=0.42). Fewer wet than dry AMD eyes experienced hypertensive phase (0/10 (0%) versus 4/10 (40%), P=0.04). There were no significant differences in early or late complications. ConclusionsExposure to anti-VEGF may influence post-operative wound healing and capsule formation which may improve glaucoma tube surgical outcomes. Prospective data is needed to consider perioperative administration of anti-VEGF for glaucoma tube surgery.

Üçüncü Basamak Sağlık Merkezinde Oküler Travmaya Bağlı Göz İçi Basıncı Yüksekliklerinin Tanı ve Tedavi Sürecinin Değerlendirilmesi: 1990-2018 yılları arası 28 yıllık analiz

AIM: To evaluate the etiological and demographic characteristics and treatment processes of patients with trauma-induced elevated intraocular pressure (IOP).&#x0D; MATHERIAL AND METHOD: We retrospectively analysed 191 patients with elevated IOP after trauma between 1990 and 2018. Demographic characteristics, type of trauma, cause of glaucoma, lens status, visual acuity, IOP, other ocular findings, medical and/or surgical treatments and follow-up periods were recorded.&#x0D; RESULTS: A total of 148 (77.5%) males and 43 (22.5%) females with a mean age of 29.68±19.47 years were analysed. Mean follow-up period was 158±23.73 months. The type of trauma was blunt in 171 patients (89.5%) and open in 20 patients (10.5%). The mean interval between trauma and IOP elevation was 78 days (3 days-5 years). Glaucoma was due to angle regression in 89 (46.6%), hyphema in 78 (40.8%), lens-related in 24 (12.6%) and other causes in 3 (1.54%) patients. Lens damage, lens-related IOP elevation and need for surgical intervention were more common after open injuries. 72% of the patients were able to achieve appropriate IOP with observation and medical treatment alone without surgery. Trabeculectomy was the most preferred effective surgical method in both trauma groups. &#x0D; CONCLUSION: The development of glaucoma after ocular trauma is an essential factor affecting visual prognosis. Early diagnosis and treatment might be challenging in proportion to the severity of ocular involvement. However, not all IOP elevations may cause glaucomatous damage, transient IOP elevations could be monitored without medication. In our study, the frequency of posttraumatic IOP elevation was higher in men and young people. This might be related to more trauma exposure in the indicated population. Blunt traumas cause IOP elevation more frequently. In contrast, the need for glaucoma surgery is more frequent after open injuries. Angle recession is the most common cause of posttraumatic glaucuma. Therefore, angle assessment is necessary in all possible cases. The status of the lens after trauma will affect the prognosis and choice of surgery. Regular follow-up is crucial for the detection of secondary glaucoma since IOP elevation may develop in the late post-traumatic period. &#x0D; &#x0D; Keywords: Ocular trauma, blunt trauma, angle recession glaucoma, traumatic glaucoma

Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight)

ObjectiveTo evaluate risk factors for intraocular pressure (IOP) spike following cataract surgery using the IRIS® Registry (Intelligent Research in Sight). DesignRetrospective clinical cohort study. SubjectsAdults with IRIS® Registry data who underwent stand-alone phacoemulsification from January 1, 2013 to September 30, 2019. MethodsIOP spike was defined as a postoperative IOP >30 mmHg and >10 mmHg from baseline within the first postoperative week. Odds ratios (OR) for demographic and clinical characteristics were calculated with univariate and multivariate logistic regression analyses. Main Outcome MeasuresIncidence and OR of IOP spike. ResultsWe analyzed data from 1,191,034 eyes (mean age 71.3 years, 61.2% female sex and 24.8% with glaucoma). An IOP spike occurred in 3.7% of all eyes, 5.2% of eyes with glaucoma and 3.2% of eyes without glaucoma (P<0.0001). Multivariable analyses of all eyes indicated a greater risk of IOP spike with higher baseline IOP (OR 1.57 per 3 mmHg), male sex (OR 1.79), glaucoma (OR 1.19), Black race (OR 1.39 compared to Asian and OR 1.21 compared to Hispanic), older age (OR 1.07 per 10 years), and complex surgery coding (OR 1.22, all P<0.0001). Diabetes (OR 0.90) and aphakia after surgery (OR 0.60) appeared to be protective against IOP spike (both P<0.0001). Compared to glaucoma suspects, there was a greater risk of IOP spike with ocular hypertension (OR 1.55), pigmentary glaucoma (OR 1.56), and pseudoexfoliative glaucoma (OR 1.52), and less risk for normal tension glaucoma (OR 0.55), primary angle closure (PAC) suspect (OR 0.67), and PAC glaucoma (OR 0.81, all P<0.0001). More baseline glaucoma medications was associated with IOP spike (OR 1.18 per medicine) while topical beta-blocker use (OR 0.68) was protective (both P<0.0001). ConclusionsHigher baseline IOP, male sex, glaucoma, Black race, older age, and complex cataract coding were associated with an early postoperative IOP spike whereas diabetes and postoperative aphakia were protective against a spike following stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on subtype of glaucoma. The findings may help surgeons stratify and mitigate the risk of IOP spike after cataract surgery.

Outcomes of Eyes Lost to Follow-up After Treatment With Intraocular or Periocular Steroid Injections.

Purpose: To evaluate the visual, intraocular pressure (IOP), and anatomic outcomes of eyes with loss to follow-up (LTFU) after intravitreal or periocular steroid injections. Methods: Patients receiving intraocular or periocular steroid injections and with LTFU for at least 180 days were included in this retrospective cohort study. Charts were reviewed for the visual acuity (VA), IOP, and central foveal thickness at the visit before LTFU, the first return visit, and 3, 6, and 12 months after return. Results: Fifty-three eyes of 47 patients were identified. The mean (±SD) age was 62.3 ± 14.9 years, the mean LTFU time was 295 ± 181.2 days (range, 182-1101), and the mean follow-up after return was 354 ± 339.3 days (range, 32-1141). The overall mean number of steroid injections was 5.2 ± 3.9 (range, 1-18). Compared with the mean logMAR VA at the visit before LTFU (0.59 [Snellen 20/77]), the mean VA remained stable at all timepoints after return as follows: return visit (0.62 [20/83]; P = .6), month 3 (0.55 [20/70]; P = .6), month 6 (0.55 [20/70]; P = .5), month 12 (0.64 [20/87]; P = .6), and final visit (0.69 [20/97]; P = .2). At the first return visit, 8 (15%) of 53 patients had an IOP of 21 mm Hg or higher (range, 21-31); 2 required treatment with a new antihypertensive medication (latanoprost and timolol, respectively). Conclusions: Patients with LTFU after receiving steroid injections maintained their VA. No patient required incisional glaucoma surgery. Compared with other etiologies, eyes with diabetic macular edema had a greater increase in IOP.

The Evolution and Current Landscape of Minimally Invasive Glaucoma Surgeries: A Review.

This review examines the evolution, current status, and future potential of minimally invasive glaucoma surgeries (MIGS), a significant advancement in the treatment of glaucoma, a leading cause of irreversible blindness. MIGS offer a less invasive alternative to traditional glaucoma surgeries, primarily aimed at reducing intraocular pressure, minimizing tissue trauma, and providing a safer profile. With the emergence of devices such as the Trabectome, iStent, and others, MIGS have expanded the surgical toolkit, allowing personalized, patient-centered care. Despite their advantages, MIGS face challenges such as efficacy in severe cases, long-term data, and accessibility. Ongoing research and technological innovations continue to refine their capabilities and applications, promising to further transform glaucoma management and patient outcomes. This paper provides an in-depth analysis of MIGS, reflecting on their impact and contemplating future directions in this dynamically evolving field.

A Comparison of the Effectiveness Between Trabeculectomy and Minimally Invasive Glaucoma Surgeries

Background and Hypothesis: Glaucoma affects 3 million Americans and is the second most common cause of blindness globally, after cataracts. It involves the degeneration of the optic nerve, often associated with increased eye pressure, leading to vision loss. Trabeculectomy was traditionally the standard surgical approach for managing glaucoma progression once medication and laser had failed. Recently, minimally invasive glaucoma surgeries (MIGS) have gained FDA approval for mild and moderate cases and are being implemented in practice. We hypothesize that MIGS procedures are just as effective as trabeculectomy in mild, moderate, and severe cases of glaucoma.&#x0D; Experimental Design or Project Methods: Using data from IU Health, patients that underwent either a MIGS procedure or a trabeculectomy for open-angle glaucoma at least a year ago were identified. Visual field data was used to stage their glaucoma. Any future glaucoma surgery was noted. Using this information, three separate Kaplan-Meier curves at 95% confidence intervals were created corresponding to each stage of glaucoma with a second surgery defined as a failure and a survival analysis was done to visualize the difference between these surgical approaches.&#x0D; Results: The sample included 119 patients and 179 eyes with a mean age of 80 and 57% females. The study had 80% power at a two-sided 5% significance level. Based on the survival analysis, there were no significant differences between trabeculectomy and MIGS in mild and moderate glaucoma (p=0.69 and 0.97 respectively). In severe glaucoma, MIGS had a lower failure rate compared to trabeculectomy (p=0.026).&#x0D; Conclusion and Potential Impact: The research comparing trabeculectomy to MIGS is still relatively new and this study shows the safety and efficacy of MIGS procedures. If confirmed, this study could potentially change the standard of care to MIGS for all stages of open-angle glaucoma.

Long-Term Clinical Outcomes of the 0.18 Mg Fluocinolone Acetonide Intravitreal Implant Following Local Corticosteroid Burst in Noninfectious Uveitis

ABSTRACT Purpose The 0.18 mg fluocinolone acetonide implant (FAi) is marketed for up to 36 months for treatment of noninfectious uveitis. An additional short-term corticosteroid burst prior to the 0.18 mg FAi, followed by attempt at long-term inflammation control with the 0.18 mg FAi may be beneficial given the low dose of the implant. We retrospectively reviewed all patients undergoing this treatment approach at our institution to determine its efficacy. Methods Patients who received a corticosteroid burst followed by the 0.18 mg FAi with at least 6-month follow-up post 0.18 mg FAi were included. The primary outcome, treatment escalation (defined as worsening inflammation requiring escalation of therapy), was modeled using Kaplan-Meier analysis. Secondary outcomes included cystoid macular edema (CME), central macular thickness, retinal vasculitis, visual acuity, anterior chamber and vitreous cell, use of systemic therapy, use of corticosteroid drops, IOP, number of IOP lowering medications, need for glaucoma surgery, need for cataract surgery, and additional local corticosteroids. Results 32 eyes were included (mean follow-up: 19.8 months). Prior to corticosteroid burst, 37.5% were on systemic therapy, 53% had CME, and 25% had retinal vasculitis. At FAi visit, CME had decreased to 18.8%. Mean time to treatment escalation after FAi was 20.3 months (95% CI 14.8–25.7 months). No patient discontinued systemic therapy and on average 15.0% of eyes required additional local corticosteroids at each follow-up interval. Conclusions This treatment approach demonstrates that the 0.18 mg FAi is a useful adjuvant for the treatment of noninfectious uveitis but may not be adequate as solo therapy.