Glaucoma Surgery Research Articles

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

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

Ocular Surface Changes in Glaucomatous Patients Undergoing Cataract Surgery Combined with Micro Invasive Glaucoma Surgery (2nd Generation Trabecular Stents Istent Inject ®): A Study about 69 Eyes

Introduction: The purpose of this study was to evaluate ocular surface changes and dry eyes symptoms in patients undergoing cataract surgery by phacoemulsification combined with implantation of two trabecular stents (Istent Inject®). Methods: This single-arm prospective interventional clinical trial enrolled 69 patients with mild-to-moderate open-angle glaucoma taking 1 to 4 glaucoma medications that underwent phacoemulsification combined with implantation of two trabecular stents (Istent). We explored several key data about ocular surface and glaucoma evolution throughout the follow-up, including the Ocular Surface Disease Index score, the Oxford score, the Efron conjunctival score, and the Fluorescein Tear Break-up Time (FTBUT). Results: Mean OSDI scores improved from 40.1 ± 21.6 (severe dry eye) preoperatively to 17.5 ± 15.3 (mild dry eye) at 3 months. While 73% of eyes had moderate or severe OSDI scores preoperatively, only 29% had such scores at 3 months. The mean FTBUT increased from 4.3 ±2.4 seconds preoperatively to 6.4 ±2.5 seconds at 3 months; the average Oxford staining score decreased from 1.4 ± 1.0 preoperatively to 0.4 ± 0.6 at 3 months. There was a reduction in the number of glaucoma medications from 1.5 to 0.6 medications. Mean IOP decreased from 17.4 ± 4.2mmHg to 14.5 ± 3.2mmHg at the 3 months follow-up. The safety profile of the surgery was excellent. Conclusion: The implantation of two trabecular stents (Istent inject®) combined with cataract surgery resulted in clinical and functional improvements in ocular surface health, as well as significant reductions in IOP and medications in patients with open-angle glaucoma.

Predicting Glaucoma Surgical Outcomes Using Neural Networks and Machine Learning on Electronic Health Records.

To develop machine learning (ML) and deep learning (DL) models to predict glaucoma surgical outcomes, including postoperative intraocular pressure, use of ocular antihypertensive medications, and need for repeat surgery. We identified glaucoma surgeries performed at Stanford from 2013-2024, with two or more postoperative visits with intraocular pressure (IOP) measurement. Patient features were identified from the electronic health record (EHR), including demographics, prior diagnosis and procedure codes, medications and eye exam findings. Classical ML and DL models were developed to predict which glaucoma surgeries would result in surgical failure, defined as (1) IOP not reduced by more than 20% of preoperative baseline on two consecutive postoperative visits, (2) increased classes of glaucoma medications, and (3) need for additional glaucoma surgery or revision of original surgery. A total of 2398 glaucoma surgeries of 1571 patients were included, of which 1677 surgeries met failure criteria. Random forest performed best for prediction of overall surgical failure, with accuracy of 75.5% and area under the receiver operator curve (AUROC) of 76.7%, similar to the deep learning model (accuracy 75.5%, AUROC 76.6%). Across all models, prediction performance was better for IOP outcomes (AUROC 86%) than need for an additional surgery (AUROC 76%) or need for additional glaucoma medication (AUC 70%). ML and DL algorithms can predict glaucoma surgery outcomes using structured data inputs from EHRs. Models that predict outcomes of glaucoma surgery may one day provide the basis for clinical decision support tools supporting surgeons in personalizing glaucoma treatment plans.

Intraoperative challenges and outcomes of pediatric cataract surgery following glaucoma filtering surgery.

To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019. We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.

Multiple use of preservative-free single dose unit dexamethasone 0.1% eye drops is safe within 24 hours

BackgroundUnpreserved single-dose unit (SDU) eye drops are commonly used to avoid benzalkonium chloride-related toxicity. Although intended for single use, many patients report off-label repeated use of SDUs over a prolonged...

The Effectiveness of Pattern Scanning Laser Trabeculoplasty as an Additional Treatment for the Patients of Open-Angle Glaucoma Receiving Full Ocular Hypotensive Medications.

Objectives: Our purpose was to examine the effectiveness of pattern scanning laser trabeculoplasty (PSLT) as an additional treatment for patients of open-angle glaucoma (OAG) receiving maximized ocular hypotensive medications (OHM). Methods: A total of 40 eyes of 33 patients (average age 72.7 ± 10.7 years) who had not previously undergone open glaucoma surgery or laser trabeculoplasty and were treated with maximized OHM between June 2018 and March 2022 were included. A 360-degree PSLT was conducted, and postoperative intraocular pressure (IOP) and survival curves at 1, 3, 6, 9, and 12 months were evaluated. Results: According to the Kaplan-Meier survival analysis, the average survival time was 8.1 months and the survival rate at 12 months was 0.55, with death defined as postoperative IOP reduction of less than 10% or requiring additional treatment. The average survival time was 4.9 months and the survival rate at 12 months was 0.28, with death defined as postoperative IOP reduction of less than 20% or requiring additional treatment. Nine eyes showed increased IOP (three eyes) or worsened visual field (six eyes) during the course and underwent additional open glaucoma surgery. In the 31 eyes which received no additional treatment after PSLT, the mean preoperative IOP was 18.5 ± 3.9 mmHg, which reduced to 15.3 ± 4.1 mmHg (p = 1.62 × 10-6), 15.5 ± 3.4 mmHg (p = 1.51 × 10-5), 15.7 ± 4.0 mmHg (p = 1.75 × 10-5), 14.7 ± 4.38 (p = 2.89 × 10-6), and 15.0 ± 4.0 mmHg (p = 5.74 × 10-9) at 1, 3, 6, 9, and 12 months after PSLT, respectively. The IOP reduction rate one year after PSLT was 18.7%. Of the 31 eyes, 13 (42%) achieved a 20% reduction in IOP compared to the baseline. Conclusions: Adjunctive treatment with PSLT in OAG patients receiving maximized OHM may be effective over 12 months of follow-up.

Transient anterior subcapsular vacuolar lens opacities after Tanito microhook trabeculotomy: report of six cases

ObjectiveTo present six cases exhibiting transient anterior subcapsular vacuolar lens opacities following early postoperative Tanito microhook trabeculotomy (TMH) performed by the same surgeon.MethodsSix patients who underwent lens-sparing TMH at Meizankai Shimizu Eye Clinic from November 2021 to May 2023, and developed anterior subcapsular vacuolar lens opacities postoperatively were reviewed. Detailed records of surgeries, follow-up findings were collected and reported.ResultsIn all six cases, anterior vacuolar subcapsular lens opacities were observed on the day after surgery, gradually decreasing without affecting visual acuity or contrast sensitivity. In all cases, without any specific interventions, the opacities disappeared by 21 months postoperatively.ConclusionAnterior subcapsular cataracts, characterized by a vacuolar appearance and transient existence, should be recognized as an early complication of ab interno glaucoma surgery, possibly linked to use of distributed ophthalmic viscosurgical devices and excessive anterior chamber irrigation leading to traumatic cataracts on the lens surface.

Ultrasonography in Detecting the Posterior Segment Pathology in Pre-Operative Cataract Patient

Background: Cataract is the leading cause of blindness globally, accounting for approximately 47.8% of blindness worldwide and 51.5% in Pakistan. The opacity of the lens in cataract patients obstructs the visualization of the posterior segment, making it challenging to predict visual outcomes post-surgery. Ultrasonography, particularly B-scan, plays a crucial role in identifying posterior segment pathologies before cataract surgery, aiding in surgical planning, and improving postoperative visual prognosis. Objective: This study aimed to evaluate the effectiveness of B-scan ultrasonography in detecting posterior segment pathologies in patients with dense cataracts, thus assisting in preoperative planning and predicting visual outcomes. Methods: This descriptive cross-sectional study was conducted at the Outpatient Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, from August 15th, 2019, to February 15th, 2020. A total of 260 eyes from patients with dense cataracts were included. Patients of all age groups and both sexes, including those with traumatic and non-traumatic cataracts, were examined. Exclusion criteria included transmittable ocular surface infections, penetrating ocular trauma, previous glaucoma or vitreoretinal surgery, and siliconized eyes. B-scan ultrasonography was performed using an 8-10 MHz frequency probe. The eye globe was assessed in axial, longitudinal, and transverse positions. Data were recorded and analyzed using SPSS version 25. Ethical approval was obtained from the institutional review board, and the study adhered to the Declaration of Helsinki. Results: Out of 260 eyes examined, 97 (37.3%) were right eyes, 105 (40.4%) were left eyes, and 58 (22.3%) had bilateral involvement. Normal findings were observed in 215 eyes (67.8%), while 32.2% showed posterior segment pathologies. The most common pathology was posterior vitreous detachment (PVD), found in 24 eyes (7.6%). Retinal detachment and vitreous hemorrhage were each observed in 15 eyes (4.7%). Other findings included asteroid hyalosis (18 eyes, 5.7%), vitreous inflammation (11 eyes, 3.5%), intraocular foreign body (3 eyes, 0.9%), persistent hyperplastic primary vitreous (1 eye, 0.3%), and posterior staphyloma (2 eyes, 0.6%). Conclusion: B-scan ultrasonography is an effective tool for detecting posterior segment pathologies in preoperative dense cataract patients, significantly influencing surgical strategies and postoperative visual outcomes. Routine use of ultrasonography in cataract patients can enhance surgical planning and improve patient counseling and prognosis.

Glaucoma surgery experiments using digital microscope-integrated optical coherence tomography and OCT-compatible instruments

There is a certain failure rate in traditional glaucoma surgery because of the lack of depth information in microscope images. In this work, we present a digital microscope-integrated optical coherence tomography (MIOCT) system and several custom-made OCT-compatible instruments for glaucoma surgery. Sixteen ophthalmologists were asked to perform trabeculectomy and canaloplasty on live porcine eyes using the system and instruments. After surgery, a subjective feedback survey about the user experience was taken. The experiment results showed that our system can help surgeons easily locate important tissue structures during surgery. The custom-made instruments also solved the shadowing problem in OCT imaging. Surgeons preferred to use the system in their future practice.

Factors predicting redislocation or suture break in eyes after scleral-fixated intraocular lens.

To investigate predictive factors for redislocation in patients with recurrent intraocular lens (IOL) dislocation after secondary scleral-fixated IOL (SF IOL) surgery. 2 tertiary referral hospitals. Retrospective case series. Patients undergoing SF IOL surgery were grouped into redislocation and no-redislocation groups. Medical records of consecutive patients who underwent SF IOL surgery between June 2014 and December 2019 at 2 tertiary referral centers were reviewed. Data regarding patient demographics, treatment factors, anatomical and functional outcomes, and postoperative complications were recorded. 237 eyes of 225 patients (169 [75.1%] men) were included. The redislocation group was more likely to have a younger mean age at the initial SF IOL surgery (redislocation vs no-redislocation, 55.4 vs 62.0 years, respectively; P = .008), have a prior history of a previous suture break (23 eyes, 52.3% vs 1 eye, 0.5%; P < .001), and have undergone the initial SF IOL surgery using <1 mm-sized side-port incisions (17 eyes, 38.6% vs 32 eyes, 16.5%; P = .002) than was the no-redislocation group. In addition, the redislocation group had a higher occurrence of complications ( P < .001). Multivariate regression revealed that younger age, left eye involvement, aphakic status before the surgery, unremarkable primary IOL dislocation cause, need for ocular hypertension treatment and glaucoma surgery, and no large incision during the initial surgery were significantly (all P < .05) associated with redislocation. Younger age, left eye involvement, postoperative complications such as ocular hypertension and glaucoma, and techniques without large incisions increase the risk of redislocation. Conversely, lower risk factors include unremarkable surgery causes and a history of aphakic conditions.

Developing a synergistic rate-retarding polymeric implant for controlling monoclonal antibody delivery in minimally invasive glaucoma surgery

Monoclonal antibodies (mAbs) have garnered substantial attention within the field of ophthalmology and can be used to suppress scar formation after minimally invasive glaucoma surgeries. Here, by controlling mAb passive diffusion, we developed a polymeric, rate-controlling membrane reservoir loaded with poly(lactic-co-glycolic acid) microspheres to deliver mAb for several weeks. Different parameters were tested to ensure that the microspheres achieved a good quality characteristic, and our results showed that 1 %W/V emulsifier with 5 %W/V NaCl achieved mAb-loaded microspheres with the highest stability, encapsulation efficiency and minimal burst release. Then, we fabricated and compared 10 types of microporous films based on polylactic acid (PLA), polycaprolactone (PCL), and polyethylene glycol (PEG). Our results revealed distinct pore characteristics and degradation patterns in different films due to varying polymer properties, and all the polymeric film formulations showed good biocompatibility in both human trabecular meshwork cells and human conjunctival fibroblasts. Finally, the optimized microspheres were loaded into the reservoir-type polymeric implant assembled by microporous membranes with different surface coating modifications. The implant formulation, which was fabricated by 60 PCL: 40 PEG (3 %W/V) polymer with 0.1 %W/V poly(lactic-co-glycolic acid) barrier, exerted the best drug release profile that can sustained release mAb (83.6 %) for 4 weeks.

Retinal toxicity secondary to inadvertent subretinal mitomycin C injection

Purpose: To report a patient who developed retinal toxicity following inadvertent subretinal mitomycin C injection during glaucoma surgery. Methods: Case report and review of the literature. Results: A 73-year-old man underwent glaucoma tube shunt surgery with sub-Tenon’s mitomycin C injection. Postoperatively he developed retinal edema, hemorrhages, and occlusive vasculopathy localized to the quadrant of the mitomycin C injection. It was determined that the sclera had been inadvertently punctured during mitomycin C injection, resulting in subretinal placement of the medication and resultant retinal toxicity. At postoperative month one, there was diffuse chorioretinal atrophy in the area of the injection. The macula was spared and he retained his preoperative visual acuity. Conclusion: Inadvertent subretinal mitomycin C injection may occur when attempting to inject the drug into the sub-Tenon’s space and can result in localized retinal toxicity.

Outcomes of slow coagulation transscleral cyclophotocoagulation in a predominantly African American glaucoma population

PurposeTo evaluate outcomes of slow coagulation transscleral cyclophotocoagulation (SC-TSCPC) in a primarily African American patient population with glaucoma. MethodsA retrospective chart review was performed for 104 consecutive cases of SC-TSCPC by a single surgeon between November 6, 2019–September 7, 2023. Power ranged from 1150 to 1500 mW, duration was 4 s, and number of spots ranged from 10 to 25. Exclusion criteria were diagnosis of neovascular glaucoma, prior CPC, visual acuity (VA) of no light perception or unable to be assessed due to patient's mental status, aphakia, or follow-up <3 months. The primary outcome measure was surgical success defined as an intraocular pressure (IOP) of 6–21 mmHg with a ≥20 % reduction from baseline, no glaucoma re-operation, and no loss of light-perception. Secondary outcome measures included VA, glaucoma medication use, and post-surgical complications. Analysis was also stratified by lens status as literature suggests a greater IOP-lowering effect in pseudophakic eyes after CPC. ResultsThere were 28 eligible patients (6 phakic, 22 pseudophakic) included in this analysis. Mean follow-up was 11.6 ± 8.3 months, and 14 patients had postoperative year 1 data available. The mean age was 75.2 ± 13.9 years, 42.9 % were female, and 92.9 % were African American, reflective of the demographics of the local community. The cumulative success rate was 68.5 % at 1 year and did not differ significantly between phakic and pseudophakic patients. Mean VA worsened from 20/600 preoperatively to 20/1050 at last follow-up (P = 0.04) and was marginally worse in the phakic group (P = 0.15). Mean IOP decreased from 31.1 ± 13.2 mmHg on 4.0 ± 1.5 medications preoperatively to 13.8 ± 7.1 mmHg on 2.6 ± 1.5 medications at last follow-up (P < 0.001; P < 0.01), with a more pronounced effect among pseudophakic patients. 85.7 % of patients had prolonged anterior chamber (AC) inflammation beyond 1 month, which persisted in 10.7 % at last follow-up. The cystoid macular edema (CME) rate was 21.4 %, with 10.7 % persistent at last follow-up. ConclusionsSC-TSCPC is an effective, non-incisional IOP-lowering procedure in phakic and pseudophakic eyes that may not otherwise be ideal candidates for incisional glaucoma surgery. Pseudophakic eyes may experience larger reductions in IOP, however, laser settings can be titrated on a case-by-case basis depending on individual patients’ goals. There was a higher incidence of prolonged AC inflammation and CME in our cohort compared to similar studies which report rates of 12.7 % and 2.7 %, respectively. Although the significance of such complications may differ based on the visual potential of each patient, these findings support existing literature that African American patients can have greater incidence of inflammation and subsequent sequalae after ocular surgery.

A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India

Background Ophthalmologists deal with daily pseudoexfoliation (PXF) due to severe secondary glaucoma, which arises after cataract surgery. Cataracts with pseudoexfoliation are age-related and are associated with open-angle glaucoma. Therefore, pseudoexfoliation is expected to occur more frequently. Pseudoexfoliation is occasionally associated with the development of thick nuclear cataracts, which may make surgery challenging. risks of cataract extraction in patients with pseudoexfoliation include zonular weakness and inadequate pupillary dilation. This may cause vitreous loss, and intraoperative or postoperative lens displacement. It could also lead to a rise in postoperative intraocular pressure (IOP), progressing to long-term inflammation, phimosis of the capsular tissue, glaucoma, and surgical corneal decompensation. Recurrent secondary cataracts are typically caused by some remaining cortical tissue and decreased zonular support, which may lead to lens epithelial cell migration. Surgery for glaucoma and cataracts is complicated by the presence of pseudoexfoliative debris. Objectives To determine the prevalence of pseudoexfoliation in cataract patients visiting the ophthalmic OPD, AVBRH hospital, to locate patients with pseudoexfoliative cataracts, to evaluate their likelihood of progressing to open-angle glaucoma, and to examine the various ocular characteristics of these patients. Methodology The study participants will undergo ophthalmological examination after considering the inclusion and exclusion criteria. This examination will include sac syringing on the lacrimal gland, estimation of the highest corrected visual acuity, slit-lamp examination, application tonometer assessment of intraocular pressure (IOP), and fundus examination using an indirect ophthalmoscope. All individuals with cataracts visiting the ophthalmology department of AVBRH will be examined under a slit-lamp to determine the presence of pseudoexfoliation in the operating eye. Expected Results Hospital statistics from India indicated that the percentage of patients with pseudoexfoliation, in addition to cataracts, ranges from 1.87% to 13.5%.

Inhibition of the rapamycin-insensitive mTORC1 /4E-BP1 axis attenuates TGF-β1-induced fibrotic response in human Tenon's fibroblasts

Subconjunctival fibrosis is the major cause of failure in both conventional and modern minimally invasive glaucoma surgeries (MIGSs) with subconjunctival filtration. The search for safe and effective anti-fibrotic agents is critical for improving long-term surgical outcomes. In this study, we investigated the effect of inhibiting the rapamycin-insensitive mTORC1/4E-BP1 axis on the transforming growth factor-beta 1(TGF-β1)-induced fibrotic responses in human Tenon's fibroblasts (HTFs), as well as in a rat model of glaucoma filtration surgery (GFS). Primary cultured HTFs were treated with 3 ng/mL TGF-β1 for 24 h, followed by treatment with 10 μM CZ415 for additional 24 h. Rapamycin (10 μM) was utilized as a control for mTORC1/4E-BP1 signaling insensitivity. The expression levels of fibrosis-associated molecules were measured using quantitative real-time PCR, Western blotting, and immunofluorescence analysis. Cell migration was assessed through the scratch wound assay. Additionally, a rat model of GFS was employed to evaluate the anti-fibrotic effect of CZ415 in vivo. Our findings indicated that both rapamycin and CZ415 treatment significantly reduced the TGF-β1-induced cell proliferation, migration, and the expression of pro-fibrotic factors in HTFs. CZ415 also more effectively inhibited TGF-β1-mediated collagen synthesis in HTFs compared to rapamycin. Activation of mTORC1/4E-BP signaling following TGF-β1 exposure was highly suppressed by CZ415 but was only modestly inhibited by rapamycin. Furthermore, CZ415 was found to decrease subconjunctival collagen deposition in rats post GFS. Our results suggest that rapamycin-insensitive mTORC1/4E-BP1 signaling plays a critical role in TGF-β1-driven collagen synthesis in HTFs. This study demonstrated that inhibition of the mTORC1/4E-BP1 axis offers superior anti-fibrotic efficacy compared to rapamycin and represents a promising target for improving the success rate of both traditional and modern GFSs.

Clinical Results of the MINIject Implant for Suprachoroidal Drainage.

Objective: This retrospective study evaluated the safety and efficacy of the new minimally invasive MINIject implant placed in the suprachoroidal space. The aim was to assess its impact on intraocular pressure (IOP) reduction and complication rate. Methods: 18 eyes from 18 patients with insufficiently controlled glaucoma received the implant using topical medications. Outcomes were changes in IOP, change in IOP medication, need for other glaucoma surgery, and rate of adverse events. Results: IOP reduced by 15% (p < 0.05) following MINIject implantation. IOP medication decreased from 3 to 1 agent (p < 0.05). Four patients (22%) required other glaucoma surgery while we did not observe any clinically relevant adverse event. Conclusions: This retrospective study indicates that MINIject implants may be a safe and effective means of reducing IOP together with a reduction in IOP medications in most patients. Larger prospective studies with longer follow-ups are necessary to confirm our results, though.

Transscleral ciliary surgery in glaucoma:from destructive surgery to minimally invasive surgery

Over the years, there has been significant advancement in the safety and effectiveness of external cyclosurgery for glaucoma. This progress ranges from the initial "cyclodestructive surgery" to modern cycloplasty techniques, expanding beyond end-stage glaucoma treatment. Notably, innovative approaches like micropulse transscleral cycloplasty and ultrasonic cycloplasty are now being employed in earlier stages of glaucoma with better visual acuity, qualifying as minimally invasive procedures. Through a comprehensive review of the historical evolution of external cyclosurgery, elucidation of the mechanisms, clinical outcomes, and potential complications associated with novel cycloplasty techniques, and integration of practical clinical insights, this article aims to furnish clinicians with a profound comprehension of external cyclosurgery for glaucoma.

Research progress in the diagnosis and treatment of childhood glaucoma

Childhood glaucoma is a disease that seriously endangers children's visual health. It will accompany the patients throughout their lives and bring a heavy burden to families and society. Most childhood blindness caused by glaucoma is preventable or treatable. Relevant research has made progress in recent years. Based on the new consensus reached by the World Glaucoma Association and the latest medical evidence at home and abroad, this article summarizes the definition, classification, diagnosis, molecular genetics, pathogenesis and comprehensive treatments including drugs and surgery of childhood glaucoma, with a focus on the application of various surgical methods, so as to provide reference for clinical and scientific research and improve the clinical diagnosis and treatment of childhood glaucoma.

To discuss the minimally invasive glaucoma surgery related to trabeculotomy from the perspective of physiological function of trabecular meshwork drainage pathway

The advent of minimally invasive glaucoma surgery (MIGS) has broadened the therapeutic options for managing glaucoma. In recent years, MIGS procedures targeting the trabecular meshwork-Schlemm's canal aqueous outflow resistance site have garnered significant attention. This focus has extended to the pathophysiological changes occurring within the aqueous outflow pathway. However, questions persist regarding the efficacy of near-peripheral or peripheral trabeculotomy in achieving the anticipated reduction of outflow resistance and the suitability of MIGS surgery for patients with primary open-angle glaucoma. By integrating clinical experience with pertinent clinical research, this paper advocates for a reevaluation of MIGS procedures to aid clinicians in making informed decisions regarding various glaucoma surgical interventions.

Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy in Eyes With Prior Failed Glaucoma Surgery.

This study concludes that GATT can be an effective and safe surgical alternative for managing IOP in eyes with prior failed glaucoma surgeries, associated with minimal complications. To report outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior failed glaucoma surgery. A retrospective study involving 30 eyes of 30 patients, all of whom had open angles on gonioscopy, experienced prior glaucoma surgery failures, and subsequently underwent GATT. The primary outcome measure was success defined as complete when the intraocular pressure (IOP) was >5 and ≤21/16mmHg without glaucoma medications and qualified with medications. The mean age was 51.8±16.1 years. Twenty-one eyes underwent GATT and 9 eyes underwent phaco-GATT. Twenty-seven eyes had failed trabeculectomy and 3 eyes had failed glaucoma drainage device. Post-GATT, the IOP decreased from 27.1±7 to 16.9±6mmHg (P<0.001) at the end of 15 months, with a mean drop in AGM from 4.9±1.0 to 2±1.6. At postoperative 1 year, the probability of complete success was 20% (95% CI: 9-43) for an IOP criterion of both 21 and 16mmHg. The qualified success probability at 1 year was 82% (67-100) for an IOP criterion of 21mmHg and 57% (38-84) for an IOP criterion of 16mmHg. Risk factor for failure was older age [hazard ratio (HR): 1.03, 95% CI: 1.01-1.06]. The complications noted were hyphema in 14 eyes (46%), majority resolved within 1 week and all by 2 weeks. None needed any intervention. This study concludes that GATT can be an effective and safe surgical alternative for managing IOP in eyes with prior failed glaucoma surgeries, associated with minimal complications.