Included Intraocular Pressure Research Articles

Ab externo 240-degree trabeculotomy versus trabeculotomy–trabeculectomy in primary congenital glaucoma

This prospective study aimed to compare the surgical outcomes of ab externo 240-degree trabeculotomy and trabeculotomy-trabeculectomy in managing primary congenital glaucoma (PCG). The study included 30 eyes of 30 patients aged less than 3 years who were diagnosed with PCG and was conducted in Menofia University Hospital between November 2018 and January 2020. The studied eyes were divided into two equal groups. Ab externo 240-degree trabeculotomy and combined trabeculotomy with trabeculectomy with MMC were performed for groups I and II, respectively. Post-operative measurements included intraocular pressure (IOP), optic disc changes, alteration in corneal clarity and transverse corneal diameter, as they are needed for antiglaucoma therapy. Post-operative complications were followed up for 1-year. There was significant reduction in IOP in both groups during the follow-up period. The reduction was higher in group I, where mean preoperative IOP was 28.20 ± 1.74 mmHg. The IOP in the group II was 28.07 ± 3.51 mmHg. The mean IOP decreased to 13.93 ± 1.8 mmHg and 14.60 ± 1.24 mmHg in groups I and II, respectively, after 1 year (P < 0.001); however, the difference between the two groups was not significant. Regarding post-operative complications, post-operative hypotony was more common in group I. Other complications such as shallow anterior chamber, choroidal detachment and blebitis occurred more frequently in group II. However, post-operative hyphema was more common in group I. Corneal clarity improved significantly in both groups, but more so in group I, where an improvement was seen in 13 cases (86.6%), compared to 11 cases in group II (73.3%). Ab externo 240° trabeculotomy and trabeculotomy-trabeculectomy are effective techniques in primary congenital glaucoma with more reduction in IOP in Ab Externo 240° trabeculotomy. Ab externo 240° trabeculotomy provided more better surgical outcome with limited complications, especially those related to bleb formation.

Efficacy and safety of Bujing Yishi tablet for glaucoma with controlled IOP: study protocol for a multi-centre randomized controlled trial

BackgroundAs an irreversible, intractable disease with vision loss, glaucoma leads to permanent and progressive damage of visual function. Lowering high intraocular pressure (HIOP) is the first choice for treating glaucoma; however, the control of HIOP is not enough to prevent progressive vison loss. Currently, the therapies to treat glaucoma with controlled IOP (GPCI) are unsatisfactory. Chinese medicine is effective for improving visual function in patients with GPCI. Bujing Yishi tablets (BJYSP) have been the standard preparation for treating GPCI in our hospital for decades. However, no rigorous randomized controlled clinical studies have investigated its effects and safety.MethodsThis study will be a 6-month, multicenter, stratified trial following a prospective, randomized, open-label, blinded endpoint (PROBE) protocol. A total of 216 eligible GPCI patients aged 18–75 years will be stratified according to the early, moderate, and advanced stages of glaucoma. After stratifying, the participants will be randomly assigned to the BJYSP group or control group at a ratio of 1:1. Following randomization, participants in the BJYSP group and control group will receive BJYSP and mecobalamin tablets, respectively, for the same 6-month period. The primary outcomes will include the best-corrected visual acuity (BCVA), visual field assessment, visual evoked potential (VEP) test, and Heidelberg retina tomography II (HRT II); the secondary outcomes will include intraocular pressure (IOP) and Traditional Chinese medicine (TCM) clinical symptom scales. The primary and secondary outcomes will be measured at baseline and 8, 16, and 24 weeks thereafter. Safety assessments will also be evaluated at baseline and 12 and 24 weeks thereafter.DiscussionThis study will be a standardized, scientific, clinical trial designed to evaluate the therapeutic effects and safety of BJYSP as a novel therapeutic strategy for improving visual function in patients with GPCI.Trial registrationChinese Clinical Trial Registry, ChiCTR1800016431. Registered on 1 June 2018.

IStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma: early clinical experience

BackgroundRetrospective, consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world, clinical setting.MethodsThe series included 56 eyes implanted with the iStent inject device with phacoemulsification. The series consisted of eyes with primary open-angle glaucoma (n = 52) and pseudoexfoliative glaucoma (n = 4). Primary outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes ≥10 mmHg and ≥ 15 mmHg.ResultsIOP was reduced by 21% to 14.7 ± 2.9 mmHg (p < 0.01) at 6 months postoperative from 18.7 ± 5.8 mmHg at baseline. Preoperatively, the mean number of glaucoma medications was 1.5 ± 0.9 and reduced by 39% to 0.9 ± 1.2 (p < 0.01) at 6 months. At 6 months, 68% of eyes had an IOP ≤15 mmHg, increased from 30% at baseline. 55% of eyes were medication-free at 6 months, up from 18% at baseline. There were no severe postoperative complications. No eyes underwent an additional glaucoma procedure.ConclusionsImplantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative. The safety profile is excellent.

Trabecular microbypass stent implantation in pseudoexfoliative glaucoma: long-term results.

To evaluate the long-term safety and efficacy of an iStent trabecular microbypass stent in combination with cataract surgery in pseudoexfoliative glaucoma (PXG). Private practice, Sioux Falls, South Dakota, USA. Retrospective, consecutive case series. Eyes with a preoperative diagnosis of PXG implanted with a single iStent trabecular microbypass stent with concomitant cataract surgery were included. Performance outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included intraoperative or postoperative complications and the need for secondary procedures. The series included 117 eyes. IOP was reduced by 25% to 15.3 ± 3.7 mm Hg at 5 years postoperatively from 20.5 ± 6.6 mm Hg at baseline. The statistically significant (P < .01) 36% reduction in medication use through 36 months was not sustained, and medication use was unchanged from baseline (1.4 ± 1.0) at 5 years postoperatively (1.3 ± 1.1) (P > .05). At 5 years, 52% of eyes had an IOP of 15 mm Hg or lesser, increased from 22% at baseline. There were no severe postoperative complications; 5 eyes (4%) underwent an additional glaucoma procedure. Implantation of a trabecular microbypass stent with concomitant cataract surgery provided a sustained reduction in IOP up to 5 years postoperatively. The long-term safety profile of the device in this population was excellent with a low rate of postoperative IOP spikes and low percentage of eyes undergoing a secondary procedure.

Surgical outcomes of Ahmed glaucoma valve implantation in patients with glaucoma secondary to iridocorneal endothelial syndrome.

To evaluate the long-term outcome of patients with iridocorneal endothelial (ICE) syndrome who underwent Ahmed glaucoma valve implantation surgery for uncontrolled glaucoma. Eighteen patients who suffered from unilateral ICE syndrome with uncontrolled glaucoma and subsequently underwent Ahmed aqueous shunt surgery at Zhongshan Ophthalmic Center between January 2008 and December 2016 were reviewed. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, further surgical interventions, and surgical complications. The mean IOP was reduced from 34.8 ± 10.6 mmHg on 3.6 ± 0.5 medications to 17.4 ± 4.9 mmHg (t = 6.791, P = 0.000) on 1.6 ± 1.1 medications (Z = -3.545, P = 0.000) at the last follow-up (42.0 ± 19.3 months). Five eyes (27.8%) achieved complete success, nine (50.0%) achieved qualified success, and the remaining four (22.2%) were considered failures. Survival was 94.4% at 1 year, 88.1% at 2 years, and 73.5% at 3 years. Four cases displayed a flat anterior chamber and were treated with a single anterior chamber reformation surgery with no recurrence. No other complications related to the glaucoma drainage implants occurred in this series. Ahmed glaucoma valve implantation appears to be a safe and effective method for treating glaucoma secondary to ICE syndrome. Postoperative shallow anterior chamber and hypotony may occur but responds well to the treatment. Early consideration may be given to aqueous shunt surgery in patients with glaucoma secondary to ICE syndrome when trabeculectomy fails.

A novel ophthalmic viscosurgical device-free phakic intraocular lens implantation makes myopic surgery safer

PurposeTo assess the efficacy and safety of a novel ophthalmic viscosurgical device-free (OVD-free) method for posterior chamber phakic intraocular lens (PIOL) implantation in myopic eyes.MethodsIn this retrospective cohort study, the medical records of myopic eyes that underwent PIOL (Implantable Collamer Lens, ICL) implantation for myopia correction at the Eye Hospital of Wenzhou Medical University between May 2015 and March 2017 were reviewed. A total of 49 eyes with complete data that met follow up requirements (2 h, 1 day, 1 week, 3 months postoperatively) were recruited. Based on the surgical techniques used, the eyes were divided into the OVD-free method group and the standard method group. The clinical data, including intraocular pressure (IOP), corrected distance visual acuity (CDVA) and spherical equivalent (SE), at each follow-up were collected for comparison. Endothelial cell loss and complications were also investigated.ResultsTwenty-one eyes received the standard method, and 28 eyes received the OVD-free method. A rise in IOP > 22 mmHg at 2 h was noted in 14 eyes (66.7%) in the standard group and none (0%) in the OVD-free group (p < 0.001). The rise in IOP from baseline was significantly higher at 2 h in the standard group (10.5 ± 5.2 mmHg vs. 2.2 ± 3.3 mmHg, difference: 8.3, 95% CI 5.8 to 10.8; p < 0.001). There was a significant difference in the time course of LogMAR CDVA changes between the two groups (p = 0.047). The LogMAR CDVA was significantly better in the OVD-free method group compared to the standard group at 1 day (− 0.076, 95% CI − 0.134 to − 0.018; p = 0.012), 1 week (− 0.071, 95% CI − 0.135 to − 0.007; p = 0.03), but not at 3 months (− 0.046, 95% CI − 0.107 to 0.015; p = 0.134). There was no significant difference in the time course of SE changes between the two groups (p = 0.471; p = 0.705). In the OVD-free group, mean endothelial cell loss was 4.6% at 3 months (2522 ± 281 vs. 2407 ± 226 cells/mm2, difference: -115, 95% CI − 295 to 65; p = 0.187). No complications were reported in both groups except for the early IOP elevation in the standard group during the observation period.ConclusionsThe OVD-free method is safe and efficient for ICL implantation. It can be a safer method of ICL implantation compared to the standard method in that it completely eliminates ophthalmic viscoelastic devices-related complications without causing additional complications.

Phacoemulsification with Trabecular micro-bypass stents in complex and moderate to advanced glaucoma: 3 year outcomes

Purpose: To evaluate longer-term (3 year) outcomes in terms of safety and efficacy of two trabecular micro-bypass stents implanted in combination with cataract surgery in patients with moderate to advanced and complex glaucoma. Patients: Fifty consecutive patients with cataract and moderate to advanced primary glaucoma or significantly raised intra-ocular pressure or secondary glaucoma or those with a history of previously failed filtering surgery. Methods: Retrospective, interventional case series. Patients underwent implantation of two trabecular micro-bypass stents in combination with cataract surgery. Outcomes measures included intra-ocular pressure (IOP), number of glaucoma medications, visual field mean deviation and need for secondary surgery. Results: The mean pre-operative IOP was 24.2 ± 7.3 mmHg, the mean post-operative IOP at 36 months (M36) was 16.2 ± 4.3 mmHg (p ≤ 0.05). This was a mean reduction of 8 mmHg (33.1%). Mean medication overall reduced from 3.2 preoperatively to 2.1 at M36 (p<0.05), a reduction of 34.4%. Visual field data was available for 30 eyes. There was no significant difference in mean MD over 36 months (p=0.267). Seven eyes (14%) required conversion to filtration surgery. No intraoperative complications were noted. Nine eyes (22.0%) were off medication at M36. Conclusion: Trabecular micro-bypass implantation in combination with cataract surgery is a safe and effective option in patients with complex and advanced glaucoma and appears to stabilize visual fields.

Combined iStent® Inject Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma.

PurposeThis retrospective audit aimed to evaluate the impact of combined iStent® Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields.Patients and MethodsPatients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification.ResultsForty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (–16%; p = 0.012; n = 35) and 12 months (–29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (–8%; p < 0.001; n = 57) and 6 months (–16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups.ConclusionThis audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification.

Short term efficacy of EX-PRESS filtration shunt implantation for open angle glaucoma.

To observe the short-term efficacy of EX-PRESS filtration shunt implantation in the treatment of open angle glaucoma, and to analyze the safety and effectiveness of the surgical method. From April 2017 to January 2018, a total of 28 eyes of 17 open angle glaucoma patients in Xiangya Hospital of Central South University were screened. Among them, 16 eyes in the experimental group were treated with EX-PRESS filtration shunt (P200)implantation, and 12 eyes in the control group underwent trabeculectomy. Related examinations were performed in 1 day before operation, 1 day after operation, 1 week after operation, 1 month after operation and 3 months after operation, which included intraocular pressure (IOP), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA), central anterior chamber depth (ACD), trabecular iris angle (TIA), the long axis of drainage nail and corneal endothelium angle (ACA), intraoperative and postoperative complications. Visual-related quality of life questionnaire was conducted and scored in 3 months after operation. In the experimental group, the IOP in 1 day after operation, 1 week after operation and 1 month after operation was decreased significantly compared with that in 1 day before operation (all P<0.05), but the IOP in 3 months after operation was not significantly decreased compared with that in 1 day before operation (P>0.05). In the control group, the IOP in 1 week after operation, 1 month and 3 months after operation was decreased significantly with that of pre-operation (all P<0.05), but the IOP in 1 day after operation was not significantly decreased compared with that in 1 day before operation (P>0.05).The BCVA between the 2 groups was significantly different in 1 week after operation, 1 month and 3 months after operation compared with that in 1 day before operation (P>0.05). The ACD in 1 day after operation, 1 week after operation, 1 month after operation and 3 months after operation was not significantly different compared with that in 1 day before operation (all P>0.05). However, the ACD in 1 week after operation and 1 month after operation was significantly different in the control group compared with that in 1 day before operation (both P<0.05). There was no significant change in the TIA in the 2 group compared with that in 1 day before operation (all P>0.05). At different observed time after operation, there was no significant difference in the ACA (all P>0.05). The correlation analysis of Pearson showed that there was a weak correlation between the ACA and the IOP (r=0.286, P<0.05). According to the standard of surgical success defined in this study, the success rate of experimental group was 81.25%, and the control group was 83.33%. There was no significant difference in the visual-related quality of life score between the experimental group and the control group (P>0.05), but the mean value in the former was higher. As a new type of anti-glaucoma surgery, the success rate of EX-PRESS filtration shunt implantation for 3-month follow-up is equivalent to that of classic trabeculectomy. The operation process is simple, and there is no significant change in the ACD before and after the operation in the period of 3-month follow-up. The stability of the anterior chamber is better. There is no significant correlation between the relative position of the shunt in the anterior chamber and the IOP. Compared with trabeculectomy, there is no significant difference in the visual-related quality of life.

Comparison of the 1-year postoperative results of phacoemulsification–trabeculectomy and phacoemulsification–ExPRESS miniature shunt combined surgeries

This study aimed to compare the 1-year postoperative phacoemulsification-trabeculectomy (P-Trab) and phacoemulsification-ExPRESS® (P-200 model) miniature shunt (P-ExPRESS) combined surgeries. This retrospective, comparative clinical study investigated 41 eyes of 41 patients diagnosed with open-angle glaucoma and cataract. Of these, 21 eyes underwent P-Trab surgery and 20 eyes underwent P-ExPRESS surgery. The 1-year follow-up results, including intraocular pressure (IOP), visual acuity (VA), medications, and complications, were reviewed and compared. A 5 ≤ IOP ≤ 18mmHg or 30% reduction from baseline was defined as Qualified Success (QS-1), and target IOP without medication was defined as Complete Success (CS-1). A 5 ≤ IOP ≤ 15mmHg or 40% reduction from baseline was defined as Qualified Success (QS-2), and target IOP without medication was defined as Complete Success (CS-2). The mean follow-up time was 16months (12-26months). Results after the twelfth month for P-Trab versus P-ExPRESS are: CS-1: 42.8% versus 60.0% (P = 0.354); QS-1: 86.7% versus 95% (P = 0.606); CS-2:33.3% versus 40% (P = 0.751); QS-2: 66.6% versus 75% (P = 0.733). Kaplan-Meier survival analysis was not statistically significant between two groups for both QS-1, CS-1 and QS-2, CS-2 (P = 0.329 vs P = 0.365, P = 0.765 vs P = 0.789, respectively). Pre-op mean IOP was: 33.19 ± 8.7 versus 34.55 ± 11.3mmHg; post-op mean IOP was: 15.19 ± 3.07 versus 15.30 ± 3.32mmHg (P = 0.913); pre-op mean VA was: 1.17 ± 1.04 versus 1.15 ± 1.07 logMAR; and post-op mean VA was: 0.61 ± 0.80 versus 0.66 ± 0.99 logMAR (P = 0.869). The pre-op mean number of antiglaucomatous medications was 3.76 ± 0.53 versus 3.30 ± 1.45, and the post-op results were 1.52 ± 1.53 versus 0.85 ± 1.26 (P = 0.135). Comparing the pre-op and post-op values, both types of surgeries were equally effective (P = 0.00). Surgical failure was 14.2% (3/21) versus 5% (1/20), and the incidence ratios of significant complications were: 47% (10/21) versus 10% (2/20) and P-Trab versus P-ExPRESS, respectively (P = 0.015). The 1-year postoperative results suggest that P-ExPRESS is as effective as P-Trab, with fewer complications.

Silicone Tube Miniature Drainage Device Implanted under Scleral Flap for the Surgical Treatment of Glaucoma

ABSTRACT Purpose To evaluate the safety and efficacy of a silicone tube miniature drainage device implanted under scleral flap for the surgical treatment of primary open-angle glaucoma (POAG). Methods This is a non-randomized prospective study. Patients with a minimum follow-up of 12 months were analyzed. Demographic information, preoperative and postoperative data including intraocular pressure (IOP), number of medications and complications were recorded. Results A total of 33 eyes of 33 patients were included in the analysis. Mean postoperative follow-up was 29.5 ± 6.9 months (range 18–50 months). The mean preoperative IOP was 25.8 ± 7.3 mmHg and decreased to 14.9 ± 4.3, 14.2 ± 3.4 and 14.9 ± 3.3 mmHg at 1 year, 2 years and last follow-up after surgery. The number of medications was decreased from 3.1 ± 1.3 preoperatively to 0.2 ± 0.7, 0.4 ± 0.9 and 0.4 ± 1.0 at 1 year, 2 years and last follow-up, respectively, after surgery. Only six (18.2%) patients used glaucoma medications at last visit. The complete success rates were 87.9% and 78.6%, respectively, at 1 and 2 years postoperatively. The operation-related complications were rare. Conclusions The silicone tube miniature drainage device implanted under the scleral flap was found to be a relatively safe and effective surgery for the treatment of POAG. Longer follow-up periods and larger sample sizes are expected.

The Tenons' Layer Reposition Approach of Trabeculectomy: A Longitudinal Case Series of a Mixed Group of Glaucoma Patients.

This 1-year prospective study demonstrated that the Tenon's layer reposition approach of trabeculectomy could achieve zero leakage rate, minimal rate of transient hypotony without compromising the surgical outcome. The purpose of this study was to investigate the effectiveness and safety of a Tenon's layer reposition approach of trabeculectomy. A prospective, noncomparative case series of 30 eyes of 30 Chinese patients with mixed types of glaucoma who underwent fornix-based trabeculectomy combined with intraoperative mitomycin C application. During the conjunctival flap closure, the Tenons' layer was identified, separated, and anchored on to the sclera surface with 8/0 vicryl, followed by conjunctival closure with 10/0 nylon as a separate layer. All patients were followed up for 1 year. Assessment including intraocular pressure (IOP), vertical cup-disc ratio measurement, best-corrected visual acuity, and visual field examination were performed before and after the operation. Qualified and complete success was defined as IOP of ≤21 mm Hg in 2 consecutive visits with or without medication, respectively. Outcomes were evaluated using scattered plot and Kaplan-Meier survival curve. Twenty-one eyes (70%) and 28 eyes (93.3%) achieved complete and partial success at 1 year, respectively. There was a significant reduction of IOP (28.5±9.6 to 15.5±2.6 mm Hg, P<0.001) and medication use (4.4±0.9 to 0.8±1.2 bottles/eye, P<0.001). There were no significant changes in best-corrected visual acuity, vertical cup-disc ratio, and visual field indices. No wound leak was identified throughout the study. The procedure did not induce significant astigmatic change. Other postoperative complications, including 2 eyes (6.7%) with transient hypotony and 1 eye (3.3%) required cataract surgery, were of relatively low rate. The Tenon's layer reposition approach of performing trabeculectomy is a safe and efficacious procedure for Chinese subjects with different types of glaucoma.

A 3D Deep Learning System for Detecting Referable Glaucoma Using Full OCT Macular Cube Scans.

PurposeThe purpose of this study was to develop a 3D deep learning system from spectral domain optical coherence tomography (SD-OCT) macular cubes to differentiate between referable and nonreferable cases for glaucoma applied to real-world datasets to understand how this would affect the performance.MethodsThere were 2805 Cirrus optical coherence tomography (OCT) macula volumes (Macula protocol 512 × 128) of 1095 eyes from 586 patients at a single site that were used to train a fully 3D convolutional neural network (CNN). Referable glaucoma included true glaucoma, pre-perimetric glaucoma, and high-risk suspects, based on qualitative fundus photographs, visual fields, OCT reports, and clinical examinations, including intraocular pressure (IOP) and treatment history as the binary (two class) ground truth. The curated real-world dataset did not include eyes with retinal disease or nonglaucomatous optic neuropathies. The cubes were first homogenized using layer segmentation with the Orion Software (Voxeleron) to achieve standardization. The algorithm was tested on two separate external validation sets from different glaucoma studies, comprised of Cirrus macular cube scans of 505 and 336 eyes, respectively.ResultsThe area under the receiver operating characteristic (AUROC) curve for the development dataset for distinguishing referable glaucoma was 0.88 for our CNN using homogenization, 0.82 without homogenization, and 0.81 for a CNN architecture from the existing literature. For the external validation datasets, which had different glaucoma definitions, the AUCs were 0.78 and 0.95, respectively. The performance of the model across myopia severity distribution has been assessed in the dataset from the United States and was found to have an AUC of 0.85, 0.92, and 0.95 in the severe, moderate, and mild myopia, respectively.ConclusionsA 3D deep learning algorithm trained on macular OCT volumes without retinal disease to detect referable glaucoma performs better with retinal segmentation preprocessing and performs reasonably well across all levels of myopia.Translational RelevanceInterpretation of OCT macula volumes based on normative data color distributions is highly influenced by population demographics and characteristics, such as refractive error, as well as the size of the normative database. Referable glaucoma, in this study, was chosen to include cases that should be seen by a specialist. This study is unique because it uses multimodal patient data for the glaucoma definition, and includes all severities of myopia as well as validates the algorithm with international data to understand generalizability potential.

Second-generation trabecular micro-bypass stent implantation: Retrospective analysis after 12- and 24-month follow-up

BackgroundThe study aimed to investigate the 24-month safety and efficacy of implantation of two second-generation iStent inject trabecular micro-bypass stents with concomitant cataract surgery.MethodsThis consecutive case series included 164 eyes of 109 patients implanted with the iStent inject® device with concomitant cataract surgery. The series was comprised of eyes with primary open-angle glaucoma (n = 84), pseudoexfoliation glaucoma (n = 42), normal-tension glaucoma (n = 18), and ocular hypertension (n = 20). All 164 eyes reached 9–14 months of follow-up (“12-month consistent cohort”), with a subset of 88 eyes reaching 21–26 months of follow-up (“24-month consistent cohort”). Performance outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included intra- or postoperative complications, the need for secondary procedures and corrected distance visual acuity. Comparisons of change in continuous (e.g., IOP) and categorical (e.g., proportions of eyes on zero medications) measures between baseline and postoperative times were made with the paired t-test and McNemar’s chi-squared test, respectively.ResultsAt 12 months postoperatively, IOP was reduced by 25.5% (from 20.0 ± 5.5 mmHg to 14.9 ± 2.0 mmHg; p < 0.001); at 24 months postoperatively, IOP was reduced by 26.6% (from 20.3 ± 6.1 mmHg to 14.9 ± 1.9 mmHg; p < 0.001). At 12 months postoperatively, mean number of glaucoma medications was reduced by 85.0% (from 2.0 ± 1.0 to 0.3 ± 0.8 medications; p < 0.001); at 24 months postoperatively, mean number of medications was reduced by 81.0% (from 2.1 ± 1.1 to 0.4 ± 0.8 medications; p < 0.001). After 12 months, 96.3% of eyes had an IOP ≤ 18 mmHg and 58.5% of eyes had an IOP ≤ 15 mmHg, with 81.1% of eyes free of any medication, compared to 1.8% of eyes medication-free in the 12-month cohort at baseline. After 24 months, 98.9% of eyes had an IOP ≤ 18 mmHg and 53.4% of eyes had an IOP ≤ 15 mmHg, with 72.7% free of medication compared to 1.1% of eyes medication-free in the 24-month cohort at baseline. Overall, a high safety profile was observed with no significant postoperative complications.ConclusionsThe insertion of iStent inject (comprised of two second-generation trabecular micro-bypass stents) with cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden up to 24 months postoperatively.

OPHTHALMIC EXAMINATION FINDINGS AND INTRAOCULAR PRESSURE MEASUREMENTS IN SIX SPECIES OF ANURA

A complete ophthalmic exam, including intraocular pressure (IOP) measurement, is key to diagnosing ocular diseases such as uveitis and glaucoma in frogs. We performed complete ophthalmic anterior segment examinations and IOP rebound tonometry measurements using two different settings (other "p" and canine "d") for six anuran species. The objectives were to describe common ocular abnormalities found in these species, to compare IOP values between different tonometer settings, and to compare IOPs between species. Examinations revealed abnormalities including cataracts (11/98 total eyes), lenticular sclerosis (10/98) and lipid keratopathy (9/98). IOP was measured with the TonoVet® and the ranges (oculus uterque, OU mm Hg other "p" setting, canine "d" setting) were giant waxy monkey tree frogs (Phyllomedusa bicolor) (3.5-7.6; 6.5-11.7; n = 5), mission golden-eyed tree frogs (Trachycephalus resinifictrix) (7.0-9.7, 13.2-15.7; n = 6), boreal toads (Bufo boreas boreas) (0.8-5.5, 5.7-10.5; n = 13), Mexican giant tree frogs (Pachymedusa dacnicolor) (3.8-5.0, 8.3-11.8; n = 3), Lake Titicaca frogs (Telmatobius culeus) (8.8-10.5, 14.0-17.2; n = 8), and mossy tree frogs (Theloderma corticale) (9.7-11.0, 15.7-17.0; n = 5). The TonoVet canine "d" setting IOP measurements were statistically higher (P = 0.01) than the other "p" setting measurements for all species except the giant waxy monkey tree frogs. IOP was significantly lower for giant waxy monkey tree frog eyes with cataracts (P < 0.05) with the other "p" setting. IOP did not statistically differ in eyes with lenticular sclerosis. IOP can be measured by rebound tonometer in anurans, but more research is needed for species-specific references using consistent settings.

Association of lamina cribrosa morphometry with retinal nerve fiber layer loss and visual field defects in primary open angle glaucoma.

Objectives:To calculate the anterior lamina cribrosa depth (ALCD) and lamina cribrosa thickness (LCT) in primary open angle glaucoma (POAG) patients and controls and to correlate lamina cribrosa (LC) parameters to retinal nerve fiber layer thickness (RNFLT) and visual field (VF) defects.Methods:The study was conducted from November 2018 to March 2019. A total of 60 correspondents (30 cases and 30 controls) were assessed for general ophthalmological investigations including intraocular pressure (IOP), axial length AXL, ophthalmoscopy, visual field (VF) testing and spectral domain ocular computed tomography (SDOCT).Results:The mean age of subjects was 62 years (Cases 67.30±1.2, controls 57.32±1.1) with more male participants. Intraocular pressure [IOP (19.85 ±1.4)], AXL (22.85 ± 1.6), VF defects (8.30 ± 4.5), RNFLT (72.58 ± 13.2) and LCT (162.51 ± 64.62) were statistically significant in POAG patients as compared to the controls.Conclusion:A thinner LC in POAG correlated significantly with the RNFLT and VF defects. LC anatomical parameters can be estimated with precision using SDOCT with enhanced depth imaging (EDI).

Prevalence of Primary Open Angle Glaucoma among Patients with Diagnosis of Systemic Hypertension and Diabetes Mellitus: The Colombian Glaucoma Study

Objective: To establish the prevalence and risk factors of Primary Open Angle Glaucoma (POAG) among patients with Systemic Hypertension (SH) and Diabetes Mellitus (DM) in six cities of Colombia. Methods: A cross-sectional study among hypertensive and diabetic patients was conducted in Colombia. This study included 2067 subjects older than 50 years of age diagnosed with SH and/or DM. Participants underwent a complete ophthalmic examination including intraocular pressure (IOP) measurement by Goldmann tonometry and blood pressure measurement. The glaucoma diagnosis was confirmed by structural and functional evidence. Interviews and standardized questionnaires were used to evaluate participants’ lifestyle and other health conditions. Results: Among participants with DM/SH, 142 cases of POAG were confirmed for a prevalence of 5.6% [95% CI: 4.6 - 6.6], while 9.1% were glaucoma suspects [95% CI: 7.8% - 10.4%]. The majority of confirmed cases (77.5%) were undiagnosed. The prevalence of POAG was significantly higher with male gender, greater age, and diastolic blood pressure > 90 mmHg as risk factors. Conclusion: We found a high prevalence of POAG in patients with adequate SH and DM care in a novel Latino population. We also found great unawareness of the disease in this population. Our results have potentially enormous public health implications for Colombia and other Latino populations.

Clinical results of ab interno trabeculotomy using the trabectome in patients with uveitic glaucoma.

To evaluate the safety and efficacy of ab interno trabeculotomy (AIT) (trabecular ablation) with the trabectome in patients with uveitic glaucoma. Traditional glaucoma filtration surgeries in the uveitic patient population come with a higher risk of complications such as failure and hypotony. Retrospective observational cohort study. All patients diagnosed with uveitic glaucoma were included in this study. Patients were excluded if they have less than 12 months of follow-up. All patients who received AIT alone or combined with phacoemulsification. Major outcomes include intraocular pressure (IOP), number of glaucoma medications and secondary glaucoma surgery, if any. Kaplan-Meier method was used for survival analysis and success was defined as IOP ≤21 mmHg, at least 20% IOP reduction from baseline for any two consecutive visits after 3 months, no additional glaucoma medications, and no secondary glaucoma surgery. A total of 45 eyes, 45 patients, with an average age of 52 years were included in the study. The majority were Japanese (40%) and underwent AIT alone (71%). IOP was reduced from 29.2 ± 8.0 to 16.7 ± 4.6 mmHg at 12 months (P < .01*), while the number of glaucoma medications was reduced from 4.0 ± 1.0 to 2.5 ± 1.6 (P < .01*). Survival rate at 12 months was 91%. Six cases required secondary glaucoma surgery and no other serious complication were reported. The trabectome AIT procedure appears to be effective in reducing IOP in uveitic glaucoma patients. Although no statistically significant difference was found in the number of glaucoma medications, a decreasing trend was found.

High Myopia and Its Associated Factors in JPHC-NEXT Eye Study: A Cross-Sectional Observational Study.

The increasing prevalence of high myopia has been noted. We investigated the epidemiological characteristics and the related factors of high myopia in a Japanese adult population. Japan Public Health Center-Based Prospective Study for the Next Generation (JPHC-NEXT) Eye Study was performed in Chikusei-city, a rural area in mid-east Japan, between 2013 and 2015. A cross-sectional observational analysis was conducted to investigate prevalence and related factors of high myopia. A total of 6101 participants aged ≥40 years without a history of ocular surgeries was included. High myopia was defined as a spherical equivalent refraction of ≤−6.00 diopters according to the American Academy of Ophthalmology. Potential high myopia-related factors included intraocular pressure (IOP), corneal structure, corneal endothelial cell density, age, height, body mass index, heart rate, blood pressure, biochemical profile, and current history of systemic and ocular disorders. The odds ratios of high myopia were estimated using the logistic regression models adjusted for the associated factors. The prevalence of high myopia was 3.8% in males and 5.9% in females with a significant difference. Age was inversely associated, IOP was positively associated, and none of other factors were associated with high myopia in both sexes. In conclusion, only age and IOP were associated with high myopia in this community-based sample.

Trabecular micro-bypass stent implantation with cataract extraction in pigmentary glaucoma.

Use of the trabecular micro-bypass stent with cataract surgery is well established to be safe and effective in primary open-angle glaucoma. This is the first study to exclusively evaluate use of the device in pigmentary glaucoma. This study aimed to investigate the safety and efficacy of a trabecular micro-bypass stent in combination with cataract surgery in pigmentary glaucoma. Retrospective, consecutive case series. Twenty-four eyes of 12 patients with pigmentary glaucoma implanted with one trabecular micro-bypass stent with concomitant cataract surgery. Baseline data was collected and compared to the following postoperative time points: 1 day, 1 week, 1 month out to 36 months (M36) after the procedure. These included intraocular pressure (IOP), number of glaucoma medications and need for additional surgery. At M36 there was a 25% reduction in IOP to 14.68 ± 3.0 (P < .01) from 19.50 ± 6.7 mmHg at baseline. The mean number of glaucoma medications was 0.75 ± 1.0 prior to the surgery and 0.59 ± 0.6 (P > .05) at 36 M. At the 36 M time-point, 95% of eyes had IOP ≤ 18 mmHg and 68% of eyes were ≤ 15 mmHg. No eyes underwent a secondary glaucoma procedure. The insertion of a single trabecular micro-bypass stent in combination with cataract surgery effectively provides a sustained reduction in IOP up to 3 years after surgery in patients with pigmentary glaucoma. The safety profile is favourable with low rate of IOP spikes and no patients requiring additional surgery.