Initial Intraocular Pressure Research Articles

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma.

iStent implantation is thought to augment the trabecular outflow channel in the anterior segment of the eye. We hypothesized that iStent with subsequent selective laser trabeculoplasty (SLT) would better control the intraocular pressure (IOP) compared to standalone SLT in patients with primary open-angle glaucoma (POAG). We, therefore, determined if the presence of an iStent combined with SLT was statistically associated with IOP lowering compared to standalone SLT. Through retrospective electronic medical record review, records of 824 eyes from 440 patients who received primary SLT without a history of iStent were considered. Additionally, 42 eyes from 28 patients who received SLT after combined phacoemulsification and iStent implantation that failed to control intraocular pressure (IOP) and/or the progression of the disease were retrospectively reviewed. IOP and number of medications, which were tracked in each patient for up to 12 months post laser, were also examined. Successful outcome was defined as a statistically significant reduction in IOP or number of medications at 6 months. As defined in univariate analysis (p ≤ 0.01), multivariate analysis included iStent, age, sex, race, and initial IOP as variables. IOP reduction was statistically associated with patients pre-SLT IOP (p < 0.001) but not with patients with iStent (p = 0.222). Medication reduction was statistically associated with the pre-SLT number of medications (p < 0.001) and iStent (p < 0.001). In eyes that received SLT, iStent was not statistically associated with a greater reduction in IOP compared to controls, but was associated with a higher reduction in the overall number of medications used 6 months after receiving SLT. The work presented should guide clinicians to consider SLT as an effective therapy after iStent implantation, in terms of glaucoma medication reduction in iStent patients, but clinicians should know that the presence of an iStent does not necessarily make subsequent SLT more effective at lowering IOP.

Pediatric Glaucoma in a University Hospital.

Aims and objectivesThis study aimed at describing the characteristics and outcomes of pediatric glaucoma patients in a university hospital in Lebanon and comparing them between primary congenital glaucoma (PCG) and secondary glaucoma.Materials and methodsSixty-four eyes of 40 pediatric glaucoma patients with a follow-up of 1 year or more were reviewed. Parameters were studied for both PCG and secondary glaucoma groups. Three major outcomes were considered: intraocular pressure (IOP) control, final best-corrected visual acuity (BCVA), and the proportion of failed angle surgeries.ResultsSixty-four eyes were included divided into 29 PCG and 35 secondary glaucoma eyes, followed up for a mean of 6.6 ± 4.7 years. Eyes with PCG presented earlier, with a higher initial IOP and underwent earlier surgery than their secondary glaucoma counterparts. Although 85.9% of all eyes achieved good IOP control, 44.4% of them had a BCVA ≥20/50 with PCG having a better visual prognosis. Secondary glaucoma eyes needed more medications at the end of their follow-up. In this group, it was shown that a later age at first surgery, unilateral disease, and multiple surgeries were associated with a BCVA < 20/50.ConclusionPatients with PCG presented earlier and with a higher IOP than secondary glaucoma; they were also operated on earlier. Both groups demonstrated good IOP control at the end of the follow-up period with PCG eyes having a superior visual outcome. Secondary glaucoma eyes required a higher number of medications at their final visit. In this population, multiple surgeries, unilateral disease, and a delayed first surgery conferred a poorer visual prognosis.Clinical significanceData regarding the characteristics of pediatric glaucoma, especially in the Middle East, are scarce. Our study sheds the light on the presentation of different types of pediatric glaucoma and their outcomes namely IOP control and visual acuity.How to cite this articleDakroub M, Khair D, Noureddine B, et al. Pediatric Glaucoma in a University Hospital. J Curr Glaucoma Pract 2021;15(1):8–13.

Hypotensive therapу of secondary glaucoma in patients with endocrine ophthalmopathy

Objective: to evaluate the efficiency of monotherapy and fixed combination therapy of secondary glaucoma (SG) in patients with endocrine ophthalmopathy (EOP).Materials and methods. We examined 145 patients (290 eyes and orbits) with different forms and activity of EOP. Among them, 30 patients (58 eyes and orbits) were diagnosed with ″SG detected for the first time and associated with EOP″ (20 % of the cases).The patients with SG received beta-adrenoblockers (BA) or prostaglandin analogues (PGA) as initial monotherapy. Two weeks later, in the absence of intraocular pressure (IOP) compensation, fixed combinations of beta-blocker/carbonic or anhydrase inhibitor (BB/CAI) or beta-blocker/prostaglandin analogue (BB/ PGA) were prescribed.Results. The PGA monotherapy reduced the IOP level by 29 % compared to the baseline level in 33 % of the cases in increased ophthalmic tonus within Me 27 [26;28] mm Hg. (Wilcoxon test, p = 0.005). In IOP levels over 29 [28;31] mmHg, BB/PGA fixed combination therapy reduced IOP by 33 % from the baseline level.Conclusion. SG monotherapy in patients with EOP is effective in increased IOP within Me 27 [26;28] mmHg. In initial IOP levels higher than 29 [28;31] mmHg, it is expedient to prescribe BB/PGA fixed combination therapy as initial therapy.

Anterior versus posterior endoscopic cyclophotocoagulation: comparison of indications, populations, and outcomes.

To examine how indications, patient characteristics, and outcomes differ between anterior and posterior approaches of endoscopic cyclophotocoagulation (ECP) in the treatment of glaucoma. This is a retrospective chart review of 9 anterior and 20 posterior ECP cases (n = 29). Posterior ECP cases were typically associated with a dramatic increase in intraocular pressure (IOP), whereas the anterior ECP was associated with chronically elevated pressures. The initial IOPs in mm Hg of posterior ECP cases (26.8 non-NVG; 35.2 NVG) were much greater than anterior ECP cases (17.8), and a greater overall reduction in IOP was observed in the posterior versus anterior ECP cases (10.3 posterior non-NVG; 21.3 posterior NVG; 3.6 anterior, P < .001). With procedural success defined as 6-month post-operative IOP falling within normal ranges and a decrease in either IOP or number of prescribed glaucoma medications, the success rate of ECP was 92% for posterior NVG, 89% for anterior and 75% for posterior non-NVG cases (P = .34), similar to the previous literature. Of the four unsuccessful cases, two resulted in a normal IOP but lacked a drop in pressure or reduction in medication burden, one resulted in a 6-point drop in IOP but remained at 23mm Hg, and one resulted in phthisis bulbi (3%) from an initial pressure above 40mm Hg. Endoscopic cyclophotocoagulation is an effective and safe procedure for severe glaucoma cases from both an anterior and posterior approach. Ophthalmologists should consider this procedure as part of their glaucoma treatment arsenal.

Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure.

PurposeTo investigate the association between peripheral vasospasm and the visual field (VF) progression rate in patients with normal-tension glaucoma (NTG) with low-teen intraocular pressure (IOP).MethodsThe finger temperature of 113 NTG patients was measured before and after exposure to ice water using a Temperature gun (cold pressor test). These patients had confirmed VF progression, despite a low-teen IOP during a follow-up period of >5 years. VF progression rates were calculated as the slope of the visual field index (VFI) and mean deviation (MD) over time. Demographic, systemic, and ocular factors and VF progression rates were compared, based on the cold pressor test results. A regression analysis was used to investigate the factors affecting VF progression rates.ResultsMean age, initial IOP, mean IOP during the follow-up period, and initial VF MD were 57.1 years, 15.8 mmHg, 12.0 mmHg, and -5.2 dB, respectively. When patients were divided into two groups (less vasospasm and more vasospasm) according to changes in temperature after exposure to ice water, the VF progression rate was significantly faster in the group with more vasospasm. In a multiple regression analysis, older age, worse initial VF MD, and greater decrease in finger temperature after ice water exposure were significantly associated with faster VF progression rates.ConclusionAn excessive drop in finger temperature after exposure to ice water was significantly associated with faster VF progression in patients with low-teen NTG. This suggests that the blood flow in the optic nerve head may also be disturbed by peripheral vasospasm, accelerating glaucomatous damage regardless of IOP.

Five-year results of non-penetrating deep sclerectomy with demineralized cancellous bone xenogenically derived collagen glaucoma implant.

To investigate the long-term effectiveness of non-penetrating deep sclerectomy (NPDS) with xenogenically derived cancellous bone collagen glaucoma implant (XCB-CGI) implantation in patients with primary open-angle glaucoma (POAG). Retrospective chart review of patients with POAG stages 2 and 3 was treated with NPDS and XCB-CGI. Follow-up was at 6months, 1, 2, 3, 4 and 5years after surgery. Main outcomes were intraocular pressure (IOP) and medication burden. Secondary outcomes were visual acuity, corneal hysteresis (CH), visual field (VF) and optical coherence tomography (OCT) parameter analysis. Among 71 patients (71 eyes), the mean age was 72.7 ± 9.8. Average initial IOP was 27.7 ± 7.9 and average initial med load was 2.36 ± 0.99. At 6months, 1, 2, 3, 4 and 5years, the average IOP was 14.9 ± 3.3mm Hg (46.2% reduction), 15.3 ± 4.0mm Hg (44.7% reduction), 14.2 ± 3.8mm Hg (48.7% reduction), 15.2 ± 3.3mm Hg (45.0% reduction), 15.5 ± 3.3mm Hg (44.0% reduction) and 14.2 ± 2.8mm Hg (48.7% reduction), respectively. In 5years, the success rate was 34% and 67%, without, and with medications (1.8 ± 0.8 meds required), respectively. Visual acuity was not significantly different (P > .05) at all follow-up visits from baseline. Mean CH increased by 2.1 ± 0.8 (P = .05). No glaucomatous deterioration of the VF and OCT parameters was detected in 56 eyes at the 5-year follow-up. NPDS with XCB-CGI implantation is an effective procedure to normalize the level of IOP, stabilize glaucomatous changes and decrease the number of meds needed for glaucoma control.

Characteristics and long-term outcomes of childhood glaucoma: a retrospective-cohort study.

Purpose: To evaluate the clinical characteristics and treatment outcomes of patients with childhood glaucoma. Methods: We retrospectively reviewed the data of patients with childhood glaucoma who visited the glaucoma clinics at the Queen Sirikit National Institute of Child Health and the King Chulalongkorn Memorial Hospital between January 2008 and January 2018. The diagnosis was based on the Childhood Glaucoma Research Network classification. We recorded their clinical characteristics and requirement of any glaucoma interventions. Results: A total of 691 eyes from 423 patients were included in this study. The patients predominantly comprised boys. The average follow-up duration was 71.3±63.8 months. The mean age at presentation was 3.9±4.4 years. Most patients presented with a high initial intraocular pressure (IOP) of 28.5±11.2 mmHg. Glaucoma associated with non-acquired ocular anomalies (22.9%) was the most common subtype, followed by primary congenital glaucoma (20.8%). We recorded a family history of glaucoma in 6.4% of patients. Most patients had bilateral glaucoma (63.4%) and required at least one intervention (51.5%). The average IOP at the latest follow-up visit was 19.1±10.8 mmHg. All glaucoma types had significantly lower IOP, compared to that at their baselines (all p<0.001). Moreover, most patients had an unfavourable visual acuity (49.5%) at their latest visit. Conclusions: Secondary glaucoma associated with non-acquired ocular anomalies is the most common subtype of glaucoma. All subtypes, including primary glaucoma, were sporadic. The majority of patients had unfavourable visual outcomes. These real-world findings are fundamental to acquire a better understanding of childhood glaucoma.

Micropulse laser trabeculoplasty and reduction of intraocular pressure: A preliminary study.

PURPOSE:The purpose of the study was to measure the change in intraocular pressure (IOP) after micropulse laser trabeculoplasty (MLT) and to evaluate subgroups based on initial IOP and severity of glaucoma.METHODS:This was a retrospective study of 34 eyes that were treated with MLT. Follow-up measurements were obtained at 3 months. Paired t-tests compared baseline to follow-up.RESULTS:IOP reduction approached significance (P = 0.055) for lower mean IOP from pre- to post-treatment. In the subset of those with baseline IOP >16, mean IOP was significantly lower (P = 0.001) from pretreatment (mean = 19.43, standard deviation [SD] = 2.48) to posttreatment (mean = 16.91, SD = 3.37). There were 34.8% (8/23) with a 20% reduction from baseline IOP. For patients with no glaucoma/early glaucoma, mean IOP was significantly lower (P = 0.003) from pretreatment (mean = 19.62, SD = 3.36) to posttreatment (mean = 16.62, SD = 3.01). In the subset of those with moderate/advanced glaucoma, there were no significant changes for mean IOP from pretreatment to posttreatment.CONCLUSION:Patients with higher initial IOP and in the early stages of glaucoma were more likely to benefit from MLT in lowering IOP. A randomized clinical trial is necessary to confirm these preliminary findings. We recommend that clinicians should consider MLT in the management of early glaucoma and among those with IOP >16 mmHg.

Predictors of Visual Functional Outcome Following Treatment for Cavernous Sinus Meningioma

Objective Cavernous sinus meningioma (CSM) can affect visual function and require expeditious treatment to prevent permanent visual loss. Authors of this retrospective study sought to determine the factors associated with visual functional outcomes in CSM patients treated with surgery, stereotactic radiosurgery (SRS), or stereotactic radiation therapy (SRT), alone or in combination. Methods Consecutive patients with CSM who had presented at an academic tertiary care hospital from 2000 to 2018 were identified through retrospective chart review. Visual function-visual eye deficit (VED), optic disc (OD) appearance, intraocular pressure (IOP), and extraocular movement (EOM)-was assessed before and after treatment for CSM. VED with visual acuity (VA) ≤ 20/200 and visual field defect ≥ -11 dB, pale OD appearance in the ipsilateral or contralateral eye, increased ipsilateral IOP, and/or EOM restriction were defined as a poor visual functional outcome. Multivariable logistic regression was used to evaluate the associations between pretreatment visual functional assessment and posttreatment visual outcomes. Results The study cohort included 44 patients (73% female; median age 55 years), with a median clinical follow-up of 14 months. Ipsilateral VED improved, remained stable, or worsened, respectively, in 0%, 33.4%, and 66.6% of the patients after subtotal resection (STR) alone; in 52.6%, 31.6%, and 15.8% after STR plus radiation treatment; in 28.5%, 43.0%, and 28.5% after gross-total resection (GTR) alone; and in 56.3%, 43.7%, and 0% after radiation treatment (SRS or SRT) alone. Contralateral VED remained intact in all the patients after STR alone and those with radiation treatment (SRS or SRT) alone; however, it improved, remained stable, or worsened in 10.5%, 84.2%, and 5.3% after STR plus radiation treatment and in 43.0%, 28.5%, and 28.5% after GTR alone. EOM remained intact, fully recovered, remained stable, and worsened, respectively, in 0%, 50%, 50%, and 0% of the patients after STR alone; in 36.8%, 47.4%, 15.8%, and 0% of the patients after STR with radiation treatment; in 57.1%, 0%, 28.6%, and 14.3% of the patients after GTR alone; and in 56.2%, 37.5%, 6.3%, and 0% of the patients after radiation treatment (SRS or SRT) alone.In multivariable analyses adjusted for age, tumor volume, and treatment modality, initial ipsilateral poor VED (OR 10.1, 95% CI 1.05-97.2, p = 0.04) and initial ipsilateral pale OD appearance (OR 21.1, 95% CI 1.6-270.5, p = 0.02) were associated with poor ipsilateral VED posttreatment. Similarly, an initial pale OD appearance (OR 15.7, 95% CI 1.3-199.0, p = 0.03), initial poor VED (OR 21.7, 95% CI 1.2-398.6, p = 0.03), and a higher IOP in the ipsilateral eye (OR 55.3, 95% CI 1.7-173.9, p = 0.02) were associated with an ipsilateral pale OD appearance posttreatment. Furthermore, a higher initial ipsilateral IOP (OR 35.9, 95% CI 3.3-400.5, p = 0.004) was indicative of a higher IOP in the ipsilateral eye posttreatment. Finally, initial restricted EOM was indicative of restricted EOM posttreatment (OR 20.6, 95% CI 18.7-77.0, p = 0.02). Conclusions Pretreatment visual functional assessment predicts visual outcomes in patients with CSM and can be used to identify patients at greater risk for vision loss.

The role of Ahmed glaucoma valve in the management of refractory glaucoma: Long-term outcomes and complications.

To retrospectively evaluate the efficacy and long-term complications of the Ahmed glaucoma valve (AGV) in refractory glaucoma. Seventy-eight eyes with glaucoma refractory to conventional surgical procedures (filtration surgery and diode laser cyclophotocoagulation) underwent AGV implantation between May 2006 and August 2018. The criteria for success were defined as an intraocular pressure (IOP) less than 18 mmHg and a decrease of at least 20% from the preoperative IOP. The criteria for failure were an IOP greater than 18 mmHg or less than 5 mmHg, an increase in medical treatment, a decrease of less than 20% of the initial IOP, the need for another glaucoma surgery, or a decrease in visual acuity attributable to the valve. IOP decreased from 31.0 ± 9.0 mmHg to 17.2 ± 7.2 mmHg (mean follow-up 32.5 months), for a mean IOP lowering of 44.5% (p < 0.001). Medical treatment was significantly reduced from 5.3 ± 1.5 to 2.8 ± 1.9 (p < 0.0001). The cumulative success rates were 59.4% at 3 years and 45.1% at 5 years. Encapsulation of the filtration bleb was the most common short-term complication (32.1%). Relevant long-term complications were bleb fibrosis with elevated IOP (12.8%) and corneal decompensation (10.2%). The AGV is an effective procedure in the long-term for controlling IOP in refractory glaucoma, with limited incidence of complications. These results suggest that the AGV might be considered earlier in the surgical strategy for glaucoma not controlled after one well-performed conventional filtration surgery.

Peripheral vascular disease \u2013 a new vascular disease associated with normal tension glaucoma: a case report

IntroductionNormal-tension glaucoma is known as a multifactorial optic neuropathy. A number of lines of evidence suggested that vascular factors played a significant role in the development of normal-tension glaucoma. The mechanisms underlying the abnormal ocular blood flow in normal-tension glaucoma are still not clear. Peripheral vascular disease seems to be associated with glaucoma populations independent of other cardiovascular risk factors. We found this presentation, for the first time, to our knowledge, as another probable vascular abnormality related to our patient with normal-tension glaucoma, although it is necessary to confirm its pathological effect in future studies.Case presentationOur patient was a 48-year-old Spanish man without any personal and family history of interest except for circulatory problems of the lower limbs with repetitive ulcers at the frontal and lateral aspects of his legs. His chief complaint was vision loss when he came to consult us. In exploration, his best corrected visual acuity was 20/20 in both eyes; initial intraocular pressure in the right eye was 14–16 mmHg and in the left eye was 16–18 mmHg, with a mild sclerosis of the lens in slit-lamp examination. No inflammation or pigmented lesion was detected in the anterior chamber. Open angle confirmed by Goldman four quadrants gonioscopy. Funduscopic examination revealed a vertical cup disc ratio of 0.6 in the right eye and 0.8 in the left eye. The patient’s neuroretinal rim was normal in the right eye, and superior thinning in the left eye was determined. Examination of the patient’s visual field showed inferior mild probable nasal scotoma in the right eye and an inferior deep arcuate scotoma defect in the left eye. His optical coherence tomography examination revealed thinning of the peripapillary nerve fiber layer thickness in the left eye and superior loss of macular retinal ganglion cells in the left eye. Normal intraocular pressure values were measured on the intraocular pressure curve without treatment (maximum value, 18–20 mmHg), discarding higher intraocular pressures measured out of office. Ultrasonic pachymetry measured 515/520 μm, and normal intraocular pressure measured with a PASCAL tonometer ruled out probable corneal biomechanical underestimations. The patient’s polysomnography study was normal and excluded sleep apnea syndrome. The patient’s serial mean blood pressure was normal, especially in the lower limbs (mean value, 125/70 mmHg), ruling out the possibility of systemic hypotension. Thyroidal and coagulation abnormalities, autoimmune disease, and inflammatory disease were excluded. Normal immunologic study and normal vascular biopsy were observed, as well as normal brain magnetic resonance imaging and a normal carotid vascular study. The primary diagnosis was moderate medium peripheral arterial disease in the lower limbs, which was confirmed by echography after ruling out other probable vascular abnormalities related to normal-tension glaucoma.ConclusionAfter ruling out other systemic diseases and vascular abnormalities related to normal-tension glaucoma, we found peripheral arterial disease as a probable vascular abnormality related to normal-tension glaucoma in our patient. To our knowledge, this is the first time such a case has been reported. Thus, further research is needed to determine the relevance of these results to the general population.

Ocular pathology associated with obstructive sleep apnea syndrome

Objective: The purpose of this study was to describe the ophthalmological findings in patients with obstructive sleep apnea syndrome (OSAS). Methods: The study group was made up of 65 patients with OSAS diagnosis and the findings were compared with the ones of the control group (n=39), which comprised patients without OSAS. An observational, analytic study, with a transversal component and a prospective component, was performed. Results: The IOP (intraocular pressure) was similar in both groups (p=0,9786). In the OSAS group, IOP increased with a higher AHI (apnea/ hypopnea index), but not significantly (p=0,057). Similarly, there was no correlation between a higher AHI and the lacrimal secretion in the OSAS group (p=0,3282). However, when we compared control with OSAS patients, we found a significantly higher degree of lacrimal hyposecretion in the latter (p=0,0003). CPAP treatment had no effect on IOP, as initial and final medium IOP were 15.06 and 14.89 respectively (p=0,8327). Regarding lacrimal secretion, it seems that CPAP treatment had an improving effect, as tear production rose from a 9.25 mm medium to 10.45 mm on the Schirmer I test (p=0,0118). Conclusions: Overall, OSAS patients showed similar IOP and glaucoma prevalence as the normal population. However, they had an abnormal tear secretion and a higher prevalence of eyelid laxity (a sign of floppy eyelid syndrome). Abbreviations: OSAS/ SASO = obstructive sleep apnea syndrome, AHI = apnea/ hypopnea index, CPAP = continuous positive airway pressure, FES = floppy eyelid syndrome, TSch/ TSCH = Schirmer test, IOP = intra-ocular pressure, PSG = polysomnography.

Trabectome, trabecular aspiration and phacoemulsification in a triple procedure for treating exfoliation glaucoma: A long-term follow-up.

This study investigates the long-term intraocular pressure (IOP) lowering potential, risk profile and success rate of a triple procedure comprising phacoemulsification, trabecular aspiration and trabectome (Microsurgical Technology, Redmond, WA, USA) for treating exfoliation glaucoma. A total of 117 eyes of 117 patients with exfoliation glaucoma underwent a combination of phacoemulsification, trabectome and trabecular aspiration. They were followed up for up to 7 years. The success rates were designated according to criteria based on the Tube versus Trabeculectomy Study and the World Glaucoma Association guidelines: A (no resurgery); B/C (IOP < 21/18 mmHg, no resurgery, IOP reduction > 20%); D (IOP ⩽ 15 mmHg, no resurgery, IOP reduction ⩾ 40%). The mean follow-up period was 46 months. IOP showed a 38% reduction from 24.5 ± 6.1 to 15.2 ± 3.6 mmHg (p < 0.0001). The Medication Score decreased by 23% from 2.2 ± 0.9 to 1.7 ±1.0 (p < 0.0001). The success rates were 87, 76, 74 and 38% according to criteria A, B, C and D. In eyes with an initial IOP of >30 mmHg, a 57% reduction from 34.2 ± 4.4 to 14.8 ± 3.2 mmHg (p < 0.0001) was observed, and the success rates were 91, 91, 82 and 59% for criteria A, B, C and D, respectively. We conclude that the triple procedure may effectively lower IOP in patients with exfoliation glaucoma over a mean follow-up period of 46 months without significant side effects. Therefore, the triple procedure may serve as first-line surgery for patients with exfoliation and cataract, even with a high initial IOP.

Effectiveness of iStent Trabecular Microbypass System Combined with Phacoemulsification versus Phacoemulsification Alone in Patients with Glaucoma and Cataract Depending on the Initial Intraocular Pressure

Introduction: To assess the effect of iStent trabecular microbypass implantation combined with phacoemulsification on intraocular pressure (IOP) and glaucoma medications and to compare this to outcomes of phacoemulsification alone in patients with mild to moderate primary open-angle glaucoma (POAG) depending on initial IOP. Materials and Methods: Eighty subjects with cataract and POAG were randomized 1:1 into either iStent implantation and cataract surgery (iStent group) (n = 44) or cataract surgery alone (control group) (n = 36). Groups were divided according to initial IOP (after washout period) into IOP <26 mm Hg and IOP ≥26 mm Hg. Patients were assessed preoperatively and at postoperative day 1, week 1, and months 1, 3, 6, 12, and 24. Outcome measures included best-corrected visual acuity, IOP, and glaucoma medications. Results: Postoperatively at 24 months, mean IOP decreased from 20.93 ± 1.28 to 17.79 ± 2.50 mm Hg in the IOP subgroup <26 mm Hg and from 26.00 ± 0.00 to 19.86 ± 2.19 in the subgroup ≥26 mm Hg in the control group. In the iStent group <26 mm Hg, IOP decreased from 22.04 ± 1.64 to 15.57 ± 2.13 mm Hg and from 26.6 ± 1.09 to 17.06 ± 2.43 mm Hg in the iStent group ≥26 mm Hg. Conclusion: In patients with open-angle glaucoma and cataract, iStent implantation combined with cataract surgery reduced IOP significantly through 2 years, with greater reductions achieved versus phacoemulsification alone. In patients with baseline IOP <26 mm Hg, surgery reduced IOP and medication use significantly declined through 2 years, with greater reductions achieved versus patients with baseline IOP ≥26 mm Hg. The study was registered at ClinicalTrials.gov under the number NCT03807869.

Surgical Outcomes in Children With Primary Congenital Glaucoma: An Eight-Year Experience.

BackgroundPrimary congenital glaucoma (PCG) is a congenital anomaly arising from an unusual development of the filtration angle, causing a remarkable rise in intraocular pressure (IOP) that is irrelevant to other ocular or systemic deformities.PurposeThe aim of the current study was to evaluate the surgical outcome in PCG patients between 2011 and February 2019.MethodsThis was a retrospective study of PCG patients who underwent trabeculotomy, trabeculectomy, deep sclerectomy, Ahmed valve, and/or cyclophotocoagulation (CPC) at a tertiary hospital. The IOP must be equal or less than 21 mmHg with or without medication to be designated a successful surgery.ResultsA total of 80 eyes (41 patients) were included in the study, with a slight male predominance of 65.9%. At presentation, the most reported age group was under 30 days (46.3%). Moreover, deep sclerotomy was the most common procedure, followed by CPC, which were performed in 48 (58.5%) and 18 (21.9%) eyes, respectively. In the overall group, the mean initial IOP was 23.65±8.52 mmHg, while the mean IOP was 16.73±8.56 mmHg at final follow-ups (p < 0.001), with a 46% reduction. The mean axial length showed a slight progression from 21.11±2.58 at the initial visit to 22.92±3.57 mm at the last follow-up (p<0.001). However, the mean horizontal diameter increased from 12.63±1.83 mm at the initial visit to 13.31±1.13 mm at the final visit (p=0.004).Conclusion An excellent IOP reduction could be accomplished in the majority of eyes. Deep sclerectomy can effectively reduce IOP in PCG without the occurrences of serious complications that are commonly seen after other procedures like trabeculectomy or trabeculotomy.

The Effectiveness of First-Generation iStent Microbypass Implantation Depends on Initial Intraocular Pressure: 24-Month Follow-Up-Prospective Clinical Trial.

Background Evaluation of efficacy of the iStent trabecular bypass implant in reducing intraocular pressure (IOP) depending on the value pretreatment IOP and number of medications used before surgery in patients with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PXG) and coexisting cataract. Methods A prospective, uncontrolled, interventional case series. 72 patients, on a mean age of 72.42 ± 9.17, were divided into two groups depending on baseline IOP: group I < 26 mmHg and group II ≥ 26 mmHg. All subjects underwent ab interno implantation of a single iStent together with cataract surgery. Best-corrected visual acuity (BCVA), IOP, number of antiglaucoma medications, visual field, and number and type of complications were examined before and after surgery. Postoperative patients were followed up at 1, 7, and 30 days and 3, 6, 12, and 24 months. All the patients were washed out preoperatively as well as postoperatively. Results The mean observation time was 20 months. The mean preoperative IOP was 21.03 ± 1.44 mmHg in group I and reduced to mean 15.60 ± 2.12 mmHg after operation. In group II, mean IOP reduced from 26.00 ± 0.00 to 18.56 ± 1.81 (p=0.003). Mean glaucoma medications decreased from 1.35 ± 0.65 to 0.29 ± 0.52 in group I (p < 0.001) and from 2.89 ± 1.18 to 1.33 ± 1.50 in group II (p < 0.001). At 24 months, medication reduction was significantly greater in group I than group II (p=0.026). Conclusions Combined cataract surgery with implantation of iStent seems to be an effective procedure in patients with mild-to-moderate open-angle glaucoma and cataract. In patients with baseline IOP < 26 mmHg, surgery reduced IOP and medication use significantly declined to 2 years, with greater reductions achieved versus patients with baseline IOP ≥ 26 mmHg. This trial is registered with NCT03807869.

Predictors of visual functional outcome following treatment for cavernous sinus meningioma.

Cavernous sinus meningioma (CSM) can affect visual function and require expeditious treatment to prevent permanent visual loss. Authors of this retrospective study sought to determine the factors associated with visual functional outcomes in CSM patients treated with surgery, stereotactic radiosurgery (SRS), or stereotactic radiation therapy (SRT), alone or in combination. Consecutive patients with CSM who had presented at an academic tertiary care hospital from 2000 to 2018 were identified through retrospective chart review. Visual function-visual eye deficit (VED), optic disc (OD) appearance, intraocular pressure (IOP), and extraocular movement (EOM)-was assessed before and after treatment for CSM. VED with visual acuity (VA) ≤ 20/200 and visual field defect ≥ -11 dB, pale OD appearance in the ipsilateral or contralateral eye, increased ipsilateral IOP, and/or EOM restriction were defined as a poor visual functional outcome. Multivariable logistic regression was used to evaluate the associations between pretreatment visual functional assessment and posttreatment visual outcomes. The study cohort included 44 patients (73% female; median age 55 years), with a median clinical follow-up of 14 months. Ipsilateral VED improved, remained stable, or worsened, respectively, in 0%, 33.4%, and 66.6% of the patients after subtotal resection (STR) alone; in 52.6%, 31.6%, and 15.8% after STR plus radiation treatment; in 28.5%, 43.0%, and 28.5% after gross-total resection (GTR) alone; and in 56.3%, 43.7%, and 0% after radiation treatment (SRS or SRT) alone. Contralateral VED remained intact in all the patients after STR alone and those with radiation treatment (SRS or SRT) alone; however, it improved, remained stable, or worsened in 10.5%, 84.2%, and 5.3% after STR plus radiation treatment and in 43.0%, 28.5%, and 28.5% after GTR alone. EOM remained intact, fully recovered, remained stable, and worsened, respectively, in 0%, 50%, 50%, and 0% of the patients after STR alone; in 36.8%, 47.4%, 15.8%, and 0% of the patients after STR with radiation treatment; in 57.1%, 0%, 28.6%, and 14.3% of the patients after GTR alone; and in 56.2%, 37.5%, 6.3%, and 0% of the patients after radiation treatment (SRS or SRT) alone. In multivariable analyses adjusted for age, tumor volume, and treatment modality, initial ipsilateral poor VED (OR 10.1, 95% CI 1.05-97.2, p = 0.04) and initial ipsilateral pale OD appearance (OR 21.1, 95% CI 1.6-270.5, p = 0.02) were associated with poor ipsilateral VED posttreatment. Similarly, an initial pale OD appearance (OR 15.7, 95% CI 1.3-199.0, p = 0.03), initial poor VED (OR 21.7, 95% CI 1.2-398.6, p = 0.03), and a higher IOP in the ipsilateral eye (OR 55.3, 95% CI 1.7-173.9, p = 0.02) were associated with an ipsilateral pale OD appearance posttreatment. Furthermore, a higher initial ipsilateral IOP (OR 35.9, 95% CI 3.3-400.5, p = 0.004) was indicative of a higher IOP in the ipsilateral eye posttreatment. Finally, initial restricted EOM was indicative of restricted EOM posttreatment (OR 20.6, 95% CI 18.7-77.0, p = 0.02). Pretreatment visual functional assessment predicts visual outcomes in patients with CSM and can be used to identify patients at greater risk for vision loss.

Glaucoma after ocular chemical burns: Incidence, risk factors, and outcome

Effects of chemical injuries on the cornea and limbus have been widely studied; however, little is known about glaucoma after ocular chemical injuries. We herein investigated the incidence, risk factors, and outcome of glaucoma in patients with ocular chemical burns. Medical records were reviewed of patients who visited our clinic for chemical injuries to the ocular surface. Patients were divided into glaucoma and non-glaucoma groups based on high intraocular pressure (IOP) readings. Clinical characteristics, treatment method, and therapeutic and visual outcomes were compared between the two groups. Of 29 patients (40 eyes), 9 patients (15 eyes, 37.5%) were diagnosed with glaucoma at 2.64 ± 2.92 months after injury. Factors associated with glaucoma included male gender (p = 0.0114), bilateral ocular involvement (p = 0.0478), severe ocular surface involvement (Dua grades IV-VI, p = 0.0180), poor initial visual acuity (p = 0.0136), high initial IOP (p < 0.0001), pupil involvement at initial examination (p = 0.0051), and the need for amniotic membrane transplantation in the acute stage (p = 0.0079). At final follow-up, IOP was uncontrolled in 3 eyes (20.0%), and visual acuity was worse in the glaucoma group than in the non-glaucoma group (logMAR 2.94 ± 1.86 vs 0.34 ± 0.69, p < 0.0001). These findings suggest that careful evaluation and intensive treatment for glaucoma are essential in patients with severe ocular burns.

Treatment success of canaloplasty and trabeculectomy by the same surgeon with the same level of experience in the long-term course

Trabeculectomy (TE) with the use of antimetabolites is the standard procedure in glaucoma surgery, whereas canaloplasty (CP) is anonpenetrating and potentially less invasive alternative. The aim of this retrospective case series was to compare the long-term success of CP and TE under the same conditions and with the same levels of experience of the surgeon as well as to investigate whether preoperative intraocular pressure (IOP) and postoperative IOP correlate with eachother. The study included 57eyes that underwent either CP or TE (CP n = 27; male = 50.0% age 60.7 ± 13.2 years; TE n = 30; male = 55.6% age 68.0 ± 9.1years). Each of the procedures was performed by the same surgeon with comparable levels of experience. The comparison included preoperative and postoperative visual field damage, preoperative and postoperative IOP (mm Hg) after 1 and 6weeks, 6and 12months as well as in the long-term course (1-3years) and the necessary local treatment at the corresponding times. With both methods no worsening of the visual field could be detected and the patient groups showed comparable preoperative and postoperative mean deviations (MD). The CP showed apositive correlation between preoperative and postoperative 1‑year IOP (r = 0.4; p = 0.022), whereas TE showed no significant correlation between preoperative and postoperative IOP. The count of local antiglaucoma medication in long-term comparison (1-3years after surgery) was higher after CP than after TE (1.5 ± 1.6 vs. 0.5 ± 0.8; p = 0.003). In both groups there were no severe postoperative complications. The overall success rates (without treatment) were higher at all time points after TE. With both methods conducted by the same surgeon with the same levels of experience, an effective reduction of the IOP was achieved. It seems that the higher the preoperative IOP before CP, the higher the achievable pressure after 1 year and in the long term. In contrast, after TE the IOP was effectively reduced in the long term regardless of the initial IOP. The CP seems to be inferior to TE under the same conditions with respect to complete surgical success (without local treatment).

GLAUCOMA PROGRESSION. IMPACT OF RISK FACTORS ON THE DISEASE

The aim of the study is to assess the effect of systemic and local risk factors on the rate of glaucoma progression, the specificity and informative nature of ophthalmological studies for assessment of the rate of glaucoma progression. Material and methods . A retrospective analysis of the medical case histories and outpatient charts of 217 patients (268 eyes) for the period from 2014 to 2017 was conducted. The patients with primary open-angle glaucoma having at least 5 Humphrey field-of-view (24-2) studies and optic coherence tomography of the optic nerve disk and retina with a guided progression analysis (GPA) function (SD-OCT) were included in the study. The patients were divided into 2 groups: with rapid progression (more than 1 dB per year, 144 eyes (103 patients)) and slow progression (less than 1 dB per year, 124 eyes (114 patients)). The data of standard ophthalmological methods of investigation (visometry, ophthalmoscopy, biomicroscopy, measurement of intraocular pressure (IOP) according to Maklakov) were additionally analyzed. Demographic and clinical data were assessed: gender, age, cornea central thickness, refraction, IOP, glucocorticosteroid intake, cardiovascular diseases presence, arterial hypertension, arterial hypotension, local hypotensive therapy. Results and discussion. The analysis revealed the main risk factors in glaucoma progression, which include age, cardiovascular diseases presence, high initial IOP values, pronounced functional changes in the visual fields (lower mean deviation), pseudoexfoliation syndrome.