Intraocular Pressure In Eyes Research Articles

IOP-induced blood-retinal barrier compromise contributes to RGC death in glaucoma.

The integrity of the blood-retinal barrier (BRB) has been largely unexplored in glaucoma. We reveal that elevated intraocular pressure (IOP) partially compromises the BRB in two human-relevant inherited mouse models of glaucoma (DBA/2J and Lmx1bV265D). Experimentally increasing IOP in mouse eyes further confirms this. Notably, the compromise induces subtle leakage, happening without bleeding or detected endothelial cell junction disruption, and it precedes neurodegeneration. Leakage occurs from peripheral veins in the retinal ganglion cell layer with a concomitant loss of the transcytosis inhibitor MFSD2A. Importantly, stabilizing β-catenin in retinal endothelial cells prevents both vascular leakage and neurodegeneration in the DBA/2J model. The occurrence of leakage in all 3 high IOP models indicates that BRB compromise may be a common, yet overlooked, mechanism in glaucoma. These findings suggest that IOP-induced BRB compromise plays a critical role in glaucoma, offering a new therapeutic target.

Effects of Genipin Crosslinking of Porcine Perilimbal Sclera on Mechanical Properties and Intraocular Pressure.

The mechanical properties of sclera play an important role in ocular functions, protection, and disease. Modulating the sclera's properties by exogenous crosslinking offers a way to expand the tissue's range of properties for study of the possible influences on the eye's behavior and diseases such as glaucoma and myopia. The focus of this work was to evaluate the effects of genipin crosslinking targeting the porcine perilimbal sclera (PLS) since the stiffness of this tissue was previously found in a number of studies to influence the eye's intraocular pressure (IOP). The work includes experiments on tensile test specimens and whole globes. The specimen tests showed decreased strain-rate dependence and increased relaxation stress due to the cross-linker. Whole globe perfusion experiments demonstrated that eyes treated with genipin in the perilimbal region had increased IOPs compared to the control globes. Migration of the cross-linker from the target tissue to other tissues is a confounding factor in whole globe, biomechanical measurements, with crosslinking. A novel quantitative genipin assay of the trabecular meshwork (TM) was developed to exclude globes where the TM was inadvertently crosslinked. The perfusion study, therefore, suggests that elevated stiffness of the PLS can significantly increase IOP apart from effects of the TM in the porcine eye. These results demonstrate the importance of PLS biomechanics in aqueous outflow regulation and support additional investigations into the distal outflow pathways as a key source of outflow resistance.

Relationship between asymmetry of transverse sinus and difference in intraocular pressure Based on MRV imaging examination

Transverse sinus asymmetry refers to the inconsistencies in the shape structure, size or blood flow of the intracranial transverse sinus. Intraocular pressure difference refers to the obvious difference in intraocular pressure between the two eyes. Transversal sinus asymmetry may be correlated with intraocular pressure difference, but the mechanism of correlation is still unclear. To investigate the relationship between transverse sinus asymmetry and IOP differences based on MRV examination, and to explore the possible mechanism. Patients with transverse sinus asymmetry were selected and examined using the MRV technique. At the same time, the patients' IOP was measured using standard methods of IOP measurement. Correlation analysis and statistical methods were used to evaluate the association between transverse sinus asymmetry and IOP differences. There was a statistically significant distinction observed between groups I and V (Z=6.78, P<0.01). Significant variations were also noted in the intraocular pressures across all groups, encompassing the average measurements of the right eye and left eye, along with the variance between the two (right eye: F=15.43, P<0.01; left eye: F=4.62, P=0.002; variance between eyes: F=41.79, P<0.01). The asymmetry of the transverse sinus exhibited a negative relationship with the intraocular pressure of the right eye (r=0.51, P<0.01) and the difference between the pressures of the two eyes (r=0.79, P<0.01); no significant association was found between the asymmetry and the left eye's intraocular pressure. In conclusion, a certain correlation exists between the intraocular pressures of the left and right eyes and the morphology of the transverse sinus. When the transverse sinus is thicker on one side, the corresponding drainage veins are thicker, resulting in lower intraocular pressure on that same side.

Congenital microcoria deletion in mouse links Sox21 dysregulation to disease and suggests a role for TGFB2 in glaucoma and myopia

Congenital microcoria (MCOR) is a rare hereditary developmental defect of the iris dilator muscle frequently associated with high axial myopia and high intraocular pressure (IOP) glaucoma. The condition is caused by submicroscopic rearrangements of chromosome 13q32.1. However, the mechanisms underlying the failure of iris development and the origin of associated features remain elusive. Here, we present a 3D architecture model of the 13q32.1 region, demonstrating that MCOR-related deletions consistently disrupt the boundary between two topologically associating domains (TADs). Deleting the critical MCOR-causing region in mice reveals ectopic Sox21 expression precisely aligning with Dct, each located in one of the two neighbor TADs. This observation is consistent with the TADs' boundary alteration and adoption of Dct regulatory elements by the Sox21 promoter. Additionally, we identify Tgfb2 as a target gene of SOX21 and show TGFΒ2 accumulation in the aqueous humor of an MCOR-affected subject. Accumulation of TGFB2 is recognized for its role in glaucoma and potential impact on axial myopia. Our results highlight the importance of SOX21-TGFB2 signaling in iris development and control of eye growth and IOP. Insights from MCOR studies may provide therapeutic avenues for this condition but also for glaucoma and high myopia conditions, affecting millions of people.

The Impact of Femtosecond Laser on Intraocular Pressure with Cataract Surgery in Healthy Eyes.

Femtosecond laser-assisted cataract surgery leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP. To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) using the LDVZ8 laser on intraocular pressure (IOP) during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS). This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a six-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed. Mean IOP increase after docking was 2.3±4.1mmHg (P<0.0001); maximum increase 17.6mmHg, peak 38mmHg. Sixty-one (61) eyes (25.1%) demonstrated an increase of ≥5mmHg and 10 (3.7%) showed an increase of ≥10mmHg; pre-docking IOP was associated with an IOP increase of ≥5mmHg (P-0.029). IOP reduction over six months post-surgery was similar for FLACS and CPCS (P>0.05),-1.33±3.12mmHg for FLACS (P<0.001) and -1.4±2.87mmHg for CPCS (P<0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β -0.742, P<0.001) and CPCS (β -0.743, P<0.001). Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS, and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.

Intraocular Pressure Changes in Non-Surgical Eyes of Patients Admitted for Glaucoma Surgery.

(1) Background: In glaucoma patients, it is observed that intraocular pressure (IOP) in non-surgical eyes decreases during hospitalization, but detailed data have not been reported. This study aimed to examine changes in IOP in the non-surgical eyes of patients admitted for glaucoma surgery. (2) Methods: This retrospective study included 487 patients (254 males, 233 females). Statistical analysis was performed separately for groups that were and were not under medication treatment. (3) Results: In non-surgical eyes, the difference in IOP between admission and discharge was -1.6 ± 4.8 mmHg (95% confidence interval (CI), -2.1 to -1.2; p < 0.0001) with a significant decrease in the medication group (n = 414), while it was -0.6 ± 4.8 mmHg with no significant change observed (95% confidence interval (CI), -1.7 to 0.57; p = 0.33) in the non-medication group (n = 73). Multiple regression analysis of the medication group showed that IOP at admission (p < 0.0001) and older age (p = 0.03) were associated with the reduction or the rate of reduction in IOP. (4) Conclusions: IOP in the non-surgical eyes of patients admitted for glaucoma surgery with medication decreased during hospitalization. The reduction was more pronounced in individuals with higher IOP at admission and in older patients. It is possible that improved medication adherence contributes to the lowering of IOP.

Intraocular Pressure Response in the Untreated Contralateral Eye After Selective Laser Trabeculoplasty.

To examine the impact of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) in the untreated contralateral eye within 12 months after the procedure. A retrospective chart review was conducted on patients with primary open-angle, normal-tension, pigmentary, or pseudoexfoliation glaucoma who received 360-degree SLT at George Washington University. Exclusion criteria included prior or subsequent laser or glaucoma surgery within 12 months of SLT, other glaucoma types, or corticosteroid use during follow-up. Primary outcomes were IOP and medication reduction, and SLT success, defined as reducing IOP by ≥20% without additional IOP-lowering procedures or medications. Follow-up occurred at six weeks, six months, and 12 months. Demographic and clinical data were analyzed using ANOVA, paired t-tests, and chi-squared tests. A total of 125 patients were included, representing a range of backgrounds: African American (57.6%), Caucasian (31.2%), Asian (5.6%), and Hispanic/Latino (4%), and 1.6% did not report their background. Significant reductions in mean IOP and medication numbers were observed in the contralateral eye at six weeks and six months (p<0.05) but not at 12 months. The contralateral eye success rates were 24% at six weeks and six months and 20.8% at 12 months. The contralateral eye was more likely to achieve success if the ipsilateral eye was successful at six weeks (odds ratio (95% confidence interval): 5.05 (1.89-13.48)), six months (16.1 (4.56-57.17)), and 12 months (5.94 (2.07-17.04)) (p<0.001 for all). First-time SLT results in statistically significant IOP and medication reductions in the contralateral eye at six weeks and six months. The contralateral eye was 5.05-16.1 times more likely to achieve success if the ipsilateral eye was successful within 12 months.

Comparison of Bent Ab-Interno Needle Goniectomy and Goniotomy in Primary Congenital Glaucoma: A Randomized Controlled Trial

PurposePrimary Congenital Glaucoma (PCG) is a potentially blinding disease, and the search for the best surgical option always remains. This study investigated the efficacy of Bent Ab-interno Needle Goniectomy (BANG) compared to the established standard of traditional goniotomy. DesignParallel group Randomized Controlled Trial ParticipantsInfants with PCG aged one month to one year with similar clinical features in both eyes. InterventionThe two eyes of eligible patients were randomized to either goniotomy or BANG using a 25-gauge needle bent as a reverse cystitome, and the surgeries were done on the same day in both eyes. Postoperatively each infant was followed up for a minimum period of one year. Main outcome measuresThe primary outcomes measured were intraocular pressure (IOP) control and the requirement for antiglaucoma medications (AGMs). The secondary outcome measures included corneal clarity enhancement, axial length stability, incidence of surgical complications or the need for repeat surgery. ResultsEight infants with both eyes eligible, were included. In each infant, one eye was randomized to BANG and the other to conventional goniotomy. The mean age was 7.6±3.6 months. There was no significant difference in the mean preoperative IOP (16.8 +8.87 mm Hg versus 17+6.0 mm Hg; p=0.48) in eyes randomized to goniotomy or BANG. The mean number of AGMs (1.7±1.11 versus 2+0.81 respectively; p=0.26) were similar in both groups. Postoperatively, the IOP at 6 months (14.05 + 4.1 vs 16.2+4.07; p=0.22) and one year (15.3 ± 3.4 versus 17.1 + 3.0; p=0.15) were similar in eyes that underwent goniotomy or BANG respectively. Both procedures demonstrated significant improvements in corneal clarity and maintained normal axial length growth. However, the BANG group required slightly more AGMs than the goniotomy group. There were no serious complications in either group. Both eyes of one patient required repeat surgery for IOP control and underwent a combined trabeculotomy with trabeculectomy at nine months and one year post-operatively, respectively. ConclusionsThis study indicates that goniotomy remains an effective surgical treatment for PCG. The absence of discernible superiority in IOP control or overall outcomes implies that the added complexity of excising the trabecular meshwork in BANG may not confer additional benefits over the established approach.

Understanding the Ocular Hypertension Model in Mice Induced by Dexamethasone-21-Acetate – Implications for Glaucoma Research

Purpose This study aimed to assess the effectiveness of monocular and bilateral injections of Dexamethasone-21-acetate (Dex-21-Ac) into the murine fornix twice a week as a glucocorticoid-induced ocular hypertension model and investigated potential systemic side effects. Methods Dex-21-Ac was administered twice weekly in three groups: bilateral injections, monocular injections, and a control group receiving the vehicle solution bilateral. After 21 days, enucleated eyes were examined using immunocytochemistry (ICC), and organ histology was performed. Results All groups receiving Dex-21-Ac injections had a significant increase in intraocular pressure (IOP). Monocular injections also resulted in a significant increase in IOP in the fellow eye. The Dex-21-Ac-treated groups showed a bilateral increase in IOP of approximately 8 mmHg, accompanied by elevated expression of alpha smooth muscle actin and fibronectin in the anterior chamber angle. There were no significant changes in weight progression. Hepatic steatosis was observed in all Dex-21-Ac-treated animals, and some suffered from residual neuromuscular blockade under fentanyl anesthesia. Conclusion Bilateral injections of Dex-21-Ac twice a week lead to a significant increase in daytime IOP and fibrotic changes in the trabecular meshwork. Unilateral application has a significant impact on the fellow eye. Local dexamethasone leads to notable systemic effects independent of changes in animal weight. Considering liver damage and associated influence on metabolization, hepatically eliminated injection anesthetics may lead to overdosing and are not recommended. They should be replaced by inhalation anesthesia.

1235 Challenges in Glaucoma Management: A Case Study on OMNI® Surgical System Interventions for Primary Open-Angle Glaucoma

Abstract Introduction This report explores the challenges faced in addressing early-stage primary open-angle glaucoma (POAG) in a 74-year-old male. Following a steroid-induced elevation in intraocular pressure (IOP) after endoscopic cyclophotocoagulation (ECP) in the right eye, the patient underwent minimally invasive canaloplasty and goniotomy using the OMNI® Surgical System (Sight Sciences) on his left eye. Case Description IOPs at diagnosis measured at 28 mmHg and 27 mmHg in the right and left eye, respectively, leading to the prescription of bilateral latanoprost. An adverse reaction to latanoprost resulted in eye swelling, hyperaemia, facial and jaw discomfort, and photophobia, prompting the cessation of the medication. In December 2022, bilateral selective laser trabeculoplasty (SLT) was performed, with minimal impact on IOP. Subsequently, in March 2023, right cataract surgery with ECP successfully reduced right eye IOP to 16 mmHg. Postoperatively, the use of dexamethasone 0.1% drops caused an intraocular steroid-response, increasing IOP (maximal IOP =25 mmHg), resolving upon medication completion. To mitigate prolonged steroid drop-associated complications, left eye phacoemulsification with OMNI canaloplasty and goniotomy was conducted in June 2023. Standard 4-week low-frequency steroid drops were administered postoperatively with no complications. Conclusions Pressure control was successfully achieved with IOP normalization to 15 mmHg bilaterally. Significant visual acuity improvements were noted post ECP (right eye=6/24 to 6/6) and OMNI (left eye=6/7.5 to 6/6). This case highlights the efficacy of OMNI combined with phacoemulsification in the safe reduction of IOP and sustained IOP control in POAG patients, alluding to its favourable safety profile.

Correlative Study of Central Corneal Thickness and Intraocular Pressure with Optic Disc Changes in Primary Open-Angle Glaucoma

Abstract Background: Primary open-angle glaucoma (POAG) is characterised by open angles, raised intraocular pressure (IOP) and optic disc changes. Undetected glaucoma is the third leading cause of blindness. The study aims to correlate central corneal thickness and IOP with optic disc changes in POAG and to aid in the early detection and timely management of glaucoma to prevent advanced damage and vision loss. Methods: In this hospital-based prospective observational study, 50 cases (100 eyes) of POAG were selected after applying the inclusion and exclusion criteria. Detailed history, ocular examination, visual acuity testing, slit-lamp examination, gonioscopy, ultrasound pachymetry for central corneal thickness (CCT), IOP with Goldmann Applanation Tonometry (GAT), fundus examination with +90D lens and visual fields on Humphrey’s automated field analyser were performed for all patients. Results: There was a statistically highly significant positive correlation between IOP and CCT in the right and left eyes (P &lt; 0.01). There was a statistically very highly significant difference between mean IOP and mean corrected IOP in the right eye and left eye also (P &lt; 0.001). There was a statistically very highly significant difference in IOP, CCT and fundus cup-to-disc ratio (CDR) with HAP staging (P &lt; 0.001). Conclusions: IOP was positively related to CCT. Thinner CCT &lt;510μm eyes are at greater risk for more advanced disc cupping. Disc cupping increased proportionately with the rise in IOP. Thinner corneal readings should alarm the ophthalmologist to evaluate the patient thoroughly for glaucoma and monitor follow-up to keep a check on possible progression.

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.

Comparing 0.75% Ropivacaine and 0.5% Levobupivacaine For Peribulbar Blockade In Vitrectomy Surgery Towards Intraocular Pressure

Peribulbar blockade is a regional anesthetic technique that can be used for vitrectomy surgery. Ropivacaine and levobupivacaine are local anesthetics that have the advantage of a long duration of action and a lower complication rate than bupivacaine. This study aims to find the effect of intraocular pressure from ropivacaine and levobupivacaine. The study design was a double-blind randomized controlled trial on 60 patients underwent vitrectomy at Netra Ophthalmic Clinic Bandung with peribulbar blockade. Twenty-nine subjects received 0.75% ropivacaine and thirty-one subjects received 0.5% levobupivacaine for peribulbar blockade. Assessment of eye intraocular pressure was assessed before the block, 5 minutes, 10 minutes, and 15 minutes. The 0.75% ropivacaine group obtained an average of 4.42mmHg at 15 minutes, while the 0.5% levobupivacaine group averaged 2.33mmHg after 15 minutes after injection. Statistical results obtained p value &lt;0.05 which means significant intraocular pressure of the two drugs. Intraocular pressure of ropivacaine 0.75% lower than levobupivacaine 0.5% in peribulbar blockade in vitrectomy surgery.

Temperature Self-Compensating Intelligent Wireless Measuring Contact Lens for Quantitative Intraocular Pressure Monitoring.

Flexible bioelectronic devices that can perform real-time and accurate intraocular pressure (IOP) monitoring in both clinical and home settings hold significant implications for the diagnosis and treatment of glaucoma, yet they face challenges due to the open physiological environment of the ocular. Herein, we develop an intelligent wireless measuring contact lens (WMCL) incorporating a dual inductor-capacitor-resistor (LCR) resonant system to achieve temperature self-compensation for quantitative IOP monitoring in different application environments. The WMCL utilizes a compact circuitry design, which enables the integration of low-frequency and high-frequency resonators within a single layer of a sensing circuit without causing visual impairment. Mechanically guided microscale 3D encapsulation strategy combined with flexible circuit printing techniques achieves the surface-adaptive fabrication of the WMCL. The specific design of frequency separation imparts distinct temperature response characteristics to the dual resonators, and the linear combination of the dual resonators can eliminate the impact of temperature variations on measurement accuracy. The WMCL demonstrates outstanding sensitivity and linearity in monitoring the IOP of porcine eyes in vitro while maintaining satisfactory measurement accuracy even with internal temperature variations exceeding 10 °C. Overcoming the impact of temperature variations on IOP monitoring from the system level, the WMCL showcases immense potential as the next generation of all-weather IOP monitoring devices.

Effect of a fixed combination of ripasudil and brimonidine on aqueous humor dynamics in mice

Ripasudil–brimonidine fixed-dose combination (K-232) simultaneously targets three different intraocular pressure (IOP) lowering mechanisms, increasing trabecular meshwork outflow and uveoscleral outflow, and reducing aqueous humor production Vascularly, ripasudil induces transient vasodilation, brimonidine transient vasoconstriction. Investigating effects on IOP, aqueous dynamics, and EVP in mice eyes by microneedle and constant-pressure perfusion methods, and on cytoskeletal and fibrotic proteins changes in HTM cells by a gel contraction assay and immunocytochemistry. Ripasudil, K-232, and brimonidine droplets significantly reduced IOP at 30 min, with K-232 sustaining the effect at 60 min. For EVP, only K-232 exhibited reduced EVP until 60 min after instillation. In vitro, ripasudil inhibited gel contractility and TGFβ2-induced fibrotic changes, whereas brimonidine did not. K-232 significantly lowered IOPs in mice by combining the effects of ripasudil and brimonidine. Brimonidine alone also showed IOP reductions with enhanced outflow facility, and the drug did not interfere with the effects of ripasudil on the trabecular meshwork outflow; K-232 and ripasudil alone both significantly lowered the EVP and enhanced outflow facility, demonstrating that K-232 efficiently reduces IOPs.

Effect of Dorzolamide-Timolol fixed dose combination on central Corneal Thickness in patients of Primary Open Angle Glaucoma Versus Normal Tension Glaucoma

PURPOSE: To evaluate the effect of dorzolamide/timolol fixed dose combination on central corneal thickness in primary open-angle and normal tension glaucoma. METHOD: This retrospective cohort study was approved by the Ethical Review Board of College of Ophthalmology and Allied vision Sciences (1469/23) and was conducted at Diagnostic clinic Mayo Hospital, Lahore from March, 2023 to September, 2023. Sample size was calculated by a formula whose level of significance (????) was 5%, standard deviation (????) 30.9 and test values of population mean (µ̥) was 540. Using non-probability convenient sampling method total sample size was 80 patients of age group 30 to 60 which divided into normal tension and primary open angle glaucoma of 40 each. Patients with corneal edema, diabetes, and allergic to dorzolamide-timolol fixed dose combination were excluded. Data was analyzed using SPSS version 25.00. Wilcoxon signed ranks test and chi-square test were used for the significance of the study. Data p-value &lt;0.005 considered significant. All the tests were performed after patient’s informed consent. Intraocular pressure (IOP) and central corneal thickness (CCT) were measured by Goldmann applanation tonometer and ultrasound Pachymeter respectively. RESULTS: IOP and CCT in right eye 16.17± 7.05 (p=0.000) and 545.50± 22.2 (p=0.098) respectively and of left eye 16.56± 7.00 (p=0.003) and 549.16± 20.0 (p=0.133) respectively. This illustrates significant difference in intraocular pressure after treatment in both eyes but insignificance difference in central corneal thickness. CONCLUSION: Dorzolamide-Timolol combination successfully reduces IOP as intended and leads to no statistically significant change in central corneal thickness.

Real-World Analysis of the Efficacy of Bimatoprost Sustained-Release Glaucoma Implant Where American Indians Comprise the Largest Minority Population.

To assess the effectiveness and safety of bimatoprost sustained release (SR) glaucoma implant as a treatment for open-angle glaucoma and ocular hypertension in a real-world private practice setting with a significant American Indian population. This retrospective study included 156 eyes from adult patients who received a single injection of bimatoprost implant between June 2020 and May 2022 at the Oklahoma Eye Surgeons. Patients were stratified by baseline intraocular pressure (IOP) (≥21 mmHg versus IOP<21 mmHg). The co-primary endpoints were changes in the mean IOP and the number of topical IOP-lowering medications from baseline to Month 6. At 6 months, eyes with baseline IOP≥21 mmHg had a significantly lower mean IOP (19.85±8.01 versus 26.25±4.84 mmHg; p<0.0001) and the mean number of IOP-lowering medications (1.04±1.44 versus 1.38±1.50; p=0.048) compared with baseline. One year after implantation, 73.58% of eyes had a ≥20% reduction in IOP, 41.51% were medication-free and 30.19% were receiving at least one fewer medication. Among eyes with baseline IOP<21 mmHg, there was a significant reduction in the mean number of IOP-lowering medicines by Month 6 (0.61±1.03 versus 1.93±1.21 at baseline; p<0.0001), with no change in IOP. At 12 months, 24.27% of eyes had a ≥20% decrease in IOP, 43.69% of eyes did not require any medications and 63.11% had at least one fewer medication compared with baseline. An analysis using Welch's two-sample t-test showed no significant differences in the outcomes between the overall population and the American Indian population (number of eyes, 23). Bimatoprost SR glaucoma implant lowered IOP in eyes with high, uncontrolled baseline IOP, while it reduced the number of medications in eyes with a controlled baseline IOP. No clinically meaningful and statistically significant differences in the efficacy of bimatoprost were observed in patients of American Indian descent.

Ultrasound cyclo plasty in advanced glaucoma: Intermediate-term success, predictors for failure and complications.

To report the intermediate-term success rate of ultrasound cyclo plasty (UCP), predictors for failure and complications in advanced glaucoma. This study included patients with advanced glaucoma who underwent UCP. The main outcome measures were intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of complications. Success was defined as an IOP reduction ≥30% and IOP between 6 mmHg and 18 mmHg with no vision-threatening complications. Cox proportional hazard regression analysis was performed to identify possible predictors for failure. We included 65 eyes of 58 patients in the study. The mean IOP and number of antiglaucoma medications decreased significantly from 27.60 ± 5.5 mmHg and 3.40 ± 0.9 at baseline to 17.80 ± 8.0 mmHg (35.51% reduction) and 2.43 ± 1.3 at 12 months and 17.10 ± 8.2 mmHg (38.04% reduction) and 2.41 ± 1.5 at 24 months, respectively (p < 0.01 for both). The success rates were 66.2% (43/65) and 72.4% (21/29), while the failure rates were 33.8% (22/65) and 27.6% (8/29) at 12 and 24 months postoperatively, respectively. The cumulative probabilities of overall success were 67.7 ± 5.8% and 33.8 ± 5.9% at 12 and 24 months, respectively. High baseline IOP and history of old glaucoma surgery were associated with a higher risk for failure (Hazard ratio = 1.10 and 5.82, p = 0.03 and p < 0.01, respectively). The most common complications were anterior chamber reaction (18.5%) and cataract development/progression (15.4%). Two eyes (3.1%) developed phthisis bulbi. Although UCP is effective in lowering IOP in eyes with advanced glaucoma, the intermediate-term success rates were moderate.

Phase 3 Randomized Clinical Trial of the Safety and Efficacy of Travoprost Intraocular Implant in Patients with Open-Angle Glaucoma or Ocular Hypertension

PurposeEvaluate the safety and intraocular pressure (IOP)-lowering efficacy of two models of the travoprost intraocular implant (fast-eluting [FE-implant] and slow eluting [SE-implant]) from one of two pivotal trials (GC-010). DesignPhase 3, multicenter, randomized, double-masked, sham-controlled, non-inferiority trial. ParticipantsSubjects with open-angle glaucoma or ocular hypertension, using 0 to 3 IOP-lowering medications at screening and having an unmedicated baseline mean diurnal IOP (average of 8AM, 10AM and 4PM timepoints) of ≥ 21 mmHg, and an unmedicated baseline IOP of ≤ 36 mmHg at each timepoint in the study eye. MethodsStudy eyes were randomized to the travoprost intraocular implant (FE-implant [n=200] or SE-implant [n=197] model) plus twice-daily (BID) placebo eye drops, or to sham procedure plus timolol ophthalmic solution, 0.5% BID (n=193). Main Outcome MeasuresThe primary outcome was mean change from baseline IOP in the study eye at 8AM and 10AM, at each of day 10, week 6, and month 3. Safety outcomes included adverse events (AEs), corneal endothelial cell counts, visual acuity, and conjunctival hyperemia assessment. ResultsMean IOP reduction from baseline over the 6 timepoints ranged from 6.6 to 8.4 mmHg for the FE-implant group, from 6.6 to 8.5 mmHg for the SE-implant group, and from 6.5 to 7.7 mmHg for the timolol group. The primary efficacy endpoint was met; the upper limit of the 95% confidence interval of the difference between the implant groups and the timolol group was < 1 mmHg at all 6 timepoints. Study eye AEs, most of mild or moderate severity, were reported in 21.5%, 27.2% and 10.8% of subjects in the FE-implant, SE-implant and timolol groups, respectively. The most common AEs included iritis (FE-implant, 0.5%; SE-implant, 5.1%), ocular hyperaemia (FE-implant, 3.0%; SE-implant, 2.6%), visual acuity reduced (FE-implant, 1.0%; SE-implant, 4.1%; timolol, 0.5%), and IOP increased (FE-implant, 3.5%; SE-implant, 2.6%; timolol, 2.1%). There was one serious study eye AE (endophthalmitis). ConclusionsThe travoprost intraocular implant demonstrated robust IOP reduction over the 3-month primary efficacy evaluation period following a single administration. The IOP-lowering efficacy of both implant groups was statistically and clinically non-inferior to the timolol group, with a favorable safety profile.

Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty.

To compare the surgical outcomes of glaucoma drainage device implantation (GDI) and trans-scleral neodymium:YAG cyclophotocoagulation (CPC) in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty (DSAEK). This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery (15 with GDI and 14 with CPC). The main outcome measures were intraocular pressure (IOP), glaucoma surgery success rate (defined as IOP of 6-21 mm Hg without additional anti-glaucoma operation), number of glaucoma medications, endothelial graft status, and best-corrected visual acuity (BCVA). The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries, both for the GDI and CPC groups. Both groups showed significant IOP reduction after glaucoma surgery. The GDI group presented a significantly higher success rate in IOP control than the CPC group (60% vs 21.4%, P=0.03). Both procedures significantly decreased the number of glaucoma medications (P=0.03). Forty percent and 57% of cases in the GDI and the CPC group, respectively, experienced endothelial graft failure during follow-up (P=0.36). Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group. Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK. GDI is preferable to CPC in refractory glaucoma cases after DSAEK, as it manifests a significantly higher success rate for IOP control, similar endothelial graft failure rate, and relatively preserves BCVA than CPC.