Intraocular Pressure Spikes Research Articles

Consequences of Clot Formation and Hyphema Post-Internal Trabeculotomy for Glaucoma.

Clot formation and hyphema following internal trabeculotomy represent distinct clinical entities. The eyes with clot formation exhibited a more pronounced postsurgical intraocular pressure spike, longer residual intracameral bleeding, and a higher risk of reoperation. The aim of this study was to investigate the consequences of clot formation and hyphema in the anterior chamber after internal trabeculotomy. In this retrospective interventional comparative study, we investigated the surgical outcomes of internal trabeculotomy in 142 eyes of 142 patients at Sensho-kai Eye Institute. Concurrent clot formation and L≥2 hyphema (height of hyphema ≥1mm) was observed in 22 eyes. In these cases, the postsurgical IOP was 29.3mmHg at 1 week, significantly higher than the 16.1mmHg in eyes that had L≥2 hyphema but without clot formation ( P =0.0002). However, the 1-week postsurgical IOP in L≥2 hyphema and clot (-) eyes, which measured 16.1mmHg was not significantly greater than that in L<2 hyphema and clot (-) eyes, which measured 18.7mmHg ( P =0.162). Thus, clot formation was identified as a significant factor contributing to high postsurgical IOP at 1 week. The resolution time for anterior chamber bleeding in eyes with concurrent clot formation and L≥2 hyphema was 12.3 days, longer than the 5.8 days observed in L≥2 hyphema eyes without clot formation ( P =0.016). Among the 22 eyes with concurrent L≥2 hyphema and clot formation, 8 required anterior chamber washout. Three of the 10 eyes that underwent washout necessitated additional trabeculectomy, a rate significantly higher than that in nonwashout eyes ( P <0.001). After internal trabeculotomy, the sequelae of concurrent clot formation and L≥2 hyphema in the anterior chamber were more severe than those of simple hyphema without clots. Clot formation negatively affected postoperative IOP.

Efficacy and safety analysis of scleral fixation intraocular lens implantation using the Yamane technique

Introduction: Cataract surgery technologies continue to manage complications. Current surgical methods for secondary Intra Ocular Lens (IOL) include Anterior Chamber IOL, Iris Claw IOL, and sutured and sutureless techniques of Scleral Fixation IOL (SFIOL). The Yamane technique of SFIOL is a novel, relatively safe, and easy method of sutureless SFIOL. This study aims to describe and analyze the surgical outcomes and complications of the Yamane IOL implantation technique. Methods: A retrospective study of 21 eyes of 21 patients that underwent scleral fixation of IOL by the Yamane technique was observed. Demographic data, primary indications for surgery, best corrected visual acuity (BCVA), intraocular pressure (IOP) pre-operative and post-operative during follow-up, and complications were also analyzed. Results: Twenty-one patients were included, with an average age of 52.57±23.41 years old. Eleven eyes with lens subluxation (52.4%), 9 eyes with aphakia (42.9%), and 1 eye with phacodonesis (4.8%) were indicated for the Yamane technique of SFIOL in this study. The preoperative mean BCVA was 2.2±0.9 LogMAR, while the 1-month postoperative BCVA was 1.1±0.9 LogMAR. The mean preoperative IOP was 15.81±6.7 mmHg, and the 1-month postoperative IOP was 16.00±7.7 mmHg. This study found that there was a significant improvement in BCVA with p=0.00 (p&lt;0.05), and there was no significant postoperative IOP spike with p=0.88 (p&lt;0.05). The main complications observed in this study were corneal edema (23.8%) and postoperative IOP spike (14,3%). Conclusion: The Yamane SFIOL technique is a relatively safe approach for the surgical management of patients who need secondary IOL implantation with significantly improved visual function without significant complications.

Couching of cataractous lens in microphthalmic eyes with irido-fundal coloboma: revisiting the historical technique.

Cataract surgery in microphthalmic eyes is challenging due to anatomical restraints, hard bulky nucleus. This series aims to evaluate the safety and efficacy of couching of intraocular lens in irido-fundal coloboma with microphthalmos. Tertiary care centre in South India. Retrospective non-comparative study in eyes with irido-fundal coloboma, corneal diameter < 7mm and brown cataract. Visual acuity less than 6/60 in other eye. Anterior chamber entry made, zonules broken and lens dislocated into the vitreous cavity in a controlled manner. Baseline Clinico-demographic details, corrected distance visual acuity (CDVA), Intra-ocular pressure (IOP), corneal diameter, axial length, lens status and post-surgery CDVA, IOP and complications recorded and followed up for atleast 6months. Fifteen eyes of 15 subjects were evaluated with a mean age 49.4 ± 10.9years. At baseline, mean IOP 14.5 ± 3.8mmHg, mean axial length 19.3 ± 0.5mm, mean corneal diameter was 6.5 ± 0.34mm and CDVA 2 logMAR which improved to 1.5 logMAR at 3months (p value 0.002). Transient spike in IOP in 33.3% subjects was medically managed with no significant difference in IOP (p > 0.05) at baseline (14.5 ± 3.8mmHg), 3months post-surgery (16 ± 2.8mmHg) and 6months post-surgery (14.9 ± 2.5mmHg). One patient underwent re-couching. No other major complications were noted. Couching of cataractous lens is an effective and safe method in microphthalmic eyes with irido-fundal coloboma as last resort procedure, where no other surgical procedure may work. It provides an ambulatory gain of visual acuity in previously non-ambulatory subjects. Corneal measurements help in determining the subset of patients where couching offers viable option.

Frequency-doubled neodymium yttrium aluminum garnet (Nd:YAG) laser trabeculoplasty as adjuvant therapy for open-angle glaucomas

The thermal frequency-doubled Nd:YAG (neodymium: yttrium-aluminum-garnet) laser was used sparingly for trabeculoplasty. Our goal was to assess the efficacy and safety of frequency-doubled Nd:YAG laser trabeculoplasty as an adjunct therapy to anti-glaucoma medications in open-angle glaucoma. Laser trabeculoplasty was performed on 41 eyes of 22 adults with open-angle glaucomas using a thermal frequency-doubled Nd:YAG laser (Green laser photocoagulator GYC-500® 532 nm, Nidek, Japan). To assess the laser’s effectiveness, patients were monitored for intraocular pressure (IOP) reduction, control, and complications at 1 hour, 1 week, and then monthly for a year. Primary open-angle glaucoma was the most common diagnosis in 31 (75.6%) eyes. The pre-laser baseline IOP was 18.87±3.66 mmHg. The mean IOP was 14.9±2.54 mmHg at Week 1 (p = 0.000), 14.65±2.50 mmHg at Month 1, 14.53±2.60 mmHg at Month 3, 15.85±2.30 mmHg at Month 6, and 15.14±2.17 mmHg at Month 12 (p=0.000). A significant percentage reduction in IOP was achieved at 1, 3, 6, and 12 months: 21.78%, 22.48%, 16.73%, and 18.53%, respectively. Patients used an average of 2.73±1.00 topical drugs before laser treatment. There was a significant reduction in medicines after laser treatment on all occasions, at 1, 3, 6, and 12 months (p = 0.000). Complications included some degree of peripheral anterior synechiae (PAS) in 20 (51.3%) eyes; an IOP spike in one patient only, bilaterally (5.1%) at 1 hour after therapy; and mild anterior uveitis in four (9.75%) cases. To summarize, frequency-doubled Nd:YAG laser trabeculoplasty is a safe and effective adjuvant therapy for open-angle glaucoma that reduces intraocular pressure and medication use.

A Prospective Comparison of 180 Versus 360-Degree Gonioscopy-Assisted Transluminal Trabeculotomy Outcomes in Pseudoexfoliation Glaucoma.

Analysis of surgical success and intraocular pressure (IOP), best-corrected visual acuity (BCVA), and antiglaucomatous medication (AGM) changes between segmental 180-degree and 360-degree gonioscopy-assisted transluminal trabeculectomy (GATT) in patients with pseudoexfoliation glaucoma (PEXG) showed no significant difference. To compare surgical outcomes of segmental 180-degree and 360-degree GATT in patients with PEXG. Prospective, comparative study of 65 PEXG eyes, who underwent segmental 180-degree GATT (GATT 180-degree group, 31 eyes) and 360-degree GATT (GATT 360-degree group, 34 eyes) in a tertiary academic center over a 12-month of follow-up. Primary outcome was qualified and complete surgical success rates for criterion A (IOP <18mm Hg and >30% reduction) and criterion B (IOP <15mm Hg and >30% reduction). Secondary outcome measures included IOP reduction, BCVA change, AGM use, and postoperative complications. The probabilities of qualified and complete success rates both for criteria A and B did not significantly differ between the groups ( P > 0.05). IOP and BCVA levels were similar at each time point ( P > 0.05). IOP reduction was 59.3 ± 9.5% in the GATT 180-degree group and 55.8 ± 18.1% in the GATT 360-degree group ( P = 0.33). No significant difference in the mean number of AGM was present at the 12-month visit (1.2 ± 1.1 in GATT 180-degree group vs 1.5 ± 1.2 in GATT 360-degree group, P = 0.25). Significantly higher incidences of postoperative hyphema and IOP spikes were observed in the GATT 360-degree group ( P = 0.01 and P = 0.008, respectively). Both segmental 180-degree and 360-degree GATT similarly reduced IOP and AGM with comparable surgical success rates in patients with PEXG at the end of 12 months. Postoperative hyphema and IOP spike rates were significantly higher after 360-degree GATT. Segmental 180-degree GATT may be sufficient to adequately modulate IOP with a lower incidence of postoperative complications in PEXG.

Intrascleral intraocular lens fixation with ab interno trabeculotomy in patients with exfoliation glaucoma with lens subluxation.

To evaluate the surgical outcomes of intrascleral intraocular lens (IOL) fixation using ab interno trabeculotomy (LOT) in patients with exfoliation glaucoma with lens subluxation. Retrospective case series. Twenty eyes of 18 patients with exfoliation glaucoma and lens or IOL subluxations were included. Three success criteria were based on postoperative intraocular pressure (IOP) (A, ≤15 mmHg; B, ≤18 mmHg; C, ≤21 mmHg). The IOP, number of glaucoma medications, and visual acuity were compared before and after surgery. Success probability was analyzed using Kaplan-Meier survival curves. Cox proportional hazards' regression models were used to examine prognostic factors for surgical failure. The mean follow-up period was 23.4 ± 7.8 months. The mean IOP significantly decreased from 23.2 ± 6.8 mmHg preoperatively to 14.0 ± 4.4 mmHg at 1 year postoperative (P<0.001). Postoperative hyphema and vitreous hemorrhage were observed in seven and 15 eyes, respectively, and washout in the anterior chamber or vitreous cavity was performed in four eyes. Postoperative IOP spikes and hypotony were observed in four eyes each. Glaucoma reoperation was performed in two eyes. The success rates at 12 months were 65%, 85%, and 90% using criteria A, B, and C, respectively. The IOP at 1 month after surgery was a significant prognostic factor for surgical failure according to criterion A (hazard ratio: 1.08; P=0.034). Intrascleral IOL fixation combined with microhook LOT is a promising option in cases of exfoliation glaucoma with subluxated lens/IOL; however, the high rate of postoperative hyphema and vitreous hemorrhage should be noted.

Efficacy and safety of first-line or second-line selective laser trabeculoplasty for normal-tension glaucoma: a multicentre cohort study

Background/aimsThis study aimed to investigate and compare the efficacy and safety of first-line and second-line selective laser trabeculoplasty (SLT) in Japanese patients with normal-tension glaucoma (NTG).Methods100 patients with NTG were...

A Case Report of Secondary Glaucoma in a Patient with HTLV-1: Discussion about the Management of Secondary Glaucoma Due to Recurrent Granulomatous Uveitis

Purpose: to investigate secondary glaucoma resulting from uveitis in a patient infected with Human T-cell Leukemia Virus Type 1 (HTLV-1) pathologically and discuss the management of glaucoma with recurrent uveitis. Clinical course: An octogenarian woman diagnosed as a carrier of HTLV-1 experienced recurrent uveitis and a sudden rise in intraocular pressure (IOP) in both eyes. Due to the uncontrolled IOP and severely damaged visual field in her left eye, a combined procedure of trabeculectomy and DGIS (glaucoma drainage implant surgery, Baerveldt 350) was performed. The presence of HTLV-1 provirus was detected in the aqueous humor. Her trabeculectomy sample was processed for light microscopic observation. Following an irregular follow-up, she presented with a sudden decrease in vision and pain in her fellow eye, four years after the glaucoma surgeries. Her right eye exhibited a significant accumulation of mutton-fat-like keratic precipitates. Results: Clinical manifestations revealed the presence of granulomatous uveitis. The combined glaucoma surgery, along with continuous topical corticosteroid medication post-surgery in her left eye, effectively suppressed the high IOP spikes and the recurrence of uveitis for 4 years. The pathological examination of the outflow pathways showed a range of damages in Schlemm’s canal (SC), including SC endothelial loss, narrowing, and occlusion, as well as loss of trabecular meshwork (TM) cells and fused TM beams. Conclusion: Combined GDIS and trabeculectomy represents a promising approach for managing such refractory cases of secondary glaucoma. Continuous topical corticosteroid medication is strongly recommended to prevent irreversible changes in SC and TM associated with granulomatous uveitis.

Needle goniotomy decreases early intraocular pressure spike compared with phacoemulsification alone

PurposeTo evaluate the effect of needle goniotomy during phacoemulsification cataract surgery on early IOP spikes in patients with glaucoma compared with phacoemulsification alone. DesignRetrospective case control series MethodsCataract surgeries with concurrent goniotomy for glaucoma (n = 46) were compared with controls (n = 115) with and without glaucoma. IOP was measured prior to surgery and monitored through six months postoperatively. Between-group differences in IOP and postoperative IOP reduction were tested with ANOVA and Welch's 2-sided t-tests. Demographic, clinical, and intraoperative variables were also analyzed for significant association with postoperative IOP using univariate analysis. The incidence of IOP spike was evaluated according to two criteria: IOP > 30 mmHg or IOP > 10 mmHg above baseline. ResultsPhaco-goniotomy significantly lowered IOP at postoperative day one and month six. Following goniotomy, IOP was reduced on average 28 % (95 % CI [21, 36]) at month six compared with baseline, a mean reduction of -6.3 mmHg (95 % CI [-8.6, -4.0]), and a significantly greater reduction than in glaucoma controls (1 %, 95 % CI [-9, 7] and -0.3 mmHg, 95 % CI [-1.7, 1.1], p < 0.05). The average month six IOP following phaco-goniotomy was 12.9 mmHg (95 % CI [11.6, 14.1]), significantly lower than for glaucoma controls (15.6 mmHg, 95 % CI [14.0, 17.3], p < 0.05). The incidence of early IOP spike was significantly higher in glaucoma controls (23.1 %) than in the phaco-goniotomy cohort (6.0 %) (OR = 4.5, p < 0.05). There were no associations between CDE, ultrasound and aspiration time, or irrigation volumes on postoperative IOP. We showed that preoperative IOP was the only significant contributor to postoperative IOP reduction after phaco-goniotomy. ConclusionIncidence of early postoperative IOP elevation after phacoemulsification alone was 4.5 times higher than after phaco-goniotomy. Needle goniotomy may be a consideration for IOP lowering in glaucomatous eyes having cataract surgery.

Intraocular pressure profile following selective laser trabeculoplasty in pigmentary and primary open-angle glaucoma.

To compare the intraocular pressure (IOP) profile and the incidence of IOP spikes following selective laser trabeculoplasty (SLT) between pigmentary glaucoma (PG) and primary open-angle glaucoma (POAG). Retrospective comparative study of 65 PG eyes of 51 patients matched with 65 POAG eyes of 65 patients who received SLT. Matching was done based on age, gender, glaucoma severity, pre-laser IOP, and number of medications. Post-SLT IOP spike was defined as IOP elevation ≥5mmHg, 30-45 min after the laser. In PG and POAG groups, the average age was 62.33 ± 9.18 and 62.58 ± 9.19 years (p = 0.95). The glaucoma severity (p = 0.708), baseline IOP (PG = 21.61 ± 1.34mmHg vs. POAG = 21.13 ± 5.09mmHg, p = 0.943), and number of topical glaucoma medications(PG = 2.34 ± 1.34 vs. POAG = 2.1 ± 1.41, p = 0.342) were comparable. More PG patients were on oral acetazolamide (PG = 26.15% vs. POAG = 1.5%, p < 0.001). Average logMAR visual acuity was significantly higher in the POAG group (0.207 ± 0.3 vs. 0.192 ± 0.37, p = 0.012). Eyes with PG received lower laser energy (POAG = 63.65 ± 22.03 mJ vs. PG = 43.71 ± 25.68 mJ, p < 0.001). IOP spikes were recorded in 5 PG eyes (7.6%) and none in the POAG group (p = 0.058). Failure rates were similar (PG = 50.7% and POAG = 43.1%, p = 0.205). In multivariable analysis, only pre-laser IOP (coefficient = 2.154 [CI: 0.765-3.543], p = 0.003) was a significant predictor of IOP change percentage after 12 months. SLT was comparably effective in both PG and POAG. IOP spikes were observed only in the PG group, though the total laser energy was lower in this group compared with POAG.

Outcomes of Ahmed glaucoma valve surgery performed by glaucoma fellows - A large retrospective study from Eastern India.

Teaching and training of glaucoma fellows on the technique of Ahmed glaucoma valve (AGV) implantation surgery is very important. The purpose of this study was to describe the clinical outcomes and complications of AGV surgery performed by glaucoma fellows of a tertiary eye center from eastern India. This was a retrospective study based on electronic medical records. Thirty-five eyes operated with AGV by five glaucoma fellows from January 2016 to November 2020 were included. Best-corrected visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications (AGMs) were the study outcome measures. The mean (±standard deviation) age of the patients was 40.5 (±19.7) years. The follow-up period was 24.37 (±13.01) months. Both complete success (IOP <21 mmHg without additional AGM) and qualified success (IOP <21 mmHg with an additional AGM) were achieved in eight eyes each (22.8%). Failure of the surgery was noted in 19 eyes (54.3%) as there was a need for repeat surgery for IOP control in 12 eyes and a persistent IOP spike (IOP >21 mmHg with AGM beyond 3 months) in seven eyes. Despite a high rate of failure of the primary surgery, with the consultants' intervention, there was statistically significant improvement in vision and IOP in all patients ( P < 0.01) at the last follow-up. AGV implantation is a challenging surgical skill to be acquired by the glaucoma fellows.

Outcomes of gonioscopy-assisted transluminal trabeculotomy in primary congenital glaucoma treatment: a retrospective study

BackgroundThis retrospective study aimed to evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in Chinese patients with primary congenital glaucoma (PCG) and identify factors influencing surgical success.MethodsFourteen patients (24 eyes) diagnosed with PCG who underwent gonioscopy-assisted transluminal trabeculotomy were recruited, and data on intraocular pressure (IOP), antiglaucoma medication, surgery-related complications, and additional treatments were collected during preoperative and postoperative visits. Surgical success was defined as IOP ≤ 21 mmHg and a reduction of > 30% from baseline, with (partial success) or without (complete success) antiglaucoma medication.ResultsMean preoperative IOP was 30.41 ± 6.09 mmHg. At the final visit, mean IOP reduction was 16.1 ± 9.1 mmHg (52%), and 19 of 24 eyes were topical medication–free. IOP was significantly decreased at each postoperative visit compared with baseline (P < 0.05 for all time points). Cumulative proportions of complete and partial success were 79.2% and 95.8%, respectively, at three years postsurgery. Patients without prior antiglaucoma procedures, without postoperative IOP spikes, and those undergoing complete trabeculotomy exhibited improved surgical prognosis. No permanent vision-threatening complications occurred in the 24 eyes by the end of the respective follow-ups.ConclusionGonioscopy-assisted transluminal trabeculotomy emerged as a safe and effective procedure for PCG treatment, characterized by outstanding IOP reduction efficacy and high surgical success rates.

Long-Term Efficacy of Selective Laser Trabeculoplasty in Primary Angle-Closure Disease After Laser Peripheral Iridotomy

ABSTRACT Purpose To evaluate the long-term efficacy of selective laser trabeculoplasty (SLT) in eyes with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG) following a laser peripheral iridotomy (LPI). Method In this prospective cross-sectional study, 45 eyes of 34 patients with PAC/PACG diagnosis, uncontrolled intraocular pressure (IOP), and visible pigmented trabecular-meshwork (TM) at least 180° on gonioscopy following a LPI were recruited. Following a detailed baseline ophthalmic evaluation, all eligible eyes underwent SLT, and the patients were examined on day1, at 1 week, 1-, 3-, and 6-months, and 1-, 2-, 3-, 4-, and 5-year subsequently. The main outcomes measured were IOP, number of IOP-lowering agents, and complications. Results The mean age of the cohort was 57.80 ± 6.44 years, the male–female ratio was 8:26, and 17 eyes were PACG, and 28 were PAC. The baseline IOP was 23.81 ± 1.78 mm Hg, and was significantly declined at all follow-ups (p < .0001). The cumulative probability of overall success was 91% and 84% at 2-, and 5-year, respectively. At 5-year SLT provided drug-freedom in 80% of PAC and 23% of PACG eyes. Six eyes had IOP spike at 1-week and two patients underwent repeat SLT after 1-year. No other complications, such as pain/discomfort, inflammation, an increase in peripheral anterior synechiae and cystoid-macular-edema, were noted. Conclusions SLT appears a safe and cost-effective procedure in PAC/mild- moderate PACG eyes with uncontrolled IOP after laser iridotomy. The long-term effectiveness of SLT as adjuvant treatment was good, but need large sized randomized studies for more validation.

Changes in intraocular pressure during the first 24 h after transscleral cyclophotocoagulation.

To estimate the changes in intraocular pressure (IOP) during the first 24 h after transscleral cyclophotocoagulation (TCP). A prospective single-centre study, where patients with glaucoma destined for treatment with TCP were asked for participation. The IOP was measured prior to TCP and at 1, 2, 4, 6 and 24 h post-TCP. An IOP spike was defined as an elevation of IOP of ≥5 mmHg compared with baseline. The visual acuity (VA) was examined at baseline and after 24 h. The mean IOP prior to TCP in 58 eyes of 58 patients was 26.2 (±8.9 SD) mmHg. Twenty-three eyes (40%) experienced an IOP spike at some examination timepoint during the first 24 h. The mean value of the IOP spike was 12.1 (±6.9) mmHg. Fifty-six per cent of the eyes with pseudoexfoliation glaucoma (PEXG) experienced an IOP spike, and 16% had an IOP spike ≥20 mmHg. The IOP was significantly reduced at the 24 h examination by 8.1 (±7.8) mmHg (n = 58). The VA 24 h after TCP was unchanged compared with baseline. Clinically significant IOP spikes were common in the first 24 h post-TCP. Almost one in five eyes had an increase of 10 mmHg and in almost one in 10 eyes, the IOP increase was 20 mmHg or higher. Eyes with PEXG had a higher occurrence of IOP spikes and displayed a greater magnitude of IOP elevation. Prophylactic post-operative IOP-lowering medication should be considered to prevent further glaucoma damage.

Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis.

To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification. Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using theGrading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs). Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.

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

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

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction.

To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens-treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 (p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) (p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE. Birnbaum F, Wakil S, Vu DM, et al. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023;17(4):169-174.

Endocyclophotocoagulation Combined with Phacoemulsification in Glaucoma Treatment: Five-Year Results.

this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years. Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, MA, USA). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after phaco-ECP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as a cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and in the first week and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. The mean ± SD values of IOP preoperatively, at 12, 24, 36, 48, and 60 months postoperatively were 22.6 ± 6.7 mmHg, 15.9 ± 3.9 mmHg (p < 0.001), 15.9 ± 2.9 mmHg (p < 0.001), 15.6 ± 2.7 mmHg (p < 0.001), 15.5 ± 3.8 mmHg (p < 0.001), and 15.2 ± 2.6 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.7%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 40.6%. All patients at the 60-month follow-up visit required the use of antiglaucoma medications-none of the patients achieved complete success. During the follow-up period, nine patients (28.3%) that required retreatment due to nonachievement of the target IOP were considered failures. Six patients (15.8%) were lost from the follow-up. A total of 23 patients were evaluated 60 months after their phaco-ECP. Complications directly associated with the procedure, such as corneal edema (25.6%), IOP spikes (20.5%), IOL dislocation (2.6%), and uveitis (12.8%), were observed in our patients. Hypotony was not observed in any of our patients. The phaco-ECP procedure was effective, well-tolerated, and safe for reducing IOP in glaucoma patients with cataracts over a long-term follow-up. Randomized, larger-scale studies are required to validate the results obtained.

Short-term report of early glaucoma surgery with a clear lens extraction and an intraocular lens, OMNI canaloplasty, and a HYDRUS microstent: a case series in younger patients.

The purpose of this case series is to report the surgical outcomes from the combination of a clear lensectomy, OMNI® canaloplasty, and a HYDRUS® microstent with an adjacent goniotomy. This is a retrospective non-comparative single-center case series of four black patients of African descent with glaucoma who were treated with a clear lensectomy, OMNI canaloplasty, and a HYDRUS microstent with an adjacent goniotomy. The surgeries were performed by an experienced cataract and glaucoma surgeon, Daniel Laroche, MD. The parameters investigated in this study were postoperative intraocular pressure (IOP) and the mean number of preoperative and postoperative medications needed. The mean age of the four patients was 44.5 years. All patients had a mean postoperative reduction in IOP of 17 mmHg to 12.7 mmHg. The mean number of preoperative medications was 2.2, while the mean number of postoperative medications was 0.3. Potential complications such as hyphema, IOP spikes, or corneal edema were not seen in this series. All patients achieved a lower IOP and stable vision with less refractive error. Patients also experienced improved visual fields, clearer vision, and more open angles. Clear lensectomy and combined microinvasive glaucoma surgery (MIGS) in patients with primary open-angle glaucoma (POAG) and narrow-angle glaucoma (NAG) results in the safe lowering of IOP. The limitations of this study include the small series size and the retrospective potential for bias. Further research with a larger series and a prospective trial with follow-up should be performed.

Surgical Outcomes of Ab Interno Trabeculotomy Without Phacoemulsification.

The aim of this study was to evaluate ab interno trabeculotomy outcomes without phacoemulsification. This retrospective study evaluated 118 eyes of patients aged 18 and above who underwent ab interno trabeculotomy between December 2017 and August 2022. When surgeries were performed in both eyes, only the eye undergoing the initial surgery was evaluated. Prior to and after surgery, the intraocular pressure (IOP) and mean number of IOP-lowering medications were compared. An IOP of ≤21 mmHg (A) and ≤18 mmHg (B) along with a ≥20% reduction in the preoperative IOP was defined as survival. Cases that required reoperation for glaucoma were defined as surgical failure. The Kaplan-Meier method was used to evaluate the survival rates. A Cox proportional hazards model was used to analyze the preoperative factors that influenced survival rates. At 36 months postoperatively, the 13.4 ± 2.8 mmHg average IOP was significantly decreased from the preoperative 23.5 ± 9.8 mmHg value (P < 0.0001). Moreover, a significant decrease in the mean number of the IOP-lowering medications to 2.3 ± 1.4 at 36 months was found versus the initial 3.9 ± 1.1 preoperative value (P < 0.0001). The survival rates for criteria A and B at 36 months postoperatively were 28% and 25%, respectively. Only the preoperative IOP was identified by multivariate analysis as a factor influencing survival rates (P < 0.0001). Hyphema in 36 eyes (30.5%) and an IOP spike in 20 eyes (16.9%) were the only observed complications. Additional glaucoma surgery was required in 27 eyes (22.9%) during the follow-up period. Utilization of ab interno trabeculotomy effectively lowered the IOP and reduced the number of IOP-lowering medications. Patients with higher preoperative IOP exhibited better postoperative outcomes.