Intraocular Pressure Research Articles

One-Year Real-World Outcomes of Ab-Externo Gel Stent Placement From the EXPAND Study.

In the real-world, retrospective, EXPAND study of consecutive adults with glaucoma, ab-externo gel stent implantation effectively lowered intraocular pressure (34%) and the medication burden (61%), with transient/self-resolving hypotony as the most frequent adverse event (28%). To assess effectiveness and safety of ab-externo gel stent (GS) implantation in glaucoma. Multicenter, real-world, retrospective study. Consecutive adults with glaucoma and ab-externo GS implantation (with/without phacoemulsification or open/closed conjunctiva) ≥12 months before study entry. Data were extracted between the baseline/preoperative and last follow-up visit or date of secondary surgical intervention (SSI). Primary effectiveness endpoint: proportion of primary eyes (first eye in bilaterally implanted patients) at Month 12 (M12) achieving ≥20% intraocular pressure (IOP) reduction from baseline without medication increase, clinical hypotony, vision loss to counting fingers, or SSI. Secondary effectiveness endpoints included complete success (IOP ≤18mmHg and ≥20% IOP reduction from medicated baseline without medication, clinical hypotony, or SSI); qualified success (same but without medication increase); and needling rate. Key safety endpoints (all eyes): intraoperative complications, postoperative adverse events (AEs), and SSIs. The safety population included 466 eyes; 80.7% received the GS alone and 85.0% were implanted with closed conjunctiva. At M12, 39.1% of all primary eyes (N=413) and 54.9% of primary eyes with IOP and medication data at baseline and M12 (N=213) achieved the primary endpoint. At M12 among all primary eyes, the complete success, qualified success, and needling rates were 33.5%, 56.5%, and 28.6%. Most eyes (97.9%) had no intraoperative complications. The most frequent postoperative AE was transient/self-resolving hypotony (IOP<6mmHg; 28.1%). Sixty-nine (14.8%) eyes required an SSI. Ab-externo GS placement effectively lowered IOP and the medication count without unexpected complications/AEs, expanding implantation options based on patients' needs and surgeons' preferences.

Cognitive Impairment in Primary Open Angle Glaucoma: A Case Control Study.

Cognitive impairment in multiple domains was observed in primary open angle glaucoma patients as compared to age and gender matched healthy controls. Evaluation of cognitive impairment in individuals with Primary Open Angle Glaucoma (POAG). In this case-control study, individuals with POAG (cases, n=70) were compared with age- and sex-matched healthy individuals (controls, n=70) using detailed ophthalmological evaluation, cognitive assessment and serum cortisol level. A multitude of tests were employed to comprehensively assess various domains of cognitive function: Addenbrooke Cognitive Examination (ACE-III; attention/orientation, memory, language, verbal fluency, and visuospatial skills), Post Graduate Institute Memory Scale (PGIMS; verbal and non verbal memory), Wisconsin Card Sorting Test (WCST; nonverbal executive functions), Go No-Go task (GNG; inhibitory control), and Trail Making Test (TMT; attention and working memory). Intraocular pressure and cup disc ratio were significantly higher (P <0.001) while retinal nerve fibre layer (RNFL) thickness and mean deviation were significantly lower in cases as compared to controls. Cases had significantly lower scores on ACE-III and PGIMS (P<0.001) and longer test completion time in TMT-A (P=0.001). The performance of cases was also significantly worse on most parameters of the WCST and GNG tasks. Serum cortisol level was significantly higher in cases (11.75±7.41mcg/dl) compared to controls (7.93±2.39 mcg/dl; P=0.02). A significant correlation was observed between serum cortisol level and WCST correct response (P=0.04), WCST error response (P=0.002) and total time taken in TMT-A (P=0.03).Visual field mean deviation also exhibited a significant correlation with serum cortisol level (P<0.001) and total time taken on WCST (P=0.03) and TMT-A (P=0.03). Individuals with POAG exhibited higher cognitive impairment and raised serum cortisol levels than age-matched healthy controls. Early recognition and management of cognitive impairment are pivotal for enhancing the quality of life and implementing comprehensive glaucoma care.

Polydipsia Induced Acute Angle-Closure Crisis.

We present a case of Acute Angle-Closure Crisis (AACC) precipitated by primary transient psychogenic polydipsia; we believe that our case is the first of its kind to be reported. A 74-year-old male presented to the emergency department with altered mental status due to acute-onset hyponatremia. Six days after admission, the patient noticed painful loss of vision in his right eye and an ipsilateral headache lasting 10-15 minutes. Upon follow-up with his primary care physician several days later, a fixed, dilated right pupil was noted. On ophthalmologic evaluation in the ER the next day, the patient was found to have markedly elevated intraocular pressure (IOP) at 47mm Hg in the right eye. He started topical brimonidine, dorzolamide 2%/timolol 0.5%, and latanoprost, and underwent phacoemulsification with placement of a posterior chamber intraocular lens (PCIOL) in the right eye. Several mechanisms of polydipsia induced AACC are proposed including choroidal expansion, increased sympathetic α-adrenergic tone, or differences in osmotic potential forces.

BMP4-GPX4 can improve the ferroptosis phenotype of retinal ganglion cells and enhance their differentiation ability after retinal stem cell transplantation in glaucoma with high intraocular pressure.

Activation of bone morphogenetic protein (BMP) 4 signaling promotes the survival of retinal ganglion cell (RGC) after acute injury. In this study, we investigated the role of the BMP4 signaling pathway in regulating the degeneration of retinal ganglion cells (RGCs) in a mouse glaucoma model and its potential application in retinal stem cell. Our results demonstrate that BMP4-GPX4 not only reduces oxidative stress and iron accumulation but also promotes neuroprotective factors that support the survival of transplanted RSCs into the host retina. These findings suggest a novel therapeutic approach for glaucoma involving the modulation of the BMP4-GPX4 pathway to protect RGCs and improve visual function through enhanced RSC differentiation.

Development and validation of a risk prediction model for early postoperative high intraocular pressure after implantation of posterior chamber intraocular lens

Objective: To develop and validate a predictive model for assessing the risk of early postoperative high intraocular pressure (HIOP) following posterior chamber intraocular lens implantation. Methods: The clinical data of patients who underwent posterior chamber intraocular lens implantation at the Second Affiliated Hospital of Zhejiang University School of Medicine between May 2023 and April 2024 were retrospectively reviewed. Patients were divided into a modeling group and a validation group with a 7∶3 ratio using computerized random allocation. The modeling group was further categorized into normal intraocular pressure and HIOP groups based on the occurrence of early postoperative HIOP. Multivariate logistic regression analysis was employed to establish a risk prediction model. Receiver operating characteristic (ROC) curve analysis was conducted using R software to assess the predictive ability and accuracy of the model, along with calibration and decision curve analysis (DCA) curve plotting. Results: A total of 239 patients (478 eyes) were enrolled. The modeling group consisted of 168 patients (82 males and 86 females) (336 eyes), with an average age of (25.5±5.1) years. The validation group consisted of 71 patients (36 males and 35 females) (142 eyes), with an average age of (24.7±5.7) years. The early postoperative HIOP incidence rate after posterior chamber intraocular lens implantation was 32.4% (109/336), while it was 26.8% (38/142) in the validation group. The multivariate logistic regression analysis indicated that preoperative refractive diopter (OR=0.873, 95%CI: 0.782-0.976, P=0.017), corneal endothelial cell count (OR=0.996, 95%CI: 0.995-0.997, P<0.001), corneal thickness (OR=1.015, 95%CI: 1.006-1.024, P=0.001), and preoperative intraocular pressure (OR=1.470, 95%CI: 1.283-1.686, P<0.001) were associated factors for early HIOP. The Hosmer-Lemeshow test showed that the χ2 value was 8.444 (P=0.391), and the area under the ROC curve (AUC) was 0.888 (95%CI: 0.852-0.925). The Youden index reached its maximum value of 0.646, with a sensitivity of 0.862 and specificity of 0.784. AUC of validation group was 0.921 (95%CI: 0.870-0.972), with a maximum Youden index of 0.765, sensitivity of 0.842 and specificity of 0.923. Conclusions: The risk prediction model constructed based on preoperative refractive diopter, corneal endothelial cell count, corneal thickness, and preoperative intraocular pressure demonstrates good predictive performance for early postoperative HIOP following posterior chamber intraocular lens implantation.

Attachment of Hydrogel Patches to Eye Tissue through Gel Transfer using Flexible Foils.

Glaucoma, a leading cause of blindness, demands innovative and effective treatments that surpass the limitations of current drug and surgical interventions to lower intraocular pressure. This study describes the generation of cell-repellent hydrogel patches, their deposition on the ocular surface, and a photoinduced chemical binding between the patches and the collagens of the eye. The hydrophilic and protein-repellent hydrogel patch is composed of a copolymer made from dimethylacrylamide and a comonomer unit with anthraquinone moieties. A thin layer of the prepolymer is deposited on a flexible foil. This foil has a hydrophobic side on top and superhydrophilic sides on the bottom. A small amount of added water can penetrate easily through the foil and release the polymer, which is thus transferred from the foil onto the eye at the desired location. Through brief irradiation with UV light with a wavelength of 365 nm, the prepolymer is simultaneously cross-linked and covalently attached to the eye's surface through C-H insertion reactions. We describe the handling, attachment, UV irradiation effects on nearby healthy tissues, biocompatibility, stability, and cellular interaction of the patches during in vitro studies.

A comparative study of Single-barrel and Double-barrel trabeculectomy: efficacy of intraoperative 5-fluorouracil in reducing intraocular pressure

ABSTRACT Background Trabeculectomy is a key surgical approach for managing glaucoma, particularly in patients with high intraocular pressure. This study compares the efficacy of Single-barrel and Double-barrel trabeculectomy techniques utilizing 5-fluorouracil (5-FU) to enhance intraocular pressure (IOP) control and surgical outcomes. Research design and methods A prospective cohort study of 78 patients (147 eyes) undergoing trabeculectomy with 5-FU was conducted. Patients were divided into Single-barrel and Double-barrel groups. Preoperative and postoperative parameters, including IOP, medication scores, and visual acuity, were assessed. Statistical analyses included propensity score matching, ANCOVA, and Kaplan-Meier survival analysis. Results Both techniques significantly reduced IOP postoperatively (p < 0.0001). The Double-barrel group demonstrated superior IOP control durability with longer time to failure (10.77 ± 1.67 months vs. 8.38 ± 1.72 months, p < 0.001), fewer total failures (11 vs. 15), and a trend toward reduced medication reliance (1.91 ± 0.80 vs. 2.11 ± 0.86, p = 0.137). Visual acuity improved in both groups, with a higher proportion of Double-barrel patients achieving 6/6 acuity. Conclusions The Double-barrel trabeculectomy technique demonstrated superior long-term IOP control and reduced reliance on glaucoma medications, highlighting its potential as a more effective surgical option in glaucoma management.

Cataract Eye Disease Diagnosis Using the Random Forest Method

This study developed a machine learning-based classification model using the Random Forest algorithm to detect cataract risk based on 11 variables: age, gender, family history, lens opacity, visual acuity reduction, light sensitivity, color changes, double vision, intraocular pressure, slit-lamp results, and visual acuity. Feature importance analysis revealed that lens opacity and visual acuity variables contributed most significantly to cataract risk prediction, followed by intraocular pressure and visual acuity reduction. The system was designed using Google Colab for model training and Streamlit as an interactive interface, enabling real-time predictions with intuitive result visualization. After optimization using Grid Search, the model achieved an accuracy of 92.0%, precision of 95.0%, sensitivity of 90.0%, F1 Score of 92.4%, and specificity of 98.0%. This system is expected to serve as an effective supporting tool for medical professionals in the early diagnosis of cataracts.

19-Year Follow-up on Patients with Axenfeld-Rieger Anomaly or Syndrome and Fuchs' Endothelial Dystrophy Including the 6th Generation in a Pedigree.

Nineteen-year follow-up after initial examination on patients with Axenfeld-Rieger anomaly or syndrome (ARAS) and coexisting Fuchs' endothelial dystrophy (FED). All individuals had previously been tested positive for the PITX2 (g.20 913 G>T) mutation. Additionally, we addressed their descendants for phenotype and genotype examination to determine their penetrance into the next generations. Twenty-nine patients (9 patients and 20 of their descendants) participated in this prospective observational study. Nine patients were examined and tested positive for the PITX variant (g.20 913 G>T) in our previous study in 2001. Fourteen descendants were genetically and clinically examined. Six descendants were not available for clinical examination but donated saliva samples for genetic analysis. Ophthalmic examination was performed, consisting of visual acuity (VA) testing, applanation tonometry, gonioscopy, and anterior segment and central fundus biomicroscopy. Peripapillary optical coherence tomography (pOCT) was performed, and endothelial cell density (ECD) and central corneal thickness (CCT) were measured. Clinical disease progression in patients with a positive PITX2 mutation, genetic defect transmission, and clinical penetrance in subsequent third to sixth generations were the main outcome measures. Ten out of twenty descendants tested positive for the PITX2 variant (g.20 913 G>T). Eight were identified as being affected by ARAS. FED was found in six patients. All of them showed ARAS. Third generation patients (mean age 82) progressed significantly in both coexisting diseases. Four of six eyes ended up in corneal edema, with VA below 0.2. Glaucoma assessment was compromised due to corneal edema. Fourth generation patients (mean age 43) showed a mean CCT of 611 µm, ECD of 1230, and intraocular pressure (IOP) of 17.5 mmHg and thinning of the peripapillary nerve fiber layer. One eye was newly diagnosed with glaucoma, elevated IOP, and mild corneal edema. Fifth generation patients (mean age 27) presented with a mean CCT of 564 µm, ECD of 2802, and IOP of 14.4 mmHg. Genetic analysis confirmed the PITX2 (g.20 913 G>T) mutation was associated with Axenfeld-Rieger and FED in 10 of 20 descendants in this family. This matches the autosomal dominant inheritance pattern with a probability of 50%. Glaucoma and corneal decompensation were progressive over 19 years, with variable expression and early onset in subsequent pedigree members.

Comparing structural and vascular parameters between advanced pseudoexfoliation glaucoma and primary open angle glaucoma using optical coherence tomography angiography

BackgroundTo compare structural and vascular parameters between advanced pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG).MethodsOne hundred and six eyes of 81 patients were enrolled in this cross-sectional study. All patients underwent complete ophthalmic examination and measurement of the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC). The vessel densities (VD) in the peripapillary and macular area were also determined using optical coherence tomography angiography (OCTA). A linear mixed model was used for the comparison of the structural and vascular parameters between groups with adjustment for type of glaucoma, age, sex, intraocular pressure (IOP), and mean deviation (MD) of the visual field C24-2.ResultsThe patients in the PXG group were significantly older (68.06 ± 10.6 vs. 61.24 ± 15.23, p = 0.01) and had worse MD in the visual field C24-2 (-24.83 ± 6.18 vs. -22.37 ± 5.94, p = 0.04). Sex and IOP were comparable between groups (p > 0.05). Perippaillry RNFL and GCC thickness were not different between groups (p > 0.05). The PXG eyes showed lower VD in the average peripapillary area (32.67 ± 7.78 vs. 37.75 ± 8.87, p = 0.027) and nasal (37.45 ± 9.74 vs. 42.15 ± 7.36, p = 0.026) and inferior (38.09 ± 8.27 vs. 42.71 ± 9.13, p = 0.041) quadrants of parafovea.ConclusionThe advanced PXG and POAG eyes have comparable structural defects in the peripapillary and inner macula while the PXG eyes may have more vascular deterioration, especially in the macula.

Biomimetic Air-Lifted Organ Culture System with a Protective Coverage Membrane for Full-Thickness Corneal Preservation.

Effective storage and utilization of limited donor corneal resources are in high demand to alleviate the shortage of donor corneal tissue. Here, we designed a static air-lifted organ culture system equipped with a protective coverage membrane, namely, an air-lifted OC-P system, to provide a biomimetic physiological environment for full-thickness corneal preservation. The air-lifted OC-P system features a unique collagen-based protective coverage membrane that can offer a moist, oxygen-rich environment for corneal epithelium, produce an appropriate intraocular pressure onto the cornea by gravity, and facilitate the maintenance of the organ culture medium level for nutrient supply during corneal preservation. Compared with conventional submerged and air-lifted corneal preservation methods, the air-lifted OC-P system remarkably improved the overall quality of the preserved corneas. These preserved corneas not only exhibited superior controllability of corneal swelling and extraordinary maintenance of the morphology and viability of all three types of corneal cells (i.e., corneal epithelium, keratocytes, and endothelium) but also demonstrated optimal optical, thermal, and mechanical properties. This air-lifted OC-P system presents a biomimetic strategy that provides a static and efficient method to replicate the corneal natural conditions for corneal preservation effectively.

Intraocular pressure rise, hyphema and uveitis in chronic lymphocytic leukemia undergoing ibrutinib treatment

Intraocular pressure rise, hyphema and uveitis in chronic lymphocytic leukemia undergoing ibrutinib treatment

Non-invasive fundoscopy as a tool to estimate intracranial pressure: a large animal model

PurposeIntracranial pressure (ICP) monitoring is in most studies considered essential in avoiding secondary brain injury in patients with intracranial pathologies. Invasive monitoring of ICP is accurate but is unavailable in many clinical and prehospital settings. Non-invasive modalities have historically been difficult to implement clinically. The retinal arteriovenous ratio (A/V ratio) has shown promise through its relationship with ICP.This study aimed to further elucidate the relationship between ICP, A/V ratio and the intraocular pressure (IOP) measured with non-invasive fundoscopy in a porcine model.MethodsWe achieved controlled values of ICP ranging from normal (5–15 mmHg) to elevated (> 20 mmHg) within the same animal subject. Six pigs were included. ICP and IOP was measured using an intraparenchymal pressure monitor and a tonometer, respectively. Fundoscopy was performed at baseline and at predefined ICP values.ResultsMixed-effects linear regression revealed a significant inverse correlation between A/V ratio and ICP ≥ 20 mmHg (slope coefficient − 0.0026734 [95%-CI: −0.0039347 – (−0.0014121)], p < 0.001). For ICP < 20 mmHg there was no change in A/V ratio (p = 0.987). Similar results were seen for ICP > IOP with a mean IOP of 10 mmHg. A Wald test showed no significant difference between ICP > IOP and ICP ≥ 20 mmHg. ROC curve analysis revealed an AUC of 0.64 for ICP ≥ 20 mmHg and 0.71 for ICP > IOP.ConclusionThe results support the hypothesis that an increase in ICP was associated with a decrease in A/V ratio. Although a slightly better fit, the model of ICP > IOP was deemed less clinically relevant than ICP ≥ 20 mmHg because of the subjects’ IOP.Further research integrating multifactorial models and machine learning is needed to enhance the diagnostic accuracy of A/V ratio via fundoscopy, enabling it to serve as a cost-effective screening tool.

Asymmetric Intraocular Pressure Changes in Dominant and Contralateral Eyes: The Dark Room Prone Provocative Test

ABSTRACT Purpose To evaluate changes in intraocular pressure (IOP) in dominant and contralateral eyes following the dark room prone provocative test (DRPPT) in the study subjects with shallow anterior chamber. Methods This was a prospective, single-center, non-randomized controlled trial of 43 subjects (86 eyes) with shallow anterior chamber. The dominant eye was identified using the card-hole method. The study subjects underwent the DRPPT for one hour. Pre- and post-DRPPT IOP was measured using an I-Care tonometer, and pupillary parameters, including amplitude of constriction, peak constriction velocity, and peak re-dilation velocity, were also measured using the RAPDx® dynamic pupillometer. Results Significant increases in IOP were observed in both the dominant and contralateral eyes after DRPPT, compared to their respective pre-DRPPT IOP levels. (p < .01). Moreover, IOP variation before and after DRPPT was significantly greater in the dominant eye than in the contralateral eye (median 3.60 mmHg vs. 2.70 mmHg, p < .05). The dominant eyes exhibited a smaller amplitude of constriction (1.07 ± 0.35 mm vs 1.14 ± 0.34 mm, P < .05) and slower constriction velocity (3.71 ± 1.12 mm/s vs 3.78 ± 1.11 mm/s, P < .05) as compared to the contralateral eyes. Conclusions This study demonstrated that the dominant eye exhibited greater IOP changes after DRPPT than the contralateral eye. Additionally, it showed smaller pupil constriction and slower contraction, indicating a higher likelihood of pupil blockage in the dominant eye with shallow anterior chambers. This asymmetry partially explains the monocular onset of acute angle-closure attacks.

Efficiency of surgical treatment for complicated cataract: clinical and functional analysis

Background. Despite the successes of ophthalmic surgery, the treatment of complicated cataract remains challenging due to concomitant conditions such as lens subluxation and glaucoma. The purpose of the study was to assess the clinical and functional state of the eye in patients with complicated cataract after lens extraction. Materials and methods. The study involved 54 patients: 36 with uncomplicated cataract (controls) and 18 (main group) with cataract complicated by primary open-angle glaucoma (POAG). They underwent an ophthalmic examination, including visometry, tonometry, echobiometry, and ophthalmoscopy. The examination was performed before surgery, the next day, 1, 3 and 6 months after phacoemulsification. Results. Six months after surgery, 97.23 % of controls and 94.45 % of patients in the main group had visual acuity ≥ 0.5. On the first day after phacoemulsification, the mean intraocular pressure (IOP) increased by 3.14 ± 0.15 mm Hg in the control group and by 0.84 ± 0.02 mm Hg in patients with POAG, but by the end of the follow-up, there was a decrease in IOP in 50 and 44.5 % of cases, respectively, compared to preope­rative values. One month after surgery, the anterior chamber depth increased by 0.94 mm in controls and by 0.44 mm in patients of the main group, remaining stable until the end of the follow-up. Conclusions. Clinical follow-up of patients with uncomplicated cataract and cataract complicated by POAG showed that after phacoemulsification, there was an improvement in visual function, stabilization of IOP and an increase in the anterior chamber depth. An increase in IOP on the first day after surgery is transient, and the dynamics of indicators over 6 months confirms the effectiveness of surgical intervention.

Peculiarities of morphofunctional changes of the eye and lamina cribrosa in myopia of various degrees: final report

Background. Myopia is the most common visual defect. Complicated myopia is one of the main causes of disability due to eye diseases. In case of myopia, the axial length increases, and all membranes are loosened. Lamina cribrosa (LC) undergoes special changes. Clinical assessment of the LC parameters has high diagnostic significance. LC defects, changes in its thickness and depth of location can be well visualized using modern research methods, and therefore, allow us to study these parameters in detail in the norm and with the development of eye pathology. The correlation between the optic disc deformation and LC deformation and its pores remains unknown. It is only known that the severity of the lesion will depend on the degree of damage to the nerve and ganglion fibers and the degree of change in the LC structure. The purpose: to study the features of morphofunctional changes in the eye and lamina cribrosa in myopia of various degrees based on the analysis of morphological and morphometric parameters. Mate­rials and methods. The study consisted of experimental and clinical parts. During the experiment, 42 animals (rabbits) (84 eyes) were studied. A comprehensive diagnostic examination of 120 people (230 eyes) was conducted. The control group included 20 patients without myopia (40 eyes). All patients were of working age, from 18 to 45 years. Patients in the main group received a vitamin complex containing carotenoids, lutein, zeaxanthin and omega-3 fatty acids, as well as vitamin B preparation. The control group did not receive treatment. Results. When studying the optic disc parameters in patients with different degrees of myopia, the most significant changes occurred in the indicators of GLV, nerve head, optic disc area. The parameters of MD and PSD perimetry differed significantly in all groups. Based on the developed markers, with the help of optical coherence tomography, it was possible to assess the general morphology and position of the LC in patients by measuring its depth and insertion in different meridians. After treatment of patients, statistically significant positive dynamics was revealed, taking into account changes in the indicators of Humphrey perimetry — MD and PSD, as well as a tendency to improve visual acuity, the absence of significant changes in the anterior-posterior segment of the eye, intraocular pressure, average refraction in the main group during the entire treatment period without significant statistical changes. The experimental study on the effect of low doses of atropine revealed the appearance of functionally active fibroblasts with the accumulation of the ground substance and thickening of the bundles of collagen fibers of the sclera and the walls of the LC pores, which is accompanied by thickening of both the sclera and the LC when using 0.5 and 0.01% atropine sulfate solution compared to the control group. Conclusions. LC defects, changes in its thickness and depth of location are well visualized using optical coherence tomography. With the experimental use of 0.01% atropine sulfate, strengthening of the sclera and LC with preservation of the morphofunctional state of the receptor apparatus of the eye was proven, which allows us to consider it advisable to use the selected concentration of the drug in the future in patients with myopia.

Improving the technique of antiglaucomatous surgery by using absorbable suture material in patients with primary open-angle glaucoma

Background. Surgical treatment of glaucoma is aimed at achieving target intraocular pressure and obtaining a sustained hypotensive effect. Fibrosis of the filtering bleb in the early and late postoperative period leads to the search for new techniques to improve surgeries. The purpose was to assess the effectiveness of an improved surgical technique using absorbable suture material in patients with primary open-angle glaucoma. Materials and methods. Work with patients was carried out in compliance with the general requirements and provisions of bioethics, which were approved by the First National Congress on Bioethics (Kyiv, 2001). Informed consent was obtained from each patient. Forty-nine individuals (47 eyes) with primary open-angle glaucoma took part in the study. The main group included 25 patients (27 eyes) with uncompensated open-angle glaucoma who underwent antiglaucomatous surgery using absorbable suture material. Control group consisted of 24 patients (20 eyes), in whom antiglaucomatous surgery was performed in a classical way without using of polyglycolide. Examinations were performed before surgery, each week after it for a month and then at 3, 6, 12, 18 and 24 weeks. In addition to standard methods, ophthalmic examination included tonography on an electronic Model 30 Pneumatonometr (Reichert, USA), control of the morphological state of the filtering bleb was carried out by computer tomography using DRI OCT Triton (Topcon, Japan) and Visante OCT (Carl Zeiss, Germany). Results. In the main group in the postoperative period, the intraocular pressure stabilized, its level did not exceed 22 mm Hg, while in the control group, there was an increase in the average indicator to 28.1 mm Hg six months after surgery. The coefficient of the outflow facility in the postoperative period in the main group was more stable and amounted to 0.26 ± 0.06 mm3/min/mm Hg, and in the control group, there was a decrease to 0.19 ± 0.08 mm3/min/mm Hg, which indicated destabilization of hydrodynamic processes. Conclusions. The technique of antiglaucomatous surgeries improved by using absorbable suture material is more effective in patients with primary open-angle glaucoma compared to classic antiglaucomatous surgery.

A novel two-stage and combined treatment of primary open-angle glaucoma and cataract: comparative efficacy and complications

Background. The approach to the treatment of patients with primary open-angle glaucoma and cataract is still a subject of debate, because when choosing a particular type of procedure, as well as determining the timing of its performance, it is necessary to consider a significant number of factors that may affect success of treatment. There are limited data on the outcomes of combined treatment of patients with primary open-angle glaucoma and complicated cataract, which includes phacoemulsification with intraocular lens (IOL) implantation and micropulse transscleral cyclophotocoagulation (MP-TSCPC). The purpose is to compare efficacy and to study the nature and frequency of complications when using novel, two-stage and combined surgical and laser methods for treating primary open-angle glaucoma with cataract. Materials and methods. The study includes 112 patients (112 eyes) with primary open-angle glaucoma stage I–IV and complicated cataract. There were 3 observation groups. In the first one (n = 34), phacoemulsification with IOL implantation was performed 1 month prior to MP-TSCPC. The second group (n = 36) included patients who underwent phacoemulsification with IOL implantation a month after MP-TSCPC. In the third group (n = 42), phacoemulsification with IOL implantation and MP-TSCPC were performed in one procedure. These groups did not statistically differ in terms of age, gender, baseline intraocular pressure, stage of primary open-angle glaucoma and nuclear lens density. The primary outcome measure was the normalization of intraocular pressure with or without the use of antiglaucoma medications and without need for repeated laser and incisional procedures after 1, 3 and 6 months. The secondary outcome measure was stabilization or expansion of visual fields 1, 3, and 6 months after treatment. The complication nature and rates were evaluated. Results. In the third group, where combined treatment was performed, the incidence of transient hypertension and inflammatory complications was statistically higher. There was a tendency to a higher incidence of corneal edema, cystoid macular edema, and hypotony as well; 7.1 % of patients required repeated MP-TSCPC, but this was statistically insignificant. According to the survival analysis, a statistically significant difference was found between the three groups in functional (p = 0.036) and hypotensive outcomes (p = 0.046), with the best result in the second group at 6 months of follow-up. Conclusions. The efficacy assessed by hypotensive and functional outcomes at a follow-up period of 6 months appeared to be statistically lower in the group of combined treatment compared to the groups in which two-stage treatment was conducted.

One tube for all: 1-year outcomes after transition to Paul glaucoma implant at a tertiary centre.

To evaluate the intraocular pressure (IOP) lowering effect and success rate of Paul glaucoma implant (PGI) in refractory glaucoma after changing practice pattern from Ahmed and Baerveldt tubes to PGI. A prospective observational study of the first 50 consecutive PGI surgeries at a single Danish tertiary centre from January 2022 to October 2023. Primary endpoints were IOP and success rates after 12 months. Secondary endpoints were the use of IOP-lowering medications and complications. All cases had a risk of failure for traditional glaucoma surgery (neovascular glaucoma, oil-filled eye or uveitis). Preoperative IOP was 29.9 ± 8.6 mmHg and the mean number of topical IOP-lowering medications used was 3.4 ± 0.76 with 14 cases of systemic acetazolamide. Twelve months after surgery IOP was reduced to 11.4 ± 3.1 mmHg and complete success rate with (a) IOP≤21 mmHg was achieved in 43%, (b) IOP≤18 mmHg in 43%, (c) IOP≤15 mmHg in 41% and (d) IOP≤12 mmHg in 33%. Qualified success rate (on topical glaucoma medications) was achieved in (a) 96%, (b) 94%, (c) 86% and (d) 71% of the cases. The number of topical IOP-lowering medications was 0.9 ± 0.9 after surgery and 47% were medication free. Early (<3 months) and late (>3 months) complications were observed in 22% and 16% of patients respectively. This study indicates that PGI provides a good IOP-lowering effect after 12 months in a population with risk factors for failure for traditional glaucoma surgery.

Fibrosis and Src Signalling in Glaucoma: From Molecular Pathways to Therapeutic Prospects

Glaucoma, a leading cause of irreversible blindness, is characterised by progressive optic nerve damage, with elevated intraocular pressure (IOP) and extracellular matrix (ECM) remodelling in the lamina cribrosa (LC) contributing to its pathophysiology. While current treatments focus on IOP reduction, they fail to address the underlying fibrotic changes that perpetuate neurodegeneration. The Src proto-oncogene, a non-receptor tyrosine kinase, has emerged as a key regulator of cellular processes, including fibroblast activation, ECM deposition, and metabolism, making it a promising target for glaucoma therapy. Beyond its well-established roles in cancer and fibrosis, Src influences pathways critical to trabecular meshwork function, aqueous humour outflow, and neurodegeneration. However, the complexity of Src signalling networks remains a challenge, necessitating further investigation into the role of Src in glaucoma pathogenesis. This paper explores the therapeutic potential of Src inhibition to mitigate fibrotic remodelling and elevated IOP in glaucoma, offering a novel approach to halting disease progression.