IOP-lowering Medications Research Articles

Intraocular Pressure Spikes Following iStent Inject and the Relationship to Aqueous Outflow in Open Angle Glaucoma.

Adding trabecular bypass surgery (TBS) to phacoemulsification creates unpredictable short-term intraocular pressure (IOP) control that may be undesirable for patients with advanced glaucoma. Aqueous outflow (AO) responses after TBS are complex and probably multifactorial. To assess IOP spikes in patients with open angle glaucoma up to 1 month after iStent inject and their relationship to AO patterns measured by hemoglobin video imaging (HVI). We studied IOP for 4 weeks after TBS with iStent inject in 105 consecutive eyes with open angle glaucoma (6 TBS only and 99 combined with phacoemulsification). The change in IOP after surgery at each time point was compared with baseline measurements and the prior postoperative visit. IOP-lowering medications were stopped on the day of surgery in all patients. A smaller pilot study of 20 eyes (TBS only = 6 and combined = 14) underwent concurrent HVI to observe and quantify perioperative AO. Aqueous column cross-sectional area (AqCA) of one nasal and one temporal aqueous vein was calculated at each time point, and qualitative observations were documented. An additional 5 eyes were studied after phacoemulsification only. Mean IOP for the entire cohort (preoperative 17.3 ± 5.6 mm Hg) was lowest the day after TBS (13.1 ± 5.0 mm Hg) and peaked at 1 week (17.2 ± 8.0 mm Hg), before stabilizing by 4 weeks (15.2 ± 5.2 mm Hg; P < 0.00001). The same IOP pattern was seen when separating the group into a larger cohort without HVI (respectively 15.9 ± 3.2 mm Hg, 12.8 ± 4.9 mm Hg, 16.4 ± 7.4 mm Hg, and 14.1 ± 4.1 mm Hg; N = 85, P < 0.00001) and the smaller HVI pilot study (respectively 21.4 ± 9.9 mm Hg, 14.2 ± 4.9 mm Hg, 20.2 ± 9.7 mm Hg, and 18.9 ± 7.6 mm Hg; N = 20, P < 0.001). More than 30% IOP elevation above baseline occurred in 13.3% of the entire cohort at 1 week after surgery. This increased to 46.7% when IOP was compared with 1 day after surgery. Inconsistent AqCA values and patterns of aqueous flow were demonstrated after TBS. AqCA after phacoemulsification alone was maintained or increased within 1 week in all 5 eyes. After iStent inject surgery in patients with open angle glaucoma, intraocular spikes were most commonly seen at 1 week. AO patterns were variable and additional studies are needed to understand the pathophysiology underlying IOP responses after this procedure.

Circumferential (360°) trabeculotomy for steroid-induced glaucoma in adults

PurposeTo evaluate the safety and efficacy of 360° circumferential trabeculotomy (TO) for steroid induced glaucoma (SIG) of short duration.MethodsRetrospective analysis of surgical results of 46 eyes of 35 patients undergoing microcatheter-assisted TO. All eyes had high intraocular pressure for at most about 3 years due to steroid use. Follow-up was between 2.63 and 47.9 months (mean 23.9, median 25.6).ResultsIntraocular pressure (IOP) before surgery was 30.8 ± 8.3 mm Hg, with 3.8 ± 1.0 pressure-lowering medications. After 1 to 2 years, mean IOP was 11.2 ± 2.6 mm Hg (n = 28); mean number of IOP-lowering medications was 0.9 ± 1.3. At their last follow-up, 45 eyes had an IOP < 21 mm Hg, and 39 eyes had an IOP < 18 mm Hg with or without medication. After 2 years, the estimated probability of having an IOP below 18 mm Hg (with or without medication) was 85 ± 6%, and the estimated probability of not using medication was 56 ± 7%. Steroid response was no longer present in all eyes receiving steroids after surgery. Minor complications consisted of hyphema, transient hypotony, or hypertony. One eye proceeded to receiving a glaucoma drainage implant.ConclusionTO is particularly effective in SIG with relative short duration. This concurs with the pathophysiology of the outflow system. This procedure seems particularly suited for eyes for which target pressures in the mid-teens are acceptable, particularly when chronic use of steroids is necessary.

Factors influencing the effectiveness of trabeculectomy: following materials of the City Multidisciplinary Hospital No. 2

BACKGROUND: Despite the ever-expanding arsenal of IOP-lowering surgeries, trabeculectomy remains the most common procedure amongst them. Therefore, the identification of factors reducing its effectiveness and potentially being able to change the surgical treatment plan is of particular importance.&#x0D; AIM: To identify factors reducing trabeculectomy effectiveness.&#x0D; MATERIALS AND METHODS: The study group consisted of 443 consecutively enrolled patients who were operated in 20162020 in Saint Petersburg City Multidisciplinary Hospital No. 2 for primary open-angle decompensated glaucoma and then observed for 6 to 24 months. Using statistical research methods, factors that significantly affected the impact of the procedure were identified.&#x0D; RESULTS: The main predictors of trabeculectomy failure following the order of decreasing importance of established relations (p) were: loss of effectiveness of the preceding IOP-lowering procedure (р = 0.0001), dry eye syndrome (р = 0.013), number of drop instillations per day (р = 0.041), and excessive preservative load due to unnecessarily aggressive topical glaucoma treatment (р = 0.039). An obvious demonstration of excessive therapy is a simultaneous administration of four IOP-lowering medications. It also causes scarring of the procedure area, especially in patients previously operated for glaucoma. Null preservative load and prostaglandin monotherapy are associated with guaranteed complete success of trabeculectomy. Unlike the intensity of medical glaucoma treatment, its duration does not have such a significant impact on trabeculectomy outcomes (р = 0.270). Close to a significant one is the relationship between poor surgical outcomes and advanced stages of the disease (р = 0.052).&#x0D; CONCLUSIONS: The main factors affecting the effectiveness of trabeculectomy were failure of the previous IOP-lowering surgeries; concomitant dry eye syndrome, arising or being aggravated by unduly intense and prolonged pharmacological effects on the eye surface; as well as delayed appliance for surgical IOP normalization at advanced disease stages.

Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes.

Selective laser trabeculoplasty (SLT) is a relatively safe and effective therapy in lowering intraocular pressures (IOP) for glaucoma. To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes. This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma (OAG, n =36) and eyes with prior glaucoma surgery (PGS, n =39) were included. Changes in mean IOP and number of glaucoma medications used evaluated at 1 d, 1 wk, 1 mo, 3 mo, 6 mo, 12 mo, and 36 mo after laser treatment. All patients (33 male, 37 female) were Chinese. The mean age was 44.34 ± 16.14 years. Mean pre-SLT IOP was 22.75 ± 2.08 mmHg in OAG and 22.52 ± 2.62 mmHg in PGS. Mean IOP was significantly reduced 1 d, 1 wk, 1 mo and 3 mo after laser treatment (P < 0.05, respectively). Whereas, there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG (P = 0.347, P > 0.05) and in PGS (P = 0.309, P > 0.05). Six months after SLT treatment, some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP. By the end of our study, the average IOP decreased to 20.73 ± 1.82 mmHg in OAG and 20.49 ± 1.53 mmHg in PGS groups. The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline. SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups. SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

One Year Results of the Preserflo MicroShunt Implantation for Refractory Glaucoma.

The Preserflo MicroShunt is an effective method to achieve a satisfying intraocular pressure (IOP) reduction in patients with complicated forms of glaucoma. To evaluate the efficacy and safety of the Preserflo MicroShunt with mitomycin C in patients with complicated glaucoma. This prospective interventional study included all patients that underwent Preserflo MicroShunt Implantation between April 2019 and January 2021 to treat severe and therapy refractory glaucoma. The patients either suffered from primary open angle glaucoma with already failed incisional glaucoma surgery or presented severe forms of secondary glaucoma (eg, after penetrating keratoplasty or globe penetrating injury). Primary endpoint was the IOP-lowering effect and the success rate after 12 months. Secondary endpoint was the occurrence of intraoperative or postoperative complications. Complete success was defined as reaching the target IOP (>6 mm Hg and <14 mm Hg) without additional IOP-lowering medication whereas qualified success was attained with the same IOP target regardless of the medication. A total of 40 eyes of 38 patients were enrolled. After 12 months 85.7% of the eyes achieved complete success with an average IOP of 10.5 ± 2.0 mm Hg, without the use of glaucoma eye drops. The average IOP reduction was 58.4% from baseline. In 5 cases (12.5%) failure occurred as revisional surgery was required. The Preserflo MicroShunt for refractory glaucoma cases achieved a high complete success rate without additional medication at 1 year. Revisional surgery was needed in some cases and long-term studies are needed.

Effectiveness and cost-effectiveness of MicroShunt implantation versus standard trabeculectomy for open-angle glaucoma (a SIGHT study): study protocol of a multicentre randomised controlled trial

BackgroundTrabeculectomy is the “gold standard” initial surgical procedure for open-angle glaucoma worldwide. During the last decade, the introduction of less invasive procedures, including new bleb-forming surgery such as the MicroShunt, has altered the approach of glaucoma management. At present, there is insufficient evidence comparing the effectiveness between these procedures nor versus trabeculectomy. Furthermore, there is no data available on patient impact and cost-effectiveness. This study aims to address this gap in evidence and establish whether MicroShunt implantation is non-inferior compared to trabeculectomy with regard to effectiveness and whether it is cost-effective.MethodsA multicentre, non-inferiority, randomised controlled trial (RCT) studying open-angle glaucoma with an indication for surgery will be conducted. Patients with previous ocular surgery except for phacoemulsification are excluded, as are patients with ocular comorbidity compromising the visual field or requiring a combined procedure. After informed consent is obtained, patients will be randomly allocated to the intervention, a PRESERFLO™ MicroShunt implantation, or the control group, trabeculectomy, using block randomisation (blocks of 2, 4 or 6 patients). In total, 124 patients will be randomised in a 1:1 ratio, stratified by centre. The primary endpoint will be intraocular pressure (IOP) one year after surgery. Secondary outcomes include IOP-lowering medication use, treatment failure, visual acuity, visual field progression, additional interventions, adverse events, patient-reported outcome measures (PROMs), and cost-effectiveness. Study outcomes will be measured up to 12 months postoperatively.DiscussionThis study protocol describes the design of a multicentre non-inferiority randomised controlled trial. To this date, cost-effectiveness studies evaluating the MicroShunt have not been undertaken. This multicentre RCT will provide more insight into whether MicroShunt implantation is non-inferior compared to standard trabeculectomy regarding postoperative IOP and whether MicroShunt implantation is cost-effective.Trial registrationClinicalTrials.gov, Identifier: NCT03931564, Registered 30 April 2019.

Success rate in micropulse diode laser treatment with regard to lens status, refractive errors, and glaucoma subtypes.

To evaluate the efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) considering different characteristics: glaucoma subtypes and lens status. A retrospective case-series study was designed to evaluate intraocular pressure (IOP), and the number of IOP-lowering medications, used by glaucoma patients treated with MP-TSCPC between 2016 and 2019. Cases had a follow-up period of 12months. Achieving an IOP reduction higher than 20%, or the decrease of at least one IOP-lowering medication, was considered a successful outcome. The same population was analyzed by classifying them in two groups as: glaucoma subtypes and lens status. The baseline spherical equivalent (SE) was also calculated for considering association with the achieved IOP. A total of 86 eyes were included. In most cases, IOP and IOP-lowering medications were decreased with a statistically significant difference (p < 0.0001), and all of them had a successful outcome. The percentage of IOP drop oscillated between 25.9% (open-angle glaucoma sub-group) and 37.5% (pseudoexfoliative glaucoma sub-group), 12months after surgery. The difference between the groups was not statistically significant (p 0.20 and 0.32 for glaucoma subtypes and lens status, respectively). The Pearson's coefficient obtained was low for the SE and IOP association, at the 12 -month postoperative mark (- 0.009; p < 0.001). The MP-TSCPC treatment was successful in decreasing IOP and IOP-lowering medications, in different glaucoma subtypes. Differences between groups (glaucomasubtypes, phakic and pseudophakic eyes) were not statistically significant. No association was found between the SE and the IOP achieved value after MS-TSCPC treatment.

Safety and Efficacy of Rapid Primary Phacoemulsification on Acute Primary Angle Closure with and without Preoperative IOP-Lowering Medication.

This study aimed to investigate the safety and efficacy of rapid primary phacoemulsification in patients with acute primary angle closure (APAC) (n = 41), with or without preoperative IOP-lowering medication. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of corneal endothelial cells (CECs), and number of IOP-lowering medications at the preoperative examination (Pre), postoperative day 1 (1d), week 1 (1w), and month 1 (1m) were used as indicators and compared. BCVA significantly improved at 1d, 1w, and 1m compared with Pre (p &lt; 0.05) and significantly improved at 1m compared to 1d (p &lt; 0.05) for all eyes. IOP significantly decreased at 1d, 1w, and 1m compared with Pre (p &lt; 0.05). CECs were not significantly different between Pre and 1m; the number of IOP-lowering medications decreased significantly from Pre to 1m (p &lt; 0.05). BCVA and IOP were not significantly different between the two groups for all periods. CECs were not significantly different between the two groups at Pre and 1m. Rapid primary phacoemulsification improved visual acuity due to improvement of corneal edema without central visual field defects and good IOP control without reoperation or IOP-lowering medication and maintained the number of corneal endothelial cells with or without preoperative IOP-lowering medication in patients with APAC.

Biotissue stent for supraciliary outflow in open-angle glaucoma patients: surgical procedure and first clinical results of an aqueous drainage biostent

Background/aimsTo report a first-in-human trial in open-angle glaucoma (OAG) subjects treated with a new microinterventional biostent-reinforced cyclodialysis technique to enhance supraciliary aqueous drainage.MethodsSubjects (N=10; 74.1±7.9 years old) with OAG and...

Efficacy and Safety of Cataract Surgery-Assisted Selective Laser Trabeculoplasty: A Pilot Study.

To evaluate the intraocular pressure (IOP)-lowering effect and safety of selective laser trabeculoplasty (SLT) with same-day cataract surgery which we named cataract surgery-assisted selective laser trabeculoplasty (CAST) compared to conventional SLT and cataract surgery as standalone procedures. Patients with primary open-angle glaucoma and cataract were included in this prospective interventional study. All patients received either a CAST procedure, standard SLT, or standard cataract surgery. IOP was assessed at baseline and at months 1, 2, 3, and 6. Topical IOP-lowering medication was canceled during the follow-up if necessary. Twenty-nine, twenty-seven, and thirty eyes received the CAST procedure, SLT, and standard cataract surgery, respectively. There was no statistically significant difference in age, male-to-female ratio, or baseline IOP between groups (P > 0.05). The mean IOP reduction at 6 months after the CAST procedure, SLT, and standard cataract surgery was -7.3 ± 3.8 mmHg, -3.8 ± 3.7 mmHg, and -0.7 ± 3.7 mmHg, respectively (P < 0.001). Eleven out of 29 (37.9%) and 5 out of 27 (18.5%) eyes achieved 30% reduction of IOP after the CAST procedure and SLT, respectively. No eyes achieved 30% reduction of IOP at the end of the follow-up in cataract surgery group. The median number of IOP-lowering medications cancelled after the CAST procedure was 1.0 (range, 0-3). No antiglaucoma medication was cancelled after SLT or cataract surgery. No adverse events were registered in patients who received the CAST procedure. At 6-month follow-up, the CAST procedure had a significantly greater IOP-lowering effect and reduction of topical antiglaucoma medication than SLT or cataract surgery alone.

Corticosteroids and glaucoma

Corticosteroid use is a major risk factor in the development of glaucoma and its aggravation. This is due to the augmentation of the intraocular pressure (IOP) induced by the corticoids. This augmentation is different between individuals: we called it steroid responsiveness, for which multiple risk factors have been identified, the most important being personal or family history of primary open angle glaucoma. The secondary augmentation of IOP depends also on the type of preparation, the mode of administration, the dosage and the duration of the therapy. Prevention and management are essentials to avoid this adverse effect. Among the most important measures, there are the education of the patient and the practitioner, IOP follow-ups after the use of corticoids and IOP-lowering medications.

The Effect of Combined Phacoemulsification and Endo-Cyclophotocoagulation on Intraocular Pressure Fluctuation Assessed by the Water Drinking Test in Patients with Primary Open Angle Glaucoma

Introduction: The aim of this study was to assess the effect of phacoemulsification and endo-cyclophotocoagulation (phaco-ECP) on intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in primary open angle glaucoma (POAG). Methods: This was a prospective observational study carried out at a tertiary referral centre. POAG patients on topical antiglaucoma medications and planned for phaco-ECP were recruited. WDT was performed before surgery and 6 weeks postoperatively by drinking 10 mL/kg of water in 5 min followed by serial IOP by Goldmann applanation tonometry measurements at 15, 30, 45, and 60 min. Mean IOP, IOP fluctuation (difference between highest and lowest IOP), IOP reduction, and factors affecting IOP fluctuation were analysed. Results: Twenty eyes from 17 patients were included. Baseline IOP was similar before (14.7 ± 2.7 mm Hg) and after (14.8 ± 3.4 mm Hg, p = 0.90) surgery. There was no difference in mean IOP (17.6 ± 3.4 mm Hg vs. 19.3 ± 4.7 mm Hg pre- and postoperative, respectively, p = 0.26) or peak IOP (19.37 ± 3.74 mm Hg vs. 21.23 ± 5.29 mm Hg, p = 0.25), albeit a significant reduction in IOP-lowering medications (2.2 ± 1.15 vs. 0.35 ± 0.93, p < 0.001) postoperatively. IOP fluctuation was significantly greater (6.4 ± 3.2 mm Hg vs. 4.6 ± 2.1 mm Hg, p = 0.015) with more eyes having significant IOP fluctuation of ≥6 mm Hg (11 eyes [55%] vs. 4 eyes [20%], p < 0.001) postoperatively. Factors that were significantly associated with increased postoperative IOP fluctuations were higher preoperative IOP fluctuation (β = 0.69, 95% CI 0.379–1.582, p = 0.004) and more number of postoperative antiglaucoma medications (β = 0.627, 95% CI 0.614–3.322, p = 0.008). Conclusion: Reducing aqueous production with phaco-ECP does not eliminate IOP fluctuation in POAG patients. The increase in postoperative IOP fluctuation suggests increased outflow resistance after phaco-ECP.

Clinical Differences between Posner-Schlossman Syndrome Patients with Intermittent Intraocular Pressure Elevation and Glaucomatous Damage

Introduction: Although there is abundant evidence that Posner-Schlossman syndrome (PSS) can lead to secondary glaucoma, data on the clinical differences between PSS patients with secondary glaucoma and those with intermittent intraocular pressure (IOP) elevation are sparse. Methods: This retrospective observational study included 52 patients (52 eyes) diagnosed with PSS and admitted to Zhongnan Hospital of Wuhan University between January 2019 and February 2022. Demographic characteristics and clinical features were gathered from admission records. Patients were divided into two groups: 27 cases with intermittent IOP elevation (group A) and 25 cases with secondary glaucoma (group B and C). Of the secondary glaucoma cases, 18 were further divided into the topical IOP-lowering medications group (group B) and 7 into the glaucoma surgery group (group C). Clinical characteristics of different groups were compared. Results: Compared to the intermittent IOP elevation group, PSS patients with secondary glaucoma had a longer course of disease, a higher incidence of iris depigmentation, lower best corrected visual acuity, lower endothelial cell density, and higher interferon-γ (IFN-γ) concentration and cytomegalovirus (CMV) deoxyribonucleic acid (DNA) copy number in the aqueous humor (all p < 0.05). Group C presented a higher CMV DNA copy number in the aqueous humor than groups A and B (p < 0.05). Compound trabeculectomy proved effective in group C, with a functional filter bleb and well-controlled IOP without disease progression after 1 year of follow-up. Conclusion: Distinctive characteristics existed between PSS patients with secondary glaucoma and those with intermittent IOP elevation. Compound trabeculectomy appears to be an effective treatment option when IOP cannot be controlled through topical medications.

Влияние пола пациентов на изменения глазной поверхности после синустрабекулэктомии

Background: the effect of gender on the rate and course of ocular surface diseases (in particular, conjunctival and corneal xerosis) is fairly well known. Meanwhile, gender-dependent changes in the ocular surface after trabeculectomy have not yet been studied. Aim: to analyze the effect of gender on changes in the ocular surface after trabeculectomy. Patients and Methods: this study enrolled 443 patients (168 men and 275 women) who underwent surgical interventions for uncontrolled primary open-angle glaucoma (POAG) in 2016–2020 and were followed up for 6–24 months. Trabeculectomy was performed as the first IOP- lowering procedure in 418 patients (150 men and 268 women) and reoperation in 25 patients (18 men and 7 women). Changes in subjective symptoms (OSDI) and clinical and functional signs of dry eye syndrome (tear film break-up time/TBUT and total tear production by Schirmer's I test) characterizing the ocular surface in various surgical outcomes (complete and partial success, failure) in men and women were analyzed. Results: women have more severe subjective symptoms but not functional signs of dry eye preoperatively. They are characterized by strict adherence to treatment (manifested in lower initial IOP compared with men) but more frequent eye drop instillations and greater cumulative preservative load on the ocular surface. Gender is not an independent risk factor for surgical failure. Successful trabeculectomy results in a significant reduction in the severity of conjunctival and corneal xerosis symptoms (OSDI) for at least 2 years in both genders. Despite clear postoperative improvement, women are significantly inferior to men in this parameter at all study control points. TBUT in both men and women increases significantly during the first 6 months postoperatively, and over the next 1.5 years TBUT stabilizes at the achieved level. An increase in Schirmer's I test results in men becomes significant only at the end of the second year of follow-up. In women, a significant increase in total tear production is reported as early as 6 months after trabeculectomy and changes slightly over the next 1.5 years. Restarting IOP-lowering medications in partial success and failure of trabeculectomy eliminates the improvement of ocular surface condition achieved during the drug-free period as early as after 6 months. Conclusions: regardless of gender, successful trabeculectomy results in a significant and long-term (at least 2 years) improvement of subjective symptoms (OSDI) and functional signs (in particular, TBUT) of conjunctival and corneal xerosis. Women are characterized by a clearer improvement in the parameters studied than men. Significant gender differences are found only when comparing subjective symptoms in the first year after surgery. Restarting IOP-lowering medications postoperatively brings the parameters back to baseline levels. KEYWORDS: gender, glaucoma, trabeculectomy, ocular surface, dry eye disease, OSDI, tear film break-up time, TBUT, Norn's test, Schirmer's I test. FOR CITATION: Antonova A.V., Nikolaenko V.P., Brzheskiy V.V., Vuks A.Ja. Effect of gender on the ocular surface after trabeculectomy. Russian Journal of Clinical Ophthalmology. 2023;23(3):136–145 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-5.

Отдельные результаты пострегистрационного наблюдательного исследования по оценке клинической эффективности и переносимости терапии препаратами Бимикомби Антиглау ЭКО и Брим Антиглау ЭКО у пациентов с разными стадиями первичной открытоугольной глаукомы в реальной клинической практике (Brim Bimicombi Antiglau real World Ophthalmology, BRAWO)

Aim: to assess the clinical efficacy and tolerability of bimatoprost/timolol (Bimicombi Antiglau ECO) and brimonidine (Brim Antiglau ECO) in different stages of primary open-angle glaucoma (POAG) compared with prior therapy. Patients and Methods: data from 1036 patients were included in the final protocol of the multicenter combined scientific and clinical study. All patients were diagnosed with POAG or were glaucoma suspects (GS) with ocular hypertension (OHT). All patients underwent a complex eye examination. Treatment with the drugs studied should have lasted 2 to 4 months. Treatment choice resulted from the lack of efficacy, ineffectiveness, or intolerance of prior therapies. The control study was conducted once not less than a month after inclusion in the study. Results: POAG (any stage) was diagnosed in 982 patients (94.8%), and GS with OHT were 54 patients (5.2%). Changing treatment regimen (in a planned manner) prevented tachyphylaxis and tolerance to previously prescribed drugs, which was established by IOP measurements (a 20% reduction in IOP compared with prior data). If the regimen was changed for any reason (overall, 6 reasons were analyzed), three most common reasons were poor clinical efficacy (36.6%), discomfort (26.6%), and poor tolerability (23.9%). Prescription of preservative-free IOP-lowering medications (eye drops studied) for 1 month after the washout period significantly (by 19 times) reduced the number of these complaints. Preservative-free medications significantly increase the maximum satisfaction with prescribed treatment regimens (Likert score 4.61 of 5) and largely meet the expectations of doctors in terms of drug efficacy and tolerability (Likert score 4.67 of 5). Conclusion: preservative-free IOP-lowering medications (eye drops studied) are effective and well tolerated. KEYWORDS: glaucoma therapy, efficacy, tolerability, bimatoprost/timolol, brimonidine, primary open-angle glaucoma, real-world clinical practice, BRAWO. FOR CITATION: Kuroyedov A.V., Kosakovskaya M.V., Gapon'ko O.V., Gorodnichiy V.V., Lovpache D.N., Bulakh I.A. Selected results of a post- registration observational study on the clinical efficacy and tolerability of Bimicombi Antiglau ECO and Brim Antiglau ECO in different stages of primary open-angle glaucoma in real-world clinical practice (Brim Bimicombi Antiglau Real World Ophthalmology, BRAWO). Russian Journal of Clinical Ophthalmology. 2023;23(3):129–135 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-4.

Deep sclerectomy-trabeculectomy with mitomycin C in treating glaucoma: postoperative long-term results.

To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy (DST) with mitomycin C (MMC) in the treatment of glaucoma. Patients who underwent DST with MMC between 2010 and 2017 were included in this retrospective observational study. Complete success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg or 30% reduction of IOP from baseline without any topical IOP-lowering agent, and qualified success defined as IOP≤21 mm Hg or 30% reduction of IOP from baseline with/without single topical agent. We evaluated the surgical success rates and complication rates of this procedure, as well as described the IOP profiles, best corrected visual acuity (BCVA) profiles and mean deviations (MD) of Humphrey visual field (HVF) 24-2 performance at each follow-up time point. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, use of topical IOP-lowering agents, baseline and postoperative IOP and optical profiles (e.g., BCVA and MD). Totally 98 eyes (mean postoperative follow-up 67.5mo) showed mean IOP reduction at every follow-up interval. Both median BCVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline. The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7 (P=0.068). Totally 84 (85.7%) eyes achieved complete success at final follow-up. Transient hyphaema and transient choroidal effusion developed in 15 eyes (15.3%) and 11 eyes (11.2%) respectively. Other complications included shallow anterior chamber in 5 eyes (5.1%), bleb leak in 4 eyes (4.1%), bleb revision in 7 eyes (7.1%), bleb needling in 9 eyes (9.2%) and repeat trabeculectomy in 1 eye (1.0%). There was no endophthalmitis, blebitis or macular oedema. There was no significant correlation between postoperative IOP control and postoperative BCVA. DST with MMC demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.

Clinical efficacy and safety of intravitreal fluocinolone acetonide implant for the treatment of chronic diabetic macular oedema: five-year real-world results.

To report 5-year real-world efficacy and safety data following the treatment of chronic diabetic macular oedema (DMO) with the intravitreal 0.19 mg fluocinolone acetonide implant(ILUVIEN). Retrospective cohort study of 31 eyes treated with ILUVIEN for chronic DMO at a tertiary centre in Birmingham (UK). Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded at baseline, and then at 1-,2-,3-, and 5-years. Safety was assessed based on intraocular pressure (IOP) -lowering medication, surgery, and other complications. BCVA significantly improved 1-year post-ILUVIEN (+4.2 letters, p < 0.05) and gradually reverted to baseline levels over the 5-year period of follow-up (+0.2 letters at year-5). A significant and sustained CRT reduction was observed throughout the 5-years. The proportion of eyes on IOP-lowering medication increased from 16% at baseline, to 70% at 5-years (p < 0.001) with eyes on a mean of 1.3 medications. Laser trabeculoplasty (n = 2), cyclodiode laser (n = 1), and trabeculoplasty and trabeculotomy (n = 1, in the same eye; 3.2%) were required for uncontrolled IOP. Other complications included endophthalmitis (n = 1) and vitreous haemorrhage (n = 1). 58% of eyes required additional intravitreal injections, with a mean 29.2 months to first injection. We observed a 69% reduction in treatment burden following treatment with ILUVIEN implant. Our real-world results confirm the efficacy of the ILUVIEN implant over 5 years, with two-thirds of eyes having improved or stable visual acuity 5 years after ILUVIEN, and an overall sustained improvement in anatomical outcome. Although the rate of IOP-lowering medications use was higher than previously reported, the rate of incisional IOP-lowering surgery and other complications remained low and in keeping with rates reported in larger studies.

Efficacy of the PRESERFLO MicroShunt and a Meta-Analysis of the Literature.

Background: Recent studies on the PRESERFLO MicroShunt suggest that it may be effective in lowering intraocular pressure (IOP); however, the number of studies on this device remains limited. Therefore, we assessed the efficacy of the PRESERFLO MicroShunt in patients with glaucoma and performed a meta-analysis of published results. Methods: Prospective study including all patients that underwent PRESERFLO MicroShunt surgery from 2018 onwards. Sub-analyses were performed for cataract-combined procedures. To compare our results, we performed a systematic review and meta-analysis. IOP, IOP-lowering medication and surgical complications reported in the retrieved studies were assessed. Results: A total of 72 eyes underwent PRESERFLO-implant surgery (59 as standalone procedure and 13 as cataract-combined procedure). No significant differences were found in IOP and IOP-lowering medication between both groups. The mean ± standard deviation IOP and IOP-lowering medications of both groups taken together declined from 21.72 ± 8.35 to 15.92 ± 8.54 mmHg (p < 0.001, 26.7% reduction) and 3.40 to 0.93 (p < 0.001, 72.6% reduction) at 1 year follow-up, respectively. Secondary surgeries were required in 19.4% of eyes, the majority (71.4%) within 6 months. The meta-analysis including 14 studies (totaling 1213 PRESERFLO MicroShunt surgeries) from the systematic review showed a mean preoperative IOP and IOP-lowering medication of 22.28 ± 5.38 and 2.97 ± 1.07, respectively. The three-years postoperative pooled mean was (weighted mean difference, 95% CI) 11.07 (10.27 [8.23−12.32], p < 0.001) mmHg and 0.91 (1.77 [1.26−2.28], p < 0.001) for IOP and IOP-lowering medication, respectively. The most common reported complication was hypotony (2−39%). Conclusion: The PRESERFLO MicroShunt is effective and safe in lowering IOP and the number of IOP-lowering medications.

Pharmacogenetics and pharmacogenomics in glaucoma therapeutics: the way to personalized therapy.

Pharmacogenetics and pharmacogenomics in glaucoma therapeutics: the way to personalized therapy.

Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy.

Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2μg/day; ILUVIEN®) in the treatment of refractory PCME after successful PPV. This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitário de São João, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300μm or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6μm, and IOP was 15.4 ± 2.4mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2μm in CMT. During follow-up (44.0 ± 14.8months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28months, respectively. The maximum IOP registered was 17.0 ± 6.0mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.