Intraocular Pressure Reduction Research Articles

Early safety and efficacy outcomes of the PAUL glaucoma implant in a Spanish population: A retrospective study

Abstract PURPOSE: The purpose of the study was to evaluate the efficacy and safety of the PAUL glaucoma implant (PGI) in refractory glaucoma patients, during the early postoperative period. METHODS: We conducted a retrospective, cohort study of patients that had received a PGI between February 2022 and December 2023. An intraluminal polypropylene suture was placed to prevent early hypotony in all cases. Demographics, intraocular pressure (IOP), and medication variation were evaluated for up to 6 months. The success rate was stratified into <18 mmHg and 30% from baseline or <15 mmHg and 40% IOP reduction. The safety outcomes were also analyzed. RESULTS: Sixteen eyes from 16 patients were included in the analysis. Fifteen of them had had a previous surgical glaucoma procedure. At 6 months, IOP decreased from 26.6 (±6.2) to 15.3 (±4.6) mmHg, with fewer glaucoma medications, from a median (interquartile range) of 3 (2–3) – 1.5 (0–2) (P < 0.005). Twelve (75%) and seven (43.8%) eyes met the qualified and complete success definition for the first category, and eight (50%) and four (25%) met the second criterion. One case with self-limiting choroidal detachments, but >6 mmHg IOP was found in our cohort. CONCLUSION: The PGI seems to be safe and effective from the early postoperative period. The IOP reduction rate could make it suitable for patients with refractory moderate-to-advanced glaucoma.

Current trends and advancements in utilizing endoscopic cyclophotocoagulation for the Treatment of Glaucoma.

Glaucoma ranks as the second most prevalent cause of global blindness. Presently, the reduction of intraocular pressure (IOP) stands as the sole efficacious method for addressing this condition. Endoscopic cyclophotocoagulation (ECP) is designed to mitigate aqueous humor production by inducing coagulation or closure of the ciliary body. Since its inception in 1990s, ECP has emerged as a pivotal modality in the therapeutic armamentarium for glaucoma. This review primarily elucidates the instrumentation employed in ECP for the treatment of glaucoma, the mechanisms underlying its efficacy in glaucoma management, and a comparative analysis of ECP in relation to other modalities for anti-glaucoma treatment. Furthermore, it examines the contemporary clinical utilization of ECP in glaucoma therapy, as well as the prevalent postoperative complications and their preventive measures. We anticipate that the role of ECP in the treatment of glaucoma will persistently evolve alongside advancements in the field. Particularly noteworthy is its expanding applicability in glaucoma therapy and its increasingly vital role in personalized comprehensive treatment approaches.

Intraocular Pressure Reduction Following Phacoemulsification in Patients with Exfoliation: A Systematic Review and Meta-Analysis

Objectives: The objective of this systematic review and meta-analysis is to evaluate the existing evidence and estimate the impact of phacoemulsification and intraocular lens implantation on the intraocular pressure (IOP) of subjects with exfoliation syndrome (XFS) or exfoliative glaucoma (XFG). Methods: In July 2024, an in-depth literature review across three databases was undertaken. This study focused only on adult patients with exfoliation who had not undergone previous ocular surgery. The primary outcome of interest was the mean IOP reduction at 6 and 12 months after uncomplicated phacoemulsification surgery. Results: This meta-analysis included one randomized controlled trial and eight observational studies, comprising 220 patients at 6 months and 430 patients at the 12-month time point, respectively. The mean IOP reduction after surgery was 3.43 mmHg (95% CI: −4.77 to −2.09) after 6 months and 2.75 mmHg (95% CI: −4.24 to −1.26) after 12 months. In both time points, there was no heterogeneity (I2 = 0), but the certainty of evidence following the GRADE evaluation was very low. Conclusions: The present meta-analysis demonstrates that phacoemulsification can significantly reduce IOP in exfoliation subjects 6 and 12 months after surgery. Nevertheless, significant limitations in included studies do not allow a precise and certain estimate of the magnitude of postoperative IOP lowering in exfoliation patients. Additional research is needed to confirm these results.

Intraocular Pressure Changes After Combined Orbital Decompression and Glucocorticoid Treatment for Graves Orbitopathy.

To evaluate the change in the intraocular pressure (IOP) in subjects with Graves orbitopathy (GO) after orbital decompression (OD) with glucocorticoids (GCs). Ninety-nine orbits of 76 patients with GO were retrospectively reviewed, with either OD (Group A), OD with intravenous glucocorticoids (i.v.GC) (Group B) or parabulbar GC (Group C) administration. The main outcome measures included pre-and post-operative IOP in the primary and upward gazes. Mean postoperative IOPs in the primary gaze were lower than the preoperative values for groups A and C (P < 0.05). The IOPs during the upward gaze were higher than those in the primary gaze before and after OD (all groups, P < 0.05). The mean postoperative and preoperative IOPs during upward gaze were similar in all groups except group C (P = 0.001). The mean decrease in IOP in the primary gaze was 1.57 ± 6.00mm Hg and 2.22 ± 2.62mm Hg in groups A and C, respectively (P < 0.05). Only in group C, the mean IOPs during upward gaze decrease by 5.29 ± 4.89mm Hg (active GO before OD), and the mean gaze-related IOP decreased from 7.75 ± 6.02 to 2.57 ± 4.21mm Hg (P < 0.05). A pbGC treatment before OD can effectively reduce the primary and upward gaze IOPs and lead to a greater postoperative reduction in the upward gaze IOP to approximate that in the primary gaze. A pbGC treatment may be preferred for patients with GO in the active or congestive phase before OD considering the IOP.

Cataract surgery combined with glaucoma surgery.

This review evaluates the surgical management of glaucoma in patients undergoing cataract surgery. Combining both procedures present challenges in balancing intraocular pressure (IOP) control, minimizing postoperative complications, and achieving optimal refractive outcomes. Recent studies highlight the effectiveness of combined glaucoma and cataract surgeries, with traditional filtering surgeries and MIGS showing significant IOP reduction. The abundance of long-term studies shows that MIGS can offer an effective and safer alternative when carefully tailored to meet the specific needs of each patient. Combining glaucoma and cataract surgery is a promising approach for patients with coexisting conditions. While traditional surgeries offer robust IOP reduction, MIGS procedures offer better safety profiles with fewer complications and more predictable refractive results. Surgeons must carefully consider the timing and choice of procedures, with further research required to develop standardized treatment algorithms.

Kinin B1- and B2-Receptor Subtypes Contract Isolated Bovine Ciliary Muscle: Their Role in Ocular Lens Function and Intraocular Pressure Reduction

Background: Bradykinin is an endogenously produced nonapeptide with many physiological and pathological functions that are mediated by two pharmacologically defined receptor subtypes, B1- and B2-receptors. Current studies sought to characterize the functional bradykinin (BK) receptors present in freshly isolated bovine ciliary muscle (BCM) using an organ-bath tissue contraction system. Methods: Cumulative longitudinal isometric tension responses of BCM strips (4–5 mm) were recorded before and after the addition of test compounds to BCM strips hooked up to an isometric strain gauge transducer system. Results: BK and its analogs (7–11 concentrations) contracted BCM in a biphasic concentration-dependent manner. The first high affinity/potency phase accounted for 40–60% of the maximal contraction by each of BK (potency, EC50 = 0.9 ± 0.3 nM), Lys-BK (EC50 = 0.7 ± 0.1 nM), Met-Lys-BK (EC50 = 1 ± 0.1 nM), Hyp3-BK (EC50 = 1 ± 0.2 nM), RMP-7 (EC50 = 3.5 ± 0.5 nM), and Des-Arg9-BK (EC50 = 10 ± 0.4nM) (mean ± SEM, n = 3–8). The second lower activity phase of contraction potency values for these peptides ranged between 100 nM and 3 µM. In the presence of a selective B1-receptor antagonist (R715; 0.1–10 µM), the concentration–response curves to Des-Arg9-BK (B1-receptor agonist) were still observed, indicating activation of B2-receptors by this kinin. Likewise, when B2-receptors were completely blocked by using a B2-selective antagonist (WIN-64338; 1–10 µM), BK still induced BCM contraction, now by stimulating B1-receptors. Conclusions: This agonist/antagonist profile of BCM receptors indicated the presence of both B1- and B2-receptor subtypes, both being responsible for contracting this smooth muscle. The BCM kinin receptors may be involved in changing the shape of the ocular lens to influence accommodation, and since the ciliary muscle is attached to the trabecular meshwork through which aqueous humor drains, endogenously released kinins may regulate intraocular pressure.

Self-assembled latanoprost loaded soluplus nanomicelles as an ophthalmic drug delivery system for the management of glaucoma

Glaucoma, a leading cause of blindness due to elevated intraocular pressure (IOP), is managed with medications like latanoprost (LAT), a prostaglandin analogue, to enhance aqueous outflow. Despite the challenge posed by eye anatomy and tear dynamics, effective ocular bioavailability via topical administration remains elusive. This study aims to optimize self-assembled nanomicelles incorporating LAT, an anti-glaucoma drug, belonging to BCS Class II (low solubility and high permeability) via a two-level, two-factor full factorial design, the nanomicelles were formulated via direct dissolution method and validated using design of expert. The optimized nanomicelles exhibited a spherical morphology, with a size of 69 nm and encapsulation efficiency of 77.5%, demonstrating a sustained LAT release over 12 h. In normotensive rabbits, the nanomicelles elicited a substantial reduction in intraocular pressure (IOP) by up to 40% for a duration of three days, that was significantly longer than the IOP-lowering efficacy of XALATAN eye drops (24 h). These findings indicated that self-assembled nanomicelles hold promise for enhancing the ocular bioavailability and extending the therapeutic duration of LAT, while providing the physical stability.

Initial results of the Paul Ahmed Comparison (PAC) study in refractory childhood glaucoma

PurposeTo compare the effectiveness and safety of the Paul Glaucoma Implant (PGI) to the Ahmed Glaucoma Valve (AGV) in managing refractory childhood glaucoma. DesignRandomized controlled trial. SettingTwo clinical centers. MethodsAn ongoing randomized controlled trial including patients ≤18 years with refractory childhood glaucoma in whom glaucoma drainage implant surgery was planned. Patients were randomized to receive either PGI or AGV. The primary outcome was the intraocular pressure (IOP) reduction. Secondary outcomes included glaucoma medication reduction, success rate, and complications rate. The success rate was defined as achieving a postoperative IOP between 6-21 mmHg without or with glaucoma medications (up to three topical glaucoma medications), without the need for additional glaucoma surgeries, and without the occurrence of vision-threatening complications or evidence of disease progression. The use of oral glaucoma medications, such as acetazolamide, was considered a failure. ResultsThe current report included 44 patients (44 eyes) who completed the one-year postoperative follow-up (25 in the PGI group versus 19 in the AGV group). The mean age at the time of surgery was 96.9±59.1 months (90.5±60.04 months in the PGI group and 105.4±58.5 months in the AGV group. Preoperatively, the mean IOP was 32.6±6.1 mmHg with a mean of 3.6±0.6 glaucoma medications in the PGI group, compared with 29.8±6.1 mmHg (p=0.1) with a mean of 3.4±0.7 glaucoma medications (p=0.35) in the AGV group. At one year, there were no statistically significant differences in the mean IOP (14.9±4.1 mmHg in the PGI group versus 15.5±3.5 in the AGV group, p=0.6) and number of glaucoma medications (1.1±1 in the PGI group versus 1.6±1.03 in the AGV group, p=0.1). The success rate of PGI was 80% vs. 73.6% in the AGV (p=0.2). The postoperative complications rate was comparable in both groups (three eyes in each group). Conclusion/RelevanceAt one year postoperatively, the IOP reduction, reduction of glaucoma medications, success rates, and rate of complications were comparable between both groups.

Application of Negative Pressure by the Ocular Pressure Adjusting Pump to Provide a Sustained Reduction in IOP.

To evaluate the sustainability of IOP reduction with continuous negative pressure application over an extended duration with use of the Ocular Pressure Adjusting Pump. Prospective, controlled, open-label, randomized, single site, pilot study. Subjects with primary open-angle glaucoma (OAG) were enrolled. One eye of each subject was randomized to receive negative pressure application; the fellow eye served as a control. The study eye negative pressure setting was programmed for 60% of the baseline IOP. Subjects wore the Ocular Pressure Adjusting Pump for 8 consecutive hours and IOP measurements occurred at 2-hour intervals for a total of 5 IOP measurements (08:00, 10:00, 12:00, 14:00, 16:00). Nine subjects successfully enrolled and completed the study. The mean programmed negative pressure setting was -12.0mmHg. At baseline, the mean IOP in the study eye was 21.4 ± 4.3mmHg. The mean IOP reduction in the study eye at hours 0, 2, 4, 6, and 8 was 8.1 (37%), 6.4 (28%), 6.3 (29%), 7.3 (34%) and 6.7 (31%), respectively. All IOP measurements during negative pressure application were reduced from baseline. There were no serious adverse events. The Ocular Pressure Adjusting Pump provides a sustained reduction in IOP while the device is worn with negative pressure applied with an IOP reduction exceeding 25% across 8hours of continuous wear.

The effects of topical latanoprost 0.005% treatment on microvascular changes in the optic nerve head and macula.

This prospective study aimed to assess the impact of topical latanoprost 0.005% treatment on the microvasculature of the macula and optic nerve head (ONH) in primary open-angle glaucoma (POAG). Fifty-seven eyes of 31 subjects were enrolled. ONH whole-image (wiVD), peripapillary (ppVD), and macular vascular density (VD) parameters were measured using optical coherence tomography angiography before treatment, at the 1st month, and at the 3rd month of treatment. There was a significant reduction in IOP post treatment, with a decrease of 17.0 ± 2.3 mmHg in the 1st month and 16.3 ± 2.5 mmHg in the 3rd month (P < 0.001 for both). ONH wiVD and ppVD significantly increased at the post-treatment 1st month (P = 0.001 for both) but decreased by the 3rd month, returning to baseline levels (P < 0.001 for both), indicating a return to pre-treatment levels (P > 0.05 for both). Similarly, macular wiVD and perifoveolar VD (pefVD) increased significantly at the 1st month (P = 0.013 and P < 0.001, respectively) but returned to baseline by the 3rd month (P < 0.001 for both). No significant difference was observed between before-treatment and post-treatment 3rd month regarding the macular wiVD and pefVD (P > 0.05 for both). Deep capillary plexus and foveal avascular zone parameters did not change during follow-up (P > 0.05 for both). The initial increase in ONH and peripapillary VD, as well as macular VD, is attributed to the acute reduction in IOP from topical latanoprost 0.005%. However, the diminishment of sustained differences by the 3rd month indicates adaptation of the ONH and retinal microvasculature to decreased IOP through compensatory mechanisms.

Outcomes of circumferential versus hemi-gonioscopy assisted transluminal trabeculotomy for congenital glaucoma

PurposeTo compare the efficacy of circumferential gonioscopy-assisted transluminal trabeculotomy (GATT) versus hemi-GATT in primary congenital glaucoma (PCG). DesignProspective randomized controlled trial MethodsThis study included children with PCG having corneal diameters <14mm and relatively clear cornea. Based on randomisation, the eyes included, underwent either circumferential GATT (360-GATT) or hemi-GATT (180-GATT). The intra-ocular pressure (IOP) reduction, requirement for glaucoma medications after surgery, need for repeat surgery and the incidence and type of complications in each group were analysed. Surgical success was defined as absolute when IOP ≤18 (criterion A) and ≤15mmHg (criterion B) was achieved without medications and qualified when the same was achieved with pressure-lowering medications. Eyes with an IOP ≥18mmHg on maximum medications, those with IOP <6 mmHg or need for further intervention for IOP control were considered failures. ResultsFifty-two eyes of children with PCG were randomized into either the 360-GATT group (22 eyes) or the 180-GATT group (30 eyes) and followed up for at least 1 year. The median follow-up duration was 22.5 months (range: 12-30 months). IOP fell by 49% and 20.5% with 360-GATT and 180-GATT respectively, final IOP being significantly lower in the former group (p=0.0003). For absolute success the cumulative survival was superior with 360-GATT for both criterion A and B at 1 year (p=0.009). Average cup disc ratio, corneal diameter and axial length reversal were significant in the 360-GATT group but not in the hemi-GATT group. ConclusionsThis study reinforces the superior efficacy of circumferential GATT for IOP control in eyes with congenital glaucoma.

The Benefit of Nocturnal IOP Reduction in Glaucoma, Including Normal Tension Glaucoma.

Nocturnal intraocular pressure (IOP) profiling has shown that the peak IOP usually occurs at night, particularly in patients with glaucoma. Multiple studies have demonstrated that these nocturnal IOP elevations drive glaucomatous progression, often despite stable daytime IOP. Existing vascular dysregulation and decreased nighttime blood pressure compound the damage via low ocular perfusion pressure while elevated nocturnal IOP disrupts axonal transport. These findings are consistent with studies that indicate lowering nocturnal IOP is important for slowing glaucoma progression. Many of the current treatment options lower nighttime IOP significantly less than daytime IOP. Non-invasive IOP-lowering treatments that effectively lower nocturnal IOP remain an unmet need in the treatment of glaucoma.

Effect of ophthalmic preparation of methyldopa on induced ocular hypertension in rabbits.

Glaucoma is a type of ocular disorder with multifaceted etiologies characterized by progressive optic nerve damage and ultimately loss of visual field. Thisstudy aimed to evaluate the possible intraocular pressure (IOP) lowering effect of an ophthalmic preparation of methyldopa (MD) in corticosteroid-induced ocular hypertension in rabbits. Forty New Zealand white male rabbits were assigned to the experiment and then randomly divided into five groups (n = 8). Ocular hypertension was induced by weekly subconjunctival injection of betamethasone suspension in both eyes. Animal groups included the control (healthy) group, which received the ophthalmic vehicle only; the standard (timolol) group, which received 0.5% timolol eye drops (ED); and the MD groups, which received 0.5%, 1%, and 2% of methyldopa ophthalmic preparation. Treatments were applied to the right eye twice daily for 7 days, whereas the left eye served as a control and was given only distilled water. IOP was recorded and ocular reflexes were observed. Weekly subconjunctival injections of betamethasone resulted in a significant elevation in the IOP (P ≤ 0.001) that was reduced after treatments with timolol 0.5% and MD at different concentrations. Timolol showed the highest reduction (P ≤ 0.001) in the mean IOP with a 30% reduction. MD showed a concentration-dependent reduction with the highest reduction (P ≤ 0.01) observed at 2% compared to the induced/distilled water (DW) eyes and no significant difference compared to the timolol 0.5% (P ≥ 0.05) with a 24.2% reduction in the mean IOP. Methyldopa managed to reduce the IOP in the chronic model of glaucoma, making MD a promising addition to the anti-glaucoma medications.

Factors influencing the outcomes of trabeculectomy, conventional canaloplasty, and mitomycin C augmented canaloplasty.

To compare the efficacy, safety, and factors influencing the outcomes of trabeculectomy (TE), conventional canaloplasty (cCP), and mitomycin C augmented canaloplasty (mCP) in glaucoma patients. Intraocular pressure (IOP), the number of IOP-lowering eye drops, and surgery-related complications were evaluated at baseline and through 18months postoperatively. Correlations between patients' demographic data, ophthalmic and non-ophthalmic conditions, outcomes and complications were evaluated. 171 patients were included. IOP and IOP-lowering eye drops were significantly (p < 0.001) reduced 18months after TE, cCP, and mCP. At the 18-month follow-up, IOP and IOP-lowering eye drops were significantly lower following TE than cCP (p < 0.001, p = 0.010, respectively) and mCP (p = 0.010, p = 0.014). At the 18-month follow-up, complete success rates were significantly higher after TE compared to cCP and mCP for IOP ≤ 21, 18, and 16mmHg (p < 0.001). Qualified success rates for IOP ≤ 16mmHg were higher following TE than cCP and mCP (p = 0.023). In the TE group, clinical hypotony at any postoperative follow-up was positively correlated with previous intravitreal anti-vascular endothelial growth factor (VEGF)-therapy (p < 0.001), leukaemia (p = 0.002), and a spherical equivalent < -3 dioptres (p < 0.001). There were no significant correlations in the cCP and mCP groups. TE, cCP, and mCP led to a significant reduction in IOP and IOP-lowering eye drops during 18months of follow-up. At 18months of follow-up, IOP and IOP-lowering eye drops were significantly lower following TE compared to cCP and mCP. Anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment in the TE group. What is known • Trabeculectomy (TE) is considered the gold standard in the surgical management of glaucoma. However, TE involves extensive postoperative management and might be associated with severe surgery-related complications. What is new • In this study, intraocular pressure (IOP) and IOP-lowering eye drops were significantly lower following TE compared to conventional canaloplasty (cCP) and mitomycin C augmented canaloplasty (mCP) at a follow-up of 18months. • In patients undergoing TE, anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment.

Effectiveness of laser therapy among patients with open-angle glaucoma: a systematic review and meta-analysis study.

This study aims to evaluate the efficacy of selective laser trabeculoplasty in improving the intraocular pressure in patients diagnosed with open-angle glaucoma. A comprehensive search was performed across electronic databases, including PubMed, Scopus, and Web of Science, until June 2024, using keywords related to "selective laser trabeculoplasty" and "open-angle glaucoma." Studies were chosen based on set eligibility criteria. Data extraction was carried out by two independent reviewers, and statistical analyses were performed using a random-effects model to calculate the pooled mean differences in IOP reduction and overall success rates. The initial search yielded 3111 articles, with 23 studies included in the systematic review and 22 in the meta-analysis. The pooled MD in IOP reduction between the SLT and control groups was -1.44 mm Hg (95% CI: -2.19 to -0.70, p < 0.01). Subgroup analyses revealed a MD of -0.76 mm Hg (95% CI: -1.31 to -0.21, p < 0.01) when comparing SLT to medication, and -0.42 mm Hg (95% CI: -0.64 to -0.19, p < 0.01) when comparing 180-degree SLT to 360-degree SLT. The pooled success rate favored SLT with an odds ratio (OR) of 0.71 (95% CI: 0.51 to 0.99, p = 0.05). There was significant heterogeneity among the studies (I² = 71%). SLT is effective in lowering IOP in OAG patients, demonstrating significant efficacy compared to medication and different SLT protocols. The findings underscore SLT's potential as a reliable treatment option. However, the observed heterogeneity underscores the necessity for standardized protocols in future research to improve comparability and verify SLT's long-term effectiveness.

Glutathione Modulates Hydrogen Sulfide Release and the Ocular Hypotensive Action of Diallyl Polysulfide Compounds.

Hydrogen sulfide (H2S) is an endogenous transmitter with the potential to regulate aqueous humor dynamics and protect retinal neurons from degeneration. The aim of the present study was two-fold: (a) to evaluate the release of H2S from two polysulfides, diallyl disulfide (DADS), and diallyl trisulfide (DATS); and (b) to investigate their ocular hypotensive actions in normotensive male and female rabbits in the presence and absence of GSH. H2S was quantified hourly for up to 6 h using a H2S-Biosensor (World Precision Instruments, Sarasota, Fl). Intraocular pressure (IOP) was assessed in normotensive New Zealand Albino rabbits using a pneumotonometer (model 30 classic; Reichert Ophthalmic Instruments, Depew, NY, USA). In the presence of GSH, there was an increase in the in vitro release of H2S produced by DADS and DATS. Both DADS and DATS also caused a dose-dependent reduction in IOP in male and female rabbits, in both treated and untreated eyes. For instance, in male animals, the presence of GSH (3% and 5%) significantly (p < 0.05, n = 5) enhanced the ocular hypotensive action of DADS (2%) and DATS (2%) from 14.02 ± 2.89% to 18.67 ± 5.6% and from 16.22 ± 3.48 to 23.62 ± 5.79%, respectively. GSH enhanced both H2S release and ocular hypotensive action of the polysulfides in a manner that was dependent on the number of sulfur atoms present in each polysulfide. Furthermore, female animals were less sensitive to the IOP-lowering action of the polysulfides, when compared to their male counterparts.

Long-Term Outcomes of Cataract Surgery: Analysis of Visual Acuity and Intraocular Pressure in a Tertiary Care Center

Abstract: Posterior capsule opacity (PCO) is a common complication following cataract surgery, caused by the proliferation of residual lens epithelial cells. This study aimed to evaluate the long-term effects of Nd:YAG laser capsulotomy on intraocular pressure (IOP) and visual acuity in PCO patients. This was a retrospective descriptive study. Samples were 24 patients diagnosed with PCO who underwent Nd:YAG laser capsulotomy at Prof. Dr. R. D. Kandou Hospital, Manado, from January 1, 2022, to January 1, 2024. The study recorded pre- and post-procedure IOP and best-corrected visual acuity (BCVA) data. Descriptive analysis, including paired t-tests, was used to assess changes in IOP and BCVA over an average follow-up period of 19.2 months. The results showed a statistically significant improvement in BCVA (p=0.000), with mean values improving from 0.72 to 0.27 LogMAR. A significant reduction in IOP was also observed (p=0.015), with long-term IOP remaining stable. A weak correlation was found between follow-up duration and IOP variation (p=0.02). In conclusion, Nd:YAG laser capsulotomy significantly improves visual acuity and stabilizes intraocular pressure in the long term for PCO patients, suggesting its effectiveness in managing post-cataract surgery complications. Keywords: posterior capsule opacity; Nd:YAG laser capsulotomy; intraocular pressure; visual acuity; cataract surgery Methods: A retrospective descriptive study was conducted on 24 patients diagnosed with PCO who underwent Nd capsulotomy at RSUP Prof Dr. R. D. Kandou Central Hospital, Manado, from January 1, 2022, to January 1, 2024. The study recorded pre- and post-procedure IOP and Best-Corrected Visual Acuity (BCVA) data. Descriptive analysis, including paired t-tests, was used to assess changes in IOP and BCVA over an average follow-up period of 19.2 months. Results: The study revealed a statistically significant improvement in BCVA (p = 0.000), with mean values improving from 0.72 to 0.27 LogMAR. A significant reduction in IOP was also observed (p = 0.015), with long-term IOP remaining stable. A weak correlation was found between follow-up duration and IOP variation (p = 0.02). Conclusion: Nd capsulotomy significantly improves visual acuity and stabilizes IOP in the long term for PCO patients, suggesting its effectiveness in managing post-cataract surgery complications.

Intraocular Pressure Fluctuation as Assessed by Water Drinking Test Following iStent inject Implantation in Open Angle Glaucoma Patients.

Introduction This study investigated the intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in open-angle glaucoma (OAG) patients after combined cataract surgery with iStent implantation. Methods This was a prospective non-randomized comparative study. Eyes with OAG and cataracts that were planned for either combined phacoemulsification and iStent implantation (iStent+CS) or phacoemulsification alone (CS) were recruited. The iStent inject (Model G2-M-IS) or iStent injectW (Model G2-W) trabecular micro-bypass stent (Glaukos Corporation, San Clemente, CA, USA) was implanted in the iStent+CS group. Water drinking test (WDT) was performed before and 3 months after surgery. WDT-IOP parameters including peak IOP, IOP fluctuation, and area under curve (AUC) were compared between the two groups. Results There were 20 eyes in the iStent+CS group and 16 eyes in the CS group. Both groups had similar pre-operative baseline IOP (15.6 ± 3.7 mmHg vs 15.8 ± 1.8 mmHg in the iStent+CS and CS group, respectively, p = 0.883). The iStent+CS group experienced greater numerical reduction in peak IOP (2.6 ± 1.9 mmHg vs 1.9 ± 2.4 mmHg; p = 0.355), IOP fluctuation (1.7 ± 2.2 mmHg vs 0.8 ± 2.5 mmHg; p = 0.289), and AUC (54.8 ± 103.6 mmHg x minute vs 25.3 ± 79.0 mmHg x minute; p = 0.355) than the CS group. There was more reduction in the number of anti-glaucoma medications in the iStent+CS group (1.4 ± 1.2) than the CS group (0.3 ± 0.9; p = 0.005). Conclusion Both combined phacoemulsification with iStent inject implantation and phacoemulsification alone reduced peak IOP, IOP fluctuation, and AUC, and none of these parameters showed statistically significant difference. Greater reduction in anti-glaucoma medications was seen in the combined group.

Comparison of Iridex MP3 and P3 probes on long-term intraocular pressure control after MicroPulse Transscleral-Cyclophotocoagulation

PurposeMicropulse transscleral cyclophotocoagulation (MP-TSCPC) is a glaucoma procedure that delivers energy to the ciliary body with minimal collateral-damage. We aim to assess the long-term effectiveness of MP-TSCPC using the original MP3 and revised P3 probe. Methods and designBaseline Retrospective cohort study was performed to obtain baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, and best-corrected visual acuity (BCVA) were obtained from pre- and post-operative visits of patients treated with MP-TSCPC. Failure was defined as IOP>21 mmHg, reduced IOP<20% below baseline, or IOP<5 mmHg on 2 consecutive follow-up visits after post-operative month 1, reoperation for glaucoma, or loss of vision to no light perception. ResultsA total of 113 eyes were enrolled, 44 using the MP3 probe and 69 with the revised P3 probe. Survival analysis found a 75% failure rate in patients treated with the revised P3 probe by the final visit with a mean time to failure (MTTF) of 4.8 ± 0.7 months which was higher than the original probe at 66% failure rate with a MTTF of 6.1 ± 1.1 months (p = 0.04). All causes of failure were due to high IOP and 67% required repeat treatment with MP-TSCPC or incisional surgery. Prior to censure of data from failure, both probes had significant reduction in IOP compared to pre-operative IOP at all time points. No significant changes in BCVA were found. Both groups were associated with low rates of complications. ConclusionBoth probes had a very low rate of visually significant complications when performed in a standardized method in accordance with surgical procedure and power settings recommended by Iridex; however, were associated with a high rate of single procedure failure due to uncontrolled IOP over the long term. The revised P3 probe was associated with a higher rate of failure. Patients experienced a reduction in IOP; however, a large proportion required additional treatment compared to the original MP3 probe.

Long-term efficacy and safety of ab externo canaloplasty in the Polish Caucasian population with open-angle glaucoma: A 3-year retrospective study.

This study aimed to assess the effectiveness and safety of ab externo canaloplasty over a 3-year follow-up period in Polish Caucasian patients with glaucoma. This retrospective study of a cases series was conducted at the Department of Ophthalmology Medical University of Bialystok, Poland. Primary outcome measures were intraocular pressure and medication burden. Secondary outcome measures were best corrected visual acuity, retinal nerve fiber layer thickness, visual field test results, endothelial cell density, intraoperative and postoperative complications, and additional glaucoma surgery. The study group consisted of 160 eyes diagnosed with early to-moderate primary open-angle glaucoma and treated with ab externo canaloplasty from 2014 to 2020. The criteria for qualified and complete success were intraocular pressure < 18 mmHg or ≥ 20% reduction in intraocular pressure from baseline with or without antiglaucoma medications, respectively. After surgery, the mean intraocular pressure decreased from 19.23 ± 4.33 to 14.52 ± 3.79 mmHg, which constituted a 36.7 ± 7.8% reduction compared to the baseline value. The number of medications decreased by two at the end of the study period (from 2.69 ± 1.05 to 0.32 ± 0.75). Complete and qualified success were achieved in 58.7% and 68.7% of the patients, respectively, at the end of follow-up. An incomplete cannulation of Schlemm's canal was the most common intraoperative complication, occurring in 32 eyes (20%). The most frequent postoperative complications were hyphema, Descemet's membrane detachment, and a transient increase in intraocular pressure. Additional surgical procedure was required in seven cases (4.4%). In 16 patients (10%), medical treatment was re-administered. Overall, our findings suggest that ab externo canaloplasty is a good option for Polish Caucasian patients with primary open-angle glaucoma. It reduces intraocular pressure and has a low postoperative complication rate. Additional glaucoma surgery or re-administration of medications is required if the target intraocular pressure is unsatisfactory.