Lower Intraocular Pressure Levels Research Articles

Assessing the Impact of PRESERFLO MicroShunt on Intraocular Pressure in Porcine Eyes Ex Vivo Using Infusion Pump System.

To evaluate the effectiveness of the PRESERFLO MicroShunt (PFM) in reducing intraocular pressure (IOP) ex vivo in porcine eyes using an infusion pump system and to simulate various IOP conditions, In this study, porcine eyes received increasing flows between 2 and 20 μL/min. IOP measurements were taken under conditions with and without the PFM [PFM (+) and PFM (-), respectively]. In the PFM (-) group, IOP increased from 7.4 mmHg to 46.3 mmHg as the flow rate increased from 2 μL/min to 20 μL/min. The rate of IOP reduction (%ΔIOP) rose with increasing flow rates, although the absolute IOP values achieved with the PFM insertion also increased. The correlation between IOPs in the PFM (-) conditions and the %ΔIOP was modeled as %ΔIOP = 22.4 Ln [PFM(-) IOP] - 41.7. According to this equation, IOP reduction by PFM insertion is 0% at IOPs of 6.4 mmHg or lower. IOP reductions of 10%, 20%, 30%, and 40% were observed when the pre-insertion IOPs were 10.1, 15.7, 24.6, and 38.4 mmHg, respectively. Achievable post-insertion IOP levels of ≤21 mmHg, ≤18 mmHg, ≤15 mmHg, and ≤12 mmHg corresponded to the initial IOPs of 33 mmHg, 26 mmHg, 20 mmHg, and 14.8 mmHg, respectively. In conclusion, the PFM effectively reduced IOP within a specific range of IOP values in an ex vivo experimental system. In clinical situations, the PFM is unlikely to be effective at low IOP levels. At higher levels, the PFM reduces IOP, but it may be insufficient to achieve the target IOP.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma.

To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18mmHg, and (3) IOP ≤ 15mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4mmHg and 32.3 ± 8.4mmHg, respectively, which significantly reduced to 14.5 ± 0.7mmHg and 11.6 ± 0.6mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Subtenon triamcinolone as an adjuvant in mitomycin-C-enhanced trabeculectomy in non-inflammatory glaucomas: A randomized clinical trial.

This unicentric randomized clinical trial was designed to compare the surgical outcomes of mitomycin C-enhanced trabeculectomy (MMC-TRAB) with and without subtenon triamcinolone acetonide (TAAC) injection in patients with non-inflammatory glaucomas. This trial is registered at the Brazilian Registry of Clinical Trials (ReBEC) under the register number RBR-53f8nh. Consecutive non-inflammatory glaucoma patients requiring surgical intervention were randomized into two groups. In the control group, eyes underwent standard MMC-TRAB, while in the intervention group, besides the standard MMC-TRAB, these eyes also received a subtenon TAAC injection (4mg) close to the bleb site at the end of the surgery. The main outcomes of the study were surgical success rates, intraocular pressure (IOP) and number of medications at all timepoints. Success was defined as IOP ≤ 15 mmHg and subdivided in complete or qualified according to the need of medication. A total of 75 eyes of 63 different patients were included (intervention group = 39 eyes; control group = 36 eyes). There was no difference between groups at baseline (p>0.11). Multivariable regression analysis indicated that IOP levels were significantly lower in the intervention group at 18 and 24 months of follow-up when number of medications was considered as a covariate (P<0.001). Complete success rates were higher in the intervention group at 06 (90.9% vs 68.7%; p = 0.03), 12 (87.2% vs 66.7%; p = 0.02) and 18 months (87.2% vs 66.7%; p = 0.02). Additionally, although success rates at 24 months were higher in the intervention group (82.0% vs 66.7%; p = 0.09), this difference did not reach statistical significance. Qualified success rates did not significantly differ between groups at all timepoints. In conclusion, this study found significantly lower IOPs levels at 18 and 24 months of follow-up and higher complete success rates until 18 months of follow-up, with the use of subtenon TAAC as an adjuvant to standard MMC-TRABs in non-inflammatory glaucoma patients.

Consanguinity Among Refractive Error, Intraocular Pressure and Etiology of Glaucoma in Diabetics Among Wheatish Population

The objective of this paper is to explore the connotation among refractive error, intraocular pressure (IOP), and primary open-angle glaucoma (POAG) among the Wheatish populace. Population-based studies give significant data with respect to the predominance and hazard factors which include refractive error for glaucoma. The connotation between myopia and glaucoma is robust at lower IOP levels and deteriorated slowly with increasing IOP. This study shows the relationship between IOP and glaucoma is solid at a lower mean value of 15 ±± 3.23 levels and debilitated progressively with expanding IOP of 17.59 ±± 3.33 for PACG, 18.85 ±± 1.20 for POAG, 18.59 ±± 2.52 for PIGM and 19.12 ±± 1.42 for OH among Wheatish population. The illustration of glaucoma in myopic eyes deteriorated with growing IOP and no association has been detected with IOP ≥≥35 mmHg.

Comparison of two phacoemulsification system handpieces: prospective randomized comparative study.

To compare the safety and efficacy of Active Sentry handpiece with Ozil handpiece for Centurion phacoemulsification system. Tertiary eye center, South India. Prospective observational study. 204 eyes of 204 patients with uncomplicated cataract who underwent phacoemulsification cataract surgery with Centurion Vision System were randomized into 2 groups: Ozil handpiece (n = 101) and Active Sentry handpiece (n = 103). Intraoperative factors such as patient pain perception, surgeon comfort level, amount of phacoemulsification energy and aspiration fluid used, and frequency of activation of active surge mitigation (ASM) were analyzed, and postoperatively, corrected distance visual acuity (CDVA) and corneal edema on day 1 were compared. A total of 204 eyes of 204 patients were included among which 101 underwent surgery with ozil hand piece and 103 with Active Sentry handpiece. Patient pain perception was comparable between the groups with no statistically significant differences in patients who had pain-free surgery (66% vs 61.3%) and those who experienced moderate pain (24.3% vs 28.7%). Surgeons were more comfortable using Ozil handpiece during entry into anterior chamber and emulsification of hard nuclei (48.5% vs 28.6%). The mean cumulative dissipated energy for soft and hard cataracts was 5.6 and 4.8 and 9.3 and 9.4 for Ozil and Active Sentry groups, respectively. ASM was activated for 53 eyes (51.5%), of which 42 eyes (79.2%) had soft cataract and 11 eyes (20.7%) hard cataract. Postoperative CDVA and incidence of corneal edema were comparable between the groups. For Centurion Vision System, Active Sentry handpiece was as safe and efficacious as the Ozil handpiece with added benefit of operating at lower intraocular pressure levels.

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes.

To evaluate real-life outcomes of XEN45 stent surgery including bleb needling (BN) and surgical bleb revision (SBR). Retrospective analysis of all XEN45 gel stents implanted in a tertiary glaucoma center with a minimum follow-up of 6 months. The main outcomes were intraocular pressure (IOP), the number of glaucoma medications, postoperative maneuvers like BN, and subsequent SBR. Success was defined as IOP ⩽ 18 and 20% reduction (criterion A), ⩽15 and 25% reduction (criterion B), and ⩽12 mmHg and 30% reduction (criterion C) reached with (qualified) or without (complete) medications at the last visit. Complete failure was defined as additional glaucoma surgery, loss of light perception, or sight-threatening complications. Multivariable Cox regression and Kaplan-Meier survival estimates tests were performed. Fifty-eight eyes with either stand-alone or combined Phaco-XEN surgery were included. Complete success by the different definitions was 50.0% (95% confidence interval, 5.8%-84.5%) (A), 50.0% (5.8%-84.5%) (B), and 25% (0.9%-66.5%) (C) whereas qualified success was 38.3% (1.6%-80.1%), 31.7% (2.0%-71.4%), and 0%, respectively, at the 24-months visit. 30% of cases underwent BN with 5-Fluorouracil, and SBR was performed in 17.5% of eyes. Low IOP levels at 1-month and early BN were significantly associated with success. The highest chance of failure was achieved in the combined Phaco-XEN group undergoing SBR. In our real-life setting, the first month IOP was associated with greater success rates. Although BN obtained improved IOP values, SBR was associated with a greater bleb survival in the stand-alone XEN group. Both BN and SBR had poor outcomes in the combined Phaco-XEN group.

The Effect of Perioperative Uveitis Control on the Success of Glaucoma Surgery in Uveitic Glaucoma.

PurposeTo study the effects of perioperative uveitis control (PUC) on postoperative intraocular pressure (IOP) and uveitis activity in uveitic glaucoma (UG) patients who required glaucoma surgeries.Patients and MethodsA retrospective chart review of 109 patients (120 eyes) which had glaucoma surgery for UG. A total of 66 eyes which had PUC were compared to 54 eyes which did not have. Measurements of IOP and uveitis activity were recorded preoperatively and over 2 years postoperatively. Average number of antiglaucoma medications and frequency of surgical failure were obtained in both groups.ResultsOver 2 years postoperatively, average IOP was lower in eyes which had PUC. Significant differences in IOP were found at 3 months (P = 0.004), 6 months (P = 0.001), 1 year (P < 0.001), and 2 years (P < 0.001). Lower grades of anterior chamber (AC) inflammation were found in eyes which had PUC. Significant differences were found at 1 month (P < 0.001), 3 months (P < 0.001) and 6 months (P = 0.001). Mean number of antiglaucoma medications at last visit was 0.7 ± 1.1 for eyes which had PUC and 2.6 ± 1.5 for eyes which did not have PUC (P < 0.001). Among eyes which had PUC, only two eyes required second glaucoma surgeries, while 16 eyes with no PUC required further glaucoma surgeries after 27.7 ± 12.5 months (P < 0.001).ConclusionProper PUC in patients going for UG surgeries results in lower IOP levels and less AC inflammation over 2 years postoperatively. A comprehensive PUC regimen is needed for uveitic glaucoma patients going for surgeries.

Outcome of repeat trabeculectomy with mitomycin C in isolation or combined with phacoemulsification.

Purpose:To evaluate the effectiveness of repeat trabeculectomy with Mitomycin C (MMC) in isolation or combined with phacoemulsification, and to identify risk factors for failure over 1 year.Methods:Retrospective review of 113 eyes of 113 patients (49 primary open angle, 27 primary angle closure, 37 secondary glaucoma) who underwent repeat trabeculectomy with MMC (isolated trabeculectomy 75 and phacotrabeculectomy 38). The primary outcome measure was intraocular pressure (IOP) at 1 year follow-up. Three IOP criteria were chosen to measure success A) IOP ≤21 mmHg and ≥20% reduction from baseline. B) IOP ≤17 mmHg and ≥20% reduction from baseline. C) IOP ≤14 mmHg.Results:Mean IOP decreased from 24.5 ± 8.8 mmHg to 16.4 ± 7.6 mmHg 1 year after repeat trabeculectomy. The mean number of medications reduced from 2.9 ± 1.0 to 0.6 ± 1.0. Complete success with trabeculectomy versus phacotrabeculectomy for criterion A was 60% vs 55.3%, criterion B 54.7% vs 50.0% and criterion C 40.0% vs 28.9%. IOP ≤14 mmHg was more likely with trabeculectomy than phacotrabeculectomy (P = 0.047). On regression analysis, duration between surgeries ≤4 years (P = 0.018) and secondary glaucoma (P = 0.046) were identified as risk factors for surgical failure with criterion A. Younger age (P = 0.042), fornix based flap (P = 0.058), and phacotrabeculectomy (P = 0.042) for criterion C.Conclusion:Repeat trabeculectomy with MMC is successful at lowering IOP and decreasing number of antiglaucoma medications. Low IOP levels are less likely with phacotrabeculectomy.

Normal tension glaucoma – case report

Normal tension glaucoma (NTG), reffered to also as low-tension glaucoma, represents a glaucomatous optic neuropathy classified as a type of Primary open angle glaucoma (POAG). It is characterized by a higher tendency of damage to the optic nerve at relatively low levels of intraocular pressure (IOP), as well as asymmetric pathological process in both eyes of the same patient. A number of IOP-independent factors play a significant role in the progression of the disease and often lead to difficulties in diagnosis and optimal therapy in these patients. We report a typical clinical case of a patient with NTG.

Management of the glaucoma patient progressing at low normal intraocular pressure.

Patients with glaucoma with disease progression despite low or normal intraocular pressure (IOP) present special challenges to the treating clinician. Treatment goals may depend on whether patients have apparent low IOP with concurrent treatment or have low IOP at baseline without treatment. We review the diagnostic and therapeutic approaches to these patients. Apparent progression at low IOP should start with confirmation of IOP, made easier by devices enabling patient home self-tonometry. Suspected visual field progression should be confirmed by repeat testing prior to advancement of therapy. Trabeculectomy remains the most effective surgical method of achieving long-term success, particularly when there is a low starting IOP. Drainage tube implantation or the use of novel micro-incisional non-bleb-forming procedures are less likely to be successful in achieving low IOP goals. Diagnostic testing is important in confirming progressive glaucomatous disease at low IOP levels. The most effective way of slowing the progression of glaucoma in a patient with low IOP is to lower the IOP further, sometimes to single digit levels, which is most often achievable with trabeculectomy.

Glaucoma surgery preferences when the surgeon adopts the role of the patient.

To survey the members of the American Glaucoma Society (AGS) to determine which glaucoma procedures they would prefer to have performed on themselves. We distributed an anonymous, electronic survey via the AGS listserv. The participants were asked to adopt the role of a patient with primary open angle glaucoma with progressive visual field loss in need of glaucoma surgery. Three preoperative intraocular pressure (IOP) levels were provided (>26 mmHg, 21-26 mmHg, and <21 mmHg), and the participants were asked to choose a glaucoma procedure they would prefer performed on themselves under each preoperative IOP levels from a list of fifteen procedures. Out of 289 responses (representing 27.4% of active and provisional AGS members), the most preferred procedures were ab interno trabeculotomy (20.3%), Xen gel stent (18.6%), iStent with two devices (14.3%) and traditional trabeculectomy augmented with mitomycin C (14.1%). 17.6% and 6.9% of participants preferred a trabeculectomy performed or a glaucoma drainage device (GDD) implanted on themselves, which is a lower than what would be offered to a hypothetical patient. Significant proportions of participants prefer non-bleb forming or conjunctiva-sparing procedures, even with low preoperative IOP levels. Older participants were more likely to prefer traditional trabeculectomy and having a single procedure across all levels of preoperative IOP. The majority of AGS participants in the survey would prefer micro-invasive glaucoma surgery over traditional trabeculectomy or a GDD performed on themselves as a primary glaucoma procedure, and most would prefer non-bleb forming and conjunctiva-sparing procedures.

Role of Cataract Surgery in IOP Lowering

Background:Glaucoma is a neurodegenerative disease of the optic nerve, which can be pathologically explained either by direct ischemia by the intra ocular pressure or by direct pressure on the optic nerve fibers as they pass through the lamina cribrosa.Glaucoma and cataract are frequently encountered in the same patient, there prevalence increasing with age.Aim of the study:Determine the effect of cataract surgery on level of intraocular pressure.Patients and methods:A prospective comparative study started since October 2012 until July 2015 eighty patients included of four groups 20 normal, 20 with pseudo exfoliation syndrome, 20 with pseudo exfoliation glaucoma, and 20 with primary open angle glaucoma (both types of glaucomas are controlled). Six readings IOP by Goldman applanation tonometry each included eye; one preoperative (phacoemulsification), one post operative 1 week, one month, three months, six month, and one year post operative.Results:All of the four included groups get lower intraocular pressure levels after cataract surgery

Effect of trabeculectomy on visual field progression in Japanese progressive normal-tension glaucoma with intraocular pressure < 15 mmHg.

We examined the effectiveness of trabeculectomy in decreasing the slope of mean deviation (MD) in Japanese patients with progressive normal-tension glaucoma (NTG) at low intraocular pressure (IOP) levels. The charts of patients who had undergone initial trabeculectomy with adjunctive mitomycin C for progressive NTG with medically controlled IOP < 15 mmHg in 2010–2013 were retrospectively reviewed. Seventeen eyes of 13 NTG patients who had undergone at least 5 times of visual field (VF) examinations in both of preoperatively and postoperatively with postoperative follow-up of ≥ 2 years were enrolled. Preoperative and postoperative MD slopes were compared to evaluate the effectiveness of trabeculectomy in slowing progression of VF. Mean IOP (8.1 ± 2.9 mmHg) and number of IOP-lowering medications (0.8 ± 1.5) were significantly lower postoperatively than preoperatively (13.9 ± 0.9 mmHg; P < 0.001 and 3.0± 0.4; P < 0.0001). In total, 91.7% of eyes with single-digit IOP postoperatively showed improvement in MD slope, whereas only 20.0% of eyes with IOP ≥ 10 mmHg postoperatively showed the improvement. Three eyes (17.6%) showed a decrease in visual acuity (VA) of ≥ 0.1 unit; this group had a lower mean postoperative IOP (6.0 ± 1.0 vs. 8.6 ± 3.0 mmHg; P = 0.1717) and a higher mean IOP reduction rate (56.2 vs. 38.5%; P = 0.8296) than eyes with a VA decrease of < 0.1 unit or no change. Thus, in this analysis of Japanese NTG patients with medically controlled IOP < 15 mmHg, achieving an IOP < 10 mmHg with trabeculectomy was beneficial for reducing the VF progression rate in progressive NTG at low IOP levels. However, an IOP < 7 mmHg by surgery would be required careful attention to VA decline.

Microinvasive Glaucoma Stent (MIGS) Surgery With Concomitant Phakoemulsification Cataract Extraction: Outcomes and the Learning Curve.

To evaluate learning effects with respect to outcomes of a microinvasive glaucoma stent (MIGS) inserted during cataract surgery in glaucoma patients. Single surgeon, observational cohort study of 25 consecutive Ivantis Hydrus microstent insertions, with a minimum follow-up of 12 months. A learning curve analysis was performed by assessing hypotensive effect, adverse effects, and surgical procedure duration, with respect to consecutive case number. Success was defined with respect to various intraocular pressure (IOP) targets (21, 18, 15 mm Hg) and reduction in required antiglaucoma medications. Complete success was defined as achieving target IOP without antiglaucoma therapy. No clinically significant adverse events or learning effects were identified, although surgical time reduced with consecutive case number. Mean follow-up was 16.8 months. At final follow-up the mean IOP for all eyes was reduced from 18.1 (±3.6) mm Hg [and a simulated untreated value of 25.9 (±5.2) mm Hg] to 15.3 (±2.2) mm Hg (P=0.007; <0.0001) and the mean number of topical antiglaucoma medications was reduced from 1.96 (±0.96) to 0.04 (±0.20) (P<0.0001). Complete success (IOP<21 mm Hg, no medications) was 96% at final follow-up. Complete success (IOP<18 mm Hg, no medications) was 80% at final follow-up, but only 32% with a target IOP of <15 mm Hg (no medications). No significant learning curve effects were observed for a trained surgeon with respect to MIGS microstent insertion performed at the time of cataract surgery. Adjunctive MIGS surgery was successful in lowering IOP to <18 mm Hg and reducing/abolishing the requirement for antiglaucoma medication in eyes with open-angle glaucoma, but less successful at achieving low IOP levels (<15 mm Hg).

Achievements and Limits of Current Medical Therapy of Glaucoma.

Prescribing medical therapy for the treatment of glaucoma can be a complex process since many parameters should be taken into consideration regarding its achievements and limits. Today, a variety of options, including multiple drug classes and multiple agents within classes, are available to the clinician, but caution should be given to their side effects and contraindications. Glaucoma patients with preexisting ocular surface disease should be treated with caution, and preferably with preservative-free formulations, as there is an increased risk for symptom deterioration. The development and use of fixed-combination therapies has reduced the preservative-related side effects that threaten patient adherence and has minimized the washout effect of multiple instillations. Adherence to medical treatment is not only crucial to its efficacy but also to its cost-effectiveness. Further factors to consider are that there are patients who are nonresponders to treatment, and also that the target intraocular pressure (IOP) cannot be reached in all patients, regardless of the response to treatment. The progression of damage can occur even under maximum medical treatment or maximally tolerated medical treatment, and regardless of whether low IOP levels are reached. Furthermore, there is some conflict between medical treatment and quality of life due to long-term everyday use and to side effects of treatment. New molecules and new delivery systems are being investigated to open new horizons in glaucoma management. Although the general rule is to initiate glaucoma management with medical treatment, the limits of medical therapy should be considered to identify those patients in need of surgical management.

Medical and Surgical Management of Glaucoma

Intraocular pressure (IOP) is part of the pathogenesis of glaucoma. This article discusses treatment and management options for patients who are progressing at low levels of IOP, glaucoma medication, neuroprotective agents to preserve retinal ganglion cells, argon laser trabeculoplasty, prophylactic laser peripheral iridotomy, incisional glaucoma surgery, as well as minimally invasive glaucoma surgery.

Glaucoma Risk Alleles at CDKN2B-AS1 Are Associated with Lower Intraocular Pressure, Normal-Tension Glaucoma, and Advanced Glaucoma

Genetic variation at the 9p21 locus encompassing the CDKN2B-AS1, CDKN2A, and CDKN2B genes has been associated with primary open-angle glaucoma (POAG) in several independent studies. This study aimed to dissect the association further and to determine genotype-phenotype correlations between genetic variation at this locus and a range of glaucoma-related traits in a large cohort of POAG patients. Comparative case series and case-control study. One thousand four hundred thirty-two POAG patients and 595 unaffected controls recruited from 2 population-based and 2 cross-sectional studies. Each patient was genotyped at 9 single nucleotide polymorphisms (SNPs) previously associated with POAG at the 9p21 locus. Each SNP was assessed for association with each outcome measure using linear regression under an additive genetic model. Associated traits were explored further including adjustment for relevant covariates. Highest recorded intraocular pressure (IOP) also was analyzed both with and without correction for central corneal thickness (CCT) and was dichotomized into high-tension glaucoma and normal-tension glaucoma (NTG). Intraocular pressure and vertical cup-to-disc ratio (VCDR). Glaucoma risk alleles at 9p21, particularly, rs7049105 and rs10120688, were associated with the presence of both NTG and advanced POAG. The SNP rs10120688 was associated with greater VCDR after adjustment for covariates (P = 0.003; β = 0.016; standard error, 0.006). In addition, multiple SNPs in the region were associated with reduced IOP, before and after adjustment for CCT. The SNP most significantly associated with IOP was also rs10120688 (P = 0.001; β = -2.135; standard error, 0.634) after adjustment for covariates under an additive model. In a comparison of high-tension versus low-tension glaucoma, this SNP was also the most significantly associated, particularly when IOP was corrected for CCT before classification of the type of glaucoma (P = 0.0009; odds ratio, 0.63; 95% confidence interval, 0.48-0.83). Patients with POAG carrying the glaucoma risk alleles at the 9p21 locus have larger VCDR and lower IOP than POAG patients without these alleles. Carriers of these alleles seem to be predisposed to POAG developing at lower IOP levels and exhibit stronger associations with NTG and advanced glaucoma phenotypes. This may be of relevance when setting target pressures in patients carrying these risk alleles.

The times they are a‐changin’: time to change glaucoma management

The times they are a‐changin’: time to change glaucoma management

Effects of Argon Laser Trabeculoplasty in the Early Manifest Glaucoma Trial

To analyze reduction of intraocular pressure (IOP) by argon laser trabeculoplasty (ALT) in the Early Manifest Glaucoma Trial and factors influencing the effect of such treatment. Cohort study based on 127 patients from the treatment group of the Early Manifest Glaucoma Trial, a randomized clinical trial. Patients randomized to the treatment arm of the Early Manifest Glaucoma Trial received a standard treatment protocol (topical betaxolol hydrochloride followed by 360-degree ALT) and then were followed up prospectively at 3-month intervals for up to 8 years. One eye per patient was included in the analyses. We investigated the relationship between IOP before ALT and subsequent IOP reduction and other factors that might have influenced the effect of ALT, including stage of the disease, trabecular pigmentation, presence of exfoliation syndrome, and treating surgeon. The mean ± standard deviation IOP before ALT and after betaxolol treatment was 18.1 ± 3.9 mm Hg, and the mean ± standard deviation short-term IOP reduction 3 months after ALT was 2.8 ± 3.9 mm Hg (12.6 ± 20.5%). The IOP before ALT strongly affected IOP reduction (P < .001); each 3-mm Hg higher IOP before ALT value was associated with an additional mean IOP reduction of approximately 2 mm Hg. The treating surgeons also had a significant impact on IOP reduction (P = 0.001), with mean values ranging from 5.8 to -1.3 mm Hg. In this cohort, which included many patients with low IOP levels, IOP before ALT markedly influenced the IOP reduction induced by ALT, seen as a much larger decrease in eyes with higher IOP before ALT. The treating surgeon also had a significant impact on ALT outcome.

Differences between the combination of the 25-gauge vitrectomy with phacoemulsification versus 20-gauge vitrectomy and phacofragmentation

In the present study we determine the differences observed between 25-gauge-vitrectomy combined with phacoemulsification, and the 20-gauge-vitrectomy combined with pars plana phacofragmentation. A prospective study of a sample of 987 eyes of 661 patients randomly divided into two groups. 25-gauge-vitrectomy plus phacoemulsification included 486 eyes, and 20-gauge-vitrectomy plus phacofragmentation 501 eyes. We evaluated the differences at the time of the surgery, the intra-and postoperative complications, and the variations in intraocular pressure. The final visual outcome was similar in both groups. The most important differences between groups were: surgical time was faster in group 1 than in group 2, (mean time: 35.16 +/- 3.49, 44.74 +/- 5.30 minutes). Intraoperative complications were more numerous in group 1. In group 1, postoperative low levels of intraocular pressure are present in all patients with 2.77% of patients with hypotension (<8 mmHg), and three choroidal effusion. In group 2, intraocular lens decentration and retinal detachment are more frequent (2.38% and 1.39%, respectively). In the present study, both techniques have a similar number of complications and have a similar postoperative outcome, and are valid for the management of the pathologies selected.