Lower Intraocular Pressure Research Articles

Associations and Outcomes Comparing First and Second Eye Trabeculectomies in Patients with Glaucoma.

The present study highlights the high correlation of outcomes of bilateral trabeculectomy in subjects with different types of glaucoma after mid-term follow-up. To evaluate the mid-term outcomes of bilateral trabeculectomy and assess the differences and associations in outcome between the first-operated and the second-operated eye. Patients with different types of glaucoma who underwent bilateral trabeculectomy from 2006 to 2022 were included in this retrospective study. All patients were followed for at least 24 months after surgery in each eye. The main outcome measure was surgical success. Complete success was defined according to intraocular pressure (IOP)≤16mmHg and at least 20% reduction from preoperative baseline IOP without any IOP lowering medications. Cumulative success was defined according to IOP≤16mmHg and at least 20% reduction from preoperative baseline IOP, with or without IOP-lowering medications. Secondary outcome measures were IOP and the number of IOP-lowering medications. In total, 186 eyes of 93 patients were included. There was no statistically significant difference in terms of the baseline IOP and number of IOP-lowering medications between the first and second operated eyes before and after surgery ( P -value>0.05). The mean follow-up time was 64.35±41.13 months and 57.13±38.41 months for the first operated and the second operated eyes, respectively. At the 24-month follow-up point, among patients whose first operated eyes were considered a complete success, 78.2% of surgeries in second eyes were successful ( P -value=0.002). On the other hand, among patients whose first operated eyes were considered a cumulative success, 80.3% of surgeries in second eyes were successful ( P value=0.012). In a multivariate analysis of factors affecting cumulative success, the outcome of the surgery in the first operated eye was the only factor that significantly impacted the outcome of surgery in the second operated eye. If the first operated eye achieved cumulative success, the odds of the second operated eye experiencing cumulative success were 6.5 ( P -value=0.02). The rates of postoperative complications in the two eyes were similar and did not show statistically significant differences. The present study demonstrates a significant correlation in surgical outcomes of trabeculectomy between the two eyes of the same patient in mid-term follow-up. Surgical success in the first-operated eye increases the odds of success in the second eye 6.5 fold.

Short-term results of direct laser trabeculoplasty (DSLT) in clinical practice.

PurposeTo report the short-term results of direct selective-laser trabeculoplasty (DSLT) in clinical practice.MethodsRetrospective review of patients treated with DSLT between December 2023 and May 2024 with ≥ 6 months follow-up. Eyes were divided according to the indication for DSLT: first-line treatment (group 1); treatment-burden reduction (group 2) and additional intraocular pressure (IOP) lowering effect (group 3). Success was defined as a decrease of ≥ 20% from baseline-IOP with no additional treatment, or as a reduction in hypotensive drugs with stable IOP.ResultsSeventy-six eyes from 44 patients were included. In group 1 (20 eyes) mean IOP dropped from 26.50 ± 2.70 mmHg at baseline to 20.35 ± 3.37 mmHg six months after DSLT (p < 0.001). No eye required topical treatment. In group 2 (28 eyes), mean baseline IOP was 15.36 ± 4.34 mmHg and remained stable at 14.75 ± 4.15 mmHg (p = 0.214). Mean number of hypotensive drugs dropped from 2.00 ± 0.72 to 1.07 ± 1.24 (p < 0.001). In group 3 (28 eyes), mean IOP dropped from 20.21 ± 5.42 mmHg to 16.54 ± 4.37 mmHg (p < 0.001), with mean number of drugs remaining stable: 1.71 ± 0.76 at baseline and 1.57 ± 0.88 six months after DSLT (p > 0.05). There were no serious adverse events. Success rates were 55% in group 1, 57.1% in group 2 and 39.3% in group 3.ConclusionsDSLT produced an IOP reduction of almost 25% in naive eyes and 17% in already-treated eyes. It can also reduce treatment burden with a stable IOP. These results support DSLT as an option at all stages of glaucoma, although the duration of its effect remains to be proven.

Efficacy of penetrating canaloplasty versus trabeculectomy in patients with bilateral primary glaucoma: a self-control study.

Schlemm's canal-based minimally invasive glaucoma surgeries (MIGSs) are gaining increasing recognition and acceptance, but majority of these MIGSs are recommended in eyes with open angle. Bleb-independent penetrating canaloplasty (PCP) restores physiological aqueous outflow in eyes with both open and closed angles. We aimed to compare the efficacy, safety, and postoperative management of penetrating canaloplasty versus trabeculectomy in patients with bilateral primary glaucoma. This study is prospective self-control case series in a tertiary hospital in China. A total of 54 eyes from 27 patients with bilateral primary open angle glaucoma (n=18) or primary angle-closure glaucoma (n=9) were included. Trabeculectomy with mitomycin C (TRAB) was performed in one eye, while PCP was performed in the contralateral fellow eye. Intraocular pressure (IOP), number of glaucoma medications, surgery-related complications and postoperative interventions were compared between groups. Complete (without medication) and qualified success (with/without medication) were defined as IOP ≤21 mmHg and ≥20% IOP reduction. Mean IOP decreased from 32.5±8.87mmHg on 2.3±1.43 medications at baseline to 14.6±4.41mmHg on 0.20±0.58 medications at 12 months in TRAB group (both p<0.0001) and from 30.0±9.61mmHg on 2.7±1.10 medications to 14.8±4.63mmHg on 0.12±0.44 medications in PCP group (both p<0.0001). Equal complete success (84.0%, P＞0.999) was achieved at 12 months in two groups. Although not statistically significant, higher qualified success was observed in TRAB (96.0%) than in PCP group (88.0%, p=0.609) at 12 month. However, 63.0% eyes (n=17) in TRAB group needed bleb managements to maintain a lower IOP. Transient IOP spike (>25mmHg, 22.2%) and microhyphaema (22.2%) were the most common complications for PCP, while hypotony (14.8%) and wound leakage (11.1%) were frequently seen after TRAB. Penetrating canaloplasty demonstrates comparable IOP-lowering effect with trabeculectomy in eyes with primary glaucoma, but with less post-operative complications and interventions.

Plant Iridoids Affect Intraocular Pressure and Vascular Flow in the Rabbit Eye

For plant-derived raw materials, there are very few studies regarding the effect of intraocular administration on intraocular pressure (IOP) and associated blood flow. Traditional folk medicine uses many natural resources for eye disorders. However, in the main, these exhibit an anti-inflammatory and moisturizing effect. The intraocular pressure reduction and neuroprotective effects are known, but only for orally administered products. In the work presented here, the effect of eight natural iridoids in concentrations of 0.1 and 0.5% in saline on IOP and blood flow in iris vessels was studied in white New Zealand rabbits. No ocular adverse effects were observed during the whole experiment. We demonstrated, for the first time, significant reductions in IOP for five of the eight iridoids tested at a concentration of 0.5%. These were verbenalin, aucubin, oleuropein, gentiopicroside, and secologanin. The highest effect of IOP lowering, a nearly 1.5 mmHg difference from baseline, was observed for verbenalin 2 h after administration. An increase in vascular inflow was observed only with the administration of aucubin, catalpol, and gentiopicroside at 2 and 3 h after administration of the 0.5% solution. This effect was contrary to the result for the reference—timolol—which significantly reduced flow by more than 100 flux during the first hours of the experiment. In summary, selected iridoids could be considered, after further investigation, as natural components for ophthalmic formulation in the prevention of eye diseases.

Evaluating the outcomes of inferonasal ahmed valve implantation using the double scleral tunnel technique in refractory glaucoma

BackgroundTo evaluate the efficacy and safety of inferonasal quadrant (IN) Ahmed Valve implantation (AVI) using the double scleral tunnel technique in patients who had previously failed glaucoma surgery.MethodsThis retrospective comparative study included data from 69 patients diagnosed with refractory glaucoma who were followed in a tertiary referral hospital. The IN-AVI group included 35 patients who underwent IN-AVI after failed trabeculectomy or superotemporal quadrant (ST) AVI, and the ST-AVI group included 34 patients who underwent primary ST-AVI. The primary outcome was to analyse the surgical success rate, the secondary outcome was to compare the intraocular pressure (IOP) reduction in the IN-AVI and ST-AVI groups at 1-year postoperatively.ResultsSignificant reduction in IOP was observed after IN-AVI at 1-year postoperatively (p < 0.001). The overall success rate was 88.6%. IN-AVI after failed trabeculectomy didn’t differ from primary ST-AVI in terms of IOP reduction. IN-AVI after failed ST-AVI showed a lower IOP reduction compared to primary ST-AVI (p = 0.003). No tube exposure was observed at 1-year postoperatively using the double scleral tunnel technique.ConclusionsIn patients with refractory glaucoma, IN-AVI after failed trabeculectomy was as effective as the primary ST-AVI. Although IN-AVI after failed ST-AVI was effective in reducing IOP, it was significantly less effective than the primary ST-AVI. The prior failure of a trabeculectomy had no impact on the success of AVI. Conversely, a second AVI was less efficacious than the primary AVI.

The effect of intraocular pressure during phacoemulsification in patients with either diabetic retinopathy or glaucoma; a randomized controlled feasibility trial.

To investigate whether performing phacoemulsification with a lower infusion pressure using the Centurion active sentry system affects surgical efficiency, complications and a range of clinical and imaging parameters compared to the higher pressures routinely used in patients with cataract and concomitant diabetic retinopathy and glaucoma. Sunderland Eye Infirmary, Sunderland, United Kingdom. Masked observer randomized controlled feasibility trial. Patients with cataracts undergoing routine phacoemulsification with either diabetic retinopathy or primary open-angle glaucoma of any severity were included and randomized to an infusion pressure of 30 ('LOW') or 60 ('HIGH') mmHg. All other fluidic settings were standardized. Surgical metrics and a range of imaging and clinical variables were measured pre- and postoperatively on days 1, 21 and 40. Seventy eyes from 70 patients underwent surgery and completed follow-up. Forty-one patients had diabetic retinopathy and 29 had glaucoma. There was no difference in any of the recorded surgical metrics including cumulative dissipated energy (CDE) between the two randomization groups (mean CDE 6.5 versus 6.1 percent seconds in the HIGH and LOW groups respectively, p = 0.68). There were no patients in either group with posterior capsule rupture or other intraoperative complications. There was no significant difference in the number of patients with raised intraocular pressure (IOP) on day 1. Seven (21.2%) patients in the LOW and 5 (13.3%) in the HIGH group had slit lamp detectable corneal oedema on day 1, which had all resolved by day 21. There were no between group differences for visual acuity, IOP, corneal thickness, and any of the optical coherence tomography (OCT) acquired measures at any of the time points. The foveal avascular zone perimeter and area were significantly smaller on day 21 than at baseline in the HIGH group as compared to the LOW group (P = 0.03 and 0.04 respectively), with a corresponding increase in the superficial vascular plexus density (p = 0.04). Using an infusion pressure of 30mmHg with standardized aspiration fluidic settings on the Centurion active sentry system did not decrease surgical efficiency or increase complication rates compared to a pressure of 60mmHg. The lower infusion pressure may cause fewer short-term changes in the retinal microvasculature, the long-term significance of which is unknown. What is known Traditionally, phacoemulsification has been carried out under relatively high intraocular pressure (IOP) to mitigate the effects of post occlusion aspiration surge during lens removal. A new enhanced phacoemulsification fluidics system has reduced surge allowing surgeons to operate at considerably lower, and more physiological IOP levels. What is new In patients undergoing phacoemulsification for moderate cataracts with either co-existing diabetic retinopathy or glaucoma, an IOP of 30 mmHg using the Centurion active sentry system did not result in any decrease in surgical efficiency or increase in complication rates compared to a higher pressure of 60 mmHg. Lower IOP phacoemulsification caused less short-term changes in the retinal microvasculature than higher pressure, the long-term significance of which is unknown and further study is needed.

Anterior-Segment Optical Coherence Tomography Imaging of Patients Undergoing Supraciliary Glaucoma Drainage Device Implantation.

To evaluate anatomical changes after implantation of a novel supraciliary minimally invasive glaucoma drainage device using swept-source anterior segment optical coherence tomography (AS-OCT). Monocentric prospective interventional case series. Forty-eight eyes with open-angle glaucoma underwent standalone or combined MINIject (MJ) implantation and were imaged postoperatively using AS-OCT at 1week, 1month, 3months, and 6months. Implant depth (D), implant position (O), cleft width (CW) in Circumferential Lake (CL) or Cleft Angle (CA), the amount of suprachoroidal fluid (SCF), and number of quadrants with visible SCF were assessed. Following MJ implantation, intraocular pressure (IOP) significantly decreased from 22.5 ± 9.0 mmHg to 14.1 ± 6.4 mmHg (p < 0.001) at 6months, with concurrent reduction in ocular hypotensive medications from 2.4 ± 1.2 to 0.4 ± 0.9 (p < 0.001). SCF grading decreased from 3.1 ± 1.0 on day 1 to 1.5 ± 1.1 at 6months (p < 0.001). Cleft width grade measured in length (CL) remained stable from 3.3 ± 0.9 to 3.2 ± 0.6 (p = 0.8), and arc-angle(CA) decreased from 35.9 ± 8.8 to 30.2 ± 7.1 degrees at 6months (p = 0.07). The number of quadrants with visible SCF decreased from 3.7 ± 0.8 to 2.2 ± 1.6 (p < 0.001). Implant depth and orientation remained stable, with 45.5% of implants anterior, 33.3% at Schwalbe's line, and 21.2% behind it. Implant orientation varied, with 13.0% touching the iris, 69.6% pointing toward the anterior chamber, and 17.4% directed at the cornea. AS-OCT is a noninvasive tool for imaging the supraciliary and suprachoroidal space after MINIject implantation. Over 6months, we found a gradual decrease in the amount of SCF drainage and the number of quadrants with visible SCF. Cleft width remained stable and was not statistically associated with IOP lowering.

Identification of Nitric Oxide Donating Dasatinib Derivatives with Intraocular Pressure Lowering and Senolytic Activities.

Based on two major risk factors of glaucoma, elevated intraocular pressure (IOP) and senescence, two new series of nitric oxide (NO) donating dasatinib derivatives 1a-f, 2a-f were designed, synthesized, and biologically evaluated. The results demonstrated that the most active compound 2e effectively released NO and increased the concentration of 3',5'-cyclic guanosine monophosphate in human trabecular meshwork cells, as well as maintained senolytic activity. Topical administration of 2e in chronic ocular hypertension (COHT) glaucoma mice not only significantly eliminated senescent cells in retina but also exhibited potent retinal ganglion cells (RGCs) surviving, IOP lowering, and visual function protection activities, which were superior to those of dasatinib. Compared with younger adult mice, aged COHT mice resulted in more severe RGCs loss, while 2e demonstrated a greater capacity to improve RGCs survival. Our findings show that dual IOP lowering and senolytic functions could be a promising therapeutic strategy for glaucoma, particularly in older patients.

A Dual-Center Study of Retinal Detachment Following Endogenous Endophthalmitis

ABSTRACT Purpose To evaluate factors associated with increased odds of retinal detachment (RD) following endogenous endophthalmitis (EE). Methods Retrospective study of individuals with EE from two tertiary care centers. Demographics, medical and ocular history, presenting clinical features, microbial cultures, and initial management were assessed in relation to subsequent RD. Results Of 93 study eyes, 30 (32.3%) diagnosed with EE developed subsequent RD. Compared with eyes that did not develop subsequent RD, eyes that developed RD had lower intraocular pressure (IOP) at presentation (RD: 14.0 ± 6.5 mm Hg vs. no RD: 17.3 ± 7.7 mm Hg, p = 0.02) and had higher rates of methicillin-resistant Staphylococcus aureus (MRSA) positive blood cultures (RD: (13/30) 43.3% vs no RD: (9/63) 14.3%, p = 0.004). The number of intravitreal injections was higher in eyes that developed subsequent RD compared to eyes that did not (RD: 5.3 ± 3.3 vs. no RD: 3.9 ± 3.0, p = 0.02), while no difference in subsequent RD was noted in eyes receiving therapeutic vitrectomy (p = 0.19). After controlling for age, sex, and duration of follow-up, lower IOP at presentation and MRSA positive blood cultures were associated with significantly higher odds of subsequent RD. Conclusion Eyes with lower IOP at presentation and positive MRSA blood cultures were associated with higher rates of subsequent RD, even after controlling for age, sex, and duration of follow-up. Longer follow-up of patients with EE with MRSA bacteremia may be warranted, and larger cohort studies to identify additional features associated with RD are needed.

Kahook dual blade goniotomy combined with phacoemulsification in eyes with primary open angle glaucoma and pseudoexfoliation glaucoma: comparative study

PurposeTo compare outcomes of phacoemulsification combined with a Kahook Dual Blade (KDB) goniotomy in eyes with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).MethodsThis retrospective comparative study was conducted in a tertiary medical center. Sixty eyes of 60 patients (27 with POAG, 33 with PXG) underwent phacoemulsification combined with a KDB goniotomy. Intraocular pressure (IOP), number of medications used, best corrected visual acuity preoperatively and at 1 day, 1 week and 1, 3, 6 and12 months postoperatively, surgical success, and surgical complications were reviewed. If IOP reduction was >%30 or postoperative IOP < 18 mmHg, the procedure was considered as surgical success.ResultsThe mean IOP reduced from 26.4 ± 5.9 mmHg at baseline to 17.9 ± 6.1mmHg at 12 months for POAG (p < 0.01) and from 27.1 ± 7.9 at baseline to 15.1 ± 2.3 mmHg at 12 months for PXG (p < 0.01). Medication use reduced from 3.4 ± 0.9 to 2.0 ± 1.3 for POAG (p < 0.01) and from 3.7 ± 0.5 to 1.8 ± 1.3 for PXG (p < 0.01) at 12 months. Mean IOP was significantly lower in PXG than POAG at week 1 and months 1, 3, 6 and 12 (all p < 0.05). Surgical success rate was 74% for POAG and 84% for PXG (p = 0.30) at 12 months. No vision-threatening complications occurred.ConclusionKDB goniotomy combined with cataract surgery was safe and effectively reduced the IOP and drug burden in patients with POAG and PXG. In the first year, significantly lower IOPs were noted in PXG compared with POAG.

Clinical aspects of the application of endoscopic laser cyclodestruction

BACKGROUND: Glaucoma remains one of the leading causes of irreversible vision loss worldwide, due to the steadily increasing incidence with age. In recent years, minimally invasive glaucoma surgery combined with cataract extraction has gained significant popularity as an alternative to traditional filtering surgeries. Among the methods of hypotensive action included in the minimally invasive glaucoma surgery concept, endoscopic laser cyclodestruction plays a special role, allowing for effective reduction of aqueous humor production. AIM: The aim of this study is to determine the optimal conditions for achieving maximum efficiency and safety of endoscopic laser cyclodestruction. MATERIALS AND METHODS: The present study analyzed the results of 110 combined procedures (phacoemulsification and endoscopic laser cyclodestruction) performed in our clinic. The study included 110 patients (56 men and 54 women) aged from 56 to 89 years (mean age 73.7 years) diagnosed with stage I–IV glaucoma and initial complicated cataract. All patients underwent anterior endoscopic laser cyclodestruction using the E2 videoendoscopic laser ophthalmic device (Endo Optiks Inc., USA) after phacoemulsification and intraocular lens implantation. Dynamic follow-up included visual acuity testing, perimetry, tonometry, instillation regimen assessment, anterior segment OCT, and registration of complications over 60 months. RESULTS: The data analysis showed no hemorrhagic complications and significant inflammatory reactions in the vast majority of patients. The average dynamics of intraocular pressure reduction over 60 months was 24.6%, indicating the high efficacy of endoscopic laser cyclodestruction in intraocular pressure lowering and in stabilizing the condition in glaucoma patients. CONCLUSIONS: Endoscopic laser cyclodestruction demonstrates high efficacy and safety, with virtually no contraindications, except in cases of technical difficulties. The optimal efficiency of the procedure is achieved by destructing the ciliary body processes over 180–200°, significantly reducing intraocular pressure and decreasing dependence on hypotensive therapy.

Biomechanical Corneal Parameters in Eyes With Chronic Ocular Hypotony and in Non-Hypotonic Eyes. Self-Controlled Case Series Study.

There are no available data concerning corneal parameters in patients with chronic ocular hypotony. Our purpose is to provide evidence and clinical correlation on the biomechanical corneal changes in chronic hypotonic eyes. A single-center, transversal, self-controlled case series study was conducted involving patients with at least one chronic hypotonic eye (defined as an intraocular pressure ≤6.5mmHg measured on three separate occasions for at least three months). The chronic hypotonic eye was the case and the contralateral eye the control (non-hypotonic eye). We collected data from baseline characteristic and intraocular pressure (mmHg). Biomechanical corneal parameters measured by Corvis ST: deformation amplitude ratio (mm), Ambrósio's relational thickness (μm), stiffness parameter at first applanation (mmHg/mm), Integrated radius (mm-1), stress-strain index, pachymetry (μm), and in addition macular folds were recorded as well. A descriptive and exploratory analysis was performed. Between November 2021 and July 2023, a total of 16 consecutive patients (7 men, 9 women; age [median (range)]: 72 (62-84)), diagnosed with chronic ocular hypotony in one eye were included: 16 chronic hypotonic eyes and 16 non-hypotonic eyes. Hypotonic versus non-hypotonic eyes [median (range)]: intraocular pressure: 4 (2-6) mmHg, 16 (8-38) mmHg; deformation amplitude ratio: 5.6 (4.3-6.6) mm, 4.7 (3.9-5.5) mm, p-value= 0.002; Ambrósio's relational thickness: 482 (263-932) μm, 530 (210-818) μm, p-value: 0.845; stiffness parameter at first applanation: 61.5 (39-100) mmHg/mm, 113 (68-130) mmHg/mm, p-value: <0.001; Integrated radius: 10.9 mm-1 (6.3-16.8), 7.9 mm-1 (6.4-10.5), p-value: <0.001; stress-strain index: 0.7 (-0.2-4.9), 1.1 (-2.7-5.6), p-value: 0.034; pachymetry 509 (456-617) μm, 512 (436-775) μm, p-value: 0.637; and macular folds: 7/16, 0/16, p-value: <0.001. Chronic hypotonic eyes (eyes with a low intraocular pressure) present biomechanical corneal changes with respect to non-hypotonic eyes, mainly in deformation amplitude ratio, stiffness parameter at first applanation, stress-strain index and Ambrósio's relational thickness parameters. These biomechanical corneal changes could reflect softer, more elastic and deformable scleras, which at its turn can bear higher risk of hypotony maculopathy.

Enhanced Aqueous Humor Outflow Following Trabeculotomy in Primary Congenital Glaucoma Eyes.

Enhanced Aqueous Humor Outflow Following Trabeculotomy in Primary Congenital Glaucoma Eyes.

Clinical outcomes of PRESERFLO® Microshunt procedure with mitomycin C alone versus with mitomycin C and bevacizumab.

The PRESERFLO® Microshunt procedure offers a safe and effective alternative to trabeculectomy procedure. The adjuvant use of anti-vascular endothelial growth factor (VEGF) with trabeculectomy has been well studied, yet little is known on the effect and safety of anti-VEGF agents used as an adjunctive therapy in PRESERFLO® procedures. To compare the outcomes of PRESERFLO Microshunt procedure using either mitomycin C (MMC) alone versus MMC augmented with bevacizumab in patients with open angle glaucoma to a follow-up time of 6 months. Retrospective observational single-center single-surgeon study. Patients' records of patients who consecutively underwent PRESERFLO Microshunt at Queen Victoria Hospital, United Kingdom, were examined. From December 2018 to January 2020, eligible patients underwent PRESERFLO Microshunt implantation with MMC alone (0.2-0.4 mg/ml), whereas from February 2020 to January 2022, patients underwent PRESERFLO Microshunt implantation with MMC (0.2-0.4 mg/ml) and adjuvant intracameral 0.1 ml of bevacizumab (1.25 mg/0.05 ml). Efficacy outcomes were analyzed, including changes in intraocular pressure (IOP) and changes in medication use. Postoperative complications and postoperative interventions were also reviewed. A total of 75 eyes were included in the analysis, 38 eyes received MMC alone, whereas 37 eyes received MMC combined with bevacizumab. There were no statistically significant differences in the demographic or clinical profile of patients between treatment groups.Both strategies were effective in terms of IOP lowering (baseline vs 6 months postoperatively: 20.0 (6.8) mmHg vs 12.8 (3.7) mmHg in the MMC group; 23.6 (6.9) mmHg vs 11.9 (4.2) mmHg in the MMC+ bevacizumab group; p < 0.001 in both comparisons). Mean anti-glaucoma medication use also reduced significantly from baseline with no difference between both groups. A higher proportion of patients required postoperative interventions (5-FU injection, needling, and bleb revision) in the MMC alone group (N = 16; 42.1%) compared to the MMC+ bevacizumab group (N = 4; 9.9%) which was statistically significant (Pearson's χ2 test; p = 0.002). Adjuvant use of bevacizumab in MMC-augmented PRESERFLO Microshunt procedure is at least as effective as MMC alone but helps reduce rates of postoperative interventions.

Acetazolamide-loaded intravitreal implants for the treatment of glaucoma: formulation, physicochemical characterization and assessment of in vitro and in vivo safety.

Acetazolamide-loaded intravitreal implants for the treatment of glaucoma: formulation, physicochemical characterization and assessment of in vitro and in vivo safety.

An atypical case of ripasudil-induced late-onset choroidal detachment: An idiosyncratic irony

We report a rare case of ripasudil-induced late-onset choroidal detachment (CD) in a 64-year-old male with advanced primary open-angle glaucoma. The patient developed 360° serous CD 2 months after initiating ripasudil in the right eye post-trabeculectomy, in the setting of low intraocular pressure. Discontinuation of ripasudil and initiation of topical and systemic steroids resulted in complete resolution of CD with visual recovery. This case highlights the potential idiosyncratic risk of CD with ripasudil, emphasizing the need for cautious use in postsurgical eyes. Early recognition and prompt intervention are essential to prevent permanent visual sequelae in such cases.

Biomechanical Strain Responses in the Sclera, Choroid, and Retina in Glaucoma Patients After Intraocular Pressure Lowering.

This study measured the strain response to intraocular pressure (IOP) change in the sclera, choroid, and retina of glaucoma patients whose optic nerve head region was imaged by optical coherence tomography (OCT) before and after IOP-lowering by laser suturelysis following trabeculectomy surgery. The strain response was calculated from digital volume correlation of the prior and after images. The strain response of the sclera, choroid, and retina were compared to those previously published for the anterior lamina cribrosa (ALC). Mean strains were lowest in the retina and highest in the prelaminar neural tissue (PLNT). Maximum principal and maximum shear strains were significantly increased with greater IOP decrease in all five eye regions. Maximum principal and maximum shear strains in the anterior lamina cribrosa and the sclera were significantly related (p = 0.0094). Strain in the radial direction was negative in the ALC and PLNT, but positive in the sclera (p = 0.017). In conclusion, the strain response of the sclera, choroid, and retina is related to the magnitude of IOP change and is smaller than those of the ALC. The strain response of the ALC and sclera are significantly related to each other.

Revolution in glaucoma treatment: a review elucidating canaloplasty and gonioscopy-assisted transluminal trabeculotomy as modern surgical alternatives.

Open-angle glaucoma (OAG) is a leading cause of permanent blindness worldwide, and surgical interventions that restore the natural aqueous humor outflow pathway have emerged as promising treatment options. Therefore, we aimed to analyze the efficacy and safety profile of specific antiglaucoma surgeries, namely canaloplasty (ab interno and ab externo techniques) and gonioscopy-assisted transluminal trabeculotomy (GATT), in surgical treatment patients with primary and secondary OAG. Consequently, a systematic review of the recent literature was conducted using online databases. The effectiveness of the surgeries was assessed by reductions in intraocular pressure (IOP) measurements and decreased use of antiglaucoma eye drops preoperatively and postoperatively. The safety profile of these procedures was evaluated by recording the incidence of specific intraoperative and postoperative complications. Independent studies have shown that ab interno and ab externo canaloplasty procedures and GATT effectively lower IOP and decline medications burden. Therefore, given the favorable safety profiles, canaloplasty and GATT are associated with low incidences of postoperative adverse events and exhibit comparable safety characteristics. However, additional research, including a well-conducted randomized controlled trial comparing ab externo and ab interno canaloplasty with GATT, is required to validate our findings.

Comparison of the Intraocular Pressure-lowering Effects of Three Primary Surgical Procedures in Pediatric Aphakic Glaucoma

Comparison of the Intraocular Pressure-lowering Effects of Three Primary Surgical Procedures in Pediatric Aphakic Glaucoma

First results of direct selective laser trabeculoplasty for the treatment of glaucoma

AimTo evaluate the efficacy and safety of direct selective laser trabeculoplasty (DSLT) on eyes with primary open-angle glaucoma (POAG) and on primary angle closure glaucoma (PACG) eyes at 1 year...