Mean Baseline Intraocular Pressure Research Articles

Efficacy of gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in patients with primary open-angle glaucoma and pseudoexfoliative glaucoma: A single surgeon's experience.

To compare the intraocular pressure (IOP)-lowering efficiency of gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) with mitomycin C in patients with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). In this retrospective comparative study, consecutive patients with POAG or PEXG who underwent GATT or TRAB by a single surgeon and with a follow-up period of at least 1 year were included. Surgical success rates, change in best-corrected visual acuity, IOP, the need for antiglaucoma medication, surgical complications, and the need for additional glaucoma surgery were compared. Surgical success was defined as an IOP reduction of ≥30% or an IOP of ≤18 mmHg. Complete success was defined as without medication. Qualified success was defined as with or without topical medication. The mean baseline IOP was 27.4 ± 8.3 and 24.6 ± 7.6 mmHg ( P = 0.13) with the mean number of medications being 3.7 ± 1.0 and 3.7 ± 1.1 ( P = 0.98) in TRAB and GATT, respectively. At 12 months, the mean IOP was 15.3 ± 3.5 and 12.5 ± 4.6 mmHg ( P = 0.24) with the mean number of medications being 0.9 ± 1.2 and 0.8 ± 1.4 ( P = 0.76) after GATT and TRAB, respectively. IOP was lowered from baseline by 52.7% ± 17.5% after TRAB and 45.7% ±18.6% after GATT ( P = 0.12). There was no decrease in best-corrected visual acuity in either group. The qualified surgical success rate was 94.4% in the GATT group and 94.9% in the TRAB group ( P = 0.75). Percentage of complete success was 64.1% and 52.8% ( P = 0.22) after TRAB and GATT, respectively. In patients with POAG and PEXG, GATT was as effective and safe as TRAB in lowering IOP and reducing the number of antiglaucomatous drugs.

The impact of different postures on acute intraocular pressure and accommodation responses during reading

IntroductionTo investigate the effects of different reading postures on intraocular pressure (IOP) and near-work-induced transient myopia (NITM) in children with myopia.MethodsSixty myopic children were instructed to read a book text placed at 33 cm for 30 min with two different reading postures: head bowed and head upright postures. The participants’ IOP and NITM were assessed using a rebound tonometer and an open-field autorefractor. The measurement of IOP was conducted prior to reading, during reading sessions (at 5, 10, 20, and 30-min intervals), and after a 5-min recovery period.ResultsFor the head bowed posture, the mean baseline IOP was 16.13 ± 2.47 mmHg. A significant rise in IOP was observed after 5 min of reading (17.17 ± 2.97 mmHg; +1.03 ± 2.29 mmHg; p = 0.014). Subsequent measurements revealed a further increase after 20 min (17.87 ± 2.90 mmHg; +1.73 ± 2.58 mmHg; p < 0.001), which continued to persist even after 30 min of reading (17.57 ± 3.46 mmHg; +1.43 ± 2.66 mmHg; p = 0.002). The IOP at different time points measured in the head upright posture did not show any significant difference in comparison to the baseline measurement (all p = 1.000). Compared to reading with the head upright, reading with the head bowed resulted in a greater increase in IOP at each time point (p < 0.05). Furthermore, the NITM was higher for reading with the head bowed than for reading with head upright at 30 min (-0.24 ± 0.53 D vs. -0.12 ± 0.47 D, p = 0.038).ConclusionReading in a head bowed position resulted in greater increases in IOP and NITM compared to reading in a head upright posture.

Comparison between modified and conventional combined Trabeculotomy-Trabeculectomy with Mitomycin-C for intraocular pressure reduction in primary congenital glaucoma.

To determine the efficacy of modified combined trabeculotomy-trabeculectomy (CTT) with mitomycin-C (MMC) versus conventional CTT with MMC for intraocular pressure (IOP) reduction in patients with primary congenital glaucoma (PCG). This interventional study was carried out in The Institute of Ophthalmology, Lahore from January 2018 to June 2019. We included 70 patients of either gender, with the age range from birth to ten years and with PCG having IOP >30 mm Hg. These patients were divided in groups A and B with 35 patients in each group. Patients in Group-A underwent modified CTT with MMC and in Group-B conventional CTT with MMC was carried out. The mean age of our patients was 15.17 ± 12.39 months. Regarding gender, 57 (81.4%) were males and 13 (18.6%) were females. Baseline mean IOP in Group-A was 32.49 ± 1.01 mm Hg whereas in Group-B mean IOP was 31.97 ± 1.04 mm Hg. After one month, the mean IOP was 27.60 ± 1.72 mm Hg in Group-A, whereas mean IOP was 27.40 ± 1.82 mmHg in Group-B. After three months, the mean IOP was 21.63 ± 1.09 mm Hg in Group-A, whereas 20.97 ± 1.12 mm Hg in Group-B. In Group-A efficacy was achieved in 14 (40%) patients whereas in Group-B efficacy was achieved in 25 (71.4%) patients. Our study revealed that conventional CTT with MMC showed better efficacy than modified CTT with MMC for reduction of IOP in PCG.

36-Month Outcomes of Standalone Kahook Dual Blade Goniotomy Compared with Ab-Interno Closed Conjunctiva Xen Gel Stent Implantation.

To compare the safety and effectiveness of standalone Kahook Dual Blade (KDB) excisional goniotomy to standalone ab-interno Xen gel stent implantation in eyes with moderate-to-severe open-angle glaucoma (OAG). A single-center, retrospective study including eyes with moderate-to-severe OAG undergoing standalone KDB goniotomy or Xen gel stent implantation was conducted. Intraocular pressure (IOP), the number of antiglaucoma medications taken daily, and best-corrected visual acuity (BCVA) were recorded at baseline and for up to 36-months. Primary outcomes assessed included changes from baseline in IOP and the number of antiglaucoma medications taken. Intergroup comparisons were conducted using independent-samples Student'st-tests. The incidence of intraoperative and postoperative adverse events and the need for glaucoma surgical re-interventions were also recorded. Eyes receiving standalone KDB (n=26) or Xen gel stent (n=45) surgery were analyzed. The baseline mean IOP and number of antiglaucoma medications in both groups were as follows: KDB: 23.2 ± 6.0 mmHg, 2.2 ± 1.4 medications; Xen: 22.7 ± 8.8 mmHg, 3.0 ± 1.0 medications. At 36 months, IOP was reduced to 16.6 ± 5.4 mmHg in KDB eyes (n=23, -23.5%; p=0.0004) and 15.3 ± 5.6 mmHg in Xen gel stent eyes (n=15, -22.1%; p=0.006), while number of antiglaucoma medications was reduced to 1.1 ± 0.7 (-30.8%; p=0.0005) and 2.2 ± 1.4 (-25.6%; p=0.01), respectively. Three eyes (11.5%) in the KDB group and 19 eyes (42.2%) in the Xen gel stent group required additional surgery before month 36 due to refractory high IOP. Both KDB goniotomy and Xen gel stent implantation significantly lowered the IOP and antiglaucoma medication burden in patients with moderate-to-severe OAG. While the Xen gel stent is frequently used to treat moderate-to-severe OAG patients with uncontrolled IOP, standalone KDB goniotomy may be equally effective as a long-term intervention, reducing the need for subsequent glaucoma surgery.

Efficacy and Safety of Diode Laser Transscleral Cyclophotocoagulation in Patients with Glaucoma.

To evaluate the efficacy and safety of transscleral diode cyclophotocoagulation (TSCPC) at 2 years of follow up. This is a retrospective review of the records of all adult patients who underwent their first TSCPC treatment between 2014 and 2019 at Unidade Local de Saúde de São João, Porto, Portugal. Data regarding intraocular pressure (IOP), best corrected visual acuity, number of IOP-lowering medications, use of oral acetazolamide, retreatments and complications during a 2-year period following TSCPC were registered. The primary outcome was overall success at 2 years, defined as IOP≥ 6 and ≤21 mmHg, with at least 20% IOP reduction from baseline, with or without IOP-lowering medications (qualified and complete success, respectively), without the development of phthisis bulbi or loss of light perception due to glaucoma and no further glaucoma procedures except TSCPC retreatment. Ninety-six eyes from 96 patients were included, mean age was 63 (±14) years. Mean IOP at baseline was 39.1 (±13.3) mmHg. Mean IOP reduction at 2 years was 18.5 (42.9%) mmHg (±16.0, min -16.0, max 56.0) (p < 0.001) and a significant reduction in the number of IOP-lowering medications and use of oral acetazolamide was observed. IOP reduction at 2 years was positively correlated with baseline IOP (r=0.682; p < 0.001). Overall success (including complete and qualified) was achieved in 42 patients (43.8%), with 34 (35.4%) presenting qualified success. Neovascular glaucoma (NVG) was the predominant diagnosis (n = 30, 31.3%), with a higher mean baseline IOP of 46.3 mmHg (±11.8, min 21.0, max 70.0) and a larger mean IOP reduction at 2 years of 24.7 (51.0%) mmHg (±16.4, min -2.0, max 55.0). Thirteen patients (13.5%) developed persistent hypotony, eight of which converted to phthisis bulbi, of which half had NVG. TSCPC can be an effective IOP-lowering procedure, demonstrating a stronger effect when the preoperative IOP is highest. However, there is a wide variability in the effect (specially in eyes with NVG) and some relevant complications, including 8.3% of patients developing phthisis bulbi after 2 years of follow up.

Effectiveness of pars plana Ahmed® valve implantation in patients with refractory glaucoma

PurposeTo evaluate the success rate and complications of the Ahmed FP7 valve implanted via Pars Plana in a group of vitrectomized patients with refractory glaucoma and anterior segment abnormalities from January 2018 to June 2023. MethodsQuasi-experimental, prospective study. Eleven eyes with refractory glaucoma were included. Participants underwent a comprehensive ophthalmic examination, including assessment of intraocular pressure (IOP) reduction, visual acuity, characterization of glaucoma type, and number of antiglaucoma medications. ResultsThe mean baseline IOP was 37.3 ± 11 mmHg, which decreased to 13.5 ± 3.0 mmHg after one year. The qualified success rate was 63.7%, while the complete success rate was 36.3%. The most common diagnosis was neovascular glaucoma in 36.4% of cases. The most frequent postoperative complications were choroidal detachment and hypotony. ConclusionsOur data suggest that implantation of the Ahmed FP7 valve via pars plana is an effective and safe option for patients with refractory secondary glaucoma.

Efectividad de la válvula de Ahmed® implantada vía pars plana en pacientes con glaucoma refractario

PurposeTo evaluate the success rate and complications of the Ahmed® FP7 valve implanted via Pars Plana in a group of vitrectomized patients with refractory glaucoma and anterior segment abnormalities from January 2018 to June 2023. MethodsQuasi-experimental, prospective study. Eleven eyes with refractory glaucoma were included. Participants underwent a comprehensive ophthalmic examination, including assessment of intraocular pressure (IOP) reduction, visual acuity, characterization of glaucoma type, and number of antiglaucoma medications. ResultsThe mean baseline IOP was 37.3±11mmHg, which decreased to 13.5±3.0mmHg after one year. The qualified success rate was 63.7%, while the complete success rate was 36.3%. The most common diagnosis was neovascular glaucoma in 36.4% of cases. The most frequent postoperative complications were choroidal detachment and hypotony. ConclusionsOur data suggest that implantation of the Ahmed FP7 valve via pars plana is an effective and safe option for patients with refractory secondary glaucoma.

A Randomized, Controlled Comparison of NCX 470, a Nitric Oxide-Donating Bimatoprost, and Latanoprost in Subjects with Open-Angle Glaucoma or Ocular Hypertension: The MONT BLANC Study

PurposeTo compare intraocular pressure (IOP)-lowering efficacy and safety profile of NCX 470, a nitric oxide (NO)-donating bimatoprost, to latanoprost in subjects with glaucoma or ocular hypertension. DesignProspective, phase 3, randomized, adaptive dose-selection, double-masked, parallel-group trial. Methods: Participants691 subjects with open-angle glaucoma or ocular hypertension and unmedicated IOP of IOP ≥26 mmHg at 8AM, ≥24 mmHg at 10AM, and ≥22 mmHg at 4PM in the study eye. Study Procedures: Subjects were randomized to treatment with NCX 470 0.065%, NCX 470 0.1%, or latanoprost 0.005%. To identify the final NCX 470 dose, an interim analysis was performed after at least 30 subjects in each group had completed the Week 2 visit. Enrolled subjects were randomized to this final NCX 470 dose, 0.1%, or latanoprost for 12 weeks. Main outcome measure: We evaluated non-inferiority followed by superiority of NCX 470 versus latanoprost, based on IOP reduction from baseline at 8AM and 4PM at 2 weeks, 6 weeks, and 3 months. ResultsNCX 470 0.1% was the final dose and 661 subjects were analyzed that received NCX 470 0.1% (n=328) or latanoprost (n=333). At baseline, the mean (SD) IOP at 8AM and 4 PM was 28.3 (2.0) mmHg and 25.5 (2.5) mmHg, respectively, in the NCX 470 0.1% group, and was significantly reduced at all on-treatment time points, with reductions ranging from 8.0-9.7 mmHg (p<0.0001 at each time point). Likewise, mean (SD) baseline IOP at 8AM and 4PM was 28.2 (2.0) mmHg and 25.4 (2.4) mmHg, respectively, in the latanoprost group and was significantly reduced at all on-treatment time points, with reductions ranging from 7.1-9.4 mmHg (p<0.0001 at each time point). At the 3-month visit, mean IOP reductions were greater with NCX 470 0.1% than latanoprost 0.005% at all 6 time points and significantly greater (p<.05) at 4 of the 6 time points. Noninferiority versus latanoprost was established at all 6 timepoints. The most common adverse event was conjunctival/ocular hyperemia and was more common in the NCX 470 group compared to latanoprost; 8 NCX 470 and 6 latanoprost subjects discontinued due to adverse events. ConclusionThe NO-donating prostaglandin analogue NCX 470 0.1% was well-tolerated and lowered IOP more than latanoprost in subjects with open-angle glaucoma or ocular hypertension at all 6 time points. With a dual mechanism of action that enhances both uveoscleral and trabecular outflow, NCX 470 could become an important first-line therapy for IOP reduction in glaucoma.

Comparison of intraocular pressure profiles during the water drinking test and the modified diurnal tension curve

ObjectivesTo compare intraocular pressure (IOP) during the water drinking test (WDT) and modified diurnal tension curve (mDTC) in open-angle glaucoma (OAG) patients, using multimodal, observer-masked tonometry.MethodsOpen-angle glaucoma subjects were prospectively enroled, excluding those who had undergone glaucoma filtration or laser surgery. Two-hourly mDTC Goldmann applanation (GAT) and rebound tonometry (RT) was performed between 8:00 and 16:00, and every 15 min for 45 min after ingestion of 800mls of water. Blood pressure, heart rate, pupillometry measurements, and optical coherence tomography (AS-OCT) were also recorded.ResultsForty-two subjects’ right eyes were included. 48% were using topical glaucoma medication. Mean baseline IOP was 14.9 ± 4.52 mmHg, with mean visual field mean deviation (±SD) −5.05 ± 5.45 dB. Strong association was found between maximum IOP during mDTC and WDT (r = 0.90, 95% CI 0.82–0.95 p < 0.0001) with agreement (mDTC-WDT) bias −0.82 mmHg, 95% LoA −1.46 to −0.18. During the WDT, mean systolic blood pressure (±SD) increased from 140.0 ± 20.0 to 153.3 ± 24.0 mmHg (p < 0.0001), mean heart rate ( ± SD) reduced from 69.5 ± 11.3 bpm to 63.6 ± 10.0 bpm (p < 0.0001), and temporal iridocorneal angle increased from 29.2 ± 6.0° to 29.6 ± 5.2° (p = 0.04).ConclusionThis study presents repeated, observer-masked IOP data showing strong correlation between maximum IOP during mDTC and WDT using multimodal tonometry. This supports WDT as a meaningful alternative to mDTC when investigating diurnal IOP characteristics in clinic, with reduced time requirements and associated costs.

Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade.

To report clinical outcomes of successful excisional goniotomy with the Kahook Dual Blade (KDB), through 60 months. This was a noncomparative, single-surgeon, retrospective review of eyes receiving successful KDB goniotomy with or without concomitant phacoemulsification between October 2015 and January 2016 with five years of uninterrupted follow-up. Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), and complications were recorded. Primary outcomes included changes from baseline in IOP, medication use, and BCVA, through five years. Fifty-two eyes of 28 patients were analyzed. Most eyes had mild primary open angle glaucoma (73%). Of the eyes analyzed, 41 underwent combined surgery and 11 underwent standalone surgery. With all eyes combined, mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0 to 13.7 mmHg, representing mean reductions of 7.3-8.0 mmHg (34.7-38.3%; p <0.0001 at every time point). Similarly, mean medication use ranged from 0.4 to 0.6 medications per eye, representing mean reductions of 1.2-1.4 medications (66-75.5%; p <0.0001 at every time point). Mean logMAR BCVA improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p < 0.0001). In eyes not requiring secondary surgical procedures (eg, long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through five years of follow-up. KDB goniotomy appears to be highly successful in Caucasian patients with open angle glaucoma on ≥1 IOP-lowering medications at baseline and with no history of prior ocular surgery. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.

Outcomes of phaco-trabeculectomy versus phaco-viscocanalostomy for primary open angle glaucoma

PurposeThis study aimed to compare the intraocular pressure (IOP)-lowering effect and postoperative adverse effects of combined phacoemulsification and trabeculectomy (PT) and combined phacoemulsification and viscocanalostomy (PVC) in eyes with primary open-angle glaucoma (POAG). MethodsIn this prospective study, eighty-one consecutive patients (81 eyes) with POAG and cataract were enrolled. The eyes were randomly assigned to either the PT group (40 eyes) or the PVC group (41 eyes). The main outcomes included the success rate based on IOP and the evaluation of adverse effects during the 6-month follow-up period. The surgery was considered a complete success if the IOP was between 6 and 20 mmHg and reduced by ≥30% without glaucoma medications or additional surgery compared to the preoperative level. A qualified success was characterized by an IOP within the range of 6−20 mmHg and a 20−30% reduction in IOP achieved through the use of glaucoma medications. ResultsThe mean baseline IOP was 23.20 ± 7.94 mmHg in the PT group and 21.29 ± 6.81 mmHg in the PVC group (P = 0.249). At 6 months, the mean postoperative IOP in the PT and PVC groups were 13.50 ± 2.49, and 13.73 ± 1.70, respectively. There was no significant difference in mean IOP between the groups at any time (P > 0.05). At 6 months, 22 patients (55%) in the PT group and 22 patients (53.66%) in the PVC group achieved complete success. Nine eyes (22.50%) in the PT group and 10 eyes (24.39%) in the PVC group achieved qualified success. The other patients (9 eyes in each group) did not meet the criteria for at least a qualified success and were considered failures (P = 0.980). Intraoperative microperforation of Descemet's membrane occurred in 2 cases (15%) in the PVC group. Postoperative complications included 4 cases (10%) of shallow/flat anterior chamber, 1 case (2.5%) of choroidal effusion, and 1 case (2.5%) of aqueous misdirection in the PT group. The rate of these postoperative adverse effects was not significant between the two groups (P > 0.05). ConclusionsThere was no significant difference in IOP reduction between PT and PVC in patients with POAG. Furthermore, PVC is safe enough in these patients, compared to PT.

SELECTIVE LASER TRABECULOPLASTY AS A VALUEABLE MODALITY OF TREATMENT IN OPEN ANGLE GLAUCOMA PATIENT

Introduction &amp; ObjectivesSelective Laser Trabeculoplasty (SLT) has became an established treatment to lower intraocularpressure (IOP) for open angle glaucoma (OAG) and ocular hypertension. The aim of this study was toevaluate IOP lowering effect of SLT and correlate its laser parameter to the successful rate in OAG.&#x0D; MethodsThis is a prospective study of seventeen eyes OAG patients in Cicendo Eye Hospital from 1stNovember 2022 to 31th December 2022. SLT performed once in OAG with uncontrolled IOP (IOP &gt;21 mmHg). Outcome measured were IOP at post laser, 1week , 1 month, and 2 months of follow upafter SLT. Successful criteria determined as greater than 20% IOP reduction. Correlation betweensetting operational of SLT and primary outcome were measured. Student’s t-test (two-tailed,dependent) has been used to find the significance of study parameters.&#x0D; ResultsA total 17 eyes underwent SLT. Mean baseline IOP was 21,12 ? 4,0 mmHg. IOP was significantlydecreased from baseline post laser 18,06 ? 3,17 mmHg; at 1 week 17,06 ? 3,25 mmHg; 1 month15,53 ? 4,52 mmHg; and at 2 month follow up 15,47 ? 4,02 mmHg (p&lt;0,001). The successful rate ofSLT after two months follow up from this study were 76,5% samples (13 eyes). Mean of total laserenergy was 75,6 ? 16,8 mJ. There was correlation between total laser energy with percentage of 1month IOP reduction (coefficient : 0,470 (p&lt;0,029)).&#x0D; ConclusionSLT is effective and safe for reducing IOP in open angle glaucoma patient.

Superonasal vs Inferonasal Subconjunctival Gel Stent Placement in Patients with Glaucoma.

To compare the safety and efficacy of subconjunctival gel stent implantation in the superonasal (SN) vs inferonasal (IN) quadrants in the treatment of glaucoma. Patients with a history of IN (n = 29) or SN, (n = 96) gel stent placement with ≥3 months of follow-up were included. Intraocular pressure (IOP) and the number of glaucoma medications were collected preoperatively and postoperatively at months 1, 3, 6, and 12. Safety measures included the number of bleb needlings, complication rate, and additional surgeries. Mean baseline IOP was 32.4 ± 11.7 mm Hg in the IN group and 21.6 ± 9.2 mm Hg in the SN group (p < 0.01). IOP was similar between groups at 3 months (IN = 15.8, SN = 15.6, p = 0.45), 6 months (IN = 17.4, SN = 15, p = 0.13), and 12 months (IN = 17.9, SN = 14.7, p = 0.15) follow-up. The number of glaucoma medications was also similar at 3 months (p = 0.31), 6 months (p = 0.24), and 12 months (p = 0.39) follow-up. Bleb needling rates were similar with 51.7% (15/29) in the IN group vs 42.7% (41/96) in the SN group (p = 0.39) and subjects requiring further surgery were 17.2% (5/29) in the IN group vs 24.0% (23/96) in the SN group (p = 0.45). Both IN and SN subconjunctival gel stent placements provide favorable safety and efficacy when treating open-angle glaucoma, with a meaningful decrease in medication use and IOP. Implantation of the subconjunctival gel stent in the IN quadrant is an effective and safe alternative to superior implantation in refractory glaucoma. Vander Zee BL, Wilson C, Berdahl JP, et al. Superonasal vs Inferonasal Subconjunctival Gel Stent Placement in Patients with Glaucoma. J Curr Glaucoma Pract 2024;18(2):63-67.

Immediate effect of anti-VEGF injections on optic nerve head: Correlation between intraocular pressure and anatomical peripapillary changes.

This study was designed to investigate retinal nerve fiber layer (RNFL) and radial peripapillary capillaries (RPC) changes on optical coherence tomography (OCT) angiography and OCT thickness alterations associated with acutely increased intraocular pressure after intravitreal injections. This observational clinical study was conducted on 35 eyes (35 patients) with treatment-naïve age-related macular degeneration (AMD) and type 1 or type 2 MNV were enrolled. All patients underwent anti-vascular endothelial grow factor (VEGF) intravitreal injections with 0.05-mL aflibercept (2 mg) between January 2022 and October 2022. Peripapillary OCT angiography perfusion density, retinal nerve fiber layer thickness, and intraocular pressure (IOP) were measured before and immediately after intravitreal injections. In particular, the analysis was performed at the following visits: (T0) 5 to 15 min before the injection of aflibercept; (T1) 2 to 5 min after the injection of aflibercept. Paired t-test was used to compare pre-injection and post-injection values. The mean baseline IOP (T0) value was 17.26 ± 2.4 mmHg and the immediate post-injection IOP (T1) mean value was 34.7 ± 11.50 mmHg (P < 0.01). The mean global RNFL thickness before and immediately after the injection was 100.9 ± 18.8 m and 98.6 ± 17.4 m (P = 0.001). Furthermore, the topographical RNFL analysis showed significant thickness reduction of the nasal and inferior sectors after the procedure when compared to T0 (P = 0.046 and P = 0.001). On the contrary, the mean RCP density changes at T1 did not reach statistically significant (P = 0.636). Furthermore, we found a significant negative correlation between the retinal nerve fiber layer global thickness and the IOP changes (Pearson's correlation = -0.126; P = 0.031). In particular, the nasal RNFL region showed a significant negative correlations with IOP values (Pearson's correlation = -0.198, P = 0,046). We reported acute IOP changes that are associated with reduced RNFL thickness in a group of patients undergoing intravitreal injections of anti-VEGF drugs for neovascular age-related macular degeneration. Moreover, topographical sub-analysis revealed that the nasal RNFL region is most prone to IOP fluctuations. This finding may explain the sudden visual acuity change in patients immediately after injection and may sustain injuries to optic nerve head structures producing glaucomatous damage.

Intraoperative iStent versus postoperative selective laser trabeculoplasty in early glaucoma patients undergoing cataract surgery: A retrospective comparative study

To compare the efficacy and safety of iStent inject® versus 360° selective laser trabeculoplasty (SLT) in patients with early glaucoma undergoing cataract surgery. A retrospective non-randomized study was conducted in 73 eyes divided into two groups: cataract surgery+intraoperative iStent (n=40) versus cataract surgery+postoperative SLT at one month (n=33). The primary endpoint was intraocular pressure (IOP) lowering≥20% between baseline and 6 months postoperatively. The secondary endpoints were IOP lowering at 1, 6 and 12 months, and the mean number of IOP-lowering medications at 6 and 12 months. The mean baseline IOP was 19.1 mmHg with no significant difference between groups. The mean baseline number of IOP-lowering medications was higher in the iStent group (n=1.95) compared to the SLT group (n=1.53; P=0.04). At 6 months, 18 (60%) patients in the SLT group and 20 (51%) patients in the iStent group achieved IOP lowering≥20% with no significant difference between groups (P=0.431). At 6 months, no difference in the mean number of IOP-lowering medications was found between groups (-0.92 and -0.89 in the iStent and SLT groups, respectively). Similar results were found at 12 months. These results suggest similar safety and efficacy of intraoperative iStent and postoperative 360° SLT in lowering IOP and reducing glaucoma eye drops in early glaucoma patients undergoing cataract surgery. Treatment choice should be based on the ophthalmologist's experience and on the cost-benefit ratio.

Intraocular Pressure Changes While Reading Smartphone Digital Text Versus Printed Text in Healthy Individuals and those with Glaucoma.

Reading results in a rise in intraocular pressure (IOP) which is greater while using smartphones compared with printed text among healthy and individuals with medically controlled primary open angle glaucoma (POAG). To compare the effect of reading for 30 minutes using smartphone and printed text on IOP. Sixty healthy volunteers and 22 patients with medically controlled POAG were asked to perform reading tasks using printed text followed by digital (smartphone) text under standardized conditions. IOP assessment was done using a rebound tonometer at baseline and subsequently at 10, 20, and 30 minutes of reading and 10 and 20 minutes post completion of reading tasks. IOP variations from baseline were measured and compared. Paired and independent ' T ' test analysis was performed to study IOP variations, and a P -value <0.05 was considered statistically significant. The mean baseline IOP among volunteers and patients withPOAG was 14.58 (±2.91) and 15.02 (±2.18) mmHg, respectively. There was a rise in IOP in all participants with reading using either of the modalities, which normalized after 20 minutes of cessation. There was a statistically significant difference in rise in IOP from baseline between the 2 modalities (printed text reading and smartphone reading) at 20 minutes {+0.78 & +2.01 ( P =0.002)} and 30 minutes {+0.64 & +1.72 ( P =0.004)} among healthy volunteers and at 20 minutes {+0.78 & +2.01 ( P =0.002)} among POAG patients. Reading is associated with the rise in IOP in both healthy volunteers and POAG individuals. The IOP rise is more marked with smartphone compared with printed text reading.

Transient Intraocular Pressure Fluctuations After Intravitreal Bevacizumab Injection in Proliferative Diabetic Retinopathy Patients: A Prospective Study.

The clinical use ofintravitreal bevacizumab (IVB),a recombinant humanized monoclonal antibody that functions as an anti-vascular endothelial growth factor (anti-VEGF), has recently increased in patients with retinal ischemic diseases such asproliferative diabetic retinopathy (PDR). The short-term and long-term complications associated with this procedure have not been well established. We aimedto study the possible short-term complication of intraocular pressure (IOP) fluctuations shortly after IVB injection in patients with PDR. A prospective case series of diabetic patients with PDR who underwent IVB injection was performed in the Department of Ophthalmology, Medical Teaching Institution, Khyber Teaching Hospital, Peshawar, Pakistan, from November 1, 2020, to May 1, 2021. The total number of PDR patients of both sexesincluded in the study was 101. A slit lamp examination was performed, and IOP readings were recorded before and 30 min after IVB injection using Goldmann applanation tonometry (GAT). IBM Statistical Package for the Social Sciences version 22 for Windowswas used to analyze the data. Safety of the procedure, defined as IOP ≤20 mmHg 30 min after IVB injection, was determined and stratified according to sex,age, duration of diabetes, and baseline IOP.A post-stratification chi-square test was applied,and a p-value <0.05 was taken as statistically significant. In this study, 60.4% of the participants were male and 39.6% were female. The age of the patients ranged from 30 to 75 years, with a mean age of 55.66±6.37 years. The mean duration of diabetes among the participants was 7.73±2.94 years and the mean baseline IOP was 15.40±1.77 mmHg. Safety(IOP ≤20 mmHg 30 min after IVB injection) was observed in 90.1% of the patients. IVBinjections are safe for use in patients with PDR in terms of immediate IOP changes. However, patients with higher baseline IOP (>15 mmHg) are more likely to develop increased IOP post-procedure and prophylaxis may be prudent in such cases.

Efficacy and safety of latanoprost/timolol fixed combination dosed twice daily compared to once daily in patients with primary open angle glaucoma.

To evaluate whether latanoprost/timolol fixed combination (LTFC) dosed twice daily may provide further intraocular pressure (IOP) reduction and evaluate the safety profile at this dose. This is an open-labeled, randomized, prospective crossover study on fourty primary open angle glaucoma patients. Two weeks of washout period were followed by randomization to either once daily (OD, group A) or twice daily dosing (BD, group B) of LTFC for 4wk. After another 2-week washout period, the patients' treatment dose was crossed-over for another 4wk. IOP reduction alongside ocular and systemic side effects were evaluated. Mean baseline IOP was 18.57±2.93 and 17.8±3.01 mm Hg before OD and BD dose respectively, (P=0.27). Mean IOP after BD dose was statistically lower (12.49±1.59 mm Hg) compared to OD (13.48±1.81 mm Hg, P=0.017). Although IOP reduction after BD dose was more (5.32±3.24 mm Hg, 29.89%) than after OD dosing (5.04 mm Hg, 27.14%), it did not reach statistical significance (P=0.68). Patients switched from OD to BD (group A) showed mean IOP reduction by 0.69 mm Hg [95% confidence interval (CI): -0.09 to 1.48 mm Hg, P=0.078]; but patients switched from BD to OD (group B) had significantly higher mean IOP by 1.25 mm Hg (95%CI: -2.04 to -0.46 mm Hg, P=0.006). BD dose had more ocular side effects albeit mild. Mean IOP after LTFC dosed twice daily is statistically lower, with additional mild side effects.

Single Administration of Bimatoprost Implant: Effects on 24-Hour Intraocular Pressure and 1-Year Outcomes

To evaluate the effects of a single bimatoprost implant administration on 24-hour intraocular pressure (IOP) lowering at 8 weeks, and 1-year IOP-lowering efficacy and safety outcomes. Multicenter, open-label, 12-month, phase 3b study (NCT04285580). Adults with open-angle glaucoma or ocular hypertension. Participants (n=31) received 10-μg bimatoprost implant in the study eye on day 1; IOP (sitting and/or supine) was measured with pneumatonometry every 2 hours throughout a 24-hour period at baseline and week 8. IOP was measured by Goldmann applanation tonometry (GAT) at hour 0 (8 am±1 hour) at baseline, weeks 8 and 16, and months 6, 9, and12. The primary endpoint was the week-8 hour-matched change from baseline in habitual position IOP over 24 hours assessed with pneumatonometry. Hour 0 IOP change from baseline measured with GAT in study eyes that received no additional (rescue) IOP-lowering treatment, treatment-emergent adverse events (TEAEs), and central corneal endothelial cell density (CECD) were evaluated through 12 months. The mean (standard deviation [SD]) baseline IOP at hour 0 was 24.2 (2.70) mmHg and 25.3 (7.15) mmHg by GAT and pneumatonometry, respectively. Pneumatonometer measurements of IOP taken over 24 hours at week 8 with the participant in habitual position (sitting from 8 am to 10 pm, supine from 12 am to 6 am) showed consistent IOP lowering through the day and night and reduced fluctuation in IOP. The range in IOP measurements over 24 hours was reduced from baseline by a mean (SD) of-1.6 (2.98) mmHg. All 31 bimatoprost implant-treated participants completed the 12-month study; 23 (74%) required no rescue IOP-lowering treatment. The mean (SD) IOP reduction from baseline at month 12 in nonrescued eyes was-4.3 (3.35) mmHg. The most common TEAE was conjunctival hyperemia (incidence 35.5%, 11/31). No implant-treated eye had a ≥ 15% loss in CECD from baseline. A single intracameral administration of the bimatoprost implant lowered IOP in the habitual position consistently throughout the day and night at week 8. The majority of participants continued to have reduced IOP for 1 year without additional therapy. The 1-year safety profile was favorable. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Comparing Ahmed-FP7 to Baerveldt-250 and Baerveldt-350 surgical outcomes: 1-year results from a retrospective cohort study leveraging the electronic health record

ObjectiveTo compare outcomes following Ahmed-FP7 (AGI-FP7), Baerveldt-250mm2 (BGI-250), or Baerveldt-350mm2 (BGI-350) implantation.Methods and analysisRetrospective cohort study comprising 800 eyes from 800 individuals who underwent surgery 1 January 2016–31 December 2020...