Outcomes Of Glaucoma Research Articles

Distribution of port wine birthmarks and glaucoma outcomes in Sturge-Weber Syndrome

PurposeTo identify which features of Sturge-Weber Syndrome (SWS) were most associated with glaucoma onset, severity, and treatment failure at a tertiary care center. DesignRetrospective cross-sectional study. SubjectsChildren who had SWS with and without glaucoma. MethodsElectronic health records were reviewed for all children with SWS presenting between 2014-2020. Examination and imaging findings from dermatology, neurology, and ophthalmology were collected. Logistic regression was used to identify factors associated with glaucoma-related outcomes. Main Outcome MeasuresPrimary outcomes included glaucoma development, progression to surgery, and treatment failure. Failure was defined as having a final intraocular pressure >21 mmHg, devastating complication, or ≤20/200 vision. ResultsTwenty-three of 44 SWS patients (52.3%) developed glaucoma, and 6 of 23 patients (26.1%) had both eyes affected. Sixteen of 29 eyes (55.2%) required surgery, and 29.6% overall met our failure criteria (mean follow-up: 5.1±4.3 years). Glaucoma diagnosis was associated with bilateral port wine birthmarks (PWB; OR 5.9; 95% CI 1.3-43.2), PWB with any lower eyelid involvement (OR 9.7, 95% CI 2.6-44.5), and choroidal hemangiomas (OR 3.8, 95% CI 1.1-13.8), but was not associated with upper eyelid or leptomeningeal angiomas, seizures, prior hemispherectomy or pulsed-dye laser. Eyes that progressed to surgery were more likely to have PWB affecting the lower eyelid (OR 33.7, 95% CI 4.5-728.0). No clinical or demographic factors were associated with treatment failure. In most cases, angle surgery failed (72.7%) but was a temporizing measure before subconjunctival filtering surgery. ConclusionsLower eyelid and choroidal angiomas were associated with glaucoma diagnosis, suggesting a spatial relationship with SWS findings. However, leptomeningeal angiomas were not associated possibly because these are further from the eye.

Visual and surgical outcomes of childhood glaucoma following cataract surgery

PurposeTo evaluate frequency of surgery and post-treatment outcomes in glaucoma following cataract surgery (GFCS). MethodsThe medical records of patients with GFCS were reviewed retrospectively. Lensectomy and glaucoma surgery details and final examination findings were collected. Inclusion criteria included history of lensectomy at <1 year of age, diagnosis of glaucoma, and at least 1 year of follow-up. ResultsOf 169 eyes of 127 GFCS patients (66 male, 58 bilateral cases), 88 eyes (52%) of 73 (57%) patients underwent glaucoma surgery (median, 3.5 years of age at first glaucoma surgery; median of two glaucoma surgeries). At final follow-up (mean, 13.6 ± 7.0 years), eyes requiring glaucoma surgery had worse visual acuity (P = 0.01) and greater cup:disk ratio (P < 0.01). GFCS patients with history of bilateral congenital cataracts had better visual acuity in affected eyes than those with history of unilateral congenital cataract (P < 0.01). Angle surgery (n = 56), Baerveldt devices (n = 38), Ahmed valves (n = 19), and cycloablation (n = 21) showed 1-year survival rates between 64% and 75%. Baerveldt implants showed the highest 5- and 10-year survival rates, at 65% and 43%, respectively. ConclusionsMore than 50% of eyes with GFCS in our study cohort required at least one glaucoma surgery. Glaucoma surgery and history of unilateral cataract were associated with worse visual acuity outcomes.

Long-term follow-up results and visual outcomes of childhood glaucoma in the black sea region of turkey.

To investigate long-term visual outcomes and factors associated with low vision in patients with childhood glaucoma. A retrospective review was conducted on the medical records of pediatric glaucoma patients at the Ondokuz Mayıs University Ophthalmology Clinic from 2005 to 2023. The patients were categorized into three groups: primary congenital glaucoma (PCG), secondary childhood glaucoma, and glaucoma following cataract surgery (GFCS). Groups were analyzed regarding visual acuity (VA), ocular conditions and comorbidities, and the cause of visual impairment. The study also investigated the potential risk factors associated with visual impairment. A total of 105 eyes of 60 patients with a mean age of 9.7 ± 5.5years were included in the study. The mean VA in logMAR was 0.59 ± 0.52. At the final follow-up, 34.1% had good VA (≥ 20/50), 29.5% had moderate VA (20/50-20/200), and 36.4% had poor VA (< 20/200). The final mean intraocular pressure (IOP) was 16.2 ± 6.2mmHg. Amblyopia was the leading cause of vision loss (38.2%), followed by glaucomatous damage (36.4%). Patients with GFCS had a higher rate of visual impairment (42.4%) and refractive error. The results of the regression analysis showed that low vision was associated with undergoing more than two surgeries, high IOP at baseline, high initial and final cup-to-disc (C/D) ratio, and high initial central corneal thickness (CCT) (CI 95%, p = 0.018, p= 0.017, p = 0.013, p = 0.003, p = 0.001, respectively). Good VA can be achieved in 34.1% of childhood glaucoma cases. However, the VA prognosis may be worse in patients with GFCS. Achieving good visual outcomes in childhood glaucoma requires timely and effective treatment, consideration of risk factors, and management of amblyopia and ocular comorbidities.

Comparing glaucoma risk in children receiving low-dose and high-dose glucocorticoid treatment after cataract surgery.

Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery. This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups. Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm. Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.

Impact of Demographics on Regional Visual Field Loss and Deterioration in Glaucoma.

To elucidate the impact of demographics, including gender, race, ethnicity, and preferred language, on regional visual field (VF) loss and progression in glaucoma. Multivariable linear mixed regressions were performed to determine the impact of race, ethnicity, and preferred language on regional VF loss with adjustment for age and gender. Regional VF loss was defined by pointwise total deviation values and VF loss patterns quantified by an unsupervised machine learning method termed archetypal analysis. All cross-sectional and longitudinal analyses were performed both without and with adjustment for VF mean deviation, which represented overall VF loss severity. P values were corrected for multiple comparisons. All results mentioned had corrected P values less than 0.05. Asian and Black patients showed worse pointwise VF loss than White patients with superior hemifield more affected. Patients with a preferred language other than English demonstrated worse pointwise VF loss than patients with English as their preferred language. Longitudinal analyses revealed Black patients showed worse VF loss/year compared to White patients. Patients with a preferred language other than English demonstrated worse VF loss/year compared to patients preferring English. Blacks and non-English speakers have more severe VF loss, with superior hemifield being more affected and faster VF worsening. This study furthered our understanding of racial, ethnic, and socioeconomic disparities in glaucoma outcomes. Understanding the VF loss burden in different racial, ethnic, and socioeconomic groups may guide more effective glaucoma screening and community outreach efforts. This research could help reduce vision loss and improve quality of life in disproportionately affected populations by guiding public health efforts to promote glaucoma awareness and access to care.

A Health-Related Quality of Life Measure for Patients Who Undergo Minimally Invasive Glaucoma Surgery

PurposeTo develop a standardized patient-reported outcome measure to assess the impact of glaucoma and treatment, including minimally invasive glaucoma surgery (MIGS), on health-related quality of life (HRQOL). DesignObservational study before and after concomitant cataract and FDA-approved implantable MIGS device surgery to provide information on the measure's performance in assessing HRQOL. Methods SettingSurvey administration was done by electronic patient-reported outcomes (ePRO) application to patients at multiple sites on a computer, iPad, or similar device. Patient PopulationOne hundred eighty-four adults completed a baseline survey, 124 completed a survey 3 months after surgery, and 106 completed the 1-month test-retest reliability survey. The age range was 37-89, and the average age was 72. Most of the respondents were female (57%), non-Hispanic White (81%), and had a college degree (56%). Main Outcome MeasuresThe Glaucoma Outcomes Survey (GOS) includes 42 questions assessing functional limitations (27 items), vision-related symptoms (7 items), psychosocial issues (7 items) and satisfaction with microinvasive glaucoma surgery (1 item). The three multiple-item scales were scored on a 0-100 range, with a higher score indicating worse health. ResultsInternal consistency reliability estimates ranged from 0.75 (vision-related symptoms) to 0.93 (functional limitations) and one-month test-retest intraclass correlations ranged from 0.65 (PROMIS global mental health) to 0.92 (functional limitations). Product-moment correlations among the GOS scales ranged from 0.56 to 0.60. Improvement in visual acuity in the study eye from baseline to the 3-month follow-up was significantly related to improvements in GOS functional limitations (r =0.18, p =0.0485), vision-related symptoms (r = 0.19, p = 0.0386), and psychosocial concerns (r = 0.18, p =0.0503). The highest proportion of responders to treatment was seen for the GOS functional limitations scale (48%), followed by GOS psychosocial issues (21%) and GOS vision-related symptoms (17%). ConclusionsThis study provides initial support for using the GOS instrument in ophthalmic procedures such as MIGS. Further evaluation of the GOS in other samples, including different patient subgroups and clinical settings, will be valuable. The instrument may be useful for evaluations of other treatments for glaucoma.

Priorities for health outcomes in glaucoma in an ethnically diverse UK cohort: an observational study

ObjectivesTo assess whether patients from minority ethnic groups have different perceptions about the quality-of-life outcomes that matter most to them.DesignCross-sectional observational study.SettingHigh volume eye centres serving the most ethnically diverse...

Surgical outcomes of pediatric glaucoma in Indian eyes

Abstract Purpose: To evaluate the surgical outcomes of pediatric glaucoma in a cohort of Indian population. Materials and Methods: We conducted a single-center retrospective study including pediatric glaucoma patients who had undergone surgery between January 2012 and January 2022. The surgeries performed were trabeculectomy with mitomycin-C or Ologen, combined trabeculectomy with trabeculotomy (CTT), Ahmed glaucoma valve (AGV) implantation, and diode laser transscleral cyclophotocoagulation. Success was defined as complete if intraocular pressure (IOP) was between 6 and 21 mmHg in children who were examined on slit lamp, or between 6 and 18 mmHg in patients examined under general anesthesia, in the absence of any glaucoma medication and as qualified, with glaucoma medication at the last follow-up. Outcome measures included IOP at the last follow-up, number of glaucoma medications, any complications, and additional surgeries. Results: Seventy-eight eyes of 68 children were included. The most common glaucoma types were primary congenital glaucoma (30.8%), followed by posttraumatic glaucoma (17.9%) and postvitreoretinal surgery glaucoma (16.7%). The mean IOP reduced from 34.17 ± 9.35 mmHg preoperatively to 21.38 ± 9.61 mmHg at the last follow-up (P &lt; 0.001). The number of glaucoma medications reduced from 2.55 ± 1.10 preoperatively to 1.76 ± 1.26 at the last follow-up (P &lt; 0.001). Success was achieved in 62.8% of eyes and the mean survival time was 3.62 years. Among all procedures, AGV implantation had a longer survival time (mean 4.86 years). Conclusion: Pediatric glaucoma management remains a challenge. Majority of the cases remain refractory in spite of multiple surgical interventions. AGV and CTT could be offered as primary surgery in cases of pediatric glaucoma with hazy cornea where goniotomy may not be an option.

Surgical Outcomes of Early Versus Late Onset Glaucoma Associated With Sturge-Weber Syndrome.

Long-term intraocular pressure control can be difficult to achieve in eyes with Sturge-Weber syndrome glaucoma. The most commonly performed primary surgery was trabeculotomyin early onset disease and tube shunt implantation in late onset disease. To compare long-term surgical outcomes of glaucoma associated with Sturge-Weber syndrome (SWS) in eyes with early and late-onset disease. Medical records of children with glaucoma associated with SWS who underwent surgical treatment between January 1990 and December 2018 were reviewed. Those diagnosed ≤2 years of age were categorized as early onset while those who were diagnosed >2 years of age were late onset. Failure was defined as intraocular pressure (IOP) >21mm Hg or reduced <20% below baseline on 2 consecutive follow-up visits after 3 months, IOP ≤5mm Hg on 2 consecutive follow-up visits, reoperation for glaucoma or a complication, or loss of light perception. Forty-three eyes of 36 children were studied, including 26 eyes in the early-onset group and 17 eyes in the late-onset group. The early-onset group more frequently presented with buphthalmos, corneal edema, and Haab striae, while late-onset group had higher baseline IOP, larger cup-to-disc ratio, and longer axial length. The most commonly performed primary surgery was trabeculotomy (50%) in early-onset group and tube shunt implantation (71%) in late-onset group. The cumulative probability of failure after 5 years follow-up was 50.6% in early-onset group and 50.9% in the late-onset group ( P =0.56). Postoperative complications occurred in 3 eyes (12%) in early-onset group and 11 eyes (65%) in late-onset group ( P <0.001). Early and late-onset SWS glaucoma may represent 2 entities with different pathogenetic mechanisms, clinical presentations, primary surgical choices, and outcomes, though this needs corroboration in future studies.

Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series.

To report the outcome of Baerveldt glaucoma implant (BGI) with Supramid© ripcord use in neovascular glaucoma (NVG). We retrospectively evaluated the surgical outcome of the BGI with Supramid© 3/0 ripcord stent in patients with NVG. No tube ligation or venting slits were performed. Supramid was removed after 3mo if the target intraocular pressure (IOP) was not achieved. Surgical success was defined as IOP≤21 mm Hg with (qualified success) or without IOP-lowering medications (complete success). Twenty-six eyes from 24 patients were included in the study. The median duration of follow-up was 4 [interquartile range (IQR)=1-5]y, ranging from 0.5 to 5y. IOP decreased by a mean of 24.2 mm Hg (59.7%); from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg, P≤0.001. The number of glaucoma medications reduced from a median of 5 (IQR=5-6) to 1 (IQR=0-2, P≤0.001) at the final follow-up. Overall success rates were 88.0% at 1y, 34.8% at 3y, 66.7% at 4y, and 50% at 5y. Hypertensive phase (HP) in the first 3mo occurred in 15/26 eyes (57.7%) with a mean IOP of 31.1 mm Hg. BGI with Supramid© ripcord stent gives close to 90% of the overall survival rate at the final follow-up without significant early hypotony. However, early HP is still a challenge.

Importance of parental compliance in postoperative rehabilitation of children with glaucoma

This study assesses the level of parental compliance with rehabilitation measures and attempts to identify the factors affecting it during the rehabilitation period of children after surgical treatment of congenital glaucoma. The study was conducted through a survey involving 62 parents of children who underwent surgical treatment for glaucoma at the ophthalmology department of the Tashkent Pediatric Medical Institute. Parents were provided with a link to the online survey after giving their consent. The questionnaire consisted of eight questions with multiple-choice answers. Analysis of the answers showed the following trends: the majority of parents had either a secondary or vocational education (59.7%); most parents lived in rural areas (64.5%); a significant portion had partial or no knowledge about the course and outcomes of glaucoma (51.6%); unreliable sources for information (45.2%); irregular adherence to the doctor's recommendations (29%); significant difficulties in following the prescribed recommendations (64.5%). It was found that the level of parental compliance with rehabilitation measures is low in a significant portion of families (37.2%) with children who underwent surgery for glaucoma. The main factors contributing to poor parental compliance include living in rural areas, insufficient knowledge about the disease, lack of strict adherence to medical recommendations, and various difficulties in implementing the prescribed recommendations (p<0.05).

Prediction of multiclass surgical outcomes in glaucoma using multimodal deep learning based on free-text operative notes and structured EHR data.

Surgical outcome prediction is challenging but necessary for postoperative management. Current machine learning models utilize pre- and post-op data, excluding intraoperative information in surgical notes. Current models also usually predict binary outcomes even when surgeries have multiple outcomes that require different postoperative management. This study addresses these gaps by incorporating intraoperative information into multimodal models for multiclass glaucoma surgery outcome prediction. We developed and evaluated multimodal deep learning models for multiclass glaucoma trabeculectomy surgery outcomes using both structured EHR data and free-text operative notes. We compare those to baseline models that use structured EHR data exclusively, or neural network models that leverage only operative notes. The multimodal neural network had the highest performance with a macro AUROC of 0.750 and F1 score of 0.583. It outperformed the baseline machine learning model with structured EHR data alone (macro AUROC of 0.712 and F1 score of 0.486). Additionally, the multimodal model achieved the highest recall (0.692) for hypotony surgical failure, while the surgical success group had the highest precision (0.884) and F1 score (0.775). This study shows that operative notes are an important source of predictive information. The multimodal predictive model combining perioperative notes and structured pre- and post-op EHR data outperformed other models. Multiclass surgical outcome prediction can provide valuable insights for clinical decision-making. Our results show the potential of deep learning models to enhance clinical decision-making for postoperative management. They can be applied to other specialties to improve surgical outcome predictions.

Glaucoma after penetrating keratoplasty and keratoprosthesis

To compare visual and glaucoma outcomes in patients with known glaucoma after a penetrating keratoplasty (PKP) or a Boston Keratoprosthesis Type 1 (KPro) as a second corneal replacement procedure. Retrospective interventional case series. Charts of 141 eyes that underwent either a PKP or KPro at the Centre hospitalier de l'Université de Montréal after one failed PKP from 2008 to 2020 were reviewed. Forty-six eyes with preoperative glaucoma were included. Data collected included demographics, indication for the initial surgery, best corrected visual acuity (BCVA), concurrent ocular disorders, number of glaucoma medications, need for glaucoma surgery, cup-to-disc ratios (CDRs), mean RNFL thickness, and visual field (VF) characteristics. Primary outcomes were glaucoma progression trends. Secondary outcomes were visual outcomes and need for additional procedures. Mean follow-up was 4.7years for the PKP and 7.3 for the KPro group (P<0.007). 30.6% of PKP compared to 70.5% of KPro patients were diagnosed with glaucoma preoperatively. Glaucoma worsened similarly in both groups; this is based on an analysis of the number of glaucoma medications, CDR, need for glaucoma surgery, and characteristic VF changes. Patients in the PKP group required significantly more regrafts than patients in the KPro group (31.8 vs. 8.3%; P=0.045). A preoperative diagnosis of glaucoma does not preclude KPro implantation. In glaucomatous eyes, the disease progressed similarly in both groups. Since both procedures increase the risk of worsening glaucoma, close follow-up is recommended. KPro may decrease the need for further corneal transplantation surgery.

Neurovascular dysfunction in glaucoma.

Retinal ganglion cells, the neurons that die in glaucoma, are endowed with a high metabolism requiring optimal provision of oxygen and nutrients to sustain their activity. The timely regulation of blood flow is, therefore, essential to supply firing neurons in active areas with the oxygen and glucose they need for energy. Many glaucoma patients suffer from vascular deficits including reduced blood flow, impaired autoregulation, neurovascular coupling dysfunction, and blood-retina/brain-barrier breakdown. These processes are tightly regulated by a community of cells known as the neurovascular unit comprising neurons, endothelial cells, pericytes, Müller cells, astrocytes, and microglia. In this review, the neurovascular unit takes center stage as we examine the ability of its members to regulate neurovascular interactions and how their function might be altered during glaucomatous stress. Pericytes receive special attention based on recent data demonstrating their key role in the regulation of neurovascular coupling in physiological and pathological conditions. Of particular interest is the discovery and characterization of tunneling nanotubes, thin actin-based conduits that connect distal pericytes, which play essential roles in the complex spatial and temporal distribution of blood within the retinal capillary network. We discuss cellular and molecular mechanisms of neurovascular interactions and their pathophysiological implications, while highlighting opportunities to develop strategies for vascular protection and regeneration to improve functional outcomes in glaucoma.

Awareness and Knowledge About Glaucoma in the Western Region of Saudi Arabia: A Population-Based Survey.

Background Glaucoma is a leading cause of irreversible blindness worldwide. This study aimed to assess the Saudi population's levels of awareness and knowledge regarding glaucoma risk factors, symptoms, treatment, and outcomes. Methods A cross-sectional study was conducted among the Glaucoma Awareness Campaign attendees during the World Glaucoma Week (2015-2016). A structured questionnaire was used, and a knowledge score (0-25) was calculated as the sum of all correct answers. Sociodemographic factors, personal and family history of glaucoma, and the presence of risk factors were investigated and analyzed as factors affecting knowledge. Results The study included 1751 participants, with amean age of 40.23 (SD ±13.86) years; 51.5% were males, 3.7% hadglaucomaand 22.6% had a family history of glaucoma. The overall awareness rate was 65.6%, which was moderately higher among females (71.6%), older participants (≥40 years, 69.7%), and highly educated participants (70.6%). Concerning knowledge, 15.4% had fair to good knowledge (score 15-25). Participants with a personal history of glaucoma had relatively greater knowledge regarding glaucoma-specific questions, such as optic nerve damage (p=0.001) and the requirement of lifetime treatment (p<0.001). Conclusion Awareness and knowledge about glaucoma are limited among the Saudi population, regardless of socioeconomic class or educational status. Knowledge about glaucoma should be further promoted to enable early screening and prevention.

Technological Advances in a Therapy of Primary Open-Angle Glaucoma: Insights into Current Nanotechnologies.

Glaucoma is a leading cause of irreversible blindness and is characterized by increased intraocular pressure (IOP) and progressive optic nerve damage. The current therapeutic approaches for glaucoma management, such as eye drops and oral medications, face challenges including poor bioavailability, low patient compliance, and limited efficacy. In recent years, nanotechnology has emerged as a promising approach to overcome these limitations and revolutionize glaucoma treatment. In this narrative review, we present an overview of the novel nanotechnologies employed in the treatment of primary open-angle glaucoma. Various nanosystems, including liposomes, niosomes, nanoparticles, and other nanostructured carriers, have been developed to enhance the delivery and bioavailability of antiglaucoma drugs. They offer advantages such as a high drug loading capacity, sustained release, improved corneal permeability, and targeted drug delivery to the ocular tissues. The application of nanotechnologies in glaucoma treatment represents a transformative approach that addresses the limitations of conventional therapies. However, further research is needed to optimize the formulations, evaluate long-term safety, and implement these nanotechnologies into clinical practice. With continued advancements in nanotechnology, the future holds great potential for improving the management and outcomes of glaucoma, ultimately preserving vision and improving the lives of millions affected by this debilitating disease.

Long-term outcomes of Baerveldt glaucoma implant surgery in Japanese patients

This study evaluated the long-term surgical outcomes of Baerveldt glaucoma implant (BGI) surgery in patients with refractory glaucoma (204 eyes/204 patients). Surgical failure was defined by: < 20% reduction in preoperative intraocular pressure (IOP), or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). Reoperation, loss of light perception vision, or hypotony also denoted failure. The probability of success at 5 years postoperatively using criteria A, B, and C was 72.4%, 49.7%, and 24.4%, respectively. The mean IOP decreased significantly from 32.7 ± 9.7 mmHg preoperatively to 13.1 ± 3.9 mmHg at 5 years; the mean number of glaucoma medications also decreased from 3.7 ± 1.2 to 1.8 ± 1.9 (both P < 0.01). The number of previous intraocular surgeries was significantly associated with failure in the multivariable analysis for criterion B (hazard ratio 1.30; P < 0.01) and criterion C (hazard ratio 1.19; P = 0.031). Early and late postoperative complications occurred in 82 (40.2%) and 28 (13.7%) eyes, respectively. Postoperative interventions were performed in 44 eyes (21.6%). BGI surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. BGI surgery is effective for refractory glaucoma. However, postoperative interventions due to complications are required in numerous cases.

Improving Compliance with Medical Treatment Using Eye Drop Aids

Achieving optimal treatment outcomes in glaucoma requires patients to adhere to their medication regimens. Possible barriers to patients’ cooperation include the misunderstanding of a treatment’s importance or errors in applying instructions, forgetfulness, financial constraints and others. Due to the fact that glaucoma usually causes no apparent symptoms or pain, on the one hand, and the significant inconvenience that the eye drops used for glaucoma treatment can cause due to local irritation, on the other, patient compliance is a challenge. To address this challenge, we require strategies for improving adherence to glaucoma treatment. The importance of proper eye drop administration techniques cannot be overstated, particularly for vulnerable populations such as the elderly, the sick and the visually handicapped. Studies have shown that failure to comply with glaucoma treatment is a significant factor affecting disease progression, emphasizing the need for interventions that improve patient compliance. Educational interventions, medication reminders and the use of assistive devices such as eye drop aids have been shown to improve adherence to glaucoma treatment. By promoting strategies that can be used to enhance treatment adherence, healthcare providers can ensure that glaucoma patients receive the full benefits of their treatment plans, reducing the risk of disease progression. Many patients struggle with the complexity of their treatment regimens and the challenges of administering eye drops. This entry provides a comprehensive overview of the different barriers to patient adherence to glaucoma eye drop treatment, emphasizing the difficulties associated with eye drop instillation. This entry examines a range of eye drop aids available to patients, evaluating their modes of action, benefits, drawbacks and effectiveness in improving patient compliance. By providing detailed information on the barriers to adherence and the range of eye drop aids available, this entry aims to support healthcare providers in helping glaucoma patients to achieve better treatment adherence and outcomes.

Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma.

To compare Ahmed glaucoma valve (AGV) outcomes in neovascular glaucoma (NVG) eyes with and without a postoperative (PO) hypertensive (HTN) phase. Retrospective study at a single tertiary care center of patients who underwent AGV implantation for NVG treatment with ≥6-month follow-up. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications (GM), and failure at month 6 or at the most recent visit. Failure was defined as decline to no light perception (NLP) vision, IOP >21 mm Hg, or need for glaucoma reoperations (all with GM). A total of 76 eyes of 74 patients (37 without HTN phase and 39 with HTN phase) with a mean follow-up duration of 28.9 ± 25.7 months (p = 0.602) were included. Both groups had similar demographics, visual acuity (VA), number of GM, etiology of NVG, and retina treatment perioperatively. Baseline IOP was significantly higher in the HTN phase group (p = 0.001). Compared to eyes without an HTN phase, HTN phase eyes more commonly met failure criteria at month 6 (33.3 vs 9.1%; p = 0.01), but both groups had a comparable cumulative failure for the entire follow-up period (p = 0.180). At the most recent visit, the number of GM was higher in the HTN phase group (p = 0.019), but IOP was similar in both groups. PO complications were comparable and uncommon in both groups. Hypertensive (HTN) phase following AGV implantation for NVG is associated with higher preoperative IOP and greater failure by PO month (POM) 6. However, eyes with and without the HTN phase had similar needs for GM and failure rates over the long term. Ramesh S, Shalaby WS, Myers JS, et al. Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma. J Curr Glaucoma Pract 2023;17(2):91-97.

Association of Neighborhood Environment with the Outcomes of Childhood Glaucoma

To determine the association between different neighborhood environment factors and the outcomes of childhood glaucoma. A retrospective cohort. Childhood glaucoma patients ≤ 18 years of age at the time of diagnosis. A retrospective chart review of childhood glaucoma patients who presented to Boston Children's Hospital between 2014 and 2019. Data collected included etiology, intraocular pressure (IOP), management, and visual outcomes. Child Opportunity Index (COI) was used as a metric of neighborhood quality. The association of visual acuity (VA) and IOP with COI scores using linear mixed-effect models, adjusting for individual demographics. A total of 221 eyes (149 patients) were included. Of these, 54.36% were male and 56.4% were non-Hispanic Whites. The median age at the time of presentation was 5 months for primary glaucoma and 5 years for secondary glaucoma. The median age at the last follow-up was 6 and 13 years for primary and secondary glaucoma, respectively. A chi-square test revealed that the COI, health and environment, social and economic, and education indexes between primary and secondary glaucoma patients were comparable. For primary glaucoma, the overall COI and a higher education index were associated with a lower final IOP (P<0.05), and higher education index was associated with a lower number of glaucoma medications at the last follow-up (P<0.05). For secondary glaucoma, higher overall COI, health and environment, social and economic, and education indices were associated with better final VA (lower logarithms of the minimum angle of resolution VA) (P<0.001). Neighborhood environment quality is a potentially important variable for predicting outcomes in childhood glaucoma. Lower COI scores were associated with worse outcomes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.