Percentage Of Intraocular Pressure Reduction Research Articles

Ab Interno Canaloplasty and Trabeculotomy Outcomes for Mild, Moderate, and Advanced Open-Angle Glaucoma: A ROMEO Analysis.

To determine if there was an association between severity of glaucoma and intraocular pressure (IOP) and medication (med) outcomes for patients in the ROMEO (Retrospective, Observational, Multicenter Evaluation of OMNI) study. Eleven ophthalmology practices in 8 US states. Post-hoc analysis of all eyes enrolled and treated with ab interno canaloplasty and trabeculotomy in the retrospective, multicenter ROMEO study. Eyes were grouped according to visual field mean deviation (MD): mild (MD better than -6 dB), moderate (MD between -6 and -12 dB), advanced (-12 dB or worse). IOP and med outcomes at 12 months were compared across groups. Least squares regression was used to assess the relationship of MD with month 12 IOP. Outcomes for 1st and last MD deciles were compared as a sensitivity analysis. One hundred and twenty-seven eyes were available for analysis including 79 mild, 42 moderate, 6 advanced. Most eyes had a reduction in IOP at Month 12 (70%) with most at 18 mmHg or less. Percentage IOP reduction was similar across the groups (mild 16.9%, moderate 18.6%, advanced 18.0%) with mean month 12 IOP between 14 and 16 mmHg. Medications were also reduced in all three groups; -0.8 (mild, P < 0.001), -0.55 (moderate, P < 0.05), and -1.0 (advanced, P = 0.139, ns). Regression analysis revealed no relationship between month 12 IOP and MD. Med reductions were observed for all groups with a reduction of 1 or more medications seen in (%, 95% CI) 69%, 59-79 (mild), 50%, 35-65 (moderate), and 60%, 21-99 (advanced). Secondary interventions tended to have greater incidence with worse MD likely reflecting lower desired IOP targets. Analysis of data from the ROMEO study suggests that similar meaningful IOP and med reductions can be expected across the range of disease severity studied.

Frequency-doubled neodymium yttrium aluminum garnet (Nd:YAG) laser trabeculoplasty as adjuvant therapy for open-angle glaucomas

The thermal frequency-doubled Nd:YAG (neodymium: yttrium-aluminum-garnet) laser was used sparingly for trabeculoplasty. Our goal was to assess the efficacy and safety of frequency-doubled Nd:YAG laser trabeculoplasty as an adjunct therapy to anti-glaucoma medications in open-angle glaucoma. Laser trabeculoplasty was performed on 41 eyes of 22 adults with open-angle glaucomas using a thermal frequency-doubled Nd:YAG laser (Green laser photocoagulator GYC-500® 532 nm, Nidek, Japan). To assess the laser’s effectiveness, patients were monitored for intraocular pressure (IOP) reduction, control, and complications at 1 hour, 1 week, and then monthly for a year. Primary open-angle glaucoma was the most common diagnosis in 31 (75.6%) eyes. The pre-laser baseline IOP was 18.87±3.66 mmHg. The mean IOP was 14.9±2.54 mmHg at Week 1 (p = 0.000), 14.65±2.50 mmHg at Month 1, 14.53±2.60 mmHg at Month 3, 15.85±2.30 mmHg at Month 6, and 15.14±2.17 mmHg at Month 12 (p=0.000). A significant percentage reduction in IOP was achieved at 1, 3, 6, and 12 months: 21.78%, 22.48%, 16.73%, and 18.53%, respectively. Patients used an average of 2.73±1.00 topical drugs before laser treatment. There was a significant reduction in medicines after laser treatment on all occasions, at 1, 3, 6, and 12 months (p = 0.000). Complications included some degree of peripheral anterior synechiae (PAS) in 20 (51.3%) eyes; an IOP spike in one patient only, bilaterally (5.1%) at 1 hour after therapy; and mild anterior uveitis in four (9.75%) cases. To summarize, frequency-doubled Nd:YAG laser trabeculoplasty is a safe and effective adjuvant therapy for open-angle glaucoma that reduces intraocular pressure and medication use.

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach.

Selective laser trabeculoplasty (SLT) emerges as a first-line treatment for newly diagnosed open-angle glaucoma and ocular hypertension. However, the interindividual response to SLT considerably varied. Large-scale clinical investigations concerning predictive factors for SLT effectiveness are limited. This study aimed to identify baseline predictors of the percentage intraocular pressure (IOP)-lowering effectiveness of SLT using an alternative mathematical approach. Mathematical equations of IOP under the steady state of aqueous humour flow were formulated. The conclusive equation integrates physiological variables, including trabecular outflow facility, uveoscleral outflow fraction, plasma protein concentration, albumin/globulin ratio, mean arterial pressure, episcleral venous pressure, and plasma osmolarity. The equation was employed to estimate the percentage of IOP reduction following SLT and subsequently subjected to global sensitivity analysis to determine significant predictors of the IOP-lowering effect of SLT using the Monte Carlo simulation of 8,192 samples. In the current model, a 50% improvement in the trabecular outflow facility impacted by SLT is associated with a mean percentage IOP reduction of 16.6%. Lower baseline trabecular outflow facilities were the strongest predictors, showing a correlation with greater effectiveness of SLT in terms of percentage of IOP reduction. The second most influential factor includes baseline uveoscleral outflow fraction, followed by baseline episcleral venous pressure. Specifically, lower baseline uveoscleral outflow fraction and episcleral venous pressure were found to be correlated with increased effectiveness of SLT. Baseline levels of plasma protein concentration, albumin/globulin ratio, mean arterial pressure, and plasma osmolarity have minimal impact on SLT success or failure. This study identifies baseline trabecular outflow facilities as the strongest predictor of SLT effectiveness. The results suggested that pre-SLT medical treatment that augments uveoscleral outflow and/or trabecular outflow facilities could compromise the effectiveness of subsequent SLT in terms of percentage IOP reduction compared to those who never received pre-SLT medication.

Longitudinal evaluation of advanced glaucoma: ten year follow-up cohort study

This study focused on patients with advanced open-angle glaucoma (OAG) and aimed to identify key factors for monitoring them. We included 127 such patients who were followed for seven years or more, undergoing annual ophthalmic examinations. Glaucoma progression was defined as a deterioration in either structure or function. The progression rates and risk factors were evaluated. The patients were divided into upper- and lower-half subgroups based on the reduction in intraocular pressure (IOP) from the baseline. Over an 11-year period, glaucoma progression was detected in 59 eyes (46.5%). The rate of change in mean deviation (MD) was − 0.43 dB/year for the entire population; − 0.67 dB/year for progressors; and − 0.20 dB/year for non-progressors. Hypertension and disc hemorrhage (DH) were more common in progressors compared to non-progressors (45.8 vs. 23.5%, 11.9 vs. 1.5%; P = 0.008 and P = 0.016). Multivariate Cox’s proportional hazard model revealed that the presence of DH and a better baseline MD were associated with glaucoma progression. Additionally, patients with a higher percentage reduction in IOP (> 20.94%) had a lower risk of progression compared to those with less reduction. Inadequate IOP reduction, better baseline MD, presence of DH, and lower central corneal thickness were identified as risk factors for progression in advanced OAG patients.

Comparison of clinical outcomes between gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in advanced-stage pseudoexfoliation glaucoma.

To compare clinical outcomes between gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) in patients with advanced-stage pseudoexfoliation glaucoma (PEXG). This comparative study comprised 62 patients who underwent GATT (N = 31) or TRAB (N = 31) for advanced-stage PEXG. Primary outcome was cumulative probability of surgical success at the end of 12-month follow-up. Success was determined as intraocular pressure (IOP) reduction ≥ 30% from baseline, IOP between 6 and 18mmHg and IOP upper limits for IOP < 15mmHg and < 12mmHg, separately. Secondary outcomes were IOP reduction, antiglaucoma medication (AGM) use, and complications in the study. Age, sex, cup/disc ratio, mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness did not significantly differ between the groups (p > 0.05 for all). The probability of cumulative surgical success at the end of 12months was similar between the two groups for IOP < 15mmHg and < 18mmHg but significantly higher after TRAB (92.0%) than GATT (82.5%) for IOP < 12mmHg (log-rank test p = 0.035). Percentage of IOP reduction from baseline was similar between the groups (53.1 ± 18.6% in GATT group and 53.0 ± 16.6% in TRAB group, p = 0.98) at the end of 12months. No significant difference in the mean number of AGM was present at the 12-month visit (1.3 ± 1.4 in GATT and 1.1 ± 1.4 in TRAB, p = 0.65). At the end of 12months, IOP reduction rate was similar between GATT and TRAB. Cumulative surgical success was higher after TRAB than GATT for IOP < 12mmHg.

Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma.

Minimally invasive glaucoma surgery (MIGS) is not typically used in patients with advanced-stage glaucoma. This study describes the outcomes and complications of patients with advanced open-angle glaucoma (OAG) who underwent XEN implantation with cataract surgery or gonioscopy-assisted transluminal trabeculotomy (GATT) with cataract surgery. This retrospective study identified patients who had undergone XEN implantation or GATT for the management of advanced OAG. Outcomes included surgical success, intraocular pressure (IOP) reduction, number of topical IOP-lowering drops, visual field mean deviation (MD), best-corrected visual acuity (BCVA), and complications. Surgical success was defined as an IOP of <14 mm Hg and a 20% reduction at 12 months without topical IOP-lowering drops (complete success) or with topical IOP-lowering drops (qualified success). Exactly 70 eyes were enrolled in this study, including 35 who had undergone XEN implantation and 35 who had undergone GATT. The overall surgical success rate was 74.3% (26 of 35) for eyes that underwent XEN implantation and 71.4% (25 of 35) for eyes that underwent GATT. Percent IOP reduction from baseline to 12 months postoperatively was 48% in the XEN cohort and 32% in the GATT cohort. Significant reduction in the use of topical IOP-lowering drops was demonstrated for both XEN (3.26 ± 1.15-1.23 ± 1.28) (p < 0.001) and GATT (2.46 ± 1.12-0.43 ± 0.78) (p < 0.001) cohorts at 12 months postoperatively. The only complication reported was transient hyphema, which occurred in three patients from the XEN group and four from the GATT group, and resolved spontaneously. Both XEN implantation and GATT may be safe and effective management options when treating patients with advanced OAG. However, larger sample sizes are required to make direct statistical comparisons between these techniques. In this study, XEN implantation and GATT combined with cataract surgery were each associated with favorable outcomes in patients with advanced OAG. Ruparelia S, Sharif M, Shoham-Hazon N. Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma. J Curr Glaucoma Pract 2023;17(2):63-67.

Efficacy of Selective Laser Trabeculoplasty in Patients on Systemic Immunosuppressive Therapy.

When comparing patients on systemic immunosuppressive therapy to those without, there was no difference in intraocular pressure (IOP) early after SLT; however, at 1 year following SLT, IOP was higher in the immunosuppression group compared with controls. To determine whether patients taking systemic immunosuppressive medications have a different IOP-lowering response to selective laser trabeculoplasty (SLT) compared with a control group of patients. All patients who underwent SLT at Mayo Clinic 2017-2021 were identified. Patients on systemic immunosuppressive medications at the time of SLT were compared with control patients not receiving systemic immunosuppressive medications. The primary endpoints of this study were the percentage IOP reduction at 1 to 2, 3 to 6, and 12 months. Additional analyses included the percentage of patients who did not require additional therapy at each time point. There were 108 eyes of 72 patients that underwent SLT in the immunosuppressed group and 1997 eyes of 1417 patients in the control group. There was no significant difference in age-adjusted change in IOP between groups at the first postoperative visit 1 to 2 months following SLT (-18.8±20.7% vs. -16.0±16.5%, P =0.256) or 3-6 months following SLT (-15.2±21.6% vs. -18.3±23.2%, P =0.062). However, at 12 months following SLT, the IOP reduction in the immunosuppressive therapy group was significantly less compared with the control group (-15.1±21.2% vs. -20.3±22.9%, P =0.045). There was no difference between groups in the number of additional treatments during the study intervals. Patients in the systemic immunosuppressive therapy group showed equivalent early IOP-lowering after SLT compared with a control group, but the treatment response was diminished at 1 year. Further studies investigating IOP regulation after SLT in immunosuppressed patients are needed.

Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety.

Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40-80. The best way to manage primary open-angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. An open-label, real-world, multicentric, observation-based 3-month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first-line therapy. Diurnal IOP measurements, best-corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day-1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Four hundred and sixty-nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once-daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. We found that netarsudil 0.02% w/v solution monotherapy when used as the first-line treatment in primary open-angle glaucoma and ocular hypertension was both safe and effective.

Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma.

Phacotrabeculectomy had a significantly lower 24-month failure rate than the isolated trabeculectomy in both the primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) patients. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG. The purpose of this study is to compare the 2-year outcomes of primary mitomycin C-augmented combined phacotrabeculectomy (Phaco+Trab) with isolated trabeculectomy (Trab) in phakic patients with POAG and PACG. We retrospectively reviewed primary glaucoma patients who underwent mitomycin C-augmented trabeculectomy and completed 2 years of follow-up. Failure rate, postoperative intraocular pressure (IOP), percentage of IOP reduction, and the number of glaucoma medications at 24 months after surgery were compared between the Phaco+Trab and Trab groups. The study included 146 eyes of 121 patients; 74 underwent Trab and 72 underwent Phaco+Trab. POAG and PACG were present in 71 and 75 eyes, respectively. Defining a failure with IOP criteria of >18mmHg or IOP reduction of <30%, the failure rates were 42% and 62% for Phaco+Trab and Trab, respectively. The Phaco+Trab group had a significantly lower failure rate than the Trab group for all subjects [risk ratio (RR): 0.60, 95% CI, 0.44-0.81, P =0.001], POAG subgroup (RR: 0.61, 95% CI, 0.41-0.93, P =0.02), and PACG subgroup (RR: 0.53, 95% CI, 0.33-0.86, P =0.01). Differences in the postoperative IOP, percentage of IOP reduction, and number of glaucoma medications were not significant between the 2 groups for all subjects, POAG, and PACG (all P >0.05). The magnitude of the effects of adding phacoemulsification to the trabeculectomy was comparable for the POAG and PACG groups, for each outcome (all P >0.05). The final 24-month failure rate in the Phaco+Trab group was lower than that in the Trab group in both the POAG and PACG subjects. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG.

Short-term outcomes of micropulse transscleral cyclophotocoagulation as a primary versus additional therapy in eyes with uncontrolled glaucoma.

To study the safety and efficacy outcomes of Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) as a primary versus additional therapy in eyes with uncontrolled glaucoma. This was a prospective, interventional, comparative study. All patients with advanced and refractory glaucoma treated with MP-TSCPC from April 2020 to December 2020 were recruited in this study. A total of 77 eyes of 77 patients were analyzed. Group A (n = 33), included patients with advanced glaucoma at high risk for invasive surgery, who underwent MP-TSCPC as the primary intervention, and group B (n = 44) included patients who had undergone previous surgical intervention and MP-TSCPC was used additionally to control the intraocular pressure (IOP). Mean IOP and mean number of antiglaucoma medications were 34.06 (13.9) mmHg and 3.64 (0.7), respectively, in group A and 35.61 (11.5) mmHg and 3.73 (0.9), respectively, in Group B. Postoperatively, the mean IOP and percentage of IOP reduction were significantly lower at 1, 3, and 6 months, that is, 20.78 (32%), 22.07 (30%), and 19.09 (37%), respectively, in group A and 23.68 (35%), 19.50 (44%), and 19.61 (42%), respectively, in group B, but there was no difference between the groups at all visits. Postoperative need for ocular hypotensive drugs did not differ in group A (P = 0.231); however, it was significantly lower in group B (P = 0.027). Group A had 87%, 77%, and 74% success rates at 1, 3, and 6 months, respectively, whereas group B had 91%, 86%, and 77% success rates at 1, 3, and 6 months, respectively. Postoperative complications and intervention did not reveal any statistical difference between the two groups. MP-TSCPC may be considered as a temporizing measure both as a primary or as an additional intervention to control the IOP in eyes with refractory and advanced glaucoma that have a high risk of vision-threatening complications with invasive surgery.

Assessment of Iridotrabecular Contact and Its Association With Intraocular Pressure After Phacoemulsification in Primary Angle Closure

To investigate the association between the quantitative assessment of iridotrabecular contact (ITC), measured by swept-source anterior segment optical coherence tomography (SS AS-OCT), and intraocular pressure (IOP) control after phacoemulsification in patients with primary angle closure disease (PACD). Retrospective, clinical cohort study. Preoperative and postoperative anterior chamber angle parameters were measured using SS AS-OCT. IOP was measured preoperatively and until 6 months postoperatively. Percent IOP reduction and fluctuation after surgery were calculated, and their relationships with SS AS-OCT parameters were assessed by correlation analyses and locally weighted scatterplot smoothing (LOWESS) regression with change-point analysis. A total of 51 eyes of 51 PACD patients were included. Preoperative ITC index and area (r=0.626, r=0.551), as well as changes in ITC index and area (r=0.632, r=0.543) after surgery, were significantly correlated with postoperative IOP reduction, after adjusting for age and gender (all P <.001). Higher postoperative ITC index (r=0.405, P=.005) and ITC area (r=0.460, P=0.001) were associated with greater postoperative IOP fluctuations. Change points on LOWESS curves were observed for preoperative ITC index (33.0%) and change in ITC index (27.0%) and percent IOP reductions were significantly correlated with them above (β=0.386, β=0.664, all P < .001) but not below the change points. Quantitative assessment of circumferential ITC can predict postoperative IOP control after phacoemulsification, and thus it may be used as a reference for determining lens extraction in PACD eyes.

MicroPulse Transscleral Laser Therapy Dosimetry Utilizing the Revised P3 Delivery Device: A Randomized Controlled Trial

To compare the long-term effectiveness and safety outcomes of 2 treatment dosages of the MicroPulse Transscleral Laser Therapy (MPTLT) procedure on intraocular pressure (IOP) control in patients with primary open-angle glaucoma. Single-blinded randomized controlled trial. A total of 19 patients with POAG without prior history of incisional glaucoma surgery. Subjects randomized into 2 treatment groups, 100-second (total energy 78.25 joules [J], fluence 109.2 J/cm2) or 120-second (total energy 93.9 J, fluence 131.0 J/cm2) total treatment duration, underwent the MPTLT procedure with the revised P3 delivery probe delivering 2.5 W energy, 31.3% duty cycle, applied in 3 sweeps per hemisphere, avoiding 3 and 9 o'clock. All subjects were followed at 1, 3, 6, 9, and 12 months to compare reduction in IOP and medication. Absolute and percentage IOP reduction at 6 months. The treatment groups were similar in age, sex, and stage of glaucoma at baseline (all P > 0.05). The 120-second group had significantly better baseline best-corrected visual acuity (BCVA) and a higher percentage of patients with prior MPTLT therapy (ranging from 4-19 months before study). Significantly greater IOP reduction was noted in the 120-second group compared with the 100-second group at 3 months, with mean IOP reduction of 7.3 ± 4.2 mmHg (vs. 0.9 ± 2.5 mmHg, P= 0.006) and percentage IOP reduction of 32.2% ± 18.3% (vs. 4.1% ± 13.7%, P= 0.007). The 120-second group continued to outperform at 6-month follow-up: mean IOP reduction of 9.0 ± 4.8 mmHg (vs. 0.8 ± 2.5 mmHg, P= 0.016) and percentage IOP reduction of 37.8% ± 19.8% (vs. 3.6% ± 13.3%, P= 0.021). At 12 months, 37.5% and 18.2% of the 100- and 120-second groups, respectively, required an additional IOP-lowering procedure (P=0.35); however, Kaplan-Meier analysis of time to intervention was not significantly different (P=0.38). There were no vision-threatening complications or changes in BCVA during the study period. This study demonstrates a dose-response relationship with improved IOP control and excellent safety profile in patients treated with higher treatment total energy and fluence using the revised MPTLT probe. Proprietary or commercial disclosure may be found after the references.

Long-term Efficacy and Safety of Micropulse Transscleral Cyclophotocoagulation in the Treatment of Refractory Glaucoma

Objective: To evaluate the long-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in refractory glaucoma. Materials and Methods: The present study was a prospective non-comparative interventional study. Patients diagnosed with refractory glaucoma were included for MP-TSCPC. The success rate was defined as an intraocular pressure (IOP) of 6 to 21 mmHg or a reduction of IOP by 20%. The percentage of IOP reduction, number of glaucoma medications, visual acuity (VA), additional procedures, and complications were evaluated. Results: Twenty eyes of 14 patients were included. The mean follow-up time was 28.1±19.5 months and up to 48 months. The mean preoperative IOP was 22±10.4 mmHg. The success rate of MP-TSCPC was 43.8% at 36 and 48-months follow-ups. The cumulative proportional success was 47.6% at 48 months with a median survival time of 36 months. IOPs showed significant reduction at 1-week follow-up (P &lt;.05) and were reduced 48.7% at 48 months. The overall number of glaucoma medications (p=0.25) and VA (p=0.23) showed no difference compared to baseline. Fifty percent of eyes required an additional procedure to control IOP. Complications included one case of corneal decompensation and three cases (15%) of cataract progression. Conclusion: MP-TSCPC demonstrated a high success rate in short-term follow-up, then showed a moderate success rate at intermediate and long-term follow-ups in refractory glaucoma. The treatment should be used with caution in cases with a history of multiple ocular surgery to avoid long-term adverse effects. Keywords: Glaucoma; Intraocular pressure; Laser coagulation; Laser therapy

Efficacy of Selective Laser Trabeculoplasty in Primary Angle-closure Glaucoma after Peripheral Iridotomy.

AimTo evaluate the efficacy of selective laser trabeculoplasty (SLT) in Southeast Asian eyes with primary open-angle glaucoma (POAG) vs primary angle-closure glaucoma after peripheral iridotomy (PACG-PI).Materials and methodsRecords of glaucoma patients who underwent SLT and had a 24-month follow-up were reviewed. Pre- and post-treatment intraocular pressure (IOP), percentage of IOP reduction in POAG, and PACG-PI groups, and probability of failure were analyzed. SLT failure was defined as any eye that did not have IOP lower than 20% compared to the baseline or had an IOP higher than the baseline on two consecutive visits. Adding medication, repeating SLT, or surgical intervention to control IOP was also considered a failure.ResultsSixty-three POAG and 12 PACG-PI eyes were eligible. The mean (standard deviation [SD]) age was 62.9 (10.2) years in POAG and 60.3 (6.2) years in PACG-PI. Mean (SD) prelaser IOP in POAG was 19.0 (4.4) mm Hg and 20.7 (4.7) mm Hg in PACG-PI. At 24 months post-SLT, mean (SD) IOP was 14.1 (4.7) mm Hg and 13.6 (2.0) mm Hg in POAG and PACG-PI, respectively. There was no significant difference in percentage of IOP reduction (22.8 ± 23.0% for POAG and 30.7 ± 19.5% for PACG-PI, p = 0.96), or failure probability (p = 0.10) between both groups.ConclusionThe efficacy of SLT at 24 months was comparable between POAG and PACG-PI.Clinical significanceSelective laser trabeculoplasty may be an option to further lower IOP in eyes with angle closure with visible trabecular meshwork (TM) after iridotomy, especially in highly pigmented eyes of Southeast Asians.How to cite this articleWongwuticomjon T, Chansangpetch S, Inobhas A, et al. Efficacy of Selective Laser Trabeculoplasty in Primary Angle-closure Glaucoma after Peripheral Iridotomy. J Curr Glaucoma Pract 2022;16(2):124-127.

Comparison of Hydrus and iStent microinvasive glaucoma surgery implants in combination with phacoemulsification for treatment of open-angle glaucoma: systematic review and network meta-analysis

ObjectivesTo compare the efficacy and safety of two Schlemm’s canal-based microinvasive glaucoma surgery (MIGS) devices, the Hydrus Microstent and the iStent Trabecular Bypass combined with phacoemulsification for treatment of open-angle...

Histological analysis of trabeculotomy – An investigation on the intraocular pressure lowering mechanism

The primary aim of trabeculotomy (TLO) and/or minimally invasive glaucoma surgery (MIGS) is to produce a direct communication between the anterior chamber (AC) and collector channels (CC), which is believed to be the process by which intraocular pressure (IOP) is normalized. However, we previously reported our finding of the large opening of the Schlemm's canal (SC) into the AC in eyes with failed TLO (Amari et al., 2015). If the routes from the AC to the CC by TLO/MIGS are direct, IOP should be stabilized at around aqueous vein pressure if the SC and CC are undamaged. However, in eyes in which TLO/MIGS is successful, IOP usually stays at around the middle or high teens post surgery. In this current study, we retrospectively investigated the specific reason for middle- or high-teens IOP following TLO/MIGS via the histological examination of trabeculectomy (TRAB) specimens that include the area of previous TLO/MIGS in eyes with failed TLO or insufficient IOP control following TLO by specifically focusing on the behavior of the SC endothelium (SCE). Patient background, maximum IOP prior to TLO/MIGS and TRAB, the number medications administered, and elapsed time between TLO/MIGS and TRAB were reviewed. In 42 TRAB specimens of 31 120–180° TLO eyes (Group A; 27 ab-externo and 4 ab-interno eyes) and 11 360° suture TLO eyes (Group B), SC length (SCL), the site of the incision in the trabecular meshwork (TM) [i.e., the center (CEN)/anterior-tip (TIP)], and TM opening into the AC [i.e., open (OPN)/closed (CLS)] were histologically investigated. The correlation between the clinical parameters of the maximum IOP of pre-TLO/MIGS, the maximum IOP of pre-TRAB, the percentage of IOP reduction (PIR), and the histological results were statistically evaluated. Our findings revealed a significant negative correlation between the maximum IOP of pre-TRAB and SCL (P = 0.0167), and a significantly higher PIR in the eyes with OPN than those with CLS in Group A (P = 0.0045). However, no significant difference in SCL was found between the OPN and CLS eyes in both groups. In comparison to Group A, a higher percentage of OPN (82%) yet a smaller SCL (P = 0.0024) was observed in Group B. No significant correlation between clinical and histological parameters was found in Group B. In both groups, the common finding was sealing of the SC openings by SC endothelium (SCE) and no direct communication between the AC and the CC. This fact indicates that the nature by which SCE seals off the opened SC lumen into the AC created by TLO may be very important for maintaining the blood-aqueous barrier. Based on these results, we concluded that accessibility for aqueous humor to the SC and preservation of the SC may be important for lowering IOP by TLO. However, the opening of the SC into the AC (OPN type) does not guarantee an adequate IOP lowering effect if the SC is widely collapsed. Thus, TLO may be improved only by eliminating the most resistant part of the TM with minimal SCE damage.

Comparison of netarsudil and latanoprostene bunod as adjuncts to maximum medical therapy in primary open-angle glaucoma

ObjectifComparer l'efficacité de 2 nouveaux collyres – le nétarsudil à 0,02 % (NET) et le latanoprostène bunod à 0,024 % (LB) – à titre de traitement d'appoint aux 4 classes de collyres formant le traitement médicamenteux maximal (TMM) dans le glaucome primitif à angle ouvert (GPAO). NatureÉtude de cohorte rétrospective réalisée dans un seul établissement (clinique universitaire de traitement du glaucome) et reposant sur des dossiers médicaux datant de 2017 à 2021, avec suivi de 30 à 90 jours. ParticipantsPatients présentant un GPAO qui prenaient déjà le TMM (4 classes de collyres) et auxquels on a prescrit le NET (n = 24) ou chez lesquels on a remplacé un analogue des prostaglandines déjà prescrit par le LB (n = 11); les patients n'avaient jamais fait l'objet d'un traitement chirurgical, à l'exception d'une trabéculoplastie sélective au laser ou d'une extraction de cataracte > 1 an plus tôt. MéthodesSoit l'ajout du NET ou le remplacement de l'analogue des prostaglandines par le LB, tout en poursuivant le TMM. Au nombre des paramètres de mesure, citons la baisse de la pression intraoculaire (BPIO) absolue en mm Hg, la BPIO en pourcentage et la proportion de patients obtenant une BPIO de > 10 % (seuil cible). RésultatsNous avons analysé les données de 35 yeux de 35 patients. La BPIO était significativement plus importante après l'ajout du NET qu'après le remplacement de l'analogue des prostaglandines par le LB. La BPIO en pourcentage obtenue sous l'effet du NET était elle aussi significativement plus importante que celle observée avec le remplacement de l'analogue des prostaglandines par le LB. Enfin, la proportion de patients ayant obtenu la BPIO cible était significativement plus élevée dans le groupe NET. ConclusionsComparativement au remplacement de l'analogue des prostaglandines par le LB, l'ajout de NET au TMM visant le GPAO a donné lieu à une BPIO significativement plus grande, et permis l'obtention d'une BPIO > 10 % chez une proportion significativement plus importante de patients.

The Relationship Between Plasma Tetrahydrocannabinol Levels and Intraocular Pressure in Healthy Adult Subjects.

BackgroundΔ9-tetrahydrocannabinol (THC) has been shown to decreased intraocular pressure (IOP). This project aims to define the relationship between plasma THC levels and IOP in healthy adult subjects.MethodsEleven healthy subjects received a single dose of inhaled cannabis that was self-administered in negative pressure rooms. Measurements of IOP and plasma THC levels were taken at baseline and every 30 min for 1 h and afterwards every hour for 4 h. IOP reduction and percent change in IOP over time were calculated. Linear regression models were used to measure the relationship between IOP and plasma THC levels. Two line linear regression models with F-tests were used to detect change points in the regression. Then, Pearson correlations were computed based on the change point.ResultsTwenty-two eyes met inclusion criteria. The average peak percentage decrease in IOP was 16% at 60 min. Percent IOP reduction as well as total IOP reduction demonstrated a negative correlation with THC plasma levels showing r-values of −0.81 and −0.70, respectively. F-tests revealed a change point in the regression for plasma levels >20 ng/ml. For levels >20 ng/ml, the correlation coefficients changed significantly with r-values of 0.21 and 0.29 (p < 0.01).ConclusionPlasma THC levels are significantly correlated with IOP reduction up to plasma levels of 20 ng/ml. Plasma levels >20 ng/ml were not correlated with further decrease in IOP. More research is needed to determine the efficacy of THC in reducing IOP for eyes with ocular hypertension and glaucoma.

Effectiveness of selective laser trabeculoplasty in advanced open‐angle glaucoma

AbstractPurposeTo study the effectiveness and safety of selective laser trabeculoplasty (SLT) for the treatment of advanced open‐angle glaucoma.MethodsWe carried out a prospective longitudinal study, including patients with advanced open‐angle glaucoma. Selective laser trabeculoplasty has been indicated either after failure of medical treatment or in cases of poor adherence to medical treatment. Measurements were obtained at 1 week, 1 month, 3 months and 6 months. Success was defined as a reduction in intraocular pressure (IOP) of more than 20% from baseline or a reduction of at least one antiglaucoma eye drops with stable intraocular pressure. A p value less than 0.05 was considered as statistically significant.ResultsFifty‐nine eyes were included in the study. Three types of glaucoma were present in our study: primary open‐angle glaucoma was the most common type followed by exfoliative glaucoma and pigmentary glaucoma. The success rate was 76.5% for failure of medical treatment and 80% for poor adherence. The most frequent side effects were the inflammatory reaction (18.6%) and the early IOP spikes (25.4%). The predictors of its effectiveness were the initial intraocular pressure (p = 0.03) and the percentage reduction in intraocular pressure at 1 month (p = 0.002).ConclusionsSelective laser trabeculoplasty is an effective and easy‐to‐perform physical treatment of advanced open‐angle glaucoma with a satisfactory safety profile (1,2). It overcomes poor adhesion problems. Our results need to be extended to assess long‐term success.Bibliography1. Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863–876.2. Sina Elahi, Harsha L Rao, Alina Dumitru, Kaweh Mansouri. Predictors of Success in Selective Laser Trabeculoplasty: Data From the Lausanne Laser Trabeculoplasty Registry. J Glaucoma. 2020 Jul;29(7):550–555.

Change of Retinal Vessel Density After Lowering Intraocular Pressure in Ocular Hypertension.

Purpose: To investigate the relationship between retinal microvasculature changes and intraocular pressure (IOP) for ocular hypertension (OHT) patients and further assess the factors associated with retinal microcirculation changes.Methods: This was a single-center prospective study designed for OHT patients, which consisted of two visits. After collecting baseline data of those who met the eligibility criteria, these patients were treated with latanoprost 0.005% ophthalmic solution for 4 weeks. Peripapillary vessel density (VD) of radial peripapillary capillaries (RPC) layer, macular VD in both superficial and deep layers, and foveal avascular zone (FAZ) area were measured by optical coherence tomography angiography (OCTA) before and after the treatment. We compared the changes in IOP and VD among the two visits by paired-sample t-test. Bonferroni correction was applied. Factors associated with VD changes were analyzed by linear regression analysis.Results: Thirty-four eyes of thirty-four patients were included. The mean IOP decreased by 6.5 ± 2.2 mmHg (p < 0.001). The peripapillary RPC VD increased significantly from 51.8 ± 2.5 to 53.0 ± 3.1% (Adjusted-p = 0.012). We found no significant difference in detailed sectors of the peripapillary region after correction. In the macular area, both the superficial and deep layers in foveal (superficial: 0.2 ± 1.9%, p = 0.523; deep: 0.0 ± 2.3%, p = 0.969) and parafoveal (superficial: 0.3 ± 3.0%, p = 0.565; deep: 0.5 ± 3.1%, p = 0.423) VD remained unchanged. The decrease of the mean FAZ area was insignificant (p = 0.295). The percentage of IOP reduction (β = 0.330, p = 0.031) and the baseline RNFL thickness (β = 0.450, p = 0.004) significantly correlated with the percentage of peripapillary RPC VD improvement in the multivariate linear regression analysis.Conclusion: The peripapillary VD in OHT patients increased after the reduction of IOP. The mild change of IOP did not alter the microcirculation in the macula. In addition, the percentage of IOP change and the baseline RNFL thickness were independent factors for the peripapillary RPC VD improvement.