Pigmentary Glaucoma Research Articles

Ripasudil in a Model of Pigmentary Glaucoma.

PurposeTo investigate the effects of Ripasudil (K-115), a Rho-kinase inhibitor, in a porcine model of pigmentary glaucoma.MethodsIn vitro trabecular meshwork (TM) cells and ex vivo perfused eyes were subjected to pigment dispersion followed by K-115 treatment (PK115). PK115 was compared to controls (C) and pigment (P). Cytoskeletal alterations were assessed by F-actin labeling. TM cell phagocytosis of fluorescent targets was evaluated by flow cytometry. Cell migration was studied with a wound-healing assay. Intraocular pressure was continuously monitored and compared to after the establishment of the pigmentary glaucoma model and after treatment with K-115.ResultsThe percentage of cells with stress fibers increased in response to pigment but declined sharply after treatment with K-115 (P: 32.8% ± 2.9%; PK115: 11.6% ± 3.3%, P < 0.001). Phagocytosis first declined but recovered after K-115 (P: 25.7% ± 2.1%, PK115: 33.4% ± 0.8%, P <0.01). Migration recuperated at 12 hours with K-115 treatment (P: 19.1 ± 4.6 cells/high-power field, PK115: 42.5 ± 1.6 cells/high-power field, P < 0.001). Ex vivo, eyes became hypertensive from pigment dispersion but were normotensive after treatment with K-115 (P: 20.3 ± 1.2 mm Hg, PK115: 8.9 ± 1.7 mm Hg; P < 0.005).ConclusionsIn vitro, K-115 reduced TM stress fibers, restored phagocytosis, and restored migration of TM cells. Ex vivo, K-115 normalized intraocular pressure.Translational RelevanceThis ex vivo pigmentary glaucoma model provides a readily available basis to investigate new drugs such as the rho-kinase inhibitor studied here.

Causes of Iris Depigmentation in Young and Middle Age. Clinical Example

The spontaneous change of eyes’ color is a quite rare complain in ophthalmological clinical practice for young and middle-aged patients. We consulted the 18-year-old patient complained that a month ago she noticed a change of the iris’ color. It was symmetrical in both eyes, which had lightened and acquired a “spotty appearance”. Before the appearance of these complaints, the patient had eyes of a rich dark brown color. After a comprehensive examination, the bilateral acute iris depigmentation (BADI) was diagnosed. BADI is bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior segment. It is more common for young and middle-aged women, and is often asymptomatic. BADI has bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior eye segment of the eye, which may affect the trabecular network. A feature of this disease is the absence of transillumination, changes in the shape of the pupil, and an inflammatory reaction. In some cases, repigmentation may occur spontaneously during the next few years. Therefore, from a prognostic point this disease has a favorable prognosis. However, patients with BADI syndrome should undergo regular ophthalmological examinations, including measurement of intraocular pressure to exclude the development of secondary open-angle pigmented glaucoma, and use sunglasses when the sun is bright. BADI syndrome must be differentiated with the following diseases: Fuchs heterochromic iridocyclitis, viral iridocyclitis caused by HSV and CMV, pigment dispersion syndrome and pseudo exfoliative glaucoma, as well as bilateral acute iris transillumination (BAIT) syndrome to make a correct diagnosis and apply adequate treatment tactics.

Changes of Ocular Dimensions as a Marker of Disease Progression in a Murine Model of Pigmentary Glaucoma.

PurposeThe elevation of intraocular pressure (IOP), a major risk factor in glaucoma, is an important parameter tracked in experimental models of this disease. However, IOP measurement in laboratory rodents is challenging and may not correlate with some key pathological events that occur in the development of glaucoma. The aims of this study were to quantify changes in ocular morphology in DBA/2J mice that develop spontaneous, age-dependent, pigmentary glaucoma and to check the possible correlation of these parameters with IOP.MethodEye morphology was evaluated with MRI in DBA/2J, DBA/2J-Gpnmb+/SjJ, and C57BL/6J female mice ages 3, 6, 9, 12, and 15 months. The animals were anesthetized with isoflurane. A planar receive-only surface coil (inner diameter = 10 mm) was placed over each animal’s left eye and the image was acquired with a 7T small animal-dedicated magnetic resonance tomograph and T2-weighted TurboRARE sequence. Ocular dimensions were manually quantitated using OsiriX software. IOP was measured with rebound tonometry.ResultsIn the control animals, no age-related changes in the ocular morphology were noted. Since 6 months of age, the anterior chamber deepening and elongation of the eyeballs of DBA/2J mice was detectable. We found a significant, positive correlation between IOP and axial length, anterior chamber area, or anterior chamber width in C57BL/6J mice but not in DBA/2J mice. However, after excluding the measurements performed in the oldest DBA/2J mice (i.e. analyzing only the animals ages 3 to 12 months), we demonstrated a significant positive correlation between IOP and anterior chamber width.ConclusionHigh-resolution magnetic resonance imaging of the eye area in mice enables reproducible and consistent measures of key dimensions of the eyeball. We observed age-dependent alterations in the eye morphology of DBA/2J mice that mostly affected the anterior chamber. We also demonstrated a correlation between some of the ocular dimensions and the IOP of C57Bl/6J mice and DBA/2J mice with moderately advanced glaucomatous pathology.

Use of automatic refractometer infrared images to screen pigment dispersion syndrome: a cross-sectional observational study from a preliminary hypothesis

Background: This study was performed to evaluate the use of anterior segment images, obtained with an automatic refractometer, to identify early defects of the iris pigment epithelium in patients with pigment dispersion syndrome (PDS) or pigmentary glaucoma (PG) without observable alterations at the slit lamp.&#x0D; Methods: In this cross-sectional observational study, carried out from January 2018 to December 2019, in Policlinico Citta di Udine Health Center, Udine, Italy, we observed anterior segment infrared images of 1700 subjects who were undergoing routine ophthalmological examination using an automatic refractometer. We selected infrared images of subjects who fulfilled the inclusion and exclusion criteria and looked for a focal defect in the iris pigment epithelium.&#x0D; Results: Twenty patients with focal iris pigment epithelial defect were identified and none of them showed evident signs of PDS. After the necessary explanations, they agreed to have further examinations to verify the possibility of PDS. An in-depth evaluation of ocular structures, including gonioscopy, demonstrated the presence of PDS in all subjects with iris defects.&#x0D; Conclusions: The use of infrared images obtained by an automatic refractometer could provide early and easy identification of PDS in crowded ophthalmology clinics or mass screening programs; yet, more well-designed studies are necessary to confirm these preliminary findings and prove this proposed screening tool.

Intraocular Pressure Peaks After Suprachoroidal Stent Implantation.

To study the efficacy and safety of suprachoroidal stent in everyday clinical practice at a tertiary glaucoma center. This retrospective single-center consecutive case series involved patients treated at Helsinki University Hospital with the CyPass Micro-Stent. Preoperative IOP was ≥18 mm Hg. Success was IOP between 6 and 18 mm Hg and lowering of IOP at least 20% from baseline without an increase in glaucoma medications over baseline or use of oral acetazolamide, and no subsequent glaucoma surgery. Of the total 38 eyes of 33 patients, 17 had primary open-angle glaucoma, 16 had exfoliative glaucoma, 2 each had uveitic glaucoma or steroid-induced glaucoma, and 1 had pigmentary glaucoma. Median preoperative IOP was 25.8 [interquartile range (IQR), 9.7] mm Hg with a median of 3 (IQR, 2) glaucoma medications. Kaplan-Meier estimate of median survival time was 79 days (95% confidence interval, 37-121 d). Success rate at 12-month follow-up was 24%. Sudden IOP elevation to over 30 mm Hg occurred in 14 eyes (37%). Highest IOP was 68 mm Hg. IOP peaks occurred between 1 week and 8 months after the surgery. In total, 43% of those with IOP elevation to >30 mm Hg had no symptoms. After the CyPass implantation, 15 eyes (39%) needed additional glaucoma surgery within a median of 167 (IQR, 109) days. Suprachoroidal stenting in a heterogenous clinical population resulted in a high incidence of sudden IOP peaks with a low success rate.

Our experience with micropulse cyclophotocoagulation in the therapy of glaucoma.

The cohort of patients consisted of 47 people, out of which 16 men and 31 women. An average age of males was 58.9 years (the range from 35 to 78 years), and an average age of females was 64.7 years (the range from 33 to 86 years). Both eyes were treated in three patients, and therefore the total number of assessed eyes was 50. Patients who underwent the therapy were in different stages of glaucoma disease, with various types of primary and secondary glaucoma. Most of the patients were those with primary open angle glaucoma (POAG): 26 patients, followed by patients with secondary pseudoexfoliative glaucoma (PEXG): 9 patients; diagnoses of the remaining patients: 4 patients - secondary pigmentary glaucoma (PG), 3 patients - primary angle closure glaucoma (PACG), 2 patients normal tension glaucoma (NTG), 3 patients - Posner-Schlossman syndrome, 1 patient - Cogan-Reese syndrome, 1 patient - neovascular glaucoma and 1 patient - secondary traumatic glaucoma. On the operated eye prior to the surgery 3 patients underwent laser iridotomy, 4 patients trabeculectomy, 4 patients EX-PRESS® implant, 3 patients EX-PRESS® implant and trabeculectomy and 1 patient transscleral cyclophotocoagulation. During surgery we opted for from 2,000 to 2,250 mW infrared laser with 810 nm wavelength which uses amicropulse system of laser energy emission. For the procedure we used anew MP3 application probe. 30% drop in intraocular pressure (IOP) compared to the baseline IOP values was set as asuccess. Our results correlated with the most of available studies when we achieved drop in the values of intraocular pressure by the minimum of 30% in 53.4% of the eyes. The effect of therapy failed in 9 eyes (18%) where we subsequently selected adifferent therapeutic procedure. MP CPC is anon-incisional laser treatment with minimum complications. It is characterized by ahigh safety profile and predictability of results. In our study we achieved drop in the values of intraocular pressure by the minimum of 30% in 53.4% of treated eyes. Its use is not limited by the type of glaucoma disease. In the event of insufficient effect, it may be repeated.

The Spectrum of Pigment Dispersion: A Case Report and Topic Review

Introduction: The spectrum of disease including pigment dispersion syndrome and pigmentary glaucoma is wide and its potentially rapid progression can affect quality of life if not accurately classified and appropriately managed. Case Presentation: This case report involves a patient with unilateral pigment dispersion syndrome and contralateral pigmentary glaucoma. Management and Outcome: Vigilant monitoring and longitudinal analysis of this case of secondary open angle glaucoma determined that he was not a rapid progressor and treatment did not need to be intensified. Discussion: Pigmentary glaucoma is, on average, a more aggressive form of disease and should therefore by managed with the appropriate amount of reverence. The velocity of the disease’s progression and risk of functional vision loss will guide the clinician on how intensive the medical or surgical intervention should be. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/the-spectrum-of-pigment-dispersion-a-case-report-and-topic-review) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Reversal of Iris Backbowing in Pigment Dispersion Syndrome

Reversal of Iris Backbowing in Pigment Dispersion Syndrome

Intraocular pressure reduction in a pigmentary glaucoma model by Goniotome Ab interno trabeculectomy.

PurposeTo investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype.MethodsEight eyes of a porcine pigmentary glaucoma model underwent 90° of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, additional 90° of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&E) was obtained.ResultsAfter the first 90° TM excision, IOP was significantly lower in G (10.2±2.4 mmHg, n = 7) than C (20.0±2.0mmHg, n = 8, P<0.01). Outflow facility in G (0.38±0.07 μl/min/mmHg) was higher than C (0.16±0.02 μl/min/mmHg, P<0.01). After the second 90° TM excision, IOP in G (6.46±0.81 mmHg, n = 7) was significantly lower than C (20.3±1.7 mmHg, n = 8, P<0.001), while the outflow facility in G (0.50±0.05 μl/min/mmHg, n = 7) was higher than C (0.16±0.01 μl/min/mmHg, n = 8, P<0.001). Compared to the first excision, excision of an additional 90° did not change of IOP (P = 0.20) or outflow facility (P = 0.17) further.ConclusionsExcision of 90° of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility.

Near-infrared transillumination imaging combined with aperture photometry for the quantification of melanin in the iris pigment epithelium.

Near-infrared transillumination is used in the diagnosis and the management of different eye diseases. In particular, it enables the visualization of melanin in the pigment epithelium of the iris. This technique is valuable in such conditions as pigment dispersion syndrome and Adie's tonic pupil. Thus, objective quantification of the amount of melanin shedded from the iris pigment epithelium may help in the management of these conditions. By combining aperture photometry with near-infrared iris transillumination this can be achieved. A total of 4 patients (7 eyes) were examined. Three patients were diagnosed with pigment dispersion syndrome in both eyes. One patient had Adie's tonic pupil in one eye. Near-infrared iris transillumination was performed by using a prototype apparatus. Aperture photometry measurements were carried out through specially developed software. The signal-to-noise ratio of the prototype apparatus was 52 dB (399:1). Each pixel within the near-infrared transillumination image corresponded with an area size of the iris of 85 μm x 83 μm. Measurements were taken from several points of the iris in all patients. The average aperture photometry value of transillumination defects was 1321.53 (ADU) ± 501.08 SD, while the average aperture photometry value of the papillary ruff was 90.83 (ADU) ± 53.4. On average transillumination defects transmit 14.55 times more near-infrared light than the papillary ruff. A prototype apparatus for the capture of near-infrared iris transillumination images and custom software enabling aperture photometry measurements of the obtained images has been developed for the purpose of this study. This study demonstrates a potential application of this technique in the diagnosis and management of patients with such conditions as pigment dispersion syndrome and Adie's tonic pupil.

Genetic Heritability of Pigmentary Glaucoma and Associations With Other Eye Phenotypes

Mechanisms behind pigmentary glaucoma, a form of early-onset glaucoma that may potentially lead to severe visual impairment or blindness, are poorly understood. To calculate the single-nucleotide polymorphism (SNP) heritability of pigmentary glaucoma and identify genetic associations with the disease. This genome-wide association study included affected individuals from Germany and control participants from the United Kingdom. Genome-wide information was obtained for patients with pigmentary glaucoma and control participants free of glaucoma by using the Illumina Human Omni Express Exome 8v1-2 chip and genomic imputation. The SNP heritability of pigmentary glaucoma was estimated through a restricted maximum likelihood analysis. Associations between the genetic variants and pigmentary glaucoma obtained from age, sex, and principal component-adjusted logistic regression models were compared with those of SNPs previously associated with other eye phenotypes using Pearson product-moment correlations. Data were collected from November 2008 to January 2018, and analysis was completed between April 2018 and August 2019. An estimate of SNP-explained heritability for pigmentary glaucoma; correlations of effect sizes between pigmentary glaucoma and iris pigmentation and myopia; and correlations of effect sizes between pigmentary glaucoma and other eye phenotypes. A total of 227 affected individuals (mean [SD] age, 58.7 [13.3] years) and 291 control participants (mean [SD] age, 80.2 [4.9] years) were included; all were of European ancestry. The SNP heritability of pigmentary glaucoma was 0.45 (SE, 0.22; P = 6.15 × 10-10). Twelve SNPs previously reported with genome-wide significant associations with eye pigmentation were associated with pigmentary glaucoma's SNP heritability (4.9% SNP heritability; 0.022; P = 6.0 × 10-4). Pigmentary glaucoma SNP effect sizes were correlated moderately for myopia (r, 0.42 [95% CI, 0.14-0.63]; P = 4.3 × 10-3) and more strongly with those for iris pigmentation (r = -0.69 [95% CI, -0.91 to -0.20]; P = .01), although this was nonsignificant per a strict adjusted significance threshold (P < .01). These findings support the conclusion that pigmentary glaucoma may have a genetic basis and be highly heritable. Variants associated with lighter eye color and myopia appear to be associated with increased risk of pigmentary glaucoma, but no shared genetic basis with primary open-angle glaucoma (or its quantitative endophenotype of cup-disc ratio) was observed.

Laser puncture of symptomatic primary iris pigment epithelial cyst causing hemeralopia: a rare case

Primary iris pigment epithelium cysts involve posterior surface of the iris and can occur at pupillary margin or anterior ciliary body. They may be stationary or progressive and sometimes regress spontaneously. These cyst can occasionally lead to angle-closure glaucoma, plateau iris syndrome and secondary pigment dispersion syndrome. A steadily growing cyst may disturb the vision by covering the visual axis and provoke an increase in intraocular pressure (IOP) or even inflammation if it touches the corneal endothelium. There are multiple management options in complicated situations. We report a case of a 17-year-old girl with unusual complaints of hemeralopia and dark-brown discolouration of pupils in both eyes. On examination, she had multiple pigment epithelial iris cysts at the pupillary margins, which were punctured with Nd:Yag laser, and the response was improvement in vision and hemeralopia without any pigment dispersion or IOP changes.

A case of bilateral acute depigmentation of the Iris in one of two identical twins

BackgroundBilateral Acute Depigmentation of the Iris (BADI) is a condition which was first described in a case series from Turkey by Tugal-Tutkin and Urgancioglu in (Graefes Arch Clin Exp Ophthalmol 244:742-6, 2006). The condition is characterized by bilateral acute depigmentation and discoloration of the iris stroma, pigment dispersion, and deposition of pigment in the angle. In our case we report a patient who developed BADI after receiving pitcher plant extract injections for chronic migraine, while her identical twin sister has normal iris architecture and pigmentation and never received any pitcher plant injections.Case presentationPatient is a 41-year-old female with history of pitcher plant extract injections to her face for chronic migraine, who later developed bilateral depigmentation of the iris. She did not have any signs of anterior segment uveitis or iridocyclitis. She has an identical twin sister who maintained normal iris pigmentation during the entire course.ConclusionsBilateral Acute depigmentation of the is a recently discovered condition described in the literature in Turkish patients (Tugal-Tutkun and Urgancioglu, Graefes Arch Clin Exp Ophthalmol 244:742-6, 2006; Tugal-Tutkun et al., Ophthalmology 116(8):1552-7, 2009). This condition affects mainly young females and is characterized by acute bilateral stromal depigmentation, without other pathologic ocular findings. These patients usually maintain normal vision and do not develop significant glaucoma from pigment collecting in the anterior chamber angle. This condition can be mistaken for Fuchs’ heterochromic iridocyclitis, pigment dispersion syndrome, pseudoexfoliation syndrome, and viral iridocyclitis. This is the first reported case in North America and is important for differentiation from the above pathologies. Our patient had a history of pitcher plant extract injections to the face but it is unclear if this is associated with our patient’s development of BADI. As awareness of this condition progresses, a possible etiology may be elucidated.

Clinical Characteristics of Pigment Dispersion Syndrome and Pigmentary Glaucoma Patients: A Cross-sectional Study

Introduction: Pigmentary Glaucoma (PG) and Pigment Dispersion Syndrome (PDS) are two different spectrums of a single disease. Since the disease is seen in younger population and is rapidly progressive blinding disease, therefore early diagnosis and treatment will reduce the burden of the disease and improve the quality of life. Aim: To evaluate clinical characteristics of PDS and PG patients in eastern part of Uttar Pradesh. Materials and Methods: This was a two years (1st January 2018 to 31st December 2019) hospital‑based retrospective cross‑sectional study of patients who attended the glaucoma clinic. Diagnosis of PDS was made when they had normal optic disc, normal visual field {with or without increased Intra Ocular Pressure (IOP)} and at least two of the following three signs were found clinically: Krukenberg spindle, homogenous moderate‑to‑heavy (≥Spaeth 2+) Trabecular Meshwork (TM) pigmentation, and any degree of zonular and/or lenticular pigment granule dusting. Patients with PDS were diagnosed with PG, if they had two or more of the following findings: initial IOP &gt;21 mmHg, glaucomatous optic nerve damage or glaucomatous visual field loss. Various parameters such as influence of demographics, IOP, Best‑Corrected Visual Acuity (BCVA), Central Corneal Thickness (CCT), Mean Deviation (MD), Visual Field Index (VFI %), spherical equivalent and clinical finding of anterior segment of study patients were analysed. Mean, standard deviation and percentage were calculated using GraphPad Instat version 3.0. Results: Among 40 patients, nine eyes of the six patients had myopia of ‑0.5D or greater, with mean refractive error of ‑3.55±4.72 spherical equivalent. The average baseline IOP in study patients (PDS+PG), was 30.21±11.42 mmHg. Twenty four (60%) patients, either in one or both eyes had glaucoma, secondary to PDS at the initial diagnosis. Thirty three (82.5%) patients had Krukenberg spindles. Homogeneous TM pigmentation was seen in all patients. Typical spoke‑like radial Iris Transillumination Defects (ITDs) were not observed in any of the patients except in one patient, who had isolated short slit‑like trans‑illumination defects in iris crypts. Conclusion: PDS patients with normal optic disc and visual field and raised IOP, should be started prophylactic treatment and needs to be monitored more closely. Thus, the finding of PDS in Indians should alert the ophthalmologist to look for glaucoma during the initial examination.

Unilateral pigment dispersion syndrome

A 40-year-old woman who presented for prescription of glasses. She had no history of ocular trauma, inflammation, or any ocular disease. Refraction was - 1,25D in the right eye, and -1 in the left eye. Corrected Visual acuity was 6/6 in both eyes. Slit-lamp biomicroscopy revealed a Krukenberg spindle in the right eye (A, B, C). At gonioscopy, the iridocorneal angle was widely open, with posterior insertion of the iris, and a Sampaolesi line (D). The angle of the left eye was normal. The intraocular pressure (IOP) was 14mmhg. Fundus examination was normal, with no optic disc alterations in both eyes. Pigment dispersion syndrome (PDS) is an ophthalmic condition defined as a dispersion of melanin pigment in the anterior segment. The release of melanin pigment results from the friction of the peripheral region of the posterior epithelium of the iris against the anterior zonular fibers. This friction causes pigment dispersion and iris transillumination. Pigment dispersion leads to the typical corneal pigmentation or Krukenberg spindle generally appears as a central, elongated, brown band on the corneal endothelium, and pigment accumulation on the trabecular meshwork. Pigment on the trabecular meshwork can lead to trabecular alterations and increased IOP. This can be associated with glaucomatous optic neuropathy: pigmentary glaucoma. PDS, more common in myopes, typically involves both eyes. unilateral involvement is unusual. The differential diagnosis, especially when it´s unilateral can be challenging and meticulous examination is warranted to make a distinction from other conditions where there is dissemination of pigment such as trauma, inflammation, tumors, and pseudoexfoliation.

Late-onset single-piece foldable intraocular lens-induced pigmentary glaucoma: A new management strategy

Phacoemulsification with foldable intraocular lens (IOL) implantation is the standard of care offered for a cataract. Single-piece acrylic (SPA) IOL is designed to be placed in the bag and not suitable for sulcus implantation. If implanted in sulcus, it can lead to pigmentary glaucoma, due to constant friction with the iris, leading to pigment release, which blocks trabecular meshwork. We report the case of pigment dispersion glaucoma due to sulcus-implanted SPA presented 3 years after cataract surgery. It was managed successfully by an IOL exchange where we could implant a foldable three piece IOL into the intact capsular bag.

What are the effects of peripheral iridotomy for people with pigmentary glaucoma?

What are the effects of peripheral iridotomy for people with pigmentary glaucoma?

Effectiveness of selective laser trabeculoplasty in glaucoma patients: a 6 years follow up study

AbstractThe use of laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) has provided an alternative strategy to treat open angle glaucoma (OAG) or ocular hypertension (OHT). SLT lowers IOP by enhancing aqueous humor outflow through the trabecular meshwork. It induces less coagulative damage than argon laser trabeculoplasty. The effect of SLT diminishes over time and some patients may need more treatment or surgery.PurposeTo evaluate long‐term effectiveness of SLT in OAG/OHT.MethodsRetrospective cohort study. All patients with OAG/OHT treated in 2012 with 180º SLT were included. Patients with &lt;1 year of follow up were excluded. Following SLT, patients were examined at 6, 12, 24, 36, 48, 60 and 72 months. In each visit IOP was measured, and fundus and anterior segment were examined. Structural images and visual fields were performed to asses glaucoma progression.ResultsSeventy‐eight eyes of 49 patients were included. Mean age was 65.2 ± 12.2 years old. Forty two eyes had OAG, 6 pseudo‐exfoliation glaucoma, two pigmentary glaucoma, two aphakic glaucoma and 26 had OHT. The mean follow‐up was 5.2 ± 1.4 years. Mean previous IOP was 21.2 ± 3.7 mmHg. After treatment, and excluding patients who required surgery, IOP had significantly decreased to 17.1 ± 3.2 mmHg at one year (n = 73; p &lt; 0.001) and to 17.4 ± 3.5 mmHg (p &lt; 0.001) at 6 years of follow‐up (n = 41). The number of drugs used was 2 ± 1.1 before treatment and 1.9 ± 1.2 (n = 41; p = 0.55) after 6 years. A total of 35 eyes (27.3%) needed more than one SLT session to achieve the desired IOP and 18 eyes (23.1%) needed glaucoma surgery in a mean time of 2 years after the first SLT. None of the patients had major complications related to SLT treatment.ConclusionAlthough the effect of SLT decreases with time, our study shows that it can be an effective technique to significantly lower IOP after 6 years of follow up.

Trabecular micro-bypass stent implantation with cataract extraction in pigmentary glaucoma.

Use of the trabecular micro-bypass stent with cataract surgery is well established to be safe and effective in primary open-angle glaucoma. This is the first study to exclusively evaluate use of the device in pigmentary glaucoma. This study aimed to investigate the safety and efficacy of a trabecular micro-bypass stent in combination with cataract surgery in pigmentary glaucoma. Retrospective, consecutive case series. Twenty-four eyes of 12 patients with pigmentary glaucoma implanted with one trabecular micro-bypass stent with concomitant cataract surgery. Baseline data was collected and compared to the following postoperative time points: 1 day, 1 week, 1 month out to 36 months (M36) after the procedure. These included intraocular pressure (IOP), number of glaucoma medications and need for additional surgery. At M36 there was a 25% reduction in IOP to 14.68 ± 3.0 (P < .01) from 19.50 ± 6.7 mmHg at baseline. The mean number of glaucoma medications was 0.75 ± 1.0 prior to the surgery and 0.59 ± 0.6 (P > .05) at 36 M. At the 36 M time-point, 95% of eyes had IOP ≤ 18 mmHg and 68% of eyes were ≤ 15 mmHg. No eyes underwent a secondary glaucoma procedure. The insertion of a single trabecular micro-bypass stent in combination with cataract surgery effectively provides a sustained reduction in IOP up to 3 years after surgery in patients with pigmentary glaucoma. The safety profile is favourable with low rate of IOP spikes and no patients requiring additional surgery.

The Chinese Glaucoma Study Consortium for Patients With Glaucoma: Design, Rationale and Baseline Patient Characteristics.

Precis:Chinese Glaucoma Study Consortium (CGSC) as the first nationwide glaucoma registry in China, we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics.Aim:As a leading cause of blindness in China, glaucoma affects 2% to 4% of adults over the age of 40 and will become increasingly prevalent as the population ages. At the national level, there are few reports on the current medical practice for glaucoma patients. CGSC will be considered as the first nationwide glaucoma registry in China. Here we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics.Methods:From December 21, 2015 to September 9, 2018, CGSC recruited patients with the diagnoses of primary angle-closure suspect, primary angle-closure, primary angle-closure glaucoma, acute primary angle closure, primary open-angle glaucoma (POAG), pigmentary glaucoma (PG), and pseudoexfoliative glaucoma (PXG) from 111 hospitals covering 67 cities from 22 provinces, 4 municipalities, and 5 autonomous regions in mainland China. Clinical data were collected using an Electronic Data Capture System designed by Tongren hospital and Gauss informed Ltd. Blood samples were collected from every patient for further genetic analysis.Results:Medical records of 10,892 patients were collected, of which 5762 patients have complete information. The average age of those with complete information (n=5762) was 62.05±11.26 years old, and 35.25% were males. Primary angle-closure disease, including primary angle-closure suspect/primary angle-closure/primary angle-closure glaucoma/acute primary angle closure, was predominant (4588, 79.63%), and the distribution for others is as follows: POAG (1116, 19.37%), PXG (41, 0.71%) and PG (17, 0.30%). A total of 16,684 blood samples were collected, of which 9917 (82.68%) were primary angle-closure disease, 1987 (16.57%) were POAG, 69 (0.58%) were PXG, 22 (0.18%) were PG, and 4689 were normal controls.Conclusions:The CGSC is the first national-level glaucoma registry study in China. Clinical data and blood samples will provide the opportunity to study the epidemiology of glaucoma in Chinese hospitals, to evaluate the level of medical diagnosis and treatment of glaucoma in China, and to identify the susceptibility loci for glaucoma.