Pretreatment Intraocular Pressure Research Articles

Efficacy and safety of first-line or second-line selective laser trabeculoplasty for normal-tension glaucoma: a multicentre cohort study

Background/aimsThis study aimed to investigate and compare the efficacy and safety of first-line and second-line selective laser trabeculoplasty (SLT) in Japanese patients with normal-tension glaucoma (NTG).Methods100 patients with NTG were...

The use of anti-glaucoma medications following pediatric glaucoma surgery: a report on efficacy and trends in Cairo University

Purpose To identify the pattern(s) in using antiglaucoma medications following glaucoma surgery in children and compare their efficacies. Methods Retrospective chart review of patients (≤12 years) receiving glaucoma surgery from January 2013 to December 2020. Partially responsive patients needing antiglaucoma medications to attain an Intraocular pressure (IOP) of at least 18 mmHg were divided into three groups: (A) received beta-blocker (β-Blockers); (B) received Prostaglandin analogues and (C) received fixed β-Blocker+ Carbonic anhydrase inhibitor (CAI) preparation. Data included demographics, clinical characteristics, IOP (before, after 1 month, and at last follow-up), and surgeries. Successful treatment attained IOP less than or equal to 18 mmHg on last follow-up. Side effects were recorded. Results Totally 200 eyes of 152 patients were included, (61%) presented within the first month of life, 54% were males, 31.6% had bilateral disease and (82.2%) had primary congenital glaucoma (PCG). Pre-treatment IOP was significantly higher in group C (P=0.009). The most common procedure performed was trabeculotomy (P=0.014). After a mean follow-up period of 20.12 months, all three groups showed a significant reduction in the IOP (P≤0.001), with the highest percent reduction attained in group C (43.7% vs. 33.4% and 33.1% in groups A and B, respectively) P=0.001. Final success rates were 41.2%, 83.3%, and 82.2% for groups A, B, and C, respectively. Dry eye was the most common side effect (32 eyes) mainly occurring in group A (21.6%). Conclusions The most frequently used antiglaucoma medications following partially successful surgery are CAI+β-Blocker combinations. They seem to have the most potent effect and are usually used as a first line the higher the initial IOP is.

Trabecular Procedures Combined with Cataract Surgery for Open-Angle Glaucoma: A Report by the American Academy of Ophthalmology

To determine the intraocular pressure (IOP) reduction of various trabecular procedures (a form of minimally invasive glaucoma surgery [MIGS]) combined with cataract surgery compared with cataract surgery alone, to compare the safety of the various trabecular procedures, and to highlight patient characteristics that may favor one trabecular procedure over another. A search of English-language peer-reviewed literature in the PubMed database was initially conducted in February 2021 and updated in April 2023. This yielded 279 articles. Twenty studies met initial inclusion and exclusion criteria and were assessed for quality by the panel methodologist. Of these, 10 were rated level I, 3 were rated level II, and 7 were rated level III. Only the 10 level I randomized controlled trials (RCTs) were included in this assessment, and all were subject to potential industry-sponsorship bias. The current analysis focuses on the amount of IOP reduction (in studies that involved medication washout) and on IOP reduction with concurrent medication reduction (in studies that did not involve medication washout). Based on studies that performed a medication washout, adding a trabecular procedure to cataract surgery provided an additional 1.6 to 2.3 mmHg IOP reduction in subjects with hypertensive, mild to moderate open-angle glaucoma (OAG) at 2 years over cataract surgery alone, which itself provided approximately 5.4 to 7.6 mmHg IOP reduction. In other words, adding a trabecular procedure provided an additional 3.8% to 8.9% IOP reduction over cataract surgery alone, which itself provided 21% to 28% IOP reduction. There was no clear benefit of one trabecular procedure over another. Patient-specific considerations that can guide procedure selection include uveitis predisposition, bleeding risk, metal allergy, and narrowing of Schlemm's canal. There are no level I data on the efficacy of trabecular procedures in subjects with pretreatment IOP of 21 mmHg or less. Trabecular procedures combined with cataract surgery provide an additional mild IOP reduction over cataract surgery alone in hypertensive OAG subjects. Additional research should standardize outcome definitions, avoid industry sponsorship bias, and study the efficacy of these procedures in normotensive OAG. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Determination of the Trans-Lamina Cribrosa Pressure Difference in a Community-Based Population and its Association with Open-Angle Glaucoma

To determine the trans-lamina cribrosa pressure difference (TLCPD) in a cohort of normal community-based patients and the relationship to primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). Retrospective cohort study of the Mayo Clinic Study of Aging. The Mayo Clinic Study of Aging is a prospective study evaluating the normal aging population. Mayo Clinic Study of Aging patients who underwent routine lumbar puncture (LP) studies with eye examinations were reviewed. The trans-lamina cribrosa pressure difference was calculated in 2 contexts of intraocular pressure (IOP): (1) maximum IOP at eye visit closest in time to the LP (closest-in-time TLCPD); and (2) IOP before IOP-lowering treatment (pretreatment IOP and pretreatment TLCPD) in POAG and NTG patients. Glaucoma patients without POAG or NTG were excluded. Regression analyses were performed to determine the relationship with glaucoma. IOP, intracranial pressure, TLCPD, POAG, normal-tension glaucoma (NTG) diagnosis, glaucoma parameters. Five hundred forty-eight patients were analyzed. Of these, there were 38 treated glaucoma patients (14 POAG and 24 NTG) and 510 nonglaucomatous patients. Cerebral spinal fluid (CSF) opening pressure was 155.0 ± 42.2 mmH2O in nonglaucomatous patients, 144.0 ± 34.0 mmH2O in POAG (P= 0.15 vs. nonglaucomatous patients), and 136.6 ± 29.3 mmH2O in NTG (P= 0.017 vs. nonglaucomatous patients). Intraocular pressure was 15.47 ± 2.9 mmHg in nonglaucomatous patients, 26.6 ± 3.7 mmHg in POAG, and 17.4 ± 3.4 mmHg in NTG. The closest-in-time TLCPD in the nonglaucomatous cohort was 4.07 ± 4.22 mmHg, which was lower than both the POAG cohort (7.19 ± 3.6 mmHg) and the NTG cohort (5.79 ± 4.5 mmHg, P= 0.04). Pretreatment TLCPD for the overall glaucoma cohort was 10.57 ± 6.1 mmHg. The POAG cohort had a higher pretreatment TLCPD (16.05 ± 5.2 mmHg) than the NTG cohort (7.37 ± 4.1 mmHg; P < 0.0001). Closest-in-time TLCPD for the nonglaucoma cohort (4.07± 4.2 mmHg) was significantly lower than pretreatment TLCPDs for both POAG (16.05 ± 5.2 mmHg; P < 0.0001) and NTG (7.37 ± 4.1 mmHg; P < 0.0001) cohorts. This study establishes the baseline TLCPD in a large cohort of normal, community-based patients. The differences in regression analysis between TLCPD and IOP suggests NTG pathophysiology is partially driven by TLCPD, but is also likely multifactorial. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Short-Term Outcomes of Bimatoprost Sustained-Release Intracameral Implant in Glaucoma.

This retrospective study found a statistically significant reduction in mean intraocular pressure (IOP) and the number of medications after intracameral Bimatoprost sustained release (SR) injection in patients with glaucoma. A history of selective laser trabeculoplasty (SLT) did not impact treatment outcomes. To determine outcomes of Bimatoprost SR on IOP and the number of topical IOP-lowering medications in patients with glaucoma. A secondary objective was to determine the outcomes of Bimatoprost SR in patients with a prior history of SLT. Retrospective case series. One hundred eighteen eyes from 84 patients that received Bimatoprost SR by 6 glaucoma specialists at Wills Eye Hospital from March 2020 to September 2021 were examined. The intervention was a single injection of intracameral Bimatoprost SR. The main outcome measures included IOP and the number of medications. The most recent mean follow-up time for all eyes was 27.8 ± 18.6 weeks. The mean posttreatment IOP at the most recent follow-up of 16.6 ± 5.3 mm Hg was significantly lower than the mean under-therapy pretreatment IOP of 18.5 ± 5.7 mm Hg for all eyes ( P < 0.01). The mean posttreatment number of medications at the most recent follow-up of 1.3 ± 1.3 decreased compared with the number of pretreatment medications of 2.1 ± 1.4 for all eyes ( P < 0.01). Analysis of multilevel models controlling for demographic variables demonstrated a statistically significant reduction in IOP and number of medications posttreatment ( P < 0.01). A prior history of SLT (n = 54) had no impact on treatment for both IOP and the number of medications ( P > 0.1 for both). Intracameral Bimatoprost SR reduced IOP and decreased the number of medications. Prior history of SLT did not impact Bimatoprost SR treatment outcomes.

Diurnal change of retinal vessel density related to hemodynamic variation in treatment-naïve low-teens normal-tension glaucoma

This study undertook to investigate the diurnal variation of optical coherence tomography angiography (OCTA) -derived retinal vessel density (RVD) in glaucoma patients with low baseline intraocular pressure (IOP). A prospective evaluation was performed on low-teens normal-tension glaucoma (low-teens NTG) patients with pre-treatment IOP < 15 mmHg and 32 healthy subjects. Superficial peripapillary and macular RVD by OCTA, IOP, and systemic blood pressure (BP) were all measured four times per day (from 9:00 a.m. to 6:00 p.m.). In the low-teens NTG group, the magnitude of diurnal changes in peripapillary RVD and macular RVD were greater than those in the healthy group. Diurnal variations of diastolic BP (DBP) and mean ocular perfusion pressure (MOPP) also were greater in the low-teens NTG group. As for the patterns of diurnal RVD change, the inferior and temporal sections of macular RVD showed significant differences between the two groups. Diurnal changes of RVD and MOPP and were greater than those in healthy eyes. The macular RVD and MOPP showed different diurnal patterns between the two groups. From these findings, OCTA-derived RVD variation could be related to hemodynamic variability in low-teens NTG.

Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes.

This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period. Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm2 and a duty cycle of 31.3%. A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028). Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis. Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.

Adduction induces large optic nerve head deformations in subjects with normal-tension glaucoma

PurposeTo assess intraocular pressure (IOP)-induced and gaze-induced optic nerve head (ONH) strains in subjects with high-tension glaucoma (HTG) and normal-tension glaucoma (NTG).DesignClinic-based cross-sectional study.MethodsThe ONH from one eye of 228...

Factors Predicting Successful Selective Laser Trabeculoplasty to Prevent Glaucoma Progression to Surgery

Purpose: To investigate the factors predicting successful selective laser trabeculoplasty (SLT) to prevent glaucoma progression to surgery in patients whose intraocular pressure (IOP) is not controlled with medications.Methods: This retrospective chart review included 102 eyes of 92 glaucoma patients who underwent SLT between 2018 and 2020. Success was defined as the prevention of glaucoma surgery for at least 1 year with an IOP less than 21 mmHg or no progression of retinal nerve fiber layer thinning. Kaplan-Meier survival analysis and the Cox proportional hazard model were used for the analysis.Results: A low pretreatment IOP, good visual acuity, and a smaller visual field defect were significantly correlated with success. When the other eye underwent glaucoma surgery or its SLT treatment failed, the success rate of SLT was lower. As the pretreatment IOP increased by 1 mmHg, the SLT failure rate increased by 1,376 times and when the SLT for the other eye failed, it increased by 19,577 times. When the mean deviation of the visual field increased by 1 decibel (dB), the SLT failure rate decreased by 0.928 times (&lt;i&gt;p&lt;/i&gt; &lt; 0.05).Conclusions: SLT is more effective in early glaucoma patients with an IOP lower than 25 mmHg, smaller visual field defect, and good visual acuity to prevent glaucoma progression to surgery.

Efficacy and Safety of Suprachoroidal Administration of Triamcinolone Acetonide in Patients of Refractory Diabetic Macular Edema

Background: To determine the efficacy and safety of suprachoroidal administration of triamcinolone acetonide in patients of refractory diabetic macular edema. Study setting: This study was conducted from September 2020 to April 2021 in the department of Ophthalmology FMU/Allied Hospital Faialabad. Study design was quasi experimental Materials and methods: sample size was 45, through non probability consecutive sampling. All 45 patients with refractory diabetic macular edema were enrolled and following parameters e.g Best corrected visual acuity (less than 20/40 on Snellen Visual acuity Chart),IOP &lt; 21 mm of Hg, Central macular thickness &gt;300 micrometers, were recorded as baseline at the start of study. Suprachoroidal triamcinolone acetonide injection 0.1 ml given to these 45 patients. Same parameters e.g Best Corrected visual acuity, Intraocular pressure, Central Macular Thickness were measured at each follow-up visit. First follow-up visit was conducted on next day then one week , one month and in third month. Results: In this study, mean of age was 50.71 ± 7.05 years. 23(51.1%) were males and 22(48.9%) were females. Pre-treatment Intra ocular pressure, best corrected visual acuity and macular thickness were 13.4± 1.9 mmHg ,0.72± 0.11 and 638.04 ± 133.9 micrometers respectively. After one-month Intra ocular pressure, Best corrected visual acuity and Central macular thickness were 13.71 ± 2.61 mmHg, 0.48± 0.11 and 314.11 ±53.8 micrometer and after three months 13.24±1.26mmHg, 0.46±0.12 and 306.9±49.52 micrometer respectively. Statistical significant difference was found for pre and post Best corrected visual acuity and Central macular thickness (p-value &lt;0.0001).In two (4.4%) patients, intra ocular pressure was raised. Practical implication: This study was highlighted safety and efficacy of suprachoroidal injection of triamcinolone acetonide in cases of refractory diabetic macular edema Conclusion: Suprachoroidal Triamcinolone acetonide injection is proved to be safe and effective treatment modality for the patients of refractory diabetic macular edema as it decreases central macular thickness and improves best corrected visual acuity. Keywords: Diabetic macular edema, Suprachoroidal, Triamcinolone acetonide, Intra ocular pressure, Optical coherence tomography, visual acuity.

Effectiveness of Netarsudil versus Brimonidine in Eyes already Being Treated with Glaucoma Medications at a Single Academic Tertiary Care Practice: A Comparative Study

Rho kinase inhibitors, such as netarsudil, are a relatively new class of medications recently introduced into the market for the treatment of glaucoma, the leading cause of irreversible blindness in the world. Previous clinical trials have studied netarsudil's efficacy when used as a first- or second-line agent but limited studies have investigated its effectiveness in the real world where it is more commonly used as a third, fourth, or fifth agent in combination with other topical medications. Equally important, prior studies have not compared its effectiveness to its peer medications in these settings. To compare intraocular pressure (IOP) lowering after initiation of netarsudil or brimonidine therapy in patients with glaucoma using >2 medications for IOP management. A chart review of 369 eyes from 279 patients followed at a single academic tertiary practice was performed with an institutional review board waiver of consent to compare IOP lowering after prescription of netarsudil (n = 176) versus brimonidine (n = 193) as a third, fourth, or fifth IOP-lowering agent. Patients were identified by querying the electronic medical record for those with a glaucoma-related diagnosis who were prescribed either medication. Five sequential IOP measurements were obtained to determine the mean change in IOP before and after treatment (ΔIOP = mean IOP4,5 - mean IOP1,2,3). A multilevel linear mixed-effects model assessed the influence of medication (independent variable) on ΔIOP (dependent variable). Additional independent variables of interest included the number of glaucoma medications at baseline, age, sex, glaucoma type and severity, race, and pretreatment IOP. Bootstrap analysis was performed to remove sampling bias and confirm mixed-effects model findings. Kaplan-Meier survival analysis evaluated the probability of requiring additional intervention within 3 years following the date of medication prescription. The unadjusted mean (SD) ΔIOP for netarsudil and brimonidine was -2.20 (4.11) mm Hg and -2.21 (3.25) mm Hg, respectively (P = 0.484). The adjusted linear mixed-effects models and bootstrap analysis demonstrated that there was no statistical difference in IOP-lowering effectiveness between the medications. Netarsudil and brimonidine failed to adequately control IOP at similar rates with 42% and 47% probabilities of survival respectively by the 3-year follow-up (P = 0.520). When escalating pharmacologic therapy, the IOP-lowering effect of netarsudil appeared to be similar to that produced by brimonidine. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX).

Long-term limitations and complications of trans-scleral diode laser cycloablation for refractory glaucoma.

Trans-scleral diode laser cycloablation (cyclodiode) is effective in the short-term management of refractory glaucoma where alternative treatments are not feasible. Long-term outcomes of 5-years or more are not well-documented, particularly in relation to intraocular pressure (IOP) control, need for further procedures and complications such as hypotony and phthisis. A review was undertaken of patient medical records with refractory glaucoma who underwent cyclodiode at City Eye Centre in Brisbane from 2012 to 2016. Data included sex, age, laterality, type of glaucoma, cyclodiode parameters, number of glaucoma medications, visual acuity and treatment with acetazolamide. Data were analysed using generalised linear modelling and Kaplan-Meier analysis. A total of 54 eyes in 54 patients (29 M:25F) with a mean age of 66 years (range 15-85 years) with a minimum of 5 years follow up were included. The mean number of burns was 23.3 (range 12-40) over 180-270 degrees, mean power per burn was 1967 mW (range 1500-2000 mW), with a mean duration of 1981 ms (1500-2000 ms). The mean pre-treatment IOP was 31.5 mmHg (range 17-56 mmHg) and mean IOP 5 years post-treatment was 16.1 mmHg (2-42 mmHg). The mean number of pre-treatment medications was 3.6 (range 1-6) and 2.7 (range 0-5) 5 years post treatment, including 5 (8.3%) on oral acetazolamide. Complications of cyclodiode were seen in 6 (11.1%) patients, including 3 (5.0%) cases of hypotony, and 2 (3.3%) phthisis. Cyclodiode is often utilised for end-stage glaucoma when the IOP is uncontrolled on medical treatment and drainage surgery is not indicated, resulting in long-term reduction of IOP and the number of medications, including acetazolamide. Hypotony and phthisis can be significant complications.

Incidence of severe rise in intraocular pressure after intravitreous injection of aflibercept with prefilled syringes

Our aim was to analyze the intraocular pressure (IOP) changes following different intravitreous injection (IVI) procedures with or without prefilled syringes (PFS) and to elaborate their possible causes. Clinical study and laboratory assessment. 173 eyes of 141 patients. The IOP was prospectively measured pre- and postoperatively in three groups of patients receiving IVI either with ranibizumab (RP), aflibercept PFS (AP) or aflibercept vials (AV). The AP emptying volume (EV) was assessed using 40 aflibercept PFS vials: the plunger was aligned precisely (normal volume, NV) or right below the indication line (high volume, HV) and the drug was ejected with (wP) or without forced pressure (nP). Primary outcome was post-treatment IOP with type of IVI and pre-treatment IOP as fixed factors. Secondary outcome was identification of possibly confounding factors (age, sex, pathology, presence of pseudophakia, spherical error, and number of injections) and IOP > 30 mmHg post-treatment. An IOP rise above 30 mmHg was observed in 8/38 (22%), 16/51 (31%) and 35/86 (41%) cases in the RP, AV and AP groups, respectively (p = 0.129). Pre-treatment IOP was the only predictive variable for IOP rise (p < 0.001). The EV values in the NVnP, NVwP, HVnP and HVwP groups were 56.06 ± 10.32, 70.69 ± 4.56, 74.22 ± 7.41 and 81.63 ± 3.67 µl, respectively (p < 0.001). We observed a marked, although not significantly higher incidence of IOP elevations with the aflibercept PFS. One possible reason may be the error-proneness of administering the correct volume with the AP. Caution should be taken when using the aflibercept PFS in order to prevent potential optic nerve damage in cases with marked elevation in IOP.

Correlation of Intraocular pressure and Visual Field Defects in Primary Open Angle Glaucoma

Aim: To correlate between intraocular pressure (IOP) with visual field pattern in primary open angle glaucoma (POAG). Methods: Pretreatment IOP at presentation was measured in 94 eyes of patients diagnosed with POAG in a descriptive correlational study. At least two Humphrey Visual Field(HVF) assessment two weeks apart was performed. Glaucomatous visual field defect and its severity was diagnosed on the basis of Hodapp-Parrish-Anderson criteria. The relationship between visual field defect and IOP were analyzed. Results: Superior arcuate scotoma was most common visual field defect seen in 18(19.1%) eyes. 56 eyes (59.6%) had mild POAG (MD of &lt;-6dB) with no cases having double arcuate scotoma whereas 1 eye (16.0%) with moderate POAG (MD of -6 to -12dB) had 1 double arcuate scotoma and 23 eyes (24.5%) with severe POAG (MD of &gt;-12dB) had 14 double arcuate scotoma. The mean IOP in mild POAG was 24.29 mmHg (range 21-30); 26.40mmHg (range 22-31) in moderate POAG and 29.70 mmHg (range 22-36) in severe POAG. Significant relation was demonstrated between elevated IOP at presentation and higher negative values of MD (p&lt;0.001). Conclusions: Higher IOP at presentation is associated with severity of POAG. Aggressive treatment should be initiated to arrest the rate of progression.

Outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma eyes

Introduction: Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) is a new treatment for glaucoma claiming to have lower levels of complications while having comparable efficacy relative to its predecessor, traditional Transscleral Continuous-wave Cyclophotocoagulation (TC-CPC).Objective: To evaluate the clinical efficacy and safety of MPTSCPC in the treatment of refractory glaucoma eyes.Methods: This uncontrolled interventional study was conducted at the Northampton General Hospital, UK. Patients who were selected to undergo MP-TSCPC due to uncontrolled intraocular pressure (IOP) or visual field progression despite maximum tolerable anti-glaucoma treatment were recruited for the study from February to September 2020. Data related to the patients were collected pre procedure and up to three months post procedure.Results: Of the 37 patients included in the study, 59.5% were females. The mean age of participants was 75.35 (SD=10.37) years. The most common types of glaucoma seen in the sample were primary open angle glaucoma and pseudoexfoliation glaucoma with 67.6% and 16.2% respectively. Mean pretreatment IOP was 26.62 (SD=8.36) mmHg. Three-month post-treatment mean IOP of 18.47 (SD=7.92) mmHg was a statistically significant (p&gt;0.001) reduction of 7.10 mm Hg. The drop in mean number of anti-glaucoma medications from 2.38 to 2.22 was not significant. Except for four patients with prolonged ocular inflammation and one patient with macular oedema, there were no significant complications following the procedure.Conclusion: MP-TSCPC is an effective and safe treatment option for refractory glaucoma over a 3 month follow up period. More extensive studies with larger sample sizes and longer follow up durations are recommended.

Evaluation of Macular and Peripapillary Blood Flow in Response to Intraocular Pressure Reduction in Patients With Posner-Schlossman Syndrome.

Purpose: The study aimed to evaluate the effect of intraocular pressure (IOP) reduction on macular and peripapillary microcirculation in patients with Posner–Schlossman syndrome (PSS) by optical coherence tomography angiography (OCTA). Methods: A prospective comparative study was conducted. Patients diagnosed with PSS at the Eye Center of Xiangya Hospital, Central South University, from February 2020 to November 2021 were consecutively included. OCTA was used for the macular and peripapillary microcirculation measurements, and optical coherence tomography (OCT) was employed for the retinal nerve fiber layer (RNFL) and lamina cribrosa depth (LCD) measurements. The patients received OCT and OCTA examinations at baseline and 1 week post-treatment when the IOP was under control. Changes in macular and peripapillary microcirculation, RNFL, and LCD were calculated for all the analyzed areas. Results: Twenty-one eyes from 21 patients were included in the study. Pre-treatment and post-treatment IOP were 43.17 ± 10.36 mm Hg (range, 30–60 mm Hg) and 17.17 ± 2.85 mm Hg (range, 13–23 mm Hg), respectively. No statistically significant changes were detected in RNFL, LCD, or macular and peripapillary microcirculation after significant IOP reduction. Conclusion: The results suggested that a large IOP reduction may not result in a significant increase in peripapillary and macular capillary perfusion in patients with PSS.

Clinical Characteristics of Idiopathic Orbital Inflammation Syndrome in Relation to Intraocular Pressure.

PurposeTo investigate the clinical characteristics of idiopathic orbital inflammation and changes in intraocular pressure (IOP) before and after its treatment.Patients and MethodsWe retrospectively studied 20 eyes from the medical records of 19 patients who were diagnosed with idiopathic orbital inflammation between April 1, 2004, and April 30, 2019, at Toyama University Hospital. The inflammation site (type of disease), treatment provided, IOP before and after treatment, and the symptoms (proptosis, decreased ocular movements or diplopia, periorbital edema, and ocular pain) were analyzed.ResultsThe types of idiopathic orbital inflammation were dacryoadenitis in 14, myositis in 7, diffuse-type in 3, and posterior periscleritis in 1 case. The mean IOP after treatment was 15.4±3.9 mm Hg, which was significantly lower than the mean pretreatment IOP of 19.0±5.3 mm Hg (p = 0.009). Before treatment, all cases with the diffuse-type had high IOPs of 21 mm Hg or more. Ocular pain and eye movement disorders were present in 86% and 100% of subjects in the group with an IOP of 21 mm Hg or higher, but 38% and 31% in the group with an IOP of 20 mm Hg or lower, respectively.ConclusionDiffuse-type of idiopathic orbital inflammation is prone to develop high IOP. Patients with idiopathic orbital inflammation and high IOP exhibit many symptoms such as decreased ocular movements, diplopia, and ocular pain.

Normal-tension glaucoma: Current concepts and approaches-A review.

Normal tension glaucoma (NTG) has remained a challenging disease. We review, from an epidemiological perspective, why we should redefine normality, act earlier at lower pre-treatment intraocular pressure (IOP) level, and the role of ocular perfusion pressures, noting that perfusion is affected by defective vascular bed autoregulation and endothelial dysfunction. The correlation of silent cerebral infarcts (SCI) and NTG may indicate that NTG belongs to a wider spectrum of small vessel diseases (SVD), with its main pathology being also on vascular endothelium. Epidemiological studies also suggested that vascular geometry, such as fractal dimension, may affect perfusion efficiency, occurrence of SCI, SVD and glaucoma. Artificial intelligence with deep learning, may help predicting NTG progression from vascular geometry. Finally, we review latest evidence on the role of minimally-invasive glaucoma surgery, lasers, and newer drugs. We conclude that IOP is not the only modifiable risk factors as, many vascular risk factors are readily modifiable.

Impact of Short-Term Topical Steroid Therapy on Selective Laser Trabeculoplasty Efficacy.

Background: To evaluate whether short-term use of topical steroid therapy affected the efficacy of selective laser trabeculoplasty (SLT) for primary open-glaucoma (POAG). Methods: 25 eyes of 25 patients, who used a drop of dexamethasone 0.1% 4 times a day for 7 days as post-laser therapy, formed the Steroid SLT group and 24 eyes of 24 patients, where no topical steroids or nonsteroidal anti-inflammatory agents as post-laser therapy were used, formed the No-steroid SLT group. Success was defined as an intraocular pressure (IOP) lowering exceeding 20% of pretreatment IOP. Results: The mean follow-up time was 21.24 months for the Steroid SLT group and 20.25 months for the No-steroid SLT group (p = 0.990). No significant difference was found between the two groups for mean pretreatment IOP (22.20 mmHg vs. 22.33 mmHg), and for mean IOP reductions during whole follow-up period. At all follow-up visits, the mean IOP reductions were smaller in the Steroid SLT group than in the No-steroid SLT group. At all follow-up visits, the mean percent IOP reduction was smaller in the Steroid SLT group than in the No-steroid SLT group, and such a difference was significant at 12 months (25.4% vs. 29.6%, p = 0.047) and 24 months (25.3% vs. 29.7%, p = 0.024). According to the Kaplan–Meier survival analysis, the 24-month success rate was 84% in the Steroid SLT group and 79.2% in the No-steroid SLT group, with no differences between the groups (p = 0.675). Conclusion: Short-term use of topical steroid therapy had no impact on the efficacy of SLT for POAG.

Selective laser trabeculoplasty lowered the untreated fellow eye long-term intraocular pressure: a 3-year observational study.

To explore the long-term intraocular pressure (IOP)-lowering effect of monocular selective laser trabeculoplasty (SLT) in the untreated fellow eyes of open-angle glaucoma (OAG) patients. This was a retrospective observational study. Consecutive Chinese OAG patients who received monocular SLT treatment were included in this study. One hundred and eighty degree SLT was conducted as adjunctive treatment when anti-glaucoma medication was not sufficiently effective after clinical evaluation. Treatment success was defined as more than 20% IOP reduction of the baseline IOP levels. IOP-decreasing amplitude and SLT success rate of both eyes were investigated during the 3-year follow-up period. Age, gender, baseline IOP levels, number of medications, and SLT energy parameters were analyzed to determine its influence on IOP reduction effect and treatment success rate. A total of 32 Chinese OAG patients were included in this study and 25 of them completed the 3-year follow-ups. Their pretreatment IOPs were 18.85 ± 2.81mmHg in the treated eyes and 17.38 ± 2.37mmHg in the fellow eyes. At the 3-year follow-up visits, IOP decreased to 2.76 ± 3.72mmHg (14.16%) in the treated eyes and 2.16 ± 2.73mmHg (11.95%) in the fellow eyes, with a success rate of 47.83% (11 in 23 cases) and 44.00% (11 in 25 cases), respectively. IOPs of both eyes decreased significantly after SLT from 6months and lasted to 3years after treatment. Baseline IOP level was positively correlated with IOP reduction in the treated eyes and other factors were not correlated with IOP reduction and treatment success. Monocular SLT treatment as adjunctive treatment could lower IOPs not only in the treated eyes but also in the untreated eyes in poor medication-controlled OAG patients. In addition, its IOP reduction effect could last to 3years after treatment in clinical practice.