Primary Glaucoma Research Articles

Complications after Gonioscopy-Assisted Transluminal Trabeculotomy in glaucoma treatment - literature review.

Glaucoma is a disease that leads to optic nerve damage and irreversible loss of the visual field. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive glaucoma surgery technique, where the surgeon opens the trabecular network and Schlemm's canal to improve the outflow of the aqueous humor. This method has shown efficacy in reducing intraocular pressure in patients with primary and secondary glaucoma. GATT has gained popularity due to its minimally invasive nature, compatibility with cataract surgery and relatively low cost. Despite its advantages, the procedure can be associated with many complications such as hyphema, intraocular pressure spikes and corneal edema. In rare cases, it can lead to Descemet's membrane detachment or cystoid macular edema. The success of GATT procedure mostly depends on the surgeon's skill and experience, but also on the patient's risk factors, including age and preoperative intraocular pressure levels. Further studies are required to understand long outcomes and identify the patients, who may be at higher risk of complications.

Changes in IOL power after laser peripheral iridotomy based on multivariate analysis

BackgroundThis study aimed to investigate the effect of laser peripheral iridotomy (LPI) on intraocular lens (IOL) power in patients with primary angle closure disease (PACD), and to construct mathematical models to assess changes in IOL power.MethodsThis study included 58 eyes of PACD patients. IOL Master700 was used to analyze and compare the changes of IOL power and ocular related parameters in each formula before and after LPI. The number of cases with IOL power changes greater than 0.5 diopters (D) in each group were counted and significant differences were analyzed using Fisher’s exact test. Pearson’s linear correlation analysis was used to ascertain the relationship between IOL power changes and ocular parameter changes to establish mathematical models.ResultsNo significant difference was found in calculated IOL power changes before and after LPI in each group. There was significant difference in the number of cases with IOL change values greater than 0.5D between the primary angle closure glaucoma (PACG) and the other two groups for each formula. IOL power changes were mainly associated with △K and △AL. Mathematical models of IOL power changes after LPI were constructed based on linear regression analysis.(PAC group: △IOLHaigis=0.026–2.950×△AL-1.414×△K, △IOLHoffer Q=-3.578×△AL-1.412×△K, △IOLSRK/T=-3.152×△AL-1.114×△K, △IOLHolladay 1=-3.405×△AL-1.291×△K, △IOLHolladay 2=-3.467×△AL-1.483×△K, △IOLBUII=-3.185×△AL-1.301×△K; PACG group:△IOLHaigis=-1.632×△K, △IOLHoffer Q=-3.770×△AL-1.434×△K, △IOLSRK/T=-3.427×△AL-1.102×△K, △IOLHolladay 1=-3.625×△AL-1.278×△K, △IOLHolladay 2=-4.764×△AL-1.272×△K, △IOLBUII=-4.935×△AL-1.304×△K).ConclusionsLPI will cause changes in some ocular parameters in patients with PACD, with great effects on IOL power calculations was observed in patients with PACG. Mathematical models based on multivariate analysis hold promise for predicting IOL power changes subsequent to LPI.

Early Results of PRESERFLO TM MicroShunt for Primary Open-angle Glaucoma in Caucasian Patients.

The PRESERFLO MicroShunt effectively lowered intraocular pressure in primary high and normal pressure open-angle glaucoma. To evaluate the efficacy and safety of the PRESERFLOTM MicroShunt in patients with primary open-angle glaucoma (POAG) and the two variants high (HPG) and normal pressure glaucoma (NPG) after one year. Single-center prospective interventional case series consecutively including eyes of White/European patients with POAG, who received the PRESERFLOTM MicroShunt as a primary and stand-alone glaucoma intervention. Primary outcome measures: change in mean 24-h IOP (mdIOP, mean of 6 measurements), peak IOP, IOP fluctuations, anti-glaucoma medications, and success rates. Secondary outcome measures: visual acuity, visual fields, complications, surgical interventions, and adverse events. Forty-two eyes of 42 POAG patients, 29 in the HPG and 13 in the NPG group, were analyzed after 1-year follow-ups. Median [Q25, Q75] mdIOP (mmHg) dropped by 30% from 16.5 [13.7-27.3] to 12.8 [10.2-14.5] in the HPG and by 40% from 14.3 [13.3-16.0] to 9.5 [8.3-11.1] in the NPG group, with a median postoperative medication use of 0 [0-0] in both groups. At one year, 92.5% of eyes were medication-free versus 0% preoperatively. The reduction of mdIOP (P=1.0), peak IOP (P=0.932), IOP fluctuations (P=0.142) and the rate of interventions (P=0.298) were not statistically significantly different between the HPG and NPG group. None of the patients experienced severe adverse events or loss of vision. Effective and safe intraocular pressure lowering was observed one year following MicroShunt implantation for primary HPG and NPG in white patients of European descent.

An epidemiological survey of visual impairment in rural populations aged 30 and above: the Handan Eye Study

Objective: To investigate the changes in prevalence and causes of blindness and visual impairment over six years among rural populations aged 30 and above in Yongnian County, Handan City, Hebei Province, a pilot area in northern China for blindness prevention and treatment, and to study the incidence of common blinding eye diseases. Methods: This population-based prospective cohort study included a baseline survey conducted from 2006 to 2007 using stratified cluster sampling, targeting 6 830 Han Chinese individuals aged 30 and above, with a response rate of 90.4%, and a follow-up survey conducted from 2012 to 2013 with 5 394 participants, maintaining a response rate of 85.3%. Visual impairment was defined according to World Health Organization standards as visual acuity<20/60 but ≥20/400, and blindness as visual acuity<20/400. Age-and gender-standardized prevalence rates of blindness and visual impairment, along with their 95% confidence intervals (CI), were estimated. The six-year incidence rates of primary glaucoma, age-related macular degeneration, and myopic maculopathy, along with their 95%CI, were reported. Results: At baseline, the standardized prevalence of bilateral blindness in individuals aged 30 and above was 0.6% (41/6 799) for presenting visual acuity and 0.5% (31/6 799) for best-corrected visual acuity. These rates were higher than those found in the follow-up survey, 0.5% (27/5 293) and 0.3% (17/5 276). Conversely, the standardized prevalence of bilateral visual impairment increased from 4.7% (361/6 799) and 1.0% (85/6 799) at baseline to 6.5% (355/5 293) and 1.4% (74/5 276) at follow-up, respectively. The leading cause of bilateral blindness was cataract in both baseline (13/31, 41.9%) and follow-up (7/17) surveys. Other major causes included myopic retinal degeneration (5/31, 16.1% at baseline; 2/17 at follow-up), glaucoma (3/31, 9.7% at baseline; 2/17 at follow-up), and corneal opacity (3/31, 9.7% at baseline; 2/17 at follow-up). Over six years, the incidence rates for primary glaucoma, early and late age-related macular degeneration, and myopic maculopathy in individuals aged 35 and above were 1.6% (95%CI: 1.2%-1.9%), 4.2% (95%CI: 3.8%-4.7%), 0.2% (95%CI: 0.2%-0.3%), and 0.1% (95%CI: 0.0%-0.2%), respectively. Conclusions: The prevalence of bilateral blindness in the rural population of Yongnian County, Handan City, Hebei Province, decreased over six years due to blindness prevention and treatment efforts but remained higher than in urban areas. Meanwhile, the prevalence of bilateral visual impairment increased since the baseline survey. Cataracts continued to be the primary cause of blindness, followed by myopic retinal degeneration, glaucoma, and corneal opacity.

The Use of Artificial Intelligence for Estimating Anterior Chamber Depth from Slit-Lamp Images Developed Using Anterior-Segment Optical Coherence Tomography.

Primary angle closure glaucoma (PACG) is a major cause of visual impairment, particularly in Asia. Although effective screening tools are necessary, the current gold standard is complex and time-consuming, requiring extensive expertise. Artificial intelligence has introduced new opportunities for innovation in ophthalmic imaging. Anterior chamber depth (ACD) is a key risk factor for angle closure and has been suggested as a quick screening parameter for PACG. This study aims to develop an AI algorithm to quantitatively predict ACD from anterior segment photographs captured using a portable smartphone slit-lamp microscope. We retrospectively collected 204,639 frames from 1586 eyes, with ACD values obtained by anterior-segment OCT. We developed two models, (Model 1) diagnosable frame extraction and (Model 2) ACD estimation, using SWSL ResNet as the machine learning model. Model 1 achieved an accuracy of 0.994. Model 2 achieved an MAE of 0.093 ± 0.082 mm, an MSE of 0.123 ± 0.170 mm, and a correlation of R = 0.953. Furthermore, our model's estimation of the risk for angle closure showed a sensitivity of 0.943, specificity of 0.902, and an area under the curve (AUC) of 0.923 (95%CI: 0.878-0.968). We successfully developed a high-performance ACD estimation model, laying the groundwork for predicting other quantitative measurements relevant to PACG screening.

Eye microcirculation in glaucoma. Part 1. Diagnostic methods

Glaucoma is a socially significant disease, which is a wide group of polyetiological diseases. In the etiology of primary glaucoma, in addition to the mechanical theory, a vascular mechanism is also distinguished, and therefore, the search and development of the most informative and accurate method for studying ocular blood flow continues. Existing methods are divided into invasive and non-invasive. Invasive methods include angiography with intravenous fluorescein and indocyanine. Non-invasive methods include ultrasound Doppler mapping and pulsed Doppler modes, optical coherence tomography with angiography and laser speckle flowography. The review presents data on modern methods for ocular hemodynamics in glaucoma and ocular hypertension with technologies for studying retrobulbar blood flow and intraocular hemocirculation.

Canaloplasty via an ab-interno surgical technique in patients with primary angle closure glaucoma

PurposeTo investigate the clinical outcomes of canaloplasty performed with the iTrack microcatheter (Nova Eye Medical, Fremont, USA) as a standalone procedure and in combination with phacoemulsification in patients with primary angle-closure glaucoma (PACG).MethodsA single-center, retrospective case series of eyes undergoing canaloplasty via an ab-interno technique with a diagnosis of PACG based on gonioscopy findings (Shaffer grading). Patients were excluded if they had previously undergone a glaucoma procedure other than Laser Peripheral Iridotomy (LPI). Eyes were grouped by glaucoma severity based on mean deviation preoperative values. Outcome measures included intraocular pressure (IOP) and number of glaucoma medications.ResultsSixty eyes (9 canaloplasty-standalone, pseudophakic, and 51 canaloplasty + phaco) were eligible. The mean baseline IOP was 21.9 ± 7.3 mmHg and number of glaucoma medications was 1.95 ± 1.4. At the latest follow-up (mean 26 ± 9.2 months), they were reduced to 14.6 ± 3.7 mmHg (p < 0.001) and 0.96 ± 1.2 (p < 0.001). IOP reduction was statistically significant when canaloplasty was performed as a standalone procedure (baseline 22.78 ± 6.72 vs 17.00 ± 3.42 at the latest follow-up) or combined with phacoemulsification (21.75 ± 7.43 vs 14.21 ± 3.66) or if canaloplasty was performed in mild (20.8 ± 4.93 vs 15.5 ± 3.63), moderate (21.9 ± 8.58 vs 13.9 ± 3.90) or severe (23.5 ± 11.3 vs 12.4 ± 3.20) glaucoma eyes, with no difference between the groups postoperatively. Medication reduction was significant when canaloplasty was performed in combination with phacoemulsification and in mild glaucoma eyes. No serious intraoperative or postoperative complications were reported.ConclusionCanaloplasty via an ab-interno surgical technique, performed as standalone or combined with phacoemulsification, is a safe and clinically effective treatment in primary angle closure glaucoma patients up to 2 years.

Impact of Phacoemulsification on Trabeculectomy Bleb Function and Morphology in Primary Angle Closure Glaucoma: A Comparative Study of the Visco-Cushion Effect

Impact of Phacoemulsification on Trabeculectomy Bleb Function and Morphology in Primary Angle Closure Glaucoma: A Comparative Study of the Visco-Cushion Effect

The many faces of secondary angle closure glaucoma: A practical approach to unveil.

Secondary angle closure glaucoma (SACG) can be quite puzzling and can challenge even an experienced glaucoma surgeon. Unlike primary angle closure glaucoma, SACG can have various ocular and systemic associations. A careful review of the symptoms and past ocular and surgical history cannot be overemphasized. Some of the SACG can be refractory, requiring drainage devices. However, sometimes, all it takes is a prompt laser iridotomy. This can significantly reduce ocular morbidity and, in some situations, even blindness. Gonioscopy, often an underutilized technique, is critical in making the right diagnosis. With the advent of imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, one can easily pick up the etiology and treat early. As many cases of SACG present acutely, it is critical that one makes a prompt diagnosis. We present here a video bouquet of illustrated examples of SACG and the steps to identify the cause by using different imaging techniques. Through this video, we aim to make the diagnosis of SACG a simpler, more streamlined, and logical process that will help in the accurate diagnosis and management. This video demonstrates various etiologies of secondary angle closure and methods to identify and treat the same. Secondary angle closure can occur either with or without pupillary block. SACG with pupillary block involves mechanisms such as seclusio pupillae, aphakic/pseudophakic glaucoma, phacomorphic glaucoma, and silicon oil-induced glaucoma. In contrast, there are various other etiologies causing anterior pulling or posterior pushing mechanisms that contribute to non-pupillary block SACG. We discuss all of these, along with the imaging modalities needed to identify the same. https://youtu.be/N0bIw7Uknww.

Serum lipid and lipoprotein profiles and their association with intraocular pressure in primary open-angle glaucoma: an observational cross-sectional study in the Chinese population

BackgroundGlaucoma is a leading cause of vision impairment and permanent blindness. Primary open-angle glaucoma (POAG) is a prominent type of primary glaucoma; however, its cause is difficult to determine. This study aimed to analyze the serum lipid profile of Chinese POAG patients and assess its correlation with intraocular pressure (IOP).MethodsThe study included 1,139, 1,248, and 356 Chinese individuals with POAG, primary angle closure glaucoma (PACG), and controls, respectively. Peripheral whole blood samples were collected at the time of diagnosis. Enzymatic colorimetry was used to determine serum levels of different lipids: high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides, cholesterol, and very low-density lipoproteins (VLDL). Additionally, immunoturbidimetry was used to quantify serum levels of apolipoproteins A (APOA), B (APOB), E (APOE), and lipoprotein A [Lp(a)], while intraocular pressure (IOP) was measured in all patients with POAG.ResultsAfter adjusting for age and sex, patients with POAG exhibited elevated serum levels of VLDL, APOA, and APOE but mitigated cholesterol levels compared with the control participants. Significantly lower serum triglyceride, VLDL, and Lp(a) levels were found in patients with PACG than in control participants. Serum cholesterol (P = 0.019; β = -0.75, 95% confidence interval [CI]: -1.38 – -0.12) and HDL levels (P < 0.001; β = -2.91, 95% CI: -4.58 – -1.25) were inversely linked to IOP in patients with POAG, after adjusting for age, sex, and ocular metrics. In addition, serum Lp(a) levels were correlated with the average IOP (P = 0.023; β = -0.0039, 95% CI: -0.0073 – -0.006) and night peak (P = 0.027; β = -0.0061, 95% CI: -0.0113 – -0.0008) in patients with POAG.ConclusionsSignificantly different serum lipid and lipoprotein profiles were observed in POAG and PACG patients. This study highlighted the differences in serum lipid and lipoprotein levels among Chinese POAG patients and their relationship with IOP and IOP fluctuation. Serum lipid and lipoprotein profiles should be considered while evaluating glaucoma risk.

Investigating the uncertain causal link between gut microbiota and glaucoma: A genetic correlation and Mendelian randomisation study.

Glaucoma is the most common cause of irreversible blindness, and gut microbiota (GM) is associated with glaucoma. Whether this association represents a causal role remains unknown. This study aims to assess the potential association and causal link between GM and various forms of glaucoma, emphasising the need for cautious interpretation of the strength of these associations. Employing a two-sample bidirectional Mendelian randomisation (MR) framework with false discovery rate correction and various sensitivity analyses, supplemented by genetic correlation analysis via linkage disequilibrium score regression (LDSC) and colocalisation for European summary-level data between MiBioGen consortium and FinnGen Study, we sought to explore the relationship between GM and glaucoma. While certain microbial taxa showed potential associations with glaucoma subtypes (e.g., Erysipelotrichaceae with primary angle closure glaucoma, Senegalimassilia with exfoliation glaucoma), the overall findings suggest a complex and not definitively causal relationship between GM and glaucoma. Notably, reverse MR analysis did not establish a significant causal effect of glaucoma on GM composition, and no consistent genetic correlations were observed between GM and glaucoma. While our study provides some evidence of associations between specific GM taxa and glaucoma, the results underscore the complexity of these relationships and the need for further research to clarify the potential causal links. The findings highlight the importance of interpreting the gut-eye axis with caution and suggest that while GM may play a role in glaucoma, it is unlikely to be a predominant causal factor.

Profile of Glaucoma Patients at a Tertiary Care Centre in Gokarneshwor, Kathmandu, Nepal

Glaucoma is a progressive optic neuropathy characterized by irreversible optic nerve damage and progressive visual field loss. It is the second leading cause of global irreversible blindness. The objective of this study was to find the prevalence, clinical profile and distribution of various types of glaucoma in patients attending a tertiary care center of Kathmandu. This was a retrospective, descriptive hospital based study conducted at glaucoma clinic at tertiary care center from March 2022 to February 2024 (24 months). Patients’ demographic profile along with comprehensive eye examination findings were reviewed from the records. Data analysis was done with SPSS version 18 and chi-square test was used for analysis. P value &lt;0.05 was considered as statistically significant. Two hundred and four patients were diagnosed with glaucoma during 2 years period. The Mean age among glaucoma patients was 55.12 ± 16.7 years. Female was common 109 (53.4%) than male 95 (46.6%). Open angle was 185 (90.7%) and close angle was 19 (9.3%) on gonioscopy. Prevalence of glaucoma seen in this study was 0.72% of total outpatients (27,970). Among the glaucoma patients, primary open angle glaucoma (POAG) was more common 84 (41.2%) followed by glaucoma suspect 46 (22.5%), normal tension glaucoma (NTG) 26 (12.7%), primary angle closure disease 19 (9.4%), ocular hypertension (OHT) 12 (5.9%), secondary glaucoma 9 (4.4%) and juvenile open angle glaucoma (JOAG) 8 (3.9%). In primary angle closure disease, primary angle closure glaucoma (PACG) was 10 (4.9%), angle closure attack 5 (2.5%) and primary angle closure suspect (PACS) 4 (2%). The most common secondary glaucoma was pigmentary glaucoma 3 (1.5%) followed by steroid induced glaucoma 2 (1%), neovascular glaucoma 2 (1%) and inflammatory glaucoma 2 (1%). The most common type of glaucoma seen in a tertiary care center of Nepal was POAG. Glaucoma was more prevalent in female patients after forty years. The prevalence of glaucoma increases with increasing age. So, the patients above the age of 40 should be screened for glaucoma for early detection and prompt treatment. Awareness of glaucoma is needed as it is one of the leading causes of blindness.

Comparative outcomes of topical and laser treatment in newly diagnosed patients with primary glaucoma

Comparative outcomes of topical and laser treatment in newly diagnosed patients with primary glaucoma

The relationship between different types of primary glaucoma and retinal vein occlusion

The relationship between different types of primary glaucoma and retinal vein occlusion

The effect of travoprost on subfoveal choroidal thickness in primary open angle glaucoma

Toassess the effect of topical travoprost on subfoveal Choroidal Thickness in Primary open glaucoma patients. The choroidal thickness, a sign of ocular blood flow can be altered by prostaglandin analogues. Hence this study was done to analyse the choroidal thickness after travoprost therapy.: This Prospective, interventional study included 41 eyes of treatment naive POAG patients. Subfoveal choroidal thickness was measured at first visit and after 3 months of topical travoprost therapy by Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT). The measurements were compared before starting the treatment and after 3 months of treatment with travoprost therapy. The mean choroidal thickness pre-treatment was 296.73 ± 28.07 mm post treatment was 311.56 ± 33.38 µm. The mean difference in choroidal thickness between pre-treatment and post-treatment was found to be 14.8 ±15.1 µm with median value(IQR) of 8 (3 - 30) µm (p-value&amp;#60; 0.00) which was statistically significant.Thecurrent study showed that Subfoveal choroidal thickness(SFCT) changes with travoprost therapy.

The Mirror Theory: Parallels between Open Angle and Angle Closure Glaucoma.

Glaucoma is a widespread ophthalmological disease, with a high impact and frequent visual morbidity. While the physiopathology of the two types of primary glaucoma (open angle and angle closure) has been studied, there seems to be little relationship between the two. In this study, we gather clinical and preclinical data to support the idea that the two primary glaucomas are "mirrored" in terms of morphological parameters and disease physiopathology. In short, primary angle closure glaucoma (PACG) is associated with hyperopia and low axial length, and primary open angle glaucoma (POAG) is associated with myopia and high axial length. Moreover, in PACG and in primary angle closure or primary angle closure suspect cases, while there is extensive iridotrabecular contact, the intraocular pressure (IOP) is still maintained in the lower half of the normal range throughout the evolution of the disease, which suggests a baseline trabecular hyperfiltration in PACG. In the opposite case, myopic eyes with open angles and a higher risk of developing POAG often have a baseline IOP in the upper half of the normal range, suggesting a baseline trabecular hypofiltration. As we explore clinical, genetic and animal model data regarding these opposing aspects, we hypothesize the existence of a mirroring relationship between PACG and POAG. Defining the relationship between the two potentially blinding diseases, with a high prevalence worldwide, may aid in understanding the mechanisms better and refining diagnosis and treatment. Thus, our theory has been named the Mirror Theory of Primary Glaucomas.

Relationship Between Glaucoma and Chronic Stress Quantified by Allostatic Load Score in the All of Us Research Program

PurposeTo assess the relationship between glaucoma and allostatic load (AL), an established framework for quantifying the physiologic effects of chronic stress through measurements of systemic biomarkers. DesignRetrospective case-control study. MethodsParticipants of the National Institutes of Health All of Us (AoU) Research Program with complete AL biomarker data between December 1984 to June 2022 and with (cases) or without (controls) primary glaucoma were identified. AL scores were calculated using the adapted Seeman AL scale consisting of 10 systemic biomarkers: body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, glomerular filtration rate, albumin, C-reactive protein, and homocysteine. AL score was defined as the number of biomarkers with measurements in the highest risk quartiles. Age was calculated as the median age at time of biomarker measurements. Logistic regression analysis was performed to assess the association between the earliest possible AL score and glaucoma adjusted for race/ethnicity. Mediation analysis was performed to estimate the relationship between race/ethnicity and glaucoma mediated by AL score. ResultsThe study cohort consisted of 349 (16.1%) cases and 1,819 (83.9%) controls with 52.7% females, 2.2% Asians, 10.7% Blacks, 10.0% Hispanics, and 72.5% non-Hispanic Whites. At the earliest timepoint (median [IQR] = 6.4 [1.9-12.2] years prior to diagnosis), cases had higher AL score than controls (3 [1-4] versus 2 [1-3], respectively; p<0.001). On multivariable analysis, higher AL score (OR=1.09 per point), Black race (OR=2.58), and Hispanic ethnicity (OR=2.12) conferred higher risk of glaucoma (p≤0.02). AL score partially mediated higher glaucoma risk among Blacks (7.5%) and Hispanics (5.0%) compared to non-Hispanic Whites. On subgroup analysis, higher AL score was significantly associated with primary open angle glaucoma (POAG; OR=1.11; p=0.01) but not primary angle closure glaucoma (PACG; p=0.87). ConclusionAoU participants with glaucoma had greater AL 6.4 years prior to diagnosis, and AL score partially mediated racial/ethnic differences in glaucoma risk. These findings suggest chronic stress may increase risk for glaucoma and contribute to racial disparities in glaucoma burden.

Role and mechanism of autonomic nervous system regulation in primary glaucoma

The regulation of blood flow in the human eye, aqueous humor production, and the outflow channels of aqueous humor are all controlled by the autonomic nervous system (ANS), encompassing both sympathetic and parasympathetic nerves. Patients with primary glaucoma often exhibit autonomic nervous system dysfunctions, which may exacerbate visual impairment. The homeostasis of the autonomic nervous system is influenced by circadian rhythms, physical exercise, emotional states, medications, and other factors. Previous studies have indicated that activities such as aerobic exercise, yoga breathing, and meditation can promote the restoration of autonomic nervous system balance, thereby reducing intraocular pressure. However, further evidence is required to substantiate the efficacy of ANS activity regulation as an effective adjunct therapy for primary glaucoma. This review examines the role and mechanisms of autonomic nervous system regulation in the context of primary glaucoma.

Modified ex-PRESS technique versus Ahmed glaucoma valve as primary glaucoma surgery for hereditary transthyretin amyloidosis glaucoma

Background To compare the efficacy of modified Ex-PRESS technique (ExP) versus Ahmed Glaucoma Valve (AGV) as primary surgery in hereditary transthyretin amyloidosis (ATTRv) secondary glaucoma. Methods Retrospective study at the national amyloidosis centre. Success was defined as an IOP ≥ 6 mmHg and ≤ 21 mmHg with no need for further glaucoma surgery or laser trabeculoplasty and without loss of light perception at the time of the last follow-up. Secondary outcomes included surgical complications, need for hypotensive drugs, and endothelial cell loss. Patients submitted to previous glaucoma surgery were excluded. Results We included 180 eyes of 150 patients, 121 in AGV and 59 in ExP group. No significant baseline differences were found between groups. At the time of last follow-up, both groups exhibited significant intraocular pressure (IOP) reduction (p < .001) and number of glaucoma medications (p < .001). Kaplan-Meyer analysis showed higher cumulative probability of success for AGV group (80.1% vs. 41.1%, p < .001) and higher mean time to failure (54.5 vs. 36.9 months, respectively, p < 0.001) at 60 months follow-up. AGV showed lower hazard (HR 0.21, 95% CI [0.111–0.407], p < .001) for failure. Conclusion AGV and ExP are safe and effective techniques in the treatment of ATTRv secondary glaucoma. However, AGV’s efficacy seems to be more durable.

Long-term Outcomes of Combined Phacotrabeculectomy Surgery in a Singapore Tertiary Hospital

PurposeTo describe the long-term outcomes of phacotrabeculectomy from a tertiary glaucoma service in Singapore. DesignRetrospective case series. MethodsSeven hundred ninety-six eyes of 698 patients who underwent phacotrabeculectomy surgery at the Singapore National Eye Centre between 2005 and 2007 with a minimum follow-up of three years were included. The primary outcome measure was intraocular pressure (IOP). Secondary outcomes included best-corrected visual acuity (BCVA), number of glaucoma medications, and surgical complications. ResultsThe mean age was 69.5 years, 51 % were male, and 86 % were Chinese. Most eyes had primary glaucoma (90.6 %). The mean follow-up duration was 9.4 years. The overall success rate at three years was 97 % if surgical success was defined as IOP ≤ 21 mm Hg, 92 % if IOP ≤ 18 mm Hg, 66 % if IOP ≤ 15 mm Hg. By Kaplan–Meier survival analysis over 13 years, the cumulative success rate fell from 98.1 % to 89.1 % if IOP ≤ 21 mm Hg, 98.1–76.9 % if IOP ≤ 18 mm Hg, 98–50.3 % if IOP ≤ 15 mm Hg. The postoperative IOP improved significantly at all time points (P < 0.05) and 72 % had at least 20 % IOP reduction. There was a slight improvement in postoperative BCVA (P < 0.05). The mean number of glaucoma medications was reduced postoperatively (P < 0.001). There were no significant risk factors for surgical failure. ConclusionsPhacotrabeculectomy was found to be safe, resulting in clinically significant IOP lowering for 13 years with reduced dependency on glaucoma medications and improved BCVA.