Glaucoma Research Articles

The effects of topical latanoprost 0.005% treatment on microvascular changes in the optic nerve head and macula.

This prospective study aimed to assess the impact of topical latanoprost 0.005% treatment on the microvasculature of the macula and optic nerve head (ONH) in primary open-angle glaucoma (POAG). Fifty-seven eyes of 31 subjects were enrolled. ONH whole-image (wiVD), peripapillary (ppVD), and macular vascular density (VD) parameters were measured using optical coherence tomography angiography before treatment, at the 1st month, and at the 3rd month of treatment. There was a significant reduction in IOP post treatment, with a decrease of 17.0 ± 2.3 mmHg in the 1st month and 16.3 ± 2.5 mmHg in the 3rd month (P < 0.001 for both). ONH wiVD and ppVD significantly increased at the post-treatment 1st month (P = 0.001 for both) but decreased by the 3rd month, returning to baseline levels (P < 0.001 for both), indicating a return to pre-treatment levels (P > 0.05 for both). Similarly, macular wiVD and perifoveolar VD (pefVD) increased significantly at the 1st month (P = 0.013 and P < 0.001, respectively) but returned to baseline by the 3rd month (P < 0.001 for both). No significant difference was observed between before-treatment and post-treatment 3rd month regarding the macular wiVD and pefVD (P > 0.05 for both). Deep capillary plexus and foveal avascular zone parameters did not change during follow-up (P > 0.05 for both). The initial increase in ONH and peripapillary VD, as well as macular VD, is attributed to the acute reduction in IOP from topical latanoprost 0.005%. However, the diminishment of sustained differences by the 3rd month indicates adaptation of the ONH and retinal microvasculature to decreased IOP through compensatory mechanisms.

Effect of Belin-Ambrósio deviation index on 2-year refractive outcomes of PRK.

To assess the effect of preoperative Belin-Ambrósio deviation (BAD-D) index on 2-year visual, refractive, and tomographic outcomes, as well as the efficacy and safety of photorefractive keratectomy (PRK) surgery. Eye clinic, Mashhad, Iran. Prospective cohort study. This study included 66 patients (66 eyes) who underwent PRK surgery, with a minimum follow-up period of 2 years. Participants were divided into 2 groups: preoperative BAD-D ≥1.60 (high BAD-D) and preoperative BAD-D <1.60 (low BAD-D). Preoperative and postoperative visual, refractive, and tomographic parameters were evaluated, and the efficacy and safety of the procedure were compared between groups. 66 patients with a mean age of 35.50 ± 8.21 years (range 22 to 55 years) were included. Postoperatively, the mean spherical equivalent (SE) of refractive error was +0.32 ± 0.65 diopters (D) in the high BAD-D group and +0.18 ± 0.66 D in the low BAD-D group ( P = .40). In addition, at 2 years of follow-up, the mean uncorrected distance visual acuity was 0.98 ± 0.07 in the high BAD-D group and 0.97 ± 0.08 in the low BAD-D group ( P = .905). Among the postoperative tomographic parameters, front elevation thickness, maximum Ambrósio relational thickness, astigmatism, and central corneal thickness were significantly different between the 2 groups (all, P < .05). At the 2-year follow-up, the mean Safety Index was 1.02 ± 0.04, and 1.01 ± 0.04 in high and low BAD-D groups, respectively ( P = .37), and the mean Efficacy Index was 0.99 ± 0.07 and 0.98 ± 0.06 in high and low BAD-D groups, respectively ( P = .40). The preoperative BAD-D index does not predict postoperative visual, refractive, and tomographic outcomes in patients with low-to-moderate myopia. However, in patients with normal preoperative BAD-D values, higher agreement was expected between the attempted and achieved SE.

Acute intraoperative fluid misdirection managed with anterior approach irido-zonulo-hyaloido-vitrectomy.

To evaluate the causes of acute fluid misdirection (AFM) and the role of irido-zonulo-hyaloido-vitrectomy (IZHV) in the management of AFM. Among the 95,712 cataract surgeries performed between April 2017 and August 2022 at a tertiary center, six eyes of six patients developed intraoperative AFM and underwent IZHV through the anterior approach. AFM was diagnosed intraoperatively when there was sudden shallowing of the anterior chamber with markedly elevated intraocular pressures (IOPs) not attributable to external causes or choroidal effusion/hemorrhage. The condition resolved with deepening of AC following IZHV. Five eyes had angle closure disease (one of them also had pseudoexfoliation), and one eye had open-angle glaucoma. The mean preop IOP was 25.8 ± 7.3 mmHg, with an IOP range of 18-36. The mean number of preop AGM was 3 ± 1.7. Four eyes developed AFM during combined cataract and trabeculectomy, and two eyes during cataract surgery. Four eyes had aqueous misdirection during or after cortical aspiration, and two eyes after creation of internal trabeculectomy ostium. IZHV was performed for all eyes through an anterior approach using a 23G vitrector, which resulted in instant resolution and deepening of the anterior chamber. The mean follow-up was 8.75 months (1-48 months), the mean postoperative IOP was 16.1 ± 2.6 mmHg, and the mean number of AGM at the last follow-up was 2.8 ± 2.2. The anterior chamber was deep, and IOP was under control in all eyes with four eyes needing AGM. One eye developed postoperative aqueous misdirection due to blockade of the IZHV opening. IZHV can be an effective solution for acute intraoperative AFM, which can be performed via an anterior approach by the anterior segment surgeon.

Ion Channel Piezo1 Induces Ferroptosis of Trabecular Meshwork Cells: A Novel Observation in the Pathogenesis in Primary Open Angle Glaucoma.

This study aims to elucidate the role of Piezo1, a mechanosensitive molecule, in trabecular meshwork cells (TMCs) in the context of Primary Open Angle Glaucoma (POAG), a leading cause of irreversible visual impairment. Dysfunction of the trabecular meshwork (TM) is a key factor in the elevated intraocular pressure (IOP) observed in POAG, yet the specific mechanisms leading to TM dysfunction are not fully understood. We performed cell stretching on human trabecular meshwork cells (HTMCs) and pharmacologically activated HTMCs with Yoda1 to study the role of Piezo1 in HTMCs. We focused on assessing cell viability, mitochondrial changes, lipid peroxidation, and the expression of ferroptosis-related targets such as acyl-CoA synthetase long-chain family member 4 (ACSL4) and glutathione peroxidase 4 (GPX4). Cell stretching induces ferroptosis in HTMCs, and this phenomenon is reversed by Piezo1 knockdown. Additionally, pharmacological activation of Piezo1 also leads to ferroptosis in HTMCs. Furthermore, inhibiting the JNK/p38 signaling pathway was found to mitigate the ferroptotic response induced by Yoda1, thereby confirming that Piezo1 induces ferroptosis in TMCs through this pathway. Notably, our experiments suggest that Yoda1 may trigger ferroptosis in the TM of mouse eyes. Our findings demonstrate that the Piezo1 pathway is a crucial mediator of ferroptosis in TMCs, providing new insights into the pathogenic mechanisms of glaucoma, particularly POAG. This study highlights the potential of targeting the Piezo1 pathway as a therapeutic approach for mitigating TM dysfunction and managing POAG.

Longitudinal OCTA vessel density loss in macula and optic nerve head in healthy, glaucoma suspect and established glaucoma eyes.

To examine longitudinal optical coherence tomography angiography (OCTA) changes in macula and optic nerve head (ONH) in healthy, glaucoma suspect (GS) and primary open-angle glaucoma (POAG) eyes. Healthy, GS and POAG eyes from Diagnostic Innovations in Glaucoma Study with ≥2 years follow-up and four visits of macular/ONH OCTA imaging were included. Rates of macular wiVD (whole-image vessel density) and ONH wiCD (whole-image capillary density) changes were calculated for each diagnosis group using join mixed-effect modelling. Differences in wiVD/wiCD change rates across diagnoses were examined through pairwise comparison. Relationships of baseline 24-2 visual field (VF) mean deviation (MD) with wiVD/wiCD change rates were evaluated for POAG eyes. There were 36, 57 and 79 eyes (25, 38 and 50 subjects) in healthy, GS and POAG groups, respectively. Rates of wiVD (range:-0.72 to -0.92 %/year) and wiCD (range:-0.28 to -0.66 %/year) loss were different from zero in all groups (p<0.05). The rates of wiCD loss differed across all diagnosis groups (p<0.001), while wiVD change rates did not increase when comparing healthy to GS eyes (p=0.167). Baseline VF MD showed a significant but modest correlation with the rates of both wiVD and wiCD loss (p<0.05), and the correlation with wiCD change rate was slightly stronger (R2=0.27 vs 0.16). In glaucoma, there is earlier microvasculature loss in the ONH than in the macula. Moreover, ONH VD loss shows a slightly stronger association with baseline VF than macular VD. Observing ONH VD loss with OCTA may help to monitor early glaucoma, which should be confirmed by future larger studies.

Observations on relative peripheral refraction in Chinese adults with myopia based on a novel application of multispectral refraction topography

In this population-based observational cross-sectional study, we investigated retinal peripheral refraction in Chinese adults with myopia. We categorized 1511 Chinese adults with myopia (18 − 55 years) into low (LM), moderate (MM), and high myopia (HM) groups. Axial length, central corneal thickness, steep keratometry, flat keratometry, and intraocular pressure were measured. Refractive difference values (RDVs) for different eccentricities (RDV0–53) and the superior (RDV-S), inferior (RDV-I), temporal (RDV-T), and nasal (RDV-N) retinal regions were measured using multispectral refractive topography. The hyperopic defocus was higher for the MM group than for the LM group in RDV20–53, RDV-S, and RDV-T and HM group in RDV20–53, RDV-S, RDV-T and RDV-N. The hyperopic defocus was higher for the HM group than for the LM group in RDV20-53, RDV-S and RDV-T but lower for the LM group in RDV-N. RDV-N decreased with age (R2 = 0.0191, slope = − 0.01, p < 0.0001), whereas RDV-S (R2 = 0.0112, slope = 0.01,p < 0.0001) and RDV-T increased (R2 = 0.0038, slope = 0.01, p = 0.0160). RDV correlated with central spherical equivalent and axial length. Flat keratometry explained the most RDV variation (RDV20–30: β = 0.0714, p < 0.0001; RDV-N: β = 0.1801, p < 0.0001; RDV-S: β = 0.1426, p < 0.0001; RDV-T: β = 0.1239, p < 0.0001). Reference values for peripheral retinal defocus are provided for Chinese adults with different myopia ranges.

Monitoring of several morphometric parameters of the optic nerve and retina in persons without glaucoma and patients with primary open-angle glaucoma using various types of spectacle correction

Purpose: to perform long-term monitoring of the state of several morphometric parameters of the retina and optic nerve in persons without glaucoma and patients with primary open-angle glaucoma (POAG) in the conditions of achieving tolerant and target IOP against the background of the use of various types of spectacle correction. Material and methods: 139 patients aged 40–60 years with various types of clinical refraction were examined, 41 subjects (81 eyes) of them were without glaucoma, 98 patients (164 eyes) had POAG at stage I–II. In addition to standard methods, the scope of the examination included optical coherence tomography (OCT) of the optic nerve and the central area of the retina to determine the thickness of the retinal nerve fiber layer (RNFL), retinal ganglion cell complex (RGCC) and the area of the neuroretinal rim (NRR). The study was conducted in 4 observation groups. The first (21subjects) and the second (20 subjects) groups were represented by persons without glaucoma who used monofocal spectacle correction and progressive spectacle correction for near work, respectively. The third (50 subjects) and the fourth (48 subjects) groups were composed of patients with POAG who also used, respectively, monofocal spectacle correction for near vision or progressive spectacle correction against the background of topical hypotensive therapy with the achievement of tolerant and target IOP. The follow-up period was three years. Results: There were no significant changes in the area of NRR (p 0,5) and in the thickness of RNFL (p 0,2) and RGCC (p 0,3) over the three-year follow-up period in all patients without glaucoma. In patients with POAG who applied progressive correction, no negative dynamics was revealed in the NRR area (p 0,5) and in the thickness of RNFL (p 0,5) and RGCC (p 0,5) during the follow-up period. POAG patients with using monofocal correction had noticeable losses in RNFL and RGCC thickness (p 0,05) without a significant decrease in the area of NRR (p 0,3). Conclusion: The progressive spectacle correction using provides accommodative regulation of IOP in POAG and implements an indirect neuroprotective effect.

Comparative evaluation of OCT with OCTA changes at the optic disc and macula in glaucoma suspect and early glaucoma.

To compare the diagnostic ability of macular ganglion cell inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on optical coherence tomography (OCT) and macular and peripapillary perfusion changes using OCT angiography (OCTA) in glaucoma suspect and early primary open angle glaucoma (POAG). Ninety patients (30 normal, 30 glaucoma suspects, and 30 early POAG) were recruited in this cross-sectional, prospective study. The average thickness of mGCIPL and pRNFL on spectral domain-OCT and macular vessel density (VD), optic nerve head (ONH) perfusion, and ONH flux index (FI) on OCTA were evaluated for early diagnosis of glaucoma. Macular VD, ONH perfusion, and ONH FI were significantly reduced in early POAG eyes compared to normal. The best correlation was observed between ONH FI and the average RNFL in both glaucoma suspects (r = 0.47, P < 0.01) and early POAG patients (r = 0.53, P < 0.01). Out of all the measured OCTA parameters, only ONH perfusion was significantly lower in glaucomatous eyes compared to glaucoma suspects (P < 0.001). Average GCIPL (0.82) and macular VD (0.76) had the highest area under the receiver operating characteristic (AUROC) curve value among all the OCT and OCTA parameters, respectively, for differentiating glaucoma suspects from controls. Rim area (0.92) and ONH FI (0.81) had the highest AUROC value among all the OCT and OCTA parameters for differentiating early POAG patients from controls. OCTA vascular parameters had a good correlation with structural damage both at the disc and the macula. OCT parameters were superior to OCTA parameters for diagnosis of glaucoma, although OCTA parameters are deranged very early in the disease.

Comparison of postoperative cyclosporine 2.0% versus betamethasone 0.1% eye drops following trabeculectomy: A randomized clinical trial.

To investigate the effect of cyclosporine A 2% eye drop following trabeculectomy on intraocular pressure (IOP) and surgical success compared to postoperative steroid drop. Prospective, randomized clinical trial in an institutional setting. Forty patients with primary open-angle glaucoma and candidates for trabeculectomy were included in this study. Standard fornix-based trabeculectomy augmented with mitomycin C was performed for all patients. None of the included subjects had a history of prior laser or intraocular surgery in that eye. All included subjects were randomly assigned to either postoperative cyclosporine A 2% or betamethasone 0.1% eye drops. IOP measured by applanation tonometer and surgical success rate. Seventy-five potentially eligible POAG patients were seen during the study period, and 40 met the study criteria and were randomly assigned to one of the study groups. Patients in the cyclosporine A 2% group had consistently lower IOP, fewer glaucoma medications, and higher success rates for at least 24 months after surgery (P < 0.0001). Complete success was more frequent in the cyclosporine group. Moreover, the cyclosporine A group had more diffuse and elevated bleb with less vascularity in the first 3 months after surgery (P ≤ 0.01). This was paralleled with fewer dry eye signs and symptoms in the cyclosporine group in the first 3 months (P < 0.03). Postoperative cyclosporine A 2% eye drop can be used instead of steroid drops and is associated with improved surgical success and decreased dry eye manifestations.

Does Laser Iridotomy Cause Secondary Epiretinal Membrane?

This study aimed to determine the frequency of epiretinal membrane (ERM) in the long term after neodymium-doped yttrium aluminum garnet laser iridotomy (LI) using spectral domain optical coherence tomography (SD-OCT). This retrospective study included 94 eyes that underwent LI for primary angle-closure glaucoma, were followed for at least 4 years, and had no ERM before the procedure. The control group consisted of 66 eyes that were followed for suspected glaucoma did not have a previous ERM. We compared the ERM frequencies of the groups at the last visit. Additionally, ERM frequencies were compared between those who had cataract surgery in the post-LI period and those who did not. After a follow-up period of at least 4 years, ERM developed in 36 of 94 eyes (38.2%) in the LI group. Of these, 32 were stage 1 ERM (34.0%) and 4 were stage 2 ERM (4.2%). In the control group, ERM developed in 13 of 66 eyes (19.6%), 12 of which were stage 1 ERM (18.1%) and 1 was stage 2 ERM (1.5%) (p=0.012). ERM developed in 14 of 32 eyes (43.7%) who underwent phacoemulsification surgery after LI and in 22 of 62 eyes (35.4%) that underwent only LI without subsequent cataract surgery (p=0.435). ERM developed significantly more frequently in the 62 phakic eyes that underwent only LI than in the eyes in the control group (p=0.045). LI appears to be a predisposing factor for the development of ERM, regardless of subsequent cataract surgery.

Comparative analysis of a novel spectral-domain OCT biometer versus swept-source OCT or OLCR biometer in healthy pediatric ocular biometry

With the advancements in ocular biometric technology, there have been significant improvements in accurately and efficiently measuring ocular parameters. The aim of this study is to compare the reliability of biometric parameters obtained using a new frequency-domain optical coherence tomography (SD-OCT) biometer with the measurements obtained from swept-source OCT (SS-OCT) and optical low coherence reflectometry (OLCR) biometers. This study employed an observational cross-sectional design. Measurements of axial length (AL), flat and steep corneal keratometry (K1 and K2), and central corneal thickness (CCT) obtained using the The Colombo IOL were compared with those obtained with the IOLMaster 700 and SW-9000 devices. The agreement were evaluated using intraclass correlation coefficient (ICC) and Bland–Altman analyses. The differences of the measurements of the three increments were assessed by one-way ANONA. 73 right eyes of 73 healthy pediatric subjects were analyzed. The AL difference measured by Colombo IOL compared with IOLmaster700 and SW-9000 were 0.00 ± 0.02 mm and − 0.07 ± 0.05 mm, respectively (P > 0.05, ANOVA). There was no statistically significant difference in CCT, K1, and K2 among the three instruments (all P > 0.05, ANOVA). The ICC values for AL, K1, K2, and CCT were 0.999, 0.996, 0.995, and 0.998, respectively. The Bland-Altman analysis showed an agreement of AL, K1, K2, and CCT with Colombo IOL and IOLMaster 700 spanned over 0.08 mm, 0.71D, 0.69D, and 12.17 μm, respectively. The agreement of AL, K1, K2, and CCT with Colombo IOL and SW-9000 spanned approximate 0.21 mm, 0.75D, 1.06D, and 14.37 μm, respectively. The new SD-OCT biometer and the SS-OCT biometer showed strong agreement in measuring AL and CCT in healthy pediatric subjects. This supports the reliability of the new SD-OCT biometer as an alternative for assessing these parameters. However, K1 and K2 could not be used interchangeably in clinical practice. Further research is needed to explore their applicability in different clinical settings and patient populations."light" />

Socioeconomic and Racial Disparities in Primary Open-Angle Glaucoma in the US.

Socioeconomic status is a potentially significant, although difficult to isolate, factor in determining glaucoma severity. To analyze the level of glaucoma severity (mild, moderate, or severe) based on demographic factors, including age, gender, ethnicity, insurance profile, and zip code, and to use this data to extrapolate the effect of socioeconomic status (SES) and race on glaucoma severity at the community level in Memphis, TN. 2913 patients from a tertiary care center with three clinic locations in Memphis, TN who had been given the diagnosis of Primary Open Angle Glaucoma (POAG) through use of the ICD-10 codes for mild (H40.1111, H40.1121, H40.1131), moderate (H40.1112, H40.1122, H40.1132) and severe (H40.1113, H40.1123, H40.1133) POAG between January 2016 and July 2021 were included in this study. Diagnoses were made after a complete glaucoma workup consisting of Snellen visual acuity, applanation IOP measurement, gonioscopy, automated Humphreys Visual Fields (10-2 and 24-2), and optic nerve OCT. Demographic information, including age, gender, ethnicity, insurance profile, and zip code, was also collected with disease severity for each patient. SES was approximated using zip code-level census poverty data and insurance profiles. Statistical analyses were performed, including descriptive, multivariable ordinal logistic modeling and stepwise multivariable linear modeling. Glaucoma severity was shown to increase with poverty rate (OR=1.089, P<0.0071), age (OR=1.030, P<0.0001), male sex (OR=1.374, P<0.0001), and Black race (OR=1.896, P<0.0001). Severity was shown to be decreased in patients with private insurance compared to Medicare (OR=0.895, P<0.093) and those from Shelby County compared to other counties (OR=0.703, P<0.0001). Our findings indicate that worsening glaucoma severity was associated with higher poverty rates in our patient population. However, isolating socioeconomic status (SES) as an independent factor influencing the incidence and severity of glaucoma remains challenging, given the strong correlation between race and SES.

Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report

BackgroundPosterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.Case presentationA 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.ConclusionsThis case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

Effectiveness of laser therapy among patients with open-angle glaucoma: a systematic review and meta-analysis study.

This study aims to evaluate the efficacy of selective laser trabeculoplasty in improving the intraocular pressure in patients diagnosed with open-angle glaucoma. A comprehensive search was performed across electronic databases, including PubMed, Scopus, and Web of Science, until June 2024, using keywords related to "selective laser trabeculoplasty" and "open-angle glaucoma." Studies were chosen based on set eligibility criteria. Data extraction was carried out by two independent reviewers, and statistical analyses were performed using a random-effects model to calculate the pooled mean differences in IOP reduction and overall success rates. The initial search yielded 3111 articles, with 23 studies included in the systematic review and 22 in the meta-analysis. The pooled MD in IOP reduction between the SLT and control groups was -1.44 mm Hg (95% CI: -2.19 to -0.70, p < 0.01). Subgroup analyses revealed a MD of -0.76 mm Hg (95% CI: -1.31 to -0.21, p < 0.01) when comparing SLT to medication, and -0.42 mm Hg (95% CI: -0.64 to -0.19, p < 0.01) when comparing 180-degree SLT to 360-degree SLT. The pooled success rate favored SLT with an odds ratio (OR) of 0.71 (95% CI: 0.51 to 0.99, p = 0.05). There was significant heterogeneity among the studies (I² = 71%). SLT is effective in lowering IOP in OAG patients, demonstrating significant efficacy compared to medication and different SLT protocols. The findings underscore SLT's potential as a reliable treatment option. However, the observed heterogeneity underscores the necessity for standardized protocols in future research to improve comparability and verify SLT's long-term effectiveness.

Mouse Model of Glucocorticoid-Induced Glaucoma.

Extended glucocorticoid (GC) treatment can lead to ocular hypertension and induce iatrogenic open-angle glaucoma. GC-induced glaucoma mimics many clinical and pathological features of primary open-angle glaucoma (POAG), and therefore mouse models of GC-induced glaucoma are utilized to study pathophysiology of glaucoma. We have recently demonstrated that weekly periocular injections of dexamethasone-21-acetate (Dex-Ac) lead to robust and significant intraocular pressure (IOP) elevation, retinal ganglion cell (RGC) loss, and optic nerve degeneration in mice. Our mouse model exhibits signature features of POAG including significant IOP elevation due to reduced outflow facility, progressive optic nerve degeneration, and structural and functional loss of RGCs. Dex-induced IOP elevation is associated with increased aqueous outflow resistance due to trabecular meshwork (TM) dysfunction including excessive extracellular matrix deposition and induction of endoplasmic reticulum stress. Mouse model of Dex-induced glaucoma represents an ideal animal model to investigate both glaucomatous damage to the TM and RGC axons and to develop novel therapies. Here, we present a detailed protocol for developing this model in laboratory settings.

Nanotubules and Cellular Communication in Trabecular Meshwork Cells.

Glaucoma causes dysfunction to tissues located in the anterior and posterior eye. In the anterior eye, the trabecular meshwork (TM) is the site of pathogenesis, where decreased TM cell numbers and alterations to the amount and composition of extracellular matrix hinder outflow of aqueous humor fluid from the anterior chamber. This causes intraocular pressure (IOP) elevation. Elevated IOP, a main risk factor for primary open-angle glaucoma, damages the axons of retinal ganglion cells in the posterior eye, which ultimately leads to blindness. Thus, clinical treatment paradigms for glaucoma are focused on reducing IOP. Normotensive IOPs are established by balancing the production of aqueous fluid from the ciliary body with drainage through the TM to Schlemm's canal. When IOP becomes elevated, TM cells coordinate a homeostatic response to lower IOP, which requires effective and efficient cellular communication. Tunneling nanotubes (TNTs) are transient specialized structures that allow cells to communicate with one another. Actin-rich tubes allow direct transmission of signals and cargoes between cells. This is important to overcome limitations of diffusion-based signaling in aqueous environments such as the anterior eye. Here, we describe a live-cell imaging method for monitoring TNTs in primary TM cells.

Impact of postoperative intraocular pressure elevation on graft endothelial cells in non-preexisting glaucoma eyes undergoing descemet membrane endothelial keratoplasty: a cohort study

BackgroundDescemet membrane endothelial keratoplasty (DMEK) has become the dominant keratoplasty procedure. However, the impact of high intraocular pressure (IOP) on the DMEK prognosis in patients without preexisting glaucoma remains unknown.MethodsNon-glaucoma patients who underwent DMEK in Peking University Third Hospital between July 2017 and March 2023 with a follow-up duration longer than six months were included in this cohort study. Eyes were divided into three groups: Group A) normal IOP; Group B) early IOP elevation (IOP ≥ 30 mmHg or increase of more than 10 mmHg from baseline within 3 days); Group C) intermediate-term IOP elevation (IOP > 21 mmHg or increase of more than 10 mmHg from baseline after 14 days postoperatively). The postoperative IOP, endothelial cell density (ECD), central corneal thickness (CCT), best-corrected visual acuity (BCVA) and rate of graft failure were analysed.ResultsForty-seven eyes from forty-seven patients were included. Thirty-seven eyes were bullous keratopathy, and ten were Fuchs endothelial corneal dystrophy. Twenty-five eyes were classified as Group A, six as Group B and sixteen as Group C. The mean peak IOP was 49.00 ± 4.99 mmHg in Group B eyes and 31.89 ± 11.75 mmHg in Group C eyes. The postoperative BCVA significantly differed from that before surgery (P < 0.001). The ECD at 3 months after surgery in eyes with intermediate-term IOP elevation was lower (P = 0.032). Four eyes with intermediate-term IOP elevation developed graft failure (P = 0.001).ConclusionsIntermediate-term IOP elevation after DMEK may reduce the graft ECD and lead to graft failure within six months after surgery. However, early IOP elevation had no effect on the prognosis. Careful IOP monitoring and intermediate-term IOP management should be conducted for graft protection.

Case Report of Phacolytic Glaucoma in the Eye Department of Dr. M. Djamil Hospital Padang

A 68-year-old man came to the polyclinic at a type A hospital in West Sumatra with complaints of pain in the right eye since 3 weeks before coming to the hospital. Anamnesis and physical examination were performed on the patient and a diagnosis of phacolytic glaucoma was established. This article aims to report a case of phacolytic glaucoma which is a rare case of secondary open-angle glaucoma.

Suicide risk in juvenile open angle glaucoma patients.

To investigate the association between juvenile open angle glaucoma (JOAG) and mental health among Koreans. This study used nationally representative data from the 8th Korea National Health and Nutrition Examination Survey (KNHANES) 2021. Glaucoma diagnosis followed the International Society of Geographical and Epidemiological Ophthalmology criteria based on glaucomatous structural defects, visual field defects, corrected vision, and intraocular pressure. As outcomes, suicidal behaviors, psychiatric counseling, and depression were evaluated through mental health questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression models, adjusting for covariates. Among 7090 participants, 3446 met the inclusion criteria for analysis, and 88 (2.6%) were diagnosed with open angle glaucoma (OAG). After adjusting for age, sex, and best-corrected visual acuity (VA), participants with OAG were revealed to have significantly higher odds of suicidal behaviors (i.e., ideation, planning, or attempts) compared with those without OAG (OR: 2.70; 95%CI: 1.12-6.54; P=0.028). This association remained significant after further adjustments for socioeconomic status, lifestyle factors, and presence of chronic conditions (P=0.031 and 0.035, respectively). However, there was no significant difference for the other two outcomes, psychiatric counseling and depression. An age-stratified analysis revealed a stronger association between OAG and suicidal behaviors in younger JOAG participants (<40y) than in older OAG participants (≥40y; OR: 3.80 vs 2.22; 95%CI: 0.79-18.22 vs 0.56-8.80, respectively). OAG patients show a higher risk of suicidal behaviors than those without glaucoma particularly in JOAG patients.

Efficacy of new two-stage methods of surgical and laser treatment for primary open-angle glaucoma combined with cataract

Background. Lowering the intraocular pressure (IOP) is the only proven method to slow the progression of glaucomatous optic neuropathy. Successful conservative treatment or surgery do not guarantee the preservation of visual fields throughout life. Despite the current advances in conservative treatment of primary open-angle glaucoma, about 5.3 % of patients still require surgical or combined treatment. There is no consensus yet on approaches to the treatment of patients with glaucoma and cataract. The objective was to evaluate the effectiveness of new two-stage methods for surgical and laser treatment of patients with primary open-angle glaucoma associated with cataract. Materials and methods. Seventy patients (70 eyes) with primary open-angle glaucoma stages I–IV complicated by cataract were included in this study. There were two observation groups. All patients received a two-stage treatment — micropulse transscleral cyclophotocoagulation (MP-TSCPC) and phacoemulsification with a monofocal intraocular lens (IOL) implantation. The first group (n = 34) included participants who underwent phacoemulsification with IOL implantation (stage 1) one month prior to MP-TSCPC (stage 2). The second group (n = 36) consisted of patients who underwent MP-TSCPC (stage 1) and phacoemulsification with IOL implantation a month after (stage 2). These groups did not statistically differ in terms of age, gender, baseline IOP, and stage of primary open-angle glaucoma. The primary outcome measure was the normalization of IOP with or without the use of antiglaucoma medications and without a need for further laser and incisional procedures in 1, 3 and 6 months. The secondary outcome was stabilization or expansion of visual fields when evalua­ting 1, 3, and 6 months after stage 2. Results. The average IOP level with antihypertensive medications before the treatment in group 1 was 27.5 ± 1.3 mmHg, in group 2 — 27.0 ± 1.1 mmHg. One month after the treatment, patients of group 1 had normal IOP in 94.2 % of eyes and in 5.8 % of eyes with local antihypertensive medications; in group 2, IOP was normal in 100 % of eyes without antiglaucoma medications (p &lt; 0.05). In 3 and 6 months, better hypotensive results were in group 2, but outcomes were not statistically significant. The visual fields were preserved at the preoperative level or expan­ded in patients from groups 1 and 2 one month after the treatment in 91.2 and 97.2 % of the eyes, respectively, 3 months after — in 91.2 and 97.2 %, 6 months after — in 88.2 and 94.4 % of the eyes, respectively. In group 2, better functional results were obtained at all time points, but it was not statistically significant. Conclusions. The studies have established a high efficacy and safety of new two-stage methods for surgical and laser treatment of patients with primary open-angle glaucoma and cataract with a follow-up period of 6 months. There was a tendency to greater efficacy of the method, where MP-TSCPC as stage 1 was followed by phacoemulsification with IOL implantation as stage 2. The nature and frequency of surgical and postoperative complications in both groups did not differ.