Glaucoma Research Articles

Intermittent Bleeding from the Iridocorneal Angle and Subsequent Ghost Cell Glaucoma Following Gonioscopy-Assisted Transluminal Trabeculotomy: A Case Report

Purpose: This study aims to present a case involving intermittent bleeding from the iridocorneal angle following gonioscopy-assisted transluminal trabeculotomy (GATT) surgery, followed by the development of ghost cell glaucoma (GCG). Methods: A 25-year-old man with a history of post-traumatic angle recession glaucoma underwent uneventful 360° GATT surgery. Results: Two weeks after the surgery, while the reason for the incomplete resolution of hyphema remained unclear, intermittent bleeding from the iridocorneal angle and hemorrhage in the inferior vitreous were observed during the patient’s follow-up examination. Although bleeding was controlled with intravenous tranexamic acid therapy, the patient required pars plana vitrectomy due to the development of GCG. Despite medical treatment, the patient’s intraocular pressure (IOP) remained elevated during follow-ups, leading to the decision to perform Ahmed Glaucoma Valve implantation surgery as a final intervention. At the latest evaluation, the patient’s IOP was under control without medication. Conclusion: Following GATT surgery, the possibility of intermittent bleeding from the iridocorneal angle should be considered if the hyphema persists beyond the expected duration. Hospitalization and closer patient monitoring may be necessary to detect intermittent bleeding.

Outcomes of microcatheter-assisted trabeculotomy in adult patients with primary congenital glaucoma and juvenile open-angle glaucoma: A case series

Abstract Trabeculotomy is conventionally performed using a rigid probe, allowing for 180° trabeculotomy. More recently, microcatheter-assisted 360° trabeculotomy (MCAT) has shown safe and effective results in pediatric glaucoma cases, particularly in primary congenital glaucoma (PCG) and to a lesser extent in juvenile open-angle glaucoma (JOAG). This case report highlights the successful intraocular pressure (IOP) control following iTrack®-assisted trabeculotomy in one adult with PCG and two with JOAG. Four eyes of three adults, aged 50, 28, and 45 years, underwent MCAT for uncontrolled PCG or JOAG, with no prior surgical history. No major complications were observed. Postoperatively, IOP ranging from 11 to 15 mmHg was achieved without the need for topical therapy or reoperation during a follow-up period of 12–14 months. These cases suggest that MCAT is both effective and safe for adults with PCG or JOAG requiring surgery.

Corneal Curvature of the Saudi Population in Relation to Age, Gender, Refractive Errors, and Central Corneal Thickness

Corneal Curvature of the Saudi Population in Relation to Age, Gender, Refractive Errors, and Central Corneal Thickness

Influence of preoperative glaucoma medication on long-term outcomes of trabeculectomy.

This retrospective study evaluated the association between preoperative topical glaucoma medication containing preservatives and long-term trabeculectomy outcomes in 309 eyes from 201 patients with primary open-angle glaucoma, followed for over 10 years. The Glaucoma Medication Intensity Index (GMII) was calculated to quantify the cumulative preoperative exposure to these medications. Kaplan-Meier analysis revealed cumulative success rates of 89.3%, 59.2%, and 46% at 1, 10, and 20 years postoperatively. At 20 years, the success group had a significantly lower GMII (3.28 vs. 8.74, p = 0.004). A GMII threshold of ≥ 4.35 was associated with poorer long-term intraocular pressure (IOP) control and shorter surgical success duration. Cox regression analysis identified advanced age at surgery, higher GMII, and subsequent cataract surgery as significant risk factors for trabeculectomy failure. These findings underscore the adverse impact of prolonged preoperative use of glaucoma medications on long-term surgical outcomes, highlighting GMII as a valuable predictor for guiding preoperative management strategies.

Goniosynechialysis for Chronic Angle-closure Glaucoma after Extracapsular Cataract Extraction: A Case Report

Purpose: We present a case of goniosynechiolysis in the treatment of chronic angle-closure glaucoma with persistent peripheral anterior synechia (PAS) after extracapsular cataract extraction (ECCE) for phacomorphic glaucoma that remained uncontrolled using topical glaucoma medications.Case summary: A 59-year-old woman presented with right eye pain and visual loss that started 3 days ago. Examination revealed an intraocular pressure (IOP) of 46 mmHg, a narrow central anterior chamber, and peripheral iridocorneal touch, indicative of phacomorphic glaucoma. Although ECCE was performed, PAS was not adequately resolved. Initially, visual acuity, IOP, and visual field were controlled with a single topical glaucoma medication. However, progressive retinal nerve fiber layer thinning and uncontrolled IOP, despite maximal medical therapy. Therefore, goniosynechiolysis was performed at 24 months after ECCE. The procedure reduced IOP from 25 mmHg to 13 mmHg without complications, such as hyphema, cyclodialysis, and fibrin formation.Conclusions: Goniosynechiolysis can be a safe and effective intervention for chronic angle-closure glaucoma with persistent PAS and elevated IOP.

The Effects of Selective Laser Trabeculoplasty in Patients With Angle Recession Glaucoma: A Case Series

The Effects of Selective Laser Trabeculoplasty in Patients With Angle Recession Glaucoma: A Case Series

Performance of Polygenic Risk Scores for Primary Open-Angle Glaucoma in Populations of African Descent.

Primary open-angle glaucoma (POAG) polygenic risk scores (PRSs) continue to be evaluated in primarily European-ancestry populations despite higher prevalence and worse outcomes in African-ancestry populations. To evaluate how established POAG PRSs perform in African-ancestry samples from the Genetics in Glaucoma Patients of African Descent (GIGA), Genetics of Glaucoma in Individuals of African Descent (GGLAD), and Million Veteran Program (MVP) datasets and compare these with European-ancestry samples. This was a multicenter, cross-sectional study of POAG cases and controls from Tanzania, South Africa, Nigeria, Ghana, and the US. Included were individuals of African descent from South Africa and Tanzania from the GIGA dataset; individuals of African descent from Ghana, Nigeria, and the US from the GGLAD dataset; and individuals of African or European descent from the US in the MVP dataset. Data were analyzed from January 2022 to July 2023. Three PRSs derived from large meta-analyses of European and Asian populations, namely Gharahkhani et al (Gharahkhani PRS), Han et al (Han PRS), and Craig et al (Craig PRS). Odds ratios (ORs) for POAG risk stratification comparing the highest and lowest quintiles; area under the receiver operating characteristic curve (AUROC), and liability coefficient of determination (R2) for the addition of PRS to a baseline of age, sex, and first 5 principal components. A total of 11 673 cases and 66 432 controls were included in this study across 7 ancestral groups. Mean (SD) age of the total participants was 76.9 (8.7) years, with 74 304 males (95.1%). The following were included in each dataset: GIGA (663 cases, 476 controls), GGLAD (1471 cases, 1482 controls), and MVP (9559 cases, 64 474 controls). Increases in ORs were found for the highest POAG risk quintile ranging from an OR of 1.68 (95% CI, 1.17-2.43) in Ghanaians to 7.05 (95% CI, 2.73-19.6) in the South African multiple ancestry group (which derives from at least 5 distinct ancestral groups: Khoisan, Bantus, Europeans, Indians, and Southeast Asians) with the Gharahkhani PRS. The Han PRS showed OR increases for the highest POAG risk quintile ranging from 2.27 (95% CI, 1.49-3.47) in African American individuals in the GGLAD dataset to 7.24 (95% CI, 6.47-8.12) in Europeans. The Craig PRS predicted OR increases in the highest quintile for all groups ranging from 1.51 (95% CI, 1.05-2.18) in Ghanaians to 6.31 (95% CI, 5.67-7.04) in Europeans. However, AUROC and R2 increases above baseline were lower for all African-ancestry compared with European-ancestry groups in the 3 tested PRSs. In this cross-sectional study, despite some improvements in OR-based risk stratification using the Gharahkhani PRSs, Han PRSs, and Craig PRSs, consistently lower improvements in AUROC and R2 for African-ancestry compared with European-ancestry groups highlight the need for risk prediction models tailored to diverse populations.

Potential utility of anterior segment optical coherence tomography and biometry in differentiating plateau iris configuration from pupillary block

ABSTRACT Clinical relevance Angle closure glaucoma is one of the most common blinding diseases encountered mainly in older age groups, although it may also occur at a younger age. Identifying the underlying cause of angle closure helps in designing specific treatment strategies essential for effective disease management. Background Primary angle closure disease, caused due to pupillary block (PB) and plateau iris configuration (PIC), necessitates different management strategies. This study assessed the potential utility of anterior segment optical coherence tomography (ASOCT) and optical biometry in distinguishing PIC from PB in primary angle closure disease of the young (PACDy). Methods Patients aged 20–40 years with PACDy and age-matched healthy controls were recruited. Ophthalmic examinations included gonioscopy, ultrasound biomicroscopy, ASOCT, and biometry. Anterior chamber depth, lens thickness, axial length, central corneal thickness, lens position, relative lens position, vitreous cavity length, lens vault, relative lens vault and angle opening distance, trabecular iris space area, and trabecular iris angle were measured. Receiver operating characteristics curve analysis evaluated the discriminative ability of these parameters. Results Of the 280 eyes, 128 were normal and 152 had PACDy. Of 128 PACDy, 88 had PIC, and 64 had PB. Both PIC and PB had significantly smaller ASOCT and biometric parameters than normal eyes. However, PIC had intermediate biometric values that fell between normal eyes and PB. All the aforementioned parameters, except central corneal thickness, showed excellent discriminating ability of PIC and PB from normal eyes; however, no single parameter can strongly differentiate PB from PIC. Axial length and relative lens vault had the highest, although weak, power for discriminating PB from PIC. Conclusion ASOCT and biometry effectively distinguish PIC and PB from normal eyes, but no single parameter reliably differentiates PIC from PB. Comprehensive gonioscopy and ultrasound biomicroscopy may be necessary for accurate diagnosis in PACDy.

Vascular Endothelial Growth Factor -460 C/T BstUI Gene Polymorphism is associated with Primary Open Angle Glaucoma

Vascular Endothelial Growth Factor -460 C/T BstUI Gene Polymorphism is associated with Primary Open Angle Glaucoma

Accelerated versus conventional corneal collagen cross-linking for keratoconus: A meta-analysis of randomized controlled trials.

To systematically compare the effectiveness of conventional corneal collagen cross-linking (CCXL) protocols and accelerated corneal collagen cross-linking (ACXL) protocols in cases with progressive keratoconus. The Cochrane library, EMBASE, MEDLINE, PubMed, and Web of Science databases were searched for randomized controlled trials (RCTs). Outcomes were clinical results and changes in corneal properties. Standardized mean differences (SMD) and 95% confidence interval (CI) were used to estimate the clinical consequences. All outcomes were distributed by different follow-up durations (6 months, 12 months, and > 12 months). We also compared maximum keratometry (Kmax) and best spectacle-corrected visual acuity (BCVA) in subgroups, which were categorized by the discrepant impregnation time period of riboflavin. We included 14 RCTs that met the eligibility criteria in this meta-analysis. At the last follow-up, CCXL was superior in postoperative change in demarcation line (SMD: -1.573; 95% CI: -2.897 to -0.248) and in Kmax (SMD:0.302; 95% CI: 0.071 to 0.533), whereas ACXL provided a significantly lower reduction in central corneal thickness (SMD: 0.498; 95% CI: 0.125 to 0.871). No differences in the changes in uncorrected visual acuity, BCVA, manifest refraction spherical equivalent, corneal biomechanical properties, and the endothelial cell density were found among both groups. CCXL was superior to ACXL in greater corneal flattening and deeper demarcation line, while ACXL seemed to cause less reduction in CCT and allow for earlier UDVA stability. To clearly define the comparative safety and clinical consequences of the different regimens of CXL, more RCTs are required.

Agreement of intraocular pressure measurement by scleral Schiotz and Goldmann applanation tonometer.

In this cross-sectional observational study, IOP was measured by GAT on the cornea and Schiotz tonometer on the temporal sclera. Axial length and central corneal thickness (CCT) were noted. IOP was then estimated from SS IOP as eGAT using a predictive formula. Agreement of IOP corrected for CCT (cGAT) with eGAT and SS IOP were assessed. The effects of age, axial length, refraction, CCT, gender, and ocular and systemic comorbidity on measured IOP were also assessed. The study included 155 patients with a mean age of 54.27 ± 10.02 years. Mean IOP measured by GAT and scleral Schiotz were 16.58 ± 2.76mm Hg and 16.10 ± 2.96mm Hg, respectively. The mean IOP by cGAT and eGAT were 16.70 ± 2.80mm Hg and 17.07 ± 3.10mm Hg, respectively. Both eGAT & SS IOP had good agreement with cGAT on the Bland-Altmann plot (p = 0.96 & 0.51, respectively). Further, SS IOP showed good agreement even with GAT IOP (p = 0.78). Age, axial length, refraction, central corneal thickness, gender, and ocular and systemic comorbidity did not show significant correlation with IOP measurement. Estimated GAT IOP showed good agreement with measured GAT values. SS IOP also agreed well with GAT IOP. Clinical significance IOP measurement on the sclera using Schiotz can be used as an alternative to GAT.

Assessment of measurement variability across automated biometry devices

Purpose: To evaluate measurement variability between different readily available automated biometric devices for the purposes of improving surgeon decision making for phakic intraocular lens (IOL) sizing. Setting: Private practice (Houston, TX, USA) Design: Prospective, single center, bilateral, non-randomized, open-label, observational study. Methods: This study included healthy eyes, with no prior eye surgery, and with a spherical equivalent of at least -1.00D. Orbscan II was compared to Argos, Atlas 9000, caliper, IOLMaster 500, IOLMaster 700, iTrace, Lenstar LS900, Pentacam HR, and Pentacam AXL Wave. Preoperative measurements included white to white (WTW), anterior chamber depth (ACD), and central corneal thickness (CCT). Linear mixed effect models were created to determine adjustment factor between the Orbscan II and other devices for WTW, ACD, and CCT measurements. Results: A total of 204 subjects (408 eyes) completed the study. All mean WTW measurements were significantly different compared to the Orbscan II (p < 0.01), except for Pentacam AXL Wave. All mean ACD and CCT measurements were significantly different compared to the Orbscan II (p < 0.01). Adjustment factors for WTW ranged from -0.65 mm to 0.24 mm. Adjustment factors for ACD ranged from -0.21 mm to -0.16 mm. Adjustment factors for CCT ranged from 19.9 µm to -36.0 µm. Conclusions: The biometers tested were not interchangeable with the Orbscan II. Adjustment factors for WTW and ACD may compensate for differences between devices and adapt ICL sizing recommendations.

Efficacy and Safety of a Fixed-Dose Combination of Brinzolamide 1%/Timolol 0.5% vs. Dorzolamide 2%/Timolol 0.5% in Indian Patients With Primary Open-Angle Glaucoma or Ocular Hypertension: A Randomized Phase 3 Study

Efficacy and Safety of a Fixed-Dose Combination of Brinzolamide 1%/Timolol 0.5% vs. Dorzolamide 2%/Timolol 0.5% in Indian Patients With Primary Open-Angle Glaucoma or Ocular Hypertension: A Randomized Phase 3 Study

Abstract 4135239: Pausing Under Pressure: Ocular Hypertension as an Atypical Cause of Heart Block

A 67-year-old male with a history of hypertension presented to the emergency department with abnormal cardiac monitor results. Prior to this, he was diagnosed with primary open-angle glaucoma by ophthalmology and underwent left-sided aqueous tube shunt placement, which was complicated by hypotony requiring revision and holding of all topical glaucoma medications. Concurrently, he was noted to have an irregular heart rhythm during a routine physical. In office ECG showed normal sinus rhythm, but subsequent 14-day continuous ECG monitor showed sinus bradycardia with nadir heart rate of 21 beats-per-minute and 114 ventricular pauses (longest 4.8 seconds) primarily due to second-degree atrioventricular (AV) block, Mobitz type 1, but also periods of high-grade AV block. He was sent to the emergency department for expedited pacemaker evaluation. On further review, heart block and ventricular pauses occurred exclusively over a 12-hour period that temporally coincided with a hospitalization for acute ocular hypertension following shunt revision. His intraocular pressure peaked at 56 mmHg (normal range 10-21 mmHg), then normalized to 21 mmHg after acetazolamide and anterior chamber paracentesis. Bradycardia resolved following ophthalmic intervention. Bradyarrhythmias were attributed to excess vagal tone from acute ocular hypertension via an atypical but recognized cause of the oculocardiac reflex, and pacemaker placement was avoided. The oculocardiac reflex is a reflex bradycardia involving the trigeminal and vagus nerves. Cardiac effects are consistent with other vagally-mediated bradyarrhythmias, including sinus bradycardia, AV block, and even asystole. This reflex occurs commonly during traction on extraocular muscles during strabismus surgery, but can be seen in other orbital and ocular stimuli. To our knowledge, this is the first documented case of ocular hypertension leading to atrioventricular block through this mechanism. This case illustrates the importance of (1) clinical context of abnormal events during extended cardiac monitoring, (2) understanding the oculocardiac reflex as a cause of bradyarrhythmias, and (3) ruling out reversible medical causes of dysrhythmias prior to permanent device implantation.

Features of Computer Static Perimetry in Primary Open-angle Glaucoma in Patients with Type 2 Diabetes Mellitus

Examined 110 eyes (55 patients) with POGC and type 2 diabetes mellitus; 40 eyes (20 patients) with POGC without diabetes mellitus and 60 eyes (30 patients) with diabetes without glaucoma. In addition to the generally accepted methods of research, the following were carried out: perimetry (static Octopus), ophthalmoscopy with Goldmann lens, binocular ophthalmoscope (Schepensa), and lens Volk-90,0D (USA), gonioscopy with lenses (Krasnova, Goldmana), tonometria by Maccov, NIidek (Japan) NT-2000 pneumometry, Tonography (Glau test-60). OCT disc optic nerve and yellow spot (Carl Zeiss Cirrus, HD OCT Model 4000/5000 Germany), OST retinal vessels with calibre meter (Cirrus HD-OCT Carl Zeiss), ultrasonic diagnosis (UZD) of central artery vessels and retinal vein (UZ-system of expert class Sono Scapesq), ultrasound of the eyes. Conducted studies of static perimetry in patients with POGC and type 2 diabetes suggest the influence of the severity of diabetic retinopathy on the course and progression of glaucoma.

Ocular Shape of Cataract with Retinitis Pigmentosa: A Case-Control Study.

To investigate the anterior segment morphology in cataracts with Retinitis Pigmentosa (RP). XXXX (anonymized for review) University Hospital. A retrospective matched case-control study. The analysis included 28 eyes of 28 patients with cataracts and RP and 28 eyes of 28 patients with cataracts but without RP, matched for age and sex. Lens thickness, anterior lens curvature (Front R), posterior lens curvature, anterior chamber depth (ACD), anterior chamber width, central corneal thickness (CCT), white-to-white distance (WTW), corneal curvature, and axial length (AL) were compared between the groups. Data were obtained from preoperative evaluations conducted before cataract surgery. The same set of comparisons was also conducted for 18 eyes of 18 patients with cataracts and RP and 18 eyes of 18 patients with cataracts but without RP, matched for age, sex, and AL. Cases including missing data, categorized as Emery-Little classification grade 4 or above, or those with a history of acute angle closure were excluded. In the age- and sex-matched analysis, cataracts with RP showed significantly a thicker lens, steeper Front R, shallower ACD, thinner CCT, and shorter AL. In the analysis matched by age, sex, and AL, cataracts with RP had a thicker lens, steeper Front R, and larger WTW. Cataracts with RP demonstrated centripetal swelling of the lens, centrifugal corneal thinning, and AL shortening. A decrease in tension between the lens and eyeball wall due to zonular weakness in the RP may lead to swelling of the lens and horizontal flattening of the eyeball.

Continuous intraocular pressure variations following positional transitions in normal subjects and open angle glaucoma patients using a contact lens sensor system.

To evaluate the efficacy of a novel contact lens sensor system (CLS) in detecting continuous intraocular pressure (IOP) variations following positional transitions, and to explore these IOP variation patterns among normal subjects, untreated glaucoma patients, and untreated ocular hypertension (OHT) subjects. This prospective comparative study included 20 normal subjects, 14 high tension glaucoma (HTG) patients, 16 normal tension glaucoma (NTG) patients, and 14 OHT subjects. Participants wore the CLS for continuous IOP monitoring while undergoing sequential body position changes: from sitting to supine to a 10° head-down tilt (HDT), with each position maintained for ten minutes. Continuous IOP parameters, including mean, peak, and fluctuation (peak minus valley) in each position, as well as increment (peak minus starting value), interval (time to arrive peak), and velocity (increment divided by interval) after two position transitions, were compared among different positions and groups, respectively. Normal subjects, HTG and NTG patients exhibited higher CLS IOP mean and peak in supine/HDT positions compared to sitting (P < 0.05), but the mean or peak in HDT did not significantly differ from that in supine (P > 0.2). In OHT, all IOP parameters showed no significant difference among various positions (P > 0.1), except for velocity. Comparisons among groups revealed that during the transition from sitting to supine, HTG demonstrated higher IOP increment than other three groups and higher velocity than normal subjects (P < 0.05). NTG patients exhibited no significant differences in IOP increment, interval and velocity, compared to normal subjects (P > 0.05). The CLS proved effective in continuously recording IOP responses following positional changes in normal and glaucomatous eyes. Transitioning from sitting to supine resulted in increased IOP among normal subjects, HTG and NTG patients, but not in OHT. Compared to normal subjects, this IOP increase was more pronounced and rapid in HTG, but comparable in NTG. WHAT IS KNOWN : Positional transitions can induce IOP variations, which differ among normal subjects and glaucoma patients, and potentially relate to glaucomatous neuropathy. However, prior findings are constrained by the discontinuity of traditional tonometry. This study utilized a novel contact lens sensor system (CLS) to continuously monitor IOP during positional transitions in normal subjects and untreated glaucoma/OHT subjects. Continuous IOP outcomes revealed that normal subjects, HTG patients, and NTG patients exhibited an increase in IOP when transitioning from sitting to supine, whereas OHT did not. Compared to normal subjects, this increase in IOP was more pronounced and rapid in HTG patients, but similar in NTG.

Global incidence and risk factors for glaucoma: A systematic review and meta-analysis of prospective studies.

This study aims to estimate global incidence and assess risk factors for glaucoma subtypes. The literature search was performed in three English (PubMed, Embase, MEDLINE) and three Chinese (China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database) databases to identify prospective studies on glaucoma incidence between 1 January 1990 and 29 November 2022. We used a multilevel mixed-effects meta-regression to estimate the age- and sex-specific incidence rate of primary open-angle glaucoma (POAG). The global and regional incidence rate of POAG in 2022 were respectively estimated. The annual cumulative incidence (ACI) of POAG and primary angle-closure glaucoma (PACG), and risk factors for POAG were pooled using a random-effects meta-analysis, respectively. The heterogeneity of the included articles was tested using the Q statistic and measured by I2 index. Publication bias was detected by funnel plots, Egger's regression test, and Begg's rank correlation test. A total of 9050 articles were identified in literature search, and 50 articles provided incidence data of glaucoma subtypes. In 2022, the global incidence rate of POAG was 23.46 (95% confidence interval (CI) = 15.68-32.91) per 10 000 person-years among 40-79 years. An increase from 5.51 (95% CI = 1.63-11.12) per 10 000 person-years in 40-44 years to 64.36 (95% CI = 49.82-80.70) per 10 000 person-years in 75-79 years was noted between the year 1990 and 2019. Across sociodemographic index (SDI) and World Health Organization (WHO) regions, the incidence rate was the highest in low SDI region and Africa, respectively. The pooled ACI of POAG was 0.21% (95% CI = 0.13%-0.30%). Six risk factors for POAG were identified, including intraocular pressure (IOP) treatment (meta-odds ratio (OR) = 3.69; 95% CI = 2.64-5.15), a family history of glaucoma (meta-OR = 2.49; 95% CI = 1.92-3.24), myopia (meta-OR = 2.08; 95% CI = 1.59-2.70), elevated IOP (meta-OR = 1.13; 95% CI = 1.11-1.15), advanced age (meta-OR = 1.07; 95% CI = 1.05-1.08), male (female: meta-OR = 0.76; 95% CI = 0.66-0.88). The pooled ACI of PACG was 0.05% (95% CI = 0.00%-0.16%). Significant disparities existed in incidence rates for glaucoma across geographic regions and age groups. Further research is needed to understand which risk factors drive glaucoma incidence in different socioeconomic strata for tailored health policy on preventing glaucoma. This study is registered with PROSPERO (number CRD42023434203).

Comparison of choroidal detachment with and without hypotony after Ahmed valve implantation.

To compare the clinical manifestations of and risk factors for choroidal detachment (CD) with or without hypotony after Ahmed valve implantation (AVI). Retrospective, consecutive case series. We enrolled patients with glaucoma who underwent AVI, and divided them into CD and non-CD groups. The patients with CD were divided into those with and without hypotony. Data collected from the chart review before and after AVI included patient demographics and ocular characteristics. We analyzed the risk factors for CD development. The relationship between hypotony and CD development was also analyzed. Among the 387 eyes, 63 developed CD. Among these 63 eyes, 42 had CD with hypotony and 21 had CD without hypotony. Multivariate regression analysis revealed that age (P < 0.001), lens status (P < 0.001), history of diabetes mellitus (DM) (P = 0.011), and history of hypertension (HTN) (P = 0.002) were significant predictors of CD development. Neovascular glaucoma (NVG) showed 42.9% of CD cases without hypotony. This rate was higher than primary open angle glaucoma (POAG) and exfoliative glaucoma (XFG). The rate of anterior chamber formation as treatment of CD was significantly higher in CD with hypotony than in CD without hypotony. Older age, pseudophakic eyes, DM, and HTN are significantly associated with CD development after AVI. NVG has higher incidence rates of CD without hypotony compared with POAG and XFG. Therefore, clinicians should pay attention to CD development after AVI especially in NVG, even if a patient is not in a hypotonic state.

The impact of different forms of exercise on intraocular pressure, blood flow, and the risk for primary open angle glaucoma.

Primary open angle glaucoma (POAG) is a chronic disease characterized by progressive optic nerve damage and irreversible loss of vision, often diagnosed at late stages. Elevated intraocular pressure (IOP) is the major risk factor for its onset and progression while older age, myopia, genetic factors, blood pressure (BP), and reduced ocular blood flow (OBF) have also been linked to the disease. Different forms of exercise are known to have significant, but variable, effects on IOP, BP, ocular perfusion pressure (OPP), OBF and oxygen metabolism, and ultimately the risk for development and progression of POAG. While population-based studies lack agreement regarding the relationship between exercise and POAG status, data suggests that resistance training causes a short-term increase in IOP, BP, and OPP. Conversely, aerobic exercise has been shown to cause a short-term decrease in IOP and increase in BP and OPP. Research also suggests that following an exercise program over an extended period may lead to a long-term decrease in IOP, however its cessation results in a prompt return to baseline levels. Data suggests normal vascular autoregulation ensures minimal change in OBF following extended exercise unless OPP rises ∼70% above baseline. Although exercise may alter IOP, BP, and OBF, both acutely and chronically, it is currently uncertain if physical activity significantly alters risk for the onset and progression of POAG.