Intraocular Pressure Reduction Research Articles

Outcomes of Phacoemulsification With or Without Kahook Dual Blade Goniotomy for Glaucoma Patients with Cataract.

This meta-analysis examines the comparative efficacy of phacoemulsification with and without Kahook Dual Blade Goniotomy in individuals with glaucoma and cataract, aiming to elucidate optimal surgical approaches for coexisting conditions. The purpose of this current study is to compare the effect of combining Kahook Dual Blade (KDB) goniotomy with phacoemulsification versus phacoemulsification alone on intraocular pressure (IOP) and medication reduction in patients with glaucoma and cataract. We conducted a systematic review and meta-analysis utilizing computer databases, including Embase (OVID), MEDLINE (OVID and PubMed), CINHAL (EBSCO), and the Cochrane Library (Wiley). We included studies examining the IOP-lowering effect of KDB goniotomy combined with phacoemulsification and studies that examined the IOP-lowering effect of phacoemulsification alone in patients with open angle glaucoma or ocular hypertension. The mean reduction of IOP and the reduction in topical glaucoma eye drops after surgery were determined. A total of 26 studies were included reporting on 1659 patients, 684 patients underwent phacoemulsification alone and 975 underwent combined phacoemulsification and KDB goniotomy. A 9.62% IOP reduction from baseline occurred following phacoemulsification as a solo procedure compared to 22.74% following combined KDB goniotomy with phacoemulsification. Similarly, the combination of the procedures caused a significant drop in the mean number of glaucoma eye drops used (mean reduction=1.35, 95% CI [1.08, 1.61]) compared to phacoemulsification alone (mean reduction=0.36, 95% CI [0.06, 0.66]). Funnel plots suggested the absence of publication bias. Both phacoemulsification alone or combined with KDB goniotomy result in a significant decrease in post-op IOP and topical glaucoma eye drops. The combination of these two procedures outperforms phacoemulsification alone in terms of both parameters.

Effects of alfaxalone, medetomidine, and xylazine on intraocular pressure in domestic pigeons (Columba livia domestica).

To evaluate the effects of alfaxalone, medetomidine, and xylazine on intraocular pressure (IOP) in domestic pigeons (Columba livia domestica). Eight 12-month-old pigeons (16 eyes). The pigeons were randomly assigned to three treatment groups (10 mg/kg of alfaxalone, 0.2 mg/kg of medetomidine, or 10 mg/kg of xylazine) with a 7-day washout period. The IOP was measured using a rebound tonometer and calibrated using the formula y = 0.439x + 2.059, where y is the tonometric IOP and x is the actual IOP. All three drugs significantly reduced IOP. Alfaxalone led to the least reduction at 5.2 mm Hg, medetomidine reduced IOP to 12.5 mm Hg, whereas xylazine resulted in the greatest reduction at 15.3 mm Hg. Alfaxalone achieved its maximum IOP reduction in 6 min, whereas medetomidine and xylazine required 95 and 115 min, respectively. Both alpha-2 agonists, medetomidine, and xylazine, showed a prolonged duration of effect and a greater reduction in IOP than those of alfaxalone. All three medications provided adequate sedation without any discernible adverse effects. The findings revealed the varied effects of these drugs on IOP in pigeons, potentially providing valuable insights that could be useful for broader applications in veterinary medicine.

Clinical Results of the MINIject Implant for Suprachoroidal Drainage

Objective: This retrospective study evaluated the safety and efficacy of the new minimally invasive MINIject implant placed in the suprachoroidal space. The aim was to assess its impact on intraocular pressure (IOP) reduction and complication rate. Methods: 18 eyes from 18 patients with insufficiently controlled glaucoma received the implant using topical medications. Outcomes were changes in IOP, change in IOP medication, need for other glaucoma surgery, and rate of adverse events. Results: IOP reduced by 15% (p < 0.05) following MINIject implantation. IOP medication decreased from 3 to 1 agent (p < 0.05). Four patients (22%) required other glaucoma surgery while we did not observe any clinically relevant adverse event. Conclusions: This retrospective study indicates that MINIject implants may be a safe and effective means of reducing IOP together with a reduction in IOP medications in most patients. Larger prospective studies with longer follow-ups are necessary to confirm our results, though.

[Comparison of surgical outcomes between Kahook Dual Blade goniotomy and Trabectome surgery in patients with open-angle glaucoma].

Objective: To compare the medium-term therapeutic effects of Kahook Dual Blade (KDB) goniotomy and Trabectome surgery in the treatment of patients with primary open-angle glaucoma (POAG). Methods: This study was a non-randomized prospective interventional controlled clinical study. POAG patients who underwent KDB goniotomy or Trabectome surgery at Beijing Tongren Hospital from May 2017 to April 2022 were enrolled. The definition of successful surgery was postoperative average intraocular pressure (IOP)≤21 mmHg (1 mmHg=0.133 kPa) and IOP decrease≥20%. Follow-up visits were conducted on the 1st day, 1st week, 1st, 3rd and 6th month after surgery. The IOP value, the number of IOP-lowering medications, the proportion of surgical success (average IOP≤21 mmHg at 6 months), and complications were evaluated. Statistical methods included independent sample t-test, Mann-Whitney rank sum test, χ2 test, repeated measures two-factor analysis of variance, Bonferroni, Friedman M test, Wilcoxon, and Log-rank. The Kaplan-Meier method was used to calculate the cumulative success rate of each group. Results: Seventeen male patients (17 eyes) and 10 female patients (10 eyes) were included. The mean age was (39.9±17.7) years old. There were 11 patients in the KDB group and 16 patients in the Trabectome group. There was no significant difference in clinical baseline conditions between the two groups (P>0.05). The IOPs in the KDB and Trabectome groups at postoperative 1 week [(16.6±6.3) and (16.4±4.1) mmHg) and 6 months [(17.8±5.3) and (19.9±4.4) mmHg) were lower than those before surgery [(25.1±9.3) and (27.4±9.1) mmHg) (all P<0.05). There was no significant difference in the overall IOP between groups (P>0.05). The IOP reduction rates in the KDB and Trabectome groups were 23.4% and 19.0%, with no significant difference (P=0.674). The numbers of IOP-lowering medications used in the KDB and Trabectome groups at 3 months [2.0 (1.0, 4.0) and 2.0 (1.0, 2.3)] and 6 months [2.0 (0.0, 4.0) and 2.0 (1.0, 3.0)] after surgery were not significantly different from those before surgery [4.0 (2.0, 4.0) and 3.0 (2.0, 4.0)] (both P>0.05). There was no statistical significance in the overall number of IOP-lowering medications used between the two groups (P>0.05). There was also no statistically significant difference in the proportion of patients with an IOP decrease of≥20% and the proportion of patients whose mean postoperative IOP was≤21 mmHg (all P>0.05). The proportions of IOP≤21 mmHg in the KDB group and the Trabectome group at 6 months after surgery were 81.8% and 68.8% (P>0.05). Serious intraoperative or postoperative complications occurred in neither group. Conclusions: Both KDB trabeculotomy and Trabectome surgery can effectively reduce IOP and have a good safety profile in treating POAG, with the same number of IOP-lowering medications.

The Effect of Exercise on Intraocular Pressure and Glaucoma.

A review of the literature found that certain types of exercise and physical activity result in transient reductions in intraocular pressure and may have a beneficial effect on glaucoma severity and progression. Glaucoma is the most common cause of irreversible vision loss worldwide. Raised intraocular pressure (IOP) is the most important risk factor for the disease. Exercise is known to result in changes in IOP. The purpose of this review was to investigate the effect of exercise on IOP and glaucoma. A comprehensive search of multiple literature databases was performed. Medline, EMBASE, and Cochrane libraries were used to search for the relevant terms. 16 original studies were selected for the review. Exercise of varying intensity and type has differing effects on IOP. Moderate-intensity aerobic exercise results in transient reductions in IOP, while high-intensity resistance exercise and weight-lifting lead to transient elevations in IOP. There is evidence to suggest that exercise and higher levels of fitness may be protective against the development of glaucoma. In addition, increased daily physical activity may be associated with less visual field progression in patients with glaucoma. While secondary causes of glaucoma are included in some of the studies discussed in this review, the findings are largely applicable to primary open angle glaucoma. Exercise may be a beneficial lifestyle modification in the management of glaucoma; however, further longitudinal studies are required to validate this.

Outcomes of a Second Ahmed Glaucoma Implant with Mitomycin-C in Pediatric Glaucoma After Initial Valve Failure.

After failure of a glaucoma drainage device in children, implantation of a second Ahmed glaucoma valve with mitomycin-C allows a significant reduction of intraocular pressure and number of medications with good medium- and long-term survival. The effectiveness of glaucoma drainage devices (GDD) is limited in time. There is little literature regarding the optimal management strategy after failure of a GDD in pediatric glaucoma. To report the outcomes of Ahmed glaucoma valve implantation (AGV) with mitomycin-C (MMC) after failure of a GDD in children. Retrospective chart review of patients with a history of at least one GDD receiving an AGV implantation with MMC between 2000 and 2019. We defined complete success as an IOP of 5 to 21mmHg without glaucoma medication and qualified success as a final IOP of 5 to 21mmHg with one or more glaucoma medication, without loss of vision. Twenty-one patients (22 eyes) met the inclusion criteria. The intraocular pressure and number of medications were significantly reduced. The probability of complete success was 47% [95%CI: 29% - 75%] at 2 years and 34% [95%CI: 18% - 65%] at 4 years. The probability of qualified success was 74% [95%CI: 56% - 97%] at 2 years, and 54% [95%CI: 34% - 84%] at 5 years. Failure happened in 10 eyes after a mean time of 4.3 years ±3.6 [6mo - 15y], 5 of which (23%) for severe complication or loss of vision. This study of implantation of a second valve with MMC reports a significant decrease of IOP and medications with medium- and long-term success rates close to those reported for a first valve implantation, although with a high risk of complications.

One Year Outcomes of Preserflo Microshunt for Primary Open Angle Glaucoma: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis concludes that the PreserFlo Microshunt glaucoma drainage device significantly reduces intraocular pressure in primary open-angle glaucoma patients at 12 months post insertion. A systematic review and meta-analysis on the effect of the PRESERFLO™ MicroShunt (PF-MS) on intraocular pressure (IOP) at 12 months has been conducted. The Pubmed/MEDLINE, Embase, CENTRAL, Google Scholar, Scopus and Web of Science databases were searched. Inclusion criteria required a diagnosis of open-angle glaucoma, PF-MS insertion, and examination of IOP over time. Meta-analyses were conducted on the primary outcome of IOP and the secondary outcome of glaucoma medication regime. Adverse events were also noted. Fourteen studies were identified for inclusion in the meta-analyses, of which none had a high risk of bias. The meta-analyses found a significant mean reduction in IOP of 9.07mmHg (95% CI 7.88 - 10.25; P<0.0001) and a significant mean reduction in mean glaucoma medication requirement of 2.37 medications (95% CI 2.15 - 2.60); P<0.0001). Hypotony and hyphaema are common early complications. The PF-MS device significantly reduced both IOP and glaucoma medication requirement at 12 months post insertion in individuals with open-angle glaucoma without a significant adverse event burden. Further research is required to determine the economic and environmental effects of widely implementing the PF-MS device into clinical practice.

180° versus 360° Selective Laser Trabeculoplasty in Open Angle Glaucoma and Ocular Hypertension: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis found that 360° selective laser trabeculoplasty (SLT) is significantly more effective than 180° SLT at reducing intraocular pressure at one month and one year follow-ups, without increased serious adverse event risk. To determine the efficacy of 180° versus 360° selective laser trabeculoplasty (SLT) in adults with open angle glaucoma (OAG) and ocular hypertension (OHT). A systematic review was performed using PubMed, Embase, and Scopus databases, from 1995 to December 30, 2023, for studies comparing 180° and 360° SLT in adults with OAG and OHT (PROSPERO ID: CRD42024497832). Meta-analyses were performed to calculate nominal percent and raw reductions in IOP between treatment groups at one-month, one-year, and two-year follow-ups, as well as success rates, defined as a 20% or greater IOP reduction. Nine studies with 1044 eyes were included; 491 received 180°SLT and 553 received 360° SLT. At the one-month follow-up, 360° SLT reduced IOP by 3.45% more (WMD=3.45; 95% CI: 2.02-4.88; P<0.00001) and 0.87mmHg more (WMD=0.87; 95% CI: 0.35-1.38; P=0.0010). At the one-year follow-up, 360° SLT reduced IOP by 4.33% more (WMD=4.33; 95% CI: 2.35-6.32; P<0.0001) and 1.15mmHg more (WMD=1.15; 95% CI: 0.25-2.04; P=0.01). At two years of follow up, 360° SLT reduced IOP by 4.86% more (WMD=4.86; 95% CI: -0.32, 10.0; P=0.07) and 1.25mmHg more (WMD=1.25; 95% CI: -0.29, 2.79; P=0.11), however the difference was not statistically significant. Compared to 360° SLT, 180° SLT had a significantly lower success rate (OR=0.50; 95% CI: 0.35-0.72; P=0.0002). There was no difference in serious complications between interventions. 360° SLT is more effective than 180° SLT at lowering IOP at one-month and one-year follow-ups as well as achieving successful IOP control without increased risk of serious complications.

Treatment Outcomes Comparing the Paul and Baerveldt Glaucoma Implants After One Year of Follow-Up.

In reducing intraocular pressure (IOP), Paul (PGI) and Baerveldt (BGI) glaucoma implants are safe and effective in patients with glaucoma. To compare efficacy and safety profiles of the PGI and BGI in the treatment of medically uncontrolled glaucoma at 1 year of follow-up. Retrospective analysis of patients implanted with a PGI or BGI with a minimum of 12 months follow-up. The primary outcome was surgical success defined as IOP ≥6 and ≤18mm Hg and at least 20% IOP reduction from baseline. Secondary outcomes included IOP measurements, number of medications, and complications. Twenty-three patients implanted with PGI and 27 with BGI were included. At last visit (12 mo), mean IOP had decreased from 23.7 ± 6.9 to 0.1 ± 2.9mm Hg in the PGI group versus 26 ± 7.3 to 10.4 ± 4.9mm Hg with the BGI ( P < 0.001 for both comparisons). Overall qualified success rates were similar between groups (PGI 91% vs BGI 89%, P = 0.784). IOP was significantly lower in the PGI at week 1 and month 1 of follow-up versus the BGI (13.6 ± 6.1 vs 20.1 ± 7.4; 14.6±3.8 vs 21.2 ± 5.8mm Hg; P < 0.002 for both) with a lower number of medications (1.57 ± 1.47 vs 2.52 ± 1.16 atmo 1, P = 0.015). Most complications were minor and similar in both groups. Both PGI and BGI are safe and effective in reducing IOP in patients with glaucoma, with similar success rates.

Efficacy of a novel low-cost torchlight transcorneal transillumination for diode laser transscleral cyclophotocoagulation in adult glaucoma.

To study the outcomes of diode laser transscleral cyclophotocoagulation (TSCPC) with trans-corneal transillumination using a novel low-cost torchlight method in refractory glaucoma. This prospective interventional study included patients with refractory glaucoma who underwent TSCPC with trans-corneal transillumination (TSCPC-TI) using a novel low-cost torchlight method. Patients completing a minimum 6-month follow-up were analyzed. They were compared to a historical control group of patients who underwent TSCPC without transillumination (TSCPC-No TI) at 6-month follow-up period. We analyzed the mean laser energy delivered, post-laser intraocular pressure (IOP) reduction, number of antiglaucoma medications (AGM), the requirement of retreatment and complications of the procedure in both groups. 32 eyes of 29 patients comprised the TSCPC-TI group and were compared with 39 eyes of 37 patients in the TSCPC-No TI group. The TSCPC-TI group required lower energy than the TSCPC-No TI group (46.15 ± 22.8 Vs 80.65 ± 56.1 J p < 0.001). At 6-month follow-up, the TSCPC-TI group required lesser AGM for IOP control (2.33 ± 1.02 vs 3.02 ± 1.32 p = 0.01). There was a significantly reduced dependence of oral acetazolamide in the TSCPC-TI group at 6 months follow-up (15.6% vs 41% p = 0.03%). The success and response rates were 71.8% Vs 23.1%; p < 0.0001 and 87.5% Vs 51.2%; p = 0.001 significantly high in the TSCPC-TI group. The TSCPC-No TI group had a significantly high failure rate (12.5% Vs 48.2% p = 0.001). Hypotony (n = 1) and phthisis (n = 2) were noted TSCPC-No TI group. TSCPC with transillumination with a low-cost torchlight resulted in a more efficient and effective cycloablation than TSCPC without transillumination.

Bent ab interno needle goniotomy versus gonioscopy-assisted transluminal trabeculotomy in primary open-angle glaucoma: study protocol of a randomized clinical trial

BackgroundMinimally invasive glaucoma surgery (MIGS) is a new class of surgeries, which combines moderate to high success rates and a high safety profile. Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) are two low-cost MIGS procedures that communicate the anterior chamber to Schlemm’s canal. Most of the available publications on MIGS are either case series or retrospective studies, with different study protocols. The aim of this manuscript is to describe a randomized clinical trial (RCT) protocol to compare the long-term intraocular pressure (IOP) control and the safety of both procedures in eyes with primary open-angle glaucoma.MethodsThis is a parallel, double-arm, single-masked RCT that includes pseudophakic primary open-angle glaucoma (POAG) eyes. After inclusion criteria, medications will be washed out to verify baseline IOP before surgery. Patients will be randomized to BANG or GATT using a sealed envelope. Follow-up visits will be 1, 7, 15, 30, 60, 90, 180, 330 and 360 days after surgery. On PO330, a new medication washout will be done. The main outcome is the IOP reduction following the procedures. Complimentary evaluation of functional and structural parameters, safety, and quality of life will be done after 30, 90, 180, and 360 days.DiscussionOur study was designed to compare the long-term efficacy and safety of two low-cost MIGS. Most of the published studies on this subject are case series or retrospective cohorts, with different study protocols, which included different types and severities of glaucomas, combined with cataract extraction. Our study only included mild to moderate POAG eyes, with previous successful cataract extraction. Moreover, it provides a standardized protocol that could be replicated in future studies investigating various types of MIGS. This would allow comparison between different techniques in terms of efficacy, safety, and patients’ quality of life.Trial registrationRetrospectively registered at the Registro Brasileiro de Ensaios Clínicos (ReBEC) platform RBR-268ms5y. Registered on July 29, 2023.The study was approved by the Ethics Committee of the University of Campinas, Brazil.

Using a Novel, Subconjunctival, Sustained-Release Mitomycin C Formulation in a Rabbit Model of Filtration Surgery with Gel Stent Implantation.

Purpose: To investigate gel stent implantation with and without intraoperative sustained-release mitomycin C (MMC SR) in a rabbit model for gel stent implantation, and to examine aqueous humor outflow (AHO) postimplantation. Methods: Four groups of rabbits were included. Group 1 was untreated (control). Groups 2, 3, and 4 received the gel stent without MMC, with MMC solution (subconjunctival injection), and with MMC SR (subconjunctival injection), respectively. Intraocular pressure (IOP) and AHO were assessed via tonometry and indocyanine green-based angiography, respectively. The main efficacy measure was change in IOP from baseline. Results: Following gel stent implantation, Groups 2, 3, and 4 maintained ≥20% IOP reduction (response) for a median duration of 1 week, 6.5 weeks, and 30 weeks, respectively. Angiography showed normal aqueous humor drainage (Group 1) beginning at the perilimbal trabecular plexus and continuing posteriorly to episcleral outflow vessels. Following implantation, drainage occurred preferentially and directly into the subconjunctival bleb. Conclusions: Gel stent implantation with MMC SR was most effective in achieving sustained, long-term IOP reduction in the rabbit model, compared with implantation with or without MMC solution. Bleb presence and the postimplantation aqueous angiography results indicated redirection of the AHO to the subconjunctival vasculature and presumed lymphatics, suggesting efficient glaucoma filtration to lower IOP in this model. This rabbit model and aqueous angiography may help refine understanding of the mechanism of action of minimally invasive glaucoma surgeries and ultimately translate to improved surgical devices and procedures for patients with glaucoma.

The Clinical Efficacy of Different Relaxation Exercises on Intraocular Pressure Reduction: A Meta-Analysis.

Objective: The aim of this study was to synthesize the available evidence on the clinical efficacy of different relaxation exercises on intraocular pressure (IOP) reduction. Methods: A systemic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was undertaken from the earliest record to 10 April 2024. Peer-reviewed studies that reported on healthy individuals and glaucoma patients engaging in relaxation exercises for at least three weeks were included. The primary outcome was changes in IOP levels from baseline, before the commencement of relaxation exercises, to post-exercise. Our statistical analysis employed a random-effects model, with effect sizes reported using Hedges' g. Results: Twelve studies were included, totaling 764 eyes (mean participant age ranging from 21.07 to 69.50 years). Relaxation exercises significantly reduced IOP, with Hedges' g being -1.276 (95% CI: -1.674 to -0.879) and I2 = 84.4%. Separate subgroup analyses showed that breathing exercises (Hedges' g = -0.860, p < 0.0001), mindfulness-based stress reduction (MBSR) (Hedges' g = -1.79, p < 0.0001), and ocular exercises (Hedges' g = -0.974, p < 0.0001) were associated with reduced IOP levels. The reduction in IOP following the relaxation exercises was found to be associated with baseline IOP either greater than (Hedges' g = -1.473, p < 0.0001) or less than 21 mmHg (Hedges' g = -1.22, p < 0.0001). Furthermore, this effect persisted with follow-up durations of less than (Hedges' g = -1.161, p < 0.0001) and more than one month (Hedges' g = -1.324, p < 0.0001). Conclusions: The current meta-analysis indicates that relaxation exercises can significantly reduce IOP levels. Relaxation exercises are a potential class of novel treatments for glaucoma patients that deserve further evaluation.

Nanocarrier-based Drug Delivery of Brinzolamide for Ocular Diseases: A Mini-Review

Abstract: Brinzolamide (BRZ) represents a significant advancement in glaucoma treatment as a topically active carbonic anhydrase inhibitor (CAI). It exhibits selectivity and potent inhibitory activity for carbonic anhydrase type II isozyme (CA-II), which is crucial in aqueous humor secretion. With excellent ocular bioavailability and a formulation optimized for physiologic pH, brinzolamide effectively lowers intraocular pressure by inhibiting CA-II in ciliary processes. Its superior ocular comfort profile enhances patient compliance. Preclinical evaluations confirm its specific CA inhibition without notable side effects, and its low systemic absorption minimizes systemic CA inhibition-related issues. BRZ's prolonged tissue half-life in the eye ensures sustained IOP reduction, supported by clinical trials demonstrating comparable efficacy with reduced dosing frequency. Challenges in ocular disease treatment arise from physiological, anatomical, and dynamic barriers hindering effective drug delivery to the eye. Nanocarriers, such as micelles, nanoparticles, liposomes, niosomes, and dendrimers, offer promising solutions by improving permeation, targeting specific sites, and overcoming the limitations of conventional forms. This review explores diverse nanomedicines, detailing their applications, advantages, and disadvantages in ophthalmic drug delivery. It also includes recent research findings for a comprehensive overview of the current landscape.

No Changes in Keratometry Readings and Anterior Chamber Depth after XEN Gel Implantation in Patients with Glaucoma.

Background: This study aimed to compare keratometry and anterior chamber depth (ACD) changes after XEN implantation in primary open-angle glaucoma (POAG) cases over a 3-month follow-up period. Methods: Twenty patients with POAG who underwent XEN63 implantation, either standalone or combined with cataract surgery, were included. Preoperative data, including best-corrected visual acuity (BCVA), refraction, gonioscopy, ophthalmoscopy, intraocular pressure (IOP) evaluation, and axial length, were collected. Corneal topography and ACD measurements were assessed preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Each patient's eye that underwent XEN surgery was included in the study group, with the fellow eye serving as a control. Results: In the study group, there was a significant decrease in IOP after XEN stent implantation at all investigated time intervals (p < 0.05). However, changes in mean ACD did not show statistically significant differences at any follow-up examination in both the study and control groups. Additionally, keratometry readings revealed no significant changes in total astigmatism or steep keratometry values in either group. Conclusions: XEN implantation in POAG cases resulted in a significant decrease in IOP over the 3-month follow-up period. However, there were no significant changes observed in mean ACD or keratometry readings, indicating stability in these parameters post-XEN implantation. These findings suggest that XEN implantation may be an effective option for IOP reduction without affecting corneal curvature or ACD in POAG patients.

Outcomes of iStent inject combined with cataract surgery in Asian eyes: Australian data from the Fight Glaucoma Blindness international registry.

To analyse real-world outcomes in Asian eyes of iStent inject, a second-generation trabecular micro-bypass stent, combined with phacoemulsification. This is a multi-centre, observational study of glaucomatous Asian eyes that have undergone iStent inject implantation combined with cataract surgery. Patient data were extracted from the Fight Glaucoma Blindness! Registry. Outcome measures included those of IOP reduction, glaucoma medication reduction, and adverse events including the need for secondary surgery. 123 eyes of 86 patients with a mean age of 68.4 ± 9.3years underwent iStent inject implantation with phacoemulsification. At baseline, the mean ± SD preoperative intraocular pressure (IOP) was 16.0 ± 4.4mmHg, and the mean preoperative number of topical glaucoma medications was 1.9 ± 1.4. At 12months 30.8% of eyes demonstrated a reduction in IOP greater than 20%, the mean IOP reduction was 12.5% with an additional reduction of 0.7 glaucoma medications. 40% of eyes were using no medications at 12months compared to 16.3% preoperatively. 8.2% of eyes required a subsequent procedure within the 12-month follow-up window. iStent inject implantation combined with phacoemulsification in Asian eyes showed a reduction of IOP and glaucoma medication use in a real-world clinical setting. The safety profile of the device is good with minimal adverse outcomes, however, a subset of patients required secondary procedures within the 12 month follow up.

Survival of medical treatment success in primary open-angle glaucoma and ocular hypertension

Background/aimsTopical agents to lower intraocular pressure (IOP) are the most common initial therapeutic measure in glaucoma prevention. This study aims to assess treatment success duration among patients initiating or intensifying...

The efficacy of adjunctive mitomycin C and/or anti-VEGF agents on glaucoma tube shunt drainage device surgeries: a systematic review.

The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit. We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months. Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction. There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.

Optic Nerve Head Pulsatile Displacement in Open-Angle Glaucoma after Intraocular Pressure Reduction Measured by Optical Coherence Tomography: A Pilot Study

This study investigated the effect of intraocular pressure (IOP) reduction on pulsatile displacement within the optic nerve head (ONH) in primary open-angle glaucoma (POAG) patients with and without axial myopia. Forty-one POAG patients (19 without myopia, 9 with axial myopia and 13 glaucoma with no intervention) participated. Swept-source optical coherence tomography (OCT) videos of the ONH were obtained before and after IOP-lowering treatment (medical or surgical) achieving a minimum IOP drop of 3 mmHg. A demons registration-based algorithm measured local pulsatile displacement maps within the ONH. Results demonstrated a significant 14% decrease in pulsatile tissue displacement in the non-myopic glaucoma cohort after intervention (p = 0.03). However, glaucoma patients with axial myopia exhibited no statistically significant change. There were no significant changes in the pulsatile ONH deformation in the control group. These findings suggest a potential link between IOP reduction and reduced pulsatile displacement within the ONH in POAG patients without myopia, offering new insights into the disease’s pathophysiology and warranting further investigation into underlying mechanisms and clinical implications.

Frequency-doubled neodymium yttrium aluminum garnet (Nd:YAG) laser trabeculoplasty as adjuvant therapy for open-angle glaucomas

The thermal frequency-doubled Nd:YAG (neodymium: yttrium-aluminum-garnet) laser was used sparingly for trabeculoplasty. Our goal was to assess the efficacy and safety of frequency-doubled Nd:YAG laser trabeculoplasty as an adjunct therapy to anti-glaucoma medications in open-angle glaucoma. Laser trabeculoplasty was performed on 41 eyes of 22 adults with open-angle glaucomas using a thermal frequency-doubled Nd:YAG laser (Green laser photocoagulator GYC-500® 532 nm, Nidek, Japan). To assess the laser’s effectiveness, patients were monitored for intraocular pressure (IOP) reduction, control, and complications at 1 hour, 1 week, and then monthly for a year. Primary open-angle glaucoma was the most common diagnosis in 31 (75.6%) eyes. The pre-laser baseline IOP was 18.87±3.66 mmHg. The mean IOP was 14.9±2.54 mmHg at Week 1 (p = 0.000), 14.65±2.50 mmHg at Month 1, 14.53±2.60 mmHg at Month 3, 15.85±2.30 mmHg at Month 6, and 15.14±2.17 mmHg at Month 12 (p=0.000). A significant percentage reduction in IOP was achieved at 1, 3, 6, and 12 months: 21.78%, 22.48%, 16.73%, and 18.53%, respectively. Patients used an average of 2.73±1.00 topical drugs before laser treatment. There was a significant reduction in medicines after laser treatment on all occasions, at 1, 3, 6, and 12 months (p = 0.000). Complications included some degree of peripheral anterior synechiae (PAS) in 20 (51.3%) eyes; an IOP spike in one patient only, bilaterally (5.1%) at 1 hour after therapy; and mild anterior uveitis in four (9.75%) cases. To summarize, frequency-doubled Nd:YAG laser trabeculoplasty is a safe and effective adjuvant therapy for open-angle glaucoma that reduces intraocular pressure and medication use.