Mean Intraocular Pressure Reduction Research Articles

Intraocular Pressure Reduction Following Phacoemulsification in Patients with Exfoliation: A Systematic Review and Meta-Analysis

Objectives: The objective of this systematic review and meta-analysis is to evaluate the existing evidence and estimate the impact of phacoemulsification and intraocular lens implantation on the intraocular pressure (IOP) of subjects with exfoliation syndrome (XFS) or exfoliative glaucoma (XFG). Methods: In July 2024, an in-depth literature review across three databases was undertaken. This study focused only on adult patients with exfoliation who had not undergone previous ocular surgery. The primary outcome of interest was the mean IOP reduction at 6 and 12 months after uncomplicated phacoemulsification surgery. Results: This meta-analysis included one randomized controlled trial and eight observational studies, comprising 220 patients at 6 months and 430 patients at the 12-month time point, respectively. The mean IOP reduction after surgery was 3.43 mmHg (95% CI: −4.77 to −2.09) after 6 months and 2.75 mmHg (95% CI: −4.24 to −1.26) after 12 months. In both time points, there was no heterogeneity (I2 = 0), but the certainty of evidence following the GRADE evaluation was very low. Conclusions: The present meta-analysis demonstrates that phacoemulsification can significantly reduce IOP in exfoliation subjects 6 and 12 months after surgery. Nevertheless, significant limitations in included studies do not allow a precise and certain estimate of the magnitude of postoperative IOP lowering in exfoliation patients. Additional research is needed to confirm these results.

Application of Negative Pressure by the Ocular Pressure Adjusting Pump to Provide a Sustained Reduction in IOP.

To evaluate the sustainability of IOP reduction with continuous negative pressure application over an extended duration with use of the Ocular Pressure Adjusting Pump. Prospective, controlled, open-label, randomized, single site, pilot study. Subjects with primary open-angle glaucoma (OAG) were enrolled. One eye of each subject was randomized to receive negative pressure application; the fellow eye served as a control. The study eye negative pressure setting was programmed for 60% of the baseline IOP. Subjects wore the Ocular Pressure Adjusting Pump for 8 consecutive hours and IOP measurements occurred at 2-hour intervals for a total of 5 IOP measurements (08:00, 10:00, 12:00, 14:00, 16:00). Nine subjects successfully enrolled and completed the study. The mean programmed negative pressure setting was -12.0mmHg. At baseline, the mean IOP in the study eye was 21.4 ± 4.3mmHg. The mean IOP reduction in the study eye at hours 0, 2, 4, 6, and 8 was 8.1 (37%), 6.4 (28%), 6.3 (29%), 7.3 (34%) and 6.7 (31%), respectively. All IOP measurements during negative pressure application were reduced from baseline. There were no serious adverse events. The Ocular Pressure Adjusting Pump provides a sustained reduction in IOP while the device is worn with negative pressure applied with an IOP reduction exceeding 25% across 8hours of continuous wear.

Efficacy and safety of the new generation of excimer laser trabeculotomy in aheterogeneous patient population-1-year follow-up

Microinvasive procedures have become established in glaucoma surgery and are preferred for patients with target pressure values that are not too low. Excimer laser trabeculotomy (ELT) represents such aminimally invasive approach and can easily be combined with cataract surgery. Over 12months the reduction in intraocular pressure (IOP), the number of antiglaucoma drugs and the incidence of adverse events were evaluated using the new EliosTM method (Elios Vision GmbH, Germering, Germany) for real-life data from aheterogeneous patient population undergoing ELT in combination with cataract surgery (phaco-ELT). In this study 20eyes of 13patients who underwent phaco-ELT were retrospectively analyzed. After standard phacoemulsification with posterior chamber lens implantation, 10microchannels were created using the excimer laser. The patients were followed for 12months and the intraocular pressure (IOP), number of antiglaucoma drugs and the occurrence of adverse events were analyzed. The average age was 65years. The preoperative IOP was 17.5(± 5.3) mm Hg. The mean IOP reduction was 4.8 mm Hg (27.4%, p < 0.001) on the first postoperative day, 3.2 mm Hg (18.3%, p = 0.22) after 6months and 2.5 mm Hg (14.3%, p = 0.14) at 12months. The number of antiglaucoma drugs decreased from an average of3.2 (± 1.3) preoperatively to0.5 (± 0.9) on day1 (p < 0.001), 1.9(± 1.2) after 6months (p = 0.008) and 2.2(± 1.3) after 12months (p = 0.013). In our cohort ELT in combination with cataract surgery is asafe minimally invasive procedure leading to an IOP reduction of 14.3% and areduction of pressure-lowering medication by1 active ingredient in patients with low initial pressure at 1‑year follow-up. As no implant is used in ELT and the conjunctiva remains untouched, subsequent procedures, including bleb-related surgery, are not negatively affected.

Longitudinal outcomes of iStent inject with cataract surgery compared to cataract surgery alone: real-world data from the Fight Glaucoma Blindness registry.

To compare combined phacoemulsification and iStent inject to phacoemulsification alone. Fight Glaucoma Blindness (FGB) registry - Australia. Prospective observational registry study. Eyes that had combined phacoemulsification with iStent inject (iStent group) were compared to eyes that had phacoemulsification only (cataract alone). Primary outcome was percentage of eyes achieving >20% IOP reduction from baseline 12 months after surgery. Secondary outcomes included mean IOP and medication reduction, adverse events and secondary procedures. At 12 months the percentage of eyes achieving >20% reduction of IOP at 12 months was significantly higher in the iStent group compared to the cataract alone group (40.9% vs 30.1% p<0.001). Adverse events occurred at a low rate in both groups, and secondary IOP lowering procedures were significantly less frequent in the iStent group compared to cataract alone. Real-world outcomes from the FGB registry at 12 months show phacoemulsification combined with iStent inject has higher efficacy and a reduced need for secondary IOP lowering surgery compared to phacoemulsification alone.

Comparison of Efficacy and Safety of Slow Coagulation Transscleral versus Micropulse Cyclophotocoagulation in Refractory Glaucoma

Background Cyclodestructive laser technology has been developed with the aim of achieving a greater reduction in Intraocular Pressure (IOP) with minimal complication. Micropulse transscleral cyclophotocoagulation (MP-TSCPC) and slow-coagulation continuous-wave transscleral cyclophotocoagulation (SC-TSCPC) are considered to have less complications than conventional techniques using continuous-wave transscleral cyclophotocoagulation. Purpose To compare IOP reduction and complications in refractory glaucoma after SC-TSCPC and MP-TSCPC procedures. Methods This study is a prospective interventional study in refractory glaucoma patients. Measurement of IOP using Goldmann applanation tonometry was performed preoperatively, and all patients were monitored at days 1, 7, and 30 in the postoperative period. Success was defined as postoperative IOP reduction of &gt; 20% from baseline with or without glaucoma medication. Complications were identified by evaluating subjective complaints and slit lamp examination. Results The study included a total of 66 eyes, with 33 eyes in each group. Baseline IOP was 50.58 ± 9.937 mmHg and 48.45 ± 12.792 mmHg in SC-TSCPC and MP-TSCPC group, respectively. The mean IOP reduction was 27.44 ± 19.96% vs 14.39 ± 23.52% (p=0.018) in day 1, 46.19 ± 27, 7 3% vs 45.83 ± 24,80% (p=0,956) in day 7 and 46.49 ± 24.63% vs 27.09 ± 23.86% in day 30 (p=0.002), in SC-TSCPC and MP-TSCPC group respectively. Complications between groups were not significantly different. However, hypotonia (IOP &lt; 6 mmHg) was found in the SC-TSCPC group. Conclusion SC-TSCPC showed greater IOP reduction than MP-TSCPC, with no significant differences in complications between the two groups.

Comparison of Efficacy of Micropulse Laser Settings for Glaucoma Management.

Objectives: This study aims to compare micropulse transscleral cyclophotocoagulation (MP-TSCPC) laser parameters and determine the optimal laser setting. Methods: A retrospective study was performed on 351 eyes from patients who underwent MP-TSCPC at four power settings (1500 mW, 2000 mW, 2250 mW, and 2500 mW) from June 2018 to December 2021. The primary measurements of the efficacy of MP-TSCPC were the degree of intraocular pressure (IOP) reduction and the number of glaucoma medication reductions. The rate of hypotony was obtained to assess the safety of MP-TSCPC. Results: At 1500, 2000, and 2500 mW, the mean IOP reduction at each visit was statistically significant compared to the baseline, and at 2250 mW, the mean IOP was only significantly different at 18 months (p < 0.05). The change in the number of medications with 2000 mW has shown significance at 1 and 3 months from the baseline; with 2500 mW, statistical significance was shown at 3, 6, 12, and 18 months (p < 0.05) compared to the baseline. Mean IOP reductions (%) were greater in 2000 mW than in 1500 mW at 1 week, 1 month, and 3 months and were greater in 2500 than in 1500 mW at 1 week (p < 0.05). There was no significance for mean IOP reductions at 6, 12, and 18 months across all powers. Only two occurrences of hypotony were reported. Conclusions: MP-TSCPC at 1500 mW, 2000 mW, and 2500 mW is a safe and effective treatment for IOP reduction. MP-TSCPC at 2250 mW is safe but may show delayed effectiveness in IOP reduction. In the long term, no one specific power setting was found to be superior for IOP reduction.

Ab-Externo XEN Gel stent implantation effectively treated refractory glaucoma with prior failed shunt tube

PurposeTo assess the efficacy of a gelatin stent (XEN 45 Gel Stent; Allergan) implant in advanced glaucoma eyes that have failed prior aqueous shunt implantation.MethodsWe retrospectively reviewed 6 patients with refractory glaucoma, defined as persistently high IOP (> 21 mmHg) despite taking at least 3 IOP-lowering medications subsequent to undergoing a glaucoma drainage device (GDD) with or without a second GDD or cilioablative procedure. Eyes with previous failed GDD underwent subconjunctival 0.3 cc (0.4 mg/ml) mitomycin C, tenonectomy, and placement of an ab- externo XEN stent. The outcome measures included change in IOP and the number of glaucoma medications. Success was defined as patients achieving an IOP ≤ 18 mmHg with a percentage reduction of 25% or 15 mmHg and 40% mean IOP reduction from baseline while taking the same number or fewer medications.ResultsAll six eyes with age of 77.6 ± 7.82 years who underwent XEN implantation following previous GDD surgery had primary open-angle glaucoma. The IOP decreased significantly from 32.33 ± 5.99 to 12.67 ± 3.27 mmHg (p < 0.001) with a follow-up of 13.9 ± 2 (11.7–16.7) months. Visual acuity and visual field remained stable after XEN placement. Compared to the baseline number of medications of 4.2 ± 0.8, all medication was discontinued except in one eye on two drops at the end of the follow-up. The overall surgical success rate was 100%. No complications, needling, or additional procedures were required.ConclusionThis study described successful implantation of the XEN stent following failed GDD. XEN Gel stent implantation associated with mitomycin C and tenonectomy can be considered a viable surgical option for patients with a history of previously failed tube shunt requiring further IOP lowering.

A retrospective review of selective laser trabeculoplasty outcomes at Lancashire Teaching Hospitals, UK.

Selective laser trabeculoplasty has been carried out at Lancashire Teaching Hospitals over the past seven years. This work aimed to review the use of SLT in this Trust. The primary objectives were to establish the efficacy of SLT in reducing intraocular pressure, to analyse how prior treatment with different topical medications can influence SLT outcomes and to analyse the outcomes in revisionary patients. We conducted a retrospective review of 288 eyes, with a known history of glaucoma or ocular hypertension and who underwent initial SLT laser treatment between October 2018 and January 2020. SLT was performed on known glaucoma and treatment naïve patients where IOP control was deemed sub-optimal. All patient data was fully anonymised. We found that SLT was effective in lowering IOP. Around two-thirds of the eyes (181/280, 65%) achieved a reduction in IOP of 10% or more. Just under half (127/280, 45%) achieved a reduction of 20% or more. For a pre-SLT IOP of 14.6 mmHg, we found that no mean change in IOP is expected, and for each 1 mmHg by which the pre-SLT IOP exceeds this threshold, the mean reduction in IOP is expected to be 0.61 mmHg. We also found that combination therapies of PGA plus aqueous suppressants gave better outcomes compared with PGA alone. We found that revisionary SLT compared favourably with the first treatment, although first-time outcomes were not a good predictor of success with revisionary SLT. Primary and revisionary SLT has been shown to be effective across the cohort of patients in this study.

Predictors of intraocular pressure response and survival after phacoemulsification for glaucomatous eyes in the IRIS registry (Intelligent Research in Sight)

This retrospective cohort study describes the real-world incidence and maintenance of clinically meaningful intraocular pressure (IOP) reduction (“response”) following stand-alone phacoemulsification for 667,987 eyes with suspected or confirmed glaucoma in the IRIS Registry (Intelligent Research in Sight) from 1/1/2013–9/30/2019. Intraocular pressure responders had ≥ 20% IOP reduction in daily mean IOP from baseline on two consecutive postoperative visits. We declared failure if a responder no longer maintained ≥ 20% IOP reduction. The estimated IOP responder rate was 41.3% by Kaplan–Meier analysis. Multivariate analysis demonstrated relationships between IOP response and baseline IOP (hazard ratio (HR) (95% confidence interval)) 1.48 (1.48–1.49), per 3 mmHg, P < 0.0001), age (HR 1.14 (1.13–1.14), per 10 years, P < 0.0001), male sex (HR 1.13 (1.12–1.15), P < 0.0001), prostaglandin analogue (HR 0.88 (0.87–0.90), P < 0.0001), and Rho-kinase inhibitor use (HR 1.50 (1.32–1.70), P = 0.01). Fifty percent of IOP responders failed at a median time of 14.3 months. Multivariate analysis demonstrated relationships between failure and baseline IOP (HR 0.75 (0.75–0.76), per 3 mmHg, P < 0.0001), nitric oxide donating prostaglandin (HR 1.78 (1.46–2.18), P < 0.0001) and Rho-kinase inhibitor use (HR 1.73 (1.43–2.09), P < 0.0001). Clinicians may counsel glaucoma patients with risk factors on whether to anticipate an IOP response and its expected duration after stand-alone phacoemulsification.

Intraocular Pressure Response in the Untreated Contralateral Eye After Selective Laser Trabeculoplasty.

To examine the impact of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) in the untreated contralateral eye within 12 months after the procedure. A retrospective chart review was conducted on patients with primary open-angle, normal-tension, pigmentary, or pseudoexfoliation glaucoma who received 360-degree SLT at George Washington University. Exclusion criteria included prior or subsequent laser or glaucoma surgery within 12 months of SLT, other glaucoma types, or corticosteroid use during follow-up. Primary outcomes were IOP and medication reduction, and SLT success, defined as reducing IOP by ≥20% without additional IOP-lowering procedures or medications. Follow-up occurred at six weeks, six months, and 12 months. Demographic and clinical data were analyzed using ANOVA, paired t-tests, and chi-squared tests. A total of 125 patients were included, representing a range of backgrounds: African American (57.6%), Caucasian (31.2%), Asian (5.6%), and Hispanic/Latino (4%), and 1.6% did not report their background. Significant reductions in mean IOP and medication numbers were observed in the contralateral eye at six weeks and six months (p<0.05) but not at 12 months. The contralateral eye success rates were 24% at six weeks and six months and 20.8% at 12 months. The contralateral eye was more likely to achieve success if the ipsilateral eye was successful at six weeks (odds ratio (95% confidence interval): 5.05 (1.89-13.48)), six months (16.1 (4.56-57.17)), and 12 months (5.94 (2.07-17.04)) (p<0.001 for all). First-time SLT results in statistically significant IOP and medication reductions in the contralateral eye at six weeks and six months. The contralateral eye was 5.05-16.1 times more likely to achieve success if the ipsilateral eye was successful within 12 months.

Efficacy and Safety of Diode Laser Transscleral Cyclophotocoagulation in Patients with Glaucoma.

To evaluate the efficacy and safety of transscleral diode cyclophotocoagulation (TSCPC) at 2 years of follow up. This is a retrospective review of the records of all adult patients who underwent their first TSCPC treatment between 2014 and 2019 at Unidade Local de Saúde de São João, Porto, Portugal. Data regarding intraocular pressure (IOP), best corrected visual acuity, number of IOP-lowering medications, use of oral acetazolamide, retreatments and complications during a 2-year period following TSCPC were registered. The primary outcome was overall success at 2 years, defined as IOP≥ 6 and ≤21 mmHg, with at least 20% IOP reduction from baseline, with or without IOP-lowering medications (qualified and complete success, respectively), without the development of phthisis bulbi or loss of light perception due to glaucoma and no further glaucoma procedures except TSCPC retreatment. Ninety-six eyes from 96 patients were included, mean age was 63 (±14) years. Mean IOP at baseline was 39.1 (±13.3) mmHg. Mean IOP reduction at 2 years was 18.5 (42.9%) mmHg (±16.0, min -16.0, max 56.0) (p < 0.001) and a significant reduction in the number of IOP-lowering medications and use of oral acetazolamide was observed. IOP reduction at 2 years was positively correlated with baseline IOP (r=0.682; p < 0.001). Overall success (including complete and qualified) was achieved in 42 patients (43.8%), with 34 (35.4%) presenting qualified success. Neovascular glaucoma (NVG) was the predominant diagnosis (n = 30, 31.3%), with a higher mean baseline IOP of 46.3 mmHg (±11.8, min 21.0, max 70.0) and a larger mean IOP reduction at 2 years of 24.7 (51.0%) mmHg (±16.4, min -2.0, max 55.0). Thirteen patients (13.5%) developed persistent hypotony, eight of which converted to phthisis bulbi, of which half had NVG. TSCPC can be an effective IOP-lowering procedure, demonstrating a stronger effect when the preoperative IOP is highest. However, there is a wide variability in the effect (specially in eyes with NVG) and some relevant complications, including 8.3% of patients developing phthisis bulbi after 2 years of follow up.

The Effects of the STREAMLINE™ Surgical System versus Endoscopic Cyclophotocoagulation in Primary and Secondary Glaucoma

Introduction: Glaucoma is an optic neuropathy that is the second most common cause of blindness worldwide and affects over three million Americans. Currently, the only known modifiable risk factor to prevent glaucomatous damage is to decrease the intraocular pressure (IOP). The STREAMLINE™ Surgical System (SSS) is a microinvasive glaucoma (MIGs) device that can create a goniotomy and dilates the drainage system of the eye to reduce IOP. Question &amp; Significance: This study aims to compare the effects on intraocular pressure of patients that had cataract surgery combined the SSS, endoscopic cyclophotocoagulation (ECP), or ECP with SSS in patients with primary and secondary glaucoma’s for 6 months post operatively. Methods: This is a retrospective chart review of patients that had cataract surgery with either ECP, SSS, or SSS + ECP from April 1st, 2022 through April 1st, 2023. Primary endpoints were mean IOP reductions and medication reliance at 6 months compared to baseline. Secondary outcomes were best corrected visual acuity (BCVA), number of patients with  20% decrease in IOP, number of patients with a decrease in IOP lower medications, and significant complications after treatment. Results: Comparing 6-month post-operative mean IOPs in these treatment groups, a significant reduction was noted only in the ECP group at the 6-month visit (p&lt;0.003). No statistically significant reduction was found in either the SSS (p=0.333) or SSS+ECP (p=0.134) groups. The percent of patients having a  20% decrease in IOP from baseline were 52%, 10%, and 38% for ECP, SSS, and SSS+ECP groups, respectively. Conclusions: In the SSS only group, we found a significantly smaller proportion of patients able to achieve the  20% IOP reduction at only 10% of patients compared to other previous studies. This difference is likely due no medication washout in our study. This study did find similar decrease in IOP lowering medications.

Minimally invasive bleb surgery versus minimally invasive glaucoma surgery: a 12-month retrospective study

This study aimed to compare the IOP-lowering effectiveness and safety of standalone Preserflo MicroShunt and iStent 1st generation implantation combined with phacoemulsification in Caucasian patients with a 12-month follow-up period. This retrospective study analyzed the medical histories of patients undergoing antiglaucoma surgery at the Department of Ophthalmology, Medical University of Bialystok, between January 2019 and January 2022. The main outcome measures were success rates (complete: proportion of eyes with IOP < 18 mmHg (criterion A) and < 15 mmHg (criterion B) or 20% reduction in IOP without any glaucoma medication; qualified: proportion of eyes achieving IOPs < 18 mmHg and < 15 mmHg or 20% reduction in IOP from baseline with or without medications), mean reduction (%) in IOP, medication burden, number of complications and additional interventions. In both groups, a significant decrease in IOP and medication burden were observed at 6 and 12 months when compared with baseline. At 12 months, qualified surgical success in criterion A was recorded in 67.4% and 85.7% of patients in the Preserfo and iStent groups, respectively (p = 0.045). Complete surgical success in criterion B at 12 months accounted to 61.4% of patients from Prserflo group and 32.7% patients in iStent group (p = 0.04). Surgical failure at 12 months was documented in 30.2% and 6.3% of patients, respectively (p = 0.003). There was a significant difference between groups in %IOP reduction after 12 months. Greater reduction was observed in Preserflo group, MD = − 8.41 CI95 [− 15.88; − 0.95], p = 0.028, (− 33.49% ± 21.59 vs − 25.07% ± 14.15 in iStent group). Both procedures effectively reduced IOP and postoperative use of antiglaucoma medications in glaucoma patients.

Canaloplasty and Trabeculotomy Combined With Phacoemulsification for Primary Angle-Closure Glaucoma: A Single-Surgeon Case Series.

To evaluate the outcomes of combined canaloplasty and trabeculotomy with phacoemulsification for primary angle-closure glaucoma (PACG). In this retrospective,consecutive, single-surgeon case series, we analyzed the pre- and postoperative measurements of PACG patients who had the procedure. Adverse events were recorded. The main outcomes were mean intraocular pressure (IOP) in each quartile of the follow-up yearand the number of IOP-lowering medications the patients were on by the end of each quartile compared to their baseline values. A total of 46 eyes from 39 PACG patients were included. The preoperative IOP and glaucoma medications taken were 19.33±6.03 mm Hg and 1.80±1.39, respectively (N=46). Postoperative IOP means (mm Hg) in the subsequent four quartiles were 14.00±3.33 (N=44), 13.44±2.83 (N=32), 14.38±2.39 (N=16), and 14.92±2.90 (N=13) (p<0.0001). The mean number of meds was 0.32±0.80, 0.22±0.42, 0.59±0.80, and 0.08±0.28 in each respective quartile (p<0.0001), while the median was 0 across all quartiles. Combining the OMNI surgical system with phacoemulsification led to substantial reductions in mean IOP and the number of IOP-lowering medications when compared to baseline measurements.

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 with 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 with 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 2 procedures outperforms phacoemulsification alone in terms of both parameters.

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 postinsertion. 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 postinsertion 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.

Micropulse Transscleral Cyclophotocoagulation in Non-Incisional Eyes with Ocular Hypertension and Primary Open-Angle Glaucoma.

To investigate the safety and effectiveness of micropulse transscleral cyclophotocoagulation (MPTSCPC) in non-incisional eyes with ocular hypertension (OHT) and early, moderate, and severe primary open-angle glaucoma (POAG). Retrospective cohort study of eyes that underwent MPTSCPC from 2016 to 2019 at an outpatient clinic in Canada. Eyes were excluded if any incisional procedures, except cataract surgery, were performed prior to MPTSCPC treatment. Laser power ranged from 900 to 2500mW. A total of 153 eyes from 93 patients were included (OHT n=22; early POAG n=46; moderate POAG n=35; severe POAG n=50). The baseline IOP was 18.37 ± 4.76mmHg in the total cohort. All cohorts experienced a significant mean IOP reduction by final follow-up (total p<0.001; OHT p=0.003; early POAG p<0.001; moderate POAG p=0.022; severe POAG p=0.015). Overall, 52.9% of eyes achieved an IOP reduction of ≥20% from baseline to final follow-up (OHT 59.1%; early POAG 58.7%; moderate POAG 45.7%; severe POAG 50.0%). There was worsening in best-corrected visual acuity in the total cohort (mean difference=0.11 ± 0.36 logMAR, p=0.11), mostly attributable to cataract progression (34.1% of phakic eyes) and ocular surface disease (7.2%). The number of topical medications and drug classes remained unchanged in the total cohort (p=0.425 and p=0.791, respectively). Twenty-two eyes (14.4%) required retreatment, which provided an additional IOP reduction of 1.26mmHg (p=0.344). By final follow-up, 8 eyes (5.2%) required escalation to incisional procedures. MPTSCPC is a safe and effective adjunct IOP-lowering treatment in non-incisional eyes with OHT and POAG.

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

PurposeTo analyse real-world outcomes in Asian eyes of iStent inject, a second-generation trabecular micro-bypass stent, combined with phacoemulsification.MethodsThis 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.Results123 eyes of 86 patients with a mean age of 68.4 ± 9.3 years underwent iStent inject implantation with phacoemulsification. At baseline, the mean ± SD preoperative intraocular pressure (IOP) was 16.0 ± 4.4 mmHg, and the mean preoperative number of topical glaucoma medications was 1.9 ± 1.4. At 12 months 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 12 months compared to 16.3% preoperatively. 8.2% of eyes required a subsequent procedure within the 12-month follow-up window.ConclusioniStent 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.

A Randomized, Controlled Comparison of NCX 470, a Nitric Oxide-Donating Bimatoprost, and Latanoprost in Subjects with Open-Angle Glaucoma or Ocular Hypertension: The MONT BLANC Study

PurposeTo compare intraocular pressure (IOP)-lowering efficacy and safety profile of NCX 470, a nitric oxide (NO)-donating bimatoprost, to latanoprost in subjects with glaucoma or ocular hypertension. DesignProspective, phase 3, randomized, adaptive dose-selection, double-masked, parallel-group trial. Methods: Participants691 subjects with open-angle glaucoma or ocular hypertension and unmedicated IOP of IOP ≥26 mmHg at 8AM, ≥24 mmHg at 10AM, and ≥22 mmHg at 4PM in the study eye. Study Procedures: Subjects were randomized to treatment with NCX 470 0.065%, NCX 470 0.1%, or latanoprost 0.005%. To identify the final NCX 470 dose, an interim analysis was performed after at least 30 subjects in each group had completed the Week 2 visit. Enrolled subjects were randomized to this final NCX 470 dose, 0.1%, or latanoprost for 12 weeks. Main outcome measure: We evaluated non-inferiority followed by superiority of NCX 470 versus latanoprost, based on IOP reduction from baseline at 8AM and 4PM at 2 weeks, 6 weeks, and 3 months. ResultsNCX 470 0.1% was the final dose and 661 subjects were analyzed that received NCX 470 0.1% (n=328) or latanoprost (n=333). At baseline, the mean (SD) IOP at 8AM and 4 PM was 28.3 (2.0) mmHg and 25.5 (2.5) mmHg, respectively, in the NCX 470 0.1% group, and was significantly reduced at all on-treatment time points, with reductions ranging from 8.0-9.7 mmHg (p<0.0001 at each time point). Likewise, mean (SD) baseline IOP at 8AM and 4PM was 28.2 (2.0) mmHg and 25.4 (2.4) mmHg, respectively, in the latanoprost group and was significantly reduced at all on-treatment time points, with reductions ranging from 7.1-9.4 mmHg (p<0.0001 at each time point). At the 3-month visit, mean IOP reductions were greater with NCX 470 0.1% than latanoprost 0.005% at all 6 time points and significantly greater (p<.05) at 4 of the 6 time points. Noninferiority versus latanoprost was established at all 6 timepoints. The most common adverse event was conjunctival/ocular hyperemia and was more common in the NCX 470 group compared to latanoprost; 8 NCX 470 and 6 latanoprost subjects discontinued due to adverse events. ConclusionThe NO-donating prostaglandin analogue NCX 470 0.1% was well-tolerated and lowered IOP more than latanoprost in subjects with open-angle glaucoma or ocular hypertension at all 6 time points. With a dual mechanism of action that enhances both uveoscleral and trabecular outflow, NCX 470 could become an important first-line therapy for IOP reduction in glaucoma.

Three-Year Outcomes of the Paul Glaucoma Implant for Treatment of Glaucoma.

In our case series, the 3-year failure for Paul Glaucoma Implant (PGI) implantation was 14.6%. At 3 years postoperatively, there was a significant reduction in mean intraocular pressure (IOP) and the number of glaucoma medications used. To determine the 3-year efficacy and safety of the PGI, a novel glaucoma tube shunt in patients with glaucoma. Retrospective review of all patients who had undergone PGI implantation in a single tertiary institution in Singapore between May 1, 2017 and January 1, 2022. Data were extracted from electronic health records (Computerized Patient Support System 2 and Epic). The primary outcome measure was failure, defined as IOP >18 mm Hg or <6 mm Hg on 2 consecutive visits after 3 months, reoperation for IOP-related indication, explantation of implant, or loss of light perception vision. Complete success was defined as the absence of failure without medications at 36 months, and qualified success similarly, but with medications. Postoperative mean IOP, mean number of IOP-lowering medications used, and visual acuity were also assessed. Forty-eight eyes in 48 patients were identified. Thirty-one patients (64.6%) had primary open angle and angle closure glaucoma, and 18 (37.5%) had previous existing tube implants or trabeculectomy. At 3 years postoperatively, 7 cases (14.6%) fulfilled the criteria for failure and 36 (75%) met the criteria for complete success. The mean IOP at 36 months was 14.9 ± 4.11 mm Hg, from the mean preoperative IOP of 20.6 ± 6.13 mm Hg ( P < 0.001). The mean number of IOP-lowering medications used was reduced from 3.13 ± 0.959 preoperatively to 0.167 ± 0.476 at 36 months ( P < 0.001). The most common postoperative complication was hypotony (n = 17, 35.4%), of which the majority were self-limiting, followed by hyphema (n = 5, 10.4%) and tube exposure (n = 4, 8.3%). The PGI demonstrated sustained IOP reduction and a reduction of medication burden at 3 years postoperatively.