Secondary Open-angle Glaucoma Research Articles

Beyond the Dusty Fog: Local Eye Drop Therapy and Potentially New Treatment Alternatives in Pseudoexfoliative Glaucoma.

Pseudoexfoliative glaucoma (PEG) is a type of secondary open-angle glaucoma characterized by the accumulation of whitish-gray material on the trabecular meshwork and lens, leading to an increase in intraocular pressure (IOP) and optic nerve damage. Local eye drop therapy is one of the first-line treatments for PEG, which include prostaglandin analogues, beta-blockers, and alpha-adrenergic agonists to lower IOP. New treatments beyond conventional techniques, however, are constantly being developed. One potential treatment proposed for PEG is based on magnetic phage display, which involves using magnetic nanoparticles conjugated to specific peptides or proteins selected using phage display techniques to remove aggregates in the anterior chamber of the eye or inflammatory cells and cytokines that contribute to PEG pathogenesis. Other potential treatments include microRNAs (miRNAs) that are involved in the regulation of gene expression at the post-transcription stages. Gene therapies, nanotechnology, immunotherapy and methods based on stem cells can also be potentially used to target and treat specific tissues and cells responsible for regulating IOP. In addition, photobiomodulation therapy (PBMT), a non-invasive procedure that utilizes low-level laser therapy to improve cellular function and promote tissue repair, can prove an interesting alternative in treating PEG. The aim of our mini-review is to provide a brief overview of these innovative methods that appear to offer potentially promising treatment options for PEG.

Socioeconomic Disparities in Glaucoma Severity at Initial Diagnosis: A Nationwide Electronic Health Record Cohort Analysis

PurposeTo assess disparities in initial disease severity among open-angle glaucoma (OAG) patients. DesignCross-sectional study. MethodsIn this analysis of Epic Cosmos, an aggregated electronic health record dataset encompassing >213 million patients, OAG patients examined in ophthalmology or optometry clinics between January 1, 2013 and June 1, 2023 were evaluated. OAG severity at presentation was classified as mild, moderate, or severe using International Classification of Disease-10 codes. Demographics, Social Vulnerability Index (SVI) scores, and Rural-Urban Commuting Area codes were evaluated as predictors of disease stage using ordinal logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. ResultsOf 245,669 patients, 38.1% had mild, 32.5% moderate, and 29.3% severe disease at presentation. In multivariable analyses, significant determinants of worse severity included older age (OR: 1.23 per decade, 95% CI: 1.22-1.23), male sex (OR: 1.37, 95% CI: 1.35-1.39), Black race (OR: 1.61, 95% CI: 1.58-1.65), Hispanic ethnicity (OR: 1.15, 95% CI: 1.11-1.18), non-commercial insurance or uninsured status (OR: 2.53, 95% CI: 2.33-2.74), secondary OAGs (e.g., pseudoexfoliative glaucoma – OR: 1.65, 95% CI: 1.58-1.72), and higher socioeconomic SVI scores (OR: 1.25 for highest versus lowest quartile, 95% CI: 1.22-1.28). Black and Hispanic patients were diagnosed at younger ages compared to White patients (mean ages: 67.8±12.3 and 68.1±12.8 vs. 73.3±11.8 years respectively, p<0.001). ConclusionsWorse OAG at presentation was associated with older age, male sex, Black race, Hispanic ethnicity, non-commercial insurance or uninsured status, secondary OAGs, and greater socioeconomic vulnerability in this nationwide cohort. These findings can help tailor screening programs towards vulnerable populations.

Steroid Induced Glaucoma and Primary Angle Closure Glaucoma: A Case Report of Mixed Mechanism Glaucoma

Introduction : Steroid induced glaucoma is a form of secondary open angle glaucoma (OAG) caused by adverse effects of steroid usage. Primary angle closure glaucoma (PACG) is characterized by shallow anterior chamber accompanied by peripheral anterior synechiae (PAS), elevated IOP and glaucomatous optic neuropathy (GON).&#x0D; Case Illustration : A 58 year-old woman presented with red eye, blurry vision, pain in her right eye radiating to the head, watery eye and halo. History of experiencing recurrent red eye, improving after taking steroid topical drug for about 3 months. Visual acuity 6/20 ph 6/20, IOP 39 mmHg, mixed conjunctival injection, shallow anterior chamber Van Herick 1-2, dilated pupil and iris pigment on anterior capsule of lens. Posterior segment showed glaucomatous optic neuropathy with cup disc ratio 0.8-0.9, anterior chamber depth 2.58, and thinning of optic nerve head layer. Patient was diagnosed with steroid induced glaucoma and mixed mechanism PACG. The patient underwent trabeculectomy procedure after mannitol injection was given to reduce IOP.&#x0D; Discussion : We diagnosed the patient with steroid induced glaucoma and mixed mechanism PACG based on history, clinical findings, and diagnostics. Steroid raised IOP by accumulating polymerized glycosaminoglycans (GAGs) in the trabecular meshwork, producing "biologic edema" thus increased outflow resistance. PACG was determined based on Van Herick and anterior chamber depth. Trabeculectomy remains an effective treatment in this case where medications were failed to control IOP.&#x0D; Conclusion : Steroid induced glaucoma commonly found in OAG, definitive treatment includes halting steroid drugs and trabeculectomy. Further follow-up is needed to evaluate angle closure mechanism.

Application of gonioscopy‐assisted transluminal trabeculotomy (GATT) in the management of refractory glaucoma in Poland

Goniotomy assisted transluminal trabeculotomy (GATT) is a kind of ab interno angle procedure. GATT spares conjunctiva and sclera, so it is a real mini invasive glaucoma surgery (MIGS). MIGS techniques are typically used in cases of early and moderate open angle glaucoma.The aim is to present the possibility of GATT application in the selected types of refractory glaucoma or secondary open angle glaucoma which are believed to be difficult in management.The results of GATT application in refractory glaucoma, inflammatory glaucoma and silicon oil glaucoma will be presented with the evaluation of IOP lowering potential in short term observation. Additionally, selected clinical cases will be showed.

The miRNA‐mRNA Interactome of human trabecular meshwork cells treated with TGF‐ beta1

Aims/Purpose: Pseudoexfoliation glaucoma (XFG) is an aggressive form of secondary open angle glaucoma, associated with activation of the TGF‐β pathway by TGF‐β1. MicroRNAs are small non‐coding genes that regulate mRNA expression. To investigate the role of TGFβ1 in glaucomatous changes in the trabecular meshwork (TM) and to determine how mRNA expression may be regulated by microRNAs in this condition, we performed a bioinformatics analysis to determine the microRNA‐mRNA interactome.Methods: Primary human trabecular meshwork cells were obtained from normal donors (n = 4) and treated with TGF‐β1 at 5 ng/mL for 24 h. RNA was extracted and miRNA‐Seq and mRNA‐Seq performed. Differential mRNA and miRNA expression was determined using a bioinformatics pipeline consisting of FastQC, STAR, FeatureCounts, edgeR (miRNA) and DESeq2 (mRNA). Putative interactions between differentially expressed mRNAs and miRNAs, in which the direction of expression of the regulated mRNA was required to be opposite to that of the regulating miRNA, were determined using interaction databases miRTarBase, TarBase, TargetScan and miRWalk. To classify mRNA species by biological function and pathway, gene enrichment was performed using Enrichr.Results: The resulting microRNA‐mRNA interactome consisted of 1202 interactions. Some highly connected microRNAs were hsa‐let‐7e‐5p, hsa‐miR‐20a‐5p, hsa‐miR‐122‐5p, and hsa‐miR‐29c‐3p. Most genes in all enriched biological functions and pathways were indicated to be regulated by microRNAs. The sub‐interactomes of several specific XFG‐related enrichment terms such as oxidative stress, unfolded protein response, signal molecules and ECM remodelling were determined.Conclusions: This work presents a genome‐wide microRNA‐mRNA regulatory network for human TM cells treated with TGF‐β1 and may serve to generate unbiased hypotheses about regulatory functions of miRNAs found to be differentially expressed in XFG.

Silicone Bubble Giving Double Trouble

Cataract formation following silicone oil (SO) implantation is a common entity following retinal intervention due to lens touch. Other causes of lens opacity are light toxicity, oxidation of lens protein, and use of intra-ocular gas in managing posterior segment pathology. We presented a case of secondary open-angle glaucoma in the right eye post SO infusion for retinal detachment, which eventually led to SO cataract after 10 months. The best corrected visual acuity was 1/60 in the right eye. Thereafter, with conservative management of high intra-ocular pressure, combined SO removal with phacoemulsification cataract surgery was done, which retrieved a visual acuity of 3/60 and an intra.ocular pressure of 12 mmHg with monotherapy.

Clinical spectrum and management of pseudoexfoliation syndrome: A cross-sectional study

Background: Pseudoexfoliation is one of the most common causes of secondary open-angle glaucoma worldwide. The current investigation is being carried out to investigate the clinical characteristics associated with pseudoexfoliation syndrome. Aims and Objectives: The current study was conducted with the goal of documenting the prevalence of the ocular clinical profile of patterns in patients with pseudo-exfoliative material attending a tertiarycare hospital’s general ophthalmology outpatient department. Materials and Methods: In the current study, 100 individuals were explored who were diagnosed with pseudoexfoliation and attended the outpatient department of ophthalmology, medical college, and hospital. The Snellen chart for visual acuity was used to test visual acuity. Pseudoexfoliation glaucomawas identified based on slit lamp examination of pseudoexfoliative material, intraocular pressure (IOP) &gt;21 mmHg, glaucomatous cupping on fundus examination, pigmentation of trabecular meshwork on gonioscopy, and glaucomatous field abnormalities on perimetry. Results: The age range of 61–70 years had the most cases of pseudoexfoliation, accounting for 23, followed by 51–60 years with 17 occurrences. The current study comprised 48 patients, 20 of whom had bilateral pseudoexfoliation and 28 of whom had unilateral pseudoexfoliation. Our findings revealed that 17 patients had high IOP. We discovered 15 cases of open-angle glaucoma and 2 cases of narrow-angle glaucoma after analyzing 48 patients. The sample of 15 individuals with open-angle glaucoma included 11 men and 4 women. Conclusion: Pseudoexfoliation becomes more common as people age, and it is often unilateral at first but progressively progresses to bilateral pseudoexfoliation, necessitating frequent follow-up in unilateral cases. Pseudoexfoliation is associated with an increased risk of glaucoma, and the majority of cases have open angles.

Radius-Maumenee Syndrome, A Rare Entity: A Case Report

Background: Radius–Maumenee syndrome (RMS) is a rare idiopathic condition characterized by the enlargement of episcleral vessels and an elevation in intraocular pressure (IOP) leading to secondary glaucoma. Case: In this report, we present a case of RMS in 23-year-old male who experienced redness in Right Eye (RE) and intermittent headaches for a duration of 10 years. The patient exhibited a best corrected visual acuity of 6/6 in both eyes. Observations: During slit lamp biomicroscopy, episcleral venous engorgement was observed in both eyes. Tonometry measured 28 mmHg in the RE and 14 mmHg in Left Eye (LE). In fundus photographs of RE and LE, there was evident cup asymmetry, along with retinal nerve fiber layer defects in superotemporal and inferotemporal regions of the right eye. Optical coherence tomography (OCT) Optic Nerve Head with hood report of RE showed loss of double hump pattern with asymmetric and severe retinal nerve fiber layer thinning in superior and inferior quadrant. Visual field testing of RE showed superior and inferior arcuate scotoma. Brain and orbit magnetic resonance angiography (MRI Angiogram) revealed no abnormal voids indicating cavernous fistula or other orbital lesions. The presence of secondary open angle glaucoma with episcleral venous engorgement and negative test results for other potential conditions led to the diagnosis of RMS in the patient. The patient is now under combination therapy with aqueous suppressants and uveoscleral outflow increasing drugs. Conclusion: This case serves as a reminder to ophthalmologists about potential association of glaucoma if there’s enlargement of episcleral vessels in eyes without inflammation.

Zespół Posnera-Schlossmana jako nawracające zapalenie błony naczyniowej o niesprecyzowanej etiologii

Uveitis is a significant civilizational issue contributing to a substantial decline in the quality of life. Its etiology is complex, ranging from autoimmune to infectious causes. The Posner-Schlossman Syndrome is characterized by recurring episodes of inflammation of the anterior segment of the uvea and elevated intraocular pressure. Although traditionally classified as secondary open-angle glaucoma, its etiopathogenesis has not been fully elucidated. Understanding it is essential to apply effective treatment and maintain proper vision.

Three-Year Efficacy and Safety Outcomes of the Second-Generation Trabecular Micro-Bypass Stents in Conjunction with Cataract Surgery in Ocular Hypertension and Open-Angle Glaucoma

Purpose: To evaluate the efficacy and safety of the iStent Inject in conjunction with phacoemulsification in patients with open-angle glaucoma. Design: Prospective, non-randomized, single-center, consecutive case series Participants: Patients with primary and secondary open angle glaucoma undergoing cataract surgery and iStent Inject Main outcomes: The primary outcome of efficacy is postoperative reduction in mean Intraocular Pressure (IOP) and number of anti-glaucomatous drop classes. A primary endpoint is the achievement of =20% IOP reduction from baseline. Secondary outcome measures include visual acuity, visual field parameters, cup-to-disk ratio, and average retinal nerve fiber layer thickness. Results: 150 eyes were included with a mean follow-up of 2.28 years (standard deviation 1.18). IOP significantly decreased at nearly all timepoints and remains significantly reduced from baseline at 36 months. IOP reduction is modest and ranges between 5.6 to 11.7 %, with IOP being stably maintained lower than baseline throughout the observation period. IOP reduction is greatest in the mild glaucoma group. The primary endpoint of an over 20% IOP reduction being achieved in overall 32% of eyes. The burden of glaucoma drops was significantly reduced by 13% at 12 months post-op (p&lt;0.005). There was no statistically significant change in visual field parameters, although they improved after cataract surgery. The rate of additional glaucoma interventions needed were very low at &lt;1%. Conclusion: The combined cataract surgery and iStent Inject procedure is safe and effective at long-term with a low rate of serious complications. It offers good visual outcomes and reasonable glaucoma control long-term.

Prevalence and Severity of Glaucoma in the California Medicare Population

PurposeTo examine the prevalence of glaucoma by type and severity in the 2019 California (CA) Medicare population, and to identify associated demographic and systemic factors. DesignRetrospective cross-sectional. MethodsThe study population included all 2019 CA Medicare beneficiaries ≥65 years old with Part A and Part B coverage. Outcomes included prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma (ACG). Covariates included age, sex, race and ethnicity, Charlson Comorbidity Index (CCI) score, pseudophakia, and age-related macular degeneration. Logistic regression modeling was used to examine multivariable predictors of each type of glaucoma. ResultsOf 5,856,491 beneficiaries in the 2019 California Medicare population, there were 220,662 (3.8%) with any glaucoma, 171,988 (2.9%) with POAG, 8,827 (0.2%) with SOAG, and 12,978 (0.2%) with ACG. The largest proportion of beneficiaries had moderate to severe glaucoma (68,553/220,662 [31.0%] for any glaucoma moderate stage, 3,168/12,978 [24.4%] for ACG severe stage). Multivariable predictors of any glaucoma included age ≥85 versus 65-69 years (adjusted odds ratio [aOR]=2.03, 95% confidence interval [CI]=2.00, 2.06), female versus male sex (aOR=1.03, 95% CI=1.02, 1.04), Black versus Non-Hispanic White race and ethnicity (aOR=1.70, 95% CI=1.67, 1.73), and CCI ≥5 versus 0 (aOR=5.59, 95%=5.51, 5.67). ConclusionsIn the 2019 CA Medicare population, multiple demographic and systemic factors were associated with increased likelihood of glaucoma, and beneficiaries with glaucoma had high prevalence of moderate to severe disease. Strategies are needed to improve early screening and diagnosis for elderly individuals at risk for glaucoma in California.

Resultados de una técnica quirúrgica de trabeculectomía ab-externo modificada en pacientes con glaucoma de ángulo abierto

ObjectiveAssess the safety and efficacy of a modified ab-external trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. Methods and analysisPatients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. ResultsForty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the follow-up time was 35.3 months (range of 1-147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. ConclusionsThis proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results.

Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma

ObjectiveAssess the safety and efficacy of a Modified Ab-externo Trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. Methods and analysisPatients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. ResultsForty-eight eyes of 38 patients were included. The mean age was 63.1 years (25–85 years), and the mean follow-up time was 35.3 months (range of 1147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. ConclusionsThis proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results.

Preliminary research of the clinical pathways of glaucomatous optic nerve damage in cases with glaucomatocyclitic crisis: A retrospective study.

To investigate the clinical pathways via which the glaucomatous optic nerve damage (GOND) occurred in cases with glaucomatocyclitic crisis (also called Posner-Schlossman syndrome, PSS). A retrospective study was conducted, 59 PSS patients with confirmed GOND were screened out from 190 PSS cases and followed up for a period of 5 ± 3.3 years. Clinical data were retrospectively analyzed systematically and dynamically, including intraocular pressure and its dynamic change, appearance of fundus, visual field and the state of anterior chamber angle in initial and later period during the episodes and intermission of PSS. Based on the clinical data, a classification and standard for the clinical pathways of GOND were established, and the clinical pathway of GOND in each patient was classified accordingly. There are at least 4 clinical pathways of GOND in PSS patients, namely: Type A: GOND was simply caused by the accumulation effect of high IOP during many attacks of PSS itself. Type B: GOND was resulted from the combined action of PSS itself and another type of secondary open-angle glaucoma. The recurrent inflammation during the episodes of PSS damaged the trabecular meshwork, which can cause elevation of IOP during the intermission of PSS. Type C: PSS combined with primary open angle glaucoma (POAG). Type D: PSS combined with primary angle-closure glaucoma (PACG). Base on the clinical gateways of GOND classification above, the cases of type A, B, C, and D were 27, 6, 19, and 7 respectively. The staging of visual field damage in cases with GOND from different clinical pathways showed a significant difference (Person chi-square χ2 test, χ2 = 7.211, P = .007). There are at least 4 clinical pathways of GOND in PSS patients, and each clinical pathway corresponds to different clinical features and different treatment principles. It is extremely important to correctly discriminate the pathways of GOND in PSS patients.

Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation.

The XEN stent safely and effectively controls intraocular pressure in select patients with history of corneal transplantation. Glaucoma is a common complication after corneal transplantation and can be difficult to manage in these patients. This study reports outcomes of XEN stent implantation in eyes with glaucoma in the setting of previous corneal transplantation. Noncomparative retrospective case series including eyes with a history of corneal transplantation and subsequent XEN stent implantation by a single glaucoma surgeon in Surrey, British Columbia, between 2017 and 2022. The analysis included patient demographics, pre and postoperative intraocular pressure (IOP), pre and postoperative glaucoma medications, peri and postoperative complications and interventions, and incidence of repeat corneal transplantation and additional glaucoma procedures to control IOP. Fourteen eyes with previous cornea transplantation underwent XEN stent implantation. Mean age was 70.1 years (range: 47-85y). Mean follow-up was 18.2 months (range: 1.5-52mo). The most common glaucoma diagnosis was secondary open angle glaucoma (50.0%). There was a significant reduction in IOP and the number of glaucoma agents at all postoperative time points ( P < 0.05). IOP decreased from 32.7 ± 10.0mm Hg at baseline to 12.5 ± 4.7mm Hg at the most recent follow-up. Glaucoma agents decreased from 4.0 ± 0.7 to 0.4 ± 1.0. Two eyes required additional glaucoma surgery to control IOP, with an average time to reoperation of 7 weeks. Two eyes underwent repeat corneal transplantation, with an average time to reoperation of 23.5 months. In selected patients with previous corneal transplants and refractory glaucoma, the XEN stent was safely implanted and effectively reduced IOP in the short term.

Pseudoexfoliation Syndrome-Clinical Characteristics of Most Common Cause of Secondary Glaucoma.

Pseudoexfoliation syndrome (XFS) is a condition in which excess material builds up not only in the structures of the anterior chamber but also throughout the body. The frequency of the syndrome varies significantly (0.3-18%) depending on the region and the method of examination. Environmental risk factors for XFS include a large number of sunny days, proximity to the equator, dietary factors such as higher consumption of coffee and tea, long-term alcohol consumption, exposure to UV, and outdoor work. The pathognomonic sign of XFS is the presence of white material on the lens capsule and other anterior chamber components. In addition, a characteristic Sampaolesi line can be observed during gonioscopy. Systemic alterations indicative of XFS have been observed in the extracellular matrix of the eyelid skin, the heart, lungs, liver, kidneys, gallbladder, meninges, and endothelium of the blood vessels. XFS is the most common cause of secondary open-angle glaucoma, which is called pseudoexfoliative glaucoma and is more severe than primary open-angle glaucoma. It is plausible that a combination of environmental factors and genetic alterations promotes the onset of pseudoexfoliation syndrome, which requires additional research.

Social Vulnerability, Prevalence of Glaucoma, and Incidence of Glaucoma Surgery in the California Medicare Population

To examine associations of Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) scores with prevalence of glaucoma and incidence of glaucoma surgery in 2019 California Medicare beneficiaries. Retrospective cross-sectional study. 2019 California Medicare beneficiaries ≥ 65 years old with part A and part B coverage. The exposure of interest was SVI score, which was assessed overall and by themes. Outcomes included prevalence of glaucoma in the study population and incidence of glaucoma surgery in beneficiaries with glaucoma. Logistic regression modeling was performed to assess associations between quartiles of each type of SVI score, prevalence of glaucoma, and incidence of glaucoma surgery, controlling for age, sex, race/ethnicity, Charlson Comorbidity Index score, pseudophakia, and age-related macular degeneration. Prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma in all beneficiaries. Incidence of any glaucoma surgery, trabeculectomy, tube shunt, minimally invasive glaucoma surgery (MIGS), and cyclophotocoagulation (CPC) in beneficiaries with glaucoma. Of 5 725 245 beneficiaries in the total study population, there were 215 814 (3.8%) with any glaucoma, and of those with glaucoma, 10 135/215 814 (4.7%) underwent glaucoma surgery. In adjusted analyses for overall SVI score, where higher levels of SVI refer to higher levels of social vulnerability, there were decreased odds of any glaucoma (adjusted odds ratio [aOR]=0.83; 95% confidence interval [CI]=0.82, 0.84 for Q4 vs. Q1), POAG (aOR=0.85; 95% CI=0.84, 0.87 for Q4 vs. Q1), and SOAG (aOR=0.59; 95% CI=0.55, 0.63 for Q4 vs. Q1) in higher (Q4) vs. lower (Q1) SVI quartile. There were increased odds of any glaucoma surgery (aOR=1.19; 95% CI=1.12, 1.26 for Q4 vs. Q1), MIGS (aOR=1.24; 95% CI=1.15, 1.33 for Q4 vs. Q1), and CPC (aOR=1.49; 95% CI=1.29, 1.76 for Q4 vs. Q1) for higher (Q4) vs. lower (Q1) SVI quartile. In the 2019 California Medicare population, there were variable associations between SVI score, prevalence of glaucoma, and incidence of glaucoma surgery. Further investigation is needed to understand the role of social, economic, and demographic factors in glaucoma care on the individual and structural levels. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Influence of Cilioretinal Arteries on Flow Density in Glaucoma Patients Measured Using Optical Coherence Tomography Angiography

It has long been speculated whether the presence of a cilioretinal artery (CRA) can influence the development of glaucomatous damage in patients with open-angle glaucoma. Studies involving healthy patients have shown a change in flow density (FD) depending on the presence of a CRA. Similarly, studies that compared the optical coherence tomography angiography (OCTA) results of healthy controls and glaucoma cohorts identified a reduction in FD in certain retinal layers for glaucoma patients. These observations raise the question of whether FD is altered in glaucoma patients depending on the presence of CRA, with possible implications for the progression of glaucomatous damage. In this prospective study, 201 eyes of 134 primary and secondary open-angle glaucoma patients who visited the Department of Ophthalmology at the University of Muenster Medical Center, Germany were included. The patients were allocated to different groups according to the presence of CRAs and the level of glaucoma severity. The FD results obtained using OCTA for the CRA and non-CRA groups were compared. While FD differed noticeably between the CRA and non-CRA cohorts in the deep macular plexus, no differences in FD were observed between the two groups when adjusted for glaucoma severity. In both the CRA and non-CRA eyes, increasing glaucoma severity correlated most strongly with a reduction in peripapillary FD. Our results suggest that the presence of CRAs does not significantly affect retinal perfusion in glaucoma patients.

Intraoperative primary partial occlusion of the PreserFlo MicroShunt to prevent initial postoperative hypotony

PurposeThe aim of the underlying study was to present a new surgical method in PreserFlo MicroShunt surgery for glaucoma. A removable polyamide suture was placed into the lumen of the MicroShunt during implantation to prevent early postoperative hypotony.MethodsThirty-one patients undergoing stand-alone glaucoma surgery with implantation of a PreserFlo MicroShunt and an intraluminal occlusion were retrospectively reviewed and compared to a control group without occlusion. Inclusion criteria were diagnosis of primary open-angle glaucoma or secondary open-angle glaucoma due to pseudoexfoliation or pigment dispersion. Patients with a history of filtrating glaucoma surgery were excluded.ResultsIOP decreased from 26.9 ± 6.6 to 18.0 ± 9.5 mmHg at the first postoperative day after PreserFlo MicroShunt implantation. Postoperative removal of the occluding suture resulted in a mean IOP reduction in 11.1 ± 7.6 mmHg. Mean visual acuity was 0.43 ± 0.24 logMAR during the first postoperative examination. The interval with the occluding intraluminal suture in place varied from days to 2–3 weeks. Patients were followed up to 1 year.ConclusionImplantation of a PreserFlo MicroShunt combined with an intraluminal suture prevented postoperative hypotony in all patients. Mean postoperative pressure was reduced despite the occluding suture in place.

Glaucoma de células fantasmas: Caso clínicio

Introduction: Ghost cell glaucoma (GCG) is a very rare secondary open angle glaucoma, in which there is a sustained increase in intraocular pressure (IOP) due to obstruction of the trabecular meshwork (TM) due to the passage of ghost cells (GC) from the vitreous into the anterior chamber, after a vitreous hemorrhage (VH). Clinical Case: We present the case of a male patient with a history of vitreous hemorrhage and sustained IOP elevation in the right eye (RE). Medical treatment was insufficient, for this reason surgical treatment was required. Postoperative evolution was favorable. Conclusion: This pathology should prefer the differential diagnosis of traumatic glaucomas, correlating high clinical suspicion and histological confirmation.