Significant Decrease In Intraocular Pressure 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.

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.

Gonioscopy-assisted Transluminal Trabeculotomy in Uveitis-related Ocular Hypertension and Glaucoma.

Gonioscopy-assisted Transluminal Trabeculotomy may be an effective first line surgery for decreasing intraocular pressure and medication burden in patients with uveitis-related ocular hypertension or glaucoma. The purpose of the study is to determine the efficacy of Gonioscopy-assisted transluminal trabeculotomy (GATT) to lower the intraocular pressure (IOP) in uveitis-related ocular hypertension (OHT) or glaucoma. Retrospective case series that included patients with uveitis-related OHT or glaucoma that underwent GATT with or without concomitant cataract extraction and intraocular lens implantation at two Canadian academic centres from July 2018 to May 2022. Primary outcomes were : complete (no medications) and qualified success (with medication), and failure defined as (1) IOP > 21mmHg with maximal medical therapy, (2) the need of additional glaucoma procedure, (3) loss of light perception secondary to glaucoma, (4) IOP < 6mmHg for 3 months. Twenty-one eyes from 18 patients were included with a mean preoperative IOP of 26.2±7.3mmHg on 4.3±0.7 classes of glaucoma drops. Average follow-up was 29.2±17.6 months and 76% of eyes (n=16) had reached at least 12 months of follow-up. At the 12 month follow-up visit, there was a significant decrease in average IOP by 9.9±7.9mmHg (38%, P=0.005) and a decrease of 1.9 in glaucoma medication classes (P=0.002). Fourteen percent of eyes achieved complete success while 80% of eyes achieved qualified success. Six eyes failed (29%) and five patients (24%) required an additional glaucoma surgery. The most common postoperative complication was hyphema (n=9; 43%). This small case series suggests that GATT may be an effective first line surgery for decreasing IOP and medication burden in patients with uveitis-related OHT or glaucoma. Further studies with longer follow-up should be conducted to assess its long-term outcomes.

Comparative efficacy and safety of different anti-VEGF agents combined with different delivery methods for neovascular glaucoma: a systematic review and Bayesian network meta-analysis

ObjectiveTo compare the efficacy and safety of different anti-vascular endothelial growth factor (VEGF) agents combined with different delivery methods for neovascular glaucoma (NVG).DesignSystematic review and Bayesian network meta-analysis (NMA).Data sourcesPubMed,...

The Effects of Lens Extraction Surgery on Intraocular Pressure and Anterior Segment Parameters in Primary Angle-Closure Glaucoma.

To investigate the effects of phacoemulsification with intraocular lens implantation (phaco+IOL) surgery on intraocular pressure (IOP) and anterior segment parameters in patients with cataract and primary angle-closure glaucoma (PACG). Fifty-five patients with PACG undergoing phaco+IOL surgery were evaluated in terms of best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), aqueous depth (AD), and lens thickness (LT) measured by optical biometry preoperatively and at the 6-month postoperative visit. They were compared with 34 healthy age-and gender-matched cataract patients who underwent phaco+IOL surgery. Preoperative evaluation revealed higher IOP, shorter axial length, shallower ACD and AD, and greater LT in the PACG group (p<0.001 for all). Postoperative evaluation in the PACG group showed an increase in BCVA, a significant decrease in IOP, an increase in ACD and AD, and a decrease in LT (p<0.001 for all). Additionally, a reduction in the average number of antiglaucomatous medications used postoperatively was observed in the PACG group (p<0.001). The changes in IOP, ACD, AD, and LT between preoperative and postoperative assessments were significantly greater in the PACG group compared to the control group (p<0.0001 for all). Phaco+IOL surgery in PACG patients leads to a significant increase in ACD compared to the control group and allows better control of IOP with fewer antiglaucomatous medications after surgery.

Influence of the calcium voltage-gated channel auxiliary subunit (CACNA2D1) absence on intraocular pressure in mice

The etiology of elevated intraocular pressure (IOP), a major risk factor for glaucoma (optic nerve atrophy), is poorly understood despite continued efforts. Although the gene variant of CACNA2D1 (encoding α2δ1), a calcium voltage-gated channel auxiliary subunit, has been reported to be associated with primary open-angle glaucoma, and the pharmacological mitigation of α2δ1 activity by pregabalin lowers IOP, the cellular basis for α2δ1 role in the modulation of IOP remains unclear. Our recent findings reveled readily detectable levels of α2δ1 and its ligand thrombospondin in the cytoskeletome fraction of human trabecular meshwork (TM) cells. To understand the direct role of α2δ1 in the modulation of IOP, we evaluated α2δ1 null mice for changes in IOP and found a moderate (∼10%) but significant decrease in IOP compared to littermate wild type control mice. Additionally, to gain cellular insights into α2δ1 antagonist (pregabalin) induced IOP changes, we assessed pregabalin's effects on human TM cell actin cytoskeletal organization and cell adhesive interactions in comparison with a Rho kinase inhibitor (Y27632), a known ocular hypotensive agent. Unlike Y27632, pregabalin did not have overt effects on cell morphology, actin cytoskeletal organization, or cell adhesion in human TM cells. These results reveal a modest but significant decrease in IOP in α2δ1 deficient mice, and this response appears to be not associated with the contractile and cell adhesive characteristics of TM cells based on the findings of pregabalin effects on isolated TM cells. Therefore, the mechanism by which pregabalin lowers IOP remains elusive.

SUCCESS RATE OF GLAUCOMA DRAINAGE DEVICE IMPLANTATION IN KARIADI GENERAL HOSPITAL SEMARANG 2020 – 2022

Introduction: Glaucoma is a leading cause of irreversible blindness, and implantation of drainage devices is an effective treatment option for patients with advanced glaucoma. The purpose of this study was to investigate the success rate of glaucoma drainage devices implantation in Kariadi Hospital. Methods: This was an observational analytic study with a retrospective design. All patients who received Virna implantation between January 2020 and December 2022 were included. Intraocular pressure (IOP) examination was performed at the baseline and at the first day, at the seventh day, at the first month, and at the third month after surgery. The success rate was divided into three groups: complete success if IOP was &lt;21mmHg without medication, qualified success if IOP was &lt;21mmHg with medication, and failure if IOP was &gt;21mmHg with medication. Results: This study included 42 patients (42 eyes) with an average age of 43.3 years. There were 16 male (38%) and 26 female (62%) patients in the group. From these patients, 11 (26.2%) had primary glaucoma and 31 (73.8%) had secondary glaucoma. There was a significant decrease in IOP from preoperative measurement (37.1±10.1mmHg) compared to IOP on the first day (13.0±6.0mmHg), on the seventh day (15.4±3.8mmHg), on the first month (18.2±4.4mmHg), and on the third month (23.4±8.9mmHg) after surgery (p&lt;0.05). At three-month follow-up, the complete success was 14.29%, the qualified success was 50%, and the failure was 35.71%. Conclusion: Glaucoma drainage device implantation was found to successfully reduce IOP in patients with advanced glaucoma. The qualified success rate was higher than complete success rate, suggesting that some patients may require medication to achieve target IOP levels.

Success of Endoscopic Laser Cyclophotocoagulation vs Repeat Transscleral Treatment after Prior Transscleral Cycloablation.

To compare the efficacy of endoscopic cyclophotocoagulation (ECP) vs repeat transscleral cyclophotocoagulation (TCP) in eyes with persistent glaucoma despite prior treatment with TCP. This was a retrospective chart review of glaucoma patients at the American University of Beirut Medical Center over 10 years who underwent ECP or repeat TCP. We reported qualified and complete success; success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, with (qualified) or without medications (complete) and without procedure-related complications. This study included 23 eyes of 21 patients with various forms of uncontrolled glaucoma who had failed TCP. A total of 13 eyes of 12 patients underwent ECP with a mean age of 39.9 ± 23.2 years, and 10 eyes of nine patients underwent repeat TCP with a mean age of 27.2 ± 22.6 years. A significant decrease in IOP was observed from 38.5 ± 7.9 mm Hg preoperatively to 25.2 ± 8.8 mm Hg postrepeat TCP (p = 0.006) and from 33.0 ± 9.5 to 12.8 ± 3.9 mm Hg post-ECP (p < 0.001), noted at a mean follow-up time of 39.2 ± 44.4 and 41.5 ± 37.4 months, respectively. The mean number of antiglaucoma medications decreased in the two groups (from 3.8 ± 1.0 preoperatively to 1.8 ± 0.9 postoperatively for ECP and from 3.5 ± 1.3 to 3.1 ± 0.9 postoperatively for TCP); however, the drop was only statistically significant post-ECP. Qualified success was significantly higher after ECP vs repeat TCP (91.7 vs 40%, respectively). Complete success was achieved only in 1/12 (8.3%) eyes in the ECP group. Endoscopic cyclophotocoagulation (ECP) performed in glaucomatous eyes previously treated with transscleral cycloablation provided more IOP control as compared to repeat TCP by directly treating viable tissue in previously skipped ciliary processes and in between processes. In glaucomatous eyes previously treated with transscleral cycloablation, ECP attained better IOP control than repeat transscleral cycloablation. Al-Haddad C, Barikian A, Moussawi ZE, et al. Success of Endoscopic Laser Cyclophotocoagulation vs Repeat Transscleral Treatment after Prior Transscleral Cycloablation. J Curr Glaucoma Pract 2023;17(4):191-196.

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction.

To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens-treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 (p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) (p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE. Birnbaum F, Wakil S, Vu DM, et al. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023;17(4):169-174.

Микроимпульсная циклофотокоагуляция в комбинированном лечении неоваскулярной глаукомы

Purpose. To evulate the efficiency of micropulse cyclophotocoagulation (MP-CPC) in the combined treatment of patients with secondary refractory neovascular glaucoma with object vision. Material and methods. The study involved 30 patients (30 eyes) with neovascular glaucoma (NVG) in the stage of partial or complete blockade of the iridocorneal angle with decompensated intraocular pressure (IOP) resistant to drug therapy, who had object vision. Two study groups were formed, 15 eyes each. The first main group is represented by patients whom performed MP-CPC (Cyclo G6 Glaucoma Laser System by IRIDEX), as a stage of combined treatment before implantation of Ahmed glaucoma valve (IAGV). The second control group included patients who initially were treated by this type of drainage surgery without preliminary micropulse laser exposure. The follow-up period was 18 months. Results. The implementation of MP-CPC in the main group led to a significant decrease in IOP on the 1st day after treatment from 27.5±6.1 to 23.6±4.6 mm Hg, with the maximum attainment of normal values on the 3rd day of observation, which averaged 20.3±4.4 mm Hg. (p&lt;0.05). By the end of the 1st month, an increase in mean IOP values to subcompensated values was recorded – 24.4±6.3 mm Hg. After valve drainage implantation, by the end of the 1st month of observation, IOP in the main group was 19 (16.5; 22.0) mm Hg, and in the control group it was 24.5 (20.5; 25.8) mm Hg. (p&lt;0.05). After 18 months of the postoperative period, the level of ophthalmotonus in the main group is 15.5 (15.0; 18.2), and in the control group – 16.5 (15.0; 19.5) mm Hg. (p&gt;0.05). A significant decrease in the amounts of hypotensive drugs in the main group was revealed: 1 (0; 2) versus 2 (1; 3) in the control group (p=0.03). In both groups, there was no significant deterioration in visual functions during the entire observation period. Conclusions. MP-CPC can be considered as a preliminary stage in the combined treatment of neovascular refractory glaucoma, as it reduces the risk of preoperative ophthalmohypertension before valve surgery, leads to a significant decrease in the amounts of hypotensive drugs in the late postoperative period, thereby improving the effectiveness treatment of patients with neovascular refractory glaucoma who have object vision. Key words: micropulse cyclophotocoagulation, neovascular glaucoma, valve's Ahmed

Experience in the management of patients with cataract-associated glaucoma

The results of 269 cases of performing of cataract phacoemulsification with IOL implantation (PHACO) and microinvasive nonpenetrating deep sclerectomy (MNPDS) at various stages have been analyzed. The main group included patients who underwent PHACO, followed by MNPDS 64 persons, 65 eyes. The group was divided into a subgroup based on the date of the second intervention. 1 subgroup patients who underwent MNPDS 1 month after PHACO (30 cases); 2 subgroup 3 months after PHACO (35 cases). The control group included patients who underwent MNPDS followed by PHACO 196 persons, 204 eyes. Patients of the main group showed a significant decrease in intraocular pressure after each stage of treatment. in the control group, intraocular pressure decreased after the first stage of treatment, but increased 6 months after surgery. In primary open-angle glaucoma associated with cataract, the most persistent hypotensive effect is observed when the first stage of cataract phacoemulsification is performed, and the second stage is antiglaucoma surgical intervention.

Comparison of Efficacy of Micropulse and Continuous Wave Cyclophotocoagulation in Patients With Pediatric Glaucoma.

Both micropulse (MP-CPC) and continuous wave (CW-CPC) cyclophotocoagulation exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. To determine and compare the effectiveness and safety of MP-CPC and CW-CPC in patients diagnosed with pediatric glaucoma. A retrospective cohort study was conducted on a total of 28 patients (81 eyes) diagnosed with pediatric glaucoma either undergoing MP-CPC or CW-CPC. Intraocular pressure (IOP) measurements, number of glaucoma medications, and the onset of complications were collected at baseline, 1-month, 3-month, 6-month, and 12-month intervals. Success rate (SR) was defined as eyes achieving IOP ≤21mm Hg and ≥5mm Hg and a 20% reduction in IOP at the last follow-up visit. All patients either undergoing MP-CPC or CW-CPC were matched for age (mean ± SD; 1.76 ± 1.69 vs 1.56 ± 2.49 y). Patients undergoing MP-CPC had significant decreases in IOP from baseline IOP at 1, 3, and 6 months with a 22% SR at 12 months. CW-CPC had a significant decrease in IOP from baseline IOP at all follow-ups, with a 27% SR at 12 months. At the 12-month follow-up, the CW-CPC cohort exhibited a significantly larger overall drop in IOP when compared with the MP-CPC cohort, (7.99 ± 7.95 vs 1.78 ± 6.89, P < 0.05); however, the difference in SR between treatment groups (27% vs 22%) at 12 months was not significant ( P > 0.05). Complications were minimal for both groups. Both MP-CPC and CW-CPC exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. Both MP-CPC and CW-CPC exhibited similar SR at 12 months, 22% and 27% respectively.

Efficacy of Continuous-Wave Transscleral Cyclophotocoagulation Post-Pars Plana Vitrectomy in Glaucoma Patients: A Retrospective Study from Poland.

BACKGROUND Glaucoma, a vision-threatening condition, results from optic nerve damage and affects millions of people worldwide. Often asymptomatic, it is hereditary, with risk factors like hypertension, diabetes, and steroid use. Despite its link with intraocular pressure (IOP), not everyone with high IOP develops glaucoma. After pars plana vitrectomy (PPV), patients face increased IOP risks. Traditional treatment includes pharmacotherapy, and, when ineffective, surgical interventions. Continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) is an alternative for refractory glaucoma but can have complications. Our study compares the efficacy and safety of CW-TSCPC after PPV. MATERIAL AND METHODS The study group consisted of 18 patients diagnosed with glaucoma who underwent the CW-TSCP procedure as the first-choice therapy after conservative treatment of glaucoma proved ineffective. The comparison group consisted of 12 patients who underwent the CW-TSCP procedure after conservative drug treatment and in whom surgical treatment of glaucoma had been unsuccessful. All patients had inadequate control of IOP after PPV. RESULTS Study and comparison group patients showed a decrease in IOP during the follow-up, independent of the type of endotamponade used (P<0.05). When the indication for PPV was retinal detachment hemorrhage into the vitreous chamber, a significant decrease in IOP between 0 days and 180 days was only found in the study group (P<0.05). In contrast, when the indication for PPV was the state after uveitis or proliferative diabetic retinopathy, a significant decrease in IOP was found at 180 days in the study and comparison groups (P<0.05). CONCLUSIONS The analysis showed that the CW-TSCPC procedure can be recommended as the first-choice invasive treatment in patients with increased IOP after PPV.

Long-term outcomes of Baerveldt glaucoma implant surgery in Japanese patients

This study evaluated the long-term surgical outcomes of Baerveldt glaucoma implant (BGI) surgery in patients with refractory glaucoma (204 eyes/204 patients). Surgical failure was defined by: < 20% reduction in preoperative intraocular pressure (IOP), or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). Reoperation, loss of light perception vision, or hypotony also denoted failure. The probability of success at 5 years postoperatively using criteria A, B, and C was 72.4%, 49.7%, and 24.4%, respectively. The mean IOP decreased significantly from 32.7 ± 9.7 mmHg preoperatively to 13.1 ± 3.9 mmHg at 5 years; the mean number of glaucoma medications also decreased from 3.7 ± 1.2 to 1.8 ± 1.9 (both P < 0.01). The number of previous intraocular surgeries was significantly associated with failure in the multivariable analysis for criterion B (hazard ratio 1.30; P < 0.01) and criterion C (hazard ratio 1.19; P = 0.031). Early and late postoperative complications occurred in 82 (40.2%) and 28 (13.7%) eyes, respectively. Postoperative interventions were performed in 44 eyes (21.6%). BGI surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. BGI surgery is effective for refractory glaucoma. However, postoperative interventions due to complications are required in numerous cases.

24-Hour efficacy of single primary selective laser trabeculoplasty versus latanoprost eye drops for Naïve primary open-angle glaucoma and ocular hypertension patients

This prospective, observer-masked, randomized clinical trial was conducted between December 2018 and June 2021 at Eye Hospital, China Academy of Chinese Medical Sciences. A total of 45 glaucoma patients from Beijing, China, were enrolled in this clinical trial to compare the short-term efficacy of primary single-selective laser trabeculoplasty (SLT) to 0.005% latanoprost eye drops for the treatment of 24-h intraocular pressure (IOP) in patients with newly diagnosed primary open angle glaucoma (POAG) and ocular hypertension (OHT). Both SLT and latanoprost significantly decreased mean 24-h IOP and peak IOP, although the latanoprost group effect was more potent when compared to the SLT group (both Ps < 0.05). Compared with the SLT group, the latanoprost group had a significant and stable decrease in IOP after treatment. The latanoprost group had a more pronounced reduction in IOP at weeks 4 and 12 (P < 0.05) but had no difference at week 1 (P = 0.097). As a first-line treatment, both SLT and latanoprost eye drops are effective in newly diagnosed POAG and OHT patients. However, the latanoprost eye drops may be better in decreasing mean and peak 24-h IOP and thus controlling 24-h IOP fluctuation compared to SLT.

Effectiveness of netarsudil 0.02% in lowering intraocular pressure in patients with secondary glaucoma

ObjectiveTo determine the effectiveness of netarsudil, 0.02% in lowering intraocular pressure (IOP) in patients with secondary forms of glaucoma. MethodsA total of 77 patients (98 eyes) with either primary open-angle glaucoma (POAG) or secondary glaucoma were reviewed retrospectively over the course of 1 year after starting netarsudil. The secondary glaucoma group was comprised of patients with uveitic, pseudoexfoliative, neovascular, congenital, and other forms of secondary glaucoma. Patient IOP measurements were collected at baseline and at 1-, 3-, 6-, and 12-month intervals. Two sample t tests and 1-way analysis of variance were used to determine differences in IOP reductions following netarsudil treatment. ResultsPatients with POAG or secondary glaucomas were matched for age (mean ± SD: 69.1 ± 16.0 years vs. 64.5 ± 21.2 years; p = 0.30). Both the POAG and secondary glaucoma patients exhibited significant decreases in IOP at each time point (1, 3, 6, and 12 months) when compared with baseline (p < 0.05). Both groups showed similar overall decreases in IOP from baseline after 1 year of treatment (6.0 ± 4.5 mm Hg vs. 6.6 ± 8.4 mm Hg; p = 0.70). Forty-sex percent of POAG patients achieved an IOP of <14 mm Hg compared with 17% of secondary glaucoma patients. Among the secondary glaucoma subtypes, netarsudil was found to be most effective for treating uveitic glaucoma, showing a decrease in IOP of 9.5 mm Hg after 12 months (p = 0.02). ConclusionNetarsudil is effective in lowering IOP in patients with certain forms of secondary glaucoma and should be considered for IOP management in those with uveitic glaucoma.

Indications, Complications, and Early Postoperative Course of Recovery of Intraocular Lens Exchange Surgery: a Single-Center Retrospective Study

To analyze the indications, complications, and early course of recovery of intraocular lens (IOL) exchange surgery. Records of patients who underwent IOL exchange during a 6-year period at a tertiary referral center were reviewed and the indications and complications after surgical intervention were analyzed. Their effects on postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), use of IOP-lowering medications, and refractive cylindrical power were assessed. One hundred and seventy-one eyes (165 patients) were investigated. The most frequent indication for IOL exchange was lens dislocation in 163 eyes (95.32%). The main causes of IOL dislocation were pseudoexfoliation syndrome (PEX) in 98 eyes (57.31%) and complications during cataract surgery in 40 eyes (23.39%). During IOL exchange, an anterior iris-claw fixation was performed in 159 eyes (92.98%). After significant initial deterioration to 1.59 ± 1.08 logMAR on postoperative day 1 (p ≤ 0.001), the CDVA recovered to preoperative levels within 28 days. A significant decrease in IOP was observed on postoperative day 1 (p = 0.04). The most common postoperative complications were corneal edema in 114 eyes (66.67%) and vitreous hemorrhage in 67 eyes (39.18%). The high early postoperative prevalence of corneal edema and intraocular hemorrhage was found to affect visual recovery after IOL exchange, causing a significant initial deterioration of CDVA and a delay of full visual recovery. These findings suggest that surgical approaches minimizing the risk of this type of complications should be favored.

Hypotensive therapy effectiveness evaluation in primary open-angle glaucoma evidenced by pattern electroretinogram data

Purpose. To evaluate the change in the functional activity of retinal ganglion cells (RGCs) in response to intraocular pressure (IOP) drop in patients with newly diagnosed early stage primary open-angle glaucoma (POAG) using a pattern electroretinogram (PERG). Material and methods. A prospective non-randomized cohort study included 12 patients (24 eyes) including 5 men, 7 women, aged 63.42 ± 2.96 years with newly diagnosed early stage POAG in at least one eye, who underwent PERG (Diopsys Nova, Diopsys, Inc.) in addition to an ophthalmologic examination. After being diagnosed with POAG, all patients were prescribed prostaglandin analogues as monotherapy. One and four months into the treatment, repeated examinations took place. Results. At these time points, a significant decrease in IOP was noted, accompanied by an increase in PERG parameters , which indicates an improvement in the functional activity of RGCs, yet no linear relationship between the IOP decrease and the improvement in PERG parameters could be found. Conclusion. Early stage naïve-treatment POAG patients with minimally impaired visual fields as determined by threshold computer perimetry may have their RGCs functional activity partially restored and IOP lessened thanks to continuous IOP-lowering therapy with prostaglandin analogues. PERG can be used as a method for evaluating the effectiveness of glaucoma hypotensive therapy in terms of maintaining and improving the functional activity of RGCs.

Phacoemulsification versus Phacoemulsification/Trabeculectomy for the Treatment of Primary Open-Angle Glaucoma Coexistent with Cataract: A Comparative Study.

Background: The purpose of this study was to evaluate the clinical outcomes in patients with primary open-angle glaucoma (POAG) and coexistent cataract treated with phacoemulsification cataract surgery, either alone or in combination with trabeculectomy. Methods: Participants in this retrospective study were 52 patients diagnosed with previously controlled POAG and coexistent cataract, who underwent either uneventful phacoemulsification cataract surgery (Group I, n = 27) or combined uneventful phacoemulsification cataract surgery and trabeculectomy (Group II, n = 25), with at least a 24-month postoperative follow-up. We recorded the changes in intraocular pressure (IOP) and in the need of anti-glaucoma medications before and after surgical procedures. Results: There was a statistically significant decrease in IOP at postoperative day 7 in both groups (p < 0.001), which remained until the end of the 24-month follow-up. At month 24, the two groups did not differ significantly in terms of IOP (14.3 ± 1.4 vs. 13.1 ± 1.2 for Group I and Group II, respectively; p = 0.447). In addition, there was a statistically significant decrease in the number of anti-glaucoma medications needed at postoperative day 7 in both groups (p < 0.001 for both groups compared to baseline). At month 24, patients in both groups needed about one additional anti-glaucoma medication to control their IOP. Of note, during the first month after surgery, 20% of patients in Group II needed 0.1 mL 5-FU injections to the bleb, although antimetabolites were not used in the primary surgery. Conclusions: Both surgical interventions, namely phacoemulsification cataract surgery alone and phacoemulsification/trabeculectomy, were found to be effective in the management of POAG with coexistent cataract, presenting a significant decrease in IOP and in the need of anti-glaucoma medications postoperatively at a long-term follow-up period of 24 months.

Эффективность синустрабекулэктомии в современной клинической практике

Aim: to assess the hypotensive effect of sinustrabeculectomy (STE) carried out within the "cascade" treatment algorithm for glaucoma. Patients and Methods: this open prospective interventional single-center cohort study was performed in 443 consequently included patients who underwent surgery for primary open-angle non-compensated glaucoma (POAG) and then were under follow-up for 6–24 months. The STE outcomes were evaluated using commonly accepted criteria of "complete success" and "qualified success", as well as "qualified failure" and "complete failure". The analysis of postoperative intraocular pressure (IOP) changes over time was performed using statistical methods. Results: the "complete success" of surgical operation achieved in 305 (68.9%) cases was associated with a significant and long-lasting decrease (at least for two years) in IOP values. The "qualified success", assuming that the renewal of medication therapy was an essential condition for maintaining a steady IOP was reported in 118 (26.6%) cases. Thus, the surgical treatment in combination with the postoperative hypotensive therapy helped to normalize IOP for at least two years in 423 (95.5%) patients of the study group. The "complete" STE failure due to the loss of filtration and the onset of indications for repeat surgery was reported in 20 (4.5%) cases. The triple combination treatment of glaucoma does not preclude from initiating further surgical IOP normalization and can be used safely prior to planned STE. A statistically significant IOP decrease from the baseline was achieved in all patients (even in the "complete failure" cases) at all 3 endpoints of the study (at 6, 12 and 24 months). The most pronounced and stable decrease in IOP during a two-year follow-up was associated with the "complete success" STE. Conclusion: a statistically significant IOP decrease from the baseline was achieved in all patients even after the "complete failure" of the surgical treatment at all endpoints of the study. The most pronounced and stable decrease in IOP during a two-year follow-up was associated with the "complete success" STE. The preoperative IOP level did not correlate with the results of STE and cannot be considered as a factor predicting its success or failure. Keywords: glaucoma, sinustrabeculectomy , intraocular pressure, glaucoma surgery, cascade algorithm, complete success, qualified success, complete failure. For citation: Antonova A.V., Nikolaenko V.P., Brzhesky V.V., Vuks A.Ya. The efficacy of sinustrabeculectomy in the modern clinical practice. Russian Journal of Clinical Ophthalmology. 2023;23(1):21–26 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-21-26.