Significant Reduction In Intraocular Pressure Research Articles

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

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

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

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

Efficacy and safety of first-line or second-line selective laser trabeculoplasty for normal-tension glaucoma: a multicentre cohort study

Background/aimsThis study aimed to investigate and compare the efficacy and safety of first-line and second-line selective laser trabeculoplasty (SLT) in Japanese patients with normal-tension glaucoma (NTG).Methods100 patients with NTG were...

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

In our case series, the three-year failure for PGI implantation was 14.6%. At three years post-operatively, there was a significant reduction in mean intraocular pressure and number of glaucoma medications used. To determine 3-year efficacy and safety of the PAUL Glaucoma Implant (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 Jan 1, 2022. Data was extracted from electronic health records (Computerized Patient Support System 2 and Epic). Primary outcome measure was failure, defined as IOP ≥18mmHg or ≤6mmHg 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. Post-operative 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 post-operatively, 7 cases (14.6%) fulfilled criteria for failure and 36 (75%) met criteria for complete success. Mean IOP at 36 months was 14.9±4.11mmHg, from mean pre-operative IOP of 20.6±6.13mmHg (P<0.001). Mean number of IOP-lowering medications used was reduced from 3.13±0.959 pre-operatively to 0.167±0.476 at 36 months (P<0.001). The most common post-operative complication was hypotony (n=17, 35.4%), of which 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 post-operatively.

Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade.

To report clinical outcomes of successful excisional goniotomy with the Kahook Dual Blade (KDB), through 60 months. This was a noncomparative, single-surgeon, retrospective review of eyes receiving successful KDB goniotomy with or without concomitant phacoemulsification between October 2015 and January 2016 with five years of uninterrupted follow-up. Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), and complications were recorded. Primary outcomes included changes from baseline in IOP, medication use, and BCVA, through five years. Fifty-two eyes of 28 patients were analyzed. Most eyes had mild primary open angle glaucoma (73%). Of the eyes analyzed, 41 underwent combined surgery and 11 underwent standalone surgery. With all eyes combined, mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0 to 13.7 mmHg, representing mean reductions of 7.3-8.0 mmHg (34.7-38.3%; p <0.0001 at every time point). Similarly, mean medication use ranged from 0.4 to 0.6 medications per eye, representing mean reductions of 1.2-1.4 medications (66-75.5%; p <0.0001 at every time point). Mean logMAR BCVA improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p < 0.0001). In eyes not requiring secondary surgical procedures (eg, long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through five years of follow-up. KDB goniotomy appears to be highly successful in Caucasian patients with open angle glaucoma on ≥1 IOP-lowering medications at baseline and with no history of prior ocular surgery. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.

Retinal Ganglion Cell Function and Perfusion following Intraocular Pressure Reduction with Preservative-Free Latanoprost in Patients with Glaucoma and Ocular Hypertension.

(1) Background: Given the global prevalence of glaucoma and the crucial role of intraocular pressure (IOP) reduction in the management of the disease, understanding the immediate effects on retinal structure and function is essential. (2) Methods: This study aimed to assess the effects of preservative-free latanoprost on morphological and functional parameters in treatment-naïve patients with ocular hypertension and open-angle glaucoma. (3) Results: This study showed a significant reduction in IOP by an average of 30.6% after treatment with preservative-free latanoprost. Despite the significant reduction in IOP, no statistically significant changes were observed in the electroretinogram (ERG) nor the optical coherence tomography/angiography (OCT/OCTA) parameters compared to baseline. An exploration of the correlation between IOP changes and various parameters revealed a significant association solely with the macular IPL/INL plexus vessel density (VD) measured with OCTA. (4) Conclusions: This finding suggests a possible association between IOP reduction and changes in the macular microcirculation and provides valuable insights into the differential effects of latanoprost. Acknowledging the study limitations, this study emphasizes the need for larger, longer-term investigations to comprehensively assess the sustained effects of preservative-free latanoprost on both IOP and retinal parameters. In addition, exploring systemic factors and conducting subgroup analyses could improve personalized approaches to glaucoma treatment.

QbD-driven thymoquinone laden nanoemulsion for glaucoma management: In vitro, ex vivo, and pre-clinical evaluation

The primary goal of the present research investigation is the development and evaluation of thymoquinone-loaded nanoemulsion (TMQ-NE) for glaucoma therapy. The Box-Behnken Design approach was used for optimization of the TMQ-NE formulation. The TMQ-NE was prepared with the low-energy method, and was evaluated for its physicochemical properties revealed 29.10 ± 0.87 nm droplet size with 0.096 ± 0.03 of polydispersity index. The TMQ-NE exhibited the 6.2 ± 0.2 pH and 302 ± 1.5mOsm/kg osmolarity. Release studies demonstrated that TMQ-NE released 84.87 ± 0.18% of thymoquinone, while ex vivo corneal permeability study showed around 90% of permeation. The safety and efficacy assessments were conducted using ex vivo HET-CAM assay and in vivo Draize test, where the formulation was found safe for ocular administration. The optimized TMQ-NE exhibited a significant reduction in intraocular pressure (IOP) by 39.59 ± 0.88% within 1.5 h post-administration in animal model. Conclusively, the findings promote thymoquinone as an optimistic treatment option for glaucoma, underscoring the potential of TMQ-NE as an effective ocular drug delivery system.

Efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy.

To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy (MAT). Totally 10 eyes of 10 patients with primary open angle glaucoma (POAG) who underwent MAT facilitated by Usights UC100 (5 eyes) or iTrack (5 eyes) were reviewed. The success of this surgery was defined as intraocular pressure (IOP) <22 mm Hg with >30% reduction, without oral glaucoma medications, or additional glaucoma surgery. The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group. MAT was achieved in all eyes in both groups. The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes, respectively. Both microcatheters produced a statistically significant reduction in IOP, and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo follow-up (12.58±1.52 and 14.84±1.89 mm Hg, respectively), but no statistical significance was there. No severe side effects were observed in either group. MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG, and Usights UC100 is as safe as iTrack.

Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty.

To compare the surgical outcomes of glaucoma drainage device implantation (GDI) and trans-scleral neodymium:YAG cyclophotocoagulation (CPC) in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty (DSAEK). This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery (15 with GDI and 14 with CPC). The main outcome measures were intraocular pressure (IOP), glaucoma surgery success rate (defined as IOP of 6-21 mm Hg without additional anti-glaucoma operation), number of glaucoma medications, endothelial graft status, and best-corrected visual acuity (BCVA). The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries, both for the GDI and CPC groups. Both groups showed significant IOP reduction after glaucoma surgery. The GDI group presented a significantly higher success rate in IOP control than the CPC group (60% vs 21.4%, P=0.03). Both procedures significantly decreased the number of glaucoma medications (P=0.03). Forty percent and 57% of cases in the GDI and the CPC group, respectively, experienced endothelial graft failure during follow-up (P=0.36). Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group. Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK. GDI is preferable to CPC in refractory glaucoma cases after DSAEK, as it manifests a significantly higher success rate for IOP control, similar endothelial graft failure rate, and relatively preserves BCVA than CPC.

Co-delivery of Brinzolamide and Timolol from Micelles-laden Contact Lenses: In vitro and In Vivo Evaluation.

Traditional eye drops exhibit a modest bioavailability ranging from 1 to 5%, necessitating recurrent application. Thus, a contact lens-based drug delivery system presents substantial benefits. Nonetheless, pharmaceutical agents exhibiting poor solubility may compromise the quintessential characteristics of contact lenses and are, consequently, deemed unsuitable for incorporation. To address this issue, the present study has engineered a novel composite drug delivery system that amalgamates micellar technology with contact lenses, designed specifically for the efficacious conveyance of timolol and brinzolamide. Utilizing mPEG-PCL as the micellar material, this study crafted mPEG-PCL micelles loaded with brinzolamide and timolol through the film hydration technique. The micelle-loaded contact lens was fabricated employing the casting method; a uniform mixture of HEMA and EGDMA with the mPEG-PCL micelles enshrouding brinzolamide and timolol was synthesized. Following the addition of a photoinitiator, 50 μL of the concoction was deposited into a contact lens mold. Subsequently, the assembly was subjected to polymerization under 365 nm ultraviolet light for 35 min, resulting in the formation of the micelle-loaded contact lenses. In the present article, we delineate the construction of a micelle-loaded contact lens designed for the administration of brinzolamide and timolol in the treatment of glaucoma. The study characterizes crucial properties of the micelle-loaded contact lenses, such as transmittance and ionic permeability. It was observed that these vital attributes meet the standard requirements for contact lenses. In vitro release studies revealed that timolol and brinzolamide could be gradually liberated over periods of up to 72 and 84 h, respectively. In vivo pharmacodynamic evaluation showed a significant reduction in intraocular pressure and a relative bioavailability of 10.84 times that of commercially available eye drops. In vivo pharmacokinetic evaluation, MRT was significantly increased, and the bioavailability of timolol and brinzolamide was 2.71 and 1.41 times that of eye drops, respectively. Safety assessments, including in vivo irritation, histopathological sections, and protein adsorption studies, were conducted as per established protocols, confirming that the experiments were in compliance with safety standards. The manuscript delineates the development of a safe and efficacious micelle-loaded contact lens drug delivery system, which presents a novel therapeutic alternative for the management of glaucoma.

7-Year Efficacy and Safety of iStent inject Trabecular Micro-Bypass in Combined and Standalone Usage.

This study evaluated 7-year effectiveness and safety of second-generation trabecular micro-bypass implantation (iStent inject) either in combination with cataract surgery or as a standalone procedure (Combined or Standalone subgroups, respectively) in eyes with open-angle glaucoma. This prospective, non-randomized, unmasked, longitudinal study included 125 consecutive iStent inject cases of a single surgeon at a large German academic hospital. Patients had considerable preoperative disease burden, with mean intraocular pressure (IOP) of 23.5mmHg, 84.8% of eyes on ≥ 2 medications, and 38.4% of eyes with prior glaucoma surgery. IOP, medications, adverse events, and secondary surgeries were assessed through 7years in the Overall cohort and in Combined (n = 81) and Standalone (n = 44) subgroups. Over 7-year follow-up, mean IOP decreased by 36.2-40.0% in Overall eyes, 34.1-38.9% in Combined eyes, and 39.5-43.5% in Standalone eyes (p < 0.001 at all timepoints for all groups). Meanwhile, mean medications decreased by 59.3-71.3% in Overall eyes, 57.9-69.0% in Combined eyes, and 62.1-76.2% in Standalone eyes (p < 0.001 at all timepoints in all groups). At last follow-up (mean 77.4months; 92.8% of patients with last visit at 6 or 7years), 83.7% of Overall eyes, 82.3% of Combined eyes, and 86.4% of Standalone eyes had achieved ≥ 20% IOP reduction vs preoperative. At last follow-up vs preoperative, 100% of eyes in all groups had the same or lower IOP and 100% had the same or lower medication regimen. Safety outcomes were favorable, with no filtration surgeries and only 4.84% of eyes experiencing clinically significant visual field loss over 7years of follow-up. iStent inject implantation with or without phacoemulsification produced significant and durable 7-year reductions in IOP (~ 34-44% reduction) and medications (~ 58-76% reduction) while preventing filtering surgery in this cohort of patients with relatively high preoperative disease burden. Combined and Standalone cases had similarly favorable effectiveness and safety.

Ab-Interno Bleb Needling in A Failed Trabeculectomy: A Case Report

Introduction : Trabeculectomy remains a gold standard of glaucoma surgical management despite a steady rate of bleb failure due to conjunctival scarring. In this case, we report a case of a failed trabeculectomy managed with ab-interno bleb needling followed by antimetabolite injection of mitomycin C.&#x0D; Case Illustration : A 18-year-old male patient with a history of blurry vision in his right eye and vision loss in his left eye. The patient had previously undergone cataract surgery due to juvenile cataracts and developed persistent high intraocular pressure (IOP) in both of his eyes. A trabeculectomy was performed on his right eye six months prior to the examination; however, the IOP remained at 22 mmHg. Ocular examination revealed a shallow anterior chamber and flat conjunctival bleb. An ab-interno bleb needling technique was performed followed by antimetabolite injection of mitomycin C under local anesthesia in an operating theatre. Follow-up results showed a significant reduction of IOP on the first day (13.3 mmHg) and a week after surgery (18.5 mmHg), maintained by one anti-glaucoma eye drop.&#x0D; Discussion : Trabeculectomy filtration surgery has a high failure rate in younger patients due to a high risk of conjunctival scarring. The ab-interno needling approach with mitomycin C injection is a novel technique that can be performed and offers the advantage of increasing aqueous outflow through a direct opening of the trabecular meshwork from within the anterior chamber.&#x0D; Conclusion : This technique provides effective management of failed trabeculectomy to achieve intraocular pressure lowering effect and a corresponding decrease in the risk of progressive glaucomatous optic neuropathy.

Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis.

To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification. Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using theGrading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs). Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.

Changes in confocal microscopy in glaucoma patients after intraocular pressure reduction with medical therapy.

Topical glaucoma medication is the first line of management to reduce intraocular pressure (IOP) in patients with glaucoma. In this study, we intended to compare the ultrastructural findings of the cornea in patients with glaucoma before and after the reduction of the IOP through confocal microscopy. Ten patients (19 eyes) with newly diagnosed glaucoma were recruited from the glaucoma services of our tertiary care center. Demographic parameters were noted, and basic ocular examination, specular microscopy (Topcon SP3000P, Tokyo, Japan), and ultrasonic pachymetry (300 AP, Sonomed Escalon, Stoneham, MA, USA) were performed. In vivo confocal microscopy of corneal sections was performed using the z-ring Confoscan 4.0 (Nidek, Inc., Freemont, CA) at baseline and after 3 months of starting glaucoma medications. The mean age of the patients was 53.53 ± 9.34 years. There was a statistically significant reduction (P < 0.0001) of IOP from 30.21 ± 7.42 mmHg (baseline) to 16.42 ± 4.14 mmHg (3 months). The mean central corneal thickness at baseline was 533.42 ± 3.96 μm, and it further decreased to 521.94 ± 42.45 μm at the end of 3 months (P = 0.006). No significant change was noted in the mean epithelial cell density, mean keratocyte density in anterior and posterior stroma, and the mean endothelial cell density and cell area (P >0.5). There was no significant percentage change in these parameters before and after the lowering of the IOP. A short-term (3 months) decrease in IOP using topical glaucoma medications caused a significant reduction in corneal thickness but did not have any significant ultrastructural changes in cornea measured using confocal microscopy.

Non-penetrating deep sclerectomy versus combined trabeculotomy-trabeculectomy in primary congenital glaucoma.

The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy-trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a 1-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to 6 months. The success rates were recorded in both groups. Forty eyes of 26 patients were included, with 20 eyes allocated to each group. The mean (standard deviation) age of all patients was 12.9 (9.5) months, with comparable ages and sex ratios between groups (both P > 0.05). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < 0.001), with no significant difference detected between the groups (all P > 0.05), except for a significantly lower IOP in NPDS group at 1 month (P < 0.05). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > 0.05). The groups had comparable success rates (P > 0.05). No serious complications were detected. CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings.

Continuous Wave Transscleral Cyclophotocoagulation and Endoscopic Cyclophotocoagulation in Childhood Glaucoma: A Meta-analysis.

To report the outcomes of continuous wave-transscleral cyclophotocoagulation (TS-CPC) and endoscopic cyclophotocoagulation (ECP) in childhood glaucoma. We performed a systematic search of relevant databases. We collected data on age, follow-up duration, type of glaucoma, previous surgical interventions, preoperative and postoperative intraocular pressure (IOP), preoperative and postoperative number of glaucoma medications, adverse events, number of sessions, and success rates at different time points. The main outcome measures are the amount of IOP and glaucoma medication reduction. We included 17 studies studying 526 patients (658 eyes); 11 evaluated the effectiveness of TS-CPC (268 patients, 337 eyes), 5 evaluated ECP (159 patients, 197 eyes), and one study compared both techniques (56 patients, 72 eyes for TS-CPC vs. 43 patients, 52 eyes for ECP). The median duration of follow-up was 28 months in the TS-CPC group and 34.4 months in the ECP group. The mean number of treatment sessions was 1.7 in the TS-CPC and 1.3 in the ECP. In the TS-CPC group, the mean IOP was significantly reduced from 31.2±8 to 20.8±8mmHg at the last follow-up (P<0.001). The mean number of glaucoma medications was reduced from 2.3±1.3 to 2.2±1.3 (P=0.37). In the ECP group, there was also a significant reduction in the mean IOP from 32.9±8mmHg with a mean of 1.7±0.7 glaucoma medications to 22.6±9.8mmHg (P<0.0001) on 1.2±1.1 medications (P=0.009) at the last follow-up. Both TS-CPC and ECP were effective in reducing the IOP and glaucoma medications in childhood glaucoma. Multiple treatment sessions were required.

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma.

Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear. This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15months. The secondary outcomes included surgical success and complications. The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14mmHg in the perforation group and 35 to 12mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications. An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

A Systematic Review of Cyclophotocoagulation Techniques: Continuous Wave Versus Micropulse for Glaucoma Treatment.

Micro-pulse cyclophotocoagulation (MP-CPC) represents the latest iteration of minimally invasive laser procedures aimed at reducing intraocular pressure (IOP) through the disruption of pigmented ciliary body epithelium. This systematic review aims to assess the efficacy and safety profile of the MP-CPC procedure in comparison to CW-CPC for the treatment of glaucoma. We initiated a search on PubMed, ScienceDirect, and the Cochrane Library databases for studies that compared micro-pulse and traditional CW-CPC in terms of their efficacy and safety profiles. We employed medical subject headings terms and keywords such as "cyclophotocoagulation," "cyclodestructive," "photocoagulation," "CPC," "micropulse," "micro-pulse," and "glaucoma" within the timeframe from 2015 to 2023. We assessed the success rate, IOP reduction, antiglaucoma medications, and complications of MP-CPC and CW-CPC. We included six articles in this study, comprising two randomized controlled trials, three retrospective, and one prospective cohort, published between 2015 and 2023. Five out of six reported a significant reduction in IOP for both procedures with comparable success rates observed in MP-CPC compared to CW-CPC. One article reported an increase in IOP in MP-CPC. Both groups reported a decrease in the number of antiglaucoma medications, while one study reported an increase in medications in both MP-CPC and CW-CPC groups. Complication rates were lower in the MP-CPC group with two articles reporting a significant decrease compared to the CW-CPC group. MP-CPC has shown promising results in the treatment of glaucoma in the adult population. With comparable results in IOP reduction and fewer instances of serious ocular complications, MP-CPC may open new possibilities for the use of cyclophotocoagulation procedures in the earlier stages of glaucoma. However, its efficacy in the pediatric population and for neovascular glaucoma remains less defined, thus warranting further studies to establish optimal laser parameters for different types of glaucoma and specific populations of glaucoma patients.

Clinical effectiveness of combined cataract surgery with iStent inject implantation in the surgical treatment of open‐angle glaucoma

Aims/Purpose: This study aims to evaluate intraocular pressure (IOP) change and reduction of topical IOP‐lowering medications after combined cataract surgery with iStentinject® implantation in the surgical treatment of open‐angle glaucoma.Methods: Retrospective chart review of 100 patients (100eyes) with different types of open‐angle glaucoma (84% ‐ primary open angle; 16% ‐ pseudoexfoliation glaucoma), who were naïve to any previous ocular procedure and underwent combined cataract surgery with iStent®implantation, was performed. Study outcomes were median IOP change in the operated eye and the mean number of topical IOP‐lowering medications at 3, 6 and 12 months after surgery.Results: The mean age of patients was 74 ± 7.5 years, 44% men and 56% women. The median pre‐ and postoperative IOP in the operated eye at 3, 6 and 12 months were 18.5(16–20) mmHg, 14.0 (12–16.75) mmHg, 14.5 (12–16) mmHg and 14.5 (12–16) mmHg, respectively. The median IOP change in the operated eyes at 3, 6 and 12 months follow up was −4 (−6 to −2) mmHg (p &lt; 0.001), −4 (−6 to −1) mmHg (p &lt; 0.001), and − 4 (−6.75 to −2) mmHg (p &lt; 0.001), respectively. The higher the preoperative IOP level, the larger was the IOP‐lowering effect at different follow‐ups after surgery (−0.57, p &lt; 0.001; −0.58, p &lt; 0.001; −0.6, p &lt; 0.001; at 3, 6 and 12 months, respectively). We found a statistically significant difference between the mean number of topical IOP‐lowering medications before and at 12 months after surgery (1.23 ± 0.8 vs. 1.08 ± 0.8; −3.42, p &lt; 0.001).Conclusions: This study shows a statistically significant IOP reduction at 3, 6 and 12 months after combined cataract surgery with iStent® implantation in glaucoma patients. The higher the preoperative IOP in the operated eye, the larger the IOP‐lowering effect after surgery at all follow‐ups. iStent inject, a minimally invasive glaucoma surgery approach is associated with the reduction of topical IOP‐lowering medications at 12 months follow‐up.References (if any): Shalaby WS, Jia J, Katz LJ, Lee D. iStent inject: comprehensive review. J Cataract Refract Surg. 2021 Mar 1;47(3):385–399. doi: 10.1097/j.jcrs.0000000000000325.

Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting.

This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.