Significant IOP Reduction Research Articles

Evaluating the 1-year success and safety of ab interno canaloplasty in combination with cataract surgery in glaucoma patients

PurposeTo evaluate the treatment success and safety of ab interno canaloplasty (AbiC) combined with cataract surgery in glaucoma patients.MethodsThe prospective case study included 43 eyes that received an AbiC combined with cataract surgery (age 73.3 ± 8.2 years). The 360° microcatheterization and viscodilatation of the Schlemm’s canal was conducted using VISCO 360 (Sight Sciences, CA, USA). The observation period was 12 months with visits at 2 and 6 as well as 12 months, 7 eyes were lost to follow up.ResultsThe preoperative IOP was 19.8 ± 4.9 mmHg and was reduced to 14.5 ± 2.8 mmHg 12 months after AbiC (p < 0.0001). The relative IOP reduction was 23.6 ± 23.1% after 12 months. Topical glaucoma medication was also reduced from 2.4 ± 1.1 drugs to 1.1 ± 1.4 (p < 0.001) after 12 months. The complete surgical success rate (defined as IOP < 18 mmHg without topical therapy) was 31.6% whereas the qualified surgical success was 89.5% (IOP < 18 mmHg, with local therapy) There were no relevant intra- or postoperative complications.ConclusionAbiC in combination with cataract surgery is a safe and effective procedure to achieve a significant reduction of IOP and local glaucoma medication 12 months after surgery.

Adjunctive use of netarsudil 0.02% in the treatment of refractory glaucoma: a one year analysis

PurposeThis study evaluates the long-term adjunctive use of netarsudil ophthalmic solution 0.02% in lowering IOP in patients with refractory glaucoma.MethodsThis retrospective chart review study was conducted at a tertiary care center. Patients who were prescribed add-on netarsudil therapy and on ≥ 3 topical glaucoma medications from 01/01/2018 to 08/31/2020 were reviewed. 47 patients (69 eyes) met the inclusion criteria. Baseline IOPs prior to the addition of netarsudil were compared to IOPs measured at 3-, 6-, and 12-month intervals. Any patients with inadequate follow-up or who had glaucoma surgery after netarsudil initiation were excluded.ResultsMedian baseline IOP (± SD) was 21 ± 5.8 mmHg (median of 2 visits prior to initiation of netarsudil). At 3-month follow-up, 64 eyes had a median IOP of 16 ± 6.7 mmHg (p < 0.01). At 6-month follow-up, 56 eyes had a median IOP of 18 ± 4.6 mmHg (p < 0.01). At 12-month follow-up, 44 eyes had a median IOP of 15 ± 6.8 mmHg (p < 0.01). At the conclusion of the study, 64% of eyes reached 1 year follow-up due to several reasons.ConclusionsPatients with refractory glaucoma showed statistically and clinically significant IOP reductions on netarsudil. IOP reduction was stable long-term with the largest decrease in IOP seen at 12 months. Although some patients will still go on to require further laser or incisional surgery, for most patients netarsudil is an effective treatment for adjunctive use in refractory glaucoma.

Phacoemulsification combined with Kahook Dual Blade Goniotomy versus with Trabectome in the treatment of open angle glaucoma.

To compare the surgical effectiveness and safety of phacoemulsification combined with KDB (Phaco-KDB) and with Trabectome (Phaco-Trabectome) at 6 months follow-up in patients with open-angle glaucoma (OAG) METHODS: This comparative case series was conducted at Beijing Tongren Hospital, including patients diagnosed with OAG who underwent Phaco-KDB from November 2021 to April 2022 and Phaco-Trabectome from April 2017 to December 2017. Surgical success was defined as an IOP reduction ≥ 20% or a postoperative IOP ≤ 21 mmHg. Kaplan-Meier methods were used to calculate cumulative rates of success among groups RESULTS: A total of 35 eyes from 29 patients were included in the analysis. At 6-month, Both groups exhibited a significant reduction in IOP and the number of IOP-lowering medications compared to preoperative (P=0.01 and P<0.01, respectively). There were no significant differences among groups in terms of reducing IOP and the number of IOP-lowering medications (all P values<0.05). In the Phaco-KDB and Phaco-Trabectome groups, 53.8% and 45.0% of patients achieved an IOP reduction of ≥ 20%, while 92.3% and 85% achieved a mean IOP ≤ 21 mmHg 6 months after surgery. The incidence of IOP spike was 20%, and 3 eyes (8.6%) needed further surgery to control the IOP CONCLUSIONS: Both Phaco-KDB and Phaco-Trabectome demonstrate a significant reduction in IOP and the number of IOP-lowering medications. Phaco-Trabectome appears to provide a more predictable postoperative course in the early postoperative period compared to Phaco-KDB, and the postoperative mean IOP is lower in Phaco-KDB compared to Phaco-Trabectome, despite not being statistically significant.

Brief Report on 12-Month Outcomes of the ab Interno Gel Stent Using the Intraoperative Posterior Sweep of Tenons (PoST) Technique

87 eyes of 70 patients (mean age 75.03 years) with an average 12-months follow-up underwent ab-interno Xen45 gel stent with PoST technique. Primary outcome: mean IOP change. Secondary outcomes: change in medications and complications. Preoperative mean IOP and medications were 18.66 mmHg and 3.36 respectively. At 12 months, mean IOP and medications were 13.1 mmHg and 1.35. Cumulative proportion of success (IOP less than 22 mmHg, ≥ 20% reduction in baseline IOP and no additional surgical intervention) was 0.72. Needling proportion was 9%. Cumulative proportion of reoperation was 0.22. The PoST technique resulted in significant reduction in IOP and medications.

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

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

Efficacy and Safety of PreserFlo MicroShunt Implantation and Its Effects on Intraocular Inflammation through Laser Flare Photometry.

The primary objective of this study is to evaluate the efficacy and safety profile of PreserFlo MicroShunt implantation in the medium- to long-term follow-up of patients with open-angle glaucoma. The secondary objective is to analyze laser flare meter (LFM) values before and after PreserFlo MicroShunt implantation. This prospective, observational, longitudinal single-center study included a total of 62 eyes from 54 patients. A subgroup of 27 eyes (26 patients) reached the 12-month follow-up. Success was defined based on three criteria: criterion A: IOP ≤21 mmHg and ≥20% reduction; criterion B: IOP ≤15 mmHg and ≥25% reduction; and criterion C: IOP ≤12 mmHg and ≥30% reduction. Success was further categorized as complete if achieved without IOP-lowering medications and qualified if achieved with medication administration. Other aspects evaluated included the number of IOP-lowering medications (baseline and postoperative), development of postoperative complications, 5-FU injections or implant revision, and LFM values. The 12-month follow-up group (27 patients) was composed by 50% males and had a mean age of 75.54 ± 9.98 years. Success rates at 12 months were as follows: 78% for criterion A, 56% for criterion B, and 26% for criterion C. Complete success, as defined by criterion A, was achieved by 67% of the patients, 29% achieved qualified success, and one eye (4%) experienced failure. IOP decreased from 25.26 ± 1.67 mmHg at baseline to 14.81 ± 0.74 mmHg at 12 months. The number of medications decreased from 3.67 ± 1.30 at baseline to 0.48 ± 0.75 at 12 months. Reported complications were choroidal detachment (11%), hyphema (5%), and athalamia (flat anterior chamber) (2%) 13 eyes (48%) received 5-FU injections, while 7 eyes (26%) underwent implant revision. No significant increase in LFM values was observed. Eyes with a regular postoperative course and IOP ≤15 mmHg showed significantly lower LFM values than patients with unfavorable outcomes (IOP >15 mmHg, development of complications, 5-FU injection, or implant revision). PreserFlo MicroShunt showed a significant reduction in IOP and a decrease in the number of IOP-lowering medications. Complications occurred at a modest frequency. The implant provides a minimally invasive approach with no significant increases in LFM values postoperatively. Higher LFM values correlate with unfavorable postoperative outcomes.

Efficacy and Safety of Aurolab Aqueous Drainage Implant Compared With Baerveldt Glaucoma Implant for Refractory Glaucoma at One Year: A Systematic Review and Meta-Analysis.

Background: Glaucoma stands as a prominent contributor to irreversible vision impairment on a global scale. For decades, the Baerveldt Glaucoma Implant (BGI) has been used to treat refractory glaucoma. Yet, the cost-effective Aurolab Aqueous Drainage Implant (AADI) has gained clinical attention as a viable alternative for managing glaucoma. Objective: The purpose of this study was to evaluate and compare the efficacy and safety of AADI and BGI in the treatment of refractory glaucoma. Methods: Following PRISMA guidelines, we conducted a systematic search of multiple databases, identifying relevant comparative studies assessing AADI versus BGI in patients with refractory glaucoma. Key outcomes included postoperative IOP, surgical success rates, antiglaucoma medication reduction (AGMR), and complication rates. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Results: Three studies comprised a total of 176 individuals with refractory glaucoma, with 107 patients receiving the AADI and 69 patients receiving the BGI. The meta-analysis revealed a statistically borderline significant reduction in postoperative IOP favoring the AADI at 3 months (mean difference [MD] = -2.74, p=0.05). There was no significant difference in the MD of AGMR between the AADI and BGI groups. The rates of total complications and surgical success did not differ significantly between the AADI and BGI groups. Conclusion: AADI demonstrates promising results in reducing IOP at 3 months compared to BGI, with comparable surgical outcomes and complication rates over the long term. Further studies with larger samples are warranted to validate these findings and assess cost-effectiveness, particularly in developing countries.

One-year experience with latanoprostene bunod ophthalmic solution 0.024% in clinical practice: A retrospective observational study.

We evaluated the IOP-lowering efficacy and safety of latanoprostene bunod (LBN) ophthalmic solution 0.024% (Vyzulta®), the first topical nitric oxide-donating prostaglandin analog (PGA), in clinical practice. A retrospective medical chart review from July 2021 to July 2023 of patients with open-angle glaucoma receiving LBN with at least 1 year follow-up was conducted. All included patients received LBN 0.024% as a replacement for a PGA, with examinations at 1-, 3-, 6-and 12-months follow-up. Main outcome measures were IOP, retinal nerve fiber layer thickness, visual fields before/after LBN use and adverse effects. Subgroup analysis with glaucoma types and PGA use were performed for additional IOP reduction after LBN use. Among 78 included patients, 47 patients (81 eyes), 60% with open-angle glaucoma (OAG) remained on LBN throughout 12-month follow-up. Baseline IOP was 18.2±4.2 mm Hg, and Prostaglandin analog (PGA)-IOP was 14.4 ± 3.0 mm Hg (21% mean IOP reduction). After switched to LBN, mean additional IOP reduction was 1.0 mm Hg at month 1, and the greatest reduction was 1.6 mm Hg (8.8% additional mean IOP reduction) at month 12 (P<0.0001). Subgroup analysis (NTG, 73%) showed that mean additional IOP reduction at month 12 was 1.3±2.0 mm Hg in NTG group and 2.1±3.2 mm Hg in POAG group (7.7% vs. 8.7% additional IOP reduction rates, P = 0.23). Subgroup analysis of PGA use at month 12 was 1.8±2.3 mm Hg in tafluoprost group and 0.5±1.7 mm Hg in travoprost group (9.5% vs.2.6% additional IOP reduction rates, P = 0.02). Tolerable ocular adverse effects included irritation (n = 16, 19.8%), mild conjunctival hyperemia (n = 11, 13.6%), dark circles (n = 4, 4.9%) and blurred vision (n = 2, 2.5%). There were no significant visual field and retinal nerve fiber layer thickness changes after 12 months of treatment with LBN 0.024%. Although high intolerable adverse effects including conjunctival hyperemia and eye irritation happened in the first month, remaining sixty percent of patients exhibited statistically significant additional IOP reductions in the replacement of other PGAs during 12 months of clinical use of LBN 0.024%.

Vision outcomes in dogs with primary glaucoma surgically treated with lensectomy and endolaser cyclophotocoagulation after an Ahmed valve gonioimplantation failure.

The aim of this study was to retrospectively evaluate vision outcomes of dogs with primary angle closure glaucoma (PACG) that underwent Ahmed valve gonioimplantation (AVG) followed by lensectomy and endolaser cyclophotocoagulation (ECP) with or without bleb resection after AVG failure. Medical records from 2008 to April 2022 were reviewed. All patients selected had an AVG performed first. Following valve failure, lensectomy-ECP was performed in addition to bleb resection as indicated. Additional ECP and AVG replacement surgeries were performed as deemed medically necessary. Main outcomes evaluated included vision preservation, average IOP reduction, and the number of glaucoma medications (both oral and topical) at 6, 12, 24, and 36 months. Fourteen eyes from 13 patients were included in the study. Females were predominant (n = 9) compared with males (n = 4). Mean age at initial glaucoma diagnosis was 6.82 years. Following AVG and lensectomy-ECP, vision was preserved in 93%, 84%, 60%, and 48% of eyes at 1, 2, 3, and 4 years respectively. Following lensectomy-ECP, there was a significant reduction in mean IOP of 9.64 mmHg (p = .015) and 9.71 mmHg (p = .016) at 2 and 6 months, respectively. There was a reduction in mean IOP of 2.45, 7.25, and 12.25 mmHg at 12, 24, and 36 months, respectively, which was not statistically significant. There was a significant decrease in the number of glaucoma medications at all evaluated time points except 24 months. Combined AVG and lensectomy-ECP is successful in maintaining vision long term as well as decreasing IOP, and the number of glaucoma medications administered.

Real-World Outcomes of Canaloplasty and Trabeculotomy Combined with Cataract Surgery in Eyes with All Stages of Open-Angle Glaucoma.

To evaluate the long-term safety and efficacy of sequential canaloplasty and trabeculotomy combined with cataract surgery in patients with mild, moderate, and advanced open-angle glaucoma. Case records of 171 consecutive patients (171 eyes) who had undergone cataract surgery followed by canaloplasty (≥180°) and trabeculotomy (≥90°) for mild, moderate, or advanced open-angle glaucoma (Shaffer grade ≥3) using the OMNI Surgical System (Sight Sciences, Inc., Menlo Park, CA) were analyzed retrospectively. Efficacy endpoints included change in mean IOP and number of medications from baseline to postoperative 12- and 24-months for the overall dataset and stratified by each stage of glaucoma. Kaplan-Meier survival analysis of success (eyes that did not require secondary surgical interventions (SSI)) by postoperative 24 months was also performed. Postoperatively, there was a statistically significant reduction in IOP (baseline of 17.2 mmHg on 1.3 medicines reduced to 14.3 on 0.8 medicines (12 months) and 14.0 on 0.9 medicines (24 months), p<0.001 for both time points). Eyes with advanced glaucoma (N=63) maintained significant IOP reduction (17.8 mmHg on 1.6 medicines at baseline reduced to 13.6 mmHg on 1.3 medicines (12 months) and 13.0 on 1.5 medicines (24 months), p<0.001). Kaplan-Meier analysis showed a 93.0% survival probability for the avoidance of SSI at 2 years after surgery. Canaloplasty and trabeculotomy combined with cataract surgery provided effective IOP reduction for eyes with all stages of glaucoma at postoperative 12 and 24 months, and the procedure yielded a 93% survival rate for SSI avoidance at 2 years.

Influence of different primary surgical techniques on long-term intraocular pressure and medication in glaucoma after congenital cataract surgery.

To assess long-time results of primary surgical treatment in children with glaucoma after congenital cataract surgery. A retrospective study of 37 eyes from 35 children with glaucoma after congenital cataract surgery, who underwent surgery between 2011 and 2021 at the Childhood Glaucoma Center, University Medical Center Mainz, Germany. Only children, who received a primary glaucoma surgery in our clinic within the given time (n = 25) and had at least one-year follow-up (n = 21), were included in the further analysis. The mean follow-up time was 40.4±35.1 months. The primary outcome was the mean reduction in IOP (in mmHg) from baseline to follow-up visits after the surgery, measured with Perkins tonometry. 8 patients (38%) were treated with probe trabeculotomy (probe TO), 6 (29%) with 360° catheter-assisted trabeculotomy (360° TO) and 7 (33%) with cyclodestructive procedures. IOP was significantly reduced after probe TO and 360° TO after 2 years, from 26.9 mmHg to 17.4 mmHg (p<0.01) and 25.2 mmHg to 14.1 mmHg (p<0.02), respectively. There was no significant IOP reduction after cyclodestructive procedures after 2 years. Both, probe TO and 360° TO led descriptively to eye drops reduction after 2 years, from 2.0 to 0.7 and 3.2 to 1.1. The reduction was not significant. In glaucoma after congenital cataract surgery, both trabeculotomy techniques, lead to good reduction of IOP after 2 years. There is a need for a prospective study with comparison to the use of glaucoma drainage implants.

Efficacy of gonioscopy-assisted transluminal trabeculotomy in advanced-age glaucoma patients

ContexteLa prévalence et la gravité de bon nombre d'affections glaucomateuses augmentent avec l’âge, et celles-ci doivent souvent faire l'objet d'un traitement chirurgical à un âge avancé. Or, les interventions chirurgicales chez ces sujets très âgés posent de nombreux défis à la fois physiologiques et psychosociaux, sans compter que les résultats risquent d’être mitigés. Dans le cadre de notre étude, nous avons évalué l'efficacité et l'innocuité de la trabéculotomie transluminale assistée par gonioscopie (GATT, pour gonioscopy-assisted transluminal trabeculotomy) chez des patients très âgés (> 85 ans). MéthodesIl s'agit d'une étude de cohorte rétrospective réalisée dans un seul établissement qui regroupait des patients consécutifs d'au moins 85 ans ayant subi une GATT, sans égard à l’étendue circonférentielle (90°–360°), réalisée conjointement à une chirurgie de la cataracte par phacoémulsification ou non. Le principal paramètre de mesure consistait en la proportion d'interventions réussies à 1 an conformément aux critères de « réussite complète » (pression intraoculaire [PIO] < 17 mm Hg sans collyre antiglaucomateux 3 mois après la GATT ni intervention supplémentaire). Parmi les paramètres secondaires, mentionnons la proportion d'interventions réussies selon les critères de substitution, les analyses transversales des PIO et de l'utilisation de collyres antiglaucomateux de même que les analyses des complications et des interventions postopératoires. RésultatsAinsi, 40 yeux de 31 patients ont été inclus dans l’étude. La PIO initiale moyenne se chiffrait à 16,75 ± 7,33 mm Hg, PIO qui était obtenue grâce à 1,60 ± 1,43 classe d'antiglaucomateux. Après 1 an, la survie cumulative selon l'analyse de Kaplan-Meier était de 46,6 %. Il s'est produit une baisse statistiquement significative de la PIO lors de toutes les mesures postopératoires, qui a atteint une moyenne de 11,78 ± 3,07 mm Hg lors de la dernière visite de suivi. On a observé des complications postopératoires dans 18 yeux; il s'agissait, dans la majorité des cas, d'hyphéma et d’œdème cornéen. ConclusionsNotre étude permet de conclure que la GATT est une intervention sûre et efficace pour le traitement du glaucome chez des populations âgées.

Evaluation of treatment response with color doppler ultrasonography in cases with primary open-angle glaucoma

Aims: Beta-blockers, the most frequently preferred drug group in glaucoma.Withcolor Doppler ultrasonography (CDU), the localization of retrobulbar vascular structures, their flow rates and directions, and the effects of the drugs used on the ocular circulation can be examined in a dynamic, reliable, and noninvasive way in less time than other techniques. The aim of our study was to compare the effects of beta-blockers, widely used in glaucoma treatment, and the additional neuroprotectant flunarizine on ocular hemodynamics using CDU. Methods: Between November 1998 and August 1999, 30 cases diagnosed with POAG in the GlaucomaUnit of the 1st EyeClinic of our center were included in the study. Patients were divided into 3 groups according to their beta-blocker treatment. Patients' CDU examinations were then examined by an experience dradiologist, and peaksys to lic flow velocity (PSFV) and end-diastolic flow velocity (EDFV) of the ophthalmicartery (OA), central retinal artery (CRA), and lateral (temporal) posterior ciliary arteries (LPCA) in the right or left eye were detected. Results: Of the 30 patients who participated in the study, 14 were male and 16 were female. Nine patients had hypertension (HT), 3 patients had diabetes (DM), and 6 patients had migraine. The mean age was similar in all three groups. There was a significant reduction in IOP in all three patient groups in whom IOP was measured after the use of topical beta-blockers (P&lt;0.01). The use of flunarizine had no effect on IOP in all three groups (P&gt;0.05). There was no statistically significant difference between groups in OA PSFVs and EDFVs at the first, second, and third measurements using the three beta-blockers (P&gt;0.05). No statistically significant difference existed between all three groups in the measurements of CRAPSFVs and EDFVs (P&gt;0.05). There were also no significant differences between groups in measurements of LPCA, PSFVs, and EDFVs at baseline and follow-up (P&gt;0.05). Conclusion: We found that the changes in hemodynamic parameters and reduction in IOP with all three beta-blockers were similar on color Doppler USG in patients using beta-blockers for the treatment of glaucoma. We observed that flunarizine had no effect on systemic hemodynamic parameters, did not affect IOP, and had no adverse effects on retrobulbar hemodynamic parameters when combined with beta-blockers. Local beta-blockers remain the mainstay of medical treatment for POAG because of their low systemic side effects and beneficial effects on the eye.

Long-term outcome of stab incision glaucoma surgery versus trabeculectomy surgery in the management of primary open angle glaucoma

Purpose To assess the long-term outcome of Stab incision glaucoma surgery (SIGS) and compare it with subscleral trabeculectomy (SST) in the management of open-angle glaucoma (OAG). Methods Twenty eyes of 20 OAG patients were randomly assigned into group 1: 10 patients underwent SIGS + Mitomycin C (MMC), and group 2: 10 patients underwent SST + MMC. The patients were followed-up over 2 years after surgery. Our outcome measures were: Postoperative intraocular pressure IOP, number of medications used, and postoperative complications. Results Twenty-four months postoperatively, the mean IOP was 13.78±2.05 mmHg in the SIGS group compared with preoperative IOP of 26.33±5.1 mmHg (P &lt;0.001, paired t-test), and 14.38±4.56 mmHg in SST group compared with preoperative IOP of 30.13±7.51 mmHg (P &lt;0.001, paired t-test). No significant differences in mean IOP between groups either preoperatively (P=0.15) or along follow-up (P=0.62 at last visit). The mean IOP drop from baseline was 12.56±5.00 mmHg (46.33±10.50%) in SIGS group and 15.75±8.22 mmHg (49.50±17.95%) in SST group (P=0.26). A significant decrease in the number of glaucoma medications was noted in the SIGSS group (P &lt;0.001), in the SST group, the number decreased but was not statistically significant (P =0.120). Conclusion SIGS is comparable with SST in achieving long-term significant and maintained IOP reduction over up to 2 years, in addition to decreasing the number of antiglaucoma medications postoperatively. SIGS is recommended for surgical management of primary OAG as it has the advantage of being a faster, easier, less traumatic alternative to conventional SST with fewer complications.

Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation.

To report the outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in post-keratoplasty glaucoma refractory to medical therapy. Medical records of 47 patients (mean age of 70.7 ± 15.7 years and follow-up of 13.9 ± 7.1 months) were retrospectively enrolled. All patients had the diagnosis of secondary glaucoma after penetrating keratoplasty (PKP; n = 28) or Descemet's stripping automated endothelial keratoplasty (DSAEK; n = 19) with no previous history of incisional glaucoma or TSCPC surgeries. Study participants underwent slow-coagulation CW-TSCPC (1250-milliwatt power and 4-second duration). A statically significant reduction of IOP from 31.8 ± 8.0 mmHg preoperatively to 16.9 ± 9.0 mmHg postoperatively was noted (p < 0.001). Similarly, the number of glaucoma medications decreased from 4.0 ± 1.0 to 2.7 ± 1.4 (p < 0.001). The overall success rates at 12 and 24 months were 68.1% and 66.0%, respectively, with no difference in success rates between post-PKP and post-DSAEK subgroups (p = 0.836). No significant changes in VA or central corneal thickness (CCT) were observed (p = 0.345 and 0.311, respectively). One (3.3%) patient had a graft rejection. The majority of the complications noted during this study were mild and transient. Our study suggests that slow-coagulation TSCPC may be a safe and efficient surgical glaucoma treatment modality in patients with medically uncontrolled post-keratoplasty glaucoma.

The effect of phacoemulsification of age-related cataract on intraocular pressure and iridocorneal angle parameters in primary open-angle glaucoma

This study investigates the changes in anterior chamber angle configuration and IOP level before and after cataract surgery in primary open-angle glaucoma (POAG) eyes, and assesses its possible relationship with the axial length of the eye. The study included 38 patients with immature senile cataract and compensated unoperated stage I-II POAG. Patients underwent anterior segment optical coherence tomography (AS-OCT) with measurement of the angle opening distance (AOD750) and trabecular-iris space area (TISA750) before and six weeks after the surgery, as well as axial length and corneal-compensated IOP (IOPcc). After the surgery 92.11% of patients showed a decrease in IOPcc an average of 1.84±1.95 mm Hg (by 12.33±10.21% of the baseline); the maximum decrease in the IOPcc level was 8.35 mm Hg (by 40.97% of the baseline). AS-OCT data indicates that cataract phacoemulsification causes an increase in anterior chamber angle width: AOD750 increased from 0.510±0.175 to 0.771±0.156 mm, and TISA750 increased from 0.266±0.090 to 0.494±0.096 mm2. The strongest correlations were found between the axial length, postoperative TISA750 increase (Δ%TISA750) and postoperative IOPcc reduction (Δ% IOPcc). Postoperatively, specific changes could be observed in the trabecular meshwork in 28.95% of cases in the form of elongation and strain of the membrane. Cataract extraction contributes to a significant reduction in IOP due to anterior chamber angle expansion, trabecular meshwork stretching, and improved aqueous outflow.

Stabilization of macular, peripapillary and papillary vascular parameters after XEN and trabeculectomy visualized by the optical coherence tomography angiography

To analyze the effect of filtration in glaucoma surgery, XEN versus trabeculectomy, on the vessel area density (VAD) of the macular, papillary and peripapillary regions using optical coherence tomography angiography (OCT-A). This prospective cohort study analyzes the vascular architecture of 47 eyes of 45 patients after two different filtrating surgery procedures (XEN stent and trabeculectomy (TE)) using the OCT-A. Participants who had an outsourced medical anti-glaucoma therapy received filtrating surgery in a 2:1 (XEN: TE) ratio. The primary outcome measurements were changes in the VAD in various layers of retinal perfusion and the foveal avascular zone (FAZ). Both interventions achieved a significant postoperative reduction in IOP (XEN 17.6 ± 3.8–13.7 ± 3.8 mmHg; TE 21.2 ± 5.4–8.8 ± 2.6 mmHg). VAD values did not change significantly after filtrating surgery. Comparing both procedures, a significantly higher VAD for patients treated with TE was seen for the superficial vessel complex (SVC) 375 µm and 750 µm (p = 0.011, p = 0.017), deep vessel complex (DVC) 375 µm (p = 0.029) and the optic disc (p = 0.028) after 6 months, while all other parameters did not differ significantly. In conclusion, VAD does not significantly improve after filtrating surgery in preoperative moderately IOP elevated eyes. The IOP lowering effect of filtrating surgery, however, can stabilize vascular parameters in all layers of perfusion.

The effectiveness and tolerability of fixed-dose combination netarsudil 0.02%/latanoprost 0.005% at a tertiary glaucoma center.

To assess real-world effectiveness and tolerability of fixed-dose combination netarsudil 0.02%/latanoprost 0.005% (FCNL) in management of glaucoma patients in a tertiary eye care center. This retrospective cohort study included glaucoma patients initiated on FCNL from January 2018 to July 2021 with at least 1-month follow-up. Demographic and clinical data were collected at baseline and at follow-up visits through 12months. Patient-solicited side effects were recorded at each visit. Maximum glaucoma pharmacotherapy was defined as surgery/laser being the next treatment option following an intensive pharmacotherapy regimen, or when pharmacotherapy could not be increased due to allergy/intolerance or all pharmacologic mechanisms already being in use. Seventy-nine eyes of 47 patients were included. Mean age was 67.7 ± 14.7years. Baseline IOP was 18.7 ± 4.9mmHg; mean change in IOP (∆IOP) each study visit compared to baseline ranged from - 1.6 ± 3.5 to - 4.4 ± 4.1mmHg (all p < 0.05). The eyes on maximum glaucoma pharmacotherapy (73.4%) had similar ∆IOP compared to those on non-maximal therapy at each visit (p > 0.2 for all). Forty-three (54.4%) eyes were switched from a prostaglandin analog alone, producing a 1-month IOP reduction of - 4.7 ± 3.9mmHg at 1month which remained significant at each visit for the 12-month study period (all p < 0.05). Across all study visits, conjunctival hyperemia was documented in 26 (32.9%) eyes. Subjective blurry vision was reported in 22 (27.8%) eyes without significant worsening of visual acuity at any visit (all p > 0.05). Six (7.6%) and 7 (8.9%) eyes required further medical or surgical/laser intervention, respectively. Kaplan-Meier analysis revealed no significant difference in the need for subsequent medical or surgical intervention between those on maximum and non-maximal pharmacotherapy (p > 0.4). FCNL was well-tolerated and demonstrated a significant and sustained reduction in IOP, even as last-line therapy before incisional or laser surgery in those on maximum glaucoma pharmacotherapy. FCNL is a viable treatment option for glaucomatous eyes before consideration of surgical intervention.

EFFICACY OF PHACOEMULSIFICATION AND PHACOEMULSIFICATION COMBINED WITH GONIOSYNECHIALYSIS IN SURGICAL TREATMENT OF CHRONIC ANGLE-CLOSURE GLAUCOMA: 2-YEARS STUDY

Aim. To study the degree of angle opening and the decrease of intraocular pressure in primary angle-closure glaucoma (PACG) after cataract phacoemulsification and cataract phacoemulsification with goniosynechialysis (phaco + GLS).&#x0D; Materials and Methods. The study involved 28 patients (28 eyes) with primary chronic angle-closure glaucoma. The patients were divided into two groups, group 1 of 15 patients undergoing phaco with posterior chamber IOL implantation, and group 2 of 13 patients undergoing phaco with IOL implantation and GLS. The patients were followed for 24 months. Phaco was indicated in cases with IOP above 22 mmHg, appositional anterior chamber angle closure, and optic neuropathy; Phaco with GSL was indicated in cases of synechial angle closure and IOP above 22 mmHg&#x0D; Results. In group 1 after Phaco, postoperative anterior chamber angle opening was &gt;20° in all quadrants. Postoperative IOP after 24 month follow-up it decreased by 32,6 % from the preoperative levels. In group 2 after Phaco+GSL, anterior chamber angle opened at least to 20° in three or more quadrants in all cases. Postoperative IOP after 24 month follow-up it decreased by 33.0% from the preoperative levels.&#x0D; Conclusions. Thus, phacoemulsification is an efficient procedure for PACG and appositional angle closure, leading to reopening of the anterior chamber angle with significant IOP reduction. Phacoemulsification alone does not lead to reopening of anterior chamber angle in cases with synechial angle closure, necessitating a combined surgery of phacoemulsification with GSL.

Risk factors for visual field progression in newly diagnosed exfoliation glaucoma patients in Sweden

The present study aimed to identify risk factors for visual field progression in newly diagnosed exfoliation glaucoma patients. Prospective nonrandomized cohort study. The study included patients with newly diagnosed exfoliation glaucoma. All patients were followed for at least 3 years with reliable visual fields. Both risk factors at inclusion and during the 3-year follow-up were considered. For inclusion, five reliable visual fields were needed. Exfoliation glaucoma was defined based on the European Glaucoma Society guidelines. Visual field evaluation was performed using the 24–2 strategy of Humphrey field analysis. Outcomes: Visual field progression. Three different approaches were used: mean deviation, visual field index, and guided progression analysis. Independent variables were tested first in a univariate linear or regression model. The significant variables were retested in a multivariate linear or logistic regression model. The results were different for the MD, VFI and GPA models. The only variable that showed a significant association in the three models was age (p = 0.004; p = 0.006; p = 0.04). Significant variables in the two models were IOP at diagnosis (p = 0.02; p = 0.04), IOP reduction in absolute terms (p = 0.006; p = 0.003), IOP reduction in relative terms (%) (p = 0.04; p = 0.009) and number of medicines (p = 0.02; p = 0.002). Significant variables in one model were family history (p = 0.04), smoking (p = 0.03), cataract surgery (p = 0.04) and SLT treatment (p ≤ 0.001). Exfoliation glaucoma is a fast progressive glaucoma. Age at diagnosis must be considered. Significant IOP reduction must be achieved to slow down progress in exfoliation glaucoma. The use of SLT treatment should be advised in exfoliation glaucoma patients.