Transient Intraocular Pressure Elevation Research Articles

Evaluation of a modified sutureless technique for scleral fixation of one-piece posterior chamber intraocular lens: a retrospective study

BackgroundThis study presents the one-year outcomes of a modified technique for transscleral suture fixation of a posterior chamber intraocular lens (PCIOL) in aphakic eyes.MethodsA retrospective chart review was conducted on 45 patients who underwent transscleral suture fixation of a foldable one-piece PCIOL through scleral pockets. Preoperative data and follow-up data for a minimum of 12 months were collected for all patients.ResultsThe mean preoperative and postoperative uncorrected distance visual acuity (UDVA) in LogMAR was 2.49 ± 0.54 and 0.54 ± 0.25, respectively (p < 0.01). The mean preoperative and postoperative best-corrected visual acuity (BCVA) in LogMAR was 0.52 ± 0.22 and 0.45 ± 0.24, respectively (p < 0.01). The mean endothelial cell loss was 110.46 ± 11.5 cells/mm2. Postoperative complications included transient corneal edema (17.7%), transient elevated intraocular pressure (22.2%), and non-significant vitreous hemorrhage (11.1%). No severe complications were observed.ConclusionThe modified technique provides stable PCIOL placement in aphakic eyes with long-term follow-up.

Controlled Study of Tanito Microhook (TMH) ab interno trabeculotomy combined with phacoemulsification for POAG/ PACG

Abstract. To evaluate the efficacy of Tanito Microhook (TMH) ab interno trabeculotomy combinated with phacoemulsification in treating primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). A retrospective comparative study was conducted to analyze 16 patients with primary open-angle glaucoma (POAG) who underwent phacoemulsification and TMH at the Second People's Hospital of Changshu from December 2021 to December 2022, along with 19 patients with primary angle-closure glaucoma (PACG) who underwent phacoemulsification, goniosynechialysis, and TMH. The follow-up period ranged from 12 to 24 months. The average preoperative IOP in the POAG group was (26.504.52) mmHg, and the average IOP was (18.001.67) mmHg at 12 months postoperatively, which was significantly lower than the preoperative value (P<0.05). The average preoperative IOP in the PACG group was (34.1114.90) mmHg, and the average IOP was (18.670.87) mmHg at 12 months postoperatively, which was lower than the preoperative value (P<0.05). The average number of anti-glaucoma drugs used by the POAG group before surgery was (2.060.21) types, and the average number of types was (0.180.10) at 12 months postoperatively, which was significantly reduced compared with the preoperative value (P<0.05). The PACG group used an average of (1.890.15) kinds of anti-glaucoma drugs preoperatively, (0.680.17) kinds of drugs postoperatively, and the difference in the number of drugs used between preoperative and postoperative periods was not statistically significant (P>0.05). The complete success rate of the POAG group was 81.3% (13/16), and the conditional success rate was 18.7% (3/16). The complete success rate of the PACG group was 47.4% (9/19), and the conditional success rate was 52.6% (10/19). The intraoperative and postoperative complications in the POAG group mainly included one case of hyphema in the anterior chamber and one case of transient intraocular pressure elevation, while the intraoperative and postoperative complications in the PACG group included one case of shallow anterior chamber after surgery, four cases of hyphema in the anterior chamber, and three cases of transient intraocular pressure elevation. No serious complications occurred in either group. The combination of TMH with cataract phacoemulsification and intraocular lens implantation demonstrates a safe and effective approach for treating POAG. Additionally, when combined with goniosynechialysis (GSL), it may be a safe and effective treatment for PACG. However, the long-term efficacy still requires further investigation through large-scale prospective controlled studies.

Transient Diagnostics and Therapeutic-Related Increase in Intraocular Pressure and Risk to the Glaucoma Patient.

This review evaluates the impact of transient intraocular pressure (IOP) elevations during common ophthalmic surgical and diagnostic procedures on glaucoma patients. Elevated IOP is a key risk factor in glaucoma, and while transient IOP spikes are frequently encountered during surgeries like cataract extraction, laser in situ keratomileusis (LASIK), and femtosecond laser-assisted cataract surgery (FLACS), the clinical significance of these short-term elevations remains uncertain, particularly for eyes with compromised optic nerves. There is still a lack of data on which IOP level and duration of IOP insult the glaucoma damage occurs. Still, it is known that the combination of the degree of IOP elevation, duration of the insult and optic nerve susceptibility are important determinants of this event.While transient IOP elevations during these procedures are generally well tolerated, patients with advanced glaucoma and severely compromised optic nerves may be at greater risk for further damage. More research is needed to fully understand the long-term implications of acute IOP spikes, particularly in patients with advanced disease.

Changes in Lens Structure in Pathological Myopia, Cataract Surgery and Special Situations

Pathological myopia is a major cause of low vision and blindness worldwide. In patients with pathological myopia, there are changes such as thinning of the lens and increase in equatorial diameter. In various population and clinic-based cohort, case-control and cross-sectional studies, it has been reported that myopic patients have a higher risk of posterior subcapsular cataract, cortical and nuclear cataract. It is known that the modern technique of phacoemulsification and intraocular lens implantation is effective in highly myopic eyes and provides significant improvement in visual acuity. However, complications related to phacoemulsification such as posterior capsule rupture, retinal detachment, progression of existing maculopathy, capsular phimosis, late lens dislocation and transient intraocular pressure elevation occur more frequently in highly myopic patients. As a result, it is extremely important that cataract surgeries of these patients are performed by experienced surgeons and that attention is paid to perioperative and postoperative complications.

UNVEILING VISUAL ACUITY AND INTRAOCULAR PRESSURE SHIFTS AFTER Nd:YAG LASER CAPSULOTOMY FOR POSTERIOR CAPSULE OPACIFICATION

Introduction: Posterior capsule opacification (PCO) of the lensis a frequent complication following cataract surgerywith intraocular lens implantation, leading to visual decline and symptoms like blurred vision, glare and halos around lights [1]. Nd:YAG laser capsulotomy is a common treatment for PCO, using a laser to create an opening in the opacified lens capsule to restore vision. Although effective, the procedure can cause a transient increase in intraocular pressure (IOP) [3]. Aim: To evaluate visual acuity outcomes and IOP changes following Nd:YAG laser capsulotomy for PCO. Material and Methods: A prospective cohort study was carried out from December 2022 to June 2024 with 61 eyes of 61 patients posted for Nd:YAG laser capsulotomy, after receiving permission from the Institutional Ethics Committee (IEC) and taking informed written consent from the participating patients. The procedure was performed with standard techniques using Appa YAG Laser Machine Model 307, and patients were followed up at 1 hour, 4 hours, 7 days, 14 days, and 28 days after the procedure. Visual acuity and IOP were monitored, and statistical comparisons were made. Statistical analysis used: Statistical tests to compare pre-procedure and post-procedure outcomesusing paired t-tests and p-value. Results: Visual acuity improved significantly (p-value<0.05) from the pre-procedure mean value of 6/60 to 6/9 one month after the procedure. IOP increased transiently, peaking at 20 mmHg in 4 hours post-procedure but returning to baseline levels (15 mmHg) by 28 days. This pattern of transient IOP elevation is consistent with the inflammatory response following the procedure. Conclusions: Nd:YAG laser capsulotomy improves visual acuity significantly with manageable transient IOP elevations. The procedurehas a favorable safety profile, withIOP levels returning to baseline within a month. Ongoing monitoring is crucial to managing any potential complication, and further research with longer follow-up is recommended for a comprehensive understanding of long-term outcomes.

Acute ocular hypertension in the living human eye: Model description and initial cellular responses to elevated intraocular pressure

This initial methods study presents the initial immunohistochemical and transcriptomic changes in the optic nerve head and retina from three research-consented brain-dead organ donors following prolonged and transient intraocular pressure (IOP) elevation. In this initial study, research-consented brain-dead organ donors were exposed to unilateral elevation of IOP for 7.5 h (Donor 1), 30 h (Donor 2), and 1 h (Donor 3) prior to organ procurement. Optic nerve tissue and retinal tissue was obtained following organ procurement for immunohistological and transcriptomic analysis.Optic nerve sections in Donor 1 exposed to 7.5-hours of unilateral sub-ischemic IOP elevation demonstrated higher levels of protein expression of the astrocytic marker, glial fibrillary acidic protein (GFAP), within the lamina cribrosa with greatest expression inferior temporally in the treated eye compared to control. Spatial transcriptomic analysis performed on optic nerve head tissues from Donor 2 exposed to 30 h of unilateral IOP elevation demonstrated differential transcription of mRNA across laminar and scleral regions. Immunohistochemistry of retinal sections from Donor 2 exhibited higher GFAP and IBA1 expression in the treated eye compared with control, but this was not observed in Donor 3, which was exposed to only 1-hour of IOP elevation. While there were no differences in GFAP protein expression in the retina following the 1-hour IOP elevation in Donor 3, there were higher levels of transcription of GFAP in the inner nuclear layer, and CD44 in the retinal ganglion cell layer, indicative of astrocytic and Müller glial reactivity as well as an early inflammatory response, respectively.We found that transcriptomic differences can be observed across treated and control eyes following unilateral elevation of IOP in brain dead organ donors. The continued development of this model affords the unique opportunity to define the acute mechanotranscriptomic response of the optic nerve head, evaluate the injury and repair mechanisms in the retina in response to IOP elevation, and enable correlation of in vivo imaging and functional testing with ex vivo cellular responses for the first time in the living human eye.

Efficacy and safety of penetrating canaloplasty versus ab externo canaloplasty for primary open-angle glaucoma: A randomized controlled trial.

To report the 2-year efficacy and safety of penetrating canaloplasty versus ab externo canaloplasty for the treatment of primary open-angle glaucoma (POAG). A single surgical site in China. This was a prospective, randomized controlled trial. POAG patients were randomly assigned to the penetrating canaloplasty or ab externo canaloplasty group. This study enrolled POAG patients who underwent penetrating canaloplasty or ab externo canaloplasty randomly. Surgical success, intraocular pressure (IOP), number of glaucoma medications, and surgical complications were evaluated until 24 months post-operatively. Surgical success was defined as 6 mmHg ≤ IOP ≤21 mmHg with an IOP reduction ≥20%, which included qualified success (with or without medications) and complete success (without medications). A total of 52 eyes (45 patients) were randomly assigned to one of two groups: the penetrating canaloplasty group (PCP, n = 26) or the ab externo canaloplasty group (CP, n = 26). The probabilities of qualified success and complete success were 92.3% and 76.9%, respectively, in the PCP group and 64.1% and 52.1%, respectively, in the CP group at 24 months (p = 0.013, p = 0.042, log-rank test). The mean IOP decreased from 30.8 ± 10.7 and 28.6 ± 11.8 mmHg to 14.1 ± 3.3 mmHg in the PCP group and 22.1 ± 13.6 mmHg in the CP group at year two (p = 0.007). The PCP group also received fewer medications (0.2 ± 0.5) than did the CP group (0.7 ± 1.2) at year two (p = 0.038). Post-operative complications were similar, and the most common complications were transient IOP elevation and hyphema in the PCP group (42.3%, 46.2%) and the CP group (38.5%, 23.1%) (p > 0.05). Compared to ab externo canaloplasty, penetrating canaloplasty had a greater surgical success rate and better IOP reduction with a comparable rate of complications.

Microglia target synaptic sites early during excitatory circuit disassembly in neurodegeneration.

During development, microglia prune excess synapses to refine neuronal circuits. In neurodegeneration, the role of microglia-mediated synaptic pruning in circuit remodeling and dysfunction is important for developing therapies aimed at modulating microglial function. Here we analyzed the role of microglia in the synapse disassembly of degenerating postsynaptic neurons in the inner retina. After inducing transient intraocular pressure elevation to injure retinal ganglion cells, microglia increase in number, shift to ameboid morphology, and exhibit greater process movement. Furthermore, due to the greater number of microglia, there is increased colocalization of microglia with synaptic components throughout the inner plexiform layer and with excitatory synaptic sites along individual ganglion cell dendrites. Microglia depletion partially restores ganglion cell function, suggesting that microglia activation may be neurotoxic in early neurodegeneration. Our results demonstrate the important role of microglia in synapse disassembly in degenerating circuits, highlighting their recruitment to synaptic sites early after neuronal injury.

EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022

Introduction & ObjectivesFiltration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy isgenerally a safe and effective procedure, complications can occur. The purpose of the study was todescribe the early postoperative complications in patients who had undergone filtration surgery.
 MethodsThis study was a retrospective study that uses secondary data from electronic medical records ofpatients who had filtration surgery between January 1, 2020, and December 31, 2022, in KariadiHospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, andtype of glaucoma. The incidence of early postoperative complications was described up to 3 weeks offollow-up.
 Results287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) hadphaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCEtrabeculectomy.Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type ofglaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%)experienced an early complication with trabeculectomy being more common (17.42%) thancombined surgery. The commonest complication found was hypotony in 69 eyes (24%). Othercomplications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), blebleakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinalhaemorrhage (0.35%).
 ConclusionThis study found the most common early postoperative complication of filtration surgery washypotony. This complication occurs frequently after trabeculectomy.

EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022

Introduction and Objective: Filtration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy is generally a safe and effective procedure, complications can occur. The purpose of the study was to describe the early postoperative complications in patients who had undergone filtration surgery. Methods: This study was a retrospective study that uses secondary data from electronic medical records of patients who had filtration surgery between January 1, 2020, and December 31, 2022, in Kariadi Hospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, and type of glaucoma. The incidence of early postoperative complications was described up to 3 weeks of follow-up. Results: 287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) had phaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCE-trabeculectomy. Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type of glaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%) experienced an early complication with trabeculectomy being more common (17.42%) than combined surgery. The commonest complication found was hypotony in 69 eyes (24%). Other complications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), bleb leakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinal haemorrhage (0.35%). Conclusion: This study found the most common early postoperative complication of filtration surgery was hypotony. This complication occurs frequently after trabeculectomy.

Üçüncü Basamak Sağlık Merkezinde Oküler Travmaya Bağlı Göz İçi Basıncı Yüksekliklerinin Tanı ve Tedavi Sürecinin Değerlendirilmesi: 1990-2018 yılları arası 28 yıllık analiz

AIM: To evaluate the etiological and demographic characteristics and treatment processes of patients with trauma-induced elevated intraocular pressure (IOP).
 MATHERIAL AND METHOD: We retrospectively analysed 191 patients with elevated IOP after trauma between 1990 and 2018. Demographic characteristics, type of trauma, cause of glaucoma, lens status, visual acuity, IOP, other ocular findings, medical and/or surgical treatments and follow-up periods were recorded.
 RESULTS: A total of 148 (77.5%) males and 43 (22.5%) females with a mean age of 29.68±19.47 years were analysed. Mean follow-up period was 158±23.73 months. The type of trauma was blunt in 171 patients (89.5%) and open in 20 patients (10.5%). The mean interval between trauma and IOP elevation was 78 days (3 days-5 years). Glaucoma was due to angle regression in 89 (46.6%), hyphema in 78 (40.8%), lens-related in 24 (12.6%) and other causes in 3 (1.54%) patients. Lens damage, lens-related IOP elevation and need for surgical intervention were more common after open injuries. 72% of the patients were able to achieve appropriate IOP with observation and medical treatment alone without surgery. Trabeculectomy was the most preferred effective surgical method in both trauma groups. 
 CONCLUSION: The development of glaucoma after ocular trauma is an essential factor affecting visual prognosis. Early diagnosis and treatment might be challenging in proportion to the severity of ocular involvement. However, not all IOP elevations may cause glaucomatous damage, transient IOP elevations could be monitored without medication. In our study, the frequency of posttraumatic IOP elevation was higher in men and young people. This might be related to more trauma exposure in the indicated population. Blunt traumas cause IOP elevation more frequently. In contrast, the need for glaucoma surgery is more frequent after open injuries. Angle recession is the most common cause of posttraumatic glaucuma. Therefore, angle assessment is necessary in all possible cases. The status of the lens after trauma will affect the prognosis and choice of surgery. Regular follow-up is crucial for the detection of secondary glaucoma since IOP elevation may develop in the late post-traumatic period. 
 
 Keywords: Ocular trauma, blunt trauma, angle recession glaucoma, traumatic glaucoma

Five-Year Outcomes of Single Trabecular Microbypass Stent (iStent®) Implantation with Phacoemulsification in Korean Patients.

This study reports the long-term intraocular pressure (IOP)-lowering efficacy and safety of a singletrabecular microbypass stent(iStent®; Glaukos Corp., San Clemente, CA, USA) for medically controlled open-angleglaucoma in Korean patients. This retrospective observational study included 42 eyes of 35 patients with primary open-angle glaucoma (POAG). All subjects underwent single first-generation iStent® implantation with phacoemulsification by a single surgeon with 5years follow-up. The primary outcomes were changes in IOP and the number of antiglaucoma medications compared to the preoperative values. The secondary outcome was the proportion of eyes with IOP ≤ 18mmHg without medication, ≤ 15mmHg without medication, and ≤ 18mmHg with or without medication. Adverse events and need for secondary glaucoma surgery were also recorded. The mean IOP decreased from 15.8 ± 2.8 to 13.8 ± 1.7mmHg and the mean number of medications was reduced from 2.24 ± 1.18 to 0.83 ± 1.12, respectively, at year5. At 3 and 5years, 80.6% and 78.6% of eyes, respectively, were receiving fewer medications than preoperative numbers. In contrast, only 50% of eyes on four preoperative medications showed medication reductions at 5years. At years3 and 5, 61.3% and 53.5% of eyes achieved IOP ≤ 18mmHg without medication, whereas 90.3% and 89.3% of eyes achieved ≤ 18mmHg regardless of medication use, respectively. Four eyes required additional glaucoma surgery (two Ahmed glaucoma valve implantations, one trabeculectomy, and one XEN45 Gel Stent implantation), and all were receiving four preoperative antiglaucoma medications. Transient IOP elevation (14.3%) was the most common complication, followed by five hyphema, one stent obstruction, one stent malposition, and one severe anterior chamber reaction. This study demonstrated a good safety profile and sustained IOP reduction after the implantation of a single trabecular microbypass stent (iStent®) with phacoemulsification in Korean patients. The majority of subjects with POAG showed a relatively good response; however, eyes receiving a higher number of medications preoperatively (especially four medications) had difficulty achieving a low target IOP.

Factors associated with 1-year outcomes and transient intraocular pressure elevation in minimally invasive glaucoma surgery using Kahook Dual Blades

In this retrospective case–control study, we aimed to investigate the mid- to long-term outcomes and factors involved in minimally invasive glaucoma surgery using the Kahook Dual Blade. Of the 229 cases since 2018 in which the dual blades were used for glaucoma surgery at the Tenri Hospital, 133 eyes of 98 patients who followed up for more than 3 months were included. Intraocular pressure (IOP), number of drops score, and need for reoperation were evaluated on day 1 and at 1, 3, 6, 9, and 12 months postoperatively. Intraocular pressure spikes occurred in 25 patients postoperatively (18.8%), occurring at approximately 4.5 days (1–10.25). The preoperative number of eye drops used and ocular axial length were found to be associated with the occurrence of spikes (OR = 1.45, 95% CI 1.02–2.06; P = 0.025 and OR = 1.41, 95% CI 0.98–1.25; P = 0.072, respectively). At the 12-month mark, no significant relationship was found between the presence of spikes or incisional extent scores and the amount of change in IOP and number of drops scores. Patients with severe visual field impairment, high preoperative IOP and drop scores, and long ocular axial length may require more frequent follow-ups after surgery to check for spikes.

Apoptosis inhibitor of macrophages/CD5L enhances phagocytosis in the trabecular meshwork cells and regulates ocular hypertension.

The trabecular meshwork (TM) cells of the eye are important for controlling intraocular pressure (IOP) and regulating outflow resistance in the aqueous humor. TM cells can remove particles and cellular debris by phagocytosis, decreasing both outflow resistance and IOP. However, the underlying mechanisms remain unclear. Here, we investigate whether apoptosis inhibitor of macrophages (AIM), which mediates the removal of dead cells and debris in renal tubular epithelial cells, regulates the phagocytic capacity of TM cells. In vitro experiments revealed that CD36, the main receptor for AIM, colocalized with AIM in human TM cells; additionally, phagocytosis was stimulated when AIM was provided. Furthermore, in a mouse model with transient IOP elevation induced by laser iridotomy (LI), removal of accumulated iris pigment epithelial cells or debris in the TM and recovery of IOP to baseline levels were delayed in AIM-/- mice, compared with control mice. However, treatment with AIM eyedrops rescued AIM-/- mice from the elevated IOP after LI. Since AIM is a protein known to inhibit macrophage apoptosis, we additionally verified its involvement in macrophage removal of cellular debris and IOP. There were no statistically significant differences in the number of macrophagesbetween control mice and AIM-/- mice in the TM. Additionally, we confirmed the rescue effect of the rAIM eyedrops after macrophageshad been removed by clodronate liposomes. Therefore, AIM plays an important role in regulating the phagocytic capacity of TM cells, thereby affecting outflow resistance. Our results suggest that drugs targeting the phagocytic capacity of TM cells via the AIM-CD36 pathway may be used to treat glaucoma.

Large-scale survey of excitatory synapses reveals sublamina-specific and asymmetric synapse disassembly in a neurodegenerative circuit

In the nervous system, parallel circuits are organized in part by the lamina-specific compartmentalization of synaptic connections. In sensory systems such as mammalian retina, degenerating third-order neurons remodel their local presynaptic connectivity with second-order neurons. To determine whether there are sublamina-specific perturbations after injury of adult retinal ganglion cells, we comprehensively analyzed excitatory synapses across the inner plexiform layer (IPL) where bipolar cells connect to ganglion cells. Here, we show that pre- and postsynaptic component loss occurs throughout the IPL in a sublamina-dependent fashion after transient intraocular pressure elevation. Partnered synaptic components are lost as neurodegeneration progresses, while unpartnered synaptic components remain stable. Furthermore, presynaptic components are either lost first or simultaneously with the postsynaptic component. Our results demonstrate that this degenerating neural circuit exhibits differential vulnerability of excitatory synapses depending on IPL depth, highlighting the ordered disassembly of synapses that is specific to laminar compartments of the retina.

Neuroprotective Effect of a Nutritional Supplement Containing Spearmint Extract, Forskolin, Homotaurine and Group B Vitamins in a Mouse Model of Transient Ocular Hypertension.

Glaucoma is one of the most common sight-threatening eye disorders and one of the main causes of irreversible blindness worldwide. The current therapies focusing on reducing intraocular pressure (IOP) are often insufficient to prevent the progression of the disease, so the therapeutic management of glaucoma remains a challenge. The aim of this study was to evaluate the neuroprotective, IOP-lowering independent effects of a nutritional supplement containing forskolin, homotaurine, spearmint extract and vitamins of the B group in a model of acute glaucoma developed in mice. Glaucoma was induced in adult wild-type C57BL/6J mice by transient elevation of IOP. The dietary supplement, branded as Gangliomix® (125 mg/kg/day), was administered by oral gavage for 17 days and ocular hypertension was induced on the 10th day of treatment. A histological analysis of the retinas was performed and RGC survival was evaluated with fluorogold labeling and Brn3a immunostaining on wholemount and retinal sections. Expression of alpha-spectrin, caspase-3, PARP-1 and GFAP was studied with western blotting or immunofluorescence. A significant increase in RGC survival was reported in the retina of mice treated with the dietary supplement as compared to vehicle-treated animals. The observed neuroprotection was associated with a calpain activity decrease, reduction in caspase-3 and PARP-1 activation, and prevention of GFAP upregulation. These effects were independent from the hypotensive effects of the supplement. Altogether, our data suggest that the dietary supplementation with forskolin, homotaurine, spearmint extract and vitamins of the B group supports RGC survival and may offer beneficial effects in glaucoma patients in combination with the currently used IOP-lowering therapy.

Neuroretinal Rim Response to Transient Intraocular Pressure Challenge Predicts the Extent of Retinal Ganglion Cell Loss in Experimental Glaucoma.

To determine if the optic nerve head (ONH) response to transient elevated intraocular pressure (IOP) can predict the extent of neural loss in the nonhuman primate experimental glaucoma model. The anterior chamber pressure of 21 healthy animals (5.4 ± 1.2 years, 8 female) was adjusted to 25 mm Hg for two hours followed by 10 mm Hg for an additional two hours. For the duration of IOP challenge the ONH was imaged using radial optical coherence tomography (OCT) scans at five-minute intervals. Afterward, a randomized sample of 14 of these subjects had unilateral experimental glaucoma induced and were monitored with OCT imaging, tonometry, and ocular biometry at two-week intervals. With pressure challenge, the maximum decrease in ONH minimum rim width (MRW) was 40 ± 10.5 µm at 25 mm Hg and was correlated with the precannulation MRW, Bruch's membrane opening (BMO) position, and the anterior lamina cribrosa surface position (P = 0.01). The maximum return of MRW at 10 mm Hg was 16.1 ± 5.0 µm and was not associated with any precannulation ONH feature (P = 0.24). However, healthy eyes with greater thickness return at 10 mm Hg had greater loss of MRW and retinal nerve fiber layer (RNFL) at a cumulative IOP of 1000 mm Hg · days after induction of experimental glaucoma. In addition, MRW and RNFL thinning was correlated with an increase in axial length (P < 0.01). This study's findings suggest that the ONH's response to transient changes in IOP are associated with features of the ONH and surrounding tissues. The neural rim properties at baseline and the extent of axial elongation are associated with the severity of glaucomatous loss in the nonhuman primate model.

Incidence and risk factors of early transient intraocular pressure elevation after canaloplasty for primary open-angle glaucoma.

Glaucoma is one of the most common optic neuropathies, featuring progressive retinal ganglion cell damage and visual field loss (Tham et al., 2014; Xu et al., 2020). Currently, the only effective treatment for this condition is the reduction of intraocular pressure (IOP) (Palmberg, 2001; Heijl et al., 2002). Canaloplasty is a proven bleb-independent surgery with good efficacy and safety profiles in primary open-angle glaucoma (POAG) (Gołaszewska et al., 2021). However, early transient postoperative IOP elevation has been reported in up to 30% of cases (Riva et al., 2019), similar to that commonly observed in other internal drainage glaucoma surgeries such as implantation using iStent (0%-21.0%), CyPass (10.8%), and Hydrus (4.8%-6.5%) (Lavia et al., 2017). This complication may be a predictor of poor reserve in the outflow system and is potentially associated with surgical failure. Nonetheless, the exact pathophysiology of glaucoma remains unknown, and studies clarifying the risk factors for postoperative IOP elevation have been scarce.

From bench to behaviour: The role of lifestyle factors on intraocular pressure, neuroprotection, and disease progression in glaucoma.

Current glaucoma management centres on intraocular pressure (IOP) reduction through pharmacological and surgical therapy. Despite broad interest in active management of glaucoma through lifestyle modifications, such recommendations have yet to be incorporated into standards of treatment. In this review, noteworthy preclinical studies and their translations in clinical populations are discussed to evaluate the roles of lifestyle factors in lowering IOP, offering neuroprotection, and/or slowing disease progression in those with open-angle glaucoma. Current literature suggests that aerobic exercise may be associated with neuroprotection and decreased disease progression. Mindfulness is associated with IOP reductions and neuroprotection. Caffeine is associated with mild, transient IOP elevations of uncertain significance. Nicotinamide supplementation is associated with neuroprotection and short-term visual function improvement. This review also highlights knowledge gaps regarding these factors and opportunities to strengthen our understanding of their role in glaucoma, including future preclinical studies that elucidate underlying mechanisms and clinical studies with additional functional endpoints and longer follow-up.

Mid-Term Results of Ab Interno Trabeculectomy among Japanese Glaucoma Patients.

The evaluation of ab interno trabeculectomy, referred to as trabectome®, among Japanese patients is insufficient. Japanese patients who underwent trabectome® at the University of Yamanashi Hospital were included. The investigated parameters were intraocular pressure (IOP), best corrected visual acuity, glaucoma medications, visual field, and corneal endothelial cell density. The success rate and its associated factors were investigated. A total of 250 eyes from 197 patients were enrolled. The trabectome® significantly reduced IOP and glaucoma medications up to 48 months. Concomitant cataract extraction enhanced the reduction in IOP and glaucoma medications up to 42 months. At 36 months postoperatively, 40.8% satisfied IOP of the same or less than 18 mmHg or more than a 20% IOP reduction with the same or less use of glaucoma medications as preoperatively. Preoperative IOP and combined cataract extraction were significantly associated with the success rate. The trabectome® alone did not show a significant reduction in corneal endothelial cells. Eyes with postoperative transient IOP elevation and removal of anterior chamber hemorrhage were 11.2% and 1.2%, respectively. Twenty-four eyes (9.6%) underwent additional glaucoma surgeries. The trabectome® could be considered an effective and safe surgery. Compared to trabectome® alone, combined cataract surgery was superior in lowering IOP and reducing glaucoma medications.