Treatment Of Glaucoma Research Articles

Diagnosis and management of patients with glaucoma in general medical practice

This article describes the importance of the timely diagnosis of suspected glaucoma. Data on the frequency of glaucoma are presented. Key clinical manifestations and diagnostic actions are described. Atypical symptoms are identified separately, according to which it is possible to suspect glaucoma. Recommendations on the interaction between a general practitioner and an ophthalmologist in the treatment of glaucoma are given. The multiplicity and volume of dispensary monitoring in patients with suspected glaucoma and glaucoma are indicated.

Acceptance of Selective Laser Trabeculoplasty as a First-Line Treatment for Primary Open-Angle Glaucoma in Saudi Arabia.

Glaucoma is the second leading cause of blindness worldwide. Early detection and timely treatment are crucial to reducing disease progression. Selective laser trabeculoplasty (SLT) has proven efficacious as a primary treatment for primary open-angle glaucoma. This study aims to evaluate the acceptance among Saudi ophthalmologists of using SLT as a primary treatment for glaucoma. This cross-sectional study enrolled 128 ophthalmologists practicing in Saudi Arabia. Data collection was conducted using a structured online questionnaire, which evaluated sociodemographic data, current glaucoma practice, the technology acceptance model (TAM), and potential barriers to incorporating SLT as the primary treatment for glaucoma. The mean age of the participants was 40 ± 9.6 years, with 65.6% being male. Almost one-third were glaucoma specialists, and 89% followed the American Academy of Ophthalmology recommendations for managing glaucoma patients. The majority (96.1%) used medical treatment as the initial therapy, 72.7% agreed that SLT is safe, and 59.4% agreed that it rapidly controls intraocular pressure. Nearly half of the participants were willing to use SLT as the primary treatment, yet only 42.2% considered themselves experienced enough to do so. The most reported barriers were inadequate training (47.7%), non-availability of SLT equipment (41.4%), and low efficacy as reported by 27.3% of participants. Despite the good overall acceptance of SLT as a first-line treatment for glaucoma, most participants still preferred medical therapy as the primary treatment. To overcome the barriers to incorporating SLT, Saudi ophthalmologists require more training and access to equipment to effectively implement this modality in their practices.

Exploring the Ocular Absorption Pathway of Fasudil Hydrochloride towards Developing a Nanoparticulate Formulation with Improved Performance.

Rho-kinase (ROCK) inhibitors represent a new category of anti-glaucoma medications. Among them, Fasudil hydrochloride, a selective ROCK inhibitor, has demonstrated promising outcomes in glaucoma treatment. It works by inhibiting the ROCK pathway, which plays a crucial role in regulating the trabecular meshwork and canal of Schlemm's aqueous humor outflow. This study aims to investigate the ocular absorption pathway of Fasudil hydrochloride and, subsequently, develop a nanoparticle-based delivery system for enhanced corneal absorption. Employing the ionic gelation method and statistical experimental design, the factors influencing chitosan nanoparticle (Cs NP) characteristics and performance were explored. Fasudil in vitro release and ex vivo permeation studies were performed, and Cs NP ocular tolerability and cytotoxicity on human lens epithelial cells were evaluated. Permeation studies on excised bovine eyes revealed significantly higher Fasudil permeation through the sclera compared to the cornea (370.0 μg/cm2 vs. 96.8 μg/cm2, respectively). The nanoparticle size (144.0 ± 15.6 nm to 835.9 ± 23.4 nm) and entrapment efficiency range achieved (17.2% to 41.4%) were predominantly influenced by chitosan quantity. Cs NPs showed a substantial improvement in the permeation of Fasudil via the cornea, along with slower release compared to the Fasudil aqueous solution. The results from the Hen's Egg Test Chorioallantoic Membrane (HET-CAM) and Bovine Corneal Opacity and Permeability (BCOP) tests indicated good conjunctival and corneal biocompatibility of the formulated chitosan nanoparticles, respectively. Lens epithelial cells displayed excellent tolerance to low concentrations of these nanoparticles (>94% cell viability). To the best of our knowledge, this is the first report on the ocular absorption pathway of topically applied Fasudil hydrochloride where the cornea has been identified as a potential barrier that could be overcome using Cs NPs.

Endocyclophotocoagulation Combined with Phacoemulsification in Glaucoma Treatment: Five-Year Results.

this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years. Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, MA, USA). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after phaco-ECP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as a cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and in the first week and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. The mean ± SD values of IOP preoperatively, at 12, 24, 36, 48, and 60 months postoperatively were 22.6 ± 6.7 mmHg, 15.9 ± 3.9 mmHg (p < 0.001), 15.9 ± 2.9 mmHg (p < 0.001), 15.6 ± 2.7 mmHg (p < 0.001), 15.5 ± 3.8 mmHg (p < 0.001), and 15.2 ± 2.6 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.7%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 40.6%. All patients at the 60-month follow-up visit required the use of antiglaucoma medications-none of the patients achieved complete success. During the follow-up period, nine patients (28.3%) that required retreatment due to nonachievement of the target IOP were considered failures. Six patients (15.8%) were lost from the follow-up. A total of 23 patients were evaluated 60 months after their phaco-ECP. Complications directly associated with the procedure, such as corneal edema (25.6%), IOP spikes (20.5%), IOL dislocation (2.6%), and uveitis (12.8%), were observed in our patients. Hypotony was not observed in any of our patients. The phaco-ECP procedure was effective, well-tolerated, and safe for reducing IOP in glaucoma patients with cataracts over a long-term follow-up. Randomized, larger-scale studies are required to validate the results obtained.

The Evolution and Current Landscape of Minimally Invasive Glaucoma Surgeries: A Review.

This review examines the evolution, current status, and future potential of minimally invasive glaucoma surgeries (MIGS), a significant advancement in the treatment of glaucoma, a leading cause of irreversible blindness. MIGS offer a less invasive alternative to traditional glaucoma surgeries, primarily aimed at reducing intraocular pressure, minimizing tissue trauma, and providing a safer profile. With the emergence of devices such as the Trabectome, iStent, and others, MIGS have expanded the surgical toolkit, allowing personalized, patient-centered care. Despite their advantages, MIGS face challenges such as efficacy in severe cases, long-term data, and accessibility. Ongoing research and technological innovations continue to refine their capabilities and applications, promising to further transform glaucoma management and patient outcomes. This paper provides an in-depth analysis of MIGS, reflecting on their impact and contemplating future directions in this dynamically evolving field.

Comparison of Visual Field Fluctuation Between Myopic and Emmetropic Glaucoma Patients

Background: Conflicting epidemiologic studies suggest that myopia may both increase and decrease the risk of glaucomatous visual field loss. To provide appropriate treatment to glaucoma patients, it is important to detect meaningful changes in the visual field, which requires distinguishing between visual field fluctuation and progression. Visual field fluctuation is defined as the variability between two visual field tests performed on separate days or months on the same eye that cannot be attributed to a pathologic change. We hypothesize that glaucoma patients with myopia will demonstrate more visual field fluctuation compared to emmetropic patients.&#x0D; Methods: Four or more 24-2 or 30-2 Humphrey visual field tests over several visits will be analyzed per patient. Data including the VFI plot, mean deviation, and threshold sensitivity on the glaucoma progression analysis will be collected to measure fluctuation. The sample is divided into two groups: 1. emmetropic glaucoma patients with a spherical equivalent refraction between +2 to -2 diopters and 2. high myopic glaucoma patients with a spherical equivalent refraction over -5 diopters. Bland-Altman plots, Mann-Whitney U tests, Root Mean Square Error (RMSE), intraclass correlation coefficients, and generalized estimating equation models for ordinal data will be used to analyze the collected data.&#x0D; Results: Thus far, 2,979 charts have been reviewed with data collected from 27 emmetropes and myopes who met the inclusion criteria. The recruitment goal is 78 per group and 156 total. Preliminary results for RMSE found a statistically significant p-value for mean deviation (0.0320), and no statistically significant difference for threshold sensitivity (0.5179) and VFI (0.0904).&#x0D; Conclusion and Potential Impact: This ongoing study will help establish if glaucoma patients with high myopia demonstrate greater visual field fluctuation. It is important for clinicians to have this information so that these patients can be examined carefully to prevent misdiagnoses or delayed glaucoma treatment.

Deep convolutional neural network for glaucoma detection based on image classification

PURPOSE: Many researchers have found that the improvement in computerised medical imaging has pushed them to their limits in terms of developing automated algorithms for the identification of illness without the need for human participation. The diagnosis of glaucoma, among other eye illnesses, has continued to be one of the most difficult tasks in the area of medicine. Because there are not enough skilled specialists and there are a lot of patients seeking treatment from ophthalmologists, we have been encouraged to build efficient computer-based diagnostic methods that can assist medical professionals in early diagnosis and help reduce the amount of time and effort they spend working on healthy situations. The Optic Disc position is determined with the help of the LoG operator, and a Disc Image map is projected with the help of a U-net architecture by utilising the location and intensity profile of the optic disc. After this, a Generative adversarial network is suggested as a possible solution for segmenting the disc border. In order to verify the performance of the model, a well-defined investigation is carried out on many retinal datasets. The usage of a multi-encoder U-net framework for optic cup segmentation is the second key addition made by this proposed work. This framework greatly outperforms the state-of-the-art in this area. The suggested algorithms have been tested on public standard datasets such as Drishti-GS, Origa, and Refugee, as well as a private community camp-based difficult dataset obtained from the All-India Institute of Medical Sciences (AIIMS), Delhi. All of these datasets have been verified. In conclusion, we have shown some positive outcomes for the detection of diseases. The unique strategy for glaucoma treatment is called ensemble learning, and it combines clinically meaningful characteristics with a deep Convolutional Neural Network.

One-Year Outcomes of the PAUL Glaucoma Implant Compared With the Ahmed Glaucoma Valve for the Treatment of Silicone Oil Glaucoma.

Longer-term studies with a larger sample size are needed to demonstrate the superiority or equivalence of these procedures. To evaluate the outcomes of the PAUL glaucoma implant (PGI) and Ahmed glaucoma valve (AGV) in patients with secondary glaucoma caused due to silicone oil emulsification. A retrospective examination was conducted using the medical records of 36 patients who developed secondary glaucoma due to silicone oil emulsification after vitreoretinal surgery and then underwent PGI and AGV implantation surgery. The main outcome measures in the PGI and AGV groups were intraocular pressure (IOP) and its change, the number of antiglaucoma medications, and postoperative complications during the 12-month follow-up period. IOP of <6mm Hg is used to define hypotonia. There was no statistically significant difference among the patients who underwent PGI and AGV surgeries in terms of IOP averages, both preoperatively and postoperatively on day 1, week 1, month 1, month 3, month 6, and month 12 ( P > 0.05). Before PGI and AGV implantation, the mean IOP was 40 ± 13mm Hg and 39.3 ± 10mm Hg, and the mean number of medications was 3.8 ± 0.4 and 4 ± 0, respectively. At the end of the 12-month follow-up period, the mean IOP was 13.5 ± 2.2 ( P < 0.001) mm Hg and 14.9 ± 4.2 ( P < 0.001) mm Hg, whereas the mean number of glaucoma medications decreased to 1.7 ± 1.3 ( P < 0.001) and 1.9 ± 1.8 ( P < 0.001) in the PGI and AGV groups, respectively. Surgical success was achieved in 17 of 18 eyes (94%) in the PGI group and 16 of 18 eyes (89%) in the AGV group. Although the outcomes were similar in both the PGI and AGV groups, complications requiring medical and surgical intervention were less common in the PGI group. Longer-term studies with a larger sample size are needed to demonstrate the superiority or equivalence of these procedures.

Effect of "365 Breathing Technique" on Intraocular Pressure and Autonomic Functions in Patients With Glaucoma: A Randomized Controlled Trial.

Patients with primary open angle glaucoma were advised to follow the "365 breathing technique" for 6 weeks in addition to their pharmacological glaucoma treatment. It helped to reduce intraocular pressure (IOP), stress biomarker-cortisol, and improve autonomic dysfunction. To study the effect of the "365 breathing technique" on IOP, autonomic functions, and stress biomarkers in patients with primary open angle glaucoma. In this randomized, controlled, interventional trial, after randomization, 40 patients in the intervention group followed "365 breathing" (three times a day, breathing rate: 6 cycles/min for 5 min) in addition to their pharmacological glaucoma treatment and 40 patients in the control group continued only with their pharmacological glaucoma treatment. IOP, serum cortisol, heart rate variability (HRV), and heart rate response to deep breathing test (DBT) were recorded at preintervention and 6 weeks postintervention. The mean IOP, serum cortisol, parameters of the HRV test, and DBT were comparable between the two groups at baseline. At the 6-week follow-up, in the intervention group, mean IOP was significantly lower (16.09 ± 2.24 vs 18.38 ± 1.58 mm Hg, P = 0.03) and serum cortisol were significantly lower (13.20 ± 3.11 vs 14.95 ± 2.60 mcg/dL, P = 0.038) compared with the control group. In the HRV test, time domain analysis showed a significant difference in the root mean square of the successive difference between RR interval values between both groups at 6 weeks ( P = 0.015) pointing towards higher postintervention parasympathetic activation in the intervention group. In frequency domain analysis (HRV test), the ratio of the low-frequency component to the high-frequency component was significantly lower in the intervention group at 6 weeks (1.65 vs 1.79, P = 0.019) indicating a shift in sympathovagal balance towards greater vagal modulation.There was a significant increase in delta heart rate ( P = 0.019) and expiratory:inspiratory ratio ( P = 0.011) in the intervention group at 6 weeks when compared with baseline values, indicating improved parasympathetic reactivity to DBT. "365 breathing" technique can reduce IOP and serum cortisol, and improve autonomic dysfunction in patients with glaucoma.

Retrospective evaluation of surgical outcomes in canine patients with primary and secondary glaucoma following diode endoscopic cyclophotocoagulation.

To evaluate the long-term outcome of endoscopic cyclophotocoagulation (ECP) for the treatment of primary and secondary glaucoma in dogs. Retrospective review of dogs that underwent ECP at two referral centers from 2004 to 2023. Medical records of 389 eyes (301 dogs) following ECP were reviewed. Outcomes evaluated included follow-up time, intraocular pressure (IOP), vision status, additional ECP procedures performed, number of medications, and complications. Patient and surgical variables and their association with IOP control and vision maintenance were evaluated. Median follow-up time was 18 months. IOP remained controlled in 90% and 95% of patients at 1 and 2 years, respectively, following ECP. IOP was controlled long-term (2 years) in cases with primary (88%) and secondary (99%) glaucoma. Post-operative vision was maintained in 63% and 49% of eyes at approximately 1 and 2 years, respectively. Median time to vision loss was 6.5 months. Repeat ECP was required in 15.4% of eyes at a median of 19 days post-operatively. Eyes that underwent more than one ECP surgery had a significantly longer median time to blindness (13.8 months) than those that underwent a single ECP procedure (3.6 months; p = .0003). The median number of anti-glaucoma medications decreased from three pre-operatively to one at 1- and 2-year post-operatively. Complications included corneal ulceration (28%), blinding hypotony (11%), retinal detachment (11%), and hyphema (10%). Endolaser cyclophotocoagulation is an effective surgery for maintaining long-term IOP control and extending vision in canine patients with glaucoma refractory to medical management.

The progress of assessment methods and treatments of neovascular glaucoma secondary to central retinal vein occlusion.

Neovascular glaucoma is a condition that results from central retinal vein occlusion and often leads to blindness. Accurate evaluation and appropriate treatment are crucial for patients. However, there is currently no uniform and clear standard to differentiate between ischemic and non-ischemic central retinal vein occlusion. Also, the assessment of neovascular glaucoma progression is uncertain. Meanwhile, although pan-retinal photocoagulation is a standard treatment to prevent the onset of neovascular glaucoma, its actual efficacy and the timing of intervention remain highly controversial. It is still challenging to balance the risks of side effects in the visual field against the uncertain effectiveness of the treatment. This paper delves into the pathogenesis of neovascular glaucoma to understand the development of therapeutic approaches. By taking into account various assessment criteria of central retinal vein occlusion and neovascular glaucoma over the years, combining functional tests and morphological tests provides the most accurate and rigorous solution. The age of patients, the extent, location, and duration of retinal ischemia are the primary factors that affect the severity and extent of ischemic central retinal vein occlusion and induce serious complications. From the perspective of prevention and treatment, the ischemic index is closely related to the development of neovascularization. The paper provides essential insights into the mechanism, efficacy, complications, and optimal timing of pan-retinal photocoagulation. Comparing the treatment effects of pan-retinal photocoagulation and intravitreal anti-VEGF injections, we suggest a combination of both treatments to explore effective treatment with fewer side effects in the long term. This article details the debate on the above issues and explores ideas for the clinical diagnosis and preventive treatment of neovascular glaucoma that results from ischemic central retinal vein occlusion.

Evaluation of the LDN-0060609 PERK Inhibitor as a Selective Treatment for Primary Open-Angle Glaucoma: An In Vitro Study on Human Retinal Astrocytes.

The term glaucoma encompasses various neurodegenerative eye disorders, among which the most common is primary open-angle glaucoma (POAG). Recently, the essential role of human retinal astrocytes (HRA) in glaucoma progression has been placed in the spotlight. It has been found that placing the endoplasmic reticulum (ER) under stress and activating PERK leads to apoptosis of HRA cells, which inhibits their neuroprotective effect in the course of glaucoma. Therefore, the aim of the present study was to evaluate the effectiveness of the small-molecule PERK inhibitor LDN-0060609 in countering ER stress conditions induced in HRA cells in vitro. The activity of LDN-0060609 was studied in terms of protein and mRNA expression, cytotoxicity, genotoxicity, caspase-3 level and cell cycle progression. LDN-0060609 at 25 μM proved to be a potent inhibitor of the major PERK substrate, p-eIF2α (49% inhibition). The compound markedly decreased the expression of pro-apoptotic ER stress-related genes (ATF4, DDIT3, BAX and Bcl-2). Treatment with LDN-0060609 significantly increased cell viability, decreased genotoxicity and caspase-3 levels, and restored cell cycle distribution in HRA cells with activated ER stress conditions. These findings indicate that the small-molecule PERK inhibitor LDN-0060609 can potentially be developed into a novel anti-glaucoma agent.

Deep learning-based identification of eyes at risk for glaucoma surgery

To develop and evaluate the performance of a deep learning model (DLM) that predicts eyes at high risk of surgical intervention for uncontrolled glaucoma based on multimodal data from an initial ophthalmology visit. Longitudinal, observational, retrospective study. 4898 unique eyes from 4038 adult glaucoma or glaucoma-suspect patients who underwent surgery for uncontrolled glaucoma (trabeculectomy, tube shunt, xen, or diode surgery) between 2013 and 2021, or did not undergo glaucoma surgery but had 3 or more ophthalmology visits. We constructed a DLM to predict the occurrence of glaucoma surgery within various time horizons from a baseline visit. Model inputs included spatially oriented visual field (VF) and optical coherence tomography (OCT) data as well as clinical and demographic features. Separate DLMs with the same architecture were trained to predict the occurrence of surgery within 3 months, within 3–6 months, within 6 months–1 year, within 1–2 years, within 2–3 years, within 3–4 years, and within 4–5 years from the baseline visit. Included eyes were randomly split into 60%, 20%, and 20% for training, validation, and testing. DLM performance was measured using area under the receiver operating characteristic curve (AUC) and precision-recall curve (PRC). Shapley additive explanations (SHAP) were utilized to assess the importance of different features. Model prediction of surgery for uncontrolled glaucoma within 3 months had the best AUC of 0.92 (95% CI 0.88, 0.96). DLMs achieved clinically useful AUC values (> 0.8) for all models that predicted the occurrence of surgery within 3 years. According to SHAP analysis, all 7 models placed intraocular pressure (IOP) within the five most important features in predicting the occurrence of glaucoma surgery. Mean deviation (MD) and average retinal nerve fiber layer (RNFL) thickness were listed among the top 5 most important features by 6 of the 7 models. DLMs can successfully identify eyes requiring surgery for uncontrolled glaucoma within specific time horizons. Predictive performance decreases as the time horizon for forecasting surgery increases. Implementing prediction models in a clinical setting may help identify patients that should be referred to a glaucoma specialist for surgical evaluation.

Modulation of TRPV4-mediated TNF-α expression in Müller glia and subsequent RGC apoptosis by statins

In addition to regulating cholesterol synthesis, statins have neuroprotective effects. Apoptosis of retinal ganglion cells (RGCs) causes a gradual loss of visual function in glaucoma. This study aimed to investigate the neuroprotective effect of statins on the RGC apoptosis induced by activated Müller glia. Primary Müller cells and RGCs were cultured from the retina of C57BL6 mice. Müller cells were activated with GSK101, a transient receptor potential vanilloid 4 (TRPV4) agonist, and tumor necrosis factor-alpha (TNF-α) released to the medium was measured using an enzyme-linked immunosorbent assay. Cells were pretreated with simvastatin or lovastatin before GSK101. RGCs were treated with conditioned media from Müller glia cultures, and apoptosis was determined using flow cytometry. TRPV4 activation through GSK101 treatment induced gliosis of Müller cells, and the conditioned media from activated Müller cells was potent to induce RGC apoptosis. Statins suppress both gliosis in Müller cells and subsequent RGC apoptosis. TNF-α release to the media was increased in GSK101-treated Müller cells, and TNF-α in the conditioned media was the critical factor causing RGC apoptosis. The increase in TRPV4-mediated TNF-α expression occurred through the nuclear factor kappa-light chain enhancer of activated B cell pathway activation, which was inhibited by statins. Herein, we showed that statins can modulate gliosis and TNF-α expression in Müller cells, protecting RGCs. These data further support the neuroprotective effect of statins, promoting them as a potential treatment for glaucoma.

The Finnish current care guideline for open-angle glaucoma.

This article is an English translation of the 4th Finnish Current Care Guideline for diagnostics, treatment and follow-up of primary open-angle glaucoma, normal-tension glaucoma and pseudoexfoliative glaucoma. This guideline is based on systematic literature reviews and expert opinions with Finland's geographical and operational healthcare environment in mind.

Changes of the bulbar conjunctiva as the result of glaucoma medication treatment

Aims/Purpose: To determine changes of the bulbar conjunctiva as the result of glaucoma medication treatment.Methods: We used an impression cytology method which implies the application of a cellulose acetate filter to the ocular surface, twice in the same place, to remove superficial layers of the nasal quadrant conjunctiva epithelium. The strips were removed after a few seconds of exposure, transferred into a fixative solution, followed by histological staining and light microscopy examination. The presence of squamous metaplasia was assessed using Nelson's scale, based on cells' morphology, staining behaviour, integrity and nucleoplasmic ratio. The case study included the first group of patients suffering from POAG and DED (80) (mean age = 63.8 ± 6.7 years) which was divided into 4 subgroups: 1 ‐ patients (40), who suffer from glaucoma for less than 5 years; 2 (40) ‐ more than 5 years; subgroup a (40) ‐ with one drug instilled, b (40) ‐ 2 or more drugs instilled. The second group consisted of almost healthy patients (mean age = 67.9 ± 8.9 years) All of them underwent general ophthalmological examination.Results: According to OSDI all glaucoma patients had dry eye symptoms (15 or more points). In subgroup 1 40% were diagnosed with Nelson I, 60% with Nelson II. In subgroup 2 15% had Nelson I, 55% had Nelson II and 30% had Nelson III. In subgroup a 20% of patients had Nelson I, 60% had Nelson II, and 20% were diagnosed with Nelson III. In subgroup b 30% had Nelson I, 60% had Nelson II, 10% of patients had Nelson III.Conclusions: 80% of cases show changes that correspond to II‐III Nelson degrees according to Nelson classification. The severity of metaplasia correlated with the duration of eye drops therapy, but not with the amount of them. According to the results that we received, and the international data, it is recommended to choose drugs without preservatives and other potentially toxic components for the long‐term treatment of glaucoma.

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.

Unsupervised Domain Adaptation Fundus Image Segmentation via Multi-scale Adaptive Adversarial Learning.

Segmentation of the Optic Disc (OD) and Optic Cup (OC) is crucial for the early detection and treatment of glaucoma. Despite the strides made in deep neural networks, incorporating trained segmentation models for clinical application remains challenging due to domain shifts arising from disparities in fundus images across different healthcare institutions. To tackle this challenge, this study introduces an innovative unsupervised domain adaptation technique called Multi-scale Adaptive Adversarial Learning (MAAL), which consists of three key components. The Multi-scale Wasserstein Patch Discriminator (MWPD) module is designed to extract domain-specific features at multiple scales, enhancing domain classification performance and offering valuable guidance for the segmentation network. To further enhance model generalizability and explore domain-invariant features, we introduce the Adaptive Weighted Domain Constraint (AWDC) module. During training, this module dynamically assigns varying weights to different scales, allowing the model to adaptively focus on informative features. Furthermore, the Pixel-level Feature Enhancement (PFE) module enhances low-level features extracted at shallow network layers by incorporating refined high-level features. This integration ensures the preservation of domain-invariant information, effectively addressing domain variation and mitigating the loss of global features. Two publicly accessible fundus image databases are employed to demonstrate the effectiveness of our MAAL method in mitigating model degradation and improving segmentation performance. The achieved results outperform current state-of-the-art (SOTA) methods in both OD and OC segmentation. Codes are available at https://github.com/M4cheal/MAAL.

The benefits of physical exercise on glaucoma management: Evidence‐based recommendations for eye care providers

The only proven method to treat glaucoma is the reduction and stabilization of intraocular pressure (IOP). A wide range of daily activities have shown to affect the IOP behaviour, and eye care specialists should be aware of their effects for the prevention and treatment of glaucoma. Indeed, the impact of physical activity on IOP has gained attention in the last years, and exercise prescription has emerged as a promising adjuvant strategy for IOP control in glaucoma patients. Previous studies have demonstrated that the IOP response to physical exercise may be dependent on numerous factors such as exercise type (e.g., endurance, resistance), exercise intensity, subjects´ fitness level, body position (e.g., supine vs. standing) and breathing pattern adopted during exercise, underlying medical conditions, concomitant mental effort or caffeine intake before exercise among others. This talk will summarize the available scientific evidence on the positive and negative effects of physical exercise on IOP, and provides practical recommendations for exercise prescription in glaucoma patients or those at risk. It will permit to better understand the potential benefits of exercise prescription as a coadjuvant strategy for the prevention and management of glaucoma, which would be of great relevance due to the important health, economic and social burdens associated with this condition.

Sigma‐1 receptor agonist ameliorates trabecular meshwork fibrosis by modulating extracellular matrix remodelling and increasing nitric oxide production

Purpose: Maintenance of normal tissue homeostasis in the trabecular meshwork (TM) is crucial for unaltered intraocular pressure (IOP). Fibrotic‐like disorder of TM can be one of the main causes of increased IOP. Thus, anti‐fibrotic drugs could be novel therapeutics for glaucoma. Nitric oxide (NO) has been recognized as an important regulator of TM outflow and maintain IOP. Recently, we reported that fluvoxamine (FLU), a potent sigma‐1 receptor (S1R) agonist, decreases the levels of key elements of fibrosis in the kidney and in lung. Therefore, here we investigated the antifibrotic effectiveness of FLU in mouse and human TM cells.Methods: Fibrosis was induced with platelet‐derived growth factor (PDGF, 20 ng/mL, 24 h) in human and mouse primary TM cells (wild type: WT; and S1R knockout: KO). All cells were treated with 10 μM FLU for 24 h. Then localization of S1R, cell ‐toxicity, −proliferation and ‐migration, and levels of F‐actin, αSMA, fibronectin, and cathepsin K were determined with immunofluorescence or brightfield microscopy. NO production was measured with a fluorescent reader.Results: S1R is localized in the endoplasmic reticulum and TM cells' cytoplasm. FLU treatment is non‐toxic and reduces the PDGF‐induced cell proliferation, migration and fibrotic protein levels (fibronectin, αSMA). Furthermore, in human TM cells, FLU increases NO production and the level of the protease, cathepsin K thus moderating the cytoskeletal rearrangements. The protective role of S1R in fibrosis is confirmed by the more prominent increase of αSMA and F‐actin bundle and clumps in the KO cells.Conclusions: S1R agonist FLU reduces fibrosis‐related processes in TM cells by increasing NO production and facilitating ECM degradation. We propose in vivo investigations as a next step, since we believe that S1R activation could be a novel and efficient treatment in glaucoma or in other fibrosis related eye disease.GrantsOTKA‐ K135398, LP2021‐3/2021, TKP2021‐EGA‐24.