Treatment Of Open-angle Glaucoma Research Articles

Efficacy of XEN gel stent implantation combined with mitomycin C injection in the treatment of open-angle glaucoma: a meta-analysis

ObjectiveTo assess the efficacy of XEN gel stent implantation combined with mitomycin C (MMC) injection in controlling intraocular pressure (IOP) and the dosage of postoperative medication for open-angle glaucoma (OAG) patients.MethodsThe PubMed, Embase, Cochrane Library, and Science Direct databases were searched from inception to August 2022 without any language restriction. All studies that compared IOP and the dose of medication before and after XEN gel stent implantation and MMC injection for OAG patients were included. Data extraction and methodological quality evaluation were performed.ResultsA total of 26 studies (2329 eyes) were involved in meta-analysis. It was revealed that IOP at 1 month after XEN implantation was significantly lower than preoperative IOP [group 1, IOP between 19.2 and 21.2 mmHg: mean difference (MD) = 7.60, 95% confidence interval (CI) [6.55, 8.66], I2 = 0%, P < 0.01; group 2, IOP between 21.6 and 22.8 mmHg: MD = 5.83, 95% CI [4.94, 6.71], I2 = 0%; group 3, IOP between 23.5 and 24.3 mmHg: MD = 9.22, 95% CI [8.33, 10.10], I2 = 0%; group 4, IOP between 24.4 and 26.2 mmHg: MD = 11.64, 95% CI [10.49, 12.80], I2 = 0%)]. Moreover, IOP at 3 months after XEN implantation was also significantly lower than preoperative IOP (MD = 8.31, 95% CI [2.54, 8.46], Z = 13.92, P < 0.00001). IOP at 6 months after XEN implantation was significantly lower than preoperative IOP, and no heterogeneity was found between two groups (group 1, IOP between 17.8 and 21.8 mmHg: MD = 5.71, 95% CI: [5.05, 6.36], I2 = 0%, P < 0.01); group 2, IOP between 22.1 and 23.9 mmHg: MD = 7.92, 95% CI [7.15, 8.70], I2 = 0%, P < 0.01). Low heterogeneity was noted in one group (group 3, IOP between 24.3 and 26.2 mmHg: MD = 9.32, 95% CI [8.66, 9.97], I2 = 30%). It was found that IOP at 12 months after XEN implantation was significantly lower than preoperative IOP (MD = 8.11, 95% CI [7.09, 9.12], Z = 15.68, P < 0.00001). There was high heterogeneity among the different baseline IOP groups at 24-month post-surgery (CHi2 = 41.74, df = 1, I2 = 97.6%, P < 0.01), while no heterogeneity was identified in two groups (group 1, IOP between 19.2 and 22.1 mmHg: MD = 6.30, 95% CI [5.76, 6.85], I2 = 0%, P < 0.01); group 2, IOP between 22.8 and 23.8 mmHg: MD = 9.11, 95% CI [8.45, 9.77], I2 = 0%). Subgroup analysis indicated that the dosage of medication was significantly reduced at 6 months after XEN implantation (group 1, the amount of medication was 2.3–2.96: MD = 1.90, 95% CI [1.78, 2.02], I2 = 0%, P < 0.01); group 2, the amount of medication was 3.2–3.3: MD = 2.59, 95% CI [2.43, 2.75], I2 = 0%). Furthermore, the dosage of medication at 12 months (MD = 1.96, 95% CI [1.72, 2.21], Z = 15.80, P < 0.01) and 24 months (group 1, the amount of medication was 1.89–2.7: MD = 6.30, 95% CI [5.76, 6.85], I2 = 0%, P < 0.01); group 2, the amount of medication was 2.72–3.07: MD = 9.11, 95% CI [8.45, 9.77], I2 = 0%) after XEN implantation was significantly lower compared with the preoperative level.ConclusionXEN implantation combined with MMC injection significantly decreased IOP in OAG patients at 1, 6, 9, 12, and 24 months after treatment. In addition, XEN implantation combined with MMC injection decreased the amount of medication used at 6, 12, and 24 months after treatment in OAG patients.

Two-Year Retrospective Study of Cataract Surgery and Schlemm Canal Hydrus Microstent in Black and Afro-Latino Patients.

The Hydrus Microstent has been shown to be efficacious in the treatment of Open-angle Glaucoma. We previously reported 1-year results of the Hydrus Microstent in Black and Afro-Latino patients. Here we report two-year results of the Hydrus Microstent in Black and Afro-Latino patients with mild to moderate open-angle glaucoma. This was a retrospective, nonrandomized study that was carried out at two private practices in Harlem, NY and Queens, NY. This study consisted of Black and Afro Latino patients who had a Hydrus Microstent implanted for the treatment of glaucoma. The evaluated parameters were intraocular pressure (IOP), reductions in the number of medications, mean deviation on visual field test and visual acuity. We excluded persons with advanced glaucoma and incomplete data. We included those with mild to moderate glaucoma and had complete two-year follow-up data. The study consisted of 86 patients and 86 eyes. The mean age was 69.The mean pre-op IOP was 14.1 on 2.17 medications. At two years the mean IOP was 14 (p = 0.651) on 0.42 medications (p = 0.000003); 88% of patients were medication free (p = 0.651), The MD on the visual field changed little from -5.73 preoperatively to -5.21 at two years. There were 3 intraocular pressure spikes and 1 case of hyphema that were treated and had complete resolution. No patients required secondary surgery. Our results show that at two years the Hydrus Microstent can maintain low intraocular pressures, reduce medication burden and, in aggregate, experienced little change in visual field Mean Deviation in Black and Afro Latino patients with mild to moderate glaucoma.

Comparative outcomes of selective laser trabeculoplasty delivered by optometrists compared with ophthalmologists: a UK-based multicentre observational study

BackgroundSelective laser trabeculoplasty (SLT), a National Institute for Care and Health Excellence recommended first-line treatment for open-angle glaucoma and ocular hypertension, is increasingly delivered by optometrists. This retrospective multicentre observational...

Fully recognizing selective laser trabeculoplasty

Selective laser trabeculoplasty (SLT), as one of the main methods for the treatment of open-angle glaucoma, has again aroused wide concern in recent years. Although SLT has a clear effect on reducing intraocular pressure, its role needs to be fully recognized. In order to provide guidance for the clinical SLT practice, this article summarizes and discusses the current status of SLT treatment for glaucoma, its therapeutic effects on primary open-angle glaucoma, ocular hypertension, and other types of glaucoma, surgical details, and application prospects.

Development and validation of the method of quantification of 5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide and its metabolites in laboratory animal plasma

Introduction. The study of the systemic exposure of a new original drug is an essential part of its preclinical study. 5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide is a new selective carbonic anhydrase II inhibitor for the treatment of open-angle glaucoma. Methods for the quantitative determination of this compound and its N-hydroxy- and N-acetyl metabolites in the plasma of laboratory animals have not been previously developed.Aim. Development and validation of a method of quantitative determination of 5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide and its metabolites N-hydroxy-5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide (M1) and N-acetyl-5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide (M2) in rat and rabbit blood plasma by HPLC-MS/MS.Materials and methods. Protein precipitation by methanol was applied for sample preparation. 5-[2-(morpholine-4-carbonyl)-1,3-oxazole-5-yl]-thiophene-2-sulfonamide was used as an internal standard. A 5 % aqueous solution of ascorbic acid was added to the plasma samples at volume ratio 1 : 2 to prevent decomposition of N-hydroxy-5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide. The combination of sodium fluoride and potassium oxalate was selected as an anticoagulant. Chromatographic separation was performed on Zorbax Eclipse Plus C18 column (150 × 3.0 mm, 3.5 µm) with Zorbax Eclipse Plus C18 pre-column (12.5 × 2.1 mm, 5.0 µm) using a mobile phase based on a 0.1 % aqueous solution of formic acid and methanol. Mass spectrometric detection was carried out in the MRM mode using electrospray ionization in negative polarity. The method was tested during a pharmacokinetic study of a 1 % ocular suspension of 5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide on 6 Wistar rats. Blood samples were collected before administration, as well as 30 min, 1 h, 1 h 30 min, 2 h, 3 h, 4 h, 6 h, 8 h, 12 h, 24 h, 48 h, 72 h, 144 h, 216 h after administration. The non-compartment approach was used for calculation pharmacokinetic parameters.Results and discussion. The developed method has been validated in parameters of selectivity, calibration curve, accuracy and precision, matrix effect, dilution integrity, carry over, reinjection reproducibility, stability. The analytical range of determination of 5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide in plasma was 10–4000 ng/ml, M1 – 1.0–400.0 ng/ml, M2 – 0.1–40.0 ng/ml. The selected combination of anticoagulant and stabilizer solution allows storage of plasma samples in freezing chamber for 28 days.Conclusion. The developed method has been fully validated and confirmed its suitability for quantitative determination of 5-[5-(trifluoromethyl)-1,2-oxazole-3-yl]-furan-2-sulfonamide and its metabolites in the blood plasma of laboratory animals. The method has been successfully used for pharmacokinetic study of 1 % ocular suspension of the drug.

Responsiveness to Selective Laser Trabeculoplasty in Open-Angle Glaucoma and Ocular Hypertension

Selective laser trabeculoplasty (SLT) is becoming the recommended first choice in the treatment of open-angle glaucoma (OAG). However, whether repeat SLT can be recommended regardless of initial response remains controversial. To assess the potential of OAG and ocular hypertension (OHT) undergoing repeat laser to respond favorably to SLT, termed responsiveness to SLT. This post hoc analysis of the Laser in Glaucoma and Ocular Hypertension Trial in China (LiGHT China) was conducted from March 2015 to April 2023 in Zhongshan Ophthalmic Center. Of 1376 newly diagnosed OAG and OHT eyes of 771 adults in the original trial, 180 eyes of 105 participants were included in the present study, which underwent initial and repeat SLT as primary treatments. Standard SLT was the primary treatment. Repeat SLT was the first choice of treatment escalation regardless of initial response. IOP reduction after SLT and the duration of effect were analyzed. The maximum reduction in IOP within 2 years after initial SLT and repeat SLT was used to identify potential nonresponsiveness. IOP reduction 2 months after SLT. A total of 180 eyes from 105 Chinese participants (mean [SD] age, 45.6 [14.5] years; 58 [55.2%] male and 47 [44.8%] female) underwent repeat SLT. Initial SLT and repeat SLT were both associated with a reduction in IOP (mean, 4.5 mm Hg; 95% CI, 3.9 to 5.1; P < .001 and mean, 3.3 mm Hg; 95% CI, 2.7 to 3.8; P < .001, respectively). The mean (SD) IOP after repeat SLT was 15.8 (3.4) mm Hg, similar to 16.0 (4.0) mm Hg after initial SLT (difference, -0.4mm Hg; 95% CI, -1.0 to 0.3; P = .24). Duration of effect after repeat SLT was longer than after initial SLT (1043 days vs 419 days; hazard ratio, 0.38; 95% CI, 0.29 to 0.50; P < .001). IOP reduction after initial SLT was uncorrelated with that after repeat SLT, and 153 eyes (85.0%) responded favorably to SLT at least once. A subset of 27 eyes (15.0%) was identified as potentially nonresponsive and found distinctive with older age (mean [SD], 54.1 [12.5] years vs 44.2 [14.2] years; difference, 10.5 years; 95% CI, 2.9 to 18.1; P = .009), higher proportion of female participants (difference, 27.5%; 95% CI, 3.6 to 51.5; P = .03), and lower baseline IOP (difference, -3.2 mm Hg; 95% CI, -5.2 to -1.3; P = .001). These post hoc analyses showed that most cases of OAG and OHT were highly responsive to SLT and support the consideration of repeat SLT regardless of initial response, while individuals who are nonresponsive to this treatment may have specific features.

Selective Laser Trabeculoplasty vs Medical Therapy for the Treatment of Open-angle Glaucoma or Ocular Hypertension: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

Selective laser trabeculoplasty (SLT) and medical therapy groups displayed comparable intraocular pressure (IOP) at most follow-ups. SLT was associated with significantly decreased rates of glaucoma surgeries, antiglaucomatous medications, and ocular adverse effects. To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) compared to medical therapy in the treatment of open-angle glaucoma (OAG) or ocular hypertension (OHT). A systematic search was performed in PubMed, Embase, Cochrane Library and Web of Science databases. Randomized controlled trials (RCTs) comparing SLT with medical therapy were included. We computed mean differences (MDs) or standardized mean differences (STDs) for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Software R, version 4.2.1, was used for statistical analyses. Subgroup analyses were performed on treatment-naive patients and on the class of drugs in the medical therapy group. Fourteen RCTs comprising 1,706 patients were included, of whom 936 were submitted to SLT. Medical therapy was associated with a significantly improved IOP at 1 month and a higher proportion of patients achieving ≥20% IOP reduction. There were no significant differences between groups in IOP at 2, 3, 6, and 12 months, IOP fluctuation, rate of eyes at target IOP, visual field, and quality of life. The SLT group exhibited significantly decreased rates of glaucoma surgeries, antiglaucoma medications, and ocular adverse effects. SLT demonstrated comparable efficacy to medical therapy in IOP control at most follow-ups, along with favorable impacts on critical treatment-related factors. Our findings support SLT as a safe and effective treatment for OAG or OHT.

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.

Long-term outcomes of canaloplasty and phaco-canaloplasty in the treatment of open angle glaucoma: a single-surgeon experience

PurposeTo evaluate and compare the long-term outcomes of canaloplasty and phaco-canaloplasty in the treatment of open angle glaucoma and assess the prognostic factors associated with surgical outcome.MethodsA 48-month retrospective analysis was performed on n = 133 open angle glaucoma eyes treated with canaloplasty and n = 57 open angle glaucoma eyes treated with phaco-canaloplasty by a single surgeon. Surgical success was defined according to six criteria, achieving a target intraocular pressure (IOP) ≤ 21, 18 or 15 mmHg on glaucoma medications (qualified success) or without any further treatment (complete success), including laser therapy or surgery. Kaplan–Meier survival analysis and Cox regression analysis were performed to evaluate surgical success and preoperative factors associated with surgical outcome. Surgical complications in the early postoperative period were compared between canaloplasty and phaco-canaloplasty.ResultsCanaloplasty and phaco-canaloplasty significantly reduced postoperative IOP and number of glaucoma medications (p = 0.001 for both). Phaco-canaloplasty showed higher rates of cumulative surgical success over canaloplasty, but only for target IOP ≤ 21 and ≤ 18 (p = 0.018 and p = 0.011, respectively). A preoperative number of > 4 glaucoma medications predicted surgical failure. Phaco-canaloplasty was associated with a higher rate of IOP peaks in the first month compared with canaloplasty (40.4% vs 12.7%, p = 0.000).ConclusionCanaloplasty and phaco-canaloplasty demonstrated long-term efficacy in the treatment of open angle glaucoma, with phaco-canaloplasty showing higher rates of surgical success compared to canaloplasty, but not for target IOPs lower than 16 mmHg. Patients on more than 4 preoperative glaucoma medications may not be good candidates for canaloplasty and may benefit from other surgical options.

Sustained Release Therapies with the Prostaglandin Analogues Intracameral Implants.

The travoprost intracameral implant was recently approved by the US Food and Drug Administration for sustained release medical treatment of open-angle glaucoma in the USA. The approval represents a substantial and progressive step forward in the area of sustained-release glaucoma therapy. Topical intraocular pressure-lowering medications for the treatment of glaucoma are faced with a host of challenges for long-term and usually lifelong care. A changing paradigm in glaucoma management involves first-line interventions with laser modalities, micro-invasive surgeries, and sustained-release treatment platforms. Future needs in the area of sustained-release therapy include a non-prostaglandin drug delivery platform and longer-term treatments that do not require surgical reintervention.

Two-year outcomes of Xen 45 gel stent implantation in patients with open-angle glaucoma: real-world data from the Fight Glaucoma Blindness registry

ObjectiveTo evaluate efficacy and safety outcomes of the Xen 45 gel stent implant over 24 months of follow-up.MethodsA retrospective analysis of prospectively collected data from the Fight Glaucoma Blindness observational...

Evaluating the effect of pulse energy on femtosecond laser trabeculotomy (FLT) outflow channels for glaucoma treatment in human cadaver eyes.

Femtosecond laser trabeculotomy (FLT) creates aqueous humor outflow channels through the trabecular meshwork (TM) and is an emerging noninvasive treatment for open-angle glaucoma. The purpose of this study is to investigate the effect of pulse energy on outflow channel creation during FLT. An FLT laser (ViaLase Inc.) was used to create outflow channels through the TM (500 μm wide by 200 μm high) in human cadaver eyes using pulse energies of 10, 15, and 20 μJ. Following treatment, tissues were fixed in 4% paraformaldehyde. The channels were imaged using optical coherence tomography (OCT) and assessed as full thickness, partial thickness, or not observable. Pulse energies of 15 and 20 μJ had a 100% success rate in creating full-thickness FLT channels as imaged by OCT. A pulse energy of 10 μJ resulted in no channels (n = 6), a partial-thickness channel (n = 2), and a full-thickness FLT channel (n = 2). There was a statistically significant difference in cutting widths between the 10 and 15 μJ groups (p < 0.0001), as well as between the 10 and 20 μJ groups (p < 0.0001). However, there was no statistically significant difference between the 15 and 20 μJ groups (p = 0.416). Fifteen microjoules is an adequate pulse energy to reliably create aqueous humor outflow channels during FLT in human cadaver eyes. OCT is a valuable tool when evaluating FLT.

Efficacy and Safety of Rho Kinase Inhibitors vs. Beta-Blockers in Primary Open-Angle Glaucoma: A Systematic Review with Meta-Analysis.

Background: In order to support the positioning of Rho kinase inhibitors (Rhokis) in the European market for the treatment of glaucoma, scientific evidence comparing the efficacy and safety of Rhokis and beta-blockers (β-βs) in the treatment of open-angle glaucoma after 3 months was assembled through a systematic review and meta-analysis (meta-A) of randomized controlled trials (RCTs). Methods: Relevant articles were searched for on PubMed, EMBASE, and the Cochrane Library. Of the 251 articles found, three met all eligibility criteria. These three articles were assessed for risk of bias. Data were extracted and a random effects meta-A was performed. The studies' methods were homogeneous but there was great heterogeneity within the data (I2 = 92-93%; p < 0.001). Results: All studies had low risk of bias. The meta-A showed statistically better efficacy of β-βs, resulting in an intraocular pressure (IOP) reduction mean difference of 1.73 (1.19-2.27) at 8 a.m., 0.66 (0.19-1.15) at 10 a.m. and 0.49 mmHg (0.001-0.98) at 4 p.m., compared to Rhokis. This difference is not clinically significant as intra-operator variability of IOP measurements varies from ±2 to ±3 mmHg The adverse effects of Rhokis were essentially topical, whereas β-βs mainly caused systemic side effects. Conclusions: This Meta-A showed that Rhokis are clinically non-inferior to beta-blockers in reducing IOP. Rhokis have a better safety profile.

Minimally invasive micro sclerostomy (MIMS) procedure in the treatment of open-angle glaucoma

BackgroundTo evaluate the safety and efficacy of the Minimally Invasive Micro Sclerotomy (MIMS) procedure in the management of uncontrolled open-angle glaucoma.MethodsA prospective, open-label, single-arm clinical evaluation with intra-subject comparisons performed at the Ophthalmologic Center after S.V. Malayan, Yerevan, Armenia. Included were adults with primary open-angle glaucoma (OAG) (N = 114) or exfoliative glaucoma (N = 6) who were uncontrolled (IOP > 21) on tolerated topical medication. Mild (N = 7), moderate (N = 66) and severe (n = 47) cases were prospectively included without preselection. Following subconjunctival Mitomycin C, an ab-interno MIMS procedure was performed alone (N = 100) or combined with phacoemulsification (N = 20). Patients were followed for 52 weeks. Procedure-related complications and adverse events were recorded. Success criteria were defined as -5 < IOP ≤ 21mmHg OR a reduction in IOP of ≥ 20% from baseline with (qualified success) or without (complete success) hypotensive medications.ResultsMean patient age was 69 ± 10.1 years. The mean duration of the procedure was 2:01 ± 0:41 min:sec. Scleral drainage channels were achieved in all cases. No device malfunctions, intraoperative complications, or serious adverse events were reported. Iris plugging of the sclerostomy site and early spikes in IOP were the most common adverse events. The only reason for failure was final IOP > 21 mmHg on tolerated medication. At 52 weeks (n = 93), mean IOP decreased by 38% from baseline (P < 0.001), from 27.9 ± 3.7 to 17.5 ± 5.3 mmHg, a difference of 10.5 mmHg (95% CI: -11.7, -9.3). One-year qualified success was documented in 82.1% (95% CI: 72.9%,89.2%) of the patients and complete success, in 70.5% (60.3-79.4%). 60% (95 CI:49.4%,69.9%) of the patients achieved maximum IOP level of 14 mmHg or at least 30% reduction in IOP.ConclusionsMIMS procedure is a relatively simple, short and safe minimally invasive bleb-forming procedure. Its efficacy, as found in this short-term evaluation, lends it suitable for mild and moderate uncontrolled open-angle glaucoma patients.Trial registrationClinicalTrials.gov ID: NCT04503590 2019-05-29.

Real-World Analysis of the Efficacy of Bimatoprost Sustained-Release Glaucoma Implant Where American Indians Comprise the Largest Minority Population.

To assess the effectiveness and safety of bimatoprost sustained release (SR) glaucoma implant as a treatment for open-angle glaucoma and ocular hypertension in a real-world private practice setting with a significant American Indian population. This retrospective study included 156 eyes from adult patients who received a single injection of bimatoprost implant between June 2020 and May 2022 at the Oklahoma Eye Surgeons. Patients were stratified by baseline intraocular pressure (IOP) (≥21 mmHg versus IOP<21 mmHg). The co-primary endpoints were changes in the mean IOP and the number of topical IOP-lowering medications from baseline to Month 6. At 6 months, eyes with baseline IOP≥21 mmHg had a significantly lower mean IOP (19.85±8.01 versus 26.25±4.84 mmHg; p<0.0001) and the mean number of IOP-lowering medications (1.04±1.44 versus 1.38±1.50; p=0.048) compared with baseline. One year after implantation, 73.58% of eyes had a ≥20% reduction in IOP, 41.51% were medication-free and 30.19% were receiving at least one fewer medication. Among eyes with baseline IOP<21 mmHg, there was a significant reduction in the mean number of IOP-lowering medicines by Month 6 (0.61±1.03 versus 1.93±1.21 at baseline; p<0.0001), with no change in IOP. At 12 months, 24.27% of eyes had a ≥20% decrease in IOP, 43.69% of eyes did not require any medications and 63.11% had at least one fewer medication compared with baseline. An analysis using Welch's two-sample t-test showed no significant differences in the outcomes between the overall population and the American Indian population (number of eyes, 23). Bimatoprost SR glaucoma implant lowered IOP in eyes with high, uncontrolled baseline IOP, while it reduced the number of medications in eyes with a controlled baseline IOP. No clinically meaningful and statistically significant differences in the efficacy of bimatoprost were observed in patients of American Indian descent.

Relationship of intraocular pressure with age, blood pressure, and central corneal thickness in subjects with open-angle glaucoma

Background: Glaucoma, a chronic optic neuropathy, is the leading cause of irreversible blindness globally. The difficulties in the identification and treatment of open-angle glaucoma lie in the multifactorial nature of the disease, including individual variations, various risk factors, and the need for personalized treatment plans. Lowering intraocular pressure (IOP) is the only proven treatment for glaucoma, and controlling its fluctuations is crucial in preventing disease progression. Aims and Objectives: This study aimed to evaluate the association between IOP and various factors in primary open-angle glaucoma (POAG) subjects and compare it to control subjects. Materials and Methods: The study utilized a case–control design that included a total of 144 participants, divided into two groups: 72 individuals recently diagnosed with POAG and 72 apparently healthy subjects without glaucoma. The age range of the participants was between 40 and 75 years old, and both sexes were represented in the study. The factors examined were age, systolic blood pressure (SBP), diastolic blood pressure (DBP), and central corneal thickness (CCT). Results: The results of the study showed that individuals with POAG had significantly higher IOP, older age, higher SBP, and higher DBP compared to the control group. In addition, CCT was significantly lower in the POAG group. There were significant positive correlations between IOP and SBP, DBP, and CCT in both the POAG and control groups. There was also a significant negative correlation between age and IOP in both the groups. Conclusion: Determination of a target IOP and achieving the set target IOP does not give complete assurance that glaucoma progression will be prevented, as many other factors also play a part in it. The findings of this study highlight the importance of considering these factors when determining the target IOP for glaucoma treatment.

Selective Laser Trabeculoplasty for the Treatment of Glaucoma: A Report by the American Academy of Ophthalmology

To review the current published literature for high-quality studies on the use of selective laser trabeculoplasty (SLT) for the treatment of glaucoma. This is an update of the Ophthalmic Technology Assessment titled, "Laser Trabeculoplasty for Open-Angle Glaucoma," published in November2011. Literature searches in the PubMed database in March 2020, September 2021, August 2022, and March 2023 yielded 110 articles. The abstracts of these articles were examined to include those written since November 2011 and to exclude reviews and non-English articles. The panel reviewed 47 articles in full text, and 30 were found to fit the inclusion criteria. The panel methodologist assigned a level I rating to 19 studies and a level II rating to 11 studies. Data in the level I studies support the long-term effectiveness of SLT as primary treatment or as a supplemental therapy to glaucoma medications for patients with open-angle glaucoma. Several level I studies also found that SLT and argon laser trabeculoplasty (ALT) are equivalent in terms of safety and long-term efficacy. Level I evidence indicates that perioperative corticosteroid and nonsteroidal anti-inflammatory drug eye drops do not hinder the intraocular pressure (IOP)-lowering effect of SLT treatment. The impact of these eye drops on lowering IOP differed in various studies. No level I or II studies exist that determine the ideal power settings for SLT. Based on level I evidence, SLT is an effective long-term option for the treatment of open-angle glaucoma and is equivalent to ALT. It can be used as either a primary intervention, a replacement for medication, or an additional therapy with glaucoma medications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

MERCURY-3: a randomized comparison of netarsudil/latanoprost and bimatoprost/timolol in open-angle glaucoma and ocular hypertension

Purpose To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT).MethodsMERCURY-3 was a 6-month prospective, double–masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3.ResultsOverall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%).ConclusionsOnce-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.

Outcomes of standalone ab interno trabeculotomy in the treatment of open-angle glaucoma in eyes with high myopia

BackgroundWe retrospectively evaluate the long-term efficacy and safety of trabeculotomy glaucoma surgery in treating open-angle glaucoma (OAG) in eyes with high myopia (HM).MethodsThis study included 20 eyes with HM (axial length ≥ 26.5 mm) and OAG; age, preoperative IOP (intraocular pressure), and sex-matched 20 non-HM eyes (axial length < 26.5 mm) served as controls. Each eye underwent standalone ab interno trabeculotomy using a Kahook dual blade. A follow-up examination was performed 36 months after surgery. The main outcome measure was the operative success rate (i.e., a ≥ 20% pre- to post-operative reduction in IOP with or without IOP-lowering medication). Kaplan–Meier analysis was employed as a measure of surgical success. The secondary outcome measures were postoperative IOP, the number of glaucoma medications, and postoperative complications.ResultsIOP and the number of glaucoma medications were statistically significantly reduced at all postoperative follow-up examinations. The Kaplan–Meier analysis demonstrated that the probability of postoperative success at 36 months was 45% and 65% for HM and non-HM eyes, respectively. In the HM group, the presence of pathological myopia was statistically significant risk factor for surgical failure. No critical postoperative complications were detected.ConclusionsIn our study, the long-term efficacy of ab interno trabeculotomy in HM eyes with OAG was inferior to that in non-HM eyes with OAG. Our findings suggest that surgical indications for trabeculotomy in HM should be determined based on the presence of pathological myopia.

Trabeculectomy Vs Non-penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes.

Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma. Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication. Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively. Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.