Types Of Open-angle Glaucoma Research Articles

Macula vessel density and its relationship with the central visual field mean sensitivity across different stages of exfoliation glaucoma

ABSTRACT Clinical relevance Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma. Background This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages. Methods In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature–function and structure–function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately. Results The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p = 0.9). The macula vessel density (%)–visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes (r = 0.464 p = 0.01), while no such correlation was notable for the early stage POAG eyes (r = –0.029 p = 0.89). Conclusion The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.

Comparison of peripapillary vascular density as measured by optical coherence tomography angiography between various types of open-angle glaucoma

The purpose of this study is to compare the peripapillary vascular density in patients with various types of open-angle glaucoma (primary open-angle glaucoma, pseudoexfoliative glaucoma and pigmentary glaucoma) with healthy subjects by optic coherence tomography angiography (OCTA). Twenty-seven eyes with diagnosed POAG, thirty-four eyes with diagnosed PXG, twenty eyes with diagnosed PG and thirty eyes of healthy individuals were included in our study. Peripapillary vessel density measurements were performed with all images; (AI-DD), intra-disc (ID-DD) and peripapillary (PP-DD); measurement of vascular density in the radial peripapillary capillary network was performed by OCTA. The Kruskal-Wallis test and post-hoc test were performed for statistical analysis. AI-DD was 50.76±2.07% in the healthy group, 47.12±2.57% in POAG, 39.71±6.64% in PXG, and 43.37±1.55% in PG. ID-DD was 50.49±3.74% in the healthy group, 49.51±6.83% in POAG, 38.42±13.46% in PXG, and 40.9±4.45% in PG. PP-DD was 51.26±3.12% in the healthy group, 50.13±3.04% in POAG, 42.31±7.31% in PXG, and 47.6±1.40% in PG. While it was found that all image and intra-disc vascular density measurements were statistically significantly lower in the PG and PXG group compared to the healthy group and the POAG (P<0.001), there was no significant difference between PXG and PG or between the control group and POAG. The lower radial peripapillary capillary density in PXG and PG compared to the POAG and healthy groups suggests that the blood flow around the optic disc is negatively affected in these patients.

Assessment of Risk Factors for Advanced Open Angle Glaucoma Presentation among Patients Visiting Jimma University Medical Center, Jimma, Ethiopia.

Glaucoma is the predominant cause of irreversible blindness, particularly the late presentation. The purpose of this study is to identify the risk factors associated with late presentation in Jimma University Medical Center. A case-control study was done among patients newly diagnosed to have open angle glaucoma (of any type) at Jimma University Medical Center from July 2014 - January 2019. Cases were patients/eyes diagnosed to have any type of open angle glaucoma with advanced glaucomatous disc features, whereas controls were patients diagnosed with early and moderate stages of glaucoma. There were 205 (116 cases and 89 controls) participants. The mean age of the participants at the time of diagnosis was 58.3±13.4yrs. Family history of blindness, presenting IOP, type of glaucoma and age were independently associated with late presentation. Patients with family history of blindness had late advanced glaucoma five times higher than those with no family history of blindness. The presence of late glaucoma among patients with presenting intra ocular pressure < 30mmHg is lower than those having ≥30mmHg (Adjusted Odds Ratio= 0.136). Primary open-angle glaucoma patients were less likely to present with advanced glaucoma than pseudoexfoliative glaucoma patients (Adjusted Odds Ratio=0.39). The chance of presenting with late glaucoma was increased by 3.4% for every one year increment of age. Presence of family history of blindness, high presenting intraocular pressure, pseudoexfoliative glaucoma and old age are risk factors for late presentation of glaucoma.

OUTCOME OF LASER MANAGEMENT IN GLAUCOMA DISEASE

The study aimed to evaluate the efficacy and predictive factors of success after selective laser trabeculoplasty (SLT) for treating various types of open-angle glaucoma in iraq. Design: The study employed a retrospective cohort design. Materials and Methods: The study retrospectively recruited subjects diagnosed with open-angle glaucoma receiving first time selective laser trabeculoplasty. Primary open-angle glaucoma (POAG), ocular hypertension (OHT) and other types of open-angle glaucoma were included. Reduced intraocular pressure (IOP) of 20% or decreased number of antiglaucoma drugs usage after SLT was defined as success. Various parameters were analyzed for association with SLT success. Results: 192 eyes were recruited in the study. Mean pre- and postSLT IOP were 19.31 ±3.59 and 15.04±3.13 mmHg, respectively. IOP decreased significantly in all follow-up visits (p&lt;0.001). Overall, 59.4% met the treatment endpoint. More than 10% postSLT IOP elevation at 1 hour was the only covariate positively associated with SLT success in both univariate (odds ratio (OR) = 1.042, p = 0.037) and multivariate analyses (OR = 1.040, p = 0.046). Underlying hypertension and preSLT IOP were negatively associated with SLT success in both univariate (OR = 0.970, p = 0.026, OR = 0.955, p &lt; 0.001) and multivariate analysis (OR = 0.970, p = 0.026, OR = 0.991, p &lt; 0.001). Conclusion: IOP significantly decreased as well as the number of antiglaucoma drugs needed after SLT. More than 10% postSLT IOP elevation at 1 hour was a positive predictor whereas systemic hypertension and preSLT IOP were negative predictors of SLT success.

Outcome After Selective Laser Trabeculoplasty for Glaucoma Treatment in a Thai Population

PurposeThe study aimed to evaluate the efficacy and predictive factors of success after selective laser trabeculoplasty (SLT) for treating various types of open-angle glaucoma in a Thai population.DesignThe study employed a retrospective cohort design.Materials and MethodsThe study retrospectively recruited Thai subjects diagnosed with open-angle glaucoma receiving first time selective laser trabeculoplasty. Primary open-angle glaucoma (POAG), ocular hypertension (OHT) and other types of open-angle glaucoma were included. Reduced intraocular pressure (IOP) of 20% or decreased number of antiglaucoma drugs usage after SLT was defined as success. Various parameters were analyzed for association with SLT success.ResultsNinety-six eyes were recruited in the study. Mean pre- and postSLT IOP were 19.31±3.59 and 15.04±3.13 mmHg, respectively. IOP decreased significantly in all follow-up visits (p<0.001). Overall, 59.4% met the treatment endpoint. More than 10% postSLT IOP elevation at 1 hour was the only covariate positively associated with SLT success in both univariate (odds ratio (OR) = 1.042, p = 0.037) and multivariate analyses (OR = 1.040, p = 0.046). Underlying hypertension and preSLT IOP were negatively associated with SLT success in both univariate (OR = 0.970, p = 0.026, OR = 0.955, p < 0.001) and multivariate analysis (OR = 0.970, p = 0.026, OR = 0.991, p < 0.001).ConclusionIOP significantly decreased as well as the number of antiglaucoma drugs needed after SLT. More than 10% postSLT IOP elevation at 1 hour was a positive predictor whereas systemic hypertension and preSLT IOP were negative predictors of SLT success.

Circulating salusin-beta levels in various open-angle glaucoma types

Circulating salusin-beta levels in various open-angle glaucoma types

Gonioscopy-assisted Transluminal Trabeculotomy: An Ab Interno Circumferential Trabeculotomy: 24 Months Follow-up.

The purpose of this study was to provide 24-month follow-up on surgical success and safety of an ab interno circumferential 360-degree trabeculotomy. Chart review of patients who underwent a gonioscopy-assisted transluminal trabeculotomy (GATT) procedure was performed by 4 of the authors (D.S.G., O.S., R.L.F., and D.G.G.). The surgery was performed in adults with various types of open-angle glaucoma with preoperative intraocular pressures (IOPs) of ≥18 mm Hg. In total, 198 patients aged 24 to 89 years underwent the GATT procedure with at least 18 months follow-up. Patients with primary open-angle glaucoma had an average IOP decrease of 9.2 mm Hg at 24 months with an average decrease of 1.43 glaucoma medications. The mean percentage of IOP decrease in these primary open-angle glaucoma groups at 24 months was 37.3%. In secondary open-angle glaucoma, at 24 months there was an average decrease in IOP of 14.1 mm Hg on an average of 2.0 fewer medications. The mean percentage of IOP decrease in the secondary open-angle glaucoma groups at 24 months was 49.8%. The cumulative proportion of failure at 24 months ranged from 0.18 to 0.48, depending on the group. In all 6 study groups, at all 5 postoperative time points (3, 6, 12, 18, and 24 mo) the mean IOP and reduction in glaucoma medications was significantly reduced from baseline (P<0.001) with the exception of one time point. The 24-month results demonstrate that GATT is relatively safe and effective in treating various forms of open-angle glaucoma. The long-term results for GATT are relatively equivalent to those previously reported for GATT and ab externo trabeculotomy studies.

Deep Sclerectomy with Porous Collagen in Open-angle Glaucoma, Short-term Study.

ABSTRACTAimTo assess the role of porous collagen in deep sclerectomy (DS), with and without trabeculo-Descemet membrane (TDM) rupture.Patients and methodsForty-six eyes with different types of open-angle glaucoma and medically uncontrolled intraocular pressure (IOP) were selected. DS was performed in all cases. Ologen was implanted as a single large piece in the scleral lake and subconjunctival space in all cases with and without TDM rupture.ResultsA total sample of 46 open-angle glaucoma patients were included in the study. The mean ± standard deviation (SD) IOP was 25.6 mm Hg ± 10.6 (range 12-58 mm Hg) pre-operatively. On follow-up, the mean ± SD IOP was 6.1 mm Hg ± 3.7 (range 2-20 mm Hg) 1 day postoperatively and 9.3 mm Hg ± 4.0 (range 4-23 mm Hg) after 1 month of follow-up, at 12 months the IOP was at 12.1 mm Hg ± 3 (range 8-18 mm Hg). The overall mean ± SD IOP reduction percentage was 48.3% ± 21.3 (range 0.0-86.2). Comparing mean IOP reductions at last follow-up between TDM rupture cases and non-TDM cases (Mann-Whitney test), the mean ± SD IOP reduction in TDM rupture patients was 12.1 ± 8.0 mm Hg (range 2-27) meanwhile, in non-TDM rupture patients it was 14.3 ± 11.4 mm Hg (range 0-50). However, the difference in IOP reduction between the two groups was not significant. (p = 0.689)ConclusionPorous collagen can enhance the results of DS; also, it helps to proceed with DS in cases of TDM rupture without converting to trabeculectomy.How to cite this article: Elbably A, Othman TM, Mousa A, Elridy M, Badawy W, Elbably M. Deep Sclerectomy with Porous Collagen in Open-angle Glaucoma, Short-term Study. J Curr Glaucoma Pract 2018;12(2):85-89.

Update on Microinvasive Glaucoma Surgery.

Update on Microinvasive Glaucoma Surgery.

Deep Sclerectomy – what I learned from my first 20 cases

SummaryDeep Sclerectomy (DS) is a commonly performed procedure for many types of open angle glaucoma, particularly in mainland Europe. The procedure has also gained popularity throughout the UK over the last years, with more units and surgeons in different parts of Great Britain teaching and learning this technically challenging but very rewarding technique. Many glaucoma sub‐specialists undergo intense fellowship training before embarking on independent practice but no experience specifically prepares you for the first months of your solo career. Additionally, DS may not be ubiquitously performed and competition from more traditional surgeries (e.g. trabeculectomy) and Micro‐incisional Glaucoma Surgery (MIGS) can result in limited exposure (or none at all) to this type of procedure during the course of a fellowship and/or insecurity when performing the first few cases independently. This part of the SIS will provide expert tips and genuine advice from a newly appointed glaucoma consultants trained in DS and currently teaching the procedure within a large UK tertiary referral setting. The speaker will share videos and experiences from the first few cases as a solo glaucoma specialist. The course will include tips on preventing and handling complications, sharing of lessons and expected pitfalls, and pearls on how to properly and safely teach residents and fellows to perform this procedure.

Update on the Prevalence, Etiology, Diagnosis, and Monitoring of Normal-Tension Glaucoma.

Glaucoma is a leading cause of blindness worldwide. Normal-tension glaucoma (NTG) is a type of open-angle glaucoma with intraocular pressure measurements always 21 mm Hg or less. A controversy surrounding NTG is the question of whether it should be regarded as a disease within the spectrum of primary open-angle glaucoma or as a distinctive disease entity. Nonetheless, NTG does have distinctive features compared with primary open-angle glaucoma: intraocular pressure-independent risk factors for development of NTG, characteristic patterns of structural and functional damage, and a unique disease course. This review provides an overview and update on the current issues surrounding the prevalence, etiology, diagnosis, and monitoring of NTG.

Ab interno trabeculectomy: a comprehensive review

PURPOSE To summarize the original literature on ab interno trabeculectomy with the Trabectome system and to review its efficacy and safety in the treatment of glaucoma. METHOD A literature search in PubMed was performed on ab interno trabeculectomy with the Trabectome system, and clinical relevant information was reviewed and summarized. RESULTS Ab interno trabeculectomy with the Trabectome system on average lowered intraocular pressure (IOP) to the mid-teens, and decreased the number of required glaucoma medications. Greater preoperative IOP correlated to a greater percent reduction in IOP. The success rates varied among studies, and the definition of success differed by authors. Intraoperative blood reflux was found in nearly all cases. Incidences of early hypotony and IOP spikes were low. No cases of endophthalmitis, wound leak, aqueous misdirection, choroidal hemorrhage or effusions, and irreversible visual acuity decrease ( ≥ 2 Snellen lines) have been reported. Available studies had a significant amount of data overlap. Only limited data on long-term results was available. There was no randomized controlled trial to date. CONCLUSIONS Ab interno trabeculectomy with the Trabectome system is an effective and safe surgical approach for patients with various types of open angle glaucoma. On average, the procedure at least in the short term lowers IOP to the mid teens regardless of preoperative IOP with or without the aid of topical medications.

Selective Laser Trabeculoplasty: A Clinical Review.

ABSTRACTSelective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with glaucoma. It achieves its results by selective absorption of energy in the trabecular pigmented cells, sparing adjacent cells and tissues from thermal damage, with minimal morphological tissue alteration following treatment. On the basis of the peer-reviewed medical literature, SLT is efficacious in lowering IOP, as initial treatment or when medical therapy is insufficient in all types of open-angle glaucoma in all races. SLT achieves intraocular pressure reduction similar to that of argon laser trabeculoplasty but without the tissue destruction and side effects. Observed side effects following SLT were almost uniformly transient and minor. We review highlights of recently published studies on the mechanisms and clinical outcome of SLT in order to address frequently raised issues pertinent to SLT in the clinical practice.Key messages: Selective laser trabeculoplasty is a safe and effective treatment modality for lowering the intraocular pressure in patients with glaucoma.How to cite this article: Alon S. Selective Laser Trabeculoplasty: A Clinical Review. J Current Glau Prac 2013; 7(2):58-65.

Clinical characteristics of newly diagnosed primary, pigmentary and pseudoexfoliative open-angle glaucoma in the Collaborative Initial Glaucoma Treatment Study

Background/aimsThree types of open-angle glaucoma (OAG)—primary, pigmentary and pseudoexfoliative—are frequently encountered. The aim of this study was to compare demographic, ocular and systemic medical information collected on people with these...

Selective Laser Trabeculoplasty in the Treatment of Open-angle Glaucoma

To determine the effect of selective laser trabeculoplasty (SLT) on different types of open-angle glaucoma (OAG) in terms of intraocular pressure (IOP). In this prospective, nonrandomized, interventional study, patients with OAG, unresponsive to maximum tolerable antiglaucoma medication, were enrolled. One thirty six eyes were studied. Distribution of glaucoma type was 91 primary OAG eyes (POAG, 66.9%), 22 pseudoexfoliative glaucoma (PEX, 16.2%) eyes, and 23 pigmentary glaucoma (PG, 16.9%) eyes. Main outcome measures were IOP and number of antiglaucoma medications used before operation, at 1 day, at 1 week, and at 1 to 18 months after surgery. Using the standard approach 360-degree SLT was done. The mean follow-up was 16.6±4.3 months. The mean preoperative IOP was 22.0±3.7 mm Hg, and reduced to 18.3±3.7 mm Hg at last visit. The overall mean IOP decrease was 3.6±2.6 mm Hg (16.3%) on the last visit compared with before surgery, indicating a reduction of 16.7% in POAG, 16.6% in PEX, and 14.5% in PG. Comparison of IOP values at 6 and 16 months showed an increase of 0.5 and 2.7 mm Hg in total sample and PG group. IOP reduction was significantly less among diabetic patients. SLT resulted in a significant IOP reduction of 16.3% at 16 months after surgery. The level of IOP reduction did not vary in POAG, PEX, and PG groups. A significant increase in IOP was observed in PG group after 6 months. The procedure seemed least effective in diabetic patients.

Pattern of intraocular pressure reduction following laser trabeculoplasty in open-angle glaucoma patients: comparison between selective and nonselective treatment

ObjectiveTo compare the pattern of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT) in open-angle glaucoma (OAG) patients, and to investigate the ability of initial IOP reduction to predict mid-term success.MethodsA prospective, nonrandomized, interventional case series was carried out. Consecutive uncontrolled OAG glaucoma patients underwent SLT or ALT; the same preoperative medical regimen was maintained during follow-up. Data collected included age, type of OAG, pre- and postoperative IOP, number of glaucoma medications, and surgical complications. Post-treatment assessments were scheduled at day 1 and 7 and months 1, 3, and 6.ResultsA total of 45 patients (45 eyes) were enrolled [SLT group (n = 25); ALT group (n = 20)]. Groups were similar for age, baseline IOP, and number of glaucoma medications (P ≥ 0.12). We found no significant differences in mean IOP reduction between SLT (5.1 ± 2.5 mmHg; 26.6%) and ALT (4.4 ± 2.8 mmHg; 22.8%) groups at month 6 (P = 0.38). Success rates (IOP ≤ 16 mmHg and IOP reduction ≥25%) at last follow-up visit were similar for SLT (72%) and ALT (65%) groups (P = 0.36). Comparing the pattern of IOP reduction (% of IOP reduction at each visit) between groups, we found a greater effect following SLT compared with ALT at day 7 (23.7% ± 13.7% vs 8.1% ± 9.5%; P < 0.001). No significant differences were observed at other time points (P ≥ 0.32). Additionally, the percentage of IOP reduction at day 7 and at month 6 were significantly correlated in the SLT group (R2 = 0.36; P < 0.01), but not in the ALT group (P = 0.89). Early postoperative success predicted late success in most SLT cases (82%). No serious complications were observed.ConclusionAlthough mid-term results suggest SLT and ALT as effective and equivalent alternatives, a greater initial IOP reduction was observed following SLT. In addition, the initial IOP reduction was a good predictor of mid-term success in patients undergoing SLT, but not ALT.

Comparison of the morphological characteristics of the glaucomatous optic nerve damage in different types of open angle glaucoma

Abstract Purpose To analyze the morphological characteristics of the ONH damage in Hyperbaric Glaucoma (HG), Focal damage glaucoma (FG) and in Pseudoexfoliative Glaucoma (PEXG), using Optical Coherence Tomography (OCT). Methods This is a prospective, cross sectional study. Basal, untreated IOP was measured in all cases. ONH and RNFL were evaluated using the OCT stratus 3.0 and the fast optic disc strategy and the fast RNFL thickness, respectively. Only one eye per patient was included. The ANOVA test was used for comparison of the means of quantitative parameters. Results 36 HB, 43 GF and 28 PEXG eyes were included in the study. Untreated IOP was 30.9 mmHg in HB, 19.1 mmHg in FG, and 24.5 mmHg in PEXG eyes. (p=0.0001 for all comparisons). No significant difference was found neither in the RNFL thickness nor in the disc area between groups. In PEXG eyes the rim area and volume were significantly greater than in the other two groups (p=0.0001). No significant difference was observed in the ONH excavation between FG and HB eyes. Conclusion Different types of Open Angle Glaucomas, with a similar degree of RNFL thickness, and similar disc areas, show different morphological ONH damage, as evaluated by the OCT. Automated morphological evaluation of the ONH may be useful to characterize different types of open angle glaucomas.

Correlation between basal IOP and functional damage in three different types of open angle glaucoma (OAG)

Abstract Purpose To analyze the correlation between basal, untreated IOP and visual field damage in newly diagnosed Hyperbaric glaucoma (HB), Focal damage glaucoma (FG) and pseudoexfoliative glaucoma (PEXG). Methods This is a prospective, cross sectional study. Basal, untreated IOP was measured in all cases. The Retinal fiber layer (RNFL) thickness was measured using the OCT stratus 3.0 and the fast RNFL thickness strategy. Visual field was evaluated using the Humphrey field analyzer, achromatic perimetry, SITA standard 24‐2 strategy. Corneal pachimetry was measured in all eyes. Only one eye per patient was included. Linear regression analyses and Pearson’s correlation coefficients between the basal IOP and the global Visual Field (VF) indices were performed. The ANOVA test was used for comparison of the means of quantitative parameters. Results 36 HB, 43 GF and 28 PEXG eyes were included in the study. Untreated IOP was 30.9 mmHg in HB, 19.1 mmHg in FG, and 24.5 mmHg in PEXG eyes. (p=0.0001 for all comparisons). Central corneal thickness was also different in each group. PEXG eyes had the thicker corneas (568.56 microns) and FG had the thinnest corneas (527.43 microns). No significant difference was found in the RNFL thickness or in the Mean Defect of the visual field between groups. Basal IOP was significantly correlated with the VF Mean Defect in HG (p=0.006, r=0.44) and in PEXG (p=0.002, r=0.55). No statistically significant correlation was found between both parameters in FG eyes. Conclusion Different types of Open Angle Glaucomas with a similar degree of glaucomatous damage, show a different correlation between untreated IOP and visual field damage.

Correlation between structural and functional damage in three different types of open angle glaucoma

Abstract Purpose To analyze the correlation between Optic Nerve Head (ONH) parameters, evaluated using Optical Coherence Tomography (OCT), and visual field damage in newly diagnosed patients with Pseudo Exfoliative Glaucoma (PEXG), Focal Damage Glaucoma (FG) and Hyperbaric Glaucoma (HG). Methods This is a prospective, cross sectional study. Basal, untreated IOP was recorded in all subjects. When both eyes of the same subject fulfilled the inclusion criteria, only one eye was randomly chosen for analysis. OCT stratus 3.0, fast optic disc strategy and Humphrey conventional achromatic perimetry (sita 24‐2) were performed. Linear regression analyses and Pearson’s correlation coefficients between several ONH parameters and the global Visual Field (VF) indices were used for the statistical analysis. Results 36 HB, 43 FG and 28 PEXG eyes were included in the study. We found strong and statistically significant correlations between the MD and the majority of the structural parameters of the ONH in the HB and PEXG groups. No significant correlation was found between any ONH parameter and MD in the FG group. We also found statistically significant correlations between most ONH parameters and the PSD in HB PEXG and FG groups. Conclusion The correlation between morphological visual field damage is different in different type of Open Angle Glaucomas.

Little evidence for association of the glaucoma gene MYOC with open-angle glaucoma

Background/aimTo determine if overexpression of the glaucoma gene MYOC is involved in the development of open-angle glaucoma (OAG) and if its promoter variants are associated with glaucoma in the Korean...