Journal of Current Glaucoma Practice最新文献

Background: Hemodialysis (HD) is a life-saving therapy for patients with end-stage renal disease (ESRD), yet its impact on ocular hemodynamics remains insufficiently characterized. Intraocular pressure (IOP) and ocular perfusion pressure (OPP) are critical determinants of ocular health, and their fluctuation during HD may predispose patients to complications, particularly in glaucoma.

Objective: To assess the effect of HD on IOP and OPP in patients on maintenance dialysis.

Materials and methods: This observational study included 50 ESRD patients undergoing regular HD. IOP was measured using a noncontact tonometer, and OPP was calculated before and after dialysis sessions. Demographic, clinical, and hemodynamic parameters were recorded. Pre- and postdialysis values were compared using paired statistical tests.

Results: Hemodialysis significantly increased IOP [right eye (RE): 13.56 ± 2.75 to 16.06 ± 1.97 mm Hg, p < 0.001; left eye (LE): 13.68 ± 2.67 to 16.51 ± 1.53 mm Hg, p < 0.001] and reduced OPP (RE: 49.2 ± 6.5 to 42.7 ± 5.8 mm Hg; LE: 47.6 ± 6.1 to 41.5 ± 5.7 mm Hg; both p < 0.001), with a mean decline of 7.6 mm Hg.

Conclusions: Hemodialysis significantly alters ocular pressure dynamics, with increased IOP and reduced OPP suggesting compromised ocular perfusion. Hypertension (HTN) and diabetes mellitus (DM) may exacerbate these effects. Although no acute ocular complications were observed, reduced OPP may increase the risk in patients with glaucoma or vascular disease. Routine ophthalmic monitoring and structured follow-up should be integrated into dialysis care.

How to cite this article: Donepudi VSS, Devasena M MA, Annamalai R, et al. The Influence of Hemodialysis on Ocular Pressure Dynamics: An Observational Study on IOP and OPP Changes. J Curr Glaucoma Pract 2025;19(4):182-185.

Aims and background: To describe cases of primary angle closure glaucoma (PACG) with neovascularization of iris/angle (NVI/NVA) with no obvious retinal pathology.

Case description: We provide a description of three patients with a diagnosis of PACG with NVI/NVA. Detailed history taking along with ophthalmic and systemic examination including slit lamp examination, gonioscopy, and fundus fluorescein angiography (FFA) was done in all patients. FFA revealed peripheral hyperfluorescence and capillary nonperfusion (CNP) areas in periphery in all three eyes. Carotid Doppler and tests for blood coagulation profile were done and no apparent cause of NVI/NVA could be found. Secondary causes of NVI such as proliferative diabetic retinopathy, central retinal vein occlusion, ocular ischemic syndrome (OIS), vasculitis, branch retinal vein occlusion, central retinal artery occlusion, branch retinal artery occlusion, and ocular tumors were ruled out. All these patients had features of angle closure and were hence diagnosed with PACG with NVI/NVA. We hypothesize that chronically raised intraocular pressure (IOP) can result in peripheral retinal ischemia, leading to elevated vascular endothelial growth factor (VEGF) production resulting in NVI/NVA.

Conclusion: PACG with NVI/NVA in absence of an obvious retinal pathology is a separate clinical entity. NVI without any obvious retinal pathology may occur in cases of PACG on account of development of peripheral retinal nonperfusion.

Clinical significance: PACG with NVI/NVA as per our series seem to have better prognosis than other causes of neovascular glaucoma (NVG). This distinction would help in management and follow-up. Caution should be taken to rule out all other causes.

How to cite this article: Angmo D, Wajiri GB, Verma S, et al. Neovascularization of the Iris/Angle in Primary Angle Closure Glaucoma: A Distinct Entity!. J Curr Glaucoma Pract 2025;19(4):229-233.

Aim and background: To evaluate the influence of age, race, and corneal factors on intraocular pressure (IOP) measurements using Goldmann applanation tonometry (GAT), Pascal dynamic contour tonometry (DCT), and the ocular response analyzer (ORA), and to assess their correlation and agreement.

Methods: A cross-sectional study included 231 eyes from 125 healthy individuals. Race was self-reported based on Brazilian Institute of Geography and Statistics criteria. Following anamnesis and ophthalmological examination, ultrasonic pachymetry, corneal curvature, and astigmatism measurements were performed. IOP was measured in random order with GAT, DCT, and ORA by a single examiner. Corneal hysteresis (CH) and corneal resistance factor (CRF) were also assessed.

Results: Age had no significant effect on tonometry readings. Race influenced only GAT measurements, with differences between mixed-race and Black (p = 0.03) and mixed-race and Asian individuals (p = 0.01). Central corneal thickness significantly affected GAT (p = 0.001) and ORA Goldmann-correlated IOP (p < 0.001). Corneal curvature influenced GAT (p = 0.007) and DCT (p = 0.001). CH significantly influenced only the corneal-compensated ORA measurement (p < 0.001). CRF affected GAT, DCT, and ORA Goldmann-related IOP readings (p < 0.001). Tonometry methods showed moderate to strong correlation (r = 0.63-0.86; p < 0.001), but only moderate agreement.

Conclusions: Age did not impact IOP measurements. Race influenced only GAT readings. Corneal properties variably affected all tonometry methods. Although the devices showed strong correlation, the agreement was moderate, highlighting the importance of considering corneal factors and device selection when evaluating IOP.

Clinical significance: The study shows that corneal features can affect IOP readings, especially with Goldmann tonometry. Age did not affect the results, and race had a small effect on Goldmann only. Devices correlated strongly but were not interchangeable due to wide limits of agreement. This means eye doctors should consider the type of device and corneal factors when checking IOP.

How to cite this article: Doi L, Oshima A, Hossaka S, et al. Influence of Age, Race, and Corneal Factors on Intraocular Pressure Measurements with Goldmann, Pascal, and Ocular Response Analyzer. J Curr Glaucoma Pract 2025;19(4):168-174.

Aims and background: Glaucoma is a leading cause of irreversible blindness worldwide. Its global prevalence is projected to exceed 110 million individuals by 2040 (Tham et al., 2014). In 2020, the disease accounted for an estimated 3.6 million cases of blindness and 4 million cases of moderate to severe visual impairment. Between 3 and 17% of patients develop refractory glaucoma, in which progression continues despite maximal medical and surgical treatment (Saunders et al., 2016). Optimizing management of these patients is essential to reduce the global burden of visual disability.

Methods: This was a single-center, observational, retrospective cohort study conducted at York and Scarborough Teaching Hospitals. We included patients with refractory glaucoma treated with a single session of transscleral cyclodiode laser between 2019 and 2023. Baseline demographics, intraocular pressure (IOP), and medication use were recorded. Treatment success was defined as ≥20% reduction in IOP and a final IOP ≤ 21 mm Hg at 12 months posttreatment or cessation of oral antihypotensive medication and/or reduction in the number of topical antiglaucoma drops.

Results: A total of 108 patients had cyclodiode laser treatment between 2019 and 2023. A total of 62 eyes from 57 patients were included. The average age of the patient was 71.5 ± 15.8 years. The mean baseline IOP was 36.4 ± 12.4 mm Hg, which significantly reduced to 19.0 ± 9.0 mm Hg at 12 months (p < 0.001). There was no significant correlation between baseline and posttreatment IOP. The average number of topical medications decreased from 3.4 ± 1.2 to 2.5 ± 1.4 (p < 0.001).

Conclusion: Transscleral cyclodiode laser achieved a 77.4% success rate in reducing IOP ≤ 21 mm Hg and ≥20% reduction. It was an effective and well-tolerated option for managing refractory glaucoma.

Clinical significance: This study supports the use of a single session of transscleral cyclodiode laser as a viable standalone treatment for patients with advanced, treatment-resistant glaucoma. Its ability to significantly lower IOP and reduce the need for systemic medications, with a favorable safety profile, makes it especially valuable for elderly and frail patients who are poor candidates for further surgery.

How to cite this article: Salari Y, Venugopal D, Sohail T, et al. Safety and Efficacy of Transscleral Cyclodiode Laser in Advanced Glaucoma: A Retrospective, Single-center Observational Cohort Study. J Curr Glaucoma Pract 2025;19(4):175-181.

Aims: This study aims to systematically evaluate and synthesize current evidence on the environmental risk factors and genetic markers associated with the development and progression of glaucoma, with a focus on primary open-angle (POAG), normal-tension glaucoma (NTG) and angle-closure glaucoma (ACG), in order to clarify their interplay, clinical implications, and potential avenues for personalized risk assessment and therapeutic intervention.

Background: Being one of the major causes of irreversible blindness in the world, glaucoma is a multifactorial optic neuropathy that has a complex interaction between clinical, environmental, and genetic factors. In this literature review, existing evidence on the risk factors and the genetic markers of glaucoma, induced by primary open-angle glaucoma (POAG), NTG, and primary angle-closure glaucoma (PACG), are synthesized.

Methodology: PubMed, Scopus, Web of Science, DOAJ, and Google Scholar have been searched by using key terms ('Glaucoma,' 'POAG,' 'ACG,' 'Risk Factors,' 'Genetic Markers,' etc.) for peer-reviewed articles, clinical trials, GWAS, and meta-analyses to meet up the study's aim.

Results: Epidemiologic studies reveal significant demographic variations, with POAG prevalent in African populations and PACG in East Asians. Key nonmodifiable risks include age, family history and ethnicity, while modifiable factors comprise elevated IOP, vascular dysregulation and lifestyle. Genetic studies implicate MYOC, OPTN and TBK1 mutations, along with emerging polygenic risk scores, underscoring the importance of personalized management considering gene-environment interactions.

Conclusion: In this review, early screening, genetic screening, and specific interventions have been highlighted to combat the menace of glaucoma that results in a high global burden.

Clinical significance: This comprehensive review enhances clinical practice by identifying high-risk populations for targeted screening and highlighting key genetic markers (e.g., MYOC, OPTN) that enable personalized glaucoma management. It improves diagnostic accuracy by clarifying modifiable (IOP, smoking) and nonmodifiable (age, family history) risk factors while informing therapeutic strategies through mechanistic insights into autophagy and vascular regulation. Additionally, the study addresses healthcare disparities by emphasizing ethnic-specific risk patterns and supports genetic counseling for familial cases, ultimately guiding more effective prevention and treatment approaches to preserve vision.

How to cite this article: Hamid SAT, Abdulmajeed SM, Chowdhury IH, et al. Risk Factors and Genetic Markers Associated with the Development and Progression of Glaucoma: A Review. J Curr Glaucoma Pract 2025;19(4):216-222.

Aim: To analyze the number of laser peripheral iridotomies (LPIs) performed from 2000 to 2021 in the United States.

Materials and methods: The Centers for Medicare and Medicaid Services Part B National Summary database was queried to obtain deidentified records of patients who underwent LPI between 2000 and 2021, and patients who underwent cataract surgery between 2011 and 2021. Annual total allowed services and charges were collected for CPT 66761 (LPI), and CPT 66982 and 66984 (cataract surgery). Annual inflation rates and population data were obtained from the US Bureau of Labor Statistics and the World Bank.

Results: The number of LPIs performed increased 58.8% from 64,935 in 2000 to 1,03,113 in 2008, remained fairly constant between 2009 and 2015, and declined 35.4% from 96,495 in 2016 to 62,376 in 2021. Allowed services per 10,000 people increased 47.37% from 2.301 in 2000 to 3.391 in 2008 before declining 44.59% to 1.879 in 2021. The US population increased 17.6% over the time period. LPI average allowed charge was $311.71 in 2000, increased to $376.77 in 2007, decreased to $269.88 in 2012, remained relatively constant from 2012 to 2018, and increased from $275.47 in 2019 to $280.33 in 2021. The average allowed charge decreased 10.1%, while the rate of cumulative inflation was 53%. Total annual allowed charge decreased 13.6% from 2000 to 2021, unadjusted for inflation.

Conclusion: From 2000 to 2021, the number of LPIs performed in the United States declined while population increased. Potential drivers include results of scientific studies that recommended early cataract surgery and observing patients with primary angle closure suspects (PACS), a shift in physician sentiment of the LPI risk-benefit ratio, and economic forces. Finally, the COVID-19 pandemic may have contributed to the decrease in LPIs in 2020 and 2021.

Clinical significance: The number of LPIs performed in the United States declined over the last 20 years, while the population has increased. Factors, such as influential studies recommending early cataract extraction and monitoring patients without LPI, shifting doctor sentiments, and economic factors may have affected LPI rates.

How to cite this article: Maheshwari A, Sarrafpour S, Jayaram R, et al. Quantification and Analysis of Laser Peripheral Iridotomies in the United States from 2000 to 2021. J Curr Glaucoma Pract 2025;19(4):208-215.

Aim: To evaluate the safety, efficacy, and risk factors for failure compared between trabeculectomy and open conjunctival ab externo Xen 45 gel stent (XGS AEO) placement.

Methods: For this retrospective single-center study, we included eyes of patients >18 years old with open-angle glaucoma and baseline intraocular pressure (IOP) >17 mm Hg who received trabeculectomy or XGS AEO placement. We excluded aphakic eyes and those missing preoperative data. The primary outcome was the rate of success (6 ≤ IOP ≤ 21 mm Hg, plus ≥20% IOP reduction from baseline, with or without ocular hypotensive medications) after 1 year, compared between groups. Alternative IOP upper limits were 18 and 15 mm Hg. Secondary outcomes were risk factors for failure, complications, and postoperative interventions.

Results: We studied 82 trabeculectomy eyes and 34 XGS AEO eyes. At 1 year, 62%, 61%, and 49% of trabeculectomy eyes and 72%, 69%, and 31% of XGS AEO eyes achieved success using IOP upper limits of 21, 18, and 15 mm Hg, respectively. There were no 1-year intergroup differences in IOP, IOP percent change, visual acuity, complications, or revision surgeries. Medication use was higher in the XGS AEO group. Prior trabeculoplasty was associated with a lower risk for failure in the XGS AEO group, but an increased risk in the trabeculectomy group. More eyes in the trabeculectomy group underwent manipulations postoperatively (p = 0.020).

Conclusion: Open conjunctival ab externo Xen placement is similar in efficacy and safety to trabeculectomy.

Clinical significance: The similar outcomes and fewer postoperative manipulations of XGS AEO implantation compared to trabeculectomy make it a reasonable surgical option in open-angle glaucoma.

How to cite this article: Applebaum SS, Hundito A, Teng CC, et al. Surgical Outcome Comparison of Open Conjunctival Ab Externo Xen 45 Gel Stent Implantation vs Trabeculectomy in Open-angle Glaucoma. J Curr Glaucoma Pract 2025;19(4):158-167.

Aims and background: Glaucoma represents a major driver of irreversible blindness globally, with intraocular pressure (IOP) reduction serving as the primary therapeutic objective. Trabeculectomy (TE), often augmented with mitomycin C (MMC), is considered the gold standard surgical treatment; however, its success is frequently compromised by postoperative fibrosis. Various MMC delivery techniques-such as sponge application and sub-Tenon injection (STI)-differ in their drug distribution profiles and may consequently affect surgical outcomes. Accordingly, we aimed to evaluate and compare the efficacy and safety of TE performed with sponge-applied MMC against STI-MMC.

Materials and methods: This prospective, randomized, controlled clinical trial enrolled 50 patients having primary or secondary glaucoma who were randomly allocated to undergo TE with either MMC sponge application (group A, n = 25) or STI-MMC (group B, n = 25) and followed for 12 months. The primary outcome measures included IOP reduction, while secondary outcomes assessed bleb morphology using the Indiana Bleb Appearance Grading Scale (IBAGS), bleb integrity via Seidel testing, and the requirement for postoperative glaucoma medications.

Results: Both groups achieved significant IOP reductions without intergroup differences at all postoperative intervals (p > 0.05). Bleb morphology differed significantly, with higher localized blebs in group A and flatter and more diffuse blebs in group B (p < 0.001). There were no significant differences in bleb vascularity or integrity. Postoperative medication needs were comparable (p = 0.732).

Conclusion: Both STI-MMC and sponge-applied MMC are equally effective for IOP control, though STI may produce more diffuse blebs, potentially reducing long-term complications. Further long-term studies are warranted.

Clinical significance: This study demonstrates STI-MMC noninferiority compared to sponge-applied MMC in achieving sustained IOP reduction after TE while highlighting distinct bleb morphologies with potential safety implications. These findings advocate for individualized MMC selection based on patient-specific risk factors, balancing technical simplicity with potential long-term safety.

Clinical trial registration: Retrospectively registered at ClinicalTrials.gov (Identifier: NCT06925412).

How to cite this article: Abdelhafeez SM, Mohammed Mohammed HE, Tharwat E, et al. Sponge Application of Mitomycin C vs Sub-Tenon Injection in Trabeculectomy: A Randomized Controlled Trial. J Curr Glaucoma Pract 2025;19(4):199-207.

Purpose: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for type 2 diabetes (T2D) and later adopted for weight loss, have demonstrated potential protection against the development of glaucoma in various peer-reviewed publications. This review provides a synthesis of the emerging evidence evaluating the link between GLP-1 RA treatment and glaucoma risk.

Methods: We performed a comprehensive literature search across PubMed, Embase (via OVID), and Scopus on May 28, 2025. Studies were included if they examined the association between GLP-1 RA use and glaucoma risk and presented novel quantitative data published in the last 6 years. Exclusion criteria included studies unrelated to glaucoma, those not evaluating GLP-1 RAs, and reviews without original data.

Results: Of the 44 studies identified, 9 met inclusion criteria: 5 retrospective observational studies, 1 nested case-control study, 1 preclinical study, 1 systematic review and meta-analysis, and 1 Mendelian randomization study. Most studies found a statistically significant association between GLP-1 RA use and reduced glaucoma risk, with stronger effects observed with prolonged exposure in three studies. One preclinical study demonstrated that the GLP-1 RA NLY01 mitigated retinal neuroinflammation and protected ganglion cells in a mouse model. Proposed mechanisms include intraocular pressure (IOP) reduction, attenuation of oxidative stress, and direct neuroprotection via GLP-1 receptor activation. However, one Mendelian randomization study did not support a causal link.

Conclusions: Current evidence suggests that GLP-1 RAs may confer a secondary benefit in reducing glaucoma risk, supported by both clinical and preclinical data. However, the predominance of retrospective studies, coupled with the lack of randomized controlled trials, limit causal inference. Further randomized controlled trials and mechanistic investigations are warranted to validate these findings and assess their translational potential in glaucoma prevention.

How to cite this article: Lang MV, Vasu P, Dorairaj EA, et al. Glaucoma Risk Reduction as a Secondary Benefit of Glucagon-like Peptide-1 Receptor Agonists: A Review of Emerging Evidence. J Curr Glaucoma Pract 2025;19(4):223-228.

How to cite this article: Bhartiya S, Aggarwal A, Dada R. Bridging Genomics and Practice: Rethinking Genetic Counseling in Glaucoma. J Curr Glaucoma Pract 2025;19(4):155-157.