Journal of Current Glaucoma Practice最新文献

Aim and background: To compare postoperative intraocular pressure (IOP) spikes and 1-year surgical success among goniotomy procedures: Kahook Dual Blade (KDB), OMNI, bent ab interno needle goniotomy (BANG), and gonioscopy-assisted transluminal trabeculotomy (GATT).

Materials and methods: This single-center, retrospective chart review included glaucoma patients ≥18 years, who underwent goniotomy from January 2021 to December 2022 with ≥3 months of follow-up. Primary outcomes were IOP spikes (≥10 mm Hg increase within 3 months) and 12-month surgical success (≥20% IOP and/or ≥1 medication reduction without further surgery). Secondary outcomes included IOP and medication changes.

Results: Among 247 eyes (107 KDB, 63 OMNI, 77 BANG; all with phacoemulsification), IOP spikes occurred in 13.0% with no difference between groups (p = 0.900). Spikes were more common in severe glaucoma and associated with failure (p = 0.041), postoperative interventions (p <0.001), and reoperation (p = 0.026). At 12 months (n = 164), 68.9% achieved success with no difference between procedures (p = 0.972). Lower baseline IOP, open-angle glaucoma (OAG), and IOP spikes predicted failure. GATT eyes (n = 39, mostly standalone) had different baseline characteristics, were excluded from main analysis, but showed similar success (79.3%) with greater IOP and medication reduction.

Conclusion: Kahook Dual Blade, OMNI, and BANG with phacoemulsification had comparable 1-year safety and efficacy. IOP spikes increase the risk of failure and reoperation, especially in severe glaucoma. GATT showed favorable outcomes when performed standalone.

Clinical significance: Choice among KDB, OMNI, and BANG can be individualized without compromising outcomes. Monitoring for IOP spikes is crucial in high-risk eyes. Standalone GATT offers strong results when cataract surgery is not needed.

How to cite this article: Shalaby WS, Chang SL, Yu J, et al. Impact of Postoperative Intraocular Pressure Spikes on Outcomes Following Goniotomy: A Comparative Study of Surgical Techniques. J Curr Glaucoma Pract 2025;19(4):186-198.

Purpose: To evaluate the effect of sub-Tenon's triamcinolone acetonide (TA) on the hypertensive phase (HP) and postoperative outcomes in patients with neovascular glaucoma (NVG) after Ahmed glaucoma valve (AGV) surgery.

Methods: We conducted a retrospective review of 112 NVG patients (58 TA, 54 non-TA) who underwent AGV implantation with a 6-month follow-up. HP was defined as intraocular pressure (IOP) > 21 mm Hg within the first 3 months. Primary outcomes included IOP and HP occurrence. Secondary outcomes included complications, number of glaucoma drops, surgical failure, and visual acuity (VA).

Results: Non-TA patients were significantly more likely to develop HP (70 vs 50%, p = 0.03). Mean IOP (18.34 ± 7.96 vs 17.75 ± 6.16 mm Hg, p = 0.75), VA (1.46 ± 0.96 vs 1.32 ± 0.94 logMAR, p = 0.56), surgical failure (63 vs 48%, p = 0.13), rates of complication (9.3 vs 5.2%, p = 0.48), and number of glaucoma eye drops (2.59 ± 1.38 vs 2.18 ± 1.63, p = 0.29) were similar at 6 months. Compared to baseline, significant IOP reductions were observed in the TA group at month 1 (-24.62 ± 16.60 vs -18.43 ± 14.39 mm Hg, p = 0.05) and month 3 (-25.65 ± 14.05 vs -19.05 ± 13.14 mm Hg, p = 0.03).

Conclusion: Sub-Tenon's TA reduces the risk of HP and short-term IOP spikes in NVG patients undergoing AGV implantation but does not improve long-term IOP regulation, visual outcomes, or surgical success.

Clinical significance: Reducing HP may help prevent early postoperative complications, improving short-term management of NVG patients receiving AGV implants.

How to cite this article: Hong AT, Kishi SH, Humayun L, et al. Effect of Sub-Tenon's Triamcinolone on Hypertensive Phase and Clinical Outcomes Following Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma Patients. J Curr Glaucoma Pract 2025;19(3):129-135.

Purpose: To investigate outcomes of interventional glaucoma therapy with canaloplasty in early glaucoma.

Methods: This retrospective single-center study included patients with mild-to-moderate open-angle glaucoma (OAG) who underwent Ab-interno canaloplasty (ABiC) with iTrack Advance (Nova Eye Medical) with or without combined phacoemulsification. Primary outcomes were intraocular pressure (IOP) and glaucoma medications at 12-, 24-month, and last follow-up (LFU) visits. Secondary outcomes included the proportion of eyes reaching target IOPs, requiring no medications, and achieving success as per American Academy of Ophthalmology (AAO) criteria.

Results: Ninety-eight eyes (60 patients, mean age: 71.4 ± 7.0 years) were included, with a mean follow-up of 19.0 ± 5.7 months. Mean IOP (mm Hg) reduced from 18.3 ± 4.3 at baseline (n = 98) to 14.2 ± 3.1 at 12 months (n = 93), 14.1 ± 3.3 at 24 months (n = 67), and 14.6 ± 3.2 at LFU (p < 0.001). Mean medications decreased from 1.9 ± 0.8 at baseline to 0.1 ± 0.5 at both 12 and 24 months, and 0.1 ± 0.4 at LFU, respectively (p < 0.001). At LFU, 89% of eyes achieved IOP ≤ 18 mm Hg, while 95% were medication-free compared to none at baseline. Success rates following combined canaloplasty and phacoemulsification (n = 90) and stand-alone canaloplasty (n = 8) were 81% and 50%, respectively. The average visual field mean deviation at baseline was -1.90 ± 2.8 dB, which remained stable at LFU (p = 0.439). The postoperative complication was a transient IOP spike (≥30 mm Hg) in two eyes. No sight-threatening complications were observed, and no additional glaucoma procedures were required.

Conclusion: Interventional treatment with iTrack Advance canaloplasty in early OAG showed high safety and achieved IOP control, with near-elimination of medication dependence sustained over 24 months postoperatively.

Clinical significance: iTrack Advance canaloplasty provides sustained IOP control and strong medication reduction in the medium term.

How to cite this article: Ondrejka S, Koerber N. The Impact of Interventional Glaucoma with and without Cataract Surgery in Early Open-angle Glaucoma: 24-month Results with a New Canaloplasty Device. J Curr Glaucoma Pract 2025;19(3):112-118.

Aims and background: The aim of this study is to compare and assess the correlation of retinal nerve fiber layer (RNFL) thickness, peripapillary retinal perfusion density, and flux index in primary open-angle glaucoma (POAG) patients and healthy eyes.

Materials and methods: This cross-sectional study analyzed 53 eyes of POAG patients and 56 eyes of healthy individuals. The peripapillary perfusion density and flux index were measured using optical coherence tomography angiography (OCTA), while the RNFL thickness was evaluated using Cirrus optical coherence tomography (OCT).

Results: In POAG patients, peripapillary retinal perfusion density significantly decreased in the superior, inferior, nasal, and total quadrants compared to healthy individuals (p = 0.0001), but no difference in the temporal quadrant (p = 0.670). The peripapillary retinal flux index also showed a significant reduction across all quadrants in the POAG group compared to healthy eyes (p = 0.0001). RNFL was significantly thinner in POAG patients than in healthy eyes (p = 0.0001 in the superior, inferior, nasal, and total RNFL; p = 0.017 in the temporal quadrant). A moderate to strong correlation was observed between peripapillary retinal perfusion density, flux index, and RNFL thickness in POAG subjects.

Conclusion: Decreased peripapillary retinal perfusion density and flux index have significant associations with RNFL thickness in POAG patients, indicating the role of peripapillary perfusion changes in RNFL thinning. This highlights the importance of including vascular assessments in POAG diagnostics and management.

Clinical significance: This study highlights the value of noninvasive diagnostic tools such as OCT and OCTA to assess both structural and vascular changes in glaucoma. This approach could help to detect POAG at an earlier stage, allowing for timely intervention to slow the disease progression.

How to cite this article: Rifada RM, Qorib LS, Riza Hardjasasmita IN, et al. Exploring Ocular Perfusion and Structural Alterations of POAG in Indonesia: Insights from OCTA and OCT Analysis. J Curr Glaucoma Pract 2025;19(3):136-142.

A cyclodialysis cleft develops when the meridional fibers of the ciliary muscle detach from the scleral spur, creating an aberrant aqueous drainage pathway between the anterior chamber and suprachoroidal space. Blunt ocular trauma and intraocular surgery have been identified as the most frequent causes. Cyclodialysis has been documented after phacoemulsification, extracapsular cataract extraction, secondary intraocular lens (IOL) implantation, goniotomy, trabeculotomy, trabeculectomy, and other intraocular surgeries. The new aqueous drainage pathway may lead to persistent severe ocular hypotony and its associated complications, which include cataract, choroidal detachment, retinochoroidal folds, disk edema, macular edema, and rarely, irreversible vision loss. The potentially blinding nature of this condition warrants early identification and appropriate management. Restoration of the attachment of the ciliary body (CB) to the sclera and closure of the cleft are the primary objectives of treatment. The etiology, pathophysiology, and surgical treatment of cyclodialysis cleft are discussed in this review.

How to cite this article: Sethi A, Udenia H, Beri N, et al. Surgical Management of Cyclodialysis Cleft: An Update. J Curr Glaucoma Pract 2025;19(3):143-152.

Background and objectives: Early diagnosis of glaucoma is one of the most crucial strategies to tackle the huge burden of glaucoma and associated blindness. Early diagnosis, though, will not cure the disease but prevent the progression of glaucoma, leading to a reduction in ocular morbidity. This study aimed to estimate the proportion of the population with knowledge of glaucoma and their attitude and practices related to the disease.

Materials and methods: We conducted this community-based cross-sectional study in Mendhasala, a rural block of Odisha, a state in eastern India. We chose two of the five sectors in the block using simple random sampling. We employed a 30 × 30 cluster sampling method, selecting 30 participants from each village. Households with at least one member over 18 were identified using systematic random sampling. The data were collected using a prestructured and validated questionnaire and analyzed using Microsoft Excel 2021.

Results: We gathered data from 899 participants, containing sociodemographic information and information about their knowledge, attitudes, and practices concerning glaucoma. The mean age of the participants was 45.7 years (SD 14.43), with an almost equal number of males and females. Only 4.23% (95% CI: 3.01%-5.8%) had ever heard of glaucoma, of whom three were unaware of the eye changes associated with the condition. Education and employment status were significant predictors of knowledge related to glaucoma.

Conclusion: Health education campaigns should be reinforced at the community level to increase the knowledge related to glaucoma. This may increase the care-seeking attitude towards glaucoma in the community.

How to cite this article: Taywade M, Nayak B, Pal D, et al. Knowledge, Attitude, and Practices Related to Glaucoma in a Rural Population of Eastern India: A Cross-sectional Study. J Curr Glaucoma Pract 2025;19(3):119-124.

Aim and background: Glaucoma is a leading cause of blindness in India, and treatment adherence is essential to prevent vision loss. However, studies have shown that treatment adherence rates among glaucoma patients in India are low. It is important to identify the factors determining treatment adherence in order to improve compliance with the treatment, thereby preventing worsening vision. The current study was conducted with an objective to assess the treatment adherence among glaucoma patients using the Morisky Medication Adherence Scale (MMAS-8) and to assess determinants of treatment adherence among the study participants. A drop instillation technique among the glaucoma patients was also evaluated.

Materials and methods: A cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at a selected tertiary care institute in Ahmedabad city. The calculated sample size was 100. Glaucoma patients receiving treatment for at least 3 months were enrolled. Systematic sampling was applied, wherein every alternate patient fulfilling the inclusion criteria was selected. After obtaining informed consent, interviews were conducted using a pretested and predesigned pro forma including MMAS-8. Participants were instructed to use sterile artificial tears, which were evaluated by the investigator for precision.

Results: The mean age of study participants was 62.0 ± 6.28 years. Among the participants, 54% were female. The study revealed that 82% of participants had poor adherence to glaucoma medication. Factors such as education, regular follow-up, and having received prior instruction were significantly associated with adherence to medications. Only 43% of the patients were able to instill the eye drops correctly.

Conclusion: Low adherence to medication was found among 82% of cases. Factors significantly associated with adherence were gender, education, duration of treatment, and having received prior instruction. Forgetfulness and the cost of treatment were the most common factors leading to low treatment adherence. Among 79 participants who were observed for the drop instillation technique, 43% were found to have instilled it properly.

How to cite this article: Shah V, Shah D, Desai HP, et al. A Cross-sectional Study on Adherence to Topical Glaucoma Medication and its Determinants among Patients Attending Glaucoma Clinics of a Tertiary Care Institute of Ahmedabad City, Gujarat, India. J Curr Glaucoma Pract 2025;19(3):107-111.

Aim and background: The XEN Gel Implant is a microstent, which aims to lower intraocular pressure by forming a subconjunctival bleb to drain aqueous. The aim of this study is to assess the IOP-lowering effects of a novel trimming surgical technique, which shortens the length of the XEN Gel Stent.

Materials and methods: Patients who underwent placement of an XEN Gel Stent using the novel primary trimming technique from 10/2020 to 6/2023 were included for chart review. The technique includes an intentional trimming of the XEN about 1 mm prior to ab interno placement. Outcomes included intraocular pressure (preoperative, postoperative month 1, postoperative month 6, postoperative year 1) as well as the number of glaucoma drops. Statistical analysis was performed to assess for differences between preoperative and postoperative outcomes.

Results: Thirty cases were included. The average age of patients was 73.3 ± 11.7 years. The average preoperative IOP was 19.9 ± 5.8 mm Hg. The average number of preoperative glaucoma drops was 2.6 ± 1.2. The average IOP at postoperative month 1 (14.0 ± 5.7 mm Hg), postoperative month 6 (13.8 ± 7.6 mm Hg), and postoperative year 1 (13.3 ± 8.0 mm Hg) were all significantly lower than preoperative IOP (p < 0.01). The average number of glaucoma drops at year 1 was 1.5 ± 1.2 and significantly lower than the number of preoperative glaucoma drops (p < 0.01). Postoperative complications included in-office bleb needling (33.3%), IOP spike (20%), hypotony (10%), and cystoid macular edema (3.3%). No cases had conjunctival erosion.

Conclusion: This surgical trimming technique for the XEN Gel Stent showed significant reductions in IOP at postoperative month 1, month 6, and year 1, as well as the need for fewer postoperative glaucoma drops for adequate control.

Clinical significance: This novel technique effectively lowers IOP among patients with a low IOP goal while maintaining a safety profile comparable to standard methods.

How to cite this article: Atta S, Li A. Intraocular Pressure and Medication Outcomes of a Novel Primary Trimming Technique for XEN Gel Stent. J Curr Glaucoma Pract 2025;19(3):125-128.