Journal of Current Glaucoma Practice最新文献

Aim and background: To characterize the effects of glaucoma treatment on the corneal endothelium by quantifying corneal endothelial morphology in eyes with and without glaucoma using in vivo specular microscopy.

Materials and methods: This is a case-control study of 304 eyes conducted at an ambulatory glaucoma clinic at a tertiary academic institution from August 2021 through July 2023. Primary outcomes include endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (Hex). Images of the central corneal endothelium were obtained using a non-contact Konan NSP-9000 specular microscope (Konan Medical, Irvine, CA, United States). The highest quality image of each cornea was selected for analysis. Each corneal endothelial image was manually graded using the Center Method and analyzed using CellChek (Konan Medical, Irvine, CA, United States) software.

Results: Glaucomatous eyes demonstrate significantly lower corneal ECD compared to control eyes and glaucoma suspect eyes. Topical glaucoma drop use, trabeculectomy, and glaucoma tube shunt surgery independently predict a significant reduction in corneal ECD. Alpha agonist, carbonic anhydrase inhibitor (CAI), and Rho-associated protein kinase (ROCK) inhibitor drops independently predict a significant reduction in corneal ECD, with ROCK inhibitors predicting the greatest absolute decrease.

Conclusion: Eyes treated with topical drops, trabeculectomy, or glaucoma tube shunt implantation demonstrate lower corneal ECD compared to control eyes. Use of topical drops from the alpha agonist, CAI, and ROCK inhibitor classes predicts significant corneal endothelial cell loss.

Clinical significance: These findings provide valuable clinical context for the medical management of glaucoma that may reduce adverse outcomes and preserve corneal function in patients receiving ocular hypotensive therapy.

How to cite this article: Yang CD, Carbonell BAC, Hussey V, et al. Decoding Corneal Endothelial Loss from Glaucoma Treatment: A Case-Control Stratification Analysis. J Curr Glaucoma Pract 2025;19(2):68-74.

Aim: To report a unique presentation of an acute attack of angle closure glaucoma.

Methods: This report describes two cases of acute angle closure (AAC) presenting with ciliary body shutdown.

Results: Case 1-A middle-aged male reported with pain, watering, congestion, and decreased vision in the right eye (RE) since 6 days. He had clinical signs of hypotony in the RE with an intraocular pressure (IOP) of 5 mm Hg and poor ocular tone digitally. A diagnosis of acute attack of angle closure glaucoma was made, and he underwent YAG laser peripheral iridotomy (LPI) in both eyes. Case 2-Reported a patient with high hypermetropia who presented with acute angle crisis following a dilated evaluation and presented with low pressures.

Conclusion: Angle closure should be strongly suspected in patients with pain and sudden vision blurring, even if the initial IOP is low.

How to cite this article: Sharma A, Dubey S. Rare Presentations of Acute Angle Closure: A Case Series. J Curr Glaucoma Pract 2025;19(2):94-96.

Background: This study compares the quality of life (QoL) assessment using the glaucoma QoL (GQL-15), where patients rate their actual status for each of the four domains of visual disability, with that when the relative importance of each domain is reported by the patient.

Methodology: This observational, cross-sectional pilot study, conducted at a tertiary care hospital in North India, enrolled 37 patients with moderate to severe glaucoma. Each patient was administered the GQL-15 questionnaire. After each question was answered, the patient was asked to indicate the relative weighting of each domain, and the answer was graded from 1 to 5. The overall QoL score was obtained by multiplying each level of functioning with each domain weight and then adding these products. The individualized measures so obtained, divided by 5, were considered as a real-world measure of personalized QoL of the patient. Personalized QoL was compared to the standard GQL-15 score.

Results: The mean age of the patients was 63.86 ± 11.08 years, with male predominance (67.57%). Patients reported the highest visual impairment with walking on uneven ground (score = 2.70 ± 1.31), seeing at night (score = 2.54 ± 1.44), and reading newspapers (score = 2.51 ± 1.36). Patients gave the highest weightage to recognizing faces (score = 3.97 ± 0.64), and finding dropped objects (score = 3.73 ± 0.77). Highest score was bagged by seeing at night (8.35 ± 5.590 and adjusting to dim lights (8.35 ± 6.05, respectively), on analysis of the weighted GQL scores.

Conclusion: Patients with moderate to severe glaucoma prioritize recognizing faces and finding dropped objects. The patients who reported greater difficulty in lighting-related tasks, as well as peripheral and distance vision, also gave it more importance. Individualizing QoL measures is necessary for a better understanding of the patients' perception of their visual disability.

How to cite this article: Bhartiya S, Ichhpujani P, Kapoor S, et al. Weighted Quality of Life in Glaucoma Patients with Advanced Disease. J Curr Glaucoma Pract 2025;19(2):85-89.

Aims and background: Erectile dysfunction (ED) and primary open-angle glaucoma (POAG) are common in the elderly population. The current study aimed at assessing the incidence of ED and its correlation with POAG severity in Malaysia.

Materials and methods: A cross-sectional study at three Malaysian suburban ophthalmology clinics was conducted from September 2019 to 2020. A total of 220 participants aged 40-80 years completed a validated Malay version of the International Index of Erectile Function-5 (IIEF-5). Glaucoma severity was classified using a revised Advanced Glaucoma Intervention Study (AGIS) score. Medical history, ocular parameters, and treatments were reviewed.

Results: The participants' mean age was found to be 69.3 (±7.5) years, with prevalence of ED being 91%. IIEF-5 scores significantly declined with increasing glaucoma severity (p < 0.001), even after adjusting for comorbidities and topical beta-blockers. AGIS and IIEF-5 scores were significantly correlated (r = -0.262, p = 0.010). The incidence of ED increased by 1.23 times (OR = 1.23, 95% CI: 1.10-1.38) with the increase of every year in age. ED was not influenced by diabetes, hypertension, hyperlipidemia, or topical beta-blockers.

Conclusion: ED is common among POAG patients and increases with glaucoma severity. The association between ED and POAG is influenced by aging, complicating the determination of a direct relationship.

Clinical significance: This study highlights the potential association between vision impairment, specifically glaucoma, and sexual health in men. Focusing on sexual health in glaucoma patients is vital in order to improve overall quality of life (QoL) as well as ensure a holistic approach to patient care. Given the commonness of both conditions in older adults, this research provides insights into the significance of taking sexual health into consideration in the comprehensive treatment of glaucoma.

How to cite this article: Chee CC, Sabah H, Yaakub A, et al. Erectile Dysfunction in Patients with Primary Open-angle Glaucoma in Malaysia. J Curr Glaucoma Pract 2025;19(2):79-84.

Purpose: To determine the precision of the air-puff tonometer compared to the Goldmann applanation tonometer (GAT) and Schiotz tonometers.

Methods: The study is a descriptive, cross-sectional study that included 410 eyes from 205 primary open-angle glaucoma patients. Intraocular pressure (IOP) was measured with the air-puff tonometer, followed by the GAT, and finally, the Schiotz tonometer. Pachymetry was performed for all patients.

Results: IOP was 20.21 ± 3.63 mm Hg for the air-puff tonometer, 18.73 ± 3.41 mm Hg for GAT, and 18.29 ± 3.92 mm Hg for the Schiotz tonometer, and this difference was not statistically significant. In both eyes, the correlation values between GAT and the air-puff tonometer were greater than 0.8, signifying a strong correlation. Additionally, the Bland-Altman analysis revealed greater agreement between the GAT and the air-puff tonometer than with the Schiotz tonometer.

Conclusion: We can be confident that the air-puff tonometer provides accurate measurements close to those obtained by the GAT. Therefore, it can be reliably used for diagnosing, screening, and monitoring glaucoma patients, particularly in rural areas and during epidemics. Additionally, the values obtained from the Schiotz tonometer can be trusted, making it a reliable option for patients under general anesthesia or when other tonometers are unavailable.

How to cite this article: Khalil KM, Ghoneim EM, Gab-Alla A, et al. Evaluation of the Accuracy of Air-puff Tonometer Compared to Goldmann and Schiotz Tonometers among Egyptians. J Curr Glaucoma Pract 2025;19(2):75-78.

Aim and background: Glaucoma drainage device (GDD) implantation is effective for intraocular pressure (IOP) control but can lead to corneal endothelial cell loss due to tube positioning in the anterior chamber. This case report presents a novel surgical technique using a XEN stent as a "rescue" option for managing corneal endothelial cell loss after GDD surgery.

Case description: A 38-year-old male with uveitic glaucoma underwent Ahmed glaucoma valve (AGV) implantation. Despite controlled IOP postoperatively, progressive corneal endothelial cell loss was observed over 2 years. Tube revision was performed by replacing the AGV tube with a XEN stent, which connected the anterior chamber to the existing AGV. Postoperatively, endothelial cell counts (ECCs) stabilized, and IOP remained well-controlled without complications.

Conclusion: Replacing a GDD tube with a XEN stent is a promising alternative to prevent further corneal endothelial cell loss while maintaining IOP control.

Clinical significance: This approach provides a novel surgical option for patients with progressive corneal endothelial cell loss after GDD surgery.

How to cite this article: Hwang YH, Kim M, Choi J. XEN Surgery as a "Rescue" for Previous Glaucoma Drainage Device Surgery with Corneal Endothelial Cell Loss: A Case Report. J Curr Glaucoma Pract 2025;19(2):97-99.

Aim and background: To investigate stand-alone Kahook Dual Blade (KDB) goniotomy outcomes, prognostic factors, and specifically whether preoperative laser trabeculoplasty (LTP) influences outcomes.

Methods: This retrospective review included 26 eyes with predominantly severe glaucoma (n = 17, 65.4%) undergoing stand-alone KDB. Inclusion criteria included postoperative follow-up of ≥ 6 months. The primary outcome was surgical success, defined as IOP reduction ≥ 20% or reduced medication burden, and IOP ≤ 21 without reoperation. Secondary outcomes included IOP reduction, glaucoma medication use, and surgical complications. The Kaplan-Meier models were used to analyze surgical success. The Cox model determined risk factors for failure.

Results: Surgical success rates at postoperative months (POM) 6 and 18 were 57.7% ± 9.7 and 35.2% ± 9.9, respectively. Greater preoperative maximum IOP (Tmax) (Unit HR 1.11, 95% CI: 1.03-1.19, p = 0.007) and postoperative IOP spike (HR 6.54, 95% CI: 1.73-24.77, p = 0.006) were risk factors for failure. IOP decreased by 35.5% through POY 1.5 (p = 0.001) with no difference in medications. LTP-naïve eyes had significantly greater IOP reduction than those with prior LTP at POM 9 (53.7% ± 5.2 vs 21.5% ± 9.8, p = 0.022) and POY 1 (46.7% ± 6.7 vs 22.0% ± 17.7, p = 0.010). Five (19.2%) eyes experienced postoperative complications, most commonly IOP spike (n = 4, 15.4%).

Conclusion: Stand-alone KDB offers safe IOP reduction through POY 1.5. Those with a history of LTP have one-half the IOP response as LTP-naïve eyes. Despite IOP improvement, only one-third were successful at POY 1.5, with Tmax and postoperative IOP spike identified as risk factors for failure.

Clinical significance: Ophthalmologists performing stand-alone KDB may expect less IOP improvement in patients with a history of LTP and should understand this procedure may provide insufficient IOP control in those with a greater preoperative Tmax or who experience a postoperative IOP spike.

How to cite this article: Claxton MR, McHenry JG, Jones JK, et al. Outcomes of Stand-alone Kahook Dual Blade Goniotomy: Higher Maximum Intraocular Pressure and Laser Trabeculoplasty as Poor Prognostic Indicators. J Curr Glaucoma Pract 2025;19(2):90-95.

Aims and background: We aimed to compare the effects of ab externo trabeculotomy (AbE-TLO), gonioscopy-assisted transluminal trabeculotomy (GATT), and Ahmed glaucoma valve (AGV) implantation on intraocular pressure (IOP) and the number of antiglaucomatous medications used in pediatric aphakic glaucoma (AG).

Materials and methods: Between 2017 and 2022, 27 eyes of 24 children who underwent AbE-TLO, GATT, and AGV in our clinic for pediatric AG were retrospectively analyzed. Corneal dimensions, corneal thickness, axial length, and surgical technique were recorded. Baseline and postoperative follow-up IOP measurements and antiglaucomatous drops used were analyzed.

Results: AbE-TLO was performed in 37% (n = 9), GATT in 30% (n = 7), and AGV implantation in 33% (n = 8) of the patients included in our study. The mean follow-up period was 39.12 ± 3.19 months. In the 2nd postoperative year, IOP decreased significantly from 33.9 to 17.7 mm Hg with AbE-TLO (p = 0.014), from 34.3 to 18.3 mm Hg with GATT (p = 0.033), and from 34.5 to 16.4 mm Hg with AGV (p = 0.002). When all three surgical methods were compared, no significant difference was observed in IOP reduction at 1 and 2 years (p > 0.05). The number of antiglaucomatous medications decreased from 2.3 to 0.8 (p = 0.005) in AbE-TLO, from 2.4 to 0.5 (p = 0.008) in GATT, and from 2.3 to 0.6 (p = 0.005) in AGV at 2 years after surgery.

Conclusion: There was a significant decrease in IOP, along with a significant reduction in the usage of antiglaucomatous drugs, across all three primary surgical methods. No significant difference was detected regarding the reduction in IOP and the usage of antiglaucomatous medications.

Clinical significance: Approximately, half of the patients with pediatric AG undergo surgery. However, the most appropriate surgical technique for AG remains unclear. Minimally invasive glaucoma surgeries, increasingly performed in recent years, now constitute a pivotal aspect of glaucoma surgical treatment. Thus, the main objective of the current research is to compare the impacts of AbE-TLO, GATT, and AGV implantation on IOP as the primary surgical method in pediatric AG.

How to cite this article: Toptan M. Comparison of the Intraocular Pressure-lowering Effects of Three Primary Surgical Procedures in Pediatric Aphakic Glaucoma. J Curr Glaucoma Pract 2025;19(1):50-54.

Aim: To compare the risk of early intraocular pressure (IOP) spikes following micropulse (MP) vs continuous wave (CW) transscleral cyclophotocoagulation (CPC).

Methods: Single-center, prospective, nonrandomized study that included glaucoma patients planned for MP- or CW-CPC at Wills Eye Hospital (2020-2021). IOP was measured using rebound tonometry (iCare) immediately before, immediately after, and 1 hour after the CPC, then on postoperative day 1. The primary outcome measure was the incidence of IOP spikes, defined as IOP elevation ≥10 mm Hg vs baseline. Patients with severe IOP spikes received IOP-lowering agents (topical or oral).

Results: Twenty-six eyes (15 CW and 11 MP) of 26 patients were included, with a mean age of 64.4 ± 15.1 years. At the baseline visit, IOP was 29.5 ± 11.3 mm Hg, and the medication number was 3.8 ± 1.4, with no difference between groups. IOPs (CW vs MP, mm Hg) were 31.9 ± 10.5 vs 24.1 ± 7.3 immediately before CPC (p = 0.044), 22.9 ± 10.8 vs 16.1 ± 6.3 immediately after CPC (p = 0.760), 24.6 ± 11.9 vs 23.2 ± 9.5 at 1 hour after CPC (p = 0.757), and 18.0 ± 6.1 vs 20.8 ± 6.9 at 1 day later (p = 0.335). Three eyes (11.5%; 1 CW, 2 MP) experienced IOP spikes (p = 0.556) at 1 hour post-CPC; IOP responded to topical and/or oral medications. At day 1 and month 1, mean IOP reduction compared to baseline was significant in CW eyes (p < 0.001) and insignificant in MP eyes (p > 0.05).

Conclusion: MP- and CW-CPC have similar risks of early postoperative IOP spikes. Significant early IOP reduction was better achieved following CW-CPC. Early postoperative IOP spikes may be detrimental; there may be a role for IOP monitoring in such cases.

Clinical significance: Understanding the early postoperative outcomes of MP- and CW-CPC is critical for optimizing glaucoma management. This study highlights that while both procedures carry a similar risk of early IOP spikes, CW-CPC demonstrates superior early IOP reduction. These insights help clinicians tailor CPC strategies to individual patient requirements.

How to cite this article: Shalaby WS, Arbabi A, Wong J, et al. Early Postoperative Intraocular Pressure Profile Following Micropulse vs Continuous Wave Transscleral Cyclophotocoagulation: Cohort Study. J Curr Glaucoma Pract 2025;19(1):8-14.