Journal of Current Glaucoma Practice最新文献

Glaucoma, a multifactorial disease, currently leads the causes of irreversible blindness globally, with complex underlying pathophysiology. For a long time, decreasing intraocular pressure (IOP) has remained the desired primary outcome for each modality of glaucoma management-medical, laser, or surgical. However, the understanding of non-IOP-dependent mechanisms and the identification of additional risk factors affecting optic nerve health have extended the range of preventive and therapeutic options for tackling glaucoma in a more holistic manner. Adopting a healthy lifestyle has been the key to managing all chronic diseases, especially cardiovascular disorders and diabetes, with proven benefits in significantly reducing their incidence and severity. Glaucoma is recognized as a chronic degenerative ailment of the second cranial nerve, and lately, there has been a tremendous upsurge in the subject to evaluate the potential role of lifestyle factors like diet, nutrition, exercises, sleep postures, and smoking in relation to the health of the optic nerve. Existing evidence suggests that some modifications in lifestyle have positive impact in preventing development and retarding its progression, although some findings are conflicting. This write-up aims to furnish a comprehensive overview of the same by analyzing existing evidence and summarizing the repercussions of different lifestyle factors-namely diet and nutritional supplements or exercises-on IOP or the perfusion pressure of the eye, which ultimately leads to retinal ganglion cell loss and optic neuropathy. Knowledge of their putative role as preventive or supportive medicine in glaucoma management can empower both patients and glaucoma specialists in mitigating the agony of the disease affecting the quality of life.

How to cite this article: Saha BC, Kumari R, Onkar A, et al. Lifestyle Modification as Complementary Medicine in Glaucoma Management. J Curr Glaucoma Pract 2025;19(1):38-49.

Purpose: To compare real-world outcomes of Henson 9000 perimeter and Humphrey field analyzer (HFA) in glaucoma patients.

Materials and methods: This retrospective study recruited patients diagnosed with glaucoma who underwent Swedish interactive thresholding algorithm (SITA) Standard perimetry (HFA, Carl Zeiss Meditec), followed by Zippy Adaptive Threshold Algorithm (ZATA) Standard perimetry (Henson 9000, Topcon Healthcare). Test durations, global indices, and reliability indices were compared. A subgroup analysis was done for patients classed as early [mean deviation (MD) ≥ -6 dB] and moderate-severe (MD < -6 dB) glaucoma. Fatigue-adjusted subgroup analysis was done, including right eyes only.

Results: 76 eyes of 44 patients were included. Henson 9000 results were within normal reliability limits, although they showed higher false positives (FP) (by 6.79%; p < 0.001), false negatives (FN) (by 23.17%; p < 0.001), and fixation losses (FL) (by 9.5%; p = 0.018). Overall, Henson tests showed a slight increase in MD (+1.01 dB, p = 0.004), with no significant differences in duration (p = 0.083) or pattern standard deviation (PSD) (p = 0.742). A strong positive correlation between devices was observed for MD (r = 0.903; p < 0.001) and PSD (r = 0.850; p < 0.001). In early glaucoma (n = 57), mean Henson test duration was shorter by 1.06 minutes (p < 0.001) with no significant difference in MD results (p = 0.083). In all right eyes (n = 38), there were no statistically significant differences in mean duration, MD, and PSD between both devices (p = 0.369, 0.168, 0.537, respectively).

Conclusion: Outcomes with the Henson 9000 were reliable, with measured global indices strongly correlated with HFA results. In early glaucoma, outcomes were comparable to HFA with shorter tests, suggesting the potential of the Henson 9000 as a screening tool for early glaucoma.

How to cite this article: Poli M. Comparison of the Real-world Performance of Henson 9000 Perimeter and Humphrey Field Analyzer in Glaucoma Patients. J Curr Glaucoma Pract 2025;19(1):55-63.

Aims: A review of the published literature was done to understand the role of endocannabinoids in glaucoma.

Background: As evidence mounts that intraocular pressure (IOP) is not the only factor in the pathogenesis and progression of glaucoma, a look into other aspects is the need of the hour. From the first instance of a drop in IOP linked to marijuana in the 1970s to the present, research has been ongoing, mostly in animals and in vitro models, with a scarcity of human studies, to delve into the world of the endocannabinoid system (ECS).

Methods: PubMed, ScienceDirect, and Google Scholar were searched for studies relating to endocannabinoids and their role in glaucoma.

Results: The ECS comprises ligands, receptors, and the synthesizing and degrading enzymes and is ubiquitous throughout the human body, including the visual system, from the eye to the occipital lobe. Apart from the IOP-lowering effect of the system, another property being investigated and implicated as an attribute of its receptors is neuroprotection. This neuroprotection seems to be mediated by excitotoxicity reduction and changes in vascular tone by acting on cannabinoid receptors.

Conclusion: The possibilities are indeed immense, and further research into the complex relationship between ECS and glaucoma is imperative to enable us to develop therapies for this otherwise chronic, progressive neuropathy, where the only armament in our hands is early diagnosis and maintenance therapy.

Clinical significance: We still do not have drugs for the prevention of retinal ganglion cell loss and for neuroprotection in glaucoma. Drugs that target cannabinoid receptors can revolutionize glaucoma management owing to their IOP-lowering action and neuroprotective effects. Based on the findings, we argue that further studies on the ECS and its implications in glaucoma are warranted to develop newer, effective, and better-targeted treatment strategies.

How to cite this article: Warjri GB, Gowtham L, Venkatraman V, et al. Role of Endocannabinoids in Glaucoma: A Review. J Curr Glaucoma Pract 2025;19(1):28-37.

Aim and background: The aim of this study is to evaluate the agreement between perimetric findings of a novel 24°, 52-loci online circular contrast perimetry (OCCP) application on three different computer monitors to determine its stability of testing across varying displays.

Materials and methods: Sixty-one participants (19 healthy controls, 42 with glaucoma) underwent SAP testing followed by OCCP testing on three uncalibrated computer monitors in randomized order: a large-screen (24-inch) desktop personal computer (DPC) (Dell, Texas, US), a 17-inch laptop (LPC) (Dell), and a 14-inch MacBook Pro (MP) (Apple, California, US).

Results: Agreement of mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI)/visual index (VI) values between MP, DPC, and LPC OCCP were strong, with intraclass correlations and Deming's coefficients ranging from 0.96 to 1.00 and 0.93 to 1.03, respectively. When OCCP tests were compared to SAP, ICCs and Deming's coefficients were less strong, ranging from 0.89 to 0.95 and 0.72 to 0.89. Bland-Altman analyses revealed higher biases (2.90 to 3.59 dB) and wider limits of agreement when comparing OCCP to SAP than when comparing OCCP on different monitors. Bland-Altman bias of contrast sensitivities for each 24-2 testing location revealed stronger relationships between OCCP tests on different monitors (-0.82 to 0.78) than between OCCP and SAP tests (-1.53 to 1.32).

Conclusion: OCCP demonstrates strong levels of test-retest agreement when performed on computer monitors of varying display and moderate to strong levels of correlation to SAP perimetric indices.

Clinical significance: With further enhancements, OCCP could potentially be used on different personal computers, which could help address current challenges in glaucoma care, such as limited access to traditional perimetric testing. This has the potential to expand the scope of glaucoma detection and monitoring, particularly in remote and underserved areas of our community.

How to cite this article: Gong A, Busija L, Skalicky SE. Evaluating the Consistency of Online Circular Contrast Perimetry Across Different Computer Monitors: A Cross-sectional Study. J Curr Glaucoma Pract 2025;19(1):15-27.

Aim and background: This study aims to evaluate the institutional interdisciplinary management protocol for neovascular glaucoma patients, focusing on a combined surgical approach involving posterior vitrectomy and Ahmed valve implantation, with previous antiangiogenic application.

Materials and methods: A retrospective review was conducted for 14 neovascular glaucoma patients who underwent the combined procedure over 4 years. Patients aged 18 years or older with prior antiangiogenic application and without other types of glaucoma or prior posterior vitrectomy were included. Surgical success was assessed as intraocular pressure reduction below 21 mm Hg, either without hypotensive medication (absolute success) or with medication (qualified success) at various time points. Secondary outcomes included intraocular pressure (IOP), number of hypotensive medications, visual acuity, underlying etiology, and postoperative complications.

Results: At baseline, patients had an average IOP of 50 mm Hg and were taking 4.4 glaucoma medications. After the 12-month follow-up, the mean IOP decreased significantly to 16.4 mm Hg, reducing the need for hypotensive medications. The qualified success rate was 100%, while absolute success was not achieved. Visual acuity and anatomical outcomes were maintained, with no cases of anatomical loss. Postoperative complications, including hyphema, choroidal detachment, and vitreous hemorrhage, were transient and self-resolved.

Conclusion: The interdisciplinary management protocol proposed showed favorable results for neovascular glaucoma management. The combined surgical approach led to a considerable reduction in intraocular pressure and glaucoma medication use, indicating a high success rate in controlling the disease. Visual acuity and anatomical outcomes remained stable during the follow-up period, with no cases of anatomical loss.

Clinical significance: This study demonstrates that combining posterior vitrectomy and Ahmed valve implantation, preceded by antiangiogenic therapy, effectively reduces intraocular pressure and glaucoma medication use in neovascular glaucoma patients. This interdisciplinary approach offers improved management and potential for better patient outcomes.

How to cite this article: Belalcazar S, Villa J, Saldarriaga C, et al. Combined Posterior Vitrectomy and Ahmed Valve Implantation with Prior Antiangiogenic Application for the Management of Neovascular Glaucoma: A Case Series Study. J Curr Glaucoma Pract 2025;19(1):3-7.

Aim and background: This study aims to evaluate the hypothesis that combining minimally invasive Kahook Dual Blade (KDB) surgery and modified deep sclerectomy enhances the efficacy of reducing postoperative intraocular pressure (IOP).

Case description: Outcomes were studied in two open-angle glaucoma patients who underwent combined KDB surgery and modified deep sclerectomy procedures.

Results: Postsurgical observations in both cases revealed extensive hyphema and flattening of the bleb within 1 month. The efficacy in reducing IOP did not surpass that of patients treated with simple trabeculotomy.

Conclusion: The combination of modified deep sclerectomy with internal excisional trabeculotomy may lead to postoperative hypotension and massive anterior chamber bleeding, potentially compromising final outcomes. Therefore, this approach is not recommended.

Clinical significance: These findings highlight the importance of carefully considering surgical approaches to optimize patient outcomes in glaucoma management.

How to cite this article: Chihara E, Chihara T. Outcome of Combined Kahook Dual Blade Surgery and Deep Sclerectomy: Adverse Effects of Postsurgical Low Intraocular Pressure. J Curr Glaucoma Pract 2024;18(4):174-177.

Aim and background: To compare outcomes of glaucoma tube shunt surgery in patients aged 85 years and older to younger adults.

Methods: Medical records were reviewed involving 207 consecutive tube shunt surgeries performed by one surgeon between 2013 and 2019. Baseline characteristics between group A (adults aged <85) and group B (aged ≥85) were compared. Changes from baseline to 12 months were compared between groups.

Results: One-year follow-up was completed for 80 of 125 eyes (group A) and 49 of 82 eyes (group B). Intraocular pressure (IOP) and number of medications were statistically significantly reduced at 12 months, with no significant difference between groups (group A: 33.1 ± 11.2 → 13.8 ± 4.5 mm Hg, group B: IOP 33.6 ± 10.2 → 14.0 ± 4.3 mm Hg; p = 0.7168; group A: 3.2 ± 1.2 → 1.6 ± 1.3 meds, group B: 3.2 ± 1.1 → 1.8 ± 1.4 meds; p = 0.8404). Success rate was 109/128 (85.1%) overall, with no significant difference between groups (p = 0.2625). LogMAR visual acuity (VA) significantly worsened in group B only (group A: 0.68 ± 0.59 preop → 0.67 ± 0.58 postop; group B: 0.79 ± 0.60 preop → 0.98 ± 0.73 postop; p = 0.0006). More older patients lost ≥0.25 logMAR VA (group A: 11/80 = 14% vs group B: 17/49 = 35%; p = 0.0051).

Conclusion: For advanced-age patients, tube shunt surgery provides good intraocular pressure control, with a higher, though acceptable, risk of loss of VA.

Clinical significance: Tube shunts may be undertaken in patients of advanced age at high risk of vision loss from glaucoma.

How to cite this article: Werner M, Byun S, Shin R, et al. Intermediate-term Outcomes of Glaucoma Drainage Device Implantation in Adults of Advanced Age. J Curr Glaucoma Pract 2024;18(4):162-170.

Purpose: To assess (1) safety and efficacy of MicroPulse transscleral laser therapy (TLT) for primary open-angle glaucoma (POAG) and (2) the influence of prior incisional glaucoma surgery, lens status, and visual acuity on TLT outcomes.

Setting: Institutional.

Design: Retrospective cohort study.

Materials and methods: Study population: Included were POAG patients aged 18-85 with TLT between 1st January 2020 and 15th July 2023; excluded were patients with secondary glaucomas, inflammatory disease, or pregnancy.Intervention: MicroPulse TLT was performed on one or both eyes with an Iridex Cyclo G6 Laser with settings: 31.3% duty cycle, 2,500 mW, 20 second/sweep/hemisphere, four to six sweeps. The revised MP3 probe was used.Outcome measures: Pre- and postop: intraocular pressure (IOP), best-corrected visual acuity (BCVA), glaucoma meds, subsequent procedures, cystoid macular edema (CME).Analysis: Kaplan-Meier (KM) survival statistics starting one month postop with dropout parameters: hypotony, subsequent glaucoma procedure, glaucoma medications >baseline, IOP >21 mm Hg, IOP reduction <20%, or loss of LP vision.

Results: Thirty-three eyes were included. Mean KM survival (months) was: all eyes 8.4 ± 1.1; phakia 6.2 ± 0.8; pseudophakia 10.8 ± 2.4; aphakia 9.2 ± 1.8; prior tube shunt 10.2 ± 1.8; no filtration 6.8 ± 0.8. IOP and glaucoma medications remained at or below baseline at all postoperative timepoints. There were no significant changes in BCVA for patients with good baseline vision (>20/40), and no patients developed hypotony, persistent inflammation, or lost LP vision. Factors limiting success were time from the procedure and number of sweeps.

Conclusion: Survival was better in pseudophakic eyes and after tube shunt surgery. Six sweeps resulted in higher success compared to four. There were no significant cases of postop CME. The procedure did not negatively impact vision in eyes with good baseline vision.

How to cite this article: Jones SG, Clark F, Toeteberg-Harms M. Phakia and Prior Incisional Surgery Impact MicroPulse Transscleral Laser Therapy for Glaucoma Outcomes: A Retrospective Cohort Study. J Curr Glaucoma Pract 2024;18(4):142-146.

How to cite this article: Dada T. Trabecular Wound Healing-the Nemesis of Trabecular MIGS. J Curr Glaucoma Pract 2024;18(4):135-136.