Journal of Glaucoma最新文献

Prcis: This matched-cohort study compares the original and Shoji editions of the Tanito microhook trabeculotomy (TMH), a reusable, FDA-cleared MIGS device, when combined with cataract surgery. Both designs demonstrated similar 2-year surgical success and safety profiles. While the Shoji edition incorporates ergonomic refinements, no significant differences in clinical outcomes were observed, supporting the continued use of either version in routine glaucoma care.

Purpose: To compare the clinical efficacy and safety of the Shoji edition of the Tanito microhook trabeculotomy (TMH Shoji edition) with the original version, both performed in combination with phacoemulsification and intraocular lens implantation, in patients with open-angle glaucoma.

Methods: A retrospective matched-cohort study including 518 eyes (original: 259, Shoji: 259) was conducted. Groups were matched on age, sex, glaucoma type, baseline IOP, visual field mean deviation, and number of medications. The primary outcome was surgical success over 2 years, followed the American Academy of Ophthalmology's recommended criteria for MIGS combined with cataract surgery: ≥1 medication reduction without IOP increase, or ≥20% IOP reduction to ≤21 mmHg without additional surgery, loss of light perception vision, or hypotony. IOP, number of medications, and postoperative complications were also recorded. Statistical analyses included Fisher exact tests and Kaplan-Meier survival with log-rank testing.

Results: At 12 months, surgical success was achieved in 46.4% of the original group and 50.1% of the Shoji group; at 24 months, the rates were 32.0% and 44.2%, respectively. Kaplan-Meier estimates showed no significant difference between groups (log-rank P=1.000). Both groups achieved reductions from baseline in mean IOP and number of glaucoma medications at all time points. Postoperative complications were infrequent and comparable between groups.

Conclusions: Both versions of TMH trabeculotomy combined with cataract surgery demonstrated acceptable mid-term surgical success and safety profiles. The Shoji edition, designed to improve access and usability, may offer advantages in certain surgical settings.

Prcis: The choice of surgical techniques among Tanito Microhook, Suture, and Trabectome does not significantly impact postoperative efficacy or complication rates. However, a wider incision in the trabecular meshwork may increase the risk of hyphema.

Purpose: To evaluate preoperative and postoperative characteristics of ab interno trabeculotomy using the Tanito Microhook (TMH), suture technique (sLOT), and Trabectome (TOM).

Methods: Preoperative and postoperative intraocular pressure (IOP), glaucoma medication scores, and complications were retrospectively analyzed in the eyes of patients undergoing ab interno trabeculotomy.

Results: The analysis included 196, 122, and 87 eyes in the sLOT, TMH, and TOM groups, respectively. Mean IOP decreased from 23.0, 21.3, and 24.8 mmHg to 14.1, 14.2, and 16.2 mmHg at 3 months (reductions: 32.6, 26.3, and 27.0%; P<0.001) in the sLOT, TMH, and TOM groups, respectively. No significant differences in percent IOP change (P=0.085) or survival rates based on four success criteria defined by IOP thresholds (≤18/≤15 mmHg) and reductions (≥0%/≥20%) (P=0.44-0.88) were observed. Hyphema occurred in 43.4%, 19.7%, and 18.4%, and IOP spikes in 24.5%, 9.8%, and 20.7% of the sLOT, TMH, and TOM groups, respectively. Multivariable analysis revealed that exfoliation glaucoma, higher baseline IOP, and concomitant cataract extraction surgery were associated with greater IOP reduction. Wider trabecular meshwork incisions increased hyphema risk, while concomitant cataract surgery reduced it. Higher baseline IOP increased IOP spike risk. Device selection did not significantly influence IOP reduction, hyphema incidence, or IOP spikes.

Conclusion: TMH, sLOT, and TOM provide similar IOP-lowering efficacy. Considering patient factors-such as baseline IOP and lens status-and using available devices while avoiding excessively wide incisions may contribute to favorable surgical outcomes.

Prcis: This comparative cross-sectional study in an indigenous black population demonstrated that high myopic eyes have a significantly thinner retinal nerve fiber layer when compared with emmetropic and other myopic subgroups.

Purpose: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness in myopes and emmetropes and determine the relationship between age and sex and RNFL thickness in myopes and emmetropes in an African population.

Methods: This was a hospital-based observational cross-sectional study in which both myopic and emmetropic subjects were recruited. Myopic subjects were classified into low [-0.5D to -3.0 diopters (D)], moderate (>-3.0D to -5.0D), and high myopia (>-5.0D) based on spherical equivalent. Myopic and emmetropic groups were further subdivided into subgroups based on age as follows: 20-29, 30-39, 40-49, and 50-59 to recruit subjects across the age groups. Consecutive subjects presenting to the eye clinic that met the eligibility criteria were recruited into the study until the sample size in each group was completed. All participants underwent full ophthalmic examination, refraction, visual fields analysis, and A-scan biometry. The peripapillary RNFL thickness of the retina was measured using the Optovue iScan Spectral Domain Optical Coherence Tomography (SD-OCT). Measurements from one eye (right) of participants were used for analysis. Quantitative data were descriptively summarized and compared using t test, ANOVA, and ANCOVA.

Results: A total of 116 participants were recruited, 28 (24.1%) subjects were emmetropes, while 33 (28.5%) had low myopia, 27 (23.3%) moderate myopia, and 28 (24.1%) high myopia. The mean age of all subjects was 36.0±11.4 years. All subgroups of myopia had thinner RNFL [Low=103.8±8.6 µm ( P =0.582); Moderate=101±6.5 µm ( P =0.171); High=94.4±7.9 µm ( P =<0.001)] compared with emmetropes (105.2±10.7 µm). There was a decrease in the mean global RNFL thickness with increasing myopia. RNFL thickness was negatively correlated with age ( r = -0.303). The rate of reduction per year was higher in emmetropes (0.66 µm) compared with myopes (0.25 µm). The rate of decline of RNFL per year is associated with thicker mean global RNFL thickness seen in emmetropes as compared with myopes.

Conclusion: High myopes in this population have thinner peripapillary RNFL values compared with emmetropes, low and moderate myopes. RNFL thickness was negatively correlated with age in both emmetropes and myopes.

Prcis: Combined phacoemulsification and Kahook Dual Blade goniotomy significantly increased the iridocorneal angle dimensions in POAG/NTG, but postoperative pilocarpine instillation did not further increase the dimensions, suggesting that this postoperative therapy offers limited clinical benefit.

Purpose: Topical pilocarpine is frequently administered for months after Kahook Dual Blade goniotomy combined with phacoemulsification (phaco-KDB) to prevent peripheral anterior synechia formation. To clarify if it offers benefits, we investigated whether iridocorneal angle dimensions after phaco-KDB show further changes after topical pilocarpine instillation in the Japanese primary open angle glaucoma (POAG) or normal tension glaucoma (NTG) eyes.

Materials and methods: Thirty eyes of 30 consecutive Japanese POAG or NTG patients (age 69.4±12.4 y) undergoing phaco-KDB were investigated using anterior segment swept-source optical coherence tomography (CASIA2, Tomey). Angle opening distance (AOD) and trabecular-iris space area (TISA) were measured at 5 locations: 250 and 500 µm distance from the scleral spur on both the temporal and nasal sides. Measurements were taken preoperatively and within 1 month postoperatively before and 1 hour after the instillation of 2% pilocarpine.

Results: The median spherical equivalent was -2.75 D (range: -18.5 D to +2.25 D). All postoperative AOD and TISA values (before pilocarpine instillation) increased clinically and statistically significantly at all 4 locations compared with the preoperative values ( P <0.001). One hour after pilocarpine instillation TISA in all and AOD in 3 of the 4 measurement locations remained unchanged ( P ≥0.135). AOD at the temporal 500 µm position increased significantly ( P <0.01) but the change was minimal (mean change=0.07 mm).

Conclusions: Phaco-KDB effectively widened the iridocorneal angle in this Japanese POAG and NTG cohort. However, angle widening did not increase further after pilocarpine instillation. This suggests that postoperative pilocarpine therapy after phaco-KDB offers limited benefit.

Prcis: Clinical Practice Guidelines for Open Angle Glaucoma (OAG) have evolved through the years and differ in their methodological quality. British, Peruvian, and Spanish guidelines have a high methodological quality.

Topic: To assess the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG).

Clinical relevance: An assessment of the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG) is reported.

Methods: A systematic review of Clinical Practice Guidelines for the diagnosis and management of OAG, published between January 2017 and November 2024, was carried out with a search in databases, meta-search engines, guidelines development institutions, ophthalmology associations and guidelines repositories (CRD42024510656). Guidelines were selected if they were published in English/Spanish during the last 7 years. Five authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications was performed. High-quality guideline was considered with at least 3/6 domains >60% including domain 3. In addition, a meta-synthesis of the recommendations for the most relevant outcomes of each guideline was performed.

Results: Eleven guidelines (20% of the 55 guidelines retrieved) published in English/Spanish, between 2017 and 2024 were selected. The lowest mean scores were in applicability and rigour of development (mean 43% and 46%, respectively). The highest score (mean 73%) was for domain 4 "clarity of presentation." British (92%), Peruvian (77%), and Spanish (75%) guidelines presented the best score in domain 3 "Rigour of development." When applying AGREE-II criteria for the overall guideline assessment, British and Spanish guidelines have the highest overall quality (6 and 5 scores, respectively). Most of the guidelines used GRADE approach for making recommendations. In the meta-synthesis, the guidelines show similar recommendations; however, we found variability in indications for selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS).

Conclusions: British, Peruvian, and Spanish guidelines for the diagnosis and management of OAG have a high methodological quality, and high scores in applicability. In contrast, European guideline have high scores in applicability and moderate quality.

Precis: At ≥3 years, GATT significantly lowered IOP and medication use in a diverse UK glaucoma cohort and subtype, with Afro-Caribbean ethnicity, non-360-degree trabeculotomy, and early postoperative IOP spikes identified as independent predictors of surgical failure.

Objective: To report the 5-year clinical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in a heterogenous glaucoma cohort at a major tertiary glaucoma center.

Methods: This is a single-center, multisurgeon, retrospective consecutive case series of all patients (111 eyes of 95 patients) who underwent GATT, with a minimum follow-up of 3 years (median: 5.1 y, range: 3-7 y) at the Birmingham Midland Eye Centre. The primary outcome was surgical success as defined by World Glaucoma Association criteria. Secondary outcome measures included intraocular pressure (IOP), number of medications, visual field parameters, retinal nerve fiber layer (RNFL) changes, further procedures, and complications.

Results: Primary glaucoma was most common (68 eyes, 61.3%), predominantly open angle (43.2%), while secondary glaucoma comprised 38.7%, primarily uveitic (18.0%). Among these, 60 eyes (54.1%) underwent GATT alone, and 51 eyes (45.9%) had GATT with cataract surgery. The mean (SD) preoperative IOP significantly improved from 30.3 mm Hg (10.5) on 3.8 (1.1) medications to 17.5 mm Hg (7.7) on 2.2 (1.7) medications at the final follow-up. Qualified and complete success rates were 57.7% and 20.7%, respectively, with an overall failure rate of 42.3% and reoperation rate of 27.9%. Mean time to failure was 1.6 years (1.5), with 21.4% of failures occurring within the first postoperative year.

Conclusion: Overall, GATT provides a minimally invasive, effective alternative to traditional surgeries, with stable visual outcomes and a manageable reoperation rate, supporting its role in advanced glaucoma management. Identified risk factors for increased surgical failure include Afro-Caribbean ethnicity and IOP spike at 1 month and non-360 degrees GATT.

Prcis: This registry-based study estimates the prevalence of glaucoma in Colombia to be 1.94%, with higher rates in women. Significant associations with comorbidities like retinal vascular occlusion, myopia, Raynaud syndrome, and obstructive sleep apnea were found.

Purpose: To estimate the prevalence of glaucoma in Colombia using data from the Individual Records of Health Services Provision (RIPS) between 2018 and 2022 and determine the prevalence ratios with diagnoses that have been linked to the development and progression of glaucoma.

Materials and methods: This observational, retrospective study analyzed secondary data from the RIPS database. The study included individuals diagnosed with glaucoma, categorized by ICD-10 codes, and associated comorbidities. The prevalence was calculated for individuals over 40 years old, and prevalence ratios were determined for comorbid conditions.

Results: Between 2018 and 2022, 399,923 patients were diagnosed with glaucoma, with a prevalence of 1.94% in individuals over 40 years old. Primary open angle glaucoma was the most common type, with a prevalence of 1.08%. The study found strong associations between glaucoma and comorbidities such as retinal vascular occlusion (prevalence ratio of 9.1 for glaucoma and 8.8 for primary open angle glaucoma), myopia (3.3 and 3.7), Raynaud syndrome (2.4 and 2.5) and obstructive sleep apnea (2.1 and 2.5). A positive but less significant association with migraine (2.0 and 1.9), hypothyroidism (2.1 and 2.2), asthma (1.7 and 1.7), diabetes (1.5 and 1.7), hypertension (1.4 and 1.4), and chronic obstructive pulmonary disease (1.2 and 1.3) was also found.

Conclusion: The prevalence of glaucoma in Colombia is consistent with global estimates, but with higher rates in women. The association between glaucoma and several comorbidities underscores the importance of an early detection and comprehensive management of these diseases.

Prcis: GATT significantly reduced intraocular pressure and reduced medication use in POAG and PXG patients over 5 years, with high success rates. Previous glaucoma surgeries and early intraocular pressure spikes were risk factors for failure.

Purpose: To evaluate the long-term outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in managing primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) over 5 years.

Patients and methods: This retrospective study involved 51 eyes of 42 patients who underwent GATT using prolene suture by a single surgeon with a follow-up duration of at least 5 years.

Results: Mean follow-up duration was 69.0±12.1 months. Mean intraocular pressure (IOP) significantly reduced in POAG patients (n=26), from 27.4±5.6 mmHg to 14.5±1.9 mm Hg ( P <0.001), and in PXG patients (n=25), from 26.4 ± 6.6 mm Hg to 13.3±2.1 mm Hg ( P <0.001) at the final visit. Correspondingly, the average number of antiglaucomatous medications decreased from 3.2±0.7 to 2.1±1.5 in POAG ( P =0.019) and from 3.5±0.7 to 1.5±1.4 in PXG ( P <0.001). The qualified cumulative surgical success rates at a target IOP ≤18 mm Hg were 83.1% (95% CI: 72.5%-93.7%) for POAG and 91.2% (95% CI: 84.7%-97.7%) for PXG, and at a target IOP ≤15 mm Hg were 68.2% (95% CI: 55.0%-81.4%) and 83.5% (95% CI: 74.4%-92.7%), respectively. Factors such as prior incisional glaucoma surgery and higher IOP levels during the first postoperative week were identified as risks for surgical failure.

Conclusion: GATT showed promising long-term efficacy and safety in POAG and PXG patients followed for 5 years, achieving significant reductions in IOP and medication dependence. Prior incisional glaucoma surgery and early postoperative IOP elevations were identified as risk factors for failure.

Prcis: In a nationally representative sample, intraocular pressure was linked to multiple adiposity indicators in men but only select measures in women, with ocular hypertension significantly associated with obesity and abdominal obesity in men.

Purpose: To evaluate the association between intraocular pressure (IOP) and adipose indicators and to investigate sex differences in these associations.

Methods: A population-based cross-sectional study. A total of 7407 Korean adults from the 2019 to 2021 Korea National Health and Nutrition Examination Survey VIII database. Body mass index (BMI), waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and cardiometabolic index (CMI) were evaluated as adiposity indicators. The IOPs in both eyes were measured using rebound tonometer. Complex sample general linear models and logistic regression analyses were performed to assess associations between adiposity indicators and IOP or ocular hypertension, adjusting for demographic, health behaviors, and clinical covariates. IOP and ocular hypertension.

Results: IOP was positively associated with all adiposity indicators (BMI, waist circumference, LAP, VAI, and CMI) in men, whereas only BMI, WC, and LAP were associated with IOP in women. For ocular hypertension, BMI, WC, and LAP were significantly associated with increased odds in men. Notably, men with both obesity and abdominal obesity had higher odds of ocular hypertension (OR 3.24, 95% CI, 1.47-7.13), and those with abdominal obesity alone also showed elevated risk (OR 3.35, 95% CI, 1.58-7.11). In women, none of the adiposity indicators or obesity categories were significantly associated with ocular hypertension.

Conclusions: In this Korean population, adiposity indicators were more strongly associated with IOP and ocular hypertension in men than in women. Abdominal adiposity appeared to play a particularly important role, suggesting sex-specific pathways in IOP regulation.

Minimally invasive glaucoma surgeries (MIGS) targeting the trabecular meshwork are emerging as a new modality in the management of primary angle closure glaucoma (PACG). Aqueous angiography (AA) allows in vivo, real-time assessment of conventional aqueous humor outflow (AHO) using tracer dyes. Herein, we discuss a novel case of AA demonstrating changes seen in AHO post-trabecular MIGS in a PACG patient. This case provides evidence that supports the hypothesis of using trabecular MIGS in treating PACG patients and encourages further research to innovate and study the efficacy of trabecular MIGS in the management of primary angle closure disease.