Journal of Glaucoma最新文献

Purpose: Previous studies have reported that migraine headaches may be one of the possible risk factors for open-angle glaucoma (OAG); however, a consensus has not been reached regarding the association between OAG and migraine. In this study, we examined the risk of developing OAG in migraine patients using a 12-year nationwide cohort.

Materials and methods: In this study, data from the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2015 was used to perform a retrospective cohort study. The study included 1,103,302 subjects, out of which 41,148 were diagnosed with migraine during 2003-2008 and were categorized as the migraine group, while 205,741 patients were selected as controls through propensity score matching at a 1:5 ratio. Subjects with migraine or OAG was ascertained based on KCD code. Multivariate Cox regression analysis was used to evaluate the hazard rate of OAG onset in the migraine group, and subgroup analysis was performed to identify any differences based on sex and age.

Results: Multivariate Cox regression analysis showed that the incidence of OAG was significantly greater among patients with migraine than among patients in the comparison group (hazard ratio [HR] 1.238; 95% confidence interval [CI] 1.160-1.132, P < 0.001). Moreover, the risk of developing OAG compared to subjects without migraine did not differ according to the presence of an aura (migraine with aura: HR 1.235; 95% CI 1.137-1.342, P < 0.001; migraine without aura: HR 1.248; 95% CI 1.143-1.363, P < 0.001). In subgroup analyses, the patients with migraine under 40-year-old were found to have a greater hazard rate (HR 1.576, 95% CI: 1.268-1.957) of developing OAG in contrast with patients with migraine and over 40-year-old (HR 1.167, 95%CI: 1.089-1.250) when compared to the corresponding non-migraine patients.

Conclusion: This study showed that migraine is a significant risk factor for OAG onset in Korean population, and the presence of aura did not affect the hazard rate of OAG development.

Prcis: Patients with migraine showed significantly increased risk of developing OAG in Korean population, without significant differences according to the presence of aura. Our results suggest presence of migraine as a possible risk factor for OAG.

Purpose: To compare two fast threshold strategies of visual field assessment: SITA-Fast (SF; Humphrey field analyser) and Elisar-Fast (EF; Advanced vision analyser) in patients with glaucoma.

Methods: In this cross-sectional observational study, of total 192 subjects, 138 subjects [150 eyes, 80 glaucoma subjects (91 eyes) and 58 healthy controls (59 eyes)] were analysed and included. Each subject underwent 24-2 EF and SF in randomized order with a minimum time interval of 1 hour between tests.

Main outcome measures: Mean test-time, pointwise and sectoral sensitivity, significance of values of mean sensitivity (MS) and global indices [mean deviation (MD) & pattern standard deviation (PSD)] and their correlation.

Results: The mean test-time was 2.59±0.25 and 3.38±0.28 minutes (P = 0.001) with SF and EF respectively. Correlation coefficient for pointwise threshold values correlated strongly for both the devices (range from 0.70 to 0.92). The Intra class correlation (ICC) value of ≥ 0.8 was observed across all sectors indicating good reliability. Bland-Altman plot denoted 95% of data for MS values within limit of Agreement (LOA). The ICC values for overall MS, MD and PSD were 0.916, 0.913 and 0.872 respectively indicating good reliability. High degree of correlation was observed for MD (r = 0.912, P=0.00) and PSD values (r=0.732, P=0.00). Comparison of values indicated a difference of 1.09 dB for MD and 0.06 dB for PSD between both strategies.

Conclusions: High degree of correlation existed between the global indices and pointwise threshold values. The study documents the ability of EF to successfully assess visual field in patients with glaucoma.

Objective: To investigate outcomes of trabeculectomy ab externo in African ancestry primary open-angle glaucoma (POAG) patients, and to analyze the impact of demographic and phenotypic factors on surgical success and complication rates.

Patients and methods: A retrospective case-control study enrolled 63 eyes of 55 POAG cases who underwent trabeculectomy ab externo. Data on demographics, family glaucoma history, surgical specifics, and pre/postoperative measures (intraocular pressure, visual acuity, visual field, medication usage, complications within one year) were collected. Analysis included linear/logistic regression models adjusting for inter-eye correlation.

Results: Trabeculectomy yielded success without additional medication in 46%, qualified success with medication in 22%, and surgical failure necessitating further intervention in 32% within one year. Subjects experienced reduction in intraocular pressure (IOP) (46%), daily glaucoma medication (73%), and eye drop usage (67%) 1-year post-trabeculectomy (all P <0.001). However, there was a postoperative decline of 56% in visual acuity (VA) ( P <0.001) and a significant worsening of visual field parameters, including a 14% decrease in mean deviation ( P =0.02) and a 19% decrease in visual field index ( P =0.004). Top of FormBottom of Form59% of patient eyes experienced complications within one year of surgery. Univariate analysis of predictive factors for surgical outcomes revealed that younger age at surgery ( P =0.01) and family history of glaucoma ( P =0.046) were predictive of lower rates of surgical success. Multivariable analysis revealed worse preoperative VA (OR 0.79 per 0.1 LogMAR increases, P =0.02) was associated with lower likelihood of surgical success.

Conclusion: This study underscores the low rates of trabeculectomy success and high rates of complications in an African ancestry population with POAG. While the procedure exhibited positive effects on IOP control and medication reduction, our analysis found that multiple factors, particularly age, family history, and worse preoperative VA play crucial roles in influencing surgical success.

Prcis: Trabeculectomy in African ancestry individuals with primary open-angle glaucoma shows a 46% success rate and frequent complications, indicating that younger age and family history are significant predictors of surgical failure in this high-risk population.

Prcis: We have developed through a consensus process 24 clinical recommendations for the comprehensive management of ocular surface inflammation in glaucoma patients, including diagnostic criteria, prevention measures, and treatment strategies according to ocular surface disease severity.

Purpose: To obtain expert consensus on the diagnosis, prevention, and management of ocular surface inflammation (OSI) in patients with glaucoma.

Methods: An international steering committee of glaucoma and/or ocular surface disease (OSD) experts and a wider faculty of members from the Educational Club of Ocular Surface and Glaucoma (ECOS-G) collaborated to develop clinical recommendations on best practice in the management of OSI in glaucoma patients using a nonanonymous interactive quasi-Delphi process. Clinical recommendations were formulated by the steering committee based on an analysis of the recent literature to determine unmet needs, together with a web-based interactive survey of faculty members' opinion in seven identified areas of OSI management in glaucoma. Topics included (1) diagnosis of OSD, (2) diagnosis of OSI, (3) causes of OSI, (4) impact of OSD/OSI, (5) prevention of OSI, (6) treatment of OSI, and (7) inflammation and the deep structures of the eye. Faculty members were invited to vote on the clinical recommendations, and the steering committee then determined whether consensus had been achieved.

Results: Consensus was obtained on 24 clinical recommendations by 80%-100% of faculty members. There was consensus that OSI should be investigated in all glaucoma patients. The main prevention measure in glaucoma patients with pre-existing OSD was the elimination/minimisation of preserved medications, especially BAK-preserved eye drops. A subtractive treatment strategy rather than an additive strategy is recommended according to OSI/OSD severity to improve the ocular health and/or before glaucoma surgery.

Conclusion: These recommendations for the management of OSI in glaucoma should be useful to guide decision-making in clinical practice.

Prcis: The study showed that Corvis ST's biomechanical intraocular pressure (bIOP) and ocular response analyzer's (ORA) cornea-compensated intraocular pressure (IOPcc) do not agree well, before or after photorefractive keratectomy (PRK), and may not be used interchangeably. bIOP remained unchanged after PRK.

Objective: To evaluate the agreement between the biomechanically corrected intraocular pressure (bIOP) measured by the Corvis ST and the IOPcc measured by the ORA before and after PRK.

Patients and methods: In this prospective interventional study, a total of 53 patients (53 eyes) were included. Measurements were acquired using both the Corvis ST and ORA devices before and 3 months post-PRK. The agreement between the 2 devices was evaluated using limits of agreement (LoA) and Bland-Altman plots.

Results: The participants had a mean age of 29.6 ± 5.21 years (range: 21 to 40), with 41 (77.4%) of them being females. After the surgery, the average change in intraocular pressure (IOP) was 0.3 ± 1.7 mm Hg for bIOP and -1.6 ± 4.0 mm Hg for IOPcc. The corresponding 95% LoA were -3.5 to 4.2 mm Hg and -9.5 to 6.3 mm Hg, respectively. The 95% LoA between bIOP and IOPcc after PRK was -2.3 to 8.5 mm Hg. Notably, the bIOP values were higher for IOPs <20 mm Hg and lower for IOPs >20 mm Hg compared with IOPcc.

Conclusions: The findings indicate a weak agreement between the Corvis ST-bIOP and the ORA-IOPcc both before and after PRK. These devices may not be used interchangeably for IOP measurement. bIOP exhibited less variation compared with the IOPcc, suggesting that the bIOP may be a better option for IOP reading after PRK.

Prcis: Wang et al compare an FDA-registered head-mounted smartphone device (PalmScan VF2000) with standard automated perimetry (SAP) in glaucoma patients and find that the head-mounted device may not fully recapitulate SAP testing.

Purpose: This study prospectively compared visual field testing using the PalmScan VF2000 Visual Field Analyzer, a head-mounted smartphone device, with standard automated perimetry (SAP).

Methods: Patients with glaucoma undergoing Humphrey Field Analyzer SAP testing were asked to complete in-office PalmScan testing using a Samsung S5 smartphone in a virtual reality-style headset. Glaucoma severity was defined as SAP mean deviation (MD) >-6 dB for mild, between -6 and -12 dB for moderate, and <-12 dB for severe. Global parameters MD and pattern SD from PalmScan and SAP were compared using t -tests and Bland-Altman analyses. Bland-Altmann analyses of PalmScan and SAP MD were conducted for the superonasal, superotemporal, inferonasal, and inferotemporal visual field quadrants. The repeatability of PalmScan was assessed using Spearman's correlations and intraclass correlation coefficients (ICCs).

Results: Fifty-one patients (51 eyes) completed both SAP and PalmScan testing and met the criteria for analysis. Compared with SAP, global MD and pattern SD measurements from PalmScan differed by an average of +0.62±0.26 dB (range: -3.25 to +4.60 dB) and -1.00±0.24 dB (range: -6.03 to +2.77 dB), respectively, while MD scores from individual visual field quadrants differed by as much as -6.58 to +11.43 dB. The agreement between PalmScan and SAP in classifying glaucoma severity was 86.3% across all eyes. PalmScan and SAP identified the same quadrant as having the worst visual field defect in 66.7% of eyes.

Conclusions: Despite advantages in cost and accessibility, the PalmScan head-mounted perimetry device may not be able to fully recapitulate SAP testing.

Prcis: Increased oxygen saturation (StO 2 ) was significantly associated with the severity of visual field (VF) damage in patients with glaucoma.

Objective: To investigate the association between retinal StO 2 percentage and the severity of VF loss in glaucoma.

Methods: A total of 198 eyes from 131 patients with glaucoma were included in this cross-sectional study. Participants underwent imaging using ocular oximetry (Zilia) and 24-2 Swedish Interactive Threshold Algorithm standard VF (Carl Zeiss-Meditec). StO 2 (%) was measured at 2 locations of the peripapillary optic nerve head (superotemporal, and inferotemporal). Measurements were reported as the mean of at least 5 measurements in each location. Associations between the severity of VF loss, reported as mean deviation, and StO 2 (%) were calculated.

Results: A total of 198 eyes of 131 patients (mean (95% CI) age, 71.1 (68.9,73.3) years, 68 females (51.9%), and 63 males (48.1%) were analyzed. In univariable analysis, higher StO 2 -0.06 (-0.12, 0.00) was associated with severity in all hemifields ( P = 0.047). Multivariate regression analysis showed that each 1% increase in StO 2 was associated with -0.06 (-0.12, -0.00) dB loss in mean deviation in all hemifields ( P = 0.043). In multivariate regression analysis in the superior hemifields, higher StO 2 -0.07 (-0.16, 0.01) tended to be associated with superior hemifield severity ( P = 0.09).

Conclusions: Retinal oximetry enabled the continuous quantitative measurement of retinal StO 2. Increased StO 2 was significantly associated with the severity of VF damage in patients with glaucoma.

Prcis: After the failure of a glaucoma drainage device in children, implantation of a second Ahmed glaucoma valve with mitomycin-C allows a significant reduction of intraocular pressure and number of medications with good medium-term and long-term survival.

Introduction: The effectiveness of glaucoma drainage devices (GDD) is limited in time. There is little literature regarding the optimal management strategy after failure of a GDD in pediatric glaucoma.

Purpose: To report the outcomes of Ahmed glaucoma valve implantation (AGV) with mitomycin-C (MMC) after failure of a GDD in children.

Methods: Retrospective chart review of patients with a history of at least 1 GDD receiving an AGV implantation with MMC between 2000 and 2019. We defined complete success as an IOP of 5-21 mm Hg without glaucoma medication and qualified success as a final IOP of 5-21 mm Hg with one or more glaucoma medication, without loss of vision.

Results: Twenty-one patients (22 eyes) met the inclusion criteria. The intraocular pressure and number of medications were significantly reduced. The probability of complete success was 47% [95% CI: 29%-75%] at 2 years and 34% [95% CI: 18%-65%] at 4 years. The probability of qualified success was 74% [95% CI: 56%-97%] at 2 years, and 54% [95% CI: 34%-84%] at 5 years. Failure happened in 10 eyes after a mean time of 4.3 years ±3.6 (6 mo to 15 y), 5 of which (23%) for severe complications or loss of vision.

Discussion: This study of implantation of a second valve with MMC reports a significant decrease in IOP and medications with medium-term and long-term success rates close to those reported for first valve implantation, although with a high risk of complications.

Prcis: The relationship between anterior scleral thickness (AST) and scleral spur (SS) length was disrupted in eyes with pseudoexfoliation (PX), and SS length was shorter in eyes with pseudoexfoliative glaucoma (PXG).

Objectives: To evaluate AST in eyes with PX and to examine the relationship between AST and Schlemm canal (SC), trabecular meshwork (TM), and SS.

Patients and methods: Thirty-eight patients with PX syndrome (PXS), 38 patients with PXG, and 38 healthy patients were included in the study. Using sweep source anterior segment optical coherence tomography, AST (0, 1, 2, and 3 mm from the SS), SC, and TM were visualized in the nasal and temporal areas, and measurements were compared between groups. The relationships between corneal thickness, TM, SS, SC, and AST were then evaluated.

Results: In all groups, the AST, SC, and TM measurements were similar ( P > 0.05). In the PXG group, SS lengths in the temporal area were shorter than those in the control and PXS groups ( P = 0.012). There were significant correlations between TM length and AST in the PXG group ( P < 0.05). The SS length exhibited moderately positive correlations with SC length and mean TM thickness in the PXG ( P < 0.05). There was a significant relationship between AST0 and SS in healthy eyes ( P < 0.05), but not in other eyes.

Conclusions: The shorter SS length observed in eyes with PXG may be a sign of structural changes. In addition, disruption of the relationship between AST and SS may be an early sign of pathologic processes, especially in eyes with PXS, and may require closer follow-up of these eyes.

Prcis: Different mechanisms of angle closure represented distinct aspects of intraocular pressure (IOP) control after phacoemulsification. Classification of angle closure mechanisms is necessary for postoperative IOP management and glaucoma progression in primary angle closure eyes.

Purpose: To investigate the relationship between the anterior chamber angle (ACA) characteristics, measured by swept-source anterior segment optical coherence tomography (SS AS-OCT), and intraocular pressure (IOP) control after phacoemulsification in eyes with primary angle closure disease (PACD) with different angle closure mechanisms.

Methods: PACD eyes were classified into 3 groups according to angle closure mechanisms using preoperative SS AS-OCT images; pupillary block (PB), plateau iris configuration (PIC), exaggerated lens vault (ELV). This retrospective, clinical cohort study included eighty-five eyes of 85 PACD patients: 34 with PB, 23 with PIC, and 28 with ELV. ACA parameters were measured preoperatively and 1 month postoperatively using SS AS-OCT. IOP measurements were performed preoperatively and during 6 months postoperatively. Postoperative IOP reduction and fluctuation were calculated, and their correlations with SS AS-OCT parameters were analyzed.

Results: PIC group showed the lowest postoperative IOP reduction compared with the other groups ( P =0.023). Preoperative ACA measurements were significantly associated with postoperative IOP reduction in ELV and PB groups, while postoperative measurements were in PIC group. Preoperative and postoperative change of iridotrabecular contact (ITC) index and area were correlated with postoperative IOP reduction in PB and ELV groups but not in PIC group. Postoperative ITC index ( P =0.031) and area ( P =0.003) showed significant correlations with postoperative IOP fluctuation only in PIC group.

Conclusions: SS AS-OCT parameters including ITC index and area showed different associations with postoperative IOP control, which should be considered in determination of lens extraction and treatment of PACD eyes.