Journal of Glaucoma最新文献

Prcis: Larger choriocapillaris microvasculature dropout area and wider angular circumference are significantly associated with 24-2C central visual field damage in primary open angle glaucoma eyes with and without axial myopia.

Purpose: To evaluate the relationship between a juxtapapillary choriocapillaris microvasculature dropout (MvD) and central visual field (VF) damage in primary open angle glaucoma (POAG) patients with or without axial myopia.

Methods: This cross-sectional study included 125 patients with POAG or glaucoma suspects stratified into no axial myopia (axial length (AL) ≤24 mm; 46 eyes), mild axial myopia (24 mm < AL ≤26 mm; 81 eyes), and high axial myopia (AL >26 mm; 59 eyes). Presence, area, and angular circumference of juxtapapillary MvD were evaluated on OCT-A en-face choroidal images and B-scans. Perimetry was conducted using the 24-2C and 10-2 Humphrey program.

Results: Mean 24-2C VF mean deviation was significantly worse in eyes with MvD compared with eyes without MvD across all groups (all P <0.042). Central VF defects detected in the 24-2C and 10-2 VF tests were significantly more prevalent among eyes with MvD (68.3% and 81.7%, respectively) compared with eyes without MvD (19.0% and 38.1%, respectively) ( P <0.001) in the mild axial myopia group. In multivariable analysis, larger MvD area ( P =0.014) and wider MvD angular circumference ( P =0.006) were significantly associated with higher likelihood of the presence of 24-2C central VF damage in overall cohort.

Conclusions: MvD area and angular circumference are significantly associated with central VF damage detected by VF 24-2C in POAG eyes with and without axial myopia. Choriocapillaris MvD assessment shows promise for identifying POAG patients with a higher risk of having central VF defects and may provide clinical insights into the pathogenesis of glaucoma in myopia.

Prcis: The diagnostic performance for detecting early glaucoma of a supra-threshold and a threshold visual field tests are compared. Their performance was found to be equivalent with the supra-threshold test being faster.

Purpose: To compare the diagnostic accuracy of a supra-threshold and a threshold visual field test in detecting early glaucoma using optical coherence tomography (OCT) as the reference standard.

Methods: Data from 54 early/suspect glaucoma patients and 37 controls underwent a Humphrey Visual field Analyzer (HFA) SITA standard 24-2 threshold test, a Henson 9000 Smart Supra test (SS) supra-threshold test and Topcon Triton OCT scan: Smart Track 3D Wide (H) (12 × 9). OCT data were classified by 3 experts as either no glaucoma (n=42), suspect (n=6), or glaucoma (n=43). Overall and Selective global indices and receiver operating characteristics (ROC) curve analysis were used to compare visual field outcomes with OCT classifications.

Results: SS was significantly faster than SITA standard (3.9 vs. 6 min). Sixty-one percent of the glaucoma sample and 81% of controls showed substantial agreement between OCT and visual field testing using the most sensitive criteria (Henson-N-miss SS, stage 2 and 3, >0 misses; HFA VFI <99%). The area under the ROC curve showed good discrimination for all global indices. The 24-2 global indices MD, PSD, and VFI ranged from 86% to 89%, whereas those for the SS test ranged from 84% to 88%. Partial area under the ROC curve (80%-100% specificity) showed a fall for all global indices. HFA MD, PSD and VFI range (61%-73%), SS test range (71%-78%).

Conclusions: The SS supra-threshold test was faster and had equivalent diagnostic accuracy to the SITA standard 24-2 threshold test in early/suspect glaucoma.

Purpose: To report the findings of a rare advanced pseudoexfoliation glaucoma patient with wipe-out phenomenon after gonioscopy-assisted transluminal trabeculotomy (GATT).

Methods: A 360-degree uneventful GATT was performed on a 71-year-old male patient with a history of uncontrolled diabetes mellitus. Sudden vision loss occurred and cystoid macular edema (CME) were detected in the early postoperative period. The CME regressed completely over 6 months but vision loss was irreversible.

Results: At the preoperative visit, the best corrected visual acuity (BCVA) was 20/70, and intraocular pressure (IOP) was 36 mm Hg with maximum topical antiglaucoma medications (AGM) in his right eye. At the postoperative first-month visit, BCVA was hand motion, and IOP was 14.5 mm Hg with topical AGM. In addition, CME was detected. A topical nonsteroidal anti-inflammatory drug and oral carbonic anhydrase inhibitor were started to reduce CME. Since CME did not regress, 3 doses of intravitreal anti-VEGF injections were administered at 1-month intervals. At the postoperative sixth-month visit, BCVA was still hand motion, and IOP was 11.1 mm Hg with topical AGM. The CME was regressed completely but BCVA did not improve.

Conclusions: The sudden, unexplained, and irreversible vision loss attributed to the wipe-out phenomenon following GATT, should be taken into consideration when offering this procedure to patients with advanced glaucoma.

Prcis: The present study highlights the high correlation of outcomes of bilateral trabeculectomy in subjects with different types of glaucoma after mid-term follow-up.

Purpose: To evaluate the mid-term outcomes of bilateral trabeculectomy and assess the differences and associations in outcome between the first-operated and the second-operated eye.

Methods: Patients with different types of glaucoma who underwent bilateral trabeculectomy from 2006 to 2022 were included in this retrospective study. All patients were followed for at least 24 months after surgery in each eye. The main outcome measure was surgical success. Complete success was defined according to intraocular pressure (IOP)≤16 mmHg and at least 20% reduction from preoperative baseline IOP without any IOP-lowering medications. Cumulative success was defined according to IOP≤16 mmHg and at least 20% reduction from preoperative baseline IOP, with or without IOP-lowering medications. Secondary outcome measures were IOP and the number of IOP-lowering medications.

Results: In total, 186 eyes of 93 patients were included. There was no statistically significant difference in terms of the baseline IOP and number of IOP-lowering medications between the first and second-operated eyes before and after surgery ( P >0.05). The mean follow-up time was 64.35±41.13 months and 57.13±38.41 months for the first-operated and the second-operated eyes, respectively. At the 24-month follow-up point, among patients whose first operated eyes were considered a complete success, 78.2% of surgeries in second eyes were successful ( P =0.002). In contrast, among patients whose first operated eyes were considered a cumulative success, 80.3% of surgeries in second eyes were successful ( P =0.012). In a multivariate analysis of factors affecting cumulative success, the outcome of the surgery in the first-operated eye was the only factor that significantly impacted the outcome of surgery in the second-operated eye. If the first-operated eye achieved cumulative success, the odds of the second-operated eye experiencing cumulative success were 6.5 ( P =0.02). The rates of postoperative complications in the 2 eyes were similar and did not show statistically significant differences.

Conclusion: The present study demonstrates a significant correlation in surgical outcomes of trabeculectomy between the 2 eyes of the same patient in mid-term follow-up. Surgical success in the first-operated eye increases the odds of success in the second eye 6.5-fold.

Prcis: In semistructured exit interviews, participants in a personalized glaucoma coaching program reported improved self-efficacy in managing their disease. Coaching was frequently cited as catalyst to enhancing medication adherence, emphasizing its role in team-based care.

Purpose: To assess patients' experience with coaching to motivate improved adherence to glaucoma self-management.

Methods and materials: Participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program completed exit interviews after participating in a 6-month coaching program. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using interpretivist grounded theory. Thematic saturation was reached after coding 30 interviews; 32 were included. Themes were identified, a codebook was generated, and 2 researchers coded the transcripts (NLC, DTD) and a third adjudicated any disagreements (EF). Main outcomes measures were defined as themes and the number of participants who expressed a theme.

Results: Of the 32 participants interviewed in this study, 59% (n=19) identified as male, 41% (n=13) identified as female, 50% (n=16) identified as Black, 34% (n=11) identified as White, and 6% (n=2) identified as Asian. Major themes surrounding coaching included how coaching promoted change in eye drop use, knowledge learned from the coach, feeling accountable to the coach, the coach being accessible, how coaches demonstrated empathy, how the coach collaborated to help people develop a sense of control and efficacy over glaucoma self-management, and how coaches built rapport. Additional themes were program satisfaction, fear of vision loss as a motivator to improve glaucoma self-management, and constructive feedback for the program.

Conclusion: This qualitative assessment of the SEE personalized glaucoma coaching program demonstrated that high-quality coaching and rapport building may help patients with previously low medication adherence feel more motivated and in control of their glaucoma.

Prcis: Metformin use was not dose-dependently linked to open angle glaucoma. Lower doses showed a protective effect, while higher doses had no significant impact.

Purpose: The present study examined the enigmatic relationship between long-term metformin use and the risk of developing open angle glaucoma (OAG) in patients with diabetes mellitus (DM). In addition, we questioned whether metformin use affects the risk of OAG in a dose-dependent manner.

Methods: This research was a retrospective cohort study using a nationally representative database established by the Health and Welfare Data Science Center of the Ministry of Health and Welfare, Taiwan, ROC. Patients diagnosed with new-onset DM between 2002 and 2013 were divided into 2 groups: a metformin-treated group and a sulfonylureas-treated group. The aim of our investigation is to evaluate the risk of OAG after a 5-year follow-up period. Using the Cox proportional hazard model, researchers estimated the risk of OAG in correlation with metformin treatment by the cumulative defined daily dose (cDDD), after adjusting for several key risk factors, such as sex, age, income, urbanization level, diabetes severity, and various comorbidities.

Result: A total of 2102 patients (0.29%) developed OAG after 5 years of being diagnosed with DM. Among patients treated with metformin, the incidence rates of OAG were 0.27%, 0.27%, 0.29%, and 0.33% with cDDDs of <30, 30-120, 120-240, and >240, respectively. Following adjustments for relevant variables, patients who received metformin treatment at cDDDs of <30, 30-120, 120-240, and >240 exhibited HRs of 0.81 (95% CI=0.71-0.92), 0.83 (95% CI=0.74-0.93), 0.90 (95% CI=0.79-1.03), and 1.03 (95% CI=0.82-1.29), respectively, compared with those treated with sulfonylureas.

Conclusion: Our findings suggest a moderate protective effect on the risk of open angle glaucoma at lower cumulative metformin dosages. A dose-dependent effect was not observed.

Prcis: Evaluation of aqueous humor outflow (AHO) pathways shows a segmental pattern with the highest outflow in the nasal quadrant and least in the temporal quadrant in patients of primary open angle glaucoma (POAG).

Aim: To quantitatively evaluate circumferential peri-limbal aqueous humor outflow (AHO) pathways in patients of primary open angle glaucoma (POAG) using aqueous angiography (AA).

Methods: A cross-sectional, observational, single-centre study recruited patients between 45 and 80 years with POAG, controlled on antiglaucoma medications, along with visually significant age-related cataract, planned for phacoemulsification surgery. AA was performed using 0.1% indocyanine green (ICG) dye injected into the anterior chamber, just before the capsulorhexis step. Images of 30 eyes of 30 patients were analyzed at 60 seconds from the injection of ICG dye for angiographic signal intensity (ASI) in 4 quadrants (90 degree each), with each quadrant further divided into 2 sectors of 45 degree each (total 8 sectors), circumferentially along the limbus. ASI was assessed by estimating the mean gray value using Image J software and compared between quadrants, sectors, severity of POAG, males versus females, and right versus left eyes. Further, calculating the normalized flow for each of the quadrants and sectors for every image, a division into high-flow (HF), intermediate-flow (IF), and low-flow(LF) regions was done. The correlation and relation of ASI with age and severity of POAG were also assessed using appropriate statistical tests.

Results: The mean age of the patients was 60.5±6.32 years (range 48-71 y), with 20 males and 10 females. Out of the 30 eyes recruited, mild/moderate POAG was seen in 13 patients, and severe POAG was present in 17 patients. Nonuniform, segmental AHO pathways with the highest ASI were seen in the nasal quadrant [52.41(42.78-57.67)] followed by superior [43.34(34.75-53.48)], inferior [28.73(21.42-35.85)], and temporal quadrant [27.71(21.23-34.87)] ( P ≤0.0001). The highest percentage of HF, IF and LF regions were documented in the nasal (83.33%), superior (36.67%), and temporal (73.33%) quadrants, respectively. A negative correlation of ASI with age (using Spearman rank correlation coefficient) was seen ( r =-0.470, P =0.009) with linear regression of β=-1.354, P =0.008. In addition, ASI between mild/moderate versus severe POAG, males versus females and right versus left eyes were not statistically significant ( P >0.05).

Conclusion: Segmental AHO pathways were noted along the limbus with maximum ASI in the nasal quadrant (HF region) followed by superior (IF region), inferior, and temporal (LF region) quadrants in patients of POAG. Patterns were similar in mild/moderate versus severe POAG, males versus females and right versus left eyes. With increasing age, a decrease in ASI was documented.

Prcis: ASOCT features of greater bleb height, thicker bleb walls, and lower reflectivity are associated with trabeculectomy success, supporting the ASOCT's utility in monitoring and predicting outcomes postsurgery through standardized imaging protocols.

Purpose: To evaluate and quantify the relationship between bleb characteristics on ASOCT with surgical outcomes.

Methods: A literature search was conducted across Medline, Embase, Cochrane, and Scopus for studies from the past 20 years, until 16 September 2024, on "glaucoma," "trabeculectomy," and "ASOCT." Data collected included patient characteristics, each study's definition of bleb success, clinical outcomes, as well as bleb characteristics. A literature review was conducted on studies that could not be used for meta-analysis.

Results: Eleven studies, with a pooled total of 528 eyes in 517 patients, were included in the final meta-analysis. Successful blebs had significantly higher mean bleb height [mean difference (MD) 0.38 mm, 95% CI: 0.20-0.56 mm, P=0.002], greater maximum bleb wall thickness (MD: 0.21 mm, 95% CI: 0.07-0.35 mm, P=0.009), and decreased reflectivity (MD: -48.9%, 95% CI: -78.3 to -19.4%, P=0.010), compared with failed blebs. No significant differences were found in bleb fluid cavity height and bleb area. Narrative synthesis revealed that wider blebs, increased fluid-filled cavity height, increased number of microcysts, larger filtration opening widths, and multiform bleb walls were also associated with higher rates of bleb success. Early bleb parameters were statistically significant predictors of bleb success up to 12 months postoperatively.

Conclusions: Greater bleb height, thicker bleb walls, and lower reflectivity on ASOCT are consistently associated with successful trabeculectomy outcomes. The ASOCT may be useful in predicting bleb success and in supplementing postoperative monitoring, hence guiding timely medical or procedural interventions, to ensure long-term bleb success.

Prcis: The presence of anterior capsular laxity caused acute angle closure glaucoma, and posterior capsular laxity alone was associated with a chronic progressive course, revealing new insight into the pathogenesis of primary angle closure disease.

Purpose: This study investigates the association between anterior or posterior capsular bag laxity during cataract surgery and clinical characteristics in patients with primary angle closure disease (PACD).

Methods: This retrospective study included 137 patients (200 eyes) diagnosed with PACD and undergoing phacoemulsification cataract surgery. Patients were categorized into 4 groups based on the condition of the capsular bag: loose anterior capsular bag (LACB), loose posterior capsular bag (LPCB), loose anterior and posterior capsular bag (LAPCB), and stable capsular bag (SCB). We analyzed the association of capsular bag laxity with clinical characteristics using ANOVA and χ 2 .

Results: Significant differences were observed among the groups in terms of sex, disease duration, anterior chamber depth (ACD), lens vault (LV), and lens Front R, while age, PACD classification, mean corneal power, axial length, and lens thickness showed no significant variation. The ACD was notably deeper in the LPCB and SCB groups. The LV was higher, and the lens Front R was smaller in the LACB and LAPCB groups. Lens Back R varied more in the LPCB group. Anterior capsular laxity, alone or combined with posterior capsular laxity, was more prevalent in cases of acute angle closure glaucoma (ACG) (56.0%) compared with chronic ACG (19.4%). Posterior capsule laxity alone was more common in chronic ACG (45.2%) than in acute ACG (10.7%).

Conclusion: The presence of anterior capsular laxity, with or without posterior capsular laxity, is associated with the development of acute ACG, whereas posterior capsular laxity alone is typically linked to the development of chronic ACG.

Prcis: Omidenepag isopropyl is a selective E-prostanoid subtype 2 (EP2) receptor agonist that lowers intraocular pressure. Omidenepag isopropyl 0.002% ophthalmic solution is effective and safe to use at the first diagnosis of primary open angle glaucoma.

Purpose: To evaluate the effectiveness and safety of omidenepag isopropyl 0.002% ophthalmic solution in treatment-naive patients at first diagnosis of primary open angle glaucoma (POAG) in real-world clinical settings in Korea.

Patients and methods: In a single-arm, multicenter, open-label, prospective, phase IV clinical trial, patients with newly diagnosed POAG received omidenepag isopropyl 0.002% (one drop once daily) for 12 weeks. The primary endpoint was the change from baseline in intraocular pressure (IOP) at week 12. Secondary endpoints included change from baseline in IOP at week 4; change from baseline in IOP at week 12 in a subgroup with normal tension glaucoma (NTG); occurrences, incidence rates and changes from baseline in safety-related indicators (macular edema, endothelial cell count, central corneal thickness, prostaglandin-associated periorbitopathy syndrome). Safety was assessed by the occurrence of adverse events (AEs).

Results: The effectiveness analysis set comprised 37 patients and the safety analysis set 50 patients. Mean IOP decreased from 16.19±2.65 mm Hg at baseline to 13.55±2.46 mm Hg at week 12 (P<0.0001), representing a 16% reduction. Mean reduction in IOP was 15% at week 4 (P<0.0001); and 16% at week 12 (P<0.0001) in the NTG subgroup (n=31). Aside from conjunctival injection, no notable changes were observed in safety-related evaluation indicators. The most common AEs were hyperemia (13 cases) and iridocyclitis (5 cases). No systemic AEs were reported.

Conclusion: Omidenepag isopropyl 0.002% ophthalmic solution is suitable for first-line use at first diagnosis of POAG, including in patients with NTG.