Journal of Glaucoma最新文献

Prcis: MIGS in combination with cataract surgery resulted in clinically significant reductions in IOP and IOP-lowering medications up to 24 months in Black patients.

Purpose: Describe outcomes following ab interno Minimally Invasive Glaucoma Surgery (MIGS) procedures US FDA cleared or approved for intraocular pressure (IOP) reduction in primary open angle glaucoma combined with cataract surgery and cataract surgery alone in Black patients.

Methods: An observational, retrospective study of glaucoma in Black patients treated with MIGS (Hydrus®, iStent Inject®, OMNI® Surgical System) with cataract surgery or cataract surgery alone, in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Deidentified data included glaucoma diagnosis, procedure data, IOP, and medication use from preoperatively through 24 months. The study period was 07/01/2016 and 12/31/2023. Eligible patients identified via Current Procedural Terminology codes coupled with electronic health records. Outcomes were changes in IOP, and medication class usage (months 6, 12, 18, and 24) stratified by baseline IOP (≤18; >18 mm Hg).

Results: In 12,828 eyes of 12,828 patients, including 189 Hydrus, 491 iStent, 91 OMNI, and 12,057 cataract surgeries, mean IOP and medication use decreased significantly in each cohort. Mean IOP reductions were in the range of 1.2-2.7 mm Hg, and medication reductions were 0.4-1.0 medications across all cohorts and time points. In MIGS cohorts, IOP reductions were greater with higher baseline IOP, and medication reductions were greater with lower baseline IOP.

Conclusions: Each MIGS procedure produced clinically and statistically significant reductions in both IOP and IOP-lowering medications up to 2 years postoperatively in Black patients. Surgeons could consider offering MIGS at the time of cataract surgery to this population.

Precis: Phacoemulsification combined with endoscopic cyclophotocoagulation had a statistically significant reduction in both intraocular pressure and number of medications as compared to Phacoemulsification alone.

Purpose: Comparative evaluation of Phacoemulsification combined with Endoscopic Cyclophotocoagulation (Phaco-ECP) Vs Phacoemulsification (Phaco) alone in primary angle closure glaucoma (PACG) with cataract.

Design: Prospective, randomized, parallel group, active controlled trial.

Participants: Patients of PACG with cataract.

Methods: A total of 100 consecutive patients with PACG and cataract were screened, of whom 66 patients meeting the inclusion criteria were recruited. Patients were randomized into 2 groups and underwent Phaco-ECP or Phaco alone. The patients were examined at baseline and at 1 week, 1 month, 3, 6, 12, 18 and 24 months. The anterior chamber angle parameters on swept-source anterior segment OCT (SS-ASOCT) were noted at baseline, and at 3, 6 and 12-months follow-up. Main Outcome Measures: The primary outcome measure was reduction in intraocular pressure (IOP) and the number of anti-glaucoma medications.

Results: The mean baseline IOP was 19.9±5.8 mmHg and 19.5±7.2 mmHg in Phaco-ECP and Phaco groups, respectively (P=0.59). The mean IOP decreased to 14.0±2.6 mmHg and 15.7±2.2 mmHg at 24 months in Phaco-ECP and Phaco group, respectively (P=0.02). The reduction in number of medications was also significantly higher in Phaco-ECP group (1.8±1.10 mmHg vs. 1.0±0.8 mmHg; P=0.02) as compared to Phaco alone group. Qualified success with IOP ≤12 mmHg was obtained in 46.6% of patients in Phaco-ECP group and 13.7% of patients in Phaco group (P=0.01). No absolute failures (requirement of trabeculectomy) were noted in Phaco-ECP whereas 6.9% of patients had failure in Phaco group (P=0.23). A significant widening of the angle parameters was noted postoperatively at 3, 6, 12 and 18 months as compared to baseline in both the groups. The other secondary outcome parameters like BCVA, visual field changes, endothelial cell count, pupil diameter and complication rate were comparable between the groups.

Conclusions: Phaco-ECP group demonstrated a significant reduction in IOP and number of medications, along with a notable widening of nasal anterior chamber angle parameters as compared to Phaco alone group.

Prcis: Thicker CT and higher CVI in the 1-12 mm circumferential annular area were noted in early PACG patients compared with healthy controls. More importantly, CVI may serve as a more sensitive indicator for disease progression.

Purpose: To investigate changes of choroidal thickness (CT) and choroidal vascularity index (CVI) in eyes with early primary angle-closure glaucoma (PACG) based on swept source optical coherence tomography angiography (SS-OCTA).

Methods: A total of 86 early PACG patients (86 eyes) and 79 healthy individuals (79 eyes) were enrolled. All subjects underwent 12×12 mm macular scan and 6×6 mm optic disc scan to analyze and compare CT and CVI. Univariate and multivariate linear regression analyses were used to evaluate the relevance of CT and CVI to related factors.

Results: In all macular regions, patients with early PACG exhibited thicker CT and higher CVI as compared with healthy controls (all P<0.05). Multivariate linear regression analysis showed that increased subfoveal CT and CVI were associated with younger age, PACG diagnosis, and/or shorter axial length (all P<0.05). After adjusting for the compound factors of age and/or axial length, subfoveal CT and CVI remained significantly higher in patients with early PACG than in healthy controls (both P<0.01). In the peripapillary locations, the mean CT of early PACG patients in the inferior nasal and inferior temporal regions was thicker than that of the healthy controls (both P<0.05).

Conclusion: Early PACG patients are usually associated with thicker CT and higher CVI in 1-12 mm annular regions of macula. The changes in CT and CVI were independent of age and axial length, indicating that alterations in choroidal characteristics may be involved in the pathogenesis of PACG.

Prcis: The MP-3 CII program may be useful for assessing central visual field function in mild-stage glaucoma, particularly in settings where direct structure-function mapping is desired.

Purpose: This cross-sectional study aimed to evaluate the performance of the newly developed MP-3 Central Goldmann size II program by comparing its central visual field sensitivity measurements with those obtained from the Humphrey Field Analyzer 10-2 SITA-Standard in patients with preperimetric and mild-stage glaucoma.

Patients and methods: This study included 35 eyes from 26 patients with mild-stage glaucoma with macular ganglion cell analysis of optical coherence tomography abnormalities. All participants underwent comprehensive ophthalmologic examinations, including Humphrey Field Analyzer (HFA) 10-2 SITA-Standard and MP-3 Central Goldmann size II visual field testing. The MP-3 Central Goldmann size II program employs a smaller Goldmann II stimulus size and a reduced number of test points compared to the HFA 10-2 SITA-Standard to enhance the detection of subtle central visual field defects.

Results: The MP-3 Central Goldmann size II demonstrated a significantly shorter examination time compared to the HFA 10-2 SITA-Standard (278.8±45.1 seconds vs. 331.7±64.1 seconds, P<0.05). For the measurement points common to both programs, a positive correlation was observed between the two devices in hemifields corresponding to ganglion cell analysis abnormalities (Spearman's rank correlation coefficient, R=0.86; P<0.05) and in the hemifield corresponding to normal ganglion cell analysis (R=0.57; P<0.05).

Conclusions: The MP-3 Central Goldmann size II program showed strong correlation with HFA 10-2 SITA-Standard in measuring central visual field sensitivity.

Prcis: This study evaluates the efficacy and safety of Preserflo MicroShunt implantation in secondary glaucoma following corneal transplantation over a consecutive 1-year follow-up period, demonstrating high success, significant IOP reduction, and no observed graft decompensation.

Purpose: This study aims to assess the efficacy and safety of Preserflo MicroShunt (PMS) implantation in patients with secondary glaucoma following keratoplasty over a 1-year follow-up.

Methods: In this prospective, single-center study, nineteen patients (19 eyes) diagnosed with secondary glaucoma following corneal graft surgery were included for PMS implantation. The study cohort comprised 17 eyes after penetrating keratoplasty and 2 after deep anterior lamellar keratoplasty. The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, endothelial cell density (ECD), and visual acuity after the procedure. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as discontinuation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and at 1 day, 1 week, 1; 3; 6, and 12 months postoperatively.

Results: The reduction in IOP was statistically significant at follow-up visits compared to baseline, with a mean decrease of 57.8% at the final follow-up. Similarly, the number of antiglaucoma medications was significantly reduced at follow-up visits relative to baseline. The qualified success rate was 84.2% and the complete success rate was 63.2%. There were no statistically significant differences in visual acuity or endothelial cell density (ECD) compared to preoperative values.

Conclusion: Preserflo MicroShunt implantation appears to be an effective and well-tolerated method of reducing intraocular pressure in patients with secondary glaucoma following keratoplasty. Long-term follow-up in a larger patient cohort is needed to confirm these results.

Prcis: This retrospective study found significantly elevated IOP measurements in eyes with keratoconus after CXL at postoperative months 1 and 3, but not after 4.5 months, compared to both baseline and untreated fellow eyes.

Purpose: To evaluate intraocular pressure changes following corneal collagen cross-linking in patients with keratoconus and compare intraocular pressure measurements across tonometry methods.

Methods: A retrospective chart review was performed of 405 patients (405 index eyes and 218 untreated fellow eyes) who underwent cross-linking between January 1, 2012, and January 1, 2024, at Duke Eye Center. Preoperative and postoperative intraocular pressure measurements were collected at approximately 1 month, 3 months, and ≥4.5 months postoperatively. Generalized estimating equation models included time point, tonometry method (iCare, Tonopen, Goldmann applanation tonometry), corticosteroid use, age, sex, and race. Wilcoxon rank-sum and sign-rank tests were used for tonometry method sub-analyses.

Results: In treated eyes, intraocular pressure significantly increased at 1 month (2.2 mmHg increase, P=0.001) and remained elevated at 3 months (1.1 mmHg increase, P<0.001), returning to baseline by ≥4.5 months (P=0.168). No significant intraocular pressure change was observed in untreated fellow eyes at any postoperative time point. Tonopen measurements were consistently higher than iCare (all P<0.001). iCare measurements showed significant elevation at 1 month postoperatively (P=0.005), and Tonopen measurements at 1 month and 3 months (both P<0.001). No elevation was observed beyond 3 months with any tonometry method.

Conclusions: Corneal collagen cross-linking was associated with transient intraocular pressure elevations postoperatively that normalizes by ≥4.5 months. Tonometry method significantly influences intraocular pressure measurements, with iCare having lower measurements compared to Tonopen. Awareness of this pattern is important when managing patients with risk factors for glaucoma following cross-linking.

Purpose: Assess the association between diabetic retinopathy (DR) and the risk of ocular hypertension (OHT) or primary open-angle glaucoma (POAG) in patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM).

Patients and methods: This retrospective cohort study utilized the TriNetX US Collaborative Network, including 166,471 patients with T1DM and 5,745,652 patients with T2DM, categorized by DR status, ages ≥ 18 years. International Classification of Diseases 10th Revision (ICD-10) codes identified T1DM, T2DM, and DR. Propensity score matching (PSM) adjusted for age, sex, race/ethnicity, body mass index (BMI), relevant medical history, blood markers, glycemic-controlling medications, intravitreal injections, and ophthalmic service visits. The primary outcome was the development of coded OHT or POAG over 10 years and lifetime, expressed as adjusted hazard ratios (aHR).

Results: DM patients with DR exhibited a significantly heightened risk of developing coded OHT or POAG. T1DM patients showed a 4.966 fold increased lifetime risk of developing OHT (95% confidence interval (CI): 2.178-11.325) and 4.262 fold increased lifetime risk of developing POAG (95% CI: 1.435-13.255), while T2DM patients had a 2.651 fold increased lifetime risk of developing OHT (95% CI: 2.412-2.915) and 2.62 fold POAG (95% CI: 2.37-2.89). This risk remained high in our sub-analysis, and patients with PDR were at a higher risk compared to those with any stage of NPDR. Sensitivity analyses confirmed these findings across various demographic and clinical variables.

Conclusions: DR is significantly associated with OHT and POAG, particularly in T1DM. These findings emphasize the need for vigilant screening and comprehensive management of diabetic patients with coexisting DR.

Precis: Diabetic retinopathy in diabetic patients significantly increases the risk of ocular hypertension and primary open angle glaucoma, with the highest risk in type 1 diabetics as high as 5-fold compared to those without diabetic retinopathy.

Prcis: Not only -zone but also -zone atrophy is observed in non-myopic eyes. The presence of -zone atrophy reflects optic nerve head canal offset during eyeball expansion, and its directionality is associated with the offset direction.

Purpose: To evaluate locations of - and -zone parapapillary atrophy (PPA) in non-myopic eyes.

Materials and methods: A total of 151 non-myopic eyes with an axial length (AXL) of less than 24.0 mm were included in this cross-sectional study. From the Bruch's membrane opening (BMO), the angular locations of the maximal width of -zone PPA (without retinal pigment epithelium) and -zone PPA (without Bruch's membrane) were compared with that of the central retinal vascular trunk (CRVT)/BMO offset, as a surrogate of lamina cribrosa/BMO offset. Based on the extent and direction of the CRVT/BMO offset, patients were classified into three groups: 1) minimal offset (offset index <0.2), 2) temporal offset, and 3) nasal offset.

Results: Sixty-four eyes had minimal offset, 53 eyes temporal offset, and 34 nasal offset. The CRVT/BMO offset showed significant angular correlations with -zone PPA (r=-0.209, P=0.026) and -zone PPA (r=-0.529, P<0.001). Presence of -zone PPA was associated with older age [odds ratio (OR)=1.119, P<0.001], longer AXL (OR=2.260, P=0.011), and the presence of -zone PPA (OR=8.952, P<0.001). Among 56 eyes with -zone PPA, 26 eyes (46.4%) had their -zone PPAs on the nasal side, which was associated with the superotemporal direction of the CRVT/BMO offset (OR=1.008, P=0.003).

Conclusions: Both - and -zone PPAs were found in non-myopic eyes. Nasally located -zone PPA was associated with the temporal direction of CRVT/BMO offset like a mirrored image of myopic PPA. -zone PPA is not restricted to myopia but represents the offset between the openings of the optic nerve head canal.

Purpose: To evaluate the long-term performance of combined phacoemulsification and iStent implantation (iStent, iStent inject, and iStent inject W) in Asian patients with glaucoma and cataracts.

Patients and methods: This retrospective study included patients who underwent combined phacoemulsification and iStent implantation at a single tertiary center from November 2016 to July 2021. Eyes with varying glaucoma subtypes and severities were included. Changes in mean intraocular pressure (IOP) and the number of glaucoma medications were assessed at baseline and postoperative months (POM) 6, 12, 24, and 36. Surgical success was evaluated using multiple definitions, including complete and qualified success (CS/QS) criteria for IOP ≤18 and ≤15 mm Hg, modified success criteria (anyIOP, anyMed, or IOPMed), and the AAO-recommended criteria.

Results: A total of 284 eyes (mean age 70.8±8.9 y) had preoperative IOP of 15.8±3.9 mm Hg on 1.6±0.8 medications. At POM 36, mean IOP reduction was 1.4 mm Hg (P<0.001), and medication use decreased by 0.8 (P<0.001). CS and QS for IOP ≤18 mm Hg were 53.4% and 89.3%, respectively; for IOP ≤15 mm Hg were 41.2% and 63.5%, respectively. Success rates were 47.4% for anyMed, 55% for anyIOP, 42.2% for IOPMed, and 56.3% for the AAO criteria.

Conclusion: Combined iStent and phacoemulsification provided sustained, long-term reductions in both IOP and medication burden over 3 years, with over half achieving success across multiple stringent criteria, supporting its role as an effective, minimally invasive surgical option in real-world clinical practice.

Prcis: Decreased outer nasal macular perfusion density correlates with worsening visual field defects across all glaucoma severity levels-particularly with central 10-2 sensitivity-highlighting its potential as a critical parameter for monitoring primary open angle glaucoma progression, including advanced stages.

Purpose: To investigate whether sectoral macular perfusion density (MPD) from optical coherence tomography angiography (OCTA) relates to central visual field (VF) sensitivity (Humphrey 10-2) across mild, moderate, and advanced primary open angle glaucoma (POAG).

Patients and methods: In this retrospective, cross-sectional analysis of 196 POAG eyes, OCTA (6×6 mm, superficial plexus) provided sectoral MPD. MPD in each sector was analyzed in relation to the sum of total deviation (TD) of the HFA central 10-2 sectors mapped to OCTA sectors. Glaucoma severity was staged by 30-2 mean deviation (MD) using Hodapp-Parrish-Anderson thresholds: mild (> -6 dB), moderate (-6 to -12 dB), severe (< -12 dB). Study design was clarified as a retrospective analysis of prospectively acquired clinical data.

Results: Outer nasal MPD decreased stepwise from mild to moderate to severe (means 46.7%, 42.7%, 39.6%; ANOVA P<0.001, η²=0.135; Cohen f=0.395). Outer nasal MPD correlated with central 10-2 TD sums within strata (moderate r=0.298, P=0.013; severe r=0.286, P=0.022) and overall (r=0.364, P<1×10‒7). In multivariable analysis for MD10-2 (complete cases), outer nasal MPD (β=0.513, P<0.001) and mGCIPL thickness (β=0.288, P<0.001) were independently associated, whereas cpRNFL was not; model R²=0.386. Power analysis based on the observed 1-way ANOVA effect (f=0.395) indicated achieved power≈0.999 at α=0.05.

Conclusions: Outer nasal MPD is strongly associated with central functional loss across severities and adds information complementary to mGCIPL, supporting OCTA as a useful adjunct when structural OCT approaches a floor, including in advanced disease.