Journal of Glaucoma最新文献

Prcis: The visualization of circle of Zinn-Haller (CZH) on optical coherence tomography angiography (OCTA) or its pattern does not have a clear effect on glaucoma, whereas the location of CZH is associated with axial length (AXL) in highly myopic eyes.

Purpose: To investigate the association between the CZH and the presence of glaucoma using swept-source optical coherence tomography angiography (SS-OCTA) images of the optic nerve of patients with high myopia (HM).

Methods: This retrospective case series included 227 eyes with HM, comprising 134 and 93 eyes with and without glaucoma, respectively. The characteristics of CZH, including visualization, pattern, and location, were assessed using SS-OCTA. Vascular parameters, such as vessel density and microvascular dropout (MvD), were quantified. The factors affecting the presence of glaucoma and the correlations between the CZH distance and AXL were identified using logistic regression analysis and Pearson correlation analysis, respectively.

Results: CZH was detected more frequently in HM patients with glaucoma (71.6%) than in patients without glaucoma (51.6%) ( P <0.002). However, the visualization of CZH was not related to the presence of glaucoma in multivariate regression analysis (odds ratio [OR], 0.688; 95% confidence interval [CI], 0.328-1.444; P =0.322). Moreover, compared with the annular pattern used as a reference, triangular and irregular patterns were not associated with the presence of glaucoma (OR: 1.043, 95% CI: 0.101-10.763, P =0.971; OR: 0.527, 95% CI: 0.255-1.092, P =0.085, respectively). MvD was significantly higher in patients with glaucoma (61.2%) than that in patients without glaucoma (2.2%) ( P <0.001) and was identified as a significant factor affecting the presence of glaucoma (OR, 42.120; 95% CI, 9.416-188.413; P <0.001). AXL showed a significant correlation with CZH distance in all patients (R=0.399; P <0.001).

Conclusions: CZH was more commonly detected in HM patients with glaucoma. However, no clear associations of glaucoma with the visualization, pattern, or location of CZH were observed in the present study. The correlation between AXL and CZH distance in eyes with HM warrants further investigation. These results may offer insights into the pathogenesis of glaucoma in eyes with HM as OCTA technology advances.

Precis: Patients in the prednisolone acetate 1% group post-SLT had higher treatment success rates comparing to other anti-inflammatory drugs.

Purpose: To investigate the effect of different anti-inflammatory regimens on selective laser trabeculoplasty (SLT) outcomes.

Patients and methods: Prospective randomized controlled trial. We included newly diagnosed primary open angle glaucoma (POAG) patients that underwent a primary SLT session. Patients were randomly divided into 3 groups (prednisolone acetate 1%, prednisolone acetate 0.12% and ketorolac tromethamine 0.5%). After SLT, intraocular pressure (IOP) data were collected at different time points: days 7 and 30, and at 3, 6 and 12 months post-SLT. Main outcome measure was the comparison of success rates (Kaplan Meier survival analysis) between groups (log-rank test).

Results: We included a total of 134 eyes from 134 newly diagnosed POAG patients (mean age: 62.64±13.86 y) with a mean follow-up of 287±104 days. We observed a significant IOP reduction following SLT treatment in all groups at 12 months (baseline IOP 19.57±3.78 vs. final IOP: 14.39±2.29 mmHg, P<0.001). Patients in the acetate prednisolone 1% group presented higher survival rates (83.7%) comparing to the other groups (prednisolone acetate 0.12%=63.9%; ketorolac tromethamine 0.5%=67.0%) at 12 months (P=0.003). Patients in the acetate prednisolone 1% group had higher chances of treatment success (hazard ratio [HR] 0.30; 95% CI: 0.13-0.68, P=0.004), as well as younger patients (HR 1.03; 95% CI: 1.00-1.05, P=0.005) and those with higher baseline IOP (HR 0.78; 95% CI: 0.72-0.85 P<0.001). In the multivariable analysis, patients in the acetate prednisolone 1% group remained with higher chances of treatment success (HR 0.37; 95% CI: 0.15-0.91, P=0.031). No sight-threatening adverse events was reported during follow-up in all groups.

Conclusions: In summary, evaluating the effect of different anti-inflammatory regimens on SLT outcomes in newly diagnosed POAG patients, we found had higher success rates in patients treated with prednisolone acetate 1% after SLT. In addition, higher baseline IOP seem to positively influence post-operative outcomes.

Precis: Inter-ocular comparison of primary angle closure glaucoma subjects with asymmetrical and symmetrical visual field loss, revealed significantly thinner central corneal thickness and higher presenting intraocular pressure in the worse eye of the asymmetrical group.

Purpose: To compare the inter-ocular clinical and biometric parameters of primary angle-closure glaucoma (PACG) with asymmetrical and symmetrical visual-field loss at presentation.

Patient and methods: Retrospective study in which the following clinical data were extracted: presenting intraocular pressure (IOP), gonioscopy, visual-field mean deviation (MD), central corneal thickness (CCT), anterior chamber depth (ACD) and axial length (AL). Asymmetrical PACG was defined as the inter-eye visual-field MD difference >6 dB, symmetrical PACG <3 dB, and those with inter-eye difference between 3-6 dB were excluded. Linear mixed effects model was used to adjust for the interdependence of the right and left eyes.

Results: Of 243 PACG subjects, 122 (50.3%) presented with asymmetrical, and 69 (28.4%) with symmetrical disease. The worse eyes in subjects with asymmetrical PACG had significantly higher presenting IOP (P<0.001), narrower angles (P<0.001), more myopic refraction (P<0.001) and thinner CCT (529.2±36.1 μm vs. 535.8±38.5 μm; P<0.001) compared to the fellow eyes; but no inter-eye differences were observed for AL (P=0.93) and ACD (P=0.53). In symmetric PACG, no significant inter-eye differences were observed for CCT (532.3±33.1 vs. 533.1±34.6 μm, P=0.67), AL (P=0.85) and ACD (P=0.18), but the relatively worse eye had higher presenting IOP (P=0.003). In the stepwise multiple linear regression analysis in the asymmetrical group, CCT was the only significant variable (P=0.006), explaining 12% of the variability of the visual-field MD of the worse eye.

Conclusions: In asymmetrical PACG, worse eyes have thinner CCT and higher presenting IOP. Difference in CCT could either be inherent or acquired, and more tests would be needed to tease that out.

Purpose: To report a rare case of hemorrhagic Descemet membrane detachment (DMD) after Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) and to discuss its management.

Methods: A 71-year-old male patient with advanced pseudoexfoliation glaucoma and dense cataract was planned to perform combined GATT and cataract extraction. DMD was noticed after blood reflux from Schlemm's canal during GATT. Circumferential ab-interno trabeculotomy was completed and DMD was reattached with air tamponade. Cataract extraction was postponed to prevent progression of DMD.

Results: Hemorrhagic DMD was monitored during a 3-month follow-up. Spontaneous resorption was not observed. A side port incision was made at the site of hemorrhagic DMD during cataract extraction. The space upon DM was washed out with a balanced salt solution to allow drainage of the hemorrhage and an air bubble was left in the anterior chamber. On the first postoperative day after cataract extraction, DM was observed to be attached and the hemorrhage had disappeared completely.

Conclusions: Hemorrhagic DMD is an unusual complication after GATT and it may be challenging to manage. Surgeons who perform GATT should be aware of this rare corneal complication.

Prcis: Greater social vulnerability, younger age, non-white race, Hispanic ethnicity, non-English speaking, Medicaid insurance, and milder glaucoma were associated with higher no-show propensity, which worsened during the Covid-19 pandemic among those subjects who were older and more socially vulnerable.

Purpose: To identify sociodemographic risk factors for higher likelihood to no-show among glaucoma subjects before and during the Covid-19 pandemic using the no-show propensity factor (NSPF), a novel attendance metric, which improves upon no-show percentages by adjusting for number of visits.

Methods: We analyzed de-identified demographic, visit attendance, and social risk factor data (social vulnerability index (SVI) and area deprivation index (ADI) scores) of de-identified glaucoma subjects from the Bascom Palmer Glaucoma Repository, computed NSPF, and categorized scores as low, intermediate, or high by the 75th and 90th percentiles for the pre-pandemic and pandemic periods. We identified predictors of NSPF scores using univariable, multivariable, and logistic regression analyses.

Results: Of 15,342 subjects, 11,474, 2,238, and 1,630 subjects had low, intermediate, and high NSPF scores respectively with no-show rates of 9.5%, 39.2%, and 57.8% respectively. Age (β=-0.039 per decade, P<0.001), Black race (β=0.152, P<0.001), Hispanic ethnicity (β=0.115, P<0.001), Medicaid (β=0.073, P<0.001), Spanish primary language (β=0.076, P<0.001), SVI scores (β=0.047 per 25% increase, P<0.001), ADI ranking (β=0.057 for highest quartile, P<0.001), and baseline moderate (β=-0.046, P<0.001) or severe (β=-0.077, P<0.001) glaucomatous disease were significant predictors of NSPF. Older age (odds ratio (OR) 1.15 per decade, P<0.001), higher overall SVI (OR 1.09 per 25% increase, P<0.001), Medicare/Tricare insurance (OR 1.13, P=0.044), and non-English/Spanish primary language (OR 1.43, P=0.020) were associated with worsening NSPF during the pandemic.

Conclusion: Younger age, non-white race, Hispanic ethnicity, non-English primary language, Medicaid, milder glaucoma, and residence in vulnerable areas are risk factors for greater propensity to no-show.

Precis: Data coming from this study suggest that selective laser trabeculoplasty could be a very important tool in the overall management of glaucoma patients at every stages, aiming to better control the visual field deterioration.

Purpose: To evaluate selective laser trabeculoplasty (SLT) effectiveness in lowering intraocular pressure (IOP) and in visual field defect progression in eyes affected by primary open angle glaucoma (POAG) at long term follow up.

Methods: A retrospective study were conducted with 67 eyes of 67 patients affected by POAG who underwent SLT between 2014 and 2021. Each patient was routinely observed in the Glaucoma Office of Università della Campania Luigi Vanvitelli and underwent a complete eye visit and visual field (VF) test with 30-2 SITA standard automated perimetry (SAP) every 6 months. When both eyes in same patient were treated, only the eye with lower mean deviation (MD) of SAP was included. Patients were observed at 6, 12, 18, 24, 30, 36, 42, 48, 54 months.

Results: A mean significant (P<0.01) lower IOP was detected at 6 months (12.92±2.7 mm Hg) ad at 54 months (13.08±2.42 mm Hg) compared to baseline (17.91±4 mm Hg). Mean MD values showed significant (P<0.01) reduction both at 6 month follow up (-0.07±0.21 dB) and at 54 month follow up (-0.3±0.34 dB) demonstrating satisfactory clinical deceleration of the progression of the disease.Mean IOP medical lowering therapy was 1.34±0.9 drugs, showing a significant (P<0.01) decrease 6 months after SLT (0.87±0.85), that remained stable (P= at 54 month follow up (0.9±0.76).

Conclusions: The results observed confirm not only the high level of effectiveness of SLT in lowering IOP and reducing the need for topical medications, but also its role in decelerating visual field deterioration in eyes affected by POAG.

Prcis: 13.9% of fixation loss responses by the Heijl-Krakau method were observed even in stable fixation eyes. The Heijl-Krakau method would overestimate the fixation loss responses.

Purpose: This study aimed to evaluate the accuracy of the Heijl-Krakau method by measuring eye positions during blind-spot stimulation.

Methods: Two thousand one hundred fifty-three eyes of 1155 glaucoma and glaucoma-suspect patients. All patients underwent a head-mounted perimeter imo test. The imo has an eye tracking system that records eye position during tests and assists the device with stimulating corrected points corresponding to eye movement. All stimulus presentations were classified into three groups: 1. fixation loss (FL) stimulus: responded to Heijl-Krakau stimuli; 2. non-FL stimulus: did not respond to Heijl-Krakau stimuli; 3. total stimuli: all other stimuli except for Heijl-Krakau stimuli. We compared the amount of fixation displacement between the FL, non-FL, and total stimuli by the Mann-Whitney U test. Relationships between the FL and mean deviation (MD), the FL and age were analyzed.

Results: The median fixation displacements with the FL, non-FL, and total stimuli were 3.2°, 1.4° and 1.5°, respectively. The fixation displacement in the FL stimulus group was greater than that in the non-FL and total stimuli groups (P<0.001). When we defined fixation displacement in the range of less than 1° as "stable eye fixation", 13.9% of the stimulus points corresponded to "stable eye fixation" with the FL stimulus. No significant relationships were found in the FL and MD, as well as in the FL and age.

Conclusion: In glaucoma and glaucoma suspected patients, after allowance for eye movement by imo patients still responded to the Heijl-Krakau blind spot monitor on 13.9% of occasions.. Our results suggest that the Heijl-Krakau method overestimates the FL response in glaucoma and glaucoma suspected patients.

Purpose: The study aimed to investigate the relationship between average daily steps (ADS) and optic disc angioflow vessel density (VD) in patients with primary open angle glaucoma (POAG).

Materials and methods: This is a cross-sectional study. Forty-one POAG patients (74 eyes) were recruited from Wenzhou Glaucoma Progression Study (WGPS) who were divided into two groups based on international physical activity guidelines: 21 subjects (38 eyes) in the ADS>10,000 group and 20 patients (36 eyes) in the ADS≤10,000 group. ADS was monitored using a waist-worn accelerometer (ActiGraph wGT3x-BT) worn on the waist for seven consecutive days, while optic disc VD was assessed by the optical coherence tomography angiography.

Results: Papillary VD was significantly denser in the ADS>10,000 group (ADS:12782±2925) compared to the ADS≤10,000 group (ADS:7418±1543) for both whole image-all VD (WIAVD) and whole image-capillary VD (WICVD) (P=0.026, 0.032, respectively). Univariate analysis indicates that WIAVD was more denser in ADS>10,000 vs ADS≤10,000 (P=0.013) and that WICVD was more denser in ADS>10,000 vs ADS≤10,000 (P=0.019). Furthermore, every 1 μm thicker in retinal nerve fiber layer (RNFL) thickness was associated with a 0.24 denser in WIAVD (P<0.0001) and a 0.23 denser in WICVD (P<0.0001). Each 1-dB improvement in mean deviation (MD) was linked to a 0.75 increase in WIAVD (P<0.0001) and a 0.83 increase in WICVD (P<0.0001). Additionally, a 1 mmHg increase in intraocular pressure was associated with a 0.5 decrease in WIAVD (P<0.009) in univariate analysis and a 0.31 decrease in multivariate analysis (P<0.012). Multivariate analysis revealed that patients with ADS>10,000 had 1.75 higher WIAVD and 1.64 higher WICVD compared to those with ADS≤10,000 after adjusting for other risk factors.

Conclusion: POAG patients with ADS>10,000 exhibited higher papillary VD compared to those with ADS≤10,000, implying that increasing daily steps, particularly exceeding 10,000 steps, may potentially enhance ocular blood flow.

Prcis: Analysis of Centers for Medicare and Medicaid Services (CMS) Physician Payment data found that physician certification year, degree of urbanization, and estimated income by zip code were significant in predicting the proportion of traditional glaucoma procedures performed by each provider in the United States.

Objective: The prevalence of microinvasive glaucoma surgery (MIGS) compared with traditional procedures has been increasing in glaucoma management. It is important to understand whether the uptake of new glaucoma procedures is associated with aspects of the physician practice.

Methods: In this cross-sectional study, data on glaucoma procedure distribution, degree of urbanization, and physician certification in the United States were extracted from the 2019 CMS Physician Payment and American Board of Ophthalmology databases. The distribution of traditional and MIGS procedure numbers for metropolitan versus non-metropolitan providers was visualized with boxplots and statistically compared using Mann-Whitney U tests. We used two-dimensional histograms and regression analyses to assess the relationship between certification year and volume of traditional versus MIGS procedures. A multivariable linear regression model was created using certification year, rural-urban commuting area code, and estimated income by practice zip code to predict the number and proportion of each type of glaucoma procedure.

Results: This study included 2625 providers from the CMS physician payment data who performed only traditional procedures (n = 370), MIGS procedures (n = 1727), or both procedure types (n = 528) in 2019. The median number of MIGS procedures performed by each provider was greater in non-metropolitan areas (31 vs 29, P = 0.015), whereas the proportion of traditional procedures performed by each provider was greater in metropolitan areas (0.24 vs 0.08, P < 0.001). Regression analysis showed a positive relationship between the certification year and the proportion of traditional procedures performed by each provider ( P < 0.001). Multivariable regression models found that certification year, rural-urban commuting area code, and estimated income of practice location were all significant predictors ( P < 0.02) of the proportion of traditional procedures performed by each provider.

Conclusion: In the United States, physicians in metropolitan areas and more recent certification years are more likely to perform a larger proportion of traditional procedures. This finding suggests that the distribution of glaucoma procedure types is related to physician factors such as degree of urbanization and duration of practice. More research is needed to better understand how such differences affect patient access and outcomes.

Prcis: In addition to standard automated perimetry tests, contrast sensitivity (CS) testing and macular analyses may predict changes in the quality of life (QOL) in patients at different stages of glaucoma.

Objective: To examine the relationship between functional and structural tests of visual function and the 25-item National Eye Institute-Visual Function Questionnaire (NEI-VFQ-25) and the 36-item Short Form (SF-36) Health Survey in patients with different stages of glaucoma.

Materials and methods: Standard automated perimetry tests, optical coherence tomography scans, and CS testing were prospectively performed in 160 patients with glaucoma. The Hoddap-Parrish-Anderson staging system was used for glaucoma staging. Health-related QOL questionnaires (NEI-VFQ-25, SF-36) were also administered to all patients.

Results: The study group comprised 29 patients with suspected glaucoma, 104 with mild glaucoma, 15 with moderate glaucoma, and 12 with severe glaucoma. The mean total score of the NEI-VFQ-25 was 88.8 ± 8.2. The SF-36 did not show a significant correlation with the data on functional and structural tests of visual function, whereas the NEI-VFQ-25 showed a low to moderate correlation ( r = 0.212 to -0.492). Vision parameters can explain up to 18.6% of the total score of the NEI-VFQ-25. CS was the only function significantly correlated with glaucoma suspects, whereas, in the early stages, visual acuity was the strongest correlated function with the NEI-VFQ-25 total score ( P = 0.003 and r = 0.551; P = 0.001 and r = 0.343, respectively). The impact of the visual field on vision-related QOL increased in the advanced stages ( P = 0.013, r = 0.688). The macular retinal ganglion cell plus inner plexiform layer thickness remained associated with NEI-VFQ-25 at all stages of glaucoma ( r = 0.335 to 0.802). The NEI-VFQ-25 total score and most of the subscales were correlated with the physical and mental component summary scores of the SF-36 ( r = 0.159 to 0.587).

Conclusion: Visual acuity correlated the most with QOL in patients with glaucoma, as measured with the NEI-VFQ-25 to assess QOL in glaucoma. The impact of visual functions on QOL varies at different stages of glaucoma.