Journal of Glaucoma最新文献

Prcis: Trabeculectomy in African ancestry individuals with primary open angle glaucoma (POAG) 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.

Objective: To investigate outcomes of trabeculectomy ab externo in African ancestry 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 1 year) were collected. The 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 1 year. Subjects experienced a 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). Fifty-nine percent of patient eyes experienced complications within 1 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 a 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: While myopia has been recognized as a positive prognostic factor for normal tension glaucoma (NTG) progression in the adult population, some myopic NTG eyes exhibited significant progression within 2 years when left untreated, even under low intraocular pressure (IOP).

Objective: To determine the natural history and risk factors associated with progressive retinal nerve fiber layer (RNFL) thinning in previously stable, treatment-naïve, patients with NTG with myopia.

Methods: This study included 111 myopic NTG eyes without IOP-lowering treatment for at least 1 year and without disease progression during the treatment-free period. The RNFL thickness was measured, and a visual field test was performed every 6-12 months for >2 years. Patients with progressive changes were classified as the P(+) group, whereas those without progression were classified as the P(-) group. Cox proportional hazards model assessed risk factors of progression, whereas linear regression determined factors associated with the rate of RNFL thinning.

Results: Progressive change was observed in 25 of the 111 participants [P(+) group, 22.5%]. A family history of glaucoma, higher mean IOP, and maximum IOP during the follow-up were significant factors both for being in the P(+) group and for a faster RNFL thinning. None with a mean IOP <11 mm Hg were in the P(+) group. Davies test identified that 14.2 mm Hg was a significant breakpoint ( P = 0.042), above which the rate of RNFL thinning increased significantly with the mean IOP ( R2 = 0.252, P = 0.034).

Conclusions: Patients with myopic NTG untreated for IOP, especially those with a family history of glaucoma or higher IOP, are at increased risk of progression. Early treatment initiation is advised for high-risk patients with myopic NTG, even when their condition appears stable.

Prcis: The Preserflo MicroShunt effectively lowered intraocular pressure in primary high and normal pressure open angle glaucoma.

Purpose: To evaluate the efficacy and safety of the Preserflo MicroShunt in patients with primary open angle glaucoma (POAG) and the 2 variants high (HPG) and normal pressure glaucoma (NPG) after 1 year.

Methods: Single-center prospective interventional case series consecutively including eyes of White/European patients with POAG, who received the Preserflo MicroShunt as a primary and standalone glaucoma intervention. Primary outcome measures: change in mean 24-hour IOP (mdIOP, mean of 6 measurements), peak IOP, IOP fluctuations, antiglaucoma medications, and success rates. Secondary outcome measures include visual acuity, visual fields, complications, surgical interventions, and adverse events.

Results: Forty-two eyes of 42 patients with POAG, 29 in the HPG and 13 in the NPG group, were analyzed after 1-year follow-ups. Median [Q25, Q75] medicated mdIOP (mm Hg) dropped by 30% from 16.5 [13.7-27.3] to 12.8 [10.2-14.5] in the HPG and by 40% from 14.3 [13.3-16.0] to 9.5 [8.3-11.1] in the NPG group, with a median postoperative medication use of 0 [0-0] in both groups. At 1 year, 92.5% of eyes were medication-free versus 0% preoperatively. The reduction of mdIOP ( P =1.0), peak IOP ( P =0.932), IOP fluctuations ( P =0.142), and the rate of interventions ( P =0.298) were not statistically significantly different between the HPG and NPG group. None of the patients experienced severe adverse events or loss of vision.

Conclusions: Effective and safe intraocular pressure lowering was observed 1 year following MicroShunt implantation for primary HPG and NPG in White patients of European descent.

Purpose: To characterize the presence of amyloid-beta (Aβ) in human glaucoma retina and to test the identification of retinal Aβ using a novel fluorescent Aβ-binding small molecule (AMDX-2011).

Methods: Postmortem human eyes with (n=4) and without (n=4) glaucoma were acquired from an eye bank. Retinas were dissected, flat-mounted, and fixed. Using the flat mounts, immunofluorescence was performed against Aβ, AMDX-2011 staining was conducted, and images were acquired using fluorescence microscopy.

Results: Fluorescence microscopy demonstrated the presence of an Aβ signal that colocalized with AMDX-2011 staining in the glaucoma retina. Colabeled puncta appeared in all quadrants of the retina, including the retina temporal to the optic nerve. The puncta were mainly located within the inner layers of the retina. Glaucoma retinas had more colabeled puncta than control retinas in all locations ( P =0.002-0.02). Colabeled puncta were also larger in the superior quadrant of glaucoma compared with control retinas ( P =0.02).

Conclusions: Aβ was detected in human glaucomatous retina, and its distribution was mapped. AMDX-2011 identification of Aβ may lead to future diagnostic tests aimed at detecting Aβ in glaucoma patients.

Prcis: In 801 participants, corneal hysteresis (CH) was positively associated with female gender and central corneal thickness, and negatively with age and axial length. Diabetes showed no significant association with CH in the adjusted models.

Purpose: To provide values of corneal hysteresis (CH) in an elderly, healthy Greek population and to investigate its association with demographic, ocular, and systemic factors.

Methods: Cross-sectional population-based study. Out of 1,092 participants in the incidence cohort of the Thessaloniki Eye Study (TES) who were re-examined between 2013 and 2015, there were 801 eligible subjects in this study according to pre-specified criteria. All subjects underwent an interview and a comprehensive clinical examination. Demographic data and medical and ophthalmic, family, and smoking histories were recorded. CH was evaluated with Ocular Response Analyzer (ORA).

Results: The mean age of study subjects was 79.7±3.9 years and 345 out of 801 participants (43.1%) were female. The mean CH among all subjects was 10.1±1.5 mmHg. After adjusting for age, gender, central corneal thickness (CCT), axial length (AL), and diabetes, CH was positively associated with female gender (β=0.446; P<0.0001) and CCT (β=0.017; P<0.0001), and negatively associated with age (β=-0.024; P=0.038) and AL (β=-0.181; P<0.0001). There was no association between CH and diabetes (β=0.186; P=0.10). In a supplementary multivariable analysis of a smaller sample size, where we included corneal curvature (CC) as an additional covariate, no association was found between CH and CC (β=-0.235; P=0.26) or age (β=-0.023; P=0.09).

Conclusion: This study outlined variations in CH among a Greek population. CH decreased with advancing age while women had greater CH compared to men. In addition, eyes with thinner corneas and longer AL had lower CH values. No significant associations were found between CH and CC or the presence of diabetes.

Precis: Glaucoma surgery impacts corneal graft survival differently by procedure type, with GDDs being most effective at reducing intraocular pressure. However, graft survival rates are comparable across trabeculectomy, CPC, and GDDs. Trabeculectomy improves visual acuity best but often requires additional interventions.

Purpose: To investigate the impact of different glaucoma procedures on corneal graft survival and corneal endothelium health.

Methods: We searched PubMed, Cochrane Library, Scopus, and Web of Science, to identify eligible studies. Studies were included based on predetermined criteria. The primary outcome was corneal graft survival, and secondary outcomes included intraocular pressure (IOP) control, visual acuity, antiglaucoma medications, additional glaucoma surgery, and postoperative complications. Meta-analyses were conducted using random-effects models, and heterogeneity was assessed using the (I2) test.

Results: Our results included 27 studies involving 905 patients were analyzed. However, there were no randomized comparative studies. The overall proportion of corneal graft survival at last follow-up was 66.4%, with the three subgroups of trabeculectomy, cyclophotocoagulation (CPC), and Glaucoma drainage devices (GDD) showing similar survival rates of 66.6%, 64.8%, and 65.6%, respectively. Short term graft survival (6 months) was similar across groups, however 2-year survival favoured trabeculectomy. GDDs were the most effective in reducing IOP with an average reduction of 21.4 mmHg compared to 18.9 mmHg for trabeculectomy and 14.8 mmHg for CPC. CPC yielded the best improvement in visual acuity reported as BCVA. GDD required the fewest postoperative antiglaucoma medications. Trabeculectomy had the highest proportion of patients needing additional surgery for glaucoma. The most common complications were hypotony, uveitis and tube obstruction.

Conclusion: There were no significant differences in corneal graft survival rates among various glaucoma surgical techniques, but these findings must be interpreted with caution due to the limitations of primary research. GDDs effectively reduced IOP and minimized the need for antiglaucoma medications. Trabeculectomy may be associated with the greatest visual acuity improvement but may carry a higher likelihood of requiring further glaucoma surgery.

Purpose: Trabecular micro-bypass devices (TBDs) such as the iStent series (Glaukos Corporation, Laguna Hills, CA), are effective in reducing intraocular pressure (IOP). However, precise placement of TBDs is crucial in achieving surgical efficacy, as device malpositioning may lead to suboptimal IOP reduction. We demonstrate two novel intra-operative signs to aid confirmation of accurate iStent placement, without reliance on imaging technologies.

Methods: Surgical technique report with video accompaniment.

Surgical technique: Two intra-operative clinical signs which confirm optimal iStent placement are described: (1) Luminal Blood Reflux - achieved by gently decompressing the anterior chamber, with or without flushing of the stent lumen with balanced salt solution (BSS), thereby confirming stent positioning in the Schlemm's Canal (SC). (2) Schlemm's Bidirectional Fluid Wave (SBFW) - observable when flushing with BSS, suggesting fluid movement in the canal segments adjacent to the iStent device, thereby confirming stent patency and positioning in the SC.

Conclusion: The identified signs are useful, feasible and reproducible indicators of accurate iStent placement. Future studies may evaluate the application of these confirmatory manoeuvres in diverse clinical contexts and further establish correlation with clinical outcomes.

Precis: Goniotomy is effective in managing intraocular pressure in childhood glaucoma secondary to uveitis with cumulative probability of success 0.94 after 1 year and 0.77 after 5 years.

Objective: To evaluate the long-term success of goniotomy for childhood glaucoma secondary to chronic uveitis.

Methods: Retrospective chart review of all children treated with goniotomy for this indication from 2001 to 2023. Post operative success was defined as IOP ≥ 6 and ≤ 21 mmHg after 1 or 2 goniotomies, without the need for further surgical intervention or sight-threatening complication.

Results: 31 eyes of 21 patients were included. Mean age at first goniotomy was 10.3 years (range 6.6- 15.7 years) with uveitis diagnosed on average 4.7 years earlier. Mean pre-operative IOP was 28.8 mmHg, on a median of 4 topical agents. Mean follow-up post-goniotomy was 6.8 years (Median 5.7 years) and average post operative IOP at 1, 5 and 8 years post-operatively was 15.9, 15.2 and 15.6 mmHg respectively. At most recent follow-up, 24 eyes (77.4%) were a surgical success. Of these, 5 (21%) needed a second goniotomy to achieve this, and 5 (21%) needed anti-glaucoma drops to maintain IOP ≤21 mmHg (two of these were cases who also underwent a second goniotomy). There were no major complications including loss of inflammatory control.

Conclusion: We confirm that this quick, safe, conjunctival sparing primary approach is safe and effective in this context, and early success rates are usually maintained in the long-term. If stable inflammatory control can be achieved pre-operatively, we recommend it as first line treatment for children with childhood glaucoma secondary to uveitis.

Prcis: Trabecular cutting minimally invasive glaucoma surgery like bent ab interno needle goniectomy (BANG) when performed in baseline aqueous angiography identified low aqueous humor outflow regions, results in greater success of intraocular pressure reduction.

Purpose: To study the efficacy of Bent Ab Interno Needle Goniectomy (BANG) in high versus low aqueous humor outflow (AHO) regions as determined by Aqueous Angiography(AA) in patients with primary open angle glaucoma (POAG).

Methods: A prospective, single-centre, pilot, randomized control trial recruited 30 eyes of 30 patients of POAG and visually significant cataract (45-80 y) and were randomised into two groups ("A": BANG performed in the high-flow regions and "B": BANG performed in the low-flow regions) of 15 each. AA was performed using indocyanine green dye (0.1%) to identify baseline high- and low-flow regions of the AHO pathways followed by BANG in these respective regions as per randomisation. Preoperative and postoperative data on IOP, number of antiglaucoma medications (AGMs) and any complications were noted over 6 months. Overall success was defined as achieving an IOP ≤15 mm Hg and ≥6 mm Hg at 6 months of follow-up with AGMs (qualified success) or without AGMs (complete success).

Results: AA revealed high-flow regions of AHO pathways in the nasal quadrant and low-flow regions of AHO pathways in the temporal quadrant in all 30 patients. Both groups had comparable demographic composition [group A age: 65.3±6.48 y and male: female (14:1) and group B age: 64.6±7.08 y and male: female (13:2)]. The mean preoperative IOPs [group A (17.27±3.43 mm Hg); group B (17.60±5.42 mm Hg)] (P=0.842) and mean postoperative IOP at 6 months [group A (15.6±4.98 mm Hg); group B (13.13±2.29 mm Hg)] (P=0.09) were similar. However, lower qualified success was seen in group A (40.00%) compared to group B (86.67%; P=0.021). Survival in Kaplan-Meier analysis was higher in group B (P=0.021). Complications were comparable in both groups.

Conclusion: Short-term results of BANG in low-flow AHO regions show enhanced success compared to those in high-flow AHO regions. This study suggests that trabecular cutting minimally invasive glaucoma surgeries (like BANG) may be performed in baseline low-flow AHO regions (temporal quadrant) instead of the high-flow AHO (nasal quadrant) regions.

Prcis: Deep sclerectomy (DS) and canaloplasty provide better intraocular pressure (IOP) control than viscocanalostomy. DS required less glaucoma medications but more interventions to reach target IOP.

Purpose: To compare real-world outcomes of three non-penetrating glaucoma surgery (NPGS) techniques.

Methods: Retrospective, cohort study of consecutive patients undergoing canaloplasty (CP), deep sclerectomy (DS), and viscocanalostomy (VC), across nine European glaucoma units. Four intraocular pressure (IOP) criteria were used to define success at 2-year follow-up: (A)IOP≤21 mmHg and ≥20% reduction; (B)IOP≤18 mmHg and ≥20% reduction; (C)IOP≤15 mmHg and ≥25% reduction; (D)IOP≤12 mmHg and ≥30% reduction. Secondary outcomes included IOP control, BCVA, number of medications over time, risk factors for failure, complications, and post-operative interventions. Success was distinguished as qualified or complete, if reached with or without antiglaucoma medications, respectively.

Results: 600 eyes (545 patients) undergoing standalone CP (201 eyes), DS (200 eyes), and VC (199 eyes) were included. Qualified success rates of CP, DS, and VP at 24 months were, respectively: (Criterion A) 85.1%, 67.6% and 64.6%; (Criterion B) 85.1%, 66.1% and 58.6%; (Criterion C) 76.6%, 55.5% and 39.0%; (Criterion D) 27.7%, 28.5% and 22.1%. Success rates were significantly different across the three techniques (P=0.04 or below), except for complete success according to criterion A (P=0.07). Mean IOP(±SD) reduced from 25.2(±6.9), 20.5(±6.7), and 22.7(±7.2)mmHg pre-operatively to 13.1(±3.1), 12.9(±4.5), and 14.7(±4.6)mmHg at post-operative year 2 in the CP, DS, and VC groups respectively (P<0.001 between pre-operative and post-operative time points for all groups).

Conclusions: All three NPGS provide sustained IOP reduction, but DS and CP provide better success rates and IOP control. Success rates were low for the most stringent cut-offs, suggesting that other techniques such as trabeculectomy may be indicated when a very low target IOP is demanded.