Journal of Glaucoma最新文献

Prcis: This research presents the burden and clinical characteristics of NVG in Zhongshan Ophthalmic Center, employing the most extensive sample size and the longest uninterrupted temporal duration so far, which may provide a theoretical reference for the effective prevention and diagnosis of NVG.

Purpose: To summarize the burden and clinical characteristics of neovascular glaucoma (NVG) in a major tertiary care center in China.

Methods: The clinical data of NVG patients in Zhongshan Ophthalmic Center (ZOC) between 2012 and 2021 were collected retrospectively, including their age, sex, affected eye, best-corrected visual acuity (BCVA), intraocular pressure (IOP), clinical stage and aetiology.

Results: In this study, we included 1877 eyes of 1749 patients who developed NVG, with 2.01:1 ratio of male to female. Their mean age was 53.14±16.69 years and those aged 41-70 years (65.2%) were most affected. Monocular patients were more predominant in most of them (92.7%), while 7.3% were binocular and 1667 eyes (88.8%) were at the angle‑closure stage. The BCVA and IOP were 2.42±0.70 logMAR and 38.6±12.2 mmHg, respectively. Over the decade, the number of NVG patients and the proportion of NVG patients among glaucoma patients showed an increasing trend, with annual percentage changes (APCs) of 9.1% (95% CI: 5.0-13.3%, P=0.001) and 4.8% (95% CI: 2.2-7.4%, P=0.003), respectively. The top three primary conditions were diabetic retinopathy (DR), retinal vein occlusion (RVO), and retinal detachment (RD). Moreover, the APCs for the constituent ratio of DR and RVO were 4.4% (95% CI: 0.5-8.4%, P=0.031) and ﹣4.6% (95% CI: ﹣8.4% to ﹣0.7%, P=0.028), respectively. However, the first and second causes of NVG in minors (<18 years old) were Coat's disease and ocular tumours, followed by RD and RVO in third place. The top cause of NVG in patients aged 65 years and older was RVO.

Conclusions: The burden of NVG is increasing, emphasizing the need to improve preventive strategies focusing on primary diseases such as DR, RVO, and RD, particularly the increasing proportion of DR cases and the previously underemphasized RD patients, while also highlighting the differences in primary diseases across different age groups.

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

Methods: Post-mortem 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 presence of Aβ signal that co-localized with AMDX-2011 staining in glaucoma retina. Co-labeled puncta appeared in all quadrants of the retina, including retina temporal to the optic nerve. The puncta were mainly located within the inner layers of the retina. Glaucoma retinas had more co-labeled puncta than control retinas in all locations (P = 0.002-0.02). Co-labeled puncta were also larger in the superior quadrant of glaucoma compared to 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 addition to standard automated perimetry tests, contrast sensitivity testing and macular analyses may predict changes in the quality of life in patients at different stages of glaucoma.

Purpose: 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 Health Survey (SF-36) in patients with different stages of glaucoma.

Materials and methods: Standard automated perimetry tests, optical coherence tomography scans, and contrast sensitivity (CS) testing were prospectively performed in 160 patients with glaucoma. The Hoddap-Parrish-Anderson staging system was used for glaucoma staging. Health-related quality of life 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--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, while in the early stages, VA 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 quality of life 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=0.335-0.802). 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=0.159-0.587).

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

Prcis: The lamina cribrosa pores of high-tension glaucoma subjects appear to take a more tortuous pathway than the LC pores of non-glaucomatous subjects.

Purpose: To compare the lamina cribrosa pore microarchitecture in high-tension glaucoma (HTG), normal-tension glaucoma (NTG) and in non-glaucomatous (NG) subjects, by reconstructions of the lamina cribrosa made from tomographic images.

Patients and methods: SD-OCT images of 52 eyes (18 NG, 18 HTG, 16 NTG) of 29 patients were analyzed. Pores were traced using segmentation software. Pore length, tortuosity and verticality were the three quantitative parameters compared between the three groups. Correlation analyses were performed to determine the effects of covariates on the three quantitative parameters.

Results: Pore tortuosity in HTG (1.419 +/- 0.093) was significantly higher (P=0.011) than in NG (1,347 +/- 0,034) but did not differ from that of NTG eyes (P=0.251). In addition, NTG had significantly shorter pores (P=0.005) than NG. No difference in pore tortuosity or verticality was found between NG and NTG (P=0.587 and P=0.120 respectively). Pore verticality and length in HTG eyes did not significantly differ from that of NG eyes (P=0.049 and P=0.033 respectively) and NTG eyes (P=0.827 and P=0.968 respectively). All of the quantitative parameters measured were not correlated with age, but were associated with glaucoma severity (VFI, MD, RNFL, GCC), except for pore verticality which was not correlated with RNFL.

Conclusion: The LC pores of HTG subjects appear to be more tortuous than the pores of NG subjects and the pores of NTG patients are shorter than those of NG subjects. Changes in pore parameters appear to be associated with severity of the glaucomatous optic neuropathy.

Prcis: We quantified and compared the gaze metrics during target-oriented visual search tasks between glaucoma and healthy controls. Based on a mathematical concept we showed that due to glaucoma, focal search becomes prominent over global search.

Purpose: Visual Search (VS) which is essential for target identification and navigation is significantly impacted by glaucoma. VS metrics can be influenced by differences in cultural exposure or coping strategies, leading to varying VS patterns. The aim of this study was to explore and label the pattern of VS based on gaze metrics quantified using eye-tracking technology.

Methods: Twenty-seven glaucoma subjects and thirty healthy controls (median age 51 (14) and 54 (19) years respectively) underwent a VS experiment during which they had to identify specific targets from real-world images. Eye movements were recorded using a remote eye-tracker and gaze metrics - Fixation Count (FC), Fixation Duration (FD), Saccade Amplitude (SA), and VS Time (VST) were computed and compared between the study groups. A Z-score-based coefficient 'K' was derived to label the search patterns as global (K ≤ - 0.1: short FD with long SA), focal (K ≥ +0.1: long FD with short SA), or a combination (K between +/-0.1).

Results: Similar to other ethnicities, Indian glaucoma subjects also exhibited statistically significantly increased FC, FD, and VST (P=0.01). Healthy controls presented a comparable proportion of focal (47%) and global (42%) search patterns while glaucoma subjects exhibited predominantly focal (56%) than global search patterns (26%, P=0.008).

Conclusions: This study suggests that glaucoma subjects perform more focal search during active gaze scanning. This change in viewing behavior reflects underlying compensatory strategies adapted for coping with their visual impairments. These search patterns can be influenced by factors such as saliency which requires further investigation.

Prcis: In this retrospective study, nonpenetrating deep sclerectomy (NPDS) and penetrating deep sclerectomy (PDS) interventions showed similar >90% complete success rates at 1-year postsurgery. However, NPDS achieved a superior safety profile in terms of best-corrected visual acuity (BCVA) recovery and rates of post-surgical complications.

Objective: Comparing the surgical outcomes of 2 surgical techniques: NPDS and PDS.

Patients and methods: This was a retrospective, longitudinal, comparative study including 66 eyes from 57 patients aged 69 ± 9 years who underwent either NPDS or PDS for medically uncontrolled open angle glaucoma. Outcome measurements included intraocular pressure (IOP), BCVA, rates of complications, postoperative corrective interventions, and glaucoma medications at baseline and at all postoperative appointments up to 1 year. An exploratory mixed-effect model was used to assess the intergroup differences between IOP and BCVA.

Results: One-year postsurgery, a similar significant IOP reduction from baseline was observed in NPDS (from 19.9 ± 1.3 to 11.5 ± 0.9 mm Hg, P < 0.001) and PDS (from 19.5 ± 1.1 to 10.7 ± 0.6 mm Hg, P < 0.001). A conservative complete success rate (defined as medicated IOP ≤16 mm Hg and ≥20% reduction in IOP) was 87% for NPDS and 97% for PDS. No BCVA changes were observed between baseline and 1-year postsurgery in both groups, and glaucoma medications showed a similar 10-fold reduction in both groups ( P < 0.001 vs baseline). However, a significant difference in the speed of postoperative BVCA recovery was observed between NPDS and PDS ( P < 0.01), with NPDS showing a faster recovery. Moreover, lower numbers of postsurgical complications and postoperative interventions were observed after NPDS compared with PDS [NPDS, n = 30 and 34 vs PDS, n = 80 and 48 ( P < 0.05), respectively].

Conclusions: The present study confirmed that both NPDS and PDS are highly effective surgical interventions for the management of primary open angle glaucoma. However, NPDS had a superior safety profile in terms of BCVA recovery, complication rates, and postoperative interventions.

Gonioscopy-assisted transluminal trabeculotomy (GATT) is a promising cost-effective minimally invasive glaucoma surgery (MIGS). The main advantage is safety with regards to low risk for hypotony and its related complications. However, the Schlemm's canal (SC) based procedures have a different set of complications, the most common being hyphema and transient intraocular pressure spike. The other rare complications being, the false passage of the suture by traversing the external wall of the SC into the suprachoroidal space or posterior chamber or breaching the internal wall of the SC into the anterior chamber. Although these complications are rare, knowledge about them is important not only for early identification but for prevention and management if they occur. Through this case report, we describe a rare complication where the suture had traversed through a dilated episcleral vein during GATT. To our knowledge, there has been no prior report of such a complication.

Prcis: The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract.

Purpose: To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract.

Patients and methods: A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18 mm Hg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression.

Results: A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8 mm Hg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P =0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P =0.036) reduced success rate.

Conclusions: The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.

Prcis: Initial presentation of glaucoma at a major eye clinic mostly features advanced disease with a high proportion of blindness. This is likely a microcosm of a nationwide issue requiring concerted strategies to detect glaucoma early.

Purpose: To characterize the severity stage of new glaucoma patients in Congolese attending a university eye clinic.

Methods: New glaucoma patients (n=118) were labeled as early or late presenters based on visual field sensitivity in the worse eye.

Results: Mean age was 58.9±15.7 years, 51.7% were males. Overall, the worse eye had advanced, whereas the better eye had moderate glaucoma, with an asymmetry of -7.4 dB ( P <0.001). Blindness was present in 30.5% of worse and 5.1% of better eyes. Seventy-two patients (61.0%) were late presenters. Visual acuity was lower ( P <0.001), intraocular pressure (IOP) higher ( P =0.02), cup-to-disc ratio larger ( P =0.011), and retinal nerve fiber layer thinner ( P =0.001) in late presenters' worse than better eye. The worse and better eyes of late presenters had advanced glaucoma, with a -9.6 dB interocular asymmetry ( P <0.001); 40.3% and 8.3% were blind, respectively. In early presenters, the worse and better eyes had moderate and early disease, respectively; the asymmetry was -3.2 dB ( P <0.001), and 15.2% were blind. Overall, 58.5% and 65.3% presented with advanced disease in the worse eye based on visual field and cup-to-disc ratio criteria of the Canadian Ophthalmological Society staging scale, respectively.

Conclusions: Most new glaucoma patients had bilateral advanced but asymmetric disease. These findings call for the establishment of community-based measures for early detection of glaucoma and a referral network system connecting community healthcare to tertiary eye clinics.

Prcis: In this meta-analysis of 6 studies and 5269 patients, deep learning algorithms applied to AS-OCT demonstrated excellent diagnostic performance for closed angle compared with gonioscopy, with a pooled sensitivity and specificity of 94% and 93.6%, respectively.

Purpose: This study aimed to review the literature and compare the accuracy of deep learning algorithms (DLA) applied to anterior segment optical coherence tomography images (AS-OCT) against gonioscopy in detecting angle closure in patients with glaucoma.

Methods: We performed a systematic review and meta-analysis evaluating DLA in AS-OCT images for the diagnosis of angle closure compared with gonioscopic evaluation. PubMed, Scopus, Embase, Lilacs, Scielo, and Cochrane Central Register of Controlled Trials were searched. The bivariate model was used to calculate pooled sensitivity and specificity.

Results: The initial search identified 214 studies, of which 6 were included for final analysis. The total study population included 5269 patients. The combined sensitivity of the DLA compared with gonioscopy was 94.0% (95% CI: 83.8%-97.9%), whereas the pooled specificity was 93.6% (95% CI: 85.7%-97.3%). Sensitivity analyses removing each individual study showed a pooled sensitivity in the range of 90.1%-95.1%. Similarly, specificity results ranged from 90.3% to 94.5% with the removal of each individual study and recalculation of pooled specificity.

Conclusion: DLA applied to AS-OCT has excellent sensitivity and specificity in the identification of angle closure. This technology may be a valuable resource in the screening of populations without access to experienced ophthalmologists who perform gonioscopy.