Journal of Glaucoma最新文献

Prcis: This prospective study demonstrates that the PreserFlo MicroShunt effectively reduces IOP and medication burden over 24 months in Asian patients with POAG, although risk of complete success failure was higher in combined cataract surgery.

Background: Glaucoma is characterized by progressive and irreversible vision loss due to optic nerve degeneration. Lowering intraocular pressure (IOP) remains the mainstay of glaucoma treatment. The PreserFlo MicroShunt (Santen Pharmaceutical Co.) is a form of minimally invasive bleb surgery.

Objectives: We investigate the efficacy and safety of PreserFlo MicroShunt device in Asian patients with primary open angle glaucoma over a 24-month postoperative period.

Design: A prospective, single-arm study of subjects with POAG receiving the PreserFlo MicroShunt surgery with or without concurrent cataract surgery.

Methods: Primary outcome at 2 years was complete success (IOP ≥20% reduction without medications and IOP<22 mm Hg if baseline IOP>21 mm Hg).

Results: Ten eyes underwent PreserFlo MicroShunt surgery, and 17 eyes underwent combined phacoemulsification and PreserFlo MicroShunt. Mean baseline IOP was 22.1 mm Hg, and the median baseline medication load was 3.0. At 6, 12, and 24 months, the complete success rate was 55.6%, 48.1%, and 37.0%, respectively. Qualified and complete success at 6, 12, and 24 months was 81.5%, 74.1%, and 63.0%, respectively. Mean reduction in IOP was 7.9, 6.0, 7.1 mm Hg at POM6 (P<0.001), POM12 (P=0.020), and POM24 (P<0.001). Reduction in median number of medications was from 3 to none at 6, 12, and 24 months (P<0.001). The risk of complete success failure was significantly higher in the combined group compared with the standalone (HR: 10.08; 95% CI: 2.26-45.07). One eye required open revision, 2 eyes required trabeculectomy, and 5 eyes had bleb needling or injection with antimetabolite.

Conclusions: Our study demonstrated that the PreserFlo MicroShunt effectively lowered IOP and medication burden in Asian eyes with POAG.

Prcis: No association between physical activity as measured by Fitbit and primary open angle glaucoma diagnosis was observed among adult participants in the All of Us Research Program.

Purpose: To investigate the associations between physical activity and glaucoma diagnosis in the United States.

Patients and methods: All subjects were adult participants in the National Institutes of Health All of Us Research Program. We defined a case cohort consisting of participants with Fitbit and electronic health record data with a diagnosis of primary open angle glaucoma (n=266). A control cohort consisted of participants with Fitbit and electronic health record data without primary open angle glaucoma diagnoses (n=7954). Descriptive analyses were performed on glaucoma and non-glaucoma cohorts' demographics including age, gender, race, ethnicity, Charlson Comorbidity Index, and ophthalmic and systemic beta-blocker prescriptions. Univariable and multivariable logistic regression adjusted for demographic factors, Charlson Comorbidity Index, and ophthalmic and systemic beta-blocker prescriptions was conducted for association between odds of glaucoma diagnosis and each physical activity metric. Age-stratified sub-analyses for patients older than 40 and older than 65 were performed.

Results: Participants in the glaucoma cohort had a significantly lower step count (6673 vs. 6891, P=0.04) and lower lightly active minutes (180 vs. 193, P<0.001). Step count and lightly active minutes did not remain significant in multivariable models, and all other activity metrics were not significant in multivariable models. These results were recapitulated in age-stratified analyses.

Conclusions: There were no definitive associations between physical activity and primary open angle glaucoma diagnosis among All of Us participants, which was replicated among age-stratified subgroup analyses.

Prcis: GPT-4o and GPT-4o Mini outperformed Gemini Pro in effectively answering glaucoma-related questions, suggesting that GPT models provide high-quality information and highlights the potential of AI chatbots to deliver medically relevant knowledge.

Purpose: Large language models (LLMs) can assist patients who seek medical knowledge online to guide their own glaucoma care. Understanding the differences in LLM performance on glaucoma-related questions can inform patients about the best resources to obtain relevant information.

Methods: This cross-sectional study evaluated the accuracy, comprehensiveness, quality, and readability of LLM-generated responses to glaucoma inquiries. Seven questions posted by patients on the American Academy of Ophthalmology's Eye Care Forum were randomly selected and prompted into GPT-4o, GPT-4o Mini, Gemini Pro, and Gemini Flash in September 2024. Four physicians practicing ophthalmology assessed responses using a Likert scale based on accuracy, comprehensiveness, and quality. The Flesch-Kincaid Grade level measured readability, while Bidirectional Encoder Representations from Transformers (BERT) Scores measured semantic similarity between LLM responses. Statistical analysis involved either the Kruskal-Wallis test with Dunn post-hoc test or ANOVA analysis with Tukey Honestly Significant Difference (HSD) test.

Results: GPT-4o rated higher in accuracy ( P =0.016), comprehensiveness ( P =0.007), and quality ( P =0.002) compared with Gemini Pro. GPT-4o Mini rated higher in comprehensiveness ( P =0.011) and quality ( P =0.007). Gemini Flash and Gemini Pro were similar across all criteria. There were no differences in readability, and LLMs mostly produced semantically similar responses.

Conclusions: GPT models surpass Gemini Pro in addressing commonly asked questions about glaucoma, providing valuable insights into the application of LLMs for providing health information.

Prcis: The Hydrus Microstent combined cataract surgery reduces IOP and medication use in mild-to-moderate glaucoma. For severe open angle glaucoma, it reduces medication use while maintaining a favorable safety profile.

Purpose: This study evaluates the 12-month clinical outcomes of Hydrus Microstent combined with cataract surgery in eyes with open angle glaucoma stratified by disease severity.

Materials and methods: Retrospective, single-surgeon cohort study. Eyes with mild-to-moderate and severe glaucoma undergoing Hydrus implantation combined with cataract surgery were included. Primary outcomes were complete (no medication) and qualified (with medication) success (6-21 mm Hg) at 1 year. Secondary outcomes included IOP, number of glaucoma medications, complications, failure, and success rates for 6-18 and 6-15 mm Hg IOP thresholds.

Results: A total of 147 eyes from 100 patients with a median baseline IOP of 16.0 [IQR: 14.0-20.0] on 2.0 [1.0-3.0] medications were included. Complete success was achieved in 78% and qualified success in 93% of eyes, with mild-to-moderate glaucoma achieving 77% and 92%, and severe glaucoma achieving 84% and 96%, respectively. In the mild-to-moderate group, mean IOP decreased from 17.1±3.8 mm Hg (SD) to 15.5±2.7 mm Hg ( P <0.0003), and medications were reduced from 2.2±1.1 to 0.6±1.1 ( P <0.0001). In the severe group, mean IOP was not significantly changed, and medications were reduced from 2.6±1.3 to 1.2±1.3 ( P =0.0008). At 12 months, 64% of eyes were medication-free, and 67% of severe cases required one or fewer medications. Focal peripheral anterior synechiae (35%) was the most common complication.

Conclusion: The Hydrus Microstent lowered medication use across all glaucoma severities. Further studies with larger sample sizes are warranted to support these findings.

Prcis: PreserFlo MicroShunt significantly reduced intraocular pressure and medication burden in Japanese eyes with prior glaucoma surgery, showing a favorable safety profile and offering a viable option for further surgical intervention regardless of previous procedure type.

Purpose: To evaluate the efficacy and safety of the PreserFlo MicroShunt (PMS) in Japanese patients with a history of at least one glaucoma surgery.

Methods: This retrospective study included Japanese glaucoma patients who underwent PMS implantation with adjunctive mitomycin C between October 2022 and July 2023, with or without simultaneous cataract surgery. All eyes had undergone at least one prior glaucoma procedure. On the basis of surgical history, patients were categorized into 2 groups: group 1 (filtration surgery) and group 2 (ab interno reconstruction surgery or laser trabeculoplasty). Primary outcomes included intraocular pressure (IOP), medication score, and logMAR visual acuity (VA) over 12 months, analyzed using a mixed-effects model. Postoperative complications and additional interventions were extracted from medical records.

Results: Group 1 included 23 eyes (mean baseline IOP: 23.1 mm Hg, 2.6 medications), and group 2 included 32 eyes (mean baseline IOP: 21.9 mm Hg, 4.2 medications). At 12 months, mean IOP was reduced by 44.6% in group 1 and 37.1% in group 2, with both groups showing significant IOP reductions (P < 0.001). Medication scores were significantly reduced at all time points in both groups (P < 0.001). No significant changes in VA or vision-threatening complications were observed.

Conclusions: PMS implantation significantly lowered IOP and reduced the need for medications in eyes with a history of glaucoma surgery, regardless of prior conjunctival manipulation. These findings support the role of PMS as a safe and effective option for further surgical intervention in this population.

Prcis: Higher radial peripapillary capillary density on OCT-A correlates independently with better visual field metrics in primary open-angle glaucoma, with similar diagnostic performance across robotic spectral-domain and swept-source OCT platforms.

Purpose: To investigate the association between optical coherence tomography angiography (OCT-A) metrics and visual field (VF) mean deviation (MD) using a robotic spectral-domain OCT (SD-OCT) and a swept-source OCT (SS-OCT).

Methods: In this prospective cross-sectional study, participants with primary open-angle glaucoma (POAG) underwent OCT-A imaging with both Topcon Maestro2 (SD-OCT) and Topcon Triton (SS-OCT). Radial peripapillary capillary (RPC) density of the superficial vascular plexus (SVP) was derived from 6×6 mm² scans centered on the optic nerve head (ONH). Associations between OCT-A metrics and VF parameters-including mean deviation (MD), visual field index (VFI), and pattern standard deviation (PSD)-were assessed using linear mixed-effects models, adjusting for scan quality, age, and retinal layer thickness.

Results: A total of 28 eyes from 18 patients met study criteria. In a multivariable model, each+1% in RPC density was associated with: a higher +1.09 dB MD on the SD-OCT ( P= 0.0241) and +1.75 dB on the SS-OCT ( P =0.0028); a higher VFI of+3.50% ( P =0.0181) for SD-OCT and+5.13% ( P =0.0019) for SS-OCT; a lower PSD of -0.92 dB ( P =0.0029) with SD-OCT and -1.21 dB ( P =0.0002) with SS-OCT.

Conclusions: OCT-A-derived RPC density is an independent correlate of VF MD across both SD-OCT and SS-OCT platforms. Despite differences in hardware and acquisition methods, both systems demonstrated comparable diagnostic performance. These findings support the integration of OCT-A into glaucoma assessment and highlight the utility of automated SD-OCT platforms in both clinical and screening environments.

Prcis: Among POAG patients, 13.6% experienced a myopic shift of 0.75 D or more at 1 month following OMDI administration. Ciliary spasm may be the underlying mechanism.

Purpose: To evaluate the incidence, pathophysiology and risk factors for myopic shift following omidenepag isopropyl (OMDI) 0.002% administration in patients with primary open angle glaucoma (POAG).

Methods: This prospective, observational study included adult patients aged 20 years or older who visited the clinic between February and December 2022 and were diagnosed with POAG (treatment-naive). Participants were prescribed OMDI 0.002% eyedrops at the baseline visit. Comprehensive ophthalmic examinations, including measurements of refractive error (RE), keratometry, corneal topography, optical biometry, visual acuity (VA), and intraocular pressure (IOP) were performed at the baseline and 1 month after OMDI instillation. Main outcome measures were changes in ocular parameters, including RE, corneal curvature (CC), central corneal thickness (CCT), anterior chamber depth (ACD), axial length, lens thickness (LT), white-to-white, VA and IOP.

Results: A total of 44 eyes of 44 subjects were included. 13.6% of patients experienced a myopic shift of 0.75 D or more 1 month after OMDI instillation. Other ocular parameter changes included increased CC, CCT, and LT, along with decreased ACD. In the correlation analysis, CC change was associated with the myopic shift. Multiple linear regression analysis further revealed that changes in both CC and VA were significantly associated with the myopic shift, though no specific risk factor was identified.

Conclusions: OMDI 0.002% eyedrops were associated with a notable incidence of myopic shift in patients with POAG. Ciliary muscle spasm is a possible underlying mechanism of myopic shift.

Precis: In glaucomatous eyes, reduced optic nerve head blood flow was significantly associated with impaired intrinsically photosensitive retinal ganglion cell function, as assessed by the post-illumination pupil response, independent of age and other confounding factors.

Purpose: To investigate whether ocular nerve head (ONH) blood flow is associated with impaired intrinsically photosensitive retinal ganglion cell (ipRGC) function, assessed by the post-illumination pupil response (PIPR), in eyes with glaucoma.

Patients and methods: This cross-sectional study included 114 eyes from 114 patients with glaucoma (mean age, 69.5 y). PIPR was evaluated by measuring pupil diameters after red and blue light exposure. The main PIPR outcomes were the amplitudes of red and blue 6-s PIPR, which are pupil diameters 6 s after red and blue light exposure. ONH blood flow was assessed by the tissue-area mean blur rate (MBR) using laser speckle flowgraphy.

Results: A significantly higher blue 6-s PIPR amplitude was observed in the low tissue-area MBR group than in the high tissue-area MBR group (93.5% vs. 91.1%, P=0.043). After adjusting for age, sex, body mass index, hypertension, diabetes, intraocular pressure, and axial length, a multivariable linear regression analysis showed that tissue-area MBR inversely correlated with the blue 6-s PIPR amplitude (regression coefficient=-0.40; 95% CI, -0.73 to -0.06; P=0.021), but not the red 6-s PIPR amplitude (regression coefficient=-0.01; 95% CI, -0.36 to -0.15; P=0.42).

Conclusions: Lower ONH blood flow in eyes with glaucoma correlated with impairments in ipRGCs independent of potential confounders, including age.

We describe a novel technique of globe rotation that facilitates direct gonioscopic visualization of the superior angle during ab interno bleb revision and evaluate its outcomes. A retrospective review of 13 eyes undergoing revision with the Grover-Fellman biplanar sclerostomy spatula was performed. The superior angle was visualized using a direct goniolens after globe rotation with limbal traction sutures and optimal patient and microscope positioning. All cases achieved successful access to the trabeculectomy ostium. Mean intraocular pressure decreased from 25.7±13 mm Hg preoperatively to 10.5±4.2 mm Hg at 6 months (P=0.005), and the median number of medications reduced from 4 (IQR 2-4) to 0 (IQR 0-2) (P=0.005). Three eyes required antiglaucoma medications and one required an aqueous drainage implant postoperatively. No bleb leaks or conjunctival perforations occurred, and the technique was also combined with other MIGS procedures in select patients. Globe rotation provides a simple means to achieve direct visualization of the superior angle and enables ab interno bleb revision with a direct goniolens. This approach may serve as a practical alternative to indirect gonioscopy and facilitate broader adoption of ab interno techniques.

Prcis: The position of the major retinal vessels varies across healthy individuals. This measurement significantly correlates with sectoral retinal nerve fiber layer thickness and can potentially improve the use of normative databases.

Objective: Evaluate the variability of major vessel position (MVP) among healthy individuals and its effect on optical coherence tomography (OCT) sectoral retinal nerve fiber layer (RNFL) thickness measurements.

Methods: Circumpapillary RNFL (cpRNFL) circle scans were collected from 88 healthy individuals (88 eyes). The MVP was determined using the commercial Heidelberg Eye Explorer software. For each of the four main temporal vessels, the MVP was defined as the angular distance (degrees) on the 3.5 mm diameter circumpapillary B-scan between the point where the circle scan intersects the vessel and the point where the circle intersects with the disc-to-fovea line.

Results: There was considerable variability in MVP among the healthy individuals. The positions of the superior and inferior veins were distributed normally, while the distributions of the arteries were skewed temporally. Sectoral cpRNFL thickness significantly correlated with superior and inferior MVP. As the MVP angle increased, the cpRNFL thickness in the superior nasal and inferior nasal sectors increased (Spearman's correlations coefficient between 0.2 and 0.42, P<0.05). In contrast, cpRNFL thickness of the superior temporal and inferior temporal sectors decreased (correlation between -0.41 and -0.26, P<0.05). The thickness of the temporal sector also decreased as MVP increased (correlation between -0.43 and -0.22, P<0.05). No significant correlation was found between MVP and nasal sector thickness.

Conclusion: The MVP is a reliable proxy for the distribution of the major RNFL bundles. Adjusting cpRNFL measurements based on MVP might improve the reliability of normative databases and reduce artifacts, particularly false positives, related to RNFL bundle position.