Journal of Glaucoma最新文献

Prcis: Ahmed glaucoma valve implantation is an effective and reliable intervention for neovascular glaucoma, demonstrating higher success and longer survival in proliferative diabetic retinopathy compared to central retinal vein occlusion. Age significantly impacts surgical outcomes.

Purpose: To evaluate and compare the surgical outcomes and prognostic factors of Ahmed glaucoma valve (AGV) implantation in neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) and central retinal vein occlusion (CRVO).

Patients and methods: This retrospective study included 48 eyes of 46 patients with NVG due to PDR (n=28) or CRVO (n=18) who underwent AGV implantation. Patients with prior glaucoma surgery were excluded. All procedures were performed by a single glaucoma surgeon using a standardized long tunnel technique. Surgical success was defined as ≥20% intraocular pressure (IOP) reduction from baseline and IOP ≤ 21 mmHg without additional glaucoma surgery or vision loss to no light perception. Kaplan-Meier survival analysis assessed surgical success, and Cox regression identified failure risk factors.

Results: The mean surgical success duration was longer in PDR (45.87 months) than CRVO (38.68 months). One-year, two-year, and three-year success rates were 95.5%, 90.4%, and 90.4% in PDR, compared to 92.3%, 64.6%, and 55.4% in CRVO. Early complications, such as hyphema, were more frequent in PDR but not statistically significant. Tube exposure was observed in only one case (2.1% of total cases), which was in the CRVO group. Including the tube exposure case, tube explantation was performed in two patients (4.2% of total cases). Older age was a significant risk factor for failure (HR=1.066, P=0.049).

Conclusion: AGV implantation provides favorable long-term outcomes for NVG secondary to PDR and CRVO, with higher success rates in PDR. Careful patient selection and standardized surgical techniques remain critical for optimizing AGV outcomes in NVG.

Prcis: The STP significantly increases IOP during TLH, with a more pronounced effect observed in patients with a high BMI.

Purpose: The present study sought to determine the impact of steep Trendelenburg position (STP) on intraocular pressure (IOP) in patients undergoing total laparoscopic hysterectomy (TLH) and to establish the relationship between age, body mass index (BMI), iridocorneal angle and surgical duration about position-related intraocular pressure changes.

Methods: Preoperative ophthalmologic evaluation was performed one day before surgery (T0). IOP was measured using a handheld contact tonometer at T1 (5 min after anesthesia), T2 (5 min after pneumoperitoneum), T3 (5 min in STP), T4 (after pneumoperitoneum release), T5 (at the end of surgery in supine position), and T6 (10 min after returning to supine). Surgery duration and patient demographics were recorded.

Results: The IOP values were found to be considerably elevated in comparison to the baseline (T0) at all designated time points (T1-T6). There was a progressive decrease in intra-abdominal pressure after the pneumoperitoneum was released (T4-T6). The findings revealed no statistically significant correlation between age and iridocorneal angle on the one hand and IOP values on the other. At T6, a negative correlation was observed between IOP and surgical duration and a positive correlation with BMI.

Conclusions: The STP significantly elevates IOP during TLH, and this effect is more pronounced in patients with higher BMI. Identifying such risk factors may guide anesthetic and surgical strategies to minimize ocular complications in procedures requiring this position.

Prcis: Glaucomatous patients with longer axial length and thinner central cornea have a higher risk of progression after refractive surgery, emphasizing the need for close monitoring for early detection and timely intervention.

Purpose: To identify risk factors associated with glaucomatous progression in eyes with a history of refractive corneal surgery (RCS).

Methods: This retrospective observational cohort study included 65 eyes of 65 patients with primary open-angle glaucoma (POAG) who underwent RCS. Glaucoma progression was determined based on structural changes in optic disc/retinal nerve fiber layer (RNFL) photographs and/or visual field (VF) deterioration. Cox proportional hazards analysis was used to identify risk factors for disease progression. VF mean deviation (MD) and RNFL thickness progression rates obtained using a linear mixed-effects model were compared across tertile groups based on axial length (AXL) and central corneal thickness (CCT), respectively.

Results: Over the follow-up period (mean 9.1±2.9 years), 23 eyes (35%) exhibited glaucomatous progression. The progression group had significantly longer AXL (P<0.001), thinner CCT (P=0.009) compared to those in the stable group. Multivariate analysis identified longer AXL (hazard ratio [HR]: 1.507, P=0.037) and thinner CCT (HR: 0.988, P=0.037) as significant predictors of glaucoma progression. VF MD declined faster in the middle and highest AXL tertile groups, while RNFL thinning was the most pronounced in the highest AXL tertile group. The lowest CCT tertile group exhibited the fastest VF MD decline and RNFL thinning.

Conclusions: Patients with POAG and a history of RCS who present with longer axial length and thinner central corneal thickness, are at significantly higher risk of glaucomatous progression, highlighting the importance of vigilant long-term monitoring in these eyes.

Prcis: We investigated early IOP changes after MPTLT in glaucoma patients. Sixteen percent experienced transient IOP spikes at 1 hour. Alpha-2 adrenergic agonist use was associated with reduced IOP elevation and lower spike risk.

Purpose: To assess the incidence and contributing factors of postoperative intraocular pressure (IOP) spike following micropulse transscleral laser therapy (MPTLT).

Patients and methods: This prospective observational study included 80 eyes from 66 glaucoma participants undergoing MPTLT. An IOP spike was defined as an increase of 5 mmHg or more at 1 hour post-laser compared to baseline. Demographic and clinical factors were assessed, and multivariable backward stepwise regression mixed-effect models were employed to identify significant associations. The main outcome measures were the change in IOP at 1 hour (1-hour IOP minus baseline IOP) and the occurrence of a 1-hour IOP spike.

Results: The mean (standard deviation) IOP change was -0.16 (6.40) mmHg at 1 hour. Thirteen eyes (16%) met the criteria for the IOP spike, with the average change of 9.73 (5.57) mmHg. Among these, five eyes (6% of all eyes) had IOP rise of greater than 10 mmHg. All eyes with IOP spike had IOP return to baseline levels or lower at 18 hours. Preexisting use of alpha-2 adrenergic (AA) agonists (coefficient -4.31, 95% CI -7.61 to -1.01, P=0.01) and higher baseline IOP (coefficient -0.12, 95% CI -0.23 to -0.004, P=0.042) were associated with less IOP elevation. Preexisting use of AA agonists was identified as a protective factor for developing an IOP spike with odds ratio of 0.20 (95% CI 0.42 to 0.91, P=0.038).

Conclusions: One sixth of the patients experienced a postoperative IOP spike. Participants with preexisting use of AA agonists tended to have a lower degree of IOP change and a lower IOP spike.

This retrospective single-center case series evaluated the outcomes of direct selective laser trabeculoplasty (DSLT) in patients with primary angle-closure glaucoma (PACG). Twelve eyes of eight phakic patients with PACG and patent laser peripheral iridotomy (LPI) underwent DSLT. The primary outcome was the percentage reduction in intraocular pressure (IOP). Secondary outcomes included treatment success, defined as an IOP reduction of ≥20% from baseline or a reduction in glaucoma medications while maintaining baseline IOP and safety parameters. The mean patient age was 71.0±9.3 years. Baseline IOP was 17.0±2.3 mmHg and decreased significantly to 13.6±3.0 mmHg at the 2-month follow-up (P=0.0024), representing an overall mean IOP reduction of 20.3%±11.6%. Treatment success was achieved in seven eyes (58.3%), with a mean IOP reduction of 27.6%±7.3%. The mean number of glaucoma medications decreased from 3.17±1.47 to 2.75±1.70 (P=0.0369), and the medications were completely discontinued in three eyes. Corrected distance visual acuity remained stable. The most common transient findings were mild anterior chamber reaction and subconjunctival hemorrhage, and no IOP spikes or other complications occurred. These preliminary results suggest that DSLT is a safe, well-tolerated, and potentially effective non-contact laser therapy for phakic patients with PACG and patent LPI. Larger prospective studies with longer follow-up periods are warranted to confirm these findings.

Prcis: This study investigates the accuracy, readability, utility, and educational value of glaucoma treatment content on social media platforms and explores how large language models assess the quality of social media posts compared with glaucoma experts.

Purpose: To assess the quality of information on glaucoma treatment available on social media platforms.

Methods: A 30-question survey consisting of the "top posts" from three social media platforms (X, Instagram, and Reddit) was assessed by five board-certified glaucoma experts across four domains (readability, utility, educational value, and accuracy) by using a five-point Likert scale. The overall quality of each post was calculated as the average of the median score assigned to each of the four domains to create a reference standard. Expert agreement was assessed using Kendall's coefficient of concordance (W). A large language model (LLM), GPT-4 (OpenAI), was then prompted to evaluate the same posts with identical instructions. Agreement with expert consensus was compared using Cohen's weighted kappa (κ) and the difference in favorability of each post assessed using McNemar's exact test.

Results: Fewer than half of social media posts on glaucoma treatment were judged favorably by glaucoma experts (40%). GPT-4 was less critical of social media content and provided a favorable rating nearly twice as often (77%, P=0.017). Despite this difference, there was moderate agreement between the LLM compared with the glaucoma experts (κ=0.421, P=0.005). The lack of agreement predominantly stemmed from cases where the experts rated the content unfavorably, with disagreement occurring in 56% of cases, compared to 0% when the content was deemed favorable (P=0.005).

Conclusions: Although glaucoma experts and artificial intelligence (AI)-based systems were in moderate agreement when evaluating the quality of posts, the LLM was less able to discriminate posts of low quality.