Journal of Glaucoma最新文献

Prcis: In acute primary angle closure, early cataract extraction is protective against glaucomatous progression through better IOP control, while higher mean IOP and worse baseline visual field defects are associated with increased risk.

Purpose: To evaluate long-term outcomes and identify risk factors for glaucomatous optic neuropathy (GON) progression after acute primary angle closure (APAC).

Methods: In this multicenter retrospective cohort study, we enrolled 156 eyes from 130 APAC patients with ≥2 years of follow-up. Baseline clinical features, including visual field mean deviation (VFMD) and optical coherence tomography (OCT) parameters, as well as follow-up intraocular pressure (IOP) and interventions, were collected. GON progression was defined by concordant structural and functional changes. Univariate and multivariate logistic regression were used to identify risk factors.

Results: The mean age was 63.9±9.6 years, and 71.5% of patients were female. During follow-up, 129 eyes (82.7%) underwent cataract extraction and 49 eyes (31.4%) underwent glaucoma surgery. Visual acuity, IOP, and medication burden improved (all P<0.05), whereas mean VFMD and OCT retinal nerve fiber layer (RNFL) thickness didn't show significant change. Twenty-three eyes (14.7%) were blind; fifteen (9.6%) due to glaucoma alone. In multivariable analysis, higher mean follow-up IOP (aOR 1.14 per mmHg, P=0.005) and worse baseline VFMD (aOR 1.07 per 1-dB worsening, P=0.048) independently predicted progression, while early cataract extraction (<3 mo) was protective (aOR 0.43, P=0.047), an effect partly mediated through IOP reduction (indirect effect β=-0.20, 95% CI -0.39 to -0.04).

Conclusions: After APAC, higher mean IOP and worse baseline VFMD are associated with GON progression. Early cataract extraction may reduce progression risk, partly through improved IOP control.

Precis: An implantable IOP sensor study in glaucoma patients found that five evenly spaced daily measurements over 18 waking hours effectively reflect the 24-hour IOP rhythm, with peaks and troughs often occurring outside clinic hours.

Purpose: The availability of an implantable IOP sensor enables patients to obtain IOP measurements over 24 hours and on demand. The current study assesses the optimal frequency of daily IOP measurements required to reflect the 24-hour IOP rhythm in glaucoma patients.

Methods: Twenty-two patients with primary open-angle glaucoma (POAG) who had previously been implanted with a sulcus-based IOP sensor (eyemate-IO, Implandata, Germany) as part of the prospective multicentric ARGOS-02 study were enrolled. The following parameters were used to characterize the 24-hour IOP rhythm: distribution of IOP measurements and timing of IOP peaks and troughs. To assess the optimal number of IOP values to predict the 24-hour rhythm, the daily count of IOP measurements and the time interval between the first and last daily measurements were used. The correlation with the detection of daily IOP variability was assessed via student T-test and a kernel-density estimate using Gaussian kernels and Earth Movers Distance.

Results: Twenty-two patients (8 female and 14 male) with a mean age of 67.8±6.8 years were followed up over 6.6±1.7 years with a total of 80,495 IOP measurements. The percentage of peak IOP values was highest (50.6%) during the early morning hours (4 to 5 am), while trough measurements occurred predominantly (42.3%) during the late-night hours (between 11 pm and 12 pm). Five IOP measurements equally distributed over an 18-hour period were sufficient to characterize the 24-hour rhythm. Additional measurements did not yield any statistically significant value in the characterization of 24-hour IOP patterns.

Conclusions: Using an implanted telemetric sensor, the results of this study show that 5 daily IOP measurements evenly spread over 18 hours, provide sufficient information for assessment of the diurnal IOP rhythm. However, patients in practice recorded on average four measurements over 14 hours, highlighting the gap between the ideal recommendation and real-life adherence.

Prcis: In our study of the factors predictive of latanoprost response, we found that normotensive subjects with higher intraocular pressure, lower uveoscleral outflow, and higher body mass index had a greater response to 1-week treatment.

Purpose: To evaluate relationships between variable intraocular pressure (IOP) responses to latanoprost and participant characteristics, baseline values and changes in aqueous humor dynamics (AHD) parameters.

Methods: We assessed 226 eyes from 113 healthy participants. AHD parameters measured at baseline and after 1-week treatment with latanoprost included: IOP by pneumatonometry, episcleral venous pressure (EVP) by venomanometry, aqueous humor flow rate by fluorophotometry, outflow facility by 2-minute pneumatonography, and uveoscleral outflow calculated using the modified Goldmann equation. IOP responses were categorized into 4 groups: nonresponders (<10% reduction), all-responders (≥10% reduction), medium-responders (10%-20% reduction), and high-responders (≥20% reduction). Generalized estimating equation models were used to analyze treatment effects and compare groups.

Results: Baseline IOP was higher in high-responders than medium-responders and nonresponders ( P =0.007 and P <0.001, respectively). Body mass index (BMI) was significantly higher in high-responders and all-responders compared with nonresponders ( P =0.02 and P =0.03, respectively). Responders had lower baseline uveoscleral outflow ( P =0.03). There were no significant differences in other baseline characteristics including EVP, outflow facility, and aqueous flow rate between the 4 groups. IOP decreased while outflow facility and uveoscleral outflow increased after latanoprost treatment in all responder groups but did not change in nonresponders. EVP and aqueous flow rate did not change significantly in any group. The change in uveoscleral outflow was greater in high-responders than in nonresponders ( P =0.004).

Conclusions: In healthy subjects, higher baseline IOP, lower uveoscleral outflow and higher BMI are predictors of a greater IOP reduction by latanoprost. A greater increase in uveoscleral outflow is responsible for this larger response.

Prcis: Using a CNN-enhanced platform, 60-4 visual fields identified peripheral glaucomatous defects missed by central testing in mild cases; facial contour correction showed these defects occurred exclusively outside the temporal visual field.

Purpose: To develop a methodology to separate facial contour-induced visual field defects from defects related to glaucoma in patients with peripheral field defects.

Methods: Ninety-seven eyes from 50 patients previously diagnosed with glaucoma were enrolled in the study. Thirty-one (62%) participants were male, and 86% were white. The study involved patients with glaucoma who underwent visual field testing using standard automated perimetry, including 10-2, 24-2, 30-2, and 60-4 visual fields. A convolutional neural network (CNN)-enhanced platform, previously developed to identify facial contour-dependent defects in healthy subjects, was used to analyze the visual field data.

Patients: The study included 97 eyes from 50 patients with glaucoma, with the majority having primary open angle glaucoma.

Results: In 90 out of 97 eyes, there were 60-4 visual field defects. However, 20 (22%) of these eyes did not have glaucomatous defects on the 10-2 or 30-2 visual fields. All patients with 60-4 defects in the absence of more central defects had mild glaucoma, and these eyes comprised 38% of the mild glaucoma group. 60-4 visual field increased the sensitivity of identifying glaucoma in mild disease. Without facial contour, the 60-4 visual field mean threshold summation was 1099.6±346.6 dB, and decreased to 1057±331 dB when accounting for facial contour, which affected 8.03%±4.02% of test points. Facial contour-dependent visual field defects were exclusively found outside the temporal visual field.

Conclusion: The study demonstrated the potential utility of 60-4 visual fields for identifying early functional glaucomatous changes that may not be detected by more central visual field tests (10-2 or 30-2). It may be important to consider peripheral visual field defects, which can be affected by facial contour, in the diagnosis and monitoring of glaucoma, particularly in mild cases.

Prcis: This study developed and validated a machine learning-based risk prediction model to estimate the likelihood of postoperative hyperopic shift in patients with primary angle closure glaucoma after IOL implantation, which may help guide individualized surgical decision-making.

Objective: This study aims to construct a predictive model for the risk of hyperopic shift (HS) after phacoemulsification combined with intraocular lens (PE+IOL) surgery in patients with primary angle closure glaucoma (PACG), with the goal of providing scientific evidence for personalized treatment and early warning.

Materials and methods: This is a retrospective cohort study that included PACG patients who underwent PE+IOL surgery between June 2019 and June 2024, according to predefined inclusion and exclusion criteria. We collected patients' demographic information, preoperative ocular examination data, and refractive changes 3-6 months postsurgery. The Boruta algorithm was used for feature selection of all clinical variables, and various machine learning models, including logistic regression (LR), random forest, support vector machine (SVM), k-nearest neighbors (KNN), and XGBoost, were developed. Model performance was assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). The best-performing model was selected for visualization and interpretability analysis. Data processing and analysis were performed using R version 4.2.3. All statistical tests were 2-sided, with a P -value <0.05 considered statistically significant.

Results: A total of 423 eyes were included, with n=267 in the non-HS group and n=156 in the HS group. Key predictive variables identified by the Boruta algorithm included target refraction, preoperative best-corrected visual acuity (BCVA), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white-to-white distance (W2W), and pupil diameter (P). Both the SVM and LR models exhibited the best predictive accuracy, with AUCs of 0.704 and 0.696, respectively, demonstrating moderate classification ability.

Conclusion: This study successfully developed a risk prediction model for HS after PE+IOL surgery in PACG patients based on various clinical features. The SVM and LR models show promising clinical application in predicting HS risk and can provide personalized postoperative management strategies for glaucoma surgery patients.

Prcis: Discrepancy between objective measures of functioning and self-reported quality of life is predicted by depressive symptoms, females, and advanced field loss while significant variability between these measures remains unexplained.

Purpose: To determine the degree to which functional metrics and self-reported quality of life agree in glaucoma, and identify factors associated with discrepancies between the two.

Patients and methods: Individuals with glaucoma or suspected glaucoma (n=227) were evaluated. Subjective functioning was assessed with the Glaucoma Quality of Life-15 (GQL-15) questionnaire. Objective metrics of functioning included balance (total sway), gait (cadence), and reading speed, which were compiled into a z-scored composite measure of function. Discrepancy scores were defined as the difference between composite functioning and GQL-15 z-scores. Linear regression models were computed to identify patient-level and neighborhood-level factors associated with discrepancy between objective functioning and self-reported quality of life.

Results: Composite functioning and GQL-15 z-scores were poorly correlated (Pearson's coefficient r=0.15, P-value=0.024). In multivariable analyses, positive discrepancy (greater function than self-report) was associated with female gender (β=0.53, P<0.001), depressive symptoms (β=0.19, P<0.001), and greater visual field damage (β=0.28, P-value=0.001). The multivariable model including gender, depressive symptoms, and visual field sensitivity accounted for 20% of the variance in discrepancy scores.

Conclusions: Female gender, depressive symptoms, and greater visual field damage are associated with greater subjective vision-related disability than predicted by objective functional impairment. The overall ability of studied measures to predict agreement between function and self-report was poor, highlighting the complexity of both self-reported impairment and functional evaluation.

Prcis: Online binocular perimetry showed moderate to strong agreement with Esterman visual field testing in glaucoma patients and controls, with high correlation coefficients and predictive capability. This tool may offer a viable, accessible alternative to machine perimeters for driving licence assessment.

Purpose: To assess the feasibility of an online computer-based binocular driving perimetry assessment (OBDP) based on online circular contrast perimetry, and agreement with binocular static Esterman visual field testing (EVFT).

Methods: A prospective comparative cohort study was conducted on patients with or without open angle glaucoma, recruited from a single-site glaucoma subspecialty practice. Eligible subjects underwent 2 visual field tests using OBDP and this was compared with the results of a single EVFT.

Results: Eighty patients were enrolled in the study, with a mean age of 69 years (+/- 13.4 SD). Of these, 49% were female, 18 were healthy controls, while 20, 18 and 24 had mild, moderate and severe glaucoma, respectively. Pearson and intraclass correlation between the 2 perimetry methods for percentage of points not seen (PNS) was 0.85 and 0.86 (95% CI: 0.78-0.9), respectively, for the overall binocular visual field. When the binocular field was subdivided into 8 sectors, intraclass coefficients (ICCs) ranged from 0.76 to 0.93 for each sector. Bland-Altman analysis revealed a difference of 1.24% (95% CI: -16.93% to 19.30%) between the 2 methods for the overall field, ranging from 0.04% to 4.17% for each sector. On the basis of the Austroads fitness to drive guidelines, OBDP demonstrated a sensitivity of 96.97% and specificity of 78.57% when compared with the EVFT. ICCs evaluating the repeatability of OBDP testing for the percentage of PNS were excellent overall (0.97) and ranged from moderate to excellent for each of the 8 sectors (0.67-0.98).

Conclusion: OBDP showed strong agreement with EVFT. As an online application that easily runs on any computer, it could expand the scope of binocular perimetry screening for licence assessment. With modifications, integration into modern clinical licensing procedures could be considered.

Prcis: This study highlights intraoperative mitomycin C (MMC) injection in trabeculectomy with a higher success rate and reduction in glaucoma medications, however, no difference in mean IOP at 1 year or safety profile, compared with MMC sponge.

Purpose: To compare the efficacy and safety of intraoperative injection of mitomycin C (MMC) versus conventional MMC-soaked sponges in patients undergoing trabeculectomy.

Methods: Pubmed, Cochrane, and Embase were searched for studies published until December 2023 comparing injection and sponge techniques during trabeculectomy. Main outcomes of interest were postoperative mean intraocular pressure (IOP) at 6 months, complete surgical success (mean IOP 5-21 mm Hg without medication), postoperative number of antiglaucoma medications ≥12 months, and postoperative complications. This study was registered in PROSPERO, CRD42023494096.

Results: A total of 1665 eyes from 17 studies [9 randomized controlled trials (RCT)] were included, of which 723 (43.42%) received intraoperative injection of MMC. The mean IOP at 6 months was significantly lower in the injection group [mean difference (MD)= -0.93; 95% CI: -1.85 to -0.01]. Also, the incidence of complete surgical success ≥6 months was higher in the injection group (OR=1.79; 95% CI: 1.33-2.40). There were no significant differences between groups for postoperative complications (OR=1.01, 95% CI: 0.69-1.49). Conversely, analysis of RCTs only showed a significant reduction in the number of medications for glaucoma control ≥12 months with injection (MD= -0.37; 95% CI: -0.60 to -0.14).

Conclusion: Intraoperative MMC injection had a greater rate of complete surgical success and reduction in the number of medications. However, there was no significant difference in mean IOP at 12 months between groups. MMC injection was as safe as sponge application in trabeculectomy.

Precis: Netarsudil shows promise as a second-line drug in early glaucoma patients with an increase in most OCTA parameters as compared with Dorzolamide, with comparable rates of side effects.

Objective: To compare the effect of Netarsudil and Dorzolamide on macular and optic nerve head (ONH) perfusion changes on Optical Coherence Tomography Angiography (OCTA), and macular ganglion cell layer (mGCL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on OCT in preperimetric/early glaucoma patients.

Participants and methods: In this prospective, randomized, parallel group, active-controlled trial 90 preperimetric/early glaucoma eyes were recruited. The primary outcome measure was change in macular and ONH perfusion, and intraocular pressure (IOP). A total of 95 patients were randomized and 45 were prescribed Netarsudil 0.02% (group 1) and 45 were prescribed Dorzolamide 2% (group 2). The IOP, ONH perfusion, ONH flux index (FI), and macular vessel density (mVD) on OCTA; pRNFL thickness and mGCL thickness on OCT of the 2 groups were recorded at baseline, 4 months, 8 months, and 12 months.

Results: The mean baseline IOP in group 1 was 19.52±3.2 mm Hg and in group 2 it was 19.5±2.97 mm Hg. Group 1 showed 2.77 mm Hg (13.23%±8.27%) decrease in IOP ( P <0.001), while group 2 showed 1.85 mm Hg (8.98%±7.32%) decrease in IOP ( P <0.001) at 12 months. Group 1 showed 1.58 mm/mm 2 increase in mVD ( P <0.001), and 0.03 (7.6%) increase in ONH FI ( P <0.001) at 12 months. However, no trend in mVD or ONH FI was seen in group 2. Group 1 showed 1.03% increase in ONH perfusion ( P <0.001), while group 2 showed 1.16% increase in ONH perfusion ( P <0.001). There was no significant difference in ONH perfusion between the 2 groups. The OCT (pRNFL and mGCL) showed normal variability in both the groups. Congestion (40%) was the most common side effect observed in the Netarsudil group, while metallic taste (42.5%) was the most common side effect in the Dorzolamide group. The side effect profile of the 2 drugs was comparable ( P =0.65).

Conclusion: Netarsudil causes an increase in all the OCTA parameters-mVD, ONH perfusion, and ONH FI-whereas Dorzolamide causes an increase only in ONH perfusion in preperimetric/early glaucoma patients. Netarsudil monotherapy also showed a higher decrease in IOP as compared with dorzolamide therapy.

Prcis: Preoperative conditions and outcomes of the Ahmed glaucoma valve and Baerveldt glaucoma implant were assessed. Differences were observed in disease type and surgical history between the 2 groups. Comparatively, the Baerveldt glaucoma implant had more complications.

Purpose: To evaluate the preoperative conditions and surgical outcomes of the Ahmed glaucoma valve and the Baerveldt glaucoma implant in clinical practice.

Patients and methods: Patients who underwent glaucoma tube-shunt surgery using the Ahmed glaucoma valve or Baerveldt glaucoma implant at Kyoto University Hospital between January 1, 2015, and December 31, 2021, were included. Patients with previous glaucoma tube shunt surgeries were excluded. Data on preoperative conditions, intraocular pressure, glaucoma medication scores, visual acuity, and complications were retrospectively obtained from medical records.

Results: We analyzed 154 eyes (Ahmed glaucoma valve, 102 eyes; Baerveldt glaucoma implant, 52 eyes) in total. No significant differences were observed between the groups except for disease type and surgical history-neovascular glaucoma and no prior glaucoma surgery were more common in the Ahmed glaucoma valve group, whereas exfoliation glaucoma, primary open angle glaucoma, and history of glaucoma surgery were more frequent in the Baerveldt glaucoma implant group. At 36 months, mean intraocular pressure and medication scores were 14.2±4.0 mm Hg and 2.1±1.5 for Ahmed glaucoma valve, and 13.0±4.6 mm Hg and 1.7±1.7 for Baerveldt glaucoma implant, respectively, with no significant differences. The 60-month cumulative success rates were 58.1% for Ahmed glaucoma valve and 60.6% for Baerveldt glaucoma implant under Definition A (intraocular pressure range: 6-21 mm Hg) and 57.5% for Ahmed glaucoma valve and 57.5% for Baerveldt glaucoma implant under Definition B (intraocular pressure range: 6-18 mm Hg). The Baerveldt Glaucoma Implant group revealed a higher incidence of postoperative complications, with hypotony being the most common complication.

Conclusion: In this large-scale real-world study, no significant differences in surgical outcomes were observed between the Ahmed glaucoma valve and the Baerveldt glaucoma implant. However, it should be noted that the implant choice tended to be influenced by glaucoma type and surgical history, reflecting differences in disease background between the treatment groups.