Journal of Glaucoma最新文献

Prcis: We developed a modified iris cerclage technique that improves best corrected visual acuity, pupillary parameters, self-assessed photophobia, and visual function index-14 questionnaire scores in patients with acute primary angle closure and permanent mydriasis after cataract surgery.

Purpose: To evaluate the efficacy of a modified iris cerclage technique in patients with acute primary angle closure (PAC) and permanent mydriasis after cataract surgery.

Patients and methods: Twelve eyes of 12 patients with acute PAC and permanent mydriasis at more than 3 months after phacoemulsification combined with intraocular lens (IOL) implantation underwent modified iris cerclage. Best corrected visual acuity (BCVA), intraocular pressure (IOP), pupil diameter, and visual function index-14 (VF-14) questionnaire and self-assessed photophobia scores before surgery and at 1 week, 1 month, and 3 months postoperatively were compared. Further, the postoperative pupil position morphology and complications were evaluated.

Results: BCVA improved from 0.48±0.23 preoperatively to 0.28±0.15, 0.27±0.15, and 0.26±0.14 at 1 week, 1 month, and 3 months postoperatively, respectively ( P =0.008). No significant difference was observed between the preoperative and postoperative IOP ( P =0.974). Pupil diameter improved from 6.34±0.51 mm preoperatively to 3.59±0.33, 3.59±0.34, and 3.58±0.32 mm at 1 week, 1 month, and 3 months postoperatively, respectively ( P <0.001). Self-assessed photophobia scores improved from 3.33±0.78 preoperatively to 0.83±0.72, 0.51±0.15, and 0.45±0.14 at 1 week, 1 month, and 3 months postoperatively, respectively ( P <0.001). VF-14 scores improved from 47.6±6.1 points preoperatively to 67.9±6.2, 72.1±6.1, and 73.5±6.0 points at 1 week, 1 month, and 3 months postoperatively, respectively ( P< 0.001). Postoperatively, all pupils were centered and round. No postoperative complications, such as iris-suture slippage, iridodialysis, or exposure of the IOL's optical zone edge, were observed.

Conclusion: Modified iris cerclage creates a centered, precisely sized, round pupil. It improves visual quality in patients with acute PAC and permanent mydriasis after cataract surgery.

Prcis: Deep sclerectomy (DS) with fibrin adhesive can constitute a safe alternative to the classic procedure using sutures, providing nonallergenic, nontoxic, and secure adhesion with no sign of aqueous humor outflow obstruction postoperatively.

Objective: To evaluate short and medium-term postoperative results of DS with a fibrin sealant.

Patients and methods: This prospective, noncomparative, interventional case series involves 12 eyes of 12 patients with uncontrolled open angle glaucoma who underwent DS with Esnoper (Clip or V2000) implant between February 2021 and March 2022. A novel method of wound closure (sclera, Tenon fascia, and conjunctiva) employing fibrin glue was used instead of classic sutures. Surgical outcomes assessed include: intraocular pressure and glaucoma therapy reduction, best-corrected visual acuity changes, and number of complications registered peri and postoperatively. All measurements were performed preoperatively, as well as at 1 day, at 1 and 2 weeks, and at 1, 2, 3, 6, 9, and 12 months after surgery.

Results: The mean intraocular pressure decreased from 24.0 ± 9.1 mm Hg to 13.8 ± 6.3 mm Hg at 1 year postoperatively ( P < 0.001). Kaplan-Meier survival analysis revealed complete and qualified success rates of 83.3% and 91.7%. The mean glaucoma therapy decreased from 3.2 ± 1.1 to 0.8 ± 1.3 drugs 12 months after surgery ( P < 0.001). Nd:YAG goniopunture was performed in 2 eyes at 1 and 12 months postoperatively. No significant best-corrected visual acuity changes were registered. Perioperatively, we noted a trabeculo-descemet microperforation in 1 eye, transient hypotony in 5 eyes, and mild hyphema in 2 eyes.

Conclusions: Fibrin adhesive provided an effective closure in sutureless DS in the patients included in our study. This modification of classical DS may simplify the surgical technique, ensure secure wound adaptation, optimize healing, and lower the risk of inflammation and fibrosis postoperatively.

Prcis: The screening program using imo strongly correlates with 10-2 Standard automated perimetry in detecting central visual field defects in early glaucoma, highlighting its potential as a valuable tool for efficient screening and severity quantification.

Purpose: To investigate the correlation between abnormalities within the central 10° of the screening program using imo, a portable head-mounted perimeter, and 10-2 standard automated perimetry in early-stage glaucoma with central visual field defects.

Methods: This retrospective study included early glaucoma with (26 eyes) and without (38 eyes) central visual field defects. The correlation between the numbers of abnormal points within the central 10° of the imo screening program and those in the probability plot of 10-2, and mean total deviation and pattern deviation, were analyzed.

Results: The imo screening program demonstrated sensitivity (80%) and specificity (98.7%) in detecting abnormalities, with a 91.6% agreement rate of 10-2. The mean number of anomalies in the 10-2 plot (pattern deviation) with P<1% was 0.85, 7.75, and 9.69 (95% confidence interval: 0.18-1.51, 5.38-10.1, and 6.89-12.5, respectively) for no, one, and two anomalies in the imo screening program, respectively. The number of anomalies with P<1% was significantly higher when the imo screening program detected one anomaly versus none (P<0.01), and two versus one (P<0.05). Mean total deviation values were -1.15, -7.5, and -15.2 (95% confidence interval: -2.32 to 0.03, -11.21 to -3.78, and -19.7 to -10.6, respectively), while mean pattern deviation values were -1.57, -9.0, and -16.0 (95% confidence interval: -2.57 to -0.57, -12.5 to -5.49, and -21.4 to -10.7, respectively), for no, one, and two anomalies in the imo screening program, respectively.

Conclusions: The imo portable head-mounted perimeter was found to correlate with 10-2 standard automated perimetry in glaucoma patients with central visual field defects and has the potential to shorten visual field testing times.

Prcis: This study provides evidence of the long-term efficacy and safety of Deep Sclerectomy as a successful surgical intervention option in cases with childhood glaucoma.

Objectives: The primary objective was to evaluate the long-term visual acuity outcomes of Deep Sclerectomy in pediatric glaucoma and identify factors predicting poor prognosis. The secondary objective was to evaluate the long-term success rate of Deep Sclerectomy in controlling intraocular pressure.

Methods: A retrospective review was conducted of all pediatric patients who underwent deep sclerectomy at King Abdulaziz University Hospital (KAUH) between 2001 and 2016. We included all patients who had valid visual acuity tests. The preoperative findings and long-term visual and intraocular pressure outcomes were analyzed.

Results: A total of 83 eyes of 68 patients were included. The mean (SD) age of participants was 11.1 (4.0) years (range: 5-25 years). The mean age at surgery was 5.9 months, and the mean follow-up period was 10.75 years. The majority of cases (83.1%) were primary congenital glaucoma. Visual acuity was ≥ 20/40 in 56.6% of cases, ranged between 20/40 and 20/200 in 18.1%, and was ≤ 20/200 in 25.3% of the operated eyes. Complete success rate (IOP ≤ 21 mmHg without medications) after one surgery was achieved in 53 eyes (63.86%). Qualified success rate (IOP ≤ 21 mmHg with medications) was achieved in 8 eyes (9.6%), while 22 eyes (26.5%) failed to achieve target IOP of ≤ 21 mmHg or needed additional surgery to achieve it. Nine eyes (10.74%) had post-operative complications.

Conclusion: Deep sclerectomy is a reasonable option for pediatric glaucoma that can provide good long-term visual outcomes and IOP control with a lower risk of surgical complications.

Prcis: Femtosecond laser-assisted cataract surgery leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP.

Purpose: To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) using the LDVZ8 laser on intraocular pressure (IOP) during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS).

Patients and methods: This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a six-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed.

Results: Mean IOP increase after docking was 2.3±4.1 mmHg (P<0.0001); maximum increase 17.6 mmHg, peak 38 mmHg. Sixty-one (61) eyes (25.1%) demonstrated an increase of ≥5 mmHg and 10 (3.7%) showed an increase of ≥10 mmHg; pre-docking IOP was associated with an IOP increase of ≥5 mmHg (P-0.029). IOP reduction over six months post-surgery was similar for FLACS and CPCS (P>0.05),-1.33±3.12 mmHg for FLACS (P<0.001) and -1.4±2.87 mmHg for CPCS (P<0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β -0.742, P<0.001) and CPCS (β -0.743, P<0.001).

Conclusions: Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS, and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.

Prcis: An objective perimetry method provides four 30-2 style reports in 8 minutes. These comprise sensitivity and delay reports for both eyes. A combined report format shows comparable diagnostic power to two forms of automated perimetry.

Purpose: To compare objective perimetry with two forms of standard automated perimetry (SAP) in glaucoma.

Methods: The study cohort contained 40 persons with glaucoma (PwG) and 94 normal control subjects. The PwG had both perimetric and pre-perimetric eyes. Multifocal pupillographic objective perimetry was performed with the objectiveField Analyser® (OFA®), which independently assesses the visual fields of both eyes concurrently. Its OFA30 test assessed the central ±30°, and the OFA15 test assessed the central ±15°, both providing 30-2 style reports. The OFA tests were repeated two weeks apart to assess test-retest variability (TRV). OFA was compared with Matrix and HFA-SITA fast 24-2 threshold testing. Diagnostic power was quantified as area under receiver operating characteristic curves (AUROC). Test durations, Mean Defects and Pattern Standard Deviations of the 4 tests were compared.

Results: At a median of 4.09±0.02 minutes/eye the OFA tests were quicker than SAP (all P≤0.0001), 2 minutes/eye if OFA per-region sensitivities and delays are considered separately. The %AUROCs for OFA, Matrix and HFA were not significantly different, averaging 93±3% (mean±SD) in perimetric eyes, and 73±6% in pre-perimetric eyes. For moderate to severe fields OFA TRV was less than published results for SAP. OFA30 mean defects were significantly correlated between repeats (r=0.91), and with OFA15 (r=0.93, both P<0.0001).

Conclusions: OFA provides extra functional measures in the form of per-region delays, and between-eye asymmetries. Both the OFA wide-field and macular tests provided comparable diagnostic power to SAP and better TRV in damaged eyes.

Prcis: The microvasculature of the optic disc and macula in eyes with acute primary angle closure and primary angle closure glaucoma was lower across the disease spectrum, but the significant difference was only observed in primary angle closure glaucoma.

Purpose: To assess the microvasculature in the optic nerve head (ONH) and macula across primary angle-closure disease (PACD) spectrum using optical coherence tomography angiography (OCTA).

Methods: OCTA (AngioVue, Fremont, CA) imaging was performed on 122 PACD subjects. Flow area (FA) and vessel density (VD) in the ONH, radial peripapillary capillary (RPC) network, and superficial and deep capillary plexuses of the macula were calculated and compared across the PACD spectrum using linear regression models with generalized estimating equations adjusted for inter-eye correlation.

Results: A total of 234 eyes including 44 primary angle-closure suspects (PACS), 93 primary angle-closure (PAC), 79 primary angle-closure glaucoma (PACG) and 18 PAC with history of previous acute primary angle-closure (APAC) were included in the analysis. Compared to other groups, PACG eyes showed smaller FA in the ONH (1.35±0.02 mm2), RPC (0.78±0.03 mm2), and the superficial retinal layer (1.08±0.03 mm2) (all P<0.05). Lower VD was also observed in the "whole image", "inside disc", and "peripapillary" regions of the ONH and RPC, and the "whole image" and "parafoveal" regions of the retinal layer in the PACG group when compared with other groups (all P<0.05). No significant differences were found for the other groups (all P>0.05). Lower VD in the ONH, RPC, and superficial retinal layer significantly correlated with worse visual field loss in PACG eyes (all P<0.05).

Conclusions: Significant reduction in the microvasculature of the optic disc and macula in PACG suggests that glaucoma development may contribute to lower VD in these regions.

Prcis: Alterations in the PINK-mediated mitophagy pathway play an important role in PEX disease.

Purpose: Pseudoexfoliation Syndrome (PEX) is a condition in which aberrant fibrillary protein builds up in various components of the eye and other extraocular tissues. In this study, we aim to investigate the functionality of intracellular auto-degradative machinery -especially mitophagy- and related genes and proteins in PEX.

Methods: Anterior lens capsules were obtained from cataracts patients with and without PEX to constitute the PEX group and age-matched controls during microincision cataracts surgery. PINK1-mediated mitophagy markers were evaluated on the transcriptional and translational level via RT-qPCR and immunohistochemistry analysis, respectively.

Results: The lens epithelial cells of PEX patients were characterized by significantly higher PINK1 gene expression compared to that of the controls (P<0.05). In terms of intensity of staining of expressed proteins, PINK1 (P<0.05), Parkin (P<0.01) and LC3B (P<0.01) were all statistically higher in PEX, compared to the controls.

Conclusion: Altered auto-degradative response -specifically mitophagy- is a component of increased oxidative stress in PEX patients. The role of this mechanism in emerging complications warrants further research.