Journal of Glaucoma最新文献

Precis: Goniotomy is effective in managing intraocular pressure in childhood glaucoma secondary to uveitis with cumulative probability of success 0.94 after 1 year and 0.77 after 5 years.

Objective: To evaluate the long-term success of goniotomy for childhood glaucoma secondary to chronic uveitis.

Methods: Retrospective chart review of all children treated with goniotomy for this indication from 2001 to 2023. Post operative success was defined as IOP ≥ 6 and ≤ 21 mmHg after 1 or 2 goniotomies, without the need for further surgical intervention or sight-threatening complication.

Results: 31 eyes of 21 patients were included. Mean age at first goniotomy was 10.3 years (range 6.6- 15.7 years) with uveitis diagnosed on average 4.7 years earlier. Mean pre-operative IOP was 28.8 mmHg, on a median of 4 topical agents. Mean follow-up post-goniotomy was 6.8 years (Median 5.7 years) and average post operative IOP at 1, 5 and 8 years post-operatively was 15.9, 15.2 and 15.6 mmHg respectively. At most recent follow-up, 24 eyes (77.4%) were a surgical success. Of these, 5 (21%) needed a second goniotomy to achieve this, and 5 (21%) needed anti-glaucoma drops to maintain IOP ≤21 mmHg (two of these were cases who also underwent a second goniotomy). There were no major complications including loss of inflammatory control.

Conclusion: We confirm that this quick, safe, conjunctival sparing primary approach is safe and effective in this context, and early success rates are usually maintained in the long-term. If stable inflammatory control can be achieved pre-operatively, we recommend it as first line treatment for children with childhood glaucoma secondary to uveitis.

Prcis: Trabecular cutting minimally invasive glaucoma surgery like bent ab interno needle goniectomy (BANG) when performed in baseline aqueous angiography identified low aqueous humor outflow regions, results in greater success of intraocular pressure reduction.

Purpose: To study the efficacy of Bent Ab Interno Needle Goniectomy (BANG) in high versus low aqueous humor outflow (AHO) regions as determined by Aqueous Angiography(AA) in patients with primary open angle glaucoma (POAG).

Methods: A prospective, single-centre, pilot, randomized control trial recruited 30 eyes of 30 patients of POAG and visually significant cataract (45-80 y) and were randomised into two groups ("A": BANG performed in the high-flow regions and "B": BANG performed in the low-flow regions) of 15 each. AA was performed using indocyanine green dye (0.1%) to identify baseline high- and low-flow regions of the AHO pathways followed by BANG in these respective regions as per randomisation. Preoperative and postoperative data on IOP, number of antiglaucoma medications (AGMs) and any complications were noted over 6 months. Overall success was defined as achieving an IOP ≤15 mm Hg and ≥6 mm Hg at 6 months of follow-up with AGMs (qualified success) or without AGMs (complete success).

Results: AA revealed high-flow regions of AHO pathways in the nasal quadrant and low-flow regions of AHO pathways in the temporal quadrant in all 30 patients. Both groups had comparable demographic composition [group A age: 65.3±6.48 y and male: female (14:1) and group B age: 64.6±7.08 y and male: female (13:2)]. The mean preoperative IOPs [group A (17.27±3.43 mm Hg); group B (17.60±5.42 mm Hg)] (P=0.842) and mean postoperative IOP at 6 months [group A (15.6±4.98 mm Hg); group B (13.13±2.29 mm Hg)] (P=0.09) were similar. However, lower qualified success was seen in group A (40.00%) compared to group B (86.67%; P=0.021). Survival in Kaplan-Meier analysis was higher in group B (P=0.021). Complications were comparable in both groups.

Conclusion: Short-term results of BANG in low-flow AHO regions show enhanced success compared to those in high-flow AHO regions. This study suggests that trabecular cutting minimally invasive glaucoma surgeries (like BANG) may be performed in baseline low-flow AHO regions (temporal quadrant) instead of the high-flow AHO (nasal quadrant) regions.

Prcis: Deep sclerectomy (DS) and canaloplasty provide better intraocular pressure (IOP) control than viscocanalostomy. DS required less glaucoma medications but more interventions to reach target IOP.

Purpose: To compare real-world outcomes of three non-penetrating glaucoma surgery (NPGS) techniques.

Methods: Retrospective, cohort study of consecutive patients undergoing canaloplasty (CP), deep sclerectomy (DS), and viscocanalostomy (VC), across nine European glaucoma units. Four intraocular pressure (IOP) criteria were used to define success at 2-year follow-up: (A)IOP≤21 mmHg and ≥20% reduction; (B)IOP≤18 mmHg and ≥20% reduction; (C)IOP≤15 mmHg and ≥25% reduction; (D)IOP≤12 mmHg and ≥30% reduction. Secondary outcomes included IOP control, BCVA, number of medications over time, risk factors for failure, complications, and post-operative interventions. Success was distinguished as qualified or complete, if reached with or without antiglaucoma medications, respectively.

Results: 600 eyes (545 patients) undergoing standalone CP (201 eyes), DS (200 eyes), and VC (199 eyes) were included. Qualified success rates of CP, DS, and VP at 24 months were, respectively: (Criterion A) 85.1%, 67.6% and 64.6%; (Criterion B) 85.1%, 66.1% and 58.6%; (Criterion C) 76.6%, 55.5% and 39.0%; (Criterion D) 27.7%, 28.5% and 22.1%. Success rates were significantly different across the three techniques (P=0.04 or below), except for complete success according to criterion A (P=0.07). Mean IOP(±SD) reduced from 25.2(±6.9), 20.5(±6.7), and 22.7(±7.2)mmHg pre-operatively to 13.1(±3.1), 12.9(±4.5), and 14.7(±4.6)mmHg at post-operative year 2 in the CP, DS, and VC groups respectively (P<0.001 between pre-operative and post-operative time points for all groups).

Conclusions: All three NPGS provide sustained IOP reduction, but DS and CP provide better success rates and IOP control. Success rates were low for the most stringent cut-offs, suggesting that other techniques such as trabeculectomy may be indicated when a very low target IOP is demanded.

Prcis: Preservative-free omidenepag isopropyl (OMDI) 0.002% ophthalmic solution and OMDI 0.002% ophthalmic solution preserved with benzalkonium chloride were bioequivalent in lowering intraocular pressure after 4 weeks' treatment in patients with primary open-angle glaucoma or ocular hypertension.

Purpose: Preservatives in ophthalmic solutions for lowering intraocular pressure (IOP) are associated with ocular surface disease. The DAISY study evaluated the bioequivalence of preservative-free omidenepag isopropyl (OMDI) 0.002% ophthalmic solution (DE-117B), with OMDI 0.002% preserved with benzalkonium chloride (BAK).

Methods: DAISY was a phase 3, randomized, evaluator-masked, crossover study conducted in Japan. Patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) were randomized 1:1 to DE-117B or OMDI 0.002% for 4 weeks (period 1) then crossed over for 4 weeks (period 2). A 4-week washout preceded both periods. The primary efficacy endpoint was mean diurnal (MD) IOP at Week 4 (combined periods 1 and 2). Bioequivalence between DE-117B and OMDI was defined as 95% confidence interval (CI) between -1.5 and 1.5 for least-squares (LS) mean between-group difference in MD IOP. Adverse events were monitored.

Results: Of 74 patients enrolled, 38 were randomized to DE-117B then OMDI, and 36 were randomized to OMDI then DE-117B. DE-117B and OMDI demonstrated bioequivalence at Week 4 (MD IOP±standard deviation in summary statistics: 17.76±2.05 mm Hg [DE-117B] vs. 17.71±2.01 mm Hg [OMDI]; LS mean±standard error between-group difference in linear mixed effects model: -0.02±0.18 mm Hg [95% CI -0.38 to 0.35]). DE-117B versus OMDI was associated with numerically lower overall ocular discomfort.

Conclusions: Preservative-free DE-117B and BAK-containing OMDI were bioequivalent in lowering IOP after 4 weeks' treatment in Japanese patients with POAG or OHT. DE-117B was well tolerated with a similar safety profile to OMDI.

Purpose: To evaluate the outcomes of slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) in pseudoexfoliation glaucoma (PXG).

Methods: A single-center, retrospective non-comparative study including consecutive patients with medically uncontrolled PXG who underwent SC-TSCPC (1250-milliwatt power and 4-second duration). The primary outcome measure was surgical success (defined as intraocular pressure (IOP) between 6 - 21 mmHg with ≥20% reduction compared to baseline and no need for further glaucoma surgeries or development of vision-threatening complications). Success was considered qualified when achieved with additional glaucoma medications and complete when achieved without additional glaucoma medications. The secondary outcomes included IOP, glaucoma medication numbers, visual acuity, and postoperative complications at 1 and 2 years after laser treatment.

Results: This study included 48 eyes of 48 patients. The median age of study participants was 87.5 years, with a median follow-up duration of 24.0 months. The qualified success for a single SC-TCPC treatment at 1 and 2 years was 58.3% and 47.9%, respectively. Cumulative qualified success (>1 SC-TSCPC) was 64.6% at 1 year and 56.2% at 2 years. Complete surgical success after a single SC-TSCPC was 45.8% at 1 year and 33.3% at 2 years, increased to 50.0% at 1 year and 39.6% at 2 years after >1 SC-TSCPC. After SC-TSCPC treatment, the mean IOP decreased from 29.2±10.3 mmHg on 3.7±1.0 medications pre-treatment to 14.3±6.43 mmHg on 2.6±1.3 medications at the final follow-up visit (P<0.001). Seven eyes (14.6%) had SC-TSCPC retreatment, and two eyes (4.2%) required incisional glaucoma surgeries. Reported postoperative complications included: decreased visual acuity in 9 (18.8%) eyes, iridocyclitis in 5 (10.4%) eyes, hyphema in 5 (10.4%) eyes, cystoid macular edema in 2 (4.2%) eyes, and transient hypotony in 2 (4.2%) eyes.

Conclusions: SC-TSCPC is an effective, relatively safe, and repeatable surgical treatment option in PXG. Further prospective investigations are suggested to confirm these findings.

Prcis: Intermittent fasting was not associated with a decreased risk of glaucoma diagnosis overall.

Objective: To examine the association between intermittent fasting ("breakfast skipping") and glaucoma in the National Health and Nutrition Examination Survey (NHANES).

Patients and methods: Retrospective, cross-sectional study of adult participants of the 2005-2008 NHANES aged 40 years and older. Intermittent fasting was defined as skipping breakfast on both days of the NHANES dietary interview. Glaucoma was defined by (1) self-reported glaucoma diagnosis, (2) cup-to-disc (CDR) ≥0.6 in at least one eye, and (3) possible, probable, or definite glaucoma based on clinical judgment of retinal imaging of individuals with CDR ≥0.6 in at least one eye. Covariates included age, sex, race/ethnicity, body mass index, blood pressure, and waist circumference. χ 2 and Fisher exact test were used for categorical variables and the t test for continuous variables. All data were weighted based on the NHANES multistage sampling design.

Results: The population included 7081 individuals 40 years or older, of whom 946 (13.4%) reported skipping breakfast on both interview days; 482 (6.8%) individuals self-reported glaucoma diagnosis, 549 (7.8%) individuals had glaucoma based on CDR ≥0.6, and 343 (6.0%) individuals had glaucoma based on clinical judgment. Diagnosis of glaucoma by all definitions was associated with older age and black or Latinx/Hispanic ethnicity ( P = 0.004) but was not associated with intermittent fasting status ( P = 0.151).

Conclusions: In the 2005-2008 NHANES population, intermittent fasting, defined as breakfast skipping, was not associated with decreased risk of glaucoma diagnosis overall. Further studies are needed to examine the potential effects of intermittent fasting on glaucoma risk.

Prcis: Patients with migraine showed a significantly increased risk of developing open angle glaucoma (OAG) in the Korean population, without significant differences according to the presence of aura. Our results suggest the presence of migraine as a possible risk factor for OAG.

Purpose: Previous studies have reported that migraine headaches may be one of the possible risk factors for open angle glaucoma (OAG); however, a consensus has not been reached regarding the association between OAG and migraine. In this study, we examined the risk of developing OAG in migraine patients using a 12-year nationwide cohort.

Materials and methods: In this study, data from the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2015 was used to perform a retrospective cohort study. The study included 1,103,302 subjects, out of which 41,148 were diagnosed with migraine during 2003-2008 and were categorized as the migraine group, while 205,741 patients were selected as controls through propensity score matching at a 1:5 ratio. Subjects with migraine or OAG was ascertained based on the KCD code. Multivariate Cox regression analysis was used to evaluate the hazard rate of OAG onset in the migraine group, and subgroup analysis was performed to identify any differences based on sex and age.

Results: Multivariate Cox regression analysis showed that the incidence of OAG was significantly greater among patients with migraine than among patients in the comparison group [hazard ratio (HR): 1.238; 95% CI: 1.160-1.132, P < 0.001]. Moreover, the risk of developing OAG compared with subjects without migraine did not differ according to the presence of an aura (migraine with aura: HR: 1.235; 95% CI: 1.137-1.342, P < 0.001; migraine without aura: HR: 1.248; 95% CI: 1.143-1.363, P < 0.001). In subgroup analyses, the patients with migraine under 40-year-old were found to have a greater hazard rate (HR: 1.576, 95% CI: 1.268-1.957) of developing OAG in contrast with patients with migraine and over 40-year-old (HR: 1.167, 95% CI: 1.089-1.250) when compared with the corresponding nonmigraine patients.

Conclusion: This study showed that migraine is a significant risk factor for OAG onset in the Korean population, and the presence of aura did not affect the HR of OAG development.

Prcis: Among 1861 adults with ocular hypertension or mild or moderate primary open angle glaucoma, those with Medicaid or no insurance had a statistically significantly lower likelihood of receiving laser trabeculoplasty compared with those with other insurance.

Purpose: To determine whether social determinants of health are associated with undergoing treatment with laser trabeculoplasty (LTP) among individuals with ocular hypertension (OHT) or mild or moderate primary open angle glaucoma (POAG).

Methods: In this cross-sectional study, we included patients with OHT or mild or moderate POAG from the National Institutes of Health All of Us Research Program, a diverse US nationwide data set. Logistic regression was performed to study the association between LTP treatment status and 7 covariates (diagnosis severity, age, gender, race/ethnicity, income, insurance status, and education).

Results: A total of 1861 subjects were included (median age of 72 y). In univariable logistic regression, diagnosis severity, older age, higher income, and insurance (non-Medicaid) were associated with LTP treatment. On multivariable logistic regression models, those with mild POAG (OR, 3.49; 95% CI: 2.12-5.87) and moderate POAG [OR, 7.15 (4.49-11.8)] were still more likely than OHT patients to have received LTP. Moreover, compared with participants with Medicaid or no insurance, participants with other insurance (eg, employer-provided, Medicare) were still more likely to have received LTP [OR, 2.24 (1.08-5.29)]. There was no significant difference in the LTP treatment likelihood based on race/ethnicity.

Conclusions: After controlling for confounders, the likelihood of receiving LTP appears to be driven primarily by insurance rather than income or race/ethnicity. Potential reasons for decreased utilization of LTP among Medicaid patients include higher rates of declining the procedure, or LTP may have been offered less frequently due to Medicaid's lower levels of reimbursement and longer reimbursement delays.