Journal of Glaucoma最新文献

Prcis: Preserflo surgery is a safe procedure, effective in reducing intraocular pressure into the "low teens," surgical survival is greatest in cases of high baseline intraocular pressure (above 21 mm Hg) and when performed as a standalone procedure.

Purpose: To evaluate midterm surgical survival and safety profile of Preserflo filtering surgery.

Methods: In this retrospective, cohort study, consecutive patients who underwent standardized Preserflo implantation with mitomycin C from December 2019 to April 2021 were included. Clinical data were retrieved from patient charts. The primary outcome was surgical survival at 24 months in accordance with World Glaucoma Association guidelines. Survival was evaluated using Kaplan-Meier statistics. Analysis was performed at the eye level and as intention to treat.

Results: Ninety-five eyes were included in this study (18 cases combined with cataract surgery). More than half of cases (n=51) were primary open angle glaucoma, with over a fifth having a prior filtering glaucoma procedure. Intraocular pressure at 24 months was significantly decreased from baseline (22.4±6.28 vs. 12.0±3.43 mm Hg), as well as the need for IOP-lowering medication [2.88 (±0.92) vs. 0.79 (±1.3), P <0.001 all comparisons]. Standalone Preserflo achieved a qualified survival (irrespective of medication) of 71% (95% CI, 62%-83%) and 44% (95% CI, 27%-75%) in the combined procedure subgroup ( P <0.05 when considering absolute survival). Eyes with baseline intraocular pressure ≥21 mm Hg showed a greater qualified survival when compared with eyes with baseline ≤18 mm Hg [80% (95% CI, 65%-100%) vs. 50% (95% CI, 32%-76%); P <0.05]. Intra and early operative complications were few, self-limited, and did not require surgical management. The reoperation rate was low (18%).

Conclusions: Preserflo filtering surgery was effective in reducing intraocular pressure into the "low teens" and presents an adequate surgical survival and safety profile. Surgical survival appeared greatest when performed as standalone and when preoperative intraocular pressure was high.

Prcis: There are significant mental, physical, and perceptual challenges in patients undergoing visual field testing, particularly in the elderly population with glaucoma.

Purpose: To quantitatively and qualitatively investigate patient experiences of undergoing visual field testing.

Methods: This cross-sectional, mixed-methods study involves adult patients attending a private outpatient ophthalmology clinic in Brisbane, Australia. Participant experiences of visual field testing were assessed using a 100 mm visual analog scale (VAS), followed by face-to-face semi-structured interviews. Outcome data comprised of VAS scores (1-100) and thematically analyzed verbatim notes.

Results: Of the 152 participants [M:F 79 (52.0%):73 (48.0%)], the age group with the highest proportion of participants was 71-80 years [n=56 (36.8%)], and most had a primary ocular diagnosis of glaucoma [n=107 (70.4%)]. The mean VAS score for visual field testing experience was 60.45 (SD=30.38). The mean VAS score of participants with glaucoma was significantly lower than that of participants without glaucoma [55.34 (31.13) vs. 72.67 (25.04); P <0.05]. Prevalent themes regarding participant experiences of visual field testing consisted of concentration difficulties, intra-test and peri-test anxiety, skepticism in the testing process, and physical discomfort. Age, sex, and mean visual field index did not influence participant experiences of visual field testing.

Conclusions: Mental and physical barriers to visual field testing tolerability were identified in a predominantly elderly population with glaucoma. Our findings highlight the importance of addressing patient concerns and apprehensions regarding visual field testing and emphasize the value of patient-initiated breaks, particularly for individuals experiencing concentration difficulties and physical discomfort.

Prcis: High perceived stress from academic pressure is associated with intraocular pressure (IOP) elevation and reduced fluctuation in juvenile-onset open angle glaucoma patients. Personalized stress assessment and relief strategies may serve as an adjunct therapy in glaucoma.

Objective: To evaluate the effect of higher perceived stress, resulting from academic pressure, on IOP in juvenile-onset open angle glaucoma (JOAG) patients compared with healthy individuals.

Methods: The study included 48 university students aged 18-27 years, comprising 24 JOAG patients on antiglaucoma eyedrops and 24 healthy controls. In an examiner-blind pretest-posttest design, participants' IOP was measured weekly using Goldmann tonometry during three follow-up visits at the beginning and end of the academic semester. Perceived Stress Scale (PSS) scores were also evaluated at these 2-time points to capture the contrast in perceived stress between periods of low and high academic pressure.

Results: The baseline PSS score at the semester's start was lower in both groups (14.1±1.9 in glaucoma vs. 13.5±2.4 in control) and significantly increased by the end of the semester (29.2±2.1 vs. 28.5±1.3; P <0.001), indicating increased perceived stress. Concurrently, IOP rose from 22.01±5.87 to 25.08±5.84 mm Hg in the glaucoma group and from 11.36±2.03 to 13.65±2.11 mm Hg in the control group. Factorial analysis revealed a significant interaction between stress and JOAG ( F(1,94) =15.94, P =0.001), partial η 2 =0.08, with stress having a greater increase on IOP in the glaucoma group (+3.10 mm Hg) compared with the control group (+2.23 mm Hg) ( t(94) =4.457, P <0.001).

Conclusions: Higher perceived stress significantly increases IOP, especially in JOAG patients, suggesting personalized stress management as a potential adjunct therapy for patients.

Prcis: This study reports 12-month outcomes of combined phacoemulsification and Hydrus Microstent implantation in Asian eyes with moderate-to-severe normal tension glaucoma (NTG), demonstrating a significant reduction in glaucoma medications with an excellent intra and postoperative safety profile.

Objective: To evaluate the 12-month safety and efficacy outcomes of combined phacoemulsification and Hydrus Microstent (Ivantis Inc.) implantation in Asian eyes with moderate to severe NTG.

Methods: Retrospective study of consecutive surgeries performed from August 2019 to August 2021 in a single tertiary eye centre in Singapore. Outcome measures included a reduction in intraocular pressure (IOP), number of glaucoma medications, and intra and postoperative complications.

Results: Data from 21 eyes of 21 subjects were analyzed. All subjects were ethnic Chinese, and the majority were males (14, 66.7%). At baseline, the mean IOP was 13.3 (2.3) mm Hg, all eyes had a Humphrey visual field mean deviation of ≥-6 dB [mean: -13.9 (4.3) dB], and all eyes were on at least one glaucoma medication. There was no statistically significant reduction in IOP at all time points compared with baseline (all P > 0.05). However, the median number of medications was reduced from 2 to 0 at all time points, up to postoperative month (POM) 12 (all P < 0.001). There were no intraoperative complications. No eyes underwent secondary glaucoma procedures nor lost any Snellen line of visual acuity by POM12. One (4.8%) eye experienced numerical hypotony at postoperative day 1, which resolved conservatively. Two (9.5%) eyes underwent laser iridoplasty for stent occlusion by iris. There was no deterioration in Humphrey visual field mean deviation at POM12 compared with baseline (n = 20, P > 0.05).

Conclusion: Combined phacoemulsification and Hydrus Microstent implantation were effective in reducing medication burden in Asian eyes with moderate to severe NTG, up to 12 months postoperatively.

Prcis: This survey highlights a deficiency in gonioscopy practices across the UK, particularly in the utilization of indentation gonioscopy and training of junior ophthalmologists. Recommendations include standardizing practice and enhancing training opportunities to improve patient care.

Objective: Gonioscopy is an important general skill learned and practiced by all grades of ophthalmologists. The aim of this study is to discover the general attitude, perception, and practice of gonioscopy among ophthalmologists in the UK.

Materials and methods: A National gonioscopy survey was carried out by utilizing an anonymous electronic questionnaire of 18 questions. The questionnaire was electronically distributed online, using the survey tool, Microsoft 2016 "MS Forms" to all grades of ophthalmologists in the UK.

Results: A total of 146 responses were analyzed. Overall, 89% of the participants felt "comfortable in performing slit lamp gonioscopy," but only 38% of junior trainees (ophthalmic specialist trainees years 1-3) felt comfortable in gonioscopy. Only 13% of the junior trainees felt they had adequate training in performing gonioscopy compared with 68% of the total respondents. Surprisingly, the majority of consultants (58%) did not "strongly agree" to be confident in assessing the angle and its configuration on gonioscopy. The most commonly used gonioscopic lens in this survey was the Zeiss four-mirror gonio lens, but only 38% of participants performed indentation gonioscopy routinely. The majority of the participants utilized the modified Shaffer's classification for gonioscopy. Fewer than expected numbers performed gonioscopy routinely for new patients with glaucoma.

Conclusion: This survey suggests that gonioscopy is not being performed according to the UK national recommendations, and few ophthalmologists perform indentation gonioscopy. Additional gonioscopy training in the curriculum may be helpful.