Journal of Glaucoma最新文献

Prcis: Disagreement in the angle closure assessment was seen between gonioscopy and ultrasound biomicroscopy (UBM) to which not only anterior, but also posterior chamber configuration UBM parameters were significantly related.

Purpose: To study diagnostic disagreement and its relating factors in assessing the angle classified as "occludable" by gonioscopy and by ultrasound biomicroscopy in eyes with van Herick grade 2 or less (eyes ≤VH2).

Methods: In 93 eyes ≤VH2 (93 subjects) with no peripheral anterior synechia, gonioscopy, UBM and anterior segment-optical coherence tomography (AS-OCT) were performed in dark, the number of eyes with ≥2 ITC-positive quadrants (contact ≥180°) based on UBM (eyes≥2-ITCUBMQuad) and that with the angle classified as occludable by gonioscopy (eyes≥2-ITCGONIOQuad) were determined, and the number of eyes not meeting these criteria, that is, eyes<2-ITCUBMQuad (contact <180°) and eyes <2-ITCGONIOQuad, were also determined. Multivariable logistic regression analysis was performed with systemic, ocular, UBM and AS-OCT parameters as explanatory variables.

Results: Out of the 93 eyes, 49 were diagnosed as eyes ≥2-ITCGONIOQuad based on gonioscopy, 63 as eyes ≥2-ITCUBMQuad on UBM, 37 as both eyes ≥2-ITCGONIOQuad and eyes≥2-ITCUBMQuad (agreement between gonioscopy and UBM), 12 as eyes ≥2-ITCGONIOQuad base on gonioscopy, but as eyes <2-ITCUBMQuad on UBM (UBM under-diagnosing), and 26 as eyes <2-ITCGONIOQuad based on gonioscopy, but as eyes ≥2-ITCUBMQuad on UBM (UBM over-diagnosing), respectively (McNemar test, P=0.0388). Longer axial length (P=0.0002), deeper anterior chamber depth (P=0.0121), greater angle-opening distance at 500 μm (P=0.0159) and smaller iris convexity (P=0.0031) were related to UBM over-diagnosing, while a greater angle-opening distance at 500 μm (P=0.0046) and smaller trabecular ciliary angle (P=0.0158) to UBM under-diagnosing.

Conclusion: Both anterior and posterior chamber configuration parameters determined based on UBM were significantly related to disagreement between gonioscopy and UBM in assessing the appositional angle closure.

Prcis: This study identifies visual acuity and intraocular pressure at 3-year and 5-year follow-ups, along with other variables such as media opacity and nystagmus, as key predictors of long-term outcomes in childhood glaucoma, aiding better management and prognostication.

Purpose: This study aims to identify key predictive variables of visual acuity (VA) and intraocular pressure (IOP) outcomes in childhood glaucoma. By understanding these factors, the study seeks to improve prognostication and management strategies for pediatric patients.

Methods: A retrospective analysis was conducted on pediatric glaucoma patients across multiple centers within the Childhood Glaucoma Research Network (CGRN). The study included patients with at least 5 years of follow-up. Variables such as sex, race, ethnicity, age of onset, laterality, and clinical measures including VA and IOP at various stages (initial visit, 3 y, 5 y, and final visits) were evaluated. Additional factors considered were anisometropia, media opacities, nystagmus, anterior segment dysgenesis (ASD), strabismus, and angle closure.

Results: The study included 396 eyes from 243 patients, with a mean age at presentation of 1.5 months. Several variables showed statistically and clinically significant correlations with final outcomes including IOP and VA at both 3-year and 5-year visits, as well as the presence of media opacities, unilateral glaucoma, nystagmus, and ASD. On the basis of multivariable prediction model analysis the 2 statistically significant predictors for visual acuity (n=31) were VA at 5-year visit and presence of angle closure. As for IOP outcomes (n=31), significant predictors included were IOP at 5-year visit and presence of nystagmus.

Conclusions: This multicenter study highlights that VA and IOP measurements at 3 and 5 years postdiagnosis, along with the presence of specific ocular conditions such as media opacity and nystagmus, are crucial in predicting long-term outcomes in childhood glaucoma.

Prcis: Glaucoma patients with significant visual field defects show poorer driving performance, higher collision risks, and a greater likelihood of driving cessation. They face difficulties with lane maintenance, slower hazard responses, and self-regulation while driving.

Purpose: Glaucoma is a chronic, progressive optic neuropathy associated with visual field (VF) defects, which in advanced disease has been shown to affect patients' activities of daily living. This systematic review qualitatively analyzes existing literature that explores the impact of glaucomatous VF loss on the driving performance of glaucoma patients, the extent of driving limitation and cessation, as well as the risk of motor vehicle collisions (MVCs).

Methods: A literature search of MEDLINE and Embase (via Ovid), PubMed, Cochrane Library, and Web of Science databases was performed for studies published from 2003 to 2023, with the terms "glaucoma," "visual field defect/disorder," and "driving," followed by selective vetting based on inclusion criteria. Within studies, data pertaining to study design, subject demographics, VF defect characteristics, driving performance and related outcomes were extracted.

Results: Initial search yielded 835 studies, with 20 studies selected. Three more studies were included through hand-searching, with a total of 23 studies included for final review. Moderate to severe VF defects resulted in poorer driving performance, with slower response times to road hazards, decreased ability for lane maintenance, and increased difficulty driving at night. Patients with more severe VF defects and with bilateral glaucoma were more likely to limit or cease driving compared with those with milder and unilateral glaucoma. A greater severity of VF loss was associated with a higher risk of MVCs.

Conclusion: More severe glaucomatous VF and bilateral glaucoma is associated with worse driving performances and a higher risk of MVCs, in both simulator and real-world settings.

Prcis: This report presents a model that can be used to determine the IOP-lowering effect of a glaucoma procedure or treatment when a medication washout is not ethical or not possible to be performed.

Background: The effect of individual (or certain predefined combinations of) glaucoma medications on intraocular pressure (IOP) has been well documented in various clinical trials. Conversely, the cumulative effect of several glaucoma medications, let alone their discontinuation (ie, washout), on IOP is still relatively unknown. This is why it is generally recommended to perform a medications' washout to analyze the effect of the glaucoma procedure without confounding factors. However, a washout is not always possible or ethical for some patients and can also increase the costs and complexity of clinical trials.

Aims: To build and validate a mathematical model of the IOP change after glaucoma medications washout.

Method: A literature search was conducted to identify studies reporting IOP values before and after washout, as well as the number of glaucoma medications used. On the basis of this, a quadratic equation was fitted to estimate the IOP change after washout, using the mean medicated IOP and the mean number of medications as input parameters.

Findings: A total of 31 groups (each group having a precise mean medicated IOP, mean number of medications, and mean postwashout IOP) from 15 studies were selected to build and validate the model. Overall, over 90% of the variability of IOP change reported in the studies was explained by the model ( R2 =0.9007). The mean difference between the IOP changes estimated by the model and the IOP changes reported in the studies was <1 mm Hg.

Conclusion: Estimating the IOP change using this model may represent an useful tool to determine the IOP-lowering effect of a glaucoma procedure or treatment when the washout is not ethical or not possible to be performed on patients. More studies need to be conducted to validate the practical robustness of this formula.

Preserflo MicroShunt (PMS) has emerged as a safe and effective subconjunctival implant for lowering intraocular pressure in glaucoma. Although most postoperative complications occur early and are transient, long-term data remain limited-particularly regarding rare but serious events such as device exposure or extrusion, which may threaten ocular integrity. This report presents 3 clinical cases of PMS exposure with distinct presentations, potential risk factors, and surgical management approaches. In the first case, a pseudophakic patient with primary open angle glaucoma developed exposure of the device body 8 months postoperatively, associated with conjunctival ischemia but without leakage. In the second case, exposure of a nonfunctioning PMS occurred 2 years after a second implant was placed in a different quadrant, following early failure of the original device. The exposed implant was removed without compromising IOP control. The third and most severe case involved extensive scleral melting, distal extrusion, and Seidel positivity, requiring device explantation and scleral grafting. Contributing factors included the use of 0.04% mitomycin C, previous surgeries, and intraoperative identification of thin Tenon's capsule. Based on these cases, PMS exposure may arise through different mechanisms-distal extrusion, body erosion, or conjunctival dehiscence-each necessitating tailored surgical intervention. Awareness of risk factors and prompt management are essential to prevent complications such as infection or hypotony. These findings highlight the importance of careful intraoperative assessment, personalized MMC application, and early detection to ensure long-term safety and device preservation.

Prcis: Noninferiority on intraocular pressure (IOP)-lowering efficacy was demonstrated for a preservative-free (PF) bimatoprost 0.01% ophthalmic gel compared with a preserved formulation following a 3-month treatment in patients with open angle glaucoma (OAG) or ocular hypertension (OHT).

Purpose: To compare the safety and IOP-lowering efficacy of a preservative-free bimatoprost 0.01% ophthalmic gel (PFB 0.01% gel) with a preserved bimatoprost 0.01% ophthalmic solution (PB 0.01%) in patients with OAG or OHT.

Methods: This prospective, phase III, multicenter, randomized, parallel group, investigator-masked, 3-month study included patients with OAG or OHT, previously treated with monotherapy, who underwent a maximum 7-week washout period. At day 1, patients were randomized to receive either PFB 0.01% gel (n=232) or PB 0.01% (n=234) dosed once daily from day 1 to day 85. The primary efficacy endpoint was the change from baseline in IOP across 9 timepoints (8 am , 10 am , and 4 pm ) at weeks 2, 6 and 12. Safety measures included adverse events (AEs) and conjunctival hyperemia.

Results: Change in IOP from baseline was consistent across timepoints and was similar between treatment groups. Noninferiority of PFB 0.01% gel to PB 0.01% on IOP-lowering over a 12-week treatment period was demonstrated based on predetermined noninferiority margins [below 1.5 mm Hg at all timepoints (9/9) and below 1 mm Hg at the majority of time points (6/9)]. Tolerability and safety were comparable with fewer treatment-related ocular AEs in the PFB 0.01% gel group compared with the PB 0.01% group (28.1% vs. 34.8%, respectively), and conjunctival hyperemia at Week 2 (54.8% vs. 63.2%, respectively).

Conclusions: PF bimatoprost 0.01% ophthalmic gel was noninferior to the preserved bimatoprost 0.01% ophthalmic solution, with similar safety and tolerability over 3 months.

Prcis: Applying different combinations of intraocular pressure and medication endpoint criteria recommended by the World Glaucoma Association can have a significant influence on the risk of failure following glaucoma surgery, which hinders the comparison of outcomes.

Purpose: The definition of success in glaucoma surgical trials lacks standardization, leading to difficulty comparing outcomes across studies. This study evaluates how different intraocular pressure (IOP) and medication criteria affect success in a representative subconjunctival minimally invasive glaucoma surgery (MIGS) dataset.

Methods: A literature review identified the range of criteria used to define surgical success in studies of Xen gel stent, which were summarized into 4 definitions: (A) final IOP within upper and lower thresholds only, (B) criteria A plus ≥20% decrease in IOP verssus baseline, (C) ≥20% IOP decrease plus no increase in medications versus baseline, (D) all 3 criteria combined. These definitions were then applied to a cohort of 308 eyes that underwent Xen surgery to compare the apparent risks of failure.

Results: Success rates at 12 months across studies reviewed ranged from 18.5% to 33.4% for complete and 22.4% to 64.6% for qualified success. In our cohort, the hazard ratios of failure ranged from 0.27 to 5.87 (95% CI: 0.21-7.63, P <0.001) across the 4 definitions. The greatest degree of difference in apparent failure rates was observed at the upper IOP threshold of 21 mm Hg, and when evaluating qualified success.

Conclusion: Using different IOP and medication criteria to define success can have a significant influence on the apparent risk of failure, particularly at the 21 mm Hg threshold and when incorporating a minimum 20% IOP reduction from baseline. Reporting success using guidelines-recommended criteria-and at multiple upper IOP thresholds may enable better comparison of outcomes between studies.

Prcis: UCP effectively reduced IOP by 54.10% in eyes with failed glaucoma surgeries after 12 months. Complete and qualified success rates were 21.05% and 68.42%, respectively, demonstrating UCP's potential as a safe and effective salvage treatment.

Purpose: This prospective study aims to evaluate the outcomes and safety of ultrasound cycloplasty (UCP) in controlling intraocular pressure in patients with prior failed glaucoma surgeries.

Patients and methods: A total of 19 eyes from 19 patients who underwent UCP following failed glaucoma surgery between September 2020 and September 2022, were included. All patients were followed for over 12 months. Intraocular pressure, ocular hypotensive medications, and best-corrected visual acuity were recorded and compared after surgery. Complete success was defined as intraocular pressure within the range of 6-21 mm Hg after treatment and a reduction of at least 20% from baseline, without the use of ocular hypotensive medications. Qualified success was defined the same as complete success but allows the presence of ocular hypotensive medications.

Results: At 12 months follow-up, intraocular pressure decreased from 44.95±10.73 mm Hg to 20.63±6.19 mm Hg, representing a reduction of 54.10% ( P <0.01). The rates of complete successes and qualified successes were 21.05% (4 of 19 eyes) and 68.42% (13 of 19 eyes) 12 months after treatment, respectively.

Conclusion: UCP is an effective and safe surgical approach for eyes with prior failed glaucoma surgeries.

Prcis: Protocol 30-2 of Melbourne Rapid Fields, online computer perimetry, provides a portable, reliable, and patient-friendly alternative to Humphrey Field Analyzer 30-2 SITA fast protocol for Japanese with all severity stages of glaucoma patients.

Purpose: Melbourne Rapid Fields (MRF) online computer perimetry is a web-browser-based software that offers white-on-white threshold perimetry using any computer. This study evaluates the perimetric results of the 30-2 protocol from MRF performed using a laptop computer in comparison to the Humphrey Field Analyzer (HFA).

Methods: A prospective and cross-sectional study of 87 eyes from 87 Japanese glaucoma patients. The MRF software includes features such as computer vision gaze monitoring and thresholding using Bayes logic. MRF's 30-2 VF results were compared with HFA 30-2 SITA-Fast, including mean deviation (MD), pattern deviation (PD), and reliability indices. Patients underwent 2 assessments on the MRF to establish test-retest reliability.

Results: Of the 87 eyes, 43 eyes had mild field defect (MD>-6 dB), 26 had moderate field defect (-12 dB≤MD≤-6 dB), and 18 had advanced field defects (MD<-12 dB). MRF demonstrated a high level of agreement with HFA in evaluating MD [intraclass correlation coefficient (ICC): 0.97; 95% CI: 0.95-0.98] and PSD (ICC: 0.91; 95% CI: 0.86-0.94). Bland-Altman analysis revealed a mean bias of -0.76 decibels (dB) [95% limits of agreement (LoA): -5.82 dB, +4.30 dB] for MD and 0.79 dB (LoA: -4.24 dB, +5.82 dB) for PSD. Regarding MRF test-retest, Bland-Altman analysis demonstrated a mean bias of 0.25 dB (LoA: - 2.48 dB, +2.99 dB) for MD and -0.21 dB (LoA: -3.22 dB, +2.79 dB) for PSD. Although false positives and fixation losses were comparable between MRF and HFA, the MRF showed slightly higher false negatives and longer test times than HFA, though these differences did not reach statistical significance. In the mild group, MRF has a sensitivity of detecting field defects of 80% and a specificity of 72%.

Conclusion: MRF provides a portable and accessible alternative to HFA for 30-2 visual field testing, with good agreement in moderate to advanced glaucoma. However, its slightly higher false negatives, longer test duration, and systemic difference in output to HFA should be considered when interpreting results. Further improvements may enhance its clinical utility.

Prcis: Artificial intelligence applied to OCTA images demonstrated high accuracy in estimating 24-2 visual field maps by leveraging information from the parapapillary area.

Purpose: To develop deep learning (DL) models estimating 24-2 visual field (VF) maps from optical coherence tomography angiography (OCTA) optic nerve head (ONH) en face images.

Methods: A total of 3148 VF OCTA pairs were collected from 994 participants (1684 eyes). DL models were trained using radial peripapillary capillary (RPC), superficial, and choroidal, as well as combined ONH VD layers, to estimate 24-2 mean deviation (MD), pattern standard deviation (PSD), 52 total deviation (TD), and pattern deviation (PD) values and compared with a linear regression (LR) model. Model accuracy was assessed by calculating mean absolute error (MAE) and R (Pearson correlation coefficient) between estimated and actual VF values.

Results: DL models outperformed LR estimates for the estimation of VF values using individual and combined layers ( P <0.001). For example, in the estimation of MD using RPC, DL achieved an R of 0.79 and MAEs of 1.77 dB. Average estimated TDs using RPC had R of 0.63 and MAEs of 3.08 dB. DL estimation using combined layers slightly improved the choroid in the estimation of MD ( P <0.01) and had comparable performance with RPC and superficial layers. It also slightly improved RPC, superficial and choroidal layer in the estimation of TDs ( P <0.01).

Conclusions: DL models from OCTA images demonstrated high accuracy in estimating 24-2 VF maps by leveraging information from ONH layers. By extending the application of DL to OCTA images using RPC or superficial layers, it may be possible to reduce the frequency of VF testing to individual patients.