Journal of Glaucoma最新文献

Prcis: Cost of disposable ophthalmic equipment.

Purpose: The authors performed a cost analysis comparing the use of disposable and reusable tonometry equipment and gonioscopy lenses.

Methods: All adult patient (≥16 y of age) visits in a 1-year period were included. Scenario analysis was employed to calculate the cost of disposable [Goldmann applanation tonometry (GAT) tips, rebound tonometry tips, and gonioscopy lenses] and reusable equipment (GAT tips and gonioscopy lenses) as well as sanitization over 2, 5, and 10 years at a single institution. To account for variability in scenario modeling, a sensitivity analysis was additionally performed. The main outcome measure was cost differences for disposable equipment compared with reusable equipment with sanitization.

Results: The total volume included was 80,356 patient visits. Accounting for variable costs, the additional cost associated with disposable tonometry (GAT or rebound tonometry tips) instead of reusable GAT was $118,723 over 2 years and $603,924 over 10 years. Assuming a gonioscopy frequency of 3.2%, the additional cost associated with disposable gonioscopy lenses was $171,100 at 5 years and $361,237 at 10 years. At a gonioscopy frequency of 10%, the additional cost associated with disposable lenses was $1,208,096 without inflation at 10 years. Overall, the total additional cost associated with disposable tonometry tips and gonioscopy lenses over reusable versions of this equipment was $965,161 over 10 years at a single institution.

Conclusion: A widespread transition from reusable to disposable tonometry and gonioscopy equipment was associated with an additional cost of $965,161 over a 10-year period at a single institution.

Prcis: In this systematic review, we find that CW-CPC produces more sustained IOP lowering in children compared to MP-CPC.

Purpose: Micropulse cyclophotocoagulation (MP-CPC) and Continuous cyclophotocoagulation (CW-CPC) are both surgical interventions used to decrease intraocular pressure (IOP) in pediatric glaucoma. Recent publications have shown conflicting results regarding the effectiveness of MP-CPC compared to CW-CPC, which this systematic review and meta-analysis aims to evaluate.

Methods: From inception through March 2025, PubMed, Embase, Scopus, Cochrane Library, and ScienceDirect were searched for studies comparing MP-CPC and CW-CPC in treating pediatric glaucoma, with IOP reported at different time intervals. A random effects model was used across all analyses.

Results: At 12 months, CW-CPC showed a significantly greater reduction in IOP compared to MP-CPC (MD: -6.88 mmHg, 95% CI: -9.46 to -4.30; P < 0.00001). No significant differences in IOP lowering were observed at 1, 3, and 6 months. Overall, CW-CPC was superior in reducing IOP (MD: -4.23 mmHg, 95% CI: -6.51 to -1.95; P = 0.0003; I² = 80%) at the last follow-up.

Conclusion: CW-CPC shows a significantly greater reduction in IOP than MP-CPC, particularly at long-term follow-up. These findings highlight the sustained efficacy of CW-CPC compared to MP-CPC in the management of pediatric glaucoma.

Prcis: Intraocular pressure (IOP) decreases as preterms mature and in moderate retinopathy of prematurity, IOP is initially low and transiently rises after laser treatment.

Purpose: This study aimed to measure intraocular pressure (IOP) in preterm infants with and without retinopathy of prematurity (ROP) and evaluate the effect of laser treatment on IOP.

Method: This prospective nonrandomized comparative study included infants born before 34 weeks of gestation weighing <2000 g at a tertiary care research and referral institute. Those with ocular or systemic conditions or requiring surgical intervention for ROP were excluded. Infants were divided into 3 groups: Group 1 (no ROP), Group 2 (ROP without treatment), and Group 3 (ROP requiring peripheral retinal ablation by laser photocoagulation). IOP was measured using a Perkins tonometer at presentation and at 1 and 3 months. The primary outcome was IOP in preterm infants with and without ROP; and the secondary outcome was change in IOP postlaser treatment.

Results: Of 107 infants, 40 (37.38%) had no ROP (Group 1), 25 (23.36%) had untreated ROP (Group 2), and 42 (39.25%) required laser treatment (Group 3). Average postmenstrual ages were 37.89±2.74 weeks 36.98±3.38, and 35.47±2.84 weeks, respectively. A moderate negative correlation between IOP and postmenstrual age was found in Group 1 ( r2 =-0.382; P =0.01) and Group 2 ( r2 = -0.6; P =0.001). Baseline IOP was significantly lower in Group 3 compared with the other groups, with a transient increase postlaser treatment that typically normalized without needing IOP treatment.

Conclusions: IOP decreases as preterm infants mature. Infants with ROP requiring laser treatment exhibit significantly low IOP at presentation, but have a postlaser spike, which generally normalises without treatment.

Prcis: Glaucoma patients with multifocal intraocular lenses (MIOLs) reported comparable vision-related quality of life but greater spectacle independence than monofocal IOL users. MIOLs may be considered for mild to moderate glaucoma patients desiring spectacle-free vision.

Purpose: To compare the vision-related quality of life (VRQoL) in glaucomatous patients receiving bilateral monofocal intraocular lens (mIOL) and multifocal intraocular lens (MIOL) implantation.

Patients and methods: This was a comparative, nonrandomized, unmasked, cross-sectional study in pseudophakic patients with mild to moderate glaucoma who underwent uneventful phacoemulsification with bilateral MIOL or mIOL implantation from January 2010 to June 2022 at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Data collection included distant and near best corrected visual acuity (BCVA), percent of spectacle independence and VRQoL. The 25-item National Eye Institute Visual Functional Questionnaire (NEI-VFQ-25) (translated into Thai) was used to access VRQoL (score 0 to 100). The scores were adjusted for age and glaucomatous staging using the analysis of covariance (ANCOVA).

Results: A total of 109 patients were enrolled. Fifty patients received MIOL and 59 received mIOL. There was significantly more moderate glaucoma in mIOL (39.7%) the MIOL group (17.5%) ( P =0.002). Postoperatively, there was no statistically significant difference in BCVA, but the MIOL group had significantly better uncorrected near VA ( P <0.001). Spectacle-free was significantly greater in MIOL (78%) than mIOL (25.4%) ( P <0.001). Mean adjusted NEI-VFQ-25 scores was 95.4 in MIOL and 93.5 in mIOL, which was not significantly different between groups ( P =0.114).

Conclusion: Glaucomatous patients with multifocal IOL experienced comparable VRQoL, but more spectacle independence compared with monofocal IOL. Multifocal IOL could be considered in mild to moderate glaucomatous patients, who spectacle-free was warranted.

Prcis: Intraluminal stent-removal post-PGI surgery significantly reduces IOP with high success rates but carries the risk of hypotony and complications, for example, suprachoroidal hemorrhage. Long-term management often requires the eventual addition of IOP-lowering therapy despite initial efficacy.

Background: To report outcomes after intraluminal stent removal following PAUL Glaucoma Implant (PGI) surgery from a single-center cohort.

Materials and methods: Retrospective review of patients undergoing intraluminal prolene removal following PGI surgery at the University Eye Hospital, Bonn, Germany, from April 2021 to November 2023.

Results: Seventy eyes of 68 patients were included. Qualified and complete success rates (95% CI) were 92.9% and 55.7% after 1 year and 88.6% (81.4% to 95.7%) and 50% (37.1% to 62.9%) at the last follow-up time point for IOP ≤18 mm Hg and 81.4% and 54.3% and 70% and 42.9% IOP ≤15 mm Hg, respectively. Mean IOP decreased from 23.93 to 12.07 mm Hg after 12 months, 11.32 mm Hg after 24 months, and 10.41 mm Hg after 36 months. The mean number of IOP-lowering eye drops was zero before and immediately after removal and increased to 1.57 (0 to 2) at 12 months, 1.15 (0 to 4) at 24 months, and 1.12 (0 to 4) at 36 months. Postoperative complications occurred in 5 eyes (7.1%). Two eyes had suprachoroidal hemorrhage, with one needing vitrectomy and one external tube ligation; one required PGI explantation for persistent hypotony.

Conclusions: Removal of the prolene stent following PGI surgery effectively lowers IOP in the short term, with a moderate increase in IOP and need for pressure-lowering therapy over time. However, it can also lead to adverse outcomes, such as hypotony and suprachoroidal hemorrhage, especially in patients with systemic risk factors or those undergoing early removal.

Prcis: A model of glaucomatous progression based upon patterns of macular ganglion cell layer (GCL) damage can help clinicians distinguish between glaucomatous damage and other causes of GCL abnormalities in eyes with high myopia.

Purpose: To evaluate a model-based approach for identifying glaucomatous macular ganglion cell layer (GCL) damage in highly myopic eyes by analyzing characteristic loss patterns.

Materials and methods: This retrospective observational study involved optical coherence tomography scans of 72 myopic eyes (axial length>25 mm), including 15 normal control eyes and 57 eyes with glaucoma or glaucoma suspects. The mean axial length was 27.09±1.61 mm (range, 25.13-35.77 mm). The mean refractive error was -7.81±2.70 D in 46 eyes without prior refractive or cataract surgery. The loss pattern in the thick donut-shaped region of the macular GCL thickness map was compared with a model predicting glaucomatous damage patterns, suggesting damage originates temporally and progresses nasally.

Results: As predicted, the temporal sectors of the 57 patients' GCL donuts showed the highest number of abnormalities significant at 5% (temporal superior: 28, temporal inferior: 37), followed by the middle sectors (superior: 26, inferior: 30), and then nasal sectors (nasal superior: 24, nasal inferior: 27). Among 3 eyes deviating from the model, 2 showed nasal defects without temporal involvement, while 1 showed an epiretinal membrane (ERM)-induced artifact. Of the 24 eyes with macular lesions (most commonly ERM in 19), 21 were diagnosed with glaucoma or glaucoma suspects. Of these, 20 conformed to the model, except 1.

Conclusions: The proposed model of glaucomatous damage patterns in macula GCL is applicable to myopic eyes, even with coexisting macular pathology. In cases deviating from the model, clinicians are advised to seek causes besides glaucoma.

Prcis: The average cumulative 2-year cost following first primary angle closure glaucoma diagnosis was $2960. Elderly and Black patients were at higher risk of being among the costliest 5% (>$9813) of cases, accounting for 21.3% of costs.

Purpose: To assess longitudinal eye care costs associated with newly diagnosed primary angle closure glaucoma (PACG) in the United States.

Methods: Patients with a diagnosis of PACG between 2009 and 2017 were identified in Optum's deidentified Clinformatics Data Mart Database based on International Classification of Diseases (ICD) codes. Newly diagnosed PACG was defined as: (1) diagnosis by an ophthalmologist or optometrist; (2) observable for at least 12 months before and 24 months after index diagnosis; (3) no prior history of glaucoma treatment; (4) PACG-related treatment initiated after index diagnosis. Logistic regression modeling was performed to identify risk factors for being in the top 5% of cumulative 2-year costs.

Results: Among 12,673 eligible patients, the average cumulative 2-year cost following first PACG diagnosis was $2960. Patient costs were highest in the 6 months immediately following diagnosis, accounting for 52.3% of all 2-year costs. 56.7% of all 2-year costs were related to treatment procedures. The costliest 5% (>$9813) of patients accounted for 21.3% of all 2-year PACG-related costs. Risk factors for being in the costliest 5% ( P <0.05) included older age, Black race, PPO or other Medicare insurance product, living in the Midwest or the South, and recent diagnosis of anatomic narrow angles (ANA).

Conclusion: Costs associated with newly diagnosed PACG were found to be disproportionately driven by a small subset of cases. Elderly and Black patients were more likely to be within the top 5% of cumulative 2-year costs. Identifying and preventing the costliest PACG cases could reduce PACG-related eye care expenditures.