Journal of Glaucoma最新文献

Prcis: Glaucoma is associated with a significant risk of bone fracture. Comprehensive patient education and targeted interventions are crucial to mitigating this risk and improving outcomes.

Purpose: To evaluate the risk ratio (RR) and hazard ratio (HR) of fractures in subjects with glaucoma compared with healthy controls.

Materials and methods: The study protocol (CRD42024527785) was registered prospectively. PubMed, EMBASE, and Web of Science were searched from their inception to April 2024. Glaucoma was identified by the presence of a visual field defect (GVFD) consistent with glaucomatous optic neuropathy, ICD codes (or similar disease-classifying codes), and self-report. Visual field damage severity was classified using the Hodapp-Anderson-Parrish criteria, with study-specific criteria for severity deemed suitable on a case-by-case basis. Both frequentist inference meta-analysis and Bayesian network meta-analysis (NMA) were conducted.

Results: Seven articles were deemed eligible for synthesis, covering a combined population of 570,694 subjects and reporting a total of 45,957 fractures. Bayesian NMA indicated that both mild and severe glaucomatous visual field defects were associated with an 80% increased RR of fractures compared with healthy counterparts [RR mild: 1.8, 95% Credible Interval (95%CrI): 1.5 to 2.3; RR severe: 1.8, 95% CrI: 1.3-2.4]. A higher HR of fractures was observed in individuals with mild (HR: 1.2; 95% CrI: 1.1-1.3) and moderate (HR: 1.4; 95% CrI: 1.1-1.8) glaucoma compared with healthy subjects.

Conclusions: Low- to moderate-quality evidence indicates a significant association between glaucoma and increased fracture risk, with individuals with mild to moderate GVFD showing the highest HR and RR of fractures. These results emphasize the role of patient education and the necessity for targeted interventions and preventive strategies to mitigate the risk of fracture among affected individuals.

Prcis: Ahmed glaucoma valve (AGV) emerges as a more effective primary procedure compared with trabeculotomy for pediatric glaucoma patients, especially within the first 2 years.

Purpose: To compare the outcomes between initial AGV implantation and trabeculotomy in children with primary congenital glaucoma (PCG).

Patients and methods: This retrospective cohort study was conducted on patients with PCG who underwent either trabeculotomy or AGV implantation between 1998 and 2022 at Soroka University Medical Center. Outcome measures included intraocular pressure (IOP) change, cup-to-disc ratio, corneal clarity, additional surgeries, ocular hypotensive medication use, and the occurrence of adverse events over 36 months of follow-up. Primary success was defined as a postoperative IOP of 5-21 mmHg without additional surgeries or serious sight-threatening complications.

Results: A total of 83 eyes from 55 patients were included: 34 in the AGV group and 49 in the trabeculotomy group. The primary success rate was significantly higher at all time points of the follow-up period in the AGV group compared with the trabeculotomy group ( P =0.014). Trabeculotomy was associated with a significantly higher risk of surgical failure compared with AGV implantation (HR: 3.23; 95% CI: 1.35-7.71; P =0.008). Notably, only 2 eyes in the AGV group underwent additional surgeries, compared with 25 in the trabeculotomy group ( P <0.001).

Conclusions: AGV as an initial procedure seems to be safe and more effective than trabeculotomy for the treatment of PCG in this select population, with fewer additional surgeries.

Prcis: Combination MIGS procedures are a potentially more efficacious method to decrease mean IOP and glaucoma medication burden; however, our findings question whether the addition of ECP to excisional goniotomy provides significant additional benefit.

Purpose: Combined microinvasive glaucoma surgery (MIGS) procedures are gaining popularity. Although the individual efficacy of excisional goniotomy and endoscopic cyclophotocoagulation (ECP) is well established, data supporting their use in combination is lacking. Our study aims to evaluate the additive benefit of ECP to excisional goniotomy with the Kahook Dual Blade (KDB) in the largest patient cohort evaluated to date.

Materials and methods: A retrospective chart review was performed of adults seen at a tertiary eye center between May 2015 and August 2019. Patients who received goniotomy alone were compared with those who received standalone goniotomy and ECP (KDB/ECP), whereas those who received goniotomy and phacoemulsification (KDB/phaco) were compared with those undergoing phacoemulsification, goniotomy, and ECP (PEcK).

Results: A total of 723 eyes were included. All 4 study groups had a decrease in mean IOP at 6, 12, and 24 months (all P <0.05) and a significant decrease in glaucoma medications at 12 months (all P <0.05). When comparing the KDB group to the KDB/ECP group, there were no statistical differences in mean IOP or number of glaucoma medications at any timepoint ( P >0.05 for all). When comparing the KDB/phaco group to the PEcK group there were no statistical differences in mean IOP ( P >0.05 for all) or glaucoma medications at 12 and 24 months. However, only the KDB/ECP and PEcK groups maintained a significant reduction in medications at 24 months.

Conclusions: Both standalone KDB goniotomy with ECP and the PEcK procedure are efficacious at lowering IOP and glaucoma medication burden. Although success rates were not improved, the addition of ECP to KDB goniotomy seems to achieve a more sustained reduction in medication burden compared with goniotomy alone.

Prcis: Quality of life scores in Chinese glaucoma patients were mainly associated with disease severity, measured by patients' visual acuity, stages of visual field defects, and intraocular pressure.

Purpose: To examine the effect of demographic, clinical, and socioeconomic factors on glaucoma patient-reported quality of life (QoL) scores.

Patients and methods: In this cross-sectional study, 1057 consecutive glaucoma patients aged 18 and above were recruited from 34 hospitals across China between November 1, 2022 and December 18, 2022. A smartphone-based survey collected demographic/socioeconomic data and incorporated the Chinese version of the Glaucoma Quality of Life-17 (Glau-QoL-17) questionnaire for patient-reported QoL evaluation. Visual functions (best-corrected visual acuity [BCVA], the higher intraocular pressure [IOP] of both eyes, and the stages of visual field impairment) were assessed by ophthalmic professionals. Multiple linear regression models were constructed to identify predictors for both overall and subscale QoL scores. Least Absolute Shrinkage and Selection Operator (LASSO) analysis was used to screen the most influential factors for the overall QoL score.

Results: The median (interquartile range) QoL score was 57 (49-65). BCVA and the stage of visual field defects of the better eye, the higher IOP reading between both eyes, the employment status, and the city tier of residence were independent predictors for QoL after adjusting for age, sex, education level, and comorbidities. LASSO analysis additionally identified primary open angle glaucoma and combined surgical and pharmacological treatment as one of the most influential factors affecting QoL. Clinical factors explained the largest variation in the multiple linear regression model.

Conclusions: QoL of glaucoma patients is primarily determined by clinical indices. Unemployment is also an important correlate of low QoL among glaucoma patients.

Prcis: The area corresponding to the peripheral visual field in the primary visual cortex of the brain is associated with ophthalmologic parameters.

Purpose: Reproducing the relationship of the visual field with the primary visual cortex is known as retinotopic mapping. The primary visual cortex is known to be atrophic in glaucoma patients. However, there are few reports on which areas most reflect glaucomatous changes. In this study, we used magnetic resonance imaging to evaluate the relationship between various ophthalmic parameters and overall and regional structural changes in the primary visual cortex to better understand changes in the brain associated with glaucoma.

Materials and methods: Twelve healthy subjects [56.1±9.3 y old, male to female ratio 6:6, mean deviation (MD) 0.6±0.7 dB] and 23 patients with glaucoma (57.8±8.0 y old, male to female ratio 8:15, MD: -10.2±6.4 dB) were enrolled. We acquired 3D-T1-weighed images to measure the overall and regional gray matter density of the visual cortex based on a priori retinotopic projection. Optical coherence tomography and visual field testing were performed, and a weighted count of retinal ganglion cells (wRGC) was calculated from the ophthalmological tests. The Spearman rank correlation coefficient was used for evaluating the correlations between these structural parameters of the visual cortex and the ophthalmological parameters.

Results: The overall primary visual cortex was positively correlated with MD ( r =0.40, P =0.02) and wRGC ( r =0.41, P =0.02). Regarding retinotopic projection, the inner area in the visual cortex, which corresponds to the peripheral visual field, was positively correlated with MD and wRGC.

Conclusion: The inner part of the primary visual cortex, which corresponds to the peripheral visual field, is closely correlated with ophthalmologic parameters commonly used for diagnosing and detecting the progression of glaucoma clinically. This suggests that evaluation of this area with MRI may be of clinical use in glaucoma assessment and monitoring.

Precis: Both Gonioscopy-assisted transluminal trabeculotomy and ab externo visco circumferential suture trabeculotomy reduced the intraocular pressure in primary congenital glaucoma by more than 50% from baseline at 2 years. There were no serious adverse events.

Purpose: Primary congenital glaucoma (PCG) is a severe form of glaucoma that presents in infancy and requires surgical intervention to prevent irreversible vision loss. Angle-based surgery is the primary treatment for PCG, with recent reports suggesting promising outcomes for gonioscopy-assisted transluminal trabeculotomy (GATT) in children with PCG. Ab externo visco circumferential suture trabeculotomy (AVCST) offers the advantages of combining the efficacy of 360-degree circumferential trabeculotomy through low-cost Prolene sutures with the facilitation of the Schlemm's canal (SC) cannulation using viscoelastic.

Methods: This retrospective interventional study compared the 1-year outcomes of GATT and AVCST in managing PCG. The records of 65 eyes of 39 children who underwent surgery for their PCG were reviewed.

Results: The key outcome measures included reduction of intraocular pressure (IOP), the success rate, and surgical complications. At 2 years, both surgical techniques demonstrated significant IOP reduction from baseline (GATT: mean reduction of 15.33±2.56 mmHg; AVCST: mean reduction of 15.96±2.95 mmHg) but there was no statistical difference between both groups at 2 years ( P =0.371). The complete success rate, defined as an IOP ≤16 mmHg with > 30% reduction from the baseline without antiglaucoma medications (AGMs) or further surgical interventions, was 87.1% for the GATT and 85.3% for the AVCST, which was not statistically significant between the 2 groups ( P =0.710). The complication rates were comparable between the 2 groups, with transient hyphaema being the most common adverse event.

Conclusions: Our findings indicate that GATT and AVCST are both effective and safe surgical options for PCG, with similar efficacy and complication profiles after 2 years. Further long-term studies are warranted to assess the durability of these outcomes.

Prcis: This study demonstrates the effectiveness of filtration surgery in preserving the central visual field in eyes showing open angle glaucoma with high myopia, highlighting the necessity of intraocular pressure reduction ≥30% for optimal outcomes.

Purpose: To evaluate the efficacy of filtration surgery in preserving the central visual field (VF) in eyes with open angle glaucoma (OAG) and high myopia (HM) and identify postoperative intraocular pressure (IOP) targets and factors associated with targeted IOP reduction.

Methods: This retrospective cohort study included 55 eyes (48 patients) with OAG and HM who underwent filtration surgery and were followed up for minimum 3 years. Preoperative and postoperative IOP values, mean deviation (MD) values, and MD slopes from Humphrey 10-2 VF tests were assessed. Participants were categorized according to the postoperative MD slope (>-0.5 dB/y or ≤-0.5 dB/y) to evaluate surgical success, defined as IOP reduction of ≥20%, ≥30%, or ≥40% from baseline. Predictors of targeted IOP reduction were identified.

Results: Significant postoperative IOP reductions were observed at all time points ( P <0.001). The mean MD slope improved from -1.53±0.91 to -1.00±1.40 dB/year ( P =0.001). Eyes with MD slope ≤-0.5 dB/year had a longer axial length (AL; P =0.048), more needling procedures ( P =0.003), and higher postoperative IOP at 1 and 2 years ( P <0.001, 0.021, respectively). Surgical success rates (IOP reduction ≥30% and ≥40%) were higher for eyes with MD slope >-0.5 dB/year ( P =0.006, 0.003), with no significant difference for IOP reduction ≥20% ( P =0.087). To achieve postoperative MD slope >-0.5 dB/year, minimum 30% IOP reduction was required. If AL was >28.01 mm, 40% IOP reduction was required. AL and needling procedure frequency were significantly associated with IOP reduction ≥30% (odds ratio=1.79 and 2.26; P =0.018 and 0.039, respectively).

Conclusions: Substantial IOP reduction is essential for preserving the central visual field in eyes with OAG and HM, particularly those with AL ≥28.01 mm. Longer AL and frequent needling procedures increase the surgical failure risk.

Precis: Non-pupillary block mechanisms are associated with larger postoperative peripheral anterior synechiae (PAS) extent at 1-year follow-up compared to pupillary block mechanisms in primary angle-closure disease (PACD).

Purpose: To evaluate the impact of preoperative angle-closure mechanisms on surgical outcomes of phacoemulsification and intraocular lens implantation (PEI) combined with VGP in PACD patients with cataracts.

Patients and methods: This prospective cohort study enrolled 56 patients (68 eyes) with PACD and cataracts. Participants were classified into pupillary block (PB) and non-pupillary block (Non-PB) groups based on the anatomical characteristics of angle closure shown in preoperative ultrasound biomicroscopy imaging. Primary outcomes included peripheral anterior synechiae (PAS) extent, intraocular pressure (IOP), and number of IOP-lowering medications over a 12-month follow-up period.

Results: Both groups showed significant reductions in PAS extent at the end of surgery compared to the baseline. At 6 and 12 months postoperatively, the Non-PB group exhibited significantly larger PAS extent compared to the PB group (P=0.025 and P=0.017, respectively). Both groups demonstrated significant IOP reduction and decreased use of IOP-lowering medications postoperatively, with no significant differences between groups. The overall complete and qualified success rates at 12 months were 71.6% and 98.5%, respectively, with no significant difference between groups.

Conclusions: Non-PB mechanisms are associated with larger postoperative PAS extent at 1-year follow-up compared to PB mechanisms, emphasizing the importance of comprehensive preoperative angle-closure mechanisms assessment in predicting and potentially minimizing PAS progression for enhanced long-term surgical efficacy in PACD treatment.

Prcis: Intraocular pressure measured by Goldmann applanation tonometry, central corneal thickness, and history of cataract surgery are factors in the discrepancies in intraocular pressure measurements between the iCare IC200 rebound tonometer and the Goldmann applanation tonometer.

Purpose: To investigate the factors affecting the discrepancies in intraocular pressure (IOP) measurements between the iCare IC200 rebound tonometer (RBT) and the Goldmann applanation tonometer (GAT).

Materials and methods: The IOP was measured sequentially using RBT followed by GAT. Bland-Altman analysis was used to determine the agreement between the RBT and GAT. Eyes were classified into 3 groups based on the difference calculated as RBT minus GAT: group A (-1 to 1 mm Hg), group B (≥3 mm Hg), and group C (≤-3 mm Hg). Logistic regression analysis was performed to identify the factors associated with the measurement discrepancies.

Results: A total of 402 right eyes were included in the study. The RBT and GAT measurements were significantly correlated (Spearman r =0.885, P <0.001). The mean IOP differences between the RBT and GAT were 0.114±2.13 mm Hg (range: -7 to 8, 95% limit of agreement: -4.06 to 4.29 mm Hg). Multivariate logistic analyses revealed that greater central corneal thickness (CCT) ( P =0.002) was significantly associated with overestimation of IOP by RBT relative to GAT. We found that underestimated IOP by RBT relative to GAT in patients with higher GAT-measured IOP ( P =0.002) and those with a history of cataract surgery ( P =0.006).

Conclusions: RBT tends to overestimate IOP relative to GAT in patients with thicker CCTs, while it underestimates IOP in those with higher GAT-measured IOP or a history of cataract surgery.

Prcis: Larger choriocapillaris microvasculature dropout area and wider angular circumference are significantly associated with 24-2C central visual field damage in primary open angle glaucoma eyes with and without axial myopia.

Purpose: To evaluate the relationship between a juxtapapillary choriocapillaris microvasculature dropout (MvD) and central visual field (VF) damage in primary open angle glaucoma (POAG) patients with or without axial myopia.

Methods: This cross-sectional study included 125 patients with POAG or glaucoma suspects stratified into no axial myopia (axial length (AL) ≤24 mm; 46 eyes), mild axial myopia (24 mm < AL ≤26 mm; 81 eyes), and high axial myopia (AL >26 mm; 59 eyes). Presence, area, and angular circumference of juxtapapillary MvD were evaluated on OCT-A en-face choroidal images and B-scans. Perimetry was conducted using the 24-2C and 10-2 Humphrey program.

Results: Mean 24-2C VF mean deviation was significantly worse in eyes with MvD compared with eyes without MvD across all groups (all P <0.042). Central VF defects detected in the 24-2C and 10-2 VF tests were significantly more prevalent among eyes with MvD (68.3% and 81.7%, respectively) compared with eyes without MvD (19.0% and 38.1%, respectively) ( P <0.001) in the mild axial myopia group. In multivariable analysis, larger MvD area ( P =0.014) and wider MvD angular circumference ( P =0.006) were significantly associated with higher likelihood of the presence of 24-2C central VF damage in overall cohort.

Conclusions: MvD area and angular circumference are significantly associated with central VF damage detected by VF 24-2C in POAG eyes with and without axial myopia. Choriocapillaris MvD assessment shows promise for identifying POAG patients with a higher risk of having central VF defects and may provide clinical insights into the pathogenesis of glaucoma in myopia.