Ophthalmology. Glaucoma最新文献

{"title":"Assessing Agreement of Intraocular Pressure from Four Mechanistically Different Tonometers in the Eye Dynamics and Engineering Network Clinical Trial","authors":"Max Liu BS ,&nbsp;David M. Reed PhD ,&nbsp;Shan Fan MD ,&nbsp;Arash Kazemi MD ,&nbsp;Vikas Gulati MD, PhD ,&nbsp;Arthur J. Sit SM, MD ,&nbsp;Sayoko E. Moroi MD, PhD ,&nbsp;Carol B. Toris PhD","doi":"10.1016/j.ogla.2025.07.010","DOIUrl":"10.1016/j.ogla.2025.07.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the measurements of intraocular pressure (IOP) by four mechanistically different tonometers in healthy participants from the Eye Dynamics and Engineering Network Aqueous Humor Dynamics clinical trial using the mean difference estimation, equivalence statistics, and adjusting for proparacaine’s effects on IOP.</div></div><div><h3>Design</h3><div>Multicenter open-label clinical trial in healthy adults (NCT01677507).</div></div><div><h3>Participants</h3><div>Enrolled were 122 participants (55.2 ± 8.8 years; 92 women and 30 men), 121 of which had measurements with and without proparacaine.</div></div><div><h3>Methods</h3><div>Participants from 3 sites had their IOPs measured with iCare rebound tonometer (RT), ocular response analyzer corneal-compensated (CC), pneumatonometer (PN), and Goldmann applanation tonometer (GAT). Intraocular pressure readings with RT and CC were collected with and without proparacaine.</div></div><div><h3>Main Outcome Measures</h3><div>Effect sizes and agreement in IOP measurements from the four tonometers was analyzed with Data analysis using Bootstrap-Coupled ESTimation, Bland–Altman Limits of Agreement (LoAs), Lin's concordance correlation coefficient (CCC), and robust equivalence two 1-sided t-tests in tandem with null hypothesis significance testing. Data analysis using bootstrap-Coupled ESTimation was used to analyze differences in IOP readings from RT and CC before and after administering proparacaine.</div></div><div><h3>Results</h3><div>Data analysis using Bootstrap-Coupled ESTimation, LoA, and CCC showed greatest effect size and poorest agreement between PN and the other tonometers. The lowest mean difference was seen when comparing GAT and CC. However, LoA and CCC found the strongest agreement between RT and GAT. Two 1-sided tests revealed tonometers can be considered equivalent to one another at ± 2 mmHg, except for PN. After applying proparacaine, IOP decreased significantly (<em>P</em> &lt; 0.0001) by RT (1.2 ± 1.9 mmHg right eye [OD]; 1.1 ± 1.7 mmHg left eye [OS]), and CC (1.4 ± 1.8 mmHg OD; 1.3 ± 2.3 mmHg OS).</div></div><div><h3>Conclusions</h3><div>When adjusted for proparacaine’s effect on IOP, 3 tonometers were equivalent between each other when determined by equivalence statistical testing with equivalence bounds ± 2 mmHg. The PN reads &gt;2 mmHg higher than RT, CC, or GAT. Therefore, when comparing IOP data from different tonometers, one should consider that not all tonometer measurements are interchangeable and the proparacaine effect should be considered.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 126-134"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the Feasibility of Accelerating Glaucoma Clinical Trials Using Portable Perimetry","authors":"Jeremy C.K. Tan MD ,&nbsp;Giovanni Montesano MD, PhD ,&nbsp;Jonathan Crowston MBBS, PhD ,&nbsp;Katharina Bell MD, PhD ,&nbsp;David P. Crabb PhD ,&nbsp;Pete R. Jones PhD","doi":"10.1016/j.ogla.2025.08.004","DOIUrl":"10.1016/j.ogla.2025.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To model whether more frequent (weekly, monthly) visual field (VF) assessments using portable “home” perimetry might more quickly detect glaucoma progression in a clinical trial context.</div></div><div><h3>Design</h3><div>Cross-sectional with additional simulations</div></div><div><h3>Participants</h3><div>Forty patients (78 eyes; n = 21 healthy, n = 16 glaucoma suspects, n = 41 manifest glaucoma).</div></div><div><h3>Methods</h3><div>Participants performed an interleaved sequence of 2 portable (Eyecatcher v3.0; EC3) and 2 reference (Humphrey Field Analzyer [HFA] SITA-Fast) VF tests (4 tests total per eye). Linear mixed modeling was then applied to one randomly selected eye per patient to mathematically predict the expected proportion of progressors detected by EC3/HFA over a 3-year period, given different testing regimens (from weekly to every 4 months), levels of variability, and underlying rates of true progression.</div></div><div><h3>Main Outcome Measures</h3><div>Test–retest variability and proportion of progressors detected.</div></div><div><h3>Results</h3><div>The portable perimeter was significantly less reliable: the Bland–Altman 95% coefficient of repeatability for mean deviation (<span><math><mrow><msubsup><mtext>CoR</mtext><mtext>MD</mtext><mrow><mn>95</mn><mo>%</mo></mrow></msubsup></mrow></math></span>) was 6.37 dB for EC3 and 4.25 dB for the HFA. Statistical simulations, however, predicted that this lower reliability would be offset by more frequent testing. Thus, modeling indicated one EC3 test per month would detect a higher proportion of slow (–0.5 dB/year), moderate (–1 dB/year), and fast (–2 dB/year) progressors compared to one HFA test every 4 months. Implications for trial sample sizes were also modeled, with the number of participants required to evidence a 20% reduction in baseline progression over 2 years (following a hypothetical intervention) predicted to decrease by 24.3%/36.3% with the addition of monthly/fortnightly home testing. There was no significant difference in mean test duration between the EC3 and HFA (226 vs. 225 seconds, <em>P</em> = 0.78), and participants rated the EC3 as somewhat easier to use (system usability scale; <em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>Home VF assessments, despite poorer reliability than current reference standard (“in-clinic”) devices, would allow faster or greater detection of glaucoma progression via an increased frequency of testing, and could reduce the sample size requirements of future clinical trials. Implications on duration, access and overall cost are discussed.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 106-116"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widefield OCT Angiography and Euclidian Distance Analysis of Microvascular Deficits in Glaucomatous Eyes","authors":"Diogo F. Muller MD,&nbsp;Yingying Shi MD,&nbsp;Maria J. Chaves-Samaniego MD,&nbsp;Khushali Shah MD,&nbsp;Gustavo Rosa Gameiro MD, PhD,&nbsp;Giovanni Gregori MD, PhD,&nbsp;Steven J. Gedde MD,&nbsp;Luis E. Vazquez MD, PhD","doi":"10.1016/j.ogla.2025.08.010","DOIUrl":"10.1016/j.ogla.2025.08.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To evaluate superficial microvascular deficits of glaucomatous eyes with widefield OCT angiography (OCTA) and Euclidian distance (ED) analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Cross-sectional study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;div&gt;Swept-source OCTA (SS-OCTA) images of healthy and glaucomatous eyes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Twelve-by-twelve mm scans of healthy and glaucomatous eyes were acquired with SS-OCTA (PLEX Elite 9000, ZEISS). The en face images of the superficial retina segmentation were exported and analyzed with ImageJ software. A fixed threshold that predicted the size of the foveal avascular zone was used to generate binarized images with vascular (white) or deficient (black) pixels. Four vascular parameters were measured within a macula-centered 9 × 10.8 mm ellipse: vascular density (VD), average ED (ED&lt;sub&gt;&lt;em&gt;avg&lt;/em&gt;&lt;/sub&gt;), maximum ED (ED&lt;sub&gt;&lt;em&gt;max&lt;/em&gt;&lt;/sub&gt;), and nonperfusion density (NPD). Euclidian distance values were visualized with a heatmap color scale. The vascular parameters were compared between healthy and glaucomatous eyes (Student t-test). Person coefficients were calculated to test correlations between the vascular parameters and retinal nerve fiber layer (RNFL) thickness, macular ganglion cell and inner plexiform layer (GCIPL) thickness, and visual field mean deviation in glaucomatous eyes. &lt;em&gt;P&lt;/em&gt; &lt; 0.05 was considered significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Vascular density, ED&lt;sub&gt;&lt;em&gt;avg&lt;/em&gt;&lt;/sub&gt;, ED&lt;sub&gt;&lt;em&gt;max&lt;/em&gt;&lt;/sub&gt;, and NPD&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Forty glaucomatous and twenty-five healthy eyes were included. Vascular density (fraction) was 0.442 ± 0.029 vs 0.320 ± 0.072 (&lt;em&gt;P&lt;/em&gt; &lt; 0.001), ED&lt;sub&gt;&lt;em&gt;avg&lt;/em&gt;&lt;/sub&gt; (μm) was 17.37 ± 0.55 vs 32.62 ± 9.54 (&lt;em&gt;P&lt;/em&gt; &lt; 0.001), ED&lt;sub&gt;&lt;em&gt;max&lt;/em&gt;&lt;/sub&gt; (μm) was 153.7 ± 49.1 vs 248.5 ± 156.6 (&lt;em&gt;P&lt;/em&gt; = 0.005), and NPD (%) was 0.97 ± 0.82 vs 7.09 ± 5.99 (&lt;em&gt;P&lt;/em&gt; &lt; 0.001) in healthy vs glaucomatous eyes. Vascular density, ED, and NPD were better in optic nerve head sectors than in temporal macula and retinal periphery sectors in both groups, but were worse in the glaucoma group across all sectors of the ellipse (&lt;em&gt;P&lt;/em&gt; &lt; 0.01 for all sectors). Microvascular deficits in glaucomatous eyes often exceeded structural and functional glaucomatous damage, and there was modest correlation between the vascular and structural or functional parameters. Pearson ρ of the correlation with average RNFL and GCIPL were highest for VD (ρ = 0.46, &lt;em&gt;P&lt;/em&gt; = 0.002 and ρ = –0.49, &lt;em&gt;P&lt;/em&gt; = 0.001, respectively) and lowest for ED&lt;sub&gt;&lt;em&gt;max&lt;/em&gt;&lt;/sub&gt; (ρ = –0.19, &lt;em&gt;P&lt;/em&gt; = 0.24 and ρ = –0.23, &lt;em&gt;P&lt;/em&gt; = 0.16, respectively).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Vascular density, ED, and NPD were worse in glaucomatous compared to healthy eyes throughout the widefield OCTA image. High ED and NPD values accentuate regions of inadequate perfusion.&lt;/div&gt;&lt;/","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 117-125"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Likelihood of Corneal Transplantation after Tube versus Trabeculectomy","authors":"Anna Marie Dickinson MD ,&nbsp;Luke Leidy ,&nbsp;Md Enamul Haque PhD ,&nbsp;Helene Lam MD ,&nbsp;Kuldev Singh MD ,&nbsp;Ann Caroline Fisher MD ,&nbsp;Bethlehem Mekonnen MD ,&nbsp;Suzann Pershing MD, MS","doi":"10.1016/j.ogla.2025.09.001","DOIUrl":"10.1016/j.ogla.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>Utilization of glaucoma drainage devices (tube shunts) has increased. In this analysis we evaluate long-term likelihood and time-to-event for corneal transplantation after trabeculectomy versus tube shunt glaucoma surgeries.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>American Academy of Ophthalmology IRIS® Registry (Intelligent Research In Sight) patients who underwent glaucoma surgery between 2001 and 2021.</div></div><div><h3>Methods</h3><div>Patients with glaucoma who underwent isolated trabeculectomy, isolated tube shunt, or both surgeries in a given eye were identified by procedure codes. Subsequent corneal transplantation procedures performed in the same eye were similarly identified. Multivariable Cox proportional hazard regression models were used to evaluate the likelihood of corneal transplantation and time from first glaucoma surgery to corneal transplantation.</div></div><div><h3>Main Outcome Measures</h3><div>Hazard ratios and 95% confidence intervals (CIs) for corneal transplantation.</div></div><div><h3>Results</h3><div>We identified 246 521 eyes among 197 910 patients with glaucoma surgery meeting study inclusion criteria. Corneal transplantation was most frequently observed among patients who previously underwent both trabeculectomy and tube shunt (5.00%, n = 672), followed by isolated tube shunt (2.97%, n = 3473) and isolated trabeculectomy (0.80%, n = 929). Eyes that only underwent tube shunts had a mean time to corneal transplantation of 2.49 years (standard deviation [SD], 2.4), compared with 3.75 years (SD, 3.3) for isolated trabeculectomy eyes and 3.21 years (SD, 2.6) for eyes that received both trabeculectomy and tube shunt. Adjusted likelihood of corneal transplantation was highest with both trabeculectomy and tube shunt (hazard ratio [HR], 5.88; 95% CI, 5.34–6.48), and isolated tube shunt (HR, 3.97; 95% CI, 3.69–4.26), compared with isolated trabeculectomy.</div></div><div><h3>Conclusions</h3><div>The likelihood of corneal transplantation is over 4 times higher after tube shunts compared with trabeculectomies. This may reflect factors such as chronic, cumulative corneal endothelial mechanical trauma from the tube shunt, changes to aqueous humor fluid circulation, altered aqueous humor composition and associated signaling pathways, differences in use of antimetabolites as adjunctive therapy, tube material, and tube movement or migration over time. Further research is needed to understand causes of corneal compromise, and consideration of corneal health is warranted in glaucoma surgical decision-making.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 1-14"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Figueroa et al.: Association of blood pressure and retinal nerve fiber layer rates of thinning in patients with moderate to advanced glaucoma (Ophthalmol Glaucoma. 2025;8:285–292)","authors":"Parth Aphale PhD,&nbsp;Himanshu Shekhar BHMS,&nbsp;Shashank Dokania BHMS","doi":"10.1016/j.ogla.2025.09.005","DOIUrl":"10.1016/j.ogla.2025.09.005","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Page e1"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrastromal Fluid Cavity in Corneal Hydrops Secondary to Congenital Glaucoma","authors":"Marie Michele Macaron MD,&nbsp;Ta Chen Peter Chang MD","doi":"10.1016/j.ogla.2025.09.008","DOIUrl":"10.1016/j.ogla.2025.09.008","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Page e3"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Classification of Visual Field Defects in Early Glaucoma","authors":"Jeremy C.K. Tan MD, FRANZCO ,&nbsp;Jack Phu PhD","doi":"10.1016/j.ogla.2025.09.010","DOIUrl":"10.1016/j.ogla.2025.09.010","url":null,"abstract":"<div><h3>Objective</h3><div>While qualitative visual field (VF) grading systems enable the classification and description of VF defects in glaucoma, they may be prone to subjective interpretation and interobserver disagreement. In this study, we characterize the types and frequencies of VF defects in a large cohort of subjects with early glaucomatous loss, using a quantitative method based on the Ocular Hypertension Treatment Study (OHTS) VF classification system.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Subjects</h3><div>One thousand three hundred thirty eyes of 733 subjects with healthy, suspect or early glaucoma.</div></div><div><h3>Methods</h3><div>We translated the OHTS system into an objective, quantitative method to classify the VF of each eye into nerve fiber bundle (bundle) and nonbundle defects comprising 14 patterns. This was applied to VF tests from subjects who received two 24-2 Swedish Interactive Thresholding Algorithm-Faster VF tests per eye on the same visit.</div></div><div><h3>Main Outcome Measures</h3><div>Distribution of initial and repeatable VF patterns across cohort and the relationship with mean deviation (MD) and test reliability.</div></div><div><h3>Results</h3><div>The mean baseline MD and pattern standard deviation (SD) was –1.08 (SD, 1.83) and 2.26 (SD, 1.26), respectively. The most common repeatable pattern was the inferior nasal step (22.6%), followed by the inferior enlarged blind spot (19.1%), superior nasal step (12.6%), and superior enlarged blind spot (11.6%). The frequency of occurrence of initial defects was significantly higher than repeatable defects for the majority of patterns. The frequency of nasal step defects decreased as MD worsened, with a corresponding increase in the frequency of arcuate defects. There was a consistently higher frequency of bundle and nonbundle defects in unreliable versus reliable tests based on a false-positive rate above 15%, including an inferior enlarged blind spot (30.0% vs. 20.8%, <em>P</em> &lt; 0.001), superior central defect (13.7% vs. 5.5%, <em>P</em> &lt; 0.001), and partial superonasal quadrant (14.4% vs. 7.2%, <em>P</em> &lt; 0.001) defects.</div></div><div><h3>Conclusions</h3><div>In a large cohort of suspect and early glaucoma, the most common VF defects were nasal step, enlarged blind spot and arcuate defects, with a significant difference in distribution between initial versus repeatable defects and reliable versus unreliable tests. Application of quantitative criteria may improve the accuracy and consistency of classifying VF defects.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 96-105"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in Primary Congenital Glaucoma, 2011–2023","authors":"Anil K. Mandal MD ,&nbsp;Vijaya K. Gothwal PhD ,&nbsp;Mohammed Hasnat Ali PhD","doi":"10.1016/j.ogla.2025.07.005","DOIUrl":"10.1016/j.ogla.2025.07.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the clinical outcomes in patients with primary congenital glaucoma (PCG) managed over a period of 13 years.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>One thousand one hundred fifty eyes of 704 patients undergoing surgery for PCG between January 2011 and December 2023 with a minimum follow-up of 6 months.</div></div><div><h3>Methods</h3><div>Medical records of children with PCG were reviewed, and demographic and clinical data were collected. Patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C (MMC) as an initial procedure were included (<em>n</em> = 1128 eyes). Complete success was defined as intraocular pressure (IOP) ≥ 6 mmHg and ≤ 16 mmHg without glaucoma medications and qualified success when 1 glaucoma medication was required. Failure was defined as uncontrolled IOP with more than 1 glaucoma medication, need for repeat surgery, chronic hypotony (IOP &lt; 6 mmHg on 2 consecutive visits at 1 month interval) or any sight-threatening complications.</div></div><div><h3>Main Outcome Measures</h3><div>Intraocular pressure control, number of glaucoma medications, visual acuity (VA), and success rate.</div></div><div><h3>Results</h3><div>The mean age of patients at first surgery was 23.1 (standard deviation [SD]: 44.7) months (range, 9 days to 233 months; median, 5 months) and mean follow-up was 60.1 (SD: 49.6) months. Infantile-onset PCG was the most common form (61%) of presentation. Primary CTT without MMC was performed in 1128 eyes (98.1%). Complete success rate was 85.9%, 69.7%, and 37.8%, at the 1st, 5th, and 10th year, respectively. The corresponding complete plus qualified success rate was 98.2%, 93.3%, and 84.1%, respectively. Overall, infantile-onset PCG showed better success rates than other 2 groups. There was a significant reduction in IOP at last follow-up (43.4%; <em>P</em> &lt; 0.0001). Preoperatively, majority of eyes (<em>n</em> = 937; 81.5%) were using glaucoma medications, whereas at last follow-up, 388 eyes (41.4%) required medications (<em>P</em> &lt; 0.0001). Of the 690 eyes (60%) that presented with corneal edema, 622 eyes (90%) had clear cornea at last follow-up (<em>P</em> &lt; 0.0001). At last follow-up, 190 eyes (23.1%) had VA of ≥20/40. Multivariate Cox proportional hazards analysis revealed level of IOP and corneal diameter to be independent risk factors for poor surgical outcome.</div></div><div><h3>Conclusions</h3><div>Our large cohort study treated by CTT without MMC is encouraging and may be considered as the initial surgical procedure in PCG. The outcomes were more favorable in children with infantile-onset PCG.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 62-74"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ab-Externo MicroShunt vs. Trabeculectomy in Primary Open-Angle Glaucoma","authors":"Joseph F. Panarelli MD ,&nbsp;Marlene R. Moster MD ,&nbsp;Julian Garcia-Feijoo MD, PhD ,&nbsp;Brian E. Flowers MD ,&nbsp;N. Douglas Baker MD ,&nbsp;Howard S. Barnebey MD ,&nbsp;Davinder S. Grover MD, MPH ,&nbsp;Michael C. Stiles MD ,&nbsp;James D. Brandt MD ,&nbsp;Henny J.M. Beckers MD, PhD ,&nbsp;Nicholas G. Strouthidis MD, PhD","doi":"10.1016/j.ogla.2025.08.009","DOIUrl":"10.1016/j.ogla.2025.08.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the long-term safety of MicroShunt implantation with trabeculectomy in eyes with primary open-angle glaucoma.</div></div><div><h3>Design</h3><div>A 3-year observational extension of a 2-year prospective randomized trial.</div></div><div><h3>Participants</h3><div>The extension study enrolled 279 patients (217 MicroShunt, 62 trabeculectomy), with 256 (198 and 58, respectively) completing the month 60 visit.</div></div><div><h3>Methods</h3><div>This trial compared clinical outcomes of MicroShunt implantation with trabeculectomy, both augmented with mitomycin C. Adverse events (AEs), intraocular pressure (IOP), and IOP-lowering medication use were recorded 36, 48, and 60 months after initial randomization.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the cumulative incidence of sight-threatening AEs. Secondary outcomes included all other AEs/complications, secondary interventions, and reductions in IOP and number of glaucoma medications.</div></div><div><h3>Results</h3><div>Rates of sight-threatening AEs were 2% (n = 4) in the MicroShunt group and 0% in the trabeculectomy group, with 1 eye each in the MicroShunt group having central retinal artery occlusion, choroidal hemorrhage (after placement of a glaucoma drainage device), progressive endothelial cell loss, and pseudophakic bullous keratopathy. Only 2 of the 4 sight-threatening AEs in the MicroShunt group were deemed related to the study device or procedure. Four eyes in the MicroShunt group experienced device erosion through the conjunctiva. Increased IOP requiring treatment was more frequent (26% vs. 8%, <em>P</em> = 0.0017), whereas hypotony (3% vs. 13%, <em>P</em> = 0.038), epiretinal membrane formation (2% vs. 8%; <em>P</em> = 0.028), and blepharoptosis (4% vs. 11%, <em>P</em> = 0.048) were less frequent in the MicroShunt group. Four patients in the trabeculectomy group required surgical revision for hypotony. Changes in endothelial cell density were similar in the MicroShunt (–19% ± 22%) and trabeculectomy (–19% ± 22%) groups, with a mean between-group difference of 0.1% (<em>P</em> = 0.98). In the mean ± standard deviation, IOP was reduced from 20.8 ± 4.9 mmHg at baseline to 14.2 ± 4.1 mmHg at month 60 in MicroShunt eyes (mean reduction, 5.5 mmHg [26%]) and from 20.1 ± 3.9 mmHg to 10.4 ± 3.7 mmHg in trabeculectomy eyes (mean reduction, 9.1 mmHg [45%]), with a between-group difference of –4.6 mmHg (<em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Both filtering procedures demonstrated favorable safety profiles over 5 years. Most AEs through 5 years did neither necessitate reoperation nor result in vision-threatening complications.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 37-47"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Follow-Up on a Juvenile Open-Angle Glaucoma Pedigree with a Novel EFEMP1 Mutation (c.1313, p.Tyr438Cys)","authors":"Brian P. Young BS ,&nbsp;Angela W. Nyunt BS ,&nbsp;Molly A. Clymer OD ,&nbsp;Mallory R. Tollefson PhD ,&nbsp;Ben R. Roos BS ,&nbsp;Michael J. Schnieders PhD ,&nbsp;Alan L. Robin MD ,&nbsp;John H. Fingert MD, PhD","doi":"10.1016/j.ogla.2025.08.003","DOIUrl":"10.1016/j.ogla.2025.08.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Determine the genetic cause of glaucoma in a juvenile open-angle glaucoma (JOAG) pedigree of European ancestry.</div></div><div><h3>Design</h3><div>Case series or pedigree analysis</div></div><div><h3>Participants</h3><div>A three-generation JOAG pedigree</div></div><div><h3>Methods</h3><div>We obtained clinical data and tested DNA for mutations in known JOAG-causing genes with Sanger sequencing for <em>MYOC</em> and whole exome sequencing for <em>EFEMP1</em>. We assessed identified mutations for pathogenicity by (1) frequency in control databases; (2) mutation analysis algorithms; (3) homology analyses; and (4) structural modeling of mutational effects on encoded proteins.</div></div><div><h3>Main Outcome Measures</h3><div>Detection of a mutation that is coinherited with glaucoma in the JOAG pedigree. Secondary measures include descriptions of glaucoma phenotype (age at presentation, maximum intraocular pressure [IOP], progression rate, and response to therapy).</div></div><div><h3>Results</h3><div>Clinical data from an average follow-up of 11.5 ± 7.05 years were available from four family members with JOAG. Members of this pedigree had a mean age of diagnosis of 32.5 ± 8.6 years (range 25–43 years) and a mean maximum treated IOP of 32.3 ± 12.0 (range 16–50) mmHg. Family members had visual field progression ranging from –0.25 to –1.1 dB/year and required an average of 1.8 ± 1.0 incisional glaucoma surgeries per eye for IOP control. No <em>MYOC</em> mutations were detected. A heterozygous missense mutation (c.1313A&gt;G, p.Tyr438Cys) was detected in the <em>EFEMP1</em> gene in all four family members with JOAG and is absent from control subjects. The p.Tyr438Cys mutation altered a highly conserved amino acid and was predicted to be pathogenic by 6 mutation analysis algorithms. Modeling of the p.Tyr438Cys mutation indicated it causes structural changes to <em>EFEMP1</em> protein that are likely detrimental to its function.</div></div><div><h3>Conclusions</h3><div>This study identifies a novel mutation, p.Tyr438Cys, as the first known glaucoma-causing <em>EFEMP1</em> mutation in a JOAG pedigree of European ancestry. Patients with the <em>EFEMP1</em> mutation p.Tyr438Cys have an early-onset severe glaucoma phenotype with high maximum IOPs that require surgical interventions and may have rapid progression. These data underscore the severity of this type of JOAG and the need for further research into its pathogenic mechanisms and therapeutic management.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 1","pages":"Pages 75-85"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}