Ophthalmology. Glaucoma最新文献

{"title":"Assessment of Remote Training, At-Home Testing, and Test-Retest Variability of a Novel Test for Clustered Virtual Reality Perimetry","authors":"Zer Keen Chia MD ,&nbsp;Alan W. Kong MD ,&nbsp;Marcus L. Turner MD ,&nbsp;Murtaza Saifee MD ,&nbsp;Bertil E. Damato MD, PhD ,&nbsp;Benjamin T. Backus PhD ,&nbsp;James J. Blaha ,&nbsp;Joel S. Schuman MD ,&nbsp;Michael S. Deiner MD ,&nbsp;Yvonne Ou MD","doi":"10.1016/j.ogla.2023.08.006","DOIUrl":"10.1016/j.ogla.2023.08.006","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the feasibility of remotely training glaucoma patients to take a 10-session clustered virtual reality (VR) visual field (VF) test (Vivid Vision Perimetry [VVP-10]) at home, analyze results for test-retest variability, and assess correspondence with conventional perimetry.</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Subjects</h3><p>Twenty-one subjects with glaucoma were enrolled and included in the feasibility assessment of remote training. Thirty-six eyes were used for test-retest analysis and determination of concordance with the Humphrey Field Analyzer (HFA).</p></div><div><h3>Methods</h3><p>Subjects were provided with a mobile VR headset containing the VVP-10 test software and trained remotely via video conferencing. Subjects were instructed to complete 10 sessions over a 14-day period.</p></div><div><h3>Main Outcome Measures</h3><p>Feasibility was determined by the number of subjects who were able to independently complete VVP-10 over the 14-day period after 1 remote training session. The intraclass correlation coefficient (ICC) for average fraction seen across 10 sessions and the standard error (SE) of the mean were primary outcome measures for assessing test-retest variability. Correlation with HFA mean sensitivity (MS) across eyes, was a secondary outcome measure.</p></div><div><h3>Results</h3><p>Twenty subjects (95%) successfully completed the VVP-10 test series after 1 training session. The ICC for VVP-10 was 0.95 (95% confidence interval [CI], 0.92–0.97). The mean SE in units of fraction seen was 0.012. The Spearman correlations between VVP-10 average fraction seen and HFA MS were 0.87 (95% CI, 0.66–0.98) for moderate-to-advanced glaucoma eyes, and decreased to 0.67 (95% CI, 0.28–0.94) when all eyes were included.</p></div><div><h3>Conclusions</h3><p>Remote training of patients at home is feasible, and subsequent remote clustered VF testing using VVP-10 by patients on their own, without any further interactions with caregivers or study staff, was possible. At-home VVP-10 results demonstrated low test-retest variability. Future studies must be conducted to determine if VVP-10, taken at home as convenient for the patient, may be a viable supplement to provide equivalent or complementary results to that of standard in-clinic assessment of visual function in glaucoma.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589419623001606/pdfft?md5=149fb6ed7c569868b5d6801b82a0ead2&pid=1-s2.0-S2589419623001606-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10303348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Differences in the Diagnostic Accuracy of OCT Angiography Macular Vessel Density for Glaucoma","authors":"Gopikasree Gunasegaran MD,&nbsp;Sasan Moghimi MD,&nbsp;Takashi Nishida MD, PhD,&nbsp;Evan Walker MS,&nbsp;Alireza Kamalipour MD, MPH,&nbsp;Jo-Hsuan Wu MD,&nbsp;Golnoush Mahmoudinezhad MD, MPH,&nbsp;Linda M. Zangwill PhD,&nbsp;Robert N. Weinreb MD","doi":"10.1016/j.ogla.2023.09.003","DOIUrl":"10.1016/j.ogla.2023.09.003","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT </span>angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma.</p></div><div><h3>Design</h3><p>Observational, cross sectional study.</p></div><div><h3>Participants</h3><p>A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study.</p></div><div><h3>Methods</h3><p>Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6 × 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes.</p></div><div><h3>Main Outcome Measures</h3><p>Macular VD and wiGCC measurements.</p></div><div><h3>Results</h3><p>Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], <em>P</em> = 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; <em>P</em> = 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; <em>P</em> = 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants.</p></div><div><h3>Conclusions</h3><p>Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41154802","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":"Determination of the Trans-Lamina Cribrosa Pressure Difference in a Community-Based Population and its Association with Open-Angle Glaucoma","authors":"Prashant D. Tailor MD ,&nbsp;Bryce J. Aul MD ,&nbsp;Arthur J. Sit MD ,&nbsp;Michael P. Fautsch PhD ,&nbsp;John J. Chen MD, PhD","doi":"10.1016/j.ogla.2023.09.002","DOIUrl":"10.1016/j.ogla.2023.09.002","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the trans-lamina cribrosa pressure difference (TLCPD) in a cohort of normal community-based patients and the relationship to primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG).</p></div><div><h3>Design</h3><p>Retrospective cohort study of the Mayo Clinic Study of Aging.</p></div><div><h3>Participants</h3><p>The Mayo Clinic Study of Aging is a prospective study evaluating the normal aging population.</p></div><div><h3>Methods</h3><p><span>Mayo Clinic Study of Aging patients who underwent routine lumbar puncture (LP) studies with eye examinations were reviewed. The trans-lamina cribrosa pressure difference was calculated in 2 contexts of </span>intraocular pressure<span> (IOP): (1) maximum IOP at eye visit closest in time to the LP (closest-in-time TLCPD); and (2) IOP before IOP-lowering treatment (pretreatment IOP and pretreatment TLCPD) in POAG and NTG patients. Glaucoma patients without POAG or NTG were excluded. Regression analyses were performed to determine the relationship with glaucoma.</span></p></div><div><h3>Main Outcome Measures</h3><p>IOP, intracranial pressure, TLCPD, POAG, normal-tension glaucoma (NTG) diagnosis, glaucoma parameters.</p></div><div><h3>Results</h3><p><span>Five hundred forty-eight patients were analyzed. Of these, there were 38 treated glaucoma patients (14 POAG and 24 NTG) and 510 nonglaucomatous patients. Cerebral spinal fluid (CSF) opening pressure was 155.0 ± 42.2 mmH</span>₂O in nonglaucomatous patients, 144.0 ± 34.0 mmH₂O in POAG (<em>P</em> = 0.15 vs. nonglaucomatous patients), and 136.6 ± 29.3 mmH₂O in NTG (<em>P</em> = 0.017 vs. nonglaucomatous patients). Intraocular pressure was 15.47 ± 2.9 mmHg in nonglaucomatous patients, 26.6 ± 3.7 mmHg in POAG, and 17.4 ± 3.4 mmHg in NTG. The closest-in-time TLCPD in the nonglaucomatous cohort was 4.07 ± 4.22 mmHg, which was lower than both the POAG cohort (7.19 ± 3.6 mmHg) and the NTG cohort (5.79 ± 4.5 mmHg, <em>P</em> = 0.04). Pretreatment TLCPD for the overall glaucoma cohort was 10.57 ± 6.1 mmHg. The POAG cohort had a higher pretreatment TLCPD (16.05 ± 5.2 mmHg) than the NTG cohort (7.37 ± 4.1 mmHg; <em>P</em> &lt; 0.0001). Closest-in-time TLCPD for the nonglaucoma cohort (4.07± 4.2 mmHg) was significantly lower than pretreatment TLCPDs for both POAG (16.05 ± 5.2 mmHg; <em>P</em> &lt; 0.0001) and NTG (7.37 ± 4.1 mmHg; <em>P</em> &lt; 0.0001) cohorts.</p></div><div><h3>Conclusions</h3><p>This study establishes the baseline TLCPD in a large cohort of normal, community-based patients. The differences in regression analysis between TLCPD and IOP suggests NTG pathophysiology is partially driven by TLCPD, but is also likely multifactorial.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141467","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":"Empowering Family Glaucoma Risk Communication Using QR-Code-Mediated Online Intervention","authors":"Shahin Hallaj MD ,&nbsp;Sagar J. Shah BS ,&nbsp;Eli K. Cehelyk MPH ,&nbsp;Lauren E. Hock MD ,&nbsp;Daniel Lee MD ,&nbsp;Reza Razeghinejad MD ,&nbsp;Jonathan S. Myers MD ,&nbsp;Rosemary Frasso PhD, MSc ,&nbsp;Natasha Nayak Kolomeyer MD","doi":"10.1016/j.ogla.2023.10.006","DOIUrl":"10.1016/j.ogla.2023.10.006","url":null,"abstract":"<div><h3>Purpose</h3><p>Attempts at engaging relatives of glaucoma patients in education and screening have had limited success. This study explores the feasibility of an electronic intervention to facilitate direct yet reliable glaucoma risk communication between open-angle glaucoma patients (probands) and their first-degree relatives (FDRs).</p></div><div><h3>Design</h3><p>Prospective survey and assessment of intervention.</p></div><div><h3>Participants</h3><p>Fifty adult probands, engaging 140 FDRs.</p></div><div><h3>Methods</h3><p>Phase I was an iterative process involving creating a customized website and Quick Response (QR)-code-based intervention designed with input from probands, FDRs of patients, community members, and researchers. In phase II, the intervention was deployed in a clinical setting; this involved recruiting probands who had a smartphone and were willing to use the QR-code to message their FDRs a standard message, including a website link about glaucoma risk in FDRs and the importance of getting examined. Follow-up interviews were conducted with probands 1 to 2 weeks after their clinic visit to assess the impact of the intervention. Demographic data, website analytics, and participant feedback were collected and analyzed.</p></div><div><h3>Main Outcome Measures</h3><p>Increased awareness of glaucoma risk among FDRs and enhanced discussions.</p></div><div><h3>Results</h3><p>At the time of the first interview, probands reported that 70% of the FDRs were aware of the probands' glaucoma diagnosis, but only 26% had undergone glaucoma screening. Ninety percent of probands had no issues using the QR-codes. Website analytics recorded 73 visits from 51 distinct internet protocol addresses (IPs). After receiving the standard message, 95% of FDRs followed up with the probands, actively discussing glaucoma. Of the probands, 84% completed the follow-up interview 1 to 2 weeks after enrollment. Fifty-nine percent of the FDRs were reported to have scheduled screening appointments. The collected feedback revealed that 96% of probands found the intervention helpful, fostering glaucoma discussions with their FDRs and improving probands’ comfort level in discussing health issues with FDRs from baseline (very comfortable: 88%, comfortable: 8%, neutral: 2%, and very uncomfortable: 2%) to the follow-up interview (very comfortable: 98% and comfortable: 2%).</p></div><div><h3>Conclusions</h3><p>This innovative online method of communicating the risk of glaucoma to FDRs of probands prompted and increased the comfort level of familial discussions of glaucoma. More than half of FDRs reported making an appointment to get screened for glaucoma.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41221484","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":"Predictors of Glaucomatous Progression in Individuals with Small and Large Optic Discs","authors":"Connie Ho BA ,&nbsp;Victoria L. Tseng MD, PhD ,&nbsp;Lourdes Grassi MD ,&nbsp;Esteban Morales MS ,&nbsp;Fei Yu PhD ,&nbsp;Anne L. Coleman MD, PhD ,&nbsp;Joseph Caprioli MD","doi":"10.1016/j.ogla.2023.11.002","DOIUrl":"10.1016/j.ogla.2023.11.002","url":null,"abstract":"<div><h3>Purpose</h3><p>To identify factors associated with glaucomatous progression in individuals with small and large optic discs.</p></div><div><h3>Design</h3><p>Retrospective review.</p></div><div><h3>Subjects</h3><p>4505 individuals with glaucoma at UCLA; 233 (59.7%) with small discs, 157 (40.3%) with large discs.</p></div><div><h3>Methods</h3><p><span><span>Small and large disc sizes were defined by OCT or </span>Heidelberg Retinal Tomography as disc area ≤ 5% (≤ 1.3 mm</span>²) and ≥ 95% (≥ 2.9 mm²<span><span>), respectively. Medical records were reviewed for demographics, systemic comorbidities, glaucoma type, ocular comorbidities, and ocular surgery. </span>Logistic regression was used to identify predictors of visual field (VF) progression in individuals with small and large discs and predictors of large versus small discs.</span></p></div><div><h3>Main Outcome Measures</h3><p>The VF deterioration with mean deviation, pointwise linear regression, and glaucoma rate index (GRI); large vs. small disc.</p></div><div><h3>Results</h3><p>In individuals with small discs, Asian versus non-Hispanic White ethnicity was associated with increased progression (adjusted odds ratio [aOR] = 4.05; 95% confidence interval [CI] = 1.12–14.59 for GRI). Higher intraocular pressure (IOP) range and peak were associated with increased progression in individuals with both small discs (aOR = 1.12; 95% CI = 1.00–1.27 and aOR = 1.05; 95% CI = 1.00–1.10 per 1 mmHg for range and peak with GRI) and large discs (aOR = 1.35; 95% CI = 1.12–1.66 and aOR = 1.11; 95% CI = 1.03–1.20 per 1 mmHg for range and peak with GRI). Multivariable predictors of having large vs. small discs included vasospastic phenotype (aOR = 2.58; 95% CI = 1.35–5.19) and Black (aOR = 20.46; 95% CI = 8.33–61.84), Hispanic/Latino (aOR = 9.65; 95% CI = 4.14–25.39), Asian (aOR = 4.87; 95% CI = 2.96–8.1), and other (aOR = 2.79; 95% CI = 1.69–4.63) versus non-Hispanic White ethnicity.</p></div><div><h3>Conclusions</h3><p>Increased odds of glaucomatous progression were associated with Asian vs. non-Hispanic White ethnicity in glaucoma patients with small optic discs, as well as with increased IOP range and peak in those with small and large discs. Individuals with a vasospastic phenotype and those from racial and ethnic minority backgrounds had increased odds of having large vs. small optic discs. Further characterization of discernible phenotypes would improve disease prognostication and help individualize glaucoma treatment.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72016305","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":"Early Postoperative Aqueous Suppression Therapy and Surgical Outcomes of Ahmed Tube Shunts in Refractory Glaucoma","authors":"Wesam Shamseldin Shalaby MD ,&nbsp;Jae-Chiang Wong BS ,&nbsp;Tony Zhehao Zhang BS ,&nbsp;Shahin Hallaj MD ,&nbsp;Sophia S. Lam BS ,&nbsp;Elizabeth A. Dale MD ,&nbsp;Michael J. Pro MD ,&nbsp;Natasha Nayak Kolomeyer MD ,&nbsp;Aakriti Garg Shukla MD ,&nbsp;Daniel Lee MD ,&nbsp;Jonathan S. Myers MD ,&nbsp;Reza Razeghinejad MD ,&nbsp;Marlene R. Moster MD","doi":"10.1016/j.ogla.2023.08.001","DOIUrl":"10.1016/j.ogla.2023.08.001","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare early vs. delayed use of aqueous suppressants on Ahmed glaucoma valve (AGV) outcomes.</p></div><div><h3>Design</h3><p>Single-center retrospective comparative case series.</p></div><div><h3>Participants</h3><p>Patients who underwent AGV surgery at Wills Eye Hospital in the period between 2016 and 2021.</p></div><div><h3>Methods</h3><p><span>Retrospective review of AGV surgery at Wills Eye Hospital 2016 to 2021 for refractory glaucoma. Two groups were created: group 1 or those who received early aqueous suppressant therapy in the first 2 weeks postoperatively whenever the intraocular pressure<span> (IOP) was &gt; 10 mmHg, and group 2 or those who received delayed treatment after 2 weeks whenever the IOP exceeded the target pressure. Aqueous suppressant therapy included topical </span></span>beta blockers<span>, carbonic anhydrase inhibitors<span>, and/or alpha agonists.</span></span></p></div><div><h3>Main Outcome Measures</h3><p><span>The primary outcome measures were the frequency of hypertensive phase (HP) defined as IOP &gt; 21 mmHg in first 3 months after an initial reduction to 21 mmHg or less in the first postoperative week not caused by tube obstruction or retraction, and month-12 surgical failure defined as 5 ≥ IOP &gt; 21 mmHg on 2 consecutive visits, vision decline to no light perception (NLP), or glaucoma reoperation<span>. Secondary outcome measures included changes in visual acuity<span> (VA), IOP, and glaucoma medications at 12 months. </span></span></span>Predictive factors for surgical failure were also identified.</p></div><div><h3>Results</h3><p>A total of 407 eyes of 391 patients (260 in group 1, 147 in group 2) with similar baseline characteristics were included. Hypertensive phase was more common in group 2 than 1 (41.5% vs. 18.5%; <em>P</em> &lt; 0.001). At month 12 (N = 303 eyes), group 1 was less likely to fail than group 2 (21.2% vs. 36.8%, <em>P</em> = 0.003). Multivariate regression analysis showed that HP (odds ratio [OR] = 10.47, <em>P</em> &lt; 0.001), delayed aqueous suppression use (OR = 2.17, <em>P</em> = 0.003), and lower baseline VA (OR = 1.56, <em>P</em> = 0.015) were the strongest predictors of month-12 failure.</p></div><div><h3>Conclusions</h3><p>Early use of aqueous suppressants may lower the risk of HP and improve AGV outcomes.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10182247","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":"The Effect of Scleral Buckle Surgery on Tonographic Outflow Facility, Positional Intraocular Pressure, and Ocular Biomechanics","authors":"Lance J. Lyons MD ,&nbsp;Arash Kazemi MD ,&nbsp;Sophie J. Bakri MD ,&nbsp;Andrew J. Barkmeier MD ,&nbsp;Raymond Iezzi MD ,&nbsp;Timothy W. Olsen MD ,&nbsp;David O. Hodge MS ,&nbsp;Arthur J. Sit SM, MD","doi":"10.1016/j.ogla.2023.07.007","DOIUrl":"10.1016/j.ogla.2023.07.007","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the in vivo effect of scleral buckle<span> surgery on ocular biomechanics and aqueous humor dynamics.</span></p></div><div><h3>Design</h3><p>Prospective observational cross-sectional study.</p></div><div><h3>Participants</h3><p><span>Nine patients with unilateral 360 degree encircling scleral buckles without vitrectomy for </span>rhegmatogenous retinal detachments, between 3 and 39 months postoperative.</p></div><div><h3>Methods</h3><p><span><span>All measurements were performed in both eyes of all participants. Intraocular pressure (IOP) was measured in the seated and </span>supine positions using pneumatonometry. Outflow facility was measured using 2-minute weighted pneumatonography. Ocular rigidity coefficient was determined from the Friedenwald equations based on the difference in IOP with and without a weighted tonometer tip. The percentage change in IOP upon transitioning from seated to supine was calculated. Measurements for buckled and nonbuckled eyes were compared using paired Student </span><em>t</em> test of means.</p></div><div><h3>Main Outcome Measures</h3><p>Sitting and supine IOP and percentage difference between the 2 positions; outflow facility; ocular rigidity coefficient.</p></div><div><h3>Results</h3><p>Seated IOP was similar between buckled and nonbuckled eyes (16.1 ± 2.5 vs. 16.7 ± 2.7 mmHg; <em>P</em> = 0.5) whereas supine IOP was lower in buckled eyes compared with nonbuckled eyes (18.7 ± 2.6 vs. 21.3 ± 2.5 mmHg; <em>P</em> = 0.008). The percentage increase in IOP upon change in body position from seated to supine was greater in nonbuckled eyes (17.4 ± 9.4% vs. 27.6 ± 9.5%; <em>P</em> = 0.005). Ocular rigidity coefficient was lower in buckled (9.9 × 10^-3 ± 1.4 × 10^-3 μL^-1) vs. nonbuckled eyes (14.4 × 10^-3 ± 3.1 × 10^-3 μL^-1; <em>P</em> = 0.006). Outflow facility was not significantly different in buckled and nonbuckled eyes.</p></div><div><h3>Conclusions</h3><p>Scleral buckling decreases ocular rigidity but does not affect outflow facility. This change in ocular biomechanics likely results in the attenuated IOP change from seated to supine position. Decreased ocular rigidity may also reduce IOP fluctuations and potentially reduce the risk for glaucoma progression.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101238","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":"Lowe Oculocerebrorenal Syndrome Comparison of Anterior Segment Anatomy in Eyes with and without Glaucoma","authors":"Dhruv M. Shah BS ,&nbsp;Libby Wei MD ,&nbsp;He Eun Forbes MS ,&nbsp;Euna Cho BS ,&nbsp;Trisha Miglani BA ,&nbsp;Isabelle Dortonne MD ,&nbsp;Monica M. Manrique MD ,&nbsp;Camilo Martinez COA ,&nbsp;William P. Madigan MD ,&nbsp;Mohamad S. Jaafar MD ,&nbsp;Moran R. Levin MD ,&nbsp;Janet L. Alexander MD","doi":"10.1016/j.ogla.2023.06.010","DOIUrl":"10.1016/j.ogla.2023.06.010","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9870777","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":"Progressive Macular Vessel Density Loss and Visual Field Progression in Open-angle Glaucoma Eyes with Central Visual Field Damage","authors":"Anna Lee MD,&nbsp;Ko Eun Kim MD, PhD,&nbsp;Woo Keun Song MD,&nbsp;Jooyoung Yoon MD,&nbsp;Michael S. Kook MD","doi":"10.1016/j.ogla.2023.06.009","DOIUrl":"10.1016/j.ogla.2023.06.009","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the association between the longitudinal changes in both macular vessel density (mVD) and macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and visual field (VF) progression (including central VF progression) in open-angle glaucoma (OAG) patients with central visual field (CVF) damage at different glaucoma stages.</p></div><div><h3>Design</h3><p>Retrospective longitudinal study.</p></div><div><h3>Participants</h3><p>This study enrolled 223 OAG eyes with CVF loss at baseline classified as early-to-moderate (133 eyes) or advanced (90 eyes) stage based on the VF mean deviation (MD) (−10 dB).</p></div><div><h3>Methods</h3><p>Serial mVDs at parafoveal and perifoveal sectors and mGCIPLT measurements were obtained using OCT angiography and OCT during a mean follow-up of 3.5 years. Visual field progression was determined using both the event- and trend-based analyses during follow-up.</p></div><div><h3>Main Outcome Measures</h3><p>Linear mixed-effects models were used to compare the rates of change in each parameter between VF progressors and nonprogressors. Logistic regression analyses were performed to determine the risk factors for VF progression.</p></div><div><h3>Results</h3><p>In early-to-moderate stage, progressors showed significantly faster rates of change in the mGCIPLT (−1.02 vs. −0.47 <span><math><mrow><mi>μ</mi></mrow></math></span>m/year), parafoveal (−1.12 vs. −0.40%/year), and perifoveal mVDs (−0.83 vs. −0.44%/year) than nonprogressors (all <em>P</em> &lt; 0.05). In advanced stage cases, only the rates of change in mVDs (parafoveal: −1.47 vs. −0.44%/year; perifoveal: −1.04 vs. −0.27%/year; all <em>P</em> &lt; 0.05) showed significant differences between the groups. By multivariable logistic regression analyses, the faster rate of mVD loss was a predictor of VF progression regardless of glaucoma stage, while the rate of mGCIPLT loss was significantly associated with VF progression only in early-to-moderate stage cases.</p></div><div><h3>Conclusions</h3><p>Progressive mVD loss is significantly associated with VF progression (including central VF progression) in the OAG eyes with CVF loss regardless of the glaucoma stage.</p></div><div><h3>Financial Disclosure(s)</h3><p>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9968103","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":"Baerveldt-350 with 3-0 Prolene Ripcord to Minimize Hypotony-Associated Complications after Spontaneous Ligature Dissolution","authors":"Jessie Wang MD ,&nbsp;Lindsay Y. Chun MD ,&nbsp;Mary Qiu MD","doi":"10.1016/j.ogla.2023.07.005","DOIUrl":"10.1016/j.ogla.2023.07.005","url":null,"abstract":"<div><h3>Purpose</h3><p>To describe the technique and demonstrate the utility and outcomes of using a thick 3-0 Prolene ripcord in the lumen of a Baerveldt-350 aqueous shunt until after the ligature suture dissolves.</p></div><div><h3>Design</h3><p>Single-center, noncontrolled, retrospective case series.</p></div><div><h3>Participants</h3><p>A total of 50 eyes from 50 patients with glaucoma undergoing placement of Baerveldt-350 aqueous shunts with 3-0 Prolene ripcords.</p></div><div><h3>Methods</h3><p>A retrospective chart review was performed for all eyes of adult patients that had undergone a Baerveldt-350 aqueous shunt placement by a single surgeon at a single academic center between October 1, 2019 and June 30, 2022.</p></div><div><h3>Main Outcome Measures</h3><p>Data collected included demographic and clinical characteristics of the patients, preoperative and postoperative clinical data including intraocular pressure<span> (IOP) and glaucoma medications, postoperative timepoints of ligature suture dissolution, and timepoints of 3-0 Prolene ripcord removal or whether they were permanently left in place.</span></p></div><div><h3>Results</h3><p>In total, 50 eyes from 50 patients were included; mean age was 69.5 years, 54.0% of patients were female, 92% of patients were Black, and 66% of eyes had primary open-angle glaucoma. Twenty-six of 50 (52%) eyes had ripcord removal at the soonest postoperative visit after spontaneous ligature dissolution, 19/50 (38%) eyes had delayed ripcord removal, and 5/50 (10%) eyes had no ripcord removal. There were no cases of hypotony-associated complications (shallow anterior chamber<span>, hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage) in this subgroup of eyes that underwent no ripcord removal.</span></p></div><div><h3>Conclusions</h3><p>Our results demonstrate that routine use of a 3-0 Prolene ripcord to partially occlude the lumen of a Baerveldt-350 is a useful strategy to minimize sudden hypotony-associated complications when the ligature suture dissolves. This strategy allows for a more controlled postoperative course and a safe 2-step decrease in IOP (1: when the ligature dissolves, and 2: when the ripcord is removed).</p></div><div><h3>Financial Disclosure(s)</h3><p>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9986035","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}