Ophthalmology. Glaucoma最新文献_第8页

Long-term Remodeling Response in the Lamina Cribrosa Years after Intraocular Pressure Lowering by Suturelysis after Trabeculectomy 小梁切除术后通过缝合降低眼压数年后，颅底斜面的长期重塑反应

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-05-01 DOI: 10.1016/j.ogla.2024.01.003

Cameron A. Czerpak PhD , Harry A. Quigley MD , Thao D. Nguyen PhD

Objective

To measure the remodeling of the lamina cribrosa (LC) years after intraocular pressure (IOP) lowering by suturelysis.

Design

Cohort study.

Participants

Glaucoma patients were imaged 20 minutes after laser suturelysis after trabeculectomy surgery and at their follow-up appointment 1 to 4 years later (16 image pairs; 15 persons).

Intervention

Noninvasive OCT imaging of the eye.

Main Outcome Measures

Deformation calculated by correlating OCT scans of the LC immediately after IOP lowering by suturelysis and those acquired years later (defined as remodeling strain).

Results

The LC anterior border moved 60.9 ± 54.6 μm into the eye (P = 0.0007), and the LC exhibited regions of large local stretch in the anterior-posterior direction on long-term, maintained IOP lowering, resulting in a mean anterior-posterior remodeling strain of 14.0% ± 21.3% (P = 0.02). This strain and the LC border movement was 14 times and 124 times larger, respectively, than the direct response to IOP lowering by suturelysis. A larger anterior LC border movement was associated with greater mean anterior-posterior remodeling strain (P = 0.004). A thinner retinal nerve fiber layer at suturelysis was also associated with greater mean anterior-posterior remodeling strain at follow-up (P = 0.05). Worsening visual field indexes during follow-up were associated with a greater mean circumferential remodeling strain (P = 0.02), due to regions of large local circumferential stretch of the LC. Eyes with a more compliant LC torsional shear strain response at lysis were associated with worse mean deviation at follow-up (P = 0.03).

Conclusions

Strains and LC border position changes measured years after IOP lowering are far larger than the immediate response to IOP lowering and indicate dramatic remodeling of the LC anatomical structure caused by IOP lowering and glaucoma progression. The remodeling strains indicate substantial local stretch in the anterior-posterior direction and are associated with movement of the LC anterior border into the eye. Eyes with greater direct strain response to IOP lowering, greater glaucoma damage at suturelysis, and greater worsening of visual field at follow-up experienced greater remodeling.

Trial Registration

ClinicalTrials.gov Identifier: NCT03267849.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的通过缝合术降低眼压数年后，测量颅骨板层（LC）的重塑情况：队列研究：小梁切除术后激光缝合术后 20 分钟和 1-4 年后复诊时对青光眼患者进行成像（16 对图像；15 人）：干预措施：眼部无创光学相干断层扫描（OCT）成像：主要结果：通过缝合术降低眼压后立即对 LC 进行的 OCT 扫描与数年后获得的 OCT 扫描（定义为重塑应变）进行对比，计算出变形情况：LC前缘向眼球内移动了60.9 ± 54.6 μm（p=0.0006），在长期维持降低眼压的过程中，LC在前后方向表现出较大的局部拉伸区域，导致平均前后重塑应变为14.0 ± 21.3%（p=0.03）。该应变和 LC 边界移动分别是缝合术降低眼压直接反应的 14 倍和 124 倍。LC 边界前移越大，前后重塑应变的平均值就越大（p=0.004）。缝合时视网膜神经纤维层（RNFL）较薄也与随访时前后平均重塑应变较大有关（p=0.04）。随访期间视野指数恶化与平均圆周重塑应变较大有关（p=0.02），这是因为局部LC圆周拉伸区域较大。结论：降低眼压数年后测量到的应变和 LC 边界位置变化远大于眼压降低后的即时反应，表明眼压降低和青光眼进展导致 LC 解剖结构发生了巨大重塑。重塑的应变表明在前后方向上存在大量的局部拉伸，并与 LC 前缘向眼内移动有关。对降低眼压的直接应变反应更大、缝合时青光眼损伤更大、随访时视野恶化更严重的眼球经历了更大的重塑。

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引用次数: 0

Opportunities for Improving Glaucoma Clinical Trials via Deep Learning-Based Identification of Patients with Low Visual Field Variability 通过基于深度学习的低视野变异性患者识别改进青光眼临床试验的机会。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-05-01 DOI: 10.1016/j.ogla.2024.01.005

Ruolin Wang BA , Chris Bradley PhD , Patrick Herbert , Kaihua Hou BA , Gregory D. Hager PhD , Katharina Breininger PhD , Mathias Unberath PhD , Pradeep Ramulu MD, PhD , Jithin Yohannan MD, MPH

Purpose

Develop and evaluate the performance of a deep learning model (DLM) that forecasts eyes with low future visual field (VF) variability, and study the impact of using this DLM on sample size requirements for neuroprotective trials.

Design

Retrospective cohort and simulation study.

Methods

We included 1 eye per patient with baseline reliable VFs, OCT, clinical measures (demographics, intraocular pressure, and visual acuity), and 5 subsequent reliable VFs to forecast VF variability using DLMs and perform sample size estimates. We estimated sample size for 3 groups of eyes: all eyes (AE), low variability eyes (LVE: the subset of AE with a standard deviation of mean deviation [MD] slope residuals in the bottom 25th percentile), and DLM-predicted low variability eyes (DLPE: the subset of AE predicted to be low variability by the DLM). Deep learning models using only baseline VF/OCT/clinical data as input (DLM1), or also using a second VF (DLM2) were constructed to predict low VF variability (DLPE1 and DLPE2, respectively). Data were split 60/10/30 into train/val/test. Clinical trial simulations were performed only on the test set. We estimated the sample size necessary to detect treatment effects of 20% to 50% in MD slope with 80% power. Power was defined as the percentage of simulated clinical trials where the MD slope was significantly worse from the control. Clinical trials were simulated with visits every 3 months with a total of 10 visits.

Results

A total of 2817 eyes were included in the analysis. Deep learning models 1 and 2 achieved an area under the receiver operating characteristic curve of 0.73 (95% confidence interval [CI]: 0.68, 0.76) and 0.82 (95% CI: 0.78, 0.85) in forecasting low VF variability. When compared with including AE, using DLPE1 and DLPE2 reduced sample size to achieve 80% power by 30% and 38% for 30% treatment effect, and 31% and 38% for 50% treatment effect.

Conclusions

Deep learning models can forecast eyes with low VF variability using data from a single baseline clinical visit. This can reduce sample size requirements, and potentially reduce the burden of future glaucoma clinical trials.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：开发并评估可预测未来视野（VF）变异性较低的眼睛的深度学习模型（DLM）的性能，并研究使用该 DLM 对神经保护试验样本量要求的影响设计：回顾性队列和模拟研究方法：我们为每位患者纳入一只具有基线可靠 VF、光学相干断层扫描（OCT）、临床测量（人口统计学、眼压、视力）和 5 次后续可靠 VF 的眼睛，以便使用 DLM 预测 VF 变异性并进行样本量估算。我们估算了三组眼睛的样本量：所有眼睛（AE）、低变异性眼睛（LVE：平均差 [MD] 斜率残差的标准偏差在第 25 百分位数以下的 AE 子集）和 DLM 预测的低变异性眼睛（DLPE：DLM 预测为低变异性的 AE 子集）。仅使用基线 VF/OCT/临床数据作为输入（DLM1）或同时使用第二个 VF（DLM2）构建 DLM，以预测低 VF 变异性（分别为 DLPE1 和 DLPE2）。数据以 60/10/30 的比例分成训练/评估/测试。临床试验模拟仅在测试集中进行。我们估算了以 80% 的功率检测 MD 斜坡 20% 至 50% 的治疗效果所需的样本量。功率定义为MD斜率明显低于对照组的模拟临床试验的百分比。模拟临床试验每 3 个月访问一次，共访问 10 次：共有 2,817 只眼睛被纳入分析。DLM1 和 DLM2 预测低 VF 变异的接收器操作特征曲线下面积分别为 0.73（95% CI：0.68, 0.76）和 0.82（95% CI：0.78, 0.85）。与包括AE相比，使用DLPE1和DLPE2可使样本量减少30%和38%（30%治疗效果）和31%和38%（50%治疗效果），以达到80%的功率：结论：DLM 可以利用单次基线临床访问的数据预测 VF 变异性较低的眼睛。结论：DLMs 可以利用单次基线临床访问的数据预测 VF 变异性低的眼，从而降低样本量要求，并有可能减轻未来青光眼临床试验的负担。

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引用次数: 0

OCT Segmentation Errors with Bruch's Membrane Opening-Minimum Rim Width as Compared with Retinal Nerve Fiber Layer Thickness 与视网膜神经纤维层厚度相比，基底膜开口-最小边缘宽度的光学相干断层扫描分割误差。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-05-01 DOI: 10.1016/j.ogla.2023.12.002

Hongli Yang PhD, Jack P. Rees BA, Facundo G. Sanchez MD, Stuart K. Gardiner PhD, Steven L. Mansberger MD, MPH

Objective

To compare the magnitude and location of automated segmentation errors of the Bruch’s membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT).

Design

Cross-sectional study.

Participants

We included 162 glaucoma suspect or open-angle glaucoma eyes from 162 participants.

Methods

We used spectral-domain optic coherence tomography (Spectralis 870 nm, Heidelberg Engineering) to image the optic nerve with 24 radial optic nerve head B-scans and a 12-degree peripapillary circle scan, and exported the native “automated segmentation only” results for BMO-MRW and RNFLT. We also exported the results after “manual refinement” of the measurements.

Main Outcome Measures

We calculated the absolute and proportional error globally and within the 12 30-degree sectors of the optic disc. We determined whether the glaucoma classifications were different between BMO-MRW and RNFLT as a result of manual and automatic segmentation.

Results

The absolute error mean was larger for BMO-MRW than for RNFLT (10.8 μm vs. 3.58 μm, P < 0.001). However, the proportional errors were similar (4.3% vs. 4.4%, P = 0.47). In a multivariable regression model, errors in BMO-MRW were not significantly associated with age, location, magnitude, or severity of glaucoma loss (all P ≥ 0.05). However, larger RNFLT errors were associated with the superior and inferior sector location, thicker nerve fiber layer, and worse visual field (all P < 0.05). Errors in BMO-MRW and RNFLT were not likely to occur in the same sector location (R² = 0.001; P = 0.15). With manual refinement, the glaucoma classification changed in 7.8% and 6.2% of eyes with BMO-MRW and RNFLT, respectively.

Conclusions

Both BMO-MRW and RNFLT measurements included segmentation errors, which did not seem to have a common location, and may result in differences in glaucoma classification.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的比较布氏膜开口-最小边缘宽度（BMO-MRW）和视网膜神经纤维层厚度（RNFLT）自动分割误差的大小和位置：横断面研究：我们纳入了来自 162 名参与者的 162 只青光眼疑似眼或开角型青光眼眼：我们使用光谱域光学相干断层成像仪（Spectralis 870 nm，海德堡工程公司，德国海德堡）对视神经进行成像，包括 24 个径向视神经头 B 扫描和 12 度毛细血管周围圆扫描，并导出 BMO-MRW 和 RNFLT 的 "仅自动分割 "原始结果。我们还导出了 "手动细化 "测量后的结果：我们计算了全球和视盘 12 个 30 度扇区内的绝对误差和比例误差。我们确定了 BMO-MRW 和 RNFLT 的青光眼分类是否因手动和自动分割而有所不同：BMO-MRW的绝对误差平均值大于RNFLT（10.8μm vs. 3.58μm，p2=0.001；p=0.15）。通过人工细化，分别有 7.8% 和 6.2% 的眼睛的 BMO-MRW 和 RNFLT 的青光眼分类发生了变化：结论：BMO-MRW 和 RNFLT 测量都包含分割误差，这些误差似乎没有共同的位置，可能导致青光眼分类的差异。

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引用次数: 0

Long-term Treatment Outcomes for Malignant Glaucoma 恶性青光眼的长期治疗效果。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-05-01 DOI: 10.1016/j.ogla.2023.12.005

Sang Wook Jin MD , Joseph Caprioli MD

Purpose

To report the contributing factors to the successful long-term treatment outcomes of a large series of patients with malignant glaucoma (MG).

Design

Retrospective, interventional, consecutive case series.

Participants

This study used data collected from 1997 to 2022 from the Glaucoma Division of the Stein Eye Institute, University of California, Los Angeles (UCLA). All patients with MG who underwent treatment at UCLA were enrolled.

Methods

The following demographic and clinical data were collected and analyzed for their relevance to successful treatment: age, gender, ethnicity, glaucoma family history, visual acuity (VA), intraocular pressure (IOP), lens status, prior glaucoma diagnosis, prior ocular surgery, prior use of antiglaucoma agents, ultrasonic axial length, qualitative anterior chamber (AC) depth, and treatment methods and outcomes.

Main Outcome Measures

Anatomical success was defined as restoration of normal AC depth, indicating relief of the MG episode. Complete success was defined as anatomical success and the reduction of IOP to < 21 mmHg without further surgery, with or without medications.

Results

A total of 74 eyes of 73 patients were identified with a diagnosis of MG. The median (interquartile range) age of the patients at the time of MG presentation was 70 years (19.5) and 49 (75.4%) patients were female. The most common prior diagnosis before MG was primary angle closure glaucoma (PACG) (34 eyes, 51.5%). The initiating event for 30 eyes (45.5%) was glaucoma surgery and for 21 eyes (31.8%) was cataract surgery. Most eyes were pseudophakic (57, 86.4%). Fifty-six eyes underwent medical treatment; MG resolved in 2 eyes with medical treatment alone. Nine eyes (7 eyes = treatment naïve; 2 eyes = failed medical treatment) underwent laser treatment and MG resolved in 5 eyes. Among the 55 eyes which had surgical treatment, 52 eyes failed medical treatment and 3 eyes were treatment naïve. The anatomical success rate with surgical treatment was 96.4% and the most commonly performed surgical procedure was combined pars plana antero-central vitrectomy, hyaloido-zonulectomy, and iridectomy.

Conclusions

Female gender, PACG, and glaucoma surgery were predisposing factors for the development of MG. Medical treatment alone for MG was inadequate in the vast majority of cases. A surgical technique consisting of combined pars plana antero-central vitrectomy, hyaloido-zonulectomy and iridectomy consistently produced high long-term success.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：报告一大批恶性青光眼（MG）患者成功获得长期治疗结果的诱因：设计：回顾性、介入性、连续性病例系列研究：本研究使用了加利福尼亚大学洛杉矶分校（UCLA）斯坦因眼科研究所青光眼部从 1997 年至 2022 年收集的数据。所有在加州大学洛杉矶分校接受治疗的 MG 患者均被纳入研究范围：方法：收集并分析以下人口统计学和临床数据，以确定其与成功治疗的相关性：年龄、性别、种族和青光眼家族史、视力（VA）、眼压（IOP）、晶状体状态、既往青光眼诊断、既往眼科手术、既往抗青光眼药物的使用、超声轴长、前房定性深度以及治疗方法和结果：解剖学成功的定义是前房深度恢复正常，表明 MG 病情缓解。完全成功的定义是：解剖学成功，眼压降至<21mmHg，无需进一步手术，用药或不用药：共有 73 名患者的 74 只眼睛被确诊为 MG。MG 患者发病时的中位年龄（四分位数间距）为 70 岁（19.5），49 名患者（75.4%）为女性。MG 之前最常见的诊断是原发性闭角型青光眼（PACG）（34 眼，51.5%）。30只眼睛（45.5%）的起因是青光眼手术，21只眼睛（31.8%）的起因是白内障手术。大多数眼球为假性角膜（57 眼，86.4%）。56 只眼睛接受了药物治疗，其中 2 只眼睛的 MG 在单纯药物治疗后得到缓解。九只眼（7 只眼为治疗无效眼；2 只眼为药物治疗失败眼）接受了激光治疗，其中 5 只眼的 MG 消失。在接受手术治疗的 55 只眼睛中，52 只眼睛药物治疗失败，3 只眼睛治疗失败。手术治疗的解剖学成功率为 96.4%，最常用的手术方法是联合平视前中央玻璃体切除术、透明带切除术和虹膜切除术：女性性别、PACG和青光眼手术是诱发MG的因素。在绝大多数病例中，仅靠药物治疗是不够的。由联合平视前中央玻璃体切除术、透明带切除术和虹膜切除术组成的手术技术始终保持着较高的长期成功率。

{"title":"Long-term Treatment Outcomes for Malignant Glaucoma","authors":"Sang Wook Jin MD , Joseph Caprioli MD","doi":"10.1016/j.ogla.2023.12.005","DOIUrl":"10.1016/j.ogla.2023.12.005","url":null,"abstract":"<div><h3>Purpose</h3><p>To report the contributing factors to the successful long-term treatment outcomes of a large series of patients with malignant glaucoma (MG).</p></div><div><h3>Design</h3><p>Retrospective, interventional, consecutive case series.</p></div><div><h3>Participants</h3><p>This study used data collected from 1997 to 2022 from the Glaucoma Division of the Stein Eye Institute, University of California, Los Angeles (UCLA). All patients with MG who underwent treatment at UCLA were enrolled.</p></div><div><h3>Methods</h3><p>The following demographic and clinical data were collected and analyzed for their relevance to successful treatment: age, gender, ethnicity, glaucoma family history, visual acuity<span><span> (VA), intraocular pressure (IOP), lens status, prior glaucoma diagnosis, prior ocular surgery, prior use of </span>antiglaucoma agents<span>, ultrasonic axial length, qualitative anterior chamber (AC) depth, and treatment methods and outcomes.</span></span></p></div><div><h3>Main Outcome Measures</h3><p>Anatomical success was defined as restoration of normal AC depth, indicating relief of the MG episode. Complete success was defined as anatomical success and the reduction of IOP to < 21 mmHg without further surgery, with or without medications.</p></div><div><h3>Results</h3><p><span>A total of 74 eyes of 73 patients were identified with a diagnosis of MG. The median (interquartile range) age of the patients at the time of MG presentation was 70 years (19.5) and 49 (75.4%) patients were female. The most common prior diagnosis before MG was primary angle closure glaucoma<span><span> (PACG) (34 eyes, 51.5%). The initiating event for 30 eyes (45.5%) was glaucoma surgery and for 21 eyes (31.8%) was </span>cataract surgery. Most eyes were pseudophakic (57, 86.4%). Fifty-six eyes underwent medical treatment; MG resolved in 2 eyes with medical treatment alone. Nine eyes (7 eyes = treatment naïve; 2 eyes = failed medical treatment) underwent </span></span>laser treatment<span> and MG resolved in 5 eyes. Among the 55 eyes which had surgical treatment, 52 eyes failed medical treatment and 3 eyes were treatment naïve. The anatomical success rate with surgical treatment was 96.4% and the most commonly performed surgical procedure was combined pars plana<span> antero-central vitrectomy<span>, hyaloido-zonulectomy, and iridectomy.</span></span></span></p></div><div><h3>Conclusions</h3><p>Female gender, PACG, and glaucoma surgery were predisposing factors for the development of MG. Medical treatment alone for MG was inadequate in the vast majority of cases. A surgical technique consisting of combined pars plana antero-central vitrectomy, hyaloido-zonulectomy and iridectomy consistently produced high long-term success.</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":"7 3","pages":"Pages 282-289"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075988","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}

引用次数: 0

Subepithelial Corneal Bullae after Posttrabeculectomy Ocular Digital Massage 小梁切除术后眼部数字按摩后的角膜上皮下囊泡

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2024.01.006

Hansen Dang BS, Nicole Radunzel BFA, CRA, Andrew Pouw MD

引用次数: 0

Optimal Performance of Selective Laser Trabeculoplasty 选择性激光小梁成形术的最佳性能瑞典最佳SLT多中心随机对照试验结果。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.10.004

Tobias Dahlgren MD , Marcelo Ayala MD, PhD , Madeleine Zetterberg MD, PhD

Purpose

Selective laser trabeculoplasty (SLT) is a first-line treatment for glaucoma and ocular hypertension. However, due to insufficient comparative evidence in efficacy and safety, several SLT treatment protocols are currently used in practice. The objective of this trial was to compare the clinical outcomes of the 4 most significant SLT variants.

Design

Prospective, multicenter, masked, randomized controlled trial (RCT).

Participants

Four hundred patients with glaucoma or ocular hypertension. The cohort consisted of both treatment-naive patients and patients undergoing glaucoma treatment, at different stages of disease.

Methods

Selective laser trabeculoplasty was performed with 50 ± 5 laser spots in 180 degrees or with 100 ± 10 spots in 360 degrees. The laser power was titrated to either just below the cavitation bubble level (“standard energy”) or to a level producing cavitation bubbles at 50% to 75% of laser applications (“high energy”). Thus, 4 different treatment protocols were included – 180/standard, 180/high, 360/standard, and 360/high. The study adhered as close as possible to regular clinical management, but within a scientific framework.

Main Outcome Measures

Reduction of intraocular pressure (IOP) 1 to 6 months after SLT. The proportion of patients achieving a 20% IOP reduction without any further intervention. Time to glaucoma treatment escalation in a Kaplan–Meier survival analysis.

Results

SLT performed with the 360/high protocol was shown to be superior regarding all primary endpoints. The IOP reduction 1 to 6 months after SLT was 5.4 mmHg in the 360/high group, compared to 3.4, 3.2, and 4.2 mmHg with the 180/standard, 180/high, and 360/standard protocols, respectively (P < 0.001). Furthermore, the success rate after 6 months was significantly higher –58.3%, compared with 30.2%, 29.3%, and 41.7% (P < 0.001). The median time to glaucoma treatment escalation was more than twice as long with 360/high SLT –1323 days, compared to 437 days, 549 days, and 620 days (P < 0.001). Although postoperative discomfort was more frequent with the 360/high protocol, symptoms were generally mild and transient. Adverse events were rare in all groups.

Conclusions

The magnitude and longevity of SLT results increases substantially if SLT is performed according to the 360/high protocol, without compromising safety. Therefore, we recommend that 360/high SLT be considered as standard treatment.

Financial Disclosures

The authors have no proprietary or commercial interest in any materials discussed in this article.

目的：选择性激光小梁成形术（SLT）是青光眼和高眼压症的一线治疗方法。然而，由于疗效和安全性方面的比较证据不足，目前在实践中使用了几种SLT治疗方案。本试验的目的是比较四种最显著的SLT变体的临床结果。设计：前瞻性、多中心、掩蔽、随机对照试验。参与者：四百名青光眼或高眼压患者。该队列包括处于不同疾病阶段的治疗幼稚患者和接受青光眼治疗的患者。方法：SLT采用180度50±5个激光点，360度100±10个激光点。激光功率被滴定到刚好低于空化气泡水平（“标准能量”）或在50-75%的激光应用中产生空化气泡的水平（“高能量”）。因此，包括了四种不同的治疗方案——180/标准、180/高、360/标准和360/高。该研究尽可能接近常规临床管理，但在科学框架内。主要观察指标：SLT术后1-6个月眼压下降。在没有任何进一步干预的情况下实现20%IOP降低的患者比例。Kaplan-Meier生存分析中青光眼治疗升级的时间。结果：使用360/high方案进行的SLT在所有主要终点方面都显示出优越性。360/高组SLT后1-6个月的IOP降低为5.4 mmHg，而180/标准、180/高和360/标准方案的IOP分别为3.4、3.2和4.2 mmHg，结论：如果按照360/high方案进行SLT，在不影响安全性的情况下，SLT结果的幅度和寿命会显著增加。因此，我们建议将360/highSLT视为标准治疗。

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引用次数: 0

Early Outcomes of Combined Phacoemulsification and Ab Interno Tanito Microhook Trabeculotomy in Open-Angle Glaucoma 联合超声乳化和Ab Interno Tanito小钩小梁切除术治疗开角型青光眼的早期疗效。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.10.007

Devendra Maheshwari MD , Davinder S. Grover MD, MPH , Rengappa Ramakrishnan DO, MS , Madhavi Ramanatha Pillai DNB , Drishti Chautani MBBS , Mohideen Abdul Kader PMT, DNB

Purpose

To study the early postoperative efficacy and safety of an Ab Interno microhook trabeculotomy (microLOT) combined with cataract surgery in patients with open-angle glaucoma.

Methods

This prospective, randomized, interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate open-angle glaucoma. One hundred fourteen patients were included for analysis. The patients were randomized to undergo microhook trabeculotomy with phacoemulsification (group 1) or phacoemulsification alone (group 2). All patients were evaluated on postoperative day 1, 15, and 30, as well as 3, 6, and 12 months postoperatively. A P value < 0.05 was considered statistically significant. Baseline and follow-up visits were compared to determine significant differences in the number of antiglaucoma medications (AGMs), intraocular pressure (IOP), and best-corrected visual acuity.

Results

There were 57 patients in each group. The baseline characteristics were similar between the 2 groups, except the number of AGMs, which was greater in group 2. The mean preoperative IOP for group 1 (phaco-microLOT) was 26.5 mmHg ± 5.2 and group 2 (phaco-alone group) was 25.3 mmHg ± 3.1 which decreased to 12.5 mmHg ±3.6 (P < 0.001) and 20.0 mmHg ± 2.7(P < 0.001) at 12 months, respectively. Logarithm of the minimum angle of resolution visual acuity improved from 0.48 (interquartile range [IQR], 0.30–0.60) preoperatively to 0.00 (0.00–0.18) postoperatively (P < 0001) in group 1 and improved from 0.30 (IQR, 0.30–0.48) to 0.00 (0.00–0.00) in group 2 (P < 0.001). In group 1, the mean (standard deviation [SD]) AGM used preoperatively was 0.6 (0.9) which was significantly reduced to 0.2 (0.5) at 12 months postoperatively, whereas in group 2, at 12 months, the mean (SD) AGM used was reduced from 1.4 (0.6) to 1.1 (0.9). In group 1, 90.3% of eyes achieved complete success at the end of 1 year. The most common complication was hyphema, noted in 4 patients with 1 eye requiring an anterior chamber washout.

Conclusion

Ab interno microhook trabeculotomy (microLOT) combined with phacoemulsification in patients with open-angle glaucoma is an efficacious procedure with relatively minimal complications.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：研究Ab Interno微钩小梁切开术（microLOT）联合白内障手术治疗开角型青光眼的术后早期疗效和安全性。方法：这项前瞻性、随机、介入性研究是对连续的视力显著白内障和轻度-中度开角型青光眼患者进行的。纳入114名患者进行分析。将患者随机分为微钩小梁切开术联合超声乳化术（第1组）或单独进行超声乳化手术（第2组）。所有患者均在术后第1、15和30天以及术后3个月、6和12个月进行评估。A p值结果：每组57例。两组的基线特征相似，只是第2组的AGM数量更多。第1组（超声乳化微滴）术前平均眼压为26.5 mmHg±5.2，第2组（单独超声乳化组）术前眼压为25.3 mmHg士3.1，降至12.5 mmHg±3.6。

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引用次数: 0

Interim Analysis of Clinical Outcomes with Open versus Closed Conjunctival Implantation of the XEN45 Gel Stent XEN45凝胶支架开放式和闭合式结膜植入术的中期临床结果分析。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.09.001

Elyse J. McGlumphy MD , Anna Do MD , Amy Du MD , Earl Randy Craven MD , Lawrence S. Geyman MD , Leo Shen MS , Joel S. Schuman MD , Joseph F. Panarelli MD

Objective

To examine the longitudinal postoperative outcomes of open versus closed conjunctiva implantation of the XEN45 gel stent.

Design

Retrospective multicenter study.

Subjects

One hundred ninety-three patients with glaucoma underwent XEN45 implantation via an open or closed conjunctiva approach.

Methods

Data on patient demographics; diagnoses; preoperative and postoperative clinical data; outcome measures, including intraocular pressure (IOP); use of glaucoma medications; visual acuity; and complications were collected. Statistical analyses were performed with P < 0.05 as significant.

Main Outcome Measures

Failure was defined as < 20% reduction in IOP from the medicated baseline or a IOP of > 21 mmHg at 2 consecutive visits at postoperative month 1 and beyond, the need for subsequent operative intervention or additional glaucoma surgery, or a catastrophic event, such as loss of light perception. Eyes that had not failed by these criteria and were not on glaucoma medications were considered complete successes. Overall success was defined as those who achieved success either with or without topical medications.

Results

Patients were followed for an average of 17 months. Complete success was achieved in 42.5% and 24.7% of the open and closed groups, respectively (P = 0.01). Overall success was achieved in 64.2% and 37.0% of the open and closed groups, respectively (P < 0.001) at the last follow-up. Bleb needling was performed in 12.4% of eyes in the open group compared with 40% of eyes in the closed group. An IOP spike of ≥ 10 mmHg was twice as likely to occur in the closed group compared with the open group during the postoperative period (40% vs. 18%; P = 0.001).

Conclusions

Implantation of XEN45 with opening of the conjunctiva resulted in a lower IOP with greater success and lower needling rate compared with those achieved with the closed conjunctiva technique. Similar rates of postoperative complications and vision loss were noted in each group. Although both procedures provide substantial IOP reduction, the open technique appears to result in higher success rates and fewer postoperative interventions.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：观察XEN45凝胶支架开放式和封闭式结膜植入术的纵向术后效果。设计：回顾性多中心研究。受试者：193名青光眼患者通过开放或闭合结膜方法接受XEN45植入术。方法：患者人口统计数据；诊断；术前和术后临床数据；结果测量，包括眼压；青光眼药物的使用；视力；并收集并发症。进行统计学分析，P＜0.05为显著性。主要结果指标：失败被定义为IOP比药物基线降低<20%，或在术后第1个月及以后连续2次访视时IOP>21mmHg，需要后续手术干预或额外的青光眼手术，或灾难性事件，如光感丧失。未达到这些标准且未服用青光眼药物的眼睛被视为完全成功。总体成功被定义为那些在使用或不使用局部药物的情况下取得成功的人。结果：患者平均随访17个月。开放组和封闭组的完全成功率分别为42.5%和24.7%（P=0.01）。最后一次随访时，开放组和闭合组的总成功率分别是64.2%和37.0%（P<0.001）。开孔组12.4%的眼睛进行了Bleb针刺，而闭孔组的这一比例为40%。术后，与开放组相比，封闭组出现≥10mmHg眼压峰值的可能性是开放组的两倍（40%对18%；P=0.001）。结论：与封闭结膜技术相比，开放结膜植入XEN45可降低眼压，成功率更高，针刺率更低。各组术后并发症和视力下降的发生率相似。尽管这两种手术都能显著降低眼压，但开放式技术似乎能带来更高的成功率和更少的术后干预。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。

{"title":"Interim Analysis of Clinical Outcomes with Open versus Closed Conjunctival Implantation of the XEN45 Gel Stent","authors":"Elyse J. McGlumphy MD , Anna Do MD , Amy Du MD , Earl Randy Craven MD , Lawrence S. Geyman MD , Leo Shen MS , Joel S. Schuman MD , Joseph F. Panarelli MD","doi":"10.1016/j.ogla.2023.09.001","DOIUrl":"10.1016/j.ogla.2023.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the longitudinal postoperative outcomes of open versus closed conjunctiva implantation of the XEN45 gel stent.</p></div><div><h3>Design</h3><p>Retrospective multicenter study.</p></div><div><h3>Subjects</h3><p>One hundred ninety-three patients with glaucoma underwent XEN45 implantation via an open or closed conjunctiva approach.</p></div><div><h3>Methods</h3><p>Data on patient demographics; diagnoses; preoperative and postoperative clinical data; outcome measures, including intraocular pressure (IOP); use of glaucoma medications; visual acuity; and complications were collected. Statistical analyses were performed with <em>P</em> < 0.05 as significant.</p></div><div><h3>Main Outcome Measures</h3><p>Failure was defined as < 20% reduction in IOP from the medicated baseline or a IOP of > 21 mmHg at 2 consecutive visits at postoperative month 1 and beyond, the need for subsequent operative intervention or additional glaucoma surgery, or a catastrophic event, such as loss of light perception. Eyes that had not failed by these criteria and were not on glaucoma medications were considered complete successes. Overall success was defined as those who achieved success either with or without topical medications.</p></div><div><h3>Results</h3><p>Patients were followed for an average of 17 months. Complete success was achieved in 42.5% and 24.7% of the open and closed groups, respectively (<em>P</em> = 0.01). Overall success was achieved in 64.2% and 37.0% of the open and closed groups, respectively (<em>P</em> < 0.001) at the last follow-up. Bleb needling was performed in 12.4% of eyes in the open group compared with 40% of eyes in the closed group. An IOP spike of ≥ 10 mmHg was twice as likely to occur in the closed group compared with the open group during the postoperative period (40% vs. 18%; <em>P</em> = 0.001).</p></div><div><h3>Conclusions</h3><p>Implantation of XEN45 with opening of the conjunctiva resulted in a lower IOP with greater success and lower needling rate compared with those achieved with the closed conjunctiva technique. Similar rates of postoperative complications and vision loss were noted in each group. Although both procedures provide substantial IOP reduction, the open technique appears to result in higher success rates and fewer postoperative interventions.</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":"7 2","pages":"Pages 116-122"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589419623001734/pdfft?md5=ed2767a84264117df7947fbe896680d7&pid=1-s2.0-S2589419623001734-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244542","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}

引用次数: 0

Plate and Tube Rotation of the Glaucoma Drainage Implant: An Unusual Complication 青光眼引流植入物的板和管旋转：不寻常的并发症

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.12.001

Arnav Panigrahi MD, Siddhartha Rao BS, MBBS, Viney Gupta MD

引用次数: 0

Artifacts in OCT Retinal Nerve Fiber Layer Imaging in Patients with Boston Keratoprosthesis Type 1 波士顿1型角膜瓣患者的光学相干断层扫描视网膜神经纤维层成像中的伪影。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.09.004

Alexandra G. Castillejos MD , Julia Devlin BS , Chhavi Saini MD , Jessica A. Sun BA , Mengyu Wang PhD , Grace Johnson BA , James Chodosh MD, MPH , Lucy Q. Shen MD

Purpose

To determine the clinical utility of OCT retinal nerve fiber layer (OCT RNFL) imaging for glaucoma evaluation in patients with Boston keratoprosthesis type 1 (KPro) by investigating imaging artifacts.

Design

Case-control study.

Subjects

Patients with KPro and without KPro (controls) matched for age, gender, and glaucoma diagnosis.

Methods

The most recent Cirrus OCT RNFL scan from 1 eye was categorized as having good signal strength (SS; ≥ 6 out of 10) or poor SS (< 6). Those with good SS were analyzed by 2 independent reviewers for artifacts. Images with good SS and no artifacts affecting the scanning circle were considered useful for glaucoma evaluation.

Main Outcome Measures

The incidence of poor SS and artifacts in OCT RNFL images; patient characteristics associated with useful scans.

Results

Sixty-five patients with KPro and 75 controls were included; 89.2% of KPro patients and 89.3% of control subjects had glaucoma (P = 0.98). Forty percent of KPro patients and 5.3% of controls had poor SS (P < 0.001). The proportion of images with either poor SS or artifacts was similar in KPro (76.9%) vs. controls (72.0%, P = 0.51). The most common artifacts in both groups were missing data (43.6%, 53.2%, respectively, P = 0.32) and motion artifact (25.6%, 19.7%, respectively, P = 0.47). Images were useful for glaucoma evaluation in 43.1% of KPro patients and in 69.3% of controls (P = 0.002). In the KPro group, patients with useful OCT scans, compared with those without, had better visual acuity (0.4 ± 0.3 vs. 0.9 ± 0.7 logarithm of the minimum angle of resolution, P = 0.004), and did not have congenital corneal pathologies (0.0% vs. 24.3%, P = 0.008). A multivariate analysis showed that KPro patients with older age had higher odds of useful OCT images (odds ratio, 1.05; P = 0.03). Among KPro patients with useful OCT scans, retinal nerve fiber layer thickness correlated with observed cup-to-disc ratio (Pearson correlation: r = −0.42, P = 0.03).

Conclusions

The rate of OCT RNFL images with either poor signal strength or artifacts in the KPro and control population was comparable. In patients with KPro, where intraocular pressure measurements are difficult and glaucoma is highly prevalent and often severe, OCT RNFL imaging can be useful for glaucoma evaluation.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：通过研究成像伪影，确定光学相干断层扫描视网膜神经纤维层（OCT-RNFL）成像在波士顿1型角膜假体（KPro）患者青光眼评估中的临床应用。设计：病例对照研究。受试者：患有KPro和未患有KPro的患者（对照组）的年龄、性别和青光眼诊断相匹配。方法：一只眼睛最近的Cirrus OCT RNFL扫描被归类为信号强度良好（SS；≥6/10）或SS较差（主要结果指标：OCT RNFL图像中SS不良和伪影的发生率；与有用扫描相关的患者特征（p结论：在KPro和对照人群中，OCT RNFL图像信号强度差或伪影的发生率相当。在KPro患者中，眼压测量困难，青光眼非常普遍且往往很严重，OCT RN FL成像可用于青光眼评估。

{"title":"Artifacts in OCT Retinal Nerve Fiber Layer Imaging in Patients with Boston Keratoprosthesis Type 1","authors":"Alexandra G. Castillejos MD , Julia Devlin BS , Chhavi Saini MD , Jessica A. Sun BA , Mengyu Wang PhD , Grace Johnson BA , James Chodosh MD, MPH , Lucy Q. Shen MD","doi":"10.1016/j.ogla.2023.09.004","DOIUrl":"10.1016/j.ogla.2023.09.004","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To determine the clinical utility of OCT<span> retinal nerve fiber layer (OCT RNFL) imaging for glaucoma evaluation </span></span>in patients<span> with Boston keratoprosthesis type 1 (KPro) by investigating imaging artifacts.</span></p></div><div><h3>Design</h3><p>Case-control study.</p></div><div><h3>Subjects</h3><p>Patients with KPro and without KPro (controls) matched for age, gender, and glaucoma diagnosis.</p></div><div><h3>Methods</h3><p>The most recent Cirrus OCT RNFL scan from 1 eye was categorized as having good signal strength (SS; ≥ 6 out of 10) or poor SS (< 6). Those with good SS were analyzed by 2 independent reviewers for artifacts. Images with good SS and no artifacts affecting the scanning circle were considered useful for glaucoma evaluation.</p></div><div><h3>Main Outcome Measures</h3><p>The incidence of poor SS and artifacts in OCT RNFL images; patient characteristics associated with useful scans.</p></div><div><h3>Results</h3><p>Sixty-five patients with KPro and 75 controls were included; 89.2% of KPro patients and 89.3% of control subjects had glaucoma (<em>P</em> = 0.98). Forty percent of KPro patients and 5.3% of controls had poor SS (<em>P</em> < 0.001). The proportion of images with either poor SS or artifacts was similar in KPro (76.9%) vs. controls (72.0%, <em>P</em> = 0.51). The most common artifacts in both groups were missing data (43.6%, 53.2%, respectively, <em>P</em> = 0.32) and motion artifact (25.6%, 19.7%, respectively, <em>P</em> = 0.47). Images were useful for glaucoma evaluation in 43.1% of KPro patients and in 69.3% of controls (<em>P</em><span> = 0.002). In the KPro group, patients with useful OCT scans, compared with those without, had better visual acuity (0.4 ± 0.3 vs. 0.9 ± 0.7 logarithm of the minimum angle of resolution, </span><em>P</em><span> = 0.004), and did not have congenital corneal pathologies (0.0% vs. 24.3%, </span><em>P</em><span> = 0.008). A multivariate analysis showed that KPro patients with older age had higher odds of useful OCT images (odds ratio, 1.05; </span><em>P</em> = 0.03). Among KPro patients with useful OCT scans, retinal nerve fiber layer thickness correlated with observed cup-to-disc ratio (Pearson correlation: <em>r</em> = −0.42, <em>P</em> = 0.03).</p></div><div><h3>Conclusions</h3><p>The rate of OCT RNFL images with either poor signal strength or artifacts in the KPro and control population was comparable. In patients with KPro, where intraocular pressure measurements are difficult and glaucoma is highly prevalent and often severe, OCT RNFL imaging can be useful for glaucoma evaluation.</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":"7 2","pages":"Pages 206-215"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162586","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}

引用次数: 0