Ophthalmology. Glaucoma最新文献

Purpose: To investigate difference in the characteristics of retinal nerve fiber layer (RNFL) defects between the inferior and superior retina in early glaucoma.

Design: Cross-sectional study.

Participants: A total of 103 eyes with early glaucoma (visual field mean deviation [MD] ≥-6.0 dB), with 131 RNFL defects identified in OCT enface images.

Methods: The location of RNFL defect was determined using clock-hour positions around the optic disc. The distribution of RNFL defects was presented as the number of defects in each location. The depth of each defect was assessed as the difference of circumpapillary RNFL (cpRNFL) thickness in the defect from normal values at the same location, using a normal reference database matched for the background characteristics of the glaucoma patients. These features were compared between the inferior and superior retina.

Main outcome measures: Characteristics of RNFL defects.

Results: The average MD of the included eyes was -2.04 ± 1.64 dB. We found that 51.9% of RNFL defects were located in the inferior retina and 48.1% in the superior retina. The angular location of RNFL defect was significantly closer to the foveola in the inferior retina than in the superior retina (43.5 ± 13.8° vs. 57.8 ± 21.4°, P < 0.0001). The RNFL defects were relatively localized to a narrower region in the inferior retina, whereas they were diffusely distributed over a broader area in the superior retina. The cpRNFL thickness difference in the defect from normal corresponded to 68.4 ± 12.6% of the normal value in the inferior retina and 55.1 ± 16.7% in the superior retina. It was significantly greater in the inferior retina, indicating deeper defects (P < 0.0001). The deep RNFL defects (cpRNFL thickness difference >65%) were significantly more frequent in the inferior retina than in the superior retina (72.1% vs. 28.5%, P < 0.0001).

Conclusions: The RNFL defects exhibited significantly different locations, distributions, and depths between the inferior and superior retina. Notably, considerable thinning of the RNFL was observed particularly in the inferior retina, even in eyes with early glaucoma. Acknowledging these asymmetrical characteristics of RNFL defect provides insights into its nature and may assist initial diagnosis of glaucoma.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Topic: This study synthesizes data on prevalence of glaucoma in India for the year 2020 and projects the disease burden through 2050.

Clinical relevance: Robust, country-specific prevalence estimates are essential to inform public health policy, guide resource allocation, and support advocacy for glaucoma prevention and care in India.

Methods: We included population-based studies published between January 2000 and January 2024 reporting glaucoma prevalence among individuals aged ≥40 years in India. A systematic search was conducted in PubMed, Scopus, and Web of Science using keywords and MeSH terms related to glaucoma epidemiology. Two independent reviewers screened articles using predefined criteria and extracted data. Risk of bias was assessed using the Joanna Briggs Institute's checklist. Pooled prevalence estimates were calculated using a random-effects restricted maximum likelihood (REML) model. A linear regression model projected future prevalence of glaucoma. Subgroup, meta-regression, and sensitivity analyses explored sources of heterogeneity (I²), and publication bias was assessed using Egger's test.

Results: Out of 1,657 identified articles, 13 studies with a cumulative sample of 50,671 participants were included in the meta-analysis. Study sample sizes ranged from 680 to 7438 participants. All included studies showed low risk of bias. The pooled glaucoma prevalence in India was estimated at 3.23% (95% CI: 2.54-3.92; I² = 95.52), with subtype-specific prevalence of 2.07% for POAG, 0.81% for PACG, and 0.29% for both secondary glaucoma (SG) and Pseudoexfoliation Glaucoma (PXFG). Subgroup analyses revealed significant variation in prevalence by age, gender, geographic zone, habitation, and diagnostic criteria, ranging from 0.29% to 4.92%. Despite stratification, heterogeneity remained high (I² = 50.57-97.62). By 2050, overall glaucoma prevalence is projected to increase to 4.52% (a 28.77% rise), with PACG prevalence doubling and POAG rising by 18.26%. No publication bias was detected (Egger's test, p = 0.2431).

Conclusion: Glaucoma poses a substantial public health challenge in India, with marked demographic and regional disparities. Strengthening prevention strategies, enhancing early detection, and addressing epidemiological data gaps are vital to mitigate the growing disease burden and inform public health responses.

Purpose: To identify predictive factors for ciliary block (CB) following combined phacoemulsification, intraocular lens implantation, and goniosynechialysis (P+I+GSL) in patients with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG).

Design: A multicenter retrospective study.

Participants: This study analyzed 66 eyes from 66 patients who underwent P+I +GSL between February 2022 and December 2024. Patients were categorized into 2 groups: those who developed CB (n = 33) and those who did not (n = 33). All participants were Chinese.

Methods: Preoperative biometric parameters obtained from ultrasound biomicroscopy and IOLMaster, along with intraoperative data, were analyzed. Univariable and multivariable logistic regression analyses were conducted to identify risk factors for CB.

Results: Compared to the non-CB group, patients who developed CB had shorter axial length (AL), narrower anterior chamber width (ACW), and thinner lenses (lens thickness [LT]) (P < 0.05) preoperatively. Multivariable analysis identified reduced ACW (odds ratio = 0.049, P < 0.05), decreased LT (odds ratio = 0.007, P < 0.05), and lack of preoperative mannitol administration (odds ratio = 0.025, P < 0.05) as significant predictors of CB. The optimal cutoff values for predicting CB were 11.72 mm for ACW and 4.84 mm for LT, with area under the curve values of 0.861 and 0.863, respectively.

Conclusions: Shorter AL, narrow ACW, thin lenses, and lack of preoperative mannitol administration are significant risk factors for CB following P+I+GSL in PAC and PACG patients. These findings highlight the importance of preoperative assessment of ACW and LT, along with the use of mannitol, which may help reduce the incidence of CB in high-risk patients.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Purpose: To evaluate whether perioperative topical prostaglandin analog (PGA) use alters the risk of pseudophakic cystoid macular edema (PCME) following routine cataract surgery.

Design: A retrospective cohort study.

Participants: Patients undergoing cataract surgery, without pre-existing high-risk factors for PCME (such as prior cystoid macular edema, uveitis, or retinal vascular diseases), categorized into three perioperative PGA exposure groups: (1) PGA prescribed within 3 months prior to surgery ("PGA Before"), (2) PGA prescribed within 1 month after surgery ("PGA After"), and (3) PGA prescribed both before and after surgery ("PGA Before & After"). The control group included patients with no PGA prescriptions any time before and 3 months after surgery.

Methods: The data were collected from the TriNetX United States Collaborative Network. Propensity score matching was conducted to balance demographics, cataract type and surgical complexity, glaucoma type and severity, comorbidities, and concomitant topical and long-term systemic anti-inflammatory medication use between groups. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to assess the 3-month risk of PCME following cataract surgery.

Main outcome measures: Three-month incidence of diagnostically significant PCME following cataract surgery.

Results: After matching, 9457 patients were included in the "PGA Before" group and its control, 1993 patients in the "PGA After" group and its control, and 2367 patients in the "PGA Before & After" group and its control. No significant difference in the risk of PCME was observed among those prescribed PGA prior to surgery (HR 1.08, 95% CI: 0.89-1.31), after surgery (HR 1.08, 95% CI: 0.68-1.70), or both before and after surgery (HR 0.86, 95% CI: 0.61-1.23), compared to matched controls.

Conclusions: Perioperative PGA use before or after cataract surgery was not associated with an increased risk of PCME. These findings provide evidence that PGA use in the perioperative period may not significantly impact the risk of PCME within 3 months postsurgery.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: The Nicotinamide and Pyruvate in Open-Angle Glaucoma Trial aims to establish whether nicotinamide and pyruvate dietary supplementation provides neuroprotection in eyes with treated open-angle glaucoma (OAG).

Design: A prospective, two-site, 21-month, placebo-controlled, double-masked, phase III randomized clinical trial.

Participants: Open-angle glaucoma patients recruited at Columbia University Irving Medical Center and Stanford University between March 1, 2023, and August 30, 2025.

Intervention: Study participants were randomized in a 1:1 ratio to either active product (3 g/day of nicotinamide and 1 g/day of calcium pyruvate) or placebo. Standard-of-care intraocular pressure-lowering treatment is continued throughout the study and can be modified at the discretion of the treating physician.

Main outcome measures: The primary outcome measure is a composite of functional change based on automated perimetry of the central 10° of the visual field and/or structural change based on spectral-domain OCT. Periodic blood collection allows for evaluation of intervention-related metabolomics, transcriptomics, and proteomics, and measurement of serum levels of nicotinamide and pyruvate. Secondary outcomes include the evaluation of the tolerability and safety of nicotinamide and pyruvate in OAG and the identification of factors that predispose to greater responsiveness to metabolic neuroprotective therapies in OAG. An intention-to-treat analysis will be performed at the conclusion of the trial.

Conclusions: This novel trial design may deliver valuable data on the neuroprotective potential of nicotinamide and pyruvate supplementation in glaucoma and improve our understanding of optimal study design for longitudinal randomized clinical trials focused on glaucoma neuroprotection.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: To evaluate the association between socioeconomic status (SES; represented by a patient's neighborhood area deprivation index) and structural and functional measurements of the eye at initial presentation for those who eventually underwent trabeculectomy.

Design: A retrospective cohort study.

Participants: We identify patients who underwent a trabeculectomy and had at least 1 OCT scan and 1 visual field (VF) test before undergoing surgery. Patients of any age with either progressing glaucoma or uncontrolled intraocular pressure, or both, who underwent a trabeculectomy and were a part of the DOMAIN cohort study were included.

Methods: We use a subject's first recorded OCT scan and VF test to obtain baseline structural and functional measurements. We next use patient addresses to determine their census block, which is then matched to the corresponding proxy for SES. Univariate and multivariate regressions controlling for race, age, and gender were used to analyze the associations between SES and structural and functional measurements at baseline.

Main outcome measure: The association between SES and structural and functional measures at baseline.

Results: Among the 154 eyes in the study, we find that living in an area with greater deprivation is associated with worse structural (larger cup volumes [CVs], thinner retinal nerve fiber layer, and ganglion cell-inner plexiform layer) and functional (lower visual field index [VFI] and mean deviation [MD]) measures at baseline. However, these associations only remained statistically significant in the multivariate analysis for CV, VFI, and MD after controlling for a patient's race, gender, and age. In addition, when comparing those living in the best and worst neighborhoods, we find that living in the area with the highest decile level of deprivation is associated with a 6.63 dB lower MD at presentation compared to those living in areas with the least deprivation.

Conclusions: Lower SES is associated with worse optic nerve damage and VF performance at presentation for eyes that eventually undergo trabeculectomy surgery.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: Assess management and outcomes of glaucoma in children with Stickler syndrome.

Design: A retrospective observational case series.

Subjects: Children (less than 18 years of age) with Stickler syndrome.

Methods: Review of 97 patients who presented between 2010 and 2025 with a clinical diagnosis of Stickler syndrome and had at least 2 documented eye exams. Examination findings, genetic information, ocular diagnoses, and surgeries were collected.

Main outcome measures: Best-corrected visual acuity, type of glaucoma, type of glaucoma surgeries.

Results: Fourteen of 97 patients (14%) with Stickler syndrome were diagnosed with glaucoma at a median age of 8.5 interquartile range [0.6, 12.3] years. There was no difference in age at presentation (P = 0.84) or length of follow-up (P = 0.29) between patients with and without glaucoma, but glaucomatous eyes were significantly more myopic at presentation (P = 0.02) and had worse final best-corrected visual acuity (P < 0.0001). Nine eyes of 5 patients (4 type I and 1 type II) had infantile-onset glaucoma, and all eyes required glaucoma drainage device implantation. Eleven eyes of 9 patients (2 type I, 4 type II, and 3 unknown) developed glaucoma following intraocular surgery (10 after retinal detachment and 1 after lensectomy), and 3 eyes required glaucoma drainage device placement. The other 8 eyes with glaucoma were medically managed.

Conclusions: Glaucoma is frequently diagnosed in children with Stickler syndrome. In the infantile-onset form, angle surgery does not seem to yield long-term intraocular pressure control, and these children typically require angle bypass surgery. Glaucoma following intraocular surgery may respond to medications, but some do require glaucoma drainage device placement, which can be complicated by prior scleral buckle or silicone oil.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.