J. Glaucoma [JOURNAL]
Sun
200 papers
The Incidence of Clinically Significant Hypotony After Trabeculectomy.
Khaliliyeh D, Jin S, Morales E … +4 more , Rabiolo A, de Gainza A, Leyva BK, Caprioli J
J Glaucoma · 2026 Apr · PMID 41692420 · Full text
PRCIS: This is a retrospective observational study investigating the congruity between numerical and clinical hypotony and the risk factors for clinical manifestations of hypotony after trabeculectomy. PURPOSE: To identi...
PRCIS: This is a retrospective observational study investigating the congruity between numerical and clinical hypotony and the risk factors for clinical manifestations of hypotony after trabeculectomy. PURPOSE: To identify risk factors associated with clinically meaningful hypotony after trabeculectomy. DESIGN: Retrospective cohort study. METHODS: Patients who underwent trabeculectomy with mitomycin-C (MMC) were included. Clinical hypotony was defined as the presence (≥ 3 wk after surgery) of choroidal detachment, hypotony keratopathy, hypotony maculopathy, or shallow anterior chamber or the need for trabeculectomy revision to resolve the hypotony at any time after surgery. Numerical hypotony was defined as intraocular pressure (IOP) ≤5 mmHg in 2 or more consecutive visits, at least one of them ≥ 3 weeks after surgery. Baseline, intraoperative, and postoperative characteristics were evaluated as potential risk factors. Univariable and multivariable analyses were conducted to assess the association between each characteristic and the presence of clinical hypotony. RESULTS: Nine hundred ninety-two eyes were included. Two hundred eighty-four eyes (28.6%) met the criteria for numerical hypotony, 222 of which (79.9%) did not show any clinical sequelae of hypotony. 99 eyes (10%) met our criteria for clinical hypotony, whereas 42 of them (42.4%) did not have numerical hypotony. The most frequent manifestation of hypotony was serous choroidal effusion (54 eyes, 5.4%) followed by shallow anterior chamber (28 eyes, 2.8%). Thirty-four eyes (3.4%) underwent trabeculectomy revision to treat the hypotony. Asian ethnicity mitigated against the development of clinical hypotony (OR: 0.29, CI: 0.10-0.72, P =0.015) and the requirement for suture lysis postoperatively was associated with a lower risk of clinical hypotony (OR: 0.49, CI: 0.29-0.81, P =0.006). CONCLUSIONS: A minority of eyes (20.1%) with numerical hypotony showed clinical manifestations of low IOP. Asian ethnicity and eyes that required suture lysis postoperatively tended to have less incidence of clinical sequelae of hypotony after trabeculectomy.
Original vs Shoji Edition of Tanito Microhook Trabeculotomy Combined with Cataract Surgery: Comparative Clinical Outcomes.
Shoji T, Nishida T, Tanito M
J Glaucoma · 2026 May · PMID 41662866 · Full text
PRCIS: This matched-cohort study compares the original and Shoji editions of the Tanito microhook trabeculotomy (TMH), a reusable, FDA-cleared MIGS device, when combined with cataract surgery. Both designs demonstrated s...
PRCIS: This matched-cohort study compares the original and Shoji editions of the Tanito microhook trabeculotomy (TMH), a reusable, FDA-cleared MIGS device, when combined with cataract surgery. Both designs demonstrated similar 2-year surgical success and safety profiles. While the Shoji edition incorporates ergonomic refinements, no significant differences in clinical outcomes were observed, supporting the continued use of either version in routine glaucoma care. PURPOSE: To compare the clinical efficacy and safety of the Shoji edition of the Tanito microhook trabeculotomy (TMH Shoji edition) with the original version, both performed in combination with phacoemulsification and intraocular lens implantation, in patients with open angle glaucoma. METHODS: A retrospective matched-cohort study including 518 eyes (original: 259, Shoji: 259) was conducted. Groups were matched on age, sex, glaucoma type, baseline IOP, visual field mean deviation, and number of medications. The primary outcome was surgical success over 2 years, followed by the American Academy of Ophthalmology's recommended criteria for MIGS combined with cataract surgery: ≥1 medication reduction without IOP increase, or ≥20% IOP reduction to ≤21 mm Hg without additional surgery, loss of light perception vision, or hypotony. IOP, number of medications, and postoperative complications were also recorded. Statistical analyses included Fisher exact tests and Kaplan-Meier survival with log-rank testing. RESULTS: At 12 months, surgical success was achieved in 46.4% of the original group and 50.1% of the Shoji group; at 24 months, the rates were 32.0% and 44.2%, respectively. Kaplan-Meier estimates showed no significant difference between groups (log-rank P = 1.000). Both groups achieved reductions from baseline in mean IOP and number of glaucoma medications at all time points. Postoperative complications were infrequent and comparable between groups. CONCLUSIONS: Both versions of TMH trabeculotomy combined with cataract surgery demonstrated acceptable mid-term surgical success and safety profiles. The Shoji edition, designed to improve access and usability, may offer advantages in certain surgical settings.
Comparison of Surgical Outcomes of Ab Interno Trabeculotomy Using Tanito Microhook, Suture, and Trabectome.
Sun C, Ikeda HO, Miyake M … +4 more , Suda K, Kameda T, Akagi T, Tsujikawa A
J Glaucoma · 2026 Jun · PMID 41636597 · Publisher ↗
PRCIS: The choice of surgical techniques among Tanito Microhook, Suture, and Trabectome does not significantly impact postoperative efficacy or complication rates. However, a wider incision in the trabecular meshwork may...
PRCIS: The choice of surgical techniques among Tanito Microhook, Suture, and Trabectome does not significantly impact postoperative efficacy or complication rates. However, a wider incision in the trabecular meshwork may increase the risk of hyphema. PURPOSE: To evaluate preoperative and postoperative characteristics of ab interno trabeculotomy using the Tanito Microhook (TMH), suture technique (sLOT), and Trabectome (TOM). MATERIALS AND METHODS: Preoperative and postoperative intraocular pressure (IOP), glaucoma medication scores, and complications were retrospectively analyzed in the eyes of patients undergoing ab interno trabeculotomy. RESULTS: The analysis included 196, 122, and 87 eyes in the sLOT, TMH, and TOM groups, respectively. Mean IOP decreased from 23.0, 21.3, and 24.8 mm Hg to 14.1, 14.2, and 16.2 mm Hg at 3 months (reductions: 32.6%, 26.3%, and 27.0%; P <0.001) in the sLOT, TMH, and TOM groups, respectively. No significant differences in percent IOP change ( P =0.085) or survival rates based on 4 success criteria defined by IOP thresholds (≤18/≤15 mm Hg) and reductions (≥0%/≥20%) ( P =0.44-0.88) were observed. Hyphema occurred in 43.4%, 19.7%, and 18.4%, and IOP spikes in 24.5%, 9.8%, and 20.7% of the sLOT, TMH, and TOM groups, respectively. Multivariable analysis revealed that exfoliation glaucoma, higher baseline IOP, and concomitant cataract extraction surgery were associated with greater IOP reduction. Wider trabecular meshwork incisions increased hyphema risk, while concomitant cataract surgery reduced it. Higher baseline IOP increased the risk of IOP spikes. Device selection did not significantly influence IOP reduction, hyphema incidence, or IOP spikes. CONCLUSION: TMH, sLOT, and TOM provide similar IOP-lowering efficacy. Considering patient factors-such as baseline IOP and lens status-and using available devices while avoiding excessively wide incisions may contribute to favorable surgical outcomes.
Ab Interno Minimally Invasive Glaucoma Surgery Effectiveness in Black Patients: An IRIS Registry Study.
Mbagwu M, Garcia KM, Herndon L
J Glaucoma · 2026 Feb · PMID 41610393 · Full text
PRÉCIS: MIGS in combination with cataract surgery resulted in clinically significant reductions in IOP and IOP-lowering medications up to 24 months in Black patients. PURPOSE: Describe outcomes following ab interno Minim...
PRÉCIS: MIGS in combination with cataract surgery resulted in clinically significant reductions in IOP and IOP-lowering medications up to 24 months in Black patients. PURPOSE: Describe outcomes following ab interno Minimally Invasive Glaucoma Surgery (MIGS) procedures US FDA cleared or approved for intraocular pressure (IOP) reduction in primary open angle glaucoma combined with cataract surgery and cataract surgery alone in Black patients. METHODS: An observational, retrospective study of glaucoma in Black patients treated with MIGS (Hydrus®, iStent Inject®, OMNI® Surgical System) with cataract surgery or cataract surgery alone, in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Deidentified data included glaucoma diagnosis, procedure data, IOP, and medication use from preoperatively through 24 months. The study period was 07/01/2016 and 12/31/2023. Eligible patients identified via Current Procedural Terminology codes coupled with electronic health records. Outcomes were changes in IOP, and medication class usage (months 6, 12, 18, and 24) stratified by baseline IOP (≤18; >18 mm Hg). RESULTS: In 12,828 eyes of 12,828 patients, including 189 Hydrus, 491 iStent, 91 OMNI, and 12,057 cataract surgeries, mean IOP and medication use decreased significantly in each cohort. Mean IOP reductions were in the range of 1.2-2.7 mm Hg, and medication reductions were 0.4-1.0 medications across all cohorts and time points. In MIGS cohorts, IOP reductions were greater with higher baseline IOP, and medication reductions were greater with lower baseline IOP. CONCLUSIONS: Each MIGS procedure produced clinically and statistically significant reductions in both IOP and IOP-lowering medications up to 2 years postoperatively in Black patients. Surgeons could consider offering MIGS at the time of cataract surgery to this population.
Long-term Outcomes of GATT for Glaucoma: ≥3 Year Follow-up at a UK Tertiary Center.
Aluzri H, Soomro S, Richardson J … +4 more , Pandey P, Mushtaq F, Sung VCT, Masood I
J Glaucoma · 2026 Feb · PMID 41604365 · Publisher ↗
PRECIS: At ≥3 years, GATT significantly lowered IOP and medication use in a diverse UK glaucoma cohort and subtype, with Afro-Caribbean ethnicity, non-360-degree trabeculotomy, and early postoperative IOP spikes identifi...
PRECIS: At ≥3 years, GATT significantly lowered IOP and medication use in a diverse UK glaucoma cohort and subtype, with Afro-Caribbean ethnicity, non-360-degree trabeculotomy, and early postoperative IOP spikes identified as independent predictors of surgical failure. OBJECTIVE: To report the 5-year clinical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in a heterogenous glaucoma cohort at a major tertiary glaucoma center. METHODS: This is a single-center, multisurgeon, retrospective consecutive case series of all patients (111 eyes of 95 patients) who underwent GATT, with a minimum follow-up of 3 years (median: 5.1 y, range: 3-7 y) at the Birmingham Midland Eye Centre. The primary outcome was surgical success as defined by World Glaucoma Association criteria. Secondary outcome measures included intraocular pressure (IOP), number of medications, visual field parameters, retinal nerve fiber layer (RNFL) changes, further procedures, and complications. RESULTS: Primary glaucoma was most common (68 eyes, 61.3%), predominantly open angle (43.2%), while secondary glaucoma comprised 38.7%, primarily uveitic (18.0%). Among these, 60 eyes (54.1%) underwent GATT alone, and 51 eyes (45.9%) had GATT with cataract surgery. The mean (SD) preoperative IOP significantly improved from 30.3 mm Hg (10.5) on 3.8 (1.1) medications to 17.5 mm Hg (7.7) on 2.2 (1.7) medications at the final follow-up. Qualified and complete success rates were 57.7% and 20.7%, respectively, with an overall failure rate of 42.3% and reoperation rate of 27.9%. Mean time to failure was 1.6 years (1.5), with 21.4% of failures occurring within the first postoperative year. CONCLUSION: Overall, GATT provides a minimally invasive, effective alternative to traditional surgeries, with stable visual outcomes and a manageable reoperation rate, supporting its role in advanced glaucoma management. Identified risk factors for increased surgical failure include Afro-Caribbean ethnicity and IOP spike at 1 month and non-360 degrees GATT.
Phacoemulsification Combined With Endoscopic Cyclophotocoagulation Versus Phacoemulsification Alone in Primary Angle Closure Glaucoma-A Randomized Controlled Trial.
Angmo D, Murthy AK, Dada T … +3 more , Sharma N, Maharana P, Pandey S
J Glaucoma · 2026 Apr · PMID 41591796 · Publisher ↗
PRECIS: Phacoemulsification combined with endoscopic cyclophotocoagulation had a statistically significant reduction in both intraocular pressure and the number of medications compared with phacoemulsification alone. PUR...
PRECIS: Phacoemulsification combined with endoscopic cyclophotocoagulation had a statistically significant reduction in both intraocular pressure and the number of medications compared with phacoemulsification alone. PURPOSE: Comparative evaluation of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco-ECP) versus phacoemulsification (phaco) alone in primary angle closure glaucoma (PACG) with cataract. DESIGN: Prospective, randomized, parallel-group, active-controlled trial. PARTICIPANTS: Patients with PACG and cataract. METHODS: A total of 100 consecutive patients with PACG and cataract were screened, of whom 66 patients who met the inclusion criteria were recruited. Patients were randomized into 2 groups and underwent phaco-ECP or phaco alone. The patients were examined at baseline and at 1 week, 1, 3, 6, 12, 18, and 24 months. The anterior chamber angle parameters on swept-source anterior segment OCT (SS-ASOCT) were noted at baseline and at the 3-, 6-, and 12-month follow-up. The primary outcome measures were reduction in intraocular pressure (IOP) and the number of antiglaucoma medications. RESULTS: The mean baseline IOP was 19.9±5.8 and 19.5±7.2 mm Hg in the phaco-ECP and phaco groups, respectively ( P =0.59). The mean IOP decreased to 14.0±2.6 and 15.7±2.2 mm Hg at 24 months in the phaco-ECP and phaco group, respectively ( P =0.02). The reduction in the number of medications was also significantly higher in the phaco-ECP group (1.8±1.10 vs. 1.0±0.8 mm Hg; P =0.02) as compared with the phaco-alone group. Qualified success with IOP ≤12 mm Hg was obtained in 46.6% of patients in the phaco-ECP group and 13.7% of patients in the Phaco group ( P =0.01). No absolute failures (requiring trabeculectomy) were noted in the phaco-ECP, whereas 6.9% of patients in the phaco group failed ( P =0.23). A significant widening of the angle parameters was noted postoperatively at 3, 6, 12, and 18 months as compared with baseline in both groups. The other secondary outcome parameters, like BCVA, visual field changes, endothelial cell count, pupil diameter, and complication rate, were comparable between the groups. CONCLUSIONS: The phaco-ECP group demonstrated a significant reduction in IOP and the number of medications, along with a notable widening of the nasal anterior chamber angle parameters compared with the phaco-alone group.
Comparison of MP-3 Microperimetry and Humphrey 10-2 for Central Visual Field Testing in Mild Glaucoma.
Ohira R, Nishijima E, Noro T … +3 more , Ogawa S, Okude S, Nakano T
J Glaucoma · 2026 Jan · PMID 41591794 · Publisher ↗
PRÉCIS: The MP-3 CII program may be useful for assessing central visual field function in mild-stage glaucoma, particularly in settings where direct structure-function mapping is desired. PURPOSE: This cross-sectional st...
PRÉCIS: The MP-3 CII program may be useful for assessing central visual field function in mild-stage glaucoma, particularly in settings where direct structure-function mapping is desired. PURPOSE: This cross-sectional study aimed to evaluate the performance of the newly developed MP-3 Central Goldmann size II program by comparing its central visual field sensitivity measurements with those obtained from the Humphrey Field Analyzer 10-2 SITA-Standard in patients with preperimetric and mild-stage glaucoma. PATIENTS AND METHODS: This study included 35 eyes from 26 patients with mild-stage glaucoma with macular ganglion cell analysis of optical coherence tomography abnormalities. All participants underwent comprehensive ophthalmologic examinations, including Humphrey Field Analyzer (HFA) 10-2 SITA-Standard and MP-3 Central Goldmann size II visual field testing. The MP-3 Central Goldmann size II program employs a smaller Goldmann II stimulus size and a reduced number of test points compared to the HFA 10-2 SITA-Standard to enhance the detection of subtle central visual field defects. RESULTS: The MP-3 Central Goldmann size II demonstrated a significantly shorter examination time compared to the HFA 10-2 SITA-Standard (278.8±45.1 seconds vs. 331.7±64.1 seconds, P<0.05). For the measurement points common to both programs, a positive correlation was observed between the two devices in hemifields corresponding to ganglion cell analysis abnormalities (Spearman's rank correlation coefficient, R=0.86; P<0.05) and in the hemifield corresponding to normal ganglion cell analysis (R=0.57; P<0.05). CONCLUSIONS: The MP-3 Central Goldmann size II program showed strong correlation with HFA 10-2 SITA-Standard in measuring central visual field sensitivity.
Choroidal Structural and Vascular Changes in Early Primary Angle Closure Glaucoma.
Liu H, Liang S, Liu X … +4 more , Geng Y, Ren T, Bu H, Liu D
J Glaucoma · 2026 Apr · PMID 41591793 · Publisher ↗
PRÉCIS: Thicker CT and higher CVI in the 1-12 mm circumferential annular area were noted in early PACG patients compared with healthy controls. More importantly, CVI may serve as a more sensitive indicator for disease pr...
PRÉCIS: Thicker CT and higher CVI in the 1-12 mm circumferential annular area were noted in early PACG patients compared with healthy controls. More importantly, CVI may serve as a more sensitive indicator for disease progression. PURPOSE: To investigate changes of choroidal thickness (CT) and choroidal vascularity index (CVI) in eyes with early primary angle closure glaucoma (PACG) based on swept source optical coherence tomography angiography (SS-OCTA). METHODS: A total of 86 early PACG patients (86 eyes) and 79 healthy individuals (79 eyes) were enrolled. All subjects underwent 12×12 mm macular scan and 6×6 mm optic disc scan to analyze and compare CT and CVI. Univariate and multivariate linear regression analyses were used to evaluate the relevance of CT and CVI to related factors. RESULTS: In all macular regions, patients with early PACG exhibited thicker CT and higher CVI as compared with healthy controls (all P <0.05). Multivariate linear regression analysis showed that increased subfoveal CT and CVI were associated with younger age, PACG diagnosis, and/or shorter axial length (all P <0.05). After adjusting for the compound factors of age and/or axial length, subfoveal CT and CVI remained significantly higher in patients with early PACG than in healthy controls (both P <0.01). In the peripapillary regions, the mean CT in early PACG patients in the inferior nasal and inferior temporal regions was thicker than that of the healthy controls (both P <0.05). CONCLUSION: Early PACG patients are usually associated with thicker CT and higher CVI in 1-12 mm annular regions of the macula. The changes in CT and CVI were independent of age and axial length, indicating that alterations in choroidal characteristics may contribute to the pathogenesis of PACG.
Intraocular Pressure Changes Following Corneal Cross-Linking in Patients With Keratoconus.
Zhao W, Karl J, Fan E … +2 more , Wisely CE, Asrani S
J Glaucoma · 2026 Apr · PMID 41591096 · Publisher ↗
PRÉCIS: This retrospective study found significantly elevated IOP measurements in eyes with keratoconus after CXL at postoperative months 1 and 3, but not after 4.5 months, compared with both baseline and untreated fello...
PRÉCIS: This retrospective study found significantly elevated IOP measurements in eyes with keratoconus after CXL at postoperative months 1 and 3, but not after 4.5 months, compared with both baseline and untreated fellow eyes. PURPOSE: To evaluate intraocular pressure changes after corneal collagen cross-linking in patients with keratoconus and compare intraocular pressure measurements across tonometry methods. METHODS: A retrospective chart review was performed of 405 patients (405 index eyes and 218 untreated fellow eyes) who underwent cross-linking between January 1, 2012, and January 1, 2024, at Duke Eye Center. Preoperative and postoperative intraocular pressure measurements were collected at ~1 month, 3 months, and ≥4.5 months postoperatively. Generalized estimating equation models included time point, tonometry method (iCare, Tonopen, Goldmann applanation tonometry), corticosteroid use, age, sex, and race. Wilcoxon rank-sum and sign-rank tests were used for tonometry method sub-analyses. RESULTS: In treated eyes, intraocular pressure significantly increased at 1 month (2.2 mmHg increase, P =0.001) and remained elevated at 3 months (1.1 mmHg increase, P <0.001), returning to baseline by ≥4.5 months ( P =0.168). No significant intraocular pressure change was observed in untreated fellow eyes at any postoperative time point. Tonopen measurements were consistently higher than iCare (all P <0.001). iCare measurements showed significant elevation at 1 month postoperatively ( P =0.005), and Tonopen measurements at 1 month and 3 months (both P <0.001). No elevation was observed beyond 3 months with any tonometry method. CONCLUSIONS: Corneal collagen cross-linking was associated with transient intraocular pressure elevations postoperatively that normalized by ≥4.5 months. Tonometry method significantly influences intraocular pressure measurements, with iCare having lower measurements compared with Tonopen. Awareness of this pattern is important when managing patients with risk factors for glaucoma after cross-linking.
Diabetic Retinopathy as a Risk Factor for Ocular Hypertension or Primary Open Angle Glaucoma in a United States-Based Cohort Study.
Rickels KL, Chauhan MZ, Saeedi OJ … +6 more , Kishor KS, Uwaydat SH, Bhattacharya SK, Lee RK, Sallam AB, Elhusseiny AM
J Glaucoma · 2026 Apr · PMID 41590998 · Publisher ↗
PURPOSE: Assess the association between diabetic retinopathy (DR) and the risk of ocular hypertension (OHT) or primary open-angle glaucoma (POAG) in patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). PATIENT...
PURPOSE: Assess the association between diabetic retinopathy (DR) and the risk of ocular hypertension (OHT) or primary open-angle glaucoma (POAG) in patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: This retrospective cohort study utilized the TriNetX US Collaborative Network, including 166,471 patients with T1DM and 5,745,652 patients with T2DM, categorized by DR status, ages ≥ 18 years. International Classification of Diseases 10 th Revision (ICD-10) codes identified T1DM, T2DM, and DR. Propensity score matching (PSM) adjusted for age, sex, race/ethnicity, body mass index (BMI), relevant medical history, blood markers, glycemic-controlling medications, intravitreal injections, and ophthalmic service visits. The primary outcome was the development of coded OHT or POAG over 10 years and lifetime, expressed as adjusted hazard ratios (aHR). RESULTS: DM patients with DR exhibited a significantly heightened risk of developing coded OHT or POAG. T1DM patients showed a 4.966-fold increased lifetime risk of developing OHT (95% CI: 2.178-11.325) and 4.262-fold increased lifetime risk of developing POAG (95% CI: 1.435-13.255), while T2DM patients had a 2.651-fold increased lifetime risk of developing OHT (95% CI: 2.412-2.915) and 2.62-fold POAG (95% CI: 2.37-2.89). This risk remained high in our subanalysis, and patients with PDR were at a higher risk compared with those with any stage of NPDR. Sensitivity analyses confirmed these findings across various demographic and clinical variables. CONCLUSIONS: DR is significantly associated with OHT and POAG, particularly in T1DM. These findings emphasize the need for vigilant screening and comprehensive management of diabetic patients with coexisting DR. PRECIS: Diabetic retinopathy in diabetic patients significantly increases the risk of ocular hypertension and primary open-angle glaucoma, with the highest risk in type 1 diabetics, as high as 5-fold compared with those without diabetic retinopathy.
Prospective One-Year Outcomes of Preserflo MicroShunt Implantation in Glaucoma Following Keratoplasty.
Bolek B, Wylęgała A, Wylęgała E
J Glaucoma · 2026 Apr · PMID 41590939 · Publisher ↗
PRÉCIS: This study evaluates the efficacy and safety of Preserflo MicroShunt implantation in secondary glaucoma following corneal transplantation over a consecutive 1-year follow-up period, demonstrating high success, si...
PRÉCIS: This study evaluates the efficacy and safety of Preserflo MicroShunt implantation in secondary glaucoma following corneal transplantation over a consecutive 1-year follow-up period, demonstrating high success, significant IOP reduction, and no observed graft decompensation. PURPOSE: This study aims to assess the efficacy and safety of Preserflo MicroShunt (PMS) implantation in patients with secondary glaucoma following keratoplasty over a 1-year follow-up. METHODS: In this prospective, single-center study, 19 patients (19 eyes) diagnosed with secondary glaucoma following corneal graft surgery were included for PMS implantation. The study cohort comprised 17 eyes after penetrating keratoplasty and 2 after deep anterior lamellar keratoplasty. The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, endothelial cell density (ECD), and visual acuity after the procedure. An IOP reduction of 20% compared with the baseline value without reintervention was considered a successful treatment. Complete success was defined as discontinuation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and at 1 day, 1 week, 1, 3, 6, and 12 months postoperatively. RESULTS: The reduction in IOP was statistically significant at follow-up visits compared with baseline, with a mean decrease of 57.8% at the final follow-up. Similarly, the number of antiglaucoma medications was significantly reduced at follow-up visits relative to baseline. The qualified success rate was 84.2% and the complete success rate was 63.2%. There were no statistically significant differences in visual acuity or endothelial cell density (ECD) compared with preoperative values. CONCLUSION: Preserflo MicroShunt implantation appears to be an effective and well-tolerated method of reducing intraocular pressure in patients with secondary glaucoma following keratoplasty. Long-term follow-up in a larger patient cohort is needed to confirm these results.
Beta Zone and Gamma Zone Parapapillary Atrophy in Nonmyopic Eyes.
Cho SD, Yun YI, Kim M … +2 more , Kim SH, Lee KM
J Glaucoma · 2026 May · PMID 41499697 · Publisher ↗
PRCIS: Not only β-zone but also ɣ-zone atrophy is observed in nonmyopic eyes. The presence of ɣ-zone atrophy reflects optic nerve head canal offset during eyeball expansion, and its directionality is associated with...
PRCIS: Not only β-zone but also ɣ-zone atrophy is observed in nonmyopic eyes. The presence of ɣ-zone atrophy reflects optic nerve head canal offset during eyeball expansion, and its directionality is associated with the offset direction. PURPOSE: To evaluate the locations of β-zone and ɣ-zone parapapillary atrophy (PPA) in nonmyopic eyes. METHODS: A total of 151 nonmyopic eyes with an axial length (AXL) of <24.0 mm were included in this cross-sectional study. From the Bruch membrane opening (BMO), the angular locations of the maximal width of β-zone PPA (without retinal pigment epithelium) and ɣ-zone PPA (without Bruch membrane) were compared with that of the central retinal vascular trunk (CRVT)/BMO offset, as a surrogate of lamina cribrosa/BMO offset. Based on the extent and direction of the CRVT/BMO offset, patients were classified into 3 groups: (1) minimal offset (offset index <0.2), (2) temporal offset, and (3) nasal offset. RESULTS: Sixty-four eyes had minimal offset, 53 eyes had a temporal offset, and 34 had a nasal offset. The CRVT/BMO offset showed significant angular correlations with β-zone PPA ( r =-0.209, P =0.026) and ɣ-zone PPA ( r =-0.529, P <0.001). Presence of β-zone PPA was associated with older age [odds ratio (OR)=1.119, P <0.001], longer AXL (OR=2.260, P =0.011), and the presence of ɣ-zone PPA (OR=8.952, P <0.001). Among 56 eyes with ɣ-zone PPA, 26 eyes (46.4%) had their ɣ-zone PPAs on the nasal side, which was associated with the superotemporal direction of the CRVT/BMO offset (OR=1.008, P =0.003). CONCLUSIONS: Both β-zone and ɣ-zone PPAs were found in nonmyopic eyes. Nasally located ɣ-zone PPA was associated with the temporal direction of CRVT/BMO offset, like a mirrored image of myopic PPA. ɣ-zone PPA is not restricted to myopia but represents the offset between the openings of the optic nerve head canal.
3-Year Outcomes of iStent Implant Combined With Phacoemulsification in Asian Eyes With Glaucoma: A Multidimensional Surgical Success Analysis.
Tan ST, Tan TF, Syn YT … +6 more , Chu A, Htoon HM, Perera SA, Wong TT, Low JR, Husain R
J Glaucoma · 2026 May · PMID 41499678 · Publisher ↗
PURPOSE: To evaluate the long-term performance of combined phacoemulsification and iStent implantation (iStent, iStent inject, and iStent inject W) in Asian patients with glaucoma and cataracts. PATIENTS AND METHODS: Thi...
PURPOSE: To evaluate the long-term performance of combined phacoemulsification and iStent implantation (iStent, iStent inject, and iStent inject W) in Asian patients with glaucoma and cataracts. PATIENTS AND METHODS: This retrospective study included patients who underwent combined phacoemulsification and iStent implantation at a single tertiary center from November 2016 to July 2021. Eyes with varying glaucoma subtypes and severities were included. Changes in mean intraocular pressure (IOP) and the number of glaucoma medications were assessed at baseline and postoperative months (POM) 6, 12, 24, and 36. Surgical success was evaluated using multiple definitions, including complete and qualified success (CS/QS) criteria for IOP ≤18 and ≤15 mm Hg, modified success criteria (anyIOP, anyMed, or IOPMed), and the AAO-recommended criteria. RESULTS: A total of 284 eyes (mean age 70.8±8.9 y) had preoperative IOP of 15.8±3.9 mm Hg on 1.6±0.8 medications. At POM 36, mean IOP reduction was 1.4 mm Hg ( P <0.001), and medication use decreased by 0.8 ( P <0.001). CS and QS for IOP ≤18 mm Hg were 53.4% and 89.3%, respectively; for IOP ≤15 mm Hg were 41.2% and 63.5%, respectively. Success rates were 47.4% for anyMed, 55% for anyIOP, 42.2% for IOPMed, and 56.3% for the AAO criteria. CONCLUSION: Combined iStent and phacoemulsification provided sustained, long-term reductions in both IOP and medication burden over 3 years, with over half achieving success across multiple stringent criteria, supporting its role as an effective, minimally invasive surgical option in real-world clinical practice.
Reduced Optic Nerve Head Blood Flow Correlates With an Impaired Postillumination Pupil Response in Glaucoma.
Yoshikawa T, Jimura H, Miyata K … +4 more , Obayashi K, Saeki K, Ogata N, Kase S
J Glaucoma · 2026 May · PMID 41480968 · Publisher ↗
PRCIS: In glaucomatous eyes, reduced optic nerve head blood flow was significantly associated with impaired intrinsically photosensitive retinal ganglion cell function, as assessed by the postillumination pupil response,...
PRCIS: In glaucomatous eyes, reduced optic nerve head blood flow was significantly associated with impaired intrinsically photosensitive retinal ganglion cell function, as assessed by the postillumination pupil response, independent of age and other confounding factors. PURPOSE: To investigate whether ocular nerve head (ONH) blood flow is associated with impaired intrinsically photosensitive retinal ganglion cell (ipRGC) function, assessed by the postillumination pupil response (PIPR), in eyes with glaucoma. PATIENTS AND METHODS: This cross-sectional study included 114 eyes from 114 patients with glaucoma (mean age, 69.5 y). PIPR was evaluated by measuring pupil diameters after red and blue light exposure. The main PIPR outcomes were the amplitudes of red and blue 6-second PIPR, which are pupil diameters 6 seconds after red and blue light exposure. ONH blood flow was assessed by the tissue-area mean blur rate (MBR) using laser speckle flowgraphy. RESULTS: A significantly higher blue 6-second PIPR amplitude was observed in the low tissue-area MBR group than in the high tissue-area MBR group (93.5% vs. 91.1%, P =0.043). After adjusting for age, sex, body mass index, hypertension, diabetes, intraocular pressure, and axial length, a multivariable linear regression analysis showed that tissue-area MBR inversely correlated with the blue 6-second PIPR amplitude (regression coefficient=-0.40; 95% CI, -0.73 to -0.06; P =0.021), but not the red 6-second PIPR amplitude (regression coefficient=-0.01; 95% CI, -0.36 to -0.15; P =0.42). CONCLUSIONS: Lower ONH blood flow in eyes with glaucoma correlated with impairments in ipRGCs independent of potential confounders, including age.
Risk Factors for Intraocular Pressure Elevation in Steep Trendelenburg Position During Surgery.
Durmus I, Yediyildiz MB, Yilmaz HA … +4 more , Taskin K, Karadağ E, Mat E, Çevik B
J Glaucoma · 2026 Mar · PMID 41474944 · Publisher ↗
PRÉCIS: The STP significantly increases IOP during TLH, with a more pronounced effect observed in patients with a high BMI. PURPOSE: The present study sought to determine the impact of steep Trendelenburg position (STP)...
PRÉCIS: The STP significantly increases IOP during TLH, with a more pronounced effect observed in patients with a high BMI. PURPOSE: The present study sought to determine the impact of steep Trendelenburg position (STP) on intraocular pressure (IOP) in patients undergoing total laparoscopic hysterectomy (TLH) and to establish the relationship between age, body mass index (BMI), iridocorneal angle, and surgical duration about position-related intraocular pressure changes. METHODS: Preoperative ophthalmologic evaluation was performed 1 day before surgery (T0). IOP was measured using a handheld contact tonometer at T1 (5 min after anesthesia), T2 (5 min after pneumoperitoneum), T3 (5 min in STP), T4 (after pneumoperitoneum release), T5 (at the end of surgery in supine position), and T6 (10 min after returning to supine). Surgery duration and patient demographics were recorded. RESULTS: The IOP values were found to be considerably elevated in comparison to the baseline (T0) at all designated time points (T1-T6). There was a progressive decrease in intra-abdominal pressure after the pneumoperitoneum was released (T4-T6). The findings revealed no statistically significant correlation between age and iridocorneal angle on the one hand and IOP values on the other. At T6, a negative correlation was observed between IOP and surgical duration and a positive correlation with BMI. CONCLUSIONS: The STP significantly elevates IOP during TLH, and this effect is more pronounced in patients with higher BMI. Identifying such risk factors may guide anesthetic and surgical strategies to minimize ocular complications in procedures requiring this position.
Impact of Major Retinal Vessel Position on Sectoral Peripapillary Retinal Nerve Fiber Layer Thickness in Healthy Eyes.
Leshno A, Tsamis E, Hood DC … +7 more , Vyas C, Kim M, De Moraes CG, Garg AS, Cioffi GA, Liebmann JM, Harizman N
J Glaucoma · 2026 Mar · PMID 41474941 · Publisher ↗
PRÉCIS: The position of the major retinal vessels varies across healthy individuals. This measurement significantly correlates with sectoral retinal nerve fiber layer thickness and can potentially improve the use of norm...
PRÉCIS: The position of the major retinal vessels varies across healthy individuals. This measurement significantly correlates with sectoral retinal nerve fiber layer thickness and can potentially improve the use of normative databases. OBJECTIVE: Evaluate the variability of major vessel position (MVP) among healthy individuals and its effect on optical coherence tomography (OCT) sectoral retinal nerve fiber layer (RNFL) thickness measurements. METHODS: Circumpapillary RNFL (cpRNFL) circle scans were collected from 88 healthy individuals (88 eyes). The MVP was determined using the commercial Heidelberg Eye Explorer software. For each of the 4 main temporal vessels, the MVP was defined as the angular distance (degrees) on the 3.5 mm diameter circumpapillary B-scan between the point where the circle scan intersects the vessel and the point where the circle intersects with the disc-to-fovea line. RESULTS: There was considerable variability in MVP among the healthy individuals. The positions of the superior and inferior veins were distributed normally, whereas the distributions of the arteries were skewed temporally. Sectoral cpRNFL thickness significantly correlated with superior and inferior MVP. As the MVP angle increased, the cpRNFL thickness in the superior-nasal and inferior-nasal sectors increased (Spearman correlations coefficient between 0.2 and 0.42, P <0.05). In contrast, cpRNFL thickness of the superior-temporal and inferior-temporal sectors decreased (correlation between -0.41 and -0.26, P <0.05). The thickness of the temporal sector also decreased as MVP increased (correlation between -0.43 and -0.22, P <0.05). No significant correlation was found between MVP and nasal sector thickness. CONCLUSIONS: The MVP is a reliable proxy for the distribution of the major RNFL bundles. Adjusting cpRNFL measurements based on MVP might improve the reliability of normative databases and reduce artifacts, particularly false positives, related to RNFL bundle position.
Surgical Outcomes of Ahmed Glaucoma Valve in Neovascular Glaucoma Secondary to Diabetic Retinopathy Versus Central Retinal Vein Occlusion.
Kanra AY, Dursun Yilmazşamli T, Altinel MG … +1 more , İmamoğlu S
J Glaucoma · 2026 Mar · PMID 41474938 · Publisher ↗
PRÉCIS: Ahmed glaucoma valve implantation is an effective and reliable intervention for neovascular glaucoma, demonstrating higher success and longer survival in proliferative diabetic retinopathy compared with central r...
PRÉCIS: Ahmed glaucoma valve implantation is an effective and reliable intervention for neovascular glaucoma, demonstrating higher success and longer survival in proliferative diabetic retinopathy compared with central retinal vein occlusion. Age significantly impacts surgical outcomes. PURPOSE: To evaluate and compare the surgical outcomes and prognostic factors of Ahmed glaucoma valve (AGV) implantation in neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) and central retinal vein occlusion (CRVO). PATIENTS AND METHODS: This retrospective study included 48 eyes of 46 patients with NVG due to PDR (n = 28) or CRVO (n = 18) who underwent AGV implantation. Patients with prior glaucoma surgery were excluded. All procedures were performed by a single glaucoma surgeon using a standardized long tunnel technique. Surgical success was defined as ≥20% intraocular pressure (IOP) reduction from baseline and IOP ≤ 21 mm Hg without additional glaucoma surgery or vision loss to no light perception. Kaplan-Meier survival analysis assessed surgical success, and Cox regression identified failure risk factors. RESULTS: The mean surgical success duration was longer in PDR (45.87 mo) than in CRVO (38.68 mo). One-year, 2-year, and 3-year success rates were 95.5%, 90.4%, and 90.4% in PDR, compared with 92.3%, 64.6%, and 55.4% in CRVO. Early complications, such as hyphema, were more frequent in PDR but not statistically significant. Tube exposure was observed in only one case (2.1% of total cases), which was in the CRVO group. Including the tube exposure case, tube explantation was performed in 2 patients (4.2% of total cases). Older age was a significant risk factor for failure (HR = 1.066, P = 0.049). CONCLUSION: AGV implantation provides favorable long-term outcomes for NVG secondary to PDR and CRVO, with higher success rates in PDR. Careful patient selection and standardized surgical techniques remain critical for optimizing AGV outcomes in NVG.
Modified Superior Angle Access Using a Direct Goniolens for Ab Interno Needling Bleb Revisions.
Manivel P, Rajamani M, Grover DS … +2 more , Nagasubramanian V, Ramamurthy C
J Glaucoma · 2026 May · PMID 41474937 · Publisher ↗
Direct visualization of the superior angle during ab interno bleb revision can be achieved by rotating the globe with traction sutures, allowing surgeons to use a standard direct goniolens rather than an indirect goniopr...
Direct visualization of the superior angle during ab interno bleb revision can be achieved by rotating the globe with traction sutures, allowing surgeons to use a standard direct goniolens rather than an indirect gonioprism. In this series of 13 eyes with failed or failing trabeculectomy blebs, globe rotation permitted consistent identification of the trabeculectomy ostium, and facilitated effective needling with the Grover-Fellman spatula without intraoperative perforations or bleb leaks. This simple modification may broaden the adoption of ab interno bleb revision and improve access to the superior angle for a range of MIGS procedures.We describe a novel technique of globe rotation that facilitates direct gonioscopic visualization of the superior angle during ab interno bleb revision and evaluate its outcomes. A retrospective review of 13 eyes undergoing revision with the Grover-Fellman biplanar sclerostomy spatula was performed. The superior angle was visualized using a direct goniolens after globe rotation with limbal traction sutures and optimal patient and microscope positioning. All cases achieved successful access to the trabeculectomy ostium. Mean intraocular pressure decreased from 25.7 ± 13 mm Hg preoperatively to 10.5 ± 4.2 mm Hg at 6 months ( P = 0.005), and the median number of medications reduced from 4 (IQR: 2-4) to 0 (IQR: 0-2) ( P = 0.005). Three eyes required antiglaucoma medications, and 1 required an aqueous drainage implant postoperatively. No bleb leaks or conjunctival perforations occurred, and the technique was also combined with other MIGS procedures in select patients. Globe rotation provides a simple means to achieve direct visualization of the superior angle and enables ab interno bleb revision with a direct goniolens. This approach may serve as a practical alternative to indirect gonioscopy and facilitate broader adoption of ab interno techniques.
Glaucoma Diagnosis in Randomized Trials: Variability and the Need for Standardization.
Amiri I, Tang V, Mwanza JC … +2 more , Szatmary G, Fleischman D
J Glaucoma · 2026 Mar · PMID 41474870 · Publisher ↗
PURPOSE: Glaucoma, a leading cause of irreversible blindness, lacks a universally accepted diagnostic definition, resulting in significant variability across clinical trials. This systematic review evaluates and categori...
PURPOSE: Glaucoma, a leading cause of irreversible blindness, lacks a universally accepted diagnostic definition, resulting in significant variability across clinical trials. This systematic review evaluates and categorizes the diagnostic criteria employed for glaucoma in randomized controlled trials (RCTs) over the past decade. METHODS: A systematic review of PubMed and ClinicalTrials.gov databases was performed for RCTs published between January 1, 2014, and December 31, 2024, involving adults diagnosed with primary open-angle glaucoma or normal-tension glaucoma. Studies explicitly stating diagnostic criteria were included. Extracted diagnostic criteria were categorized into clinically relevant groups. RESULTS: Of 482 identified articles, 83 met inclusion criteria. Significant variability in glaucoma definitions was observed, encompassing 57 unique definitions. Criteria differed notably in intraocular pressure (45 unique definitions), visual field impairment (40), structural optic nerve parameters (35), and retinal nerve fiber layer assessments (15). Definitions were grouped into Mixed Criteria (37.3%), Combined Comprehensive (31.3%), IOP-Emphasized (27.7%), Visual Field-Emphasized (2.4%), and Imaging-Focused (1.2%). CONCLUSIONS: Substantial heterogeneity exists in glaucoma diagnostic criteria across recent RCTs, complicating clinical comparability and risking diagnostic inaccuracies. This highlights the urgent need for universally standardized definitions informed by collaborative international consensus, incorporating structural-functional correlations and advanced imaging technologies.
Factors Associated With Glaucomatous Progression in Eyes With Prior Refractive Corneal Surgery.
Yeo S, Sung KR
J Glaucoma · 2026 Mar · PMID 41474867 · Publisher ↗
PRÉCIS: Glaucomatous patients with longer axial length and thinner central cornea have a higher risk of progression after refractive surgery, emphasizing the need for close monitoring for early detection and timely inter...
PRÉCIS: Glaucomatous patients with longer axial length and thinner central cornea have a higher risk of progression after refractive surgery, emphasizing the need for close monitoring for early detection and timely intervention. PURPOSE: To identify risk factors associated with glaucomatous progression in eyes with a history of refractive corneal surgery (RCS). METHODS: This retrospective observational cohort study included 65 eyes of 65 patients with primary open angle glaucoma (POAG) who underwent RCS. Glaucoma progression was determined based on structural changes in optic disc/retinal nerve fiber layer (RNFL) photographs and/or visual field (VF) deterioration. Cox proportional hazards analysis was used to identify risk factors for disease progression. VF mean deviation (MD) and RNFL thickness progression rates obtained using a linear mixed-effects model were compared across tertile groups based on axial length (AXL) and central corneal thickness (CCT), respectively. RESULTS: Over the follow-up period (mean: 9.1±2.9 y), 23 eyes (35%) exhibited glaucomatous progression. The progression group had significantly longer AXL ( P <0.001), thinner CCT ( P =0.009) compared with those in the stable group. Multivariate analysis identified longer AXL [hazard ratio (HR): 1.507, P =0.037] and thinner CCT (HR: 0.988, P =0.037) as significant predictors of glaucoma progression. VF MD declined faster in the middle and highest AXL tertile groups, whereas RNFL thinning was the most pronounced in the highest AXL tertile group. The lowest CCT tertile group exhibited the fastest VF MD decline and RNFL thinning. CONCLUSIONS: Patients with POAG and a history of RCS who present with longer axial length and thinner central corneal thickness, are at significantly higher risk of glaucomatous progression, highlighting the importance of vigilant long-term monitoring in these eyes.
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