Journal Of Glaucoma[JOURNAL]
Sun
200 papers
Intraoperative Injection Versus Sponge-Applied Mitomycin C During Trabeculectomy In Glaucoma: A Systematic Review and Meta-Analysis.
Gaban N, Pelison G, Binotti WW … +2 more , Taranta LF, Krishnan C
J Glaucoma · 2025 Dec · PMID 40934144 · Publisher ↗
PRÉCIS: This study highlights intraoperative mitomycin C (MMC) injection in trabeculectomy with a higher success rate and reduction in glaucoma medications, however, no difference in mean IOP at 1 year or safety profile,...
PRÉCIS: This study highlights intraoperative mitomycin C (MMC) injection in trabeculectomy with a higher success rate and reduction in glaucoma medications, however, no difference in mean IOP at 1 year or safety profile, compared with MMC sponge. PURPOSE: To compare the efficacy and safety of intraoperative injection of mitomycin C (MMC) versus conventional MMC-soaked sponges in patients undergoing trabeculectomy. METHODS: Pubmed, Cochrane, and Embase were searched for studies published until December 2023 comparing injection and sponge techniques during trabeculectomy. Main outcomes of interest were postoperative mean intraocular pressure (IOP) at 6 months, complete surgical success (mean IOP 5-21 mm Hg without medication), postoperative number of antiglaucoma medications ≥12 months, and postoperative complications. This study was registered in PROSPERO, CRD42023494096. RESULTS: A total of 1665 eyes from 17 studies [9 randomized controlled trials (RCT)] were included, of which 723 (43.42%) received intraoperative injection of MMC. The mean IOP at 6 months was significantly lower in the injection group [mean difference (MD)= -0.93; 95% CI: -1.85 to -0.01]. Also, the incidence of complete surgical success ≥6 months was higher in the injection group (OR=1.79; 95% CI: 1.33-2.40). There were no significant differences between groups for postoperative complications (OR=1.01, 95% CI: 0.69-1.49). Conversely, analysis of RCTs only showed a significant reduction in the number of medications for glaucoma control ≥12 months with injection (MD= -0.37; 95% CI: -0.60 to -0.14). CONCLUSION: Intraoperative MMC injection had a greater rate of complete surgical success and reduction in the number of medications. However, there was no significant difference in mean IOP at 12 months between groups. MMC injection was as safe as sponge application in trabeculectomy.
Associations Between IgE-Allergen Sensitization and Glaucoma: An Analysis of Korea National Health and Nutrition Examination Survey.
Kwak J, Kim YK
J Glaucoma · 2025 Nov · PMID 40928373 · Publisher ↗
PRÉCIS: Analysis of 1175 Korean adults in the 2019 KNHANES study found that sensitization to house dust mites and birch pollen significantly increased glaucoma risk, while oak pollen sensitization showed a protective eff...
PRÉCIS: Analysis of 1175 Korean adults in the 2019 KNHANES study found that sensitization to house dust mites and birch pollen significantly increased glaucoma risk, while oak pollen sensitization showed a protective effect. BACKGROUND: The relationship between allergen sensitization and glaucoma remains poorly understood. This study investigated the association between specific allergen sensitization patterns and glaucoma risk using data from the 2019 Korea National Health and Nutrition Examination Survey. METHODS: In this population-based cross-sectional study, we analyzed 1175 adult participants (≥19 y) who completed ophthalmologic examinations and allergen sensitization assessments. Glaucoma diagnosis was based on International Society of Geographical and Epidemiological Ophthalmology criteria. Specific IgE antibodies against 7 common allergens were measured using ImmunoCAP assays, with significant sensitization defined as IgE ≥3.5 kU/L. We employed the Synthetic Minority Over-sampling Technique to address class imbalance. Multiple logistic regression models were employed to evaluate associations between allergen sensitization and glaucoma, adjusting for demographic and clinical factors. RESULTS: Among the participants, 50 (4.3%) were diagnosed with glaucoma. Analysis of allergen sensitization patterns revealed house dust mites as the most prevalent allergen (11.7% overall), with comparable rates between the glaucoma (12.0%) and non-glaucoma groups (11.7%). Birch pollen sensitization followed at 4.1% and 4.0% in the glaucoma and non-glaucoma groups, respectively. Multivariate logistic regression analysis, after adjusting for confounders, identified house dust mite sensitization as having the strongest positive association with glaucoma (OR: 3.08, 95% CI: 1.40-6.77, P =0.005), followed by birch pollen (OR: 2.69, 95% CI: 1.02-7.12, P =0.046). Interestingly, oak pollen sensitization demonstrated a protective effect (OR: 0.24, 95% CI: 0.07-0.81, P =0.022). CONCLUSIONS: Our findings suggest a complex relationship between allergen sensitization and glaucoma, with different allergens showing varying associations with disease risk.
Bent Ab Interno Needle Goniotomy Versus Gonioscopy-Assisted Transluminal Trabeculotomy in Primary Open Angle Glaucoma: A Randomized Clinical Trial.
Ayub G, Costa VP
J Glaucoma · 2025 Nov · PMID 40928363 · Publisher ↗
PRÉCIS: Gonioscopy-assisted transluminal trabeculotomy achieved a higher success rate than Bent Ab interno Needle Goniotomy in pseudophakic primary open angle glaucoma eyes at 12-months. PURPOSE: To evaluate and compare...
PRÉCIS: Gonioscopy-assisted transluminal trabeculotomy achieved a higher success rate than Bent Ab interno Needle Goniotomy in pseudophakic primary open angle glaucoma eyes at 12-months. PURPOSE: To evaluate and compare the efficacy and safety of standalone Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in pseudophakic primary open angle glaucoma (POAG) eyes. METHODS: Parallel, double-arm, 1:1 ratio, single masked, single surgeon, randomized clinical trial. Uncontrolled mild to moderate pseudophakic POAG eyes, defined by visual field mean deviation, were enrolled. Antiglaucoma medication was washed out before surgery and at 11 months. Patients were followed for 12 months. Surgical success was defined as 6≤IOP≤18 mm Hg and 20% IOP reduction from baseline with (qualified) or without (complete) the use of medication. RESULTS: Twenty-two eyes underwent BANG and 23 underwent GATT. At inclusion, mean IOPs were 21.18±2.87 mm Hg versus 19.87±2.34 mm Hg ( P =0.1) under 2.41±0.9 versus 2.35±0.88 medications ( P =0.71) in the BANG and GATT groups, respectively. Baseline washout IOPs were 25.55±4.9 mm Hg versus 25.43±4.98 mm Hg in the BANG and GATT groups, respectively ( P =0.92). At POD330, IOPs in GATT and BANG groups were 15.62±3.29 mm Hg (-21.38%, P =0.04) and 16.95±2.82 mm Hg (-19.97%, P <0.01), respectively ( P =0.16). At POD360, after washout, IOPs were 21.57±11.11 mm Hg (-15.17%, P =0.06) and 24.59±7.94 mm Hg (-3.75%, P =0.53) ( P =0.31 between the groups). The mean number of medications used at POD330 was 1.1±1.55 in GATT (-53.19%, P <0.01) and 1.82±1.05 in BANG eyes (-24.48%, P =0.06) ( P =0.08 between the groups). GATT eyes had higher complete (60.1% vs. 4.5%, P <0.01) and qualified success rates (64.7% vs. 22.7%, P =0.01) than BANG eyes. Transient hyphema was the most common complication following GATT (56.52%) and BANG (40.9%). CONCLUSION: GATT eyes achieved higher success rates, lower mean IOPs and required less antiglaucoma medication than BANG eyes after 11-months.
Deep Learning Estimation of 24-2 Visual Field Map From Optic Nerve Head Optical Coherence Tomography Angiography.
Mahmoudinezhad G, Moghimi S, Ru L … +13 more , Yong YX, Yang D, Cheng J, Beheshtaein S, Walker E, Latif K, Du KH, Gunasegaran G, Nishida T, Christopher M, Zangwill L, Vasconcelos N, Weinreb RN
J Glaucoma · 2025 Nov · PMID 40923848 · Publisher ↗
PRÉCIS: Artificial intelligence applied to OCTA images demonstrated high accuracy in estimating 24-2 visual field maps by leveraging information from the parapapillary area. PURPOSE: To develop deep learning (DL) models...
PRÉCIS: Artificial intelligence applied to OCTA images demonstrated high accuracy in estimating 24-2 visual field maps by leveraging information from the parapapillary area. PURPOSE: To develop deep learning (DL) models estimating 24-2 visual field (VF) maps from optical coherence tomography angiography (OCTA) optic nerve head (ONH) en face images. METHODS: A total of 3148 VF OCTA pairs were collected from 994 participants (1684 eyes). DL models were trained using radial peripapillary capillary (RPC), superficial, and choroidal, as well as combined ONH VD layers, to estimate 24-2 mean deviation (MD), pattern standard deviation (PSD), 52 total deviation (TD), and pattern deviation (PD) values and compared with a linear regression (LR) model. Model accuracy was assessed by calculating mean absolute error (MAE) and R (Pearson correlation coefficient) between estimated and actual VF values. RESULTS: DL models outperformed LR estimates for the estimation of VF values using individual and combined layers ( P <0.001). For example, in the estimation of MD using RPC, DL achieved an R of 0.79 and MAEs of 1.77 dB. Average estimated TDs using RPC had R of 0.63 and MAEs of 3.08 dB. DL estimation using combined layers slightly improved the choroid in the estimation of MD ( P <0.01) and had comparable performance with RPC and superficial layers. It also slightly improved RPC, superficial and choroidal layer in the estimation of TDs ( P <0.01). CONCLUSIONS: DL models from OCTA images demonstrated high accuracy in estimating 24-2 VF maps by leveraging information from ONH layers. By extending the application of DL to OCTA images using RPC or superficial layers, it may be possible to reduce the frequency of VF testing to individual patients.
Comparing Performance of Large Language Model-Based Tools on Patient-Driven Glaucoma Inquiries.
Gupta D, Wagner SL, Castillejos Ellenthal AG … +5 more , Gross AW, Lu ES, Chang EK, Rao AS, Succi MD
J Glaucoma · 2026 Jan · PMID 40923845 · Publisher ↗
PRÉCIS: GPT-4o and GPT-4o Mini outperformed Gemini Pro in effectively answering glaucoma-related questions, suggesting that GPT models provide high-quality information and highlights the potential of AI chatbots to deliv...
PRÉCIS: GPT-4o and GPT-4o Mini outperformed Gemini Pro in effectively answering glaucoma-related questions, suggesting that GPT models provide high-quality information and highlights the potential of AI chatbots to deliver medically relevant knowledge. PURPOSE: Large language models (LLMs) can assist patients who seek medical knowledge online to guide their own glaucoma care. Understanding the differences in LLM performance on glaucoma-related questions can inform patients about the best resources to obtain relevant information. METHODS: This cross-sectional study evaluated the accuracy, comprehensiveness, quality, and readability of LLM-generated responses to glaucoma inquiries. Seven questions posted by patients on the American Academy of Ophthalmology's Eye Care Forum were randomly selected and prompted into GPT-4o, GPT-4o Mini, Gemini Pro, and Gemini Flash in September 2024. Four physicians practicing ophthalmology assessed responses using a Likert scale based on accuracy, comprehensiveness, and quality. The Flesch-Kincaid Grade level measured readability, while Bidirectional Encoder Representations from Transformers (BERT) Scores measured semantic similarity between LLM responses. Statistical analysis involved either the Kruskal-Wallis test with Dunn post-hoc test or ANOVA analysis with Tukey Honestly Significant Difference (HSD) test. RESULTS: GPT-4o rated higher in accuracy ( P =0.016), comprehensiveness ( P =0.007), and quality ( P =0.002) compared with Gemini Pro. GPT-4o Mini rated higher in comprehensiveness ( P =0.011) and quality ( P =0.007). Gemini Flash and Gemini Pro were similar across all criteria. There were no differences in readability, and LLMs mostly produced semantically similar responses. CONCLUSIONS: GPT models surpass Gemini Pro in addressing commonly asked questions about glaucoma, providing valuable insights into the application of LLMs for providing health information.
Comparison of 30-2 Visual Field Using Melbourne Rapid Fields Online Perimetry and Humphrey Field Analyzer.
Sugihara K, Kong YXG, Hosokawa M … +1 more , Okanouchi T
J Glaucoma · 2025 Nov · PMID 40923841 · Publisher ↗
PRÉCIS: Protocol 30-2 of Melbourne Rapid Fields, online computer perimetry, provides a portable, reliable, and patient-friendly alternative to Humphrey Field Analyzer 30-2 SITA fast protocol for Japanese with all severit...
PRÉCIS: Protocol 30-2 of Melbourne Rapid Fields, online computer perimetry, provides a portable, reliable, and patient-friendly alternative to Humphrey Field Analyzer 30-2 SITA fast protocol for Japanese with all severity stages of glaucoma patients. PURPOSE: Melbourne Rapid Fields (MRF) online computer perimetry is a web-browser-based software that offers white-on-white threshold perimetry using any computer. This study evaluates the perimetric results of the 30-2 protocol from MRF performed using a laptop computer in comparison to the Humphrey Field Analyzer (HFA). METHODS: A prospective and cross-sectional study of 87 eyes from 87 Japanese glaucoma patients. The MRF software includes features such as computer vision gaze monitoring and thresholding using Bayes logic. MRF's 30-2 VF results were compared with HFA 30-2 SITA-Fast, including mean deviation (MD), pattern deviation (PD), and reliability indices. Patients underwent 2 assessments on the MRF to establish test-retest reliability. RESULTS: Of the 87 eyes, 43 eyes had mild field defect (MD>-6 dB), 26 had moderate field defect (-12 dB≤MD≤-6 dB), and 18 had advanced field defects (MD<-12 dB). MRF demonstrated a high level of agreement with HFA in evaluating MD [intraclass correlation coefficient (ICC): 0.97; 95% CI: 0.95-0.98] and PSD (ICC: 0.91; 95% CI: 0.86-0.94). Bland-Altman analysis revealed a mean bias of -0.76 decibels (dB) [95% limits of agreement (LoA): -5.82 dB, +4.30 dB] for MD and 0.79 dB (LoA: -4.24 dB, +5.82 dB) for PSD. Regarding MRF test-retest, Bland-Altman analysis demonstrated a mean bias of 0.25 dB (LoA: - 2.48 dB, +2.99 dB) for MD and -0.21 dB (LoA: -3.22 dB, +2.79 dB) for PSD. Although false positives and fixation losses were comparable between MRF and HFA, the MRF showed slightly higher false negatives and longer test times than HFA, though these differences did not reach statistical significance. In the mild group, MRF has a sensitivity of detecting field defects of 80% and a specificity of 72%. CONCLUSION: MRF provides a portable and accessible alternative to HFA for 30-2 visual field testing, with good agreement in moderate to advanced glaucoma. However, its slightly higher false negatives, longer test duration, and systemic difference in output to HFA should be considered when interpreting results. Further improvements may enhance its clinical utility.
Open Angle Glaucoma Treatment Preferences of Glaucoma Specialists in the United States.
Liu J, Kim IM, Chen EM … +5 more , Porco TC, McLeod SD, Gazzard G, O'Brien KS, Sun CQ
J Glaucoma · 2025 Nov · PMID 40891949 · Publisher ↗
PRÉCIS: This cross-sectional survey study evaluated the current treatment preferences of US glaucoma specialists for open angle glaucoma, finding that most preferred selective laser trabeculoplasty over topical medicatio...
PRÉCIS: This cross-sectional survey study evaluated the current treatment preferences of US glaucoma specialists for open angle glaucoma, finding that most preferred selective laser trabeculoplasty over topical medications for treatment-naive patients with ocular hypertension and open angle glaucoma. PURPOSE: To describe US glaucoma specialists' preferences regarding the use of selective laser trabeculoplasty (SLT) versus topical glaucoma medications for the treatment of open angle glaucoma. METHODS: Actively practicing glaucoma specialists from the American Glaucoma Society were invited to participate in a survey assessing treatment preferences and influencing factors. Multivariable logistic regressions were performed to determine predictors of preference for SLT. RESULTS: Of 136 eligible respondents, 65%-71% preferred SLT for treatment-naive patients with ocular hypertension, mild-to-moderate primary open angle glaucoma (POAG), pseudoexfoliation glaucoma, or pigmentary glaucoma. For mild-to-moderate POAG on one medication, 75% of respondents favored SLT. For advanced POAG on maximum medical therapy, 57% of respondents favored surgery and 38% preferred SLT. Respondents indicated that reducing medication nonadherence (93%), suitable glaucoma type or stage (88%), and experience performing SLT (83%) were key facilitators in recommending SLT to their patients. In contrast, patients' inability to position for the procedure (78%), unsuitable glaucoma type or stage (67%), and comorbidities or contraindications to SLT (55%) were primary reasons to not recommend SLT. Physicians in private practice, those who completed fellowship training more recently, and those who see more treatment-naive glaucoma patients were significantly more likely to prefer SLT over medication. CONCLUSION: The majority of US glaucoma specialists report a preference for SLT over medication for open angle glaucoma treatment, demonstrating that acceptance of SLT has increased over the past several years, especially for treatment-naïve patients. Statistically significant predictors of SLT preference were practice setting, practice duration, and patient volume.
Effectiveness and Safety of Omidenepag Isopropyl 0.002% Ophthalmic Solution in Treatment-Naive Patients With Primary Open Angle Glaucoma: A Prospective Multicenter Phase IV Study.
Bae HW, Lee EJ, Jung JJ … +1 more , Park KH
J Glaucoma · 2025 Sep · PMID 40838859 · Full text
PRÉCIS: Omidenepag isopropyl is a selective E-prostanoid subtype 2 (EP2) receptor agonist that lowers intraocular pressure. Omidenepag isopropyl 0.002% ophthalmic solution is effective and safe to use at the first diagno...
PRÉCIS: Omidenepag isopropyl is a selective E-prostanoid subtype 2 (EP2) receptor agonist that lowers intraocular pressure. Omidenepag isopropyl 0.002% ophthalmic solution is effective and safe to use at the first diagnosis of primary open angle glaucoma. PURPOSE: To evaluate the effectiveness and safety of omidenepag isopropyl 0.002% ophthalmic solution in treatment-naive patients at first diagnosis of primary open angle glaucoma (POAG) in real-world clinical settings in Korea. PATIENTS AND METHODS: In a single-arm, multicenter, open-label, prospective, phase IV clinical trial, patients with newly diagnosed POAG received omidenepag isopropyl 0.002% (one drop once daily) for 12 weeks. The primary endpoint was the change from baseline in intraocular pressure (IOP) at week 12. Secondary endpoints included change from baseline in IOP at week 4; change from baseline in IOP at week 12 in a subgroup with normal tension glaucoma (NTG); occurrences, incidence rates and changes from baseline in safety-related indicators (macular edema, endothelial cell count, central corneal thickness, prostaglandin-associated periorbitopathy syndrome). Safety was assessed by the occurrence of adverse events (AEs). RESULTS: The effectiveness analysis set comprised 37 patients and the safety analysis set 50 patients. Mean IOP decreased from 16.19±2.65 mm Hg at baseline to 13.55±2.46 mm Hg at week 12 (P<0.0001), representing a 16% reduction. Mean reduction in IOP was 15% at week 4 (P<0.0001); and 16% at week 12 (P<0.0001) in the NTG subgroup (n=31). Aside from conjunctival injection, no notable changes were observed in safety-related evaluation indicators. The most common AEs were hyperemia (13 cases) and iridocyclitis (5 cases). No systemic AEs were reported. CONCLUSION: Omidenepag isopropyl 0.002% ophthalmic solution is suitable for first-line use at first diagnosis of POAG, including in patients with NTG.
Trabeculectomy Bleb Characteristics in Relation to Bleb Success Using Anterior Segment Optical Coherence Tomography-A Systematic Review and Meta-Analysis.
Sim JJL, Betzler BK, Dorairaj S … +2 more , Dada T, Ang BCH
J Glaucoma · 2025 Sep · PMID 40838860 · Publisher ↗
PRÉCIS: ASOCT features of greater bleb height, thicker bleb walls, and lower reflectivity are associated with trabeculectomy success, supporting the ASOCT's utility in monitoring and predicting outcomes postsurgery throu...
PRÉCIS: ASOCT features of greater bleb height, thicker bleb walls, and lower reflectivity are associated with trabeculectomy success, supporting the ASOCT's utility in monitoring and predicting outcomes postsurgery through standardized imaging protocols. PURPOSE: To evaluate and quantify the relationship between bleb characteristics on ASOCT with surgical outcomes. METHODS: A literature search was conducted across Medline, Embase, Cochrane, and Scopus for studies from the past 20 years, until 16 September 2024, on "glaucoma," "trabeculectomy," and "ASOCT." Data collected included patient characteristics, each study's definition of bleb success, clinical outcomes, as well as bleb characteristics. A literature review was conducted on studies that could not be used for meta-analysis. RESULTS: Eleven studies, with a pooled total of 528 eyes in 517 patients, were included in the final meta-analysis. Successful blebs had significantly higher mean bleb height [mean difference (MD) 0.38 mm, 95% CI: 0.20-0.56 mm, P=0.002], greater maximum bleb wall thickness (MD: 0.21 mm, 95% CI: 0.07-0.35 mm, P=0.009), and decreased reflectivity (MD: -48.9%, 95% CI: -78.3 to -19.4%, P=0.010), compared with failed blebs. No significant differences were found in bleb fluid cavity height and bleb area. Narrative synthesis revealed that wider blebs, increased fluid-filled cavity height, increased number of microcysts, larger filtration opening widths, and multiform bleb walls were also associated with higher rates of bleb success. Early bleb parameters were statistically significant predictors of bleb success up to 12 months postoperatively. CONCLUSIONS: Greater bleb height, thicker bleb walls, and lower reflectivity on ASOCT are consistently associated with successful trabeculectomy outcomes. The ASOCT may be useful in predicting bleb success and in supplementing postoperative monitoring, hence guiding timely medical or procedural interventions, to ensure long-term bleb success.
Twelve-Month Outcomes of Ultrasound Cycloplasty After Failed Glaucoma Surgery: A Prospective Study.
Li L, Li Y, Hong L … +2 more , Wang Y, Zhu X
J Glaucoma · 2025 Nov · PMID 40833426 · Publisher ↗
PRÉCIS: UCP effectively reduced IOP by 54.10% in eyes with failed glaucoma surgeries after 12 months. Complete and qualified success rates were 21.05% and 68.42%, respectively, demonstrating UCP's potential as a safe and...
PRÉCIS: UCP effectively reduced IOP by 54.10% in eyes with failed glaucoma surgeries after 12 months. Complete and qualified success rates were 21.05% and 68.42%, respectively, demonstrating UCP's potential as a safe and effective salvage treatment. PURPOSE: This prospective study aims to evaluate the outcomes and safety of ultrasound cycloplasty (UCP) in controlling intraocular pressure in patients with prior failed glaucoma surgeries. PATIENTS AND METHODS: A total of 19 eyes from 19 patients who underwent UCP following failed glaucoma surgery between September 2020 and September 2022, were included. All patients were followed for over 12 months. Intraocular pressure, ocular hypotensive medications, and best-corrected visual acuity were recorded and compared after surgery. Complete success was defined as intraocular pressure within the range of 6-21 mm Hg after treatment and a reduction of at least 20% from baseline, without the use of ocular hypotensive medications. Qualified success was defined the same as complete success but allows the presence of ocular hypotensive medications. RESULTS: At 12 months follow-up, intraocular pressure decreased from 44.95±10.73 mm Hg to 20.63±6.19 mm Hg, representing a reduction of 54.10% ( P <0.01). The rates of complete successes and qualified successes were 21.05% (4 of 19 eyes) and 68.42% (13 of 19 eyes) 12 months after treatment, respectively. CONCLUSION: UCP is an effective and safe surgical approach for eyes with prior failed glaucoma surgeries.
Ocular and Systemic Risk Factors and Clinical Implications in Glaucoma Patients With Retinal Vein Occlusion.
Lee M, Park MS, Lee C … +1 more , Baek SU
J Glaucoma · 2025 Nov · PMID 40833354 · Publisher ↗
PRÉCIS: Ocular factors such as worse visual acuity, increased optic disc cupping, and peak IOP-commonly associated with advanced glaucoma-have been identified as risk factors for concurrent RVO in glaucoma. PURPOSE: This...
PRÉCIS: Ocular factors such as worse visual acuity, increased optic disc cupping, and peak IOP-commonly associated with advanced glaucoma-have been identified as risk factors for concurrent RVO in glaucoma. PURPOSE: This study aimed to identify ocular and systemic factors associated with concurrent retinal vein occlusion (RVO) in glaucoma and to examine their clinical significance. PATIENTS AND METHODS: This retrospective study analyzed glaucoma patients with RVO, which was compared with a matched control group of glaucoma without RVO. Various ocular and systemic factors were identified as increasing the risk of RVO. RVO subgroup analyses were performed in central retinal vein occlusion (CRVO) and branch retinal vein occlusion. The RVO group was then categorized into correspondence and noncorrespondence groups based on the synchronicity of RVO location and glaucomatous defect. RESULTS: A total of 86 eyes in the RVO group and 70 eyes in the control group were included. Multivariate analysis identified significant risk factors for RVO, including worse visual acuity (VA) (HR=4.887, P =0.011), higher peak intraocular pressure (IOP) (HR=4.140, P =0.005), and increased vertical cup-to-disc ratio (CDR) (HR=3.061, P =0.020). Subgroup analysis revealed that higher peak IOP ( P =0.030) and lower peripapillary retinal nerve fiber layer thickness ( P =0.019) were associated with CRVO. In the RVO group, 68.6% were categorized into the correspondence group, of which the ocular and systemic profiles were similar to the noncorrespondence group. CONCLUSION: These findings suggest that glaucoma and RVO may share common pathophysiologic mechanisms, with elevated IOP potentially contributing to the development of RVO. The majority of RVO locations in glaucoma were synchronous with existing glaucomatous defects, which highlights the need for regular fundus examinations in high-risk individuals.
Exposure of PreserFlo Microshunt: Risk Factors and Surgical Management.
Morales-Fernández L, García-Bardera J, Martínez-de-la-Casa JM … +1 more , García-Feijoo J
J Glaucoma · 2025 Nov · PMID 40833350 · Publisher ↗
Preserflo MicroShunt (PMS) has emerged as a safe and effective subconjunctival implant for lowering intraocular pressure in glaucoma. Although most postoperative complications occur early and are transient, long-term dat...
Preserflo MicroShunt (PMS) has emerged as a safe and effective subconjunctival implant for lowering intraocular pressure in glaucoma. Although most postoperative complications occur early and are transient, long-term data remain limited-particularly regarding rare but serious events such as device exposure or extrusion, which may threaten ocular integrity. This report presents 3 clinical cases of PMS exposure with distinct presentations, potential risk factors, and surgical management approaches. In the first case, a pseudophakic patient with primary open angle glaucoma developed exposure of the device body 8 months postoperatively, associated with conjunctival ischemia but without leakage. In the second case, exposure of a nonfunctioning PMS occurred 2 years after a second implant was placed in a different quadrant, following early failure of the original device. The exposed implant was removed without compromising IOP control. The third and most severe case involved extensive scleral melting, distal extrusion, and Seidel positivity, requiring device explantation and scleral grafting. Contributing factors included the use of 0.04% mitomycin C, previous surgeries, and intraoperative identification of thin Tenon's capsule. Based on these cases, PMS exposure may arise through different mechanisms-distal extrusion, body erosion, or conjunctival dehiscence-each necessitating tailored surgical intervention. Awareness of risk factors and prompt management are essential to prevent complications such as infection or hypotony. These findings highlight the importance of careful intraoperative assessment, personalized MMC application, and early detection to ensure long-term safety and device preservation.
Assessment of Vascular Density, Macular Layer Thickness, and Foveal Avascular Zone in Pseudoexfoliation Disease.
Nohasfarmaniyeh S, Movahedi MM, Azimi A … +4 more , Mahmodi T, Hassanipour H, Bostanian P, Parsaei H
J Glaucoma · 2025 Nov · PMID 40833342 · Publisher ↗
PRÉCIS: Significant reductions were observed in macular vessel density and ganglion cell layer thickness in patients with XFG and XFS, suggesting these parameters may serve as early biomarkers for diagnosing and monitori...
PRÉCIS: Significant reductions were observed in macular vessel density and ganglion cell layer thickness in patients with XFG and XFS, suggesting these parameters may serve as early biomarkers for diagnosing and monitoring the progression of glaucoma. OBJECTIVE: This study aims to enhance early glaucoma diagnosis in pseudoexfoliation syndrome (XFS) patients by assessing changes in macular vessel density and retinal layer thickness, and by investigating the relationship between these parameters and disease progression from XFS to pseudoexfoliation glaucoma (XFG). PATIENTS AND METHODS: This cross-sectional study involved 25 eyes from 17 XFS patients, 32 eyes from 21 early XFG patients, and 34 age- and sex-matched healthy controls. Vessel density in the superficial and deep vascular complexes was assessed using Optical Coherence Tomography Angiography (OCTA), while the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and outer layer thickness were analyzed via spectral-domain optical coherence tomography (SD-OCT). Foveal avascular zone (FAZ) parameters were calculated, and the correlation between vessel density and macular layer thickness was examined. RESULTS: All groups were age- and sex-matched. Vessel density in the Superficial Vascular Complex (SVC) was significantly lower in XFG compared with controls across all sectors ( P <0.05). In the Deep Vascular Complex (DVC), significant differences were seen only in the temporal sector. GCL thickness decreased significantly in all sectors, while RNFL thickness differed only in the inferior sector. Outer retinal layer thickness was significantly greater in the XFS group. FAZ area and irregularity significantly increased in the SVC across groups ( P <0.05). CONCLUSIONS: The study demonstrates that early retinal microvascular and structural changes-particularly reduced superficial vessel density in the temporal macula, thinning of the GCL, thickening of the outer retina, and FAZ enlargement-are detectable in XFS before glaucoma onset. Integrating these OCTA and SD-OCT findings into routine screening may enhance early diagnosis and guide timely intervention of glaucoma.
Vision-Related Quality of Life in Glaucomatous Patients With Multifocal Intraocular Lens.
Kitnarong N, Phongsuphan T, Jiamsawad S
J Glaucoma · 2025 Oct · PMID 40833337 · Full text
PRÉCIS: Glaucoma patients with multifocal intraocular lenses (MIOLs) reported comparable vision-related quality of life but greater spectacle independence than monofocal IOL users. MIOLs may be considered for mild to mod...
PRÉCIS: Glaucoma patients with multifocal intraocular lenses (MIOLs) reported comparable vision-related quality of life but greater spectacle independence than monofocal IOL users. MIOLs may be considered for mild to moderate glaucoma patients desiring spectacle-free vision. PURPOSE: To compare the vision-related quality of life (VRQoL) in glaucomatous patients receiving bilateral monofocal intraocular lens (mIOL) and multifocal intraocular lens (MIOL) implantation. PATIENTS AND METHODS: This was a comparative, nonrandomized, unmasked, cross-sectional study in pseudophakic patients with mild to moderate glaucoma who underwent uneventful phacoemulsification with bilateral MIOL or mIOL implantation from January 2010 to June 2022 at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Data collection included distant and near best corrected visual acuity (BCVA), percent of spectacle independence and VRQoL. The 25-item National Eye Institute Visual Functional Questionnaire (NEI-VFQ-25) (translated into Thai) was used to access VRQoL (score 0 to 100). The scores were adjusted for age and glaucomatous staging using the analysis of covariance (ANCOVA). RESULTS: A total of 109 patients were enrolled. Fifty patients received MIOL and 59 received mIOL. There was significantly more moderate glaucoma in mIOL (39.7%) the MIOL group (17.5%) ( P =0.002). Postoperatively, there was no statistically significant difference in BCVA, but the MIOL group had significantly better uncorrected near VA ( P <0.001). Spectacle-free was significantly greater in MIOL (78%) than mIOL (25.4%) ( P <0.001). Mean adjusted NEI-VFQ-25 scores was 95.4 in MIOL and 93.5 in mIOL, which was not significantly different between groups ( P =0.114). CONCLUSION: Glaucomatous patients with multifocal IOL experienced comparable VRQoL, but more spectacle independence compared with monofocal IOL. Multifocal IOL could be considered in mild to moderate glaucomatous patients, who spectacle-free was warranted.
Standalone Canaloplasty and Trabeculotomy Using the OMNI Surgical System in Patients With Open Angle Glaucoma: A Systematic Review and Meta-analysis.
Zhu D, Shah P, Zhang C … +9 more , Ho B, AbouKasm G, Musheyev B, Goldburg S, Zhu E, Wong A, Bitrian E, Tello C, Djougarian A
J Glaucoma · 2025 Nov · PMID 40758055 · Publisher ↗
PRÉCIS: This systematic review and meta-analysis found that standalone OMNI resulted in significant intraocular pressure (IOP) reduction at the 1-month, 6-month, 1-year, and 2-year time points and significantly improved...
PRÉCIS: This systematic review and meta-analysis found that standalone OMNI resulted in significant intraocular pressure (IOP) reduction at the 1-month, 6-month, 1-year, and 2-year time points and significantly improved topical medication burden at 1-year. PURPOSE: To determine the efficacy of standalone canaloplasty and trabeculotomy using the OMNI Surgical System in open angle glaucoma (OAG) patients. MATERIALS AND METHODS: A systematic review was performed using the PubMed, Embase, and Scopus databases for all studies using the OMNI Surgical System for standalone canaloplasty and trabeculotomy in OAG patients with baseline intraocular pressure (IOP) >18 mm Hg (PROSPERO ID: CRD420251044505). Meta-analyses were performed to calculate the IOP change following treatment at 1-month, 6-month, 1-year, and 2-year follow-ups. We also evaluated changes in topical medications and the proportion of medication-free patients at 1 year. RESULTS: Five studies with 290 eyes at baseline were included. At the 1-month follow-up, there was a significant mean IOP reduction of 7.40 mm Hg following standalone OMNI (MD=-7.40; 95% CI: -10.61 to -4.20; P <0.0001). At the 6-month follow-up, mean IOP reduction was 7.25 mm Hg (MD=-7.25; 95% CI: -9.60 to -4.89; P <0.0001). At the 1-year follow-up, mean IOP reduction was 7.49 mm Hg (MD=-7.49; 95% CI: -9.47 to -5.50; P <0.0001). At 2-year follow-up, mean IOP reduction was 8.77 mm Hg (MD=-8.77; 95% CI: -10.35 to -7.19; P <0.0001). In addition, at the 1-year follow-up, mean reduction of topical medications was 0.77 (MD=-0.77; 95% CI: -1.44 to -0.09; P =0.025), and 46.2% of patients were medication-free (95% CI: 35.6%-57.2%). CONCLUSIONS: The OMNI Surgical System is an effective standalone procedure for canaloplasty and trabeculotomy in OAG patients and led to a significant reduction in IOP at multiple timepoints and medication burden.
Glaucoma and Risk of Fractures: A Systematic Review, Meta-Analysis, and Network Meta-Analysis.
Gallo Afflitto G, Aiello F, Swaminathan SS … +5 more , Matarazzo F, Stuart KV, Khawaja AP, Costagliola C, Nucci C
J Glaucoma · 2025 Oct · PMID 40748268 · Publisher ↗
PRÉCIS: Glaucoma is associated with a significant risk of bone fracture. Comprehensive patient education and targeted interventions are crucial to mitigating this risk and improving outcomes. PURPOSE: To evaluate the ris...
PRÉCIS: Glaucoma is associated with a significant risk of bone fracture. Comprehensive patient education and targeted interventions are crucial to mitigating this risk and improving outcomes. PURPOSE: To evaluate the risk ratio (RR) and hazard ratio (HR) of fractures in subjects with glaucoma compared with healthy controls. MATERIALS AND METHODS: The study protocol (CRD42024527785) was registered prospectively. PubMed, EMBASE, and Web of Science were searched from their inception to April 2024. Glaucoma was identified by the presence of a visual field defect (GVFD) consistent with glaucomatous optic neuropathy, ICD codes (or similar disease-classifying codes), and self-report. Visual field damage severity was classified using the Hodapp-Anderson-Parrish criteria, with study-specific criteria for severity deemed suitable on a case-by-case basis. Both frequentist inference meta-analysis and Bayesian network meta-analysis (NMA) were conducted. RESULTS: Seven articles were deemed eligible for synthesis, covering a combined population of 570,694 subjects and reporting a total of 45,957 fractures. Bayesian NMA indicated that both mild and severe glaucomatous visual field defects were associated with an 80% increased RR of fractures compared with healthy counterparts [RR mild: 1.8, 95% Credible Interval (95%CrI): 1.5 to 2.3; RR severe: 1.8, 95% CrI: 1.3-2.4]. A higher HR of fractures was observed in individuals with mild (HR: 1.2; 95% CrI: 1.1-1.3) and moderate (HR: 1.4; 95% CrI: 1.1-1.8) glaucoma compared with healthy subjects. CONCLUSIONS: Low- to moderate-quality evidence indicates a significant association between glaucoma and increased fracture risk, with individuals with mild to moderate GVFD showing the highest HR and RR of fractures. These results emphasize the role of patient education and the necessity for targeted interventions and preventive strategies to mitigate the risk of fracture among affected individuals.
The Relationship Between MRI-Measured Structure of the Visual Cortex and Visual Function in Patients With Glaucoma.
Yamada A, Tatewaki Y, Omodaka K … +3 more , Matsudaira I, Taki Y, Nakazawa T
J Glaucoma · 2025 Oct · PMID 40729655 · Publisher ↗
PRÉCIS: The area corresponding to the peripheral visual field in the primary visual cortex of the brain is associated with ophthalmologic parameters. PURPOSE: Reproducing the relationship of the visual field with the pri...
PRÉCIS: The area corresponding to the peripheral visual field in the primary visual cortex of the brain is associated with ophthalmologic parameters. PURPOSE: Reproducing the relationship of the visual field with the primary visual cortex is known as retinotopic mapping. The primary visual cortex is known to be atrophic in glaucoma patients. However, there are few reports on which areas most reflect glaucomatous changes. In this study, we used magnetic resonance imaging to evaluate the relationship between various ophthalmic parameters and overall and regional structural changes in the primary visual cortex to better understand changes in the brain associated with glaucoma. MATERIALS AND METHODS: Twelve healthy subjects [56.1±9.3 y old, male to female ratio 6:6, mean deviation (MD) 0.6±0.7 dB] and 23 patients with glaucoma (57.8±8.0 y old, male to female ratio 8:15, MD: -10.2±6.4 dB) were enrolled. We acquired 3D-T1-weighed images to measure the overall and regional gray matter density of the visual cortex based on a priori retinotopic projection. Optical coherence tomography and visual field testing were performed, and a weighted count of retinal ganglion cells (wRGC) was calculated from the ophthalmological tests. The Spearman rank correlation coefficient was used for evaluating the correlations between these structural parameters of the visual cortex and the ophthalmological parameters. RESULTS: The overall primary visual cortex was positively correlated with MD ( r =0.40, P =0.02) and wRGC ( r =0.41, P =0.02). Regarding retinotopic projection, the inner area in the visual cortex, which corresponds to the peripheral visual field, was positively correlated with MD and wRGC. CONCLUSION: The inner part of the primary visual cortex, which corresponds to the peripheral visual field, is closely correlated with ophthalmologic parameters commonly used for diagnosing and detecting the progression of glaucoma clinically. This suggests that evaluation of this area with MRI may be of clinical use in glaucoma assessment and monitoring.
Comparison of Dorzolamide and Netarsudil on Intraocular Pressure and Ocular Perfusion in Early Glaucoma: A Randomized Controlled Trial.
Angmo D, Jain V, Warjri GB … +3 more , Sharma N, Azad SV, Dada T
J Glaucoma · 2025 Dec · PMID 40719703 · Publisher ↗
PRECIS: Netarsudil shows promise as a second-line drug in early glaucoma patients with an increase in most OCTA parameters as compared with Dorzolamide, with comparable rates of side effects. OBJECTIVE: To compare the ef...
PRECIS: Netarsudil shows promise as a second-line drug in early glaucoma patients with an increase in most OCTA parameters as compared with Dorzolamide, with comparable rates of side effects. OBJECTIVE: To compare the effect of Netarsudil and Dorzolamide on macular and optic nerve head (ONH) perfusion changes on Optical Coherence Tomography Angiography (OCTA), and macular ganglion cell layer (mGCL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on OCT in preperimetric/early glaucoma patients. PARTICIPANTS AND METHODS: In this prospective, randomized, parallel group, active-controlled trial 90 preperimetric/early glaucoma eyes were recruited. The primary outcome measure was change in macular and ONH perfusion, and intraocular pressure (IOP). A total of 95 patients were randomized and 45 were prescribed Netarsudil 0.02% (group 1) and 45 were prescribed Dorzolamide 2% (group 2). The IOP, ONH perfusion, ONH flux index (FI), and macular vessel density (mVD) on OCTA; pRNFL thickness and mGCL thickness on OCT of the 2 groups were recorded at baseline, 4 months, 8 months, and 12 months. RESULTS: The mean baseline IOP in group 1 was 19.52±3.2 mm Hg and in group 2 it was 19.5±2.97 mm Hg. Group 1 showed 2.77 mm Hg (13.23%±8.27%) decrease in IOP ( P <0.001), while group 2 showed 1.85 mm Hg (8.98%±7.32%) decrease in IOP ( P <0.001) at 12 months. Group 1 showed 1.58 mm/mm 2 increase in mVD ( P <0.001), and 0.03 (7.6%) increase in ONH FI ( P <0.001) at 12 months. However, no trend in mVD or ONH FI was seen in group 2. Group 1 showed 1.03% increase in ONH perfusion ( P <0.001), while group 2 showed 1.16% increase in ONH perfusion ( P <0.001). There was no significant difference in ONH perfusion between the 2 groups. The OCT (pRNFL and mGCL) showed normal variability in both the groups. Congestion (40%) was the most common side effect observed in the Netarsudil group, while metallic taste (42.5%) was the most common side effect in the Dorzolamide group. The side effect profile of the 2 drugs was comparable ( P =0.65). CONCLUSION: Netarsudil causes an increase in all the OCTA parameters-mVD, ONH perfusion, and ONH FI-whereas Dorzolamide causes an increase only in ONH perfusion in preperimetric/early glaucoma patients. Netarsudil monotherapy also showed a higher decrease in IOP as compared with dorzolamide therapy.
Longitudinal Trends in Resource Utilization Associated With Newly Diagnosed Primary Angle Closure Glaucoma in the United States.
Guth D, Apolo G, Seabury SA … +3 more , Lung K, Toy B, Xu BY
J Glaucoma · 2025 Oct · PMID 40673780 · Full text
PRÉCIS: The average cumulative 2-year cost following first primary angle closure glaucoma diagnosis was $2960. Elderly and Black patients were at higher risk of being among the costliest 5% (>$9813) of cases, accounting...
PRÉCIS: The average cumulative 2-year cost following first primary angle closure glaucoma diagnosis was $2960. Elderly and Black patients were at higher risk of being among the costliest 5% (>$9813) of cases, accounting for 21.3% of costs. PURPOSE: To assess longitudinal eye care costs associated with newly diagnosed primary angle closure glaucoma (PACG) in the United States. METHODS: Patients with a diagnosis of PACG between 2009 and 2017 were identified in Optum's deidentified Clinformatics Data Mart Database based on International Classification of Diseases (ICD) codes. Newly diagnosed PACG was defined as: (1) diagnosis by an ophthalmologist or optometrist; (2) observable for at least 12 months before and 24 months after index diagnosis; (3) no prior history of glaucoma treatment; (4) PACG-related treatment initiated after index diagnosis. Logistic regression modeling was performed to identify risk factors for being in the top 5% of cumulative 2-year costs. RESULTS: Among 12,673 eligible patients, the average cumulative 2-year cost following first PACG diagnosis was $2960. Patient costs were highest in the 6 months immediately following diagnosis, accounting for 52.3% of all 2-year costs. 56.7% of all 2-year costs were related to treatment procedures. The costliest 5% (>$9813) of patients accounted for 21.3% of all 2-year PACG-related costs. Risk factors for being in the costliest 5% ( P <0.05) included older age, Black race, PPO or other Medicare insurance product, living in the Midwest or the South, and recent diagnosis of anatomic narrow angles (ANA). CONCLUSION: Costs associated with newly diagnosed PACG were found to be disproportionately driven by a small subset of cases. Elderly and Black patients were more likely to be within the top 5% of cumulative 2-year costs. Identifying and preventing the costliest PACG cases could reduce PACG-related eye care expenditures.
Efficacy of Filtration Surgery and Risk Factors for Central Visual Field Deterioration in Highly Myopic Eyes With Open Angle Glaucoma.
Yoshida T, Zhou N, Yoshimoto S … +6 more , Sugisawa K, Ohno M, Yasuda S, Shiotani Y, Teramatsu R, Ohno-Matsui K
J Glaucoma · 2025 Oct · PMID 40658095 · Publisher ↗
PRÉCIS: This study demonstrates the effectiveness of filtration surgery in preserving the central visual field in eyes showing open angle glaucoma with high myopia, highlighting the necessity of intraocular pressure redu...
PRÉCIS: This study demonstrates the effectiveness of filtration surgery in preserving the central visual field in eyes showing open angle glaucoma with high myopia, highlighting the necessity of intraocular pressure reduction ≥30% for optimal outcomes. PURPOSE: To evaluate the efficacy of filtration surgery in preserving the central visual field (VF) in eyes with open angle glaucoma (OAG) and high myopia (HM) and identify postoperative intraocular pressure (IOP) targets and factors associated with targeted IOP reduction. METHODS: This retrospective cohort study included 55 eyes (48 patients) with OAG and HM who underwent filtration surgery and were followed up for minimum 3 years. Preoperative and postoperative IOP values, mean deviation (MD) values, and MD slopes from Humphrey 10-2 VF tests were assessed. Participants were categorized according to the postoperative MD slope (>-0.5 dB/y or ≤-0.5 dB/y) to evaluate surgical success, defined as IOP reduction of ≥20%, ≥30%, or ≥40% from baseline. Predictors of targeted IOP reduction were identified. RESULTS: Significant postoperative IOP reductions were observed at all time points ( P <0.001). The mean MD slope improved from -1.53±0.91 to -1.00±1.40 dB/year ( P =0.001). Eyes with MD slope ≤-0.5 dB/year had a longer axial length (AL; P =0.048), more needling procedures ( P =0.003), and higher postoperative IOP at 1 and 2 years ( P <0.001, 0.021, respectively). Surgical success rates (IOP reduction ≥30% and ≥40%) were higher for eyes with MD slope >-0.5 dB/year ( P =0.006, 0.003), with no significant difference for IOP reduction ≥20% ( P =0.087). To achieve postoperative MD slope >-0.5 dB/year, minimum 30% IOP reduction was required. If AL was >28.01 mm, 40% IOP reduction was required. AL and needling procedure frequency were significantly associated with IOP reduction ≥30% (odds ratio=1.79 and 2.26; P =0.018 and 0.039, respectively). CONCLUSIONS: Substantial IOP reduction is essential for preserving the central visual field in eyes with OAG and HM, particularly those with AL ≥28.01 mm. Longer AL and frequent needling procedures increase the surgical failure risk.
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