Journal Of Glaucoma[JOURNAL]
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200 papers
The Effect of Endoscopic Cyclophotocoagulation on the Outcomes of Excisional Goniotomy With and Without Phacoemulsification.
Mayeda M, Scott AT, Young CC … +5 more , SooHoo JR, Pantcheva MB, Patnaik JL, Kahook MY, Seibold LK
J Glaucoma · 2025 Oct · PMID 40637567 · Publisher ↗
PRÉCIS: Combination MIGS procedures are a potentially more efficacious method to decrease mean IOP and glaucoma medication burden; however, our findings question whether the addition of ECP to excisional goniotomy provid...
PRÉCIS: Combination MIGS procedures are a potentially more efficacious method to decrease mean IOP and glaucoma medication burden; however, our findings question whether the addition of ECP to excisional goniotomy provides significant additional benefit. PURPOSE: Combined microinvasive glaucoma surgery (MIGS) procedures are gaining popularity. Although the individual efficacy of excisional goniotomy and endoscopic cyclophotocoagulation (ECP) is well established, data supporting their use in combination is lacking. Our study aims to evaluate the additive benefit of ECP to excisional goniotomy with the Kahook Dual Blade (KDB) in the largest patient cohort evaluated to date. MATERIALS AND METHODS: A retrospective chart review was performed of adults seen at a tertiary eye center between May 2015 and August 2019. Patients who received goniotomy alone were compared with those who received standalone goniotomy and ECP (KDB/ECP), whereas those who received goniotomy and phacoemulsification (KDB/phaco) were compared with those undergoing phacoemulsification, goniotomy, and ECP (PEcK). RESULTS: A total of 723 eyes were included. All 4 study groups had a decrease in mean IOP at 6, 12, and 24 months (all P <0.05) and a significant decrease in glaucoma medications at 12 months (all P <0.05). When comparing the KDB group to the KDB/ECP group, there were no statistical differences in mean IOP or number of glaucoma medications at any timepoint ( P >0.05 for all). When comparing the KDB/phaco group to the PEcK group there were no statistical differences in mean IOP ( P >0.05 for all) or glaucoma medications at 12 and 24 months. However, only the KDB/ECP and PEcK groups maintained a significant reduction in medications at 24 months. CONCLUSIONS: Both standalone KDB goniotomy with ECP and the PEcK procedure are efficacious at lowering IOP and glaucoma medication burden. Although success rates were not improved, the addition of ECP to KDB goniotomy seems to achieve a more sustained reduction in medication burden compared with goniotomy alone.
Quality of Life and Associated Factors in Chinese Glaucoma Patients.
Qiao Y, Tan C, Lai J … +5 more , He J, Zhu J, Zou H, Sun X, Chen J
J Glaucoma · 2025 Oct · PMID 40637562 · Publisher ↗
PRÉCIS: Quality of life scores in Chinese glaucoma patients were mainly associated with disease severity, measured by patients' visual acuity, stages of visual field defects, and intraocular pressure. PURPOSE: To examine...
PRÉCIS: Quality of life scores in Chinese glaucoma patients were mainly associated with disease severity, measured by patients' visual acuity, stages of visual field defects, and intraocular pressure. PURPOSE: To examine the effect of demographic, clinical, and socioeconomic factors on glaucoma patient-reported quality of life (QoL) scores. PATIENTS AND METHODS: In this cross-sectional study, 1057 consecutive glaucoma patients aged 18 and above were recruited from 34 hospitals across China between November 1, 2022 and December 18, 2022. A smartphone-based survey collected demographic/socioeconomic data and incorporated the Chinese version of the Glaucoma Quality of Life-17 (Glau-QoL-17) questionnaire for patient-reported QoL evaluation. Visual functions (best-corrected visual acuity [BCVA], the higher intraocular pressure [IOP] of both eyes, and the stages of visual field impairment) were assessed by ophthalmic professionals. Multiple linear regression models were constructed to identify predictors for both overall and subscale QoL scores. Least Absolute Shrinkage and Selection Operator (LASSO) analysis was used to screen the most influential factors for the overall QoL score. RESULTS: The median (interquartile range) QoL score was 57 (49-65). BCVA and the stage of visual field defects of the better eye, the higher IOP reading between both eyes, the employment status, and the city tier of residence were independent predictors for QoL after adjusting for age, sex, education level, and comorbidities. LASSO analysis additionally identified primary open angle glaucoma and combined surgical and pharmacological treatment as one of the most influential factors affecting QoL. Clinical factors explained the largest variation in the multiple linear regression model. CONCLUSIONS: QoL of glaucoma patients is primarily determined by clinical indices. Unemployment is also an important correlate of low QoL among glaucoma patients.
Two-Year Results of Gonioscopy-Assisted Transluminal Trabeculotomy Versus Ab Externo Visco Circumferential Suture Trabeculotomy in Primary Congenital Glaucoma.
Elwehidy AS, Elhofi AS, Abdelkader AME … +1 more , GabAllah NM
J Glaucoma · 2025 Oct · PMID 40637554 · Publisher ↗
PRECIS: Both Gonioscopy-assisted transluminal trabeculotomy and ab externo visco circumferential suture trabeculotomy reduced the intraocular pressure in primary congenital glaucoma by more than 50% from baseline at 2 ye...
PRECIS: Both Gonioscopy-assisted transluminal trabeculotomy and ab externo visco circumferential suture trabeculotomy reduced the intraocular pressure in primary congenital glaucoma by more than 50% from baseline at 2 years. There were no serious adverse events. PURPOSE: Primary congenital glaucoma (PCG) is a severe form of glaucoma that presents in infancy and requires surgical intervention to prevent irreversible vision loss. Angle-based surgery is the primary treatment for PCG, with recent reports suggesting promising outcomes for gonioscopy-assisted transluminal trabeculotomy (GATT) in children with PCG. Ab externo visco circumferential suture trabeculotomy (AVCST) offers the advantages of combining the efficacy of 360-degree circumferential trabeculotomy through low-cost Prolene sutures with the facilitation of the Schlemm's canal (SC) cannulation using viscoelastic. METHODS: This retrospective interventional study compared the 1-year outcomes of GATT and AVCST in managing PCG. The records of 65 eyes of 39 children who underwent surgery for their PCG were reviewed. RESULTS: The key outcome measures included reduction of intraocular pressure (IOP), the success rate, and surgical complications. At 2 years, both surgical techniques demonstrated significant IOP reduction from baseline (GATT: mean reduction of 15.33±2.56 mmHg; AVCST: mean reduction of 15.96±2.95 mmHg) but there was no statistical difference between both groups at 2 years ( P =0.371). The complete success rate, defined as an IOP ≤16 mmHg with > 30% reduction from the baseline without antiglaucoma medications (AGMs) or further surgical interventions, was 87.1% for the GATT and 85.3% for the AVCST, which was not statistically significant between the 2 groups ( P =0.710). The complication rates were comparable between the 2 groups, with transient hyphaema being the most common adverse event. CONCLUSIONS: Our findings indicate that GATT and AVCST are both effective and safe surgical options for PCG, with similar efficacy and complication profiles after 2 years. Further long-term studies are warranted to assess the durability of these outcomes.
Screening of Glaucoma in High-Risk Minority Populations.
Nassiri N, Wilson MR
J Glaucoma · 2025 Jul · PMID 40569244 · Publisher ↗
PRECIS: This chapter reviews the current recommendations on screening for open angle glaucoma in Black and Hispanic populations. Strategies for increasing case-finding and decreasing cost, with emphasis on evolving techn...
PRECIS: This chapter reviews the current recommendations on screening for open angle glaucoma in Black and Hispanic populations. Strategies for increasing case-finding and decreasing cost, with emphasis on evolving technologies, are presented. PURPOSE: To address the current recommendations on primary open angle glaucoma screening in high-risk minority populations and to discuss potential strategies to improve the screening of glaucoma in these populations. METHODS: A literature review was performed by searching PubMed, EMBASE, and Google Scholar. All English-language papers that resulted from the search terms from January 1980 to October 2023 were reviewed. RESULTS: In the next few decades, the societal burden of glaucoma will increase because of the demographic shift to an older and more diverse US population, including Black and Hispanic populations, which have been shown to have a higher prevalence of the disease. The current (2022) conclusion of the US Preventive Services Task Force is that the evidence to assess the balance of benefits and harms of screening for glaucoma in adults is insufficient to recommend widespread screening. The Preferred Practice Pattern guideline similarly states that screening for glaucoma in the general population is not cost-effective. However, the guidelines state that screening is more useful and cost-effective when it is targeted at populations at high risk for glaucoma, such as older adults, those with a family history of glaucoma, and Black and Hispanic individuals. Strategies for improving the effectiveness of glaucoma screening must increase case finding and decrease cost. New screening technologies, such as telemedicine and artificial intelligence, are expanding access for underserved populations. CONCLUSIONS: There is still no clear consensus on the effectiveness of glaucoma screening for the general population. However, glaucoma screening may be useful and cost-effective when it is targeted at populations at high risk for glaucoma, particularly using emerging technologies that improve access and case-finding.
Gonioscopy-Assisted Transluminal Trabeculotomy in Patients With Angle Recession Glaucoma.
Mirza E, Mirza GD
J Glaucoma · 2025 Jul · PMID 40569243 · Publisher ↗
PRÉCIS: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a successful minimally invasive glaucoma surgery (MIGS) technique for treating patients with angle recession glaucoma (ARG). PURPOSE: To share 1-year follo...
PRÉCIS: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a successful minimally invasive glaucoma surgery (MIGS) technique for treating patients with angle recession glaucoma (ARG). PURPOSE: To share 1-year follow-up outcomes of GATT in patients with ARG. PATIENTS AND METHODS: Six eyes of 6 patients with ARG were reviewed in this retrospective study. All of the patients had uncontrolled intraocular pressure (IOP) with antiglaucoma medications (AGM) and a history of blunt ocular trauma (BOT). Preoperative IOP; the number of preoperative AGM; postoperative IOP at first month, third, sixth, and 12th months; postoperative IOP spikes, the need for postoperative AGM, and the need for further surgical interventions were recorded. RESULTS: Five patients underwent GATT and 1 patient underwent GATT combined with phacoemulsification. IOP decreased from 30.30 [7.20] mm Hg preoperatively to 11.95 [3.45] mm Hg postoperatively at the 12th month (P=0.028), with a median difference of -19.50 mm Hg (95% CI: -25.10 to -14.55). After GATT, all patients had varying degrees of hyphema that did not require surgical intervention. IOP peaks were observed in the postoperative first month in 3 patients and IOP was controlled with AGM in these patients. The median (IQR) preoperative number of AGM decreased significantly compared with the median (IQR) postoperative number of AGM at the 12th month [P=0.038, 4.00 (0.25) vs. 2.00 (1.25), median difference: -1.50, 95% CI: -2.00 to -0.50]. During the 1-year follow-up, no patients with ARG required additional surgical intervention. CONCLUSION: Due to its low complication rates and successful IOP-lowering effect, we recommended that GATT is an effective, safe, and considerable MIGS procedure for patients with ARG.
Costs Associated With the Use of Disposable Gonioscopy Lenses and Tonometry Tips.
Kassotis A, Berkowitz ST, Patel S … +5 more , Schehlein E, Liebmann JM, Cioffi GA, Robin AL, Garg Shukla A
J Glaucoma · 2025 Nov · PMID 40560605 · Publisher ↗
PRÉCIS: Cost of disposable ophthalmic equipment. PURPOSE: The authors performed a cost analysis comparing the use of disposable and reusable tonometry equipment and gonioscopy lenses. METHODS: All adult patient (≥16 y of...
PRÉCIS: Cost of disposable ophthalmic equipment. PURPOSE: The authors performed a cost analysis comparing the use of disposable and reusable tonometry equipment and gonioscopy lenses. METHODS: All adult patient (≥16 y of age) visits in a 1-year period were included. Scenario analysis was employed to calculate the cost of disposable [Goldmann applanation tonometry (GAT) tips, rebound tonometry tips, and gonioscopy lenses] and reusable equipment (GAT tips and gonioscopy lenses) as well as sanitization over 2, 5, and 10 years at a single institution. To account for variability in scenario modeling, a sensitivity analysis was additionally performed. The main outcome measure was cost differences for disposable equipment compared with reusable equipment with sanitization. RESULTS: The total volume included was 80,356 patient visits. Accounting for variable costs, the additional cost associated with disposable tonometry (GAT or rebound tonometry tips) instead of reusable GAT was $118,723 over 2 years and $603,924 over 10 years. Assuming a gonioscopy frequency of 3.2%, the additional cost associated with disposable gonioscopy lenses was $171,100 at 5 years and $361,237 at 10 years. At a gonioscopy frequency of 10%, the additional cost associated with disposable lenses was $1,208,096 without inflation at 10 years. Overall, the total additional cost associated with disposable tonometry tips and gonioscopy lenses over reusable versions of this equipment was $965,161 over 10 years at a single institution. CONCLUSION: A widespread transition from reusable to disposable tonometry and gonioscopy equipment was associated with an additional cost of $965,161 over a 10-year period at a single institution.
Association of Lens Anterior and Posterior Capsular Bag Laxity With Clinical Characteristics in Primary Angle Closure Disease.
Pei XT, Zhang S, Deng L … +4 more , Yu XW, Mei F, Qing GP, Fan ZG
J Glaucoma · 2025 Sep · PMID 40539947 · Publisher ↗
PRÉCIS: The presence of anterior capsular laxity caused acute angle closure glaucoma, and posterior capsular laxity alone was associated with a chronic progressive course, revealing new insight into the pathogenesis of p...
PRÉCIS: The presence of anterior capsular laxity caused acute angle closure glaucoma, and posterior capsular laxity alone was associated with a chronic progressive course, revealing new insight into the pathogenesis of primary angle closure disease. PURPOSE: This study investigates the association between anterior or posterior capsular bag laxity during cataract surgery and clinical characteristics in patients with primary angle closure disease (PACD). METHODS: This retrospective study included 137 patients (200 eyes) diagnosed with PACD and undergoing phacoemulsification cataract surgery. Patients were categorized into 4 groups based on the condition of the capsular bag: loose anterior capsular bag (LACB), loose posterior capsular bag (LPCB), loose anterior and posterior capsular bag (LAPCB), and stable capsular bag (SCB). We analyzed the association of capsular bag laxity with clinical characteristics using ANOVA and χ 2 . RESULTS: Significant differences were observed among the groups in terms of sex, disease duration, anterior chamber depth (ACD), lens vault (LV), and lens Front R, while age, PACD classification, mean corneal power, axial length, and lens thickness showed no significant variation. The ACD was notably deeper in the LPCB and SCB groups. The LV was higher, and the lens Front R was smaller in the LACB and LAPCB groups. Lens Back R varied more in the LPCB group. Anterior capsular laxity, alone or combined with posterior capsular laxity, was more prevalent in cases of acute angle closure glaucoma (ACG) (56.0%) compared with chronic ACG (19.4%). Posterior capsule laxity alone was more common in chronic ACG (45.2%) than in acute ACG (10.7%). CONCLUSION: The presence of anterior capsular laxity, with or without posterior capsular laxity, is associated with the development of acute ACG, whereas posterior capsular laxity alone is typically linked to the development of chronic ACG.
Relationship of 24-2C Central Visual Field Damage to Juxtapapillary Choriocapillaris Dropout in Glaucoma Eyes With or Without Axial Myopia.
Jiravarnsirikul A, Belghith A, Rezapour J … +10 more , Micheletti E, Nishida T, Moghimi S, Suh MH, Jonas JB, Walker E, Christopher M, Fazio MA, Weinreb RN, Zangwill LM
J Glaucoma · 2025 Sep · PMID 40536831 · Publisher ↗
PRÉCIS: Larger choriocapillaris microvasculature dropout area and wider angular circumference are significantly associated with 24-2C central visual field damage in primary open angle glaucoma eyes with and without axial...
PRÉCIS: Larger choriocapillaris microvasculature dropout area and wider angular circumference are significantly associated with 24-2C central visual field damage in primary open angle glaucoma eyes with and without axial myopia. PURPOSE: To evaluate the relationship between a juxtapapillary choriocapillaris microvasculature dropout (MvD) and central visual field (VF) damage in primary open angle glaucoma (POAG) patients with or without axial myopia. METHODS: This cross-sectional study included 125 patients with POAG or glaucoma suspects stratified into no axial myopia (axial length (AL) ≤24 mm; 46 eyes), mild axial myopia (24 mm < AL ≤26 mm; 81 eyes), and high axial myopia (AL >26 mm; 59 eyes). Presence, area, and angular circumference of juxtapapillary MvD were evaluated on OCT-A en-face choroidal images and B-scans. Perimetry was conducted using the 24-2C and 10-2 Humphrey program. RESULTS: Mean 24-2C VF mean deviation was significantly worse in eyes with MvD compared with eyes without MvD across all groups (all P <0.042). Central VF defects detected in the 24-2C and 10-2 VF tests were significantly more prevalent among eyes with MvD (68.3% and 81.7%, respectively) compared with eyes without MvD (19.0% and 38.1%, respectively) ( P <0.001) in the mild axial myopia group. In multivariable analysis, larger MvD area ( P =0.014) and wider MvD angular circumference ( P =0.006) were significantly associated with higher likelihood of the presence of 24-2C central VF damage in overall cohort. CONCLUSIONS: MvD area and angular circumference are significantly associated with central VF damage detected by VF 24-2C in POAG eyes with and without axial myopia. Choriocapillaris MvD assessment shows promise for identifying POAG patients with a higher risk of having central VF defects and may provide clinical insights into the pathogenesis of glaucoma in myopia.
Wipe-Out Phenomenon After Gonioscopy-Assisted Transluminal Trabeculotomy.
Mirza E, Mirza GD, Adam M … +1 more , Okka M
J Glaucoma · 2025 Sep · PMID 40526102 · Publisher ↗
PURPOSE: To report the findings of a rare advanced pseudoexfoliation glaucoma patient with wipe-out phenomenon after gonioscopy-assisted transluminal trabeculotomy (GATT). METHODS: A 360-degree uneventful GATT was perfor...
PURPOSE: To report the findings of a rare advanced pseudoexfoliation glaucoma patient with wipe-out phenomenon after gonioscopy-assisted transluminal trabeculotomy (GATT). METHODS: A 360-degree uneventful GATT was performed on a 71-year-old male patient with a history of uncontrolled diabetes mellitus. Sudden vision loss occurred and cystoid macular edema (CME) were detected in the early postoperative period. The CME regressed completely over 6 months but vision loss was irreversible. RESULTS: At the preoperative visit, the best corrected visual acuity (BCVA) was 20/70, and intraocular pressure (IOP) was 36 mm Hg with maximum topical antiglaucoma medications (AGM) in his right eye. At the postoperative first-month visit, BCVA was hand motion, and IOP was 14.5 mm Hg with topical AGM. In addition, CME was detected. A topical nonsteroidal anti-inflammatory drug and oral carbonic anhydrase inhibitor were started to reduce CME. Since CME did not regress, 3 doses of intravitreal anti-VEGF injections were administered at 1-month intervals. At the postoperative sixth-month visit, BCVA was still hand motion, and IOP was 11.1 mm Hg with topical AGM. The CME was regressed completely but BCVA did not improve. CONCLUSIONS: The sudden, unexplained, and irreversible vision loss attributed to the wipe-out phenomenon following GATT, should be taken into consideration when offering this procedure to patients with advanced glaucoma.
Surgical Outcomes of 180-Degree Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Nasal Versus Temporal Incisions.
Okada Y, Mieno H, Ueno M … +3 more , Yoshii K, Mori K, Sotozono C
J Glaucoma · 2025 Aug · PMID 40526085 · Publisher ↗
PRÉCIS: Performing 180-degree gonioscopy-assisted transluminal trabeculotomy for primary open angle glaucoma and pseudoexfoliation glaucoma patients can be expected to be equally effective with either a nasal or temporal...
PRÉCIS: Performing 180-degree gonioscopy-assisted transluminal trabeculotomy for primary open angle glaucoma and pseudoexfoliation glaucoma patients can be expected to be equally effective with either a nasal or temporal incision at 12 months postoperative. PURPOSE: Anatomically, there are more collector channels on the nasal-side (NS) than on the temporal-side (TS) of the eye. This study aimed to clarify the differences in efficacy between NS and TS incisions for lowering intraocular pressure (IOP) in glaucoma patients who underwent 180-degree gonioscopy-assisted transluminal trabeculotomy (hemi-GATT). PATIENTS AND METHODS: This multicenter retrospective cohort study was conducted on 423 consecutive eyes with primary open angle glaucoma and pseudoexfoliation glaucoma that underwent hemi-GATT between April 2016 and March 2022 at Kyoto Prefectural University of Medicine Hospital, Kyoto, Japan and 3 affiliated medical facilities. Only the patients who had the same type of glaucoma in both eyes and underwent the same surgical procedure were included. Hemi-GATT was performed with an NS incision in the right eye (NS group) and a TS incision in the left eye (TS group). IOP and medication scores were retrospectively investigated. RESULTS: This study involved 100 eyes of 50 patients. Median IOP (NS group/TS group) (mm Hg) at before surgery and at 1-day and 1-, 3-, 6-, and 12-months postoperative was 17.0 (interquartile range: 15.0-19.8)/16.0 (15.0-19.8), 11.0 (9.0-12.8)/11.0 (10.0-13.0), 14.0 (11.8-16.0)/13.0 (11.8-15.3), 13.0 (11.0-14.0)/11.0 (11.0-13.0), 13.5 (11.3-15.0)/12.5 (11.3-14.0), and 13.0 (11.0-15.0)/12.0 (11.0-14.0), respectively, thus showing a significant postoperative decrease of IOP. The median medication scores (NS group/TS group) were 3.0 (interquartile range: 2.0-4.0)/3.0 (2.0-4.0) at preoperative and 0.0 (0.0-2.0)/0.0 (0.0-1.0) at 12-months postoperative, thus showing a significant postoperative reduction. No significant differences were observed between the NS and TS groups at any point. CONCLUSIONS: Our findings revealed no significant difference in efficacy between NS and TS incisions for lowering IOP in glaucoma patients who underwent hemi-GATT.
Functional Assessment of Aqueous Humor Outflow by Aqueous Angiography in Primary Open Angle Glaucoma.
Beri N, Patil A, Sharma A … +3 more , Bari A, Sharma N, Dada T
J Glaucoma · 2025 Sep · PMID 40526081 · Publisher ↗
PRÉCIS: Evaluation of aqueous humor outflow (AHO) pathways shows a segmental pattern with the highest outflow in the nasal quadrant and least in the temporal quadrant in patients of primary open angle glaucoma (POAG). AI...
PRÉCIS: Evaluation of aqueous humor outflow (AHO) pathways shows a segmental pattern with the highest outflow in the nasal quadrant and least in the temporal quadrant in patients of primary open angle glaucoma (POAG). AIM: To quantitatively evaluate circumferential peri-limbal aqueous humor outflow (AHO) pathways in patients of primary open angle glaucoma (POAG) using aqueous angiography (AA). METHODS: A cross-sectional, observational, single-centre study recruited patients between 45 and 80 years with POAG, controlled on antiglaucoma medications, along with visually significant age-related cataract, planned for phacoemulsification surgery. AA was performed using 0.1% indocyanine green (ICG) dye injected into the anterior chamber, just before the capsulorhexis step. Images of 30 eyes of 30 patients were analyzed at 60 seconds from the injection of ICG dye for angiographic signal intensity (ASI) in 4 quadrants (90 degree each), with each quadrant further divided into 2 sectors of 45 degree each (total 8 sectors), circumferentially along the limbus. ASI was assessed by estimating the mean gray value using Image J software and compared between quadrants, sectors, severity of POAG, males versus females, and right versus left eyes. Further, calculating the normalized flow for each of the quadrants and sectors for every image, a division into high-flow (HF), intermediate-flow (IF), and low-flow(LF) regions was done. The correlation and relation of ASI with age and severity of POAG were also assessed using appropriate statistical tests. RESULTS: The mean age of the patients was 60.5±6.32 years (range 48-71 y), with 20 males and 10 females. Out of the 30 eyes recruited, mild/moderate POAG was seen in 13 patients, and severe POAG was present in 17 patients. Nonuniform, segmental AHO pathways with the highest ASI were seen in the nasal quadrant [52.41(42.78-57.67)] followed by superior [43.34(34.75-53.48)], inferior [28.73(21.42-35.85)], and temporal quadrant [27.71(21.23-34.87)] ( P ≤0.0001). The highest percentage of HF, IF and LF regions were documented in the nasal (83.33%), superior (36.67%), and temporal (73.33%) quadrants, respectively. A negative correlation of ASI with age (using Spearman rank correlation coefficient) was seen ( r =-0.470, P =0.009) with linear regression of β=-1.354, P =0.008. In addition, ASI between mild/moderate versus severe POAG, males versus females and right versus left eyes were not statistically significant ( P >0.05). CONCLUSION: Segmental AHO pathways were noted along the limbus with maximum ASI in the nasal quadrant (HF region) followed by superior (IF region), inferior, and temporal (LF region) quadrants in patients of POAG. Patterns were similar in mild/moderate versus severe POAG, males versus females and right versus left eyes. With increasing age, a decrease in ASI was documented.
Influence of Retinopathy of Prematurity and Laser Therapy on Intraocular Pressure in Preterm Infants.
Verma P, Katoch D, Singh SR … +5 more , Kumar P, Singh AK, Thattaruthody F, Pandav SS, Kaushik S
J Glaucoma · 2025 Oct · PMID 40439621 · Publisher ↗
PRÉCIS: Intraocular pressure (IOP) decreases as preterms mature and in moderate retinopathy of prematurity, IOP is initially low and transiently rises after laser treatment. PURPOSE: This study aimed to measure intraocul...
PRÉCIS: Intraocular pressure (IOP) decreases as preterms mature and in moderate retinopathy of prematurity, IOP is initially low and transiently rises after laser treatment. PURPOSE: This study aimed to measure intraocular pressure (IOP) in preterm infants with and without retinopathy of prematurity (ROP) and evaluate the effect of laser treatment on IOP. METHOD: This prospective nonrandomized comparative study included infants born before 34 weeks of gestation weighing <2000 g at a tertiary care research and referral institute. Those with ocular or systemic conditions or requiring surgical intervention for ROP were excluded. Infants were divided into 3 groups: Group 1 (no ROP), Group 2 (ROP without treatment), and Group 3 (ROP requiring peripheral retinal ablation by laser photocoagulation). IOP was measured using a Perkins tonometer at presentation and at 1 and 3 months. The primary outcome was IOP in preterm infants with and without ROP; and the secondary outcome was change in IOP postlaser treatment. RESULTS: Of 107 infants, 40 (37.38%) had no ROP (Group 1), 25 (23.36%) had untreated ROP (Group 2), and 42 (39.25%) required laser treatment (Group 3). Average postmenstrual ages were 37.89±2.74 weeks 36.98±3.38, and 35.47±2.84 weeks, respectively. A moderate negative correlation between IOP and postmenstrual age was found in Group 1 ( r2 =-0.382; P =0.01) and Group 2 ( r2 = -0.6; P =0.001). Baseline IOP was significantly lower in Group 3 compared with the other groups, with a transient increase postlaser treatment that typically normalized without needing IOP treatment. CONCLUSIONS: IOP decreases as preterm infants mature. Infants with ROP requiring laser treatment exhibit significantly low IOP at presentation, but have a postlaser spike, which generally normalises without treatment.
Outcomes of Phacogoniotomy for Medically Controlled and Uncontrolled Primary Open Angle Glaucoma With Cataract: A Multicenter Study.
Song Y, Ye X, Yang M … +22 more , Zhang Z, Zeng L, Fan H, Xie L, Zhu X, Zhang H, Feng Y, Xu J, Ke M, Bao Q, Pan X, Ge Q, Lin F, Yang Z, Fang Z, Wang Z, Xiaokaiti D, Fan S, Fan N, Qi Y, Zhang X, ECO study group
J Glaucoma · 2025 Aug · PMID 40408227 · Publisher ↗
PRÉCIS: Phacogoniotomy, a combination of phacoemulsification and intraocular lens implantation (PEI) and 120-degree goniotomy (GT), was an effective and safe surgical treatment for medically controlled or uncontrolled pr...
PRÉCIS: Phacogoniotomy, a combination of phacoemulsification and intraocular lens implantation (PEI) and 120-degree goniotomy (GT), was an effective and safe surgical treatment for medically controlled or uncontrolled primary open angle glaucoma (POAG) with cataract. PURPOSE: To evaluate the efficacy and safety of PEI combined with 120-degree GT in the treatment of medically controlled or uncontrolled POAG with cataract. METHODS: Multicenter observational study conducted in 9 ophthalmic institutes/general hospitals in China. Patients with medically controlled [baseline intraocular pressure (IOP) ≤21 mmHg] or uncontrolled (baseline IOP > 21 mmHg) POAG with clinically significant cataract were included, who were followed up with at least 12 months. The IOP, topical hypotensive medication, surgery complications, visual acuity, surgery success were recorded and compared between groups at baseline and the final visit. Complete surgical success was defined as postoperative IOP of 5-18 mmHg without additional topical medications, vision-threatening complications or reoperation for glaucoma. Qualified success is same as complete success except allowing use of ocular hypotensive medications. RESULTS: One hundred participants with 132 eyes were included with a mean follow-up time of 17.5±5.2 months ( range:12-32) postoperatively. In general, the mean IOP reduced from 21.2±7.4 mmHg at baseline to 14.7±2.9 mmHg postoperatively ( P <0.05), with an average reduction of 6.4±7.9 mmHg (23.5±25.6%). The mean number of hypotensive medications declined from 1.6±1.2 to 0.3±0.6, with a mean reduction of 1.4±1.2. One hundred eight out of 132 (81.8%) eyes achieved complete success and 118 (89.4%) achieved qualified success of surgery, respectively. The chief complications involved hyphema (15.2%), corneal edema (19.7%), IOP spike (8.3%), or hypotony (1.5%). In subgroup analysis of medically controlled versus medically uncontrolled pariticpants, difference was found neither in IOP at final visit (14.5±0.3 vs. 15.1±0.4 mmHg; P =0.28), medication (1.8±1.1 vs. 1.4±1.3; P =0.54), and complete (85.3% vs. 77.2%; P =0.23) or qualified success rate (95.0% vs. 86.0%; P =0.27), nor in any kind of surgery complications (all P s>0.05), respectively. CONCLUSION: POAG with cataract could be effectively treated by phacogoniotomy, regardless of medically controlled or medically uncontrolled status at baseline.
Glaucoma Patient Perspectives on Effective Coaching for Self-Management.
Carey NL, DuPuis DT, Lin G … +10 more , Flores E, Mitchell J, Darnley-Fisch D, Imami N, Heisler M, Resnicow K, McHaney-Conner P, Priester A, MacKenzie C, Newman-Casey PA
J Glaucoma · 2025 Sep · PMID 40387429 · Publisher ↗
PRÉCIS: In semistructured exit interviews, participants in a personalized glaucoma coaching program reported improved self-efficacy in managing their disease. Coaching was frequently cited as catalyst to enhancing medica...
PRÉCIS: In semistructured exit interviews, participants in a personalized glaucoma coaching program reported improved self-efficacy in managing their disease. Coaching was frequently cited as catalyst to enhancing medication adherence, emphasizing its role in team-based care. PURPOSE: To assess patients' experience with coaching to motivate improved adherence to glaucoma self-management. METHODS AND MATERIALS: Participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program completed exit interviews after participating in a 6-month coaching program. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using interpretivist grounded theory. Thematic saturation was reached after coding 30 interviews; 32 were included. Themes were identified, a codebook was generated, and 2 researchers coded the transcripts (NLC, DTD) and a third adjudicated any disagreements (EF). Main outcomes measures were defined as themes and the number of participants who expressed a theme. RESULTS: Of the 32 participants interviewed in this study, 59% (n=19) identified as male, 41% (n=13) identified as female, 50% (n=16) identified as Black, 34% (n=11) identified as White, and 6% (n=2) identified as Asian. Major themes surrounding coaching included how coaching promoted change in eye drop use, knowledge learned from the coach, feeling accountable to the coach, the coach being accessible, how coaches demonstrated empathy, how the coach collaborated to help people develop a sense of control and efficacy over glaucoma self-management, and how coaches built rapport. Additional themes were program satisfaction, fear of vision loss as a motivator to improve glaucoma self-management, and constructive feedback for the program. CONCLUSION: This qualitative assessment of the SEE personalized glaucoma coaching program demonstrated that high-quality coaching and rapport building may help patients with previously low medication adherence feel more motivated and in control of their glaucoma.
Analysis of Standard Automated Visual Field Tests in Glaucoma and the Role of Facial Contour.
Jamali D S, Garmany A, Kaplan TM … +4 more , Mousavi MS, Ashourizadeh H, Tarakji Z, Khanna CL
J Glaucoma · 2025 Dec · PMID 40377481 · Publisher ↗
PRÉCIS: Using a CNN-enhanced platform, 60-4 visual fields identified peripheral glaucomatous defects missed by central testing in mild cases; facial contour correction showed these defects occurred exclusively outside th...
PRÉCIS: Using a CNN-enhanced platform, 60-4 visual fields identified peripheral glaucomatous defects missed by central testing in mild cases; facial contour correction showed these defects occurred exclusively outside the temporal visual field. PURPOSE: To develop a methodology to separate facial contour-induced visual field defects from defects related to glaucoma in patients with peripheral field defects. METHODS: Ninety-seven eyes from 50 patients previously diagnosed with glaucoma were enrolled in the study. Thirty-one (62%) participants were male, and 86% were white. The study involved patients with glaucoma who underwent visual field testing using standard automated perimetry, including 10-2, 24-2, 30-2, and 60-4 visual fields. A convolutional neural network (CNN)-enhanced platform, previously developed to identify facial contour-dependent defects in healthy subjects, was used to analyze the visual field data. PATIENTS: The study included 97 eyes from 50 patients with glaucoma, with the majority having primary open angle glaucoma. RESULTS: In 90 out of 97 eyes, there were 60-4 visual field defects. However, 20 (22%) of these eyes did not have glaucomatous defects on the 10-2 or 30-2 visual fields. All patients with 60-4 defects in the absence of more central defects had mild glaucoma, and these eyes comprised 38% of the mild glaucoma group. 60-4 visual field increased the sensitivity of identifying glaucoma in mild disease. Without facial contour, the 60-4 visual field mean threshold summation was 1099.6±346.6 dB, and decreased to 1057±331 dB when accounting for facial contour, which affected 8.03%±4.02% of test points. Facial contour-dependent visual field defects were exclusively found outside the temporal visual field. CONCLUSION: The study demonstrated the potential utility of 60-4 visual fields for identifying early functional glaucomatous changes that may not be detected by more central visual field tests (10-2 or 30-2). It may be important to consider peripheral visual field defects, which can be affected by facial contour, in the diagnosis and monitoring of glaucoma, particularly in mild cases.
Association Between Long-Term Metformin Use and Risk of Open Angle Glaucoma in Patients With Diabetes Mellitus.
Huang SW, Lai YR, Yang Y … +5 more , Gau SY, Chung NJ, Tsai TH, Huang KH, Lee CY
J Glaucoma · 2025 Sep · PMID 40372117 · Publisher ↗
PRÉCIS: Metformin use was not dose-dependently linked to open angle glaucoma. Lower doses showed a protective effect, while higher doses had no significant impact. PURPOSE: The present study examined the enigmatic relati...
PRÉCIS: Metformin use was not dose-dependently linked to open angle glaucoma. Lower doses showed a protective effect, while higher doses had no significant impact. PURPOSE: The present study examined the enigmatic relationship between long-term metformin use and the risk of developing open angle glaucoma (OAG) in patients with diabetes mellitus (DM). In addition, we questioned whether metformin use affects the risk of OAG in a dose-dependent manner. METHODS: This research was a retrospective cohort study using a nationally representative database established by the Health and Welfare Data Science Center of the Ministry of Health and Welfare, Taiwan, ROC. Patients diagnosed with new-onset DM between 2002 and 2013 were divided into 2 groups: a metformin-treated group and a sulfonylureas-treated group. The aim of our investigation is to evaluate the risk of OAG after a 5-year follow-up period. Using the Cox proportional hazard model, researchers estimated the risk of OAG in correlation with metformin treatment by the cumulative defined daily dose (cDDD), after adjusting for several key risk factors, such as sex, age, income, urbanization level, diabetes severity, and various comorbidities. RESULT: A total of 2102 patients (0.29%) developed OAG after 5 years of being diagnosed with DM. Among patients treated with metformin, the incidence rates of OAG were 0.27%, 0.27%, 0.29%, and 0.33% with cDDDs of <30, 30-120, 120-240, and >240, respectively. Following adjustments for relevant variables, patients who received metformin treatment at cDDDs of <30, 30-120, 120-240, and >240 exhibited HRs of 0.81 (95% CI=0.71-0.92), 0.83 (95% CI=0.74-0.93), 0.90 (95% CI=0.79-1.03), and 1.03 (95% CI=0.82-1.29), respectively, compared with those treated with sulfonylureas. CONCLUSION: Our findings suggest a moderate protective effect on the risk of open angle glaucoma at lower cumulative metformin dosages. A dose-dependent effect was not observed.
Factors Influencing Discrepancies in Intraocular Pressure Measurements Between iCare IC200 and Goldmann Tonometer.
Zhang H, Nam JW, Sung MS … +1 more , Park SW
J Glaucoma · 2025 Sep · PMID 40366221 · Publisher ↗
PRÉCIS: Intraocular pressure measured by Goldmann applanation tonometry, central corneal thickness, and history of cataract surgery are factors in the discrepancies in intraocular pressure measurements between the iCare...
PRÉCIS: Intraocular pressure measured by Goldmann applanation tonometry, central corneal thickness, and history of cataract surgery are factors in the discrepancies in intraocular pressure measurements between the iCare IC200 rebound tonometer and the Goldmann applanation tonometer. PURPOSE: To investigate the factors affecting the discrepancies in intraocular pressure (IOP) measurements between the iCare IC200 rebound tonometer (RBT) and the Goldmann applanation tonometer (GAT). MATERIALS AND METHODS: The IOP was measured sequentially using RBT followed by GAT. Bland-Altman analysis was used to determine the agreement between the RBT and GAT. Eyes were classified into 3 groups based on the difference calculated as RBT minus GAT: group A (-1 to 1 mm Hg), group B (≥3 mm Hg), and group C (≤-3 mm Hg). Logistic regression analysis was performed to identify the factors associated with the measurement discrepancies. RESULTS: A total of 402 right eyes were included in the study. The RBT and GAT measurements were significantly correlated (Spearman r =0.885, P <0.001). The mean IOP differences between the RBT and GAT were 0.114±2.13 mm Hg (range: -7 to 8, 95% limit of agreement: -4.06 to 4.29 mm Hg). Multivariate logistic analyses revealed that greater central corneal thickness (CCT) ( P =0.002) was significantly associated with overestimation of IOP by RBT relative to GAT. We found that underestimated IOP by RBT relative to GAT in patients with higher GAT-measured IOP ( P =0.002) and those with a history of cataract surgery ( P =0.006). CONCLUSIONS: RBT tends to overestimate IOP relative to GAT in patients with thicker CCTs, while it underestimates IOP in those with higher GAT-measured IOP or a history of cataract surgery.
Bleb Complications After XEN Gel Stent Implantation Linked to Mitomycin C.
Brown MM, Sattarova V, Chanbour W … +2 more , Hou J, Sheheitli H
J Glaucoma · 2025 Aug · PMID 40366219 · Publisher ↗
PRÉCIS: This series describes 3 cases of complications following XEN gel stent Implantation and mitomycin C use that highlight the need for further studies on alternative antifibrotic agents for use during glaucoma filtr...
PRÉCIS: This series describes 3 cases of complications following XEN gel stent Implantation and mitomycin C use that highlight the need for further studies on alternative antifibrotic agents for use during glaucoma filtration surgery. PURPOSE: We report the surgical management of 3 cases of postoperative bleb complications following XEN gel stent implantation that are attributed to the use of mitomycin C (MMC). OBSERVATIONS: Case 1: 76-year-old male with primary open angle glaucoma (POAG) underwent XEN gel stent with MMC in the left eye. He presented with neurotrophic keratitis and thin conjunctiva with overlying epithelial defect and underlying avascular sclera consistent with scleromalacia four years following XEN surgery. He underwent scleral patch graft with conjunctival pedicle advancement flap and amniotic membrane transplant. He has progression of scleromalacia and consequently underwent five additional surgeries for scleral patch graft placement with cryopreserved amniotic membrane transplant in addition to conjunctival autograft from the contralateral eye.Case 2: 81-year-old male with POAG underwent XEN gel stent placement with MMC in the right in superotemporal quadrant. Due to persistently elevated intraocular pressures, he subsequently underwent Baerveldt tube shunt implantation in the superotemporal quadrant in the right eye. He presented to our clinic 3 years later with Baerveldt tube erosion and surrounding scleral melt. He underwent tube shunt removal with scleral patch graft.Case 3: 59-year-old male with POAG in both eyes who underwent cataract extraction and XEN gel placement with MMC in both eyes. Two years after XEN surgery, he developed bilateral nonhealing conjunctival epithelial defects over the blebs with minimal improvement on medical therapy. He required removal of the XEN gel stent with bleb revision and placement of inferonasal Baerveldt tube shunt in both eyes. CONCLUSIONS AND IMPORTANCE: XEN gel stent implantation with mitomycin C was associated with scleral melt and blebitis, similar to reports following trabeculectomy. Adjunctive antimetabolite use should consider individualized patient risk profiles.
Diagnostic Accuracy of Smart Supra Perimetry in Comparison With Standard Automated Perimetry in the Detection of Early Glaucoma.
Sukumar S, Harper RA, Tsamis E … +2 more , Hood D, Henson DB
J Glaucoma · 2025 Sep · PMID 40366217 · Full text
PRÉCIS: The diagnostic performance for detecting early glaucoma of a supra-threshold and a threshold visual field tests are compared. Their performance was found to be equivalent with the supra-threshold test being faste...
PRÉCIS: The diagnostic performance for detecting early glaucoma of a supra-threshold and a threshold visual field tests are compared. Their performance was found to be equivalent with the supra-threshold test being faster. PURPOSE: To compare the diagnostic accuracy of a supra-threshold and a threshold visual field test in detecting early glaucoma using optical coherence tomography (OCT) as the reference standard. METHODS: Data from 54 early/suspect glaucoma patients and 37 controls underwent a Humphrey Visual field Analyzer (HFA) SITA standard 24-2 threshold test, a Henson 9000 Smart Supra test (SS) supra-threshold test and Topcon Triton OCT scan: Smart Track 3D Wide (H) (12 × 9). OCT data were classified by 3 experts as either no glaucoma (n=42), suspect (n=6), or glaucoma (n=43). Overall and Selective global indices and receiver operating characteristics (ROC) curve analysis were used to compare visual field outcomes with OCT classifications. RESULTS: SS was significantly faster than SITA standard (3.9 vs. 6 min). Sixty-one percent of the glaucoma sample and 81% of controls showed substantial agreement between OCT and visual field testing using the most sensitive criteria (Henson-N-miss SS, stage 2 and 3, >0 misses; HFA VFI <99%). The area under the ROC curve showed good discrimination for all global indices. The 24-2 global indices MD, PSD, and VFI ranged from 86% to 89%, whereas those for the SS test ranged from 84% to 88%. Partial area under the ROC curve (80%-100% specificity) showed a fall for all global indices. HFA MD, PSD and VFI range (61%-73%), SS test range (71%-78%). CONCLUSIONS: The SS supra-threshold test was faster and had equivalent diagnostic accuracy to the SITA standard 24-2 threshold test in early/suspect glaucoma.
Clinical Outcomes of Intraluminal Stent Removal After PAUL Glaucoma Implant Surgery.
Weber C, Samarghitan D, Bourauel L … +5 more , Walz W, Hundertmark S, Petrak M, Holz FG, Mercieca K
J Glaucoma · 2025 Oct · PMID 40366195 · Publisher ↗
PRÉCIS: Intraluminal stent-removal post-PGI surgery significantly reduces IOP with high success rates but carries the risk of hypotony and complications, for example, suprachoroidal hemorrhage. Long-term management often...
PRÉCIS: Intraluminal stent-removal post-PGI surgery significantly reduces IOP with high success rates but carries the risk of hypotony and complications, for example, suprachoroidal hemorrhage. Long-term management often requires the eventual addition of IOP-lowering therapy despite initial efficacy. BACKGROUND: To report outcomes after intraluminal stent removal following PAUL Glaucoma Implant (PGI) surgery from a single-center cohort. MATERIALS AND METHODS: Retrospective review of patients undergoing intraluminal prolene removal following PGI surgery at the University Eye Hospital, Bonn, Germany, from April 2021 to November 2023. RESULTS: Seventy eyes of 68 patients were included. Qualified and complete success rates (95% CI) were 92.9% and 55.7% after 1 year and 88.6% (81.4% to 95.7%) and 50% (37.1% to 62.9%) at the last follow-up time point for IOP ≤18 mm Hg and 81.4% and 54.3% and 70% and 42.9% IOP ≤15 mm Hg, respectively. Mean IOP decreased from 23.93 to 12.07 mm Hg after 12 months, 11.32 mm Hg after 24 months, and 10.41 mm Hg after 36 months. The mean number of IOP-lowering eye drops was zero before and immediately after removal and increased to 1.57 (0 to 2) at 12 months, 1.15 (0 to 4) at 24 months, and 1.12 (0 to 4) at 36 months. Postoperative complications occurred in 5 eyes (7.1%). Two eyes had suprachoroidal hemorrhage, with one needing vitrectomy and one external tube ligation; one required PGI explantation for persistent hypotony. CONCLUSIONS: Removal of the prolene stent following PGI surgery effectively lowers IOP in the short term, with a moderate increase in IOP and need for pressure-lowering therapy over time. However, it can also lead to adverse outcomes, such as hypotony and suprachoroidal hemorrhage, especially in patients with systemic risk factors or those undergoing early removal.
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