Journal Of Glaucoma[JOURNAL]
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200 papers
Effect of Postoperative Pilocarpine Eyedrops in the Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy Surgery.
Espinoza G, Gómez LM, Rodríguez-Una I … +3 more , Duarte-Bueno LM, Parra JC, Serrano-Gómez S
J Glaucoma · 2025 Aug · PMID 40359054 · Publisher ↗
PRÉCIS: Postoperative pilocarpine use did not significantly alter IOP reduction or medication burden following GATT in patients with OHT and POAG. Furthermore, it had no effect on reducing IOP spikes or the development o...
PRÉCIS: Postoperative pilocarpine use did not significantly alter IOP reduction or medication burden following GATT in patients with OHT and POAG. Furthermore, it had no effect on reducing IOP spikes or the development of PAS. PURPOSE: To evaluate the effect of postoperative pilocarpine use on intraocular pressure (IOP), glaucoma medications, and complications in patients undergoing gonioscopy-assisted transluminal trabeculotomy (GATT). METHODS: This retrospective study included patients with ocular hypertension or primary open angle glaucoma who underwent stand-alone GATT or combined with cataract extraction between June 2021 and April 2023. Participants were divided into a pilocarpine group (n=28) and a control group (n=25). Pilocarpine 2% was administered twice daily for 4 weeks following surgery in the pilocarpine group. Outcomes, including IOP, visual acuity, glaucoma medication use, and complications were assessed at multiple postoperative intervals up to 12 months. RESULTS: Baseline characteristics were similar between groups. Surgical success rates at 12 months were 80.8% for the pilocarpine group and 79.2% for the control group ( P =0.999). No significant differences in IOP reduction were found at any follow-up visit. Considering pilocarpine as 1 drug, the mean number of medications was higher in the pilocarpine group from day 1 to month 1 after surgery ( P <0.001). However, from the third month through the 12-month follow-up, the study groups were comparable. Although postoperative complications were similar, on the first postoperative day, 5 patients (17.9%) in the pilocarpine group exhibited hyphema ≥25%, whereas none in the control group did ( P =0.053). CONCLUSIONS: Routine postoperative pilocarpine use following GATT did not appear to significantly impact surgical outcomes or complication rates. However, given its potential association with greater hyphema extension in the early postoperative period, a rational and selective use, rather than routine administration, might be more appropriate.
12-Month Intraocular Pressure and Hypotensive Medications Outcomes After Phaco-ELIOS Procedure-A Real World Study.
Moreno-Valladares A, Vinokurtseva A, González-Rodríguez JM … +6 more , Ahmed IIK, Gonzalez-Aquino E, Puerto-Amorós N, Roquet E, Soldevila A, Canut MI
J Glaucoma · 2025 Aug · PMID 40359015 · Publisher ↗
PRÉCIS: Combined phaco-ELIOS in ocular hypertension and glaucoma showed a statistically significant reduction in the number of hypotensive medications of 1.5 compared with baseline, with 78.4% of eyes being medication-fr...
PRÉCIS: Combined phaco-ELIOS in ocular hypertension and glaucoma showed a statistically significant reduction in the number of hypotensive medications of 1.5 compared with baseline, with 78.4% of eyes being medication-free at 12 months. PURPOSE: To describe the change in medication and intraocular pressure 12 months after the combined phacoemulsification-ELIOS procedure. METHODS: Retrospective, multicenter interventional case series of adults with ocular hypertension or glaucoma undergoing phaco-ELIOS. Clinical data were collected and analyzed from preoperative baseline up to 12 months postoperatively. The primary outcome was the mean change in medication compared with baseline. Secondary outcomes were intraocular pressure change from baseline, incidence of acute postoperative intraocular pressure elevation, and surgical success at 1 year, defined as intraocular pressure reduction of ≥20% compared with baseline with no increase in medications, or reduction of ≥1 medications compared with baseline with intraocular pressure equal or below baseline, with no secondary glaucoma surgeries and no loss of light perception. RESULTS: One hundred twelve eyes were included. Forty-two patients (51.2%) were female. Mean (±SD) age was 70.6 (±9.6) years. The most frequent diagnosis was primary open angle glaucoma (71.4%). The mean number of medications at baseline and 12 months was 1.8 (±0.8) and 0.4 (±0.7), respectively, representing a reduction of 1.5 (±1.0) ( P <0.0001). At the end of follow-up, 78.4% of eyes were medication-free. Mean intraocular pressure at baseline and 12 months was 19.9 (±4.0) mm Hg and 16.7 (±2.6) mm Hg, respectively, a significant decrease of 3.2 mm Hg (±4.0) or 13.7% ( P <0.0001). Surgical success was achieved in 75.9% of eyes at 12 months. CONCLUSIONS: Combined phaco-ELIOS in glaucoma significantly reduced medication use and IOP, with over 75% of eyes being medication-free at 12 months.
Malignant Glaucoma Following Gonioscopy-Assisted Transluminal Trabeculotomy.
Gunay M, Turk A, Kurutas OK … +3 more , Yilmaz U, Uzlu D, Kose B
J Glaucoma · 2025 Aug · PMID 40359006 · Publisher ↗
In this observational case-series study, we aimed to report malignant glaucoma (MGL) occurence in 4 consecutive cases (4 women; mean age, 60±11.0 y) after gonioscopy-assisted transluminal trabeculotomy (GATT) between Jan...
In this observational case-series study, we aimed to report malignant glaucoma (MGL) occurence in 4 consecutive cases (4 women; mean age, 60±11.0 y) after gonioscopy-assisted transluminal trabeculotomy (GATT) between January 2021 and September 2024 and to evaluate clinical characteristics and treatment outcomes. All patients had primary angle closure glaucoma (PACG) before GATT. They were hypermetropic (+1.75 to +2.00 diopters) and had 360-degree peripheral anterior synechia (PAS) on gonioscopy. Axial length and anterior chamber depth values ranged from 20.85 to 21.22 mm and 1.92 to 2.04 mm, respectively. Preoperative plateau iris appearance was confirmed by using ultrasound biomicroscopy and anterior segment optical coherence tomography in all cases. Intraocular pressure (IOP) ranged from 36 to 45 mm Hg before GATT with maximal antiglaucoma therapy. MGL was diagnosed on the first postoperative day after GATT. IOP levels at the time of MGL diagnosis ranged from 19 to 29 mm Hg. Due to no response to initial medical treatment, one case underwent pars plana vitrectomy with subsequent Nd:YAG laser hyaloidotomy for MGL recurrence, and, other 3 cases received irido-zonulo-hyaloido-vitrectomy (IZHV). The incidence of post-GATT MGL development was 1.3% (4/300 eyes). We first describe post-GATT MGL occurrence in 4 consecutive cases that had advanced PACG. They all had preoperative plateau iris appearance. Proper detection and adequate treatment of MGL are necessary to provide good IOP control and to prevent further angle damage after GATT.
Relationship Between Periodontitis and Open Angle Glaucoma: The Korea National Health and Nutrition Examination Survey.
Noh JH, Lee MY, Yoo C … +2 more , Sung KR, Kim JM
J Glaucoma · 2025 Aug · PMID 40341462 · Publisher ↗
PRÉCIS: Using Korean National Health and Nutrition Examination Survey (KNHANES) data, this study reveals a significant association between periodontitis and open angle glaucoma. PURPOSE: To investigate the relationship b...
PRÉCIS: Using Korean National Health and Nutrition Examination Survey (KNHANES) data, this study reveals a significant association between periodontitis and open angle glaucoma. PURPOSE: To investigate the relationship between periodontitis and open angle glaucoma. METHODS: Data from 17,478 subjects in the KNHANES 2010-2011 were analyzed. We included 6215 subjects aged 19 years or older who underwent both dental and ophthalmological examinations that met International Society of Geographical and Epidemiological Ophthalmology criteria. Exclusions included ocular surgery (eg, refractive, cataract, retina), age-related macular degeneration, those who were pregnant or who were undergoing orthodontic treatment, and those with missing data. The final analysis included 3681 subjects. Periodontal disease was assessed using the Community Periodontal Index (CPI) developed by the WHO. RESULTS: Of 3681 subjects, 197 (4.59%) had glaucoma and 3484 (95.41%) did not. Among the 197 glaucoma patients, 80 (39.48%) had periodontitis; among those without glaucoma, 892 (22.20%) had periodontitis ( P <0.001). The periodontitis group was more likely to have glaucoma than the nonperiodontitis group [odds ratio (OR), 1.53; 95% CI, 1.06-2.22; adjusted for age, sex, DM, HTN, smoking rate, and drinking rate]. For those older than 40 years, the OR was 1.75 (95% CI, 1.18-2.61), and that for men was 1.65 (95% CI, 1.01-2.70). When comparing the group with and without periodontitis in DM patients, the OR was 2.70 (95% CI, 1.46-5.02). CONCLUSION: This study shows a significant association between periodontitis and glaucoma, especially in patients aged 40 and older, men, and those with diabetes. Future follow-up studies are needed to elucidate the mechanism behind this association.
Associations and Outcomes Comparing First and Second-Eye Trabeculectomies in Patients With Glaucoma.
Nilforushan N, Rahimnezhad N, Abolfathzadeh N … +2 more , Miraftabi A, Banifatemi M
J Glaucoma · 2025 Sep · PMID 40341455 · Publisher ↗
PRÉCIS: The present study highlights the high correlation of outcomes of bilateral trabeculectomy in subjects with different types of glaucoma after mid-term follow-up. PURPOSE: To evaluate the mid-term outcomes of bilat...
PRÉCIS: The present study highlights the high correlation of outcomes of bilateral trabeculectomy in subjects with different types of glaucoma after mid-term follow-up. PURPOSE: To evaluate the mid-term outcomes of bilateral trabeculectomy and assess the differences and associations in outcome between the first-operated and the second-operated eye. METHODS: Patients with different types of glaucoma who underwent bilateral trabeculectomy from 2006 to 2022 were included in this retrospective study. All patients were followed for at least 24 months after surgery in each eye. The main outcome measure was surgical success. Complete success was defined according to intraocular pressure (IOP)≤16 mmHg and at least 20% reduction from preoperative baseline IOP without any IOP-lowering medications. Cumulative success was defined according to IOP≤16 mmHg and at least 20% reduction from preoperative baseline IOP, with or without IOP-lowering medications. Secondary outcome measures were IOP and the number of IOP-lowering medications. RESULTS: In total, 186 eyes of 93 patients were included. There was no statistically significant difference in terms of the baseline IOP and number of IOP-lowering medications between the first and second-operated eyes before and after surgery ( P >0.05). The mean follow-up time was 64.35±41.13 months and 57.13±38.41 months for the first-operated and the second-operated eyes, respectively. At the 24-month follow-up point, among patients whose first operated eyes were considered a complete success, 78.2% of surgeries in second eyes were successful ( P =0.002). In contrast, among patients whose first operated eyes were considered a cumulative success, 80.3% of surgeries in second eyes were successful ( P =0.012). In a multivariate analysis of factors affecting cumulative success, the outcome of the surgery in the first-operated eye was the only factor that significantly impacted the outcome of surgery in the second-operated eye. If the first-operated eye achieved cumulative success, the odds of the second-operated eye experiencing cumulative success were 6.5 ( P =0.02). The rates of postoperative complications in the 2 eyes were similar and did not show statistically significant differences. CONCLUSION: The present study demonstrates a significant correlation in surgical outcomes of trabeculectomy between the 2 eyes of the same patient in mid-term follow-up. Surgical success in the first-operated eye increases the odds of success in the second eye 6.5-fold.
Aqueous Humor Dynamics Changes and Predictors of IOP Response to Latanoprost in Healthy Subjects.
Kazemi A, Reitinger JC, Toris CB … +5 more , Gulati V, Fan S, Reed DM, Moroi SE, Sit AJ
J Glaucoma · 2025 Dec · PMID 40341017 · Full text
PRÉCIS: In our study of the factors predictive of latanoprost response, we found that normotensive subjects with higher intraocular pressure, lower uveoscleral outflow, and higher body mass index had a greater response t...
PRÉCIS: In our study of the factors predictive of latanoprost response, we found that normotensive subjects with higher intraocular pressure, lower uveoscleral outflow, and higher body mass index had a greater response to 1-week treatment. PURPOSE: To evaluate relationships between variable intraocular pressure (IOP) responses to latanoprost and participant characteristics, baseline values and changes in aqueous humor dynamics (AHD) parameters. METHODS: We assessed 226 eyes from 113 healthy participants. AHD parameters measured at baseline and after 1-week treatment with latanoprost included: IOP by pneumatonometry, episcleral venous pressure (EVP) by venomanometry, aqueous humor flow rate by fluorophotometry, outflow facility by 2-minute pneumatonography, and uveoscleral outflow calculated using the modified Goldmann equation. IOP responses were categorized into 4 groups: nonresponders (<10% reduction), all-responders (≥10% reduction), medium-responders (10%-20% reduction), and high-responders (≥20% reduction). Generalized estimating equation models were used to analyze treatment effects and compare groups. RESULTS: Baseline IOP was higher in high-responders than medium-responders and nonresponders ( P =0.007 and P <0.001, respectively). Body mass index (BMI) was significantly higher in high-responders and all-responders compared with nonresponders ( P =0.02 and P =0.03, respectively). Responders had lower baseline uveoscleral outflow ( P =0.03). There were no significant differences in other baseline characteristics including EVP, outflow facility, and aqueous flow rate between the 4 groups. IOP decreased while outflow facility and uveoscleral outflow increased after latanoprost treatment in all responder groups but did not change in nonresponders. EVP and aqueous flow rate did not change significantly in any group. The change in uveoscleral outflow was greater in high-responders than in nonresponders ( P =0.004). CONCLUSIONS: In healthy subjects, higher baseline IOP, lower uveoscleral outflow and higher BMI are predictors of a greater IOP reduction by latanoprost. A greater increase in uveoscleral outflow is responsible for this larger response.
Anterior Segment Parameters are Associated With Intraocular Pressure Spikes Following Cataract Surgery in Glaucoma Patients.
Rees JP, Khuu TH, Sanchez FG … +4 more , Gardiner SK, Jones EP, Kinast RM, Mansberger SL
J Glaucoma · 2025 Aug · PMID 40340970 · Publisher ↗
PRÉCIS: Increasing lens thickness was the anterior segment parameter most associated with IOP spikes in glaucoma patients after cataract surgery. PURPOSE: To determine whether anterior segment anatomy is associated with...
PRÉCIS: Increasing lens thickness was the anterior segment parameter most associated with IOP spikes in glaucoma patients after cataract surgery. PURPOSE: To determine whether anterior segment anatomy is associated with intraocular pressure spike on postoperative day 1 (POD1) after cataract surgery in participants with glaucoma. METHODS: Optical biometry measured multiple eye parameters before cataract surgery in 48 eyes (39 participants) with glaucoma. Preoperative intraocular pressure (IOP) was the mean of 3 visits before cataract surgery and postoperative IOP on day 1 was defined as the IOP on POD1 after cataract surgery. Change in IOP was the difference between postoperative and preoperative IOP. A "5 mm Hg IOP spike" and "10 mm Hg IOP spike" were defined as POD1 IOP ≥ 21 mm Hg with IOP ≥5 or ≥10 mm Hg higher than preoperative IOP, respectively. RESULTS: Mean POD1 IOP (22.8±8.8 mm Hg) was significantly higher than mean preoperative IOP (15.3±3.6 mm Hg, P <0.001). A 5 mm Hg IOP spike occurred in 45.8% of eyes (22/48 eyes), and 29.2% of eyes (14/48 eyes) had a 10 mm Hg IOP spike. Multivariable analysis showed that increased lens thickness (LT) and axial length (AL) were associated with a 5 mm Hg IOP spike ( P =0.04 and P =0.09, respectively), and increased LT was associated with a 10 mm Hg IOP spike ( P =0.02). When using change in IOP, increased LT and a lower number of preoperative medications were significant predictors of increased IOP after cataract surgery. CONCLUSIONS: IOP spikes were common in glaucoma patients after cataract surgery and were associated with anterior segment anatomy. Future studies may use risk factors to identify and prevent IOP spikes in glaucoma patients after cataract surgery.
Micropulse Transscleral Laser Treatment Versus Continuous Wave Transscleral Cyclophotocoagulation for the Treatment of Glaucoma or Ocular Hypertension: A Meta-Analysis.
Chavez MP, Guedes GB, Pasqualotto E … +4 more , de Almeida INF, Lopes LM, Prata TS, de Souza TT
J Glaucoma · 2025 Aug · PMID 40293349 · Publisher ↗
PRÉCIS: Micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation demonstrated comparable intraocular pressure across all follow-ups. MP-TLT was associated with significantly...
PRÉCIS: Micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation demonstrated comparable intraocular pressure across all follow-ups. MP-TLT was associated with significantly lower risks of ocular complications, such as hypotony, prolonged inflammation, and phthisis bulbi. PURPOSE: To compare the efficacy and safety of micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) for the treatment of glaucoma or ocular hypertension. METHODS: A systematic search was conducted in PubMed, Cochrane Library, Embase, and ClinicalTrials.gov. Randomized controlled trials (RCTs) or cohort studies comparing MP-TLT and CW-TSCPC were included. Weighted mean differences (MDs) were computed for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% CIs. Heterogeneity was assessed with I2 statistics. Software R, version 4.4.0, was used for statistical analyses. Subgroup analyses were conducted on glaucoma types. RESULTS: Eleven studies encompassing 1054 eyes from 986 patients were included, with 47.4% receiving MP-TLT. There were no significant differences in IOP between CW-TSCPC and MP-TLT at 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months of follow-up. The MP-TLT group required a significantly higher number of hypotensive medications but displayed significantly reduced risks of overall complications, ocular hypotony, prolonged inflammation, and phthisis bulbi compared with CW-TSCPC. CONCLUSION: MP-TLT and CW-TSCPC showed similar efficacy in IOP control. However, MP-TLT demonstrated a greater safety profile, suggesting its potential suitability for patients requiring repeat interventions or those with lower tolerance for ocular complications.
Ahmed Glaucoma Valve Implantation Versus Trabeculotomy as Initial Intervention for Primary Congenital Glaucoma-Long-Term Follow-Up.
Tal-Mushinski E, Imtirat A, Kerman T … +6 more , Yariv I, Dor O, Amitai N, Saadi R, Elsana B, Tsumi E
J Glaucoma · 2025 Oct · PMID 40272367 · Publisher ↗
PRÉCIS: Ahmed glaucoma valve (AGV) emerges as a more effective primary procedure compared with trabeculotomy for pediatric glaucoma patients, especially within the first 2 years. PURPOSE: To compare the outcomes between...
PRÉCIS: Ahmed glaucoma valve (AGV) emerges as a more effective primary procedure compared with trabeculotomy for pediatric glaucoma patients, especially within the first 2 years. PURPOSE: To compare the outcomes between initial AGV implantation and trabeculotomy in children with primary congenital glaucoma (PCG). PATIENTS AND METHODS: This retrospective cohort study was conducted on patients with PCG who underwent either trabeculotomy or AGV implantation between 1998 and 2022 at Soroka University Medical Center. Outcome measures included intraocular pressure (IOP) change, cup-to-disc ratio, corneal clarity, additional surgeries, ocular hypotensive medication use, and the occurrence of adverse events over 36 months of follow-up. Primary success was defined as a postoperative IOP of 5-21 mmHg without additional surgeries or serious sight-threatening complications. RESULTS: A total of 83 eyes from 55 patients were included: 34 in the AGV group and 49 in the trabeculotomy group. The primary success rate was significantly higher at all time points of the follow-up period in the AGV group compared with the trabeculotomy group ( P =0.014). Trabeculotomy was associated with a significantly higher risk of surgical failure compared with AGV implantation (HR: 3.23; 95% CI: 1.35-7.71; P =0.008). Notably, only 2 eyes in the AGV group underwent additional surgeries, compared with 25 in the trabeculotomy group ( P <0.001). CONCLUSIONS: AGV as an initial procedure seems to be safe and more effective than trabeculotomy for the treatment of PCG in this select population, with fewer additional surgeries.
A Morphologic Model of Glaucomatous Damage to the Macular Ganglion Cell Layer in Myopic Eyes.
Kim MJ, Tsamis E, Leshno A … +6 more , Gomide G, De Moraes CG, Cioffi GA, Liebmann JM, Park KH, Hood DC
J Glaucoma · 2025 Oct · PMID 40272358 · Publisher ↗
PRÉCIS: A model of glaucomatous progression based upon patterns of macular ganglion cell layer (GCL) damage can help clinicians distinguish between glaucomatous damage and other causes of GCL abnormalities in eyes with h...
PRÉCIS: A model of glaucomatous progression based upon patterns of macular ganglion cell layer (GCL) damage can help clinicians distinguish between glaucomatous damage and other causes of GCL abnormalities in eyes with high myopia. PURPOSE: To evaluate a model-based approach for identifying glaucomatous macular ganglion cell layer (GCL) damage in highly myopic eyes by analyzing characteristic loss patterns. MATERIALS AND METHODS: This retrospective observational study involved optical coherence tomography scans of 72 myopic eyes (axial length>25 mm), including 15 normal control eyes and 57 eyes with glaucoma or glaucoma suspects. The mean axial length was 27.09±1.61 mm (range, 25.13-35.77 mm). The mean refractive error was -7.81±2.70 D in 46 eyes without prior refractive or cataract surgery. The loss pattern in the thick donut-shaped region of the macular GCL thickness map was compared with a model predicting glaucomatous damage patterns, suggesting damage originates temporally and progresses nasally. RESULTS: As predicted, the temporal sectors of the 57 patients' GCL donuts showed the highest number of abnormalities significant at 5% (temporal superior: 28, temporal inferior: 37), followed by the middle sectors (superior: 26, inferior: 30), and then nasal sectors (nasal superior: 24, nasal inferior: 27). Among 3 eyes deviating from the model, 2 showed nasal defects without temporal involvement, while 1 showed an epiretinal membrane (ERM)-induced artifact. Of the 24 eyes with macular lesions (most commonly ERM in 19), 21 were diagnosed with glaucoma or glaucoma suspects. Of these, 20 conformed to the model, except 1. CONCLUSIONS: The proposed model of glaucomatous damage patterns in macula GCL is applicable to myopic eyes, even with coexisting macular pathology. In cases deviating from the model, clinicians are advised to seek causes besides glaucoma.
SMOTE-Enhanced Explainable Artificial Intelligence Model for Predicting Visual Field Progression in Myopic Normal Tension Glaucoma.
Kim SY, Jin JJ, Ha A … +8 more , Song CH, Park SH, Kang KH, Lee J, Huh MG, Jeoung JW, Park KH, Kim YK
J Glaucoma · 2025 Jul · PMID 40249240 · Publisher ↗
PRÉCIS: The AI model, enhanced by SMOTE to balance data classes, accurately predicted visual field deterioration in patients with myopic normal tension glaucoma. Using SHAP analysis, the key variables driving disease pro...
PRÉCIS: The AI model, enhanced by SMOTE to balance data classes, accurately predicted visual field deterioration in patients with myopic normal tension glaucoma. Using SHAP analysis, the key variables driving disease progression were identified. PURPOSE: To develop and validate a Synthetic Minority Over-sampling Technique (SMOTE)-enhanced artificial intelligence (AI) model for predicting visual field progression in myopic normal tension glaucoma (NTG) patients. METHODS: This retrospective cohort study included 100 eyes from myopic NTG patients with a mean follow-up of 10.3±3.2 years. Baseline parameters included intraocular pressure (IOP), central corneal thickness, axial length, and visual field metrics. A SMOTE-enhanced AI model was created to address class imbalance in progression events. Model performance was evaluated using receiver operating characteristic (ROC) analysis, cross-validation, and calibration plots. Predictive factor importance was evaluated through SHapley Additive exPlanations (SHAP) analysis. RESULTS: Visual field progression was observed in 28% of patients, with a median progression time of 3.2 years. The AI model achieved an area under the ROC curve (AUC) of 0.83 (95% CI, 0.75-0.91), with promising sensitivity (0.81) and specificity (0.77). SHAP analysis identified baseline mean deviation (MD), age, axial length, baseline IOP, and visual field index (VFI) as key predictors. When patients were stratified based on model-predicted risk scores, those with scores above 0.8 had significantly higher observed progression rates (82.6%) compared with those with lower risk scores. Subgroup analysis revealed strong correlations between progression risks and older age, greater axial length, and worse baseline MD. CONCLUSIONS: The SMOTE-enhanced AI model shows reasonable predictive performance and potential clinical utility for identifying visual field progression in myopic NTG patients, though further validation in larger cohorts is needed. By addressing class imbalance and myopia-specific challenges, this approach enables personalized risk stratification and early intervention.
The Role of Vitreous Zonule Attachments to the Posterior Lens Equator in Primary Angle Closure Glaucoma.
Huang J, Li M, Huang C
J Glaucoma · 2025 Jul · PMID 40249239 · Publisher ↗
PRÉCIS: Shorter axial length was associated with the absence of the attachments between the posterior insertion zone of the vitreous zonules and the posterior lens equator. Primary angle closure disease eyes without vitr...
PRÉCIS: Shorter axial length was associated with the absence of the attachments between the posterior insertion zone of the vitreous zonules and the posterior lens equator. Primary angle closure disease eyes without vitreous zonules had a more anteriorly rotated ciliary body. PURPOSE: To assess the clinical significance of the attachments between the posterior insertion zone of the vitreous zonules and the posterior lens equator (PVZ INS-LE strands) and vitreous zonules (VZ) in primary angle closure disease (PACD). METHODS: This cross-sectional study consisted of 90 PACD and 30 cataract eyes from an eye clinic. PVZ INS-LE strands, VZ, and anterior segment parameters were assessed by ultrasound biomicroscopy (UBM). The presence of PVZ INS-LE strands and VZ was compared between groups. Baseline ocular characteristics and UBM parameters were compared among PACD eyes. Factors associated with the absence of PVZ INS-LE strands and VZ were identified. RESULTS: Forty percent of control eyes and 71.1% of PACD showed PVZ INS-LE strands absent. PACD 22.2% and no control eyes showed VZ absent. PVZ INS-LE strands absent group had shorter axial length ( P =0.018), larger ciliary-ciliary angle ( P =0.010), and smaller trabecular-ciliary process distance at 750 μm ( P =0.022). Shorter axial length was independently associated with absence of PVZ INS-LE strands (OR=2.230; 95% CI: 1.027-4.838; P =0.043). VZ absent group had larger ciliary-ciliary angle ( P <0.001), smaller trabecular-ciliary angle ( P =0.040), shorter iris-ciliary process distance at 750 μm ( P =0.092), and shorter trabecular-ciliary process distance at 750 μm ( P =0.026). CONCLUSIONS: PVZ INS-LE strands were less likely to be seen in APACD and their fellow eyes. All types of PACD eyes had less presence of VZ. PACD eyes without VZ appeared to have more anterior rotation of the ciliary body. Shorter AL was independently associated with the absence of PVZ INS-LE strands.
Impact of Physical Activity Levels on Visual Field Progression in Individuals With Glaucoma.
Seo JH, Nishida T, Moghimi S … +6 more , Wu JH, Fazio MA, Girkin CA, Liebmann JM, Zangwill LM, Weinreb RN
J Glaucoma · 2025 Jul · PMID 40249228 · Publisher ↗
PRÉCIS: Higher self-reported physical activity level was associated with a slower rate of visual field mean deviation loss in patients with primary open angle glaucoma. PURPOSE: To determine the impact of physical activi...
PRÉCIS: Higher self-reported physical activity level was associated with a slower rate of visual field mean deviation loss in patients with primary open angle glaucoma. PURPOSE: To determine the impact of physical activity (PA) on visual field (VF) progression rates in patients with primary open angle glaucoma (POAG). METHODS: In this longitudinal study, POAG patients were included who had ≥5 visits, ≥2 years of follow-up VFs and underwent PA questionnaire at the baseline. PA levels were assessed using the physical activity index (PAI), metabolic equivalents of task (MET)-minutes, and walking pace. Univariable and multivariable linear mixed-effects models were used to determine the impact of PA levels on the rates of VF mean deviation (MD) loss. RESULTS: One hundred thirty-one eyes from 80 POAG patients were included over a median follow-up of 4.9 (IQR: 4.0-6.7) years. The median age of patients was 68.6 (IQR: 59.3-77.8) years and the median baseline VF MD was -3.5 (IQR: -8.3 to -1.3). In the univariable analysis, slower VF MD loss was associated with active PAI category (0.30 [95% CI: 0.01-0.58] dB/year vs. inactive PAI category; P =0.041) and higher PA amount (0.14 [95% CI: 0.01-0.27] dB/year per 1000 MET-minutes; P =0.036). Significant association with the rate of VF MD loss was not found for baseline VF MD ( P =0.263) and walking pace ( Ps >0.05). In the multivariable analysis including glaucoma severity and other covariates, slower VF MD loss was associated with higher PA amounts (0.15 [95% CI: 0.02-0.28] dB/year per 1000 MET-minutes; P =0.024). CONCLUSIONS: Higher PA amounts are an independent predictor of a slower rate of VF MD loss. Further research is needed to explore whether increased PA protects against glaucoma progression.
Staphylococcus Capitus Blebitis Following Preserflo MicroShunt Implantation.
Kudsieh B, Almazan-Alonso E, Ruiz-Medrano J … +2 more , Samaan M, Ruiz-Moreno JM
J Glaucoma · 2025 Jul · PMID 40249227 · Publisher ↗
PURPOSE: To report a case of early-onset blebitis following Preserflo MicroShunt implantation. PATIENTS AND METHODS: Case report. RESULTS: A 73-year-old woman with a history of open angle glaucoma secondary to pseudoexfo...
PURPOSE: To report a case of early-onset blebitis following Preserflo MicroShunt implantation. PATIENTS AND METHODS: Case report. RESULTS: A 73-year-old woman with a history of open angle glaucoma secondary to pseudoexfoliative syndrome in her right eye underwent Preserflo MicroShunt implantation augmented with mitomycin C. Three months postoperatively, she experienced ocular pain and a decrease in visual acuity. Clinical examination revealed conjunctival hyperemia surrounding a whitish filtering bleb, positive conjunctival fluorescein staining, and a positive Seidel sign leading to hypotony. In addition, an inflammatory reaction was observed in the anterior chamber, along with localized vitreous haze. Management included topical antibiotic therapy, removal of necrotic tissue, and explantation of the Preserflo MicroShunt. Staphylococcus capitis was isolated from both conjunctival and implant cultures, confirming the clinical diagnosis of infectious blebitis. Intraocular pressure and visual function were successfully restored after surgery. CONCLUSIONS: Blebitis is a rare but potentially serious complication following Preserflo MicroShunt implantation with mitomycin C. Device removal may be necessary to prevent bacterial infection from extending beyond the filtering bleb into the anterior chamber.
Gap Analysis of Standard Automated Perimetry Concept Representation in Medical Terminologies.
Hallaj S, Halfpenny W, Radgoudarzi N … +16 more , Boland MV, Swaminathan SS, Wang SY, Xu BY, Amarasekera DC, Stagg B, Chen A, Hribar M, Thakoor KA, Goetz KE, Myers JS, Lee AY, Christopher MA, Zangwill LM, Weinreb RN, Baxter SL
J Glaucoma · 2025 Aug · PMID 40193233 · Publisher ↗
PRÉCIS: In this multi-institutional effort, we identified gaps in SAP data elements within medical terminologies. We proposed new concepts to LOINC to enhance SAP data standards and big data representation and improve in...
PRÉCIS: In this multi-institutional effort, we identified gaps in SAP data elements within medical terminologies. We proposed new concepts to LOINC to enhance SAP data standards and big data representation and improve interoperability across health care systems. PURPOSE: To identify gaps in the representation of Standard Automated Perimetry (SAP) data elements in Logical Observation Identifiers Names and Codes (LOINC) and the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) and propose solutions for those gaps. METHODS: SAP source data elements and Digital Imaging and Communications in Medicine (DICOM) standard from 2 commonly used perimeter devices were extracted and compared against existing concepts in standardized terminologies using the OMOP CDM Athena browser and LOINC using the LOINC browser. Gap areas were identified and classified following conventions used by Health Level 7 Fast Healthcare Interoperability Resources and discussed within the OHDSI Eye Care and Vision Research Workgroup in iterative rounds aiming to address gaps. New codes were developed upon reaching a consensus and proposed for inclusion in LOINC. RESULTS: Among 107 data elements extracted from the perimeters, 82% (n=88) of SAP data elements lacked representation. Of the 19 remaining elements, 2.8% (n=3) were wider, 1.9% (n=2) were narrower, and 13% (n=14) had equivalent representation. In addition, only 2.6% (n=3) of the 116 DICOM attributes related to SAP had representation in standardized terminologies. Several existing relevant codes were defined ambiguously or erroneously (eg, visual field index, pupil diameter, perimeter format Kowa). CONCLUSION: There is a lack of representation of some SAP data elements in standardized medical terminologies, hampering interoperability and data sharing. We identified gaps and proposed new concepts for addition to LOINC, aiming to improve SAP data standards and interoperability.
Efficacy and Safety of the Preserflo MicroShunt in Pediatric Glaucoma.
Duarte SR, Lima-Cabrita A, Barão RC … +7 more , Barata A, Brito C, Stalmans I, Lemmens S, Breda JB, Pinto LA, Teixeira FJ
J Glaucoma · 2025 Jun · PMID 40178489 · Publisher ↗
PRÉCIS: Preserflo significantly reduced both intraocular pressure and the number of glaucoma medications in selected cases of pediatric glaucoma, as far as a 2-year period, with a favorable safety profile. PURPOSE: To as...
PRÉCIS: Preserflo significantly reduced both intraocular pressure and the number of glaucoma medications in selected cases of pediatric glaucoma, as far as a 2-year period, with a favorable safety profile. PURPOSE: To assess the efficacy and safety of the Preserflo device in selected cases of pediatric glaucoma. METHODS: Retrospective multicenter observational study. Patients aged 18 years or younger who underwent Preserflo implantation with at least 6 months of follow-up were included. The primary outcome was a surgical success, defined as an intraocular pressure between 6 and 21 mm Hg with a reduction of ≥20% (criterion A) or ≥30% (criterion B), no need for further surgery and no severe surgery-related complications. Secondary outcomes included postoperative intraocular pressure, number of hypotensive drugs, and adverse effects. RESULTS: Twenty eyes from 20 patients (mean age: 11.7±1.1 y) were included, most with uveitic glaucoma (n=8 eyes; 40%). Average follow-up was 18.3±7.7 months, with 55% (n=11) completing 24 months. Mean intraocular pressure was significantly reduced from 27.8±1.3 mm Hg at baseline to 14.2±8.5 mm Hg and 14.6±13.9 mm Hg at 12 and 24 months, respectively ( P <0.001 for both). Average medication reduced from 2.9±1.1 to 0.9±1.3 ( P =0.006) at 24 months. Qualified surgical success (regardless of medication) was 60% and 50% after 12 months, for criteria A and B, and 45% at 24 months (criteria A and B). In both time points and for both criteria, 35% of cases were complete successes (drop-free). No sight-threatening complications were registered. CONCLUSION: Real-world data from Preserflo use suggests this to be a safe and effective surgical option for the treatment of selected cases of pediatric glaucoma.
Comparison of Event-based Analysis Versus Trend-based Analysis in the Detection of Glaucoma Progression by Optical Coherence Tomography 3-Dimensional Rim Measurements.
Scott TD, Guzman Aparicio MA, Ratanawongphaibul K … +9 more , Lee H, Zemplenyi M, Tsikata E, Margeta MA, Ondeck CL, Coleman AL, Yu F, de Boer JF, Chen TC
J Glaucoma · 2025 Aug · PMID 40178477 · Full text
PRÉCIS: Compared with trend-based analysis, event-based analysis detects OCT structural progression in more patients and at an earlier time point. Using event-based analysis, MDB rim thickness detects progression more of...
PRÉCIS: Compared with trend-based analysis, event-based analysis detects OCT structural progression in more patients and at an earlier time point. Using event-based analysis, MDB rim thickness detects progression more often than RNFL thickness. PURPOSE: To determine whether event-based or trend-based analysis best detects glaucoma progression using spectral domain optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness and minimum distance band (MDB) neuroretinal rim measurements. METHODS: Over 5 years, 124 open angle glaucoma patients had yearly dilated eye examinations, disc photography, Humphrey visual field (HVF 24-2) testing, 2-dimensional (2D) OCT RNFL thickness measurements, and 3-dimensional (3D) OCT MDB rim measurements, all on the same day. One eye of each patient was analyzed, which was randomly selected if both eyes from a patient were eligible. Using global RNFL thickness and global MDB rim thickness, event-based progression was defined as change greater than normal aging change and expected inter-test variability. Trend-based analysis used linear regression with progression defined as rate of decline greater than age-related decline. RESULTS: The average follow-up for the 124 open angle glaucoma patients was 66.9±16.4 months. Event-based analysis was better than trend-based analysis because it detected progression in more patients (15.3% by RNFL event-based analysis versus 8.1% by RNFL trend-based analysis, P =0.025; 52.4% by MDB event-based analysis versus 9.7% by MDB trend-based analysis, P <0.001) and earlier (RNFL: mean 28.8 vs. 63.2 mo; P <0.001; MDB: mean 30.7 vs. 56.2 mo; P <0.003) whether using MDB rim thickness or RNFL thickness. Using event-based analysis, MDB rim thickness detected progression more often than RNFL thickness (52.4% vs. 15.3%; P <0.001). CONCLUSIONS: Compared with trend-based analysis, event-based analysis detected OCT structural progression in more glaucoma patients and at an earlier time point.
Slow-Coagulation Transscleral Cyclophotocoagulation in Pseudoexfoliation Glaucoma.
Khodeiry MM, Yusuf R, Dorizas CA … +4 more , Elhusseiny AM, Sayed MS, Ruan M, Lee RK
J Glaucoma · 2025 Apr · PMID 40146528 · Publisher ↗
PRÉCIS: Further prospective investigations are suggested to confirm these findings. PURPOSE: To evaluate the outcomes of slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) in pseudoexfoliation glaucoma (PXG)....
PRÉCIS: Further prospective investigations are suggested to confirm these findings. PURPOSE: To evaluate the outcomes of slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) in pseudoexfoliation glaucoma (PXG). METHODS: A single-center, retrospective non-comparative study including consecutive patients with medically uncontrolled PXG who underwent SC-TSCPC (1250-milliwatt power and 4-second duration). The primary outcome measure was surgical success [defined as intraocular pressure (IOP) between 6 and 21 mmHg with ≥20% reduction compared with baseline and no need for further glaucoma surgeries or development of vision-threatening complications]. Success was considered qualified when achieved with additional glaucoma medications and complete when achieved without additional glaucoma medications. The secondary outcomes included IOP, glaucoma medication numbers, visual acuity, and postoperative complications at 1 and 2 years after laser treatment. RESULTS: This study included 48 eyes of 48 patients. The median age of study participants was 87.5 years, with a median follow-up duration of 24.0 months. The qualified success for a single SC-TCPC treatment at 1 and 2 years was 58.3% and 47.9%, respectively. Cumulative qualified success (>1 SC-TSCPC) was 64.6% at 1 year and 56.2% at 2 years. Complete surgical success after a single SC-TSCPC was 45.8% at 1 year and 33.3% at 2 years, increased to 50.0% at 1 year and 39.6% at 2 years after >1 SC-TSCPC. After SC-TSCPC treatment, the mean IOP decreased from 29.2±10.3 mmHg on 3.7±1.0 medications pretreatment to 14.3±6.43 mmHg on 2.6±1.3 medications at the final follow-up visit ( P <0.001). Seven eyes (14.6%) had SC-TSCPC retreatment, and 2 eyes (4.2%) required incisional glaucoma surgeries. Reported postoperative complications included: decreased visual acuity in 9 (18.8%) eyes, iridocyclitis in 5 (10.4%) eyes, hyphema in 5 (10.4%) eyes, cystoid macular edema in 2 (4.2%) eyes, and transient hypotony in 2 (4.2%) eyes. CONCLUSIONS: SC-TSCPC is an effective, relatively safe, and repeatable surgical treatment option in PXG. Further prospective investigations are suggested to confirm these findings.
Vascular Density and Retinal Structure Relationships Across Sectors and Regions of the Optic Nerve in Patients With Primary Open Angle Glaucoma.
Ritzer L, Harris A, Arciero J … +7 more , Siesky B, Fry B, Januleviciene I, Oddone F, Carnevale C, Eckert G, Verticchio Vercellin A
J Glaucoma · 2025 Apr · PMID 40146003 · Full text
PRÉCIS: The relationship between structural and hemodynamic parameters in patients with primary open angle glaucoma is strongest in the temporal region of the optic nerve. PURPOSE: To investigate the relationship between...
PRÉCIS: The relationship between structural and hemodynamic parameters in patients with primary open angle glaucoma is strongest in the temporal region of the optic nerve. PURPOSE: To investigate the relationship between radial peripapillary capillary (RPC) vessel density (VD) and retinal nerve fiber layer (RNFL) thickness in quadrants and sectors of the optic nerve head (ONH) in patients with and without primary open angle glaucoma (POAG). METHODS: In a cross-sectional prospective analysis, 191 subjects (80 early-stage POAG; 111 non-glaucomatous controls) were assessed for RNFL thickness and RPC VD in each quadrant [superior (S), inferior (I), nasal (N) and temporal (T)] and sector [inferior-temporal (IT), temporo-inferior (TI), temporo-superior (TS), superior-temporal (ST), inferior-nasal (IN), naso-inferior (NI), naso-superior (NS), and superior-nasal (SN) sectors] of the ONH through optical coherence tomography angiography (OCTA). Pearson correlations were used to test for associations between measurements, with P<0.05 considered statistically significant. RESULTS: Significantly stronger positive correlations were found between RPC VD and RNFL thickness in the S, I, and T quadrants in POAG patients compared with non-glaucomatous controls (all P<0.05). The temporal quadrant in POAG patients displayed the largest difference in correlation compared with controls. A stronger positive correlation was also found between RPC VD and RNFL thickness in the temporal sectors of the ONH in POAG patients compared with controls, with the largest difference in the TS sector (all P<0.05). CONCLUSION: Early-stage POAG patients have a stronger relationship between RPC VD and RNFL in the temporal regions of the ONH compared with non-glaucomatous controls, with the TS sector demonstrating the largest difference between groups. Temporal sector VD loss may represent an early-stage biomarker for vascular-linked POAG disease.
Assessing Vascular and Structural Hemiretinal Asymmetry at Different Stages of Normal Tension Glaucoma Using Optical Coherence Tomography.
Lu X, Chen DF, Wang C … +5 more , Zhang J, Wang T, Zhang C, Huang Q, Liang Y
J Glaucoma · 2025 Jul · PMID 40131027 · Publisher ↗
PRÉCIS: Hemiretinal asymmetry in different stages of normal tension glaucoma (NTG) may be helpful in diagnosis and staging. PURPOSE: To investigate hemiretinal asymmetry in peripapillary capillary vessel density (pcVD),...
PRÉCIS: Hemiretinal asymmetry in different stages of normal tension glaucoma (NTG) may be helpful in diagnosis and staging. PURPOSE: To investigate hemiretinal asymmetry in peripapillary capillary vessel density (pcVD), macular vessel density (macVD), circumpapillary retinal nerve fibre layer (RNFL) thickness, and macular ganglion cell-inner plexiform layer (GCIPL) across various stages of normal tension glaucoma (NTG) and determine its potential as a staging tool. SUBJECTS AND METHODS: A total of 199 subjects were included, categorized into the preperimetric, early, moderate, and advanced stage based on mean deviation (MD). Vessel density was measured using optical coherence tomography angiography, while peripapillary RNFL and macular GCIPL thickness were assessed with spectral-domain optical coherence tomography scans. The asymmetry parameter was defined as the absolute difference between superior and inferior values in the same eye. We analysed the characteristics of these parameters across glaucoma stages and evaluated the distribution of structural damage among the groups. RESULTS: Hemiretinal asymmetry parameters showed significant statistical differences across the 4 groups, following a trend of moderate > early > late > preperimetric stages. Furthermore, hemiretinal difference in pcVD (hd pcVD) ( P= 0.009) and hemiretinal difference in RNFL (hd RNFL) ( P= 0.003) have statistical differences between preperimetric and early stage. Besides, 50% to 80% of the participants in each stage exhibited smaller structural parameters in the inferior hemisphere. CONCLUSIONS: The hemiretinal asymmetry parameter exhibits a clear trend across different stages of NTG, aiding in the staging of NTG before reaching the moderate stage. Furthermore, it has advantages in differentiating between the preperimetric and early stages. In addition, the intraocular inferior hemisphere structure damage is more severe.
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