Trabecular Procedures Combined with Cataract Surgery for Open-Angle Glaucoma: A Report by the American Academy of Ophthalmology.

PURPOSE: To determine the intraocular pressure (IOP) reduction of various trabecular procedures (a form of minimally invasive glaucoma surgery [MIGS]) combined with cataract surgery compared with cataract surgery alone, to compare the safety of the various trabecular procedures, and to highlight patient characteristics that may favor one trabecular procedure over another. METHODS: A search of English-language peer-reviewed literature in the PubMed database was initially conducted in February 2021 and updated in April 2023. This yielded 279 articles. Twenty studies met initial inclusion and exclusion criteria and were assessed for quality by the panel methodologist. Of these, 10 were rated level I, 3 were rated level II, and 7 were rated level III. Only the 10 level I randomized controlled trials (RCTs) were included in this assessment, and all were subject to potential industry-sponsorship bias. RESULTS: The current analysis focuses on the amount of IOP reduction (in studies that involved medication washout) and on IOP reduction with concurrent medication reduction (in studies that did not involve medication washout). Based on studies that performed a medication washout, adding a trabecular procedure to cataract surgery provided an additional 1.6 to 2.3 mmHg IOP reduction in subjects with hypertensive, mild to moderate open-angle glaucoma (OAG) at 2 years over cataract surgery alone, which itself provided approximately 5.4 to 7.6 mmHg IOP reduction. In other words, adding a trabecular procedure provided an additional 3.8% to 8.9% IOP reduction over cataract surgery alone, which itself provided 21% to 28% IOP reduction. There was no clear benefit of one trabecular procedure over another. Patient-specific considerations that can guide procedure selection include uveitis predisposition, bleeding risk, metal allergy, and narrowing of Schlemm's canal. There are no level I data on the efficacy of trabecular procedures in subjects with pretreatment IOP of 21 mmHg or less. CONCLUSIONS: Trabecular procedures combined with cataract surgery provide an additional mild IOP reduction over cataract surgery alone in hypertensive OAG subjects. Additional research should standardize outcome definitions, avoid industry sponsorship bias, and study the efficacy of these procedures in normotensive OAG. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Central Visual Field Testing in Early Glaucoma: A Report by the American Academy of Ophthalmology.

PURPOSE: To evaluate the current published literature on the utility of the 10-2 visual field (VF) testing strategy for the evaluation and management of early glaucoma, defined here as mean deviation (MD) better than -6 decibels (dB). METHODS: A search of the peer-reviewed literature was last conducted in June 2023 in the PubMed database. Abstracts of 986 articles were examined to exclude reviews and non-English-language articles. After inclusion and exclusion criteria were applied, 26 articles were selected, and the panel methodologist rated them for strength of evidence. Thirteen articles were rated level I, and 8 articles were rated level II. The 5 level III articles were excluded. Data from the 21 included articles were abstracted and reviewed. RESULTS: The central 12 locations on the 24-2 VF test grid lie within the central 10 degrees covered by the 10-2 VF test. In early glaucoma, defects detected within the central 10 degrees generally agree between the 2 tests. Defects within the central 10 degrees of the 24-2 VF test can predict defects on the 10-2 VF test, although the 24-2 may miss defects detected on the 10-2 VF test. In addition, results from the 10-2 VF test show better association with findings from OCT scans of the macular ganglion cell complex. Modifications of the 24-2 test that include extra test locations within the central 10 degrees improve detection of central defects found on 10-2 VF testing. CONCLUSIONS: Evidence to date does not support routine testing using 10-2 VF for patients with early glaucoma. However, early 10-2 VF testing may provide sufficient additional information for some patients, particularly those with a repeatable defect within the central 12 locations of the standard 24-2 VF test or who have inner retinal layer thinning on OCT scans of the macula. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Aqueous Shunts with Extraocular Reservoir for Open-Angle Adult Glaucoma: A Report by the American Academy of Ophthalmology.

PURPOSE: To evaluate the recently published literature on the efficacy and safety of the use of aqueous shunts with extraocular reservoir for the management of adult open-angle glaucomas (OAGs). METHODS: A search of peer-reviewed literature was last conducted in April 2023 of the PubMed database and included only articles published since the last aqueous shunt Ophthalmic Technology Assessment, which assessed articles published before 2008. The abstracts of these 419 articles were examined, and 58 studies were selected for full-text analysis. After inclusion and exclusion criteria were applied, 28 articles were selected and assigned ratings by the panel methodologist according to the level of evidence. Twenty-five articles were rated level I and 3 articles were rated level II. There were no level III articles. RESULTS: Implantation of aqueous shunts with extraocular reservoir can lower intraocular pressure (IOP) by between one-third and one-half of baseline IOP, depending on whether it is undertaken as the primary or secondary glaucoma surgery. Success rates for aqueous shunts were found to be better than for trabeculectomies in eyes with prior incisional surgery. Conversely, in eyes without prior incisional surgery, implantation of aqueous shunts was found to have an overall lower success rate as the primary glaucoma procedure compared with trabeculectomy. Although both valved and nonvalved aqueous shunts with extraocular reservoir were effective, the nonvalved device generally achieved slightly lower long-term IOPs with fewer glaucoma medications and less need for additional glaucoma surgery. Both devices slow the rates of visual field progression with efficacy comparable with that of trabeculectomy. Early aqueous humor suppression after aqueous shunt implantation is recommended for the management of the postoperative hypertensive phase and long-term IOP control. No strong evidence supports the routine use of mitomycin C with aqueous shunt implantation for OAG. CONCLUSIONS: Implantation of aqueous shunts with extraocular reservoir, including valved or nonvalved devices, has been shown to be an effective strategy to lower IOP. Strong level I evidence supports the use of aqueous shunts with extraocular reservoir by clinicians for the management of adult OAG. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Selective Laser Trabeculoplasty for the Treatment of Glaucoma: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the current published literature for high-quality studies on the use of selective laser trabeculoplasty (SLT) for the treatment of glaucoma. This is an update of the Ophthalmic Technology Assessment titled, "Laser Trabeculoplasty for Open-Angle Glaucoma," published in November 2011. METHODS: Literature searches in the PubMed database in March 2020, September 2021, August 2022, and March 2023 yielded 110 articles. The abstracts of these articles were examined to include those written since November 2011 and to exclude reviews and non-English articles. The panel reviewed 47 articles in full text, and 30 were found to fit the inclusion criteria. The panel methodologist assigned a level I rating to 19 studies and a level II rating to 11 studies. RESULTS: Data in the level I studies support the long-term effectiveness of SLT as primary treatment or as a supplemental therapy to glaucoma medications for patients with open-angle glaucoma. Several level I studies also found that SLT and argon laser trabeculoplasty (ALT) are equivalent in terms of safety and long-term efficacy. Level I evidence indicates that perioperative corticosteroid and nonsteroidal anti-inflammatory drug eye drops do not hinder the intraocular pressure (IOP)-lowering effect of SLT treatment. The impact of these eye drops on lowering IOP differed in various studies. No level I or II studies exist that determine the ideal power settings for SLT. CONCLUSIONS: Based on level I evidence, SLT is an effective long-term option for the treatment of open-angle glaucoma and is equivalent to ALT. It can be used as either a primary intervention, a replacement for medication, or an additional therapy with glaucoma medications. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Unusual Presentations of Low-Tension Glaucoma.

Low-tension glaucoma can sometimes be difficult to diagnose, particularly if patients do not have a classic presentation. This case series shows the value of Humphrey visual field (HVF) 10-2 tests to identify deficits in central vision. Case 1 describes a female in her mid-60s who presented complaining of a "blind spot" in her right eye. While a HVF 24-2 suggested her test was "within normal limits," an HVF 10-2 showed an unusually shaped scotoma in her right eye that matched her visual complaint. Case 2 describes a male in his mid-60s who was referred to the glaucoma service by a retina specialist. He complained of a "blind spot" in his left eye and was revealed to have a focal central scotoma on his HVF 10-2 test. Both patients presented with normal intraocular pressures, and both had been cleared by retina specialists and neuro-ophthalmologists. Both patients were then diagnosed with low-tension glaucoma, and treatment to date has been successful in slowing vision loss.

Corneal Hysteresis for the Diagnosis of Glaucoma and Assessment of Progression Risk: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the current published literature on the utility of corneal hysteresis (CH) to assist the clinician in the diagnosis of glaucoma or in the assessment of risk for disease progression in existing glaucoma patients. METHODS: Searches of the peer-reviewed literature in the PubMed database were performed through July 2022. The abstracts of 423 identified articles were examined to exclude reviews and non-English articles. After inclusion and exclusion criteria were applied, 19 articles were selected, and the panel methodologist rated them for level of evidence. Eight articles were rated level I, and 5 articles were rated level II. The 6 articles rated level III were excluded. RESULTS: Corneal hysteresis is lower in patients with primary open-angle glaucoma, primary angle-closure glaucoma, pseudoexfoliative glaucoma, and pseudoexfoliation syndrome compared with normal subjects. Interpretation of low CH in patients with high intraocular pressure (IOP) or on topical hypotensive medications is complicated by the influence of these parameters on CH measurements. However, CH is also lower in treatment-naïve, normal-tension glaucoma patients compared with normal subjects who have a similar IOP. In addition, lower CH is associated with an increased risk of progression of glaucoma based on visual fields or structural markers in open-angle glaucoma patients, including those with apparently well-controlled IOP. CONCLUSIONS: Corneal hysteresis is lower in glaucoma patients compared with normal subjects, and lower CH is associated with an increased risk of disease progression. However, a causal relationship remains to be demonstrated. Nevertheless, measurement of CH complements current structural and functional assessments in determining disease risk in glaucoma suspects and patients. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Endoscopic Visualization for Atypical Uveitis Glaucoma Hyphema Syndrome Management.

We discuss how ophthalmic endoscopy was used in the management of 6 cases with atypical uveitis glaucoma hyphema syndrome. For case 1, the endoscope was used to remove a retained haptic foreign body after an intraocular lens (IOL) exchange with an iris-sutured IOL for a complete capsular bag-IOL complex dislocation. In case 2, the endoscope was key in identifying the presence and location of vascular lesions at the site of previous pars plana sclerotomies. In case 3, the endoscope enabled visualization of a large segmental Soemmering's Ring pushing a 3-piece IOL haptic into the posterior iris. For case 4, the endoscope allowed viewing of the sharp edge of the optic where the haptic of a one-piece lens had been amputated, and the sharp edge of the cut optic was anteriorly oriented and continuing to rub the posterior iris. In case 5, the endoscope confirmed the presence of 1 haptic of a 1-piece lens out of the capsular bag and in the sulcus space. Also, it showed that the capsular bag had inadequate zonular support to attempt repositioning the haptic into the bag. In case 6, the endoscope was helpful in identifying a 1-piece plate haptic IOL in the sulcus, with synechiae and anterior location causing iris bulging inferiorly.

Comparison of Iridocorneal Angle Assessments in Open-Angle Glaucoma and Ocular Hypertension Patients: Anterior Segment Optical Coherence Tomography and Gonioscopy.

Purpose: To quantitatively compare iridocorneal angle assessments using gonioscopy and anterior segment optical coherence tomography (AS-OCT). Patients: US and Chinese patients with open-angle glaucoma (OAG) and/or ocular hypertension (OHT). Methods: Analysis was pooled from 2 multicenter, noninterventional studies conducted in the US and China. Gonioscopy Shaffer grade and an AS-OCT method that approximates the angle width relative to local morphologic variations were compared by measuring the same iridocorneal angles. A third, separate, single-center, noninterventional study was conducted to verify results observed from the pooled analysis. Results: From the pooled studies, a total of 239 eyes were measured using Shaffer grade and AS-OCT. Of these, 6 were Shaffer grade 2, 37 in Shaffer grade 3, and 196 in Shaffer grade 4. There was a trend of increasing Shaffer grade with increasing AS-OCT angle width. Open iridocorneal angles, Shaffer grade ≥3, had a ~98% sensitivity and 88% positive predictive value for identifying AS-OCT angle width ≥300 µm, using the AS-OCT method. To verify these results, a total of 28 right eyes were imaged for the third study. A trend of increasing Shaffer grade with increasing AS-OCT angle width was observed, and angles with Shaffer grade ≤2 had AS-OCT angle width <300 µm. Conclusion: The AS-OCT method can determine the space in the anterior chamber and can potentially identify angles that are the appropriate size for certain glaucoma devices. Information gathered from AS-OCT can provide additional comprehensive and quantitative assessment to gonioscopy.

Assessing accommodative presbyopic biometric changes of the entire anterior segment using single swept-source OCT image acquisitions.

BACKGROUND/OBJECTIVES: To evaluate biometric changes throughout the anterior chamber during accommodation and presbyopia using single image acquisition swept-source anterior-segment optical coherence tomography (AS-OCT). SUBJECT/METHODS: Anterior-segment images were obtained using a new swept-source AS-OCT device (ANTERION, Heidelberg Engineering) from healthy volunteers (n = 71) across two centers in this prospective observational case series. In one image acquisition, cornea through posterior lens, including the ciliary muscle on both sides of the right eye, was imaged. Subjects undertook no accommodative effort and -1, -3, and -5 D of target vergence. Two-way repeated measures ANOVA modeling was performed for ciliary muscle measurements, lens parameters, aqueous depth (AD), and pupil diameter (PD). The first ANOVA factor was accommodative stimuli, and the second factor included age and refractive status. RESULTS: Maximum ciliary muscle thickness increased with accommodative stimuli (p < 0.001), while the distance from the scleral spur to the maximal point on the ciliary muscle and posterior ciliary muscle thickness (CMT2) decreased (p < 0.001-0.002). Older individuals showed no accommodative changes for ciliary muscle parameters, lens thickness, lens vault, PD, and AD (p = 0.07-0.32). Younger- and middle-aged eyes showed statistically significant accommodative structural alterations for these endpoints (p < 0.001-0.002), but with different patterns, including early loss of CMT2 contraction in middle-aged eyes. Within the middle-aged group, myopic eyes maintained better capacity for accommodative structural change. CONCLUSIONS: Swept-source AS-OCT demonstrated multiple simultaneous anterior-segment biometric alterations in single acquisition images, including early loss of posterior ciliary muscle function and better maintained capacity for anterior-segment structural change in myopia.

Does the ISNT rule apply to the radial peripapillary capillary vessel density in OCT angiography?

PURPOSE: To investigate the applicability of ISNT (inferior ≥ superior ≥ nasal ≥ temporal), IST (inferior ≥ superior ≥ temporal), and T min (temporal quadrant with the minimum value) rules to the peripapillary nerve fiber layer (NFL) thickness and radial peripapillary capillary (RPC) vessel density (VD) using Optical Coherence Tomography (OCT) and OCT angiography (OCT-A). MATERIALS AND METHODS: This cross-sectional study included 134 eyes of 74 healthy individuals. NFL thickness and RPC VD were measured in all four quadrants using OCT and OCT-A in order to determine the number of eyes that obey the ISNT, IST, and T min rules. RESULTS: Mean age was 48.8 ± 15.5 (range 25-82) years. The ISNT rule was valid in 52 eyes (38.81%) on OCT and only 12 eyes (8.95%) on OCT-A scans. The IST rule was followed by 83 (61.94%) and 37 (27.61%) eyes on OCT and OCT-A scans respectively. The T min rule was valid in 86 eyes (64.18%) in OCT scans and in 26 eyes (19.4%) in OCT-A scans. CONCLUSION: The topography of the RPC network does not obey the ISNT rule in healthy eyes. The ISNT rule and its variants were found to be more relevant in OCT NFL thickness measurements compared to OCT-A RPC VD measurements.

Posterior cyclodialysis cleft following intravitreal injection.

PURPOSE: To describe an unusual complication of an intravitreal injection. OBSERVATION: Here, we report a case of hypotony following an intravitreal injection due to a posterior cyclodialysis cleft and describe its management and resolution. CONCLUSIONS: Posterior cyclodialysis clefts are a rare cause of hypotony following intravitreal injection. Posterior clefts may not be visualized by conventional gonioscopy. Ultrasound biomicroscopy may be useful in aiding diagnosis. IMPORTANCE: This report highlights a rare cause of hypotony following intravitreal injection and illustrates the importance of adjunctive imaging for accurate diagnosis.

Age- and refraction-related changes in anterior segment anatomical structures measured by swept-source anterior segment OCT.

PURPOSE: To assess the effects of age and refractive status on anterior segment anatomical structures, including the ciliary body, using a new swept-source anterior segment optical coherence tomography (AS-OCT) device. METHODS: This prospective observational study included 63 healthy volunteers (mean age: 44.2 years). Images of the anterior segment were obtained using a new swept-source AS-OCT (ANTERION, Heidelberg Engineering GmbH, Heidelberg, Germany) with tracking and image averaging from the right eye of all participants. Repeatability as well as inter- and intra-observer reliability of biometric measurements were evaluated. The impact of image tracking and averaging on ciliary muscle measurements was tested. Univariate and multivariable statistical models were developed to evaluate the relationship of age and refractive status on anterior segment biometric measurements. RESULTS: For all test-retest repeatability and inter- and intra-observer reproducibility of swept-source AS-OCT measurements, high intraclass correlation (ICC) was noted (0.88-1.00). The nasal maximum ciliary muscle thickness (CMTMAX) and distance between scleral spur to the thickest point of the ciliary muscle (SSMAX) were larger than those on the temporal side (p<0.001 and p = 0.006, respectively). Nasal and temporal CMTMAX (p = 0.004 and p<0.001, respectively) and lens thickness (p<0.01) increased with age. Nasal and temporal SSMAX decreased with older age and increasing hyperopia (p = 0.01 and p<0.001, respectively). Image averaging resulted in improved ciliary muscle measurements (p = 0.008 to 0.02). Lens vault increased with older age and increased hyperopia (p<0.01). OCT measurements of the angle decreased with older age and increased hyperopia (p<0.001 to 0.03). Aqueous depth decreased with older age and increased hyperopia (p<0.01). Pupil diameter decreased with older age (p<0.01). CONCLUSIONS: Repeatability and reproducibility of biometric measurements using the ANTERION AS-OCT were excellent. Image averaging improved the accuracy of ciliary muscle measurements. The device produced measurements of biometric parameters that described superficial and deep structures including the ciliary body and full lens thickness from a single image.

Comparison and Correlation of Retinal Sensitivity Between Microperimetry and Standard Automated Perimetry in Low-tension Glaucoma.

PRéCIS:: Our study demonstrated that in low-tension glaucoma (LTG) patients, Microperimeter-3 (MP-3)-derived and Humphrey Field Analyzer (HFA)-derived retinal sensitivities were similar and strongly correlated, allowing the respective data to be interrelated. PURPOSE: To compare and correlate retinal sensitivities obtained by Nidek MP-3 with those obtained from the HFA in eyes with LTG. MATERIALS AND METHODS: In this prospective comparative study, 45 eyes of 24 LTG patients underwent retinal sensitivity assessments using the MP-3 (Nidek Technologies) and the HFA (Carl Zeiss Meditec) at the UCLA-Doheny Eye Center. Global and pointwise retinal sensitivity measurements were compared and correlated between the 2 devices. RESULTS: No statistically significant differences (P=0.85) were noted between the mean retinal sensitivities determined by each device (MP-3: 26.33±4.31 dB; range, 13.05 to 31.60 vs. HFA: 26.42±3.98 dB; range, 17.17 to 30.96), and a strong correlation (r=0.66, P<0.001) was noted for retinal sensitivity measurements. In addition, moderate to strong correlations were observed between the mean retinal sensitivity derived by MP-3 versus HFA-derived mean deviation (r=0.57, P<0.001), as well as, the pattern standard deviation (r=0.67, P<0.001). The intraclass correlation coefficient was excellent (ICC=0.80, 95% confidence interval, 0.63-0.89), while the Bland-Altman analysis showed good agreement between the 2 devices with respect to retinal sensitivity. CONCLUSION: Retinal sensitivity measurements obtained by the MP-3 microperimetry instrument and the standard automated HFA perimeter were similar and highly correlated in patients with LTG. Given the potential benefits of microperimetry technology such as auto-eye-tracking and potentially more precise structure-function correlations, the use of microperimetry to monitor visual function in glaucoma management warrants further consideration.

Efficacy of Combined Suprachoroidal Stent and Cataract Surgery in Patients With Glaucoma.

PURPOSE: The purpose of this study was to evaluate the efficacy of intraocular pressure (IOP) control after combined CyPass Micro-Stent implantation and cataract surgery (combined surgery). METHODS: All cases of combined surgery performed from February 2017 to July 2018 at Stein and Doheny Eye Institutes were reviewed. The primary outcome was a qualified success with stratified IOP targets based on criteria: final IOP (A) ≤18 mm Hg and reduction of 20%, (B) ≤15 mm Hg and reduction of 25%, (C) ≤12 mm Hg and reduction of 30%. Secondary outcome measures included postoperative IOP and number of medications, complications, additional glaucoma surgery, and postoperative refractive error. Predictive factors for failure were investigated. IOP spike was defined as a postoperative IOP ≥30 or >10 mm Hg increase from preoperative IOP. RESULTS: One hundred forty-one eyes (107 patients) were included. Mean (±SD) preoperative IOP was 15.4±3.4 mm Hg on an average of 2.2±1.1 medications. A statistically significant reduction in IOP and number of medications was seen at 12 months (13.8±4.2 mm Hg, 1.3±1.3 medications, P<0.001). Fifteen eyes (10.6%) had a postoperative IOP spike. Thirteen eyes (9.2%) experienced 17 complications (12.1%). Additional glaucoma surgery was performed in 3 eyes (2 patients). Cumulative success rates at 1 year based on criteria A, B, and C were 42%, 33%, and 28%, respectively. Lower preoperative IOP, greater preoperative medication number, the occurrence of postoperative IOP spike, and non-Caucasian ethnicity were associated with failure. CONCLUSION: Combined CyPass Micro-Stent implantation and cataract surgery may reduce glaucoma medication burden with a success rate of 28% to 42% at 1 year.

Reproducibility and agreement of four anterior segment-optical coherence tomography devices for anterior chamber angle measurements.

PURPOSE: To compare the reproducibility and agreement of anterior chamber angle (ACA) parameters and metrics obtained by four different anterior segment-optical coherence tomography (AS-OCT) devices. METHODS: In this prospective study, 30 eyes from 15 normal subjects underwent anterior segment angle scanning using the Spectralis, Cirrus, and Optovue spectral domain optical coherence tomography (SD-OCT), as well as the Visante time-domain optical coherence tomography (TD-OCT). For each eye, the scan line was performed perpendicularly on the inferior (270°) angle, and the inferior ACA image was acquired 2 times. Inter-instrument and intra-instrument, as well as inter-observer and intra-observer reproducibility of anterior chamber angle metrics, Schwalbe's line (SL) to scleral spur (SS) distance (TM-Span), angle opening distance (AOD), and trabecular iris space area (TISA) measurements, were evaluated by intraclass correlation coefficients (ICCs) and Bland-Altman plots with limits of agreement (LoA). RESULTS: For this cohort of 30 eyes of 15 normal subjects, the mean TM-Span, AOD, and TISA were 0.966 ± 0.198 mm, 0.750 ± 0.205 mm, and 0.286 ± 0.090 mm2 from the Spectralis; 0.929 ± 0.113 mm, 0.717 ± 0.120 mm, and 0.267 ± 0.095 mm2 from the Cirrus; 0.923 ± 0.191 mm, 0.683 ± 0.161 mm, and 0.265 ± 0.072 mm2 from the Optovue; and 0.970 ± 0.070 mm, 0.705 ± 0.150 mm, and 0.279 ± 0.065 mm2 from the Visante. The intra-instrument (ICCs > 0.838), intra-grader (ICCs > 0.910), and inter-grader (ICCs > 0.869) agreement were good. Agreement between the four instruments was also good with ICCs from 0.901 to 0.967 for TM-Span, 0.887 to 0.941 for AOD, and 0.923 to 0.961 for TISA. CONCLUSIONS: Consistent and reproducible ACA measurements could be obtained from multiple AS-OCT devices including both SD- and TD-OCT instruments. These findings have relevance when considering multiple imaging devices in future studies.

Clinical results of ab interno trabeculotomy using the trabectome in patients with uveitic glaucoma.

IMPORTANCE: To evaluate the safety and efficacy of ab interno trabeculotomy (AIT) (trabecular ablation) with the trabectome in patients with uveitic glaucoma. BACKGROUND: Traditional glaucoma filtration surgeries in the uveitic patient population come with a higher risk of complications such as failure and hypotony. DESIGN: Retrospective observational cohort study. PARTICIPANTS: All patients diagnosed with uveitic glaucoma were included in this study. Patients were excluded if they have less than 12 months of follow-up. METHODS: All patients who received AIT alone or combined with phacoemulsification. MAIN OUTCOME MEASURES: Major outcomes include intraocular pressure (IOP), number of glaucoma medications and secondary glaucoma surgery, if any. Kaplan-Meier method was used for survival analysis and success was defined as IOP ≤21 mmHg, at least 20% IOP reduction from baseline for any two consecutive visits after 3 months, no additional glaucoma medications, and no secondary glaucoma surgery. RESULTS: A total of 45 eyes, 45 patients, with an average age of 52 years were included in the study. The majority were Japanese (40%) and underwent AIT alone (71%). IOP was reduced from 29.2 ± 8.0 to 16.7 ± 4.6 mmHg at 12 months (P < .01*), while the number of glaucoma medications was reduced from 4.0 ± 1.0 to 2.5 ± 1.6 (P < .01*). Survival rate at 12 months was 91%. Six cases required secondary glaucoma surgery and no other serious complication were reported. CONCLUSIONS AND RELEVANCE: The trabectome AIT procedure appears to be effective in reducing IOP in uveitic glaucoma patients. Although no statistically significant difference was found in the number of glaucoma medications, a decreasing trend was found.

Quantitative Analysis of Retinal and Choroidal Vascular Parameters in Patients With Low Tension Glaucoma.

PRéCIS:: By using OCT-A, we observed a reduction of the superficial macular, peripapillary, and optic nerve, as well as the choriocapillaris in eyes with low tension glaucoma, compared with normal controls. PURPOSE: The purpose of this study was to investigate macular and optic disc vascular parameters in patients with low tension glaucoma (LTG) using optical coherence tomography angiography (OCTA). METHODS: In this cross-sectional study, images were prospectively acquired from both eyes of 26 patients with clinically diagnosed LTG and 22 age-matched volunteers with normal healthy eyes using the Zeiss swept-source (SS) OCTA (Plex Elite 9000, Carl Zeiss Meditec). Perfusion density (PD) and vessel length density (VLD) within a 5 mm diameter circle centered over the macula and optic nerve head were analyzed. RESULTS: The final analysis cohort included 49 eyes with LTG and 40 healthy control eyes. Mean age was 60±10 years in the LTG group and 60±17 years in the control group. The LTG group had a statistically significant reduction in PD of the choriocapillaris (CC) compared with normal controls (71.74±8.37% vs. 80.48±3.84%; P<0.001). There was no statistically significant difference in PD between the LTG and control groups for the superficial vascular plexus (SVP), deep capillary plexus (DCP) or the optic nerve head and peripapillary area (ONH+PP) (P>0.05). The LTG group did show statistically significant reductions in VLD compared with normal controls for the SVP (2083.64±153.76 mm/mm vs. 2154.63±144.18 mm/mm; P=0.03) and ONH + PP (1813.76±271.69 mm/mm vs. 1950.23±169.33 mm/mm; P=0.03), whereas the DCP VD was similar between the 2 groups (P>0.05). CONCLUSIONS: Eyes with low tension glaucoma seems to show a lower CC perfusion density, as well as a lower SVP and ONH+PP vessel length density compared to normal eyes.