Ophthalmology. Glaucoma最新文献

{"title":"Social Factors Associated with the Risk of Glaucoma Suspect Conversion to Glaucoma","authors":"Jo-Hsuan Wu MD ,&nbsp;Willam Halfpenny MB BChir, MEng ,&nbsp;Jennifer Bu MD ,&nbsp;Manreet Brar BS ,&nbsp;Robert N. Weinreb MD ,&nbsp;Sally L. Baxter MD, MSc","doi":"10.1016/j.ogla.2024.06.007","DOIUrl":"10.1016/j.ogla.2024.06.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine social factors associated with the 5-year risk of glaucoma suspects (GS) converting to open-angle glaucoma (OAG).</div></div><div><h3>Design</h3><div>Retrospective cohort analysis.</div></div><div><h3>Subjects</h3><div>We screened for participants diagnosed with GS in the <em>All of Us</em> database. Cases that converted to OAG within 5 years of GS diagnosis (the “conversion group”) were compared with control cases that did not convert.</div></div><div><h3>Methods</h3><div>Demographic, socioeconomic and health-care utilization data of the cases were extracted and compared between the conversion group and the control group. Multivariable Cox proportional hazards modeling was used to identify potential factors associated with the risk of conversion.</div></div><div><h3>Main Outcome Measures</h3><div>Hazard ratios (HRs) of significant factors associated with the risk of conversion.</div></div><div><h3>Results</h3><div>A total of 5274 GS participants were identified, and 786 (15%) cases converted to OAG within 5-year follow-up. The 2 groups showed significant differences in age, race, gender, employment status, income/education level, history of intraocular surgery, and health-care utilization patterns. In the multivariable model, African American/Black race (HR : 1.70 [95% confidence interval (CI), 1.44–2.00]), older age at GS diagnosis (1.17 [95% CI, 1.09–1.25]), male gender (1.30 [95% CI, 1.13–1.50], no history of recreational drug use (1.23 [1.07–1.42]), history of intraocular surgery (1.60 [95% CI, 1.02–1.53]), and having more reasons for delayed health-care access (2.27 [95% CI, 1.23–4.18]) were associated with a greater hazard of conversion, while being employed (0.71 [95% CI, 0.60–0.86]) was associated with a smaller hazard of conversion (<em>P</em> &lt; 0.05 for all).</div></div><div><h3>Conclusions</h3><div>Several social factors were associated with the conversion from GS to OAG, which may help to identify patients at higher risk of disease progression. Future studies are needed to examine the basis for these findings and the potential interventions that could address them.</div></div><div><h3>Financial Disclosures</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 551-562"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Ultrasound Biomicroscopy Study of Acute Hydrops in Neonatal Glaucoma with Sturge–Weber Syndrome","authors":"Madhu Sharma MS, DNB,&nbsp;Samridhi Vohra MBBS,&nbsp;Sushmita Kaushik MS, FAICO","doi":"10.1016/j.ogla.2024.05.002","DOIUrl":"10.1016/j.ogla.2024.05.002","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Page e12"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Differences in the Prevalence and Treatment Patterns for Neovascular Glaucoma in the American Academy of Ophthalmology IRIS® Registry","authors":"Victoria L. Tseng MD, PhD ,&nbsp;Deyu Pan MS ,&nbsp;Ken Kitayama MD, PhD ,&nbsp;Fei Yu PhD ,&nbsp;Anne L. Coleman MD, PhD","doi":"10.1016/j.ogla.2024.07.006","DOIUrl":"10.1016/j.ogla.2024.07.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine racial and ethnic differences in the prevalence and treatment patterns for neovascular glaucoma (NVG) in at-risk individuals in the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight).</div></div><div><h3>Design</h3><div>Observational retrospective cohort study.</div></div><div><h3>Participants</h3><div>Eyes in the IRIS Registry with a retinal ischemia based on a history of proliferative diabetic retinopathy, retinal vein occlusion, and/or ocular ischemic syndrome.</div></div><div><h3>Methods</h3><div>Race and ethnicity was defined as Asian, Black, Hispanic/Latino, non-Hispanic White, and other/unknown. In eyes with retinal ischemia, the outcome was NVG. In eyes with NVG, outcomes included treatment of retinal ischemia with pan-retinal photocoagulation (PRP), and surgery to lower intraocular pressure (IOP) with trabeculectomy, tube shunt, and cyclophotocoagulation (CPC). Covariates included age, sex, region of residence, insurance type, smoking status, and systemic and ocular comorbidities. Cox proportional hazards regression was used to examine adjusted associations between race and ethnicity and NVG and each type of NVG treatment.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of NVG, PRP, trabeculectomy, tube shunt, CPC, and any IOP-lowering surgery.</div></div><div><h3>Results</h3><div>Of 312 106 eyes with retinal ischemia, there were 5885 (1.9%) with NVG. Compared to eyes of individuals who identified as non-Hispanic White, eyes of individuals who were Black and Hispanic/Latino had higher hazards of NVG in adjusted analyses (hazards ratio [HR] = 1.28, 95% confidence interval [CI] = 1.15–1.43 [for Black]; HR = 1.32, 95% CI = 1.17–1.47 [for Hispanic/Latino]). Compared with eyes of individuals who were non-Hispanic White, there was higher hazards of trabeculectomy in eyes of individuals who were Hispanic/Latino (adjusted HR = 1.91, 95% CI = 1.08–3.39) and higher hazards of tube shunt (adjusted HR = 1.35, 95% CI = 1.07–1.69) and of any IOP-lowering surgery (adjusted HR = 1.29, 95% CI = 1.09–1.53) in eyes of individuals who were Black. There were no statistically significant differences in the hazards of PRP or CPC.</div></div><div><h3>Conclusions</h3><div>Eyes of Black and Hispanic/Latino individuals with retinal ischemia in the IRIS Registry had higher likelihood of NVG and of IOP-lowering surgery for NVG. Further study is needed to examine the medical and social factors that preclude optimal management of diabetic eye disease, in order to prevent its blinding complications.</div></div><div><h3>Financial Disclosures</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 615-623"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Nonreturn after Loss to Follow-Up from Glaucoma Care","authors":"Lauren M. Wasser MD ,&nbsp;Julie Cassidy BA ,&nbsp;Hsing-Hua Sylvia Lin PhD ,&nbsp;Andrew M. Williams MD","doi":"10.1016/j.ogla.2024.07.007","DOIUrl":"10.1016/j.ogla.2024.07.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Loss to follow-up (LTFU) in primary open-angle glaucoma (POAG) can lead to undertreatment, disease progression, and irreversible vision loss. Patients who become LTFU either eventually re-establish glaucoma care after a lapse or never return to the clinic. The purpose of this study is to examine a large population of patients with POAG who became LTFU to determine the proportion that return to care and to identify demographic and clinical factors associated with nonreturn after LTFU.</div></div><div><h3>Design</h3><div>Retrospective longitudinal cohort study.</div></div><div><h3>Participants</h3><div>Patients with a diagnosis of POAG with a clinical encounter in 2014 in the IRIS® Registry (Intelligent Research in Sight).</div></div><div><h3>Methods</h3><div>We examined follow-up patterns for 553 663 patients with POAG who had an encounter in the IRIS Registry in 2014 by following their documented clinic visits through 2019. LTFU was defined as exceeding 1 calendar year without an encounter. Within the LTFU group, patients were classified as returning after a lapse in care (return after LTFU) or not (nonreturn after LTFU).</div></div><div><h3>Main Outcome Measures</h3><div>Proportion of patients with nonreturn after LTFU and baseline demographic and clinical characteristics associated with nonreturn among LTFU patients with POAG.</div></div><div><h3>Results</h3><div>Among 553 663 patients with POAG, 277 019 (50%) had at least 1 episode of LTFU over the 6-year study period. Within the LTFU group, 33% (92 471) returned to care and 67% (184 548) did not return to care. Compared to those who returned to care, LTFU patients with nonreturn were more likely to be older (age &gt;80 years; relative risk [RR] = 1.48; 95% confidence interval [CI]: 1.47–1.50), to have unknown/missing insurance (RR = 1.31; 95% CI: 1.30–1.33), and to have severe-stage POAG (RR = 1.13; 95% CI: 1.11–1.15). Greater POAG severity and visual impairment were associated with nonreturn with a dose-dependent relationship in the adjusted model that accounted for demographic characteristics. Among those with return after LTFU, almost all returned within 2 years of last appointment (82 201; 89%) rather than 2 or more years later.</div></div><div><h3>Conclusions</h3><div>Half of patients with POAG in the IRIS Registry had at least 1 period of LTFU, and two thirds of LTFU patients with POAG did not return to care. More effort is warranted to re-engage the vulnerable patients with POAG who become LTFU.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 572-579"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Incidence and Presentation Features of Glaucoma in Vogt–Koyanagi–Harada Syndrome","authors":"Abdelaziz Abdelaal MD ,&nbsp;Abdul Rhman Hassan MD ,&nbsp;Basant E. Katamesh MD ,&nbsp;Mennatullah Mohamed Eltaras MD ,&nbsp;Hashem Abu Serhan MD","doi":"10.1016/j.ogla.2024.06.005","DOIUrl":"10.1016/j.ogla.2024.06.005","url":null,"abstract":"<div><h3>Topic</h3><div>To determine the cumulative incidence and features of glaucoma in patients with Vogt–Koyanagi–Harada (VKH) syndrome compared with nonglaucoma patients.</div></div><div><h3>Clinical Relevance</h3><div>Knowing the exact burden of secondary glaucoma in VKH could guide its screening and management in clinical practice as a part of the regular follow-up for patients with VKH.</div></div><div><h3>Methods</h3><div>The review protocol was preregistered on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO) [CRD42023462794]. PubMed, Scopus, Web of Science, EBSCOhost, and Google Scholar were searched for studies reporting the cumulative incidence and features of glaucoma presentation in VKH. A manual search was also conducted to supplement the primary search. Subgroup analyses based on glaucoma type, VKH stage, and patients’ age were conducted. All analyses were conducted using STATA. Fixed- and random-effects models were selected according to the observed heterogeneity. Studies’ methodological quality was determined using the National Institutes of Health tool.</div></div><div><h3>Results</h3><div>The analysis of 7084 eyes revealed a progressive increase in the cumulative incidence of secondary glaucoma over time. The cumulative incidence was lowest at VKH onset (7%) and highest at 15 years (26%). Open-angle (12%; 95% confidence interval [CI]: 9%–14%) is more common than angle-closure glaucoma (7%; 95% CI: 3%–13%). Glaucoma cumulative incidence is highest in the chronic recurrent stage of VKH (33%; 95% CI: 12%–59%) and among children &lt; 18 years of age (26%; 95% CI: 16%–37%). Features associated with glaucoma occurrence in VKH showed comparable rates with nonglaucoma cases. However, a meta-analysis to determine risk factors of glaucoma development in VKH was not feasible secondary to the lack of adjusted risk measures in included studies. Studies' quality was questionable in 5 studies. The certainty of evidence was moderate-to-high.</div></div><div><h3>Conclusion</h3><div>The cumulative incidence of glaucoma increases throughout VKH’s course, with a higher tendency in children, chronic recurrent stages, and long-term follow-up. Future research should focus on examining risk factors of glaucoma development in VKH through adjusted multivariable regression models.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 587-601"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Glaucoma after Cataract Surgery Performed in Infancy in Congenital Rubella Syndrome","authors":"Gayathri J. Panicker MS ,&nbsp;Sumita Agarkar MS, DNB ,&nbsp;Mona Khurana MS ,&nbsp;Visakh Thomas DNB","doi":"10.1016/j.ogla.2024.07.001","DOIUrl":"10.1016/j.ogla.2024.07.001","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with nonrubella cataracts and to identify associated risk factors.</div></div><div><h3>Design</h3><div>Retrospective case control study.</div></div><div><h3>Participants</h3><div>Children with CRS who had undergone cataract surgery in infancy and age-matched infants who had undergone cataract surgery for infantile cataracts were included.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of glaucoma and probability of survival was compared among the 2 groups.</div></div><div><h3>Methods</h3><div>Risk factors for the development of glaucoma were assessed. The minimum follow-up was 1 year after cataract surgery.</div></div><div><h3>Results</h3><div>The study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the nonrubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the 2 groups (<em>P</em> = 0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (<em>P</em> = 0.19). Mean follow-up was 5.8 ± 3.7 years for CRS group and 6.4 ± 3.4 years for the nonrubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 vs controls 0.8; log rank <em>P</em> = 0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (<em>P</em> &gt; 0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83; 95% confidence interval, 1.44–5.57; <em>P</em> = 0.002) in CRS eyes.</div></div><div><h3>Conclusion</h3><div>There was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared with infants who had undergone surgery for infantile cataracts. Because the 10-year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow-up is recommended especially in eyes with at-risk features.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 602-607"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-Arc Slow-Coagulation Transscleral Cyclophotocoagulation Laser Protocol","authors":"Izabela N.F. Almeida MD, PhD ,&nbsp;Isabella C.T.P. Resende MD ,&nbsp;Lucas M. Magalhães MD ,&nbsp;Hemengella K.A. Oliveira BM ,&nbsp;Fábio N. Kanadani MD, PhD ,&nbsp;Tiago S. Prata MD, PhD","doi":"10.1016/j.ogla.2024.06.008","DOIUrl":"10.1016/j.ogla.2024.06.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the short-term effectiveness and safety results of a new continuous laser protocol, double-arc slow-coagulation transscleral cyclophotocoagulation (DA-TSCPC).</div></div><div><h3>Design</h3><div>Multicenter retrospective study.</div></div><div><h3>Participants</h3><div>We reviewed the clinical records of refractory glaucoma patients that had undergone DA-TSCPC between April 2019 and July 2022, with at least 12 months of postoperative follow-up.</div></div><div><h3>Methods</h3><div>The technique was standardized (energy: 1400 mW; duration: 4 seconds; 28 applications). The applications were divided into 2 rows (upper and lower arcs). For each arc, 7 spots were applied over the ciliary body shadow and 7 spots 1.5 mm behind, sparing the 3 and 9 o’clock meridians.</div></div><div><h3>Main Outcome Measures</h3><div>Success was defined as postoperative intraocular pressure (IOP) between 6 and 18 mmHg and an IOP reduction of 30% (without oral acetazolamide). For eyes with no light perception (NLP), in which treatment goal was pain relief, success was defined as a 30% IOP reduction and no pain (without oral acetazolamide). Patients were divided according to visual acuity: ≥ 20/400 (group 1) and &lt; 20/400 (group 2).</div></div><div><h3>Results</h3><div>Ninety eyes of 90 patients (mean age: 61 ± 15 years) were included. Glaucoma diagnosis frequency was: neovascular glaucoma (38%), open-angle glaucoma (28%), silicone oil secondary glaucoma (17%), and others (18%). Overall, the mean IOP was significantly reduced from 35 ± 12 to 22 ± 14 mmHg (<em>P</em> &lt; 0.01) at the last follow-up visit. The number of hypotensive eye drops (2.6 ± 1–2.3 ± 1; <em>P</em> = 0.02) and the use of oral acetazolamide (61%–11%; <em>P</em> &lt; 0.01) were also reduced. Kaplan–Meier survival analysis revealed a global success rate of 65.6% after 12 months. A higher success rate was found for group 1 (78.6%) compared to group 2 (59.6%; <em>P</em> = 0.047; logrank test). The main complications observed were corneal ulcer (4.4%), macular edema (1.1%), and hyphema (1.1%). Among the 26 eyes with NLP, 65% achieved success criteria at 12 months and 2 (7.7%) developed phthisis.</div></div><div><h3>Conclusions</h3><div>Based on these initial retrospective data, the DA-TSCPC protocol seems to be an alternative for refractory glaucoma management, presenting significant IOP reduction and a good safety profile after 1 year. Better outcomes were observed in eyes with less severe functional damage.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 580-586"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractive Outcomes Following Combined Cataract and Microinvasive Glaucoma Surgery","authors":"Abdulla Shaheen MD ,&nbsp;Gabriele Gallo Afflitto MD ,&nbsp;Swarup S. Swaminathan MD","doi":"10.1016/j.ogla.2024.07.003","DOIUrl":"10.1016/j.ogla.2024.07.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm’s canal stent (CE/SCS) insertion.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified.</div></div><div><h3>Methods</h3><div>Refraction data were analyzed at postoperative month (POM) 1 and 6 with Kruskal–Wallis and Dunn’s tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was mean refraction at POM1 and POM6 across the 3 surgical groups. Secondary outcomes were comparisons of refraction and visual acuity (VA) among different goniotomy and Schlemm’s canal stent (SCS) devices, as well as incidence of anisometropia.</div></div><div><h3>Results</h3><div>A total of 8360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7815 CE alone) from 6059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was −0.36 ± 0.91D, −0.31 ± 0.85D, and −0.39 ± 0.88D respectively (<em>P</em> = 0.019). Mean logarithm of the minimum angle of resolution VA was 0.10 ± 0.20, 0.08 ± 0.19, and 0.14 ± 0.26 respectively (<em>P</em> = 0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (<em>P</em> = 0.217). At POM6, mean SEs were −0.38 ± 0.97D (CE/goniotomy), −0.35 ± 0.81D (CE/SCS), and −0.40 ± 0.91D (CE alone; <em>P</em> = 0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma/normal-tension glaucoma eyes, mean SE at POM1 was −0.36 ± 0.73D (CE/goniotomy), −0.24 ± 0.84D (CE/SCS), and −0.45 ± 0.81D (CE alone; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and VA, although these small magnitude differences were unlikely to be clinically meaningful.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 608-614"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Stress and Intraocular Pressure in Glaucoma","authors":"Nathalie Sena Ferreira MD ,&nbsp;Vital Paulino Costa MD, PhD ,&nbsp;Juliana Frange Miranda MD ,&nbsp;Lucas Oliveira Cintra MD ,&nbsp;Lucas Santos Barbosa MD ,&nbsp;Maira Gomes Barbosa da Silva MD ,&nbsp;Nayara Alves Abreu MD ,&nbsp;Ricardo Yuji Abe MD, PhD","doi":"10.1016/j.ogla.2024.07.004","DOIUrl":"10.1016/j.ogla.2024.07.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the intraocular pressure (IOP) behavior after applying a standardized protocol to induce psychological stress in patients with primary open-angle glaucoma (POAG).</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Participants</h3><div>A total of 39 patients with POAG were included: 18 in the stress group and 21 in the control group.</div></div><div><h3>Methods</h3><div>Patients were randomized to undergo the Trier Social Stress Test (TSST) or to be included in the control group. All participants were submitted to a modified diurnal tension curve (DTC) 1–4 weeks before randomization, with 3 IOP measurements performed between 8:00 <span>am</span> and 2:00 <span>pm</span><span>.</span> We evaluated the response to the TSST by measuring the levels of salivary cortisol, salivary amylase, IOP, mean arterial pressure, and heart rate before, immediately after, and 40 minutes after the TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals.</div></div><div><h3>Main Outcome Measures</h3><div>Changes in IOP (mmHg), salivary cortisol and amylase, heart rate, mean arterial pressure, and STAI scores.</div></div><div><h3>Results</h3><div>At baseline, there were no significant differences between the groups regarding age (<em>P</em> = 0.661), sex (<em>P</em> = 0.669), salivary cortisol (<em>P</em> = 0.104), and mean DTC IOP for the right (<em>P</em> = 0.439) and left (<em>P</em> = 0.576) eyes. We observed a significant mean IOP increase of 3.8 mmHg (right eye; <em>P</em> &lt; 0.001) and 4.1 mmHg (left eye; <em>P</em> &lt; 0.001) when we compared IOP measurements obtained during the DTC and immediately after TSST. Salivary cortisol (5.9 nmol/L; <em>P</em> = 0.004), salivary amylase (323 388 UL; <em>P</em> = 0.004), mean arterial pressure (10.1 mmHg; <em>P</em> &lt; 0.001), and heart rate (12.9 bpm; <em>P</em> &lt; 0.001) also increased significantly after the TSST. In addition, 61.1% (11 of 18) of the patients in the TSST group showed an IOP increase &gt; 4 mmHg following the test. The STAI-state score significantly increased after the TSST compared to baseline (<em>P</em> &lt; 0.001) and decreased from poststress to the recovery period (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Patients with POAG present significant elevations of IOP, salivary cortisol and amylase, mean arterial pressure, heart rate, and STAI scores after psychological stress induced by the TSST.</div></div><div><h3>Financial Disclosures</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 518-530"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Retinal Nerve Fiber Layer Thinning in the Unaffected Contralateral Eyes of Patients with Unilateral Normal-Tension Glaucoma","authors":"","doi":"10.1016/j.ogla.2024.04.009","DOIUrl":"10.1016/j.ogla.2024.04.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To observe the rate of progressive retinal nerve fiber layer (RNFL) thinning in the unaffected eyes of patients with unilateral normal-tension glaucoma (NTG), in comparison with that of healthy subjects, and to identify the factors associated with progressive RNFL thinning.</div></div><div><h3>Design</h3><div>Retrospective, longitudinal, observational study.</div></div><div><h3>Participants</h3><div>Ninety-five patients with unilateral NTG and 61 healthy controls.</div></div><div><h3>Methods</h3><div>This study included unilateral NTG and healthy control subjects who were followed up for longer than 4 years and in whom at least 5 reliable retinal nerve fiber layer thickness (RNFLT) measurements were performed using OCT. Factors associated with the rate of thinning of the unaffected eyes of unilateral patients with NTG were identified using regression analysis.</div></div><div><h3>Main Outcome Measures</h3><div>The rate of progressive RNFL thinning and the associated factors.</div></div><div><h3>Results</h3><div>Retinal nerve fiber layer thickness decreased significantly in both the unaffected eyes of unilateral patients with NTG and the healthy eyes (both <em>P</em> &lt; 0.001). The RNFL thinning was significantly faster in the unaffected eyes of unilateral patients with NTG than in the healthy eyes (<em>P</em> &lt; 0.001), specifically in the temporal-inferior (TI) sector (<em>P</em> = 0.003). Factors associated with faster RNFL thinning in the unaffected eyes of unilateral patients with NTG were thicker baseline RNFL of the unaffected eyes (<em>P</em> = 0.002) and a worse visual field (VF) mean deviation (MD) in the NTG eyes (<em>P</em><span> = 0.040). In the healthy controls, the rate of RNFL thinning in the contralateral eyes was the only factor associated with faster thinning (</span><em>P</em> = 0.007).</div></div><div><h3>Conclusions</h3><div>The unaffected eyes of unilateral patients with NTG showed faster RNFL thinning than healthy control eyes, more obviously in the TI sector, and were likely to progress faster when they had a thicker baseline RNFL, and when the NTG eyes had a worse VF MD. In unilateral patients with NTG, initiation of prophylactic treatment could be considered for the unaffected eyes when they are accompanied by a risk of developing glaucoma.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 5","pages":"Pages 431-439"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}