Ophthalmology. Glaucoma最新文献

{"title":"Acute Angle Closure and Blindness in China","authors":"Xiaojie Wang MS,&nbsp;Aijun Tian BS,&nbsp;Shaodan Zhang MD,&nbsp;Bo Qu MD,&nbsp;Lijun Zhao MD,&nbsp;Xiaojing Pan MD,&nbsp;Peng Lu MD,&nbsp;Xinqi Chang BS,&nbsp;Lu Yang MD,&nbsp;Shaoping Ha BS,&nbsp;Jibing Wang MD,&nbsp;Jiangang Yang MD,&nbsp;Xiaohui Wang MS,&nbsp;Peng Yao MD,&nbsp;Yuxia Yang MD,&nbsp;Wenzong Zhou BS,&nbsp;Lei Yu MS,&nbsp;Juntao Zhang MS,&nbsp;Hongbing Cai MS,&nbsp;Junhua Li MS,&nbsp;Yuanbo Liang MD, PhD","doi":"10.1016/j.ogla.2026.01.012","DOIUrl":"10.1016/j.ogla.2026.01.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute angle closure (AAC) is a sight-threatening ophthalmic emergency. However, it remains uncertain whether the incidence of AAC-related blindness has declined in recent years. This study aimed to provide a contemporary analysis of the rate, clinical characteristics, and management outcomes of AAC-related blindness in China.</div></div><div><h3>Design</h3><div>A multicentric, retrospective observational study.</div></div><div><h3>Subjects</h3><div>Data of consecutive AAC cases were collected from 23 hospitals throughout China during 3 distinct periods: September 7, 2020, to January 6, 2021; September 7, 2021, to January 6, 2022; and September 7, 2022, to January 6, 2023.</div></div><div><h3>Methods</h3><div>Clinical data were retrospectively gathered through a standardized chart review. Generalized estimating equations was employed to compare biometric parameters, corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), and blindness rates before and after treatment.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the rate of blindness, determined by CDVA and UDVA, both before and after treatments. Secondary outcomes included the time from symptom onset to treatment and its effect on blindness rates, along with the effectiveness of laser and surgical interventions in reducing these rates.</div></div><div><h3>Results</h3><div>Among the 2626 consecutive AAC patients included in the study (76.0% female; mean age 66.8 ± 9.2 years), only 34.3% sought treatment within 72 hours of symptom onset. At presentation, blindness rates were 28.6% for CDVA and 42.4% for UDVA. After intervention, these rates significantly decreased to 16.4% for CDVA (<em>P</em> &lt; 0.001) and 20.1% for UDVA (<em>P</em> &lt; 0.001). Both laser and surgical treatments significantly improved mean logarithm of the minimum angle of resolution visual acuity with CDVA improving from 0.42 to 0.29 for laser treatment and from 0.88 to 0.65 for surgery.</div></div><div><h3>Conclusions</h3><div>Active treatment significantly reduced the AAC-related blindness rate from 28.6% at presentation to 16.4% after intervention. However, the persistently high rate of blindness was strongly associated with delayed medical presentation, underscoring an urgent need for initiatives that improve early access to care.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 4","pages":"Pages 431-439"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymmetric Retinal Nerve Fiber Layer Defects in Early Glaucoma","authors":"Yu Sawada MD, PhD,&nbsp;Mami Morita MD,&nbsp;Makoto Araie MD, PhD","doi":"10.1016/j.ogla.2026.01.007","DOIUrl":"10.1016/j.ogla.2026.01.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate difference in the characteristics of retinal nerve fiber layer (RNFL) defects between the inferior and superior retina in early glaucoma.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Participants</h3><div>A total of 103 eyes with early glaucoma (visual field mean deviation [MD] ≥–6.0 dB), with 131 RNFL defects identified in OCT enface images.</div></div><div><h3>Methods</h3><div>The location of RNFL defect was determined using clock-hour positions around the optic disc. The distribution of RNFL defects was presented as the number of defects in each location. The depth of each defect was assessed as the difference of circumpapillary RNFL (cpRNFL) thickness in the defect from normal values at the same location, using a normal reference database matched for the background characteristics of the glaucoma patients. These features were compared between the inferior and superior retina.</div></div><div><h3>Main Outcome Measures</h3><div>Characteristics of RNFL defects.</div></div><div><h3>Results</h3><div>The average MD of the included eyes was –2.04 ± 1.64 dB. We found that 51.9% of RNFL defects were located in the inferior retina and 48.1% in the superior retina. The angular location of RNFL defect was significantly closer to the foveola in the inferior retina than in the superior retina (43.5 ± 13.8° vs. 57.8 ± 21.4°, <em>P</em> &lt; 0.0001). The RNFL defects were relatively localized to a narrower region in the inferior retina, whereas they were diffusely distributed over a broader area in the superior retina. The cpRNFL thickness difference in the defect from normal corresponded to 68.4 ± 12.6% of the normal value in the inferior retina and 55.1 ± 16.7% in the superior retina. It was significantly greater in the inferior retina, indicating deeper defects (<em>P</em> &lt; 0.0001). The deep RNFL defects (cpRNFL thickness difference &gt;65%) were significantly more frequent in the inferior retina than in the superior retina (72.1% vs. 28.5%, <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>The RNFL defects exhibited significantly different locations, distributions, and depths between the inferior and superior retina. Notably, considerable thinning of the RNFL was observed particularly in the inferior retina, even in eyes with early glaucoma. Acknowledging these asymmetrical characteristics of RNFL defect provides insights into its nature and may assist initial diagnosis of glaucoma.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 4","pages":"Pages 360-371"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991974","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":"Predicting Perimetric Glaucoma Development in Suspects Using Widefield OCT-Based Risk Scores","authors":"Huiyuan Hou MD, PhD,&nbsp;Takashi Nishida MD, PhD,&nbsp;Evan Walker MS,&nbsp;Mary K. Durbin PhD,&nbsp;Anya Guzman BS,&nbsp;Alireza Kamalipour MD, MPH,&nbsp;Natchada Tansuebchueasai MD,&nbsp;Mohsen Adelpour MD,&nbsp;Linda M. Zangwill PhD,&nbsp;Robert N. Weinreb MD,&nbsp;Sasan Moghimi MD","doi":"10.1016/j.ogla.2026.01.009","DOIUrl":"10.1016/j.ogla.2026.01.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the predictive ability of baseline widefield OCT–based risk scores for the development of perimetric glaucoma in glaucoma suspect eyes.</div></div><div><h3>Design</h3><div>A prospective cohort study.</div></div><div><h3>Participants</h3><div>Two hundred fifty-seven glaucoma suspect eyes with normal visual fields (VFs) at baseline from 180 patients.</div></div><div><h3>Methods</h3><div>Baseline macular and peripapillary inner retinal layer thickness measurements were obtained using swept-source OCT widefield scans (12 mm × 9 mm) that included both the optic disc and macula. Three OCT-based risk scores were calculated for each eye using measurement segments and grids from the OCT reports. Glaucoma progression was defined as the development of repeatable abnormal VF results. Marginal Cox proportional hazards model was applied to evaluate baseline predictors, including risk scores and individual OCT thickness metrics, with adjustment for confounding factors.</div></div><div><h3>Main Outcome Measures</h3><div>Time-dependent receiver operating characteristic (ROC) curves and decision curve analysis evaluated model performance and clinical utility.</div></div><div><h3>Results</h3><div>The mean follow-up time for glaucoma suspects was 2.8 years. During this period, 80 suspect eyes progressed to perimetric glaucoma. Circumpapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell complex thickness, ganglion cell-inner plexiform layer thickness, mean deviation, and the 3 OCT-based risk scores were predictors of progression in univariable models, showing significant hazard ratios, whereas only the OCT-based risk scores remained statistically significant in multivariable models. Each 10-point increase in OCT-based risk scores across the 3 models corresponded to a 1.15-fold to 1.21-fold increase in risk. The risk scores demonstrated higher area under ROCs, compared to individual OCT parameters, across all time points. Decision curve analysis showed that individual OCT parameters offered no greater net benefit than treating all patients regardless of risk, whereas the Fukai risk scores consistently yielded higher net benefit.</div></div><div><h3>Conclusions</h3><div>Baseline OCT-based risk scores from a single wide scan, incorporating both peripapillary RNFL and macular thickness measurements, are associated with the subsequent development of perimetric glaucoma development in glaucoma suspect eyes, offering valuable insights for risk stratification in a single integrated metric and may aid in early intervention and clinical management in glaucoma suspects.</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":"9 4","pages":"Pages 380-389"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lens Particle Glaucoma after Neodymium-Doped Yttrium Aluminum Garnet Capsulotomy","authors":"Aafreen Bari MD,&nbsp;Kalaimani Senguttuvan MD,&nbsp;Tanuj Dada MD","doi":"10.1016/j.ogla.2026.04.003","DOIUrl":"10.1016/j.ogla.2026.04.003","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 4","pages":"Page e13"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949964","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":"Patient-Portal Messages Reengage Glaucoma Patients after Loss to Follow-Up","authors":"Anne Schulman BA ,&nbsp;Hai-Wei Liang PhD ,&nbsp;Arya M. Prasad BA ,&nbsp;Andrew M. Williams MD","doi":"10.1016/j.ogla.2026.01.002","DOIUrl":"10.1016/j.ogla.2026.01.002","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 3","pages":"Pages 353-355"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953876","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":"A Nonrandomized, Comparative Case Series of Combined Phacoemulsification with iStent Inject W and OMNI Surgical System","authors":"Ethan Wen Wei Tiong MBChB ,&nbsp;Aysha Salam MBBS ,&nbsp;Navanandhanan Pradeesh MBChB ,&nbsp;Imran Masood MBBS","doi":"10.1016/j.ogla.2025.11.005","DOIUrl":"10.1016/j.ogla.2025.11.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To compare efficacy and safety outcomes of phacoemulsification combined with either iStent inject W or OMNI surgical system with different degrees of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with glaucoma.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Single-center, retrospective, nonrandomized comparative cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;div&gt;Consecutive cases that underwent phacoemulsification combined with either iStent inject W or OMNI surgical system with at least 12-month follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Single-center retrospective comparative cohort study comparing outcomes between 3 groups: phacoemulsification with iStent inject W (phaco-iStent) or OMNI with either 90° to 180° (phaco-OG [OMNI and GATT]180) or &gt;180° to 360° (phaco-OG360) of GATT.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Success at 12 months is defined as medication-free with either a 20% intraocular pressure (IOP) reduction or IOP ≤18 mmHg. Primary outcomes were IOP and the number of glaucoma medications. Secondary outcomes included complications and the need for further glaucoma surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 294 eyes (phaco-iStent, 135; phaco-OG180, 39; phaco-OG360, 120) of 250 patients were included with similar baseline IOP (18 mmHg, &lt;em&gt;P&lt;/em&gt; = 0.91) and medications (2.04 vs. 1.67 vs. 2.01, &lt;em&gt;P&lt;/em&gt; = 0.22) across groups. Significant reductions in IOP and number of glaucoma medications were observed across all 3 groups (&lt;em&gt;P&lt;/em&gt; &lt; 0.0014), although no significant differences were found between procedures for any outcome measure. Success rates were 25.2%, 38.5%, and 32.5%, whereas medication-free rates were 28.1%, 38.5%, and 35.0% for the phaco-iStent, phaco-OG180, and phaco-OG360 groups, respectively, without significant differences. Phaco-OG360 achieved significantly higher rates of medication-free IOP reductions of ≥30% compared with phaco-iStent (&lt;em&gt;P&lt;/em&gt; = 0.013) in exploratory analysis. Complications were more frequent in the phaco-OG180 and phaco-OG360 groups compared with the phaco-iStent group, with higher rates of microhyphema (5.1% and 10.8% vs. 0.7%) and layered hyphema (12.8% and 4.2% vs. 0.7%), respectively. One eye in the phaco-OG360 group underwent a trabeculectomy at 6 months.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;All procedures significantly reduced IOP and medication burden, with no significant difference in overall success rates. Phaco-iStent has a better safety profile, although phaco-OMNI may provide higher rates of medication-free IOP reduction. Outcomes between 180° and 360° of GATT were similar, suggesting limited additional benefit from extending trabeculotomy. These findings may help guide decision-making in combined phacoemulsification and canal-based minimally invasive glaucoma surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Financial Disclosure(s)&lt;/h3&gt;&lt;div&gt;Proprietary or commercial disclosure may be found in the Footnotes and Disclosures ","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 3","pages":"Pages 267-275"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650096","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 Trouble: Tamponade-Induced Secondary Glaucoma in a Colobomatous Eye","authors":"Sagarika Snehi DNB, FAICO,&nbsp;Vandana Iyer MS,&nbsp;Anusua Kar MBBS","doi":"10.1016/j.ogla.2026.02.004","DOIUrl":"10.1016/j.ogla.2026.02.004","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 3","pages":"Page e11"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596512","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":"Long-Term Outcomes of Nonvalved Glaucoma Drainage Devices in Uveitic Glaucoma","authors":"Hussain Aluzri MBChB ,&nbsp;Andrew J. Swampillai MBBS, FRCOphth ,&nbsp;Sami Hussain MBBs, BSc (Hons) ,&nbsp;Imran Masood MBChB, FRCOphth ,&nbsp;Velota C.T. Sung FRCS (Ed), FRCOpth","doi":"10.1016/j.ogla.2025.12.005","DOIUrl":"10.1016/j.ogla.2025.12.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the long-term efficacy and safety profile of nonvalved glaucoma drainage devices (GDDs) in the management of refractory uveitic glaucoma.</div></div><div><h3>Design</h3><div>Retrospective interventional case series.</div></div><div><h3>Participants</h3><div>Sixty-five eyes of 51 patients.</div></div><div><h3>Methods</h3><div>Patients underwent Baerveldt (78.5%) or Molteno (21.5%) GDD implantation at a single tertiary center between 2000 and 2021. The mean follow-up period was 12.05 ± 4.9 years.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome was surgical success defined by World Glaucoma Association criteria. Secondary outcomes included intraocular pressure (IOP) control, medication burden, and complications.</div></div><div><h3>Results</h3><div>Mean IOP decreased from 32.6 ± 8.4 mmHg preoperatively to 12.2 ± 5.2 mmHg at the last follow-up (<em>P</em> &lt; 0.0001), with concurrent glaucoma medications reduction from 3.8 ± 0.8 to 0.9 ± 1.1 (<em>P</em> &lt; 0.0001). At the final visit, qualified and complete success rates were 58.5% (38/65) and 33.8% (22/65), respectively. The mean survival time was 12.8 years for qualified success and 8.1 years for complete success. Failure occurred in 41.5% (27/65) of eyes, most commonly due to hypotony (13 eyes) or inadequate IOP reduction (10 eyes). Mean best-corrected visual acuity was unchanged (0.49 ± 0.53 vs 0.59 ± 0.72 logarithm of the minimum angle of resolution, <em>P</em> = 0.34).</div><div>On multivariate analysis, Baerveldt implantation (hazard ratio [HR], 5.56; 95% confidence interval [CI], 2.20–14.09; <em>P</em> &lt; 0.001) and concurrent systemic biologic therapy (HR, 28.57; 95% CI, 6.90–111.11; <em>P</em> &lt; 0.001) were strong independent predictors of qualified success.</div></div><div><h3>Conclusions</h3><div>Nonvalved GDDs offer durable IOP control and preserved vision in uveitic glaucoma, for over a decade, with 58.5% qualified success and 41.5% failure at final follow-up (12.05 ± 4.9 years). These findings represent the longest reported outcomes for this cohort.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"9 3","pages":"Pages 309-319"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783838","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":"Two-Year Outcomes of Combined Phacoemulsification and Ab Interno Tanito Microhook Trabeculotomy in Open-Angle Glaucoma","authors":"Devendra Maheshwari MD ,&nbsp;Madhavi Ramanatha Pillai DNB ,&nbsp;Davinder S. Grover MD, MPH ,&nbsp;Nimrita Gyanchand Nagdev MS ,&nbsp;Shivam Gupta MS ,&nbsp;Mohammed Sithiq Uduman MSc ,&nbsp;Rengappa Ramakrishnan DO, MS","doi":"10.1016/j.ogla.2025.12.004","DOIUrl":"10.1016/j.ogla.2025.12.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the 24-month safety and efficacy of phacoemulsification combined with ab interno Tanito microhook trabeculotomy (microLOT) compared with phacoemulsification alone in patients with open-angle glaucoma (OAG) and cataract.</div></div><div><h3>Design</h3><div>Prospective, randomized, interventional clinical trial.</div></div><div><h3>Participants</h3><div>Patients with mild-to-moderate OAG and visually significant cataract.</div></div><div><h3>Methods</h3><div>One hundred fourteen eyes of 114 patients were randomized to phacoemulsification and microLOT (Phaco-microLOT) (n = 57) or phacoemulsification alone (n = 57).</div></div><div><h3>Main Outcome Measures</h3><div>Intraocular pressure (IOP), antiglaucoma medication (AGM) burden, best-corrected visual acuity, surgical success, and complications were assessed through 24 months. Success was defined as a combination of at least 20%, 25%, or 30% reduction in IOP and an absolute IOP of less than 21, 18, or 15 mmHg, respectively (criteria 1, 2, and 3).</div></div><div><h3>Results</h3><div>At 24 months, 99 patients out of the original cohort of 114 patients were analyzed (group 1 = 50; group 2 = 49). The mean IOP decreased from 26.5 ± 5.2 to 15.2 ± 4.9 mmHg in the Phaco-microLOT group and from 25.3 ± 3.1 to 18.2 ± 2.8 mmHg in the phaco-alone group (<em>P</em> &lt; 0.001). The percentage IOP reduction was significantly greater in group 1 (42.6% vs. 28.1%, <em>P</em> = 0.004). In group 1, the mean (standard deviation) AGM used preoperatively was 0.6 (0.9), which significantly decreased to 0.2 (0.4) at 24 months, whereas in group 2, it marginally increased from 1.4 (0.6) to 1.5 (0.9). Overall success (complete + qualified) in group 1 using criteria 1, 2, and 3 was 83.3%, 72.9%, and 43.8%, whereas in group 2 it was 57.8%, 40%, and 20%, respectively. The risk of failure in group 2 was 2.87 times higher. No additional complications were observed, and no interventions were required between 12 and 24 months of follow-up.</div></div><div><h3>Conclusions</h3><div>Phacoemulsification and microLOT achieved sustained and superior IOP and medication reduction at 24 months, with a favorable safety profile compared to the phacoemulsification alone group. These results underscore the long-term role of microLOT for OAG.</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":"9 3","pages":"Pages 287-294"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776699","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":"Nicotinamide and Pyruvate in Open-Angle Glaucoma","authors":"Aakriti Garg Shukla MD, MSc ,&nbsp;Emmanouil Tsamis OD, PhD ,&nbsp;Carlos Gustavo De Moraes MD, PhD ,&nbsp;Simon W. John PhD ,&nbsp;Donald C. Hood PhD ,&nbsp;Jeffrey L. Goldberg MD, PhD ,&nbsp;Lisa A. Hark PhD, MBA ,&nbsp;Marzhan Atakulova MD, MSc ,&nbsp;Yujia Wang MPH ,&nbsp;David S. Greenfield MD ,&nbsp;George A. Cioffi MD ,&nbsp;Jeffrey M. Liebmann MD","doi":"10.1016/j.ogla.2025.12.008","DOIUrl":"10.1016/j.ogla.2025.12.008","url":null,"abstract":"<div><h3>Purpose</h3><div>The Nicotinamide and Pyruvate in Open-Angle Glaucoma Trial aims to establish whether nicotinamide and pyruvate dietary supplementation provides neuroprotection in eyes with treated open-angle glaucoma (OAG).</div></div><div><h3>Design</h3><div>A prospective, two-site, 21-month, placebo-controlled, double-masked, phase III randomized clinical trial.</div></div><div><h3>Participants</h3><div>Open-angle glaucoma patients recruited at Columbia University Irving Medical Center and Stanford University between March 1, 2023, and August 30, 2025.</div></div><div><h3>Intervention</h3><div>Study participants were randomized in a 1:1 ratio to either active product (3 g/day of nicotinamide and 1 g/day of calcium pyruvate) or placebo. Standard-of-care intraocular pressure-lowering treatment is continued throughout the study and can be modified at the discretion of the treating physician.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome measure is a composite of functional change based on automated perimetry of the central 10° of the visual field and/or structural change based on spectral-domain OCT. Periodic blood collection allows for evaluation of intervention-related metabolomics, transcriptomics, and proteomics, and measurement of serum levels of nicotinamide and pyruvate. Secondary outcomes include the evaluation of the tolerability and safety of nicotinamide and pyruvate in OAG and the identification of factors that predispose to greater responsiveness to metabolic neuroprotective therapies in OAG. An intention-to-treat analysis will be performed at the conclusion of the trial.</div></div><div><h3>Conclusions</h3><div>This novel trial design may deliver valuable data on the neuroprotective potential of nicotinamide and pyruvate supplementation in glaucoma and improve our understanding of optimal study design for longitudinal randomized clinical trials focused on glaucoma neuroprotection.</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":"9 3","pages":"Pages 241-249"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859674","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}