Ophthalmology. Glaucoma最新文献

{"title":"GLAUrious but Not Entirely Noninferior: A Critical Review of Clinical Trial Design.","authors":"Aakriti Garg Shukla, Vishwanath H Prathikanti, Henry D Jampel","doi":"10.1016/j.ogla.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.08.005","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254010","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 Comparison of 24-2C SITA Faster and 10-2 SITA Standard for Detecting Damage in the Macula in Mild-Stage Glaucoma.","authors":"Euido Nishijima, Ryosuke Ito, Kei Sano, Yuka Igari, Sachiyo Okude, Takahiko Noro, Shumpei Ogawa, Gary C Lee, Aiko Iwase, Tadashi Nakano","doi":"10.1016/j.ogla.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.09.009","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the diagnostic accuracy of 24-2C SITA Faster and 10-2 SITA Standard in detecting macular damage in mild-stage glaucoma.</p><p><strong>Design: </strong>Multicenter diagnostic accuracy study based on prospectively collected data.</p><p><strong>Participants: </strong>In total, 108 eyes from 108 patients with mild-stage glaucoma (normal tension glaucoma, 58; high tension glaucoma, 50) and 52 eyes from 52 healthy controls at the Jikei University School of Medicine and Tajimi Iwase Eye Clinic.</p><p><strong>Methods: </strong>Participants underwent 24-2C SITA Faster and 10-2 SITA Standard visual field testing on the same day, in randomized order. Optical coherence tomography with ganglion cell analysis identified macular damage. McNemar's test and non-inferiority analysis (10% margin) compared detection accuracy. Test durations were compared using pairwise t-tests.</p><p><strong>Main outcome measures: </strong>Sensitivity and specificity of 24-2C SITA Faster and 10-2 SITA Standard for detecting macular damage, and test duration.</p><p><strong>Results: </strong>For overall macular damage, 24-2C SITA Faster demonstrated sensitivity/specificity of 0.64/0.93 (total deviation [TD]) and 0.67/0.93 (pattern deviation [PD]), while 10-2 SITA Standard demonstrated 0.69/0.94 (TD) and 0.77/0.93 (PD). McNemar's test revealed no significant difference, and 24-2C SITA Faster was non-inferior within the 10% margin. Sub-analysis with a strict 5% margin, revealed that 10-2 SITA Standard was superior to 24-2C SITA Faster when using PD plot for all parameters. Mean test duration was significantly shorter for 24-2C SITA Faster (158.5 seconds) than for 10-2 SITA Standard (330.0 seconds; p < 0.001).</p><p><strong>Conclusions: </strong>24-2C SITA Faster is a non-inferior and more time-efficient alternative to 10-2 SITA Standard for detecting macular damage in mild-stage glaucoma; however, 10-2 SITA Standard may be considered superior for detecting subtle macular defects using PD.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182417","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":"Quantitative classification of visual field defects in early glaucoma.","authors":"Jeremy C K Tan, Jack Phu","doi":"10.1016/j.ogla.2025.09.010","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.09.010","url":null,"abstract":"<p><strong>Objective: </strong>While qualitative visual field (VF) grading systems enable the classification and description of VF defects in glaucoma, they may be prone to subjective interpretation and interobserver disagreement. In this study we characterise the types and frequencies of VF defects in a large cohort of subjects with early glaucomatous loss, using a quantitative method based on the Ocular Hypertension Treatment Study (OHTS) VF classification system.</p><p><strong>Design: </strong>Cross-sectional study SUBJECTS: 1330 eyes of 733 subjects with healthy, suspect or early glaucoma METHODS: We translated the OHTS system into an objective, quantitative method to classify the VF of each eye into nerve fibre bundle (bundle) and non-bundle defects comprising 14 patterns. This was applied to VF tests from subjects who received two 24-2 SITA-Faster VF tests per eye on the same visit.</p><p><strong>Main outcome measures: </strong>Distribution of initial and repeatable VF patterns across cohort, and the relationship with mean deviation and test reliability.</p><p><strong>Results: </strong>The mean baseline MD and PSD was -1.08 (SD 1.83) and 2.26 (SD 1.26) respectively. The most common repeatable pattern was the inferior nasal step (22.6%), followed by the inferior enlarged blind spot (19.1%), superior nasal step (12.6%) and superior enlarged blind spot (11.6%). The frequency of occurrence of initial defects was significantly lower than repeatable defects for the majority of patterns. The frequency of nasal step defects decreased as MD worsened, with a corresponding increase in frequency of arcuate defects. There was a consistently higher frequency of bundle and non-bundle defects in unreliable versus reliable tests based on a false positive rate above 15%, including an inferior enlarged blind spot (30.0% vs 20.8%, P < 0.001), superior central defect (13.7% vs 5.5%, P < 0.001) and partial superonasal quadrant (14.4% vs 7.2%, P < 0.001) defects.</p><p><strong>Conclusions: </strong>In a large cohort of suspect and early glaucoma, the most common VF defects were nasal step, enlarged blind spot and arcuate defects, with a significant difference in distribution between initial versus repeatable defects and reliable versus unreliable tests. Application of objective criteria may improve the accuracy and consistency of classifying VF defects.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182450","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":"Enhanced Detection of Glaucoma Progression using WidefieldSwept-Source Optical Coherence Tomography.","authors":"Marc G Sarossy, Maxime Jannaud, Xavier Hadoux, Sandy Rezk, Dongzhe Li, Michael A Coote, Ghee Soon Ang, Joana Galvao, Peter van Wijngaarden, Keith R Martin, Zhichao Wu","doi":"10.1016/j.ogla.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.09.007","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the effectiveness of evaluating widefield swept-source optical coherence tomography (OCT) scans for detecting glaucoma progression compared with conventional circumpapillary retinal nerve fiber layer (cpRNFLT) measurements.</p><p><strong>Design: </strong>Longitudinal study.</p><p><strong>Participants: </strong>One-hundred and fifty-six eyes with glaucoma from 115 participants.</p><p><strong>Methods: </strong>This study included individuals seen over ≥2 visits that were 12 months apart, and who were also scheduled for retest visits within ≤1 month at the baseline and 12-month visits. A circumpapillary circle scan on spectral-domain OCT and a widefield 15×15 mm OCT volume scan was acquired from each eye at each visit. A total of 286 and 284 unique visit pairs were thus available where OCT scans were obtained 12 months and ≤1 month apart respectively, serving as the case and control groups respectively. Widefield OCT scans from these visit pairs were evaluated by two graders, who assessed the ganglion cell complex (GCC) thickness and thickness difference maps for glaucoma progression, masked to the time difference between the two scans.</p><p><strong>Main outcome measures: </strong>Percentage of eyes deemed as progressing at 95% specificity.</p><p><strong>Results: </strong>Evaluation of widefield OCT scans identified >2 times as many eyes as progressing over a 12-month period (Grader 1 = 36.7%, Grader 2 = 38.1%) than cpRNFLT measurements from spectral-domain OCT (16.8%; P<0.001 for both) at 95% specificity. For the subset of 96 (62%) eyes with a baseline visual field mean deviation (MD) ≥-6 dB, evaluation of widefield OCT scans identified ≥3 times as many eyes as progressing (Grader 1= 41.1, Grader 2 = 46.3%) compared to cpRNFLT measurements (13.6%; P<0.001 for both). There was substantial between-grader agreement for the eyes identified as progressing on widefield OCT imaging (Gwet's first-order coefficient [AC₁] = 0.76). Evaluation of widefield OCT scans in a two-arm trial seeking to detect a ≥30% treatment effect in one study eye with 80% power was estimated to reduce sample size requirements by 69% compared to cpRNFLT measurements, or by 80% when only including eyes with an MD ≥-6 dB.</p><p><strong>Conclusions: </strong>Qualitative evaluation of widefield OCT scans showed an enhanced detection rate for structural progression than cpRNFLT measurements in glaucoma eyes.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139632","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 Attitudes Toward Distress Screening and Referral in Glaucoma Care.","authors":"Eun Young Choi, Natalie Chou, Hannah M Fisher, Davina Malek, Alessandro A Jammal, Tamara Somers, Kelly Muir, Felipe A Medeiros, Samuel I Berchuck","doi":"10.1016/j.ogla.2025.09.004","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.09.004","url":null,"abstract":"<p><p>A mixed-methods study of 300 glaucoma patients found strong support for screening and referral for psychological distress. Greater interest among those with elevated distress or higher intraocular pressure highlights an opportunity to integrate psychosocial support into glaucoma care.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102874","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":"Likelihood of Corneal Transplantation Following Tube versus Trabeculectomy: An IRIS® Registry (Intelligent Research in Sight) Study.","authors":"Anna Marie Dickinson, Luke Leidy, M Enamul Haque, Helene Lam, Kuldev Singh, Ann Caroline Fisher, Bethlehem Mekonnen, Suzann Pershing","doi":"10.1016/j.ogla.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.09.001","url":null,"abstract":"<p><strong>Objective: </strong>Utilization of glaucoma drainage devices (tube shunts) has increased. In this analysis we evaluate long-term likelihood and time-to-event for corneal transplantation following trabeculectomy versus tube shunt glaucoma surgeries.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>American Academy of Ophthalmology IRIS® Registry (Intelligent Research In Sight) patients who underwent glaucoma surgery between 2001 and 2021.</p><p><strong>Methods: </strong>Patients with glaucoma who underwent isolated trabeculectomy, isolated tube shunt, or both surgeries in a given eye were identified by procedure codes. Subsequent corneal transplantation procedures performed in the same eye were similarly identified. Multivariable Cox proportional hazard regression models were used to evaluate the likelihood of corneal transplantation, and time from first glaucoma surgery to corneal transplantation.</p><p><strong>Main outcome measures: </strong>Hazard ratios and 95% confidence intervals (CIs) for corneal transplantation.</p><p><strong>Results: </strong>We identified 246,521 eyes among 197,910 patients with glaucoma surgery meeting study inclusion criteria. Corneal transplantation was most frequently observed among patients who previously underwent both trabeculectomy and tube shunt (5.00%, n = 672), followed by isolated tube shunt (2.97%, n = 3,473) and isolated trabeculectomy (0.80%, n = 929). Eyes that only underwent tube shunts had a mean time to corneal transplantation of 2.49 years (SD 2.4), compared to 3.75 years (SD 3.3) for isolated trabeculectomy eyes and 3.21 years (SD 2.6) for eyes that received both trabeculectomy and tube shunt. Adjusted likelihood of corneal transplantation was highest with both trabeculectomy and tube shunt (HR 5.88; 95% CI 5.34-6.48), and isolated tube shunt (HR, 3.97; 95% CI, 3.69-4.26), compared to isolated trabeculectomy.</p><p><strong>Conclusions: </strong>The likelihood of corneal transplantation is over four times higher following tube shunts compared to trabeculectomies. This may reflect factors such as chronic, cumulative corneal endothelial mechanical trauma from the tube shunt, changes to aqueous humor fluid circulation, altered aqueous humor composition and associated signaling pathways, differences in use of antimetabolites as adjunctive therapy, tube material, and/or tube movement or migration over time. Further research is needed to understand causes of corneal compromise, and consideration of corneal health is warranted in glaucoma surgical decision-making.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082157","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":"Clinical outcomes of Hydrus Microstent implantation for open-angle glaucoma: Results from a large academic center.","authors":"Natalie R Hamilton, Anam Akhlaq, Patrick O Nnoromele, Nicolas Gasquet, Catalina Garzon, Yulia Nam, Leangelo Hall, Pradeep Y Ramulu, Ian Pitha, Mona Kaleem, Jella An, Elyse J McGlumphy, Jacob A Kanter, Thomas V Johnson","doi":"10.1016/j.ogla.2025.08.011","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.08.011","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the clinical outcomes of Hydrus Microstent implantation with cataract extraction for the treatment of open angle glaucoma (OAG) over a maximum of 4 years.</p><p><strong>Design: </strong>Retrospective, single-center, single-arm, longitudinal cohort study.</p><p><strong>Subjects: </strong>308 patients (464 eyes) with OAG who underwent Hydrus Microstent implantation with cataract extraction between February 2019 and December 2021, followed for a median (interquartile range, IQR) of 2.0 (1.3, 2.8) years.</p><p><strong>Methods: </strong>Medical records were reviewed to collect demographic and clinical data. After assessment for Gaussian distribution, mean and standard deviation (SD) or median and IQR were calculated. Change from baseline was calculated with mixed-effects models and expressed as mean change and standard error (SE).</p><p><strong>Main outcome measures: </strong>1) Intraocular pressure (IOP); 2) number of glaucoma medications; 3) need for additional glaucoma procedures; and 4) rate of glaucoma progression, calculated using mean deviation (MD) from standard automated perimetry and optical coherence tomography peripapillary retinal nerve fiber layer (RFNL) thickness.</p><p><strong>Results: </strong>Among 308 patients, 60.7% (n=187) were White and 50.6% (n=156) were female. The median (IQR) age was 74 (68, 78) years. Most eyes had mild (63.8%) or moderate (23.9%) OAG. Of 464 eyes, 99 (21.4%) had undergone prior procedures for glaucoma. At baseline, the mean (±SD) IOP was 16.0±3.7 mmHg while taking 1.9±1.1 glaucoma medications. After Hydrus implantation, a sustained reduction was observed in mean IOP [mean change±SE]: -1.9±0.3 at 6 months (p<0.0001), -1.2±0.2 at 1 year (p<0.0001), -1.2±0.2 at 2 years (p<0.0001), -1.6±0.3 at 3 years (p<0.0001) and -1.2±0.7 at 4 years (p=0.02)]. Glaucoma medications were reduced by 1.2±0.1 at 6 months (p<0.0001), 1.1±0.1 at 1 year (p<0.0001), 1.0±0.1 at 2 years (p<0.0001), 0.9±0.1 at 3 years (p<0.0001) and 0.5±0.2 at 4 years (p=0.03). Only 14 eyes (3.2%) required additional glaucoma procedures. Compared to the lookback period, the rates of visual field MD and RNFL loss decreased in the postoperative period by 0.18±0.08 dB/year (-0.18±0.02 vs 0.004±0.08 dB/year, p=0.02) and 0.51±0.29 μm/year (-0.47±0.12 vs 0.04±0.21 μm/year, p=0.07), respectively.</p><p><strong>Conclusions: </strong>In this non-trial setting, cataract surgery with Hydrus Microstent implantation was associated with sustained reductions in IOP, glaucoma medication burden, and disease progression rate.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008680","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":"Wide-field Optical Coherence Tomography Angiography and Euclidian Distance Analysis of Microvascular Deficits in Glaucomatous Eyes.","authors":"Diogo F Muller, Yingying Shi, Maria J Chaves-Samaniego, Khushali Shah, Gustavo Rosa Gameiro, Giovanni Gregori, Steven J Gedde, Luis E Vazquez","doi":"10.1016/j.ogla.2025.08.010","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.08.010","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate superficial microvascular deficits of glaucomatous eyes with wide-field optical coherence tomography angiography (OCTA) and Euclidian distance (ED) analysis.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Subjects: </strong>Swept-source OCTA (SS-OCTA) images of healthy and glaucomatous eyes.</p><p><strong>Methods: </strong>12x12mm scans of healthy and glaucomatous eyes were acquired with SS-OCTA (PLEX® Elite 9000, ZEISS). The en face images of the superficial retina segmentation were exported and analyzed with ImageJ software. A fixed threshold that predicted the size of the foveal avascular zone (FAZ) was used to generate binarized images with vascular (white) or deficient (black) pixels. Four vascular parameters were measured within a macula-centered 9x10.8mm ellipse: vascular density (VD), average ED (ED_avg), maximum ED (ED_max), and non-perfusion density (NPD). ED values were visualized with Heat-map color scale. The vascular parameters were compared between healthy and glaucomatous eyes (Student's t-test). Person coefficients were calculated to test correlations between the vascular parameters and retinal nerve fiber layer (RNFL) thickness, macular ganglion cell and inner plexiform layer (GCIPL) thickness, and visual field mean deviation (VFMD) in glaucomatous eyes. P<0.05 was considered significant.</p><p><strong>Main outcome: </strong>VD, ED_avg, ED_max, and NPD RESULTS: Forty glaucomatous and twenty-five healthy eyes were included. VD (fraction) was 0.442 ± 0.029 vs. 0.3205 ± 0.072 (P<0.001), ED_avg (μm) was 17.37 ± 0.549 vs. 32.62 ± 9.545 (P<0.001), ED_max (μm) was 153.7 ± 49.15 vs. 248.5 ± 156.6 (P=0.005), and NPD (%) was 0.97 ± 0.82 vs. 7.09 ± 5.99 (P<0.001) in healthy vs. glaucomatous eyes. VD, ED, and NPD were better in ONH sectors than in temporal macula and retinal periphery sectors in both groups, but worse in the glaucoma group across all sectors of the ellipse (P<0.01 for all sectors). Microvascular deficits in glaucomatous eyes often exceeded structural and functional glaucomatous damage, and there was modest correlation between the vascular and structural/functional parameters. Pearson r of the correlation with average RNFL and GCIPL were highest for VD (r=0.46, P=0.002 and r=-0.49, P=0.001, respectively) and lowest for ED_max (r=-0.19, P=0.24 and r=-0.23, P=0.16, respectively).</p><p><strong>Conclusions: </strong>VD, ED, and NPD were worse in glaucomatous compared to healthy eyes throughout the wide-field OCTA image. High ED and NPD values accentuate regions of inadequate perfusion.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006935","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":"Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma:5-Year Safety Results from a Randomized, Multicenter Study.","authors":"Joseph F Panarelli, Marlene R Moster, Julian Garcia-Feijoo, Brian E Flowers, N Douglas Baker, Howard S Barnebey, Davinder S Grover, Michael C Stiles, James D Brandt, Henny J M Beckers, Nicholas G Strouthidis","doi":"10.1016/j.ogla.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.08.009","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the long-term safety of MicroShunt implantation with trabeculectomy in eyes with primary open-angle glaucoma (POAG).</p><p><strong>Methods: </strong>This was a 3-year observational extension of a 2-year prospective randomized trial comparing clinical outcomes of MicroShunt implantation with trabeculectomy, both augmented with mitomycin C. Adverse events (AEs), intraocular pressure (IOP), and IOP-lowering medication use were recorded 36, 48, and 60 months after initial randomization. The primary outcome was the cumulative incidence of sight-threatening AEs. Secondary outcomes included all other AEs/complications, secondary interventions, and reductions in IOP and number of glaucoma medications.</p><p><strong>Results: </strong>The extension study enrolled 279 patients (217 MicroShunt, 62 trabeculectomy), with 256 (198 and 58, respectively) completing the month 60 visit. Rates of sight-threatening AEs were 2% (n=4) in the MicroShunt group and 0% in the trabeculectomy group, with one eye each in the MicroShunt group having central retinal artery occlusion, choroidal hemorrhage (following placement of a glaucoma drainage device), progressive endothelial cell loss, and pseudophakic bullous keratopathy. Only two of the four sight-threatening AEs in the MicroShunt group were deemed related to the study device or procedure. Four eyes in the MicroShunt group experienced device erosion through the conjunctiva. Increased IOP requiring treatment was more frequent (26% versus 8%, P=0.0017), whereas hypotony (3% versus 13%, P=0.038), epiretinal membrane formation (2% versus 8%; P=0.028), and blepharoptosis (4% versus 11%, P=0.048) were less frequent, in the MicroShunt group. Four patients in the trabeculectomy group required surgical revision for hypotony. Changes in endothelial cell density were similar in the MicroShunt (-19% ± 22%) and trabeculectomy (-19% ± 22%) groups, with a mean between-group difference of 0.1% (P=0.98). Mean ± SD IOP was reduced from 20.8 ± 4.9 mmHg at baseline to 14.2 ± 4.1 mmHg at month 60 in MicroShunt eyes (mean reduction, 5.5 mmHg [26%]) and from 20.1 ± 3.9 mmHg to 10.4 ± 3.7 mmHg in trabeculectomy eyes (mean reduction, 9.1 mmHg [45%]), with a between-group difference of -4.6 mmHg (P<0.0001).</p><p><strong>Conclusion: </strong>Both filtering procedures demonstrated favorable safety profiles over 5 years. Most AEs through 5 years did not necessitate reoperation nor result in vision-threatening complications.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006949","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":"Predictors of Selective Laser Trabeculoplasty Efficacy Results from the Swedish Optimal SLT Multicenter Randomized Controlled Trial.","authors":"Tobias Dahlgren, Marcelo Ayala, Madeleine Zetterberg","doi":"10.1016/j.ogla.2025.08.008","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.08.008","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the impact of potential predictor variables on selective laser trabeculoplasty (SLT) efficacy in the Swedish Optimal SLT (OSLT) trial.</p><p><strong>Design: </strong>Post hoc analysis of a multicenter, masked, randomized controlled trial.</p><p><strong>Subjects: </strong>512 eyes from 399 patients enrolled in the OSLT trial.</p><p><strong>Methods: </strong>Patients were randomized to one of four SLT variants, differing in treatment extent (180° or 360°) and laser power (standard or high). Analyses were performed with linear mixed models (LMMs), which allowed optimal use of all the data and applied comprehensive adjustment to the results. A wide selection of potential predictors for SLT efficacy were first analyzed separately regarding their association with intraocular pressure reduction (IOPR). Predictors meeting a threshold of p<0.1 were then included in a multivariable candidate model, which was refined through manual stepwise backwards selection until only significant variables (p<0.05) remained. Thereafter, other variables of interest were evaluated in this model.</p><p><strong>Main outcome measure: </strong>Mean IOPR 1-6 months after SLT.</p><p><strong>Results: </strong>The 360/high protocol remained the most efficacious SLT variant after adjustment for predictors (coefficient estimate (CE) 360/high 2.0, 360/standard 0.9, and 180/high -0.1, with 180/standard as the reference; p<0.001). Higher baseline IOP was a positive predictor for both absolute IOPR (CE 0.35; p<0.001), and relative IOPR (CE 0.72; p<0.001). A larger IOPR from the prior SLT (CE 0.18; p=0.004), as well as IOPR in the contralateral eye (CE 0.57; p<0.001) were also highly significant positive predictors. Conversely, the present analyses suggest that SLT efficacy is diminished by pseudoexfoliations (CE -0.69; p=0.02), the number of prior SLTs (CE -0.54; p=0.004), and increased corneal thickness (CE -0.01; p<0.002). Consultants/specialists and residents achieved similar SLT results, but individual surgeon performance mattered (p=0.003) as well as if the surgeon used the dominant hand (CE 0.35; p=0.050). However, age, glaucoma medication, cataract surgery, anterior chamber angle pigmentation, inflammatory symptoms, or postoperative anterior chamber flare had no correlation with SLT efficacy.</p><p><strong>Conclusions: </strong>The 360/high protocol remained the most effective and reliable technique after adjustment for multiple predictors. No evidence was found to advise against 360/high SLT for any particular group of patients. Selective laser trabeculoplasty (SLT) is a first line treatment for open angle glaucoma and ocular hypertension (OHT).^1-3 SLT can be performed with different techniques (treatment protocols), primarily differing in the extent of the treatment area, the number of laser spots, and the principles for setting the laser power.⁴ For years, there has been a lack of evidence for the optimal treatm","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002057","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}