Ophthalmology. Glaucoma最新文献

{"title":"Early Outcomes of Direct versus Conventional Selective Laser Trabeculoplasty in a Propensity-Matched Cohort.","authors":"Jason Dossantos, Muhammad Abrar Irfan, Jella An","doi":"10.1016/j.ogla.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.ogla.2026.09.007","url":null,"abstract":"<p><strong>Purpose: </strong>To compare 6-month outcomes and safety of direct selective laser trabeculoplasty (dSLT) versus conventional 360° selective laser trabeculoplasty (SLT) in clinical practice.</p><p><strong>Design: </strong>Retrospective propensity-matched cohort study.</p><p><strong>Participants: </strong>Consecutive eyes undergoing dSLT or conventional 360° SLT between 2024 and 2026. All glaucoma subtypes and severities were eligible, including eyes with prior laser trabeculoplasty or incisional glaucoma surgery. After separate matching, the completed-treatment cohort included 247 eyes from 147 patients, and the treatment-attempted sensitivity cohort included 254 attempts from 148 patients, including 7 incomplete dSLT procedures.</p><p><strong>Methods: </strong>SLT eyes were matched 1:2 to dSLT eyes using propensity scores based on age, sex, race/ethnicity, glaucoma type and severity, baseline intraocular pressure (IOP), and baseline medication burden. Complete and partial success through 6 months were assessed with Kaplan-Meier and weighted Cox models. Secondary analyses evaluated IOP change, medication burden, adverse events, and secondary interventions.</p><p><strong>Main outcome measures: </strong>Complete success, defined as no secondary IOP-lowering intervention and either at least 20% IOP reduction without medication increase or IOP at or below baseline with reduction of at least 1 topical glaucoma medication.</p><p><strong>Results: </strong>Six-month complete success was 30.5% after SLT versus 16.2% after dSLT. After adjustment, dSLT was associated with a higher hazard of complete-success failure (adjusted HR, 1.66; 95% CI, 1.08-2.54; P=0.020). Partial success numerically favored SLT (32.5% vs 20.0%) but was not significant (adjusted HR, 1.45; 95% CI, 0.96-2.20; P=0.078). In 84 eyes from 51 patients, adjusted IOP reduction was greater after SLT (between-group difference, 2.98 mmHg; 95% CI, 0.71-5.26; P=0.010). Medication burden was similar at month 6 (1.9 SLT vs 2.0 dSLT). Adverse events were uncommon (6.9% vs 11.8%; P=0.192), although incomplete treatment occurred only with dSLT (4.6%; P=0.044).</p><p><strong>Conclusions: </strong>Both dSLT and conventional SLT reduced IOP and medication burden through 6 months with favorable short-term safety. Conventional SLT was associated with greater IOP reduction and a higher probability of complete success, suggesting a modest early efficacy advantage in treatment-experienced eyes.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018743","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":"Iris Insertion and Trabecular Meshwork Composition in Primary Congenital Glaucoma and Normal Eyes Using Anterior Segment OCT.","authors":"Jiaxing Wang, Jeffrey Liu, Zara Saleem, Michelle Go, Sharon F Freedman, Bo Wang","doi":"10.1016/j.ogla.2026.09.005","DOIUrl":"10.1016/j.ogla.2026.09.005","url":null,"abstract":"<p><strong>Purpose: </strong>To quantify iridocorneal angle morphology in pediatric eyes with primary congenital glaucoma (PCG) compared to normal controls using overhead-mounted anterior segment OCT (AS-OCT), including iris insertion and trabecular meshwork (TM) intensity.</p><p><strong>Design: </strong>Prospective, cross-sectional, masked observational study.</p><p><strong>Participants: </strong>Eyes of children <5 years old with PCG and normal controls undergoing examination under anesthesia.</p><p><strong>Methods: </strong>Nasal and temporal angles were imaged using AS-OCT. A masked ophthalmologist analyzed images using MATLAB and ImageJ. Clinical data were collected.</p><p><strong>Main outcome measures: </strong>Iris insertion (distance from scleral spur to iris plane), normalized TM intensity, and TM homogeneity.</p><p><strong>Results: </strong>Forty-nine patients (86 eyes: 33 PCG; 53 normal) from one center were imaged (01/2023-02/2026). Mean age was younger (9.2 ± 9.1 vs. 15.9 ± 11.0 months, P = 0.003), and mean intraocular pressure (IOP) higher (29.8 ± 8.1 vs. 12.9 ± 4.9 mmHg, P < 0.001), in PCG vs. controls, respectively. Iris insertion was more anterior in PCG eyes vs. controls (80.6 ± 85.0 vs. 143.7 ± 68.8 μm, P < 0.001). Iris insertion did not correlate with IOP in PCG (P = 0.30) or controls (P = 0.33). Iris insertion also showed no significant association with age. Normalized TM intensity did not differ significantly between PCG and controls (0.59 ± 0.17 vs. 0.58 ± 0.19, P = 0.70) but decreased with age.</p><p><strong>Conclusions: </strong>In our cohort, AS-OCT imaging demonstrated a more anterior iris insertion in PCG eyes compared to controls, independent of IOP and age, confirming structural alteration of the anterior chamber angle. These findings may help guide further studies on the relationship between angle morphology and glaucoma phenotype.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018772","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":"Bicuspid Iris: A Manifestation of Anterior Segment Dysgenesis.","authors":"Akanksha Sharma, Faisal Thattaruthody, Ranjan Kumar Behera","doi":"10.1016/j.ogla.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.ogla.2026.08.005","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992609","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":"Guidelines for Disinfection of Applanation Tonometers: A Position Statement from the American Glaucoma Society and the American Academy of Ophthalmology.","authors":"Cheryl Khanna, Aakriti Shukla, Armin Garmany, Geoffrey Emerick, Darby Miller, Alan L Robin, Emily Schehlein","doi":"10.1016/j.ogla.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.ogla.2026.09.003","url":null,"abstract":"<p><p>Glaucoma is the leading cause of irreversible blindness in the United States and across the globe. Accurate measurement of intraocular pressure (IOP) is essential for management. As such, equitable access to accurate and high-quality tonometry to measure IOP is critical. In the 1950s, the Goldmann applanation tonometer (GAT) replaced the Schiotz tonometer as the clinical reference standard for measuring IOP. Current disinfection guidelines, using a categorization system devised in the 1930s, place tonometers in the same category as tonometers with instruments such as endoscopes and bronchoscopes, the latter of which contact the mucous membranes, as semi-critical instruments, requiring them to undergo high-level disinfection (HLD). Available clinical evidence has not shown an increased risk of disease transmission with low-level disinfection (LLD) of tonometers. At the same time, HLD for GAT may give rise to potential patient safety concerns. HLD chemicals can cause corneal burns and can damage instrumentation by dissolving the glue holding the applanation tip together, causing the tip to swell and crack. The damaged tip can both harm patients' corneas and produce inaccurate intraocular pressure readings. To circumvent the inconvenience, error and cost associated with HLD, many healthcare systems have adopted disposable tonometer tips, which generate large amounts of plastic waste and impose unsustainable costs. Because LLD has been effective in preventing disease transmission in practice, we propose that tonometers be reclassified as a non-critical-use item under the Spaulding classification system. As a non-critical item, tonometers would not require HLD, but rather low-level disinfection. Patients at increased risk of developing an infection, for example, those with corneal abrasions or a history of ocular trauma, signs of possible ocular infection such as erythema or discharge, or a history of chronic viral infection, can be evaluated with single-use tonometer tips or other acceptable methods of tonometry, facilitating more efficient utilization of resources while ensuring high-quality patient care.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992581","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 Role of Mental Health Care in Optimizing Glaucoma Outcomes.","authors":"Christine Y Kim, Ali S Raza, Mona A Kaleem, Ethan G Lester","doi":"10.1016/j.ogla.2026.07.012","DOIUrl":"https://doi.org/10.1016/j.ogla.2026.07.012","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946350","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":"Comparison of Structure-Function Relationships between Tablet-Based Perimetry and Conventional Bowl Perimetry: a Cross-Sectional Study.","authors":"Jan Niklas Lüke, Amelie Poell, Philip Enders, Vincent Lüke, Constantin Niederau, Thomas Dietlein, Alexandra Lappa, Silvia Schrittenlocher","doi":"10.1016/j.ogla.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.ogla.2026.09.001","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the structure-function relationship between optical coherence tomography (OCT) parameters of the optic nerve head and corresponding sectoral mean sensitivity (MS) values obtained using tablet-based perimetry (TP) and conventional bowl-based static perimetry (CBP).</p><p><strong>Design: </strong>Post-hoc analysis of a cross-sectional observational study.</p><p><strong>Subjects: </strong>A total of 140 eyes from 77 patients with suspected or confirmed glaucoma were included after exclusion.</p><p><strong>Methods: </strong>Participants underwent visual field testing using tablet-based perimetry and conventional bowl-based perimetry (Octopus 900; G-Pattern), as well as spectral-domain optical coherence tomography (SD-OCT, Spectralis) of the optic nerve head, within an eight-week interval. Based on the Garway-Heath map, visual field sensitivity points were assigned to corresponding sectors of the peripapillary retinal nerve fiber layer (pRNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW). Mean sensitivity values were converted to a linear scale. Structure-function relationships were assessed using Spearman's rank correlation coefficient.</p><p><strong>Main outcome measures: </strong>Sectoral and global correlations between visual field mean sensitivity and OCT-derived BMO-MRW and pRNFL thickness, comparing tablet-based perimetry with conventional bowl-based perimetry.</p><p><strong>Results: </strong>Both BMO-MRW and pRNFL thickness demonstrated statistically significant moderate to strong correlations with visual field sensitivity across most sectors and at the global level (BMO-MRW: ρ = 0.64; pRNFL: ρ = 0.69; both P < 0.01). Global structure-function correlations were comparable between TP and CBP (BMO-MRW: ρ = 0.65 vs. 0.64; P = 0.87). In glaucoma-relevant temporo-inferior sectors, TP showed equal or stronger correlations with structural parameters compared with CBP, whereas weaker associations were observed in nasal sectors.</p><p><strong>Conclusions: </strong>Tablet-based perimetry demonstrates a reliable structure-function relationship with optic nerve head morphometry, with correlations comparable to those obtained using conventional bowl-based perimetry. These findings support the potential clinical utility of tablet-based perimetry for structural-functional assessment in glaucoma.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931908","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":"ELIOS Excimer Laser Trabeculostomy with Phacoemulsification in Primary Open-Angle Glaucoma: 24-Month Outcomes of Pivotal Trial.","authors":"Mark Gallardo, Steven R Sarkisian, George Reiss, Andy Lee, Paul Singh, Navaneet Borisuth, Mohamed Yassine, Kelly Swaim, Cathleen McCabe, Yi-Jing Duh, Hsin Yi Ling, Rupali Nangia, Iqbal Ike K Ahmed","doi":"10.1016/j.ogla.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.ogla.2026.08.006","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate 24-month safety and effectiveness of excimer laser trabeculostomy combined with phacoemulsification in patients with mild-to-moderate primary open-angle glaucoma (POAG).</p><p><strong>Design: </strong>Prospective, multicenter, non-randomized pivotal investigational device exemption trial (NCT04899063).</p><p><strong>Participants: </strong>Adults (≥45 years) with mild-to-moderate POAG, operable age-related cataract, medicated intraocular pressure (IOP) ≤24 mmHg on 1-3 ocular hypotensive medications, and unmedicated diurnal IOP (DIOP) 22-34 mmHg after washout.</p><p><strong>Methods: </strong>Patients underwent phacoemulsification with intraocular lens implantation followed by excimer laser trabeculostomy (ELIOS System; Bausch + Lomb) and were followed for 24 months. Coprimary effectiveness endpoints were compared with prespecified performance goals derived from phacoemulsification-only control arms of other pivotal minimally invasive glaucoma surgery (MIGS) trials.</p><p><strong>Main outcome measures: </strong>Coprimary endpoints were proportion of patients achieving ≥20% reduction in unmedicated mean DIOP from baseline at months 12 and 24 (performance goals >79% and >68.5%) and mean change in unmedicated DIOP at the same timepoints (performance goals ≤-7.2 and ≤-6.15 mmHg). Safety outcomes included adverse events, endothelial cell density (ECD), corrected distance visual acuity, visual field, and pachymetry.</p><p><strong>Results: </strong>A total of 318 patients underwent the procedure (mean±SD age, 70.3±7.3 years; medicated IOP at screening, 17.05±3.01 mmHg; unmedicated DIOP at baseline, 24.53±2.51 mmHg). Both coprimary endpoints were met at months 12 and 24: a ≥20% reduction in unmedicated DIOP was achieved by 84.2% and 76.1% of patients (P=0.0116 and P=0.0018 vs. performance goals), respectively, and the mean±SE change in unmedicated DIOP was -8.17±0.21 mmHg and -7.35±0.22 mmHg (both P<0.0001 vs. performance goals), respectively. Mean DIOP decreased to 15.98 mmHg at month 12 and 16.76 mmHg at month 24. At month 23, 82.0% of patients were medication-free. No intraoperative adverse events occurred during the ELIOS procedure, and the postoperative safety profile in this population was consistent with that expected following phacoemulsification alone. ECD reduction occurred early and stabilized from month 3 through month 24.</p><p><strong>Conclusions: </strong>Through 24 months, excimer laser trabeculostomy with phacoemulsification provided sustained, clinically meaningful reductions in unmedicated DIOP and medication use, with a favorable safety profile, supporting its use as a MIGS option in patients with mild-to-moderate POAG undergoing cataract surgery.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914232","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":"Are We Doing Better a Decade Later?: Glaucoma in Patients with Boston Keratoprosthesis Type 1.","authors":"In Young Chung, Rachel Y Chen, Kyong Min Lee, Cara Knasel, Chhavi Saini, Eric Wang, Alja Crnej, James Chodosh, Joseph B Ciolino, Teresa C Chen, Ula V Jurkunas, Roberto Pineda, Jia Yin, Michael Y Chen, Eleftherios I Paschalis, Thomas H Dohlman, Lucy Q Shen","doi":"10.1016/j.ogla.2026.08.008","DOIUrl":"10.1016/j.ogla.2026.08.008","url":null,"abstract":"<p><strong>Purpose: </strong>To compare glaucoma outcomes after Boston type 1 keratoprosthesis (KPro) implantation in a recent cohort with a previous cohort from a decade before.</p><p><strong>Design: </strong>Retrospective comparative cohort study.</p><p><strong>Subjects: </strong>Patients who underwent KPro surgery at Mass Eye and Ear: 67 eyes (64 patients) from 2016 to 2023 and 97 eyes (79 patients) from 2004 to 2009.</p><p><strong>Methods: </strong>Development of de novo glaucoma and glaucoma progression were defined as an increase in cup-to-disc ratio (CDR) ≥0.2 from baseline to final follow-up, assessed by experienced KPro specialists and corroborated with OCT and Humphrey visual field (HVF) data when available.</p><p><strong>Main outcome measures: </strong>Primary outcome was glaucoma progression within 4 years after KPro. Secondary outcomes were postoperative visual acuity (VA), intraocular pressure (IOP), and complications.</p><p><strong>Results: </strong>Mean follow-up was similar between the recent and previous cohorts (3.2 ± 1.2 vs. 3.4 ± 1.1 years, P = 0.43). Prior infection and failed corneal grafts were more common in the recent cohort (43% vs. 22%, P = 0.003; 67% vs. 33%, P < 0.001). Preoperative VA was similar (logarithm of the minimum angle of resolution [LogMAR] 1.77 ± 0.89 vs. 1.96 ± 0.53, P = 0.09) but recent and previous cohorts differed in final VA (LogMAR 1.59 ± 1.20 vs. 1.10 ± 0.82, P = 0.002). Despite a higher prevalence of pre-existing glaucoma (79% vs. 63%, P = 0.03), glaucoma progression was less frequent in the recent cohort (11% vs. 47%, P < 0.001), while de novo glaucoma rates were similar (P = 0.84). In the recent cohort, CDR-based assessments agreed with OCT and HVF findings in 78% and 89% of 21% of eyes, respectively. Notably, more patients in the recent cohort received glaucoma surgery prior to (40% vs. 18%, P = 0.001) or concurrently (12% vs. 2%, P = 0.01) with KPro surgery. The recent cohort had lower final IOP (13 ± 5 vs. 16 ± 6 mmHg, P < 0.001) and fewer eyes requiring ≥2 topical glaucoma medications (P = 0.005). Endophthalmitis occurred more frequently in the recent cohort (7% vs. 1%, P = 0.03), whereas other complications were similar (P ≥ 0.07).</p><p><strong>Conclusions: </strong>Despite a greater baseline glaucoma burden, the recent cohort experienced lower rates of glaucoma progression and improved IOP control, likely reflecting earlier and more frequent surgical glaucoma interventions. Nonetheless, vision-threatening complications remain an ongoing challenge, emphasizing the need for continued effort to improve postoperative care for patients with keratoprosthesis.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907703","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":"Weekly Home Monitoring of Glaucoma with Virtual Reality Perimetry: A 2-Year Prospective Longitudinal Study.","authors":"Ping Huang, Reza Razeghinejad, Natasha Nayak Kolomeyer, Elizabeth Dale, Michael J Pro, Lauren E Hock, Tina Xia, Dilru Amarasekera, Cindy X Zheng, Jonathan S Myers","doi":"10.1016/j.ogla.2026.08.007","DOIUrl":"10.1016/j.ogla.2026.08.007","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility, and adherence of unsupervised high-frequency home virtual reality (VR) perimetry and its agreement with standard automated perimetry in open-angle glaucoma and to compare the precision of progression estimates.</p><p><strong>Design: </strong>Prospective, longitudinal cohort study.</p><p><strong>Participants: </strong>Fifty-three patients (106 eyes) with open-angle glaucoma.</p><p><strong>Methods: </strong>Participants performed weekly home testing with the Olleyes VisuALL VR perimeter (HomeVF) during longitudinal follow-up. In-office Humphrey Field Analyzer (HVF) 24-2 SITA Standard testing was performed every 6 months. Agreement in mean deviation (MD) and pattern standard deviation (PSD) was assessed using repeated-measures correlation and Bland-Altman analysis. Baseline estimate variability and standard errors (SEs) of the slopes were compared between modalities.</p><p><strong>Main outcome measures: </strong>Primary outcome was HomeVF-HVF agreement for MD and PSD. Secondary outcomes included adherence, reliability, and test duration. Exploratory outcomes included test-retest variability and slope-estimate precision.</p><p><strong>Results: </strong>Fifty-three participants were enrolled; 51 contributed follow-up data, and 2 contributed baseline data only. The mean follow-up was 16.6 ± 8.3 months (range, 2.1-30.5 months), and a total of 4817 HomeVF tests were collected, with a median of 77 tests per participant (interquartile range, 36-130). At 24 months, 86.7% of eligible participants remained active, with a mean frequency of >2 tests per month. Mean HomeVF duration was shorter than HVF (4.93 ± 0.66 vs. 5.80 ± 1.09 min; P < 0.001). Overall, the median percentage of reliable tests/eye was 98.4%. HomeVF correlated strongly with HVF (MD r = 0.83-0.94; PSD r = 0.81-0.86) across all time points. In paired HVF-aligned comparisons through 12 months, HomeVF values were consistently higher than HVF values (mean difference [HomeVF - HVF]: MD +1.42 to +1.46 dB; PSD +0.78 to +1.34 dB). Inter-test variability was similar between the two modalities. The MD slope SEs were significantly lower with HomeVF (0.40 vs. 0.53 dB/year; P = 0.049).</p><p><strong>Conclusions: </strong>Unsupervised home VR perimetry is feasible over long-term follow-up, demonstrating sustained adherence, high reliability, comparable inter-test repeatability, and strong agreement with office HVF with predictable offsets. Higher-frequency home testing improves the precision of MD progression estimates, supporting home VR perimetry as a practical adjunct for longitudinal glaucoma monitoring.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893048","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":"Dose-Effectiveness Optimizing in Micropulse Transscleral Cyclophotocoagulation: A Cohort Study in Refractory Glaucoma.","authors":"Yanyan Wu, Xiaofeng Zhu, Zidong Chen, Ziyi Cai, Pingping Liu, Yimin Zhong, Xinbo Gao, Yingting Zhu, Zhidong Li, Shu Tu, Shufen Lin, Fengbin Lin, Lei Fang, Yangfan Yang, Minbin Yu","doi":"10.1016/j.ogla.2026.08.003","DOIUrl":"10.1016/j.ogla.2026.08.003","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the clinical outcomes, safety profile, and dose-response relationship of micropulse transscleral cyclophotocoagulation (MPCPC) utilizing augmented dose protocols in Chinese patients with refractory glaucoma.</p><p><strong>Design: </strong>Retrospective, single-center study.</p><p><strong>Participants: </strong>Patients treated with MPCPC at Zhongshan Ophthalmic Center from August 2022 to August 2024.</p><p><strong>Methods: </strong>Laser parameters of MPCPC were standardized at 2000 mW and a 31.3% duty cycle, with patients stratified into 3 groups based on treatment duration: 160 seconds, 200 seconds, and 240 seconds.</p><p><strong>Main outcome measures: </strong>Participants were followed up for 12 months to assess changes in best-corrected visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications. Treatment success was defined as a final IOP between 5 and 21 mmHg or a ≥ 20% reduction from baseline, without the need for increased antiglaucoma medications or surgical re-intervention.</p><p><strong>Results: </strong>A total of 229 eyes from 229 patients were analyzed: 160 s (n = 66), 200 s (n = 35), and 240 s (n = 128). At 12 months postoperatively, the 240 s group achieved a 38.7% IOP reduction, which was significantly superior to the 25.5% reduction observed in the 160 s group (P = 0.028). Linear regression identified a significant dose effect, with each 40-second increment in laser duration associated with an additional 5.9% IOP reduction (β = 0.059, P = 0.035). Kaplan-Meier survival analysis revealed the highest cumulative success probability in the 240 s group (68.7%), followed by the 200 s group (58.1%) and the 160 s group (53.6%) (P = 0.040). Multivariate Cox regression confirmed that eyes with shorter treatment duration and eyes with longer axial length had a higher risk of treatment failure (P < 0.05). Notably, a decline in visual acuity occurred only in the 160 s group (P = 0.036). The number of antiglaucoma medications was significantly reduced in all 3 groups compared with baseline (P < 0.01). Complication rates did not differ significantly among the 3 groups (P = 0.155).</p><p><strong>Conclusions: </strong>MPCPC constitutes a safe and potent modality for IOP reduction, exhibiting a dose-dependent effectiveness. The augmented-dose protocols of 200-240 s seem to optimize long-term IOP control. Patients with longer axial length have a potential risk of treatment failure, which is likely attributable to posterior displacement of the ciliary body.</p><p><strong>Financial disclosure(s): </strong>The authors have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801562","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}