Ophthalmology. Glaucoma最新文献

{"title":"Sulcus Tube in a Patient with Axenfeld-Rieger Syndrome.","authors":"Lauren S Blieden, Peter T Chang","doi":"10.1016/j.ogla.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.05.003","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276827","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 Outflow of Trials, Tribulations, and Perseverance.","authors":"Ronald L Fellman, Davinder S Grover, Ruikang K Wang","doi":"10.1016/j.ogla.2025.05.002","DOIUrl":"10.1016/j.ogla.2025.05.002","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276826","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":"Visual Outcomes and Risk Factors For Progression in Juvenile Open-Angle Glaucoma.","authors":"Kasem Seresirikachorn, Daniel M Vu, Anila Narayana, Kornkamol Annopawong, Boonsong Wanichwecharungruange, Ta Chen Peter Chang","doi":"10.1016/j.ogla.2025.06.003","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.06.003","url":null,"abstract":"<p><strong>Purpose: </strong>To report the visual outcomes of patients diagnosed with juvenile open angle glaucoma (JOAG) at presentation and final follow-up, and to analyze the rate of visual impairment progression and associated risk factors.</p><p><strong>Design: </strong>Retrospective clinical cohort study.</p><p><strong>Participants: </strong>This retrospective study included all patients diagnosed with JOAG over 13 years from two tertiary hospitals in Bangkok, Thailand, with a minimum follow-up of one year.</p><p><strong>Methods: </strong>We categorized visual impairment and blindness according to the World Health Organization criteria at both the initial presentation and the final follow-up visit. Progression was defined as a shift to a more severe category of visual impairment in each eye; we identified the risk factors associated with visual impairment progression.</p><p><strong>Main outcome measures: </strong>The proportions of visual impairment and blindness at the beginning and end of the study period. The progression rates of visual impairments were calculated at 1, 3, and 5 years.</p><p><strong>Results: </strong>We included a total of 203 eyes from 106 patients in this study. At the initial assessment, 31.5% of eyes were blind, and this percentage significantly increased to 35.5% (p<0.001) after an average follow-up of nearly 8 years. Bilateral blindness in patients rose from 15.2% to 19.8% (P<0.001) over the same period. Among patients without visual impairment at presentation, 96.3%, 93.1%, and 87.7% maintained stable vision at 1, 3, and 5 years, respectively. In comparison, patients with moderate visual impairment had stable outcomes in 84.6%, 67.7%, and 67.7% of cases at the same time points. However, the progression rates of visual outcomes did not significantly differ across varying visual impairment categories (p=0.08). A higher number of glaucoma surgeries per patient was identified as an associated factor for visual impairment progression (adjusted hazard ratio=2.25; CI 1.34-3.78, p=0.002).</p><p><strong>Conclusions: </strong>JOAG is associated with severe visual impairment both at initial presentation and after treatment. Despite slow progression, more than 10% of patients experienced worsening vision over five years, with the number of glaucoma surgeries being a significant associated factor for progression. Lifelong follow-up and early detection are crucial in reducing morbidity in this patient group.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287381","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":"Short-Term Rates of Visual Field Change Predict Glaucoma Progression.","authors":"Mohsen Adelpour, Sasan Moghimi, Takashi Nishida, Leo Meller, Kelvin H Du, Alireza Kamalipour, Natchada Tansuebchueasai, Golnoush Mahmoudinezhad, Linda M Zangwill, Robert N Weinreb","doi":"10.1016/j.ogla.2025.05.006","DOIUrl":"10.1016/j.ogla.2025.05.006","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the prognostic significance of short-term rates of visual field (VF) mean deviation (MD) change in predicting progression across various levels of glaucoma severity.</p><p><strong>Design: </strong>Observational cohort.</p><p><strong>Participants: </strong>A total of 349 eyes from 254 patients followed up to 5 years.</p><p><strong>Methods: </strong>Primary open-angle glaucoma eyes were included with ≥ 5 24-2 VFs tests during the initial 2 years over a period of up to 5 years. Two assessment methods, Guided Progression Analysis (GPA) and a United States Food and Drug Administration (FDA)-consistent end point, were utilized to identify progression events. Rates of change in VF MD during the initial 2 years were calculated, and survival models were employed to evaluate the risk of faster initial VF MD loss on the development of GPA and FDA-consistent end points.</p><p><strong>Main outcomes and measures: </strong>Risk of progression based on initial MD change rates.</p><p><strong>Results: </strong>Over a mean follow-up of 4.3 years, progression was observed in 17.2% (GPA end point) and 24.9% (FDA-consistent end point) of eyes. Faster initial rates of VF MD loss significantly increased the progression risk (hazard ratio [HR] per 0.1 dB/year faster for GPA: 1.16, 95% confidence interval [CI]: 1.12-1.20; HR for FDA: 1.16, 95% confidence interval: 1.12-1.21; both P < 0.001) with survival-adjusted R² values of 0.67 for GPA and 0.75 for FDA-consistent end points. Global initial 2-year slopes showed the highest predictive accuracy for FDA progression events, with adjusted R² values of 0.75 overall, 0.71 for early glaucoma, and 0.42 for moderate-to-advanced glaucoma. Superior and inferior sectoral slopes demonstrated lower abilities to explain the variability across all severity groups. The model's predictive accuracy was higher in early glaucoma (R², 0.71) compared to moderate-advanced stages (R², 0.42) for both criteria.</p><p><strong>Conclusions: </strong>The initial 2-year rate of VF MD change predicts subsequent progression events based on FDA-consistent criteria in both early and moderate-to-advanced glaucoma eyes. These findings suggest initial VF MD change rates identify patients at higher risk of future progression, enabling timely management decisions and, also, potentially serving as a progression end point in clinical trials.</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":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236072","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":"Obstructive Sleep Apnea as a Potentiator of Primary Open-Angle Glaucoma and Necessity for Interventional Therapy.","authors":"Pranav Vasu, Isabella V Wagner, Paul Connor Lentz, Priyanka Gumaste, Yazan Abubaker, Bryan C H Ang, Abhimanyu S Ahuja, Emily Dorairaj, Ibrahim Qozat, Darby D Miller, Syril Dorairaj","doi":"10.1016/j.ogla.2025.05.005","DOIUrl":"10.1016/j.ogla.2025.05.005","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the rate of progression of primary open-angle glaucoma (POAG) in patients with obstructive sleep apnea (OSA) compared with non-OSA mild-moderate POAG comparators and to assess the utilization of surgical and laser intervention.</p><p><strong>Design: </strong>A retrospective cohort study of the TriNetX US Collaborative Network was conducted by analyzing international electronic health record data from January 2004 to October 2024.</p><p><strong>Participants: </strong>Patients in the TriNetX US Collaborative Network with a diagnosis of mild-moderate POAG, stratified with respect to OSA status.</p><p><strong>Methods: </strong>Patients were assessed for outcomes at 3, 5, and 10 years. Propensity score matching was conducted between cohorts matched for baseline demographics, comorbidities, and medication use. Odds ratios (ORs) and 95% confidence intervals (CIs) were subsequently calculated.</p><p><strong>Main outcome measures: </strong>Risk of development of severe POAG.</p><p><strong>Results: </strong>After propensity score matching, 5277 patients with, and 5277 patients without OSA were included in final analysis. At 3 (OR, 2.791; 95% CI, 2.289-3.403), 5 (OR, 2.300; 95% CI, 1.947-2.717), and 10 years (OR, 2.198; 95% CI, 1.873-2.578), the OSA cohort demonstrated significantly higher odds of developing severe POAG than the non-OSA comparators. Secondary outcomes of minimally invasive glaucoma surgery and trabeculectomy surgery yielded no significant difference between both cohorts (P > 0.05) at all follow-up times. However, laser therapy and tube shunt surgery demonstrated a significantly greater incidence in the OSA cohort at each time point.</p><p><strong>Conclusions: </strong>The rate of glaucoma surgery appears similar between patients with POAG with and without OSA, despite those with OSA demonstrating a greater risk of rapid progression and vision loss. Future practice patterns should pay special attention to patients with OSA and consider offering more aggressive or earlier intervention, which may aid in limiting disease progression.</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":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144614","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 rate of failure of trabeculectomy and tube shunt surgery in eyes with uveitic glaucoma and ocular hypertension: The purpose of this study is to look at the outcomes of trabeculectomy and tube shunt surgery in a large cohort of patients with uveitis.","authors":"Sylvia L Groth, Craig W Newcomb, Wei Yang, Abhishek Payal, Hosne Begum, Naira Khachatryan, R Oktay Kaçmaz, Kurt A Dreger, James T Rosenbaum, H Nida Sen, Eric B Suhler, Jennifer E Thorne, Nirali P Bhatt, C Stephen Foster, Douglas A Jabs, Grace A Levy-Clarke, Jeanine M Buchanich, Gui-Shuang Ying, John H Kempen, Sapna Gangaputra","doi":"10.1016/j.ogla.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.05.004","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the incidence of failure of trabeculectomy vs. tube shunt glaucoma surgery in eyes of patients with uveitis.</p><p><strong>Design: </strong>Multi-center retrospective cohort study.</p><p><strong>Participants: </strong>Among 356 eyes of 288 patients with noninfectious inflammatory eye disease undergoing first incisional glaucoma surgery using one of the techniques, 244 eyes had tube shunts (TS) and 112 eyes had trabeculectomy augmented with mitomycin-C (Trab-MMC).</p><p><strong>Methods: </strong>Standardized chart review was used to collect clinical data over time retrospectively. Cox regression analyses with adjustment for propensity score and inter-eye correlations were performed to compare the incidence of failure of glaucoma surgery between TS and Trab-MMC.</p><p><strong>Main outcome measures: </strong>Failure of glaucoma surgery of the first five years postoperatively, defined as: (1) IOP≤ 5 mmHg or >21 mmHg at two consecutive visits at least 90 days apart beginning three months after surgery; or (2) reoperation; or (3) complete blindness (no light perception).</p><p><strong>Results: </strong>The median age was 40.3 years (IQR 13.4-57.3) in the TS group and 44.2 years (IQR 29.0-58.9) in the Trab-MMC group. The median pre-glaucoma surgery IOP was 29.0 mm Hg (IQR 21-35.5) in the TS group and 30.0 mm Hg (IQR 20-38) in the Trab-MMC group. Anterior uveitis was most common location of primary inflammation in both the TS group (52.5%) and Trab-MMC group (55.4%). Failure was observed in the TS group in 23.5%, 27.1% and 30.8% cumulatively through 12, 24, and 36 months respectively vs. 16.1%, 25.6% and 30.0% respectively in the Trab-MMC group. In the propensity score adjusted Cox regression analysis, there was no significant difference in failure incidence rate between the TS and trab-MMC groups (adjusted hazard ratio 1.08, 95% CI 0.65-1.78, p=0.77). Success without requirement for IOP-lowering medicines was observed more frequently in the Trab-MMC group.</p><p><strong>Conclusions: </strong>TS and Trab-MMC fail frequently with similar incidences when done as the first glaucoma surgery among eyes with uveitis over 5 years of follow-up, but there were more complete successes in the Trab-MMC group compared to the TS group at 12, 24 and 36 months.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144616","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":"Milky Aqueous Humor.","authors":"Tarannum Mansoori, Mantravadi Lakshmi Karthika","doi":"10.1016/j.ogla.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.007","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095945","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":"Influence of CYP1B1 Variants on Phenotypic Characteristics and Therapeutic Outcomes in Primary Congenital Glaucoma.","authors":"Rita Rodrigues, David Alves, João Esteves-Leandro, Marta Silva, João Barbosa-Breda, João Tavares-Ferreira, Joana Araújo, Susana Fernandes, Renata Oliveira, António Melo, Flávio Alves, Augusto Magalhães, José Cotta, Sérgio Estrela-Silva","doi":"10.1016/j.ogla.2025.04.012","DOIUrl":"10.1016/j.ogla.2025.04.012","url":null,"abstract":"<p><strong>Purpose: </strong>To identify CYP1B1 variants in primary congenital glaucoma (PCG) patients from Northern Portugal and examine genotype-phenotype correlations.</p><p><strong>Design: </strong>Cross sectional observational study.</p><p><strong>Participants: </strong>Seventy-one patients diagnosed and treated for PCG at ULS São João, Porto, Portugal, were included. These patients met the following criteria: available genetic testing data, a minimum follow-up period of 1 year, and the last appointment between January 2022 and January 2024.</p><p><strong>Methods: </strong>Demographic and clinical data were collected. CYP1B1 variants were screened using DNA sequencing. A next-generation sequencing (NGS) glaucoma panel was performed in patients with heterozygous or absent CYP1B1 variants in the screening. Genotype-phenotype correlations were assessed by comparing clinical characteristics between patients with identified biallelic plausible disease-causing variants in CYP1B1 variants and those with negative genetic testing results.</p><p><strong>Main outcome measures: </strong>CYP1B1 variants, sex, laterality, age at diagnosis, age at first surgery, number of surgical procedures, number of intraocular pressure (IOP)-lowering medications, IOP at last follow-up, and final best-corrected visual acuity (BCVA).</p><p><strong>Results: </strong>Sixty-six unrelated probands and 5 affected relatives (133 eyes) were analyzed. Two plausible disease-causing CYP1B1 variants were identified in 60.6% (43/71) of patients. Nineteen distinct CYP1B1 variants were identified, including 4 novel variants. The most frequent variants were c.535del (43.5%) and c.1200_1209dup (28.2%). Compared with negative genetic testing group (n = 22), patients with CYP1B1 variants (n = 43) showed significantly higher rates of bilateral disease (100% vs. 68%, P < 0.001), earlier disease onset (median 0 vs. 5.5 months, P < 0.001), poorer final BCVA (median 0.5 vs. 0.25 logarithm of the minimum angle of resolution, P = 0.025), higher IOP at last follow-up (median 16 vs. 12 mmHg, P < 0.001), and greater need for surgical interventions (median 2 vs. 1, P = 0.014) and IOP-lowering medications (median 2 vs. 0, P = 0.005). Next-generation sequencing testing in CYP1B1-negative patients identified 3 novel heterozygous variants of uncertain significance in the TEK gene.</p><p><strong>Conclusions: </strong>Primary congenital glaucoma patients from Northern Portugal with CYP1B1 variants are more likely to present with bilateral disease, earlier onset, and a more severe clinical phenotype, suggesting a strong genotype-phenotype correlation.</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":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043049","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":"Loss to Follow-Up and Risk of Incident Blindness among Patients with Glaucoma in the IRIS® Registry.","authors":"Andrew M Williams, Hai-Wei Liang, Hsing-Hua Sylvia Lin","doi":"10.1016/j.ogla.2025.05.001","DOIUrl":"10.1016/j.ogla.2025.05.001","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the association between loss to follow-up (LTFU) and risk of incident blindness among a national registry cohort of patients with primary open-angle glaucoma (POAG).</p><p><strong>Design: </strong>Retrospective longitudinal cohort study.</p><p><strong>Participants: </strong>Patients with a POAG diagnosis who had at least 2 visual acuity (VA) measurements documented in the IRIS® Registry (Intelligent Research in Sight) in both 2014 and 2019.</p><p><strong>Methods: </strong>Loss to follow-up was defined as a calendar year or more without an encounter. Univariable and multivariable robust log-Poisson regression models were used to estimate the risk of incident blindness, with intervals of LTFU as the primary exposure of interest. Effect modification by baseline characteristics on the association between LTFU and incident blindness was also assessed.</p><p><strong>Main outcome measures: </strong>Incident blindness in 1 or both eyes (VA ≤ 20/200) in 2019 among patients who were not blind in 2014.</p><p><strong>Results: </strong>Among the 149 172 patients, incident monocular blindness occurred in 6338 (4.2%), and incident binocular blindness occurred in 691 (0.5%) over the 6-year period. While most patients maintained follow-up every year (90%), 8.8% were LTFU for 1-2 years, and 1.1% were LTFU for 3-4 years. Patients with LTFU had greater risk of blindness. In an adjusted model that accounted for age, sex, race/ethnicity, insurance, smoking status, glaucoma severity, baseline intraocular pressure, baseline cup-to-disc ratio, and history of glaucoma surgery, risk of incident monocular blindness was greater among patients with a lapse of 1-2 years (adjusted relative risk [aRR] = 1.19, 95% confidence interval [CI]: 1.05-1.35) or a lapse of 3-4 years (aRR = 2.17, 95% CI: 1.66-2.78) compared to patients with no lapse in care. Race/ethnicity demonstrated a significant effect modification in the association between the longest lapse between encounters and the risk of blindness (P = 0.02). The risk of incident blindness after a lapse of 3-4 years (compared to no lapse) was higher among Black patients (aRR = 3.12, 95% CI: 2.06-4.76) than White patients (aRR = 1.93, 95% CI: 1.37-2.73). No effect modifications were identified by other baseline variables.</p><p><strong>Conclusions: </strong>Loss to follow-up is an independent risk factor for incident blindness among patients with POAG. Lapses in care are particularly consequential for Black patients. Efforts to reduce LTFU may mitigate preventable glaucoma blindness.</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":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041863","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-Site Trabeculotomy vs. Gonioscopy-Assisted Transluminal Trabeculotomy in the Treatment of Primary Congenital Glaucoma: A Randomized Prospective Study.","authors":"Reem M Aboulhassan, Yasmine M ElSayed, Amanne Esmael, Ghada Gawdat, Ahmed ElKateb, Hala ElHilali","doi":"10.1016/j.ogla.2025.04.013","DOIUrl":"10.1016/j.ogla.2025.04.013","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to compare the outcomes of 2-site rigid probe trabeculotomy (RPT) compared to gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of primary congenital glaucoma (PCG).</p><p><strong>Design: </strong>A prospective randomized controlled study SUBJECTS: The study included 77 eyes of 60 patients with PCG with clear corneas all aged < 5 years.</p><p><strong>Methods: </strong>Patients were randomized to undergo either 2-site trabeculotomy using a RPT or GATT using a 5/0 polypropylene suture. Success was defined as achieving a final intraocular pressure (IOP) < 18 mmHg without (complete) or with medications (qualified).</p><p><strong>Main outcome measures: </strong>Primary outcomes were reduction of IOP and medications. Secondary outcomes were complications and success rates. Anterior segment OCT (AS-OCT) was performed to compare changes in angle morphology.</p><p><strong>Results: </strong>The two-site RPT group included 39 eyes, and the GATT group included 38 eyes. There was a significant reduction in IOP and glaucoma medications at 1, 3, 6, 9, and 12 months postoperatively in both groups (P < 0.001) with no significant difference in IOP or IOP-lowering medications between both groups at any follow-up (FU). At the final FU, there was a 49% ± 13% IOP reduction in the 2-site RPT trabeculotomy group compared to 44% ± 25% in the GATT group (P = 0.2). Success was achieved in all eyes in the RPT group and in 95% in the GATT group. Hyphema was the most frequently observed complication; with no vision-threatening complications in either group. Postoperative AS-OCT findings included angle widening, trabecular shelf, and peripheral anterior synechia.</p><p><strong>Conclusions: </strong>Circumferential trabeculotomy using ab interno GATT or ab externo 2-site trabeculotomy yielded comparable results in terms of safety and efficacy. Gonioscopy-assisted transluminal trabeculotomy has the advantage of sparing the conjunctiva which may be needed for future interventions.</p><p><strong>Financial disclosure(s): </strong>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043051","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}