Ophthalmology. Glaucoma最新文献

{"title":"Outcomes of Preserflo MicroShunt Implantation in Refractory Childhood Glaucoma Following Ahmed Glaucoma Valve Surgery.","authors":"Javier García-Bardera, Julian Garcia-Feijoo, Laura Morales-Fernández, Clara Heredia-Pastor, Álvaro Ponce-de-León, Mireia García-Bermúdez, Marco Antonio Pascual-Santiago, Bárbara Burgos-Blasco, Jose María Martínez-de-la-Casa, Julián Garcia-Sánchez","doi":"10.1016/j.ogla.2025.04.011","DOIUrl":"10.1016/j.ogla.2025.04.011","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical outcomes of Preserflo MicroShunt (PMS) implantation with mitomycin C (MMC) in managing refractory childhood glaucoma previously treated with Ahmed glaucoma valve (AGV).</p><p><strong>Design: </strong>A single-arm retrospective cohort study.</p><p><strong>Participants: </strong>Twenty-three eyes of 22 patients with refractory childhood glaucoma and a history of AGV implantation.</p><p><strong>Methods: </strong>All patients underwent PMS implantation with intraoperative MMC (0.04% for 2.5 minutes). Primary endpoints included intraocular pressure (IOP) reduction, reduction in antiglaucomatous medications, and surgical success. \"Complete success\" was defined as achieving target IOP without medications; \"qualified success\" allowed for medications. Safety parameters included intraoperative and postoperative complications and the need for further interventions.</p><p><strong>Main outcome measures: </strong>Intraocular pressure reduction, antiglaucomatous medication reduction, and surgical success rates.</p><p><strong>Results: </strong>Median follow-up was 23 months (interquartile range: 18-41). Mean baseline IOP was 27.0 ± 4.3 mmHg with 3.2 ± 0.5 medications. At 1 year, IOP decreased to 14.1 ± 4.4 mmHg (-47.0%) with 0.4 ± 1.0 medications and to 16.9 ± 3.6 mmHg (-40.2%) with 1.2 ± 1.5 medications at 2 years. Overall success rates for ≥20% IOP reduction were 91.3% at 1 year (69.9% complete success) and 72.7% at 2 years (45.5% complete success); for ≥30% reduction, they were 82.6% and 63.6%, respectively. During follow-up, 1 case of device extrusion was observed at 3 months, and another required surgical revision at 5 months.</p><p><strong>Conclusions: </strong>Preserflo MicroShunt implantation with MMC offers a valuable surgical option for managing refractory childhood glaucoma after AGV. The procedure achieved substantial reductions in both IOP and medication burden. Larger studies with extended follow-up are recommended to confirm its long-term efficacy.</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":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031280","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":"Microspherophakia: Kugel Fountain Presentation.","authors":"Devendra Maheshwari, Shivam Gupta, Madhavi Pillai","doi":"10.1016/j.ogla.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.03.004","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065233","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":"Prevalence of Myocilin Mutations in a Cohort of Patients with Juvenile Open-Angle Glaucoma from sub-Saharan Africa.","authors":"Olusola Olawoye, Brian P Young, Angela W Nyunt, Oluwatoyin F Fafowora, Magdalene Ajani, Tarela Sarimiye, Brendan A Creemer, Ben R Roos, Anne L Coleman, Michael B Gorin, Michael A Hauser, Todd E Scheetz, Adeyinka Ashaye, John H Fingert","doi":"10.1016/j.ogla.2025.04.010","DOIUrl":"10.1016/j.ogla.2025.04.010","url":null,"abstract":"<p><strong>Purpose: </strong>Determine the prevalence and the role of myocilin (MYOC) gene mutations in a sub-Saharan population of patients with juvenile open-angle glaucoma (JOAG).</p><p><strong>Design: </strong>Prospective case-control.</p><p><strong>Participants: </strong>Forty-five patients with JOAG and 41 normal control subjects from the ophthalmology clinics of the University College Hospital Ibadan, Nigeria.</p><p><strong>Methods: </strong>DNA was tested for MYOC coding sequence mutations using Sanger sequencing. Identified mutations were evaluated for pathogenicity using ClinGen scoring; assessing prevalence in large public databases of patients with African ancestry (gnomAD and 1000 Genomes); and mutation analysis algorithms: PolyPhen, Sorting Intolerant from Tolerant (SIFT), BLOSUM62, MutationTaster, Combined Annotation Dependent Depletion (CADD), and AlphaMissense. The prevalence of variants was compared between patients with JOAG and normal controls from Ibadan using a mutation burden analysis using Sequence Kernel Association Test (SKAT-O).</p><p><strong>Main outcome measures: </strong>Sanger DNA sequencing data indicating the presence or absence of glaucoma-causing mutations in the MYOC gene.</p><p><strong>Results: </strong>A total of 10 instances of 4 MYOC variants were detected. A p.Pro370Leu variant, which has been previously categorized by the ClinGen as pathogenic, was detected in 3 (6.7%) of 45 JOAG probands. A p.Arg470Cys MYOC variant, previously categorized a variant of unknown significance, was identified in 1 (2.2%) of 45 JOAG probands. A p.Glu352Lys variant, previously categorized as benign, was detected in 2 (4.4%) of JOAG probands. Both the p.Pro370Leu and p.Arg470Cys variants were absent from control subjects and large public databases, whereas p.Glu352Lys was present at a frequency > 1%, which is inconsistent with pathogenicity. Finally, synonymous missense variant, p.Glu396Glu, was also detected. A total of 5 of 6 mutation analysis algorithms supported the pathogenicity of the p.Pro370Leu and p.Arg470Cys variants, whereas slightly fewer (4 of 6) suggested that p.Glu352Lys is pathogenic.</p><p><strong>Conclusions: </strong>Myocilin mutations are the most common known cause of JOAG in populations of European ancestry. Our case-control study estimated the prevalence of pathogenic MYOC mutations to be 8.9% in an African population from Nigeria. Myocilin mutations are the most common known cause of JOAG in sub-Saharan Africa; however, they account for a minority of cases.</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":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065319","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":"Associations between Clustered Visual Field Progression and Locations of Disc Hemorrhages in Glaucoma: A 3-Year Prospective Study.","authors":"Tadamichi Akagi, Takeo Fukuchi, Tomomi Higashide, Sachiko Udagawa, Shinji Ohkubo, Kazuhisa Sugiyama, Hidenobu Tanihara, Makoto Araie, Goji Tomita, Chota Matsumoto, Atsuo Tomidokoro, Masanori Hangai, Hisashi Kawata, Maya Inai, Yuki Tanaka","doi":"10.1016/j.ogla.2025.04.009","DOIUrl":"10.1016/j.ogla.2025.04.009","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of disc hemorrhages (DHs) at different locations on clustered visual field (VF) progression in patients with primary open-angle glaucoma (POAG) over a 3-year prospective study.</p><p><strong>Design: </strong>A prospective multicenter cohort study.</p><p><strong>Participants: </strong>Patients diagnosed with POAG and intraocular pressure (IOP) ≤18 mmHg undergoing prostaglandin analog monotherapy.</p><p><strong>Methods: </strong>Visual field testing, IOP measurements, fundus photography, and OCT scans were conducted quarterly over a 3-year period. Disc hemorrhage locations were categorized into superior, inferior, temporal, and nasal quadrants. The VF was subdivided into superior, inferior, and central regions, with the central VF further divided into superior central and inferior central zones. A multivariable linear mixed-effects model with random intercepts and slopes was employed to analyze the relationship between DH history at specific locations and progressive changes in clustered total deviation (TD).</p><p><strong>Main outcome measures: </strong>Association between DH location and the rate of clustered VF progression.</p><p><strong>Results: </strong>Among 186 eyes from 109 patients, DH occurred in 61 eyes (32.8%). Superior, inferior, temporal, and nasal DH were observed in 19, 31, 21, and 2 eyes, respectively. A faster superior TD slope was significantly associated with inferior DH (P = 0.032), but not with superior or temporal DH. A faster inferior TD slope was significantly associated with a worse inferior baseline TD value (P = 0.009) and marginally associated with superior DH (P = 0.053) but not with inferior or temporal DH. A faster central TD slope was significantly associated with temporal DH (P < 0.001) and inferior DH (P = 0.034) but not with superior DH. Detailed analysis revealed that inferior DH was significantly associated with the superior central TD slope (P = 0.010) but not with the inferior central TD slope. Although DH recurrence was observed in 37 eyes, the number of DH events did not show an additive effect on corresponding clustered VF progression.</p><p><strong>Conclusions: </strong>The location of DH was strongly associated with corresponding clustered VF progression in patients with POAG. Both temporal and inferior DH represent risk factors for central VF 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":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063319","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":"Reverse Pupillary Block in Yamane Technique Scleral-Fixated Intraocular Lens.","authors":"Pietro Paolo Saba, Edoardo Panico, Mario R Romano","doi":"10.1016/j.ogla.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.03.008","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031324","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":"Disease Progression, not Intraocular Pressure, Should Guide Escalation of Treatment in Glaucoma.","authors":"Giovanni Montesano, David F Garway-Heath, Gus Gazzard","doi":"10.1016/j.ogla.2025.04.005","DOIUrl":"10.1016/j.ogla.2025.04.005","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043434","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":"Re: Zhou et al.: Incidence of acute cystoid macular edema after starting a prostaglandin analog compared with other classes of glaucoma medications (Ophthalmol Glaucoma. 2025;8:4-11).","authors":"James O Robbins, Sanjay G Asrani","doi":"10.1016/j.ogla.2025.04.008","DOIUrl":"10.1016/j.ogla.2025.04.008","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054088","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 Methods to Deliver Mitomycin C in Trabeculectomy Surgery: A Systematic Review and Meta-Analysis.","authors":"Alessandro Ghirardi, Siqi Fan, Karl Mercieca, Gianni Virgili, Stefano De Cillà, Alessandro Rabiolo","doi":"10.1016/j.ogla.2025.04.004","DOIUrl":"10.1016/j.ogla.2025.04.004","url":null,"abstract":"<p><strong>Topic: </strong>Compare different methods to deliver mitomycin C (MMC) in trabeculectomy surgery.</p><p><strong>Clinical relevance: </strong>Knowing the best way to apply MMC may provide guidance to glaucoma surgeons and improve outcomes.</p><p><strong>Methods: </strong>Systematic review and meta-analysis (PROSPERO CRD42023394371) for studies comparing ≥ 2 methods to apply MMC in trabeculectomy published until February 22, 2023, from Medline, EMBASE, and CENTRAL. Randomized clinical trials (RCTs), quasi-randomized, and prospective nonrandomized controlled studies published in English and conducted on human subjects were included. The primary outcome was surgical failure at 1 year. Secondary outcomes included intraocular pressure (IOP), number of glaucoma medications, postoperative complications, and interventions. A random-effects meta-analysis was conducted for ≥ 3 studies, whereas a fixed-effect model was used for 2 studies. The certainty of evidence was assessed with Grading Recommendations Assessment, Development and Evaluation (GRADE) score.</p><p><strong>Results: </strong>From 7899 records, 8 articles from 7 RCTs compared intraoperative sub-Tenon MMC injection (315 participants) and intraoperative MMC-soaked sponges (327 participants). One RCT and 1 quasi-randomized study compared postoperative (60 participants) and intraoperative (60 participants) MMC-soaked sponge application. In the injection vs. sponges comparison, no significant difference in surgical failure (relative risk [RR]: 0.78, 95% confidence interval [CI]: 0.48-1.28; P = 0.33, GRADE score moderate) or IOP (mean difference [MD]: -0.85 mmHg, 95% CI: -2.19 to 0.49; P = 0.21, GRADE score moderate) was found at 1 year. Sub-Tenon injection resulted in fewer postoperative medications (MD: -0.40, 95% CI: -0.63 to -0.18; P < 0.001; GRADE score moderate) and better bleb morphology (GRADE score high) in terms of height (MD: -0.39, 95% CI: -0.61 to -0.18; P < 0.001), extension (MD: 0.28, 95% CI: 0.11-0.45; P = 0.001), and vascularity (MD: -0.52, 95% CI: -0.72, -0.31; P < 0.001) than sponges. Serious complication and reintervention rates were low and comparable between groups. We did not perform a meta-analysis comparing postoperative and intraoperative sponge application because of heterogeneity in the study designs of the included studies.</p><p><strong>Conclusions: </strong>Intraoperative sub-Tenon MMC injection is noninferior to intraoperative MMC-soaked sponges in trabeculectomy surgery in terms of surgical failure and IOP control, with a reduced number of medications, improved bleb morphology, and similar safety profile. Further research with a long-term follow-up is necessary to confirm their long-term equivalence.</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":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050407","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":"Meaningful Patient Partnerships: A Qualitative Study of Patient Perspectives and Shared Decision-Making Regarding Glaucoma Surgery.","authors":"Zayn Al-Timimi, Samrat Sarkar, Sapna Nand, Simon E Skalicky, Sartaj Sandhu, Hamish Dunn, Lisa Keay","doi":"10.1016/j.ogla.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.006","url":null,"abstract":"<p><strong>Purpose: </strong>Patient-centered care is key to successful clinical outcomes and meaningful clinician-patient relationships. Accordingly, a comprehensive understanding of patient perspectives is essential to aligning the clinician's focus and patient's goals. However, our understanding of patients' perceptions of glaucoma surgery and involvement in surgical decision-making has not kept pace with the rapid treatment advances in the field and move toward earlier surgery with the advent of minimally invasive glaucoma surgery devices. The purpose of this study was to understand the perspectives and priorities of people with glaucoma when considering glaucoma surgery through qualitative analysis of semistructured interviews.</p><p><strong>Design: </strong>A qualitative study.</p><p><strong>Participants: </strong>Individuals diagnosed with glaucoma, above 18 years of age, and able to communicate effectively in English. Interviews were conducted with 40 participants: 23 participants who had undergone glaucoma surgery and 17 who had not.</p><p><strong>Methods: </strong>Interviews were conducted over telephone, using an interview guide developed in consultation with people with glaucoma and surgeons. The cohort was purposely sampled to ensure representation across age, sex, socioeconomic status, remoteness, glaucoma severity, clinic settings, and treatment histories. Transcripts were iteratively analyzed to identify key themes pertaining to perceptions of glaucoma surgery and involvement in decision-making.</p><p><strong>Main outcome measures: </strong>Surgical perception and involvement themes, including barriers and bridges to confidence in glaucoma surgery.</p><p><strong>Results: </strong>Six key themes were identified: (1) patients feeling rushed; (2) onus on the patient to seek information; (3) undercurrents of anxiety; (4) perceptions of surgery shaped by understanding and expectations of the disease and its treatment paradigm; (5) trust in surgeon imbuing confidence in surgery; and (6) empowerment through understanding of alternatives. Key barriers to patient involvement included patient anxiety, time pressures (real or perceived), and perceived urgency of intervention.</p><p><strong>Conclusions: </strong>Shared decision-making in glaucoma surgery remains aspirational. This study provides valuable insights into patient perceptions of glaucoma surgery, which can help inform patient-centered care. Readily applicable \"practice points\" are proposed to optimize patient involvement and empowerment.</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":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Reversal of Optic Nerve Cupping in Steroid-Induced Glaucoma.","authors":"Manasi Tripathi, Vinit Tanwar, Varun Gogia","doi":"10.1016/j.ogla.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.03.005","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059805","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}