Ophthalmology. Glaucoma最新文献

{"title":"Enhanced Aqueous Humor Outflow Following Trabeculotomy in Primary Congenital Glaucoma Eyes.","authors":"Shikha Gupta, Xiaowei Zhang, Arnav Panigrahi, Robert N Weinreb, Viney Gupta, Alex S Huang","doi":"10.1016/j.ogla.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.002","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063392","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 Frontloading Approach to Meet Guideline-Recommended Visual Field Testing for Glaucoma: Time and Cost.","authors":"Henrietta Wang, Katherine Masselos, Jeremy C K Tan, Nimesh B Patel, Ashish Agar, Michael Kalloniatis, Jack Phu","doi":"10.1016/j.ogla.2025.04.003","DOIUrl":"10.1016/j.ogla.2025.04.003","url":null,"abstract":"<p><strong>Purpose: </strong>To measure the time and clinical resources taken to obtain 6 reliable visual field (VF) tests for glaucoma in a glaucoma clinic.</p><p><strong>Design: </strong>Longitudinal, prospective study in a glaucoma clinic.</p><p><strong>Subjects: </strong>Ten thousand and ten SITA-Faster VF tests of 535 clinical subjects.</p><p><strong>Methods: </strong>The cumulative number of VF tests with false-positive rates ≤15% for each eye of each subject was counted over time, and from there, the time to achieve 6 VF tests was determined and compared under frontloaded (2 VFs per eye per visit) and non-frontloaded (first VF within the frontloaded set) conditions. Costs to attain 6 VF tests were modeled.</p><p><strong>Main outcome measures: </strong>Visual field counts and costs for attainment.</p><p><strong>Results: </strong>Eight thousand nine hundred thirty-one of the 10 010 VF results had a false-positive rate of ≤15%. Approximately 90% of subjects had early or moderate open-angle glaucoma. When using the frontloading protocol, it took an average of 1.4 years to attain 6 reliable VFs for right and left eyes, respectively. For the non-frontloaded protocol, the average times were 2.6 and 2.5 years for the right and left eyes, respectively; 82.5% of right eyes and 85.4% of left eyes achieved 6 reliable VFs within 2 years when frontloaded, but the proportion was only 15.8% and 18.8% when non-frontloaded for right and left eyes, respectively. There was a significantly lower cost for obtaining 6 reliable VFs with frontloading than non-frontloading, due to fewer office visits.</p><p><strong>Conclusions: </strong>A frontloading approach and SITA-Faster paradigm led to patients attaining 6 reliable VFs over 14 months sooner than non-frontloaded, with >84% receiving the recommended number of 6 tests in the first 2 years. The frontloading approach overall leads to savings in time and cost in comparison to non-frontloading for achieving 6 reliable VFs and thus potentially provides an avenue for earlier detection of glaucomatous change.</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":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041983","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":"Association of Eye Drop-Treated Diseases and Conditions That Can Impair Eye Drop Self-Administration.","authors":"Tianyi Wang, Hong Su An, Jaqueline Stoutin, Alexander D Valentine, Leah K Depperschmidt, Matthew Callewaert, Michael Goldstein, Joshua D Stein","doi":"10.1016/j.ogla.2025.04.001","DOIUrl":"10.1016/j.ogla.2025.04.001","url":null,"abstract":"<p><strong>Objective: </strong>Eye drops are often first-line treatment for glaucoma and dry eye disease (DED). Unfortunately, proper eye drop self-administration is difficult, and this is likely magnified in persons with comorbid rheumatological, neurological, or cognitive disorders. This study investigates the association between ocular conditions often treated with eye drops (glaucoma and DED) and medical conditions that may impair proper eye drop self-administration.</p><p><strong>Design: </strong>A retrospective database study.</p><p><strong>Participants: </strong>From 6 health systems, 1 446 229 patients participated in the Sight Outcomes Research Collaborative between January 2012 and December 2021.</p><p><strong>Methods: </strong>We determined the proportion of patients with glaucoma or DED with medical conditions that may limit proper eye drop self-administration and created multivariable logistic regression models assessing associations between glaucoma or DED and comorbid conditions.</p><p><strong>Main outcome measures: </strong>Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of glaucoma or DED.</p><p><strong>Results: </strong>Among 247 899 patients with glaucoma (mean [standard deviation] age: 60.1 [15.1] years, 56.2% female, 19.5% Black), 106 927 (43%) had ≥ 1 comorbid condition that could affect eye drop self-administration. Among 321 941 patients with DED (mean [standard deviation] age: 55.9 [16.1] years, 66.4% female, 12.6% Black), 156 811 (49%) had ≥ 1 such condition. Patients with ≥ 1 impairment affecting eye drop self-administration had 17% greater odds of glaucoma (aOR: 1.17, CI: 1.16-1.18) and 66% greater odds of DED (aOR: 1.66, CI: 1.65-1.68), compared with other patients. Persons with 2, 3, and ≥ 4 conditions that may affect eye drop administration had 27%, 39%, and 53% higher odds of glaucoma, respectively, compared with persons without such conditions (P < 0.0001). Persons with 2, 3, and ≥ 4 health conditions that may impair eye drop administration had 76%, 121%, and 156% higher odds of DED, respectively (P < 0.0001).</p><p><strong>Conclusions: </strong>Nearly half of all patients with glaucoma or DED have ≥ 1 medical condition that may impair eye drop self-administration. Clinicians should assess patients' physical and mental capacity to self-administer topical ocular therapy. Some patients may benefit from alternative therapies that reduce or eliminate the need for eye drops.</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":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059668","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":"Impact of the COVID-19 Pandemic on Medicare Reimbursement and Glaucoma Procedure Utilization: APayment-VolumeElasticity and Trends Analysis.","authors":"Jason Dossantos, Hoang-Viet Tran, Sinan Akosman, Julie Thomasian, David Belyea","doi":"10.1016/j.ogla.2025.03.012","DOIUrl":"10.1016/j.ogla.2025.03.012","url":null,"abstract":"<p><strong>Purpose: </strong>To examine how the coronavirus disease 2019 (COVID-19) pandemic impacted the relationship between Medicare reimbursement and glaucoma procedure service volume in the United States.</p><p><strong>Design: </strong>A retrospective, longitudinal database study.</p><p><strong>Participants: </strong>A complete dataset of all glaucoma procedures performed on Medicare Part B beneficiaries from 2019 to 2022.</p><p><strong>Methods: </strong>Linear mixed-effects model using Medicare Part B data, controlling for year, charges, denials, reimbursement-to-charge ratio (RCR), service setting, Current Procedural Terminology code, state, Medicare population, number of ophthalmologists, and median income. The RCR was calculated as the ratio of weighted mean reimbursement to weighted mean charge, representing the proportion of reimbursed charges. Weighted averages for denials, charges, and reimbursements (adjusted for inflation) were also calculated.</p><p><strong>Main outcome measures: </strong>Payment-volume elasticities, defined as the percent change in procedure volume per 1% change in Medicare payment, for traditional glaucoma surgeries (tubes and shunts), minimally invasive glaucoma surgeries (MIGSs), and laser procedures. Additional measures included weighted averages of charges, reimbursements, denials, and RCR across procedure categories and service settings.</p><p><strong>Results: </strong>Traditional surgeries showed a 2.3% decrease in volume per 1% payment increase (95% confidence interval [CI]: -2.9% to -1.7%; P < 0.001; Rc² = 0.89) and a 10.2% decline in volume. Mean reimbursement for traditional surgeries decreased by 5%, with a 7.7% drop in RCR. Laser procedures exhibited a 6.7% volume decrease per 1% payment increase (95% CI: -7.1% to -6.2%; P < 0.001; Rc² = 0.97) and a 16% total decline, with no change in RCR. Minimally invasive glaucoma surgeries declined by 16.2% overall but demonstrated an 8.3% volume increase per 1% payment rise (95% CI: 7.9%-8.7%; P < 0.001; Rc² = 0.90), with a 64% improvement in RCR. Overall, glaucoma procedure volumes fell by 15.6%, mean reimbursement decreased by 7.3%, and denied claims increased by 46.7%. Ambulatory surgical centers (ASCs) experienced a 15.2% volume decline but an 11.5% increase in reimbursement, supported by a 42.9% rise in RCR.</p><p><strong>Conclusions: </strong>Glaucoma procedure volumes declined between 2019 and 2022, particularly for traditional surgeries and MIGS. Traditional and laser procedures had negative payment-volume elasticities, whereas MIGS showed positive elasticity. These findings suggest factors beyond reimbursement rates, like shifts to less invasive treatments and COVID-19 disruptions, significantly influenced clinical decision-making.</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":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060417","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":"Gonioscopy-Assisted Transluminal Trabeculotomy for Myocilin-Associated Juvenile Open-Angle Glaucoma: A Case Series of 8 Eyes Over 2.2 to 4.1 Years.","authors":"Erin A Boese, Wallace L M Alward, John H Fingert","doi":"10.1016/j.ogla.2025.03.011","DOIUrl":"10.1016/j.ogla.2025.03.011","url":null,"abstract":"<p><strong>Objective: </strong>Mutations within the myocilin (MYOC) gene are the first known single-gene cause of both primary open-angle glaucoma and juvenile open-angle glaucoma (JOAG). Subsequent studies have shown these mutations cause trabecular meshwork dysfunction, resulting in markedly elevated intraocular pressures (IOPs) at young ages. Angle-based procedures, like gonioscopy-assisted transluminal trabeculotomy (GATT), bypass the trabecular meshwork, and as such, are hypothesized to be particularly effective in this angle-based disease. The purpose of this case series is to evaluate the efficacy of GATT for MYOC-associated JOAG.</p><p><strong>Design: </strong>A retrospective chart review was performed evaluating patients under the age of 18 years with known MYOC-associated JOAG who underwent GATT. A total of 8 eyes of 4 children are included.</p><p><strong>Participants: </strong>All participants had a strong family history of MYOC glaucoma.</p><p><strong>Methods: </strong>All patients underwent a thorough clinical evaluation, including visual acuity, slit lamp examination, optic nerve fundoscopy, and IOP measurements by Goldmann applanation. Most patients also underwent 24-2 Swedish Interactive Thresholding algorithm (SITA) standard Humphrey visual fields and fundus photography, and all patients had retinal nerve fiber layer OCT.</p><p><strong>Main outcome measures: </strong>Main outcome measures include IOP and number of medications. Additional measures include visual acuity, optic nerve photos, visual field testing, and OCT.</p><p><strong>Results: </strong>Following 360° GATT, all 8 eyes of 4 children had a mean drop in IOP of 26 mmHg (68%), and all were able to stop glaucoma medications entirely. Our patients were followed up between 2.2 and 4.1 years with no evidence of decreasing efficacy or glaucomatous progression. All patients maintain 20/20 visual acuity or better in both eyes, and glaucoma has stabilized on all available ancillary testing (OCT, Humphrey visual field, and optic nerve photos). One patient (patient 4) had a notable reversal of cupping.</p><p><strong>Conclusions: </strong>In MYOC-associated JOAG, the pathology is concentrated at the trabecular meshwork (TM), lending itself well to angle-based surgeries, especially GATT. Gonioscopy-assisted transluminal trabeculotomy is particularly effective in children with MYOC JOAG, allowing them to avoid, or at least delay, the need for more invasive surgeries like trabeculectomy and tube shunt surgeries with over 4 years of follow-up. To date, this is the first genetically directed glaucoma surgery available.</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":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797239","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 Systematic Review of Sex-Based Reporting in Topical Glaucoma Medication Clinical Trials.","authors":"Helen Zhao, Rachel E Davis, Alexander S Davis, Susan L Meoli, Elizabeth A Cretara","doi":"10.1016/j.ogla.2025.03.010","DOIUrl":"10.1016/j.ogla.2025.03.010","url":null,"abstract":"<p><strong>Topic: </strong>The National Institutes of Health (NIH) issued guidance in 2016 that sex should be treated as a biological variable in clinical studies; however, previous research has shown that biomedical studies still fail to include sex as a biological variable (SABV) in study design and analysis. We hypothesize that despite evidence for sex-specific glaucoma risk factors, clinical trials for glaucoma topical medications also fail to treat SABV.</p><p><strong>Clinical relevance: </strong>Prior studies have found sex-specific genetic and hormonal risk factors for glaucoma suggesting that biological sex may influence the disease course.</p><p><strong>Methods: </strong>We performed a systematic review on Pubmed and Google Scholar using terms including generic names of common glaucoma medications, and filters \"randomized control trial\" and \"clinical trial.\" Resulting studies were reviewed and included if they met inclusion criteria including randomized controlled trial design, testing of topical glaucoma medications in patients with open-angle glaucoma or ocular hypertension, and published between 2002-2022. Included studies were read and assessed on metrics pertinent to SABV including sex reporting and matching, sex-based analysis of medication efficacy, adverse events (AEs), and mention of SABV in the discussion and conclusion.</p><p><strong>Results: </strong>We identified 543 studies; 122/543 (22.5%) met inclusion criteria representing 31 644 subjects; 16 656/31 644 (52.6%) were women. Sex of subjects was reported in 109/122 (89%) studies. However, only 5/122 (4%) mentioned sex in data analysis, including efficacy (1), AEs (1), and mention of sex in the discussion or conclusion (4). We found that studies published after the NIH guidance on SABV in 2016 and studies funded by the NIH were not more likely to include SABV, however only 3 of 122 (2.5%) studies were NIH-funded. Pregnancy or lactation were exclusion criteria for 31/122 (25%) studies.</p><p><strong>Conclusions: </strong>While the majority of glaucoma topical medication clinical trials reported sex and achieved sex-matching, they failed to include sex-based analysis of medication efficacy or AEs. Opportunities remain to include SABV to improve our understanding of the impact of biological sex on glaucoma treatment, although that may require increases in sample size.</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":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756235","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":"Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy in Children with Early-Onset Glaucoma Secondary to Sturge-Weber Syndrome.","authors":"Zeynep Aktas, Yasmine El Sayed, Ahmet Yucel Ucgul, Ghada Gawdat, Hala Elhilali, Fayrouz Aboalazayem","doi":"10.1016/j.ogla.2025.03.009","DOIUrl":"10.1016/j.ogla.2025.03.009","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in managing early-onset glaucoma secondary to Sturge-Weber syndrome (SWS).</p><p><strong>Design: </strong>A retrospective interventional case series.</p><p><strong>Participants: </strong>Medical records of 16 patients (22 eyes) diagnosed with early-onset glaucoma secondary to SWS who underwent GATT surgery were reviewed.</p><p><strong>Methods: </strong>All patients underwent GATT surgery using a 5-0 or 6-0 prolene suture under general anesthesia.</p><p><strong>Main outcome measures: </strong>The primary outcomes were intraocular pressure (IOP) reduction, complete surgical success (IOP ≤ 18 mmHg without medications), qualified surgical success (IOP ≤ 18 mmHg with medications), and postoperative complications.</p><p><strong>Results: </strong>The mean IOP decreased significantly from 25.4 ± 4.8 mmHg at baseline to 15.7 ± 4.2 mmHg at the final follow-up (P < 0.001), representing a 38.19% reduction. The mean age at the time of GATT surgery was 33.6 ± 33.9 months. The mean follow-up duration was 16.3 ± 6.4 months. Complete surgical success was achieved in 45.4% of eyes (10 out of 22), while qualified success was reached in 81.8% of eyes (18 out of 22). Despite the overall success, 18.1% of eyes (4 eyes) required additional surgical interventions during the follow-up period. These included Ahmed glaucoma valve implantation in 1 eye, trabeculectomy in 2 eyes, and transscleral diode laser cyclophotocoagulation in 1 eye. Transient hyphema was the only reported complication, resolving spontaneously within 1 week without further intervention.</p><p><strong>Conclusions: </strong>Gonioscopy-assisted transluminal trabeculotomy appears to be a promising surgical option for managing early-onset glaucoma in patients with SWS, offering significant IOP reduction and a favorable safety profile within the limitations of our study. However, further studies with longer follow-up periods and comparative groups are necessary to confirm these findings.</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":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744518","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 Field of Eyes with Peripapillary Intrachoroidal Cavitation and Its Association with Deep Optic Nerve Head Structural Changes.","authors":"Kaho Akiyama, Shuichiro Aoki, Shiroaki Shirato, Rei Sakata, Megumi Honjo, Makoto Aihara, Hitomi Saito","doi":"10.1016/j.ogla.2025.03.007","DOIUrl":"10.1016/j.ogla.2025.03.007","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the location-specific association of deep optic nerve head (ONH) structures and background characteristics with visual field (VF) sensitivity in eyes with peripapillary intrachoroidal cavitation (PICC).</p><p><strong>Design: </strong>A prospective cross-sectional study.</p><p><strong>Subjects: </strong>One hundred twenty-nine eyes of 93 consecutive cases with PICC determined on fundus photographs and confirmed on OCT.</p><p><strong>Methods: </strong>Peripapillary intrachoroidal cavitation location was determined on ONH-centered OCT radial slices according to Garway-Heath sectors. Visual field defect (VFD) corresponding to the location of the PICC sector was considered absent when the pattern deviation probability plot showed no point with a probability < 1% within the corresponding 24-2 Humphrey VF sector. Sectoral mean total deviation (TD) was calculated for structure-function analysis. The presence of full-thickness retinal defect was determined, and PICC depth and deep ONH parameters were calculated with OCT slices.</p><p><strong>Main outcome measures: </strong>A best-fit multivariable linear mixed model was applied to identify factors associated with sectoral mean TD corresponding to PICC location. Explanatory variables included age, sex, axial length, intraocular pressure, presence of full-thickness retinal defect, circumpapillary retinal nerve fiber layer thickness (cpRNFLT), PICC depth, Bruch membrane opening (BMO) area, scleral flange opening (SFO) area, and SFO/BMO offset magnitude.</p><p><strong>Results: </strong>Among 254 sectors with PICC, 136 sectors (54%) did not present corresponding VFD. Suspected VFD was most frequent in the temporal (34/50, 68%) and inferior temporal (67/104, 64%) sectors. In the best-fit multivariable analysis, worse sectoral TD in the PICC sectors was associated with the presence of full-thickness retinal defect (P = 0.036) and thinner cpRNFLT (P < 0.001) but was not associated with PICC depth or other deep ONH parameters.</p><p><strong>Conclusions: </strong>Although PICC alone did not necessarily cause corresponding VFD, PICC in the temporal sectors should be carefully examined for VFD. Full-thickness retinal defect, a myopia-induced tissue disruption, and cpRNFLT thinning at the PICC location were significantly associated with worse VF, whereas PICC size and other myopia-related deep ONH structural changes were not. Identification of these factors provides a foundation for understanding VF sensitivity reduction in eyes with characteristically highly myopic ONH changes.</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":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733313","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":"Silicone Oil and Glaucoma-Related Adverse Events in Pediatric Vitreoretinal Surgery.","authors":"Meghan Sharma, Laura Huertas, David J Taylor Gonzalez, Roya Garakani, Audina M Berrocal, Ta C Chang","doi":"10.1016/j.ogla.2025.03.006","DOIUrl":"10.1016/j.ogla.2025.03.006","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess the risk of glaucoma-related adverse events (GRAEs) in pediatric patients following silicone oil use in vitreoretinal (VR) surgery, positing that silicone oil exposure increases GRAE risk.</p><p><strong>Design: </strong>A single-center retrospective cohort study at a tertiary care facility.</p><p><strong>Participants: </strong>Pediatric patients aged 0 to 18 years who underwent VR surgery between April 2019 and April 2021 were included. Patients with previously diagnosed glaucoma or who had undergone glaucoma surgery were excluded.</p><p><strong>Methods: </strong>Review of medical records for intraoperative use of silicone oil and postoperative occurrence of GRAE, defined as elevated intraocular pressure (>21 mmHg), initiation of pressure-lowering medications, performance of pressure-lowering surgery, or a diagnosis of childhood glaucoma based on the Childhood Glaucoma Research Network criteria.</p><p><strong>Main outcome measures: </strong>Survival analysis of GRAE between patients exposed vs. not exposed to silicone oil during VR surgery.</p><p><strong>Results: </strong>Of the 186 pediatric patients analyzed, 64 (34.4%) were exposed to silicone oil, and 102 developed GRAE (54.8%). Median survival time to GRAE was 2.0 months (95% confidence interval [CI]: 0.3, 7.7) for silicone oil exposure in patients vs. 25.3 months (95% CI: 3.6, N/A) for patients not exposed to silicone oil (P = 0.0045). Patients exposed to silicone oil had a 52% increased risk of GRAE compared to those not exposed to silicone oil when adjusted for age at VR surgery (hazard ratio: 1.52 [95% CI: 1.01, 2.28], P = 0.0425).</p><p><strong>Conclusions: </strong>In this exploratory study, GRAE was commonly observed following pediatric VR surgery, particularly in patients exposed to silicone oil. These findings underscore the importance of careful glaucoma surveillance following VR surgery in children.</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":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694417","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":"Comparative Study of Early Safety and Effectiveness Outcomes of the PreserFlo MicroShunt with and without an Intraluminal Suture Stent.","authors":"Jason Chami, Jeremy C K Tan, David Manning, George Kong, Jason Cheng, Hamish Dunn, Anna Galanopoulos, Brian Chua, Joanne Thai, Mark Hassall, Jamie E Craig, Mitchell Lawlor","doi":"10.1016/j.ogla.2025.03.003","DOIUrl":"10.1016/j.ogla.2025.03.003","url":null,"abstract":"<p><strong>Objective: </strong>To assess the early safety and effectiveness outcomes of the PreserFlo MicroShunt with and without an intraluminal suture stent.</p><p><strong>Design: </strong>Multicenter observational retrospective study using data from the Fight Glaucoma Blindness registry.</p><p><strong>Participants: </strong>A total of 183 eyes in 172 patients, with a mean age of 73 ± 14 years, who underwent PreserFlo MicroShunt surgery with/without intraluminal stent suture placement, and with at least 6 months of follow-up. Eyes were divided into 2 groups: stent (68 eyes) and no-stent (115 eyes).</p><p><strong>Methods: </strong>Baseline and postoperative measurements of intraocular pressure (IOP), visual acuity (VA), number of glaucoma medications, and adverse events were recorded at 1, 3, and 6 months. Outcomes were compared between stent and no-stent groups using t tests for continuous variables and Fisher exact tests for categorical variables.</p><p><strong>Main outcome measures: </strong>The primary outcome measures were the incidence of numerical hypotony (IOP ≤ 5 mmHg) and symptomatic hypotony (numerical hypotony plus ≥10 letters of VA loss) within 1 month, 1 to 3 months, and 3 to 6 months postoperatively. Secondary outcome measures included surgical success rates (defined as IOP ≤12, ≤15, ≤18, or ≤21 mmHg and ≥20% IOP reduction without hypotony and without additional glaucoma medications) and the need for secondary surgical interventions.</p><p><strong>Results: </strong>In the first postoperative month, the stent group had significantly lower rates of numerical hypotony (24% vs. 44%; P = 0.007) and symptomatic hypotony (13% vs. 28%; P = 0.027) than the no-stent group. The rate of device revision, explant, or replacement with an alternative shunt was also significantly lower in the stent group (3 eyes; 4.4%) than in the no-stent group (17 eyes; 14.8%; P = 0.047). No significant differences in hypotony rates were observed in the later follow-up windows (1-3 and 3-6 months), nor were there significant differences in surgical success rates between the stent and no-stent groups at any time point.</p><p><strong>Conclusions: </strong>The use of an intraluminal suture stent in PreserFlo MicroShunt surgery reduces the incidence of early hypotony without compromising surgical success. These findings suggest that routine use of intraluminal sutures may improve early postoperative safety.</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":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639876","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}