Malarial retinopathy refers to a constellation of changes seen in severe or complicated malaria cases. These include: retinal whitening, vessel changes-whitening, tramlining, retinal hemorrhages, and papilledema. There are very few Indian studies on this entity. Since retina can be easily visualized by direct ophthalmoscopy, this study was done to determine prevalence of malarial retinopathy among malaria cases and to determine relationship between malarial retinopathy and severity of the disease. The study was done at Indoor and Outdoor Departments of Tropical Medicine, School of Tropical Medicine (STM), Kolkata, with the support of the Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Medical College, Kolkata. Adult malaria cases, both complicated/severe and uncomplicated, were included. Patients unable or unwilling to cooperate with eye examination, contraindications to tropicamide eye drops (angle closure glaucoma or known allergy to product), severe corneal scarring or cataracts hindering view by ophthalmoscopy, diabetes mellitus, hypertension, intracranial space occupying lesions, epilepsy, alcohol use, chronic renal failure, age > 60 years and any other known ocular/systemic disease that can cause retinopathy changes were excluded. Severe malaria was diagnosed as per the WHO criteria. Cases with acute febrile illness of other causes were taken in control arm, and normal population subjects were taken as controls. All patients were assessed clinically, followed by appropriate laboratory investigations and then direct ophthalmoscopic examination was done. Ocular findings were be collaborated with severity of illness. A total of 71 malaria cases were included in our study. Among them, 12 cases were of severe malaria, and rest of the cases were uncomplicated. Of the 12 severe malaria cases, 8 were Plasmodium vivax, 3 were Plasmodium falciparum, and 1 was mixed. Uncomplicated malaria cases were mostly P. vivax (35 out of 59). Features suggestive of malarial retinopathy were noted in 9 out of 12 cases of severe malaria (75%) and 2 out of 59 cases of uncomplicated malaria (3.4%). We noted two cases of retinal changes-one case of retinal whitening in falciparum malaria and one case of vivax malaria with retinal hemorrhage in the uncomplicated group. Both of the cases subsequently needed admission for recurrent vomiting, reduced urine output, and severe weakness 40 dengue cases were included in control arm of AFI cases-20 DHF cases and 20 cases of DF with warning signs. Among them, retinal hemorrhage was noted in one case of DHF (2.5%). Out of 40 sepsis cases, retinal hemorrhage was seen in one case (2.5%). No retinal changes were noted among 40 other AFI cases which included scrub typhus, enteric fever, chikungunya, and acute viral hepatitis. Also, no abnormality was detected on ophthalmoscopy in 40 healthy individuals. The presence of retinopathy was suggestive of severe malaria (p < 0.05). We found the sensitivity and specificity of malarial retinopathy as a marker of severe malaria to be 75% and 96.6% with a positive predictive value of 81.8%. Malarial retinopathy may serve as an important clinical biomarker for predicting severe malaria. All clinicians should be appropriately trained in performing direct ophthalmoscopy to detect the retinopathy changes.
Medication nonadherence contributes to vision loss from glaucoma, a leading cause of irreversible blindness in the US. Intervention to improve adherence can benefit health outcomes and quality of life, while reducing health system and public health burden. To compare the Support, Educate, Empower (SEE) intervention with standard written education on glaucoma medication adherence. The SEE study was a parallel, nonmasked, 1:1 randomized clinical trial testing intervention superiority. Participants were recruited from the University of Michigan (UM) and Henry Ford Health System (HFHS) between April 27, 2021, and December 18, 2023. Adults with glaucoma taking 1 or more ocular hypotensive eye drop medications who self-reported adherence of 85% or lower were eligible. The SEE intervention is a 6-month motivational interviewing-based glaucoma health coaching program administered by a nonphysician counselor, including 3 in-person sessions, 4 between-visit phone calls, personalized multimedia glaucoma education, and automated medication reminders. The control consisted of usual care and 3 mailings of standard written glaucoma education. Medication adherence (primary outcome) was electronically monitored (AdhereTech) and calculated as the percentage of doses taken on time divided by those prescribed over the 6-month study period. Change in glaucoma-related distress (secondary outcome) was also investigated. Of 236 participants enrolled (108 in UM and 128 in HFHS), 235 (mean [SD] age, 67.3 [10.9] years; 124 [53%] female) were randomized to the SEE intervention (n = 117) or control (n = 118). Participant characteristics were balanced between groups. Mean (SD) self-reported adherence was 63.9% (17.9%). Medication adherence was significantly better in the SEE intervention group compared with that among control participants (mean [SD], 77.6% [19.7%]; n = 113 vs 58.0% [25.2%]; n = 114; difference, 19.7%; 95% CI, 13.7 to 25.6; P < .001), and more achieved 80% or greater adherence (62 of 113 [54.9%] vs 27 of 114 [23.7%]; P < .001). The difference in change in glaucoma-related distress between intervention and control was -0.3 (95% CI, -0.5 to -0.1) after adjusting for baseline distress. The SEE glaucoma coaching program improved glaucoma medication adherence and reduced glaucoma-related distress compared with standard written education. The SEE program represents an evidence-based method to improve medication adherence necessary to improve glaucoma outcomes. ClinicalTrials.gov Identifier: NCT04735653.
Binocular visual field (VF) loss affects vision-related quality of life (VR-QoL) but the relationship between specific VF loss patterns and difficulties with specific tasks remains poorly understood. Archetypal analysis offers a promising method to elucidate spatial patterns of VF loss. In this study, we aimed to develop archetypes for binocular VF loss and assess their relationship with VR-QoL. We included 7305 pairs of reliable standard automated perimetry (24-2 SITA fast and standard) test results of patients from 5 glaucoma clinics in England from a Healthcare Quality Improvement Partnership-funded audit. We executed an archetypal analysis on the corresponding integrated VFs (estimates of the binocular VFs from pairs of monocular VFs) to identify the best-fitting set of archetypes from our dataset. Then, we used these archetypes to deconstruct the binocular VF of 269 patients with glaucoma from the Netherlands that had completed 4 different VR-QoL questionnaires. Finally, relationships between each of the archetypes and different aspects of VR-QoL were analyzed. The archetypal analysis demonstrated that a solution comprising 12 archetypes provides the best-fitting model. Our analysis of the 269 patients' with glaucoma data showed various significant and plausible relationships between the different archetypes and various aspects of VR-QoL. Our results demonstrate how archetypes can elucidate relationships between the location of a VF defect and different aspects of VR-QoL in glaucoma. This may help clinicians and patients better understand the impact of different types of VF defects.
Glaucoma is one of the leading causes of irreversible blindness and is characterised by progressive loss of retinal ganglion cells. While therapies to lower intraocular pressure slow the progression of the disease in most patients, a significant subset still shows progression despite treatment. Transcorneal electrical stimulation (TES) may potentially activate neuroprotective pathways and slow the progression of visual field defects. The OkuStim 2 System is a medical device for TES which was originally developed for the treatment of retinitis pigmentosa and similar retinal dystrophies and shall now be tested for the treatment of glaucoma. Stimulation of the diseased retina with weak currents can activate signalling pathways and the release of substances that have a protective effect on the retinal cells. This neuroprotective effect might preserve physiological functions of the retina for longer and slow down its gradual degeneration. Long-term use is required to maintain this effect. The TES-GPS study is investigating the safety and efficacy of TES in open-angle glaucoma. TES-GPS (short title for glaucoma pilot study) is a prospective, randomised, double-blind, sham-controlled, single-centre pilot study at the University Medical Center Mainz. 50 patients with progressive visual field loss due to open-angle glaucoma will be randomised 1:1 to receive either TES with the OkuStim 2 System or sham stimulation. The primary endpoint is the change in visual field sensitivity (Humphrey mean deviation) after 18 months. Secondary endpoints include changes in visual acuity, intraocular pressure, optical coherence tomography (OCT) parameters and quality of life (National Eye Institute Visual Function Questionnaire 25, NEI-VFQ 25). The intervention consists of weekly 30 min TES sessions, which are conducted in the patient's home after initial training in the clinic. The study comprises up to 13 scheduled visits over 18 months. The study is conducted in accordance with ISO14155, Medical Device Regulation (EU) 2017/745, International Council for Harmonisation Good Clinical Practice and the Declaration of Helsinki. Approval was obtained from the Ethics Committee of the Landesaerztekammer Rheinland-Pfalz in Mainz and from Bundesinstitut fuer Arzneimittel und Medizinprodukte. Results will be published in peer-reviewed journals and presented at scientific conferences. NCT06682962.
A minority (13 of 91) of patient-reported outcome measures for adult glaucoma meet rigorous quality standards for development. Others, despite limited evidence describing development, have been validated in glaucoma populations and should be used judiciously. To identify, characterize and assess the quality of existing patient-reported outcome measures (PROMs) relevant to adult glaucoma patients, focusing on development and validation. We searched multiple databases for studies reporting development, validation, adaptation, or extension of vision-related PROMs in adults with glaucoma. Eligible reports were grouped by instrument for assessment using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias checklist's "Standards for evaluating the quality of PROM development." Among 91 instruments represented by 140 reports, 57 were developed for use in glaucoma patients; the remainder were validated in glaucoma patients. The instruments vary in length and complexity and evaluate domains within several constructs: vision-related QoL, health-related QoL, glaucoma knowledge, disease symptoms, vision-related activity limitation, treatment preferences, treatment side effects, patient satisfaction, and psychological status. According to COSMIN criteria, "adequate" development was documented for just 17 of 91 instruments, with descriptions of constructs, population(s) and context(s) for use, and published studies in the target population. Among these 17, concept elicitation was described for 13, of which 7 were developed since 2021. Thirteen instruments stand out in rigorous quality analysis based on the COSMIN Risk of Bias checklist. Other instruments without evidence of sound development have nevertheless been rigorously validated. PROMs we commonly use should be understood in the context of what they were designed to do, what they do well, their efficiency and limitations. It behooves us to follow and document best practices for developing and validating novel instruments.
To perform a bibliometric analysis of publications focusing on inflammatory mechanisms in glaucoma, thereby comprehensively understanding the current research status and identifying potential frontier directions for future studies. A systematic search was conducted in the Web of Science Core Collection (WoSCC) database to retrieve relevant literature published from January 1, 2000, to August 31, 2025 (data accessed on September 12, 2025). Multiple data visualization tools were employed to conduct in-depth analyses of the included publications, covering aspects such as publication quantity and quality, evolutionary trends of research hotspots, keyword co-occurrence networks, and collaborative patterns among countries/regions, institutions, and authors. A total of 3381 articles related to glaucoma inflammation were extracted from WoSCC. The analysis showed that the USA had the highest research output in this field (29.04%, n=982), followed by China (18.40%, n=622) and UK (6.01%, n=203). Based on citation frequency and burst intensity, the USA also ranked as the most influential country. Baudouin C and Sun X were identified as the most productive authors, while Journal of Glaucoma and Investigative Ophthalmology & Visual Science were the journals with the highest number of published relevant articles. Additionally, keyword analysis revealed that "neuroinflammation", "retinal ganglion cells (RGCs)", "pathophysiology", and "traditional Chinese medicine" are emerging research hotspots in the field of immune-inflammatory responses in glaucoma. This study presents a comprehensive bibliometric overview of research on glaucoma-related inflammation, indicating that this field has received extensive scientific attention with a steady upward trend in research activity. Furthermore, it establishes a theoretical basis for the development of neuroinflammation-targeted therapeutic strategies for glaucoma and emphasizes the necessity of strengthening interdisciplinary collaboration to promote the clinical translation of research findings.
To investigate the association between care continuity and the risk of glaucoma surgery in patients newly diagnosed with primary open angle glaucoma (POAG). This nationwide cohort study utilized data from the Korean National Health Insurance Service-Senior Cohort (2002-2019) on patients who were newly diagnosed with POAG between 2004 and 2016 and had at least four ambulatory clinic visits for POAG within 2 years after diagnosis. Based on their continuity of care indices, we categorized participants into high and low care continuity groups. We utilized the Kaplan-Meier method to determine the cumulative incidence of glaucoma surgery, excluding laser treatments, and applied Poisson regression to estimate incidence rates. We employed a Cox proportional hazards regression model to assess the relationship between care continuity and the risk of glaucoma surgery in patients with POAG. Among the 12,713 newly diagnosed patients with POAG, 6,769 (53.1%) were female, with a mean (standard deviation) age of 66.58 (8.24) years. The cumulative incidence of glaucoma surgery was significantly higher in patients with low care continuity (P < .001). Similarly, the incidence rate of glaucoma surgery was higher in these patients (adjusted hazard ratio, 1.64; 95% confidence interval, 1.31 to 2.06, P < .001). This increased risk was particularly pronounced in female patients, patients aged ≥70 years, and those with lower comorbidities. Low care continuity is associated with increased risk of glaucoma surgery in patients with POAG. Therefore, interventions aimed at improving care continuity in patients with POAG should be considered to improve glaucoma treatment outcomes. Low care continuity increases the risk of glaucoma surgery in primary open-angle glaucoma patients, especially in females and older adults. Enhancing care continuity may improve treatment outcomes.
In a hybrid telemedicine model consisting of alternating in-person and telemedicine visits, ∼95% of telemedicine visits for glaucoma had findings and assessments consistent with in-person visits, suggesting this model's effectiveness in monitoring glaucoma. A hybrid model of teleophthalmology involves an in-person visit for imaging with a technician, followed by a telemedicine visit with an ophthalmologist. At our institution, we alternate in-person visits with hybrid telemedicine visits. The purpose of this study is to evaluate the sensitivity and specificity of this novel telemedicine platform for identifying findings that can lead to management changes for glaucoma. The medical records of patients seen by a telemedicine-using ophthalmologist at a tertiary eye center for a glaucoma-related condition from September 2023 to October 2024 were reviewed. The main outcome measures were cup-disc ratio, retinal nerve fiber layer thinning, visual field defects, and changes in findings or management between in-person and telemedicine visits. Sensitivity and specificity were calculated, and paired t tests and χ 2 testing were also used. A total of 102 patients (mean age 65 y; 63% female) underwent 162 hybrid telemedicine visits for glaucoma-related concerns. The most common diagnoses were glaucoma suspect (36%) and moderate stage glaucoma (26%). Using a χ 2 test, telemedicine visits demonstrated significantly greater consistency in findings and assessments with in-person visits than would be expected by chance ( P <0.001). The sensitivity of telemedicine in detecting worsening clinical findings was 75%, and the specificity was 100%. Approximately 95% of telemedicine visits had findings and assessments consistent with both preceding and subsequent in-person visits, indicating the effectiveness of a hybrid telemedicine model for monitoring and managing glaucoma progression.
Glaucoma is the leading cause of irreversible blindness in the world. There are limited qualitative study focusing on patients' experience of glaucoma. The aim of the study was to explore the lived experiences of patients living with glaucoma. A qualitative study was conducted involving eight patients from January 2024 to June 2024 at glaucoma department of an eye hospital after approval from the institutional review committee (Reference number: BEH-IRC/093/024), using in-depth interview. Semi-structured interviews were carried out with selected participants until data saturation was achieved. The interviews were audiorecorded, transcribed verbatim, and analyzed using thematic analysis. Patients receiving glaucoma treatment for more than five years and willing to participate were included in the study. Out of the eight participants, seven were male with mean age of 43.12±12.86 years. Based on the interviews, seven main themes were identified. These include experiences and ideas about the moment they first noticed the condition, their emotional response after being diagnosed, a sense of relief after receiving accurate information, how they manage the disease, their sources of information, changes in their work life, and the involvement of family members in attending regular glaucoma checkups. This study explored the experiences of patients living with glaucoma. Findings showed that the patients with early diagnosis, proper education with counseling, proper treatment and regular follow up preserved their visual function.
In this meta-analysis of 1,083 eyes with UG, GDDs achieved the overall surgical success rate of 65.40%, with AGVs demonstrating the greatest IOP reduction and BGIs requiring fewer postoperative medications. This study aimed to compare the effectiveness and complication profiles of different types of glaucoma drainage devices (GDDs) in patients with uveitic glaucoma (UG). A comprehensive literature search across PubMed, Web of Science, Cochrane Library, and Embase identified relevant GDD implantation studies in UG through October 12,2025. Literature screening, data extraction, and quality assessment were implemented using EndNote, followed by meta-analyses via "meta" package in R software (version 4.3.0). Thirty-eight studies (1,083 eyes) were analyzed. The meta-analysis indicated a remarkable drop in intraocular pressure (IOP) across all GDDs types postoperatively. Among these, the Ahmed glaucoma valves (AGVs) presented the greatest IOP reduction than other devices [MD=-28.87, 95% CI: (-38.38, -19.36)]. Postoperative use of topical IOP-lowering medications declined universally across all devices, with the Baerveldt Glaucoma Implants (BGIs) again showing the most pronounced reduction [MD=-5.28, 95% CI (-8.40, -2.15)]. In the comparative analysis between AGVs and BGIs, the BGIs group required fewer postoperative IOP-lowering medications than the AGVs group. The overall surgical success rate post-GDD implantation was 65.40% (95% CI: 54.90%-74.60%), with complete success and qualified success rates of 36.40% (95%CI:25.40%-49.00%) and 40.30% (95%CI:25.60%-56.90%). Postoperative complications included elevated IOP in 22.70% and hypotony in 18.40% of AGV-implanted eyes. Ahmed, Baerveldt, Molteno and PAUL® Glaucoma Implant are effective surgical options for UG management. However, current evidence remains scarce for novel devices, and the differences in efficacy and complication profiles among devices warrant consideration in individualized treatment planning.
Glaucoma is a leading cause of irreversible blindness worldwide, with profound physical and psychosocial effects. In Ethiopia, limited access to specialized eye care, delayed diagnosis, and low awareness exacerbate its impact on patients' quality of life. This review aimed to synthesize existing evidence on the prevalence and determinants of poor QoL among glaucoma patients in Ethiopia. Following the PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Scopus, Web of Science, CINAHL, and Google Scholar up to March 2025 (PROSPERO: CRD420251018342). Eligible studies assessed QoL among adult glaucoma patients in Ethiopia using standardized instruments. Methodological quality was appraised using the Joanna Briggs Institute checklist, and a random-effects model was applied to estimate pooled prevalence. Heterogeneity was evaluated with I2 statistics, and certainty of evidence was assessed using the GRADE framework. Four hospital-based studies met the inclusion criteria. Three NEI-VFQ-25 studies were meta-analyzed, yielding a pooled prevalence of 47% (95% CI: 44-50; I2 = 19.6%). One additional WHOQOL-BREF study, which was not pooled because of tool heterogeneity, reported a comparable prevalence of 46.3%. Factors consistently associated with poorer QoL included older age, rural residence, low education, economic hardship, limited healthcare access, disease severity, and psychological distress. Nearly half of Ethiopian glaucoma patients experience impaired QoL. The certainty of this evidence is low to very low due to cross-sectional study designs and limited representativeness. Strengthening early detection, equitable access to eye care, patient education, and psychosocial support is essential, while community-based longitudinal studies are needed to generate higher-quality evidence.
Systematic meta-analysis demonstrates greater IOP reduction, fewer glaucoma medication use and higher surgical success rate with 360-degree trabeculotomy compared to traditional angle surgery in primary congenital glaucoma. Primary congenital glaucoma (PCG) is a rare vision threatening disorder, which can lead to blindness if untreated. The aim of the study is to compare the effectiveness of traditional angle surgery (goniotomy and rigid probe trabeculotomy) versus 360° trabeculotomy in children with PCG. A comprehensive search was conducted across PubMed, EMBASE, Scopus, Cochrane (CENTRAL), Science Direct and Clinicaltrials.gov. A total of 1740 studies were obtained from databases, and 12 studies, 3 RCTs and 9 Retrospective studies met the inclusion criteria. Mean Differences (MD) for continuous outcomes and Odds Ratios (OR) for dichotomous outcomes were analyzed. The primary outcomes were the reduction in intraocular pressure (IOP) and numbers of anti-glaucoma medications at 12 months postoperatively. Pooled analysis of 778 eyes demonstrated that 360° trabeculotomy showed significant reduction in IOP and number of anti-glaucoma medications compared to traditional angle surgery by -2.10 mmHg (-3.26,-0.94; P=0.0004, I²=55%) and -0.47 drops (-0.69, -0.25; P<0.0001, I²=55%), respectively. Compared to traditional angle surgery group, the 360° trabeculotomy group showed higher complete and qualified success rates with OR of 5.07 (3.43-7.50; P<0.0001, I²=4%) and 3.00 (1.47-6.12; P=0.003, I²=46%) respectively, and as well as, reduction in failure rate with OR of 0.18 (0.11-0.31; P<0.0001, I²=14%). No statistically significant differences were observed for post-operative axial length, change in cup/disc ratio, change in horizontal corneal diameter. 360° trabeculotomy showed greater reduction in IOP and number of anti-glaucoma medications postoperatively than traditional angle surgery with improved success and reduced failure rates.
The impact of glaucoma-suspect or glaucoma diagnoses on quality of life (QOL) outcomes in children with noninfectious uveitis (NIU) has not been well characterized. This study evaluated the impact of glaucoma-related diagnoses on vision-related QOL (VRQOL) and vision-related functioning (VRF) using the Effects of Youngsters' Eyesight on QOL (EYE-Q), overall QOL (Pediatric QOL Inventory: PedsQL), and anxiety and depression (Revised Children's Anxiety and Depression: RCAD). Children with chronic, NIU were categorized as no glaucoma (Gla-) and glaucoma-suspect or glaucoma (Gla+) for QOL analysis. Demographic and clinical data were collected. Patients and parents/proxies completed the EYE-Q, PedsQL, and RCADS. Statistical analyses were performed, with significance defined at P <0.05. Seventy-six children (mean age, 10.7 ± 4.6 years; 71% female) were included, 36 (47%) with glaucoma-related diagnoses (Gla+). Most had bilateral (82%), anterior (91%) NIU and were associated with juvenile idiopathic arthritis (JIA) (67%). Children with JIA were less likely to develop Gla+. Affected eyes with glaucoma had more complications at NIU diagnosis (P = 0.003), including synechiae (P <0.001) and cataracts (P < 0.001), compared with the Gla- group. While Gla+ children had lower QOL scores than Gla- children, these differences were not statistically significant. However, parents of Gla+ children reported poorer VRF (P = 0.017), lower total EYE-Q scores (P = 0.013), and higher RCADS scores (P = 0.041), which persisted over time. Non-JIA uveitis and eyes with complications at uveitis presentation are more likely to develop glaucoma-related diagnoses. Parents/proxies of children with Gla+ reported lower QOL scores in both eye-specific and psychosocial functioning, highlighting the need for behavioral health interventions.
Micropulse transscleral cyclophotocoagulation (MP-TSCPC) has gained considerable acceptance as a preferred cyclodestructive intervention for refractory glaucoma, offering significantly enhanced safety profiles through precisely controlled pulse energy delivery while maintaining equivalent therapeutic outcomes compared with traditional modalities. To compare the efficacy and safety profiles of MP-TSCPC versus continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in patients with refractory glaucoma. This prospective, randomized, single-blind study included 52 patients (52 eyes) with refractory glaucoma assigned to either MP-TSCPC or CW-TSCPC. Patients were followed for 18 months. Secondary outcomes included absolute IOP values, medication reduction, preservation of visual acuity, visual function parameters, quality of life, and complication rates. Success was defined as IOP between 6-21 mm Hg without medications (complete success), with medications (qualified success), or either (cumulative success). Patients were followed for 18 months. At 18 months, 47 eyes completed follow-up (24 in MP-TSCPC and 23 in CW-TSCPC). The MP-TSCPC group (n=24) achieved a 34.43% IOP reduction from baseline, compared with 42.86% in the CW-TSCPC group (n=23), P=0.052. Complete success rates were 25.00% (6/24) for MP-TSCPC and 21.74% (5/23) for CW-TSCPC (P=0.999), while qualified success rates were 29.16% (7/24) and 39.13% (9/23), respectively (P=0.550). The cumulative success rates were 54.17% for MP-TSCPC and 60.87% for CW-TSCPC (P=0.706). The CW-TSCPC group experienced significantly higher rates of postoperative pain (56.52% vs. 20.83%, P=0.012) and prolonged inflammation (34.78% vs. 8.33%, P=0.039). Visual function parameters remained stable in both groups throughout the study period. Quality of life improved significantly in the MP-TSCPC group but not in the CW-TSCPC group, although between-group differences were not statistically significant. MP-TSCPC demonstrated comparable efficacy to CW-TSCPC in IOP reduction and success rates for refractory glaucoma management, while offering a significantly improved safety profile with less postoperative pain and inflammation. These findings suggest that MP-TSCPC may be considered as a preferred initial cyclodestructive option when balancing efficacy and safety, though larger studies are needed to confirm these findings.
PreserFlo® MicroShunt implantation alone may be well tolerated for the corneal endothelium across glaucoma subtypes over 12 months, whereas combination with cataract extraction may increase the risk of endothelial compromise, with a tendency toward a more pronounced reduction in pseudoexfoliation glaucoma. To evaluate the impact of PreserFlo® MicroShunt (PMS) implantation on corneal endothelial cell density (ECD) over 12 months, stratified by glaucoma subtype and surgical procedure. This retrospective cohort study included 103 eyes with primary open-angle glaucoma, pseudoexfoliation glaucoma (PEXG), and secondary open-angle glaucoma without PEXG, all undergoing PMS implantation (either alone or combined with cataract extraction [PMS-CE]) between August 2022 and December 2023. Changes in ECD, coefficient of variation (CV), and hexagonal cell percentage (HEX) were assessed. Firth logistic regression was employed to evaluate risk factors for >10% ECD loss. Subgroup analyses were performed by surgical procedure. No significant within-group ECD, CV, or HEX changes were observed at 12 months in any glaucoma subtype. Thirteen eyes (12.6%) exhibited >10% ECD loss, predominantly in the PMS-CE group. Multivariate analysis identified PMS-CE as a significant risk factor (odds ratio [OR]: 12.1; 95% confidence interval [CI]: 2.69-75.0; P <0.001). In the PMS-CE subgroup, PEXG was associated with greater risk of ECD loss (OR: 9.39; CI: 1.19-125.0; P=0.033). PMS-alone demonstrated a favorable safety profile for the corneal endothelium across glaucoma subtypes. However, PMS-CE may pose an elevated risk of endothelial compromise, with a tendency toward a more pronounced reduction in PEXG eyes.
While a few studies have reported on single nucleotide polymorphisms associated with glaucoma in the Korean population, comprehensive data on genotype-phenotype correlations across multiple candidate genes are lacking. This study aimed to investigate the associations of variants in 10 candidate genes (CDKN2B, SIX1, SIX6, SCYL1, CHEK2, ATOH7, DCLK1, RERE, CDC7, and CARD10) with primary open-angle glaucoma (POAG) susceptibility and structural phenotypic features. We employed a 2-stage study design consisting of a discovery phase (targeted sequencing of 100 subjects) and a confirmation phase (genotyping of 24 selected variants in a total cohort of 382 subjects: 160 POAG cases and 222 controls). Associations with POAG risk and structural parameters, including vertical cup-to-disc ratio and retinal nerve fiber layer thickness (RNFLT), were analyzed using multivariable logistic regression and analysis of variance. The Benjamini-Hochberg false discovery rate method was applied to account for multiple testing. Regarding POAG susceptibility, 3 variants in DCLK1, SIX6, and SCYL1 showed nominal significance in the initial analysis but did not withstand false discovery rate correction. However, regarding phenotypic traits, rs33912345 in SIX6 demonstrated robust significant associations with both increased vertical cup-to-disc ratio and reduced average, superior, temporal and inferior RNFLT. Additionally, rs748189671 in RERE was significantly associated with temporal RNFLT. In detailed clock-hour analysis, variants in DCLK1 and SIX1 also showed significant correlations with 3 o'clock sector of RNFLT. Our findings identify DCLK1, SIX1, SIX6 and RERE as key genetic factors influencing optic nerve morphology and RNFLT in the Korean population. These results suggest that these genes may primarily modulate the structural vulnerability of the optic nerve, highlighting their potential utility for phenotypic profiling of glaucoma in the Korean population. However, these results are exploratory, and further large-scale studies are warranted to validate these associations and elucidate their clinical implications in glaucoma genetics.
This matched-cohort study compares the original and Shoji editions of the Tanito microhook trabeculotomy (TMH), a reusable, FDA-cleared MIGS device, when combined with cataract surgery. Both designs demonstrated similar 2-year surgical success and safety profiles. While the Shoji edition incorporates ergonomic refinements, no significant differences in clinical outcomes were observed, supporting the continued use of either version in routine glaucoma care. To compare the clinical efficacy and safety of the Shoji edition of the Tanito microhook trabeculotomy (TMH Shoji edition) with the original version, both performed in combination with phacoemulsification and intraocular lens implantation, in patients with open angle glaucoma. A retrospective matched-cohort study including 518 eyes (original: 259, Shoji: 259) was conducted. Groups were matched on age, sex, glaucoma type, baseline IOP, visual field mean deviation, and number of medications. The primary outcome was surgical success over 2 years, followed by the American Academy of Ophthalmology's recommended criteria for MIGS combined with cataract surgery: ≥1 medication reduction without IOP increase, or ≥20% IOP reduction to ≤21 mm Hg without additional surgery, loss of light perception vision, or hypotony. IOP, number of medications, and postoperative complications were also recorded. Statistical analyses included Fisher exact tests and Kaplan-Meier survival with log-rank testing. At 12 months, surgical success was achieved in 46.4% of the original group and 50.1% of the Shoji group; at 24 months, the rates were 32.0% and 44.2%, respectively. Kaplan-Meier estimates showed no significant difference between groups (log-rank P = 1.000). Both groups achieved reductions from baseline in mean IOP and number of glaucoma medications at all time points. Postoperative complications were infrequent and comparable between groups. Both versions of TMH trabeculotomy combined with cataract surgery demonstrated acceptable mid-term surgical success and safety profiles. The Shoji edition, designed to improve access and usability, may offer advantages in certain surgical settings.
To examine if clusters of colocated damaged locations repeatedly found during prior SITA-Standard (SS) visual field tests are not replicated in a subsequent SITA-Faster (SFR) test. Visual field series from the Lions Eye Institute, Perth, Australia were extracted if they had at least 4 SS fields followed by a SFR field and all fields had false positive rates and fixation losses less than 15%. Clusters of damaged locations were defined as either an isolated location with no damaged neighbors or a group of connected 24-2 points (not crossing the horizontal) that all had Pattern Deviation (PD) probability values below 1% of normal in all 3 SS tests immediately preceding the SFR test. For each cluster, the number of locations that were damaged in the SFR field that overlapped the established and repeatable SS clusters was computed and reported. We compare this proportion of overlap against the same calculations using the last SS as the final field. We also examine the effect of relaxing the PD criteria for damage in the final field on the proportion of overlap. 2519 eyes were included. For established, repeatable, and clusters of size 1, 2, 3, and 4 locations, the follow-up SFR field completely missed 46%, 26%, 11%, and 14% of the clusters whereas SS missed significantly less 26%, 11%, 4% and 1% (t-test with mixed paired and unpaired observations and p < 0.05). Relaxing the criteria for damage in the final field to PD < 5% reduced the miss rates for both methods, but SFR was still significantly worse than SS (SFR: 24%, 8%, 3%, and 6% vs. SS: 13%, 3%, 1%, and 1%). SITA-Faster tends to miss established clusters of damaged locations of size 4 or fewer locations in follow up visits at a higher rate than SITA-Standard.
In this meta-analysis of 10 randomized controlled trials involving 1,880 eyes, preservative-free latanoprost (PFL) demonstrated comparable intraocular pressure-lowering efficacy to preserved latanoprost (PL), but with significantly lower risk of ocular surface hyperemia, supporting its use in patients with sensitivity to preservatives. To review the efficacy and safety of preservative-free latanoprost (PFL) versus preserved latanoprost (PL) for glaucoma and ocular hypertension. The protocol was registered in PROSPERO (CRD420251027099) and performed the literature search on PubMed, Scopus, CENTRAL, ScienceDirect, and Google Scholar in March 2025 to find eligible randomized controlled trials (RCTs). Outcomes of interest include IOP reduction and ocular adverse events (OAEs). Risk of bias was evaluated using Cochrane RoB 2.0. The meta-analyses were executed in Rstudio. The search yielded 591 records, of which 10 studies involving 1,880 patients from the USA, India, South Korea, and various European countries were included in this study. Meta-analyses showed a significantly greater mean IOP reduction with PL compared to PFL at 2 weeks (MD=0.43 mmHg, 95% CI: 0.05-0.81), with no significant difference at 4, 6, and 12 weeks (MD=0.03 mmHg, 95% CI: -0.31-0.37; MD=0.14 mmHg, 95% CI: -0.20-0.48; and MD=0.22 mmHg, 95% CI: -0.15-0.59, respectively). In terms of safety, PFL was associated with a significantly lower risk of ocular surface hyperemia (RR=0.66, 95% CI: 0.51-0.85) and and a lower-though not statistically significant-risk of overall OAEs (RR=0.81, 95% CI 0.66-1.00). GRADE assessment constitute to low to moderate certainty of evidence. PFL have comparable IOP-lowering efficacy compared to PL, with superior ocular tolerability. These findings support the use of PFL as a suitable alternative to PL, particularly in patients sensitive to preservatives.
Slow coagulation transscleral cyclophotocoagulation showed useful intraocular pressure control in Korean patients with medically uncontrolled glaucoma. This study aimed to evaluate the treatment outcomes of slow coagulation transscleral cyclophotocoagulation (SC-CPC) in Korean patients with medically uncontrolled glaucoma. Medical records of 95 eyes from 95 patients who underwent SC-CPC to control intraocular pressure (IOP) were reviewed. Success was defined as an IOP of 6-21 mmHg with a ≥20% reduction from baseline, and no additional incisional surgery for glaucoma. Visual acuity presented as logarithm of the minimum angle of resolution (logMAR), the number of glaucoma medications, corneal endothelial cell count, and complications were analyzed. At 12 months postoperatively, mean IOP decreased from 32.7±13.8 mmHg to 16.2±9.4 mmHg (P<0.001) and the mean number of medications decreased from 2.6±0.9 to 2.0±1.0 (P<0.001). Mean visual acuity declined from 0.69±0.94 to 0.80±0.99 logMAR (P=0.015). No significant changes were found in corneal endothelial cell counts at any postoperative visits (P>0.05). Eighteen eyes (18.9%) underwent repeated SC-CPC treatments. The most common complication was transient hypotony (4.2%), followed by macular edema (3.2%), prolonged hypotony (1.1%), and corneal decompensation (1.1%). The 12-month success rate was 57.1%. SC-CPC is a useful method for IOP control in Korean patients with medically uncontrolled glaucoma.