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Clinical Advances in Glaucoma: Current Status and Prospects
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Clinical Advances in Glaucoma: Current Status and Prospects

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 24 January 2026 | Viewed by 2762

Special Issue Editors

Dr. Rubén Sánchez-Jean

E-Mail Website
Guest Editor
Hospital Clinico San Carlos, Madrid, Spain
Interests: ophthalmology; glaucoma surgery; new devices in glaucoma treatment; quality of life in glaucoma patients; cataract surgery; IOLs designs
Dr. Carmen Dora Méndez-Hernández

E-Mail Website
Guest Editor
Hospital Clinico San Carlos, Madrid, Spain
Interests: glaucoma surgery; new devices in glaucoma treatment; childhood glaucoma; intraocular pressure; retinal nerve fiber layer; retinal ganglion cell; visual field; optical coherence tomography; angiography; retinography; filtering surgery; minimally invasive glaucoma surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Federico Sáenz-Francés San Baldomero

E-Mail Website
Guest Editor
Hospital Clínico San Carlos de Madriddisabled, Madrid, Spain
Interests: glaucoma; cataract surgery; eye diseases; phacoemulsification; statistics; biostatistics; clinical research; clinical ophthalmology; ophthalmology; epidemiology

Special Issue Information

Dear Colleagues,

Glaucoma currently encompasses a group of chronic and progressive diseases with no single and definitive treatment. The use of hypotensive eye drops entails a series of limitations, such as difficulty in patient compliance, lack of response in some patients, decreased hypotensive efficacy over time, and prolonged use leading to alterations in the ocular surface. Another treatment option is laser, but its hypotensive effect is of limited duration, and it is not free of complications. Filtering surgery is usually the most effective procedure for reducing intraocular pressure, but it is relatively frequently associated with the presence of complications such as hypotony, blebitis, endophthalmitis, transient loss of visual acuity, etc.

In recent years, surgical techniques have been sought that are effective in the long term with a lower incidence of complications and that are simple and easily reproducible. In this regard, multiple devices have recently been designed that facilitate the exit of aqueous humor in a minimally invasive manner through different routes: trabecular meshwork, suprachoroidal space, and subconjunctival space.

In addition, widely known technology, such as the excimer laser or the femtosecond laser, is being implemented in glaucoma surgery.

Dr. Rubén Sánchez-Jean
Dr. Carmen Dora Méndez-Hernández
Dr. Federico Sáenz-Francés San Baldomero
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • glaucoma surgery
  • new techniques
  • minimally invasive glaucoma surgery
  • intraocular pressure
  • optometry
  • IOLs designs

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Published Papers (2 papers)

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Research

20 pages, 2230 KB  
Article
Relationship Between Parapapillary Microvasculature Dropout and Visual Field Defect in Glaucoma: A Cross-Sectional OCTA Analysis
by Fiorella Cuba-Sulluchuco and Carmen Mendez-Hernandez
J. Clin. Med. 2025, 14(19), 6936; https://doi.org/10.3390/jcm14196936 - 30 Sep 2025
Viewed by 350
Abstract
Background: Glaucoma is a multifactorial optic neuropathy and the leading cause of irreversible blindness worldwide. Vascular mechanisms, including impaired perfusion of the optic nerve head, are increasingly recognized as contributors to disease progression. Optical coherence tomography angiography (OCTA) enables non-invasive assessment of retinal [...] Read more.
Background: Glaucoma is a multifactorial optic neuropathy and the leading cause of irreversible blindness worldwide. Vascular mechanisms, including impaired perfusion of the optic nerve head, are increasingly recognized as contributors to disease progression. Optical coherence tomography angiography (OCTA) enables non-invasive assessment of retinal and choroidal microvasculature, including peripapillary microvasculature dropout (MvD), which may serve as a marker of glaucomatous damage. Methods: A cross-sectional case–control study was conducted, including patients with primary open-angle glaucoma (OAG) and healthy controls. All participants underwent a comprehensive ophthalmic evaluation and OCTA imaging using the PLEX Elite 9000 system. Peripapillary vessel density (pVD), flow index (pFI), peripapillary choroidal thickness (PCT), β-zone parapapillary atrophy (β-PPA), and choroidal vascular indices were measured. MvD was defined as the complete absence of microvasculature within the β-PPA boundary. Statistical analyses included univariate and multivariate regression models to examine variables associated with PCT and to assess the association between MvD and visual field mean defect (MD), as well as other glaucoma characteristics. ROC curve analysis was performed to evaluate the ability of MvD to discriminate between different levels of visual field defects. Results: A total of 87 eyes (41 glaucomatous, 46 controls) were analyzed. Glaucoma patients exhibited significantly lower pVD, pFI, PCT, and choroidal vascular indices compared to the controls. MvD was detected in 10 glaucomatous eyes and was associated with a larger β-PPA area, smaller choroidal luminal and stromal areas, and worse mean deviation (MD) values. Multivariate regression showed that the number of ocular hypotensive treatments and StructureIndex variables were significantly associated with PCT (adjusted R2 = 0.14). Logistic regression analysis identified MD, MD slope, and β-PPA area as variables significantly associated with the presence of MvD. ROC analysis showed that the presence of MvD had good discriminatory ability for visual field mean defects (MDs) (AUC = 0.77, 95% CI: 0.69–0.87; p = 0.005). Conclusions: Peripapillary MvD detected by OCTA is associated with reduced choroidal vascularity, increased β-PPA, and greater visual field deterioration in glaucoma patients. MvD may serve as a structural marker associated with functional deterioration in glaucoma patients. Full article
(This article belongs to the Special Issue Clinical Advances in Glaucoma: Current Status and Prospects)
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15 pages, 1210 KB  
Article
Two-Year Outcome of Selective Laser Trabeculoplasty for Normal-Tension Glaucoma in Japan: First-Line or Second-Line Selective Laser Trabeculoplasty (FSS) Study
by Tomoko Naito, Koji Nitta, Takako Miki, Akiko Narita, Tairo Kimura, Yasushi Ikuno, Shiro Mizoue, Maki Katai, Yoshiaki Saito, Mami Nanno, Naoki Tojo, Naoto Tokuda, Shigeki Yamabayashi, Katsuyoshi Suzuki, Kimihito Konno, Hiroaki Ozaki, Toru Nakazawa, Tadashi Nakano, Kenji Nakamoto, Naoya Nezu, Shigeru Mori, Kazuyuki Hirooka, Itaru Kimura, Takeshi Sagara, Toyoaki Tsumura, Aika Tsutsui, Kae Sugihara, Takuji Matsuda, Yoshitaka Tasaka, Satoru Tsuda, Tomoyuki Watanabe, Naka Shiratori, Yutaro Tobita, Kaori Komatsu, Akiko Harano, Kazuhisa Sugiyama, Keiji Yoshikawa and Masaki Tanitoadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(10), 3459; https://doi.org/10.3390/jcm14103459 - 15 May 2025
Viewed by 2053
Abstract
Objectives: The objective of this study is to investigate the two-year continuous efficacy, risk factors, and safety profile of selective laser trabeculoplasty (SLT) in Japanese individuals diagnosed with normal-tension glaucoma (NTG) who underwent SLT as either a first-line or second-line treatment. Methods [...] Read more.
Objectives: The objective of this study is to investigate the two-year continuous efficacy, risk factors, and safety profile of selective laser trabeculoplasty (SLT) in Japanese individuals diagnosed with normal-tension glaucoma (NTG) who underwent SLT as either a first-line or second-line treatment. Methods: A retrospective chart review was conducted of patients with NTG who underwent SLT as either an initial or secondary therapy at 26 medical institutions in Japan between January 2020 and December 2021 with a 2-year follow-up. The primary endpoint was a reduction in the rate of intraocular pressure (IOP) over 2 years after SLT. To estimate the time-varying effect of IOP reduction, a linear mixed-effects model was employed. The secondary endpoints were numerical IOP reduction, treatment success rates shown by a Kaplan–Meier analysis, and complications. Success was defined as an outflow pressure improvement rate (ΔOP) ≥ 20% (definition A) or an IOP reduction rate ≥ 20% (definition B) without further treatment. A Cox proportional hazards regression analysis was used to identify the risk factors to successful SLT treatment. The study was registered with UMIN-CTR (ID: UMIN R000064045). Results: A total of 230 eyes from 230 individuals participated in this study, with 148 eyes receiving SLT as an initial (first-line) therapy and 82 eyes undergoing SLT as a secondary (second-line) intervention. In the first-line group, the mean IOP dropped from 16.7 ± 2.3 mmHg to 13.7 ± 2.4 mmHg at two years post-treatment, reflecting a 16.8% reduction. In the second-line group, the average IOP declined from 15.9 ± 2.5 mmHg to 13.2 ± 2.0 mmHg, marking a 14.4% decrease over the same period. The treatment success rate according to definition A (ΔOP ≥ 20%) was 73.7% at 2 years. Analysis using a linear mixed-effects model identified time (p < 0.001), age (p = 0.044), baseline IOP (p < 0.001), and central corneal thickness (CCT) (p < 0.001) as statistically significant contributors to IOP reduction following SLT. However, neither the Group (first-line vs. second-line) variable (p = 0.386) nor the Time × Group interaction (p = 0.298) reached statistical significance. A lower baseline IOP and a thicker CCT were confirmed as significant predictors of SLT treatment failure. Conclusions: Both initial and secondary SLT treatments for NTG proved to be effective and safe over a two-year period, although the extent of IOP reduction was smaller in cases with a lower baseline IOP. Our findings indicate that the IOP-lowering effect of SLT in NTG is influenced by pretreatment IOP levels, aligning with previous studies on primary open-angle glaucoma and ocular hypertension. However, in contrast to those earlier findings, our research identified pretreatment central corneal thickness as a statistically significant factor influencing SLT efficacy in NTG. These results support the role of SLT as a reliable and safe therapeutic option for managing NTG. Full article
(This article belongs to the Special Issue Clinical Advances in Glaucoma: Current Status and Prospects)
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