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Diagnosis, Treatment, and Prevention of Glaucoma
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Diagnosis, Treatment, and Prevention of Glaucoma

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

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 9505

Special Issue Editors

Dr. Manuele Michelessi

E-Mail Website
Guest Editor
IRCCS—Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy
Interests: glaucoma clinical and surgical management; diagnostic accuracy; systematic review
Special Issues, Collections and Topics in MDPI journals
Dr. Gloria Roberti

E-Mail Website
Guest Editor
IRCCS—Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy
Interests: glaucoma; visual field; medical treatment; surgical treatment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

On behalf of the Journal of Clinical Medicine editorial team, I am delighted to present the Special Issue “‘Diagnosis, Treatment, and Prevention of Glaucoma”.

Glaucoma is the second leading cause of blindness worldwide. It has been estimated that more than 70 million people are affected by glaucoma worldwide, with 8 million affected by bilateral blindness. Glaucoma is completely asymptomatic until the very advanced stages, and primary prevention is not feasible. Therefore, early diagnosis and early treatment are fundamental in preventing blindness.

Recent advances in technology have improved the diagnosis and prevention as well as treatment for glaucoma patients. Optical coherence tomography development, a structure–function approach and minimally invasive glaucoma surgery devices are just a few examples of these advances.

This Special Issue is focused on all the aspects related to the diagnosis, treatment and prevention of glaucoma. Authors are welcomed to submit original high-quality articles to contribute to the discussion in this field of research.

Dr. Manuele Michelessi
Dr. Gloria Roberti
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
  • OCT
  • visual field
  • blindness
  • glaucoma surgery
  • intraocular pressure
  • glaucoma prevention
  • glaucoma treatment

Related Special Issue

Published Papers (7 papers)

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Research

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8 pages, 563 KiB  
Article
Short-Term Effect of Micropulse Transscleral Laser Therapy on Intraocular Pressure in Untreated Fellow Eyes of Glaucoma Patients: Preliminary Results
by Laura L. Fortuna, Thomas Dervos, Zisis Gatzioufas, Hendrik P. N. Scholl, Konstantin Gugleta and Tim J. Enz
J. Clin. Med. 2023, 12(11), 3680; https://doi.org/10.3390/jcm12113680 - 26 May 2023
Viewed by 1347
Abstract
It has been observed that an intraocular pressure (IOP) altering intervention in one eye is followed by a consensual response in the untreated fellow eye. The underlying mechanisms remain unclear. Involvement of neuronal, cytokine, and hormonal regulation of aqueous humor dynamics, as well [...] Read more.
It has been observed that an intraocular pressure (IOP) altering intervention in one eye is followed by a consensual response in the untreated fellow eye. The underlying mechanisms remain unclear. Involvement of neuronal, cytokine, and hormonal regulation of aqueous humor dynamics, as well as improved treatment adherence or systemic absorption of topically administered medical compounds, have been suggested. Our aim was to investigate the short-term effects of unilateral micropulse transscleral laser therapy on IOP in the fellow eye. All medical records of glaucoma patients who underwent micropulse transscleral laser therapy in a tertiary referral center between May 2019 and February 2023 were collected and analyzed. We found a significant reduction in IOP in the treated eyes, indicating successful treatment. In the fellow eyes, despite not having changed any of the pharmacological IOP-reducing therapies, a significant reduction in IOP from 17.0 ± 5.1 mmHg to 13.5 ± 4.4 mmHg (p < 0.01) was observed. This reduction was, however, short-term and reached statistical significance on the first postoperative day only. Our findings support the concept of consensual inter-eye responses to unilateral IOP changes. Further research is warranted to elucidate the mechanisms underlying this phenomenon. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma)
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12 pages, 2107 KiB  
Article
One-Year Outcomes of PreserfloTM MicroShunt Implantation versus Trabeculectomy for Pseudoexfoliation Glaucoma
by Matthias Nobl, Clara Grün, Stefan Kassumeh, Siegfried Priglinger and Marc J. Mackert
J. Clin. Med. 2023, 12(8), 3000; https://doi.org/10.3390/jcm12083000 - 20 Apr 2023
Cited by 2 | Viewed by 993
Abstract
This retrospective, single-center study evaluates the safety and efficacy of PreserfloTM MicroShunt (MicroShunt) implantations compared to trabeculectomies (TETs) in patients diagnosed with pseudoexfoliation glaucoma (PEXG). A total of 31 eyes from 28 patients received a MicroShunt implantation, and 29 eyes from 26 [...] Read more.
This retrospective, single-center study evaluates the safety and efficacy of PreserfloTM MicroShunt (MicroShunt) implantations compared to trabeculectomies (TETs) in patients diagnosed with pseudoexfoliation glaucoma (PEXG). A total of 31 eyes from 28 patients received a MicroShunt implantation, and 29 eyes from 26 patients received a TET. Surgical success was defined as an intraocular pressure (IOP) between 5 mmHg and 17 mmHg at the end of the follow-up period, no need for surgical revisions or secondary glaucoma surgery, and no loss of light perception. In the MicroShunt group, the mean IOP dropped from 20.8 ± 5.9 mmHg at baseline to 12.4 ± 2.8 mmHg (p < 0.0001) after one year. In the TET group, the mean IOP dropped from 22.3 ± 6.5 mmHg to 11.1 ± 3.7 mmHg (p < 0.0001) after 12 months. In both of the groups, the mean number of medications was reduced significantly (MicroShunt from 2.7 ± 1.2 to 0.2 ± 0.7; p < 0.0001 vs. TET from 2.9 ± 1.2 to 0.3 ± 0.9; p < 0.0001). Considering the success rates, 83.9% of the MicroShunt eyes achieved complete success, and 90.3% qualified for success at the end of the follow-up period. In the TET group, the rates were 82.8% and 93.1%, respectively. The postoperative complications were comparable between both groups. In conclusion, the MicroShunt implantation demonstrated non-inferiority regarding its efficacy and safety profile compared to TET in PEXG at a follow-up of one year. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma)
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13 pages, 951 KiB  
Article
Influence of Cilioretinal Arteries on Flow Density in Glaucoma Patients Measured Using Optical Coherence Tomography Angiography
by Julian Alexander Zimmermann, Jens Julian Storp, Raphael Diener, Moritz Fabian Danzer, Eliane Luisa Esser, Nicole Eter and Viktoria Constanze Brücher
J. Clin. Med. 2023, 12(7), 2458; https://doi.org/10.3390/jcm12072458 - 23 Mar 2023
Cited by 1 | Viewed by 984
Abstract
It has long been speculated whether the presence of a cilioretinal artery (CRA) can influence the development of glaucomatous damage in patients with open-angle glaucoma. Studies involving healthy patients have shown a change in flow density (FD) depending on the presence of a [...] Read more.
It has long been speculated whether the presence of a cilioretinal artery (CRA) can influence the development of glaucomatous damage in patients with open-angle glaucoma. Studies involving healthy patients have shown a change in flow density (FD) depending on the presence of a CRA. Similarly, studies that compared the optical coherence tomography angiography (OCTA) results of healthy controls and glaucoma cohorts identified a reduction in FD in certain retinal layers for glaucoma patients. These observations raise the question of whether FD is altered in glaucoma patients depending on the presence of CRA, with possible implications for the progression of glaucomatous damage. In this prospective study, 201 eyes of 134 primary and secondary open-angle glaucoma patients who visited the Department of Ophthalmology at the University of Muenster Medical Center, Germany were included. The patients were allocated to different groups according to the presence of CRAs and the level of glaucoma severity. The FD results obtained using OCTA for the CRA and non-CRA groups were compared. While FD differed noticeably between the CRA and non-CRA cohorts in the deep macular plexus, no differences in FD were observed between the two groups when adjusted for glaucoma severity. In both the CRA and non-CRA eyes, increasing glaucoma severity correlated most strongly with a reduction in peripapillary FD. Our results suggest that the presence of CRAs does not significantly affect retinal perfusion in glaucoma patients. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma)
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11 pages, 1307 KiB  
Article
Quantification of Iris Atrophy by Swept-Source Optical Coherence Tomography in Posner–Schlossman Syndrome
by Xiaoqin Yan, Mu Li, Wei Chen and Zhiqi Chen
J. Clin. Med. 2022, 11(21), 6484; https://doi.org/10.3390/jcm11216484 - 01 Nov 2022
Cited by 1 | Viewed by 1478
Abstract
Purpose: To investigate iris atrophy in Posner–Schlossman syndrome (PSS). Methods: Sixty-one patients with PSS were included. Using swept-source optical coherence tomography, the thickness of anterior border layer (A), middle stromal layer (M), and the posterior pigmented epithelial layer (P) of iris [...] Read more.
Purpose: To investigate iris atrophy in Posner–Schlossman syndrome (PSS). Methods: Sixty-one patients with PSS were included. Using swept-source optical coherence tomography, the thickness of anterior border layer (A), middle stromal layer (M), and the posterior pigmented epithelial layer (P) of iris were measured at 500 μm, 1000 μm, 1500 μm, 2000 μm, and 2500 μm from the pupillary edge in both PSS-affected and fellow eyes. The relationships between iris thickness and corneal endothelium density, cup-to-disc (C/D) ratio, and retinal nerve fiber layer (RNFL) thickness were also estimated in PSS-affected eyes. Results: Iris thickness parameters, including M500, M1000, A1500, A2000, P2000, and P2500, were significantly thinner in PSS-affected eyes than in fellow eyes (all p < 0.05). Moreover, M500 and M1000 were significantly associated with corneal endothelium density (p = 0.047 and 0.018, respectively), and M500 was significantly associated with C/D ratio (p = 0.001) and RNFL thickness (p = 0.037) in PSS-affected eyes. Conclusions: Iris showed significant thinning and atrophy in PSS-affected eyes, and iris stromal thickness close to the pupillary edge could be a novel clinical predictor of the changes in corneal endothelium, C/D ratio, and RNFL thickness in PSS. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma)
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8 pages, 233 KiB  
Article
Evaluation of the Efficacy Duration of Topical Therapies in Eyes with Primary Open-Angle Glaucoma
by Michele Lanza, Angelo Leone, Gabriele Scognamiglio, Luigi Serra, Clemente Maria Iodice, Paolo Melillo and Francesca Simonelli
J. Clin. Med. 2022, 11(20), 6166; https://doi.org/10.3390/jcm11206166 - 19 Oct 2022
Cited by 1 | Viewed by 1331
Abstract
Background: To investigate the efficacy interval of the topical therapies available for primary open-angle glaucoma (POAG) and the ocular and systemic features potentially associated. Methods: This retrospective study included 190 patients with POAG undergoing first topical therapy, throughout a follow-up of 15 years. [...] Read more.
Background: To investigate the efficacy interval of the topical therapies available for primary open-angle glaucoma (POAG) and the ocular and systemic features potentially associated. Methods: This retrospective study included 190 patients with POAG undergoing first topical therapy, throughout a follow-up of 15 years. The patients started one topical intraocular pressure (IOP)-lowering drug within single molecules such betablockers, prostaglandin or dorzolamide, or fixed combinations such as betablockers + prostaglandin, betablockers + dorzolamide, or betablockers + brimonidine. Efficacy duration was measured as the time between the start of the therapy and the change due to IOP increase or visual field worsening. For each patient, ocular and systemic features and comorbidities were analysed to detect any significant correlation with the length of effectiveness of every drug used. Results: The molecules explored showed some discrepancies in terms of mean duration of efficacy; however, no significant differences were demonstrated (p > 0.05). Furthermore, when evaluating the overall cohort, no systemic or ocular features correlated significantly with the effectiveness of the molecules explored. However, the same analysis carried out upon stratifying the different groups according to the IOP-lowering drops they received, demonstrated that the drug efficacy could be influenced by several ocular and systemic features. Conclusion: Data observed in this study suggest that there is no difference in using one of the medications evaluated as first choice of treatment of POAG if the patients are accurately evaluated and the most recent guidelines are adopted. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma)
8 pages, 227 KiB  
Article
Glaucoma Progression Diagnosis: The Agreement between Clinical Judgment and Statistical Software
by Gloria Roberti, Manuele Michelessi, Lucia Tanga, Luca Belfonte, Laura Maria Del Grande, Marisa Bruno and Francesco Oddone
J. Clin. Med. 2022, 11(19), 5508; https://doi.org/10.3390/jcm11195508 - 20 Sep 2022
Cited by 2 | Viewed by 936
Abstract
Background: To explore the agreement between clinical judgment and Guided Progression Analysis II (GPAII) in the evaluation of visual fields (VF) progression in patients with glaucoma. Methods: Three glaucoma experts and three general ophthalmologists were asked to rate the VF series by classifying [...] Read more.
Background: To explore the agreement between clinical judgment and Guided Progression Analysis II (GPAII) in the evaluation of visual fields (VF) progression in patients with glaucoma. Methods: Three glaucoma experts and three general ophthalmologists were asked to rate the VF series by classifying them as progressive through the observation of the overview report. The agreement between clinical judgment and GPAII event analysis (EA) and trend analysis (TA) was assessed by Cohen statistic. The sensitivity and specificity of clinical judgment in detecting the presence of progression was evaluated considering the results of GPAII as the reference standard. Results: 66 VF series were included in the study. Glaucoma experts, general ophthalmologists, GPAII EA, and GPAII TA found progression in 39%, 38%, 15%, and 21% of the VF series (p < 0.05). The clinical judgment of glaucoma experts and general ophthalmologists was discordant with GPAII EA in 27.2% and 28.7% (k = 0.35, 95% CI 0.15–0.56 and k = 0.30, 95% CI 0.09–0.52) and with GPAII TA in 21.2% and 25.7% of the VF series examined (k = 0.51, 95% CI 0.31–0.72 and k = 0.41, 95% CI 0.18–0.62). Considering the GPAII EA and TA as reference standard, glaucoma experts showed a sensitivity of 90% and 92.8% and a specificity of 69.6% and 75%, while general ophthalmologists showed a sensitivity of 80% and 78.5% and a specificity of 69.6% and 73%. Conclusions: The agreement between clinical judgment and GPAII ranges from fair to moderate. Glaucoma experts showed better ability than general ophthalmologists in detecting VF progression. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma)

Review

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25 pages, 1613 KiB  
Review
Technological Advances in a Therapy of Primary Open-Angle Glaucoma: Insights into Current Nanotechnologies
by Julita Zembala, Alicja Forma, Roksana Zembala, Jacek Januszewski, Patryk Zembala, Dominik Adamowicz, Grzegorz Teresiński, Grzegorz Buszewicz, Jolanta Flieger and Jacek Baj
J. Clin. Med. 2023, 12(18), 5798; https://doi.org/10.3390/jcm12185798 - 06 Sep 2023
Cited by 1 | Viewed by 1764
Abstract
Glaucoma is a leading cause of irreversible blindness and is characterized by increased intraocular pressure (IOP) and progressive optic nerve damage. The current therapeutic approaches for glaucoma management, such as eye drops and oral medications, face challenges including poor bioavailability, low patient compliance, [...] Read more.
Glaucoma is a leading cause of irreversible blindness and is characterized by increased intraocular pressure (IOP) and progressive optic nerve damage. The current therapeutic approaches for glaucoma management, such as eye drops and oral medications, face challenges including poor bioavailability, low patient compliance, and limited efficacy. In recent years, nanotechnology has emerged as a promising approach to overcome these limitations and revolutionize glaucoma treatment. In this narrative review, we present an overview of the novel nanotechnologies employed in the treatment of primary open-angle glaucoma. Various nanosystems, including liposomes, niosomes, nanoparticles, and other nanostructured carriers, have been developed to enhance the delivery and bioavailability of antiglaucoma drugs. They offer advantages such as a high drug loading capacity, sustained release, improved corneal permeability, and targeted drug delivery to the ocular tissues. The application of nanotechnologies in glaucoma treatment represents a transformative approach that addresses the limitations of conventional therapies. However, further research is needed to optimize the formulations, evaluate long-term safety, and implement these nanotechnologies into clinical practice. With continued advancements in nanotechnology, the future holds great potential for improving the management and outcomes of glaucoma, ultimately preserving vision and improving the lives of millions affected by this debilitating disease. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma)
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