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Clinical Advances in the Diagnosis and Treatment of Glaucoma and Ocular Hypertension

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Dear Colleagues,

In the last few years, the diagnosis of glaucoma has been significantly modified by the clinical introduction of innovative devices. The use of new sophisticated statistical models pursues the early detection of progression at any stage of the disease. Very recently, the first steps toward the integration of structural and functional data have been accomplished. There is increased awareness of progression at any stage of the disease by integrating structural and functional data. There is increased awareness of the importance of limiting ocular surface damage induced by treatments in order to achieve adequate adherence and preserve the quality of life in glaucoma patients. New medications are now available, and neuroprotection is frequently used as a complementary treatment for intraocular pressure reduction. Finally, the recent clinical introduction of several devices for minimally invasive glaucoma surgery has strongly modified the frequency and time at which patients are allocated to surgery. Following these innovations and despite the availability of specific guidelines, decision-making processes for glaucoma patients have become more complex, also due to increased attention to socioeconomic burdens and cost effectiveness analyses.

In this Special Issue, we seek to outline new advances in the glaucoma field, focusing on strategies to improve the clinical management of our patients.

Prof. Dr. Paolo Fogagnolo
Guest Editor

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11 pages, 865 KiB

Open AccessArticle

Kahook Dual Blade Goniotomy Outcomes in the Underserved Dominican Republic Black and Afro-Latinx Population

by Cristos Ifantides, Hernan Bejar, Jennifer Patnaik, Erin Sieck, Mina Pantcheva, Cara Capitena Young, Margarita Arbaje and William McCollum

J. Clin. Med. 2025, 14(7), 2201; https://doi.org/10.3390/jcm14072201 - 24 Mar 2025

Viewed by 426

Abstract

Background/Objectives: Black and Afro-Latinx communities have a higher propensity for more-severe glaucoma at a younger age. This study aimed to use the Kahook Dual Blade (KDB) to treat all glaucoma subtypes and severity levels in this historically underserved community. Materials and Methods: This study involved a retrospective analysis of surgical case records, with follow-up through 20 months. The subjects were glaucoma patients at Hospital Elias Santana in Santo Domingo, Dominican Republic. Inclusion criteria were age >18 years and a minimum follow-up of 1 year after surgery. All glaucoma subtypes and disease severities were included, including previous glaucoma procedures. Sequential patients undergoing KDB goniotomy alone or in combination with phacoemulsification cataract surgery were assessed. IOP data and number of medications were collected at specific time points: baseline, postoperative day 1, postoperative week 1, and postoperative months 1, 3, 6, 12, 16, and 20. Surgical outcome was determined using IOP and number of medications. Success was defined as either a 20% or more reduction in IOP or a decrease in at least one topical therapy. Recorded postoperative complications were hyphema, ocular hypertension, and need for additional glaucoma surgery. Results: A total of 90 eyes from 90 patients were included. A total of 100% of the patient population was Black or Afro-Latinx. The most common glaucoma subtype was primary open-angle (76.7%). Most of the eyes had severe glaucoma (53.3%). The mean preoperative baseline IOP was 20.5 mmHg. The mean postoperative IOP from all time points ranged from 12.9 to 13.5 mmHg (all time points were significantly lower than baseline IOP, p < 0.0001). A mean reduction in IOP percent of at least 31.5% was seen at every time point. There was a mean reduction of two medications by postoperative month 20. Surgical success was achieved in 95.6% of patients at postoperative month 1 and remained high throughout the study period (95.4% at month 20). Conclusions: KDB goniotomy achieved successful IOP and medication reduction across all levels of glaucoma severity. Surgical success rates were maintained to 20 months. While MIGS has historically been used as an intervention in mild-to-moderate glaucoma, our study results show that the KDB can play a significant role in all stages of glaucoma, including severe. MIGS should be considered as a favorable intervention in all disease severities in Black and Afro-Latinx communities around the world. Full article

(This article belongs to the Special Issue Clinical Advances in the Diagnosis and Treatment of Glaucoma and Ocular Hypertension)

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