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Medicina
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The Pathophysiology and Treatment of Glaucoma
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The Pathophysiology and Treatment of Glaucoma

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (1 June 2025) | Viewed by 4695

Special Issue Editors

Dr. Aharon Wegner

E-Mail Website
Guest Editor
1. Vista Augenklinik Seefeld, Holbeinstrasse 25, 8008 Zürich, Switzerland
2. Department of Ophthalmology, Technical University of Munich, Munich, Germany
Interests: glaucoma; AI; laser treatment; ophthalmology
Prof. Dr. Alon Harris

E-Mail Website
Co-Guest Editor
Icahn School of Medicine at Mount Sinai, New York, NY, USA
Interests: ocular blood flow; glaucoma
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Glaucoma is a continuous enigma.

It was already known in ancient Greece: "Glaucosis" was first mentioned in Hippocratic writings as a blinding disease most often occurring in the elderly.

Glaucoma is a multifactorial disease that is the leading cause of irreversible vision loss worldwide. The damage it causes is not restricted to the optic nerve; it also spreads to the brain.

One would expect that after 2500 years we would have a comprehensive understanding of the normal physiology and pathophysiology of glaucoma. That is not the case; even our understanding and data on the most important risk factor, intraocular pressure, are incomplete. We do not know why or what causes intraocular pressure to rise at night to levels that are considered above-normal during the day. Why do these high intraocular pressure levels not cause damage? The discrepancy between functional tests (such as perimetry) and anatomical measurement (such as nerve fiber thickness) in many patients is not understood. In many cases, the diagnosis of glaucoma is like a puzzle that you have put together correctly.

It is incredible that the only way to treat glaucoma till now has been to reduce the intraocular pressure, which is only a risk factor of developing glaucoma.

Over the years, Many surgical technics and various implants have been introduced in the last thirty years. Nevertheless, the success rate, meaning the number of patients not losing sight, has been relatively stable in recent decades.

Creating and analyzing big data with artificial intelligence will hopefully bring new insights to this complex disease.

New insights into the causes, early diagnosis, biomarkers, and treatment methods to resolve the stalemate that we are in are welcomed.

Dr. Aharon Wegner
Prof. Dr. Alon Harris
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. Medicina is an international peer-reviewed open access monthly 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 2200 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

  • pathophysiology
  • diurnal changes
  • intraocular pressure
  • perimetry
  • nerve fiber thickness
  • OCT-A
  • treatment strategies
  • sustained release therapies
  • laser treatment
  • biomarkers
  • microinvasive glaucoma surgery (MIGS)
  • artificial intelligence

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Published Papers (3 papers)

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Research

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17 pages, 917 KiB  
Article
Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Advanced Glaucoma: A Retrospective Analysis
by Gülizar Soyugelen, Umay Güvenç and Ayşe Burcu
Medicina 2025, 61(3), 444; https://doi.org/10.3390/medicina61030444 - 3 Mar 2025
Viewed by 1105
Abstract
Background and Objectives: The search for less invasive and more effective methods in the surgical treatment of glaucoma continues. For advanced glaucoma, all surgical options carry a high risk of complications and vision loss. The aim of this study was to evaluate the [...] Read more.
Background and Objectives: The search for less invasive and more effective methods in the surgical treatment of glaucoma continues. For advanced glaucoma, all surgical options carry a high risk of complications and vision loss. The aim of this study was to evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) surgery in advanced glaucoma. Materials and Methods: In this retrospective study, advanced open-angle glaucoma (OAG) patients were followed up on the 1st day, 1st week, and 1st month, then monthly for 6 months and then every 3 months after GATT surgery. Outcomes at 6 and 24 months were analyzed to evaluate early and long-term surgical success. Surgical success was defined as a ≥20% intraocular pressure (IOP) reduction from baseline, final IOP ≤21 mmHg, and no need for additional glaucoma surgery. Pre- and postoperative measurements included IOP, retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT), peripapillary vessel density (VD) via optical coherence tomography angiography, and visual field (VF) tests. Results: Among 44 advanced glaucoma patients (61.4% pseudoexfoliative glaucoma), surgical success was 81.8% at 6 months and 76.5% at 24 months. Mean IOP decreased from 26.9 ± 10.4 mmHg preoperatively to 13.8 ± 8.3 mmHg at 3 months (40.36% reduction, p < 0.001) and 13.9 ± 4.0 mmHg at final follow-up (42.12% reduction, p < 0.001). Disease progression was absent in 66% of patients. BCVA initially declined (0.61 ± 0.36 to 0.41 ± 0.33 logMAR at 3 months, p = 0.011) but returned to baseline (0.59 ± 0.35 logMAR at final follow-up, p = 1.00). Glaucoma medications decreased by 66.2%, and peripapillary VD remained stable (p > 0.05). The most common complication was mild hyphema (34.1%), which resolved without intervention; only one patient (2.3%) experienced vision-threatening complications (wipe-out phenomenon in degenerative myopia). Conclusions: GATT is a safe and effective alternative to trabeculectomy for advanced glaucoma, achieving significant IOP reduction with stable VD and low rates of serious complications. This study provides novel insights by offering long-term (24-month) follow-up data, evaluating peripapillary VD stability, and specifically assessing GATT outcomes in an advanced glaucoma cohort. However, caution is advised in patients with additional ocular pathologies. Full article
(This article belongs to the Special Issue The Pathophysiology and Treatment of Glaucoma)
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9 pages, 265 KiB  
Article
Age, Sex, and Clinical Characteristics of Juvenile Open-Angle Glaucoma Patients in a Saudi Tertiary Hospital: A Retrospective Study of Surgical and Non-Surgical Outcomes
by Amar Almulhim and Abdulmohsen Almulhim
Medicina 2024, 60(10), 1591; https://doi.org/10.3390/medicina60101591 - 28 Sep 2024
Cited by 1 | Viewed by 1453
Abstract
Background/Objectives: Juvenile Open Angle Glaucoma (JOAG) is a condition that presents peculiar issues because it starts at a very early age and, in the end, causes substantial vision loss. This study aimed to analyze the age and gender distribution and treatment outcomes [...] Read more.
Background/Objectives: Juvenile Open Angle Glaucoma (JOAG) is a condition that presents peculiar issues because it starts at a very early age and, in the end, causes substantial vision loss. This study aimed to analyze the age and gender distribution and treatment outcomes in JOAG patients. Methods: We carried out a retrospective study at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, from 2015 to 2022. We extracted data from the medical records. Visual acuity data were converted to the logarithm of the minimum angle resolution (LogMAR) for standardized analysis. The CARL ZEISS Humphrey 745i Field Analyzer/HFA II-i Visual Field Analyzer was used to perform visual field examinations under the 24-2 program SITA standard. Results: The study involved 45 JOAG patients (87 affected eyes) with a mean age of 26.91 years. Myopia was the prevailing trait (93%), and a family history of glaucoma was found in 51.1% of cases. Most of the patients presented with severe visual field defects in both eyes (right—57.1%, left—44.4%). Regarding visual acuity, we found that the majority of affected categories belonged to either mild or moderate in both eyes. Initial and final Intraocular pressure (IOP) measurements together showed a significant reduction (p < 0.001) and clearly demonstrated the need for IOP control. Surgical and non-surgical treatments significantly reduced IOP, with no gender or eye differences Conclusions: This research offers important data concerning JOAG demographics (age and gender), clinical picture, and treatment results. Though early-onset presents challenges, multidimensional therapeutic methods have great potential to get JOAG under control and maintain visual function. Additional research is needed to study the genetic causes of JOAG and assess the long-term treatment outcomes. Full article
(This article belongs to the Special Issue The Pathophysiology and Treatment of Glaucoma)

Review

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10 pages, 524 KiB  
Review
Mathematical Modeling and Artificial Intelligence to Explore Connections Between Glaucoma and the Gut Microbiome
by Madeline C. Rocks, Priyanka Bhatnagar, Alice Verticchio Vercellin, Lorenzo Sala, Brent Siesky, Gal Antman, Keren Wood, Riccardo Sacco and Alon Harris
Medicina 2025, 61(2), 343; https://doi.org/10.3390/medicina61020343 - 14 Feb 2025
Cited by 1 | Viewed by 1407
Abstract
Background and Objectives: Glaucoma is a major cause of irreversible blindness, with primary open-angle glaucoma (POAG) being the most prevalent form. While elevated intraocular pressure (IOP) is a well-known risk factor for POAG, emerging evidence suggests that the human gut microbiome may also [...] Read more.
Background and Objectives: Glaucoma is a major cause of irreversible blindness, with primary open-angle glaucoma (POAG) being the most prevalent form. While elevated intraocular pressure (IOP) is a well-known risk factor for POAG, emerging evidence suggests that the human gut microbiome may also play a role in the disease. This review synthesizes current findings on the relationship between gut microbiome and glaucoma, with a focus on mathematical modeling and artificial intelligence (AI) approaches to uncover key insights. Materials and Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, covering studies from its inception to 1 August 2024. Selected studies included basic science, observational research, and those incorporating mathematical-related models. Results: Traditional statistical and machine learning approaches, such as random forest regression and Mendelian randomization, have identified associations between specific microbiota and POAG features. These findings highlight the potential of AI to explore complex, nonlinear interactions in the gut–eye axis. However, limitations include variability in study designs and a lack of integrative, mechanistic models. Conclusions: Preliminary evidence supports the existence of a gut–eye axis influencing POAG disease. Combining data-driven and mechanism-driven models with AI could identify therapeutic targets and novel biomarkers. Future research should prioritize longitudinal studies in diverse populations and integrate physiological data to improve model accuracy and clinical relevance. Furthermore, physics-based models could deepen our mechanistic understanding of the gut–eye axis in glaucoma, advancing beyond associative findings to actionable insights. Full article
(This article belongs to the Special Issue The Pathophysiology and Treatment of Glaucoma)
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