Search Results (1,034)

Pseudoexfoliation glaucoma (PXG) is a unique cause of open-angle glaucoma with a more severe clinical course and higher intraocular pressure (IOP) than primary open-angle glaucoma (POAG). This reflects progressive structural failure of the trabecular meshwork (TM) driven by pseudoexfoliation (PXF) fibrillar material deposition, distinguishing PXG from POAG pathogenically. The TM, an active load-bearing filtration sieve, regulates IOP and is most affected by XFM deposition and extracellular matrix (ECM) dysregulation in PXG. Despite extensive research, the mechanism of trabecular dysfunction remains unclear, with both mechanical obstruction and ischemic/oxidative stress implicated. This narrative review amalgamates evidence across TM biology, PXF material science, and glaucoma pathophysiology to propose a five-stage framework for TM failure in PXG. Full article

Glaucoma is a major global health concern, identified as the foremost cause of irreversible blindness, affecting nearly 95 million individuals. It is characterized by the progressive degeneration of retinal ganglion cells (RGCs), leading to significant vision-related disabilities and an extensive socio-economic impact. The concept that glaucoma should be viewed not solely as an ocular condition but also as a neurodegenerative disorder, sharing pathophysiological features with diseases like Alzheimer’s and Parkinson’s, is now widely accepted. This review examines the convergence of molecular mechanisms, including the roles of amyloid precursor proteins and neuroinflammation, that contribute to RGC loss. Notably, lithium, traditionally used as a mood stabilizer, has emerged as a potential neuroprotective agent for the treatment of Alzheimer’s disease. In light of the common neurodegenerative mechanisms linking glaucoma with central neurodegenerative diseases, here, we review the current evidence supporting lithium’s therapeutic potential in glaucoma, emphasizing the need for further clinical studies to determine its effectiveness in preserving optic nerve health and improving patient outcomes. Full article

Background/Objectives: Trabecular micro-bypass (iStent) implantation has been shown to effectively reduce intraocular pressure (IOP) and medication burden in open-angle glaucoma. However, its efficacy in primary angle closure glaucoma (PACG) remains unclear. We conducted this study to evaluate the one-year clinical outcomes of phacoemulsification combined with goniosynechialysis and iStent implantation (Phaco-GSL-iStent) in Korean patients with PACG. Methods: This retrospective study included 65 PACG eyes that underwent Phaco-GSL-iStent with follow-up of ≥12 months. Postoperative changes in mean IOP and glaucoma medications were assessed through postoperative 12 months. Predictors of postoperative changes in IOP and glaucoma medications were also evaluated. Results: Mean IOP significantly decreased from 18.3 ± 0.4 to 13.8 ± 0.3 mmHg at postoperative 12 months (p < 0.001). Mean number of glaucoma medications showed a statistically significant but small decrease from 2.85 ± 0.15 to 2.44 ± 0.13 at 12 months (p = 0.008). The 12-month cumulative qualified success rate was 86.2%. In multivariable analysis, IOP reduction at postoperative 12 months was positively associated with preoperative IOP (B = 0.707, p < 0.001). IOP spikes (defined as an increase of 5 mmHg or more from the baseline) were observed in two eyes (3.1%). Conclusions: These one-year outcomes suggest that Phaco-GSL-iStent can be an effective option to lower IOP in patients with PACG. However, the reduction in glaucoma medication use was limited in this study sample. Full article

Background/Objectives: Schlemm canal-based minimally invasive glaucoma surgery (MIGS) can be combined with cataract surgery, but topical glaucoma therapy alone is not a sufficient indication for adding MIGS. This review addresses when cataract surgery alone may be sufficient, when combined cataract surgery and MIGS may be appropriate, and when filtration surgery should be considered. Methods: This narrative review used a targeted PubMed/MEDLINE search of English-language literature published from January 2000 to May 2026 to support source identification and reference selection. The review focused on cataract surgery combined with Schlemm canal- or trabecular meshwork-targeted MIGS, including stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures, medication burden, ocular surface disease, refractive and visual outcomes, corneal endothelial safety, complications, angle visibility, guideline-based decision-making, and patient selection. Final references were selected according to clinical relevance to cataract-surgeon decision-making and evidence priority, with emphasis on guidelines, systematic reviews or meta-analyses, randomized or prospective comparative studies, pivotal or long-term studies, large real-world or post-market studies, and clinically informative safety, refractive, endothelial, imaging, or complication-related studies. Results: Stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures can provide additional IOP and medication reduction compared with cataract surgery alone in selected eyes with mild-to-moderate open-angle glaucoma. Stent-based procedures generally have a lower hyphema risk, whereas trabeculotomy/goniotomy-based procedures may provide comparable or greater IOP reduction in selected eyes but are associated with more frequent hyphema. In normal-tension glaucoma or low-baseline-IOP eyes, the expected benefit is often medication reduction or modest IOP lowering rather than reliable achievement of very low target IOP. Available refractive evidence remains limited and procedure-specific, but suggests that major refractive instability is uncommon in appropriately selected eyes. Conclusions: The decision to combine Schlemm canal-based MIGS with cataract surgery should be goal-directed rather than based solely on the presence of topical therapy. Practical selection should integrate glaucoma subtype, disease stage, baseline and target IOP, expected phacoemulsification-only IOP reduction, medication burden, ocular surface status, adherence, angle visibility, endothelial reserve, refractive objectives, and future filtration surgery options. Full article

The calcareous tubes of the annelid worm Ditrupa are known from the Eocene to present-day marine settings. It has a distinctive and unique outer layer comprising regularly ridged prismatic fabric (RRP), and a more chaotic inner layer of semi-oriented, needle-to-thread-like calcite, simple preferentially orientated prismatic (SPOP) fabric. We use electron backscattered diffraction (EBSD) analysis in conjunction with scanning electron microscopy (SEM) backscattered (BSE) imaging and energy dispersive X-ray (EDX) mapping in the study of the tube structure of (?)Eocene Ditrupa sp. The fabric of both layers can often be observed even within the older fossil materials. EBSD Inverse Pole Figures and pole figure plots show that the crystallographic c-axis is orientated parallel to both of the elongate calcite crystals of the two fabric layers, although orientation between the two layers is perpendicular to each other. The crystals and c-axis of the RRP fabric is approximately perpendicular to the outer tube margin, while those in the SPOP fabric are more distributed with an orientation parallel to the tube circumference. The current work confirms the single crystal origin of RRP fabric crystals and indicates that these grew incrementally and were likely controlled by an organic framework. The inner layer fabric is also shown to be unique to Ditrupa, and although it has elements similar to lamello-fibrillar (LF) and irregular orientated prismatic (IOP) fabrics, should be assigned to simple preferentially orientated prismatic (SPOP) fabric previously noted from Ditrupa bartonensis. Given the range of unusual features associated with the latter fabric, it may also at least in part be controlled through an in situ organic framework. Therefore, both layers of the tube of Ditrupa may be unique amongst the annelids, as well as being organic framework controlled or influenced. Full article

Background/Objectives: We aim to determine whether prior cataract surgery affects the intraocular pressure (IOP)-lowering effect of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). Methods: This prospective interventional cohort study initially included 92 patients with POAG who were inadequately controlled or intolerant to topical therapy and were treated with SLT. Of these, 84 patients completed all scheduled visits and constituted the final analyzed dataset. Patients were divided into phakic and pseudophakic groups, with cataract surgery performed at least one year before SLT in all pseudophakic eyes. All patients underwent standardized 360-degree SLT by a single specialist. The primary outcome was IOP reduction at one year. Secondary outcomes included percentage IOP reduction and treatment success, defined as ≥20% IOP reduction. Data were analyzed using Statistica^TM 14.0.1.25 (TIBCO Software Inc., Palo Alto, CA, USA, USA). Results: Before SLT, the median IOP was 20.5 mmHg in phakic eyes and 21 mmHg in pseudophakic eyes. One year after SLT, median IOP decreased insignificantly in phakic eyes (4.0 mmHg; p = 0.262), whereas it decreased significantly in pseudophakic eyes (5.5 mmHg; p = 0.004). At one year post-SLT, an IOP reduction of ≥20% was observed in 53.6% of phakic and 72.7% of pseudophakic eyes. Pseudophakic patients were significantly older than phakic patients, as expected, because age-related senile cataract is more common in older individuals, and the groups also differed by gender distribution. This gender imbalance was coincidental and reflected the non-randomized inclusion of POAG patients according to clinical need for SLT rather than predefined matching. In unadjusted analyses, one-year IOP reduction was positively associated with age (p = 0.048), pretreatment IOP (p < 0.001), and prior cataract surgery (p = 0.047). However, after adjusting for age, gender, and baseline IOP in a multivariate sensitivity analysis, prior cataract surgery was not an independent predictor of success; only pretreatment IOP predicted a significant reduction (p = 0.031) in the analysis of 84 eyes. Conclusion: Although pseudophakic eyes showed greater unadjusted IOP reduction after SLT over one year, lens status was not an independent predictor after adjustment for potential confounders. Therefore, the observed pseudophakic advantage should be interpreted as a hypothesis-generating association warranting further research into the effect of pseudophakia on SLT response. Full article

Glaucoma is a chronic, progressive optic neuropathy and the second leading cause of irreversible blindness worldwide. Although elevated intraocular pressure (IOP) remains the principal modifiable risk factor, it is neither necessary nor sufficient for disease development. The literature indicates that systemic conditions such as obstructive sleep apnea (OSA) may contribute to its pathogenesis. The pathophysiology of glaucoma is supported by several theories, primarily the mechanical and vascular theories. This review describes the pathophysiological links between OSA and glaucoma considering current theories. The principal connecting mechanism appears to be chronic intermittent hypoxia and reduced ocular perfusion pressure, which trigger optic nerve head hypoxia, oxidative stress, and biomechanical remodeling of the lamina cribrosa. These processes interact within a vicious cycle that progressively compromises the metabolic support of optic nerve axons. The mechanisms described are particularly relevant to normal-tension glaucoma, which may be associated with OSA. Retinal nerve fiber layer thinning appears among the earliest markers of optic nerve vulnerability, whereas IOP and visual field changes are more variable. These observations underscore the clinical relevance of the OSA–glaucoma relationship and support a multidisciplinary approach incorporating routine ophthalmic screening for subclinical optic nerve damage. Full article

Background/Objectives: Despite available treatment options, glaucoma continues to be a leading cause of irreversible blindness. Current medications have multiple limitations, including rapid drainage, ocular irritation, requirement for multiple daily dosings, and systemic side effects. The current study was designed to engineer and characterize a pregabalin-containing enhanced delivery formulation (PRG-EDF) to directly address these inadequacies. Methods: PRG-EDF eye drops were prepared using ingredients that are either U.S. Food and Drug Administration (FDA)-approved for ophthalmic use or have established safety profiles. The formulation was characterized using multiple evaluations, including pH, zetasizer analyses, viscosity, in vitro drug release, transcorneal permeability, determination of dose concentration and volume, systemic exposure, and potential for tachyphylaxis. Efficacy was evaluated using both Dutch belted rabbits and baboons. Results: PRG-EDF provides extended release for up to 24 h. Ex vivo data reveal that PRG-EDF does not alter the inherent high PRG corneal permeability. An intraocular pressure (IOP) study using DB rabbits demonstrates that 40 µL of PRG-EDF, 0.6%, is the optimum dose of our formulation. Comparison of the efficacy of PRG-EDF with commercial products demonstrated its superiority in overall IOP-lowering efficacy. An extended in vivo assessment demonstrated that the potency of PRG-EDF reached maximum IOP-lowering amplitude after 4 weeks of daily dosing. Moreover, an in vivo bioadhesion assay demonstrated that EDF remained on the ocular surface for up to 24 h. Impressively, PRG-EDF is as effective in baboons as in rabbits. Conclusions: We have successfully engineered a highly promising once-daily glaucoma medication with superior efficacy, as illustrated by higher IOP-lowering ability and prolonged duration of action. Full article

Background/Objectives: We aimed to evaluate the relationship between lens thickness (LT) and postoperative outcomes following cataract surgery versus combined cataract–glaucoma procedures in a predominantly Black and Caribbean population, and to assess the utility of LT and the Laroche Glaucoma Risk Calculator in predicting intraocular pressure (IOP) reduction. Methods: This retrospective cohort study included 187 eyes from patients aged ≥50 years that underwent cataract surgery alone or combined cataract–glaucoma surgery (goniotomy or Ahmed retrobulbar/intraconal tube) at a single center in Queens, New York. Preoperative and ≥3-month postoperative data included IOP, visual acuity (logMAR), medication burden, visual field mean deviation, and anterior segment biometry. Patients were stratified by surgical type, diagnosis, and glaucoma risk. Associations between LT and postoperative IOP reduction were analyzed. Results: Mean LT was 4.53 mm. Greater LT was associated with increased postoperative IOP reduction across all groups. Eyes with LT ≥4.5 mm showed greater IOP reduction compared to LT ≤4.2 mm (2.63 vs. 1.19 mmHg). Combined procedures yielded greater IOP reduction than cataract surgery alone, with the largest decrease in the Ahmed group (−4.56 mmHg). Cataract surgery alone produced smaller but significant reductions (−1.58 mmHg) and the greatest visual acuity improvement. Medication burden decreased substantially in the combined groups. Patients with angle-closure glaucoma had the highest LT. High-risk patients demonstrated greater IOP reduction than low-risk patients. Conclusions: Increased LT may serve as a predictive biomarker for postoperative IOP reduction. Incorporating LT and the Laroche Glaucoma Risk Calculator into preoperative planning may enhance surgical decision-making and outcomes, particularly in underserved populations. Full article

Purpose: To investigate the short-term impact of scleral lens wear on intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness. We hypothesized that scleral lens wear would produce a measurable elevation in IOP accompanied by detectable RNFL thinning compared with soft contact lens wear. Methods: This prospective, randomized, contralateral-eye crossover study included 31 healthy participants (mean age: 26 ± 3 years). Each participant wore a 16.5 mm scleral lens over one eye and a soft contact lens over the fellow eye for 8 h, with assignments reversed between visits. IOP was measured using two tonometers: a transpalpebral Diaton tonometer and a non-contact tonometer (NCT), and RNFL thickness was measured by optical coherence tomography at four time points: pre- and post-lens application, and pre- and post-lens removal. Results: Eyes fitted with scleral lenses exhibited a significant IOP increase immediately after lens application (pre-application: 11 ± 3 mmHg vs. post-application: 16 ± 4 mmHg, p < 0.001), sustained throughout 8 h of wear (pre-removal: 16 ± 4 mmHg), and returned to baseline after removal (11 ± 3 mmHg). No significant IOP changes were observed in soft contact lens-wearing eyes (p > 0.05). Scleral lens wear was also associated with small but statistically significant peripapillary RNFL thinning (pre-application: 110 ± 11 µm vs. post-application: 107 ± 11 µm, p < 0.001), which returned to baseline after lens removal. No significant RNFL changes were observed with soft contact lens wear (p > 0.05). Bland–Altman analysis revealed poor agreement between Diaton and NCT measurements, consistent with the published literature on transpalpebral tonometry. Conclusions: Short-term scleral lens wear was associated with transient IOP elevation and peripapillary RNFL thinning, both reversible upon lens removal, in healthy young adults. These findings highlight the need for further longitudinal investigation in at-risk populations such as those with ocular hypertension, keratoconus, or early glaucoma before clinical monitoring recommendations can be established. Full article

Background: This study assessed the 5-year clinical outcomes of phacoemulsification combined with implantation of either the first-generation iStent Trabecular Micro-Bypass or the Hydrus Microstent in eyes with open-angle glaucoma. Methods: In this prospective, non-randomized comparative study, 65 eyes of 65 patients underwent combined cataract and micro-invasive glaucoma surgery with either iStent or Hydrus implantation. Intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), surgical success, postoperative complications, and subsequent glaucoma procedures were analyzed over a 60-month follow-up. Results: At 60 months, outcome data were available for 47 eyes (72.3%), including 25 eyes in the iStent group and 22 eyes in the Hydrus group. Baseline characteristics did not differ significantly between groups. Mean IOP at 60 months was similar after iStent and Hydrus implantation (16.7 ± 1.8 mmHg vs. 16.5 ± 1.9 mmHg, respectively). The mean number of glaucoma medications decreased from 1.86 ± 0.94 to 1.36 ± 1.08 in the iStent group and from 1.60 ± 0.72 to 0.36 ± 0.49 in the Hydrus group, with significantly fewer medications required after Hydrus implantation at 60 months. Medication-free complete surgical success using the IOP ≤ 18 mmHg criterion was achieved in 20.0% of iStent-treated eyes and 63.6% of Hydrus-treated eyes. No eye underwent additional glaucoma surgery or selective laser trabeculoplasty during follow-up. Conclusions: In this prospective non-randomized comparative cohort, both procedures provided comparable long-term treated IOP control when combined with phacoemulsification. Hydrus implantation was associated with a greater medication-sparing effect and a higher proportion of medication-free complete surgical success at 5 years; however, these findings should be interpreted in the context of the non-randomized design and available-case follow-up. Full article

Background/Objectives: The objective was to describe the one-year outcomes of salvage trabeculectomy (TLE) in eyes with persistent elevation of intraocular pressure (IOP) requiring early surgical intervention after failed minimally invasive glaucoma surgery (MIGS). Methods: This retrospective observational study included 38 eyes of 38 consecutive Japanese patients who underwent TLE within 100 days after Trabectome (TOM) or microhook ab interno trabeculotomy (μTLO) because of uncontrolled IOP despite maximally tolerated medical therapy. Surgical success was defined as (1) IOP reduction ≥30% from baseline, (2) 5 < IOP < 18 mmHg, (3) no additional glaucoma surgery, and (4) no loss of light perception. The Kaplan–Meier method was used to estimate the one-year success rate. Changes in IOP, medication use, best-corrected visual acuity (BCVA), and mean deviation (MD) were analyzed using the Wilcoxon matched-pairs signed-rank test and a linear mixed-effects model. Results: The median interval between MIGS and TLE was 41.5 days (interquartile range, 28–70 days). The one-year surgical success rate was 86.8% (Kaplan–Meier estimate). IOP and medication use were significantly reduced after TLE (p < 0.0001) and remained stable throughout the 12-month follow-up. BCVA did not differ significantly between baseline and 12 months after TLE, whereas a small but statistically significant difference in MD was observed. No serious vision-threatening complications were encountered. Conclusions: TLE performed shortly after failed MIGS achieved substantial IOP reduction with acceptable safety over a one-year follow-up period. TLE may be considered as one of the surgical options in cases where sufficient IOP reduction cannot be achieved after failed MIGS, and no effective alternative treatments are available. Full article

Intraocular foreign bodies penetrating the eye can lead to serious complications, including endophthalmitis, and therefore require urgent removal. We present the case of a 9-year-old boy with an intraocular foreign body lodged in the lens with a corneal flap wound. The injury occurred while hammering a bicycle frame. The patient presented with sudden pain, tearing, and decreased visual acuity in the left eye. On admission, the left eye distance best-corrected visual acuity (BCVA) was 0.4 and intraocular pressure (IOP) was 17 mmHg. Slit-lamp examination of the left eye revealed a full-thickness corneal flap wound, a traumatic cataract, and a foreign body located centrally within the lens. B-scan ultrasonography demonstrated an echogenic focus within the lens consistent with an intralenticular metallic foreign body, with a normal posterior segment, a regular appearance of the optic disc, and an attached retina. The patient underwent phacoaspiration of the traumatic cataract with intraocular lens implantation and simultaneous removal of the foreign body. Given the corneal flap wound located in the visual axis and the absence of ocular hypotony, the decision was made not to place a corneal suture. At discharge, BCVA improved to 1.0, with IOP of 17 mmHg and normal fundus appearance. Full article

Background/Objectives: To evaluate the clinical outcomes and prognostic factors of Baerveldt glaucoma implant (BGI) surgery performed as a primary filtering procedure in eyes without prior glaucoma filtering surgery. Methods: This retrospective cohort study included 148 eyes of 148 patients who underwent BGI surgery with a 350-mm² endplate at a single tertiary center. Surgical success was defined using three intraocular pressure (IOP)-based criteria: IOP > 21 mmHg (criterion A), >17 mmHg (criterion B), or >14 mmHg (criterion C), failure to achieve ≥ 20% IOP reduction, need for additional glaucoma surgery, loss of light perception, or persistent hypotony. Kaplan–Meier survival analysis and multivariable Cox proportional hazards regression were used to evaluate surgical outcomes and prognostic factors. Results: The 5-year cumulative probability of surgical success was 70.6%, 49.8%, and 27.6% for criteria A, B, and C, respectively. Mean IOP decreased significantly from 33.5 ± 10.0 mmHg preoperatively to 13.9 ± 4.0 mmHg at 5 years (p < 0.01); number of glaucoma medications decreased from 4.0 ± 1.2 to 1.8 ± 1.9 (p < 0.01). Younger age was associated with a higher risk of surgical failure (criterion A: hazard ratio [HR] 0.97, p < 0.01; criterion B: HR 0.98, p = 0.011; criterion C: HR 0.97, p < 0.01). More previous intraocular surgeries were associated with failure under criterion B (HR 1.30, p = 0.048). Early and late postoperative complications occurred in 34.5% and 14.2% of eyes, respectively; 20.9% required additional postoperative interventions. Conclusions: BGI surgery performed as a primary filtering procedure demonstrated favorable long-term IOP control in eyes without prior glaucoma filtering surgery. Younger age was identified as a consistent risk factor for surgical failure. Full article

Glaucoma is the leading cause of irreversible blindness worldwide and is characterized by progressive retinal ganglion cell (RGC) loss and optic nerve degeneration. While elevated intraocular pressure (IOP) remains the primary modifiable risk factor, a certain proportion of patients continue to deteriorate despite adequate IOP control, pointing to IOP-independent mechanisms of neurodegeneration. Oxidative stress—defined as an imbalance between the production of reactive oxygen species and the capacity of endogenous antioxidant defenses—has emerged as a central, multi-tiered contributor to glaucoma pathogenesis. In the anterior segment, chronic oxidative damage to the trabecular meshwork impairs aqueous humor outflow and drives IOP elevation. In addition, oxidative stress may impair ocular biomechanical integrity, including corneal hysteresis and lamina cribrosa, resulting in heightened susceptibility to IOP fluctuations. In the posterior segment, oxidative stress directly contributes to mitochondrial damage and vascular endothelial injury, leading to RGC apoptosis. The nuclear factor erythroid 2-related factor 2 (Nrf2)/Kelch-like ECH-associated protein 1 (Keap1) pathway coordinates the principal endogenous antioxidant response, while nicotinamide adenine dinucleotide (NAD⁺) depletion links redox imbalance to metabolic vulnerability of RGCs. This narrative review synthesizes evidence published up to March 2026 on the molecular mechanisms of oxidative stress in glaucoma, the role of biomarkers in aqueous humor and systemic circulation, and the translational landscape of antioxidant-based neuroprotection—including nicotinamide, coenzyme Q10, alpha-lipoic acid, and Nrf2-activating compounds. We highlight gaps between preclinical promise and clinical evidence, and outline priorities for future randomized controlled trials. Full article