Search Results (56)

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

Glaucoma surgery is entering a precision-based era in which surgical success is determined not only by intraocular pressure reduction, but also by the anatomical mechanism targeted, the expected durability of effect, safety profile, medication burden, quality of life, and preservation of future therapeutic options. Microinvasive glaucoma surgery (MIGS) has become an important component of this paradigm by expanding the surgical continuum toward earlier, anatomically targeted, and tissue-sparing intervention. However, MIGS does not represent a homogeneous procedural category; rather, it encompasses distinct approaches that modulate different components of aqueous humor dynamics, including the trabecular meshwork, Schlemm’s canal, distal collector channels, the subconjunctival space, the suprachoroidal pathway, and aqueous production. This narrative review synthesizes contemporary evidence and proposes a mechanism-based framework for glaucoma surgery, with particular emphasis on trabecular and Schlemm’s canal-based procedures as representative examples of physiologically oriented conventional outflow enhancement. Canal-based interventions, trabecular bypass, goniotomy, trabeculotomy, and canaloplasty are most appropriate when enhancement of conventional outflow can achieve clinically meaningful pressure and medication reduction, particularly in mild-to-moderate open-angle glaucoma. By contrast, subconjunctival filtration, trabeculectomy, and aqueous shunt surgery remain indispensable when lower target pressures are required, especially in advanced or rapidly progressive disease. Lens extraction and ciliary body-directed procedures further illustrate the importance of aligning surgical strategy with disease phenotype and anatomical mechanism. The future of glaucoma surgery will therefore depend on individualized procedure selection guided by glaucoma stage, target pressure, angle and lens anatomy, outflow pathway integrity, safety considerations, and long-term surgical sequencing. Full article

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness driven by elevated intraocular pressure from compromised aqueous outflow. While genome-wide association studies have identified numerous risk loci, specific candidate proteins and their cellular mechanisms remain elusive. We employed a multi-omics framework integrating UK Biobank plasma proteomics (N = 53,022) and large-scale POAG GWAS summary statistics. We performed a Proteome-Wide Association Study, Mendelian Randomization, and Bayesian colocalization to infer causality. Identified candidates were mapped to human and mouse ocular scRNA-seq atlases to characterize cell-type specificity, followed by druggability assessments. We prioritized five putative causal proteins, with SEL1L and TFPI demonstrating the strongest evidence. Cross-species scRNA-seq revealed that SEL1L and SERPINF1 are robustly expressed in the trabecular meshwork (TM), particularly the juxtacanalicular tissue, implicating them in outflow resistance. Conversely, TFPI and SLC9A3R2 localize to Schlemm’s canal endothelium, suggesting a role in modulating barrier function. Pathway analyses highlighted endoplasmic reticulum protein processing and coagulation cascades. This study maps putative causal POAG proteins to conventional outflow pathway cells, highlighting SEL1L as a novel target for TM homeostasis and TFPI for drug repurposing, thereby providing data-driven hypotheses to facilitate precision glaucoma therapeutics. Full article

Background/Objectives: Rho-associated protein kinase inhibitors reduce intraocular pressure (IOP) by enhancing aqueous humor outflow through the trabecular meshwork–Schlemm’s canal pathway. However, it remains unclear whether the fixed-dose combination of ripasudil hydrochloride hydrate and brimonidine tartrate (GLAALPHA) enhances conventional aqueous outflow in vivo. Methods: This single-center randomized clinical trial included healthy adult volunteers who received GLAALPHA, a brimonidine tartrate–brinzolamide fixed-dose combination (Ailamide), or brimonidine tartrate monotherapy (Aiphagan) in a crossover sequence. The aqueous column width in the episcleral veins was assessed at baseline and at 2 h (primary outcome) and 8 h using hemoglobin video imaging. Results: Among 24 participants, analyses included 23 GLAALPHA-treated eyes, 21 Ailamide-treated eyes, and 22 Aiphagan-treated eyes. Two hours after instillation, the aqueous column width significantly increased from baseline only in the GLAALPHA group (p = 0.002). The percent increase in the aqueous column width at 2 h was significantly greater with GLAALPHA than with Ailamide (p = 0.039) and not significantly different between GLAALPHA and Aiphagan (p = 0.114). At 8 h, the aqueous column width did not differ from the baseline in any groups. Conclusions: In healthy adult eyes, GLAALPHA significantly increased the aqueous column width in the episcleral veins 2 h after instillation, indicating enhanced conventional aqueous outflow. These findings provide evidence that GLAALPHA promotes trabecular outflow beyond the effects of brimonidine tartrate-containing comparators and offer mechanistic insights into its action. Full article

Background: In 2016, Charles McMonnies advanced a theory positing that the use of scleral lenses might result in an elevation of intraocular pressure (IOP) due to the compression of the episcleral veins, consequently diminishing the eye’s capacity for draining aqueous humor. Alternative drainage pathways are capable of compensating only for 10–30% of the aqueous humor that requires drainage. Then it remains a quantity of fluid trapped in the anterior chamber. Recent data has demonstrated that the scleral lenses wear results indeed in an augmentation of the anterior chamber volume and a reduction of the iridocorneal angle, concomitant with a compression of Schlemm’s canal. Assuming that aqueous humor production remains constant, this imbalance between inflow and outflow can only lead to an increase in intraocular pressure. Methods: Several studies have attempted to answer this question over the past 10 years. Most authors have encountered the inherent difficulty of measuring IOP while the lens is still in place. Others were performed without waiting for the required time (>4 h of wear) for the lens to exert its maximum compression, thus minimizing their impact. Some attempted to assess IOP via the sclera (pneumotonometry), a technique known to give variable results and hard to reproduce. Ultimately, there are few reliable ways to assess IOP. One of them is by directly observing changes in the optic nerve structure over time. Results: These works indicate that there is indeed a moderate increase (<5 mmHg) in IOP. Could this be causing neuropathy and long-term negative impacts for patients who may be at risk? Based on the clinical experience of those involved in the field for many years, it is unlikely that IOP variations may have an impact on a healthy optic nerve. However, glaucoma patients or those at risk could be adversely affected in the long term. Conclusions: It is still too early to determine, without a doubt, the actual impact of the likely increase in IOP resulting from the structural changes caused by wearing scleral lenses Further work is therefore urgently needed to document these longitudinal changes. Full article

Background: To evaluate the effects of preoperative topical ripasudil, a Rho-associated protein kinase (ROCK) inhibitor, on Schlemm’s canal (SC) morphology in patients with primary open-angle glaucoma (POAG). Methods: This study included 95 SC specimens obtained during trabeculectomy from 95 patients with POAG. Based on preoperative treatment, patients were divided into two groups: ripasudil (−) group (n = 68) receiving four topical medications [FP receptor agonist, β-blocker, carbonic anhydrase inhibitor (CAI), and α₂ agonist], and ripasudil (+) group (n = 27) receiving the same four medications plus ripasudil. SC morphology parameters were assessed in thrombomodulin (TBM)-stained sections, including length parameters [TBM-positive/negative and opened/closed SC lengths] and area parameters [TBM-positive/negative and opened SC areas]. Between-group comparisons were performed using unpaired t-tests, and multiple regression analysis was conducted to adjust for age, gender, preoperative intraocular pressure (IOP), and oral CAI use. Results: The ripasudil (+) group had significantly longer total SC length (TSC: 302.5 µm) than the ripasudil (−) group (273.0 µm, p = 0.023). Among area parameters, the ripasudil (+) group showed significantly larger opened SC area (OSC-A: 2689 µm² vs. 1881 µm², p = 0.008) and TBM-negative opened SC area (NOSC-A: 716 µm² vs. 305 µm², p = 0.001), whereas TBM-positive opened SC area (POSC-A) was not significantly different between groups (2001 µm² vs. 1575 µm², p = 0.096). After multivariate adjustment, ripasudil use remained significantly associated with longer TSC (p = 0.011) and larger OSC-A (p = 0.014) and NOSC-A (p = 0.001). Conclusions: Preoperative use of topical ripasudil was associated with preservation of SC lumen morphology, particularly in regions lacking SC endothelium. These findings provide a theoretical basis for therapeutic strategies employing ROCK inhibitors to maintain SC morphology and function. Full article

Glaucoma is a group of progressive optic neuropathies and the leading cause of irreversible vision loss worldwide. It is a chronic eye disease, and its major pathological features include fibrosis of the trabecular meshwork, Schlemm’s Canal and lamina cribrosa. Central to fibrosis is extracellular matrix (ECM) remodelling and metabolic reprogramming. Glutaminolysis is an alternative energy pathway that has previously been shown to be implicated in the metabolic reprogramming associated with cancer and other fibrotic diseases, facilitating ECM remodelling and cell proliferation. This paper reviews fibrosis, glutaminolysis in the setting of fibrosis, and fibrosis and glutaminolysis in the context of glaucoma. We review the evidence for fibrosis and metabolic reprogramming in oncology and systemic fibrotic diseases, which reveals a predilection for glutaminolysis. We review the current therapies that exist to target these pathways, and find glutaminolysis to be a potential target for future therapies in glaucoma. Full article

Cell motility—the dynamic process encompassing migration, adhesion modulation, cytoskeletal remodeling, and extracellular matrix (ECM) interactions—is fundamental to ocular homeostasis. In glaucoma, disrupted motility of trabecular meshwork (TM) and Schlemm’s canal (SC) cells contributes to impaired aqueous humor outflow and elevated intraocular pressure (IOP), while reactive motility of optic nerve head (ONH) glial cells promotes fibrosis and neurodegeneration. Mechanistically, TM/SC motility is regulated by Rho GTPase and ROCK signaling, focal adhesion dynamics, and ECM interactions, while glial cells respond to mechanical stress and cytokines such as TGF-β₂. Cytoskeletal alterations, ECM stiffening, and endothelial–mesenchymal transition (EndMT) contribute to glaucomatous damage by reducing normal cell motility and tissue remodeling capacity. Aberrant motility at the ONH, including heterogeneous astrocytic reactivity, leads to lamina cribrosa remodeling and retinal ganglion cell degeneration. Therapeutically, ROCK inhibitors improve TM/SC motility and outflow, suppress EndMT, and may confer neuroprotection. Stem cell-based strategies and modulation of TGF-β₂ or mechanotransduction pathways represent emerging approaches to restore physiological motility and regenerative potential. Despite promising advances, challenges remain in ensuring targeted, durable, and safe modulation of cellular dynamics. Understanding and therapeutically harnessing cell motility offers a unifying framework to address both pressure-dependent and neurodegenerative mechanisms in glaucoma. Full article

Background: This study aims to present the clinical outcomes, safety profile, and mid-term results of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with failed trabeculectomy. Methods: The studied group consisted of 62 patients after failed trabeculectomy. All patients underwent GATT, as a standalone procedure or in combination with cataract surgery (Phaco-GATT), between 2021 and 2023 and had at least 12 months of follow-up. The patients were examined at 1 day, 7 days, 1 month, 3 months, 6 months, and 12 months after surgery, with evaluation of visual acuity, intraocular pressure (IOP), number of antiglaucoma drops, and possible surgical complications. Results: The mean IOP before surgery was 37.22 ± 9.07 mmHg, and after the GATT procedure, it significantly decreased to 15.91 ± 5.28 mmHg at the 12-month follow-up. A comparison of patients with one or more previous antiglaucoma procedures showed no differences. A comparison of the degrees of successful canulating and deroofing of Schlemm’s canal revealed no statistical significance concerning IOP values or the number of medications. When comparing the IOP between the patients after standalone GATT and Phaco-GATT, a tendency for higher IOP values in the latter group was observed. In 21 (33.3%) patients, hyphema affecting visual acuity was observed early after surgery, which resolved spontaneously. Six patients (9.7%) needed additional surgery to obtain the target pressure. Conclusions: GATT is an effective and safe IOP-lowering surgical option in open-angle glaucoma patients with failed trabeculectomy. Full article

Background: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival-sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group of patients with a wide variety of open- and closed-angle glaucomas with or without cataract extraction and to report on risk factors for failure. Methods: A retrospective chart review of consecutive patients with primary or secondary open- or closed-angle glaucoma who underwent GATT, with or without concomitant phacoemulsification. Demographics, baseline clinical characteristics, and postoperative outcomes were collected from patients’ medical records. Primary outcomes were success rates (IOP of 18 mmHg or lower and one of the following: IOP reduction > 30% from baseline on the same or fewer medications or an IOP ≤ baseline with fewer medications as compared to baseline) and complication rates. Intraocular pressure (IOP) and the number of glaucoma medications were secondary outcome measures. Results: GATT was performed on 126 eyes of 121 patients. Mean follow-up was 583 ± 266 days. Cumulative success at 1Y was 0.88 for GATT combined with cataract extraction, 0.96 for GATT alone, 0.88 for primary open-angle glaucoma (POAG), 0.89 for secondary open-angle glaucoma (SOAG), and 0.76 for primary angle-closure glaucoma (PACG). IOP decreased from a mean of 20.65 mmHg to 14.1 mmHg, and medication decreased from a mean of 3.47 to 1.4 at the last follow-up. Forty-four eyes (34%) were classified as failures. Factors associated with an increased risk of failure were worse preoperative corrected visual acuity (OR = 2.46, p = 0.024) and a postoperative IOP spike (OR = 2.62, p = 0.028). Twelve eyes (9.5%) required further surgery for IOP control. Risk factors for requiring further surgery for IOP control were preoperative maximal IOP (OR = 1.066, p = 0.047) and a postoperative IOP spike (OR = 4.531, p = 0.036). Conclusions: GATT achieved good surgical success with good IOP and medication reduction across a wide range of glaucomas, in combination with lens extraction or as a standalone procedure. GATT should be considered early in the treatment paradigm of medically uncontrolled glaucoma. Full article

Filtration surgery is highly effective in lowering intraocular pressure; however, it is associated with a higher risk of severe complications. Visual dysfunction may persist in relatively uneventful cases because of induced astigmatism or worsening optical aberrations. Therefore, for early- to moderate-stage glaucoma, an increasing number of surgeons are prioritizing surgical safety and preserving postoperative visual function by opting for minimally invasive glaucoma surgery (MIGS). Among the various MIGS techniques, canal-opening surgery—targeting aqueous outflow through the Schlemm’s canal (Schlemm’s canal-based MIGS, CB-MIGS)—has gained increasing popularity. Unlike filtration surgery, CB-MIGS does not require creating an aqueous outflow pathway between the intraocular and extraocular spaces. Consequently, it is considered a minimally invasive procedure with a reduced risk of severe complications and is increasingly being chosen for suitable cases. Although this surgical technique has limitations in lowering intraocular pressure, it avoids the manipulation of the conjunctiva or sclera and is primarily performed through a small corneal incision. Therefore, a minimal impact on induced astigmatism or postoperative refractive changes is expected. However, few reviews comprehensively summarize postoperative changes in visual function. Therefore, this study reviews the literature on visual function after CB-MIGS, focusing on changes in best-corrected visual acuity (BCVA), refraction, astigmatism, and the effectiveness of visual field preservation to assess the extent of these postoperative changes. Hyphema is the primary cause of early postoperative vision loss and is often transient in cases in which other complications would have led to visual impairment. Severe complications that threaten vision are rare. Additionally, compared with filtration surgery, postoperative visual recovery tends to be faster, and the degree of induced astigmatism is comparable to that of standalone cataract surgery. When combined with cataract surgery, the refractive error is at the same level as that of cataract surgery alone. However, in some cases, mild hyperopic shifts may occur because of axial length shortening, depending on the extent of intraocular pressure reduction. This possibility has been highlighted in several studies. Regarding the effectiveness of slowing the progression of visual field defects, most studies have focused on short- to medium-term postoperative outcomes. Many of these studies have reported the sufficient suppression of progression rates. However, studies with large sample sizes and long-term prospective designs are limited. To establish more robust evidence, future research should focus on conducting larger-scale, long-term investigations. Full article

Glaucoma is a leading cause of irreversible blindness, with elevated intraocular pressure (IOP) as the most important risk factor. The trabecular meshwork (TM) and Schlemm’s canal are the main components of the proximal aqueous humor outflow pathway. Their dysfunction is a major contributor to IOP elevation. This study aims to identify and validate key biomarkers for TM and Schlemm’s canal endothelial (SCE) cells. A Microarray was performed on characterized human TM and SCE cells to analyze their transcriptome profiling. Differentially expressed genes (DEGs) were identified and cross-referenced with published single-cell RNA sequencing (scRNA-Seq) datasets to ensure cell-specific relevance. Further validation was performed using qPCR and re-confirmed on the scRNA-seq datasets. One-way ANOVA was used for statistical analysis, and p < 0.05 was considered significant. The Microarray revealed 341 DEGs, with TM cells enriched in metabolic and signaling pathways and SCE cells enriched in adhesion, immune, and morphogenesis-related processes. Cross-referencing with scRNA-Seq data refined the list of candidate biomarkers, and qPCR confirmed the significant gene expression differences between TM and SCE cells. CTTNBP2 and MGARP were identified as TM cell markers. JAM2, PODXL, and IFI27 are new SCE cell biomarkers. The validated biomarkers offer insights into glaucoma pathophysiology and lay the groundwork for targeted therapies. Full article

Objectives: The objective of this study was to evaluate the impact of diabetes mellitus (DM) on the outcome of Schlemm’s canal-based minimally invasive glaucoma surgery (MIGS). Methods: In a retrospective interventional cohort study, postoperative intraocular pressure (IOP) and intracameral bleeding were analyzed in 25 diabetic patients and 84 non-diabetic patients, with primary open-angle glaucoma (POAG) or ocular hypertension (OH). Results: The mean follow-up period for all 109 eyes was 35.3 ± 24.8 months. There was no significant difference in preoperative IOP between cohorts with or without diabetes. However, the post-surgical IOP between 3 months and 2 years was significantly higher in the cohort with diabetes (p = 0.019 to 0.001). The 3-year survival probability of achieving an IOP ≤ 15 mmHg was 17.8 ± 0.09% in patients with diabetes, significantly lower than the 30.4 ± 0.06% observed in patients without diabetes (p = 0.042 Log-rank test). The 3-year survival probability of achieving an IOP ≤ 18 mmHg was 56.7 ± 0.12% in patients with diabetes compared to 79.5 ± 0.05% in patients without diabetes, indicating a marginally significant difference between cohorts with and without diabetes (p = 0.065). When the random effect of diabetes mellitus (DM) was analyzed alongside the fixed effects of preoperative IOP, age, refractive error, and the extent of canal opening using a multivariate linear mixed model, DM emerged as a significant risk factor for higher postoperative IOP at both 6 and 12 months (p < 0.001). Conclusions: Diabetes mellitus is a significant risk factor for poor outcomes following Schlemm’s canal-based MIGS, particularly in achieving lower postoperative IOP. Full article

Background/Objectives: Primary open-angle glaucoma (POAG), if caused by elevated intraocular pressure (IOP), may require a trabeculotomy (LOT), in which the trabecular meshwork (TM) and Schlemm’s canal (ISC) are incised. However, the association between the incision angle and outcomes remains unclear. Therefore, in this study, we investigated the surgical outcomes of a trabeculotomy combined with cataract surgery in patients with POAG over a 12-month follow-up period. Methods: We included 66 patients (corresponding to 83 eyes) with POAG who underwent trabeculotomy ab externo with a metal probe (M-LOT: 120° incision of the TM and ISC), ab interno with a Kahook Dual Blade^® (K-LOT: 180° incision of the TM and ISC), or ab interno with a 5-0 nylon suture (S-LOT: 360° incision of the TM and ISC) between January 2015 and December 2022. We assessed IOP, the percentage reduction from preoperative IOP, the number of IOP-lowering medications taken, the incidence of postoperative complications, and the success rate using Kaplan–Meier survival analysis. Results: The median IOP was significantly lower than the baseline across all three groups. The number of IOP-lowering medications taken was significantly reduced only in the M-LOT group. The mean percentage reduction from the preoperative IOP in the K-LOT group was significantly lower than that in the M and S-LOT groups. Beween those subjected to an ab ineterno LOT, the S-LOT group demonstrated a significantly higher rate of IOP reduction 12 months after the operation compared to the K-LOT group. Kaplan–Meier cumulative survival analyses revealed a lower success rate for the K-LOT group than for the M and S-LOT groups. The M-LOT group had the lowest incidence of hyphema and IOP spikes, whereas the S-LOT group had the highest incidence of these complications. Conclusions: The M-, K-, and S-LOTs had different surgical outcomes during the 12 months of follow-up, with the M-LOT group showing the fewest complications. These results will help in selecting the most suitable trabeculotomy strategy for patients with POAG. Based on the postoperative outcomes of the ab interno K- and S-LOTs, a wider incision of the TM and ISC leads to effective IOP reduction. Full article

Introduction: Glaucoma, one leading cause of irreversible vision loss worldwide, is primarily caused by elevated intraocular pressure (IOP). Recently, minimally invasive glaucoma surgeries (MIGSs) have become popular due to their shorter surgical times, tissue-sparing nature, and faster recovery. One such MIGS, the Hydrus^® nickel–titanium alloy Microstent, helps lower IOP by improving aqueous humor outflow. The NIDEK GS-1 automated 360° gonioscope provides advanced imaging of the chamber angle for evaluation and documentation. The aim of this study was to test automated 360° gonioscopy for the detection of postoperative positional variations after Hydrus^® Microstent implantation. This study is the largest to date to evaluate post-op positioning of the Hydrus^® Microstent using the NIDEK GS-1. Materials and Methods: This study analyzed postoperative outcomes and stent location in eyes diagnosed with mild to moderate glaucoma that underwent Hydrus^® Microstent implantation with or without phacoemulsification. Patients with prior IOP-lowering surgery or vitrectomy were excluded. Analyses of the postoperative Hydrus^® Microstent position were based on the evaluation of automated 360° gonioscopy images. Results: Twenty-three eyes were included in the study, and all showed a reduction in IOP and a decrease in antiglaucomatous drop use postoperatively. Postoperative gonoscopic images showed variations in implant position. In all cases, the proximal inlet was clearly visible in the anterior chamber. The degree of protrusion into the anterior chamber was variable. The distal tip of the stent was visible behind the trabecular meshwork in Schlemm’s canal in five cases, in the anterior chamber in one case, and not visible in seven cases. In no case did postoperative alterations in the position of the implant lead to explantation. Conclusions: This study demonstrated that the Hydrus^® Microstent can effectively lower IOP even in the presence of postoperative positional variations. Automated 360° gonioscopy was found to be a useful tool to verify and document the postoperative position of the implant. Positional changes did not require device explantation in any of the cases evaluated. Full article