Search Results (114)

Background and Clinical Significance: Malignant glaucoma, also described as aqueous misdirection syndrome, most commonly occurs following trabeculectomy in patients with primary angle-closure glaucoma and a shallow anterior chamber. Management aims to restore normal anterior segment anatomy, re-establish aqueous flow from the posterior to the anterior chamber, and achieve adequate intraocular pressure control. This report presents a case of malignant glaucoma developing after trabeculectomy, with emphasis on current diagnostic and therapeutic approaches. Case Presentation: A patient with primary angle-closure glaucoma, pseudophakia of the right eye, and a patent laser peripheral iridotomy, receiving maximal tolerated topical antiglaucoma therapy, was referred to the Department of Ophthalmology due to uncontrolled intraocular pressure. The patient was scheduled for trabeculectomy of the right eye. In the immediate postoperative period, intraocular pressure was adequately controlled. However, on postoperative day five, a significant elevation in intraocular pressure was observed, accompanied by persistent shallowing of the anterior chamber. Topical and systemic hypotensive therapy, posterior capsulotomy and hyaloidotomy were performed without improvement of the local condition. The patient was qualified for irido-zonulectomy with pars plana vitrectomy. Following surgical intervention, normalization of intraocular pressure was achieved, and the anatomy of the anterior chamber was restored. Conclusions: Malignant glaucoma remains a challenging postoperative complication and is frequently refractory to conservative pharmacological and laser-based interventions. Early recognition and prompt surgical management, particularly irido-zonulectomy combined with pars plana vitrectomy, significantly increase the likelihood of anatomical and functional success. Full article

Glaucoma is a leading cause of irreversible blindness in Africa, with disease burden exacerbated by limited access to eye care, shortages of trained ophthalmologists, and socioeconomic disparities. This review synthesizes prospective and interventional studies evaluating glaucoma management modalities and associated clinical outcomes in an African population. Trabeculectomy remains the predominant surgical intervention, achieving success rates of approximately 80%, with enhanced outcomes when augmented with anti-metabolites such as mitomycin-C or 5-fluorouracil. Laser-based interventions, including selective laser trabeculoplasty and transscleral cyclophotocoagulation, demonstrate moderate to high efficacy in reducing intraocular pressure, while nonpenetrating surgeries such as deep sclerectomy, viscocanalostomy, and canaloplasty provide substantial pressure reduction with fewer complications. Pediatric interventions, notably goniotomy, show efficacy in lowering intraocular pressure, although region-specific evidence remains limited. Evidence on pharmacological intervention remains scarce, fragmented, with high rates of non-adherence frequently reported, highlighting the need for rigorously-designed outcome-oriented studies to inform clinical practice. Adoption of newer surgical and laser techniques is constrained by cost, limited equipment, and insufficient subspeciality expertise. Improving glaucoma outcomes in Africa will require strategic expansion of access to effective treatments, strengthen local surgical capacity, and prioritize evidence-based research. Collectively, these efforts will provide a more robust framework to optimize glaucoma management and reduce the burden of irreversible blindness across the continent. 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

Objectives: This study aimed to compare surgically induced corneal astigmatism (SIA) between Baerveldt glaucoma implant (BGI) surgery and trabeculectomy and to identify prognostic factors associated with SIA. Methods: This retrospective cohort study included 109 and 229 eyes that underwent BGI surgery and trabeculectomy, respectively, at Fukui University Hospital. Corneal astigmatism was assessed preoperatively, and at 6 months postoperatively, the mean SIA (M-SIA) and centroid SIA were calculated, and factors associated with M-SIA were determined. Results: BGI surgery was associated with greater SIA than trabeculectomy. Postoperative corneal astigmatism was −1.53 ± 1.01 D in the BGI group and −1.33 ± 0.92 D in the trabeculectomy group (p = 0.044). The M-SIA was significantly larger in the BGI group (1.41 ± 1.05 D vs. 0.94 ± 0.74 D, p < 0.01). Multivariate regression revealed that BGI surgery and lower preoperative corneal astigmatism were independently associated with greater M-SIA. Subgroup analysis revealed that older age and lower preoperative astigmatism were significant predictors of larger M-SIA in the BGI group, whereas only preoperative astigmatism was significant in the trabeculectomy group. Conclusions: BGI surgery was associated with greater and more variable SIA than trabeculectomy. Surgical type, baseline astigmatism, and age are important predictors of postoperative SIA. Full article

Background: Glaucoma, a leading cause of blindness worldwide, can be managed surgically when medical treatments are insufficient. Trabecular meshwork (TM)-based micro-invasive glaucoma surgery (MIGS) has emerged as a less invasive surgical approach to lowering intraocular pressure (IOP) and managing glaucoma. Methods: This narrative review synthesizes the scientific literature and trials on TM-based MIGS techniques, including trabecular micro-bypass stents, goniotomy and trabeculotomy procedures, electrocautery and laser-based approaches, and ab interno canaloplasty. Among these techniques, efficacy, pivotal clinical trials, medication reduction, safety profiles, complications, and determinants of surgical success were examined. Results: While all TM-based MIGS devices assessed achieved meaningful IOP reduction compared with trabeculectomies, there was no consensus on which TM-based MIGS technique yielded the best outcomes. TM-based MIGS had a good safety profile compared with traditional glaucoma surgeries. Common postoperative complications included transient hyphema, corneal edema, and anterior chamber inflammation. Ultimately, the success of TM-based MIGS procedures depended on many factors, including surgical technique, device type, and patient-specific factors. Conclusions: TM-based MIGS are an effective and safe surgical management option for eligible glaucoma patients requiring moderate IOP reduction. Future research should focus on the long-term outcomes of MIGS procedures, compare MIS devices, and explore the mechanistic and histopathological changes induced by MIGS. Full article

Background: Scattering of the sclera limits optical coherence tomography (OCT) imaging of deeper targets including lesions, malignancies, and other surgical targets. While existing applications of fluorescein dye are currently focused on fluorescence properties for tissue labeling, the absorption characteristics of the dye also hold potential for scleral tissue clearing. Methods: Fluorescein is investigated here to gauge the potential impact of its optical clearing on intrasurgical OCT guidance. Fluorescein was applied topically to ex vivo porcine and human eye models. OCT imaging was conducted over time to assess the increases in imaging depth due to fluorescein clearing. High-speed microscope-integrated OCT was used during pilot trabeculectomy surgery on cleared eye models to assess clearing applications in a surgical context. Results: The OCT depth of imaging increased with fluorescein concentration and application time. The effect saturates at a near-20% concentration with 50 min of application time, with a maximum signal increase of +15 dB. Reversal of the effect was observed following 10 min of rinsing. Conclusions: High-concentration fluorescein dye has novel applications as an optical clearing agent, increasing the OCT imaging depth through highly scattering biological tissue. These properties can be leveraged for improved image guidance in surgical contexts. Full article

Healthcare systems worldwide are burdened significantly due to glaucoma, which is a leading cause of irreversible blindness. A total of 76 million are currently affected, and it is estimated that by the year 2040, 112 million will be affected by glaucoma. Minimally invasive glaucoma surgery (MIGS) is a recent innovation that plays a key role in glaucoma management. We aimed to conduct a systematic review of the safety and efficacy of MIGS devices and procedures and their use in primary open-angle glaucoma (POAG) to lower intraocular pressure (IOP). Methods: A comprehensive electronic search of the PubMed database was conducted, and randomized controlled trials (RCTs) comparing MIGS devices and techniques with cataract surgery or other glaucoma procedures that had been published by 1 May 2025 were included. Results: Thirty RCTs were included in the systematic review. Studies show that MIGSs are as safe and effective as other procedures, including phacoemulsification and trabeculectomy, at lowering IOP. Conclusions: Short-term trials indicate that MIGSs are a safe and effective treatment option for primary open-angle glaucoma. MIGS procedures lead to favorable outcomes, including decreases in mean IOP and medication use, compared with other glaucoma procedures or standalone phacoemulsification. Independent long-term follow-up studies are needed further to elucidate the efficacy and long-term safety of MIGS. Full article

The classic triad of clinical findings in pigment dispersion syndrome was described decades ago. It consists of radial, spoke-like iris transillumination defects, pigment deposits on the corneal endothelium known as the Krukenberg spindle, and a densely and homogenously pigmented trabecular meshwork. PDS occurs approximately three times more frequently in young myopic men than in women and is most often identified between 30 and 50 years of age. The diagnostic evaluation does not differ from the standard examination performed in patients with suspected glaucomatous optic neuropathy. However, it must additionally incorporate examinations specific to PDS. The possible therapeutic approaches varying by disease stage will be discussed, including pharmacologic treatment, laser procedures (iridotomy and trabeculoplasty), and surgical approaches such as canaloplasty, trabeculectomy, and other glaucoma surgeries. In order to better identify patients requiring an optimal therapeutic strategy, we propose a division into five stages of PDS: (1) preclinical PDS, (2) visible PDS, (3) PDS converting to pigmentary glaucoma, (4) pigmentary glaucoma, and (5) inactive PDS. Therapeutic strategies of each stage are described below. Full article

Background: Trabeculectomy and minimally invasive glaucoma surgery (MIGS) such as goniotomy aim to reduce intraocular pressure (IOP) and medication burden but are often performed in patients with differing disease severity. Methods: We retrospectively reviewed 100 eyes from 76 adults with glaucoma that underwent either goniotomy (n = 50; Kahook Dual Blade = 42, OMNI = 8) or trabeculectomy ab externo (n = 50) at a tertiary center between May 2022 and June 2023, with at least six months of follow-up. Baseline and six-month IOP, number of medications, and postoperative complications were recorded. Eyes undergoing trabeculectomy had higher preoperative IOP than those undergoing goniotomy (22.6 ± 7.7 vs. 19.1 ± 5.9 mmHg). Results: At six months, trabeculectomy achieved a greater absolute IOP reduction (8.8 ± 0.8 vs. 5.4 ± 0.8 mmHg; p = 0.004), likely reflecting higher baseline IOP, while goniotomy yielded a larger medication reduction (1.47 ± 0.30 vs. 0.72 ± 0.20; p = 0.041). Hyphema occurred more often after trabeculectomy, and the small number of OMNI cases precluded device comparison. Conclusions: In this short-term retrospective series, trabeculectomy achieved larger absolute IOP reduction whereas goniotomy offered greater medication reduction, highlighting the need to individualize surgical choice and confirm these findings in larger prospective studies. Full article

Background: Trabeculectomy remains gold-standard surgical approach for intraocular pressure (IOP) control in glaucoma, yet its impact on optic nerve head (ONH) morphology and retinal microvasculature has not been fully clarified. This study aimed to investigate structural and vascular changes of the ONH and macula after trabeculectomy using spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA). Methods: In this retrospective study, data from 22 patients with primary open-angle glaucoma who underwent uncomplicated trabeculectomy were reviewed. The fellow eye served as control. Structural parameters, including Bruch’s membrane opening (BMO), maximum cup depth (MCD), and cup area, were measured with SD-OCT. Vessel density (VD) of the optic disc, peripapillary retina, and macular superficial (SCP) and deep (DCP) capillary plexuses were analyzed with OCTA. Preoperative and two-month postoperative data were compared using paired statistical tests. Results: Mean IOP decreased from 23.1 ± 3.9 mmHg to 13.2 ± 3.2 mmHg (p < 0.001). Significant postoperative reductions were observed in BMO (−5 ± 6%, p = 0.004), MCD (−31 ± 8%, p < 0.001), and cup area (−44 ± 18%, p < 0.001). RNFL thickness and ONH vascular parameters remained stable. In contrast, DCP vessel density increased in the foveal (p = 0.002) and parafoveal (p = 0.023) regions, while SCP density showed no significant change. Conclusions: Trabeculectomy was associated with measurable reversal of optic disc cupping, indicating partial structural recovery of the ONH following IOP reduction. The selective improvement in deep retinal vessel density suggests a layer-specific microvascular response. These findings provide further insight into the interplay between mechanical and vascular mechanisms in glaucoma and may inform postoperative monitoring strategies. Full article

The rapid development of ophthalmic surgery in recent years has made big steps forward, making interventions such as penetrating and lamellar keratoplasty or trabeculectomy widely practiced. However, the use of non-absorbable sutures in these procedures poses significant challenges. Indeed, unequal tension between the various stitches can lead to deformations of the cornea or lens and consequently to problems such as post-operative astigmatism or anisometropia. To overcome these problems, sutures with improved closure via a highly stretchable behaviour together with an excellent elastic return are a credible solution. Accordingly, to widen the plethora of superelastic polymeric materials, in the present study a novel solution deriving from two furan-based polyesters, poly(pentamethylene furanoate), PPeF, and poly(hexamethylene furanoate), PHF, was successfully obtained. Of note, these homopolymers are also entirely derived from sustainable sources. The two homopolymers were physically and chemically mixed to obtain copolymers with different block lengths, which were characterised from molecular, thermal, mechanical, and surface wettability points of view, showing interesting properties which were easily modulated as a function of block length. Lastly, all the materials showed good stability over time and cell viability and, for some of them, a great mechanical recovery upon deformation was also observed. Full article

The primary cause of post-operative failure following glaucoma filtration surgery is excessive bleb scarring. Traditional anti-fibrotics such as Mitomycin C (MMC) and 5-fluorouracil (5-FU) have greatly improved bleb survival but are not without their complications. Insights gained from traditional trabeculectomy studies can be directly applied to modern minimally invasive glaucoma surgery (MIGS) techniques. As surgical techniques continue to advance and overall safety improves, there is a growing need to explore other novel therapeutics that offer increased efficacy and favourable safety profiles. This review aims to provide insight into the pathophysiology of wound healing as well as discuss current and emerging strategies being developed to address wound healing post glaucoma filtration surgery. Full article

Objectives: We aimed to determine if a 2-week pre-operative course of fluorometholone (FML) eyedrops in chronically medicated glaucoma patients reduces the levels of the pro-inflammatory cytokine Monocyte Chemoattractant Protein 1 (MCP-1) and improves early post-operative outcomes after trabeculectomy or phaco-trabeculectomy. Methods: We conducted a single-center, unmasked, prospective pilot interventional case series of 36 patients with glaucoma who received a 2-week course of FML eyedrops prior to undergoing trabeculectomy. A multiplex bead assay was used to quantify the presence of MCP-1 levels in tear samples before and after the use of FML eyedrops, and 307 eyes without treatment with topical FML served as historical controls. Clinical outcome measures of early post-operative outcomes included IOP and additional post-operative interventions (i.e., needling, glaucoma medications, and surgery) required to achieve the desired IOP at 6 months. Results: Out of 36 patients who received FML, 19 patients had a low MCP-1 level (<250 pg/mL/mg) at baseline, which did not significantly change after using FML, and were excluded from analysis. Of the 17 remaining patients, propensity score-matched analysis was conducted to compare them with 17 patients who did not receive FML, matching for the variables of age, gender, ethnicity, diagnosis, longest glaucoma medication duration, and surgery type. Patients with FML treatment had lower odds of requiring any post-operative intervention (including needling, surgery, or IOP-lowering medications) (OR 0.22, CI 0.049–0.95, p = 0.042) compared to patients who did not have pre-operative FML treatment. Conclusions: In patients with higher levels of MCP-1 pre-operatively, the use of FML for 2 weeks pre-operatively improved their early post-operative outcomes following trabeculectomy or phaco-trabeculectomy. Full article

Background and Objectives: This study aims to comparatively evaluate the outcomes of glaucoma surgeries performed by a single surgeon during the non-pandemic period (2019, 2021, and the first quarter of 2022) versus the pandemic year (2020). The analysis focuses on key surgical outcomes, including intraocular pressure (IOP) reduction, intraoperative and postoperative complications, surgical success and failure rates, and their broader clinical implications. Materials and Methods: Out of a total of 66 patients admitted between November 2019 and March 2022, 45 met the inclusion and exclusion criteria and were enrolled in the study. All patients underwent glaucoma surgery conducted by the same surgeon employing a standardized technique (trabeculectomy ± iridectomy ± mitomycin C). The evaluated clinical parameters included preoperative and postoperative IOP values (with specific assessment on the first postoperative day), early and late intraoperative and postoperative complications, as well as postoperative success and failure rates. Results: The majority of glaucoma cases—particularly those of primary open-angle glaucoma—were recorded in 2021 and 2022, in contrast to 2019 and 2020, when pseudoexfoliative and secondary closed-angle glaucomas predominated. Over the observation period, retrobulbar anesthesia was more frequently utilized in 2019. Statistical analysis indicated that the surgical failure rate was not significantly influenced by the presence of complications, patient age, associated comorbidities, or the specific surgical variant performed. Conclusions: The conduct of glaucoma surgery during the pandemic period was marked by substantial operational and clinical constraints when compared to non-pandemic years, primarily as a consequence of decreased patient accessibility and the reprioritization of healthcare resources, despite the acknowledged emergency status of these procedures. Nonetheless, the overall incidence of early intraoperative and postoperative complications remained minimal, with transient intraocular hypotony emerging as the predominant adverse event, observed in ten cases. Across all study cohorts, more than 80% of patients achieved qualified surgical success, while only 18% exhibited surgical failure, underscoring the robustness of standardized operative protocols under variable healthcare conditions. Consistent with the directives of the American Academy of Ophthalmology (AAO) and the European Glaucoma Society (EGS), glaucoma must be regarded as a genuine ophthalmic emergency necessitating prompt surgical intervention when intraocular pressure cannot be adequately managed through pharmacological or laser-based therapies. The current findings reinforce the imperative of timely glaucoma surgery, irrespective of pandemic or non-pandemic circumstances, as a critical measure for averting irreversible optic nerve damage, mitigating functional visual loss, and sustaining long-term ocular integrity. Full article

Backgrounds/Objectives: Trabeculectomy is the gold standard for glaucoma drainage surgery, but it is associated with a risk of sight-threatening complications. The PreserFlo MicroShunt (PF) is a less invasive alternative that aims to reduce complications and simplify post-operative care. This study aimed to compare the effectiveness and safety of PF to trabeculectomy in the management of glaucoma. Methods: This was a retrospective cohort analysis of 95 eyes (48 PF, 47 trabeculectomy) from a single-center private practice in Brisbane, Australia. Data were collected from November 2017 to January 2024. Primary outcomes included intraocular pressure (IOP) and the number of medications. Secondary outcomes included best-corrected visual acuity (BCVA) and complications. Inverse probability of treatment weighting (IPTW) was applied to baseline covariates, and weighted regression and Cox proportional hazards models were then used to estimate treatment effects. Results: The two groups had comparable patient characteristics, although the PF group was older with worse visual field mean deviation. At 12 months, both procedures significantly reduced IOP and medications; however, differences were not statistically significant between groups (2.9 mmHg; 95%CI: −2.0, 7.9; p = 0.303, and 0.4; 95%CI: −0.13, 0.96; p = 0.138, respectively). The estimated probabilities of qualified success were comparable (74.9% PF vs. 72.5% trabeculectomy). Intra-operative stenting in PF eyes eliminated early post-operative hypotony. The incidence of open surgical revision in the PF group vs. the trabeculectomy group was 14.6% vs. 2.1% (p = 0.059, respectively). PF was associated with faster post-operative inflammation resolution (hazard ratio: 6.3; 95%CI: 2.8, 14.5; p < 0.001). Conclusions: Both PF and trabeculectomy are effective for glaucoma management. PF is a less invasive procedure with a lower rate of early hypotony when stented. Trabeculectomy has a tendency for lower IOP reduction and less requirement for open revision, although this did not reach statistical significance. This highlights the need for longer-term studies and improved techniques, such as more effective anti-fibrotic strategies. Full article