Search Results (95)

Background: This study aimed to evaluate prognostic factors of early filtering blebs using anterior segment swept-source optical coherence tomography (AS SS-OCT) in patients with uveitic and neovascular glaucoma. Methods: This retrospective cohort study included 22 eyes from 22 patients who underwent trabeculectomy (11 eyes each with uveitic or neovascular glaucoma). Intrableb characteristics were assessed using AS SS-OCT at 1 month, postoperatively. Surgical success was defined as intraocular pressure (IOP) ≤ 18 mmHg and ≥30% IOP reduction without medication at 12 months. Logistic regression was used to identify the prognostic factors associated with IOP control. Results: Sixteen eyes (72.7%) achieved surgical success, while six (27.3%) were unsuccessful. Eyes with successful IOP control at 12 months showed thicker and less reflective bleb walls with microcysts compared with unsuccessful cases of IOP control, in the early postoperative phase (all p < 0.033). However, IOP at the time of OCT did not significantly differ between the groups (p = 0.083). Multivariate logistic regression analysis revealed that higher bleb wall reflectivity at 1-month post-trabeculectomy was significantly associated with a higher surgical failure rate at 12 months after trabeculectomy (hazard ratio = 1.072, p = 0.032). Conclusions: Early intrableb assessment using AS SS-OCT may be beneficial for managing filtering blebs after trabeculectomy in uveitic and neovascular glaucoma. Higher bleb wall reflectivity in the early post-trabeculectomy phase may indicate poor features of the filtering bleb, suggesting the need for timely interventions for refractory cases. Full article

Combined trabeculectomy–phacoemulsification is known to provoke more inflammation and yield a poorer long-term efficacy than trabeculectomy alone. This study evaluates whether a similar trend exists for Ahmed glaucoma valve implantation when performed with or without concurrent phacoemulsification. We retrospectively analyzed 51 eyes from patients who underwent either Ahmed-Alone (n = 25) or PhacoAhmed (n = 26) surgery over a 5-year period. The primary outcomes included intraocular pressure (IOP), the use of IOP-lowering medications, and the need for further surgical intervention. Absolute success was defined as IOP reduction > 20% and IOP < 21 mmHg without medication; relative success allowed for continued pharmacologic therapy. Both groups showed a significant IOP reduction, with similar final mean IOP values (Ahmed-Alone: 14.02 ± 4.76 mmHg; PhacoAhmed: 13.89 ± 4.17 mmHg; p = 0.99) and comparable reductions in medication use (p = 0.52). Reinterventions occurred less frequently and later in the PhacoAhmed group (12% vs. 27.3%; median time: 27.1 vs. 12 months). Absolute success was not achieved in any PhacoAhmed case but occurred in 9.3% of Ahmed-Alone cases; relative success rates were similar (83.3% vs. 81.4%; p = 0.291). These findings suggest that combining phacoemulsification with Ahmed valve implantation does not significantly alter efficacy or safety profiles. Additional prospective studies are warranted to assess long-term outcomes. Full article

Trabeculectomy with mitomycin C is a key surgical intervention for managing glaucoma when conservative treatments fail. The success of trabeculectomy is influenced by various factors, including preoperative ocular characteristics like conjunctival vascularity. This study aims to explore the relationship between the preoperative conjunctival vascular area and post-trabeculectomy outcomes in glaucoma patients. By analyzing the conjunctival vascular density, intraocular pressure (IOP), bleb morphology, laser suture lysis (LSL) frequency, and postoperative eye drops, this research sheds light on the impact of preoperative vascularity on surgical success. Results show that lower preoperative conjunctival vessel density is associated with favorable outcomes, such as better bleb formation and reduced need for postoperative interventions, while higher conjunctival vessel density correlates with complications like hyphema. These findings emphasize the importance of assessing preoperative conjunctival vascularity to optimize trabeculectomy outcomes and personalize treatment strategies for glaucoma patients. Full article

Wipe-out is defined as a sudden, unexplained, and irreversible loss of residual central vision following glaucoma surgery, typically in eyes with advanced visual field damage and severely compromised optic nerves. The purpose of this review is to critically assess the current incidence, risk factors, pathophysiological mechanisms, and clinical relevance of “wipe-out”, a rare but devastating complication of glaucoma surgery characterized by sudden, unexplained central vision loss postoperatively. A comprehensive literature review was conducted, analyzing key peer-reviewed studies from electronic databases (PubMed, Medline, and Google Scholar) published up to 2025. The data from the literature published prior to the year 2000 suggest that wipe-out incidences range broadly from <1% to 13%. Contemporary prospective studies and large-scale reviews indicate a significantly lower current incidence, frequently below 1%. Identified risk factors include severe preoperative visual field loss (especially split fixation), older age, immediate postoperative hypotony, and compromised optic nerve head perfusion. The proposed mechanisms involve acute vascular insults, ischemia–reperfusion injury, and accelerated apoptosis of already vulnerable retinal ganglion cells. Modern MIGS and refined trabeculectomy techniques exhibit notably lower wipe-out risks compared to historical data. The literature emphasizes preventive management, including careful patient selection, incremental intraocular pressure reduction, and minimally invasive anesthetic approaches. Although wipe-out syndrome represents a serious complication, its incidence in modern glaucoma surgery is minimal. The considerable benefits of contemporary surgical approaches—particularly MIGS—in preserving vision clearly outweigh this very low risk. Ophthalmologists should remain vigilant but confident in the safety and efficacy of modern glaucoma surgical techniques, emphasizing proactive intervention to prevent blindness rather than avoiding necessary surgery in consideration of the minimal risk of wipe-out. Full article

Background: This study aimed to report the efficacy and safety of peribleb autologous blood injections in patients with hypotony maculopathy following trabeculectomy. Methods: In this retrospective chart-review study, patients with hypotony maculopathy from over-filtering bleb following mitomycin C (MMC)-augmented trabeculectomy treated with ≥1 peribleb autologous blood injections, ≥12 months of follow-up, and macula optical coherence tomography (OCT) imaging were included. Patients with previous laser cyclophotocoagulation were excluded. Hypotony maculopathy was defined as choroidal folds in the macular region, as assessed by OCT. Results: Nine patients met the inclusion criteria (mean age 62.3 ± 17.0). The mean intraocular pressure (IOP) at hypotony maculopathy diagnosis was 3.8 ± 1.5 mmHg. Most (n = 7) patients received a single injection (4 injections n = 1, 5 injections n = 1). Significant improvements in mean overall IOP after blood injection were observed (8.3 ± 2.4 mmHg; p = 0.008). Improvements in visual acuity and the resolution of hypotony maculopathy were observed in patients requiring a single injection only. No intra-operative adverse events were recorded. Successful bleb surgical revision was performed for two patients refractory to blood injections. Conclusions: Peribleb autologous blood injection increased IOP, improved visual acuity, and resolved hypotony maculopathy in 5.3 weeks in 7/9 patients. This procedure is not a contra-indication for further surgical revision. Full article

Background/Objectives: In glaucoma patients, the fluctuation in intraocular pressure during the day seems to have an influence on the progression of the disease. The contact lens sensor (CLS) Triggerfish^® from the company SENSIMED records ocular dimensional changes for 24 h. The aim was to determine the amplitude of the measurements with a contact lens sensor before and after trabeculectomy (TE) in glaucoma patients. Methods: Twelve patients with glaucoma were included in this prospective, single-arm, single-center, interventional study. All patients received a CLS measurement for 24 h 8 ± 2 days before and 12 weeks (±1 week) after surgery. The raw data of the measurements were modeled using a double-harmonic cosine function. Fluctuation in the raw CLS data, amplitude, and the MESOR (midline estimating statistic of rhythm, rhythm-adjusted mean) of the modeled data were investigated. The safety and feasibility of the CLS measurements were evaluated. Results: Nine patients underwent the complete 24-h wearing period before and after surgery. Whereas the MESOR changed significantly before and after surgery (p = 0.04), the amplitude of the modeled data did not change significantly and the daytime fluctuation and circadian rhythm also did not vary significantly. The CLS could be safely removed from all study eyes after surgery. Conclusions: The non-significant change in amplitude suggests that diurnal fluctuations persist after TE. This contrasts with reports in the literature that show that TE reduces diurnal fluctuations. It can be assumed that the significant reduction in the MESOR represents the reduction in the average intraocular pressure over 24 h. The CLS can be used safely three months after TE. Full article

The aim of this study is to present interesting images of a clinical case of asymmetrical bilateral ciliary body cysts associated with pseudoexfoliative syndrome (PEX), leading to unilateral reverse pupillary block and subsequent secondary angle-closure glaucoma in a 64-year-old patient who presented with vision loss and redness, revealing angle-closure glaucoma in the left eye. Slit lamp examination showed an asymmetrical iris configuration between the eyes, with a normal appearance in the right eye and an inverted “volcano-shape” iris appearance, corresponding to reverse pupillary block, with pseudoexfoliation in the left eye. Multimodal imaging confirmed the presence of bilateral ciliary body cysts, which were unexpectedly identified in the right eye. The patient’s secondary angle-closure glaucoma in the left eye was likely due to anterior displacement of the iris from these cysts. Following an inadequate response to topical and systemic treatments, the patient underwent trabeculectomy in the left eye, successfully stabilizing the intraocular pressure (IOP) and leading to the resolution of the reverse pupillary block. This case underscores the importance of thorough ocular examination and multimodal imaging in diagnosing complex clinical presentations like secondary angle-closure glaucoma stemming from the combination of ciliary body cysts’ pressure towards the angle, the pseudoexfoliative material component, and the reverse pupillary block configuration. All of the findings provided critical diagnostic clues leading to the identification of the underlying pathology. Full article

Objectives: This study evaluated the clinical preferences of glaucoma specialists regarding glaucoma surgery and postoperative management in Japan in 2024. Methods: A survey about clinical practice preferences regarding glaucoma surgery and postoperative care was administered among 50 glaucoma specialists who were councilors in the Japan Glaucoma Society. Results: Minimally invasive glaucoma surgery (MIGS) plus phacoemulsification was the most preferred procedure for nonoperated mild to moderate cases of primary open-angle glaucoma (POAG) (94.6%) and normal tension glaucoma (NTG) (67.3%) associated with cataract. Microhook surgery was the most preferred among the MIGS procedures. Meanwhile, PreserFlo MicroShunt (PMS) surgery is emerging as a popular option for cases of POAG and NTG, especially in advanced-stage pseudophakic eyes that underwent prior corneal incision phacoemulsification (40.1%). Long-tube shunt surgeries were predominantly preferred for POAG after two failed trabeculectomies (69.4%) and for neovascular glaucoma with prior vitrectomy after a failed trabeculectomy (73.0%). Among long-tube shunt surgeries, the Ahmed glaucoma valve (AGV) was preferred over the Baerveldt glaucoma implant. Trabeculectomy required the most frequent follow-up visits within the first postoperative year, whereas PMS and long-tube shunt surgeries required comparatively fewer follow-up visits. Overall, MIGS involved less frequent follow-up visits versus filtering surgeries. Conclusions: MIGS is currently the procedure of choice for primary glaucoma surgery in Japan. Among glaucoma specialists of the Japan Glaucoma Society, PMS surgery is becoming popular for cases of POAG and NTG. Refractory glaucoma is commonly treated with long-tube shunt surgeries, especially the AGV. Full article

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

Childhood glaucoma encompasses a group of rare but severe ocular disorders characterized by increased intraocular pressure (IOP), posing significant risks to vision and quality of life. Primary congenital glaucoma has a prevalence of one in 10,000–68,000 people in Western countries. More worryingly, it is responsible for 5–18% of all childhood blindness cases. According to the Childhood Glaucoma Research Network (CGRN), this spectrum of disease is classified into primary glaucoma (primary congenital glaucoma and juvenile open-angle glaucoma) and secondary glaucomas (associated with non-acquired ocular anomalies, non-acquired systemic disease, acquired conditions, and glaucoma after cataract surgery). They present very specific ocular characteristics, such as buphthalmos or progressive myopic shift, corneal modifications such as Haab striae, corneal edema or increased corneal diameter, and also glaucoma findings including high intraocular pressure, specific visual fields abnormalities, and optic nerve damage such as increased cup-disc ratio, cup-disc ratio asymmetry of at least 0.2 and focal rim thinning. Surgical intervention remains the cornerstone of treatment, and initial surgical options include angle surgeries such as goniotomy and trabeculotomy, aimed at improving aqueous outflow. For refractory cases, trabeculectomy and glaucoma drainage devices (GDDs) serve as second-line therapies. Advanced cases may require cyclodestructive procedures, including transscleral cyclophotocoagulation, reserved for eyes with limited visual potential. All in all, with appropriate management, the prognosis of PCG may be quite favorable: stationary disease has been reported in 90.3% of cases after one year, with a median visual acuity in the better eye of 20/30. Immediate recognition of the specific signs and symptoms by caregivers, primary care providers, and ophthalmologists, followed by prompt diagnosis, comprehensive surgical planning, and involving the caregivers in the follow-up schedule remain critical for optimizing outcomes in childhood glaucoma management. Full article

Background/Objectives: Micropulse laser trabeculoplasty (MLT) is gaining attention as a non-invasive treatment option for primary open-angle glaucoma (POAG), offering an alternative to traditional surgeries and medications. This systematic review evaluates the effectiveness, safety, and potential of MLT in glaucoma management. Methods: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, following the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. Results: We identified 79 articles, and after removing duplicates and screening abstracts, 56 articles were eligible for further review. A detailed full-text analysis was conducted on 26 articles, of which 15 met the predefined inclusion criteria. Conclusions: MLT shows promise as a primary or adjunctive treatment for reducing intraocular pressure (IOP) in glaucoma and ocular hypertension patients. Current evidence supports its efficacy and safety; however, additional long-term studies are needed to confirm its durability and compare its effectiveness with traditional surgical and pharmacological approaches. Standardizing treatment protocols and refining patient selection criteria could enhance MLT’s clinical value and support its broader adoption in glaucoma care. Full article

Background: The PreserFlo™ MicroShunt (PFMS) is a bleb-forming device considered to be less invasive than traditional glaucoma surgery such as trabeculectomy. This study evaluates the 1-year success rates as well as safety profile of PFMS in patients having high intraocular pressure (IOP) and/or glaucoma refractory to drop therapy with a history of prior intravitreal dexamethasone therapy. Methods: A total of 16 eyes after PFMS implantation due to elevated IOP after intravitreal dexamethasone implant (DEX-I) administration were included in this retrospective cohort study. Success rates and secondary outcomes were evaluated. Results: Qualified and complete success rates at 12 months, respectively, were 14/16 and 12/16 eyes for criterion A, 13/16 and 11/16 eyes for B, 13/16 and 11/16 eyes for C, and 6/16 and 6/16 eyes for D. The overall mean (range) preoperative IOP decreased from 27 (16–38) mmHg to 13 (10–17) mmHg at 12 months. BCVA was not significantly different up to 12 months (p = 0.63). The preoperative mean (range) number of medications decreased from 3.56 (2–4) to 0.31 (0–3) at 12 months. One eye underwent needling twice, and two eyes were revised surgically. One patient needed replacement of the PFMS. There were no hypotony-related complications. Conclusions: The PFMS is an effective surgical option for patients with steroid-induced IOP elevation. It demonstrates satisfactory short-term success rates, a reduced need for pressure-lowering eye drops, an excellent safety profile with minimal postoperative care, and a low complication rate. Additional interventions such as needling or revisions were infrequently necessary. However, PFMS may not be the ideal choice for cases requiring a low target pressure (≤12 mmHg). Full article

Introduction: To report the role of prostaglandin-associated periorbitopathy (PAP) severity on the surgical efficacy of Ahmed Glaucoma Valve (AGV) implantation. Subjects and Methods: Retrospective observational case series. Participants were the consecutive 102 eyes from 102 Japanese subjects (55 males, 47 females; mean age ± standard deviation, 74.9 ± 7.8 years) who underwent AGV implantation for primary open-angle glaucoma (POAG), completed full postoperative visits for 12 months, and had information on PAP severity graded by the Shimane University PAP Grading System (SU-PAP). Data were collected via medical chart review. Comparison of surgical success rates among groups stratified by SU-PAP grades (grades 0–3) using survival curve analysis. Failure was defined based on additional glaucoma surgery, IOP reduction in less than 20%, postoperative IOP exceeding 18 mmHg (definition A) or 15 mmHg (definition B), or postoperative visual acuity reduced to no light perception. Results: At 12 months postoperatively, the success rates for grades 0, 1, 2, and 3 were 47%, 43%, 42%, and 73%, respectively, for definition A (p = 0.35) and 35%, 26%, 19%, and 27%, respectively, for definition B (p = 0.64, log-rank test). For definition A, younger age was associated with surgical failure (Hazard ratio = 0.97/year, p = 0.049, Wald test), while no other factors, including gender, preoperative IOP, medications, refractive error, history of conjunctival manipulation procedures, or SU-PAP grade, were associated with surgical failure. For definition B, no factors were found to influence surgical outcomes. Conclusions: The preoperative severity of PAP might not affect the postoperative outcomes of AGV. Given that the success rate of trabeculectomy is influenced by PAP severity, in cases with severe PAP, physicians are advised to consider long-tube shunt surgery as an initial filtration procedure or as a rescue procedure when filtration surgery is unsuccessful. Full article

Background/Objectives: This paper will compare the outcomes—safety and efficacy—of three minimally invasive glaucoma surgeries (MIGSs),the Hydrus Microstent, iStent, and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT), for intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG). Methods: A literature search of Ovid Medline and Embase identified studies evaluating the Hydrus, iStent, and GATT. Data on IOP reduction, medication use, and complications were analyzed. Results: Studies show the Hydrus, iStent, and GATT reduce IOP and medication burden in POAG patients, with some complications. For the Hydrus, studies showed 37.09% (27.5 ± 4.4 to 17.3 ± 3.7 mmHg) and 25% (16.8 to 12.6 mmHg) IOP reduction. Meanwhile, medication burden decreased from 2.5 ± 0.7 to 1.0 and from 2.1 to 1.15. For the iStent, studies showed a 36.39% (21.1 to 13.4 mmHg) and 8.19% (17.1 to 15.7 mmHg) IOP drop. Medication burden decreased from 2.87 to 1.24 and from 1.7 to 0.26. For GATT, studies showed a 49.33% (27.70 ± 10.30 to 14.04 ± 3.75) and 39.09% (26.40 ± 6.37 to 16.08 ± 2.38) IOP drop. Medication burden reduced from 3.73 ± 0.98 to 1.82 ± 1.47 and from 3.12 ± 0.80 to 0.45 ± 0.96. Conclusions: The Hydrus, iStent, and GATT are effective alternatives to trabeculectomy for mild to moderate POAG. They reduce and control IOP and dependence on medications with manageable safety profiles. In all three options, there were some clinically significant complications based on the p-value. For the Hydrus, it was PAS. For the iStent, they were PAS, FB sensation, IOP spikes, and microhyphema. For GATT, it was IOP spikes. However, further long-term studies, especially randomized controlled trials, are needed to support these results. Full article

Background/Objectives: Glaucomatous neuropathy, a progressive deterioration of retinal ganglion cells, is the leading cause of irreversible blindness worldwide. While elevated intraocular pressure (IOP) is a well-established modifiable risk factor, increasing attention is being directed towards IOP-independent factors, such as vascular alterations. Color Doppler imaging (CDI) is a prominent technique for investigating blood flow parameters in extraocular vessels. This prospective, nonrandomized clinical trial aimed to assess the impact of ab externo canaloplasty on ocular blood flow parameters in patients with primary open-angle glaucoma (POAG) at a three-month follow-up. Methods: Twenty-five eyes of twenty-five patients with early or moderate POAG underwent canaloplasty with simultaneous cataract removal. CDI was used to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs) before and after surgery. Results: The results showed a significant reduction in IOP and improvement in mean deviation at three months post-surgery. Best corrected visual acuity and retinal nerve fiber layer thickness significantly increased at each postoperative control visit. However, no significant changes were observed in PSV, EDV, and RI in the studied vessels. Conclusions: In conclusion, while canaloplasty effectively reduced IOP and medication burden, it did not significantly improve blood flow parameters in vessels supplying the optic nerve at three months post-surgery. Careful patient selection considering glaucoma severity and vascular risk factors is crucial when choosing between canaloplasty and more invasive procedures like trabeculectomy. Further larger studies are needed to comprehensively analyze this issue. Full article