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The number of eye diseases treated with intravitreal injections is increasing. Obviously, an injection of fluid into the eye results in an increase of intraocular pressure (IOP), the main risk factor for glaucoma. However, the effect of these repeated IOP increases on the eye is unclear. Therefore, we performed a systematic review with meta-analyses. PubMed, Embase and Clinical Trials Registries were searched for articles investigating the relationship between intravitreal injections (anti-vascular endothelial growth factor [anti-VEGF] or steroids) and either IOP, retinal nerve fiber layer (RNFL)-thickness and glaucoma. Multiple meta-analyses were performed, combining data on intravitreal injection of anti-VEGF medication and dexamethasone implants. A total of 74 articles were eligible for meta-analyses. The short-term effect of an intravitreal injection of anti-VEGF showed a statistically significant increase in IOP. One day after injection of anti-VEGF, however, IOP was significantly lower than baseline. The long-term time-intervals showed no significant difference in IOP. After intravitreal injection of a dexamethasone implant, IOP was significantly higher than baseline 1 month post-injection. RNFL-thickness was significantly reduced 6 and 12 months post-injection of anti-VEGF, as well as at end of follow up. Caution is advised when using intravitreal medication, especially when treating patients with advanced glaucoma; in these cases, prophylactic IOP-lowering medication may be considered.

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness in the world and is influenced by various sociodemographic factors. This meta-analysis aims to determine the worldwide prevalence of POAG in the adult general population for the last 20 years, and explore variation in prevalence by age, gender and geographical location. An electronic literature search was performed using the PubMed, Embase, and Web of Science databases. Population-based cross-sectional or cohort studies published in the last 20 years (2000–2020) that reported prevalence of POAG were recruited. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. The prevalence of POAG was analyzed according to various risk factors. A random effect model was used for the meta-analysis. Fifty publications with a total of 198,259 subjects were included in this meta-analysis. The worldwide overall prevalence of POAG was 2.4% (95% CI 2.0 ~ 2.8%). The prevalence increases with age. Men are found to be more susceptible to POAG than women (RR 1.28, p < 0.01). Africa is found to have the highest prevalence of POAG (4.0%) among all continents. The current estimated global population of POAG is 68.56 million (95% CI 59.99 ~ 79.98). POAG is a worldwide vision threatening disease with high prevalence for the last 20 years. The population-based prevalence of POAG varies widely across individual studies, due to variations in risk factors of age, gender, and population geographic location.

We conducted a retrospective observational cohort study using a nationwide claims database (JMDC database) to investigate the treatment persistence of antiglaucoma ophthalmic solution monotherapy. Patients aged 18 years or older who were diagnosed with glaucoma between November 2018 and August 2020, and prescribed omidenepag isopropyl (OMDI), prostaglandin F receptor agonists (FP), or beta-blockers (BB) monotherapies were included. A total of 36,450 patients (5,865 patients prescribed OMDI, 20,715 patients prescribed FP, and 9,870 patients prescribed BB) were analyzed. The cumulative treatment persistence rate at three years was 27.0% (95% confidence interval [CI]: 25.9–28.1) in patients prescribed OMDI, which was significantly higher than 20.9% (95% CI: 20.4–21.5) in those prescribed FP; the hazard ratio was 0.835 (95% CI: 0.806–0.865, p  < 0.0001), calculated with the multivariate Cox proportional hazards model. The median duration of treatment persistence, calculated with the Kaplan-Meier methods, was 281 days in those prescribed OMDI, 204 days in those prescribed FP, and 152 days in those prescribed BB; the treatment persistence of OMDI tended to be longer than FP or BB. OMDI had a longer treatment persistence compared to other antiglaucoma ophthalmic solutions in the real-world setting, suggesting that OMDI would be a promising first-line treatment option in the long-term management of glaucoma.

This study compared the efficacy safety profiles of the Xen 63 and Preserflo MicroShunt devices, both standalone, in patients with primary open-angle glaucoma (POAG). It is a retrospective and single-center study conducted on consecutive on patients with medically uncontrolled POAG who underwent either a standalone Xen 63 or a standalone Preserflo and had a 12-month follow-up visit. The primary outcome was the mean IOP at month-12. Sixty eyes were included, 30 eyes in each Xen 63 and Preserflo groups, respectively. Preoperative IOP was significantly lowered from 20.8 ± 3.6 mmHg and 19.1 ± 3.8 mmHg to 14.2 ± 4.5 mmHg and 12.8 ± 2.3 mmHg in the Xen 63 and Preserflo groups, respectively ( p  < 0.0001 each, respectively); without significant differences between groups ( p  = 0.1346). Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.6 to 0.2 ± 06 drugs and from 2.3 ± 0.7 to 0.3 ± 0.6 drugs, in the Xen 63 and Preserflo groups, respectively ( p  < 0.0001 each, respectively); without significant differences between groups ( p  = 0.5212). Regarding safety, one (3.3%) eye in the Preserflo group required a device removal due to maculopathy. Three (10.0%) eyes in the Xen 63 group underwent needling. In conclusion, both the Xen 63 and the Preserflo devices effectively and safely reduced IOP and the requirement for IOP-lowering medications, exhibiting comparable IOP levels after 12 months.

Accurate, comprehensive, and consistent reporting of adverse events is of great importance for treatment decisions in clinical practice and patient safety. Aiming to evaluate the completeness and transparency of reported adverse events we conducted a retrospective analysis of completed clinical trials on glaucoma interventions registered in ClinicalTrials.gov from September 27, 2009, and updated and with results on or before November 1, 2023, as well as in corresponding journal publications. Any difference in completeness, number, or terminology/description of adverse events and all-cause mortality between ClinicalTrials.gov and the publication was categorized as inconsistent reporting of adverse events. All 79 trials with results both in the registry and a journal publication exhibited at least one inconsistency in reporting adverse events. In 19 publications (24%), the number of serious adverse events was smaller than in the registry. 69 (87%) trials reported more other adverse events in the registry than in the publication. Trials completed after the FDAA mandate for summary reporting of all-cause mortality more often reported this item in the registry but not in the publication. Trials on glaucoma interventions do not consistently report adverse events and thus introduce concerns about study credibility and potential harms of the interventions. Journals and other stakeholders in trial reporting must address this problem to ensure the safety of patients and trust in health interventions.

To assess the efficacy of using a nylon suture as a stent in the PreserFlo MicroShunt (PMS) lumen to prevent postoperative hypotony, 59 eyes that underwent PMS implantation with follow-up for > 6 months were analyzed. Patients were divided into no intrastenting (NST) and intrastenting (ST) groups, with the ST group subdivided into 9 − 0 nylon suture fully placed (9 F), 9 − 0 nylon suture placement in only half of the lumen (9 H), 10 − 0 nylon suture fully placed (10 F), and 10 − 0 nylon suture placement in only half of the lumen (10 H). The distribution was as follows: 23 eyes in the NST group, 10 in the 9 F group, 9 in the 9 H group, 11 in the 10 F group, and 6 in the 10 H group. No significant differences were observed in preoperative and 6-month postoperative intraocular pressure, number of glaucoma medications, or cumulative survival rate between groups. Postoperative hypotony occurred in 13 eyes (56.5%) in the NST group, one (2.78%) in the ST group ( p  = 0.00014). Post-intrastent removal, hypotony occurred in 6 eyes (16.7%) in the ST group. These findings suggest that intrastent placement effectively prevents postoperative hypotony, regardless of nylon suture diameter or insertion length; however, timing is crucial as hypotony may occur after removal.

This study compares the one-year outcomes of standalone Ahmed glaucoma valve (AGV) implantation and standalone Paul glaucoma implant (PGI) in adult patients with primary and secondary glaucoma. A retrospective, single-center, comparative study was conducted on adult patients who underwent standalone PGI and AGV at the University Medical Center Mainz. The primary outcome measures were the changes of IOP and the number of antiglaucoma eye medication at one year postoperatively. Secondary outcome measures included complete and qualified success rates, failure rates, visual acuity logMAR and the incidence of adverse events. A total of 24 adult patients were included in the AGV group and 28 in the PGI group. The median preoperative intraocular pressure decreased from 29.5mmHg (Interquartile range (IQR) 21–42) to 16.0mmHg (IQR 7–37) in the AGV group, and from 34.0 mmHg (IQR 13–56) to 16.0 (IQR 7–21) mmHg in the PGI group at the one-year follow-up. The median number of classes of intraocular pressure-lowering medications reduced from 3.5 to 0 in the AGV group, and from 3.0 to 0 in the PGI group. There were no statistically significant differences between the groups for any success criteria or failure. The AGV produced more encapsulation than the PGI, and the latter more tube exposures. Both the Ahmed Glaucoma Valve and the Paul Glaucoma Implant effectively reduce IOP and the number of antiglaucoma medications at one year with comparable safety profiles.

The ability of deep learning architectures to identify glaucomatous optic neuropathy (GON) in fundus photographs was evaluated. A large database of fundus photographs (n = 14,822) from a racially and ethnically diverse group of individuals (over 33% of African descent) was evaluated by expert reviewers and classified as GON or healthy. Several deep learning architectures and the impact of transfer learning were evaluated. The best performing model achieved an overall area under receiver operating characteristic (AUC) of 0.91 in distinguishing GON eyes from healthy eyes. It also achieved an AUC of 0.97 for identifying GON eyes with moderate-to-severe functional loss and 0.89 for GON eyes with mild functional loss. A sensitivity of 88% at a set 95% specificity was achieved in detecting moderate-to-severe GON. In all cases, transfer improved performance and reduced training time. Model visualizations indicate that these deep learning models relied on, in part, anatomical features in the inferior and superior regions of the optic disc, areas commonly used by clinicians to diagnose GON. The results suggest that deep learning-based assessment of fundus images could be useful in clinical decision support systems and in the automation of large-scale glaucoma detection and screening programs.

This study aimed to determine whether glaucoma progression was linear or not in newly diagnosed exfoliation glaucoma patients. A total of 96 patients with newly diagnosed exfoliation glaucoma were included. These patients were required to undergo at least seven visual field tests within 3 years (± 1 month), and all were treated at the time of inclusion. The study was a non-randomized, prospective cohort study. The outcome of the study was visual field progression. Progression was assessed based on mean deviation (MD), visual field index (VFI), and “Guided Progression Analysis”. The MD and VFI values were plotted against time, and distribution and curve fit were calculated. The results showed that the general rate of progression of the cohort was − 3.84 (± 2.61) dB for the MD values and 9.66 (± 6.25)% for the VFI values over 3 years. The best-fitted curve for MD and VFI values in the 36 months period was significant for both linear and exponential curves ( p  ≤ 0.001; p  ≤ 0.001). However, in the MD group, the F and the R 2 values were higher for exponential than for linear function (linear: F = 42.60, R 2  = 0.059; exponential: F = 53.26, R 2  = 0.073). The opposite results were found among VFI values. The F and the R 2 values were slightly better for linear than for exponential (linear: F = 37.22, R 2  = 0.052; exponential: F = 35.55, R 2  = 0.050). In conclusion, the study found that visual field progression between diagnosis and 18 months seemed to be exponential. However, after 18 months, the IOP reduction effects probably ameliorated progression, making the curve linear.

Glaucoma drainage devices (GDD) are an important treatment option for advanced and complex glaucoma patients. To prevent tube erosion, different materials may be used to patch the tube. The aim of this study was to compare tube erosion rates of allogenous fascia lata versus corneal stromal patches relating to Ahmed glaucoma implant (AGI) and Paul glaucoma implant (PGI) surgeries. In this retrospective study, 84 patients were included. The tube was covered with allogenous fascia lata ( n  = 43) or a corneal stromal patch ( n  = 41). 32 eyes of 31 patients underwent AGI and 52 eyes of 52 patients underwent PGI surgeries. The number of tube erosions was evaluated during 18 months of follow-up. Tube erosions occurred in 4 patients with fascia lata patches (9.3%) and 1 patient (2.4%) with a corneal stromal patch ( p  = 0.184). In the superior quadrants ( n  = 78; 92.9% of all GDD), tube erosions were significantly more frequent with fascia lata ( n  = 4) compared to corneal stromal ( n  = 0) patches ( p  = 0.045). There was no difference in the number of tube erosions between the AGI ( n  = 2) and PGI ( n  = 3) group ( p  = 0.928). Tube erosions after GDD are rare. Fascia lata patches were more frequently associated with tube erosions than corneal stromal patches.