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ObjectiveTo compare the efficacy and safety of ab interno canaloplasty (ABiC) with gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG).MethodThis randomised clinical trial recruited eyes with OAG and no previous incisional ocular surgery, among which 38 were randomised to ABiC and 39 to GATT. Follow-ups were performed at 1, 3, 6 and 12 months postoperatively. The primary outcome measures were intraocular pressure (IOP) and use of glaucoma medication at 12 months postoperatively. The secondary outcome measure was complete surgical success (not requiring glaucoma surgery, IOP ≤21 mm Hg and non-use of glaucoma medications).ResultsBoth groups had similar demographic and ocular characteristics. A total of 71 of the 77 subjects (92.2%) completed 12-month follow-up. At 12 months, mean IOP was 19.0±5.2 mm Hg in the ABiC group and 16.0±3.1 mm Hg in the GATT group (p=0.003). Overall, 57.2% of ABiC patients and 77.8% of GATT patients were medication free (p=0.06). The number of glaucoma medications was 0.9±1.3 in the ABiC group and 0.6±1.2 in the GATT group (p=0.27). The 12-month cumulative rate of complete surgical success was 56% in the ABiC group and 75% in the GATT group (p=0.09). Three eyes in the ABiC group and one eye in the GATT group required additional glaucoma surgery. Hyphema (87% vs 47%) and supraciliary effusion (92% vs 71%) were noted more often in the GATT group than in the ABiC group.ConclusionsThe preliminary result showed that GATT had an advantage over ABiC in IOP reduction for OAG patients, accompanied by favourable safety at 12-month postoperatively.Trial registration numberChiCTR1800016933.

We demonstrated whether the difference of trabecular meshwork remodeling occur depending on the incisional cross-sectional area by comparing Kahook dual-blade goniotomy (KDB) and ab interno trabeculotomy with a microhook. Phakic eyes with primary open-angle or exfoliative glaucoma were randomised into a KDB or a microhook group. The primary outcome was an incisional cross-sectional area quantified by anterior segment optical coherence tomography. In subgroup analysis, the number of patients with the unidentifiable incisional area was compared between the groups. Secondary outcomes were the rate of intraocular pressure changes, the laser flare metre values, corneal endothelial cell densities, the number of glaucoma medications, the usage rate per glaucoma medication type and postoperative complications between the two groups. A total of 29 eyes in 29 patients in the KDB and microhook group were included respectively, with an overall mean age of 72.6 ± 8.1 years. The incisional cross-sectional area of the KDB group was significantly larger at 1 week and at 1, 6 and 12 months ( p  < 0.01) postoperatively. The number of patients with the nonidentified incisional area was higher at 1, 6 and 12 months postoperatively ( p  ≤ 0.03) in the microhook group. The flare values in the KDB group were higher than those in the microhook group at 12 months postoperatively ( p  = 0.02). No significant differences were observed in other secondary outcomes. Incisional cross-sectional area remains larger in eyes treated with KDB goniotomy than in those treated with ab interno trabeculotomy with the microhook, whereas KDB goniotomy did not have an advantage in controlling intraocular pressure postoperatively. Trial registration: UMIN000041290 (UMIN, University Hospital Medical Information Network Clinical Trials Registry of Japan; date of access and registration, 03/08/2020).

Purpose To compare outcomes of phaco-canaloplasty (PC) and phaco-non-penetrating deep sclerectomy (PDS) with a viscoelastic compound. Methods This study included 29 eyes after PC and 30 after PDS. Indications were uncontrolled primary open-angle glaucoma (POAG) and a cataract. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), and number of medications were evaluated. Follow-up examinations were performed on days 1 and 7, and after 1, 3, 6, and 12 months. Complete and qualified success was an IOP ≤ 18 mmHg. Results At the 12-month follow-up, mean IOP decreased in the PC group from 19.0 ±6.9 mmHg to 12.6 ±2.7 mmHg, and in the PDS group, from 19.1 ±5.8 mmHg to 14.3 ±3.5 mmHg ( P  < 0.05). Both groups preoperatively and at 12 months showed no significant differences in IOP ( P  > 0.05). There was no statistically significant difference between the number of medications used ( P  > 0.05). Complete and qualified success rates for both groups were 79.0 % and 76.9 % ( P  = 0.701). The most frequent postoperative PC complication was hyphema (58.0 %); for PDS, bleb fibrosis was most frequent (26.7 %). No PC patients required postoperative management. PDS patients required postoperative interventions 58.7 % of the time, including a 5-fluorouracil (5-FU) injection (58.7 %), suture lysis (48.3 %), and needling (27.6 %). Conclusions Both PC and PDS lead to an effective decrease in IOP on a short-term follow-up basis and demonstrate similar efficacy and safety profiles. PDS patients required additional procedures including 5-FU injections, suture lysis, or needling. PC patients required no additional procedures.

Purpose The aim of this work was to study the reduction in intraocular pressure (IOP) after two selective laser trabeculoplasty (SLT) treatments in the same area of the trabecular meshwork (TM) compared to two SLT treatments in two different areas of the TM when the initial SLT treatment has failed. Methods This was a prospective randomized clinical trial for testing the effect of repeated SLT treatments in reducing IOP. The patients in the study all suffered from primary open-angle or pseudoexfoliation glaucoma. All patients were treated initially with SLT (SLT 1) over 180° in the lower half of the TM. Patients who were chosen for retreatment with SLT (SLT 2) were asked to participate in the study. The patients in the study were randomized to either SLT 2 in the same, already-treated TM area or to SLT 2 in the upper untreated TM area. The IOP was measured before and 2 h, 1 month, 3 months, and 6 months after the SLT 2 treatment. Patients who changed medical therapy regimens during this time were excluded. Results A total of 40 patients were included in both groups. At baseline, there were no significant differences between the groups in regards to age ( t -test, p  = 0.44), gender (χ 2 , p  = 0.14), pseudoexfoliation glaucoma (χ 2 , p  = 0.07), time between SLT 1 and SLT 2 ( t -test, p  = 0.78), IOP before SLT 1 ( t -test, p  = 0.78), or IOP before SLT 2 ( t -test, p  = 0.32). At the conclusion of the study, there were no significant differences in IOP between the groups 2 h ( t -test, p  = 0.65), 1 month ( t -test, p  = 0.60), 3 months ( t -test, p  = 0.42), or 6 months ( t -test, p  = 0.66) after the SLT 2 treatment. Conclusions Two SLT treatments of the same TM area do not have a significant effect on IOP compared to two SLT treatments in two different areas.

Background The optimal surgical management in primary congenital glaucoma (PCG) remains a subject of debate. The aim of this study was to assess efficacy of pneumatic trabecular bypass (PTB) in comparison to conventional trabeculotomy (T) in the treatment of PCG. Methods In a prospective comparative experimental study, one eye per child suffering from PCG underwent either PTB or T. Complete examinations were performed before surgery, postoperatively at one and seven days, then monthly for a minimum of six months. The main outcome measures were the IOP, number of IOP-lowering medications, change in cup/disc ratio, and corneal clarity. Results Seventeen eyes (patients) were operated on for PTB compared to 25 eyes (patients) in the T group. The mean (±SD, range) preoperative IOP in the PTB and T groups was 34.7 (6.4, 26–48) mmHg and 26.4 (6.6, 18–44) mmHg, respectively, and these dropped at six months of follow-up to 14.9 (3.6, 11–24) mmHg and 18.8 (8.0, 6–34) mmHg, respectively. The mean reductions of IOP were 55.87 %(±11) and 28.4 %(±28.8), ( p  = 0.001), where those for cup/disc ratio were 39.0 %(±29) and 17.5 %(±39.7) ( p  = 0.088) in the PTB and T groups, respectively. The number of IOP-lowering medications had dropped from 1.7 ± 0.5 to 0.7 ± 1.0 in PTB patients, compared to an insignificant change in the T group (0.64 ± 0.9 & 0.62 ± 0.9 pre- and post-operatively respectively). Corneal clarity improved in 13 eyes (76.5 %) in the PTB group, while three eyes (12 %) had worsened in the T group. Total cumulative chances for success were 88.2 % (15 out of 17 eyes), compared to 56 % (14 out of 25 eyes), in the PTB and T groups, respectively ( p  = 0.027). Conclusions PTB is a promising surgical technique for the control of primary congenital glaucoma. A randomized controlled trial with a longer follow-up is recommended.

To evaluate structural alterations and healing responses in the trabecular meshwork region with optical coherence tomography (AS-OCT) following after gonioscopy assisted transluminal trabeculotomy (GATT) and microincisional trabeculectomy (MIT). 73 eyes of 67 patients (M:F = 45:22) with ≥6 months of follow-up after MIT (n = 41) or GATT (n = 32) with or without combined cataract surgery were included for this prospective study. The angle as seen on AS-OCT at 1, 3, 6 months after surgery were evaluated for structural alterations like peripheral anterior synechiae (PAS), hyphema, and hyperreflective scarring responses. The scarring was graded according to the linear extent measured from the centre of the trabecular meshwork (TM) gutter to the sclera/cornea as mild (<250μ), moderate (250-500μ), and severe(˃500μ), while the pattern of scarring was graded as open saucer/gutter, closed gutter, and trench pattern. The association of the need for medication or surgical outcome and clinical variables and AS-OCT parameters including the pattern and severity of scarring were analysed using multivariate regression. All eyes achieved significant reduction of IOP and number of medications with a final IOP of 15±3.2mm Hg at a mean follow-up of 8±32. months. While mild scarring was seen more common in MIT, severe scarring was seen in >65% of GATT eyes compared to 31% of MIT eye, p<0.001. An open saucer was equally seen in MIT and GATT while the trench pattern was more commonly seen in GATT eyes (>50%). Severe scarring in a trench pattern seemed to predict the need for medications for IOP control, though they independently did not seem to influence the final IOP or surgical outcome. A severe form of scarring in a trench pattern on AS-OCT predicted the need for glaucoma medications after MIGS surgery. Regular monitoring of the scarring responses by AS-OCT and clinical examination are necessary to identify those at need for medications after MIGS.

Aims:To evaluate the efficacy and tolerability of nonpenetrating filtering surgery in the treatment of patients with open-angle glaucoma. Methods: Pertinent studies were selected by extensive searches. A total of 17 randomized controlled trials were included in the present meta-analysis. The main outcome measures were risk differences (RDs) of complete success for efficacy and postoperative complications for tolerability. Pooled estimates were computed according to a random-effects model. Results:Viscocanalostomy and deep sclerectomy were significantly less effective than tra- beculectomy, and pooled RDs of complete success were –0.16 (95% confidence interval, CI, –0.30 to –0.02) and –0.10 (–0.19 to 0.00). Deep sclerectomy plus mitomycin C (MMC) was also less effective than trabeculectomy plus MMC, with pooled RD of complete success being –0.16 (95% CI –0.32 to –0.01). Viscocanalostomy and deep sclerectomy caused main complications in fewer patients than trabeculectomy. Conclusions:Viscocanalostomy and deep sclerectomy were less effective than trabeculectomy in the treatment of open-angle glaucoma, and deep sclerectomy plus MMC was also less effective than trabeculectomy plus MMC. However, viscocanalostomy and deep sclerectomy were associated with fewer complications than trabeculectomy.

Purpose To evaluate the effect of uneventful cataract surgery on Schlemm’s canal (SC) and the trabecular meshwork (TM) in cases with pseudoexfoliation (PX). Methods In this prospective study, 37 PX and 37 normal eyes, who underwent cataract surgery, were included. The PX group was further divided into two subgroups: PX syndrome (PXS) and PX glaucoma (PXG). Preoperative complete ophthalmologic examination, anterior segment (AS) imaging using a Scheimpflug camera, and measurements of SC length and area and TM thickness and length using AS optical coherence tomography (AS-OCT) were performed in all cases. All measurements were repeated at the first and third months after surgery. Results Preoperative intraocular pressure (IOP), AS parameters, SC, and TM values showed no significant differences between the groups ( p  > 0.05). After surgery, there was a significant increase in AS parameter values and a significant decrease in IOP values in both the PX and control groups ( p  < 0.05). The nasal and temporal SC area showed a significant increase in the PX group after surgery ( p  = 0.007, p  = 0.003, respectively). In the subgroup analysis, the only significant change in the nasal and temporal SC area was in the PXS group ( p  = 0.006, p  = 0.003, respectively). Conclusion Cataract surgery resulted in an increase in the SC area in patients with PXS. This increase may be due to multiple mechanisms including the IOP-lowering effect of cataract removal, change in AS, and removal of intraocular PX material after surgery.

The study aimed to compare the 12-month post-operative outcomes of iStent and iStent inject W (inject W), and the factors associated with their success in open-angle glaucoma. This single-center, retrospective comparative case series evaluated the medical records of patients who underwent iStent (comprising 1 stent) or inject W (comprising 2 stents) implantation with cataract surgery for primary open-angle glaucoma and normal tension glaucoma between January 2019 and March 2022. The 12-month post-operative efficacy outcomes included intraocular pressure (IOP), glaucoma medications, and survival analysis of the probability of success. \"Failure\" was defined as any of the following conditions compared to baseline: 1) IOP elevation, 2) increased glaucoma medication, or 3) IOP decline not exceeding 20% when glaucoma medication scores were comparable, and 4) need for additional glaucoma surgery. The safety outcomes included intra- and post-operative adverse events and changes in the best-corrected visual acuity and visual field. The study comprised 55 eyes in the iStent and 105 in the inject W groups. At 12 months, treatment success was achieved in 66.0% of iStent and 78.4% of inject W eyes. The mean IOP was lower, and the percent reduction from baseline was equal in iStent-treated eyes (8.0% reduction, 14.8 mmHg to 13.7 mmHg, P<0.01) and inject W-treated eyes (11.9% reduction, 15.0 mmHg to 13.8 mmHg, P<0.01) (between-group comparison, P = 0.23). The mean medication burden decreased significantly from 2.5 to 1.1 for iStent (55.0% reduction, P<0.01) and 2.9 to 1.7 for iStent inject (46.8% reduction, P<0.01), with no significant differences between the two groups (P = 0.17). Both devices exhibited excellent safety. Both devices significantly reduced IOP and glaucoma medication 12 months post-operatively. The outcome measures did not differ significantly between the two groups, and lower baseline IOP was predictive of surgical failure.

We performed a prospective, longitudinal study to investigate the association between the preoperative intrascleral vasculature assessed using anterior segment (AS)-optical coherence tomography angiography (OCTA) and surgical outcomes of trabecular meshwork-targeted micro- or minimally invasive glaucoma surgery (MIGS). We included 37 patients with primary open-angle glaucoma. Preoperative AS-OCTA images of the sclero-conjunctiva of the nasal corneal limbus were acquired in the superficial (conjunctival) and deep (intrascleral) layers. The vessel densities (VDs) of each layer were measured separately in the entire area, limbal side, and fornix area. Surgical success was determined by postoperative intraocular pressure (IOP) and IOP reduction. Twenty-three and 14 eyes were classified as having successful and unsuccessful outcomes, respectively. The deep VDs of the entire area and fornix area were significantly lower in the successful group ( P  = 0.031 and P  = 0.009). The success rate was significantly higher for eyes with a lower deep VD than for eyes with a higher deep VD. A greater IOP reduction was significantly associated with lower deep VD in the fornix area ( P  = 0.022) and higher preoperative IOP ( P  < 0.001). These results indicate that intrascleral vasculature assessed using preoperative AS-OCTA was negatively correlated with surgical success and IOP reduction resulting from trabecular meshwork-targeted MIGS. AS-OCTA images might help predict MIGS outcomes.