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Glaucoma and pregnancy is an uncommon combination, but it constitutes a very challenging situation for the treating doctor. The challenge is not only controlling the intraocular pressure and preventing glaucoma progression in the mother, but also having to deal with her mental stress and anxiety regarding the safety of her child. The situation is further worsened by the lack of definite guidelines as to how to deal with such patients. Relative rarity of glaucoma in this population restricts any large prospective randomized clinical trials or any large systematic studies. Moreover, none of the existing anti-glaucoma medications is absolutely safe in pregnancy. Current practice patterns depend on some case reports, a few observational studies and a few animal studies that attempt at determining the safety and efficacy of the available medicines. These are then prescribed on the basis of their relative safety in any particular stage of pregnancy or lactation. Newer medications that were released recently in 2018, such as Vyzulta and Rhopressa, presently have limited data to support their safety for use during pregnancy. Laser trabeculoplasty, conventional filtration surgery (of course without anti-metabolites), and minimally invasive glaucoma surgery represent a few non-pharmacological management options. Surgical procedures such as trabeculectomy and tube-shunts or collagen matrix implants, and newer minimally invasive glaucoma surgery procedures such as the gelatin stents are currently being explored and may prove to be viable solutions for severe glaucoma during pregnancy, although they too have their own inherent drawbacks. Management of glaucoma during pregnancy and lactation requires careful consideration of the disease status, gestational stage, US Food and Drug Administration classification and guidelines, and potential benefits and limitations of the various therapeutic modalities. This review focuses on the importance of a multidisciplinary team approach, starting with preconception planning and counseling, determining the treatment options depending on the stage of glaucoma and of pregnancy, and emphasizes the involvement of the patients, their obstetrician, and pediatrician through active discussion regarding the various medical, laser, or surgical modalities currently available or under exploration for use during pregnancy and lactation. The ultimate aim is to achieve an optimal balance between the risks and benefits of any type of intervention, and to customize treatment on an individual basis in order to achieve the best outcomes for both mother and fetus.

Glaucoma is considered a chronic disease that requires lifelong management. Chronic diseases are known to be highly associated with psychological disturbances such as depression and anxiety. There have also been many studies on association between anxiety or depression and glaucoma. The majority of these studies explained that the glaucoma diagnosis causes anxiety or depression. However, It is also necessary to evaluate whether the psychological disturbance itself affect glaucoma. Therefore, we investigated the association of anxiety and depression with glaucoma progression, and elucidate mechanisms underlying that. We included 251 eyes with open angle glaucoma who were followed up for at least 2 years in this retrospective case-control study. The Beck Anxiety Inventory (BAI) and Beck Depressive Inventory-II (BDI-II) were used to assess anxiety and depression in glaucoma patients. Patients were classified into groups (high-anxiety group; HA-G, low-anxiety group; LA-G, high-depression group; HD-G, low-depression group; LD-G) according to their score on the BAI or BDI-II (separately). In logistic regression analysis, disc hemorrhage, peak intraocular pressure (IOP) and RNFL thickness loss rate were significantly associated with high anxiety (p = 0.017, p = 0.046, p = 0.026). RNFL thinning rate and disc hemorrhage were significant factors associated with anxiety in multivariate models (p = 0.015, p = 0.019). Multivariate linear regression analysis showed a significant positive correlation between the rate of RNFL thickness loss and BAI score (B = 0.058; 95% confidential interval = 0.020–0.097; p = 0.003), and RNFL loss and IOP fluctuation (B = 0.092; 95% confidential interval = 0.030–0.154; p = 0.004). For the depression scale, visual field mean deviation and heart rate variability were significantly associated with high depression in multivariate logistic regression analysis (p = 0.003, p = 0.006). We suggest that anxiety increase the risk of glaucoma progression and they are also associated with IOP profile and disc hemorrhage.

Introduction: The rate of unknown glaucoma is around 50% in industrialized countries. The purpose of our study was to estimate the prevalence of unknown cases of ocular hypertension, glaucoma suspects, and glaucoma in patients consulting for refractive disorders in France. Methods: A retrospective study in the Point Vision ophthalmology center was led in Toulouse, France. All participants consulting for refractive disorders between June 2015 and June 2017 in the ophthalmology center were included. The cases were identified by the assessment of intraocular pressure, optic nerve head structure, and visual field. Ocular hypertension was defined as an intraocular pressure >21 mm Hg. Glaucoma was defined as the association of a glaucomatous papilla and two successive pathological visual fields. Glaucoma suspect was defined as the association of a glaucomatous papilla without visual field defect. The primary endpoint was the prevalence of unknown ocular hypertension, glaucoma suspects, and glaucoma in patients seen in an ophthalmology center. Results: A total of 66,068 patients (mean age = 37 years) consulted for a refraction visual assessment during the study period. Among them, 234 had a visual field and a retinal nerve fiber layer assessment for ocular hypertension and/or suspicious papilla. The prevalence of unknown cases of ocular hypertension, glaucoma suspect, and glaucoma was 2.6, 0.8, and 0.5 per 1,000 consultants, respectively. Median age at diagnosis of ocular hypertension, glaucoma suspect, and glaucoma was 52, 53, and 65 years, respectively. Conclusion: The present study highlights the importance of glaucoma screening in people over 40 years old with the measurement of intraocular pressure and an optic nerve head assessment.

Hintergrund: Die optische Kohärenztomographie-Angiographie (OCTA) ist eine neue, nichtinvasive Methode, die eine quantitative Beurteilung der retinalen Durchblutung und der Durchblutung am Sehnerv erlaubt. In dieser Arbeit erläutern wir die Grundlagen der Anwendung dieser Methode und geben einen Überblick über die Erkenntnisse, die durch diese Methode bei Glaukom gewonnen wurden. Methoden: Eine selektive Literaturrecherche und Auswertung eigener Daten liegen dieser Arbeit zugrunde. Ergebnisse: Quantitative OCTA-Parameter zeigen eine gute Reproduzierbarkeit bei Glaukompatienten. Glaukompatienten zeigen eine verminderte Flussdichte am Sehnerv sowie im Bereich der Makula im Vergleich zu einer gesunden Kontrollgruppe. Die Flussdichteparameter zeigen insgesamt eine gute diagnostische Diskriminierung. Sie sind aber den strukturellen Parametern, die in der Routinediagnostik angewendet werden, nicht überlegen. Die verminderte Flussdichte korreliert mit dem Ausmaß des strukturellen und funktionellen Glaukomschadens. Schlussfolgerung: Die OCTA ist nichtinvasiv, schnell und reproduzierbar. Erste Ergebnisse von Studien bei Glaukompatienten zeigen das hohe diagnostische Potenzial dieser Methode. In der klinischen Routine könnte die OCTA in Zukunft eine Rolle spielen.

Background: Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two.Methods: In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at controlled-trials.com (ISRCTN32038223). Findings: Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0·89 (SD 0·18) in the selective laser trabeculoplasty group versus 0·90 (SD 0·16) in the eye drops group, with no significant difference (difference 0·01, 95% CI −0·01 to 0·03; p=0·23). At 36 months, 74·2% (95% CI 69·3-78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93·0%) than in the eye drops group (91·3%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20 000 per quality-adjusted life-year gained. Interpretation: Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice. Funding: National Institute for Health Research, Health and Technology Assessment Programme.

Purpose: To evaluate papillary, peripapillary, and macular vasculature with optical coherence tomography angiography in preperimetric (PPG), primary open-angle glaucoma (POAG), and normal eyes, and to assess diagnostic ability and associations among the vasculature and structural damage. Methods: This was an observational, cross-sectional study. Retinal nerve fiber layer (RNFL), ganglion cell complex thickness, whole-image (wiVD), inside disc (idVD), peripapillary (ppVD), and macular vessel densities were obtained. Analysis of variance, post hoc test, and Pearson coefficient were used. The areas under the receiver operating characteristic curve (AUC) and cut-offs were calculated. Results: Thirteen healthy, 39 PPG, and 19 POAG eyes were included. Papillary and peripapillary VD were lower in POAG eyes in all parameters analyzed. wiVD in PPG eyes (52.37 ± 5.04%) was significantly decreased compared to healthy eyes (58.02 ± 2.02%, p < 0.05). AUC ranged from 0.62 to 0.90; the established cut-off values were 56% for wiVD, 55% for idVD, and 62% for ppVD. Pearson's correlation coefficient showed a direct correlation between the papillary or peripapillary VD and RNFL thickness. Conclusions: Vessel densities in POAG eyes are significantly lower than in healthy eyes, and they show good discriminatory abilities. A diminished microvascular network is associated with RNFL thinning more strongly in POAG than in PPG eyes.

Background: We assessed bleb morphology and the intraocular pressure(IOP)-lowering effect of trabeculectomy with ologen compared to mitomycin C (MMC) in juvenile open-angle glaucoma (JOAG). Methods: This is a prospective interventional comparative study conducted on 40 eyes (20 patients) with medically uncontrolled JOAG, randomly operating one eye for trabeculectomy with ologen (group A: 20 eyes) and the other with MMC (group B: 20 eyes). IOP measurement, SITA standard perimetry, and spectral domain optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness were all done pre- and postoperatively. Postoperative blebs were assessed clinically using the Moorfields bleb grading system (MBGS) and anterior segment OCT (AS-OCT). All patients were examined for up to 1 year postoperatively. Results: The mean postoperative IOP was statistically significantly lower than the mean preoperative IOP at each follow-up in each group. At 1 year, the mean postoperative IOP was significantly lower in group A. According to the MBGS, blebs with an ologen implant showed significantly better scoring than those with MMC. AS-OCT showed that ologen-induced blebs had significantly more fluid-filled spaces, cleavage planes, and less fibrosis. Conclusion: Ologen resulted in a lower long-term postoperative IOP, a better bleb morphology, and fewer complications. Our results suggest that ologen may be a useful alternative to MMC in JOAG.

Ziel: Untersuchung der Frage, ob sich postoperativ die Lichtempfindlichkeit vollständig regeneriert und nach erfolgreicher chirurgischer Behandlung einer rhegmatogenen Netzhautablösung (RNA) auf das Niveau vor deren Entwicklung zurückkehrt. Methoden: Wir untersuchten retrospektiv 44 Augen von 44 Patienten, bei denen eine RNA erfolgreich operiert und nachfolgend eine zentrale 30-2-Humphrey-Perimetrie durchgeführt worden war. Die Durchschnittsabweichung in der Humphrey-Perimetrie in der wiederangelegten Netzhaut wurde mit der horizontalen oder vertikalen Entsprechung in der präoperativ nicht-abgelösten Netzhaut verglichen. Ergebnisse: Die Durchschnittsabweichung in der wiederangelegten Netzhaut war signifikant niedriger als im Vergleichsareal (p < 0,0001). Der gemittelte verbleibende Lichtempfindlichkeitsverlust korrelierte nicht mit der postoperativen Sehschärfe (p = 0,8047) oder deren Veränderung (p = 0,8047). Schlussfolgerungen: Die Lichtempfindlichkeit in der abgelösten Netzhaut in Augen mit RNA regeneriert sich nach erfolgreicher operativer Behandlung nicht vollständig.

Ziel: Ziel dieser Studie ist die Untersuchung der Prävalenz und der klinischen Merkmale des Charles-Bonnet-Syndroms (CBS) bei einer Gruppe türkischer Patienten mit verschiedenen Netzhauterkrankungen. Methoden: 264 Patienten mit einem bestkorrigierten Visus von ≤20/40 im besseren Auge wurden mit einer standardisierten Frage nach dem Vorliegen von CBS-Symptomen befragt. Bei positiver Antwort wurde ein Fragebogen mündlich erhoben, um mehr über die Beschwerden im Einzelnen zu erfahren. Ergebnisse: An der Studie nahmen 125 (47,3%) Frauen und 139 (52,7%) Männer im mittleren Alter von 72,1 Jahren (Spannweite: 31-90 Jahre) teil. Bei 17 Patienten (6,4%) wurde ein CBS diagnostiziert. 3 Patienten (17,7%) hatten nichtkomplexe Halluzinationen, 14 (82,3%) hatten komplexe Halluzinationen. Schlussfolgerung: CBS ist bei Patienten mit einer Netzhauterkrankung und beeinträchtigtem Sehvermögen nicht ungewöhnlich. Kliniker, die Patienten mit beeinträchtigtem Sehvermögen behandeln, sollten an CBS denken. Übersetzung aus Ophthalmologica (DOI:10.1159/000446295)