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The term glaucoma refers to a broad group of diseases causing characteristic optic nerve damage. Elevated intraocular pressure (IOP) does not define glaucoma but has been strongly associated with the development and progression of glaucomatous damage and is currently the only modifiable risk factor. Among new surgical procedure to reduce IOP, the XEN gel stent implantation offers sub-conjunctival filtration by the implantation of a flexible 6mm tube. In the present work we have prospectively collected data on XEN implantations performed at our site with the aim to assess the efficacy and safety of the procedure. In this research we found that a post-operative IOP below or equal to 9 mmHg, which is the theoretical pressure drop of the implant, is also predictive of long-term efficacy of the procedure. We reported and analysed two relevant complications regarding the XEN implantation. Choroidal detachment has been associated with higher patient's age and with an increased number of IOP-lowering drugs. We also reported cases where the implant appeared damaged during the follow-up and we described the clinical course. Then, comparing XEN with trabeculectomy, we found that the two procedures are comparable when the IOP success criterion is in the mid-teens but is favourable to trabeculectomy when a very low IOP target is needed.

OBJECTIVE: To identify systematic reviews on interventions for glaucoma conditions and assess their reliability, thereby generating a list of potentially reliable reviews for updating the glaucoma practice guidelines. DESIGN: Cross sectional study PARTICIPANTS: Systematic reviews of interventions for glaucoma conditions. METHODS: We used a database of systematic reviews and meta-analyses in vision research and eye care maintained by the Cochrane Eyes and Vision United State Satellite as a source of reviews. We examined all Cochrane systematic reviews of interventions for glaucoma conditions published before August 7(th), 2019 and all non-Cochrane systematic reviews of interventions for glaucoma conditions published between January 1(st), 2014 and August 7(th), 2019. MAIN OUTCOME MEASURES: We assessed eligible reviews for reliability, extracted characteristics, and summarized key findings from reviews classified as reliable. RESULTS: Of the 4,451 systematic reviews in eyes and vision identified, 129 met our eligibility criteria and were assessed for reliability. Of these, we classified 49 (38%) as reliable. We found open-angle glaucoma (22/49) to be the condition with the most reviews and medical management (17/49) and intraocular pressure (43/49) to be the most common interventions and outcomes studied. Most reviews found a high degree of uncertainty in the evidence, which hinder the possibility of making strong recommendations in guidelines. These reviews found high-certainty evidence about a few topics: reducing IOP helps prevent glaucoma and its progression; prostaglandin analogues are the most effective medical treatment for lowering IOP; laser trabeculoplasty is as effective as medical treatment as a first-line therapy in controlling IOP; the use of IOP lowering medications peri- or post-operatively to accompany laser (e.g., trabeculoplasty) reduces the risk of post-operative IOP spikes; conventional surgery (i.e., trabeculectomy) are more efficacious than medications in reducing IOP; antimetabolites and beta-radiation improve IOP control after trabeculectomy. There is weak evidence regarding the effectiveness of minimally invasive glaucoma surgeries. CONCLUSIONS: The majority of systematic reviews evaluating interventions for glaucoma are of poor reliability. Even among those that may be considered reliable, there are important limitations in the value of information due to the uncertainty of the evidence as well as small and sometimes unimportant clinical differences between interventions.

To investigate the clinical, anatomical, and patient-reported outcomes of phacoemulsification (PE) with intraocular lens implantation performed to treat primary angle closure (PAC) and primary angle-closure glaucoma (PACG).Patients were evaluated at baseline and at 6 months after PE. The examination included visual acuity, intraocular pressure (IOP), visual field, optic nerve head, endothelial cell count (ECC), aqueous depth, and ocular biometric parameters. Patient-reported visual function and health status were assessed. Coprimary outcome measures were IOP changes, angle widening, and patient-reported visual function; secondary outcome measures were visual acuity changes, use of IOP-lowering medications, and complications. Univariate and multivariate analyses were performed to determine the predictors of IOP change.Thirty-nine cases were identified, and postoperative data were analyzed for 59 eyes, 39 with PACG and 20 with PAC. Globally, PE resulted in a mean reduction in IOP of -6.33 mm Hg (95% CI, -8.64 to -4.01,Our data support the usefulness of PE in lowering the IOP in patients with PAC and PACG. Although PE resulted in several anatomical and patient-reported visual improvements, we observe that a marked decrease in ECC should be carefully weighed before surgery.

Background/objectives: To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control). Methods: Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value Results: A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65–0.80 and 0.61–0.75, respectively, p Conclusion: This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.