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Purpose: To compare the effectiveness and safety of the Paul glaucoma implant (PGI) to the Ahmed glaucoma valve (AGV) in managing refractory childhood glaucoma., Design: Randomized controlled trial., Setting: Two clinical centers., Methods: An ongoing randomized controlled trial including patients ≤ 18 years with refractory childhood glaucoma in whom glaucoma drainage implant surgery was planned. Patients were randomized to receive either PGI or AGV. The primary outcome was the intraocular pressure (IOP) reduction. Secondary outcomes included glaucoma medication reduction, success rate, and complications rate. The success rate was defined as achieving a postoperative IOP between 6-21 mmHg without or with glaucoma medications (up to three topical glaucoma medications), without the need for additional glaucoma surgeries, and without the occurrence of vision-threatening complications or evidence of disease progression. The use of oral glaucoma medications, such as acetazolamide, was considered a failure., Results: The current report included 44 patients (44 eyes) who completed the one-year postoperative follow-up (25 in the PGI group versus 19 in the AGV group). The mean age at the time of surgery was 96.9 ± 59.1 months (90.5 ± 60.04 months in the PGI group and 105.4 ± 58.5 months in the AGV group). Preoperatively, the mean IOP was 32.6 ± 6.1 mmHg with a mean of 3.6 ± 0.6 glaucoma medications in the PGI group, compared with 29.8 ± 6.1 mmHg (P = .1) with a mean of 3.4 ± 0.7 glaucoma medications (P = .35) in the AGV group. At one year, there were no statistically significant differences in the mean IOP (14.9 ± 4.1 mmHg in the PGI group versus 15.5 ± 3.5 in the AGV group, P = .6) and number of glaucoma medications (1.1 ± 1 in the PGI group versus 1.6 ± 1.03 in the AGV group, P = .1). The success rate of PGI was 80% versus 73.6% in the AGV (P = .2). The postoperative complications rate was comparable in both groups (three eyes in each group)., Conclusion/relevance: At one year postoperatively, the IOP reduction, reduction of glaucoma medications, success rates, and rate of complications were comparable between both groups., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To compare safety, tolerability and intraocular pressure (IOP)-lowering efficacy of pattern scanning laser trabeculoplasty (PSLT) with selective laser trabeculoplasty (SLT) in fellow eyes of untreated patients with glaucoma., Design: Randomized controlled trial., Participants: Twenty-nine patients (58 eyes) with primary and secondary open angle glaucoma (OAG) were randomized to undergo PSLT or SLT in each eye., Methods: Pattern scanning laser trabeculoplasty was performed using the Pascal laser (Pascal Streamline 577; Topcon Inc., Tokyo, Japan). Patients' comfort level to treatment was assessed using a visual analogue scale (VAS). Follow-up visits were at week 1, month 1, 3 and 6. Success was defined as IOP reduction ≥20%., Main Outcome Measures: Safety, tolerability and IOP reduction., Results: The mean age of patients was 54.1 ± 15.5 years. Baseline IOP was similar between both groups (PSLT, 17.3 ± 4.0 mmHg; SLT, 16.8 ± 3.6 mmHg, p > 0.05). In the PSLT group, the mean IOP at 1, 3 and 6 months was 14.2 ± 3.5, 13.9 ± 2.6 and 14.0 ± 2.7 mmHg, respectively. In the SLT group, the mean IOP at 1, 3 and 6 months was 14.4 ± 4.1, 13.7 ± 3.2 and 13.7 ± 3.1 mmHg, respectively. The IOP reduction in the PSLT group was greater than the SLT group at 1 month (p < 0.01) and 3 months (p < 0.01). VAS score was better in PSLT eyes: 23.9 ± 20.5 (range, 0-82) than in SLT eyes: 50.4 ± 25.3 (range, 0-98) (p < 0.001). No serious adverse events were recorded., Conclusions: Both laser modalities had similar safety and efficacy profiles while PSLT was better tolerated by patients., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Current management of glaucoma entails the medical, laser, or surgical reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which is commensurate with either stability or delayed progression of visual loss. In the published literature, the hypothesis is often made that IOP control implies a single IOP measurement over time. Although the follow-up of glaucoma patients with single IOP measurements is quick and convenient, such measurements often do not adequately reflect the untreated IOP characteristics, or indeed the quality of treated IOP control during the 24-h cycle. Since glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous, it is logical that we should aim to understand the efficacy of all treatment options throughout the 24-h period. This article first reviews the concept and value of diurnal and 24-h IOP monitoring. It then critically evaluates selected available evidence on the 24-h efficacy of medical, laser and surgical therapy options. During the past decade several controlled trials have significantly enhanced our understanding on the 24-h efficacy of all glaucoma therapy options. Nevertheless, more long-term evidence is needed to better evaluate the 24-h efficacy of glaucoma therapy and the precise impact of IOP characteristics on glaucomatous progression and visual prognosis.

The evidence in support of intraocular pressure (IOP) lowering to reduce risk of glaucoma onset or progression is strong, although the amount and quality of IOP reduction is less well defined. The concept of a target IOP includes a percentage reduction, calculated IOP, or a predetermined IOP figure or range. Yet none of these strategies have been validated. In addition, our understanding of the way IOP influences glaucoma risk is continuously evolving. Examples of this include the data on IOP fluctuation and lamina cribrosa and cerebrospinal fluid pressure differentials. That these variables are not included in target IOP calculation potentially undermines its accuracy and usefulness. We summarize the evidence for target IOP, new developments in our understanding of IOP and glaucoma pathogenesis, as well as emerging strategies for setting targets and assessing response to treatment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aim: To evaluate the efficacy and tolerability of flunarizine, a nonselective calcium channel blocker, on intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH)., Design: Randomized, placebo-controlled, double blind, cross-over phase II trial., Methods: Ten patients diagnosed with bilateral OAG or OH were included. Each patient served as his own control. On the first study visit, 1 drop of either 0.05% flunarizine or placebo was applied in the study eye. Patients were followed-up during 6 hours (0, 15, 30, and 60 min, 2, 3, 4, and 6 h) for vital signs, slit lamp examination, corneal fluorescein staining, and IOP. After a wash-out period of 4 weeks, 1 drop of either placebo or flunarizine was applied in the same eye and patients were followed-up for another 6 hours., Results: The flunarizine group showed a statistically significant decrease from baseline at T2, T3, T4, and T6 hours (P=0.01, P=0.03, P=0.01, and P=0.03, respectively). No significant difference in IOP decrease from baseline (P>0.06) was observed between the 2 groups. There was no statistically significant difference in all of the following parameters: limbal hyperemia, bulbar or palpebral conjunctival hyperemia, corneal staining with fluorescein, best-corrected visual acuity, comfort of eye drops, and vital signs., Conclusions: The absence of a statistically significant difference in IOP reduction between the 2 groups may be due to the small number of patients included. However, a single dose of 0.05% flunarizine significantly reduced IOP when compared with baseline values, whereas this was not observed with placebo.

The authors report their initial clinical results with a novel wireless ocular telemetry sensor (OTS) (Sensimed AG, Switzerland) for continuous intraocular pressure (IOP) monitoring in patients with open angle glaucoma. This was a prospective, observational cohort of 15 patients. The OTS is a disposable silicone contact lens with an embedded micro-electromechanical system, which measures changes in corneal curvature induced by variations in IOP. An antenna, mounted around the eye, receives the data, which are then transmitted to a recorder. A signal was recorded in all patients. Thirteen (87%) patients completed 24-h IOP monitoring: one patient discontinued IOP monitoring due to device intolerance, and incomplete recordings were obtained in a second patient due to technical device malfunction. In 9/13 (69%) patients, the highest signals were recorded during the nocturnal period. No serious adverse events were recorded. The OTS shows good safety and functionality to monitor IOP fluctuations in patients over 24 h. This technology has the potential to provide hitherto unobtainable data on the chronobiology of IOP, possibly leading to improved care of glaucoma patients.

Aim: To investigate the relationship between intrascleral bleb height and intraocular pressure (IOP) following deep sclerectomy with collagen implant (DSCI) and mitomycin C (MMC) in eyes with clinically flat blebs., Methods: The records of 25 eyes of 22 consecutive patients presenting with clinically flat blebs following DSCI with MMC for primary or secondary open angle glaucoma were reviewed. Anterior segment optical coherence tomography (AS-OCT) scans were used to evaluate postoperative intrascleral bleb height and its relation to IOP control. Eyes requiring postoperative bleb manipulations, needling or goniopunctures were excluded., Results: The mean age of the patients was 71.9+/-12.6 years, and the mean preoperative IOP was 25.3+/-5.6 mm Hg. The mean time of the AS-OCT examination from the operation was 8+/-4.9 months, and the mean IOP at that time was 13.8+/-4.2 mm Hg (p<0.001). All operated eyes manifested an intrascleral bleb with AS-OCT. The mean intrascleral bleb height was 0.58+/-0.16 mm. IOP and intrascleral bleb height were found to be inversely correlated (p<0.001, r=-0.626). None of the eyes had subconjuctival blebs, and 17/25 eyes showed microscopic conjuctival fluid collections., Conclusion: The authors report a positive inverse correlation between intrascleral bleb height and postoperative IOP in eyes presenting clinically flat blebs following DSCI with MMC, suggesting an important role for intrascleral filtration in lowering IOP. Further studies are warranted to evaluate this relationship at different postoperative time points and possibly with different types of implants.

Purpose: To compare the intraocular pressure (IOP) diurnal fluctuations of glaucoma patients treated with latanoprost 0.005% once a day with patients with controlled IOP after deep sclerectomy or trabeculectomy., Methods: The trial included 60 prospectively recruited subjects with primary open-angle glaucoma. The medical group consisted of 20 patients with controlled IOP (<18 mm Hg) under latanoprost 0.005% monotherapy and with no history of previous intraocular surgery or argon laser trabeculoplasty; the surgical groups included 20 patients after trabeculectomy, and 20 patients after deep sclerectomy with collagen implant (DSCI). The patients in the surgical groups had a controlled IOP without any ocular hypotensive medications. All patients underwent a diurnal tension curve (08:00-17:00/three-hour intervals), followed by a water-drinking test (WDT) with the last IOP measurement taken at 21:00 hours. The between-group differences were tested for significance by means of analysis of variance (ANOVA)., Results: Baseline IOP was significantly different between the trabeculectomy group (10.1 mm Hg (3.4 SD)), the DSCI group (13.9 mm Hg (2.8)) and the latanoprost group (15.5 mm Hg (2.0); p = 0.005). The average IOP during the diurnal tension curve (10.1, 13.7, and 15.7 mm Hg, respectively, for the trabeculectomy, DSCI, and latanoprost groups) differed significantly between groups (ANOVA; p<0.0001), but the variation was comparable in the three groups (ANOVA; p = 0.13). After the WDT, elevation of IOP was significantly greater among patients treated with latanoprost (p = 0.003)., Conclusion: Trabeculectomy patients had a statistically significant lower average IOP in the diurnal tension curve compared with the other two groups. No wider variation in diurnal IOP with latanoprost compared with the surgical procedures was found. The IOP increase during the WDT was most marked in patients under latanoprost therapy.

Aim: To assess intraocular pressure (IOP) changes of the contralateral eyes of eyes undergoing trabeculectomy with mitomycin C (MMC)., Methods: Non-comparative retrospective study of 24 consecutive patients who underwent trabeculectomy with MMC that led to more than 45% reduction in IOP. In the contralateral eyes, IOP before surgery was compared with IOP 1 day and 1 month after surgery. 11 fellow eyes were under topical hypotensive therapy while 13 contralateral eyes were not (12 contralateral eyes had previous filtering surgery and one had normal tension glaucoma). No patients had systemic ocular hypotensive therapy., Results: Mean IOP in all contralateral eyes decreased from 15.5 (SD 5.5) mm Hg to 12.5 (3.8) mm Hg (p<0.01), and 13.0 (4.7) mm Hg (p<0.001) 1 day and 1 month after surgery, respectively. In the 11 fellow eyes under topical ocular hypotensive therapy mean IOP was reduced from 19.5 (4.0) mm Hg to 13.5 (2.2) mm Hg (p<0.01), and 16.5 (2.8) mm Hg (p<0.05) 1 day and 1 month after surgery, respectively. In the 13 fellow eyes not under topical ocular hypotensive therapy mean IOP was reduced from 12.1 (4.2) mm Hg to 11.6 (4.7) mm Hg (p not significant) and 9.8 (3.8) mm Hg (p0.01) 1 day and 1 month after surgery, respectively., Conclusions: In the present population, a month after trabeculectomy, mean IOP in the contralateral eyes decreased independently of whether these contralateral eyes were undergoing topical ocular hypotensive therapy or not.

Aim: To study the possibility of using intraocular pressure (IOP) in the first postoperative day after sclerectomy as a prognostic indicator., Methods: Non-randomised prospective trial involving 105 eyes of 105 patients with medically uncontrolled primary and secondary open angle glaucoma. Visual acuity, IOP, and slit lamp examinations were performed before and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, 54, 60, and 66 months. Visual field examinations were repeated every 6 months. A split point on day 1 IOP of less than or equal to 5 mm Hg (61%) versus more than 5 mm Hg (39%) was used. The first postoperative day IOP was examined in relation to the need for subsequent Nd:YAG goniopuncture, the subsequent use of postoperative antiglaucoma medications, and as a stratification variable in the Kaplan-Meier analyses., Results: The mean follow up was 43.2 (SD 14.3) months. The mean preoperative IOP was 26.8 (SD 7.7) mm Hg; the mean postoperative IOP was 5.1 (3.3) mm Hg at day 1 and 11.8 (3.1) mm Hg at month 60. Patients with IOP 5 mm Hg, the median time to failure was only 6 months (CI 2 to 9). No significant difference in postoperative antiglaucoma medications was observed., Conclusion: First postoperative day IOP can be considered to be a significant prognostic indicator in deep sclerectomy.

Abdelrahman M Elhusseiny,1,2,&ast; Mohamed M Khodeiry,3,4,&ast; Richard K Lee,4 Tarek Shaarawy,5 Salman Waqar,6 Mohamed S Sayed6 1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Department of Ophthalmology, Boston Children’s Hospital, Boston, MA, USA; 3Department of Ophthalmology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA; 4Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 5Department of Ophthalmology, Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland; 6Glaucoma Division, Moorfields Eye Hospitals, Dubai, United Arab Emirates&ast;These authors contributed equally to this workCorrespondence: Mohamed S Sayed, Glaucoma Division, Moorfields Eye Hospitals, Dubai, United Arab Emirates, Tel +97144297888, Email msayed82@hotmail.comPurpose: The Paul glaucoma implant (PGI, Advanced Ophthalmic Innovations, Singapore, Republic of Singapore) is a recently developed novel non-valved glaucoma drainage device (GDD) designed to effectively reduce the intraocular pressure (IOP) in glaucoma patients with a theoretically reduced risk of postoperative complications such as hypotony, endothelial cell loss, strabismus, and diplopia. Limited literature has evaluated its use in adult glaucoma; however, its use in pediatric glaucoma has not been reported to date. We present our early experience with PGI in refractory childhood glaucoma.Patients and Methods: This study was retrospective single-surgeon case series in a single tertiary center.Results: Three eyes of 3 patients with childhood glaucoma were enrolled in the study. During nine months of follow-up, postoperative IOP and number of glaucoma medications were significantly lower than preoperative values in all the enrolled patients. None of the patients developed postoperative complications including postoperative hypotony, choroidal detachment, endophthalmitis, or corneal decompensation.Conclusion: PGI is an efficient and relatively safe surgical treatment option in patients with refractory childhood glaucoma. Further studies with larger number of participants and longer follow-up period are required to confirm our encouraging results.Keywords: glaucoma, pediatric, intraocular pressure, tube, Paul glaucoma implant

PURPOSE: To compare prospectively the results of deep sclerectomy (DS) vs deep sclerectomy with collagen implant (DSCI) METHODS: Randomized prospective trial involving 26 eyes (13 patients) with medically uncontrolled primary and secondary open angle glaucoma. Collagen implant was randomly assigned to one eye of each patient. RESULTS:: The mean follow-up period was 49.5 (SD 20) months for the DS-treated eyes, and 56.5 (SD 14) months for the DSCI-treated eyes (P=0.4). The mean preoperative intraocular pressure (IOP) was 24.1 (SD 7)?mmHg for the DS-treated eyes, and 25.3 (SD 6)?mmHg for the DSCI-treated eyes (P=0.5). The mean IOP at the first postoperative day was 6.4 (SD 3)?mmHg for the DS-treated eyes, and 3.7 (SD 2)?mmHg for the DSCI-treated eyes (P=0.05). The mean IOP at 12 months postoperative day was 15.4 (SD 3)?mmHg for the DS group, and 10.4 (SD 4)?mmHg for the DSCI-treated eyes (P=0.04), while at 48 months it was 16 (SD 3)?mmHg for the DS group, and 10 (SD 4)?mmHg for the DSCI-treated eyes (P=0.005). Complete success rate, defined as an IOP lower than 21?mmHg without medication, was 38%(5/13 patients) at 48 months for the DS-treated eyes, and 69%(9/13 patients) for the DSCI-treated eyes. Qualified success rate: patients who achieved IOP below 21?mmHg with or without medication, was 69%(9/13 patients) at 48 months and 100%(13/13 patients) for the DSCI group. The mean number of medications was reduced from 2.4 (SD 0.8) to 1.1 (SD 1) after DS, and was reduced from 2.2 (SD 0.7) to 0.4 (SD 0.6) in the DSCI group (P=0.001). For those eyes treated with DSCI, IOP was 3.21?mmHg lower than for those treated with DS (P<0.0001). CONCLUSION: The use of a collagen implant in DS seems to enhance the success rates, provides significantly lower IOP levels, and lowers the need for postoperative medications.Eye (2005) 19, 298-302. doi:10.1038/sj.eye.6701469 Published online 16 July 2004 [ABSTRACT FROM AUTHOR]

AIM: To identify the value of using collagen implant in deep sclerectomy. METHODS: A prospective randomised trial of 104 eyes (104 patients) with medically uncontrolled primary and secondary open angle glaucoma. All patients had deep sclerectomy (DS), half of them with and the other half without a collagen implant (CI) sutured in the scleral bed. The main outcome measures were intraocular pressure (IOP), visual acuity, number of treatments preoperative and postoperative, and Nd:YAG goniopunctures. RESULTS: Mean follow up period was 44.5 (SD 21) months for the DS group and 43.9 (SD 14) months for the deep sclerectomy with a collagen implant (DSCI) group. The mean preoperative IOP was 23.3 (SD 7.2) mm Hg for the DS group and 25.6 (SD 4.9) mm Hg for the DSCI group. The mean IOP at the first postoperative day was 6.1 (SD 4.21) mm Hg for the DS group and 5.1 (SD 3.3) mm Hg for the DSCI group. At 48 months IOP was reduced by 40% (14 versus 23.3 mm Hg) for the DS group and by 50% (12.7 versus 25.6 mm Hg) for the DSCI group. Complete success rate, defined as IOP lower than 21 mm Hg without medication, was 34.6% (18/52 patients) at 48 months for the DS group, and 63.4% (33/52 patients) for the DSCI group. Qualified success rate; patients who achieved IOP below 21 mm Hg with or without medication, was 78.8% (41/52 patients) at 48 months and 94% (49/52 patients) for the DSCI group. The mean number of medications was reduced from 2.1 (SD 0.8) to 1.0 (SD 1) after DS, and was reduced from 2.2 (SD 0.7) to 0.4 (SD 0.6) in the DSCI group (p = 0.001) CONCLUSION: The use of a collagen implant in DS enhances the success rates and lowers the need for postoperative medication. [ABSTRACT FROM AUTHOR]