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Purpose: To determine whether a risk calculator changes treatment recommendations made by glaucoma specialists in cases of ocular hypertension., Methods: Two groups of case scenarios were created using the results of the Ocular Hypertension Treatment Study (OHTS) such that pairs of scenarios had the same risk of developing glaucoma. Glaucoma specialists were asked to review the cases and to make treatment recommendations. Only the second group included the estimated risk of glaucoma. The recommendations of the specialists were analyzed using ordinal regression and 2 measures termed confidence and inconsistency. The relative weighting of risk factors derived from physician recommendations was also compared with the weighting of those factors in the OHTS. The main outcome measure was quantitative change in recommendations when physicians were provided with an estimate of glaucoma risk., Results: Inclusion of the calculator changed recommendations, increasing the measure of confidence and decreasing the measure of inconsistency. The relative weighting of risk factors by physicians in cases in which they did not have a risk calculation were different from the weights of those same risk factors in the OHTS. Even with the risk calculation, physicians tended to weight intraocular pressure and cup-disc ratio more heavily than the OHTS would suggest., Conclusions: Use of a risk calculator in cases of ocular hypertension changed treatment recommendations. Furthermore, the relative weighting of risk factors was more consistent with the published results from the OHTS when a risk calculation was available.

Abstract Glaucoma, a leading cause of blindness due to elevated intraocular pressure (IOP), is managed with medications like latanoprost (LAT), a prostaglandin analogue, to enhance aqueous outflow. Despite the challenge posed by eye anatomy and tear dynamics, effective ocular bioavailability via topical administration remains elusive. This study aims to optimize self-assembled nanomicelles incorporating LAT, an anti-glaucoma drug, belonging to BCS Class II (low solubility and high permeability) via a two-level, two-factor full factorial design, the nanomicelles were formulated via direct dissolution method and validated using design of expert. The optimized nanomicelles exhibited a spherical morphology, with a size of 69 nm and encapsulation efficiency of 77.5%, demonstrating a sustained LAT release over 12 h. In normotensive rabbits, the nanomicelles elicited a substantial reduction in intraocular pressure (IOP) by up to 40% for a duration of three days, that was significantly longer than the IOP-lowering efficacy of XALATAN eye drops (24 h). These findings indicated that self-assembled nanomicelles hold promise for enhancing the ocular bioavailability and extending the therapeutic duration of LAT, while providing the physical stability.

Background: Lens-induced glaucomas (LIGs) occur due to the lens’s size, position, or inflammation, causing either open-angle or angle-closure mechanisms. These conditions vary clinically, and understanding their effect on post-operative cataract surgery outcomes is crucial for achieving better visual results. Aims and Objectives: The aim of the study was to evaluate the characteristics, risk factors, and their consequences in LIG on post-operative visual outcome, intraocular pressure, inflammation, and optic disc changes. Materials and Methods: Patients diagnosed with LIG between December 2019 and April 2021 underwent cataract surgery and were assessed pre-and postoperatively for visual outcomes, intraocular pressure (IOP), inflammation, and optic disc changes. Results: During the 18-month study, 2700 cataract cases attended the outpatient department at Oxford Medical College, Bangalore. Among them, 50 cases (1.85%) were diagnosed with LIG. The age range was 37–75 years, with a mean of 60.02 (61.70 years for females, 58.04 years for males). Best-corrected visual acuity (BCVA) of 6/12 or better was achieved in 48% of cases, while severe inflammation resulted in BCVA below 6/60 in 69.23%. Elevated IOP was noted in cases with symptoms lasting 2–4 weeks (39.67 mmHg). Glaucomatous disc damage affected 36% of cases, more common in phacomorphic glaucoma (54%) than phacolytic (28%), and significantly correlated with symptom duration over 2 weeks (P

Abstract Corneal hysteresis (CH) is associated with glaucomatous structural changes. We retrospectively investigated the association between CH and the regional circumpapillary retinal nerve fibre layer thickness (cpRNFLT) in 419 eyes of 419 patients with normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG). CH was used as the explanatory variable, and cpRNFLT (total and quadrant) was used as the dependent variable. Standardized β coefficients were compared both overall and between the NTG and POAG groups. Multiple regression analysis with CH as the explanatory variable and cpRNFLT parameters as the dependent variables suggested that even after adjusting for age, sex, intraocular pressure (IOP), axial length, and central corneal thickness, all areas of the cpRNFLT were significantly associated with CH, except for the nasal quadrant. In the stratified analysis by glaucoma type, a positive relationship between CH and regional cpRNFLT tended to be maintained in the NTG group but not in the POAG group (P = 0.060 for interaction). Additionally, in the NTG group, the CH-inferior cpRNFLT relationship was particularly strong in the less-IOP fluctuation group. These results suggest that CH may be a potential predictor of anatomical vulnerability around the optic nerve, particularly enhancing the inferior regions of NTG.

Background Vernal keratoconjunctivitis (VKC) is a chronic allergic condition affecting both eyes found predominantly in children and adolescents. Topical steroids are associated with an increase in intraocular pressure (IOP). Topical loteprednol etabonate (LE) and fluorometholone acetate (FA) have good efficacy and lesser side effects. Objectives The study was done to assess the efficacy and effect of topical LE and FA on IOP in VKC. Materials and Methods A nonrandomized interventional study was conducted among patients aged 6–20 years attending eye outpatient department with VKC. Patients were assessed on day 0 for signs and symptoms of VKC, and IOP measurement was done. They were divided into two groups and LE (0.5%) was administered in one group and FA (0.1%) in another along with olopatadine (0.1%) in both the groups. Follow-up examinations were done on day 7, 14, and 28 in both the groups. Results Out of 64 patients included in the study (32 in each LE and fluorometholone [FM] group), a moderate degree of VKC was the common type observed in both the groups. Both the groups showed a significant decrease in mean symptom and sign scores on day 7, 14, and 28 than the baseline score (P < 0.001). Mean IOP was not found to be significantly raised (P > 0.05) in the two groups on follow-up. Conclusion In patients with VKC, topical application of 0.5% LE and 0.1% FA is equally effective and safe without any significant rise of IOP.

Abstract Swimming goggles (SG) are widely used in water sports, and this study aimed to evaluate the acute effects of wearing SG on intraocular pressure (IOP), anterior chamber biometrics, axial length (AL), and optic nerve head (ONH) morphology. Twenty-eight healthy young adults participated in this cross-sectional study, with assessed parameters including IOP, central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), AL, and optical coherence tomography (OCT) imaging of the ONH, specifically Bruch membrane opening (BMO), Bruch membrane opening-minimum rim width (BMO-MRW), lamina cribrosa depth (LCD), and prelaminar tissue (PLT). Measurements were taken at four time points: before wearing SG, at the 1st and 10th minutes of wearing, and immediately after removal. The results showed a significant increase in IOP at the 1st and 10th minutes of SG wear compared to pre-wear and post-removal values. Additionally, decreases in CCT, ACD, and ACA, along with an increase in AL, were observed while wearing SG. However, these changes reverted to baseline after the goggles were removed. No significant alterations were detected in ONH parameters during the study. The findings suggest that wearing SG induces an acute rise in IOP and changes in anterior segment parameters, likely due to oculopression, but does not appear to affect ONH morphology in the short term. Further studies are needed to investigate any potential long-term effects.

Introduction: Cataracts are a major cause of preventable blindness in India. A considerable number of patients continue to present with advanced cataracts, which can result in complications such as Lens Induced Glaucoma (LIG). LIG is a secondary glaucoma that occurs due to mature or hypermature cataracts, potentially causing significant visual impairment. Aim: To determine the clinical presentation, prognostic factors, and surgical outcomes in patients with LIG. Materials and Methods: A prospective study involving 60 patients with LIG was conducted at a tertiary care centre in Western Maharashtra, India from September 2022 to June 2024. All patients underwent Small Incision Cataract Surgery (SICS) and were followed-up postoperatively on day 1, day 7, and week 6. Results: The mean age of the patients was 69.03 years, with 66.7% being females. Symptoms such as pain, redness, headache and diminished vision were present in all patients. The mean duration of symptoms was 4.08 days. All patients presented with poor visual acuity (

Abstract Glaucoma, a blinding eye disease with optic neuropathy, is usually associated with elevated intraocular pressure (IOP). The currently available pharmacological and surgical treatments for glaucoma have significant limitations and side effects, which include systemic reactions to medications, patient non-compliance, eye infections, surgical device failure, and damage to the eye. Here, we present Sensor-Actuator-Modulator (SAM), an engineered double mutant version of the bacterial stretch-activated mechanosensitive channel of large conductance (MscL) that directly senses tension in the membrane lipid bilayer of cells and in response, transiently opens its large nonspecific pore to release cytoplasmic fluid. The heterologously expressed mechanosensitive SAM channel acts as a tension-activated pressure release valve in trabeculocytes. In the trabecular meshwork (TM), SAM is activated by membrane stretch caused by elevated IOP. We have identified several SAM variants that are activated at physiologically relevant pressures. Using this barogenetic technology, we have demonstrated that SAM is functional in cultured TM cells, and successfully transduced in vivo in TM cells by use of AAV2/8. Further, it is effective in enhancing aqueous humor outflow facility leading to lowering the IOP in a mouse model of ocular hypertension.

Abstract This retrospective cohort study describes the real-world incidence and maintenance of clinically meaningful intraocular pressure (IOP) reduction (“response”) following stand-alone phacoemulsification for 667,987 eyes with suspected or confirmed glaucoma in the IRIS Registry (Intelligent Research in Sight) from 1/1/2013–9/30/2019. Intraocular pressure responders had ≥ 20% IOP reduction in daily mean IOP from baseline on two consecutive postoperative visits. We declared failure if a responder no longer maintained ≥ 20% IOP reduction. The estimated IOP responder rate was 41.3% by Kaplan–Meier analysis. Multivariate analysis demonstrated relationships between IOP response and baseline IOP (hazard ratio (HR) (95% confidence interval)) 1.48 (1.48–1.49), per 3 mmHg, P

BACKGROUND: Uveitis is the inflammation of the iris, ciliary body, vitreous, retina, or vascular membrane, in which the most common complication is a secondary increase in intraocular pressure that is difficult to compensate with antihypertensive drugs. Ahmed valve implantation in uveal glaucoma is an effective surgical method to reduce intraocular pressure. CLINICAL CASE DESCRIPTION: In the Department of Surgical Treatment of Glaucoma of the S. Fyodorov Eye Microsurgery Federal State Institution, Ahmed valve implantation was performed in two patients with refractory, repeatedly operated uveal glaucoma. As a result of valve implantation, in both cases, compensation of intraocular pressure within up to 15 months after surgery was possible. CONCLUSION: Ahmed valve implantation in secondary uveal repeatedly operated glaucoma in patients with chronic uveitis and corneal dystrophy achieved compensation of intraocular pressure and preserved visual functions.

IntroductionDuring endothelial keratoplasty, anterior chamber gas is titrated to a desired fill, which is difficult to optimize by visualization alone. This study evaluates how an anterior chamber gas fill correlates with intraocular pressure (IOP) and iris-angle configuration as identified by optical coherence tomography (OCT).MethodsEleven cadaveric eyes were studied in three configurations: baseline, air-fill just spanning limbus-to-limbus (“full-fill”), and air-fill maximally filling the anterior chamber (“overfill”). At each configuration, IOP was measured by Tonopen and iris-angle was determined by analyzing OCT images.ResultsNo differences in IOP or irisangles were identified between baseline and full-fill configurations (p=0.113 and p=0.152, respectively). When compared to overfill configuration, differences in IOP and iris-angles were identified for baseline (p

This study aims to evaluate the efficacy of selective laser trabeculoplasty in improving the intraocular pressure in patients diagnosed with open-angle glaucoma. A comprehensive search was performed across electronic databases, including PubMed, Scopus, and Web of Science, until June 2024, using keywords related to "selective laser trabeculoplasty" and "open-angle glaucoma." Studies were chosen based on set eligibility criteria. Data extraction was carried out by two independent reviewers, and statistical analyses were performed using a random-effects model to calculate the pooled mean differences in IOP reduction and overall success rates. The initial search yielded 3111 articles, with 23 studies included in the systematic review and 22 in the meta-analysis. The pooled MD in IOP reduction between the SLT and control groups was -1.44 mm Hg (95% CI: -2.19 to -0.70, p < 0.01). Subgroup analyses revealed a MD of -0.76 mm Hg (95% CI: -1.31 to -0.21, p < 0.01) when comparing SLT to medication, and -0.42 mm Hg (95% CI: -0.64 to -0.19, p < 0.01) when comparing 180-degree SLT to 360-degree SLT. The pooled success rate favored SLT with an odds ratio (OR) of 0.71 (95% CI: 0.51 to 0.99, p = 0.05). There was significant heterogeneity among the studies (I² = 71%). SLT is effective in lowering IOP in OAG patients, demonstrating significant efficacy compared to medication and different SLT protocols. The findings underscore SLT's potential as a reliable treatment option. However, the observed heterogeneity underscores the necessity for standardized protocols in future research to improve comparability and verify SLT's long-term effectiveness.

Background and purpose: Pseudoexfoliation syndrome (PEX) is a common age-related disorder, characterized by the secretion of fibrillar material from intraocular components, particularly along the anterior segment structures. This condition leads to obstruction of the trabecular meshwork impairing aqueous humor outflow and subsequently increasing intraocular pressure (IOP). These factors contribute to an increased risk of developing glaucoma, damage to the internal ocular structures, and irreversible vision loss. Therefore, screening and evaluating individuals with this syndrome may allow timely identification of glaucoma risk and implementation of appropriate preventive or therapeutic measures. Consequently, it is crucial to screen for PEX syndrome to assess glaucoma risk and take necessary actions to preserve vision and ocular health. This study aims to determine the prevalence of glaucoma in patients with PEX syndrome to accurately assess the risk of developing glaucoma. This assessment may include monitoring of intraocular pressure, preventive measures, and specific treatments. Materials and methods: This cross-sectional study was conducted on patients over 40 years old diagnosed with pseudoexfoliation (PEX) syndrome referred to the ophthalmology department of Bu-Ali Sina Hospital in Sari from February 2019 to March 2020. Initially, comprehensive ophthalmic examinations, including autorefraction with a Topcon autorefractometer, visual acuity determination with Snellen E charts, slit lamp examination, and fundoscopy with a 90D lens, were performed for all patients. Subsequently, intraocular pressure (IOP) was measured using a Goldmann tonometer. In individuals suspected of glaucoma, an angle examination using a three-mirror goniolens to assess the trabecular meshwork, and cup/disc ratio using Cirrus HD-NFL OCT (Carl Zeiss Meditec, Inc.) was performed. Based on clinical findings, patients were categorized into glaucoma and non-glaucoma groups. The data were analyzed using SPSS version 22 software. Descriptive statistics, including mean, standard deviation, frequency, and percentage, were used to describe the data. For comparing the means of quantitative variables, the t-test was utilized, while the chi-square test was used for comparing the means of qualitative variables between the glaucoma and non-glaucoma groups. A statistically significant level of P

Abstract This study investigated intraocular pressure (IOP) in Dutch belted rabbits using two different tonometers, rebound tonometry (TonoVet Plus; TVP) and a Tonopen (Tono-Pen AVIA Vet; TPA). Post-pubescent male Dutch belted rabbits aged 36 weeks (n = 10 animals) were used in the study. IOP measurements were conducted every 2 weeks for 22 weeks using TVP and TPA on both eyes of each rabbit. The average IOP measurements were compared by the paired Student’s t-test. Pairwise Pearson’s correlation coefficients and Bland–Altman statistics were used. The overall mean IOP measured with TPA was significantly higher than that with TVP (23.5 ± 4.9 vs. 21.8 ± 2.4 mmHg for the right eyes; P = 0.045, and 23.0 ± 4.7 vs. 21.5 ± 2.4 mmHg for the left eyes; P = 0.047). Both tonometers tended to show increased IOP readings with age, and positive correlations between IOP and age were observed with both TPA (r = 0.95, P

Background: Globally, it is expected that 111 million people will have glaucoma by 2040. Intraocular pressure (IOP) is the most crucial clinical risk factor for glaucoma onset and/or progression. Aims and Objectives: The aim of the study is to compare 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Materials and Methods: The prospective randomized clinical study was conducted on patients with mild-to-moderate POAG or OHT on a single prostaglandin analog (e.g., latanoprost) not achieving target IOP. Patients with narrow-angle glaucoma, any ocular surgery, and advanced glaucoma were excluded from the study. Patients were followed up at 15 days, 1 month, 2 months, and 3 months for a complete ophthalmic examination. Results: The maximum number of patients showed 41–60 years of age group. The male–female ratio was 1.8:1. A mild-to-moderate adverse event in the form of conjunctival hyperemia was seen in all groups. The mean reduction in IOP (mmHg) from baseline to 3 months in Groups A, B, and C is 5.7±0.923, 7.11±0.832, and 6.83±0.707 mmHg, respectively. Conclusion: When given in combination with 0.005% latanoprost and comparing IOP reduction in terms of efficacy, 0.4% ripasudil and 0.02% netarsudil are almost similar, but ripasudil was well tolerated and showed minimal ocular adverse effects; hence, ripasudil is better in comparison to netarsudil.

Objectives: To review the current literature related to the correlation between translaminar pressure difference (TLPD) and glaucoma. Materials and Methods: In this article, we conducted a literature review using MEDLINE via PubMed, Cochrane Eyes and Vision, and Google Scholar from 01/01/2010 to 31/12/2022. Search terms included “glaucoma”, “intraocular pressure”, “translaminar cribrosa pressure gradient/difference”, “intracranial pressure”, and “cerebrospinal fluid pressure”. Of 471 results, 8 articles were selected for the meta-analysis. Results: Our meta-analysis demonstrated significantly higher intraocular pressure, lower cerebrospinal fluid pressure (CSFp), and greater TLPD in high-tension and normal-tension glaucoma groups compared to healthy groups. Conclusion: The differences in CSFp and TLPD between glaucoma and healthy people detected in current studies suggests a potential relationship between TLPD and glaucoma.

Abstract Mutations in myocilin (MYOC) are the leading known genetic cause of primary open-angle glaucoma, responsible for about 4% of all cases. Mutations in MYOC cause a gain-of-function phenotype in which mutant myocilin accumulates in the endoplasmic reticulum (ER) leading to ER stress and trabecular meshwork (TM) cell death. Therefore, knocking out myocilin at the genome level is an ideal strategy to permanently cure the disease. We have previously utilized CRISPR/Cas9 genome editing successfully to target MYOC using adenovirus 5 (Ad5). However, Ad5 is not a suitable vector for clinical use. Here, we sought to determine the efficacy of adeno-associated viruses (AAVs) and lentiviruses (LVs) to target the TM. First, we examined the TM tropism of single-stranded (ss) and self-complimentary (sc) AAV serotypes as well as LV expressing GFP via intravitreal (IVT) and intracameral (IC) injections. We observed that LV_GFP expression was more specific to the TM injected via the IVT route. IC injections of Trp-mutant scAAV2 showed a prominent expression of GFP in the TM. However, robust GFP expression was also observed in the ciliary body and retina. We next constructed lentiviral particles expressing Cas9 and guide RNA (gRNA) targeting MYOC (crMYOC) and transduction of TM cells stably expressing mutant myocilin with LV_crMYOC significantly reduced myocilin accumulation and its associated chronic ER stress. A single IVT injection of LV_crMYOC in Tg-MYOC Y437H mice decreased myocilin accumulation in TM and reduced elevated IOP significantly. Together, our data indicates, LV_crMYOC targets MYOC gene editing in TM and rescues a mouse model of myocilin-associated glaucoma.

Abstract Digital ocular massage has been reported to temporarily lower intraocular pressure (IOP). This could be related to an enhanced aqueous humor outflow; however, the mechanism is not clearly understood. Using anterior segment optical coherence tomography, the Schlemm’s canal (SC) and trabecular meshwork (TM) can be imaged and measured. Here, 66 healthy adults underwent digital ocular massage for 10 min in their right eyes. The IOP and dimensions of the SC and TM were measured before and after ocular massage. All subjects demonstrated IOP reduction from 15.7 ± 2.5 mmHg at baseline to 9.6 ± 2.2 mmHg immediately after, and median of 11.6 mmHg 5-min after ocular massage (Friedman’s test, p

Background Posterior subcapsular cataracts (PSC) and raised intraocular pressure (IOP) are the most common ocular complications of oral steroid administration, particularly following long-term use or treatment with high doses. Objective To evaluate the association between cumulative steroid dose and duration of treatment with the occurrence of PSC and raised IOP, as well as its associated factors in children with idiopatic nephrotic syndrome (INS). Methods This cross-sectional study included children aged 4–18 years with INS who received oral steroid therapy for at least six consecutive months. Patients underwent complete eye examinations by an ophthalmologist to evaluate their visual acuity as well as the occurrence of PSC and/or raised IOP. Results Of 92 subjects, 19.6% had PSC, 12% had raised IOP, and one had a best corrected visual acuity (BCVA) of

Objectives:To investigate the effects of phacoemulsification with intraocular lens implantation (phaco+IOL) surgery on intraocular pressure (IOP) and anterior segment parameters in patients with cataract and primary angle-closure glaucoma (PACG).Materials and Methods:Fifty-five patients with PACG undergoing phaco+IOL surgery were evaluated in terms of best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), aqueous depth (AD), and lens thickness (LT) measured by optical biometry preoperatively and at the 6-month postoperative visit. They were compared with 34 healthy age-and gender-matched cataract patients who underwent phaco+IOL surgery.Results:Preoperative evaluation revealed higher IOP, shorter axial length, shallower ACD and AD, and greater LT in the PACG group (p

Introduction/Objective. Intraocular pressure is an important parameter of eye health, especially when glaucoma is suspected. So far, few studies have been published that aimed to determine the average value of intraocular pressure and central corneal thickness in a healthy population aged 20–30 years. The aim of this study was to determine the distribution of the values of intraocular pressure and central corneal thickness in healthy student population. Methods. In a cross-sectional study, intraocular pressure and central corneal thickness were measured on a sample of a healthy population, aged 22–37 years. Intraocular pressure was measured using the Goldmann applanation tonometry method, while central corneal thickness was measured using ultrasound pachymetry. The analysis of numerical values was done using the methods of descriptive statistics. Results. By measuring intraocular pressure and central corneal thickness in 641 subjects (1282 eyes), the average value of intraocular pressure was determined to be 14.79 ± 2.31 mmHg, and central corneal thickness was 553.92 ± 25.56 μm. By comparing two groups of subjects, one male group and the other one female, we determined that there was no statistically significant difference in the average value of intraocular pressure (t-test, p > 0.05), and the average value of central corneal thickness (t-test, p > 0.05) between the sexes. Conclusion. The determined average value of intraocular pressure and central corneal thickness is similar to those determined in other cross-sectional studies of this type. No statistically significant difference was found in the intraocular pressure values and the central thickness of the cornea by sex.

Introduction: Ocular manifestations of Haemodialysis (HD) are one of the important causes of morbidity in End-stage Renal Disease (ESRD) patients. According to studies, the incidence rate of glaucoma in the dialysis group was higher than that in the non dialysis group. Angle-closure glaucoma was found to be more common, which depends on anterior chamber morphology. Aim: To assess the effect of HD on Intraocular Pressure (IOP), Anterior Chamber Depth (ACD), and Lens Thickness (LT) in patients with ESRD. Materials and Methods: This was a single-centre crosssectional observational study conducted in the Department of Ophthalmology on 170 eyes of 87 patients undergoing HD for at least three months. The study was conducted between October 2020 and October 2022 at the Dialysis Centre of Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, Maharashtra, India. These patients underwent ophthalmological evaluation pre- and postdialysis. IOP, ACD, and LT were measured 30 minutes prior to and 30 minutes after the HD session. The paired t-test was used to compare differences in means, and a p-value of

Background: Primary open-angle glaucoma (POAG) is a significant cause of irreversible blindness worldwide. Aims and Objectives: This study aimed to investigate the prevalence of POAG among hypertensive patients. Materials and Methods: A comprehensive analysis was conducted on 200 hypertensive patients, categorizing them by gender, age groups, and blood pressure ranges. POAG was diagnosed using standardized criteria, and mean intraocular pressure (IOP) values were compared between POAG patients and normal individuals. The study also assessed the change in IOP across various ranges of systolic and diastolic blood pressure (SBP and DBP). Results: Among the hypertensive population, 5% of males and 3% of females were diagnosed with POAG, indicating a slightly higher prevalence in males. POAG incidence was notably higher in the 60–69 years of age group, suggesting a potential correlation with older age. Analysis of mean IOP values demonstrated significantly higher readings in both eyes of POAG patients compared to normal individuals, aligning with the hallmark of glaucoma. The distribution of hypertensive patients across different SBP and DBP ranges revealed that higher SBP levels (140–149 mmHg and ≥160 mmHg) were associated with more POAG cases. Similarly, elevated DBP levels (90–99 mmHg) showed the highest number of POAG cases. Conclusion: Our study suggests a slightly higher prevalence of POAG in male hypertensive patients and highlights older age as a potential risk factor. Elevated IOP, a characteristic feature of glaucoma, was confirmed in POAG patients. In addition, our findings indicate a potential association between higher SBP and DBP levels and an increased likelihood of POAG, emphasizing the importance of blood pressure management in glaucoma care.

Background: Pseudoexfoliation is one of the most common causes of secondary open-angle glaucoma worldwide. The current investigation is being carried out to investigate the clinical characteristics associated with pseudoexfoliation syndrome. Aims and Objectives: The current study was conducted with the goal of documenting the prevalence of the ocular clinical profile of patterns in patients with pseudo-exfoliative material attending a tertiary care hospital’s general ophthalmology outpatient department. Materials and Methods: In the current study, 100 individuals were explored who were diagnosed with pseudoexfoliation and attended the outpatient department of ophthalmology, medical college, and hospital. The Snellen chart for visual acuity was used to test visual acuity. Pseudoexfoliation glaucoma was identified based on slit lamp examination of pseudoexfoliative material, intraocular pressure (IOP) >21 mmHg, glaucomatous cupping on fundus examination, pigmentation of trabecular meshwork on gonioscopy, and glaucomatous field abnormalities on perimetry. Results: The age range of 61–70 years had the most cases of pseudoexfoliation, accounting for 23, followed by 51–60 years with 17 occurrences. The current study comprised 48 patients, 20 of whom had bilateral pseudoexfoliation and 28 of whom had unilateral pseudoexfoliation. Our findings revealed that 17 patients had high IOP. We discovered 15 cases of open-angle glaucoma and 2 cases of narrow-angle glaucoma after analyzing 48 patients. The sample of 15 individuals with open-angle glaucoma included 11 men and 4 women. Conclusion: Pseudoexfoliation becomes more common as people age, and it is often unilateral at first but progressively progresses to bilateral pseudoexfoliation, necessitating frequent follow-up in unilateral cases. Pseudoexfoliation is associated with an increased risk of glaucoma, and the majority of cases have open angles.

Introduction: The prevalence of co-existing cataract and glaucoma is increasing in the adult population. Combined surgeries have become more popular. However, there is a conflict over which technique provides the best Intraocular Pressure (IOP) control with good postoperative outcomes. Aim: To compare the efficacy of single-site versus two-site phacotrabeculectomy with mitomycin-C in patients with Primary Open-angle Glaucoma (POAG) and cataract. Materials and Methods: A prospective cohort study was conducted in the Department of Ophthalmology, S.V. Medical College, Tirupati, Andhra Pradesh, India, over a period of one year from January 2019 to January 2020. A total of 50 cases of POAG coexisting with cataract were analysed in the present study. Twentyfive cases were included in each group (Group-1 and Group-2). Phacoemulsification and trabeculectomy were both performed through a superior scleral tunnel in the single-site approach. The two-site method combines a superior trabeculectomy with a temporal clear corneal phacoemulsification. A concentration of 0.2 mg/mL of MMC was applied in both groups for three minutes. Patients were followed-up for three months after surgery to evaluate Intraocular Pressure (IOP), the need for antiglaucoma medication, and postoperative best-corrected Visual Acuity (VA). Comparative analysis was done using the Student’s t-test, and a p-value

Background: Hydrogen sulfide (H2S) is an endogenous transmitter with the potential to regulate aqueous humor dynamics and protect retinal neurons from degeneration. The aim of the present study was two-fold: (a) to evaluate the release of H2S from two polysulfides, diallyl disulfide (DADS), and diallyl trisulfide (DATS); and (b) to investigate their ocular hypotensive actions in normotensive male and female rabbits in the presence and absence of GSH. Materials and Methods: H2S was quantified hourly for up to 6 h using a H2S-Biosensor (World Precision Instruments, Sarasota, Fl). Intraocular pressure (IOP) was assessed in normotensive New Zealand Albino rabbits using a pneumotonometer (model 30 classic; Reichert Ophthalmic Instruments, Depew, NY, USA). Results: In the presence of GSH, there was an increase in the in vitro release of H2S produced by DADS and DATS. Both DADS and DATS also caused a dose-dependent reduction in IOP in male and female rabbits, in both treated and untreated eyes. For instance, in male animals, the presence of GSH (3% and 5%) significantly (p < 0.05, n = 5) enhanced the ocular hypotensive action of DADS (2%) and DATS (2%) from 14.02 ± 2.89% to 18.67 ± 5.6% and from 16.22 ± 3.48 to 23.62 ± 5.79%, respectively. Conclusions: GSH enhanced both H2S release and ocular hypotensive action of the polysulfides in a manner that was dependent on the number of sulfur atoms present in each polysulfide. Furthermore, female animals were less sensitive to the IOP-lowering action of the polysulfides, when compared to their male counterparts.

Abstract Background In primary open-angle glaucoma (POAG), lowering intraocular pressure (IOP) is the only proven way of slowing vision loss. Schlemm’s canal (SC) is a hybrid vascular and lymphatic vessel that mediates aqueous humour drainage from the anterior ocular chamber. Animal studies support the importance of SC endothelial angiopoietin-TEK signalling, and more recently TIE1 signalling, in maintaining normal IOP. However, human genetic support for a causal role of TIE1 and TEK signalling in lowering IOP is currently lacking. Methods GWAS summary statistics were obtained for plasma soluble TIE1 (sTIE1) protein levels (N = 35,559), soluble TEK (sTEK) protein levels (N = 35,559), IOP (N = 139,555) and POAG (N cases = 16,677, N controls = 199,580). Mendelian randomization (MR) was performed to estimate the association of genetically proxied TIE1 and TEK protein levels with IOP and POAG liability. Where significant MR estimates were obtained, genetic colocalization was performed to assess the probability of a shared causal variant (PPshared) versus distinct (PPdistinct) causal variants underlying TIE1/TEK signalling and the outcome. Publicly available single-nucleus RNA-sequencing data were leveraged to investigate differential expression of TIE1 and TEK in the human ocular anterior segment. Results Increased genetically proxied TIE1 signalling and TEK signalling associated with a reduction in IOP (− 0.21 mmHg per SD increase in sTIE1, 95% CI = − 0.09 to − 0.33 mmHg, P = 6.57 × 10–4, and − 0.14 mmHg per SD decrease in sTEK, 95% CI = − 0.03 to − 0.25 mmHg, P = 0.011), but not with POAG liability. Colocalization analysis found that the probability of a shared causal variant was greater for TIE1 and IOP than for TEK and IOP (PPshared/(PPdistinct + PPshared) = 0.98 for TIE1 and 0.30 for TEK). In the anterior segment, TIE1 and TEK were preferentially expressed in SC, lymphatic, and vascular endothelium. Conclusions This study provides novel human genetic support for a causal role of both TIE1 and TEK signalling in regulating IOP. Here, combined evidence from cis-MR and colocalization analyses provide stronger support for TIE1 than TEK as a potential IOP-lowering therapeutic target.

Introduction: There is an intricate association between serum Uric Acid (UA) levels and Primary Open Angle Glaucoma (POAG). UA levels in the blood are known to be a good indicator of antioxidant function, and a decrease in UA plays a key role in the pathogenesis of POAG. However, the association of serum UA and Uric Acid Creatinine Ratio (UACR) in POAG cases in the Indian population remains unexplored. Aim: To investigate the association of serum UA levels and serum UACR with POAG. Materials and Methods: This cross-sectional study was conducted among patients who attended the Outpatient Department (OPD) of Opthalmology at Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. The duration of the study was one year and six months, from January 15, 2021 to July 15, 2022. The study included 200 recently diagnosed patients with POAG, who were divided into three groups based on Intraocular Pressure (IOP): Group 1 (mild) with an IOP of 21-30 mmHg, group 2 (moderate) with an IOP of 31-50 mmHg, and group 3 (severe) with an IOP greater than 51 mmHg. Age and gender-matched 199 healthy subjects were included as the control group. Blood samples were collected from the study subjects after obtaining informed consent and were tested for serum UA (using the modified Trinder method) and serum creatinine (using Jaffe’s method) in a semiautomatic analyser (Erba chem 7). The data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0 software and MS Excel 2007. Results: The mean age of the study participants of all three groups was found to be 51.19±5.06 years with 46.7% male and 53.3% female subjects. The serum UA levels were 5.55±0.74 mg/dL in the mild POAG group, 4.1±0.5 mg/dL in the moderate POAG group, and 2.67±0.6 mg/dL in the severe POAG group (p-value

Background: One of the most important preconditions for any anesthetic operation is perioperative hemodynamic stability during laryngoscopy and intubation, which has been the subject of extensive research and documentation. Numerous approaches have been proposed to protect the patient from the sympathetic reaction, intraocular pressure (IOP) response, and catecholamine response during laryngoscopy and intubation. Aims and Objectives: To study the efficacy of two doses of intravenous dexmedetomidine premedication given as a single bolus dose over 10 min, 0.4 μg/kg and 0.6 μg/kg, 10 min before induction in preventing the rise of intraocular pressure following succinylcholine administration and endotracheal intubation. Materials and Methods: A retrospective randomized study was conducted. Ethical committee permission and signed informed consent were obtained from 60 eligible patients before the trial began. Results: Premedication with either 0.4 mcg/kg I.V. or 0.6 mcg/kg I.V. of dexmedetomidine diluted in normal saline at a 2 mcg/mL concentration administered over 10 min before induction resulted in significant obtundation of the rise in IOP associated with succinylcholine administration and intubation. Sympathetic response to laryngoscopy and intubation was also significantly diminished. The dose of 0.4 mcg/kg I.V. produced the best hemodynamic stability. Conclusion: Therefore, from the above research it can be concluded that, before succinylcholine delivery and intubation, dexmedetomidine 0.4 mcg/kg I.V. can be used as a premedication in situations where an increase in IOP could be hazardous.

Background: AxenfeldRieger syndrome is a genetically heterogeneous group of morphogenesis disorders associated with abnormal development of the anterior segment of the eye, teeth, the organ of hearing, and abdominal region. Сongenital glaucoma, which is refractory to standard methods of treatment due to pronounced changes in the structures of the anterior segment of the eyeball and other comorbidities, is frequent manifestation of this syndrome. There are several methods for treating glaucoma in patients with AxenfeldRieger syndrome: sinus trabeculectomy, implantation of drainage devices and transscleral cyclocoagulation. Сlinical case description: A patient with congenital glaucoma associated with AxenfeldRieger syndrome underwent sinus trabeculectomy with posterior scleral trepanation in the right eye and valve drainage implantation in the left eye at the S. Fyodorov Eye Microsurgery Federal State Institution, Moscow due to the intraocular pressure decompensation. In the postoperative period, an encapsulated cyst around the body of the drainage was detected, and then a revision of the operation area was performed. After the anti-glaucoma operations, the intraocular pressure compensation was achieved in the follow-up period up to 9 months. Conclusion: Depending on the degree of the changes in the anterior chamber angle structures, sinus trabeculectomy or valve drainage implantation are the methods of choice for the surgical treatment aimed at the intraocular pressure compensation and visual function preservation in patients with Axenfeld-Rieger syndrome.

Background: Increased cup-disc ratio (CDR) is a hallmark of open-angle glaucoma (OAG), an age-related neurodegenerative disease of significant importance for public health. There are few studies on the distribution of CDR in the Nordic populations. Methods: The distribution of CDR was studied in 749 subjects aged 65–74 years in a population survey in the rural district of Tierp, Sweden, from 1984 to 86. The optic discs were assessed with binocular ophthalmoscopy at a slit lamp. Drawings of the discs were made in the protocol and used for the calculation of vertical CDRs. Odds ratios, adjusted for age and sex, according to Mantel-Haenszel (ORMH), were determined to estimate predictors of increased CDR, defined as a ratio in the upper quartile. For these analyses, the eye with the most advanced OAG or the highest pressure was chosen. Automated perimetry was used to identify OAG. Results: The distribution of vertical CDR was fairly close to that of other European-derived populations. The mean CDR was 0.45 in both eyes, with no difference between women and men. An increased ratio was associated with the age ≥70 years, a positive family history of OAG and intraocular pressure ≥20 mmHg. OAG increased the risk 8-fold (ORMH 8.06; 95% CI 4.12–15.8). Conclusions: In this study, the distribution of CDR was fairly close to that of other European-derived populations. As expected, OAG increased the risk of having a CDR in the upper quartile. The CDR increased with age.

Introduction: Vascular dysregulation is a common underlying factor between migraine and glaucoma. Fluctuations in Ocular Perfusion Pressure (OPP) can lead to ischaemia and damage to the optic nerve head. It is unclear if the risk of glaucoma in migraine patients is due to low OPP. Aim: To compare the OPP of migraine patients with healthy controls and assess the role of OPP as a risk factor for glaucoma in migraine patients. Materials and Methods: This case-control study was conducted from June 2019 to May 2020 at Yenepoya Medical College Hospital, Mangaluru, Karnataka, India. Adult patients of either gender, aged between 18 and 40 years, diagnosed with migraine, were included in the study. Intraocular Pressure (IOP), blood pressure, and OPP were measured in 94 migraine patients and compared with 94 age-matched controls. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Independent t-tests were used for comparison. Adjusted odds ratios were calculated using binary logistic regression, and a p-value

Objective: We aimed to compare the intraocular pressure (IOP), keratometry values (K), and anterior segment parameters of patients with clinically unilateral pseudoexfoliation syndrome (PEX) with the other eyes without PEX and the control group. Material and Method: Fifty four patients with unilateral PEX findings and 40 participants without PEX findings in both eyes were included in the study as a control group. IOP was measured by Goldmann applanation tonometry. K values and anterior segment parameters [central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal angle (ICA), and anterior chamber volume (ACV)] were measured using Scheimpflug imaging technique. Results: The mean age of PEX patients was 67.9±9.2 years, while the mean age of the control group was 58.9±5.7 years. The IOP values of the eyes with PEX were significantly higher than the other eyes (p=0.02), and there was no significant difference between them and the control group (p=0.59). In terms of K values and anterior segment parameters, the measurements of eyes with PEX and the other eyes, and eyes with PEX and control group were similar (p gt;0.05). Conclusion: In our study, eyes with PEX had higher IOP values than the fellow eyes and control group. In addition, thinner CCT, narrower ACD, and ICA values were found in eyes with PEX than in the other eyes. However, these values were not statistically significant.

Background: Precise use of Goldmann applanation tonometry (GAT) in the measurement of intraocular pressure (IOP) requires significant training since inaccuracies are common in the hands of untrained ophthalmic observer. Aims and Objectives: This study was conducted with the objective to measure interobserver agreement between two ophthalmologists in measuring the IOP using GAT in suspected glaucoma patients. Materials and Methods: This prospective observational study evaluated the agreement between the two observers for the measurement of the IOP using the GAT. The observers recorded IOP readings for 100 patients during two visits; both right and left eyes of the patients were examined during these visits. Pearson’s correlation coefficient, intraclass correlation coefficient (ICC), and Bland–Altman plot were used to interpretate the results as statistical measure. A P0.90) was observed among the two observers. The agreement limit for the right eye and left eye during the first visit was (2.68, −2.18) and (2.32, −2.38), respectively. Agreement limit for the right eye and left eye during the second visit was (2.73, −2.11) and (1.83, −2.36), respectively. Conclusion: On seeing the Bland–Altman plot, it was found that there was excellent agreement between observers 1 and 2 since mostly observation lie within μ±1.96*σ. Since there was fine agreement found between the two trained observers. This indicates proper training of opthmalogosists can increase the precision in measuring IOP using GAT.

Axenfeld-Rieger (AR) syndrome is an inherited Autosomal Dominant (AD) disorder with ocular, dental, and craniofacial defects, whereas AR anomaly presents only with ocular changes. Hereby, the authors present a case report of 40-year-old male patient who reported to the Outpatient Department (OPD) with complaints of diminution of vision in Both Eyes (BE) for three years. There was a significant family history. Visual acuity was limited to hand movements in both eyes. Both eyes showed prominent Schwalbe’s line, iris atrophic patches, and ectropion uvea. Intraocular Pressure (IOP) was high in the Right Eye (RE) and within normal limits in the Left Eye (LE). No craniofacial or dental anomalies were detected. Gonioscopy revealed a closed angle with broad peripheral anterior synechiae in both eyes. Fundus examination revealed a Cup Disc Ratio (CDR) of 0.5 in the RE and 0.9 in the LE. AR anomaly is a rare case. Long-term follow-up of these cases is as important as early diagnosis and treatment to prevent blindness.

Glial cells, a type of non-neuronal cell found in the central nervous system (CNS), play a critical role in maintaining homeostasis and regulating CNS functions. Recent advancements in technology have paved the way for new therapeutic strategies in the fight against glaucoma. While intraocular pressure (IOP) is the most well-known modifiable risk factor, a significant number of glaucoma patients have normal IOP levels. Because glaucoma is a complex, multifactorial disease influenced by various factors that contribute to its onset and progression, it is imperative that we consider factors beyond IOP to effectively prevent or slow down the disease’s advancement. In the realm of CNS neurodegenerative diseases, glial cells have emerged as key players due to their pivotal roles in initiating and hastening disease progression. The inhibition of dysregulated glial function holds the potential to protect neurons and restore brain function. Consequently, glial cells represent an enticing therapeutic candidate for glaucoma, even though the majority of glaucoma research has historically concentrated solely on retinal ganglion cells (RGCs). In addition to the neuroprotection of RGCs, the proper regulation of glial cell function can also facilitate structural and functional recovery in the retina. In this review, we offer an overview of recent advancements in understanding the non-cell-autonomous mechanisms underlying the pathogenesis of glaucoma. Furthermore, state-of-the-art technologies have opened up possibilities for regenerating the optic nerve, which was previously believed to be incapable of regeneration. We will also delve into the potential roles of glial cells in the regeneration of the optic nerve and the restoration of visual function.

Abstract Background Testosterone may be a possible modifiable risk factor for open-angle glaucoma (OAG) and intraocular pressure (IOP), but evidence has been scarce and conflicting. In this study we evaluated the association of testosterone and its genetic predisposition with incident (i) OAG, IOP, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCL +). Methods Participants aged 45–100 years were derived from the prospective, population-based Rotterdam Study. Ophthalmic examinations and serum testosterone measurements (including bioavailable and free testosterone) were performed from 1991 onwards. Follow-up took place every 4–5 years. A total of 187 out of 7898 participants were diagnosed with incident (i) OAG during follow-up. Genotyping was performed in 165 glaucoma cases and 6708 controls. We calculated sex-specific weighted genetic risk scores (GRS) for total and bioavailable testosterone. Associations with iOAG were analyzed using multivariable logistic regression. Associations with IOP, RNFL, and GCL + were analyzed with multivariable linear regression. Analyses were stratified on sex and adjusted for at least age, body mass index, and follow-up duration. Results In men, testosterone was not associated with iOAG. However, the GRS for higher total testosterone was associated with an increased iOAG risk (odds ratio [OR] with 95% confidence interval [95% CI]: 2.48 [1.18; 5.22], per unit). In women, higher values of bioavailable testosterone (2.05 [1.00; 4.18] per nmol/L) and free testosterone (1.79 [1.00; 3.20] per ng/dL) were significantly associated with increased risk of iOAG. Moreover, the GRS for higher bioavailable testosterone was associated with an increased iOAG risk (2.48 [1.09; 5.65], per unit). Higher bioavailable and free testosterone were adversely associated with IOP (0.58 [0.05; 1.10] per nmol/L and 0.47 [0.04; 0.90] per ng/dL). Higher total testosterone was inversely associated with peripapillary RNFL and GCL + (Beta [95% CI]: − 3.54 [− 7.02; − 0.06] per nmol/L and − 2.18 [− 4.11; − 0.25] per nmol/L, respectively). Conclusions In women, higher testosterone levels increased the risk of iOAG. Both IOP-dependent and IOP-independent mechanisms may underlie this association. Managing testosterone levels may be particularly relevant for the prevention of neurodegeneration in the eye. Future research should confirm these findings.

Introduction: Glaucoma is an idiopathic, progressive optic disc neuropathy complicating into irreversible blindness if untreated. Early diagnosis by screening cases from high-risk populations has a pivotal role in managing this major public health problem with high treatment expenditures. Objectives: To identify the various ocular and non ocular risk factors of glaucoma and to identify the drug prescription pattern among glaucoma patients.Method: This was an observational, case-control study including 165 adult Glaucoma patients on treatment as cases and 165 age and sex-matched healthy individuals as controls, all of which were randomly selected from the patients visiting a tertiary eye care center. Various risk factors, drug prescription pattern and symptoms of the patients were recorded and analyzed.Results: A total of 165 adult Glaucoma patients and age and gender matched 165 controls were enrolled. Majority of the patients (41.21%) complained of blurring of vision at the time of study. The Odds ratios for Family history, Hypertension, Diabetes Mellitus, Migraine, Sleep apnea and Smoking showed strong association as risk factors for Glaucoma and the differences between the two groups were statistically significant (p value < 0.05). The mean number of drugs per prescription ± SD was 1.88 ± 0.79. Fixed drug formulations were prescribed in 42.4% patients. All the drugs were prescribed by their brand names and majority of them were in the form of eye drops.Conclusion: Primary Open Angle Glaucoma (POAG) was the most common subtype in the study. Age, Family history, Myopia, Hypertension, Diabetes Mellitus, Sleep Apnea, Migraine, Corticosteroid usage and Smoking emerged as putative risk factors. In consistence with present guidelines, Prostaglandin analogs were the most prescribed antiglaucoma drugs. The considerable proportion of asymptomatic cases (23%) suggests the need for periodic eye examinations to detect glaucomatous changes at an early stage

Purpose: To investigate whether trabecular aspiration (TA) has an effective medium-term intraocular pressure (IOP)-lowering and medication-saving effect in patients with pseudoexfoliation glaucoma (PEG). In addition, a subgroup analysis of patients with or without a previous trabeculectomy was performed. Methods: Records of 290 consecutive eyes with PEG that underwent TA between 2006 and 2012 at the Department of Ophthalmology, Mainz, Germany, were retrospectively analyzed with a follow-up period of 3 years. The main outcomes were IOP and the need for further medical treatment. Results: Of the 290 eyes with PEG that received TA, 167 eyes from 127 patients met the inclusion criteria. Among these eyes, 128 received TA and cataract surgery (Phaco-TA) without having had a trabeculectomy (group I) before, 29 had Phaco-TA after a previous trabeculectomy (group II) and 10 underwent stand-alone TA after a previous trabeculectomy (group III). In the whole cohort, the median IOP decreased immediately after TA and remained significantly lower compared to the baseline throughout the period of 36 months. Likewise, the median number of antiglaucoma drugs was reduced over the whole period. At the same time, in group I, the median IOP and the number of antiglaucoma drugs were reduced over 36 months. In contrast, in the post-trabeculectomy groups (group II and III), the median IOP and the number of antiglaucoma drugs could not be reduced. While most of the patients that received Phaco-TA with or without a previous trabeculectomy (group I and II) did not require further surgical intervention during the follow-up period, almost all patients receiving stand-alone TA after a previous trabeculectomy (group III) needed surgical therapy, most of them between the second and the third year following TA. Conclusions: Phaco-TA has an effective medium-term pressure-lowering and medication-saving effect, especially in patients without a previous trabeculectomy. In trabeculectomized eyes, the effect of TA is limited but still large enough to delay more invasive surgical interventions in some patients.

Background: Ocular hypertension (OH) is a condition characterized by elevated intraocular pressure (IOP) exceeding the normal range, without any evident damage to the optic nerve or visual field defects characteristic of glaucoma. It constitutes a significant precursor to the development of glaucoma, a leading cause of irreversible vision loss worldwide. Emerging evidence has shown that microcirculation alterations in eyes with OH could serve as predicting factors to identify eyes at high risk for progression to glaucoma. In view of the above, the purpose of our study is to investigate microcirculation alterations of the radial peripapillary capillary plexus using optical coherence tomography angiography (OCT-A) in patients with ocular hypertension (OH). Methods: A total of 192 eyes were included in this observational, comparative, single-centre study and were divided in two groups: OH eyes and healthy controls. OCT-A was performed to analyze microcirculation characteristics at the peripapillary area. Radial peripapillary capillary density was measured at the total area of the optic disc and at each separate region (superior, inferior, inside). The parameters of age, medical treatment for ocular hypertension, sex and retinal fiber layer thickness were evaluated. Results: Total radial peripapillary capillary density was significantly lower in patients with OH than in healthy controls Concerning the microcirculation characteristics at each separate region of the peripapillary area, the results were as follows: inferior radial peripapillary capillary density was significantly decreased in individuals with OH than in controls, while measurements in the superior peripapillary area and internal optic disc were similar in both groups. Conclusions: Our study indicates decreased radial peripapillary capillary density in eyes with OH. Microcirculation alterations in the inferior peripapillary area could potentially comprise biomarkers for OH progression to glaucoma.

Introduction: The purpose of this study was to compare iCare HOME (TA022) with Goldmann applanation tonometer and to evaluate the self-tonometry measurements among the Indian population. Methods: Eligible patients underwent iCare HOME training through guided demonstration (verbal, pictorial, video) and practised self-tonometry measures using iCare HOME. Certification for independent iCare HOME measure was provided if first iCare HOME intraocular pressure (IOP) measurement fell within ± 5 mmHg of Goldmann applanation tonometer (GAT) measurement which was measured by the trained clinician (principal investigator). Certified participants underwent simulated home self-tonometry measurements using iCare HOME, and agreement with GAT IOP measurements was assessed. Results: Seven of 83 participants (8.43%) failed to complete the study due to difficulty in performing the task, leading to non-certification. Patients who could use the iCare HOME had a mean age of 53 ± 15.55years (53% males; 46% females). Only one in 12 subjects did not qualify to use iCare HOME. The overall mean difference between iCare HOME and GAT was 0.83 mmHg (95%, 3.92 and -2.25) with 94.7% agreement. At various pressure ranges, 7-16 mmHg, 17-23 mmHg and >23 mmHg, the mean difference between iCare HOME and GAT was 1.22 mmHg (95%, 4.32 and -1.86) with 97.4% agreement, 0.77 mmHg (95%,3.69 and -2.19) with 91.3% agreement, -0.11 mmHg (95%, 2.52 and -2.74) with 100% agreement respectively. The intra-class correlation coefficient of the iCare HOME device was 0.997(95% CI,0.995-0.998). Conclusions: Patients were able to perform self- tonometry using iCare HOME with good reliability and safety. iCare HOME shows good agreement with GAT. Further studies with proper home environment will be recommended to study the diurnal comparisons with GAT.

Glaucoma is a multifunctional disease with several trace elements associated with its pathophysiology. This review aimed to provide readers with a sound and scientific understanding of the risk factors related to the pathogenicity of the disease. This review covers the aspects of investigating trace element risk factors associated with glaucomatous pathogenesis from a fundamental biomechanical point of view. A study of a significant amount of literature suggests that several trace element elements are associated with intraocular pressure (IOP), trabecular meshwork, and optical nerve oxidative stress changes in complex eye diseases. Traces such as selenium, chromium, manganese, magnesium, iron, cobalt, copper, and zinc elements are significantly associated with primary open-angle glaucoma (POAG). Other risk factors, such as trace elements, modulate opposing aqueous humor production and outflow dynamics, extracellular matrix structure and function, and neurotransmitter release. The current evidence and human expertise help us understand that our diet contains numerous factors that may influence optically dynamic parameters, such as IOP and drug outcome effectiveness.

Introduction: Ghost cell glaucoma (GCG) is a very rare secondary open angle glaucoma, in which there is a sustained increase in intraocular pressure (IOP) due to obstruction of the trabecular meshwork (TM) due to the passage of ghost cells (GC) from the vitreous into the anterior chamber, after a vitreous hemorrhage (VH). Clinical Case: We present the case of a male patient with a history of vitreous hemorrhage and sustained IOP elevation in the right eye (RE). Medical treatment was insufficient, for this reason surgical treatment was required. Postoperative evolution was advantageous. Conclusion: This pathology should prefer the differential diagnosis of traumatic glaucomas, correlating high clinical suspicion and histological confirmation.

Introduction: Intraocular pressure (IOP) in pregnancy decreases slightly towards the 18th gestation week, however in pregnant patients with glaucoma or ocular hypertension the IOP could be variable and will not necessarily be reduced. Therefore, some pregnant women require potentially risky treatment for them and their fetuses. Objective: To describe the relevant ocular physiopathological changes, management options and possible adverse effects of treatment during pregnancy and lactation, in patients with associated glaucoma. Materials and methods: A literature review of publications was carried out from 2001 to 2021, considering the corresponding MeSH terms for glaucoma, pregnancy, lactation, and intraocular pressure (IOP). In a structured way, the information was extracted and synthesized. Results: It is increasingly common to identify pregnant patients with glaucoma. This condition can be treated with topical medications, but most of those are category C. The treatment option with selective laser trabeculoplasty seems to be a safe treatment, but the evidence is limited. Glaucoma surgery is an option in case of poor IOP control and visual function deterioration. The use of antimetabolites is fully contraindicated in this group of patients. During lactation, it is necessary to adjust topical medications, considering the conditions of the newborn. Conclusions: The approach to glaucoma in the pregnant patient requires a precise balance between IOP control to prevent visual damage in the pregnant/lactating female and the prevention of adverse effects in the fetus/newborn.

Abstract Objective Glaucoma is a chronic neurological disease that is associated with high intraocular pressure (IOP), causes gradual damage to retinal ganglion cells, and often culminates in vision loss. Recent research suggests that glaucoma is a complex multifactorial disease in which multiple interlinked genes and pathways play a role during onset and development. Also, differential availability of trace elements seems to play a role in glaucoma pathophysiology, although their mechanism of action is unknown. The aim of this work is to disseminate a web-based repository on interactions between trace elements and protein-coding genes linked to glaucoma pathophysiology. Results In this study, we present Glaucoma-TrEl, a web database containing information about interactions between trace elements and protein-coding genes that are linked to glaucoma. In the database, we include interactions between 437 unique genes and eight trace elements. Our analysis found a large number of interactions between trace elements and protein-coding genes mutated or linked to the pathophysiology of glaucoma. We associated genes interacting with multiple trace elements to pathways known to play a role in glaucoma. The web-based platform provides an easy-to-use and interactive tool, which serves as an information hub facilitating future research work on trace elements in glaucoma.

Background: Increased intraocular pressure (IOP) and pseudoexfoliation (PEX) are major risk factors for open-angle glaucoma (OAG), an age-related neurodegenerative disease of significant importance for public health. There are few studies on the distribution of IOP in populations where PEX is a common finding. Methods: The distribution of IOP was studied in 733 subjects 65–74 years of age, examined in a population survey in the rural district of Tierp, Sweden, 1984–86. The difference between the right and left eye and the effect of which eye was measured first were examined. Odds ratios, adjusted for age and sex, according to Mantel-Haenszel (ORMH), were calculated to estimate predictors of increased IOP, defined as a pressure ≥20 mm Hg in either eye. The pressure was measured with Goldmann applanation tonometry. Automated perimetry was used to identify OAG. Results: The distribution of IOP was close to that of other European-derived populations. The pressure in the first measured eye was higher than in the second measured eye. Increased IOP was related to OAG and PEX, ORMH 8.97 (95% confidence interval [CI] 3.84–20.9) and 2.40 (95% CI 1.53–3.76), respectively. An IOP ≥20 mm Hg increased the risk of having been diagnosed with diabetes (ORMH 1.83; 95% CI 1.08–3.09). Conclusion: In this study of subjects 65–74-years-old in Sweden, the distribution of IOP was close to that of other European-derived populations. Although the difference was small, the pressure in the first measured eye was higher than in the second eye. Increased IOP was strongly related to untreated OAG and PEX.

N/A ("Approach to" article type)

Abstract Background and Aim Goldman Applanation Tonometry (GAT), the gold standard of tonometry, is used without fluorescein in low‐resource settings. Nevertheless, corneal biomechanics differ among population groups. Purpose The aim of the study is to assess the relationship between GAT findings with and without fluorescein among glaucomatous and nonglaucomatous adults in Malawi. Methods This was a cross‐sectional quantitative study involving 22 glaucoma patients and 22 nonglaucoma patients at Mzuzu Central Hospital. We used a purposive sampling technique to select participants into the two groups. Next, we measured intraocular pressure using GAT with and without fluorescein. Then we entered the data into SPSS version 25. We employed the Wilcoxon test to make comparisons based on age and gender. We considered the value of p