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Purpose: To assess intra‐ (repeatability) and inter‐observer (reproducibility) variability of laser speckle flowgraphy (LSFG) for retinal blood flow (RBF) measurement in 20 eyes of wild type (C57BL/6J) mice and effect of intravitreal Aflibercept on RBF in optic nerve head (ONH) region of 10 eyes of Ins2 (Akita) diabetic mice. Methods: 'Mean blur rate (MBR)' was measured for all quadrants of tissue area (MT), vessel (MV) and total area (MA) of ONH region. Changes in MT were analysed at each timepoint. Repeatability was evaluated by measuring MBR variability without changing mouse head position, and reproducibility after resetting mouse head position by another operator. Coefficient of repeatability (CR) through Bland–Altman plot method coefficient of variation (COV) and Intraclass correlation coefficient (ICC) was calculated. Intravitreal Aflibercept (1 μg) was administered to Akita eyes and intraocular pressure (IOP) was measured using a tonometer at baseline, day 7, 14, 21 and 28 post‐injection. Hurvich and Tsai's criterion was used. Results: Coefficient of repeatability values of repeatability and reproducibility for all quadrants were within limits of agreement. Reliability was excellent (ICC 0.98–0.99) and reproducibility was moderate to excellent (ICC 0.64–0.96). There was a non‐significant IOP increase in all Akita eyes at Day 28 (p > 0.05), and significant increase in MT in all quadrants at Day 21 and superior, inferior and temporal quadrants at Day 28 (p < 0.05). Conclusion: Laser speckle flowgraphy demonstrates excellent repeatability and moderate to excellent reproducibility in measuring RBF. Intravitreal Aflibercept injection results in a significant increase in MT up to 28 days post‐injection without significant increase in IOP. [ABSTRACT FROM AUTHOR]

Aims: To estimate the changes in intraocular pressure (IOP) during the first 24 h after transscleral cyclophotocoagulation (TCP). Methods: A prospective single‐centre study, where patients with glaucoma destined for treatment with TCP were asked for participation. The IOP was measured prior to TCP and at 1, 2, 4, 6 and 24 h post‐TCP. An IOP spike was defined as an elevation of IOP of ≥5 mmHg compared with baseline. The visual acuity (VA) was examined at baseline and after 24 h. Results: The mean IOP prior to TCP in 58 eyes of 58 patients was 26.2 (±8.9 SD) mmHg. Twenty‐three eyes (40%) experienced an IOP spike at some examination timepoint during the first 24 h. The mean value of the IOP spike was 12.1 (±6.9) mmHg. Fifty‐six per cent of the eyes with pseudoexfoliation glaucoma (PEXG) experienced an IOP spike, and 16% had an IOP spike ≥20 mmHg. The IOP was significantly reduced at the 24 h examination by 8.1 (±7.8) mmHg (n = 58). The VA 24 h after TCP was unchanged compared with baseline. Conclusion: Clinically significant IOP spikes were common in the first 24 h post‐TCP. Almost one in five eyes had an increase of 10 mmHg and in almost one in 10 eyes, the IOP increase was 20 mmHg or higher. Eyes with PEXG had a higher occurrence of IOP spikes and displayed a greater magnitude of IOP elevation. Prophylactic post‐operative IOP‐lowering medication should be considered to prevent further glaucoma damage. [ABSTRACT FROM AUTHOR]

To evaluate a commercially available dexamethasone intracanalicular insert to treat dry eye. Single-center, double-masked randomized controlled trial. Patients with clinically significant aqueous-deficient dry eye (combined ocular surface staining score, ≥ 3 [0–12]; corneal fluorescein staining score, ≥ 2 [0–6]; and Schirmer's wetting, < 10 mm at 5 minutes in both eyes) with symptoms (dryness, eye discomfort, or visual fatigue, ≥ 30 [0–100]) despite treatment with at least 1 prescription drop and deemed candidates for topical steroid therapy. Seventy-five adult patients were enrolled. A 1:1 randomization sequence was used to determine which eye of each patient would receive the treatment (dexamethasone 0.4-mg intracanalicular insert with 30-day elution time) or sham (collagen plug). The fellow eye received the opposite treatment. Patients were masked to treatment assignment. Follow-up visits (at weeks 2, 4, and 6) were performed by a masked investigator. Dry eye parameters and patient symptoms were used for efficacy, and intraocular pressure (IOP) was used for safety assessment. The severity of dry eye was comparable between the treatment arms (fellow eyes) at baseline. Eyes that received the dexamethasone insert showed significantly less corneal staining at week 4 (mean difference [MD], −0.55; 95% confidence interval [CI], −0.91 to −0.19) and conjunctival staining at week 4 (MD, −0.68; 95% CI, −1.05 to −0.30) and week 6 (MD, −0.34; 95% CI, −0.65 to −0.02). Schirmer's wetting was comparable between the two treatment arms. Although the patients reported less dryness in eyes that received the insert at week 4 (MD, −5.5; 95% CI, −11.4 to 0.4), no statistically significant differences were found in any patient-reported symptoms. At week 4, dexamethasone-treated eyes were more likely to show an IOP increase (by 5–10 mmHg; 9 eyes vs. 1 eye; relative risk, 9.00; 95% CI, 1.14–71.0). All cases of increased IOP were managed with short-term topical β-blockers and subsided. The dexamethasone intracanalicular insert may be considered a dropless dual treatment for clinically significant aqueous-deficient dry eye when topical steroid treatment is deemed appropriate. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

To evaluate the safety and intraocular pressure (IOP)-lowering efficacy of 2 models of the travoprost intraocular implant (fast-eluting [FE] and slow-eluting [SE] types) from 1 of 2 phase 3 trials (the GC-010 trial). Multicenter, randomized, double-masked, sham-controlled, noninferiority trial. Patients with open-angle glaucoma or ocular hypertension having an unmedicated baseline mean diurnal IOP (average of 8 am , 10 am , and 4 pm time points) of ≥ 21 mmHg, and IOP of ≤ 36 mmHg at each of the 8 am , 10 am , and 4 pm timepoints at baseline. Study eyes were randomized to the travoprost intraocular implant (FE implant [n = 200] or SE implant [n = 197] model) or to timolol ophthalmic solution 0.5% twice daily (n = 193). The primary outcome was mean change from baseline IOP in the study eye at 8 am and 10 am , at each of day 10, week 6, and month 3. Safety outcomes included adverse events (AEs) and ophthalmic assessments. Mean IOP reduction from baseline over the 6 time points ranged from 6.6 to 8.4 mmHg for the FE implant group, from 6.6 to 8.5 mmHg for the SE implant group, and from 6.5 to 7.7 mmHg for the timolol group. The primary efficacy end point was met; the upper limit of the 95% confidence interval of the difference between the implant groups and the timolol group was < 1 mmHg at all 6 time points. Study eye AEs, most of mild or moderate severity, were reported in 21.5%, 27.2%, and 10.8% of patients in the FE implant, SE implant, and timolol groups, respectively. The most common AEs included iritis (FE implant, 0.5%; SE implant, 5.1%), ocular hyperemia (FE implant, 3.0%; SE implant, 2.6%), reduced visual acuity (FE implant, 1.0%; SE implant, 4.1%; timolol, 0.5%), and IOP increased (FE implant, 3.5%; SE implant, 2.6%; timolol, 2.1%). One serious study eye AE occurred (endophthalmitis). The travoprost intraocular implant demonstrated robust IOP reduction over the 3-month primary efficacy evaluation period after a single administration. The IOP-lowering efficacy in both implant groups was statistically and clinically noninferior to that in the timolol group, with a favorable safety profile. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD). Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies. After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12–95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12–95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16–49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16–49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections. Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Introduction: This study was conducted to analyze and compare the intraocular pressure (IOP) treatment effect of the slow-eluting (SE) travoprost intracameral implant to the IOP treatment effect of topical prostaglandin analog (PGA) monotherapy in a subgroup of subjects who were on pre-study PGA monotherapy prior to enrollment in the two pivotal phase 3 trials of the travoprost intracameral implant. Methods: A combined study population of 133 subjects from two phase 3 trials, who were on topical PGA monotherapy at screening, subsequently underwent a washout period from their topical PGA, and then were randomized and administered an SE travoprost intracameral implant. The subjects were analyzed for the IOP treatment effects of the pre-study topical PGA monotherapy and the in-study SE travoprost intracameral implant. Paired t-tests were used to compare the difference in screening minus post-washout baseline IOP versus month 3 minus post-washout baseline IOP. The IOP-lowering efficacy in eyes administered an SE travoprost intracameral implant was compared to the IOP lowering in the same eyes while on a topical PGA monotherapy prior to study entry. Results: Pre-study topical PGA monotherapy and the SE travoprost intracameral implant demonstrated IOP treatment effects of −5.76 mmHg and −7.07 mmHg, respectively. The IOP-lowering treatment effect was significantly greater by 1.31 mmHg for the SE travoprost intracameral implant relative to pre-study PGA monotherapy (95% confidence interval: −2.01, −0.60; P = 0.0003). Conclusions: The SE travoprost intracameral implant demonstrated superior IOP-lowering treatment effect versus pre-study topical PGA monotherapy with a superiority margin that was both statistically significant and clinically meaningful. The greater IOP reduction from baseline while on the SE implant versus pre-study topical PGA monotherapy may be a reflection of the optimized adherence and continuous elution of PGA therapy into the anterior chamber achieved with the SE travoprost intracameral implant. Trial Registration: ClinicalTrials.gov identifiers, NCT03519386 and NCT03868124. [ABSTRACT FROM AUTHOR]

Introduction: This study reports our experiences with systematic retinal screening in Denmark through optometrists with access to tele-ophthalmological services before, during, and after the COVID-19 pandemic. Methods: We evaluated an optometrist-based retinal screening system with a referral option for tele-ophthalmological service by a consultant ophthalmologist within the time period of August 1, 2018 to September 30, 2023. The optometrist collected patient history, refraction, best-corrected visual acuity, intraocular pressure, basic slit-lamp examination, 4-in-1 visual field report, and retinal imaging using color fundus 45° photography. Tele-ophthalmological services were provided by consultant ophthalmologists. Within pre-defined periods of pre-COVID-19, COVID-19, and post-COVID-19, we evaluated the rate of referrals to the tele-ophthalmological service, diagnoses made, and referrals to the public healthcare system. Results: A total of 1,142,028 unique individuals, which corresponded to 19.1% of the entire population of Denmark, underwent screening by the optometrists; 50,612 (4.4%) of these individuals were referred to the tele-ophthalmological examination by consultant ophthalmologists. A referral for further ophthalmic examination, either at hospital or at an ophthalmic practice, was made for 10,300 individuals (20.4% of those referred for tele-ophthalmology, corresponding to 0.9% of the population screened). The referral rate from the screening to the tele-ophthalmological service increased from before COVID-19 (3.4%) to during COVID-19 (4.3%) and further after COVID-19 (6.4%). This increase coincided with an increasing prevalence of conditions seen in the tele-ophthalmological service. Conclusion: During a period of 5 years, 19.1% of the entire population of Denmark underwent retinal screening. This provided an adjunctive health service during a period of severe strain on the public healthcare system, while limiting the number of excessive referrals to the public healthcare system. Temporal trends illustrated an increased pattern of use of a large-scale tele-ophthalmological system. [ABSTRACT FROM AUTHOR]

Purpose: To report a case series of patients with uveitic glaucoma who were treated with micropulse transscleral cyclophotocoagulation (mpCPC). Methods: This retrospective case series consists of patients from the University of Colorado Sue Anschutz-Rodgers Eye Center from 2015 to 2020 who were diagnosed with uveitic glaucoma. Information collected includes demographic data, type of uveitis, glaucoma severity, and prior glaucoma surgeries. Pre- and postoperative best corrected visual acuity, intraocular pressure (IOP), glaucoma medications, degree of inflammation, and uveitis therapies were included up to 36 months postoperatively. Surgical success was defined as an IOP reduction of 30% with achievement of IOP goal using the same number of glaucoma medications or less at 6 months or 1 year. Uveitis success was defined as the absence of persistent anterior uveitis at 3 months. Results: Six patients and seven eyes with uveitic glaucoma underwent mpCPC. Types of uveitis included idiopathic anterior uveitis, HLA-B27-associated anterior uveitis, varicella zoster virus anterior uveitis, juvenile idiopathic arthritis-associated chronic anterior uveitis, lichen planus-associated intermediate uveitis, and sarcoidosis-associated panuveitis. Two of six eyes (33.3%) at 6 months and three of five eyes (60%) at 1 year achieved surgical success. Around 6 months postoperatively, two out of seven eyes (28.6%) required Ahmed glaucoma valve placement (n = 1) or repeat mpCPC (n = 1). One eye (14.3%) required phacoemulsification with goniotomy followed by an Ahmed glaucoma valve 18 months after mpCPC. There were no cases of persistent anterior uveitis, hypotony, or phthisis after mpCPC in this cohort. Conclusions: Micropulse transscleral cyclophotocoagulation may safely reduce intraocular pressure in some patients with uveitic glaucoma without exacerbation of intraocular inflammation. Multiple treatments may be required to achieve longer-term success. [ABSTRACT FROM AUTHOR]

To compare the effects of intranasal (IN) and intramuscular (IM) midazolam–butorphanol–ketamine on intraocular pressure (IOP), tear production (TP) and sedation in rabbits. Prospective, randomized, crossover experimental study. Fourteen male New Zealand White rabbits, aged 1–2 years, body mass 3.1 ± 0.8 kg (mean ± standard deviation). Rabbits were administered midazolam (1 mg kg–1), butorphanol (1.5 mg kg–1) and ketamine (5 mg kg–1) via IN and IM routes. IOP, TP and sedation scores were assessed at 0 (before drug administration), 5, 15, 30, 45 and 60 minutes after drug administration. Heart rate (HR), respiratory rate (f R), rectal temperature (RT), noninvasive mean arterial blood pressure (MAP) and peripheral hemoglobin oxygen saturation (SpO 2) were simultaneously recorded until 45 minutes after drug administration. The onset and duration of sedation and sedation scores were recorded. Drug delivery route had no significant impact on mean IOP (p = 0.271) or TP (p = 0.062), and there were no significant changes over time for IOP (p = 0.711) or TP (p = 0.372). Similarly, delivery route had no significant impact on HR (p = 0.747), f R (p = 0.872), RT (p = 0.379), MAP (p = 0.217) and SpO 2 (p = 0.254). Sedation onset was faster with IN (3.0 ± 1.0 minutes) than with IM administration (4.9 ± 0.7 minutes) (p = 0.011), but sedation duration was significantly longer with IM (52.6 ± 7.2 minutes) than with IN delivery (30.7 ± 6.8 minutes) (p = 0.004). There was no significant difference in sedation scores between the two delivery routes at any of the recorded time points. The combination of midazolam–butorphanol–ketamine had minimal impact on physiological and ocular variables regardless of the route of administration, whereas IN drug administration led to a shorter onset and duration of action than IM administration. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long-term outcomes of patients with non-infectious uveitis treated with 0.19 mg fluocinolone acetonide insert (FAi) for up to 36 months in clinical practice. Methods: A retrospective study conducted at a single uveitis center. Results: Fifty eyes of 39 patients were included. Mean best corrected visual acuity (BCVA) and central retinal thickness (CRT) remained stable until month 36 after FAi implantation (61.04 vs. 70.25 letters and 370.8 vs. 332.5 µm, respectively). The recurrence rate was 34% (17 eyes) after 36 months, of which 82% (14 eyes) received high-dose corticosteroids before FAi. Mean intraocular pressure (IOP) remained unchanged (13.38 vs. 15.74 mmHg), while most phakic eyes (13 of 14 eyes) required cataract surgery. Conclusions: We show that FAi effectively prevents recurrences of non-infectious uveitis for up to three years in clinical practice, comparable with randomized clinical trials. Patients who received high-dose corticosteroids before FAi have an increased risk for early recurrence and should be considered for scheduled re-treatment. [ABSTRACT FROM AUTHOR]

Primary open-angle glaucoma (POAG) is accompanied with gray matter (GM) changes across the brain. However, causal relationships of the GM changes have not been fully understood. Our aim was to investigate the causality of GM progressive changes in POAG using Granger causality (GC) analysis and structural MRI. Structural MRI from 20 healthy controls and 30 POAG patients with elevated intraocular pressure (IOP) were collected. We performed voxel-wise GM volume comparisons between control and POAG groups, and between control and four POAG subgroups (categorized by IOP). Then, we sequenced the structural MRI data of all POAG patients and conducted both voxel-wise and region of interest (ROI)-wise GC analysis to investigate the causality of GM volume changes in POAG brain. Compared to healthy controls, reduced GM volumes across the brain were found, GM volume enlargements in the thalamus, caudate nucleus and cuneus were also observed in POAG brain (false discovery rate (FDR) corrected at q< 0.05). As IOP elevated, the reductions of GM volume were more severe in the cerebellum and frontal lobe. GC analysis revealed that the bilateral cerebellum, visual cortices, and the frontal regions served independently as primary hubs of the directional causal network, and projected causal effects to the parietal and temporal regions of the brain (FDR corrected at q < 0.05). POAG exhibits progressive GM alterations across the brain, with oculomotor regions and visual cortices as independent primary hubs. The current results may deepen our understanding of neuropathology of POAG. [ABSTRACT FROM AUTHOR]

Glaucoma is identified by the loss of retinal ganglion cells (RGCs). The primary approach to managing glaucoma is to control intraocular pressure (IOP). Lately, there has been an increasing focus on neuroprotective therapies for glaucoma because of the limited effectiveness of standard methods in reducing IOP and preventing ongoing vision deterioration in certain glaucoma patients. Various drug-based techniques with neuroprotective properties have demonstrated the ability to decrease the mortality of retinal ganglion cells. This study will analyze the currently recommended drug-based techniques for neuroprotection in the prospective treatment of glaucoma. [ABSTRACT FROM AUTHOR]

Background and Objectives: To evaluate the surgical outcomes of intraocular lens (IOL) refixation with vitrectomy in patients with elevated intraocular pressure (IOP) due to IOL subluxation. Materials and Methods: Patients with elevated IOP due to IOL subluxation who had undergone IOL refixation with vitrectomy between 1 June 2013 and 31 December 2023 were retrospectively evaluated. The primary outcome measure was surgical success or failure. Surgical success was defined as a reduction of ≥20% in the preoperative IOP or IOP ≤ 21 mmHg (criterion A), IOP ≤ 18 mmHg (criterion B), or IOP ≤ 15 mmHg (criterion C). Reoperation, loss of light perception, and hypotony were considered as surgical failure. The IOP, number of glaucoma medications used, postoperative complications, and visual acuity were evaluated as the secondary outcomes. The surgical outcomes were compared between the glaucoma and ocular hypertension (OH) groups. Results: At 12 months postoperatively, the probability of success was 72.5%, 54.1%, and 28.4% using criterion A, B, and C, respectively, and the mean IOP and mean number of glaucoma medications used had decreased significantly (p < 0.01 and p = 0.03, respectively). Furthermore, the cumulative success rate was significantly higher in the OH group than in the glaucoma (100% vs. 47.4%; p < 0.01) when using criterion A. Additional glaucoma surgery was required only in the glaucoma group. Conclusions: IOL refixation surgery significantly decreases the IOP and number of glaucoma medications required in patients with elevated IOP due to IOL subluxation. Thus, IOL refixation surgery alone without glaucoma surgery might be effective as the primary procedure in such patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study investigates the relationship between thyroid eye disease (TED) and open-angle glaucoma (OAG), focusing on disease severity and clinical features. Materials and Methods: Conducted at the Timis County Emergency Clinical Hospital, the research included 106 patients, with 53 having both conditions and 53 having only OAG. Key metrics analyzed included intraocular pressure (IOP) using a Goldmann applanation tonometer, the retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) characteristics evaluated using optical coherence tomography (OCT). Results: Results indicated that patients with both TED and OAG experienced a 6.09% reduction in RNFL thickness and showed more rapid disease progression, with 48.35% having active TED. The mean IOP in TED patients was 27.5 ± 4.9 mmHg, which was similar to those with only OAG. Demographic factors, including age and gender, influenced the clinical course and disease severity. Conclusions: These findings underscore the importance of specialized monitoring and treatment strategies for patients with coexisting TED and OAG to prevent vision loss. [ABSTRACT FROM AUTHOR]

Background/aimsTo evaluate the association of macular vessel density (VD) and ganglion cell complex (GCC) thickness with 10-2 central visual field (CVF) progression in glaucoma.MethodsIn this retrospective cohort study, patients with glaucoma from Diagnostic Innovation in Glaucoma Study with≥five 10-2 visual field (VF) tests and 3-year follow-up before optical coherence tomography (OCT) and OCT angiography (OCTA) imaging were included. Whole-image GCC thickness (wiGCC) and superficial VD (wiVD) were obtained from 6*6 macula scans. The association of wiVD and wiGCC with past rate of 10-2 VF mean deviation worsening, and with past CVF progression (defined using clustered linear regression criteria) was evaluated using linear mixed models after adjusting for confounders.ResultsFrom 238 eyes (141 patients), 25 eyes (11%) of 16 patients were CVF progressors. In the multivariable analysis of the association between OCT/OCTA parameters and past rate of 10-2 CVF worsening, lower wiVD (β=-0.04 (-0.05, -0.02); p

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.

Thanatporn Threetong,1 Somchai Yongsiri,2 Kornkamol Annopawong3 1Department of Ophthalmology, Faculty of Medicine, Burapha University, Chonburi, Thailand; 2Department of Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand; 3Department of Ophthalmology, Rajavithi Hospital and College of Medicine, Rangsit University, Bangkok, ThailandCorrespondence: Kornkamol Annopawong, Department of Ophthalmology, Rajavithi Hospital and College of Medicine, Rangsit University, 2, PhayaThai Road, Thung PhayaThai, Ratchathewi, Bangkok, 10400, Thailand, Tel +66949951594, Email a.kornkamol@gmail.comPurpose: To evaluate the surgical outcomes and identify ocular and systemic prognostic factors of trabeculectomy with mitomycin C (MMC) in the eyes of patients with neovascular glaucoma (NVG) in Thailand.Patients and Methods: This retrospective study was conducted by reviewing records of Thai patients with NVG who underwent trabeculectomy with MMC between 2013 and 2022. Criterion failure was defined as intraocular pressure (IOP) > 21 mmHg or less than a 20% reduction below baseline on two consecutive study visits after 3 months, IOP ≤ 5 mmHg on two consecutive study visits after 3 months, reoperation for glaucoma, and loss of light perception. Kaplan–Meier survival curves were used to examine success rates, and risk factors were analyzed using Cox’s proportional hazard model.Results: The study included 106 eyes of 106 patients with a mean age of 57 years (range, 27– 87 years). The cause of NVG was proliferative diabetic retinopathy (PDR) in 63 eyes (59.43%), central retinal vein occlusion (CRVO) in 39 eyes (36.79%), and ocular ischemic syndrome (OIS) in 4 eyes (3.77%). The cumulative probability of success in the first year was 73.6% with anti-glaucoma medication and 54.7% without medication. The multivariate model demonstrated that major cardiovascular events (hazard ratio [HR], 2.778 p=0.001) and preoperative systemic antiglaucoma medication use (HR, 1.837, p=0.045) were prognostic factors for surgical failure among all NVG patients. Postoperative manipulation with a subconjunctival injection of MMC occurred significantly more frequently in the failure group (HR, 3.100; p< 0.001).Conclusion: Trabeculectomy with MMC effectively reduced the elevated IOP associated with NVG in Thailand. Underlying systemic diseases involving major vascular events and the use of adjunct systemic IOP-lowering medications were prognostic factors for surgical failure.Keywords: intraocular pressure, major vascular events, stroke, myocardial infarction, vascular endothelial growth factor

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.

AIM: To investigate the patterns of short-term intraocular pressure (IOP) fluctuations and identify the contributing factors following intravitreal injection in patients with retinal vascular diseases. METHODS: Totally 81 patients were enrolled in this case control study. Eyes were categorized into 7 groups, including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), idiopathic choroidal neovascularization (CNV), proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), macular edema secondary to branch (BVOME) and central (CVOME) retinal vein occlusion. IOP was measured in all patients using rebound tonometer at 7 preset time points perioperatively. Additionally, based on the administered medication, the eyes were classified into three treatment groups, including dexamethasone intravitreal implant (IVO), intravitreal conbercept (IVC), and intravitreal ranibizumab (IVR). To compare IOP values at various time points across groups, we employed one-way ANOVA, independent sample t-test or χ2 test and multivariate logistic regression analysis. RESULTS: Peak IOP values across all groups were observed at 40s, and 5min after intravitreal injection. Statistical differences in IOP were detected at the 5min among the 7 indication groups (F=2.50, P=0.029). When examing the impact of medications, the IVO group exhibited lower average IOP values at both 40s and 5min compared to the IVC and IVR groups (P

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.

Purpose: to evaluate the clinical effectiveness of using green lens glasses to reduce IOP in healthy people during psychoemotional stress. Materials and methods. IOP variation was estimated for 23 students, who alternatively wore green lens glasses for 1 hour and did not wear them. The research was done during classwork so the students experienced intense mental load. Results. With no chromatic optical correction, the average IOP which initially was 15.45 ± 2.37 mm Hg (95% CI: 13.75–17.15), increased after one hour up to 16.85 ± 2.40 mm Hg (95% CI: 15.13–18.57), which was statistically significant (p = 0.029). In the chromatic correction experiment, the initial average IOP was 16.15 ± 2.73 mm Hg (95% CI: 14.87–17.43), and only slightly increased after one hour to reach 16.48 ± 3.0 mm Hg (95% CI: 15.04–17.91), and the change was statistically insignificant (p = 0.526). Side effects of green lens glasses, specifically a change in colour perception, were registered in 96% of the students observed. Conclusion. Green lens glasses reduce the rate of IOP elevation under psychological stress. However, we have not received any information about an IOP decrease achievable by such glasses.

Purpose: to conduct a comparative analysis of the clinical efficacy of a fixed combination of antihypertensive drugs: brinzolamide 1 % = timolol 0.5 % and dorzolamide 2 % = timolol 0.5 % for the prevention of intraocular hypertension in patients with silicone oil tamponade of the vitreal cavity.Patients and methods. The study was conducted in the Orenburg branch of S. Fyodorov Eye Microsurgery Federal State Institution during 2022. A retrospective analysis of case histories of 60 patients with retinal detachment and severe proliferative syndrome was carried out. All patients underwent subtotal vitrectomy. To prevent intraocular hypertension after tamponade of the vitreal cavity with silicone oil, patients were prescribed antihypertensive drugs: group 1 (n = 30) — a combination of brinzolamide 1 % = timolol 0.5 %; group 2 (n = 30) — dorzolamide 2 % = timolol 0.5 %. The therapeutic result was evaluated after 2 weeks, 1, 2 and 3 months. The observation included an ophthalmological examination, as well as a questionnaire to assess drug tolerance.Results. IOP after silicone oil tamponade and before the application of drugs had no statistically significant differences between the studied groups and amounted to 27.15 ± 3.56 mm Hg — in group 1 and 28.53 ± 5.99 mm Hg — in group 2. Both studied combinations provided a decrease in IOP, however, a more pronounced effect after 2 weeks of therapy with subsequent maintenance of a normal IOP level for 3 months was recorded in group 2 when using the dorzolamide / timolol combination, despite the appearance of minor discomfort during instillation. A decrease in IOP from baseline was found to be 43.5 % (p ≤ 0.01) with the combination dorzolamide/timolol and 33.3 % (p ≤ 0.01) for brinzolamide/timolol.Conclusion. The results of the study showed that both fixed combinations of drugs provide a decrease in IOP in patients after silicone tamponade, but the dorzolamide/timolol combination had a more pronounced therapeutic effect.

Alan W Kong, Adrian Au, Weilin Song, Angela J Oh, Tara A McCannel Department of Ophthalmology, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USACorrespondence: Tara A McCannel, Department of Ophthalmology, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095, USA, Email TMcCannel@jsei.ucla.eduPurpose: Distinguishing an iris melanoma from an iris nevus can be challenging as few clinical features other than documented growth are helpful in making the diagnosis. In this study, we compared the presenting intraocular pressure (IOP) and cup-to-disc ratio (CDR) between affected and unaffected eyes in patients with iris melanoma and iris nevus.Patients and methods: This was a single-institution retrospective case series of patients treated for iris melanoma and iris nevus from January 2013 to October 2022. Thirty-nine subjects with iris melanoma and forty age-matched patients with iris nevus were included. We analyzed the difference in IOP, CDR, and diagnosis of glaucoma between affected and unaffected eyes in patients with iris melanoma and control iris nevus cohort.Results: The average IOP for eyes with iris melanoma and iris nevus was 18.8± 6.1 mmHg and 14.6± 3.5 mmHg (P< 0.001), respectively. The average CDR was 0.36± 0.27 and 0.24± 0.14 (P=0.02), respectively. The average IOP of the contralateral unaffected eye in iris melanoma patients was 16.3± 3.5 mmHg, significantly less than the affected eye (P=0.03). The average CDR of the contralateral unaffected eye in iris melanoma was 0.25± 0.15, which was trending towards being less than the affected eye (P=0.05). There was no difference in the average IOP (P=0.89) or average CDR (P=0.49) between the affected and unaffected eye in patients with iris nevus.Conclusion: We demonstrate that patients with iris melanoma are more likely to have greater IOP and CDR in the affected eye compared to the unaffected eye, and a diagnosis of unilateral glaucoma than eyes with iris nevus. Patients with iris melanoma had greater IOP asymmetry between the affected and unaffected eye. Therefore, IOP and CDR asymmetry may suggest a diagnosis of iris melanoma.Keywords: iris melanoma, iris nevus, secondary glaucoma, intraocular pressure, cup to disc ratio

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.

Abstract Purpose To determine the feasibility of a prototype needle that enhances vitreous reflux (VR) to control intraocular pressure (IOP) in intravitreal injection (IVI). Methods We created an eye model to compare IVI using a standard 30-G needle with four different versions of a 30-G prototype needle with one to four surface grooves that enhanced VR. We injected 50, 70, and 100 µl saline through porcine sclera or 460-µm-thick rubber and measured the peak and 3-second pressure before we extracted the needle and measured the 10-second pressure. Results 50-µl injection through sclera with the standard needle resulted in mean (SD) pressure of 58.6 (3.8) mmHg at peak, 52.8 (4.7) mmHg at 3 s, and 39.6 (18.0) mmHg at 10 s. The prototype needle lowered the pressure; four grooves resulted in mean (SD) pressure of 29.4 (5.6) mmHg at peak, 22.0 (3.7) mmHg at 3 s, and 7.2 (6.6) mmHg at 10 s. 70-µl and 100-µl injections through sclera with the standard needle resulted in mean (SD) pressure of 68.8 (3.6) and 86.0 (6.0) mmHg at peak. Similar to 50-µl injection, the prototype needle lowered the pressure for 70-µl and 100-µl injections. At 10 s, we observed varying leakage at the injection site for sclera but not for rubber. Conclusions The study provides proof of concept for a needle design for which surface grooves enhance VR and counteract the effect of IVI on IOP. The safety and efficacy of the prototype needle must be studied further in a clinical trial.

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 (

AIM: To synthesize the current body of research regarding the diurnal variations in intraocular pressure (IOP) and corneal biomechanical and morphological parameters, highlighting their significance in various eye conditions. METHODS: A comprehensive review of studies on the diurnal variations of IOP and corneal parameters was conducted. Tonometry findings from various studies were assessed, including the Goldmann applanation tonometry (GAT) and non-contact tonometers. Data on the variations in central corneal thickness (CCT), corneal curvature, and corneal biomechanics measured by the Ocular Response Analyzer system across different population groups was extracted and analyzed. RESULTS: In both healthy subjects and those with Fuchs dystrophy, IOP and CCT demonstrate marked diurnal declines. GAT remains the gold standard for tonometry, with the highest reliability. However, its measurements are influenced by CCT. Keratoconus patients and those with pseudoexfoliation showed significant diurnal variations in IOP. The biomechanical parameters, especially corneal hysteresis (CH) and the corneal resistance factor (CRF), largely remain stable throughout the day for most of eye conditions, with some exceptions. Notably, the corneal morphology diurnal variation, particularly curvature, yielded mixed conclusions across studies. CONCLUSION: Circadian rhythms significantly influence various corneal parameters, most notably IOP and CCT. Further studies should emphasize standardized approaches larger sample sizes, and delve deeper into less-explored areas, such as the effects of orthokeratology lenses on diurnal biomechanical shifts.

Over half a century has passed since the inception of vitrectomy, and the indications for its utilization in ophthalmology encompass the majority of vitreoretinal disorders. Technological advancements and equipment innovation have drastically reduced the surgical risk of vitrectomy, but some complications remain unavoidable. Occasionally, unexpected or unexplained visual impairments can manifest. Vitrectomy is associated with a high incidence of optic neuropathy, which can manifest weeks to months following the procedure and result in permanent visual impairment. An intraoperative optic nerve injury and a postoperative secondary injury comprise the causes. Intraocular pressure, dye toxicity, or mechanical damage can cause intraoperative optic nerve injury. Secondary injuries that occur after surgery include an increase in intraocular pressure, toxicity to silicone oil, oxidative stress, and other alterations in the microenvironment. This review will discuss the common causes, clinical manifestations, and related management of optic neuropathy connected to vitrectomy in order to attract the interest of ophthalmologists.

Aim and Objective: To study the clinical outcome of cataract surgery in patients with phacolytic glaucoma. MATERIALS AND METHODS: This is a hospital based prospective interventional study done on 50 eyes of 50 cases of phacolytic glaucoma conducted over one year. Following initial medical management, patients underwent lens extraction through manual small incision cataract surgery (SICS). Clinical examination, best corrected visual acuity and intraocular pressure were noted preoperatively as well as postoperatively. Result: A total of 50 patients were enrolled in this study with female to male ratio of 1.5:1. The mean age of presentation was 62.48 years. Preoperative vision in the affected eye was only perception of light in all of them and IOP measured at presentation was 50 mm in 8 (16%). Thirty patients (60%) had good vision in fellow eye due to pseudophakia. The average duration between the first and second eye surgery was 1-3 years. 94% of our patients were from rural areas. All patients presented within one week of the onset of symptoms. All patients underwent manual small incision cataract surgery with rigid IOL implantation in 35 patients (70%), whereas 15 cases (30%) were left aphakic and planned for secondary IOL at a later date. Intraoperative complications noted were zonular dehiscence in 38%, anterior capsular calcification which led to difficulty in anterior capsulorhexis in 32%, peripheral rhexis runoff in 20%, subluxated lens in 12% and posterior capsular rupture in 14%. BCVA at the end of 1 month was >6/12 in 21 patients (42%), 6/12-6/18 in 14 patients (28%), and

Abstract Introduction To investigate the effects of different reading postures on intraocular pressure (IOP) and near-work-induced transient myopia (NITM) in children with myopia. Methods Sixty myopic children were instructed to read a book text placed at 33 cm for 30 min with two different reading postures: head bowed and head upright postures. The participants’ IOP and NITM were assessed using a rebound tonometer and an open-field autorefractor. The measurement of IOP was conducted prior to reading, during reading sessions (at 5, 10, 20, and 30-min intervals), and after a 5-min recovery period. Results For the head bowed posture, the mean baseline IOP was 16.13 ± 2.47 mmHg. A significant rise in IOP was observed after 5 min of reading (17.17 ± 2.97 mmHg; +1.03 ± 2.29 mmHg; p = 0.014). Subsequent measurements revealed a further increase after 20 min (17.87 ± 2.90 mmHg; +1.73 ± 2.58 mmHg; p

Abstract Background Glaucoma is a leading cause of vision impairment and permanent blindness. Primary open-angle glaucoma (POAG) is a prominent type of primary glaucoma; however, its cause is difficult to determine. This study aimed to analyze the serum lipid profile of Chinese POAG patients and assess its correlation with intraocular pressure (IOP). Methods The study included 1,139, 1,248, and 356 Chinese individuals with POAG, primary angle closure glaucoma (PACG), and controls, respectively. Peripheral whole blood samples were collected at the time of diagnosis. Enzymatic colorimetry was used to determine serum levels of different lipids: high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides, cholesterol, and very low-density lipoproteins (VLDL). Additionally, immunoturbidimetry was used to quantify serum levels of apolipoproteins A (APOA), B (APOB), E (APOE), and lipoprotein A [Lp(a)], while intraocular pressure (IOP) was measured in all patients with POAG. Results After adjusting for age and sex, patients with POAG exhibited elevated serum levels of VLDL, APOA, and APOE but mitigated cholesterol levels compared with the control participants. Significantly lower serum triglyceride, VLDL, and Lp(a) levels were found in patients with PACG than in control participants. Serum cholesterol (P = 0.019; β = -0.75, 95% confidence interval [CI]: -1.38 – -0.12) and HDL levels (P

Nawaf Almarzouki Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaCorrespondence: Nawaf Almarzouki, Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia, Email nawaf.almarzouki@gmail.comBackground: Glaucoma, a leading cause of irreversible vision loss, is characterized by progressive degeneration of retinal ganglion cells. Intraocular pressure (IOP) remains a well-established risk factor, but recent research suggests environmental and lifestyle factors may also play a role.Objective: This review aimed to evaluate the current evidence on the impact of environmental factors on glaucoma progression.Methods: We conducted a systematic review following PRISMA guidelines, searching various databases for studies on environmental factors and glaucoma progression.Results: Our review identified several key findings. IOP remains the most crucial modifiable risk factor. Aerobic exercise and mindfulness practices may lower IOP and provide neuroprotection. Lifestyle modifications like smoking cessation and balanced diets were also emphasized. Studies suggest air pollution exposure, particularly PM2.5, may be associated with an increased risk of glaucoma. However, the studies were primarily observational, and more research is needed to establish causality and elucidate underlying mechanisms.Conclusion: This review highlights the multifaceted nature of glaucoma, emphasizing the interplay between established risk factors (IOP) and emerging environmental influences (air pollution). Environmental factors hold promise as potential targets for glaucoma prevention and management strategies. Future research should focus on well-designed studies to investigate causal relationships and biological mechanisms.Keywords: glaucoma, intraocular pressure, IOP, environmental factors, air pollution, lifestyle modifications, aerobic exercise, diet, public health

Abstract Purpose The objective of this study was to evaluate anterior segment parameters across various phenotypes of polycystic ovary syndrome (PCOS), considering body mass index (BMI), serum estradiol and testosterone levels. Materials and Methods This prospective study included 116 women with PCOS, with each of the four distinct phenotype comprising 29 women. Additionally, 29 healthy women were included in the control group. All participants underwent comprehensive ophthalmologic examinations, including intraocular pressure (IOP) measurements. Anterior segment parameters, such as central corneal thickness (CCT), axial length (AL), aqueous depth (AD), anterior chamber depth (ACD), and lens thickness (LT) were measured using optic biometry. Endothelial cell density (ECD) was assessed using non-contact specular microscopy. The BMI was calculated, and serum levels of estradiol and testosterone were noted. Results IOP was found to be significantly higher (p = 0.003) and CCT was significantly thicker (p = 0.004) in all phenotypes of PCOS compared to the control group. BMI, serum estradiol and free testosterone were found to correlate with both IOP and CCT. AL, AD, ACD and LT values showed no significant differences compared to the control group. Although ECD tend to be higher in the PCOS phenotypes, this difference was not statistically significant (p > 0.05). Conclusion Given our findings that CCT and IOP are significantly elevated in PCOS phenotypes. PCOS should be considered as an important factor when evaluating female patients for anterior segment diseases and glaucoma.

AIM: To observe early clinical outcome with lens position adjustment following the implantable collamer lens (ICL) surgery. METHODS: Sixty patients were selected for this retrospective study. One eye from each patient received Toric ICL for astigmatism correction, and the other received non-astigmatic ICL surgery using horizontal position. Patients with higher postoperative arch height were selected, and their non-astigmatic eye clinical outcome were observed after ICL surgery at 1wk, 1, and 3mo. The clinical measurements included uncorrected visual acuity (UCVA), intraocular pressure (IOP), refractive state, corneal endothelium cell count, and arch height. Three months later, the ICL in each patient's non-astigmatic eye was adjusted to the vertical from the horizontal position. The results were compared before and 1wk, 1, and 3mo after adjustment. RESULTS: UCVA and IOP were significantly reduced 1wk after position adjustment compared to 1wk after ICL implantation (P0.05). CONCLUSION: Early positioning adjustment post-phakic ICL implantation can benefit patients with adjusted arch height or higher IOP. Despite the good clinical effects, the doctors should pay attention to the potential for adverse effects on UCVA and corneal endothelium cells following early position adjustment after posterior chamber phakic ICL implantation.

With the significant changes in people's lifestyles, the prevalence of myopia is escalating globally, which has aroused the close attention of clinicians. Myopia is easy to combine with other serious ophthalmic diseases, especially in patients with high myopia(HM), often combined with primary open angle glaucoma(POAG), and the incidence rate is much higher than that of people with normal refractive status. The condition becomes especially complex when HM co-exists with POAG. In recent years, we have focused on the characteristics of fundus changes in patients in clinical work. Early detection of patients with POAG from HM is the key to in-depth understanding and effective prevention and treatment of these two diseases. In this paper, we review the recent literatures on the relationship between HM and POAG from the aspects of epidemiology, pathogenesis, and clinical features, and summarize the research progress, so as to provide help for early detection, early diagnosis, and early treatment of the disease.

PurposeTo investigate the impact of trabecular bypass surgery targeted to angiographically determined high- vs. low-aqueous humor outflow areas on outflow facility (C) and intraocular pressure (IOP).DesignEx vivo comparative study.SubjectsPostmortem ex vivo porcine and human eyes.MethodsPorcine (n = 14) and human (n = 13) whole globes were acquired. In both species, anterior segments were dissected, mounted onto a perfusion chamber, and perfused using Dulbecco's phosphate buffered solution containing glucose in a constant flow paradigm to achieve a stable baseline. Fluorescein was perfused into the anterior chamber and used to identify baseline segmental high- and low-flow regions of the conventional outflow pathways. The anterior segments were divided into 2 groups, and a 5 mm needle goniotomy was performed in either a high- or low-flow area. Subsequently, C and IOP were quantitatively reassessed and compared between surgery in baseline "high-flow" and "low-flow" region eyes followed by indocyanine green angiography.Main outcome measuresOutflow facility.ResultsIn all eyes, high- and low-flow segments could be identified. Performing a 5-mm goniotomy increased outflow facility to a variable extent depending on baseline flow status. In the porcine high-flow group, C increased from 0.31 ± 0.09 to 0.39 ± 0.09 μL/mmHg/min (P = 0.12). In the porcine low-flow group, C increased from 0.29 ± 0.03 to 0.56 ± 0.10 μL/mmHg/min (P

ObjectiveTo investigate the effect of smoking on choroidal microvasculature dropout (MvD) in glaucoma.DesignCross-sectional study.SettingTertiary glaucoma centre.Participants223 eyes of 163 patients with primary open-angle glaucoma who had undergone imaging with optical coherence tomography angiography and completed a questionnaire on smoking from the Diagnostic Innovations in Glaucoma Study.Primary outcome measuresLinear mixed-effects models were used to determine the effect of each parameter on MvD area and angular circumference. The sensitivity analysis was performed by categorising the glaucoma severity determined by visual field mean deviation (MD).ResultsMvD was found in 37 (51.4%) eyes with smoking history and in 67 (44.4%) eyes with non-smokers (p=0.389). Larger MvD area and wider angular circumference were found in smokers compared with non-smokers (p=0.068 and p=0.046, respectively). In a multivariable model, smoking intensity was significantly associated with MvD area (0.30(95% CI 0.01 to 0.60) each 0.01 mm2 per 10 pack-years; p=0.044). In eyes with moderate-severe glaucoma (MD

BACKGROUND: Patients with glaucoma on topical glaucoma medication are often affected by dry eye symptoms and thus likely to rub or squeeze their eyelids. Here, we telemetrically measure peak intraocular pressure (IOP) during eyelid manoeuvres and eyelid rubbing. METHODS: Eleven patients with primary open-angle glaucoma (POAG) previously implanted with a telemetric IOP sensor (Eyemate-IO) were instructed to look straight ahead for 1 min as a baseline measurement. Next, 6 repeats of blinking on instruction with 10 s intervals in between were performed. In addition, 5 repeats of eyelid closure (n=9), eyelid squeezing and eyelid rubbing (n=7) were performed with 15 s intervals in between. IOP was recorded via an external antenna placed around the study eye. Average peak IOP increases from baseline were analysed and tested against zero (no change) with one-sample t-tests. RESULTS: For eyelid rubbing, the average peak ∆ IOP increase (mean±SEM) was 59.1±9.6 mm Hg (p

ObjectivesTo investigate the associations of alcohol consumption and smoking with the development of perimetric glaucoma in patients with suspected glaucoma.DesignA retrospective cohort study of patients suspected to have glaucoma enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES).SettingThree tertiary glaucoma centres in the USA.Participants825 eyes of 610 patients with glaucoma suspect eyes with normal visual fields (VF) at baseline were followed over an average of 9 years from the DIGS and ADAGES studies.Outcome measuresDevelopment of glaucoma was defined as occurrence of three consecutive abnormal VF tests during follow-up. Univariable and multivariable Cox regression models were used to investigate lifestyle-related factors associated with development of VF loss over time.ResultsVF tests were abnormal three times in a row in 235 (28.5%) eyes. Alcohol consumption was associated with a higher risk of developing glaucoma (HR 1.57, 95% CI 1.03 to 2.38, p=0.037). In men, the risk of developing glaucoma in alcohol drinkers (HR 1.92, 95% CI 1.00 to 3.68, p=0.048) was greater than non-alcohol drinkers. In individuals of African descent, the risk of developing glaucoma in alcohol drinkers (HR 1.79, 95% CI 1.02 to 3.15, p=0.043) was greater than non-alcohol drinkers. Age was a modifier of the relationship between smoking and glaucomatous VF defects (p=0.048). The risk of developing glaucoma in smokers (HR 1.73, 95% CI 1.10 to 2.72, p=0.019) was greater than never smokers after adjustment for confounding factors in older patients (age >61 years).ConclusionAlcohol consumption was associated with an increased risk of developing glaucoma, particularly in men and individuals of African descent. The risk of developing glaucoma among smokers suspected of having glaucoma was influenced by age, with older individuals having a higher risk than younger people.Trial registration numberNCT00221897 and NCT00221923.

Background/aimsTo investigate the factors associated with choroidal microvasculature drop-out (MvD) enlargement detected by optical coherence tomography angiography (OCT-A) in glaucomatous eyes.MethodsNinety-one eyes of 68 primary open-angle glaucoma patients were enrolled. Only eyes with a minimum of four good quality OCT-A and OCT scans of the optic nerve head acquired at least and with a minimum of 2 years follow-up were included. Area and angular circumference of MvD were analysed on en face images. Univariable and multivariable mixed effects models were constructed to identify the factors contributing to MvD area and angular circumference change over time.ResultsPeripapillary MvD was detected in 53 (58.2%) eyes at baseline and in an additional 17 (18.6%) eyes during follow-up, whereas MvD was not detected in 21 (23.0 %) eyes during the entire follow-up period. In multivariable analysis, worse baseline visual field (VF) mean deviation (MD) (ß=0.27, 95% CI 0.10 to 0.44, p=0.002), greater intraocular pressure (IOP) fluctuations (ß=0.86, 95% CI 0.24 to 1.48, p=0.007), higher peak IOP (ß=0.17, 95% CI -0.01 to 0.35, p=0.067) and greater number of IOP lowering medications (ß=1.36, 95% CI 0.67 to 2.05, p

OBJECTIVE: To evaluate the effects of scleral lens size and the duration of wear on intraocular pressure (IOP) during lens wear. METHODS: Healthy adults were recruited for this prospective and randomized study. Intraocular pressure measurements were performed using a pneumotonometer. A block randomization was used to assign the order of scleral lens diameter of either 15.6 mm or 18.0 mm for 5-hr bilateral wear over a course of two visits. Scleral IOP (sIOP) was measured during the predetermined intervals, 1.25 hr apart, during the 5-hr scleral lens wear. Corneal IOP (cIOP) was measured before and after the scleral lens wear. The primary outcome measure was the mean change in sIOP from prelens insertion baseline. RESULTS: Corneal IOP unchanged after scleral lens removal compared with the baseline measurements ( P =0.878). Smaller and larger lenses introduced significantly higher sIOP at 2.5 hr after lens insertion with the mean (95% CI) increase of 1.16 (0.54, 1.78) mm Hg and 1.37 (0.76, 1.99) mm Hg, respectively. There was no difference in IOP change between the smaller and larger diameter lenses ( P =0.590). CONCLUSIONS: Well-fitted scleral lenses do not result in clinically significant changes in intraocular pressure during 5-hr lens wear in young and healthy individuals.

PrcisRacial/ethnic minorities are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. In addition, we highlight a gap in the use of diagnosis codes.PurposeThe purpose of this study was to analyze patterns of diagnosis coding usage and validate epidemiologic patterns of glaucoma onset and severity among primary glaucoma patients within the National Institutes of Health All of Us database.Patients and methodsWe used International Classification of Disease diagnosis codes to build 4 cohorts of patients with mild, moderate, severe, and unspecified stage glaucoma (N=2982). Descriptive analyses were stratified by disease stage, and mean age at diagnosis was compared across racial and ethnic groups. Multivariable ordinal regression was used to examine risk factors for increasing glaucoma severity.ResultsOf 2982 participants, 1714 (57%) had unspecified severity staging. Black/African Americans and other races were diagnosed with glaucoma at significantly younger ages compared with Whites (means 60 and 60 vs. 66 y; P

Purpose: This study investigated the relationship between blood pressure and intraocular pressure in treatment-naive, non-glaucoma patients with different blood pressure statuses, focusing on the 24-h ocular volume and nocturnal blood pressure decline. Methods: Treatment-naive, non-glaucoma patients undergoing hypertension evaluation were enrolled as study participants. Simultaneous 24-h ambulatory blood pressure measurement and 24-h ocular volume recording with a contact lens sensor. We also compared ocular volume curve parameters between normotensive and hypertensive patients, as well as between those with and without nocturnal blood pressure decline. Results: A total of 21 patients, including 7 normotensive and 14 treatment-naive hypertensive individuals, were included in the study. of them, 11 were dippers and 10 were non-dippers. No significant difference in the 24-h ocular volume slope was observed between the hypertensive and normotensive patients (p=0.284). However, dippers had a significantly higher 24-h ocular volume slope (p=0.004) and nocturnal contact lens sensor output (p=0.041) than non-dippers. Conclusion: Nocturnal blood pressure decline, rather than the blood pressure level, is associated with the increased 24-h ocular volume slope and nocturnal ocular volume. Further studies are required to determine whether the acceleration of glaucoma progression in dippers is primarily due to low blood pressure, high intraocular pressure, or a combination of both. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and “slow cook” transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. Methods: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). Results: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was -0.10 ± 0.35 and -0.074 ± 0.16 in the micropulse- and “slow cook” transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the slow cook” and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the slow cook” transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and slow cook” transscleral cyclophotocoagulation, respectively (p<0.001). Conclusion: Both techniques reduced intraocular pressure effectively. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine whether early-stage intraocular pressure can be modulated using a thermal face mask. Methods: In this prospective clinical study, healthy participants were randomized on a 1:1:1 allocation ratio to three mask groups: hypothermic (G1), normothermic (G2), and hyperthermic (G3). After randomization, 108 eyes from 108 participants were submitted to clinical evaluations, including measurement of initial intraocular pressure (T1). The thermal mask was then applied for 10 minutes, followed by a second evaluation of intraocular pressure (T2) and assessment of any side effects. Results: The hypothermic group (G1) showed a significant reduction in mean intraocular pressure between T1 (16.97 ± 2.59 mmHg) and T2 (14.97 ± 2.44 mmHg) (p<0.001). G2 showed no significant pressure difference between T1 (16.50 ± 2.55 mmHg) and T2 (17.00 ± 2.29 mmHg) (p=0.054). G3 showed a significant increase in pressure from T1 (16.53 ± 2.69 mmHg) to T2 (18.58 ± 2.95 mmHg) (p<0.001). At T1, there was no difference between the three study groups (p=0.823), but at T2, the mean values of G3 were significantly higher than those of G1 and G2 (p<0.00). Conclusion: Temperature was shown to significantly modify intraocular pressure. Thermal masks allow the application of temperature in a controlled, reproducible manner. Further studies are needed to assess the duration of these effects and whether they are reproducible in patients with pathologies that affect intraocular pressure. [ABSTRACT FROM AUTHOR]

Purpose: To compare impact of intranasal infusion of dexmedetomidine, ketamine, or combination of both on IOP in children. Patient & methods: This prospective, randomized, observational study was conducted at Benha University Hospital, Egypt and included ASA I or II children aged 1–6 years who underwent examination under sedation. They were randomly divided into three groups: Group D (dexmedetomidine 3 μg/kg); Group DK (dexmedetomidine 1 μg/kg with ketamine 2 mg/kg) & Group K (ketamine 4 mg/kg). We assessed IOP difference before and after sedation. Secondary outcomes were sedation scale assessment (Ramsay Sedation Score), emergency agitation and medication side effects. Results: We studied 118 children divided into Group D (36 patients), Group DK (42 patients) & Group K (40 patients). IOP was significantly lower in group D (13 ± 3 mmHg) than in groups DK (16 ± 4 mmHg) and K (17 ± 3 mmHg), with no significant difference between groups DK and K. Ramsay 3 was higher in group K (65%) compared to groups D and DK (22.2% and 9.5%, respectively), while Ramsay 4 was higher in group D and DK (52.8% and 52.4%, respectively) compared to group K (35%). Post-sedation nausea and vomiting were higher in group K (25%) compared to groups D and DK (0% for each). Agitation was higher in group K (62.5%) than in groups D and DK (0% for each) (p < 0.001). Conclusion: Intranasal dexmedetomidine and ketamine combination are viable for achieving optimal sedation in pediatric patients undergoing surgeries or medical procedures with no significant change in the IOP. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyse Gillies Temporal approach Vs Towel Clip method for reduction of zygoma fractures. Method: A randomised comparative study was conducted on 30 patients having zygoma fractures confirmed with pre-operative NCCT face with 3 D reconstruction. Patients were divided into 2 groups, Group-1- Gillies temporal approach and Group-2- Towel clip method. Clinical observations were recorded in a predesigned proforma for all the patients and analysed statistically. Results: Gillies Temporal Approach significantly p < 0.001 took longer time for reduction than Towel Clip Method. Post-operative pain was experienced more in Group 1 than Group 2. Intraocular pressure was compared at different time intervals and significant difference was noted. Also, Occulocardiac reflex was observed in Group 1. Mean trismus index was 16.87 ± 5.12 mm in Group 1 and 13.33 ± 4.11 mm in Group 2 preoperatively which significantly increased to 51.93 mm in Group 1 and 51.73 mm in Group 2 one month post-op. Reduction was maintained post-operatively with good quality of outcome in both the groups. Conclusion: Non-comminuted zygomatic complex fractures can be effectively treated using Towel Clip Method as this method is cost-effective, minimally invasive, safe, causing minimum or no damage to soft tissue and easy to perform based on surgeon's skill and requires less operating time, proving it equally efficient method with excellent aesthetic outcomes. [ABSTRACT FROM AUTHOR]