Malignant glaucoma treated by low-dose laser cycloplasty: a 1-year multicenter prospective noncomparative study

AIM:To report a one-year clinical outcomes of low-dose laser cycloplasty(LCP)among malignant glaucoma patients.METHODS:In this prospective,multicenter,noncomparative clinical study,participants with malignant glaucoma were recruited and underwent LCP at eight ophthalmic centers in China.Patients were followed up at 1wk,1,3,6,and 12mo.Intraocular pressure(IOP),number of glaucoma medications,anterior chamber depth(ACD),and complications were recorded.Anatomical success was defined as the reformation of the anterior chamber based on slit-lamp biomicroscopy.Recurrence was defined by the presence of a shallow orflat anterior chamber after initial recovery from treatment.RESULTS:A total of 34 eyes received LCP.Mean IOP and medications decreased from 36.1±11.5 mm Hg with 3.3±1.5 glaucoma medications pre-treatment to 20.9±9.8 mm Hg(P<0.001)with 2.9±1.6 medications(P=0.046)at 1d,and 17.4±6.7 mm Hg(P<0.001)with 1.3±1.7 medications(P<0.001)at 12mo.The ACD increased from 1.1±0.8 mm at baseline to 1.7±1.0 mm and to 2.0±0.5 mm at 1d and 12mo,respectively.A total of 32(94.1%)eyes achieved initial anatomical success.During follow-up,2(5.9%)eyes failed and 8(23.5%)eyes relapsed,yielding a 12-month anatomical success rate of 64.3%.Complications including anterior synechia(8.82%),choroidal/ciliary detachment(5.88%)and hypopyon(2.94%)were observed within 1wk.CONCLUSION:LCP is simple,safe,and effective in reforming the anterior chamber in malignant glaucoma.

Trend of glaucoma internal filtration surgeries in a tertiary hospital in China

AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had been diagnosed with glaucoma and received antiglaucoma surgery between January 1,2015 and December 31,2021 was conducted.The glaucoma diagnosis in this study included primary open angle glaucoma,primary angleclosure glaucoma,secondary glaucoma,and paediatric glaucoma.The types of surgeries were categorised as internal filtration,external filtration,and cyclodestruction surgery based on the pathway of aqueous humor outflow.The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed.RESULTS:The number of patients hospitalised for glaucoma surgery increased yearly,from 752 in 2015 to 1373 in 2021,at the Eye Hospital of Wenzhou Medical University.Regarding the patients diagnosed with primary open angle glaucoma,internal filtration surgery increased from 27.40%of the sample to 54.40%of the sample,while external filtration surgery decreased from 71.50%to 44.20%between 2015 and 2021.For paediatric glaucoma,internal filtration surgery increased from 37.50%in 2015 to 88.20%in 2021.Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma,the proportion of internal filtration surgery also showed an increase from 18.20%in 2015 to 40.90%in 2021.Meanwhile,internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00%in 2015,and showed a small increase by 2021.CONCLUSION:As surgical technology and surgical experience continue to elevate and improve,the range of glaucoma surgeries are correspondingly evolving.This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.

Effect of low dose laser cycloplasty on deepening anterior chamber in chronic angle-closure glaucoma

AIM:To describe the outcome of using low-dose laser cycloplasty(LCP)in chronic angle-closure glaucoma(CACG).METHODS:A retrospective case series.Medical charts of CACG patients who underwent LCP in the Eye Hospital of Wenzhou Medical University were reviewed.The main outcomes included intraocular pressure(IOP),the number of glaucoma medication,anterior segment parameters and surgery-related complications.RESULTS:A total of 7 eyes of 7 CACG patients(age 38.9±11.0y)underwent LCP with a mean follow-up of 27.1±13.7mo(range 16-48mo).Following LCP,mean IOP and glaucoma medications decreased from 26.1±6.1 mm Hg with 3.1±1.1 glaucoma medications pre-treatment to 14.9±3.1 mm Hg(P=0.027)with 0.4±1.1 glaucoma medications(P=0.001)at final follow-up.The anterior chamber depth(ACD),angle opening distance500 and trabecular-iris angle increased from 1.65±0.33 mm,0.05 mm(range 0-0.30 mm)and 5.1°(range,0-31.97°)at baseline to 1.98±0.43 mm(P=0.073),0.53 mm(range 0.42-0.91 mm,P=0.015),45.9°(range,40.2°-59.4°),(P=0.015)in the long-term follow-up,respectively.The deepening of ACD and reopening of anterior chamber angle(ACA)was observed in 6 eyes(85.7%).CONCLUSION:LCP is a promising treatment option for patients with CACG via reducing IOP and glaucoma medication without serious complications.In addition,LCP can bring a significant deepening in ACD and reopening of ACA.

A new bleb-independent surgery namely penetrating canaloplasty for corticosteroid-induced glaucoma: a prospective case series

AIM: To report the outcomes of penetrating canaloplasty for corticosteroid-induced glaucoma in a case series.METHODS: Penetrating canaloplasty is a blebindependent filtering surger y unifying canaloplasty and trabeculectomy. In this study, the surger y was performed to restore the natural outflow through surgically expanded Schlemm’s canal and generated trabeculum ostium. A total of 10 eyes of 8 patients were treated with penetrating canaloplasty for corticosteroid-induced glaucoma. Intraocular pressure(IOP) and the number of glaucoma medications at postoperative 3, 6, 12, 18, 24,36, and 48mo were documented as primary endpoint.Complications after the surgery were recorded as secondary endpoint.RESULTS: Penetrating canaloplasty was accomplished successfully for all 10 eyes, with a mean follow-up of 20.4±13.0mo(range 6-48mo). The mean preoperative IOP and number of anti-glaucoma medications were 45.1±6.5 mm Hg and 3.3±0.5 respectively. The mean post-operative IOP at 3, 6, 12, 18, 24, 36, and 48mo were 15.8±6.0, 14.7±3.3,15.3±2.0, 15.6±2.6, 17.5±1.8, 16.5±4.9, and 14.0 mm Hg.The number of anti-glaucoma medications at these time points were all 0. This surgery failed to control the IOP in 1 eye at 1mo after surgery. Hyphaema occurred in 3 eyes on the first day after surgery. Postoperative transient IOP increasing was encountered with in two eyes from 1wk to 1mo after surgery. Choroidal detachment developed in one eye but responded well to conservative treatment.CONCLUSION: Penetrating canaloplasty is effective for corticosteroid-induced glaucoma without serious complications, making it a viable or preferred alternative option.

Association of peripheral anterior synechia,intraocular pressure,and glaucomatous optic neuropathy in primary angle-closure diseases

AIM:To investigate the association of peripheral anterior synechiae(PAS)with intraocular pressure(IOP)and glaucomatous optic neuropathy(GON)in primary angle closure(PAC)and primary angle-closure glaucoma(PACG).METHODS:Totally 355 eyes(238 PAC and 117 PACG)of 181 patients were included in this retrospective analysis of baseline data from a randomized clinical trial.All patients had undergone a comprehensive ophthalmic examination.The extent of PAS in clock hours as determined on gonioscopy was documented.The independent effect of the extent of PAS on IOP and the prevalence of GON were determined using multivariable generalized estimating equation(GEE)models.RESULTS:The frequency of GON increased with the extent of PAS and a higher IOP.PAS were more extensive(8 vs 1 clock hour,P<0.001)and IOP higher(28.01 vs 18.00 mm Hg,P<0.001)in PACG compared to PAC.The prevalence of GON among the PAS quartiles were 10.2%(PAS<0.5 clock hours),16.9%(PAS≥0.5 and PAS<3 clock hours),29.6%(PAS≥3 and PAS<7 clock hours),and 74.4%(PAS≥7 clock hours),respectively.After adjusting for IOP,age,gender,spherical equivalent,average Shaffer score and number of medications,the odds ratio(OR)for GON was 4.4(95%CI:1.5-13.0;P=0.007)with PAS≥3 clock hours and 13.8(95%CI:4.3-43.6;P<0.001)with PAS≥7 clock hours as compared to eyes with PAS<0.5 clock hours.The frequency of GON increased linearly with the extent of PAS.Extent of PAS was also associated with higher IOP.Eyes with both PAS≥6 clock hours and IOP≥21 mm Hg had the highest risk of GON compared to eyes with both PAS<6 clock hours and IOP<21 mm Hg(OR=18.0,95%CI:7.5-43.4;P<0.001).CONCLUSION:The extent of PAS in PAC and PACG is an important predictor of higher IOP and is linearly associated with GON independent of IOP,suggesting other factors related to PAS formation may be involved in the development of GON in PACG.

Observation seasonal variation of intraocular pressure in young healthy volunteers

AIM:To investigate fluctuation of intraocular pressure(IOP)and seasonal variation of 24-hour IOP during one year in healthy participantsMETHODS:Totally 13 young healthy volunteers participated in this study.IOP was measured with Canon TX-20 at about 8:00-9:00 a.m.from Monday to Friday every week for a whole year.They also underwent 24-hour IOP examination every three months.Blood pressure,heart rate,temperature,humidity,atmosphere pressure,sunshine duration and other environment parameters were recorded.RESULTS:The yearly fluctuation curve showed IOP in the summer months were lower than other seasons.In the multivariable generalized estimating equation analysis,IOP had a negative correlation with both temperature and sunshine duration(P<0.05).There also was a seasonal effect on 24-hour IOP.However,all intraclass correlation coefficients values of minimum,maximum and average of the 24-hour IOP and each individual IOP were less than 0.30.CONCLUSION:IOP is trend to be higher in cold days than warm days.IOP have negative association with both environmental temperature and duration of sunshine.On a season-to-season basis,24-hour IOP is not highly reproducible in healthy volunteers.

WHY NOT LASER TO SC AB INTERO? ELT: EXCIMER LASER TRABECULOSTO- MY

Why not treat the locus of most open angle glaucoma pathology: the juxtacanalicular trabecular meshwork and inner wall of Schlemm's canal? What are the goals and limitations? The goal is to achieve a continuous outflow pathway from the anterior chamber into Schlemm's canal. The limitation is avoiding injury to the outer wall of Schlemm's canal and collector channels while pro-

Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results

Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using vis-ual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout eight years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-to-disc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At eight years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved 1OP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success rate was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through eight years postoperative.VF-MD remained stable until postoperative year five and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naive POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical suc-cess,and favorable safety outcomes,throughout the eight-year follow-up.Our data additionally support the efficacy of this combined procedure in stabilizing or slowing disease progression.

Evening exercise is associated with lower odds of visual field progression in Chinese patients with primary open angle glaucoma

Background:Exercise is widely known to lower intraocular pressure and increase ocular blood flow,which may be beneficial for glaucoma management.However,there are few studies that have reported on the relationship between exercise and glaucoma progression.The aim of our study was to investigate the exercise habits of those with primary open angle glaucoma(POAG)and its association with the progression of visual field(VF)loss.Methods:Daily physical activity(PA)was monitored by an accelerometer(ActiGraph wGT3x-BT)which patients wore for more than 10 h of being awake on their right wrists for 1 week.Results:Seventy-one non-progressive and 27 progressive patients were enrolled in the study.24-h moderate to vigorous physical activity(MVPA)exercise showed that POAG patients had similar variation trends consisting of 3 wave peaks and 2 wave hollows.Minutes spent in MVPA was 19.89±15.81 and 21.62±15.10 during 07:00–09:00 h(p=0.204),15.40±14.49 and 15.67±12.43 during 15:00–17:00 h(p=0.822)and 17.26±21.11 and 11.42±11.58 during 18:00–20:00 h(p=0.001)in the non-progressive and progressive group,respectively.Univariate analysis indicated that 10 min of MVPA(18:00–20:00 h)[odds ratio,OR(95%CI)=0.82(0.73,0.92)],average mean arterial pressure[OR(95%CI)=0.96(0.94,0.98)],age[OR(95%CI)=1.06(1.03,1.08)],male[OR(95%CI)=0.67(0.48,0.96)],spherical equivalent[OR(95%CI)=1.14(1.07,1.22)]and IOP-lowering medications[OR(95%CI)=1.54(1.16,2.05)]were significantly correlated with having progressive VF damage.Multivariable analysis showed that 10 min of MVPA(18:00–20:00 h)[OR(95%CI)=0.85(0.75,0.97)]was associated with progressive VF loss even after adjusting for other risk factors.Conclusions:Evening exercise may lower the odds of VF progression,suggesting that exercise habits possibly play an important role in glaucoma progression.

Long‑term outcomes of two first‑generation trabecular micro‑bypass stents(iStent)with phacoemulsification in primary open‑angle glaucoma:eight‑year results

Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout 8 years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-todisc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At 8 years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved IOP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative.VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical success,and favorable safety outcomes,throughout the 8-year follow-up.Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.

A versatile 3D-printable hydrogel for antichondrosarcoma,antibacterial,and tissue repair

Following operative treatment of chondrosarcoma,post-surgery tissue reconstruction may be confronted with daunting challenges,including the delayed self-repair of defective tissue,tumor recurrence,and bac-terial infection.To overcome these challenges,a methacrylic anhydride(MA)modified sericin(SerMA)solution mixed with procyanidins(PC)loaded polydopamine(PDA)modified ZIF-8(PC@ZIF-8@PDA)nanoparticles to form a multifunctional PC@ZIF-8@PDA/SerMA hydrogel after exposure under blue light.Hydrogel products with pre-designed shapes were printed out by using the SerMA solution carrying PC@ZIF-8@PDA nanoparticles and chondrocytes,indicating that PC@ZIF-8@PDA/SerMA hydrogels with personalized shapes can be fabricated via 3D printing.Photocrosslinked PC@ZIF-8@PDA/SerMA hydrogel is able to kill chondrosarcoma cells and bacteria,like Staphylococcus aureus(S.aureus),and Escherichia coli(E.coli),by its photothermal activity combined with near-infrared radiation(NIR).The PC@ZIF-8@PDA/SerMA hydrogel exhibited an antioxidative activity and a good biocompatibility and was easily monitored by its florescent and photoacoustic properties.Rabbit articular cartilage defects were efficiently repaired by PC@ZIF-8@PDA/SerMA hydrogels with encapsulated corresponding autologous chondrocytes,and mice skin burning wounds were swiftly regenerated by applying this hydrogel.Hence,the PC@ZIF-8@PDA/SerMA hydrogel can be potentially applied to the clinic treatment of chondrosarcoma and tissue defect repair after chondrosarcoma resection due to its multifunction in the future.

Surgical outcomes of XEN45 implantation,trabeculectomy vs.penetrating canaloplasty in open-angle glaucoma:A non-randomized comparative study

To the Editor:Glaucoma is a leading cause of irreversible blindness worldwide.[1]Trabeculectomy with mitomycin C(MMC)has been the standard surgical intervention for reducing intraocular pressure(IOP)and slow down the progression of glaucoma.[2]However,some serious complications with devastating consequences can occur after trabeculectomy,such as bleb-related infections,suprachoroidal hemorrhage,vitreous hemorrhage,and malignant glaucoma.Over the last decade,many novel ophthalmic surgical devices have been used in glaucoma.The XEN45 microstent(Allergan,Dublin,CA,USA)is a hydrophilic cross-linked porcine gelatin stent.It is implanted ab-interno.