PRECIS:The Baby Vision Screener (BaViS) is a device that can test visual fields in infants and young children. Using this device, visual field constriction can be documented in young children with primary congenital glaucoma. PURPOSE:Visual field extent is compromised in patients with glaucoma. While it is relatively easy to quantify visual fields in adults, monitoring visual fields in infants and young children with glaucoma is challenging. Lack of readily available diagnostic equipment is also a barrier. This study aimed to investigate the feasibility of a new device called Baby Vision Screener (BaViS) for measuring visual field extent in this population. METHODS:BaViS is a dome-shaped device with LEDs on its surface and an infrared camera mounted to monitor in real-time and record the tested individual's face, along with the presented stimuli. Stato-kinetic LED stimuli were presented in BaViS to perform kinetic perimetry. Fourteen infants (mean age ± SD: 4.4±3.4 mo) and 15 young children (mean age ± SD: 3.5±1.8 y) diagnosed with bilateral primary congenital glaucoma were tested using BaViS monocularly, binocularly, or both. RESULTS:Visual field isopters were plotted in 77% of the participants. The youngest infant tested using this device was 29 days old. The youngest participant for whom we could map a reliable visual field isopter was 2.3 months old. Constriction of the visual field was observed in 50% of the participants on whom a reliable visual field could be obtained. CONCLUSION:This preliminary study demonstrates that BaViS can be used to test the visual fields in young infants and children with glaucoma. Such a test may be useful for long-term follow-up until the child is ready to be tested using other conventional devices.
PRECIS:This study used fNIRS during a Go/No-Go task to reveal altered prefrontal activation in POAG patients, indicating compensatory cortical recruitment and subtle cognitive dysfunction, highlighting glaucoma's broader neurodegenerative and cognitive impact. PURPOSE:To evaluate cognitive function in individuals with primary open-angle glaucoma (POAG) by assessing prefrontal cortical activity during a behavioral inhibition test (Go/No-Go task) using functional near infrared spectroscopy (fNIRS). PATIENTS:Fifteen patients with mild to moderate POAG and fifteen age and gender matched healthy controls. METHODS:In this pilot case-control study, all participants underwent cognitive assessment using Addenbrooke's Cognitive Examination III (ACE-III), and quality-of-life assessment using EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire. Prefrontal cortical activation patterns were assessed in the prefrontal cortex using a 17-channel fNIRS system during a block-design Go/No-Go task assessing sustained attention and response inhibition. Using statistical parametric mapping (SPM) with general linear model (GLM) analysis, the study observed activation/deactivation in prefrontal cortical regions. RESULTS:Mean age and gender ratio were comparable between the two groups. POAG patients demonstrated significantly lower cognitive scores on ACE-III and reduced health-related quality of life compared to healthy controls (P<0.001). fNIRS demonstrated abnormal prefrontal activation in POAG, with significant hyperactivation during Go versus Rest at channels 8, 13, and 14 (P<0.05), not observed in healthy controls. Conversely, in No-Go vs Rest, healthy controls exhibited significant activation at channels 8, 10, and 15 (P<0.05), absent in POAG. Finally, the Go vs No-Go contrast revealed heightened deactivation in POAG at channel 17 (P<0.05), not observed in healthy controls. CONCLUSIONS:Patients with POAG demonstrated altered and less efficient prefrontal cortical activation patterns during tasks requiring attention and inhibition. These fNIRS based findings suggest early cortical dysfunction in glaucoma.
PRCIS:This study shows that GCC thickness is most sensitive for detecting progression at the onset of glaucoma, but less sensitive than cpRNFL thickness. These findings suggest no clear additional value of GCC thickness over cpRNFL overall, although further evaluation in larger cohorts with advanced glaucoma is warranted. PURPOSE:To compare the sensitivity of ganglion cell complex (GCC) thickness in the macula to circumpapillary retinal nerve fiber layer (cpRNFL) thickness from OCT, and Mean Deviation (MD) and Visual Field Index (VFI) from Standard Automated Perimetry (SAP), for detecting glaucomatous progression across glaucoma stages. METHODS:Using longitudinal data from 205 eyes (125 participants), contrast-to-noise ratios (CNRs) were calculated for GCC, cpRNFL, MD and VFI. Glaucoma stage was defined by MD. Contrast was the parameter difference between two stages; noise was the variability from linear regression residuals from five consecutive OCT scans and HFA 24-2 tests per eye. Higher CNR indicates greater sensitive for detecting progression between stages. RESULTS:CNRs ranged from 3.7 to 13.2. In the transition from suspect to mild glaucoma, cpRNFL (13.2) and GCC (8.7) had significantly higher CNRs than MD (4.5) and VFI CNR (4.8); cpRNFL was also significantly higher than GCC. No significant CNR differences were found between structural and functional measures in later stages. CONCLUSIONS:GCC thickness is more sensitive than functional measures, but less than cpRNFL thickness, for detecting progression at glaucoma onset. In later stages, structural and functional parameters showed comparable sensitivity within the limits of the available data.
The purpose of this brief report is to report on the outcome of glaucoma management in children after pars plana vitrectomy (PPV) in Alexandria Main University hospital. The Medical records of children presenting with glaucoma after PPV were reviewed. Data extracted included patients' demographic data, antenatal, natal and postnatal history, indication for PPV and surgical details, details of glaucoma surgery, clinical preoperative and postoperative follow up. Success of glaucoma surgery was defined as an IOP ≤ 16 mmHg and ≥ 20% reduction from the presenting IOP. The study included 9 eyes of 8 children, that had undergone PPV for ROP (6 eyes) and vitreous haemorrhage (3 eyes). All study eyes were subjected to combined trabeculectomy-trabeculotomy with Mitomycin C. The mean ± standard deviation of the age at glaucoma surgery and follow up duration were 7.9±4.43 and 11.1±10.0 months respectively. The mean ± standard deviation of the preoperative and last visit IOP and C/D ratio were 22.9±6.9 mmHg, 0.8±0.2, 16.9±5.8 mmHg (P=0.063) and 0.4±0.3 (P=0.036) respectively. The success rate at final follow up was 55.6%. In this study, glaucoma after PPV has a poor prognosis and does not generally respond to combined filtering and angle surgery.
PRCIS:Intraoperative triamcinolone injection plus a reduced topical steroid schedule was compared with the standard topical steroid regimen post-trabeculectomy. Overall success was similar between the groups, although complete success was more likely with the standard, intensive topical steroid schedule. PURPOSE:Compare trabeculectomy outcomes between patients receiving a standard prednisolone acetate postoperative regimen (Drop group) and those receiving intraoperative periocular injection of triamcinolone (16 mg) combined with a reduced steroid regimen (TAC group). PATIENTS AND METHODS:Patients receiving one of the 2 steroid regimens were reviewed retrospectively for 2 years postoperatively. Primary outcome was surgical success defined as (1) intraocular pressure (IOP) ≤18 mm Hg with >20% reduction without or with glaucoma medication (complete or qualified success); and (2) no clinical hypotony, further glaucoma surgery, or loss of visual acuity. RESULTS:Complete success at 24 months was 51.8% in the Drop group (56 eyes) and 37.5% in the TAC group (26 eyes; P =0.02 by logistic regression). Overall success (complete plus qualified) at 24 months was 88.8% in the Drop group and 87.5% in the TAC group, comparable in the 2 groups ( P =0.13). Postoperative IOP was similar between the 2 groups at 24 months (Drop: 10.26±3.75 mm Hg; TAC: 11.08±3.69 mm Hg; P >0.20). No differences were observed in surgical complications. CONCLUSION:Complete success is more likely in the Drop group, but overall success was high and similar between the 2 groups. These results suggest that TAC and an abbreviated steroid schedule are a viable alternative to the more intense traditional drop regimen, particularly in patients who might not be able to follow an intense postoperative drop schedule due to dexterity issues, inconvenience, or poor compliance.
PURPOSE:To compare outcomes of trabeculectomy (TRAB) performed after Ahmed glaucoma valve (AGV) implantation with those of repeat TRAB and to identify factors related to surgical failure. METHODS:In this retrospective study, patients who underwent a second TRAB were divided into two groups: TRAB after AGV implantation (TaA) and repeat TRAB (TaT). Primary outcome was surgical success, defined as a postoperative intraocular pressure (IOP) <21 mmHg or a ≥20% reduction from baseline, with or without glaucoma medications. Pre- and postoperative IOP and IOP reduction rates were compared via paired sample t-tests. Surgical success rates were analyzed with Kaplan-Meier survival analysis. Risk factors for surgical failure were evaluated with Cox proportional hazards model. RESULTS:Forty-three eyes were included (TaA, n=20; TaT, n=23), and the TaA group had more secondary glaucoma (P=0.004) and higher baseline IOP (P <0.001). Postoperative IOP, IOP reduction rates, and success rates were comparable between the two groups up to 2 years. Higher postoperative IOP at 1 month was associated with failure in both groups (hazard ratio [HR] 1.151, P=0.036 in TaA; HR 1.188, P=0.009 in TaT). The postoperative 1-month IOP ≥17.5 mmHg was associated with an increased risk of failure. CONCLUSIONS:TRAB after AGV implantation achieved similar postoperative outcomes to those of repeat TRAB, supporting its role as a potential secondary option in intractable glaucoma treatment. Early postoperative IOP is a favorable prognostic marker, highlighting the importance of stabilizing IOP during this period. PRCIS:Trabeculectomy after Ahmed valve implantation showed outcomes comparable to repeat trabeculectomy, with prior shunt surgery not precluding success. Early postoperative intraocular pressure at 1 month was a strong predictor of long-term surgical success.
PURPOSE:Glaucoma drainage devices (GDDs) are essential in the management of refractory glaucoma, yet up to 10% fail annually. Optimal surgical management after GDD failure remains unclear. This systematic review summarizes current evidence on surgical options after failed GDDs. METHODS:A systematic search of PubMed, Web of Science, and Scopus (November 26th, 2025) was performed according to PRISMA guidelines. Eligible studies included observational designs and clinical trials reporting outcomes of surgical interventions in eyes with failed GDDs. Data on intraocular pressure (IOP), medications, success, and complications were extracted. RESULTS:Forty-four studies (1560 eyes; 1518 patients) were included. Reported interventions included second GDD implantation (SGDD), cyclophotocoagulation (CPC), trabeculectomy, non-bleb-forming procedures (e.g., trabectome, GATT), and revision surgeries. SGDD was the most common approach, lowering IOP by >30%, though success ranged from ~30% at 3 years to >90% at 1 year, with frequent corneal decompensation. CPC achieved comparable IOP reductions (25-45%) and fewer device-related complications, but a higher risk of chronic hypotony was occasionally reported. One randomized trial found similar efficacy between CPC and SGDD with fewer reoperations in the CPC group. Revision and non-bleb-forming procedures yielded heterogeneous yet encouraging results. Pediatric outcomes were less favorable. CONCLUSIONS:After GDD failure, several surgical options exist. SGDD remains the most studied for IOP reduction but possibly carries higher complication rates. CPC likely offers comparable efficacy with fewer reoperations, though chronic hypotony risk warrants caution. Trabeculectomy arises as a promising option in selected patients. Evidence remains limited by retrospective designs and variable success definitions. PRCIS:This systematic review summarizes surgical options after failed glaucoma drainage devices, showing that second implants and cyclophotocoagulation provide meaningful intraocular pressure reduction, while trabeculectomy and newer surgical approaches may represent promising alternatives.
Transconjunctival bleb needling is a relatively simple and effective procedure used to restore aqueous humor outflow in failing trabeculectomy blebs. Although generally considered safe, several complications have been reported, including bleb leakage, hypotony, and choroidal effusion. We report a case of non-rhegmatogenous serous retinal detachment following transconjunctival bleb needling in a 56-year-old man with diabetes, Fuchs heterochromic iridocyclitis, and secondary glaucoma who underwent the procedure for an encapsulated bleb after Trabeculectomy. The patient developed persistent serous retinal detachment postoperatively, which was successfully managed with Pars plana vitrectomy. Although serous retinal detachment has been reported after glaucoma filtration surgery, this complication following transconjunctival bleb needling has rarely been described. The underlying mechanism is likely multifactorial, involving mechanical, inflammatory, and ischemic factors. Clinicians should be aware of this rare complication and include it in preoperative counseling.
PRCIS:Potentially avoidable blindness due to glaucoma affects 10.4/10000 Indian adults aged ≥50 years. Early detection may prevent vision impairment. Nearly half of the people with unilateral glaucoma-associated vision loss have no perception of light in the affected eye. PURPOSE:We aimed to estimate the population prevalence and number of persons visually impaired (VI) due to glaucoma in India. METHODS:Deidentified data from the National Blindness Survey 2015-19 in the population aged ≥50 years were analyzed to estimate vision loss due to glaucoma. Diagnosis was based on optic disc assessments. Prevalence (95% CIs), risk factors (odds ratios, ORs), and burden for 2023 were estimated using thresholds for presenting visual acuity (PVA) in the better eye: <6/18 for moderate-severe visual impairment (MSVI) and <3/60 for blindness. RESULTS:Eighty-five thousand one hundred thirty-five participants aged ≥50 years were examined, and glaucoma was the cause of VI in 485 (59.6/10000; 95% CI: 47.6-74.7) participants and the most avoidable cause of VI in 181 participants (22.6/10000; 95% CI: 18.1-28.2). This included 96 with blindness (10.4/10000; 95% CI: 7.7-13.8) and 64 with MSVI (8.2/10000; 95% CI: 5.4-12.5). Among 304 with unilateral glaucoma-associated vision loss, 49.3% had no perception of light in the affected eye. Prevalence of avoidable glaucoma MSVI or blindness increased from 11.2/10000 in 50-59 years to 23.7/10000 in 70-79 years age group (adjusted OR 1.8; 95% CI: 1.0-3.0) and was associated with illiteracy ( OR =2.6; 95% CI: 1.2-5.7) and residence in Northern zone of India ( OR =2.9, 95% CI: 1.7-4.8) but not with sex or rural residence. CONCLUSION:There is a significant burden of vision impairment and blindness caused by glaucoma in India, which needs redressal through policy and programmatic interventions.
PRCIS:The Compass perimeter, despite its integrated eye-tracking, demonstrated similar variability at scotoma borders with 24-2 visual field testing in glaucoma patients compared to the conventional Humphrey Field Analyzer. PURPOSE:Increased variability at the borders of glaucomatous scotomas measured with the Humphrey Field Analyzer (HFA) has been partly attributed to gaze instability. The Compass perimeter (CMP), which incorporates eye tracking to compensate for gaze instability, may reduce variability at scotoma borders. This study determined the test-retest variability (TRV) at scotoma borders measured with the CMP and compared it with that of the HFA. METHODS:One eye of each glaucoma patient was tested with both the CMP (24-2 ZEST) and the HFA (24-2 SITA standard) during three visits (screening, baseline, and follow-up). Eyes were stratified by mean deviation (MD) into mild (MD >-6 dB), moderate (-12 dB ≤MD <-6 dB) or advanced glaucoma (MD <-12 dB). Scotoma borders were identified using the HFA total deviation plot from the screening visit. TRV at scotoma edges was defined as the mean absolute difference of scotoma border points (SBP) between baseline and follow-up visual field (VF) tests (3-10 d apart). TRV was compared between devices using the Wilcoxon signed-rank test. RESULTS:29 eyes (31% women; median [IQR] age 64 [56-72] years) were included. Mean (SD) time between baseline and follow-up was 6.4 (1.3) days. No statistically significant differences in SBP-TRV were found between CMP and HFA for all glaucoma stages combined (1.8 vs. 1.9 dB, P=0.42) or within individual stages. CONCLUSION:CMP and HFA show comparable variability at scotoma borders with 24-2 VF testing, indicating no significant advantage of CMP eye tracking in reducing scotoma edge variability.
Précis: Angle width and iris area measured by anterior OCT are increasingly predictive of intraocular pressure and ocular hypertension below parameter-specific angle width cutoffs. Cumulative gonioscopy score is weakly predictive below all score cutoffs. Purpose: To assess ocular biometric determinants of intraocular pressure (IOP) and risk factors for ocular hypertension (OHTN). Methods: CHES participants underwent Goldmann applanation tonometry, gonioscopy, ultrasound A-scan, and anterior segment OCT (AS-OCT) imaging. Biometric data from one eye per participant were used to develop linear and logistic regression models of IOP and OHTN (IOP >21 mm Hg), respectively, below different angle width cutoffs adjusted for central cornea thickness (CCT). Results: A total of 2360 eyes of 2360 eligible participants (1518 female, 842 male) were analyzed. Mean age was 60.2±7.8 years. Multivariable stepwise linear regression models and change-point analysis showed that below a trabecular iris space area (TISA 750 ) measurement of 0.08 mm 2 , models became increasingly predictive of IOP up to an adjusted R 2 of 0.84. Smaller TISA 750 and iris area (IA) were the only parameters consistently associated ( P ≤0.04) with higher IOP for TISA 750 below 0.20, 0.10, and 0.05 mm 2 . In multivariable models of OHTN (AUC≤0.95), smaller TISA 750 was associated with OHTN for TISA 750 <0.20, 0.10, and 0.05 mm 2 ( P ≤0.03), while IA was associated with OHTN for TISA 750 <0.05 mm 2 ( P ≤0.03). Cumulative gonioscopy score (sum of gonioscopy grades) was weakly predictive of IOP at all cutoffs (adjusted R 2 ≤0.08). Conclusion: TISA 750 and IA become strongly predictive of IOP when angle width decreases below a TISA 750 cutoff of 0.08 mm 2 . The relationship between cumulative gonioscopy score and IOP is weak below all gonioscopy score cutoffs. AS-OCT measurements could supplement gonioscopy by helping identify individuals at higher risk for elevated IOP from angle closure.
PURPOSE:Structural differences in the retinal nerve fiber layer (RNFL) of African ancestry individuals are underrepresented in the Cirrus HD-OCT normative database. Our prior study reclassified primary open-angle glaucoma (POAG) color codes using RNFL data from healthy African ancestry controls. This study compares color-code classification between the Cirrus database and our reclassification for African ancestry POAG cases. PATIENTS:787 eyes from the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. METHODS:Eyes were staged using the Enhanced Glaucoma Staging System (GSS2), and RNFL thickness color codes were reclassified based on an African ancestry-specific cohort. RESULTS:The POAAGG reclassification model reported fewer abnormal yellow and red color codes (16.4% and 6.3%) than Cirrus (18.0% and 9.4%, P<0.001). Reclassification shifted 12.8% of red codes to yellow/green and 23.0% of yellow codes to green (P<0.001). Among stage 1 glaucoma eyes, 19.0% of red codes and 23.1% of yellow codes shifted to greener classifications (P=0.04). Similar patterns were seen in quadrant- and stage-specific analyses. CONCLUSIONS:The discrepancy in POAG color-code classification suggests that an ancestry-conscious normative database may reduce overdiagnosis in African ancestry individuals. PRECIS:Our study showed lower occurrence of primary open-angle glaucoma in African ancestry patients when taking their ancestry into consideration compared to the Cirrus HD-OCT classification.
PRCIS:The OMNI surgical device produces a statistically significant reduction in intraocular pressure and a significant increase in tonographic outflow facility at 3 months, which is found to be nonsignificant at 12 months for both parameters. PURPOSE:OMNI is a minimally invasive glaucoma surgical device designed to address all 3 points of conventional outflow resistance (juxtacanalicular trabecular meshwork, inner wall of Schlemm canal, and resistance distal to the canal). This study assessed its effects on intraocular pressure (IOP) and on changes in tonographic outflow facility (TOF) after medication washout. METHODS:Thirty eyes of 30 patients with uncontrolled open angle glaucoma or ocular hypertension were prospectively recruited. Each patient underwent a 4-week washout baseline IOP measurement and TOF recording via digital Schiøtz tonography. Patients received standalone 360-degree canaloplasty and 160 to 180-degree trabeculotomy. Measurements were repeated at 3 and 12 months post-treatment (with further washout). RESULTS:At 3 months, a mean IOP reduction by 3.26 mm Hg from baseline (27.25±9.0 vs. 23.99±10.84 mm Hg, P =0.03) was achieved, with a statistically significant increase in TOF (0.068±0.045 vs. 0.14±0.090 µL/min/mm Hg, P =0.0002). At 12 months, a mean IOP reduction of 1.57 mm Hg was achieved (27.25±9.0 vs. 25.68±12.04 mm Hg, P =0.6) with no significant TOF change (0.068±0.045 vs. 0.10±0.09 µL/min/mm Hg, P =0.07). Thirty-two percent experienced a >20% IOP reduction (n=9), with 25% achieving an IOP <18 mm Hg (n=7) at 12 months. CONCLUSIONS:This is the first study to assess the standalone effect of the OMNI device on IOP and TOF changes pre- and post-treatment. While an IOP reduction and an increase in TOF were noted at 3 months, these were not statistically significant at 12 months.
PRCIS:Despite both CW-TSCPC and MP-TSCPC being effective in reducing IOP, with low rates of complications, MP-TSCPC appears to achieve higher success rates with less significant visual acuity loss compared with CW-TSCPC. PURPOSE:To compare the efficacy and safety of continuous wave transscleral cyclophotocoagulation (CW-TSCPC) using the slow-coagulation technique versus micropulse (MP) TSCPC in patients with glaucoma and good visual acuity. PATIENTS AND METHODS:Retrospective multicenter study including patients with logMAR visual acuity (VA) of <0.5 and at least 6 months of follow-up. Surgical success was defined as IOP ≤18 mm Hg and at least a 30% reduction from baseline IOP with or without glaucoma medication, without loss of >2 lines of vision. For criterion A, patients who required a new CPC session during follow-up were considered a failure. For criterion B, the additional need for CPC was not considered a failure. RESULTS:We included a total of 200 eyes from 200 glaucoma patients (110 eyes in the CW-TSCPC and 90 in the MP-TSCPC groups). There was a significant reduction in IOP levels and the number of medications after CPC in both groups ( P <0.001). Considering criterion A, success rates at 12 months were 61% and 76% in the CW-TSCPC and MP-TSCPC groups, respectively ( P =0.087). Considering criterion B, success rates were 75% and 87% in the CW-TSCPC and MP-TSCPC groups, respectively ( P =0.289). Significant VA loss was observed in 20% of the eyes in the CW-TSCPC group and 10% of the eyes in the MP-TSCPC group ( P =0.016). CONCLUSION:Both CW-TSCPC and MP-TSCPC are safe and effective in reducing IOP, with low rates of complications or serious adverse events.
PRCIS:The Susanna Glaucoma Drainage Device achieved sustained 5-year IOP and medication reduction, with a 80.9% success rate and a favorable safety profile, supporting its effectiveness for long-term management of refractory glaucoma. PURPOSE:To evaluate the 5-year outcomes of the Susanna Glaucoma Drainage Device for the treatment of glaucoma. PATIENTS AND METHODS:Medical records from consecutive patients aged 18 years or older with glaucoma who underwent implant surgery with the Susanna Glaucoma Drainage Device from January 2017 to January 2020 were included. The primary outcome was success, defined as IOP ≥6 and <18 mm Hg and the absence of loss of light perception or additional glaucoma surgery. Secondary outcomes included IOP, hypotensive therapy, adverse events, and surgical interventions. RESULTS:A total of 104 patients were included; the mean patient age was 60.8±17.6 years. The mean preoperative IOP was 29.9±11.6 mm Hg, with 2.8±0.9 glaucoma medications. At 5 years, the cumulative success rate was 80.9%. IOP and medication use were significantly reduced at all postoperative visits. At 5 years, mean IOP was 13.4±3.6 mm Hg (55.2% reduction, P <0.001), and mean medication use was 1.9±1.4 (32.1% reduction, P <0.001). The primary reason for failure was elevated IOP (38.9%). Five patients underwent glaucoma reoperation to lower IOP; 2 cases were treated with cyclophotocoagulation, while 3 underwent a second SGDD inferiorly. Hypotony-related failure was observed in 1 case. Among the failures, 5 patients developed significant vision loss. CONCLUSIONS:The Susanna implant effectively reduced IOP and medication dependence over 5 years. It demonstrated a high success rate (80.9%) and sustained pressure control. These findings support the long-term efficacy of the Susanna implant in managing refractory glaucoma.
PRCIS:Axenfeld-Rieger syndrome (ARS) is a rare genetic disorder characterized by anterior segment dysgenesis and secondary glaucoma, often accompanied by systemic defects. This study investigated the clinical and genetic features in 4 Chinese families with ARS. PURPOSE:To characterize the clinical phenotypes and identify the causative genetic mutations in 4 unrelated Chinese families with ARS. METHODS:Affected individuals from 4 Han Chinese families underwent comprehensive clinical and ophthalmological examinations. Genetic analysis was performed using whole-exome sequencing (WES) and validated by copy number variation sequencing (CNV-seq) and qPCR. RESULTS:All affected individuals exhibited anterior segment dysgenesis. Secondary glaucoma was present in 7 of them. Systemic manifestations, including dental and umbilical abnormalities, were observed in all affected individuals. Genetic analysis identified novel heterozygous PITX2 mutations in all 4 families: 3 distinct microdeletions (ranging from 206 bp-449.97 kb) and 1 nonsense mutation (p.Phe140*), all predicted to cause haploinsufficiency. CONCLUSIONS:Four novel PITX2 mutations, including microdeletions, were identified in Chinese ARS families. The 206 bp genomic DNA deletion appeared to be an essential region (chr4: 111543411-111543616) for PITX2 function in ocular and systemic development, underscoring the necessity of full gene dosage.
PRCIS:Combined Phaco+GATT surgery significantly alters corneal biomechanics and aberrometry, increasing deformability and affecting postoperative IOP interpretation in patients with POAG or PEXG. PURPOSE:To evaluate the changes in corneal biomechanical properties and corneal aberrometry following combined phacoemulsification and gonioscopy-assisted transluminal trabeculotomy (Phaco+GATT) in patients with primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG). PATIENTS AND METHODS:In this prospective comparative study, 28 eyes of 26 patients with visually significant cataracts and either POAG or PEXG underwent combined Phaco+GATT surgery. Corneal biomechanical parameters were assessed using the Corvis ST, and corneal aberrometry was evaluated using the Pentacam AXL, both preoperatively and 3 months postoperatively. Statistical analyses included paired t tests, Wilcoxon signed-rank tests, and linear regression modeling. RESULTS:Significant postoperative reductions in Goldmann applanation tonometry intraocular pressure (IOP) and biomechanically corrected IOP were observed. Parameters such as A1 time, A2 velocity, SP-A1, and SSI significantly decreased, indicating increased corneal deformability. Conversely, deflection amplitude max, peak distance, and corneal biomechanical index (CBI) significantly increased. Higher-order aberrations (HOAs) from the corneal back also showed significant elevation. Regression analysis revealed that preoperative IOP was the most significant predictor of changes in several biomechanical parameters, while central corneal thickness (CCT) was significantly associated with changes in astigmatism. CONCLUSION:assisted transluminal trabeculotomy was associated with measurable changes in corneal biomechanics and aberrometry at 3 months postoperatively. These changes may affect postoperative IOP interpretation, including the potential for IOP underestimation, and should be considered when evaluating visual and pressure outcomes. Longer-term studies are needed to determine the durability and clinical significance of these findings.
PRCIS:A strong intraocular pressure reduction with omidenepag isopropyl predicts greater efficacy of patterned laser trabeculoplasty in primary open angle glaucoma, while prior omidenepag use does not diminish laser treatment outcomes. OBJECTIVES:To determine whether the intraocular pressure (IOP)-lowering response to omidenepag isopropyl (OMDI) predicts the efficacy of patterned laser trabeculoplasty (PLT) in primary open angle glaucoma (POAG) patients and to assess any interaction between OMDI and PLT when used in combination. METHODS:This retrospective propensity score-matched study included 63 eyes treated with OMDI followed by PLT and 63 matched eyes treated with PLT alone, matched by baseline IOP and age. IOP reduction with OMDI was assessed before PLT, and the IOP-lowering outcomes of PLT were evaluated 1 month after the procedure. Statistical analyses were performed to identify predictors of PLT response within each group and to compare PLT efficacy between the groups. RESULTS:Baseline characteristics were comparable between the groups. The IOP reduction rate after PLT did not differ significantly between the OMDI+PLT and PLT-only groups. In the OMDI+PLT group, PLT responders had greater IOP reductions from OMDI than nonresponders (31.52±13.03% vs. 15.62±17.43%; P <0.001). Linear regression identified the IOP-lowering rate from the OMDI as the sole significant predictor of PLT response in the OMDI+PLT group ( B =0.792, P <0.001). In the PLT-only group, only baseline IOP predicted the PLT response. CONCLUSIONS:A greater IOP-lowering response to OMDI predicts a larger IOP reduction with PLT, supporting the use of OMDI responsiveness as a potential indicator of PLT efficacy in POAG. OMDI administration did not alter the IOP-lowering effects of PLT.
PURPOSE:To summarize the main topics discussed during the 29th Annual Optic Nerve Rescue and Restoration Think Tank Meeting "The Future of Glaucoma: Harnessing Data, AI, and Precision Medicine for Patient-centered Care" held in New York on June 20th and 21st, 2025. METHODS:The main findings from presentations on data integration and the application of artificial intelligence (AI) to advance understanding of primary open angle glaucoma pathogenesis and improve disease diagnosis and management are summarized. RESULTS:The researchers discussed the importance of data integration for AI development, highlighting specific challenges in glaucoma, including data standardization and sharing, and the initiatives of the National Institutes of Health (NIH) and the National Eye Institute (NEI) in this context. Specific examples of AI tools used to advance knowledge of glaucoma pathophysiology, diagnosis, and management are presented. CONCLUSIONS:AI is improving the understanding of glaucoma and enhancing its diagnosis and management. The NEI and NIH are spearheading several initiatives in AI, Ophthalmology, and Glaucoma; yet, glaucoma as a disease entity remains without a unified definition. There is also a need to measure critical glaucoma endophenotypes with devices that possess uniform standards. For imaging devices, interoperability across platforms and unfettered access to data could improve patient care and advance our understanding of glaucoma. With its rich data resources, the glaucoma community is uniquely positioned to lead a cultural shift, enabling larger data sets, stronger collaboration, and future studies that will help translate AI advances into clinical care.
