Background:Gel-based ocular phantom models provide a controlled platform to test the biomechanical factors and validate emerging diagnostic technologies. Despite the growing application in ophthalmic research, no comprehensive bibliometric analysis has been conducted to map their evolution and translational relevance in glaucoma diagnostics. Purpose:The study aimed to bridge this gap by identifying global research trends and highlighting the emerging role of gel-based ocular phantoms in intraocular pressure (IOP) assessment and glaucoma-related diagnostic applications. Materials and methods:A bibliometric analysis of open-access literature (2020-2025) was conducted using the Scopus database. Keyword co-occurrence and temporal overlay analysis were performed using VOSviewer to assess research trends, geographical contributions, and thematic evolution from general tissue-mimicking models to glaucoma-specific applications. Results:A total of 1,116 publications related to gel or tissue-mimicking phantoms were identified. The results showed a progressive narrowing of research focus from generic tissue-mimicking phantoms toward ocular biomechanical models for IOP assessment, with 62 publications specifically related to glaucoma, IOP, biomechanical modeling, sensor validation, or fluid dynamics. The United States and China emerged as leading contributors. The overlay visualization demonstrated a recent shift toward ocular biomechanics in glaucoma diagnostic simulation, reflecting growing clinical translation. Conclusion:Ocular gel phantoms are emerging as an integral experimental platform for addressing the biomechanical variability and enhancing safer preclinical validation of glaucoma diagnostic instruments. Clinical significance:The findings of this study highlight the importance of ocular biomechanics in glaucoma diagnostics and suggest the importance of gel phantom integration for preclinical validation of ocular biomechanics-related instruments to enhance accuracy.
Purpose:The aims are to study the prevalence, causes, and challenges of neuro-ophthalmic disorders being misdiagnosed as glaucoma in a tertiary care setting and to identify strategies for improving diagnostic skills in resource-constrained settings. Design:Single-center, retrospective, cross-sectional study over a period of 6 months, that is, July-December 2024, at a tertiary care hospital in Central India. Methodology:Medical records of 53 patients who presented to the glaucoma clinic during the study period were reviewed. All of them had already been diagnosed with glaucoma at other facilities. Seventeen such patients, who were later established to have nonglaucomatous (neuro-ophthalmic) conditions, were analyzed. Patients who were proven to have either primary or secondary glaucoma after comprehensive ophthalmic and neuroimaging evaluation were excluded. The demographic data, clinical findings, investigation results, and causes of misdiagnosis were analyzed. Results:The proportion of misdiagnosis was 32% (17/53). Compressive optic neuropathy was the most common mimicker, followed by demyelinating optic neuropathy at 23.5% and ischemic optic neuropathy at 17.6%. Major contributing factors to diagnostic error included falsely elevated intraocular pressure (IOP), optic disk cupping with pallor, family history of glaucoma, and lack of access to central corneal thickness assessment, visual field analysis, and neuroimaging. Visual field analysis and magnetic resonance imaging (MRI) were key investigations in diagnosis. Conclusion:Neuro-ophthalmic conditions mistaken for glaucoma lead to delayed and inappropriate management. The introduction of structured diagnostic algorithms, multimodal imaging, and clinician training, supported by telemedicine and artificial intelligence (AI)-assisted tools, may lead to a significant reduction in misdiagnosis and promote earlier diagnosis, especially in resource-constrained healthcare settings.
A middle-aged male patient with bilateral advanced glaucoma, who had undergone trabeculectomy, developed a suprachoroidal hemorrhage (SCH) on post-operative day 1. Ultrasound (USG) confirmed the presence of appositional choroidal mounds with clotted blood in the suprachoroidal space. The patient underwent recombinant tissue plasminogen activator (rtPA) injection into the suprachoroidal space in the first stage, followed by trocar-assisted drainage 5 hours later. This report aims to highlight the effectiveness of rtPA in aiding the lysis and subsequent drainage of clotted blood from the suprachoroidal space. This technique is especially useful when early drainage of SCH is being planned because of appositional/kissing choroidals or uncontrolled intraocular pressure (IOP), especially in one-eyed patients.
Background:Glaucoma is a leading cause of irreversible blindness worldwide, and environmental risk factors beyond intraocular pressure (IOP) are increasingly being investigated. Ambient air pollution, particularly fine particulate matter (PM₂.₅), may contribute to glaucomatous optic neuropathy through oxidative stress and vascular dysregulation; however, existing evidence remains fragmented. Objective:To systematically review and quantitatively synthesize the association between ambient air pollution exposure and glaucoma risk, IOP, and structural markers of glaucomatous optic neuropathy. Methods:This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered with PROSPERO. PubMed and Embase were searched from inception to 30th December 2025, for observational studies evaluating ambient air pollution exposure and glaucoma-related outcomes. Random-effects meta-analysis using generic inverse-variance methods was conducted for studies reporting associations between long-term PM₂.₅ exposure and glaucoma. Other pollutants were synthesized narratively. Results:Eighteen observational studies from diverse geographic regions were included, of which eight contributed to the PM₂.₅ meta-analysis. Higher long-term PM₂.₅ exposure was associated with an increased risk of glaucoma (pooled RR = 1.12; 95% CI, 1.06-1.18), with moderate heterogeneity (I² = 78.7%). Associations for NO₂, NOx, PM₁₀, and CO were directionally positive but heterogeneous. Structural changes, including RNFL and GCIPL thinning, and modest IOP elevations were also reported. Conclusion:Long-term PM₂.₅ exposure is associated with increased glaucoma risk, suggesting a potential environmental contribution; however, causality cannot be established from the available observational evidence. These findings highlight the need to integrate ocular outcomes into environmental health policy and to prioritize prospective studies capable of addressing confounding and temporality.
Prostaglandin analogs, including travoprost, are widely used to lower intraocular pressure in primary open-angle glaucoma. While generally safe, rare posterior segment changes have been reported. Retinal pigment epithelial detachment (RPED) associated with travoprost is uncommon and poorly documented. We report three patients who developed serous RPED shortly after initiating topical travoprost, none of whom had preexisting macular disease. Optical coherence tomography (OCT) confirmed the detachments, and complete anatomical and visual recovery occurred following discontinuation of travoprost and initiation of alternative glaucoma therapy. A clear temporal relationship was observed between drug initiation and RPED onset. The absence of clinical or OCT features suggestive of alternative diagnoses-such as central serous chorioretinopathy, age-related macular degeneration, or pachychoroid spectrum disorders-combined with consistent reversibility, suggests a possible association between travoprost and RPED. These findings emphasize the importance of early recognition and timely intervention, as RPED appears fully reversible when identified promptly, preventing potential persistent visual impairment.
Aim and background:To report a case in which a targeted early minimally invasive glaucoma surgery (MIGS) approach successfully prevented irreversible sight loss from acute secondary angle closure following tectonic penetrating keratoplasty (PKP) in an eye with a prior porcine-derived corneal stromal implant (Xenia®) as treatment for advanced keratoconus. Case description:The authors describe successful surgical treatment of a patient who developed acute intraocular pressure (IOP) elevation following tectonic PKP for perforated bacterial microbial keratitis. We demonstrate that combined goniosynechialysis (GSL) and iStent Inject® trabecular micro-bypass implantation are effective in reversing postoperative synechial angle closure, restoring angle integrity, and preventing progressive glaucomatous optic neuropathy and, thus, irreversible sight loss in an eye with a functioning PKP. Conclusion:The authors highlight the importance of early recognition and referral to a glaucoma specialist for prompt mechanism-targeted MIGS to manage postkeratoplasty secondary angle closure. Clinical significance:Early targeted MIGS intervention may prevent the need for complex glaucoma filtration surgery in eyes with secondary synechial angle closure following corneal transplant surgery.
Background:Secondary glaucoma is caused by underlying medical conditions, ocular injury, or drugs that increase intraocular pressure (IOP), causing damage to the optic nerve. It has a multifactorial etiology, making diagnosis and treatment complicated, and posing risks of irreversible loss of vision or blindness if left untreated. Aim:The review assessed clinical complications and comorbidities of secondary glaucoma. Materials and methods:A literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on studies from the past decade. Included studies involved patients aged ≥40 years diagnosed with secondary glaucoma in tertiary care or ophthalmology centers. Data on clinical complications, surgical outcomes, visual impacts, and the influence of hypertension, diabetes, and treatment modalities were analyzed. Results:Patients with secondary glaucoma were found to have a significantly higher incidence of comorbidities such as hypertension and diabetes. Pseudoexfoliation syndrome was described as the most common secondary glaucoma. The visual acuity test results were variable for a given patients, and the mean IOP for neovascular glaucoma stood at 40.67 mm Hg. Cup-to-disk ratio varied for traumatic and uveitic glaucoma, indicating structural damage to the optic nerve. The male patients had higher prevalence rates. Conclusion:Early diagnosis and a multidisciplinary management strategy are essential for preventing complications of secondary glaucoma. Modern diagnostic modalities such as optical coherence tomography and visual field testing, along with targeted therapies, can improve clinical outcomes and minimize morbidity. Contribution:This review provides an overview of the complications associated with secondary glaucoma.
Purpose:To evaluate the morphometric eye characteristics of the children of patients with primary angle-closure glaucoma (PACG) aged 19-40 years, compared to healthy controls. Methods:This cross-sectional study involved 44 eyes of 22 prepresbyopic children of patients with PACG and 44 eyes of 22 sex- and age-matched healthy subjects with no parental history of glaucoma. For both groups, biometric measurements for the anterior segment were performed using the Sirius topographer. These measurements are central corneal thickness (CCT), iridocorneal angle (ICA), anterior chamber volume (ACV), anterior chamber depth (ACD), axial length (AL), horizontal anterior chamber diameter (HACD), macular ganglion cell layer (GCL), peripapillary retinal nerve fiber layer (RNFL), and topographic disc measurements. Results:The ACD, ACV, ICA, and HACD values of the study group were significantly lower than the control group (p < 0.05 for all). The study group had significantly lower AL values (22.99 ± 0.17 mm) than the control group (23.64 ± 0.17 mm) (p < 0.001). No statistically significant differences were found between the study and control groups regarding the CCT values, the global mean of macular GCL, and peripapillary RNFL measurements, or optic disc topographic measurements (p > 0.05). Conclusion:The results showed no statistical differences in GCL, RNFL, and disc topographic measurements between the children of patients with PACG and sex- and age-matched healthy subjects without a positive family history. However, AL, ICA, ACD, ACV, and HACD were significantly lower in the prepresbyopic children of patients with PACG.
Background and Objectives:Glaucoma is a leading cause of irreversible blindness, primarily managed by lowering intraocular pressure (IOP). In individuals with both cataract and glaucoma, phacoemulsification alone can substantially reduce IOP. However, to achieve better pressure control, combining cataract surgery with cyclophotocoagulation has gained attention as an effective approach. Among the available methods, micropulse transscleral cyclophotocoagulation (MP-TCP) and endoscopic cyclophotocoagulation (ECP) represent two techniques that target the ciliary body through distinct mechanisms, differing in their level of invasiveness and therapeutic outcomes. The objective of this study is to evaluate the safety and efficacy of phacoemulsification combined with MP-TCP compared with phacoemulsification combined with ECP in patients presenting with both cataract and glaucoma. Materials and methods:In this randomized trial-based study, adults aged 40-80 years undergoing cataract surgery with glaucoma were enrolled and randomized to receive either phaco + MP-TCP or phaco + ECP. Primary outcomes included variations in IOP, several IOP-lowering therapeutics, clarity of vision [logMAR (minimum angle of resolution)], and complications observed over 12 months postoperative follow-up. Results:Baseline characteristics were comparable between ECP (24 eyes) and MP-TCP (15 eyes) groups. Both interventions significantly reduced IOP over time, with the endoscope group showing greater early reductions at 1 week and 3 months, although differences were no longer significant by 6 and 12 months. Medication burden decreased in both groups, with MP demonstrating a greater reduction at 1 week but no significant differences afterward. Visual acuity improved similarly across both treatments throughout follow-up. Complication rates were low and comparable (20.8 vs 21.4%). Overall, endoscopic treatment achieved larger early IOP reductions, while long-term outcomes, including IOP control, medication use, visual acuity, and safety, were similar between the two interventions. Conclusion:Both phaco + MP-TCP and phaco + ECP are effective, safe surgical options for managing glaucoma in patients undergoing cataract surgery. ECP offers superior early IOP reduction, whereas MP-TCP more effectively reduces medication dependence. The choice of technique should be tailored to individual clinical priorities. Clinical significance:Phaco + MP-TCP and phaco + ECP are safe and efficacious options for patients with coexisting cataract and glaucoma, with ECP providing greater early IOP reduction and MP-TCP offering sustained medication burden relief. The choice of procedure should be individualized based on patient priorities and clinical needs.
Aim and background:The Baerveldt glaucoma implant (BGI) is a tube shunt that has proven long-term safety and efficacy in lowering intraocular pressure (IOP). However, it requires temporary ligation for 6-8 weeks before it can take effect. This study compares the efficacy and safety of the BGI modified with a reversible ventilating mattress suture (vsBGI) to allow early flow with the unmodified BGI. Materials and methods:A retrospective cohort study was performed at the University of Iowa, including patients who underwent either an unmodified Baerveldt tube shunt (BGI) or a vsBGI between 2016 and 2023. Primary outcomes were IOP, number of glaucoma medications, and best-corrected visual acuity. Adverse events within 3 months postoperatively were recorded. Results:A total of 124 eyes from 114 patients were included in the study. The vsBGI group had 62 eyes from 58 patients, and the BGI group had 62 eyes from 56 patients. At baseline, median IOP was significantly higher in the vsBGI group compared to those receiving the standard BGI (p < 0.001), but on day 1 and week 1, the median IOP was significantly lower in the vsBGI group than BGI (p < 0.001). By month 3, there was no significant difference in IOP between the two groups. From week 1 through month 3, patients in the vsBGI group required significantly fewer topical medications compared to those with the standard BGI (all p ≤ 0.017), even though no baseline differences were observed. Visual acuity was not significantly different between the groups at any time point. The number of adverse events or rate of reoperations in the 3-month postoperative period were not statistically different between vsBGI and BGI. Conclusion:The reversible ventilating suture modification to the BGI tube shunt is a safe and effective method of allowing early aqueous humor flow and reducing IOP in the early postoperative period. Clinical significance:The ventilating suture modification to the BGI provides a practical approach to overcoming the delay in IOP lowering that accompanies traditional tube ligation. By permitting controlled early aqueous flow, the vsBGI achieves meaningful pressure reduction in the immediate postoperative period without increasing adverse events or reoperation rates.
Glaucoma is a chronic, progressive optic neuropathy characterized by retinal ganglion cell (RGC) death and visual field loss. It is the leading cause of irreversible blindness globally, affecting more than 70 million people, and its prevalence is expected to rise with aging populations. Traditionally, glaucoma was defined primarily as a disease of intraocular pressure (IOP) dysregulation, but recent decades have reframed it as a complex neurodegenerative disorder involving multiple systemic and local risk factors. In parallel, systemic neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS) pose immense healthcare and socioeconomic burdens. The concept of the "eye as a window to the brain" arises from the fact that the retina and optic nerve are direct extensions of the central nervous system (CNS). This has positioned the eye as a valuable site for studying neurodegenerative processes noninvasively, using advanced imaging modalities such as optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Glaucoma is a chronic neurodegenerative optic neuropathy, and the concept of the "eye as a window to the brain" highlights its overlap with systemic diseases such as AD, PD, and MS. How to cite this article:Singh P, Karkhur S, Verma V, et al. Glaucoma and Systemic Neurodegenerative Diseases: The Brain-Eye Continuum. J Curr Glaucoma Pract 2026;20(1):26-30.
Aims and background:Myopic glaucoma is a distinct subtype of glaucomatous optic neuropathy that is often underrecognized or misdiagnosed, particularly in younger patients whose intraocular pressures (IOP) fall within statistically normal ranges. High myopia presents complex structural, functional, and biomechanical challenges that hinder both early detection and effective disease management.This review summarizes current evidence on the pathophysiology, clinical presentation, diagnostic limitations, and tailored therapeutic strategies for myopic glaucoma, providing a practical clinical framework for improved management. Materials and methods:This narrative review synthesizes current evidence from peer-reviewed clinical and basic science studies on myopic glaucoma. Drawing on a comprehensive literature search, it addresses the pathophysiology, clinical presentation, diagnostic limitations, and tailored therapeutic strategies for myopic glaucoma, with the aim of establishing a clinically relevant framework to inform optimized management. Results:The global prevalence of myopia is increasing, with high myopia substantially elevating the risk of glaucoma, particularly among Asian populations. Structural alterations-including axial elongation, scleral thinning, lamina cribrosa deformation, and optic nerve head tilting-augment biomechanical vulnerability to glaucomatous damage, even when IOP remains within normal limits.Myopic glaucoma is often characterized by tilted optic discs, peripapillary atrophy, and early paracentral visual field defects, which may not be detected by standard perimetric methods. Diagnosis is complicated by the limitations of optical coherence tomography (OCT), including segmentation errors and the lack of normative databases specific to myopic eyes. Moreover, disease progression may occur even with low IOP, and distinguishing glaucomatous damage from myopia-induced structural changes remains a significant challenge. Recent advances, such as the identification of the crescent moon sign, implementation of 10-2 visual field testing, and use of biomechanically compensated tonometry, have improved diagnostic accuracy.Management requires lower IOP targets due to increased structural fragility, often necessitating combined medical therapy or early surgical intervention. However, surgery in young highly myopic patients carries a heightened risk of hypotony maculopathy.Emerging technologies, including artificial intelligence (AI)-based algorithms and widefield optical coherence tomography angiography (WF-OCTA), enhance diagnostic precision by addressing anatomical distortions and facilitating the early detection of glaucomatous changes. Conclusion and clinical significance:Early identification and tailored management of myopic glaucoma are crucial to mitigate vision loss in this high-risk population. Awareness of the unique challenges posed by high myopia, combined with emerging diagnostic and therapeutic approaches, can improve patient outcome and reduce the burden of undiagnosed disease. How to cite this article:Diniz CK, Meira MA, Gondim LAVAS, et al. Managing Myopic Glaucoma-Beyond Structural Fragility and Diagnostic Challenges: Review Article. J Curr Glaucoma Pract 2026;20(1):20-25.
Purpose:To evaluate long-term outcomes of ab interno canaloplasty in patients with open-angle glaucoma, focusing on intraocular pressure (IOP) control and medication use over a 10-year period. Materials and methods:This retrospective case series evaluated 27 eyes of 22 patients with pseudoexfoliative (PEX) or primary open-angle glaucoma (POAG) who underwent ab interno canaloplasty using the iTrack microcatheter (Nova Eye Medical, Fremont, CA, USA) between October 2014 and October 2016. The majority of procedures were performed in conjunction with cataract surgery (23 of 27 eyes). Main outcome measures were changes in mean IOP and number of glaucoma medications. Results:Over an average follow-up of 78.7 ± 37.0 months [last follow-up (LFU)], mean IOP (mm Hg) significantly decreased from 19.9 ± 5.2 at baseline to 14.7 ± 3.7 (-26%; p < 0.001) at LFU, while the mean medication use reduced from 1.9 ± 1.0 to 1.0 ± 1.1 (-50%; p = 0.004). Visual field mean deviation (VF MD) (dB) remained stable (-7.86 ± 6.90 to -7.61 ± 6.63; p = 0.498). Among the seven eyes followed for 10 years, IOP decreased from 19.4 ± 3.2 to 14.9 ± 2.3 (-24%, p = 0.010), while medication use remained stable (1.7 ± 0.9 to 2.0 ± 1.2, p = 0.604) with no serious complications or need for additional glaucoma surgery. Conclusion:iTrack ab interno canaloplasty achieved sustained reductions in IOP and medications, with no safety concerns. Seven eyes were followed up for 10 years, showing sustained IOP reduction. How to cite this article:Koerber N, Ondrejka S. Safety and Effectiveness Outcomes of Ab Interno Canaloplasty in Open-angle Glaucoma: 10-year Results. J Curr Glaucoma Pract 2026;20(1):11-13.
Background:Phacoemulsification cataract surgery, the standard treatment for visually significant cataracts, has been shown to influence intraocular pressure (IOP); however, the extent and underlying mechanisms of this effect may differ in patients with systemic conditions such as diabetes mellitus. Although some evidence exists, studies have reported conflicting results regarding whether diabetic and nondiabetic patients exhibit differences in postoperative IOP changes following phacoemulsification. Therefore, this study aimed to evaluate and compare postoperative IOP alterations in diabetic and nondiabetic patients. Methods:A prospective observational study was conducted among 208 adults aged ≥50 years with cataract, including 104 diabetic and 104 nondiabetic patients. The study adhered to STROBE guidelines. IOP was measured preoperatively and at 1 and 6 weeks postoperatively using Goldmann applanation tonometry. Data normality was assessed with the Shapiro-Wilk test, sphericity with Mauchly's test, and variance homogeneity with Levene's test. Repeated measures ANOVA evaluated changes in IOP over time and between groups, including time × group interactions, while linear mixed-effects modeling accounted for repeated measurements and estimated the magnitude of postoperative IOP changes. A p-value < 0.05 was considered statistically significant. Results:Repeated measures ANOVA showed significant effects of time (F = 610.5, p = 0.003), diabetes (F = 32.1, p = 0.041), and the time × diabetes interaction (F = 55.2, p = 0.002), indicating IOP decreased over time in all patients, with greater reductions in nondiabetics. Linear mixed-effects modeling confirmed significant postoperative IOP decreases: nondiabetic patients showed reductions of 1.2 mm Hg at 1 week (β = -1.20, 95% CI:-1.88 to -0.52) and 2.5 mm Hg at 6 weeks (β =-2.50, 95% CI:-3.34 to -1.66), whereas diabetic patients had smaller reductions (1 week × diabetes: β = 0.90, 95% CI: 0.16-1.64; 6 weeks × diabetes: β = 1.75, 95% CI: 0.97-2.53). Among diabetics, higher HbA1c (β = 1.70, 95% CI: 0.82-2.58) and diabetes duration (β = 1.30, 95% CI: 0.56-2.04) were significantly associated with change in postoperative IOP. Conclusion:Phacoemulsification effectively lowers IOP in older adults with cataract; however, the reduction is smaller in diabetic patients and is influenced by HbA1c levels and diabetes duration. Careful postoperative monitoring of IOP is recommended in diabetic individuals. A randomized controlled trial is recommended to further investigate these differences and the impact of glycemic control on postoperative IOP outcomes. How to cite this article:Papadopoulos Z. Intraocular Pressure after Uneventful Phacoemulsification in Diabetic and Nondiabetic Patients: A Prospective Observational Study. J Curr Glaucoma Pract 2026;20(1):4-10.
Purpose:To compare the outcomes of trabeculectomies between glaucoma specialists and trainees at a tertiary eye care hospital in North India. Materials and methods:A retrospective evaluation of charts of patients undergoing primary trabeculectomy by either specialist consultants or glaucoma service trainees between October 2019 and March 2022 was conducted. Outcome measures were complete success, qualified success, and failure. Results:The study included 511 trabeculectomy surgeries, of which consultants performed 360 (70.4%) cases, and trainees performed 151 (29.5%) cases, with the consultants operating on more secondary glaucoma cases. The trainees had a significantly higher intraocular pressure (IOP) postoperatively; however, complete success, qualified success, and failure rates at 3 and 6 months were comparable between the two groups. The complication rate was also similar between the two groups, with the trainees showing a higher rate of return to OT. Conclusion:The high glaucoma burden in India emphasizes the necessity for more surgeons proficient in glaucoma procedures. This need can be met through organized training programs. A well-structured training program, incorporating hands-on wet-lab experience and supervised intraoperative training, enables trainees to achieve outcomes comparable to those of experienced glaucoma specialists when proctored. And thus, help increase the number of glaucoma specialists. This study emphasizes the need for such training programs while alleviating concerns about trainees performing surgeries that are perceived to be at higher risk. How to cite this article:Sharma A, Gandhi M, Daga D, et al. Comparison of Short-term Results of Trabeculectomies by Specialists and Trainees in an Indian Tertiary Care Eye Hospital. J Curr Glaucoma Pract 2026;20(1):14-19.
How to cite this article: Vasu P, Bharitya S, Dorairaj SK. Glaucoma After Dark: Sleep, Circadian Stress, and Unmeasured Drivers of Disease. J Curr Glaucoma Pract 2026;20(1):1-3.
Aim and background:To describe a case of Preserflo MicroShunt implantation in both eyes of a patient with intraocular pressure (IOP) rise after receiving bilateral Descemet's stripping automated endothelial keratoplasty (DSAEK), with poor IOP control by medical treatment alone. Case description:A female patient, previously diagnosed with primary open-angle glaucoma (POAG) and Fuchs' corneal dystrophy in both eyes, developed bilateral bullous keratopathy in late 2021. The patient underwent combined DSAEK and cataract surgery in her right eye (RE) in December 2021 and in April 2022 in her left eye (LE). After the surgical procedures, we observed an IOP rise not controlled by medical treatment. Bilateral Preserflo MicroShunt implantation was chosen as the surgical option to reduce the IOP increase and was performed in June 2022 in the LE and in July 2022 in the RE. The Preserflo MicroShunt implantation was successful in reducing the IOP in both eyes after bilateral DSAEK without the need for any additional hypotonic medical treatment. We observed good positioning of the device and the maintenance of corneal graft transparency and adhesion in both eyes after a 6-month follow-up from the most recent procedure. Conclusion:Preserflo MicroShunt has the potential to be a safe and effective technique in cases of IOP increase after endothelial keratoplasty. Further investigations with larger patient samples are required to validate our findings. Clinical significance:IOP elevation after corneal transplantation can pose a challenge in the postoperative period and may lead to the need for glaucoma surgery. Our report on a case of bilateral Preserflo implantation after DSAEK highlights the potential benefits of this relatively new glaucoma surgical technique in the management of these patients. How to cite this article:Della Lena F, Boni N, Messina M, et al. Bilateral Preserflo MicroShunt Implantation after Descemet's Stripping Automated Endothelial Keratoplasty: A Case Report. J Curr Glaucoma Pract 2026;20(1):34-37.
Aim and background:To report a case of bilateral acute angle closure glaucoma following phentermine monotherapy after prior topiramate discontinuation, highlighting the ocular risks of widely used weight loss medications, whether prescribed alone or in combination. Topiramate has a well-established role in acute bilateral angle closure glaucoma through ciliochoroidal permeability changes and choroidal effusion, while phentermine is contraindicated in glaucoma and has been implicated in bilateral angle closure glaucoma in one report. This case addresses a gap in recognizing phentermine's independent effects when used separately. Case description:A 31-year-old woman with a medical history of diabetes, hypertension, and migraines was prescribed topiramate 25 mg nightly and phentermine 15 mg daily for weight loss management. She discontinued topiramate after 2 days due to nausea, but continued phentermine. More than 1 week after topiramate cessation, she developed acute bilateral blurred vision, eye pain, and tearing. Examination revealed intraocular pressures (IOP) of 55 and 53 mm Hg in the right and left eyes, respectively. Gonioscopy demonstrated complete 360° angle closure bilaterally. B-scan ultrasonography confirmed bilateral choroidal effusions, suggesting a nonpupillary block mechanism similar to topiramate-induced angle closure. Management included immediate phentermine discontinuation and intensive medical therapy with cycloplegic agents and steroid drops, and maximum medical treatment including intravenous mannitol, systemic and topical carbonic anhydrase inhibitors, topical β-blockers, and α agonists. IOPs normalized within 48 hours, and gonioscopy demonstrated open angles bilaterally by day 2. Conclusions:This case demonstrates that phentermine monotherapy can be associated with bilateral acute angle closure glaucoma through mechanisms similar to topiramate-induced closure, occurring even after topiramate discontinuation. The temporal relationship and presence of choroidal effusions strongly implicate phentermine as the primary causative agent. Clinical importance:Comprehensive ocular risk assessment is essential for all weight loss medications, including phentermine when used alone, to identify drug-induced angle closure mechanisms and guide prompt management to prevent serious complications. How to cite this article:Parekh Z, Shah A, Zhou P, et al. Bilateral Acute Angle Closure Glaucoma Following Phentermine Monotherapy. J Curr Glaucoma Pract 2026;20(1):31-33.
Aims and background:Glaucoma is a leading cause of irreversible blindness worldwide. Its global prevalence is projected to exceed 110 million individuals by 2040 (Tham et al., 2014). In 2020, the disease accounted for an estimated 3.6 million cases of blindness and 4 million cases of moderate to severe visual impairment. Between 3 and 17% of patients develop refractory glaucoma, in which progression continues despite maximal medical and surgical treatment (Saunders et al., 2016). Optimizing management of these patients is essential to reduce the global burden of visual disability. Methods:This was a single-center, observational, retrospective cohort study conducted at York and Scarborough Teaching Hospitals. We included patients with refractory glaucoma treated with a single session of transscleral cyclodiode laser between 2019 and 2023. Baseline demographics, intraocular pressure (IOP), and medication use were recorded. Treatment success was defined as ≥20% reduction in IOP and a final IOP ≤ 21 mm Hg at 12 months posttreatment or cessation of oral antihypotensive medication and/or reduction in the number of topical antiglaucoma drops. Results:A total of 108 patients had cyclodiode laser treatment between 2019 and 2023. A total of 62 eyes from 57 patients were included. The average age of the patient was 71.5 ± 15.8 years. The mean baseline IOP was 36.4 ± 12.4 mm Hg, which significantly reduced to 19.0 ± 9.0 mm Hg at 12 months (p < 0.001). There was no significant correlation between baseline and posttreatment IOP. The average number of topical medications decreased from 3.4 ± 1.2 to 2.5 ± 1.4 (p < 0.001). Conclusion:Transscleral cyclodiode laser achieved a 77.4% success rate in reducing IOP ≤ 21 mm Hg and ≥20% reduction. It was an effective and well-tolerated option for managing refractory glaucoma. Clinical significance:This study supports the use of a single session of transscleral cyclodiode laser as a viable standalone treatment for patients with advanced, treatment-resistant glaucoma. Its ability to significantly lower IOP and reduce the need for systemic medications, with a favorable safety profile, makes it especially valuable for elderly and frail patients who are poor candidates for further surgery. How to cite this article:Salari Y, Venugopal D, Sohail T, et al. Safety and Efficacy of Transscleral Cyclodiode Laser in Advanced Glaucoma: A Retrospective, Single-center Observational Cohort Study. J Curr Glaucoma Pract 2025;19(4):175-181.
