PURPOSE:To identify risk factors for changes in Bruch's membrane opening-based optical coherence tomography (OCT) parameters after glaucoma surgery and to evaluate duration and dynamics of structural reversal of disc cupping (SRDC) in three different types of glaucoma surgery. DESIGN:Retrospective, interventional case series. METHODS:Evaluation of 151 eyes of 151 patients who received trabeculectomy, ab-interno trabeculotomy or glaucoma drainage device (GDD) surgery. Dynamics of postoperative change in Bruch membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fibre layer thickness in spectral-domain OCT were assessed. Multiple linear regression models identified risk factors for occurrence and magnitude of SRDC. RESULTS:Compared with baseline, BMO-MRW increased significantly up to the 9-month follow-up (p=0.048) after surgery. A multiple regression model for all patients showed a high relative reduction in intraocular pressure (IOP) (standard β=-0.272, p<0.001), an early date of follow-up (stand β=-0.280, p<0.001) and GDD as surgical procedure (standard β=0.169, p=0.027) as significant risk factors for SRDC.Within the first 9 months after intervention, a low postoperative IOP (standard β=-0.469, p<0.001), a young age (standard β=-0.423, p<0.001) and a short axial length (standard β=-0.235, p=0.040) had a significant impact on the BMO-MRW increase. CONCLUSION:In this set of patients with glaucoma undergoing different types of IOP-lowering surgery, significant SRDC was seen up to 9 months postoperatively. Risk factors for the extent of SRDC were younger age at surgery, early hypotonia or low postoperative IOP and hyperopia.

Purpose: To investigate through a case-matched analysis whether failed ab interno XEN45 Gel Stent implantation exerts an influence on the outcome after subsequent implantation of a Preserflo MicroShunt. Methods: In this retrospective study, 70 eyes from 70 participants who underwent Preserflo MicroShunt implantation were included. Thirty-five eyes each underwent primary stent implantation (control group) or had previously undergone failed XEN45 Gel Stent implantation (post-XEN group). The two groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum intraocular pressure (IOP), preoperative medication score, cup/disc-ratio, follow-up time, and age. Surgery was defined as either “success” or “failure” based on the following three scores: an IOP reduction of >20% and IOP at the longest follow-up <21 mmHg (Score A) or <18 mmHg (Score B) or IOP ≤15 mmHg and an IOP reduction ≥40% (Score C). In all scores, revision surgery was considered a failure. Furthermore, we compared postoperative IOP and medication score, side effects, and revision rate between both groups. Results: Mean IOP decreased from 28.9 to 12.2 mmHg in the post-XEN group and from 27.7 to 12.9 mmHg in the control group, while the mean medication score decreased from 2.1 in the post-XEN group and from 2.6 in the control group to 0.3, respectively. Comparative analyses between the two groups did not reveal a significant difference in postoperative IOP, medication score, side effects, revision, or success rate. Conclusion: Preserflo MicroShunt implantation can be considered a viable option for repeat surgery in patients with bleb failure after prior XEN45 Gel Stent implantation.

Purpose:To determine differing outcomes among pseudophakic patients with exfoliation glaucoma who underwent combined trabectome surgery and trabecular aspiration and phakic patients treated by a triple procedure with additional phacoemulsification. Methods:This retrospective study involved 75 eyes of 75 participants, of which 25 eyes received combined ab-interno trabeculectomy and trabecular aspiration (Trabectome + TA group), and 50 eyes underwent a triple procedure with additional phacoemulsification (triple group). The groups were matched at a 1:2 ratio, based on the following criteria: preoperative intraocular pressure (IOP), maximum known preoperative IOP, preoperative medication score, cup/disc ratio, follow-up time, and age. Successful surgery was defined by three scores: IOP at longest follow-up <21 mmHg (Score A) or <18 mmHg (Score B), without re-surgery and an IOP reduction >20% or IOP ≤15 mmHg without re-surgery and an IOP reduction ≥40% (Score C). Results:The preoperative IOP was 23.7 ± 5 mmHg, respectively, and decreased to 15.2 ± 4 mmHg in the triple group, which is significantly lower than postoperative IOP in the Trabectome + TA group, being 18.6 ± 8 mmHg during an average follow-up period of 33.4 ± 26 months (P = 0.02). The success rate in the triple group was significantly higher than in the Trabectome + TA group, according to Score A (78% vs. 40%) and Score B (70% vs. 36%). When aiming at a lower target IOP (Score C), the success rates did not differ significantly (36% vs. 24%). Conclusions:Cataract extraction, as a part of a triple procedure, seems to contribute to more effective IOP-lowering than trabectome surgery and trabecular aspiration alone in patients who underwent standalone phacoemulsification previously.

The purpose of this retrospective study was to compare the outcomes after combined phacoemulsification and ab-interno trabeculectomy via Kahook Dual Blade (KDB) and Trabectome, being represented in two groups of patients of Caucasian ethnicity with matched baseline criteria. We included 60 eyes of 49 participants being treated for cataract, of which 30 eyes underwent additional ab-interno trabeculectomy via KDB (Kahook group) and 30 eyes received additional Trabectome surgery (Trabectome group). For this comparative analysis, the Kahook group and Trabectome group were matched at a 1:1-ratio, based on the following criteria: preoperative IOP, maximum known preoperative IOP, preoperative medication score, cup/disc-ratio, follow-up time, best-corrected visual acuity and age. Successful surgery was defined by three scores: IOP at longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) without re-surgery and an IOP reduction > 20% or IOP ≤ 15 mmHg without re-surgery and an IOP reduction ≥ 40% (Score C). Furthermore, we compared postoperative IOP, as well as medication score, and side effects between both groups. Both surgical techniques led to a relative IOP reduction of 29% within their respective groups. Specifically, preoperative IOP decreased from 19.5 ± 5.0 mmHg to 13.8 ± 3.9 mmHg in the Kahook group, and from 19.8 ± 4.5 mmHg to 14.0 ± 3.9 mmHg in the Trabectome group during an average follow-up period of 23–24 months. There was no statistical significant difference noted. Both the KDB and Trabectome yielded similar success rates, according to Score A (67% vs. 70%), Score B (63% vs. 67%) and Score C (33% vs. 23%). There were no severe side effects notes in either group. In conclusion, the KDB and Trabectome showed similar IOP-lowering properties and safety profiles within our two matched groups of Caucasian patients.

To analyze the longitudinal change in Bruch’s membrane opening minimal rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (pRNFL) thickness using optical coherence tomography (OCT) after implantation of a PRESERFLO® microshunt for surgical glaucoma management in adult glaucoma patients. Retrospective data analysis of 59 eyes of 59 participants undergoing implantation of a PRESERFLO microshunt between 2019 and 2022 at a tertiary center for glaucoma management. Surgical management included primary temporary occlusion of the glaucoma shunt to prevent early hypotony. Pre- and post-operative OCT examinations of the optic nerve head (ONH) and intraocular pressure (IOP) were assessed. Longitudinal change in morphometric spectral domain OCT parameters of the ONH was correlated to change in IOP. BMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first three months after surgery (BL = 171.15 ± 66.80 μm; FU = 180.78 ± 70.394 μm; p = 0.034). For the same postoperative period, the mean preoperative IOP of 24.97 ± 7.22mmHg was lowered after surgery to 13.70 ± 5.09 mmHg. Eighteen months after surgery, there was no significant change in BMO-MRW compared to baseline (BL = 169.83 ± 52.69 μm; FU = 164.98 ± 55.85 μm; p = 0.271), while mean IOP was 13.08 ± 4.48 mmHg. A decrease in IOP correlated significantly with a change in BMO-MRW (r = 0.453, p < 0.05) three months after surgery. Peripapillary RNFL thickness was unchanged in follow-up after three months (p > 0.16) and significantly decreased in later follow-up (p = 0.009). PRESERFLO® microshunt implantation with primary temporary occlusion leads to a significant transient increase in BMO-MRW. This phenomenon is also known as structural reversal of disc cupping (SRDC). The effect seems to be less pronounced and of shorter duration when compared to previous data after trabeculectomy with comparable pre- and postoperative IOP levels.

To assess the practicality of two novel perimetry devices for glaucoma in daily clinical practice: a head-mounted virtual reality headset and a tablet-based perimeter. Both were compared to conventional bowl perimetry and glaucoma experts qualitatively assessed the results. The study included 363 eyes from 199 patients. All patients performed two perimetry examinations with one or both eyes: standard automated perimetry on a conventional bowl perimeter (CBP; Octopus 900, Haag-Streit) and subsequently one of two novel perimetry methods: virtual reality perimetry (VRP; n=100 patients; “PalmScan VF2000” MicroMedicalDevice) or tablet-based perimetry using the Melbourne Rapid Fields application (MRF; n=99 patients; Glance Optical Pty.Ltd.). Additionally, a panel of 10 glaucoma experts was asked to evaluate the new methods. There was a very high correlation between VRP and CBP for mean deviation and pattern standard deviation (ICC 0.956 and 0.825, respectively). The correlation was moderate to high with the tablet-based perimetry using the MRF application (0.832 for mean deviation and 0.566 for pattern standard deviation). 74.6

Purpose To assess the prevalence of anxiety and depression among individuals diagnosed with glaucoma, using standardised psychometric instruments, to define factors associated with these psychological diseases, and to identify a potential healthcare gap. Methods In this cross-sectional study, 249 patients with glaucoma were assessed using the 7-item Generalised Anxiety Disorder (GAD-7) scale and the Patient Health Questionnaire (PHQ-9). Correlation analyses explored links between psychometric scores, general mental and physical health functioning, vision-related quality of life and biosocial factors. Results Among participants, 1.2% had a prior anxiety diagnosis and 11.2% a depression diagnosis, yet screening revealed higher rates: 42.2% for anxiety and 34.9% for depression, indicating significant underdiagnosis (p<0.001, respectively). PHQ-9 and GAD-7 scores correlated strongly (p<0.001). Higher PHQ-9 scores were linked to poorer mental and physical health functioning as well as lower vision-related quality of life (p<0.001, respectively), female gender, living alone (p=0.02, respectively), younger age and lower income (p=0.01, respectively). Similarly, higher GAD-7 scores were associated with worse mental health functioning and vision-related quality of life (p<0.001, respectively), female gender (p=0.003), reduced physical health functioning (p=0.03) and lower income (p=0.002). Conclusion Anxiety and depression are frequently underdiagnosed in patients with glaucoma, highlighting a significant healthcare gap. The higher prevalence of these conditions in patients with glaucoma compared with the general population underscores the need for routine psychometric screening to enhance detection and management. Bridging this gap calls for an integrated care model that incorporates psychological evaluation and support into standard protocols, enabling comprehensive, patient-centred care tailored to age, gender, vision-related and socioeconomic factors.

(Deutsch) Hintergrund: Ziel dieser Studie war es erstmalig in Deutschland die Akzeptanz von innovativen Perimetriemethoden, wie die Virtual Reality-Brillenperimetrie (VRP) und die Tablet-basierte Perimetrie (TBP) im Vergleich zur konventionelle Halbkugelperimetrie (HKP) bei Glaukompatienten zu untersuchen. Patienten und Methoden: 204 Glaukompatienten wurden mit dem 30-2 TOP Programm (Octopus, Haag-Streit) untersucht und anschließend mit einer der beiden neuen Methoden: Gruppe 1 (VRP; n=101) und Gruppe 2 (TBP mittels der Melbourne Rapid Fields Glaucoma App; n=103). Anschließend wurde einen Fragebogen über die Erfahrung mit der neuen Untersuchung im Vergleich zur konventionellen Untersuchung beantwortet. Ergebnisse: 77% der Patienten aus Gruppe 1 (VR) und 89.9% der Patienten aus Gruppe 2 (TBP) beurteilten die Untersuchung mit der jeweiligen neuen Untersuchungsmethode als „einfacher“ oder „viel einfacher“ im Vergleich zur konventionellen HKP. Hinsichtlich der Bequemlichkeit gaben 86% bzw. 90.9% der Patienten der Gruppe 1 bzw. Gruppe 2 an, die jeweils neue Methode zu bevorzugen. Die Dauer der Untersuchung betrug mit der HKP 2,67±0,98 Minuten (Mittelwert ± Standardabweichung), mit der VR-Brille 6,26±1,88 Minuten (Mittelwert ± Standardabweichung) und mit dem Tablet bei 4±0,71 Minuten (Mittelwert ± Standardabweichung). Bezogen auf diesem Aspekt, fanden die Mehrheit der Patienten beide Untersuchungen (HKP und VR) zu 51% gleich und bei dem Vergleich zu dem Tablet, bevorzugten die Mehrheit zu 54% das Tablet der HKP gegenüber. 80% bzw. 81,8% der Patienten aus Gruppe 1 bzw. 2 konnten sich vorstellen jeweils die neue Perimetriemethode regelmäßig als Verlaufskontrolle zu verwenden. Schlussfolgerung: Die Mehrheit der befragten Glaukompatienten empfanden die Untersuchung mit der Virtual Reality Brillenperimetrie und der Tablet-basierte Perimetrie durchweg als positiv und bevorzugten diese gegenüber der konventionelle Halbkugelperimetrie. Abstract (Englisch) Purpose: The aim of this study was to investigate the acceptance of innovative perimetry methods such as virtual reality perimetry (VRP) and tablet-based perimetry (TBP) in comparison to conventional bowl perimetry (HKP) in glaucoma patients for the first time in Germany. Patients and Methods: 204 glaucoma patients were examined with the 30-2 TOP programme (Octopus, Haag-Streit) and then with one of the two new methods: Group 1 (VRP; n=101) and Group 2 (TBP using the Melbourne Rapid Fields Glaucoma App; n=103). Subsequently, a questionnaire was answered about the experience with the new examination compared to the conventional examination. Results: 77% of patients from group 1 (VR) and 89.9% of patients from group 2 (TBP) rated the examination with the respective new examination method as "easier" or "much easier" compared to conventional HKP. With regard to convenience, 86% and 90.9% of patients in Group 1 and Group 2 respectively stated that they preferred the new method. The duration of the examination was 2.67±0.98 minutes (mean ± standard deviation) with the HKP, 6.26±1.88 minutes (mean ± standard deviation) with the VR perimetry and 4±0.71 minutes (mean ± standard deviation) with the tablet. Regarding this aspect, the majority of patients found both examinations (HKP and VR) to be 51% the same and when compared to the tablet, the majority preferred the tablet to the HKP by 54%. 80% and 81.8% of patients in groups 1 and 2 respectively could imagine using the new perimetry method regularly as a follow-up. Conclusion: The majority of the glaucoma patients surveyed found the examination with virtual reality spectacle perimetry and tablet-based perimetry to be consistently positive and preferred them to conventional hemispherical perimetry.

PURPOSE:The aim of this study was to investigate the acceptance of innovative perimetry methods such as virtual reality perimetry (VRP) and tablet-based perimetry (TBP) in comparison to conventional hemisphere perimetry (HP) in glaucoma patients for the first time in Germany. PATIENTS AND METHODS:We examined 204 glaucoma patients using the 30 - 2 TOP algorithm (Octopus, Haag-Streit) followed by one of the two new methods: Group 1 (VRP; n = 101) and Group 2 (TBP using the Melbourne Rapid Fields Glaucoma App; n = 103). Subsequently, patients were asked to fill out a questionnaire on their experience with the new examination compared to the conventional examination. RESULTS:More than three-quarters of patients at 77% in Group 1 (VR) and 89.9% of patients in Group 2 (TBP) found the respective new examination method "easier" or "much easier" than the conventional HP. An overwhelming majority of patients in Group 1 and Group 2 found the new method more comfortable at 86% and 90.9%, respectively. Examination durations were: 2.67 ± 0.98 min for HP, 6.26 ± 1.88 min for VR perimetry, and 4 ± 0.71 min for the tablet method; figures given as means ± standard deviation. Just over half the patients at 51% found HP and VR headset to be similar for duration with 54% preferring the tablet over conventional hemisphere perimetry. By far the most patients in Groups 1 and 2 at 80% and 81.8%, respectively, reported willingness to use the new perimetry method regularly in future follow-up examinations. CONCLUSION:Most glaucoma patients surveyed consistently responded favourably to VR headset and tablet-based perimetry, preferring these examinations to conventional hemispherical perimetry.

This work aimed to investigate changes in optic nerve head (ONH) morphometry based on Bruch membrane opening in children with extensive nocturnal intraocular pressure (IOP) elevations. The course of Bruch membrane opening-based optic nerve head (ONH) morphometry was analysed in thirty-two patients younger than 18 years with evaluable SD-OCT examinations of the ONH and nocturnal posture-dependent IOP elevation above 25 mmHg. Longitudinal changes in neuroretinal rim tissue, as measured by Bruch Membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness, were assessed. One year after the 24 h IOP measurement, global BMO-MRW (− 1.61 ± 16.8 µm, n.s.; p = 0.611) and RNFL (+ 0.64 ± 3.17 µm; n.s.; p = 0.292) measurements were not significantly different from the baseline. No significant BMO-MRW reduction (− 3.91 ± 24.3 µm; n.s. p = 0.458) or deviation in RNFL thickness (+ 1.10 ± 3.52 µm) was observed at the four-year follow-up. Absolute IOP values measured in the supine position did not correlate with changes in global BMO-MRW or RNFL thickness. Posture-dependent IOP elevations do not seem to influence retinal nerve fibre layer thickness or Bruch membrane opening-based morphometric data in childhood.

Purpose To assess and compare the risk for development of cystoid macula edema (CME) after glaucoma drainage device (GDD) implantation versus conventional trabeculectomy with mitomycin (trab) for glaucoma. Methods Retrospective review of consecutive patients receiving trab or GDD implantation between 2016 and 2018. Inclusion criteria were availability of pre- and postoperative spectral domain optical coherence tomography (SD-OCT) of the macula. SD-OCT images were evaluated for presence of CME qualitatively, central subfield thickness (CST) and macular volume (MV). Results 73 eyes could be included, 42 received trab and 31 GDD surgery. Eyes receiving trab on average had 0.8 ± 0.8 previous intraocular operations, while eyes with GDD implantation had 3.1 ± 1.9 ( p < 0.001). Occurrence of postoperative CME was significantly more frequent after GDD implantation (6 out of 31 (19.4%)) than after trab (2 out of 42 eyes = 4.8%), (p = 0.049). Mean preoperative CST as well as MV was comparable in both groups (CST before trab: 282.7 ± 23.0 µm, CST before GDD 284.2 ± 27.3 µm, p = 0.287; MV before trab: 7.8 ± 1.1 mm 3 , MV before GDD: 8.0 ± 0.8mm 3 , p = 0.305). Mean postoperative CST and MV were significantly higher after GDD (CST 338.5 ± 129.3 µm, MV 8.8 ± 2.6 mm 3 ) than after trabeculectomy (CST 290.6 ± 60.2 µm, p = 0.038; MV 7.8 ± 1.2mm 3 , p = 0.039). Conclusions In real-life conditions, GDD surgery seems to be associated with a higher risk to develop CME when compared to conventional trabeculectomy. This information may be helpful for glaucoma surgeons to advise the patients on postoperative risks of surgery.

BackgroundThe aim of this study was to compare the outcome of implantation of a XEN45 Gel Stent with the outcome of implantation of a Preserflo MicroShunt in a matched-pair analysis in eyes being na & iuml;ve to filtering surgery. MethodsIn this comparative, retrospective study, 50 eyes that had undergone XEN45 Gel Stent implantation were compared with 50 eyes after Preserflo implantation. Follow-up was at least 6 months, and surgical success was measured by criteria A (IOP < 21 mmHg, IOP reduction >20%, no repeat surgery); criteria B (IOP < 18 mmHg, IOP reduction >20%, no repeat surgery); and criteria C (IOP <= 15 mmHg, IOP reduction >= 40%, no repeat surgery). ResultsAfter a follow-up period of 12 months, mean IOP had decreased from preoperative 25.2 +/- 4.8 mmHg in the XEN group to 14.5 +/- 4.0 (n = 35) and from 25.3 +/- 6.8 mmHg to 11.9 +/- 2.9 (n = 41) in the Preserflo group, respectively. The IOP at the last follow-up of the two groups differed significantly (p < 0.01). The probability of surgical success did not differ concerning Criteria A and B, but surgical success was significantly higher in the Preserflo group for Criteria C (60%, p < 0.01). ConclusionBoth the Preserflo and XEN45 Gel Stent provide an effective and safe treatment option for advanced glaucoma and have a high potential to reduce intraocular pressure. Absolute IOP levels of <16 mmHg after 12 months were significantly more frequent in the Preserflo group.

Das Glaukom ist weltweit eine der häufigsten Ursachen für irreversible Erblindung. Der Hauptrisikofaktor der Erkrankung ist ein individuell zu hoher Augeninnendruck und die Drucksenkung immer noch die einzig etablierte Therapie. Bei mangelnder konservativer Drucksenkung und Adhärenz sowie bestehender Unverträglichkeit der konservativen Therapie werden operative Verfahren notwendig. Mittlerweile gibt es mehr als ein Dutzend verschiedene operative Verfahren zur Drucksenkung. In diesem Beitrag werden die Verfahren, die einen subkonjunktivalen Abfluss ohne Platte vor dem Äquator gemeinsam haben, vorgestellt und diskutiert. Hierzu zählen die Trabekulektomie, das XEN-Gel-Implantat sowie der PreserFlo MicroShunt.

To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)‐lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open‐angle glaucoma (POAG).

Filterkissenversagen nach Implantation von filtrierenden Stents (z. B. Preserflo Stent) stellen eine über die letzten Jahre entstandene häufige Herausforderung in der Glaukomchirurgie dar. Im Folgenden wird hierzu eine Technik zur offenen Filterkissenrevision mit Mitomycin C (0,2 mg/ml) und Ologen-Implantation dargestellt, deren Ziel es ist, durch Fibrose verloren gegangenes Filtrationsvolumen zu reetablieren und längerfristig zu erhalten.

Purpose Currently, there are no specific data on the circadian course of intraocular pressure (IOP) in children, especially for IOP measurements in the supine position. The study aimed to characterize the diurnal and nocturnal IOP fluctuations in supine and sitting positions in patients less than 18 years of age. Methods Seventy-nine eyes of 79 patients under 18 years of age with suspicious optic nerve heads or ocular hypertension could be included in this study. All included patients showed an inconspicuous retinal nerve fiber layer thickness and Bruch’s membrane minimum rim width by coherence tomography. IOP measurements during the 24-h IOP profile were retrospectively evaluated. Measurements were taken at 10:00, 16:00, 20:00, and 23:00 h in the sitting position and at 6:00 h in the morning in the supine position using iCare rebound tonometry on 2 consecutive days. Results Thirty-four of 79 children (43.0%) had peak nocturnal IOP values > 25 mmHg. The mean daily IOP was 18.8 ± 5.6 mmHg, and the mean daily fluctuation was 6.1 ± 4.0 mmHg. At 6 am, supine measurements were elevated to 25.1 ± 8.0 mmHg. Extensive fluctuations with values > 40 mmHg in the nocturnal supine measurement occurred in a relevant share of patients ( n = 5). Conclusion There appear to be relevant diurnal and nocturnal IOP fluctuations in healthy children (< 18 years). Nocturnal IOP measurements in supine patients with risk factors for glaucoma may provide important additional information to identify critical patients for further follow-up.