Ophthopedia

Ophthopedia Update:Risk of primary acquired nasolacrimal duct obstruction among gastroesophageal reflux disease patients: a global population-based study: Eye, Published online: 22 March 2025; doi:10.1038/s41433-025-03759-5Risk of primary acquired nasolacrimal duct obstruction among gastroesophageal reflux disease patients: a global population-based study #Ophthalmology #Eye #Ophthotwitter

ICYMI: Ophthopedia Update:Evaluation of ChatGPT-4 in Detecting Referable Diabetic Retinopathy Using Single Fundus Images: Publication date: Available online 18 March 2025 Source: AJO International Author(s): Owais Aftab, Hamza Khan, Brian L. VanderBeek, Drew Scoles, Benjamin J. Kim, Jonathan C. Tsui #Ophthalmology #AJOInternational

ICYMI: Ophthopedia Update:CERKL-ASSOCIATED RETINAL DEGENERATION IN PORTUGAL: MUTATIONAL SPECTRUM AND RETINAL PHENOTYPES: Publication date: Available online 18 March 2025 Source: AJO International Author(s): Catarina Pestana Aguiar, Lilianne Duarte, Célia Azevedo Soares, Pedro Marques-Couto, Sérgio Estrela-Silva, Ana Luísa Carvalho, João Pedro Marques #Ophthalmology #AJOInternational

Ophthopedia Update:Gonioscopy-Assisted Transluminal Trabeculotomy in Patients with Angle Recession Glaucoma: Précis: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a successful minimally invasive glaucoma surgery (MIGS) technique for treating patients with angle recession glaucoma (ARG). Purpose: To share one-year follow-up outcomes of GATT in patients with ARG. Patients and Methods: Six eyes of six patients with ARG were reviewed in this retrospective study. All of the patients had uncontrolled intraocular pressure (IOP) with antiglaucoma medications (AGM) and a history of blunt ocular trauma (BOT). Preoperative IOP; the number of preoperative AGM; postoperative IOP at first month, third, sixth, and 12th months; postoperative IOP spikes, the need for postoperative AGM, and the need for further surgical interventions were recorded. Results: Five patients underwent GATT and one patient underwent GATT combined with phacoemulsification. IOP decreased from 30.30 [7.20] mmHg preoperatively to 11.95 [3.45] mmHg postoperatively at 12th month (P=0.028), with a median difference of −19.50 mmHg (%95 CI: −25.10 to −14.55). After GATT, all patients had varying degrees of hyphema that did not require surgical intervention. IOP peaks were observed in the postoperative first month in 3 patients and IOP was controlled with AGM in these patients. The median [IQR] preoperative number of AGM decreased significantly compared to the median [IQR] postoperative number of AGM at 12th month (P=0.038, 4.00 [0.25] vs. 2.00 [1.25], median difference: −1.50, %95 CI: −2.00 to −0.50). During the one-year follow-up, no patients with ARG required additional surgical intervention. Conclusion: Due to its low complication rates and successful IOP-lowering effect, we recommended that GATT is an effective, safe, and considerable MIGS procedure for patients with ARG. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. #Glaucoma #Ophthalmology #Ophthotwitter

Ophthopedia Update:Social Vulnerability Associated with Frequency of Visual Field and Optical Coherence Tomography Testing in Glaucoma Patients: Precis: Higher Social Vulnerability Index scores, limited-English proficiency and retirement/disability status were associated with lower odds of completing one visual field and optical coherence tomography/year in glaucoma patients. Purpose: To assess the correlation between sociodemographic factors and the Social Vulnerability Index to the likelihood of not receiving one visual field testing and one retinal nerve fiber layer optical coherence tomography test per year. Methods: Patient records with glaucoma living in Washington state from a single academic institution (2014–2021) were reviewed. Those with a single visit, an address with no Social Vulnerability Index score, or a diagnosis relating to pre-glaucoma, glaucoma-suspect, or ocular hypertension were excluded. Demographic data, Social Vulnerability Index scores, and the number of visual fields and optical coherence tomography were collected. Patients were classified as meeting testing criteria if they had at least one visual field and optical coherence tomography per year. Logistic regression was used to assess if sociodemographic factors and Social Vulnerability Index scores were associated with not meeting testing criteria. Results: 3,971 patients were included: 1,470 (37.0%), 1,834 (46.2%), and 1,413 (35.6%), had at least 1 visual field/year, at least 1 optical coherence tomography/year, and at least 1 visual field and 1 optical coherence tomography/year, respectively. On average 0.8±0.6 visual field/year and 0.9±0.6 optical coherence tomography/year were performed. Limited English proficiency (P=0.009), being disabled/retired (P=0.003), and higher Social Vulnerability Index scores (P #Glaucoma #Ophthalmology #Ophthotwitter

Ophthopedia Update:Visual Field Progression in Glaucoma During COVID-19: Precis: Visual fields in glaucoma significantly progressed during the COVID-19 pandemic, likely due to reduced compliance and lack of availability of medication. Purpose: To study the impact of the COVID-19 pandemic on the rate of visual field progression in glaucoma and to validate the factors affecting progression. Methods: This hospital based prospective cohort study included patients diagnosed with primary open angle glaucoma, primary angle closure glaucoma and ocular hypertension who fulfilled the eligibility criteria. We included 234 eyes with at least five reliable Humphrey visual fields (24-2 SITA Standard) before 24th March 2020 and two or more after. Glaucoma Progression Analysis software was used to carry out both trend and event-based analysis. Rates of progression pre and post pandemic were compared. Univariate and Multivariate logistic regression analysis were done to identify factors affecting progression. Results: Rate of visual field progression increased significantly post lockdown, Mean Deviation(MD) pre lockdown -0.1(SD:0.8) (95% CI: −0.196, 0.001) dB/year versus −0.3(SD:0.6) (95% CI: −0.362, −0.208) dB/year post lockdown (P #Glaucoma #Ophthalmology #Ophthotwitter

Ophthopedia Update:Pattern of Long Term Intraocular Pressure Variation following Gonioscopy-assisted Transluminal Trabeculotomy: Two-year Outcomes: Précis: Patients with clinically uncontrolled open-angle glaucoma submitted to isolated gonioscopy-assisted transluminal trabeculotomy or combined with phacoemulsification not only achieved low mean IOPs, but also demonstrated stable IOP patterns during a 24-month follow-up. Purpose: To assess the impact of gonioscopy-assisted transluminal trabeculotomy (GATT) on long term intraocular pressure (IOP) variation. Patients and Methods: An unicentric retrospective study including 169 consecutive patients who had undergone standalone GATT or combined with phacoemulsification (PHACOGATT) due to clinically uncontrolled open-angle glaucoma, with at least 12 months of follow-up was conducted. Long term mean IOP, long term IOP peak, long term IOP fluctuation, coefficient of variation, mean-positive IOP variation, sustained clinically significant positive IOP variation and number of follow-up visits with IOP ≥15 mmHg were investigated. Results: 169 eyes from 169 patients were included (GATT group=101 patients; PHACOGATT group=68 patients). Mean long term IOP (12.0±1.8 vs. 11.2±2.0 mmHg), mean long term IOP peak (12.9±2.6 vs. 11.8±3.5 mmHg) and mean coefficient of variation (0.07±0.08 vs. 0.05±0.09) were lower in the PHACOGATT group, while mean IOP fluctuation (1.0±3.7 mmHg vs. 1.2±1.8 mmHg) was lower in the GATT group. Additionally, overall mean-positive IOP variation was 0.79±1.64 mmHg. Finally, only 6.5% of the patients presented sustained clinically significant positive IOP variation and IOP was ≥15 mmHg in 5.9% of the follow-up visits. Conclusions: Patients with clinically uncontrolled open-angle glaucoma submitted to GATT or PHACOGATT achieved low mean IOPs and demonstrated stable IOP patterns. Our results provide additional evidence supporting GATT and PHACOGATT as viable options for the treatment of medically uncontrolled glaucoma patients requiring low and stable IOPs. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. #Glaucoma #Ophthalmology #Ophthotwitter

Ophthopedia Update:Fractal Dimension Analysis of Peripapillary Microvasculature in Primary Congenital Glaucoma: Precis: In this prospective multicenter study, eyes with primary congenital glaucoma exhibited lower retinal vascular parameters compared to healthy controls, as assessed by optical coherence tomography angiography fractal dimension analysis. Purpose: To study the retino-choroidal peripapillary microvascular pattern in primary congenital glaucoma (PCG) using fractal dimension (FD) analysis and compare it to healthy controls. Methods: This was a prospective multicenter comparative study. We obtained peripapillary optical coherence tomography angiography (OCTA) scans (Optovue Inc, Fremont, CA) and computed FD at the vitreous/retina (large retinal vessels), inner limiting membrane/nerve fiber layer (ILM-NFL) (radial peripapillary capillary plexus, RPC), and the choroid. Other peripapillary OCTA parameters, including the whole image inside the disk and peripapillary superior and inferior vascular density (VD) parameters, were also collected. One eye per patient was included in the analysis Results: We included a total of 17 PCG eyes and 24 control eyes. The mean age at the time of enrollment was 8.24±0.75 years in the PCG group compared to 8.33±1.09 in controls (P=0.74). Eight patients (47%) in the PCG group and 14 (58.3%) in the control group were male. Among the PCG group, the mean vitreo-retina (large retinal vessels) FD (1.79) and ILM-NFL (RPC) FD (1.75) were significantly reduced compared to controls (vitreo-retina FD (1.85), ILM-NFL FD (1.82), P-value 0.011 and 0.014, respectively). There was no statistically significant difference in the averaged choroidal FD between both groups (1.89 vs. 1.88, P=0.29). All optic nerve VD parameters (whole image, inside disc, superior, and inferior-hemi) were also significantly reduced in the PCG group. Conclusion: PCG was associated with lower vascular parameters in the vitreo-retina (large retinal vessels) and ILM-NFL (RPC) layers as detected by OCTA FD. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. #Glaucoma #Ophthalmology #Ophthotwitter

Ophthopedia Update:One-Year Outcomes of Gonio Scratch as a Minimally Invasive Glaucoma Surgery with Cataract Removal: Précis: This study evaluated the 1-year efficacy and safety of a novel minimally invasive glaucoma surgery, gonio scratch, in reducing intraocular pressure of eyes with open-angle glaucoma and cataracts. Purpose: To evaluate the 1-year efficacy and safety of phacoemulsification cataract extraction combined with gonio scratch (GS-Phaco), a novel minimally invasive glaucoma surgery, in patients with open-angle glaucoma and cataracts. Patients and Methods: This prospective multicenter clinical trial was conducted at Hiroshima University, Yokoyama Retina Clinic, Kusatsu Eye Clinic, and Miyoshi Eye Clinic in Japan. The primary outcome measure was the rate of intraocular pressure (IOP) control. Failure was defined as an IOP of >18 mmHg or >14 mmHg, a #Glaucoma #Ophthalmology #Ophthotwitter

Ophthopedia Update:Comparison between Phacoemulsification-iStent Inject W and Phacoemulsification-Micropulse Transscleral Laser Therapy in Asian Eyes with Mild-Moderate Open Angle Glaucoma: Précis: In this retrospective cohort study, the 1-year cumulative probability of failure was comparable, achieving 52.20% in the phacoemulsification-iStent inject W (phaco/iStent) group and 47.80% in the phacoemulsification-micropulse transscleral laser therapy (phaco/MPTLT) group (P=0.994). Purpose: To compare the 1-year efficacy and safety of phacoemulsification combined with iStent Inject W (phaco/iStent) and phacoemulsification combined with micropulse transscleral laser therapy (phaco/MPTLT). Methods: Retrospective cohort study that included patients with mild-moderate open angle glaucoma (OAG) and cataract who underwent either phaco/iStent or phaco/MPTLT in a tertiary hospital in Singapore between August 1, 2016 and December 31, 2022. The primary outcome measures were cumulative probabilities of failure between the two groups with failure defined as disease progression by Ocular Coherence Tomography (OCT-RNFL) or Visual Field Test (VFT), repeat glaucoma surgery, and inability to maintain intraocular pressure (IOP) lower than pre-operative baseline or the use of glaucoma medications for 2 consecutive visits after 1 month post-operatively. Additionally, post-operative mean IOP, average number of IOP lowering medications, visual acuity, and complications were analyzed. Results: Forty-six patients were included. 23 eyes underwent phaco/iStent and 23 had phaco/MPTLT. The two groups had comparable cumulative probabilities of failure (52.20% phaco/iStent, 47.80% phaco/MPTLT; P=0.994) and mean IOP (15.57+2.95 mmHg phaco /iStent, 14.39+2.25 mmHg phaco/MPTLT; P=0.136) after 1 year. The change in IOP before surgery to 12 months is -1.04+3.07 mmHg in the phaco/iStent group (P=0.593) and -2.43+4.12 mmHg in the phaco/MPTLT group (P=0.022). Both achieved significant medication reduction burden (P #Glaucoma #Ophthalmology #Ophthotwitter