Aim and background: This study aims to evaluate the institutional interdisciplinary management protocol for neovascular glaucoma patients, focusing on a combined surgical approach involving posterior vitrectomy and Ahmed valve implantation, with previous antiangiogenic application. Materials and methods: A retrospective review was conducted for 14 neovascular glaucoma patients who underwent the combined procedure over 4 years. Patients aged 18 years or older with prior antiangiogenic application and without other types of glaucoma or prior posterior vitrectomy were included. Surgical success was assessed as intraocular pressure reduction below 21 mm Hg, either without hypotensive medication (absolute success) or with medication (qualified success) at various time points. Secondary outcomes included intraocular pressure (IOP), number of hypotensive medications, visual acuity, underlying etiology, and postoperative complications. Results: At baseline, patients had an average IOP of 50 mm Hg and were taking 4.4 glaucoma medications. After the 12-month follow-up, the mean IOP decreased significantly to 16.4 mm Hg, reducing the need for hypotensive medications. The qualified success rate was 100%, while absolute success was not achieved. Visual acuity and anatomical outcomes were maintained, with no cases of anatomical loss. Postoperative complications, including hyphema, choroidal detachment, and vitreous hemorrhage, were transient and self-resolved. Conclusion: The interdisciplinary management protocol proposed showed favorable results for neovascular glaucoma management. The combined surgical approach led to a considerable reduction in intraocular pressure and glaucoma medication use, indicating a high success rate in controlling the disease. Visual acuity and anatomical outcomes remained stable during the follow-up period, with no cases of anatomical loss. Clinical significance: This study demonstrates that combining posterior vitrectomy and Ahmed valve implantation, preceded by antiangiogenic therapy, effectively reduces intraocular pressure and glaucoma medication use in neovascular glaucoma patients. This interdisciplinary approach offers improved management and potential for better patient outcomes.

Aim: To compare the risk of early intraocular pressure (IOP) spikes following micropulse (MP) vs continuous wave (CW) transscleral cyclophotocoagulation (CPC). Methods: Single-center, prospective, nonrandomized study that included glaucoma patients planned for MP- or CW-CPC at Wills Eye Hospital (2020–2021). IOP was measured using rebound tonometry (iCare) immediately before, immediately after, and 1 hour after the CPC, then on postoperative day 1. The primary outcome measure was the incidence of IOP spikes, defined as IOP elevation ≥10 mm Hg vs baseline. Patients with severe IOP spikes received IOP-lowering agents (topical or oral). Results: Twenty-six eyes (15 CW and 11 MP) of 26 patients were included, with a mean age of 64.4 ± 15.1 years. At the baseline visit, IOP was 29.5 ± 11.3 mm Hg, and the medication number was 3.8 ± 1.4, with no difference between groups. IOPs (CW vs MP, mm Hg) were 31.9 ± 10.5 vs 24.1 ± 7.3 immediately before CPC (p = 0.044), 22.9 ± 10.8 vs 16.1 ± 6.3 immediately after CPC (p = 0.760), 24.6 ± 11.9 vs 23.2 ± 9.5 at 1 hour after CPC (p = 0.757), and 18.0 ± 6.1 vs 20.8 ± 6.9 at 1 day later (p = 0.335). Three eyes (11.5%; 1 CW, 2 MP) experienced IOP spikes (p = 0.556) at 1 hour post-CPC; IOP responded to topical and/or oral medications. At day 1 and month 1, mean IOP reduction compared to baseline was significant in CW eyes (p < 0.001) and insignificant in MP eyes (p > 0.05). Conclusion: MP- and CW-CPC have similar risks of early postoperative IOP spikes. Significant early IOP reduction was better achieved following CW-CPC. Early postoperative IOP spikes may be detrimental; there may be a role for IOP monitoring in such cases. Clinical significance: Understanding the early postoperative outcomes of MP- and CW-CPC is critical for optimizing glaucoma management. This study highlights that while both procedures carry a similar risk of early IOP spikes, CW-CPC demonstrates superior early IOP reduction. These insights help clinicians tailor CPC strategies to individual patient requirements.

Aim and background: The aim of this study is to evaluate the agreement between perimetric findings of a novel 24°, 52-loci online circular contrast perimetry (OCCP) application on three different computer monitors to determine its stability of testing across varying displays. Materials and methods: Sixty-one participants (19 healthy controls, 42 with glaucoma) underwent SAP testing followed by OCCP testing on three uncalibrated computer monitors in randomized order: a large-screen (24-inch) desktop personal computer (DPC) (Dell, Texas, US), a 17-inch laptop (LPC) (Dell), and a 14-inch MacBook Pro (MP) (Apple, California, US). Results: Agreement of mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI)/visual index (VI) values between MP, DPC, and LPC OCCP were strong, with intraclass correlations and Deming's coefficients ranging from 0.96 to 1.00 and 0.93 to 1.03, respectively. When OCCP tests were compared to SAP, ICCs and Deming's coefficients were less strong, ranging from 0.89 to 0.95 and 0.72 to 0.89. Bland-Altman analyses revealed higher biases (2.90 to 3.59 dB) and wider limits of agreement when comparing OCCP to SAP than when comparing OCCP on different monitors. Bland-Altman bias of contrast sensitivities for each 24-2 testing location revealed stronger relationships between OCCP tests on different monitors (–0.82 to 0.78) than between OCCP and SAP tests (–1.53 to 1.32). Conclusion: OCCP demonstrates strong levels of test-retest agreement when performed on computer monitors of varying display and moderate to strong levels of correlation to SAP perimetric indices. Clinical significance: With further enhancements, OCCP could potentially be used on different personal computers, which could help address current challenges in glaucoma care, such as limited access to traditional perimetric testing. This has the potential to expand the scope of glaucoma detection and monitoring, particularly in remote and underserved areas of our community.

Aims: A review of the published literature was done to understand the role of endocannabinoids in glaucoma. Background: As evidence mounts that intraocular pressure (IOP) is not the only factor in the pathogenesis and progression of glaucoma, a look into other aspects is the need of the hour. From the first instance of a drop in IOP linked to marijuana in the 1970s to the present, research has been ongoing, mostly in animals and in vitro models, with a scarcity of human studies, to delve into the world of the endocannabinoid system (ECS). Methods: PubMed, ScienceDirect, and Google Scholar were searched for studies relating to endocannabinoids and their role in glaucoma. Results: The ECS comprises ligands, receptors, and the synthesizing and degrading enzymes and is ubiquitous throughout the human body, including the visual system, from the eye to the occipital lobe. Apart from the IOP-lowering effect of the system, another property being investigated and implicated as an attribute of its receptors is neuroprotection. This neuroprotection seems to be mediated by excitotoxicity reduction and changes in vascular tone by acting on cannabinoid receptors. Conclusion: The possibilities are indeed immense, and further research into the complex relationship between ECS and glaucoma is imperative to enable us to develop therapies for this otherwise chronic, progressive neuropathy, where the only armament in our hands is early diagnosis and maintenance therapy. Clinical significance: We still do not have drugs for the prevention of retinal ganglion cell loss and for neuroprotection in glaucoma. Drugs that target cannabinoid receptors can revolutionize glaucoma management owing to their IOP-lowering action and neuroprotective effects. Based on the findings, we argue that further studies on the ECS and its implications in glaucoma are warranted to develop newer, effective, and better-targeted treatment strategies.

Glaucoma, a multifactorial disease, currently leads the causes of irreversible blindness globally, with complex underlying pathophysiology. For a long time, decreasing intraocular pressure (IOP) has remained the desired primary outcome for each modality of glaucoma management—medical, laser, or surgical. However, the understanding of non-IOP-dependent mechanisms and the identification of additional risk factors affecting optic nerve health have extended the range of preventive and therapeutic options for tackling glaucoma in a more holistic manner. Adopting a healthy lifestyle has been the key to managing all chronic diseases, especially cardiovascular disorders and diabetes, with proven benefits in significantly reducing their incidence and severity. Glaucoma is recognized as a chronic degenerative ailment of the second cranial nerve, and lately, there has been a tremendous upsurge in the subject to evaluate the potential role of lifestyle factors like diet, nutrition, exercises, sleep postures, and smoking in relation to the health of the optic nerve. Existing evidence suggests that some modifications in lifestyle have positive impact in preventing development and retarding its progression, although some findings are conflicting. This write-up aims to furnish a comprehensive overview of the same by analyzing existing evidence and summarizing the repercussions of different lifestyle factors—namely diet and nutritional supplements or exercises—on IOP or the perfusion pressure of the eye, which ultimately leads to retinal ganglion cell loss and optic neuropathy. Knowledge of their putative role as preventive or supportive medicine in glaucoma management can empower both patients and glaucoma specialists in mitigating the agony of the disease affecting the quality of life.

Aims and background: We aimed to compare the effects of ab externo trabeculotomy (AbE-TLO), gonioscopy-assisted transluminal trabeculotomy (GATT), and Ahmed glaucoma valve (AGV) implantation on intraocular pressure (IOP) and the number of antiglaucomatous medications used in pediatric aphakic glaucoma (AG). Materials and methods: Between 2017 and 2022, 27 eyes of 24 children who underwent AbE-TLO, GATT, and AGV in our clinic for pediatric AG were retrospectively analyzed. Corneal dimensions, corneal thickness, axial length, and surgical technique were recorded. Baseline and postoperative follow-up IOP measurements and antiglaucomatous drops used were analyzed. Results: AbE-TLO was performed in 37% (n = 9), GATT in 30% (n = 7), and AGV implantation in 33% (n = 8) of the patients included in our study. The mean follow-up period was 39.12 ± 3.19 months. In the 2nd postoperative year, IOP decreased significantly from 33.9 to 17.7 mm Hg with AbE-TLO (p = 0.014), from 34.3 to 18.3 mm Hg with GATT (p = 0.033), and from 34.5 to 16.4 mm Hg with AGV (p = 0.002). When all three surgical methods were compared, no significant difference was observed in IOP reduction at 1 and 2 years (p > 0.05). The number of antiglaucomatous medications decreased from 2.3 to 0.8 (p = 0.005) in AbE-TLO, from 2.4 to 0.5 (p = 0.008) in GATT, and from 2.3 to 0.6 (p = 0.005) in AGV at 2 years after surgery. Conclusion: There was a significant decrease in IOP, along with a significant reduction in the usage of antiglaucomatous drugs, across all three primary surgical methods. No significant difference was detected regarding the reduction in IOP and the usage of antiglaucomatous medications. Clinical significance: Approximately, half of the patients with pediatric AG undergo surgery. However, the most appropriate surgical technique for AG remains unclear. Minimally invasive glaucoma surgeries, increasingly performed in recent years, now constitute a pivotal aspect of glaucoma surgical treatment. Thus, the main objective of the current research is to compare the impacts of AbE-TLO, GATT, and AGV implantation on IOP as the primary surgical method in pediatric AG.

Purpose: To compare real-world outcomes of Henson 9000 perimeter and Humphrey field analyzer (HFA) in glaucoma patients. Materials and methods: This retrospective study recruited patients diagnosed with glaucoma who underwent Swedish interactive thresholding algorithm (SITA) Standard perimetry (HFA, Carl Zeiss Meditec), followed by Zippy Adaptive Threshold Algorithm (ZATA) Standard perimetry (Henson 9000, Topcon Healthcare). Test durations, global indices, and reliability indices were compared. A subgroup analysis was done for patients classed as early [mean deviation (MD) ≥ –6 dB] and moderate-severe (MD < –6 dB) glaucoma. Fatigue-adjusted subgroup analysis was done, including right eyes only. Results: 76 eyes of 44 patients were included. Henson 9000 results were within normal reliability limits, although they showed higher false positives (FP) (by 6.79%; p < 0.001), false negatives (FN) (by 23.17%; p < 0.001), and fixation losses (FL) (by 9.5%; p = 0.018). Overall, Henson tests showed a slight increase in MD (+1.01 dB, p = 0.004), with no significant differences in duration (p = 0.083) or pattern standard deviation (PSD) (p = 0.742). A strong positive correlation between devices was observed for MD (r = 0.903; p < 0.001) and PSD (r = 0.850; p < 0.001). In early glaucoma (n = 57), mean Henson test duration was shorter by 1.06 minutes (p < 0.001) with no significant difference in MD results (p = 0.083). In all right eyes (n = 38), there were no statistically significant differences in mean duration, MD, and PSD between both devices (p = 0.369, 0.168, 0.537, respectively). Conclusion: Outcomes with the Henson 9000 were reliable, with measured global indices strongly correlated with HFA results. In early glaucoma, outcomes were comparable to HFA with shorter tests, suggesting the potential of the Henson 9000 as a screening tool for early glaucoma.