Aim and background: To assess the efficacy of 2% dorzolamide/0.5% timolol/0.2% brimonidine tartrate fixed combination (DTB-FC) eye drops in patients with intermediate glaucoma stage. Materials and methods: A retrospective case series study was performed, including eyes diagnosed with primary open-angle (POAG) or chronic angle-closure glaucoma (CACG), which were at intermediate stage of the illness according to the Brusini grading system and were initially treated with 2% dorzolamide/0.5% timolol fixed combination (DT-FC), and switched at baseline to DTB-FC. Main outcome was intraocular pressure (IOP) baseline measured, as well as at weeks 1 and 2, months 1, 3, and 6, and 1 year after switching. IOP differences were analyzed using analysis of variance (ANOVA) repeated measures. Results: A total of 36 eyes from 22 patients were included in the study. The median age of the participants was 61 years [interquartile range (IQR) 53–71], with 59.1% (n = 13) being female. At baseline, 1, 2 weeks, 1, 3, 6 months, and 1 year after switching to DTB-FC, the mean IOP values were 20.3 (95% CI, 19.5–21.1), 15.3 (95% CI, 14.5–16.1), 15.5 (95% CI, 14.7–16.2), 15.5 (95% CI, 14.8–16.0), 15.5 (95% CI, 14.9–16.2), 15.5 (95% CI, 14.8–16.2) and 15.3 (95% CI, 14.7–15.9) mm Hg, respectively (p > 0.001). The mean IOP reduction after 1 year of treatment was −5.0 ± (4.2–5.8) mm Hg. Treatment success rates were 86.1, 80.6, 80.6, 77.8, 72.2, and 66.7%, respectively. When stratified by diagnosis, there were no statistically significant differences in the treatment success rates between POAG and CACG (p > 0.05). Conclusion: Therapy switching from DT-FC to DTB-FC was shown to be effective in reducing IOP of eyes with POAG or CACG during 6–12 months. Clinical significance: The DTB-FC therapy improved the therapeutic management of POAG or CACG previously treated with DT-FC therapy, which may be relevant to prevent its progression in the future.

Purpose: To assess (1) safety and efficacy of MicroPulse transscleral laser therapy (TLT) for primary open-angle glaucoma (POAG) and (2) the influence of prior incisional glaucoma surgery, lens status, and visual acuity on TLT outcomes. Setting: Institutional. Design: Retrospective cohort study. Materials and methods: Study population: Included were POAG patients aged 18–85 with TLT between 1st January 2020 and 15th July 2023; excluded were patients with secondary glaucomas, inflammatory disease, or pregnancy. Intervention: MicroPulse TLT was performed on one or both eyes with an Iridex Cyclo G6 Laser with settings: 31.3% duty cycle, 2,500 mW, 20 second/sweep/hemisphere, four to six sweeps. The revised MP3 probe was used. Outcome measures: Pre- and postop: intraocular pressure (IOP), best-corrected visual acuity (BCVA), glaucoma meds, subsequent procedures, cystoid macular edema (CME). Analysis: Kaplan–Meier (KM) survival statistics starting one month postop with dropout parameters: hypotony, subsequent glaucoma procedure, glaucoma medications >baseline, IOP >21 mm Hg, IOP reduction <20%, or loss of LP vision. Results: Thirty-three eyes were included. Mean KM survival (months) was: all eyes 8.4 ± 1.1; phakia 6.2 ± 0.8; pseudophakia 10.8 ± 2.4; aphakia 9.2 ± 1.8; prior tube shunt 10.2 ± 1.8; no filtration 6.8 ± 0.8. IOP and glaucoma medications remained at or below baseline at all postoperative timepoints. There were no significant changes in BCVA for patients with good baseline vision (>20/40), and no patients developed hypotony, persistent inflammation, or lost LP vision. Factors limiting success were time from the procedure and number of sweeps. Conclusion: Survival was better in pseudophakic eyes and after tube shunt surgery. Six sweeps resulted in higher success compared to four. There were no significant cases of postop CME. The procedure did not negatively impact vision in eyes with good baseline vision.

Aims and background: To evaluate the safety and efficacy of MicroPulse® transscleral laser therapy (MP-TLT) using the revised MicroPulse P3® (MP3) probe compared to the original probe. Materials and methods: A retrospective study of 122 consecutive eyes of 99 glaucoma patients who received MP-TLT with a minimum of 12 months follow-up. The primary outcome was success at 12 months, defined as final IOP <18 mm Hg and either IOP reduction of >20% or any medication reduction, without any adverse events or secondary surgical interventions (SSIs) within 12 months. Results: Ninety-five eyes in 75 patients were treated with the original probe, and 27 eyes of 24 patients were treated with the revised probe. The mean total energy and fluence used were 113.6 joules (J) and 54.3 J/cm² for the original probe, and 79.9 J and 140.1 J/cm² for the revised probe. Subjects were mostly white with primary open-angle glaucoma and a mean age of 70.3 years. Significantly more eyes with advanced glaucoma were treated with the revised probe compared to the original probe (p < 0.001). At baseline, mean IOP was 23.0 ± 7.5 on 2.94 ± 1.19 medications for the original probe compared to 22.6 ± 6.9 (p = 0.799) on 3.15 ± 1.32 medications (p = 0.429) for the revised probe. At 12 months, mean IOP was 17.9 ± 5.9 mm Hg (21.4% reduction) on 2.55 ± 1.40 medications (13.0% reduction) for the original probe compared to 14.8 ± 5.7 mm Hg (29.7% reduction, p = 0.063) on 3.07 ± 1.49 medications (2.2% reduction, p = 0.279) for the revised probe. Thirty-one of 95 eyes (32.6%) and 11 of 27 eyes (40.7%) treated with original and revised MP-TLT, respectively, achieved success at 12 months (p = 0.435). The rate of SSIs was 12% and similar between groups (p = 0.833). Significantly more eyes treated with the original probe underwent repeat MP-TLT within 12 months (44.2 vs 22.2%, p = 0.049). No adverse events occurred in either group. Conclusion and clinical significance: The revised probe for the MP3 device may result in an improved and longer-lasting IOP-lowering effect compared to the original probe, while maintaining an excellent safety profile.

Aims and background: The objective of this study is to determine the prevalence of female sexual dysfunction (FSD) in older adults with primary open-angle glaucoma (POAG) and its correlation with the severity of visual field (VF) defects. Additionally, potential associated factors with FSD were identified. Materials and methods: This cross-sectional study included a total of 210 female patients with POAG, aged between 40 and 80 years, from three tertiary centers in two states of Malaysia, conducted between September 2019 and 2020. FSD was assessed using the self-administered Bahasa Malaysia version of the Female Sexual Function Index-6 (MvFSFI-6), with scores of ≤19 indicating FSD. The severity of POAG was evaluated using the modified Advanced Glaucoma Intervention Study (AGIS) scoring system, predicated on two reliable consecutive VFs evaluated by two masked investigators, categorizing the condition as mild, moderate, or severe. Medical records were reviewed for POAG management and other systemic comorbidities. Sociodemographic data, including education and living status, were obtained from the participants. Results: The participants’ average age was 66.7 (7.9) years. The prevalence of FSD is 78.5%. MvFSFI-6 scores decreased with age (r = –0.88; p < 0.001) and revealed an exponential decline with increasing AGIS scores (r = –0.238, p = 0.010). Higher education was correlated with a 67% decreased possibility of experiencing FSD (OR = 0.33, 95% CI 0.12–0.88). Conclusion: FSD is common among female patients with POAG. Sexual well-being is a crucial factor for women with POAG, particularly those with severe VF defects and lower education levels. Ophthalmologists, gerontologists, and women's health experts need to address this issue to ensure a better quality of life (QoL) for older adults. Clinical significance: Sexual dysfunction (SD) among women with POAG increases with the severity of the disease, especially among those with lower education levels. To ensure a good QoL for these women, sexual function should be included in the comprehensive management of POAG.

Aim and background: To compare outcomes of glaucoma tube shunt surgery in patients aged 85 years and older to younger adults. Methods: Medical records were reviewed involving 207 consecutive tube shunt surgeries performed by one surgeon between 2013 and 2019. Baseline characteristics between group A (adults aged <85) and group B (aged ≥85) were compared. Changes from baseline to 12 months were compared between groups. Results: One-year follow-up was completed for 80 of 125 eyes (group A) and 49 of 82 eyes (group B). Intraocular pressure (IOP) and number of medications were statistically significantly reduced at 12 months, with no significant difference between groups (group A: 33.1 ± 11.2 → 13.8 ± 4.5 mm Hg, group B: IOP 33.6 ± 10.2 → 14.0 ± 4.3 mm Hg; p = 0.7168; group A: 3.2 ± 1.2 → 1.6 ± 1.3 meds, group B: 3.2 ± 1.1 → 1.8 ± 1.4 meds; p = 0.8404). Success rate was 109/128 (85.1%) overall, with no significant difference between groups (p = 0.2625). LogMAR visual acuity (VA) significantly worsened in group B only (group A: 0.68 ± 0.59 preop → 0.67 ± 0.58 postop; group B: 0.79 ± 0.60 preop → 0.98 ± 0.73 postop; p = 0.0006). More older patients lost ≥0.25 logMAR VA (group A: 11/80 = 14% vs group B: 17/49 = 35%; p = 0.0051). Conclusion: For advanced-age patients, tube shunt surgery provides good intraocular pressure control, with a higher, though acceptable, risk of loss of VA. Clinical significance: Tube shunts may be undertaken in patients of advanced age at high risk of vision loss from glaucoma.

Background: This article contains two cases with accompanying surgical videos, illustrating the use of a Tutoplast plug to create a watertight seal in the corneoscleral fistula formed after tube shunt removal. Case description: These cases demonstrate that Tutoplast can be cut into a strategic geometric shape to both plug the fistula formed at the tube entry site and reinforce adjacent areas of scleral thinning during tube removal or repositioning surgery. Specifically, a piece of dehydrated scleral Tutoplast was shaped into a small rectangle with an attached larger rectangle. The smaller rectangle or “head” would plug the fistula, while the attached larger rectangle or “body” could be used to reinforce the adjacent area of scleral thinning. The patch graft was sutured to the sclera at the four corners and resembled a turtle with four sutures for legs, with its head in the fistula. Hence, this technique is called the scleral “Turtle-Plast.” Conclusion and clinical significance: This “Turtle-Plast” technique is advantageous over direct suturing of the tube track because the head of the turtle provides an astigmatically neutral, watertight seal for the short anterior fistula, which can often be technically challenging to secure. Meanwhile, the body of the turtle can serve as a more substantive piece of patch graft to suture down to the underlying sclera that may be susceptible to thinning.

Aim and background: This study aims to evaluate the hypothesis that combining minimally invasive Kahook Dual Blade (KDB) surgery and modified deep sclerectomy enhances the efficacy of reducing postoperative intraocular pressure (IOP). Case description: Outcomes were studied in two open-angle glaucoma patients who underwent combined KDB surgery and modified deep sclerectomy procedures. Results: Postsurgical observations in both cases revealed extensive hyphema and flattening of the bleb within 1 month. The efficacy in reducing IOP did not surpass that of patients treated with simple trabeculotomy. Conclusion: The combination of modified deep sclerectomy with internal excisional trabeculotomy may lead to postoperative hypotension and massive anterior chamber bleeding, potentially compromising final outcomes. Therefore, this approach is not recommended. Clinical significance: These findings highlight the importance of carefully considering surgical approaches to optimize patient outcomes in glaucoma management.