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Challenges and Opportunities in Glaucoma

Challenges and Opportunities in Glaucoma

Oladosu, T. O., & Awoseemo, A. B. (2023)


Glaucoma, the silent thief of sight remains a beglaring eye condition leading to optic nerve damage due to elevated pressure within the eye. It is one of the major irreversible blinding eye conditions in the world, perhaps devastating as it is mostly without symptoms till considerable vision is lost. This comprehensive article acclaim the silentious nature of this ailment; highlights the distinctive features of glaucoma among other eye disorders; provides practical measures to optimize one’s eye health; shares experiences and feedbacks from people with glaucoma; and identifies promising prospects of glaucoma diagnosis and management. The information therein aims to create awareness about the course and scourge of glaucoma to readers, as well as call the attention of the eye health practitioners to the perceived challenges encountered by patients with glaucoma with the aim of improving consumer’s outcome and quality of life.

Sharma, B., Khan, H., Sinha, A., Chakrabarti, M., & Sharma, T. (2024)


Aims: To compare the safety and efficacy of phacoemulsification combined with two individual kinds of trabecular bypass micro-stent device insertion. This study compares Phacoemulsification with Hydrus stent versus phacoemulsification combined with I-Stent inject W in patients with medically uncontrolled primary open-angle glaucoma (POAG).

Material and Methods: A retrospective comparative case series.

Results: Eighty eyes of 75 patients with 2 years completed follow-up after combined phacoemulsification with trabecular by-pass stent (s) were included. Forty eyes of 37 patients had Hydrus stent (Hydrus Group-PH) and the other 40 eyes of 38 patients had I-stent inject W (I-stent Group-Pi) insertion combined with phacoemulsification and intraocular lens implantation. Patient demographics and preoperative characteristics of the two groups studied are comparable. A post-operative decrease of 20 percentage or more in the IOP was achieved in 33 eyes (82.5%) in PH group and 30 eyes (75%) in Pi group (p=0.57). The Hydrus group (PH) had a post-operative reduction in the mean number of medications in 22 eyes (55%) in comparison to 18 eyes (45%) in the I-stent group (Pi). Second stage trabeculectomy was avoided in 31 eyes (77.5%) in the Hydrus group and 27 eyes (67.5%). There was no significant difference in rate of complications between two groups.

Conclusion: Both Hydrus stent and I-stent inject W combined with phacoemulsification and intra-ocular lens implantation, are efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). The reduction in the mean IOP and in the mean number of post-operative glaucoma medications was higher for the patients in Hydrus stent group than in I-stent inject W group.

Jiao, Y., & Gale, J. (2023)


Optic disc drusen (ODD) are acellular calcified deposits within the optic nerve head. They arise early in life, usually remain asymptomatic with a benign prognosis, and they are most often clinically relevant as they can be mistaken for papilloedema, can result in asymptomatic optic nerve thinning resembling glaucoma, or can have complications such as anterior ischaemic optic neuropathy with sudden loss of vision. There is still a lot of uncertainty about the pathogenesis of ODD, and prognostic factors for vision loss in the long term. The strongest association of ODD is with pseudoxanthoma elasticum, a condition of systemic ectopic calcification. Understanding the shared biochemical pathways underlying pseudoxanthoma elasticum and other conditions with the same phenotype, highlights pyrophosphate as an important factor in ectopic calcification and a potential therapy.

Paulson, C., Barker, D., Pompoco, C., Sh, T., Conley, M. P., Patil, A., Amakiri, N., Stagg, B. C., Ritch, R., Kang, J. S., Wiggs, J. L., Curtin, K., & Wirostko, B. (2022)


Background: Prior data suggest an association between non-melanoma skin cancer, i.e., basal and squamous cell cancers most often located in areas of sun exposure, and pseudoexfoliation syndrome. This study aimed to evaluate the association between these conditions and UV exposure through a detailed questionnaire in a large and robust Utah population.

Methods: The two arms of this study are a population-based study (evaluated via chart review) and a UV exposure study (evaluated via a questionnaire). Participants answered a questionnaire designed to assess lifelong UV exposure, including leisure and occupational sun exposure, likelihood to tan or burn in early life, eye and hair color, smoking behavior, vitamin D deficiency, skin cancer history, alcohol consumption, and caffeine intake.

Conclusion: Descriptive findings suggest UV exposure over an adult’s lifespan may associate with a higher risk of non-melanoma skin cancer in Utah exfoliation patients vs. unaffected individuals. Patients with exfoliation glaucoma reside at higher elevations than non-glaucoma patients.

Murdoch, M., & Mathew, M. (2023)


Aims: To report success proportions in functional trabeculectomised eyes undergoing phaco-emulsifcation with a novel curvilinear capsulorhexis method.

Methods: An observational series. Seventy two eyes of 72 patients were identified who underwent cataract surgery in eyes with functional prior trabeculectomy surgery using a Leweke cannula (cases). A previously reported group of 53 eyes in 53 patient who had routine cataract surgery (not using this technique) post-trabeculectomy surgery was used to compare outcomes (controls).

Main outcome measure: The primary outcome measure was intraocular pressure (IOP) success (IOP ≤21, ≤18, ≤15 mmHg) at 5 years post cataract surgery. Complete success was no new medication or surgical intervention for IOP and partial success was additional medical therapy required to achieve the IOP target.

Results: At final follow-up, the overall failure proportion of the combined groups for an IOP ≤21mmHg was 20% (24/125) at final review. Thirty percent who were a partial success prior to cataract surgery, failed in both controls and cases at final follow-up. Of those who were a complete success prior to phaco-emulsification; 33% were partial successes and 30% failed in the control group; 50% were partial successes and 10% failed in the case group, at final follow-up.

Logistic regression for an outcome of failure showed the Leweke cannula to be protective OR 0.28 (95% CI 0.09 to 0.85, p=0.03). African/Caribbean ethnicity was a risk factor for failure.

Conclusions: Our results suggest that cataract surgery may affect trabeculectomy outcomes, but not as profoundly as is currently perceived. Using the Leweke technique seems to result in earlier medication recommencement, but a strong reduction in the need for further surgical intervention in fully functional trabeculectomies.