Interventional Glaucoma

After decades of slow, but steady, progress in the advancement of glaucoma as a subspecialty, the last quarter century has seen tremendous innovation in this field.

The 2017 Charles D. Kelman Lecture touched on three main areas-from the teaching of the phaco technique during the early years of phaco to use of phaco in glaucoma patients to the introduction of phaco to surgeons in developing countries.

Persistent bleeding in a glaucoma patient with neovascular glaucoma after metastatic renal carcinoma requires a range of surgical methods to treat.

Optical coherence tomography angiography (OCTA) is a new imaging technique that has the potential to move rapidly into routine clinical practice. OCTA comprises different OCT-based technologies, which enable the non-invasive assessment of retinal perfusion, based on red blood cell movement in the optic nerve head, the peripapillary and the macular retina.

As another year comes to an end, five members of Ophthalmology Times Europe’s Editorial Advisory Board reflect and share their perspectives on the exciting opportunities that lie ahead for ophthalmologists in 2018, whilst also considering the potential challenges.

Micropulse transscleral cyclophotocoagulation utilises a different delivery modality than its predecessor, continuous-wave laser cycloablation, to produce a biological reaction without the lethal effects caused by thermal buildup.

A prospective, observational study found that eyes with mild POAG could be differentiated from pre-perimetric glaucomatous eyes, which also could be differentiated from normal eyes using OCTA-derived retinal vessel density measurements.

A phase III trial for the fixed-combination netarsudil/latanoprost agent (Roclatan, Aerie Pharmaceuticals)reports positive results. The company plans to submit a NDA for the drug in early 2018.

High-intensity focused ultrasound cyclocoagulation is safe and effective in most refractory glaucomatous eyes. Complete success was achieved in 80% (24/30) of treated eyes that had undergone the maximum of three procedures.

A pioneering dye-based technique that enables aqueous humour outflow to be studied has the potential to improve glaucoma angle-based procedures and surgery outcomes.

An implantable glaucoma sensor has received CE mark approval for marketing in the European Union. The sensor (Eyemate, Implandata Ophthalmic Products) can provide frequent IOP readings, informing patients and their physicians about how the pressure changes by time of day and from one day to another.

Innovations in sustained-drug delivery and neuroprotection are bringing glaucoma specialists one step closer to additional therapeutic options.

A new imaging technique can show the deaths of individual cells in people with glaucoma by labelling the cells with fluorescent dye, according to researchers. The approach might eventually be used to diagnosis the disease in its early stages or measure its progression.

Prostaglandin-based topical therapy has been the ‘go-to treatment’ for open-angle glaucoma for decades. In contrast, laser trabeculoplasty has conventionally remained reserved for patients unresponsive or unable to adhere to medication-based therapy.

For 20 years I have effectively employed endoscopic cyclophotocoagulation (ECP) as a primary or secondary line of glaucoma treatment. ECP is a minimally invasive glaucoma surgical (MIGS) option capable of reducing IOP in the majority of patients and can potentially eliminate the need for drainage surgery, including trabeculectomy (trab) and glaucoma drainage devices (GDDs).

The loss of autoantibodies may serve as useful biomarkers for glaucoma, according to Nadine von Thun Und Hohenstein-Blaul, Johannes Gutenberg University Mainz, Mainz, Germany, and colleagues.

Despite the legalization of marijuana by several state governments, physicians should not recommend smoking it as a treatment for glaucoma, said Sunita Radhakrishnan, MD. “It has been approved by public opinion rather than regulatory process,” said Sunita Radhakrishnan, MD. 

The finding raises questions about whether the supplements could play a role in glaucoma, wrote H. Esfandiari of the University of Medical Sciences in Tehran, Iran and colleagues in the journal Eye.

An analysis of U.S. claims data reveals a substantial proportion of patients (17%) remained untreated 4 years after their initial diagnosis of open-angle glaucoma.

Work is progressing on contact lenses that can monitor biomarkers in tear film for intraocular pressure, diabetes mellitus, and other health conditions.

Clinicians can predict which patients with ocular hypertension are most likely to develop primary open-angle glaucoma (POAG) using short-wave automated perimetry, scanning laser polimetry, and confocal laser ophthalmoscopy, as well as the patient’s age, researchers said.

Although the diagnosis of primary congenital or early developmental glaucoma is often straightforward, similar phenotypic features can occur in other paediatric conditions, which are consequently sometimes mistaken for early childhood glaucoma. Ophthalmologists who care for children with glaucoma must keep such potential mimics in mind.

Despite predictions that the prevalence of APACG, a leading cause of blindness, is set to rise worldwide, some authors have reported a decline in certain countries.