New treatments for glaucoma.

Purpose Of Review: This review highlights new Federal Drug Administration (FDA) approved glaucoma treatments to familiarize providers with immediately available options.

Recent Findings: New FDA-approved treatments include the bimatoprost implant, travoprost implant, direct selective laser trabeculoplasty (DSLT), and ocular pressure adjusting pump. The bimatoprost implant is approved for a single administration with effects lasting for about 1 year, as opposed to the nearly 3-year effect for the travoprost implant.

Challenging the "Topical Medications-First" Approach to Glaucoma: A Treatment Paradigm in Evolution.

Topical glaucoma medications are effective and safe, but they have numerous well-documented limitations that diminish their long-term utility and sustainability. These limitations can include high rates of nonadherence (with associated glaucoma progression), concerning side effects, inconsistent circadian intraocular pressure (IOP) control, complex dosing regimens, difficulty with self-administration, costs, and decreased quality of life. Despite these limitations, topical medications traditionally have been first-line in the glaucoma treatment algorithm, as no other minimally invasive treatment alternatives existed.

Impact of Heads-Up Display Use on Ophthalmologist Productivity, Wellness, and Musculoskeletal Symptoms: A Survey Study.

Purpose: To explore how ophthalmologist productivity, wellness, and musculoskeletal (MSK) symptoms are affected by heads-up display (HUD) use.

Methods: A digital survey was emailed to the United States ophthalmologists. Questions covered topics including MSK health, surgical output, work hours, wellness hours, and factors related to HUD use.

Outcomes of Sutureless Ahmed Glaucoma Valve Surgery: A Retrospective Study.

Introduction: This study compared the safety and efficacy of sutureless Ahmed glaucoma valve surgery (AGV standalone) to sutureless AGV plus cataract surgery (AGV-CEIOL) in Black or Hispanic patients.

Methods: Records from Black or non-white Hispanic patients who received either AGV standalone or AGV-CEIOL from 2014 to 2019 at a Bronx, New York practice were reviewed. All surgeries were performed using a sutureless technique with Tisseel fibrin glue.

Factors associated with vision loss in Black or Hispanic patients 1 year after standalone or combined Ahmed glaucoma valve surgery.

Purpose: To determine factors associated with vision loss 1 year after Ahmed glaucoma valve (AGV) surgery in Black or Hispanic patients, who bear disproportionate glaucoma burdens yet have been underrepresented in pivotal trials.

Methods: This retrospective study included Black or Hispanic patients who received AGVs standalone or combined with phacoemulsification and/or cyclodestructive lasers. Univariate and multivariate generalized estimating equations evaluated the effects of baseline, surgical, and postoperative factors on vision loss of two Snellen lines or more at the 1-year follow-up visit.

First Real-World, Multicenter, Post-Marketing, Retrospective Study of Dexamethasone Intraocular Suspension for Inflammation After Cataract Surgery.

Purpose: To evaluate dexamethasone intraocular suspension 9% (intraocular DXM) in real-world clinical use to manage inflammation associated with cataract surgery.

Setting: Patients who underwent cataract surgery and received intraocular DXM at 22 outpatient eye surgery centers in the US.

Design: Retrospective, observational chart review.

Digital Survey Assessment of Factors Associated with Musculoskeletal Complaints Among US Ophthalmologists.

Purpose: To quantify features of musculoskeletal (MSK) complaints among US ophthalmologists and analyze factors related to symptom severity.

Methods: Cornea, glaucoma, retina, and comprehensive practitioners were invited to complete a web-based survey via email. Data on demographics, practice and procedural volumes, wellness activities, job stress, MSK health, the Total Disability Index (TDI), and ergonomics were collected.

Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement.

Purpose: To compare the safety and efficacy of two different techniques for implantation of the XEN Gel Stent, a minimally invasive surgical device for the treatment of refractory glaucoma.

Methods: A retrospective chart review of eyes that received ab interno or ab externo XEN Gel Stent placement from February 2017 to October 2019 was conducted. A single surgeon (NMR) performed all operations.

The association between corneal hysteresis and surgical outcomes from trabecular meshwork microinvasive glaucoma surgery.

Purpose: To assess whether an association exists between pretreatment corneal hysteresis (CH) and the magnitude of intraocular pressure (IOP) and medication burden reduction following microinvasive glaucoma surgery (MIGS).

Methods: Retrospective chart review of 84 eyes from 57 patients with CH measurements who underwent trabecular meshwork MIGS in a glaucoma practice in New York City with follow-up visits at 3-6 and 9-12 months. MIGS included canaloplasty, goniotomy, microbypass stents, or a combination thereof.

Improved Efficacy of Topical Latanoprost 0.005% Demonstrated by Corneal Biomechanical Correcting Modified Goldmann Prism.

Purpose: To evaluate intraocular pressure (IOP) reduction measured by a Goldmann applanation tonometer (GAT) prism and a modified surface Goldmann (CATS) prism with the institution of a topical prostaglandin analog (PGA) or alternatively a topical beta blocker.

Design: Prospective, open-label, randomized, controlled, and reference device comparison.

Methods: Thirty-six (36) treatment naïve glaucoma patients (72 eyes) were randomized equally to treatment with latanoprost 0.

Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery.

Minimally invasive glaucoma surgery (MIGS) has become a reliable standard of care for the treatment of glaucoma when combined with cataract surgery. This review describes the MIGS procedures currently combined with and without cataract surgery with a focus on visual outcomes based on the literature and the experience of the ASCRS Glaucoma Clinical Committee.

Surgical outcomes associated with a sutureless drainage valve implantation procedure in patients with refractory glaucoma.

Purpose: To evaluate the safety and efficacy profile of a sutureless procedure for drainage valve implantation with combined cataract removal and/or endoscopic cyclophotocoagulation (ECP).

Materials And Methods: A retrospective case series study of consecutive surgeries for Ahmed glaucoma valve (AGV; New World Medical) implantation in a 1-year period was analyzed. The surgery was performed using a Tisseel fibrin sealant (Baxter Healthcare Corporation) in place of sutures.

12-Month Outcomes of Goniotomy Performed Using the Kahook Dual Blade Combined with Cataract Surgery in Eyes with Medically Treated Glaucoma.

Introduction: To describe the 12-month efficacy and safety of goniotomy performed using the Kahook Dual Blade (KDB) in combination with cataract surgery in eyes with medically treated open-angle glaucoma (OAG).

Methods: This was a prospective, interventional case series conducted at seven centers in North America. Consecutive patients with medically treated OAG and visually significant cataract underwent phacoemulsification combined with goniotomy (PE + goniotomy) using KDB.

Goniotomy with a single-use dual blade: Short-term results.

Purpose: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a single-use dual blade (Kahook) in patients with mild to end-stage glaucoma.

Setting: International multicenter ophthalmic care centers.

Design: Prospective interventional case series.

Displacement of bag-placed hydrogel lenses into the vitreous following neodymium: YAG laser capsulotomy.

We report two cases in which hydrogel lens implants have dislocated posteriorly into the vitreous body following YAG laser capsulotomy. These lenses were placed in the bag in conjunction with a capsulorhexis. A comparison with our results using silicone and poly(methyl methacrylate) implants indicates that this phenomenon has occurred only with hydrogel implants.

New spatula to facilitate bimanual phacoemulsification.

In recent years bimanual phacoemulsification has become an increasingly popular method of cataract extraction. We describe a new spatula designed to manipulate and protect the posterior capsule safely during phacoemulsification. In addition, this spatula can be used to facilitate irrigation/aspiration.

Clinical endothelial cell loss following phacoemulsification and silicone or polymethylmethacrylate lens implantation.

This study is a comparison of endothelial cell loss seen by two surgeons using the same surgical technique (posterior chamber phacoemulsification) with posterior chamber implants of two different materials (silicone and polymethylmethacrylate [PMMA]). One hundred four silicone lenses were implanted following phacoemulsification and compared with 160 PMMA lenses implanted during the same period. A significant feature of these procedures was the incidence of endothelial cell loss of greater than 1,200 cells/mm2.

Initial clinical studies with silicone intraocular implants.

Initial clinical studies with 117 silicone implants are presented. Techniques of implantation including flat insertion, bar-style folder, and syringe-style inserter are discussed. Visual results were compared with results after polymethylmethacrylate (PMMA) lens implantation and were equal if not better.

Clinical experience with Nd:YAG laser vitreolysis in the anterior segment.

The clinical experience of two surgeons performing Nd:YAG laser anterior vitreolysis to disrupt vitreous strands adherent to surgical wounds with and without pupillary distortions and/or cystoid macular edema is presented. We describe our technique. The results indicate that vision improved in 50% of the cases, with visual acuity improving from 20/40 or better in three of 20 eyes preoperatively to 11 of 20 eyes postoperatively.