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Kiuchi Y, Inoue T, Shoji N, Nakamura M, Tanito M. The Japan Glaucoma Society guidelines for glaucoma 5th edition. Jpn J Ophthalmol 2023; 67:189-254. [PMID: 36780040 DOI: 10.1007/s10384-022-00970-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 02/14/2023]
Abstract
We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.
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Affiliation(s)
- Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-31 Kasumi, Minami-ku, Hiroshima, Japan.
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
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A pilot study for smartphone photography to assess bleb morphology and vasculature post-trabeculectomy. Int Ophthalmol 2020; 41:483-490. [PMID: 33051769 PMCID: PMC7553381 DOI: 10.1007/s10792-020-01598-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022]
Abstract
Purpose The current grading systems used for bleb morphology assessment in patients post-trabeculectomy are based on standardized slit-lamp photographs and anterior segment imaging devices. The lack of availability of these expensive and non-portable devices in resource-deficient settings is a significant deterrent in their widespread utilization for proper post-operative management. The rapidly evolving utilization of smartphone photography has significantly benefited diagnostics of posterior segment disorders and is now being increasingly utilized for monitoring anterior segment pathologies as well as post-surgical course. In this study, we study a novel use of smartphones for bleb photography for assessing the morphological characteristics as vascularity and microcysts. Methods In this pilot, observational study, we compared the trabeculectomy bleb images of five subjects, obtained by iPhone X (dual lens) and iPhone 6S (single lens). We captured two image sets with both smartphones first with a focussed torchlight and then with a built-in flash video light. Results The images resulting from the newer iPhone X were substantially superior than those from iPhone 6S. For the 12-megapixel dual-camera set-up on the iPhone X, the 1 × lens resulted in better images than the 2 × lens with contrast and overall clarity of the area of interest. While the macro-lens attachment had promising results at 1 × zoom, there is no added advantage of the macro-lens attachment as it resulted in considerable loss of image quality at twice the zoom. Using a 20 D lens helped attain higher magnification and better framing as it reduced the focussing distance needed to get sharp images. The images obtained from both smartphones were of higher quality when illuminated from an external source when compared to the native iPhone flash due to even exposure and fewer autofocus artefacts. Conclusion Analyses of all image sets showed that the current generation in-built camera app on IOS and newer iPhone camera optics resulted in high-quality images of the ocular surface with high magnification without any loss in clarity. Electronic supplementary material The online version of this article (10.1007/s10792-020-01598-9) contains supplementary material, which is available to authorized users.
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Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. West Indies Glaucoma Laser Study (WIGLS): 1. 12-Month Efficacy of Selective Laser Trabeculoplasty in Afro-Caribbeans With Glaucoma. Am J Ophthalmol 2017; 184:28-33. [PMID: 28962966 DOI: 10.1016/j.ajo.2017.09.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To characterize the 12-month intraocular pressure (IOP)-lowering efficacy of selective laser trabeculoplasty (SLT) as sole therapy for primary open-angle glaucoma (POAG) in an Afro-Caribbean population. DESIGN Stepped-wedge trial. METHODS Subjects in St. Lucia and Dominica with established POAG were randomized to prompt washout of IOP-lowering medications followed by SLT, 3-month delay followed by washout and SLT, or 6-month delay followed by washout and SLT. Baseline IOP was obtained on 2 different days after washout. Bilateral 360-degree SLT was performed in 1 session. Posttreatment assessments took place 1 hour, 1 week, and 3, 6, 9, and 12 months post-SLT. The main outcome measure was SLT success (defined as IOP ≤ target IOP in both eyes) at 12 months. Target IOP was a 20% or greater reduction in IOP from postwashout baseline. RESULTS Overall, 72 patients underwent SLT treatment. Mean IOP at enrollment was 15.4 ± 3.6 mm Hg in right eyes and 15.4 ± 3.6 mm Hg in left eyes, which rose to 21.0 ± 3.3 mm Hg and 20.9 ± 3.0 mm Hg, respectively, after washout. Mean IOP at 3, 6, 9, and 12 months ranged from 12.5 mm Hg to 14.5 mm Hg (29.7% to 39.5%; P < .0001 in each eye at each time point). The 12-month success rate was 78%. Transient photophobia and discomfort were common. CONCLUSIONS SLT monotherapy safely provides significant IOP reduction in Afro-Caribbean eyes with POAG. This treatment can play a significant role in preventing glaucoma vision loss and blindness in people of African descent living in resource-limited regions.
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Affiliation(s)
- Tony Realini
- West Virginia University Eye Institute, Morgantown, West Virginia.
| | | | - Darra Burt
- Saint Lucia Blind Welfare Association, Castries, Saint Lucia
| | - Goundappa K Balasubramani
- Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Yang K, Jin L, Li L, Zeng S, Dan A, Chen T, Wang X, Li G, Congdon N. Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China. Br J Ophthalmol 2016; 101:131-137. [PMID: 27073204 DOI: 10.1136/bjophthalmol-2015-308331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/05/2016] [Accepted: 03/19/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there. METHODS Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points). RESULTS Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (≤6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up. CONCLUSIONS Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up.
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Affiliation(s)
- Ke Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Siming Zeng
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Aihua Dan
- Red Cross Hospital of Yunnan Province, Kunming, China
| | - Tingting Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiuqin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Guirong Li
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,ORBIS International, New York, USA.,Queen's University Belfast, Belfast, UK
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Khandelwal RR, Raje D, Rathi A, Agashe A, Majumdar M, Khandelwal R. Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction. Eye (Lond) 2014; 29:363-70. [PMID: 25502867 DOI: 10.1038/eye.2014.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 09/30/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the efficacy of safe surgery system trabeculectomy combined with manual small incision cataract surgery/phacoemulsification in primary glaucoma coexistent with cataract. METHODS This is a retrospective analysis of 105 cases who underwent single-site combined surgery between January 2008 and December 2009. Safe surgery system trabeculectomy with diffuse and posterior application of mitomycin C was performed in all cases. Cataract extraction was done either by Manual Small Incision Cataract Surgery (MSICS) or phacoemulsification. Main outcome measures were success rate of trabeculectomy, as determined by four different IOP goals and incidence of postoperative complications. Analysis was performed using R-2.15, and the significance was tested at 5% level. RESULTS The minimum follow-up period was 12 months. The overall success rates (with or without medication) when safe surgery system trabeculectomy was combined with MSICS were 91, 70, and 51% for IOP ≤18, ≤15, and ≤12 mm Hg, respectively, and target IOP was achieved in 72% cases. The mean IOP reduction was 43.8% with MSICS and 42.08% with phacoemulsification. The surgical outcome was not significantly different for both techniques. Postoperative complications were infrequent and comparable. CONCLUSION The Safe Surgery System Trabeculectomy combined with cataract surgery offers excellent IOP control with minimal postoperative complications. It offers an effective and improved solution for primary glaucoma coexistent with cataract found in developing countries.
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Affiliation(s)
- R R Khandelwal
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - D Raje
- MDS Bioanalytics, Nagpur, India
| | - A Rathi
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - A Agashe
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - M Majumdar
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - R Khandelwal
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
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Evaluation of an injectable thermosensitive hydrogel as drug delivery implant for ocular glaucoma surgery. PLoS One 2014; 9:e100632. [PMID: 24950176 PMCID: PMC4065085 DOI: 10.1371/journal.pone.0100632] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/28/2014] [Indexed: 11/20/2022] Open
Abstract
In this study, a biodegradable thermo-sensitive hydrogel from poly(trimethylene carbonate)15-F127-poly(trimethylene carbonate)15 (PTMC15-F127-PTMC15) was designed and evaluated as an injectable implant during ocular glaucoma filtration surgery in vivo and in vitro. Mitomycin C (MMC) was loaded into this hydrogel for controlled released to prolong the efficacy and to reduce the long-term toxicity. The properties of the hydrogel were confirmed using 1H NMR and gel permeation chromatography (GPC). Compared to the Pluronic F127 hydrogel, the PTMC15-F127-PTMC15 hydrogel showed a good solution-gel transition temperature at 37°C, a lower work concentration of 5% w/v and a longer mass loss time of more than 2 weeks. The in vitro study showed that the drug could be released from PTMC15-F127-PTMC15 (5% w/v) hydrogel for up to 16 days with only 57% of drug released in the first day. Moreover, the cell toxicity, which was tested via LDH and ANNEXIN V/PI, decreased within 72 h in human tenon's fibroblast cells (HTFs). The in vivo behavior in a rabbit glaucoma filtration surgery model indicated that this hydrogel loaded with 0.1 mg/ml MMC led to a better functional bleb with a prolonged mean bleb survival time (25.5±2.9 days). The scar tissue formation, new collagen deposition and myofibroblast generation appeared to be reduced upon histological and immunohistochemistry examinations, with no obvious side effects and inflammatory reactions. The in vitro and in vivo results demonstrated that this novel hydrogel is a safe and effective drug delivery candidate in ocular glaucoma surgery.
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Kim C, Radcliffe NM. One Year of Glaucoma Research in Review: 2011 to 2012. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:364-73. [PMID: 26107730 DOI: 10.1097/apo.0b013e3182747e4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To provide the practicing clinical ophthalmologist with an update of pertinent glaucoma literature published over the past 12 months. METHODS The authors conducted a one year (July 1, 2011 to June 30, 2012) English language glaucoma literature search on Pubmed using the following terms: automated perimetry, optic nerve imaging, optical coherence tomography, glaucoma structure and function, intraocular pressure, central corneal thickness, medical therapy and compliance in glaucoma, glaucoma laser treatment, cataract extraction and intraocular pressure, secondary glaucoma, glaucoma surgery, pediatric glaucoma, molecular biology in glaucoma, and miscellaneous topics in glaucoma. DESIGN Literature review. RESULTS This review includes original and review articles that reflect novel aspects and updates in the field of glaucoma, while excluding letters to the editor, unpublished works, and abstracts. CONCLUSIONS This review is not meant to be all-inclusive-rather, it highlights literature that is most applicable to ophthalmologists in practice.
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Affiliation(s)
- Charles Kim
- From the Department of Ophthalmology, Weill Cornell Medical College, New York, NY
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