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PURPOSE: To investigate the risk factors related to decrease in vessel density (VD) observed in primary open-angle glaucoma (POAG), due to acute increase in intraocular pressure (IOP) by an ophthalmodynamometer (OPD). METHODS: This cross-sectional study involved 42 eyes of participants (22 Controls and 20 POAG patients) that underwent optical coherence tomography angiography (OCT-A) to assess VD in the peripapillary region in three examination sets: primary gaze position (1), 25-degree adduction (2) and 25-degree adduction with OPD compression (3). Individual relationships between IOP levels and changes in the superficial complex VD were evaluated after image processing and exclusion of large retinal vessels. Multivariable regression analysis was used to verify factors associated with differences in VD induced by IOP elevation. RESULTS: A significant increase in IOP was induced by OPD compression during adduction (mean ± SD, Control: + 13.8 ± 2.8; POAG: + 13.4 ± 2.1 mmHg). Only during IOP elevation (set 3), a significant VD decrease was observed both in POAG eyes (p = 0.008) and controls (p = 0.022). Baseline IOP (p = 0.022), maximum IOP (p = 0.003), and scleral rigidity (p = 0.029) were significantly associated with VD decreases in eyes with POAG. No changes were observed in VD during adduction gaze exclusively. CONCLUSION: Acute IOP elevation induced with OPD, but not adduction gaze, decreased peripapillary VD measured with OCT-A imaging. IOP levels and scleral rigidity significantly affected VD reduction in POAG patients. Thus, high scleral rigidity may decrease the ability of the globe to dampen the well-known effects of IOP fluctuation on glaucoma onset and progression. KEY MESSAGES: What is known Decrease vascular density in the peripapillary retina was associated with POAG, but factors related to the vascular response to elevated IOP are unexplored. What is new OCT-A quantification shows decreases in vascular density of the superficial layers of the peripapillary retina during an acute elevation in IOP. High IOP levels and scleral rigidity significantly affected vascular density reduction in POAG patients.

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PURPOSE: To evaluate the accuracy of a positive self-reported glaucoma family history. MATERIAL AND METHODS: Cross-sectional study. Each subject was asked if they had a first-degree relative diagnosed with glaucoma. If their answer was affirmative, the relative was invited to attend on ophthalmic evaluation and underwent complementary exams to confirm or exclude the glaucoma diagnosis. Only one relative was included per subject. RESULTS: We included 204 subjects in the study (102 subjects and their respective relatives). The accuracy of family history of glaucoma was 76.96% of the cases. In the univariable analysis, subjects with college degree had 2.34 [(P = 0.010; 95% confidence interval (CI) 1.18-4.63)], with higher family income 3.72 (P = 0.003; 95% CI 1.57-8.85) and those with health insurance 3.42 (P = 0.001; 95% CI 1.67-6.98) more chances to have a true positive family history for glaucoma. In the multivariable logistic regression analysis, none of the variables presented significant association. CONCLUSION: Around 24% of patients may not provide reliable information about family history for glaucoma. When asking about a glaucoma family history, clinicians should consider the real accuracy of this self-reported data.

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AIM: There have been a number of clinical trials in glaucoma research published in the past two decades. Most of these trials were designed to evaluate very specific issues in selected populations placing them in the explanatory end of the pragmatic-explanatory continuum. The purpose of this study was to assess the level of pragmatism of published randomized controlled trials in glaucoma. METHODS: A PubMed search using 'glaucoma' from 1995 to 2022 and randomized controlled trial (RCT) article type was done. Each study was assessed by three independent examiners using the Pragmatic-Explanatory Continuum Indicator Summary version 2 (PRECIS-2) toolkit. Scores were calculated for each study to determine the level of pragmatism. A summed score ≥36 was indicative of a very pragmatic study. RESULTS: Thirty-two different articles were included in the analysis. These papers represented 13 different landmark trials. The median PRECIS-2 score was 32 (range, 25 for the Early Manifest Glaucoma Trial (EMGT) to 34 to the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Ocular Hypertension Treatment Study). The Treatment of Advanced Glaucoma Study (TAGS), was considered very pragmatic and scored 33 points. CONCLUSION: Despite the number of RCTs in glaucoma, there is still a need for more pragmatic studies.

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Aim: Globally, one of the leading causes of preventable blindness is primary open-angle glaucoma (POAG). The study assessed the clinical presentations of POAG patients attending an eye center in Abuja, Nigeria. Materials and methods: Records of 188 eyes, collected from 94 patients diagnosed with POAG for a period of 1 year at the eye center, were reviewed. Clinical records, including age, gender, visual acuity (VA), central cornea thickness (CCT), intraocular pressure (IOP), cup-to-disk ratios, and retinal nerve fiber layer (RNFL) thickness of the participants, were extracted and analyzed. Results: The majority of the participants were males (56.4%) and adults (57.4%), most of whom had normal VA (>70% in each eye). Our analysis revealed normal average estimates of RNFL thickness, IOP, and CCT among the participants. Females had thicker RNFL compared to males (p = 0.02). Although CCT decreased with age (r = -0.28, p = 0.005), there was no such link between IOP and CCT (r = 0.09, p = 0.38). Conclusion: Central cornea thickness (CCT), RNFL thickness, and IOP in isolation should not be used as early indicators for POAG; rather, a combination of these and other indices is recommended. Early detection through active screening and treatment in the community for at-risk groups is highly advised. How to cite this article: Ezinne NE, Kwarteng MA, Ekemiri KK, et al. Clinical Profile of Primary Open-angle Glaucoma Patients at an Eye Center in Nigeria. J Curr Glaucoma Pract 2023;17(3):113-117.

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Introducción: El glaucoma es la principal causa de ceguera irreversible en el mundo. La prevalencia mundial de glaucoma en personas de 40 a 80 años se estima en un 3,5 %. Objetivo: Comparar el efecto reductor de la PIO de Latanoprostene bunod (LBN) al 0,024% con Latanoprost al 0,005 % en sujetos con glaucoma de ángulo abierto (GAA) o hipertensión ocular (HTO). Metodología: Ensayo observacional de estudio de cohorte prospectivo. Resultados: Fue realizado en 28 pacientes (56 ojos) quienes fueron aleatorizados en 2 grupos paralelos (28 ojos por grupo), el grupo Latanoprost y el grupo LBN. En el grupo LBN la media de la PIO antes del tratamiento fue de 25,3 ± 6,6 mmHg y la media de la PIO luego de 1 mes de tratamiento fue de 16,5 ± 4,9 mmHg (p<0,05). En el grupo Latanoprost la media de la PIO antes del tratamiento fue de 23,6 ± 3,6 mmHg y la media de la PIO luego de 1 mes de tratamiento con Latanoprost al 0,005% fue de 15,3 ± 2,4 mmHg (p<0,05). Sin embargo, al comparar las PIOs luego de 1 mes de tratamiento con LBN 0,024% y Latanoprost 0,005% se objetiva que la diferencia en reducción de la presión intraocular entre estos dos fármacos no fue significativa (p= 0,238). Discusión: Las prostaglandinas tópicas, con su potente efecto hipotensor ocular son una importante opción de tratamiento para el glaucoma. La reducción de la PIO es la esperada con ambos medicamentos, sin embargo, no existen diferencias significativas entre ambas luego de 1 mes de uso. Con respecto a los efectos secundarios, en el grupo LBN se encontró más efectos adversos oculares.

Introduction: Glaucoma is the main cause of irreversible blindness worldwide. The global prevalence of glaucoma in people aged 40 to 80 years is estimated at 3.5%. Objective: To compare the intraocular pressure (IOP) lowering effect of 0.024% Latanoprostene bunod (LBN) with 0.005% Latanoprost in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). Methods: Observational trial of prospective cohort study. Results: It was performed in 28 patients (56 eyes) who were randomized into 2 parallel groups (28 eyes per group), the Latanoprost group and the Latanoprostene bunod (LBN) group. In the LBN group, the mean intraocular pressure before treatment was 25.3 ± 6.6 mmHg and the mean intraocular pressure after 1 month of treatment was 16.5 ± 4.9 mmHg (p<0,05). In the Latanoprost group, the mean intraocular pressure before treatment was 23.6 ± 3.6 mmHg and the mean intraocular pressure after 1 month of treatment with 0.005% Latanoprost was 15.3 ± 2.4 mmHg (p<0,05). However, when comparing the IOPs to the 1-month treatment with Latanoprostene bunod 0.024% and Latanoprost 0.005%, it is observed, through ANOVA, that the difference in intraocular pressure reduction between these two drugs is not significant (p= 0,238). Discussion: Topical prostaglandins, with their potent ocular hypotensive effect (resulting from increased uveoscleral outflow), are an important treatment option for glaucoma. The IOP reduction is as expected with both drugs, however, there are no significant differences between the two. In the LBN group, more drug-related ocular adverse effects were found after 1 month of use.

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BACKGROUND: Primary open-angle glaucoma (POAG), the world's main cause of irreversible blindness, is an asymptomatic and neurodegenerative disease of multifactorial etiology with ethnic and geographic disparities. Multiethnic genome-wide association studies (GWAS) identified single nucleotide variants (SNVs) in ATXN2, FOXC1, and TXNRD2 loci as risk factors for POAG pathophysiology and/or endophenotypes. The aim of this case-control study was to investigate the association of the variants rs7137828 (ATXN2), rs2745572 (FOXC1), and rs35934224 (TXNRD2), as risk factors for POAG development, additionally to rs7137828 association with glaucoma clinical parameters in a Brazilian cohort from the Southeast and South regions. METHODS: This investigation comprised 506 cases and 501 controls. Variants rs2745572 and rs35934224 were genotyped through TaqMan® assays and validated by Sanger sequencing. Variant rs7137828 was genotyped exclusively by Sanger sequencing. RESULTS: The primary research outcome revealed that the variant rs7137828 (ATXN2) was associated with an increased risk for the development of POAG in the presence of the TT genotype compared to the CC genotype (p = 0.006; Odds Ratio [OR] = 1.717; Confidence Interval [CI] 95% = 1.169-2.535). There was no significant association of rs2745572 and rs35934224 genotypes with POAG. The CT genotype of the rs7137828 was associated with the vertical cup-to-disk ratio (VCDR) (p = .023) but not with the age at diagnosis or the mean deviation. CONCLUSION: Our data indicate the rs7137828 associated with increased risk for the development of POAG and VCDR in a Brazilian cohort. If validated in additional populations, these findings may enable the development of relevant strategies for early diagnosis of glaucoma in the future.

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Objetivo: Evaluar la seguridad de facoemulsificación asociada a la trabeculectomía gonioasistida modificada con tijeras. Métodos: Estudio experimental de intervención en 103 ojos (103 pacientes) con glaucoma primario de ángulo abierto. Se realizó facoemulsificación y trabeculectomía gonioasistida modificada con tijeras (51 ojos, casos) y facoemulsificación- trabeculectomía estándar (52 ojos, controles). En los casos se requirió tijera y pinza vítreo-retinal y se resecó trabéculo por abordaje interno. Se evaluó la agudeza visual, el astigmatismo inducido, la pérdida de células endoteliales y la aparición de complicaciones quirúrgicas en ambos grupos a los tres meses de seguimiento posoperatorio. Resultados: La AVSC se incrementó en ambos grupos a los tres meses postoperatorios. Sin embargo, fue mayor para la FACO-TGAM (0,81 ± 0,16vs. 0,71 ± 0,16), con diferencias significativas (p= 0,002). El astigmatismo inducido fue significativamente mayor en el grupo control (0,53 ± 1,14Dvs.1,8 ± 1,20D (p< 0.001). Las complicaciones quirúrgicas posoperatorias fueron más frecuentes en el grupo control (57 por ciento vs. 73 por ciento p= 0,14). La pérdida de células endoteliales no mostró diferencias significativas (p= 0,82). Conclusiones: La recuperación visual y el menor número de complicaciones ubican la facoemulsificación y trabeculectomía gonioasistida modificada con tijeras como técnica de elección para el tratamiento de pacientes con catarata y el glaucoma primario de ángulo abierto(AU)

Objective: To evaluate the safety of phacoemulsification associated with modified gonio-assisted trabeculectomy with scissors. Methods: Experimental intervention study in 103 eyes (103 patients) with primary open-angle glaucoma. Phacoemulsification and modified gonioassisted trabeculectomy with scissors (51 eyes, cases) and standard phacoemulsification-trabeculectomy (52 eyes, controls) were performed. In the cases, scissors and vitreoretinal forceps were required and trabeculum was resected by internal approach. Visual acuity, induced astigmatism, loss of endothelial cells and the appearance of surgical complications were evaluated in both groups at three months postoperative follow-up. Results: The uncorrected visual acuity increased at three postoperative months in both groups, however it was higher for the PHACO-TGAM (0.81 ± 0.16 vs 0.71 ± 0.16); with significant differences (p = 0.002). Induced astigmatism was significantly higher in the control group (0.53 ± 1.14 D vs. 1.8 ± 1.20 D, (p < 0.001). Postoperative surgical complications were more frequent in the control group (57 percent vs 73 pèrcent, p = 0.14), the endothelial cell loss did not show significant differences (p = 0.82). Conclusions: the visual recovery and the lower number of complications place phacoemulsification and modified gonio-assisted trabeculectomy with scissors as the technique of choice for the treatment of patients with cataract and primary open-angle glaucoma(AU)

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PURPOSE: To investigate peripheral microvascular abnormalities associated with patients with open-angle glaucoma (OAG). DESIGN: This was a cross-sectional study. PARTICIPANTS: Patients with OAG and controls. METHODS: All subjects underwent detailed ophthalmic evaluation, including Humphrey visual field (HVF) tests and swept source OCT. To evaluate peripheral microvascular abnormalities, nailfold capillaroscopy (NFC) and laser Doppler imaging (LDI) were performed. The presence of microhemorrhages, tortuous capillaries, dilated capillaries, avascular areas, and the capillary density, among other characteristics, were recorded using NFC; fingertip blood flow (FBF) was measured using LDI at different time points, before and 1, 10, and 20 minutes after exposure to a cold stimulus. In addition, venous blood samples were collected to measure serum endothelin-1 (ET-1) concentrations as well as serum autoantibodies. MAIN OUTCOME MEASURES: Presence of microhemorrhages, tortuous capillaries, and dilated capillaries; FBF; ET-1; and autoantibodies. RESULTS: Sixty-eight subjects (43 patients with OAG and 25 controls) were enrolled in the study. Microhemorrhages were found in the nail bed of 65.1% of the patients with OAG compared with 25.0% of the controls (P = 0.003). There was a significant difference in the mean FBF at the baseline in patients with OAG versus controls (293.6 ± 100.2 vs 388.8 ± 52.0 perfusion units, respectively, P < 0.001), together with a significant decrease in the mean FBF 10 and 20 minutes after cold stimulus in patients with OAG in comparison to controls (P < 0.001 for all comparisons). There was a positive correlation between mean baseline FBF and HVF mean deviation (r = 0.27, P = 0.03) and between mean baseline FBF and average retinal nerve fiber layer thickness (r = 0.44, P = 0.001). Neither the analysis of ET-1 concentrations (P= 0.71) nor the autoantibodies measurements (P > 0.05, for all) showed any difference between the 2 groups. CONCLUSIONS: Significant peripheral microvascular abnormalities were found in patients with OAG compared to controls, suggesting that microvascular changes might play a role in the pathogenesis of the disease. In addition, part of these peripheral microvascular abnormalities seems to be correlated with both functional and structural glaucomatous damage. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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PURPOSE: Prostaglandin analogs (PGAs) are first-line treatments for ocular hypertension (OHT) and open-angle glaucoma (OAG). However, frequent side effects and high costs hinder patient's compliance resulting in disease progression. Evidence suggests selective laser trabeculoplasty (SLT) may be considered a first-line treatment for OHT and OAG due to its safety profile, minor side effects, and reduced costs. Considering that PGAs and SLT share action mechanisms, it is hypothesized that previous PGA therapy may affect subsequent SLT efficacy. Therefore, we analyzed if PGAs reduce SLT efficacy. METHODS: An evidence-based review was performed to assess the safety and efficacy of SLT in patients previously treated with PGAs. For this purpose, we performed an extensive literature search using the National Library of Medicine's PubMed and Google Scholar database for all English language articles published until May 2021. RESULTS: There is evidence of non-superiority of PGAs therapy versus SLT for OHT and OAG. A multicenter, randomized, observer-masked clinical trial (RCT) of untreated OHT and OAG patients concluded that SLT should be offered as the first-line treatment for these patients. This study was supported by a meta-analysis of RCTs, comparing SLT efficacy versus antiglaucoma drugs only, with the advantage of an SLT lower rate of adverse effects. CONCLUSIONS: Cost-effectiveness, patient compliance, and antiglaucoma drugs' side effects, including higher surgical failure, favor consideration of SLT as first-line therapy for OAG and OHT. Furthermore, SLT efficacy does not seem to be affected by prior PGA administration; however, larger cohort, comparative, multicenter RCTs are necessary to answer this question.

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PURPOSE: Interleukin-6 (IL-6) is a proinflammatory cytokine with pleiotropic effects which has been related to primary open angle glaucoma (POAG) due to its particular effect of protecting the retinal ganglion cells (RGc) from the apoptosis. Different single nucleotide polymorphisms (SNP) have been associated with POAG. The aim of this study was to determine whether an association between IL-6 rs1800795 (-174 G>C) SNP and a higher risk for POAG is present in western Mexican population. METHODS: One hundred and sixty-five unrelated Mexican mestizo patients with POAG and 108 control subjects were included. Genomic DNA was extracted from leukocytes and purified, followed by genotyping and amplification by polymerase chain reaction (PCR) with Taqman Biosystem probes. Allelic and genotypic diversity was evaluated between cases and control subjects. RESULTS: There was no statistically significant association between allele and genotype frequencies, neither with dominant nor recessive genetic association models (p > 0.05). CONCLUSION: Even though there is a role of IL6 in the pathophysiology of POAG, our results ruled out the association between IL-6 and the rs1800795 SNP showing not to be an index of higher risk for POAG in Mexican population.

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OBJECTIVE: To measure the magnitude and duration of the hypotensive effect of two prostaglandin analogues in glaucoma patients using the water drinking test (WDT). METHODS: Patients received latanoprost or travoprost every 24 h and then every 48 h. Untreated WDT were performed at 7 am and with treatment 12, 36 and 44 h after the last dose; intraocular pressure (IOP) peak, fluctuation and the difference between peak and isolated IOP measurements at consultation times were calculated. RESULTS: Forty-one eyes of 21 patients with primary open-angle glaucoma were included; 22 eyes received latanoprost, and 19 received travoprost. Mean untreated isolated IOP was 17.20 standard deviation (S.D.) 3.73 and 16.95 S.D. 2.61 mmHg and peak pressure 22.45 S.D. 2.91 and 21.58 S.D. 3.79 mmHg, for the latanoprost and travoprost groups, respectively. With treatment, peak pressure was reduced by 22.64% and 20.29% at 12 h, 18.44% and 14.64% at 36 h and 16.17% and 14.46% at 44 h, respectively. The fluctuation without treatment was 4.36 and 5.11 mmHg, and with treatment at 12 h was reduced to 2.77 and 2.89 mmHg, increasing again at 36 and 44 h. CONCLUSIONS: A hypotensive effect was evident up to 44 h after the last dose of latanoprost and travoprost, similar for the two drugs and decreasing over time. IOP fluctuation was only reduced at 12 h.

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PURPOSE: To investigate the association between the time of occurrence of intraocular pressure (IOP) peaks during the water-drinking test (WDT) and visual field damage in a cohort of primary open-angle glaucoma (POAG) patients. METHODS: In this retrospective, cross-sectional study, 98 eyes from 49 consecutive POAG patients were followed in a referral clinical practice. The relationship between the time when IOP peaks occurred during the WDT and the visual field mean deviation (MD) assessed with 24-2 visual field was tested with mixed-effects models. RESULTS: MD value was significantly associated with the time of IOP peak occurrence (P = 0.020) when adjusting for the number of medications, but not with the IOP peak values (P = 0.238). CONCLUSION: The time of IOP peaks occurrence during the WDT was associated with glaucoma severity among treated POAG patients.

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Glaucoma is a mixed group of optic neuropathies that lead to irreversible visual field loss and blindness if left untreated. It is estimated that 3.5% of the global population aged 40 to 80 years have any glaucoma, being the primary open-angle and the primary angle-closure glaucoma the most prevalent forms. Although the age-standardised prevalence of blindness caused by glaucoma has decreased substantially over the last decades, population growth and ageing impose many challenges in preventing glaucoma-related morbidities on a global level. In addition, difficulties in diagnoses and treatment, along with its chronic and irreversible nature, urge the development and implementation of innovative approaches in confronting the disease. This manuscript reviews recent literature related to the epidemiology of primary glaucomas in adults, the risk factors attributed to the development of the disease, and discuss challenges and potential solutions from a public health perspective.

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Introdução: Glaucoma é uma neuropatia óptica caracterizada pela perda irreversível das células ganglionares retinianas, sendo a pressão intraocular (Po) o principal fator de risco para a doença. Grandes variações da pressão intraocular durante um determinado período de tempo têm atraído a atenção como um potencial fator de risco para o desenvolvimento e progressão do glaucoma. Objetivo: Avaliar a relação entre a flutuação de 24 horas da pressão intraocular (∆Po) e a espessura da camada de fibras nervosas da retina (CFNR) medida por tomografia de coerência óptica de domínio espectral (TCO-DE). Método: O estudo incluiu 125 olhos de 65 pacientes. Sessenta e três olhos (50,4%) tiveram o diagnóstico de glaucoma primário de ângulo aberto (GPAA) e 62 (49,6%) foram considerados suspeitos de glaucoma (SG). Todos os olhos foram submetidos a imagens usando TCO-DE, juntamente com medição da Po de 24 horas e perimetria computadorizada acromática. Apenas pacientes com ∆Po anormal (>6 mmHg) foram incluídos. Correlação e modelos mistos lineares generalizados foram usados para investigar a relação entre ∆Po e a espessura da CFNR ajustando para potenciais fatores de confusão, como idade, diagnóstico de glaucoma, espessura da córnea, Po média durante 24 horas e gravidade da doença. Resultados: A idade média foi semelhante entre os grupos SG e GPAA (62,2 ± 15,6 vs. 64,6 ± 12,0, P = 0,50), enquanto o desvio médio do campo visual apresentou diferença entre SG e GPAA (0,41 ± 1,33 vs. -3,09 ± 3,23, P <0,001). A Po média também foi semelhante entre os grupos SG e GPAA (15,6 ± 3,47 vs. 15,6 ± 2,83 mmHg, P = 0,90), assim como o pico da Po às 6h (21,7 ± 3,85 vs. 21,3 ± 3,80 mmHg, P = 0,68). Correlações negativas estatisticamente significativas foram encontradas no grupo GPAA entre a Po às 6h e a espessura da CFNR global (rs = 0,543; P < 0,001), quadrantes inferior (rs = -0,540; P < 0,001), superior (rs = -0,405; P = 0,009) e nasal (rs = −0,561; P < 0,001). Correlações negativas também foram encontradas entre ∆Po e a espessura da CFNR global (rs = −0,591; P < 0,001), e todos os demais setores (P < 0,05). No SG a Po às 6h correlacionou-se apenas com a espessura da CFNR no quadrante inferior (rs = −0,307; P = 0,047). Cada 1 mmHg maior na ∆Po foi associado à afilamento de -1,44 µm na espessura global da CFNR (IC 95%: -2,77 a -0,11, P = 0,03). Além disso, cada incremento de 10 anos na idade foi associado à afilamento de -3,56 µm na espessura global da CFNR (IC 95%: -6,06 a -1,05, P = 0,006). O GPAA teve uma afilamento média de -10,91 µm na CFNR global em relação aos SG (IC 95%: -20,21 a -1,62, P = 0,02). A Po média não foi associada à espessura global da CFNR (IC 95%: -1,37 a 0,91, P = 0,69). Conclusão: Maior ∆Po foi associado à menor espessura global da CFNR medida pelo TCO-DE, em pacientes com ∆Po >6 mmHg. Esse achado corrobora um papel potencial da flutuação da Po como fator de risco para perda estrutural no glaucoma.

Introduction: Glaucoma is an optic neuropathy characterized by irreversible loss of retinal ganglion cells, with intraocular pressure (IOP) being the main risk factor for the disease. Large variations in IOP over a period of time have attracted attention as a potential risk factor for the development and progression of glaucoma. Purpose: To evaluate the relationship between 24-hour fluctuation of intraocular pressure (∆IOP) and retinal nerve fiber layer (RNFL) thickness measured by spectraldomain optical coherence tomography (SD-OCT). Material and Methods: The study included 125 eyes of 65 patients. Sixty-three eyes (50.4%) had a diagnosis of primary open angle glaucoma (POAG) and 62 (49.6%) were considered glaucoma suspects (GS). All eyes underwent imaging using SDOCT, along with 24-hour IOP measurement and standard automated perimetry. Only patients with abnormal ∆IOP (>6 mmHg) were included. Correlation and generalized linear mixed models were used to investigate the relationship between ∆IOP and RNFL thickness adjusting for potential confounding factors such as age, glaucoma diagnosis, corneal thickness, mean IOP during 24 hours, and disease severity. Results: Mean age was similar between the SG and POAG groups (62.2 ± 15.6 vs. 64.6 ± 12.0, P = 0.50), while the mean deviation of visual field showed a difference between SG and POAG (0.41 ± 1.33 vs. -3.09 ± 3.23, P < 0.001). The mean Po was also similar between GS and POAG groups (15.6 ± 3.47 vs 15.6 ± 2.83 mmHg, P = 0.90) as was IOP peak at 6 AM (21.7 ± 3.85 vs. 21.3 ± 3.80 mmHg, P = 0.68). Statistically significant negative correlations were found in POAG group between IOP at 6 AM and RNFL thickness in global (rs = −0.543; P < 0.001), inferior (rs = −0.540; P < 0.001), superior (rs = −0.405; P = 0.009), and nasal quadrants (rs = −0.561; P < 0.001). Negative correlations were also found between ∆IOP and RNFL thickness in global (rs = −0.591; P < 0.001), and all other sectors (P < 0.05). In GS IOP at 6 AM correlated only with RNFL thickness in the inferior quadrant (rs = −0.307; P = 0.047). Each 1 mmHg higher in ∆IOP was associated with thinning of -1.44 µm in global RNFL thickness (95% CI: -2.77 to -0.11, P = 0.03). Also, each 10-years increment in age was associated with thinning of -3.56 µm in global RNFL thickness (95% CI: 6.06 to -1.05, P = 0.006). POAG had on average -10.91 µm thinning in global RNFL than glaucoma suspects (95% CI: -20.21 to -1.62, P = 0.02). Mean IOP was not associated with global RNFL thickness (95% CI: -1.37 to 0.91, P = 0.69). Conclusion: Higher ∆IOP was associated with lower global RNFL thickness measured by SD-OCT, in patients with ∆IOP > 6 mmHg. This finding corroborates a potential role for IOP fluctuation as a risk factor for structural loss in glaucoma.

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RESUMEN Introducción: Las estrategias de SITA Estándar fueron aprovechadas por más de dos décadas, pero buscando aun mejorar el tiempo sin perder la calidad, se volvió a crear una nueva estrategia más corta, a la cual llamaron estrategia FASTER. Objetivo: Determinar la correlación entre las estrategias SITA Estándar 24 -2 y SITA Faster 24 -2 para evaluar el daño campimétrico en pacientes con Glaucoma Primario de Angulo Abierto. Metodología: Estudio observacional analítico. RESULTADOS: Se analizó 74 resultados de análisis del campo visual utilizando dos técnicas SITA Estándar 24 - 2 y SITA Faster 24 - 2. El tiempo de prueba para la estrategia SITA Estándar fue de 379,64 ± 72,75 segundos y para la estrategia SITA Faster 170,93 ± 49,17 (p<0,0001), probando una reducción de tiempo del 55% para la segunda. Los valores de desviación media, desviación patrón estándar y el índice de campo visual no mostraron diferencias estadísticamente significativas entre ambas pruebas. La Prueba de Hemicampo de glaucoma con el cálculo del índice Kappa de Cohen arroja un valor de 0,316 con un intervalo de confianza del 95 % de (0,098 - 0,534) lo que indica que es estadísticamente significativo. Discusión: Los resultados generales indican que es posible reemplazar la estrategia SITA Estándar 24 -2 con la estrategia SITA Faster 24 - 2. Este cambio será especialmente útil para aumentar la frecuencia de exámenes campimétricos, determinante para una detección más temprana de la progresión del glaucoma y así mejorar las conductas terapéuticas que se toman con los pacientes que acuden a nuestro servicio.

ABSTRACT Introduction: SITA Standard strategies were used for more than two decades, but still seeking to improve time without losing quality, a new shorter strategy was created again, which they called the FASTER strategy. Objective: To determine the correlation between the SITA Standard 24-2 and SITA Faster 24-2 strategies to evaluate the visual field damage in patients with Primary Open Angle Glaucoma. Methodology: Analytical observational study. Results: 74 visual field analysis results were analyzed using two techniques SITA Standard 24 - 2 and SITA Faster 24 - 2. The test time for the SITA Standard strategy was 379.64 ± 72.75 seconds and for the SITA strategy Faster 170.93 ± 49.17 (p <0.0001), proving a 55% time reduction for the second. The mean deviation, standard deviation and visual field index values do not show statistically significant differences between both tests. The Glaucoma Hemifield Test with the calculation of the Cohen's Kappa index gives a value of 0.316 with a 95% confidence interval of (0.098 - 0.534) which indicates that it is statistically significant. Discussion: The overall results indicate that it is possible to replace the SITA Standard 24-2 strategy with the SITA Faster 24-2 strategy. This change will be especially useful to increase the frequency of campimetric examinations. A greater frequency of examinations is important for earlier detection of glaucoma progression and thus improve the therapeutic behaviors that are taken with the patients who come to our service.

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Objetivo: Determinar los hallazgos por eco-Doppler orbitario en pacientes con glaucoma primario de ángulo abierto según factores de riesgo aterosclerótico. Métodos: Se realizó un estudio observacional descriptivo y transversal en 300 órbitas de 150 pacientes con diagnóstico de glaucoma primario de ángulo abierto. A todos los casos se les realizó tonometría de contorno dinámico y tomografía de coherencia óptica. Se identificaron mediante interrogatorio y por el laboratorio clínico los factores de riesgo aterosclerótico: hipertensión arterial, tabaquismo, diabetes mellitus tipo 2, dislipidemia, obesidad y consumo excesivo de alcohol. Se les realizó ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales se procedió a evaluar mediante eco-Doppler las arterias oftálmica, central de la retina y ciliares posteriores temporales. Resultados: La edad media de los sujetos estudiados fue de 62,3 años. El 55,3 por ciento correspondió al sexo femenino y el 47,3 por ciento al color blanco de la piel. El número de factores de riesgo mostró una correlación lineal moderada, positiva y significativa con el índice de resistencia, mientras que con las velocidades dicha correlación resultó ser negativa. Todos los factores de riesgo expresaron efectos dañinos sobre la hemodinámica del flujo ocular, la presión intraocular y el grosor de las capas de fibras neurorretinianas temporales. Tras ajustar para la edad, esta negativa influencia continuó siendo relevante en la mayoría de los casos. Conclusiones: Los aspectos vasculares del glaucoma deben integrarse a la práctica clínica de esta afección, lo que ayudará a que el enfoque sea más completo, y redundará en un mejor pronóstico de la enfermedad(AU)

Objective: Determine the orbital echo-Doppler findings in patients with primary open angle glaucoma according to atherosclerotic risk factors. Methods: A cross-sectional observational descriptive study was conducted of 300 orbits of 150 patients diagnosed with primary open angle glaucoma. All the cases underwent dynamic contour tonometry and optical coherence tomography. Interrogation and clinical laboratory testing led to identification of the following atherosclerotic risk factors: arterial hypertension, smoking, diabetes mellitus type 2, dyslipidemia, obesity and excessive alcohol consumption. Orbital and carotid Doppler ultrasounds were performed, and only if they were normal they would be followed by echo-Doppler evaluation of the ophthalmic, central retinal and posterior temporal ciliary arteries. Results: Mean age of the study subjects was 62.3 years. 55.3 percent were female and 47.3 percent had white skin. The number of risk factors showed a moderate, positive and significant linear correlation with the resistive index, and a negative correlation with the velocities. All the risk factors expressed harmful effects on ocular flow hemodynamics, intraocular pressure and the thickness of temporal neuroretinal fibers. After adjusting for age, this negative influence continued to be relevant in most cases. Conclusions: The vascular aspects of glaucoma should be incorporated into the clinical management of this condition. This will make the approach more thorough and help achieve a better diagnosis(AU)

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RESUMO Objetivo: Avaliar os resultados da facotrabeculectomia em seguimento igual ou superior a 5 anos. Métodos: Estudo retrospectivo, de intervenção e analítico realizado no centro cirúrgico da clínica de olhos de Juazeiro do Norte com pacientes operados no período de 2006 a 2013. Foram envolvidos na investigação 34 olhos de 29 pacientes com catarata senil e glaucoma primário de ângulo aberto submetidos à facotrabeculectomia. Foi criado um escore de risco de dano glaucomatoso variando de 0 a 5 ao avaliar pressão intraocular, escavação do disco óptico, número de drogas hipotensoras utilizadas para o tratamento do glaucoma e a idade do paciente em anos. A amostra foi de conveniência e pareada. Foi utilizado o teste de Wilcoxon pareado para a verificação de diferenças entre médias. Foi aceito p< 0,05 para a rejeição da hipótese de nulidade. O estudo foi aprovado pelo comitê de ética da plataforma Brasil e segue a resolução 466 do Conselho Nacional de Saúde. Resultados: A média da acuidade visual foi significantemente maior após o seguimento de 5 anos (média pré-operatória 0,42 +/- 0,23 ver-sus média pós-operatória 0,62 +/- 0,29 - p=0,0031). A média dos escores de risco para dano glaucomatoso após 5 anos de seguimento foi significativamente menor quando comparado ao pré-operatório (media pré-operatória: 9,47 +/- 1,61 versus média pós-operatória 6,55 +/- 2,21) p < 0,0001, considerado extremamente significante. Conclusão: A facotrabeculectomia foi significantemente efetiva na melhora da acuidade visual e na redução do risco de dano glau-comatoso após seguimento pós-operatório igual ou superior a 5 anos.

ABSTRACT Objective: To evaluate the results of phacotrabeculectomy in a follow-up of five years or more. Methods: Retrospective, interventional and analytical study that was carried out in the surgical center of clínica de olhos do juazeiro with patients operated on from 2006 to 2013. 34 eyes of 29 patients with senile cataract and primary open-angle glaucoma, who underwent phacotrabeculectomy were involved in the investigation. A risk score for glaucomatous dam-age ranging from 0 to 5 when evaluating intraocular pressure, excavation of the optic disc, number of hypotensive drugs used to treat glaucoma and the patient's age in years. The sample was of convenience and paired. The paired Wilcoxon test was used to verify differences be-tween means. P <0.05 was accepted for the rejection of the null hypothesis. The study was approved by the ethics committee of the Brazil platform and follows the principles of resolu-tion 466 of the National Health Council. Results: The mean visual acuity was significantly higher after a five-year follow-up (preoperative average 0.42 +/- 0.23 versus postoperative average 0.62 +/- 0.29 - p = 0.0031). The average risk score for glaucomatous damage after five years of follow-up was significantly lower when compared to the preoperative (preoperative mean: 9.47 +/- 1.61 versus postoperative mean 6.55 +/- 2, 21) p <0.0001, considered extremely significant. Conclusion: Phacotrabeculectomy was significantly effective in improving visual acuity and reducing the risk of glaucomatous damage after a five-year postoperative follow-up.

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INTRODUCTION: To describe the outcomes of Baerveldt glaucoma implants implanted via a modified technique with regard to early intraocular pressure (IOP) reduction in cases of uncontrolled glaucoma. METHODS: The medical records of patients who had Baerveldt glaucoma implants of 350 or 250 mm2 implanted via a modified technique and were followed up for a period of at least 6 months were reviewed. The primary outcome measures were the mean IOP and number of glaucoma medications at each visit. We evaluated complete success rates at 1 day, 1 week and 1 month, defined as IOP values [Formula: see text] 5 mmHg and ≤ 21 mmHg prior to ligature rupture. RESULTS: A total of 42 eyes had Baerveldt glaucoma implants and met the inclusion criteria. The mean preoperative intraocular pressure (IOP) was 34.2 ± 11.2 mmHg. The postoperative mean IOP values were 15.1 mmHg ± 8.8 (p < 0.05), 17.7 ± 7.1 mmHg (p < 0.05), 12.3 ± 4.0 mm Hg (p < 0.05) at 1 day, 1 month, and 6 months, respectively. The rate of complete success on the first day was 78%, at the first month was 69%, and at 6 months was 95.2%. The number of glaucoma medications used was significantly lower at 6 months (P = < 0.001). CONCLUSION: The modified surgical technique using Baerveldt implants enables a safe, effective, and reliable IOP control in early postoperative patients with uncontrolled glaucomas.

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PURPOSE: To compare provocative test-based and long-term intraocular pressure variation parameters in patients with stable open-angle glaucoma. METHODS: A prospective observational study was carried out in which stable open-angle glaucoma patients (⩾3 years of follow-up without any changes on current medical regimen) were consecutively enrolled. All patients were submitted to a water-drinking test. Long-term intraocular pressure parameters were obtained from isolated intraocular pressure measurements from each visit (⩾5 visits). We investigated the correlation and agreement between the following water-drinking test and long-term intraocular pressure parameters: mean, peak, and fluctuation. In addition, the percentage of eyes with significant intraocular pressure peaks during the water-drinking test (defined as a difference ⩾25% between water-drinking test intraocular pressure peak and mean long-term intraocular pressure) was assessed. RESULTS: Sixty-three eyes from 63 open-angle glaucoma patients (mean age, 60.7 ± 11.8 years) were included. Mean and water-drinking test intraocular pressure peak correlated significantly with mean (r = 0.67) and maximum long-term intraocular pressure (r = 0.52), respectively (p < 0.01). The correlation between water-drinking test intraocular pressure fluctuation and long-term intraocular pressure fluctuation was not significant (p = 0.45). Limits of agreement from Bland-Altman plots exceeded the maximum allowed difference between methods (3 mm Hg) for all the intraocular pressure parameters analyzed, suggesting poor agreement between water-drinking test-derived and long-term intraocular pressure values. Overall, significant water-drinking test intraocular pressure peaks were observed in 39.7% of these eyes with stable open-angle glaucoma. CONCLUSION: Although some water-drinking test-based and long-term intraocular pressure parameters correlate significantly, water-drinking test results may not reflect the long-term intraocular pressure profile of stable open-angle glaucoma patients, as their agreement is poor. Many of these patients may experience significant water-drinking test intraocular pressure peaks, despite long-standing stable disease and unchanged medical regimen.

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PURPOSE: To quantify abnormalities in the peripapillary microvasculature in eyes with primary open-angle glaucoma (POAG) and paracentral visual field (VF) loss. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Thirty-three POAG patients, including 15 with paracentral VF loss and 18 with peripheral VF loss, and 31 control participants underwent swept-source OCT angiography (OCTA) of the peripapillary region. METHODS: The POAG groups were matched by VF mean deviation (MD). The peripapillary microvasculature from the internal limiting membrane to the retinal nerve fiber layer (RNFL) interface was quantified within a 0.70-mm annulus around Bruch's membrane opening after removal of large vessels. Both vessel density (VD) and the integrated OCTA by ratio analysis signal (IOS) suggestive of flow were measured. Regional VD and IOS were measured from the affected hemisphere corresponding to the VF hemifield of more severe loss, which was used to calculate the paracentral total deviation (PaTD), or total deviation within the central 10°. One eye per participant was included. MAIN OUTCOME MEASURES: Difference in peripapillary OCTA measurements between paracentral and peripheral VF loss groups and correlation of peripapillary VD and IOS with PaTD. RESULTS: The POAG groups had matched VF MD (-3.1 ± 2.5 dB paracentral vs. -2.3 ± 2.0 dB peripheral; P = 0.31), did not differ in average RNFL thickness (71.1 ± 14.7 µm vs. 78.1 ± 15.0 µm; P = 0.55), but differed in age (59.2 ± 9.6 years paracentral vs. 67.4 ± 6.6 years peripheral; P = 0.02). Compared with control participants, both paracentral and peripheral VF loss groups showed reduced VD (P < 0.001 and P = 0.009, respectively) and IOS (P < 0.001 and P = 0.01, respectively) in the affected hemisphere. Compared with POAG eyes with peripheral VF loss, the paracentral group showed reduced peripapillary VD (38.0 ± 2.0%, 35.0 ± 2.2%, respectively; P = 0.001) and IOS (44.3 ± 3.1%, 40.4 ± 4.0%, respectively; P = 0.02) in the affected hemisphere. Among all POAG eyes, peripapillary VD and IOS of the affected hemisphere correlated significantly with functional measurement of paracentral loss (PaTD, r = 0.40, P = 0.02; r = 0.45, P = 0.008; respectively). These correlations remained significant after adjusting for age (r = 0.41, P = 0.02; r = 0.47, P = 0.01; respectively). CONCLUSIONS: Regional peripapillary microvasculature showed decreased VD and flow in POAG with paracentral loss, supporting its importance in this glaucoma subtype.

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