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To characterize laser speckle flowgraphy (LSFG) pulse waveform parameters for ocular circulation evaluation, a multicenter, prospective, cross-sectional study was conducted in 111 eyes of 86 healthy Japanese individuals. Optic nerve head (ONH) tissue-area, vessel-area mean blur rate (MT and MV, respectively), and MT and MV pulse waveform parameters were obtained using LSFG and ONH structural parameters using planimetry. Multivariate linear mixed-effects modeled regression analysis identified factors contributing to MT- or MV-waveforms using age, gender, smoking history, body mass index, systolic and diastolic blood pressure, heart rate, intraocular pressure, axial length, disc, rim, and β-peripapillary atrophy areas, MT or MV, central retinal artery, and vein equivalents (CRAE and CRVE) as explanatory variables. MT- and MV-waveforms significantly correlated with one or more systemic factors, consistent with previous studies. Following confounding factor adjustment, MT-Skew significantly negatively correlated with β-PPA area (P = 0.026); MT- and MV-flow acceleration index positively correlated with CRAE, MT, and MV (P = 0.041-< 0.001), compatible with these parameters' observed correlations to systemic factors. Significantly negative correlations of the blowout score and acceleration time index to CRAE partly conflicted with their correlations to systemic factors, and other waveform parameters showed little correlation to ocular factors. Thus, Skew and flow acceleration index assisted the in vivo ocular circulation characterization.

Aim: To investigate the usefulness of data augmentation in visual field (VF) trend analyses in patients with glaucoma., Method: This study included 6380 VFs from 638 eyes of 417 patients with open-angle glaucoma. Various affine transformations were applied to augment the VF data: (1) rotation, (2) scaling, (3) vertical and horizontal shift and (4) a combination of these different transformations. Using pointwise linear regression (PLR), the total deviation (TD) values of a patient's 10th VF were predicted using TD values from shorter VF series (from first to third VFs (VF1-3) to first to ninth VFs (VF1-9)) with and without VF data augmentation, and the root mean squared error (RMSE) was calculated., Results: With PLR, mean RMSE without VF augmentation averaged from 3.95 (VF1-3) to 19.01 (VF1-9) dB. The RMSE was significantly improved by applying the different transformations: (1) rotation (from VF1-3 to VF1-7), (2) scaling (from VF1-3 to VF1-6), (3) vertical and horizontal shifts (from VF1-3 to VF1-4) and (iv) a combination of these (from VF1-3 to VF1-7). Progression rates in VF1-10 had better agreement with those in shorter VF series when a combination of affine transformation was applied. The differences in rates were between 1.9 (VF1-3) and 0.39 (VF1-9) dB if augmentation was used, which was significantly smaller than that observed when augmentation was not applied (from 2.6 with VF1-3 to 0.26 dB with VF1-9)., Conclusion: It is useful to apply VF data augmentation techniques when predicting future VF progression in glaucoma using PLR, especially with short VF series., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of the study was to investigate the usefulness of processing visual field (VF) using a variational autoencoder (VAE). The training data consisted of 82,433 VFs from 16,836 eyes. Testing dataset 1 consisted of test-retest VFs from 104 eyes with open angle glaucoma. Testing dataset 2 was series of 10 VFs from 638 eyes with open angle glaucoma. A VAE model to reconstruct VF was developed using the training dataset. VFs in the testing dataset 1 were then reconstructed using the trained VAE and the mean total deviation (mTD) was calculated (mTD VAE ). In testing dataset 2, the mTD value of the tenth VF was predicted using shorter series of VFs. A similar calculation was carried out using a weighted linear regression where the weights were equal to the absolute difference between mTD and mTD VAE . In testing dataset 1, there was a significant relationship between the difference between mTD and mTD VAE from the first VF and the difference between mTD in the first and second VFs. In testing dataset 2, mean squared prediction errors with the weighted mTD trend analysis were significantly smaller than those form the unweighted mTD trend analysis.

Background/aims: To investigate the usefulness of the Octopus (Haag-Streit) EyeSuite's cluster trend analysis in glaucoma., Methods: Ten visual fields (VFs) with the Humphrey Field Analyzer (Carl Zeiss Meditec), spanning 7.7 years on average were obtained from 728 eyes of 475 primary open angle glaucoma patients. Mean total deviation (mTD) trend analysis and EyeSuite's cluster trend analysis were performed on various series of VFs (from 1st to 10th: VF1-10 to 6th to 10th: VF6-10). The results of the cluster-based trend analysis, based on different lengths of VF series, were compared against mTD trend analysis., Result: Cluster-based trend analysis and mTD trend analysis results were significantly associated in all clusters and with all lengths of VF series. Between 21.2% and 45.9% (depending on VF series length and location) of clusters were deemed to progress when the mTD trend analysis suggested no progression. On the other hand, 4.8% of eyes were observed to progress using the mTD trend analysis when cluster trend analysis suggested no progression in any two (or more) clusters., Conclusion: Whole field trend analysis can miss local VF progression. Cluster trend analysis appears as robust as mTD trend analysis and useful to assess both sectorial and whole field progression. Cluster-based trend analyses, in particular the definition of two or more progressing cluster, may help clinicians to detect glaucomatous progression in a timelier manner than using a whole field trend analysis, without significantly compromising specificity., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose: To validate the usefulness of the "Random Forests" classifier to diagnose early glaucoma with spectral-domain optical coherence tomography (SDOCT)., Methods: design: Comparison of diagnostic algorithms., Setting: Multiple institutional practices., Study Participants: Training dataset included 94 eyes of 94 open-angle glaucoma (OAG) patients and 84 eyes of 84 normal subjects and testing dataset included 114 eyes of 114 OAG patients and 82 eyes of 82 normal subjects. In both groups, OAG eyes with mean deviation (MD) values better than -5.0 dB were included., Observation Procedure: Using the training dataset, classifiers were built to discriminate between glaucoma and normal eyes using 84 OCT measurements using the Random Forests method, multiple logistic regression models based on backward or bidirectional stepwise model selection, a least absolute shrinkage and selection operator regression (LASSO) model, and a Ridge regression model., Main Outcome Measures: Diagnostic accuracy., Results: With the testing data, the area under the receiver operating characteristic curve (AROC) with the Random Forests method (93.0%) was significantly (P < .05) larger than those with other models of the stepwise model selections (71.9%), LASSO model (89.6%), and Ridge model (89.2%)., Conclusion: It is useful to analyze multiple SDOCT parameters concurrently using the Random Forests method to diagnose glaucoma in early stages., (Copyright © 2016 Elsevier Inc. All rights reserved.)

This prospective randomized study compared test results of size modulation standard automated perimetry (SM-SAP) performed with the Octopus 600 and conventional SAP (C-SAP) performed with the Humphrey Field Analyzer (HFA) in glaucoma patients. Eighty-eight eyes of 88 glaucoma patients underwent SM-SAP and C-SAP tests with the Octopus 600 24-2 Dynamic and HFA 24-2 SITA-Standard, respectively. Fovea threshold, mean defect, and square loss variance of SM-SAP were significantly correlated with the corresponding C-SAP indices (P < 0.001). The false-positive rate was slightly lower, and false-negative rate slightly higher, with SM-SAP than C-SAP (P = 0.002). Point-wise threshold values obtained with SM-SAP were moderately to strongly correlated with those obtained with C-SAP (P < 0.001). The correlation coefficients of the central zone were significantly lower than those of the middle to peripheral zone (P = 0.031). The size and depth of the visual field (VF) defect were smaller (P = 0.039) and greater (P = 0.043), respectively, on SM-SAP than on C-SAP. Although small differences were observed in VF sensitivity in the central zone, the defect size and depth and the reliability indices between SM-SAP and C-SAP, global indices of the two testing modalities were well correlated.

Purpose: To evaluate the short-term results of Trabectome surgery performed on Japanese patients., Methods: Retrospective observational study. Trabectome surgery was performed on 117 eyes from 101 patients at Kitasato University Hospital from December 2010 to June 2013, involving 48 eyes with primary open-angle glaucoma (POAG), 62 eyes with secondary open-angle glaucoma (SOAG), and 7 eyes with developmental glaucoma. Trabectome surgery alone was performed on 34 phakic eyes (the phakic group) and 35 pseudophakic eyes (the pseudophakic group), and Trabectome surgery combined with phacoemulsification (the combined surgery group) was performed on 48 eyes. The main outcomes assessed were intraocular pressure (IOP), number of IOP-lowering medications, and success probabilities using Kaplan-Meier life-table analyses. Failure risk factors were identified using the Cox proportional hazards ratio., Results: In all cases, after a mean follow-up of 18.5 ± 13.5 months, IOP was reduced from 31.6 ± 9.9 (SD) mmHg using 5.0 ± 1.7 medications to 16.4 ± 5.4 mmHg using 3.8 ± 1.8 medications. One year after surgery, IOP was reduced from 29.4 ± 7.8 to 16.1 ± 3.8 mmHg in POAG, from 33.6 ± 11.1 to 14.7 ± 2.9 mmHg in SOAG, from 33.0 ± 10.2 to 15.7 ± 3.3 mmHg in the phakic group, from 32.6 ± 9.3 to 15.3 ± 3.0 mmHg in the pseudophakic group, and from 29.9 ± 10.0 to 15.2 ± 3.0 mmHg in the combined surgery group. There were no statistically significant differences in IOP at each measurement point, either between POAG and SOAG or among the three procedure subtypes. The POAG and SOAG success rates at 12 months using postoperative IOP ≤ 21 mmHg and ≥20 % reduction in baseline as criteria were 53.9 and 77.2 %, respectively (p = 0.024, log-rank test). Twenty-one eyes (17.9 %) needed additional trabeculectomy. None of the univariate and multivariate risk factors for failure were detected., Conclusions: Trabectome surgery is safe and effective for Japanese patients whose target IOP is 18 mmHg or above. However, it is necessary to carefully consider Trabectome surgery for advanced POAG cases.

Purpose: To investigate the repeatability and reproducibility of intraocular pressure (IOP) and central corneal thickness (CCT) measurements using a noncontact tono/pachymeter (NT-530P) and to assess the correlation of CCT with IOP., Methods: Forty-six eyes of healthy volunteers were measured by two examiners. Three consecutive measurements per eye were performed. Repeatability was assessed using the coefficient of variation, and reproducibility was assessed using Bland-Altman plots. Linear correlations were used to determine agreement between CCT and noncorrected IOP and CCT and corrected IOP, which was calculated using a formula built into the NT-530P., Results: The coefficient of variation for IOP was 6.4% and for CCT was 0.4%. The 95% limits of agreement between examiners were -0.17 ± 1.42 mmHg (range: -2.95 to 2.61 mmHg) for IOP, -0.93 ± 4.37  μ m (range: -9.50 to 7.64  μm) for CCT. The corrected IOP was significantly higher than the noncorrected IOP (P = 0.010.3). The noncorrected IOP significantly correlated with CCT (r = -0.4883, P = 0.0006). The corrected IOP showed no significant correlation with CCT (r = -0.0285, P = 0.8509)., Conclusions: NT-530P offered repeatability and reproducibility in both IOP and CCT measurements. The corrected IOP calculated using the NT-530P was independent of the CCT, suggesting that this IOP may be less influenced by the central corneal thickness.

Purpose: To assess the effect of corneal astigmatism on intraocular pressure (IOP) measurements using an Ocular Response Analyzer (ORA) and a Goldmann applanation tonometer (GAT)., Methods: We prospectively examined 59 normal eyes of 59 healthy volunteers (18 men, 41 women; age, mean +/- standard deviation, 40.5 +/- 14.2 years; age range, 19-68 years). We quantitatively assessed the values of corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOP(G)) using an ORA (Reichert Ophthalmic Instruments). We also measured the IOP using a GAT (GAT-IOP). The amount of corneal astigmatism was assessed with an autokeratometer. We carried out these measurements three times, and the mean value obtained was used for statistical analysis., Results: The mean IOPcc, IOP(G), and GAT-IOP were 14.7 +/- 2.6, 14.0 +/- 2.8, and 14.2 +/- 1.7 mmHg respectively. The mean corneal astigmatism was 0.94 +/- 0.55 D. We found no significant correlation between IOPcc and corneal astigmatism (Pearson's correlation coefficient r = -0.04, p = 0.79), or between IOP(G) and corneal astigmatism (r = 0.09, p = 0.52). However, we found a weak, but significant, correlation between GAT-IOP and corneal astigmatism (Pearson's correlation coefficient r = 0.34, p = 0.009)., Conclusions: Both IOPcc and IOP(G) measured with ORA were less affected by the amount of corneal astigmatism, and the GAT-IOP readings were significantly higher in eyes with greater corneal astigmatism, suggesting that IOPcc as well as IOP(G) may be helpful for accurate IOP measurements in eyes with some corneal astigmatism.

Background: To investigate intraocular pressure (IOP) measurement values in normal tension glaucoma (NTG) eyes using two different types of tonometer that are supposed to be little affected by corneal biochemical properties., Methods: This study included 30 normal eyes of 16 healthy subjects and 30 eyes of 16 patients with NTG. IOP was measured with a Goldmann applanation tonometer (GAT), a Pascal dynamic contour tonometer (DCT), and a Reichert ocular response analyzer (ORA) three times each for normal and NTG eyes. The main measures were GAT-IOP, DCT-IOP, corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), and central corneal thickness (CCT)., Results: In normal eyes, GAT-IOP was 13.2 +/- 1.4 mmHg; DCT-IOP, 13.0 +/- 1.6 mmHg; IOPcc, 13.6 +/- 2.0 mmHg; and IOPg, 12.4 +/- 2.0 mmHg. Multivariate analysis revealed no significant differences between the four measurements (p = 0.08). CCT was 524.6 +/- 27.3 microns. In NTG eyes, GAT-IOP was 13.1 +/- 1.3 mmHg; DCT-IOP, 13.7 +/- 1.3 mmHg; IOPcc, 15.2 +/- 2.0 mmHg; and IOPg, 12.7 +/- 2.0 mmHg. Multivariate analysis showed significant differences between the four measurements (p < 0.01). Sheffé's test showed that IOPcc was significantly higher than GAT-IOP, DCT-IOP, and IOPg (GAT-IOP vs IOPcc: p < 0.0001; DCT-IOP vs IOPcc: p = 0.01; IOPcc vs IOPg: p < 0.0001). CCT was 515.4 +/- 32.9 microns, with no significant difference between normal and NTG eyes (p = 0.15)., Conclusions: We investigated the values of IOP in NTG eyes as measured by the DCT and ORA. IOPcc was significantly greater than GAT-IOP, DCT-IOP and IOPg in NTG eyes, suggesting the possibility that IOP values may be underestimated.

Purpose: A prospective study was conducted to evaluate the intraocular pressure (IOP) lowering effect of brinzolamide 1.0% ophthalmic suspension as an adjunctive therapy with latanoprost 0.005% ophthalmic solution in patients with open angle glaucoma or ocular hypertension., Patients and Methods: Fourteen patients with open angle glaucoma (OAG) or ocular hypertension (OH) who had been using latanoprost 0.005% for more than 6 months were initiated on adjunctive brinzolamide therapy. The IOP values at 1 month, 2 months, and 3 months were compared with those measured immediately before adding brinzolamide to the regimen (baseline). The incidence of adverse events such as conjunctival hyperemia and corneal epithelial defect were also examined., Results: The baseline IOP was 21.1 +/- 4.8 mmHg (mean +/- standard deviation). After 1 month, 2 months, and 3 months of therapy IOP was 16.9 +/- 4.5 mmHg, 16.6 +/- 4.0 mmHg, and 15.9 +/- 3.1 mmHg, respectively, showing significant reductions in IOP at all the measuring time-points during the study compared with the baseline value (p < 0.01). Conjunctival hyperemia developed in one patient after 1 month and in another after 2 months; however, both were mild, and therapy was continued. Corneal epithelium defect was observed in 3 patients. One of them had mild defect before brinzolamide was added to the regimen. Increase of eye discharge was seen in one patient. No serious side effects were otherwise observed., Conclusion: The addition of brinzolamide to a latanoprost 0.005% regimen may further lower intraocular pressure in patients with open angle glaucoma or ocular hypertension.

Purpose: We investigated the possibility of applying cross-linked hyaluronate hydrogel (HA gel) during trabeculectomy in rabbit eyes., Subjects and Methods: 1. We injected 0.9% salt solution (n = 3), Opegan-HI (n = 3), or HA gel (n = 3) into the subconjunctiva to make a follicle, and investigated its size. 2. After making a limbal-based conjunctival flap and a scleral flap, we injected HA gel or 0.9% salt solution into the subconjunctiva of rabbit eyes and sutured each flap (n = 4 each). Three weeks after the operation, we incised the conjunctiva and investigated the case of peeling away the conjunctival flap or the scleral flap. 3. We performed trabeculectomy with and without subconjunctival HA gel (n = 7 and 6, respectively), and compared the reduction of intraocular pressure between the two groups., Results: The results showed that the formation of the follicle was excellent and it was easy to peel away the adhesion. The reduction of intraocular pressure was statistically significant 4 weeks after the operation in which the HA gel was used., Conclusions: It could be useful to apply HA gel in trabeculectomy to prevent adhesion.

Purpose: Retrospectively, we reviewed the records of 65 patients (115 eyes) regarding the intraocular pressure (IOP) after laser in situ keratomileusis (LASIK)., Methods: The mean patient age was 31.2 +/- 10.5 years. The average preoperative spherical equivalent was -6.85 +/- 2.54 diopters. A noncontact pneumatic tonometer and a Goldmann applanation tonometer were used in measuring the IOP., Results: The IOP after LASIK was significantly lower than that before surgery (Mann-Whitney U-test). The IOP correlated significantly with the corrected diopter value, corneal thickness, and corneal curvature (Spearman rank correlation)., Conclusions: The postoperative IOP can be underestimated due to decreased corneal thickness and curvature. When evaluating IOP after LASIK surgery, this possibility should be carefully investigated.

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. [ABSTRACT FROM AUTHOR]

Introduction: Micropulse transscleral cyclophotocoagulation (MP-TSCPC) is a method for intraocular pressure (IOP) reduction in patients with glaucoma; however, the specific mechanisms underlying its ability to reduce IOP remain unclear. We therefore investigated the morphological changes and mechanisms of IOP reduction after MP-TSCPC. Methods: The right eyes of 4 pigmented rabbits were treated with MP-TSCPC with power setting corresponding to those used in glaucoma patients (1 power: 2,000 mW; time: 160 s; duty cycle: 31.3%). Power settings of 1, 1/8, 1/16, and 1/32 power were applied to the right eyes. The left eyes were used as controls. A light microscope and electron microscope were used to observe morphological findings after 1 week of MP-TSCPC. IOP and IOP reduction rate were compared before and after MP-TSCPC application on days 1, 3, and 5, and at 1 week. Results: In the pre-MP-TSCPC, IOP was 16.7 ± 0.6 mm Hg. The IOP of rabbit treated with the 1 power was 3 mm Hg, with an IOP reduction rate of 80%; however, the eyes developed phthisis bulbi. The IOP was 7.0 ± 0.0 mm Hg 1 week after MP-TSCPC (IOP reduction rate: 59%) in rabbit treated with the 1/8 power. Reduction in IOP was observed, but there was significant tissue invasion to the ciliary body. The IOP was 10.3 ± 0.6 mm Hg (IOP reduction rate: 40%) 1 week after MP-TSCPC in rabbit treated with the 1/16 power, which was more effective to reduce IOP than that with the 1/8 power. Tissue invasion to the ciliary body was negligible, nonpigmented epithelial cells of the pars plicata were damaged, basal infoldings were destroyed, and repair was accompanied by proliferating tissue. No IOP reduction or tissue change was observed in rabbit treated with the 1/32 power. Conclusion: A potential mechanism for IOP reduction in pigmented rabbits is aqueous humor transport dysfunction due to damage to the nonpigmented epithelial cells of the pars plicata and destruction of basal infoldings. The power of MP-TSCPC was consistent with both morphological changes and IOP reduction. [ABSTRACT FROM AUTHOR]

Purpose. To compare the clinical outcomes of the different treatments for acute primary angle closure (APAC). Methods. We retrospectively reviewed the clinical charts of 87 eyes of 87 patients undergoing treatment for APAC. We investigated the best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and secondary interventions after each treatment. Results. The pretreated IOP was 56.4 ± 9.0 mmHg. As the first treatment for APAC, all eyes underwent topical 2% pilocarpine and systemic mannitol administration. Subsequent laser iridotomy (LI) and lensectomy were necessary in 29 eyes (33%) and 35 eyes (40%), respectively. Bullous keratopathy developed in 1 eye (1%), and following glaucoma surgery was required in 7 eyes (8%). The BSCVA at the final follow-up was 0.16 ± 0.53 and 0.01 ± 0.20 logMAR (Mann–Whitney U test, p = 0.149), the IOP was 12.8 ± 2.6, and 12.6 ± 2.9 mmHg (p = 0.860), and the ECD was 2295.9 ± 658.2 and 2244.1 ± 622.0 cells/mm2 (p = 0.735) in the LI and lensectomy groups, respectively. Conclusions. Approximately 26% of eyes with APAC were resolved after the initial medical treatment, and subsequent surgical treatments, such as LI and lensectomy, were required in 33% and 40% of eyes, respectively. We found no significant differences in the BSCVA, the IOP, or the ECD among LI and lensectomy treatment groups. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the rate and time of occurrence of intraocular pressure (IOP) elevation early after trabectome surgery (TOM) and the characteristics of glaucoma patients recovering from IOP elevation. Method: Four hundred sixty eyes of 460 glaucoma (191 primary and 269 secondary open-angle glaucoma) patients who underwent TOM were evaluated. IOP elevation early after TOM was diagnosed when IOP increased by more than 5 mmHg over baseline within 1 week to 3 months. If the IOP decreased with the administration of anti-glaucoma eye drops alone, patients were classified as recovered. If the IOP did not decrease despite additional anti-glaucoma eye drop use, patients were classified as non-recovered. The rate and time of occurrence of IOP elevation early after TOM were investigated. Demographic and ocular variables related to recovery and non-recovery were identified by multivariate logistic regression analysis. Results: Of the 460 patients, IOP elevation early after TOM occurred in 102 (22.2%). IOP elevation occurred most frequently at postoperative week 1. Of the 102 patients with IOP elevation, 55 (53.9%) recovered and 47 (46.1%) did not. A large hyphema size the day after surgery was associated with increased likelihood of recovery from IOP elevation (odds ratio [OR], 6.6). A history of past selective laser trabeculoplasty (SLT; OR, 0.10) and high baseline IOP (OR, 0.86) were associated with reduced likelihood of recovery from IOP elevation. Conclusion: IOP elevation early after TOM occurred most frequently at postoperative week 1. Patients with a large hyphema size, no history of SLT, and a lower baseline IOP recovered from IOP elevation early after TOM. A large hyphema the day after surgery suggested an increased likelihood of recovery from IOP elevation. [ABSTRACT FROM AUTHOR]

Glaucoma surgery is performed to lower intraocular pressure (IOP); ideally, the IOP reduction is safely maintained for an extended period of time. Although trabeculectomy was considered the gold standard for glaucoma surgery for many years because of its effective IOP reduction, yet now it is considered unsafe because of serious complications. In recent years, minimally invasive glaucoma surgery (MIGS), which emphasizes safety and can be performed rapidly, has become widespread. Because MIGS does not involve conjunctival incisions, patients can undergo future trabeculectomy. If IOP reduction can be maintained safely, the number of anti-glaucoma drops can be reduced and visual function maintained, good outcomes for patients with glaucoma. Currently, many types of MIGS approved in Japan are reported to yield relatively good results, with targets of approximately 15–19 mmHg. However, the IOP-lowering effects of MIGS are limited. In procedures targeting Schlemm's canal, it is difficult to lower IOP beyond episcleral venous pressure. In some instances, a beneficial effect cannot be achieved if function is reduced beyond the collector channel. There are many unclear aspects regarding long-term outcomes following MIGS. Notably, investigation is ongoing to determine which patients are likely to benefit most from surgery. Based on previous reports, this review describes the characteristics and results of MIGS, approved in Japan, as well as underlying factors that affect the preoperative predictions and outcomes of the surgical procedure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 72-month clinical results of trabectome surgery (TOM) in patients with primary open-angle glaucoma (POAG), secondary OAG and childhood glaucoma. Method: A total of 305 eyes from 249 glaucoma patients were analyzed in the current retrospective single-center study. Kaplan-Meier analysis was performed using three criteria: criterion A (postoperative intraocular pressure [IOP] ≤ 21 mmHg and ≥ 20% reduction from baseline IOP); criterion B (postoperative IOP ≤ 18 mmHg and ≥ 20% reduction from baseline IOP); and criterion C (postoperative IOP ≤ 16 mmHg and ≥ 20% reduction from baseline IOP). The changes in IOP, medication score, success probability, results of the multivariate analysis for success and failure risk factors, and complications were analyzed. Results: The baseline IOP in all glaucoma patients decreased from 29.2 ± 9.8 mmHg with a 5.3 ± 1.7 medication score to 16.4 ± 5.8 mmHg (− 43.8%) with a 4.2 ± 1.5 medication score at 72 months (p < 0.01). The success probabilities in all cases for 72 months based on criterion A, B, and C were 44%, 35%, and 17%, respectively. For criterion A, no significant differences were found in the success probability according to the glaucoma subtype for 72 months. The combined surgical procedure significantly decreased the failure risk (hazard ratio [HR]: 0.59). On the other hand, the presence of POAG (HR: 1.6) and a history of past selective laser trabeculoplasty (HR: 2.2) significantly increased failure risk. One patient (0.3%) demonstrated endophthalmitis after TOM but recovered through appropriate treatment. Conclusion: At the 72-month time point, approximately half of the glaucoma patients maintained an IOP ≤ 21 mmHg with ≥ 20% IOP reduction. TOM is a safe surgery but may not yield sufficient IOP reduction in patients who have received SLT or have POAG. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of different levels of intraocular stray light on kinetic perimetry findings. Methods: Twenty-five eyes of 25 healthy young participants were examined by automated kinetic perimetry (Octopus 900) using Goldmann stimuli III4e, I4e, I3e, I2e, and I1e. Each stimulus was presented with a velocity of 3°/s at 24 meridians with 15° intervals. Four levels of intraocular stray light were induced using non-white opacity filter (WOF) filters and WOFs applied to the clear plastic eye covers of the participants. The visual acuity, pupil diameter, isopter area, and kinetic sensitivity of each meridian were analyzed for each WOF density. Results: Visual acuity deteriorated with increasing WOF densities (p < 0.01). With a visual acuity of 0.1 LogMAR units, the isopter areas for III4e, I4e, I3e, I2e, and I1e decreased by -32.7 degree2 (-0.2%), -255.7 degree2 (-2.6%), -381.2 degree2 (-6.2%), -314.8 degree2 (-12.8%), and -59.2 degree2 (-15.2%), respectively; kinetic sensitivity for those stimuli decreased by -0.1 degree (-0.1%), -0.8 degree (-1.4%), -1.6 degree (-3.7%), -2.7 degree (-9.7%), and -1.7 degree (-16.2%), respectively. The pupil diameter with each WOF density was not significantly different. Conclusion: Kinetic perimetry measurements with a high-intensity stimulus (i.e., III4e) were unaffected by intraocular stray light. In contrast, measurements with the I4e, I3e, I2e, and I1e stimuli, especially I2e and I1e, were affected. Changes in the shape of the isopter resulting from opacity must be monitored, especially in cases of smaller and lower-intensity stimuli. [ABSTRACT FROM AUTHOR]

. Purpose: To investigate the intraocular pressure (IOP) and corneal biomechanical properties of normal and normal-tension glaucoma (NTG) eyes. Methods: This study included 83 normal and 83 NTG eyes. We measured corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal resistance factor (CRF), corneal hysteresis (CH) and central corneal thickness (CCT) three times each for normal and NTG eyes using an Ocular Response Analyzer (ORA). Results: No significant difference in CCT was seen between normal eyes (541.4 ± 26.8 μm) and NTG eyes (535.4 ± 24.9 μm; p = 0.16). IOPcc was significantly higher in NTG eyes (16.1 ± 2.6 mmHg) than in normal eyes (15.1 ± 2.9 mmHg; p = 0.01), while IOPg was significantly lower in NTG eyes (14.1 ± 2.7 mmHg) than in normal eyes (15.1 ± 3.0 mmHg; p = 0.04). CRF and CH were significantly lower in NTG eyes (CRF, 8.9 ± 1.5 mmHg; CH, 9.2 ± 1.3 mmHg) than in normal eyes (CRF, 10.6 ± 1.4 mmHg; CH, 10.8 ± 1.3 mmHg; p < 0.0001 each). Conclusion: IOPcc was significantly higher in NTG eyes than in normal eyes. The ORA may be useful for distinguishing between the IOPcc of NTG eyes with normal IOP and that of normal eyes. In addition, the ORA enables CRF and CH to be measured in vivo, and weakness of the lamina cribrosa may be clinically inferred from the fact that CRF and CH were reduced in NTG eyes in our study. Low CRF and CH may be clues to the pathology of NTG. [ABSTRACT FROM AUTHOR]

To assess the effect of corneal astigmatism on intraocular pressure (IOP) measurements using an Ocular Response Analyzer (ORA) and a Goldmann applanation tonometer (GAT). We prospectively examined 59 normal eyes of 59 healthy volunteers (18 men, 41 women; age, mean ± standard deviation, 40.5 ± 14.2 years; age range, 19–68 years). We quantitatively assessed the values of corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPG) using an ORA (Reichert Ophthalmic Instruments). We also measured the IOP using a GAT (GAT-IOP). The amount of corneal astigmatism was assessed with an autokeratometer. We carried out these measurements three times, and the mean value obtained was used for statistical analysis. The mean IOPcc, IOPG, and GAT-IOP were 14.7 ± 2.6, 14.0 ± 2.8, and 14.2 ± 1.7 mmHg respectively. The mean corneal astigmatism was 0.94 ± 0.55 D. We found no significant correlation between IOPcc and corneal astigmatism (Pearson’s correlation coefficient r = −0.04, p = 0.79), or between IOPG and corneal astigmatism ( r = 0.09, p = 0.52). However, we found a weak, but significant, correlation between GAT-IOP and corneal astigmatism (Pearson’s correlation coefficient r = 0.34, p = 0.009). Both IOPcc and IOPG measured with ORA were less affected by the amount of corneal astigmatism, and the GAT-IOP readings were significantly higher in eyes with greater corneal astigmatism, suggesting that IOPcc as well as IOPG may be helpful for accurate IOP measurements in eyes with some corneal astigmatism. [ABSTRACT FROM AUTHOR]

To investigate intraocular pressure (IOP) measurement values in normal tension glaucoma (NTG) eyes using two different types of tonometer that are supposed to be little affected by corneal biochemical properties. This study included 30 normal eyes of 16 healthy subjects and 30 eyes of 16 patients with NTG. IOP was measured with a Goldmann applanation tonometer (GAT), a Pascal dynamic contour tonometer (DCT), and a Reichert ocular response analyzer (ORA) three times each for normal and NTG eyes. The main measures were GAT-IOP, DCT-IOP, corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), and central corneal thickness (CCT). In normal eyes, GAT-IOP was 13.2 ± 1.4 mmHg; DCT-IOP, 13.0 ± 1.6 mmHg; IOPcc, 13.6 ± 2.0 mmHg; and IOPg, 12.4 ± 2.0 mmHg. Multivariate analysis revealed no significant differences between the four measurements ( p = 0.08). CCT was 524.6 ± 27.3 microns. In NTG eyes, GAT-IOP was 13.1 ± 1.3 mmHg; DCT-IOP, 13.7 ± 1.3 mmHg; IOPcc, 15.2 ± 2.0 mmHg; and IOPg, 12.7 ± 2.0 mmHg. Multivariate analysis showed significant differences between the four measurements ( p < 0.01). Sheffé’s test showed that IOPcc was significantly higher than GAT-IOP, DCT-IOP, and IOPg (GAT-IOP vs IOPcc: p < 0.0001; DCT-IOP vs IOPcc: p = 0.01; IOPcc vs IOPg: p < 0.0001). CCT was 515.4 ± 32.9 microns, with no significant difference between normal and NTG eyes ( p = 0.15). We investigated the values of IOP in NTG eyes as measured by the DCT and ORA. IOPcc was significantly greater than GAT-IOP, DCT-IOP and IOPg in NTG eyes, suggesting the possibility that IOP values may be underestimated. [ABSTRACT FROM AUTHOR]

Brinzolamide is indicated for the reduction of intraocular pressure (IOP) in eyes with ocular hypertension or open-angle glaucoma. Brinzolamide is an effective inhibitor of carbonic anhydrase and lowers IOP by suppressing formation of aqueous humor in the eye. It is formulated as a 1% ophthalmic suspension, with a recommended dosing frequency of three times daily in USA and twice daily in many other locations, including the EU and Japan. The goals of this article are to summarize the preclinical data pertaining to brinzolamide, to review safety and efficacy data from Phase III and Phase IV clinical trials and to describe the role of brinzolamide in the management of glaucoma. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the time courses of angle opening parameters and the relationships of these with the corneal endothelial cell density (ECD) and the intraocular pressure (IOP) after posterior chamber phakic intraocular lens (Visian ICLTM, STAAR Surgical) implantation. We evaluated 116 eyes of 59 consecutive patients (mean age ± standard deviation, 34.0 ± 8.8 years) who underwent V5 implantable collamer lens (ICL) implantation. Preoperatively and 1 day, 1 week, and 1, 3, and 18 months postoperatively, we quantitatively measured the angle opening distance at 500 µm (AOD500), the trabecular-iris space area (TISA500), and the trabecular iris angle (TIA500), using anterior segment optical coherence tomography (CASIA 2, Tomey), and assessed the relationships of these measurements with ECD and IOP in ICL-implanted eyes. All angle parameters (AOD500, TISA500, and TIA500) significantly decreased 1 day postoperatively but remained stable thereafter. At 18 months postoperatively, we found no significant correlations of the angle parameters with ECD (Pearson correlation coefficient r = −0.108, p = 0.249 for AOD500; r = −0.162, p = 0.083 for TISA500; r = −0.022, p = 0.815 for TIA500) or between the angle parameters and IOP (r = −0.106, p = 0.256 for AOD500; r = −0.021, p = 0.826 for TISA500; r = −0.018, p = 0.850 for TIA500). The angle opening metrics significantly decreased immediately after ICL implantation but remained stable thereafter. Narrowing of the angle did not significantly affect ECD or IOP in ICL-implanted eyes during the 18-month postoperative period. [ABSTRACT FROM AUTHOR]