Combined phacoemulsification and trabeculectomy is able to achieve greater reduction in intraocular pressure (IOP), higher rates of complete surgical success and fewer postoperative manipulations and visits compared with combined phacoemulsification and Xen implantation in glaucomatous eyes.Purpose: Our study aims to compare and understand the differences between the efficacy and safety of XEN45 implantation and trabeculectomy in Asian eyes with glaucoma. Materials and Methods: This was a retrospective, single-center, comparative study of consecutive patients who underwent combined phacoemulsification and trabeculectomy (Phaco-Trab) from January 2013 to June 2014 and combined phacoemulsification and XEN45 implantation (Phaco-Xen) from May 2017 to September 2018 in a tertiary Ophthalmology center in Singapore. Outcome measures included IOP, number of anti-glaucoma eyedrops, success rate, factors leading to success/failure, number of postoperative interventions and visits required, and surgical complications.Results: A total of 137 eyes (91 Phaco-Trab, 46 Phaco-Xen) were included. Phaco-Trab group had greater mean IOP reduction at all time points beyond postoperative month (POM) 1 (mean difference 2.9 to 3.8 mm Hg; P < 0.05), and greater reduction in mean number of antiglaucoma eyedrops beyond POM3, thought this was not statistically significant. At POM12, complete success was achieved in 83.5% in Phaco-Trab and 52.2% of Phaco-Xen group, respectively (P < 0.001). There was no significant factor associated with surgical failure, other than the difference in surgical procedure. Phaco-Trab group required fewer number of postoperative interventions (P = 0.009), with only a mean of 0.1 bleb interventions required per patient, versus 1.5 in Phaco-Xen group (P < 0.001). Safety profiles in both groups were comparable, with no statistically significant difference in intraoperative/postoperative complications. Conclusion:Phaco-Trab has significantly higher reduction in both IOP and number of antiglaucoma medications compared with Phaco-Xen group, with greater surgical success and fewer postoperative manipulations and visits. Safety profiles were comparable.

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Background To understand the differences between two different optical coherence tomography angiography (OCTA) devices in detecting glaucomatous from healthy eyes by comparing their vascular parameters, diagnostic accuracy and test-retest reliability. Methods A cross-sectional observational study was performed on healthy and glaucoma subjects, on whom two sets of OCTA images of optic disc and macula were acquired using both AngioVue (Optovue, USA) and Swept Source (Topcon, Japan) OCTA devices during one visit. A novel in-house software was used to calculate the vessel densities. Diagnostic accuracy of the machines in differentiating healthy versus glaucomatous eyes was determined using area under the receiver operating characteristic curve (AUROC) and test-retest repeatability of the machines was also evaluated. Results A total of 80 healthy and 38 glaucomatous eyes were evaluated. Glaucomatous eyes had reduced mean vessel density compared to healthy controls in all segmented layers of the optic disc and macula using AngioVue (p ≤ 0.001). However, glaucomatous eyes had higher mean vessel density on optic disc scans using Swept Source, with lack of statistically significant difference between healthy and glaucomatous eyes. The AUROC showed better diagnostic accuracy of AngioVue (0.761–1.000) compared to Swept Source (0.113–0.644). The test-retest reliability indices were generally better using AngioVue than Swept Source. Conclusions AngioVue showed better diagnostic capability and test-retest reliability compared to Swept Source. Further studies need to be undertaken to evaluate if there is any significant difference between the various machines in diagnosing and monitoring glaucoma.

The iCare HOME tonometer is a useful tool which can be used by patients for fairly accurate and reliable self-measurement of intraocular pressure (IOP).Purpose: The aim was to compare the accuracy of IOP measurements of trained glaucoma patients using the iCare HOME tonometer before and after a week of self-monitoring at home and study the repeatability of patient measurements done at home. Materials and Methods:A total of 40 glaucoma patients had IOPs measured using the Goldmann applanation tonometer and the iCare HOME. Patients were trained to use the iCare HOME and measured their IOP twice daily over a loan period of 7 days. Bland-Altman analysis was used to assess agreement between Goldmann applanation tonometer and iCare HOME readings. Intraclass correlation coefficient compared inter-rater reliability of iCare HOME measurements, and test-retest variability for the patient's readings over the 7-day period were analyzed. A 5-point Likert scale questionnaire was used to assess the patient's experience with the device.Results: Up to 32 patients (80%) were able to obtain IOP readings within 3 mm Hg of the glaucoma nurse clinician's readings at the preloan visit, and up to 36 patients (90%) at the postloan visit. Good inter-rater reliability was observed between iCare HOME measurements by the glaucoma nurse clinician and patients. At the postloan visit, inter-rater reliability was good for right eye readings and excellent for left eye readings. No distinct trend in test-retest variability was identified over the 7-day period. 65% of patients agreed the device was easy to use and 89% would recommend the device to other glaucoma patients. Conclusion:Patients trained to use the iCare HOME device can do so with fair accuracy compared with trainers with accuracy improving within 1 week of usage.

Background Glaucoma is the leading cause of irreversible blindness. Normal tension glaucoma (NTG) is a subset of open-angle glaucoma, demonstrating glaucomatous optic nerve damage in the absence of raised intraocular pressure (IOP). NTG is more prevalent in Asian populations. While generally slow-progressing, NTG may be associated with significant central visual field loss. In recent years, minimally invasive glaucoma surgery has been added to the armamentarium of glaucoma surgery. This prospective study aims to evaluate 12-month surgical outcomes of combined iStent inject (Glaukos Corporation, Laguna Hills, CA) implantation and phacoemulsification in Asian eyes with NTG. Methods This is a prospective, single-centre case series of 30 eyes followed up until 12 months after surgery. Outcome measures included IOP, number of glaucoma medications, best-corrected visual acuity (BCVA) and intra and postoperative complications. Results Mean age of subjects was 73.1 ± 6.3 years. Majority were ethnic Chinese (n = 27, 90%). Baseline medicated mean IOP was 13.8 ± 2.4 mmHg and mean number of glaucoma medications was 1.3 ± 0.7. Mean Humphrey visual field mean deviation was − 13.7 ± 7.6. The mean IOP reduction at all timepoints from postoperative month (POM) 3 onwards was statistically significant (all P < 0.05), with mean reduction of 1.2 mmHg (95% CI: 0.1–2.2, P = 0.037) by POM12. There was statistically significant reduction in mean number of medications from postoperative day (POD) 1 onwards (all P < 0.05), with mean decrease of 1.0 medication (95% CI: 0.9–1.1, P < 0.001) by POM12. By POM12, 25 (83.3%) eyes were medication-free. Three (10%) eyes had stent occlusion by iris requiring laser iridoplasty. One eye had gross hyphema which resolved on conservative management before POM1. Mean BCVA improved from the baseline 0.3 ± 0.3 logMAR to 0.1 ± 0.1 logMAR postoperatively (P < 0.001). There were no major adverse or sight-threatening events. No eyes required further glaucoma surgery during the 12-month follow-up period. Conclusion Asian eyes with NTG which underwent combined iStent inject implantation and phacoemulsification demonstrated a significant and sustained reduction in IOP and glaucoma medications, up to 12 months postoperatively.