Purpose: Nycthemeral (24-hour) glaucoma inpatient intraocular pressure (IOP) monitoring has been used in Europe for more than 100 years to detect peaks missed during regular office hours. Data supporting this practice is lacking, partially because it is difficult to correlate manually drawn IOP curves to objective glaucoma progression. To address this, we deployed automated IOP data extraction tools and tested for a correlation to a progressive retinal nerve fiber layer loss on spectral-domain optical coherence tomography (SDOCT). Methods: We created and deployed a machine-learning image analysis software to extract IOP data from hand-drawn, nycthemeral IOP curves of 225 retrospectively identified glaucoma patients. The relationship between demographic parameters, IOP and mean ocular perfusion pressure (MOPP) data to SDOCT data was analyzed. Sensitivities and specificities for the historical cut-off values of 15 mmHg and 22 mmHg in detecting glaucoma progression were calculated. Results: IOP data could be extracted efficiently. The IOP average was 15.2±4.0 mmHg, nycthemeral IOP variation was 6.9±4.2 mmHg, and MOPP was 59.1±8.9 mmHg. Peak IOP occurred at 10 AM and trough at 9 PM. Disease progression occurred mainly in the temporal-superior and -inferior SDOCT sectors. No correlation could be established between demographic, IOP, or MOPP parameters and SDOCT disease progression. The sensitivity and specificity of both cut-off points (15 and 22 mmHg) were insufficient to be clinically useful. Outpatient IOPs were non-inferior to nycthemeral IOPs. Conclusion: IOP data obtained during a single visit make for a poor diagnostic tool, no matter whether obtained using nycthemeral measurements or during outpatient hours.

Although most jurisdictions allow stereoscopically deficient and monocular individuals to drive, studies regarding these visual components' effects on driving have to date yielded contradicting results. Interviews, record reviews, and experiments have been used to unmask these effects. In interviews, participants with amblyopia reported several difficulties operating automobiles. Record reviews yielded mixed results, with studies revealing an increased crash rate and/or severity in a group of stereoscopically deficient commercial drivers, whereas studies of non-commercial drivers failed to make that association. Furthermore, experimental studies showed that individuals with reduced stereopsis braked earlier and were less likely to crash. With regard to monocularity, real-life experiments failed to demonstrate a poorer driving performance and simulation studies showed that drivers with sudden monocularity were more likely to crash and drive off the road. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):6–12.]

We investigated whether trabeculopuncture (TP) could detect distal outflow resistance to predict the outcome of canal-based glaucoma surgery such as ab interno trabeculectomy (AIT). These procedures have a high utilization in open angle glaucoma, but fail in eyes with an unidentified distal outflow resistance. We assigned 81 porcine eyes to two groups: trial (n = 42) and control (n = 39). At 24 h, four YAG-laser trabeculopunctures were placed nasally, followed by a 180° AIT at the same site at 48 h. The proportion of TP responders between both AIT groups was compared. Histology and outflow canalograms were determined. Both post-TP and post-AIT IOPs were lower than baseline IOP (p = 0.015 and p < 0.01, respectively). The success rates of TP and AIT were 69% and 85.7%, respectively. Sensitivity and specificity values of TP as predictive test for AIT success were 77.7% and 83.3%, respectively. The positive and negative predictive values were 96.6% and 38.5%, respectively. We conclude that a 10% reduction in IOP after TP can be used as a predictor for the success (> 20% IOP decrease) of 180° AIT in porcine eyes.

Purpose: We hypothesized that a recently introduced epibulbar micro-shunt (PRESERFLO, P) produces nycthemeral (24h) intraocular pressure (IOP) profiles different from ab-interno trabeculectomy (Trabectome, T). P is a flow restrictor that drains fluid into the sub-tenon space. In contrast, T increases conventional outflow, which is limited by episcleral venous pressure. Methods: In this prospective cohort, we analyzed 68 patients (34 P and 34 T) who presented for 24-h IOP monitoring 6 to 12 months after surgery. IOP and tonographic outflow facility were measured in the habitual position using a pneumatonometer. The IOP variation was considered the primary outcome measure. Glaucoma medications were also compared. Results: P had a higher baseline IOP than T (24.8&plusmn;10.0 vs. 17.3&plusmn;7.9 mmHg, p=0.001). Postoperatively, P and T had similar nycthemeral IOP profiles, but IOP in P was significantly lower than in T, except at 4 pm. P had a lower absolute IOP variation than T (5.8&plusmn;2.6 vs. 7.1&plusmn;2.7 mmHg, p=0.049). The relative IOP variation was similar in both (34.8&plusmn;13.2 vs. 37.2&plusmn;13.1, p=0.45) as was the tonographic outflow facility (0.35&plusmn;0.23 vs. 0.26&plusmn;0.18 &micro;l/min/mmHg, p=0.097). Conclusion: Nycthemeral IOP profiles of P and T were similar, but P had lower IOPs and less variation than T. This could reflect how T, unlike P, is more impacted by habitual, positional factors, especially at night.

Purpose: This study aimed at comparing two approaches for the implantation of PRESERFLO microshunts. The standardized approach (A) is an anterior approach that necessitates performing a 6-8 mm perilimbal peritomy. The second approach (P) merely required a 3 mm incision, about 2 mm away from the limbus. Methods: 126 patients, who received PRESERFLO microshunts, were retrospectively examined. Parameters compared included intraocular pressure (IOP), surgical time, medication count and complications. The follow-up duration was 9 months. Results: The baseline IOP was 21.8±8.5 mmHg and 23.9±8.1 mmHg, in A and P, respectively (p=0.08). Surgical duration differed significantly between groups (26±0.8 vs 10±0.4 minutes for A and P, respectively; p<0.001). Postoperative IOP levels were at 10.8±5.9 mmHg in A and 10.6±4.5 mmHg in P at 30 days (p=0.62) and remained thereafter similar throughout the study (all intra-group p-values>0.08). Additionally, no significant differences were recorded between groups at any point in time. Preoperative medication count was 3.2±1.3 drops in A and 3.3±1.0 drops in P(p=0.4). Postoperative values were 0.2±0.6 in A and 0.3±0.7 in P at 9 months. Both groups exhibited similar numbers of complications and surgical revisions (p-values>0.05). Conclusion: Both techniques showed satisfactory IOP and medication count reductions as well as similar safety profiles, with the posterior incision technique being 2.6 times faster than the anterior incision approach.