Daniella Bach‐Holm

Purpose: To compare the inflammatory response in the eye after trabeculectomy to after phacoemulsification, focusing on anterior chamber flare (AC flare) and central macular thickness (CMT). Methods: Data from 436 participants in two randomized controlled trials were analysed. Anterior chamber flare was measured in 69 participants undergoing trabeculectomy and 367 participants undergoing phacoemulsification preoperatively. Postoperative assessments were made on day 7 in trabeculectomy participants and on day 3 in phacoemulsification participants. CMT was assessed at baseline and 3 months postoperatively in both groups and 4 weeks postoperatively for trabeculectomy participants and 3 weeks postoperatively for phacoemulsification participants. Results: At baseline, AC flare and CMT were comparable between the groups. Early postoperatively, AC flare was 22.1 ph/ms [95% CI 19.1, 25.7] for trabeculectomy and 18.9 ph/ms [95% CI 17.8, 20.2] for phacoemulsification. Both groups significantly increased in AC flare from their baseline values, but the difference in increase between them was not significant ( p = 0.46). In the trabeculectomy group, CMT showed no significant increase at 4 weeks but a significant rise of 2.3 microns from baseline to 3 months from 241 microns [95% CI 235.9, 246.1] to 243.3 microns [95% CI 237.6, 249.1] ( p = 0.038). In the phacoemulsification group, CMT was significantly increased at 3 weeks and remained significantly elevated at 3 months from 242.6 microns [95% CI 240.4, 244.8] to 249.8 microns [95% CI 247.3, 252.4], increased by 7.2 microns ( p < 0.0001). CMT increased significantly more after phacoemulsification compared to trabeculectomy at 3 to 4 weeks ( p = 0.014) and 3 months ( p < 0.0001) with respect to baseline values. Conclusion: No significant difference in AC flare was found between trabeculectomy and phacoemulsification participants at baseline and early postoperatively. CMT did not increase at 4 weeks but increased significantly at 3 months after trabeculectomy. Phacoemulsification led to a significantly higher CMT increase at both 3 weeks and 3 months with respect to baseline compared to trabeculectomy.

Purpose: To compare bleb morphology after trabeculectomy using a visual grading system, the Indiana Bleb Appearance Grading Scale (IBAGS) and anterior segment optical coherence tomography (AS‐OCT). Methods: Fifty‐seven patients who underwent trabeculectomy were included in this study. Clinical evaluations of the bleb and imaging with anterior segment OCT were conducted 12 months postoperatively. Bleb assessments were performed using a slit‐lamp microscope with the IBAGS and a 3D AS‐OCT CASIA2. Results: Bleb height evaluations from IBAGS and AS‐OCT measurements showed a moderate positive correlation ( p = 0.03), indicating alignment between the two systems. IBAGS variables explained about 16% of the variance in IOP, with a significant negative relationship between bleb height and IOP (for each unit increase in bleb height, IOP decreased by 1.9 mmHg; p = 0.03). The overall model fit was significant for IBAGS ( p = 0.03) but not for AS‐OCT ( p = 0.2), suggesting that IBAGS may be more relevant for predicting IOP. Conclusion: IBAGS demonstrated a stronger association with IOP, suggesting its greater relevance in assessing trabeculectomy bleb morphology for predicting surgical success. Additionally, we found a significant correlation between bleb height measurements obtained from IBAGS and the AS‐OCT system. By integrating both systems, a more comprehensive approach to monitoring bleb function can be achieved, ultimately improving the accuracy of postoperative glaucoma management.

To investigate levels of specific plasma-biomarkers related to neurodegeneration and inflammation in patients with different chronic degenerative retinal diseases, using an ultrasensitive technology called ‘single molecule array’ (SiMoA). Also, to investigate if biomarkers were measurable in the patient’s blood, dependent on age and medical comorbidities, and useful for stratifying the diseases. This exploratory, cross-sectional study recruited 151 adults at the Department of Ophthalmology, Rigshospitalet, Denmark (period 2019 to 2020). Clinical data came from the electronic medical-record system. The study population consisted of 131 patients: 32 with diabetic retinopathy (DR; 51 diabetes, DM), 27 with glaucoma, 53 with inherited retinal degeneration (IRD and 20 healthy controls (HC). Medical comorbidities included organ failure, other active eye diseases, and comorbidities. Three biomarkers, neurofilament-light-chain (NFL), glial-fibrillary-acidic-protein (GFAP), and CXC-motif chemokine ligand 13 (CXCL13), were measured with SiMoA technology. The age-adjusted values were reported as fold differences (FD) with 95% confidence intervals (CI). Increased NFL levels were found in DR patients compared to HCs (FD 1.81 95%CI 1.43, 2.28, p < 0.001, adj-p < 0.001). Similarly increased NFL levels were reported in advanced DR (PDR, DME), compared to both DM (FD 2.52 (95%CI: 1.71; 3.72, p < 0.001, adj-p < 0.001, and FD 2.04 (95%CI: 1.33; 3.12, p < 0.001, adj-p < 0.001), respectively) and HCs (FD 2.35 (95%CI: 1.67; 3.30, p < 0.001, adj-p < 0.001), and FD 1.89 (95%CI: 1.28; 2.79, p < 0.001, adj-p < 0.001) respectively). Independent of comorbidities, decreased NFL-levels were seen in IRD compared to DR (FD 0.49 (95% CI 0.39; 0.61, p < 0.001; adj-p < 0.001), ±comorbidities). Decreased GFAP levels were seen in DM patients compared to HCs (FD 0.69; 95%CI 0.55, 0.87, p = 0.002, adj-p = 0.02), but contrary to an increasing trend in advanced DR compared to DM (-comorbidities). These results imply that these biomarker-tests are useful for detecting and monitoring development of retinopathy in the circulations of diabetes patients. Plasma-biomarkers may be useful to stratify between retinal disease types. Prospective studies are underway to explore this hypothesis in depth.

Purpose: Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic–pituitary–adrenal axis suppression. We wish to compare glaucoma outcomes following high‐dose and low‐dose glucocorticoid treatment after paediatric cataract surgery.Methods: This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low‐dose or high‐dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High‐dose treatment included 0.5–1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6–8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low‐dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.Results: Overall, 267 children (388 eyes) were included in the study. Ninety‐five children (133 eyes) had received high‐dose treatment and had a median follow‐up time of 89 months (IQR: 57.2–107.4), while 173 children (255 eyes) had received the low‐dose treatment and had a median follow‐up time of 40.5 months (IQR: 22.9–60.4). Survival curves showed a lower risk of glaucoma in the low‐dose group for children with axial lengths ≥18 mm.Conclusion: Low‐dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High‐dose glucocorticoid should be limited in children undergoing cataract surgery.

Purpose: To investigate visual development and long‐term complications after cataract surgery in childhood.Methods: This cross‐sectional study included patients from a family with Marner's hereditary cataracts who had cataract surgery before 18 years of age. The study was conducted from 1 January 2022 until 31 December 2022. The patients contributed to their medical files and participated in an updated ophthalmologic examination.Results: We included 52 patients (101 eyes, 34 females). The median age at cataract surgery was 7 years (IQR: 5–10) and the age at examination was 40 years (IQR: 21–54). Primary and secondary intraocular lens implantation had been performed in 47.5% (25 patients, 48 eyes) and 16.8% (10 patients, 17 eyes). Visual acuity was ≤0.3 logMAR in 77% (78 eyes), and 6 dB) in 24% (24 eyes). Thirty‐five patients (67%) held a driver's licence, and three were not allowed to drive due to low visual function. All patients were employed.Conclusion: After cataract surgery in childhood, many patients achieve normal visual acuity, but mild visual field loss is common. Long‐term follow‐up is important due to the high risk of glaucoma.

Purpose: To determine vision‐related quality of life (VR‐QoL) and functional and structural parameters associated with VR‐QoL in patients with glaucoma before and 12 months after trabeculectomy.Methods: Fifty‐eight patients undergoing trabeculectomy were included. Participants completed the 25‐item National Eye Institute Visual Function Questionnaire (VFQ‐25) prior to and 12 months after trabeculectomy. Functional (visual acuity and visual fields) and structural (ganglion cell layer volume) parameters were evaluated for their association with VR‐QoL using multiple linear regression of VFQ‐25 subscale scores. Intraocular pressure and the number of glaucoma medications were also included in the analyses.Results: The VFQ‐25 composite score did not change after trabeculectomy (before: 74.9; 12 months: 74.0; p = 0.512). The subscale mental health had a significantly higher score 12 months after trabeculectomy (before: 65.6; 12 months: 71.4; p = 0.017). The VFQ‐25 scores for general health (before: 68.5; 12 months: 62.5; p = 0.009) and role difficulties (before: 78.9; 12 months: 53.7; p < 0.001) were significantly lower 12 months after trabeculectomy. No functional or structural parameters were associated with VFQ‐25 composite score.Conclusion: Overall, VR‐QoL in glaucoma patients was similar before and after trabeculectomy, reflecting the procedure's stabilizing effect on both objective and subjective visual function. The absence of correlations between VR‐QoL and clinical parameters emphasizes the multifaceted nature of VR‐QoL and highlights the limitations of depending solely on objective clinical metrics to evaluate patients' subjective experiences. Using both objective measures and VR‐QoL, clinicians can better understand the challenges patients face due to glaucoma and trabeculectomy, potentially leading to better solutions.

This prospective randomized controlled trial aimed to compare the efficacy and safety of topical preservative-free diclofenac (DICLO) to dexamethasone (DEX) eyedrops, and their combination (DEX+DICLO) after trabeculectomy. Sixty-nine patients with medically uncontrolled glaucoma were randomized to receive topical postoperative treatment with DICLO (n = 23), DEX (n = 23), or a combination of DEX and DICLO (n = 23). The primary outcome was the intraocular pressure (IOP) 12 months postoperatively. Secondary outcomes included surgical success, failure, visual field, and visual acuity from baseline to 12 months postoperatively. IOP reached the lowest point one day after trabeculectomy. At 12 months, IOP was 10.0 mmHg (95% CI, 8.4–11.6 mmHg) for DICLO, 10.9 mmHg (95% CI, 9.4–12.3 mmHg) for DEX, and 11.2 mmHg (95% CI, 9.1–13.3 mmHg) for DEX+DICLO. There were no significant differences in IOP, surgical success, failure, visual field, or visual acuity between the DICLO, DEX, or DEX+DICLO groups. We found that topical diclofenac was not statistically different from topical dexamethasone in controlling IOP 12 months after trabeculectomy. Combining diclofenac and dexamethasone offered no added IOP control compared to dexamethasone alone.

Stickler syndrome (STL) is a collagenopathy caused by pathogenic variants in collagen-coding genes, mainly COL2A1 or COL11A1 associated with Stickler syndrome type 1 (STL1) or type 2 (STL2), respectively. Affected individuals manifest ocular, auditory, articular, and craniofacial findings in varying degrees. Previous literature and case reports describe high variability in clinical findings for patients with STL. With this case report, we broaden the clinical spectrum of the phenotype. Case report on two members of a family (mother and son) including clinical examination and genetic testing using targeted trio whole exome sequencing (trio-WES). A boy and his mother presented with microphthalmia, congenital cataract, ptosis, and moderate-to-severe sensorineural hearing loss. Trio-WES found a novel heterozygote missense variant, c.4526A>G; p(Gln1509Arg) in COL11A1 in both affected individuals. We report a previously undescribed phenotype associated with a COL11A1-variant in a mother and son, expanding the spectrum for phenotype-genotype correlation in STL2, presenting with microphthalmia, congenital cataract, and ptosis not normally associated with Stickler syndrome.

Purpose: To examine the long‐term risk of glaucoma after cataract surgery in childhood. Methods: This study took place from January 2022 until December 2022 and included patients from a large family with hereditary childhood cataract who had cataract surgery before 18 years of age. Patients underwent an ophthalmologic examination to determine the presence of glaucoma or ocular hypertension (OHT). Patients who did not want to participate in the examination could contribute with a medical journal from their treating ophthalmologist. The risk of long‐term glaucoma was determined using survival analysis, and risk factors were assessed using a Cox proportional hazards regression model. Results: We included 68 patients (133 eyes) with a median age at cataract surgery of 7 years (IQR: 5–10). The median follow‐up time after cataract surgery to glaucoma/OHT or the latest ophthalmologic examination was 35 years (IQR: 15–48). Twelve patients (18 eyes) had glaucoma, and five patients (eight eyes) had OHT, resulting in 15 patients with glaucoma/OHT. The long‐term risk of glaucoma/OHT diagnosed in adulthood was 47.7% (CI: 21.8–70.9) at the age of 70 years of patients who were free of glaucoma before their 18th year. We could not confirm or dismiss an association between glaucoma/OHT and sex, age at surgery, number of ocular interventions before 18 years of age or glaucoma after cataract surgery in a first‐degree relative. Conclusion: Cataract surgery in childhood is associated with a high risk of late‐onset glaucoma. Regular lifelong follow‐up is important to ensure early diagnosis and prevent extensive vision loss.