Steven L. Mansberger

Précis: Increasing lens thickness was the anterior segment parameter most associated with IOP spikes in glaucoma patients after cataract surgery. Purpose: To determine whether anterior segment anatomy is associated with intraocular pressure spike on postoperative day 1(POD1) after cataract surgery in participants with glaucoma. Methods: Optical biometry measured multiple eye parameters before cataract surgery in 48 eyes(39 participants) with glaucoma. Preoperative intraocular pressure(IOP) was the mean of 3 visits prior to cataract surgery and postoperative IOP on day 1 was defined as the IOP on POD1 after cataract surgery. Change in IOP was the difference between postoperative and preoperative IOP. A “5 mmHg IOP spike” and “10 mmHg IOP spike” were defined as POD1 IOP ≥ 21 mmHg with IOP ≥5 or ≥10 mmHg higher than preoperative IOP, respectively. Results: Mean POD1 IOP(22.8±8.8 mmHg) was significantly higher than mean preoperative IOP(15.3±3.6 mmHg, PP=.04 and P=.09, respectively), and increased LT was associated with a 10 mmHg IOP spike (P=.02). When using change in IOP, increased LT and lower number of preoperative medications were significant predictors of increased IOP after cataract surgery. Conclusions: IOP spikes were common in glaucoma patients after cataract surgery and were associated with anterior segment anatomy. Future studies may use risk factors to identify and prevent IOP spikes in glaucoma patients after cataract surgery.

To determine the associations of blindness within rural and urban counties using a registry of blind persons and geospatial analytics. We used the Oregon Commission for the Blind registry to determine the number of persons who are legally blind, as well as licensure data to determine the density of eye care providers (optometrists and ophthalmologists) within each county of the State of Oregon. We used geospatial statistics, analysis of variance, and logistic regression to determine the explanatory variables associated with blindness within counties. We included 8350 individuals who are legally blind within the state of Oregon in the calendar year 2015. The mean observed prevalence of registered blindness was 0.21% and ranged almost 9-fold from 0.04% to 0.58% among counties (p < .001). In univariate models, higher blindness was associated with increasing median age (p = .027), minority race (p < .001), decreased median household income (p < .001), increased poverty within a county (p < .001), and higher density of ophthalmologists (p = .003). Density of optometrists was not associated with prevalence of blindness (p = .89). The final multivariable model showed higher blindness to be associated with lower median household income, higher proportion of black race, and lower proportion of Hispanic race (p < .001 for all). Geospatial analytics identified counties with higher and lower than expected proportions of blindness even when adjusted for sociodemographic factors. Clinicians and researchers may use the methods and results of this study to better understand the distribution of individuals with blindness and the associated factors to help design public health interventions.

Précis: Short-term overall success rates were high with either SGDD or CPC. However, SGDD was associated with more clinic visits and an increased risk of additional glaucoma surgery. Both treatments were reasonable options for eyes with inadequately controlled IOP after a single GDD. Purpose: The purpose of this study is to compare the implantation of a second glaucoma drainage device (SGDD) and transscleral cyclophotocoagulation (CPC) in eyes with inadequately controlled intraocular pressure (IOP), despite the presence of a preexisting glaucoma drainage device. Methods: Patients with inadequately controlled IOP, despite the medical therapy and a preexisting glaucoma drainage device, were enrolled at 14 clinical centers and randomly assigned to treatment with a SGDD or CPC. Main Outcome Measures: Surgical failure was defined as: (1) IOP ≤5 mm Hg or >18 mm Hg or P=0.63). Although the study was underpowered, no significant differences in IOP, postoperative number of IOP-lowering medications, or adverse events were observed. The number of additional glaucoma surgeries (P=0.003), office visits during the first 3 months (PP<0.001) were greater in the SGDD group. Conclusions: Short-term overall success rates were high with either SGDD or CPC. However, SGDD was associated with more clinic visits and an increased risk of additional glaucoma surgery.

Précis: When compared with cataract surgery in glaucoma patients, trabecular micro-bypass and goniotomy resulted in a large decrease in the incidence of intraocular pressure (IOP) spikes, a modest effect on IOP, and a minimal effect on medication burden. Purpose: To compare changes in IOP and ocular hypotensive medications in 3 surgical cohorts: cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy). Materials and Methods: We included 138 eyes diagnosed with open-angle glaucoma: (1) 84 eyes with cataract surgery alone, (2) 25 eyes with cataract/trabecular surgery, and (3) 29 eyes with cataract/goniotomy surgery. We compared the groups for postoperative IOP and the number of ocular hypotensive medications. We adjusted for preoperative IOP, and preoperative and postoperative number of ocular hypotensive medications. We defined an IOP spike as IOP ≥21 mm Hg and 10 mm Hg higher than preoperative on postoperative day 1. Results: All 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively when compared with their own preoperative baselines. When compared with cataract surgery alone, cataract/trabecular and cataract/goniotomy had similar IOP lowering at 1 month postoperatively, and variable results at 3 and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy decreased IOP on postoperative day 1, and had relative risk reduction of ~70% for IOP spikes (P≤0.001 for both). Conclusion: Trabecular micro-bypass and goniotomy when added to cataract surgery resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden when compared with cataract surgery alone in glaucoma patients.