Mi Sun Sung

Background/Objectives: To describe the study protocol and baseline characteristics of participants in the Myopic Normal-Tension Glaucoma Treatment Study (MYNT-GTS), which is a randomized controlled trial evaluating the effect of intraocular pressure (IOP)-lowering treatment on glaucoma progression in eyes with myopic normal-tension glaucoma (NTG). Methods: A prospective, multicenter, randomized controlled clinical trial and baseline cross-sectional analysis. The study enrolled 473 treatment-naïve NTG eyes with myopia (spherical equivalent ≤ −1.0 diopters or axial length [AXL] > 24.0 mm) aged 20–60 years from 9 tertiary referral centers in South Korea. Participants were randomized at a 1:1 ratio into a treated group and an untreated group managed by active surveillance, and stratified by age, baseline IOP, AXL, and visual field (VF) mean deviation (MD). Treatment was initiated or intensified when predefined structural or functional progression was detected. Comprehensive examinations including quantitative assessments of the optic nerve head structure and microvasculature, medication adherence, and quality of life were performed every 4 months during the first year and every 6 months thereafter. Glaucoma progression was assessed from the rate of circumpapillary retinal nerve fiber layer (RNFL) thinning, and the rate of VF deterioration was assessed from the MD or visual field index (VFI). Results: The 473 enrolled participants comprised 239 assigned to the treated group and 234 to the untreated group. Most of the baseline variables did not differ significantly between the groups, including age (43.1 ± 9.1 vs. 43.9 ± 9.1 years [mean ± standard deviation], p = 0.33), baseline IOP (14.9 ± 2.6 vs. 14.7 ± 2.5 mmHg, p = 0.26), AXL (26.31 ± 1.37 vs. 26.32 ± 1.34 mm, p = 0.94), global RNFL thickness (79.5 ± 11.4 vs. 80.5 ± 13.2 μm, p = 0.38), and VF MD (−2.71 ± 2.58 vs. −2.32 ± 2.52 dB, p = 0.10). Conclusions: The vast majority of the analyzed variables did not differ significantly between the treated and untreated groups at baseline, supporting the validity of the subsequent comparisons. As the first prospective, multicenter randomized controlled trial dedicated to myopic NTG, the MYNT-GTS should clarify the efficacy of IOP-lowering treatment and inform the individualized management of myopic NTG. Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea, KCT0005225.

To evaluate the outcomes of a standardized 12-week oral valganciclovir regimen in Korean patients with CMV anterior uveitis and to identify predictors of recurrence. Eighteen eyes with PCR-confirmed CMV anterior uveitis were retrospectively analyzed. All patients received oral valganciclovir 900 mg twice daily for 6 weeks followed by 450 mg twice daily for 6 weeks, then were maintained on 0.15% topical ganciclovir ointment. Clinical parameters including intraocular pressure (IOP) and corneal endothelial cell density (ECD) and recurrence were evaluated. Median age was 51 years; 86.3% were male. During oral therapy, all patients achieved resolution of inflammation and keratic precipitates, with IOP control and reduction in glaucoma medications. No relapse occurred during treatment, but 13 patients (72.2%) recurred after discontinuation, median 4 weeks. Lower baseline and final ECD were seen in recurrence cases. Higher IOP at week 1 was significantly associated with recurrence (p = 0.047). Among relapsed patients, repeated oral therapy frequently led to further relapse, whereas compounded 2% topical ganciclovir achieved sustained remission in most. A standardized 12-week oral valganciclovir regimen was effective for induction but relapse after discontinuation was common. Early IOP response may predict recurrence, and prolonged maintenance with 2% topical ganciclovir could provide a practical option for high-risk patients.

This study aimed to compare the efficacies and safety of enhanced and standard monofocal intraocular lenses (IOLs) in eyes with early glaucoma. Patients with concurrent cataracts and open-angle glaucoma (OAG) were enrolled. They underwent cataract surgery with IOL implantation. The comprehensive preoperative ophthalmic examination included the manifest refraction; monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA); visual field (VF); and contrast sensitivity (CS); defocus curves and questionnaires were assessed three months postoperatively. Totals of 34 and 38 patients had enhanced and standard monofocal IOLs, respectively. The enhanced monofocal IOL provided better UIVA than the standard monofocal IOL (p = 0.003) but similar UDVA, CDVA, and UNVA. The enhanced monofocal IOL had more consistent defocus curves than the standard monofocal IOL, especially at −1 (p = 0.042) and −1.5 (p = 0.026) diopters. The enhanced monofocal IOL provided better satisfaction (p = 0.019) and lower spectacle dependence (p = 0.004) than the standard monofocal IOL for intermediate vision, with similar VF and CS outcomes. In conclusion, enhanced monofocal IOLs are recommended for patients with OAG because they provide better intermediate vision, higher satisfaction, and lower dependence on spectacles than standard monofocal IOLs, without worsening other visual outcomes.

This study aimed to compare the efficacies and safety of enhanced and standard monofocal intraocular lenses (IOLs) in eyes with early glaucoma. Patients with concurrent cataracts and open-angle glaucoma (OAG) were enrolled. They underwent cataract surgery with IOL implantation. Manifest refraction; monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA); visual field (VF); contrast sensitivity (CS); defocus curves and questionnaires were assessed three months postoperatively. Thirty-four and 38 patients had enhanced and standard monofocal IOLs, respectively. The enhanced monofocal IOL provided better UIVA than the standard monofocal IOL (p = 0.003) but similar UDVA, CDVA and UNVA. The enhanced monofocal IOL had more consistent defocus curves than the standard monofocal IOL, especially at -1 (p = 0.042) and -1.5 (p = 0.026) diopters. The enhanced monofocal IOL provided better satisfaction (p = 0.019) and lower spectacle dependence (p = 0.004) than the standard monofocal IOL for intermediate vision, with similar VF and CS. In conclusion, the enhanced monofocal IOL is recommended for patients with OAG because they provide better intermediate vision, higher satisfaction, and lower dependence on spectacles than standard monofocal IOL, without worsening other visual outcomes.

We aimed to investigate the effects of different concentrations of vascular endothelial growth factor (VEGF) on the extracellular matrix (ECM) and fibrotic proteins in human trabecular meshwork (TM) cells. We also explored how the Yes-associated protein (YAP)/transcriptional co-activator with PDZ-binding motif (TAZ) signaling pathway modulates VEGF-induced fibrosis. We determined cross-linked actin network (CLAN) formation using TM cells. Changes in fibrotic and ECM protein expression were determined. High VEGF concentrations (10 and 30 ng/mL) increased TAZ and decreased p-TAZ/TAZ expression in TM cells. Western blotting and real-time PCR revealed no YAP expression changes. Fibrotic and ECM protein expression decreased at low VEGF concentrations (1 and 10 ρg/mL) and significantly increased at high VEGF concentrations (10 and 30 ng/mL). CLAN formation increased in TM cells treated with high VEGF concentrations. Moreover, TAZ inhibition by verteporfin (1 μM) rescued TM cells from high-VEGF-concentration-induced fibrosis. Low VEGF concentrations reduced fibrotic changes, whereas high VEGF concentrations accelerated fibrosis and CLAN formations in TM cells in a TAZ-dependent manner. These findings reflect the dose-dependent influences of VEGF on TM cells. Moreover, TAZ inhibition might be a therapeutic target for VEGF-induced TM dysfunction.

This study aimed to comprehensively analyze various parameters in advanced glaucoma patients to identify the factors that can affect best-corrected visual acuity (BCVA) in advanced glaucoma. This cross-sectional retrospective study included 113 patients (mean age, 61.66 ± 13.26 years; males, 67) who had advanced glaucomatous damage (113 eyes; mean BCVA, 0.18 ± 0.38 logMAR; mean deviation of 30-2 visual field [VF], −19.08 ± 6.23 dB). Peripapillary retinal nerve fiber layer (RNFL) and total and segmented macular thickness (RNFL, ganglion cell layer (GCL), and inner plexiform layer (GCL)) were measured using Spectralis optical coherence tomography (OCT). Correlations between BCVA and OCT parameters or 30-2 VF parameters were assessed using Pearson correlation analysis. Multivariate regression analysis was performed to determine the factors associated with BCVA in advanced glaucoma patients. Peripapillary RNFL thickness, subfoveal choroidal thickness, and global macular RNFL, GCL, IPL, and total thickness were found to be significantly correlated with BCVA and central visual function. Multivariate analysis showed a significant correlation between subfoveal choroidal thickness and BCVA. In addition, central VF mean sensitivity, especially inferior hemifield, showed a significant relationship with BCVA. In conclusion, subfoveal choroidal thickness and central VF sensitivity, especially the inferior hemifield area, are factors that affect BCVA in advanced glaucoma.

BackgroundTo investigate the long-term visual field (VF) outcome and baseline factors associated with functional sequelae in patients who experienced an episode of acute primary angle closure (APAC) and underwent subsequent lens extraction. MethodsFifty patients (50 eyes) who experienced an APAC episode and underwent subsequent lens extraction at Chonnam National University Hospital were enrolled in this retrospective study. Patients underwent VF examinations after 1 year of an acute episode. They were classified into two groups based on whether they had significant VF defects or not. Demographic data were recorded, and baseline anterior-segment OCT (AS-OCT) images were analysed. Multivariate logistic regression analysis was performed to assess baseline risk factors for presence of VF defects. ResultsTwenty-five (50%) eyes were found to have varied degree of VF defects after 1 year of an acute episode. Longer duration between the symptom onset and IOP lowering (p = 0.005), a higher presenting IOP (p = 0.014), and flat iris curvature (p = 0.037) at baseline AS-OCT measurement were significant predictors of VF loss. The area under the receiver operating characteristic curve (AUC) revealed that combination of these three potential baseline factors could predict the long-term VF outcome (AUC = 0.921). ConclusionsPatients exhibiting a long duration between symptom onset and IOP lowering, a high presenting IOP, and flat iris curvature were at a higher risk of visual impairment after an episode of APAC. The eyes with such features may require more careful follow-up after an episode of APAC.

Background: To investigate long-term outcomes of prediction error after phacotrabeculectomy and to determine risk factors that may cause unstable prediction error after phacotrabeculectomy in glaucoma patients. Methods: A total 120 eyes of 120 patients who had underwent uncomplicated phacotrabeculectomy (combined group) or phacoemulsification (phaco-only group) were included. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) were measured before and after surgery, and anterior segment parameters including anterior chamber depth (ACD), lens vault (LV), and anterior vault (AV) measured using anterior-segment optical coherence tomography were compared between the two groups. The mean absolute error (MAE) at 3, 6, 12, and 24 months postoperatively were compared. Risk factors associated with unstable prediction error (MAE ≥ 0.5) were investigated in the combined group. Results: In both groups, BCVA was improved and IOP was decreased significantly. MAE at 3, 6, 12, 24 months postoperatively were not significantly different between two groups. The risk factors for unstable prediction error after 12 months of phacotrabeculectomy were old age and LV. Whereas, the only factor predicting unstable prediction error after 24 months of phacotrabeculectomy was LV. The cut-off value of LV for predicting unstable refractive error analyzed by the ROC curve was 0.855 mm. Conclusions: Phacotrabeculectomy may be an effective treatment with stable long-term outcomes of prediction error similar to phacoemulsification in patients with glaucoma. However, elderly patients or patients with large LV may be predisposed to unstable prediction error after phacotrabeculectomy.