Wungrak Choi

Purpose: This study aimed to compare the intraocular pressure (IOP)-lowering efficacy, incidence of adverse effects, tolerability, and patient satisfaction of omidenepag isopropyl 0.002% and latanoprost 0.005% in a real-world clinical setting.Methods: A total of 100 patients with glaucoma were randomized to receive either omidenepag isopropyl or latanoprost. Changes in IOP, the incidence of adverse effects, and patient satisfaction were assessed at 1 and 6 months after treatment initiation.Results: Ninety patients were included in the final analysis. At 1 month, the reduction in IOP was significantly greater in the latanoprost group (−1.98 ± 2.09 mmHg) than in the omidenepag isopropyl group (−1.07 ± 1.86 mmHg; p = 0.034). However, no significant difference between groups was observed at 6 months (−2.43 ± 2.68 mmHg vs. −1.73 ± 2.34 mmHg; p = 0.189). The incidence of adverse effects did not differ significantly between the two groups with the exception of transient blurred vision at 1 minute after instillation at both 1 and 6 months, and foreign body sensation. Latanoprost was associated with significantly better instillation comfort at both time points (p = 0.005), whereas overall patient satisfaction scores were not significantly different (p = 0.483).Conclusions: Latanoprost demonstrated superior short-term (1-month) IOP reduction and slightly better instillation comfort at both 1 and 6 months, while long-term (6-month) IOP-lowering efficacy was comparable between the two agents. These findings provide practical evidence for informing drug selection in routine clinical practice.

Background: Central visual loss (CVL) is a devastating complication after surgery for severe-stage glaucoma. The mechanisms underlying CVL remain poorly understood. We hypothesized that early postoperative intraocular pressure (IOP) dynamics, rather than the choice of surgery, primarily determine visual prognosis, with risk influenced by baseline visual reserve. Methods: This retrospective cohort study included 523 eyes of 523 patients with severe-stage glaucoma (mean deviation <−20 dB) who underwent trabeculectomy or Ahmed glaucoma valve (AGV) implantation. The primary outcome was CVL at 3 months postoperatively. To address baseline confounding, the primary analysis focused on identifying risk factors for CVL using Firth penalized logistic regression, with a prespecified subgroup analysis stratified by baseline best-corrected visual acuity (BCVA) and prespecified sensitivity analyses. Results: The study cohort exhibited significant confounding by indication, with the AGV group representing a higher-risk population. Despite these disparities, 1-year outcomes, including CVL incidence, were comparable (18.2% vs. 14.0%, P = 0.198), with consistent findings in propensity score-adjusted analyses. The most powerful predictors of CVL were not the surgery type but early postoperative IOP instability. A dichotomous risk profile emerged from the stratified analysis: in eyes with good baseline vision (BCVA >20/200), 1-month hypotony (IOP 21 mmHg) was the sole independent predictor (OR 2.89; 95% CI 1.03–8.11; P = 0.038). A persistently high IOP trajectory predicted the poorest visual recovery. Conclusions: The risk of CVL after severe-stage glaucoma surgery is not monolithic but is fundamentally conditioned by baseline visual reserve. Visual prognosis depends less on the surgical procedure and more on maintaining early postoperative IOP stability within a tailored range. These findings compel a shift from a uniform IOP target toward an individualized, risk-stratified postoperative management strategy.

For accurate glaucoma diagnosis and monitoring, reliable retinal layer segmentation in OCT images is essential. However, existing 2D segmentation methods often suffer from slice-to-slice inconsistencies due to the lack of contextual information across adjacent B-scans. 3D segmentation methods are better for capturing slice-to-slice context, but they require expensive computational resources. To address these limitations, we propose a 2.5D segmentation framework that incorporates a novel cross-slice feature fusion (CFF) module into a U-Net-like architecture. The CFF module fuses inter-slice features to effectively capture contextual information, enabling consistent boundary detection across slices and improved robustness in noisy regions. The framework was validated on both a clinical dataset and the publicly available DUKE DME dataset. Compared to other segmentation methods without the CFF module, the proposed method achieved an 8.56% reduction in mean absolute distance and a 13.92% reduction in root mean square error, demonstrating improved segmentation accuracy and robustness. Overall, the proposed 2.5D framework balances contextual awareness and computational efficiency, enabling anatomically reliable retinal layer delineation for automated glaucoma evaluation and potential clinical applications.

Purpose: To evaluate the efficacy and safety of latanoprostene bunod 0.024% (LBN) in Korean patients with glaucoma or ocular hypertension in a real-world clinical setting.Methods: This retrospective study included patients who initiated LBN treatment between March 1, 2022, and December 31, 2024. Patients were categorized into monotherapy, switched therapy, and concomitant therapy groups. Changes in intraocular pressure (IOP) were assessed at baseline, month 1, and month 6 according to treatment group and diagnosis. The type and frequency of adverse events were also analyzed.Results: Among the 138 patients initially identified, 129 were included in the analysis. The mean IOP for all patients was 17.4 ± 4.9 mmHg at baseline, 16.0 ± 4.6 mmHg at month 1, and 14.6 ± 3.7 mmHg at month 6. The mean IOP reduction was -1.4 ± 2.8 mmHg at month 1 (p < 0.001) and -2.2 ± 3.3 mmHg at month 6 (p < 0.001). Subgroup analyses by treatment type (monotherapy, switched, and concomitant) and diagnosis revealed significant IOP reductions at both time points across all groups. Adverse events occurred in 22 patients (17.1%), with eye pain being the most frequent. No serious adverse events were observed, including systemic side effects, severe visual impairment, or significant ocular complications.Conclusions: LBN significantly reduced IOP in Korean patients with glaucoma and ocular hypertension, irrespective of prior IOP-lowering medication use and was well tolerated with a favorable safety profile. These findings support the use of LBN as an effective treatment option for Korean patients with glaucoma or ocular hypertension in diverse clinical settings.

Background: This retrospective, comparative study evaluated the long-term impact of pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal on glaucoma progression, focusing on the influence of glaucoma severity and adjunctive internal limiting membrane (ILM) peeling. Methods: A total of 231 eyes from patients diagnosed with primary open-angle glaucoma and coexisting ERM were included. Participants were divided into two groups: 114 eyes underwent PPV for ERM removal (PPV group) and 117 eyes did not undergo surgery (non-PPV group). The PPV group was further subdivided based on glaucoma severity and ILM peeling. Functional and structural parameters were assessed over 4 years using visual field testing, intraocular pressure (IOP) measurement, and optical coherence tomography. Linear mixed models were used for statistical analysis. Results: The PPV group demonstrated a significant deterioration in mean deviation and visual field index, compared with the non-PPV group, over 4 years (p<0.001). However, the rate of progression did not differ significantly based on glaucoma severity. Patients with severe glaucoma experienced a relatively greater functional burden. Adjunctive ILM peeling did not worsen functional or structural outcomes. IOP and medication use remained stable throughout the study period. Conclusions: While associated with long-term visual field decline, PPV for symptomatic ERM demonstrates a consistent impact on glaucoma progression, irrespective of baseline disease severity. ILM peeling does not confer additional risk. These findings support individualised surgical decision-making based on patient symptoms rather than glaucoma stage alone.

Objectives: The purpose of this study was to evaluate the diagnostic accuracy of glaucoma by establishing normative data on retinal nerve fiber layer (RNFL) thickness, specifically for healthy Koreans, using Huvitz spectral-domain optical coherence tomography (OCT). This study also aimed to compare the obtained RNFL thickness data with normative values provided by the Cirrus OCT system to identify any device-specific differences that could impact glaucoma diagnosis. Methods: This prospective observational study included 148 healthy participants aged 20–69 years at Gangnam Severance Hospital. Participants underwent comprehensive ophthalmologic evaluations, including RNFL thickness measurements using Huvitz OCT, which were compared with existing normative Cirrus OCT data. RNFL thickness was analyzed by quadrant (superior, inferior, nasal, and temporal) and clock-hour sectors. Statistical analysis included one-way analysis of variance (ANOVA) for group comparisons and linear regression to assess age-related changes. Results: The average RNFL thickness was 91.13 ± 13 μm, with the thickest measurements in the superior quadrant (111.85 ± 18.53 μm) and the thinnest in the nasal quadrant (68.35 ± 20.03 μm). Significant age-related thinning was observed across all quadrants, particularly the superior and inferior quadrants. Comparison with the Cirrus OCT system revealed significant differences, with the Huvitz OCT results showing thinner RNFL in the superior and inferior quadrants. Conclusions: This study established normative RNFL thickness data in healthy Koreans using Huvitz OCT, providing essential reference data for clinical glaucoma diagnosis. The differences between Huvitz and Cirrus OCT systems underscore the need for device- and population-specific normative data to improve diagnostic accuracy in glaucoma management.

Long‐term steroid use, though essential for treating eye diseases, can cause increased intraocular pressure (IOP) in susceptible individuals and may lead to steroid‐induced glaucoma in a subset of patients. This study investigated the effect of bone morphogenetic protein‐7 (BMP‐7) on steroid‐induced extracellular matrix (ECM) synthesis in human trabecular meshwork (TM) cells. We sought to explore the potential of BMP‐7 as a protective agent against steroid‐induced ECM accumulation in the TM. Human TM cells (HTMCs) were treated with either steroids alone or a combination of steroids and BMP‐7 to compare their effects on ECM production. BMP‐7, known for its transforming growth factor beta (TGF‐β) antagonistic properties, was administered using a micellized protein transduction domain (mPTD)‐fused BMP‐7 polypeptide to enhance activity. Gene expression analysis was conducted to identify specific genes involved in ECM regulation. BMP‐7 effectively inhibited steroid‐induced ECM accumulation in HTMCs. There was a significant reduction in ECM production in the steroid and BMP‐7 co‐treated group compared with that in the steroid‐only group. Furthermore, several genes involved in ECM regulation were identified in the co‐treatment, underscoring BMP‐7's potential role in modulating ECM metabolism. These findings demonstrate that BMP‐7 exerts protective, anti‐fibrotic effects in HTMCs by inhibiting steroid‐induced ECM synthesis. BMP‐7 may serve as a promising therapeutic target for preventing or treating steroid‐induced glaucoma by maintaining normal aqueous humor outflow and preventing IOP elevation.

This study evaluates the safety and visual outcomes of enhanced monofocal intraocular lenses compared to standard monofocal intraocular lenses in patients with varying severities of glaucoma. Utilizing data from surgeries performed in 2021, the study involved patients aged 40 and older with visually significant cataracts and diagnosed glaucoma or glaucoma suspects. The findings indicate that both enhanced and standard monofocal lenses lead to significant improvements in best-corrected visual acuity, visual field index, mean deviation, and retinal nerve fiber layer thickness postoperatively. No significant differences were observed between the two groups in the extent of these improvements, suggesting that enhanced monofocal lenses may offer a viable alternative for patients with glaucoma, providing significant visual benefits and potentially better intermediate vision while preserving overall visual function.