In this prospective, randomized clinical trial, 50 medically uncontrolled chronic angle-closure glaucoma (CACG) eyes without cataract of 50 patients were investigated to compare phacoemulsification versus trabeculectomy with adjunctive mitomycin C.

Patients were randomized into undergoing either phacoemulsification or trabeculectomy with adjunctive mitomycin C. After surgery, patients were followed up every three months for two years. Main outcome measures were IOP and requirement for glaucoma drugs.

A total of 26 CACG eyes were randomized to receive phacoemulsification, and 24 eyes underwent trabeculectomy with mitomycin C. Phacoemulsification and trabeculectomy resulted in significant and comparable IOP reduction at 24 months following surgery (reduction of 8.4 mmHg or 34% for phacoemulsification vs. 8.9 mmHg or 36% for trabeculectomy; p=0.76). It was reported that over the first 24 months, trabeculectomy-treated eyes required on average 1.1 fewer drugs than phacoemulsification-treated eyes (p<0.001). However, trabeculectomy was associated with significantly more surgical complications than phacoemulsification (46% vs. 4%; p=0.001). Furthermore, eight (33%) of 24 trabeculectomy eyes demonstrated cataract during follow-up.

To conclude, both phacoemulsification and trabeculectomy are effective in reducing IOP in medically uncontrolled CACG eyes without cataract. Trabeculectomy is more effective than phacoemulsification in reducing dependence on glaucoma drugs, but is associated with more complications.

The authors of the following prospective, longitudinal clinical trial compared detection of progressive retinal nerve fiber layer thickness (RNFL) atrophy identified using time-domain optical coherence tomography (TD-OCT) with visual field progression using standard automated perimetry in glaucoma suspect and preperimetric glaucoma patients or perimetric glaucoma patients.

They noted that eligible eyes with two years or more of follow-up underwent TD-OCT and standard automated perimetry every six months. They defined the occurrence of visual field progression as the first follow-up visit reaching a significant (p<.05) negative visual field index slope over time. Additionally, they defined RNFL progression or improvement as a significant negative or positive slope over time, respectively. They also defined specificity as the number of eyes with neither progression nor improvement, divided by the number of eyes without progression. The study authors calculated Cox proportional hazard ratios using univariate and multivariate models with RNFL loss as a time-dependent covariate.

They reported that 310 glaucoma-suspect and preperimetric glaucoma eyes and 177 perimetric glaucoma eyes were included in their study. A total of 89 eyes showed visual field progression and 101 eyes showed RNFL progression. The average time to detect visual field progression in those 89 eyes was 35 ± 13 months, and the average time to detect RNFL progression in those 101 eyes was 36 ± 13 months. According to the authors, in multivariate Cox models, average and superior RNFL losses were associated with subsequent visual field index loss in the entire cohort (every 10-µm loss; hazard ratio, 1.38; p=.03; hazard ratio, 1.20; p=.01; respectively). Among the entire cohort of 487 eyes, 42 had significant visual field index improvement and 55 had significant RNFL improvement (specificity, 91.4% and 88.7%, respectively).

Structural progression is associated with functional progression in glaucoma suspect and glaucomatous eyes. Average and superior RNFL thickness may predict subsequent standard automated perimetry loss.

Researchers sought to characterize the morphology, prevalence and topography of subretinal drusenoid deposits, a candidate histological correlate of reticular pseudodrusen, with reference to basal linear deposit (BlinD), a specific lesion of age-related macular degeneration (AMD), and to propose a biogenesis model for both lesions.

They postfixed donor eyes with median death-to-preservation of 2:40 hours in osmium tannic acid paraphenylenediamine and prepared them for macula-wide high-resolution digital sections. They determined annotated thicknesses of 21 chorioretinal layers at standard locations in sections through the fovea and the superior perifovea.

In 22 eyes of 20 white donors (83.1 ± 7.7 years), SDD appeared as isolated or confluent drusenoid dollops punctuated by tufts of retinal pigment epithelium apical processes and associated with photoreceptor perturbation, the researchers noted. They detected subretinal drusenoid deposits and BlinD in 85 and 90% of non-neovascular AMD donors, respectively. The study researchers observed that subretinal drusenoid deposit was thick (median, 9.4 µm) and more abundant in the perifovea than in the fovea (p<0.0001). Additionally, BlinD was thin (median, 2.1 µm) and more abundant in the fovea than in the perifovea (p<0.0001).

In conclusion, subretinal drusenoid deposits and BlinD prevalence in AMD eyes are high. Subretinal drusenoid deposits organized morphology, topography and impact on surrounding photoreceptors imply specific processes of biogenesis. Contrasting topographies of subretinal drusenoid deposits and BlinD suggest relationships with differentiable aspects of rod and cone physiology, respectively. A two-lesion, two-compartment biogenesis model incorporating outer retinal lipid homeostasis is presented.