Evolving Surgical Paradigms for Primary Angle-Closure Glaucoma

Two recent randomized trials challenged traditional approaches by demonstrating the efficacy of angle-opening procedures for the treatment of advanced disease.

Kimberly Jun, MD, and Nehali Nanti, MD

Glaucoma Today

Key Takeaways Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. Advanced disease has traditionally been managed with filtration surgery. Two recent randomized trials indicated that less invasive surgical approaches might be safer alternatives in select patients. Peripheral Iridectomy With Goniosynechialysis and Goniotomy vs Trabeculectomy for Advanced PACG: a Randomized Clinical Trial Lin F, Lv A, Li F, et al; TVG Study Group1 Industry support for this study: None ABSTRACT SUMMARY This multicenter randomized controlled trial (RCT) compared the safety and effectiveness of surgical peripheral iridectomy with goniosynechialysis and goniotomy (SPI + GSL + G) versus trabeculectomy in 88 eyes with advanced primary angle-closure glaucoma (PACG) without cataract. The primary outcome was IOP at 12 months. Secondary outcomes included surgical success, defined as an IOP between 5 and 18 mm Hg or a 20% or greater reduction from baseline with or without medication; postoperative complications and interventions; and number of prescribed antihypertensive medications. STUDY IN BRIEF A randomized controlled trial compared the safety and effectiveness of surgical peripheral iridectomy with goniosynechialysis and goniotomy versus trabeculectomy in patients with advanced primary angle-closure glaucoma (PACG) without cataract. The combined procedure demonstrated a noninferior IOP reduction compared to trabeculectomy at 12 months. Complete success rates were slightly lower with the combined procedure (60.5% vs 82.2%), but far fewer postoperative interventions were required (7% vs 55.6%). WHY IT MATTERS PACG is a leading cause of irreversible blindness worldwide.

Ocular Syphilis: the Great Imitator

Learn some of the different ways this increasingly common disease can present and proven ways to manage it.

Connor Kortright, OD

Modern Optometry

Ocular syphilis, often dubbed the great imitator because it can present as several other conditions, continues to challenge clinicians with its diverse and often misleading presentations. With incidence rates rising annually,1 optometrists are increasingly likely to encounter this elusive disease in practice. In my home state of New York, new cases of syphilis have steadily increased to reach more than 10,000 in 2022, after essentially no new cases were reported in 2000.2 This article presents five cases that show the diverse presentations of ocular syphilis and just how difficult it can be to detect this tricky, and increasingly common, disease. CASE NO. 1: A MISDIAGNOSED KERATITIS A 33-year-old Black man presented with bilateral eye pain persisting for 1 month.3 It was initially treated as conjunctivitis by a previous provider. He had a pustular facial rash, and his vision was reduced to 20/70 OD and 20/60 OS. Examination revealed bilateral peripheral ulcerative keratitis. Workup later confirmed syphilis infection with HIV coinfection. The patient was initially treated with steroids but was transitioned to 4 million units of intravenous (IV) penicillin every 4 hours for 14 days after confirmation of syphilis infection, leading to remarkable visual recovery (20/20 OU). CASE NO.

Ocular Releases Phase 3 Data for Wet AMD Candidate Axpaxli

Eyetube

Ocular Therapeutix releases its long-awaited SOL-1 phase 3 data for wet AMD drug candidate Axpaxli; Nordic Pharma expands the availability of its novel dry eye therapy Lacrifill; and Alcon launches the only multifocal toric contact lens featuring Water Gradient Technology. Learn more about your ad choices. Visit megaphone.fm/adchoices