Background: The glucagon-like peptide 1 receptor agonist (GLP-1RA) is an antidiabetic medication with vascular protection and anti-inflammatory properties. Theoretically, the use of GLP-1RA should inhibit the development of open-angle glaucoma (OAG) as both vascular damage and inflammation are associated with OAG. Therefore, our objective was to investigate the association between the application of GLP-1RA and the subsequent OAG in individuals with type 2 diabetes mellitus (T2DM). Methods: We conducted a retrospective cohort study by using data from the National Health Insurance Research Database (NHIRD) of Taiwan. Participants with T2DM were divided into those who used GLP-1RA and those who did not, forming the GLP-1RA and control groups. The primary outcome was the occurrence of OAG based on diagnostic codes. Cox proportional hazard regression was employed to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for OAG. Results: 91 patients in the control group developed OAG, and 40 patients in the GLP-1RA group developed OAG. After adjustment for all covariates, the GLP-1RA group exhibited a significantly lower incidence of OAG compared with the control group (aHR: 0.712, 95% CI: 0.533-0.936. P = 0.0025). In the subgroup analyses, the association between GLP-1RA use and OAG incidence was more pronounced in patients with T2DM using GLP-1RA and aged younger than 60 years (P = 0.0438). Conclusion: The prescription of GLP-1RA is associated with a lower incidence of subsequent OAG in individuals with T2DM, and this association was more significant in patients with T2DM under the age of 60 years.

This study aimed to survey the effect of androgen deprivation therapy (ADT) on the development of open angle glaucoma (OAG) in prostate cancer using the data from national health insurance research database (NHIRD) of Taiwan. A retrospective cohort study was conducted and patients were regarded as prostate cancer with ADT according to related diagnostic, procedure and medication codes. Each prostate subject with ADT was matched to one patient with prostate cancer, but without ADT, and two participants without both prostate cancer and ADT; 1791, 1791 and 3582 patients were recruited in each group. The primary outcome was set as the OAG development according to related diagnostic codes. Cox proportional hazard regression was used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of ADT for the incidence of OAG. There were 145, 65 and 42 newly developed OAG cases in the control group, prostate cancer without ADT group and prostate cancer with ADT group. The prostate cancer with ADT group showed a significantly lower risk of OAG development compared to the control group (aHR: 0.689, 95% CI: 0.489-0.972, p = 0.0341), and the risk of OAG development in the prostate cancer without ADT group was similar compared to that in the control group (aHR: 0.825, 95% CI: 0.613-1.111, p = 0.2052). In addition, ages older than 50 years old would lead to higher incidence of OAG development, respectively. In conclusion, the use of ADT will lead to a similar or lower rate of OAG development.

UNASSIGNED: The purpose of this meta-analysis is to systematically compare the IOP-lowering effect of different microstents combined with phacoemulsification versus phacoemulsification for patients with OAG and cataract.
UNASSIGNED: This work was done through the data searched from PubMed, EMBASE, and the Cochrane Library. The Cochrane Handbook was also used to evaluate the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software.
UNASSIGNED: A total of 8 randomized controlled trials (RCTs) were included. Compared with phacoemulsification alone, microstent implantation with phacoemulsification resulted in significant reduction in the postoperative IOP (MD = -1.66, 95%CI: [-2.25 to -1.06]). Patients with medication free and patients with beyond 20% IOP reduction were significantly increased in the microstent implantation with phacoemulsification group compared with phacoemulsification alone group (RR = 1.54, 95%CI: [1.34 to 1.77]; RR = 1.34, 95%CI: [1.24 to 1.45]).
UNASSIGNED: Both microstent implantation with concurrent phacoemulsification and phacoemulsification alone result in a significant reduction in IOP. In terms of both reductions, microstent implantation with phacoemulsification significantly outperforms phacoemulsification alone.

Purpose: To investigate the diagnostic abilities of the perfusion density (PD) and structural thickness parameters in the peripapillary and macular regions measured by optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT) and to test if their diagnostic abilities of early glaucoma are different between highly myopic (HM) and non-highly myopic (NHM) patients. Methods: A total of 75 glaucoma patients and 65 controls were included in the analyses. The glaucoma detection abilities of macular PD and peripapillary PD, along with macular ganglion cell-inner plexiform layer (mGCIPL) thickness and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were compared between the HM and NHM group. Diagnostic ability was assessed by area under the receiver operating characteristics (AUC) curves, adjusted by age, axial length, and signal strength. Results: The diagnostic ability of macular PD and mGCIPL thickness had no significant difference in both HM and NHM groups. However, the diagnostic ability of peripapillary PD except in the temporal section was significantly lower in the HM group than in the NHM group (all p < 0.05). The diagnostic ability of the superior, nasal, and average pRNFL thickness was also significantly lower in the HM group than in the NHM group (all p < 0.05). Conclusion: This study demonstrated that although peripapillary PD and macular PD were both significantly reduced in patients with highly myopia, the diagnostic ability of peripapillary PD in HM patients was significantly lower than that in NHM patients, while macular PD was not. Macular OCTA along with OCT imaging should be included in the imaging algorithm in early glaucoma diagnosis in highly myopic patients.

The incidences of open angle glaucoma (OAG) and high myopia are increasing concomitantly. Considering the aging population and concurrent rapid increase in the number of individuals with myopia, the risk of visual defects caused by highly myopic OAG is likely to increase dramatically over the next few decades. However, precise screening and diagnosis of OAG is challenging because of the tilt and rotation of the optic disc, as well as extensive β-zone parapapillary atrophy in highly myopic eyes. Recent advances in optical coherence tomography (OCT) and OCT angiography (OCTA) technologies imply that both modalities are promising tools for the detection of highly myopic OAG. Notably, the diagnosis of OAG remains to be determined with the longitudinal changes of functional damages (e.g. visual field defect, visual electrophysiological changes). We herein describe some aspects of microvascular and microstructural pathology in patients with highly myopic OAG and proposes a framework for the development of novel diagnostic and therapeutic strategies.

OBJECTIVE: To observe the short-term efficacy of EX-PRESS filtration shunt implantation in the treatment of open angle glaucoma, and to analyze the safety and effectiveness of the surgical method.
METHODS: From April 2017 to January 2018, a total of 28 eyes of 17 open angle glaucoma patients in Xiangya Hospital of Central South University were screened. Among them, 16 eyes in the experimental group were treated with EX-PRESS filtration shunt (P200)implantation, and 12 eyes in the control group underwent trabeculectomy. Related examinations were performed in 1 day before operation, 1 day after operation, 1 week after operation, 1 month after operation and 3 months after operation, which included intraocular pressure (IOP), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA), central anterior chamber depth (ACD), trabecular iris angle (TIA), the long axis of drainage nail and corneal endothelium angle (ACA), intraoperative and postoperative complications. Visual-related quality of life questionnaire was conducted and scored in 3 months after operation.
RESULTS: In the experimental group, the IOP in 1 day after operation, 1 week after operation and 1 month after operation was decreased significantly compared with that in 1 day before operation (all P<0.05), but the IOP in 3 months after operation was not significantly decreased compared with that in 1 day before operation (P>0.05). In the control group, the IOP in 1 week after operation, 1 month and 3 months after operation was decreased significantly with that of pre-operation (all P<0.05), but the IOP in 1 day after operation was not significantly decreased compared with that in 1 day before operation (P>0.05).The BCVA between the 2 groups was significantly different in 1 week after operation, 1 month and 3 months after operation compared with that in 1 day before operation (P>0.05). The ACD in 1 day after operation, 1 week after operation, 1 month after operation and 3 months after operation was not significantly different compared with that in 1 day before operation (all P>0.05). However, the ACD in 1 week after operation and 1 month after operation was significantly different in the control group compared with that in 1 day before operation (both P<0.05). There was no significant change in the TIA in the 2 group compared with that in 1 day before operation (all P>0.05). At different observed time after operation, there was no significant difference in the ACA (all P>0.05). The correlation analysis of Pearson showed that there was a weak correlation between the ACA and the IOP (r=0.286, P<0.05). According to the standard of surgical success defined in this study, the success rate of experimental group was 81.25%, and the control group was 83.33%. There was no significant difference in the visual-related quality of life score between the experimental group and the control group (P>0.05), but the mean value in the former was higher.
CONCLUSIONS: As a new type of anti-glaucoma surgery, the success rate of EX-PRESS filtration shunt implantation for 3-month follow-up is equivalent to that of classic trabeculectomy. The operation process is simple, and there is no significant change in the ACD before and after the operation in the period of 3-month follow-up. The stability of the anterior chamber is better. There is no significant correlation between the relative position of the shunt in the anterior chamber and the IOP. Compared with trabeculectomy, there is no significant difference in the visual-related quality of life.
目的: 观察EX-PRESS引流钉植入术治疗开角型青光眼的短期疗效，分析该手术方式的安全性及有效性。方法: 筛选从2017年4月至2018年1月中南大学湘雅医院收治的17个开角型青光眼患者，共28只眼。试验组16只眼，行EX-PRESS引流钉(P200型)植入术；对照组12只眼，行复合式小梁切除术。术前1 d，术后1 d，术后1周，术后1个月及术后3个月行相关检查。检查内容包括眼内压(intraocular pressure，IOP)、裸眼视力(uncorrected visual acuity，UCVA)、最佳矫正视力(best corrected visual acuity，BCVA)、中央前房深度(central anterior chamber depth，ACD)、小梁虹膜角(trabecular iris angle，TIA)、引流钉管腔长轴与角膜内皮夹角(long axis ofdrainage nail and corneal endothelium angle，ACA)以及术中和术后并发症。术后3个月对患者进行视觉相关生活质量问卷调查并评分。结果: 试验组术后1 d，术后1周和术后1个月IOP与术前1 d相比显著降低，差异均有统计学意义(均P<0.05)，术后3个月IOP与术前1 d相比，差异无统计学意义(P>0.05)；对照组术后1周、术后1个月、术后3个月IOP与术前1 d相比均显著降低，差异均有统计学意义(均P<0.05)，术后1 d IOP与术前1 d相比，差异无统计学意义(P>0.05)。试验组和对照组术后1周、术后1个月、术后3个月BCVA与术前1 d相比，差异均无统计学意义(均P>0.05)。试验组术后1 d，术后1周，术后1个月和术后3个月ACD与术前相比，差异均无统计学意义(均P>0.05)；对照组术后1周、术后1个月ACD与术前相比，差异均有统计学意义(均P<0.05)，术后1 d和术后3个月与术前相比，差异无统计学意义(P>0.05)。试验组和对照组术后1 d，术后1周，术后1个月和术后3个月TIA与术前相比，差异均无统计学意义(均P>0.05)。术后1 d，术后1周，术后1个月和术后3个月ACA之间差异均无统计学意义(均P>0.05)。将ACA与对应IOP进行Pearson相关性分析，二者呈弱相关关系(r=0.286，P<0.05)。根据疗效标准，术后3个月试验组成功率为81.25%，对照组成功率为83.33%。试验组和对照组术后3个月视觉相关生活质量评分比较，差异无统计学意义(P>0.05)。结论: EX-PRESS引流钉植入术作为一种新型抗青光眼手术，术后3个月手术成功率与经典的复合式小梁切除术相当；其手术过程操作简单，术前及术后ACD无显著变化，前房稳定性较好，术后引流钉在前房相对位置与降IOP效果之间呈弱相关关系；与复合式小梁切除术相比，二者术后3个月视觉相关生活质量评分无显著差别。.

OBJECTIVE: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of tafluprost 0.0015% eye drops [benzalkonium chloride (BAK) 0.1 mg/mL] compared with that of latanoprost 0.005% eye drops (BAK 0.2 mg/mL) for primary open angle glaucoma (POAG) and ocular hypertension (OHT).
METHODS: All the randomized controlled trials (RCTs) about treating POAG and OHT comparing tafluprost and latanoprost were collected by searching PubMed, Embase, Cochrane Library, CNKI and VIP. The outcomes of interest to evaluate the clinical efficacy and adverse effects included IOP and patient-related drop discomfort.
RESULTS: Five RCTs involving 888 glaucoma patients were included. The results showed that, 1) at the end of the study, no statistically significant differences were observed in IOP reduction [standard mean difference (SMD) =0.48, 95%CI 0.07 to 0.88, P=0.085] between tafluprost and latanoprost; 2) No statistically significant differences were observed in adverse events of foreign-body sensation [relative risk (RR) =0.62, 95%CI 0.26 to 1.46, P=0.269], eye irritation (RR=1.16, 95%CI 0.49 to 2.75, P=0.744), eye pain (RR=2.000, 95%CI 0.949 to 4.216, P=0.07), iris hyper-pigmentation (RR=0.741, 95%CI 0.235 to 2.334, P=0.61), dry eye (RR=1.154, 95%CI 0.409 to 3.256, P=0.79) and eye pruritus (RR=1.600, 95%CI 0.536 to 4.774, P=0.4) between tafluprost and latanoprost. However, tafluprost showed more reported incidence of conjunctival hyperaemia than latanoprost (RR=2.11, 95%CI 1.24 to 3.59, P=0.006).
CONCLUSIONS: Tafluprost 0.0015% eye drops (BAK 0.1 mg/mL) and latanoprost 0.005% eye drops (BAK 0.2 mg/mL) are comparable in lowering IOP for open angle glaucoma (OAG) and OHT. It does not differ in the incidence of foreign-body sensation, eye irritation, eye pain, iris hyper-pigmentation, dry eye and eye pruritus, but tafluprost shows less ocular tolerability because of more incidence of conjunctival hyperaemia.

OBJECTIVE: To systematically review and Meta-analyze studies of managing open angle glaucoma (OAG) with gonioscopy-assisted transluminal trabeculotomy (GATT) and to evaluate its effectiveness and safety.
METHODS: Eligible studies were retrieved and screened from five main electronic databases. Mean difference (MD) was hired to show the pooled effectiveness of intraocular pressure (IOP) and medication decrease achieved by GATT. In addition, combined surgical success and reoperation rates were calculated, and complications were also summarized.
RESULTS: Ten studies were included for systematic review, but one study was not pooled for Meta-analysis due to the repeated data. The combined IOP decrease after GATT was 9.81 mm Hg (95%CI: 7.98-11.63 mm Hg) which showed significant reduction from the baselines (Z=10.52, P<0.0001). Similarly, the number of medications after GATT also decreased distinctly compared with that of medication before the surgery (Z=9.09, P<0.0001), and the pooled medication decrease was 1.68 (95%CI: 1.31-2.04). In addition, the combined surgical success rate was 85%, while the pooled reoperation rate was 20%. Sight-threatening complications occurred scarcely, whereas the pooled occurrence rate of hyphemia was as high as 36.0%.
CONCLUSIONS: GATT could effectively lower IOP and decrease medications for patients with OAG. Moreover, the procedure appears to be a safe and promising treatment for OAG due to its minimally-invasive and conjunctiva-sparing nature.

Glaucoma is a chronic, progressive optic neuropathy characterized by the loss of peripheral vision first and then central vision. Clinically, normal tension glaucoma is considered a special subtype of glaucoma, in which the patient\'s intraocular pressure is within the normal range, but the patient experiences typical glaucomatous changes. However, increasing evidence has challenged the traditional pathophysiological view of normal tension glaucoma, which is based only on intraocular pressure, and breakthroughs in central nervous system imaging may now greatly increase our knowledge about the mechanisms underlying normal tension glaucoma. In this article, we review the latest progress in understanding the pathogenesis of normal tension glaucoma and in developing imaging techniques to detect it, to strengthen the appreciation for the connection between normal tension glaucoma and the brain.

OBJECTIVE: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma (OAG).
METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm\'s canal (SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure (IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete (qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without (with or without) anti-glaucoma medications.
RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg (mean IOP reduction of 51%) at 5y after surgery, and 15.6±2.8 mm Hg (mean IOP reduction of 49.9%) at 10y after surgery (P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5y and 0.67±0.8 at 10y postoperatively (P<0.001). The follow-up period was 104.5±37.0mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval (CI): 0.80-0.88], 73% (95%CI: 0.68-0.78), and 59% (95%CI: 0.52-0.66) after 5y, and 80% (95%CI: 0.76-0.84), 69% (95%CI: 0.64-0.74), 51% (95%CI: 0.44-0.58) after 10y, respectively. There was a relationship between age, preoperative IOP and success rate (P<0.01, P<0.05). A total of 31 eyes (31.3%) in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg (P<0.01). Neither blebitis nor endophthalmitis occurred.
CONCLUSIONS: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It\'s a safe procedure with less complications over 10y in Chinese individuals with OAG.