The authors of this prospective, randomized, controlled multi-center clinical trial assessed the long-term safety and efficacy of a single trabecular micro-bypass stent with concomitant cataract surgery versus cataract surgery alone for mild-to-moderate open-angle glaucoma (OAG) at 29 U.S. investigational sites.

They randomly assigned eyes with mild-to-moderate glaucoma with an unmedicated intraocular pressure (IOP) of 22 mmHg or higher and 36 mmHg or lower to have cataract surgery with iStent trabecular micro-bypass stent implantation (stent group) or cataract surgery alone (control group). They followed patients for 24 months postoperatively.

The incidence of adverse events was low in both groups through 24 months of follow-up, the authors reported. They also noted that at 24 months, the proportion of patients with an IOP of 21 mmHg or lower without ocular hypotensive medications was significantly higher in the stent group than in the control group (p=.036). Overall, the mean IOP was stable between 12 months and 24 months (17.0 mmHg ± 2.8 [SD] and 17.1 ± 2.9 mmHg, respectively) in the stent group but increased (17.0 ± 3.1 mmHg to 17.8 ± 3.3 mmHg, respectively) in the control group. The study authors found that ocular hypotensive medication was statistically significantly lower in the stent group at 12 months; it was also lower at 24 months, although the difference was no longer statistically significant.

Patients with combined single trabecular micro-bypass stent and cataract surgery had significantly better IOP control on no medication through 24 months than patients having cataract surgery alone. Both groups had a similar favorable long-term safety profile.

Genetic variation at the 9p21 locus encompassing the CDKN2B-AS1, CDKN2A, and CDKN2B genes has been associated with primary open-angle glaucoma (POAG) in several independent studies. Researchers in Australia conducted the following comparative case series and case-control study to dissect the association further and to determine genotype–phenotype correlations between genetic variation at this locus and a range of glaucoma-related traits in a large cohort of POAG patients. Included in their study were 1,432 POAG patients and 595 unaffected controls recruited from two population-based and two cross-sectional studies.

The researchers genotyped each patient at nine single nucleotide polymorphisms (SNPs) previously associated with POAG at the 9p21 locus. They assessed each SNP for association with each outcome measure using linear regression under an additive genetic model. They explored associated traits further including adjustment for relevant covariates and they also analyzed highest recorded intraocular pressure (IOP) both with and without correction for central corneal thickness (CCT) and dichotomized these pressures into high-tension glaucoma and normal-tension glaucoma (NTG). IOP and vertical cup-to-disc ratio (VCDR) were the main outcome measures.

According to the study researchers, glaucoma risk alleles at 9p21, particularly rs7049105 and rs10120688, were associated with the presence of both NTG and advanced POAG. They also noted that the SNP rs10120688 was associated with greater VCDR after adjustment for covariates (p=0.003;β=0.016; standard error, 0.006). They reported that multiple SNPs in the region were associated with reduced IOP, before and after adjustment for CCT and that the SNP most significantly associated with IOP was also rs10120688 (p=0.001; β=–2.135; standard error, 0.634) after adjustment for covariates under an additive model. In a comparison of high-tension versus low-tension glaucoma, the researchers found that this SNP was also the most significantly associated, particularly when IOP was corrected for CCT before classification of the type of glaucoma (p=0.0009; odds ratio, 0.63; 95% confidence interval, 0.48–0.83).

In conclusion, patients with POAG carrying the glaucoma risk alleles at the 9p21 locus have larger VCDR and lower IOP than POAG patients without these alleles. Carriers of these alleles seem to be predisposed to PAOG developing at lower IOP levels and exhibit stronger associations with NTG and advanced glaucoma phenotypes. This may be of relevance when setting target pressures in patients carrying these risk alleles.

To evaluate the anatomical success rate of scleral buckling surgery in the treatment of rhegmatogenous retinal detachment and to evaluate the differences in outcome between patients suffering macula-off retinal detachment and those without a macular involvement, the Munster Study on Therapy Achievements in Retinal Detachment (MUSTARD) retrospective interventional case series was conducted.

A total of 4,325 patients who underwent surgery between 1980 and 2001 were included. The macular was involved in 53.94% (n=2,134) of 3,956 patients with nontraumatic retinal detachment. The main outcome measure was the achievement of dry anatomical attachment of the retina.

The success rate in patients with macula-off retinal detachment is 80.46% and thus 7.78% lower (p<0.01) than that in those patients with their macula intact whose success rate amounted to 88.24%. The overall success rate of all 4,325 MUSTARD patients was 83.98%.

It was concluded that scleral buckling is an established and mostly successful method for the treatment of retinal detachment. As this case series demonstrated, even eyes with macula-off can be treated successfully by this procedure, thereby avoiding the complications of primary vitrectomy.