LEOS (LASER ENDOSCOPY OPHTHALMIC SYSTEM)

 

BVI Medical, a leading global ophthalmic device company, has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its innovative glaucoma surgical system, Leos™ (Laser Endoscopy Ophthalmic System).

Leos™ introduces a novel, more intuitive laser endoscopic cyclophotocoagulation (ECP) procedure that integrates seamlessly into the surgical workflow.

This laser system lowers intraocular pressure by addressing aqueous humor production in a minimally invasive ab interno procedure.

It incorporates unique endoscopic capabilities to provide superior visualization of the eye anatomy in a way not seen in the past, or with the latest imaging systems.

https://www.bvimedical.com/bvi-medical-announces-approval-of-breakthrough-technology-fda-510k-clearance-of-its-laser-endoscopy-ophthalmic-system-leos/

DIRECT SELECTIVE LASER TRABECULOPLASTY (DSLT)

Selective Laser Trabeculoplasty (SLT) is an effective first-line treatment option for patients with open-angle glaucoma and normal-tension glaucoma.

Alcon has improved the delivery system of SLT machines with the development of the Voyager Direct Selective Laser Trabeculoplasty (DSLT) system.

Voyager™ DSLT is designed to automatically deliver 120 laser pulses directly through the limbus to the trabecular meshwork, thereby improving aqueous outflow and reducing intraocular pressure.

The GLAUrious Study comparing DSLT and SLT did not find inferiority of the DSLT procedure at 6 and 12 months of follow-up.

The study demonstrated that DSLT with the Eagle device is effective in providing a clinically meaningful reduction in IOP at 6 months that is sustained out to 12 months.

The protocol included DSLT: 120 shots, 3 ns, 400 µm spot size, energy 1.4–1.8 mJ delivered at the limbus over 2 s. SLT: approximately 100 shots, 3 ns, 400 µm spot size administered 360 degrees at the limbus using any gonioscopy lens, energy 0.3–2.6 mJ.

According to the authors, a sample size of 164 is sufficient to detect a non- inferiority margin of 1.95 mm Hg for change from baseline IOP.

REFERENCE:

Congdon N, Azuara-Blanco A, Solberg Y, Traverso CE, Iester M, Cutolo CA, Bagnis A, Aung T, Fudemberg SJ, Lindstrom R, Samuelson T, Singh K, Blumenthal EZ, Gazzard G; GLAUrious study group. Direct selective laser trabeculoplasty in open angle glaucoma study design: a multicentre, randomised, controlled, investigator-masked trial (GLAUrious). Br J Ophthalmol. 2023 Jan;107(1):62-65. doi: 10.1136/bjophthalmol-2021-319379. Epub 2021 Aug 25. PMID: 34433548; PMCID: PMC9763163.

ESNOPER CLIP

 

Drainage implants act as flow controllers, space maintainers, and healing modulators, reducing the risk of scleral fibrosis.

The suprachoroidal implantation of drainage devices improves deep sclerectomy (DS) techniques by decreasing aqueous production by detachment of the ciliary body or by increasing the choroidal resorption of aqueous humor.

DS creates a trabeculo-descemet window by removing the deep scleral flap and the corneal stroma. This allows gradual aqueous filtration through the thin trabeculo-descemet membrane (TDM) and prevents dangerously rapid IOP decreases.

DS preserves the integrity of the anterior chamber and has the advantage of superior filtration control and reduced occurrence of perioperative and postoperative complications (e.g., hypotonia, flat anterior chamber, and choroidal detachment).

The Esnoper Clip is a nonabsorbable foldable implant made from HEMA, a nonionic polymer with a low tendency for protein deposits. The implant has a double-plate design, which facilitates both trabecular and uveoscleral drainage. It is also found to reduce fibrosis, ensuring maintenance of both the above-mentioned spaces, thus avoiding their collapse over time.

The implant has internal channels to facilitate aqueous humor flow through the device and has lateral notches for non-sutured supraciliary placement.

This implant has 2 plates, one is placed on the scleral bed and the other in the supraciliary space. The shape of the implant has been designed to preserve the patency of the intrascleral and suprachoroidal spaces and to maximize both aqueous-humor drainage pathways long after surgery.

A significant limiting factor in the long-term success of DS with uveoscleral implants is the inflammatory potential of the suprachoroidal region, characterized by significant cell infiltration and fibrosis.

A study of 39 eyes by Alina-Dana Baxant, from Charles University, Prague, showed a 87.2% success rate at one year, following DS with Esnoper Clip implantation in patients with uncontrolled glaucoma.

REFERENCE:

Baxant AD, Klimešová YM, Holubová L, Pluhovský P, Bartošová J, Veselý Ľ, Nemčoková M, Rosina J, Studený P. Efficacy and Safety of Deep Sclerectomy With the Esnoper Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective Study. J Glaucoma. 2023 Mar 1;32(3):227-235. doi: 10.1097/IJG.0000000000002137. Epub 2022 Oct 14. PMID: 36256952; PMCID: PMC9981320.

PER-001 INTRAVITREAL IMPLANT

 

Endothelin is the most potent vasoconstrictor in the human body and is upregulated in glaucoma. Endothelin is involved in inflammation and cell death through its receptors expressed in retinal vascular and neuroretinal cells. Multiple lines of evidence implicate vascular dysregulation as a driver of glaucomatous disease progression, and excess endothelin levels play a key role in reducing ocular blood flow.

PER-001 is a small molecular endothelin 1 receptor antagonist administered as a bio-erodible intravitreal implant. It is being evaluated for treating open-angle glaucoma and other ocular indications driven by ischemia, such as diabetic retinopathy, geographic atrophy, and retinal vein occlusion. It is administered into the vitreous using a single-use, 25-gauge applicator. It is designed to provide a sustained release of PER-001, allowing for a convenient every 6 months dosing frequency.

The intended treatment is pursuing both vascular benefits, such as improved autoregulation and perfusion by targeting the entire retinal vasculature and choroid, as well as non-vascular benefits, such as blocking ET-1-mediated “neurotoxicity” involving apoptotic and oxidative injury pathways in the neuroretina.

Perfuse Therapeutics, Inc. (“Perfuse Therapeutics”), a biopharmaceutical company, announced the details of PER-001. Data from three cohorts of patients with glaucoma in the completed Phase 1/2a clinical trial demonstrate that PER-001 is well tolerated and shows promise as the first disease-modifying therapy for glaucoma. A study in rabbit and monkey eyes demonstrated controllable biodegradation and sustainability of the implant without any ocular or systemic adverse findings for up to 3 and 6 months in rabbits and non-human primates, respectively.

https://perfusetherapeutics.com/perfuse-therapeutics-announces-oral-presentation-on-per-001-intravitreal-implant-for-glaucoma-at-the-association-for-research-in-vision-and-ophthalmology-arvo-meeting/

DENGUE ASSOCIATED ACUTE ANGLE CLOSURE GLAUCOMA

 

Dengue is a mosquito-borne viral disease transmitted by Aedes aegypti. It is caused by one of four dengue virus serotypes (DENV-1 to DENV-4) from the Flavivirus family.

Ophthalmic complications range from subconjunctival hemorrhage and anterior uveitis to severe optic neuritis, retinal vasculitis, maculopathy, and panophthalmitis. Other diverse ocular effects include central retinal artery occlusion, bilateral vitreous hemorrhage, and uncommonly acute angle-closure glaucoma (AACG).

From: Pierre Filho Pde T

Dengue can directly inflame ocular anatomical tissues. The ocular structures have a particularly poor tolerance for inflammatory insult and disruption of vessel regulation due to their rich choroid and ciliary body vasculature. These structures are involved in vascular leakage, which causes forward displacement of the lens-iris diaphragm and narrowing of the anterior chamber angle, potentially leading to AACG. 

Edema in the ciliary body exacerbates the mechanical crowding of the angle structures, increasing outflow resistance through the trabecular meshwork.

AACG can also be precipitated by certain drugs used to treat dengue complications, or by medications that patients may have been taking before hospitalization. For example, sulfonamide-based antibiotics and anti-epileptics, such as topiramate, have been associated with drug-induced AACG due to ciliochoroidal effusion and angle closure. Severe dengue may cause systemic capillary leak syndrome, which acts synergistically with these pharmacologic triggers to worsen anterior segment crowding and precipitate glaucoma. In addition, systemic hypovolemia and electrolyte imbalances may exacerbate vascular instability in ocular tissues, leading to fluid extravasation and segmental edema.

Dengue may have an associated autoimmune-mediated inflammation in the anterior segment. Such immune responses would further augment ciliary body edema, interfere with aqueous production and outflow, and have detrimental effects on IOP regulation. In addition, genetic predispositions associated with human leukocyte antigen (HLA) alleles could participate in the autoimmune eye inflammation induced by the dengue virus and need to be further studied.

Hypothesized Sequence of Events:

Dengue virus infection generates a systemic inflammatory response mediated by cytokines. This, in turn, leads to vascular permeability and extravasation of fluid from the ciliary body, resulting in ocular edema. The resulting anterior segment anatomical changes lead to narrowing or closure of the anterior chamber angle, ultimately leading to AACG. Additionally, the dengue pathophysiology, medications, individual anatomical predispositions, and possibly autoimmune pathways provide a multifactorial basis for AACG development in dengue-affected individuals.

REFERENCE:

Al-Essa A (April 11, 2025) Acute Angle-Closure Glaucoma as an Ocular Complication of Dengue Fever: A Comprehensive Review. Cureus 17(4): e82119. doi:10.7759/cureus.82119.

Pierre Filho Pde T, Carvalho Filho JP, Pierre ET. Bilateral acute angle closure glaucoma in a patient with dengue fever: case report. Arq Bras Oftalmol. 2008 Mar-Apr;71(2):265-8. doi: 10.1590/s0004-27492008000200025. PMID: 18516431.

SMART EYE PRESSURE MONITORING DEVICE

 

Prakhar Austin Mohan, a third-year B.Tech student at MIET Engineering Institute in Meerut, India, has designed A non-contact tonometer, called the 'Smart Eye Pressure Monitoring Device'.

In conversation with ETV Bharat, Prakhar said that traditional machines for glaucoma testing cost up to Rs 1.5 lakh, but the device he has developed will cost between Rs 20,000 and Rs 25,000 only.

According to Prakhar, the device was developed using a microcontroller.

“It provides data processing and wireless connectivity. It has a non-invasive IOP sensor, which accurately measures eye pressure without pain,” Prakhar said. He explained that he had used a cloud-connected model, which analyzes the data and monitors the pressure pattern in the eye.

The device has an OLED display and is linked to a mobile app, which provides real-time readings and alerts to patients as well as doctors. Its IOT integration enables continuous monitoring, remote access, and emergency alerts, Prakhar said.

WHEN WILL THE DEVICE HIT THE MARKET?
Prakhar informed the news portal that the device is in the final stage of development, and he has also applied for a patent to launch the device in the market. He said that the tonometer has provided accurate results during the testing phase.

https://www.etvbharat.com/en/!offbeat/eye-catching-news-for-glaucoma-patients-uttar-pradesh-engineering-student-develops-frugal-device-to-measure-eye-pressure-enn25040501950

RED-FREE (GREEN) FILTER-ENHANCED GONIOSCOPY

 

A study has shown that gonioscopy using a red-free (green) filter can enhance visibility of the iridocorneal angle.

The angles were imaged with an indirect 4-mirror goniolens with standard halogen light, red-free green filter and also warm light filter of the slit lamp. The images and videos were recorded using a smartphone adaptor to the slitlamp. The illumination was set at 1/4^th with 20x magnification.

The study found that the contrast of the gonioscopy images was enhanced objectively with a red-free filter compared to standard light photos. The built-in warm filter of the slit lamp also provided better visualization of the iridocorneal angle structures.

The evaluation of the images and videos by two glaucoma specialists revealed that the red-free (green) filter provided enhanced tissue visualization for the pigmentation of the trabecular meshwork in 90% (n = 9) of the cases, and the quality of visualization did not worsen during regular gonioscopy.

Also, the warm color provided good contrast between the angle structures, as well as being less irritating to the photosensitive patients. This filter was also found to be superior in identifying the Schlemm’s canal, as it appeared orange or red, unlike the usual halogen light appearance, where it appears white and is often difficult to identify.

This enhancement can facilitate the accurate identification of the angle structures, particularly in instances where gonioscopic interpretation is challenging and when the patient is sensitive to light.

VIEW VIDEO HERE: https://www.youtube.com/watch?v=bgRP3EmCC3Q

REFERENCE: Iqbal MI. Red-Free (Green) Filter-Enhanced Gonioscopy with Smartphone: A Pilot Study. Cureus. 2024 Jan 3;16(1):e51559. doi: 10.7759/cureus.51559. PMID: 38313936; PMCID: PMC10835508.

FOOD INSECURITY AND GLAUCOMA

 

Food insecurity is a complex social determinant of health (SDOH) that refers to the household-level economic and social conditions of limited or uncertain access to adequate food.

Food insecurity is typified by alternating periods of food adequacy and scarcity, creating a cyclical stressor that has been proposed to have complex health effects through altered feeding behaviors, nutritional status, and financial decision-making.

Food insecurity has been proposed to lead to a broad set of behaviors that increase an individual’s risk for disease and disease progression.

These feeding behaviors predispose individuals to metabolic dysregulation, reduced antioxidant intake, and chronic inflammation, which may further exacerbate the impact on individual physical and mental health. This could cause chronic eye diseases such as GLAUCOMA.

78,964 participants from The National Institutes of Health All of Us (AoU) Research Program were included in a study to assess the association of food insecurity with chronic eye diseases. Among the participants, 9732 (12.4%) had food insecurity. [1]

Of the total 78,695 participants, 2095 (2.7%) had GLAUCOMA, 1398 (1.8%) had AMD, 1127 (1.4%) had DR, and 10,135 (12.9%) had cataracts.

Participants who reported food insecurity had significantly higher odds of GLAUCOMA (adjusted odds ratio [aOR]: 1.43, 95% confidence interval [CI]: 1.18e1.72, P 0.001) compared with those without food insecurity. Participants had a 43% increased likelihood of GLAUCOMA.

No significant associations were observed between food insecurity and AMD (aOR: 0.91, 95% CI: 0.67e1.21, P ¼ 0.544), DR (aOR: 1.15, 95% CI: 0.93e1.42, P ¼0.180), or cataracts (aOR: 0.97, 95% CI: 0.87e1.08, P ¼ 0.635) in adjusted regression models.

REFERENCE:

[1] Talebi R, Yu F, Tseng VL, Coleman AL. Association between food insecurity and chronic eye disease in the National Institutes of Health’s All of US Research Program. Ophthalmology Science. 2025;5(3):100697.

VisuALL ANALYZER

 

The Olleyes VisuALL  Analyzer (vFA) is a virtual reality visual function platform designed to monitor the retinal sensitivity in patients with eye diseases. This mobile device performs Standard Automated Perimetry and other psychophysical tests, including assessment of visual acuity, color vision, contrast sensitivity, pupillometry, and extraocular motility.

The VisuALL is a portable automated perimeter that uses a virtual interface that has the potential to provide an immersive testing experience for patients. The VisuALL has two displays (one for each eye), allowing it to test both eyes simultaneously but separately with a similar test duration to other perimeters. 

The VisuALL Virtual Reality Software suite works with the seamless synergy of three elements: the WebApp, the Cloud, and Olleyes Approved VR Headset.

Annie, a Virtual Assistant, is designed to boost efficiency, monitor patients, explain the testing process to patients, and organize the test data for easy reading.

The headset runs the VisuALL Patient Testing Application (PTA), which was written in Unity (a cross-platform gaming engine). By leveraging this engine, VisuALL can create a fully immersive and self-contained environment in order to perform self-directed, interactive training tutorials for the patient and then proceed to the VF test. 

Another key component of the VisuALL PTA is the proprietary thresholding algorithms, which implement complex decision trees to determine most efficiently what the patient's threshold for light detection is at each location. 

The VisuALL uses Goldmann size III test stimuli in each VF protocol and tests both eyes simultaneously. 

The vFA has both strong short-term and long-term test-retest reliability in addition to high correlation with HFA in a standard clinical setting.

After testing is complete, the software generates a report that includes the patient's name, date of birth, gender, test ID, examination date, test time, and test strategy. It also lists the fixation losses, false positives, and false negatives. Below is a plot of the threshold values for each of the 50 points tested, and a grayscale representation of the threshold values.

COMPANY WEBSITE: https://olleyes.com/

OMNI SURGICAL SYSTEM

 

The OMNI Surgical System from Sight Sciences is an implant-free, minimally invasive technology, despite being a comprehensive procedure, indicated for canaloplasty (microcatheterization and transluminal visco-dilation of Schlemm’s canal) followed by trabeculotomy (cutting of trabecular meshwork) to reduce intraocular pressure in adult patients with or without cataract surgery, for mild, moderate, and advanced primary open-angle glaucoma (POAG).

The OMNI is a handheld instrument with a hollow tip through which ophthalmic viscosurgical device (OVD) can be injected to perform visco-dilation and through which a microcatheter can be deployed to perform trabeculotomy. Other features of the device include a gear wheel for advancement and withdrawal of the microcatheter, a port for loading OVD into the device, and a reservoir to hold it.

Under gonioscopic view, the handpiece tip is introduced into the OVD-filled anterior chamber through a temporal corneal incision and advanced to the nasal angle.

The tip then engages and passes through trabecular meshwork, and the microcatheter is deployed via the cannula into and through 180° of Schlemm’s canal.

The microcatheter is then retracted slowly as a fixed volume of OVD is injected to visco-dilate the canal and collector channels.

The procedure is then repeated on the remaining 180° of the canal.

To perform the trabeculotomy, the same catheter is advanced once again through 180° of Schlemm’s canal and withdrawn using a cheese-wire technique to unroof the canal; this process can be repeated on the remaining 180° of the canal.

Standard anti-inflammatory (dexamethasone) and anti-microbial (ofloxacin) therapy are prescribed postoperatively.

Newer modifications include a cannula tip featuring a new profile that allows for gentle and precise access to Schlemm’s canal, while still enabling a complete 360-degree catheterization associated with the OMNI procedure.

New enhancements enable surgeons to more easily rotate and position the cannula tip within Schlemm’s canal using precise finger rotations rather than wrist adjustments.

COMPANY WEBSITE: https://omnisurgical.com/

WALKING 10,000 STEPS DAILY AND GLAUCOMA

 

In the 1960s, a Japanese company created a pedometer called ‘Manpo-kei,’ which translates to ‘10,000 steps meter.’ The number was chosen because it sounded catchy and promoted an active lifestyle. Therefore, the common 10,000 steps daily concept did not originate from any health organization guidelines. Instead, it was merely a trendy marketing idea. 

However, modern research has since validated the health benefits of walking more daily, even if 10,000 isn’t a strict requirement.

Walking 10,000 steps per day provides individuals with a specific goal. It helps people avoid a sedentary lifestyle, which is linked with health issues like heart disease, high blood pressure, high cholesterol, type 2 diabetes, certain cancers, osteoporosis, depression, and anxiety.

Studies show that increasing daily step count is associated with lower mortality risk, improved cardiovascular health, lower cardiovascular-associated mortality, a decreased cancer risk, and better metabolic function. 

Movement releases endorphins, helping to reduce stress and boost mood.

A study by Yuanbo et al, published in the recent edition of the Journal of Glaucoma, has shown that patients with primary open angle glaucoma (POAG) with average daily steps (ADS) of more than 10,000 exhibited higher papillary (optic disc) vessel density (VD) compared with those with ADS less than 10,000. This indicates that increasing daily steps, particularly exceeding 10,000 steps, may potentially enhance ocular blood flow. (1)

The study reported that papillary VD was significantly denser in the ADS >10,000 group (ADS:12782±2925) compared with that of the ADS ≤10,000 group (ADS:7418±1543).

Therefore, the 10,000 daily step routine can be a useful regimen for POAG patients to improve ocular blood flow. Vascular abnormalities have been associated with the development and progression of glaucoma. (2)

REFERENCE:

1. Liang, Yuanbo MD, PhD; Yu, Yun PhD; Wen, Xin MD; Wang, Mei MD, PhD; Lan, Yuqing MD, PhD; Pan, Xiafei MD,. Walking More Than 10,000 Steps Per Day May Be Associated With Increased Optic Disc Vessel Density in Patients With Primary Open Angle Glaucoma. Journal of Glaucoma 34(4):p 249-255, April 2025. | DOI: 10.1097/IJG.0000000000002548
2. Ahmad SS. Controversies in the vascular theory of glaucomatous optic nerve degeneration. Taiwan J Ophthalmol. 2016 Oct-Dec;6(4):182-186. doi: 10.1016/j.tjo.2016.05.009. Epub 2016 Aug 1. PMID: 29018738; PMCID: PMC5525630.

 

OPTIC NERVE STIMULATION (ONS) THERAPY

 

An innovative approach to glaucoma treatment is electrical stimulation of the retina and optic nerve.

In a study by Gall, transcutaneous electrical stimulation was applied through supra- and infra-orbital electrodes to the eyes of 82 patients diagnosed with optic neuropathies. The treated group had a significant improvement in visual field of 24% compared to baseline. This improvement persisted for at least 2 months. [1]

Another study by Ota involved five eyes of four patients suffering from POAG, who underwent transcorneal electrical stimulation. There was a significant linear relationship between changes in MD values and the number of electrical stimulation sessions, indicating partially restored visual fields (p < 0.01). [2]

However, a study by Rock in which transcorneal electrical stimulation was done the results were equivocal. Patients were randomized into three groups with no stimulation (sham), and electrical stimulation intensities below (subthreshold) or above (suprathreshold) individual phosphene thresholds. No statistically significant differences in visual fields between groups were reported. [3]

A study of optic nerve stimulation (ONS) by Erb et al involved 101 eyes in 70 patients (31 female, 39 male). The subjects included primary open-angle glaucoma (POAG, 65), normal tension glaucoma (NTG, 13), angle-closure glaucoma (ACG, 6), pseudoexfoliative glaucoma (PEX, 6), juvenile glaucoma (4), pigmentary glaucoma (4), glaucoma fere absolutum (2), and congenital glaucoma (1). [4]

The ONS treatment was conducted using the Eyetronic® device (Neuromodtronic GmbH, Potsdam, Germany) that applied electrical stimulation via goggles with embedded supraorbital and infraorbital electrodes and recorded EEG signals via an electrode cap.

The study revealed a significant change of MD by − 0.5 dB/year on average in visual field testing. MD significantly decreased from PRE 14.0 dB (median) to POST 13.4 dB (p < 0.01). 64 eyes in 49 patients showed constant or reduced MD as compared to baseline (PRE 13.4 dB vs. POST 11.2 dB). In 37 eyes of 30 patients, MD increased from PRE 14.9 dB to POST 15.6 dB.

Median MD at baseline before ONS treatment was 14 dB, more than 58% of eyes had an advanced vision loss with an MD > 12 dB, more than 80% of eyes were classified as moderate or advanced glaucoma, corresponding to an MD ≥ 6 dB.

The Eyetronic therapy involves the application of gentle electrical pulses, which stimulate the metabolism of neurons, restoring their function and stopping further cellular degeneration.

The therapy involves 10 sessions of 60 minutes each, applied over 10 consecutive days.

WEBSITE: https://eyetronic-therapie.de/en/

REFERENCES:

1. Gall C, Schmidt S, Schittkowski MP, Antal A, Ambrus GG, Paulus W, et al. Alternating current Stimulation for vision restoration after optic nerve damage: a randomized clinical trial. PLoS One. 2016;11(6):e0156134.
2. Ota Y, Ozeki N, Yuki K, Shiba D, Kimura I, Tsunoda K, et al. The efficacy of Transcorneal electrical Stimulation for the treatment of primary open angle Glaucoma: a pilot study. Keio J Med. 2018;67(3):45–53.
3. Rock T, Naycheva L, Willmann G, Wilhelm B, Peters T, Zrenner E, et al. Transcorneal electrical stimulation in primary open angle glaucoma. Ophthalmologe. 2017;114(10):922–9.
4. Erb C, Eckert S, Gindorf P, Köhler M, Köhler T, Neuhann L, Neuhann T, Salzmann N, Schmickler S, Ellrich J. Electrical neurostimulation in glaucoma with progressive vision loss. Bioelectron Med. 2022 Mar 31;8(1):6. doi: 10.1186/s42234-022-00089-9. PMID: 35361287; PMCID: PMC8969331

BREAST CANCER AND GLAUCOMA

 

PRE-PRINT:

Breast carcinoma is the most commonly occurring cancer among females. An estimated 2.3 million new cases of breast carcinoma are diagnosed annually worldwide. These patients have a potential risk of ocular complications, not only from the disease itself, but also due to side effects of medications such as corticosteroids and cytotoxic drugs used to treat breast cancers. [1] Metastases to the eye can affect almost every structure of the eye and adnexa, affecting vision and ocular motility from involvement of the extra-ocular muscles. Often, the ocular findings are the first indication of the disease involving the breast. [2]

Glaucoma can occur through diverse mechanisms in such patients. However, there are only a few case reports and studies available to understand the association between the two conditions. Glaucoma and breast carcinoma are two serious conditions affecting the morbidity and mortality of the affected patient. It would be an important exercise to assess the extent of association between these two conditions.

REFERENCES:

Łukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review. Cancers (Basel). 2021 Aug 25;13(17):4287.

Swampillai AJ, Booth AP, Cohen VML. Ciliary body and iris metastases with anterior chamber angle infiltration: a rare complication from invasive ductal breast cancer. J Glaucoma. 2020;29:e12-e15.

CATCH OUR ARTICLE COMING SOON ON: TOUCHReviews in Ophthalmology

 

THABIT IBN QURRA

 

Thābit ibn Qurra (full name: Abū al-Ḥasan Ṯhābit ibn Qurra ibn Zahrūn al-Ḥarrānī al-Ṣābiʾ) was a scholar known for his work in mathematics, medicine, astronomy, and translation. He was born in 826 or 836 and died on February 19, 901.

Thābit was born in Harran in Upper Mesopotamia, which at the time was part of the Diyar Mudar subdivision of the al-Jazira region of the Abbasid Caliphate. He spent most of his life in Baghdad.

Thābit was a well-known physician of his time and produced several medical treatises and commentaries. His works included general reference books such as al-Dhakhira fī ilm al-tibb ("A Treasury of Medicine"), Kitāb al-Rawda fi l–tibb ("Book of the Garden of Medicine"), and al-Kunnash ("Collection").

Thabit was the first to describe occlusion therapy for treating lazy eye or amblyopia. He suggested the closure of the normal eye with a patch to strengthen the lazy eye by forcing the “visual spirit” to transfer into the lazy eye: This was a leading breakthrough in ophthalmology.

REFERENCES:

• Abudawood GA, Alshareef R, Alghamdi S. Arab and Muslim scientists and their contributions to the history of ophthalmology. Saudi J Ophthalmol 2020;34:198-201.
• https://en.wikipedia.org/wiki/Th%C4%81bit_ibn_Qurra

FIBRONECTIN for NERVE REGENERATION

 

The central nervous system (CNS) projection neurons do not regenerate after axonal injury or degeneration. 

Several intra- and extra-cellular factors have been discovered that regulate axon regeneration. However, it is still difficult to find mechanisms to bypass extracellular inhibitors associated with glial scar and myelin formation (e.g., Cspg, Mag, NogoA, OMgp, Semaphorins) and help regenerate a complete axon.

As the CNS matures, the retinal ganglion cells (RGCs) lose their ability for intrinsic axon growth. This happens with a change in the initial axonal preference for an extracellular matrix (ECM) substrate to grow, conferred by integrin α and β heterodimers. Changes in the extracellular environment compromise the function of neuronal integrin subunit expression and axonal growth following injury or other deleterious events.

Lukomska and colleagues found that an ECM substrate fibronectin (Fn) which interacts with integrins was excessively present in some RGCs that survived optic nerve crush injury. It was found that Fn promotes survival and axon regeneration of axotomized adult RGCs in culture without glial scar inhibitors.

Injury-activated macrophages/microglia upregulate Fn. These cells are recruited by axon regeneration-promoting zymosan. This increases the Fn levels in the injured area.

The researchers found that Fn’s RGD motif, which interacts with Itga5 and ItgaV promotes long-term survival and long-distance axonal regeneration of adult RGCs. Some of the axons were found to reach the optic chiasm when co-treated with rpl7a gene therapy.

In conclusion, augmenting Fn levels in the damaged CNS is a promising therapeutic neuroprotective and neuroregenerative approach.

REFERENCE:

Lukomska A, Rheaume BA, Frost MP, Theune WC, Xing J, Damania A, Trakhtenberg EF. Augmenting fibronectin levels in injured adult CNS promotes axon regeneration in vivo. Exp Neurol. 2024 Sep;379:114877. doi: 10.1016/j.expneurol.2024.114877. Epub 2024 Jun 27. PMID: 38944331; PMCID: PMC11283980.

 

KAHOOK DUAL BLADE vs iSTENT: A META-ANALYSIS

 

The Kahook Dual Blade (KDB) is a modern goniotomy device. The goal for inventing the KDB device was to find a better and more efficient method for removing a complete strip of trabecular meshwork (TM) using an ab interno approach while minimizing damage to surrounding tissues.

CHECK LINK: https://ourgsc.blogspot.com/search?q=kahook

The iStent is a minimally invasive glaucoma surgery (MIGS) device devised to bypass the obstructed TM and allow the flow of aqueous from the anterior chamber into the Schlemm’s canal.

CHECK LINK: https://ourgsc.blogspot.com/search?q=iStent

A systematic review and meta-analysis comparing the KDB with iStent implantation with phacoemulsification was done by Guedes et al.

Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject).

The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (odds ratio: 0.68; 95% CI: 0.50 to 0.92; P = 0.01; I2 = 40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13 mm Hg; 95% CI: 0.43 to 1.83; P = 0.002; I2 = 51%).

By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69 mm Hg; 95% CI: 0.44 to 2.95; P = 0.008; I2 = 74%). However, compared with the phaco iStent inject group, there was no significant difference in IOP reduction (MD: −0.72 mm Hg; 95% CI: −3.69 to 2.24; P = 0.63; I2 = 64%). Medication reduction and the incidence of adverse events were comparable between groups.

RESULT:

The study concluded that KDB goniotomy may offer better surgical success compared with Stent implantation when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared with iStent. However, iStent inject showed a similar IOP reduction to KDB.

REFERENCE:

Guedes J, Amaral DC, de Oliveira Caneca K, Cassins Aguiar EH, de Oliveira LN, Mora-Paez DJ, Cyrino LG, Louzada RN, Moster MR, Myers JS, Schuman JS, Shukla AG, Shalaby WS. Kahook Dual Blade Goniotomy Versus iStent Implantation Combined With Phacoemulsification: A Systematic Review and Meta-Analysis. J Glaucoma. 2025 Mar 1;34(3):232-247. doi: 10.1097/IJG.0000000000002522. Epub 2024 Dec 9. PMID: 39641580.