To explore the genetic variants of trabeculodysgenesis under ultrasound biomicroscopy (UBM) and its association with surgical outcomes in patients with primary congenital glaucoma (PCG).

In this prospective case series, consecutive patients with PCG underwent microcatheter-assisted trabeculotomy (MAT) and followed for at least 24-month after surgery. All participants underwent UBM and whole-exome sequencing prior to MAT and were classified into two groups with severe trabeculodysgenesis or mild trabeculodysgenesis under UBM. Surgical success was defined as a postoperative IOP of ≤21 mm Hg with at least a 20% reduction from preoperative IOP without additional medical or surgical therapy.

Severe trabeculodysgenesis was observed in 23 (40%) eyes of 14 patients (median age: 57mo, range: 3–169mo; 11 males) with 8 carrying causative CYP1B1 variants, while mild trabeculodysgenesis occurred in 34 eyes (60%) of 18 patients (median age: 23.5mo, range: 3–110mo; 12 males) without any causative variants. The success rate of MAT was 0 in patients with causative CYP1B1 gene variants and 75.0% in those without (P<0.001). Cox regression survival analysis showed that carrying CYP1B1 gene variants [OR_CYP1B1=0.356 (95%CI: 0.132, 0.962), P=0.042] and having severe trabeculodysgenesis [OR_Type=0.116 (95%CI: 0.034, 0.403), P=0.001] were associated with a higher risk of surgical failure.

PCG patients with severe trabeculodysgenesis under UBM are prone to harbor causative CYP1B1 gene variants, which could serve as a valuable predictor of potential Schlemm’s canal dysgenesis and MAT prognosis. Genetic screening in patients with severe trabeculodysgenesis under UBM is beneficial for genetic counseling and may help reduce the incidence of complex cases.

To explore and summarize outcomes of a modular surgical approach for the personalized management of angle-closure glaucoma (ACG) secondary to nanophthalmos.

This was a retrospective interventional case series involving consecutive patients with nanophthalmos and ACG. All patients were treated with a modular surgical approach tailored to their specific disease characteristics, which included the following surgical combinations: Procedure Ⅰ [phacoemulsification (phaco)+goniosynechialysis (GSL)], Procedure Ⅱ [Procedure Ⅰ +irido-zonulo-hyaloid-vitrectomy (IZHV)], Procedure Ⅲ [phaco +IZHV+Ahmed glaucoma valve (AGV) implantation], and Procedure Ⅳ (Procedure Ⅲ+scleral window creation).

A total of 92 eyes from 62 patients were enrolled, with a median age of 52 (range: 23-72)y and a median axial length of 19.89 (range: 14.84-20.99) mm. According to the patients’ distinct clinical characteristics, 14, 26, 22, and 30 eyes underwent Procedures Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The median follow-up duration was 13 (range: 12-36)mo. At the final follow-up visit, all patients achieved a sustained intraocular pressure (IOP) below 21 mm Hg without the administration of anti-glaucoma medications. Postoperative complications included malignant glaucoma (MG, 9 eyes), uveal effusion (UE, 5 eyes), suprachoroidal hemorrhage (1 eye), fibrin membrane formation (4 eyes), uveitis (1 eye), macular edema (1 eye), and impaired corrected distance visual acuity (CDVA, 6 eyes). Univariate analysis revealed that younger age was associated with a higher risk of MG (OR: 1.06, P=0.04), UE (OR: 1.07, P=0.046), and impaired CDVA (OR: 1.11, P=0.02).

The modular surgical approach yields favorable and consistent clinical prognoses, while reducing the incidence of complications, in the challenging clinical scenario of ACG secondary to nanophthalmos.

To describe the alterations of the vitreous pathology and anterior chamber (AC) angle structures following transscleral cyclophotocoagulation (TSCP) and better understand the mechanism of post-laser intraocular pressure (IOP) reduction in angle-closure glaucoma (ACG).

Porcine eyes ex vivo and rabbit eyes in vivo were used. In porcine eyes, permeability rates of the anterior vitreous cortex (AVC) and anterior hyaloid membrane (AHM) were assessed using Schirmer’s strips. Permeability rates in the circumlental space were compared with or without TSCP bursts. Fluorescein diffusion times from the vitreous to the AC were compared between eyes with and without TSCP. In rabbit eyes, changes in IOP and AC angle structures under ultrasound biomicroscopy (UBM) were evaluated at intervals of 30min, 7d, and 14d after TSCP. Vitreous pathology was examined using scanning electron microscopy (SEM) immediately and 14d after TSCP.

In porcine eyes (n=20), the median (range) permeability rates were 10.3 (range 9.8–10.8) mm/min for the AVC and 4.3 (range 3.9–4.9) mm/min for the AHM (P=0.009). Permeability rates in the circumlental space were 4.2 (range 3.8–4.9) mm/min in areas without TSCP, 6.2 (range 5.7–6.8) mm/min in areas with non-burst TSCP, and 11.3 (range 10.9–11.8) mm/min in areas with burst TSCP (P=0.002). The median (range) fluorescein diffusion time was 5 (range 3–8)min in eyes undergoing TSCP, whereas it was 40min (range 35–68) in eyes without TSCP (P<0.001). In rabbit eyes (n=20), SEM showed immediate localized damage to the AHM, AVC, and posterior lens zonules in areas subjected to TSCP bursts, and obvious lens zonule loss with cellular infiltration and possible vitreous liquefaction by post-op day 14. Persistent widening of AC angles was noted at postoperative days 7 and 14, although a significant reduction in IOP was only observed at postoperative day 7.

TSCP-induced damage on the zonules, AHM, and AVC potentially enhances fluid outflow from the vitreous, leading to a widened AC angle and vitreous liquefaction in rabbits. These observations offer insights into mechanisms of TSCP in lowering IOP and pathogenic roles of vitreous in ACG.