The edition · Ophthalmology
After a failed trabeculectomy, repeat trabeculectomy slowed field loss at least as well as an Ahmed valve — and peak pressure predicted who progressed
A 186-eye cohort backs redo trabeculectomy, a meta-analysis finds less post-keratoplasty glaucoma after DMEK than DSAEK, cheap anti-inflammatories track with less sight-threatening diabetic retinopathy, intra-arterial chemotherapy saves more cT3b/c retinoblastoma eyes, and VR defocus training slowed axial growth a little.
The edition in brief
Today's ophthalmology edition closes on an AJO cohort (12 September) of 186 eyes with failed trabeculectomy: field progression was similar after repeat trabeculectomy and Ahmed valve (31% vs 35%), but trabeculectomy gave lower pressure on fewer drops and slowed progression more relative to before surgery. Each mmHg of postoperative peak IOP raised the risk of field loss by 11%. The lead is a meta-analysis of 33 studies and 5235 eyes (AJO, 22 September): de novo glaucoma was 3% after DMEK against 11% after DSAEK, and ocular hypertension 9% against 34%, though certainty is low and steroid exposure confounds it. A TriNetX cohort (Ophthalmology, 10 September) found cetirizine, ibuprofen and prednisone associated with 40–60% less diabetic macular oedema and proliferative retinopathy, similar to fenofibrate — hypothesis-generating only. An 11-centre Chinese cohort of 1566 eyes (BJO, 1 September) found intra-arterial chemotherapy salvaged more cT3b and cT3c retinoblastoma eyes than intravenous chemotherapy, with no survival penalty against enucleation; cT3d still warrants enucleation. A 120-child trial (JAMA Ophthalmology, 27 August) of VR defocus training slowed axial growth by 0.11 mm over six months. The pearl is on recording peak IOP, not just mean, after glaucoma surgery.
Glaucoma after endothelial keratoplasty: 3% after DMEK, 11% after DSAEK
Monitor IOP closely after endothelial keratoplasty — pressure rise is common, less so after DMEK — and keep steroid exposure as low as graft safety allows.
Cetirizine, ibuprofen and prednisone were associated with less sight-threatening diabetic retinopathy
Do not prescribe anti-inflammatories for diabetic retinopathy; this association justifies a trial, not a change in practice.
Retinoblastoma cT3b/c: intra-arterial chemotherapy saved more eyes than intravenous, without a survival cost
For unilateral cT3b or cT3c retinoblastoma, consider intra-arterial chemotherapy for globe salvage; enucleate cT3d promptly.
VR defocus training slowed axial growth by 0.11 mm in six months
Keep to established myopia control — atropine, defocus spectacles, orthokeratology — while VR training remains a six-month result.
Record the peak IOP after glaucoma surgery, not just the mean
After glaucoma surgery, track and act on peak IOP, not only the mean.
Failed trabeculectomy: a repeat trabeculectomy is a sound choice alongside a tube
After a failed trabeculectomy, offer repeat trabeculectomy as a real option — it matched the Ahmed valve on field progression with lower pressure.
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