The association between glaucoma treatment adherence with disease progression and loss to follow-up.

Prospective cohort study from Brazil to evaluate glaucoma treatment adherence using a medication event monitoring system (MEMS) device and correlate with glaucoma progression and loss to follow-up (LTF) after one year of follow up. We included primary open glaucoma (POAG) patients treated with at least one ocular hypotensive eye drop. MEMS devices was used to monitor adherence for 60 days and evaluate the percentage of doses prescribed taken within the 60-day period. We classified patients according to rates of adherence: low adherence (less than 75% from MEMS measurements) and high adherence (more than 75% from MEMS measurements). We applied a questionnaire to investigated self-reported behavior towards treatment behaviors (glaucoma treatment compliance assessment tool, GTCAT). We also correlated rates of treatment adherence with clinical, demographical variables and the occurrence of glaucoma progression or LTF after one year of observation. We included 110 POAG patients and found that 28.18% of them were considered low adherent. We identify several variables associated with poor adherence such as glaucoma progression, LTF, younger age, low educational and income levels, absence of health insurance, years of disease and peak intraocular pressure. Several constructs from the self-reported GTCAT were also correlated with the rates of treatment adherence. To date, this is the first study in Latin America to evaluate glaucoma treatment adherence with MEMS devices and correlate adherence rates with glaucoma progression and LTF. We found a low-adherence rate of 28.18% and several additional risk factors were statistically associated with poor adherence.

Trabeculectomy in Eyes With High Myopia.

PRCIS: Primary trabeculectomy was safe and effective at lowering intraocular pressure (IOP) in patients with primary open angle glaucoma and high myopia. PURPOSE: To investigate the efficacy and safety of trabeculectomy in patients with glaucoma and high myopia. PATIENT AND METHODS: Retrospective case-control study. Glaucomatous patients with high myopia undergoing primary trabeculectomy surgery with at least 1 year of follow-up were compared with an age-matched control group without high myopia undergoing the same procedure. Surgical success was defined as: IOP ≤ 15 mm Hg with (qualified) or without (complete) antiglaucoma medications and at least 20% reduction from baseline IOP at the end of 48 months of follow-up. RESULTS: We included a total of 90 eyes from 90 patients (45 eyes with high myopia and 45 controls). Within the 90 eyes, 70 eyes underwent trabeculectomy and 20 eyes underwent combined phacoemulsification and trabeculectomy. Although patients with high myopia had higher chances for failure (37% vs. 22%) compared with controls, the difference was not statistically significant ( P =0.067). In the multivariable analysis, patients of African descent ( P =0.043) and those with juvenile glaucoma ( P =0.001) had more chances of failure, even after adjusting for myopia. There was no statistically significant difference between complication rates in both groups. CONCLUSION: Trabeculectomy was effective in reducing IOP in patients with high myopia and glaucoma, without the additional risk of complications compared with a control group.

Differentiating Branch Retinal Artery Occlusion From Normal Tension Glaucoma With Optical Coherence Tomography Angiography.

BACKGROUND: To describe a patient with branch retinal artery occlusion that was misdiagnosed as normal tension glaucoma (NTG). CASE PRESENTATION: A female 76-year-old patient presenting inferior nasal visual field scotoma, neuroretinal thinning in the optic disk of the right eye with corresponding atrophy of superior retinal nerve fiber layer in optical coherence tomography (OCT). She was treated with latanoprost eye drops for NTG. However macular OCT angiography showed a localized thinning of the inner retina following the superior temporal branch retinal artery path, along with a superficial and medium capillary plexus reduction and superior macular ganglion cell layer atrophy. Further investigation with carotid arteries angio-tomography revealed an atheromatous lesion in the right and left carotid bulb with stenosis of 50-60%, in addition to aneurysms of the cavernous, pituitary and communicating segments of the left and right internal carotid artery, reinforcing the diagnosis of superior temporal branch retinal artery ischemic. CONCLUSION: This case highlights the importance of establishing differential diagnosis in cases of presumed NTG and reinforces the use of the OCT angiography in clinical practice.