* BACKGROUND AND OBJECTIVE: To investigate the outcome and complication rates of trabeculectomy following the combined use of intraoperative, topical 5-fluorouracil (5-FU) and low-dose, postoperative subconjunctival 5-FU injections. * PATIENTS AND METHODS: Forty-one eyes of 41 patients with advanced, medically uncontrolled glaucoma underwent trabeculectomy with intraoperative episcleral application of 5-FU (50 mg/ml for 5 minutes). A variable number of subconjunctival 5-FU injections were administered postoperatively at the discretion of the operating surgeon. * RESULTS: Six-, 12-, and 15-month life-table success rates (5 mm Hg ≤ intraocular pressure [IOP ≤ 21 mm Hg) were 100%, 97%, and 83%, respectively. Mean postoperative IOP was 12.1 ± 4.3 mm Hg. An average of 2.2 ± 1.6 (range 0 to 7) supplemental subconjunctival 5-FU injections were administered postoperatively. Corneal epithelial erosions developed in 7 (17%) of the eyes. Five of 7 patients who underwent subsequent surgical procedures maintained successful control of IOP at an average of 11.0 ± 4.8 (range 5 to 16) months after the secondary surgery. * CONCLUSION: Trabeculectomy with intraoperative 5-FU is effective in controlling IOP while possibly minimizing the need for frequent postoperative injections and the occurrence of corneal epitheliopathy. [Ophthalmic Surg Lasers 1998;29:552-561.]

To determine the rate of visual field (VF) loss before and after the diagnosis of primary open angle glaucoma (POAG) in the Ocular Hypertension Treatment Study (OHTS). Prespecified analyses of data collected prospectively in a clinical trial with extended follow-up. Participants who developed POAG during OHTS 1 and 2 (February 1994 to December 2008) constitute an inception cohort. Follow-up data were collected in OHTS 3 (January 2016-April 2019). Analyses were performed from July 2021 to August 2022. In OHTS 1 and 2, visual field (VF) tests were performed every 6 months and stereoscopic optic disc photographs were taken every 12 months. These tests were repeated in OHTS 3. Slopes of mean deviation (MD) were calculated by linear regression for all eyes in OHTS 1 and 2: eyes that did not develop POAG, eyes that developed optic disc POAG only, and eyes that developed VF POAG with/without optic disc POAG. Mean pre- and post-POAG slopes were calculated for eyes with a minimum of 5 VFs for each period. Mean age at diagnosis of POAG was 66.4 ± 9.5 SD years (n = 282 participants), (56%) were male, 61% were White non-Hispanic and 32% were Black not Hispanic by self-report. The post-POAG slope was -0.40 ± 0.64 SD dB/year for all POAG eyes (n = 280 eyes), -0.19 ± 0.4 SD dB/yr. for optic disc POAG only eyes (n = 112 eyes), and -0.54 ± 0.7 SD dB/yr. for VF POAG eyes with or without optic disc POAG (n = 168 eyes). Among the VF POAG eyes, 69 (41%) had post-POAG MD slopes worse than or equal to -0.5 dB/year, 35 (21%) had slopes worse than or equal to -1.0 dB/year, and 9 (5.4%) had slopes worse than or equal to -2.0 dB/year. Some participants in OHTS had rapid rates of VF loss in one or both eyes despite being followed in a clinical study. This emphasizes that ocular hypertensive patients require careful follow-up, especially those at high risk of developing POAG to ensure early diagnosis and appropriate treatment of POAG.

The diagnosis of primary open-angle glaucoma (POAG) progression based on structural imaging such as color fundus photos (CFPs) is challenging due to the limited number of early biomarkers, as commonly determined by clinicians, and the inherent variability in optic nerve heads (ONHs) between individuals. Moreover, while visual function is the main concern for glaucoma patients, and the ability to infer future visual outcome from imaging will benefit patients by early intervention, there is currently no available tool for this. To detect glaucoma progression from ocular hypertension both structurally and functionally, and identify potential objective early biomarkers associated with progression, we developed and evaluated deep convolutional long short-term memory (CNN-LSTM) neural network models using longitudinal CFPs from the Ocular Hypertension Treatment Study (OHTS). Patients were categorized into four diagnostic groups for model input: healthy, POAG with optic disc changes, POAG with visual field (VF) changes, and POAG with both optic disc and VF changes. Gradient-weighted class activation mapping (Grad-CAM) was employed for the post hoc visualization of image features, which may be associated with the objective POAG biomarkers (rather than the biomarkers determined by clinicians). The CNN-LSTM models for the detection of POAG progression achieved promising performance results both for the structural and functional models, with an area under curve (AUC) performance of 0.894 for the disc-only group, 0.911 for the VF-only group, and 0.939 for the disc and VF group. The model demonstrated high precision (0.984) and F1-score (0.963) in the both-changes group (disc + VF). Our preliminary investigation for early POAG biomarkers with Grad-CAM feature visualization signified that retinal vasculature could serve as an early and objective biomarker for POAG progression, complementing the traditionally used optic disc features and improving clinical workflows.