Glaucoma is a main cause of irreversible blindness worldwide, with a high impact on productivity and quality of life. The mechanical and ischemic theories are currently the most recognized pathophysiological pathways that explain the neurodegeneration of retinal nerve fibers in glaucoma. In this narrative review, aspects of ischemia in glaucoma are discussed, including vascular dysregulation, retinal ischemia signaling pathways, roles of vascular endothelial growth factors, and future research and therapeutic directions. In conclusion, a better understanding of the ischemic processes in glaucoma may lead to innovative treatment options and improved management and follow-up of our patients.

Childhood glaucoma encompasses a group of rare but severe ocular disorders characterized by increased intraocular pressure (IOP), posing significant risks to vision and quality of life. Primary congenital glaucoma has a prevalence of one in 10,000–68,000 people in Western countries. More worryingly, it is responsible for 5–18% of all childhood blindness cases. According to the Childhood Glaucoma Research Network (CGRN), this spectrum of disease is classified into primary glaucoma (primary congenital glaucoma and juvenile open-angle glaucoma) and secondary glaucomas (associated with non-acquired ocular anomalies, non-acquired systemic disease, acquired conditions, and glaucoma after cataract surgery). They present very specific ocular characteristics, such as buphthalmos or progressive myopic shift, corneal modifications such as Haab striae, corneal edema or increased corneal diameter, and also glaucoma findings including high intraocular pressure, specific visual fields abnormalities, and optic nerve damage such as increased cup-disc ratio, cup-disc ratio asymmetry of at least 0.2 and focal rim thinning. Surgical intervention remains the cornerstone of treatment, and initial surgical options include angle surgeries such as goniotomy and trabeculotomy, aimed at improving aqueous outflow. For refractory cases, trabeculectomy and glaucoma drainage devices (GDDs) serve as second-line therapies. Advanced cases may require cyclodestructive procedures, including transscleral cyclophotocoagulation, reserved for eyes with limited visual potential. All in all, with appropriate management, the prognosis of PCG may be quite favorable: stationary disease has been reported in 90.3% of cases after one year, with a median visual acuity in the better eye of 20/30. Immediate recognition of the specific signs and symptoms by caregivers, primary care providers, and ophthalmologists, followed by prompt diagnosis, comprehensive surgical planning, and involving the caregivers in the follow-up schedule remain critical for optimizing outcomes in childhood glaucoma management.

Background: Refractive errors are a common ophthalmological complaint, with a significant potential on the quality of life of our patients—myopia in particular has a growing incidence worldwide. Recent research focused on the ratio between the axial length of the eye (AL) and the corneal radius of curvature (CR), as it had proven valuable in refractive error diagnosis, and risk of progression and of complications. The objective of the study is to compare young emmetropic, hyperopic, and myopic eyes in terms of corneal biomechanics and ocular biometry, focusing on the AL/CR ratio. Methods: This cross-sectional study included 144 myopic eyes, 92 emmetropic eyes, and 47 hyperopic eyes. Measurements included cycloplegic autorefractometry (SE—spherical equivalent), Ocular Response Analyzer (CH—corneal hysteresis, CRF—corneal resistance factor), Aladdin biometry (AL, CR, ACD—anterior chamber depth, CCT—central corneal thickness, AL/CR ratio). Results: ACD, AL, and AL/CR were significantly higher and CCT, SE, CH, and CRF were lower in myopia. The AL/CR ratio correlated positively with AL and ACD and negatively with SE and CR in myopes and hyperopes, and correlated positively with AL and negatively with SE, CH, CRF, and CCT in emmetropes. Conclusions: The AL/CR ratio is significantly higher in myopes and significantly lower in hyperopes, compared to emmetropes, with differences also being in biomechanical properties (CH, CRF) and morphological ones (AL, CCT, ACD). This suggests the AL/CR ratio as a future potential biomarker for refractive errors, particularly for their risk of progression and complications.

Background: Primary angle-closure glaucoma (PACG) carries a high risk of irreversible blindness. This case highlights the challenges of managing refractory PACG in a patient with a history of prematurity and the subsequent development of postoperative complications. Case Presentation: A 45-year-old woman with a history of prematurity and monocular vision (no light perception in left eye) presented with acute angle closure in the right eye (RE). Despite maximal medical therapy, the RE intraocular pressure (IOP) remained at 54 mmHg. Less invasive options like laser iridotomy or standalone lens extraction were deemed insufficient, and to achieve efficient IOP lowering, the patient underwent combined phacotrabeculectomy, which was soon complicated by malignant glaucoma (aqueous misdirection) and hyphema. This necessitated a secondary intervention involving pars plana anterior vitrectomy and posterior capsulotomy. Over an 18-month follow-up, the patient suffered recurrent complications, including a spontaneous vitreous hemorrhage and eventually uncontrolled IOP. Management required a vitrectomy and the subsequent implantation of an Ahmed glaucoma valve. Although the valve procedure was followed by a transient early postoperative hyphema, the patient’s condition stabilized. At the final 28-month follow-up, the RE best corrected visual acuity was 20/25 with an IOP of 12–18 mmHg without medication. Conclusions: This case notes an interesting coexistence of advanced adult-onset angle-closure glaucoma and a history of prematurity, though a direct causal or anatomical link remains speculative due to the lack of advanced anterior segment imaging. The clinical course underscores the necessity of aggressive surgical management for aqueous misdirection and the risk of recurrent intraocular hemorrhage in advanced glaucoma. While a definitive developmental relationship cannot be established from a single case, this presentation highlights that an individualized history of prematurity may be a noteworthy consideration during comprehensive long-term ophthalmic evaluations.