Purpose: This study aimed to evaluate and compare the effectiveness and safety of Paul glaucoma implant (PGI) and Baerveldt 350 glaucoma implant (BGI) over a 1-year follow-up period. Methods: This retrospective study was conducted in a private clinic. It compared 27 patients consecutively treated with the PGI to a historical cohort of 29 eyes that received the BGI prior to the introduction of the PGI between 2018 and 2023. Intervention: A new drainage device, the Paul implant, was placed in the anterior or posterior chamber of eyes with uncontrolled intraocular pressure (IOP). Main Outcome Measures: The main outcome measures were success rate, final mean IOP, IOP reduction percentage, medication reduction, and complications. Statistical analyses, including adjustments for confounders, were used to compare the performance of PGI and BGI over at least a 12-month period. Results: Significant reductions in IOP were observed in both groups (P < 0.001). At 1 year, no significant differences were found in mean IOP (BGI: 12.0 mmHg, SD 2.9; PGI: 11.2 mmHg, SD 6.0) or medication usage (P > 0.05). The failure rates were 7% for BGI and 18% for PGI, with complete success rates of 56% for BGI and 32% for PGI. Hypertensive phases occurred in 32% of the BGI cases and in 19% of the PGI cases. No significant differences in the complication rates or postoperative visual acuity were observed between the groups. Conclusion: PGI and BGI exhibited comparable efficacy and safety profiles after 1 year.

Purpose: To investigate risk factors associated with success and failure in double-plate tube surgery. Methods: This retrospective case-series observational study included 243 consecutive eyes that underwent anterior-segment double-plate tube surgery from 1990 to 2015. Evaluation of the efficacy of the device was based on the final intraocular pressure (IOP) and the need for anti-glaucoma medication. We also assessed success and failure according to risk factors for trabeculectomy and an early hypertensive phase (HP). Results: Preoperative IOP was 37.3± 13.1 mmHg (mean±SD) with 3.0± 0.7 medications. After a median follow-up of 44.3 months, the mean IOP was 14.6± 6.3 mmHg with 0.4± 1.0 medications. The final IOPs ranged from 6 to 21 mmHg in 87.24% of eyes; however, 25.47% required medication. No risk factors studied were associated with surgical failure. Preoperative IOP, glaucoma type, previous surgery, previous anti-glaucoma drugs, implant type, and HP were associated with partial success (p< 0.05). HP and preoperative use of brimonidine reduced the probability of complete success by 66.9% and 68.2%, respectively (p< 0.05). HP was more likely when chronic preoperative prostaglandin analogues were administered (odds ratio [OR] 4.286; 95% confidence intervals [CI] 1.593– 11.529; P=0.0039) and when the tube was located in the posterior chamber (OR 3.561; 95% CI 1.286– 9.861; P=0.0145). Conclusion: Tube surgery is effective and seems to be independent of the major risk factors for glaucoma surgery. However, previous surgery and some chronic preoperative drugs are related to the need for glaucoma medication to achieve the target pressure.

Background/Objectives: This study aimed to compare the visual outcomes of two diffractive trifocal intraocular lenses (IOLs): the Bi-Flex Liberty 677MY (Medicontur; Zsámbék, Hungary) and the FineVision POD F (BVI Medical; Waltham, MA, USA). Methods: A prospective study with a 3-month follow-up was conducted. A total of 62 patients were divided into two groups according to the type of lens implanted: 31 patients with the Liberty lens (61.1 ± 6.4 years) and 31 patients with the Finevision lens (61.9 ± 6.8 years). Three measurement sessions were conducted (baseline, 1 month, and 3 months). These sessions included measurements of the subjective refraction, visual acuity, and defocus curve. Both eyes of each patient were operated on and included in the statistical analysis. Results: Three months after surgery, monocular visual acuity with the Liberty lens was statistically greater than with the Finevision lens at defocus values of −2.00 D (50 cm) and −2.50 D (40 cm) (p < 0.01). In this regard, the near visual acuity results (40–50 cm) with the Liberty lens showed greater variability compared to those of the Finevision lens. Binocularly, however, the Finevision lens demonstrated a statistically significant improvement in visual acuity than the Liberty lens at a defocus of −1.50 D (67 cm) (p = 0.01). Both IOLs provided visual acuities better than 0.20 logMAR for a defocus range from distance (0.00 D) to near (−3.50 D). Conclusions: Future studies are needed to investigate which patient ocular parameters could predict improved near vision with the Liberty lens or intermediate vision with the Finevision lens.

Background: Different aqueous restrictive manoeuvres in non-valved devices affect intraocular pressure (IOP) levels in the first postoperative month. This study compares tube ligature (TL) alone to TL plus rip cord stent (TLS) on the efficacy of the Baerveldt 350. Methods: We conducted a retrospective consecutive case-series observational study to assess efficacy by measuring IOP, success rates and the reduction of antiglaucoma medication usage over 3 years. Results: The study included 43 eyes in the TL group and 29 in the TLS group. Initial IOPs were 26.67 mm Hg for TL and 28.21 mm Hg for TLS. After 1 year, IOP decreased to 13.03 mm Hg and 12.11 mm Hg, respectively. Over 3 years, TLS consistently achieved greater reductions in IOP compared with TL, with significant differences of 3.56 mm Hg in the second year (p=0.01) and 3.34 mm Hg in the third year (p=0.01). Mean antiglaucoma medication use decreased from 3.03 (SD 1.29) to 0.72 (SD 0.47) over 3 years, representing a 76.24% reduction, with no differences between the TL and TLS groups. Failure rate at 1 year was significantly lower for TLS under the success criteria of IOP=(6–18) mm Hg (TL: 33.33%, TLS: 7.14%, p=0.02). Rates of transient hypotension and hypertensive phase were higher in the TL group: 93.02% vs 34.48% (p<0.001) and 58.14% vs 32.14% (χ²=4.59, p=0.03), respectively. Conclusion: Adding the rip cord stent to the Baerveldt implant significantly enhances long-term IOP control and reduces failure rates compared with TL alone. The lower incidence of hypertensive phases could be due to sequential tube opening. Small sample size, lack of randomisation and follow-up discrepancies may introduce bias and limit statistical power, highlighting the need for further research to confirm these conclusions.

Real-Life Effectiveness and Safety of Selective Laser Trabeculoplasty as Primary, Adjunctive, and Substitutive Therapy - Turkish Journal of Ophthalmology

Objectives: This study aimed to evaluate the diagnostic performance of peripapillary retinal nerve fiber layer (RNFL) thickness measurements corrected by artificial intelligence (AI) compared to original uncorrected values for glaucoma detection in highly myopic patients. Methods: This cross-sectional diagnostic accuracy study included 57 eyes from highly myopic patients (31 with glaucoma, 26 without glaucoma). Peripapillary RNFL parameters were obtained using Spectralis optical coherence tomography (OCT). A deep learning algorithm (MGU-Net) was employed to automatically segment retinal layers and compensate for scan tilt in elongated eyes, producing AI-corrected measurements. RNFL thickness values were extracted for six sectoral parameters (ST, SN, N, IN, T, IT) and global. Diagnostic performance was assessed using area under the ROC curve (AUC) and compared between corrected and uncorrected values. Multivariable logistic regression models were also developed using stepwise selection. Results: AI-corrected values were significantly lower than original measurements in all sectors (p < 0.001), with mean differences ranging from 15 to 35 µm. In glaucomatous eyes, significant thinning was observed in the global (p = 0.049) and inferior nasal (IN) sector (p = 0.037) among corrected values. The highest AUCs were found in IN (0.69), IT (0.67), and global (0.66) for corrected values, and in IT (0.63), T (0.59), and global (0.63) for uncorrected data. A model combining ST, T, and IT AI-corrected values achieved an AUC of 0.79. Conclusions: AI-corrected RNFL thickness measurements improve consistency and enhance diagnostic performance in highly myopic glaucoma patients. Correction algorithms may reduce false positives and help reveal glaucomatous damage otherwise obscured by myopic anatomical changes.