Purpose: Conjunctival incisional surgery is a known risk factor for trabeculectomy failure. The occurrence of avascular bleb following failed ab interno XEN stent implantation has been documented in patients undergoing trabeculectomy with mitomycin C (MMC). However, reports on same quadrant trabeculectomy with MMC after failed ab externo open conjunctiva XEN stent implantation are scarce. This study sought to document the 1-year clinical outcomes and bleb morphology following this procedure.Case summary: This retrospective study reviewed the medical records of 4 eyes from 4 patients who received trabeculectomy with MMC in the same quadrant following ab externo open conjunctiva XEN stent implantation failure. At 1 year after trabeculectomy, the intraocular pressure was successfully controlled without glaucoma medication, and no visual field progression was observed. Anterior segment tomography indicated that the blebs were elevated and broad, with a suprascleral fluid-filled space evident in all eyes. There were no instances of prolonged hypotony or bleb leakage one year after the trabeculectomy, although an avascular bleb was observed in one eye. Conclusions Performing trabeculectomy with MMC in the same quadrant appears to be an effective method for reducing IOP after the failure of ab externo open conjunctiva XEN stent implantation.

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye.Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0. Conclusions Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.

Purpose: To report a case of angle-closure glaucoma caused by pupillary block in a patient with familial exudative vitreoretinopathy (FEVR).Case summary: A 20-year-old man with FEVR presented with sudden-onset pain in his left eye. The best-corrected visual acuity (BCVA) was 0.04, and the intraocular pressure (IOP) was 76 mmHg. The central anterior chamber depth was reduced to twice the corneal thickness. Gonioscopy revealed 360° angle closure. Anterior segment optical coherence tomography and ultrasound biomicroscopy demonstrated a closed angle and anteriorly convex peripheral iris due to forward displacement of the lens–iris diaphragm and contact between the iris and lens. Trabeculectomy and cataract surgery were performed because the IOP was not controlled despite maximal medical therapy. At 9 months postoperatively, the IOP was 13 mmHg without the use of glaucoma medications, and the BCVA was 0.1. Conclusions In patients with FEVR, angle-closure glaucoma due to pupillary block can occur even at a young age. FEVR should be considered in young patients with acute angle-closure glaucoma.

Purpose: Conjunctival incisional surgery is a known risk factor for trabeculectomy failure. The occurrence of avascular bleb following failed ab interno XEN stent implantation has been documented in patients undergoing trabeculectomy with mitomycin C (MMC). However, reports on same quadrant trabeculectomy with MMC after failed ab externo open conjunctiva XEN stent implantation are scarce. This study sought to document the 1-year clinical outcomes and bleb morphology following this procedure.Case summary: This retrospective study reviewed the medical records of 4 eyes from 4 patients who received trabeculectomy with MMC in the same quadrant following ab externo open conjunctiva XEN stent implantation failure. At 1 year after trabeculectomy, the intraocular pressure was successfully controlled without glaucoma medication, and no visual field progression was observed. Anterior segment tomography indicated that the blebs were elevated and broad, with a suprascleral fluid-filled space evident in all eyes. There were no instances of prolonged hypotony or bleb leakage one year after the trabeculectomy, although an avascular bleb was observed in one eye. Conclusions Performing trabeculectomy with MMC in the same quadrant appears to be an effective method for reducing IOP after the failure of ab externo open conjunctiva XEN stent implantation.

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye.Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0. Conclusions Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.

Purpose: To report a case of angle-closure glaucoma caused by pupillary block in a patient with familial exudative vitreoretinopathy (FEVR).Case summary: A 20-year-old man with FEVR presented with sudden-onset pain in his left eye. The best-corrected visual acuity (BCVA) was 0.04, and the intraocular pressure (IOP) was 76 mmHg. The central anterior chamber depth was reduced to twice the corneal thickness. Gonioscopy revealed 360° angle closure. Anterior segment optical coherence tomography and ultrasound biomicroscopy demonstrated a closed angle and anteriorly convex peripheral iris due to forward displacement of the lens–iris diaphragm and contact between the iris and lens. Trabeculectomy and cataract surgery were performed because the IOP was not controlled despite maximal medical therapy. At 9 months postoperatively, the IOP was 13 mmHg without the use of glaucoma medications, and the BCVA was 0.1. Conclusions In patients with FEVR, angle-closure glaucoma due to pupillary block can occur even at a young age. FEVR should be considered in young patients with acute angle-closure glaucoma.

Purpose: Conjunctival incisional surgery is a known risk factor for trabeculectomy failure. The occurrence of avascular bleb following failed ab interno XEN stent implantation has been documented in patients undergoing trabeculectomy with mitomycin C (MMC). However, reports on same quadrant trabeculectomy with MMC after failed ab externo open conjunctiva XEN stent implantation are scarce. This study sought to document the 1-year clinical outcomes and bleb morphology following this procedure.Case summary: This retrospective study reviewed the medical records of 4 eyes from 4 patients who received trabeculectomy with MMC in the same quadrant following ab externo open conjunctiva XEN stent implantation failure. At 1 year after trabeculectomy, the intraocular pressure was successfully controlled without glaucoma medication, and no visual field progression was observed. Anterior segment tomography indicated that the blebs were elevated and broad, with a suprascleral fluid-filled space evident in all eyes. There were no instances of prolonged hypotony or bleb leakage one year after the trabeculectomy, although an avascular bleb was observed in one eye. Conclusions Performing trabeculectomy with MMC in the same quadrant appears to be an effective method for reducing IOP after the failure of ab externo open conjunctiva XEN stent implantation.

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye.Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0. Conclusions Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.

Purpose: To report a case of angle-closure glaucoma caused by pupillary block in a patient with familial exudative vitreoretinopathy (FEVR).Case summary: A 20-year-old man with FEVR presented with sudden-onset pain in his left eye. The best-corrected visual acuity (BCVA) was 0.04, and the intraocular pressure (IOP) was 76 mmHg. The central anterior chamber depth was reduced to twice the corneal thickness. Gonioscopy revealed 360° angle closure. Anterior segment optical coherence tomography and ultrasound biomicroscopy demonstrated a closed angle and anteriorly convex peripheral iris due to forward displacement of the lens–iris diaphragm and contact between the iris and lens. Trabeculectomy and cataract surgery were performed because the IOP was not controlled despite maximal medical therapy. At 9 months postoperatively, the IOP was 13 mmHg without the use of glaucoma medications, and the BCVA was 0.1. Conclusions In patients with FEVR, angle-closure glaucoma due to pupillary block can occur even at a young age. FEVR should be considered in young patients with acute angle-closure glaucoma.

Purpose: To investigate factors associated with variability in the longitudinal visual field (VF) test in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study enrolled POAG patients with VF ≥ 12 who were followed up for ≥ 6 years. First, 52 total deviation values of VF series for each eye were linearly regressed against time (years), and the root mean square error (RMSE) of the residuals was used to measure long-term pointwise VF variability. The mean deviation (MD) of the VF series for each eye was linearly regressed against time (years), and the RMSE of the residuals was used to measure long-term global VF variability. Using hierarchical clustering, variable clustering was performed to select variables and Spearman’s correlation was used as a similarity index. We fitted a mixed effect linear regression model and evaluated factors associated with the long-term VF variability in each regression model. Results: The study included 246 eyes of 157 patients with POAG. Worse baseline peripapillary retinal nerve fiber layer (RNFL) thickness, lower baseline intraocular pressure (IOP), lower mean IOP, greater IOP fluctuation, and a faster VF decay rate were associated with increased long-term pointwise VF variability in the RNFL thickness model (all p ≤ 0.037). Worse baseline MD, lower baseline IOP, lower mean IOP, and faster VF decay rate were associated with increased long-term global VF variability in the MD model (all p ≤ 0.035). Conclusions Lower baseline and mean IOP, greater IOP fluctuation, worse glaucoma severity, and a faster VF decay rate were associated with greater long-term VF variability in patients with POAG. These factors should be considered when evaluating VF progression.