Four articles. Four minutes. | Issue #18
Surgery: Prolene ripcord reduced Baerveldt postoperative interventions with similar 5-year IOP control
Laser: Longer MPCPC treatment duration was associated with greater 1-year IOP lowering in refractory glaucoma
Health Systems: High myopia was the strongest correlate of missed glaucoma diagnosis despite recent eye care
Genetics: Higher residential sunlight exposure was associated with greater POAG risk and faster RNFL thinning
A prospective randomised comparison of two different stenting sutures when using the Baerveldt 101-350 aqueous shunt - Lab transition to clinical process
Methods
In this prospective randomized study, 94 patients with refractory glaucoma undergoing Baerveldt 101-350 implantation received either 3-0 Supramid (nylon, n=48) or 3-0 Prolene (polypropylene, n=46) as the intraluminal occluding suture, with IOP, suture management, and complications followed for 60 months. A paired laboratory model compared wet-state swelling of the two suture materials.
Results
Both groups achieved similar IOP and medication use through 60 months (mean IOP 11 mmHg in each group). Prolene required no intraluminal suture adjustments versus 10 with Supramid (P=0.001), and removal occurred later (8.9 vs 5.0 months, P<0.001). In the laboratory model, Supramid swelled by approximately 60% versus 3% for Prolene. Transient hypotony after suture removal occurred in 3/48 Supramid eyes (6.25%) and none with Prolene, although overall hypotony incidence did not differ significantly between groups.
Conclusion
In this single-center randomized study, Prolene ripcord provided similar 5-year pressure control with fewer postoperative manipulations and later removal than Supramid. Generalizability is limited by the single-surgeon technique, clinician-determined removal timing, and a baseline IOP imbalance between randomized groups.
Our Angle
Baerveldt surgery can have an unpredictable postoperative course, in part because the timing of ligature opening and subsequent flow can be difficult to control. A ripcord that behaves predictably while the capsule matures may reduce hypotony and the need for early postoperative intervention, making the transition from a ligated to a functioning tube more controlled. The most useful finding here is that Prolene achieved similar long-term IOP control with fewer interventions and later ripcord removal, consistent with its greater dimensional stability in aqueous.
I would not interpret 8–9 months as a universal target for ripcord removal or conclude that Prolene eliminates hypotony. This was a single-surgeon study using a specific restrictive technique with external ligatures and individualized removal decisions, and overall hypotony rates were not statistically different between groups. Still, for surgeons who already use an intraluminal ripcord with a non-valved tube, the study is a useful reminder that suture material may matter as much as caliber. A dimensionally stable monofilament Prolene ripcord may offer more predictable postoperative flow modulation without compromising long-term pressure lowering.
Laser
Dose-effectiveness Optimizing in Micropulse Transscleral Cyclophotocoagulation: A Cohort Study in Refractory Glaucoma
Design: Retrospective single-center cohort
Journal: Ophthalmology Glaucoma, August 2026
Authors: Wu et al.
In 229 Chinese eyes with refractory glaucoma treated with MPCPC at 2,000 mW and a 31.3% duty cycle, longer treatment duration was associated with greater IOP lowering: 240 seconds produced a 38.7% reduction at 12 months versus 25.5% with 160 seconds, and each additional 40 seconds was associated with 5.9 percentage points more IOP reduction. Kaplan-Meier success was highest with 240 seconds (68.7% vs 53.6% with 160 seconds), while overall complication rates did not differ significantly. Treatment duration was not randomized and evolved over time. Also, although mean BCVA worsened significantly only within the 160-second group, clinically significant >=2-line visual deterioration occurred in all three groups.
Health Systems
Diagnostic discrepancies in glaucoma: underdiagnosis, overdiagnosis and missed opportunities in a nationwide South Korean population
Design: Nationwide cross-sectional study
Journal: British Journal of Ophthalmology, August 2026
Authors: Cho et al.
Among 18,710 Korean adults in KNHANES 2019-2021, weighted glaucoma prevalence was 3.9%, but only 17.1% of affected participants reported a prior diagnosis. Of undiagnosed cases, 44.7% had seen an ophthalmologist within the prior year, and high myopia was the strongest correlate of this 'missed diagnostic opportunity' (OR 23.53), along with younger age, rural residence, and thicker RNFL. At the other extreme, 59.7% of participants reporting a prior glaucoma diagnosis did not meet the study's ISGEO criteria. These estimates require caution: a recent eye examination did not necessarily include glaucoma screening, and self-reported prior 'glaucoma' may have included ocular hypertension or glaucoma-suspect status, potentially inflating the apparent missed-opportunity and false-positive rates.
Genetics
Interaction of genetic susceptibility and sunlight exposure on primary open-angle glaucoma risk and progression
Design: Hospital-based retrospective case-control study
Journal: British Journal of Ophthalmology, August 2026
Authors: Hsia et al.
In a Taiwanese cohort of 745 participants (149 with POAG and 596 matched controls), greater residential solar insolation was associated with higher odds of POAG (adjusted OR 1.20) and faster RNFL thinning (beta=-0.09 micrometers/year). The POAG gradient across polygenic-risk quartiles was steeper among participants living in higher-sunlight areas, and mediation analysis found no evidence that IOP explained the association. These findings are hypothesis-generating rather than practice-changing: residential insolation is only a proxy for individual ocular UV exposure, and the polygenic risk score was developed in European-ancestry populations and showed modest discrimination (AUC 0.59) in this East Asian cohort.
FDA accepts a new drug application for bimatoprost grenod, a nitric oxide-donating prostaglandin eye drop for open-angle glaucoma and ocular hypertension, with a target decision date of April 30, 2027.
CMS finalizes Medicare payment rates for a noninvasive nighttime IOP-lowering device ahead of its fourth-quarter commercial launch, establishing a 13-month capped rental of approximately $14,200 for the pump system.
A British Journal of Ophthalmology study reports that fenofibrate users had roughly half the odds of progressing to vision-threatening diabetic retinopathy and more than two-thirds lower odds of diabetic macular edema across 4,316 matched pairs.
FDA grants De Novo authorization for a precision optical filter for episodic migraine, establishing the first device classification for migraine-associated light sensitivity in patients aged 12 and older.
Moorfields Eye Hospital originally opened in 1805 under which name?
A. Royal London Eye Infirmary
B. London Dispensary for Curing Diseases of the Eye and Ear
C. British Institute of Ophthalmology
D. St. Thomas Eye Clinic
See answer at bottom of newsletter.
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The Open Angle is a weekly glaucoma research digest for busy eye care professionals.
Four articles worth knowing, in under four minutes.
Edited by Jella An, MD, MBA and Jason Dossantos, MD.
The Open Angle is an educational editorial product. It is not medical advice. Readers should review original sources before changing practice.
Trivia Answer: B