Four articles. Four minutes. | Issue #26
Surgery: Medication-free success at one year favored trabeculectomy over slow-burn cyclophotocoagulation
Laser: Iridotomy in the narrowest quadrant was not linked to greater two-week angle widening in PACS
Diagnostics: Binocular random perimetry was associated with lower central sensitivity than monocular testing
Nutrition: Omega-3 prescriptions were linked to fewer recorded glaucoma diagnoses in patients with dry eye
Trabeculectomy versus Transscleral Cyclophotocoagulation as a Primary Surgical Procedure in Glaucoma: A Multicenter Randomized Controlled Trial
Methods
This multicenter Brazilian trial randomized 86 adults undergoing their first glaucoma procedure to trabeculectomy with mitomycin C or slow-burn transscleral cyclophotocoagulation (CPC); 77 eyes of 77 patients were analyzed. The primary endpoint was 12-month surgical success, defined as IOP 6 to 18 mmHg without serious complications or nonprotocol glaucoma surgery.
Results
Trabeculectomy achieved lower mean IOP at 12 months than CPC (10.14 vs 14.58 mmHg; P<0.001). Success without medication or protocol retreatment was also higher (74.4% vs 28.9%; P<0.001). Qualified success, allowing medication and one needling revision or repeat CPC session, was 97.4% versus 86.8% (P=0.083).
Conclusion
Both procedures lowered IOP as a first glaucoma operation, with lower final pressure and greater medication independence after trabeculectomy. The qualified-success findings do not establish equivalence.
Our Angle
This trial is useful because it compares two procedures with very different effectiveness, safety, and postop-management profiles. These were fairly advanced eyes. Mean visual field MD was approximately −15 dB, patients were taking more than 3 medications, and baseline IOP was about 23 mmHg. Both procedures produced meaningful pressure reduction: a mean IOP of 14.6 mmHg after slow-burn CPC may be entirely adequate for many patients, while trabeculectomy achieved an even lower mean IOP of 10.1 mmHg with substantially greater medication independence. The appropriate choice therefore depends not only on how low the IOP needs to go, but also on how much procedural risk and postoperative management are justified to get there.
The CPC results are particularly useful because this nonincisional approach achieved mid-teen IOP without creating a bleb and without significant vision-threatening complications over 12 months. That matters when considering the lifelong risks and management burden associated with bleb-forming surgery and other incisional complications. The tradeoff was lower medication-free success and more retreatment: 10 of 38 CPC eyes required repeat laser and 4 ultimately underwent trabeculectomy. Conversely, 5 of 39 trabeculectomy eyes required needling. Because the study counted one repeat CPC or one needling as qualified success, success rates should be interpreted alongside the very different intervention burden of the two strategies.
With only 77 analyzed eyes and 12 months of follow-up, this study cannot define long-term comparative safety or durability. Still, it expands the conversation beyond IOP alone: trabeculectomy remains the more predictable choice when very low IOP and medication independence are paramount, while slow-burn CPC may be an attractive primary option when a mid-teen target is acceptable and avoiding conjunctival incision, bleb-related risk, and intensive postoperative management is a priority.
Laser
Effect of laser peripheral iridotomy location on angle widening in primary angle closure suspects: the six-year ZAP trial
Design: Post hoc cohort analysis of a randomized trial
Journal: British Journal of Ophthalmology, October 2026
Authors: Shean et al.
Superior iridotomy was associated with the largest short-term angle widening in 427 primary angle-closure suspect eyes; placement in the narrowest quadrant was not associated with greater widening. In this post hoc Zhongshan Angle-Closure Prevention Trial analysis, mean angle opening distance 750 μm from the scleral spur increased by 83 μm with superior, 73 μm with temporal, and 63 μm with nasal placement at 2 weeks. Placement was not randomized, and only 44 eyes received nasal iridotomies. Seven eyes progressed to primary angle closure over 6 years, too few for a formal site comparison or conclusions about better long-term clinical outcomes.
Diagnostics
Central Visual Field Differences Between Monocular and Binocular Random Perimetry in Glaucoma
Design: Retrospective single-center paired study
Journal: Ophthalmology Science, October 2026
Authors: Shoji et al.
IMOvifa binocular random perimetry recorded lower central sensitivity than monocular testing in 488 patients, especially in worse eyes; peripheral 24plus differences were smaller. This mode presents each stimulus to one eye with both eyes open and does not measure natural binocular vision. Among 222 patients with bilateral 10-2 data, sensitivity at the four central locations averaged 1.03 dB lower in worse eyes and 0.28 dB lower in better eyes. Test order was not randomized, and median intervals between modes were 256 days for 24plus and 266 days for 10-2, leaving progression and learning as possible contributors. An apparent central decline after a mode change warrants confirmation by repeat testing with the same strategy before being attributed to progression.
Nutrition
Relationship Between Omega-3 Fatty Acids and Glaucoma Risk in Patients With Dry Eye Disease: A Multinational Retrospective Cohort Study
Design: Multinational retrospective matched cohort study
Journal: Translational Vision Science & Technology, June 2026
Authors: Pan et al.
Omega-3 prescriptions were associated with fewer glaucoma diagnoses among 14,168 matched adults with dry eye disease: 5.00% versus 10.43% over up to 5 years. Primary open-angle glaucoma was recorded in 0.75% versus 1.69%, with lower rates of ocular hypertension and glaucoma medication initiation as well. The groups did not share a common time zero: outcome follow-up began 3 months after the first omega-3 prescription for users but 3 months after dry eye diagnosis for controls, and users also had to receive a second prescription within 1 year to qualify. Conditioning exposure on a future second prescription can preferentially select patients who remain engaged in care and continue therapy, a bias propensity matching cannot remove. Unknown supplement dose and formulation and unverified glaucoma diagnoses add further uncertainty; this association is hypothesis-generating and does not establish that omega-3 prevents glaucoma.
An uncontrolled study of an investigational bimatoprost-eluting IOL found 18 of 21 evaluable patients off glaucoma drops four years after cataract surgery.
A wearable glaucoma perimeter debuts at AAO with a claimed range covering early through advanced field loss; comparative accuracy results were not reported.
FDA approves subcutaneous satralizumab for adults with thyroid eye disease, allowing home administration after training and maintenance injections every four weeks.
An investigational oral kinase inhibitor for noninfectious uveitis prolonged time to treatment failure versus placebo in two phase 3 trials, its sponsor reports.
Which eye disease was known as "Egyptian ophthalmia" during the Napoleonic Wars?
A. Pterygium
B. Vernal keratoconjunctivitis
C. Trachoma
D. Epidemic keratoconjunctivitis
See answer at bottom of newsletter
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The Open Angle is a weekly glaucoma research newsletter 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 EXPLANATION
Which eye disease was known as "Egyptian ophthalmia" during the Napoleonic Wars?
C. Trachoma
Egyptian ophthalmia became associated with the severe contagious eye disease affecting troops during and after the Napoleonic campaigns. Trachoma is the diagnosis commonly linked to that historical episode.
The long-term threat came from repeated conjunctival inflammation and scarring, with entropion and trichiasis damaging the cornea. The name reflects where the disease became notorious to those armies, not the full geographical distribution of trachoma. Its spread also helped shape the development of dedicated eye-care institutions in Europe.