BackgroundGlaucoma is the leading cause of irreversible blindness worldwide, with primary open-angle glaucoma (POAG) arising as the most common subtype. Recent studies have shown that muscarinic and prostaglandin pathways can modulate bone remodeling under systemic, context-dependent conditions. M3 muscarinic receptor activation has been linked to increased bone formation and decreased resorption, whereas continuous prostaglandin E2 (PGE2) administration inhibits bone resorption, with intermittent use inducing bone formation. Given the minimal systemic findings of topical ophthalmic medications, the clinical relevance of bone remodeling effects for patients treated with glaucoma eye drops, particularly in regard to osteoporosis, remains uncertain and warrants evaluation.Patients and MethodsA retrospective cohort study was conducted using the TriNetX network with approximately 100 million de-identified electronic medical records. Cohorts included POAG patients prescribed either prostaglandin analogs (e.g. latanoprost, bimatoprost, travoprost, tafluprost) without muscarinic agonist use, or muscarinic M3 agonists (e.g. pilocarpine, carbachol) without prostaglandin analog use. Propensity score matching was performed for age, sex, comorbidities, and concurrent glaucoma medications to limit possible cofounders. The outcome was defined as a diagnosis of osteoporosis without current pathological fracture (ICD code M81). Risk ratios (RR), odd ratios (OR), and 95% confidence intervals (CI) were calculated.ResultsAfter matching, each cohort included 6,743 patients. The incidence of osteoporosis is 13.3% in the prostaglandin cohort and 8.9% in the muscarinic cohort. Prostaglandin agonist use was associated with a statistically significant increase in osteoporosis risk (RR = 0.67, 95% CI 0.60-0.73; OR = 0.63, 95% CI 0.57-0.71; p < 0.0001).ConclusionProstaglandin agonist use was associated with an increased risk of osteoporosis compared with muscarinic agonist therapy in POAG patients. These findings suggest potential systemic effects (e.g. changes to bone health) of prostaglandin agonist use beyond previously known local, ocular effects and highlight the importance of considering osteoporosis risk in glaucoma management.

We report a case of distinctive ripple-like Descemet membrane folds after combined microhook ab interno trabeculotomy (µLOT) and cataract surgery. A 70-year-old Japanese man with primary open-angle glaucoma and cataract underwent nasal µLOT followed by phacoemulsification and intraocular lens implantation in the right eye. At 1 week postoperatively, unusual ripple-like Descemet membrane folds, which had not been noted at the examination on postoperative day 1, were observed in the inferior cornea with localized corneal edema. Best-corrected visual acuity was 0.4 in decimal notation. Multimodal imaging revealed no apparent Descemet membrane detachment or tears. Review of the surgical video showed inadvertent aspiration of the Descemet membrane during irrigation/aspiration (I/A), followed by the appearance of the folds. The patient was managed conservatively, and the folds resolved completely by 3 months postoperatively, with best-corrected visual acuity improving to 1.2. We hypothesize that incision of peripheral supporting structures during µLOT may have reduced tangential tension in the Descemet membrane, increasing its susceptibility to aspiration during subsequent I/A. This mechanism remains unconfirmed. Careful I/A manipulation following µLOT is warranted, and conservative management may be appropriate for similar folds without associated Descemet membrane detachment or tears. As minimally invasive glaucoma surgery is often performed by ophthalmology trainees and surgeons with limited surgical experience, this report may serve as an educational example of an intraoperative complication during combined surgery.

Objective: To compare clinical outcomes of combined trabeculotome tunnelling trabeculoplasty (3T) and phacoemulsification vs. 3T alone for primary open-angle glaucoma (POAG) with cataract. Methods: Retrospective cohort study. Patients with POAG and cataract who underwent 3T combined with phacoemulsification and intraocular lens implantation or 3T alone at Chengdu Integrated Traditional Chinese and Western Medicine Hospital between January 2023 and December 2024 were enrolled. They were divided into two groups according to surgical modality: the observation group with eyes receiving 3T combined with phacoemulsification and intraocular lens implantation and the control group with those receiving 3T alone. The intraocular pressure (IOP), best-corrected visual acuity [converted to logarithm of the minimum angle of resolution(logMAR)], number of antiglaucoma medications, and complications were recorded on postoperative day 1, week 1, month 1, month 3, and month 6, and the success rate at 6 months was evaluated. Results: There were 59 patients (71 eyes), with a mean age of (62.81±7.80) years, including 38 males and 21 females. The observation group comprised 35 eyes and the control group 36 eyes. The preoperative IOP was (23.76±5.01) mmHg (1 mmHg=0.133 kPa) in the observation group and (24.56±6.08) mmHg in the control group; at 6 months postoperatively, the IOP decreased to (15.28±2.80) mmHg and 15.00 (13.50, 18.00) mmHg, respectively. Both groups showed a significant IOP reduction from baseline (P<0.05), but the difference between groups was not statistically significant (P>0.05). At 6 months, the best-corrected visual acuity in the observation group improved significantly from baseline, with a mean improvement of 0.38 logMAR (P<0.05), whereas no significant improvement was observed in the control group (P>0.05). The number of antiglaucoma medications decreased postoperatively in both groups, with no statistically significant difference between groups (P>0.05). Regarding complications, the incidence of hyphema was 5.7% (2/35) in the observation group and 11.1% (4/36) in the control group, with no statistically significant difference (P>0.05). The incidence of IOP rebound was 20.0% (7/35) in the observation group, which was significantly lower than that in the control group (41.7%, 15/36) (P<0.05). At 6 months postoperatively, the overall success rate was 88.6% in the observation group and 80.6% in the control group, with no statistically significant difference (P>0.05). Conclusions: The 6-month follow-up results of this study indicate that 3T combined with cataract extraction is a safe and effective treatment for POAG with cataract, significantly improving visual acuity, effectively reducing IOP, and decreasing the number of antiglaucoma medications, with a low rate of postoperative complications.

Glaucoma is the leading cause of irreversible blindness worldwide, driven by progressive retinal ganglion cell (RGC) degeneration. While genetic and environmental risk factors have been identified, the cell-type-specific mechanisms underlying pathogenesis remain incompletely understood. Single-cell RNA sequencing (scRNA-seq) enables high-resolution analysis of cellular heterogeneity, developmental trajectories and intercellular communication networks. This review synthesizes recent scRNA-seq advances across two critical domains in glaucoma research: (1) aqueous humor outflow pathway (AHOP) physiology and pathology; (2) primary open-angle glaucoma (POAG) pathogenesis. We identify convergent themes, including mitochondrial dysfunction as a shared mechanism across subtypes, the central role of neuroinflammation in RGC degeneration, and the therapeutic potential of metabolic interventions. We further discuss challenges in translating animal models to human disease, integrating multi-species datasets, and resolving cell-type-specific susceptibility. Finally, we highlight emerging directions in spatial transcriptomics, multi-omics integration, and precision medicine.