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Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials
摘要： background The only widely accepted, effective treatment for open- angle glaucoma (OAG) is to reduce the intraocular pressure (IOP), with medical therapy being the typical first- line therapy. Notably, an alternative therapy is selective laser trabeculoplasty (SLT), which is safe and effective in lowering the IOP. Nonetheless, whether SLT could replace medication as the first- line therapy for OAG is still under debate. Methods Studies involving randomised controlled trials conducted before August 2019 that compared the efficacy of SLT- related and medication- only treatments for OAG were selected from PubMed, Embase, Cochrane Library and Web of Science. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology was employed to rate the quality of the body of evidence. results 1229 patients in eight trials were included. The overall results revealed no significant differences between SLT- related and medication- only treatments regarding the IOP reduction (mean difference (MD): 0.18, 95% CI ?0.72 to 1.07, p=0.70, I2=73%) and the success rate of IOP control (risk ratio: 1.02, 95% CI 0.99 to 1.04, p=0.74, I2=0%). The SLT- related therapy group required significantly fewer medications compared with the medication- only group (MD: ?1.06, 95% CI ?1.16 to ?0.96, p<0.0000, I2=5%). A quantitative analysis was not performed concerning adverse events and quality of life because of the limited data available. Conclusion SLT is safe and has a lower incidence of ocular side effects. SLT can be the choice of first- line therapy for OAG. However, clinicians should consider the cost- effectiveness, as well as the patient’s characteristics, before deciding on the therapeutic option.
关键词： selective laser trabeculoplasty,intraocular pressure,meta-analysis,medication,open-angle glaucoma
更新于2025-09-23 15:19:57
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Predictors of Success in Selective Laser Trabeculoplasty
摘要： Selective laser trabeculoplasty (SLT) is a common procedure to lower intraocular pressure (IOP) in patients with glaucoma. However, reports are conflicting regarding what factors contribute to SLT success. The purpose of this study was to determine predictors of SLT success. A total of 997 eyes from 677 patients were included in the study. Mean age was 70.2±11.5 years. Selective laser trabeculoplasty success was achieved in 227 eyes (22.8%), whereas 770 eyes (77.2%) did not meet success criteria. Intraocular pressure before SLT was 21.9±5.2 mmHg while taking 2.0±1.2 medications in eyes with successful SLT, compared with 19.0±5.0 mmHg (P < 0.0001) while taking 2.1±1.3 medications (P = 0.52) in eyes with SLT failure. At the 1-year follow-up, mean IOP in eyes with SLT success was 14.7±3.2 mmHg with 2.0±1.2 medications, compared with 16.3±4.7 mmHg (P = 0.008) with a mean of 1.9±1.3 medications (P = 0.37) in eyes with SLT failure. Eyes with SLT success more often showed greater angle pigment (P = 0.03). Age, glaucoma severity, total SLT power, type of glaucoma, severity of glaucoma, visual field mean defect, and retinal nerve fiber layer thickness were not found to correlate with success. No difference was found between the rate of success based on treatments before SLT, whether surgical or medical. In this large cohort of eyes undergoing SLT, greater IOP and angle pigment before SLT correlated positively with SLT success. Age, total SLT power, severity of glaucoma, and prior treatments were not associated with SLT success or failure.
关键词： intraocular pressure,predictors of success,glaucoma,Selective laser trabeculoplasty
更新于2025-09-23 15:19:57
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Time course of bilateral microglial activation in a mouse model of laser-induced glaucoma
摘要： Microglial activation is associated with glaucoma. In the model of unilateral laser-induced ocular hypertension (OHT), the time point at which the inflammatory process peaks remains unknown. Different time points (1, 3, 5, 8, and 15 d) were compared to analyze signs of microglial activation both in OHT and contralateral eyes. In both eyes, microglial activation was detected in all retinal layers at all time points analyzed, including: i) increase in the cell number in the outer segment photoreceptor layer and plexiform layers (only in OHT eyes) from 3 d onward; ii) increase in soma size from 1 d onward; iii) retraction of the processes from 1 d in OHT eyes and 3 d in contralateral eyes; iv) increase in the area of the retina occupied by Iba-1+ cells in the nerve fiber layer/ganglion cell layer from 1 d onward; v) increase in the number of vertical processes from 1 d in contralateral eyes and 3 d in OHT eyes. In OHT eyes at 24 h and 15 d, most Iba-1+ cells were P2RY12+ and were down-regulated at 3 and 5 d. In both eyes, microglial activation was stronger at 3 and 5 d (inflammation peaked in this model). These time points could be useful to identify factors implicated in the inflammatory process.
关键词： Microglial activation,retinal layers,glaucoma,inflammation,ocular hypertension
更新于2025-09-23 15:19:57
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Quantitative and Morphological Corneal Endothelial Changes After Selective Laser Trabeculoplasty and Retinal Photocoagulation
摘要： Selective laser trabeculoplasty (SLT) and retinal photocoagulation (RP) are two common laser procedures often performed at a wavelength of 532 nm, and may affect the corneal endothelium. This study used corneal specular microscopy to determine the impact of these procedures on the corneal endothelium. Design: Retrospective cohort study in a private practice. Methods: There were 249 eyes from 136 consecutive patients who underwent SLT for open-angle glaucoma and 132 eyes from 74 patients who underwent RP included. Corneal specular microscopy was performed immediately before and after each procedure and at 1-month postprocedure. Microscopy data included quantitative measures, such as cell density and central corneal thickness, and morphological measures, including percentage of hexagonal cells and coefficient of variation in cell area. Results: There was a small (just over 1%) reduction in corneal endothelial cell count from pre-SLT to post-SLT (P ? 0.008), and a statistically significant recovery at 1 month (P ? 0.04). Central corneal thickness also transiently increased from pre-SLT to post-SLT (P ? 0.03). Although polymegathism was unchanged, changes in pleomorphism were observed (P ? 0.03). The only change in the RP group was an increase in polymegathism between pre-RP and post-RP (P ? 0.001). Conclusions: SLT has measurable effects on both quantitative and morphological characteristics of the corneal endothelium, which seem to be transient. RP has fewer measurable effects, likely because, although the total laser energy is similar, it is delivered over a much longer time (3 ns versus 0.1 s). The changes observed in both procedures are minor and unlikely to be of clinical significance.
关键词： corneal endothelium,laser surgery,glaucoma
更新于2025-09-23 15:19:57
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Automatic Computer-Aided Diagnosis of Retinal Nerve Fiber Layer Defects Using Fundus Photographs in Optic Neuropathy
摘要： PURPOSE. To evaluate the validity of an automatic computer-aided diagnosis (CAD) system for detection of retinal nerve fiber layer (RNFL) defects on fundus photographs of glaucomatous and nonglaucomatous optic neuropathy. METHODS. We have proposed an automatic detection method for RNFL defects on fundus photographs in various cases of glaucomatous and nonglaucomatous optic neuropathy. In order to detect the vertical dark bands as candidate RNFL defects, the nonuniform illumination of the fundus image was corrected, the blood vessels were removed, and the images were converted to polar coordinates with the center of the optic disc. False positives (FPs) were reduced by using knowledge-based rules. The sensitivity and FP rates for all images were calculated. RESULTS. We tested 98 fundus photographs with 140 RNFL defects and 100 fundus photographs of healthy normal subjects. The proposed method achieved a sensitivity of 90% and a 0.67 FP rate per image and worked well with RNFL defects with variable depths and widths, with uniformly high detection rates regardless of the angular widths of the RNFL defects. The average detection accuracy was approximately 0.94. The overall diagnostic accuracy of the proposed algorithm for detecting RNFL defects among 98 patients and 100 healthy individuals was 86% sensitivity and 75% specificity. CONCLUSIONS. The proposed CAD system successfully detected RNFL defects in optic neuropathies. Thus, the proposed algorithm is useful for the detection of RNFL defects.
关键词： computer-aided diagnosis,glaucoma,optic neuropathy,fundus photographs,retinal nerve fiber layer
更新于2025-09-19 17:15:36
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The Relationship Between Retinal Nerve Fiber Layer Thickness and Optic Nerve Head Neuroretinal Rim Tissue in Glaucoma
摘要： PURPOSE. The purpose of this study was to determine the relationship between optical coherence tomography (OCT) measures of retinal nerve fiber layer (RNFL) and neuroretinal rim (NRR) in a nonhuman primate experimental glaucoma model, and in a population of clinical patients. METHODS. For nonhuman primates, normative data were collected from 44 healthy monkeys, and nine animals with unilateral experimental glaucoma that were followed longitudinally. Cross-sectional human subjects data were collected from 89 healthy, 74 glaucoma suspects, and 104 glaucoma patients. Individualized transverse scaling for OCT scans was calculated using a schematic eye that incorporated optical ocular biometry. Custom algorithms were used to quantify RNFL thickness with and without vessels removed, scaled minimum rim width (sMRW), and neural rim volume (NRV). RESULTS. For the experimental glaucoma group, NRR parameters showed the first changes with increased cumulative IOP. The data for both NRR and RNFL measures were best fit by an exponential rise model (NRV, R2 ? 0.79, P < 0.01, sMRW, R2 ? 0.74, P < 0.01). The major retinal vascular thickness contribution to the RNFL decreased (0.03 lm/lm, P < 0.01) with RNFL loss, but the percent vascular contribution increased ((cid:2)0.1%/lm, P < 0.01) with disease progression. Overall, the findings for the cross-sectional human data were similar to those of the experimental model. CONCLUSIONS. The findings illustrate a nonlinear relationship between NRR and RNFL measures and provide support for the use of multiple OCT scaled morphological measures for the diagnosis and management of primary open angle glaucoma in humans.
关键词： glaucoma,neuroretinal rim,RNFL,optical coherence tomography
更新于2025-09-19 17:15:36
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[IEEE 2018 Congreso Internacional de Innovacio?n y Tendencias en Ingenieri?a (CONIITI) [International Congress of Innovation and Trends in Engineering] - Bogota (2018.10.3-2018.10.5)] 2018 Congreso Internacional de Innovación y Tendencias en Ingeniería (CONIITI) - A Computer Vision Approach Based on the Retinal Nerve Fiber Thickness Analysis to Estimate the Risk of Suffering Glaucoma
摘要： According to estimations of the World Health Organization (WHO), approximately 4.5 million persons will become blind due to the primary Glaucoma. For these reasons, in this paper, we present a simple approach to estimate the risk of suffering from glaucoma that presents a patient. Our proposal relies on the automatic analysis of Optical Coherence Tomography (OCT) images through the calculus of nerve fiber and ganglionary vessels areas. To this aim, our system separates the two areas mentioned before through computer vision techniques and the Newton Interpolation Method. Once the two areas are separated, the system determines the size of each of them. This proposal was validated through an experiment carried out with OCT 30 images (per eye). The results are encouraging, and the suggestions provided by the system match with medical diagnosis.
关键词： Glaucoma,Optical Coherence Tomography,Computer vision,Retinal nerve fiber,Newton interpolation polynomial
更新于2025-09-19 17:15:36
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Segmentation of the Optic Nerve Head Based on Deep Learning to Determine its Hemoglobin Content in Normal and Glaucomatous Subjects
摘要： Objective: To determine the limits of the optic nerve head (ONH) in color fundus images using Deep learning (DL) for the estimation of its hemoglobin topographic distribution. Also, to evaluate the usefulness of that distribution in glaucoma diagnosis singly or in association with perimetry. Methods: A DL method was trained using 40000 fundus images and applied to 89 normal eyes and 77 confirmed or suspect glaucomas. DL and manual segmentation were compared. The eyes were also examined once with TOP perimetry (Octopus 300) and Spectralis-OCT and twice with Cirrus-OCT and Laguna ONhE, a program which estimates hemoglobin from color photographs, using improved criteria from previous studies. Results: The Sorensen-Dice similarity index between manual and automatic segmentations was 0.993. Intra-class correlation coefficients were similar when comparing the results of the Laguna ONhE indices using the manual and automatic segmentations (confidence intervals: 0.933-0.978). For specificity close to 95%, the GDF index, a factor that measures the distribution of hemoglobin at the nerve, obtained sensitivities between 70.1 and 74.0% (manual vs. automatic segmentations). The retinal nerve fiber layer thickness (RNFLT) of both OCTs provided sensitivities between 67.1 and 68.8% and the BMO-RMW of Spectralis-OCT 69.7%. Associating several normalized indices, e.g. a new visual field harmony index (Threshold Coefficient of Variation, TCV) and GDF, provided 85.7% sensitivity for 97.8% specificity. GDF correlation with Spectralis-OCT BMO-RMW index was similar to that obtained between this index and the RNFLT of the same instrument. For 95% specificity, the diagnostic concordance (kappa value) between both Spectralis-OCT indices was 0.694 and between its BMO-RMW and Laguna ONhE GDF 0.804-0.828. Conclusion: A fully automatic delimitation of the optic nerve head allows the correct, reproducible and efficient use of the Laguna ONhE method, and its effectiveness is greatly increased if associated with a perimetric harmony index.
关键词： Glaucoma,Visual field,Hemoglobin,Perfusion,Morphology,Perimetry,Optic nerve head
更新于2025-09-19 17:15:36
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Analyse glaukombedingter Makulaver?nderungen mittels optischer Koh?renztomografie
摘要： Background In glaucoma, progressive retinal nerve fibre loss can be measured in the peripapillary and macular regions using optical coherence tomography (OCT). The goal of this study was to evaluate the impact of glaucoma on all measurable retinal layers using the spectral domain OCT (SD-OCT). Materials and Methods SD-OCT scans using automated retinal layer segmentation were performed in both eyes of primary open-angle glaucoma patients with strictly monocular absolute visual field scotoma in the central 10° of their visual field. The same measurements were performed in one eye per person in a healthy age-matched control group. The mean thickness of all retinal layers in the central 24 × 24° of the macular region was compared between groups. Results SD-OCT scans were performed in 24 eyes of 12 glaucoma patients (10 female, 2 male) with a mean age of 72.3 ± 8.1 years and in 12 eyes of 12 healthy controls (9 female, 3 male) with a mean age of 66.0 ± 7.6 years. Statistically significant thickness differences between the glaucomatous and the healthy eyes could be demonstrated for the retinal nerve fibre layer, the ganglion cell layer, the inner plexiform layer and the complete retinal thickness, with lower mean thicknesses in the glaucoma group. Conclusion Using SD-OCT, single retinal layers of the macular region can be scanned and measured automatically. In glaucoma, a decrease in thickness of the inner retinal layers containing ganglion cells and their axons or dendrites could be demonstrated compared to healthy eyes. No corresponding difference in thickness could be found for the outer retinal layers using SD-OCT measurements.
关键词： scotoma,retina,glaucoma,optical coherence tomography,macula
更新于2025-09-19 17:15:36
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Optic Nerve Head Astrocytes Display Axon-Dependent and -Independent Reactivity in Response to Acutely Elevated Intraocular Pressure
摘要： PURPOSE. Optic nerve head (ONH) astrocytes provide support for axons, but exhibit structural and functional changes (termed reactivity) in a number of glaucoma models. The purpose of this study was to determine if ONH astrocyte structural reactivity is axon-dependent. METHODS. Using rats, we combine retrobulbar optic nerve transection (ONT) with acute controlled elevation of intraocular pressure (CEI), to induce total optic nerve axon loss and ONH astrocyte reactivity, respectively. Animals were euthanized immediately or 1 day post CEI, in the presence or absence of ONT. ONH sections were labeled with fluorescent-tagged phalloidin and antibodies against b3 tubulin, phosphorylated cortactin, phosphorylated paxillin, or complement C3. ONH label intensities were quantified after confocal microscopy. Retrobulbar nerves were assessed for axon injury by light microscopy. RESULTS. While ONT alone had no effect on ONH astrocyte structural orientation, astrocytes demonstrated significant reorganization of cellular extensions within hours after CEI, even when combined with ONT. However, ONH astrocytes displayed differential intensities of actin (phosphorylated cortactin) and focal adhesion (phosphorylated paxillin) mediators in response to CEI alone, ONT alone, or the combination of CEI and ONT. Lastly, label intensities of complement C3 within the ONH were unchanged in eyes subjected to CEI alone, ONT alone, or the combination of CEI and ONT, relative to controls. CONCLUSIONS. Early ONH astrocyte structural reactivity to elevated IOP is multifaceted, displaying both axon dependent and independent responses. These findings have important implications for pursuing astrocytes as diagnostic and therapeutic targets in neurodegenerative disorders with fluctuating levels of axon injury.
关键词： elevated intraocular pressure,glaucoma,optic nerve head,axon,astrocyte reactivity
更新于2025-09-19 17:15:36