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Effect of a single session of micropulse laser trabeculoplasty on corneal endothelial parameters
摘要： Background: To evaluate the effect of a single session of micropulse laser trabeculoplasty on the cornea in eyes with primary open-angle glaucoma and pseudoexfoliation glaucoma. Methods: This single-centre, prospective, case series enrolled patients with primary open-angle and pseudoexfoliation glaucoma under treatment with glaucoma agents that required additional intraocular pressure reduction. Eyes underwent 360 degrees treatment with 532 nm micropulse laser trabeculoplasty. Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-ef?cient of variation of endothelial cells were measured before micropulse laser trabeculoplasty and at one, three and six months after treatment. Results: Twenty eyes of 20 patients (mean age 67.6 (cid:1) 8.0 years) with primary open-angle glaucoma and 18 eyes of 18 patients (mean age 71.44 (cid:1) 6.43 years) with pseudoexfoliation glaucoma were included in the study. Treatment with micropulse laser trabeculoplasty resulted in statistically signi?cantly lower intraocular pressure compared to baseline in both primary open-angle and pseudoexfoliation glaucoma eyes (p < 0.0001 at both comparisons). Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-ef?cient of variation of the endothelial cell size showed no signi?cant change between baseline and six months after micropulse laser trabeculoplasty in both primary open-angle and pseudoexfoliation glaucoma eyes. Conclusion: A single session of micropulse laser trabeculoplasty did not affect central corneal thickness and corneal endothelium parameters in eyes with primary open-angle and pseudoexfoliation glaucoma.
关键词： micropulse laser trabeculoplasty,corneal endothelium,hexagonal cell ratio,pseudoexfoliation,glaucoma
更新于2025-09-11 14:15:04
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Double-session micropulse transscleral laser (CYCLO G6) for the treatment of glaucoma
摘要： This study aims to evaluate the effectiveness and safety of double-session micropulse transscleral (MP3) laser for the treatment of glaucoma. This was a retrospective chart review of all patients who underwent MP3 laser with the standard protocol and were within at least 12 months of their follow-up appointments. Eyes were treated at 2000 mW with 31.3% duty cycle for 80 s per treatment session, with double sessions in each hemifield alternating between upper and lower and upper and lower. Success criterion was defined as a greater than 20% reduction in intraocular pressure (IOP) and an IOP between 6 and 18 mmHg at the end of the follow-up period. Eighty-nine eyes of seventy-six glaucoma patients were included; 31 of which were considered primary, i.e., no previous glaucoma surgery. The average pre-treatment IOP was 29.9 ± 6.4 mmHg. At around 16.7 ± 3.1 months of follow-up, the average IOP was 14.8 ± 4.7 mmHg (p < 0.001) (28.8 ± 7.4 to 15.7 ± 5.3 mmHg, p < 0.001, at 17.0 ± 3.1 months in the primary eyes). The number of topical glaucoma medications was reduced from 3.6 ± 0.5 to 1.9 ± 0.9 at the last evaluation (p < 0.001). The best corrected visual acuity in logMAR ranged from 0.41 ± 0.34 preoperatively to 0.45 ± 0.44 at the last visit (p = 0.2), and also remained stable in primary eyes. Success was obtained in 86.5% of the eyes, with 1.5 ± 0.8 procedures, and in 90.3% with 1.2 ± 0.5 MP3 laser procedures in the primary eye group. MP3 laser in two consecutive 80-s sessions was shown to be safe and effective in the treatment of glaucoma. Primary eyes required lower number of MP3 laser procedures.
关键词： Treatment outcome,Glaucoma,Ciliary body/surgery,Intraocular pressure,Laser surgery
更新于2025-09-11 14:15:04
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Two-Dimensional Plasmonic Grating for Intraocular Pressure Sensing
摘要： Glaucoma is a group of characteristic optic neuropathies that collectively are the leading cause of irreversible blindness globally. Elevated intraocular pressure (IOP) is the major causal risk factor. While the fundamental mechanisms of the IOP elevation and consequent optic neuropathy are not well understood, recent studies have indicated that there may be pressure spikes directed at the optic nerve head during accommodation and that IOP may not be homogeneous throughout the eye. To facilitate the in situ and in vivo measurement of IOP in various locations within the vitreous and facilitate measurement of accommodative IOP spikes at the ONH, here, we report the development of an implantable, biocompatible, and miniaturized IOP sensor using 2-D plasmonic grating that generates structural color. The change of the grating period with pressure between 0 and 50 mmHg results in a change in the visible color, allowing us to observe small changes in pressure without additional electronics.
关键词： glaucoma,intraocular pressure (IOP),Electromagnetic wave sensors,optical nerve head (ONH),surface plasmon
更新于2025-09-11 14:15:04
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Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients
摘要： This study aimed at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma. Patients with moderate to advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable antiglaucoma medications were selected to undergo MP-TSCPC using the MP3 handpiece with the Iridex Cyclo G6 (IRIDEX Laser Systems). Follow-up examinations took place on a regular basis until 15 months postoperatively. Seventy-five eyes of 69 patients (53.6% male patients) were included. Mean age was 55.5 ± 22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity at baseline ranged between 0 and 2.1 logMAR. Mean prelaser IOP was 26.0 ± 7.91 mm Hg. This was reduced significantly to 13.8 ± 5.6 mm Hg (44.0% reduction, P < 0.001) at week 1, and to 18.0 ± 7.7, 18.4 ± 7.1, 16.7 ± 6.2, 15.1 ± 4.1, 15.7 ± 5.32, and 14.8 ± 5.50 mm Hg at months 1, 3, 6, 9, 12, and 15, respectively. The mean number of antiglaucoma drops decreased significantly up to 12 months of follow-up (P = 0.008) and that of oral acetazolamide tablets decreased significantly up to 15 months (P < 0.001). The success rate decreased progressively with time, reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered, and no eye lost vision completely. MP-TSCPC is an efficient noninvasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.
关键词： intraocular pressure,micropulse transscleral cyclophotocoagulation,glaucoma
更新于2025-09-11 14:15:04
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West Indies Glaucoma Laser Study (WIGLS) 3. Anterior Chamber Inflammation Following Selective Laser Trabeculoplasty in Afro-Caribbeans with Open-angle Glaucoma
摘要： In the absence of prophylactic anti-inflammatory therapy, anterior chamber inflammation (characterized by cells and less commonly flare) is minimal and transient after selective laser trabeculoplasty in Afro-Caribbean glaucoma patients.
关键词： inflammation,selective laser trabeculoplasty,glaucoma,West Indies
更新于2025-09-11 14:15:04
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The Rationale for Selective Laser Trabeculoplasty in Africa
摘要： Glaucoma is the leading cause of irreversible blindness in Africa. The condition is treatable but not curable. There are numerous obstacles to glaucoma care in Africa, including availability, accessibility and affordability of treatments, as well as medication nonadherence among patients. Medical therapy is costly relative to the average income in Africa and it requires daily self-dosing by patients. Surgery is of limited availability in many regions in Africa, and a high proportion of patients refuse surgery because it is expensive. Selective laser trabeculoplasty (SLT) proves to be a favorable alternative to medical or surgical care, as it is highly effective and safe in people of African descent, more cost-effective than medical therapy, quick and easy to perform, and portable. The procedure also requires no postoperative care, thus obviates the issue of nonadherence. In uncontrolled studies, SLT has a high response rate and it lowers intraocular pressure by 30% to 40%, which exceeds the goal in international guidelines for initial therapies. The African Glaucoma Consortium (AGC), a member-driven stakeholder collective, has been formed in part to develop the infrastructure for continent-wide improvements in glaucoma care. It embraces SLT as a potential key tool in their development plans. The mission of AGC includes improving clinical care by educating existing and new health care professionals to expand the provider network, by conducting trials to identify optimal care strategies for glaucoma in Africa, and by facilitating the development of an integrated network of Centers of Excellence to bring SLT and other crucial glaucoma therapies to communities throughout Africa.
关键词： selective laser trabeculoplasty,Africa,glaucoma
更新于2025-09-11 14:15:04
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Relating optical coherence tomography to visual fields in glaucoma: structure-function mapping, limitations and future applications
摘要： Combining information from optical coherence tomography (OCT) imaging and visual field testing is useful in the clinical assessment and monitoring of patients with glaucoma. Measurements of retinal nerve fibre layer thickness or neuroretinal rim width taken around the optic nerve head may be related to the visual field using a structure–function map. In this review, the structure–function mapping methods in clinical use are discussed. Typical clinical maps provide a population average, ‘one size fits all’ representation, but in recent years methods for customising structure–function maps to individual eyes have been developed and these are reviewed here. In the macula, visual field stimuli stimulate photoreceptors for which associated retinal ganglion cells are peripherally displaced. Recently developed methods that relate OCT measurements to visual field test locations in the macula are therefore also reviewed. The use of structure–function maps to relate OCT measurements to localised visual field sensitivity in new applications is also explored. These new applications include the selection of visual field test locations and stimulus intensities based on OCT data, and the formal post-test combination of results across modalities. Such applications promise to exploit the structure–function relationship in glaucoma to improve disease diagnosis and monitoring of progression. Limitations in the validation and use of current structure–function mapping techniques are discussed.
关键词： optical coherence tomography,visual fields,glaucoma,perimetry
更新于2025-09-11 14:15:04
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Structure–Function Relationship in Glaucoma Using Ganglion Cell–Inner Plexiform Layer Thickness Measurements
摘要： PURPOSE. To evaluate the structure–function relationship between ganglion cell–inner plexiform layer (GCIPL) thickness at the macula and 10-2 standard automated perimetry (SAP) in glaucoma and to evaluate the relationship using a recently proposed linear model. METHODS. In a cross-sectional analysis, structure–function relationship was determined in 50 glaucomatous eyes (40 patients, mean deviation: (cid:2)15.4 6 7.5 dB) and 21 control eyes (13 subjects, mean deviation: (cid:2)3.4 6 3.0 dB), which had undergone 10-2 SAP and GCIPL imaging on the same day. Functional loss was derived from total deviation numerical values on 10-2 SAP and calculated on both a linear (reciprocal of Lambert) and a decibel scale after accounting for the retinal ganglion cell displacement at the macula. Strength of relationship was reported as coef?cient of determination (R2) of the linear regression models ?tted to the data separately for different sectors. The relationship was also evaluated using a linear model. RESULTS. The R2 for the associations between GCIPL thickness sectors and the corresponding sector SAP total deviation values ranged from 0.19 (for superonasal GCIPL sector) to 0.60 (for average GCIPL thickness) when functional loss was calculated on the decibel scale and 0.16 (for superonasal sector) to 0.54 (for inferior sector) on the linear scale. All associations were statistically signi?cant (P < 0.05). The linear model ?tted the data reasonably well. CONCLUSIONS. Signi?cant structure–function associations were found between GCIPL thickness measurements at the macula and the functional loss measured on 10-2 SAP in glaucoma. Best ?t was found for the inferior and average GCIPL sector thickness. The linear model was useful to study the structure–function relationship.
关键词： visual ?eld,ganglion cell–inner plexiform layer,glaucoma,structure–function relationship
更新于2025-09-11 14:15:04
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Spectral Domain Optical Coherence Tomography Assessment of Macular and Optic Nerve Alterations in Patients with Glaucoma and Correlation with Visual Field Index
摘要： Introduction. To evaluate the sectorial thickness of single retinal layers and optic nerve using spectral domain optic coherence tomography (SD-OCT) and highlight the parameters with the best diagnostic accuracy in distinguishing between normal and glaucoma subjects at di?erent stages of the disease. Material and Methods. For this cross-sectional study, 25 glaucomatous (49 eyes) and 18 age-matched healthy subjects (35 eyes) underwent a complete ophthalmologic examination including visual ?eld testing. Sectorial thickness values of each retinal layer and of the optic nerve were measured using SD-OCT Glaucoma Module Premium Edition (GMPE) software. Each parameter was compared between the groups, and the layers and sectors with the best area under the receiver operating characteristic curve (AUC) were identi?ed. Correlation of visual ?eld index with the most relevant structural parameters was also evaluated. Results and Discussion. All subjects were grouped according to stage as follows: Controls (CTRL); Early Stage Group (EG) (Stage 1 + Stage 2); Advanced Stage Group (AG) (Stage 3 + Stage 4 + Stage 5). mGCL TI, mGCL TO, mIPL TO, mean mGCL, cpRNFLt NS, and cpRNFLt TI showed the best results in terms of AUC according classi?cation proposed by Swets (0.9 < AUC < 1.0). These parameters also showed signi?cantly di?erent values among group when CTRL vs EG, CTRL vs AG, and EG vs AG were compared. SD-OCT examination showed signi?cant sectorial thickness di?erences in most of the macular layers when glaucomatous patients at di?erent stages of the disease were compared each other and to the controls.
关键词： glaucoma,spectral domain optical coherence tomography,macular thickness,optic nerve,visual field index
更新于2025-09-11 14:15:04
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Glaucoma Drainage Device Tube Retraction and Blockage in a Patient with Iridocorneal Endothelial Syndrome Treated With Nd:YAG Membranectomy
摘要： Purpose: To report on a case that demonstrates the successful treatment of tube blockage of the Ahmed Glaucoma Valve at its aqueous entry site by Nd:YAG laser membranectomy. Method: We report a case of refractory intraocular pressure elevation in a patient with iridocorneal endothelial syndrome after glaucoma drainage device due to blocked tube from the iridocorneal endothelial syndrome membrane. In July 2014, our patient presented with sudden right eye elevated intraocular pressure to 67 mmHg despite a well-controlled intraocular pressure in the range of teens with timolol alone over the last 2 years. Gonioscopy showed total synechial angle closure and increasing her medical treatment failed to control the intraocular pressure. Ahmed glaucoma valve was implanted successfully. However, recurrence of raised intraocular pressure from partial tube retraction and tube blockage at its aqueous entry site by an endothelial membrane was noted at 2 weeks after the surgery. Nd:YAG laser membranectomy was performed on 2 occasions to restore the patency of the tube shunt. After the second laser membranectomy, the patient’s intraocular pressure returned to, and remained at, normal level since. Conclusion: Tube occlusion by membrane is a well-known complication following glaucoma drainage device tube in patients with iridocorneal endothelial syndrome. Nd:YAG membranectomy is effective to restore the patency of tube lumen without subjecting patients to more invasive surgical interventions including tube extender or another glaucoma drainage device. However, more studies are required to ascertain the long term effect of laser membranectomy to a blocked tube, in comparison to other treatment modalities. To our knowledge, this is the first reported case of using laser membranectomy alone in treating Ahmed glaucoma valve tube obstruction due to a retracted tube blocked by endothelial membrane.
关键词： Iridocorneal endothelial syndrome,Laser membranectomy,Ahmed valve obstruction,Glaucoma drainage devices
更新于2025-09-10 09:29:36