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Ocular Aberrations and Corneal Thickness-Intraocular Pressure Relationship One Year after Laser in situ Keratomileusis (LASIK) Enhancement with An Aspheric Ablation Profile
摘要： Objective: To evaluate the effect of an aspheric LASIK refractive enhancement performed by relifting the original flap on the higher order aberrations (HOA) of the eye and the relationship between central corneal thickness (CCT) and intra-ocular pressure (IOP). Methods: Consecutive case series of 30 eyes requiring refractive enhancement from 1804 uncomplicated primary LASIK procedures performed in 2012. Flap relift and wavefront optimized ablation (Wavelight Allegretto Eye Q 400 Hz excimer laser) were performed in all cases. Pre-and post-operative examination included Shack-Hartmann aberrometry for 3 mm and 5 mm pupil sizes, CCT and IOP. Postoperative results at 1 year were compared to baseline values. Results: Changes in average values of coma, spherical aberration (SA), trefoil, CCT and IOP were not significant. Linear regression revealed significant associations between change (y) in trefoil and pre-enhancement value of trefoil for 3 mm pupil (0.828x-0.045, r=0.722, p<0.001), coma and pre-enhancement value of coma for 5 mm pupil (y=0.281x-0.030, r=0.501, n=30, p=0.048), SA for 3 mm pupil compared with change in CT (y=0.0080-0.0009x, r=-0.378, p=0.0392), and SA for 5 mm pupil compared with change in CCT (y=0.0035x-0.0541, r=0.524, p=0.0029). Also there was a significant association between IOP and CCT both pre-(IOP=0.0313CT-3.3, r=0.740, p<0.0001) and post-enhancement (IOP=0.0243CT-0.018, r=0.675, p<0.0001). Conclusion: LASIK enhancement with an aspheric ablation profile did not significantly impact on the average values for HOAs, IOP or CCT. For individual cases, the likely shift in magnitude of coma, trefoil and SA can be estimated and, the change in SA is correlated with changes in CCT. The change in the abscissa value linking IOP with CCT may be an indication of changes in biomechanical properties of the cornea in the central region.
关键词： High order aberrations (Hoas),LASIK enhancement,Wavefront,Intraocular pressure (IOP),Excimer laser,Wavelight allegretto,Corneal thickness
更新于2025-09-16 10:30:52
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Transscleral Diode Laser Cyclophotocoagulation
摘要： To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma. Design: Retrospective case series. Participants: Seventy-eight eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course. Methods: This study compared 52 eyes treated with slow-coagulation TSCPC with 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings, and outcomes were assessed. Main Outcome Measures: Visual acuity (VA), intraocular pressure (IOP), and postsurgical complications. Results: The initial mean VA was 1.94 logarithm of the minimum angle of resolution (logMAR; standard deviation [SD], 0.73 logMAR) in the slow-coagulation TSCPC group and 1.71 logMAR (SD, 0.90 logMAR) in the standard TSCPC group (P ? 0.507). Initial IOP was 37 mmHg (SD, 13 mmHg) in the slow-coagulation group and 39 mmHg (SD, 13 mmHg) in the standard group (P ? 0.297). The follow-up periods were 16.36 and 24.68 months for the slow-coagulation and standard groups, respectively (P ? 0.124). Visual acuity remained better than light perception in 71.1% of slow-coagulation TSCPC patients and 65.0% of standard TSCPC patients (P ? 0.599). Intraocular pressure remained less than 20 mmHg in 46% of slow-coagulation TSCPC patients and 44% of standard TSCPC patients (P ? 0.870). The mean number of complications was higher in the standard group (1.46; SD, 1.24) versus the slow-coagulation group (0.62; SD, 0.75; P ? 0.002). The incidence of the need for a second procedure (slow-coagulation group, 28.8%; standard group, 23.1%; P ? 0.588) and maximum number of medications needed to control IOP after surgery (P ? 0.771) were similar between the 2 groups. Conclusions: In this case series, slow-coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques also were comparable, although standard TSCPC showed a higher incidence of prolonged inflammation after surgery. This study suggests that slow-coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged postoperative inflammation—a feared complication of TSCPC—when compared with standard pop-titrated TSCPC.
关键词： intraocular pressure,visual acuity,glaucoma,complications,slow-coagulation,transscleral cyclophotocoagulation,standard pop-titrated
更新于2025-09-12 10:27:22
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Intraocular Pressure Changes during Femtosecond Laser-Assisted Cataract Surgery: A Comparison between Two Different Patient Interfaces
摘要： Purpose. The aim of this retrospective cohort study was to evaluate intraocular pressure (IOP) changes during femtosecond laser-assisted cataract surgery (FLACS) using two di?erent patient interface systems. Methods. 116 eyes of 116 patients scheduled for cataract surgery were divided into 2 groups: group 1 (61 eyes) and group 2 (55 eyes) underwent FLACS using Catalys Laser with ?uid interface (liquid optics interface, LOI) and LenSx Laser with curved interface and soft contact lens (SoftFit), respectively. IOP was assessed using a portable rebound tonometer (Icare?) preoperatively, after docking, immediately after surgery, at one and seven days postoperatively. Results. In group 1, the mean IOP (±SD) was 14.1 ± 0.4 mmHg before surgery, 33.2 ± 1.1 mmHg after docking, and 21.4 ± 0.9 mmHg immediately after surgery. In group 2, the mean IOP was 13.8 ± 0.4 mmHg before surgery, 24.2 ± 1.4 mmHg after docking, and 20.2 ± 1.2 mmHg immediately after surgery. After the docking procedure, a statistically signi?cant increase in IOP from the baseline was found in both groups (p < 0.001). Moreover, no statistically signi?cant di?erence in IOP measured at 1 and 7 days postoperatively was observed compared with the preoperative values (p > 0.05) using both laser platforms. No intraoperative and postoperative complications were observed. Conclusions. FLACS suction phase resulted in a transient increase of IOP in both groups, especially with the LOI system, and it is probably related to the greater pressure of a suction ring and suction generated through the vacuum, independently from the e?ect of femtosecond laser itself.
关键词： femtosecond laser-assisted cataract surgery,LenSx Laser,intraocular pressure,Catalys Laser,patient interface systems
更新于2025-09-12 10:27:22
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Micropulse Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma
摘要： Purpose: To assess the short-term ef?cacy and safety of micropulse transscleral diode laser cyclophotocoagulation (MP-TSCPC) in the management of refractory glaucoma and to compare outcomes based on prior glaucoma surgeries. Design: Retrospective analysis. Participants: Patients with refractory glaucoma who underwent MP-TSCPC at a single institution by 1 of 4 surgeons. Methods: Chart review of cases of MP-TSCPC using the Iridex Cyclo G6 (Mountain View, CA) laser with standard parameters and laser duration at the discretion of each treating physician. Main Outcome Measures: Probability of postoperative success was estimated by the Kaplan-Meier method. Success parameters included intraocular pressure (IOP) 6 to 21 mmHg with or without topical antihypertensive therapy, 20% or more IOP reduction from baseline for any 2 consecutive visits after 3 postoperative months, and no subsequent glaucoma surgery. Results: One hundred sixteen eyes of 116 patients (mean age, 65.8±16.9 years) were included. Baseline IOP was 22.2±7.9 mmHg, and mean postoperative follow-up time was 6.3±3.4 months (range, 3e12 months.) Postoperative IOP at the ?nal follow up was 15.3±6.6 mmHg (P < 0.01), corresponding to a reduction of approximately 6.9 mmHg (31.1%). Most eyes (66.4%) underwent at least 6 months of follow-up. Short-term probability of success was 93.1% at 3 months and 74.3% at 6 months. Eyes that had undergone prior traditional glaucoma surgery (trabeculectomy, tube shunt, excessive pressure-regulating shunt system miniature glaucoma shunt [Alcon, Fort Worth, TX], or a combination thereof) demonstrated a higher probability of success (67.6%) compared with eyes that had not (41.4%; P ? 0.014). The most common complications were decline in best-corrected visual acuity (7.8%) and hypotony (1.7%). Conclusions: Micropulse transscleral diode laser cyclophotocoagulation has a signi?cant short-term ocular hypotensive effect and favorable safety pro?le in eyes with refractory glaucoma. The probability of successful outcome was greater in eyes that had undergone prior traditional glaucoma surgery. Ophthalmology Glaucoma 2019;-:1e11 a 2019 by the American Academy of Ophthalmology
关键词： efficacy,micropulse transscleral diode laser cyclophotocoagulation,intraocular pressure,safety,refractory glaucoma
更新于2025-09-12 10:27:22
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Real-World Outcomes of Selective Laser Trabeculoplasty in the UK
摘要： Objective: Selective laser trabeculoplasty (SLT) is a common treatment option for managing glaucoma and ocular hypertension. We assessed the real-world effectiveness of SLT and baseline factors associated with treatment success in the United Kingdom (UK). Design: Retrospective observational study of de-identified electronic medical records (Medisoft? Glaucoma module) from 5 UK ophthalmology teaching centers. Participants: Adult patients undergoing their first recorded SLT. For bilateral SLT (same day), analyses included one randomly selected eye. Methods: Patient demographics, procedure details and clinical outcomes data were extracted. Factors associated with treatment success were assessed using multivariable Cox regression. Main outcome measures: Change from baseline in intraocular pressure (IOP) and glaucoma medication use at 12?18 and 24?36 months post-SLT. A Kaplan-Meier survival analysis was also conducted. SLT failure was defined as any further glaucoma procedure post-SLT or any of the following at 2 consecutive visits: IOP >21 mmHg, IOP reduction <20% from baseline, or an increase in glaucoma medications from baseline. Results: 831 SLT-treated eyes (mean baseline IOP 22.0 mmHg) of 831 patients were analyzed. At 12?18 and 24?36 months post-SLT, respectively, significant reductions in IOP (?4.2 [95% CI: ?4.7 to ?3.7] and ?3.4 [95% CI: ?4.1 to ?2.7] mmHg; both P<0.0001) and significant increases in the number of glaucoma medications (0.13 [95% CI: 0.04 to 0.23], P=0.007, and 0.20 [95% CI 0.06 to 0.33], P=0.005) were observed. Survival analysis demonstrated treatment success in 70%, 45%, and 27% of eyes at 6, 12, and 24 months post-SLT, respectively. Higher baseline IOP was strongly associated with treatment success (HR 0.64 for baseline IOP >21 mmHg vs ≤21 mmHg, 95% CI: 0.53–0.76; P<0.001). SLT success was not significantly associated with age (P=0.78), baseline visual field mean deviation (P=1.00) or the concurrent use of IOP-lowering medication (P=0.52). Conclusion: Most patients initially responded to SLT, but a majority failed within 1 year. SLT efficacy was better in patients with higher baseline IOP but did not differ by glaucoma severity or by concurrent use of IOP-lowering medication. These findings may help inform which patients are suitable for SLT therapy.
关键词： Selective laser trabeculoplasty,intraocular pressure,glaucoma,real-world outcomes,ocular hypertension
更新于2025-09-12 10:27:22
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Pulse Waveform Analysis of the Ocular Blood Flow Using Laser Speckle Flowgraphy before and after Glaucoma Treatment
摘要： Although reduction in intraocular pressure (IOP) is the principle of glaucoma treatment, impaired ocular blood ?ow is believed to play a role in the progression of glaucoma. This study evaluated the e?ect of glaucoma treatment on pulse waveforms for optic nerve head (ONH) microcirculation in patients with glaucoma. Fifty-one subjects were included on the basis of the glaucoma treatment administered, which involved instillation of prostaglandin (PG) analogs (PG group; n ? 28) or trabeculectomy (trabeculectomy group; n ? 23). ONH blood ?ow, represented by the mean blur rate (MBRT) and pulse waveforms, was measured using laser speckle ?owgraphy before and 1 and 3 months after treatment. Three months after treatment, IOP exhibited a signi?cant decrease (p < 0.05). Although there was no signi?cant change in MBRT after treatment, the acceleration time index (ATI) signi?cantly decreased (p ? 0.034) in the PG group. In the trabeculectomy group, there was no signi?cant change in the MBRT after treatment, while ?uctuation (p ? 0.019) and blowout score (BOS) (p ? 0.036) exhibited signi?cant decrease and increase, respectively. Multiple regression analysis showed that mean deviation was signi?cantly associated with the rate of change in the BOS (p ? 0.013), age was a signi?cant contributing factor for the rate of change in ?uctuation in the trabeculectomy group, re?ection was signi?cantly associated with the ATI (p ? 0.037) in the in the PG group. Both glaucoma treatments can change the pulse waveforms, with MBRT remaining unchanged, and IOP reduction owing to the treatment may contribute to stable blood ?ow in the tissue area of the ONH. As impaired ocular blood ?ow plays a role in the progression of glaucomatous damage, it would be bene?cial if glaucoma treatment could improve the stability of ONH microcirculation.
关键词： prostaglandin analogs,laser speckle flowgraphy,trabeculectomy,intraocular pressure,glaucoma,ocular blood flow
更新于2025-09-12 10:27:22
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Long-Term Outcomes and Predictive Factors for Success of Selective Laser Trabeculoplasty
摘要： Purpose: To investigate long-term outcomes and predictive success factors for selective laser trabeculoplasty (SLT). Methods: This retrospective chart review included 66 eyes of 66 glaucoma or ocular hypertension patients who underwent SLT between 2004 and 2011. All patients were followed-up for at least 2 years after the procedure. The intraocular pressure (IOP) was measured before the treatment, at postoperative 1 week, 1 month and every 3 months thereafter. Success was defined as an IOP decrease ≥ 3 mm Hg or ≥ 20% of the pretreatment IOP. The success rate was determined based on the Kaplan-Meier survival analysis. The predictive success factors were analyzed using the Cox proportional hazard model. Results: The mean follow-up period was 4.78 ± 1.98 (2-8) years. The mean pretreatment IOP was 23.79 ± 2.83 mm Hg. The mean IOP reduction was 6.64 ± 3.21 mm Hg. The success rates were 80%, 75%, 69%, 63%, 50%, 45%, and 42% after 1, 2, 3, 4, 5, 6, and 7 years, respectively. Only high pretreatment IOP was significantly correlated with success (p = 0.044). Conclusions: SLT was an effective tool for lowering IOP in glaucoma patients. Higher pretreatment IOP was a predictive success factor.
关键词： Success rate,Predictive factor,Glaucoma,Intraocular pressure,Selective laser trabeculoplasty (SLT)
更新于2025-09-12 10:27:22
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Neodymium Laser Treatment of IOP Rise Following Ex-press Glaucoma Device Implantation
摘要： To report on the use neodymium laser for treatment of eyes with IOP rise following Ex-Press glaucoma filtration device implantation. We retrospectively examined the medical records of 73 patients who underwent Ex-Press device implantation at four medical institutions between 2007 and 2015 and subsequently developed an IOP rise. Enrollment criteria included patients with POAG on whom post treatment IOP data is available. Indications for treatment with neodymium laser were an IOP above target and a flat bleb. In order to disrupt the presumed micro-blockage, the neodymium laser was aimed at the axial and relief ports of the Ex-Press device. Applanation tonometry measurements were followed up after neodymium treatment for variable time intervals. Success was defined as an IOP < 18 mm Hg at 6 months without further surgical or laser-based glaucoma interventions. 73 charts were reviewed. 20 patients were excluded due to insufficient data or a diagnosis other than POAG. Data from 53 eyes of the remaining 53 patients was analyzed. The mean duration between Ex-Press implantation and rise in IOP requiring neodymium intervention was 34.2 months (range, 1.1 – 67.2). We found a statistically significant immediate IOP lowering effect in all eyes, with a mean IOP drop of 13.34 +/- 8.99 mm Hg, and a mean post treatment IOP of 14.30 ± 8.57 mm Hg (P<0.0001). Of a subset of 43 eyes on which 6 months follow up IOP data was available, 11 eyes required further glaucoma intervention (surgery or laser based); four eyes had an IOP of 18 or greater at 6 months. In the remaining 28 successful eyes, a sustained IOP below 18 mm Hg was observed at 6 months, with a mean pressure of 11.39 ± 4.03 mm Hg (P < 0.0001). Hypotony (IOP < 5) occurred in 3 eyes immediately following treatment and self-resolved by 1 week. Our retrospective case series suggests that neodymium laser is a potential consideration in eyes with sustained IOP rise after Ex-Press device implantation.
关键词： intraocular pressure,neodymium laser,Ex-Press glaucoma filtration device,glaucoma
更新于2025-09-12 10:27:22
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Dynamic Scheimpflug Ocular Biomechanical Parameters in Healthy and Medically Controlled Glaucoma Eyes
摘要： To evaluate the relationship between biomechanical parameters measured with a dynamic Scheimpflug analyzer and glaucoma. Cross-sectional observational data of 47 eyes of 47 consecutive subjects with medically controlled primary open-angle glaucoma and 75 eyes of 75 healthy subjects examined with a dynamic Scheimpflug analyzer (Corvis ST) were retrospectively investigated. Eight biomechanical parameters were compared between eyes with and without glaucoma using multivariable models adjusting for intraocular pressure (IOP), central corneal thickness, age, and axial length. In multivariable models, glaucoma was negatively correlated with A1 time (P < 0.001, coefficient = ?0.5535), A2 time (P = 0.008, coefficient = ?0.1509), radius (P = 0.011, coefficient = ?0.4034), and whole eye movement (P < 0.001, coefficient = ?0.0622). Negative correlation between glaucoma and 3 parameters (A1 time, A2 time, and radius) consistently indicate larger deformability of the cornea and negative correlation between glaucoma and whole eye movement indicate smaller eye movement, in glaucoma eyes. There were significant correlations of many biomechanical parameters with other baseline factors (8 parameters with IOP, 2 with central corneal thickness, 4 with age, and 7 with axial length). Eyes with medically controlled glaucoma were more deformable than healthy eyes, which may increase the risk of optic nerve damage through an underestimation of IOP and biomechanical vulnerability of the globe. Many parameters showed a significant correlation with baseline factors, suggesting the importance of adjustment for these confounding factors when evaluating the correlation between biomechanical parameters and ocular diseases. These results suggest the relevance of measuring biomechanical properties of glaucoma eyes for accurate IOP measurement and risk assessment.
关键词： intraocular pressure,glaucoma,cornea,biomechanics,Scheimpflug photography
更新于2025-09-12 10:27:22
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Double-Session Micropulse Transscleral Laser (CYCLO G6) as a Primary Surgical Procedure for Glaucoma
摘要： PURPOSE: To evaluate the safety and effectiveness of double-session micropulse transscleral laser (MP3) as a primary treatment modality for glaucoma. METHODS: Patients who underwent MP3 therapy with double sessions in each hemifield, with a follow-up period of at least 6 months, were retrospectively considered. Patients were categorized into two groups: GI (no previous glaucoma surgery) and GII (with previous glaucoma surgery). Success was defined by either achieving a final intraocular pressure (IOP) between 6 and 18 mmHg and an IOP reduction of more than 20%, or a minimum 50% reduction in the number of glaucoma medications, at the last visit, without any serious complications. RESULTS: Eighty-four eyes were included in the GI group and 101 in the GII group, with the latter demonstrating relatively higher preoperative IOP (31.1±5.4 vs. 26.2±6.9 mmHg, p<0.001). Final IOP (14.9±5.2 vs. 13.6±4.1 mmHg, p=0.06), average MP3 treatment time (358.0±50.7 vs. 362.7±67.8 seconds, p=0.5), and follow-up duration (10.8±5.1 vs. 12.3±5.4 months, p=0.06) were similar between the groups. The percentage reduction with regard to glaucoma medication was higher in GI than in GII (49.1±28.8 vs. 38.8±30.1%, p=0.02). GI underwent fewer MP3 procedures than GII (1.2±0.5 vs. 1.5±0.8, p=0.002). No hypotony or phthisis bulbi was observed in GI (1 and 2 in GII, respectively). Procedural success was noted in 92.9% of the cases in GI and 87.1% in GII. CONCLUSION: Double-session MP3 therapy could be considered as a safe and effective procedure to treat glaucoma in eyes that have not undergone any previous glaucoma surgery. Primary eyes achieved a success-rate similar to those with refractory glaucoma with fewer MP3 procedures and fewer glaucoma medications.
关键词： Cyclophotocoagulation,Glaucoma,Laser,Intraocular Pressure,Micropulse
更新于2025-09-12 10:27:22