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Differences in Optic Nerve Head Blood Flow Regulation in Normal Tension Glaucoma Patients and Healthy Controls as Assessed With Laser Speckle Flowgraphy During the Water Drinking Test
摘要： Précis: Optic nerve head (ONH) perfusion was not signi?cantly altered in subjects with normal tension glaucoma (NTG) nor in healthy individuals after performing the water drinking test (WDT), because of its limited effect on ocular perfusion pressure (OPP). Purpose: ONH blood ?ow can be maintained stable in healthy individuals because of a physiological phenomenon called autoregulation. Impairment of autoregulation has been shown especially under condition of NTG. The purpose of this study was to investigate the ONH blood ?ow autoregulation in patients with NTG by in?uencing the OPP with the WDT. Methods: The study included 9 eyes from 9 white patients with a diagnosis of NTG and 9 eyes from age-matched and sex-matched healthy individuals. In the glaucoma group, the antiglaucomatous therapy was paused 3 weeks before the investigations. Measurements of ONH blood ?ow were performed with laser speckle ?owgraphy. After baseline measurements, individuals ingested 800 mL of water in <5 minutes. Measurements were repeated after 15, 30, and 45 minutes. Results: The water ingestion led to a signi?cant rise in intraocular pressure (P < 0.001) but also mean arterial pressure (P < 0.001) in both groups. This resulted in stable OPP (P = 0.051) with no signi?cant difference between the groups (P = 0.43). ONH blood ?ow remained stable over time in both groups (P = 0.719). No signi?cant interaction of time and group was shown for all parameters. Conclusions: Our ?ndings show that the WDT does not signi?cantly in?uence the OPP and therefore has to be considered inferior to other methods used to assess blood ?ow autoregulation.
关键词： laser speckle ?owgraphy,normal tension glaucoma,water drinking test,blood ?ow regulation
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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Changes on Confocal Scanning Laser Ophthalmoscopy with the Heidelberg Retinal Tomography after a Cardiac Catheterism in a Patient with Progressive Glaucoma
摘要： Purpose: We present a case of a patient with progressive open angle glaucoma who presented changes suggestive of improvement in the Heidelberg retinal tomography 3 (HRT3) analysis after a cardiac catheterization. Observation: A 69-year-old woman presented with progressive open angle glaucoma despite maximum tolerable antiglaucomatous topical treatment. A filtering surgery (trabeculectomy) was performed and successfully achieved intraocular pressure (IOP) levels of 10 mm Hg on average. Despite this, changes were evidenced in the HRT3 protocols (trend analysis and topographic change analysis) suggesting marked progression. Brimonidine 0.2% twice a day was initiated, and a cardiovascular examination was requested. A cardiac catheterism was performed in the following weeks, and afterward, all structural parameters improved until the last control. Medication was not discontinued, and no signs of apparent progression on the HRT3 parameters have been evidenced up until the time of writing this case report. Conclusions and Importance: There was a marked improvement in the HRT3 parameters (trend and topographic change analysis), suggesting that the progression stopped after a cardiac catheterism in a patient with progressive glaucoma despite having the IOP controlled. To our knowledge, this is the first case of a patient with progressive glaucoma that was medically and surgically managed, and despite achieving low IOP levels, the progression detected by the HRT3 analysis could not be stopped until a cardiac catheterization was performed.
关键词： Blood flow,Open-angle glaucoma,Disease progression,Heidelberg retinal tomography 3,Imaging technique
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
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Contact Transscleral Cyclodiode Laser Treatment for Refractory Glaucoma After Penetrating Keratoplasty
摘要： This is a retrospective study with long-term follow-up using transscleral cyclodiode laser photocoagulation (TCP) with low complication rate and good graft survival and intraocular pressure (IOP) control. Selective 180-degree TCP may offer a good IOP control with reduced complication rates.
关键词： refractory glaucoma,cyclodiode laser,penetrating keratoplasty,long-term outcomes
更新于2025-09-12 10:27:22
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Evaluating the Laser Output of the Micropulse P3 Laser Delivery Device Following Repeated Use
摘要： Repeated use of the Micropulse P3 (MP3) probe during micropulse transscleral cyclophotocoagulation is associated with an increase in laser output over time. The purpose of this study was to examine the laser efficacy of the MP3 probe following repeated use. This was an observational study carried out using Cyclo G6 Glaucoma Laser System with 6 MP3 laser delivery probes. Each probe was fired for 100 seconds, every 10 minutes until the probe was deactivated. The laser output was measured using a laser power meter. Maximum observed laser power output was also noted. All probes were deactivated after 90 minutes (9 cycles) of use. Mean laser output of all 6 probes was determined, and results suggested an increase in output with time. When examining the differences in total laser output for each cycle, no significant differences were observed for the first 4 cycles, but not for the remaining 5 cycles, wherein the increased laser outputs were found to be significantly different from baseline (cycle 1). Findings suggest a possible increase in laser output with repeated use, especially after 4 cycles, and clinicians need to be cautious if they intend to use the probes repeatedly.
关键词： laser delivery,micropulse transscleral cyclophotocoagulation,glaucoma
更新于2025-09-12 10:27:22