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Appraisal of Bleb Using Trio of Intraocular Pressure, Morphology on Slit Lamp, and Gonioscopy
摘要： PurPOsE: The aim of this study was to assess bleb function using Wuerzburg bleb classification score (WBCS) for bleb morphology on slit lamp, intraocular pressure (IOP), and gonioscopy. MEthOds: A total of randomly selected 30 eyes posttrabeculectomy were assessed for bleb function with the trio of bleb morphology, IOP, and gonioscopy. Bleb was assessed using the WBCS of 0–12 on slit lamp, IOP was assessed using applanation tonometry, and visualization of inner ostium and iridectomy were assessed using gonioscopy. Postoperative patients of less than six weeks were excluded from the study. rEsults: The correlation between WBCS and the duration of trabeculectomy was found to be highly significant (P value = 0.029). The correlation of IOP with WBCS was also found to be strongly positive (P = 0.000). IOP was found to be highly associated with peripheral iridectomy (P = 0.000), internal window (P = 0.001), and bleb characteristics.
关键词： gonioscopy,bleb morphology,trabeculectomy,intraocular pressure,WBCS
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
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Predictors of Short-Term Intraocular Pressure Change after Laser Peripheral Iridotomy
摘要： To describe short-term intraocular pressure (IOP) changes after laser peripheral iridotomy (LPI) and identify factors predicting IOP lowering. Design: Multicenter, prospective randomized study. Participants: Four hundred fifty-five South Indian eyes of 455 participants 30 years of age or older with a diagnosis of primary angle-closure suspect (PACS), primary angle closure (PAC), or PAC glaucoma (PACG). Methods: Participants were randomized to superior or nasal/temporal LPI. Multivariate regression models were used to determine preoperative features and LPI parameters associated with change in IOP from baseline to the 2-week postoperative examination. Main Outcome Measures: Change in IOP at 2 weeks after LPI compared with baseline. Results: Among all treated eyes, 11.0% of eyes demonstrated a 20% or more decrease in IOP after LPI, whereas 19.6% demonstrated at least a 20% increase in IOP. Intraocular pressure changes occurring after LPI did not differ by LPI location (P > 0.5 for all comparisons). Although the anterior chamber angle widened after LPI (P < 0.001) and was classified as open after laser in most eyes (64% in all 4 quadrants), there was no significant association between gonioscopic angle opening and LPI-induced IOP change (P ? 0.7). Linear regression analysis demonstrated more IOP lowering with higher baseline IOP (3.2 mmHg more lowering per 10-mmHg higher baseline IOP; 95% confidence interval [CI], 2.3e4.1 mmHg) and PAC/PACG diagnosis (1.4 mmHg more IOP lowering vs. PACS diagnosis; 95% CI, 0.2e2.6 mmHg) predicted a lower IOP after LPI. After multivariate adjustment, only higher baseline IOP predicted lower IOP after LPI (P < 0.001). Features not associated with IOP lowering included demographic, visual, and A-scan measures; baseline gonioscopic angle width; total laser energy; LPI area; and LPI location (P > 0.08 for all). Eyes with PAC/PACG, as compared with PACS, demonstrated more IOP lowering after LPI (1.2(cid:2)1.7 mmHg vs. e0.4(cid:2)1.0 mmHg; P < 0.001) after adjusting for baseline IOP. Conclusions: Neither LPI location nor degree of gonioscopic angle opening was associated with statistically significant change in IOP after LPI. Although significant IOP lowering after LPI was uncommon in the overall cohort, higher baseline IOP and PAC/PACG diagnosis predicted lower postoperative IOP.
关键词： primary angle-closure suspect,primary angle closure,laser peripheral iridotomy,intraocular pressure,PAC glaucoma
更新于2025-09-19 17:13:59
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Predictors of selective laser trabeculoplasty success in open angle glaucoma or ocular hypertension: does baseline tonography have a predictive role?
摘要： background The determinants of success of selective laser trabeculoplasty (SLT) in treatment- na?ve patients with open angle glaucoma (OAG) and ocular hypertension (OHT) have not been understood fully. Therefore, we have conducted this study to explore the predictors of success. Methods This is a retrospective review of a pre- existing database of patients who had received primary SLT at St Thomas’ Hospital, London, UK. Patients with OAG and OHT who had received primary 360° SLT treatment and had reliable baseline tonographic outflow facility (TOF) with minimum of 1 year of follow- up were included. Univariate and multivariate analyses were performed to find the determinants of success. results One hundred and seventy- four patients between August 2006 and February 2010 had received primary 360° SLT treatment and had baseline TOF measurement. Of these, 72 subjects fulfilled the eligibility criteria. In multivariate regression analysis, the only variable associated with success was baseline intraocular pressure (IOP) (R2=0.32, beta=?0.51, p<0.001, 95% CI ?2.02 to ?0.74). Conclusion To our knowledge, this is the only study investigating the pretreatment TOF (measured with electronic Shi?tz tonography) and IOP as determinants of success 12 month’s post-360° SLT in treatment- na?ve patients with OAG and OHT. This study demonstrated that pretreatment IOP (and not TOF) is the only determinant of success after primary SLT therapy.
关键词： selective laser trabeculoplasty,intraocular pressure,ocular hypertension,tonographic outflow facility,open angle glaucoma
更新于2025-09-19 17:13:59
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Safety and Efficacy of 0.1% Nepafenac versus 1% Prednisolone Acetate Eye Drops after Laser Iridotomy a?? A Prospective, Randomized Trial
摘要： Purpose: To compare 0.1% nepafenac, a topical non-steroidal anti-inflammatory drop, with 1% prednisolone acetate in controlling inflammation after Nd:YAG laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS). Design: Prospective randomized controlled trial. Participants: One hundred and fifty-two PACS patients undergoing bilateral LPI. Methods: Patients were randomized to 0.1% nepafenac or 1% prednisolone acetate eye drop in both eyes. Medications were given 4 times daily for 7 days, then twice daily for additional 7 days. Investigators were masked to the type of medication. Right eyes in patients with bilateral PACS and the eye with PACS in asymmetrical disease (primary angle closure in fellow eye) were analyzed. Outcome measures: Non-inferior control of inflammation, defined as absence of cell in the anterior chamber at 2weeks and absence of rebound iritis with medication discontinuation, was the primary outcome, while difference in the rise in intraocular pressure (IOP) was a secondary outcome. Results: Both groups were comparable in baseline characteristics, including IOP, and total laser energy. Nepafenac was non-inferior to prednisolone with regards to inflammation control, with one(1.3%) nepafenac-treated patient failing to meet the primary endpoint because of 1+ anterior chamber cell at 2 weeks and 4(5.4%) prednisolone-treated eyes failing to meet the primary endpoint because of rebound iritis (p <0.001). A greater rise in IOP from baseline to 2 weeks was observed in the prednisolone group compared to the nepafenac group (+2.6 vs. +0.6 mmHg; p=0.004), though at 4 weeks IOPs were not significantly different than baseline in either group (p>0.05 for both). Two weeks after LPI, 3 nepafenac-treated eyes and 10 prednisolone-treated eyes demonstrated a 6-15 mmHg IOP elevation from baseline (p=0.10); while 2 prednisolone-treated eyes and no nepafenac-treated eyes had IOP elevation >15 mmHg (p=0.20). Four weeks after LPI, more prednisolone-treated eyes had IOP elevation of 6-15 mmHg as compared to nepafenac-treated eyes (6 vs. 1, p=0.04); no eyes had IOP elevation >15 mmHg. In an unplanned exploratory analysis, 8 prednisolone-treated patients, but no nepafenac-treated patients required repeat LPI (p=0.003). Conclusions: In our study, nepafenac was non-inferior to prednisolone acetate in controlling post-LPI inflammation with less impact on IOP.
关键词： nepafenac,prednisolone acetate,intraocular pressure,laser peripheral iridotomy,inflammation
更新于2025-09-19 17:13:59
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To Study the Efficacy of Laser Peripheral Iridoplasty in the Treatment of Eyes With Primary Angle Closure and Plateau Iris Syndrome, Unresponsive to Laser Peripheral Iridotomy, Using Anterior-Segment OCT as a Tool
摘要： The article discusses the efficacy of laser peripheral iridoplasty (LIP) in treating eyes with primary angle closure and plateau iris syndrome, unresponsive to laser peripheral iridotomy (LPI), using anterior-segment OCT as a tool. It highlights the importance of angle anatomy in the pathomechanism of primary angle closure glaucoma and the role of ASOCT in providing an objective picture of angle structures over time and after interventions. The study was conducted on 100 eyes of primary angle closure randomized to undergo either LPI or LPI plus LIP, with results showing significant IOP lowering in the LIP group, especially in eyes with appositional closure and synechiae <180 degrees.
关键词： intraocular pressure,plateau iris syndrome,primary angle closure,anterior-segment OCT,laser peripheral iridoplasty
更新于2025-09-16 10:30:52
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West Indies Glaucoma Laser Study (WIGLS)—2
摘要： To identify factors associated with intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in Afro-Caribbean people with primary open-angle glaucoma (POAG). Design: This was a prospective stepped-wedge study. Methods: Data were drawn from 72 Afro-Caribbean subjects with POAG participating in the ongoing West Indies Glaucoma Laser Study. Multivariable mixed-model analysis was utilized to develop a predictive model for percent IOP reduction 12 months following SLT. Putative factors (age, sex, site, baseline IOP, prior use of prostaglandin therapy, number of prewashout IOP-lowering medications, central corneal thickness, severity of glaucoma, duration of follow-up, and signs of acute postoperative inflammation) were evaluated in bivariate analysis. Factors significant at P ≤ 0.2 were included in the final model. Right and left eye data were modeled separately. Results: At month 12 following SLT, mean IOP reductions in the West Indies Glaucoma Laser Study were 6.2 to 6.5 mm Hg (29.7% to 31.0%) in right and left eyes. The only factor significant in both eyes (P = 0.0005 in right eyes and P < 0.0001 in left eyes) was time, with IOP reductions being greatest at month 3 and declining slightly over time through month 12. Vertical cup-disc ratio (P = 0.006) and prior prostaglandin therapy (P = 0.004) were significant only in right eyes, and central corneal thickness (P = 0.014) was significant only in left eyes. Factors significant only unilaterally did not approach significance in fellow eyes, suggesting the possibility that these represent type 1 errors. Site (St. Lucia vs. Dominica) was not a significant factor, establishing generalizability of these treatment outcomes to a broader population of African-derived people. Conclusions: This analysis did not identify any subject-specific factors consistently predictive of therapeutic response to SLT. Of note, no factors predicted a suboptimal response. These findings favorably position SLT for broad application as primary therapy in African-derived people with POAG.
关键词： selective laser trabeculoplasty,intraocular pressure,glaucoma,low-income and middle-income countries
更新于2025-09-16 10:30:52
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Selective Laser Trabeculoplasty Protects Glaucoma Progression in the Initial Primary Open-Angle Glaucoma and Angle-Closure Glaucoma after Laser Peripheral Iridotomy in the Long Term
摘要： Purpose. To compare the ability of SLT in preventing glaucoma progression in the initial primary angle-closure glaucoma (PACG) after laser peripheral iridotomy and primary open-angle glaucoma (POAG) in the long term. Methods. 60 patients with the initial stage of PACG after laser peripheral iridotomy and 64 initial POAG patients were recruited in a prospective study. Complete success of selective laser trabeculoplasty (SLT) was de?ned as a 20% intraocular pressure (IOP) reduction with topical hypotensive medications without any hypotensive intervention. Pre-SLT rate of progression and post-SLT rate of progression (ROP) was detected in the both groups by means of the trend and the event analysis of perimetry, the Guided Progression Analysis, and the optical coherence tomography- (OCT-) based negative trend for either the thickness of the peripapillary retinal nerve ?ber layer (RNFL) or ganglion cell complex (GCC). Results. IOP decreased signi?cantly after SLT in both the groups. 30% in PACG and 19% in POAG had the progression according to perimetry and 49% in PACG and 40% in POAG had the progression, respectively, according to OCT. After SLT, ROP was reduced from ? 0.14 ± 0.39 dB/year to ? 0.08 ± 0.48 dB/year, p ? 0.034, in PACG and from ? 0.09 ± 0.36 dB/year to ? 0.04 ± 0.43 dB/year, p ? 0.021, in POAG. According to RNFL trend analysis, ROP was reduced from ? 1.86 ± 2.9 μm/year to ? 1.38 ± 2.2 μm/year, p ? 0.039, and from ? 1.24 ± 2.23 μm/year to ? 0.76 ± 1.73 μm/year, p ? 0.037, in PACG and POAG, and according to GCC, ROP was reduced from ? 1.88 ± 2.9 μm/year to ? 1.34 ± 2.0 μm/year, p ? 0.040, and from ? 1.35 ± 2.16 μm/year to ? 0.91 ± 1.86 μm/year, p ? 0.040, in PACG and POAG, respectively. ROP was signi?cantly faster in PACD than in POAG between 2 and 6 years after SLT: ? 0.15 ± 0.46 dB/year and 0.02 ± 0.38 dB/year (p ? 0.042). However, it did not di?er signi?cantly according to OCT. Conclusion. SLT is an e?ective treatment for initial PACG after LPI and POAG that can prevent functional and structural deterioration in the long term.
关键词： Ganglion Cell Complex,Laser Peripheral Iridotomy,Optical Coherence Tomography,Primary Angle-Closure Glaucoma,Selective Laser Trabeculoplasty,Intraocular Pressure,Retinal Nerve Fiber Layer,Primary Open-Angle Glaucoma,Glaucoma Progression
更新于2025-09-16 10:30:52
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SALT Trial: Steroids after Laser Trabeculoplasty
摘要： This study examined whether short-term use of topical nonsteroidal anti-inflammatory drug (NSAID) or steroid therapy affected the efficacy of selective laser trabeculoplasty (SLT). Design: Double-masked, randomized, placebo-controlled, dual-center, multisurgeon trial. Participants: Patients older than 18 years with intraocular pressure (IOP) of more than 18 mmHg for whom the clinician decided SLT was the appropriately indicated therapy were randomized to 1 of 3 groups in a ratio of 1:1:1 as follows: ketorolac 0.5%, prednisolone 1%, or saline tears. Methods: After SLT, patients randomized into each group were instructed to use an unmarked drop 4 times daily starting the day of SLT and continuing for 4 additional days. The Kruskal-Wallis test and Wilcoxon rank-sum test were used for continuous variables when comparing 2 or 3 treatment groups, respectively. The Fisher exact test was used for categorical variables. Main Outcome Measures: The primary outcome of this study was IOP at 12 weeks. Secondary outcome measures included IOP at 1 and 6 weeks, patient-reported pain, and detectable anterior chamber inflammation. Results: Ninety-six eyes of 85 patients fit inclusion criteria and were enrolled between the 2 sites. The NSAID, steroid, and placebo groups were similar in baseline demographics and baseline IOP (mean, 23.3±3.9 mmHg; P = 0.57). There was no statistically significant difference in IOP decrease among groups at week 6. Both the NSAID and steroid groups showed a statistically significantly greater decrease in IOP at week 12 compared with the placebo group (mean, -6.2±3.1 mmHg, -5.2±2.7 mmHg, and -3±4.3 mmHg, respectively; P = 0.02 [analysis of variance] and P = 0.002 [t test] for NSAID vs. placebo groups; P = 0.02 for steroid vs. placebo groups). Conclusions: Significantly better IOP reduction at 12 weeks was measured in eyes treated with steroid or NSAID drops after SLT. Short-term postoperative use of NSAID or steroid drops may improve IOP reduction after SLT. Longer-term follow-up studies are indicated.
关键词： steroid,NSAID,SLT,selective laser trabeculoplasty,anti-inflammatory,IOP,intraocular pressure
更新于2025-09-16 10:30:52
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<p>Intraocular Pressure Calculation in Myopic Patients After Laser-Assisted In Situ Keratomileusis</p>
摘要： Background: Corneal refractive surgery is widely used worldwide. Myopia is the most common reason for laser-assisted corneal refractive surgery (LASIK) and one of the risk factors for glaucoma. Intraocular pressure (IOP) measurement becomes variable postoperatively as the results are affected by the decrease in corneal thickness and biomechanics. This prospective clinical case study attempted to establish a simple correction formula for the calculation of IOP in post-LASIK myopic patients. Methods: This study included 300 eyes of 150 patients with myopia and myopic astigmatism as a refractive error who underwent LASIK. IOP was measured preoperatively and 6 months postoperatively. Preoperative and postoperative corneal thickness as well as ablation depth were measured. Statistical analysis was performed to detect the relationship between ablation depth and change in IOP. An attempt was made to construct a correction formula for the calculation of post-LASIK IOP. Results: The age of the patients ranged between 18 and 50 (mean ± SD 34.78±8.8) years. The spherical equivalent of refractive error ranged between ?1.5 and ?10 diopters. The mean IOP decreased signi?cantly from 15.72±2.37 mmHg preoperatively to 11.71±2.24 mmHg postoperatively, with a mean difference of 4±1.75 mmHg (p?0.001). A positive correlation was detected between corneal thickness and IOP difference among patients both preoperatively and postoperatively (p?0.001). A positive correlation was identi?ed between ablation depth and IOP change (p?0.001). The correction formula for IOP was established: Real IOP=4+0.7(preoperative IOP)?0.3(ablation depth). Conclusion: IOP measurements change after corneal refractive surgery with LASIK. A corrected formula may be a good option for the proper calculation of post-LASIK IOP.
关键词： intraocular pressure calculation,Goldmann applanation tonometry,laser in situ keratomileusis,glaucoma,post-LASIK glaucoma
更新于2025-09-16 10:30:52