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Comparison between broadband and monochromatic photopic negative response in full-field electroretinogram in controls and subjects with primary open-angle glaucoma
摘要： Purpose A prospective, cross-sectional, case–control study was conducted to investigate the role of broadband and monochromatic photopic negative response (PhNR) of the full-field flash electroretinogram (ERG) in the evaluation of ganglion cell damage in primary open-angle glaucoma (POAG) subjects. Methods Subjects with POAG and age-matched normal subjects were recruited from the outpatient department of a tertiary eye care center in South India. A total of 25 patients with POAG and 50 age-matched normal subjects were recruited. ERG was recorded using broadband (3.5 cd.s/m2 white stimulus on 10 cd/m2 white background) and monochromatic (3.5 cd.s/m2 red stimulus on 10 cd/m2 blue background and 1 cd.s/m2 blue stimulus on 10 cd/m2 yellow background) stimuli. Results The reduction in PhNR amplitude in POAG compared to normal individuals was higher in red-on-blue PhNR [26.37 μV; p < 0.001, confidence interval (CI) 19.34 to 33.4] as compared to broadband stimuli (16.41 μV; p < 0.001, CI 8.68 to 24.13), and blue on yellow (21.96 μV; p < 0.001, CI 10.12 to 33.8). Red-on-blue PhNR amplitudes correlated better with mean deviation (MD; r = -0.66, p < 0.05), pattern standard deviation (PSD; r = -0.4, p = 0.04), visual field index (VFI; r = -0.58, p < 0.05), and retinal nerve fiber layer thickness (r = -0.67, p < 0.05) in comparison with broadband and monochromatic blue-on-yellow PhNR. Receiver operating characteristic curve revealed largest area under the curve (0.89) in red-on-blue PhNR compared to broadband (0.76) and blue on yellow (0.74). The sensitivity and specificity was also higher in red-on-blue PhNR (72% and 80%, respectively) as compared to the other stimuli (sensitivity and specificity of broadband 0.68 and 0.7, blue on yellow 0.64 and 0.7, respectively). Conclusion Correlation of PhNR with Humphrey visual field parameters and retinal nerve fiber layer thickness showed that red-on-blue PhNR can be a useful additional tool for clinical assessment of retinal ganglion cell dysfunction in glaucoma patients. Red-on-blue PhNR was more sensitive as compared to white-on-white and blue-on-yellow PhNR in identifying ganglion cell dysfunction and correlates well with other structural and functional tests for glaucoma such as MD, PSD, VFI, and RNFL thickness.
关键词： Primary open-angle glaucoma,Photopic negative response,Broadband ERG,Full-field electroretinogram,Monochromatic ERG
更新于2025-09-23 15:23:52
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Effect of Apraclonidine and Diclofenac on Early Changes in Intraocular Pressure After Selective Laser Trabeculoplasty
摘要： Précis: Adjuvant diclofenac and apraclonidine eye drop given in conjunction with selective laser trabeculoplasty (SLT) do not significantly impact medium-term intraocular pressure (IOP) reduction compared with placebo, but apraclonidine can be used to blunt immediate postlaser pressure spikes. Purpose: There is limited high-grade evidence guiding the choice of eye drops given before and after SLT. The authors chose to measure IOP during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. Materials and Methods: In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016 and 2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. Results: Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1 hour and 2 hours post-SLT in the placebo and diclofenac study arms (mean = +4.05 ± 0.58 mm Hg and +4.47 ± 0.73, respectively, P < 0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean = ?2.41 ± 0.88 mm Hg, P < 0.0001 vs. other study arms post-SLT). There were no significant differences between the 3 arms of the study on the long-term IOP reduction achieved by SLT (6 wk: P = 0.51, 6 mo: P = 0.42). Conclusions: Neither the use of apraclonidine before SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.
关键词： open-angle glaucoma,non–steroidal anti-inflammatory,selective laser trabeculoplasty,intraocular pressure,ocular hypertension
更新于2025-09-23 15:21:01
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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 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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Selective laser trabeculoplasty as the primary treatment for open angle glaucoma: time for change?
摘要： Laser trabeculoplasty came to the fore more than 20 years ago when the Glaucoma Laser Trial (GLT) showed that eyes treated initially with argon laser trabeculoplasty (ALT) had lower intraocular pressure (IOP) with better visual field and optic disc status, compared with their fellow eyes initially treated with topical medication [1]. Selective laser trabeculoplasty (SLT) was then introduced in 1995, and has since largely superseded ALT, with less damage to the trabecular meshwork architecture, fewer reported adverse events and potentially better repeatability [2]. Several randomized trials have reported that SLT may provide similar IOP lowering to medical therapy in open angle glaucoma (OAG) and ocular hypertension (OHT) [3]. SLT may also be an alternative treatment option in OAG patients who cannot tolerate medications due to side effects, and unable or unwilling to undergo surgery [4]. However, SLT is currently not widely accepted as a first-line intervention in treatment-naive eyes, despite increasing evidence that it is as efficacious as a prostaglandin analog in lowering IOP for OAG and OHT [5]. The recently published results from the "LiGHT" study support the use of SLT as a primary treatment for OHT and OAG [6]. In this multicentre randomized trial conducted in the United Kingdom (UK), subjects received either initial SLT (laser-first, n = 356) or glaucoma medical therapy (medicine-first, n = 362) [6]. Majority of patients was European white (68.2%) with OHT (31.9%) or mild OAG (50.6%) [7]. Glaucoma progressed in a lower proportion of patients in the laser-first compared with the medicine-first arm (3.8% versus 5.8%). Over the course of 36 months, IOP control was also better in the laser-first arm, with a lower number of glaucoma medications required and no glaucoma surgeries. Due to the significant reduction in the cost of surgery and glaucoma medications, the laser-first approach was also cost-effective in the context of the National Health Service (NHS) in England and Wales, with overall cost savings of ￡451 per patient. However, the treatment arms did not differ significantly in the primary outcome of health-related quality of life assessed using the EQ-5D (difference, 0.012; 95% confidence interval [CI], ?0.007 to 0.031; p = 0.23) [6]. This is not surprising, given that the EQ-5D-5L is a generic questionnaire that is not the most sensitive tool to investigate vision-related quality of life [8].
关键词： open angle glaucoma,LiGHT study,primary treatment,Selective laser trabeculoplasty,ocular hypertension
更新于2025-09-19 17:13:59
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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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Inner Retinal Changes in Primary Open-Angle Glaucoma Revealed Through Adaptive Optics-Optical Coherence Tomography
摘要： To examine the microstructural changes in the inner nuclear layer (INL) and ganglion cell layer (GCL) in a primary open-angle glaucoma (POAG) subject at 2 timepoints, 4 months apart. This case-control study (1 POAG subject and 1 normal control) used the single cell, 3-dimensional volumetric imaging capability of an adaptive optics-optical coherence tomography-scanning laser ophthalmoscopy system to examine the inner retina. At the area of greatest glaucomatous change in the POAG subject [3-degrees temporal (T), 3-degrees inferior (I), right eye], the GCL was greatly thinned at both timepoints, yet retinal ganglion cell soma remained visible amid a meshwork of capillaries. Microcystic lesions in the INL were visible at both timepoints, ranging in diameter from 8 to 43 μm on day 1 to 11 to 64 μm at 4 months, with an average diameter increase of ～124%. Small hyperre?ective features (not seen in the contralateral eye or control subject) at a depth midway through the INL seemed correlated to the development of microcysts. We demonstrate the ability to image microcystic lesions early in their development and have quanti?ed longitudinal changes. The presence of small hyperre?ective structures at a layer midway through the INL seems to be a precursor to their formation and is a potential biomarker for assessing POAG severity and progression. The adaptive optics imaging system is also able to visualize retinal ganglion cells in this subject, despite severe thinning of the GCL.
关键词： optical coherence tomography,adaptive optics,retinal ganglion cells,microcysts,primary open-angle glaucoma
更新于2025-09-16 10:30:52
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CO2 Laser-assisted Deep Sclerectomy Combined With Phacoemulsification in Patients With Primary Open-angle Glaucoma and Cataract
摘要： To assess the safety and efficacy of CO2 laser-assisted sclerectomy surgery (CLASS) combined with phacoemulsification in patients with primary open-angle glaucoma (POAG) and visually significant cataracts. This was a prospective, uncontrolled, interventional case series. Seventeen patients (17 eyes) diagnosed with POAG and cataracts were enrolled starting from November 2015. All subjects underwent CLASS combined with phacoemulsification surgery by the same surgeon. After the surgery, all patients were followed for 12 months. The preoperative to postoperative changes in intraocular pressure (IOP), glaucoma medication requirements, best-corrected visual acuity and adverse events were recorded. The results of 17 eyes of 17 patients were included in the statistical analysis. The baseline mean IOP was 23.94 ± 8.57 mm Hg (mean ± SD), and patients used 2.18 ± 0.88 types of antiglaucoma medication. At 12 months postsurgery, the mean IOP was 14.67 ± 2.97 mm Hg, and patients used 0.59 ± 0.87 types of antiglaucoma medication (both P < 0.001). The logarithm of the minimal angle of resolution of the best-corrected visual acuity improved from 0.77 ± 0.42 preoperatively to 0.33 ± 0.47 postoperatively (P < 0.05). Two patients experienced intraoperative perforation accompanied by iris prolapse. One patient exhibited postoperative choroidal detachment. CLASS with phacoemulsification may become a safe and effective intervention for patients with POAG and visually significant cataracts.
关键词： cataract,primary open-angle glaucoma,phacoemulsification,CLASS,laser surgery
更新于2025-09-16 10:30:52
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Crystalline lens changes after selective laser trabeculoplasty in Afro-Caribbean patients with open-angle glaucoma; report 4 of the West Indies Glaucoma Laser Study (WIGLS)
摘要： To characterize changes in nuclear, cortical, and posterior subcapsular lens opacities after selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG).
关键词： SLT,lens opacities,Afro-Caribbean,open-angle glaucoma,selective laser trabeculoplasty
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