ABSTRACT
ABSTRACT Purpose: To evaluate the effectiveness in intraocular pressure reduction and safety of micropulse transscleral diode cyclophotocoagulation in refractory glaucoma. Methods: We prospectively evaluated a case series of 21 eyes of 21 consecutive patients with refractory glaucoma treated with micropulse transscleral diode cyclophotocoagulation at 12-month follow-up. The total treatment time was at the discretion of the surgeon, considering baseline and target intraocular pressure and glaucoma diagnosis. Intraocular pressure, inflammation, visual acuity, and number of medications were monitored. Success was defined as intraocular pressure between 6 and 21 mmHg and/or 30% reduction from baseline intraocular pressure with or without the use of antiglaucoma medications. Visual acuity loss was defined as a loss of ≥2 lines of vision on the Snellen chart or a ≥2-level decrease in visual function in patients with nonmeasurable chart acuity. Results: The mean age was 61.04 ± 12.99 years, and 11 (52.4%) patients were male, with most (95%) patients showing low visual acuity at baseline (count fingers or worse). The mean intraocular pressure was 33.38 ± 15.95 mmHg, and the mean number of medications was 3.5 ± 1.1 at baseline. After 1, 3, 6, and 12 months, 76.19%, 57.14%, 55.56%, and 66.67%, respectively, of the patients were classified as treatment successes. Seven (33.3%) patients required new laser treatment and were considered treatment failures. The mean intraocular pressure reduction was 44.72% ± 29.72% in the first week and 41.59% ± 18.93% at the end of follow-up (p=0.006). The mean number of medications significantly dropped to 2.00 ± 1.7 at the 12-month visit (p=0.044). Complications included hypotony (4.8%), intraocular inflammation after 1 month (19%), and visual acuity loss (4.8%). Conclusions: Micropulse transscleral diode cyclophotocoagulation was safe and effective for reducing intraocular pressure in eyes with refractory and advanced glaucoma, with reduced need for ocular antihypertensive medication.
RESUMO Objetivo: Avaliar a eficácia na redução da pressão intraocular e na segurança da ciclofotocoagulação com laser de diodo transescleral em glaucoma refratário. Métodos: Avaliamos prospectivamente uma série de casos de 21 olhos de 21 pacientes com glaucoma refratário tratados com ciclofotocoagulação com laser de diodo transescleral com acompanhamento por 12 meses. O tempo total de tratamento ficou a critério do cirurgião, considerando a pressão intraocular inicial e alvo e o tipo de glaucoma. Pressão intraocular, inflamação, acuidade visual e número de medicamentos foram monitorados. O sucesso foi definido como pressão intraocular entre 6 e 21 mmHg e/ou redução de 30% da pressão intraocular basal com ou sem o uso de medicamentos glaucomatosos. Perda da acuidade visual foi definida como perda de ≥2 linhas de visão na tabela de Snellen ou uma diminuição de ≥ 2 níveis na função visual em pacientes com acuidade do gráfico não mensurável. Resultados: A idade média foi de 61,04 ± 12,99 anos e 11 (52,4%) pacientes eram do sexo masculino, com a maioria (95%) dos pacientes apresentando baixa acuidade visual inicialmente (conta dedos ou pior). A pressão intraocular média foi de 33,38 ± 15,95 mmHg, e o número médio de medicamentos foi de 3,5 ± 1,1, no início do estudo. Após 1, 3, 6 e 12 meses, 76,19%, 57,14%, 55,56% e 66,67%, respectivamente, dos pacientes foram classificados como sucesso do tratamento. Sete (33,3%) pacientes necessitaram de novo tratamento com laser e foram considerados falhas no tratamento. A redução média da pressão intraocular foi de 44,72% ± 29,72% na primeira semana e 41,59% ± 18,93% no final do seguimento (p=0,006). O número médio de medicamentos diminuiu significativamente para 2,00 ± 1,7 na visita de 12 meses (p=0,044). As complicações incluíram hipotonia (4,8%), inflamação intraocular após 1 mês (19%) e perda de acuidade visual (4,8%). Conclusões: A ciclofotocoagulação com laser de diodo transescleral foi segura e eficaz para reduzir a pressão intraocular em olhos com glaucoma refratário e avançado, com necessidade reduzida de hipotensores oculares.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Glaucoma/surgery , Laser Coagulation/methods , Visual Acuity , Glaucoma/physiopathology , Glaucoma, Neovascular/surgery , Ciliary Body/surgery , Ciliary Body/physiopathology , Prospective Studies , Laser Coagulation/instrumentation , Intraocular PressureABSTRACT
The authors conducted a review of classical and conflicting theories of accommodation and presbyopia. They make a critical comparison with the findings of magnetic resonance imaging (MRI) that have been developed in recent decades. Based on these studies, formulates a new approach on the subject, shifting the focus of the discussion of the lens to the posterior pole of the eye.
Os autores revisaram as teorias clássicas e conflitantes sobre acomodação e presbiopia. E as compararam criticamente com os achados de imagem por ressonância magnética (MRI) que têm se desenvolvido nas últimas décadas. Baseado nestes estudos, formulam uma nova abordagem sobre o tema, mudando o foco da discussão do cristalino para o polo posterior do olho.
Subject(s)
Humans , Presbyopia/physiopathology , Presbyopia/diagnostic imaging , Accommodation, Ocular/physiology , Lens, Crystalline/physiopathology , Aging/physiology , Magnetic Resonance Imaging , Ciliary Body/physiopathology , Elasticity , Emmetropia/physiology , Models, TheoreticalABSTRACT
The main ocular manifestation of rhinosporiosis is lid or conjunctival infection. Conjunctival rhinosporiodosis is very rately causing sclera necrosis. A patient named Shumi (8 years), D/O.- Rukan Uddin of Rupchandrapur, Atpara, Netrokona admitted on 09/03/2003 in the department of Ophtalmology, Mymensingh Medical College Hospital with complains of mass in right eye looks externally like a growth in upper lid and mild dimness of vision of right eye. On examination, it was found that she got VAR : 6/24 and having a shaphyloma near 12-00 O'clock position with a mass adjacent to it which was identified as rhinosporiodosis after excisional biopsy. No history of ocular trauma or any other ocular disease was found.
Subject(s)
Biopsy , Child , Ciliary Body/physiopathology , Conjunctivitis/diagnosis , Environmental Pollution/adverse effects , Eye Infections, Fungal/complications , Female , Humans , Rhinosporidiosis/complications , Sclera/physiopathologyABSTRACT
PURPOSE: This study aimed to evaluate the clinical efficacy of contact diode trans-scleral cyclophotocoagulation (TSCPC) for treatment of refractory glaucomas. METHOD: Fifty two eyes of 52 patients, (post-penetrating keratoplasty glaucoma: 16 eyes; adherent leucoma with secondary glaucoma: 8 eyes; aphakic glaucoma: 6 eyes; neovascular glaucoma: 6 eyes; narrow angle glaucoma: 6 eyes; and other secondary glaucomas: 10 eyes) were followed up from 3.5-18 months (average 12 months) after TSCPC. The treatment parameters using the contact G probe were--energy: 3-4J; area: 40 spots spread over 360 degrees; site: 1.2-1.5 mm posterior to limbus. Retreatments (22 eyes; 42%) were given whenever intraocular pressure (IOP) exceeded 22 mmHg despite maximum tolerable topical therapy. RESULTS: IOP decreased from a baseline of 44.7 (+/- 7.3) mmHg to 15 (+/- 3.7) mmHg at first week and was 15.2 +/- (8.2) mmHg at the last follow up. Successful control of IOP (< 22 mmHg) occurred in 30 (58%) eyes after a single treatment and in 48 (92%) eyes following retreatment. Complications included reduction in visual acuity from light perception (LP) only to no light perception (NLP) in two eyes and phthisis bulbi in one eye. CONCLUSION: Contact trans-scleral diode laser cyclophotocoagulation is effective in lowering IOP in eyes with intractable glaucoma with few side effects in Indian subjects.