Efficacy of selective laser trabeculoplasty versus latanoprost as initial management in glaucoma / Eficácia da trabeculoplastia seletiva a laser versus latanoprosta como tratamento inicial no glaucoma

ABSTRACT Objective: To compare the hypotensive effect of SLT vs the use of latanoprost in the initial management of patients with suspected glaucoma and diagnosis of glaucoma. To evaluate the patients' quality of life using the Glaucoma Quality of Life questionnaire. Methods: Randomized controlled clinical trial conducted in the city of Cartagena, Colombia, between October 2021 to June 2023. Assignment to the SLT or latanoprost group with follow-up at days 7, 30, 90, 180, and 365 in patients diagnosed with suspected glaucoma, mild and moderate glaucoma. Results: 31 patients (60 eyes), of which 17 were men. Group SLT were 31 eyes and the latanoprost group included 29 eyes. The mean baseline IOP of the SLT group was 18.9mmHg and in the latanoprost group, it was 19.6mmHg. The mean IOP at the end of the follow-up group SLT was 13.9mmHg and for latanoprost 14.5mmHg. The IOP reduction percentage at one year of follow-up in the SLT group was 23.4% and that of the latanoprost group was 23.6% Conclusions: Selective laser trabeculoplasty with Nd-YAG laser is as effective as the use of prostaglandin analogues as initial treatment in the early stages of glaucoma. Regarding the quality of life scale, although there were no statistically significant differences in both groups, the SLT showed an increase in the difficulty perceived by the patient for activities that involve peripheral vision, which is the most affected in patients with glaucoma.

RESUMO Objetivo: Comparar o efeito hipotensor da trabeculoplastia seletiva a laser versus o uso de latanoprosta no tratamento inicial de pacientes com suspeita de glaucoma e diagnóstico de glaucoma; avaliar a qualidade de vida dos pacientes por meio do Glaucoma Quality of Life Survey. Métodos: Ensaio clínico randomizado controlado realizado na cidade de Cartagena, Colômbia, entre outubro de 2021 e junho de 2023. Atribuição ao grupo trabeculoplastia seletiva a laser ou latanoprosta com acompanhamento nos dias 7, 30, 90, 180 e 365 em pacientes diagnosticados com suspeita de glaucoma, glaucoma leve e moderado. Resultados: Foram incluídos 31 pacientes (60 olhos), sendo 17 homens. No Grupo Trabeculoplastia Seletiva a Laser, foram 31 olhos, e, no Grupo Latanoprosta, 29 olhos. A pressão intraocular basal média do Grupo Trabeculoplastia Seletiva a Laser foi de 18,9mmHg e, no Grupo Latanoprosta, foi de 19,6mmHg. A pressão intraocular média no fim do grupo de acompanhamento trabeculoplastia seletiva a laser foi de 13,9mmHg e para latanoprosta de 14,5mmHg. A percentagem de redução da pressão intraocular em 1 ano de acompanhamento no Grupo Trabeculoplastia Seletiva a Laser foi de 23,4% e a do Grupo Latanoprosta foi de 23,6%. Conclusões: A trabeculoplastia seletiva a laser com Nd-YAG é tão eficaz quanto o uso de análogos de prostaglandinas como tratamento nas fases iniciais do glaucoma. Em relação à escala de qualidade de vida, embora não tenha havido diferenças estatisticamente significativas em ambos os grupos, a A trabeculoplastia seletiva a laser mostrou aumento na dificuldade percebida pelo paciente para atividades que envolvem a visão periférica, que é a mais afetada em pacientes com glaucoma.

Regla ISNT en fotografías de disco óptico, oftalmoscopia indirecta y medición de CFN con OCT / ISNT rule in optic disc photographs, indirect ophthalmoscopy and RNFL measurement with OCT

Introducción: La pérdida del anillo neurorretiniano (ANR) es una característica distintiva del glaucoma que genera desviación de la regla ISNT. Objetivos: Determinar el porcentaje de ojos sanos que cumplen la regla ISNT y establecer cuál de sus variantes es más aplicable a la población normal. Métodos: Evaluación del orden del grosor del anillo neurorretiniano por medio de fotografía de disco óptico, capa de fibras nerviosas en tomografía de coherencia óptica (OCT) y evaluación clínica por oftalmoscopia indirecta. Resultados: Se evaluaron 102 ojos sanos de pacientes con edad promedio 44.1 años. El porcentaje de la regla ISNT en foto de disco, OCT y oftalmoscopia indirecta se cumplió en el 36.3, 38.2 y 29.4% de los ojos respectivamente, la variación de la regla en la que se excluye cuadrante nasal y temporal, conocida como regla «IS¼, aumentó sus porcentajes de cumplimiento al 73.5, 52.9 y 54.9% al ser evaluadas en foto de disco, OCT y oftalmoscopia indirecta, respectivamente. Conclusiones: La regla ISNT solo es válida en un tercio de los ojos evaluados mediante los métodos descrito

Background: Neurorretinal rim loss is an important characteristic of glaucoma that generates deviation from the ISNT rule. Objective: To determine what percentage of normal eyes follow the ISNT rule, and wich ISNT rule variants may be more generalizable to the normal population. Methods: Neurorretinal rim assessment from optic disc photographs, retinal nerve fiber layer (RNFL) thickness measurements from (OCT) and clinical evaluation by indirect ophthalmoscopy. Results: 102 healthy eyes were evaluated, with an average age of 44.1 ± 11.7 years. The percentage of agreement of ISNT rule was verified in in disk photo (36.3%), OCT (38.2%) and indirect ophthalmoscopy (29.4%) of the total population. The variation of the rule in which the nasal (73.5) and temporal (52.9%) quadrant are excluded, known as the "IS" rule, increased its compliance percentages from 73.5%, 52.9% and 54.9% when evaluated in disk photo, OCT and indirect ophthalmoscopy, respectively.

Efecto de la música en el glaucoma. Reporte de caso / Music effect in glaucoma. A case report

Introducción: Documentamos el caso de un paciente músico profesional de instrumento de viento, con glaucoma de ángulo abierto secundario a aumento de la presión venosa epiescleral como consecuencia de su actividad musical, y cómo esto afecta la presión intraocular y la progresión de la enfermedad. Objetivo: Evidenciar la asociación existente entre tocar instrumentos de viento y el desarrollo de glaucoma y su progresión acelerada. Resumen del caso: Varón de 62 años, músico profesional (instrumento de viento de alta resistencia: trombón de vara). Procedente de otra institución con diagnóstico de glaucoma de tensión normal, con fluctuaciones de presión intraocular (PIO) > 10 mmHg en monitoreo con curva de 24 horas, posterior a tocar el instrumento. Se evidenciaron fluctuaciones en la tonometría de hasta 6 mmHg (promedio por toma) al ser tomada en reposo y 20 minutos después de tocar el instrumento. Finalmente, se diagnostica glaucoma crónico de ángulo abierto secundario a aumento de la presión venosa epiescleral, asociado probablemente a su profesión. Conclusiones: Este reporte evidencia que tocar instrumentos de viento genera elevaciones de la PIO, que al ser repetitivas pueden influir en el desarrollo de glaucoma y su progresión

Introduction: We document the case of a professional wind instrument musician patient, with open-angle glaucoma secondary to increased episcleral venous pressure as a consequence of his musical activity, and how this affects intraocular pressure and disease progression. Objective: To demonstrate the association between playing wind instruments with the development of glaucoma and its accelerated progression. Case summary: 62 year old male patient, professional musician (high resistance wind instrument: rod trombone). Extrainstitutionally, they give a diagnosis of normal tension glaucoma, with IOP fluctuations > 10 mmHg in 24-hour monitoring of the curve, after playing the instrument. Fluctuations in tonometry of up to 6 mmHg (average per dose) were observed when taken at rest and 20 minutes after playing the instrument. Finally, chronic open-angle glaucoma was diagnosed secondary to increased episcleral venous pressure, probably associated with his profession. Conclusions: This report shows how playing wind instruments generates IOP elevations, which, being repetitive, can influence the development of glaucoma and its progression