A Review of Selective Laser Trabeculoplasty: "The Hype Is Real".

Presently, there is no efficacious treatment for glaucomatous optic neuropathy; the current treatment is focused on lowering intraocular pressure (IOP). Studies have demonstrated the safety and efficacy of selective laser trabeculoplasty (SLT) in reducing the IOP in eyes with open-angle (OAG) glaucoma or ocular hypertension (OH). Moreover, the European Glaucoma Society has instated SLT as the first-line or adjunctive treatment in OAG or OH, reiterating its clinical significance. In this review, we outline the old and the new roles of SLT, with an emphasis on clinical practice, and look further into its renewed appeal and future developments.

Impact of Short-Term Topical Steroid Therapy on Selective Laser Trabeculoplasty Efficacy.

BACKGROUND: To evaluate whether short-term use of topical steroid therapy affected the efficacy of selective laser trabeculoplasty (SLT) for primary open-glaucoma (POAG). METHODS: 25 eyes of 25 patients, who used a drop of dexamethasone 0.1% 4 times a day for 7 days as post-laser therapy, formed the Steroid SLT group and 24 eyes of 24 patients, where no topical steroids or nonsteroidal anti-inflammatory agents as post-laser therapy were used, formed the No-steroid SLT group. Success was defined as an intraocular pressure (IOP) lowering exceeding 20% of pretreatment IOP. RESULTS: The mean follow-up time was 21.24 months for the Steroid SLT group and 20.25 months for the No-steroid SLT group (p = 0.990). No significant difference was found between the two groups for mean pretreatment IOP (22.20 mmHg vs. 22.33 mmHg), and for mean IOP reductions during whole follow-up period. At all follow-up visits, the mean IOP reductions were smaller in the Steroid SLT group than in the No-steroid SLT group. At all follow-up visits, the mean percent IOP reduction was smaller in the Steroid SLT group than in the No-steroid SLT group, and such a difference was significant at 12 months (25.4% vs. 29.6%, p = 0.047) and 24 months (25.3% vs. 29.7%, p = 0.024). According to the Kaplan-Meier survival analysis, the 24-month success rate was 84% in the Steroid SLT group and 79.2% in the No-steroid SLT group, with no differences between the groups (p = 0.675). CONCLUSION: Short-term use of topical steroid therapy had no impact on the efficacy of SLT for POAG.

Comparison of the Ocular Trauma Score and Pediatric Ocular Trauma Score as Two Prognostic Models in Pediatric Open Globe Injuries. / Vergleich des Ocular Trauma Score mit dem Pediatric Ocular Trauma Score als 2 prognostische Modelle zur Behandlung von offenen Augenverletzungen bei Kindern.

AIM: To compare the ocular trauma score (OTS) and the pediatric ocular trauma score (POTS) as prognostic models of visual outcome after open globe injury in children during a period of 19 years. PATIENTS AND METHODS: A retrospective study of 36 open globe injuries in 36 patients younger than 18 years was conducted from January 2000 to January 2019. For each case, OTS and POTS points were calculated. RESULTS: Significant differences were observed in our patients using the two models regarding categories 1 to 4. One third of the cases were in categories 1 and 2 using the OTS model, and nearly 60% using the POTS model. Nearly 60% of our patients were in categories 3 and 4 using the OTS model and 30.6% using the POTS model. In category 5, no difference was observed between the two models. The comparison of distribution of the percentage of final visual acuity between OTS and POTS model in each category revealed a significant difference in category 1 in final visual acuity 20/40 or more (25 vs. 50%) as well as in final visual acuity 20/20 (0 vs. 30%). In category 2, final visual acuity was not significantly different in 20/40 or more between the two models; however, there was a significant difference in final visual acuity 20/20 - 12.5% in the OTS model and 45.5% in the POTS model. In category 3, significant differences were revealed between the two models. Using the OTS model, final visual acuity 20/40 or more was observed in more than 60% and using POTS model in 100%; final visual acuity 20/20 was observed in 36.3% using OTS model and in 50% using POTS model. In category 4 and 5, no differences were observed between OTS and POTS models. CONCLUSION: Our study did not confirm the benefit of POTS. The distribution of our cases among OTS categories demonstrated a significant difference between the two models with more cases distributed in lower categories in POTS group. In the POTS group, the prognosis for final visual acuity was significantly better in the first three categories than in the OTS group, probably as a result of a lower calculation for POTS points. In our opinion, the OTS model is easier to use, has a higher prognostic accuracy, and should be further used in counselling of paediatric cases.

SCREENING FOR DIABETIC RETINOPATHY - A TWELVE-MONTH REVIEW.

The purpose is to provide a twelve-month database review of screening for diabetic retinopathy (DR). A total of 1428 diabetes mellitus (DM) patients screened in 2017 were analyzed in a retrospective study. Retinal photographs were reviewed by an ophthalmologist for the presence and stage of DR, as well as for additional nondiabetic findings. The following grading categories of DR were used: without DR, mild non-proliferative DR (NPDR), moderate NPDR, severe non-proliferative NPDR, proliferative DR (PDR), clinically significant macular edema (CSME) and ungradable finding. Severe NPDR, PDR and CSME were classified as vision-threatening DR. Out of 1428 DM patients, 27 were diagnosed with type 1 DM and 1401 with type 2 DM, 353 of them had newly diagnosed type 2 DM. Without DR category was recorded in 85.2% of all eyes screened, 2.8% were ungradable, and 12% showed varying stages of DR. Vision-threatening DR was found in 2.8% and additional nondiabetic findings in 5.2% of all screened eyes. In the group of newly diagnosed type 2 DM, 92.5% of screened eyes were without DR, 3.1% were ungradable and 4.3% showed varying stages of DR. In the group of newly diagnosed type 2 DM, vision-threatening DR was recorded in 0.1% and additional nondiabetic finding in 5.7% of the eyes screened. In conclusion, a small proportion of screened DM patients with detected DR had vision-threatening DR.

[Cataract Surgery in Very Old Patients]. / Kataraktoperation bei Menschen im hohen Alter.

BACKGROUND: In recent years, there has been an increase in the number of very old patients requiring a cataract operation. However, there is little information on the intraoperative complications and safety in these patients. For various reasons, operations on patients from age 85 may be demanding: dense nuclear cataract, narrow pupils, low count of endothelial cells, loose zonula, and other ocular or systemic diseases. The aim of this retrospective study was to compare very old to younger cataract patients with respect to intraoperative complications and the maturity of the cataract. PATIENTS AND METHODS: This was a retrospective study on 4065 cataract patients treated in our department with IOL implantation with the corneal small incision technique between January 2015 and January 2018. The patients were split by age (from 85 and under 85). RESULTS: Of the 4065 cataract operations, 10.6% (431/4065) were performed on patients aged at least 85, 1.7% (69/4065) on patients aged at least 90 and 0.1% (4/4065) on patients of at least 95 years. There were statistically significant differences between the younger and older patients with respect to pupil dilatation (4.6 vs. 6.0%), use of the capsule tension ring (0.4 vs. 0%) and in capsule staining (5.5 vs. 7.0%). There were no intraoperative complications (e.g. anterior capsule laceration) in patients aged at least 85 and in 0.71% of patients aged under 85; loss of vitreous fluid was recorded in none of the patients in the older group and in 0.41% of patients in the younger group. CONCLUSION: Our study confirms that advanced age alone is not a contraindication for a cataract operation and is not associated with a greater rate of intraoperative complications. Cataract operations on very old patients are generally successful, but should be undertaken early - particularly on multimorbid patients or those with dementia - in order to support the psychological status. The age of the patient is irrelevant.

Comparative study of the efficacy of selective laser trabeculoplasty as initial or adjunctive treatment for primary open-angle glaucoma.

AIM: The aim of this study is to compare the efficacy of selective laser trabeculoplasty as initial or adjunctive treatment for primary open-angle glaucoma in a retrospective chart review. METHODS: 28 eyes of 28 patients with newly diagnosed primary open-angle glaucoma, who formed the initial selective laser trabeculoplasty group, and 31 eyes of 31 patients suffering from medical uncontrolled primary open-angle glaucoma, who formed the adjunctive selective laser trabeculoplasty group, were treated with 180° selective laser trabeculoplasty. Patients were evaluated 1, 3, 6, 12, 18 and 24 months after treatment. Success was defined as an intraocular pressure lowering exceeding 20% of pretreatment intraocular pressure. RESULTS: The mean follow-up time was 20.25 months (standard deviation = 8.1) for the initial selective laser trabeculoplasty group and 18.87 months (standard deviation = 8.8) for the adjunctive selective laser trabeculoplasty group (p = 0.538). No significant difference was found between the two groups for mean pretreatment intraocular pressure (21.43 mmHg (standard deviation = 3.2) vs 21.97 mmHg (standard deviation = 2.6); p = 0.766), for mean intraocular pressures and mean intraocular pressure reductions during whole follow-up period. At all follow-up visits, the mean percent intraocular pressure reduction was smaller in the adjunctive selective laser trabeculoplasty group than in the initial selective laser trabeculoplasty group, and such a difference was significant at 1 month (21.55% vs 26.79%; p = 0.039) and 24 months (24.82% vs 28.10%; p = 0.041). According to the Kaplan-Meier survival analysis, the 24-month success rate was 71.4% in the initial selective laser trabeculoplasty group and 71% in the adjunctive selective laser trabeculoplasty group, with no differences between the groups (p = 0.913). CONCLUSION: Selective laser trabeculoplasty is equally efficient in reducing intraocular pressure as initial or adjunctive treatment for primary open-angle glaucoma over 24 months.

[Spectral Domain Optical Coherence Tomographic Findings in Systemic Lupus erythematosus in Patients Treated with Chloroquine]. / Ergebnisse spektraler optischer Kohärenztomografie bei den mit Chloroquin behandelten Patienten mit systemischem Lupus erythematodes.

PURPOSE: To recognise possible retinal changes in patients with SLE treated with chloroquine phosphate, as depending on the duration of treatment. METHODS: The study included 41 patients (82 eyes) who received treatment for SLE with chloroquine or hydroxychloroquine phosphate and had not previously been diagnosed with retinal pathology. Participants were divided into two groups according to the duration of treatment. The first group included 18 patients (36 eyes) treated for up to five years and the second group consisted of 23 patients (46 eyes) treated from five to twenty years. We performed a thorough eye exam, including best-corrected visual acuity, colour vision, visual field examination, dilated fundus examination, autofluorescence imaging, color fundus photography and spectral domain optical coherence tomography. RESULTS: Mean duration of treatment in the first group was 2.79 ± 1.37 years, and in the second group 8.67 ± 2.26 years. The difference in central retinal thickness between the two groups was not statistically significant (p > 0.05). Comparison of parafoveal thickness between the two groups was statistically non-significant in all quadrants (p > 0.05). Visual field examination, autofluorescence images and colour fundus photographs were without noteworthy pathology. CONCLUSION: Our results indicate that there were no significant changes in retinal structure between groups that depended on the duration of treatment. Hence, we can conclude that a yearly follow-up of these patients is sufficient to discover possible preclinical maculopathy.

Phacoemulsification in isolated endogenous Candida albicans anterior uveitis with lens abscess in an intravenous methadone user.

We report the clinical course of a 31-year-old former intravenous drug user on methadone substitution therapy who injected methadone mixed with orange juice. She developed isolated metastatic Candida albicans anterior uveitis, which was treated with adequate systemic and local antifungal therapy. The uveitis regressed, but despite adequate local and systemic treatment, a lens abscess developed. Phacoemulsification and endocapsular intraocular lens implantation were performed, and the patient recovered 20/20 visual acuity in the affected eye. In patients with a history of injection drug use, persisting intravenous drug or substitution therapy abuse must be considered. Quick diagnosis and adequate treatment can prevent the development of widespread C albicans endophthalmitis, which has a poor visual prognosis. Early administration of antifungal and surgical therapy is crucial for achieving good functional results.

[Posterior capsule opacification after phacoemulsification in patients with rheumatoid arthritis]. / Posteriore Kapselopazifikation nach Phakoemulsifikation bei Patienten mit rheumatoider Arthritis.

PURPOSE: To assess the posterior capsule opacification (PCO) rate after phacoemulsification with polyacrylic intraocular lens (IOL) implantation in patients with rheumatoid arthritis (RA) compared with the controls, and to assess whether preoperative activity of RA is associated with a higher incidence of PCO. METHODS: 24 eyes of 20 RA patients operated in a period of 4 years were included in our study. A control group of 20 eyes from 20 health subjects were also included in our study. All procedures were performed by a single surgeon with the same surgical technique and postoperative medication. RESULTS: One year postoperatively in two eyes (8.3%) of RA-patients lens epithelial cells (LEC) migration of grade 1 was observed, in controls also in two eyes (10%). No correlation was observed between age, duration of RA or preoperative activity of RA and the PCO rate. CONCLUSION: Following acrylic IOL implantation, the PCO rate one year after surgery was 8.3% in RA patients and 10% in controls. RA patients present no higher risk for PCO development than controls.

Ocular blood flow velocity determined by color Doppler imaging in diabetic retinopathy.

PURPOSE: To measure and investigate changes of blood flow velocity by color Doppler imaging in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (PCA) in diabetic retinopathy (DR) and to compare the results with those in healthy control subjects. METHODS: In this investigation we included 44 eyes of 44 diabetic patients with different stages of DR forming group NPDR (11 eyes with mild and 11 eyes with moderate nonproliferative DR) and group SNPDR/PDR (19 eyes with severe nonproliferative and 3 eyes with proliferative DR) and 22 eyes of 22 healthy age- and sex-matched subjects forming control group HC. With color Doppler imaging we measured the peak systolic velocity (PSV, cm/s) and end-diastolic velocity (EDV, cm/s) of blood flow in the OA, CRA and PCA. The resistance index of each vessel was then calculated. Statistical analysis comparing the results of groups NPDR, SNPDR/PDR and HC was carried out. Statistical significance was set at p < 0.05. RESULTS: There was a statistically significant increase in PSV in the OA in group SNPDR/PDR compared with group HC (35.71 +/- 6.90 vs. 31.45 +/- 4.32 cm/s; mean +/- SD). There was a statistically significant decrease in PSV in the CRA in group NPDR compared with group HC (8.50 +/- 1.62 vs. 10.61 +/- 1.75 cm/s; mean +/- SD) and in group SNPDR/PDR compared with group HC (7.34 +/- 1.78 vs. 10.61 +/- 1.75 cm/s; mean +/- SD), also there was a statistically significant decrease in EDV in group SNPDR/PDR compared with group HC (2.05 +/- 0.53 vs. 3.00 +/- 0.81 cm/s; mean +/- SD). A statistically significant decrease in EDV in the PCA in group SNPDR/PDR compared with group HC (2.95 +/- 1.04 vs. 3.95 +/- 0.98 cm/s; mean +/- SD) was found, also there was a statistically significant increase in the resistance index in group SNPDR/PDR compared with group NPDR (0.72 +/- 0.05 vs. 0.67 +/- 0.07; mean +/- SD) and in group SNPDR/PDR compared with group HC (0.72 +/- 0.05 vs. 0.67 +/- 0.05; mean +/- SD). CONCLUSIONS: In this investigation, color Doppler imaging was used to determine significant changes of blood flow velocity in the OA, CRA and PCA in DR compared with healthy control subjects and the changes of blood flow velocity become further significant considering the progression of DR. This points to the presence of circulatory changes in the OA, CRA and PCA in diabetic patients with DR.

[Efficacy of selective laser trabeculoplasty in the treatment of primary open-angle glaucoma]. / Wirksamkeit der selektiven Lasertrabekuloplastik bei der Behandlung von primärem Offenwinkelglaukom.

BACKGROUND: Our aim was to investigate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study. PATIENTS AND METHODS: In 36 eyes of 36 patients suffering from uncontrolled POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and one day, one week, one month and 3, 6, 12, 18, 24, 30, 36, 42 and 48 months after. A failure was defined as an IOP reduction of less than 20% from pretreatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged. RESULTS: The mean follow-up time was 34 months (SD 12.9). The mean pretreatment IOP was 22.9 mm Hg (SD 2.1). At one month of follow-up, the mean IOP reduction was 5.3 mm Hg (SD 2.1) or 23.1% and at 6 months 5.6 mm Hg (SD 2.6) or 24.5%. At 12 months of follow-up, the mean IOP reduction was 5.6 mm Hg (SD 2.3) or 24.5% and at 24 months 6.2 mm Hg (SD 2.5) or 27%. At 36 months of follow-up, the mean IOP reduction was 6.4 mm Hg (SD 2.1) or 27.4% and at the end of 48 months of follow-up, the mean IOP reduction was 5.9 mm Hg (SD 2.0) or 25.4%. The success rate after 12 months determined from the Kaplan-Meier survival analysis was 97%, after 24 months 88%, after 36 months 76% and after 48 months 71%. CONCLUSION: SLT is an effective procedure for the treatment of POAG.