ABSTRACT
Studying the lamina cribrosa (LC) is relevant to understand the mechanisms of retinal ganglion cell degeneration in glaucoma and develop new diagnostic and therapeutic strategies. We would like to present some of the emerging trends and hot topics in imaging of the lamina cribrosa in glaucoma from the 2016 ARVO (The Association of Research in Vision and Ophthalmology) annual meeting, which was held in Seattle, WA, USA. Presentation of the path of ganglion cells through the pores of the lamina cribrosa as well as changes to the shape of the lamina cribrosa with increase of the intraocular and intracerebral pressure have been of great international interest.
Subject(s)
Glaucoma/diagnostic imaging , Glaucoma/pathology , Image Enhancement/methods , Ophthalmology/trends , Optic Nerve/diagnostic imaging , Optic Nerve/pathology , Early Diagnosis , Humans , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
BACKGROUND: Trabeculectomy provides an excellent reduction of intraocular pressure (IOP) and is the reference technique in the treatment of glaucoma patients. Canaloplasty is a relatively new surgical non-penetrating procedure for restoring the natural outflow pathway of aqueous humour. The aim of canaloplasty is to permanently distend the collapsed Schlemm's canal with the placement of a 360° intracanalicular tension suture. OBJECTIVES: This review article describes the comparison between trabeculectomy and canaloplasty with and without cataract surgery. MATERIAL AND METHODS: Original studies, case reports and reviews are described and the results are discussed. RESULTS: Although canaloplasty may not be as effective in reducing IOP, trabeculectomy can be associated with severe vision-threatening complications however, the combination of canaloplasty with cataract surgery achieves a higher IOP reduction than canaloplasty alone. In contrast, trabeculectomy alone provides better IOP control than phacotrabeculectomy due to a higher risk of early bleb scarring induced by an increased intraocular inflammatory reaction. CONCLUSION: If a higher postoperative IOP is acceptable and additional topical glaucoma medication tolerable, canaloplasty can be considered as an alternative to trabeculectomy as the incidence of complications is low and postoperative care less intensive. Canaloplasty may also be suitable for patients with high risk of bleb failure and early glaucoma with a target IOP not necessarily requiring a filtering procedure. Therefore, canaloplasty offers a treatment option for the management of open-angle glaucoma, especially in combination with cataract surgery.
Subject(s)
Aqueous Humor/physiology , Glaucoma, Open-Angle/surgery , Glaucoma/surgery , Intraocular Pressure , Trabeculectomy/methods , Glaucoma, Open-Angle/drug therapy , Humans , Intraocular Pressure/drug effects , Ophthalmic Solutions/therapeutic use , Trabeculectomy/adverse effectsABSTRACT
Systemic hypertension affects approximately 25 % of the population worldwide and is the most important preventable risk factor for cardiovascular diseases. Hypertension-related fundus abnormalities can be classified into hypertensive retinopathy, choroidopathy, and optic neuropathy. Hypertensive retinopathy causes vascular constriction of retinal arterioles and typical fundus findings, such as blot hemorrhages, hard exudates and cotton wool spots resulting from ischemia within the nerve fiber layer. The use of a detailed grading system based on the severity of vascular constriction is not practicable as arteriosclerotic changes are common among elderly people. Therefore, early stages with pure vascular pathology should be differentiated from severe forms of hypertensive retinopathy with parenchymal changes of the fundus. Screening the retina for hypertensive changes is essential in cases of severe systemic hypertension, acute visual impairment, diabetes mellitus and pregnancy.
Subject(s)
Hypertension/complications , Hypertension/diagnosis , Retinal Diseases/diagnosis , Retinal Diseases/etiology , Diagnosis, Differential , HumansABSTRACT
This article reports a case of a pituitary adenoma as the cause of unilateral visual impairment and concomitant unilateral macular pathology. Pituitary adenomas can be classified into hormone-secreting and inactive tumors of the adenohypophysis and lead to typical symptoms in cases of hypersecretion of hormones or hypopituitarism. A pituitary adenoma classically presents with bitemporal hemianopia when compression occurs at the optic chiasm. Imaging is crucial in diagnosing pituitary adenomas. Microsurgical or endoscopic transsphenoidal surgery, hormone therapy and radiotherapy are the treatment options.
Subject(s)
Adenoma/diagnosis , Adenoma/surgery , Hemianopsia/diagnosis , Nerve Compression Syndromes/diagnosis , Optic Nerve Diseases/diagnosis , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/surgery , Adenoma/complications , Diagnosis, Differential , Female , Hemianopsia/etiology , Hemianopsia/prevention & control , Humans , Middle Aged , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/prevention & control , Optic Chiasm , Optic Nerve Diseases/etiology , Optic Nerve Diseases/prevention & control , Pituitary Neoplasms/complications , Treatment OutcomeABSTRACT
Behçet's disease is a chronic recurrent systemic vasculitis and can affect nearly all organ systems. Eye involvement is characterized by uveitis with occlusive retinal vasculitis. Oral aphthous ulcers are the major primary symptom and arthritis, genital ulcerations and skin lesions are common extraocular manifestations. Gastrointestinal and vascular symptoms or manifestations of the central nervous system are less frequently seen. Biologic agents are used alone or in combination with immunosuppressive or cytotoxic drugs to prevent relapse as the prognosis is poor in patients with retinal vasculitis.
Subject(s)
Behcet Syndrome/complications , Behcet Syndrome/diagnosis , Retinal Vasculitis/diagnosis , Retinal Vasculitis/etiology , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/etiology , Anti-Infective Agents/therapeutic use , Behcet Syndrome/drug therapy , Humans , Male , Middle Aged , Retinal Vasculitis/drug therapy , Retinal Vein Occlusion/drug therapy , Treatment OutcomeABSTRACT
Orbital metastases occur in 2-5 % of cancer patients. Common primary sites that cause orbital metastases are breast, lung and prostate cancer. In up to 25 % of patients orbital metastasis is the initial sign of an unknown primary tumor. Clinical symptoms are proptosis, ocular motility disorder and visual impairment. Imaging procedures may be useful in diagnosing orbital metastases but are not specific. Treatment is palliative. Radiotherapy, chemotherapy and surgical debulkment in selected patients are treatment options.
Subject(s)
Eye Neoplasms/diagnosis , Eye Neoplasms/secondary , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/etiology , Papilledema/diagnosis , Papilledema/etiology , Aged , Eye Neoplasms/surgery , Humans , Male , Neoplasms, Unknown Primary/surgery , Papilledema/surgery , Treatment OutcomeABSTRACT
Patients at high risk of developing complications (e.g. high myopia, aphakia, advanced visual field defects) benefit from non-penetrating glaucoma surgery (NPGS). Neovascular glaucoma, traumatic glaucoma or patients with a narrow angle (a scleral spur must at least be visible) are not suitable for NPGS. The aim of deep sclerectomy (DS) is mainly external subconjunctival drainage. Modified with mitomycin C and intrascleral implants, intraocular pressure (IOP) and success of DS are comparable to trabeculectomy. Viscocanalostomy and the further development to canaloplasty aim for blebless IOP control. Viscocanalostomy has an extremely low complication profile but only a slight reduction in IOP. Canaloplasty creates much more favourable results. Combined with phacoemulsification canaloplasty appears to lower IOP comparable to phacotrabeculectomy and demonstrates a more sustainable success compared to canaloplasty alone.
