Continuous 24-hour ocular dimensional profile recording in medically treated normal-tension glaucoma.

PURPOSE: To analyze the 24-hour ocular dimensional profile in normal-tension glaucoma (NTG) patients on medical treatment. METHODS: Consecutive, medically treated NTG subjects were recruited from a university eye center. Subjects were on a mean of 1.7±0.7 types of antiglaucoma medications and 56.6% were on a prostaglandin analog. A contact lens-based sensor device was worn in one eye of NTG patients to record the intraocular pressure (IOP)-related profile for 24 hours, recording the following: variability from mean over 24 hours, nocturnally and diurnally, as well as the number of peaks and troughs diurnally and nocturnally. RESULTS: In 18 NTG subjects, the nocturnal variability around the mean contact lens-based sensor device signal was 48.9% less than the diurnal variability around the mean. The number of peaks was 54.7% less during the nocturnal period than during the diurnal period. The rate of increase in the ocular dimensional profile when going to sleep was significantly greater than the rate of decrease upon waking (P<0.001). CONCLUSION: In medically treated NTG subjects, there was more variability in the IOP-related pattern during the daytime and there were fewer peaks during sleep.

Efficacy of selective laser trabeculoplasty for normal tension glaucoma: 1 year results.

BACKGROUND: Normal tension glaucoma (NTG) is commonly treated with anti-glaucoma medications. Recently, selective laser trabeculoplasty (SLT) has been demonstrated to lower the intraocular pressure (IOP) and medication use in NTG. The purpose of this study was to investigate the efficacy of a single session of SLT for NTG at 1 year. METHODS: This prospective cohort study recruited NTG patients taking anti-glaucoma medication. Potential subjects were excluded if they had had previous glaucoma surgery or laser and also if intraocular surgery or additional SLT procedures were performed after the first treatment. All subjects underwent a 1-month washout. A 30% IOP reduction was set as the target IOP. A single session of SLT was performed to 360 degrees of the trabecular meshwork. At 1-month after SLT, medication was resumed to achieve the target IOP. The IOP was measured every 3 months, and the number of medications was recorded at 3, 6, and 12 months. Only the right eye was used for statistical analysis. RESULTS: In 41 right eyes, the mean pre-study IOP was 14.3 ± 3.4 mmHg while on 1.5 ± 0.8 eye drops. The post-washout IOP was 16.2 ± 2.2 mmHg. A mean of 191.1 ± 26.3 SLT shots at 1.0 ± 0.07 mJ were applied. There was significant IOP reduction at all time intervals following SLT when compared to the post-washout IOP (P < 0.0001). The number of medications was significantly reduced at all time intervals following SLT when compared to the pre-study level (P < 0.0001). At 12 months, the mean IOP was 12.2 ± 2.2 mmHg while on 1.1 ± 0.9 eye drops. CONCLUSIONS: A single session of SLT for NTG achieved an additional 15% IOP reduction while using 27% less medication at 1 year compared to pre-study levels. TRIAL REGISTRATION: The Clinical Trials Register of the University of Hong Kong HKCTR1847 The European Clinical Trials Database 2014-003305-15 (August 11, 2014) ( https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-003305-15 ).

A randomized control trial to evaluate the effect of adjuvant selective laser trabeculoplasty versus medication alone in primary open-angle glaucoma: preliminary results.

BACKGROUND: The objective of this study was to investigate the effects of adjuvant selective laser trabeculoplasty (SLT) versus medication alone on intraocular pressure (IOP) control, medication use, and quality of life in patients with primary open-angle glaucoma. METHODS: This prospective, randomized control study recruited 41 consecutive primary open-angle glaucoma subjects with medically-controlled IOP ≤21 mmHg. The SLT group (n=22) received a single 360-degree SLT treatment. The medication-only group (n=19) continued with their usual treatment regimen. In both groups, medication was titrated to maintain a target IOP defined as a 25% reduction from baseline IOP without medication, or <18 mmHg, whichever was lower. Outcomes, which were measured at baseline and at 6 months, included the Glaucoma Quality of Life-15 (GQL-15) and Comparison of Ophthalmic Medications for Tolerability (COMTOL) survey scores, IOP, and the number of antiglaucoma medicines. RESULTS: The baseline IOP was 15.8±2.7 mmHg and 14.5±2.5 mmHg in the SLT and medication-only groups, respectively (P=0.04). Both groups had a comparable number of baseline medication (P=0.2), GQL-15 (P=0.3) and COMTOL scores (P=0.7). At 6 months, the SLT group had a lower IOP (P=0.03) and required fewer medications compared with both baseline (P<0.0001) and with the medication-only group (P=0.02). There was no statistically significant difference in the 6-month GQL-15 or COMTOL score as compared to baseline (P≥0.4) or between the two treatment groups (P≥0.2). CONCLUSION: A single session of adjuvant SLT provided further reductions in IOP and medication without substantial changes in quality of life or medication tolerability at 6 months.

Predictors of success in selective laser trabeculoplasty for primary open angle glaucoma in Chinese.

PURPOSE: To determine the predictors of success for adjuvant selective laser trabeculoplasty (SLT) in Chinese primary open angle glaucoma (POAG) patients. METHODS: This prospective study recruited Chinese subjects with unilateral or bilateral POAG currently taking medication to reduce intraocular pressure (IOP). All subjects received a single session of 360° SLT treatment and continued their medications for 1 month. SLT success was defined as IOP reduction ≥20% at 1 month. The following covariates were analyzed in both groups via univariate and multivariate analyses: age, sex, lens status, initial IOPs, post-SLT IOPs, number and type of medications, SLT shots and energy, and pre-SLT investigations. RESULTS: In 51 eyes of 33 POAG subjects, the success rate of SLT was 47.1%. Certain groups of patients were associated with greater success using univariate analysis. These groups included the following: older age (coefficient =0.1; OR: 1.1; P=0.0003), a higher pre-SLT IOP (coefficient =0.3; OR: 1.3; P=0.0005), using four types of antiglaucoma medication (coefficient =2.1; OR: 8.4; P=0.005), a greater degree of spherical equivalent (coefficient =2.1; OR: 8.4; P=0.005), and the use of a topical carbonic anhydrase inhibitor (coefficient =1.7; OR: 6.0; P=0.003). None of the covariates were significant using multivariate analysis. CONCLUSION: Older age, a higher pretreatment IOP, using multiple antiglaucoma medications especially topical carbonic anhydrase inhibitor, and higher refractive errors were associated with greater SLT success.

Early Postoperative Results and Complications of using the EX-PRESS Shunt in uncontrolled Uveitic Glaucoma: A Case Series of Preliminary Results.

PURPOSE: The purpose of this case series is to describe the efficacy of the EX-PRESS shunt in uveitic glaucoma. METHODS: This prospective case series sequentially recruited uveitic glaucoma subjects with intraocular pressure (IOP) > 21 mm Hg despite maximal topical antiglaucoma medications from July 2012 to July 2013 in Hong Kong. All subjects received a trabeculectomy with mitomycin C (MMC) and EX-PRESS shunt implantation. The primary outcome measures included preope-rative IOP and postoperative IOP on day 1, 1 week, 1 month, and every 3 months thereafter. The secondary outcome measures included postoperative complications and follow-up procedures, pre- and postoperative Snellen best corrected visual acuity and cup-disc ratio, as well as the number of antiglaucoma medication required. RESULTS: In a case series of five subjects with uncontrolled uveitic glaucoma, two had inactive anterior uveitis, and three had active panuveitis. The mean preoperative IOP was 35.4 ± 12.6 mm Hg on 3.8 ± 0.5 antiglaucoma eye drops. The mean day 1, 1 week and 1 month IOP's were 6.6 ± 3.7 mm Hg, 7.2 ± 3.2 mm Hg, and 12.6 ± 8.2 mm Hg, respectively. One case required subconjunctival MMC injections postoperatively; two required conjunctival resuture for leakage; and two had early postoperative hypotony that resolved after oral prednisolone. At 6 months, the mean IOP was 13.2 ± 4.6 mm Hg. Four out of five subjects had IOP < 21 mm Hg without medication, and all had IOP < 21 mm Hg with antiglaucoma medication. CONCLUSION: The EX-PRESS shunt demonstrates good IOP control with a propensity for hypotony in the early postoperative period in this small uveitic glaucoma series. How to cite this article: Lee JWY, Chan JCH, Qing L, Lai JSM. Early Postoperative RESULTS and Complications of using the EXPRESS Shunt in uncontrolled Uveitic Glaucoma: A Case Series of Preliminary RESULTS. J Current Glau Prac 2014;8(1):20-24.

Argon laser peripheral iridoplasty versus systemic intraocular pressure-lowering medications as immediate management for acute phacomorphic angle closure.

BACKGROUND: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) and systemic intraocular pressure (IOP)-lowering medications in the immediate management of acute phacomorphic angle closure. METHODS: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours posttreatment in both arms. RESULTS: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP < 25 mmHg (18.8 ± 7.5 minutes versus 115.0 ± 97.0 minutes, P = 0.001, F test); had a greater IOP reduction within 30 minutes (69.8% ± 7.7% versus 40.9 ± 23.9%, P = 0.03, t-test); and had a consistently smaller post-attack cup to disc ratio (0.50 ± 0.02 versus 0.60 ± 0.20, P = 0.002, F test). CONCLUSION: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure.