RESUMEN
PRECIS: Repeat micropulse transscleral cyclophotocoagulation (MPTCP) has some benefit in lowering intraocular pressure (IOP). There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi. AIM: This study aimed to determine the efficacy and safety of repeated MPTCP for an Asian population with refractory glaucoma. METHODS: This is a retrospective case series of 43 eyes (43 patients) with severe glaucoma which underwent repeated MPTCP. Baseline parameters were taken from the visit just before the second MPTCP session. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, without further glaucoma reoperation, and ≤3 total MPTCP episodes. The IOP, number of IOP-lowering medications, and best-corrected visual acuity were documented preoperatively and postoperatively. Postoperative complications were also analyzed. RESULTS: The mean age±SD was 57.4±18.2 years with a mean follow-up duration of 28.9±27.5 months. Neovascular glaucoma was the most common type of glaucoma [18 eyes (41.9%)]. The success rates at postoperative years 1, 2, and 3, and the latest follow-up were 36.4%, 42.9%, 32.0%, and 39.5%, respectively. The median survival time of repeat MPTCP was 4.6 months. Compared with the preoperative mean IOP (35.2±11.0 mm Hg), the mean IOP at postoperative years 1, 2, and 3, and latest follow-up, was 27.8±13.7 mm Hg (P=0.004), 27.4±12.4 (P=0.003), 31.8±13.2 (P=0.35), and 27.1±13.8 mm Hg (P=0.002), respectively. The mean number of IOP-lowering medications was reduced from 3.3±0.9 preoperatively to 2.8±1.3 at the final follow-up (P=0.007). Postoperative complications included prolonged hypotony [3 eyes (7.0%)] and phthisis bulbi [2 eyes (4.7%)]. CONCLUSION: Repeated MPTCP is at best moderately effective in lowering IOP for eyes with advanced glaucoma.
Asunto(s)
Glaucoma , Presión Intraocular , Adulto , Anciano , Cuerpo Ciliar/cirugía , Estudios de Seguimiento , Glaucoma/cirugía , Humanos , Coagulación con Láser , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza VisualRESUMEN
PRECIS: Micropulse transscleral cyclophotocoagulation (MPTCP) is only moderately effective in lowering intraocular pressure (IOP) and is useful as an adjunct procedure to other glaucoma surgeries. There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi. AIM: The aim of this study was to determine the efficacy and safety of a single MPTCP treatment for an Asian population with advanced glaucoma. METHODS: This is a retrospective single-center study of 207 eyes (207 patients) with advanced glaucoma which underwent first-time MPTCP between January 1, 2008, and March 31, 2018. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, and without glaucoma reoperation. The IOP, best-corrected visual acuity, and number of glaucoma medications were also analyzed. RESULTS: The mean (SD) age was 64.9±16.9 years. The mean follow-up duration was 18.7±16.2 months. The rate of success at postoperative years 1 and 2 follow-up was 44.1% and 32.6%, respectively. The median survival time of MPTCP was 9.0 months and 85 (40.9%) eyes received reoperation. The mean IOP decreased from 31.5±12.0 mm Hg preoperatively to 22.1±10.3 and 23.8±11.8 mm Hg at postoperative years 1 and 2, respectively (P<0.0001). The mean number of glaucoma medications was reduced from 3.3±1.0 preoperatively to 2.6±1.1 and 2.4±1.1 at postoperative years 1 and 2, respectively (P<0.0001). Significant complications included prolonged hypotony [1 eye (0.5%)], phthisis bulbi [7 eyes (3.4%)], and best-corrected visual acuity reduction [29 eyes (13.9%)]. CONCLUSION: Single first-time MPTCP for advanced glaucoma eyes was moderately effective in lowering IOP but >50% failed by 1 year.
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Glaucoma , Presión Intraocular , Anciano , Anciano de 80 o más Años , Cuerpo Ciliar/cirugía , Estudios de Seguimiento , Glaucoma/cirugía , Humanos , Coagulación con Láser , Persona de Mediana Edad , Estudios Retrospectivos , Esclerótica/cirugía , Resultado del Tratamiento , Agudeza VisualAsunto(s)
Anticuerpos Monoclonales , Miopía , Humanos , Miopía/inducido químicamente , Miopía/diagnósticoRESUMEN
PURPOSE: To determine the demographics, risk factors, clinical and microbiological characteristics, and treatment outcome of post-traumatic infective keratitis. METHODS: Consecutive patients with post-traumatic infective keratitis presenting to the Ophthalmology Department of a tertiary referral hospital in Singapore between March 2012 and March 2016 were prospectively identified. A standardized data collection form was used to document patient demographics, microbiological diagnosis, antibiotic sensitivity, and pretreatment and posttreatment ocular characteristics. Any contact lens-induced keratitis was excluded from the study. RESULTS: In total, 26 patients were included for analysis. The mean age was 40.0 years (SD ± 19.4) and 84.6% of the patients were male. The majority of the patients (69.2%, n = 18) had sustained work-related injury in their eyes. Gram-negative organisms were predominant isolates (75.0%, n = 12) in culture-positive corneal scrapings (n = 16). Pan-sensitive Pseudomonas aeruginosa was the commonest organism isolated among the culture-positive cases (56.2%, n = 9). Three patients (18.7%) had developed fungal keratitis and Acanthamoeba was isolated in 1 patient (6.2%) with polymicrobial keratitis. Infections resolved with medical treatment in 22 eyes (84.6%) and 4 eyes (15.3%) required therapeutic corneal transplantation. CONCLUSIONS: A shift of practice in post-traumatic infective keratitis should be considered in tropical countries to include Gram-negative cover. Work safety practices with vigilance in initiating treatment and education by front-line physicians such as ophthalmology and general practitioners should be reinforced.
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Bacterias/aislamiento & purificación , Lesiones de la Cornea/complicaciones , Infecciones Fúngicas del Ojo/microbiología , Queratitis/microbiología , Adulto , Lesiones de la Cornea/diagnóstico , Lesiones de la Cornea/epidemiología , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/etiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Queratitis/epidemiología , Queratitis/etiología , Masculino , Estudios Retrospectivos , Factores de Riesgo , Singapur/epidemiología , Factores de TiempoRESUMEN
PURPOSE: The purpose of this study was to explore the interrelationships among retinal vascular caliber, retinal nerve fiber layer (RNFL), and glaucoma; in particular, whether the relationship between narrower retinal vascular caliber and glaucoma is mediated by thinning of RNFL. METHODS: A total of 9407 participants, including 253 glaucoma and 195 primary open-angle glaucoma (POAG) cases from the Singapore Epidemiology of Eye Diseases Study were included in this study. All participants underwent standardized examinations. Glaucoma was defined according to International Society for Geographical and Epidemiologic Ophthalmology criteria. Logistic regression analyses were used to determine the total direct effects of retinal vascular calibers on glaucoma. Regression-based mediation analyses were used to evaluate the indirect effects of retinal vascular caliber on glaucoma through RNFL thinning. RESULTS: After we adjusted for relevant covariates, narrower retinal arteriolar caliber (per standard deviation [SD], 15.1-µm decrease) was associated with glaucoma (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06-1.38) and POAG (OR, 1.23; 95% CI, 1.06-1.43). Similarly, narrower retinal venular caliber (per SD, 21.6µm decrease) was associated with glaucoma (OR, 1.51; 95% CI, 1.32-1.73) and POAG (OR, 1.64; 95% CI, 1.41-1.91). In addition, there were significant indirect effects of retinal vascular narrowing on glaucoma through thinning of RNFL (all P < 0.001), with mediated proportion of 36.9% and 12.9% in retinal arteriole- and venule-related analysis, respectively. CONCLUSIONS: Mediation analyses indicated that the effect of retinal vascular narrowing on glaucoma was partially the result of thinning of RNFL. These findings provide additional mechanistic insights linking retinal vascular narrowing and glaucoma.
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Glaucoma/patología , Fibras Nerviosas/patología , Neuronas Retinianas/patología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Glaucoma/etnología , Humanos , Masculino , Persona de Mediana Edad , Nervio Óptico/patología , Estudios Prospectivos , Retina/patología , Singapur/etnologíaRESUMEN
This study aims to systemically review the effect of laser iridotomy on the corneal endothelium. Searches were performed for studies that either compared corneal endothelial cell density/count, corneal thickness and morphology pre- and postiridotomy, or evaluated the postiridotomy development of corneal decompensation. There were 26 eligible studies. Our review shows that the effect of laser iridotomy on the corneal endothelium has been investigated with varying results. Although it has been demonstrated to be a relatively safe procedure, there is still the potential long-term risk of corneal decompensation, for which a corneal transplantation may be indicated eventually. The longest interval between laser iridotomy and corneal decompensation reported was 8 years. Mechanisms proposed for endothelial damage include direct focal injury, thermal damage, mechanical shock waves, iris pigment dispersion, transient rise in intraocular pressure, inflammation, turbulent aqueous flow, time-dependent shear stress on endothelium, chronic breakdown of blood-aqueous barrier and damage from bubbles that settled onto the endothelium. Inherent risk factors identified were iridotrabecular contact, current or prior acute angle closure, pigmented irides, small iris-to-endothelium distance, pre-existing endothelial disease and diabetes. Intervention-related risk factors include laser type, delivery and quantity. The significance of the risk factors and their direct association with the development of corneal decompensation remain to be determined. Understanding these risk factors may allow physicians to counsel their patients better. They may offer opportunities for preventive strategies, allowing us to ensure that a procedure performed to prevent disease progression and visual loss does not cause further morbidity.
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Endotelio Corneal , Iridectomía , Iris , Terapia por Láser , Humanos , Recuento de Células , Edema Corneal/etiología , Edema Corneal/fisiopatología , Endotelio Corneal/fisiopatología , Iris/cirugía , Factores de RiesgoRESUMEN
AIMS: To determine the relationship between macular ganglion cell-inner plexiform layer (GC-IPL) thickness and optic disc/retinal nerve fibre layer (RNFL) parameters in non-glaucomatous eyes measured by spectral-domain optical coherence tomography (SD-OCT). METHODS: 491 non-glaucomatous Chinese aged 40-80 years were recruited from a population-based study and underwent standardised ophthalmic examination. SD-OCT was used to measure GC-IPL thickness, optic disc parameters and RNFL thickness. Univariate and multiple linear regression analyses were performed to assess the association between GC-IPL and optic disc/RNFL parameters. RESULTS: In univariate analyses, all RNFL parameters and rim area were significantly correlated with all macular GC-IPL parameters (p<0.001, r=0.12-0.56). In multiple regression analyses, after adjusting for age, gender, disc area, signal strength and axial length, average RNFL thickness (per µm decrease) was most strongly correlated with average GC-IPL thickness (ß=-0.30, standardised ß=-0.499, p<0.001) compared with other optic disc/RNFL parameters. CONCLUSIONS: Our study demonstrated only fair correlations between macular GC-IPL and optic disc/RNFL parameters measured by SD-OCT. This information is important for further evaluation of macular GC-IPL thickness as an additional marker in detecting glaucomatous damage and progression.
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Glaucoma/patología , Mácula Lútea/anatomía & histología , Fibras Nerviosas , Disco Óptico/anatomía & histología , Células Ganglionares de la Retina/citología , Tomografía de Coherencia Óptica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Pueblo Asiatico , Estudios Transversales , Progresión de la Enfermedad , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Valores de Referencia , Tomografía de Coherencia Óptica/normas , Campos VisualesRESUMEN
PURPOSE: To determine the distribution, variation, and determinants of ganglion cell-inner plexiform layer (GC-IPL) thickness in nonglaucomatous eyes measured by high-definition optical coherence tomography (HD-OCT). METHODS: Six hundred twenty-three Chinese adults aged 40 to 80 years were consecutively recruited from a population-based study. All subjects underwent a standardized interview, ophthalmic examination, and automated perimetry. HD-OCT with macular cube protocol was used to measure the GC-IPL thickness. Univariate and multiple linear regression analyses were performed to examine the relationship between GC-IPL thickness with ocular and systemic factors. RESULTS: The mean (±SD) age of study subjects was 52.84 ± 6.14 years, 50.1% were male, and all subjects had normal visual fields with no signs of glaucoma or glaucoma suspect. The mean overall, minimum, superior, and inferior GC-IPL thicknesses were 82.78 ± 7.01 µm, 79.67 ± 9.17 µm, 83.30 ± 7.89 µm, and 80.16 ± 8.31 µm, respectively. In multiple linear regression analysis, GC-IPL thickness was significantly associated with age (ß = -0.202, P < 0.001), female sex (ß = -2.367, P < 0.001), axial length (ß = -1.279, P = 0.002), and mean peripapillary retinal nerve fiber layer (RNFL) thickness (ß = 0.337, P < 0.001). IOP, central corneal thickness, disc area, serum glucose level, and history of diabetes mellitus had no significant influence on GC-IPL thickness. CONCLUSIONS: Thinner GC-IPL was independently associated with older age, female sex, longer axial length, and thinner RNFL thickness. These factors should be taken into account when interpreting GC-IPL thickness measurements with HD-OCT for glaucoma assessment.
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Fibras Nerviosas , Disco Óptico/anatomía & histología , Células Ganglionares de la Retina/citología , Tomografía de Coherencia Óptica , Adulto , Anciano , Anciano de 80 o más Años , Longitud Axial del Ojo , Femenino , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Agudeza Visual/fisiología , Pruebas del Campo Visual , Campos Visuales/fisiologíaRESUMEN
PURPOSE: To investigate the long-term rates of blindness and visual field (VF) progression in treated primary angle-closure glaucoma (PACG) patients. DESIGN: Retrospective observational case series. METHODS: PACG patients with ≥10 years of follow-up were analyzed. All VFs (static automated perimetry, central 24-2 threshold test) performed were reviewed and reliable VFs (fixation losses <20%, false positives and false negatives <33%) were scored using the Advanced Glaucoma Intervention Study (AGIS) system. Progression of a VF defect was defined as a change of ≥4 from baseline on 2 consecutive VF tests. RESULTS: From the 137 eyes of 87 patients with PACG with ≥10 years of follow-up identified, 6% and 30.1% were blind based on initial visual acuity (VA) and VF criteria respectively and 12.0% had an initial AGIS score of 20; these were excluded. Eighty-three eyes from 57 patients (all Chinese, mean age 59.9 ± 8.2 years, 67.5% female) were analyzed. The mean AGIS score was 5.14 ± 4.37 at baseline. VF deterioration was detected in 27 eyes (32.5%) of 21 patients, with 4.8% and 7.2% of eyes progressing to blindness based on VA and VF criteria respectively. On Cox regression, eyes with VF progression had higher mean overall IOP (P < .001), and higher prevalence of previous acute angle closure (AAC, P = .008). CONCLUSIONS: Over 10 years, a third of PACG patients were found to have VF progression, with 7% progressing to blindness while on treatment. Eyes with higher mean overall IOP and a history of previous AAC were more likely to have VF progression.
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Pueblo Asiatico/estadística & datos numéricos , Ceguera/epidemiología , Glaucoma de Ángulo Cerrado/fisiopatología , Trastornos de la Visión/fisiopatología , Campos Visuales/fisiología , China/epidemiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Cerrado/epidemiología , Gonioscopía , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tonometría Ocular , Trastornos de la Visión/epidemiología , Agudeza Visual/fisiología , Pruebas del Campo VisualRESUMEN
OBJECTIVE: To determine the prevalence of plateau iris in Asian eyes with primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). METHODS: In this cross-sectional observational study, subjects older than 40 years with PACG who had a patent laser peripheral iridotomy underwent UBM in 1 eye. Ultrasound biomicroscopy images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least 2 quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris. RESULTS: One hundred eleven subjects (70 from Singapore, 41 from Thailand) with PACG were recruited. The mean (SD) age was 65.6 (8.1) years, and 63.9% were female. Based on standardized UBM criteria, plateau iris was found in 36 of 111 eyes (32.4%; 95% confidence interval, 24.4%-41.6%). In these 36 eyes, quadrant-wise analysis showed 66.7% had plateau iris in 2 quadrants; 22.2%, in 3 quadrants; and 11.1%, in all quadrants. CONCLUSIONS: About 30% of PACG eyes with a patent laser peripheral iridotomy were found to have plateau iris on UBM, highlighting the importance of non-pupil block mechanisms in Asian individuals.
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Pueblo Asiatico/etnología , Anomalías del Ojo/etnología , Glaucoma de Ángulo Cerrado/etnología , Iris/anomalías , Adulto , Anciano , Anciano de 80 o más Años , Cuerpo Ciliar/diagnóstico por imagen , Estudios Transversales , Anomalías del Ojo/diagnóstico por imagen , Femenino , Glaucoma de Ángulo Cerrado/diagnóstico por imagen , Glaucoma de Ángulo Cerrado/cirugía , Gonioscopía , Humanos , Presión Intraocular , Iridectomía , Iris/diagnóstico por imagen , Iris/cirugía , Terapia por Láser , Masculino , Microscopía Acústica , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Singapur/epidemiología , Tailandia/epidemiología , Tonometría Ocular , Malla Trabecular/diagnóstico por imagenRESUMEN
OBJECTIVE: To confirm the presence of uveal effusion in the eyes of Asian patients with primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). METHODS: In this observational case series, 70 patients with PACG (28 untreated patients with newly diagnosed PACG and 42 patients who had undergone previous laser iridotomy and were being monitored) and 12 patients with acute primary angle closure (APAC) were recruited. Eyes of patients with newly diagnosed PACG and APAC underwent UBM before and after laser iridotomy, whereas eyes of patients with treated PACG underwent UBM at enrollment. Uveal effusion was defined as a clear space between the choroid and sclera and was graded as follows: grade 0, none; grade 1, slitlike; grade 2, bandlike; and grade 3, obvious. RESULTS: Overall, uveal effusion was found in 11 of 70 eyes with PACG (15.7%; 95% confidence interval, 8.8%-26.2%) and in 3 of 12 eyes with APAC (25%; 95% confidence interval, 8.0%-53.4%). For patients with newly diagnosed PACG, uveal effusion was found in 4 of 28 eyes (14.2%; 95% confidence interval, 5.1%-32.1%) before laser iridotomy; 2 eyes had effusion after laser iridotomy. When present, the effusion was grade 1 in PACG eyes and grade 2 or 3 in APAC eyes. CONCLUSIONS: Uveal effusion was present in a significant proportion of Asian eyes with PACG and APAC, confirming a recent report of this finding.