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PROPÓSITO: Comunicar nuestros resultados con la ciclofotocoagulación transescleral con el láser diodo Micropulse(R) (Iridex) en el tratamiento del glaucoma. MÉTODOS: Estudio retrospectivo en pacientes adultos con glaucoma con al menos 6 meses de seguimiento y solo una sesión de Micropulse(R). Se utilizó la misma técnica quirúrgica, el único parámetro de láser que podía variar fue el tiempo total de tratamiento (en segundos). Los parámetros restantes se mantuvieron fijos en 2 W de potencia y 0,5 ms (31,3%) de ciclo activo. RESULTADOS: Se obtuvo un total de 22 ojos de 17 pacientes con glaucoma de diversos tipos y estadios (en su mayoría congénitos y pseudoexfoliativos). El tiempo medio de seguimiento fue 7,9 meses. La duración total del tratamiento varió de 100 a 180 segundos. Definición de éxito: 5 mmHg < presión intraocular (PIO) < 21 mmHg, y una reducción ≥ 20% del valor basal y no adición de inhibidores orales de la anhidrasa carbónica y no reoperación. La tasa de éxito global fue del 72,7% en el primer mes, del 54% a los 4 meses, del 41% a los 6 meses y del 27,3% en el seguimiento final. Los pacientes tratados con duraciones de tratamiento más prolongadas (180 s) lograron mejores resultados. La reducción promedio de la PIO en ojos exitosos fue del 36% (de 26,3 a 16,7 mmHg, DE: 4,58, p = 0,028). No se informaron complicaciones. CONCLUSIONES: En una población heterogénea de glaucoma (principalmente de tipo congénito y pseudoexfoliativo) obtuvimos una baja tasa de éxito (27,3%) en el mediano plazo con una sola sesión de Micropulse(R)

OBJECTIVE: To report the results using Micropulse(R) transscleral cyclophotocoagulation (Iridex) in the treatment of glaucoma. METHODS: Retrospective study in adult patients with glaucoma with at least 6 months of follow-up, and only one session of Micropulse (R). The same surgical technique was used in all cases. The only laser parameter that could vary was the total treatment duration (in seconds). The remaining parameters were fixed at 2 Watts of power and 0.5 ms (31.3%) of active cycle. RESULTS: A total of 22 eyes of 17 patients with glaucoma of various types and stages were included (mainly congenital and pseudoexfoliation). The mean follow-up time was 7.9 months. The total treatment duration varied from 100 to 180 seconds. Definition of success: 5 mmHg < Intraocular pressure (IOP) < 21mmHg and a reduction of ≥ 20% of the baseline value and no addition of oral carbonic anhydrase inhibitors, and no re-operation. The overall success rate was 72.7% in the first month, 54% at 4 months, 41% at 6 months, and 27.3% at final follow-up. Patients with longer treatment durations (180 s) achieved better results. The mean reduction in IOP in successful eyes was 36% (from 26.3 to 16.7 mmHg, SD 4.58, P = .028). No complications were reported. CONCLUSIONS: In a heterogeneous population of glaucoma (mostly congenital and pseudoexfoliation types), a low success rate (27.3%) was obtained in the medium-term with a single session of Micropulse(R)

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OBJECTIVE: To report the results using Micropulse® transscleral cyclophotocoagulation (Iridex) in the treatment of glaucoma. METHODS: Retrospective study in adult patients with glaucoma with at least 6 months of follow-up, and only one session of Micropulse®. The same surgical technique was used in all cases. The only laser parameter that could vary was the total treatment duration (in seconds). The remaining parameters were fixed at 2 Watts of power and 0.5ms (31.3%) of active cycle. RESULTS: A total of 22 eyes of 17 patients with glaucoma of various types and stages were included (mainly congenital and pseudoexfoliation). The mean follow-up time was 7.9 months. The total treatment duration varied from 100 to 180seconds. Definition of success: 5mmHg

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PURPOSE: To evaluate megalopapillas in order to determine whether they constitute a different population, according to their specific features. MATERIAL: Evaluation of the optic nerve head of 405 eyes divided into 172 normal eyes, 168 pre-perimetric glaucomas (phase 3 or 4), 30 primary congenital glaucomas (children with pure congenital glaucomas operated more than once and diagnosed within the first year of age), and 35 megalopapillas. METHOD: The examinations were performed with the HRT (Heidelberg Retina Tomograph), using a wavelength of 680 nm and the new standard reference plane. Each examination results from the mean of 3 image acquisitions with a SD lower than n = 20. Each optic nerve head was studied in 360 degrees (segments), as well as in quadrants and octants separately (predefined segments). The visual fields were assessed with either the Octopus 1-2-3 or the Octopus 101, programs G2 and G2x (three complete phases). The intraocular pressure was measured by means of daily pressure curves including 7 measurements with applanation tonometry at the office and the first one at 6/7 a.m. with the patient still in bed. Gonioscopic examinations were also performed for classification purposes. RESULTS: By comparing all the stereometric parameters with the Total Area (disc area) and the Rim Volume it has been concluded that the megalopapilla group is different from both the normal control group and the glaucoma group. The disc area of the congenital glaucomas was not statistically different from the megalopapillas, but it was in terms of rim volume and other parameters. CONCLUSION: megalopapilla is an entity characterized by a large optic nerve head which may appear abnormal, with an increased cup, but associated with a normal rim volume, normal visual field and normal IOP. Special attention should be given to its differentiation from pseudoglaucomatous diseases. DISCUSSION: The frequency of megalopapillas seems to be quite higher than in congenital optic nerve head anomalies, but is has been virtually ignored by the literature worldwide so far.

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PURPOSE: To determine the effect of the most frequent used antiglaucomatous drugs on the optic nerve head flow. To see the response of the autoregulation system in hypertensive, preperimetric and advanced perimetric glaucomas. MATERIALS: In this preliminary report, optic nerve head parameters and retinal perfusion values were measured in 25 healthy controls as well as in 72 glaucomatous optic nerve heads. The glaucomatous sample was divided into three groups: 24 eyes treated with Betaxolol, 24 with Brinzolamide and 24 treated with Brimonidine (each of these groups was conformed by 8 hypertensive glaucomas, 8 preperimetric glaucomas, and 8 perimetric glaucomas). METHODS: Patients were examined with scanning laser Doppler flowmetry (wave length 638 nm), and flow, volume and velocity indices were assessed in each report. Perfusion maps were analyzed with the new SLDF software, version 3.2 (automatic full field perfusion image analizer). Examinations were also performed with the Heidelberg Retina Tomograph (wave length 638 nm), using the new standard reference plane. Visual fields were performed with the Octopus 123 or 101 perimeters, programs Glx and G2, with 3 phases completed. Diurnal pressure curve with applanation tonometry and gonioscopy (for classification) were also performed. RESULTS: In this preliminary report, it was found that eyes in Hypertensive or preperimetric stages of glaucoma, seem to use their regulation systems in order to preserve their optic nerve head circulation, while advanced perimetric glaucomas seem not be able to preserve their optic nerve head flow. And that antiglaucomatous drugs were not able to increase optic nerve head flow neither. DISCUSSION: Optic nerve head blood supplies is regulated by an autoregulation system. This phenomenon may act in normals, hypertensive and preperimetric glaucomas, but it seems not be able to preserve blood flow in advanced glaucomas. Optic nerve head flow returns to normal values with treatment in glaucoma first stages, while it seems that it could not be restored in advanced glaucomas.

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PURPOSE: To analyze the effect of glaucomatocyclitic crisis on the optic nerve head, as well as its consequent structural and hemodynamic changes. To evaluate the surgical indication for Posner-Schlossman syndrome. MATERIALS AND METHODS: Four Posner-Schlossman syndrome cases were evaluated for an analysis of the phenomena occurring in the optic disc by means of retinal confocal tomography and Scanning Laser Doppler Flowmetry, and their correlation with visual function as measured with automated computerized perimetry. In all cases the images were obtained in the mediate period after the attack, while in case 1, measurements were performed in the immediate and mediate periods before, during and after the attack. RESULTS: Significant differences were found between optic nerve head parameters and retinal flow measurements in the different phases evaluated. No permanent optic nerve head damage was demonstrated in any of the cases studied, except for case 4 (Posner-Schlossman syndrome associated with traumatic glaucoma). All the variables analyzed returned to normal values after remission of the acute rise in intraocular pressure. CONCLUSIONS: During the attacks of ocular hypertension the optic nerve head experiences significant morphologic changes and hemodynamic variations; nevertheless since they are transient, they fail to cause permanent damage. There was only one case, in which there was optic disc damage and visual field loss. It can be concluded that surgery should be restricted to those cases with severe and disabling symptoms (relative surgical indication) or to cases with progressive optic neuropathy with visual field loss, when the syndrome is associated with glaucoma (absolute surgical indication).

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PURPOSE: To determine whether there are angiographic differences among normal, preperimetric and advanced glaucoma eyes using indocyanine green angiography with SLO. This method was chosen because of its sensibility to detect peripapillary capillary vessels. METHODS: Scanning laser opthalmoscopy was preformed on normal eyes, preperimetric glaucomas and advanced glaucomas. MATERIAL: The authors used a confocal SLO (Heidelberg Retina Angiograph-HRA) CONCLUSION: Several changes may be seen on peripapillary capillary vessels at the different glaucomatous stages. DISCUSSION: In normal subjects HRT shows preservation of the disc/cup area ratio; indocyanine green angiography shows normal prepapillary plexus pattern on the neuroretinal rim and cup. Subjects on glaucomatous preperimetric stage reveal a decrease in the disc/cup area ratio as a result of an increase of the cup area secondary to a reduction of the neuroretinal rim area. ICG at this hipertensive stage shows an increase in prepapillary plexus visualization, which may be a consequence of increased blood flow while autoregulation is still operative. Subjects with advanced glaucoma show prominent decrease in the disc/cup area ratio as well as marked capillary droupout in ICG angiography.

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