Alzheimer's disease: A review of its visual system neuropathology. Optical coherence tomography-a potential role as a study tool in vivo.

Alzheimer's disease (AD) is a prevalent, long-term progressive degenerative disorder with great social impact. It is currently thought that, in addition to neurodegeneration, vascular changes also play a role in the pathophysiology of the disease. Visual symptoms are frequent and are an early clinical manifestation; a number of psychophysiologic changes occur in visual function, including visual field defects, abnormal contrast sensitivity, abnormalities in color vision, depth perception deficits, and motion detection abnormalities. These visual changes were initially believed to be solely due to neurodegeneration in the posterior visual pathway. However, evidence from pathology studies in both animal models of AD and humans has demonstrated that neurodegeneration also takes place in the anterior visual pathway, with involvement of the retinal ganglion cells' (RGCs) dendrites, somata, and axons in the optic nerve. These studies additionally showed that patients with AD have changes in retinal and choroidal microvasculature. Pathology findings have been corroborated in in-vivo assessment of the retina and optic nerve head (ONH), as well as the retinal and choroidal vasculature. Optical coherence tomography (OCT) in particular has shown great utility in the assessment of these changes, and it may become a useful tool for early detection and monitoring disease progression in AD. The authors make a review of the current understanding of retinal and choroidal pathological changes in patients with AD, with particular focus on in-vivo evidence of retinal and choroidal neurodegenerative and microvascular changes using OCT technology.

Real life experience following combined excimer laser trabeculostomy and phacoemulsification in eyes with ocular hypertension or mild glaucoma and cataract.

OBJECTIVES: To assess the efficacy and safety of combined phacoemulsification and excimer laser trabeculostomy (ELT) in eyes with cataract and mild controlled glaucoma or ocular hypertension (OHT). METHODS: Single-centre analysis of eyes that underwent phacoemulsification and ELT between 2017 and 2021. Change in intraocular pressure (IOP), glaucoma medication requirements, corrected distance visual acuity (CDVA), complications and re-interventions were evaluated. Success was defined as a reduction ≥20% from preoperative IOP, an IOP ≤ 14 mmHg or a reduction in glaucoma medication requirements with an IOP equal or lower than the preoperative IOP. RESULTS: Mean follow-up was 658 ± 64 days. Mean preoperative IOP was 17.76 ± 4.88 mmHg, it decreased to 15.35 ± 3.10 mmHg at 1 year (n = 37) (p = 0.006) and to 14.00 ± 3.78 at 3 years (n = 8) (p = 0.074). Mean number of glaucoma medication requirements decreased from 2.02 ± 1.0 preoperatively to 1.02 ± 0.96 at 1 year (n = 37) (p < 0.001) and to 1.63 ± 0.92 at 3 years (n = 8) (p = 0.197). Complete success was achieved in 17.7% of eyes and qualified success in 54.8%. Two eyes of 2 patients had early postoperative hyphema. Two eyes of 1 patient underwent filtering surgery 2 months after the procedure, and 2 eyes of 1 patient underwent laser trabeculoplasty 3.8 years after the procedure due to uncontrolled IOP. CONCLUSIONS: Combined phacoemulsification and ELT is effective and safe in eyes with mild glaucoma or OHT and cataract. It significantly reduced IOP and glaucoma medication requirements 1 year after surgery.

Facoemulsificación y trabeculostomía con láser excímero en ojos con hipertensión ocular o glaucoma leve y catarata. Experiencia real, eficacia y seguridad / Real life experience following combined excimer laser trabeculostomy and phacoemulsification in eyes with ocular hypertension or mild glaucoma and cataract

Objetivo Evaluar la eficacia y la seguridad de la trabeculostomía con láser excímero (ELT) y facoemulsificación en ojos con hipertensión ocular (HTO) o glaucoma leve y catarata. Métodos Estudio unicéntrico de ojos a los que se realizó facoemulsificación y ELT entre 2017 y 2021. Se evaluó el cambio en la presión intraocular (PIO), la necesidad de medicamentos para controlar la PIO, la agudeza visual mejor corregida, las complicaciones y las reintervenciones. El éxito del procedimiento se definió como una reducción del 20% de la PIO, una PIO ≤14mmHg o la reducción de medicamentos con una PIO menor o igual a la preoperatoria. Resultados El seguimiento promedio fue de 658 ±64días. El promedio de PIO preoperatoria fue 17,76 ±4,88mmHg y disminuyó a 15,35 ±3,10mmHg al año de seguimiento (n=37) (p = 0,006) y a 14,00 ±3,78mmHg a los 3años (n=8) (p=0,074). El número de medicamentos para controlar la PIO disminuyó de 2,02 ±1,00 en el preoperatorio a 1,02 ±0,96 al año (n=37) (p<0,001) y a 1,63 ±0,92 a los 3años de seguimiento (n=8) (p=0,197). El éxito completo se alcanzó en el 17,7% de los ojos y el éxito calificado en el 54,8%. Dos ojos de 2 pacientes presentaron hipema postoperatorio temprano. Dos ojos de un paciente requirieron una cirugía filtrante y dos ojos de un paciente una trabeculoplastia selectiva para controlar la PIO. Conclusiones La combinación de ELT y facoemulsificación es efectiva y segura en ojos con HTO o glaucoma leve y catarata. En esta serie hubo una reducción significativa de la PIO y del número de medicamentos para controlar la PIO (AU)

Objective To assess the efficacy and safety of combined phacoemulsification and excimer laser trabeculostomy (ELT) in eyes with cataract and mild controlled glaucoma or ocular hypertension (OHT). Methods Single-centre analysis of eyes that underwent phacoemulsification and ELT between 2017 and 2021. Change in intraocular pressure (IOP), glaucoma medication requirements, corrected distance visual acuity (CDVA), complications and re-interventions were evaluated. Success was defined as a reduction ≥20% from preoperative IOP, an IOP ≤14mmHg or a reduction in glaucoma medication requirements with an IOP equal or lower than the preoperative IOP. Results Mean follow-up was 658 ±64days. Mean preoperative IOP was 17.76 ±4.88mmHg, it decreased to 15.35 ±3.10mmHg at 1 year (n=37) (P=.006) and to 14.00 ±3.78 at 3years (n=8) (P=.074). Mean number of glaucoma medication requirements decreased from 2.02 ±1.0 preoperatively to 1.02 ±0.96 at 1 year (n=37) (P<.001) and to 1.63 ±0.92 at 3years (n=8) (P=.197). Complete success was achieved in 17.7% of eyes and qualified success in 54.8%. Two eyes of 2 patients had early postoperative hyphema. Two eyes of 1 patient underwent filtering surgery 2 months after the procedure, and 2 eyes of 1 patient underwent laser trabeculoplasty 3.8years after the procedure due to uncontrolled IOP. Conclusions Combined phacoemulsification and ELT is effective and safe in eyes with mild glaucoma or OHT and cataract. It significantly reduced IOP and glaucoma medication requirements 1 year after surgery (AU)