RESUMO
BACKGROUND: Continuous-wave transscleral cyclophotocoagulation (CW-TSCP) is usually reserved for advanced/refractory glaucoma. Micropulse transscleral laser therapy (MPTLT) utilises short energy pulses separated by 'off'-periods. MPTLT is postulated to have fewer complications, but its relative efficacy is not known. The National Institute for Health and Care Excellence (NICE) has deemed the evidence supporting MPTLT use of inadequate quality, limiting its use to research. This study aims to evaluate MPTLT efficacy and safety compared to CW-TSCP. METHODS: This 24-month follow-up retrospective audit included 85 CW-TSCP and 173 MPTLT eyes at a London tertiary referral centre. Primary outcome was success rate at the last follow-up; defined as at least 20% intraocular pressure (IOP) reduction with the same/fewer medications, and IOP between 6 and 18 mmHg. Secondary outcomes were acetazolamide use and success rates per glaucoma type. Safety outcomes were reported as complication rates. RESULTS: By 24-months, mean IOP reduced from 34.6[±1.4]mmHg to 19.0[ ± 3.0]mmHg post-CW-TSCP (p < 0.0001); and from 26.1[±0.8]mmHg to 19.1[±2.2]mmHg post-MPTLT (p < 0.0001). Average IOP decreased by 45.1% post-CW-TSCP, and 26.8% post-MPTLT. Both interventions reduced medication requirements (p ≤ 0.05). More CW-TSCP patients discontinued acetazolamide (p = 0.047). Overall success rate was 26.6% for CW-TSCP and 30.6% for MPTLT (p = 0.83). Only primary closed-angle glaucoma saw a significantly higher success rate following CW-TSCP (p = 0.014). CW-TSCP complication rate was significantly higher than MPTLT (p = 0.0048). CONCLUSION: Both treatments significantly reduced IOP and medication load. CW-TSCP had a greater absolute/proportionate IOP-lowering effect, but it carried a significantly greater risk of sight-threatening complications. Further prospective studies are required to evaluate MPTLT compared to CW-TSCP.
Assuntos
Corpo Ciliar , Glaucoma , Pressão Intraocular , Fotocoagulação a Laser , Esclera , Humanos , Estudos Retrospectivos , Pressão Intraocular/fisiologia , Feminino , Masculino , Fotocoagulação a Laser/métodos , Pessoa de Meia-Idade , Idoso , Esclera/cirurgia , Glaucoma/cirurgia , Glaucoma/fisiopatologia , Corpo Ciliar/cirurgia , Seguimentos , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto , Idoso de 80 Anos ou maisRESUMO
A worldwide outbreak of coronavirus disease 2019 (COVID-19), identified as being caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), was classified as a Public Health Emergency of International Concern by the World Health Organisation (WHO) on January 30, 2020. Initial sex-disaggregated mortality data emerging from the Wuhan province of China identified male sex as a risk factor for increased COVID-19 mortality.â¯â¯ In this systematic review, we aimed to assess the role of sex in the risk of mortality from COVID-19 in adult patients through comparison of clinical markers and inflammatory indexes.⯠A systematic search was conducted on the following databases:â¯PubMed, WHO COVID-19 database, Ovid MEDLINE, andâ¯Web of Science between the dates of June 15, 2020, and June 30, 2020.â¯Key search terms used included: "sex", "gender", "SARS-COV-2",â¯"COVID" and "mortality".â¯We accepted the following types of studiesâ¯concerning adult COVID-19 patients: retrospectiveâ¯cohort, observationalâ¯cohort, case series, and applied research.â¯Further studies were extracted from referenceâ¯searching.â¯The risk of bias was determined using theâ¯National Institutes of Health Quality Assessment Tool for Observational Cohort, Cross-Sectional Studies, and Case Series.⯠We identified a total of 16 studies published between January 2020 and June 2020 for analysis in this systematic review. Our study population consisted of 11 cohort studies,â¯four case series, andâ¯oneâ¯genetic study, including a total of 76,555 participants. Ten of the studiesâ¯included in this review observedâ¯a higher risk of mortality amongâ¯malesâ¯compared to females, and eight of these studies found this risk to be statistically significant.â¯â¯ Sex-disaggregated COVID-19 mortalityâ¯data identifiesâ¯male patients with comorbidities as being at an increased risk of mortality worldwide. Further investigation revealed differences in immune response regulated by sex hormones, angiotensin-converting enzyme 2 (ACE2) expression, and healthâ¯behavioursâ¯as contributing factors to increased risk of mortality from COVID-19 among males.â¯â¯ Nineâ¯out of theâ¯16â¯studies included were conducted in China.â¯In order toâ¯comprehensively assess sex-differences in the risk of mortality from COVID-19, more studies will need to be conducted worldwide.â¯Sex-disaggregatedâ¯COVID-19â¯data published in the medical literature is limited,â¯however it has become evident that male sex is an important risk factor for mortality.â¯Further exploration into the impact of sex on this pandemic isâ¯requiredâ¯in order toâ¯develop targeted therapies, as well as public health policies,â¯and to prevent sex bias in treatment.