Two-Year Follow-up of MicroPulse Transscleral Laser Therapy in Patients with Primary Open-Angle Glaucoma. / 2-Jahres-Ergebnisse nach transskleraler MicroPulse-Lasertherapie bei Patienten mit primärem Offenwinkelglaukom.

PURPOSE: To determine the long-term efficacy and safety of MicroPulse transscleral laser therapy (TLT) over a 24-month period in patients with primary open angle glaucoma. METHODS: This prospective interventional case series evaluated data from 44 medically treated eyes of primary open angle glaucoma (POAG) patients who received MicroPulse TLT to achieve further reduction in IOP. The reduction in 24-hr mean diurnal intraocular pressure (IOP), diurnal IOP fluctuations, and peak IOP were monitored after 3, 12, and 24 months. Postoperative complications, failure rates, and factors influencing IOP reduction were also evaluated. RESULTS: IOP decreased from 16.1 ± 3.4 mmHg preoperatively to 13.0 ± 2.9 mmHg (n = 31; p < 0.001), 12.3 ± 3.0 mmHg (n = 27; p < 0.001), and 13.1 ± 2.6 mmHg (n = 23; p < 0.001) at the 3-month, 12-month and 24-month follow-ups. At 24 months, 23 eyes (52%) had a sufficient IOP reduction to reach the individual target pressure. No severe complications were observed. No parameters could be identified that correlated with successful IOP reduction after treatment. The highest failure rate was observed during the first 3 months and remained stable thereafter. CONCLUSION: For about 50% of POAG eyes receiving the maximum tolerated treatment, MicroPulse TLT proved an effective method of further lowering IOP so as to reach the individual target pressure.

Comparison of Different Nutritional and Lifestyle Factors between Glaucoma Patients and an Age-Matched Normal Population.

PURPOSE: To compare nutritional and lifestyle factors between glaucoma patients and an age-matched control group. METHODS: One hundred and ninety (190) glaucoma patients were enrolled in this study. The control group comprised 97 age-matched participants. Data on physical activity, nicotine smoking, and several nutritional habits like coffee and alcohol consumption as well as high-salt and high-protein intake were collected using a standardised questionnaire. RESULTS: Age and gender were not statistically significantly different between the groups. There was a tendency for higher physical activity in the glaucoma group in comparison to the control group (47.3 vs. 35.4%; p = 0.056). Statistically significantly more glaucoma patients were nonsmokers (n = 169; 89.4%) compared to the control group (n = 64; 66.7%; p = 0.001). Glaucoma patients were also more often teetotal compared to the control group (21.6% compared to 14.4%; p < 0.001). Similarly, more glaucoma patients drank larger amounts of coffee in comparison to the control group (p = 0.001). One hundred and seventy-six (96.7%) glaucoma patients and 88 (90.7%) control subjects had high-protein intake (p = 0.035). High-salt intake was significantly lower in the glaucoma group (69.3 vs. 73.2%; p = 0.018). Of the 190 glaucoma patients, 81 had early visual field impairments (MD > - 6 dB) and 109 patients had moderate (MD between - 6 dB and - 12 dB) to severe (MD < - 12 dB) visual field defects. The severity of visual field defects, whether early, moderate, or severe, had no statistically significant impact on lifestyle parameters. CONCLUSION: Contrary to our original hypothesis that glaucoma patients would tend to follow an unhealthier lifestyle than the control group, the opposite was seen. Presumably, the cause of this healthier lifestyle is the desire to contribute positively through the course of the disease.

[Results of Re-switch from Intravitreal Aflibercept to Ranibizumab in Patients with Exudative Age-related Macular Degeneration]. / Resultate nach Rückumstellung von intravitrealem Aflibercept auf Ranibizumab bei persistierender Aktivität einer altersbedingten Makuladegeneration.

BACKGROUND: The purpose of this study was to investigate the effectiveness of re-switch from intravitreal aflibercept to ranibizumab in patients with exudative age-related macular degeneration. MATERIALS AND METHODS: This retrospective case series included 17 eyes of 17 patients who had previously switched from ranibizumab to aflibercept and finally back to ranibizumab. Main outcomes were change of visual acuity (VA) and assessment of central macular thickness (CMT). Secondary outcomes included predictive factors which had a beneficial effect as VA and CMT before re-switch, number of previous injections and gender. RESULTS: The mean VA was 0.64 ± 0.36 logMAR before the switch, and 0.87 ± 0.40 logMAR before the re-switch, and gained with a slight but not significantly improvement up to 0.85 ± 0.58 logMAR after the re-switch (p = 0.896). The average CMT before the switch was 448.6 µm ± 181.5. This decreased to 343.8 µm ± 161.3 after the switch (p = 0.614) to 299.1 µm ± 155.8 at switchback (p = 0.133). Overall, 8 patients (47%) had an improvement of vision, whereas in 5 patients (30%) VA deteriorated. Further analysis of predictive factors revealed a mean improvement of VA in male patients after re-switch, while female patients lost VA, with statistical significance between after the switch and after the re-switch to the benefit of male patients (p = 0.016). CONCLUSIONS: A re-switch from aflibercept to ranibizumab may enable improvement in morphological parameters and stabilization of VA in patients with exudative age-related macular degeneration who achieved no more benefit from the initial switch.