[Results of selective laser trabeculoplasty (SLT) as initial treatment for normal tension glaucoma].

PURPOSE: A 3-year prospective study was performed to evaluate treatment outcomes following selective laser trabeculoplasty (SLT) used as initial treatment for normal tension glaucoma (NTG). SUBJECTS AND METHODS: SLT was performed as initial treatment in 42 NTG patients (42 eyes). Thirty-seven of the patients were untreated and 5 patients had discontinued antiglaucoma medications. Two patients were excluded because they did not visit our clinic during the study period. The study was conducted on the remaining subjects (40 eyes of 40 patients). RESULTS: The intraocular pressure (IOP) was 15.8 +/- 1.8 mmHg before SLT, 13.2 1.9 mmHg after one year, 13.5 +/- 1.9 mmHg after two years, and 13.5 +/- 1.9 mmHg after three years. The IOP after SLT was significantly lower than that before SLT. One month after SLT, the outflow pressure was improved at least 20% (deltaOP) in 92.5% of the patients. The success rate for the effect of IOP reduction at three years after SLT was 40.0% by Kaplan-Meier survival analysis. 27.5% of the patients who had two consecutive deltaOP less than 20%, 25.0% of the patients who had begun antiglaucoma ophthalmic solution, and 15.0% of the patients who had undergone repeated SLT were judged to have reached the endpoint. Kaplan-Meier survival analysis revealed that the success rate for the visual field at three years after SLT was 82.4% (the visual field loss progression was judged to have reached its endpoint when a significant sensitivity loss was first detected in two consecutive points of the same adjacent test points of at least 3 points in the Glaucoma Progressive Analysis for the Humphrey Visual Field Analyzer). Complications included conjunctival hyperemia (52.5%), eye discomfort (12.5%), visual disturbance (blurry vision and photophobia) (10.0%), and eye pain (5.0%). These complications resolved within a few days, and there were no severe complications such as increased IOP or iritis. CONCLUSION: Our results suggest that SLT is an effective initial treatment for NTG.

In vivo laser confocal microscopy after descemet stripping with automated endothelial keratoplasty.

PURPOSE: To investigate in vivo corneal changes in patients with bullous keratopathies before and after Descemet stripping with automated endothelial keratoplasty (DSAEK) using laser confocal microscopy. DESIGN: Single-center, prospective, comparative clinical study. METHODS: Seven patients (two men, five women; mean age, 68.9 years; range, 59 to 78) with bullous keratopathies who underwent DSAEK enrolled in this study. Laser confocal microscopy was performed before and one, three, and six months after DSAEK. Selected images were evaluated qualitatively and quantitatively for degree of haze and density of deposits. RESULTS: Preoperatively, corneal epithelial edema, subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle-shaped materials in the stroma were observed in all patients. After DSAEK, subepithelial haze, donor-recipient interface haze, and interface particles were observed in all five measurable cases; postoperative haze and particles decreased statistically significantly (P < .05) over follow-up. CONCLUSIONS: In vivo laser confocal microscopy is capable of identifying subclinical corneal abnormality after DSAEK with high resolution. Further studies in a large number of patients and long-term follow-up after DSAEK using this device are needed to fully understand long-term corneal stromal changes after DSAEK and whether the preexisting corneal stromal pathologies are reversible.

Intraocular pressure after Descemet's stripping and non-Descemet's stripping automated endothelial keratoplasty.

PURPOSE: To evaluate the effect on intraocular pressure (IOP) of increased corneal thickness after Descemet's stripping automated endothelial keratoplasty (DSAEK) and of non-Descemet's stripping automated endothelial keratoplasty (nDSAEK) as measured by four different techniques. METHODS: Twenty-four eyes (22 patients; mean age, 74.0 years) with successful DSAEK (11 eyes) or nDSAEK (13 eyes) treatment at least 3 months prior to testing were enrolled. IOP was measured with Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), pneumatonometry, and Tono-Pen XL (Tonopen). Central corneal thickness (CCT) was measured by ultrasonic pachymetry. These data were used for statistical analysis. RESULTS: Mean IOP measured by GAT, DCT, pneumatonometry, and Tonopen was 14.4, 13.9, 11.2, and 13.2 mmHg, respectively, in the DSAEK group; and 15.0, 14.4, 12.5, and 14.4 mmHg, respectively, in the nDSAEK group. Correlations between IOP and CCT were not statistically significant in either group. Pressure measured by pneumatonometry was significantly and consistently lower than that obtained by the other three methods. CONCLUSION: For both DSAEK and nDSAEK, IOP readings by the four tonometers seem to be unrelated to artificially thickened corneas.