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.

[Ultrasonic frequency currents and laser radiation in combined treatment of glaucoma].

A total of 178 patients aged 53 to 78 years with advanced and progressive primary open angle glaucoma have undergone a hypotensive operation. It is shown that it is beneficial for the patients to combine medication with ultratonotherapy of eyelid region for restoration of hydro- and hemodynamics in the operated eye; to give an impact on the projection of the cortical sight centers for activation of trophic and neuroregulatory mechanisms of visual functions. Such a combined approach improves the course of the postoperative period and prolongs remission in glaucomatous atrophy of the visual nerve.

Use of beta radiation to control I.O.P.

The use of ophthalmic applicator containing Strontium-90 beta ray was used to bring about a change in I.O.P. by its effect on the ciliary body. The change in I.O.P. depends on the degree of damage done to the ciliary body. The study showed that the change in I.O.P. was directly proportional to the intensity of beta rays application - higher the dose of beta radiation more was the damage and more the reduction in I.O.P.

[Effects of low-intensity laser irradiation on visual fields of patients with glaucoma]. / Deistvie nizkointensivnogo lazernogo izlucheniia na pole zreniia bol'nykh glaukomoi.

Twenty-three patients (28 eyes) with open-angle glaucoma and controlled intraocular pressure were administered a course of He-Ne laser treatment. Irradiation parameters were as follows: wavelength 0.63 microns, light spot diameter 5 mm, energy 2 mWt, session duration 240 sec. A course consisted of 10 sessions. Seventeen eyes of the same patients were controls. Visual field was examined before the treatment and after it, immediately and in 3 to 3.5 months using Humphrey field analyzer and full field 120 points threshold related test. The treatment resulted in field deficit reduction by 10% and more in 21 (75%) of the 28 eyes. On an average, visual field deficit reduced by 22.4%. Three to 3.5 months after the treatment the mean value of visual field deficit was still lower than initially by 19.7%. No side effects were observed in any of the cases. In controls a trend to increase of field deficit developed within the same period, though the differences were statistically unreliable. The data indicate a positive effect of local low-energy laser exposure on visual field status of patients with primary open-angle glaucoma and controlled intraocular pressure.

[The endovascular laser therapy of primary glaucoma]. / Endovaskuliarnaia lazernaia terapiia pervichnoi glaukomy.

Intravascular irradiation of the blood with He-Ne laser at a wavelength 680 nm and 0.5 mWt power via Leukocyte light-guide introduced into one of the cubital veins was used in the treatment of patients with primary glaucoma. Treatment efficacy was assessed from changes in vision acuity, visual field, angioscotomas, blind spot, ophthalmic tone, and tonographic parameters. Treatment efficacies of traditional therapy and the suggested exposure were compared. Endovascular laser therapy exerted a more marked effect as regarded improvement of vision acuity, decrease of the blind spot and angioscotomas, reduction of intraocular pressure, and improvement of tonographic parameters. This recommends such exposure for the treatment of primary glaucoma patients in complex with other treatment modalities.

[Laser irradiation: study of total effect of irradiation of the eyeball. A clinical study]. / Lazernoe izluchenie: issledovanie obshchego deistviia pri obluchenii glaznogo bloka. Klinicheskoe issledovanie.

Lipid peroxidation products, antioxidant system parameters, somatotrophic hormone, corticosteroids, fibronectin, and cyclic nucleotides were measured in the blood of 119 patients with open-angle glaucoma and mature senile cataract before and after a course of exposure of the eyeball to He-Ne laser. Statistically significant changes in the examined parameters were revealed, explaining to a great measure the antiinflammatory and vasodilating effects of laser and its ability to intensify the repair processes.

Effect of beta radiation on success of glaucoma drainage surgery in South Africa: randomised controlled trial.

OBJECTIVE: To evaluate whether beta radiation may offer a practical method of improving surgical success for glaucoma drainage surgery in South Africa. DESIGN: Double blind, randomised controlled trial. SETTING: Three public hospitals in South Africa. PARTICIPANTS: 450 black Africans with primary glaucoma. INTERVENTIONS: Trabeculectomy with 1000 cGy beta radiation or standard trabeculectomy without beta radiation (placebo). MAIN OUTCOME MEASURES: Primary outcome measure was surgical failure within 12 months (intraocular pressure > 21 mm Hg while receiving no treatment for ocular hypotension). Secondary outcomes were visual acuity, surgical reintervention for cataract, and intraoperative and postoperative complications. RESULTS: 320 people were recruited. beta radiation was given to 164; 20 (6%) were not seen again after surgery. One year after surgery the estimated risk of surgical failure was 30% (95% confidence interval 22% to 38%) in the placebo arm compared with 5% (2% to 10%) in the radiation arm. The radiation group experienced a higher incidence of operable cataract (18 participants) than the placebo group (five participants; P = 0.01). At two years the estimated risks with placebo and beta radiation were, respectively, 2.8% (0.9% to 8.3%) and 16.7% (10.0% to 27.3%). CONCLUSION: beta radiation substantially reduced the risk of surgical failure after glaucoma surgery. Some evidence was, however, found of an increased risk for cataract surgery (a known complication of trabeculectomy) in the beta radiation arm during the two years after surgery. TRIAL REGISTRATION: ISRCTN62430622 [controlled-trials.com].

[Late results of transscleral hypotensive low-energy laser therapy of glaucoma]. / Otdalennye rezul'tatay transskleral'noi gipotenzivnoi nizkoénergeticheskoi lazerterapii glaukomy.

The paper discusses remote observations (within 5 years) over 64 patients (94 eyes) with open-angle glaucoma after transscleral hypotensive low-energy laser therapy. Before treatment, intraocular pressure was moderately increased in 63 eyes (67%), high--in 31 (33%). In 27 eyes with minimum, moderately expressed dystrophic changes in the anterior segment of the eye, a course of transscleral hypotensive low-energy laser therapy, 1-2 sessions, resulted in normalization of intraocular pressure and improvement of hydrodynamics, remaining stable within the whole period of observation. In 49 eyes with moderately expressed dystrophic changes in the anterior segment of the eye, a course of 3-5 sessions brought about normalization of intraocular pressure, remaining stable within 6-12 months, on the average. In 18 eyes with strongly expressed dystrophic changes in the anterior segment of the eye, a partial hypotensive effect was achieved and the patients were operated a month later. In patients with a normalized intraocular pressure, stabilization of visual functions (visual acuity and visual field) within the whole period of observation is also recorded.

Randomized controlled clinical trial of beta irradiation as an adjunct to trabeculectomy in open-angle glaucoma.

OBJECTIVE: To assess the effect of a single intraoperative application of 750 cGy of beta irradiation on the outcome of trabeculectomy for uncontrolled open-angle glaucoma. DESIGN: A prospective, randomized, double-blind, placebo-controlled clinical trial. PARTICIPANTS: Sixty-one eyes of 61 Caucasian patients at low risk of filtering surgery failure, with poorly controlled primary or secondary open-angle glaucoma undergoing routine trabeculectomy. METHOD: Patients were randomly assigned to control or beta irradiation groups. All patients underwent standard trabeculectomy with fornix-based conjunctival incision. Eyes assigned to beta irradiation received 750 cGy of beta irradiation directly over the sclerostomy site on completion of conjunctival suturing. An identical but inactive applicator was applied to control eyes, delivering no radiation. Both operator and patient remained masked to the assignment for the 12-month follow-up period. MAIN OUTCOME MEASURES: The main outcome measure was intraocular pressure (IOP) control. Complete success of IOP control was defined as an IOP less than 21 mmHg at 12 months without need for additional medication. Qualified success was defined as an IOP less than 21 mmHg at 12 months where additional medication was required. RESULTS: Complete success of IOP control was achieved in 19 (86%) control eyes and 35 (90%) irradiated eyes (P = 1.0). Qualified success of IOP control was achieved in 21 (95%) control eyes and 39 (100%) irradiated eyes at 12 months follow-up (P = 1.0) CONCLUSIONS: We experienced a very high success rate of filtration surgery in this select population without adjunctive irradiation. Our sample size was too small to show any improvement in success with use of beta irradiation in this group. Other studies would have to be done to determine whether it may have measurable benefit in cases with a high risk of filtration failure.

Beta radiation as an adjunct to low-risk trabeculectomy.

PURPOSE: To assess a single dose of intraoperative beta radiation used to enhance the success rate of trabeculectomy in a population of low-risk glaucoma patients in whom antimetabolites might not be indicated. METHODS: A prospective randomized trial of 65 eyes was designed, with 31 eyes receiving 750 rads of intraoperative beta radiation (group 1), and 34 eyes receiving no supplementation (group 2). RESULTS: Mean follow-up time was 24 months. Mean postoperative intraocular pressure was 12.2 mmHg in group 1, and 13.7 mmHg in group 2 (P = 0.16). Mean decrease in intraocular pressure was 10.3 mmHg in group 1, and 9.3 mmHg in group 2 (P = 0.49). The two groups were not significantly different in terms of surgical complications. CONCLUSION: For this population of low-risk patients, there was no significant difference in outcome after applications of a single intraoperative dose of beta radiation.

Trabeculectomy with beta radiation: long-term follow-up.

PURPOSE: To evaluate the long-term outcome and complications of trabeculectomy with beta radiation. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Forty-three patients with confirmed primary open-angle glaucoma (POAG), who received trabeculectomy with adjunctive beta radiation at the Prince of Wales Hospital between June 1991 and November 1994. METHODS: Patients fulfilling the preceding criteria were followed up longitudinally. The visual acuity, intraocular pressure (IOP), bleb morphology, and complications were evaluated. MAIN OUTCOME MEASURES: Visual acuity, IOP, bleb morphology, complications. RESULTS: Forty-three eyes of 43 consecutive Chinese patients were recruited and successfully followed up for a minimum of 7 years. The mean age +/- 1 standard deviation (SD) was 60.9 +/- 13.0 years. There were 29 males and 14 females. The mean baseline IOP +/- 1 SD was 28.3 +/- 5.8 mmHg. The mean postoperative IOP +/- 1 SD after the initial trabeculectomy was 11.9 +/- 4.3 mmHg, and the mean number of preoperative IOP-lowering eyedrops +/- 1 SD was reduced from 2.8 +/- 0.5 to 0.7 +/- 1.0 at 7 years follow-up. The qualified success rate at 7 years follow-up, defined as IOP

Yag láser en el tratamiento del glaucoma crónico de ángulo abierto / Yag laser in the treatment of chronic open angle glaucoma

Se presentan 50 ojos con glaucoma crónico de ángulo abierto descompensado en el que se emplean las técnicas de: trabeculopuntura, trabeculospasis o goniopuntura, los que tiene como objetivo facilitar el dreneje del acuoso a través del ángulo iridocornela. Se informan los resultados