ABSTRACT
PURPOSE: To verify whether scanning laser polarimeter with the new variable corneal compensation algorithm (GDx VCC) and scanning laser ophthalmoscopy (Heidelberg Retina Tomograph (HRT)) allow measuring retinal ganglion cell loss in patients with multiple sclerosis (MS). PATIENTS AND METHODS: We enrolled 23 MS patients with a history of previous demyelinating monocular optic neuritis. Examination included visual evoked potentials (VEPs), scanning laser ophthalmoscopy, and scanning laser polarimeter. HRT was performed to assess optic nerve head (ONH) shape, while GDx VCC was used to evaluate the retinal nerve fibre layer thickness (RNFLt) around the ONH. Statistical analysis was performed comparing results obtained for each eye with the available normative database and with the unaffected fellow eye. RESULTS: When the affected eye group was compared to the fellow-eye group, a significant (P<0.05) difference was found for few GDx VCC parameters. In contrast, no significant correlation was observed between clinical assessment and imaging techniques when the normal database of HRT and GDx VCC was used. A significant association was observed between VEP latency and some GDx VCC parameters. CONCLUSIONS: Our results suggested that scanning laser polarimetry could detect loss of ganglion cells following demyelinating optic neuritis, but further studies are needed.
Subject(s)
Neuromyelitis Optica/pathology , Optic Disk/pathology , Retinal Ganglion Cells/pathology , Adult , Algorithms , Cell Death , Cross-Sectional Studies , Evoked Potentials, Visual , Female , Humans , Male , Middle Aged , Multiple Sclerosis/pathology , Multiple Sclerosis/physiopathology , Neuromyelitis Optica/diagnosis , Neuromyelitis Optica/physiopathology , Ophthalmoscopy/methods , Prospective Studies , Scanning Laser Polarimetry/methods , Signal Processing, Computer-AssistedABSTRACT
We analyzed the long-term success of argon laser trabeculoplasty (ALT) performed in 237 eyes of 175 patients diagnosed with primary open-angle glaucoma and followed for up to 11 years (maximum, 132 months) after treatment. The cumulative proportion of success, defined as the avoidance of glaucoma surgery or an intraocular pressure never exceeding 22 mm Hg, was calculated throughout follow up using the Kaplan-Meier life-table analysis. The success rates were: 78% at 1 year (n = 205), 71% at 3 years (n = 139), 61% at 5 years (n = 73), and 40% at 10.5 years (n = 19). Our data confirm previous reports of the high initial success rate of ALT, followed by a time-dependent decrease in its efficacy.
Subject(s)
Glaucoma, Open-Angle/surgery , Laser Therapy , Trabeculectomy , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Intraocular Pressure , Life Tables , Male , Middle Aged , PrognosisABSTRACT
We have performed ab-externo photoablative filtration surgery on 19 patients affected by uncontrolled primary open-angle glaucoma. All cases had wide open angles, were previously treated with argon laser trabeculoplasty and were considered good candidates for trabeculectomy. After topical and peribulbar anesthesia, a limbus-based conjunctival flap was dissected. Photoablation of a rectangular area at the limbus was performed with an argon fluoride excimer laser (193 nm), at 180 mJ x sq cm fluence. The beam was shaped in the appropriate fashion using a custom-made metal mask. Photoablation was continued until aqueous appeared percolating through the juxtacanalicular tissue at the bottom of the crater; a water-tight closure of conjunctiva was then performed. Postoperatively, the anterior chamber reaction was minimal; in no case a flat chamber or choroidal detachment was observed. In 18 of the 19 cases the IOP was significantly lowered, and a filtering bleb developed. Mean preoperative IOP was 26.4 (+/- 7) mmHg. At a median follow-up of 9 months (range 4-15) the IOP is < or = 18 mmHg on no medications in 16 (84%) of the eyes, with a mean value of 13.3 (+/- 6) mmHg. Our short-term results support excimer laser photoablative filtration as a relatively safe and effective procedure for primary open-angle glaucoma.