ABSTRACT
PURPOSE: This study analyzes the influence of various factors on the hypotensive effect of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: A retrospective study of the SLT effect was performed in 582 patients (756 eyes; mean age - 71.9±9.5 years) with POAG stages I-III. The level of intraocular pressure (IOP) decrease was assessed at 1 day, 1, 3, 6, and 12 months after SLT. The relationship between the hypotensive effect and age, gender, glaucoma stage, initial IOP level, number and type of instilled drugs, presence of intraocular lenses, and the surgeon performing the intervention were analyzed. RESULTS: In the entire sample, the hypotensive effect of SLT after 1 day was 4.1±3.4 mm Hg, after 1, 3, 6, and 12 months - 3.7±4.8; 3.5±3.8; 3.1±3.4 and 2.3±3.8 mm Hg, respectively. The hypotensive effect of SLT was most dependent on the preoperative IOP level (R>0.64, p<0.05). No significant correlation was found between the hypotensive effect and the stage of POAG, gender, age, number of hypotensive drugs, phakia/aphakia, and the surgeon. A weaker hypotensive effect of SLT was found in eyes receiving monotherapy with α2-adrenoceptor agonists (p<0.03) and a combination of four drugs (p<0.02). CONCLUSION: SLT is an effective method of additional IOP reduction in POAG at any stage and with any hypotensive regimen. At the same time, the results of its use in real clinical practice indicate the need for more careful IOP control after the procedure, especially in eyes with POAG stage III, as well as in eyes without hypotensive therapy and on the maximum drop regimen.
Subject(s)
Glaucoma, Open-Angle , Intraocular Pressure , Laser Therapy , Trabeculectomy , Humans , Glaucoma, Open-Angle/surgery , Glaucoma, Open-Angle/physiopathology , Trabeculectomy/methods , Female , Male , Aged , Intraocular Pressure/physiology , Retrospective Studies , Laser Therapy/methods , Treatment Outcome , Middle Aged , Antihypertensive Agents/therapeutic useABSTRACT
Varix of the vortex vein ampulla is a rare benign condition that has clinical similarities to more concerning choroidal lesions that pose a threat to vision, in particular choroidal melanoma. The article describes two clinical cases, one of which is unique due to the combination of bilateral lesion and the presence of multiple varices in one eye. A brief review of the literature on this condition is also provided.
Subject(s)
Choroid Neoplasms , Melanoma , Varicose Veins , Choroid/blood supply , Choroid/diagnostic imaging , Choroid Neoplasms/diagnosis , Diagnosis, Differential , Humans , Melanoma/diagnosis , Varicose Veins/diagnostic imaging , Varicose Veins/etiologyABSTRACT
PURPOSE: To evaluate the influence of different topical hypotensive drugs on incidence of choroidal effusion (CE) following laser trabeculoplasty as the second stage of combined laser-surgical treatment plan in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study included 60 patients with previously operated stage I and II POAG who has 'b-c' intraocular pressure (IOP) on maximum hypotensive therapy. Fistulizing subscleral removal of the outer wall of Schlemm's canal (a.k.a. subscleral sinusotomy) was the first stage of treatment plan. The second stage took place 14 days later in the form of laser trabeculoplasty. In order to reduce the risk of IOP spikes, all patients were prescribed specific hypotensive therapy 5 days prior to the procedure. The 1st group included 30 patients (30 eyes) who were asked to use Brimonidine-Purite (0.15%). The 2nd group included 30 patients (30 eyes) who used either nonselective ß-blockers, or carbonic anhydrase inhibitors. IOP was measured on days 1, 5, 9, and 12 after stage 1, as well as after laser trabeculoplasty. Ophthalmic examination included ultrasound imaging and optical coherence tomography. RESULTS: After the combined laser-surgical treatment, the IOP reliably decreased in both groups. Choroidal effusion was observed in 7 cases in the 1st group and in 15 cases in the 2nd group. Change in IOP was less prominent in patients who had received instillations of α2-adrenomimetic (p<0.05). CONCLUSION: Patients who received Brimonidine-Purite 0.15% before laser trabeculoplasty had lower IOP drop than those on pre-surgical therapy with nonselective ß-blockers or carbonic anhydrase inhibitors. Topical application of 0.15% Brimonidine-Purite 5 days prior to laser trabeculoplasty as the second stage of combined laser-surgical treatment resulted in statistically significant reduction of the incidence of postoperative choroidal effusion, likely due to α2-adrenomimetics inhibiting the secretory function of the ciliary Body to the lesser extent than drugs of other groups that were tested.
Subject(s)
Glaucoma, Open-Angle , Laser Therapy , Trabeculectomy , Adrenergic Agonists , Glaucoma, Open-Angle/therapy , Humans , Incidence , Intraocular Pressure , Tonometry, OcularABSTRACT
AIM: to comparatively evaluate the hypotensive effect of minimally invasive (type 1) and basic (type 2) subscleral removing of the external wall of Schlemm's canal with subsequent laser trabeculopuncture in patients with open-angle glaucoma (POAG). MATERIAL AND METHODS: The main group included 60 patients (64 eyes) treated with the minimally invasive technique. The control group included 105 patients (105 eyes), who underwent the type 2 surgery. RESULTS: After sinusotomy, intraocular pressure (IOP) decreased by 25% of its preoperative values in most patients (in 90.6% of patients from the main group and 81.9% of the controls, p<0.05). After laser trabeculopuncture, IOP further decreased down to 15.6±0.4 mmHg in the main group and 17.4±0.3 mmHg in the control group (p<0.05). Twelve months after the combined treatment, the hypotensive effect was still present in 81.2% of patients from the main group and 90.5% of the controls. None of the patients required additional hypotensive therapy. CONCLUSION: In POAG patients, the effect of minimally invasive subscleral removal of the external wall of Schlemm's canal (microfistulazing procedure) followed by laser trabeculopuncture is no weaker than that of basic technique.