Assessment of Pain in Glaucoma Patients Undergoing Micropulse Transscleral Laser Therapy.

BACKGROUND: This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain. METHODS: This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All patients were asked to rate both types of pain using a numerical rating scale (NRS). The risk factors were explored using multivariable mixed-effects ordinal logistic regression. RESULTS: The mean (SD) NRS pain score during the procedure was 3.57 (3.41) (range 0-10), which included no, mild, moderate, and severe pain in 30 (30%), 33 (33%), 17 (17%), and 20 (20%) eyes, respectively. The mean (SD) NRS score of overnight pain was 2.99 (2.28) (range 0-9), which included no, mild, moderate, and severe pain in 17 (17%), 59 (59%), 17 (17%), and 7 (7%) eyes, respectively. Twenty-seven (27%) eyes reported worse pain overnight than during the procedure. Increased age, initial intraocular pressure, and pain during the procedure were significantly associated with increased overnight pain (p < 0.05). CONCLUSIONS: Up to a fourth of eyes had worse pain after discharge. Older age, initial intraocular pressure, and pain during the procedure were risk factors for higher levels of overnight pain.

Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma.

PRCIS: Phacotrabeculectomy had a significantly lower 24-month failure rate than the isolated trabeculectomy in both the primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) patients. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG. PURPOSE: The purpose of this study is to compare the 2-year outcomes of primary mitomycin C-augmented combined phacotrabeculectomy (Phaco+Trab) with isolated trabeculectomy (Trab) in phakic patients with POAG and PACG. MATERIALS AND METHODS: We retrospectively reviewed primary glaucoma patients who underwent mitomycin C-augmented trabeculectomy and completed 2 years of follow-up. Failure rate, postoperative intraocular pressure (IOP), percentage of IOP reduction, and the number of glaucoma medications at 24 months after surgery were compared between the Phaco+Trab and Trab groups. RESULTS: The study included 146 eyes of 121 patients; 74 underwent Trab and 72 underwent Phaco+Trab. POAG and PACG were present in 71 and 75 eyes, respectively. Defining a failure with IOP criteria of >18 mm Hg or IOP reduction of <30%, the failure rates were 42% and 62% for Phaco+Trab and Trab, respectively. The Phaco+Trab group had a significantly lower failure rate than the Trab group for all subjects [risk ratio (RR): 0.60, 95% CI, 0.44-0.81, P =0.001], POAG subgroup (RR: 0.61, 95% CI, 0.41-0.93, P =0.02), and PACG subgroup (RR: 0.53, 95% CI, 0.33-0.86, P =0.01). Differences in the postoperative IOP, percentage of IOP reduction, and number of glaucoma medications were not significant between the 2 groups for all subjects, POAG, and PACG (all P >0.05). The magnitude of the effects of adding phacoemulsification to the trabeculectomy was comparable for the POAG and PACG groups, for each outcome (all P >0.05). CONCLUSIONS: The final 24-month failure rate in the Phaco+Trab group was lower than that in the Trab group in both the POAG and PACG subjects. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG.

Ciliochoroidal effusion and its association with the outcomes of micropulse transscleral laser therapy in glaucoma patients: a pilot study.

We investigate the development of ciliochoroidal effusion following micropulse transscleral laser therapy (MPTLT) and evaluate the relationship between the early postoperative ciliochoroidal effusion (ECE) and short-term treatment outcomes. Glaucoma patients who underwent MPTLT were assessed for ciliochoroidal effusion by anterior segment optical coherence tomography (AS-OCT) at postoperative 1, 4, 12 weeks. The subjects were classified based on AS-OCT findings at postoperative 1 week into eyes with and without ECE. The absolute intraocular pressure (IOP), IOP reduction and number of antiglaucoma medications were compared between eyes with and without ECE. A total of 50 eyes were included, of which 23 (46%) developed ciliochoroidal effusion at postoperative 1 week. Almost all effusion resolved at 4 weeks. At 12 weeks, the mean IOP (SD) significantly decreased from 28.5 (12.8) mmHg to 17.8 (10.5) mmHg (p < 0.001), and the mean number of medications (SD) decreased from 4.1 (0.9) to 3.3 (1.1) (p < 0.001). Eyes with ECE had significantly greater IOP reduction (p = 0.009) and lower absolute IOP (p = 0.008) at the 4-week visit. There was no significant difference in number of medications between the groups. In conclusion, ciliochoroidal effusion was commonly observed following MPTLT. Eyes with ECE had overall greater IOP reduction during early post-operation.

Sensitivity and Specificity of New Visual Field Screening Software for Diagnosing Hemianopia.

PURPOSE: To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting hemianopia. PATIENTS AND METHODS: Forty-three subjects with hemianopia and 33 controls were tested with the CU-VF software on a personal computer and SAP. Hemianopia was defined as the presence of a hemianopic field respecting the vertical meridian on SAP with the corresponding neuroimaging pathology as evaluated by 2 neuro-ophthalmologists. Results of CU-VF were independently evaluated by 2 neuro-ophthalmologists, 1 general ophthalmologist, and 1 general practitioner in terms of the presence of hemianopia. Sensitivity, specificity, and kappa coefficient for inter-observer reliability were calculated. Satisfaction and ease of use were evaluated with a visual analog-scale questionnaire and analyzed using paired t-test. RESULTS: The sensitivity (95% CI) and specificity (95% CI) of the CU-VF to detect hemianopia was 74.42% (58.53-85.96) and 93.94% (78.38-99.94). Kappa coefficient between neuro-ophthalmologists versus general ophthalmologist and general practitioner were 0.71 and 0.84, respectively. The mean (SD) test duration was 2.25 (0.002) minutes for the CU-VF and 5.38 (1.34) minutes for SAP (p < 0.001). Subjects reported significantly higher satisfaction and comfort using the CU-VF software compared to SAP. CONCLUSION: The CU-VF screening software showed good validity and reliability to detect hemianopia, with shorter test duration and higher subject satisfaction compared to SAP.

Low Vision Enhancement with Head-mounted Video Display Systems: Are We There Yet?

SIGNIFICANCE: Head-mounted video display systems and image processing as a means of enhancing low vision are ideas that have been around for more than 20 years. Recent developments in virtual and augmented reality technology and software have opened up new research opportunities that will lead to benefits for low vision patients. Since the Visionics low vision enhancement system (LVES), the first head-mounted video display LVES, was engineered 20 years ago, various other devices have come and gone with a recent resurgence of the technology over the past few years. In this article, we discuss the history of the development of LVESs, describe the current state of available technology by outlining existing systems, and explore future innovation and research in this area. Although LVESs have now been around for more than two decades, there is still much that remains to be explored. With the growing popularity and availability of virtual reality and augmented reality technologies, we can now integrate these methods within low vision rehabilitation to conduct more research on customized contrast-enhancement strategies, image motion compensation, image-remapping strategies, and binocular disparity, all while incorporating eye-tracking capabilities. Future research should use this available technology and knowledge to learn more about the visual system in the low vision patient and extract this new information to create prescribable vision enhancement solutions for the visually impaired individual.

Capability of Ophthalmology Residents to Detect Glaucoma Using High-Dynamic-Range Concept versus Color Optic Disc Photography.

BACKGROUND: Assessment of color disc photograph (C-DP) is affected by image quality, which decreases the ability to detect glaucoma. High-dynamic-range (HDR) imaging provides a greater range of luminosity. Therefore, the objective of this study was to evaluate the capability of ophthalmology residents to detect glaucoma using HDR-concept disc photography (HDR-DP) compared to C-DP. DESIGN: Cross-sectional study. METHODS: Twenty subjects were classified by 3 glaucoma specialists as either glaucoma, glaucoma suspect, or control. All C-DPs were converted to HDR-DPs and randomly presented and assessed by 10 first-year ophthalmology residents. Sensitivity and specificity of glaucoma detection were compared. RESULTS: The mean ± SD of averaged retinal nerve fiber layer (RNFL) thickness was 74.0 ± 6.1 µm, 100.2 ± 9.6 µm, and 105.8 ± 17.2 µm for glaucoma, glaucoma suspect, and controls, respectively. The diagnostic sensitivity of HDR-DP was higher than that of C-DP (87% versus 68%, mean difference: 19.0, 95% CI: 4.91 to 33.1; p = 0.014). Regarding diagnostic specificity, HDR-DP and C-DP yielded 46% and 75% (mean difference: 29.0, 95% CI: 13.4 to 44.6; p = 0.002). CONCLUSIONS: HDR-DP statistically increased diagnostic sensitivity but not specificity. HDR-DP may be a screening tool for nonexpert ophthalmologists.

Effect of Ayurved Siriraj herbal recipe Chantaleela on platelet aggregation.

INTRODUCTION: Ayurved Siriraj Chantaleela recipe is a traditional Thai remedy consisting of eight medicinal plants, which is employed for the treatment of fever. OBJECTIVE: To investigate the effects of Ayurved Siriraj Herbal recipe Chantaleela on platelet aggregation. STUDY DESIGN: Clinical research; ex vivo with before and after study design. MATERIAL AND METHOD: Twelve healthy male and female volunteers participated in the present study. Platelet aggregation test before Chantaleela ingestion was done as a control. After administration of 750 mg Chantaleela (3 x 250 mg tablets) every 8 hours for 3 doses, platelet aggregation was measured 8 hours following the first dose using an aggregometer and microplate reader. Adrenaline (Adr) and adenosine diphosphate (ADP) were used as platelet stimulants. Platelet aggregation was measured again at 32 hours and 8-10 days after the first dose. RESULTS: All of the participants completed the present study without any adverse event. Ayurved Siriraj Chantaleela did not affect platelet aggregation; neither Adr nor ADP were used as platelet agonists in both aggregometer and microplate reader Subgroup analysis revealed no significant change in platelet aggregation after Chantaleela administration according to the control for both male and female groups. The same results were also obtained in other subgroup analysis including hyperaggregation group, hypo-normal aggregation group. CONCLUSION: From the present study, normal dose of Chantaleela for alleviation of fever does not have an effect on either platelet aggregation or platelet numbers. It may conclude that the present study supports the safety use of Chantaleela for relieving fever as platelet status does not need to be taken into consideration.