Functional Hand-Based Splint in the Treatment of Metacarpal Fractures.

Background: Post-treatment stiffness remains a significant hurdle following treatment for displaced or minimally displaced metacarpal fractures. Treatment goals should focus on a stable and acceptable reduction, minimal patient morbidity, and optimal mobility. Methods: A retrospective review of all non-operative metacarpal fractures over a five-month period at a tertiary center hand clinic treated with a hand-based splint were reviewed for radiologic and clinical stability. The splint allowed metacarpophalngeal joint, interphalangeal joint, and radiocarpal joint motion. Data collected included age, handedness, type and location of fracture, occupation, and ability to continue working. Radiologic images were reviewed by a radiologist not otherwise involved in patient care. Results: Thirty-three patients were reviewed with a total of 39 fractures of the second, third, fourth, and fifth metacarpals. Nine patients had nondominant hand fractures while 24 were dominant hand injuries. Twenty out of 24 patients employed pre-injury were able to continue working without missing any days. Three patients were lost to the final follow-up. The average splint duration was 24 days. Twenty-seven of 30 patients showed no change in alignment from start of splinting to end, while three showed some change but remained within non-operative criteria. Conclusion: A hand-based functional splint for metacarpal fractures allows for excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintains functional motion throughout treatment. It can be applied to any non-operative fracture of the second through the fifth metacarpal.

Contexte: La raideur post-traitement reste un obstacle significatif après traitement des fractures métacarpiennes déplacées ou peu déplacées. Les objectifs thérapeutiques doivent se concentrer sur une réduction stable et acceptable, une morbidité minimale pour le patient et une mobilité optimale. Méthodes: La stabilité radiologique et clinique de toutes les fractures métacarpiennes non opérées sur une période de cinq mois dans un centre tertiaire de traitement de la main avec une attelle basée sur la main a fait l'objet d'une analyse rétrospective. L'attelle permettait le mouvement de l'articulation métacarpophalangienne, de l'articulation interphalangienne et de l'articulation radiocarpienne. Les données ollectées ont inclus l'âge, le côté de la main dominante, le type et l'emplacement de la fracture, la profession et l'aptitude à poursuivre le travail. Les images radiographiques ont été analysées par un radiologiste qui n'était pas impliqué dans les soins aux patients. Résultats: Trente-trois patients ont été inclus dans l'analyse avec un total de 39 fractures des 2e, 3e, 4e et 5e métacarpiens. Neuf patients avaient des fractures de la main non dominante et 24 patients avaient des blessures de la main dominante. Parmi les 24 patients à l'emploi avant la blessure, 20 ont pu continuer à travailler sans manquer un seul jour. Trois patients ont été perdus de vue au suivi final. La durée moyenne du port de l'attelle a été de vingt-quatre jours. Sur 30 patients, 27 n'ont eu aucune modification de l'alignement entre le moment de la pose de l'attelle et son retrait, tandis qu'un changement a été observé chez trois patients, sans pour autant répondre à des critères d'indication chirurgicale. Conclusion: Une attelle fonctionnelle basée sur la main pour les fractures métacarpiennes permet une excellente conservation de la réduction de la fracture et un retour précoce ou immédiat aux activités habituelles avant la blessure, une faible morbidité pour les patients et le maintien d'une mobilité fonctionnelle tout au long du traitement. Cette technique est applicable à toute fracture non chirurgicale du 2e au 5e métacarpien.

Conversion of fused hip to total hip arthroplasty with presurgical and postsurgical gait studies.

This case study presents a subject with a fused hip converted to total hip arthroplasty. Kinematic gait analysis was conducted on 3 occasions, presurgery, 4 months postsurgery, and 2.5 years postsurgery. Presurgery data showed decreased cadence and shorter step length; sound limb possessed increased hip, knee range of motion (ROM), and increased knee flexion during stance; the affected limb had minimal hip motion and normal knee ROM with abnormal pattern. At 4 months postsurgery, the sound limb showed decreased step length, whereas the affected limb showed increased knee extension during stance and increased hip ROM. Data obtained at 2.5 years postsurgery indicated decreased cadence and speed and increased ROM in both limbs. The total hip arthroplasty had provided relief of chronic back and affected hip pain and improved mobility. Gait-specific training is recommended.

Efficacy and Safety of Selective Laser Trabeculoplasty among Ethiopian Glaucoma Patients.

BACKGROUND: Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering intraocular pressure (IOP). PURPOSE: To determine the efficacy and safety of SLT among Ethiopian patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and ocular hypertension (OHT). METHOD: A prospective, nonrandomized interventional study was conducted at Menelik II Hospital, Ethiopia. Patients on antiglaucoma medication with uncontrolled IOP and those patients treated for the first time with 360 degrees of SLT were included. Success was defined as an IOP lowering of > 20% from baseline without repeat treatment. RESULT: A total of 95 eyes of 61 patients with a diagnosis of OAG and OHT were enrolled. The diagnosis was POAG in 55 (57.9%) eyes, PXG in 22 (23.2%) eyes, and OHT in 18 (18.9%) eyes. Seventy (73.7%) eyes were on medications, and 25 (26.3%) eyes were treated with laser as primary therapy. The mean (SD) baseline IOP and medication were 24.3 ± 2.5 mmHg and 1.29 ± 1.01, respectively. The one-year mean (SD) IOP reduction was 6.7 ± 4.2 mmHg and medication reduction was 0.26 ± 1.34. The overall IOP reduction at 12 months was 27.6%, and the success rate was 60%. The mean IOP (SD) reduction for patients who were treated for the first time with laser and on antiglaucoma medication was 6.5 ± 3.1 mmHg and 6.8 ± 2.8 mmHg, respectively. Post-SLT, patients experienced transient ocular pain, brow ache, headache, and/or blurring of vision in 31.6%, anterior chamber reaction in 36.8%, and IOP spike ≥ 6 mmHg in 11.6%. CONCLUSION: SLT is an effective and safe treatment modality for OHT, POAG, and PXG among Ethiopian patients either as a first-line treatment or as an adjunct to topical glaucoma treatment.

Building capacity in local government for integrated planning to increase physical activity: evaluation of the VicHealth MetroACTIVE program.

Integrated planning is a holistic approach to addressing the needs of local communities built on partnerships between those responsible for development, environmental quality and service provision. This study investigated the extent and key influences on the use of integrated planning to promote physical activity among six metropolitan councils in Melbourne Australia, which took part in the MetroACTIVE Project funded by the Victorian Health Promotion Foundation from 2005 to 2007. The evaluation entailed interviews conducted at the mid-term (N = 67) and completion (N = 50) of the project, and the review of relevant documents. Respondents included elected councillors, chief executive officers, officers from different council divisions and the project staff employed in each council. Three councils showed evidence of integrated planning for physical activity, whereas the remainder focused on the delivery of community participation programs. Leadership from senior management and an organizational culture that supported collaboration across council departments were prerequisites for integrated planning. Employment of a dedicated project officer with skills for engaging management and building partnerships within the organization was important. Barriers to integrated planning were a complex organization structure, high demands on the council due to a growing residential population and a poor climate among staff. Overall, integrated planning was found to be a viable approach for developing a coordinated approach to this issue involving the range of council services and functions. Ongoing strategies are needed to facilitate senior management commitment and organizational capacity for integrated planning, with leadership provided by departments responsible for infrastructure or corporate planning.

Patterns of knee osteoarthritis in Arabian and American knees.

This study illustrates differences in the cartilage degeneration in osteoarthritic knees in patients with more frequent hyperflexion activities of daily living compared with Western patients. Proximal tibial articular cartilage wear and cruciate ligament condition were assessed in Saudi Arabian and North American patients with varus osteoarthritis undergoing total knee arthroplasty. In anterior cruciate ligament (ACL) intact knees, there were significant differences in wear location, with a clearly more anterior pattern in Saudi Arabian knees. Complete ACL deficiency occurred in 25% of North American knees but only 14% of Saudi Arabian knees. These ACL-deficient knees showed the most severe cartilage wear in both groups and posterior medial wear patterns. Biomechanical descriptions of knee flexion and axial rotation during kneeling or squatting are consistent with the more pronounced anteromedial and posterolateral cartilage wear patterns observed on the Saudi Arabian knees. These observations provide insight into altered knee mechanics in 2 culturally different populations with different demands on knee flexion.

Improving maximum flexion with a posterior cruciate retaining total knee arthroplasty: a fluoroscopic study.

Achieving a large range of motion (ROM) is a much-desired clinical outcome after total knee arthroplasty (TKA), especially in Asian and Middle Eastern cultures. TKA design plays an important role in providing the post-operative ROM. This study investigated the kinematics of a new high-flexion posterior cruciate ligament retaining total knee replacement, featuring an enlarged posterior condylar offset and a more conforming tibiofemoral articulation. Two flexion activities were compared to determine which provides higher flexion kinematics. Sixteen North American patients with 20 total knee implants were studied using fluoroscopy and shape matching techniques. Maximum skeletal flexion during a lunge activity averaged 120 degrees +/- 11 degrees, with 11 degrees +/- 4 degrees tibial internal rotation. Kneeling activities showed 11 degrees greater average maximum skeletal flexion (131 degrees +/- 13 degrees, p < 0.05) and 1 degrees less tibial internal rotation (10 degrees +/- 4 degrees, p > 0.05) than lunge activities. We conclude that specific knee implant design features can facilitate high flexion in fixed-bearing cruciate retaining TKA, and that kneeling activities provide higher flexion than lunge activities.

Rationale and Results for Fixed-Bearing Pivoting Designs in Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is a maturing technology, and the focus for improvement centers on optimizing patient satisfaction and further reducing revisions. It is commonly assumed that achieving closer-to-normal knee mechanics in a TKA will result in further improvement in outcomes and revision rates. Fixed-bearing TKA designs with asymmetric pivoting articulations are designed to provide more natural joint stability and kinematics. These designs have been used for more than 20 years and there is a substantial body of literature characterizing their performance. This article reviews the various design types of fixed-bearing pivoting TKA designs, and recounts their clinical, functional, and patient-preference performance from peer-reviewed studies. To date, the evidence suggests there is measurable benefit to providing closer-to-normal joint stability and kinematics, and that fixed-bearing, pivoting TKA designs may decrease instability-related revisions and improve patient satisfaction.

A Cam-Post Mechanism Is No Longer Necessary in Modern Primary Total Knee Arthroplasty.

Conclusive evidence supporting a clinical difference between posterior-stabilized (PS) and cruciate-retaining (CR) designs in total knee arthroplasty (TKA) does not currently exist, despite both designs being used for decades. Proponents of PS designs that employ a cam-and-post mechanism cite in vivo fluoroscopic data that demonstrate improved posterior rollback; however, optimal rollback has never been correlated to superior clinical outcomes. Recently, anterior-lipped and more conforming CR bearings, such as ultracongruent, medial pivot, and dual-pivot designs, have been used to substitute for the posterior cruciate ligament and obviate the need for the cam-post mechanism of a traditional PS design. Advantages of avoiding a PS TKA include eliminating the risk of box cut induced femoral condylar fracture, improving operative efficiency by removing procedural steps, removing the articulation that is a source of wear, postdeformation, breakage, or dislocation, and eliminating patellar clunk. Health care reform efforts mandate cost reduction, and procedural efficiencies and minimizing inventory through the removal of unnecessary bearing options foster that initiative.

An in vivo model for intraoperative assessment of impingement and dislocation in total hip arthroplasty.

We have developed an intraoperative model to quantify total hip arthroplasty impingement and dislocation mechanics using fluoroscopy and shape-matching techniques. Two patient groups were investigated: group 1 consisted of 12 hips using 28- or 32-mm femoral heads and an anterolateral surgical approach, and group 2 consisted of 17 hips using 22- or 26-mm femoral heads and a posterolateral surgical approach. During intraoperative hip stability testing consisting of extension and external rotation motions, group 1 was more unstable, and prosthetic impingement was the major reason for dislocation. With flexion and internal rotation motions, group 2 was more unstable, and superior-lateral impingement or soft tissue traction was the major reason for dislocation. Intraoperative quantitative assessment of hip mechanics provides a safe and clinically relevant method to characterize potential complications and evolve techniques to prevent them.

Association between dislocation, impingement, and articular geometry in retrieved acetabular polyethylene cups.

We used a novel analysis technique and retrieved acetabular polyethylene liners to investigate relationships between impingement damage, dislocation history, and polyethylene liner geometry. Forty-eight polyethylene liners with neutral rim elevation were visually assessed for peripheral rim damage consistent with impingement between the liner rim and femoral component. Liner articular geometry was measured using a digital stylus, and the geometric relationships between the liner rim and center of the femoral head were characterized by lip height, head center inset, and head penetration into the polyethylene liner. Thirteen (27%) retrieved liners had rim impingement damage and 12 (25%) had a history of dislocation. The proportion of liners with impingement was not significantly different among dislocated and stable liners. Lip height, head center inset, and head penetration were not significantly different between liners with and without impingement damage. Dislocated liners had a significantly shorter head center inset, with significantly less head penetration because of shorter functional duration. Designing polyethylene liners with a sufficiently deep articular surface that exceeds 0.95 mm may prove beneficial for decreasing the prevalence of early dislocation, independent of impingement damage.

Structural and functional changes to the retina and optic nerve following panretinal photocoagulation over a 2-year time period.

PurposeTo evaluate long-term structural and functional changes to the retina and optic nerve following panretinal photocoagulation (PRP) in diabetic retinopathy (DR) patients.MethodsParticipants were patients with DR requiring PRP and control patients with DR not requiring PRP. The Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT) were performed to analyze the optic nerve and macula. Best-corrected visual acuity (BCVA) and visual field (VF) testing were done to measure central and peripheral vision. Wide-field fluorescein angiogram was performed to monitor the progression of diabetic ischemia. The primary outcome measure was to determine the degree of retinal and optic nerve changes before and after PRP.ResultsThere was a non-significant thickening of the macula and retinal nerve fiber layer at 6 months post laser that recovered by 24 months. Mean perfused ratio was significantly increased (P=0.02) at 12 and 24 months post laser. Independently grading patient stereophotographs, grader 1 indicated there was a non-significant increase in cup to disk ratio post laser, while grader 2 indicated a significant increase at 6 (P=0.04), 12 (P=0.02), and 24 months (P=0.005). There was a significant VF decrease (P≤0.02) at 12 and 24 months post laser with BCVA showing a non-significant trend of deteriorating results.ConclusionDespite an improvement in peripheral perfusion, there was a significant progressive decline of peripheral VF over the study period. Clinical grading of the optic nerve was more unreliable following PRP, despite the absence of significant morphological changes as detected by the OCT and HRT.

Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial.

AIMS: To compare selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT), in terms of intraocular pressure (IOP) lowering, in patients with open-angle glaucoma. METHODS: 176 eyes of 152 patients were enrolled in this study, 89 in the SLT and 87 in the ALT groups. Patients were randomised to receive either SLT or ALT treatment to 180 degrees of the trabecular meshwork. Patients were followed up to 12 months after treatment. The main outcome measured was IOP lowering at 12 months after treatment, compared between the SLT and ALT groups. RESULTS: No significant difference (p = 0.846) was found in mean decrease in IOP between the SLT (5.86 mm Hg) and ALT (6.04 mm Hg) groups at 1 year or at any other time points, nor were there any significant differences in the rate of early or late complications between the two groups. CONCLUSIONS: SLT is equivalent to ALT in terms of IOP lowering at 1 year, and is a safe and effective procedure for patients with open-angle glaucoma.

Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study.

AIM: To determine the long term intraocular pressure (IOP) response to phacoemulsification in patients with and without exfoliation syndrome (XFS). METHODS: Prospective, multicentre, cohort study with the following inclusion criteria: age over 50 years, open iridocorneal angle, and cataract. Two groups were enrolled: those with XFS and those without. The main outcome was mean IOP reduction 2 years after phacoemulsification cataract extraction (PCE). Univariate and multivariate analyses were performed. RESULTS: 183 patients were enrolled, 71 with and 112 without XFS. There were 29 patients with glaucoma in both groups. Mean baseline IOP was higher in XFS compared to control eyes (17.60 (SD 3.23) mm Hg v 16.08 (3.18) mm Hg, p = 0.002). Overall IOP reduction was significantly greater in the XFS group at the 2 year time point (-1.85 mm Hg v -0.62 mm Hg in the controls (p = 0.0037)). Multivariate analysis demonstrated that the IOP lowering effect in the XFS group may be related to irrigation volume at the time of surgery. In the subgroup analyses IOP lowering was significantly greater in the XFS and XFG patients than in controls without glaucoma, and POAG controls, respectively. The percentage of patients with a postoperative IOP spike was similar and relatively high in both XFS and control groups (34% v 25%; p = 0.54). CONCLUSION: IOP decreases more in patients with XFS following PCE compared to control eyes without XFS. This effect is more pronounced in glaucoma patients and persists for at least 2 years.

Long-term efficacy of phototherapeutic keratectomy on recurrent corneal erosion syndrome.

PURPOSE: To assess the long-term sequelae, principally time-to-first-recurrence, of phototherapeutic keratectomy (PTK) for the treatment of recurrent corneal erosion syndrome (RCES). METHODS: A retrospective case series was performed. Thirty-nine eyes in 33 patients with RCES required PTK and were treated using the VISX STAR Excimer Laser System. The data were analyzed with the Kaplan-Meier survival estimate. RESULTS: Patients were characterized by the cause of their RCES. More than 50% had epithelial corneal dystrophies, 31% were posttraumatic, and 15% were idiopathic. Overall, 25% of eyes had a recurrence by 3 months, and 36% had a recurrence by 9 months. The mean follow-up time was 17.4 months (range, 0.4-67.6 months). Of those who had a primary recurrence, 38% had a second and 15% had a third. Visual acuity was slightly decreased within 2 weeks after surgery, and 10% of patients developed transient haze. No serious adverse effects were reported. CONCLUSION: PTK is an important treatment of RCES refractory to other therapies. Long-term data suggest that most patients treated with PTK do not develop recurrences, and side effects from PTK are minimal.

Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: results from a randomised clinical trial.

BACKGROUND/AIMS: The efficacy and safety of selective laser trabeculoplasty (SLT) has been found to be equivalent to argon laser trabeculoplasty (ALT). Since SLT produces significantly less disturbance to the trabecular meshwork and is theoretically more repeatable than ALT, it has potential to replace ALT as the standard procedure to treat medically uncontrolled open angle glaucoma. This study's objective is to determine factors that predict successful SLT at 1 year post-treatment. METHODS: As part of a randomised clinical trial comparing the efficacy and safety of SLT to ALT, data on 72 SLT patients were collected, and successful SLT defined as having an SLT induced intraocular pressure (IOP) reduction of >or=20% at 1 year post-treatment follow up. RESULTS: 43 out of the 72 patients who had completed their 1 year follow up visit had an IOP reduction of >or=20% from baseline. No glaucoma risk factors studied predicted successful SLT. The amount of trabecular meshwork pigmentation was not a significant predictor. However, it was discovered that baseline IOP strongly predicted SLT success (odds ratio=1.16; p=0.0001). CONCLUSION: SLT success was significantly predicted by baseline IOP but not by age, sex, other glaucoma risk factors, type of open angle glaucoma, or by degree of trabecular meshwork pigmentation.

Nd:YAG laser corneal disruption as adjuvant treatment for infectious crystalline keratopathy.

PURPOSE: To report on the use of the Nd:YAG laser corneal disruption in the treatment of infectious crystalline keratopathy. METHOD: Case report. A 52-year-old woman with infectious crystalline keratopathy unresponsive to topical antibiotics was treated with an Nd:YAG laser to the intrastromal crystals. RESULTS: After Nd:YAG laser treatment, the infiltrate completely cleared within 4 weeks. CONCLUSIONS: Nd:YAG laser treatment may be effective in disrupting the protective glycocalyx matrix within the intrastromal crystals, rendering the bacteria susceptible to topical antibiotics. This treatment should be considered for patients with infectious crystalline keratopathy clinically resistant to topical antibiotics.

Herpes zoster ophthalmicus in patients with human immunodeficiency virus infection.

PURPOSE: To investigate the ocular complications of herpes zoster ophthalmicus in patients with human immunodeficiency virus (HIV) infection. METHODS: This was a retrospective cohort study of 48 HIV-infected patients (48 eyes) treated at San Francisco General Hospital for herpes zoster ophthalmicus from December 1985 through March 1994. RESULTS: All patients were initially treated with either intravenous or oral acyclovir. The median CD4 lymphocyte count at diagnosis was 48 per mm3 (range, 2 to 490 per mm3). Fifteen patients (31%) had mild or no ocular involvement. Seventeen patients (35%) had stromal keratitis, mostly mild, and two (4)% developed chronic infectious pseudodendritic keratitis. Twenty-four study patients (50%) had iritis, but only three (6%) had elevations in intraocular pressure. Two patients (4%) developed postherpetic neuralgia, and two others (4%) had zoster-associated central nervous system disease. Only two patients (4%) developed necrotizing retinitis, both in the form of the progressive outer retinal necrosis syndrome. CONCLUSIONS: Excluding the patients with retinitis and central nervous system disease, the rate of sight-threatening complications in our series was lower than expected. Almost one third of study patients had no ocular complications or only mild surface epithelial disease. Although the relatively low incidence of sight-threatening disease in our study population may have been a consequence of aggressive management with acyclovir, chronic infectious pseudodendritic keratitis, retinitis, and central nervous system disease, complications of ophthalmic zoster whose pathogenesis is largely a consequence of active viral replication, were particularly devastating and difficult to manage.

Lattice corneal dystrophy type 1 in a Canadian kindred is associated with the Arg124 --> Cys mutation in the kerato-epithelin gene. sgupta@ogh.on.ca.

PURPOSE: To identify the mutation responsible for lattice corneal dystrophy type 1 in an extended Canadian kindred. METHODS: A search for a mutation in the candidate gene, kerato-epithelin, was carried out by single-strand conformation polymorphism and sequencing analyses. RESULTS: AC --> T mutation at position 417 was detected in exon 4 of the kerato-epithelin gene, which is expected to cause an Arg124 --> Cys change. This is the same nucleotide change described previously in two Swiss families with lattice corneal dystrophy type 1. CONCLUSION: Although the possibility that the three families (two previously described Swiss families and this Canadian kindred) are related has not been excluded, it appears that the unique phenotype of lattice corneal dystrophy type 1 is caused by this particular amino acid change.

Atopy and keratoconus: a multivariate analysis.

BACKGROUND/AIMS: The primary goal of this study was to determine if atopy is a risk factor for keratoconus. Other potential risk factors were also studied and included age, sex, race, eye rubbing, mitral valve prolapse, handedness, collagen vascular disease, ocular trauma, pigmentary retinopathy, Marfan's syndrome, Down's syndrome, and a history of contact lens wear. METHODS: A case-control study was designed (n=120) with incident cases assembled from the years 1985-99. Controls were chosen from the same person-time experience as cases and were picked from a source population with multiple outcomes ensuring that none was knowingly related to any of the potential exposures being studied. Atopy was defined based on the UK working group 1994 definition (at least 4/6 criteria = complete, 3/6 criteria = incomplete, and at least 1/6 criteria = partial). Keratoconus was defined based on clinical criteria and previously published I-S values. Multiple logistic regression was used in the analysis to obtain the odds ratios as the measure of association. RESULTS: In the univariate associations, there was an association between keratoconus and atopy as well as eye rubbing and family history of keratoconus. However, in the multivariate analysis, only eye rubbing was still a significant predictor of keratoconus (odds ratio = 6.31 p = 0.001). CONCLUSIONS: This study supports the hypothesis that the most significant cause of keratoconus is eye rubbing. Atopy may contribute to keratoconus but most probably via eye rubbing associated with the itch of atopy. No other variable measured was significantly associated with the aetiology of keratoconus.

Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial.

AIMS: To compare the effectiveness of selective laser trabeculoplasty (SLT, a 532 nm Nd:YAG laser) with argon laser trabeculoplasty (ALT) in lowering the intraocular pressure (IOP) in patients with medically uncontrolled open angle glaucoma. METHODS: A prospective randomised clinical trial was designed. Patients were randomised to treatment with either SLT or ALT and were evaluated at 1 hour, 1 week, 1, 3, and 6 months post-laser. RESULTS: There were 18 eyes in each group. Baseline characteristics were similar in both groups. In the SLT group the mean IOP at baseline, 1, 3, and 6 months was 22.8 (SD 3.0), 20.1 (4.6), 19.3 (6.0), and 17.8 (4.8) mm Hg, respectively. In the ALT group, the mean IOP at baseline, 1, 3, and 6 months was 22.5 (3.6), 19.5 (4.7), 19.6 (5.6), and 17.7 (3.3) mm Hg, respectively. There was a greater anterior chamber reaction, 1 hour after SLT v ALT (p< 0.01). Patients with previous failed ALT had a better reduction in IOP with SLT than with repeat ALT (6.8 (2. 4) v 3.6 (1.8) mm Hg; p = 0.01). CONCLUSION: SLT appears to be equivalent to ALT in lowering IOP during the first 6 months after treatment. There is a slightly greater anterior chamber reaction 1 hour after SLT. Patients with previous failed ALT had a significantly greater drop in IOP when treated with SLT v ALT. These results need to be confirmed with a larger sample size.