Phacoemulsification combined with micropulse cyclodiode laser in glaucoma patients: efficacy and safety.

OBJECTIVE: To evaluate the safety and efficacy of phacoemulsification combined with Micropulse transscleral cyclophotocoagulation (MP-TSCPC) in glaucoma patients. METHODS: This is a retrospective case-note review. The participants were adult patients with diagnoses of glaucoma and cataract who required a further reduction in IOP or a reduction in the number of glaucoma drops. All consecutive patients who underwent cataract surgery (CS) combined with MP-TSCPC laser between October 2018 and July 2019 were included in the study. The effect on visual acuity (VA), intraocular pressure (IOP) and number of anti-glaucoma drops were evaluated at 6 and 12 months in addition to any complications that occurred during any time point of the study. RESULTS: 42 eyes were included in the study. Mean IOP was reduced from 19.5 ± 5.4 mmHg by 22.5% to 15.1 ± 4.6 at 6 months post-operatively and by 19.5% to 15 ± 6.6 mm Hg at 12 months (p < 0.001 at both time points). The number of anti-glaucoma medications also reduced significantly from 2.8 ± 1.3 to 1.6 ± 1.2 at 6 months and to 2.2 ± 1.3 at 12 months (p < 0.001 at both time points). The success rate was 56% at 6 months and 54% at 12 months. 54.7% of our patients who completed 12 months follow up had an improvement or unchanged vision at the last visits. CONCLUSION: This is the first study evaluating the effect of cataract surgery combined with MP-TSCPC in glaucoma patients. We demonstrated that this led to a reduction in IOP and the number of anti-glaucoma medications at 6 and 12-month postoperatively. The majority of patients had either stable or better vision at 12 months follow-up.

Intraocular pressure changes following topical ocular hypotensive medications washout.

BACKGROUND: To review the changes in intraocular pressure (IOP) following topical hypotensive medications washout in patients with primary open angle glaucoma (POAG), ocular hypertension (OHT) and uveitic glaucoma (UG)/OHT. METHODS: The study included 120 patients with POAG, OHT and UG recruited from prospective clinical trials between February 2013 and July 2017. We excluded 20 eyes with IOP of ≤21 mm Hg, 11 eyes with previous incisional surgery and 17 eyes with incomplete data. UG eyes with active inflammation and on steroid treatment were excluded. Participants underwent a 1-month washout period from topical ocular hypotensive medications before IOP phasing. Comparisons were made between pre/post-washout IOP, and highest-recorded (peak) and post-washout IOP. RESULTS: A total of 110 eyes with POAG, 33 eyes with OHT and 43 eyes with UG were included for analysis. The mean pre-washout IOP was 18.1±3.3 mm Hg in POAG, 18.8±3.3 mm Hg in OHT and 17.9±8.8 mm Hg in UG; the mean post-washout IOP was 26.6±4.8 mm Hg, 26.4±3.9 mm Hg, 23.1±10.1 mm Hg in POAG, OHT and UG, respectively. The mean increase in IOP after washout was significantly lower in UG compared with POAG and OHT eyes (p=0.01). The percentage of eyes with post-washout IOP <22 mm Hg was 12.7% in POAG, 6.1% in OHT and 51.2% in UG. CONCLUSION: Active inflammation and steroid treatment contributes to elevated IOP in uveitis. Therefore, IOP may revert to normal once inflammation subsides. We recommend ocular hypotensive treatment washout to be considered in UG eyes that have IOP under control in the absence of recurrence of uveitis.

Effect of high-intensity focused ultrasound (HiFU) treatment on intraocular pressure and aqueous humour dynamics: 12 -months results.

PURPOSE: High intensity focused ultrasound (HiFU) is a cyclodestructive therapy for controlling intraocular pressure (IOP) in glaucoma. The mechanism of action is thought to be through destruction of the ciliary epithelium as well as increased uveoscleral outflow. We reviewed the change in aqueous humour dynamics parameters including aqueous humour flow rate, tonographic outflow facility (TOF) and uveoscleral outflow at 12 months. PATIENTS AND METHODS: This is a prospective observational study. Consecutive patients with open angle glaucoma (OAG) or ocular hypertension (OHT) requiring further IOP lowering were enroled in the study between August 2016 and January 2017. Patients were commenced on medication washout period prior to baseline and twelve months' visit. RESULTS: Sixteen patients (OAG) in the treatment group underwent assessment at twelve months follow up. Mean age was 63.1 ± 11 years. Eleven patients were African/Caribbean and 5 were Caucasian. Nine patients were female and 7 were male. Mean post-washout IOP was reduced by 21% (28.3 ± 5.7 at baseline vs 22.4 ± 8.4 mmHg at 12 months, p = 0.04). Aqueous humour flow rate was reduced by 16% at twelve months (2.40 ± 0.6 at baseline vs 2.02 ± 0.6 µl/min at 12 months, p = 0.0493). There was no statistically significant change in the TOF (0.12 ± 0.09 at baseline vs 0.08 ± 0.05 µl/min/mmHg at 12 months, p = 0.08) or uveoscleral outflow (0.6 ± 1.3 at baseline vs 1.3 ± 0.85 µl/min at 12 months, p = 0.15). CONCLUSION: In this study, we demonstrated that the observed IOP reduction was likely due to aqueous humour flow rate reduction. The TOF and uveoscleral outflow were not detectibly changed.

Predictors of selective laser trabeculoplasty success in open angle glaucoma or ocular hypertension: does baseline tonography have a predictive role?

BACKGROUND: The determinants of success of selective laser trabeculoplasty (SLT) in treatment-naïve patients with open angle glaucoma (OAG) and ocular hypertension (OHT) have not been understood fully. Therefore, we have conducted this study to explore the predictors of success. METHODS: This is a retrospective review of a pre-existing database of patients who had received primary SLT at St Thomas' Hospital, London, UK. Patients with OAG and OHT who had received primary 360° SLT treatment and had reliable baseline tonographic outflow facility (TOF) with minimum of 1 year of follow-up were included. Univariate and multivariate analyses were performed to find the determinants of success. RESULTS: One hundred and seventy-four patients between August 2006 and February 2010 had received primary 360° SLT treatment and had baseline TOF measurement. Of these, 72 subjects fulfilled the eligibility criteria. In multivariate regression analysis, the only variable associated with success was baseline intraocular pressure (IOP) (R2=0.32, beta=-0.51, p<0.001, 95% CI -2.02 to -0.74). CONCLUSION: To our knowledge, this is the only study investigating the pretreatment TOF (measured with electronic Shiøtz tonography) and IOP as determinants of success 12 month's post-360° SLT in treatment-naïve patients with OAG and OHT. This study demonstrated that pretreatment IOP (and not TOF) is the only determinant of success after primary SLT therapy.