Laser Iridotomy Research Articles

Does Laser Iridotomy Cause Secondary Epiretinal Membrane?

This study aimed to determine the frequency of epiretinal membrane (ERM) in the long term after neodymium-doped yttrium aluminum garnet laser iridotomy (LI) using spectral domain optical coherence tomography (SD-OCT). This retrospective study included 94 eyes that underwent LI for primary angle-closure glaucoma, were followed for at least 4 years, and had no ERM before the procedure. The control group consisted of 66 eyes that were followed for suspected glaucoma did not have a previous ERM. We compared the ERM frequencies of the groups at the last visit. Additionally, ERM frequencies were compared between those who had cataract surgery in the post-LI period and those who did not. After a follow-up period of at least 4 years, ERM developed in 36 of 94 eyes (38.2%) in the LI group. Of these, 32 were stage 1 ERM (34.0%) and 4 were stage 2 ERM (4.2%). In the control group, ERM developed in 13 of 66 eyes (19.6%), 12 of which were stage 1 ERM (18.1%) and 1 was stage 2 ERM (1.5%) (p=0.012). ERM developed in 14 of 32 eyes (43.7%) who underwent phacoemulsification surgery after LI and in 22 of 62 eyes (35.4%) that underwent only LI without subsequent cataract surgery (p=0.435). ERM developed significantly more frequently in the 62 phakic eyes that underwent only LI than in the eyes in the control group (p=0.045). LI appears to be a predisposing factor for the development of ERM, regardless of subsequent cataract surgery.

The many faces of secondary angle closure glaucoma: A practical approach to unveil.

Secondary angle closure glaucoma (SACG) can be quite puzzling and can challenge even an experienced glaucoma surgeon. Unlike primary angle closure glaucoma, SACG can have various ocular and systemic associations. A careful review of the symptoms and past ocular and surgical history cannot be overemphasized. Some of the SACG can be refractory, requiring drainage devices. However, sometimes, all it takes is a prompt laser iridotomy. This can significantly reduce ocular morbidity and, in some situations, even blindness. Gonioscopy, often an underutilized technique, is critical in making the right diagnosis. With the advent of imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, one can easily pick up the etiology and treat early. As many cases of SACG present acutely, it is critical that one makes a prompt diagnosis. We present here a video bouquet of illustrated examples of SACG and the steps to identify the cause by using different imaging techniques. Through this video, we aim to make the diagnosis of SACG a simpler, more streamlined, and logical process that will help in the accurate diagnosis and management. This video demonstrates various etiologies of secondary angle closure and methods to identify and treat the same. Secondary angle closure can occur either with or without pupillary block. SACG with pupillary block involves mechanisms such as seclusio pupillae, aphakic/pseudophakic glaucoma, phacomorphic glaucoma, and silicon oil-induced glaucoma. In contrast, there are various other etiologies causing anterior pulling or posterior pushing mechanisms that contribute to non-pupillary block SACG. We discuss all of these, along with the imaging modalities needed to identify the same. https://youtu.be/N0bIw7Uknww.

Low-cost do-it-yourself (DIY) kit for glaucoma procedures.

Surgical skill training in ophthalmology is pivotal for ensuring optimal and safe patient outcomes. Access to traditional training resources such as cadaveric or animal eyes, as well as modern alternatives such as silicone eyeballs and simulators, remains limited, especially in resource-constrained settings. We present a series of innovative and low-cost do-it-yourself (DIY) models for glaucoma training using readily available hospital waste materials. These models allow ophthalmic assistants, fellows, and junior consultants to practice various procedures before transitioning to live patients, thereby enhancing surgical proficiency and minimizing the financial burden on both trainees and training institutions. We were able to practice procedures such as tonometry, central corneal thickness measurement, laser suture lysis, laser iridotomy, anterior chamber decompression, bleb needling, trabeculectomy flap construction, and suturing. By providing a practical and easy training solution, these models have the potential to boost confidence among glaucoma trainees and thus address the growing demand for skilled glaucoma surgeons.

Epidemiology and Treatment of Patients With Primary Open Angle Glaucoma in Germany: A Health Claims Data Analysis.

Based on a large administrative database of German claims data, our study provides current estimates of the prevalence and incidence of primary open angle glaucoma (POAG) in Germany and describes selected outcomes for prevalent patients with POAG. To estimate the prevalence and incidence of POAG in Germany, to describe the patient population in terms of comorbidity burden, routine care, and overall healthcare resource utilization (HCRU) and associated costs, and to describe treatment patterns over time in patients undergoing relevant laser procedures. Based on anonymized German claims data, we carried out a retrospective, noninterventional study covering calendar years 2016-2021. For the adult German population (≥18y), we estimated a POAG 1-year prevalence of 1.70% and a 1-year incidence of 0.17% in 2018; both increased with age, peaking in 80- to 89-year-olds. Prevalence and incidence were lower in 2020 (1.65% and 0.16%, respectively), the first year of the SARS-CoV-2 pandemic. Most patients solely received topical treatment. Most surgically treated patients underwent laser trabeculoplasty, followed by laser iridotomy, trabeculectomy, and filtration operations with implant. In patients undergoing laser trabeculoplasty, the treatment regimen was nearly unchanged in the second year after, compared with 2 years before the procedure. Multimorbidity was commonly observed; 75.5% of patients had arterial hypertension and 50.0% had disorders of lipoprotein metabolism and other lipidemias, compared with 60.1% and 39.2%, respectively, in an age- and sex-matched control sample. Our study provides insights into epidemiology and routine care of POAG in Germany and HCRU in prevalent patients. There was little change in treatment regimens in patients who underwent laser trabeculoplasty, 2 years after the procedure. Most patients were multimorbid highlighting the need for comprehensive care.

Intraocular Pressure While Using Gonioscopy, SLT, and Laser Iridotomy Lenses: An Ex Vivo Study.

The purpose of this study was to measure intraocular pressure (IOP) elevation while applying standard gonioscopy, selective laser trabeculoplasty (SLT), and laser iridotomy procedural lenses. Twelve cadaver eyes were mounted to a custom apparatus and cannulated with a pressure transducer which measured IOP. The apparatus was mounted to a load cell which measured the force on the eye. Six ophthalmologists performed simulated gonioscopy (Sussman 4 mirror lens), SLT (Latina lens), and laser iridotomy (Abraham lens) while a computer recorded IOP (mm Hg) and force (grams). The main outcome measures were IOP and force applied to the eye globe during ophthalmic diagnostics and procedures. The average IOP's during gonioscopy, SLT, and laser iridotomy were 43.2 ± 16.9 mm Hg, 39.8 ± 9.9 mm Hg, and 42.7 ± 12.6 mm Hg, respectively. The mean force on the eye for the Sussman, Latina, and Abraham lens was 40.3 ± 26.4 grams, 66.7 ± 29.8 grams, and 65.5 ± 35.9 grams, respectively. The average force applied to the eye by the Sussman lens was significantly lower than both the Latina lens (P = 0.0008) and the Abraham lens (P = 0.001). During gonioscopy indentation, IOP elevated on average to 80.5 ± 22.6 mm Hg. During simulated laser iridotomy tamponade, IOP elevated on average to 82.3 ± 27.2 mm Hg. In cadaver eyes, the use of standard ophthalmic procedural lenses elevated IOP by approximately 20 mm Hg above baseline.

Telemedicine for Screening and Follow-Up of Glaucoma: A Descriptive Study.

Introduction: Glaucoma is a leading cause of irreversible blindness. It is a prevalent disease worldwide, affecting ∼70 million people and expected to reach up to 112 million by 2040. Purpose: The aim of this study is to describe the implementation and initial experience of a telemedicine program to monitor glaucoma and glaucoma suspect patients in a large, integrated health care system during the COVID-19 pandemic. Methods: A retrospective chart review of established glaucoma or glaucoma suspect patients who participated in a telemedicine evaluation at the ophthalmic center of a large, Colombian health care system between June 2020 and April 2023 was conducted. Clinical and sociodemographic variables were analyzed. Generated clinical orders for additional testing, surgical procedures, follow-ups, and referrals, as well as changes in medical treatment, were evaluated. Results: A total of 11,034 telemedicine consults were included. The mean ± standard deviation age of this group was 63 ± 17.2 years and 67% were female. Of the patients who attended teleconsults, 49% were glaucoma suspects and 38.5% were followed with a diagnosis of open-angle glaucoma. After the consult, 25% of patients were referred to a glaucoma specialist, 40% had additional testing ordered, and 8% had a surgical procedure ordered, mainly laser iridotomy (409 cases). Almost a third of patients returned for subsequent telemedicine visits after the initial encounter. Despite some technical difficulties, 99.8% of patients attended and completed their scheduled telemedicine appointments. Conclusions: A telemedicine program aimed to monitor established glaucoma patients can be successfully implemented. Established patients within an integrated health care system have high adherence to the virtual model. Further research by health care institutions and government agencies will be key to expand coverage to additional populations. Clinical Trial Registration Number: CEIFUS 1026-24.

Comparison of Nd: YAG Laser Iridotomy Alone Versus Sequential Argon-Nd: YAG Laser Iridotomy in Patients with Primary Angle Closure Spectrum

Purpose: To compare the mean Nd: YAG energy used and mean decrease in IOP 3-hours post-laser, in Nd: YAG Laser iridotomyalone versus sequential Argon-Nd:YAGiridotomy in patients with primary angle closure spectrum. Study Design: Quasi experimental Study. Place and Duration of Study: Department of Ophthalmology, Allied Hospital, Faisalabad from March 2022 to August 2022. Methods: After taking approval from Ethical review board, 70 patients with angle closure spectrumwere included in the study. Out of 70, 25 patients were primary angle closure suspect (PACS), 28 had primary angle closure (PAC) and 17 patients had primary angle closure glaucoma (PACG). We sorted patients into Group A (those who underwent sequential Argon-Nd: YAG Laser peripheral iridotomy) and Group B (those who underwent Nd: YAG laser alone). Mean Nd: YAG energy used was noted in each group and compared using SPSS version 25.0. Mean decrease in IOP 3-hours post-laser was also noted and compared. Results: Mean decrease in IOP 3 hours post-laser was 5.46 ± 3.70 mmHg for sequential Argon-Nd: YAG LPI versus 3.46 ± 2.38 mmHg for Nd: YAG LPI alone (p-value = 0.009). Mean Nd: YAG energy used in sequential Argon-Nd: YAG LPI group was significantly lesser when compared to Nd: YAG LPI alone group (32.70 ± 38.87 versus 139.37 ± 62.32 mJ) which was found to be statistically significant (p = 0.0001). Conclusion: Sequential Argon-Nd-YAG laser iridotomy uses significantly less Nd:YAG energy than conventional Nd:YAG only method with better IOP control.

Cost–Utility Analysis of Prophylactic Laser Peripheral Iridotomy for Primary Angle Closure Suspects

To assess the cost-utility of prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) suspects (PACS). Economic evaluation. Our Markov model randomized PACS eyes to LPI or observation for 40 one-year cycles (100,000 iterations per strategy). Each cycle, an eye remained in its current health state, advanced linearly through PAC, mild, moderate, severe, and end-stage PAC glaucoma (PACG), or died. Transition rates were derived from the literature including the Zhongshan Angle Closure Prevention (ZAP) trial and the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (ANA-LIS). Eyes with acute-angle closure advanced to either PAC or directly to various PACG severities. A tracker monitored accumulated perimetric decibel reduction to progress PACG through increasing severities, with an annual probability of either stable or severity-dependent perimetry loss. We set a willingness to pay of an incremental cost-effectiveness ratio (ICER) <$50,000/quality-adjusted life-years. At age 50 years, LPI was cost-saving using ZAP data and cost-effective using ANA-LIS data. The ZAP iterations became cost-effective from the societal perspective when the model started at age 55 years and third-party perspective at age 70 years. LPI was no longer cost-effective from the societal perspective using ANA-LIS data at age 80 years or from the societal perspective using ZAP data or third-party perspective with ANA-LIS data at age 85. Probabilistic sensitivity analyses favored LPI until starting age 85. Prophylactic LPI for PACS is cost-effective across a spectrum of ages and should be considered from a public health perspective.

Longitudinal Rates of Change in Structural Parameters of Optical Coherence Tomography in Primary Angle Closure Glaucoma following Laser Iridotomy along with Peripheral Iridoplasty.

This study aimed to investigate longitudinal rates of change (LRCs) of structural parameters from optical coherence tomography (OCT) in patients with primary angle closure glaucoma (PACG) after laser iridotomy (LI) along with laser peripheral iridoplasty (PI). Among 146 patients diagnosed with PACG, thirty-two subjects (32 eyes) who underwent LI plus PI and accomplished more than five times of reliable OCT tests were included in the current retrospective study. Retinal nerve fiber layer (RNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured by spectral-domain OCT with three month interval. LRCs of global and six Garway-Heath sectors were investigated using the linear mixed-effects model which adjusted BMO area, sex, and age. Imaging of dual Scheimpflug analyzer was performed before and at 1 week after LI with PI and yearly thereafter. The mean follow-up period was 32.28 ± 13.34 months with a mean number of 10.18 ± 3.33 OCT images. Baseline characteristics are as follows: age, 63 ± 7.9 years; female, 62.5%; intraocular pressure(IOP), 15.48 ± 4.79 mmHg; anterior chamber depth, 2.09 ± 0.18 mm; and mean deviation, -7.97 ± 8.48 dB. Global LRC of BMO-MRW was 0.86 ± 1.34 μm/yr and RNFL was -0.64 ± 0.22 μm/yr. IOP decreased significantly to 13.06 ± 2.21 mmHg (p=0.001) while anterior chamber volume (p=0.011) and mean anterior chamber angle (p=0.022) increased significantly after LI along with PI compared to the baseline at the final visit. LRC of a new parameter, BMO-MRW, and LRC of RNFL were relatively low in patients with PACG, following LI along with PI. After widening of the anterior chamber angle and decrease of IOP due to LI plus PI, PACG might show stable structural prognosis assessed by OCT.

Long-Term Efficacy of Selective Laser Trabeculoplasty in Primary Angle-Closure Disease After Laser Peripheral Iridotomy

ABSTRACT Purpose To evaluate the long-term efficacy of selective laser trabeculoplasty (SLT) in eyes with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG) following a laser peripheral iridotomy (LPI). Method In this prospective cross-sectional study, 45 eyes of 34 patients with PAC/PACG diagnosis, uncontrolled intraocular pressure (IOP), and visible pigmented trabecular-meshwork (TM) at least 180° on gonioscopy following a LPI were recruited. Following a detailed baseline ophthalmic evaluation, all eligible eyes underwent SLT, and the patients were examined on day1, at 1 week, 1-, 3-, and 6-months, and 1-, 2-, 3-, 4-, and 5-year subsequently. The main outcomes measured were IOP, number of IOP-lowering agents, and complications. Results The mean age of the cohort was 57.80 ± 6.44 years, the male–female ratio was 8:26, and 17 eyes were PACG, and 28 were PAC. The baseline IOP was 23.81 ± 1.78 mm Hg, and was significantly declined at all follow-ups (p < .0001). The cumulative probability of overall success was 91% and 84% at 2-, and 5-year, respectively. At 5-year SLT provided drug-freedom in 80% of PAC and 23% of PACG eyes. Six eyes had IOP spike at 1-week and two patients underwent repeat SLT after 1-year. No other complications, such as pain/discomfort, inflammation, an increase in peripheral anterior synechiae and cystoid-macular-edema, were noted. Conclusions SLT appears a safe and cost-effective procedure in PAC/mild- moderate PACG eyes with uncontrolled IOP after laser iridotomy. The long-term effectiveness of SLT as adjuvant treatment was good, but need large sized randomized studies for more validation.

Ophthalmic surgeries on post mortem porcine eyes with picosecond ultrashort laser pulses.

This work demonstrates significant advantages in ophthalmic surgeries through the use of picosecond ultrashort laser pulses instead of state-of-the-art nanosecond laser pulses. These ultrashort lasers shall serve as universal tools more effectively combining advantages of high precision, low impact and economic advantages compared to existing instruments. As samples, we used post-mortem porcine eyes on which we performed the experiments with both picosecond and nanosecond lasers. Performed surgeries were laser iridotomy, (post-) cataract treatment/capsulotomy and selective laser-trabeculoplasty. Pulse widths were between 12 ps and 220 ns with pulse energies between 30 μJ and 10 mJ at 532 nm and 1,064 nm. Additionally, we investigated accompanying shock waves, cavitation bubbles, and heat effects during the ablation processes. For all surgeries, significant differences were observed between picosecond and nanosecond pulses: It was possible to scale the pulse energy down to 10 of microjoules rather than requiring millijoules, and resulting tissue ablations are much more precise, more deterministic and less frayed. The shock wave and cavitation bubble investigation revealed major differences in pressure between picosecond pulses (0.25 MPa, 50 μJ) and nanosecond pulses (37 MPa, 5 mJ). The heat input during ablation could be lowered by two orders of magnitude. Picosecond ultrashort laser pulses show substantial benefits for several ophthalmic surgeries, with regard to ablation precision, shock wave generation and heat input. They are better than state-of-the-art ophthalmic nanosecond lasers in all aspects tested.

Intraoperative Iridectomy in Femto-Laser Assisted Smaller-Incision New Generation Implantable Miniature Telescope.

In this study, we aimed to report the short-term (6 months) effects on visual functionality and safety of femto-laser assisted smaller-incision new-generation implantable miniature telescope (SING-IMT™) implanting, particularly related to postsurgical intraocular pressure increase, in patients suffering from end-stage age-related macular degeneration (AMD) and cataract. This device, designed for monocular use, aims to minimise the impact of the central scotoma by projecting the images onto a larger area of the photoreceptors surrounding the macula. In this prospective multicentric observational case series study, 6 eyes of 6 patients who underwent SING-IMT™ implantations were enrolled. At baseline and 6 months follow-up, best corrected distance visual acuity (BCDV) and best corrected near visual acuity (BCNVA), intraocular pressure (IOP), anterior chamber depth, endothelial cells count were assessed. In addition, IOP was also measured at 7, 15, 30, 45 days, and at 3 months follow-up. Finally, the incidence of complications was evaluated. At final follow-up, in the study eyes, mean BCDVA improved by +10.0 letters (6.25; 13.8) letters and mean BCNVA improved by -0.30 logMAR (-0.55; -0.20). At postoperative month 6, we reported a mean IOP decrease of 4.50 mmHg (-5.75; -0.25). Interestingly, 83.3% of patients had an increased IOP value in at least one of the first two postoperative follow-ups (7 days and 15 days). In patients in whom intraoperative mechanical iridotomy was not performed, it was necessary to perform a postoperative YAG laser iridotomy to improve IOP management. Compared to the baseline, ECD loss at 6 months follow-up was 12.6%. The SING IMT™ device was found to be effective in the distance and near vision improvement, without serious postoperative complications. We recommend intraoperative mechanical iridectomy in order to easily manage post-operative IOP and to avoid sudden IOP rise with its possible consequences. These good results can be a hope to partially improve the quality of life of patients suffering from severe end stage macular atrophy.

Acute glaucoma attack in a patient recovered from coronavirus infection (case report)

The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.

Anterior Segment OCT Image after Laser Iridotomy

Anterior Segment OCT Image after Laser Iridotomy

On the pathogenetic classification of primary angleclosure glaucoma

Purpose: to clarify the pathogenetic classification of primary angle-closure glaucoma (PACG) based on genetic studies and retrospective analysis.Material and methods. 28 patients (44 eyes) aged 40 to 75 years with various forms of initial, advanced, advanced and terminal stages of PACG, as well as combined glaucoma, were observed.Results. Pathogenetically significant genetic polymorphisms responsible for synechiogenesis in chronic PACG have been found. Clinical and genetic analysis of PACG showed that the classification based on the clinical course, the mechanisms of closure of the iridocorneal angle (ICA), the distribution by stages of primary closure of the ICA, the severity of the pathological process and the level of intraocular pressure, fail to take into account the genetic characteristics of patients with PACG: these are predetermined at birth. In appositional closure of the ICA, preventive laser iridotomy is indicated, while in synechial closure, preventive iridotomy may aggravate synechiogenesis.Conclusion. A pathogenetic classification of PACG has been proposed, which takes account of its hereditary nature. This classification, is advisable to use when choosing a treatment tactics.

Monocular Diplopia Associated with Peripheral Iridotomy

Laser iridotomy is the procedure of choice for primary angle-closure glaucoma. Ms. CS, a 47-year-old Caucasian female with a history of migraines, came to the clinic for an increased frequency of intermittent headaches, halos, and blurry vision in both eyes. Gonioscopy was performed in both eyes to assess the angles

Identification and Analysis of Primary Cilia in the Corneal Endothelial Cells of Patients with Bullous Keratopathy

Purpose To identify primary cilia in human corneal endothelial cells (CECs) obtained from patients with bullous keratopathy (BK). Methods This study involved CEC specimens obtained from 10 eyes of 10 consecutive patients (three males and seven females; mean age: 74.5 years, range: 68–90 years) with BK who underwent Descemet’s stripping automated endothelial keratoplasty at Baptist Eye Institute, Kyoto, Japan between August 2019 and September 2020. Three corneal buttons obtained from 3 patients who underwent penetrating keratoplasty for keratoconus were used as 'non-BK' controls. All specimens were evaluated with immunofluorescence staining using an antibody against acetylated α-tubulin. Results Ciliary expression was observed in six of the 10 CEC specimens; i.e. in two specimens obtained from BK patients after glaucoma surgery (trabeculectomy), in two specimens obtained from patients with Fuchs endothelial corneal dystrophy, and in two specimens obtained from a patient with BK after laser iridotomy for primary angle closure. There was acetylated α-tubulin staining but no hair-like structures in two specimens, and ciliary expression was unknown in two specimens due to the absence of cells. The length of the primary cilia varied between all specimens. In contrast, no primary cilia were observed in the corneal buttons obtained from the three keratoconus patients. Conclusion The findings in this study clearly demonstrate the expression of primary cilia in the CECs of patients afflicted with BK.

Comparing the Effectiveness of Laser Therapy, Medicaments and Surgical Treatment in Patients with Angle Closed Glaucoma

Abstract The study goal was to compare the efficiency of the medicaments, laser and surgical treatment in the patients with primary angle closure glaucoma (PACG) in order to achieve: normalization of intraocular pressure (IOP), maintaining the useful visual acuity and stabilization of visual field loss. All patients were treated at Clinic of Ophthalmology of Clinical Centre Kragujevac in Kragujevac, Serbia, in the period from June 15, 2010 to June 15, 2014. There were 116 patients in this study. They diagnosed with PACG, and they had been adequate selected for this study. They were treated with: medicaments; Nd:YAG (Neodymium:Yittrium Aluminum Garnet) laser iridotomy, and glaucoma surgery. Clinical ophthalmology controls have been introduced once or twice a month, and the vision field loss was tested three times every year. During the monitoring period of one year: no statistically significant difference occurred in terms of changes of the visual acuity among the three study-groups. The best IOP regulation was achieved after the laser treatment (53.4%), followed by the surgical treatment (28.5%), while the weakest was recorded in patients treated with the medicaments (18.1%). The percentage of the visual field loss was the biggest of patients treated with the medicaments (57%), and then the patients treated with the laser iridotomy (35%), while the least one occurred of the patients with the surgical treatment (23%). In the laser-treated group of 62 patients, the frequency of complications was 17.8%; while the out of 33 patients who had been treated (surgical), the frequency of complications was 19%. Laser iridotomy was shown to be effective of 89.5% of study-patients with PACG, while non-reactive studypatients underwent to the trabeculectomy. In addition to the high efficacy of Nd:YAG laser iridotomy in regulating of IOP values of the patients with PACG, the advantage of laser-method was in: the maneuvering of outpatients, it was easy to do, had a short lead time and was used in local anesthesia.

Apoptosis inhibitor of macrophages/CD5L enhances phagocytosis in the trabecular meshwork cells and regulates ocular hypertension.

The trabecular meshwork (TM) cells of the eye are important for controlling intraocular pressure (IOP) and regulating outflow resistance in the aqueous humor. TM cells can remove particles and cellular debris by phagocytosis, decreasing both outflow resistance and IOP. However, the underlying mechanisms remain unclear. Here, we investigate whether apoptosis inhibitor of macrophages (AIM), which mediates the removal of dead cells and debris in renal tubular epithelial cells, regulates the phagocytic capacity of TM cells. In vitro experiments revealed that CD36, the main receptor for AIM, colocalized with AIM in human TM cells; additionally, phagocytosis was stimulated when AIM was provided. Furthermore, in a mouse model with transient IOP elevation induced by laser iridotomy (LI), removal of accumulated iris pigment epithelial cells or debris in the TM and recovery of IOP to baseline levels were delayed in AIM-/- mice, compared with control mice. However, treatment with AIM eyedrops rescued AIM-/- mice from the elevated IOP after LI. Since AIM is a protein known to inhibit macrophage apoptosis, we additionally verified its involvement in macrophage removal of cellular debris and IOP. There were no statistically significant differences in the number of macrophagesbetween control mice and AIM-/- mice in the TM. Additionally, we confirmed the rescue effect of the rAIM eyedrops after macrophageshad been removed by clodronate liposomes. Therefore, AIM plays an important role in regulating the phagocytic capacity of TM cells, thereby affecting outflow resistance. Our results suggest that drugs targeting the phagocytic capacity of TM cells via the AIM-CD36 pathway may be used to treat glaucoma.

Twenty-Four-Hour Intraocular Pressure in Chronic Primary Angle-Closure Disease.

Primary angle closure and primary angle closure glaucoma may exhibit normal intraocular pressure. Twenty-four-hour intraocular pressure fluctuation is highest in primary angle closure glaucoma. The degree of peripheral anterior synechiae was associated with a 24-hour intraocular pressure pattern in primary angle-closure disease without laser iridotomy. The purpose of this study was to study 24-hour intraocular pressure (IOP) patterns in eyes with chronic primary angle-closure disease and evaluate associations between peripheral anterior synechiae (PAS) and 24-hour IOP pattern. In this prospective cohort study, 59 eyes of 35 Asian patients with chronic primary angle-closure disease underwent complete ocular examinations at Ramathibodi Hospital, Mahidol University. Twenty-four-hour IOP records were obtained using Goldmann applanation tonometry at 2-hour intervals. Peak, mean, and trough 24-hour IOP values and 24-hour IOP fluctuation (difference between peak and trough values) were compared among groups. None of the participants received any treatment before complete data collection. Even univariable analysis demonstrated a significant difference in peak, mean, and trough IOP and 24-hour IOP fluctuation between the 3 groups; the magnitude of trough IOP was not higher than 21mmHg in all groups. In multivariable analysis, PAC and PACG eyes showed significantly higher peak IOP ( P =0.020 and 0.006, respectively) and 24-hour IOP fluctuation ( P =0.048 and 0.001, respectively) compared with PACS eyes. In comparison between combined PACS and PAC eyes versus PACG eyes, PACG eyes revealed significantly higher 24-hour IOP fluctuation. The degree of PAS was associated with peak and mean IOP values and with 24-hour IOP fluctuation in PAC and PACG eyes. Twenty-four-hour IOP fluctuation was highest in PACG eyes. Although PAC and PACG eyes showed higher peak IOP and 24-hour IOP fluctuation values, compared with PACS eyes, trough IOP in PAC and PACG eyes were mostly below 21mmHg. In addition, the degree of PAS was associated with a 24-hour IOP pattern in either PAC or PACG eyes.