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Purpose: This study investigated the efficacy and safety of selective laser trabeculoplasty (SLT) in Korean patients with medically uncontrolled pseudoexfoliation glaucoma (PEXG).Methods: This retrospective observational study enrolled 43 medically uncontrolled PEXG patients who underwent a 360° SLT and were followed up for at least 12 months after SLT. The intraocular pressure (IOP) before and after SLT at 1 week, 1, 3, 6, and 12 months was evaluated. Treatment success was defined as an IOP reduction of ≥20% from the baseline and an IOP equal to lower than 22 mmHg without additional anti-glaucomatous intervention. Additionally, every follow-up medical record was reviewed to assess any possible side effects of SLT.Results: Based on the Kaplan-Meier survival analysis, the treatment success rate at 12 months after SLT was 41.9% (18 eyes). For the success group at the 12 months follow-up, SLT showed a mean IOP reduction of 10.3 ± 5.0 mmHg (from 25.6 ± 4.4 to 15.2 ± 2.9 mmHg; 39.3%, p < 0.05). Among the 25 eyes that were considered as the treatment failure group, 14 eyes underwent glaucoma filtering surgeries, four eyes received additional SLT, and further intervention and follow-up was refused for seven eyes. During the overall follow-up period, there were no significant adverse events.Conclusions: SLT is a partially effective and safe procedure for lowering IOP in Korean patients with medically refractory PEXG. Therefore, it can be considered as one of the alternative treatment modalities in patients who are at high risk for conventional filtering surgery.

PRCIS The multiplicity of treatment options for lowering intraocular pressure (IOP) is both a blessing and a challenge. Some attention to cost-analysis might assist in choosing an optimal therapy, especially in a cost-constrained, international setting. PURPOSE The aim of this study was to quantify and to analyze the relative cost of various glaucoma surgical procedures and selective laser trabeculoplasty surgery per mm Hg IOP reduction ($/mm Hg) since standard cost-utility methods are not well suited to the study of glaucoma which characteristically only claims visual acuity in its end stages. METHODS Published glaucoma treatment studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for a given treatment modality. A US perspective was adopted, using Medicare allowable costs were used to calculate a newly introduced parameter-cost per mm Hg IOP reduction-at 1 year postoperatively. RESULTS The cost per mm Hg IOP reduction after 1 year of treatment ranged from $190/mm Hg for trabeculectomy to $1376/mm Hg for iStent. For reference, the cost of selective later trabeculoplasty surgery was $121/mm Hg. After the first year, cost/mm Hg ranged from $12 to $61/mm Hg. CONCLUSIONS Conventional glaucoma surgeries and selective laser trabeculoplasty surgery were the most cost-efficient surgical methods to lower IOP compared with the various minimally invasive glaucoma surgeries options. They may be more appropriate management when cost is an important issue.

Purpose To identify systematic reviews of interventions for glaucoma conditions and to assess their reliability, thereby generating a list of potentially reliable reviews for updating glaucoma practice guidelines. Design Cross-sectional study. Participants Systematic reviews of interventions for glaucoma conditions. Methods We used a database of systematic reviews and meta-analyses in vision research and eye care maintained by the Cochrane Eyes and Vision United States Satellite. We examined all Cochrane systematic reviews of interventions for glaucoma conditions published before August 7, 2019, and all non-Cochrane systematic reviews of interventions for glaucoma conditions published between January 1, 2014, and August 7, 2019. Main Outcome Measures We assessed eligible reviews for reliability, extracted characteristics, and summarized key findings from reviews classified as reliable. Results Of the 4451 systematic reviews in eyes and vision identified, 129 met our eligibility criteria and were assessed for reliability. Of these, we classified 49 (38%) as reliable. We found open-angle glaucoma (22/49) to be the condition with the most reviews and medical management (17/49) and intraocular pressure (IOP; 43/49) to be the most common interventions and outcomes studied. Most reviews found a high degree of uncertainty in the evidence, which hinders the possibility of making strong recommendations in guidelines. These reviews found high-certainty evidence about a few topics: reducing IOP helps to prevent glaucoma and its progression, prostaglandin analogs are the most effective medical treatment for lowering IOP, laser trabeculoplasty is as effective as medical treatment as a first-line therapy in controlling IOP, the use of IOP-lowering medications in the perioperative or postoperative periods to accompany laser (e.g., trabeculoplasty) reduces the risk of postoperative IOP spikes, conventional surgery (i.e., trabeculectomy) is more effective than medications in reducing IOP, and antimetabolites and β-radiation improve IOP control after trabeculectomy. The evidence is weak regarding the effectiveness of minimally invasive glaucoma surgeries. Conclusions Most systematic reviews evaluating interventions for glaucoma are of poor reliability. Even among those that may be considered reliable, important limitations exist in the value of information because of the uncertainty of the evidence as well as small and sometimes unimportant clinical differences between interventions.

Supplemental Digital Content is available in the text., Précis: In eyes with trabeculoplasty response, those with lower baseline pressure, angle recession or uveitis had shorter survival. Eyes without medications before treatment remained medication-free for a median of 197 days. Purpose: We examined patients in a large clinical registry to assess factors associated with laser trabeculoplasty (LTP) response durations. Methods: This is a retrospective cohort study with LTP patients in the Intelligent Research in Sight Registry. Data were extracted if the eye had a LTP procedure code and a glaucoma diagnosis. In responders [≥20% intraocular pressure (IOP) reduction], any post-LTP IOP that was above 80% of baseline was considered a failure event. Eyes were censored if IOP-lowering medication/procedure was added/performed, or if the eye reached the end of follow-up. First eye of bilaterally treated patients were included. Results: A total of 79,332 patients/eyes were included; 53.2% female; mean age 71.5 years; 64.5%White; 71.2% primary open angle glaucoma. Mean baseline IOP was 21.6±5.3 mm Hg (2.1±1.5 medications). Eyes with higher baseline IOP had longer survival (>24 mm Hg median 349 d; 18 to 24 mm Hg median 309 d

Sljepoća sa svojim socijalnim i ekonomskim posljedicama predstavlja teret svakom društvu. Etiologija sljepoće mijenjala se tijekom 20.stoljeća do danas. Sljepoća uzrokovana zaraznim bolestima oka danas je u padu, dok se među najčešće uzroke smatraju katarakta, glaukom i makularna degeneracija ovisna o dobi. Glaukom je bolest koju karakterizira optička neuropatija koja s vremenom dovodi do oštećenja vidne funkcije i nepovratnog gubitka vida. Klinički, glaukom se dijeli na primarni, sekundarni i kongenitalni. Primarni glaukom dijeli se na primarni glaukom otvorenog kuta (engl. Primary Open-angle Glaucoma (POAG) i primarni glaukom zatvorenog kuta (engl. Primary Angle-closure Glaucoma (PACG). POAG čini 90 % svih slučajeva glaukoma u zapadnom svijetu. Obilježen je progresivnim i asimptomatskim tijekom te čak 50 % bolesnika nije ni svjesno bolesti, dok u nerazvijenim zemljama ta brojka dostiže i 90%. Drugi je najčešći uzrok sljepoće diljem svijeta i predstavlja velik javnozdravstveni problem. Pravilna dijagnostika sastoji se od detaljno uzete anamneze, pregleda vidne oštrine, mjerenja očnog tlaka, određivanja vidnog polja, mjerenja debljine rožnice, pregleda očnog kuta i provjere oštećenja očnog živca pomoću optičke koherentne tomografije (OCT). Terapija glaukoma sastoji se od antiglaukomskih lijekova (adrenergički agonisti, adrenergički antagonisti, inhibitori karboanhidraze, parasimatikomimetici, derivati prostaglandina i prostamidi, kombinacija navedenih lijekova), terapije laserom (laserska iridotomija, laserska trabekuloplastika, laserska iridoplastika, ciklofotokoagulacija) i kirurške terapije., Blindness with its social and economic consequences is a burden to any society. The etiology of blindness has changed during the 20th century to the present day. Blindness caused by infectious eye diseases is declining today while cataracts, glaucoma and age-dependent macular degeneration are among the most common causes. Glaucoma is a disease characterized by optic neuropathy that over time leads to impaired visual function and irreversible vision loss. Clinically, glaucoma is divided into primary, secondary and congenital. Primary glaucoma is divided into Primary Open-angle Glaucoma (POAG) and Primary Angle-closure Glaucoma (PACG). POAG accounts for 90% of all glaucoma cases in the Western world. It is characterized by a progressive and asymptomatic course, and as many as 50% of patients are not even aware of the disease, while in underdeveloped countries this number rises to 90%. It is the second most common cause of blindness worldwide and poses a major public health problem. Proper diagnosis consists of a detailed history, examination of visual acuity, measurement of intraocular pressure, determination of visual field, measurement of corneal thickness, examination of the ocular angle and examination of optic nerve damage using optical coherence tomography (OCT). Glaucoma therapy consists of antiglaucoma drugs (adrenergic agonists, adrenergic antagonists, carbonic anhydrase inhibitors, parasympathomimetics, prostaglandin derivatives and prostamides, a combination of these drugs), laser therapy (laser iridotomy, laser trabeculoplasty, cybeculoplasty, cybecolaguloplasty, laser trabeculoplasty).

BACKGROUND We aimed to evaluate the efficacy and safety of pneumatic trabeculoplasty (PNT) and selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG) and ocular hypertension (OHT). MATERIAL AND METHODS We randomly divided 120 cases (120 eyes) of POAG or OHT into 2 groups: PNT and SLT. The changes in anterior chamber angle, intraocular pressure (IOP), treatment effect, macular retinal ganglion cell complex (GCC) thickness, visual field, adverse reactions, and complications were observed before and 3 months after treatment. RESULTS In the PNT group, the opening range of anterior chamber angle at 1 week, 2 weeks, 1 month, and 3 months after surgery was significantly larger than that before surgery. In the SLT group, the open range of anterior chamber angle was significantly less than that before surgery at 1 week and 2 weeks after surgery. The open range of anterior chamber angle in the PNT group was significantly larger than that in the SLT group at 1 week, 2 weeks, 1 month, and 3 months after surgery. The mean IOP of the 2 groups decreased significantly after surgery. The postoperative mean IOP of the SLT group was significantly higher than that of the PNT group, and the decrease of IOP in the PNT group was significantly greater than that of the SLT group. The effective rate of the PNT group was higher than that of the SLT group. CONCLUSIONS Both PNT and SLT can reduce the IOP of patients with POAG and OHT. PNT appears to have better short-term treatment efficiency than SLT.

Purpose To report an uncommon case of hyperopic shift and corneal haze, flattening and thinning following a single session of selective laser trabeculoplasty (SLT), and provide longitudinal clinical data and serial analyses of corneal profile through Scheimpflug imaging. Furthermore, a careful literature review was undertaken to determine possible risk factors for this complication. Observations A 47-year-old woman presented with blurred vision and mild corneal edema and haze three days following routine SLT. Ten days later, corneal edema resolved, but she was still symptomatic. Refraction exam revealed a significant hyperopic shift and high astigmatism (+4.00–6.00 x 80° versus −11.50 -0.75 x 170° at baseline). Scheimpflug imaging revealed a partial collapse of the corneal architecture, with an expressive central cornea flattening (>10 diopters) and thinning (>190μm). Over six months, refractometric and corneal parameters gradually (but not completely) returned to their pre-operative values. Conclusions and Importance This tetrad of clinical findings - hyperopic shift, corneal haze, flattening and thinning - following SLT is referred herein by the authors as selective trabeculoplasty-induced keratopathy (STIK), which is a rare but serious complication. A critical analysis based on this case findings and on the few others reported so far suggests high-myopic patients to be more predisposed to this complication, as all reported cases had −5.0 diopters or more. Future studies are warranted to determine whether this complication can be prevented.

PRéCIS:: The 24-hour ocular dimensional profile recorded by a contact lens sensor was affected by intraocular pressure lowering interventions. Among different treatments, incisional surgery had the most significant effect.We investigated the effect of different intraocular pressure (IOP)-lowering interventions on contact lens sensor (CLS) parameters and their relationship with Goldmann applanation tonometry (GAT)-measured IOP reduction.Data from reliable CLS recordings performed before and after IOP-lowering interventions were analyzed. Three interventions were evaluated: topical medications, laser trabeculoplasty, and incisional surgery. A set of 115 different CLS parameters were derived from 24-hour curves. We compared before versus after values for each parameter. In addition, linear regression was performed using the percentage change of each CLS parameter as the outcome variable and the type of IOP-lowering procedure as the predictor after adjusting age and race. Finally, we investigated the relationship between changes in CLS parameters and GAT IOP with the Spearman rank correlation coefficient.A total of 182 eyes of 182 patients were included in the analyses: 60 (33%) topical medications, 69 (38%) laser, and 53 (29%) surgery. The mean GAT IOP change was 3.6±6.5 mm Hg (P0.001). Overall, more CLS parameters had a significant change after surgery than in the other groups (surgerylaser=drug). Linear regression showed that, for 20 CLS parameters, surgery was the most predictive of greatest percentage change in CLS signals. In all, 11 (9.5%) of the CLS parameters were significantly correlated with GAT changes.Incisional glaucoma surgery had a more pronounced effect on GAT and CLS parameters than laser and drugs. The CLS can detect changes in patterns resulting from IOP-lowering interventions beyond daytime GAT IOP. This device could potentially be used to assess treatment efficacy in glaucoma.

To evaluate the effectiveness of a single session of micropulse laser trabeculoplasty (MLT) to lower intraocular pressure (IOP) in patients with pseudoexfoliation glaucoma (PEXG). In this single-center, one-arm, prospective study patients with PEXG under prostaglandine analogue monotherapy with inadequate IOP control were treated with 360° 532-nm MLT. Patients were evaluated at 1 day, 1 month, 3 months, 6 months, and 12 months post-MLT while they were treated with the same drug regimen as pre-MLT. Mean IOP reduction and percentage of IOP change during the follow-up were calculated. Cases that required any further intervention, like additional hypotensive medication, laser or surgical therapy, throughout the study period were considered failures and removed from the study. Twenty-seven eyes (27 patients, 17 male) were included in the study. The age of the patients was 72.37 ± 6.29 years and the baseline IOP was 20.41 ± 1.87 mmHg. Treatment with MLT resulted in significantly lower IOP at 1, 3, 6, and 12 months after MLT compared to baseline (p

Objective: To compare the outcomes of selective laser trabeculoplasty (SLT) on treatmentnaive, primary open-angle glaucoma (POAG) patients with those of SLT on patients previously treated medically and/or surgically. Secondary objectives: To establish whether age, race or gender influenced SLT outcomes. Design: A retrospective chart review of patients who received SLT therapy for POAG between June 2011 and January 2015. Subjects: Group A: Treatment-naive patients (n = 15). Group B: Prior medical therapy and/or prior surgery (n = 69). Methods: Group A: Patients were treated with SLT therapy as first line, with medical treatment added as needed. Group B: Patients were treated with SLT therapy as additional therapy to medication and/or surgery. All patients were followed up for at least 1 year. Main outcome measures: A reduction in intraocular pressure (IOP) of at least 20% from baseline was considered significant. Results: The following percentage reduction in IOP was found in the different groups: Group A 50.7%, Group B 32.0%, Africans 52.2%, Indians 29.8% and Caucasians 28.87%. Conclusion: In our study patients, SLT achieved significant reductions in IOPs in treatmentnaive as well as previously surgically and medically treated eyes with POAG. Statistically significant higher reductions in IOP at 1 year after SLT was seen in treatment-naive eyes, patients older than 70 years when compared with younger patients, female patients (54%) when compared with male patients (30%) and in patients of African (52%) descent compared with Caucasians (30%).

OBJECTIVES To determine the effect of laser trabeculoplasty on peripapillary retinal nerve fibre layer thickness (RNFL), fovea avascular zone (FAZ), peripapillary and macular vessel density (VD) in glaucoma using with optical coherence tomography angiography (OCT-A). METHODS This was a prospective observational study performed at the Glaucoma Research Centre, Montchoisi Clinic, Lausanne, Switzerland. Thirty-seven eyes with primary open-angle glaucoma from 21 patients were included. Optical coherence tomography angiography (OCT-A) scans were performed before laser trabeculoplasty and at 2 and 6 months after the procedure. AngioVue AngioAnalytic (Optovue Inc, Fremont, CA, USA) software was used to analyse the RNFL, FAZ, peripapillary and macular VD. Changes were analysed using mixed models, controlling for intraocular pressure (IOP) and signal strength index (SSI) variations. RESULTS Mean IOP decreased from 18.5 (±3.7) mmHg at baseline to 15.6 (±2.7) mmHg after 2 months (-15.3%; p

International audience; Le glaucome est une neuropathie optique cécitante dont le principal facteur de risque est l’augmentation de la pression intraoculaire (PIO). Le trabéculum, au niveau de l’angle iridocornéen, constitue la principale voie de drainage de l’humeur aqueuse (HA) hors de l’œil, et son dysfonctionnement est responsable d’une augmentation de la PIO. Le trabéculum est une structure tridimensionnelle fenêtrée complexe composée de cellules trabéculaires intriquées dans une organisation multicouche de matrice extracellulaire (MEC). L’objectif de cette revue de la littérature est de fournir un état des lieux de la connaissance sur le trabéculum et sa physiopathologie dans le glaucome. Ainsi, nous présenterons les bases anatomiques et cellulaires au centre de la régulation de la résistance à l’écoulement de l’HA, les mécanismes physiopathologiques d’altération trabéculaire impliqués dans les différents types de glaucomes, ainsi que les stratégies thérapeutiques existantes ou en développement ciblant le trabéculum.

To assess the effectiveness of topical ocular hypotensive medications in patients with open-angle glaucoma and to identify factors associated with postwashout intraocular pressure (IOP) elevation.Secondary analysis of prerandomization data from 2 prospective, multicenter, randomized clinical trials.Fourteen hundred subjects (1,400 eyes, 781 from the HORIZON study of the Hydrus micro-stent and 619 from the COMPASS study of the Cypass micro-stent) with primary open-angle glaucoma who were using 0-4 classes of topical IOP-lowering medication underwent Goldmann applanation tonometry before and after a protocol-defined washout period.The mean (standard deviation) age was 70.7 (8.0) years and 55.6% were female. The change in IOP following washout for patients using 0 (n = 100), 1 (n = 705), 2 (n = 355), 3 (n = 214), or 4 (n = 26) medications was 0.2 (2.8), 5.7 (3.3), 6.9 (3.7), 8.8 (5.0), and 9.5 (4.1) mm Hg, respectively (P.001, Kruskal-Wallis test). Postwashout IOP change was similar between the HORIZON and COMPASS cohorts. No difference in postwashout IOP change was detected among individual prostaglandin analogues in patients on monotherapy. A generalized linear model identified the following factors to be associated with greater IOP rise upon medication washout: greater number of glaucoma medications, higher unmedicated IOP, thinner central corneal thickness (CCT), lack of prior selective laser trabeculoplasty (SLT), and male sex.Cessation of glaucoma medications results in a dose-dependent IOP increase in treated open-angle glaucoma patients. Two independent clinical trial cohorts exhibit similar levels of IOP elevation upon washout, using standardized methodology to estimate real-world medication effectiveness. Thicker CCT and history of SLT may predict reduced response to IOP lowering medications.

Selective laser trabeculoplasty (SLT) is the “golden standard” of laser glaucoma surgery. Its efficacy can be compared to pharmacological therapy, while in some cases its advantages may even lead to a more stable hypotensive effect. SLT may be used as a primary treatment for primary open-angle glaucoma patients and patients with ocular hypertension, while also considered safe and effective in cases when a repeat procedure is required. SLT may potentially decrease the demand for antiglaucoma drugs, improve patient’s response to treatment, make the treatment more comfortable and overall increase the patient’s quality of life. New modifications of standard laser treatment procedures have been emerging lately. This article summarizes scientific data on the efficacy and safety of the new generation of laser trabeculoplasty. It specifies the charateristics of micropulse laser trabeculoplasty (MLT), pattern-scanning trabeculoplasty (PLT) and titaniumsapphire laser trabeculoplasty (TSLT) and recounts the latest research dedicated to them.

Benjamin Abramowitz,1 Nisha Chadha,2 Amr Kouchouk,3 Rashed Alhabshan,4 David A Belyea,4 Tania Lamba4 1Glaucoma Department, Eye Consultants of Northern Virginia, Springfield, VA, USA; 2Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA; 3Cornea Department, Atlantis Eyecare, Torrance, CA, USA; 4Department of Ophthalmology, The George Washington University, Washington, DC, USA Aim: The aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients. Patients and methods: In all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1hour and 1, 1–6, 6–12, 6–24, 24–36, and 36–52weeks. Patients completed a survey 1week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3mmHg from baseline. Results: IOP was lowered to ≥3mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24–52weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24–52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52weeks post treatment. There were more treatment failures in the micropulse group up to 52weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005). Conclusion: Micropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure. Keywords: randomized controlled trial, selective laser trabeculoplasty, micropulse, glaucoma, intraocular pressure

Purpose: We compared the efficacy of sub-Tenon triamcinolone acetonide (STTA) to intravitreal triamcinolone aceto­nide (IVTA) injections during cataract surgery (CS) for patients with diabetic macular edema (DME). Methods: The medical records of 33 eyes (26 patients) with DME which had undergone CS with STTA were compared to those of 34 eyes (27 patients) with DME which had undergone CS with IVTA. Central foveal thickness and best-corrected visual acuity (BCVA) were measured at the baseline and 1, 3, and 6 months after the surgery. Results: The BCVAs after STTA and IVTA were significantly improved at 3 and 6 months. Thirteen eyes in the IVTA group and 21 eyes in the STTA group required other therapies (p < 0.05). One case developed intraocular pressure elevation after IVTA and underwent selective la ser trabeculoplasty. Conclusions: Ophthalmologists should consider the merits and demerits of IVTA and STTA for DME treatment after CS.

Argon laser trabeculoplasty as well as selective laser trabeculoplasty can be used in patients with exfoliation syndrome with similar safety and efficacy. However, treatment effect may abruptly reverse and patients need to be followed regularly to monitor intraocular pressure control. Newer laser treatment modalities including micropulse laser trabeculoplasty, titanium sapphire laser trabeculoplasty and pattern scanning trabeculoplasty show promising results but need to be studied in exfoliation patients. For exfoliation patients with angle closure, peripheral iridectomy, iridoplasty or cataract extraction can be very helpful. For refractory exfoliation glaucoma, transscleral diode laser cyclophotocoagulation offers a reasonable option to lower intraocular pressure. Other approaches to cyclophotocoagulation such as micropulse transcleral diode laser need to be studied further in exfoliation patients.

Objective Laser trabeculoplasty effectively reduces intraocular pressure (IOP) in primary open angle glaucoma, with argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) showing equivalent outcomes. However, it is unclear which laser modality is more effective in pseudoexfoliation (PXE) glaucoma. This study aims to compare the effectiveness of ALT and SLT in PXE glaucoma. Design Retrospective cohort study. Methods A chart review evaluating patients diagnosed with PXE glaucoma and treated with laser trabeculoplasty from 2005-2015. Patients with previous glaucoma surgery, other forms of secondary glaucoma, ocular surgery within six months of initial trabeculoplasty or lacking preoperative IOP measurements were excluded. Post-laser measurements were recorded until 24 months after initial intervention. Follow-up data was censored if the patient underwent a subsequent trabeculoplasty different from initial laser treatment. Results We included 84 patients in the ALT group and 123 in the SLT group. The mean (SD) baseline IOP values were 22.7 (±5.6) and 21.6 (±4.8) respectively (p = 0.11), while number of medications were 2.0 (±1.0) and 1.8 (±1.3) for ALT and SLT groups respectively (p = 0.36). The mean IOP reduction for the ALT group at 6, 12 and 24 months were 5.2 (±6.1), 5.4 (±6.9), and 4.9(±7.7) respectively. The corresponding values for the SLT group were 3.4 (±5.2), 3.8 (±4.6), and 4.6 (±6.5). Comparison of both lasers at each time point revealed no significant differences (p > 0.05) in IOP reduction or reduction of glaucoma medication. Conclusions Our study showed equivalent efficacy between ALT and SLT in patients with PXE glaucoma.

Purpose To compare the efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation with mitomycin C (MMC) versus trabeculectomy with MMC. Design International, multicenter, retrospective interventional cohort study. Participants Three hundred fifty-four eyes of 293 patients (185 microstent and 169 trabeculectomy) with no prior incisional surgery. Methods Consecutive eyes with uncontrolled glaucoma underwent microstent or trabeculectomy surgery from January 1, 2011 through July 31, 2015 at 4 academic ophthalmology centers: Toronto, Canada; Frankfurt, Germany; Salzburg, Austria; and Leuven, Belgium. Main Outcome Measures Primary outcome measure was hazard ratio (HR) of failure, with failure defined as 2 consecutive intraocular pressure (IOP) readings of 17 mmHg without glaucoma medications (complete success) at least 1 month after surgery despite in-clinic interventions (including needling). Secondary outcome measures included IOP thresholds of 6 to 14 mmHg and 6 to 21 mmHg and same thresholds allowing for medications (qualified success), interventions, complications, and reoperations. Results Baseline characteristics were similar, except more men (56% vs. 43%), younger patients (average, by 3 years), better preoperative visual acuity (22% vs. 32% with 0.4 logarithm of the minimum angle of resolution vision or worse), and more trabeculoplasty (52% vs. 30%) among microstent eyes. The adjusted HR of failure of the microstent relative to trabeculectomy was 1.2 (95% confidence interval [CI], 0.7–2.0) for complete success and 1.3 (95% CI, 0.6–2.8) for qualified success, and similar for other outcomes. Time to 25% failure was 11.2 months (95% CI, 6.9–16.1 months) and 10.6 months (95% CI, 6.8–16.2 months) for complete success and 30.3 months (95% CI, 19.0–∞ months) and 33.3 months (95% CI, 25.7–46.2 months) for qualified success. Overall, white ethnicity was associated with decreased risk of failure (adjusted HR, 0.49; 95% CI, 0.25–0.96), and diabetes was associated with increased risk of failure (adjusted HR, 4.21; 95% CI, 2.10–8.45). There were 117 and 165 distinct interventions: 43% and 31% underwent needling, respectively, and 50% of trabeculectomy eyes underwent laser suture lysis. There were 22 and 30 distinct complications, although most were transient. Ten percent and 5% underwent reoperation ( P = 0.11). Conclusions There was no detectable difference in risk of failure and safety profiles between standalone ab interno microstent with MMC and trabeculectomy with MMC.

Implementation of the micropulse technology in retinal laser therapy has led to the application of the method glaucoma treatment as well. Effectiveness of MicroPulse Laser Trabeculoplasty (MLT) is comparable to the previous ALT and SLT procedures. The therapy may be considered as first-line treatment or as a replacement or supplementation of the eye drop therapy.

Selective laser trabeculoplasty (SLT) has been indicated as a safe and efficient treatment for primary open-angle glaucoma; however, recent studies have also shown positive results with the use of SLT in some clinical conditions related to primary angle-closure glaucoma (PACG). Despite the potential benefits of SLT in selected cases of PACG, the mechanisms underlying the modifications in the trabecular meshwork tissue of patients with PACG are poorly understood. This narrative review approached both the current, limited knowledge about the histological changes observed in different forms of PACG and the clinical results of SLT treatment for PACG. Favourable outcomes of SLT in patients with PACG, specifically in areas of non-occluded angle, need further substantiation through large controlled clinical trials. A deeper understanding of the biomolecular changes of those areas is essential to improve both laser technical details and the clinical efficacy of SLT therapy.

Purpose To demonstrate disposable trabeculoplasty lens damage after routine selective laser trabeculoplasty (SLT) for primary open-angle glaucoma. Methods Disposable single-mirror laser lenses were used to perform SLT in 2 patients with primary open-angle glaucoma. Images of the single-use mirrors were taken before and after treatment. Results One lens showed heavy focal loss of reflectivity of its mirror with SLT settings of 0.8 to 0.9 mJ × 97 shots on a patient with a lightly pigmented angle. Aiming beam splashing or loss was noted after most shots. The second lens showed much less damage with 0.6 mJ × 90 shots in a heavily pigmented angle. Conclusion Although single-use Gonio lenses have gained popularity for their role in infection control and elimination of wear and tear of reusable lenses, our cases show that damage occurs to the silver mirror because of high laser fluence, interfering with proper aiming and possibly diminishing delivered energy and treatment efficacy.