Five-Year Long-Term Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma

Purpose Selective laser trabeculoplasty (SLT) is known as a safe laser therapy for an effective reduction in intraocular pressure (IOP). The aim of this study was to examine the therapeutic success of SLT in open-angle glaucoma (OAG) patients with a long-term follow-up of 5 years. Methods Forty-six eyes of forty OAG patients, some with previous intraocular surgery, underwent SLT (24 males, 16 females). Therapeutic success was categorized as: category (I) – IOP reduction ≤ 21 mmHg and > 20% compared to baseline IOP with additional glaucoma medication; category (II) – IOP reduction ≤ 18 mmHg and > 30% compared to baseline IOP with additional glaucoma medication; category (III) – IOP reduction ≤ 18 mmHg without any additional glaucoma medication at all follow-ups. Therapeutic failure was defined as the necessity of any further glaucoma surgery (IV). Results (1) SLT was well tolerated in all eyes, and no severe side effects or complications were recorded. (2) After 1-year follow-up, therapeutic success was 27% (I), 30% (II), and 3% (III). The therapeutic failure rate was 40% (IV). (3) After 2 years follow-up, therapeutic success was 7% (I), 10% (II), and 0% (III). The therapeutic failure rate was 83% (IV). (4) After 3 years follow-up, the therapeutic failure rate increased up to 100% (IV). Conclusion SLT seemed to be effective in lowering IOP in the first year in the present cohort, however, the long-term effect is low and additional local therapy or surgical interventions are necessary.

Diagnose eines Zentralarterienverschlusses (ZAV) ohne Funduskopie

ZusammenfassungDer retinale Zentralarterienverschluss stellt mangels etablierter evidenzbasierter Therapie eine der wenigen bisher ungelösten ophthalmologischen Probleme dar. Ein vielversprechender kurativer Ansatz ist die intravenöse Fibrinolyse mit dem Ziel der raschen Wiederherstellung der retinalen Perfusion. Die aktuelle Studienlage empfiehlt eine Therapieeinleitung innerhalb von 4,5 h. Dieses Fenster wird aufgrund von Verzögerungen in der Diagnostik (z. B. der Zeitverlust bis zur augenärztlichen Untersuchung) und der anschließenden Prozessierung der Patienten (Weiterleitung in ein spezialisiertes Zentrum) häufig verpasst. In dieser Arbeit stellen die Autoren ein differenzialdiagnostisches Hilfsmittel in Form eines Frage- und Untersuchungsbogens vor, mit dessen Hilfe die Zeit bis zur möglichen Therapieeinleitung deutlich verkürzt werden könnte.

Assessment of Tear Film Anomalies in Childhood Obesity

Purpose To determine if childhood obesity has an effect on the ocular surface and tear film of children who are afflicted. Methods Patients who had childhood obesity, 85 eyes, and patients who were healthy, 75 eyes, were enrolled in this prospective and comparative study. The tear film breakup time (TF-BUT), tear meniscus area and height (TMA and TMH) values, Schirmer test scores, and ocular surface disease index (OSDI) scores were obtained for all participants. Results The TMH, TMA, TF-BUT, and Schirmer test results were statistically significantly lower in the obesity group (p < 0.001 for all). The children with obesity and insulin resistance had lower TMH, TMA, TF-BUT, and Schirmer test results when compared to the children without insulin resistance (p < 0.05 for all). The body mass index was found to be correlated with the TMH, TMA, TF-BUT, and Schirmer test results (p < 0.001 for all). Conclusion Children with obesity had lower TMA, TMH, TF-BUT, and Schirmer test results than healthy subjects. When insulin resistance was added to obesity, these values were even lower.

Coats Disease in 9 Patients: A Hispanic Case Series

Background/Aim To describe demographic and clinical characteristics, treatment, and visual prognosis of Coats disease in Hispanic patients. Methods A retrospective chart review was performed on nine patients (ten eyes) diagnosed with Coats disease in our two clinical centrers from 2004 – 2017. Results Mean age at diagnosis was 5.5 years (range 1 – 12 years) and mean follow-up time was 48 months (range 9 – 108 months). Eight patients (89%) were male and had unilateral disease and one (11%) female patient had bilateral disease. In 40% of the cases, patients were asymptomatic. Visual acuity at first presentation was worse than hand motion in 60% of the eyes. Half of the eyes (5/10 eyes, 50%) had exudative retinal detachment (≥ stage IIIA). Vascular ablation with cryotherapy combined with retinal photocoagulation was the most frequent therapeutic approach (40%). Despite anatomical success at 6 months in 100% of the treated eyes, visual outcome at 1 year of treatment was poor (worse than 20/200) in 70% of the cases. Conclusions In our case series, patients were mostly asymptomatic on presentation, with severe stages of Coats disease. Even with anatomical success after surgical treatment in all treated cases, long-term visual prognosis remained very limited.