Julia Song

High failure rate associated with 180 degrees selective laser trabeculoplasty.

Purpose:To determine the efficacy of selective laser trabeculoplasty (SLT) in a tertiary care referral center. Patients and Methods:In this retrospective study of selective laser trabeculoplasty performed by five physicians, 94 eyes from 94 patients were included. A majority (83/92, 90%) underwent 180° selective laser trabeculoplasty. Selective laser trabeculoplasty failure was defined in two ways: (1) IOP decrease <3 mm Hg (definition one), or (2) IOP decrease <20% (definition two), on two successive visits ≥4 weeks after SLT. Results:Overall failure rates were 68% (64/94) and 75% (70/94) (by definitions one and two, respectively). By survival/life-table analysis, mean time to failure was 6 months and 5.5 months, by definitions one and two, respectively. By the end of the study (14.5 months), the failure rates were 86% and 92% by definitions one and two, respectively. By each definition, in both univariable and multivariable analysis, only lower baseline IOP was a significant predictor of failure. Conclusions:Selective laser trabeculoplasty had an overall low success rate in our tertiary clinic population, with overall failure rates of 68% to 74% in those who underwent 180° selective laser trabeculoplasty.

Effect of laser in situ keratomileusis on optic nerve head topography and retinal nerve fiber layer thickness

Purpose: To determine whether laser in situ keratomileusis (LASIK) produces significant changes in optic nerve head (ONH) topography and retinal nerve fiber layer (RNFL) thickness as measured by the Heidelberg Retina Tomograph (HRT) and to evaluate the potential neuroprotective effect of topical betaxolol on these changes. Setting: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Methods: In this prospective randomized double‐masked comparative case series, 34 patients having LASIK for myopia were randomly assigned to receive topical betaxolol 0.5% solution or placebo twice a day for 2 days before the procedure and 7 days after the procedure. Preoperative and postoperative (1 week and 1 and 3 months) images were made with the HRT. Four HRT parameters (rim area, rim volume, mean RNFL thickness, and cup shape measure) were analyzed in a masked fashion. The Student paired t test was used for statistical analysis. Results: No significant changes from baseline occurred in any HRT parameter in either patient group or when the patients were evaluated as a single group. Conclusions: Laser in situ keratomileusis did not adversely affect ONH morphology or RNFL thickness as measured by HRT. Since no neural damage was detected, the potential neuroprotective effect of betaxolol could not be evaluated.

The effect of surgery on intraocular pressure fluctuations with electroconvulsive therapy in a patient with severe glaucoma.

We sought to report glaucoma surgery as a possibly protective measure in patients with elevated intraocular pressure (IOP) during electroconvulsive therapy (ECT). An interventional case report is reported. IOP measurements were taken in patients with progressive glaucoma who had one eye fitted with a glaucoma tube implant and other without tube implant before, during, and after ECT treatment. IOP fluctuation was reduced in the eye that had undergone double tube implant surgery. Surgical intervention may blunt the IOP spikes associated with ECT.