The AO-SLO images revealed details of glaucomatous damage that are difficult, if not impossible, to see with current OCT technology. Adaptive optics SLO may prove useful in following progression in clinical trials, or in disease management, if AO-SLO becomes widely available and easy to use.

Laser surgery that lowers eye pressure by destroying a part of the eye that produces fluid inside the eye for people with uncontrolled glaucoma What is the aim of this review?The aim of this Cochrane Review was to find out how laser procedures compare to other approaches for lowering the pressure in the eye for people with glaucoma that has not responded to other types of treatment. We collected and analyzed all relevant studies of cyclodestructive procedures to answer this question and found five studies. Key messagesThere was not enough information to compare the di erent surgery options to each other. We were unable to conclude which type of surgery worked the best and was the safest.What was studied in this review? Some people who have glaucoma (damage to the optic nerve in the back of the eye) also have a buildup of pressure within the eye. This pressure may be because the eye has di iculty draining the fluid. If the ciliary body is destroyed, it can no longer produce too much fluid. Doing this may reduce the pressure within the eye and provide pain relief to people with glaucoma. There are several ways to destroy the ciliary body, which is known as cyclodestruction. Doctors can use a laser to destroy cells in the ciliary body, or they can freeze the cells. We wanted to compare these types of surgeries with more traditional surgeries for glaucoma. The laser surgery can be done in many di erent Cyclodestructive procedures for refractory glaucoma (Review)

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Background Glaucoma is a leading cause of blindness worldwide. It results in a progressive loss of peripheral vision and, in late stages, loss of central vision leading to blindness. Early treatment of glaucoma aims to prevent or delay vision loss. Elevated intraocular pressure (IOP) is the main causal modifiable risk factor for glaucoma. Aqueous outflow obstruction is the main cause of IOP elevation, which can be mitigated either by increasing outflow or reducing aqueous humor production. Cyclodestructive procedures use various methods to target and destroy the ciliary body epithelium, the site of aqueous humor production, thereby lowering IOP. The most common approach is laser cyclophotocoagulation. Objectives To assess the effectiveness and safety of cyclodestructive procedures for the management of non-refractory glaucoma (i.e. glaucoma in an eye that has not undergone incisional glaucoma surgery). We also aimed to compare the effect of different routes of administration, laser delivery instruments, and parameters of cyclophotocoagulation with respect to IOP control, visual acuity, pain control, and adverse events. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 8); Ovid MEDLINE; Embase.com; LILACS; the metaRegister of Controlled Trials (mRCT) and ClinicalTrials.gov . The date of the search was 7 August 2017. We also searched the reference lists of reports from included studies. Selection criteria We included randomized controlled trials of participants who had undergone cyclodestruction as a primary treatment for glaucoma. We included only head-to-head trials that had compared cyclophotocoagulation to other procedural interventions, or compared cyclophotocoagulation using different types of lasers, delivery methods, parameters, or a combination of these factors. Data collection and analysis Two review authors independently screened search results, assessed risks of bias, extracted data, and graded the certainty of the evidence in accordance with Cochrane standards. Main results We included one trial (92 eyes of 92 participants) that evaluated the efficacy of diode transscleral cyclophotocoagulation (TSCPC) as primary surgical therapy. We identified no other eligible ongoing or completed trial. The included trial compared low-energy versus high-energy TSCPC in eyes with primary open-angle glaucoma. The trial was conducted in Ghana and had a mean follow-up period of 13.2 months post-treatment. In this trial, low-energy TSCPC was defined as 45.0 J delivered, high-energy as 65.5 J delivered; it is worth noting that other trials have defined high- and low-energy TSCPC differently. We assessed this trial to have had low risk of selection bias and reporting bias, unclear risk of performance bias, and high risk of detection bias and attrition bias. Trial authors excluded 13 participants with missing follow-up data; the analyses therefore included 40 (85%) of 47 participants in the low-energy ...