Diode laser TSCP is a safe and highly effective method for lowering IOP in patients with uncontrolled glaucoma. Higher total energy levels in a given treatment session appear to be associated with increased success as defined by the percentage of patients achieving an IOP < 21 or 22 mm Hg, without an increased risk of additional complications or vision loss.
Glutamate receptors appear to play a key role in several forms of experience-dependent modification of both the strength of synapses and synaptic connectivity. In developing Xenopus frogs, the connections made by isthmotectal axons relaying visual input from the eye to the ipsilateral tectum are markedly influenced by the visual activity of contralateral retinotectal axons, and normal binocular visual input is necessary in order for the ipsilateral visuotectal map to come into register with the contralateral map. We have tested whether NMDA receptors play a role in establishment of the topographic matching of binocular maps during development. We have examined the effects of chronic treatment of tectum with either the receptor agonist NMDA or the antagonists APV or CPP applied throughout early postmetamorphic life using subpial implants of drug-impregnated elvax. Both antagonists blocked the matching of the ipsilateral map to the contralateral map, while NMDA permitted such matching. Our data therefore indicate that NMDA receptors are involved in the experience-dependent establishment of matching binocular maps during development.
The purpose of this study was to determine the percentage of treatment-naive glaucoma patients initially treated with latanoprost monotherapy who do not respond with a clinically meaningful reduction of intraocular pressure (IOP). A database search of previously untreated patients with newly diagnosed primary open angle glaucoma, ocular hypertension or pseudoexfoliative glaucoma initially treated with once-daily latanoprost, 0.005% monotherapy was conducted. Charts were randomly reviewed until 20 patients meeting inclusion criteria were identified. Baseline IOP was compared to IOP measured 1 to 3 months after the initiation of therapy. Intraocular pressure (+/- S.D.) following latanoprost treatment (17.0 +/- 3.5 mm Hg) was significantly (p < 0.0005) less than baseline (23.9 +/- 4.2 mm Hg) in the study population. Based on our criteria of a clinically meaningful decrease in IOP, we identified a subgroup of patients (25%) who were non-responsive to latanoprost monotherapy. Non-responders did not differ from responders with regard to baseline IOP or age. Although latanoprost may be an effective IOP-lowering agent in most patients, there exists a subgroup of patients who are unresponsive. As with any topical glaucoma agent, IOP must be monitored regularly to confirm effectiveness.
Visual input during a critical period of development plays a major role in the establishment of orderly connections in the developing visual system. In Xenopus laevis, the matching of visual maps from the two eyes to the optic tectum depends on binocular visual input during the critical period, which extends from late tadpole to early juvenile stages. Alterations in eye position, which produce a mismatch of the tectal maps, normally evoke a compensatory adjustment in the map of the ipsilateral eye only during the critical period. However, continuous application of the glutamate receptor agonist N-methyl-D-aspartate (NMDA) after the normal end of the critical period restores this ability to realign the visual map.
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