Laser trabeculoplasty for open angle glaucoma

Rolim-de-Moura, Christiane; Paranhos, Augusto; Wormald, Richard

doi:10.1002/14651858.cd003919.pub2

Cited by 67 publications

(39 citation statements)

References 86 publications

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“…Topical antiglaucoma medications are commonly used as first-line treatment before surgery to reduce the exposure to surgical complications. 1 In the past, argon laser trabeculoplasty (ALT) and later, selective laser trabeculoplasty (SLT) have been demonstrated to have a similar IOP-lowering efficacy as medications but without their side effects such as ocular irritation, allergies, redness, dryness, or inconvenience; laser trabeculoplasty has also been demonstrated to potentially reduce IOP-related fluctuations on 24-h recordings. 2–8 …”

Section: Introductionmentioning

confidence: 99%

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

et al. 2015

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The aim of the study was to investigate the safety and efficacy of using MLT in the treatment of open-angle glaucoma (OAG).This prospective cohort included subjects ≥18 years of age with OAG, defined as the open angle on gonioscopy with glaucomatous optic neuropathy evident from optical coherence tomography. Subjects with IOP < 21 mm Hg were classified as normal tension glaucoma and those with IOP ≥21 mm Hg were classified as primary open-angle glaucoma. Those with angle closure, secondary glaucoma, prior laser trabeculoplasty, use of systemic IOP-lowering medications, corneal pathologies, follow-up <6 months, recent intraocular surgery, or only 1 functional eye were excluded. A single session of unilateral MLT treatment was delivered using a 577 nm diode laser to 360° of the trabecular meshwork to reduce IOP or medication load. Medications were titrated up or down at 1 month after laser to achieve a 25% IOP reduction from presentation or an IOP <18 mm Hg, whichever was lower. The following were compared using the Repeated Measures ANOVA with Bonferroni's Multiple Comparison Test: IOP (on presentation, pre-MLT, day 1, 1 week, 1 month, 3 months, and 6 months after MLT) and the number of medications (pre-MLT, 3 months, and 6 months after MLT). After 6 months, responders with initial success to MLT (IOP reduction ≥20% at 1 month) received treatment in the fellow eye.In 48 subjects with OAG, the mean number of MLT shots applied was 120.5 ± 2.0 shots using a mean energy of 1000 mW per shot. Only 7.5% had a mild, self-limiting anterior uveitis postlaser with no change in the Snellen visual acuity at 6 months (P's > 0.5). The IOP and number of medications were significantly reduced at all time intervals following MLT compared to the pre-MLT level (P's < 0.0001). At 6 months, the IOP was reduced by 19.5% in addition to a 21.4% reduction in medication compared to pretreatment levels. The MLT success rate was 72.9%. During the first 6 months only 2.1% required a repeated laser trabeculoplasty.MLT was effective in reducing IOP and medications in OAG with minimal postlaser inflammation and low failure rate at 6 months following laser.

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Section: Introductionmentioning

confidence: 99%

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

et al. 2015

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“…the eye [20,21]. To reduce fibrosis after surgery, cytotoxins may be applied to the eye repeatedly, but this procedure can cause damage to the extraocular tissues.…”

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confidence: 99%

Controlled Drug Delivery From Composites of Nanostructured Porous Silicon and Poly( L -Lactide)

et al. 2012

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Aims: Porous silicon (pSi) and poly(L-lactide) (PLLA) both display good biocompatibility and tunable degradation behavior, suggesting that composites of both materials are suitable candidates as biomaterials for localized drug delivery into the human body. The combination of a pliable and soft polymeric material with a hard inorganic porous material of high drug loading capacity may engender improved control over degradation and drug release profiles and be beneficial for the preparation of advanced drug delivery devices and biodegradable implants or scaffolds. Materials & methods: In this work, three different pSi and PLLA composite formats were prepared. The first format involved grafting PLLA from pSi films via surface-initiated ring-opening polymerization (pSi–PLLA [grafted]). The second format involved spin coating a PLLA solution onto oxidized pSi films (pSi–PLLA [spin-coated]) and the third format consisted of a melt-cast PLLA monolith containing dispersed pSi microparticles (pSi–PLLA [monoliths]). The surface characterization of these composites was performed via infrared spectroscopy, scanning electron microscopy, atomic force microscopy and water contact angle measurements. The composite materials were loaded with a model cytotoxic drug, camptothecin (CPT). Drug release from the composites was monitored via fluorimetry and the release profiles of CPT showed distinct characteristics for each of the composites studied. Results: In some cases, controlled CPT release was observed for more than 5 days. The PLLA spin coat on pSi and the PLLA monolith containing pSi microparticles both released a CPT payload in accordance with the Higuchi and Ritger–Peppas release models. Composite materials were also brought into contact with human lens epithelial cells to determine the extent of cytotoxicity. Conclusion: We observed that all the CPT containing materials were highly efficient at releasing bioactive CPT, based on the cytotoxicity data. Original submitted 16 December 2010; Revised submitted 29 September 2011; Published online 6 March 2012

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“…Incisional glaucoma surgery is used whenever the prior interventions are not successful in controlling IOP (American Academy of Ophthalmology 2015). LTP has been shown in several large clinical trials and one Cochrane Review to be effective in lowering IOP (Ederer 2004;GLT 1990;Rolim de Moura 2007), and can be performed as a first-line therapy or in conjunction with medical therapy. On average, LTP reduces IOP by 25% to 30% from baseline (Stein 2007).…”

Section: Background Description Of the Conditionmentioning

confidence: 99%

Perioperative medications for preventing temporarily increased intraocular pressure after laser trabeculoplasty

Zhang

Weizer

Musch

2013

Cochrane Database of Systematic Reviews

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Background-Glaucoma is the international leading cause of irreversible blindness. Intraocular pressure (IOP) is the only currently known modifiable risk factor; it can be reduced by medications, incisional surgery, or laser trabeculoplasty (LTP). LTP reduces IOP by 25% to 30% from baseline, but early acute IOP elevation after LTP is a common adverse effect. Most of these IOP elevations are transient, but temporarily elevated IOP may cause further optic nerve damage, worsening of glaucoma requiring additional therapy, and permanent vision loss. Antihypertensive prophylaxis with medications such as acetazolamide, apraclonidine, brimonidine, dipivefrin, pilocarpine, and timolol have been recommended to blunt and treat the postoperative IOP spike and associated pain and discomfort. Conversely, other researchers have observed that early postoperative IOP rise happens regardless of whether people receive perioperative glaucoma medications. It is unclear whether perioperative administration of antiglaucoma medications may be helpful in preventing or reducing the occurrence of postoperative IOP elevation.

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Laser trabeculoplasty for open angle glaucoma

Cited by 67 publications

References 86 publications

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

Controlled Drug Delivery From Composites of Nanostructured Porous Silicon and Poly( L -Lactide)

Perioperative medications for preventing temporarily increased intraocular pressure after laser trabeculoplasty

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