Selective laser trabeculoplasty: past, present, and future

Over the past two decades, selective laser trabeculoplasty (SLT) has increasingly become an established laser treatment used to lower intraocular pressure in open-angle glaucoma and ocular hypertensive patients. In this review we trace the origins of SLT from previous argon laser trabeculoplasty and review the current role it has in clinical practice. We outline future directions of SLT research and introduce emerging technologies that are further developing this intervention in the treatment paradigm of glaucoma.Eye advance online publication, 5 January 2018; doi:10.1038/eye.2017.273

Argus II retinal prosthesis malrotation and repositioning with intraoperative optical coherence tomography in a posterior staphyloma

Michael I Seider, Paul Hahn Duke University Eye Center, Durham, NC, USA Introduction: The Argus II retinal prosthesis may improve visual function in patients with severe vision loss from retinitis pigmentosa. Optimal centration of the electrode array over the macula is important to achieve optimal visual results. Argus tack malrotation is a novel entity that may be encountered during placement, especially in patients with posterior staphyloma.Methods: Retrospective case review.Results: During tacking of the electronics array a clockwise rotation occurred resulting in malposition. We hypothesize this was secondary to undue rotation or posterior pressure applied during tack insertion in conjunction with placement over a previously unrecognized posterior staphyloma. Intraoperative optical coherence tomography, because of the cross-sectional images provided, was helpful in visualizing the distance between the electronics array and the retina, which was difficult to assess using the surgical microscope alone. Repositioning was achieved by adjusting the tack without removal. The patient experienced an improvement in vision as a result of the surgery.Conclusion: Malrotation may occur when tacking the Argus II prosthesis, and the presence of a posterior staphyloma may increase this risk. It is important to differentiate malrotation from tack misplacement – the former may be addressed with array unrotation or partial tack withdrawal and the latter may require tack removal and reinsertion. Also, intraoperative optical coherence tomography may be helpful in characterizing electronics array position during surgery. Keywords: Argus, retinitis pigmentosa, retinal tac