Long-term safety and efficacy of selective laser trabeculoplasty as primary therapy for the treatment of pseudoexfoliation glaucoma compared with primary open-angle glaucoma

Tarek A Shazly1,2, Jan Smith3, Mark A Latina41Ophthalmology Department, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; 2Ophthalmology, Assiut University Hospital, Assiut, Egypt; 3Oslo Eye Institute, Oslo, Norway; 4Reading Health Center, Reading, MA, USAPurpose: To investigate the safety and efficacy of selective laser trabeculoplasty (SLT) to reduce intraocular pressure (IOP) in patients with pseudoexfoliation glaucoma (PXFG) compared with primary open-angle glaucoma (POAG).Design: Non-randomized, prospective, clinical trial.Methods: Nineteen eyes of 13 patients with POAG and 18 eyes of 13 patients with PXFG were treated with SLT. Patients were followed without antiglaucoma medications until additional medical, laser, or surgical intervention was initiated, at which time they were considered failures, had withdrawn from the study, or underwent a second SLT.Results: The POAG and PXFG eyes showed similar reductions of IOP over the 49 months of follow-up. At 30 months of follow-up the POAG group showed a mean IOP of 17.6 ± 2.8 mmHg and a mean IOP reduction of 5.7 ± 2.1 mmHg; the PXFG group showed a mean IOP of 18.3 ± 4.7 and a mean IOP reduction of 5.3 ± 3.0 mmHg. Four eyes in the PXFG group and three eyes in the POAG group failed by 30 months. The cumulative probability of success was 74% for the PXFG group and 77% for the POAG group. Four PXFG eyes underwent a second SLT after 30 months of follow-up with a final IOP of 17.6 ± 2.8 mmHg. There were no serious adverse events.Conclusion: SLT is a safe and effective method to lower IOP in patients with PXFG as initial glaucoma therapy. Both groups showed similar IOP reductions and failure rates.Keywords: glaucoma, selective laser trabeculoplasty, primary open angle glaucoma, pseudoexfoliation glaucoma, intraocular pressure, laser, trabecular meshwor

The Relationship between Obstructive Sleep Apnea and Atrial Fibrillation: A Complex Interplay

In recent years, growing evidence suggests an association between obstructive sleep apnea (OSA), a common sleep breathing disorder which is increasing in prevalence as the obesity epidemic surges, and atrial fibrillation (AF), the most common cardiac arrhythmia. AF is a costly public health problem increasing a patient's risk of stroke, heart failure, and all-cause mortality. It remains unclear whether the association is based on mutual risk factors, such as obesity and hypertension, or whether OSA is an independent risk factor and causative in nature. This paper explores the pathophysiology of OSA which may predispose to AF, clinical implications of stroke risk in this cohort who display overlapping disease processes, and targeted treatment strategies such as continuous positive airway pressure and AF ablation

Orbital leiomyosarcoma metastasis presenting prior to diagnosis of the primary tumor.

Leiomyosarcomas, neoplasms of smooth muscle, are rarely found within the orbit. Orbital leiomyosarcoma may be primary, metastatic, or secondary to radiation. When they are metastatic, patients almost exclusively have a history of a primary leiomyosarcoma, often occurring in the spermatic cord, skin, gastrointestinal tract, or the uterus. We present the case of 48-year-old woman who presented with a metastatic orbital leiomyosarcoma, which was identified before the primary tumor

Entre seguridad humana y estatal: ¿ofrece la Unión Europea una respuesta coherente a los desafíos de seguridad en Centroamérica, Colombia y Venezuela?

Centroamérica, Colombia y Venezuela enfrentan importantes desafíos de seguridad. Pese al discurso de seguridad humana en su política hacia América Latina, la Unión Europea (UE) ha tenido aproximaciones diferentes a los tres conflictos: desde el nexo seguridad-desarrollo en Centroamérica y un compromiso de cooperación combinado con la “securitización” del conflicto en Colombia, hasta una política de sanciones y diplomacia en Venezuela. Metodología: mediante una perspectiva comparada y un marco analítico común de análisis de contenido cualitativo, el artículo plantea la pregunta: ¿qué concepto de seguridad, estatal o humana, está detrás de las políticas de la UE hacia estos países y con qué grado de coherencia se implementa? Conclusiones: se demuestra que la UE hace un manejo poco coherente del nexo seguridad-desarrollo hacia los países seleccionados debido a inconsistencias internas y externas, en este caso sobre todo de cara a EE. UU. como principal donante de la región y “socio” transatlántico. Originalidad: el artículo deconstruye la imagen de la UE como socio de desarrollo comprometido con la seguridad humana. Aunque la política de la UE sigue estando más enfocada en afrontar las causas como la desigualdad y la pobreza que las consecuencias de la inseguridad, la política del nexo seguridad-desarrollo refleja una cierta securitización del desarrollo a la hora de cooperar con países en conflicto y Estados frágiles considerados potenciales “amenazas” a la seguridad, como Colombia o Venezuela

Selective Laser Trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks

Purpose: To report and assess the complication of intraocular pressure (IOP) elevations after selective laser trabeculoplasty (SLT) in patients with heavily pigmented trabecular meshworks.Design: Noncomparative, observational case series.Methods: Retrospective analysis of the medical files of four glaucoma patients with heavily pigmented trabecular meshwork, who presented with IOP elevations after SLT.Results: All four glaucoma patients presented with post-SLT IOP elevations. Three had features of pigmentary dispersion syndrome, and the fourth had a heavily pigmented trabecular meshwork. Two patients had previous argon laser trabeculoplasty (ALT) in the same eye in which SLT was performed, and one had a previous ocular trauma. Eventually, three of the patients required surgical trabeculectomy.Conclusions: This case series suggests that post-SLT IOP elevations can be a serious adverse event in some glaucomatous patients. It is recommended by the authors that patients with a deeply pigmented trabecular meshwork, taking multiple topical medications and having previous ALT treatment, should be considered at higher risk for this complication

Effect of prior cataract surgery on the long-term outcome of selective laser trabeculoplasty

Tarek A Shazly1, Mark A Latina2, John J Dagianis3, Satyakant Chitturi41Ophthalmology, Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, MA, USA; 2Reading Health Center, Reading, MA, USA; 3Nashua Eye Associates, Nashua, NH, USA; 4Andhra Medical College, Visakhapatnam, IndiaObjective: To determine if pseudophakia affects selective laser trabeculoplasty (SLT) intraocular pressure (IOP) lowering effect.Methods: A retrospective chart review was performed on 94 eyes of 75 consecutive patients who underwent SLT as primary treatment for ocular hypertension and primary open-angle glaucoma between 2002 and 2005 and completed at least 30 months follow up. Patients were excluded if they required additional glaucoma medications, laser, or ocular surgery during the follow-up period. Patients were categorized as phakics or pseudophakics. Independent-samples t-test was performed to compare the mean percentage of IOP reduction at 3, 6, 12, 18, and 30 months after SLT between the phakic and pseudophakic groups.Results: Seventy-six phakic and 18 pseudophakic eyes were included. IOP reduction in phakic group was 27.4% (2 week), 29.8% (3 months), 27.7% (9 months), 27.4% at (12 months) and 27.3% at (30 months). In pseudophakic patients, the mean IOP reduction was 19.8% (2 weeks), 26.5% (3 months), 23.2% (9 months), 22.5% (12 months), and 25.9% (30 months). An independent-sample t-test compared the percentage of IOP reduction between the phakic and pseudophakic groups and revealed higher percentage of IOP reduction in the phakic group at 2 weeks by 7.6% (P = 0.01). P value for difference was 0.34 (3 months), 0.25 (6 months), 0.18 (9 months), 0.12 (12 months), 0.36 (18 months), and 0.7 (30 months) after SLT.Conclusions: SLT response was delayed in pseudophakic compared to phakic patients, while the long-term effectiveness of SLT is the same in both groups.Keywords: intraocular pressure, pseudophakic, cataract surger

Comparison of Bunch Compression Schemes for the AXXS FEL

Different types of electron bunch compression schemes are compared for the AXXS FEL design study. The main linac for the proposed machine is based on CLIC x-band structures. This choice leaves several options for the bunch compression schemes which impact the injection system RF band. Both harmonic linearization and phase modulation linearization are considered and their relative strengths and weaknesses compared. Simulations were performed to compare the performance of an s-band injector with a higher harmonic RF linearization and an x-band injector. One motivation for the study is to optimise the length of the AXXS machine, allowing the linac to fit onto the proposed and also act as the injector to the existing storage ring at the Australian Synchrotron

Nanoplasmonic Accelerators Towards Tens of TeraVolts per Meter Gradients Using Nanomaterials

Ultra-high gradients which are critical for future advances in high-energy physics, have so far relied on plasma and dielectric accelerating structures. While bulk crystals were predicted to offer unparalleled TV/m gradients that are at least two orders of magnitude higher than gaseous plasmas, crystal-based acceleration has not been realized in practice. We have developed the concept of nanoplasmonic crunch-in surface modes which utilizes the tunability of collective oscillations in nanomaterials to open up unprecedented tens of TV/m gradients. Particle beams interacting with nanomaterials that have vacuum-like core regions, experience minimal disruptive effects such as filamentation and collisions, while the beam-driven crunch-in modes sustain tens of TV/m gradients. Moreover, as the effective apertures for transverse and longitudinal crunch-in wakes are different, the limitation of traditional scaling of structure wakefields to smaller dimensions is significantly relaxed. The SLAC FACET-II experiment of the nano2WA collaboration will utilize ultra-short, high-current electron beams to excite nonlinear plasmonic modes and demonstrate this possibility