Where does selective laser trabeculoplasty stand now? A review

Background: Chronic treatment of glaucoma can present a challenge in patients who lack the means and/or the discipline to use daily glaucoma medication. We wondered if selective laser trabeculoplasty (SLT) could be a useful alternative. Methods: Inclusion criteria: controlled trials comparing efficacy of SLT in adult patients with any form of open angle glaucoma or ocular hypertension and case reports on side effects of SLT. Two recent meta-analyses identified eight randomized clinical trials (RCTs) comparing the effect of SLT with medication (prostaglandin analogs) and with argon laser trabeculoplasty (ALT). We took these eight RCTs as reference base and calculated their success rates where they were not given. Other articles were added to elaborate on technique and side effects. Results: Mean intraocular pressure (IOP) reduction after SLT was 3.8-8.0 mmHg after 6 months to 1 year. Mean success rate of SLT at 6 months to 1 year is 55-82 %. Higher IOP before laser predicts a higher IOP-lowering effect. In terms of mean IOP reduction, reduction in number of medications and treatment success, the effect of SLT was found to show no clinically relevant difference from that of contemporary medication (prostaglandin analogs) and from ALT. Conclusions: The evidence indicates that SLT is an efficacious primary or adjunctive therapy for treating glaucoma

Quality of life in glaucoma patients after selective laser trabeculoplasty

AIM: To compare quality of life and treatment satisfaction between patients who had selective laser trabeculoplasty (SLT) and those on medication. METHODS: A prospective clinical trial on 143 glaucoma patients that received SLT and a control group that continued using anti glaucoma medication was conducted. Tear break-up time (BUT), punctuate keratitis, need for help, use of artificial tears and the treatment satisfaction survey of intraocular pressure (IOP) were measured at baseline, 6 and 12mo. RESULTS: SLT was able to reduce the mean number of medications needed from 1.56 +/- 0.81 to 0.42 +/- 0.66 at six months and to 0.33 +/- 0.69 at one year. Punctuate keratitis was observed significantly less often (12.24%) after SLT than before (35.94%; P=0.03). Use of artificial tears and BUT did not change significantly after SLT (P > 0.05). At baseline, patients in the SLT group were significantly less convinced of medication effectiveness (P=0.006) and complained more about side effects (P=0.003). After SLT, these patients had significantly more confidence in their therapy (P < 0.001), showed less side effects (P=0.006), complained less about changes in appearance of the eyes (P=0.003) and were less inconvenienced by the use of eye drops (P < 0.001). CONCLUSION: SLT is able to improve treatment-related quality of life in glaucoma patients

La médaille dite de Fourvières et sa légende hébraique

par S. FerarèsAus: Revue numismatique ; 191

Impaired processing of serial order determines working memory impairments in Alzheimer’s disease

Background: Working memory (WM) problems are commonly observed in Alzheimer's disease (AD), but the affected mechanisms leading to impaired WM are still insufficiently understood. The ability to efficiently process serial order in WM has been demonstrated to be fundamental to fluent daily life functioning. The decreased capability to mentally process serial position in WM has been put forward as the underlying explanation for generally compromised WM performance. Objective: Determine which mechanisms, such as order processing, are responsible for deficient WM functioning in AD. Method: A group of AD patients (n = 32) and their partners (n = 25), assigned to the control group, were submitted to an extensive battery of neuropsychological and experimental tasks, assessing general cognitive state and functioning of several aspects related to serial order WM. Results: The results revealed an impaired ability to bind item information to serial position within WM in AD patients compared to controls. It was additionally observed that AD patients experienced specific difficulties with directing spatial attention when searching for item information stored in WM. Conclusion: The processing of serial order and the allocation of attentional resources are both disrupted, explaining the generally reduced WM functioning in AD patients. Further studies should now clarify whether this observation could explain disease-related problems for other cognitive functions such as verbal expression, auditory comprehension, or planning