Argon laser peripheral iridoplasty versus systemic intraocular pressure-lowering medications as immediate management for acute phacomorphic angle closure.

Background: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) and systemic intraocular pressure (IOP)-lowering medications in the immediate management of acute phacomorphic angle closure. Methods: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours posttreatment in both arms. Results: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP < 25 mmHg (18.8 ± 7.5 minutes versus 115.0 ± 97.0 minutes, P = 0.001, F test); had a greater IOP reduction within 30 minutes (69.8% ± 7.7% versus 40.9 ± 23.9%, P = 0.03, t-test); and had a consistently smaller post-attack cup to disc ratio (0.50 ± 0.02 versus 0.60 ± 0.20, P = 0.002, F test). Conclusion: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure. © 2013 Lee et al, publisher and licensee Dove Medical Press Ltd.published_or_final_versio

Argon laser peripheral iridoplasty (ALPI) versus systemic intraocular pressure lowering medications as the immediate management for phacomorphic angle closure

Poster Session: Glaucoma PhenotypesPurpose: To compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) to systemic intraocular pressure (IOP) lowering medications in the immediate management of phacomorphic angle closure. Patients and methods: This was a prospective randomized controlled study conducted at a district hospital in Hong Kong, China. Consecutive cases of phacomorphic angle closure were recruited from December 2009 to December 2010. Patients received intravenous (IV) and oral carbonic anhydrase inhibitor or ALPI as the initial treatment. IV mannitol was administered in both groups for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours post treatment. The following perimeters were compared between the 2 arms: Snellen best correct visual acuity (BCVA); duration of symptoms; presenting IOP; IOP at 15 minutes, 30minutes and hourly after treatment until IOP < 25 mmHg; post-op angle, retinal nerve fibre layer (RNFL), endothelial count, BCVA and IOP. Results: Ten consecutive cases were included in the study. Six cases received medication therapy and 4 received ALPI. The mean age was 79.7 ± 7.2 in the medical therapy group and 78.3 ± 11.0 in the ALPI group. The presenting IOP was 50.7 ± 8.4 mmHg and 50.25 ± 6.9 mmHg in the medical therapy and ALPI group respectively. The duration of phacomorphic glaucoma in the medical group was 2.8 ± 3.5 days and 0.9 ± 0.25 days in the ALPI group. In the medical therapy group, 50% (3/6) required IV mannitol and none in the ALPI group. The time taken to reduce the presenting IOP to < 25 mmHg was 115.0 ± 97.0 minutes in the medical therapy group and 18.8 ± 7.5 minutes in the ALPI group. Within the first 30minutes, the drop in IOP was 20.8 ± 13.5mmHg in the medical group and 34.8 ± 3.2mmHg in the ALPI group, representing a 41.0% and 69.3% drop in IOP respectively. The degree of peripheral anterior synechiae (PAS) formation at 3 months was 45 ± 45.3° and 22.5 ± 5° in the medical and ALPI group respectively. The RNFL, angle, endothelial count, post-op VA and IOP were comparable in both groups. Conclusion: ALPI is an effective and safe IOP lowering modality in acute phacomorphic angle closure, offering a more rapid reduction of IOP, avoiding the use of systemic carbonic anhydrase inhibitor and hyperosmotic agents, and with seemingly less PAS formation and comparable post-op results as compared to medical therapy. ALPI should replace medical therapy as first line treatment in phacomorphic angle closure especially in elderly patients cannot tolerable the side effects of systemic IOP-lowering medication.published_or_final_versio

Efficacy of selective laser trabeculoplasty for normal tension glaucoma: 1 year results

BACKGROUND: Normal tension glaucoma (NTG) is commonly treated with anti-glaucoma medications. Recently, selective laser trabeculoplasty (SLT) has been demonstrated to lower the intraocular pressure (IOP) and medication use in NTG. The purpose of this study was to investigate the efficacy of a single session of SLT for NTG at 1 year. METHODS: This prospective cohort study recruited NTG patients taking anti-glaucoma medication. Potential subjects were excluded if they had had previous glaucoma surgery or laser and also if intraocular surgery or additional SLT procedures were performed after the first treatment. All subjects underwent a 1-month washout. A 30% IOP reduction was set as the target IOP. A single session of SLT was performed to 360 degrees of the trabecular meshwork. At 1-month after SLT, medication was resumed to achieve the target IOP. The IOP was measured every 3 months, and the number of medications was recorded at 3, 6, and 12 months. Only the right eye was used for statistical analysis. RESULTS: In 41 right eyes, the mean pre-study IOP was 14.3 +/- 3.4 mmHg while on 1.5 +/- 0.8 eye drops. The post-washout IOP was 16.2 +/- 2.2 mmHg. A mean of 191.1 +/- 26.3 SLT shots at 1.0 +/- 0.07 mJ were applied. There was significant IOP reduction at all time intervals following SLT when compared to the post-washout IOP (P < 0.0001). The number of medications was significantly reduced at all time intervals following SLT when compared to the pre-study level (P < 0.0001). At 12 months, the mean IOP was 12.2 +/- 2.2 mmHg while on 1.1 +/- 0.9 eye drops. CONCLUSIONS: A single session of SLT for NTG achieved an additional 15% IOP reduction while using 27% less medication at 1 year compared to pre-study levels.Trial registration: The Clinical Trials Register of the University of Hong Kong HKCTR1847The European Clinical Trials Database 2014-003305-15 (August 11, 2014) (https://eudract.ema.europa.eu/).published_or_final_versio

A randomized control trial to evaluate the effect of adjuvant selective laser trabeculoplasty versus medication alone in primary open-angle glaucoma: preliminary results

BACKGROUND: The objective of this study was to investigate the effects of adjuvant selective laser trabeculoplasty (SLT) versus medication alone on intraocular pressure (IOP) control, medication use, and quality of life in patients with primary open-angle glaucoma. METHODS: This prospective, randomized control study recruited 41 consecutive primary open-angle glaucoma subjects with medically-controlled IOP /=0.4) or between the two treatment groups (P>/=0.2). CONCLUSION: A single session of adjuvant SLT provided further reductions in IOP and medication without substantial changes in quality of life or medication tolerability at 6 months.published_or_final_versio

Simultaneous polychromatic flow cytometric detection of multiple forms of regulated cell death

Queen Mary University London.GS

Wound dressings for a proteolytic-rich environment

Wound dressings have experienced continuous and significant changes over the years based on the knowledge of the biochemical events associated with chronic wounds. The development goes from natural materials used to just cover and conceal the wound to interactive materials that can facilitate the healing process, addressing specific issues in non-healing wounds. These new types of dressings often relate with the proteolytic wound environment and the bacteria load to enhance the healing. Recently, the wound dressing research is focusing on the replacement of synthetic polymers by natural protein materials to delivery bioactive agents to the wounds. This article provides an overview on the novel protein-based wound dressings such as silk fibroin keratin and elastin. The improved properties of these dressings, like the release of antibiotics and growth factors, are discussed. The different types of wounds and the effective parameters of healing process will be reviewed

Detection of Glaucoma in subjects with systemic hypertension using optic disc images from retinopathy screening programme

Poster Presentatio

Transcorneal electrical stimulation therapy for glaucomatous optic neuropathy

Session - Glaucoma 1: paper no. 381-3PURPOSE: To examine the efficacy of transcorneal electrical stimulation (TES) in enhancing the function of the optic nerve in glaucomatous optic neuropathy - To document any side effects arising from TES to treat a chronic eye disease METHODS: Adult patients were recruited in one hospital in Hong Kong. Patients with bilateral glaucomatous optic neuropathy of similar degree, as determined by optic disc morphology, Humphrey visual field (VF) and/or optical coherence tomography (OCT) were recruited. Any form of glaucoma was included. One eye was randomized to receive TES (treatment arm) by drawing envelop, and the other eye would automatically be in the control arm. Each patient received TES for a period of 30 minutes once per week over 26 weeks. The studied parameters, including visual acuity, intraocular pressure, anterior segment and posteior segment examination with microscopy, VF, OCT for retinal nerve fibre layer (RNFL) and electroretinography (ERG) using multifocal ERG, were measured once at baseline, every 3 months during the study period, and at 3 and 6 months after the last stimulation. OUTCOME MEASURES: Primary outcome: VF, ERG signal Secondary outcomes: RNFL thickness RESULTS: Forteen patients were enrolled into the study and three of them completed at least 3 months treatment and investigations at the time of report. The 3 patients were from 63-76 years old, 2 males and 1 female. Regarding the VF, all patients demonstrated improvement in at least one of the parameters (median deviation and visual field index) in the treatment eye at 3 months post-treatment as compared to the baseline. In 2 of the patients, both parameters improved. In contrast, in all the 3 patients, the fellow control eye did not show any improvement in any one of the VF parameters. (Table 1) All 3 patients also showed improvement in at least 3 out of the 4 ERG signal parameters. (Table 2) OCT findings were inconsistent. There were no side-effects reported by any patient during the treatment. CONCLUSIONS: Preliminary data on our glaucoma patients demonstrated potential benefit of TES in terms of improvement in VF and ERG signal. TES can be a promising novel treatment for glaucomatous optic neuropathy. Further studies on the exact duration, pulse duration and current density to achieve maximal benefit would be neccessary

Intraocular pressure related pattern amplitude reduction after clinically successful selective laser trabeculoplasty in normal tension glaucoma

Poster session 10: Other: POAG, ACGTo investigate intraocular pressure (IOP) related patterns before and after selective laser trabeculoplasty (SLT) for normal tension glaucoma (NTG).In this prospective cohort study, 18 NTG patients underwent SLT. Success was defined as IOP reduction ≥ 20% by Goldmann applanation tonometry. 24-hour IOP-related pattern recording with a contact lens sensor (CLS) (SENSIMED Triggerfish, Sensimed, Switzerland) was done before (baseline) and 1 month after SLT. A cosine function was fitted to the mean CLS patterns for each individual in the SLT success and non-success groups and the amplitude before and after SLT was calculated. Diurnal, nocturnal, and 24-hour CLS pattern local variability was determined for pre- and post-SLT sessions. Cosine amplitude and variability were compared before and after SLT by group using paired t-tests, with α = 0.05. Patients (11 women, 7 men) had a mean age of 65.1 ± 13.7 years. Mean IOP was 15.3 ± 2.2 mm Hg at baseline and was reduced by 17.0% to 12.7 ± 1.8 mm Hg 1 month after SLT (P = 0.001). SLT was successful in 8 patients (44%). The amplitude of the fitted cosine was reduced by 24.6% in the success group, but displayed an amplitude increase of 19.2% post-SLT in the non-success group. Higher diurnal local variability of the CLS pattern was observed after SLT in non-success subjects (P = 0.002), while nocturnal variability showed no significant change. The increase in diurnal variability in the non-success group led to an increase in 24-hour variability in this group (P = 0.001). No change in local variability (diurnal, nocturnal, and 24-hour) was seen in the success group. The IOP-related pattern cosinor amplitude was reduced in NTG patients with a successful SLT treatment whereas the non-success group exhibited an increase of cosine amplitude. Higher diurnal and 24-hour CLS pattern variability was observed in non-success patients 1 month post-SLT