ObjectiveThis pilot study evaluates the pressure lowering potential of subthreshold micropulse diode laser trabeculoplasty (MDLT) for a clinically meaningful duration in patients with medically uncontrolled open angle glaucoma (OAG).Designprospective interventional case series.ParticipantsThirty-two eyes of 20 consecutive patients with uncontrolled OAG (12 bilateral and 8 unilateral).MethodsConfluent subthreshold laser applications over the inferior 180° of the anterior TM using an 810 nm diode laser in a micropulse operating mode. The intraocular pressure (IOP) was measured at baseline and at 1 hour, 1 day, 1 week, 3, 6, 9, and 12 months post-treatment. Flare was measured with a Kowa FM 500 flare-meter at baseline and at 3 hours, 1 day, 1 week, and 12 months post-treatment. After treatment, the patients were maintained on their pre-treatment drug regimen.Main outcome measuresCriteria for treatment response were IOP reduction ≥3 mm Hg and IOP ≤21 mm Hg within the first week after MDLT. Eyes not complying to the above criteria during the follow-up were considered treatment failure. Mean IOP change and percentage of IOP reduction during the follow-up were calculated.ResultsOne eye was analyzed for bilateral patients. A total of 20 eyes were thus included. Four eyes (20%) did not respond to treatment during the first week. One additional eye failed at the 6 month visit. The treatment was successful in 15 eyes (75%) at 12 months. The IOP was significantly lower throughout follow-up (p < 0.01). At 12 months, the mean percentage of IOP reduction in the 15 respondent eyes was 22.1% and 12 eyes (60%) had IOP reduction higher than 20%. During the first two postoperative days, one eye with pigmentary glaucoma experienced a significant increase of flare associated with an IOP spike (34 mm Hg) that was controlled with systemic drugs; afterwards it qualified as a respondent and completed the study. No increase of flare was found in any other patient. No peripheral anterior synechiae formed.ConclusionsIn this case series, MDLT was effective in reducing IOP in 75% of medically insufficiently controlled OAG eyes without significant complications. This justifies randomized clinical studies to compare MDLT with current IOP lowering strategies.

Purpose: Aim of this retrospective, observational study is to describe features of a population sample, affected by primary open angle glaucoma (POAG) in order to evaluate damage progression on the basis of the emerged individual risk factors. Methods: We included 190 caucasian patients (377 eyes), evaluating relationship between individual risk factors (explicative variables) and MD (Mean Deviation) of standard automated perimetry. We also considered the dependent variable NFI (Neural Fiber Index) of GDx scanning laser polarimetry. Progression has been evaluated through a statistic General Linear Model on four follow up steps (mean follow up 79 months). Results: Factors reaching statistical significance, determining a worsening of the MD variable, are: age (P<0.0001), intraocular pressure (IOP) at follow up (P < 0.0001), female gender (P<0.0001), hypertension (P< 0.0001) and familiarity (P = 0.0006). Factors reaching statistical significance, determining a worsening of the NFI variable, are only IOP at follow up (P = 0.0159) and depression (P = 0.0104). Conclusion: Results of this study confirm and enforce data coming from most recent studies: IOP remains the main risk factor for glaucoma assess and progression; age and familiarity are great risk factors as underlined in the last decades; female sex can be an important risk factors as emerged only in the last years; arterial hypertension should always be evaluated in timing of our clinic follow up.

Purpose To compare the effect of dorzolamide hydrochloride 2%, timolol maleate 0.5%, and their fixed combination on intraocular pressure (IOP) and retinal and optic nerve head haemodynamics in primary open-angle glaucoma patients. Methods Twenty-eight patients with early-moderate glaucomatous damage treated with b-blockers (46 months) with IOP values ranging from 18 to 22 mmHg at trough participated in this trial. After a 4-week washout period, patients were randomized in two groups: group I started with dorzolamide 2% monotherapy and group II with timolol 0.50% monotherapy for 4 weeks. After this period, both groups switched to dorzolamide/ timolol fixed combination for 4 weeks. IOP, ocular diastolic perfusion pressure (ODPP), heart rate, and Scanning Laser Doppler Flowmetry measurements at the peripapillary retina and neuroretinal rim were taken at T0 (enrolment), T1 (wash out), T2 (monotherapy), and T3 (dorzolamide/timolol). Data were compared between different study times. Statistical analysis was conducted using a paired t-test. Results Between T1 and T3, IOP decreased significantly in group I (À21.40%) (Po0.001) and in group II (À21.25%) (Po0.001). At the same time intervals, blood flow increased significantly at rim level for group I ( þ 30.03%) (Po0.05) and also when all patients were considered (rim þ 17.99%) (Po0.05). Between T1 and T3, we also observed a significant increase of ODPP in group I ( þ 7.24%) (Po0.01) and in group II ( þ 6.08%) (Po0.05) and when all patients were considered ( þ 8.43%) (Po0.01). Conclusions Dorzolamide/timolol fixed combination increased blood flow significantly at the neuroretinal rim showing a combination of hypotensive and haemodynamic effects.

In 2001, for the first time in its life, the AISG is holding its Annual Meeting far away from its traditional venue, i.e. Rapallo.The explanation for this decision on the part of its Directive Council, approved, moreover, enthusiastically, by the great majority of its members, lies, in my opinion, in two good reasons: 1 the concomitant IGS with the weight of its programme and the number of participants, as well as the outstanding names present; 2 the attractive beauty of this famous city of Prague, so full of history and charming spots.Our idea has been very much appreciated by our Greek colleagues, who have decided to join us in this initiative, which, on the other hand, has been supported right from the beginning as well by the organizers of IGS, Prof Melamed and Prof Schumann. To both of them go our sincere thanks for their welcome and collaboration.Let us think of it this way, however, that a third good reason for joining our forces may lie in the desire not only to exchange ideas and knowledge, but to meet friends who, for many reasons of life, we see all too rarely and with whom it is so nice to spend some time in a pleasant atmosphere speaking of many topics not necessarily only of ophthalmology.Also for this reason, let us succeed in respecting the times of the programme so as to have more time for enjoying ourselves. 7Prague opening remarks Partly as a result of my participation as moderator in the 1999 American Academy of Ophthalmology Glaucoma Subspecialty Day Symposium on Normal Tension Glaucoma, I have been requested to present an overview on this topic. Having made liberal use of materials provided by each of the speakers in the symposium, I wish to thank Drs Brian Lee, David Greenfield and Roger Hitchings and acknowledge their contributions. This presentation will be divided into the following four sections:I. The misnomer of normal tension glaucoma (NTG). II. Potentially contributing factors in the pathogenesis of glaucoma and their relevance to normal tension glaucoma. III. Potentially differentiating characteristics between glaucoma with normal IOP and glaucoma with elevated intraocular pressure (IOP). IV. Lessons learned from the Normal Tension Glaucoma Study. I. The misnomer of normal tension glaucoma (NTG)There is considerable controversy on whether normal tension glaucoma represents a distinct entity or is simply primary openangle glaucoma (POAG) with IOP within the normal range. Because IOP is a continuous variable with no definite dividing line between normal and abnormal, many authorities are questioning whether the term normal tension glaucoma should be abandoned. Normal tension glaucoma is typically defined as a glaucomatous optic neuropathy despite IOP consistently below 21 mmHg. The question must therefore be asked, 'What's so special about 21 mmHg?' Answering that question requires a review of Leydhecker's landmark investigation of 1958 wherein the IOPs of 20 000 eyes were obtained with Schiotz tonometry (Leydhecker et al. 1959). The mean IOP was found to be 15.5 mmHg with a standar...

The authors used the Zeiss Humphrey (Mod840, 5OMHz) ultrabiomicroscope to evaluate the changes that Brimonidine, Apraclonidine, Latanoprost and Ibopamine cause in the anterior chamber and on the ciliary body of healthy subjects. The eyes of 60 volunteers, separated into 4 groups according to drug instilled, were studied and the parameters analyzed were: anterior chamber depth (ACD), pupillary diameter (PD), angle opening at 500 microns from the scleral spur (AOD500), trabecular iris angle (TIA) and iris thicknesses (ID1 and ID3).The study showed the miotic effect of Brimonidine (S) that was accompanied by an angle opening (S). Apraclonidine and Latanoprost caused no statistically significant changes in the angle or in the ciliary body. Ibopamine caused mydriasis (9.The UBM, therefore, showed itself to be useful also in the study of the mechanism of action of drugs on the angular structures and on the ciliary body.