The two-stage surgery is a safe and effective modality.

This study characterized and evaluated normal tension glaucoma (NTG) in obstructive sleep apnea syndrome (OSAS). In this retrospective, cross-sectional study, all participants were examined with polysomnography (PSG). Functional parameters of standard automated perimetry (SAP) were recorded. Structural parameters in optical coherence tomography angiography (OCTA) included peripapillary superficial vessel density (VD RPC), peripapillary whole-layer (VD NH), and superficial and deep macular area VD. Participants were categorized into perimetric and nonperimetric groups by SAP result. Low reliability of SAP and signal strength index <50 in OCTA were excluded. Severity of OSAS was graded by apnea-hypopnea index (AHI) in PSG. Those with moderate/severe OSAS (AHI ≥ 15, n = 39) had longer neck circumference and shorter ocular axial length than mild OSAS (AHI < 15, n = 14). Furthermore, there was significantly higher AHI and larger neck circumference in the NTG perimetric group (n = 27) than in the control group (n = 26; p < 0.001 and p = 0.047, respectively). Superficial and deep-layer peripapillary and macular area VD significantly decreased in the perimetric group. Overall, structural and functional parameters show that VF PSD was negatively correlated with VD NH and VD RPC (p = 0.007, p = 0.015); and VF MD was positively correlated with VD NH (p = 0.029), but not significantly to VD RPC (p = 0.106). OSAS is a risk factor of NTG. With aid of OCTA, whole-layer retinal capillary dropout supports that the vascular dysregulation of OSAS leads to NTG.

BACKGROUND AND OBJECTIVE: To assess the long-term results of Nd:YAG laser iridotomy in the treatment of patients with primary angle-closure glaucoma and occludable angles to evaluate the risk–benefit ratio and the role of gonioscopy in predicting the outcome after Nd:YAG laser iridotomy. PATIENTS AND METHODS: The records of 138 consecutive patients (231 eyes) who underwent Nd:YAG laser iridotomy in one hospital during 3 years (from 1989 to 1991) were reviewed. The mean follow-up period was 51 months. RESULTS: Of all eyes, 25.1% were treated for chronic angle-closure glaucoma and 10.8% were treated for acute angle-closure glaucoma; most eyes (64.1%) underwent prophylactic iridotomy for occludable angles. Decreased intraocular pressure (IOP) was noted in most eyes after Nd:YAG laser iridotomy; only 10 eyes required further filtration surgery. Visual acuity was unchanged or improved in 97.9% of all eyes at the 6-month visit. Cataract progression was primarily responsible for those eyes with decreased acuity. Ninety-seven percent of eyes had quantitatively wider angles after laser treatment; 8 of 14 eyes with peripheral anterior synechiae of more than 270° underwent further surgery to control IOP. Transient elevated IOP and iris bleeding occurred in 23.5% and 12.2% of the eyes, respectively; other complications were rare. CONCLUSION: Nd:YAG laser iridotomy is a safe and effective procedure for the treatment and prevention of angle-closure glaucoma. Gonioscopy is useful to predict the outcome after Nd:YAG laser iridotomy. [Ophthalmic Surg Lasers Imaging 2003;34:291–298.]