Efficacy of selective laser trabeculoplasty following incisional glaucoma surgery

AIM： To evaluate the efficacy of selective laser trabeculoplasty（SLT） in glaucomatous eyes with previous incisional glaucoma surgery. METHODS： A retrospective cohort of eyes that underwent SLT at a single institution from 2013-2015 were followed for 1 y. Reduction in intraocular pressure（IOP） following SLT was evaluated in eyes with prior trabeculectomy with Ex Press mini shunt（Alcon, Ft Worth, TX, USA）, Ahmed valve（New World Medical, Cucamonga, CA, USA）, or combined phacoemulsification-trabeculectomy. A control group was included with eyes without prior surgery that underwent SLT. Success was defined as 〉20% drop in IOP from pre-SLT baseline. RESULTS： One-hundred and six eyes were included with 53 in both the prior glaucoma surgery（PGS） and no prior glaucoma surgery（NPGS） groups. Mean pre-SLT IOP was 19.2±4.3 and 20.6±6.0 mm Hg for PGS and NPGS groups, respectively（P=0.17）. Both groups produced statistically significant IOP reductions at 1 and 6 mo（P〈0.04）. At 6 mo, mean IOP reduction reached 7.3% and 10.8% for the PGS and NPGS groups, respectively（P=0.42）. Overall, 27.9% and 31.7% of eyes in PGS and NPGS groups met success criteria at 1 y（P=0.70）. In the PGS group, eyes with baseline IOP ≥21 mm Hg had IOP reductions of 18.1%（P〈0.001）, 16.7%（P〈0.01）, and 8.4%（P=0.31） compared to eyes with baseline IOP 〈21 mm Hg who had IOP reductions of 2.3%（P=0.39）, 3.4%（P=0.19）, and 1.1%（P=0.72） at 1, 6 mo, and 1 y, respectively. CONCLUSION： SLT is efficacious in eyes with prior incisional glaucoma surgery and results in similar IOP reductions compared to eyes without PGS. A larger IOP reduction is observed following SLT in eyes with higher pre-SLT IOP.

Scleral surgery for the treatment of presbyopia: where are we today?

Presbyopia corrections traditionally have been approached with attempts to exchange power,either at the cornea or the lens planes,inducing multifocality,or altering asphericity to impact the optical system.Treatments that affect the visual axis,such as spectacle and contact lens correction,refractive surgeries,corneal onlays and inlays,and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye.Their aim is instead to enhance‘pseudoaccommodation’by facilitating an extended depth-of-focus for which vision is sufficient.There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution,rather than a‘vision correction’solution that compromises other components of the optical system.Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia.While the theoretical justification of scleral surgical procedures remains controversial,there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia.Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s,and this remains an active area of research.In this article,we discuss the historic scleral surgical procedures,the two scleral procedures currently available,as well as an outlook of the future for the scleral surgical space for treating presbyopia.