Glaucoma progression analysis by Spectral-Domain Optical Coherence Tomography (SD-OCT).

Spectral domain optical coherence tomography (SD-OCT) provides an objective quantification of the lesions of various target tissue structures in glaucoma, with unprecedented resolution, which has now demonstrated its interest in controlling the progression of glaucomatous neuropathy, from early stages to late stages. A certain number of well-established proofs state that a progressive modification in OCT is a common predictor of functional loss, and that patients with rapid OCT changes have an increased risk of developing glaucomatous scotoma. Follow-up of the progression goes through three stages.

[Evaluation of the efficacy of diode laser endocyclophotocoagulation combined with cataract surgery in glaucoma].

Introduction: Surgical techniques, which reduce the secretion of aqueous humor are underutilized in the surgical management of glaucoma; the diode laser coupled to an endoscope, endocyclophotocoagulation (ECP), is an emerging technology in the treatment of glaucoma. Indeed, thanks to its direct, focal and controllable approach to diode laser treatment of the ciliary processes, ECP renders this a safer technique compared to transscleral diode laser. We present preliminary results and an evaluation of the efficacy of ECP combined with cataract surgery performed at the Al Bassar clinic in Mohammedia, Morocco.

Primary open angle glaucoma and snoring: prevalence of OSAS.

Introduction: Obstructive sleep apnea syndrome (OSAS) may be suspected at interview, notably in case of snoring. Various studies suggested a link between primary open angle glaucoma (POAG) and OSAS. The present study sought to determine OSAS prevalence in POAG associated with snoring.

[What to do if the intraocular pressure measurement does not appear reliable].

Among the various intraocular pressure (IOP) measurement methods available today, Goldmann applanation tonometry (GAT) remains the gold standard for in-office routine IOP measurement. However, numerous factors may affect IOP measurement with GAT, namely corneal features. Before any interpretation of an IOP value, the measurement conditions should be checked and the central corneal thickness evaluated, since GAT overestimates IOP in thick corneas and underestimates IOP in thin ones.

[Is it possible to combine fixed therapeutic associations?].

The number of fixed associations to treat intraocular pressure has increased over the recent years, to improve patient's treatment adherence. They are generally considered as comparable to the same components administered separately with, in some cases, less side effects. It could thus be appealing to combine fixed associations to reduce these side effects and retain efficacy.

[Glaucoma in children and adolescents: diagnosis and therapeutic difficulties].

The management of glaucoma in young patients has made considerable progress over the recent years. Its treatment is essentially surgical, mainly filtration procedure. Use of antimetabolites combined with filtration is highly recommended.

[The place of SLT in managing glaucoma].

Selective laser trabeculoplasty (SLT) is effective in reducing intraocular pressure (IOP) in glaucomatous patients and patients with ocular hypertension. Equivalent to argon laser trabeculoplasty in terms of IOP reduction, SLT has the advantage of preserving surrounding structures. Easy and rapid to perform, SLT may be an interesting therapeutic approach in the management of glaucoma.

[The physician-patient relationship in glaucoma].

Healthcare of chronic pathologies, especially in glaucoma, which is asymptomatic for a long period of time, is based on a good, confident relationship between physicians and patients. This relationship has to be created, maintained, and reinforced throughout follow-up. The patient's information source is to a large extent the physician, who must provide all the necessary information concerning the disease, including the definition, prognosis, follow-up, and treatment.

[High blood pressure-low ocular pressure: the parallels. The ophthalmologist's point of view].

Although numerous similarities exist between hypertension and high intraocular pressure, risk models of hypertension are far in advance of glaucoma models. With the results of cohort studies such as the OHTS and the EMGT, we can define risk factors for developing glaucoma as well as risk factors for glaucoma progression. To facilitate the evaluation of the risk of developing glaucoma in patients with high intraocular pressure, a new calculator, the STAR (scoring tool for assessing risk), has been developed based on the results of the OHTS.

[How to assess the stability of glaucoma? Visual field].

Visual field results are subject to fluctuations in glaucoma and it is important to evaluate them to differentiate fluctuation and progression. Three visual fields are thus required for the determination of progression because of these short or long term fluctuations. During each measurement, some points are tested twice in order to assess short term fluctuation.

[Medical treatments and practices. What should be done when a prostaglandin proves ineffective?].

Prostaglandin analogs are very frequently used as first-line therapy in the treatment of glaucoma. In some cases, they may be ineffective or insufficient or they may induce side effects. The absence of an ocular pressure-lowering effect of a prostaglandin is in general a class effect.

[Particular clinical situations in the glaucoma patient. True or false deterioration of the visual field?].

Measurement errors, correction errors, head position errors, changes in strategy, fluctuations. There are many parameters influencing the results of visual field measurement. When in doubt, it is indispensable to repeat the examination before concluding that the results have deteriorated.

[How to conduct glaucoma therapy when pressure stays high despite topical treatment?].

When glaucoma worsens with elevated ocular pressure despite an initial treatment, an additional reduction of pressure is needed. It is necessary to evaluate the cause of the therapeutic failure which could be the consequence of a low compliance from the patient, a poor efficacy of the topical drug or a short or long term drift of this efficacy. Depending on the aetiology, another monotherapy or a combination of treatments should be initiated.

[Should the ophthalmologist prescribe generic drugs?].

It seems obvious that an ophthalmologist should encourage the use of generic drugs. However, it is important to know the exact definition of a generic drug and the type of studies to be conducted before a generic drug is released on the market. A generic drug is a drug that has the same composition quantitatively as well as qualitatively of the active compound as the original drug.

[When should the anti-glaucoma treatment start?].

The decision to start a glaucoma treatment in a newly diagnosed patient is easy when the disease is clearly identified with typical optic nerve cupping, visual field defect, and elevated intraocular pressure. However it often appears more complicated, especially in young patients for whom a careful analysis of the fundus and an examination of nerve fiber layers should be assessed to detect an early sign of glaucoma before any visual field change. If glaucoma is present, patients with intraocular pressure above 14 mmHg should be treated, as in such cases there is always a "pressure risk factor".

[Evaluation of confocal microscopy in the analysis of the external trabecular membrane during deep nonpenetrating sclerectomy].

Purpose: Deep non penetrating sclerectomy (DNPS) is a new filtering surgical procedure whose aim is a selective ablation of the external portion of the trabecular meshwork (TM) which is involved in the aqueous outflow resistance, i.e. the inner wall of Schlemm's canal (SC) and the external trabecular layers, especially the cribriform TM.

[Trans-scleral diode laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma].

Purpose: To evaluate the success rate of contact diode transscleral cyclophotocoagulation (TSCPC) in pediatric refractory glaucoma.

Patients: and method: Twenty-eight eyes of 28 patients (age range 5 months to 26 years) with medical and surgical refractory pediatric glaucoma due to primary congenital glaucoma (group 1, 20 eyes) or aphakic congenital glaucoma (group 2: 8 eyes), were included in this retrospective study. All eyes underwent one or more TSCPC with the diode laser (Oculight SLX, Iris Medical) with a minimal follow-up of 2 months.

[Consensus on neovascular glaucoma].

Neovascular glaucoma is a dreadful pathology with a rapid spontaneous evolution responsible for painful and blind eye. The main cause is an anterior neovascular proliferation following a broad retinal ischemia. Early diagnosis and treatment are required in order to maintain a good visual status and a satisfactory IOP control with medical, surgical or cylodestructive procedures.

[Deep nonpenetrating sclerectomy and open angle glaucoma. Intermediate results from the first operated patients].

Purpose: The aim of this retropective study is to evaluate and to compare in glaucoma patients, the mid-term results of the non penetrating deep-sclerectomy (NPDS) with collagen implant or with per operative application of 5 fluorouracile (5 FU).

Material And Methods: The aim of the NPDS, a new filtering surgical procedure, is to remove under a scleral flap the Schlemm's canal and the juxtacanalicular trabecular meshwork responsible for the outflow resistance in order to obtain a sub-conjunctival filtration of the aqueous humor with no opening of the anterior chamber. Forty-two open angle glaucoma patients with uncontrolled intra-ocular pressure and with no risk factor of bleb fibrosis, underwent a NPDS.