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Intense pulsed light‑based treatment for the improvement of symptoms in glaucoma patients treated with hypotensive eye drops

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Eye and Vision 2024年第2期10卷 12-21页

作者： Jose Maria Martinez‑de‑la‑Casa Carlos Oribio‑Quinto Almudena Milans‑del‑Bosch Pilar Perez‑garcia Laura Morales‑Fernandez Javier garcia‑Bella Jose Manuel Benitez‑del‑Castillo julian garcia‑feijoo David P.Pinero Ophthalmology Unit Department of Ophthalmology and ORLFaculty of MedicineHospital Clinico San-CarlosUniversidad Complutense de MadridInstituto de Investigacion Sanitaria del Hospital Clinico San-Carlos(IdISSC)28040 MadridSpain Department of Immunology Ophthalmology and ORLSchool of MedicineInstituto de Investigaciones Oftalmologicas Ramon CastroviejoUniversidad Complutense de MadridMadridSpain Department of Optics Pharmacology and AnatomyUniversity of AlicanteAlicanteSpain

Background:Ocular surface disease in glaucoma patients is a significant ocular co-morbidity that can affect 40%to 59%of these patients worldwide.The current study was aimed at evaluating the potential clinical benefit of an intense pulsed light(IPL)-based treatment in glaucomatous patients with ocular surface disease due to prolonged hypotensive eyedrop treatments.To our knowledge,this is the first series analyzing the therapeutic effect of this treatment option in this type of patients.Methods:This non-comparative prospective case series study enrolled a total of 30 glaucoma patients ranging in age from 57 to 94 years old and treated with hypotensive eyedrops for years with dry eye symptomatology.All patients received four sessions of IPL treatment using the Optima IPL system(Lumenis,Yokneam,Israel)adjusted to the official optimized Lumenis setting.Changes in symptomatology,corneal staining,conjunctival hyperemia,non-invasive break-up time(NIBUT),tear osmolarity,tear meniscus height(TMH),meiboscore and meibomian gland expressibility was analyzed after treatment.Results:Statistically significant reductions were observed after IPL treatment in the symptomatology scores measured with different questionnaires[ocular surface disease index(OSDI),standard patient evaluation of eye dryness(SPEED)and symptom assessment questionnaire in dry eye(SANDE)]as well as with the visual analogue scale(P<0.001).Mean change in OSDI was−15.0±11.3.A significant reduction was found after treatment in the corneal staining score(P<0.001).A significant reduction was found in tear film meniscus height(P=0.012),as well as in tear film osmolarity(P=0.001).A significant reduction was also found in meibomian gland expressibility(P=0.003),changing the percentage of grade 3 eyes from 44.4%before IPL to 17.2%after treatment.Conclusions:IPL therapy combined with meibomian gland expression(MGX)seems to be an effective option to improve symptomatology in glaucomatous patients with ocular surface disease due to prolonged hypotensive eyedrop treatment

关键词： Glaucoma Intense pulsed light Dry eye Meibomian glands

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Correlations between corneal and optic nerve head variables in healthy subjects and patients with primary open angle glaucoma

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International Journal of Ophthalmology(English edition) 2015年第6期8卷 1156-1161页

作者： Federico Saenz-Frances Luis Janez Lara Borrego-Sanz Clara Berrozpe-Villabona Jose Maria Martinez-de-la-Casa Laura Morales-Fernandez julian garcia-Sanchez Enrique Santos-Bueso julian garcia-feijoo Department of Ophthalmology Clinico San Carlos HospitalComplutense University of Madrid Technology of Knowledge Institute Complutense University of Madrid

AIMTo correlate corneal variables (determined using the Pentacam) with optic nerve head (ONH) variables determined using the Heidelberg retina tomograph (HRT) in healthy subjects and patients diagnosed with primary open angle glaucoma (POAG).METHODSMeasurements were made in 75 healthy eyes and 73 eyes with POAG and correlations examined through Pearson correlation coefficients between the two sets of variables in the two subject groups. The corneal variables determined were corneal volume (CVol), central corneal thickness (CCT), overall corneal thickness (OvCT), the mean thickness of a circular zone centered at the corneal apex of 1 mm radius (zone I) and the mean thickness of several concentric rings, also centered at the apex until the limbus, each of 1 mm width (zones II to VI respectively). The ONH variables were determined using the HRT.RESULTSThe following pairs of variables were correlated in the control group: CCT-disc area (DAr) (-0.48; P<0.0001), Zone I-DAr (-0.503; P<0.0001) and Zone II-DAr (-0.443; P<0.0001); and in the POAG group: CCT-cup-to-disc area ratio (CDRa) (-0.402; P<0.0001), Zone I-CDRa (-0.418; P<0.0001), Zone II-CDRa (-0.405; P=0.006), Zone I-cup shape measure (CSM) (-0.415; P=0.002), Zone II-CSM (-0.405; P=0.001), Zone IV-height variation contour (HVC) (0.378; P=0.002); Zone V-HVC (0.388, P<0.0001).CONCLUSIONSIn the healthy subjects, significant negative correlation was detected between central and paracentral corneal thickness and optic disc area. In contrast, the POAG patients showed significant negative correlation between central and paracentral corneal thickness and the cup-disc ratio and CSM, and positive correlation between peripheral corneal thickness and HVC.

关键词： glaucoma optic nerve head corneal thickness

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Dependence of dynamic contour and Goldmann applanation tonometries on peripheral corneal thickness

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International Journal of Ophthalmology(English edition) 2017年第10期10卷 1521-1527页

作者： Federico Saenz-Frances Claudia Sanz-Pozo Lara Borrego-Sanz Luis Ja?ez Laura MoralesFernandez Jose Maria Martinez-de-la-Casa julian garcia-Sanchez julian garcia-feijoo Enrique Santos-Bueso Ophthalmology Department Clinico Universitario San Carlos HospitalComplutense University Institute of Knowledge Technology Complutense University

AIM：To determine the effects of peripheral corneal thickness（PCT）on dynamic contour tonometry（DCT）and Goldmann applanation tonometry（GAT）.METHODS：A cross-sectional study.We created a software which calculates the corneal contour（CC）as a function of the radius from the corneal apex to each pixel of the contour.The software generates a central circumference with a radius of 1 mm and the remainder of the cornea is segmented in 5 rings concentric with corneal apex being its diameter not constant around the corneal circumference as a consequence of the irregular CC but keeping constant the diameter of each ring in each direction of the contour.PCT was determined as the mean thickness of the most eccentric ring.Locally weighted scatterplot smoothing（LOWESS）regression was used to determine the pattern of the relationship between PCT and both DCT and GAT respectively.Thereafter,two multivariable linear regression models were constructed.In each of them,the dependant variable was intraocular pressure（IOP）as determined using GAT and DCT respectively.In both of the models the predictive variable was PCT though LOWESS regression pattern was used to model the relationship between the dependant variables and the predictor one.Age and sex were also introduced control variables along with their first-degree interactions with PCT.Main outcome measures include amount of IOP variation explained through regression models（R2）and regression coefficients（B）.RESULTS：Subjects included 109 eyes of 109 healthy individuals.LOWESS regression suggested that a 2nd-degree polynomial would be suitable to model the relationshipbetween both DCT and GAT with PCT.Hence PCT was introduced in both models as a linear and quadratic term.Neither age nor sex nor interactions were statistically significant in both models.For GAT model,R2was 17.14%（F=9.02;P=0.0002）,PCT linear term B was-1.163（95%CI：-1.163,-0.617）.PCT quadratic term B was 0.00081（95%CI：0.00043,0.00118）.For DCT model R2was 14.28%（F=9.29;P=0.0002）,PCT linear term B was-0.712（95%CI：-1.052,-0.37

关键词： Goldmann applanation tonometry dynamic contour tonometry peripheral corneal thickness corneal thickness

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