Reducing intraocular pressure (IOP) seems to be the only treatment that slows progression in glaucoma. The IOP can be decreased by pharmaceutical treatment, laser [selective laser trabeculoplasty (SLT)] treatment, or surgery. Prostaglandin analogues have been postulated to share action mechanisms with SLT and to possibly diminish the effects of SLT treatment. The aim of this Swedish prospective, nonrandomized study was to investigate the effects of prostaglandin analogues in inflammation and IOP reduction after SLT treatment.

A total of 118 patients were included in the study. Inclusion criteria consisted of glaucoma (open-angle or pseudoexfoliation glaucoma) patients who will be treated with SLT. Inflammation was measured with a laser flare meter (Kowa FM-500) and measurements were made before SLT and then 2h, 1 week, and 1 month after SLT treatment. IOP was also checked at the same time intervals. Additionally, the SLT treatment was performed over 90° and all patients were divided into two groups: those receiving prostaglandins analogues and those treated with nonprostaglandin analogues.

It was reported that inflammation before and after SLT showed no significant difference between the groups at all the time intervals studied (t-test, before: p=0.16; 2 h: p=0.14; 1 week: p=0.12; and 1 month: p=0.36). IOP reduction showed no significant difference between the groups (t-test, p=0.31).

It was concluded that SLT treatment effects do not seem to be influenced by the use of prostaglandin analogues.

The authors of this Korean retrospective, interventional case series investigated the correlation between fundus autofluorescence (FAF) and the results of spectral-domain optical coherence tomography (SD-OCT) as well as visual acuity (VA) in patients with diabetic macular edema (DME) and to determine the visual prognostic factors.

They included 61 patients with DME who underwent intravitreal injection of bevacizumab (IVB) as their first treatment and obtained an assessment of VA and FAF and SD-OCT images before and after IVB (pre- and post-IVB). The authors also graded foveal FAF on a scale of 1 to 4 and they determined the presence or absence of FAF at the foveola. The association of FAF with VA and the SD-OCT results, including central macular thickness (CMT), outer nuclear layer thickness, the integrity of the external limiting membrane (ELM), and the integrity of the junction between the inner and outer segment of the photoreceptor (IS/OS) served as the main outcome measures.

The study authors associated better VA, preservation of the ELM, and IS/OS pre-IVB with better VA post-IVB. Of the types of DME, cystoid macular edema significantly correlated with increased FAF at the foveola. They found that a higher level of FAF was 5.6 times more likely to occur in DME with a defect in IS/OS and 10 times more likely to occur with each 10-µm increase in CMT. Each increase by a factor of 0.1 in the logarithm of the minimum angle of resolution (logMAR) pre-IVB increased the probability of high FAF by a factor of 1.73. Despite severe DME, fewer eyes with a low level of FAF exhibited an IS/OS defect and large logMAR VA than eyes with a high level of FAF with severe DME pre-IVB. According to the authors, the average grade of FAF pre-IVB was higher in patients with decreased vision during follow-up than in patients with increased or unchanged good vision.

The strong association of FAF with SD-OCT parameters and VA in patients with DME could aid in the prediction of the restoration of photoreceptor integrity and subsequent visual recovery, especially in patients with severe DME, in whom photoreceptor integrity before treatment could not be adequately evaluated, even with SD-OCT.

In the following study, the researchers sought to examine the feasibility of rotating choriocapillaris, Bruch's membrane (BM) and retinal pigment epithelium (RPE) through 180° on a vascular pedicle and to assess revascularization and tissue preservation postoperatively. Such an approach could be used in the treatment of age-related macular degeneration (AMD), where there is focal disease at the macula with healthy tissues located peripherally.

Successful surgery was performed in six rhesus macaque monkeys, which have a very similar choroidal blood supply to humans. After inducing a retinal detachment, the researchers used the recurrent branch of the long posterior ciliary artery as a pedicle around which they rotated a graft stretching to the temporal equator. They reattached the retina over the rotated graft and followed up on eyes for up to 6 months with repeated angiography and optical coherence tomography (OCT). Additionally, they assessed morphology of retinal cells and BM by immunohistochemistry and electron microscopy.

The study researchers noted that revascularization of the choroid was limited, with reestablishment of drainage to the vortex veins seen in only one case. There was a secondary loss of the RPE and outer retina evident on histological analysis three months after surgery. The underlying BM however remained intact.

They concluded that pedicled choroidal rotation surgery is technically feasible in vivo with intraoperative control of bleeding. However, lack of graft revascularization with the technique in its current form leads to neuroretinal and RPE tissue loss, and graft shrinkage. We found no evidence that rotational grafts are likely to improve the outcomes presently achieved with free graft techniques.

To examine how demographic and geographic variations in U.S. populations from 2011 to 2050 will contribute to estimated numbers of primary open-angle glaucoma (POAG) cases, investigators conducted this cross-sectional study. They found that despite the high prevalence of POAG in African Americans and Hispanics, the largest group in the United States is currently among older non-Hispanic white women, but is expected to shift to Hispanic men over the next few decades.

Investigators used prevalence rates from selected population-based studies to estimate the number of persons aged 40 years and older with POAG in the United States. For calculation, they multiplied the age-, sex-, and race/ethnicity-specific prevalence rates by the U.S. Census estimates and projections from 2011 to 2050. Main outcome measures are estimated numbers of persons with POAG in different age, sex, and racial/ethnic groups and total and per capita POAG rates by state.

The investigators reported that in 2011, 2.71 million persons in the United States have POAG, with the highest estimated number among populations aged 70 to 79 years (31%), women (53%), and non-Hispanic whites (44%). The largest demographic group is non-Hispanic white women. In 2050, an estimated 7.32 million persons will have POAG, with the highest number among populations aged 70 to 79 years (32%), women (50%), and Hispanics (50%). The largest demographic group will shift to Hispanic men. During the next 40 years, the highest per capita POAG rates will double in New Mexico, Texas, and Florida.

Given this shift, the greatest yield from screening programs is likely to be in those states with high numbers of non-Hispanic white women and Hispanic men.