Overview: Open-angle glaucoma (POAG) is a leading cause of irreversible blindness globally, characterized by progressive degeneration of retinal ganglion cells and nerve fibers, resulting in reductions in macular and papillary perfusion, visual field, contrast sensitivity, and visual acuity. Management of POAG and ocular hypertension, a predisposing condition, focuses on reducing intraocular pressure (IOP) through drug therapies, surgery, and laser treatments such as MLT. Subthreshold micropulsed macular laser (SMPL) represents an innovative solutio with neuroprotective potential, as it avoids visible damage to the treated tissue. Aim of the study: to evaluate the IOP-lowering effect of subthreshold micropulsed laser applied at the trabecular level (MLT) and to investigate the possible neuroprotective function at the macular level (SMPL) in a court of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Materials and methods: The study involved 12 patients with POAG who underwent standard MLT in both eyes, with randomized assignment of one eye to also receive SMPL treatment. Six patients had a full follow-up of 12 months, 9 of 6 months and all 12 at least 3 months. During the follow-up visual acuity (ETDRS), IOP, microperimetry, 24-2 visual field, OCT and Angio-OCT have been monitored. Data were analyzed by ANOVA, dividing patients into two groups: the “Treated” group (eyes undergoing MLT and SMPL) and the “Control” group (eyes treated with MLT only). Results: A mild but significant improvement in the functional visual acuity parameter (ETDRS) was observed in the Treated group. In both groups there is a trend in the reduction of IOP, particularly in the Treated group. Anatomically, Angio-OCT did not show statistical significance for the group size. Structural OCT, Visual Field and Microperimetry showed a progression trend in both study groups. This finding was likely influenced by one patient in the sample who had a sudden progression of the Glaucomatous defect related to tonometric decompensation. Conclusion: MLT micropulsed laser is effective in reducing ocular pressure. Subthreshold micropulsed macular laser (SMPL), on the other hand, shows no structural and anatomical effects compared to the Control group, however, confirming the safety profile of macular laser on the anatomical structures. In order to confirm and further investigate these promising effects, especially from a neuroprotective perspective, it will be necessary to perform new studies with larger samples and longer follow-ups.
Panoramica: Il glaucoma ad angolo aperto (POAG) è una delle principali cause di cecità irreversibile a livello globale, caratterizzato dalla progressiva degenerazione delle cellule ganglionari retiniche e delle fibre nervose, con conseguenti riduzioni della perfusione maculare e papillare, del campo visivo, della sensibilità al contrasto e dell'acuità visiva. La gestione del POAG e dell’ipertensione oculare, una condizione spesso predisponente, si focalizza sulla riduzione della pressione intraoculare (IOP) attraverso terapie farmacologiche, interventi chirurgici e trattamenti laser come il MLT. Il laser maculare micropulsato sottosoglia (SMPL) rappresenta una soluzione innovativa con un potenziale neuroprotettivo, poiché consente di evitare danni visibili al tessuto trattato. Obiettivo dello studio: valutare l’effetto ipotonizzante del laser micropulsato sottosoglia applicato a livello trabecolare (MLT) e di indagare la possibile funzione neuroprotettiva a livello maculare (SMPL) in una corte di pazienti affetti da glaucoma primario ad angolo aperto (POAG) e ipertensione endoculare (OHT). Materiali e metodi: Lo studio ha coinvolto 12 pazienti con POAG, sottoposti a MLT standard in entrambi gli occhi, con assegnazione randomizzata di un occhio a ricevere anche il trattamento SMPL. 6 pazienti hanno avuto un follow-up completo di 12 mesi, 9 di 6 e tutti e 12 almeno di 3 mesi. Tale follow-up ha monitorato parametri quali acuità visiva (ETDRS), IOP, microperimetria, campo visivo 24-2, OCT e Angio-OCT. I dati sono stati analizzati con ANOVA, suddividendo i pazienti in due gruppi: il gruppo "Trattato" (occhi sottoposti a MLT e SMPL) e il gruppo "Controllo" (occhi trattati solo con MLT). Risultati: Nel gruppo Trattato si è osservato un miglioramento modesto ma significativo del parametro funzionale acuità visiva (ETDRS). In entrambi i gruppi vi è una tendenza nella riduzione della IOP, in particolare nel gruppo Trattato. Dal punto di vista anatomico, l’Angio-OCT non ha mostrato significatività statistica per la dimensione del gruppo. L’OCT strutturale, il Campo Visivo e la Microperimetria hanno evidenziato un trend di progressionein entrambi i gruppi in studio. Questo dato è stato verosimilmente influenzato da un paziente del campione che ha avuto un repentino peggioramento del difetto glaucomatoso correlato ad uno scompenso tonometrico. Conclusione: Il laser micropulsato MLT risulta efficace nel ridurre la pressione oculare. Il laser maculare micropulsato sottosoglia (SMPL), invece, non mostra effetti strutturali e anatomici significativi rispetto al gruppo di controllo, confermando il profilo di sicurezza del laser maculare sulle strutture retiniche. Al fine di confermare e approfondire questi effetti promettenti, soprattutto in ottica neuroprotettiva, sarà necessario eseguire nuovi studi con campioni più estesi e follow-up prolungato.
Laser Micropulsato Sottosoglia: Studio Clinico Sperimentale nel Trattamento del Glaucoma Primario ad Angolo Aperto e dell'Ipertensione Oculare
MARDEGAN, MILENA
2023/2024
Abstract
Overview: Open-angle glaucoma (POAG) is a leading cause of irreversible blindness globally, characterized by progressive degeneration of retinal ganglion cells and nerve fibers, resulting in reductions in macular and papillary perfusion, visual field, contrast sensitivity, and visual acuity. Management of POAG and ocular hypertension, a predisposing condition, focuses on reducing intraocular pressure (IOP) through drug therapies, surgery, and laser treatments such as MLT. Subthreshold micropulsed macular laser (SMPL) represents an innovative solutio with neuroprotective potential, as it avoids visible damage to the treated tissue. Aim of the study: to evaluate the IOP-lowering effect of subthreshold micropulsed laser applied at the trabecular level (MLT) and to investigate the possible neuroprotective function at the macular level (SMPL) in a court of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Materials and methods: The study involved 12 patients with POAG who underwent standard MLT in both eyes, with randomized assignment of one eye to also receive SMPL treatment. Six patients had a full follow-up of 12 months, 9 of 6 months and all 12 at least 3 months. During the follow-up visual acuity (ETDRS), IOP, microperimetry, 24-2 visual field, OCT and Angio-OCT have been monitored. Data were analyzed by ANOVA, dividing patients into two groups: the “Treated” group (eyes undergoing MLT and SMPL) and the “Control” group (eyes treated with MLT only). Results: A mild but significant improvement in the functional visual acuity parameter (ETDRS) was observed in the Treated group. In both groups there is a trend in the reduction of IOP, particularly in the Treated group. Anatomically, Angio-OCT did not show statistical significance for the group size. Structural OCT, Visual Field and Microperimetry showed a progression trend in both study groups. This finding was likely influenced by one patient in the sample who had a sudden progression of the Glaucomatous defect related to tonometric decompensation. Conclusion: MLT micropulsed laser is effective in reducing ocular pressure. Subthreshold micropulsed macular laser (SMPL), on the other hand, shows no structural and anatomical effects compared to the Control group, however, confirming the safety profile of macular laser on the anatomical structures. In order to confirm and further investigate these promising effects, especially from a neuroprotective perspective, it will be necessary to perform new studies with larger samples and longer follow-ups.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/78416