Nowadays, lasers are used in various medical fields. Ophthalmology was the first medical specialty to utilize lasers in patient treatment and still remains the leading medical field that uses laser energy for both therapeutic and diagnostic purposes. The neodymium: yttrium-aluminum-garnet (Nd: YAG) laser is one of the most common lasers used in ophthalmology. It is a solid-state laser with a wavelength of 1064 nm that works on the principle of photodisruption. Since its introduction in ophthalmology over 40 years ago, it has found various applications, mainly for procedures where cutting or disruption of ocular tissue is required. Compared to surgical alternatives, the use of Nd: YAG lasers on ocular tissue is minimally invasive. In this review, we focus on the two most common ophthalmic applications of Nd: YAG laser - laser peripheral iridotomy and posterior capsulotomy. The history of the techniques, current trends, potential complications, and the prognosis for future use is discussed.

This systematic review aimed to clarify the relationship between the location of laser peripheral iridotomy (LPI), a common procedure to prevent or treat angle-closure glaucoma, and the incidence of post-procedure visual disturbances known as dysphotopsias. Understanding this relationship is crucial due to the high frequency of LPIs performed and the significant impact dysphotopsia can have on vision and quality of life. Articles investigating the relationship between LPI location and dysphotopsia in at least five patients were identified via a literature search of OVID MEDLINE (1946-November 19, 2022) and EMBASE (1946-November 19, 2022). Non-comparative and non-English studies were excluded. Studies did not require a control group to be included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and Cochrane Risk of Bias 2 (RoB2) tool were used to appraise included studies. Our review included three studies encompassing 1756 eyes from 878 patients. The location of LPI was grouped into superior (604 patients, 889 eyes), inferior (150 patients, 150 eyes), and nasal/temporal (443 patients, 717 eyes). The analysis showed no significant difference in the incidence of any new dysphotopsia types among the location groups post-LPI. Overall, the incidence of lines, ghost images, and blurring significantly increased after LPI, while halos and glare significantly decreased. In conclusion, the current literature suggests that the location of LPI has no significant relationship to the types and rates of dysphotopsia experienced thereafter. While there is a 2-3% risk of linear dysphotopsia after LPI regardless of location, LPI may also resolve pre-existing halos and glare.
摘要: 周边虹膜激光切开术 (LPI) 是预防或治疗闭角型青光眼的一种常见手术, 本综述旨在阐明周边虹膜激光切开术 (LPI) 选择的位置与术后视力障碍发生率之间的关系。由于 LPI 手术的高频率以及视力障碍对视力和生活质量的重要影响, 对其了解至关重要。通过对 OVID MEDLINE (1946 年至 2022 年 11 月 19 日) 和 EMBASE (1946 年至 2022 年 11 月 19 日) 数据库进行文献检索, 发现至少有五名患者的 LPI 位置与视力障碍之间关系的研究文章。非比较型研究和非英文研究被排除在外。纳入研究无需对照组。采用推荐、评估、发展和评价分级 (GRADE) 系统和 Cochrane Risk of Bias 2 (RoB2) 工具对纳入的研究质量进行评估。本综述包括三项研究, 涉及 878 名患者的1756只眼睛。LPI 的位置分为上侧 (604名患者, 889只眼) 、下侧 (150名患者, 150只眼) 和鼻/颞侧 (443名患者, 717只眼) 。分析结果表明, LPI 后各位置组的新发生的视力障碍类型发生率无明显差异。总体而言, LPI后线性视力障碍、黑影和视物模糊的发生率明显增加, 而光晕和眩光则明显减少。总之, 目前文献表明, LPI位置与术后出现的视力障碍类型和发生率没有相关性。无论在哪个位置, LPI后都有 2%-3% 的线性视力障碍风险, 但LPI 也可以解决之前存在的光晕和眩光问题。.

OBJECTIVE: To determine the need to measure intraocular pressure one hour after laser peripheral iridotomy in patients with narrow angles, to determine the significance of the immediate IOP spike after LPI, and to assess risk factors associated with these.
METHODS: A review of the literature on IOP measurements after LPI was conducted using the PubMed databases in January 2020.
RESULTS: The proportion of treated eyes with an IOP spike one hour after treatment was between 6 and 9.8% depending on the study. Fewer than 1% of the eyes had an immediate post-treatment IOP of 30mmHg or more. Risk factors associated with IOP spikes include hyphema, pigment dispersion, and high pretreatment IOP. Patients of Asian descent, who possess thick irides, or any patient having thick irides, also exhibited increased risk of IOP spikes.
CONCLUSIONS: The majority of the studies that have evaluated this complication were conducted in an Asian population, which affects the generalisability of these results to a wider population, considering anatomical differences. Although it is not uncommon to observe IOP spikes following LPI, the majority will not experience an increase of 10mmHg from baseline or a post-LPI IOP of 30mmHg or more. Even though it has been recommended to measure the IOP of all patients one hour after an LPI in order to avoid missing a spike, we suggest measuring IOP one hour after an LPI in patients who possess at least one risk factor or if there is any preexisting damage to the optic nerve.

OBJECTIVE: To evaluate the efficacy of vitrectomy combined with hyaloido-zonula-iridectomy from an anterior or a posterior approach in patients with treatment-resistant aqueous misdirection (chronic aqueous misdirection) by systematically reviewing existing literature in combination with presentation of a case series.
METHODS: A systematic literature review was performed in PubMed, EMBASE and Cochrane Library databases using search terms: malignant glaucoma, ciliary block, ciliolenticular block and aqueous misdirection. A consecutive series of three pseudophakic patients (5 eyes) diagnosed with chronic aqueous misdirection after cataract surgery is presented.
RESULTS: A literature search identified 31 articles describing treatment of chronic aqueous misdirection with vitrectomy and a hyaloido-zonula-iridectomy. Studies, where patients were treated with a complete vitrectomy from pars plana in combination with a hyaloido-zonula-iridectomy, reported low relapse rates. Studies describing a surgical approach with vitrectomy performed from the anterior chamber, followed by a hyaloido-zonula-iridectomy, also reported low relapse rates except for one reporting relapse in nearly half of the patients. In our case series, a complete vitrectomy combined with a hyaloido-zonula-iridectomy resolved the chronic aqueous misdirection in all five eyes after one procedure except one eye where the hyaloido-zonula-iridectomy was repeated due to an insufficient opening. Some of the eyes still needed antiglaucomatous treatment due to chronic angle closure.
CONCLUSIONS: In treatment-resistant malignant glaucoma, vitrectomy combined with a hyaloido-zonula-iridectomy should be considered performed to ensure communication between the anterior chamber and the vitreous cavity. If the condition has been unresolved for a long time, extensive synechiae of the angle may decrease the success rate due to chronic angle closure.

Massive hyphaema presentation after a laser iridotomy is very rare. We report a 63-year-old man with ischaemic heart disease on dual antiplatelet therapy (aspirin plus ticagrelor) who was diagnosed as a primary angle-closure suspect and was to undergo a neodymium-doped yttrium aluminium garnet laser iridotomy at Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia in 2016. While performing the iridotomy in the left eye, active bleeding occurred that finally filled approximately 75% of the anterior chamber. Intraocular pressure (IOP) increased to 62 mmHg. Mannitol and a topical dorzolamide/timolol were used to control the increase in IOP. The hyphaema slowly resolved over the following week without sequelae. This case revealed that massive hyphaema can complicate laser iridotomy in patients on dual antiplatelet therapy, although this is rare. Therefore, if patients are taking aspirin and ticagrelor, it would be advisable to stop the second medication if possible. In addition, sequential application of photocoagulation and photodisruption lasers might diminish the risk of significant bleeding.

UNASSIGNED: We report a case of patient who underwent bilateral eyeball tattoo procedure for cosmetic purpose complicated with intraocular dye injection which led to ocular inflammation, secondary glaucoma, and cataract.
UNASSIGNED: A 21-year-old female presented to emergency department with severe right eye pain and photophobia 21 days after conjunctival tattooing procedure. Slit-lamp examination revealed right-sided eyelid edema and black deposits of tattoo ink under the bulbar conjunctiva. Dye deposits were also present in anterior chamber, covering corneal endothelium, iris and anterior lens\' capsule. Ocular inflammation and secondary glaucoma were diagnosed. The patient underwent surgical treatment to control ocular inflammation. Intraocular pressure remained stable after Nd:YAG iridotomy and on topical drugs. Moreover, during the follow-up, in contralateral eye, we observed \"conjunctival lumps\"-local hypersensitivity reaction to the dye, which were asymptomatic to the patient.
UNASSIGNED: Eyeball tattooing complications are new challenges that ophthalmologist may have to face nowadays. We also reviewed for the first time possible complications of eyeball tattooing described in available literature.

Endothelial keratoplasty is currently the preferred method for the treatment of endothelial dysfunctions and dystrophies. Descemet Membrane Endothelial Keratoplasty (DMEK), described by Gerrit Melles in 2006, is performed by selectively replacing the damaged endothelium with a healthy counterpart. It leads to a faster visual recovery and better refractive outcomes with a limited risk of rejection compared to Descemet\'s Stripping Automated Endothelial Keratosplasty (DSAEK), which includes a thin stromal layer. Open debate still exists between DMEK and DSAEK. This article aims to provide a literature review and enlighten the reader on the DMEK technique, its results and complications.

OBJECTIVE: To report four cases of acute primary angle closure (PAC) after blepharoplasty and forehead lifting procedures and review the previous reported cases in the literature.
METHODS: Four female subjects with age range of 50-67 years developed PAC 2-5 days after blepharoplasty and endoscopic forehead lifting procedures. All presented with pain, nausea, blurred vision, red eye, and eyelid swelling. Diagnosis was delayed in the first subject because of considering the signs and symptoms as usual postoperative ones. Presumed risk factors for the PAC were female gender (all), advanced age (all), pupillary dilation (all), and hyperopia (case 2).
RESULTS: Medical treatment controlled the pressure which was followed by bilateral YAG Laser iridotomy. They fully recovered with no optic neuropathy in their last follow-up examination 10 months to 10 years after the procedures.
CONCLUSIONS: Risk of PAC should be investigated preoperatively and its presentation should be considered in the postoperative follow-up of subjects with periorbital facial procedures.

OBJECTIVE: To describe the ultrasound biomicroscopy (UBM) and B-scan ultrasonography findings and therapeutic approach for ciliochoroidal detachment secondary to acute primary angle-closure glaucoma (APACG) in four patients. We also reviewed the literature.
METHODS: Case report and systematic literature review.
RESULTS: The four patients were referred to our department for further management of APACG. The UBM and B-scan ultrasonography examinations were conducted 2 days after the beginning of medical treatment and demonstrated ciliochoroidal detachment in four eyes of the four patients. The patients all received intravenous infusion of corticosteroid therapy (10 mg dexamethasone once daily for 5-7 days). We reviewed the UBM findings, which confirmed that the ciliochoroidal detachment disappeared. The patients then underwent trabeculectomy combined with peripheral iridotomy surgery. The patients all ultimately recovered very well.
CONCLUSIONS: APACG with ciliochoroidal detachment is rare and has hidden clinical manifestations, and the pathophysiological mechanism is not yet fully understood. Anti-glaucoma surgery may increase the detachment. UBM and B-scan ultrasounds are useful tools for ciliochoroidal detachment diagnosis in APACG patients before operative treatment.

This review article summarizes four key case reports published in the field of glaucoma in the year 2015. The first article describes a novel technique for draining choroidal fluid in patients with uveal effusion syndrome. The second article describes 2 cases of recurrent vitreous block despite adequate surgical intervention. The third article describes 2 cases of endogenous steroid response glaucoma. The last article describes the treatment of visual phenomena following iridectomy using femtosecond laser assisted keratopigmentation.