Trabeculectomy and postoperative ocular hypertension in secondary angle-closure glaucoma

I performed trabeculectomies to reduce the introacular pressure to 20 mm Hg or lower, in 56 eyes with medically uncontrollable primary open-angle glaucoma or secondary angle-closure glaucoma. In the former group, I achieved success in 85% of cases, 65% without further antiglaucomatous therapy. In the latter group, 59% obtained a successful result, 41% without additional treatment. The readings of applanation tonometry on the first postsurgical day were compared to those obtained after one year. Although approximately 50% of eyes in both glaucoma categories had an initially elevated pressure after trabeculectomy, it decreased steadily in most of those with primary open-angle glaucoma. In the secondary angle closure glaucoma population, this immediate postoperative ocular hypertension was significantly correlated with eventual failure of the operation.     

Ultrasound biomicroscopic imaging in intermediate uveitis

The clinical benefit of propofol anaesthesia in the prevention of postoperative nausea and vomiting (PONV) is still being elucidated despite many studies to date. In this study 64 adult female patients scheduled for thyroidectomy received, in a randomized double-blind fashion, propofol with air or isoflurane with nitrous oxide for maintenance of anaesthesia. The primary response variable was the presence or absence of vomiting in the first six hours. A group sequential design was used to allow interim analysis. After 64 patients, the fourth analysis showed that fewer patients receiving propofol vomited or required an anti-emetic during the first six hours (P < 0.05). There was no significant difference detected in the 6 to 24 hour interval. In this group of female patients, total intravenous anaesthesia (TIVA) with propofol is associated with an early reduction in early postoperative vomiting compared with standard inhalational techniques. This reduction in vomiting does not appear to persist beyond the first six hours.     

Laser therapy and angle-closure glaucoma

All forms of primary and secondary pupillary block angle-closure glaucoma result in an increased resistance to aqueous flow at the pupil margin. As the pressure in the posterior chamber increases, the iris bows forward until the trabecular meshwork is occluded and aqueous outflow is interrupted. Most pupillary block glaucomas are ocular urgencies and require immediate medical therapy to lower intraocular pressure. The definitive treatment for pupillary block is laser therapy. By creating a hole in the iris, the pressure in the anterior and posterior chambers is equalized, allowing the angle to remain open. This discussion reviews the indications, contraindications, and techniques involved in the laser management of angle-closure glaucomas.     

Ultrasound biomicroscopic analysis of anterior proliferative vitreoretinopathy

PURPOSE: To report the use of ultrasound biomicroscopy for preoperative assessment of anterior proliferative vitreoretinopathy. METHODS: Case report. In a 35-year-old man with tractional retinal detachment and anterior proliferative vitreoretinopathy, we used ultrasound biomicroscopy with UX-02 (Rion Co Ltd, Tokyo, Japan) to perform the preoperative analysis of the ciliary body, anterior vitreous, and detached peripheral retina. RESULTS: In all meridians, the posterior insertion of the vitreous was drawn anteriorly, creating a retinal trough, and the meridian distance between the anterior and posterior vitreous base insertions was reduced. Retinochoroidal detachment was detected posterior to the anterior vitreous base insertion. Based on these imagings, sclerotomy locations were selected. CONCLUSION: Ultrasound biomicroscopy may be useful to assess anterior proliferative vitreoretinopathy preoperatively and to decide on sclerotomy sites.     

Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma

PURPOSE: To evaluate long-term intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (IOL) implantation in patients with primary angle-closure glaucoma. SETTING: Ophthalmology Department, Groote Schuur Hospital, Cape Town, South Africa. METHODS: This retrospective study comprised 17 patients (19 eyes) with primary angle-closure glaucoma who had ECCE and posterior chamber IOL implantation. Four presented initially with acute glaucoma, 5 with subacute angle-closure glaucoma, and 8 (10 eyes) with chronic angle-closure glaucoma. In all, less than half the circumference of the angle was permanently closed. The drainage angle was evaluated preoperatively and postoperatively to monitor changes in the amount of angle closure. Intraocular pressure was measured in the early and late postoperative periods. RESULTS: On the first postoperative day, mean IOP was 17.2 mm Hg, although 5 patients (26%) had an IOP rise above 21 mm Hg despite the use of perioperative topical pilocarpine gel. After a mean follow-up of 19 months, IOP remained below 22 mm Hg without medication in 13 eyes (68%) and with topical medication in 5 eyes (26%). Mean number of glaucoma medications was reduced from 1.5/eye preoperatively to 0.5/eye postoperatively. CONCLUSION: Cataract extraction with IOL implantation resulted in good long-term IOP control in patients with primary angle-closure glaucoma, suggesting that combined cataract and trabeculectomy surgery may not be necessary to achieve long-term IOP control in these patients.     

Long-term results of non-filtering surgery for the treatment of primary angle-closure glaucoma

BACKGROUND: We previously reported the effectiveness of goniosynechialysis and trabeculotomy ab externo for adult-onset glaucoma. In this study, we performed non-filtering surgery on patients with primary angle-closure glaucoma and studied the long-term outcome of this treatment. METHODS: Included in this study were 35 eyes of 25 patients with primary angle-closure glaucoma, each of which had an intraocular pressure greater than 20 mmHg with maximal tolerated antiglaucoma medication, even after laser iridotomy or surgical iridectomy. Of these 35 eyes, 22 underwent trabeculotomy and 13 underwent goniosynechialysis. All patients were followed up for at least 18 months. RESULTS: In 21 (95%) of 22 eyes after trabeculotomy, and in 12 (92%) of 13 eyes after goniosynechialysis, intraocular pressures were well controlled at or below 21 mmHg at the final examination. However, in two of the 21 eyes in which trabeculotomy was a success, and in four of the 12 eyes in which goniosynechialysis was successful, the procedure had to be repeated before adequate control of pressure was achieved. CONCLUSION: Our results show that intraocular pressure in most cases of primary angle-closure glaucoma can be controlled by restructuring of the physiologic aqueous outflow route by means of goniosynechialysis or trabeculotomy, and that filtering surgery is not necessary.     

Surgical decisions in chronic angle-closure glaucoma

A retrospective study of 57 eyes with chronic angle-closure showed that eyes with visual field loss are less likely to be improved by iridectomy than those without visual field loss in the presence of visual field loss, trabeculectomy achieved more satisfactory control of glaucoma than did iridectomy, and there was no noticeable difference in surgical complications between iridectomy and trabeculectomy in this small series. It is suggested that iridectomy is indicated for most cases of chronic angle closure without visual field loss, especially if the pressure is medically controllable. In the presence of visual field loss, iridectomy is usually a wise choice if medical control is easily achieved preoperatively. However, trabeculectomy might be the best choice in most patients with visual field loss and medically uncontrolled pressure, regardless of the gonioscopic findings.     

Ultrasound biomicroscopic findings of anterior hyaloidal fibrovascular proliferation

We performed ultrasound biomicroscopy (UBM) on 5 eyes with anterior hyaloidal fibrovascular proliferation (AHFVP), which had developed after vitrectomy for proliferative diabetic retinopathy. AHFVP was observed as a thick membrane or a mass image which extended from the vitreous base to the pars plicata, and was apparently differentiated from the anterior vitreous membrane and cilliary body. UBM showed proliferative stalks extending from sclerotomy sites toward the anterior vitreous membrane. These UBM images indicated that AHFVP originated from sclerotomy sites. UBM also enabled us to detect traction detachment of the peripheral retina associated with AHFVP, which could not be observed by conventional B-mode echography. Thus UBM is useful in establishing a diagnosis of AHFVP, and this technique is valuable to determine the indication and the timing of surgical treatment for AHFVP.     

Immediate argon laser peripheral iridoplasty as treatment for acute attack of primary angle-closure glaucoma: a preliminary study

OBJECTIVE: This study aimed to examine the intraocular pressure (IOP)-lowering effects and safety of immediate argon laser peripheral iridoplasty (ALPI) as a first-line treatment for acute primary angle-closure glaucoma (PACG). DESIGN: A prospective cohort study. PARTICIPANTS: Ten consecutive patients with their first attack of PACG, with IOP of 40 mmHg or greater, were recruited into the study. INTERVENTION: On presentation, each patient received topical pilocarpine (4%) and timolol (0.5%) and immediate ALPI as primary treatment. The IOPs at 15, 30, and 60 minutes after ALPI were documented by applanation tonometry. When the corneal edema had settled, laser peripheral iridotomy was performed as a definitive treatment. MAIN OUTCOME MEASURES: The IOP, corneal edema, and complications from ALPI were measured. RESULTS: The mean IOP of this group of patients was reduced from 59.5+/-10.4 mmHg to 28.7+/-14.9 mmHg at 15 minutes, 21.7+/-13.1 mmHg at 30 minutes, and 16.0+/-9.4 mmHg at 60 minutes after ALPI. No complications from the laser procedure were encountered during the study period. In nine of the ten patients, the corneal edema cleared up 1 hour after ALPI. In the remaining patient, the cornea cleared up 2 hours after ALPI. CONCLUSION: From this preliminary study, immediate ALPI, without adjunctive systemic antiglaucoma treatment, appeared to be very effective in controlling the IOP and returning corneal clarity in acute PACG. Its safety also appeared reassuring and did not have the risks associated with conventional systemic therapies.     

Contrast sensitivity in glaucoma and ocular hypertension

It is known that contrast sensitivity declines with advancinG age and during different ophthalmological diseases. The authors examined 263 eyes of 141 patients with different types of glaucoma and 213 eyes of 107 patients with ocular hypertension. The patients were divided into two groups by age: A = under 60 years (mean 53.2 in glaucoma, 51.1 in OH) and B = 60 years and above (mean 67.5 in glaucoma and 65.6 in OH). For examination of contrast sensitivity the authors used a VCTS 6500 board from a 3 m distance, the visual field was examined by means of Goldman's kinetic perimeter or a static Optifield II perimeter and the discs of the optic nerve were examined biomicroscopically or a photograph of the disc was taken. Impaired contrast sensitivity was found in group A in 71.7% of glaucoma patients and in 61.6% in ocular hypertension. In group B in 81.7% glaucoma patients and in 75.1% of patients with ocular hypertension. The authors also proved an association between the decline of contrast sensitivity and impairment of the perimeter and enlargement of the glaucoma excavation of the optic disc. The authors recommend examination of the contrast sensitivity as a supplementary method for screening and observation of ocular hypertension and glaucoma.     

Changes in ocular dimensions and refraction with accommodation

We assessed the accuracy of the family history (FH-RDC) and family study (SADS-L) methods for obtaining information about the presence of psychopathology in 274 first-degree relatives of patients with psychotic disorders. The family history method had only modest sensitivity, 40.8% for affective disorders and 58.6% for psychotic disorders, but high specificity, 94.1% for affective disorders and 98.7% for psychotic disorders. For both disorders, sensitivity was higher for relatives who had had previous psychiatric admissions. However, with the family study method, we found that relatives with affective disorder were more likely to be interviewed than those relatives with other disorders. Hence, the family study method may be prone to selection bias that distorts morbid risk estimates. We conclude that the best way of collecting information regarding family psychopathology is to interview directly as many relatives as possible and to collect supplementary family history information on unavailable relatives.     

Topical carbonic anhydrase inhibition increases ocular pulse amplitude in high tension primary open angle glaucoma

We report herein an unusual case of a composite glandular-neuroendocrine carcinoma of the hilar bile duct. A 71-year-old Japanese woman was admitted to our hospital suffering from general fatigue, progressive jaundice, and a high fever. Computed tomography and angiography findings revealed a solid hypervascular mass in the hepatic hilus. Thus, a subsegmentectomy of the liver (S4, S5) and bile duct resection with lymph node dissection were performed. A tumor measuring 6.0 x 3.0 cm was found to be located in the bile duct of the hepatic hilus. Histologically, the tumor was composed of well-differentiated adenocarcinoma and small cell neuroendocrine carcinoma cells, with a histological transition between the two components. Grimelius' method revealed the presence of diffuse positive tumor cells in neuroendocrine carcinoma. The neuroendocrine tumor cells were also diffusely immunoreactive to chromogranin A. To the best of our knowledge, only 22 previous cases of composite glandular-neuroendocrine carcinoma in the biliary tract have been reported; however, this is the first case report of a clearly composite tumor of the hilar bile duct.     

The fellow eye in acute angle-closure glaucoma (author's transl)]

With 5 years after the acute angle-closure glaucoma of an eye, in the fellow eye the same disease developed in only 15% of cases, but in 42% of cases in spite of the preventive miotic therapy a chronic angle-closure glaucoma developed unnoticed by the patients. Hence preventive iridectomy is suggested in the fellow eye.     

Effect of orally administered hydrocortisone on the ocular tension in primary open-angle glaucoma subjects. Preliminary report

We studied the possible influence on the pattern of diurnal ocular tension curve by peroral hydrocortisone in 16 eyes of 16 subjects with primary open-angle glaucoma. The baseline diurnal curve was determined by Schiotz tonometry six times daily starting at 10 a.m. and repeated every four hours. The baseline curve showed a significant rise in the daytime with a fall during the night. On another day, 20 mg hydrocortisone was given perorally at 5 p.m., for a repeat 24-h measurement period. A significant rise in ocular tension over the baseline resulted in the following night-time tonometric readings, i.e. at 10 p.m. (P less than 0.01) and 2 a.m. (P less than 0.001). The results seem to strongly indicate that plasma cortico-steroid levels dictate the pattern of diurnal variation of ocular tension.     

A comparative study of visual field damage in low-tension and primary open-angle glaucoma

Methods to encapsulate biological materials are now widely used. Sometimes bioencapsulation is considered as a universal technique conducting to identical results independently on the biological material used. For instance, a similar behavior is frequently waited for different strains of immobilized microorganisms without taking into account substantial differences in its physiological and morphological characteristics. Often interactions with the matrix support are also neglected. Thus, some concepts developed throughout all these years working in bioencapsulation merits to be revisited.     

Comparison of conventional and high-pass resolution perimetry in a prospective study of patients with glaucoma and healthy controls

The effects of mm-waves 60.22-62.22 GHz and 75 GHz on A-type K+ currents and the effects of 61.22 GHz on Ca2+ currents of Lymnaea neurons were investigated using a whole-cell voltage-clamp technique. The open end of a rectangular waveguide covered with a thin Teflon film served as a radiator. Specific absorption rates at the waveguide outlet, inserted into physiological solution, were in the range of 0-2400 W/kg. Millimeter wave irradiation increased the peak amplitudes, activation rates, and inactivation rates of both ion currents. The changes in A-type K+ current were not dependent on the irradiation frequency. It was shown that the changes in the amplitudes and kinetics of both currents resulted from the temperature rise produced by irradiation. No additional effects of irradiation on A-type K+ current other than thermal were found when tested at the phase transition temperature or in the presence of ethanol. Ethanol reduced the thermal effect of irradiation. Millimeter waves had no effect on the steady-state activation and inactivation curves, suggesting that the membrane surface charge and binding of calcium ions to the membrane in the area of channel locations did not change.     

The prevalence and implications of ocular hypertension and glaucoma in thyroid-associated orbitopathy

Experiments are carried out on 3400 mice, irradiated in dose 8 Gy (LD97/30). beta-Ketoanalogs of adrenaline (adrenalone, 50-150 mumol/kg), m,p-dipivaloyladrenaline (20 mumol/kg) and phenylephrine (but at 2070 mumol/kg) have the high radioprotective effect (survival is 60-100%), beta-ketoanalogs of isoprenaline and m-benzoylphenylephrine have the middle RPE (50-60%). Their effective doses (except dipivaloyladrenalone) are considerably bigger (in 9-76 times), than beta-hydroxysubstances doses, but the toxicity of benzoylphenylephrone, dipivaloyladrenalone and especially adrenalone is by far lower (consequently in 3, 8, 2, 7 and 136 times). Therapeutic indexes of beta-ketosubstances achieve 35-100.