Appraisal and management of ocular hypotony and glaucoma associated with uveitis.
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Anti-Inflammatory Agents↗
Biomedical subjects
A Mermoud
Publications and source records attributed to A Mermoud.
Nonpenetrating filtering surgery in glaucoma.
Since 1967, trabeculectomy has been the standard drainage operation for most cases of medically uncontrolled glaucoma. It is associated with significant risk of hypotony, hyphema, choroidal effusion or hemorrhage, and bleb failure. Toward the goal of a safer and more reproducible glaucoma filtering surgery, nonperforating filtering surgeries are now performed in primary open-angle glaucoma, normal-pressure glaucoma, and most cases of secondary glaucoma. The site of highest resistance to outflow, the juxtacanalicular trabecular meshwork, is bypassed with avoidance of penetration into the anterior chamber. Different techniques of nonpenetrating filtering surgeries are discussed here.
Anterior Chamber↗
[Combined surgery for cataract and glaucoma: phacoemulsification and nonpenetrating surgery].
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Cataract↗
Corneal thickness in ocular hypertension, primary open-angle glaucoma, and normal tension glaucoma.
OBJECTIVES: To determine the effect of central corneal thickness (CCT) on the measurement of intraocular pressure (IOP) and on the resultant reclassification of patients as having primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), or ocular hypertension (OHT). METHODS: Intraocular pressure (Goldmann applanation tonomety) and CCT (ultrasound pachymetry) were measured in 22 patients with NTG, 49 with POAG, 44 with OHT and in 18 control subjects. The CCT was used to obtain a corrected value for the IOP and to reclassify the type of glaucoma. RESULTS: There was no significant difference in CCT between controls (552 +/- 35 microns) and patients with POAG (543 +/- 35 microns), but the CCT in the group with NTG (521 +/- 31 microns) was significantly lower than that in the control group or the group with POAG (P < .001), and the CCT in the group with OHT (583 +/- 34 microns) was significantly higher than in controls or patients with POAG (P < .001). Correcting IOP for corneal thickness, 31% of the patients with NTG could be reclassified as having POAG, and 56% of the patients with OHT as normal. CONCLUSIONS: Patients with NTG have a thinner CCT than do patients with POAG or controls. Underestimation of the IOP in patients with POAG who have thin corneas may lead to a misdiagnosis of NTG, while overestimation of the IOP in normal subjects who have thick corneas may lead to a misdiagnosis of OHT.
Aged↗
Transport of rimsulfuron and its metabolites in soil columns
This paper presents a study on degradation, sorption and transport of the sulfonylurea herbicide rimsulfuron and its major metabolites in alluvial soil columns. The formulation of rimsulfuron was found to strongly affect its degradability. Hydrolysis of pure rimsulfuron takes place rapidly in distilled water (t(1/2)=2.2 days) or indeed instantaneously in alkaline solution. The formulated rimsulfuron (Titus, 25% rimsulfuron, Du Pont De Nemours) is more persistent in alluvial soil suspensions (t(1/2)=7.5 days). The study of sorption of Titus and its two major metabolites (1 and 2) revealed that these three chemicals are potentially highly mobile in the studied soil: in suspension distribution coefficients of 0.0028, 0.125 and 0.149 cm3 g(-1) were obtained respectively. Given the instability of rimsulfuron in alkaline solutions, the pH effect was evaluated with metabolite 2 in water saturated Fontainebleau sand columns at pH 6, 8 and 10. Transport was found to be strongly dependent on pH; a linear relationship was obtained between pH and the retardation factor or the dispersion coefficient. In alluvial soil columns, rimsulfuron from Titus was found to be very mobile (R=1.2) and rapidly degraded into metabolites 1 and 2, which were transported at a similar velocity. Nevertheless, the risks of groundwater contamination by rimsulfuron seem very low, as it is rapidly degraded under dynamic conditions (t(1,2)=1.4 days). On the other hand the relatively stable metabolite 2 seems likely to persist in the soil and to be transported to the groundwater. Special attention should thus be given to this compound at least as long as its harmlessness is not demonstrated.
Journal Article↗
Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma.
PURPOSE: To assess the efficacy and postoperative complications of deep sclerectomy with collagen implant (DSCI), a nonpenetrating filtration procedure. SETTING: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. METHODS: Forty-four eyes of 44 patients with medically uncontrolled open-angle glaucoma had DSCI and a matched control group of 44 patients, trabeculectomy. A superficial scleral flap was raised and a deep sclerectomy performed in the scleral bed. Schlemm's canal was opened, and the cornea was dissected to Descemet's membrane. At that stage, aqueous filtered through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed; the scleral flap and conjunctiva were then closed. Examinations were performed before surgery and postoperatively at 1 and 7 days and 1, 2, 3, 6, 9, 12, 15, 18, and 24 months. RESULTS: The mean follow-up was 14.4 months +/- 6.3 (SD) (range 3 to 24 months). The mean preoperative intraoperative pressure (IOP) was 26.7 +/- 7.3 mm Hg. The mean postoperative IOP was 6.1 +/- 4.5 mm Hg at 1 day and 11.0 +/- 4.4 mm Hg at 1 week; it remained stable for the next 24 months. The success rate, defined as an IOP lower than 21.0 mm Hg without medication, was 69% in the DSCI group and 57% in the trabeculectomy group at 24 months postoperatively (P = .047). The number of postoperative complications was significantly lower in the DSCI group than in the trabeculectomy group. CONCLUSIONS: The success rate of DSCI may be comparable to that of trabeculectomy, with fewer complications.
Aged↗
Combined surgery for cataract and glaucoma: phacoemulsification and deep sclerectomy compared with phacoemulsification and trabeculectomy.
PURPOSE: To compare the outcome of phacoemulsification-intraocular lens (IOL) implantation combined with nonperforating deep sclerectomy (P-DS) with that of phacoemulsification-IOL implantation combined with trabeculectomy (P-T). SETTING: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. METHODS: This prospective study involved 60 eyes of 60 patients with cataract and various types of open-angle glaucoma. Thirty eyes had P-DS and 30, P-T. Follow-up was performed at regular intervals for up to 18 months. RESULTS: Mean follow-up was 12.5 months +/- 6.5 (SD) and 12.6 +/- 4.9 months for the P-DS and P-T groups, respectively. Mean preoperative intraocular pressure (IOP) was similar in both groups (24.8 +/- 5.9 mm Hg in the P-DS group and 24.6 +/- 7.2 mm Hg in the P-T group). There was no statistically significant difference in IOP decrease (14.2 +/- 4.0 mm Hg in the P-DS group and 15.2 +/- 2.8 mm Hg in the P-T group). Visual outcome was similar in both groups. The P-DS group experienced significantly less inflammation (40.0% versus 83.0%; P = .0012) and hyphema (6.7% versus 36.7%; P = .010) than the P-T group. CONCLUSION: Deep sclerectomy combined with cataract surgery resulted in an IOP reduction similar to that with phacotrabeculectomy with the same visual outcome, but the lower complication rate makes ambulatory care easier.
Adolescent↗
[Effect of naftidrofuryl (praxilene) on optic nerve head blood flow in the patient with glaucoma].
PURPOSE: To evaluate the effects of an S2 specific antiserotonine agent (Naftidrofuryl) on the optic nerve head blood flow in glaucomatous patient. PATIENTS AND METHOD: 11 glaucomatous subjects were enrolled in the study. After administration of 200 mg naftidrofuryl twice daily for 7 days: values of optic nerve head blood flow (Fonh), velocity and volume were recorded in the temporal rim and cup of the optic nerve head. Blood flow measurements were performed by laser doppler flow-metry at day 0 and day 7 before and one and two hours after drug administration. RESULTS: Our study showed a significant improvement of perfusion pressure (p = 0.02) at day 7 and an increase of mean ophthalmique artery pressure (p = 0.03). DISCUSSION: Our preliminary results on a small number of patients and a short follow-up indicate that the use of naftidrofuryl may enhance optic nerve head blood flow in glaucomatous patients. Further studies may confirm these results.
Aged↗
[Study of the optic papilla and nerve fiber layer in glaucoma].
BACKGROUND: For diagnosis and follow-up of glaucoma an exact evaluation of the optic nerve disc and the nerve fiber layer is necessary. METHODS: The slit-lamp evaluation of the optic nerve disc and nerve fiber layer is presented as well as the evaluation with the Nerve Fiber Analyzer and the Heidelberg Retina Tomograph. RESULTS: Signs of a glaucomatous optic disc include a difference of more than 0.2 in the vertical cup to disc (CD) ratio between the eyes, a vertical CD ratio exceeding more than 0.1 the horizontal, larger CD ratios in small optic discs, notching of the neuroretinal rim, an enlarged zone beta of parapapillary chorioretinal atrophy, and peripapillary hemorrhages. Atrophy of the nerve fiber layer may be localized or diffuse. Both types of atrophy may be present at the same time. CONCLUSIONS: Knowledge of all signs of the glaucomatous optic disc and forms of nerve fiber layer atrophy allows an earlier diagnosis of glaucoma and an earlier recognition of progression.
Glaucoma↗
Deep sclerectomy with collagen implant: medium term results.
AIMS: To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI), a new non-penetrating filtration procedure. METHODS: Non-randomised prospective trial involving consecutive patients. 100 eyes of 100 patients with medically uncontrolled primary and secondary open angle glaucoma. A superficial scleral flap was raised and a deep sclerectomy was performed in the scleral bed. Schlemm's canal was opened and dissection of the cornea was performed up to Descemet's membrane, at which point aqueous percolated through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed. Visual acuity, intraocular pressure (IOP) measurements, and slit lamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, and 36 months. RESULTS: The mean follow up period was 17.8 (SD 8.7) months. The mean preoperative IOP was 27.8 (8.6) mm Hg; the mean postoperative IOP was 5.7 (4.0) at day 1, 11.2 (4.6) at month 1, 14.0 (3.5) at month 12, and 13.0 (3.8) at month 36. Complete success rate, defined as an IOP lower than 21 mm Hg without medication, was 44.6% at 36 months. Qualified success rate, defined as an IOP lower than 21 mm Hg with medication, was 97.7% at 36 months. Early postoperative complications included hyphaema in seven patients, would leak in 10 patients, and subtle choroidal detachment in 11 patients. Goniopuncture was performed in 41 of the patients, and 5-fluorouracil injections were made in 23 patients; cataract progression occurred in seven patients. When comparing the different types of open angle glaucoma, no difference was found in terms of reduction in IOP, number of patients requiring antiglaucoma medications, or success rate. CONCLUSIONS: Deep sclerectomy with collagen implant appears to provide reasonable control of IOP at medium term follow up, with few immediate postoperative complications.
Aged↗
Nd:Yag goniopuncture after deep sclerectomy with collagen implant.
BACKGROUND AND OBJECTIVE: To study the need, the safety and the success rate of Nd:Yag goniopuncture in eyes that underwent deep sclerectomy with collagen implant. PATIENTS AND METHODS: The first 100 patients that underwent deep sclerectomy with collagen implant were prospectively followed. Deep sclerectomy with collagen implant is a non-penetrating filtering surgery which allows filtration of aqueous from the anterior chamber to the subconjunctival space through a remaining trabeculo-Descemet's membrane without opening the anterior chamber. Goniopunctures with Nd:Yag laser were performed at the site of surgery when the filtration through the trabeculo-Descemet's membrane was considered to be insufficient with elevated intraocular pressure. The laser treatment was performed using a Lasag 15 gonioscopy contact lens (CGA1). Goniopunctures were performed using the free-running Q-switched mode with an energy ranging from 2 to 4 mJ. RESULTS: Of 100 patients who underwent deep sclerectomy with collagen implant, goniopunctures with Nd:Yag laser were performed in 41 patients (41%). The mean time between deep sclerectomy with collagen implant and goniopuncture was 9.9 months +/-1.2 months (+/-SE). The mean IOP before laser treatment was 22.2 mm +/-7.0 mm Hg and decreased to 12.5 mm +/-5.8 mm Hg immediately after laser treatment and remained stable for the next 2 years of follow-up. The immediate success rate of goniopuncture was 83%. Choroidal detachment occurred in two patients (5%). CONCLUSION: Nd:Yag goniopuncture is an efficient and safe treatment for low filtration through the trabeculo-Descemet's membrane after deep sclerectomy with collagen implant.
Aged↗
Sterile mucopurulent conjunctivitis associated with the use of dorzolamide eyedrops.
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Aged↗
Identification of a new heterozygous point mutation in the COL1A2 gene leading to skipping of exon 9 in a patient with joint laxity, hyperextensibility of skin and blue sclerae. Mutations in brief no. 166. Online.
A heterozygous deletion of exon 9 in the COL1A2-mRNA of a patient with symptoms of both the Ehlers-Danlos-Syndrome and the Osteogensis Imperfecta is described. In the genomic DNA of the patient, exon 9 is homozygously present. We identified a novel heterozygous point mutation in the splice donor site of intron 9, leading to a G-->A substitution in position +5. This mutation leads to heterozygous skipping of exon 9 in the COL1A2-mRNA of this patient. The deletion results in a shortened (by 18 amino acids) but in frame 12(1) chain, which probably leads to the formation of abberantly processed triple helices.
Alternative Splicing↗
Post-operative inflammation following deep sclerectomy with collagen implant versus standard trabeculectomy.
BACKGROUND: An investigation was carried out to compare post-operative inflammation following deep sclerectomy with collagen implant (DSCI) versus standard trabeculectomy. METHODS: In this prospective randomized study, 46 eyes of 46 Caucasian patients with medically uncontrolled chronic open-angle glaucoma and without previous glaucoma surgery underwent filtering surgery. Twenty-four eyes underwent DSCI. Twenty-two eyes underwent standard trabeculectomy. Pre- and post-operative flare, measured using laser flare photometry, were compared between the two groups. RESULTS: In both groups, the mean anterior chamber flare increased on the first post-operative day, then decreased progressively. DSCI was associated with lower flare measurements post-operatively. The difference was statistically significant up to 1 month post-operatively: 16.3 +/- 7.8 vs 72.5 +/- 38.9 (P < 0.001) at 1 day, 7.8 +/- 4.6 vs 44.7 +/- 29.2 (P < 0.001) at 1 week, 5.9 +/- 1.6 vs 7.0 +/- 2.8 (P = 0.012) at 1 month, 6.4 +/- 1.8 vs 6.5 +/- 1.9 (P = 0.77) at 2 months, 5.9 +/- 1.8 vs 6.1 +/- 1.6 (P = 0.65) at 3 months. CONCLUSION: Surgically induced inflammation can be reduced with DSCI. This may be due to the lack of iridectomy, irrigation, and penetration of the anterior chamber. Eyes at increased risk of post-operative inflammation, such as those with uveitic or traumatic glaucoma, may benefit from this procedure. Further studies are needed to evaluate the long-term functional and anatomical outcomes of DSCI.
Aged↗
An ultrasound biomicroscopic study of eyes after deep sclerectomy with collagen implant.
OBJECTIVE: This study aimed to assess the natural history of eyes after deep sclerectomy with collagen implant (DSCI), a nonperforating glaucoma-filtering surgery. DESIGN: The design was a prospective, longitudinal, observational, and nonrandomized study. PARTICIPANTS: Forty-five eyes of 41 patients with medically uncontrolled open-angle glaucoma were studied. INTERVENTION: Deep sclerectomy with collagen implant was performed. MAIN OUTCOME MEASURES: Ultrasound biomicroscopy (UBM) of the sclerectomy site was performed 1, 2, 3, 6, 9, 12, and 18 months after surgery. The following parameters were assessed: length and height of the collagen implant, thickness of the residual trabeculodescemetic membrane, and bleb appearance. RESULTS: Mean intraocular pressure decreased from a preoperative value of 26.3 +/- 3.5 mmHg (mean +/- standard deviation) to a postoperative value of 16.6 +/- 3.1 mmHg (mean +/- standard deviation) at 18 months (P < 0.001). The UBM findings showed a subconjunctival filtration with a nonperforated thin trabeculodescemetic membrane. In 23 eyes (51%), a hypoechoic area in the suprachoroidal space was observed. The thickness of the trabeculodescemetic membrane was stable throughout the study with a mean value of 0.13 mm +/- 0.02 (mean +/- standard deviation) at 18 months. The collagen implant dissolved slowly within 6 to 9 months, leaving a tunnel in the sclera. CONCLUSIONS: The UBM findings are consistent with intraocular pressure lowering by aqueous filtration through the thin remaining trabeculodescemetic membrane to an area under the scleral flap, which was maintained open by the collagen implant. The authors speculate that aqueous humor then reached the subconjunctival space and, eventually, was filtered through the thin scleral wall into the suprachoroidal space. Complete resorption of the collagen implant occurred between 6 and 9 months after surgery.
Aged↗
Management of phacolytic glaucoma: experience of 135 cases.
We retrospectively analyzed 135 eyes with phacolytic glaucoma. A trabeculectomy was added to standard cataract surgery if symptoms endured for more than seven days, or if preoperative control of intraocular pressure (IOP) with maximal medical treatment was inadequate. In the early postoperative period, IOP was significantly lower in the combined surgery group (89 eyes) compared to the cataract surgery group (46 eyes) (p < 0.001). At 6 months there was no difference in IOP or visual acuity between the two groups. There were no serious complications related to trabeculectomy. It is reasonable to conclude that in eyes with a long duration of phacolytic glaucoma, addition of a trabeculectomy to cataract surgery is safe, prevents postoperative rise in intraocular pressure and decreases the need for systemic hypotensive medications. A randomized trial is on to further address this question.
Adult↗
[Glaucoma: modern diagnostic and therapeutic approach].
Primary open angle glaucoma may be a severe ocular disease and may lead to blindness if not diagnosed and/or treated in time. The pathogenic mechanism is a progressive loss of ganglion cells leading to cupping of the optic nerve head. The main risk factor is an elevated intraocular pressure, but optic nerve vascular deficiency, neuronal degeneration or genetic factors have to be considered as other potential risk factors. The actual diagnostic tools and the latest technologies for the medical, laser and surgical treatment are described in this paper.
Acetazolamide↗
[Modern anti-glaucoma drugs and their secondary effects].
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Adrenergic alpha-Agonists↗