PubMed · 5659909
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E R Thomas. Thomas paracentesis needle.. https://pubmed.ncbi.nlm.nih.gov/5659909/
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BACKGROUND: The purpose of this study was to evaluate the influence of previous argon laser trabeculoplasty (ALT) on transforming growth factor-beta 2 (TGF-beta 2) concentration of the aqueous humor and its influence on bleb scarring after trabeculectomy. METHODS: Fifty-one patients with primary open-angle glaucoma (POAG) and 29 patients with exfoliation (XFS) glaucoma were recruited for this prospective study before undergoing trabeculectomy. Sixty to 200 micro l of aqueous humor were analyzed for total and biologically active TGF-beta 2 concentrations (R and D Systems). TGF-beta 2 levels and a standardized bleb assessment were compared between the ALT- and non-ALT-treated groups. RESULTS: POAG eyes without ALT showed significantly higher total TGF-beta 2 levels (2,317.7+/-1,041.1 pg/ml) than eyes with previous ALT (1,621.6+/-899.6 pg/ml; P=0.026). No significant difference was found for active TGF-beta 2 levels (ALT: 238.1+/-119.0 pg/ml; no ALT: 220.1+/-96.9 pg/ml; P=0.585). In XFS patients ALT did not alter total TGF-beta 2 levels (ALT: 1,524.9+/-624.9 pg/ml, no ALT: 1,220+/-499.1 pg/ml; P=0.20), but active TGF-beta 2 was significantly higher in the ALT-treated (237.0+/-99.7 pg/ml) than in the non-ALT-treated (140.0+/-95.3 pg/ml, P=0.028) group. Bleb grading revealed no statistical difference between the ALT- and non-ALT-treated groups in POAG (P=0.545, Fisher's exact test), whereas XFS patients with ALT were at increased risk for scarring compared to non-ALT-treated patients (P=0.053). CONCLUSIONS: ALT appears to increase the risk of scarring in XFS patients because of increased levels of activated TGF-beta 2.
PURPOSE: To report a corneal perforation during laser in situ keratomileusis (LASIK) after previous electrothermokeratoplasty. DESIGN: Interventional case report. METHODS: A 49-year-old man presented with primary hyperopia in the right eye and residual hyperopia after electrothermokeratoplasty in the left eye. His refraction was +4.00 in the right eye and +7.00 -3.00 x 135 degrees in the left eye, with a central pachymetry of 535 microm and 549 microm, respectively. Phacoemulsification with intraocular lens (IOL) insertion in the right eye and a two-step keratophacorefractive procedure with a piggyback IOL insertion and LASIK in the left eye were proposed. RESULTS: Postoperative refraction was -0.50 -0.50 x 150 degrees 20/20 in the right eye. Postphacoemulsification refraction was -4.75 -4.25 x 135 degrees in the left eye. Laser in situ keratomileusis was performed in the left eye, 4 months later, with uneventful astigmatic laser ablation. During the myopic ablation, a sudden outcome of aqueous humor in one of the temporal corneal scars was observed. CONCLUSIONS: Unpredictably thin areas after electrothermokeratoplasty may lead to unexpected corneal perforation during LASIK. The available pachymetry systems may be unreliable after electrothermal keratoplasty.
PURPOSE: To demonstrate how an inferior iridectomy prevents a pupillary block in aphakic patients with a silicone oil tamponade. DESIGN: Observational case series. METHODS: Photographs of two patients who had undergone vitrectomy, lensectomy, membrane peeling, silicone oil tamponade, and inferior iridectomy for a complex retinal detachment were evaluated. RESULTS: In the thin layer of erythrocytes covering the endothelium, we observed an arc clear of erythrocytes anterior to the inferior iridectomy. CONCLUSIONS: With silicone oil blocking the pupil, aqueous humor was channeled through the inferior iridectomy with sufficient force to sweep the endothelium anterior to the iridectomy clean of erythrocytes, thus visualizing the mechanism that prevents a pupillary block glaucoma.