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PubMed1976

[Complete or peripheral iridectomy in acute glaucoma? (author's transl)].

The re-examinations of 28 complete sector and 27 peripheral iridectomies, performed because of acute glaucoma, showed an equally good regulation of IOP from both methods, even in longstanding cases (stadium III of Leydhecker) and when an operation during an attack is necessary. The postoperative reduction in vision mainly caused by cataract, was seen more frequently after sector iridectomy. In acute glaucoma the peripheral iridectomy as the less extensive and less severe procedure is to be preferred to the sector iridectomy with the exception, that an optical iridectomy is indicated.

Adult↗
PubMedDate not supplied

Phacotrabeculectomy without peripheral iridectomy.

BACKGROUND AND OBJECTIVE: Peripheral iridectomy has been a long established part of glaucoma drainage surgery. This series examines the potential to dispense with iridectomy when trabeculectomy is combined with modern small-incision cataract surgery. PATIENTS AND METHODS: Twenty-five unselected consecutive patients underwent a standardized phacotrabeculectomy by a single surgeon. Outcome measures included visual acuity, intraocular pressure control, and complication rates. Mean follow-up was 12.2 months. RESULTS: There were no complications related to lack of peripheral iridectomy. Intraocular pressure was reduced from a mean of 23.4 mm Hg (SD 5.1) to 15.9 (SD 3.8) at 6 months, and 15.4 (SD 3.5) at 12.2 months. There were 2 relative failures of surgery whose IOP reached preoperative targets with additional medical treatment. Best Snellen acuity improved by a mean of 1.5 lines. CONCLUSIONS: Phacotrabeculectomy without peripheral iridectomy appears to be safe, although we consider that a corneal fistula and careful control of postoperative overdrainage is necessary to allow this. The success rate and lack of complications is good by comparison with other series. This could be related to the absence of release of factors influencing healing at the time of an iridectomy.

Aged↗
PubMed2002

Intraocular production and release of nerve growth factor after iridectomy.

PURPOSE: To determine the presence of nerve growth factor (NGF), NGF mRNA, and NGF receptor (TrkA) in rabbit ocular tissues, and whether changes occur in NGF and NGF mRNA levels after experimental iridectomy. METHODS: Immunohistochemistry for NGF and TrkA and in situ hybridization for NGF mRNA were performed on rabbit cornea, iris, ciliary body, and lens in the basal state. Quantification of NGF mRNA and NGF protein levels in these tissues was performed by RT-PCR and immunoenzymatic assay, respectively. A time course of NGF concentration in the aqueous humor and the expression of NGF mRNA in iris and ciliary body were performed after the iridectomy and were compared with levels in a sham-treated group (paracentesis). RESULTS: Cornea, iris, ciliary body, and lens expressed NGF mRNA, NGF protein, and TrkA in the basal state. The highest levels of NGF were detected in the iris (8938.0 +/- 3968.1 pg/g), and the lowest were in the aqueous humor (22.8 +/- 9.7 pg/mL). Experimental iridectomy induced a transient increase of NGF concentration in the aqueous humor that reached its peak 4 hours after the experimental injury (464.4 +/- 29.9 pg/mL versus the control group 101.6 +/- 18.8 pg/mL; P < 0.001) and returned to baseline value after 7 days. A significant increase of NGF mRNA was also observed 1 hour and 4 hours after the iridectomy in the iris (1 hour, 788 +/- 85 OD; 4 hours, 760 +/- 81 OD versus baseline, 246 +/- 32 OD; P < 0.0001) and ciliary body (1 hour, 330 +/- 19 OD; 4 hours, 453 +/- 52 OD versus baseline, 219 +/- 37 OD; P < 0.05), but not in the cornea, lens, or any tissues from the control group. CONCLUSIONS: NGF is present and produced in the anterior segment of the eye and is released in the aqueous humor in the basal state. Experimental iridectomy induces increased production of NGF in the iris and in the ciliary body and an increased concentration of NGF in the aqueous humor.

Animals↗
PubMed2002

[A clinical study on laser peripheral iridoplasty for primary angle-closure glaucoma with positive provocative tests after iridectomy].

OBJECTIVE: To evaluate the therapeutic effects of laser peripheral iridoplasty for primary angle closure glaucoma with positive dark room and prone test after laser peripheral iridectomy. METHODS: A long-term prospective study of 56 eyes (34 cases) with primary angle-closure glaucoma was carried out. The patients presented with positive dark room and prone provocative test after laser peripheral iridectomy, and laser peripheral iridoplasty by Double-Frequency Nd:YAG laser was performed on them. Their extent of goniosynechia was less than 1/2 circumference of the anterior chamber angle. Forty-nine eyes (27 cases) of all those studied were acute angle-closure glaucoma and the other 7 eyes (7 cases) were chronic angle-closure glaucoma. The inferior peripheral anterior chamber depth, anterior chamber angle, the configuration of peripheral iris and intraocular pressure were observed carefully, and the dark room, prone and mydriatic provocative tests were performed. The postoperative follow-up ranged from 1 year to 4 years. RESULTS: The results showed that in all these cases, the peripheral anterior chamber depth was increased, the anterior chamber angle was widened on goniscope and the trabecular meshwork could be visualized widely in static state. All patients did not have ocular hypertension and damage of visual field in the follow up. Mydriatic, dark room and prone provocative tests following laser peripheral iridoplasty were negative. CONCLUSIONS: In some acute angle-closure glaucoma and chronic angle-closure glaucoma patients, the pupillary block is relieved by laser peripheral iridectomy, but provocative tests can also be positive because of the abnormal configuration of the peripheral iris. Pupillary dilation results in peripheral iris bunching, and the surface of the trabecular meshwork can be blocked, hypertension then occurs. But the laser peripheral iridoplasty can improve the shape of the peripheral iris effectively and it can prevent the disease from deteriorating. The goniscopic examination and provocative tests following laser peripheral iridectomy are very important and also effective in detecting this kind of glaucoma.

Adult↗
PubMed1976

Incidence of photophobia in peripheral and sector iridectomy.

Fifth patients had bilateral intracapsular cataract extractions with a peripheral iridectomy in one eye and a sector iridectomy in the opposite eye. There was no difference in photophobia between the two eyes in 78% of patients. Twelve percent of the patients had greater photophobia in the eye with the peripheral iridectomy, and 10% had greater photophobia in the eye with the sector iridectomy.

Adult↗
PubMed1984

Laser iridectomy in the management of chronic angle-closure glaucoma.

Nineteen eyes of 16 patients (12 men and four women ranging in age from 41 to 75 years) underwent laser peripheral iridectomy for treatment of uncontrolled chronic angle-closure glaucoma (25 to 62 mm Hg). Five of eight eyes (62.5%) with glaucomatous cupping but full visual fields attained postiridectomy intraocular pressures of less than 22 mm Hg with medical therapy. Seven of nine eyes (77.7%) that had both glaucomatous optic disk damage and visual field loss before iridectomy had controlled intraocular pressures with medical therapy after iridectomy. Because laser iridectomy is safer than trabeculectomy, we recommend that it be the initial procedure in the treatment of chronic angle-closure glaucoma.

Aged↗
PubMed1982

Laser iridectomy treatment of acute pseudophakic pupillary block glaucoma.

A 71-year-old patient developed acute pupillary block glaucoma two years after uncomplicated extracapsular cataract surgery with primary implantation of a Choyce-style anterior chamber lens. He presented one week after the onset of pain. The attack was relieved with argon laser iridectomy. The presumed mechanism was rotation of the intraocular lens due to blunt trauma, occluding the previously patient single surgical iridectomy site. We felt that in this case, laser iridectomy was a good, safe alternative to surgical iridectomy.

Aged↗
PubMed1985

Histopathology of neodymium: YAG laser iridectomy in humans.

Fifteen peripheral iridectomy specimens were obtained, with informed consent, from patients with primary narrow angle glaucoma, after previous neodymium:YAG (Nd:YAG) laser iridectomy. The iridectomies were performed three hours to ten weeks after laser application. Iridectomy specimens were examined by scanning and/or transmission electron microscopy. Early effects of the Nd:YAG laser on the iris were mild hemorrhage and fibrinous aggregates. There were no inflammatory cell infiltrates. At later time intervals (up to 2 months post-laser treatment) the holes showed irregular thickness of iris pigment epithelium at the margins, and tissue atrophy limited to the immediate margins of the hole. Elsewhere the iris was structurally intact. The diameter of the holes varied from 60 to 500 microns. The larger holes corresponded to cases that had received more application shots.

Aged↗
PubMed1979

Management of acute primary angle-closure glaucoma: a long-term follow-up of the results of peripheral iridectomy used as an initial procedure.

For the past 12 years peripheral iridectomy has been used as the initial surgical procedure after an acute attack of angle-closure glaucoma. The operation has been performed 2 to 5 days after the pressure has been controlled medically and has been followed routinely by prophylactic peripheral iridectomy in the fellow eye. Peripheral iridectomy for primary acute angle-closure glaucoma controlled the condition without any need for further medical or surgical therapy in 72% of cases. Careful and frequent follow-up within the first 4 postoperative months is essential to prevent further field loss, which can occur very rapidly if the pressure is not adequately controlled. If the pressure remains uncontrolled, further surgery should not be delayed. It was impossible to decide which patients would eventually need trabeculectomy when they first attended in the acute attack. Peripheral iridectomy as a prophylactic procedure was entirely effective in preventing an acute angle-closure attack in the fellow eye.

Acute Disease↗
PubMed1981

A comparison between peripheral iridectomy with thermal sclerostomy and trabeculectomy: a controlled study.

In 15 patients with primary open-angle glaucoma who required surgery in both eyes because of progressive glaucomatous disease a peripheral iridectomy with thermal sclerostomy was performed in one eye and a trabeculectomy in the other eye, the choice of procedure being determined randomly. In all 15 cases at one year and 13 cases at 5 years after operation the immediate complication rate was higher in patients receiving peripheral iridectomy with thermal sclerostomy. The average final level of intraocular pressure (on no treatment) was 16 mmHg in patients receiving peripheral iridectomy with thermal sclerostomy and 22 mmHg in those in whom a trabeculectomy was performed. The control of disease was the same in both groups, there being an improvement in the visual field in approximately one-third of all cases and stability of the visual field in all other cases except for one. However, twice as many patients after trabeculectomy required additional medical therapy to maintain the intraocular pressure in a range that was considered satisfactory. Stability of intraocular pressure was virtually the same in both groups. The mechanism of control of intraocular pressure in patients receiving peripheral iridectomy with thermal sclerostomy appeared to be gross filtration in all cases, whereas such gross filtration was observed in only 2 eyes in which a trabeculectomy had been performed.

Adolescent↗
PubMed2002

[Intraocular lens implantation and coreoplasty for congenital cataract after optical iridectomy].

OBJECTIVE: To explore the therapeutic method for congenital perinuclear cataract after optical iridectomy. METHODS: Twelve cases (24 eyes) with congenital perinuclear cataract after optical iridectomy were selected. After extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation, the sides of the iridectomy were sutured to complete the coreoplasty. RESULT: No patient complained of photophobia and monocular diplopia postoperatively. Every one got a nearly round pupil with light reaction and a corrected visual acuity >/= 0.5. CONCLUSION: The combination of ECCE, IOL implantation and coreoplasty is a good therapeutic method for congenital perinuclear cataract after optical iridectomy.

Adolescent↗
PubMedDate not supplied

Rhegmatogenous retinal detachment with Schwartz's syndrome following Nd:YAG laser peripheral iridectomy in the management of pigmentary glaucoma.

A case of rhegmatogenous retinal detachment complicated by Schwartz's syndrome following Nd:YAG laser peripheral iridectomy in the management of pigmentary glaucoma is described. A 36-year-old man underwent Nd:YAG laser peripheral iridectomy for pigmentary glaucoma. Three days later, he had a rhegmatogenous retinal detachment. The break remained open following scleral buckling with persistent subretinal fluid, "iridocyclitis," and elevated intraocular pressure. Two months later, the patient underwent revision of the scleral buckle. Following closure of the retinal break, the retina flattened, and within 2 weeks the "iridocyditis" resolved and the intraocular pressure decreased to approximately 20 mm Hg. Rhegmatogenous retinal detachment may occur following laser peripheral iridectomy, and suggests the necessity for a prospective dinical trial to evaluate the role of laser peripheral iridectomy in the management of pigmentary glaucoma.

Adult↗
PubMed1990

[Surgical iridectomy following acute angle-closure glaucoma. A retrospective study of 107 patients].

In 69 of 107 patients with primary angle-closure glaucoma, it was possible to control intraocular pressure and visual fields by means of peripheral surgical iridectomy; in 17 of these patients topical glaucoma medication was required in addition. In 11 cases a second surgical operation other than iridectomy was necessary: 6 lensectomies for malignant glaucoma in 2 cases and lens subluxation or phacomorphic glaucoma in 4 and 5 filtering procedures. Among the 85 treated fellow eyes 68 were controlled by iridectomy alone and 17 eyes needed additional topical glaucoma medication. One case of persisting wound leakage from the corneo/scleral wound was the only complication observed in this study. The advantages and disadvantages of peripheral surgical iridectomy are compared with those of argon and neodymium: YAG iridotomies. Owing to the low rate of complications the authors apply the surgical approach as the routine technique for primary angleclosure glaucoma.

Follow-Up Studies↗
PubMed1986

Neodymium:YAG laser iridectomy and acute cataract formation in the rabbit.

The Q-switched Neodymium:YAG (Nd:YAG) laser in the single pulse mode was used to perform iridectomies in pigmented and albino rabbits. Seventy-one iridectomies were attempted. Seventy-six percent (54/71) of these were patent at the time of enucleation. Iridectomy closure was not noted during the 24-day study period. Lenticular damage was not detected in any case. Patency rates in pigmented (70%) and albino (78%) irides were similar. Energy levels of 6 mJ or greater resulted in a higher rate of patency. Settings below 6 mJ were associated with more significant bleeding and had a low rate of success. The histology of acute Q-switched Nd:YAG laser iridectomy is characterized by fragmentation of the stroma and wide dispersion of the pigment epithelium. Minimal healing occurs with retention of normal iris architecture without atrophy or fibrosis. Results indicate that this procedure can be performed with minimal operative complications and without a tendency for closure.

Animals↗
PubMed1986

Laser iridectomy. A controlled study comparing argon and neodymium: YAG.

Laser peripheral iridectomies were performed on both eyes of 38 patients with acute or chronic primary angle-closure glaucoma or with narrow angles capable of closure. The right eye was treated with the neodymium YAG laser (Nd:YAG) and the left eye with the argon laser. Patients were followed for a minimum of eight months. The mean number of applications to produce iris penetration was six with the Nd:YAG laser and 73 with the argon laser. Visual acuity, postoperative intraocular pressure (IOP), corneal changes, and pigment dispersion were similar in the two groups. Microhyphema was more prevalent in the Nd:YAG iridectomy group. Pupillary distortion, iritis, and late failure of patency were more frequent in the argon laser group. Nd:YAG laser iridectomies require fewer applications and produce less inflammation. This controlled study demonstrates that when properly and carefully performed, the Nd:YAG laser is at least as effective and appears to be as safe as the argon laser for performing peripheral iridectomies.

Adult↗
PubMed1985

Laser peripheral iridectomy comparing Q-switched neodymium YAG with argon.

Twenty-five patients who required bilateral peripheral iridectomies had the right eye treated by the Nd YAG laser and the left eye by the pulsed argon laser. The photodisruption of iris tissued produced by the Nd YAG produces a quicker more efficient iridectomy than the thermal effect of the argon laser with less tendency to healing and inflammation. We conclude that Neodymium YAG laser iridectomy is a safe effective alternative to argon laser iridectomy with no increase in complications during the follow up period and is preferred by the patients.

Argon↗
PubMed1981

[Iridectomy].

The importance of v. Graefe's iridectomy is considered in the light of medical history. Modern indications for iridectomy, including possible variations (sector iridectomy, peripheral, basal iridectomy) are discussed. Surgical techniques (scleral incision with conjunctival flap, corneal incision, laser iridotomy) and their advantages and complications are described.

Eye Injuries↗
PubMed2005

Small incision surgical iridotomy and iridectomy.

PURPOSE: To describe a minimally invasive method to create a full-thickness surgical iridectomy. DESIGN: An interventional case series. METHODS: Surgical iridectomies were performed through a 1-mm clear corneal incision. The anterior chamber was prepared with acetylcholine chloride 10 mg/ml and sodium hyaluronate 1%. A 25-gauge aspiration-cutter "probe" was introduced through the corneal incision such that the aspiration portal was occluded by the iris stroma. Then aspiration (600 mm/Hg) cutting (300 cpm) was used to create a surgical iridotomy in 2 cases. Then the probe was removed. RESULTS: Full-thickness iridotomies were created. None of the patients were noted to have a secondary increase in intraocular pressure, hyphema, infection, cataract or vision loss. The clear-corneal wounds were self-sealing. CONCLUSIONS: Small incision surgical iridectomy can be minimally invasive and effective. Use of a 25-gauge aspiration-cutting probe allowed for small incision surgery, rapid rehabilitation and no significant complications.

Biopsy↗