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PubMed1984

Pupillary and iridovitreal block in pseudophakic eyes.

Twenty-six cases of pupillary and iridovitreal block in pseudophakic eyes are reported. Although ten patients presented with acute angle closure glaucoma, the majority were asymptomatic and had normal intraocular pressures. While cure was finally achieved in all cases, recurrence of block occurred in six eyes as late as two months after initial successful treatment. A variety of therapeutic modalities including argon laser iridectomy, argon laser gonioplasty (iridoplasty), surgical iridectomy, surgical vitrectomy, Q-switched Nd:YAG laser iridectomy and Nd:YAG laser photodisruption of the anterior vitreous face were needed. Despite successful relief of pupillary and iridovitreal block in these eyes with no evidence of glaucoma prior to cataract and lens implant surgery, four eyes developed eight or more clock hours of peripheral anterior synechiae, and nine eyes continue to require chronic medical therapy for glaucoma.

Aged↗

PubMed1991

Effect of angle closure glaucoma and surgical intervention on the corneal endothelium.

To assess the effect of acute angle closure glaucoma (AACG) and related surgical intervention on the corneal endothelium, specular microscopy was performed following surgery in a series of 69 patients: 27 for AACG, 9 for incipient angle closure, 17 for chronic angle closure glaucoma (CACG), and 16 for chronic open angle glaucoma (COAG). Peripheral iridectomy for incipient angle closure glaucoma caused no significant effect on the corneal endothelium, but, following peripheral iridectomy or drainage operation for AACG, significant lowering of the endothelial cell count was present in the affected eye (p less than 0.05) with 1,000 cells/mm2 in 7 cases. This was related to the presence of segmental iris atrophy (p less than 0.01). Peripheral iridectomy for CACG or incipient angle closure glaucoma was not accompanied by a significant effect, but drainage operation for CACG or COAG was associated with a significant fall in count (p less than 0.01). Thus, both AACG and drainage operation significantly affect the corneal endothelium, and this should be assessed before undertaking further surgery.

Acute Disease↗

PubMed2001

Latanoprost-induced iris heterochromia and open-angle glaucoma: a clinicopathologic report.

PURPOSE: To report the histopathologic and immunohistochemical findings from the iridectomy specimen of a patient with acquired unilateral iris heterochromia due to latanoprost. PATIENT AND METHODS: A 45-year-old woman with open-angle glaucoma and unilateral iris heterochromia was evaluated for uncontrolled intraocular pressure increase. Subsequently, the patient underwent trabeculectomy with mitomycin C and an iridectomy specimen was obtained for analysis. RESULTS: The histopathologic analysis of the iridectomy specimen did not reveal any nuclear atypia, nuclear crowding, or mitotic figures. Immunohistochemical studies showed that the iris melanocytes were negative for HMB45 and S-100, and weakly positive for Melan A. CONCLUSION: Latanoprost-associated iris color change may exhibit a diffuse, uniform, dark velvet-brown appearance, thereby simulating diffuse iris melanoma. Histopathologic and immunohistochemical analysis confirmed the benign characteristics of the affected iris melanocytes.

Antihypertensive Agents↗

PubMed1977

Fluorescein pupillary flow in aphakics with intact and spontaneous openings of the vitreous face.

The passage of fluorescein dye, injected into the general circulation, from the posterior to the anterior chamber was studied in 60 selected aphakic eyes between 2 days and 4 weeks after an uneventful cataract extraction. In a group of 22 eyes with intact anterior hyaloid, fluorescein was seen to pass only through the pupillary margin, mostly within 20 seconds of the beginning of the eye injection. In 24 eyes with rents in the anterior hyaloid the dye was seen percolating only through the vitreous face openings. No fluorescein passed through the pupillary margin or the peripheral iridectomy in this group of eyes. The appearance time of the dye was delayed to about twice the normal appearance time. In 8 eyes with rents in the anterior hyaloid the dye passed only through the pupillary margin. In 4 eyes with anterior vitreous rents the fluorescein appeared through the anterior vitreous face opening. From the analysis of the data it appears that the spontaneous breaks in the anterior vitreous face may represent a 'self-c,re' of pupillary and iridectomy block by the vitreous in aphakics in a high proportion of cases. It is our impression that 3 peripheral iridectomies and a very tight closure of the wound can prevent the complication of spontaneous breaks of the vitreous face.

Cataract Extraction↗

PubMed1987

Posterior synechiae after glaucoma operations: aggravation by shallow anterior chamber and pilocarpine.

Posterior pupillary synechiae affect a proportion of eyes subjected to iridectomy with or without drainage operation because (1) aqueous humour bypasses the pupil; (2) traumatic iridocyclitis occurs; (3) there is immobility of the iris in the iridectomy sector; (4) in eyes with angle closure glaucoma closer apposition of the iris to the anterior lens capsule increases the tendency; (5) pilocarpine aggravates (4) both in angle closure glaucoma and open angle glaucoma and produces a small immobile pupil facilitating pupillary membrane formation (occlusio pupillae). Pilocarpine should be avoided if possible as medical treatment at any time after a drainage operation. A beta blocker is the drug of choice. To eliminate posterior synechiae over a fair number of degrees of pupil (say 30 degrees) sector iridectomy can be done.

Aged↗

PubMed1991

Can the pilocarpine phenylephrine provocative test be used to detect covert angle closure?

Mapstone introduced the term 'partial angle closure' to describe how eyes with apparently open angles could be damaged by a covert angle closing mechanism, identifiable by a positive result of the pilocarpine phenylephrine provocative test (PPPT). This paper presents a 10-year follow-up of 68 patients with narrow but open anterior chamber angles who, on the basis of a positive PPPT, underwent peripheral iridectomy (PI) or laser iridotomy LI). In the 42 patients with glaucoma or ocular hypertension the mean intraocular pressure (IOP) was unchanged following iridectomy; 45% of eyes which showed glaucomatous optic disc damage at presentation and 25.6% of ocular hypertensive eyes subsequently required trabeculectomy to achieve IOP control. In 16 patients with no ocular abnormality other than a narrow angle 19 eyes had positive PPPTs and underwent PI. After a 10-year follow-up only one of the 13 untreated fellow eyes developed angle closure glaucoma. As this is usually bilateral, many of the positive tests in this group of patients may therefore have been false positives. This study shows that eyes with narrow angles which had positive PPPT results did not benefit from PI iridectomy or LI and therefore a positive PPPT is not indicative of the presence of an angle closing mechanism.

Follow-Up Studies↗

PubMed1991

Nd-YAG laser hyaloidotomy for malignant glaucoma following one-piece 7 mm intraocular lens implantation.

Three cases of malignant glaucoma following extracapsular cataract extraction with 7 mm one-piece posterior chamber intraocular lens implantation are presented. Nd-YAG laser hyaloidotomy was successfully performed in all eyes, but was difficult and required several sessions in two eyes. In the third eye, which had a sector iridectomy, laser hyaloidotomy applied over the edge of the lens optic through the iridectomy resulted in brisk deepening of the anterior chamber and reduction of intraocular pressure. We propose that the one-piece 7 mm optic posterior chamber intraocular lens may constitute an obstacle to successful hyaloidotomy, mainly owing to its large size, as it may block aqueous percolation from the vitreous into the anterior chamber. Eyes prone to develop malignant glaucoma after surgery should have a sector or large peripheral iridectomy to facilitate postoperative Nd-YAG laser hyaloidotomy if required.

Aged↗

PubMed1994

Acute angle closure glaucoma: relative failure of YAG iridotomy in affected eyes and factors influencing outcome.

The treatment of acute angle closure glaucoma has been influenced by the development of the YAG laser and its ability to perform iridotomies as an outpatient procedure. In this retrospective study the results of YAG iridotomy were compared with surgical peripheral iridectomy. When compared with surgical peripheral iridectomy patients, YAG iridotomy patients were at greater risk of proceeding to further surgery, with this risk being significantly associated with increasing duration of attack. The authors suggest that in selected cases, surgical iridectomy should be given consideration as a primary procedure.

Acute Disease↗

PubMed1997

Non-trans-scleral suture fixation of posterior chamber intraocular lenses in the absence of posterior capsular support.

PURPOSE: To develop a new technique for fixation of posterior chamber intraocular lens (IOL) in the absence of posterior capsule support. MATERIALS AND METHODS: We performed non-trans-scleral fixation of intraocular lenses on 24 cases (24 eyes) without posterior capsule support. Two scleral flaps with limbal incisions and two peripheral iridectomies were made at 1 o'clock and 7 o'clock positions respectively. A suture-leading needle was used to lead the prolene suture from the limbal incision and iridectomy on one side through the iridectomy and limbal incision on the other side. Intraocular lens (IOL) was then fixed in the ciliary sulcus. RESULTS: After a mean follow-up of 6.6 months (range from 3 to 14 months), corrected visual acuity of 16 cases (16 eyes, 66.7%) got 0.5 or better. Postoperative complications included discoria (4 eyes), surface membrane formation (1 eye), choroidal detachment (1 eye) and tilt of IOL (1 eyes), but all were not severe. CONCLUSION: In some situations such as low intraocular pressure, non-penetration scleral fixation may be a good way to implant IOL in the absence of posterior capsule support.

Adolescent↗

PubMed2001

[A study on the treatment of secondary glaucoma due to intumescent senile cataract].

OBJECTIVE: To discuss surgical methods of treating secondary glaucoma due to intumescent senile cataract. METHODS: Of 47 inpatient cases (49 eyes) who suffered from secondary glaucoma due to intumescent senile cataract, 28 cases (30 eyes) had been performed the following four different types of operation; (1) extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation with peripheral iridectomy, (2) ECCE and PC-IOL implantation with segmental iridectomy, (3) ECCE and PC-IOL implantation with trabeculectomy, and (4) five-combined-operation including scleral trephination, cyclodialysis, vitreous paracentesis, ECCE and PC-IOL implantation. RESULTS: The corrected visual acuities in 28 eyes had improved, whereas that in 2 eyes did not improve because of optic nerve atrophy. All the intraocular pressure in 30 eyes was within normal limit, including 12 eyes topically using antiglaucoma drugs. CONCLUSION: Most of patients with secondary glaucoma due to intumescent senile cataract can be cured surgically by iridectomy or trabeculectomy combined with ECCE and PC-IOL implantation. The five-combined-operation is an effective way to treat difficult cases such as long-term disease course, result with antiglaucoma drugs not satisfactory and swelling lens with flat anterior chamber.

Age Factors↗

PubMed1997

[A new type of headache of ocular origin: ophthalmotonic headache. Diagnosis and treatment].

INTRODUCTION: In some patients it was seen that chronic headaches disappeared after laser iridectomies had been done to prevent glaucoma, in persons with normal intra-ocular pressure (IOP). OBJECTIVE: To make a study of patients with headache, some of whom were treated with topical beta-blockers (carteolol) and others by Yag-laser iridectomies. The effect on headache and IOP was analyzed. MATERIAL AND METHODS: A survey, ophthalmological examination and headache provocation test were carried out in patients with headaches, and the changes in IOP determined by pharmacologically inducing miosis and mydriasis were recorded. Three treatment groups were formed and the results analyzed statistically. RESULTS: In the 12 patients treated pharmacologically, 62% improved and in 14% the headaches disappeared. In the 16 treated using laser 94% were cured and 6% improved. When both types of treatment were used on 9 patients, 22% improved and 78% were cured. The validity of the ocular pressure curve was checked in the diagnosis of blockage of the pupil. CONCLUSIONS: Some headaches of ocular origin (ophthalmotonic), not previously described, occur due to abrupt changes in intraocular pressure, and improve significantly when the IOP is reduced by beta-blockers or Yag-laser iridectomies are done. A valid provocation tests for diagnosis of this type of headache is described. We consider that blockage of the pupil and/or of the angle of the anterior chamber are possible etiopathogenic mechanisms.

Adrenergic beta-Antagonists↗

PubMed2006

[Cataract extraction including posterior chamber lens implantation in the treatment of acute glaucoma].

OBJECTIVE: The aim of this study was to compare phacoemulsification in eyes with angle-closure glaucoma to the partner eyes with or without iridectomy or laser iridotomy, respectively. METHODS: Twelve eyes with an elevated intraocular pressure due to an angle closure that were treated by phacoemulsification and IOL implantation were compared with 12 partner eyes with narrow angle and iridectomy or iridotomy without intraocular pressure elevation and cataract extraction. The average follow-up period was 15.7+/-2.1 months. RESULTS: The average intraocular pressure in eyes with angle-closure glaucoma was 54.1+/-14.7 mmHg and in the partner eyes 22.4+/-8.6 mmHg preoperatively. Follow-up pressure was 19.3+/-2.0 mmHg in eyes with angle-closure glaucoma and 18.8+/-1.5 mmHg in the partner eyes. CONCLUSION: Primary cataract extraction including posterior chamber lens implantation into eyes with angle-closure glaucoma reduced intraocular pressure to normal levels, increased visual acuity, and decreased the number of antiglaucomatous drugs. Eyes with angle-closure glaucoma do not respond differently to phacoemulsification and lens implantation compared to eyes with narrow angle without pressure elevation during and after phacoemulsification.

Aged↗

PubMed2004

Delayed-onset, bleb-associated endophthalmitis caused by Lecythophora mutabilis.

PURPOSE: To report delayed-onset, bleb-associated endophthalmitis caused by Lecythophora mutabilis. DESIGN: Interventional case report. METHODS: Description of an otherwise healthy woman who developed delayed-onset fungal endophthalmitis associated with a preexisting filtering bleb. RESULTS: A 57-year-old woman who underwent trabeculectomy with Mitomycin C in her left eye 8 years earlier presented with a 10-day history of pain and decreased vision in her left eye. She underwent anterior chamber and vitreous taps and injection of intraocular antibiotics. Cultures grew the mold Lecythophora mutabilis. The patient underwent treatment with intraocular and systemic antifungal agents, three pars plana vitrectomies, partial iridectomy, and cryopexy to the bleb and angle structures. Four months after her last treatment, her left eye shows no residual infection, and vision corrects to 20/80. CONCLUSION: Bleb-associated endophthalmitis caused by L. mutabilis is resistant to amphotericin B but responsive to intravitreal and systemic voriconazole together with pars plana vitrectomy, iridectomy, and cryopexy to the bleb and angle structures.

Antifungal Agents↗

PubMed2004

[Angle closure glaucoma in association with relative anterior microphthalmus (RAM) after premature birth-retinopathy (ROP)].

BACKGROUND: The infantile angle-closure glaucoma is a common and well characterized complication of retinopathy of prematurity (ROP). Progressive shallowing of the anterior chamber by retrolental fibrous masses is mostly responsible for the pressure elevation during the first years of life. Apart of this pathogenesis, ROP-associated glaucoma is totally different in cases that do not manifest until adulthood. Only few cases are described in the literature. CASE REPORT: A 36-year-old female patient presented with symptoms of acute intraocular pressure (IOP) elevation and fundus results of a cicatricial ROP stadium II. Control of IOP was not achieved by systemic and topical drug treatment. The biometry showed a relative anterior microphthalmus (RAM) in myopia. After peripheral iridectomy, the IOP normalized and remained stable over a long-time period. CONCLUSION: Myopia induction after ROP and ROP treatment often lead to special anatomical conditions corresponding to the classical relative anterior microphthalmus. Shallowing of the anterior chamber and development of angle-closure glaucoma increase with age. Thus, a manifestation not before the third decade of life was a typical finding in the literature review. A detailed recording of history and consideration of the biometric data are of importance for diagnosis. Peripheral iridectomy was found to be the therapy with the highest success rate. The increase of a pupillary block mechanism can prevent further visual loss to the often pre-damaged eyes. Consideration of this entity is crucial in unilateral IOP elevation, because an increasing prevalence of these patients can be expected due to the increase of premature babies since 1970.

Adult↗

PubMed2005

[The autologous ipsilateral rotating penetrating keratoplasty: an early surgical procedure to prevent deep irreversible amblyopia in Peters anomaly].

PURPOSE: It is a challenge to prevent irreversible amblyopia in infants suffering from Peters anomaly. In some cases of centrally located corneal opacifications an optical sector iridectomy can not lead to a clear optical axis. The homologous penetrating keratoplasty as early surgical procedure has shown an extremely poor outcome with a high risk of irreversible graft failure. We report on the autologous ipsilateral rotating penetrating keratoplasty in an eight-week-old infant suffering from Peters anomaly. PATIENTS: An autologous ipsilateral rotating penetrating keratoplasty was performed in an eight-week-old infant suffering from Peters anomaly to prevent irreversible amblyopia. RESULTS: After a follow-up time of 8 months we saw a clear graft within the optical axis without any complications in wound healing. We removed the single sutures two months after keratoplasty. Postoperative astigmatism could be corrected first by fitting a special nursery contact lens and after reduction of astigmatism because of suture removal we fitted special nursery glasses. The intraocular pressure remained within the normal range during the follow-up period. CONCLUSION: The autologous ipsilateral rotating penetrating keratoplasty should be considered superior to homologous keratoplasty in infants with Peters anomaly if sector iridectomy is not advisable because of a central corneal opacification. Resulting high refractive errors can be successfully corrected by special contact lens fitting or by nursery glasses.

Amblyopia↗

PubMedDate not supplied

Bioptics by angle-supported phakic lenses and photorefractive keratectomy.

PURPOSE: To assess efficacy and safety of the combination of angle-supported phakic intraocular lenses (IOLs) and photorefractive keratectomy (PRK) for the correction of myopia and astigmatism. METHODS: Prospective, non-randomized single-surgeon study on 48 patients (76 eyes) undergoing angle-supported phakic IOL implantation with surgical peripheral iridectomy, followed 2 to 3 months later by PRK to correct residual refractive error. Twenty-three patients (33 eyes) achieved good uncorrected visual acuity with IOL implantation alone and did not undergo PRK. Thus, the study was completed by 25 patients (43 eyes) with preoperative mean defocus equivalent (DEQ) of 15.73 D (SD 4.67 D) and mean astigmatism of -2.87 D (SD 1.39 D). RESULTS: Eight months after PRK, mean spherical equivalent was -0.08. Mean DEQ was 0.47 D (SD 0.37); 42/43 eyes (98%) were within +/-1 D of DEQ, and 33/43 eyes (77%) within +/-0.5 D. Mean uncorrected visual acuity was 0.7 (SD 1.9). Safety index was 1.25; efficacy index 1.11. Best-corrected visual acuity improvement (0.16) was statistically significant (95% CI: 1.1 to 2). Halos were moderate in 6/25 patients (24%); severe in 1/25 patients (4%). Endothelial cell density decreased by -6.6%. Pain after PRK was severe in 3/25 patients (12%) and moderate in 13/25 patients (52%). Complications were recurrent iridocyclitis in one eye, transient ocular hypertension in two eyes, and incomplete iridectomy in one eye. CONCLUSIONS: Angle-supported phakic IOLs followed by adjustment by PRK offer good efficacy, predictability, and safety to manage large refractive myopic errors.

Adult↗

PubMed1982

Iris nodules in von Recklinghausen's Neurofibromatosis. Electron microscopic confirmation of their melanocytic origin.

A 75-year-old man had generalized neurofibromatosis (NFT) with bilateral iris nodules and a mature cataract with elevated intraocular pressure in his left eye. At the time of intracapsular cataract extraction, a sector iridectomy was performed. Electron microscopic studies of the iris nodules within the iridectomy specimen unequivocally established that the spindle-shaped cells within the nodules were of melanocytic origin. We believe that the iris nodules in NFT represent melanocytic hamartomas.

Aged↗

PubMed1988

Iris inflammatory cells, fibronectin, fibrinogen, and immunoglobulin in various ocular diseases.

Using immunohistochemical techniques, we analyzed the inflammatory cell subpopulation and the presence of fibronectin and immunoglobulin in iridectomy specimens from 50 patients with cataracts, glaucoma, and uveitis, and from ten normal eyes. The irises from patients with uveitis showed the highest numbers of T-lymphocytic infiltration compared with all other groups. Concentrations of fibronectin, fibrinogen, and immunoglobulins were significantly higher in the uveitic group compared with other diseases and normal controls. The irises from patients with glaucoma showed fewer infiltrating cells and less fibronectin and fibrinogen. Enhancement of major histocompatibility complex class II antigen HLA-DR expression was observed in all disease groups compared with controls. These findings suggest that in patients with uveitis and acute glaucoma the infiltrating T lymphocytes and the presence of fibronectin, fibrinogen, and immunoglobulins may contribute to the greater risk of postsurgical inflammation, leading to such problems as closure of the iridectomy. The enhancement of HLA-DR antigen expression in the iris may indicate abnormalities of iris resident cells seen in various diseases.

Aged↗