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PubMed1992

Argon laser gonioplasty in the treatment of angle-closure glaucoma.

We used argon laser gonioplasty to treat angle-closure glaucoma unrelieved by patent iridectomy. Laser energy (mean; 30 spots, 723 mW, and 0.2 second) was applied to the peripheral iris stroma to open the anterior chamber angle. Twenty of 32 eyes were successfully treated. After a median follow-up period of 18 months, 17 of these 20 successfully treated eyes (85%) had an intraocular pressure less than or equal to 19 mm Hg, and 19 of these 20 successfully treated eyes (95%) had an intraocular pressure less than or equal to 21 mm Hg. The 20 successfully treated eyes had a median duration of angle closure of 12 days. Twelve unsuccessfully treated eyes had a median duration of angle closure of 90 days. All successfully treated eyes had more than 50% of the treated angle opened by argon laser gonioplasty and all but three successfully treated eyes had more than three clock hours opened by argon laser gonioplasty. Argon laser gonioplasty may be successful in treating angle-closure glaucoma unrelieved by iridectomy, especially in cases that are recognized and treated soon after onset.

Acute Disease↗
PubMed1981

Long-term follow-up of laser iridotomy.

Argon laser iridotomy was performed on 140 eyes, with greater than one year postoperative follow-up in 88 eyes. Iris holes were satisfactorily produced in every eye treated, with two-thirds having only one treatment session. Late reclosure of laser iridotomy was rare and easily treated. At an average of 1.8 years after treatment, visual acuity was the same or improved in 85% of the eyes. Cataract progression was responsible for those eyes with decreased acuity; the rate of progression being comparable to similar groups of aged persons treated by surgical iridectomy for angle closure types of glaucoma. Other complications were temporary and did not affect vision. Laser iridotomy appears to have particular advantages in certain patients, particularly those with chronic angle closure glaucoma, aphakic pupillary block, or incomplete surgical iridectomy.

Follow-Up Studies↗
PubMed1994

Emulsified anterior chamber silicone oil and glaucoma.

PURPOSE: This retrospective study was undertaken to assess the occurrence of postoperative anterior chamber emulsified silicone oil after intravitreal instillation and to examine the relation between such emulsification and new postoperative glaucoma. METHODS: Forty-eight consecutive eyes received intravitreal silicone oil, were followed for at least 1 year, and were evaluated postoperatively by gonioscopy on at least one occasion. Eight eyes received 1000 cs oil, and 40 eyes received 5000 cs oil from which low molecular weight contaminants were removed. All aphakic and pseudophakic eyes received an inferior iridectomy. Oil was removed in 19% of eyes during follow-up. RESULTS: Fifty-six percent of eyes manifested anterior chamber emulsified oil postoperatively. The oil was typically identified only on gonioscopy. This complication developed in 50% of eyes receiving 1000 cs oil and 58% of eyes receiving highly homogeneous 5000 cs oil. Of the 48 eyes, new postoperative glaucoma best explained by interval angle oil emulsification developed in 5 (10%). CONCLUSION: Anterior chamber oil emulsification occurred frequently, despite inferior peripheral iridectomy in aphakic or pseudophakic eyes and the use of highly purified, higher viscosity oil in 83% of eyes. In this series, new glaucoma in the setting of angle oil emulsification only developed in 10% of eyes. The glaucoma was managed medically in four of five patients.

Adolescent↗
PubMed1998

Management of ophthalmic complications of homocystinuria.

OBJECTIVE: To determine the safety and efficacy of surgical versus medical management in the treatment of ophthalmic complications of homocystinuria, and also to document ocular complications of homocystinuria other than lens dislocation. DESIGN: Retrospective case series. PARTICIPANTS: Forty-five patients with ophthalmic complications of homocystinuria participated. INTERVENTION: Eighty-four surgical procedures were performed on 40 patients. There were 82 procedures done with the patients under general anesthesia and 2 with the patients under local anesthesia. Medical therapy was attempted initially in all patients with lens dislocation and was the sole therapy used for five patients. MAIN OUTCOME MEASURES: Complications resulting from medical or surgical treatment and final visual acuity were studied. RESULTS: All patients had a history of lens subluxation or dislocation. Fourteen (31%) were receiving dietary treatment at the time of presentation and 29 (64%) were mentally retarded. Eighty-two procedures were performed with the patients under general anesthesia with 2 surgical complications and 1 postsurgical complication. Lens dislocation into the anterior chamber was the most frequent indication for surgery (50%) followed by pupillary block glaucoma (12%). Prophylactic peripheral iridectomy was not successful in preventing lens dislocation into the anterior chamber in five patients. Anesthetic precautions such as stockings to prevent deep venous thrombosis, preoperative hydration, or aspirin were given in 85% of cases. Other common ophthalmic complications found include optic atrophy (23%), iris atrophy (21%), anterior staphylomas (13%), lenticular opacities (9%), and corneal opacities (9%). CONCLUSION: Laser iridectomy was unsuccessful in preventing lens dislocation into the anterior chamber. With appropriate anesthetic precautions and modern microsurgical techniques, the risks associated with the surgical management of ocular complications of homocystinuria are reduced. Surgical treatment should be considered, especially for cases of repeated lens dislocation into the anterior chamber or pupillary block glaucoma. If a conservative, nonsurgical approach is undertaken, these patients must be observed carefully for repeat episodes of lens dislocation.

Adolescent↗
PubMed1999

A malignant glaucoma-like syndrome following pars plana vitrectomy.

OBJECTIVE: To report two cases of a malignant glaucoma-like syndrome following pars plana vitrectomy. DESIGN: Two interventional case reports. INTERVENTION: The first patient was treated with a neodymium:YAG laser peripheral iridectomy with hyaloidectomy and with intracameral tissue plasminogen activator. The second patient was treated with a posterior approach iridectomy through residual hyaloid, zonules, and iris. MAIN OUTCOME MEASURES: Axial anterior chamber depth and intraocular pressure (IOP). RESULTS: The interventions resulted in deepening of the anterior chambers and normalization of IOPs. CONCLUSION: A pseudomalignant glaucoma syndrome may be related to obstruction of aqueous flow, either by residual anterior hyaloid or by fibrin and other inflammatory debris at the level of the ciliary body-zonular apparatus. Treatment of this syndrome involves restoring aqueous flow to the anterior chamber by disrupting the residual anterior hyaloid or clearing fibrin or inflammatory debris. The clinician should not disregard the possibility of a pseudomalignant glaucoma syndrome following vitrectomy despite the fact that vitrectomy has traditionally been considered a curative treatment for malignant glaucoma.

Aged↗
PubMed1999

High incidence of cataract formation after implantation of a silicone posterior chamber lens in phakic, highly myopic eyes.

OBJECTIVE: To assess the effectiveness and safety of implantation of a negative, silicone, posterior chamber intraocular lens (IOL) in the ciliary sulcus of phakic, highly myopic eyes. DESIGN: Noncomparative consecutive interventional series. PARTICIPANTS: Eighteen eyes of 10 patients suffering from high-degree myopia (spherical equivalent < -10 diopters) undergoing implantation of a Fyodorov 094M-1 IOL by the same surgeon (P.H.B.) were evaluated. INTERVENTION: A standard surgical technique was used in all patients under peribulbar anesthesia. The IOL was implanted in the ciliary sulcus immediately in front of the natural lens under protection of a viscoelastic substance (Healon) through a 3.5-mm temporal or nasal clear-corneal tunnel. No sutures were necessary in any case. A peripheral iridectomy was performed intraoperatively in 14 eyes, whereas 4 additional eyes received a yttrium-aluminum-garnet peripheral iridectomy after surgery. At the end of surgery, gentamicin and dexamethasone were given both topically and subconjunctivally. MAIN OUTCOME MEASURES: Visual acuity and refraction were measured before surgery, as well as 1 day, 3 months, 6 months, and 2 years after surgery. Postoperative complications were recorded. RESULTS: Best-corrected visual acuity remained unchanged (1 eye) or improved (6 eyes by 1, 5 eyes by 2, and 2 eyes by 3 Snellen lines, respectively) in 14 of 17 eyes, whereas 3 eyes experienced a decrease in best-corrected visual acuity by 1 Snellen line. Postoperative refraction approached the desired slight undercorrection at all times of examination. Cataract formation of the anterior subcapsular (8 eyes) or nuclear (only 1 eye) type was observed in overall 9 (52.9%) of 17 eyes. When considering only the patients with a follow-up of 2 years, the incidence of cataract formation was 81.9% (9 of 11 eyes). CONCLUSIONS: The high incidence of cataract formation should discourage the implantation of the type of IOL used in this study in phakic eyes to correct high-degree myopia.

Adult↗
PubMed2003

Feasibility and safety of laser treatments in eyes with an intraocular implantable miniature telescope.

PURPOSE: To evaluate the feasibility and safety of laser treatments in rabbit eyes fitted with an implantable miniature telescope (IMT). SETTING: The Goldschleger Eye Research Institute, Tel-Aviv University, Sheba Medical Center, Tel-Hashomer, Israel. METHODS: In this study, IMTs were implanted in the capsular bag in 19 eyes of 19 pigmented rabbits. After the rabbits recovered from surgery, neodymium:YAG (Nd:YAG) laser iridectomy (4 eyes), Nd:YAG laser capsulotomy (8 eyes), or argon laser photocoagulation of the retina (6 eyes) was performed. One day after the laser treatment, the rabbits were killed. An observer blinded to the treatment received by individual rabbits examined the enucleated eyes histopathologically to evaluate the laser lesions and their effect on ocular tissues. RESULTS: Laser iridectomy and laser posterior capsulotomy were carried out without difficulty. Laser photocoagulation of the posterior pole and the retinal periphery could be accomplished only when the laser beam was aimed around the optic of the IMT. It was not possible to carry out effective laser treatment of the retina through the IMT's optic. Treatment was difficult when adhesions between the pupil margin and the IMT optic were encountered. CONCLUSIONS: Standard laser treatments in eyes with an IMT in the capsular bag were feasible in pigmented rabbits, whose eyes are a good model for the eyes of human patients. Laser treatment of the retina was difficult to perform when adhesions between the pupil margin and the IMT were present.

Animals↗
PubMed1997

Glaucoma after cataract extraction and posterior chamber lens implantation in children.

PURPOSE: To evaluate the incidence of postoperative glaucoma in children who have cataract extraction and posterior chamber intraocular lens (IOL) implantation. SETTING: Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. METHODS: The incidence of glaucoma of all etiologies was evaluated in 45 eyes of 37 selected consecutive patients aged 1 to 18 years who had cataract extraction and posterior chamber IOL implantation from 1991 to 1994. Mean follow-up was 23 months (range 6 to 38 months). Nineteen patients had traumatic and 18 had developmental cataract. Exclusion criteria were microcornea smaller than 9.0 mm in diameter, preoperative glaucoma, or poor pupil dilation. The surgical technique comprised a continuous curvilinear anterior capsulorhexis in most cases, extracapsular aspiration by Ocutome or phacoemulsification, and retention of the posterior capsule. A peripheral iridectomy was done in 7 eyes (16%). Postoperative medications included topical atropine combined with topical, subconjunctival, and systemic corticosteroids and antibiotics. RESULTS: Three patients with traumatic cataract developed postoperative glaucoma during the follow-up. One developed pseudophakic pupillary block; however, a peripheral iridectomy prevented glaucoma. Two other patients developed late-onset glaucoma: one secondary to angle recession and the other to peripheral anterior synechias. No patient with developmental cataract developed glaucoma. CONCLUSION: Careful patient selection, atraumatic surgical technique, continuous curvilinear capsulorhexis, in-the-bag IOL placement, postoperative atropine, and topical and systemic corticosteroids significantly lower the incidence of pseudophakic pupillary block and glaucoma. Although no patient developed glaucoma, lifelong follow-up is mandatory to detect chronic open-angle and traumatic angle-recession glaucoma.

Adolescent↗
PubMed1997

Cataract formation after penetrating keratoplasty.

PURPOSE: To assess the incidence and risk factors for developing cataract after penetrating keratoplasty (PKP). SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This retrospective analysis of 251 phakic patients who had PKP between 1987 and 1994 assessed the incidence of and risk factors for cataract formation. Patients were assigned to one of two groups: Group 1 (n = 96), patients with keratoconus and corneal dystrophy; Group 2 (n = 88), patients with corneal scar and adherent leucoma. Preoperative, intraoperative, and postoperative lens details were noted. Data on intraoperative iris procedures (excess manipulation, pupilloplasty, synechiolysis, peripheral iridectomy) and postoperative topical steroid usage were assessed. RESULTS: Sixty-seven patients were excluded because of incomplete lens status data. Of the remaining 184 patients, 45 (24.45%) developed cataract. Most cataracts (n = 31) developed within the first year of surgery. The incidence of cataract was significantly higher in Group 2 (n = 29) than in Group 1 (n = 16) (P = .0102). There was no significant between-group difference in mean steroid dose (P = .7064); however, the mean dose was significantly higher in eyes with cataracts (563 +/- 234 units) than in those without (479 +/- 127 units) (P = .0352). In Group 2, 9 of 20 patients who had synechiolysis, 1 of 3 who had pupilloplasty, and 2 of 5 who had peripheral iridectomy developed cataract. In Group 1, no patient had iris-related procedures. CONCLUSION: Excessive steroid use and intraoperative iris manipulations are major risk factors for cataract formation after PKP.

Adolescent↗
PubMed1998

Endogenous hyaluronan in the normal and traumatized rabbit iris.

PURPOSE: Hyaluronan concentration in the iris tissue after iridectomy was studied in order to establish the influence of trauma on the production of hyaluronan in the anterior chamber of the eye and whether the iris participates in this process or not. METHOD: Hyaluronan was measured with a radiometric assay at different time points after surgery and identified with specific histochemical staining. RESULTS AND CONCLUSIONS: The concentration of hyaluronan in iris tissue peaked two days after surgery, reaching an average of 115.3 (S.E.M.:+/-12.2) microg/g. It then decreased slowly to almost normal values after 3 to 5 weeks. Histochemistry demonstrated the most intense hyaluronan staining in the iris stroma and in iridial processes around the iridectomy two days after the operation. Our findings indicate in situ synthesis of hyaluronan in the iris tissue.

Animals↗
PubMed2002

Effects of sympathetic denervation on the hyaluronan content of the anterior segment in the normal and traumatized rabbit eye.

PURPOSE: To determine whether there is any involvement of sympathetic nerves in the regulation of ocular hyaluronan production in the normal and traumatized rabbit iris. METHODS: Unilateral sympathetic denervation was performed by removing the right superior cervical ganglion. Hyaluronan concentrations in the iris and aqueous were measured with a radiometric assay at various time intervals after denervation. Peripheral iridectomy was also performed in both denervated and non-denervated eyes. RESULTS: Hyaluronan concentrations in the iris tissue after denervation were observed to have increased after 1 day, reaching a peak of 129.6 +/- 5.7 microg/g wet weight at day 3. Two weeks later, hyaluronan concentrations had fallen back to normal levels. Ocular trauma with peripheral iridectomy in denervated eyes caused an increase of hyaluronan content of up to 253.5 +/- 30.5 microg/g wet weight, which was not significantly different from hyaluronan concentrations observed after the same trauma in non-denervated eyes. CONCLUSION: Cervical sympathetic denervation results in a moderate increase of the hyaluronan content in the rabbit iris and does not appear to influence the hyaluronan response of the iris to trauma.

Animals↗
PubMed1995

[Thermal photodisruptive laser iridotomy. A retrospective long-term study].

BACKGROUND: The combined application of the argon- and Nd:YAG-laser for iridotomies permits utilizing advantages of both lasertypes and avoiding their disadvantages. Long-term results of this thermal-photodisruptive technique have so far not been presented, however. PATIENTS AND METHODS: 127 eyes of 70 patients with an average age of 67.8 years were retrospectively examined in order to obtain information on the longterm results, with special attention being given to a potential occlusion of the iris coloboma, potential cataract progression, regulation of IOP, the pigmentation of the anterior chamber angle and the formation of synechiae. The average time of follow-up was 2.8 years. Laser iridotomy had been performed because of glaucoma of the involved eye or at the fellow eye or because of a narrow angle situation. RESULTS: The total amount of energies applied was 1.1 J on the average for the argon laser and 172.2 mJ for the Nd:YAG-laser. Iris colobomas with an average diameter of 500 microns were performed on all eyes. Due to this large diameter none of the colobomas was found to be occluded. Progression of cataract was seen in 21/127 eyes (16.5%). In some of the cases this seemed to be attributable to a lentogene component already in starting the acute angle closure glaucoma or the narrow angle situation. IOP was within the normal range in 113/127 (89.0%) eyes not additionally treated by any other therapy. In 46/74 (62.2%) eyes was increased pigmentation of the chamber angle. Synechiae arose in 25/74 (33.8%) eyes. These, however, could be significantly reduced by giving mydriatics immediately after the procedure. There were no significant differences on comparing laser iridotomy with surgical iridectomy. CONCLUSION: Thermal-photodisruptive laser iridotomy has become a successful alternative method to the application of either argon- or Nd:YAG-laser alone. Since it is a low-risk procedure, it should be regarded as the method of choice prior to surgical iridectomy.

Adult↗
PubMed1997

Induction of rabbit cyclooxygenase 2 in the anterior uvea following glaucoma filtration surgery.

PURPOSE: This study was undertaken to evaluate for the presence of cyclooxygenase 2 (COX2) gene expression in the anterior uvea of rabbits following glaucoma filtration surgery. METHODS: One of the following surgical procedures were performed on the right eye of New Zealand white albino rabbits: (1) paracentesis (2.5 mm limbal incision); (2) iridectomy through a 2.5 mm limbal incision; (3) lamellar scleral flap formation or (4) full glaucoma filtration surgery. The animals were sacrificed within 3 hours of post-surgery, and the anterior uveal tissues were isolated. Polymerase chain reaction-based techniques were employed to assay for the presence of COX2 transcript. RESULTS: A partial coding sequence of the previously unreported rabbit COX2 gene was obtained. COX2 mRNA was detected in the operated eyes of animals that underwent either full filtration surgery or iridectomy through a limbal incision. CONCLUSIONS: In normal rabbit anterior uveal tissue, there appears to be minimal expression of COX2 message. After experimental glaucoma filtration surgery, there is rapid induction of COX2 message.

Amino Acid Sequence↗
PubMed1977

Visual field status in the management of chronic angle-closure glaucoma.

A retrospective analysis of the case histories of 40 patients with chronic angle-closure glaucoma yielded 31 eyes without visual field loss and 26 eyes with field loss. Peripheral iridectomy was highly successful in cases without field loss. Trabeculectomy was significantly more successful (93%) than iridectomy (64%) in treating cases with field loss. It is suggested that the choice of surgical procedure in this syndrome be dictated in part by the character of the visual field.

Chronic Disease↗
PubMed2006

Trabeculectomy with mitomycin C combined with direct cauterization of peripheral iris in the management of neovascular glaucoma.

PURPOSE: To determine the outcomes of trabeculectomy with mitomycin C (MMC) combined with direct cauterization of peripheral iris before iridectomy in the management of neovascular glaucoma (NVG), and to demonstrate the effect of this surgical technique on decreasing the incidence of intraoperative bleeding and early postoperative hyphema. METHODS: This prospective study was based on 72 eyes of 72 patients with NVG who underwent primary trabeculectomy with MMC combined with direct cauterization of peripheral iris before iridectomy. The patients were evaluated for intraoperative and early postoperative complications such as hyphema, and operative success rates. Operative success was defined as an intraocular pressure (IOP) < or =22 mm Hg (+/-medical therapy) in the absence of phthisis. The mean IOP and the mean number of antiglaucomatous medications at baseline and at the posttrabeculectomy sixth month were compared by paired Student t test. RESULTS: The mean preoperative IOP was 39.3+/-5.6 mm Hg (range, 29 to 60 mm Hg) whereas it was 20.02+/-4.3 mm Hg (range, 14 to 38 mm Hg) at the postoperative sixth month. The mean preoperative number of antiglaucoma medications was 3.2+/-0.4 (range, 2 to 4) but it reduced to 1.8+/-0.6 (range, 1 to 4) at the postoperative sixth month. These differences were statistically significant (P<0.00001). The IOP was < or =22 mm Hg (+/-medical therapy) in 69 eyes (95.8%) at the postoperative first week, in 62 eyes (86.1%) at the postoperative first month, in 60 eyes (83.3%) at the postoperative third month and in 48 eyes (66%) at the postoperative sixth month. Hyphema occurred in 15 eyes (20.8%) within the first week of the surgery. In 12 eyes it was transient; however, in 3 eyes irrigation of anterior chamber was required. CONCLUSIONS: Trabeculectomy with MMC combined with direct cauterization of peripheral iris decreases the incidence of both intraoperative bleeding, and early postoperative hyphema, and provides reduction of IOP and the number of antiglaucomatous medications in cases with NVG in a 6-month follow-up period.

Adult↗
PubMed1988

Early detection of primary angle-closure glaucoma. Limbal and axial chamber depth screening in a high risk population (Greenland Eskimos).

In an unselected population of 541 Greenland Eskimos, a survey was performed aiming at early primary angle-closure glaucoma (PACG) detection. Of the men 162/274 and women 182/267 were above the age of 40. The ophthalmological examination included slit-lamp grading of limbal chamber depth (LCD), axial Haag Streit pachymetric chamber depth (ACD) measurement and direct gonioscopy in all shallow chamber cases. Dark room prone position provocative tests were extensively used in suspects. In 3 men and 5 women PACG was diagnosed, giving, above age 40, a prevalence of 2% in men (3/162) and increasing the PACG prevalence to 10% in women (18/182) as 13 were known a priori. PACG suspects, needing prophylactical iridectomy or pilocarpine, constituted 1 man and 6 women. Furthermore, narrow angles were found in 14 men and 27 women above age 40, and so far untreated. On the present background of highly effective surgical and YAG-laser iridectomy facilities in early PACG, local, other arctic and global prevention of blindness aspects are briefly discussed, with a special outlook to SE-Asia.

Adult↗
PubMed1989

Argon laser trabeculoplasty for chronic angle-closure glaucoma uncontrolled by iridotomy.

Nineteen eyes of 19 Japanese patients with medically uncontrollable chronic angle-closure glaucoma following laser iridotomy or surgical iridectomy underwent argon laser trabeculoplasty (ALT), applying low-power and a small number of laser burns over a small extent of the trabecular meshwork. All the eyes had glaucomatous optic disc damage, visual field loss, and intraocular pressure elevation before ALT. In each case, the extent of peripheral anterior synechiae was equal or less than 50% of the angle. The mean follow-up was 35 months. Life-table analysis (Kaplan-Meier method) showed that the probability of success was 66% at the end of three years after ALT. It is concluded that in the cases of uncontrollable chronic angle-closure glaucoma following laser iridotomy or surgical iridectomy, ALT should be tried before filtration surgery.

Female↗