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PubMed1977

Outflow changes in normal eyes after closed-angle glaucoma.

Twenty-four patients with spontaneous acute closed-angle glaucoma in one eye were selected for study. All 24 eyes had a peripheral iridectomy, were normotensive, and had no gonioscopically visible peripheral anterior synechiae. Of the 24 contralateral eyes 14 gave a positive response to provocative tests and had peripheral iridectomy. The remaining 10 eyes did not give positive responses to the tests and were on no treatment. The 24 pairs of eyes were provoked with pilocarpine and phenylephrine. Tonography was performed at the start of the test, 1 1/2 hours later, and at its termination. At the start of the test the 24 eyes that had had spontaneous closed-angle glaucoma showed a higher pressure and lower outflow facility than the 24 contralateral eyes. This difference disappeared as the test progressed. It is concluded that apparently normal eyes--after an acute attack--do none the less show a significant degree of damage to the outflow system. Ten pairs of eyes from 10 normal persons were provoked in a similar fashion and at no point did a significant difference appear between right and left eyes.

Acute Disease↗
PubMed1977

Pseudophakic pupillary-block glaucoma.

Four cases of iris-supported pseudophakic pupillary-block glaucoma were presented. Pupillary-block glaucoma is the first postoperative complication seen following the implantation of an intraocular lens, and in our series occurred at an incidence of 3-8%. A short review was made of pupillary-block glaucoma with all types of intraocular lenses, with emphasis on the iris-supported lens. The role of inflammation, haemorrhage, and vitreous and lens material in obstructing aqueous flow at the pupil and peripheral iridectomy site was emphasised. Pitfalls in the diagnosis and management of this condition were reviewed. Methods of prevention and treatment were reviewed with emphasis on early mydriasis, along with carbonic anhydrase inhibitors and hyperosmotic agents as a primary medical treatment. Iridectomy, laser iridotomy, or transfixation of the iris was mentioned as a surgical treatment.

Aged↗
PubMed1977

Partial angle closure.

During the course of negative provocative test for closed-angle glaucoma using pilocarpine and phenylephrine 60% of eyes develop significant reductions in outflow facility at some stage during the test. It is shown that these reductions can be explained by postulating the presence of partial-angle closure since: (1) A random sample (6) of 53 eyes showing an abnormal response subsequently had a peripheral iridectomy. On reprovoking they then behaved as normal eyes with a uniform increase in outflow. (2) Fifty-eight eyes that had a peripheral iridectomy for closed-angle glaucoma (spontaneous or induced) responded to provocative testing as do normal eyes.

Drug Combinations↗
PubMed1980

Timolol in operated closed-angle glaucoma.

Tonometry in 9 eyes (7 patients) provides some evidence that timolol eye drops are useful in improving control of pressure in eyes operated for closed-angle glaucoma. In cases 1 and 2 (Figs, 1 and 2) this beta 1 and 2 blocker reduced pressure consistently. Case 3 (Fig. 3) showed that timolol 0.5% twice daily was as effective as pilocarpine 2% or 4% with adrenaline 1%. The effect of timolol 0.5% in case 4 (Fig. 4) and case 6 (Fig. 6) was additive to pilocarpine and adrenaline; in case 5 (Fig. 5) it probably improved the effect of adrenaline, but in cases 4 and 5 there may have been some loss of effect with time. Case 7 (Fig. 7) showed a good effect of timolol, reversed on withdrawal, but pressure fell again in spite of continued withholding of timolol. Timolol will be especially valuable in the control of pressure if an operation involving iridectomy has not been completely successful in open-angle glaucoma or more especially in closed-angle glaucoma because it has no effect on the pupil. Miotics will tend to produce posterior pupillary synechiae because aqueous humour will go through the iridectomy, not under the edge of the pupil. The danger will be greater in eyes with closed-angle glaucoma because the pupil is closely applied to the anterior lens surface, which will also tend to produce irritative iridocyclitis.

Epinephrine↗
PubMed1982

Corticosteroid-induced ocular hypertension. II. An acquired form.

Thirty-five patients with unilateral closed-angle glaucoma treated by peripheral iridectomy and prophylactic peripheral iridectomy in the fellow eyes were subjected to corticosteroid provocative test in both eyes. 51% of the eyes with closed-angle glaucoma and 11% of their fellow eyes had a positive corticosteroid pressure response. The closed-angle glaucoma eyes had their fellow eyes responded differently as shown by the frequency distribution graphs and also by the difference between the corticosteroid-induced change in pressure (Wilcoxon test, z=-4.80, p less than 0.0001). These results provide evidence for an acquired form of corticosteroid-induced ocular hypertension and the possible pathogenic factors for the first time. The clinical significance of an acquired form of corticosteroid-induced ocular hypertension is discussed.

Aged↗
PubMed1999

Iris crystals in chronic uveitis.

AIMS: To analyse the unusual physical sign of iris crystals occurring in patients with uveitis. METHODS: Demographic details and clinical features were documented in 24 patients with chronic uveitis and iris crystals. Plasma immunoglobulin subclasses were measured, and a histopathological review of iridectomy specimens from 33 patients with chronic uveitis was also undertaken. RESULTS: The mean age of patients was 38 years, with a slight preponderance of females. 17 patients had Fuchs' heterochromic cyclitis although a number of other uveitis entities were represented. There was no correlation between severity of clinical signs and presence of iris crystals. Over a mean follow up period of 15 months no significant change in the number, size, or position of the crystals was seen except in four patients who underwent intraocular surgery. Only three patients had raised plasma IgG1. The review of the histology of iridectomy specimens failed to show evidence of Russell body formation in any patient. CONCLUSIONS: Iris crystals appear to be rare but may be underreported as they are small and can easily be missed. They are likely to be associated with disease processes in which there is active immunoglobulin production within the anterior chamber, such as Fuchs' heterochromic cyclitis.

Adolescent↗
PubMed2000

Long term results of glaucoma surgery among participants in an east African population survey.

AIM: To evaluate the long term results of glaucoma surgery among people in East Africa. METHODS: Participants in a population based survey of eye disease prevalence were offered glaucoma surgery using standardised criteria. Either surgical iridectomy or trabeculectomy was carried out as indicated by a medical officer or by one of two ophthalmologists. Trabeculectomy methods included releasable sutures and mitomycin C in the majority of eyes. Subjects were examined during the first week and 2 months after surgery. Nearly 3 years later, re-examination was carried out in those who were still resident in the region. RESULTS: Among 46 people who were offered iridectomy, trabeculectomy, or combined cataract extraction/lens implant/trabeculectomy, 21 people underwent surgery (46%). Of the 21, 19 were re-examined at 3 years (90%), including 16/18 eyes after trabeculectomy. Among these, intraocular pressure (IOP) declined from 29.9 (SD 9.4) mm Hg to 14.7 (5.9) mm Hg, with 16 of 18 eyes (89%) achieving a reduction > 25%. Hypotony maculopathy, late bleb leak, and late endophthalmitis were not detected. Visually significant cataract developed in 5/15 re-examined eyes that underwent trabeculectomy alone (33%), possibly associated with pre-existing cataract and diagnosis of angle closure glaucoma, but not with mitomycin C use. CONCLUSIONS: Nearly half of those with glaucoma among residents of rural African villages accepted the offer of surgical therapy. While technical success was achieved at satisfactory levels, the development of cataract must be considered an important issue for application of glaucoma surgical therapy programmes.

Africa, Eastern↗
PubMed1984

Aqueous humor catecholamines.

The catecholamines norepinephrine, (NE) epinephrine (E) and dopamine (DA) were detected for the first time in the aqueous humor of humans under general anesthesia and monkeys under ketamine. The catecholamine levels in aqueous humor of 9 humans were assayed. NE was 0.796 +/- 0.457 ng./ml., E ranged between 0 and 0.132 ng./ml. in 4 out of 9 subjects, and DA was found in 2 of the 9 eyes. (0. 123ng ./ml. and 0. 318ng ./ml..) Plasma levels were measured in 8 of the human subjects at the time of aqueous sampling -NE was 0.311 +/- 0.171, E ranged between 0 and 0.097 (4 out of 8 subjects) and DA was detected in one subject- 0.037 ng./ml.. Monkey aqueous levels were NE:2.843 +/- 0.668 and DA:0.462 +/- 0.177 ng./ml., with an intact iris. (N = 8 eyes.) NE was 0.497 +/- 0.049, and DA 0.426 +/- 0.218 ng./ml. after total iridectomy. (N = 4 eyes) E was not detected in the monkey under these conditions. Whilst NE may be produced in part by the iris, DA levels were not affected by iridectomy. This implies that DA may be produced by structures unrelated to sympathetic nerve endings of the iris in the anterior segment of the non-human primate eye, perhaps by diffusion from the ciliary body or retina. Ketamine is known to inhibit catecholamine uptake, which may explain the high levels measured in the monkey. Human aqueous catecholamine levels measured under anesthesia may be affected by a variety of the drugs used. It is postulated that dopaminergic neurones and associated receptors may be present in the anterior segment of the eye. This may explain the presence of aqueous humor dopamine and the effects of dopaminergic drugs on intraocular pressure.

Adult↗
PubMed1976

Subconjunctival gentamicin prophylaxis against postoperative endophthalmitis in the rabbit.

An experimental aphakic rabbit model was employed in order to evaluate the correlation of the clinical course of postoperative endophthalmitis and the ability to recover microorganisms in the postoperative time period, the ocular antibiotic penetration of gentamicin, and the value of antibiotic prophylaxis. 2. Staphylococcus aureus is far more pathogenic organism than Staphylococcus epidermidis. A concentration of 5,000 organisms resulted in an 88% infection rate whereas 50,000 organisms and greater resulted in 100% infection rate after extracapsular cataract extraction. 3. Staphylococcus aureus could be isolated from the eyes demonstrating infection following cataract extraction for 2 days (3 days in one case) and then could no longer be recovered despite the persistance of intraocular inflammation. 4. The infection which appeared in animals receiving 5,000 organisms of Staphylococcus aureus after peripheral iridectomy was significantly milder than that which occurred following cataract extraction. In addition, the microorganisms could only be isolated on the first postoperative day. 5. When 20 mg of gentamicin sulfate was administered subconjunctivally following the post-cataract extraction or post-iridectomy administration of the 5,000 organisms of Staphylococcus aureus, none of the eyes developed clinical signs of endophthalmitis nor could bacteria be recovered. 6. Subconjunctivally administered gentamicin sulfate rapidly penetrated into the aphakic rabbit eye; 75-100 mug/ml appears in the aqueous humor at 1 hour and persists in bactericidal concentrations for at least 4 hours in both the treated and contralateral eyes. 7. Antimicrobial (subconjlnctival gentamicin sulfate 20 mg/prophylaxis at the time of surgery in the experimental animal significantly reduced the incidence of experimental postoperative bacterial endophthalmitis.

Animals↗
PubMed1999

Apraclonidine 0.5% versus brimonidine 0.2% for the control of intraocular pressure elevation following anterior segment laser procedures.

BACKGROUND AND OBJECTIVE: Both apraclonidine hydrochloride 0.5% and brimonidine tartrate 0.5% are potent alpha-2 agonists, effective in controlling the intraocular pressure (IOP) rise following argon laser trabeculoplasty (ALT). Brimonidine has recently become available commercially as a 0.2% solution. Our goal in this study was to compare the efficacy and side effect profile of 0.2% brimonidine to that of 0.5% apraclonidine in the prevention of IOP spikes following anterior segment laser procedures. PATIENTS AND METHODS: Patients undergoing argon laser trabeculoplasty, Nd:Yag peripheral iridectomy or posterior capsulotomy were prospectively randomized to receive either apraclonidine 0.5% or brimonidine 0.2%, approximately 10 minutes prior to laser surgery. Intraocular pressure was measured by a masked observer, using Goldmann applanation tonometry, before and 1 hour after the treatment. RESULTS: 51 ALTs, 21 peripheral iridectomies, and 13 posterior capsulotomies were performed. The incidence of an IOP rise greater than 5 mmHg was 3/43 (7.0%) in the brimonidine group and 0/42 (0%) in the apraclonidine group (P = 0.08, chi-squared). There were no IOP elevations greater than 8 mmHg. All IOP rises of greater than 5 mmHg occurred in the ALT sub-group, and within this sub-group, the mean change in IOP from pre- to post-op was -4.00 +/- 5.87 in the brimonidine group versus -4.29 +/- 3.86 in the apraclonidine group (P = 0.84). There was a statistically significant decrease in IOP from baseline in both drug groups (P < .0001). CONCLUSIONS: Both drugs are highly effective in controlling IOP spikes following anterior segment laser procedures. There is a tendency toward higher risk of IOP rise following argon laser trabeculoplasty with 0.2% brimonidine as compared to 0.5% apraclonidine, however, this was not statistically significant.

Adrenergic alpha-Agonists↗
PubMed2000

[The congener eye in patients with unilateral classical malignant glaucoma].

PURPOSE: To prospectively study in a follow-up period, ranging from 5 to 20 years, "the fate" of the fellow eye in patients with unilateral classical malignant glaucoma. METHODS: The fellow eye of 10 patients had been thoroughly examined immediately after the beginning of an adequate therapy of the unilateral classical malignant glaucoma. RESULTS: In 6 cases the fellow eye was apparently normal and 4 cases exhibited an intermittent primary angle-closure glaucoma. Surgery of the fellow eye was accepted immediately by two patients; in one a peripheral iridectomy was carried out and in the other one a trabeculectomy. The other 8 patients initially turned down surgery but accepted in thereafter in a period of time ranging between 1 and 8 years. A peripheral iridectomy was performed in two cases, a trabeculectomy in other two and a combined procedure (trabeculectomy with pars plana aspiration of the aqueous trapped within the vitreous in 3 cases and the same procedure plus lens extraction on one patient) in the remaining 4 cases, since they developed into a primary chronic angle-closure glaucoma. CONCLUSIONS: Prophylactic surgery should be best done when the fellow eye is apparently normal having an entirely open angle and both the ocular tension and the visual function normal. The treatment of the advanced primary chronic angle-closure glaucoma of the fellow eye consists in trabeculectomy with pars plana aspiration associated with cataract extraction if the lens is opaque.

Adult↗
PubMedDate not supplied

Laser trabeculodissection with a photopolishing scanning excimer laser.

A phase I study of nonpenetrating trabeculectomy (Zimmerman procedure) using a scanning excimer laser system was conducted to evaluate the ability of this laser system to achieve the deep dissection required to allow significant filtration without inadvertent penetration into the anterior chamber. A photopolishing, scanning 193 nm excimer laser system (LS 2000, LaserSight, Inc.) was used with a proprietary fluence, spot size, scanning pattern, and ablation shape to perform a trabeculodissection under a scleral flap with a limbal-based conjunctival flap in 8 cases of advanced glaucoma including 5 eyes that had a failed trabeculectomy. The laser trabeculodissection (LTD) was carried through Schlemm's canal and the juxtacanalicular trabecular meshwork, achieving vigorous aqueous outflow. No peripheral iridectomy was done. The scleral flap was closed loosely with a 10-0 suture. Mitomycin-C was used intraoperatively. In no case did inadvertent penetration into the anterior chamber occur. No peripheral iridectomy was performed. No intraoperative hyphema occurred. There was no postoperative iritis except minimal anterior chamber reaction in 1 eye with preoperative rubeosis. Postoperatively, a good filtering bleb was achieved in all 8 eyes with substantial reduction in the intraocular pressure without topical antiglaucoma therapy. No cases of postoperative shallowing (overfiltration) occurred. Gonioscopy, postoperatively, revealed no new peripheral anterior synechiae (PAS) to the filtration site and an intact inner trabecular meshwork. All eyes were followed for a minimum of 6 months. In this phase I study, laser trabeculodissection (LTD) with a 193 nm photopolishing, scanning system appears to be a promising alternative to full-thickness trabeculectomy, achieving significant filtration while perhaps avoiding much of the risk of filtration surgery. The laser system seemed to provide a more reliable, better-controlled dissection than a knife. The aqueous drainage seems to have acted as a self-regulating endpoint by absorbing UV energy, thus avoiding inadvertent penetration into the anterior chamber. More study is needed to establish the appropriate role of LTD in glaucoma therapy.

Chronic Disease↗
PubMed1975

Trabeculectomy: a re-evaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to and including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in cases of primary glaucoma treated with a Scheie procedure and 16 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior changes than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye; (2) chronic angle closure glaucoma where an iridectomy is considered insufficient; (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential; (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery; and (5) cases where endophthalmitis is a real concern, as in the very young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Administration, Topical↗
PubMedDate not supplied

Trabeculectomy: a reevaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to an including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in patients with primary glaucoma treated with a Scheie procedure and 16.6 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior chambers than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye, (2) chronic angle-closure glaucoma where an iridectomy is considered insufficient, (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential, (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery, and (5) patients where endophthalmitis is a real concern, as in the young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Adolescent↗
PubMed1975

Simultaneous (combined) operation for glaucoma with cataract.

Henceforth we mention the observations of one of the authors (E.G.) which were made in 1949 and published in 1956. The author recommends iridectomy of one pillar, intracapsular extraction of the cataract and iridenclesis of the other pillar for the treatment of cases with glaucoma together with cataract. Between the years 1968 and 1976 in the Department of Ophthalmology of the Hospital Universitario de Caracas, 966 cataract extractions were performed; within these, 84 were performed in glaucomatous eyes. In 17 cases the procedure that is used today was performed: iridectomy of one pillar, sphincterotomy, intracapsular extraction and iridencleisis of the other pillar. In other cases, other procedures were used. From our observations we consider that this technique is the most recommended in cases of glaucoma together with cataract.

Cataract↗
PubMed1975

Melanoma of the iris: report of 72 cases treated surgically.

Seventy-two cases of malignant melanoma of the iris treated surgically have been reviewed from Wilmer Institute records with respect to the age, sex, and race of the patients and the clinical and histologic results. Clinical features studied include location and extent of tumor, duration, presence of preexisting lesions, and associated features such as hyphema, glaucoma, cataract, pupillary distortion, and vascularity of the tumor. Surgical therapy included iridectomy, iridocyclectomy and enucleation. Complications of iridectomy included cases of hyphema, cataract, wound dehiscence and episcleral seeding of the tumor. Complications of iridocyclectomy included cases of vitreous loss, cataract, high astigmatism and incomplete excision. Histopathologic features were studied, and the relationship of cell type and tumor cohesiveness to tumor behavior was stressed. Tumor deaths were observed in two of the 72 cases. Clinicopathologic and statistical features in this series of 72 patients were compared with those previously reported series of iris melanomas, and the therapy of these lesions was discussed.

Adolescent↗
PubMed1975

[Malignant melanoma of the iris - 23 years after incomplete excision of the tumour (author's transl)].

A 54-year-old male was 1948 submitted to a sectorial iridectomy because of a histologically proved malignant melanoma of the iris. 1971 an absolute secondary glaucoma had developed, and the eyeball was excised. Though histologically tumour issue of the original type was found in the chamber angle and ciliary muscle as well as around scleral blood vessels and subconjunctivally any clinical manifestation of generalization never was observed since the iridectomy 23 years ago.

Adult↗
PubMed2005

[Ultrastructure of the iris pigmentary epithelium].

The iris pigmentary epithelium has identical structure as the retinal epithelium has. The peripheral iridectomy makes it possible to obtain sufficient amount of tissue to be used for the multiplication of the pigmentary epithelium cells in tissue culture, or, for direct implantation into the subretinal space. The technique of the peripheral iridectomy is regardful enough; in none of the specimens mechanically damaged cells were found.

Aged↗