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PubMed2004

[Glaucoma and ultrasound biomicroscopy].

Ultrasound biomicroscopy (UBM) can provide high-resolution images in the living human eye; this resolution has been compared to microscopic resolution. This system is particularly useful in studying the anterior segment and analyzing the different types of glaucoma. Anatomical aspects, physiopathological processes and surgical results in glaucoma could be evaluated with UBM. This exploration is also important in determining differential diagnosis, risk factors, and prognostic elements. In addition, using UBM after filtering surgery helps detect early complications and understand poor surgical outcome.

Diagnosis, Differential↗
PubMed2006

[Congenital glaucoma and trabeculodysgenesis. Clinical and genetic aspects].

Congenital glaucoma is generally related to an iridocorneal angle malformation, with an obstacle to aqueous humor outflow. This spectrum of diseases can involve the angle, the iris and the cornea. The diagnosis relies on characteristic signs and is confirmed by an examination under general anaesthesia and paraclinical examinations (especially echography). An early diagnosis is essential for beginning surgical treatment. Several filtering surgery techniques with equivalent intraocular pressure results are available, but visual function must be protected in all cases. In many cases, genetic counseling relies on a careful clinical analysis and sometimes on a molecular analysis. A number of ocular and/or general abnormalities can be accompanied by glaucoma in infants and children. They must be screened in case of associated signs, but the existence of these abnormalities leads to suspicion of associated glaucoma.

Abnormalities, Multiple↗
PubMed2006

[Argon laser iridoplasty in the treatment of angle closure glaucoma with plateau iris syndrome].

INTRODUCTION: Plateau iris predisposes to the onset of an angle-closure glaucoma attack without pupillary block. This is a morphological anomaly of the iris characterized by anterior insertion, root thickness greater than the norm, and anterior rotation of the ciliary processes into the posterior chamber, pushing the base of the iris into the angle. Argon laser iridoplasty is useful to retract the peripheral iris using the thermal effect of the laser to widen the iridocorneal angle. MATERIALS AND METHODS: The study investigated nine eyes of five patients who had had iridoplasty for iris plateau angle-closure glaucoma, diagnosed by dynamic gonioscopy (or indentation gonioscopy) and confirmed by ultrasound biomicroscopy (UBM). There were four females and one male, with a mean age of 42.2 years (range, 30-53 years). The mean intraocular pressure (IOP) before iridoplasty was 21.1 mmHg. The number of antiglaucoma treatments was 1 or 2, with all patients receiving miotic treatment. All patients had undergone argon laser iridotomy beforehand to remove the pupillary block frequently associated with iris plateau. Iridoplasty was done in two sessions with postoperative IOP-lowering treatment. The laser parameters used were: duration, 0.3 s; power, 500 mW; diameter, 300 microm. RESULTS: The postoperative IOP evaluated at 1 month was 14.4 mmHg with a reduction in the hypotensive treatment. No treatment was prescribed for four eyes, a single hypotensive treatment for four eyes, and two hypotensive medications for one eye. DISCUSSION: Pure iris plateau syndrome, leading to closure of the angle, is very rare compared to pupillary block, but these two mechanisms often co-exist. The physiopathology explains that the mechanism of isolated iris plateau is not modified by iridectomy. However, the advantage of argon laser iridoplasty, which retracts the periphery of the iris so as to widen the iridocorneal angle, must be emphasized. This technique can alleviate the need for high-risk filtering surgery, but longer follow-up is necessary to evaluate its duration and efficacy.

Adult↗
PubMed2001

Quantitation of mitomycin C in human ocular tissues by high-performance liquid chromatography-photo-diode array detection.

A chromatographic method, which can quantitate mitomycin C (MMC) along with two antiglaucoma drugs, is described. The separation of MMC, alphagan and timolol was performed on a reversed-phase C18 column with water-methanol-trifluoroacetic acid (65:35:0.01, v/v) as the mobile phase. By monitoring at 360, 248 and 296 nm, the lower limits of detection for MMC, alphagan and timolol are, respectively, 1.0, 2.0 and 5.0 ng (injection amount) at three-time S/N ratio. The dynamic ranges of quantitation for the three drugs are, respectively, 1.0 ng-10.0 microg, 2.0 ng-10.0 microg and 5.0 ng-10.0 microg with linearity being larger than 0.9960. This method was applied to the determination of MMC levels in Tenon's and trabeculum tissues of 10 glaucoma patients. MMC levels in these tissues, which were obtained from glaucoma filtering surgery, were determined following a multiple extraction with methanol. The recovery of MMC for a two-batch extraction was better than 91.2%. The reproducibility of measurement for the MMC levels in these tissues is 2.5-6.0% RSD for triplicate injections. The intra-day variation of retention times for the MMC peaks was less than 1.6% RSD (n=3). The inter-day variation of retention times for the MMC peaks was less than 4.8% RSD (n=3). MMC was detectable in three trabeculum tissues out of 10 cases (ranging from 0.8 to 25.5 ng/mg specimen), while MMC was detected in nine Tenon's tissues out of 10 cases (ranging from 0.3 to 21.1 ng/mg specimen). The results obtained show that the method is sensitive and selective for the quantitation of MMC.

Antihypertensive Agents↗
PubMed1992

Phacoemulsification and modified trabeculectomy for managing combined cataracts and glaucoma.

Seven eyes in four patients who had combined cataract extraction, intraocular lens implantation, and glaucoma filtering surgery were examined retrospectively. A phacoemulsification technique was used with trabeculectomy performed under a modified limbal flap. All patients achieved a final visual acuity of 20/40 or better and intraocular pressure of less than 20 mm Hg without medication. The techniques are described and the management of combined cataracts and glaucoma is discussed.

Cataract Extraction↗
PubMed1995

Evaluation of 35 consecutive SI-30 PhacoFlex lenses with high-refractive silicone optic implanted in the capsulorhexis bag.

Thirty-five PhacoFlex foldable open-loop lenses with high-refractive silicone optics were evaluated. All lenses were implanted using a folding forceps and were fixated in the bag. Mean follow-up was 14 months. With adequate forceps, the lens may be inserted through a 3.2 mm incision, using a 3 mm long self-sealing sclerocorneal tunnel. With a well-centered 4 mm to 5 mm capsulorhexis opening, centration was very satisfactory. Moderate decentration occurred in two cases, one from a small, heavily shrinking capsulorhexis and the other from a poorly shaped capsulorhexis that captured the optic along its edge. Except in one case of combined cataract and filtering surgery, all optics were at a pronounced distance from the iris. Consequently, signs of iris chafing or iridocapsular synechias and cellular invasion were not seen. The optic typically exhibited a slight bluish tint and minute granular inclusions without clinical significance. Neither discoloration nor haze was present. Best visual acuity was 20/25 or better in all cases. The small wound required for insertion makes the PhacoFlex especially appropriate for clear corneal incision surgery. Attempts are being made to minimize the grainy appearance of the optic. Increasing the rigidity of the loops may be advantageous.

Aged↗
PubMed1988

Unfastening of an Adams-de Weese clip: an uncommon cause of recurrent pulmonary embolism after interruption of the inferior vena cava.

Recurrent pulmonary embolism after placement of a caval clip is uncommon. We report the case of a patient admitted for recurrent venous thrombosis of the lower limbs, 11 years after placement of an Adams-de Weese clip. Severe pulmonary embolism occurred in spite of anticoagulant treatment. After an unsuccessful attempt to insert a Greenfield filter, surgery was performed. The clip was found to have come unfastened; simple repeat closure was performed. We were unable to find any similar reports in the literature. In spite of its rarity, this cause should be considered when faced with recurrent pulmonary embolism in patients having undergone inferior vena caval clipping.

Constriction↗
PubMed2000

Poly(ortho esters) - their development and some recent applications.

Poly(ortho esters) have been under development since the early 1970s and four families of such polymers have been described. Of most interest are poly(ortho ester) III and poly(ortho ester) IV. Poly(ortho ester) III is a semisolid material that has been shown to be highly biocompatible and is currently being investigated as an adjunct to glaucoma filtering surgery and other ocular applications. However, the polymerization is difficult to control and is not readily scaled up. Poly(ortho ester) IV can be easily prepared in a highly reproducible manner, is very stable provided moisture is rigorously excluded and has also been shown to be highly biocompatible. It is currently under development for a variety of applications, such as ocular delivery, protein release, post-operative pain treatment and post-operative cancer treatment.

Animals↗
PubMed2000

A poly(ortho ester) designed for combined ocular delivery of dexamethasone sodium phosphate and 5-fluorouracil: subconjunctival tolerance and in vitro release.

A viscous hydrophobic poly(ortho ester) (POE) has been developed as a biocompatible, biodegradable sustained release system for selected cases of glaucoma filtering surgery. Dexamethasone and 5-fluorouracil (5-FU) are frequently administered together post-operatively, for their anti-fibroblastic and anti-inflammatory properties, respectively. A combined sustained release of both drugs could be advantageously used. Drug release kinetics were studied using specially designed thermostated cells. Subconjunctival tolerance was evaluated on New Zealand albino rabbits by clinical evaluation. Due to its basicity, the addition of dexamethasone sodium phosphate (DEX-P) stabilized the polymer and prolonged 5-FU in vitro release from 2 to 4 days. Both therapeutic agents were released concomitantly, according to a linear profile. The presence of 5-FU only slightly affected the overall subconjunctival tolerance of POE in rabbits, whereas the addition of DEX-P markedly improved POE tolerance by reducing the hyperemia of the conjunctiva to a minimal grade.

Animals↗
PubMedDate not supplied

Trabeculectomy: a retrospective follow-up of 700 eyes.

A major focus of our study was to determine the value of postoperative intraocular pressure (IOP) in predicting the outcome of trabeculectomy (TE). The medical charts of 547 patients undergoing glaucoma filtering surgery at the Department of Ophthalmology of the University of Cologne from 1987 to 1996 were reviewed. The status of the visual field, level of visual acuity, appearance of the bleb, cup/disc ratio and IOP were studied. Pre- and post-operative glaucoma medication was recorded. The eyes with congenital glaucoma and those treated with antimetabolites were excluded. The results are presented with particular emphasis being placed not only on intraocular pressure (IOP) control but also on the progression of glaucomatous damage (deterioration of visual field or disc damage) and the decrease of visual acuity. The tonometric success rate of TE in controlling the IOP < 21 mmHg was 61%. Defining the rigid criteria for success of trabeculectomy as an IOP < 21 mmHg, no further visual field loss, no disc damage and no additionally required surgical intervention due to glaucoma, the success rate decreased to 44%. The results indicate that other factors than normalization of IOP determine the success rate of TE. Should trabeculectomy be the therapy of first choice in the early stage of glaucoma? Should trabeculectomy fail to control the IOP in the first eye, would this allow options, such as the use of antimetabolites in the second eye?

Female↗
PubMed1989

Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: effect on intraocular pressure control.

Twenty-three eyes of 22 consecutive patients with primary chronic angle-closure glaucoma (PCACG) undergoing extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation were studied prospectively to assess the effect of ECCE on intraocular pressure (IOP) control. For comparison, a group of 21 eyes with open angle glaucoma (OAG) which had undergone ECCE were reviewed retrospectively. The PCACG group had a low incidence of acute post-operative IOP elevations (9%), and long-term the majority (65%) achieved an IOP less than 21 mmHg off all glaucoma medications. In the OAG group the IOP control was largely unaffected. We recommend that eyes with cataract and PCACG should be considered for ECCE as a first procedure rather than combined cataract and filtering surgery.

Aged↗
PubMed1992

Rational choice of therapy in established open angle glaucoma.

Currently, the standard treatment for primary open angle glaucoma favours initial medical therapy. Laser trabeculoplasty and filtering surgery are reserved for those patients who fail medical therapy. There is now, however, good evidence to suggest that perhaps this approach deserves reassessment.

Glaucoma, Open-Angle↗
PubMed1997

Long-term results and complications after trabeculectomy with a single per-operative application of 5-fluorouracil.

We retrospectively evaluated a consecutive series of 45 patients (45 eyes) who underwent trabeculectomy augmented with a single intra-operative 5 minute application of 5-fluorouracil (5-FU; 25 mg/ml). All patients were at an increased risk of subconjunctival fibrosis and surgical failure. The mean follow-up period was 24 months (range 12-42, SD 6.9). The mean pre-operative intraocular pressure (IOP) was 29.1 mmHg (SD 6.1) and the mean IOP at the last post-operative visit was 16.6 mmHg (SD 6.4) (p < 0.0001) with a mean IOP reduction of 42%. The number of medications reduced from a mean of 2.3 (SD 0.7) pre-operatively, to 0.8 (SD 0.7) post-operatively (p < 0.0001) and 22 eyes (49%) required no topical treatment for IOP control. An IOP of 21 mmHg or less with or without medications was achieved in 80% of cases. There was no significant difference in final IOP or success rate over time between low- and high-risk patients, although the low-risk patients did better in the first 12-18 months. Complications included hypotony maculopathy in 2 cases (4%), leaking bleb in 5 cases (11%) and giant bleb in 1 case (2%), giving a total of 8 cases (18%) with bleb-related sequelae. In the short to medium term, a single per-operative application of 5-FU is a useful adjunctive treatment during glaucoma filtering surgery for low- to moderate-risk cases, although a steady increase in the failure rate was associated with increasing length of follow-up.

Adult↗
PubMed2002

Delayed hypersensitivity to brimonidine tartrate 0.2% associated with high intraocular pressure.

PURPOSE: To report the late presentation of an allergic reaction to brimonidine tartrate 0.2% associated with an elevation of intraocular pressure. METHODS: During a 6-month period six Caucasian patients (three were male), with primary open angle glaucoma (POAG) or ocular hypertension, with an allergic reaction to brimonidine tartrate eye drops were identified. Brimonidine was initiated as additional medical therapy in four patients and monotherapy in two patients. The median age of the patients was 67 years (range 57-73 years). RESULTS: There were nine eyes with a follicular conjunctivitis; three patients received brimonidine in one eye only. In two patients an additional redness of the periocular skin was present. The median duration on brimonidine therapy before the onset of the allergic reaction was 12 months (range 5-15 months). The median intraocular pressure (IOP) before the onset of the allergy was 18 mmHg (range 16-21 mmHg). There was a significant elevation of IOP at the time of the allergy with a median IOP of 28 mmHg (range 20-44 mmHg) (P = 0.007, Wilcoxon sign rank test). The cessation of brimonidine allowed the resolution of the allergic reaction. The intraocular pressure was then controlled with alternative medication in eight eyes. One patient went on to have filtering surgery. CONCLUSIONS: A delayed hypersensitivity reaction to brimonidine tartrate eye drops resembles a viral follicular conjunctivitis. It is imperative that it is recognised as such, as it may occur many months after brimonidine is initiated. This allergy has been found to be associated with a loss of control of the IOP. Though this is a small cohort of patients, it is not unreasonable to suggest that patients on brimonidine eye drops should be instructed to report promptly to their ophthalmologist the onset of redness of their eyes so that their glaucoma control may be reassessed.

Aged↗
PubMed2003

Prevalence of open-angle glaucoma in Iceland: Reykjavik Eye Study.

PURPOSE: To establish the age- and sex-specific prevalence of open-angle glaucoma (OAG) subsuming pseudoexfoliation (PEX) in the city of Reykjavik. METHODS: Participants 50 years of age and older who were part of the Reykjavik Eye Study and classified as having glaucoma were divided into three categories:Category 1: two or more of the following based on optic nerve stereophotograph reading: vertical cup to disc ratio (VCDR) 97.5th percentile (>0.7), focal glaucomatous disc change, C/D asymmetry of 97.5th percentile difference between eyes (>0.2) as well as glaucomatous visual field defect (GVFD). Category 2: 99.5th percentile of VCDR (>0.8) and 99.5% percentile difference between eyes (>/=0.3), without a GVFD. Category 3: VA<3/60 and IOP>99.5th percentile or VA <3/60 and evidence of filtering surgery. For a glaucoma suspect, one of the following was present: VCDR>99.5th percentile (>0.8), focal glaucomatous disc change, C/D asymmetry of 99.5th percentile (> or =0.3), GVFD only, IOP> or =23 mmHg (97.5 percentile). PEX was diagnosed by the presence of a central shield and/or a peripheral band on the anterior lens capsule. RESULTS: Of 42 persons (22 males and 20 females) with OAG, 13 (31.0%) had PEX. The minimum prevalence of OAG was 4.0% (42/1045) (95% CI 2.8-5.2) for those 50 years and older and 10.3% (95% CI 8.5-12.2) for PEX. The prevalence of OAG increases with age (OR=1.10/year, 95% CI 1.07-1.13, P=0.000) and the same applies for the prevalence of PEX, OR=1.10 (95% CI 1.07-1.12, P=0.000). CONCLUSION: There is a 10% annual increase for both OAG and PEX in persons 50 years and older.

Age Distribution↗
PubMed2002

Effect of diode laser contact transscleral pars plana photocoagulation on intraocular pressure in glaucoma.

PURPOSE: To evaluate the efficacy of diode laser contact transscleral pars plana photocoagulation (CTPPP) for intraocular pressure (IOP) control in glaucoma and its clinical application. METHOD: A prospective, non-randomized hospital-based pilot study was conducted. Fourteen patients with poor visual acuity (VA worse than 6/60) and medically uncontrolled, refractory glaucoma were recruited, and CTPPP was performed after informed consent. RESULTS: Mean preoperative IOP was 41.0 mmHg (SD 12.6, range 27-70, n = 14). At 1 week postoperatively, IOP was reduced in 12 of 14 (86%) patients to a mean of 28.6 mmHg (SD 15.8, range 3-55, n = 14). This represented a mean decrease of 12.4 mmHg. Mean IOP was 34.0 mmHg (SD 17.4, range 5-71, n = 14) and 31.6 mmHg (SD 13.4, range 5-22, n = 12) at 4 and 12 weeks, respectively. The IOP reduction was significant at 1 week (P = 0.001, paired t-test) and at 12 weeks (P = 0.04, paired t-test). The two patients with preoperative pain reported abolition of pain after the procedure. Seven of 13 patients on preoperative antiglaucoma eye drops did not require eye drops postoperatively. CONCLUSION: Diode laser CTPPP was found to significantly reduce IOP in the majority of patients at 1 week postoperatively, with less but still significant effect at 12 weeks. Its potential application as a procedure for short-term IOP reduction in medically uncontrolled glaucoma requiring filtering surgery needs to be further investigated.

Adult↗
PubMed2000

[Long-term follow-up of 700 trabeculectomies].

BACKGROUND: A major focus of our study was to determine the value of postoperative intraocular pressure (IOP) in predicting the outcome of trabeculectomy (TE). PATIENTS AND METHODS: The medical charts of 547 patients undergoing glaucoma filtering surgery at the Department of Ophthalmology of the University of Cologne from 1987 to 1996 were reviewed. The eyes with congenital glaucoma and those treated with anti-metabolites were excluded. RESULTS: Defining the qualified criteria for success of trabeculectomy as an IOP </21 mm Hg throughout the entire study period, no evidence of progressive disc damage or further visual field loss, no decrease in visual acuity and no additionally required surgical intervention due to glaucoma, there was a success rate of 44.4%. In 50% the tonometric failure took place within the first 34 days trabeculectomy. No significant difference in survival by sex (p = 0.53), surgical technique, limbal versus fornix-based flap (p = 0.28) and by type of glaucoma (p = 0.26) was shown. But the patient group with prior argon laser trabeculoplasty had a significant lower success rate in terms of normalization of IOP (p = 0.03). There was no significant difference in the outcome of trabeculectomy between the first and second eye. CONCLUSION: The identification of patients at risk of failure in terms of IOP in the early post-operative period is possible, thus, closer follow-up and early medical or surgical intervention may be indicated. Should trabeculectomy be the therapy of first choice in the early stage of glaucoma and in case of failure in the first eye, this would allow options, such as the use of anti-metabolites in the second eye.

Adult↗
PubMed2000

[Aqueous outflow pathway imaging in the rabbit with fluorescein and indocyanine green].

PURPOSE: The purpose of this study was to visualise the rabbit aqueous outflow pathway using a numeric imaging system with ICG and fluorescein injection in the anterior chamber. MATERIAL AND METHODS: We performed a simultaneous injection of Indocyanin Green (ICG) and Fluorescein into the anterior chamber of rabbit eyes. Using a digital camera, we took several sequenced pictures to visualize the distribution of the dyes within the outflow pathway. We observed the dynamics of the outflow over time. RESULTS: In the early phases, the shape of the outflow canal around the limbus was clearly seen. Several collecting veins close to the recti muscles were also identified. There was only slight fluorescein leakage during the early phases, allowing adequate visualization of the morphology of the outflow system. In the late phases, the sclera was stained with the fluorescein, and no details were thus visible. The ICG dye allowed better recognition of the fine details of the outflow structure. CONCLUSION: This method was relatively simple, safe and precise, and allowed us to visualise the details of the outflow pathways in the rabbit eyes. These results could be of great value in further evaluating the outcome of filtering surgeries in animal models.

Angiography↗