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At least 685 records · Page 38Linked to original sources
PubMed1997

Prospective study of ab externo erbium:YAG laser sclerostomy in humans.

PURPOSE: To evaluate the efficacy of ab externo erbium:YAG (Er:YAG) laser sclerostomy in controlling intraocular pressure in eyes with uncontrolled glaucoma. METHODS: We performed ab externo laser sclerostomy on eyes of 26 patients. Mean +/- SD postoperative follow-up was 11.4 +/- 0.9 months. Complete success was defined as intraocular pressure below 22 mm Hg with no adjunct medication; qualified success was defined as intraocular pressure below 22 mm Hg with medication. RESULTS: In all eyes, ab externo Er:YAG laser sclerostomy achieved a functioning fistula with a prominent filtering bleb. Twelve eyes had had neodymium:YAG (Nd:YAG) laser iridotomy at the site of laser sclerostomy 2 weeks before filtering surgery; 14 eyes had surgical iridectomy at the site of laser sclerostomy. Mean preoperative intraocular pressure of 30.7 +/- 7.3 mm Hg (range, 17.0 to 48.0 mm Hg) was significantly (P < .05) reduced to 18.3 +/- 1.0 mm Hg (range, 0 to 25.0 mm Hg) at 2 weeks postoperatively. thereafter, marked regression was noted: at 1 month postoperatively, intraocular pressure was 20.1 +/- 9.5 mm Hg (range, 4.0 to 44.0 mm Hg); half-life of complete success was 25 days; of qualified success, 56 days; and of a functioning filtering bleb, 36 days. CONCLUSIONS: Ab externo Er:YAG laser sclerostomy reliably created successful full-thickness fistulae with prominent filtering blebs in human glaucomatous eyes. However, a transient phase of ocular hypotony caused by aqueous overfiltration, followed by an ongoing rate of fistula patency failure, renders Er:YAG laser sclerostomy, as performed in this study, unsuitable for long-term pressure control.

Adult↗
PubMed1993

Congenital cysts of the iris stroma.

We managed three cases of congenital iris stromal cysts and compared them with 22 cases in the published reports to delineate the clinical features of this condition and determine the best treatment. Our first patient, a 5-month-old girl, had injection of a cyst with trichloroacetic acid, but developed a cataract and endothelial damage to the cornea and the eye was eventually enucleated. Our second patient, a 9-week-old girl, was treated with repeated xenon photocoagulation, drainage of the cyst, and cryotherapy, but required enucleation of the eye. Our third patient, a 5-month-old girl, had excision of the cyst by sector iridectomy with preservation of vision and no recurrence two years later. Our results suggest that complete surgical excision is a superior method of treatment for congenital cysts of the iris stroma.

Cysts↗
PubMed1993

An ultrasound biomicroscopic analysis of angle-closure glaucoma secondary to ciliochoroidal effusion in IgA nephropathy.

Immunoglobulin A nephropathy is a common glomerulonephritis of unknown cause. Episcleritis, scleritis, anterior uveitis, and keratoconjunctivitis sicca have been associated with this disease. We diagnosed angle-closure glaucoma secondary to ciliochoroidal effusion in a patient with IgA nephropathy confirmed by biopsy. High-frequency ultrasound biomicroscopy was used to determine internal relationships of angle structures and to follow changes with treatment. Supraciliary effusion undetected by B-scan ultrasound and retinal examination was easily imaged by ultrasound biomicroscopy. Glaucoma mechanisms included forward rotation of the ciliary processes, which caused direct angle closure in a manner similar to plateau iris. Ultrasound biomicroscopy showed that cycloplegia improved this mechanism by retracting the ciliary processes, but angle closure secondary to forward iris bowing from pupil block remained. Iridectomy was performed and immediately opened the angle. Ultrasound biomicroscopy proved a useful method of defining mechanisms and a helpful guide to treatment in this type of glaucoma.

Anterior Eye Segment↗
PubMed1992

Trabeculectomy without conjunctival incision.

A trabeculectomy technique with conventional instruments, but without conjunctival incision or intracameral manipulation, was completed in 12 eye-bank eyes, two cat eyes, and in five patients with glaucoma. A partial-thickness limbal corneal flap provided access to an intrastromal limbal pocket through which the subconjunctival space was entered with an irrigating cystotome. The anterior chamber was entered at the surgical corneoscleral limbus beneath the corneal flap and the peripheral iridectomy was completed without difficulty. Full-thickness or guarded limbal fistulas could be created. Guarded limbal fistulas were completed in five of five patients with glaucoma. The technique produced low-lying, diffuse filtration blebs that persisted throughout the three-month postoperative period and reduced mean intraocular pressure from 33 to 12 mm Hg. Corneal trabeculectomy holds promise as a method for a filtration operation that does not require conjunctival incision, intracameral manipulation, or costly technology.

Aged↗
PubMed1991

The physiologic characteristics of relative pupillary block.

In biometric photographs of 13 patients, we quantified the iris contour in eyes with central anterior chamber depths ranging from 1.9 to 3.4 mm (epithelium to lens surface). This actual profile was compared to that predicted by a theoretical analysis of the forces acting on the iris. The average discrepancy between the calculated actual and the theoretically predicted iris position was only -0.01 to +0.03 mm. The close agreement validates the model under normal conditions and in the presence of relative (nonsynechial) pupillary block. The theoretical iris shape may not occur under conditions that violate the underlying physical assumptions of the mathematical model, such as when iridectomy eliminates the pressure difference between the anterior and posterior chamber or when synechiae introduce additional forces on the iris other than the ones included in the analysis.

Anterior Chamber↗
PubMed1989

Glaucoma in the Maroteaux-Lamy syndrome.

We report four patients who had glaucoma in association with the Maroteaux-Lamy syndrome. Two of these patients had acute angle-closure glaucoma, one had chronic angle-closure glaucoma, and one was treated for open-angle glaucoma; however, the angle structures could not be seen by gonioscopy. Standard peripheral iridectomy was inadequate for treatment of this angle-closure glaucoma because of the considerably increased thickness of the peripheral cornea that occurs in these patients. Our findings suggest that glaucoma may be more common in the Maroteaux-Lamy syndrome than has been realized and that the initial mechanism is secondary acute or chronic angle closure not related to pupillary block.

Adult↗
PubMed1991

Pseudophakic pupillary-block glaucoma in children.

We studied 16 children, ranging in age between 3 and 8 years, who had posterior chamber intraocular lens implantation and developed inflammatory pupillary-block glaucoma. Prophylactic peripheral iridectomy had not been performed in any of the eyes. The patients were treated medically, and YAG laser iridotomy was performed successfully one week after initial control of intraocular pressure. Of 16 eyes in which intraocular pressure remained uncontrolled, trabeculectomy was necessary in three eyes and irreversible glaucomatous visual loss occurred in two eyes. Our data demonstrate the need for stringent and more frequent postoperative follow-up of children after intraocular lens implantation, especially during the first four postoperative weeks. Careful long-term follow-up for treatment after cataract is mandatory to prevent development of amblyopia.

Acetazolamide↗
PubMed1998

A dummy orbit for training in diagnostic procedures and laser surgery with enucleated eyes.

PURPOSE: A dummy orbit for enucleated eyes was developed for training residents in diagnostic and surgical procedures. METHODS: Porcine eyes were used to construct the model. The device is made of black anodized metal. The final prototype was tested for ease of use and optical quality. Principal elements are an adjustable eye support, a cylinder, and a removable ring. RESULTS: The dummy orbit and enucleated eye allow direct and indirect ophthalmoscopy; inspection with contact lenses, including gonioscopy; and retinal laser coagulation using contact lenses. Laser trabeculoplasty, argon laser trabeculotomy, Nd:YAG laser iridectomy, and Nd:YAG laser capsulectomy are possible, as well as training in tonometry and ultrasonography techniques. CONCLUSION: The dummy orbit is a valuable aid for teaching and training in diagnostic and laser surgery procedures with nondissected enucleated eyes.

Animals↗
PubMed2000

Tissue plasminogen activator to treat impending pupillary block glaucoma in patients with acute fibrinous HLA-B27 positive iridocyclitis.

PURPOSE: To report the use of intracameral tissue plasminogen activator to dissolve fibrinous membranes and break posterior synechiae in patients with acute HLA-B27-positive iridocyclitis with impending pupillary block. METHODS: Two patients with severe acute fibrinous iridocyclitis and seclusio pupillae were identified. Because of the concern of impending pupillary block, intracameral tissue plasminogen activator (12.5 microg in 0.1 ml, Activase; Genentech, Inc, South San Francisco, California) was injected with a 25-gauge needle through the corneal limbus. RESULTS: Both patients showed complete dissolution of fibrin with disruption of posterior synechiae. There were no adverse events after injection. Neither patient required further invasive intervention, and both fully recovered with medical management. CONCLUSIONS: Intracameral tissue plasminogen activator is a safe and effective agent for patients with severe acute iridocyclitis and pupillary seclusion. Patients with clinical signs suggestive of impending pupillary block glaucoma may be considered for tissue plasminogen activator injection to avoid the possible need for emergency surgical iridectomy and synechiolysis.

Acute Disease↗
PubMed2002

Efficacy of latanoprost in reducing intraocular pressure in patients with primary angle-closure glaucoma.

Two independent, prospective trials were recently conducted to assess the efficacy of latanoprost in reducing intraocular pressure (IOP) in patients with primary angle-closure glaucoma (PACG). The first study was a 2-week, randomized, double-masked comparison of latanoprost treatment and timolol treatment in patients with PACG. Patients were randomized to one of two parallel treatment groups, receiving either placebo in the morning and latanoprost 0.005% in the evening, or timolol 0.5% twice daily. The mean IOP reduction in latanoprost group was 8.8 +/- 1.1 mm Hg (mean +/- SEM, p < 0.001; 34.2%) from a mean baseline IOP of 25.7 +/- 0.9 mm Hg, and the corresponding figures for the timolol group were 5.7 +/- 0.9 mm Hg (p < 0.001; 22.6%) from a mean baseline IOP of 25.2 +/- 1.1 mm Hg. A significantly greater IOP reduction of 3.1 +/- 1.5 mm Hg (95% confidence interval: 0.1 to 6.0) was achieved in the latanoprost group compared to the timolol treatment group (p = 0.04). In the second study, latanoprost 0.005% once a day was added adjunctively to PACG patients with persistently elevated IOP after iridectomy, despite treatment with beta-blockers and pilocarpine. The IOP decreased by about 21% during the first 3 months, and showed a reduction of about 36% at the end of 1 year. At the 1-year follow-up, IOP was <20 mm Hg in all eyes. In both studies, latanoprost was well tolerated with few adverse events. These results demonstrate that latanoprost is effective in reducing IOP in patients with PACG.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

A history of primary angle closure glaucoma.

The satisfactory control and cure of attacks of primary angle closure glaucoma spans one hundred years following von Graefe's iridectomy in 1856. Gonioscopy was required to validate the theories of shallow anterior chamber and pupillary obstruction, but the gonioscopists looked for the causes of angle closure in their own territory at the angle in the periphery of the anterior chamber and disregarded the center. General agreement of the importance of pupil block was thereby delayed for over ten years. Advances in pharmacology and the invention of laser surgery gave opthalmologists a comfortable control of a formerly distressing, blinding disease.

Glaucoma, Angle-Closure↗
PubMed1980

Pearce-style posterior chamber lenses.

The Pearce-style iris suture and sutureless lenses are described. Insertion of these lenses in 439 eyes yielded good visual results with a high degree of patient satisfaction. With the exception of forty (9.1%) eyes which required discissions, the complication rate was low. The absence of pupillary block glaucoma indicates that peripheral iridectomies are not necessary with Pearce lens styles. Use of the sutureless lens simplifies implant surgery, however, only time will show if it also reduces the complication rate.

Aged↗
PubMed1981

A technique for suturing the Shearing posterior chamber implant to the iris.

An iris suture is sometimes indicated for additional fixation of a Shearing posterior chamber lens. This suture may be placed after prolapsing the superior J-loop through the iridectomy and limbal incision, thus allowing direct visualization while working safely away from the posterior capsule. Possible indications and contraindications for this technique are discussed.

Humans↗
PubMed1981

Laser photomydriasis in pseudophakic pupillary block.

Pupillary block glaucoma is a potential complication of implantation. Early recognition and prompt medical therapy will generally successfully treat the condition. In some instances surgical treatment is required if medical therapy is inadequate. Laser iridectomy and laser photomydriasis are other alternatives to surgical therapy. This case reports successful treatment of pseudophakic pupillary block glaucoma using laser photomydriasis.

Aged↗
PubMed1982

Dislocation of the Kelman II anterior chamber intraocular lens.

The Kelman II anterior chamber intraocular lens, because of its three-point fixation, may rotate in a counterclockwise direction so that the long arm of the lens is displaced through the peripheral iridectomy and the short arm is dislocated into the anterior chamber. In four of the five cases reported here, a second surgical procedure was necessary to correct the problem.

Aged↗
PubMed1983

The triple procedure: combined penetrating keratoplasty, extracapsular cataract extraction and lens implantation. An expanded experience.

The results of 177 triple procedures are presented from a continuous series of 197 cases recorded from 1973 to 1982. Eighty-nine percent achieved a visual acuity of 20/40 or better within a minimum followup period of six months. The complication rate was low, and usually managed medically. Subsequent major surgical procedures were required in only twelve (7%) of these cases (eight repeat keratoplasty, two retina repair, one resuture of graft incision, and one peripheral iridectomy). Subsequent minor surgical procedures were for discission of the posterior lens capsule in 50% of the medallion-style lens cases, and in 7% of the posterior chamber lens cases.

Adult↗
PubMed1984

Biomechanical properties of the Ong capsular lens and results of four years of clinical experience.

We developed a capsular supported lens based on a biomechanical concept. Specific management of the anterior and posterior capsules ensured double capsular pocket fixation. For safe as well as atraumatic insertion, we applied the basic movement of the "downward swinging of a falling leaf," that worked effectively within a shallow anterior chamber. Because of the irido-lenticular clearance, the classic iridectomy was not indicated. Reconstituting the posterior chamber and artificially deepening it contributed to the integrity of the pupillary functions. The absence of capsular and zonular ruptures, the low rate of dislocations, decentrations and secondary capsule opacification in 200 lens implantations confirmed the biomechanical concept.

Biomechanical Phenomena↗
PubMed1985

Diagnosis and surgical management of phacoanaphylactic uveitis following extracapsular cataract extraction with intraocular lens implantation.

One year after a successful extracapsular cataract extraction with posterior chamber lens implantation of a Cilco Kratz modified J-loop lens, the patient, a 79-year-old white female, developed a severe granulomatous uveitis unresponsive to topical or systemic steroid therapy. All usual uveitis tests were negative, and no evidence of masquerade-syndrome-type uveitis was found. The possibility of lens-induced uveitis was considered. A B-scan ultrasound revealed high density echoes in the superotemporal portion of the capsular bag, and an operative procedure consisting of a sector iridectomy, removal of the implant, removal of white cortical material in the capsular bag as well as residual lens capsule, and an anterior vitrectomy was done. Pathologic examination of the specimens revealed lens material engulfed by large macrophages, foam cells, and plasma cells. The patient's uveitis rapidly subsided. She is now off all medication and has normal aphakic vision. The differential diagnosis, surgical management, and implications of this problem are discussed.

Aged↗