Showing papers in "Journal of Glaucoma in 2002"
TL;DR: In this article, the Esterman binocular visual field test and other visual function tests were compared to clinical tests of glaucoma patients and to persons with normal vision and blind persons.
Abstract: PURPOSE: To determine how glaucoma patients with various degrees of vision loss rate their vision, and to determine if the Esterman binocular visual field test and other visual function tests correlate with those ratings. METHODS: Two hundred thirty-seven glaucoma patients evaluated their vision using 2 utility tests, the linear rating scale and the time trade-off test, and 2 quality-of-life instruments, the National Eye Institute Visual Function Questionnaire (VFQ) and the Short Form 36 (SF-36). Their results were compared to clinical tests of their vision and to persons with normal vision (n = 12) and blind persons (n = 12). RESULTS: On a scale of 0 (blind) to 100 (ideal), subjects with normal vision rated their vision higher (90 +/- 8.0) than did glaucoma subjects and suspects (75.7 +/- 17.6) and "blind" subjects (15.6 +/- 15.3), P = .001. Mean scores for the Esterman test were 89.7 +/- 13.4 for the glaucoma group. The Esterman test correlated moderately with the overall VFQ score (partial correlation coefficient [PCC] = 0.32, P = .001), but only weakly with the linear rating scale (PCC = 0.17, P = .02) and the time trade-off test (PCC = -0.16, P = .06). Correlation between the linear rating scale and the overall VFQ score was good (PCC = 0.56, P = .0001) and was moderate with several domains of the SF-36 (e.g., social function PCC = 0.32, P = .0001). CONCLUSIONS: Utility values that glaucoma patients assign to their vision do not correlate well with Esterman test results. A challenge for the future will be designing clinical tests that better correlate with patient perceptions.
190 citations
TL;DR: Deep sclerectomy with collagen implant is another surgical treatment option in the management of glaucoma, showing pressure results comparable with trabeculectomy but with a lower rate of early postoperative complications.
Abstract: PurposeTo study the efficacy and safety of deep sclerectomy with collagen implant in one eye versus trabeculectomy in the other eye of the same patient.MethodsThe authors conducted a nonrandomized prospective trial of 20 patients with medically uncontrolled primary and secondary open-angle glaucoma.
176 citations
TL;DR: Observations concerning the potential role of endothelin in glaucoma pathophysiology is presented and discussed relative to its effects on the optic nerve head and in relation to glAUcoma theories.
Abstract: Summary:Endothelin is a vasoactive peptide that has been shown to play an important role in vascular homeostasis. Recently, endothelin and its receptors have been found in ocular tissues where it appears to have a regulatory function. Endothelin is found in both the aqueous and vitreous humors and i
160 citations
TL;DR: The protective effect of memantine suggests that excessive stimulation of NMDA receptors by glutamate is involved in causing cell damage in these RGC injury models.
Abstract: Purpose To evaluate the neuroprotective effect of memantine, an NMDA receptor channel blocker, in two retinal ganglion cell (RGC) injury models in rats. Methods Neuroprotective effect of memantine was tested in partial optic nerve injury and chronic ocular hypertensive models. In the optic nerve injury model, memantine (0.1 - 30 mg/kg) was injected intraperitoneally immediately after injury. Two weeks later, optic nerve function was determined by measuring compound action potential and surviving RGC was determined by retrograde labeling with dextran tetramethyl rhodamine. Chronic ocular hypertension was attained by laser photocoagulation of episcleral and limbal veins. Memantine (5 or 10 mg/kg) was administered continuously each day with an osmotic pump, either immediately after or 10 days after first laser photocoagulation, for 3 weeks, after which RGC survival was determined. Results Two weeks after partial optic nerve injury, there was approximately 80% reduction in RGC number. Memantine (5 mg/kg) caused a twofold increase in compound action potential amplitude and a 1.7-fold increase in survival of RGCs, respectively. In the chronic ocular hypertension model there was 37% decrease in RGCs after 3 weeks of elevated intraocular pressure. Memantine (10 mg/kg daily) reduced ganglion cell loss to 12% when applied immediately after first laser photocoagulation, and prevented any further loss when applied 10 days after first laser photocoagulation. Conclusion The protective effect of memantine suggests that excessive stimulation of NMDA receptors by glutamate is involved in causing cell damage in these RGC injury models.
135 citations
TL;DR: To compare the efficacy and safety of brimonidine-Purite (Alphagan; Allergan, Irvine, CA) 0.15% and 0.2% three times daily in patients with glaucoma or ocular hypertension in a 12-month, randomized, multicenter, double-blinded study.
Abstract: PurposeTo compare the efficacy and safety of brimonidine-Purite (Alphagan; Allergan, Irvine, CA) 015% and 02% three times daily with brimonidine (Alphagan) 02% three times daily in patients with glaucoma or ocular hypertensionPatients and MethodsIn this 12-month, randomized, multicenter, double-
127 citations
TL;DR: The use of intraoperative mitomycin C during deep sclerectomy significantly reduced the postoperative IOP and increased the success rate of the procedure.
Abstract: PURPOSE: To prospectively study and compare the effectiveness and the safety of primary deep sclerectomy with and without the use of mitomycin C in eyes with open-angle glaucoma. PATIENTS AND METHODS: A total of 90 eyes of 90 patients with primary open-angle glaucoma or pseudoexfoliative glaucoma underwent deep sclerectomy. Patients were enrolled consecutively and assigned randomly to undergo deep sclerectomy without the use of mitomycin C (DS group) and deep sclerectomy with the application of mitomycin C (DSMMC group) in a concentration of 0.2 mg/mL for 2.5 minutes, before the superficial scleral flap formation. RESULTS: The intraocular pressure was significantly decreased by 7.13 mm Hg or 27.59% in the DS group and by 11.68 mm Hg or 42.25% in the DSMMC group at the end of the follow-up period. The intraocular pressure reduction in the DSMMC group was statistically significant when compared with that in the DS group (P <0.05). The complete (IOP <22 mm Hg without medication) and qualified (IOP < 22 mm Hg with or without medication) success rates at the end of the follow-up period were 42.5% and 72.5% in the DS group and 50% and 95% in the DSMMC group. The qualified success rate in the DSMMC group was statistically significant when compared with that in the DS group. Differences in complications (choroidal detachment, hyphema, leakage) seen between the two groups were statistically nonsignificant. A hemorrhagic detachment of the Descemet membrane was observed in one eye in the DSMMC group. CONCLUSIONS: The use of intraoperative mitomycin C during deep sclerectomy significantly reduced the postoperative IOP and increased the success rate of the procedure.
124 citations
TL;DR: Donor sclera may be slightly more cost-efficient, but gamma-irradiated pericardium has sterility advantages, and no material was more prone to melting than another.
Abstract: PurposeSurgeons may use various materials, including donor sclera, dura, or pericardium grafts to cover glaucoma drainage implant tubes, prior to repositioning conjunctiva. We reviewed our experience with these materials.Patients and MethodsSixty-four eyes with at least 24 months follow-up status po
111 citations
TL;DR: Aqueous V EGF concentration is increased in eyes with glaucoma and no significant correlation was found between aqueous humor and plasma VEGF concentrations.
Abstract: PURPOSE To assess the concentrations of vascular endothelial growth factor (VEGF) in aqueous humor in eyes with and without glaucoma. METHODS Concentrations of VEGF were measured using a sandwich ELISA kit in aqueous humor aspirates taken during anterior segment surgery from 87 patients, of whom 54 had glaucoma (27 primary open-angle glaucoma, 8 angle-closure glaucoma, 16 exfoliative glaucoma) and 33 had cataract only. RESULTS Vascular endothelial growth factor was detected in all samples. The concentration in eyes with cataract only without glaucoma was 102.4 +/- 29.7 pg/mL (mean +/- SD), which was significantly lower than that from eyes with glaucoma (146.7 +/- 51.8 pg/mL). There were no significant differences between primary open-angle glaucoma (140.4 +/- 51.0 pg/mL), angle-closure glaucoma (142.8 +/- 40.2 pg/mL), and exfoliative glaucoma (158.6 +/- 58.9 pg/mL). An unusually high VEGF concentration was detected in one eye with neovascular glaucoma (759 pg/mL) and two eyes with uveitic glaucoma (322 pg/mL). No effect of age, gender, or previous history of medical, laser, or surgical treatment of the aqueous humor VEGF concentration could be detected ( > 0.05). Aqueous humor and plasma VEGF concentrations were measured and compared in 46 patients. The aqueous humor VEGF concentration (144.2 +/- 107.9 pg/mL) was significantly higher ( < 0.01) than the plasma concentration (79.2 +/- 46.1 pg/mL). No significant correlation was found between aqueous humor and plasma VEGF concentrations. CONCLUSION Aqueous VEGF concentration is increased in eyes with glaucoma.
110 citations
TL;DR: In eyes with open-angle glaucoma, viscocanalostomy is less effective in reducing intraocular pressure than standard filtering surgery, however, postoperative complications are more frequent after filtering surgery.
Abstract: PURPOSE To assess the intraocular pressure-lowering efficacy and the postoperative complication profile of viscocanalostomy versus trabeculectomy. PATIENTS AND METHODS Sixty eyes of 60 patients with medically uncontrolled open-angle glaucoma were randomized either to the viscocanalostomy or to the trabeculectomy group of the trial. Viscocanalostomy was performed according to Stegmann's technique using high-molecular-weight sodium hyaluronate to fill the ostia of the Schlemm canal. For trabeculectomy, a modified Cairns-trabeculectomy was performed. Examinations were performed before surgery and postoperatively daily for 1 week. Follow-up visits were scheduled 1, 6, and 12 months after surgery. RESULTS The mean (SD) preoperative intraocular pressure was 27.1 (7.1) mm Hg for all patients enrolled. One day after surgery, mean (SD) intraocular pressure was 15.9 (5.2) for the trabeculectomy group (P <0.001) and 15.7 (3.6) for the viscocanalostomy group (P <0.001), respectively. The success rate, defined as an intraocular pressure lower than 22 mm Hg without medication, was 56.7% in the trabeculectomy group and 30% in the viscocanalostomy group at 12 months postoperatively (P = 0.041). The number of postoperative complications was lower in the viscocanalostomy group than in the trabeculectomy group. CONCLUSIONS In eyes with open-angle glaucoma, viscocanalostomy is less effective in reducing intraocular pressure than standard filtering surgery. However, postoperative complications are more frequent after filtering surgery.
107 citations
TL;DR: Evidence is provided that retinal ganglion cells undergo morphologic changes prior to cell death; cell volume is reduced in surviving cells with corresponding reductions in the size of the axon and dendritic tree.
Abstract: SUMMARY:
There has been some debate concerning the selective loss of retinal ganglion cells belonging to the magnocellular pathway in early glaucoma. Although histologic studies of retinal ganglion cells in experimental and human glaucoma have suggested selective loss of the larger cells and, by implication, selective damage to the magnocellular pathway, this has not been confirmed using psychophysical tests. Recent studies of retinal ganglion cell morphology in experimental glaucoma provide evidence that retinal ganglion cells undergo morphologic changes prior to cell death; cell volume is reduced in surviving cells with corresponding reductions in the size of the axon and dendritic tree. The magnitude of these changes is consistent with cell shrinkage as an explanation for the apparent selective damaged reported in earlier studies. It is also likely that widespread changes in the retinal ganglion cell population precede cell death, which will affect the physiologic behavior of these cells.
102 citations
TL;DR: Patients with uveitic glaucoma can have good outcomes after trabeculectomy with antiproliferative agents, and male gender was the only statistically significant risk factor for trabECUlectomy failure.
Abstract: PurposeTo evaluate the outcome of trabeculectomy with antiproliferative agents in patients with uveitic glaucomaMethodsA retrospective chart review of 44 eyes of 44 patients with uveitic glaucoma who underwent trabeculectomy with mitomycin C or 5-fluorouracil. The authors defined complete success as
TL;DR: In unilateral EXS, factors associated with conversion to EG were initial IOP, pupillary dilatation value, and difference in IOP between the fellow eyes, and no risk factors for conversion to bilateral EXS were found.
Abstract: PurposeThis prospective 10-year follow-up study was conducted to examine conversion of nonglaucomatous eyes with unilateral exfoliation syndrome (EXS) to bilateral EXS and to glaucoma. Risk factors for conversion to a bilateral condition and to glaucoma were studied.PatientsSixty-three nonglaucomato
TL;DR: The increased IOP in ocular hypertensive patients is caused by a reduction in trabecular outflow facility and uveoscleral outflow and when both ocular normotensive and hypertensive groups are combined, aqueous flow and anterior chamber volume decrease slightly with age.
Abstract: PurposeTo evaluate the mechanism of the intraocular pressure (IOP) elevation in ocular hypertension (OHT), aqueous humor dynamics were compared in patients with OHT versus age-matched ocular normotensive (NT) volunteers.MethodsIn this retrospective study, one group included patients diagnosed with O
TL;DR: In this paper, the levels of free amino acids and protein in the vitreous of rat eyes are altered with chronic intraocular pressure (IOP) elevation or after optic nerve transection.
Abstract: Purpose To investigate whether the levels of free amino acids and protein in the vitreous of rat eyes are altered with chronic intraocular pressure (IOP) elevation or after optic nerve transection. Materials and Methods The concentrations of 20 amino acids in the vitreous humor were measured by high-performance liquid chromatography in both eyes of 41 rats with unilateral IOP elevation induced by translimbal photocoagulation. Eyes were studied 1 day and 1, 2, 4, and 9 weeks after initial IOP elevation. The same amino acids were measured in 41 rats 1 day and 2, 4, and 9 weeks after unilateral transection of the orbital optic nerve. The intravitreal protein level was assayed in additional 22 rats with IOP elevation and 12 rats after nerve transection. Two masked observers evaluated the amount of optic nerve damage with a semiquantitative, light-microscopic technique. Results In rats with experimental glaucoma, amino acid concentrations were unchanged 1 day after treatment. At 1 week, 4 of 20 amino acids (aspartate, proline, alanine, and lysine) were higher than in control eyes (P ≤ 0.01), but this difference was nonsignificant after Bonferroni correction for multiple simultaneous amino acid comparisons (none achieved P 0.05). Vitreous protein level was significantly higher in glaucomatous eyes than their paired controls at 1 day (P Conclusion Chronic experimental glaucoma and transection of the optic nerve increase the amount of protein in the rat vitreous above control levels. In the vitreous of rats with experimental glaucoma, a number of free amino acids were transiently elevated to a modest degree, but no significant difference in vitreous glutamate concentration was detected (P > 0.01).
TL;DR: The findings suggest that the Ahmed implant is less likely to create problems leading to reoperations or visual acuity loss than the Molteno or Krupin implants.
Abstract: OBJECTIVE To compare the efficacy of the nonvalved double-plate Molteno implant with two valved implants, the Krupin Eye Valve with Disc and the Ahmed Glaucoma Valve, in the treatment of recalcitrant glaucoma. PATIENTS AND METHODS The authors performed a nonrandomized retrospective review of patients who received the Molteno implant (n = 27), Krupin Eye Valve with Disc (n = 13), or Ahmed Glaucoma Valve (n = 13), with adjunctive mitomycin C. RESULTS Kaplan-Meier life-table analysis showed that the Molteno implant patients were more likely to maintain an intraocular pressure between 5 and 15 mm Hg than Ahmed Glaucoma Valve patients (P = 0.03). Success rates at 1 year were 80% (95% CI, 66-97%) for the Molteno implant, 39% (19-77%) for the Krupin Eye Valve with Disc, and 35% (15-82%) for the Ahmed Glaucoma Valve. However, Ahmed Glaucoma Valve patients were less likely to experience complications requiring reoperation or loss of two or more lines of visual acuity (P < 0.01) than Molteno implant or Krupin Eye Valve with Disc patients. CONCLUSIONS This nonrandomized study suggests that the Molteno implant with mitomycin C is more likely to result in intraocular pressures in the lower teens than the Ahmed Glaucoma Valve with mitomycin C. The findings suggest that the Ahmed implant is less likely to create problems leading to reoperations or visual acuity loss than the Molteno or Krupin implants.
TL;DR: The aqueous humor of dogs with hypertensive glaucoma contains significantly higher levels of endothelin 1 than that of healthy dogs.
Abstract: Purpose Endothelin 1 is a small peptide that is involved in regulation of intraocular pressure and modulation of ocular circulation. To investigate the role of endothelin 1 in canine glaucoma, the authors measured aqueous humor levels of endothelin 1 in healthy dogs and in dogs with hypertensive glaucoma. Methods Aqueous humor samples were obtained with general anesthesia from the eyes of healthy dogs (n = 5) and dogs with hypertensive glaucoma (n = 10). Measurements were made by enzyme immunoassay for endothelin 1. Results The endothelin 1 aqueous humor range was 1.12 - 3.63 pg/mL for healthy dogs and 1.97 - 14.97 pg/mL for glaucomatous dogs. The healthy and glaucomatous canine endothelin 1 aqueous levels (mean +/- SD) were 2.33 +/- 0.90 and 8.11 +/- 5.03 pg/mL, respectively. A two-way analysis of variance indicated that this difference was significant (P = 0.0084). The effect of age on endothelin 1 levels was not significant (P = 0.6283). The large variability found within the glaucomatous group could be explained by the degree of damage of the retina (P = 0.0006). There was no significant correlation between intraocular pressure and endothelin 1 aqueous humor levels within the glaucomatous group (P = 0.29). Conclusions The aqueous humor of dogs with hypertensive glaucoma contains significantly higher levels of endothelin 1 than that of healthy dogs.
TL;DR: Pharmacological neuroprotection with a selective inhibitor of inducible nitric oxide synthase may be useful for the treatment of glaucoma.
Abstract: PurposeTo test the hypothesis that nitric oxide, synthesized by inducible nitric oxide synthase, causes degeneration of retinal ganglion cells in an animal model of glaucoma.MethodsRats with unilateral, chronic, moderately elevated intraocular pressure were treated orally with L-N6-(1-iminoethyl)lys
TL;DR: In a large representative sample of the population, knowledge about glaucoma, its signs and symptoms, risk factors, treatment, and possible outcome is poor and may be an important cause for failure to detect glAUcoma and may result in blindness from the disease.
Abstract: Purpose To determine the general population's knowledge about glaucoma. Materials and methods A representative survey of the German population was conducted in which 2,742 men and women were interviewed face to face. The sample was matched with the German population for age, sex, education, income, and other factors. Questions were asked concerning the nature, occurrence, possible risk factors, and course of glaucoma. Results Fifty-one percent of the population had an active knowledge of the term "glaucoma" and 75% had a passive knowledge of the term. Of those interviewees with a passive knowledge, glaucoma was thought to be associated with raised intraocular pressure (IOP) by 28% and loss of visual field (14%) but also with corneal (14%) or lens disease (10%). Only 8.4% correctly recognized a basic glaucoma definition. Suspected symptoms were blurred vision (39%), pain (28%), or reading difficulties (22%). Twenty-nine percent of respondents believed that one is able to feel increased IOP. Prevention of visual loss was believed to be possible by reading (16%) or smoking less (11%). Therapeutic measures known were surgery (63%), laser treatment (26%), and medical treatment (23%). Information about glaucoma was mainly obtained from friends (44%), and less often from doctors (13%). Conclusions In a large representative sample of the population, knowledge about glaucoma, its signs and symptoms, risk factors, treatment, and possible outcome is poor. Lack of knowledge in the general population may be an important cause for failure to detect glaucoma and may result in blindness from the disease.
TL;DR: The test-retest variability of Heidelberg Retina Tomograph II stereometric parameters is comparable to that reported for the Heidelberger RetinaTomograph, a new clinical instrument for glaucoma management.
Abstract: PurposeTo study the test-retest variability of stereometric parameters on the Heidelberg Retina Tomograph II, a new clinical instrument for glaucoma management.MethodsIn a cross-sectional study of 24 consecutive cases of glaucoma and 26 healthy subjects, Heidelberg Retina Tomograph II stereometric p
TL;DR: Plateau iris was common in the clinic population studied and anteriorly directed ciliary processes were seen both in eyes with plateau iris as well as in Eyes with PACG that had deep anterior chambers after iridotomy.
Abstract: PurposeTo evaluate the presence of plateau iris in eyes with primary angle-closure glaucoma (PACG) after laser peripheral iridotomy by gonioscopy and ultrasound biomicroscopy and to evaluate the pathogenesis of this condition by comparing the UBM parameters of these eyes with those in normal subject
TL;DR: FDP is a valid screening test for glaucoma and the scoring system described by Patel et al. provided the best results.
Abstract: PURPOSE To evaluate the validity of frequency doubling perimetry (FDP) in the detection of glaucomatous field defects. METHODS Group I consisted of 85 eyes of 85 patients with established field defects in automated perimetry, classified by severity of defect. Group II consisted of 48 eyes of 48 control subjects. Both groups underwent Swedish Interactive Testing Algorithm (SITA) standard tests as well as FDP screening strategies (C20-1 and C20-5 and full threshold test). Sensitivity and specificity measures for the FDP tests were calculated using one new and two previously published algorithms. RESULTS A described scoring system provided the best sensitivity (85.9%) and specificity (95.1%). For moderate and severe cases, the sensitivity improved to 91%. Quantification of the defect did not improve detection. CONCLUSIONS FDP is a valid screening test for glaucoma. The scoring system described by Patel et al. provided the best results.
TL;DR: Higher total energy levels in a given treatment session appear to be associated with increased success as defined by the percentage of patients achieving an IOP < 21 or 22 mm Hg, without an increased risk of additional complications or vision loss.
Abstract: PurposeTo evaluate the effect of a single treatment of contact diode laser transscleral cyclophotocoagulation (TSCP) on intraocular pressure (IOP) in patients with refractory glaucoma and perform a historical meta-analysis of the relationship between successful IOP control and various laser paramete
TL;DR: Trabeculectomy augmented with mitomycin C application at both sites could produce a greater lowering of intraocular pressure with low incidence of postoperative complications, and could provide an increased chance of long-term success.
Abstract: PurposeTo assess the efficacy and safety of simultaneous mitomycin C application under conjunctival and scleral flaps in patients with repeat trabeculectomy.MethodsA total of 44 patients (44 eyes) with previous failed filtering surgery were randomized to one of two groups. The both-flaps group compr
TL;DR: Intracranial compressive lesions are an important diagnostic consideration in the workup of normal-pressure glaucoma and should be considered in the selection of patients for follow-up treatment.
Abstract: PurposeTo determine if there was an increased prevalence of intracranial compressive lesions in patients with clinically diagnosed normal-pressure glaucoma compared with a group of patients with progressive primary open-angle glaucoma.Patients and MethodsIn a prospective, comparative, observational
TL;DR: Confocal microscopy is a diagnostic tool used to evaluate microscopic aspects of Haab striae and endothelial morphologic changes in glaucomatous megalocornea and unsuspected alterations, such as nerves abnormalities and focal endothelial tractions by scar tissue were observed.
Abstract: Purpose To report the microscopic findings of congenital glaucoma-related megalocornea using in vivo confocal microscopy. Patients and methods Two consecutive adult patients presenting the typical features of glaucomatous megalocornea underwent a complete ophthalmologic examination. The first patient presented with progressive glaucoma with bilateral megalocornea. The second patient's left eye was affected by megalocornea without actual evidence of glaucoma, whereas the right eye was healthy. Both patients were examined using a new-generation scanning slit corneal confocal microscope. Results In both patients, confocal microscopy revealed a mild reduction of keratocyte density in the mid and rear stroma, a particular abnormal "clew-shaped" morphology of stromal nerves, and the presence of discontinuous hyperreflective structures overhanging the endothelial layer at the level of the Descemet membrane. The endothelium showed severe polymegethism, pleomorphism, and a markedly decreased cell density, and focal cellular lesions were noted. Conclusion Confocal microscopy is a diagnostic tool used to evaluate microscopic aspects of Haab striae and endothelial morphologic changes in glaucomatous megalocornea. Unsuspected alterations, such as nerves abnormalities and focal endothelial tractions by scar tissue, were observed.
TL;DR: Baseline measurements should best rely on the second testing session, since MD and mean sensitivity are somewhat poorer when subjects with no prior VF experience are first tested on the FDT instrument.
Abstract: Purpose: To evaluate the presence, duration and magnitude of a learning effect in serial visual field (VF) testing, using the commercially available frequency doubling technology (FDT) instrument. Patients and Methods: 21 healthy adults with no prior VF experience underwent 6 serial VF tests, using the full-threshold C-20 program of the Zeiss-Humphrey FDT analyzer, on one randomly chosen eye. Tests were spaced at least two days apart. Results: The average mean sensitivity was 32.37 ± 2.6 dB; the average mean deviation (MD) was 1.22 ± 1.8 dB. The MD at the first examination (0.28 ± 2.1 dB) was significantly poorer than at any of the other testing sessions (p<0.003). Similarly, the mean sensitivity at the first examination (31.16 ± 3.0 dB) was significantly lower than any other testing session (p<0.004). The proportion of improvement from the first to the second session was 63% and 65% of the total improvement, for mean sensitivity and MD, respectively. Mean test duration showed a modest reduction, from 4.40 ± 0.3 minutes in the first session to 4.17 ± 0.4 minutes in the last session (p 0.023). A sub-analysis comparison of the different VF segments showed a more prominent learning effect in the peripheral and nasal visual segments (p<0.0001). Conclusion: Baseline measurements should best rely on the second testing session, since MD and mean sensitivity are somewhat poorer when subjects with no prior VF experience are first tested on the FDT instrument. This may be especially true for the purpose of following patients over time.
TL;DR: Long-term follow-up data indicated that 30% of Chinese eyes with acute primary angle closure successfully treated with immediate laser peripheral iridoplasty followed by laser peripheraliridotomy developed peripheral anterior synechiae and an increase in intraocular pressure.
Abstract: PURPOSE To study the long-term clinical course and complications of patients with acute primary angle-closure treated with immediate laser peripheral iridoplasty followed by laser peripheral iridotomy. PATIENTS AND METHODS Consecutive patients with acute primary angle closure treated with immediate laser peripheral iridoplasty, followed by laser peripheral iridotomy, at the Prince of Wales Hospital from July 1997 through January 2000 were followed up to document the clinical course of their disease and any complications from the laser treatment. Visual acuity, intraocular pressure, gonioscopic findings, corneal and lens clarity, iris appearance, pupillary reaction, and progression of glaucomatous optic neuropathy were evaluated. RESULTS Thirty eyes of 29 Chinese patients with acute primary angle closure treated initially with either argon or diode laser peripheral iridoplasty were recruited. The mean follow-up period was 33.0 +/- 9.3 months. Twenty-one eyes (70%) had no further attack and maintained normal intraocular pressure without medications, and 9 eyes (30%) developed chronic angle-closure glaucoma with peripheral anterior synechiae. All eyes had pigmented laser marks on the peripheral iris, but none had peripheral corneal burn. CONCLUSIONS Long-term follow-up data indicated that 30% of Chinese eyes with acute primary angle closure successfully treated with immediate laser peripheral iridoplasty followed by laser peripheral iridotomy developed peripheral anterior synechiae and an increase in intraocular pressure. There were minimal long-term complications on the cornea and the lens from the laser treatment.
TL;DR: Free conjunctival autologous graft is a safe and successful procedure for bleb repair and bleb reduction, however, patients should be aware of the postoperative possibility of requiring medical or surgical intervention for IOP control after revision.
Abstract: Purpose To describe methods and outcomes of excisional revision of a filtering bleb (bleb revision) using free conjunctival autologous graft either for bleb repair or for bleb reduction after trabeculectomy and deep sclerectomy with an implant. Methods Retrospective medical records were reviewed for a consecutive noncomparative case series comprising patients who underwent excisional revision of a filtering bleb between May 1998–January 2001. Excisional revision using free conjunctival autologous graft (bleb revision) was performed either for bleb repair, to treat early and late leaks and hypotony with maculopathy, or for bleb reduction, to improve ocular pain, discomfort, burning, foreign body sensation, tearing, and fluctuations of visual acuity. Methods The revision consisted of bleb excision and free conjunctival autologous graft. The bleb histopathology was analyzed in patients who underwent bleb repair. Results Sixteen patients were included in the study, consisting of nine patients who had a trabeculectomy and seven patients who had a deep sclerectomy with an implant. Bleb revision was necessary in 14 patients due to leaking filtering bleb (bleb repair), and in 2 patients due to bleb dysesthesia (bleb reduction). After a follow-up of 15.1 ± 8.4 months, the mean intraocular pressure (IOP) rose from 7.8 ± 6.3 mm Hg to 14.3 ± 6.5 mm Hg, and the visual acuity from 0.4 ± 0.3 to 0.7 ± 0.3, with a P value of 0.008 and 0.03, respectively. The complete success rate at 32 months, according to the Kaplan-Meier survival curve, was 38.3%, and the qualified success rate was 83.3%. Results Four patients (25%) required additional suturing for persistent bleb leak. To control IOP, antiglaucoma medical therapy was needed for six patients (37.5%) and repeated glaucoma surgery was needed for one patient. Conclusion Free conjunctival autologous graft is a safe and successful procedure for bleb repair and bleb reduction. However, patients should be aware of the postoperative possibility of requiring medical or surgical intervention for IOP control after revision.
TL;DR: Although phacoemulsification and IOL implantation through a superior clear-corneal incision have little effect on mean intraocular pressure (IOP) in a group of patients who have undergone previous trabeculectomy, this procedure may jeopardize the long-term IOP control in individual patients.
Abstract: PurposeTo determine the effect of phacoemulsification with intraocular lens (IOL) implantation, using a superior clear-corneal incision, on the long-term intraocular pressure (IOP) control in patients who have undergone previous trabeculectomy.MethodsTwenty-eight consecutive patients who underwent p
TL;DR: Topical anesthesia is a safe and effective alternative to retrobulbar anesthesia for primary trabeculectomy and does not pose a problem to the surgeon.
Abstract: PURPOSE To compare the safety and efficacy of topical versus retrobulbar anesthesia for primary trabeculectomy METHODS A prospective study of 36 consecutive patients undergoing trabeculectomy who were randomized to receive topical (n = 18) or retrobulbar (n = 18) anesthesia. Operating conditions, patient comfort, and surgical outcome were evaluated. SETTINGS Tertiary-care university hospital ambulatory surgical center. RESULTS There were no differences in operating conditions (P = 0.14), pain during (P = 0.54) or after (P = 0.76) surgery, or supplemental anesthesia required (P = 0.34) between the two groups. Very few patients in either group were bothered by touch sensation, tissue manipulation, or the microscope light. Chemosis, subconjunctival hemorrhage and eyelid hemorrhage were seen exclusively in the retrobulbar group (P <0.03), and were all attributable to the injection. Inadvertent eye movement was present more frequently in the topical group (P = 0.01), although this did not pose a problem to the surgeon. No surgical complications were encountered in either group. CONCLUSION Topical anesthesia is a safe and effective alternative to retrobulbar anesthesia for primary trabeculectomy.