Comparative efficacy of orally and topically administered beta blockers for chronic simple glaucoma.

This open study of beta blockers in chronic simple glaucoma compared the efficacy of once daily (o.d.) oral nadolol therapy with twice daily (b.d.) topical timolol therapy. Sixty eight patients were randomly assigned to starting doses of either 20, 40, or 80 mg of nadolol o.d. (51 patients) or 0.25% timolol b.d. (17 patients) and were seen at weekly intervals for a four-week (short-term) period. Upward dosage titration (80 mg o.d. maximum, nadolol and 0.5% b.d. maximum, timolol) was permitted if, at any visit, the intraocular pressure (IOP) in either eye was greater than 21 mmHg. At the end of 4 weeks the IOPs of a comparable number of patients were controlled (IOP less than 22 mmHg) with 20 mg nadolol o.d. and 0.25% timolol b.d. The 40 mg and 80 mg o.d. nadolol regimens were comparable with each other, superior to the 20 mg regimen, and (at least) equivalent to 0.5% timolol. The absolute degree of IOP reduction achieved with oral nadolol was equivalent to that with topical timolol. Alterations in blood pressure and heart rate were predictably greater with the orally administered beta blocker. Long-term therapy (up to 24 months) in 28 nadolol patients and 5 timolol patients indicates no more likelihood of tolerance with nadolol therapy. Patient withdrawals from the study due to adverse reactions occurred with nadolol but not timolol. Since oral nadolol administered once daily is as efficacious as b.d. topical timolol, it can be recommended as first-line therapy for certain subsets of the glaucoma clinic population.     

The European glaucoma prevention study design and baseline description of the participants

OBJECTIVES: The European Glaucoma Prevention Study seeks to evaluate the efficacy of reducing intraocular pressure (IOP), with dorzolamide to prevent or delay patients affected by ocular hypertension from developing primary open-angle glaucoma. DESIGN: Randomized, double-blinded, controlled clinical trial. PARTICIPANTS: Patients (age > or =30 years) were enrolled from 18 European centers. The patients fulfilled a series of inclusion criteria including the measurements of IOP (22-29 mmHg), two normal and reliable visual fields (VFs) (on the basis of mean defect and corrected pattern standard deviation/corrected loss of variance of standard 30/II Humphrey or Octopus perimetry), and normal optic disc as determined by the Optic Disc Reading Center (vertical and horizontal cup-to-disc ratios; asymmetry between the two eyes < or =0.4). INTERVENTION: Patients were randomized to the treatment with dorzolamide or a placebo. MAIN OUTCOME MEASURES: End points are VF and/or optic disc changes. A VF change during the follow-up must be confirmed by two further positive tests. Optic disc change is defined by the agreement of two out of three independent observers evaluating optic disc stereo-slides. RESULTS: One thousand seventy-seven subjects were randomized between January 1, 1997 and May 31, 1999. The mean age was 57.03 +/- 10.3 years; 54.41% were women and 99.9% were Caucasian. Mean IOP was 23.6 +/- 1.6 mmHg in both eyes. Mean visual acuity was 0.97 +/- 0.11 in both eyes; mean refraction was 0.23 +/- 1.76 diopters in the right eye and 0.18 +/- 1.79 diopters in the left eye. Previous use of medication for ocular hypertension was reported by 38.4% of the patients, systemic hypertension by 28.1%, cardiovascular diseases by 12.9%, and diabetes mellitus by 4.7%. The qualifying VFs were normal and reliable according to protocol criteria. CONCLUSIONS: The mean IOP of the patients enrolled in the European Glaucoma Prevention Study is consistent with the estimated mean IOP (within the range of 22-29 mmHg) found in a large sample of the European population. The European Glaucoma Prevention Study should be able to better address the clinical question of whether pharmacological reduction of IOP (by means of dorzolamide) in ocular hypertension patients at moderate risk for developing primary open-angle glaucoma effectively lowers the incidence of primary open-angle glaucoma.     

玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼

目的:评价玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼的效果。方法:对30例(30眼)伴玻璃体积血的新生血管性青光眼患者采用玻璃体切割联合Ahmed青光眼引流阀植入术治疗,术后随访10~20(平均12)mo。结果:术后眼压控制在6.0~21.0mmHg25眼(其中3例需加用一种降眼压药物),3例眼压>21.0mmHg,2例长期低眼压,成功率83%。结论:玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼,术后成功率高,视力有所提高,并发症少。     

Primary combined trabeculotomy-trabeculectomy for early-onset glaucoma in Sturge-Weber syndrome.

OBJECTIVE: To evaluate the safety and efficacy of primary combined trabeculotomy-trabeculectomy in the management of early-onset glaucoma associated with Sturge-Weber syndrome (SWS). DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Ten eyes of nine patients were included in this study. All patients with SWS who underwent primary combined trabeculotomy-trabeculectomy from January 1993 through December 1996 were included. One patient had bilateral surgery. INTERVENTION: Primary combined trabeculotomy-trabeculectomy. MAIN OUTCOME MEASURES: Pre- and postoperative intraocular pressures (IOPs), corneal clarity and diameters, visual acuities, success rate, bleb characteristics, time of surgical failure (if any), and complications. RESULTS: The mean preoperative IOP was 28.2 mmHg +/- 7.35 mmHg with medication (mean, 1.2 +/- 0.6; range, 0-2). The mean postoperative IOP was 11.8 mmHg +/- 1.8 mmHg, with a mean percent reduction of 55.8 +/- 12.6 in IOP (P < 0.0001). All eyes maintained a postoperative IOP < 16 mmHg without medication over a mean follow-up of 27.6 +/- 16.4 months (range, 12-64 months). Normal corneal clarity was achieved in all eight eyes that had corneal edema. There were no significant intraoperative complications. Postoperatively, one patient developed a shallow anterior chamber with choroidal detachment, which was successfully managed conservatively. CONCLUSION: Primary combined trabeculotomy-trabeculectomy is safe, effective, and sufficiently predictable to be considered the first choice of surgical treatment in early-onset glaucoma associated with SWS.     

Cataract surgery in patients with acute primary angle-closure glaucoma

We investigated the results of cataract surgery in acute angle-closure glaucoma patients whose intraocular pressure (IOP) was not controlled with conventional treatment. We compared postoperative IOP and best corrected visual acuity (BCVA) with preoperative data in 10 eyes of 10 patients who had undergone cataract surgery for acute angle-closure glaucoma. Initial and preoperative mean IOP were 50.0 +/- 6.4 mmHg and 34.9 +/- 9.3 mmHg, respectively. Mean follow-up was 6.3 +/- 5.9 months. Postoperative mean IOP was 12.0 +/- 4.2 mmHg. All eyes were controlled at less than 21 mmHg and seven of them (70%) were controlled at less than 21 mmHg without medication. Postoperative BCVA was improved in 9 eyes. The complications were transient IOP elevation in 2 eyes and exudative membrane in 4. Cataract surgery may be effective to control IOP and improve visual acuity in patients with acute angle-closure glaucoma. However, follow up is necessary because of a high incidence of postoperative complications.     

Timolol 0.5%/dorzolamide 2% fixed combination versus timolol 0.5%/pilocarpine 2% fixed combination in primary open-angle glaucoma or ocular hypertensive patients

PURPOSE: To establish the efficacy and safety of timolol maleate/dorzolamide fixed combination (TDFC) versus timolol maleate/pilocarpine fixed combination (TPFC), each given twice daily, in primary open-angle glaucoma or ocular hypertensive patients. METHODS: In this prospective, multicentred, double-masked trial, 37 patients were treated twice daily with timolol for 4 weeks. They were then randomized to one of the treatment medications for 6 weeks, after which they were treated with timolol again for 2 weeks before being placed on the opposite treatment medication for 6 weeks. RESULTS: A total of 36 patients completed the trial. Their mean baseline intraocular pressure (IOP) was 22.3 +/- 3.7 mmHg. Following 6 weeks of treatment, the mean trough (08.00 hours) IOP was 18.0 +/- 2.2 mmHg for TDFC and 17.4 +/- 2.0 mmHg for TPFC (p = 0.22). The mean diurnal curve IOP was 18.1 +/- 2.2 mmHg for TDFC and 16.7 +/- 1.9 mmHg for TPFC (p = 0.0007). At the remaining time-points (10.00, 18.00 and 20.00 hours), TPFC IOPs were statistically lower than TDFC IOPs (p < 0.03). There were statistically more unsolicited reports of vision change and ocular pain associated with TPFC (p = 0.04). Six patients were discontinued early from TPFC therapy (17%) versus two from TDFC (6%) (p = 0.13). CONCLUSIONS: This study suggests that TPFC can provide at least a similar efficacious reduction in IOP as TDFC in patients with primary open-angle glaucoma or ocular hypertension.     

Effects of topical dorzolamide on IOP after phacoemulsification with different types of ophthalmic viscosurgical devices

PURPOSE: To evaluate the effect of topical dorzolamide on postoperative intraocular pressure (IOP) after routine phacoemulsification surgery with different type of ophthalmic viscosurgical device (OVD). METHODS: Patients who were scheduled for phacoemulsification with intraocular lens (IOL) implantation were evenly divided into four groups. Group I (83 eyes) received one drop of topical dorzolamide immediately after surgery and 1.4% NaHa (BD Visc) was used as a cohesive OVD during IOL implantation. Group II (83 eyes) did not receive any topical antiglaucoma medication after operation and 1.4% NaHa was used as a cohesive OVD. Group III (83 eyes) received topical dorzolamide and 1% NaHa (Healon) was used, and Group IV (83 eyes) did not receive any topical and 1% NaHa was used in operation. Mean postoperative IOPs were compared between groups. RESULTS: Eyes with 1.4% NaHa usage (18.2+/-9.2 mmHg) had higher mean postoperative IOPs than eyes with 1% NaHa usage (15.5+/-5.3 mmHg) (p=0.002). Mean postoperative IOPs were lower in eyes with dorzolamide application (15.6+/-7.2 mmHg) than in eyes without any medication (18.1+/-8.5 mmHg) both in eyes with 1.4% NaHa and 1% NaHa usage (p=0.003). Dorzolamide application caused an average 2.5 mm decrease in mean postoperative IOPs in both groups. CONCLUSIONS: Effects of OVDs on IOP rises after phacoemulsification surgery are closely related to their molecular structure. Increase in viscosity rendered higher postoperative IOP increments. However, topical dorzolamide application effectively reduced postoperative IOP increments in eyes with both Healon and BD Visc use.     

Accuracy of the Tonosafe disposable tonometer head compared to the Goldmann tonometer alone

PURPOSE: To assess the accuracy of the Tonosafe disposable prism tonometer head via a randomised controlled prospective trial. METHODS: The intraocular pressure (IOP) of 69 patients (31 men, 38 women) involving 137 eyes was measured using both the Tonosafe disposable and the Goldmann tono-meter head. The average age of patients was 66.5 years (range 23-93 years). The two examiners (PM and SL) who performed tonometry were masked while a separate observer read the IOP measurements. The order was randomised between Tonosafe and Goldmann devices. The minimum interval between the two measurements was 15 min. Patients with corneal and external diseases were excluded from the study. RESULTS: The mean IOP using the Goldmann tonometer head was 17.44 +/- 4.97 mmHg. The mean IOP using the Tonosafe disposable head was 17.58 +/- 5.03 mmHg. The mean difference was 0.14 +/- 1.73 mmHg (95% CI -0.44, 0.16, P= 0.36). Subgroup analysis on eyes with IOP > 21 mmHg showed the Tonosafe disposable head was on average 0.15 +/- 2.40 mmHg higher than the Goldmann tonometer head. There was a high level of correlation between the IOPs obtained with the Goldmann and Tonosafe heads. Pearson's coefficient of correlation was 0.94 (P < 0.0001). CONCLUSION: The Tonosafe disposable prism head was found to be accurate in IOP measurement, even in the higher range.     

Correlation of asymmetric glaucomatous visual field damage and water-drinking test response

PURPOSE: To determine whether there is a correlation between asymmetric glaucomatous visual field (VF) damage and water-drinking test (WDT) response. METHODS: A retrospective analysis was conducted of VF and WDT data from 101 patients with glaucoma in clinical therapy, who were receiving treatment with the same topical medication in both eyes, and asymmetric VF defect. Eyes were classified according to mean deviation (MD) into "better" and contralateral "worse" eyes. Maximum mean difference in basal IOP was 2 mm Hg between both eyes. The peak IOP and fluctuation obtained with the WDT were compared between both groups. For the statistical analysis, the Tukey post hoc multiple comparison test and paired t-test were used. RESULTS: Better and contralateral worse eyes presented mean MDs of -4.6 +/- 5.3 and -9.0 +/- 7.4 dB, respectively (P < 0.001). Mean basal IOPs were 13.9 +/- 3.3 and 13.9 +/- 3.1 mm Hg, respectively (P = 0.67). Mean maximum IOPs after water ingestion were 16.5 +/- 3.8 mm Hg in the group with less severe VF defect and 17.2 +/- 4.1 mm Hg in the contralateral group with worse visual fields (P < 0.001). Mean fluctuation (maximum IOP - minimum IOP after water ingestion) was 3.6 +/- 1.8 and 4.4 +/- 2.2 mm Hg (P < 0.001), respectively. CONCLUSION: Eyes with worse MDs presented higher IOP peaks and fluctuation after water ingestion. This study demonstrates a lower capacity of eyes with worse glaucomatous lesion to respond to a stimulus that leads to a transitory elevation of IOP.     

Clinical evaluation of the intraocular pressure in patients with glaucoma or ocular hypertension by a self-assessable tonometer.

PURPOSE: To investigate the clinical efficacy of a new patient-operated intraocular pressure tool, the Proview eye pressure monitor (PEPM; Bausch & Lomb, Inc., Rochester, NY), for monitoring intraocular pressure (IOP) in patients with glaucoma or ocular hypertension. PATIENTS AND METHODS: One hundred and forty eyes of 70 Taiwanese patients from the Tri-Service General Hospital (Taiwan, Republic of China) who had been diagnosed with ocular hypertension or glaucoma were studied. After being fully trained during an initial clinic visit, patients measured their own IOP with the PEPM at home. The IOPs were measured again using a Haag-StreitBern Goldmann tonometer (GT; Haag-Streit, K?niz, Switzerland) during subsequent outpatient visits. The training time, assessment of the patients' ease of PEPM use, and accuracy of measured PEPM IOPs in relation to GT IOPs were recorded and analyzed. RESULTS: Relative to GT readings, PEPM readings tended to be overestimated at lower pressure (<10 mmHg) and underestimated at higher pressure (>20 mmHg). Between 10 to 20 mmHg, PEPM measurements did not significantly differ from GT measurements. Up to 80% of the PEPM measurements fell within +/- 3 mmHg of the corresponding GT readings. When consideration was limited to GT readings of > or =21 mmHg, PEPM measured IOPs of > or =21 mmHg with a sensitivity of 80% and a specificity of 90%. The mean satisfaction rating of PEPM use was 88.3 +/- 2.0 (maximum, 100). The mean training time for appropriate use of PEPM was 17.9 +/- 4.0 minutes. The older the patients, the longer the training time that was required. CONCLUSION: Our data suggest that after appropriate training: (1) PEPM and GT measurements correspond well between 10 mmHg and 20 mmHg and (2) PEPM could offer patients with glaucoma or ocular hypertension an easy-to-use, substantially reliable means of selfmonitoring IOP.     

正常眼压性青光眼中眼压与视野间的关系

目的 :探讨正常眼压性青光眼 (normalpressureglaucoma ,NPG)的眼压、视野和相互关系。方法 :分析 98例新诊断NPG患者的眼压曲线和视野状态。结果 :眼压曲线呈单峰式波动 ,双眼对称 ,总体平均水平位于 16mmHg上下 ,波动幅度 <2mmHg。患者男性眼压均值右眼为15 70± 2 5 7mmHg、左眼为 15 46± 2 %41mmHg ,女性右眼为 16 5 2± 1 97mmHg、左眼为 16 45± 2 0 1mmHg ,眼压与年龄相关不显著 (P >0 0 5 )。患者各相应年龄组的眼压均高于正常老年人 (分别P <0 0 2 ,P <0 0 1,P <0 0 0 1)。在 98例患者 196眼的视野中 ,5 2例患者为单眼损害 ,14 4眼的视野损害在损害形态和部位上与眼压升高的原发性开角型青光眼 (hp -POAG)相符合 ,但旁中心损害侵入中心固视区者约占 2 2 2 2 %。在两眼视野损害相对轻重的划分中 ,视野损害不同分级状态下眼压的平均值、最高值和波动差二者间差异不显著 (P >0 0 2 ) ,单侧视野损害患者患眼与对侧眼眼压差异不显著 (P >0 0 5 ) ,但同侧视野损害较重且眼压较高眼数的构成比最大 ,约占 5 5 1%(P <0 0 1)。结论 :NPG患者的眼压状态在单值水平、波动幅度和双眼对称性上均与一般群体生理眼压相一致 ,但平均眼压高于年龄可比的正常老年人。视野损害特征与hp -POAG相符合 ,     

Tight orbit syndrome: a previously unrecognized cause of open‐angle glaucoma

Purpose: To describe a new syndrome of tight orbit and intractable glaucoma with a poor visual prognosis. Methods: A retrospective observational case series of six patients seen at two centres between 2001 and 2007 assessing intraocular pressure (IOP), best‐corrected visual acuity and visual field. Results: Three men and three women, ranging in age at diagnosis from 14 to 53 years, demonstrated similar orbital features and progressive visual field loss despite intensive management with medication and laser and operative surgery. Highest IOPs ranged from 30 to 50 mmHg. Trabeculectomy and/or glaucoma drainage devices were attempted in five patients but all failed. One patient underwent orbital decompression with achievement of IOP control. Final IOP at last follow‐up was variable; only two patients achieved IOP in the normal range, with the rest ranging from 25 to 40 mmHg. All patients had advanced visual field loss. Conclusion: Tight orbit syndrome presents a serious clinical challenge. Despite maximum medical therapy and surgical intervention IOP is difficult to control, resulting in progressive visual field loss.     

Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery

PURPOSE: To evaluate the safety and efficacy of trabeculectomy with or without mitomycin-C (MMC) in the management of glaucoma in aphakia and pseudophakia following congenital cataract surgery. PATIENTS AND METHODS: All patients of glaucoma with aphakia or pseudophakia who underwent trabeculectomy with or without MMC from January 1989 to April 2000 were included. The medical records of 19 consecutive patients (23 eyes) were reviewed. Data collected from a retrospective chart review were analysed. Outcome measures were evaluated using Kaplan-Meier survival analysis. Pre- and postoperative intraocular pressures (IOPs), visual acuities, success rate, bleb characteristics, surgical failure and complications were the main outcome measures. Successful IOP control was defined as an IOP between 6 and 21 mmHg, without antiglaucoma medications, without further antiglaucoma surgery and without any sight-threatening complication. RESULTS: The mean age of patients was 8.8+/-5.5 years at the time of trabeculectomy with MMC compared to 11.0+/-12.4 years for trabeculectomy without MMC. Eight patients underwent trabeculectomy with MMC and 11 patients underwent trabeculectomy without MMC. There was no statistically significant difference between the two groups in terms of visual acuity, IOP, antiglaucoma medications, age at cataract surgery and at trabeculectomy. The IOP reduced from a preoperative level of 34.2+/-8.9 mmHg (range: 20-52) to a postoperative level of 18.4+/-12.2 mmHg (range: 2-60) with a mean follow-up of 24.2+/-17.9 months. The mean reduction in IOP in the MMC group was 15.5+/-17.3 and 16.3+/-13.8 mmHg in the other group (P = 0.967). Overall, complete success was achieved in 36.8%, qualified success in 21.1% and surgical failure in 42.1% of patients with a mean follow-up of 24.2+/-17.9 months. There was no difference in the success between the two groups at the last follow-up. One patient developed bleb-related endophthalmitis in both eyes following trabeculectomy with MMC. CONCLUSIONS: The success rate of trabeculectomy in glaucoma following congenital cataract surgery was 36.8% at the end of 3 years. The present study proves a poor success rate of trabeculectomy in a small series of aphakic Asian Indian patients even with the use of MMC.     

Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments.

BACKGROUND: Intravitreal silicone oil injection used for managing complicated retinal detachments can be associated with elevated intraocular pressure (IOP). This study was undertaken to determine the incidence of glaucoma in patients who underwent silicone oil injection, as well as to evaluate the effectiveness of medical and surgical therapy in patients in whom glaucoma developed. METHODS: The postoperative courses of 50 eyes of 47 consecutive patients who underwent pars plana vitrectomy and silicone oil injection for the management of complicated retinal detachments were reviewed retrospectively. The outcomes of patients who underwent silicone oil removal and/or glaucoma surgery also were evaluated. RESULTS: The mean overall postoperative IOP before any glaucoma surgery was 16.7 +/- 9.3 mmHg (range, 0 to 45 mmHg), with a mean follow-up of 16.6 +/- 12.1 months (range, 2 to 51 months). Twenty-four (48%) eyes had postoperative IOPs of at least 25 mmHg and IOP elevations of at least 10 mmHg above the preoperative levels. Twenty-one (42%) eyes underwent complete removal of silicone oil and/or glaucoma surgery to effect IOP control. The IOPs were controlled to 21 mmHg or less (but > 5 mmHg) in 8 of 14 eyes that underwent removal of silicone oil alone, in 3 of 5 eyes that underwent Molteno implantation, and in 1 eye that underwent Nd:YAG transscleral cyclophotocoagulation, but not in 1 eye that underwent a modified Schocket procedure (mean follow-up, 13.5 +/- 11.0 months; range, 0.2 to 33 months). CONCLUSION: Intraocular pressure elevation is a common occurrence after intravitreal silicone oil injection. The underlying mechanism may often be multifactorial in nature. Patients in whom uncontrolled IOP develops may benefit from aggressive medical and/or surgical treatment with silicone oil removal, glaucoma implants, or cyclodestructive procedures.     

Target intraocular pressure and risk factors for progression of visual field loss in primary open-angle glaucoma

PURPOSE: Evaluation of intraocular pressure(IOP) control below the target level stated by Iwata and study of risk factors for progression of visual field loss in primary open-angle glaucoma (POAG) despite successful reduction of IOP. SUBJECTS AND METHODS: Statistical difference of visual field deterioration between 27 eyes of POAG with IOPs above target levels and 48 eyes of POAG with IOP below target levels was examined for 28.1 +/- 10.2(mean +/- standard deviation) months. The relationship between the progression of visual field loss and factors of initial visual field loss, mean IOP, variance of IOP, peripapillary atrophy (zone beta), records of glaucoma surgery, age, and sex were studied in 48 patients(48 eyes) with IOPs below target levels. RESULTS: Eight of the 48 eyes(16.7%) showed progression of visual field loss with IOPs below their target levels whereas 15 of the 27 eyes(55.6%) had IOPs above their target levels(p = 0.002). The risk factors for the progression of visual field loss in POAG despite good control of IOP were severity of initial visual field loss(p = 0.003), peripapillary atrophy(p = 0.002), and male sex(p = 0.03). CONCLUSIONS: The control of IOP below target level is beneficial for patients with POAG. However, the risk factors which represent circulatory damage, such as peripapillary atrophy, may have a bad influence on the continuing deterioration of visual fields in patients with severe visual field damage, independently of good control of IOP.     

Refractory glaucoma – tube or diode?

BACKGROUND: The aim of the present study was to assess the relative effectiveness of tube surgery and cyclodiode laser in terms of achieving intraocular pressure control. METHODS: A retrospective study was undertaken to compare patients undergoing double plate Molteno tube implantation with patients undergoing diode cyclophotocoagulation. Intraocular pressure (IOP) was documented at 7 days prior to surgery and postoperatively at various time points. Surgical success was defined as a final IOP between 6 (inclusive) and 21 mmHg (inclusive), without the use of topical medication, while 'qualified' success was defined as IOP within the same range with the use of topical medication. RESULTS: Twenty-eight diode patients and 26 tube patients were included for the study. An average follow up of 150 weeks (range = 21-322 weeks) was available. Mean preoperative IOP was 37 +/- 12 mmHg for the tube group and 39 +/- 16 mmHg for the diode group (t = 0.51, P = 0.61). The final IOP was 17 +/- 12 mmHg for the tube group and 21 +/- 13 mmHg for the diode group (t = 0.35, P = 0.73). Surgical success was achieved in 46% of tube eyes and 11% of diode eyes, while qualified success was achieved in 81% of tube eyes compared with 64% of eyes in the diode group. Two eyes which underwent diode became phthisical. CONCLUSIONS: IOP control may be achieved in a greater number of patients with tube surgery. The possible benefits of IOP control in diode patients need to be weighed against the risks of long-term visual loss and the need for multiple re-treatments in this group.     

Sinusotomy with intraoperative mitomycin C administration in selected eyes with advanced glaucomatous damage

PURPOSE: To study the surgical outcome of sinusotomy with intra-operative mitomycin C administration (0.04%, 3 minutes) in a total of 17 selected glaucoma eyes from 14 patients with advanced glaucomatous damage. Selection criteria were 1. an eye with visual field defect threatening the central fixation, while the central visual acuity of the contralateral eye was already impaired; and/or 2. an aphakic or pseudophakic eye with advanced glaucomatous damage in a patient of advanced age. MATERIALS AND METHODS: Patients' age, preoperative mean deviation (Humphrey 30-2 program) and intraocular pressure (IOP) averaged 63.5 +/- 11.1 (mean +/- standard deviation) years, -18.6 +/- 6.7 (mean +/- standard deviation) dB, and 20.7 +/- 4.1 (mean +/- standard deviation) mmHg, respectively. RESULTS: No postoperative hypotony (< 5 mmHg) or deterioration of visual acuity equal to or more than 2 lines of Ishihara Visual Acuity Chart were encountered and the mean postoperative IOP ranged between 11 and 13 mmHg up to 18 months postoperatively with less medication than preoperatively. The success was defined as IOP < or = 15 mmHg without oral carbonic anhydrase inhibitors and with less medication than preoperatively. The life-table method analysis according to the above criteria yielded a success probability of 70.6 +/- 11.1 (mean +/- standard deviation) % (standard error) at 18 months postoperatively.     

Sinusotomy with Intraoperative Mitomycin C Administration in Selected Eyes with Advanced Glaucomatous Damage

Purpose: The surgical outcome of sinusotomy with intra-operative mitomycin C administration (0.04%, 3 minutes) in a total of 17 selected glaucoma eyes from 14 patients with advanced glaucomatous damage was examined. Selection criteria were (1) an eye with visual field defect threatening the central fixation, while the central visual acuity of the contralateral eye was already impaired; and/or (2) an aphakic or pseudophakic eye with advanced glaucomatous damage in a patient of advanced age.Materials and Methods: Patient's age, preoperative mean deviation (Humphrey 30-2 program) and intraocular pressure (IOP) averaged 63.5 +/- 11.1 (mean +/- standard deviation) years, -18.6 +/- 6.7 (mean +/- standard deviation) dB, and 20.7 +/- 4.1 (mean +/- standard deviation) mmHg, respectively.Results: No postoperative hypotony (< 5 mmHg) or deterioration of visual acuity equal to or more than 2 lines of Ishihara Visual Acuity Chart were encountered and the mean postoperative IOP ranged between 11 and 13 mmHg up to 18 months postoperatively with less medication than preoperatively. The success was defined as IOP 相似文献   

The negative correlation between age and intraocular pressures measured nyctohemerally in elderly normal-tension glaucoma patients

PURPOSE. To evaluate the correlation between age and intraocular pressure (IOP) measured every 3 h for 24 h in older normal-tension glaucoma (NTG) patients. METHODS. Ninety consecutive patients suspected of having NTG on the basis of both visual field defect and disc appearance were hospitalized for measurement of nyctohemeral IOP every 3 h over a 24-h period with a Goldmann tonometer after a 4-week wash-out of any existing medication. Sixty-nine patients (76.7%) were diagnosed as having NTG. Sixty-nine eyes of 69 subjects were enrolled for this prospective, cross-sectional study. They were divided into two groups by age (cut-off between 59 and 60 years: group 1, under 60 years; group 2, over 60 years). The correlations between age and the mean, maximum and minimum IOP and IOP variation of the eight nyctohemeral IOP measurements nyctohemerally were evaluated for each group. The times of day at which the maximum and minimum IOPs were observed were recorded. RESULTS. Groups 1 and 2 consisted of 28 patients (age: 50.2+/-6.1 years) and 42 patients (age: 70.3+/-6.1 years) ( P<0.0001), respectively. Neither mean, maximum or minimum IOP nor the IOP variation was significantly different between the groups (all P values > or =0.115). The mean, maximum and minimum IOP in group 2 were all correlated with age ( n=41; r=-0.516, P=0.0004; r=-0.434, P=0.004; r=-0.522, P=0.0004, respectively), while none of those in group 1 was correlated with age (all P values > or =0.303). CONCLUSION. The IOPs of the elder NTG patients have a negative correlation with age while those of the younger ones have no relation to age.