Adjunctive mitomycin C in primary trabeculectomy in young adults: a long-term study of case-matched young patients

· Objective: The purpose of this study was to determine the efficacy of initial mitomycin C (MMC)-augmented trabeculectomy for uncomplicated glaucoma in young patients. · Methods: A retrospective chart review was performed on all glaucoma patients aged between 15 and 40 years without previous surgery that underwent initial trabeculectomy with MMC between 1988 and 1995 at the University Eye Hospital of Cologne. Success (survival) was defined as an intraocular pressure (IOP) of 21 mmHg or lower, with (qualified success) or without (complete success) glaucoma medications. The results were compared with a case-matched control group that did not receive antiproliferative therapy. · Results: Eleven eyes of 11 patients fulfilled the inclusion criteria of initial MMC-augmented trabeculectomy. Using cumulative life-table analysis the success rate was 91% at 1 year and 73% at 5 years for the control group. For the MMC group the success rate was 91% at 1 year and 5 years, respectively. At final visit, mean IOP was significantly (P<0.001) lower for the MMC group (13.3±3.9 mmHg) than for controls (18.0±1.3 mmHg). Significant differences were also found in the complication rate: complications associated with excessive aqueous overfiltration, such as shallow anterior chamber (36%), choroidal detachment (45%) and persistent hypotony (27%), featured particularly in the MMC group. Conversely, scarring of the filtering bleb (18%) and Tenon’s cysts (18%) were observed exclusively in control eyes. · Conclusion: The present results suggest that initial MMC trabeculectomy for uncomplicated glaucoma in young patients significantly reduces IOP and number of adjunctive medications, postoperatively, albeit at the price of a high incidence of hypotony. Received: 24 November 1997 Revised version received: 19 January 1998 Accepted: 27 January 1998     

Aqueous flare in retinitis pigmentosa

· Background: The purpose of this study was to quantify blood-ocular barrier impairment by measuring aqueous flare in retinitis pigmentosa (RP) and to search for clinical correlations. · Methods: Forty-nine patients (94 eyes) with RP and 85 normal controls were examined. Aqueous flare was quantified with the noninvasive laser flare-cell meter (FC-1000, Kowa, Japan). Degrees of cystoid macular edema (CME), vitreous pigment dusting (VPD), intraretinal migration of retinal pigment epithelium, and waxy pallor of the optic nerve head were determined semiquantitatively by biomicroscopy. Data were analyzed using the t-test the Mann-Whitney U-test, the chi-squared test and regression analysis by taking into account the dependency of data from two eyes of the same patients. · Results: Aqueous flare (photon counts/ms) was significantly higher in RP (mean 10.11±3.53) than in normals (3.89±0.94; P<0.001). Clinically significant CME was present in 26% of eyes with RP, being significantly more frequent in autosomal dominant RP (11 of 16 eyes, 69%) than in other variants (17%; P<0.005). Multivariate analysis revealed that CME was most strongly associated with flare values (r=0.84, P<0.01), whereas – after adjusting for CME – correlations between aqueous flare and other clinical findings did not reach significance. · Conclusion: RP eyes show increased aqueous flare values, indicating impairment of blood-ocur barriers. This appears to be associated with CME and with autosomal dominant RP. Received: 27 June 1997 Accepted: 1 October 1997     

小切口白内障摘除联合小梁切除术治疗开角型青光眼

目的:观察小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术治疗合并白内障的开角型青光眼的疗效。方法:回顾分析2004-01/2010-06在我院住院行小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术且资料完整的32例56眼开角型青光眼的疗效,根据患者年龄、眼球筋膜情况、视神经受损程度及术后要求达到的靶眼压确定术中用或不用丝裂霉素C(MMC),其中29眼术中使用MMC,27眼不使用MMC,患者均有明显的晶状体混浊。随访6～24(平均14.2±6.7)mo。结果:术中使用MMC组29眼,术前眼压(39.2±10.6)mmHg,术后眼压(13.2±5.5)mmHg,仅1眼需辅助1种局部降眼压药。不使用MMC组27眼,术前眼压(30.1±9.2)mmHg,术后眼压(17.5±8.1)mmHg,有4眼需辅助1种局部降眼压药,1眼需辅助2种局部降眼压药,1眼再手术。术后不需使用降眼压药者49眼(88%)。术后47眼(84%)最佳矫正视力提高。结论:小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术可有效治疗合并白内障的开角型青光眼。     

Anterior chamber paracentesis and pH values in patients with acute primary angle closure

Background

To assess the efficacy and safety of anterior chamber paracentesis (ACP) and the changes in pH values in eyes with acute primary angle closure (APAC).

Methods

This retrospective case-control study involved 22 patients with APAC who underwent ACP (study group) and 21 patients with APAC who did not undergo ACP (control group). Intraocular pressure (IOP) and visual acuity were measured before treatment and 15 min and 24 h after treatment in both groups. The pH of aqueous humor was measured immediately after ACP in the study group.

Results

A total of 43 eyes in 43 patients were reviewed. The IOP 15 min after ACP (23.3?±?9.6 mmHg) and 24 h after ACP (21.6?±?12.0 mmHg) were significantly lower than that before ACP (58.6?±?12.9 mmHg). The IOP 15 min after ACP was significantly lower than the IOP 15 min after conventional treatment (55.4?±?10.3 mmHg). Visual acuity recovery was achieved earlier after ACP than after conventional treatment. Hyphema after ACP was noted in one eye. The mean pH of the aqueous humor in APAC was 6.99?±?0.35. The pH of the aqueous humor significantly correlated with the duration of acute IOP elevation and the IOP before ACP.

Conclusions

ACP is an effective and safe procedure. The pH of aqueous humor is lower in eyes with APAC of longer duration and in eyes with higher IOP at presentation.     

激光蛋白细胞检测仪在葡萄膜炎中的应用价值

目的:探讨激光蛋白细胞检测仪(laser flare cell meter,LFCM)定量测定葡萄膜炎患者房水闪辉的临床应用价值。方法:选择2009-07/2010-07在我院就诊、复查的葡萄膜炎患者129例171眼,根据其临床特点将其分为前葡萄膜炎组87例87眼,中间葡萄膜炎组10例20眼,后葡萄膜炎组32例64眼;正常对照组50例100眼。应用LFCM(FM-600型)检测各期患者房水闪辉情况,检查前所有患者均经裂隙灯显微镜检查,并进行房水闪辉分级。结果:前葡萄膜炎患者裂隙灯检查前房闪辉48眼(1+),35眼(2+),2眼(3+),2眼(4+);LFCM检测1～2级房水闪辉的平均值分别为28.6±6.7pc/ms,144.3±28.1pc/ms,3～4级房水闪辉由于背景干扰大,检测结果显示警告或无法检测;前葡萄膜炎患者1～2级房水闪辉的裂隙灯显微镜检查与LFCM测定结果呈正相关(r=0.901,P<0.01);与对照组房水闪辉值比较(5.1±1.8pc/ms),差异具有统计学意义(P<0.05)。中间葡萄膜炎患者裂隙灯检查前房闪辉10眼(1+),10眼(2+),LFCM检测1～2级房水闪辉的平均值分别为31.7±5.0pc/ms,130.7±12.9pc/ms;中间葡萄膜炎患者1～2级房水闪辉的裂隙灯显微镜检查与LFCM测定结果呈正相关(r=0.867,P<0.01);与对照组房水闪辉值比较,差异具有统计学意义(P<0.05)。后葡萄膜炎患者裂隙灯检查前房闪辉均为0级,LFCM检测房水闪辉的平均值为9.8±3.1pc/ms,高于对照组,差异具有统计学意义(P<0.05)。结论:LFCM(FM-600型)可确切判断葡萄膜炎患者轻、中度的血-房水屏障破坏,对判断眼前段炎性反应和指导临床治疗有重要意义。     

小梁切除术联合丝裂霉毒C治疗青光眼的临床疗效

目的:探讨小梁切除联合丝裂霉素C(mitomycin C,MMC)治疗青光眼的临床疗效。方法:原发性青光眼患者57例95眼随机分为两组,为小梁切除术联合MMC(T+MMC)组(31例54眼)和小梁切除术(T)组(26例41眼),术后随访4~6mo,观察其前房、滤过泡、眼压及并发症。结果:T+MMC组术后1d平均眼压为11.24±3.73mmH g,较术前眼压明显降低(P<0.01),与T组比较差异无统计学意义(P>0.05)。而末次随访平均眼压为16.15±3.62mmH g,与T组(18.79±5.27mmH g)比较具有统计学差异(P<0.05)。T+MMC组和T组功能性滤过泡形成率分别为94.44%和80.48%,组间差异具有显著统计学意义(P<0.01)。两组偶发前房出血、角膜水肿,均治愈。结论:采用小梁切除术联合MMC治疗青光眼,术后眼压控制及滤过泡形态维持均良好,并发症少。     

Quantification of blood-aqueous barrier breakdown after photorefractive keratectomy for myopia

· Background: Photorefractive keratectomy (PRK) using the excimer laser is a well-established surgical technique for correction of mild to moderate myopic refraction errors in case of spectacle or contact lens incompatibility. As it is still uncertain whether this procedure causes intraocular inflammatory changes, it was the purpose of this study to quantify breakdown of the blood-aqueous barrier following PRK and to look for possible correlations with clinical parameters. · Patients and methods: Aqueous flare was quantified using the laser flare-cell meter after medical pupil dilation preoperatively and on days 1, 3 and 7 as well as 1 month and 3 months following PRK with a 193-nm excimer laser (MEL 60, Aesculap-Meditec) in 37 eyes of 22 patients. The preoperative spherical equivalents were −4.4±3.1 D (range −1.5 to −8.0 D). Pre-, intra- and postoperative treatment was standardized. · Results: Preoperatively, aqueous flare values were 3.9±0.8 photon counts/ms and showed no significant correlation with the spherical equivalent (p>0.1). Postoperatively, aqueous flare rise was very small with flare values not significantly higher than preoperative values. All postoperative flare values were below the normal limit ( <8.0 photon counts/ms). Flare was highest on day 3 after PRK surgery. There was no statistically significant correlation between aqueous flare and depth of stromal ablation. The number of aqueous “cells” did not increase following PRK at any postoperative follow-up examination. · Conclusion: Our results indicate that PRK in mild to moderate myopia does not cause a significant breakdown of the blood-aqueous barrier. Received: 28 January 1998 Revised version received: 6 April 1998 Accepted: 4 May 1998     

Mitomycin‐C‐augmented deep sclerectomy in patients with primary open‐angle glaucoma and exfoliation glaucoma: a 1‐year prospective study

Purpose: To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in patients with primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG). Methods: A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication. Results: Preoperatively, the mean IOPs were 23.1 ± 5.8 and 25.4 ± 8.3 mmHg, and 13.8 ± 6.1 and 11.2 ± 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use. Conclusion: DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications.     

Mitomycin C‐augmented deep sclerectomy in primary open‐angle glaucoma and exfoliation glaucoma: a three‐year prospective study

Purpose: To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG) patients. Methods: A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopuncture treatments and complications were compared postoperatively after 36‐ month follow‐up. Surgery was considered as a complete success when IOP was <18 mmHg without antiglaucoma medication. Results: Preoperatively the mean IOPs were 23 ± 6 mmHg and 25 ± 8 mmHg, and 13 ± 4 mmHg and 11 ± 4 mmHg in the POAG and ExG groups, respectively, at 36 months. At 36 months, 74% and 73% of surgeries were a complete success in the POAG and ExG group, respectively [not significant (NS)]. Two patients (8%) of the POAG group and one of the ExG group (3%) were receiving antiglaucoma medication at 36 months (NS). Nd:YAG laser goniopuncture was performed more often in the ExG group (87%) than in the POAG group (61%, p = 0.024). Postoperatively choroidal detachment occurred in 16% of eyes in the POAG group and in 11% of eyes in the ExG group (NS). Conclusions: DSCI with MMC augmentation appears to be as effective in patients with ExG and POAG in lowering IOP to target levels at medium term with few immediate postoperative complications.     

NPTS联合透明质酸钠生物胶治疗开角型青光眼

目的:回顾总结非穿透性小梁切除联合透明质酸钠生物胶植入及丝裂霉素应用治疗开角型青光眼的疗效。方法:对20例24眼开角型青光眼施行非穿透性小梁切除手术,术中巩膜床植入透明质酸生物胶及应用丝裂霉素,术后随访12～36mo,观察眼压、视力、前房角、滤过泡等情况。结果:术后1,2,3a时眼压分别为16.32±5.25,17.28±5.70,18.26±5.20mmHg,与术前眼压35.52±7.6mmHg相比明显下降(P<0.01)。术后视力达到或高于术前水平22眼,视力下降2眼。术中、术后均未出现浅前房及前房炎症反应。24眼均有功能型滤过泡。结论:非穿透性小梁切除联合透明质酸钠生物胶植入及丝裂霉素应用能安全、有效地治疗开角型青光眼。     

Prophylactic use of timolol maleate to prevent intraocular pressure elevation after Nd-YAG laser posterior capsulotomy

Purpose To evaluate the effective prophylaxis of topical 0.5% timolol maleate for the intraocular pressure rise following Nd-YAG laser posterior capsulotomy. Methods A total of 190 eyes of 184 patients who underwent Nd-YAG laser posterior capsulotomy were randomly assigned to pre-treatment with either topical application of 0.5% timolol maleate (treatment group) or nothing (control group). Results The mean intraocular pressure (IOP) of the treatment group was 14.8 ± 3.0 mmHg before capsulotomy and 15.7 ± 3.4 mmHg after capsulotomy (P > 0.05), whereas IOP was 15.1 ± 3.3 mmHg and 17. 2 ± 4.3 mmHg (P < 0.05) for the control group. There was no statistically significant difference between the two groups with regard to mean IOP before capsulotomy (P > 0.05), but a statistically significant difference was seen between the two groups after capsulotomy (P < 0.05). Six of 91 eyes (6.6%, two with aphakia) in the treatment group had an IOP elevation greater than 6 mmHg compared with 14 of 99 eyes (14.1%, eight with aphakia) in the control group (P < 0.01). Conclusion Pre-treatment with a topical application of 0.5% timolol maleate is effective in preventing IOP elevation after Nd-YAG laser posterior capsulotomy.     

Effect of different application depths of mitomycin-C in deep sclerectomy with collagen implant: a randomized controlled trial

Purpose: To evaluate effects of mitomycin‐C (MMC) in deep sclerectomy with collagen implant applied under the superficial scleral flap or under the deep scleral flap. Methods: Twenty‐five patients with primary or secondary open‐angle glaucoma and at high risk for postoperative cicatrization underwent deep sclerectomy and were randomly distributed to the two treatment arms. In the superficial MMC group (S‐MMC), MMC was applied under the superficial scleral flap using a soaked sponge for 60 s; in the deep MMC group (D‐MMC), MMC was applied under the deep scleral flap for 60 s before entering the Schlemm's canal. In both groups, remaining MMC was irrigated with 40 mL balanced salt solution. Patients were followed up for up to 2 years. The volume of filtering blebs was studied with ultrasound biomicroscopy at the last follow‐up visit. Results: Mean preoperative intraocular pressure (IOP) was 20.5 ± 8.9 mmHg for D‐MMC and 21.6 ± 6.6 mmHg for S‐MMC eyes (P = 0.67). The mean postoperative IOP was 5.3 ± 3.3 mmHg (D‐MMC) and 6.9 ± 4.8 mmHg (S‐MMC) at day 1 (P = 0.22) and 11.4 ± 6.3 mmHg (D‐MMC) versus 11.3 ± 4.6 mmHg (S‐MMC) at last follow up (P = 0.54). The mean number of medications per patient was reduced from 2.5 ± 0.5 to 0.4 ± 0.5 (D‐MMC) (P < 0.001) and from 2.5 ± 0.9 to 0.3 ± 0.4 (S‐MMC) (P < 0.001). Ultrasound biomicroscopy at 24 months showed mean intrascleral space volume of 1.97 ± 0.35 mm3 (D‐MMC) and 5.68 ± 0.42 mm3 (S‐MMC) (P < 0.05). Conclusion: No significant difference in efficacy and safety was found between the two groups at a mean of 19.2 months of follow up. Deep scleral application of MMC, however, seems to produce significantly smaller intrascleral blebs.     

The effect of lateral decubitus position on intraocular pressure in healthy young subjects

Purpose: To investigate the effect of change of body posture from supine to lateral decubitus position (LDP) on intraocular pressure (IOP) in healthy young subjects. Methods: We evaluated 38 eyes of 19 healthy young Korean subjects. IOP was measured using Tonopen XL^® in both eyes in the sitting and supine position, 5 and 30 min after right LDP and 5 min after returning to the supine position. A week later, IOP was measured in the same sequence except that the subjects assumed the left LDP. The eye on the lower side in the LDP was termed as a dependent eye. Results: The mean IOP of the dependent eyes increased significantly at 5 min after changing from supine to right (16.26 ± 2.73 mmHg versus 18.54 ± 2.95 mmHg, p < 0.01) or left LDP (15.53 ± 2.41 mmHg versus 17.53 ± 3.37 mmHg, p < 0.01); this IOP increase in the dependent eyes persisted at 30 min after changing to right (18.47 ± 2.97 mmHg, p < 0.01) or left LDP (17.79 ± 2.20 mmHg, p < 0.01). Upon returning to the supine position, IOP of the dependent eyes decreased significantly (16.83 ± 2.67 mmHg, p < 0.01 for right LDP and 16.47 ± 2.32 mmHg, p < 0.01 for left). However, this effect of the positional change was not found in the non‐dependent eyes (all, p > 0.05). Mean IOP in the dependent eye was significantly higher than that in the non‐dependent eye at 30 min after changing to the right (+0.89 ± 1.52 mmHg) or left LDP (+1.84 ± 2.03 mmHg). Conclusion: The postural change from supine to LDP significantly increased IOP of the dependent eyes.     

Relationship between optic disc cupping change and intraocular pressure control in adult glaucoma patients

• Background: Until recently, there has been a paucity of quantitative evidence for intraocular pressure (IOP)-dependent optic disc cupping change in adult glaucoma patients. Therefore, we investigated the relationship between optic disc cupping change and IOP control. • Methods: The study involved 78 eyes of 78 randomly selected adult patients with early to moderate chronic open-angle glaucoma (COAG), treated on various therapeutic regimens, who had had two consecutive successful optic disc analyses with the Rodenstock Optic Nerve Head Analyzer 15.8 ± 14.8 weeks apart. • Results: The mean initial IOP of 27 eyes (34%) with cupping reversal did not differ from that of 17 eyes (22%) demonstrating progressive deterioration (29.2 ± 8.8 vs 26.2 ± 6.1 mmHg,P > 0.5), but the reversal group did have a significantly greater mean IOP decrease than the progression group (−10.8 ± 7.9 vs −1.0 ± 7.7 mmHg,P < 0.001) and significantly lower mean final IOP (18.3 ± 6.1 vs 25.2 ± 7.9 mmHg,P < 0.003). • Conclusion: A decrease of optic disc cupping is more likely with a greater IOP reduction and a lower final IOP, and an increase of cupping is more likely with less or no IOP reduction and a higher final IOP. Part of the content was presented as a paper of PAAO at the 1991 Joint Annual Meeting of the AAO/PAAO, Anaheim, California The authors have no proprietary interest in the Rodenstock Optic Nerve Head Analyzer     

Association between corneal hysteresis and central corneal thickness in glaucomatous and non‐glaucomatous eyes

Purpose: We aimed to determine corneal hysteresis values (CH) using the ocular response analyser (ORA) in non‐glaucomatous and glaucomatous eyes and their relationship with central corneal thickness (CCT). Methods: Corneal hysteresis, intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) and CCT were prospectively evaluated in 74 non‐glaucoma subjects with IOP < 21 mmHg and in 108 patients with treated primary open‐angle glaucoma (POAG). One eye in each subject was randomly selected for inclusion in the analysis. Results: Mean (± standard deviation [SD]) age was 59.2 ± 14.2 years in the non‐glaucoma group and 62.4 ± 9.8 years in the glaucoma group. Mean (± SD) GAT IOP was 15.7 ± 2.65 mmHg and 16.38 ± 2.73 mmHg in the non‐glaucoma and glaucoma groups, respectively. There was no statistically significant difference between the two groups in mean age (p = 0.396) or mean GAT IOP (p = 0.098). Mean (± SD) CH was 10.97 ± 1.59 mmHg in the non‐glaucoma and 8.95 ± 1.27 mmHg in the glaucoma groups, respectively. The difference in mean CH between the two groups was statistically significant (p < 0.0001). There was a strong positive correlation between CH and CCT in the non‐glaucoma group (r = 0.743) and a significantly (p = 0.001) weaker correlation (r = 0.426) in the glaucoma group. Conclusions: Corneal hysteresis was significantly lower in eyes with treated POAG than in non‐glaucomatous eyes. The corneal biomechanical response was strongly associated with CCT in non‐glaucoma subjects, but only moderately so in glaucoma patients. It can be assumed that diverse structural factors, in addition to thickness, determine the differences in the corneal biomechanical profile between non‐glaucomatous and glaucomatous eyes. Corneal hysteresis could be a useful tool in the diagnosis of glaucoma.     

Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma

Background: To report the outcome of intravitreal Bevacizumab followed by Ahmed valve implantation in the management of neovascular glaucoma in a patient group with extended follow-up. Methods: The records of 16 patients (18 eyes) with neovascular glaucoma refractory to medical therapy who presented to a single surgeon between 2006–2008 were reviewed. Patients received pan-retinal photocoagulation and then intravitreal Bevacizumab followed by Ahmed valve implantation. The main outcome measures were: control of IOP (with or without additional medication), visual acuity (VA) and failure (IOP >21 mmHg or <6 mmHg, reoperation for glaucoma, or loss of light perception). Results: Pre-operatively, all patients received pan-retinal photocoagulation followed by IVB at a mean of 15.9 (range 4–60) days prior to AGV. The mean pre-operative IOP was 37.1 mmHg (±13.4) on 3.2 (±0.87) medications. Of the 18 eyes, 14 eyes (78%) were treated with AGV alone and 4 eyes (22%) with AGV combined with cataract extraction. Sixteen eyes (89%) received mitomycin C treatment intraoperatively. Post-operatively, the mean follow-up period was 63 months (24–84). At final follow-up, the success rate was 50% (33.3% complete, 16.7% qualified) with a mean IOP of 18.1 mmHg (±9.5) on a mean number of 1.5 (±1.6) medications. The failure rate was 50%, with five eyes (27.8%) not meeting the IOP criteria for success (of these, three eyes required additional surgery to lower the IOP) and five eyes (22.2%) lost light perception. Conclusion: Intravitreal Bevacizumab followed by AGV offers long-term control of IOP without additional surgical intervention in the majority of cases.     

Long-term intraocular pressure changes after vitrectomy for epiretinal membrane and macular hole

Background

To investigate long-term intraocular pressure (IOP) changes after vitrectomy for epiretinal membrane (ERM) or macular hole (MH).

Methods

We retrospectively reviewed the medical records of 57 eyes with ERM and 61 eyes with MH that underwent vitrectomy. IOP levels and changes at 1, 3, 6, 12 months, and the final visit from baseline were evaluated in vitrectomized eyes and non-vitrectomized fellow eyes.

Results

In the ERM group, the mean follow-up period was 29.3 months; the mean preoperative IOP in the operated eyes was 12.9?±?2.5 mmHg and the final IOP was 13.2?±?2.9 mmHg. In the MH group, the mean follow-up period was 25.6 months; the mean preoperative IOP in the operated eyes was 13.3?±?2.5 mmHg and the final IOP was 14.0?±?3.2 mmHg. The mean final IOP of the fellow unoperated eyes was 13.0?±?2.5 mmHg in the ERM group and it was 12.9?±?3.2 mmHg in the MH group. A significant difference was found between the operated eyes and fellow eyes at the final visit in the MH group (P?<?0.01) but not in the ERM group (P?=?0.40). MH group was significantly at high risk of IOP increase after vitrectomy (P?<?0.01).

Conclusions

IOP increase after vitrectomy was found in some eyes with MH during long-term follow-up but it was unlikely in eyes with ERM.     

Comparative laser flare measurement and fluorophotometry in anterior and posterior uveitis

Summary Recent studies have sought to quantify aqueous flare by laser flare measurement. An increase in aqueous flare caused by a rise of protein concentration was frequently found both in anterior and posterior segment disease. This has been interpreted as a breakdown of the blood – aqueous barrier (BAB). By measuring the diffusion coefficient of the BAB compared to the aqueous flare value in patients with anterior and posterior uveitis, the extent to which the increase in flare value was related to a possible break down of the BAB was examined. Patients: Thirty-nine normal eyes (23–78 years; 41.6 ± 18.6), 18 eyes with anterior uveitis (iritis, iridocyclitis; 18–57 years; 35.2 ± 12.4) and 29 eyes with posterior uveitis (chorioretinitis or retinochorioiditis; 18–51 years; 31.7 ± 10.5). The diffusion coefficient P(a) of the BAB was measured fluorophotometrically, while the flare value was quantified by laser flare measurement. Results: Flare values (1/ms) were found to be significantly increased (p < 0.001) compared to normal eyes (4.6 ± 1.7) both in anterior uveitis (20.9 ± 8.5) and in posterior uveitis (17.4 ± 8.3) but did not significantly differ between them (p = 0.43). The diffusion coefficient P(a) (10^–3/min) of the BAB was not significantly different (p > 0.05) between normal eyes (0.5 ± 0.2) and eyes with posterior uveitis (0.9 ± 0.7), whereas it was significantly increased (p < 0.001) in anterior uveitis (6.5 ± 5.4) compared to the other groups. Conclusions: (1) In posterior uveitis, an increased flare value is not necessarily correlated with a breakdown of the BAB; proteins may enter the aqueous from posterior. (2) Assessing the function of the BAB in posterior segment disease using laser measurement should be carried out with caution; if possible, permeability measurements of the BAB should be undertaken seperately.      

难治性青光眼睫状体光凝疗效观察

目的:评价激光经巩膜睫状体光凝术(transscleral cyclo-photocoagulation,TSCPC)治疗难治性青光眼的临床疗效。方法:对36眼难治性青光眼采用低能量1.5~2.1W,多点数10~32的TSCPC,术后随访观察并记录眼压,视力,眼部自觉症状以及并发症,随访时间约3mo。结果:术前平均眼压62.89±17.36mmHg,最后随访平均眼压为21.13±7.06mmHg,经配对资料t检验,术前眼压与术后眼压相比,差别具有统计学意义(P<0.05)。手术有效率83%。指数以上视力10眼中术后6眼视力无变化,4眼视力提高。6眼眼压控制欠佳,行睫状体冷冻手术。术前所有眼痛的患者眼痛均消失或缓解,并发症少,程度轻,主要有色素膜炎,前房出血等,无眼球萎缩发生。结论:TSCPC是难治性青光眼的一种简单安全有效的治疗方法。     

The effect of intraocular pressure on the absorption of air from the vitreous cavity

· Background: The duration of an intraocular gas bubble used in vitreoretinal surgery is an important determinant of the safety and effectiveness of intraocular gas use. Considerable variability impedes the clinical determination of this parameter. The aim of the study was to study experimentally the relationship between intraocular pressure (IOP) and the absorption of an intravitreal air bubble. · Methods: We compared the rate of absorption of an intravitreal air bubble in rabbit eyes that had been treated with cyclocryotherapy (n = 17) to the absorption of air bubbles in untreated fellow eyes (n = 17). · Results: Intravitreal air bubble persisted longer in the cyclocryotherapy-treated rabbit eye (mean ± SD 78 ±16 h) than in the control fellow eyes (43 ± 15 h). This difference was statistically significant (P < 0.001). The length of time an air bubble persisted could be predicted from the IOP. · Conclusions: The reason for the increased length of time an air bubble remained in cyclocryotherapy-treated eyes is probably the result of several factors, including primarily reduced aqueous flow and reduced IOP. Our results show that the duration of air injected into the vitreous cavity correlated to IOP. In addition to other known factors, the IOP should be considered in predicting intravitreal gas persistence. Received: 18 February 1997 Revised version received: 30 May 1997 Accepted: 6 June 1997