Ultrasound biomicroscopy evaluation of angle closure in a patient with multiple and bilateral iridociliary cysts

PURPOSE: The aim of this study was to describe the findings of ultrasound biomicroscopy (UBM) in a case with bilateral, multilobulate primary iridociliary cysts presenting as chronic angle-closure glaucoma. HISTORY AND SIGNS: An 82-year-old woman was admitted to a tertiary ophthalmological centre for a thorough exploration of the gradual deterioration of her visual fields and optic discs. Clinical evaluation of the patient revealed angle-closure glaucoma and cataract in both eyes. The use of UBM disclosed the presence of bilateral, multilobulate iridociliary cysts in all quadrants. The presence of multiple and bilateral iridociliary cysts was the cause of iris anterior displacement and the subsequent angle closure in this patient. CONCLUSIONS: Primary iridociliary cysts may rarely progress to a size that can compromise the angle. They are usually considered as benign and stationary lesions. The advent of UBM is an invaluable tool for the contemporary ophthalmologist in order to set the diagnosis and follow the evolution of those lesions.     

Multiple bilateral iridociliary cysts: ultrasound biomicroscopy and clinical characteristics

BACKGROUND: To describe the utility of ultrasound biomicroscopy in diagnosing multiple bilateral iridociliary cysts and to determine the clinical significance of this condition. METHODS: A retrospective review of 73 patients referred for ultrasound biomicroscopy who were found to have bilateral iridociliary cysts. RESULTS: Seventy-three patients were identified who demonstrated 2 or more cysts in 1 eye and at least 1 in the other with ultrasound biomicroscopy. A solitary iris elevation was the most common reason for referral (84.9%). There were 44 patients for whom sufficient follow-up data were available, with a mean follow-up of 40.4 months. Clinical sequelae included 1 case of sectoral cataract (2.3%) and 4 cases of cyst-related glaucoma (9.1%). INTERPRETATION: Multiple bilateral iridociliary cysts is a common condition with occasional clinical significance. Ultrasound biomicroscopy is a valuable technique in diagnosing this condition. Patients who have significant angle compromise should be followed and treated as required for glaucoma.     

Angle-closure glaucoma in teenagers

OBJECTIVE: To report the occurrence of angle-closure glaucoma in 2 teenagers. DESIGN: Observational case reports, review of literature. METHODS: Review of case histories, examinations, biometries, visual fields, and ultrasound biomicroscopy findings in 2 teenagers with angle-closure glaucoma. MAIN OUTCOME MEASURES: Intraocular pressure, gonioscopy, Humphrey 24-2 visual field (SITA Standard), and ultrasound biomicroscopy. RESULTS: The first case involved a 15-year-old white male who presented with an intraocular pressure of 60 mm Hg in the right eye and 24 mm Hg in the left eye and 360-degree appositional closure in both eyes. Ultrasound biomicroscopy revealed prominent bilateral ciliary pigment epithelial cysts pushing the iris anteriorly towards the angle. The second case involved a 14-year-old white male with a strong family history of primary angle-closure glaucoma. The patient had pupillary block and an intraocular pressure of 24 mm Hg in the right eye and 40 mm Hg in the left eye on routine eye examination. Gonioscopy and ultrasound biomicroscopy revealed appositional closure of the angle in all 4 quadrants bilaterally. CONCLUSION: Primary angle-closure glaucoma is uncommon in younger individuals. Therefore, the finding of angle-closure glaucoma in a young individual should alert the physician to the possibility of a secondary cause of angle closure, such as iris pigment epithelial cysts. In addition, special attention to family history is important as the configuration of an occludable anterior chamber angle may, in some instances, be inherited.     

Laser iridocystotomy for bilateral acute angle-closure glaucoma secondary to iris cysts

PURPOSE: To report laser iridocystotomy for bilateral acute angle-closure glaucoma secondary to peripheral iris cysts. METHOD: Case report. RESULTS: In a 55-year-old man with increased bilateral intraocular pressure, gonioscopy revealed varied angle narrowing. Bilateral angle-closure glaucoma secondary to peripheral iris cysts was diagnosed by ultrasound biomicroscopy. The peripheral iris cysts could not be seen in mydriasis by gonioscopy. Therefore, we decided to perform laser iridocystotomy with argon and Nd:YAG laser. Collapse of the cysts after laser treatment was demonstrated by ultrasound biomicroscopy. At follow-up, 9 months after laser treatment, intraocular pressure had dropped below 20 mm Hg in both eyes without further therapy. The iris cysts did not recur, which was demonstrated by ultrasound biomicroscopy. CONCLUSIONS: Peripheral iris cysts may produce angle closure and may cause secondary angle-closure glaucoma. If transpupillary laser cystotomy is not possible, laser iridocystotomy may produce collapse of the iris cysts and correction of secondary angle closure.     

Acute angle closure glaucoma secondary to a choroidal melanoma.

PURPOSE: Report a case of acute angle closure glaucoma secondary to a choroidal melanoma. METHODS: Case report of a 75-year-old woman who presented with acute angle closure glaucoma with bilateral narrow angles. After medical management with drops and peripheral laser iridotomies in both eyes, the pressure was controlled and the angles were noted to be open. This allowed safe dilation of the pupils to perform funduscopic examination. A large choroidal melanoma was noted in the eye with the acute angle closure attack. RESULTS: Dilated fundus exam after peripheral laser iridotomies revealed a choroidal melanoma as the cause for the acute angle closure glaucoma. CONCLUSION: It is important to do a thorough eye examination to rule out secondary causes of angle closure, such as a potentially life-threatening tumor, when a patient presents with acute angle closure glaucoma.     

原发性虹膜睫状体囊肿与前房角变化对应关系的研究

目的 探讨原发性虹膜睫状体囊肿的大小、分布特征及其与相应部位前房角变化的关系.方法 横断面观察性病例研究.在本院眼科行常规体检的人群中,若发现浅前房,进一步行UBM检查.对UBM检查中发现有虹膜睫状体囊肿的患者,记录其囊肿数量、大小、眼别、部位和象限,比较UBM图像上囊肿所在部位的前房角形态与非囊肿部位的前房角形态,观察并记录前房角是否变窄或关闭,分析囊肿导致相应前房角变窄或关闭的相关因素.分别采用t检验、X2检验和直线相关分析对数据进行统计.结果 在457例受检者(914只眼)中,发现有囊肿的患者134例(200只眼),占被检人数的29.32%,均为原发性虹膜睫状体囊肿.共检出囊肿502个,其中41.24%(207/502)位于虹膜睫状沟,58.37%(293/502)位于睫状冠;44.22%(222/502)位于颞下象限,26.88%(135/502)位于鼻下象限,23.11%(116/502)位于颞上象限,5.38%(27/502)位于鼻上象限.囊肿的平均大小为(0.6289±0.2329)mm,中囊肿占86.05%(432/502).虹膜睫状沟囊肿导致相应部位前房角变窄或关闭的发生率为82.13%(170/207),睫状冠囊肿导致相应部位前房角变窄或关闭的发生率为22.87%(67/293),二者差异有统计学意义(X2=170.83,P<0.01).囊肿大小导致相应前房角变窄或关闭的比例值,行直线相关分析,二者呈正相关(r=0.9939,P<0.01).结论 正常人群中原发性虹膜睫状体囊肿的发病比例高,部分囊肿可导致前房角变窄或关闭;囊肿的部位和大小是导致相应部位的前房角变窄或关闭的相关因素.     

The Heredity and Treatment of Angle-closure Glaucoma Secondary to Iris and Ciliary Body Cysts

Three families with peripheral iris and ciliary body cysts are described. The cysts were multiple in 10 of the 11 affected patients, and they were bilateral in 8 of the 11. Angle closure glaucoma secondary to the cysts was present in 4 of the 11 cases. The management of this glaucoma requires a high index of suspicion, careful gonioscopic evaluation and proper medical and/or surgical treatment. Laser therapy for the angle closure caused by pigmented cysts may be curative. Nonpigmented ciliary body cysts are refractory to argon laser treatment and carry a poor prognosis. The cases described suggest an autosomal dominant hereditary pattern. The importance of examination and follow up of healthy relatives of patients with iris and ciliary body cysts is stressed, as early detection and treatment by laser cystotomy may prevent or cure angle closure glaucoma if the disease is diagnosed prior to the establishment of synechial closure.     

Angle closure in younger patients

PURPOSE: Angle-closure glaucoma is rare in children and young adults; only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients aged 40 or younger with angle closure in our database. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Our database was searched for patients aged 40 years or younger with angle closure. Data recorded included age at initial consultation, age at the time of diagnosis, gender, slit-lamp examination, gonioscopy, ultrasound biomicroscopy (from 1993 onward), clinical diagnosis, and therapy. Patients with prior incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age at the time of consultation was 34.4 +/- 9.4 (standard deviation) years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients); iridociliary cysts (8 patients); retinopathy of prematurity (7 patients); uveitis (5 patients); isolated nanophthalmos (3 patients); relative pupillary block (2 patients); Weill-Marchesani syndrome (3 patients); and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSIONS: The etiology of angle closure in young individuals differs from the older population and is typically associated with structural/developmental ocular anomalies rather than relative pupillary block. After laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention.     

闭角型青光眼中睫状体囊肿的检测

目的 探讨睫状体囊肿与闭角型青光眼的关系.方法 用超声生物显微镜(UBM)对260例(260只眼)连续闭角型青光眼患者进行眼前段检查.结果 在260只连续检查的闭角型青光眼中有睫状体囊肿的20只眼(7.69%)共22个囊肿,其中单发性囊肿的有18只眼(90%),多发性囊肿的有2只眼(10%).囊肿分布颞侧9个(41%),下方9个(41%),鼻侧2个(9%),上方2个(9%).在22个囊肿中有13个囊肿其所对应处房角关闭,9个囊肿其所对应处房角未关闭,卡方检验P=0.394.结论 睫状体囊肿在闭角型青光眼中的发生率较高的.而且他们分布的位置多在颞侧和下方.     

A statistical comparison study of glaucoma in the Third Affiliated Hospital of China Medical College and Kyushu University

We classified 331 glaucoma patients who visited the eye clinic of the Third Affiliated Hospital of China Medical College during the 2 year period from January 1985 to December 1986 according to the type of glaucoma. The results were compared with those obtained from 275 glaucoma patients who visited the eye clinic of Kyushu University during an overlapping period of 2 years, from January 1986 to December 1987. Patients with glaucoma were found to comprise 1.5% of the 22,869 outpatients in the Third Affiliated Hospital of China Medical College, and 1.8% of the 15,585 outpatients in Kyushu University. The distribution of various types was as follows: primary angle closure glaucoma (76.4%), primary open angle glaucoma (4.8%), secondary glaucoma (11.8%), exfoliation glaucoma (0) and congenital glaucoma (5.7%) in the Third Affiliated Hospital of China Medical College, and primary angle closure glaucoma (34.5%), primary open angle glaucoma (12.7%), secondary glaucoma (22.2%), exfoliation glaucoma (14.9%) and congenital glaucoma (10.9%) in Kyushu University. The present results suggest that the incidence of primary angle closure glaucoma in China is higher than in Japan, and that the incidence of primary angle closure glaucoma is higher than that of primary open angle glaucoma in these two countries. It is of interest that the high incidence of primary angle closure glaucoma in China and Japan coincides with the study in Canadian Eskimos. The incidences of secondary glaucoma and exfoliation glaucoma in Japan are higher than in China. This might be due to differences in diagnostic facilities in the two countries.     

Rainbow halos occur less following implantation of extended range of vision one-piece intraocular lenses vs diffractive bifocal intraocular lenses

AIM: To observe the characteristics of iridociliary cysts in myopic patients and evaluate the influences on the position and safety of implantable collamer lens (ICL) after surgery.METHODS: Totally 270 eyes of 135 patients who underwent ICL surgery for the correction of myopia were included in this study. We observed preoperative and postoperative morphology of iridociliary cysts in ultrasonic biomicroscopy (UBM) image.RESULTS: A total of 138 iridociliary cysts were found in 88 eyes of 50 patients among 270 eyes of 135 patients before surgery (37%). Twenty-five patients had cysts in one eye (50%) and 25 had cysts in both eyes (50%). The prevalence of iridociliary cysts was negatively correlated with age, but no gender difference (P>0.05). The incidence of iridociliary cysts was much less in eyes with myopia greater than -9.00 D (P<0.05). The diameter of the largest cyst was 1.96 mm and the smallest cyst was 0.24 mm, with a majority within the range of 0.5 to 1.0 mm. Most of the cysts were located in the inferior temporal quadrant. One year after ICL implantation, 51 iridociliary cysts (37%) remained unchanged, 47 cysts (34%) decreased in size, and 40 cysts (29%) disappeared. Most of cysts that changed after surgery were smaller than 1.0 mm (P<0.05) and located in the nasal and temporal sides around the haptics of implantable lens. All the implantable lens were in their original position.CONCLUSION: Iridociliary cysts are commonly seen in myopic eyes. The cysts have no impact on the safety of ICL surgery. Some cysts may decrease in size or disappear after ICL implantation.     

Primary cysts in the iridociliary sulcus: ultrasound biomicroscopic features of 210 cases

BACKGROUND: Primary cysts occur spontaneously, whereas secondary cysts arise following surgical or nonsurgical injury and can lead to further complications. We performed a study to observe and characterize primary iridociliary cysts through the examination of ultrasound biomicroscopic (UBM) images from affected patients. METHODS: The UBM images from 210 patients were analysed and the characteristics of each cyst were observed and recorded. The patients had been examined and received the diagnosis of iridociliary cysts between 1990 and early 1998 at a major referral centre for the diagnosis and treatment of cancer in Toronto. RESULTS: Of the 210 cysts 169 (80%) occurred in isolation, and the remainder occurred in the presence of a tumour. The mean horizontal diameter of the isolated cysts was 1.72 mm, and the mean vertical diameter was 1.04 mm. Isolated cysts were solitary in 101 cases (60%) and showed multiple loculations in 68 (40%). Solitary cysts were slightly larger than those with multiple loculations. Isolated cysts were associated with markedly narrowed or closed angles locally in 110 cases (65%). INTERPRETATION: Primary iridociliary cysts are common and need to be differentiated from iris and ciliary body tumours. UBM is a definitive method of diagnosing these lesions. Cysts can cause localized angle closure but rarely cause clinical complications. Cysts associated with anterior segment tumours may give an erroneous impression as to tumour size.     

Bilateral angle closure glaucoma following general anesthesia

Although unilateral angle closure glaucoma is quite common, simultaneous bilateral acute angle closure is very rare and is usually induced by an external cause. General anesthesia is a triggering factor for acute angle closure glaucoma. We report two cases of simultaneous bilateral angle closure glaucoma following non-ocular surgery under general anesthesia. One patient had cholecystectomy, the other craniotomy for tumor resection.In the postoperative period following general anesthesia, any patient at risk for angle closure glaucoma should be followed closely; patients with periorbital pain and visual symptoms should be examined for angle closure glaucoma attack in both eyes.     

拉坦前列素滴眼液治疗真性小眼球继发闭角型青光眼的疗效观察

目的 探讨拉坦前列素滴眼液对真性小眼球继发闭角型青光眼的治疗效果.方法 系列病例研究.选择2009年6月至2010年7月在首都医科大学附属北京同仁医院眼科中心收治的真性小眼球继发闭角型青光眼5例共9只眼,使用了0.005%拉坦前列素滴眼液或激光虹膜周切后联合0.005%拉坦前列素滴眼液,随访观察3～16个月,对其视力及眼压、眼底及视野等进行了监测.结果 真性小眼球继发闭角型青光眼5例患者共9只眼在治疗后眼压控制在10～20mmHg之间,视力无下降,视野及眼底杯/盘比无进展.结论 使用0.005%拉坦前列素滴眼液治疗真性小眼球继发闭角型青光眼是安全有效地方法,避免了小梁切除术后可能出现的眼部并发症.

Abstract：

Objective To study the effect of latanoprost on the trealment of nanophthalmos combined angle closure glaucoma. Methods Clinical case series. From June 2009 to July 2010, in Beijing Tongren Eye Center and Beijing Tongren Hospital, five patients (9 eyes) diagnosed as nanophtalmos combined with angle closure glaucoma were treated with latanoprost eye drops and followed up 3 to 16 months for clinical evaluation. The clinical outcomes included visual acuity, IOP, fundus examination and visual field examination. Results In 9 eyes, the IOP was controlled under normal level. The visual acuity, fundus examination and visual field examination did not vary from the baseline.Conclusions Latanoprost eye drops is effective and safe in the treatment of nanophthalmos combined with angle closure glaucoma.     

Argon laser iridoplasty in the treatment of plateau-like iris configuration as result of numerous ciliary body cysts

PURPOSE: To report the use of argon laser peripheral iridoplasty in the treatment of plateau-like iris configuration as a result of iris and ciliary body cysts. DESIGN: Case report. METHODS: A 43-year-old male with plateau iris syndrome was demonstrated by high frequency ultrasound biomicroscopy (UBM), to have numerous iris and ciliary body cysts. Bilateral argon laser peripheral iridoplasty was performed. RESULTS: Argon laser iridoplasty opened the drainage angle in both eyes. CONCLUSION: Argon laser iridoplasty is an effective and safe treatment for plateau iris syndrome and may also prove valuable in the treatment of plateau-like iris configuration resulting from iridociliary cysts.     

Secondary angle-block glaucoma in posterior scleritis

Posterior scleritis is an often misdiagnosed disease of the eye. Mainly it appears in elderly women and tends to be recurrent. Symptoms leading to diagnosis are swelling of the eye lids, a red eye, disturbances of the motility and protrusio bulbi. In rare cases you find exudative choroidal or retinal detachment, edema of the macula, or the optic nerve head, and secondary angle closure glaucoma. Often posterior scleritis is associated with general illness as herpes zoster, mixed connective tissue diseases, or Boeck's disease. Differential diagnosis are choroidal tumors as for example, melanoma, hemangioma, and metastases. The typical uveal effusion can also be caused by an arterio-venous fistula, panretinal photocoagulation, buckling procedure for retinal detachment, and by intraocular surgery in general. Especially cyclitis anularis pseudotumorosa has to be considered and shut out. Most important diagnostical means are ultrasound, and CT-scan. The underlying case describes an 81 years old woman that presented with acute angle closure glaucoma, and exudative choroidal detachment of the right eye. The ultrasound and CT-scan investigations confirmed the diagnosis of scleritis posterior. The acute angle closure glaucoma, and the choroidal detachment regressed immediately under the treatment with steroids given locally and systemically. There was no impact of miotics and peripheral iridectomy which both could not avoid recurrence of angle closure glaucoma.     

原发性虹膜睫状体囊肿研究进展

原发性虹膜睫状体囊肿好发于虹膜睫状沟和睫状冠,常规眼科检查不易发现。随着超声生物显微镜（UBM）在眼科临床的应用,发现其在人群中的发病率远高于之前的报道,亦有报道认为囊肿可诱发闭角型青光眼。UBM检查在其发现和诊断中起着重要作用,且有助于判断囊肿对房角形态的影响,但该囊肿与青光眼、浅前房的关系,尚无相关的研究报道。关于该囊肿的分类、名称目前尚无统一的标准。就原发性虹膜睫状体囊肿的流行病学、组织病理学、UBM检查、并发症、诊断和治疗等做一综述,并提出关于原发性虹膜睫状体囊肿的新的分类法。     

Narrowing of the anterior chamber angle during Valsalva maneuver: a possible mechanism for angle closure

PURPOSE: To evaluate changes at the anterior chamber angle during Valsalva maneuver in eyes suspected to have a primary adult glaucoma. METHODS: Seventy-six consecutive patients underwent recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, angle recess area, scleral spur-iris root distance, iris thickness, iridociliary angle, ciliary body thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva maneuver was standardized to a pressure of 40 mmHg for 15 seconds, using a manometer. RESULTS: The mean baseline intraocular pressure changed from 19.5+/-4.1 mmHg to 29.5+/-4.8 mmHg during Valsalva (p<0.0001). The anterior chamber angle recess narrowed from 17.9+/-9.5 to 7.8+/-9.2 degrees (p=0.0001). The angle recess area diminished from 0.15+/-0.14 mm2 to 0.14+/-0.12 mm2 (p=0.03) and the scleral spur to iris distance decreased from 0.19+/-0.2 mm to 0.16+/-0.18 mm (p=0.0001). The iridociliary angle narrowed from 72.6+/-33.5 degrees to 62.5+/-32.8 degrees (p=0.04). There was a significant increase in the thickness of the ciliary body, from 0.99+/-0.19 mm to 1.12+/-0.16 mm (p=0.001) and in iris thickness from 0.47+/-0.07 mm to 0.55+/-0.09 mm (p=0.0001). There was no significant change in the angle opening distance, anterior chamber depth, or pupillary diameter. A significant narrowing of the angle to less than 5 degrees was seen in 37 eyes, with iridocorneal apposition present in 28 eyes. After multivariate regression analysis it was found that the baseline ciliary body thickness and angle recess were significant predictors of narrowing of the angle (R2=96.1%). CONCLUSIONS: Significant elevation of the intraocular pressure, narrowing of the anterior chamber angle recess, thickening of the ciliary body, and increase in the iris thickness is seen during the Valsalva maneuver. The Valsalva maneuver may lead to angle closure in eyes anatomically predisposed to primary angle closure glaucoma.     

A case of secondary glaucoma due to bilateral anterior chamber shallowing caused by Marfan's syndrome

 Purpose: To report the clinical manifestations and treatment of a case of secondary glaucoma evolving from bilateral anterior chambers flattening caused by Marfan’s syndrome. Methods: The ophthalmic and systemic features, B-scan and UBM characteristics were recorded. Therapy and efficacy were analyzed. Results: Marfan’s syndrome, in this case, caused bilateral iris-lens diaphragm anterior dislocation, anterior chamber flattening, pupillary block, angle closure,and finally resulted in the persistent increased intraocular pressure (IOP). After undergoing pars plana vitrectomy and lensectomy combined with anterior chamber reformation, the visual acuity of the patient’s right eye increased from 6/150 to 6/7.5 (best-corrected) and that of the left eye was improved from 6/100 to 6/10 (best-corrected). The IOP of the right eye fell to 18 mm Hg, and the left eye to 12 mm Hg. Conclusion: Marfan’s syndrome can cause bilateral anterior chambers flatterning, and induce secondary angle closure glaucoma. Combined pars plana vitrectomy, lensectomy and anterior chamberplasty can re-form anterior chambers, control IOP and maintain visual function.     

Traumatic glaucoma--a survey

Traumatic glaucomas represent a very heterogeneous group of entities due to a variety of pathomechanisms which increase the intraocular pressure in the early or late phase after traumatic injury (blunt or penetrating injury, acid or alkali burn). Little is known about the real prevalence of traumatic glaucoma. Angle recession, hyphema-associated and lens-associated mechanisms are the most common causes of traumatic glaucoma after blunt ocular trauma. Secondary angle closure due to peripheral anterior synechiae is the most common pathomechanism leading to glaucoma in patients with penetrating eye injury or acid or alkali burn. Early anti-inflammatory therapy for eye injuries is the most important step in the prevention of traumatic glaucoma. Although no general recommendations exist, topical potent corticosteroids significantly decrease the risk of glaucoma development. Medical and surgical treatment of traumatic glaucoma has often been disappointing. Therefore the visual prognosis of these eyes is often restricted. Antiglaucomatous drugs that reduce the secretion of aqueous humor (e. g., beta-blockers) should be preferred. Mitomycin-augmented trabeculectomy is the surgical method of first choice in patients with open angle traumatic glaucoma. Transscleral cyclophotocoagulation represents the method of first choice in secondary angle closure glaucoma due to anterior peripheral synechiae. New surgical techniques will increase the possibilities of an effective reduction of the intraocular pressure in secondary angle closure glaucoma. These new procedures are endoscopic cyclophotocoagulation, retinectomy, and the implantation of drainage devices via the pars plana. Further evaluation and modifications of these surgical techniques should markedly improve the visual prognosis of eyes with secondary angle closure glaucoma. For a few types of traumatic glaucoma (e. g., after epithelial ingrowth) no effective treatment modality is available at present.