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Forty-eight patients with narrow-angle glaucoma were treated with M-900 argon laser (Coherent Radiation, USA). Reduction of intraocular pressure as low as 20 +/- 1.82 mm Hg on an average was achieved. Fluid discharge efficacy coefficient has improved. The authors claim that laser cyclotrabeculospasis a sufficiently effective method for the treatment of primary narrow-angle glaucoma.
Focal corneal edema overlying the site of argon laser iridotomy followed by generalized corneal decompensation developed in six eyes of five patients. The average interval between the iridotomy and the development of focal edema was 3 years, with generalized edema appearing an average of 3.5 months later. Light, scanning and transmission electron microscopy of tissue removed at the time of corneal transplantation showed abnormalities characteristic of Fuchs' dystrophy in two patients. Possible contributing factors include episodes of intraocular pressure elevation, cornea guttata and the use of high total amounts of energy during laser iridotomy.
The iridocorneal angle of the left eye was investigated in 203 Samoyeds. Comparison was made of judgements of the width of the anterior opening of the ciliary cleft when performing gonioscopy with an objective method of estimation based on measurements on goniophotographs. Results indicated high degree of correlation. Various degrees of narrowness of the iridocorneal angle width were revealed and clinical glaucoma with total-angle closure was found in 6 of 203 dogs. The intraocular pressure was significantly (P less than 0.01) higher in eyes with closed iridocorneal angles than in eyes with any other width of the angle. Appearance of the structures of the iridocorneal angle, particularly the pigment bands, indicated extensive individual variation. In approximately 25% of the eyes, dysplasia of the pectinate ligaments of variable degree existed, indicating that this anomaly is common in the Samoyed breed. Significant difference was not evident in intraocular pressure in eyes with different degrees of dysplasia of the pectinate ligaments.
A retrospective review of 16 initial, consecutive cases of Molteno implantation with at least 6 months of follow up showed that all eyes developed either or both early-onset (12 eyes) or late-onset (7 eyes) complications. The early-onset complications, which included choroidal effusions and flat anterior chambers, tended to resolve without difficulty. By contrast, the late-onset complications, which included 4 implant extrusions, 2 vitreous hemorrhages, 1 persistent hyphema, 1 cystoid macular edema, 1 opacified vitreous face, and 1 tractional detachment with fibrous ingrowth, tended to herald poor visual prognoses. Implant removal was required in three cases. Overall, vision improved in 3 eyes (18.8%), remained unchanged in 3 (18.8%), and deteriorated two or more lines in 10 (62.4%). In 3 eyes vision deteriorated to no light perception; 2 of them became phthisical. These complications often occurred despite successful control of intraocular pressure (less than 23 mm Hg). The relatively high complication rates in this series as compared with previously reported ones probably reflects a combination of factors not necessarily related to the Molteno surgery; primarily, the patients in this small series may have had more severe disease and more prior surgeries than those in other such series.
The case of a 70-year-old woman displaying a quasiabsolute glaucoma with large scleral juxtalimbic ectasias at both eyes is reported. The gonioscopic examination shows a closed-angle glaucoma developing for about 10 years with subacute crises, neglected by the patient. Vision at the right eye 1/50 nc, intraocular pressure at the right eye = 34.4 mmHg vision at the left eye = 3/50 nc, intraocular pressure at the left eye = 41.4 mmHg. The ocular examination reveals a small anterior chamber, sectorial iridic atrophies, a mydriatic pupil, the camerular angle closed. The fundus of the eye shows the atrophy of the papilla and excavation with the C/D ratio 0.9 at the right eye and 0.8 at the left eye. It is pointed out that the closed-angle glaucoma may have a subacute course, leading finally to the quasiabsolute stage, with large scleral ectasias like in the open-angle glaucoma.
Analysis of 1400 cases of retinitis pigmentosa revealed that (1) 32 cases (2.3%) were associated with glaucoma, of which (2) 30 cases were of the angle closure type; (3) the C/D ratio was normal in over one half of the cases, and in 5 cases the optic disk remained normal after 1/2-5 years of persistent IOP elevation; (4) in 31 cases (97%) the blood pressure was below the norm of equivalent age group; and (5) pathologic examination of the trabecular meshwork in 14 cases showed no excessive pigment deposition to obstruct the outflow channels.
In 22 cases of acute closed-angle glaucoma, the plasma cardionatrin content was obviously elevated than in a normal control group. The variation of cardionatrin level may be the result of local ocular pathology and the stress of protective response of the organism. Whether a relationship with glaucoma existed remains to be explored.
Argon laser iridoplasty was performed in 40 eyes of 33 patients of primary angle closure glaucoma. There were 12 male and 21 female patients. The mean ages of the male and female patients were 51 years and 48.4 years respectively. Forty eyes were divided into two groups. Group I consisted of ten eyes of subacute angle closure glaucoma and group II included thirty eyes of chronic angle closure glaucoma. Argon laser iridoplasty was performed with Coherent 9000 model using laser settings of spot size 200 micron, duration 0.2 second and power 0.7 watt. A total of 80 spots were applied over 360 degree circumference. The intraocular pressure control (below 22 mm Hg) was achieved after iridoplasty in all the eyes (100%) in group I, where as in group II the intraocular pressure was controlled in 70% eyes. The follow up period varied from 3 months to one year with a mean of eight months. The success rate with iridoplasty was directly related to the extent of peripheral anterior synechiae, optic disc cupping and presence of visual field changes.
Angle closure glaucoma is an infrequent form of glaucoma occurring when the filtration mechanism for the aqueous humor is obstructed by apposition of the peripheral iris to the trabecular meshwork. Anatomic features associated with acute-angle closure include congenitally small anterior segments, increased lens thickness, and shallow anterior chamber depth. We present two patients who developed signs and symptoms of angle closure glaucoma after receiving aerosolized atropine for treatment of chronic obstructive pulmonary disease. We recommend that before instituting therapy with an inhaled anticholinergic agent, the patient should be questioned concerning prior history of angle closure glaucoma symptoms and signs and the anterior chamber depth should be examined using iris illumination. Patients having shallow anterior chambers, or possible prior angle closure glaucoma attacks, should be examined by an ophthalmologist before inhalant anticholinergic therapy.
We present a case of infectious crystalline keratopathy occurring after 5-fluorouracil filtering surgery. The patient had discrete, branching, white crystalline lesions in the anterior corneal stroma. Cultures grew Streptococcus viridans, and gram-positive cocci were demonstrated in corneal tissue biopsy specimens. Toxic and immunosuppressive properties of 5-fluorouracil may have participated in the pathogenesis of the infectious crystalline keratitis.
The efficacy of sclerocyclodialysis surgical technique was analyzed in 65 patients (67 eyes) with closed-angle glaucoma with organic blocking of the anterior chamber corner. Ophthalmic tone normalization directly after surgery was achieved in all the cases; in late periods (1 to 3.5 years after the operation) the best hypotensive effect with improved or preserved visual functions was observed mainly in the patients with the initial or well-developed stages of the glaucomatous process.
We report six eyes in six patients in which corneal decompensation developed 18 or more months after argon laser iridectomy (ALI). In addition to the level of laser energy used, other risk factors included performing ALI during an attack, diabetes, and a cornea damaged by glaucomatous attack. The interval between the ALI and corneal decompensation ranged from 18 months to 3 1/2 years.
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Patients with nanophthalmos are prone to develop a chronic painless type of glaucoma in middle age, probably due to the natural increase in the size of the lens which is already relatively too large for the small eye. Although the underlying mechanism is obscure, a slowly progressive "creeping" chronic angle-closure is postulated, but gonioscopic evaluation is difficult due to the shallow anterior chamber, with grade I and slit angles. Response to medical treatment is poor and miotics may even make the condition worse by producing relative pupillary block and by relaxing the lens zonule. Ordinary glaucoma surgery is to be avoided in nanophthalmos because of the fear of postoperative ciliary-block malignant glaucoma. Periopheral iridectomy performed in five eyes at an advanced stage of the chronic angle-closure did not facilitate glaucoma control in three eyes, and in two eyes in which the operation was combined with posterior sclerotomy, the eyes became blind from vitreous hemorrhage. Lenx extraction in five eyes controlled the glaucoma but was followed by choroidal effusion and nonrhegmatogenous retinal detachements in two eyes and blindness in another eye when combined with a posterior sclerotomy. No firm therapeutic recommendations can be made on the basis of the author's experience in the six reported cases. Conventional medical therapy seems ineffectual even when begun early in the glaucoma. Conventional glaucoma surgery must be performed early, before permanent damage to the outflow mechanism occurs but removal of the lens must be anticipated. The surgeon must also remain aware of the high incidence of serious posterior-segment complications which inexplicably follow glaucoma or lens surgery in nanophthalmos, as described by Brockhurst.
Two sets of multiple regression equations (prediction systems) were derived from the analysis of ocular biometric data obtained from glaucoma patients (16 open angle; 16 angle-closure) and 75 normal subjects. Discriminant scores were established for both sets of equations which minimised the number of false negatives. One set, the 'Glaucoma Equations' was applied to the data to segregate the glaucoma from the normal subjects. The other prediction system, the 'Classification Equations,' was then applied to the group defined as glaucomatous to discriminate between patients in the angle-closure and open angle categories. The performance of these equations, obtained by comparing the predicted and actual classifications for this sample, was such that between 9 and 12% of false positives and 0 and 3% false negatives were found on the 'Glaucoma Equations' and between 6 and 12% of false positives with no false negatives on the 'Classification Equations.'
Family histories were taken from 124 index patients, who had presented with either angle-closure or open angle glaucoma to the University Department of Ophthalmology, Manchester, between 1967 and 1972. Their first-degree relatives numbered 886, i.e. siblings, offspring and parents. Relatives were contacted by post and asked to attend for eye examination. Out of a total of 886 relatives, only 187 relatives were actually examined. The reasons for this low attendance rate are discussed; e.g. 423 relatives had already died.
The postoperative course of 309 eyes subjected to trabeculectomy has been studied over a 7-year period. The results have been compiled with regard to effectiveness to maintain a normal range of intraocular pressure with and without postoperative medication. The figures have been assessed in toto and for 3 groups of glaucoma, namely, open angle, chronic angle-closure, and acute angle-closure. Results support those of other reports to show that trabeculectomy gives satisfactory control over the years in a reasonably high proportion of eyes and with relatively few postoperative complications. There is also a small group of combined trabeculectomy with cataract extraction.
Combined cyclodialysis and cataract extraction was performed on 78 eyes in a consecutive series of 26 years duration. This operation was performed on eyes with severe glaucoma, inadequately controlled on maximum medical therapy, and with a cataract needing extraction. Glaucoma types included open-angle, angle-closure with peripheral anterior synechias, combined open-angle and angle-closure, and secondary to uveitis. Seventy of the 78 eyes had follow-up of six months or more and the results in these 70 eyes were analyzed. In thirteen percent of the eyes in this study the postoperative intraocular pressure was the same or higher than the preoperative level, or reductions of intraocular pressure were not clinically significant. Eighty-seven percent (61 eyes) had a clinically significant lowering of intraocular pressure following the combined procedure. Thirty-nine percent (27 eyes) of the 70 eyes in this study had a tension of 0-14 mm Hg, and 44% (31 eyes) had a tension of 15-20 mm Hg. Intraocular pressure was improved significantly more often in patients over 60 years of age. Resulting intraocular pressures of 14 mm Hg or less were more likely when the cyclodialysis was performed in the lower quadrant. The results of the combined procedure were not significantly influenced by the type of glaucoma involved or by a history of previous glaucoma surgery. Bleeding was a frequent complication, but was not related to resulting intraocular pressure. Other complications were rare. We conclude that combining cyclodialysis with cataract extraction is safe and effective, and is a suitable procedure when there is need for surgery to relieve severe glaucoma, along with a need for cataract extraction.