[The modification of posterior sclerocyclostomy in treating ciliochoroidal detachment after glaucoma-control operations].
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Aged↗
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Results for “Glaucoma, Open-Angle”
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[The influence of the fixation of the scleral flap on the hypotensive effect of trabeculectomy].
The author analyzes 60 trabeculectomies with fixation of the superficial scleral flap by three nodular sutures (n = 24) and by one nodular suture (n = 36). He comes to the conclusion that trabeculectomy with scleral flap fixation by one nodular suture is preferable to its fixation with three sutures, for it creates better conditions for the formation of filtration pad and provides a more stable hypotensive effect, as evidenced by the results of three-year follow-up (75% vs. 41.6%). Nonetheless the author claims that fixation of the scleral flap with 3-4 sutures is desirable in cases when filtering trabeculectomy variants are deliberately employed or when trabeculectomy modifications with uveoscleral discharge stimulation are used.
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[Excessive cicatrization after glaucoma-control operations: the participation of plasma fibronectin].
Based on the results of examinations of 300 patients with primary glaucoma after trabeculectomy, the author has developed clinical criteria for the evaluation of the intensity of the reparative processes at the site of intervention. Plasma fibronectin levels were found to grow with the progress of glaucoma (from Stage I to Stage II almost twofold). Analysis of correlations and regressions has revealed reliable relationships between plasma fibronectin levels and clinical values of the intensity of reparative processes at the site of surgery. Preoperative measurements of plasma fibronectin help predict with a high degree of probability the hypotensive effect of surgery.
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Recent pathogenic concepts of primary open angle glaucoma and soft glaucoma (POAG).
Loss of mainly field in POAG is due to Schnabel's cavernous atrophy of the axons at their scleral passage, built up by aligned stacks of glial collagen (IV and I) tissue plates, which contain capillaries. Organisation, size and structural surroundings encircle isolated or grouped axons not evenly distributed. The stereotype pattern of fieldloss linked to a characteristic optic nerve lesion suggests POAG be considered a N.O. disease as raised IOP may be only one of the risk factors. Are cavernous atrophy (loss of field) and the trabecular spaces narrowing (rise of IOP) both the result of the same pathogenic mechanism acting on the collagen fiber (IV and I) of the scleral coat, resp. lamina cribrosa (posterior segment) and trabecular meshwork (anterior segment)? If so, IOP-rise only worsens the condition as will do a hemodynamic energy crisis at the level of the axons. Interactive dominance at any of both levels may explain unexpected discrepancies between IOP and fieldloss. Considering "to treat or not to treat" accurate field loss predictability testing, urgent research topic, are discussed.
Anterior Chamber↗
Indications for trabeculectomy in open angle glaucoma.
Trabeculectomy is the most commonly performed filtering procedure in the surgical treatment of open angle glaucoma. One may oversimplify and state that a trabeculectomy is indicated in a case of uncontrolled IOP on maximum tolerated medical therapy in the presence of significant optic disk and/or visual field changes. However, before one actually proposes a trabeculectomy one must consider for a given patient: How does one define IOP control? What are the chances of success of the surgery? What are the operative risks? What are the risks of not operating for the case under consideration? And more generally: What are the arguments of earlier surgery? Where does Argon Laser Trabeculoplasty fit into the therapeutic regimen? The questions are examined with the specific goal of making a rational decision for the patient at hand.
Glaucoma, Open-Angle↗
Cyclocryotherapy as an alternative treatment for primary glaucoma.
Cyclocryotherapy was used as an alternative treatment for primary glaucoma in a series of 56 patients, both with narrow and open angle. In this prospective study treatment was successful in 87.7% of the cases (Peak I.O.P. < or = 20 mm Hg) with a mean follow up period of 10.1 months. Mean intraocular tension decreased from 29.7 mm Hg preoperatively down to 17.25 mm Hg postoperatively. About 60% of the eyes, however, needed an additional local treatment. Postoperative complications were rare and mild. A conjunctival congestion, and a mild self limiting iridocyclitis, were the most frequent ones. Long term efficacy was evaluated retrospectively (21 eyes with primary glaucoma; mean follow up period: 51 months). 58.3% were still controlled today, the majority of them requiring local medication. A further deterioration of visual field, however, had been noticed in 26.6% of these "obviously normotensive eyes". Because of its good efficacy and its lack of severe complications as opposed to trabeculectomy cyclocryotherapy is suggested as a first choice treatment in primary glaucoma.
Ciliary Body↗
Structural changes of the lamina cribrosa and of the trabeculum in primary open angle glaucoma (POAG).
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Aging↗
Measurement of retinal nerve fiber layer thickness and its functional correlations with the visual field.
We have developed a technique for stereophotogrammetric measurements of retinal nerve fiber layer thickness at the disc margin. This technique has a reproducibility ranging from 3.9% to 6.0% in normal, ocular hypertensive and high pressure open angle glaucomatous eyes. The presence of a halo or scleral crescent had no effect on the reproducibility of the measurements. The measurements have shown that ocular hypertensive eyes have about an 18% decrease of retinal nerve fiber layer thickness compared to normals. High pressure open angle glaucomatous eyes have about a 43% decrease in retinal nerve fiber layer thickness compared to normals. This technique allows the development of maps of retinal nerve fiber layer thickness so that localized changes at the disc margin can be detected. The thinnest nerve fiber layer occurs primarily in the temporal segment. This technique has also correlated measurements of nerve fiber layer thickness with other measurements of the optic disc, particularly showing a significant correlation with area of pallor as well as measurements of the width of optic disc cup at about halfway between surface and the bottom of the cup. A significant correlation with visual field loss has been shown in high pressure open angle glaucomatous eyes, primarily with the temporal quadrant of the retinal nerve fiber layer and the nasal visual field. The rate of the visual field change in primary open angle glaucoma has been correlated with the initial nerve fiber layer thickness, with the greater the retinal nerve fiber layer thickness the greater the rate of the visual field loss during follow-up. These findings suggest that retinal nerve fiber layer thickness discriminates between normal, ocular hypertensive eyes as well as those with open angle glaucomas and may be useful in following patients with open angle glaucoma prior to development of the visual field loss.
Glaucoma, Open-Angle↗
Value of trabeculectomy specimens in glaucoma.
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Adolescent↗
Peripheral nasal field defects in glaucoma.
One hundred fifty-one eyes of 101 consecutive patients with chronic open-angle and low tension glaucoma showed typical visual field changes. Sixty of the eyes had a nasal step, either alone or in combination with other defects. In 17 of these eyes, it was possible to demonstrate an isolated scotoma in the nasal periphery. It was concluded that the peripheral nasal step is a nerve fiber bundle defect that in its earliest phase produces a scotoma. In this sense, it behaves similar to the more central defects, rather than simply as a depression of isopters nasally.
Adult↗
Diathermo-trabeculotomy ab externo: indications and long-term results.
The authors present the results of 2 years' observation of 47 eyes operated with diathermo-trabeculotomy ab externo. This technique, based on a diathermic effect in association with trabeculotomy ab externo, allows an ample opening of Schlemm's canal and of the trabecular meshwork, with normalisation of intraocular pressure and outflow facility, for a period of up to 2 years, in open-angle and congenital glaucoma.
Electrocoagulation↗
Combined cyclodialysis and 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.
Adolescent↗
[Topical oxpernolol in the treatment of various forms of glaucoma (author's transl)].
Oxprenolol is a new beta-adrenergic blocking drug, whose effectiveness in the treatment of various forms of glaucoma has been evaluated. The drug was administered topically as 0.5% -1%-2% solution. The results of the investigation may be summarized as follows: The instillation of the drug produces a transient and slight conjunctival hyperaemia and a not significant miosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaumiosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaucoma. The concentration of 0.5% Oxprenolol seems to be as effective as topical 1% Propranolol. At the same concentration (0.5%), Oxprenolol produces no significnat change of the systemic blood pressure or of the heart rate. Topical pre-treatment with 1% Oxprenolol inhibits the systemic side-effects (tachycardia) produced by topical Isoproterenol, a wellknown ocular hypotensive drug. The authors conclude the investigation affirming that Oxprenolol may represent a new effective means for the medical treatment of glaucoma.
Chronic Disease↗
Pilocarpine therapy in glaucoma: effects on anterior chamber depth and lens thickness in patients receiving long-term therapy.
The effect of pilocarpine hydrochloride on the anterior chamber depth and lens thickness was measured in 20 eyes of patients with chronic open-angle glucoma who were receiving long-term glaucoma therapy with pilocarpine. Measurements were made with high-resolution ultrasonic biometry. This study demonstrated that regardless of their age (58.4 years, average) and the fact that they had been regularly using pilocarpine from two to four times a day, 85% of these patients demonstrated narrowing of the anterior chamber (AC) depth (average, 0.19 mm) and thickening of the lens (average, 0.21 mm) with each instillation of pilocarpine. In approximately 15% of eyes, a repeatable deepening of the AC depth and flattening of the lens was noted.
Administration, Topical↗
The histopathology of pigmentary dispersion syndrome with glaucoma.
Iris tissue and trabecular meshwork, obtained at time of trabeculectomy, was studied using the light and electron microscope in a 54-year-old woman with pigmentary dispersion syndrome with glaucoma. The specific defect was a loss of the outer epithelial cells of the iris with marked thinning of the remaining outer layers so that the two-cell architecture of the iris epithelium was maintained. In addition, the radial muscle layer was increased in both number and size of muscle fiber. It would appear that the pigmentary dispersion syndrome may represent a congenital or developmental abnormality of the iris epithelium, or both, and that the glaucoma which occasionally occurs in conjunction with this syndrome is of the usual open-angle type.
Atrophy↗
Glucocorticoid responsiveness associated with HLA-B12.
Primary open-angle galucoma (POAG) patients are more responsive to glucocorticoids, and have increased prevalences of the histocompatibility antigens HLA-B7 and HLA-B12. We report herein a comparison of in vitro cellular responsiveness to glucocorticoids and HLA classification for 25 POAG patients, and 25 individuals who respond to topical dexamethasone with intraocular pressure is greater than 31 mm. HG. (GG responders). Within both the POAG and GG groups, significantly greater responsiveness to prednisolone occurs in patients with HLA-B12 antigen. No such association occurs for patients with HLA-B7.
Aged↗
Diurnal variations in outflow facility.
Tonography was carried out at 8 AM, 2 PM, and 8 PM on 43 normal eyes, 58 open-angle glaucomatous eyes and 10 ocular hypertensive eyes. Diurnal variations in outflow facility and their relation to those in intraocular pressure (IOP) were studied. Diurnal variations in outflow facility were present in almost all eyes, with approximately a 10% exception. The average diurnal variation in true outflow facility (deltaCtrue) was 0.10 microliter/min/mm Hg in normal eyes and 0.07 microliter/min/mm Hg in glaucomatous eyes. The average rate of diurnal variation in true outflow facility: formula: (see text) was 43.6% in normal eyes and 69.1% in glaucomatous eyes. The value was greater in glaucomatous eyes than in normal eyes. The curve of diurnal variations in true outflow facility was divided into 5 types, and in glaucomatous eyes the value of outflow facility was apt to increase in the morning and decrease in the evening. In 42% of the normal and 45% of the glaucomatous eyes, inverse relation was seen between diurnal variations in outflow facility and diurnal rhythm in IOP. It is thought that diurnal variations in outflow facility, along with diurnal fluctuations in the rate of aqueous formation, are one of the factors responsible for the diurnal rhythm found in IOP.
Adult↗