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[Changes in intraocular pressure during dialysis].

We studied 29 patients on dialysis for terminal uremia, of whom one showed a dramatic rise in intraocular pressure (IOP) during dialysis. We examined the blood pressure (BP) and body weight (BW) before and after treatment in each patient and visual acuity by gonioscopic examination and optic disk status. After dialysis the statistically significant fall in BP and BW was observed in all patients, and in 28 subject an significant rise in IOP was noted. Only one patient experienced a dramatic rise in IOP, and he was the only one suffering from angular glaucoma during the last two years. All this time he was continually treated for glaucoma. After dialysis his IOP was 45 mmHg. With the adequate medication, his IOP lowered to the point when he was able to bear iridectomy which was done with argon and YAG laser. After the surgery his IOP reached the normal values. His visual acuity was good (1.0), visual field was normal, gonioscopic findings showed a narrow angle (Shaffer I, with normal pigmentation), and the optic disk had no abnormalities. It is not yet clear what was the cause of IOP rise during dialysis. It might be that the increased production of aqueous humor, which has been reported in such cases, might be caused by imbalance between blood and aqueous osmolality. If dialysis causes decrease in blood osmolality and if, at some time, blood becomes hypotonic in relation to ocular fluid, then the regular osmotic forces transfer the fluid to the ocular fluid into the eye. This case suggests that all patients on dialysis should undergo a minute ocular anamnesis and examination, and if needed administered adequate medication during the treatment.

Adult↗
PubMed1997

Biometric study of acute primary angle-closure glaucoma.

We investigated the biometric characteristics of acute primary angle-closure glaucoma (PACG) patients and sought guidelines to predict subjects at high risk of acute attack. We enrolled 80 patients who suffered acute attack of angle-closure glaucoma and 60 nonglaucoma subjects. The biometric data, measured with A scan ultrasonography, and the outcomes after various treatments were analyzed. Six patients were excluded because they were lost to follow-up. In the acute PACG patients, the axial length (mean +/- standard deviation) was 22.25 +/- 0.77 mm, the anterior chamber depth (corneal thickness included) was 2.28 +/- 0.23 mm, and the lens thickness was 4.94 +/- 0.28 mm. In the nonglaucoma subjects, the axial length was 23.26 +/- 0.76 mm, the anterior chamber depth (corneal thickness included) was 3.11 +/- 0.25 mm, and the lens thickness was 4.48 +/- 0.30 mm. An anterior chamber depth of less than 2.70 mm was the most sensitive (94%) and specific (94%) parameter to differentiate acute PACG patients from nonglaucoma subjects. The intraocular pressure was controlled within the satisfactory range in 58 patients by laser iridectomy, with or without antiglaucoma medication. Eight patients needed additional gonioplasty and eight required filtering surgery to control the intraocular pressure. Our findings provide useful information about the biometric data of eyes of patients with acute angle-closure glaucoma and offer a useful guide to predict those patients at high risk of acute attack.

Acute Disease↗
PubMed1997

[Postoperative flat anterior chamber. The therapeutic approach].

OBJECTIVE: The study of clinical entities followed by postoperative flat anterior chamber and their therapeutical possibilities. Retrospective study of all flat anterior chamber cases in a series of 315 patients operated for glaucoma. There were 16 flat anterior chamber cases with ocular hypotony, 3 cases with pupillary block and 9 cases with ciliary block. Stage I flat anterior chamber cases with ocular hypotony responded well to medical treatment. The most efficient surgical procedures were the application of additional sutures and excision of the over filtering bleb. The most frequent complications are: secondary cataract (75%), filtering failure (25%) and uveitis (18.75%). Flat anterior chamber cases with pupillary block resulted from obstruction and were managed with a new peripheral iridectomy. Flat anterior chamber cases with ciliary block had a severe evolution and didn't show any improvement under medical therapy. All cases were managed successfully by vitreous surgery (especially using pars plana aspiration). The incidence of postoperative flat anterior chamber can be reduced by accurate surgical procedure. Most of flat anterior chamber cases with ocular hypotony had a favorable evolution under medical treatment. Cases associated with intraocular hypertension needed surgical management.

Adrenal Cortex Hormones↗
PubMed1976

Differential diagnosis and treatment of dislocated lenses.

Ectopia lentis continues to be a perplexing diagnostic and therapeutic problem for most ophthalmologists. However, thorough investigation, both systemic and ocular, can in most cases, establish either an environmental etiology or the nature of the heritable disorder. In cases with systemic disease and ectopia lentis, the ophthalmologist should insure that each patient obtains adequate consultation with other specialists in order that proper prophylactic and therapeutic measures are available. The Marfan syndrome, homocystinuria, and the Weill-Marchesani together account for the majority of dislocated lenses. Each of these requires a somewhat different therapeutic approach. Glaucoma should be recognized as a frequent complication in each of these conditions but is most serious in the Weill-Marchesani syndrome in which it often occurs early in life and remains unrecognized until serious damage has occurred. Because of the pupillary-block nature of the glaucoma in this condition, a prophylactic peripheral iridectomy must be seriously considered in every case while lens surgery should be undertaken if the glaucoma cannot be controlled by medical or surgical means. In homocystinuria, because of the potential vascular complications of general anesthesia, the ophthalmologist is often in a dilemma. The lens in this condition seems to be more mobile than in other ectopia lentis disorders and therefore likely to compromise vision earlier in life. However, due to the risk of vascular thrombosis, lens surgery should be delayed whenever possible until the patient is old enough to tolerate local anesthesia. Likewise, patients with the Marfan syndrome should be handled conservatively and, in general, function quite well simple with spectacle correction. Due to the high frequency of immediate surgical complications, it is advisable to avoid an open-sky technique to lens removal, using aspiration or a pars plana approach instead.

Abnormalities, Multiple↗
PubMed1998

Recalcitrant malignant glaucoma following pars plana vitrectomy, scleral buckle, and extracapsular cataract extraction with posterior chamber intraocular lens implantation.

Pars plana vitrectomy is employed to treat cases of aqueous misdirection that are refractory to medical and laser treatment. The authors describe a 65-year-old man without previous aqueous misdirection in whom this condition developed after a procedure that included pars plana vitrectomy. The aqueous misdirection recurred despite multiple interventions, including medical treatment, transiently successful Nd:YAG laser capsulo-hyaloidotomy, and surgical disruption of the anterior hyaloid face. It finally resolved after repeated pars plana vitrectomy with hyaloido-capsulo-iridectomy. There has been no recurrence 7 months after this procedure. The authors conclude that the surgical treatment of aqueous misdirection refractory to more conservative measures should include adequate disruption of the anterior hyaloid to prevent recurrence.

Aged↗
PubMed1996

[Extra-capsular cataract extraction and intraocular lens implantation in cases with cataract and a small pupil with synechiae].

OBJECTIVE: To introduce a new surgical technique for cataract with a small synechia pupil and evaluate its effects. METHODS: 43 eyes of 40 patients were operated on and followed up for 3-30 months. Surgical procedures included iridectomy, separating the posterior synechiae, straight cutting of upper iris and making 3 little cuts at inferior pupillary margin, extracapsular cataract extraction, intraocular lens implantation, and at last suturing the iris cuts to form a round pupil. RESULTS: Postoperatively, all 43 eyes had 3-4 mm basically round pupil and 42 eyes (97.7%) had improved vision. Of the 32 eyes followed up for more than three months, 22 eyes (68.8%) obtained visual acuities 0.5 or better, 10 eyes (31.2%) had visual acuities worse than 0.4 which were attributed to posterior segment abnormalities. Intraoperatively, no posterior capsular rupture was seen, and postoperatively, no severe complications were found. CONCLUSION: The results suggest that patients with cataract and a small synechia pupil obtain improved vision and round pupil without unacceptable risk by means of the surgical technique mentioned in this paper.

Adolescent↗
PubMed1998

Histopathological features of lepromatous iridocyclitis; a case report.

A peripheral iridectomy specimen which included a portion of the ciliary body from an advanced lepromatous leprosy patient was studied histopathologically. The lepromatous granuloma in the iris was similar in content and appearance to that of skin lesions. It appeared that even in this advanced lepromatous patient the dilator muscles of the iris were preserved. This study agrees with the earlier observation that the dysfunction of the iris in lepromatous disease is most probably the result of autonomic nerve destruction. Further, it is possible that the lepromatous involvement of the iris may reflect the histopathological changes in the ciliary body.

Aged↗
PubMed1998

[Neoplasm metastasis to the eye--diagnosis and therapy].

PURPOSE: The increasing occurrence of neoplastic metastases to the eye encouraged us to present our own observation on this topic. MATERIAL AND METHODS: We have examined 17 patients with metastatic tumors of the eye (in 6 cases there was bilateral involvement). The group included 11 females and 6 males, aged 43 to 69 years. The most common primary tumor was breast carcinoma (9 women-13 eyes); then cancers of lung (4 men), gastrointestinal tract (2 women-3 eyes), maxillary sinus (1 case); and malignant lymphoma (1 case). In 5 patients the eye was enucleated because of secondary glaucoma. RESULTS: Improvement or stopping the progression of the disease was achieved in 1 of 2 patients treated with argon laser, 3 of 6 patients treated with xenon lamp photocoagulation, and in all 8 eyes treated with gamma-therapy. In one case of metastatic tumor of the iris a partial iridectomy was performed. A case of systemic malignant lymphoma was treated pharmacologically. CONCLUSIONS: It seems that the best option of treatment of eye metastases is gamma-therapy, particularly effective in small lesions. Authors emphasize that it is necessary to perform routine ophthalmologic examinations in patients with breast cancer, lung cancer, and other neoplasms associated with high risk of metastases to the eye. This can allow to early detect eye metastases and start the appropriate treatment.

Adult↗
PubMed1998

Experimental ocular surgery with a high-repetition-rate erbium:YAG laser.

PURPOSE: To evaluate the performance in ocular surgery and the ocular tissue interactions resulting from increasing the maximum repetition rate of a pulsed-mode erbium:YAG laser system from 30 to 200 pulses per second. METHODS: An erbium:YAG laser was used that emitted at 2.94 microm with an output graduated from 0.2 mJ to 25 mJ and a repetition rate from 2 Hz to 200 Hz and that was equipped with a flexible optical fiber attached to various interchangeable 20-gauge endoprobes to perform ocular surgery in enucleated pig eyes. The specific maneuvers were performed in close contact in nontransmitting aqueous media and included inner retinal ablation, retinotomy, lens capsulotomy, lens ablation, iridotomy, and iridectomy. Selected tissue specimens were examined by light microscopy. RESULTS: Increasing the repetition rate to the 200-Hz range significantly improved the smoothness, continuity, and speed of all surgical maneuvers. Compared with the 30-Hz rate, substantially lower energies per pulse were efficient with the 200-Hz rate. The "sticking effect" between the tip of the probe and the target tissue at low-repetition rates, which resulted in discontinuation of the surgical maneuver, particularly during lens surgery, was eliminated with the use of high-repetition rates. Use of high-repetition rates produced a zone of residual thermal damage less than 30 microm in all ocular tissues. The histologic findings of tissue interactions were comparable to those obtained in published studies in which the same wavelength and low hertz rates were used. CONCLUSIONS: The high-repetition-rate erbium:YAG laser technology described is advantageous, compared with low-repetition-rate erbium:YAG lasers, and is applicable in a variety of ocular surgical procedures. Innovations in endoprobe design and further study will determine its role in contemporary ocular surgery.

Animals↗
PubMed1976

[The fellow eye in acute angle-closure glaucoma (author's transl)].

With 5 years after the acute angle-closure glaucoma of an eye, in the fellow eye the same disease developed in only 15% of cases, but in 42% of cases in spite of the preventive miotic therapy a chronic angle-closure glaucoma developed unnoticed by the patients. Hence preventive iridectomy is suggested in the fellow eye.

Glaucoma↗
PubMed1998

[Cataract and the exfoliative syndrome].

Exfoliation syndrome is more frequently in the older age and represents a risk factor for cataract surgery. This paper presents the results of a clinical trial made on 436 patients with troubles of transparency of the lens who were investigate in our clinic during January 1995-January 1997, and in whom, clinic and paraclinic exams have not revealed any associated ocular disease. In 14% of these patients who presented troubles of transparency of the lens were found uni- or bilateral exfoliation. The authors present the treatment applied both in patients in clinical follow-up (50% of patients with exfoliation syndrome develop secondary glaucoma) and patients who underwent surgical treatment. The patients with exfoliation syndrome and cataract have had a high risk to develop intra- and postoperative complications. The surgical treatment suggested by authors is extracapsular cataract extraction, either or without lens implantation and peripheral iridectomy which represents a compulsory step.

Aged↗
PubMed2004

Crossover comparison of timolol and latanoprost in chronic primary angle-closure glaucoma.

OBJECTIVE: To compare latanoprost and timolol maleate as primary therapy in 60 eyes with chronic primary angle-closure glaucoma after a laser iridotomy. METHODS: We performed a prospective, randomized, crossover study of 60 eyes of 30 patients with chronic primary angle-closure glaucoma after laser iridotomy. Patients were randomized to 2 groups: those taking latanoprost once daily or those taking timolol twice daily. Three months after treatment with the first drug, the second drug was substituted. The circadian rhythm of intraocular pressure (IOP) was recorded before the start of therapy, at 3 months, and at 7 months. The fourth month was the washout period for the first drug. RESULTS: The mean baseline IOP was 23.5 +/- 2.1 mm Hg, which decreased by 8.2 +/- 2.0 mm Hg with latanoprost (P<.001) and by 6.1 +/- 1.7 mm Hg with timolol (P =.01). The decrease in IOP was greater for patients taking latanoprost (P<.001). Latanoprost was significantly more effective in eyes having morning and afternoon peaks of IOP. A total of 43 eyes (72%) of patients taking latanoprost and 26 (43%) on timolol achieved a reduction of more than 30% from baseline IOP. CONCLUSION: There were greater mean and peak IOP reductions achieved with 0.005% latanoprost once daily compared with 0.5% timolol twice daily.

Aged↗