Central corneal thickness in pediatric glaucoma.

PURPOSE: To compare the central corneal thickness (CCT) of children with and without glaucoma and to estimate the effect CCT may have on the intraocular pressure (IOP) assessment of children. PATIENTS AND METHODS: CCT and IOP measurements were performed in an unmasked fashion in 34 consecutive children with glaucoma and 28 consecutive children without glaucoma. Patients with corneal edema or extensive corneal scarring were excluded. IOPs in the pediatric glaucoma group were corrected for CCT using a linear algorithm; adjustments of 3 mm Hg or more were considered clinically significant. RESULTS: Mean CCT for eyes with glaucoma was 610.2+/-121.9 microm; for the control eyes, mean CCT was 555.6+/-38.4 microm (P < .001). Mean CCT was 543.3+/-66.9 microm for eyes with primary congenital glaucoma, 591.9+/-23.1 pm for those with Sturge-Weber syndrome, 662.7+/-68.7 microm for those with aphakic glaucoma, 754.5 +/-92.6 microm for those with aniridia, and 820.6+/-133.7 microm for those with microcornea (P < .001). Applying a correction formula for IOP with CCT adjustment, the adjusted IOP was overestimated by > or =3 mm Hg in 14 (41.2%) eyes and underestimated by > or = 3 mm Hg in 5 (14.7%) eyes. CONCLUSIONS: The mean CCT was higher for the pediatric glaucoma group than for the control group. However, the CCTs varied significantly depending on the specific diagnoses. CCT was estimated to have a clinically significant effect on IOP measurements in more than half of the patients with pediatric glaucoma. Pachymetry results should be considered in the management of these patients.

Subconjunctival sodium hyaluronate 2.3% in trabeculectomy: a prospective randomized clinical trial.

PURPOSE: To investigate the efficacy of subconjunctival sodium hyaluronate 2.3% in increasing the success rate of glaucoma filtering surgery and promoting filtering blebs with characteristics presumed to predict better success. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Fifty-five patients scheduled for glaucoma surgery. INTERVENTION: Patients underwent routine trabeculectomy, with or without phacoemulsification and intraocular lens implantation. In the study group (n = 28), sodium hyaluronate 2.3% was injected between the scleral and conjunctival flaps at the conclusion of the surgery. In the control group (n = 27), balanced salt solution (BSS) was injected in the same fashion, in an unmasked design. MAIN OUTCOMES MEASURES: Surgical success was defined as (1) a complete success if the intraocular pressure (IOP) was 21 mmHg or less without any antiglaucoma medication, and (2) a qualified success if the IOP was 21 mmHg or less, with or without antiglaucoma medication. Patients requiring additional surgery, including needling, or with IOP more than 21 mmHg, even when receiving antiglaucoma medications, were considered to have failed treatment. Success rates in both groups were compared using Kaplan-Meier survival curves and the log-rank test. The morphologic characteristics of the filtering blebs were evaluated using the Indiana Bleb Appearance Grading Scale. Other outcome measures were IOP, visual acuity, need for antiglaucoma medication, and any complications. RESULTS: Fifty-two patients completed the study (27 in the study group and 25 in the control group), with a mean follow-up of 12.3 months. Complete success rates were 77.8% for the study group and 84.0% for the control group 12 months after surgery (P>0.5); qualified success rates were 88.9% for the study group and 92.0% for the control group (P>0.6). Mean IOP decreased from 26.0+/-10.0 mmHg to 11.6+/-4.1 mmHg in the study eyes (P<0.001) and from 24.9+/-9.7 mmHg to 13.0+/-4.1 mmHg in the control eyes (P<0.001). Intraocular pressure measurements in both groups were similar at all visits (P>0.05). The study eyes had more diffuse blebs than the control eyes (62.5% > or =4 clock-hours vs. 22.7%; P = 0.012). Postoperative complications were similar in the study eyes (14.8%) and the control eyes (20.0%; P>0.6). CONCLUSIONS: There was no difference in success rates in patients who received subconjunctival sodium hyaluronate 2.3% compared to BSS injections. Subconjunctival sodium hyaluronate 2.3% was associated with more diffuse blebs after filtering surgery.

Results of the use of the Ex-PRESS miniature glaucoma implant in technically challenging, advanced glaucoma cases: a clinical pilot study.

PURPOSE: To report results of implantation of the Ex-PRESS Miniature Glaucoma Implant (Optonol, Neve Ilan, Israel) shunt directly under the conjunctiva in advanced glaucoma. DESIGN: Noncomparative case series. METHODS: Chart review of eleven cases of Ex-PRESS implantation. Outcome measures included intraocular pressure (IOP), complications, visual acuity, and additional interventions. Failure was defined as unacceptably high IOP requiring revision or explantation. RESULTS: Four patients (36%) failed. Ten (91%) experienced hypotony during postoperative week one. In the seven nonfailures, mean pre and postoperative IOPs were 30.3 +/- 9.3 mm Hg and 13.6 +/- 4.4 mm Hg, respectively (P = .006). The logMAR visual acuity did not change significantly from baseline to follow up (logMAR 1.1 +/- 0.9 and 1.4 +/- 0.9, respectively, P = .13). There were no intraoperative complications. Postoperative complications in the 11 eyes included choroidal detachment in 3 (27%) and suprachoroidal hemorrhage in 2 (18%). Of the 7 successful cases, additional interventions were required in 4 (57%). CONCLUSIONS: Despite significant IOP reduction, the incidence of complications following Ex-PRESS implantation directly under the conjunctiva was unacceptably high in this group of patients.