Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure.

PURPOSE: To evaluate quantitatively, by means of ultrasound biomicroscopy (UBM), changes in the anterior segment configuration, including the ciliary processes, induced by cataract surgery in eyes with primary angle closure. DESIGN: Retrospective interventional case series. PARTICIPANTS: Thirty-one eyes of 31 patients with primary angle closure or primary angle-closure glaucoma were treated with cataract surgery. Before cataract surgery, 10 eyes had been treated with laser peripheral iridotomy, and 1 with laser peripheral iridoplasty. METHODS: Configuration of the anterior chamber was examined by means of UBM before and at 3 months after cataract surgery. MAIN OUTCOME MEASURES: Using UBM, anterior chamber depth (ACD), angle opening distance at points 500 mum from the scleral spur (AOD500), and trabecular-ciliary process distance (TCPD) were measured. RESULTS: Not only ACD and AOD500, but also TCPD, increased significantly after cataract surgery, compared with measurements obtained before surgery (P<0.001). Postoperative AOD500 was correlated significantly with postoperative TCPD (r = 0.72, P<0.001) and with the amount of change of TCPD caused by cataract surgery (Delta TCPD) (r = 0.52, P<0.01). CONCLUSIONS: Cataract surgery attenuated anterior positioning of the ciliary processes in eyes with primary angle closure, concomitant with significant widening of the angle. Cataract surgery resulted in not only complete dissolution of lens volume and pupillary block, but also attenuation of the anterior positioning of the ciliary processes, all of which contributed to postoperative widening of the angle in eyes with primary angle closure.

Triamcinolone acetonide with vitrectomy for treatment of macular edema associated with branch retinal vein occlusion.

PURPOSE: To review the efficacy of a combination of triamcinolone acetonide (TA) injection and pars plana vitrectomy (PPV) for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Seventeen eyes with macular edema associated with BRVO underwent PPV with an intraoperative injection of TA (10 mg) into the vitreous cavity. Residual or recurrent macular edema was treated with postoperative sub-Tenon capsule injections of TA (20 mg). RESULTS: With PPV and an intraoperative injection of TA, 82% of eyes showed rapid reduction of macular edema; foveal thickness decreased from 507 +/- 115 microm preoperatively to 261 +/- 123 microm 2 months after surgery (P = 0.0041). However, 59% of eyes showed recurrence of macular edema during the follow-up period. Twelve eyes with residual or recurrent macular edema received sub-Tenon capsule injections of TA; of these eyes, 9 showed substantial reduction of macular edema. Foveal thickness decreased from 381 +/- 102 microm to 256 +/- 56 microm (P = 0.0076) 2 weeks after postoperative injections of TA. At the final visit, visual acuity (logMAR) improved from 0.74 +/- 0.40 preoperatively to 0.40 +/- 0.34 (P = 0.010). CONCLUSION: An intraoperative injection of TA in combination with PPV has the potential to facilitate the absorption of macular edema associated with BRVO. In addition, residual or recurrent macular edema can be treated with additional sub-Tenon capsule injections of TA.

Neovascular glaucoma after branch retinal artery occlusion.

BACKGROUND: Neovascular glaucoma (NVG) occurring after branch retinal artery occlusion (BRAO) might not be as rare as previously thought. We report a case of unilateral NVG after BRAO. CASE: A 72-year-old man with chronic heart failure suffered from BRAO in the left eye. Funduscopic examination showed retinal edema and many cotton wool spots in the superotemporal retina. OBSERVATIONS: Five weeks later, he had increased blurring of vision due to a second BRAO in the inferotemporal retina of the left eye. Three days later, he felt pain and had severe visual loss in the left eye. In the presence of angle neovascularization, intraocular pressure (IOP) in the left eye rose to 35 mmHg. Immediate focal photocoagulation to the affected retina diminished the neovascularization and lowered the IOP. CONCLUSION: It is possible for NVG to occur as a complication of BRAO.

Cataract surgery for residual angle closure after peripheral laser iridotomy.

PURPOSE: To investigate the frequency of residual angle closure after resolution of pupillary blocking by laser peripheral iridotomy and the effects of subsequent cataract surgery to resolve angle closure completely. DESIGN: Retrospective, consecutive, interventional study. PARTICIPANTS: Among 70 eyes treated with laser iridotomy, 13 with residual angle closure were treated with cataract surgery. METHODS: The provocative test of angle closure by prone position in a dark room for 1 hour was performed; increases in tension of > or =8 mmHg, 6 or 7 mmHg, and < or =5 mmHg were considered to be positive, suspected positive, and negative, respectively. Configuration of the anterior chamber was examined using ultrasound biomicroscopy (UBM). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), response to the dark room prone position test, and morphologic analysis by UBM were evaluated before and 3 months after cataract surgery. RESULTS: Residual angle closure after iridotomy was seen in 27 (38.6%) of 70 eyes; this was confirmed functionally by the dark room prone position test and morphologically by UBM. Eyes with IOP of > or =20 mmHg or with a glaucomatous visual field defect before iridotomy had a significantly higher incidence of residual angle closure after iridotomy than eyes without these findings (P<0.05). In all the eyes with residual angle closure after iridotomy, the response to the prone position test became negative after cataract surgery, with significant lowering of IOP (P<0.01). CONCLUSIONS: Residual angle closure after iridotomy was common, especially in eyes with primary angle closure and poorly controlled IOP or glaucomatous optic neuropathy. Cataract surgery was effective to resolve completely the residual angle closure after iridotomy and lower IOP.

Retinal cystoid spaces in acute Vogt-Koyanagi-Harada syndrome.

PURPOSE: Exudative retinal detachment in acute Vogt-Koyanagi-Harada syndrome often is associated with subfoveal yellowish round structures. This report describes the incidence and clinical characteristics of these structures. DESIGN: Interventional case series. METHODS: We reviewed the fundus photographs and medical records of 35 eyes of 19 Japanese patients with bilateral diffuse choroiditis at the onset of acute Vogt-Koyanagi-Harada syndrome. RESULTS: All eyes showed subretinal fluid in the posterior pole. In addition, yellowish round structures were seen in 15 eyes (43%). Most of the yellowish structures were subfoveal in location and ranged in size from less than 1 disk diameter to 3 disk diameters. In 6 eyes with these structures, optical coherence tomography showed liquid accumulation in the retina or thin walls, which seemed to separate the cystoid spaces from the subretinal fluid. Late-phase fluorescein angiography showed pooling of dye within these structures as well as within the subretinal fluid. Immediately after corticosteroid administration was initiated, these structures began to be less obvious, and they disappeared completely within several days; there was a concomitant reduction in the subretinal fluid. At the initial visit, visual acuity in eyes with these yellowish structures was slightly less than that in eyes without them, but no differences in visual acuity were found during the period of follow-up. CONCLUSION: Subfoveal yellowish round structures may be a common feature in acute Vogt-Koyanagi-Harada syndrome. However, they appear to have only a minor (if any) effect on visual prognosis.