Otago Glaucoma Surgery Outcome Study: Examining the Development of Strabismus Causing Diplopia in Patients Who Have Received Molteno Implant Surgery.

OBJECTIVE: To evaluate the development of postoperative strabismus causing diplopia in patients who received Molteno implant surgery for the treatment of glaucoma. METHODS: The Otago Glaucoma Surgery Outcome study (OGSOS) was used to select cases who had undergone Molteno implant surgery to examine the effect on the development of strabismus causing diplopia. Information was collected on treatments provided to correct motility disturbance, and their success, in this retrospective non-comparative study. RESULTS: 32 cases (3.3%) were found to have developed diplopia following the Molteno implant surgery from a total of 977 cases. Of these, the strabismus in 23 cases was described in sufficient detail to permit clinical categorization. Most (19/23) demonstrated an exodeviation, hyperdeviation, or a combination thereof, although 2/6 cases with superonasal plate location demonstrated a hypodeviation. Diplopia generally resolved spontaneously (20/32 cases). Treatment was required in eight cases, usually conservative and successful (6/8 cases), but strabismus surgery was required in two cases, and was unsuccessful. CONCLUSIONS: This study found a low incidence of diplopia developing post-Molteno implant surgery. Strabismus features suggested a restrictive etiology, and spontaneous recovery was common (62.5%). Surgical correction proved unsuccessful - confirming persistent postoperative diplopia after Molteno implant surgery to be a rare but surgically challenging complication.

High rate of incidental glaucoma detection in New Zealand.

AIM: To investigate how glaucoma is initially detected in New Zealanders and what factors aroused disease suspicion. METHODS: A postal survey of 500 randomly selected members of the Glaucoma New Zealand database was undertaken in 2012 to analyse factors relating to their initial presentation and diagnosis of glaucoma. Online surveys and telephone interviews were used to increase the response rate. RESULTS: The overall response rate was 80% (376/468) of eligible participants. The sample had an average age of 76 years. Prior to diagnosis, 80% (290/361) of participants who responded to this question reported no suspicion of glaucoma. A positive family history for glaucoma was the most common reason (71%) for presenting to a health care professional with a suspicion of glaucoma (13% of total sample). After diagnosis, 95% (357/376) of respondents reported that they had informed family members of their diagnosis. CONCLUSIONS: This study confirmed that the majority of glaucoma was discovered through incidental findings. A positive family history was the most common risk factor prompting examination, knowledge about which appeared to increase dramatically post-diagnosis. These findings indicated that there was potential to educate the public about glaucoma in order to raise awareness and diagnose the disease earlier.

Choroidal melanoma treated with stereotactic fractionated radiotherapy and prophylactic intravitreal bevacizumab: The Dunedin Hospital experience.

INTRODUCTION: Choroidal melanoma (CM) is the most common primary ocular malignancy in adults. This study reviewed the Dunedin Hospital (DH) experience in the treatment of CM with stereotactic fractionated radiotherapy (SRT) and the outcome of prophylactic use of intravitreal injection bevacizumab (PIB) in preventing radiation retinopathy (RR). METHODS: A retrospective study was conducted of patients at DH who underwent SRT for CM with and without PIB from 1 January 2001 to 31 January 2012. In DH, some patients who had SRT following the introduction of intravitreal bevacizumab in December 2006 were also treated with PIB with the expectation that this might reduce the risk of developing RR, although the evidence of its effectiveness in this respect is not clear. The primary outcome measure was local progression as monitored with regular ultrasound. Secondary outcome measures were metastatic progression incidence, enucleation incidence, no functional vision incidence, overall survival, disease-specific mortality, incidence of RR, and radiotherapy to clinical diagnosis of RR time. RESULTS: Twenty-seven patients who were followed up at DH were reviewed after a mean follow-up of 5.1 years (range 0.4-12.6). Fourteen patients received PIB. The local progression, metastatic progression and enucleation rate were 4%, 8% and 11%, respectively. The no functional vision (hand movements or less) rate was 62%. Overall survival was 63%, but only three (11%) deaths were due to metastatic choroidal melanoma. Incidence of RR was 57% and 54% for those that received PIB and those who did not, respectively. PIB did not reduce the rate of RR (P = 1.00). CONCLUSION: This study reaffirmed that SRT achieves very good local control and eye retention rates. PIB did not appear to reduce the radiation retinopathy rate in this study, and more studies are required especially Phase II and III trials to determine PIB efficacy in preventing RR.

Otago Glaucoma Surgery Outcome Study: Further Histology and Immunohistochemistry of Molteno Implant Blebs.

PURPOSE: To describe findings of light microscopic examination of Molteno implant bleb capsules. METHODS: Histological and immunohistochemical features of bleb capsules including distribution of apoptotic cells and cell fragments were examined in 11 eyes 0.2 to 30.4 years after Molteno implants. RESULTS: In the superficial layer of capsules, high proportions of cells showed cytological features of apoptosis, with a higher proportion of cells showing specific immunohistochemical features of apoptosis with a mean of 22% (range, 3%-40%) of cells staining positively for Fas ligand. This demonstrated that cells migrating into the superficial capsule were replaced over approximately 1 to 6 days. In the deeper layer a mean of 8% (range, 3%-38%) of apoptosing cells stained positively for Fas ligand. These lower proportions of positively staining cells and cell fragments in the deeper layers, and the presence of occasional positively staining cells on the inner surface of capsules, demonstrated continuous migration of cells into the deeper layers associated with breakdown of connective tissue matrix and the release of numerous membrane-bound vesicles. CONCLUSIONS: These findings demonstrated unexpectedly rapid turnover of cells in the superficial layer of the bleb capsule, where most cells were efficiently phagocytosed by nearby monocytic cells, macrophages, and histiocytes; the remaining cells migrating into the deeper layers completed apoptosis and disintegrated with release of collagenolytic enzymes and Fas ligand positive presumed "death messengers" that were carried toward the superficial layers by the aqueous.

Otago Glaucoma Surgery Outcome Study: cytology and immunohistochemistry of trabeculectomy blebs.

PURPOSE: To describe findings of light microscopic examination of trabeculectomy blebs. METHODS: Histologic and immunohistochemical features of blebs including cell types, and distribution of apoptotic cells and proapoptotic death messengers were examined in six eyes 6.0 to 25.9 years after trabeculectomy. RESULTS: All specimens showed a channel opening into a rectangular cleft in the middle layer of sclera. The channels showed degenerative changes with disintegration and loss of collagen fibers and few pyknotic cells. Changes were extensive on the upper surface of the cleft forming irregular channels extending through and around the edges of the superficial scleral flap into moderately cellular and vascular oedematous conjunctiva covered by intact epithelium. Immunohistochemical staining demonstrated migration of histiocytes from superficial blood vessels into the deeper layers where they apoptosed and disintegrated. Fas ligand+ proapoptotic death messengers were concentrated in the superficial conjunctival regions of blebs. CONCLUSIONS: These results indicated that the normal cell processes in functioning trabeculectomy blebs were similar to that of Molteno implant capsules. These processes involved migration of cells from superficial blood vessels into perivascular spaces and the deeper tissues where apoptosis occurred. Apoptosis was associated with breakdown of tissue matrix and release of proapoptotic death messengers that were transported by aqueous to the superficial layers where they suppressed collagen synthesis by inducing apoptosis in metabolically active cells.

Accuracy of visual acuity testing in New Zealand primary health care.

AIM: To determine if visual acuity is tested reliably in primary health care in New Zealand. METHODS: Fifteen to 26 'eyes' from seven participants were tested in the Eye Department of Dunedin Hospital under standardised conditions; and across 17 centres in nine general practices and the Emergency Department of Dunedin Hospital for comparison. Variables including lighting and distance were measured; chart type and centre conditions were recorded. RESULTS: Eleven centres (65%) produced visual acuity scores that were inconsistent with the Eye Department, where 10 (59%) of them produced worse visual acuity scores and one centre (6%) produced better visual acuity score. Ten centres (59%) did not meet New Zealand Transport Agency standards of adequate illumination of greater than 500 lux. Ten centres (59%) failed to have their charts at the specified distance. CONCLUSION: There were inconsistencies in visual acuity testing in primary health care in Dunedin, New Zealand which may be related to the overall poor compliance with lighting and distance standards. These factors are potentially easily modifiable and their change should lead to improvements in visual acuity measurements.

Otago glaucoma surgery outcome study: comparative results for the 175-mm2 Molteno3 and double-plate molteno implants.

OBJECTIVE: To evaluate the efficacy of the 175-mm2 Molteno3 implant in patients with nonneovascular glaucoma. METHODS: A hospital-based, retrospective historical control comparative case series comparing results in the first 87 eyes to receive the 175-mm(2) Molteno3 implant with those in a control group of 115 eyes receiving the 274-mm(2) double-plate Molteno implant. RESULTS: Success was defined as an intraocular pressure (IOP) of at least 6 mm Hg but not more than 21 mm Hg with or without hypotensive medication. The mean postoperative follow-up was 3.0 years (range, 13 days to 5.6 years) in the Molteno3 implant group and 6.2 years (range, 1 day to 13.9 years) in the double-plate Molteno implant group. The mean (SD) preoperative IOP was 25.6 (7.1) mm Hg in the Molteno3 implant group in eyes treated with a mean of 2.3 ocular hypotensive medications, and 25.7 (8.0) mm Hg in the double-plate Molteno implant group in eyes treated with a mean of 2.2 medications. The mean (SD) postoperative IOP at 36 months was 13.9 (3.2) mm Hg in the Molteno3 implant group in eyes treated with a mean of 0.9 ocular hypotensive medications, and 14.5 (3.4) mm Hg in the double-plate group in eyes treated with a mean of 0.7 medications. The probability of IOP control at 3 years was 0.79 in both groups. There was significantly more postoperative hypotony in eyes without a polyglactin 910 tie in the Molteno3 implant group (P= .04); however, significantly more eyes with flat anterior chambers in the double-plate group required anterior chamber reformation (P= .03). CONCLUSION: The 175-mm(2) Molteno3 implant provided intermediate-term successful treatment of nonneovascular glaucoma comparable to that provided by the double-plate Molteno implant.

Otago glaucoma surgery outcome study: electron microscopy of capsules around Molteno implants.

UNLABELLED: PURPOSE. To report the ultrastructure of cells and extracellular matrix components in Molteno implant capsules examined by scanning and transmission electron microscopy. METHODS: Ultrastructural features including cytology, distribution of apoptotic cells, collagens, basement membranes, elastic fibrils, and glycoproteins were examined by scanning and transmission electron microscopy. Findings were correlated with the clinical features of 31 specimens of glaucomatous eyes treated with Molteno implants 0.3 to 14.9 years previously. RESULTS: Capsules showed two layers: an outer, moderately cellular vascular layer of normal-appearing cells and collagen and an inner, avascular, hypocellular layer of altered cells and collagen. Cells included fibroblasts, myofibroblasts, and tissue histiocytes that showed features indicating metabolic activity, with swelling, vacuolation, and apoptosis, and the formation of numerous membrane-bound vesicles. These features, together with alteration and disintegration of extracellular matrix, increased with time after surgery. CONCLUSION: The results support those in previous light microscopic studies and indicate that the normal life cycle of capsules in both primary and secondary glaucoma include continual outer surface renewal balanced by inner surface degeneration associated with apoptosis and breakdown of tissue matrix components which become more marked over time.

Long-term results of primary trabeculectomies and Molteno implants for primary open-angle glaucoma.

OBJECTIVE: To describe the long-term outcomes of primary trabeculectomies and primary Molteno implants performed in cases of primary open-angle glaucoma at Dunedin Hospital. METHODS: Prospective comparative case series of 718 eyes (500 patients) and 260 eyes (195 patients) that had trabeculectomy and Molteno implants, respectively, at Dunedin Hospital as the first drainage operation for primary open-angle glaucoma between 1976 and 2007, and followed up for a mean of 7.7 (range, 0.0-28.0) and 5.0 (range, 0.0-27.4) years, respectively. RESULTS: The probability of intraocular pressure (IOP) control at 21 mm Hg or less following trabeculectomy at 1, 2, 5, 10, 15, and 20 years was 0.95 (95% confidence interval [CI], 0.94-0.97), 0.93 (95% CI, 0.91-0.96), 0.89 (95% CI, 0.86-0.92), 0.82 (95% CI, 0.78-0.86), 0.74 (95% CI, 0.68-0.80), and 0.68 (95% CI, 0.59-0.77), respectively. There were 96 (13%) failures (using the >21-mm Hg definition of failure) in the trabeculectomy group by the final follow-up. The probability of IOP control at 21 mm Hg or less following Molteno implant insertion at 1, 2, 5, 10, 15, and 20 years was 0.98 (95% CI, 0.97-1.0), 0.97 (95% CI, 0.96-1.0), 0.96 (95% CI, 0.92-0.99), 0.96 (95% CI, 0.92-0.99), 0.91 (95% CI, 0.81-1.00), and 0.91 (95% CI, 0.81-1.00), respectively. In the Molteno implant group, there were 8 (3%) failures (using the >21-mm Hg definition of failure) by the final follow-up. CONCLUSION: Insertion of a Molteno implant provided superior IOP control to trabeculectomy when carried out as a first operation in cases of primary glaucoma.

The epidemiology of giant cell arteritis in Otago, New Zealand: a 9-year analysis.

AIMS: To study the epidemiology of biopsy proven giant cell arteritis (GCA) in patients in the Otago region, New Zealand. MATERIALS AND METHODS: Records of 363 consecutive patients who underwent temporal artery biopsy at Dunedin Hospital between 1996­2005 were reviewed. Annual incidence of biopsy-proven GCA was estimated, epidemiologic characteristics of the biopsy-positive group was compared with the biopsy-negative group. RESULTS: Among the 363 patients who underwent temporal artery biopsy there were 105 (29%) males and 258 (71%) females; biopsy-proven GCA was diagnosed in 70 (19%) patients. The mean age of biopsy-positive group was 72.8 years (range 57-91 years, SD 8.2), which was comparable to the biopsy-negative group 73.4 years (range 50­97 years, SD 9.5), p<0.2. The mean annual incidence of GCA in Otago was 12.73/100,000 CI (11.7­14.3, p<0.5) for patients ≥50 years over the 9 years of observation. CONCLUSIONS: The first large study of GCA from Australasia demonstrated that a variation in the annual incidence rate for giant cell arteritis in Otago, New Zealand showed a cyclic pattern. The overall incidence seems to reflect the ethnic origins of the majority of the population from Britain.

Access to elective surgery in New Zealand: considering equity and the private and public mix.

New Zealand has a two-tier health system with elective surgery provided by both publicly funded state hospitals and by private hospitals. Issues of equity should be considered across such systems-where the better off can access surgery in private hospitals regardless of relative clinical need. This study evaluated equity of provision of surgery after the introduction of a prioritization system to manage access. Data for people receiving publicly funded elective joint replacement, prostatectomy or cataract surgery between 2000 and 2005 were obtained, as well as most recent data for people receiving privately funded surgery (2001 and 2002). Denominators were derived from the 2001 census for the population of District Health Board regions. NZDep2001, a small-area deprivation index, was used to identify people in poorest deciles. Despite the introduction of a prioritization system aimed at increased equity and fairness, the provision of elective surgery remains inequitable geographically. High private provision was not associated with better access to publicly funded surgery. Moreover, the argument that private provision for the well off reduces the burden on the public system allowing better access for the poor was not supported. Consequences of two-tier health systems, as in New Zealand, need more investigation and public discussion.

Otago glaucoma surgery outcome study: tissue matrix breakdown by apoptotic cells in capsules surrounding molteno implants.

PURPOSE: To identify cell types and extracellular matrix components in Molteno implant capsules. METHODS: Histologic features including cytology, distribution of apoptotic cells, cytoantigens, collagens, basement membranes, elastic fibers, and glycoproteins were examined by light microscopy. Findings were correlated with the clinical features of 19 ocular specimens with glaucoma that had been treated with Molteno implants 11 days to 20 years previously. RESULTS: All but the earliest specimen capsules showed two layers: a moderately cellular outer layer of normally stained collagen and an inner avascular hypocellular layer of altered collagen. Capsules contained metabolically active fibroblasts and macrophages showing swelling, vacuolation, and apoptosis with localized loss of extracellular matrix in the inner layers of older capsules. Type I collagen was present in trace amounts. Collagens types III and VI and fibronectin were present in high concentrations in the capsules. Basement membrane material (collagen type IV and laminin) and thrombospondin were concentrated in the inner avascular layers. CONCLUSIONS: These results support previous findings that the normal capsule life cycle includes continual inner surface degeneration and external surface renewal. The cells and tissue matrix components of the outer capsule layer matched those involved in the initial phase of wound healing in vascular connective tissue. The tissue matrix components and widespread apoptosis found in the inner fibrodegenerative layer reflect scar tissue remodelling induced by exposure to the aqueous.

Otago Glaucoma Surgery Outcome Study: long-term results of 841 trabeculectomies.

BACKGROUND: To describe the long-term outcomes of trabeculectomies performed at Dunedin Hospital and followed in the Otago Glaucoma Surgery Outcome Study. METHODS: Prospective non-comparative case series of 841 eyes of 607 patients who had first trabeculectomies for primary open- or closed-angle glaucoma at Dunedin Hospital between 1976 and 2005 and followed for a mean of 7.5 years (standard deviation 6.0). RESULTS: The probability of a trabeculectomy controlling the intraocular pressure at 21 mmHg or less at 1, 10 and 20 years was 0.96 (95% confidence interval [CI] 0.95, 0.97), 0.86 (95% CI 0.83, 0.89) and 0.79 (95% CI 0.74, 0.83), respectively. Visual acuity was maintained or improved between preoperative assessment and final follow up in 68% of cases. The probability of not being blind following trabeculectomy at 1, 10 and 20 years was 0.98 (95% CI 0.96, 0.98), 0.83 (95% CI 0.80, 0.87) and 0.70 (95% CI 0.64, 0.76), respectively. The proportion of those with glaucomatous field loss increased during follow up from 16% (44/283) at 0-5 years to 50% (10/20) for those with 21 or more years of follow up. A repeat drainage procedure was required in 65 eyes (8%) (56 Molteno implant insertions and 9 repeat trabeculectomies). CONCLUSIONS: Intraocular pressure was well controlled by trabeculectomy; however, a steady decline in intraocular pressure control, visual acuity and visual field occurred during follow up.

Scleral wrap increases the long-term complication risk of bone-derived hydroxyapatite orbital implants.

BACKGROUND: This study was prompted by previous findings that suggested that scleral wrapping increased the rate of complications following insertion of bone-derived hydroxyapatite orbital implants and compared the long-term results of implants inserted with and without scleral wraps. METHODS: This retrospective case series reviewed the long-term outcomes of 159 patients who had undergone enucleation with insertion of a bone-derived hydroxyapatite orbital implant at Dunedin Hospital between 1977 and 2006. Implants were inserted with and without scleral wraps in 85 and 74 cases, respectively. Follow up was 0.5-27.5 years (mean 8.2 years) for the whole series and 9.7 years for the sclera group and 6.7 years for the group without sclera. Patient details were obtained from theatre records, case note review, patient interview and examination, interview of patient relatives and family general practitioner records. The main outcome measures were the rates of minor or major complications and their treatments and outcomes. RESULTS: Twenty-seven cases (17%) suffered minor complications of limited implant exposure that either healed spontaneously, with implant drilling or wound resuturing and 11 cases (7%) suffered major complications requiring explantation. Of 38 patients with postoperative complications, 31 (82%) had scleral wraps compared with 7 (18%) without sclera (P < 0.001; OR 5.14, 95% CI 2.00-14.78). CONCLUSION: Bone-derived hydroxyapatite orbital implants inserted without scleral wrap were associated with better clinical outcomes and a lower rate of long-term complications. It is therefore recommended that these implants be inserted without a scleral wrap.

Long-term results of Molteno implant insertion in cases of chronic angle closure glaucoma.

BACKGROUND: This study was undertaken to provide data on the long-term results of cases of chronic angle closure glaucoma with additional risk factors treated by Molteno implants between 1985 and 2004 at Dunedin Hospital, New Zealand. METHODS: A prospective non-comparative case series followed 21 eyes (17 patients) for a mean of 5.7 years (range 1.3-16.3 years) in terms of intraocular pressure, visual acuity and subsequent procedures. RESULTS: Insertion of a Molteno implant has controlled the intraocular pressure at 21 mmHg or less in 100% of cases at 5 years after surgery, the probability of control being 0.95 (95% CI 0.91-0.99). The mean number of hypotensive medications reduced from 2.04 (SD 0.92) preoperatively to 1.40, 0.64 and 0.66 at 1, 2 and 5 years, respectively. The mean visual acuity improved from 6/18 preoperatively to 6/12 at 1 year and declined to 6/13.5 at 2 and 5 years. CONCLUSION: Insertion of Molteno implants was a safe and effective procedure in the management of complex cases of chronic angle closure glaucoma.

Otago glaucoma surgery outcome study: cytology and immunohistochemical staining of bleb capsules around Molteno implants.

PURPOSE: To describe the cytology and immunohistochemistry of Molteno implant capsules from cases of primary and secondary glaucoma. METHODS: Histologic features of capsules including cell cytology, the distribution of activated (proliferating) cells, apoptosing cells, and membrane bound vesicles (presumed death messengers) were assessed by light microscopy and correlated with clinicopathological features in 10 noninflamed eyes with good intraocular pressure control (nine autopsy and one enucleation) obtained from 2 months to 16.8 years after insertion of Molteno implants. RESULTS: All bleb capsules demonstrated two distinct layers. The thin external layer was cellular with fairly numerous small blood vessels coursing through normally staining, regularly arranged collagen fibers. The thicker, deeper layer was avascular, relatively acellular, and characterized by regularly arranged swollen and fragmented collagen fibers. Most cells in the external layer appeared normal; however, between 5% (in recently formed blebs) and approximately 50% (in well established blebs) showed cytological and/or immunohistochemical changes characteristic of metabolic activation and/or apoptosis. All cells in the deeper layer, regardless of time after surgery, also demonstrated cytological and/or immunohistochemical staining characteristic of metabolic activation and/or apoptosis. In addition, the deeper layer evidenced large numbers of minute membrane-bound vesicles (presumed death messengers). CONCLUSIONS: The balance between activation and apoptosis regulates the thickness and permeability of bleb capsules, and the normal lifecycle of bleb capsules includes continual inner surface degeneration and external surface renewal.

Long-term results of Molteno implant insertion in cases of neovascular glaucoma.

OBJECTIVE: To describe the long-term outcomes of cases of neovascular glaucoma drained by Molteno implants. METHODS: A prospective study of 145 eyes (130 patients) followed up for a mean of 3.3 years (range, 0.02 year [5 days] to 18.1 years) in the province of Otago, New Zealand, from 1979 to 2002. RESULTS: Insertion of a Molteno implant controlled the intraocular pressure at 21 mm Hg or less with a probability (95% confidence interval) of 0.72 (0.64-0.80), 0.60 (0.51-0.69), and 0.40 (0.29-0.50) at 1, 2, and 5 years, respectively. Failure to control intraocular pressure at 1, 2, and 5 years was significantly correlated with persistent iris neovascularization (P<.001, P<.001, and P = .01, respectively). Visual acuity at final follow-up in nonenucleated eyes was maintained or improved in 56 eyes (39%) and deteriorated to light perception or better in 25 (17%) or no light perception in 47 (32%). Seventeen eyes (12%) were enucleated. CONCLUSIONS: The insertion of Molteno implants for neovascular glaucoma maintained or improved vision in 39% of eyes, whereas 12% were eventually enucleated (all of which initially had visual acuity <20/1200). The outcome depended mainly on progression of the underlying vascular disease.

Otago Glaucoma Surgery Outcome Study: follow-up of young patients who underwent Molteno implant surgery.

OBJECTIVE: To provide data on the results of patients with nonneovascular juvenile glaucoma who had Molteno implant surgery in the province of Otago, New Zealand. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Fifty-five operations in 52 eyes of 45 patients with nonneovascular juvenile glaucoma who had Molteno implant surgery between the ages of 9 and 49 years from 1976 to 2003 at Dunedin Hospital and were observed for a mean of 12.2 years (range, 0.1-25). INTERVENTION: Insertion of a Molteno implant. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) and visual acuity (VA). RESULTS: Insertion of a Molteno implant controlled IOP at < or =21 mmHg with probabilities of 0.89 (95% confidence interval [CI], 0.81-0.97) at both 1 and 2 years and 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.66-0.90), and 0.71 (95% CI, 0.58-0.85) at 5, 10, and 15 years, respectively. Mean VA was 20/100 preoperatively; improved to 20/60 at 1 year; and stabilized at 20/120 at 5, 10, and 15 years postoperatively. Twenty-nine eyes had their preoperative VA maintained or improved at final follow-up, and the VAs of 17 eyes deteriorated but were at least light perception at final follow-up. CONCLUSION: The use of Molteno implants in cases of nonneovascular juvenile glaucoma controlled IOP with a probability of 0.71 15 years postoperatively, whereas 53% maintained or improved their vision from their preoperative VA at final follow-up.

Ultraviolet photography of the in vivo human cornea unmasks the Hudson-Stähli line and physiologic vortex patterns.

PURPOSE: To perform ultraviolet (UV) macrophotography of the normal in vivo human cornea, establishing biometric data of the major component of UV absorption for comparison with the Hudson-Stähli (HS) line, the distribution of iron demonstrated by Perl stain, and cases of typical amiodarone keratopathy. METHODS: Nonrandomized comparative case series of UV photographs of 76 normal corneas (group 1) and 16 corneas with typical amiodarone keratopathy (group 2). Image-analysis software was used to grade the major component of UV absorption for slope and the coordinates of its points of intersection with the vertical corneal meridian and inflection. RESULTS: In group 1 the major component had a mean slope of 5.8 degrees, sloping down from nasal to temporal cornea. The mean coordinates of points of intersection with the vertical corneal meridian and inflection were (0, 0.30) and (0.02, 0.31), respectively. No significant differences between groups 1 and 2 were found for slope (P = 0.155), intersection with the vertical corneal meridian (P = 0.517), and point of inflection (P = 0.344). The major component of UV absorption was consistent with published characteristics of the HS line, and coincidence of UV absorption and Perl-stained iron was demonstrated in one corneal button. A vortex pattern of UV absorption was observed in all corneas. CONCLUSIONS: UV photography demonstrates subclinical corneal iron, confirming its deposition in an integrated HS line/vortex pattern. Coincident iron and amiodarone deposition occurs in amiodarone keratopathy.