Can topical ketorolac 0.5% improve the function of Ahmed® glaucoma drainage devices?

BACKGROUND AND OBJECTIVE: To determine whether postoperative use of topical ketorolac tromethamine 0.5% affects intraocular pressure (IOP) following Ahmed glaucoma drainage device (New World Medical, Inc., Rancho Cucamonga, CA) implantation. PATIENTS AND METHODS: Patients undergoing Ahmed implantation at the University of Michigan from January 2002 to June 2008 were reviewed. Fourteen eyes received ketorolac after surgery; 50 eyes did not. Preoperative and postoperative IOP and glaucoma medications were recorded for both groups; the two-sided Student's t test was used to compare these parameters. RESULTS: Mean preoperative IOP was similar in the two groups (35.1 ± 11.9 vs 37.0 ± 12.2 mm Hg; P = .60). At postoperative month 6, the ketorolac group had significantly lower IOP compared with the no ketorolac group (13.1 ± 3.7 vs 19.5 ± 9.3 mm Hg, respectively; P = .0003). There was no difference in the number of glaucoma medications postoperatively between the two groups. CONCLUSION: Ketorolac may lead to lower postoperative IOP following Ahmed implantation.

Bleb morphology characteristics and effect on positional intraocular pressure variation.

BACKGROUND AND OBJECTIVE: To study bleb morphology and positional intraocular pressure (IOP) change (IOP supine to IOP sitting). PATIENTS AND METHODS: In this observational case series, blebs were graded for height, extent, vascularity, microcysts, and "ring of steel." Positional IOP change was analyzed using the paired t test. Associations between IOP change and bleb morphologies were evaluated by regression adjusting for inter-eye dependency. RESULTS: Ninety-five eyes of 68 subjects were included. Decreased bleb height (P = .05), absence of microcysts (P = .02), and increased bleb vascularity (P = .02) were associated with larger positional IOP change. Twenty patients with a filter in one eye and a medically treated fellow eye had larger positional IOP change in the medically treated eye (6.1 vs 4.6 mm Hg, respectively; P = .01). CONCLUSION: Successful filtration surgery results in both lower IOP and less positional IOP change compared with medically treated eyes. Bleb features associated with smaller positional IOP change include higher elevation, microcysts, and less vascularity.

Subconjunctival placement of human amniotic membrane during high risk glaucoma filtration surgery.

BACKGROUND AND OBJECTIVE: To determine whether subconjunctival placement of amniotic membrane improves filtration results in patients with glaucoma at high risk for surgical failure. PATIENTS AND METHODS: Retrospective review of 17 eyes of 15 patients who had amniotic membrane applied during glaucoma surgery with or without mitomycin C or 5-fluorouracil. RESULTS: Mean intraocular pressure decreased from 27.0 +/- 9.1 mm Hg preoperatively to 18.1 +/- 11.0 mm Hg postoperatively with a mean follow-up of 179 days. Complications included self-limited conjunctival wound dehiscence (n = 5), uveitis recurrence (n = 2), and cataract progression (n = 1). CONCLUSIONS: The results suggest that subconjunctival placement of amniotic membrane may improve filtration outcome in high risk eyes. It will be of interest to determine whether the anti-inflammatory, anti-angiogenic, and antifibrotic properties of amniotic membrane placed subconjunctivally and under the scleral flap will improve filtration surgery outcome by a prospective, randomized study.

Gonioscopy in primary angle closure glaucoma.

Primary angle closure is a condition characterized by obstruction to aqueous humor outflow by the peripheral iris, and results in changes in the iridocorneal angle that are visible through gonioscopic examination. Gonioscopy in these eyes, however, can be difficult. This chapter discusses techniques that might help in the examination. These include beginning the examination with the inferior angle, methods to help in looking over the iris, cycloplegia, locating the corneal wedge, indentation, van Herick estimation, examining the other eye, and topical glycerin. Finally, there is a discussion about the pathology associated with the closed angle, with emphasis on the appearance of iris bombé, plateau iris, and the distinction between iris processes and peripheral anterior synechiae.