[Juvenile glaucoma in propionic acidemia]. / Juveniles Glaukom bei Propionazidämie.

Propionic acidemia (PA) is a rare autosomal recessive disorder resulting from deficiency of the biotin-dependent enzyme propionyl-CoA carboxylase, which is necessary for the catabolism of branched chain amino acids and odd-chain fatty acids. Although optic atrophy was documented in four cases, no glaucomatous optic atrophy has yet been described. This article describes the first case of a 12-year-old boy with PA showing bilateral glaucomatous optic disc atrophy due to dysgenetic changes of the angle of the anterior chamber.

[Subconjunctival or general anaesthesia in trabeculectomy--a retrospective analysis of the bleeding risk from a glaucoma surgeon's point of view]. / Subkonjunktivalanästhesie oder Vollnarkose bei der Trabekulektomie--retrospektive Analyse des perioperativen Blutungsrisikos aus Sicht des Glaukomchirurgen.

INTRODUCTION: The aim of this study was to compare the intraoperative and early postoperative outcome of trabeculectomy with mitomycin C in glaucoma patients undergoing general anaesthesia compared to those undergoing subconjunctival anaesthesia. METHODS: The perioperative results of consecutive glaucoma patients receiving a trabeculectomy with mitomycin C either under general anaesthesia (group 1, n = 60) or in subconjunctival anaesthesia (group 2, n = 60) were analysed in a retrospective study. All surgical procedures were performed by one surgeon and only one eye of each patient with no history of previous conjunctival surgery was included in the study. RESULTS: No significant peri- and postoperative differences concerning period of hospitalisation, intraocular pressure, filtration-bleb bleedings, hyphaema, frequency of laser suture lysis, hypotony, chorioidal detachment or revision surgery could be shown between the two groups. Considering all patients together, there was a significant correlation between the occurrence of postoperative filtering bleb bleedings and the absolute number of topical antiglaucomatous substances used prior to surgery. CONCLUSIONS: The perioperative risk profile of penetrating glaucoma surgery with subconjunctival anaesthesia seems to be similar to that of procedures under general anaesthesia. For prevention of postoperative filtering bleb bleedings, the administration of topical antiglaucomatous drugs should be stopped before surgery.

[Combined phacoemulsification with trabecular aspiration with differing outcomes in pseudoexfoliative glaucoma - a retrospective study]. / Kombinierte Phakoemulsifikation mit Trabekelaspiration bei Pseudoexfoliations-Glaukom mit unterschiedlichem Ausgangsdruck - eine retrospektive Studie.

INTRODUCTION: The aim of this study was to differentiate the pressure-reducing results following trabecular aspiration combined with small incision cataract surgery in eyes with pseudoexfoliation depending on preoperative pressure and medication score. PATIENTS AND METHODS: A retrospective analysis was made of 104 exfoliative eyes of 104 patients who underwent combined phaco/trabecular aspiration. Success was defined as a relative reduction of IOP of at least 20 %, absolute IOP of ≤ 20 mmHg, stable or reduced medication score and a lack of any further pressure-reducing surgery. RESULTS: The success rate was 0.68 and 0.64 after 1 and 2 years. In eyes with medically uncontrolled preoperative IOP (> 20 mmHg) the IOP dropped significantly from 25.4 ± 4.3 mmHg to 17.0 ± 3.4 mmHg after two years. In eyes with preoperative controlled IOP the pressure lowering effect was low (17.1 ± 2.3 to 15.9 ± 2.3 mmHg) with a significant reduction of medication. CONCLUSIONS: Combined cataract surgery and trabecular aspiration is a reasonable option in exfoliative eyes with IOP values in the low twenties in order to achieve a reduction of topical medications and to reach a stable IOP level.

Accuracy and reproducibility of axial length measurement in eyes with silicone oil endotamponade.

AIM: To assess the accuracy and signal quality of axial length measurements by partial coherence laser interferometry (PCI) for optical biometry in eyes with conventional silicone oil (SO) or heavy silicone oil (HSO) as endotamponade. METHODS: We included 26 eyes with SO endotamponade (SO, n = 15; HSO, n = 11) using a Zeiss IOLMaster for measurement of axial length the day before and at least 6 weeks after SO removal. We analysed the intra-individual deviation between both measurements and signal-to-noise ratio (SNR) as a marker for signal quality. We included 16 contralateral eyes without history of vitreoretinal surgery to act as the control group. RESULTS: The mean axial length was 24.76 (SD 2.07) mm (SO 24.63 (SD 2.12) mm, HSO 24.93 (SD 2.10) mm, control 24.95 (SD 2.61) mm) before and 24.75 (SD 1.96) mm after oil removal with a mean intra-individual deviation of 0.13 (SD 0.11) mm (SO 0.13 (SD 0.12) mm, HSO 0.13 (SD 0.09) mm, control 0.02 (SD 0.01) mm) while SNR at baseline was 5.7 (SD 3.5) (SO 6.6 (SD 4.0), HSO 4.4 (SD 2.2), control 8.6 (SD 3.9)). CONCLUSION: In our analysis, optical biometry using PCI generated results with acceptable accuracy and signal quality for measurement of axial length in SO-filled eyes.

[Early postoperative spikes of the intraocular pressure (IOP) following phacoemulsification in late-stage glaucoma]. / Frühe postoperative Augeninnendruckspitzen nach Phakoemulsifikation bei terminalen Glaukomen.

BACKGROUND: Modern cataract surgery with use of viscoelastics can induce remarkable early spikes of the intraocular pressure (IOP) in patients with glaucoma. PATIENTS AND METHODS: The purpose of this prospective study was to investigate risk factors for an early increase of the IOP following cataract surgery in eyes with end-stage glaucoma. Clear cornea phacoemulsification with implantation of a foldable acrylic lens was performed in 25 eyes with end-stage glaucoma (primary open-angle glaucoma including normal tension glaucoma or exfoliative glaucoma) either under topical anesthesia or under general anesthesia. In eyes with exfoliative glaucoma, trabecular aspiration was performed additionally. IOP measurements were conducted at the day before surgery, 4 hours following surgery and on the first morning following surgery. RESULTS: Cataract surgery was performed without complications. The mean IOP was 18.5 +/- 4.2 mm Hg with 2.1 +/- 1.0 topical medications. 4 hours postoperatively, mean IOP was 31.3 +/- 11.9 mm Hg. In eyes with exfoliative glaucoma (n = 12) the early postoperative IOP was 28.5 +/- 12.0 mm Hg, but without significant difference compared to eyes with POAG (n = 13). The early postoperative IOP showed significant correlation with the maximum IOP in patient's history (p = 0.014). CONCLUSIONS: Patients with late-stage glaucoma can experience considerable early IOP spikes following uneventful cataract surgery, although preoperatively IOP is controlled by topical medications. Postoperative IOP monitoring is recommended at the day of surgery, especially if high IOP values are reported in patient's history.

Effect of 3.0 mm tunnel and 6.0 mm corneoscleral incisions on the blood-aqueous barrier.

PURPOSE: To study of the effect of silicone intraocular lens (IOL) implantation using a 3.0 mm tunnel incision with that of implantation though a 6.0 mm corneoscleral incision after phacoemulsification in human eyes. SETTING: Department of Ophthalmology, University of Köln, Germany. METHODS: In a prospective, randomized clinical study, 50 patients with senile cataract had phacoemulsification and IOL implantation through a 3.0 mm tunnel or a 6.0 mm corneoscleral incision. To assess blood-aqueous barrier (BAB) disruption, preoperative and postoperative sodium fluorescein concentrations in the anterior chamber were measured with the Fluorotron Master II. Diclofenac sodium 0.1% was applied to the operative eyes five times a day for 5 days. The contralateral eyes served as controls. RESULTS: There was no significant between-group difference in sodium fluorescein concentrations in the 5 days after surgery. CONCLUSION: The findings underline our clinical impression that BAB disruption 5 days after surgery does not differ significantly with the type and length of scleral incision used for IOL implantation.