Filtering bleb function after clear cornea phacoemulsification: a prospective study.

AIM: To evaluate the influence of clear cornea phacoemulsification on filtering bleb morphology, function, and intraocular pressure (IOP) in glaucomatous eyes with previously successful filtering surgery. METHODS: The clinical course of 30 patients (30 eyes) who underwent clear cornea phacoemulsification after successful filtering glaucoma surgery was prospectively evaluated. Mean IOP and filtering bleb morphology (standardised assessment criteria and score 0-12, 12 = optimum) were determined before surgery, and 3 days, 6 months, and 12 months after surgery. The control group consisted of 36 patients with glaucoma after clear cornea phacoemulsification without previous filtering surgery. RESULTS: Mean IOP increased after phacoemulsification by about 2 mm Hg (preoperatively 14.28 (SD 3.71) mm Hg, 12 months postoperatively 16.33 (3.31) mm Hg, p = 0.006). 15 patients (50%) showed an IOP increase of >2 mm Hg, 11 patients (36.7%) had no IOP difference (within 2 mm Hg), and in four patients (13.3%) IOP decreased >2 mm Hg. Mean score of filtering bleb morphology 1 year after surgery decreased from 9.5 to 9.0 (p = 0.154). In three of 30 preoperatively IOP regulated eyes the postoperative IOP was 21 mm Hg. The control group showed an average IOP decrease of 2.01 mm Hg (p = 0.014) 12 months after cataract surgery. CONCLUSION: An increase in IOP was found 1 year after phacoemulsification in half of the filtered glaucomatous eyes. IOP in glaucomatous eyes without previous filtering surgery decreased in the same period. Cataract extraction using clear cornea phacoemulsification may be associated with a partial loss of the previously functioning filter and with an impairment of filtering bleb morphology.

[Quantitative and objective follow-up of papilledema with the Heidelberg Retina Tomograph]. / Quantitative und objektive Verlaufskontrolle der Papillenschwellung mit dem Heidelberg-Retina-Tomographen.

UNLABELLED: The Heidelberg retina tomograph (HRT) is a new instrument to analyze the three-dimensional structure of the retina. It is based on confocal laser scanning technology. Scientific interest has so far focused on the follow-up of glaucomatous optic nerve head damage. As parameters such as cup depth and cup volume can be reproduced with a high degree of accuracy, this new instrument may prove to be an excellent tool to follow up swelling of the optic disk. PATIENTS AND METHOD: A total of 21 patients suffering from optic disk swelling of various etiologies were included in a pilot study. Measurements were taken at six different time points. The maximum optic disk elevation and the volume of swelling were evaluated. Visual acuity and the visual field were determined, and fundus photographs were taken. RESULTS: A reduction in optic disk swelling over time may be demonstrated by both morphological parameters and correlates with improvement in fundus changes. The change in the volume of swelling is greater than the change in maximum disk elevation. The course of optic disk swelling differs between patients with anterior ischemic optic neuropathy and those with pseudotumor cerebri. No correlation was found between our measurements with the HRT and functional parameters (visual acuity and visual field). CONCLUSION: The HRT is a good tool for the follow-up of optic disk swelling, particularly optic disk elevation due to increased intracranial pressure.