Combination of autologous blood injection and bleb compression sutures to treat hypotony maculopathy.

PURPOSE: To report successful use of a combination of autologous blood injection and bleb compression sutures to treat overfiltration with hypotony maculopathy after trabeculectomy with mitomycin C. METHODS: Two patients underwent the combined procedure and were followed until visual acuity and intraocular pressure (IOP) were stable over three consecutive visits (4 to 9 months). RESULTS: Both patients experienced improvement in visual acuity both subjectively and objectively, and both patients had an elevation in IOP that persisted over three consecutive visits. CONCLUSIONS: Combination autologous blood injection and bleb compression suture placement may be an effective means of treating hypotony maculopathy after trabeculectomy with mitomycin C.

Control of intraocular pressure after trabeculectomy.

Control of intraocular pressure (IOP) is the goal of trabeculectomy, and pursuit of this goal does not end with the completion of the surgical procedure. Proper postoperative management of the trabeculectomy patient requires an understanding of possible events that alter IOP and knowledge of the treatments to control IOP. Recent changes in surgical technique, including the use of antimetabolites, have provided new challenges in the postoperative management of trabeculectomy patients. Interventions are described to restore the flow of aqueous to the filtering bleb in the early postoperative period, to manage flat anterior chambers with both high and low intraocular pressures, to manage a failing filtering bleb, and to manage hypotony. Herein we discuss current methods for controlling IOP in the postoperative period.

A simple modification of the Hoskins lens for patients with dermatochalasis.

This brief report describes the use of transparent tape to modify the Hoskins lens for use in patients with dermatochalasis. The modification of the lens allows it to be used in these patients without the aid of an assistant.

Rapid visual recovery and long-term intraocular pressure control after donor scleral patch grafting for trabeculectomy-induced hypotony maculopathy.

PURPOSE: To report on a 21-year-old man who had persistent hypotony maculopathy eight months after trabeculectomy with mitomycin C. METHODS: He was treated by excising the filtering bleb, placing a donor scleral patch graft over the trabeculectomy site, and bringing conjunctiva superior to the previous bleb over the patch graft. RESULTS: He had rapid resolution of his hypotony accompanied by an increase in visual acuity from 4/200 preoperatively to 20/80 at one day, and 20/20 at three months postoperatively. He also established and maintained a filtration bleb which kept his intraocular pressure in the mid teens without the use of medication. CONCLUSION: Scleral patch grafting may provide rapid resolution of visual loss secondary to hypotony maculopathy.

Comparison of the miotic effects of dapiprazole and dilute pilocarpine in patients with the pigment dispersion syndrome.

PURPOSE: Pharmacologically induced miosis can inhibit exercise-induced anterior chamber pigment dispersion in patients with the pigment dispersion syndrome. Long-term inhibition of pigment dispersion in these patients could delay or prevent the development of glaucoma. Unfortunately, most commercially available miotic medications are poorly tolerated by these patients due to their visual side effects. This study evaluates the miotic effects of two medications that cause minimal visual side effects in patients with the pigment dispersion syndrome. PATIENTS AND METHODS: Pupil diameter in darkness and amplitude of pupil constriction to light were measured before and 1 h after instillation of two drops of 0. 5 dapiprazole in one eye and two drops of 1/6 pilocarpine in the fellow eye of 10 patients with the pigment dispersion syndrome. Gonioscopic photography of iris contour before and after medications was performed in two patients who had significant posterior iris bowing on baseline examination. RESULTS: Pupil diameter in darkness and amplitude of pupil constriction to light were significantly smaller in eyes treated with 1/6 pilocarpine. Posterior iris bowing was markedly reduced by 1/6 pilocarpine but not by 0. 5 dapiprazole in the two patients with posterior iris bowing. CONCLUSION: Cholinergic agonists appear to be superior to alpha-adrenergic antagonists as candidate drugs for inhibiting pigment dispersion in patients with the pigment dispersion syndrome.

Quantitation of iris transillumination defects in eyes of patients with pigmentary glaucoma.

Iris transillumination defects may be important markers of disease severity and/or disease activity in patients with pigmentary glaucoma. We present a simple method for quantitation of iris transillumination defects using infrared iris transillumination videography and computerized image analysis. Three observers independently made multiple measurements of percent iris transillumination (the percentage of visible iris that transilluminates) from three standard images using the technique. The interobserver coefficient of variation was 20.35, 6.55, and 8.01%, respectively, for mild, moderate, and marked iris transillumination. The intraobserver coefficient of variation was much smaller for each image, measuring 4.11, 3.23, and 2.38%, respectively, for mild, moderate, and marked iris transillumination. To exemplify the utility of the technique, a single observer measured percent iris transillumination for both eyes of a group of 13 consecutive patients with asymmetric pigmentary glaucoma. There was a significant correlation between the amount of iris trapsillumination and the severity of glaucoma in the eyes of these patients.

Effects of jogging exercise on patients with the pigmentary dispersion syndrome and pigmentary glaucoma.

BACKGROUND: Exercise-induced anterior chamber pigment dispersion with intraocular pressure (IOP) elevation has been reported in patients with the pigmentary dispersion syndrome. Marked pigment dispersion with or without elevation of IOP could predispose these patients to visual field loss. The authors designed this study to evaluate the effects of jogging exercise on anterior chamber pigment and IOP in a group of patients with the pigmentary dispersion syndrome or pigmentary glaucoma. METHODS: Fourteen subjects with the pigmentary dispersion syndrome, 10 subjects with pigmentary glaucoma, and 10 control subjects underwent a 45-minute protocol of jogging exercise. Anterior chamber pigment was graded and IOP was measured before and up to 3 hours after completion of the exercise protocol. RESULTS: Eyes of experimental subjects were significantly more likely to develop exercise-induced pigment dispersion than were eyes of control subjects. In experimental subjects, eyes treated with pilocarpine at the time of the study were significantly less likely to develop exercise-induced pigment dispersion than eyes not treated with pilocarpine. In two experimental subjects, pre-exercise treatment with pilocarpine appeared to inhibit exercise-induced pigment dispersion. CONCLUSIONS: The authors do not believe that all patients with the pigmentary dispersion syndrome or pigmentary glaucoma need to avoid exercise. However, for patients with these disorders who regularly engage in jogging or more strenuous or more jarring types of exercise, they suggest an evaluation before and after the type of exercise in question. If marked exercise-induced pigment dispersion occurs, pilocarpine therapy may be an alternative to avoidance of the exercise.

Effect of inhibitors of arachidonic acid metabolism on corneal neovascularization in the rat.

We used computerized image analysis to evaluate quantitatively the ability of topically applied corticosteroids (dexamethasone sodium phosphate, prednisolone acetate), cyclooxygenase inhibitors (flurbiprofen, indomethacin, ketorolac), lipoxygenase inhibitors (REV 5901, esculetin, quercetin), and dual cyclooxygenase/lipoxygenase inhibitors (BW 755C, BW A540C) to reduce corneal neovascularization in the rat induced by silver/potassium nitrate cauterization. Significant decreases in the neovascular response were found with corticosteroids and cyclooxygenase inhibitors. A complete dose-response curve was performed for a representative compound from each class. Dexamethasone was found to be superior to flurbiprofen in its ability to reduce neovascularization in this model, while no significant inhibition was noted with either REV 5901 or BW 755C, even at high doses. We conclude that the corneal angiogenic response in this model can be reduced by inhibition of cyclooxygenase as well as by other mechanisms that are steroid-dependent but are, as yet, poorly defined.

Quantitation of corneal neovascularization using computerized image analysis.

We have developed a method for quantitating corneal neovascularization, induced in anesthetized rats by silver nitrate/potassium nitrate cauterization, using a LeMont OASYS video input image analyzer. Corneal vessels are visualized by perfusing the upper half of deeply anesthetized animals with a mixture of 10% india ink, 11% gelatin in lactated Ringer's solution. The eyes are then rapidly cooled using a stream of compressed dichlorodifluoromethane (Freon) to solidify the gelatin mixture. Magnified images of flat preparations of the corneas are acquired using a television camera attached to a dissecting microscope. The images are electronically converted to digital form and the digitized data are stored in the image analyzer. The area of the cornea and blood vessels are independently determined by analyzing the digitized data as discrete values of varying shades of gray (gray-scale analysis). The area and gray scale of the injury and its distance from the corneoscleral limbus can also be measured to determine variability of location and intensity of the injury in different animals. This technique allows the area occupied by new blood vessels during studies on corneal neovascularization in rats to be rapidly quantitated.