Retropupillary Fixation of Iris-Claw Intraocular Lens for Aphakic Eyes in Children.

PURPOSE: To report outcome, complications and safety of retropupillary fixated iris-claw intraocular lenses in a pediatric population. DESIGN: Retrospective study. PATIENTS AND METHODS: Ten consecutive pediatric patients (15 eyes) underwent placement of retropupillary fixated iris-claw intraocular lenses between October 2007 and July 2013 at the Department of Ophthalmology, Medical University Graz and General Hospital Klagenfurt, Austria. Postoperative visual acuity and complications were analyzed. RESULTS: Median final best-corrected visual acuity improved by 0.12 logMAR from preoperative baseline. Mean postoperative spherical equivalent was -0.05 ± 1.76 D. No serious complications were observed intra- or postoperatively during the entire follow-up period of up to 40 months. One patient experienced a haptic disenclavation with IOL subluxation immediately after a car accident. CONCLUSION: Our study demonstrates that iris-claw intraocular lens implantation behind the iris is safe in children with lack of capsular support and yields excellent visual outcome with low complication rate.

Trabeculectomy with mitomycin C versus Ahmed glaucoma implant with mitomycin C for treatment of pediatric aphakic glaucoma.

PURPOSE: To compare trabeculectomy with mitomycin C (T+MMC) and Ahmed glaucoma implant with MMC (AGI+MMC) in treatment of aphakic glaucoma in children below 16 years of age. DESIGN: Randomized clinical trial. PARTICIPANTS: Subjects less than 16 years of age who had previously undergone anterior lensectomy and vitrectomy for treatment of congenital cataract with unresponsive aphakic glaucoma (at least on 2 medications) were allocated in 2 groups: trabeculectomy with MMC (group A, 15 eyes) and AGI (group B, 15 eyes). METHODS: Fifteen eyes in each group underwent T+MMC or AGI+MMC. Complete and qualified success were defined as 5< or =intraocular pressure< or =21 mm Hg without and with medication, respectively. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, and complications. RESULTS: Complete and qualified success rates were 33.3% and 40% in T+MMC group versus 20% and 66.7% in AGI+MMC group, respectively (P=0.36). Mean follow-up was 14.8 and 13.1 months and complication rates were 40% and 26.7% (P=0.44), respectively. CONCLUSIONS: T+MMC and AGI+MMC are comparable in terms of success rate and complications in pediatric aphakic glaucoma. PRECIS: This randomized clinical trial demonstrated comparable safety and efficacy for MMC trabeculectomy and AGI in the treatment of pediatric aphakic glaucoma.

Ahmed valve drainage implant surgery in the management of paediatric aphakic glaucoma.

BACKGROUND: Paediatric aphakic glaucoma presents months or years after cataract surgery in children and is a major long term complication. The results of surgical treatment are poor and many children require multiple and repeat procedures with poor visual outcomes. METHODS: 13 children (19 eyes) had Ahmed valve implantation surgery, nine of the children had previous procedures such as cycloablation or trabeculectomy. Mitomycin was used at surgery in some patients and valve needling with Healon GV and 5-fluorouracil in some blebs after surgery. SF(6) gas was also used at the time of surgery in most children to reform the anterior chamber. RESULTS: 12 of the children (18 eyes) achieved intraocular pressure control of 15 mm Hg or less with a valve alone or with additional medical therapy. CONCLUSION: Ahmed valve implantation surgery alone or in combination with medical therapy is successful and safe in the management of paediatric aphakic glaucoma.

Blood-aqueous barrier changes after the use of prostaglandin analogues in patients with pseudophakia and aphakia: a 6-month randomized trial.

OBJECTIVES: To investigate the effects of prostaglandin analogues on the blood-aqueous barrier and to evaluate the occurrence of cystoid macular edema in aphakic or pseudophakic patients with glaucoma. METHODS: In this randomized, masked-observer, 6-month clinical trial, patients with primary open-angle, pseudophakic, or aphakic glaucoma were treated once daily with bimatoprost (n = 16), latanoprost (n = 15), or travoprost (n = 17) or twice daily with unoprostone (n = 16) or lubricant drops (control group) (n = 16). Blood-aqueous barrier status, which was assessed using a laser flare meter; intraocular pressure; the occurrence of angiographic cystoid macular edema; and conjunctival hyperemia were evaluated. RESULTS: Mean flare values were significantly higher in the bimatoprost, latanoprost, and travoprost groups throughout follow-up (P < .02). Four latanoprost-treated eyes, 1 bimatoprost-treated eye, and 1 travoprost-treated eye developed cystoid macular edema; all cases resolved after discontinuation of the prostaglandin analogue and treatment with topical diclofenac sodium. Mean intraocular pressure reductions after 6 months were higher for the latanoprost (26%), bimatoprost (28%), and travoprost (29%) groups than for the control (3%) and unoprostone (14%) groups (P< .05). Bimatoprost induced significantly higher hyperemia scores than latanoprost, unoprostone, and placebo (P< .01). CONCLUSION: Bimatoprost, latanoprost, and travoprost use may lead to disruption of the blood-aqueous barrier in patients with pseudophakia and aphakia.

Fluorescein angiographic evaluation of the effect of latanoprost treatment on blood-retinal barrier integrity: a review of studies conducted on pseudophakic glaucoma patients and on phakic and aphakic monkeys.

Endogenous prostaglandins (PGs) have been claimed to play a role in the development of cystoid macular edema (CME). Two fluorescein angiographic studies evaluating the effect of latanoprost, a new ocular hypotensive PG analogue, on blood-retinal barrier integrity are, therefore, reviewed here. In the first study, six of eight unilaterally aphakic cynomolgus monkeys were treated bilaterally once daily for six months with 0.035% latanoprost (seven times the clinically used oculohypotensive concentration). Two of the animals served as controls. Fluorescein angiography of the fundus after one, three and six months of treatment revealed no leakage of fluorescein in any of the 16 eyes. In another study, pseudophakic eyes of 16 glaucoma patients who received twice-daily treatment with 0.006% latanoprost for four weeks were compared to eight patients treated with placebo. Biomicroscopic examination did not reveal any signs of CME and only one placebo-treated eye revealed a slight perifoveal leakage of fluorescein. These studies suggest that topically-applied latanoprost does not have a fluorescein angiographically detectable direct effect on the integrity of the blood-retinal barrier system in phakic or aphakic monkey eyes or in pseudophakic human eyes. This does not rule out the occurrence of CME in eyes more susceptible to CME, due to vitreous loss, posterior capsulotomy, or other postoperative situations. Especially in those eyes a study with latanoprost is proposed. Since, fluorescein angiography is a rather crude method of detecting abnormalities of the blood-retinal barriers, vitreous fluorometry in addition is suggested.

[The characteristics of the pathogenesis and immunomodulator treatment in the postoperative period in pseudophakia patients]. / Particularitati ale patogeniei si tratamentul imunomodulator în perioada postoperatorie la bolnavii cu pseudofac.

The investigation has revealed an immunological character of the exudative reaction in postoperative period of patients with artificial crystalline lens. We noted a cellular immunodeficiency and an increase of immunoglobulins G and A in the lacrimal liquid. The administration of 5-FU (5-fluoroucile) and levamizol decreased the inflammation in the postoperative period.

Cyclo-oxygenase inhibitors in ophthalmology.

Cyclo-oxygenase inhibitors, which are formulated as ophthalmic eyedrop preparations, have recently become commercially available for use by ophthalmologists in the United States to inhibit intraoperative miosis during cataract surgery and to prevent postoperative inflammation. In addition, they are available worldwide as ocular antiinflammatory drugs and are used in the prevention and treatment of pseudophakic and aphakic cystoid macular edema. Understanding the rationale behind the use of these agents requires an understanding of the pathophysiology of the cyclo-oxygenase inhibitors. In this review recent advances in laboratory and clinical science are emphasized. The role of COIs during and following surgery is examined.

Effectiveness of ketorolac tromethamine 0.5% ophthalmic solution for chronic aphakic and pseudophakic cystoid macular edema.

The effect of ketorolac tromethamine 0.5% ophthalmic solution (a new nonsteroidal anti-inflammatory agent) treatment was compared to placebo treatment in patients with chronic, angiographically proven aphakic or pseudophakic cystoid macular edema (visual acuity less than or equal to 20/40 for six months) during a three- to four-month double-masked, randomized study. Twenty-six patients completed this study without significant ocular or systemic toxicity. The improved distance visual acuity observed in the ketorolac treatment group (8/13 patients) was statistically different from the improved vision observed in the placebo treated group (1/13 patients) (P = .005). No patient on a regimen of ketorolac therapy had a significant decrease in Snellen distance visual acuity while on treatment, but two patients in the placebo group demonstrated a decrease in visual acuity of two lines or more. Fluorescein angiography was consistent with changes in visual acuity.

[Comparative studies of the pressure-lowering effect of timolol and phospholine iodide (author's transl)]. / Vergleichsuntersuchungen mit Timolol und Phospholine-jodid bei Aphakieglaukom.

A comparative study of the intraocular pressure-lowering effects of timolol and phospholine iodide in cases of aphakic glaucoma was carried out. The authors compared the I.O.P.-lowering effect of these two drugs in 30 eyes (30 patients) with aphakic glaucoma over an eight-month observation period. The following was established after a statistical analysis of the material: 1. The I.O.P.-lowering effect of timolol in aphakic glaucoma cases is almost identical with the effect of the drug in cases of chronic open-angle glaucoma. 2. The administration of phospholine iodide in such cases leads to a stable I.O.P. regulation and it seems that this therapy should be preferred to treatment with timolol. 3. Timolol therapy in cases of aphakic glaucoma should be considered an enrichment of the known treatment methods. 4. The administration of timolol requires constant follow-up and if this is not possible therapy with pilocarpine or phospholine iodide should be preferred.

[Efficacy and safety of long-term maintenance treatment with timolol ophthalmic solution in chronic open-angle glaucoma (author's transl)]. / Wirksamkeit und Sicherheit der Langzeitbehandlung mit Timolol-Augentropfen beim chronischen Offenwinkelglaukom.

Timoptol Ophthalmic Solution (timolol maleate, MSD) is a topical beta-adrenergic receptor blokking agent which lowers elevated intraocular pressure when applied once or twice daily. It represents a major advance in topical therapy for glaucoma and elevated intraocular pressure. It is more effective in reducing elevated intraocular pressure and produces fewer side effects than pilocarpine and epinephrine. It does not alter pupil size or affect visual acuity. Timoptol maintained satisfactory reductions in intraocular pressure in long-term maintenance studies treating over 100 patients for up to 16 months. The drug was well tolerated and without serious adverse effects. In general, reductions in intraocular pressure for non-white patients (predominantly Blacks) were similar to the Whites.