Efficacy of selective laser trabeculoplasty in phakic and pseudophakic eyes.

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in open-angle glaucoma and ocular hypertension. MATERIALS AND METHODS: Charts of 28 pseudophakic eyes and 60 phakic eyes that underwent 360-degree SLT were retrospectively reviewed. Patients were examined at 1, 3, 6, and 12 months. Treatment success was defined as ≥20% intraocular pressure (IOP) reduction, with no additional medications, laser, or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction, and success rates for phakic and pseudophakic eyes were compared. RESULTS: Mean percentage of IOP reduction post-SLT at 1-, 3-, 6-, and 12-month visits were 21.4%, 25.8%, 24.8%, and 23.7%, respectively, in the pseudophakic group and 22.8%, 25.0%, 25.7%, and 21.2%, respectively, in the phakic group. Success rates ranged between 60% and 64% in the pseudophakic group and between 58% and 73% in the phakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rate were seen between the groups at any of the post-SLT visits (P>0.05). CONCLUSIONS: Application of 360-degree SLT seems to be an efficient and safe treatment option for the management of phakic and pseudophakic open-angle glaucoma and ocular hypertension.

Comparison of dorzolamide/timolol versus brimonidine/timolol fixed combination therapy in the management of steroid-induced ocular hypertension.

PURPOSE: To compare the efficacy of fixed combinations of dorzolamide-timolol (FCDT) and brimonidine-timolol (FCBT) in patients with intraocular pressure (IOP) elevations after intravitreal triamcinolone acetonide (IVTA) injections. MATERIALS AND METHODS: This was a prospective, randomized, open-label study. Patients who received IVTA injections due to diffuse diabetic macular edema and who had an IOP of 24 mm Hg or higher after IVTA treatment were included. They were randomized to receive either FCBT or FCDT twice daily. Follow-up visits were scheduled on week 4 and 12 weeks after starting the study medication. At all follow-up visits, IOP was measured with Goldmann applanation tonometry. The primary outcome measure was mean IOP, the secondary outcome was reduction in mean IOP at 4 and 12 weeks compared with postinjection values. RESULTS: Sixty patients were randomized in 1:1 ratio. The FCBT and FCDT groups were similar in terms of age, sex, and preinjection IOP (P>0.05 for all). Mean postinjection IOP was 31.95±7.39 and 29.83±5.17 mm Hg in FCBT and FCDT groups, respectively (P=0.239). After 4 weeks, mean IOP was 17.05±3.61 mm Hg in FCBT and 18.93±3.30 mm Hg in FCDT groups (P=0.063). After 12 weeks, mean IOP in the FCBT and FCDT study groups was 16.35±2.70 and 18.43±2.82 mm Hg, respectively (P=0.012). Both fixed combinations significantly reduced IOP in comparison with the postinjection values (P<0.05). Mean reduction in IOP after 4 weeks were 14.90±7.28 mm Hg in FCBT and 10.90±4.83 mm Hg in FCDT groups (P=0.024); after 12 weeks, these values were 15.60±7.77 and 11.40±5.89 mm Hg in FCBT and FCDT groups, respectively (P=0.035). CONCLUSIONS: Both FCBT and FCDT are effective in controlling IOP elevations after IVTA injections. The results of this study suggest that FCBT is superior to FCDT in reducing IOP and provides better IOP control after IVTA injections.

Trabeculectomy for advanced glaucoma.

The objective of this study is to evaluate the visual prognosis and postoperative course in advanced glaucoma patients who underwent trabeculectomy. The records of 30 patients with advanced visual field (VF) defects undergoing trabeculectomy were retrospectively reviewed. Severe VF defects were defined as those with a sensitivity of ≤5 dB either in more than 85% of test points, excluding the central four points, or in >75% of test points, including three of the central four points with threshold automated perimetry. Main outcome measures were intraocular pressure (IOP), corrected visual acuity (VA) and mean deviation (MD) of VF tests. Mean preoperative IOP, VA and MD values were compared with their respective postoperative values. The latest examination of each patient was used to determine postoperative outcome measures. In addition, any complications encountered were recorded. A total of 34 trabeculectomies were performed. The mean age was 59.3 years (13-80 years). The mean follow-up time was 41.1 months (3-120 months). Preoperatively the mean IOP was 28.4 ± 13.1 mmHg, and the mean postoperative IOP was 14.8 ± 5.0 mmHg (P = 0.001). Preoperatively the mean VA was 0.87 ± 80, and the mean value of the MD was -24.5 ± 6.7 dB. At the latest follow-up there was no significant difference in VA (0.89 ± 79, P = 0.699) and MD (-23.9 ± 6.7, P = 0.244) values. Transient hypotony occured in five eyes while one eye with mitomycin C trabeculectomy experienced extended hypotony. Ten eyes showed reduction of VA between 1 and 5 lines due to cataracts and five eyes had late bleb failure with uncontrolled IOP. One patient had late endophthalmitis and one patient presented with blebitis, both of which were successfully treated. No patients experienced wipe-out phenomenon. In conclusion, our study of advanced glaucoma patients undergoing trabeculectomy, vision was preserved with no cases of unexplained loss of central vision. IOP was largely controllable, with cataract being the leading factor decreasing VA at late term.

Cornea plana associated with open-angle glaucoma: a case report.

Cornea plana is a rare disease in which the cornea is flattened with a low refractive power. In addition to these features, hypermetropia, deep central corneal opacities, hazy corneal limbus, peripheral scleralization of the cornea and early arcus senilis can also be seen. Closed-angle glaucoma may occur as a result of shallow anterior chamber and narrow angle; however, open-angle glaucoma has also been reported in these patients. Measuring the real intraocular pressure (IOP) value of such eyes is difficult since tonometers are affected by corneal curvature. Therefore, the diagnosis of glaucoma may be delayed for a long time. In this case report we aimed to present a case of cornea plana with early open-angle glaucoma and to investigate which tonometer was appropriate for measuring the correct IOP value in such eyes.

Corneal biomechanical properties during the menstrual cycle.

PURPOSE: To determine if corneal biomechanical properties change during phases of the menstrual cycle. METHODS: Twenty-five healthy women of reproductive age with no ocular pathology or systemic diseases were recruited. Corneal hysteresis, corneal resistance factor, Goldman-correlated intraocular pressure, and corneal-compensated intraocular pressure were measured by a Reichert ocular response analyzer at three phases of the menstrual cycle, beginning on days 3 to 5 (follicular phase), again at ovulation (days 14-16, ovulatory phase), and at the end of the cycle (days 25-28, luteal phase). RESULTS: Twenty-one participants completed the study. The mean corneal hysteresis values at follicular, ovulatory, and luteal phases were 10.7, 10.7, and 10.7 mmHg (p > 0.05), and the mean corneal resistance factor values at the same time points were 9.9, 9.9, and 9.8 mmHg (p > 0.05), respectively. Corneal-compensated intraocular pressure and Goldman-correlated intraocular pressure readings were stable during the course (p > 0.05 for all). CONCLUSIONS: Corneal biomechanical properties and intraocular pressure as measured by an ocular response analyzer do not change statistically significantly during the different phases of the menstrual cycle. We conclude that measurements of the ocular response analyzer can be safely utilized in healthy female subjects without considering the possible effects of varying hormonal levels during the menstrual cycle.

Ocular manifestations and surgical results in patients with Alport syndrome.

We report the ocular manifestations of Alport syndrome and the surgical results in 4 patients. All 4 patients had anterior lenticonus; 2 also had posterior lenticonus in both eyes, 3 had flecked retina, and 1 had posterior polymorphous dystrophy. In both eyes of the 4 patients, phacoemulsification with intraocular lens (IOL) implantation was performed to treat anterior and posterior lenticonus. The postoperative visual acuity was excellent in all patients. We recommend phacoemulsification with IOL implantation as a safe and effective procedure in patients with lenticonus secondary to Alport syndrome.

Long-term results in endoscopic dacryocystorhinostomy: is intubation really required?

OBJECTIVE: The long-term (median follow-up eight years) results of endoscopic dacryocystorhinostomy approach and silicone intubation were evaluated by various aspects. STUDY DESIGN: Case series with planned data collection of 38 procedures for postsaccal stenosis were analyzed. SUBJECTS AND METHODS: Silicone intubation was not used in 19 of the randomly selected procedures. Anatomical and functional surgical success was evaluated subjectively and objectively. RESULTS: The patients' complaints improved in 84.2 percent of eyes in the intubation group, and in 94.7 percent of the group without intubation, with a mean follow-up of 112 and 96 months after surgery, respectively. Postoperative endoscopic examinations revealed that the rhinostomy opening was visible in 17 sides with intubation (89.5%) and 18 sides without intubation (94.7%). CONCLUSIONS: Considering the similar surgical success rates, and disadvantageous factors such as granulation formation, patient discomfort, and cost related to intubation, we recommend endoscopic dacryocystorhinostomy without intubation as the treatment of choice in cases of chronic epiphora due to postsaccal stenosis of the lacrimal drainage system.

Congenital Horner's syndrome and the usefulness of the apraclonidine test in its diagnosis.

We present a seven-month-old baby with miosis of the left pupil, left hypochromia, mild ipsilateral ptosis, left hemifacial anhidrosis and asymmetrical facial flushing. A diagnosis of Horner's syndrome (HS) was presumed and was confirmed by instillation of apraclonidine eye drops. Miosis was reversed upon apraclonidine instillation. Magnetic resonance imaging of the head, neck and thorax and ultrasonography of the neck and abdomen did not reveal any pathological conditions. Although delivery-related brachial plexus injury is known as the most common cause of congenital HS, it should be investigated and should include neuroimaging of the sympathetic pathway, to exclude a serious underlying disease. As in our case, a specific etiology may not always be elicited. Pharmacological testing with apraclonidine may be a practical alternative to cocaine in the diagnosis of HS.

Primary orbital neuroblastoma in a neonate.

Neuroblastoma is an undifferentiated malignant tumor of the primitive neuroblasts. Orbital neuroblastoma is typically a metastatic tumor. We describe a two-days-old girl, who presented with a large tumor in her left orbit. Magnetic resonance imaging revealed that the tumor originated from the retrobulbar area, extending into the upper and lateral orbit. She was operated on the fifth day of life. A histopathologic diagnosis of neuroblastoma was made. Medical evaluation including chest roentgenogram, ultrasonography of the abdomen, whole body computerized tomogram and bone scintigraphy showed no evidence of systemic involvement or metastasis. Neuroblastoma should be considered in the differential diagnosis of neonatal orbital tumors.