Exercise and iris concavity in healthy eyes.

PURPOSE: To study the effect of exercise on the configuration of the anterior chamber angle in healthy persons. METHODS: Both eyes of 22 healthy persons were scanned by Ultrasound Biomicroscopy. Before and after 10 minutes of exercise the anterior chamber angle and the area of the peripheral anterior chamber were measured on the scannings. RESULTS: After exercise the anterior chamber angle/peripheral area increases in all eyes due to changes in the iris configuration. The myopic group shows the largest change. CONCLUSION: Reverse pupillary block (iris concavity) is not pathognomonic in pigmentary glaucoma, it occurs in all normal eyes after exercise, most pronounced in myopics. Consequently, the difference between physiological and pathological reverse pupillary block has to be clarified.

Intrastromal holmium laser keratostomy: long-term results.

BACKGROUND AND OBJECTIVES: A new filtering procedure, the Intrastromal Holmium Laser Keratostomy (ILK) has been developed. A laser canal is created intrastromally in the cornea anterior to Schwalbe's line in the floor of a corneo-scleral tunnel incision made with a knife from the corneal site. Theoretically, the complications of the conventional Subconjunctival Holmium Laser Sclerostomy (SLS) can thus be avoided. Experimental and clinical evaluation of the new procedure, as well as clinical long-term results are presented. PATIENTS AND METHODS: The ILK was evaluated experimentally on bank eyes and clinically using postoperative Ultrasound Biomicroscopy (UBM). The clinical long-term effect was evaluated by a follow-up of the first 22 ILK performed on 17 eyes in 17 consecutive patients with complicated, refractory primary and secondary open angle glaucoma. Preoperative subconjunctival mitomycin-C injection (0.02 mL of 0.2 mg/mL) was used. RESULTS: The experimental and clinical evaluations show that the collateral thermal tissue coagulation made by the Holmium laser in ILK probably is an advantage, because the subsequent shrinkage prevents postoperative self sealing of the laser canal. Complete surgical success without medication and reoperations was reached in 63% of the eyes with a mean observation time of 22.5 months (range: 16.6-26.7 mos.). Any failure appeared within the first 10 months. Only 13% of the eyes had early iris incarcerations, there were no late incarcerations. Twenty-five percent had temporary shallow anterior chambers. CONCLUSION: The mitomycin-ILK procedure has shown obvious better results than the conventional SLS technique due to a considerable reduction in postoperative complications. Since the present material further developments in the ILK technique has made this procedure still more attractive.

[Glaucoma patients treated by practicing ophthalmologists in Denmark. Estimated number of patients and the extent of visual field defects]. / Glaukompatienter i behandling hos praktiserende øjenlaeger i Danmark. Estimat af antal patienter samt omfang af synsfeltsdefekter.

A test survey based on a questionnaire was carried out among Danish eye practitioners. The response rate was 72%. The purpose was to estimate the minimum number of patients suffering from glaucoma (prevalence). Survey results show a prevalence of 0.65%. Further, the survey shows a clear correlation between glaucoma diagnosis and age. The number of glaucoma patients increase from approximately 0.5% for persons 50 years of age to approximately 5% for persons 80 years of age. Seventy-two percent of the diagnosed glaucoma patients have visual field defects at different stages. Six percent have central islands on both eyes, the equivalent of a prevalence for social blindness of 0.04%. Ninety-three percent of the diagnosed glaucoma patients receive anti-glaucomatous treatment, of these 42% combination therapy. Eighty percent of glaucoma patients in combination therapy received three or more drugs.

Short-term effect of latanoprost and timolol eye drops on tear fluid and the ocular surface in patients with primary open-angle glaucoma and ocular hypertension.

PURPOSE: To investigate and compare the short term effects of topical latanoprost and timolol on the tear fluid and ocular surface condition in patients with bilateral primary open angle glaucoma or ocular hypertension. METHODS: Thirty-seven patients were included in this randomized, double-masked, parallel group study. Patients received either latanoprost 0.005% (n= 18) or timolol 0.5% (n= 19) instilled once daily in the morning for a treatment period of 27 days. Routine ophthalmic examinations, including intraocular pressure measurement, as well as tests to evaluate tear fluid and the ocular surface were performed. RESULTS: After one drop of medication, tear secretion was significantly reduced by timolol, but not by latanoprost. At the end of the study the break-up time (BUT) was significantly decreased in the timolol group but not in the latanoprost group. The BUT still remained in the normal range in both groups, although it is important to note that timolol was administered at half the clinical dose. Both latanoprost and timolol tended to increase Rose-Bengal staining of the cornea and conjunctiva after one month of treatment but no statistically significant difference was found between the groups. Corneal sensitivity was within the normal range for all patients during the study. CONCLUSION: Regarding ocular surface effects, no clinically important differences between latanoprost and timolol were observed as all the effects remained in the normal range.

Exercise and reversed pupillary block in pigmentary glaucoma.

PURPOSE/METHODS: The effect of exercise on the iris contour was investigated with ultrasound biomicroscopy in two patients with pigmentary glaucoma. RESULTS/CONCLUSION: Ten minutes of bicycle exercise strikingly increased the iris concavity. After Nd:YAG laser iridotomy the iris remained plane after a repeated exercise test. We believe that exercise increased the ocular pulse, which augmented cyclic aqueous movements through the pupil. Combined with a reverse pupillary block, the resulting intermittent excessive iris concavity caused pigment dispersion.

The morphology of conjunctiva after long-term topical anti-glaucoma treatment. A quantitative analysis.

On biopsy material, differences in the degree of conjunctival inflammation and fibrosis between topically treated glaucoma patients and age matched controls, were examined histologically. Eighteen patients with primary glaucoma underwent goniotrephinations, because maximal medical therapy had failed. The patients had received at least two types of topical anti-glaucoma drugs for at least 12 months (mean 46 months). The control group consisted of 18 age-matched control patients without glaucoma, who had received no topical therapy. These patients underwent cataract surgery or squint surgery. Biopsies were taken from the infero-temporal bulbar quadrant with a biopsy forceps. The specimens were fixed while stabilized on a rubber support to exclude any major shrinkage. Specimens were analyzed by light microscopy for the content of inflammatory cells (plasma cells, lymphocytes, polymorphs, macrophages and mast cells), goblet cells and fibroblasts. No significant difference in the histologic parameters between the two groups could be demonstrated. The study suggests that topical treatment for periods up to 4 years with anti-glaucoma drugs does not induce morphological signs of inflammation and fibrosis of the conjunctiva.

Trabeculotomy in juvenile primary open-angle glaucoma.

Long-term results of trabeculotomy in juvenile primary open-angle glaucoma (JPOAG) were investigated based on a follow-up study of 16 eyes in 11 patients, diagnosed when they were between 10 and 45 years old. Preoperative visual field defects were found in 75% (12/16) of the eyes. After a mean follow up of 7 years (range, 1 to 18 years), 88% (14/16) of the eyes had an intraocular pressure (IOP) of 21 mm Hg or less (peak pressure at diurnal curves). Nine of these were receiving no medical treatment and five were being treated with beta-blockers and/or dipivefrin. The best results were in the younger patients; the success rate of those under age 40 years was 100%. After normalization of IOP, visual field testing showed no progression in defects. We conclude that trabeculotomy rather than filtering surgery should be used to treat JPOAG, because the success rate of filtering surgery decreases with decreasing age. Also, the good functional results achieved in these patients after normalization of IOP may indicate that ocular hypertension is the only risk factor in JPOAG.

Limbus-based versus fornix-based conjunctival flap in glaucoma filtering surgery.

Eighteen consecutive patients suffering from the same type of glaucoma in both eyes were treated with bilateral trabeculectomy. Surgery with both fornix-based and limbus-based flap was performed on each patient, one procedure in each eye. Pre- and postoperative intraocular pressure, morphology of the fistulation bleb, anterior chamber depth and need for additional treatment were recorded. Half a year after surgery, the fornix-based flap procedure was superior (p < 0.05) concerning high success rate, little additional therapy and good morphology of the bleb.

Congenital ectopia lentis and secondary buphthalmos likely occurring as an autosomal recessive trait.

A family from Turkey with congenital ectopia lentis, likely occurring as an autosomal recessive trait, is presented. No systemic disorders such as homocysteinuria, Marfan's or Weill-Marchesani's syndromes were found in any of the patients. However, all patients except one were less than 2 years old when first examined so that lens luxation must have happened very early in life. Besides almost total lack of zonular threads the patients presented anomalies of ocular dimensions with increased corneal diameters and axial lengths, and in several cases glaucomatous distension of the optic discs could also be found. A possible explanation for these buphthalmic changes and their relation to lens luxation taking place very early in life is proposed. The importance of early diagnosis and treatment is discussed.

Evaluation of the retinal nerve fiber layer in early glaucoma. Physiological and pathological findings.

In this study on retinal nerve fiber layer (RNFL) evaluation in early glaucoma we investigated whether the greatest retinal vein width is a usable measure to distinguish physiological findings from beginning pathological defects. Seven normal control eyes and 23 glaucomatous eyes with small relative Octopus defects (greater than 10 db and less than 20 db) were photographed. In the control group 3 eyes had no RNFL loss, 4 eyes had localized defect less than 1 vein width. In the glaucoma group 1 eye had a localized defect less than 1 vein width, 7 eyes had localized defects greater than or equal to 1 vein width and 12 eyes had diffuse defects. Based on the present study it seems reasonable to define small localized defects as pathological if they at any point are greater than or equal to 1 vein width. According to this definition our study showed a specificity of 100% and sensitivity of 95% which means that the method is usable as an extra parameter in the diagnosis of early glaucoma.

Panretinal xenonphotocoagulation combined with cyclocryotherapy in the treatment of severe glaucoma.

In 12 eyes with glaucoma (none of them neovascular and all eyes with vision) which had proved resistant to conventional types of medicine and surgery, a panretinal xenonphotocoagulation (XPRP) reduced intraocular pressure (IOP) from an average of 30 mmHg to 20 mmHg measured 3/4 month after the treatment. After cyclocryotherapy of the 2 lower quadrants (CCR), IOP, after an initial fall, had risen to pre-treatment values after a similar interval. XPRP followed by CCR had an especially strong and lasting IOP reducing effect. The combination was less painful than CCR alone, even if both generally had to be repeated. We suggest that XPRP potentiates the damage of the secretory epithelium made by CCR, by strangling the posterior (long ciliary) blood supply of the ciliary body. IOP measured 2 1/2 years after the treatments averaged 18 mmHg (range 11-22). Phthisis did not develop in any of the eyes.

[Eye care in Greenland in 1979-1988]. / Ojenlaegearbejdet i Grønland 1979-1988.

Specialist eye care in Greenland is described on the basis of 66 reports from all 30 visiting consultants during a ten-year period. During this time the durations of the visits increased to approximately seven months per year for 8-9 ophthalmologists who undertook approximately 2,500 consultations annually. The diagnoses were distributed as follows: 30% anomalies of refraction, 15% cataract, 12% conditions in the posterior segment and 10% glaucoma, i.e. a considerable proportion of eye diseases associated with advancing age and with a particular Greenlandic influence. The workload was particularly great and averaged more than a reasonable weekly load despite the increase in number of days of employment. Until 1985-1986, eye surgery activities showed a considerable increase after which operative interventions for cataract and glaucoma were mainly referred to Rigshospitalet. The great increase in the number of referrals is discussed in relation to the marked changes in the therapeutic possibilities for cataract and glaucoma: extracapsular cataract extraction with posterior chamber implantation using an operation microscope and YAG-laser iridectomy of early angle closure glaucoma. The requirement of an eye surgical unit in Greenland appears to be pressing together with continuation of specialist eye care in the districts.

Effect of changes in PCO2 and body positions on intraocular pressure during general anaesthesia.

Elevated arterial carbon dioxide tension, induced by the administration of CO2 via the respiratory air or by hypoventilation, entailed a gradual increase in the IOP in patients without eye diseases under general anaesthesia. A sudden cessation of CO2 administration or hyperventilation caused such a rapid, simultaneous fall in IOP to values below the initial level that the pressure variations must be of vascular nature, presumably related to changes in choroidal blood volume. The above-mentioned procedures always cause a change in the central venous pressure (CVP) simultaneously with the IOP changes. Alterations of the CVP induced by hydrostatic factors in postural changes, placing the head 15 degrees above or below the horizontal level while keeping the PaCO2 constant, caused IOP changes of the same configuration and magnitude as described above. It is concluded, therefore, that presumably the CO2-conditioned IOP changes are due predominantly to changes in central venous pressure, being one link in a CO2-conditioned action upon the general circulation, entailing passive secondary changes in the choroidal venous blood volume and thereby an influence upon the IOP. On the basis of the present results it appears rational to recommend hyperventilation to keep the PaCO2 between 25 and 30 mm and a 15 degree anti-Trendelenburg position in operations on the eye under general anaesthesia, since both procedures afford a low central venous pressure and consequently a low pressure in the posterior segment of the eye, with its attendant advantages as regards vitreous complications and the insertion of intraocular lenses. Owing to the risk of an unacceptable fall in BP in the combined procedure, a frequent checking of the BP is needed.

Congenital glaucoma before and after the introduction of microsurgery. Results of "macrosurgery" 1943-1963 and of microsurgery (trabeculotomy/ectomy) 1970-1974.

Primary trabeculotomy (in five eyes "converted" to trabeculectomy) normalized the tension in all 21 eyes with congenital glaucoma without associated diseases, (mean postoperative tension 12 mmHg, range 8-20 mm). Re-operation was needed for only one eye. Preoperatively glaucomatous cupping was present in 18 of these 21 eyes. Ten of the 18 eyes with glaucomatous cupping were operated upon before the age of 6 months two before 11 months and the appearance of the disc was normalized in these 12 eyes. Repeated trabeculotomy, -ectomy was without success in three of five operated eyes in patients with congenital glaucoma of several years duration previously treated by "macrosurgery". In patients with associated diseases normal tension was achieved by means of trabeculotomy/-ectomy in two eyes in two Sturge-Weber children with unilateral congenital glaucoma and in both eyes in a child with a chromosomal defect with bilateral congenital glaucoma. Repeated trabeculotomy/ectomy was on the other hand without success in a child with bilateral aniridia with congenital glaucoma and hydrocephalus. Presupposing acute or subacute microsurgery, the present operative results of congenital glaucoma without diseases are far better than those obtained in previous decades by "macrosurgery" which, despite frequent re-operations, effected normalization of the tension in only 61% of the eyes (11 of 26 patients (42%) with bilateral congenital glaucoma without associated diseases and treated by macrosurgery in previous decades were under the Care of the Blind).

The distended disc in early stages of congenital glaucoma.

In 12 out of 18 eyes operated upon for congenital glaucoma without associated diseases the preoperative glaucomatous cupping had disappeared at follow-up 2 weeks to 3 months after the operation (trabeculotomy ab externo on 9 eyes and trabeculectomy on 3 eyes). Of the 12 eyes, 10 had had the operation performed before the age of 6 months, in contrast to the group in which glaucomatous cupping of the disc was irreversible where operation had been performed in the age range 6 months--12 years (mean 6 years). The mean postoperative tension value in the 18 eyes was 12 mm (range 8-20) mm) without medication, mean observation time 3 years. It seems likely that during the first phases of congenital glaucoma the disc is distended, i.e. of increased diameter and depth. This form of glaucomatous cupping and the increased diameter of the disc may be due to pressure-conditioned enlargement of the scleral canal and omnidirectional distention of the lamina cribrosa. This distention manifests itself mainly in the central areas of the lamina cribrosa and the disc, and usually disappears when the tension is normalized by surgery during the first phases of the disease.

Conjunctival goblet cells in patients with cystic fibrosis.

In five patients with cystic fibrosis of the pancreas the mucous glandular system of the conjunctiva was studied, as changes, if any, in the conjunctival goblet cells might be applicable as a diagnostic test in questionable cases. A whole-mount technique was used, specially developed for studying conjunctival goblet cells. In all five cases the qualitative as well as quantitative goblet-cell findings were in accordance with a previously reported normal material. In particular, there were no signs of stagnated secretion.