Late clear corneal wound failure after trivial trauma.

A clear corneal cataract wound ruptured after trivial trauma. The wound did not meet the criteria for wound stability as previously recommended. This case illustrates the potential public health hazard with the increasing use of clear corneal cataract surgery. Proper wound design can eliminate this risk. Patients without proper wound design should be cautioned to wear protective eyewear to avoid serious or blinding trauma.

Timolol hemihydrate vs timolol maleate to treat ocular hypertension and open-angle glaucoma.

PURPOSE: We compared the therapeutic efficacy and safety of timolol hemihydrate to timolol maleate in patients with ocular hypertension and chronic open-angle glaucoma. METHODS: We conducted this three-month study as a multicentered, masked, parallel group comparison. Both the 0.25% and 0.5% concentrations were evaluated against similar concentrations of timolol maleate. Dosing was twice daily. An open-label, nine-month study followed the masked portion of the protocol, in which all patients received either 0.25% or 0.5% timolol hemihydrate. A total of 371 patients were included in both the 0.25% and 0.5% studies. RESULTS: We found statistically similar intraocular pressures with both the 0.25% (18.3 and 18.6 mm Hg for the hemihydrate and maleate groups, respectively) and 0.5% (19.9 and 19.5 mm Hg for the hemihydrate and maleate groups, respectively) concentrations of timolol hemihydrate and timolol maleate after three months of masked treatment. Likewise, peak intraocular effect at two hours after taking the medication was statistically similar between medicines at both concentrations. Likewise, both ocular and systemic safety were similar between the maleate and hemihydrate preparations at both concentrations. In the nine-month open-label protocol, therapeutic efficacy (19.9 and 19.1 mm Hg for the 0.25% and 0.5% concentrations, respectively) and safety of timolol hemihydrate were similar to effect and safety of the three-month protocol. CONCLUSIONS: This study suggests that timolol hemihydrate had an ocular hypotensive efficacy and safety profile statistically equivalent to that of timolol maleate for up to three months of therapy. Timolol hemihydrate showed efficacy and safety similar to that observed within the first three months, for up to one year of therapy.

5-FU-supplemented phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy.

I reviewed the charts of 129 consecutive patients: 38 of whom underwent 5-fluorouracil (5-FU)-supplemented, combined phacoemulsification, posterior chamber lens implantation, and trabeculectomy (phaco/5-FU group); 55 of whom underwent the same combined procedure without 5-FU (phaco group); and 36 of whom underwent a similar combined procedure in which extracapsular cataract surgery was performed instead of phacoemulsification, again without 5-FU (ECCE group). I evaluated and compared the surgical results in these three groups at several points, up to and including 1 year postoperatively, in terms of intraocular pressure (IOP), number of antiglaucoma medications being used, presence or absence of a visible filtering bleb, visual field, anterior chamber cell and flare, visual acuity, postoperative induced astigmatism, and incidence of cystoid macular edema. At 3 months and beyond, there were more blebs in the phaco/5-FU group than in the phaco or ECCE groups. IOPs were generally lowest in the phaco/5-FU group, as were the number of antiglaucoma medications being used. There was no significant difference in the distribution of the amount of visual field loss among the three groups. Inflammation was generally least in the phaco/5-FU group, but there was no significant difference among the groups in terms of postoperative-induced astigmatism and visual acuity. I conclude that 5-FU-supplemented phacoemulsification combined surgery is safe and probably produces better filtering results than those achieved without the adjunctive use of 5-FU.

Combined surgery for cataract and glaucoma.

The current literature and meeting abstracts regarding combined cataract and glaucoma surgery are reviewed. Potential acuity measurements are compared. Intraoperative manipulation of the pupil, wound size, antimetabolites, and types of filtration surgery are also discussed. Postoperative intraocular pressure rise, fibrinous anterior chamber reaction, induced postoperative astigmatism, and anterior and posterior capsular problems are presented. Although great strides in techniques in each of the areas of cataract and glaucoma surgery have occurred, the long-term benefits of combined surgery have yet to be demonstrated. Ethical issues surround the use of antimetabolites.

YAG anterior capsulectomy and lysis of posterior synechiae after cataract surgery.

An anterior capsulotomy sometimes contracts enough following a small-diameter capsulorhexis to obscure vision. Nine cases are presented in which a YAG-laser anterior capsulectomy eliminated this problem with no complications.

New developments in the drug treatment of glaucoma.

This article reviews standard treatment modalities for patients with glaucoma and describes 3 classes of drugs which are undergoing development: apraclonidine (aplonidine, ALO 2145), an alpha 2-adrenergic agonist which has been released for clinical use; topical carbonic anhydrase inhibitors, a modification of the systemic carbonic anhydrase inhibitors currently in use; and prostaglandins (PGs), a new class of drugs with topical ocular hypotensive activity. Standard treatment modalities include parasympathomimetic agents such as pilocarpine, carbachol, and phospholine iodide, which lower intraocular pressure (IOP) by increasing aqueous outflow through the trabecular meshwork. A newer form of pilocarpine as a gel produces a longer action. Adrenergic agonist medications, such as epinephrine (adrenaline) and its prodrug dipivefrine (dipivalyl epinephrine), function by increasing uveoscleral outflow and trabecular outflow facility. A decrease in aqueous formation by the ciliary processes is thought to be the mechanism of action of beta-adrenoceptor antagonists, but the physiological basis for this action has not been clearly demonstrated. A newer beta-blocker, betaxolol, has relatively selective beta 1-blocking activity. Carbonic anhydrase inhibitors are nonbacteriostatic sulphonamide derivatives which decrease aqueous formation by the ciliary body. Almost 50% of patients taking these medications are unable to tolerate them because of their adverse effects, and there is thus much interest in the development of a topical carbonic anhydrase inhibitor with the potential for fewer adverse effects. MK 507 is the most recent and most potent compound in the series of topically active carbonic anhydrase inhibitors. Apraclonidine hydrochloride is a derivative of clonidine hydrochloride, an alpha 2-adrenergic agonist. Clonidine has previously been shown to lower IOP significantly, but has the potential to produce marked lowering of both systolic and diastolic blood pressures. Its major ocular effect appears to be a decrease in aqueous production. The structural modification to apraclonidine decreases corneal absorption and the drug's ability to cross the blood-brain barrier, minimising the risk of centrally mediated cardiovascular side effects. Apraclonidine may also influence secondary avenues of aqueous outflow, such as uveoscleral outflow, and may also affect conjunctival and episcleral vascular flow. It produces a mean decrease in IOP of 25% for as long as 12 hours. Adverse effects include blanching of the conjunctiva, minimal mydriasis and eyelid retraction. This drug has been approved in the US for use in prevention of elevated IOP after argon laser trabeculoplasty and iridotomy, and has potential uses in preventing an IOP rise after YAG laser posterior capsulotomy and cataract surgery in patients already on other antiglaucomatous medications.(ABSTRACT TRUNCATED AT 400 WORDS)

A comparison of the effect of flurbiprofen, dexamethasone, and placebo on cyclocryotherapy-induced inflammation.

A double-blind study was performed to compare the effects of a placebo, a topical corticosteroid, and a topical non-steroidal prostaglandin inhibitor on the inflammation and the course of intraocular pressure that follows cyclocryotherapy. Flurbiprofen 0.03%, dexamethasone phosphate 0.1%, and a sterile vehicle placebo were used both pre and postoperatively. Less anterior chamber flare was seen in flurbiprofen-treated eyes than those receiving placebo, but only at four weeks after surgery. More erythema was seen in flurbiprofen-treated eyes than in those receiving dexamethasone. Significance was approached showing more anterior chamber cells in placebo-treated eyes than in steroid-treated eyes. Cyclocryotherapy produces inflammation which is difficult to control with topically administered medications.