Effects of atropine on anterior chamber depth and anterior chamber inflammation after primary trabeculectomy.

PURPOSE: To investigate the effects of postoperative atropine on central and peripheral anterior chamber depth and anterior chamber inflammation in patients undergoing primary trabeculectomy. METHODS: Two separate groups of patients who were phakic without previous intraocular surgery undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine. In the first group of patients, 24 eyes of 21 patients undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine, and their anterior chamber depth was measured. Central and peripheral chamber depths were measured using the EAS-1000 anterior segment analysis system (Nidek, Tokyo, Japan) before surgery and on postoperative days 1, 3, 7, 14, and 30. In the second group, 34 patients undergoing primary trabeculectomy were prospectively randomized to atropine or no atropine, and their anterior chamber reaction was documented. The amount of cells and flare was measured using the Kowa laser flare meter (FM-500) and cell counter (LC-500) (Kowa Electronics and Optics, Tokyo, Japan) preoperatively and on postoperative day 1, 7, and 30. RESULTS: Compared with preoperative measurements, a small (approximately 0.1 mm) but statistically significant deepening of the central and peripheral anterior chamber depth on days 1, 7, 14, and 30 was found in patients who used atropine. In the nonatropine group, no statistically significant change was found in central or peripheral anterior chamber depths at any time as compared with preoperative values. There was no statistically significant difference in the cell or flare counts between the atropine and nonatropine groups at any time. CONCLUSIONS: This study showed a small but statistically significant deepening of the anterior chamber with atropine. No statistically significant differences were observed in the cell or flare counts between atropine and nonatropine groups. Routine atropine use after trabeculectomy may not be necessary to reduce postoperative complications, such as shallowing of the anterior chamber or anterior chamber inflammation. In patients with a shallow anterior chamber, however, atropine would be expected to deepen the chamber.

Effect of wind instrument playing on intraocular pressure.

PURPOSE: To evaluate the effect of wind instrument playing on intraocular pressure. METHODS: In a prospective, nonrandomized clinical trial, 24 eyes of 24 wind instrument players with no history of any ocular or systemic disease were evaluated. The musicians were members of Bilkent Academic Symphony Orchestra of Bilkent University in Ankara. A complete eye examination, including best-corrected visual acuity, slit-lamp examination, and fundus examination, was performed. The intraocular pressure was measured before and after a 90-minute rehearsal of a piece by Wagner. All intraocular pressure measurements were carried out by the same researcher using Goldmann applanation tonometry. The difference in intraocular pressure measurements before and after the 90-minute wind instrument-playing performance was analyzed. RESULTS: The mean intraocular pressure was 13.79 +/- 1.93 mm Hg before and 15.12 +/- 2.44 mm Hg after the performance. Wind instrument playing significantly increased the mean intraocular pressure by 9.6% (P = 0.0149). CONCLUSION: These results indicate that wind instrument playing may significantly increase intraocular pressure in healthy patients. The significance of this finding for patients with suspected normal-tension or high-tension glaucoma needs further evaluation.

Optic disc measurements with the 78 diopter lens, Zeiss 4-mirror contact lens and computerized image analysing system.

We evaluated the 78 diopter (D) lens and Zeiss 4-mirror lens for the measurement of vertical and horizontal optic disc diameters during slit-lamp biomicroscopy and compared the results with the measurements made with the computerized image analysing system (IMAGEnet 640, Topcon, Japan) in 30 eyes of 30 patients. The 78D lens and Zeiss 4-mirror lens measurements both correlated well with the computerized image analysis measurements (r=0.881 for vertical and r=0.895 for horizontal disc diameter measurements with the 78D lens and r=0.883 for vertical and r=0.891 for horizontal disc diameter measurements with the Zeiss 4-mirror lens). The 78D lens measurements overestimated vertical disc diameter by 5.3% and horizontal disc diameter by 4.4%. The Zeiss 4-mirror lens underestimated the vertical disc diameter by 2.4% and horizontal disc diameter by 2.2%. Thus either lens can be used for a quick estimation of the optic disc size, since the results correlate well with the computerized image analysis measurements.

Visual function following trabeculectomy: effect on corneal topography and contrast sensitivity.

PURPOSE: This study was to determine the role of changes in refractive error, contrast sensitivity, and corneal topography in transient changes in visual function following trabeculectomy. METHODS: We performed a prospective study evaluating these factors in 13 consecutive patients undergoing a standardized trabeculectomy. Preoperatively, and at 1, 4, and 12 weeks postoperatively, we measured best-corrected visual acuity, refractive error, and contrast sensitivity and analyzed computerized video-keratographic studies including estimated corneal visual acuity. RESULTS: One week postoperatively, best-corrected visual acuity decreased at least one line in 8 of 13 patients, whereas no eyes had decreased contrast sensitivity. Mean central corneal astigmatism increased 1.4 diopters along the surgical meridian. By 12 weeks, visual acuity returned to preoperative levels in all patients and the corneal topographic changes returned to within 1 diopter of preoperative values in 12 of 13 patients. Postoperative changes in estimated corneal visual acuity were similar to those in best-corrected visual acuity with no statistically significant difference. CONCLUSIONS: Corneal topographic changes appear to contribute to visual acuity reduction following trabeculectomy. In most cases this is transient with return to preoperative topography within 12 weeks.

Aqueous humor penetration of topically applied ciprofloxacin, ofloxacin and tobramycin.

UNLABELLED: The purpose of this study was to determine the aqueous humor concentrations of topically applied ciprofloxacin (CAS 86393-32-0), ofloxacin (CAS 82419-36-1) and tobramycin (CAS 79645-27-5). Thirty patients undergoing cataract extraction or trabeculectomy were randomly divided into three groups and each of the group received either 0.3% ciprofloxacin, ofloxacin or tobramycin topical drops preoperatively. Eyedrops were instilled for six times at a frequency of one drop every 15 minutes, beginning 90 minutes before initiation of the surgery. At the time of surgery, 0.1 ml aqueous fluid was aspirated from the anterior chamber. Concentrations of the antimicrobial agents were determined using the microbroth dilution procedure outlined by the National Committee for Clinical Laboratory Standards. Escherichia coli (ATCC 25922) was used as a standard strain for determination of minimal inhibitory concentrations (MICs). The mean aqueous levels of ciprofloxacin and ofloxacin were found to be 0.092 +/- 0.077 microgram/ml, 0.964 +/- 0.693 microgram/ml, respectively. Tobramycin did not reach the concentration that could be detected by applied method. CONCLUSION: The mean aqueous humor levels of ofloxacin and ciprofloxacin were more than the MICs levels for most of the ocular pathogens which may cause postoperative endophthalmitis.

Picosecond neodymium:yttrium lithium fluoride (Nd:YLF) laser peripheral iridotomy.

PURPOSE: We evaluated the picosecond neodymium:yttrium lithium fluoride (Nd:YLF) laser for performing peripheral iridotomies of predetermined size and shape in various types of irides. METHODS: In the first part of the study, we determined operating parameters from performing 60 iridotomies in human cadaver eyes. Subsequently, using the parameters obtained in cadaver eyes, iridotomies were created in eyes of patients with primary angle-closure glaucoma. RESULTS: In the cadaver eyes, the optimal parameters were a rectangular cutting pattern of 0.3 x 0.3 mm, 500-microns cutting depth, 50-microns spot separation, 200 to 400 microJ of energy per pulse, 200 to 400 pulses per second, and no focal offset distance. In 18 eyes of 11 patients, iridotomies with well-defined margins and size were created. Minimal hemorrhage occurred intraoperatively in ten of 18 eyes (55.6%), which did not affect the outcome of the procedure. Increases of postoperative intraocular pressure at one hour averaged 3.5 +/- 5.1 mm Hg, with an increase of more than 10 mm Hg in three eyes (16.7%), and a maximum of 12 mm Hg. We observed no corneal or retinal damage. CONCLUSION: The picosecond Nd:YLF laser seems to be an effective instrument for reliably performing peripheral iridotomies of precise size and shape using low energy per pulse levels. This laser, unlike the argon laser, is successful independent of iris thickness or color and can easily make a larger iridotomy than is often possible with the Nd:YAG laser.

Gonioscopic ab interno Nd:YLF laser sclerostomy in human cadaver eyes.

We explored the potential of the picosecond Nd:YLF laser to perform gonioscopic ab interno sclerostomy in human cadaver eyes. Full-thickness sclerostomies were created in 12 such eyes and confirmed by external scleral and histopathologic examination. Optimum parameters for successful completion of a sclerostomy were: a rectangular pattern of 0.3 mm by 0.3 mm, a repetition rate of 1000 pulses per second, an energy-per-pulse of 400 mJ, and a spot separation between 10 and 50 microns, with no focal offset. The Nd:YLF laser reliably created successful gonioscopic sclerostomies with minimal adjacent thermal damage in human cadaver eyes.

A human cadaver eye model for anterior and posterior segment laser applications.

We have developed a cadaver eye model that allows anterior and posterior segment laser procedures to be performed under closely simulated in vivo conditions. The model consists of a reusable container with an artificial cornea with a refractive power and an anterior radius of curvature similar to those of the human cornea, and a fresh cadaver eye, prepared by removing the cornea and adjusting the biometric parameters to normal values. This cadaver eye model appears to be a valuable tool for teaching and practicing anterior and posterior segment laser procedures, as well as for research on new laser systems and applications.

Intraoperative 5-Fluorouracil administration in trabeculectomy.

The purpose of this study was to determine whether 5-fluorouracil administered as a single intraoperative dose beneath the conjunctival flap during trabeculectomy in patients with glaucoma would be safe and effective. This prospective case series consists of 43 eyes of 43 consecutive patients who underwent trabeculectomy with intraoperative topical administration of 5-fluorouracil. Surgical outcome and success rate of the procedure were evaluated at a 6-month follow-up period. Success was defined as a postoperative intraocular pressure (IOP) of