Conjunctival marginal zone B-cell lymphoma (MALT lymphoma) with amyloid and relapse in the stomach.

The authors report a localized (primary) conjunctival marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue (MALT)-type), with amyloid deposition with relapse in the stomach, 14 months after the initial diagnosis. Ocular adnexal marginal zone B-cell MALT lymphoma is often localized at diagnosis; some relapse in typical MALT sites. There are few reports of localized conjunctival lymphoma with a relapse in the stomach. The authors suggest that all patients with localized ocular adnexal lymphoma be followed for an extended period.

A short term study of the additive effect of timolol and brimonidine on intraocular pressure.

PURPOSE: To evaluate the additive ocular hypotensive effect of the combination of brimonidine and timolol on intraocular pressure (IOP) reduction in patients with glaucoma. METHODS: This was a prospective, randomized, double-masked, crossover study in 20 patients with primary open angle glaucoma (POAG) on therapy receiving timolol maleate 0.5% twice daily, with IOP greater than or equal to 22 mmHg in one eye. The treatment period was 3 weeks and during this period timolol + brimonidine or timolol + placebo were applied topically twice daily and IOP, blood pressure, heart rate and pupil size were measured. RESULTS: Combined therapy (timolol + brimonidine) had clinically significant IOP-lowering effect during the treatment period P << 0.01). The mean diurnal IOP was significantly reduced by an average of 5.1-5.9 mmHg (21.2-24.5%) compared with baseline value. The timolol + placebo combination had no clinically significant IOP-lowering effect (P > 0.05). No clinically significant side effects were observed during the treatment of both groups. CONCLUSIONS: This study showed that the combination of topically applied brimonidine and timolol cause a marked and sustained IOP reduction.

Effect of ketanserin administration on intraocular pressure.

PURPOSE: We evaluated the effect of oral single-dose (20 mg) ketanserin on intraocular pressure (IOP) in normotensive and hypertensive eyes. METHODS: This study included 15 healthy volunteers and 16 patients with ocular hypertension. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, IOP and pupil diameter were recorded at baseline and at 1-hour intervals for 6 h, in addition, tonographic outflow facility was studied at the third hour after the administration of placebo or an oral single dose of 20 mg ketanserin given in a randomized double-blind crossover fashion. The alternative treatment was applied a week later. RESULTS: In both groups, oral single-dose (20 mg) ketanserin significantly lowered IOP and SBP (p < 0.01). No variation was observed in DBP, heart rate and pupil diameter (p >0.01). Moreover, after drug administration, the total outflow facility measured by conventional tonography increased in a statistically significant way (p < 0.01). Placebo did not induce any significant reduction in IOP and SBP in either group. CONCLUSION: The results showed that systemic ketanserin can be used in the treatment of glaucoma patients to reduce IOP.

Adverse effects of topical antiglaucoma drugs on the ocular surface.

PURPOSE: This study was designed to determine the effect of long-term antiglaucoma topical medication on the ocular surface; measuring basal Schirmer's and tear break-up time tests using conjunctival impression cytology. METHODS: The ocular surfaces of 30 control subjects (group 1), 24 primary open-angle glaucoma patients treated with 0.5% betaxolol hydrochloride (group 2), 27 primary open-angle glaucoma patients treated with 0.5% timolol maleate (group 3) and 26 primary open-angle glaucoma patients treated with 0.5% betaxolol and 1% dipivefrin hydrochloride (group 4) were evaluated. Basal Schirmer's and tear break-up time tests were measured and ocular surface changes were determined by impression cytology. Impression cytology specimens of each group were graded and scored in the range 0-3 according to Nelson's method. RESULTS: Patients in groups 2, 3 and 4 showed statistically significant fewer normal basal Schirmer's tests (wettability) and tear break-up time tests (P < 0.01). Also, the conjunctival impression cytology scores were significantly higher in groups 2, 3 and 4 than in group 1 (P < 0.01). CONCLUSIONS: The conclusion was that it is possible that conjunctival surface and tear film function change after the long-term use of antiglaucoma medication.

Extracapsular cataract extraction with posterior chamber lens implantation in capsular glaucoma.

PURPOSE: To evaluate intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in patients with capsular glaucoma (CG) and coexisting cataract. METHODS: This prospective study included 20 patients (20 eyes) having CG and cataract whose IOPs were under 22 mm Hg and controlled with antiglaucoma medication. All patients had ECCE with PCIOL implantation and the follow-up period was at least 18 months. IOP was measured postoperatively at 3, 6, 9, 12 and 18 months and compared with preoperative IOP. RESULTS: Following the cataract extraction, PCIOL implantation produced a statistically significant reduction in IOP at all time points compared with the preoperative IOP during the study period (p < 0. 001). The mean preoperative IOP was 18.25 +/- 1.83 mm Hg; postoperatively at 1 month, it was 13.45 +/- 2.06 mm Hg; at 3 months 14.80 +/- 2.50 mm Hg; at 6 months 15.35 +/- 1.27 mm Hg, at 12 months 14.85 +/- 1.87 mm Hg and at 18 months 15.15 +/- 1.42 mm Hg (p < 0. 0008). The mean reduction in IOP was 16.98% from baseline at 18 months postoperatively. The mean number of antiglaucoma medication was reduced from 1.35/eye preoperatively to 0.60/eye postoperatively at 18 months (p < 0.0007). CONCLUSION: The result of our study revealed that ECCE with PCIOL implantation may be a reliable choice in controlling IOP in patients with CG.

Effect of conjunctival structure and inflammatory cell counts on intraocular pressure after trabeculectomy.

PURPOSE: To evaluate the conjunctival structure and inflammatory cell counts and to determine the predictive value of these histological parameters for postoperative intraocular pressure (IOP) levels after trabeculectomy. METHODS: A clinical and histological study was performed on consecutive patients. Postoperative (mean 32. 8 +/- 18.4 months; range 6-60 months) conjunctival biopsies of 36 eyes of 28 primary open-angle glaucoma patients who had trabeculectomy between 1992 and 1995 were included in the study. According to postoperative pressure control, patients with < or = 16 mm Hg and those with >16 mm Hg were taken as groups 1 and 2, respectively. The control group (group 3) consisted of 15 age-matched patients without glaucoma, who had received no topical therapy. We compared the conjunctival structure and cell counts within these groups. Goblet cells, acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharides and collagen compositions were determined in groups 1, 2 and 3. RESULTS: The number of goblet cells was significantly higher in group 1 (6.74 +/- 7.23) than group 2 (3. 09 +/- 2.77; p = 0.017). No statistical difference was observed in the number of acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharide or collagen compositions between groups 1 and 2 (p > 0.05). In addition, when groups 1 and 2 were compared with the control group, there was a significant decrease in goblet cells (p < 0.001), an increase in acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness and vascular density (p < 0.001), but there was no significant difference in mucopolysaccharide and collagen compositions (p > 0.05). CONCLUSIONS: This study suggests that at the time of surgery a high number of goblet cells may be a predictor of lowered IOP (< or = 16 mm Hg) following trabeculectomy without antimetabolite.

Additive effect of latanoprost and dorzolamide in patients with elevated intraocular pressure.

PURPOSE: To evaluate the additive ocular hypotensive effect of latanoprost and dorzolamide in combination, on intraocular pressure reduction in patients with elevated intraocular pressure (IOP). METHODS: Thirty patients with ocular hypertension or early capsular or primary open-angle glaucoma and elevated IOP were randomly assigned to two parallel treatment groups. The treatment period was twenty days. Fifteen patients (Group 1) received latanoprost once daily during the first ten days and, in addition, dorzolamide three times daily during the second ten days. Fifteen patients (Group 2) received dorzolamide three times daily during the first ten days and, in addition latanoprost, once daily during the second ten days. IOP was measured and conjunctival hyperemia was evaluated. RESULTS: In Group 1, the mean IOP on day 0 was 26.8 mm Hg; on day 10, 18.7 mm Hg; and on day 20, 15.9 mm Hg. In Group 2, the mean IOP on day 0 was 26.3 mm Hg; on day 10, 21.2 mm Hg; and on day 20, 16.1 mm Hg. Both groups had clinically significant IOP-lowering effect on day 10 as compared with baseline day (30.2% and 19.4% respectively) (p<0.01). When dorzolamide was added to latanoprost, the additional IOP reduction was 2.8 mm Hg (15%) (p<0.01) compared with 5.1 mm Hg (24.1%) (p<0.01) when latanoprost was added to dorzolamide. No local serious adverse reactions were observed. A mild but statistically significant increase in conjunctival hyperemia was seen in latanoprost applied patients. CONCLUSIONS: The results showed that latanoprost and dorzolamide can be combined successfully to reduce IOP with their additive effects.

The determination of additive effect and intraocular pressure lowering effects of 0.05% bromocriptine and 0.25% timolol.

It has been confirmed that topically applied bromocriptine has a satisfactory intraocular pressure (IOP) lowering effect without serious ocular or systemic side effects. We compared the IOP lowering effects of 0.05% bromocriptine and 0.25% timolol and determined whether they have an additive effect in lowering IOP in normal volunteers. In a double-blind, randomised, prospective, single-dose study, we measured IOP in 24 ocular normotensive subjects before (baseline) and 2, 4 and 6 hours after topical instillation of the following drugs: timolol and bromocriptine alone (n: 14), timolol+bromocriptine, timolol+placebo, bromocriptine+placebo (n: 10). Both bromocriptine and timolol have a significant IOP lowering effect (p < 0.01) compared with the baseline value during the study period. There were no significant differences in IOP lowering effect between timolol and bromocriptine at 2 and 4 hours (p > 0.05), but timolol was more efficacious than bromocriptine at 6 hours (p < 0.05). An additive effect in lowering IOP was not found. Although timolol and bromocriptine have no additive effect in lowering IOP, topically applied bromocriptine may be used in the treatment of glaucoma.