Slow coagulation versus micropulse transscleral cyclophotocoagulation for refractory childhood glaucoma.

PURPOSE: To compare the safety and efficacy of micropulse laser (MP-TSCP) and slow coagulation transscleral cyclophotocoagulation (TSCP) with a diode laser for reducing intraocular pressure (IOP) in patients with refractory childhood glaucoma (CG). METHODS: Patients with CG and at least 12 months of medical chart data were included. Data on preoperative and postoperative outcomes were analyzed. The primary outcomes were an IOP of 6-21 mmHg and/or ≥ 20% reduction in the baseline value. RESULTS: A total of 17 eyes were included. The preoperative mean IOP was 28 mmHg in the MP-TSCP and 29.9 mmHg in the TSCP. The mean IOP decreased significantly to 17.26 ± 3.27 mmHg in the MP-TSCP and 14.68 ± 5.79 mmHg TSCP at the last medical record. Three anti-glaucoma meds were administered to the eyes preoperatively in both groups. A mean of 1.02 eye drops was administered to the MP-TSCP and 2.06 to the TSCP. The number of medications decreased by 2.38 ± 1.55 in the MP-TSCP and 0.82 ± 1.68 in the TSCP. The median preoperative visual acuity (logMAR) was 1.51 ± 1.06 in the MP-TSCP and 1.87 ± 0.74 in the TSCP. The variation in mean visual acuity (logMAR) was -0.027 ± 0.05 in the MP-TSCP and -0.40 ± 0.58 in the TSCP. The most frequent complication was corneal decompensation (one - MP-TSCP and two - TSCP). CONCLUSION: Both techniques were effective and relatively safe for reducing IOP. These techniques appear to extend the indications of cyclophotocoagulation in CG eyes and improve the functional prognosis.

Trabecular micro-bypass implant (iStent®) in a case of bilateral acute depigmentation of the iris / Micro implante trabecular (iStent®) em um caso de despigmentação aguda bilateral da íris

ABSTRACT We report a case of bilateral acute depigmentation of the iris in which satisfactory intraocular pressure control was obtained after resolution of the acute disease with a trabecular implant (iStent®). A 62-year-old woman presented with bilateral simultaneous acute eye pain, photophobia, increased intraocular pressure (34 mmHg), circulating pigment in the anterior chamber, areas of depigmentation in the iris, and posterior synechiae. She had received oral amoxicillin-clavulanate and moxifloxacin for pneumonia 2 months previously. Bilateral acute depigmentation of the iris was suspected as well as a viral etiology. She received oral acetazolamide, aciclovir, and prednisone, besides topical prednisolone, betaxolol, brimonidine, dorzolamide, and atropine. The disease gradually resolved in 4 months but, after 1 year, she developed bilateral cataracts, and still needed three drugs for intraocular pressure control (16/18 mmHg). Cataract-iStent® combined surgery was performed in both eyes. One year after surgery, intraocular pressure was 11/12 mmHg, without medication. iStent® was safe and effective on this secondary glaucoma.

RESUMO Relatamos um caso de despigmentação aguda bilateral da íris, no qual obtivemos adequado controle da pressão intraocular com o implante do iStent®, após resolução da fase aguda da doença. Paciente feminina, 62 anos, atendida com quadro agudo, bilateral e simultâneo de dor ocular, fotofobia, hipertensão ocular (34 mmHg), pigmentos circulantes na câmara anterior, áreas de despigmentação iriana e sinéquias posteriores. Havia recebido amoxicilina-clavulanato e moxifloxacina orais para pneumonia 2 meses antes. Suspeitando-se de despigmentação aguda bilateral da íris ou de etiologia viral, recebeu acetazolamida, aciclovir e prednisona orais, e colírios prednisolona, betaxolol, brimonidina, dorzolamida e atropina. O quadro se resolveu gradualmente em 4 meses, porém, após 1 ano, desenvolveu catarata bilateral e ainda usava 3 colírios hipotensores (pressão intraocular 16/18 mmHg). A cirurgia combinada de catarata-iStent® foi realizada em ambos os olhos. Um ano depois, a pressão intraocular mantinha-se 11/12 mmHg, sem medicação. O iStent® foi seguro e eficaz no controle deste glaucoma secundário.

Trabecular micro-bypass implant (iStent®) in a case of bilateral acute depigmentation of the iris.

We report a case of bilateral acute depigmentation of the iris in which satisfactory intraocular pressure control was obtained after resolution of the acute disease with a trabecular implant (iStent®). A 62-year-old woman presented with bilateral simultaneous acute eye pain, photophobia, increased intraocular pressure (34 mmHg), circulating pigment in the anterior chamber, areas of depigmentation in the iris, and posterior synechiae. She had received oral amoxicillin-clavulanate and moxifloxacin for pneumonia 2 months previously. Bilateral acute depigmentation of the iris was suspected as well as a viral etiology. She received oral acetazolamide, aciclovir, and prednisone, besides topical prednisolone, betaxolol, brimonidine, dorzolamide, and atropine. The disease gradually resolved in 4 months but, after 1 year, she developed bilateral cataracts, and still needed three drugs for intraocular pressure control (16/18 mmHg). Cataract-iStent® combined surgery was performed in both eyes. One year after surgery, intraocular pressure was 11/12 mmHg, without medication. iStent® was safe and effective on this secondary glaucoma.

[Scleral injury caused by needling revision with adjunctive mytomicin-C: case report]. / Lesão escleral durante o agulhamento com mitomicina C: relato de caso.

A 70-year-old female patient underwent cataract and glaucoma surgery on her left eye in 1996. Eleven years later, we performed two bleb needling revisions with adjunctive mytomicin-C, in order to decrease an uncontrolled intraocular pressure of 32 mmHg. After the second needling, she developed severe overfiltration, with flat anterior chamber, choroidal effusion, and impending corneal decompensation. Conservative treatment with cycloplegic and corticosteroid eye drops, acetazolamide and therapeutic contact lenses was unsuccessfully tried. Anterior chamber reformation was successively tried with air, 4% ophthalmic viscosurgical device and 1% sodium hyaluronate, with only temporary results. Compressive sutures above the overfiltering bleb were applied, unsuccessfully. In order to avoid additional corneal endothelium damage, a surgical bleb revision was performed and revealed a large area of ciliary body and choroidal exposure under the conjunctiva. It was covered by a donor scleral patch graft providing successful resolution. Nevertheless, we had to reintroduce hypotensive eyedrops. While bleb needling is a relatively safe and effective procedure, ophthalmologists should be aware of the possibility of potentially serious complications, such as in this case report.

Lesão escleral durante o agulhamento com mitomicina C: relato de caso / Scleral injure caused by needling revision with adjunctive mytomicin-C: case report

Paciente de 70 anos foi submetida à cirurgia de catarata e glaucoma no olho esquerdo em 1996. Onze anos depois, com a pressão intraocular descontrolada (32 mmHg), foram realizados dois agulhamentos episclerais com mitomicina-C, na tentativa de recuperar a função da trabeculectomia. Após o segundo agulhamento, a paciente evoluiu com importante hiperfiltração, atalamia grau III e iminente descompensação da córnea. Foi tentado o tratamento clínico com corticóide, cicloplégico, inibidores da produção do aquoso e lente de contato terapêutica, sem sucesso. A câmara anterior foi sucessivamente preenchida com ar, metilcelulose 4 por cento e hialuronato de sódio 1 por cento, com melhora apenas temporária. Foram feitas suturas compressivas sobre a bolsa filtrante, sem sucesso. Realizou-se, então, a revisão cirúrgica da fístula, que evidenciou grande área de exposição do corpo ciliar e da coróide, correspondente ao local do agulhamento. O quadro estabilizou-se após recobrimento com enxerto de esclera de cadáver e reintrodução de terapia hipotensora tópica. A gravidade da complicação descrita por um procedimento relativamente fácil e seguro, ressalta a importância deste relato de caso.

A 70-year-old female patient underwent cataract and glaucoma surgery on her left eye in 1996. Eleven years later, we performed two bleb needling revisions with adjunctive mytomicin-C, in order to decrease an uncontrolled intraocular pressure of 32 mmHg. After the second needling, she developed severe overfiltration, with flat anterior chamber, choroidal effusion, and impending corneal decompensation. Conservative treatment with cycloplegic and corticosteroid eye drops, acetazolamide and therapeutic contact lenses was unsuccessfully tried. Anterior chamber reformation was successively tried with air, 4 percent ophthalmic viscosurgical device and 1 percent sodium hyaluronate, with only temporary results. Compressive sutures above the overfiltering bleb were applied, unsuccessfully. In order to avoid additional corneal endothelium damage, a surgical bleb revision was performed and revealed a large area of ciliary body and choroidal exposure under the conjunctiva. It was covered by a donor scleral patch graft providing successful resolution. Nevertheless, we had to reintroduce hypotensive eyedrops. While bleb needling is a relatively safe and effective procedure, ophthalmologists should be aware of the possibility of potentially serious complications, such as in this case report.

[Efficacy of latanoprost versus travoprost assessed by daily intraocular pressure curve]. / Eficácia do latanoprosta x travoprosta avaliada pela curva diária de pressão intraocular.

PURPOSE: To assess the efficacy of latanoprost (L) and travoprost (T) as monotherapy as well as both drugs associated with 0.5% timolol maleate twice a day regarding the daily curve of intraocular pressure (DCPo) with the measurement of intraocular pressure (IOP) at 6 am in bed. METHODS: Retrospective study analyzing the daily curve of intraocular pressure of patients treated with L or T with or without 0.5% Tim. Patients who did not correctly follow the treatment were excluded. We also excluded the patients who used the prostaglandin analog associated with any other antiglaucomatous drug different from 0.5% Tim and those who were treated with more than two antiglaucomatous drugs. Statistical analysis was made through the SPSS 11.0 program calculating mean intraocular pressure (Pm), variability (V), p value and standard deviation. Ethnic aspects or type of glaucoma were no criteria of inclusion or exclusion in this study. RESULTS: Seventy-five patients (142 eyes) were included. The average age was 61.7 years. Thirty-three (44.0%) patients were male and 42 (56.0%) were female. Thirteen patients (26 eyes 18.3%) used L, 18 patients (33 eyes - 23.2%) were treated with T, 18 patients (32 eyes - 22.5%) used latanoprost and 0.5% timolol (L 0.5%Tim) and 26 patients (51 eyes - 35.9%) used travoprost and 0.5% timolol (T 0.5%Tim). Chronic simple glaucoma was the most common type (92.0%), followed by congenital glaucoma (6.7%) and glaucoma secondary to cataract surgery (1.3%). Pm was 15.2 (+/- 4.2) mmHg among those treated with L and 14.8 (+/- 3.2) mmHg among the T users. Those patients showed a V of 2.0 (+/- 1.2) and 3.2 (+/- 1.9). In the group of L 0.5%Tim and T 0.5%Tim the Pm and V were 14.9 (+/- 2.2) mmHg, 15.0 (+/- 3.2) mmHg, 2.4 (+/- 1.2) and 2.8 (+/- 1.6) respectively. No statistical significant difference was found in the Pm neither with the drugs used as monotherapy nor with them associated with 0.5% timolol maleate as well as in the V with both drugs associated with 0.5% timolol maleate. However, V showed a significant statistically difference when we considered the drugs in monotherapy, the IOP fluctuation being lower with L (t= -2.9; p=0.005). CONCLUSION: In the daily curve of intraocular pressure performed with the measurement of intraocular pressure at 6 am in bed, L and T associated with 0.5% timolol maleate had a similar efficacy; however, in monotherapy, Pm was similar in both drugs but the V obtained with L was lower the difference being statistically significant.

Eficácia do latanoprosta x travoprosta avaliada pela curva diária de pressão intraocular / Efficacy of latanoprost versus travoprost assessed by daily intraocular pressure curve

OBJETIVO: Avaliar, através da curva diária de pressão intraocular (CDPo), a eficácia do latanoprosta (L) e do travoprosta (T) como monoterapia e do L e T associados ao maleato de timolol 0,5 por cento (LTim 0,5 por cento e TTim 0,5 por cento) em pacientes glaucomatosos. MÉTODOS: Análise retrospectiva da curva diária de pressão intraocular de pacientes glaucomatosos em uso de L ou T ou das associações LTim 0,5 por cento e TTim 0,5 por cento. Foram excluídos os pacientes que não usaram a(s) medicação(ões) de maneira correta na curva diária de pressão intraocular e aqueles que estavam em uso de L ou T associado a outro hipotensor qão o timolol 0,5 por cento ou em uso de mais de dois colírios antiglaucomatosos. Foram analisados, em cada grupo, a pressão média (Pm) e a variabilidade (V) e seus respectivos desvios padrões. Utilizou-se o programa SPSS 11.0 na análise estatística. Raça, idade, sexo e tipo de glaucoma não foram critérios para a inclusão ou a exão dos pacientes. RESULTADOS: Foram incluídos 75 pacientes (142 olhos) com idade média de 61,7 anos, sendo 33 (44,0 por cento) do sexo masculino e 42 (56,0 por cento) do feminino. Treze pacientes (26 olhos - 18,3 por cento) usavam L; 18 pacientes (33 olhos - 23,2 por cento) usavam T; 18 pacientes (32 olhos - 22,5 por cento) estavam em tratamento com LTim 0,5 por cento e 26 pacientes (51 olhos - 35,9 por cento) usavam a associação TTim 0,5 por cento. Sessenta e nove pacientes (92,0 por cento) eram portadores de glaucoma crônico simples; 5 (6,7 por cento) de glaucoma congênito e 1 (1,3 por cento) de glaucoma pós-pseudofacia. Nos grupos L e T, os valores da Pm foram 15,2 (± 4,2) mmHg e 14,8 (±3,2) mmHg e os da V foram 2,0 (± 1,2) e 3,2 (± 1,9), respectivamente. Nos grupos LTim 0,5 por cento e TTim 0,5 por cento, os valores da Pm foram 14,9 (± 2,2) mmHg e 15,0 (±3,2) mmHg e os da V foram 2,4 (± 1,2) e 2,8 (± 1,6), respectivamente. Não houve diferença estatisticamente significativa na Pm entre ...

PURPOSE: To assess the efficacy of latanoprost (L) and travoprost (T) as monotherapy as well as both drugs associated with 0.5 percent timolol maleate twice a day regarding the daily curve of intraocular pressure (DCPo) with the measurement of intraocular pressure (IOP) at 6 am in bed. METHODS: Retrospective study analyzing the daily curve of intraocular pressure of patients treated with L or T with or without 0.5 percent Tim. Patients who did not correctly follow the treatment were excluded. We also excluded the patients who used the prostaglandin analog associated with any other antiglaucomatous drug different from 0.5 percent Tim and those who were treated with more than two antiglaucomatous drugs. Statistical analysis was made through the SPSS 11.0 program calculating mean intraocular pressure (Pm), variability (V), p value and standard deviation. Ethnic aspects or type of glaucoma were no criteria of inclusion or exclusion in this study. RESULTS: Seventy-five patients (142 eyes) were included. The average age was 61.7 years. Thirty-three (44.0 percent) patients were male and 42 (56.0 percent) were female. Thirteen patients (26 eyes 18.3 percent) used L, 18 patients (33 eyes - 23.2 percent) were treated with T, 18 patients (32 eyes - 22.5 percent) used latanoprost and 0.5 percent timolol (L 0.5 percentTim) and 26 patients (51 eyes - 35.9 percent) used travoprost and 0.5 percent timolol (T 0.5 percentTim). Chronic simple glaucoma was the most common type (92.0 percent), followed by congenital glaucoma (6.7 percent) and glaucoma secondary to cataract surgery (1.3 percent). Pm was 15.2 (± 4.2) mmHg among those treated with L and 14.8 (± 3.2) mmHg among the T users. Those patients showed a V of 2.0 (± 1.2) and 3.2 (± 1.9). In the group of L 0.5 percentTim and T 0.5 percentTim the Pm and V were 14.9 (± 2.2) mmHg, 15.0 (± 3.2) mmHg, 2.4 (± 1.2) and 2.8 (± 1.6) respectively. No statistical significant difference was found in the Pm neither ...

[Mitomicyn C eye drops as alternative treatment for pyogenic granuloma in anophthalmic socket]. / Mitomicina C colírio como tratamento para granuloma piogênico em cavidade anoftámica.

PURPOSE: To evaluate the efficacy of mitomycin C eye drops 0.02% concentration (0.02% MMC) in pyogenic granuloma in anophthalmic socket. METHODS: Six patients who presented pyogenic granuloma were treated with 0.02% MMC four times a day in fifteen-day cycles with intervals of fifteen days between each cycle. The patients were observed every week. RESULTS: Among the six studied patients, one presented a complete resolution of the pyogenic granuloma after a ten-day treatment with 0.02% MMC that is, before the end of the first cycle. In two patients, the treatment was successful after two weeks using 0.02% MMC (one complete cycle). In other two patients, the resolution of the lesion occurred after five weeks that is, at the beginning of the second cycle. 0.02% MMC was not successful in only one patient whose lesion persisted after two cycles of the treatment. None of the patients presented complications after the use of 0.02% MMC. CONCLUSION: The topical use of 0.02% MMC proved efficacy in the treatment of anophthalmic socket pyogenic granuloma. A small number of patients took part in this study, therefore another randomized and comparative research is necessary in order to compare the efficacy of 0.02% MMC with other drugs such as corticosteroids and antimetabolites.

Mitomicina C colírio como tratamento para granuloma piogênico em cavidade anoftámica / Mitomicyn C eye drops as alternative treatment for pyogenic granuloma in anophthalmic socket

OBJETIVO: Avaliar a eficácia do uso tópico de colírio de mitomicina C 0,02 por cento (MMC 0,02 por cento) no tratamento de pacientes com granuloma piogênico em cavidade anoftálmica. MÉTODOS: Seis pacientes portadores de granuloma piogênico em cavidade anoftálmica foram submetidos ao tratamento com mitomicina C 0,02 por cento instilada quatro vezes ao dia durante ciclos quinzenais e intervalo de 15 dias entre os ciclos. Os pacientes foram acompanhados semanalmente. RESULTADOS: Foram acompanhados seis pacientes dos quais um apresentou resolução do granuloma piogênico ao final do primeiro ciclo de uso da MMC 0,02 por cento. Em dois pacientes a MMC 0,02 por cento foi eficaz na resolução da lesão após a segunda semana de tratamento (primeiro ciclo). Dois pacientes apresentaram resolução completa do granuloma piogênico na quinta semana de uso da MMC 0,02 por cento (início do segundo ciclo). Este fármaco foi ineficaz em apenas um paciente que persistiu com a lesão após dois ciclos de tratamento. Não foram observadas complicações decorrentes do uso de MMC 0,02 por cento em nenhum dos pacientes. CONCLUSÃO: A MMC 0,02 por cento tópica mostrou-se eficaz no tratamento de granuloma piogênico em cavidade anoftálmica, entretanto, diante de casuística pequena, torna-se necessário estudo mais amplo, comparando a eficácia da MMC 0,02 por cento com drogas já utilizadas no tratamento desta lesão, tais como os esteróides e antimetabólicos.

PURPOSE: To evaluate the efficacy of mitomycin C eye drops 0.02 percent concentration (0.02 percent MMC) in pyogenic granuloma in anophthalmic socket. METHODS: Six patients who presented pyogenic granuloma were treated with 0.02 percent MMC four times a day in fifteen-day cycles with intervals of fifteen days between each cycle. The patients were observed every week. RESULTS: Among the six studied patients, one presented a complete resolution of the pyogenic granuloma after a ten-day treatment with 0.02 percent MMC that is, before the end of the first cycle. In two patients, the treatment was successful after two weeks using 0.02 percent MMC (one complete cycle). In other two patients, the resolution of the lesion occurred after five weeks that is, at the beginning of the second cycle. 0.02 percent MMC was not successful in only one patient whose lesion persisted after two cycles of the treatment. None of the patients presented complications after the use of 0.02 percent MMC. CONCLUSION: The topical use of 0.02 percent MMC proved efficacy in the treatment of anophthalmic socket pyogenic granuloma. A small number of patients took part in this study, therefore another randomized and comparative research is necessary in order to compare the efficacy of 0.02 percent MMC with other drugs such as corticosteroids and antimetabolites.