The analysis of the glaucoma screening event results obtained during the World Glaucoma Week in Zagreb, Croatia.

PURPOSE: To report the prevalence of undiagnosed glaucoma, as well as demographic characteristics and risk factors among glaucoma suspects who were detected in a publicly promoted intraocular pressure (IOP) based glaucoma screening event. METHODS: A total of 2468 subjects older than 18 years participated in the glaucoma screening event in Zagreb, in 2014, which included a medical interview and IOP measurement using Icare tonometer. 256 subjects (10.37%) were identified as glaucoma suspects, out of which 125 (5.06%) subjects underwent further detailed ophthalmic examination and were classified into five diagnostic groups. RESULTS: The prevalence of all types of newly diagnosed glaucoma was 1.175%, while the prevalence of ocular hypertension (OH), primary open-angle glaucoma (POAG), primary angle closure (PAC) and secondary glaucoma (SG) was 0.16%, 0.89%, 0.16% and 0.12%, respectively. The prevalence of newly diagnosed glaucoma in glaucoma suspects was 23.2%. 17.60% of glaucoma suspects were diagnosed as POAG. Older age was statistically significantly associated with POAG (p = 0.001) and PAC (p = 0.029). At the univariate level, refractive errors were a statistically significant predictor of POAG, and those with hyperopia had more than three times larger odds for POAG. At the multivariate level, none of the predictors reached statistical significance. CONCLUSION: Successful cooperation between healthcare institutions and media can be a useful way of increasing awareness and detection of individuals at an increased risk for developing glaucoma.

SUBCONJUNCTIVAL FRAGMENTATION OF A PREVIOUSLY EFFICIENT XEN GEL STENT IMPLANTATION AND SUCCESSFUL BLEB FORMATION: A CASE REPORT.

The XEN gel stent is one of the available minimally invasive glaucoma surgery devices, a new generation implant, which is designed to reduce intraocular pressure in patients with primary open angle glaucoma if past medical treatments have failed. This report presents a case of subconjunctival fragmentation of the XEN gel stent after a three-month follow-up of successful XEN gel implantation. A 70-year-old male patient was treated for primary open angle glaucoma. He underwent successful phacoemulsification and intraocular lens implantation two years before. Due to medical therapy failure in controlling glaucoma, XEN gel stent implantation was suggested to the patient. The implant was successfully placed in both eyes, and extended bleb and drainage aqueous humor from the anterior chamber to the subconjunctival space was obtained. Three months after the surgery, at a regular follow-up visit, three fragments of the subconjunctival part of the XEN gel implant were found in his left eye. Neither serious complications nor intraocular pressure increase were detected. A new potential complication of the XEN gel implant is described.

Effect of Different Visual Impairment Levels on the Quality of Life in Glaucoma Patients.

The aim of this study was to assess the effect of different visual impairment levels on difference in the subjective quality of life estimation. We included 150 patients with glaucoma whose best-corrected visual acuity in the better-seeing eye was 0.5 and less. All of them were in advanced stage of the disease, with visual field defect worse than 12 dB in mean defect, when measured with the Octopus Visual Field Analyzer. In order to assess the quality of life, we used the Impact of Vision Impairment questionnaire. Additionally, we used General Information Questionnaire, which was developed for the purpose of this study. The information obtained from the questionnaires was analyzed using the Robust Discriminant Analysis program. Difference analysis was performed for each of the three areas of the questionnaire (reading and accessing information, mobility and inde-pendence, and emotional well-being). Results of this study confirmed the difference between the groups of patients with different levels of visual impairment, varying from total visual loss up to vis-ual acuity 0.5 on the better-seeing eye in the effects of visual impairment on the quality of life. All levels of visual impairment had the largest effect in the area of reading and accessing information, slightly less in the area of mobility and independence, and the least effect was in the area of emotional well-being. Based on the results, it is concluded that all levels of visual impairment have negative effect on the quality of life in glaucoma patients.

Structure-Function Relationship of Changes in Visual Field Indices with Quadrant and Average Retinal Nerve Fiber Layer Thickness in the Eyes with Exfoliation.

The progressive nature of glaucoma suggests it should be possible to detect structural changes such as retinal nerve fiber layer (RNFL) thickness loss before the condition becomes clinically apparent with visual field (VF) impairment. Therefore, the aim was to analyze RNFL thickness and VF changes in study groups with unilateral exfoliation syndrome (XFS), bilateral XFS and bilateral exfoliative glaucoma (XFG), and compare it with controls. The study included 114 subjects (228 eyes) divided into 4 groups according to the presence of exfoliation: 30 subjects with unilateral XFS (30 with clinically visible XFS and 30 fellow eyes), 24 subjects (48 eyes) with bilateral XFS, 28 (56 eyes) subjects with bilateral XFG, and control group (32 subjects). All subjects underwent VF and RNFL measurements after ophthalmologic examination. Both eyes of unilateral XFS (clinically -visible and fellow eye) showed positive correlation between Mean Defect (MD) and square root of Loss of Variance (sLV) and between MD and inferior quadrant RNFL thickness. In bilateral XFS and XFG, there was negative correlation between MD and inferior quadrant RNFL thickness. Inferior, superior and nasal quadrant RNFL thickness was lower in XFG group than in other groups. In bilateral XFS group, the inferior quadrant RNFL thickness was lower as compared with unilateral XFS group (in both eyes). The mean RNFL thickness negatively correlated with MD in bilateral XFS and XFG groups. In conclusion, structural changes before VF impairment have an important role in early detection of glaucoma in subjects at risk.

Analysis of Ganglion Cell Complex and Retinal Nerve Fiber Layer Thickness in Glaucoma Diagnosis.

The aim was to compare retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses in patients with primary open angle glaucoma (POAG), ocular hypertension (OH) and healthy subjects, and to investigate the role of GCC parameters in glaucoma diagnosis. Eighty-one patients were divided into four groups according to Hodapp-Parrish-Anderson classification: 26 OH, 22 early POAG, 10 moderate to advanced POAG, and 23 healthy subjects. All patients underwent RNFL and GCC thickness measurement using SOCT Copernicus HR. All RNFL and GCC parameters were significantly lower in POAG than in OH and healthy subjects, especially Average RNFL, RNFL Superior and Inferior, GCC Average, and GGC Inferior. Of all RNFL parameters, the highest area under the receiver operating characteristic curve (AUC) was recorded for Average RNFL, 0.906. GCC Average, and GCC Superior and Inferior had the overall highest AUCs (0.957, 0.955 and 0.946, respectively) with 100% specificity. The RNFL Average and Inferior and GCC Average, Superior and Inferior were identified as the main predictors for development of glaucoma (p=0.015 and p=0.014 vs. p=0.002, p=0.002 and p=0.003, respectively). In conclusion, GCC parameters showed a slightly better glaucoma discriminating ability and were found to be better predictors for development of glaucoma as compared with RNFL.

Comparison of Optic Nerve Head Morphology in Patients with Primary Open Angle Glaucoma and Non-Arteritic Anterior Ischemic Optic Neuropathy.

The aim of this study was to assess damage to retinal ganglion cells (RGC) and morphology of the optic nerve head (ONH) in patients with primary open angle glaucoma (POAG) and non-arteritic anterior ischemic optic neuropathy (NAION). The study included three groups of patients, as follows: 40 eyes with POAG, 40 eyes with NAION and 40 eyes with refraction anomaly. All patients underwent standard automated perimetry and analysis of ONH topography by using confocal scanning laser ophthalmoscopy (CSLO)-HRT II. Visual field defects such as decreased retinal sensitivity prevailed in the eyes with POAG, whereas in the eyes with NAION they were mostly manifested as concentrically narrowed visual field and quadrant excesses. Topographic ONH alterations, examined by HRT II, showed the same number of sectors to be affected in the eyes with POAG and NAION. A larger number of sectors in the upper part of ONH were affected in the eyes with NAION. Optic disc morphology differed significantly between the eyes with POAG and NAION by a higher rate of neuroretinal rim thinning and higher mean cup depth in the POAG group.

CORRELATION BETWEEN MACULAR CHANGES IN EXFOLIATION SYNDROME AND EXFOLIATIVE GLAUCOMA.

The aim of the study was to evaluate macular thickness and macular volume in unilateral and bilateral exfoliation syndrome and to compare them with exfoliative glaucoma and control eyes using optical coherence tomography. This prospective study included 114 subjects (228 eyes) divided into 4 groups according to the presence of exfoliation: 30 patients with unilateral syndrome, 24 patients with bilateral syndrome, 28 patients with bilateral glaucoma and control group without glaucoma or exfoliation syndrome (32 subjects). All subjects were older than 50 years. Patients with visual acuity under 0.6 according to Snellen were excluded, as well as those with refraction errors, i.e. hypermetropia over +3 spherical diopters, myopia over -5 spherical diopters, astigmatism over 2 cylindrical diopters, patients with affections that might affect the macula or the optic nerve, such as diabetic retinopathy, macular degeneration, macular edema, epiretinal membrane, vascular occlusions, neuropathies, and patients having undergone eye surgery except for pseudophakic patients with visual acuity within the set limits. Study results confirmed the hypothesis on the existence of structural changes of macular parameters before the functional ones, thus representing an early sign of glaucomatous damage in risk groups such as unilateral and bilateral exfoliation syndrome. If the glaucoma had already manifested (exfoliative glaucoma in this study) with changes in optic disc and visual field, structural changes confirmed the clinical findings and warned of the disease severity.

Prevalence of Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma in Population of North-West Croatia Aged 40 and Over

The purpose of this study was to assess the prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma and to evaluate its association with open-angle glaucoma in patients attending the Department of Ophthalmology, Dr Tomislav Bardek General Hospital in Koprivnica, northwestern Croatia. This prospective study was conducted at Dr Tomislav Bardek General Hospital between December 2012 and October 2013. A total of 5349 subjects aged 40 or above presenting for general ophthalmic examination were screened for pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Each patient underwent complete ophthalmologic examination including ocular history, visual acuity testing, slit-lamp examination, applanation tonometry, optic disc evaluation, visual field analysis, and gonioscopy if glaucoma was suspected. Exclusion criteria were pseudophakic and/or aphakic patients of any age, patients with concomitant congenital eye disease, and patients with very dense ocular media opacities. Out of 5349 patients examined, there were 1994 (38.38%) males and 3201 (61.61%) females. The prevalence of pseudoexfoliation syndrome was 3.6% and primary open angle glaucoma 9.4%, out of which 23.6% with pseudoexfoliation glaucoma. The findings of this study improve our knowledge of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Croatia, particularly in the northwest region.

Initial Clinical Experience with Ahmed Valve Implantation in Refractory Pediatric Glaucoma

The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma medications) and changes in visual acuity. Complications were recorded. After AGV implantation, IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively high complication rate limiting the overall success rate.

[Prognostic value of ophthalmic artery color Doppler sonography for progression to glaucoma in vitiligo patients]. / Prognosticka vrijednost ultrazvucnog nalaza arterije oftalmike u bolesnika s vitiligom za nastanak glaukoma.

The aim of this study was to assess the prognostic value, i.e. the role of hemodynamic changes in the ophthalmic artery determined by color Doppler imaging in patients with vitiligo in relation to the occurrence of primary open-angle glaucoma (POAG), and to call attention to the importance of examination of the vascular component in routine examinations of patients by clinical dermatologists and ophthalmologists, due to the possible correlation of vitiligo and ophthalmologic changes indicating POAG. Clinical observations and research have shown that patients treated for vitiligo are often diagnosed with POAG or have confirmed diagnosis in their medical history. These findings motivated the research of the vascular component as a possible correlation between vitiligo and POAG. The vascular component of POAG and its role in the dynamics of glaucoma progression has not been fully explained and is still somewhat controversial, and the resulting ischemic disorders are primarily related to optical nerve damage. During the course of a continuous two-year research started in March 2008 and completed in March 2010, a total of 42 patients with vitiligo were examined in the specialist dermatovenereology unit of the Department of Skin Diseases and Sexually Transmitted Diseases. Following clinical examination and Wood's lamp examination, patients with suspected glaucoma were referred to the glaucoma unit of the Department of Ophthalmology to detect or check the progression of POAG. At the Department of Internal Medicine, Split University Hospital Center, color Doppler imaging of ophthalmic artery was performed in all patients on both eyes to examine its hemodynamics. All study participants underwent complete ophthalmologic examination: visual acuity, fundus of the eye, eye pressure measurement, anterior eye segment biomicroscopy with gonioscopy and visual field. In conclusion, our study showed color Doppler imaging and investigation of vascular parameters in ophthalmic artery to provide an insight into the vascular function in differential analysis and can be determined as a correlation or potential risk factor related to vitiligo and POAG. For this reason, we suggest that patients treated for vitiligo, irrespective of their age, sex, affected area, localization and duration of the disease, should regularly undergo complete ophthalmologic examination with special emphasis on POAG diagnosis. Considering the relatively limited sample and trial period, we can already substantiate and confirm that the correlation is not random. Future research in a larger number of vitiligo and POAG patients should provide definitive answer concerning correlation between the two diseases and lead to final conclusion, along with investigation of other hematologic factors related to blood hypercoagulability in order to reach better understanding of the vascular component function.

Macular thickness and volume parameters measured using optical coherence tomography (OCT) for evaluation of glaucoma patients.

The aim of this study was to evaluate macular thickness parameters in glaucoma patients and to compare them to normal subjects using Optical Coherence Tomography (OCT). This prospective, observational study included 20 primary open angle glaucoma patients (POAG) and 20 healthy subjects in control group. Exclusion criteria were diabetes and other macular pathology, like age-related macular degeneration, macular oedema, central serous retinopathy and high myopia >4.00 dsph. OCT imaging of peripapillar retina and macular area were performed using Cirrus HD OCT In these two groups of patients we analyzed changes of macular thickness parameters (central subfield thickness, macular volume, and average macular thickness). The group of glaucoma patients had decreased values of the two macular thickness parameters: macular volume and average macular thickness, compared to control group. There was no difference in central macular thickness, presumably because of the absence of the ganglion cells in this layer. Macular imaging can be a useful additional method to determine glaucoma status and has a potential for tracking glaucoma progression.

Intralesional triamcinolone acetonide injection for chalazion.

The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of 15.27 +/- 6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.

Safety and efficacy of monotherapy change to fixed combination (travoprost 0.004%/timolol 0.5%) in 6 months follow up period.

PURPOSE: To assess the safety and efficacy of changing antiglaucoma therapy to the travoprost 0.004%/timolol 0.5% (TTFC) fixed combination from previous monotherapies. METHODS: Prospective, open-label, observational, multicenter cohort. A change was done from prior monotherapy at day 0 to TTFC dosed once a day, regardless in the evening or in the morning, without washout period. Active evaluation of systemic and local tolerability (adverse events), and efficacy. i.e., intraocular pressure (IOP) lowering was done at control 1 (day 30), control 2 (day 90) and control 3 (day 120). RESULTS: 40/155/170 patients (79/309/339 eyes) completed the study (120 days/ 90 days/baseline, respectfully). At control 1 excluded were patients with low tolerability (severe hyperemia (6 patients), discomfort (4), chest pain (1)) and non responders (IOP lowering less than 15% from baseline IOP or target IOP >18 mmHg (4 patients)). Mean IOP at control 1 was 15.92 +/- 1.85 mm Hg (21.66% reduction) for 155 patients (non responders excluded), at control 2 was for 155 patients 15.67 +/- 2.17 mm Hg (21.14% reduction), and at control 3 for 40 patients 16.28 +/- 1.59 mm Hg (19.86% reduction). At control 2 analysis of IOP reduction by 4 groups of previous monotherapy (timolol 0,5% (N = 33/66), latanoprost 0.005% (N = 49/98), betaxolol 0.5% (N = 30/60), and travoprost 0.004% (N = 43/85) was performed. 40 patients/79 eyes endured to control 3 (after day 90 free samples were not available for all patients). Analysis of IOP reduction by 4 groups of previous monotherapy medications was performed (timolol 0.5% (N = 7/14), latanoprost 0.005% (N = 14/28), betaxolol 0.5% (N = 7/14), travoprost 0.004% (N = 12/23)). CONCLUSIONS: Changing patients from prior monotherapy to TTFC can provide on average a further reduction in IOP, while demonstrating a favorable safety profile.

Endogenous steroid sex hormones and atherosclerosis of retinal arteries in men.

BACKGROUND: Increasing evidence suggests that both male and female sex hormones may be associated with the development of atherosclerosis, but almost all such data are based on studies of patients with coronary artery disease. To our knowledge, there are no data on the effects of endogenous sex hormones on atherosclerosis of the retinal arteries in men, and the purpose of this study was to explore that association. MATERIAL/METHODS: In 101 consecutive adult male patients treated in a university hospital outpatient clinic, atherosclerotic changes of the retinal vessels were identified prospectively by direct ophthalmoscopy and were graded on a scale of 1 to 4 according to Scheie. Commercial radioimmunoassay kits were used to measure serum levels of testosterone, estradiol, progesterone, androstenedione, and dehydroepiandrosterone sulfate. The chi-square test was used to compare the results with those from 47 matched male subjects with healthy retinal vessels. RESULTS: Retinal vessel atherosclerosis was inversely correlated with the serum progesterone concentration (P<0.001). The lower the progesterone concentration, the more advanced the stage of retinal vessel disease. A similar but less statistically significant correlation was noticed for dehydroepiandrosterone sulfate (P<0.05). A weak (P<0.05) similar association between the degree of retinal artery atherosclerosis and estradiol levels was also found. CONCLUSIONS: Low endogenous progesterone levels and, to a degree, low dehydroepiandrosterone sulfate and estradiol levels might be associated with atherosclerosis of the retinal arteries in men.

Botulinum toxin A injection for primary and recurrent chalazia.

BACKGROUND: To study the efficacy and safety of subcutaneous botulinum toxin A injections in the treatment of primary and recurrent chalazia. METHODS: Prospective, placebo-controlled consecutive case-series trial. Sixty three patients were divided into two groups: group 1 consisting of 32 patients previously diagnosed with and treated for primary or recurrent chalazia with 2-5 international units (IU) in 0.2-0.5 ml of preserved saline solution of botulinum toxin injection, and group 2 consisting of 31 patients receiving placebo. The main outcome measures were localization and duration of the disease, size of chalazion before and after treatment, clinical resolution of chalazion, time to resolution, and complications of treatment. RESULTS: There was a clinically and statistically significant between-group difference in the rate of therapeutic success and post-therapeutic chalazion regression, but not in the rate of complications. CONCLUSIONS: Botulinum toxin A injection is effective and safe treatment for primary and recurrent chalazia. Lesion regression that did not respond to the average of two injections would benefit more from surgical excision or systemic antibiotic therapy.

Bilateral optic neuritis as initial manifestation of neurosyphilis in a HIV-positive patient.

Syphilis, a disease which used to be terminal up to the 1950s, has become curable with the discovery of penicillin. In the last few years, an increase in its incidence has been recorded in the world as well as in Croatia, primarily with the human immunodeficiency virus (HIV) co-infection. We present a 40-year-old male patient who complained of a sudden decrease of visual acuity on both eyes, accompanied by dizziness. Clinical examination revealed low visual acuity and blurred edges of the optical nerve head without prominence. Pulse corticosteroid therapy failed to produce any recovery of visual acuity. Additional tests were done including Treponemapallidum hemagglutination assay (TPHA), which confirmed the infection with Treponema pallidum. The patient was administered Extencillin therapy. As a reaction to therapy administered, the patient's visual acuity gradually fully recovered. In the medical literature available, there is no report of optical neuritis as the first and only manifestation of HIV and syphilis coinfection.

[Ophthalmological causes of headache]. / Okularni uzroci glavobolje.

Ophthalmologic causes of headache represent a very complex and extensive problem, and very often differential diagnostic problem too. Many various reasons of headache can be caused by ophthalmologic diseases like those of anterior and posterior eye segments, acute and subacute angle closed glaucoma and orbital diseases. Headache can be caused by no or poor correction of the refraction anomalies. Ophthalmologic causes of headache are quite frequently connected with conditions that affect other body systems apart from the eyes, nervous and/or vascular system in particular. Although ophthalmologic examination very provides the clue in patients with headache, the diagnostic and therapeutic approach to the problem has to be interdisciplinary.

Intravitreal bevacizumab for neovascular glaucoma.

The aim of the study was to assess short-term efficacy of intravitreal bevacizumab in a series of patients with neovascular glaucoma. Eleven patients with neovascular glaucoma and symptomatic elevation of intraocular pressure were treated with 1.25 mg/0.1 mL of bevacizumab. In three patients, intravitreal bevacizumab was administered preoperatively, one day before pars plana vitrectomy. Additional therapy was only performed if topical medication failed to result in satisfactory control of intraocular pressure. Patients were followed-up for a minimum of 8 weeks. In all study patients, intravitreal application of bevacizumab resulted in marked regression of iris neovascularization within the first three postoperative days. Appropriate control of intraocular pressure was achieved in seven patients, whereas four patients required additional therapy for intraocular pressure regulation. No side effects of intravitreal bevacizumab were recorded. Thus, intravitreal bevacizumab seems to be a potent adjunct in the management of neovascular glaucoma. Additional studies of bevacizumab long-term safety and efficacy are warranted.

Comparison of preoperative and postoperative astigmatism after superotemporal or superonasal clear corneal incision in phacoemulsification.

The aim of this work was comparison of preoperative and postoperative astigmatism after superotemporal or superonasal clear corneal incision. Twenty eight eyes of 28 patients treated with phacoemulsification through superotemporal or superonasal 3 mm clear corneal incision were examined by kerato-refractometer preoperatively and six months postoperatively. Adequate score was assigned to each preoperative and postoperative K-value with associated axis of astigmatism to enable comparison. Wilcoxon paired samples test was used for statistical analysis. Postoperative uncorrected Snellen visual acuity was 0.5 or better in 26 patients. In one patient visual acuity was 0.3 because of diabetic maculopathy. Postoperative astigmatism was less or equal than preoperative in 18 and greater in 10 patients. There was no statistical difference between the preoperative and postoperative astigmatism (Wilcoxon paired samples test, p = 0.966) and therefore the conclusion can be made that the superotemporal or superonasal clear corneal incision has minimal effect on corneal astigmatism.

[Use of antiglaucoma therapy to reduce acute intraocular pressure rise following neodymium: YAG laser iridotomy in angle-closure glaucoma patients]. / Lokalna terapija glaukoma u redukciji akutnog povisenja intraokularnog tlaka u bolesnika s glaukomom zatvorenog kuta nakon neodymium: YAG laserske iridotomije.

AIM: To evaluate the efficacy of topical antiglaucoma therapy in reducing acute intraocular pressure (IOP) elevation after neodymium: Yag laser iridotomy. PATIENTS AND METHODS: Primary angle-closure glaucoma (PACG) eyes were randomized to receive premedication with latanoprost and pilocarpine, brimonidine 0.2% and pilocarpine or only with pilocarpine before Yag laser iridotomy. Postoperative IOP changes were compared with Wilcoxon signed-ranks test using the fellow eyes in each group. RESULTS: Postoperative pressure spikes were significantly lower in the groups of patients with local antiglaucoma therapy with pilocarpine than in the control group. Mean elevation of IOP was less in the groups of patients with local antiglaucoma therapy with pilocarpine at 2 hours postoperatively. CONCLUSION: Local antiglaucoma therapy may reduce the acute IOP rise following Yag laser iridotomy in PACG eyes.