Aqueous misdirection and flat chamber after posterior chamber implants with and without trabeculectomy.

Three patients developed flat anterior chamber and were ultimately diagnosed as having aqueous misdirection after trabeculectomy with extracapsular cataract extraction and posterior chamber lens implantation (glaucoma triple procedure). A fourth patient developed aqueous misdirection after posterior chamber lens implantation only (without trabeculectomy). This latter was cured by repeated pars plana vitrectomy, not requiring removal of the pseudophakos. In only one of the three eyes with the triple procedure did the lens have to be removed and anterior vitrectomy performed, whereas the remaining two were cured by neodymium-YAG laser disruption of the anterior hyaloid. In these two cases, the posterior capsule remained intact. Neodymium-YAG laser vitreolysis should be the first step in the management of these cases because of its safety compared with open surgery.

Herpes simplex virus dermatitis in patients using latanoprost.

PURPOSE: To describe the possible association of latanoprost with herpetic dermatitis of the periocular skin. METHOD: Interventional case reports. A 79-year-old woman with open-angle glaucoma developed a vesicular dermatitis of the left lower eyelid 14 months after starting latanoprost therapy. An 84-year-old man with pigmentary glaucoma developed a vesicular dermatitis of the right upper lid after 2 months of treatment with latanoprost and 8 days of treatment with tobramycin/dexamethasone for presumed bacterial conjunctivitis. In both cases, the dermatitis was characteristic of a herpetic infection. RESULTS: Latanoprost was discontinued in both cases. The woman was treated with vidarabine 3% ointment, and the man was not treated with antiviral agents. In both patients, the dermatitis healed uneventfully. The lesions of the man were cultured, and a biopsy was performed; herpes simplex virus type 1 was recovered from the culture and confirmed by immunofluorescence testing. CONCLUSION: Latanoprost, which has been associated with reactivation of herpetic keratitis, may also cause reactivation of herpetic dermatitis of the periocular skin.

Optic neuropathy in Paget's disease.

Of 22 patients (18 men and four women ranging in age from 50 to 89 years) with radiographic and clinical evidence of Paget's disease, nine had visual field defects. All nine had arcuate scotomas and five of the nine had generalized constriction. The visual field changes were asymptomatic in six of nine patients and progressive in two patients. Only two patients had radiographic evidence of optic canal constriction by bony impingement. There was no objective improvement in the optic neuropathy in the three patients treated with synthetic salmon calcitonin. Our data suggested that the optic neuropathy of Paget's disease cannot be explained solely on the basis of bony compression and the cause of optic neuropathy in patients with normal optic canals remains unknown.

Recurrent intraoperative choroidal effusion in Sturge-Weber syndrome.

The formation of a massive choroidal effusion without hemorrhage during a trabeculectomy procedure was documented in a 17-year-old male with Sturge-Weber syndrome, most probably representing the youngest patient in the literature with this intraoperative complication. The occurrence of similar signs during a previous trabeculectomy procedure in the same eye, suggested the possible recurrent nature of this entity. Preparation of a posterior sclerotomy site before entering the eye during intraocular surgery in patients with Sturge-Weber Syndrome might help in the immediate management and in preventing complications due to the formation of massive choroidal effusion.

Psychotic reaction in an adult after topical cyclopentolate.

A case of psychotic reaction to topical cyclopentolate HCl (Cyclogyl) in an adult is reported. The reaction was characterized by hallucination, disorientation, amnesia and aggressive behavior which lasted for approximately 2h.

The significance of normal angle vessels.

One hundred patients (200 eyes) were examined over a one-year period for the presence of normal anterior chamber angle vessels. Normal vessels were observed in the angle in 21% of eyes examined. The types, location, and number of normal vessels are documented. The significance of these vessels in two eyes with anterior chamber angle fixated lenses is discussed.

The significance of disc hemorrhage in open-angle glaucoma.

Thirty eyes of 25 patients with open-angle glaucoma and disc splinter hemorrhage (20 with unilateral and five with bilateral hemorrhage) were studied as to the extent of the visual field loss in relation to the time of onset and location of the disc hemorrhage. The degree of visual field deterioration over a follow-up period of one month to seven years was found to be higher in eyes with disc hemorrhage when compared to the contralateral eyes without disc hemorrhage of patients with bilateral open angle glaucoma.

Possible significance of cilioretinal arteries in open-angle glaucoma.

To study the possible prognostic significance of the cilioretinal artery in open-angle glaucoma, the disc stereophotographs of one hundred consecutive patients with bilateral open-angle glaucoma were reviewed for the presence of cilioretinal arteries. The charts of 20 patients with unilateral cilioretinal arteries were then studied for the extent of the optic disc cupping and visual field damage. Despite the absence of a significant difference in the intraocular pressure between the two groups, eyes with cilioretinal arteries showed larger cup/disc ratios and more visual field damage when compared to the contralateral eyes without cilioretinal arteries in the same patients.

Modified trabeculectomy: a new procedure for neovascular glaucoma.

A new surgical procedure has been described specifically for neovascular glaucoma with residual visual function. The procedure included excision of a large trabecular segment under a limbal-based scleral flap, partial non-penetrating cyclodiathermy, and partial ablation of abnormal iris vessels followed by a wide sector iridectomy. The preliminary results in five eyes with advanced neovascular glaucoma were encouraging.

Pigment distribution in Waardenburg's syndrome: a new hypothesis.

Two cases of Waardenburg's syndrome are presented. The first case is an example of Waardenburg's type II (without dystopia canthorum) with bilateral sectoral iris heterochromia and fundus bicolor, hyperpigmented skin patches, characteristic facies and deafness. The second case is an example of Waardenburg's type I (with dystopia canthorum) with complete iris heterochromia and characteristic facies. Bilateral glaucoma was also present in the second case. Previously unrecognized details of iris architecture in Waardenburg's syndrome are described. Pigmentation anomalies of the skin are also discussed. It is hypothesized that the ocular pigmentary disturbance in Waardenburg's syndrome is widespread and involves the hyperchromic as well as the hypochromic areas of the eyes. A possible association with glaucoma might be explained by such a hypothesis.