Argon laser trabeculoplasty controls one third of cases of progressive, uncontrolled, open angle glaucoma for 5 years.

Seventy-eight patients (109 eyes) with progressive glaucoma had argon laser trabeculoplasty as a substitute for filtration surgery and were then followed up for a minimum of 5 years. One hundred spots were placed at the anterior margin of the posterior trabecular meshwork over 360 degrees. Consecutive cases between 1980 and 1985 were reviewed, 95% of treated cases being included in the final analysis. Eighty-two eyes had primary open angle glaucoma. If only the group with primary open angle glaucoma is considered, the failure rate the first year was 19%. After that, the failure rate was approximately eight per year. At the end of 5 years, 65% of all eyes had failed. At the end of 10 years, data were available on 84 of the original 109 treated eyes; in 80 treatment had failed, and four were still receiving medical therapy.

Choroidal invasion of retinoblastoma: metastatic potential and clinical risk factors.

There is considerable debate about the significance of choroidal invasion of retinoblastoma with regard to metastatic disease. The charts of patients with retinoblastoma were reviewed over a 17 year period to determine the frequency of histopathological choroidal invasion of retinoblastoma and its risk for eventual metastatic disease. Sixty seven of 289 eyes (23%) enucleated for retinoblastoma had histopathological evidence of choroidal invasion. Those patients with choroidal invasion (with or without optic nerve invasion) were more likely to develop metastases than those without choroidal invasion (p = 0.0001). When considering those patients with isolated choroidal invasion of retinoblastoma, excluding those with associated optic nerve invasion, there was no significant risk but there was a trend towards the development of metastases (p = 0.10). The clinical factors found to be predictive for choroidal invasion from retinoblastoma from a univariate analysis included increased intraocular pressure (p = 0.04) and iris neovascularisation (p = 0.007) and, from a multivariate analysis, iris neovascularisation (p = 0.02). The histopathological factors statistically associated with choroidal invasion included the presence of optic nerve invasion (p = 0.002) and poorly differentiated retinoblastoma (p = 0.003). Factors not predictive for choroidal invasion included the age, race, and sex of the patient and the tumour laterality, inheritance, size, and growth pattern. Choroidal invasion of retinoblastoma is a risk for metastases, especially if it is associated with any degree of optic nerve invasion.

Single intraoperative applications of 5-fluorouracil during filtration surgery: early results.

Experimental studies from our laboratory have suggested that single exposures to 5-fluorouracil (5-FU) would have a similar effect to subconjunctival injections of 5-FU and a less permanent effect on subconjunctival fibroblasts than mitomycin C (MMC). Thirty four eyes of 33 glaucoma patients with an increased risk of filtration surgery failure were treated with a single intraoperative 5 minute exposure of sclera and subconjunctival tissues to 5-FU, 25 mg/ml. The follow up period ranged from 3-9 months, during which two high risk eyes failed completely and one required topical beta blockers to control intraocular pressure. No low/moderate risk eyes failed. Single 5 minute intraoperative exposures to 5-FU are convenient, inexpensive, have no significant corneal side effects, and may be a useful adjunctive treatment to optimise the results of glaucoma filtration surgery, particularly in the large group of low/moderate risk patients.

Motion detection threshold and field progression in normal tension glaucoma.

Psychophysical tests may demonstrate abnormalities of visual function before the appearance of conventional visual field loss in glaucoma. Motion detection thresholds (MDT) were measured in the normal fellow eye of 51 patients with confirmed normal tension glaucoma and initially unilateral field loss. Humphrey visual fields from the initially normal eye covering a mean follow up of 3.4 years were assessed using pointwise linear regression analysis. In 22 of the 51 eyes with normal visual fields at presentation, field deterioration occurred at one or more Humphrey locations within a mean of 1.7 (SD 1.6) years. An initially abnormal MDT test showed a sensitivity of 73% and a specificity of 90% in predicting field deterioration within the cluster of four Humphrey locations closest to the original MDT test site. Sensitivity was lower (40%) in predicting progression at retinal locations distant from the MDT test site, though specificity remained high (90%).

[Iris neovascularization, increased intraocular pressure and vitreous hemorrhage as risk factors for invasion of the optic nerve and choroid in children with retinoblastoma]. / Irisneovaskularisationen, erhöhter Augeninnendruck und Glaskörperblutungen als Risikofaktoren für den Befall des Sehnerven und der Aderhaut bei Kindern mit Retinoblastom.

A review of 289 eyes enculeated for retinoblastoma to evaluate prognostic factors for involvement of the choroid or optic nerve revealed choroidal invasion in 67 eyes (22%) and optic nerve invasion in 84 eyes (27%) due to retinoblastoma. Intraocular pressure (IOP) > or = 22 mmHg was found in 85 eyes prior to enucleation. A total of 118 eyes (38% showed histopathologic evidence of the development of glaucoma: 90 of them with iris neovascularisation and 28 with angle closure configuration. Patients with elevated IOP, iris neovascularisation and angle closure configuration had a significantly higher risk of optic nerve (P < 0.005) and choroidal (P < 0.002) involvement. On the other hand, optic nerve invasion due to retinoblastoma was significantly more frequent in eyes with elevated IOP (P < 0.02) and iris neovascularisation or angle closure configuration (P < 0.01). Risk factors for choroidal invasion of retinoblastoma were raised IOP (P < 0.04) and iris neovascularisations or angle closure configuration (P < 0.01) (univariant analysis). Raised IOP, iris neovascularisations and vitreous haemorrhage remained significant in the multivariant analysis. This study emphases the importance of IOP, iris neovascularisation and angle closure configuration as risk factors for outspreading invasion due to retinoblastoma.

Argon laser trabeculoplasty controls one third of patients with progressive, uncontrolled open-angle glaucoma for five years.

This study demonstrates that ALT can provide a 5-year benefit to around one third of patients with glaucoma sufficiently severe and uncontrolled that filtration surgery is considered advisable. Whether or not this conclusion can be generalized to patients with earlier stages of glaucoma or better IOP control cannot be stated.

Long-term prognosis of eyes having had operative suprachoroidal expulsive hemorrhage.

We reviewed the charts of 15 patients having had an operative suprachoroidal expulsive hemorrhage (SEH) at least 5 years prior to the time of review. In all cases the eyes were glaucomatous. All SEH occurred in close association with the surgery, with 14 cases occurring at the time of surgery and 1 case developing within 2 days of the procedure. Three eyes were markedly worse following the SEH, losing six or more lines of vision; in all cases this loss was due to retinal detachment. In a fourth eye in which a retinal detachment occurred postoperatively, fair acuity (20/100) was preserved. The other 11 eyes not having retinal detachment had no further complications, though 6 eyes eventually lost acuity during the next 5-15 years; this loss was due to progressive glaucoma and/or macular degenerative change and did not appear to be a function of damage related to the SEH itself. Two eyes subsequently had uncomplicated cataract extraction resulting in visual improvement. When an SEH neither causes immediate loss of choroid or retina nor is associated with postoperative retinal detachment, the SEH itself may not damage the long-term clinical course of the affected eye.

Long-term results of ab externo neodymium:YAG cyclophotocoagulation.

Neodymium: YAG cyclophotocoagulation (CPC) was performed in 128 eyes of 123 patients with refractory glaucoma. In each eye, 40 burns delivered with energy of up to 7 J were placed 1.5 mm behind the limbus in a 360 degrees pattern. The minimal follow-up period was 24 months, with the mean being 36.9 (range, 24-84; SD, 5.8) months. The mean intraocular pressure was 35.0 (range 23-54; SD, 12.2) mmHg preoperatively, 20.6 (range 15-24; SD, 3.5) mmHg after 1 year, and 20.2 (range 12-24; SD, 8.1) mmHg after 2 years. A total of 25 eyes (19.5%) lost 2 or more lines in visual acuity. Success was defined as a lowering of intraocular pressure by > 30% and a decrease in visual acuity of < 2 Snellen lines. By this definition the success rate was 52.4%. There was no correlation with either the diagnosis, the stage of the disease, or the pigmentation of the trabecular meshwork, although patients with secondary traumatic or uveitic glaucoma tended to be less responsive to CPC. The most common acute complication of treatment was transient corneal edema. Phthisis bulbi developed in 1 eye (0.8%). In conclusion, CPC achieved satisfactory long-term control of intraocular pressure in the majority of patients with severe late-stage glaucoma.

Intraobserver and interobserver reproducibility of the Nidek EAS-1000 Anterior Eye Segment Analysis System.

The NIDEK EAS-1000 is a camera and computer system designed to facilitate measurement and analysis of the anterior segment of the eye. To evaluate the interobserver reproducibility of the system, three examiners assessed the anterior chamber depth and peripheral angle measurement in 20 disease-free eyes. Intraobserver reproducibility was determined by each investigator's photographing and analyzing the same eye on three different occasions. Interobserver correlation for the anterior chamber depth (using the first three readings of the same eye made by each examiner) was 0.97, with an 95% CI of 0.94 to 0.98. Interobserver correlation for angle measurement (again using the first three readings of the same eye made by each examiner) was 0.89, with a 95% confidence interval (CI) of 0.81 to 0.95. Intraobserver correlations for anterior chamber depth were 0.98 for each of the three examiners (mean, 0.98), wiht a 95% CI of 0.91 to 0.99. Intraobserver correlations for anterior chamber depth were 0.98 for each of the three examiners (mean, 0.98), with a 95% CI of 0.91 to 0.99. The intraobserver CI for angle measurement was 0.97 (range, 0.95 to 0.99). The intraobserver and interobserver reproducibility of the NIDEK EAS-1000 system was excellent.