Combined clear cornea phacoemulsification in the treatment of pseudoexfoliative glaucoma associated with cataract: significance of trabecular aspiration and ab interno trabeculectomy.

BACKGROUND: In the present study, the effectiveness of combined cataract surgery and ab interno trabeculectomy (Trabectome) in exfoliation glaucoma (PEX) was compared with combined cataract surgery and trabecular aspiration. METHODS: In this retrospective comparative cohort outcome study, 27 consecutive patients (mean age 73.41 years ± 10.78) in group 1 suffering from visually significant cataract and PEX glaucoma (mean preoperative IOP 23.41 mmHg ± 5.86) were treated with phacoemulsification combined with Trabectome; and 28 consecutive patients (73.83 years ± 8.94) were treated with phacoemulsification combined with trabecular aspiration (mean preoperative IOP 22.22 mmHg ± 6.33). The intraocular pressure (IOP) and the number of antiglaucoma eyedrops before and after surgery were evaluated. RESULTS: Examinations were performed prior to surgery, 1 day, 6 weeks, 3 months, 6 months, and 1 year after surgery. In both groups there was a statistically significant decrease in postoperative IOP during the whole follow-up period. Comparing the two groups, there was a statistically significant lower IOP in the Trabectome group 1 day (p = 0.019), 6 months (p = 0.025), and 1 year (p = 0.019) after surgery. Between the two groups, there was no statistically significant difference in the number of antiglaucoma eyedrops at any time. CONCLUSIONS: Both procedures have the ability to significantly lower the postoperative IOP during the first year. However, clear cornea phacoemulsification combined with Trabectome seems to be more effective in IOP reduction in cases of PEX glaucoma associated with cataract.

Intraocular antibody synthesis against rubella virus and other microorganisms in Fuchs' heterochromic cyclitis.

INTRODUCTION: Fuchs' heterochromic cyclitis (FHC) is a common intraocular disease of uncertain etiology that has recently been related to rubella virus (RV) infection. METHODS: We investigated the synthesis of RV-specific IgG using aqueous humor and serum samples from 63 consecutive patients with FHC. In addition, intraocular immunoglobulin G production against herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV) and toxoplasma gondii was determined. In 20 patients, the detection of RV RNA was additionally performed by RT-PCR on the E1 gene. Forty-six patients with HSV- and VZV-associated uveitis, HLA B-27 positive anterior uveitis, and Posner-Schlossman syndrome served as controls. RESULTS: Specific intraocular antibody synthesis against RV was confirmed in all 63 FHC patients, whereas none of the 46 controls was positive for RV IgG. Interestingly, in 11 patients with positive RV IgG synthesis, additional HSV (eight), VZV (one) and CMV (two) specific antibodies could be detected. Only twice was viral RNA detectable by PCR in a patient with FHC. CONCLUSIONS: In this largest reported series of FHC patients, we detected a strong association between FHC and intraocular antibody synthesis against rubella virus. Furthermore, in 11 patients, it was possible to confirm an additional intraocular antibody synthesis, in particular HSV. PCR-positive results in the aqueous humor were exclusively obtained for RV. In contrast to other studies, the RV genome could only be identified in two patients (10%).

Adverse effects and short-term results after selective laser trabeculoplasty.

PURPOSE: To evaluate the risk of adverse effects and to demonstrate short-term results after selective laser trabeculoplasty (SLT) in glaucoma patients. METHODS: Sixty-four eyes of 64 patients with primary open-angle glaucoma, not sufficiently treated with local antiglaucomatous therapy, were included in this prospective study. Intraocular pressure (IOP), anterior chamber cells, anterior chamber flare, and vitreous haze (according to the Standardization of Uveitis Nomenclature Working Group) were examined before SLT, for 24 hours, 14 days, 6 weeks, and 3 months after laser. Furthermore, macular thickness measurements in 9 Early Treatment Diabetic Retinopathy Study subfields, including central subfield, measured by Spectralis OCT were performed. The differences between prelaser and postlaser values were obtained. RESULTS: The average of mean preoperative IOP measurement was 19.1±3.972 mm Hg compared with 12.9±2.513 (P<0.001), 13.2±3.331 (P<0.001), 14.1±2.731 (P<0.001), and 13.9±2.922 mm Hg (P<0.001) 24 hours, 14 days, 6 weeks, and 3 months post-SLT, respectively. The central subfield preoperatively was 278.14±74.355 µm compared with 277.14±71.461 (P=0.177), 277.14±71.461 (P=0.354), 287.34±74.363 (P=0.414), and 257.45±68.431 µm (P=0.214) 24 hours, 14 days, 6 weeks, and 3 months after treatment. Anterior chamber cells, anterior chamber flare, and vitreous haze were not denoted at any time of examination. CONCLUSIONS: In this study, no significant increase in macular thickness and no other adverse effects were present. Furthermore, SLT was found to significantly lower IOP in glaucoma patients in addition to local therapy. In conclusion, SLT has a good ability to reduce IOP with a minor risk of adverse effects.

Influence of prostaglandin analogue on outcome after combined cataract surgery and trabecular aspiration in pseudoexfoliative glaucoma.

PURPOSE: The aim of this study was to analyze the postoperative outcome and risk profile after combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma (PEX) associated with cataract. 
 METHODS: In this retrospective study, 69 eyes of 60 patients with visually significant cataract and PEX were treated with small-incision cataract surgery combined with trabecular aspiration. The intraocular pressure (IOP), number of antiglaucoma eyedrops before and after surgery, as well as complications were measured at all postoperative visits (1 day, 7 days, 6 weeks, 6 months, 12 months). 
 RESULTS: There was a statistically significant decrease in postoperative IOP during the follow-up period. There was no significant difference in the number of medications being used after 6 weeks follow-up. Six months and 12 months after surgery, the number of antiglaucoma eyedrops decreased significantly. Complications were fibrinotic iritis in 4 eyes (5.9%), cystoid macular edema in 3 eyes (4.4%), and hyphema in 1 eye (1.4%). Fibrinotic iritis and macular edema were present in only 37 of 69 eyes that were treated with prostaglandin analogues.
 CONCLUSIONS: Small-incision cataract surgery combined with trabecular aspiration in cases of PEX associated with cataract is effective in IOP reduction over a 1-year follow-up. Prostaglandin analogues may increase the risk of postoperative macular edema and fibrinotic iritis. Preoperative medication exchange may be considered.