Short-term effects of neodymium-YAG transscleral cyclocoagulation in patients with uncontrolled glaucoma.

Transscleral Nd-YAG cyclocoagulation has been reported to lower intraocular pressure (IOP) in animals, eyes and more recently in human eyes. We treated 14 patients with uncontrolled IOP using this technique. Three patients were lost to follow-up. The mean follow-up time was 12 (SD 2.6) weeks. There was a decrease in IOP in all patients. Seven had final IOP readings less than or equal to 25 mmHg (63.6%). Six patients had IOP less than or equal to 21 mmHg (54.5%). Fairly severe complications occurred in most patients. None, however, developed phthisis bulbi. Two patients had one treatment (18%), eight patients had two treatments (72%), and one patient had three treatments (9%). This preliminary study confirms that Nd-YAG cyclocoagulation effectively lowers IOP in patients with uncontrolled glaucoma over the short term.

Ocular leukemia in King Abdulaziz University Hospital - Jeddah.

To the best of our knowledge, ocular leukemia has not been reported in Saudi Arabia. Seventy-two leukemia patients were seen in King Abdulaziz University Hospital in Jeddah over the last 10 years. Thirty-one of those patients had an ocular examination. Seventeen of these were found to have ocular abnormalities related to leukemia. Ten had acute lymphoblastic leukemia, four had acute myeloid leukemia and three had chronic myeloid leukemia. The retina and vitreous were involved in 12 of the ocular relapses, the anterior segment leukemic infiltrate in nine, glaucoma in five, opportunistic infection in four, cranial nerve palsies in three, proptosis and hypotony in two. Conjunctival hemorrhage, choroidal infiltrate and cataract were present in one relapse each. The optic nerve was involved in nine relapses, which is a serious condition that requires immediate intervention to save the patient's sight. Computed tomography (CT) scan of the brain and orbit was useful in differentiating between optic nerve infiltrate and papilledema. Most ocular relapses responded well to chemotherapy except relapses with optic nerve and anterior segment infiltrate, which required irradiation to save the patient's sight and prevent further relapses. In conclusion, the presented data have shown that ocular leukemia is not rare and emphasizes the importance of early ophthalmologic examination and radiation.

Primary angle closure glaucoma and retinitis pigmentosa.

The prevalence of primary open angle glaucoma in patients with retinitis pigmentosa ranges from 2-12%. To the best of our knowledge the prevalence of primary angle closure glaucoma in retinitis pigmentosa patients has not been reported. This study was conducted to determine the prevalence of primary angle closure glaucoma in patients with retinitis pigmentosa and the relationship between the two. We reviewed 538 retinitis pigmentosa patients' charts seen between 1974-1987, in the Ocular Genetic Clinic in the Hospital of Sick Children, Toronto, Canada. The prevalence of primary angle closure glaucoma in our retinitis pigmentosa patients over 40 was 1.03%. We also reviewed three patients with primary angle closure glaucoma and retinitis pigmentosa. One patient had typical bilateral retinitis pigmentosa, one patient had bilateral sector retinitis pigmentosa, and one patient had unilateral retinitis pigmentosa and primary angle closure glaucoma in the same eye. Our data indicate that there is a strong association between retinitis pigmentosa and primary angle closure glaucoma.

Neodymium: YAG transscleral cyclocoagulation in human eyes.

Transscleral neodymium: YAG (Nd:YAG) cyclocoagulation has been successfully used to lower intraocular pressure (IOP) in rabbits. The authors treated 24 patients with uncontrolled glaucoma using the thermal mode of the Nd:YAG laser. The patients were followed for a mean of 8.8 months. A total of 62.5% of treated eyes achieved an IOP on last follow-up of 25 mmHg or less. The mean pretreatment pressure was 47.2 mmHg and the mean posttreatment pressure was 25.7 mmHg (P = 0.009). The complications and potential clinical usefulness of this mode of therapy are discussed.

Leukemic infiltrate versus anterior uveitis.

Anterior segment leukemic infiltrate (ASLI) is rare; it is found in 0.5% to 2.5% of all leukemic relapses. Its clinical manifestations, at times, are similar to those of anterior uveitis (AU). We report the cases of three patients, all of whom had ASLI as their primary manifestation of relapse. We observed some major clinical differences between ASLI and AU that may help differentiate these two conditions without using anterior chamber paracentesis and/or iris biopsy. The development of resistance to leukemic therapy is the major factor in treatment failure.