High-frequency deep sclerotomy as adjunctive therapy in open angle glaucoma patients.

INTRODUCTION: Glaucoma is a chronic, progressive disease of the optic nerve that can cause vision loss and blindness. High-frequency deep sclerotomy (HFDS) is a novel ab interno procedure used to lower intraocular pressure (IOP). This study aims at examining hypotensive effects of HFDS in patients with medically uncontrolled primary open-angle glaucoma (POAG). METHODS: 23 patients (23 eyes) participated in this study. They were all affected by primary open-angle glaucoma and used maximum prescribed medical therapy. It is important to note that the target intraocular pressure (IOP) was not detected in any study participant. The target intraocular pressure is the highest IOP value at which no new damages of the optic nerve occur. The procedure was performed with a custom-made, high-frequency dissection probe by applying bipolar current of 500 kHz. Six pockets (1mm deep, 0.3mm high, and 6mm wide) were made ab interno in nasal sclera (through trabecular meshwork and Schlemm's canal). Tobramycin/dexamethasone and pilocarpine eye drops were administered postoperatively for a month. RESULTS: The mean value of the base intraocular pressure had been 25.6mmHg before the procedure. Significant complications were not recorded either during the surgery or in a post-operative follow-up period. The average IOP for our patients reduced by 8.6mmHG (33.6%) after a year. The mean value of the instilled anti-glaucoma eye drops had been 2.78 (SD=0.45) before the HFDS and 0.61 (SD=1.04) at the end of the research. The target IOP was not achieved in five cases (21.7% of our sample). DISCUSSION/CONCLUSION: This study presents the data on our first surgical experience with high-frequency deep sclerotomy that was conducted on 23 patients who had medically-uncontrolled, primary, open-angle glaucoma. The results indicate that HFDS is safe and efficient in reducing IOP.

Mirizzi syndrome--two case reports and a short review of the literature.

The authors have analyzed the problem of Mirizzi syndrome (MS) and found in the literature that it was reported in 0.3% to 3% of patients undergoing cholecystectomy. Anatomic disorder, especially the presence of cholecystocholedochal fistula, increases the risk of bile duct injury during cholecystectomy, albeit more often during laparoscopic than laparotomic cholecystectomy. A comparative study was performed regarding the incidence of MS in two groups of patients: 332 patients in Zrenjanin in the year 2009, and 531 patients in Belgrade in the year 2005, with an incidence of MS found in 2 patients in Zrenjanin (0.63%) and 4 patients in Belgrade (0.75%). The incidence rate was 6% in Zrenjanin and 7.5% in Belgrade, but there was no statistically significant difference between the two groups. All patients with MS were diagnosed during the operative period using operative cholangiography. During preoperative diagnosis, patients underwent laboratory ultrasound examination, and those who were suspected of having an anatomic disorder underwent operative cholangiography, although patients today more often undergo choledochoscopy then cholangiography. MS according to classification by Csendes was found in all 6 patients undergoing operation.

Hypotensive effect of selective laser trabeculoplasty in patients with medically uncontrolled primary open-angle glaucoma.

INTRODUCTION: Glaucoma is a chronic, progressive disease of the optic nerve which if left untreated can lead to blindness at end stages. A decrease of intraocular pressure (IOP) has proven to slow down the progression of the disease. IOP decrease can be achieved by medical, laser and surgical treatment. OBJECTIVE: The aim of this study was to evaluate the response of patients with medically uncontrolled primary open angle glaucoma to selective laser trabeculoplasty (SLT). METHODS: The study involved baseline characteristics recorded for each of 35 patients (48 eyes) in whom, despite being under full medication we could not achieve a satisfactory IOP. Patients, who had pressure above 25 mmHg under the maximal medication therapy, were not included into the study and were referred for surgical treatment. IOP was measured on admission, 1 hour, 7 days, 1, 3, 6 and 12 months after SLT. We considered satisfactory surgical result if IOP was decreased more than 20% of the initial value. Also, we investigated the influence of baseline IOP on SLT outcome after 12 months. Patient inclusion criteria were inability to reach target IOP with maximal medical therapy. Exclusion criteria were congenital glaucoma, any type of angle closure glaucoma, advanced-stage glaucoma, eyes with previous laser or surgical glaucoma applications and patients with baseline IOP > 25 while fully medicated. Patients who could not be followed for at least 12 months were also excluded. RESULTS: The mean age of our patients was 73 ± 12 years. The mean baseline IOP was 20.48 mmHg (SD = 1.91), and the mean change in IOP from baseline of the treated eye after one year was 4.47 mmHg (SD = 2.12). In eyes with a higher baseline IOP the reduction of pressure at the end of the study was significantly higher. Satisfactory effect of IOP reduction after one year was achieved in 64.58% of eyes. The IOP reduction did not show to be dependent as regarding age and gender. CONCLUSION: SLT effectively lowers IOP in patients with primary open-angle glaucoma, and the intervention is not followed by significant complications. Our results confirm that the IOP reduction is more significant if the initial value is higher. Our first reliable results of IOP reduction were confirmed one month after the procedure so that the procedure should not be repeated before one month has elapsed.The study is limited by a small number of eyes, which is insufficient to make a complete case analysis.