Comparison of outcomes of trabeculectomies using 0.4 mg/ml versus 0.2 mg/ml concentrations of mitomycin-C

Methods: A prospective, randomized, comparative study was performed involving patients undergoing trabeculectomy who were randomly assigned to either 0.2 mg/ml MMC for 4 minutes or 0.4 mg/ml for 2 minutes. The IOP, bleb characteristics, and occurrence of complications were compared. Age and gender of the patients, preoperative IOP, MMC concentration, bleb characteristics, angle status, and age of the surgery were analyzed to determine if they are predictive factors of the postoperative IOP using univariate and multivariate analyses. Results Seventy-four eyes of 68 patients underwent trabeculectomy: 36 eyes were treated with 0.2 mg/ml MMC for 4 minutes and 38 eyes with 0.4 mg/ml MMC for 2 minutes. There was no statistically significant difference in the mean preoperative IOP and postoperative IOP, as well as in the mean percent change in IOP (p = 0.87) between the 2 groups. Univariate and multivariate analyses showed the preoperative IOP (p = 0.02) and the type of filtering bleb (cystic p < 0.001; diffuse p = 0.045) as predictive factors of postoperative IOP. KaplanMeier survival curves showed no significant difference between the 2 groups at an average follow-up of 20 weeks. Conclusion: There is no significant difference in the outcomes of trabeculectomies using 0.2 mg/ml and 0.4 mg/ml MMC. Preoperative IOP and bleb characteristics are factors predictive of successful filtration surgery.

Correlation of central corneal thickness and Goldmann applanation tonometry among Filipinos

Methods: A prospective cross-sectional study was performed among Filipino patients consulting at the General Ophthalmology Clinic of the Philippine General Hospital. They underwent a comprehensive eye examination. CCT obtained by ultrasonic pachymetry and IOP by Goldmann applanation tonometry were correlated using linear regression analysis. Factors affecting CCT measurements were analyzed by ANOVA. Results: Two hundred twenty two eyes of 112 patients were included in the study. CCT ranged from 451.0 mm to 653.6 mm with a mean of 531.5 mm +/- 33.8 mm. There was a significant linear correlation between CCT and IOP (r=0.63). The IOP was noted to rise by 4.3 mm Hg/100 mm CCT. Conclusion: The CCT among Filipinos is normally distributed and is comparable to the distribution obtained by metaanalysis of worldwide data. The study also found a direct correlation between CCT and IOP among Filipinos.

The cost-effectiveness of management of Filipino patients with chronic primary glaucoma in a tertiary charity hospital setting

Chronic primary glaucoma affects sight very quietly - until such time that the progression of the disease is considerably advanced. The search for the ideal therapeutic approach to the disease can only provide, at best, for the arrest of the damage to the optic nerve head by bringing down the intraocular pressure to a level low enough to elude harm. Patients afflicted with the disease are bound to a therapy of a lifetime. This has implications of understated proportions in the economic scenario of a developing country. This study is conceived to determine the cost-effectiveness of chronic primary glaucoma management. A cross-sectional study design is employed to answer this objective. Medical records of 290 study eyes of 148 patients with chronic primary glaucoma (aged 14 - 88 years) are evaluated for cost-effectiveness of therapy. Results have shown that on one hand, medical therapy has a mean annual cost of PhP 5,830.00 + 278.00. On the other hand, surgical therapy has a one-time mean annual cost of PhP 8,100.00 + 359.00.Comparing cost-effectiveness using analysis of covariance (ANCOVA), one finds that filtering surgery is at least twice more cost effective than medical management (p0.001). Surgical complications, however, may hamper the effectiveness of filtering surgery. The study recommends that young patients with advanced disease and with higher IOP at the time of consult could be served more efficiently with a filter, whereas elderly patients approaching their life expectancy who can comply with the demands of effective medical management may not benefit much from it.

Wound strength of experimental corneal perforations sealed with fibrin glue in cadaver porcine eyes

Objectives: This is a study to determine the relative wound strength of a commercial fibrin tissue adhesive (Beriplast P, Aventis Behring) compared to 10-0 nylon sutures in sealing experimentally induced corneal perforations in cadaver porcine eyes. Methodology: Single Blind Completely Randomized Design. Sixty freshly enucleatedporcine eyes with an average corneal diameter of 11.5 mm were used. These were randomly allocated into the 3.2 mm perforation group (n = 30) and the 5.2 mm perforation group (n = 30). All perforations were made perpendicular to the corneal surface with a standard preset metal keratome at the central portion of the cornea. Fifteen corneal perforations in each group were again randomly sealed with either interrupted nylon 10-0 sutures or Beriplast P (65-115 mg/mL). Intraocular pressure was raised by injecting normal saline into the anterior chamber and determined by a manometer attached to it. The presealing and postsealing leaking pressures were recorded. Wound leak was determined by Seidels test Results: The mean leaking pressure of the 3.2 mm group sealed with nylon suture was 237.47 mm Hg and 237.33 mm Hg for those sealed with fibrin tissue adhesive. The mean leaking pressures of the 5.2-mm group was 1984 mm Hg for both sealing techniques. The difference in leakingpressures of both sealing techniques was not significant using a power of 80 percent to detect a difference of 30 mm Hg Conclusion: The wound strength of corneal perforations sealed with fibrin tissue adhesive, as measured by the leaking pressures, is comparable to that of those sealed with nylon 10-0 sutures in cadaveric porcine eyes. (Author)

Latanoprost in the management of angle closure glaucoma

Objective: To investigate the effect of latanoprost in IOP after laser iridectomy or filtering surgery Methodology: Patients of chronic angle closure glaucoma post laser iridectomy or filtering surgery were given latanoprost 0.005 percent eye drop in the evening for 2-6 weeks after a washout period ranging from 5 days - 28 days. IOP was measured at 9:00 a. m., 1:00 p.m. and 5: 00 p.m. per patient using a calibrated goldmann applanation tonometer Results: 29 patients were enrolled in study. There was a significant reduction in IOP among these patients Conclusion: Latanoprost 0.005 percent provides a significant reduction in IOP among patients with residual angle closure after laser iridectomy or filtering surgery. (Author)