Intraocular pressure measurements by three different tonometers in children with aphakic glaucoma and a thick Cornea

Background: To evaluate the agreement in intraocular pressure [IOP] measurements by Ocular Response Analyzer [ORA] and Tono-Pen XL [TXL] with the Goldmann Applanation Tonometer [GAT] and to examine corneal biomechanical properties in aphakic glaucoma patients with a central corneal thickness [CCT] >600 micro

Methods: Thirty-six eyes of aphakic glaucoma patients [group 1] and 40 eyes of normal children [group 2] were studied. The mean ORA and TXL IOP values were compared with the GATIOP values. Regression analyses were used to evaluate the associations between IOP and CCT, corneal hysteresis [CH], and corneal resistance factor [CRF]. Bland-Altman plots were used to evaluate the agreement between the tonometers

Results: The mean +/- standard deviations of the age and male/ female ratio were 16.58 +/- 5.44 and 15.75 +/- 5.04 years and 14/22 and 18/22 in group 1 and group 2, respectively. CCT in group 1 was 651.1 +/- 42 and in group 2 was 567.3 +/- 32.4. In group 1, the mean TXL [22.4, P=0.004], IOPcc [corneal compensated] [27.8, P=0.005], and IOPg [Goldmann correlated] values [28.1, P<0.0001] were greater than GAT-IOP [20.6]. In group 2, only IOPg value [16.4] was higher than GAT-IOP [14.8, P=0.04]. IOP reading of all the tonometers were positively and negatively associated with CRF and CH in the multiple regression analysis, respectively

Conclusion: The TXL had a greater agreement with the GAT, and the ORA overestimated IOP in aphakic glaucoma patients. The ORA and TXL seemed to be affected by CH and CRF

Gonioscopic features in patients with acute and chronic angle-closure glaucoma

A number of ocular biometric parameters, iris hiotologic and anatomic characters have been suggested as inciting factors for converting patients with narrow angle to angle-closure glaucoma. This study was conducted to determine if there was any goniscopic difference between patients with acute angle-closure glaucoma [AACG] and chronic angle-closure glaucoma [CACG]. The study is a retrospective analysis of the charts of 97 patients with asymmetric CACG and 15 patients with unilateral AACG. The age, sex, type of glaucoma, gonioscopic findings and optic nerve head cup/disc ratio were recorded for all patients. Dynamic gonioscopy and Spaeth's convention were used to grade the drainage angle. The eyes with AACG or more optic nerve damage in CACG groups were considered as involved eye, and the contralateral eyes in the AACG and CACG groups were considered as noninvolved and less-involved, respectively. There was no significant difference between patients with AACG and CACG in terms of age, gender, refraction, and laterality of the involved eyes. In intragroup analysis, no significant difference was observed for distribution of iris attachment, irido-corneal angle, iris configuration, or trabecular pigmentation. In intergroup analysis, the superior iris was attached more anterior in the involved eyes of AACG compared to that in CACG [P=0.007]. Moreover, the iris root attachment was also more anterior in both the superior [P=0.001] and inferior [P=0.002] angles of the noninvolved eyes of AACG vs. than those in the less-involved eyes of CACG group. The findings of the study indicate that there is no significant difference between the eyes with AACG or CACG in terms of goniscopic findings. However, the superior iris attachment was located more anterior in eyes with AACG compared to that in eyes with CACG

effect of addition of low dose atracurium to local anesthetic in retrobulbar block for cataract surgery

Addition of some neuromuscular blockers to local anesthetics proved to be effective in improving the quality of anesthesia in different regional techniques. This study was carried out to determine whether the addition of low-dose atracurium to a local anesthetic has any effect on the onset and duration of akinesia in retrobulbar block. This study was conducted on sixty-four unpremedicated, ASA I or II patients scheduled for cataract surgery under local anesthesia. The patients were assigned to one of the two treatment groups in a randomized, double-blind manner. The case group received 2 ml of 2% lidocaine [40 mg] and 0.5 mL atracurium [5 mg]. The control group received 2 ml of 2% lidocaine [40 mg] and 0.5 ml 0.9% NaCl. The onset of akinesia [the inability to move the eye in all four directions] was scored as 0 to 2: 0, no akinesia; 1, partial akinesia; and 2, complete akinesia. The onset and duration of akinesia and also adverse effects and complications of each method were recorded throughout the study. In 4 out of 64 patients, complete akinesia was not achieved and statistical analysis was done on 60 others with complete akinesia. With regard to age, sex, weight, and duration of the surgery, there were no significant differences between the case and control groups. The onset of complete akinesia was quicker and duration longer in the case group than in the control group. The onset of complete block was 4.7 +/- 1.1 minutes in the case group and 6.9 +/- 0.96 minutes in the control group [P<0.001]. The duration of akinesia was 104.07 +/- 17.6 minutes in the case group and 87.1 +/- 16.2 minutes in the control group [P<0.001]. This study demonstrated that atracurium had a local action on the extraocular muscles. It shortened the onset period of retrobulbar block, prolonged its duration, and provided excellent surgical conditions without any specific complications

simple way to achieve the routine position for phacoemulsification in a patient with marked thoracic kyphosis

To introduce a simple way for achieving the routine position for phaco-emulsification in a patient with a marked thoracic kyphosis. A 74-year-old man with marked thoracic kyphosis and visually significant cataracts presented for surgery; he was unable to lie flat due to the severe deformity. The best possible surgical position was achieved by placing a chair with an adjustable top between a standard operating table and another small table. The wheels of the table and the chair were securely immobilized by adhesive tape. The space between the operating table and the small table was filled with rolled towels and covered with a blanket. The patient lay down with his head placed on the small table while the kyphotic portion of his thorax fitted into the free space between the small table and the operating table. The variable top of the chair allowed adjusting the space in order to accommodate his kyphotic thorax. Successful temporal approach phacoemulsification was performed comfortably while the patient lay in the standard position required for cataract surgery. It is possible to position patients with thoracic problems on a standard operating table using readily available equipment in the operating theater

Aqueous humor levels of soluble fas and fas-ligand in patients with primary open angle and pseudoexfoliation glaucoma

Glaucoma is one of the most common causes of blindness and is usually associated with elevated intraocular pressure. In patients with primary open angle glaucoma the number of trabecular meshwork cells is decreased. Death of the trabecular meshwork cells may be a result of apoptosis. To investigate the aqueous humor levels of soluble Fas [sFas] and Fas-Ligand [sFasL] in glaucomatous patients. Concentration of sFas and sFasL were measured by ELISA in 41 eyes with glaucoma [21 with pseudoexfoliation and 20 with primary open angle glaucoma] and 39 eyes with cataract as controls. The sFas concentration was lower in the primary open angle than the pseudoexfoliation glaucoma and the cataract groups [p=0.002 and p= 0.004, respectively]. The sFasL level did not show any significant difference in the three groups. A lower level of sFas may provide proper microenvironment for increased apoptosis of trabecular meshwork cells in primary open angle glaucoma

Aqueous levels of anti-hekicobacter pylori IgG antibody in patients with primary open angle and pseudoexfoliation glaucoma

Glaucoma is a progressive optic neuropathy and is one of the leading causes of blindness worldwide. Different factors have been contributed in the pathogenesis of glaucoma including H. pylori infection. To determine the levels of anti-H. pylori IgG antibody in the aqueous humor of patients with pseudoexfoliation and primary open angle glaucoma, in comparison with age and sex matched cataract patients. This study was conducted on 41 cases of glaucoma [21 with pseudoexfoliation and 20 with primary open angle glaucoma] and 39 cases of cataract as control group. Aqueous humor was aspirated at the beginning of glaucoma or phacoemulsification cataract surgery in glaucoma and cataract patients, respectively. Anti-H. pylori IgG concentration was measured by means of an enzyme- linked immunosorbent assay. Results: The aqueous levels of anti-H. pylori IgG in primary open angle glaucoma [0.44'0.64 U/ml] had no significant difference with cataract [0.24 +/- 0.52U/ml] and pseudoexfoliation glaucoma group [0.63 +/- 0.71U/ml] [P=0.18 and 0.44, respectively]. However, the concentration of this antibody was higher in the aqueous humor of pseudoexfoliation glaucoma patients compared to the control group [p=0.03]. The results of this study did not support a relation between H. pylori infection and primary open angle glaucoma. The elevated concentration of anti-H. pylori IgG in pseudoexfoliation glaucoma compared to cataract patients may be due to the breakdown of blood-aqueous-barrier

Outcomes of single-plate molteno implants in refractory glaucoma

To evaluate the success rate and complications of single-plate Molteno tube implantation in patients with intractable glaucoma. We reviewed the records of patients who had undergone single-plate Molteno tube implantation from 1995 to 2000 with at least 18 months of follow up. Thirty-six eyes of 35 [20 male and 15 female] patients with mean age of 29.7 +/- 25.3 [range 3-77] years were enrolled in the study. Preoperative intraocular pressure [LOP] was 34.5 +/- 10,4 mmHg with a mean of 2.3 +/- 0.8 medications which decreased to 18.0 +/- 7.6 mmHg with 1.9 +/- 1.2 medications after 32.8 +/- 161 months of follow up [P<0.0001]. Complete success [IOP: 7-21 mmHg without medications], incomplete success [IOP: 7-21 mmHg with medication] and total success [sum of complete and incomplete success] rates were 19.5%, 55.6%, and 75%, respectively. At final follow up, visual acuity improved 1 line in 10 [27.8%], decreased >/= 1 line in 8 [22.2%] and remained unchanged in 18[50%] eyes. Postoperative complications occurred in 20 eyes [55.6%] including encapsulated bleb in 10 eyes [27.8%], tube-iris touch in 4 [11%], flat anterior chamber in 3 [8.4%], tube-cornea touch in 2 [5.6%], and retinal detachment, tube-lens touch, and tube blockage, each in 1 [2.8%]. IOP dropped to zero in one eye resulting in visual loss. In eyes at high risk for trabeculectomy failure, implantation of the Molteno tube can be considered as a procedure with acceptable success for control of IOP and preservation of vision. Long term follow-up is recommended to ensure timely management of the frequent complications of this procedure