The Effect of Contact Transscleral Nd:YAG Laser C yclophotocoagulation in Refractory Glaucoma

We observed the change of intraocular pressure(IOP)and the complications after contact transscleral cyclophotocoagulation with Neodymium:YAG (Nd:YAG)laser for the refractory glaucoma patients. Refractory glaucoma in twenty eyes was treated with contact transscleral continuous-wave Nd:YAG laser cyclophotocoagulation with a sapphire-tipped probe. Using 7W of power for 0.7 seconds with 32 applications and intraocular pressure(IOP) was measured at 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months and 6 months, postoperatively. The intraocular pressure(IOP)decreasing rate was 62% and the success rate was 60%at 6 months postoperatively. It is suggested that contact transscleral cyclophotocoagulation with Nd:YAG laser is useful in lowering IOP in refractory glaucoma patients.

Complications of Hydroxyapatite Orbital Implants (A Review of 110 Consecutive Cases)

There are many clinical reports on implant exposure as a complication of hydroxyapatite orbital implantation, but relatively small number of reports have concerned full range of complications that can occur with hydroxyapatite orbital implants. The authors analyzed all the complications associated with the 110 hydroxyapatite orbital implants performed by one surgeon at the department of ophthalmology, Presbyterian Medical Center between January 1993 and June 1998, and discussed the management and progression of them. There were 8 kinds, 40 cases of soft tissue problems, 3 kinds, 20 cases of eyelid problems, and 7 kinds, 27 cases with prosthesis and pegging.Most of them were improved with conservative management and surgical treatments were required in 2 cases with conjunctival wound disruption, 5 cases with implant exposure, 3 cases with overgrowth of subconjunctival granulation tissue, 3 cases with ptosis, 1 case with eyelid laxity, 2 cases with peg extraction, and 4 cases with poor peg position. Surgeons and patients who want to use hydroxyapatite as an orbital implant would be more satisfied with thorough knowledge on many possible complications and their etiology, proper prevention and management.

A Case of Late Onset Bleb-Related Endophthalmitis after Trabeculectomy with Mitomycin C

Adjunctive use of Mitomycin C (MMC)in trabeculectomy has greatly improved the success rate. Trabeculectomy with MMC, however, has resulted in a cystic and thin-walled filtering bleb, which may be more susceptible to infection. Late onset bleb-related endophthalmitis developed in a glaucoma patient at 40 months after MMC trabeculectomy. Filtering bleb in this patient had been avascular, thin-walled and cystic prior to the occurrence of endophthalmitis. Patient complained of decreased visual acuity with ocular discomfort and conjunctival injection and showed a mucopurulent infiltrate within the bleb, hypopyon and vitritis. Visual acuity was hand motion. An intensive treatment included anterior chamber irrigation, lensectomy,par plana vitrectomy, intravitreal and subconjunctival antibiotics (vancomycin,gentamycin) injection and topical and systemic corticosteroid (dexamethasone) and antibiotics,which led to a resolution.