Primary glaucomas: current concepts and management.

Glaucoma is a leading cause of blindness. Delay in diagnosis of open angle glaucoma (OAG) results from lack of symptoms. In angle closure glaucoma (ACG) there is often neglect of symptoms. Creating awareness about the disease and screening the high risk groups would reduce the burden of irreversible blindness due to glaucoma. Adequate therapy in the form of drops, lasers and surgery is available. Close interaction with the physician is important as many topical antiglaucoma medications have adverse systemic side-effects and many drugs used for systemic diseases raise the intra-ocular pressure (IOP). All drugs currently available for glaucoma lower IOP but new drugs for neuroprotection may change the future management strategies. While drugs and surgery are the mainstay for OAG, laser iridotomy is the definitive treatment for ACG.

The role of artificial drainage devices in glaucoma surgery.

The use of artificial drainage devices (ADDs) or "setons" in glaucoma surgery is generally restricted to patients with refractory glaucoma at high risk for failure from conventional filtration surgery. ADDs, both valved and nonvalved are currently available in this country. Recently, some of these devices have been propogated as primary treatment even for primary glaucomas. This article examines the role of ADDs in the modern management of the glaucomas. Specific indications for ADDs and methods to reduce the complication of overfiltration are discussed. The use of antimitotics, such as 5-fluorouracil or mitomycin, with traditional filtration has decreased the indications for ADDs. The literature and our experience confirm that currently there is no role for use of ADDs as a primary procedure in most glaucomas.

A modified technique of anterior peribulbar anaesthesia.

A modified technique of peribulbar anaesthesia consisting of a single injection of anaesthetic solution with a 26G, half inch insulin needle was evaluated in 50 eyes. The operative procedures included extracapsular cataract extraction with intraocular lens implantation in 20 eyes, intracapsular lens extraction in 20 eyes, and trabeculectomy in 10 eyes. Complete anaesthesia was obtained in 45 eyes (90%). No significant complications were observed except for mild to moderate conjunctival chemosis in 40 eyes (80%). The technique is easy to learn, safe, effective and relatively economical.

Medical and socio-economic aspects of long term therapy of open angle glaucoma.

Hundred patients of open angle glaucoma (OAG) who were on any one of the three drugs pilocarpine, timolol and epinephrine--for an average period of 3.3 years were chosen. Proforma regarding socio-economic status and the patients' reaction to long-term medication were recorded. Though the objective and subjective effects of long term medication were negligible the financial constraints were considerable. More than 70% patient would prefer laser's and surgery because of the cumbersome schedule and financial burden. The visit to the clinic was a time consuming process suggesting a lack of adequate glaucoma follow-up at the peripheral level. The study reflects a need for reorientation of glaucoma management.

The additive influence of nevus flammeus and the nevus of Ota on congenital glaucoma.

Nevus flammeus and nevus of Ota are commonly encountered dermatological conditions, but both individually, are only occasionally associated with glaucoma. The occurrence of isolated nevus flammeus along with nevus of Ota in the same patient is also extremely rare. We are presenting two unusual cases, both having a nevus of Ota, together with nevus flammeus and severe congenital glaucoma.

Secondary juvenile glaucomas in India.

A comparative retrospective study of 164 cases of juvenile secondary gla as presenting to the glaucoma service in 1984 and 100 cases in 1988, to the changes brought about by health education and innovations in ophthalmic care is undertaken.

Argon laser iridoplasty: a primary mode of therapy in primary angle closure glaucoma.

Argon laser iridoplasty was performed in 40 eyes of 33 patients of primary angle closure glaucoma. There were 12 male and 21 female patients. The mean ages of the male and female patients were 51 years and 48.4 years respectively. Forty eyes were divided into two groups. Group I consisted of ten eyes of subacute angle closure glaucoma and group II included thirty eyes of chronic angle closure glaucoma. Argon laser iridoplasty was performed with Coherent 9000 model using laser settings of spot size 200 micron, duration 0.2 second and power 0.7 watt. A total of 80 spots were applied over 360 degree circumference. The intraocular pressure control (below 22 mm Hg) was achieved after iridoplasty in all the eyes (100%) in group I, where as in group II the intraocular pressure was controlled in 70% eyes. The follow up period varied from 3 months to one year with a mean of eight months. The success rate with iridoplasty was directly related to the extent of peripheral anterior synechiae, optic disc cupping and presence of visual field changes.

Role of 5 fluorouracil in the management of failed glaucoma surgery.

Filtering surgery for glaucoma usually controls the intraocular pressure adequately. However, in glaucoma patients with aphakia, neovascularisation of iris, previous failed filtering surgeries and relatively young patients, results of surgery leave much scope for improvement. Most failures of filtering surgery are related to extra-ocular factors. Histopathological studies of eyes after failed filtering operations have suggested that proliferation of fibroblasts and deposition of collagen constitute a barrier to filteration. There is also a positive correlation between success of filtering surgery and inhibition of fibroblast growth by the patients aqueous humour. Thus agents inhibiting fibroblast proliferation should play an important role in increasing the success rate of filtering surgery. 5 Fluorouracil is a pyrimidine analogue which has been utilised for over 15 years as an antimetabolite in cancer therapy. Its efficiency in inhibiting fibroblast proliferation in vitro and in rabbit eyes has been proved beyond doubt. We undertook a pilot project to estimate the efficiency of the subconjunctival 5 FU to increase the changes of success in problematic cases of glaucoma in pigmented eyes.

Microsurgical instruments and their care.

The microsurgical instruments should be chosen such that they are less than 10 cm long, made of titanium, dulled, have very little closing pressure and the working parts do not open more than 10mm. They should be cleaned with ultrasonic cleaners and sterilised preferably by Ethylene oxide, though Cidex and dry heat can also be used.

Assessment of visual evoked response in chronic simple glaucoma.

1. The largest number of VEP abnormalities were found in check size 16 and alterate 1.88 cycles/sec. 2. With check size 32 and alt/sec. 1.88. (a) Delayed latency (BA) was found in 18.2% eyes without field defect (statistically nearly significant). (b) Delayed latency (BA) was found in 38.5% eyes with field defect (statistically significant (P less than 0.05). 3. When the check size 16 and alt. rate 1.88 cycles/sec. delayed VEP latency (BA) was found in 23.1% eyes with glaucomatous field defect (which is statistically significant (P less than 0.05). 4. When the check size is 32 and alt/sec. 7.5 delayed VEP latency (BT) was found in 30.2% eyes with glaucomatous field defect (showing statistically significant mean difference).