A comparison of the circadian rhythm of intraocular pressure in primary phronic angle closure glaucoma, primary open angle glaucoma and normal eyes.

PURPOSE: To evaluate the circadian rhythm of intraocular pressure (IOP) in primary chronic angle closure glaucoma (PCACG), primary open angle glaucoma (POAG), and normal eyes. METHODS: Cross-sectional study of newly diagnosed patients of POAG (60 eyes), PCACG following laser iridotomy (75 eyes), and age and sex matched normal controls (75 eyes). All subjects underwent applanation tonometry at 7 a.m., 10 a.m., 1 p.m., 4 p.m., 7 p.m., and 10 p.m. by a masked observer. Circadian rhythms were classified based upon the timing and presence of peak pressure. RESULTS: Age and gender in all three groups were comparable. Diurnal IOP fluctuations were significantly higher in PCACG (7.69+3.03 mmHg) and POAG (8.31+2.58 mmHg) groups compared to normal controls (4.83 + 2.46 mmHg). PCACG eyes and controls had similarly timed circadian rhythms, with PCACG eyes having a consistently higher IOP. At 7 and 10 a.m., IOP peaked more often in POAG eyes compared to PCACG eyes. A plateau type of circadian rhythm was most common in normal eyes. The timing of peak IOP could be significantly correlated with the type of primary glaucoma examined. CONCLUSION: Afternoon peaks were more common in postiridotomy PCACG eyes, similar to the rhythm in normal eyes. Morning peaks were more frequent in POAG eyes. Diurnal fluctuation > 6 mmHg, associated with an IOP of 21 mmHg or more was never seen in a normal eye.

Cumulative effect of risk factors on short-term surgical success of mitomycin augmented trabeculectomy.

CONTEXT: Risk factors for failure of trabeculectomy may have a cumulative effect on the outcome. AIMS: To study the effect of preoperative ocular risk factors on the surgical outcome of trabeculectomy augmented with 2 commonly used doses of Mitomycin C. SETTINGS AND DESIGN: In a prospective cohort study, cases were recruited over an 18 month period. 92 eyes of 83 patients with one to three known risk factors for failure of trabeculectomy underwent Mitomycin-C (MMC) augmented trabeculectomy. METHODS AND MATERIAL: Trabeculectomy was done with a randomly chosen MMC dose of 0.2 mg/ml or 0.4 mg/ml. All cases were followed up for a period of at least 3 months. Surgical success was defined as the lowering of intraocular pressure (IOP) below 21 mmHg during the follow up period. STATISTICAL ANALYSIS USED: Chi square test, paired t test, odds ratio, effect size. RESULTS: Eyes with two or three risk factors (out of aphakic glaucoma, failed trabeculectomy, neovascular glaucoma, post uveitic glaucoma, traumatic glaucoma, adherent leucoma, juvenile glaucoma, prolonged medical therapy, steroid induced glaucoma, post penetrating keratoplasty glaucoma and developmental glaucoma) had a significantly poorer surgical success rate (88% and 78%) than eyes with one risk factor (100%). 0.4 mg/ml MMC used sub-sclerally had a statistically similar effect on lowering the IOP as 0.2 mg/ml in all groups. The rate of complications was significantly higher in the 0.4 mg/ml subgroup. CONCLUSIONS: The presence of more than one preoperative ocular risk factor, affects the surgical success of MMC augmented trabeculectomy in high-risk cases. Because of the significantly higher rate of complications with the higher dose of MMC, this should be used sparingly, only in cases with more than two risk factors.

Visual field assessment in glaucoma: comparative evaluation of manual kinetic Goldmann perimetry and automated static perimetry.

PURPOSE: To compare the detection and assessment of progression of visual field defects in primary open-angle glaucoma with manual suprathreshold perimetry on Goldmann perimeter and automated static threshold perimetry on Humphery visual field (HVF) analyzer. METHODS: 105 eyes of 54 patients of primary open-angle glaucoma were followed up with 3-monthly perimetry on Goldmann perimeter and HVF analyzer, for a period of 9 months. RESULTS: HVF analyzer picked up visual field defects in 48 (46%) eyes whereas Goldmann perimeter picked up visual field defects in 26 (25%) eyes. HVF analyzer demonstrated progression in 14 eyes whereas Goldmann perimeter detected progression in 7 eyes during follow up of 9 months. CONCLUSIONS: HVF analyzer is superior to Goldmann perimeter to document and to demonstrate progression of visual field defects in primary open-angle glaucoma.

Biochemical speciation of enterococci causing human infections.

As Enterococci are now coming up as important nosocomial pathogens, their speciation and antibiotic sensitivity testing is important. 120 isolates of Enterococci from various clinical samples were physiologically and biologically characterised. Speciation on the basis of recommended methods revealed 114(95%) as E. faecalis and 6(5%) as E. faecium. Antibiogram of the 120 isolates showed that 100(83.3%) were sensitive to Ampicillin. Combination of Penicillin and Gentamicin was more effective. E. faecium was more drug resistant.

Presumptive identification & antibiotic susceptibility of group B Streptococci.

Three presumptive identification tests were conducted on 60 strains of beta haemolytic group B streptococci (GBS) & evaluated for their sensitivity as compared to the standard serological grouping. The GBS were further subjected to serotyping and antibiotic sensitivity testing. Hippurate was hydrolysed by 96.6%, the CAMP test was positive in 83.3% & pigment was produced by 95%. The commonest serotype was la (33.3%) followed by lb (30%). Hundred percent strains were sensitive to Penicillin, Ampicillin, Erythromycin & Cephlexin. 76.7% showed MIC of 50 ug/ml or more for Tetracycline & 66.7% were inhibited by 3.2 ug/ml or less of Gentamicin.