Short-term results of initial trabeculectomy with intraoperative or postoperative 5-fluorouracil for primary glaucomas.

Thirty-three eyes of 33 patients were prospectively evaluated to study the short term efficacy, safety, and overall surgical outcome of initial trabeculectomy for primary glaucomas with adjunctive intraoperative or postoperative 5-Fluorouracil (5-FU) use. Twelve eyes serving as controls underwent trabeculectomy without adjunctive antimetabolites. Eleven eyes received intraoperative 5-FU, while 10 eyes received subconjunctival 5-FU postoperatively. Intraocular pressure (IOP) was maintained below 22 mmHg at 3 months of follow up in 90.9% and 80% of patients in the intraoperative and postoperative 5-FU groups, respectively, without use of additional antiglaucoma medications, whereas 66.7% of the patients in the control group achieved similar IOP levels. Hypotony (IOP < 6 mmHg) was seen more commonly after intraoperative 5-FU (27.3%). Corneal epithelial defects were seen exclusively in the postoperative 5-FU group (40%). The use of intraoperative 5-FU exclusively as a mode of antimetabolites delivery seems an acceptable alternative to enhance success rates of trabeculectomy for the primary glaucomas.

Short-term results of initial trabeculectomy with intraoperative or postoperative 5-fluorouracil for primary glaucomas.

Thirty three eyes of 33 patients were prospectively evaluated to study the short term efficacy, and overall surgical outcome of initial trabeculectomy for primary glaucomas with adjunctive intraoperative on postoperative 5-Fluorouracil (5-FU) use. Twelve eyes served as control who underwent trabeculectomy without adjunctive antimetabolites. Eleven eyes received intraoperative 5-FU, while 10 eyes received subconjunctival 5-FU postoperatively. Intraocular pressure (IOP) was maintained below 22 mmHg at 3 months of follow up in 90.9% and 80% of patients in the intraoperative and postoperative 5-FU groups respectively, without use of additional antiglaucoma medications, whereas 66.7% of the patients in the control group achieved similar IOP levels. Hypotony (I.O.P. < 6 mmHg) was seen more commonly after intraoperative 5-FU (27.3%). Corneal epithelial defects were seen exclusively in the postoperative 5-FU group (40%). The use of intraoperative 5-FU exclusively as a mode of antimetabolite delivery seems an acceptable alternative to enhance success rates of trabeculectomy for the primary glaucomas.

Leprotic keratopathy in India.

Corneal affections cause severe ocular morbidity in leprosy. Poor nutrition and low socio-economic status make the eyes prone to repeated secondary infections which makes the pattern of corneal disease in this country different from that reported in western literature. A study of 250 patients shows that leprotic keratopathy has 4 different patterns. Primary leprous keratitis was seen in 56.5% of cases, while secondary leprous keratitis (groups B, C & D) constituted 57.7%. In the latter group the ocular morbidity could be prevented by controlling infection and prevention of concomitant diseases. Cases of lepromatous leprosy showed a consistently higher incidence of different types of corneal involvement than tuberculoid cases.

Argon laser iridotomy in angle closure glaucoma.

Argon laser iridotomy was successfully performed in 30 eyes of glaucoma patients. A modified two stage procedure has been described to achieve a successful iridotomy in pigmented eyes. At the chosen site of laser iridotomy, partial thickness burns were applied in the first stage followed by a penetrating burns in the second stage. This minimised the complications associated with laser iridotomy and decreased the incidence of subsequent closure. At the end of 6 months follow up the success rate was 93.3 percent.

Evaluation of precorneal tear film in leprosy.

The present study analyses the precorneal teat film using schirmer's test and tear film breakup time (BKUT) in 400 eyes of patients with various types of leprosy. An abnormal tear film BKUT (47.2%) was observed to be much more informative in the present series than the study of schirmer's test alone (25.4%). In patients with lagophthalmos an abnormal tear film BKUT (70%) was higher as compared to an abnormal schirmer's test (40%); while in cases of lagophthalmos with ectropion an abnormal schirmer's test was seen less frequently (26.8%) than in cases of lagophthalmos without ectropion (58.3%). This implied an increase in the aqueous content of the tear film in cases of lagophthalmos with ectropion on the basis of an associated chronic conjunctivitis. Lagophthalmos and ectropion have been identified as additional factors contributing to corneal morbidity. There was a statistically significant difference in the tear film abnormality in different types of leprosy, the maximal difference being in the lepromatous variety.

Uveal changes in leprosy.

A total of 424 leprosy patients were screened for uveal involvement. Uveal changes were found in 11.2% of these patients. Uveal involvement was more common in patients with greater duration of the disease and in patients on irregular Dapsone therapy. Of the patients with uveal involvement 82% were lepromatous, 16% were borderline and 2% were of tuberculoid leprosy. Uveal changes in form of active iridocyclitis (21.3%), healed iridocyclitis (58.5%), iris atrophy (10.6%), iris pearls (7.4%), small irregular pupil (46.7%), pupil refractory to dilatation (56.3%) were seen. Posterior segment involvement was rare. Lepromatous and borderline leprosy patients with no clinical evidence of uveal involvement had decreased power of accommodation as compared to normal subjects.

Repositioning of pupil for visual disability.

The authors have successfully utilised the technique of photocoagulation of iris in 35 cases for improving the visual acuity in cases suffering from ocular leprosy. The photocoagulation was considered to be very useful in cases with corneal scars, highly vascularised adherent leukomas, where keratoplasty stands a poor risk. It has also been recommended for cases with pinpoint pupil not dilating with drugs for diagnostic and prognostic value.