Avaliação da eficácia da trabeculotomia transluminal assistida por gonioscopia em glaucoma avançado e não avançado / Evaluation of efficacy of gonioscopy-assisted transluminal trabeculotomy in advanced-stage and non-advanced stage glaucoma

RESUMO Objetivo Avaliar a eficácia da trabeculotomia transluminal assistida por gonioscopia correlacionada com a gravidade do glaucoma. Métodos Análise restrospectiva de prontuários de pacientes que foram submetidos à trabeculotomia transluminal assistida por gonioscopia no período de 2019 a 2021 em um hospital privado. Resultados Vinte olhos foram submetidos à trabeculotomia transluminal assistida por gonioscopia (dois olhos) ou facectomia e trabeculotomia transluminal assistida por gonioscopia (18 olhos). Pacientes portadores da doença avançada obtiveram redução de 5mmHg (26,5%) na pressão intraocular, com redução de 2,3 drogas, e olhos com glaucoma leve ou moderado apresentaram redução de 8mmHg (40%) na pressão intraocular média e 2,1 drogas. Metade dos olhos operados teve hifema nos primeiros dias como principal complicação cirúrgica. Conclusão A trabeculotomia transluminal assistida por gonioscopia é um procedimento eficaz na redução da pressão intraocular e na redução da quantidade de drogas em uso, apresentando maior redução da pressão intraocular em olhos com glaucoma leve/moderado.

ABSTRACT Objective To evaluate efficacy of gonioscopy-assisted transluminal trabeculotomy and relate to severity of glaucoma. Methods A retrospective analysis of medical records of patients submitted to gonioscopy-assisted transluminal trabeculotomy, at a private hospital, from 2019 to 2021. Results A total of 20 were submitted to gonioscopy-assisted transluminal trabeculotomy (2 eyes) or facectomy and gonioscopy-assisted transluminal trabeculotomy (18 eyes). Patients with advanced-stage disease achieved a decrease by 5 mmHg (26.5%) in IOP, with a reduction of 2.3 drugs, and eyes with mild or moderate glaucoma showed a drop by 8 mmHg (40%) in mean IOP and of 2.1 drugs. Half of the operated eyes had hyphema in the first days as the main surgical complication. Conclusion Gonioscopy-assisted transluminal trabeculotomy is an effective procedure to reduce IOP and the number of drugs being used, with greater IOP decrease in eyes with mild/moderate glaucoma.

Caracterización clínica y epidemiológica del síndrome pseudoexfoliativo / Clinical and epidemiological characterization of pseudoexfoliation syndrome

Objetivo: Determinar las características clínicas y epidemiológicas del síndrome pseudoexfoliativo. Métodos: Se realizó un estudio de 109 ojos correspondientes a 55 pacientes atendidos en el Centro de Microcirugía Ocular y en el Servicio de Glaucoma del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre julio del año 2016 y septiembre de 2017. Para su caracterización se realizaron determinaciones a través de la gonioscopia, la tonometría, la paquimetría, la microscopia endotelial, el fondo de ojo y la medición de la agudeza visual. Resultados: El promedio de edad fue de 74,6 años, con predominio del sexo masculino (60 por ciento) y la piel blanca (78,2 por ciento), con antecedentes frecuentes de enfermedad vascular, particularmente hipertensión arterial (65,5 por ciento). El 92,7 por ciento presentaba catarata bilateral con predominio nuclear. Todos los pacientes tenían ángulo camerular abierto y la presión intraocular era alta en el 36,4 por ciento de los casos. La presencia de glaucoma fue del 56,4 por ciento, más frecuente el unilateral (38,2 por ciento). En relación con el endotelio corneal, la celularidad estaba disminuida en el 40 por ciento, con polimegatismo (58,2 por ciento) y pleomorfismo (72,7 por ciento). Conclusión: No se encuentra relación entre las alteraciones corneales, la edad, la presión intraocular y la presencia de material pseudoexfoliativo(AU)

Objective: Determine the clinical and epidemiological characteristics of pseudoexfoliation syndrome. Methods: A study was conducted of 109 eyes of 55 patients attending the Ocular Microsurgery Center and Glaucoma Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from July 2016 to September 2017. Characterization was based on determinations made by gonioscopy, tonometry, pachymetry, endothelial microscopy, funduscopy and visual acuity measurement. Results: Mean age was 74.6 years, with a predominance of the male sex (60 percent), white skin (78.2 percent) and frequent antecedents of vascular disease, particularly arterial hypertension (65.5 percent). All the patients had cataract, which was predominantly bilateral and nuclear in 92.7 percent. In all cases the chamber angle was open, whereas intraocular pressure was high in 36.4 percent. 56.4 percent of the patients had glaucoma, which was more commonly unilateral (38.2 percent). Regarding the corneal endothelium, cellularity was reduced in 40 percent, with polymegethism (58.2 percent) and pleomorphism (72.7 percent). Conclusion: No relationship was found between corneal alterations, age and intraocular pressure, and the presence of pseudoexfoliative material(AU)

Glaucoma congénito primario: ¿cuándo es preciso sospechar? / Primary congenital glaucoma: when should it be suspected?

RESUMEN Se realiza una actualización sobre el diagnóstico y tratamiento del glaucoma infantil primario, considerando la importancia que tiene un diagnóstico precoz y un tratamiento oportuno para obtener los mejores resultados posibles. Actualmente, a pesar del surgimiento de nuevos fármacos y de técnicas quirúrgicas para tratar esta afección, aún existen discrepancias sobre cómo debemos realizar el diagnóstico positivo; qué tratamiento o técnica quirúrgica emplear; cuándo y cuál sería la mejor. Cuando se trata de glaucoma pediátrico (primario o secundario), presente en etapas tan tempranas de la vida -incluso al nacimiento, donde la cirugía está indicada lo más precozmente posible, con la disyuntiva de cuáles medicamentos podemos emplear o no, por desconocimiento de qué efectos indeseables pudieran presentarse en estas edades y además, teniendo en cuenta que estos niños serán nuestros pacientes para toda la vida- es necesario conocer y repasar una vez más este tema. Se recomienda instruir a pediatras y oftalmólogos generales para lograr la remisión adecuada y precoz del niño a un centro especializado para su tratamiento quirúrgico, y mejorar así su pronóstico visual(AU)

ABSTRACT Updated information is provided about the diagnosis and treatment of primary childhood glaucoma, given the importance of early diagnosis and timely treatment to obtain the best possible results. Despite the emergence of new drugs and surgical techniques to treat this disorder, there is still controversy about how we should perform the positive diagnosis, what treatment or surgical technique should be used and when, and which would be the best. When childhood glaucoma (whether primary or secondary) presents at early stages of life - even at birth -, in which case surgery should be indicated as soon as possible, we are faced with the dilemma of what drugs we may or may not use, due to lack of knowledge about undesirable effects which could appear at these ages, and bearing in mind that these children will be our patients for a lifetime. It is thus necessary to be informed about this topic and go over it once again. It is recommended to instruct pediatricians and ophthalmologists to ensure timely, appropriate referral of the child patient to a specialized center where they will receive surgical treatment, thus improving their visual prognosis(AU)

Glaucoma neovascular y atrofia esencial de iris / Neovascular glaucoma and essential iris atrophy

Los glaucomas secundarios son de difícil manejo, independientemente de las causas. Entre ellos, el glaucoma neovascular representa un reto para los oftalmólogos por las causas que lo producen y la gran pérdida visual que provoca. De igual manera, el síndrome iridocorneoendotelial es una enfermedad poco frecuente. El glaucoma ocurre aproximadamente en el 50 por ciento de los casos en dependencia del síndrome que predomine, mucho más grave en la atrofia esencial del iris. Presentamos un caso clínico de una paciente femenina de 58 años de edad en quien aparecen en cada ojo, de manera independiente, estos dos tipos de glaucomas secundarios(AU)

Secondary glaucomas are always difficult to manage, no matter what their causes might be. Among them, neovascular glaucomas pose a challenge to ophthalmologists, due to the factors bringing them about and the great visual loss they produce. On the other hand, iridocorneal endothelial syndrome is an uncommon condition. Glaucoma develops in about 50 percent of the cases, depending on the prevailing syndrome, and is much more severe in essential iris atrophy. A clinical case is presented of a 58-year-old female patient with these two types of secondary glaucoma, one type in each eye(AU)

Diabetes mellitus tipo 2 en pacientes con diagnóstico de glaucoma primario de ángulo abierto durante el período 2010-2014 / Type 2 diabetes mellitus in patients diagnosed with primary open angle glaucoma during the period 2010-2014

RESUMEN Objetivo La asociación entre diabetes mellitus tipo 2 y glaucoma primario de ángulo abierto aún no está claramente establecida. Este estudio tiene como objetivo identificar la frecuencia entre ambas patologías en pacientes del Hospital Teodoro Maldonado Carbo durante el período 2010-2014 Métodos Se realizó un estudio retrospectivo, de corte transversal, de proporción, en una muestra de 283 pacientes mayores de 30 años cuyo diagnóstico fue de GPAA (Glaucoma primario de ángulo abierto) confirmado mediante estudio de tonometría, gonioscopia, campimetría y ausencia de causas secundarias de aumento de PIO. Se utilizaron criterios de la ADA/OMS para establecer el diagnóstico de DM2. Resultados La frecuencia de pacientes con diabetes en pacientes con diagnóstico de GPAA, que fueron atendidos en consultorios de Emergencia, Endocrinología y Oftalmología del Hospital Regional Teodoro Maldonado Carbo, durante el período 2010-2014, fue de 26,15% (74 de 283 pacientes), con importantes diferencias entre sexo y lugar de residencia. Conclusiones: Se demostró la existencia de una alta proporción entre DM2 y GPAA mediante razón de proporción.

ABSTRACT Objective The association between diabetes mellitus type 2 (DM2) and Primary Open- Angle Glaucoma (POAG) is not clearly established yet. This study has the objective to identify the frequency of both diseases in patients of Teodoro Maldonado Carbo Hospital during the period 2010-2014. Methods A retrospective, cross-sectional frequency was conducted on a sample of 283 patients over age 30 whose diagnosis was confirmed by examination of POAG tonometry, gonioscopy, perimetry and absence of secondary causes of increased intraocular pressure. ADA/OMS criteria were used to establish the diagnosis of DM2. Results The frequency of patients with diabetes diagnosed with POAG patients who were treated at the services of Emergency, Endocrinology and Ophthalmology of the Regional Hospital Teodoro Maldonado Carbo, during the period 2010-2014, was 26.15% (74 of 283 patients) with significant differences between sex and place of residence. Conclusions The existence of a high proportion between DM2 and POAG was demonstrated by prevalence ratio.

Acute angle closure glaucoma following ileostomy surgery

Angle-closure glaucoma can be induced by drugs that may cause pupillary dilatation. We report a case of a patient that developed bilateral angle closure glaucoma after an ileostomy surgery because of systemic atropine injection. This case report highlights the importance of a fast ophthalmologic evaluation in diseases with ocular involvement in order to make accurate diagnoses and appropriate treatments.

O glaucoma de fechamento angular pode ser induzido por drogas que podem causar dilatação da pupila. Nós relatamos um caso no qual a paciente desenvolveu fechamento angular em ambos os olhos após injeção sistêmica de atropina. Este caso mostra a importância de uma pronta intervenção em doenças com envolvimento ocular com o objetivo de realizar o tratamento adequado.

Efficacy of goniosynechialysis in the treatment of chronic angle-closure glaucoma: a five-case report / Eficácia da goniossinequiálise no tratamento do glaucoma crônico de ângulo fechado: relato de cinco casos

We retrospectively analyzed the clinical data of five patients with chronic angle-closure glaucoma who underwent goniosynechialysis (GSL). The patients presented a circumferential synechial angle-closure for less than or up to six months due to an acute primary angle-closure and a minimum six month follow up after GSL. After an average follow-up was of 32.4±13.9 months, visual acuity improved in four (80%) eyes. Before GSL, the intraocular pressure (IOP) varied from 34 to 58 mmHg. After GSL, the IOP varied from 8 to 44 mmHg. IOP was normalized by GSL with or without medication in 80% of the eyes. Before GSL, all patients were on maximum antiglaucomatous treatment including the use of 250 mg of oral acetazolamide three times daily. After GSL, three patients no longer required antiglaucomatous medication and one needed to use one topical antiglaucomatous medication. GSL was effective and safe in four patients and unsuccessful in one patient. An increase of the GSL success rate occurs when it is associated with phacoemulsification and intraocular lens implantation.

Analisamos retrospectivamente os dados clínicos de cinco pacientes com seio camerular fechado por sinéquias anteriores periféricas (SAP) secundárias à crise aguda de fechamento angular primário e submetidos à goniossinequiálise (GSL). Os pacientes apresentavam fechamento sinequial circunferencial por seis meses ou menos e foram acompanhados, no mínimo, por seis meses após a GSL. Após um acompanhamento médio de 32.4±13.9 meses, a acuidade visual melhorou em quatro (80%) olhos. Antes da GSL, a pressão intraocular (Po) variou de 34 a 58 mmHg. Após a GSL, a Po variou de 8 a 44 mmHg. A Po foi normalizada pela GSL com ou sem medicação em 80% dos olhos. Antes da GSL, todos os pacientes estavam sob tratamento antiglaucomatoso máximo incluindo o uso de 250 mg de acetazolamida por via oral três vezes ao dia. Após a GSL, três pacientes não mais necessitaram de medicação antiglaucomatosa e um paciente necessitou usar apenas uma medicação tópica antiglaucomatosa. A GSL foi eficaz e segura em quatro pacientes e não foi eficaz em um paciente. Ocorre um aumento da taxa de sucesso da GSL quando ela é associada à facoemulsificação com implante de lente intraocular.

Angle imaging: Advances and challenges.

Primary angle closure glaucoma (PACG) is a major form of glaucoma in large populous countries in East and South Asia. The high visual morbidity from PACG is related to the destructive nature of the asymptomatic form of the disease. Early detection of anatomically narrow angles is important and the subsequent prevention of visual loss from PACG depends on an accurate assessment of the anterior chamber angle (ACA). This review paper discusses the advantages and limitations of newer ACA imaging technologies, namely ultrasound biomicroscopy, Scheimpflug photography, anterior segment optical coherence tomography and EyeCam, highlighting the current clinical evidence comparing these devices with each other and with clinical dynamic indentation gonioscopy, the current reference standard.

Glaucoma anterior chamber morphometry based on optical Scheimpflug images / Morfometria da câmara anterior no glaucoma avaliada pelas imagens de Scheimpflug

Purpose: To compare the performance of gonioscopy and noncontact morphometry with anterior chamber tomography (High Resolution Pentacam - HR) using optical Scheimpflug images in the evaluation of the anterior chamber angle (ACA). Methods: Transversal study. 112 eyes from 74 subjects evaluated at the Glaucoma Department, Fluminense Federal University, underwent gonioscopy and Pentacam HR. Using gonioscopy, the ACA was graded using the Shaffer Classification (SC) by a single experienced examiner masked to the Pentacam HR findings. Narrow angle was determined in eyes in which the posterior trabecular meshwork could not be seen in two or more quadrants on non-indentation gonioscopy (SC Grade 2 or less). Pentacam HR images of the nasal and temporal quadrants were evaluated by custom software to automatically obtain anterior chamber measurements, such as: anterior chamber angle (ACA), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results: Based on gonioscopy results, 74 (60.07 percent) eyes of patients classified as open-angle (SC 3 and 4) and 38 (33.93 percent) eyes of patients classified as narrow-angle (SC 1 and 2). Noncontact morphometry with Scheimpflug images revealed a mean ACA of 39.20 ± 5.31 degrees for open-angle and 21.18 ± 7.98 degrees for narrow-angle. The open-angle group showed significant greater ACV and ACD values when compared to narrow-angle group (ACV of 193 ± 36 mm³ vs. 90 ± 25 mm³, respectively, p<0.001; and ACD of 3,09 ± 0,42 mm vs. 1,55 ± 0,64 mm, respectively, p<0.0001.). In screening eyes with open-angle and narrow-angle with the Pentacam ACA of 20º (SC Grade 2) using the ROC curves, the analysis showed 52.6 percent of sensitivity and 100 percent of specificity. Conclusions: The Pentacam showed ability in detecting eyes at risk for angle closure analyzing ACV and ACD.

Objetivo: Comparar os resultados da gonioscopia com as medidas morfométricas do segmento anterior obtidas pela tomografia (Pentacam High Resolution - HR), utilizando imagens ópticas de Scheimpflug na avaliação do ângulo da câmara anterior (ACA). Métodos: Realizado estudo transversal com avaliação de 112 olhos de 74 pacientes avaliados no Setor de Glaucoma da Universidade Federal Fluminense, submetidos ao exame da gonioscopia e do Pentacam HR. Na gonioscopia o ACA foi classificado utilizando a Classificação de Shaffer (SC), realizado por um único examinador experiente, e seus resultados foram comparados às medidas do Pentacam HR. Ângulos estreitos foram classificados nos olhos em que a malha posterior trabecular não foi observada em dois ou mais quadrantes na gonioscopia tradicional (SC Grau 2 ou menor). As imagens dos quadrantes nasal e temporal obtidas pelo Pentacam HR foram avaliadas por um software personalizado que obtêm automaticamente as seguintes medidas da câmara anterior: ângulo da câmara anterior (ACA), volume da câmara anterior (ACV) e profundidade da câmara anterior (ACD). Resultados: Com base nos resultados gonioscopia, 74 (60,07 por cento) olhos foram classificados como ângulo aberto (SC 3 e 4) e 38 (33,93 por cento) olhos foram classificados como ângulo estreito (SC 1 e 2). A morfometria de não contato com as imagens Scheimpflug revelou uma média de ACA 39,20 ± 5,31 graus nos ângulos abertos e 21,18 ± 7,98 graus nos ângulos estreitos. O grupo classificado como ângulo aberto mostrou medidas significativamente maiores de ACV e ACD quando comparado ao grupo de ângulo estreito (ACV de 193 ± 36 mm³ vs 90 ± 25 mm³, respectivamente, p <0,001 e ACD de 3,09 ± 0,42 mm vs 1,55 ± 0,64 mm, respectivamente, p<0,0001). Na diferenciação dos olhos com ângulo aberto e olhos com ângulo estreito no Pentacam, a análise das curvas ROC demonstraram que na medida de 20º (SC Grau 2) resultaram em 52,6 por cento de sensibilidade em 100 por cento de especificidade. Conclusões: O Pentacam HR mostrou habilidade em detectar os olhos com risco de fechamento angular na analise do ACV e do ACD.

Smith-method assessment of anterior chamber depth for screening for narrow anterior chamber angles.

PURPOSE: To compare the axial anterior chamber depth (ACD) using the Smith method, in patients under treatment for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), with an age-matched control group. MATERIALS AND METHODS: Triplicate just-touching-slit-length (JTSL) measurements of the axial anterior chamber depth were determined in 198 eyes of 99 patients (39 control; 36 POAG; and 24 PACG) recruited from King Saud University clinics, Riyadh, Saudi Arabia. Goldmann tonometry and gonioscopy were carried out as a part of the patient's routine examination. Subjects with a history of intraocular surgery for glaucoma or any other anterior segment disease were excluded form the study. The average ACD estimate by the JTSL method were compared among the various groups. RESULTS: The average JTSL estimates were: Control group 2.33+/-0.68 mm (axial ACD estimate = JTSL estimate x 1.4); POAG group 1.98+/-0.97 mm; PACG group 0.65+/-0.41 mm. There was no significant reduction (P = 0.068) of the JTSL estimate in the POAG group, compared to the control group. There was a statistically significant (P < 0.001) reduction of the JTSL estimate in the PACG group, compared to both the control and POAG groups. CONCLUSION: The Smith-method JTSL technique may be used for non-invasive rapid screening, to help identify patients at risk of developing angle-closure, during routine examination of patients in the ophthalmology clinic.

Evaluation of the anterior chamber angle in Asian Indian eyes by ultrasound biomicroscopy and gonioscopy.

PURPOSE: To compare the ultrasound biomicroscopic measurement of the anterior chamber angle in Asian Indian eyes, with the angle width estimated by gonioscopy. MATERIALS AND METHODS: Participants: Patients with open and closed angles attending a glaucoma clinic were recruited for the study. OBSERVATION PROCEDURES: Temporal quadrants of the angles of patients were categorized by gonioscopy as Grade 0 to Grade 4, using Shaffer's classification. These angles were quantified by ultrasound biomicroscopy (UBM) using the following biometric characteristics: Angle opening distance at 250 micro (AOD 250) and 500 micro (AOD 500) from the scleral spur and trabecular meshwork-ciliary process distance (TCPD). The angles were further segregated as "narrow angles" (Schaffer's Grade 2 or less) and "open angles" (Schaffer's Grade 3 and 4). MAIN OUTCOME MEASURES: The UBM measurements were computed in each case and analyzed in relation to the gonioscopic angle evaluation. RESULTS: One hundred and sixty three eyes of 163 patients were analyzed. One hundred and six eyes had "narrow angles" and 57 eyes had "open angles" on gonioscopy. There was a significant difference among the mean UBM measurements of each angle grade estimated by gonioscopy (P < 0.001). The Pearson correlation coefficient between all UBM parameters and gonioscopy grades was significant at the 0.01 level. The mean AOD 250, AOD 500 and TCPD in narrow angles were 58+/-49 micro, 102+/-84 micro and 653+/-124 respectively, while it was 176+/-47 micro, 291+/-62 micro and 883+/-94 micro in eyes with open angles (P < 0.001) respectively. CONCLUSIONS: The angle width estimated by gonioscopy correlated significantly with the angle dimensions measured by UBM. Gonioscopy, though a subjective test, is a reliable method for estimation of the angle width.

Cuerpo extraño en ángulo de la cámara anterior del ojo: presentación de un caso / A strange body in an angle of the anterior chamber of the eye: a case presentation

Se presenta un paciente portador de un cuerpo extraño intraocular, el cual estaba martillando hierro sobre hierro y sintió que le cayó algo en el ojo. Presentó disminución brusca de la agudeza visual. Al examen físico se observó puerta de entrada en córnea y a la gonioscopía cuerpo extraño enclavado en el mismo. Se realizó tratamiento quirúrgico con extracción de cuerpo extraño e iridectomía periférica. Al mes de evolución el paciente había recuperado la agudeza visual de 0.4 a 0.9, evolucionando satisfactoriamente. Se realiza revisión del tema recomendando extracción de todo cuerpo extraño que penetre dentro del ojo...

Importancia del diagnóstico precoz del glaucoma / Early diagnosis importance of glaucoma

Se expone al resultado de 100 pacientes estudiados (200 ojos) que asistieron a la consulta externa de Oftalmología del Hospital Universitario Faustino Pérez de Matanzas de enero del 2004 a marzo del 2005 los cuales referían: cefalea, visión de halos de colores, cambios frecuentes de espejuelos, disminución de la agudeza visual, algunos no presentaban síntomas su jetivos, pero se les detectó alteración de la relación copa/Disco en el fondo de ojo y otros elevación del tono ocular, por lo que se incluyeron en el estudio. Se les realizó a todos los pacientes toma de agudeza visual con optotipo de Snellen y optometría, examen con lámpara de hendidura gonioscopía, oftalmoscopía directa, tonometría, campo visual y curva tonométrica. Predominó el glaucoma crónico simple de ángulo abierto presentando alteración copa disco tonometría de más de 25 milímetros de mercurio y defectos campimétricos típicos el 57 por ciento de los pacientes. Se actualizó el tratamiento médico de esta entidad. Se recomienda la utilización de betabloqueadores como fármaco inicial como segunda opción miótico pilocarpina al 2 por ciento, y inhibidores de la anhidraza carbónica, agonista adrenérgicos y cirugía invasiva o no...

Laser trabeculoplasty as a primary treatment of primary open angel glaucoma

To evaluate the efficacy of laser trabeculoplasty as a primary procedure in the treatment of eyes with primary open angle glaucoma. The patients included in this study were required to have an age 50 years or older, phakic eyes, cup/disc ratio of 0.5 or more, polar notching or narrowing of the neuroretinal rim, and asymmetry of cup! ratio of cup/disc ratio>0.2 between the two eyes, glaucomatous visual field defects, open angle on gonioscopy, basal IOP >/-18 mmHg, and a best corrected visual acuity of more than 20/80. Those patients underwent laser trabeculoplasty in one eye as primary treatment. The IOP was measured 1,2 hours, 1 day, 1 week, 1, 2, and 3 months postoperatively. Twenty eyes of 20 patients with primary open angel glaucoma were included in the study. The mean pre-laser lop was 24.7 +/- 2.7 mmHg, which was increased one hour after treatment to 27.6 +/- 2.3 mmHg. After the 3 months, the mean IOP was 17.1 +/- 3.2 mmHg with a mean reduction of lop of about 7.6 mmHg which represent a 30.8% reduction from the initial IOP. No patient developed significant complications. Laser trabeculoplasty is considered a save, and effective procedure as a primary treatment of patients complaining of primary open angle glaucoma. It can be performed as an outpatient procedure without admission of the patient. The patients should be followed-up closely within the first hour of the procedure for any episodes of rise of IOP. Long term follow-up is recommended as there may be late rise of IOP that necessitate either repetition of the procedure or addition of topical pressure lowering drugs

Ultrasound biomicroscopic dimensions of the anterior chamber in angle-closure glaucoma patients

In order to evaluate the morphologic types of appositional angle-closure glaucoma, biometric measurements were made in angle-closure glaucoma patients using Ultrasound biomicroscopy (UBM). Twenty-six patients with primary angle-closure glaucoma and 21 cataract patients with as a control group were examined. The angle-closure glaucomatous eyes were classified as type B in which the angle closure started at the bottom of the angle and type S in which the angle closure occurred in the vicinity of Schwalbe's line. The trabecular-ciliary process distance (TCPD, type B; 873.20+/-86.77 microm, type S; 832.52+/-82.96 microm, control; 1233.50+/-73.01 microm, p = 0.000) and the angle opening distance (AOD500, type B; 89.75+/-63.27 microm, type S; 88.85+/-72.95 microm, control; 304.40+/-104.30 microm, p = 0.000) were significantly shorter in patients with angle closure vice control group. No significant difference were noted in the three groups of patients in regards to iris thickness or ciliary process-iris angle. In this study, we have demonstrated that there are two types of appositional angle-closure and have shown the forward rotation of the ciliary process without changes of the ciliary process-iris angle in cases of angle-closure glaucoma.

Gonioscopy.

Gonioscopy forms part of a complete ophthalmic examination and is mandatory for the diagnosis and management of glaucoma. Gonioscopy permits identification of eyes at risk for closure and detects angle abnormalities that could have diagnostic and therapeutic implications. The technique of gonioscopy, its value in management, and guidelines for routine use are discussed in this paper.

Gonioscopic Changes after posterior chamber intraocular lens implantation

The aim of this work was to evaluate the morphological changes of the anterior chamber angle seen gonioscopically after posterior chamber intra-ocular lens [PC.IOL] implantation. This work included 20 eyes [16 patients] which were all operated by the extracapsular cataract extraction technique with [PC.IOL.] implantation. all eyes were subjected to pre-operative and post-operative pre-dilatation gonoscopic examination in all quadrants using Goldmann 3 mirror contact lens in a duration ranging from 6 weeks up to 6 months after surgery. The results of gonioscopic examination in our study revealed peripheral anterior synechia in 45%, pigment dispersion in 75% and patches of iris atrophy were observed in 40% of eyes

Toy suction cup subconjunctival hemorrhage in the mentally retarded

A 13-year-old mentally retarded girl was playing with a fellow resident of her mental institution with a toy that had rubber suction cups to stiks it on smooth surfaces. The complication of the patient removed one of these suction cups, sized 5.5 inch in diameter, from the toy and stuck it on the left side of the face of the patient, completely covering her left orbit. It took nearly two minutes to pry the suction cup loose from the face of the terrified patient. Both left eyelids were heavily bruised and a large subconjuctival hemorrhage also developed. Fortunately, no intraocular bleeding occurred. We strongly advise that the toys with suction cups or any other parts with potential risk should be kept away from all children with mental retardation. [Pakistan Journal of Ophthalmology 9:31, 46, April, 1993.]