Indocyanine green anterior segment angiography for studying conjunctival vascular changes after trabeculectomy.

BACKGROUND: The aim of the study was to evaluate the use of indocyanine green (ICG) for angiography of the anterior segment to characterize conjunctival and episcleral vasculature changes after trabeculectomy. METHODS: This was a prospective evaluation of anterior segment ICG angiography in 10 eyes of 10 patients undergoing trabeculectomy for the first time. Trabeculectomy was performed with intraoperative sponge application of 5-fluorouracil (5 cases) or mitomycin C (5 cases). Anterior segment ICG angiography was performed prior to surgery, then at 2 weeks and 2 months after surgery. RESULTS: With ICG, the anterior segment vessels were well delineated, including deep episcleral veins, which have not been clearly shown in previous angiographic techniques. Late phases of the angiogram could also be studied. The vascular alterations after trabeculectomy noted included oss of vascularity over the bleb area and vascular anastomoses along the perimeter of the avascular bleb. CONCLUSIONS: Angiography using ICG has potential as an investigative tool to study the conjunctival and episcleral vasculature changes after trabeculectomy.

Vascular patterns in pterygium and conjunctival autografting: a pilot study using indocyanine green anterior segment angiography.

AIMS: To characterise the vasculature of pterygium using indocyanine green (ICG) anterior segment angiography and to demonstrate the pattern of revascularisation following conjunctival autografting. METHODS: ICG anterior segment angiography was performed on nine patients with pterygium. Angiography was repeated at 1-2 weeks and 2 months following conjunctival autografting in these patients. RESULTS: Angiography showed a single feeder vessel originating from the anterior conjunctival circulation in six cases (66.7%). This vessel branched to form the radial vessels of the pterygium. Following conjunctival autografting, reperfusion of the vessels in the conjunctival autograft was demonstrable as early as 1 week postoperatively from the episcleral bed. At 2 months postoperatively, the graft appeared well perfused with mild leakage demonstrable at the edges of the graft. CONCLUSIONS: A single feeder vessel from the anterior conjunctival circulation branches to form the radial vessels in pterygium. Reperfusion of conjunctival autografts occurs as early as 1 week postoperatively from the episcleral bed.

Long-term clinical course of primary angle-closure glaucoma in an Asian population.

PURPOSE: To study the long-term clinical course of patients with primary angle-closure glaucoma (PACG). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Sixty-five consecutive patients who were diagnosed with PACG at one Singapore hospital from January 1990 through December 1994. METHODS: Primary angle-closure glaucoma was defined as the presence of glaucomatous optic neuropathy and compatible visual field loss associated with a closed angle in the same eye. All study eyes underwent laser peripheral iridotomy (LPI). There were two groups of patients studied. Group A consisted of those with a past documented history of an episode of acute angle closure (that had resolved after LPI). Group B consisted of those with no previous acute episode. The presenting features, management, and subsequent long-term intraocular pressure (IOP) outcome were analyzed. MAIN OUTCOME MEASURES: Intraocular pressure and the need for further glaucoma treatment. RESULTS: The follow-up period was 63 +/- 29 months (mean +/- standard deviation). The mean presenting IOP was 40 +/- 16 mmHg, and the presenting vertical cup-to-disc ratio was 0.6 +/- 0.2. Of the 83 eyes, only five eyes (6%) did not require any treatment after LPI in the long term. In group A (35 eyes), all eyes required further treatment with antiglaucoma medications. Twenty-two eyes (62. 9%) eventually underwent filtering surgery at a mean of 7.3 months after the commencement of treatment. In group B (48 eyes), 43 eyes (89.6%) underwent further medical therapy, of which 22 eyes (45.8%) eventually underwent filtering surgery at a mean of 18.4 months after the commencement of treatment. CONCLUSIONS: Despite the presence of a patent LPI, most eyes with established PACG require further treatment to control IOP. Medical therapy fails in most cases, necessitating filtering surgery. Patients risk experiencing further glaucomatous visual damage if this trend is not detected.

Necrotising scleritis after bare sclera excision of pterygium.

AIM: To report cases of scleral necrosis after simple pterygium excision in which adjunctive treatment was not used. METHODS: We reviewed four patients who presented with scleral melt after pterygium excision without the use of adjunctive treatment in the form of beta irradiation, mitomycin C, or thiotepa. Each patient was thoroughly investigated to exclude underlying disease. RESULTS: Certain similarities were found between our patients with pterygium melt and cases of surgically induced necrotising scleritis including the location of melt, associated inflammation, and its response to steroid treatment in the latent period before they presented. CONCLUSION: Bare sclera pterygium excision can cause surgically induced necrotising scleritis years after the surgery.

Cerebellar mutism with subsequent dysarthria in an adult: case report.

An adult case of mutism and subsequent dysarthria after posterior fossa surgery is presented. An EEG performed during the mute phase showed widespread left hemisphere abnormality although the CT findings were normal. The possible mechanisms underlying this syndrome are discussed.

Clinical course and outcome of primary acute angle-closure glaucoma in Singapore.

PURPOSE: Data is lacking with regard to the factors which may predict the outcome of an acute glaucoma eye to treatment and its long-term prognosis. This study was carried out to identify such factors, in particular among Singaporeans. METHODS: Fifty-seven eyes were included in this retrospective analysis and factors analysed included age and sex; the duration of onset of symptoms to the time they presented to hospital; state of pupil and presenting intraocular pressure (IOP); whether attack is terminated by medical treatment alone or a second procedure (eg laser, trabeculectomy) was required; final outcome with respect to the development of chronic angle closure glaucoma and state of pupil at last follow-up. RESULTS: Patients with 24 to 72 hours' delay in presentation had a relative risk of 2.78 (CI = 1.03-7.46) in developing chronic glaucoma. Those who required the addition of a laser procedure to control the initial presenting IOP while those who proceeded to a trabeculectomy had relative risks of 3.63 (CI = 1.49-8.89) and 4.83 (CI = 1.18-19.7) respectively in developing chronic glaucoma when compared to patients who did not require any secondary treatment. CONCLUSION: Delay in presentation, and unresponsiveness to medical treatment in termination of the acute attack in an acute angle closure glaucoma patient carry a significant risk of chronic glaucoma.