Treatment of hyperfiltering blebs with Nd:YAG laser-induced subconjunctival bleeding.

PURPOSE: To assess the feasibility of a new technique to manage hyperfiltering blebs after penetrating glaucoma surgery. METHODS: Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser bursts were used to induce bleeding in conjunctival and episcleral vessels in the bleb area to achieve local delivery of autologous blood. RESULTS: In the three cases reported here in which this technique was used, the treatment was successful and safe, leading to resolution of hypotony and reduction of the bleb with no complications. CONCLUSION: Subconjunctival bleeding can be achieved using Nd:YAG laser, and can represent a valuable alternative to autologous blood injection in cases of hyperfiltration after glaucoma surgery.

Viscocanalostomy: a pilot study.

PURPOSE: Viscocanalostomy is a new, non-penetrating procedure for glaucoma surgery. We started a prospective study to assess the effectiveness and safety of the operation. Materials and methods. Up to March 1998 we enrolled 33 patients (33 eyes) suffering from glaucoma, uncontrolled despite maximum medical therapy, who underwent viscocanalostomy according to Stegmann's technique. A complete ophthalmological examination was performed the day before surgery and on days 1 and 7 postoperatively. Further visits were scheduled at months 1, 3, 6 and 12. RESULTS: In four eyes Schlemm's canal was either missed or not deroofed properly, and the procedure was converted into simple trabeculectomy. After a mean follow-up of 3.0 +/- 2.6 months (range 1-10), success defined as IOP > 2 and < 21 mmHg with no medication was obtained in 86.2% of the cases (25/29); 23 out of 29 eyes (79.3%) had IOP > 2 and < 16 mmHg. In the 25 successful eyes, mean IOP was 27.7 +/- 9.5 mmHg (range 13-48) preoperatively and 12.0 +/- 3.0 mmHg (range 7-18) (p < 0.0001) at the end of the follow-up period. Mean VA ranged from 0.35 +/- 0.34 to 0.32 +/- 0.32 (n.s.). Intraoperative complications included: Descemet rupture (7), with iris plugging in two cases; choroidal deroofing (3), irregular incision of Schlemm's canal (2). Postoperative complications included: self-resolving 2-mm hyphema (4); IOP spike (1); inadvertent filtering bleb (2); hypotony with choroidal detachment for one week (1). CONCLUSIONS: In this short-term study, viscocanalostomy proved effective and safe in lowering IOP in glaucomatous eyes.

Nd:YAG laser iridotomy in pigment dispersion syndrome: an ultrasound biomicroscopic study.

AIMS: Ultrasound biomicroscopy was used to study the shape of the iris and the iridolenticular contact in pigment dispersion syndrome (PDS) eyes, to compare them with matched normal eyes, and to assess the morphological effects of laser iridotomy in PDS eyes. METHODS: 50 eyes of 50 patients suffering from PDS (group 1), and 15 normal eyes of 15 subjects matched for age and refraction (group 2), were studied by ultrasound biomicroscopy (UBM, Humphrey-Zeiss). Nd:YAG laser iridotomy was proposed to the 30 PDS patients with concave iris and 18 underwent the treatment. RESULTS: The iris was concave in 27 eyes in group 1, and three more eyes showed a concave iris during accommodation. Among normals, iris concavity was present in two eyes. The height of the iris convexity was -0.15 (0.24) mm (range -0.65 to +0.21), in the eyes of group 1, whereas it was +0.07 (0.10) mm (range -0.21 to +0.16) in group 2 (p < 0.0012). Group 1 had greater iridolenticular contact than group 2: 1.55 (0.78) mm (range 0.30-2.88) and 1.07 (0.61) (range 0.30-2.50; p = 0.0304). After laser iridotomy, only one eye still had a concave iris. Pre- and post-treatment deflections were -0.35 (0.18) mm (range -0.61 to -0.05) and +0.01 (0.06) mm (range -0.12 to +0.17), respectively (p < 0.0001). Pre- and post-treatment iridolenticular contact was 2.10 (0.65) mm (range 0.70-2.88) and 0.93 (0.38) mm (range 0.4-1.75), respectively (p < 0.0001). After laser iridotomy, the treated irises were flatter than normal (p = 0.0207), whereas the iridolenticular contact was not significantly different. CONCLUSIONS: Laser iridotomy can restore a normal iris shape and iridolenticular contact in eyes suffering from PDS.

Evaluation of fixation one year after perifoveal laser treatment of subfoveal choroidal neovascularization.

The natural prognosis of subfoveal neovascularization is severe visual acuity loss. Perifoveal laser photocoagulation is meant to spare a small portion of the central retina so as to possibly preserve foveal fixation. The aim of this retrospective study was to detect the persistence of central fixation and to evaluate the visual function of patients who had undergone perifoveal laser photocoagulation one year before, due to the presence of age-related macular degeneration with subfoveal neovascularization. The visual function was assessed by means of visual acuity (VA) measurement, central perimetry, scanning laser ophthalmoscope (SLO) scotometry and capability of using low-vision aids with success. Twelve eyes of 12 patients, 5 males and 7 females, with mean age 72.6 +/- 9.62 years, were included in the Study Group. Mean VA was 0.22 +/- 0.089 before laser treatment, 0.17 +/- 0.054 one week after laser treatment (p = 0.0152) and 0.13 +/- 0.063 one year after laser treatment (p = 0.045), with a statistically significant reduction of VA overtime (initial-final p = 0.0015). Mean lesion size was 2.12 +/- 0.528 disc diameters on the last follow-up fluorescein angiogram. One year after laser treatment, perimetry showed the persistence of central fixation in 2 eyes, while 10 eyes seemed to have lost it. SLO scotometry revealed central dot stimulus perception in 6 eyes and no central residual in 6 eyes. The SLO fixation plot showed persistence of central fixation also in 1 eye in which static perimetry had not detected it. The preferential retinal locus was located on the upper or upper-right margin of the lesion in 8 of the 9 eyes with paracentral fixation. All patients achieved a useful reading VA using low-vision aids, with 7.16 +/- 6.1 mean magnification power. The eyes with central visual residual on SLO scotometry had a final VA slightly higher than those without central residuals (VA 0.158 +/- 0.03 and 0.098 +/- 0.07, respectively), though the difference was not statistically significant (p = 0.0977).

Contact transscleral cyclophotocoagulation with diode laser in refractory glaucoma.

OBJECTIVE: To evaluate the clinical effectiveness of contact transscleral cyclophotocoagulation (CTCP) with diode laser. DESIGN AND PATIENTS: Forty-eight seeing eyes and 20 blind and painful eyes of 68 patients suffering from refractory glaucoma were treated using a diode laser (EOS3000, Laser Science) coupled with a 400-microns optic fiber ending in a 3-mm focusing tip. Sixteen to twenty 3.9-J (2.6 W x 1.5 to 2.5 s) laser spots were placed over 360 degrees, 1.5 mm from the corneolimbal junction. RESULTS: In the seeing-eye group, the follow-up was 20.7 +/- 8.14 months, pre- and posttreatment IOPs were 37.1 +/- 11.27 and 19.5 +/- 8.73 mmHg respectively (p < 0.0001), and success (IOP > 2 and < or = 21 mmHg) was 70.8%. No significant visual acuity change was found in the successful eyes, whereas a significant visual acuity reduction was found in the unsuccessful cases (p = 0.03). In the blind-eye group, the follow-up was 20.5 +/- 8.54 months, pre- and post-treatment IOPs were 50.7 +/- 15.05 and 20.6 +/- 13.99 mmHg respectively (p < 0.0001), and success (remission of pain) was 100%. As for complications, one seeing eye developed a spontaneously-resolved vitreous hemorrhage and one seeing and one blind eye became hypotonic, though no phthysis was observed. No conjunctival or lens damage was detected, and no scleral thinning was revealed by ultrasound biomicroscopy. No case of sympathetic ophthalmia was found. CONCLUSIONS: Diode laser can be successfully employed for CTCP in refractory glaucoma.