Abnormal cupping of the optic disc: clinical screening before performing a neuroimaging examination.

Imaging studies in typical glaucomatous cupping are usually needless. This article reviews the various clinical presentations for considering imaging in patients presenting with cupped disc.

Emergencies in glaucoma: a review.

Most severe eye diseases and injuries ultimately require intervention by an ophthalmologist. The urgency of referral depends on various factors, including level of vision loss, duration of symptoms, and presence of comorbid diseases. Of special importance are five acute eye problems in which emergency management by primary care physicians can be critical to visual outcome: high-velocity injuries, chemical injuries, acute angle-closure glaucoma, arteritic ischemic optic neuropathy, and central retinal artery occlusion. This paper will focus on emergencies in glaucoma, especially primary and secondary closed-angle glaucoma and secondary open-angle glaucoma. Delay in presentation, and unresponsiveness to medical treatment of the acute ocular hypertension attack carry a significant risk of chronic glaucoma, whatever the mechanism of disease is. Whenever the acute glaucoma crisis does not cease with an appropriate medical treatment, a laser and/or surgical intervention needs to be urged.

Wound healing after glaucoma surgery: how to manage it?

Agents such as the antimetabolites 5-fluorouracil (5FU) and mitomycin-C (MMC) have revolutionised glaucoma surgery in patients with a high risk of surgical failure. However, vision threatening complications can be associated with the use of these agents. Changes in antimetabolites application during and after the surgery can increase the safety and reduce the complications while maintaining effectiveness.

[Low dose intravitreal triamcinolone acetonide in the treatment of neovasular glaucoma]. / Injection intravitreenne de faible dose d'acetonide de triamcinolone dans le traitement du glaucome neovasculaire.

PURPOSE: To report the effect of an intravitreal injection of 4 mg of crystalline triamcinolone acetonide (Kenacort) as symptomatic treatment of neovascular glaucoma. MATERIAL AND METHODS: This clinical study is based on clinical and experimental investigations that examined the tolerability and the angiostatic effect of triamcinolone acetonide. The study includes prospectively 8 eyes of 8 patients with neovascular glaucoma secondary to ischemic central retinal vein occlusion (n=8). All patients received an intravitreal injection of 4 mg of crystalline triamcinolone acetonide (0.1 cc) as the only procedure or in combination with transscleral cyclodiode as glaucoma treatment. Their mean age was 74.5 +/- 14.4 years. Mean intraocular pressure (IOP) was 38.9 +/- 9.3 mmHg. Mean follow-up was 6 months. RESULTS: 4 of 8 patients were treated by crystalline triamcinolone acetonide as the only procedure (n=3). Twenty seven days after intravitreal kenacort injection, the others four patients have been treated by transscleral cyclodiode (n=4) as glaucoma treatment. After injection, including the first postoperative day, patients report a subjective reduction of ocular pain. Furthermore no intra- or extraocular inflammatory reactions were observed during the follow-up. Intraocular pressure was significantly reduced to 18 +/- 6.2 mm Hg at the end of the follow-up period. When considering only the four patients in which the intraocular cortisone injection was the only procedure performed, mean intraocular pressure decreased from 41.75 +/- 7.05 mm Hg to 20.5 +/- 6.6 mm Hg. Iris neovascularisation was significantly decreased from grade IV to grade I in all patients at the end of the follow-up CONCLUSION: Intravitreal injection of 4 mg triamcinolone acetonide contributes to a better management of the neovascular glaucoma.

[Non perforating trabecular surgery with reticulated hyaluronic acid implant]. / La chirurgie non perforante du trabéculum avec implant d'acide hyaluronique réticulé.

Non perforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant (Skgel) allows aqueous humor to leave anterior chamber through a thin trabeculo-Descemet's membrane into a sclerocorneal space filled with Skgel implant and then via the outflow physiological channels. Good intraocular pressure results are obtained with less or without external filtration decreasing the incidence of per- and postoperative complications found after trabeculectomy. This surgery is actually only indicated for primary open angle glaucoma, the trabeculectomy still remaining the gold standard procedure for the other glaucoma cases.

Effect of topical betablockers on human retinal vessels diameters.

PURPOSE: To measure the effect of topical betaxolol 0.5% and timolol 0.5% on retinal vessels diameters by means of photographic enlargement. METHODS: Thirteen glaucomatous patients (primary open angle glaucoma (POAG) and ocular hypertensive (OH)) were treated twice daily with betaxolol 0.5% for one year. These same patients were subsequently treated with timolol 0.5% during the following year. Fundus photographs were taken with Canon camera 30 degree angle at baseline and two hours after instillation at 3, 6 and 12 months of treatment for each drug. The diameters of the superior and inferior temporal vessels (arteries and veins) were measured at one and two disc radii from the margin of the disc using photographic enlargement (x 66.7) of the right eye and were analysed under double masked fashion during the same session. RESULTS: A significant increase of the mean arterial diameter (+ 7.4% p = 0.000 paired t) was found after 12 months of betaxolol treatment, while no persistent further difference (+ 1.3% NS) was found after 12 months of timolol treatment. No modification was found in venous diameter. CONCLUSION: Betaxolol treatment is associated with a beneficial effect on retinal arteries width whereas Timolol does not yield the same amplitude of benefit.