Suprachoroidal hemorrhage after Molteno implantation.

PURPOSE: The objective of this study is to identify the rate and the associated risk factors for suprachoroidal hemorrhage (SCH) after Molteno drain implantation. METHODS: Data from the Molteno pilot study and single versus double-plate Molteno study were reviewed retrospectively for the occurrence of SCH. Follow-up intervals, demographic variables, ocular data, and medical history were collected. RESULTS: SCH occurred in 6% of the patients enrolled in the Molteno studies; all cases were delayed and none were intraoperative. Significantly associated factors in a multiple logistic regression for SCH were the extent of intraocular pressure (IOP) drop after surgery, the post-operative IOP, a diagnosis of angleclosure glaucoma, and possibly the number of prior surgeries as well. Eyes with SCH did significantly less well in terms of visual acuity outcomes and were more likely to have inadequately controlled IOP. CONCLUSIONS: This study suggests that SCH occurs at the same frequency after Molteno implantation as after filtering surgery with antimetabolite use and that eyes with SCH do less well.

Experience with the baerveldt implant in young patients with complicated glaucomas.

PURPOSE: Previous studies have suggested that glaucoma shunt implantation may be useful in the management of glaucoma in young patients in whom goniotomy and/or trabeculotomy have failed or are inappropriate. Herein, we describe our initial experience with Baerveldt implantation in young patients with complicated glaucomas. METHODS: Charts of all patients with glaucoma who were under 21 years of age, and who underwent Baerveldt implantation between March 1, 1991 and March 1, 1993 with at least a 6-month follow-up (30 eyes of 30 patients) were reviewed retrospectively. RESULTS: The patients' ages ranged from 2 months to 20 years (mean, 6.6 +/- 6.4 years) with follow-up of 6-25 months (mean, 15.0 +/- 6.3 months). Intraocular pressure (IOP) was reduced from a preoperative range of 17-78 mm Hg (mean, 35.5 +/- 13.1 mm Hg) to a range of 6-22 mm Hg (mean, 13.5 +/- 4.2 mm Hg) postoperatively. Six- and 12-month life-table success rates (6 +/- IOP +/- 21 without additional glaucoma surgery or devastating complication) were 93% and 86%, respectively. CONCLUSION: Baerveldt implantation is a useful approach to the treatment of glaucoma in young patients with complicated glaucomas.

Intermediate-term results of a randomized clinical trial of the 350- versus the 500-mm2 Baerveldt implant.

BACKGROUND: The Baerveldt glaucoma implant is a large equatorial aqueous shunting device that is installed through a single-quadrant conjunctival incision. The intermediate-term results of a randomized study comparing the 350- and 500-mm2 Baerveldt implants are reported. METHODS: Seventy-three patients with medically uncontrollable, nonneovascular glaucomas associated with aphakia, pseudophakia, or failed filters were enrolled in a randomized, prospective study comparing 350- and 500-mm2 Baerveldt implants. Surgical success was defined as 6 mmHg < or = final intraocular pressure < or = 21 mmHg without glaucoma reoperation or devastating complication. RESULTS: Of patients with 350- and 500-mm2 implants, 93% and 88%, respectively, achieved surgical success (18-month life-table analysis, P = 0.93). The 500-mm2 implants afforded intraocular pressure control with significantly fewer medications (0.7 versus 1.3; P = 0.006). The postoperative visual acuities remained within one line of the preoperative visual acuities or improved in 62% and 66% of patients in the 350- and 500-mm2 groups, respectively (P = 0.93). Complication rates were statistically similar. The most frequent ones in the 350- and 500-mm2 groups, respectively, were serous choroidal effusion (16% and 32%), strabismus (16% and 19%), anterior uveitis (14% and 11%), and corneal or corneal graft edema (11% each). CONCLUSION: The intermediate-term results of the 350- and 500-mm2 Baerveldt implants were statistically comparable with respect to surgical and visual outcomes, as well as complications, although the larger implant was associated with a higher rate of some complications. However, the 500-mm2 Baerveldt implant afforded intraocular pressure control with fewer medications than the 350-mm2 implant.

Krupin disk implantation for complicated glaucomas.

BACKGROUND: The Krupin Eye Valve with Disk (Krupin disk) is a glaucoma shunt that incorporates a slit valve intended to minimize early postoperative hypotony. METHODS: The medical records of all patients who have undergone Krupin disk implantation at the Doheny Eye Institute between July 1990 and December 1992 (25 eyes of 25 patients) were reviewed. RESULTS: Intraocular pressure (IOP) was reduced from a mean of 36.1 +/- 11.5 mmHg to 15.3 +/- 7.5 mmHg at follow-up intervals of 4 to 19 months (mean, 13.2 months). On the first postoperative day, IOPs ranged from 0 to 40 mmHg. In two eyes (8%), the IOP was less than 6 mmHg, and in five eyes (20%) the IOP was more than 21 mmHg. Serous choroidal effusion and/or choroidal hemorrhage occurred in seven patients (28%). Six- and 12-month life-table success rates (6 < or = IOP < or = 21 mmHg) were 84% and 66%, respectively. CONCLUSION: The Krupin disk lowers IOP in most patients; however, the presence of a slit valve does not eliminate either early postoperative hypotony with its attendant complications or early IOP spikes.

The potential role of ophthalmology as an entry point to the healthcare system.

PURPOSE: To evaluate whether patients who receive ophthalmic care have other physicians and whether ophthalmologists can serve as a significant entry point to the healthcare system. METHODS: Two hundred fourteen patients at a tertiary care eye institute were surveyed regarding their non-ophthalmologist physicians. Demographic, medical, and other data also were collected through the survey. RESULTS: Twenty-eight percent of patients did not have a physician healthcare provider other than their ophthalmologist at their initial visit. Fifteen percent had no other physician, whereas 13% had one as a consequence of subsequent referral by the ophthalmologist. Even among those patients who were 40 years of age and older, 31% initially only had an ophthalmologist as their sole physician provider. Being older, female, and having Medicare, a Health Maintenance Organization membership, or private indemnity insurance were associated with a higher likelihood of having non-ophthalmologist physicians. CONCLUSIONS: These results suggest that a significant number of patients seeking eye care from an ophthalmologist have no other physician. These findings stress the need for eye care providers to have thorough medical education and clinical training. In addition, eye care may serve as a useful entry point into the healthcare system for a significant number of patients in the United States.

Effect of 5-Fluorouracil on corneoscleral wound healing.

5-Fluorouracil has been advocated as an adjunct to filtration in combined extracapsular cataract extraction, intraocular lens implantation, and trabeculectomy; however, it may exert an undesirable inhibitory effect on cataract wound healing. Accordingly, the effect of 5-fluorouracil on corneoscleral wound healing was evaluated in an animal model. During the first 2 weeks following creation of full-thickness corneoscleral wounds, 40 rabbits were randomly assigned to receive either 10 subconjunctival injections of 5 mg 5-fluorouracil or normal saline. After sacrifice, 2, 4, 8, or 16 weeks postoperatively, the tensile strength of a 5-mm wound segment from each rabbit was measured with a tensiometer; histologic analysis was performed on untested portions of the wounds. 5-Fluorouracil was found to produce a trend toward decreased wound strength; however, this effect diminished over time. Histologic analysis was consistent with early inhibition of healing with resumption of healing following discontinuation of the drug. We conclude that 5-fluorouracil delays healing and development of tensile strength in rabbit corneoscleral wounds.