Control of intraocular pressure after deep sclerectomy.

AIM: To study the long-term outcome of deep sclerectomy in patients with open angle glaucoma. METHODS: Prospective consecutive series of 43 eyes (38 patients) with medically uncontrolled open-angle glaucoma undergoing deep sclerectomy. All patients underwent clinical assessment before and after surgery at day 7 and at months 1, 3, 6, 12, 18, 24, 36. Surgical success was considered if the patient's intraocular pressure (IOP) < 22 mmHg and the IOP was lowered by more than 20% without the use of any medication. Kaplan-Meier survival curves were used to evaluate the success rate. RESULTS: The mean follow-up time was 28.1 +/- 8.2 months. Mean IOP decreased significantly from a preoperative value of 24.6 +/- 5.5 mmHg to a postoperative value of 18.5 +/- 4.6 mmHg at 36 months (P < 0.001). Microperforation of TDM occurred in three cases (7.0%) and ciliary body prolapse in one case (2.3%) but did not prevent completion of the operation. Postoperatively, hyphaema was detected in one case and shallow anterior chamber in another case and both were treated conservatively. Bleb encapsulation with elevation of IOP occurred in two cases (4.7%) and was treated with 5-fluorouracil subconjunctival injection. Goniopuncture with neodymium : YAG laser was performed in two cases (4.7%). There were no other late complications with the exception of failure of the operation. On the life-table analysis the success rate at 12, 24, and 30 months were 61.4, 36.6, and 18.9%, respectively. CONCLUSION: Deep sclerectomy reduced the IOP temporarily while minimising the risk of postoperative complications commonly encountered with standard trabeculectomy. However, after long-term follow-up surgery failed to maintain a low IOP.

Ultrasound biomicroscopy in deep sclerectomy.

PURPOSE: To evaluate by ultrasound biomicroscopy (UBM) the anatomical characteristics and the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy after long-term follow-up. METHODS: In all, 22 eyes of 21 consecutive patients who had deep sclerectomy were examined by UBM. Several UBM variables were prospectively evaluated, including the presence and maximum length and height of the intrascleral space, the minimum thickness of residual trabeculo-Descemet membrane (TDM), the presence and type of subconjunctival filtering bleb, and the presence of other possible drainage sites, for example suprachoroidal. Surgical success was considered to be achieved when the IOP was <22 mmHg and the IOP was lowered by more than 20% without the use of any medication. The possible association between UBM variables and the surgical outcome was determined. RESULTS: The mean time between surgery and the UBM examination was 12.0+/-5.3 months. The mean IOP decreased significantly from a preoperative value of 23.7+/-4.0 to 16.0+/-3.9 mmHg at the time of UBM (P<0.01). There was a poor correlation between the level of IOP at the time of UBM and the length of intrascleral space (r2=0.0016), the height of the intrascleral space (r2=0.136), or the thickness of remaining TDM (r2=0.0009). The presence and type of filtering bleb were not associated with the success. CONCLUSIONS: In patients undergoing deep sclerectomy, UBM examination after long-term follow-up showed the presence of an intrascleral space and a filtering bleb in most patients. The surgical outcome was not associated with the UBM variables of the surgical area.

Colour vision of diabetics.

The Farnsworth-Munsell 100-hue test has been assessed as a screening test for the detection of diabetic retinopathy likely to benefit from laser photocoagulation therapy. Two hundred and thirty-two diabetic eyes of 126 patients were tested. The results were assessed both for total error score relative to age and for the presence of polarity. Although the incidence of abnormal colour discrimination was found to correlate with the severity of retinopathy, the test was not sufficiently selective to be of value as a screening test in the detection of retinopathy requiring treatment.

Acute phthisis bulbi and external ophthalmoplegia in herpes zoster ophthalmicus.

A patient developed acute phthisis bulbi and external ophthalmoplegia with herpes zoster ophthalmicus (HZO). The clinical course and ocular complications of HZO are described briefly and the cause of phthisis bulbi and external ophthalmoplegia in zoster ophthalmicus is discussed. It is suggested that the acute hypotonia in HZO is due to an ischemic necrosis of the ciliary body, resulting from an occlusive vasculitis which may also be responsible for the external ophthalmolplegia.

Optic nerve sarcoidosis: a report of three cases.

Three cases are reported of sarcoidosis, confirmed by a positive Kveim-Silzbach test, presenting with optic nerve swelling. One case subsequently developed gross peripheral retinal ischaemia. Two cases developed peripapillary disciform lesions, with subretinal neovascularization.

Serious retinopathy in a diabetic clinic: prevalence and therapeutic implications.

In a series of 1000 patients examined consecutively in a large diabetic clinic, 95 (9.5%) were classified as having serious diabetic retinopathy. The definition was confined to exudative retinopathy (macular oedema or hard exudates encroaching upon the macula), proliferative retinopathy, and retinal ischaemia (as evidenced by the presence of soft exudates in the absence of hypertension, together with characteristic vascular changes). The diagnosis of serious diabetic retinopathy is always accompanied by a need for specialised ophthalmological assessment (including fluorescein angiography) and, often, urgent photocoagulation. Investigation and treatment are time-consuming, and such patients therefore constitute a major workload for the ophthalmological services: the average time for an ophthalmic consultation was found to be 20 min, and when fluorescein angiography was added to this the time increased to 40 min. The average time spent on photocoagulation for neovascularization was 2 h for each eye, and for exudative retinopathy 30 min for each eye.