Comparison of combined cataract and glaucoma surgery using planned extracapsular and phacoemulsification techniques.

BACKGROUND AND OBJECTIVE: The surgical management of coexisting cataract and glaucoma is a common problem for the ophthalmologist. PATIENTS AND METHODS: We evaluated intraocular pressure (IOP) reduction and bleb formation in combined cataract and filtration surgery, comparing planned extracapsular cataract extraction (ECCE) and phacoemulsification approaches coupled with similar trabeculectomy techniques. Seventy-two eyes with primary open-angle or pseudoexfoliation glaucoma underwent combined cataract and filtration surgery. Thirty-five eyes underwent planned ECCE, intraocular lens (IOL) implantation, and trabeculectomy, and 37 eyes underwent phacoemulsification, IOL implantation and trabeculectomy. Minimum follow-up for both groups was 1 year with a mean of 16 months. RESULTS: The mean IOP reduction for phacoemulsification/trabeculectomy eyes (5.0 +/- 4.3 mm Hg) was significantly lower than the mean IOP reduction for ECCE/trabeculectomy eyes (2.9 +/- 4.1 mm Hg; P < 0.03). There was no significant difference between the groups in terms of visual acuity improvement or glaucoma medication reduction. CONCLUSION: Combined cataract and filtration surgery using phacoemulsification is associated with greater IOP reduction than combined surgery using ECCE.

Relapsing acute myeloid leukemia manifesting as hypopyon uveitis.

PURPOSE: Although acute lymphoblastic leukemia may masquerade as hypopyon uveitis, acute myeloid leukemia has only rarely been reported to cause this complication, and ocular relapse generally has been associated with evidence of malignant cells at other sites. We studied a patient with acute myeloid leukemia whose only sign of relapse was bilateral anterior uveitis with pseudohypopyon that was refractory to topical and systemic corticosteroids. METHODS: A 26-year-old woman with acute myeloid leukemia in remission, who had bilateral anterior uveitis and increased intraocular pressure at initial examination, was studied clinically. Blood films, bone marrow smears, and preparations were examined by using immunoperoxidase staining. RESULTS: Although there was no evidence of leukemia in the blood or bone marrow samples, the cells obtained from the anterior chamber showed myeloblastic leukemic cells with morphologic characteristics similar to those present in the original bone marrow biopsy obtained 14 months previously. Irradiation and chemotherapy were used to kill the malignant cells in the eye and central nervous system. The persisting glaucoma resolved after anterior chamber washout of necrotic tumor cells. CONCLUSIONS: Unusual features of uveitis in this patient indicated that she had a masquerade syndrome, despite normal results of bone marrow and blood film tests. Aspiration of intraocular cellular infiltrate for cytopathologic examination was required to obtain the correct diagnosis and enable treatment to commence without delay.

Acute uveitis associated with rifabutin use in patients with human immunodeficiency virus infection.

PURPOSE: We studied patients with a new anterior uveitis syndrome associated with rifabutin use. METHODS: Nine patients with the acquired immunodeficiency syndrome (AIDS) who developed acute anterior uveitis were identified retrospectively from institutional ophthalmology, infectious disease, and AIDS primary care practices. Five patients initially had hypopyon; in three patients hypopyon was bilateral and recurrent. The medical history, initial signs and symptoms, diagnostic examination, clinical course, and response to therapy were ascertained by a review of the medical records. RESULTS: All nine patients were being treated with rifabutin for treatment of, or prophylaxis against, Mycobacterium avium complex. In no patient was another untreated cause of uveitis found. In each patient the uveitis resolved rapidly without sequelae with treatment with topical corticosteroids alone. In eight patients uveitis resolved completely while treatment or prophylaxis for M. avium complex was maintained. CONCLUSIONS: We studied a new hypopyon uveitis syndrome in patients with AIDS who are being treated with rifabutin. The interaction of multiple drugs may contribute to this uveitis syndrome. This uveitis is remarkable because it is fulminant yet responds rapidly to topical corticosteroids. Characterization of this syndrome is important because hypopyon in the immunocompromised patient generally mandates intensive, and sometimes invasive, ophthalmic and systemic examination and therapy. Additional study is required to determine whether immune status, underlying infection, or drug-related factors contribute to the development of this uveitis syndrome. Although this syndrome remains a diagnosis of exclusion, ophthalmologists must be aware of it, so that intervention is guided appropriately.

Advantages of a cross-correlation technique for ERG measurement in children.

The measurement of ERGs of infants and children suspected of having retinal dysfunction can present some significant practical problems. Often the degree of cooperation is less than ideal, the stimulus actually reaching the retina may vary, and the level of background electrical activity can mask small responses. Single flash ERGs often are not adequate in such circumstances, and usually it is advantageous to use some form of noise reduction. Conventional averaging techniques can be used, but one disadvantage is the time required to average a significant number of responses. The use of rapid, pseudorandomly timed stimuli and a cross-correlation signal recovery procedure offers some theoretical and practical advantages. Usually a better defined response (with a higher signal-to-noise ratio) can be obtained in a relatively short time, sometimes in a few seconds. In addition, the pseudorandomly timed flash stimuli inherently contain a wide range of frequencies, so that in effect the frequency response of the outer layers of the retina is being measured. Some clinical examples will be described to illustrate the practical application of this procedure for measuring the cone and rod ERGs of young patients.

Stripe therapy for amblyopia with a modified television game.

A variation of "stripe therapy" for amblyopia was evaluated with the use of 50 amblyopic subjects. The stimulus consisted of a television game that had been modified to allow simultaneous display of the game and moving stripe patterns. Subjects used their amblyopic eye to play the game for 20 min/wk. Some of the subjects played the game with the super-imposed stripes, whereas a control group played the game without stripes. The exposure sessions continued for eight to 12 weeks, after which the subjects' visual acuities were measured for follow-up periods lasting up to a year. The visual acuities of many persons improved while they were playing the television game, but with wide variation in performance. During the six- to 12-month follow-up period, the visual acuities of patients decreased from the levels attained during the exposure period. There seemed to be no major difference between the results from persons exposed to stripes and those from the control group, either during the exposure sessions or during the follow-up period.

Use of a video-game/stripe presentation for amblyopia therapy.

A variation of "stripe therapy" for amblyopia is described, using a composite video presentation of a television game with horizontal or vertical moving stripe backgrounds. The initial study has been carried out with two groups of amblyopic subjects, one group exposed to stripe backgrounds while playing the television games, and a small control group playing the games without any striped backgrounds. A wide range of results was obtained over several weekly exposure sessions, from possibly significant improvement to essentially no change in visual acuity. The results obtained from the group exposed to striped backgrounds do not appear to be markedly better than those obtained from the control group.