"White-puncture": A simple technique to prevent tearing of the anterior capsule during capsulorhexis in intumescent white cataracts. / Blancopunción: una técnica simple para prevenir el desgarro de la cápsula anterior durante la capsulorrexis en cataratas blancas intumescentes.

In order to avoid radial tearing of the anterior capsule while performing continuous circular capsulorhexis (CCC) in a white intumescent cataract, called the "Argentinian flag sign" when CCC is associated with a previous capsular stain with trypan blue, an initial puncture of the anterior capsule is performed with a 30G needle as the first step of the surgical procedure, that means, prior to any previous aperture of the anterior chamber. This act seems to allow the pressure of the intracrystalline space and the pressure of the anterior chamber to be equalized, as the liquefied content of the intumescent white cataract is released into a presumably hermetic anterior chamber, avoiding the dreaded anterior capsular radial tear. This technique, called "white-puncture", has been used in 174 cases without any associated complications.

Antioxidant status in the aqueous humour of patients with glaucoma associated with exfoliation syndrome.

PURPOSE: To establish the antioxidant status of the aqueous humour in glaucoma associated with exfoliation syndrome (XFG) and to compare it to primary open-angle glaucoma (POAG) and cataract patients. METHODS: Patients were diagnosed with POAG, XFG, or cataract (n=25 for each group). Total reactive antioxidant potential (TRAP) was measured by chemiluminescence. Ascorbic acid levels and the activities of catalase, glutathione peroxidase (GPx), and superoxide dismutase (SOD) were measured spectrophotometrically.ResultsTRAP value was lower in XFG (28+/-2 microM Trolox) than in POAG (55+/-8 microM Trolox; P<0.001). TRAP values in both glaucomas were lower than the cataract value (124+/-5 microM Trolox; P<0.001). A decrease in ascorbic acid was measured in XFG (230+/-20 microM) compared with POAG (415+/-17 microM; P<0.001). Ascorbic acid in both glaucomas was lower than in cataract (720+/-30 microM; P<0.001). A significant increase in GPx was found in XFG (30+/-2 U/ml) compared with POAG (16+/-3 U/ml). GPx activity in both glaucomas was increased when compared with cataracts (6+/-2 U/ml; P<0.001). A significant increase of 67% in SOD activity was observed in the glaucoma group vscataract group (27+/-3 U/ml; P<0.001), but no changes were found between both glaucomas. CONCLUSIONS: The antioxidant status of the aqueous humour may play a role in the pathophysiology of both glaucomas.

Clinical features associated with mutations in the chromosome 1 open-angle glaucoma gene (GLC1A)

BACKGROUND: A substantial proportion of cases of glaucoma have a genetic basis. Mutations causing glaucoma have been identified in the chromosome 1 open-angle glaucoma gene (GLC1A), which encodes a 57-kd protein known as myocilin. The normal role of this protein and the mechanism by which mutations cause glaucoma are not known. METHODS: We screened 716 patients with primary open-angle glaucoma and 596 control subjects for sequence changes in the GLC1A gene. RESULTS: We identified 16 sequence variations that met the criteria for a probable disease-causing mutation because they altered the predicted amino acid sequence and they were found in one or more patients with glaucoma, in less than 1 percent of the control subjects. These 16 mutations were found in 33 patients (4.6 percent). Six of the mutations were found in more than 1 subject (total, 99). Clinical features associated with these six mutations included an age at diagnosis ranging from 8 to 77 years and maximal recorded intraocular pressures ranging from 12 to 77 mm Hg. CONCLUSIONS: A variety of mutations in the GLC1A gene are associated with glaucoma. The spectrum of disease can range from juvenile glaucoma to typical late-onset primary open-angle glaucoma.

Small incision trabeculectomy avoiding Tenon's capsule. A new procedure for glaucoma surgery.

BACKGROUND AND PURPOSE: Wound healing at the level of Tenon's capsule is a common cause of trabeculectomy failure. The purpose of this study is to present a new technique for glaucoma filtering surgery in which an injury to Tenon's capsule is minimized. METHODS: A 2.5-mm conjunctival peritomy was performed without cutting Tenon's capsule. A partial-thickness incision was made at the limbus and a scleral pocket was dissected 2 to 3 mm posteriorly. The subconjunctival space was entered with a cystotome passed through the scleral pocket, and balanced salt solution (BSS, Alcon Laboratories, Ft. Worth, TX) was injected, forming a subconjunctival bleb. In patients considered high risk, 5-fluorouracil (5 mg) was mixed with the BSS injected. The anterior chamber was entered at the initial limbal incision. A 1.5- by 1-mm fragment of the floor of the pocket was excised, followed by a peripheral iridectomy. The scleral wound, as well as the conjunctiva, was closed with separate 10-0 nylon sutures. This procedure was performed in 30 glaucomatous eyes. Seven high-risk eyes received four to seven postoperative injections of 5 mg of 5-fluorouracil. RESULTS: Preoperative intraocular pressure (IOP) was 34.5 +/- 8.1 mmHg. Postoperative IOP was 13.2 +/- 4.1 at 6 months (P < 0.01), and 90% of the eyes had IOP less than or equal to 18 mmHg without medication. Mean follow-up was 7.6 months (range, 6-14 months). Blebs were low-lying and diffuse. No serious complications were encountered. CONCLUSIONS: This new technique is a safe procedure that effectively reduces IOP. It is done through a small incision without sophisticated instruments. More cases and a prospective trial are needed to ascertain its potential advantages over those of conventional trabeculectomy.