Longitudinal evaluation of central corneal thickness in congenital glaucoma.

PURPOSE: To assess the central corneal thickness in primary congenital glaucoma before and after surgical treatment and compare it with a normal population. METHODS: We conducted a longitudinal analysis of primary congenital glaucoma patients, in whom we measured central corneal thickness before and after treatment (Group 1). We compared our results with a normal population (Group 2), who underwent ophthalmological examination under anesthesia for other reasons. RESULTS: Mean age (months) in Group 1 (N=23) and Group 2 (N=40) at the time of the first exam was 5.5 and 9.2 (P=0.004), respectively. Mean central corneal thickness (microns) in Group 1 was: 663 before treatment and 557 after treatment (P<0.001). In Group 2, mean central corneal thickness (microns) was 551. Comparisons show statistical difference between mean values before and after treatment (P<0.001), but not between post-treatment CCT mean values in Group 1 and mean CCT values in Group 2 (P=0.627). CONCLUSION: In primary congenital glaucoma, central corneal thickness values show unique peculiarities. They are higher than normal before treatment (thicker corneas), due to corneal edema caused by elevated intraocular pressure. After surgical treatment, central corneal thickness measurements decrease toward the mean values for the normal population.

[How should we follow end-stage glaucoma?]. / Comment surveiller un glaucome agonique ?

End-stage glaucoma is characterized by a near total structural loss and similarly deteriorated visual function. It is very difficult to follow patients in this stage of the disease by standard automated perimetry. The purpose of this article is to discuss how to better follow patients with end-stage glaucoma. Monitoring of glaucoma must take into account the measurement of intraocular pressure, structural evaluation and functional assessment. Structural evaluation has only minor importance at this stage, and the most useful tool is qualitative analysis, especially through stereo disc photography, looking for disc hemorrhages. Conversely, functional assessment is of major importance. Specific techniques and strategies should be used. Patients' complaints are very important in this stage of glaucoma. Trial frames are very useful for accurate testing of visual acuity, and are preferable to phoropters. Visual field measurement must be adapted to this end stage of glaucoma, by using targeted strategies, such as: testing the central 10 degrees, testing a 24-2 field with a size V stimulus, and Goldmann perimetry. Any slight sign of worsening must be taken into account, so as to detect any progression of the disease.

Topical versus peribulbar anesthesia in non-penetrating deep sclerectomy. A cost-effectiveness analysis.

AIM: To assess the costs and cost-effectiveness ratio of topical and peribulbar anesthesia in non-penetrating deep sclerectomy for the surgical treatment of open-angle glaucoma. PATIENTS AND METHODS: We evaluated the associated direct costs with both topical and peribulbar anesthesia. Effectiveness was defined as the proportion of patients that experienced no pain during the surgical procedure and was obtained from the literature. Cost-effectiveness was defined as direct cost of anesthesia per patient with no pain. We also calculated the incremental cost-effectiveness ratio (ICER) in order to determine which intervention was dominant. RESULTS: Direct costs were US$ 45.60 and US$ 49.18 for topical and peribulbar anesthesia respectively. The great majority of patients experienced no pain with any of the procedures (91.7% for the topical group and 69.7% for the peribulbar group). Cost-effectiveness ratio was US$ 49.73 for topical anesthesia and US$ 70.56 for peribulbar anesthesia. The ICER was negative and topical anesthesia was dominant over peribulbar anesthesia. CONCLUSION: Topical anesthesia was less costly and more effective than peribulbar anesthesia in avoiding pain in non-penetrating deep sclerectomy.

[Multifocal, toric, and aspheric intraocular lenses for glaucoma patients]. / Implants multifocaux, toriques et asphériques pour les patients glaucomateux.

Cataract surgery has greatly developed over recent years, mainly due to the introduction and availability of newer intraocular lenses (IOLs) with modern platforms and better visual outcomes. Aspheric, multifocal, and toric lenses are among these new lenses. Glaucomatous eyes have a number of particularities that can influence the way these implants are indicated and used. Contrast sensitivity is usually reduced in eyes with glaucoma and, sometimes, a poor IOL choice can aggravate the disease. Small pupils and zonular weakness are frequently associated with certain types of glaucoma (e.g. pseudoexfoliative glaucoma) and can limit the indication of some of the newer IOLs. Lastly, in some cases of combined surgery, the postoperative axial length and anterior chamber depth can change after surgery, requiring adjustments in the IOL power calculation. The purpose of this article is to quickly review some of the specific features of cataract surgery in the glaucomatous eye, some of the IOL choices, and the necessary precautions for these eyes.

[Anesthesia in glaucoma surgery]. / L'anesthésie dans la chirurgie du glaucome.

Various types of anesthesia, as well as different surgical techniques are available in glaucoma surgery. This study's purpose is to review and update the different possibilities of anesthesia according to the various types of surgical procedures in glaucoma. The different types of anesthesia for glaucoma surgery are general anesthesia, local anesthesia or topical anesthesia. In children, general anesthesia has an absolute indication, whatever the surgical procedure to be used. In adults, literature demonstrates that local anesthesia (retrobulbar or peribulbar) is the most frequently used technique. There is a growing interest in topical anesthesia, which has brought many advantages, for glaucoma surgery (trabeculectomy, deep sclerectomy, aqueous shunt surgery and combined procedures). Choice among the different modalities of anesthesia has to be done according to various parameters based on both patient and surgeon point of view. A close link between surgeon and anesthesiologist is of an utmost importance to ensure the most efficient, comfortable, and appropriate anesthesia for each individual patient.

[Topical versus peribulbar anesthesia in nonpenetrating deep sclerectomy]. / Anesthésie topique versus anesthésie péribulbaire dans la sclérectomie profonde non perforante.

INTRODUCTION: Ophthalmic surgery has developed enormously over the past few years. Topical anesthesia is a safe and current procedure in cataract surgery, giving patients quicker and more comfortable recovery. Some authors have used this type of anesthesia for trabeculectomy with good results. This study aims to assess the patient's pain and comfort during and 1 day after nonpenetrating deep sclerectomy compared to peribulbar anesthesia. METHOD: A visual analog pain scale (0-10) was applied to 69 patients 15 min and 24 h after a nonpenetrating deep sclerectomy procedure. Topical anesthesia (proximetacaine 0.5% drops) associated with an intravenous sedation with propofol was used in 36 patients (group 1) and peribulbar anesthesia (lidocaine 2% associated with bupivacaine 0.75%) was given to 33 patients (group 2) in a randomized and prospective way. The surgical team was the same for all procedures. Results were compared using a Mann-Whitney U test. RESULTS: Mean age (+/- standard deviation) was 60.25+/-15.90 years in group 1 and 59.15+/-15.36 years in group 2 (p=0.871). For the first evaluation (15 min after surgery), the mean values and their respective deviations were the following: 0.11 +/- 0.40 (0-2) in group 1 and 0.82+/-1.49 (0-5) in group 2 (p=0.014). After 24 h, the mean values and deviations were as follows: 2.83 +/- 1.34 (1-6) in group 1 and 2.45+/-2.09 (0-8) in group 2 (p=0.125). DISCUSSION: Pain perception by the patient undergoing nonpenetrating deep sclerectomy was statistically different between the two groups in the first evaluation (15 min after the procedure). The topical anesthesia (associated with propofol sedation) group had less pain sensation. The first 24 h assessment showed no significant difference between the groups. CONCLUSION: Topical anesthesia (associated with propofol sedation) is a valuable and interesting alternative for patients undergoing nonpenetrating deep sclerectomy, providing the same or slightly better comfort than peribulbar anesthesia.