Visual experience during phacoemulsification-trabeculectomy under peribulbar anesthesia.

BACKGROUND AND OBJECTIVE: To investigate the subjective visual experience of patients with concurrent cataract and glaucoma during phacoemulsification-trabeculectomy under peribulbar anesthesia. PATIENTS AND METHODS: Consecutive patients with concurrent cataract and glaucoma who underwent phacoemulsification-trabeculectomy under peribulbar anesthesia for the first time were interviewed using a standardized questionnaire between 30 minutes and 4 hours after the surgery. They were asked about their intraoperative visual experiences and their reaction to their visual experience. There was no preoperative discussion with the patients on possible intraoperative visual sensations that they might experience. No preoperative or intraoperative sedation was used. RESULTS: Sixty patients with a mean age of 64.8 years (range: 41 to 86 years) were included in the study. Light perception was reported by 73.3% of patients and no light perception by 26.7% throughout the operation. Some patients reported they could also see movements (65%), flashes (53.3%), one or more colors (48.3%), a change in light brightness (38.3%), instruments (8.3%), and/or the surgeon/medical staff (1.7%). Of the 29 patients (48.3%) who saw one or more colors, 18 patients saw yellow, 12 blue, 4 green, 2 orange, and 1 red. One patient (1.7%) found the visual experience frightening and the rest (98.3%) found theirs pleasant. CONCLUSION: The majority of patients with concurrent cataract and glaucoma undergoing phacoemulsification-trabeculectomy using peribulbar anesthesia experience a variety of visual sensations, although only a minority was frightened by the visual experience.

Betaxolol hydrochloride ophthalmic suspension 0.25% and timolol gel-forming solution 0.25% and 0.5% in pediatric glaucoma: a randomized clinical trial.

PURPOSE: To describe the safety profile and clinical response on elevated intraocular pressure (IOP) of betaxolol hydrochloride ophthalmic suspension 0.25% (betaxolol) and timolol maleate ophthalmic gel-forming solution (TGFS) (0.25% and 0.5%), in subjects under 6 years of age. METHODS: Subjects were randomized to betaxolol 0.25% (twice daily) or TGFS (daily) (0.25% or 0.5%) in this double-masked study. IOPs were obtained at the same time of day (9 AM) at 2 baseline visits and weeks 2, 6, and 12. Mean change from baseline in IOP was the primary efficacy parameter. RESULTS: One hundred five subjects were randomized (34 to betaxolol, 35 to TGFS 0.25%, 36 to TGFS 0.5%). Betaxolol, TGFS 0.25%, and TGFS 0.5% produced statistically significant mean reductions in IOP; mean reductions after 12 weeks of treatment were 2.3, 2.9, and 3.7 mm Hg, respectively. In subjects who were not being treated with topical IOP-lowering medication at baseline, mean IOP reductions after 12 weeks of treatment were 3.1, 4.8, and 3.8 mm Hg, respectively. In patients discontinuing 1 or more topical IOP-lowering medications at baseline, mean IOP reductions at Week 12 were 1.8, 1.8, and 3.7 mm Hg, respectively. Responder rates (> or =15% reduction from baseline) for betaxolol, TGFS 0.25%, and TGFS 0.5% were 38.2, 45.7, and 47.2%, respectively. Adverse events were predominantly nonserious and did not interrupt patient continuation in the study. CONCLUSIONS: Betaxolol ophthalmic suspension 0.25%, TGFS 0.25%, and TGFS 0.5% were well tolerated. Despite low responder rates, all 3 treatments produced statistically significant mean reductions in IOP in pediatric glaucoma subjects.

Suprachoroidal hemorrhage following removal of releasable suture after combined phacoemulsification-trabeculectomy.

We report a case of suprachoroidal hemorrhage following removal of a releasable suture after combined phacoemulsification-trabeculectomy.

Mutation analysis of the cathepsin C gene in Indian families with Papillon-Lefèvre syndrome.

BACKGROUND: PLS is a rare autosomal recessive disorder characterized by early onset periodontopathia and palmar plantar keratosis. PLS is caused by mutations in the cathepsin C (CTSC) gene. Dipeptidyl-peptidase I encoded by the CTSC gene removes dipeptides from the amino-terminus of protein substrates and mainly plays an immune and inflammatory role. Several mutations have been reported in this gene in patients from several ethnic groups. We report here mutation analysis of the CTSC gene in three Indian families with PLS. METHODS: Peripheral blood samples were obtained from individuals belonging to three Indian families with PLS for genomic DNA isolation. Exon-specific intronic primers were used to amplify DNA samples from individuals. PCR products were subsequently sequenced to detect mutations. PCR-SCCP and ASOH analyses were used to determine if mutations were present in normal control individuals. RESULTS: All patients from three families had a classic PLS phenotype, which included palmoplantar keratosis and early-onset severe periodontitis. Sequence analysis of the CTSC gene showed three novel nonsense mutations (viz., p.Q49X, p.Q69X and p.Y304X) in homozygous state in affected individuals from these Indian families. CONCLUSIONS: This study reported three novel nonsense mutations in three Indian families. These novel nonsense mutations are predicted to produce truncated dipeptidyl-peptidase I causing PLS phenotype in these families. A review of the literature along with three novel mutations reported here showed that the total number of mutations in the CTSC gene described to date is 41 with 17 mutations being located in exon 7.