ABSTRACT
PURPOSE: To analyze the results of myopic epi-LASIK treatment. PATIENTS AND METHODS: Retrospective study on 55 eyes of 29 patients having undergone epi-LASIK with the Gebauer epikeratome and the Nidek EC-5000 excimer laser. The eyes were sorted into four groups depending on the degree of myopic spherical equivalence. Postoperative pain was assessed on a visual analog scale and haze was graded clinically on a scale from 0 to 5. RESULTS: The mean maximal postoperative pain during the first 24 h was graded 2.65. It was minor or absent in 41.5% of eyes. Haze was noted in 49.1% of eyes at month 3. It never exceeded 2. DISCUSSION: Epi-LASIK is more reproducible than LASEK. However, like LASEK, it does not prevent postoperative pain. Haze was also observed, although it was less frequent and intense than with photorefractive keratectomy, according to the literature. CONCLUSION: Randomized comparative double-blind studies are needed to prove that epi-LASIK is more effective and safer than the other surface laser photoablation procedures.
Subject(s)
Keratomileusis, Laser In Situ/methods , Myopia/surgery , Clinical Trials as Topic , Double-Blind Method , Humans , Myopia/classification , Randomized Controlled Trials as Topic , Reproducibility of Results , Retrospective Studies , SafetyABSTRACT
Uveitic glaucoma is a secondary form of glaucoma. Treatment is essentially medical, based on antiglaucomatous medications and immunomodulatory therapy. Therefore, some patients may need filtrating surgery to control intraocular pressure. Understanding the cellular and biochemical modifications of aqueous humor that occur during intraocular inflammation and identification of anatomical modifications of the iridocorneal angle, trabecula, pupil, and ciliary body allow physicians to adapt management depending on the different clinical patterns of uveitic glaucoma. We propose a general review of the role of inflammatory mediators and etiopathogenic mechanisms involved in uveitic glaucoma.
Subject(s)
Glaucoma/etiology , Intraocular Pressure , Uveitis/complications , Uveitis/physiopathology , Glaucoma/immunology , Humans , Uveitis/immunologyABSTRACT
PURPOSE: To report middle-term results of deep sclerectomy in uveitis patients with glaucoma who are resistant to medical therapy. PATIENTS AND METHODS: Eight eyes of eight patients (mean age, 56.9 years; range, 46-67 years) with uveitic glaucoma resistant to medical therapy underwent deep sclerectomy without antimetabolites between 1994 and 2001. All patients had their uveitis controlled before and after surgery by anti-inflammatory therapy. RESULTS: Mean follow-up was 42.2 months. Intraocular pressure was reduced from a mean preoperative value of 32.3 mmHg to a mean postoperative value of 15.2 (52.9% reduction). Success was obtained in seven eyes (87.5%). It was complete in four eyes (57.2%) and relative in three eyes (42.8%). Failure was noted in one eye (12.5%), controlled later by trabeculectomy. Antiglaucomatous medication was reduced from a mean of 2.9 medications preoperatively to 0.6 medications (79.3% reduction). Postoperative complications included one case of lens opacity and one case of hyphema. CONCLUSION: The low rate of surgical complications and the lack of failure risk factors except inflammation and long-term use of antiglaucomatous medication may explain the high success rate of deep sclerectomy in this study.
Subject(s)
Glaucoma/etiology , Glaucoma/surgery , Sclera/surgery , Trabeculectomy , Uveitis/complications , Uveitis/surgery , Aged , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
PURPOSE: To report middle-term results of trabeculectomy in patients with uveitic glaucoma resistant to medical therapy. PATIENTS AND METHODS: Seventeen eyes of 14 patients with uveitic glaucoma resistant to medical therapy were treated by trabeculectomy without antimetabolites from 1994 to 2001. The patients'mean age was 48.1 years (range, 23-63 years). All had their uveitis controlled for at least 3 months before surgery by an anti-inflammatory therapy. RESULTS: Mean follow-up was 52.1 months. Success was obtained in 11 eyes (64.7%). It was complete in five eyes (45.5%) and relative in six eyes (54.5%). Failure was noted in six eyes (35.3%), which were treated with a second filtering surgery. Intraocular pressure was reduced from a mean preoperative value of 34.2 mmHg to a mean postoperative value of 18.6 (45.6% reduction). Antiglaucomatous medication was reduced from a mean of 2.8 medications preoperatively to 1.1 medications (60.7% reduction). Postoperative complications included three cases of lens opacity, two cases of hyphema, two cases of transitory hypotony, one case of flat anterior chamber, and one case of inflammation relapse. CONCLUSION: In the absence of failure risk factors except inflammation, trabeculectomy without antimetabolites can be successful in uveitic glaucoma not controlled by medical therapy, with good results even at the middle term.
Subject(s)
Glaucoma/etiology , Glaucoma/surgery , Trabeculectomy , Uveitis/complications , Adult , Female , Humans , Male , Middle AgedABSTRACT
PURPOSE: To evaluate anatomical and functional prognosis of urgent penetrating keratoplasty in perforated infectious corneal ulcers. METHODS: Seven eyes of seven patients had an urgent penetrating keratoplasty for perforated infectious corneal ulcers. Anatomical success was defined by eradication of infection and preservation of eye from enucleation and phthisis bulbi. Corneal graft survival was defined by the presence of a clear graft. RESULTS: The patients'mean age was 40.5 years. Four eyes had bacterial corneal ulcer and three eyes had herpetic corneal ulcer. Anatomical success was obtained in six eyes. The graft remained clear in two eyes. Graft rejection was noted in four eyes after a mean period of 4.5 months. Postoperative complications were ocular inflammation (one eye), ocular hypertension (three eyes), cataract (one eye), peripheral anterior synechiae (one1 eye), graft ectasia (one eye), bacterial infection (one eye) and recurrent herpetic keratitis (one eye). The mean follow-up period was 22 months, ranging from 9 to 32 months. CONCLUSION: Urgent penetrating keratoplasty can preserve eye integrity and eradication of the infectious process in a large part of perforated bacterial and herpetic corneal ulcers. Visual rehabilitation is often a secondary objective. Adapted antimicrobial treatment reduces graft reinfection and steroid treatment reduces the frequency of some complications, especially graft rejection.
Subject(s)
Corneal Ulcer/surgery , Keratitis, Herpetic/complications , Keratoplasty, Penetrating , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Child , Corneal Ulcer/complications , Corneal Ulcer/etiology , Emergencies , Female , Follow-Up Studies , Graft Rejection , Humans , Male , Middle Aged , Postoperative Care , Postoperative Complications , Time Factors , Treatment OutcomeABSTRACT
The authors report the case of a thirteen-year-old girl who developed clinical manifestations suggestive of Schönlein-Henoch purpura and in whom biologic tests outruled this condition and led to the diagnosis of Waldenström hyperglobulinemic purpura. Investigations illustrated the immunologic nature of this disease, outruled an underlying disease and established the diagnosis of primary hyperglobulinemic purpura.
