Mitomycin C in higher risk trabeculectomy: a prospective comparison of 0.2- to 0.4-mg/cc doses.

PURPOSE: This randomized, masked, prospective study was conducted to compare the outcome of filtering surgery using doses of 0.2 mg/cc or 0.4 mg/cc of mitomycin C (MMC) in eyes that were at higher risk from previous conjunctival incisional surgery. METHODS: Eyes of 50 consecutive patients with primary open-angle, pseudoexfoliation, or pigmentary glaucoma requiring trabeculectomy who had previously undergone either limbal cataract surgery or trabeculectomy were enrolled. Patients received an intraoperative dose of either 0.2 or 0.4 mg/cc MMC for 2 minutes (n = 25 in each study group). Intraocular pressure (IOP), logMAR visual acuity, and complications were monitored at regular intervals for 1 year. Unpaired student t tests were used to compare percent decrease in IOP in both study groups at each interval. RESULTS: The percent decrease in IOP was not significantly different between groups at 1 day, 1 week, 1 month, 3 months, 6 months, or 1 year after surgery. LogMAR visual acuity was not significantly different between groups at 1 month, 6 months, or 1 year. Treatment failure occurred in seven patients in the 0.2 mg/cc group (28%) and seven patients in the 0.4 mg/cc group (29.2%). Postoperative hypotony, choroidal effusions and hemorrhages, and wound leaks occurred in both groups, but occurred more often in the group receiving 0.4 mg/cc MMC. CONCLUSION: Filtering surgery performed on higher risk eyes was as effective using a lower dose (0.2 mg/cc) of MMC as that using a higher dose (0.4 mg/cc). Incidence of complications and treatment failures was slightly higher in the group receiving high-dose MMC.

A case of orbital emphysema as an ocular emergency.

Orbital emphysema is radiologically apparent in 50% of cases of orbital fractures, but it is generally a benign, self-limited condition. However, visual loss may occur if a fracture produces orbital compression via a ball-valve effect, allowing air to enter but not leave the orbit. A case of compressive orbital emphysema complicated by ischemic optic neuropathy is reported. Intraorbital needle aspiration relieved the compression with improvement of visual acuity and normalization of intraocular pressure.

Avellino corneal dystrophy. Clinical manifestations and natural history.

PURPOSE: The pathologic features of a variant of granular corneal dystrophy has been described in which the presence of lattice changes in addition to characteristic granular lesions has been documented. The authors investigated the mode of inheritance, natural history, and clinical manifestations of this dystrophy. METHODS: A family with this condition was investigated, and a pedigree was established. Family members underwent ophthalmic examination, and ophthalmic history was obtained. In addition, pathologic examination of corneal tissue from affected patients was performed. RESULTS: Similar to the four previously described cases, this family also traced its origins to Avellino, Italy. This autosomal dominant condition affected 27 of 92 family members, ranging in age from 5 to 77 years. Granular deposits were the earliest and most common manifestations. Lattice lesions were present in some patients with granular lesions. Older patients had anterior stromal haze between deposits, which impaired visual acuity. Recurrent granular deposits were noted in donor corneal tissue after penetrating keratoplasty for this condition. Pathologic examination of corneal tissue from affected patients confirmed the presence of hyaline material seen in granular dystrophy as well as fusiform deposits of amyloid, similar to those seen in lattice dystrophy type I. CONCLUSION: This study establishes the natural history and clinical manifestations of this condition.