RESUMEN
AIMS: To compare the outcomes of neovascular glaucoma (NVG) treated with and without intravitreal bevacizumab in a large case comparison study. METHODS: The study is a retrospective, comparative, case series of 163 eyes of 151 patients with NVG, including 99 treated without and 64 treated with intravitreal bevacizumab. Medical and surgical treatments for NVG were assessed. The main outcome measures were visual acuity (VA) and intraocular pressure (IOP). RESULTS: At the time of NVG diagnosis, the median VA was count fingers (CF) in the non-bevacizumab group and 2/300 in the bevacizumab group. IOP (mean±SD) was 43.1±13.0 mm Hg in the non-bevacizumab group and 40.8±11.5 mm Hg in the bevacizumab group. IOP (mean±SD) decreased to 18.3±13.8 mm Hg in the non-bevacizumab group and 15.3±8.0 mm Hg in the bevacizumab group, and the median VA was CF in both treatment groups at a mean follow-up of 12 months. Panretinal photocoagulation (PRP) substantially reduced the need for glaucoma surgery (P<0.001) in bevacizumab treated NVG eyes. CONCLUSIONS: Although bevacizumab delayed the need for glaucoma surgery, PRP was the most important factor that reduced the need for surgery. Vision and IOP in eyes with NVG treated with bevacizumab showed no long-term differences when compared with eyes that were not treated with bevacizumab. Thus, intravitreal bevacizumab serves as an effective temporizing treatment, but is not a replacement for close monitoring and definitive treatment of NVG. PRP remains the treatment modality that affects the course of NVG in terms of decreasing the need for surgery to control IOP.
Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Glaucoma Neovascular/tratamiento farmacológico , Anciano , Antihipertensivos/uso terapéutico , Femenino , Estudios de Seguimiento , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/fisiopatología , Humanos , Presión Intraocular/fisiología , Inyecciones Intravítreas , Coagulación con Láser , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To report the long-term outcomes of patients with iridocorneal endothelial (ICE) syndrome who required surgery for glaucoma. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-six patients with ICE syndrome who underwent surgery for glaucoma at one institution between January 1987 and January 2000. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, number of glaucoma medications, and further surgical interventions were measured. RESULTS: Five eyes had a trabeculectomy with an antifibrotic agent alone, seven eyes had a trabeculectomy with an antifibrotic agent and a subsequent glaucoma drainage implant (GDI), and 14 eyes had a GDI alone. In eyes that underwent a trabeculectomy with an antifibrotic agent, preoperative IOP was reduced from a mean of 38.8 +/- 10.5 mmHg on 2.3 +/- 0.8 glaucoma medications to a mean of 11.8 +/- 4.3 mmHg on 1.2 +/- 1.4 medications at last follow-up after surgery (83.8 +/- 40.3 months). In eyes that underwent GDI surgery, preoperative IOP was reduced from a mean of 35.2 +/- 13.0 mmHg on 2.0 +/- 1.3 glaucoma medications to a mean of 8.7 +/- 11.2 mmHg on 1.2 +/- 1.1 medications at last follow-up after surgery (50.5 +/- 40.7 months). Twenty-four eyes (92%) had an IOP less than 22 mmHg, and 22 eyes (85%) had visual acuity 20/400 or better at last follow-up (55.8 +/- 41.5 months). Mean number of glaucoma surgeries per patient over the follow-up period was 1.6 +/- 1.2. Trabeculectomy with antifibrotic agents had a survival of 73% at 1 year, 44% at 3 years, and 29% at 5 years. Glaucoma drainage implants had a survival of 71% at 1 year, 71% at 3 years, and 53% at 5 years. CONCLUSIONS: Glaucoma associated with ICE syndrome can be managed successfully surgically, although multiple procedures are often needed.
Asunto(s)
Enfermedades de la Córnea/complicaciones , Endotelio Corneal/patología , Glaucoma/cirugía , Enfermedades del Iris/complicaciones , Adulto , Antihipertensivos/uso terapéutico , Fluorouracilo/uso terapéutico , Estudios de Seguimiento , Glaucoma/etiología , Implantes de Drenaje de Glaucoma , Humanos , Presión Intraocular , Persona de Mediana Edad , Mitomicina/uso terapéutico , Reoperación , Síndrome , Adherencias Tisulares , Trabeculectomía , Resultado del Tratamiento , Agudeza VisualRESUMEN
OBJECTIVE: To report the clinical course of a series of patients who had late endophthalmitis develop after glaucoma drainage implant (GDI) surgery. DESIGN: Noncomparative, interventional, consecutive case series. PARTICIPANTS: Four patients were identified with late endophthalmitis associated with Baerveldt glaucoma implants. METHODS: The medical records of all patients with endophthalmitis associated with a GDI treated at the Bascom Palmer Eye Institute or University of Florida between January 1, 1987 and December 31, 1999 were retrospectively reviewed. Patients with culture-positive endophthalmitis diagnosed more than 1 month after GDI surgery were included in this series. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure (IOP). RESULTS: Late endophthalmitis associated with Baerveldt glaucoma implants developed 7 weeks to 2 years postoperatively. Exposure of the GDI tube was present in all cases. The implant was removed in three of four patients. Visual acuity worsened from preinfection level in two of four cases. IOP was controlled at last follow-up in all patients, although replacement of the explanted GDI was required in one patient. CONCLUSIONS: Late endophthalmitis may occur after GDI surgery. Exposure of the GDI tube seems to represent a major risk factor for these infections. To prevent this potentially devastating complication, we recommend prophylactic surgical revision with a patch graft in all cases in which there is an exposed GDI tube.
Asunto(s)
Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/microbiología , Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma/cirugía , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Anciano de 80 o más Años , Antibacterianos , Remoción de Dispositivos , Quimioterapia Combinada/uso terapéutico , Endoftalmitis/diagnóstico , Endoftalmitis/terapia , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/terapia , Femenino , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Presión Intraocular , Masculino , Mycobacterium chelonae/aislamiento & purificación , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/terapia , Pseudomonas aeruginosa/aislamiento & purificación , Reoperación , Estudios Retrospectivos , Staphylococcus aureus/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación , Agudeza VisualRESUMEN
OBJECTIVE: To determine the intermediate-term outcome of 350-mm(2) Baerveldt glaucoma implants. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Sixty-five patients (65 eyes). INTERVENTION: Implantation of 350-mm(2) Baerveldt glaucoma drainage device. MAIN OUTCOME MEASURES: Intraocular pressure, number of glaucoma medications, best-corrected Snellen visual acuity, length of follow-up, risk factors for failure, and complications. RESULTS: Mean intraocular pressure was reduced from a preoperative value of 32 mmHg to a 2-year postoperative value of 14 mmHg (56% reduction, P < 0.001). Success rates at 2-year follow-up were 71%, 81%, 78%, 60%, and 47% for the overall group, primary open-angle glaucoma group, neovascular group, uveitic group, and other group, respectively. After accounting for the effect of diagnosis group, significant risk factors in the overall group for failure at 2 years included younger age, high preoperative intraocular pressure, and more prior incisional surgeries. Glaucoma medication use in our overall study population was reduced from 2.5 mean preoperative medications to 0.8 postoperative medications (68%). Median change in Snellen visual acuity between preoperative and 2-year postoperative visits was not significant in the overall group. Postoperative complications included choroidal effusion in 15 patients (23%), tube obstruction by blood or vitreous in five patients (8%), phthisis in four patients (6%), aqueous misdirection in two patients (3%), strabismus in two patients (3%), tube-cornea touch in two patients (3%), endophthalmitis in two patients (3%), and retinal detachment in two patients (3%). No patients had suprachoroidal hemorrhage. CONCLUSIONS: The 350-mm(2) Baerveldt glaucoma implants are a safe and effective treatment for intermediate-term intraocular pressure control in patients with refractory glaucoma.
Asunto(s)
Implantes de Drenaje de Glaucoma , Glaucoma/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Glaucoma/tratamiento farmacológico , Glaucoma/fisiopatología , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias , Falla de Prótesis , Implantación de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Agudeza VisualRESUMEN
PURPOSE: To report a patient with unilateral glaucoma associated with Sotos syndrome. Sotos syndrome (cerebral gigantism) is a disorder of growth and development with characteristic facial changes and normal endocrine function. Ocular manifestations may also include megalocornea, iris hypoplasia, cataracts, megalophthalmos, strabismus, nystagmus, and retinal dystrophy. METHODS: Case report. A 50 year-old man with the clinical features of Sotos syndrome presented with complaints of decreased vision in the left eye. RESULTS: Ophthalmologic examination revealed bilateral megalocornea, megalophthalmos, iris hypoplasia and transillumination defects, cataracts, and unilateral glaucoma. Intraocular pressure was lowered, and visual field loss was stabilized with topical medications. CONCLUSION: Sotos syndrome patients should be examined routinely to allow for early detection and treatment of potential ocular problems, including glaucoma.
Asunto(s)
Anomalías Múltiples/etiología , Encéfalo/anomalías , Anomalías del Ojo/etiología , Gigantismo/complicaciones , Glaucoma/etiología , Anomalías Múltiples/patología , Catarata/etiología , Córnea/anomalías , Córnea/patología , Anomalías del Ojo/patología , Humanos , Presión Intraocular , Iris/anomalías , Iris/patología , Masculino , Persona de Mediana Edad , Síndrome , Campos VisualesRESUMEN
OBJECTIVE: To describe the surgical insertion of a Baerveldt drainage implant and postoperative visual acuity and intraocular pressure (IOP) outcomes in patients with a preexisting scleral buckle. METHODS: Medical records of all patients with a preexisting scleral buckle who underwent insertion of a Baerveldt drainage implant at Bascom Palmer Eye Institute, Miami, Fla, from January 1, 1994, through December 31, 1998, were reviewed. Outcome measures included visual acuity and IOP at 1 year. RESULTS: At 1 year postoperatively, 14 (88%) of 16 patients had stable or improved visual acuity. Preoperatively, mean IOP was 30.9 mm Hg and the mean number of antiglaucoma medications was 3.4; at 1 year postoperatively, mean IOP was 12.0 mm Hg and the mean number of antiglaucoma medications was 0.8 (P<.001). Nine patients (56%) achieved an IOP of greater than 5 and no greater than 21 mm Hg without medication, and an additional 7 (44%) achieved this level of IOP control with medication. No patient required further surgery for uncontrolled IOP during the follow-up interval, which ranged from 19. 1 to 45.5 months. CONCLUSION: Baerveldt drainage device insertion behind or over a preexisting encircling band is often successful in managing refractory glaucoma in patients who have undergone previous scleral buckling procedures. Arch Ophthalmol. 2000;118:1509-1513
Asunto(s)
Implantes de Drenaje de Glaucoma , Glaucoma/cirugía , Implantación de Prótesis/métodos , Curvatura de la Esclerótica , Adolescente , Adulto , Anciano , Femenino , Glaucoma/etiología , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Desprendimiento de Retina/complicaciones , Desprendimiento de Retina/cirugía , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: To report visual acuity and intraocular pressure outcomes among patients who have undergone combined pars plana vitrectomy and placement of a glaucoma drainage implant. METHODS: The medical records of all patients who underwent combined pars plana vitrectomy and placement of a glaucoma drainage implant at the Bascom Palmer Eye Institute by one of the authors between January 1, 1990, and February 28, 1998, were reviewed. Forty patients (40 eyes) were identified, including 14 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, 15 patients with other posterior segment disease, seven patients with secondary angle-closure glaucoma, and four patients with aphakia with ruptured anterior hyaloid face. Main outcome measures included visual acuity and intraocular pressure at 1 year postoperatively. RESULTS: At 1 year postoperatively, 31 (77.5%) of 40 patients had stable or improved visual acuity; three eyes (7. 5%) had a final visual acuity of no light perception and three additional eyes (7.5%) were enucleated (because of chronic pain in two eyes and endophthalmitis in one eye). Mean preoperative intraocular pressure was 34 mm Hg and the median number of preoperative antiglaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiglaucoma medications was zero. Twenty-two patients (55.0%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mm Hg without antiglaucoma medication, and an additional seven patients (17.5%) achieved this level of intraocular pressure control with medication. Only one patient (2.5%) underwent further glaucoma surgery for uncontrolled intraocular pressure. CONCLUSIONS: Although combined pars plana vitrectomy and placement of a glaucoma drainage implant is often a successful management option in selected patients with refractory glaucoma, visual outcome may be poor because of severe underlying ocular disease and postoperative complications.
Asunto(s)
Implantes de Drenaje de Glaucoma , Glaucoma de Ángulo Cerrado/cirugía , Glaucoma Neovascular/cirugía , Vitrectomía , Adulto , Anciano , Anciano de 80 o más Años , Afaquia Poscatarata/complicaciones , Niño , Femenino , Glaucoma de Ángulo Cerrado/etiología , Glaucoma de Ángulo Cerrado/fisiopatología , Glaucoma Neovascular/etiología , Glaucoma Neovascular/fisiopatología , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Implantación de Prótesis , Enfermedades de la Retina/complicaciones , Rotura , Resultado del Tratamiento , Agudeza Visual , Cuerpo Vítreo/lesionesAsunto(s)
Segmento Anterior del Ojo/patología , Núcleo del Cristalino/patología , Subluxación del Cristalino/etiología , Facoemulsificación/efectos adversos , Anciano , Anciano de 80 o más Años , Segmento Anterior del Ojo/cirugía , Edema Corneal/etiología , Edema Corneal/patología , Femenino , Gonioscopía , Humanos , Implantación de Lentes Intraoculares , Núcleo del Cristalino/cirugía , Subluxación del Cristalino/patología , Subluxación del Cristalino/cirugía , Reoperación , Agudeza VisualRESUMEN
This study determines the relation between visual field impairment, visual functioning, and global quality of life in patients with glaucoma. Binocular visual field impairment was calculated from simultaneous Esterman visual field testing using the Humphrey automated perimeter. Visual acuity impairment, defined with the American Medical Association's Guides to the Evaluation of Permanent Impairment; visual functioning, measured with the VF-14 and the field test version of the National Eye Institute-Visual Functioning Questionnaire; and global quality of life, assessed with the Medical Outcomes Study 36-Item Short Form Health Survey, were determined in 147 consecutive patients with glaucoma. None of the Medical Outcomes Study 36-Item Short Form Health Survey domains demonstrated more than a weak correlation with visual field impairment. The VF-14 scores were moderately correlated (r = -0.58). Of the National Eye Institute-Visual Functioning Questionnaire scales, peripheral vision (r = -0.60), distance activities (r = -0.56), and vision-specific dependency (r = -0.56) were moderately correlated with visual field impairment; vision-specific social functioning, near activities, vision-specific role difficulties, general vision, vision-specific mental health, color vision, and driving were modestly correlated with visual field impairment (r value between -0.32 and -0.55); visual pain was weakly correlated with visual field impairment; and general health and vision-specific expectations were not notably correlated with visual field impairment. Statistically adjusting for visual acuity weakened the correlations. The Medical Outcomes Study 36-Item Short Form Health Survey indicated that our patients with glaucoma were comparable with previously studied patients without severe systemic medical problems. However, the Medical Outcomes Study 36-Item Short Form Health Survey scores did not correlate with visual field impairment in our study. Based on the moderate correlation between binocular visual field impairment with the VF-14 and the National Eye Institute-Visual Functioning Questionnaire, these questionnaires may be useful among patients with glaucoma.
Asunto(s)
Glaucoma/fisiopatología , Calidad de Vida , Agudeza Visual/fisiología , Campos Visuales/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Glaucoma/psicología , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Pruebas del Campo VisualRESUMEN
OBJECTIVE: To determine the outcome of outpatient treatment of bleb infection after trabeculectomy. DESIGN: Retrospective review. SETTING: University referral center. PATIENTS: Twelve eyes with bleb infection and without clinical vitreous involvement of 11 patients treated as out-patients from January 1994 to May 1996. INTERVENTIONS: After culture of the bleb surface, treatment consisted of intensive topical antibiotics alone (9 eyes), combined with subconjunctival antibiotic injection (1 eye), oral antibiotics (1 eye), or both (1 eye). Five eyes received topical corticosteroids. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure, and bleb characteristics. RESULTS: All eyes responded to treatment within 24 to 48 hours, and recovered visual acuity to within 1 line of the preinfection level. Intraocular pressure continued to be controlled after resolution of infection in 11 eyes (92%); 1 bleb failed and medical therapy was resumed. Bleb leaks were noted during treatment of infection in 11 eyes, and 5 eyes (42%) underwent bleb revision. Organisms cultured from the bleb surface included Staphylococcus aureus (8 eyes), Haemophilus influenzae (2 eyes), and Streptococcus (1 eye). Outpatient treatment costs were estimated to be 78% less than inpatient treatment costs, per 24 hours. CONCLUSION: Outpatient treatment of bleb infection was efficacious in this group of patients.
Asunto(s)
Atención Ambulatoria , Antibacterianos , Antiinflamatorios/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Glaucoma/cirugía , Complicaciones Posoperatorias/tratamiento farmacológico , Trabeculectomía/efectos adversos , Administración Tópica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/economía , Bacterias/aislamiento & purificación , Infecciones Bacterianas del Ojo/etiología , Femenino , Glucocorticoides , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Esclerótica/microbiología , Agudeza VisualAsunto(s)
Hipema/complicaciones , Enfermedades del Iris/complicaciones , Xantogranuloma Juvenil/complicaciones , Biopsia , Estudios de Seguimiento , Humanos , Hipema/patología , Hipema/terapia , Lactante , Enfermedades del Iris/patología , Enfermedades del Iris/terapia , Masculino , Xantogranuloma Juvenil/patología , Xantogranuloma Juvenil/terapiaAsunto(s)
Iris/irrigación sanguínea , Neovascularización Patológica/inducido químicamente , Enfermedades de la Retina/inducido químicamente , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Humanos , Masculino , Metilfenidato , Neovascularización Patológica/cirugía , Pentazocina , Enfermedades de la Retina/cirugía , Neovascularización Retiniana/inducido químicamente , Neovascularización Retiniana/cirugíaAsunto(s)
Fondo de Ojo , Escleritis/diagnóstico , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Disco Óptico/diagnóstico por imagen , Prednisona/uso terapéutico , Esclerótica/diagnóstico por imagen , Escleritis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Ultrasonografía , Agudeza VisualRESUMEN
Two different measures of response to therapy were evaluated in a model of keratitis caused by Aspergillus fumigatus in Dutch-belted rabbits. Combined pre and post-inoculation treatment with oral fluconazole 37.5 mg/kg bid or itraconazole 40 mg/kg bid was compared to post-inoculation treatment only and untreated controls using a standardized clinical disease severity score and quantitative isolate recovery techniques. For both drugs, there was no difference in isolate recovery rates among all three groups. However, a significant improvement in clinical disease was noted in the pre and post-inoculation treatment group compared to controls (p less than .01) and to the post-inoculation group (p less than .05) for fluconazole. A similar trend, though not statistically significant, was apparent with itraconazole treatment. This disparity highlights the difficulties associated with measuring responses to therapy in keratomycosis and emphasizes the need for more sensitive and specific measures.
Asunto(s)
Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Fluconazol/uso terapéutico , Queratitis/tratamiento farmacológico , Cetoconazol/análogos & derivados , Administración Oral , Animales , Aspergilosis/patología , Aspergillus fumigatus/efectos de los fármacos , Aspergillus fumigatus/aislamiento & purificación , Recuento de Colonia Microbiana , Modelos Animales de Enfermedad , Infecciones Fúngicas del Ojo/patología , Itraconazol , Queratitis/microbiología , Queratitis/patología , Cetoconazol/uso terapéutico , Variaciones Dependientes del Observador , ConejosRESUMEN
After intrastromal injection of a standardized inoculum of Candida albicans blastoconidia in Dutch-belted rabbits, the efficacy of subconjunctival therapy with amphotericin B and miconazole was evaluated using a quantitative isolate recovery technique. The subconjunctival injection of miconazole resulted in the recovery of significantly more viable organisms compared to the number recovered in controls (2,000 micrograms daily, P less than .02; 3,000 micrograms daily, P less than .01, respectively). Amphotericin B, in contrast, in dosages of 500 or 1,500 micrograms daily, had a significant therapeutic effect (P less than .03). The anomalous response to subconjunctival therapy with miconazole seen in this model suggests an effect on host defense mechanisms.