[Use of antiglaucoma therapy to reduce acute intraocular pressure rise following neodymium: YAG laser iridotomy in angle-closure glaucoma patients]. / Lokalna terapija glaukoma u redukciji akutnog povisenja intraokularnog tlaka u bolesnika s glaukomom zatvorenog kuta nakon neodymium: YAG laserske iridotomije.

AIM: To evaluate the efficacy of topical antiglaucoma therapy in reducing acute intraocular pressure (IOP) elevation after neodymium: Yag laser iridotomy. PATIENTS AND METHODS: Primary angle-closure glaucoma (PACG) eyes were randomized to receive premedication with latanoprost and pilocarpine, brimonidine 0.2% and pilocarpine or only with pilocarpine before Yag laser iridotomy. Postoperative IOP changes were compared with Wilcoxon signed-ranks test using the fellow eyes in each group. RESULTS: Postoperative pressure spikes were significantly lower in the groups of patients with local antiglaucoma therapy with pilocarpine than in the control group. Mean elevation of IOP was less in the groups of patients with local antiglaucoma therapy with pilocarpine at 2 hours postoperatively. CONCLUSION: Local antiglaucoma therapy may reduce the acute IOP rise following Yag laser iridotomy in PACG eyes.

[Combined laser treatment in the management of acute and subacute primary angle closure glaucoma]. / YAG laserska iridotomija i argonska laserska iridoplastika--kombinirani laserski zahvat u lijecenju akutnog i subakutnog primarnog glaukoma zatvorenog kuta.

UNLABELLED: Primary angle closure glaucoma remains a disease with high visual morbidity worldwide. Patients with primary angle closure glaucoma may have dramatic signs and symptoms that can lead to permanent blindness in a short period of time if not properly treated. Conventionally, medical treatment was used to lower the intraocular pressure (IOP), followed by laser peripheral iridotomy. It acts by elevating pupillary block present in the condition. Laser peripheral iridoplasty is a tehnique using low energy contraction burns to mechanically pull open the angle, thereby reducing the IOP. AIM: The aim of this study was to evaluate the therapeutic effect and safety of combined laser technique (argon laser iridoplasty and YAG laser peripheral iridotomy) in the management of medically unresponsive acute and subacute angle closure glaucoma. PATIENTS AND METHODS: Sixteen eyes with acute and subacute primary angle closure glaucoma unresponsive to medical treatment were included in the study. All patients were treated by laser tehnique that included YAG laser peripheral iridotomy and argon laser iridoplasty in the eye without satisfactory response to previous laser treatment. We also documented complications of laser treatment. The IOP levels were documented by applanation tonometry. RESULTS: In 14 of 16 eyes combined laser treatment resulted in rapid IOP reduction. Only two patients failed to respond to the combined laser therapy and were surgically treated (clear lens extraction). No serious laser complications were recorded during the early period after laser therapy. CONCLUSION: YAG laser peripheral iridotomy and argon laser iridoplasty as a combined treatment may be useful for IDP lowering in the management of medically unresponsive acute and subacute primary angle closure glaucoma.

Analysis of the qualitative dermatoglyphics of the digito-palmar complex in patients with primary open angle glaucoma.

The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10-30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito-palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.

Trabeculectomy with mitomycin C in glaucoma associated with uveitis.

The patients with uveitic glaucoma are at high risk for failure following drainage surgery because of young age of these patients, preoperative long-term control of inflammation and postoperative complications. Twenty-two trabeculectomies performed in 22 patients with uveitic glaucoma were retrospectively evaluated to analyze the effect of intraoperative application of mitomycin C (MMC). Success rates, postoperative levels of intraocular pressure (IOP) and postoperative complications were studied. After a mean follow-up of 10.6 months (range, 5-28 months), 15 patients (68.2%) achieved IOP of 21mmHg or less without antiglaucoma medications. There were statistically significant reduction in IOP postoperatively during the period studied (p < 0.001). Early postoperative complications included chorioidal detachment (9.1%), shallow anterior chamber (9.1%), hyphema (13.6%), macular edema (4.5%) and raised IOP (27.3%). Late postoperative complications included exacerbation of uveitis (4.5%), macular edema (4.5%), cataract (22.7%) and raised IOP (31.8%). The eyes with raised IOP needed additional antiglaucoma medication. The results of this retrospective and uncontrolled study suggest that intraoperative application of MMC may be a good option for enhancement of short-term trabeculectomy success rates in patients with uveitic glaucoma.