A comparison of Healon and Amvisc on the early postoperative pressure after extracapsular cataract extraction with implantation of posterior chamber lens.

Two viscoelastic agents, Healon and Amvisc, both hyaluronic acids, were evaluated in two prospective, randomized and masked studies in order to compare the effects of the viscoelastics and timolol (Blocadren ) on the early postoperative intraocular pressure (IOP) after planned extracapsular cataract extraction with implantation of a posterior chamber lens. The study protocols were similar, especially with regard to the sample size, pre-, per- and postoperative management and sampling. The IOP was measured preoperatively, 3-6 and 24 h postoperatively. The testing of Amvisc revealed that aspiration or non-aspiration of Amvisc at the end of surgery was of little importance for the IOP, and that timolol significantly reduced the IOP 3-6 h postoperatively in the order of about 8 mmHg. The postoperative IOP was lower for Amvisc than for Healon only when the viscoelastic material was aspirated and topical timolol was administered. In all the other groups there were no significant differences between the viscoelastics as far as the postoperative pressure was concerned. Multiple regression revealed a marked pressure reducing effect of timolol 3-6 h postoperatively in both groups, but no effect was observed 24 h postoperatively. The two viscoelastic agents showed minor effect on the IOP both 3-6 and 24 h postoperatively.

The quantitative effect of Healon on early postoperative intraocular pressure after extracapsular cataract extraction with implantation of a posterior chamber lens.

In a prospective, randomized and masked study the quantitative effect of sodium hyaluronate (Healon) on early postoperative intraocular pressure after cataract surgery was evaluated. At the end of planned extracapsular cataract extraction with implantation of posterior chamber lens, 0.1 ml or 0.2 ml of Healon was injected into the anterior chamber. The intraocular pressure was measured preoperatively, 3-6 h and 24 h postoperatively. All patients received topical timolol at the end of surgery. The results were compared to eyes operated with identical techniques where Healon was aspirated at the end of surgery. Three to six hours postoperatively a significant drop in mean intraocular pressure from preoperative pressure occurred when Healon was aspirated, but no statistical differences in mean intraocular pressure appeared when 0.1 ml or 0.2 ml of Healon was injected. The frequencies of pressure rise above 30 mmHg show no differences among the groups. Twenty-four hours postoperatively a significant pressure elevation from mean preoperative pressure occurred when 0.1 ml or 0.2 ml Healon was injected compared to the group were Healon was aspirated at the end of surgery. Similar results are seen when pressure rise above 30 mmHg are concerned.

Evaluation of a flexible one-piece open-loop anterior chamber lens 'Symflex 350B' 3-4 years after implantation.

One-piece, open-loop flexible anterior chamber lens, Symflex 350B, was implanted in 90 eyes, 26 after extracapsular cataract extraction (ECCE), and 57 after intracapsular cataract extraction (ICCE), and in 7 cases the operation was done as a secondary implantation. The cohort was followed 3.4-4.4 years, 68 eyes were included in the last examination. At the final examination 7 eyes (10.29%) had developed corneal oedema. 6 eyes had undergone ICCE and one eye had been secondarily implanted. In no case was vaulting or malposition of the intraocular lens (IOL) found. The decompensation appeared shortly after the operation in 2 cases, one case being a secondary implantation between 1 year and 3-4 years after implantation. All extracapsularly operated eyes showed normal corneas, but the difference was not statistically significant. Neither ovalling of the pupils, nor tissue growth over the haptic feet in the anterior chamber angle, nor the visual acuity (VA) changed significantly from the 1-year to the 3-4-years examination. The intraocular pressure (IOP), however, was statistically significantly lowered 3-4 years postoperatively.

Pilocarpine drops do not reduce intraocular pressure sufficiently in pseudoexfoliation glaucoma.

The reason for the poorer prognosis of pseudoexfoliation syndrome glaucomas (PXSG) compared with primary open angle glaucomas (POAG) is not fully understood. An open, comparative, cross-over study was performed in 15 patients (= eyes) with POAG and 15 patients (= eyes) with PXSG. Two different pharmacokinetic principles of drug administration were applied to uncover possible differences in short-term (hours) response to topical antiglaucomatous treatment. Intermittent pilocarpine drop medication (2%) and continuous low-dose pilocarpine delivery by a membrane-controlled Ocusert unit (P40) were used. The 'carry-over' pressure reduction of an ordinary four times a day drop medication was significantly less effective in controlling the morning intraocular pressure (9 a.m.) in PXSG than in POAG. The duration of action of pilocarpine drops was reduced in PXSG. Defining 'normotensive' pressure as < or = 20 mmHg, only 1 of the 15 PXSG eyes (6.7%) reached a normotensive level in the morning, compared with 8 of the 15 POAG eyes (53.3%). Using a continuous supply of pilocarpine (Ocusert), no differences between POAG and PXSG eyes were found. The study demonstrates the insufficient control of intraocular pressure in PXSG, compared with POAG, by identical antiglaucomatous drop medications. This may suggest an insufficient depot function of topical drugs in PXSG. In consequence, pseudoexfoliation material (PXM) must be sought in eyes with glaucoma, as PXM eyes will probably benefit from a more intense medical treatment compared with eyes without PXM.

The effect of Healon and timolol on early postoperative intraocular pressure after extracapsular cataract extraction with implantation of a posterior chamber lens.

In a prospective, randomized, masked study the effect of sodium hyaluronate (Healon) and timolol on the acute intraocular pressure rise after extracapsular cataract extraction with implantation of a posterior chamber lens were evaluated. Intraocular pressure was measured preoperatively and 3-6 h and 24 h postoperatively. When no timolol was used, a significant rise in intraocular pressure was observed at 3-6 h, whether or not Healon was aspirated. Timolol reduced the intraocular pressure rise, especially during the first 3-6 h after surgery. When timolol was not applied at the end of surgery, IOP exceeded 30 mmHg in 28% 3-6 h postoperatively, compared to only 4% when timolol was applied.

Uncomplicated retrobulbar neuritis and the development of multiple sclerosis.

A retrospective study of 30 patients hospitalized with a diagnosis of uncomplicated retrobulbar neuritis was carried out. The follow-up period was 2-11 years; 57% developed multiple sclerosis. When the initial examination revealed oligoclonal bands in the cerebrospinal fluid, the risk of developing multiple sclerosis increased to 79%. With normal cerebrospinal fluid the risk decreased to only 10%. In the majority of cases, the diagnosis of MS was made during the first 3 years after retrobulbar neuritis.

Argon laser trabeculoplasty--5 years experience from a local eye department.

Argon Laser Trabeculoplasty (ALT) have been used in the treatment of open angle glaucoma since 1982. During a five-year period, 1982-1986, the annual rate of glaucoma filtering operations has decreased steadily from 65 to 8. The pressure reducing effect is good both in simple and capsular glaucoma. In secondary glaucoma ALT failed to control the intraocular pressure in about 50%. Simple and capsular glaucoma respond well to repeated ALT, but in secondary glaucoma repeated ALT seems to be useless.

Fundus fluorescein angiography in fundus flavimaculatus and Stargardts disease.

Three siblings who had fundus flavimaculatus and two patients who had Stargardts disease were studied by means of fundus fluorescein angiography. The angiograms revealed in all cases an abolished visibility of the chorioidal circulation. New flecks are usually non-fluorescent. Later on, hyperfluorescent areas are seen at identical places both in the preretinal and retinal phases, strongly indicating a window effect of the retinal layer. The missing chorioidal flush is probably due to a blocking effect of the emitting and exciting light. Some of the retinal flecks may fade away, leaving corresponding areas of hyperfluorescence that usually persist. In some cases, however, a previous fluorescent area may become non-fluorescent. The similar angiographic picture may indicate that fundus flavimaculatus and Stargardts disease are different expressions of the same disease.

Pilocarpine medication in open-angle glaucoma. A study using pilocarpine eyedrops and an ocular therapeutic system.

Two modes of topical pilocarpine therapy were applied to sixteen patients with open-angle glaucoma. A pilocarpine drop medication (2% solution four times daily) was compared to a constant and continuous supply of pilocarpine by a therapeutic delivery system (Ocusert P-40). The pressure reducing efficiency was studied in the morning and in the following four hour period of an ordinary drop medication regimen. The results indicate about equal pressure reducing properties in both high and low pre-treatment pressure values. However, compared to pilocarpine drops, we found a statistically significant lower pressure in the morning after the Ocusert unit, especially in glaucomatous eyes with high pre-treatment pressure.

The value of fluorescein fundus angiography in evaluating optic disc oedema.

43 patients with blurred disc margins were studied by means of fluorescein fundus angiography. The differentiation between very early disc oedema and a normal disc was possible, due to an increased capillary network, some microaneurysms and the late fluorescence located in a special circular manner at disc margin. It was not possible to differentiate between optic neuritis and papilloedema, although minor differences may exist. Ischaemic optic neuropathy is a type of optic disc oedema which clearly differs from other causes of oedema when studied by fluorescein fundus angiography. The method is especially suitable in differentiating pseudopapilloedema from genuine oedema of the optic disc.