The effect of anterior chamber depth on endothelial cell count after filtration surgery.

Eighteen patients undergoing glaucoma filtration surgery underwent specular microscopic examination 1 day prior to surgery and 4 to 6 months after surgery. Patients were evaluated postoperatively for the presence of iridocorneal or lenticular-corneal touch, anterior chamber depth, and inflammation. Ten eyes that maintained their anterior chamber following glaucoma filtration surgery did not have a significant decrease in corneal endothelial cell density. However, eight eyes that developed a shallow anterior chamber with iridocorneal touch had a mean (+/- SD) decrease of 265 +/- 185 cells (12.4%) peripherally and 250 +/- 243 cells (11.6%) centrally in corneal endothelial cell count. None of the patients with iridocorneal touch developed corneal edema after a mean follow-up of 44.4 +/- 18.0 months. Iridocorneal touch after glaucoma filtration surgery is associated with loss of endothelial cells yet appears to be well tolerated by the cornea.

Prevention of intraocular pressure elevation following neodymium-YAG laser posterior capsulotomy.

Thirty-two eyes of 32 patients were treated with 0.5% timolol, 2% pilocarpine, or normal saline five and 30 minutes following neodymium-YAG laser posterior capsulotomy in a randomized, double-masked study. Mean maximum intraocular pressure (IOP) elevation was 8 +/- 2 mm Hg following treatment with normal saline, 5 +/- 3 mm Hg following treatment with 2% pilocarpine, and 1 +/- 2 mm Hg following treatment with 0.5% timolol. Fewer patients treated with 0.5% timolol developed an IOP elevation of 5 mm Hg or more than control patients. On aphakic patient treated with 0.5% timolol developed a maximum IOP greater than or equal to 40 mm Hg. We found that treatment with 0.5% timolol after neodymium-YAG laser posterior capsulotomy provides partial protection from IOP elevation.

Resection of solitary metastasis. Approach to palliative treatment of hepatic involvement with choroidal melanoma.

Local resection was performed as palliative treatment of solitary hepatic metastases from choroidal melanoma in two patients. One patient survived three years after partial hepatectomy, and the second patient was in excellent clinical condition one year after hepatic resection despite radiologic evidence of possible recurrent metastases elsewhere. Our review suggests that local resection of solitary hepatic metastases may constitute an effective approach to palliation of hepatic involvement with uveal melanoma and may possibly lead to longer survival.

Accessory lacrimal gland fistula secondary to ptosis surgery.

This is a case report of the development of a lacrimal fistula following repeated anterior levator resections for severe ptosis. The fistula was excised and pathologically traced to an accessory lacrimal gland. This patient represented the first documented case following an accessory lacrimal gland as the source for a fistula following levator resections for ptosis.

The influence of supplemental sodium acetate on carbonic anhydrase inhibitor-induced side effects.

A double-masked, randomly assigned, crossover trial of the effect of supplemental two-weak courses of sodium acetate (90 mEq/day) and placebo on carbonic anhydrase inhibitor (CAI)-induced side effects of malaise, fatigue, and others ("malaise symptom complex") was performed in 28 patients. Fifteen patients (54%) experienced significant improvement while receiving supplemental sodium acetate compared with five (18%) receiving a placebo. A relationship was observed between the clinical efficacy of the acetate supplementation and the measured improvement in serum carbon dioxide combining power. No changes in intraocular pressure were observed when supplemental sodium acetate was given. The results confirm the beneficial effect of supplemental alkalinization for such CAI-induced symptoms in somewhat less than half of the affected patients and suggest the need for long-term studies in which the dosage of sodium acetate is titrated in relation to measured changes in the level of metabolic acidosis.