Intravitreal sustained-release ganciclovir.

Current treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome involves frequent intravenous administration of sodium ganciclovir that often results in unacceptable side effects. We have developed devices that release ganciclovir at rates of 2 micrograms/h and 5 micrograms/h in vitro. When implanted into the vitreous of rabbit eyes, mean intravitreal ganciclovir levels of 9 mg/L and 16 mg/L were maintained for more than 80 and 42 days, respectively. Devices were well tolerated, with no toxic effects attributable to the polymers used in the devices. This investigation indicates that these devices can maintain therapeutic levels of drug for extended periods and are well tolerated in the rabbit eye. They may prove useful in the clinical management of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome.

The relationship of mean defect to corrected loss variance in glaucoma and ocular hypertension.

Statistical analysis of visual-field data is permitted by the quantitative techniques used in automated perimetry. The visual-field indices mean defect (MD) and corrected loss variance (CLV) provide an opportunity to analyze and follow visual fields mathematically. We investigated the relationship of MD to CLV in 32 glaucoma suspects and 17 patients with visual-field defects due to chronic open-angle glaucoma. In glaucoma patients with early and moderate disease (up to a MD of 18 dB), the CLV statistically covaried with the MD (R2 = 0.85). Beyond an MD of 18 dB, increases in the MD seemed to cause a decline in the CLV. These results differ from prior reports on the relationship of MD and CLV. Reasons for this and implications for the use of these statistics in the clinical management of the glaucoma patient are discussed. These results may be helpful in the understanding of the pathophysiologic basis of damage in glaucoma.

The use of viscoelastic substances in the drainage of postoperative suprachoroidal hemorrhage.

Suprachoroidal hemorrhage is a serious surgical complication occurring in up to 10% of aphakic patients undergoing filtration surgery. Surgical treatment includes drainage of the hemorrhage through sclerotomies and reformation of the anterior chamber with balanced salt solution or air. Two patients are presented whose suprachoroidal hemorrhages were managed with the instillation of 10% sodium hyaluronate. The intraocular administration of a space-occupying fluid produces an even distribution of hydraulic force to facilitate drainage of the hemorrhage and avoids the optical problems associated with the use of intraocular air. While most cases of suprachoroidal hemorrhage can be effectively managed using balanced salt solution or air, we believe that viscoelastic agents may be of special benefit in selected situations.

Lens subluxation as a complication of cyclocryotherapy.

There are many well known complications of cyclocryotherapy. This case represents what we believe to be the first report of cyclocryotherapy leading to lens subluxation. The patient was a 14-year-old boy with a history of ocular trauma that had resulted in intractable glaucoma. Six locations were treated inferiorly using the freeze-thaw-freeze technique. Postoperatively the patient's zonular attachment was disrupted inferiorly and the lens subluxated superiorly. While remote trauma may have been partly responsible, we suspect that the cyclocryotherapy precipitated the lens subluxation.