Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy.

PURPOSE: To determine whether extracapsular cataract extraction and posterior chamber lens implantation combined with trabeculectomy provides better long-term results than extracapsular cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract. METHODS: In a prospective, randomized clinical trial, 35 patients with bilateral, symmetric, primary open-angle glaucoma and visually disabling cataracts were randomly selected to undergo surgery with trabeculectomy in one eye and without in the other. All procedures were performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases. RESULTS: After an average of 87 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation reduced intraocular pressure by 4.4 +/- 3.3 mm Hg, reduced the number of medications by 1.28 +/- 0.86, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in six of 35 eyes. After an average of 80 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy reduced intraocular pressure by 8.2 +/- 4.6 mm Hg (P =.0001), reduced the number of medications by 1.76 +/- 0.82 (P=.0002), increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in one eye (P =.05). Both groups had similar improvement in visual acuity and perioperative complications. CONCLUSIONS: Extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered for patients in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.

Visual outcomes after anterior vitrectomy: comparison of ECCE and phacoemulsification.

PURPOSE: To determine whether vitrectomy instrumentation improved outcomes when vitreous loss occurred during either extracapsular cataract extraction (ECCE) or phacoemulsification (PE) with posterior chamber lens implantation (PCIOL). METHODS: A consecutive series of ECCE + PCIOL (group 1: 1985-1989) and PE + PCIOL (group 2: 1993-1997) surgeries by a single surgeon was reviewed retrospectively. RESULTS: In group 1, 14 of 647 patients (2.2%) and in group 2, 9 of 665 patients (1.4%) experienced vitreous loss. In group 1, final visual acuity averaged 20/83; in group 2, 20/25 (P = .005). Average follow-up was 5.7 years (group 1) and 3.2 years (group 2). Uveitis, glaucoma, corneal problems, and retinal problems were assessed. CONCLUSIONS: Anterior vitrectomy reduced complications from vitreous loss. Fewer vitreous losses occurred with PE than ECCE. Patients with vitreous loss after PE attained better vision.

Cataract extraction and lens implantation with and without trabeculectomy: an intrapatient comparison.

OBJECTIVE: To determine whether cataract extraction and lens implantation combined with trabeculectomy provides better long-term results than cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract randomly selected to receive surgery with trabeculectomy in one eye and without in the other. METHODS: A prospective, randomized clinical trial involving 35 patients with bilateral symmetric primary open-angle glaucoma and visually disabling cataracts with procedures performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases. RESULTS: After an average of 87 months of follow-up, cataract extraction and lens implantation reduced intraocular pressure 4.4 mm Hg, reduced number of medications by 1.28, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in 6 of 35 eyes. After an average of 80 months of follow-up, cataract extraction, lens implantation, and trabeculectomy reduced intraocular pressure 8.2 mm Hg, reduced number of medications by 1.76, increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in 1 eye. Both groups had similar improvement in visual acuity and perioperative complications. CONCLUSIONS: Extracapsular cataract extraction, lens implantation, and trabeculectomy is a complex procedure that was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered in patients who may not be able to comply with a complex medical regimen, in whom pressure elevation in the immediate postoperative period would be undesirable, or in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.

Exudative retinal detachment secondary to orbital and intraocular benign lymphoid hyperplasia.

A 69-year-old white woman presented with glaucoma secondary to benign lymphoid hyperplasia and elevated episcleral venous pressure. Retinal detachment developed subsequent to trabeculectomy and cataract formation. A biopsy of orbital tissue that surrounded the vortex veins revealed mature lymphocytes. Cytology of subretinal fluid also revealed the presence of lymphocytes. Radiation therapy resulted in absorption of subretinal fluid.

Clinical experience with the Fieldmaster perimeter.

Perimetry performed on a Fieldmaster Model 200 on a consecutive series of 167 patients in a clinical practice setting demonstrated that Fieldmaster testing elicited 95% of defects found on Goldmann kinetic perimetry with very few false-positive or false-negative results; relatively unskilled personnel were able to conduct Fieldmaster testing well; and as our personnel and patients became familiar with the test, the rate of incomplete examinations declined to less than 2%.

Naturally occurring immune-complex glomerulonephritis in monkeys (Macaca irus). I. Light, immunofluorescence and electron microscopic studies.

Light, immunofluorescence and electron microscopic studies were carried out on renal biopsies from 32 randomly selected adult monkeys (Macaca irus). Histopathology was limited to glomeruli and consisted of mild to moderate segmental increases in mesangial cells, mesangial matrix, and/or glomerular basement membrane (GBM) thickness in 41% of the animals. Granular deposits of IgM were present in the mesangial region and along the GBM in 72% of the monkeys, whereas IgG, C1q, C4 and C3 were detected in approximately 30%. Electrondense deposits were seen predominantly in epithelial foot processes adjacent to the GBM and, to a lesser extent, in the mesangium. Those monkeys with the heaviest IgM deposition were found to have decreased serum levels of C3, IgM and IgA. Follow-up biopsies over a period of 3 to 11 months revealed that the disease process was persistent yet nonprogressive. No correlation with age or sex was noted. All animals examined were clinically healthy and had normal renal function. This is the first documented occurrence of spontaneous immune-complex glomerulonephritis in a large monkey population. It appears to be a persistent disease which does not progress to renal insufficiency and which may serve as an investigative model for mild nonprogressive forms of human glomerulonephritis.