Phacoemulsification in patients with previous trabeculectomy: role of 5-fluorouracil.

UNLABELLED: Cataract surgery in a patient with previous trabeculectomy is considered to have an adverse effect on the long-term survival of the filtering bleb. 5-Fluorouracil (5-FU) has been used in patients with a pre-existing bleb, undergoing cataract surgery, but there are no published reports for or against its use in such cases. This study was carried out to evaluate the protective role of subconjunctival 5-FU on the pre-existing bleb from trabeculectomy in patients undergoing phacoemulsification. METHODS: This retrospective study was carried out on patients with pre-existing filtering bleb from trabeculectomy for primary open-angle glaucoma who then underwent phacoemulsification at least 12 months after trabeculectomy. Data were collected for two groups of patients. Group 1 (22 patients) received 5-FU at the end of successful phacoemulsification, whereas group 2 (25 patients) did not receive it. The two groups were comparable with respect to age, gender, intraocular pressure (IOP), type of glaucoma, number of adverse risk factors present, and duration of follow-up. Any worsening of IOP control was analysed using mean IOP and mean change in the treatment for glaucoma. RESULTS: Mean IOP was comparable in the two groups, but there was a significant difference in mean change in glaucoma treatment between the two groups at 12 months postoperatively. Worsening of IOP control was seen in 13.6% of the patients in group 1 and in 36.4% in group 2 (P-value=0.03). CONCLUSION: Our study suggests that 5-FU has a protective effect on the functioning bleb and may be used routinely at the end of phacoemulsification in such cases.

The treatment of encapsulated trabeculectomy blebs in an out-patient setting using a needling technique and subconjunctival 5-fluorouracil injection.

PURPOSE: Encapsulation of the trabeculectomy bleb is a common cause of drainage failure in the early post-operative period. The primary management of bleb encapsulation has previously been to restart medical therapy, but recent advances in the technique of needle manipulation and the introduction of adjunctive 5-fluorouracil (5-FU) have increased the popularity of early surgical bleb management. By reporting the results of bleb needling in a series of patients, we aim to illustrate its safety and efficacy. METHODS: We have reviewed a series of 32 eyes in which needling and 5-FU injection was performed for bleb encapsulation, and analysed the results over a follow-up period of 10.7 +/- 2.9 months. RESULTS: In 14 (43.7%) cases, primary needling was performed; in the other 18, needling was performed after conservative treatment had proved inadequate. The mean intraocular pressure (IOP) of the group decreased from 29.2 +/- 10.5 mmHg prior to needling to 15.9 +/- 4.0 mmHg at the most recent attendance (paired t-test p = 1.3 X 10(-7), with all eyes having a final IOP measurement of 22 mmHg or less. Twenty-three (71.9%) of the cases maintained a target IOP of 18 mmHg or less without additional treatment; 5 (15.6%) were qualified successes with an untreated IOP between 19 and 21 mmHg. The remaining 4 (12.5%) patients, whose IOPs ranged between 20 and 22 mmHg with one hypotensive agent, were considered needling failures. Choroidal detachment complicated the procedure in 2 cases; in each this resolved with conservative management and without long-term visual consequence. CONCLUSION: This technique is recommended as a safe and effective method of treating bleb encapsulation.

Posterior scleritis--an unusual manifestation of Cogan's syndrome.

Cogan's syndrome is characterized by a non-luetic interstitial keratitis associated with vertigo, tinnitus and profound deafness. Evidence of a systemic vasculitis is found in up to 50% of patients. Atypical forms of Cogan's syndrome have been described in which the ocular inflammatory disease may be more severe. We describe a case of atypical Cogan's syndrome in association with bilateral posterior scleritis. Serial B-scan ultrasound measurements of posterior scleral thickness were found to be useful in assessing disease activity, in combination with clinical findings. Combination therapy with prednisolone and cyclosporin controlled the ocular disease but the deafness was irreversible. The length of follow-up of this case highlights the frequent relapses and difficult management problems which may be faced. This multisystem disease requires the close co-operation of ophthalmologist, physician and otorhinolaryngologist. Aggressive therapeutic intervention with high-dose combined immunosuppressive agents may be necessary to control severe ocular inflammatory disease.

Dye enhanced laser photocoagulation in the treatment of a peripapillary subretinal neovascular membrane.

A 45-year-old female with an elevated peripapillary subretinal neovascular membrane was treated with dye enhanced laser photocoagulation, using indocyanine green and the diode laser. Following treatment the membrane regressed, with flattening of the lesion. No side effects occurred and excellent visual acuity was maintained over a 12 month follow-up period.

The management of post-keratoplasty astigmatism by post-operative adjustment of a single continuous suture.

Penetrating keratoplasty was performed in 39 consecutive patients. A 16 bite 10-0 nylon continuous suture was used. Post-operatively, the suture was adjusted to reduce astigmatism, as determined by refraction, keratoscopy and keratometry. Suture adjustment was performed if astigmatism was over 4 dioptres (D). The suture was tightened in the flatter meridian and loosened in the steeper meridian. Twenty-one patients had suture adjustment performed. Prior to adjustment, mean (+/- standard deviation) astigmatism measured 6.33 +/- 1.38 D. Following adjustment, mean astigmatism was significantly reduced to 2.69 +/- 1.14 D (p < 0.0001). The average final astigmatism for the entire group was 2.66 +/- 1.12 D. The use of a continuous adjustable suture in penetrating keratoplasty significantly reduced the post-operative astigmatism in a group of patients undergoing penetrating keratoplasty.

Tonic pupils and human parvovirus (B19) infection.

We document the case of a young woman with bilateral internal ophthalmoplegia and subsequently tonic (Adie's) pupils, corneal epitheliopathy, and uveitis due to human parvovirus B19 infection. To our knowledge, this is the first reported case of ocular complications of this virus.