Long-term changes in intraocular pressure after clear corneal phacoemulsification: normal patients versus glaucoma suspect and glaucoma patients.

PURPOSE: To compare the effects of clear corneal phacoemulsification on intraocular pressure (IOP) in patients without glaucoma, glaucoma suspects, and patients with glaucoma. SETTING: Urban, multisubspecialty private practice. METHODS: A retrospective analysis of patients who had clear corneal phacoemulsification with a minimum of 12 months follow-up was performed. The patients were divided into 3 groups: no glaucoma (NG), glaucoma suspects (GS), and glaucoma (GG). None had a history of prior surgery. Glaucoma suspects included patients with elevated IOPs, abnormal discs, pseudoexfoliation syndrome, or pigment dispersion syndrome on no medications and with no field defects. Glaucoma patients had received only medical treatment. Two-tailed, homoscedastic t tests were used for statistical analysis. RESULTS: There were 143 patients (164 eyes) in the NG group, 65 (75) in the GS group, and 61 (71) in the GG group. The mean preoperative IOP was 16.42 mm Hg +/- 2.77 (SD), 17.59 +/- 4.15 mm Hg, and 16.97 +/- 4.86 mm Hg in the 3 groups, respectively. At 1 year, the mean IOP was lower in all groups: 14.37 +/- 2.97 mm Hg, 15.68 +/- 3.38 mm Hg, and 15.86 +/- 4.00 mm Hg, respectively. The change was statistically significant in the NG and GS groups. Glaucoma patients showed a statistically significant reduction in the number of glaucoma medications postoperatively. CONCLUSION: Clear corneal phacoemulsification was associated with a statistically significant long-term reduction in IOP.

Recurrence of unilateral retinoblastoma following radiation therapy.

A retrospective analysis of 65 unilateral retinoblastoma patients treated initially with external beam radiation, revealed that 25 eyes (38.5%) developed local recurrence of retinoblastoma. The mean age at diagnosis was 1.8 years for patients who developed recurrences vs. 0.9 years for those who did not. Ninety-six percent of the recurrences occurred less than two years from the age at diagnosis; the amount of time from the end of external beam radiation treatment until a tumor recurred was independent of the age at diagnosis. The initial largest basal diameter was 10.7 DD for tumors which later recurred and 5.9 DD for tumors that were cured. Sixty-nine percent of eyes in groups III-V had tumor recurrence, and 10% of eyes in groups I-II had recurrence. All but one eye (24 eyes) that developed recurrence were enucleated. Family history of retinoblastoma, location of the tumor, gender, and laterality did not significantly correlate with the mean age of initial diagnosis for tumors that recurred or the mean time of onset for recurrence.

Unilateral retinoblastoma: new intraocular tumours after treatment.

A retrospective chart review of 427 eyes diagnosed with unilateral retinoblastoma was performed to determine which eyes, which patients, and when new intraocular tumours would develop after treatment. Mean follow up was 8.16 years. Twenty five (6%) of 427 unilateral retinoblastoma patients developed new intraocular tumours after treatment. Five (1%) unilateral patients who were previously treated with enucleation developed new tumours (in the fellow eye). Fifteen (24%) unilateral patients who were previously treated with external beam radiation developed new tumours (equally in either eye). New tumours did not develop in the macula of either eye. The relative risk of developing new intraocular tumours after treatment was 16% in patients diagnosed before 1 year old and 2.2% for patients diagnosed after 1 year old (p < 0.001). The mean time to onset for the development of new tumours after treatment was 0.74 years; no new tumours appeared after 7.5 years of age. Those patients who are diagnosed with unilateral retinoblastoma in the first 6 months of life and have a family history of the disease are at greatest risk of developing new intraocular tumours.