Neodymium: YAG transconjunctival laser revision of late-failing filtering blebs.

OBJECTIVE: To study the effectiveness of neodymium:YAG (Nd:YAG) laser transconjunctival revision of late-failing filtering blebs. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Thirty consecutive patients from a glaucoma referral practice at the Ohio State University Department of Ophthalmology. INTERVENTION: Transconjunctival Nd:YAG laser revision of blebs diagnosed as failing secondary to episcleral fibrosis. MAIN OUTCOME MEASURE: Reduction in intraocular pressure (IOP) and survival of bleb. RESULTS: Reduction in IOP was attained in 24 (80%) of 30 patients with a mean prelaser IOP of 21.21 mmHg and a mean 1-week postlaser IOP of 13.97 mmHg (P < 0.0001). These results were maintained at the 1-, 3-, and 12-month follow-up visits with mean IOPs of 16.31 mmHg (P = 0.0008), 14.81 mmHg (P < 0.0001), and 15.25 mmHg (P = 0.0003), respectively. Two-year data were available on a small number of patients (4) with a mean of 15.25 mmHg (P = 0.0085). Mean time interval between trabeculectomy and laser revision was 31 months. CONCLUSION: Late-failing filtering blebs are often amenable to Nd:YAG transconjunctival revision.

Antimetabolite use in revising failing filtering blebs.

This article evaluates the efficacy of a subconjunctival injection of mitomycin-C (MMC) followed by needling of the scar tissue to restore bleb function. By means of preoperative ultrasonic biomicroscopy, all the eyes in this study were categorized into one of three groups: Group I (bleb present), Group II (minimal bleb), and Group III (no bleb present). This classification was carried out to try to control for differences in bleb appearance that may correlate with bleb function.

A new water bath for ultrasonic biomicroscopy.

Ultrasonic biomicroscopy (UBM) has added greatly to our understanding of the development of certain forms of glaucoma. Methylcellulose is usually recommended as the appropriate coupling medium between the transducer and the eye because of its increased viscosity, which makes it more easily retained on the eye. A new water bath has been developed that fits the eye so well that saline, a superior coupling agent, can be substituted for methylcellulose. This new water bath is a flexible polysiloxane cup with a beveled inner edge, providing a watertight seal and thus permitting the use of saline as the coupling medium for UBM. Saline, because of its lack of impurities, generates images that are superior in quality to those produced with methylcellulose as the coupling medium.

Late argon laser suture lysis after mitomycin C trabeculectomy.

BACKGROUND: Argon laser suture lysis has been effectively used in the early post-operative period to enhance filtration after trabeculectomy. The most substantial reductions in intraocular pressure (IOP) occur when laser suture lysis is performed during the first 2 postoperative weeks, and virtually no effect has been reported after the fourth postoperative week. Mitomycin C, used as adjunct therapy, improves the success rate of trabeculectomy in high-risk eyes and may change the time course for effective suture lysis. METHODS: The authors used late laser suture lysis in five high-risk patients after mitomycin C trabeculectomy. The mean patient age was 66.8 +/- 15.7 years, and laser suture lysis was performed an average of 13 +/- 5.8 weeks (range, 7-21 weeks) after surgery. RESULTS: The mean IOP before suture lysis was 20.2 +/- 3.8 mmHg. The average IOP reduction immediately after suture lysis was 11.4 +/- 3.9 mmHg. The average IOP 3 to 4 months after laser suture lysis was 9.4 +/- 3.4 mmHg. CONCLUSION: The authors postulate that adjunctive mitomycin C therapy markedly delays wound healing and appears to extend the period that laser suture lysis is clinically effective.

Iris nevus syndrome.

A case of iris nevus (Cogan-Reese) syndrome is presented. Our patient's condition was recognized clinically and followed for many years. The unusual amount of proliferated endothelium and abnormal basement membrane and the pedunculated pigment nodules and ectropion uvea were most interesting. If there is a spectrum of disease that includes essential iris atrophy, Chandler's syndrome, and iris nevus syndrome, one would have to say this case fits at the iris nevus end.

A bubble-free goniolens.

A modified Goldmann-type gonioscopy lens has been developed which can be successfully applied to the cornea without requiring methylcellulose or other viscous solution between the cornea and the inner surface of the contact lens. This goniolens does not indent the cornea, leaving the anterior chamber angle configuration unaltered during gonioscopy. In addition the optic disc can be visualized with the slit lamp by looking through the central portion of the goniolens.

Argon laser treatment of the ciliary processes in aphakic glaucoma with flat anterior chamber.

We treated three patients (a 72-year-old man, a 68-year-old woman, and a 60-year-old man) with aphakic glaucoma with flat anterior chamber by administering laser burns to the ciliary processes (11 ciliary processes in one case, 27 in the second, and three in the third). There was some improvement in all three cases; in one case the intraocular pressure decreased from more than 50 mm Hg to less than 20 mm Hg. In each case the anterior chamber deepened immediately without administration of cycloplegics.

Two-stage Neodymium-YAG laser trabeculotomy.

A preliminary report of a newly devised glaucoma operation is presented. This procedure combines a non-penetrating trabeculectomy with Neodymium:Yittrium-Aluminum-Garnet (Nd:YAG) trabeculotomy. This thus creates a through and through filtration under a scleral flap without actually entering the anterior chamber.