Bilateral Scheie's procedure with Ophthalmic Viscoelastic Device and 5-Fluorouracil.

INTRODUCTION: The surgical management of glaucoma has evolved over time. CASE REPORT: This report describes the first ever case, to our knowledge, of bilateral Scheie's procedures performed with retention of an ophthalmic viscoelastic device and intraoperative and post-operative 5-fluorouracil injections. DISCUSSION: These procedures have now successfully controlled the intraocular pressure in both of the patient's eyes for more than 17 years.

Selective Laser Trabeculoplasty Reduces Intraocular Pressure Peak in Response to the Water Drinking Test.

PURPOSE: To determine the effect of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) peak and fluctuation induced by the water drinking test (WDT) in patients with open-angle glaucoma and ocular hypertension. METHODS: Patients with open-angle glaucoma or ocular hypertension underwent the WDT before and after SLT within a 12-month period. No other changes to therapeutic regimen were permitted. IOP was measured with a Goldmann applanation tonometer at baseline and every 15 minutes for 45 minutes following a fluid challenge of 800 mL over 15 minutes. Baseline, peak, and percentage fluctuation in IOP from baseline were compared using a repeated measures analysis of variance with Bonferroni adjustment. RESULTS: Twenty eyes from 20 patients were included in this study. The median patient age was 73±15 years (interquartile range) and 70% of patients were female. Ten eyes (50%) had a diagnosis of primary open-angle glaucoma and 10 eyes had ocular hypertension. Following SLT there was a statistically significant reduction in mean baseline IOP from 16.9±2.4 to 14.2±2.3 mm Hg (P<0.001), peak IOP from 21.9±3.7 to 16.9±3.1 mm Hg (P<0.001). CONCLUSIONS: Patients with open-angle glaucoma and ocular hypertension treated with SLT have significantly reduced peak IOPs and fluctuation in IOP in response to the WDT.

Surgical outcomes of combined trabeculectomy-cyclodialysis for glaucoma.

PURPOSE: To determine the performance of combined trabeculectomy-cyclodialysis surgery over a 25-year period. METHODS: A retrospective cohort study of 55 eyes (39 patients) treated between 1987 and 2012 was performed.The following data were collected: age, sex, glaucoma etiology, preoperative and postoperative number of topical medications, preoperative and postoperative laser trabeculoplasty, intraoperative and postoperative 5-fluorouracil application, lens status at the time of surgery, postoperative cataract surgery, duration of follow-up, and complications. Best-corrected LogMAR visual acuity was assessed preoperatively, at 1 year, and then at 2-yearly intervals for the duration of follow-up. Intraocular pressure (IOP) was assessed preoperatively and then at 1 week, 4 weeks, 1 year, and then at 2-yearly intervals for the duration of follow-up. Visual field indices were collected at baseline and at the completion of follow-up.Failure was defined as reoperation for glaucoma, progression to legal blindness, IOP≤5 mm Hg, >21 mm Hg, or <20% reduction below baseline. All others were a "complete success" if no additional topical medication was required and a "qualified success" if medication was required. Analyses using 18 and 15 mm Hg as upper limits for success were also performed. RESULTS: Mean IOP fell from 25.2 to 11.9 mm Hg over a mean 11.2 years. At completion of follow-up 32 eyes (58.2%) achieved an unqualified success, 18 (32.7%) a qualified success, and 5 (9.1%) a failure. No patient progressed to legal blindness. Cases with greater preoperative IOP had a greater reduction in IOP (P<0.0001). On univariate analysis no intraoperative application of antimetabolite (OR, 0.74; 95% CI, 0.49-0.94; P=0.022) and a longer follow-up (OR, 1.16; 95% CI, 1.02-1.33; P=0.025) predicted a higher final IOP; these were not significant on multivariate analysis. Thirty-six of 47 phakic eyes developed cataract; the majority occurred in the first 4 years. CONCLUSION: Combined trabeculectomy-cyclodialysis produces sustained lowering of IOP for long periods of time, despite a cataractogenic effect.