Corneal sensitivity and morphology of the corneal subbasal nerve plexus in primary congenital glaucoma.

BACKGROUND: To quantify the corneal subbasal nerve density and the total number of nerve fibers in primary congenital glaucoma (PCG) and to evaluate their impact on corneal sensitivity. METHODS: Forty eyes of 26 PCG patients were compared with 40 eyes randomly selected from 40 non-glaucoma patients who populated the control group. Central corneal sensitivity (CCS) was assessed by means of Cochet-Bonnet esthesiometry. The mean subbasal nerve density and the total number of nerve fibers were quantified by laser-scanning confocal microscopy. Normality of data was assessed by Kolmogorov-Smirnov testing. Differences in parameters were assessed with Student's t-test, while correlations with CSS were assessed with Pearson's correlation. RESULTS: Significant differences were identified in the mean subbasal nerve density (2108 ± 692 µm in PCG, 2642 ± 484 µm in controls, P = 0.003) and in the total number of nerve fibers (12.3 ± 4.2 in PCG, 15.4 ± 3.1 in controls, P = 0.02). Both groups presented comparable mean CCS and tortuosity. Both groups presented strong correlations between CCS and mean nerve density (r = 0.57 in PCG, r = 0.67 in controls, all P < 0.05), and between CCS and total number of nerve fibers (r = 0.55 in PCG, r = 0.56 in controls, all P < 0.05). CONCLUSION: PCG exerts significant changes in both the mean subbasal nerve density and the total number of nerve fibers. However, these changes do not appear to affect central corneal sensitivity.

Comparison of the effects of dorzolamide/timolol and latanoprost/timolol fixed combinations upon intraocular pressure and progression of visual field damage in primary open-angle glaucoma.

OBJECTIVE: To report the long-term effect of the dorzolamide/timolol (DTFC) and latanoprost/timolol (LTFC) fixed combinations on intraocular pressure (IOP) and visual field defects over time in naïve primary open-angle glaucoma (POAG) patients. STUDY DESIGN AND METHODS: Prospective, 4-year, open-label, interventional study. SETTING: high-volume outpatient clinic. PATIENTS: 178 patients were assigned to receive medical treatment with either DTFC or LTFC. INTERVENTION: over 4 years, tri-monthly IOP and yearly visual field assessment (Octopus 101, Program G2). outcomes: effect of treatment on IOP, visual field indices mean defect (MD), and visual field indices variance loss (VL) over time. RESULTS: DTFC and LTFC significantly (p < or = 0.001) reduced mean IOP over time (from 22.6 +/- 3.0 to 13.8 +/- 1.9 mmHg and from 22.3 +/- 4.0 to 14.7 +/- 1.9 mmHg, respectively). In all, 56 patients (70.9%) and 14 (17.9%) showed a significant MD improvement in the DTFC- and LTFC-treated groups, respectively, p = 0.0001. DTFC progressively and significantly decreased mean VL (from 30.21 +/- 23.88 to 8.11 +/- 8.50 dB). Mean sensitivity slopes during follow-up were 1.14 dB/year and -0.34 dB/year for DTFC and LTFC treatment groups, respectively; p = 0.028. CONCLUSION: Both treatments significantly reduced IOP as compared with baseline. Additionally, treatment with dorzolamide/timolol fixed combination seem to be effective in preventing glaucomatous visual field progression. This study has some limitations that should be noted, among them its open-label design.

Repeatability of intraocular pressure and corneal biomechanical properties measurements by the ocular response analyser.

BACKGROUND: The Ocular Response Analyser (ORA, Reichert Ophthalmic Instruments) is a non-contact applanation tonometer, providing two measures of intraocular pressure (IOP) - IOPg which represents a Goldmann equivalent IOP measure and IOPcc, representing a measure of IOP independent of corneal effects. In addition, the device provides two measures believed to represent corneal biomechanical properties: corneal hysteresis (CH) and corneal resistance factor (CRF). The aim of this study was to assess the repeatability of these measurements. PATIENTS AND METHODS: One randomly chosen eye from 49 healthy volunteers was measured four times consecutively with the ORA prior to Goldmann applanation tonometry (GAT). The repeatability coefficient (RC), the coefficient of variation (CV) and the intraclass correlation coefficient (ICC) were calculated as a measure of intrasession repeatability. RESULTS: CH was the most variable and IOPg the most repeatable measure, with an RC of 2.61 and 1.97, respectively, and ICC of 0.86 and 0.92, respectively. CV ranged between 5.73 % for IOPg and 12.38 % for CH. ORA IOP measurements were higher than GAT (IOPcc = 17.43 +/- 3.23; IOPg = 17.53 +/- 3.0; GAT = 15.75 +/- 2.77 mmHg). CONCLUSIONS: ORA measurements show good short-term repeatability in normal volunteers. Thus, this device appears to be applicable in clinical practice.

A comparison of the fixed combination of latanoprost and timolol with the unfixed combination of brimonidine and timolol in patients with elevated intraocular pressure. A six month, evaluator masked, multicentre study in Europe.

PURPOSE: To compare the intraocular pressure (IOP) reducing effect and safety of fixed combination (FC) latanoprost/timolol with unfixed combination (UFC) brimonidine/timolol in patients with increased IOP. METHODS: In this 6 month, randomised, evaluator masked, parallel group European study, patients with glaucoma or ocular hypertension and IOP > or =21 mm Hg on monotherapy or >16 mm Hg on dual therapy received either FC latanoprost/timolol at 8:00AM or UFC brimonidine/timolol at 8:00AM and 8:00PM. The primary outcome was the difference from baseline to month 6 in mean diurnal IOP reduction. RESULTS: 325 of 334 randomised patients were included in intent to treat analyses (FC latanoprost/timolol, 163; UFC brimonidine/timolol, 162). Baseline diurnal IOP levels were similar: FC latanoprost/timolol, 26.4 (SD 2.7) mm Hg; UFC brimonidine/timolol, 26.5 (SD 2.8) mm Hg (p = 0.851). At month 6, levels were 16.9 (SD 2.8) mm Hg in FC latanoprost/timolol patients and 18.2 (SD 3.1) mm Hg in UFC brimonidine/timolol patients (p<0.001). No adverse events were reported by 76.4% and 75.5% of patients receiving FC latanoprost/timolol versus UFC brimonidine/timolol, respectively. Larger proportions of brimonidine/timolol treated patients reported study medication related adverse events (18.6% v 7.3%) and discontinued study participation because of this (10.8% v 1.8%). CONCLUSION: Fixed combination latanoprost/timolol administered once daily is both more effective and better tolerated than twice daily dosing with UFC brimonidine/timolol.

[Results of strontium-yttrium-90 for pterygia]. / Résultat de la thérapie au strontium-yttrium-90 des ptérygions.

MATERIAL AND METHODS: [corrected] In the Institute of Radio-Oncology in Lucerne we reviewed the records of 75 patients with 97 pterygia in a retrospective study. All patients had the same number of fractions (4), the same single fraction dose (1250cGy) and the same total dose (5000cGy). The operation technique used was the bare sclera technique. Patients were treated following three different concepts. The first group was treated prior to the operation, 1 fraction weekly, at least 2 months before operation. The second group was treated postoperatively, also one fraction weekly, immediately after operation. The third group received 2 fractions prior to and 2 fractions following operation. RESULTS: We observed only 2 out of 97 (2%) recurrences in the second group. Because of their clinically inactive behavior these two cases required no further treatment. Three patients showed teleangiectasia as a moderate reaction. As a severe complication we observed one ulcus corneae, which was successfully treated with a lamellar keratoplasty, for a complication rate of 1%. CONCLUSION: Beta irradiation has proved to prevent pterygium recurrence. Severe late complications after excision and B-irradiation may partly be caused by other factors than irradiation alone. But it seems unequivocal that there is a relation with the high single-dose procedure of more than 2200cGy or re-irradiation. Fractionation must therefore be used.

[Sclerothalamectomy (STE): stable postoperative intraocular pressure regulation in primary open-angle and pseudoexfoliative glaucoma]. / Die Sklerothalamektomie (STE): Stabile postoperative Augendruckregulierung beim Offenwinkel- und Kapselhäutchenglaukom.

BACKGROUND: Since the 70th years we operated the hemorrhagic glaucoma by a ciliary body exposure after Benedikt. In a few patients we noted a stable intraocular pressure regulation for years, often in these cases where there is no filtering bleb. This signifies, that the ciliary body is heavily involved in the resorption of the anterior chamber fluid. During the following next years we further developed this operating technique and we use it today successfully in the operative treatment of primary open angle- and pseudoexfoliative glaucoma. PATIENTS AND METHODS: Since march 1996 we performed a sclerothalamectomy in 46 eyes. In approximate the half of cases the operation was done combined with a cataract surgery. 27 eyes had a primary open angle and 19 eyes a pseudoexfoliative glaucoma with a mean preoperative intra-ocular pressure of 29.79 +/- 7.96 mm Hg respectively of 33.58 +/- 9.32 mm Hg. RESULTS: The mean follow-up was in the case of primary open angle glaucoma 18.3 +/- 8.9 (median 20) and in the case of pseudoexfoliative glaucoma 15.8 +/- 11 (median 16) months. The mean postoperative intra-ocular pressure, which range in the group of primary open angle glaucoma 13.9 +/- 1.6 mm Hg and in the group of pseudoexfoliative glaucoma 12.9 +/- 2.5 mm Hg, was significant lower with significant less postoperative medication compared with the preoperative values during the complete follow-up (p < 0.01). There was no evidence in a significant difference between the both groups regarding the postoperative complication rate and intra-ocular pressure. We observed altogether in 7 eyes a flat filtering bleb, 5/27 in the primary open angle glaucoma and 2/19 in the pseudoexfoliative glaucoma group. In all of other cases we didn't state a filtering bleb. CONCLUSION: The sclerothalamectomy leeds to a long-term stable intra-ocular pressure with a contemporary low complication rate in the case of primary open angle- and pseudoexfoliative glaucoma.