Diurnal intraocular pressure reduction with latanoprost 0.005% compared to timolol maleate 0.5% as monotherapy in subjects with exfoliation glaucoma.

AIMS: To compare the diurnal intraocular pressure (IOP) efficacy and safety of timolol vs latanoprost in subjects with exfoliation glaucoma (XFG). METHODS: A 3-month prospective, single-masked, active-controlled, parallel comparison performed in six centres in Greece that randomized subjects in a 1 : 1 ratio to either latanoprost in the evening (2000 hours) and placebo in the morning (0800 hours), or timolol twice daily (0800 and 2000 hours). RESULTS: In all, 103 subjects completed the study. After 3 months of chronic dosing, the latanoprost group exhibited a trend to a greater diurnal IOP reduction from an untreated baseline (24.9+/-3.2-17.4+/-2.9) compared with timolol (24.7+/-2.8-18.3+/-1.9 mmHg) (P=0.07). Latanoprost showed a significantly greater IOP reduction at 0800 hours (-8.5 vs -6.0 mm Hg for timolol, P<0.0001) whereas no difference was observed between the two medications at 1000, 1400, and 2000 hours after a Bonferroni Correction. In addition, latanoprost demonstrated a narrower range of diurnal IOP (2.4) than timolol (3.2 mmHg)(P=0.0017). Safety was similar between groups, except there was more conjunctival hyperaemia with latanoprost (n=8) than timolol (n=1)(P=0.01). CONCLUSIONS: This study suggests that latanoprost provides a statistically lower 08:00-hour IOP and better range of IOP than timolol in the treatment of XFG glaucoma.

Long-term course of surgically induced astigmatism after a 5.0 mm sclerocorneal valve incision.

PURPOSE: To study surgically induced astigmatism (SIA) after a sutureless 5.0 mm sclerocorneal valve incision. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This study evaluated SIA in 34 cases of sutureless cataract surgery with a 5.0 mm superior sclerocorneal valve incision and implantation of a poly(methyl methacrylate) intraocular lens. Keratometry was measured with a Zeiss keratometer in all cases preoperatively, and 1 day, 1 week, 1 and 3 months, and 1 and 5 years postoperatively. RESULTS: Surgically induced astigmatism, calculated by Cravy's vector analysis, showed an initial mean with-the-rule shift of 0.35 diopter (D), followed by an against-the-rule shift to a mean of -0.30 D after 1 month. One year postoperatively, mean SIA was -0.46 D. Between 1 and 5 years postoperatively, there was a statistically significant increase in mean SIA calculated by Cravy's vector analysis; SIA increased from -0.46 D after 1 year to -0.76 D after 5 years postoperatively. CONCLUSIONS: A small, although statistically significant, amount of postoperatively induced astigmatism occurred 5 years after a sutureless 5.0 mm sclerocorneal valve incision.

Surgically induced astigmatism following a 4.0 mm sclerocorneal valve incision.

PURPOSE: To determine whether sutureless small incision cataract surgery reduces induced astigmatism over the long term. SETTING: University Eye Hospital, Vienna, Austria. METHODS: In a prospective study, we investigated surgically induced astigmatism in 63 cases of no-stitch, small incision cataract surgery with a 4.0 mm square sclerocorneal tunnel and implantation of a flexible intraocular lens. Follow-up was 4 to 5 years. Keratometry was measured with a Zeiss keratometer preoperatively and after 1 day, 1 week, 1, 3, and 9 months, and a median of 4.4 years. In 21 nonoperated eyes, we investigated the natural course of astigmatism over 5 years. RESULTS: The mean keratometric cylinder stabilized at 0.8 diopter (D) after 1 week and slightly decreased to 1.0 D after 4 to 5 years. Cravy's vector analysis showed an immediate against-the-rule (ATR) shift of -0.2 D that remained relatively stable until 9 months. Between 9 months and 4.4 years postoperatively, there was a statistically significant increase in ATR induced astigmatism from -0.2 to -0.5 D. The natural course of astigmatism in the nonoperated eyes showed an ATR shift of -0.1 D for the same period. CONCLUSION: The result show a small, though statistically significant amount of postoperatively induced astigmatism 4 to 5 years after no-stitch, small incision cataract surgery.

Comparison of results and complications following combined ECCE-trabeculectomy versus small-incision-trabeculectomy and posterior chamber lens implantation.

PURPOSE: To compare the efficacy and complication rate of two standard cataract extraction techniques with different incision lengths when combined with trabeculectomy. METHODS: 54 eyes after combined ECCE, posterior chamber lens implantation and trabeculectomy (ECCE-group) are compared with 49 eyes following phacoemulsification, trabeculectomy and implantation of a folded flexible posterior chamber lens (small-incision group). Minimum follow-up was 24 months. RESULTS: Glaucoma control was achieved in all eyes of both groups. There was a tendency towards a higher number of patients without therapy in the small-incision group (82% versus 65%, p = 0.07). Final mean IOP (14.2 +/- 3.0 mmHg versus 15.5 +/- 2.7 mmHg, p = 0.02) and mean therapy index (0.2 +/- 0.5 versus 0.4 +/- 0.6, p = 0.03) were significantly lower in the small-incision group. Postoperative complications such as severe fibrin effusion (41% versus 18%, p = 0.018), early postoperative IOP rises > 25 mmHg (18% versus 2%, p = 0.009), filtering bleb scarring (63% versus 8%, p < 0.0001) and the total number of complications (87% versus 63%, p = 0.006) were significantly higher in the ECCE-group. CONCLUSION: With the decrease of the incision size necessary for the cataract extraction a reduction of postoperative complications and better functional results are achieved in combined cataract/glaucoma surgery.

Long-term results of combined trabeculectomy and small incision cataract surgery.

We did a prospective study of 49 eyes (36 patients) with coexisting cataract and glaucoma who had combined trabeculectomy, phacoemulsification, and implantation of a folded polyHema intraocular lens through the trabeculectomy opening. Preoperatively, intraocular pressure (IOP) was controlled (< 20 mm Hg) in 13 eyes on a mean of 2.2 medications and uncontrolled (> 20 mm Hg) in 36 eyes on a mean of 2.4 medications. Preoperative visual acuity ranged from 20/40 to hand movements. At the end of the follow-up, IOP was below 18 mm Hg in all eyes (100%), without therapy in 39 (80%) and with reduced therapy in 8 (16%). Two (4%) eyes were controlled on the same medication regimen. Visual acuity improved in 42 patients (86%); 38 (78%) achieved a visual acuity of 20/40 or better. A filtering bleb was observed in 45 eyes (92%). The most common early postoperative complication was fibrin exudation into the anterior chamber. Late complications included posterior synechias and vision-impairing capsule opacifications. Visual acuity improved after neodymium:YAG laser treatment in all eyes with opacification without further complications. We conclude that the combination of small incision cataract surgery and trabeculectomy is a successful surgical approach for long-term visual rehabilitation and glaucoma control.

No-stitch, small incision cataract surgery with flexible intraocular lens implantation.

Small incision cataract surgery has several advantages over conventional surgery, including faster postoperative visual rehabilitation. We evaluated 100 consecutive cases of no-stitch, small incision surgery with a square sclerocorneal tunnel and a flexible intraocular lens. Permanent self-sealing of the wound seemed to increase intraoperative safety considerably. With the specific incision used, corneal trauma and irrigation fluid outflow were minimal. Refraction and K-readings stabilized within the first postoperative week, which is when most eyes attained best final visual acuity. No early peak or protracted drift of astigmatism occurred. Minimally leaking wounds in three eyes were left unsutured; a transient filtering bleb was observed in two of these eyes after resorption of an intracameral air bubble. Our results support the theoretical concept and justify the use of no-stitch, small incision surgery.

Evaluation of 100 consecutive IOGEL 1003 foldable bag-style lenses implanted through a self-sealing tunnel incision.

The IOGEL 1003 hydrogel lens, designed for better capsular bag fit, was implanted in 100 consecutive eyes. We evaluated the visual and morphological results obtained with a mean follow-up of six months. Visual acuity was within Food and Drug Administration standards; however, morphological results were less satisfactory. Decentration of 1 mm or more occurred in 24% of the cases. Higher diopter lenses required a minimum incision size of 4 mm and tended to tear when folded. Once in the eye, they regularly came in contact with the iris. A gap between the posterior optic surface and capsule occurred in 61% of eyes. Within the short follow-up period, 9% of eyes required YAG discission because of Elschnig pearl formation. In conclusion, the newer IOGEL 1003 lens performed no better than earlier IOGEL lens models when placed in the bag, and the possible benefit of decreasing posterior lens subluxation after early YAG capsulotomy is offset by the disadvantages.

Evaluation of the first 100 consecutive PhacoFlex silicone lenses implanted in the bag through a self-sealing tunnel incision using the Prodigy inserter.

We evaluated the performance of the PhacoFlex silicone lens with open polypropylene loops and the disposable Prodigy inserter in a series of 100 consecutive no-stitch cases. Loading the lens into the PRO-1A inserter model was easy, as was inserting it through a 4 x 4 mm self-sealing sclerocorneal tunnel incision. If the chamber was deep and the capsular fornix expanded, unfolding the polypropylene loops was safe and direct bag placement was always possible. If the capsular bag was insufficiently distended, however, the posterior loop tended to entangle with wrinkles in the posterior capsule, jeopardizing the capsule's integrity. With a round and well-centered 4 mm to 5 mm capsulorhexis, centration was good provided the lens was completely within the bag. Even with proper bag placement of the haptics, however, the optic occasionally decentered slightly and tilted because of secondary capture in the capsulorhexis opening. With an incomplete capsulorhexis or a jagged-edged capsulotomy, malpositioning was not uncommon. This was due to secondary displacement of one haptic into the sulcus or partial capture of the optic by the anterior capsule leaf. Because of the flexibility of the polypropylene loops, the lenses tended to decenter and tilt following capsular shrinkage.

[Suitability of the open loop lens Phacoflex XI-30 for capsular sick implantation by self-sealing sclerocorneal tunnel incisions]. / Eignung der faltbaren Offenschlingen-Linse Phacoflex SI-30 für die Kapselsackimplantation durch selbstdichtende sklerokorneale Tunnel-Inzisionen.

SCOPE OF THE STUDY: We studied a new intraocular lens implant with a high-refractive silicone optic and prolene C-loops. Suitability for folding and implantation with the recommended instruments as well as its performance as a capsular bag implant were evaluated. The impact of the self-sealing wound construction used on postoperative corneal stability was also studied. PATIENTS AND METHODS: We included 35 consecutively operated eyes. Capsulorhexis and phacoemulsification were performed. A well-centered and round 4-5 mm anterior capsular opening was aimed at. Using the Fine Universal or the Livernois-McDonald folder the optic was folded lengthwise and the leading loop tucked within the crease. The lens was implanted through a self-sealing sclerocorneal tunnel which measured 3.0 mm in length and 3.2 mm in width. RESULTS: With the instrumentation described, a 3.2 mm incision was adequate. - The lens centered well. In one case each decentration resulted from an optic-edge-by-rhexis-rim capture with an inappropriately shaped rhexis and from excessive capsular bag shrinkage with a too small rhexis. As a rule, the posterior capsule was distended and, with five exceptions, firmly attached to the optic. Fibrosis had resulted in only two cases where the rhexis had evaded the optic edge. Except for a single case where a filtering procedure had been simultaneously performed, optic-to-iris clearance was pronounced in all cases. Consequently, signs of iris chafing were never seen and iridocapsular synechiae had never formed in the latter. - Typically, fine granules scattered within the material and a bluish-violet tint were noted. However, neither intensive haze nor brownish discoloration as well as shell- or inner contour-phenomena were never present. - Vector analysis showed a negligible initial astigmatic shift against the wound that did not progress further on. CONCLUSION: This new implant performs very satisfactory. It may be even further improved by eliminating the granular inclusions and increasing the haptic rigidity. In order to prevent fibrotic opacification of the posterior capsule full circular overlap of the optic periphery by the anterior capsular leaf should be aimed at. The advantage of the reduced incision width required for insertion makes it very appropriate for clear corneal incision surgery.

Clinical results with three different kinds of small optic PMMA-IOLs.

In this prospective study the clinical results using three different small optic IOLs are presented. The best results were achieved in those cases with an anterior capsule rim overlapping the entire optic periphery. In those cases with sulcus fixation, haptic in/out and optic in/out positions a higher percentage of capsule fibrosis (Soemmering's rings) was documented (sulcus fixation: 100%, haptic in/out position: 75%, optic in/out position: 65.5%, bag: 7.3%). The fibrosis developed because of contact between the anterior and the posterior capsule leaf. These cases also showed decentrations of the intraocular lens (IOL) more often (sulcus fixation: 50%, haptic in/out position: 75%, optic in/out position: 34.5%, bag: 31.7%). Only one patient was disturbed by glare and halo phenomenons. Cellular reactions on the lens surface were moderate in most cases. Differences specific to lens type were found between the three IOLs implanted. The clinical results were comparable to the results of other comprehensive IOL studies. Under certain indication small optic IOLs represent an alternative to flexible implants for small incision surgery.

Combined small-incision cataract surgery and trabeculectomy--technique and results.

In a prospective study 35 eyes of 25 patients with coexisting cataract and glaucoma underwent trabeculectomy, phacoemulsification and implantation of a folded polyHema intraocular lens through the trabeculectomy opening. Follow-up ranged from 6 to 27 months (mean 13.3). The mean age was 76.4 (68 to 88 years). 22 eyes suffered from primary open angle glaucoma, 10 eyes from a pseudoexfoliation glaucoma and 3 eyes had a chronic angle closure glaucoma. Preoperatively intraocular pressure was controlled in 10 eyes with a mean medication of 2.1 but uncontrolled in 25 eyes (mean medication: 2.5). The preoperative visual acuity ranged from 20/40 to hand motions. Postoperatively intraocular pressure was controlled (< 18 mmHg) in all (100%) eyes and without therapy in 32 (91%) eyes. Three (9%) eyes had to be treated with topical timolol twice a day after surgery. Mean intraocular pressure dropped from 21.2 +/- 6.0 mmHg preoperatively to 13.5 +/- 2.1 mmHg postoperatively. Vision improved in all but 4 eyes, 25 (74%) achieving a visual acuity of 20/40 or better. The causes for failed improvement or deterioration of vision were senile macular degeneration in 2 eyes and central retinal vein occlusion and vascular optic nerve atrophy in one eye respectively. Post-operative complications included hyphema in 9 (26%) eyes, fibrin effusion to a various extent into the anterior chamber in 19 (54%) eyes and delayed hypotony (< 5 mmHg) with chorioidal effusion in 1 (3%) eye. Fibrin effusion was frequently observed in eyes with intraocular pressure below 10 mmHg, iris surgery and hyphema. Finally the complications did not effect the results regarding visual acuity or glaucoma control.(ABSTRACT TRUNCATED AT 250 WORDS)

Induced astigmatism following small incision cataract surgery combined with trabeculectomy.

The combination of phacoemulsification and implantation of foldable intraocular lenses through a small incision with a trabeculectomy is increasingly preferred in glaucoma patients with coexisting cataract. Small incisions induce less astigmatism and thereby enhance visual recovery. This study should clarify if this benefit of small incision cataract surgery is preserved when combined with a trabeculectomy. Thirty-five eyes were included in this study. Preoperative astigmatism measurements were compared with those obtained one month and one year postoperatively. Vector analysis was performed. A series of 30 cases which underwent small incision cataract surgery alone were used as a control group. One month postoperatively the eyes undergoing the combined procedure showed about the same with-the-rule astigmatic peak (mean: +0.32 dpt.) as the control group eyes (mean: +0.26 dpt.; p > 0.05). One year postoperatively both groups showed the same against-the-rule astigmatic shift (mean: -0.28 dpt.; p > 0.05). In conclusion, patients undergoing small incision cataract surgery combined with trabeculectomy showed a small amount of surgically induced astigmatism. When compared with patients which underwent small incision cataract surgery alone, the difference in astigmatic changes was found to be statistically not significant.

Endothelial cell density and corneal pachometry after no-stitch, small-incision cataract surgery.

In a prospective study we used the change of central and peripheral (12 o'clock-position) corneal thickness (CT) after no-stitch small incision cataract surgery as a parameter of tissue traumatisation (33 eyes) and compared the values to a series of cases (32 eyes) with conventional 3.5 mm scleral step incision. In both groups the peripheral measurements showed a higher increase in corneal thickness than the central. After 1 month all eyes regained their central preoperative thickness. Increase in corneal thickness (delta CTc, delta CTp) after the different postoperative periods were correlated. The values of the central cornea showed no significant difference between the two groups. 1, 7 and 30 days after surgery the increase of peripheral CT was significantly higher in the no-stitch group. This fact was underlined by the clinical aspect at the slit lamp and is due to the anatomical and surgical characteristic of this procedure. One month postoperatively there was no increased endothelial cell loss in the no-stitch group (3%). No-stitch cataract surgery surgery provides a lot of intra- and postoperative advantages. The problem of increased swelling of the peripheral corneal entry seems to be a secondary one as corneal thickness decreases with time. Concerning the prospective endothelial cell loss it is mandatory to study the long term results.

[Effect of argon laser trabeculoplasty on unrestricted outflow of aqueous humor in eyes with simple glaucoma]. / Der Einfluss der Argonlasertrabekuloplastik auf die Abflussleichtigkeit des Kammerwassers bei Augen mit Glaucoma simplex.

In this prospective study we used the oculopressions-tonometry (OPT) for determination of the aqueous humor outflow facility (C). 53 phacic eyes with glaucoma simplex were examined pre- and postoperatively. One hour after operation C decreased from 0.15 to 0.14. In correlation to this fact the IOD increased. After 7 days C was higher already than preoperatively, 30 days and 6 months after operation C showed normal values. After 6 months the mean decrease in IOD was 5.8 mm Hg, the mean increase in C was 39%. The rate of success after 30 days was 77.4%. IOP and C showed statistically significant changes. The problems with determining C and the causes of the fluctuation of C during our follow-up are discussed.