Combined trabeculectomy and phacoemulsification: a one-site vs a two-site approach.

PURPOSE: To compare the results of combined trabeculectomy and phacoemulsification surgery with intraocular lens implant by means of a one-site vs a two-site approach. METHODS: Glaucomatous patients with a coexisting cataract were randomly assigned to undergo either a one-site or two-site combined procedure. One-site surgery was performed with a limbus-based conjunctival flap and scleral tunnel at the 12-o'clock position. Two-site surgery was performed with a limbus-based conjunctival flap for the trabeculectomy in the superior nasal quadrant and a temporal clear cornea incision for phacoemulsification. Mitomycin C (0.4 mg/ml for 2 minutes) was applied to the scleral surface at the trabeculectomy site for both approaches. All patients received intraocular lens implants at the time of combined surgery. RESULTS: Thirty-three eyes of 33 patients were included in this study. Preoperative intraocular pressure and number of glaucoma medications were similar in the two groups. Corrected visual acuity improved similarly in both groups. Intraocular pressure decreased in both groups at last follow-up but was not significantly different (P = .129) between the one-site and two-site groups. At last follow-up, the one-site group required significantly more (P = .030) medications than did the two-site group. CONCLUSIONS: Combined trabeculectomy and phacoemulsification surgery in which one-site and two-site techniques were used yielded similar improvements in corrected visual acuity and intraocular pressure reduction. However, the one-site group required more medication to maintain intraocular pressure control than did the two-site group.

Simultaneous angle closure in twins.

PURPOSE: This article reports identical twin sisters who were found to have acute angle-closure glaucoma at the same time. METHODS: Two case reports. RESULTS: Two 73-year-old identical twin sisters presented to the emergency room with a complaint of decreased vision and eye pain after having been in a fist fight with each other the previous night. One sister exhibited signs of angle-closure glaucoma with an intraocular pressure > 50 mmHg in the left eye, while her twin sister presented with bilateral angle-closure glaucoma and similar intraocular pressures. Both patients were treated with anti-glaucoma medications and bilateral laser iridotomies. CONCLUSIONS: Polygenetic factors influence the configuration of the anterior chamber, but other environmental factors contribute to the risk of developing primary angle-closure glaucoma. Potentially occludable angles are more common in individuals with a first-degree relative with acute angle closure. Screening of these patients (especially twins) for occludable angles is recommended.

Topical carbonic anhydrase inhibitors.

Dorzolamide, a topically active carbonic anhydrase inhibitor, is an effective new glaucoma medication that creates a decrease in intraocular pressure similar to that produced by beta-blockers. When beta-blockers are contraindicated, dorzolamide may be used as a first-line therapy. It has excellent additivity with other topical ocular hypotensive medications, including beta-blockers and pilocarpine. Systemic side effects are minimal, particularly compared with those of oral carbonic anhydrase inhibitors. However, local side effects, including corneal edema in patients with borderline endothelial function, may occur. Decreased visual acuity and allergic reactions, which occur frequently, may curtail the use of dorzolamide in some patients.