Long-term results of combined viscotrabeculotomy-trabeculectomy in refractory developmental glaucoma.

BACKGROUND: To evaluate the outcomes of combined viscotrabeculotomy-trabeculectomy in patients with refractory developmental glaucoma and to compare the success and complication rates with classical trabeculotomy-trabeculectomy procedure. PATIENTS AND METHODS: Patients who were selected for this study had cloudy corneas with a diameter of 13 mm or greater and with an initial intraocular pressure (IOP) of 27 mmHg or more, and they were divided into two groups. Group 1 consisted of 40 eyes of 24 patients who had undergone combined viscotrabeculotomy-trabeculectomy with a mean follow-up time of 55.6+/-18.4 months, and group 2 consisted of 35 eyes of 20 patients who had undergone classical trabeculotomy-trabeculectomy with a mean follow-up time of 57.2+/-19.0 months. Pre- and postoperative IOPs, mean antiglaucoma medication, mean corneal diameter, success rates, intra- and postoperative complications were compared between two groups. RESULTS: Mean IOP reduced from a preoperative level of 33.2+/-5.3 and 32.8 mmHg to 14.2+/-3.1 and 15.3+/-3.3 in group 1 and group 2, respectively (P<0.001). The mean number of antiglaucoma medications used after surgery was significantly lower in group 1 (P<0.05). Kaplan-Meier survival analysis showed that the success probability at the last visits was 90 and 71.4% in group 1 and group 2, respectively, and the difference was statistically significant (P=0.01). The most common early postoperative complication was transient IOP elevation in group 1 and hyphema in group 2 (for each, P<0.001). CONCLUSION: Use of viscoelastic materials during trabeculotomy-trabeculectomy may increase the success rate of the procedure by prevention of postoperative hemorrhage, anterior chamber shallowing, adhesion of the incision lips or fibroblastic proliferation.

Long-term results of viscotrabeculotomy in congenital glaucoma: comparison to classical trabeculotomy.

BACKGROUND: To evaluate the outcomes of viscotrabeculotomy in patients with primary congenital glaucoma and to compare the success and complications rates with classical trabeculotomy. PATIENTS AND METHODS: Patients who were selected for this study had all presented with primary congenital glaucoma before the age of 12 months, and they were divided into two groups. Group 1 consisted of 58 eyes of 34 patients who underwent viscotrabeculotomy, and group 2 consisted of 51 eyes of 30 patients who underwent classical trabeculotomy. Pre-and postoperative intraocular pressures (IOPs), mean antiglaucoma medication, mean corneal diameter, success rates, intra-and postoperative complications were compared between two groups. RESULTS: Mean preoperative IOP was 30.6 (SD 5.7) mm Hg in group 1 and 29.9 (4.9) mm Hg in group 2. At the last visits, it was 16.2 (2.9) mm Hg and 17.3 (2.8) mm Hg, respectively (p<0.001). The mean number of antiglaucoma medications used after surgery was significantly lower in group 1 (p<0.05). At the last visits, the success rates of group 1 and group 2 were 91.3% and 68.6%, respectively, and the difference was statistically significant (p = 0.02). The most common early postoperative complication was transient IOP elevation in group 1 and hyphaema in group 2 (for each, p<0.001). CONCLUSION: Use of viscoelastic materials during trabeculotomy may increase the success rate of the procedure by prevention of postoperative haemorrhage, adhesion of the incision lips or fibroblastic proliferation.

Intravitreal triamcinolone acetonide injection as primary treatment for diabetic macular edema.

PURPOSE: To evaluate the effectiveness of intravitreal triamcinolone injection on the course of diabetic macular edema. METHODS: Forty-eight eyes of 48 diabetic patients were treated with 8 mg of intravitreal triamcinolone injection as the primary therapy for diabetic macular edema. The main outcome measures included best-corrected visual acuity, fundus fluorescein angio- graphy, macular edema map values of Heidelberg Retinal Tomograph II (HRT II), and intraocular pressures before and after intravitreal injection. RESULTS: The visual acuity increased in 41 of 48 eyes (85.4%) during a mean follow-up time of 7.5 months. The mean baseline best-corrected logMAR (logarithm of minimal angle of resolution) value for visual acuities of the patients before intravitreal triamcinolone injection was 1.17+/-0.20. After treatment, it was 0.85+/-0.29 at 1 month, 0.73+/-0.30 at 3 months, and 0.74+/-0.31 at 6 months, and the differences were significant when compared with baseline values (for each, p<0.001). The mean edema map values significantly decreased by 36% at the 6-month examinations when compared with preinjection values (p<0.001). Average intraocular pressure rose 24.3%, 29.1%, and 11.8% from baseline at the 1-, 3-, and 6-month follow-up intervals. Intraocular pressure elevation exceeding 21 mmHg was observed in 8 of 48 eyes (16.6%), but was controlled with topical antiglaucomatous medications in all eyes. CONCLUSIONS: Intravitreal triamcinolone application provides significant improvement in visual acuity of diabetic patients and clinical course of macular edema, and may therefore be a promising approach in the primary treatment of diabetic macular edema.

Scleral tunnel for the implantation of glaucoma seton devices.

The technique described in this paper shows how to use a long scleral tunnel for the implantation of anterior tube parts of glaucoma drainage devices. It involves the creation of a scleral tunnel beginning 10 mm behind the limbus and extending to the anterior chamber. Anterior tube parts of Krupin eye valve with disk is inserted through the scleral tunnel to the anterior chamber. The disk part is secured to the episclera as used in the standard technique. We have used this technique in 6 eyes of 6 consecutive patients with refractory glaucoma. The placement of anterior tubes as part of glaucoma seton devices was done in all patients. While mean intraocular pressure (IOP) was 39.3 +/- 4.9 mm Hg (ranged from 29 to 56 mm Hg) preoperatively, it was 16.6 +/- 5.3 mm Hg (ranging from 11 to 25 mm Hg) at the end of follow up. Mean follow-up time was 7.16 +/- 1.16 months (ranging from 6 to 9 months). After surgery, conjunctival erosion or displacement of the anterior tube and dellen formation were not found in any eyes. The use of a long scleral tunnel for the implantation of anterior tube parts of glaucoma seton devices offers some advantages over standard implantation techniques.

Effects of frequency-doubled Nd:YAG laser trabeculoplasty on diurnal intraocular pressure variations in primary open-angle glaucoma.

In order to investigate the effects of laser trabeculoplasty (LT) on diurnal intraocular pressure (IOP) variations in 36 eyes of 30 cases with primary open-angle glaucoma (POAG) in which medical treatment was terminated, the IOP curves, recorded 24 h before as well as 24 h and 12 weeks after LT were compared. Twelve weeks after LT, significant IOP decreases were observed: 36.42% in the mean IOP, 29. 77% in the mean peak IOP and 50.04% in the mean pressure range. LT might therefore have beneficial effects on the diurnal IOP variations in cases with POAG.