Reduction of intra-ocular pressure by ocular compression before combined peri- and retrobulbar block.

The intra-ocular pressure immediately before glaucoma surgery can be raised. We wished to investigate if ocular compression for 20 min before a combined peri- and retrobulbar injection would result in a lower pressure after the block. Sixty consecutive patients scheduled for filtration surgery were randomly assigned to receive ocular compression using an external pressure device for 20 min before combined peri- and retrobulbar injection (intervention group, who also received compression after the block) or to a control group in whom pressure was applied only after the block was completed. The intra-ocular pressure was measured at baseline, after the 20-min pre-injection compression (intervention group), after injecting the block, and after the 10-min post-injection compression. The pressure did not differ between groups at baseline, after the block or after the post-injection compression. In the intervention group, the compression before the block reduced the median (IQR [range]) pressure from 21.0 (17.0-25.0 [12.0-40.0]) mmHg to 16.8 (12.5-22.5 [7.5-33.5]) mmHg (p<0.001). We conclude that external ocular compression reduces the intra-ocular pressure, but applying an additional compression for 20 min before injecting the block is not beneficial.

Reversal of optic disc cupping in glaucoma.

AIM: To study whether reversal of optic disc cupping after intraocular pressure (IOP) reduction is related to risk of glaucoma progression. METHODS: In this prospective follow-up study, where 51 patients with exfoliation glaucoma and five with ocular hypertension combined with exfoliation syndrome were followed for 6 years after IOP reduction, 24 showed progression of glaucoma in visual fields or optic nerve head (ONH) stereophotographs. ONH topography was measured with the Heidelberg Retina Tomograph (HRT). A decrease in HRT parameter cup volume of more than 5% was considered cup reversal. Multiple logistic regression was used to model progression of glaucoma. RESULTS: Cup reversal (OR 0.226; 95% CI 0.055 to 0.918, p = 0.037), final IOP (OR 1.216; 95% CI 1.000 to 1.479, p = 0.050) and visual field mean defect at entry (OR 1.158; 95% CI 1.034 to 1.296, p = 0.011) were associated with progression. IOP change from study entry to 6-year control visit was not associated with progression (OR 0.964, 95% CI 0.850 to 1.092, p = 0.56). CONCLUSION: Cup reversal seemed to be an independent protective factor for progression of glaucoma.

Posterior capsular opacification in pseudophakic eyes with a silicone or acrylic intraocular lens.

PURPOSE: To compare posterior capsular opacification in eyes with IOL of two different materials--silicone or acrylic. METHODS: Eighty consecutive eyes undergoing cataract surgery were prospectively randomized in two groups, 40 eyes receiving a silicone (Sl--30NB) and 40 eyes an acrylic (Acrysof MA60BM) intraocular lens (IOL). The same surgeon performed phacoemulsification and the intraocular lens (PHACO IOL) operation in all cases. Patients were re-examined on the first postoperative day, after one week, four months, and 1-2.4 years. Seven eyes were lost to late control. RESULTS: Clinically significant posterior capsular opacification (PCO) (including eyes with capsulotomy already performed) was equally common in both groups; 25% in the silicone group and 19% in the acrylic group (p=0.53). The posterior capsule remained clear in 61% of the silicone and 76% of the acrylic IOL eyes (p=0.18). In the whole study group, 29% of eyes with and 14% without concurrent ocular diseases had significant PCO (p=0.13). In the silicone IOL group, PCO was more common in eyes with concurrent ocular diseases (44%) than eyes without other diseases (10%) (p=0.049). Eyes with acrylic IOL showed no difference in significant PCO, with or without other diseases (18% and 20%, respectively). CONCLUSIONS: In a consecutive series of 80 cataract eyes central PCO was equally common in eyes receiving a silicone or an acrylic IOL. In the silicone IOL group, however, significant PCO was more common if there was concurrent ocular disease, while with the acrylic IOL concurrent ocular disease did not seem to increase the risk of PCO.

Blood flow of the optic nerve head and peripapillary retina in exfoliation syndrome with unilateral glaucoma or ocular hypertension.

BACKGROUND: The purpose was to study whether any differences exist in the optic nerve head (ONH) and peripapillary retinal blood flow between the two eyes of patients with unilateral exfoliation glaucoma or ocular hypertension (OHT) with exfoliation syndrome. METHODS: This cross-sectional study included 50 patients. All had exfoliation syndrome with glaucoma or OHT in one eye, and these eyes comprised the study group. The fellow eyes, all normotensive, comprised the control group. Blood flow was measured with scanning laser Doppler flowmetry in the lamina cribrosa region, in the rim area, and on the peripapillary retina. Multiple linear regression analyses were used to identify any associations between different factors and differences in flow. RESULTS: Flow in the rim area was significantly higher in the study eyes than in the control eyes, with a mean difference of 172 arbitrary units (P = 0.001). The difference of 40 units in the laminar area was of borderline significance (P = 0.065) and no significant difference was found in the peripapillary retina (P = 0.530). In the study eyes, blood flow of the ONH lamina and rim area decreased with increasing glaucomatous damage, and treatment with topical timolol was associated with reduced blood flow in the lamina cribrosa and rim area. Perfusion pressure was associated only with flow in the peripapillary area (P = 0.021). CONCLUSIONS: Advanced glaucomatous damage was associated with reduced flow both in the lamina cribrosa and the rim area but not in the peripapillary retina. Treatment with topical timolol was associated with decreased flow in the ONH.

Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma.

PURPOSE: To study the effect of phacoemulsification and intraocular lens implantation (PHACO IOL) on intraocular pressure (IOP) and glaucoma medication in open-angle glaucoma (OAG) eyes. METHODS: 38 open-angle glaucoma (OAG) eyes with cataract underwent phacoemulsification and intraocular lens implantation (PHACO IOL) performed by one surgeon (RJU). None of the patients had prior intraocular surgery. Surgery was performed by scleral incision on 37% and by clear corneal incision on 63%. Patients were re-examined on the first postoperative day, after one week, 4 months, and in 29 cases 1-3.7 (mean 2.8) years after the operation. RESULTS: The mean preoperative IOP was 18.4+/-3.3 mmHg with a mean of 1.7 glaucoma medications. On the first postoperative day, the mean IOP rose to 28.2 +/- 12.5 mmHg. IOP > or = 30 mmHg occurred in 39.5% of the eyes. After one week, IOP had returned to the preoperative level. After 4 months, IOP had further decreased to 16.1 +/- 3.8 mmHg (p = 0.0027). After a mean follow-up of 1-3.7 (mean 2.8) years, the average postoperative IOP was 15.1 +/- 2.9 mmHg, being significantly (p = 0.001) lower than the preoperative IOP with 86% of the patients having a mean of 1.6 drugs on average. The type of incision (scleral vs. corneal) did not affect the postoperative IOP level. Using the criteria of Bigger and Becker (1971) the long-term IOP control after PHACO-IOL surgery was improved or unchanged in 86% and worse in 14% of the preoperatively well-controlled OAG eyes. CONCLUSIONS: In OAG eyes PHACO IOL is associated with a significant decrease in IOP with less medication up to 1-3.7 (mean 2.8) years.

Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation.

PURPOSE: To evaluate intraocular pressure (IOP) after phacoemulsification and intraocular lens (IOL) implantation in nonglaucomatous eyes with and without exfoliation. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: One hundred ninety-six eyes that had phacoemulsification with IOL implantation were examined. Eyes with a history of intraocular disease or surgery that could affect IOP were excluded. The study comprised the remaining 160 eyes: 23 with exfoliation (EXF group) and 137 without exfoliation (non-EXF group). Follow-up data were available for 136 eyes. The same surgeon performed all surgeries. Patients were examined on the first postoperative day and after 1 week, 4 months, and 1.0 to 2.7 years. RESULTS: One day postoperatively, IOP rose in the EXF group from a mean preoperative level of 16.3 mm Hg +/- 2.7 (SD) to 21.0 +/- 8.5 mm Hg, a 28.4% increase (P =.0061). In the non-EXF group, mean IOP rose from 16.2 +/- 3.4 mm Hg to 20.5 +/- 5.7 mm Hg, a 29.9% increase (P =.001). In 4 eyes (17.4%) in the EXF group and 8 eyes (5.8%) in the non-EXF group, IOP increased to 30 mm Hg or higher at 1 day. After this, significant IOP decreases occurred in both the EXF and non-EXF group, respectively, as follows: 14.2 +/- 3.0 mm Hg (12.0% decrease from preoperative value; P =.001) and 15.0 +/- 2.9 mm Hg (5.9%; P =.001) 1 week postoperatively; 12.8 +/- 2.7 mm Hg (20.2%; P =.0002) and 13.8 +/- 2.7 mm Hg (13.2%; P =.001) after 4 months; and 12.3 +/- 2.6 mm Hg (23.2%; P =.0001) and 12.7 +/- 2.7 mm Hg (21.2%; P =.001) after 1.0 to 2.7 years. There was no significant difference between the 2 groups. CONCLUSION: After phacoemulsification with IOL implantation, IOP decreased significantly and remained lower than preoperatively in eyes with and without exfoliation. One day postoperatively, transient pressure peaks were more common in eyes with exfoliation. One eye without exfoliation developed glaucoma.

Scanning laser ophthalmoscopy of the optic nerve head in exfoliation glaucoma and ocular hypertension with exfoliation syndrome.

AIMS: To study the relation between optic nerve head topography (Heidelberg retina tomograph, HRT) and disc area, visual field index mean defect (MD), and intraocular pressure (IOP), and to see whether change in HRT parameters is associated with change in MD in a prospective follow up. METHODS: 80 consecutive patients (69 patients with exfoliation glaucoma and 11 with ocular hypertension combined with exfoliation syndrome) were examined before IOP reducing intervention and prospectively followed every 6 months for 2 years. RESULTS: At the entry point, multiple regression analysis showed significant linear association between MD and all HRT parameters, when controlling for disc area. Disc area showed significant association with cup area, cup/disc area ratio, rim area, cup volume, and mean RNFL thickness. Six months after intervention IOP had decreased significantly. Reversible changes in cup area, cup/disc area ratio, rim area, cup volume, rim volume, mean cup depth, and maximum cup depth were associated with decrease in IOP. During the follow up period from 6 month to 2 years, IOP did not change significantly, and MD was used as a measure of progression of glaucoma. During this period, only cup shape measure among HRT parameters showed significant association with subsequent change in MD. CONCLUSION: Disc area should be taken into account when using HRT to compare patients. Any effect of change in IOP should be also taken into account when using HRT in follow up. Cup shape measure is a promising indicator of progression of glaucomatous damage.

Photorefractive keratectomy in ophthalmic residents.

PURPOSE: To find out how ophthalmologists themselves experience the correction of myopia after photorefractive keratectomy. Visuomotor functions were of special interest. METHODS: Four ophthalmology residents and one medical engineer underwent photorefractive keratectomy for myopia. Objective measurements including refraction, corneal topography, perimetry, contrast sensitivity, pattern visual evoked potentials, in vivo confocal microscopy, and a car driving simulator test were performed preoperatively, postoperatively, and at 6 months. Subjective evaluation was reported. RESULTS: Performing ophthalmological examinations and microsurgery without spectacles was easier postoperatively and was appreciated by the four ophthalmology residents. Minimal haze formation, good accuracy, and normal performance in the car driving simulator were also observed. Visual fields, contrast sensitivity, and pattern visual evoked potentials did not show changes. Negative observations included postoperative pain for 2 to 4 days, dry eye symptoms, a period of anisometropia between operations, and hypersensitivity of the lids. CONCLUSIONS: The four ophthalmic residents were satisfied with the outcome of their refractive surgery. Low to moderate myopic correction did not affect the objective measurements of high and low contrast sensitivity, pattern visual evoked potentials, or simulated car driving in dark illumination.

Exfoliation syndrome and exfoliation glaucoma.

Exfoliation syndrome abnormal deposition in the anterior segment of the eye of an unknown substance thought to be related to elastic fibres and basement membrane components is associated with accelerated cataract progression. increased frequency of intraoperative and postoperative complications and increased risk for glaucoma and. therefore, is a clinically important finding. A clear association has been shown with age. The syndrome occurs worldwide but its prevalence seems to vary from country to country. The best-known sign of exfoliation syndrome is deposits of greyish-white material on the anterior lens surface. Sometimes exfoliation material can also be seen at the pupillary border, on the anterior iris surface, corneal endothelium, and on the anterior vitreous face. When clinically detected, exfoliation syndrome is somewhat more often unilateral than bilateral. According to recent investigations clinically unilateral exfoliation syndrome is probably never truly unilateral but rather asymmetric, because exfoliation material has been detected ultrastructurally and immunohistochemically around iris blood vessels of the nonexfoliative fellow eyes. Indeed, electron microscopy identifies in various organs of patients with exfoliation syndrome fibrils similar to those seen in intraocular exfoliation deposits. Other clinical signs associated with exfoliation syndrome are pigment dispersion, transillumination defects of the iris and reduced response to mydriatics. In unilateral exfoliation syndrome, intraocular pressure (IOP) of the exfoliative eye is approximately 2 mmHg higher than IOP of the nonexfoliative fellow eye. Whether elevated IOP, vascular changes or exfoliation syndrome itself is the main factor causing optic nerve head damage and conversion of an exfoliative eye to glaucomatous, is not known. Glaucoma in the exfoliation syndrome has been shown to have a more serious clinical course than in primary open-angle glaucoma (POAG). At the time of diagnosis, IOP and its diurnal variation are generally higher and visual field defects tend to be greater in exfoliation glaucoma than in POAG. Because the decrease in lOP variation and lowering of the mean IOP level has been shown to improve visual field prognosis more in exfoliation glaucoma than in POAG, the glaucomatous process is considered to be more pressure-related in exfoliation glaucoma. Furthermore, progression of optic disc damage has been shown to be similar in exfoliation glaucoma and POAG when lOPs are lowered to a comparable level by the treatment. However, vascular disturbances in the posterior segment of the eye might after all be of equal importance in these two types of glaucoma; optic disc haemorrhages and venous occlusions have been reported to be as frequent in exfoliation glaucoma as in POAG. Perhaps in exfoliation glaucoma circullatory disturbances combined with high IOP lead to a particularly relentlessly progressing form of the disease.

Optic disc changes in normotensive persons with unilateral exfoliation syndrome: a 3-year follow-up study.

BACKGROUND: If, at the time of glaucoma diagnosis, the intraocular pressure (IOP) is higher and the initial field loss more advanced in glaucomatous eyes with than without exfoliation, the cause of the optic disc damage has been suggested to be the high IOP associated with the exfoliation syndrome (EXS). We decided to investigate whether EXS alone, without the contributory effect of measured raised IOP, is a risk factor for optic nerve damage. METHODS: Twenty-two non-glaucomatous, normotensive persons with clinically unilateral EXS were examined for IOP, visual fields (Octopus G1) and disc topography (Imagenet, Topcon) and followed up for 3 years. RESULTS: At the start, the paired exfoliative (E) and non-exfoliative (NE) eyes did not differ in IOP, disc, rim, or cup areas, or cup volumes. They differed in R/D (rim/disc) radius ratio in the inferior section of the optic disc. During the follow-up period, the IOP increased in the E and the NE eyes, and changes indicative of nerve fiber loss were measured in both eyes. In those (n=14) in whom the IOP in the two eyes was equal throughout the follow-up period, disc changes took place only in the E eye. CONCLUSION: The exfoliative process in itself may be a risk factor for optic disc changes.

The use of confocal scanning laser tomography in the evaluation of retinal elevation in age-related macular degeneration.

OBJECTIVE: To evaluate the feasibility of using confocal scanning laser tomography in the analysis of macular topography in patients with subfoveal choroidal neovascularization associated with age-related macular degeneration (AMD) and to analyze quantitatively the changes in topography after local strontium-plaque radiation therapy. DESIGN: Prospective case series. PARTICIPANTS: A total of 16 eyes with subfoveal choroidal neovascular membranes (CNVM) treated with strontium-90 (90Sr)-plaque radiation therapy and 16 fellow eyes of 16 patients were examined. INTERVENTION: Confocal scanning laser analysis of macular surface topography before and after irradiation of the macula was performed. MAIN OUTCOME MEASURES: Parameters describing the height and volume of the retinal elevation in the macula were measured. RESULTS: The maximum height of the macular lesion at baseline was 0.25 mm (standard deviation [SD], 0.12 mm) in eyes showing regression of the CNVM during follow-up and 0.34 mm (SD, 0.19 mm) in eyes showing continued growth of the CNVM. During follow-up, a mean decrease in the maximum height of the macular lesion ranging from 0.03 to 0.10 mm occurred in eyes with regression of the CNVM, whereas the mean maximum height increased by 0.07 to 0.15 mm during follow-up visits in eyes with continued growth of the CNVM. All parameters describing the mean height and volume of the lesion also decreased significantly in patients showing angiographic regression, whereas they increased or remained unchanged in patients with continuous growth of the CNVM despite irradiation. The corresponding parameters also were higher in fellow eyes with untreated CNVM than in eyes without exudative AMD. CONCLUSIONS: Confocal scanning laser tomography can be used to monitor the amount of the change in neurosensory detachment in AMD. The parameters obtained by confocal scanning laser tomography correlate with CNVM perfusion after 90Sr-plaque radiation therapy. This technology is a useful tool for objective evaluation of morphologic change after institution of new therapeutic methods for the treatment of AMD.

Quantitative evaluation of papilledema in pseudotumor cerebri.

PURPOSE: To determine the feasibility of adapting confocal scanning laser (CSL) tomography of the optic disc for quantitative evaluation of papilledema in pseudotumor cerebri (PTC). METHODS: Confocal scanning laser tomography of the optic disc was performed in 11 patients with diagnosed PTC and 12 visually normal control subjects of similar age. In five patients with active papilledema, CSL tomography was performed serially over several months. To quantify optic disc characteristics, surface topography was measured in 0.1-mm steps along the horizontal and vertical meridians and four oblique meridians. Best fit polynomial functions, describing surface topography along each meridian, were derived using linear regression analysis. RESULTS: Third-order polynomials provided excellent fits (significantly better than the second-order functions) to the surface topography for all meridians in the control subjects and patients with PTC. In control subjects and PTC patients an asymmetry in the slope of the optic disc contours was evident along the horizontal but not the vertical meridian. In patients with active papilledema a significant elevation of the center of the disc was accompanied by a change in overall surface topography. Each of the PTC patients followed up serially had a pronounced posterior deformation of the disc (i.e., a reduction in papilledema) that was initially apparent in the temporal meridian and did not proceed uniformly across all meridians. CONCLUSIONS: Confocal scanning laser tomography can quantify the magnitude and monitor the resolution of papilledema in PTC. Studies of optic nerve head topography may provide further insight into optic nerve compliance with elevated intracranial pressure.

Effects of long-term contact lens wear on the corneal endothelium.

PURPOSE: To analyze the long-term effects of soft and hard (PMMA) contact lenses (CL) on the human corneal endothelium. METHODS: One hundred and one contact lens wearers with > or =10 years' wearing time and 50 healthy control subjects were examined with specular microscope. RESULTS: The mean corneal endothelial cell densities of the CL wearers (2846 cells/mm2) and of the control eyes (2940 cells/mm2) differed by 94 cells/mm2 (p<0.05). The mean values for the coefficient of variation (CV) differed significantly (p<0.0001); for all CL wearers: mean CV=0.31, vs. for controls: 0.22. The mean endothelial cell density of the eyes exposed to CL wear for more than 25 years (30 eyes) was 2575 cells/mm2 (mean CV: 0.36). Rather low densities (<2000 cells/mm2) were observed in 16 eyes of the CL group (8%). Cell densities less than 2500 cells/mm2 were observed in a total of 41 eyes (20%) in the CL group, whereas in the control group (100 eyes) all of the subjects, except one, had cell densities of more than 2500 cells/mm2 in both eyes. CONCLUSION: A subgroup of PMMA as well as soft contact lens wearers react not only with high pleomorphism and polymegethism but also with a decrease in endothelial cell density.

Diagnosis and management of pigmentary glaucoma.

Pigment dispersion syndrome and pigmentary glaucoma affect typically young, myopic persons. Iridozonular contact causes pigment dispersion and obstruction of the trabecular meshwork. Accumulation of pigment may result in transient elevation of intraocular pressure or irreparable damage to the meshwork accompanied by uncontrolled glaucoma. In the reviewed publications the transition from pigment dispersion syndrome to pigmentary glaucoma was found to be 20%. The main risk factors for the transition were ocular hypertension and myopia. Dapiprazole, an alpha-adrenergic blocking agent, was found to be effective in treating pigmentary glaucoma and in preventing pressure spikes after exercise. Dapiprazole causes miosis without affecting accommodation. Yttrium aluminum garnet laser iridotomy reduced the incidence of ocular hypertension in pigment dispersion syndrome, although the effect was less pronounced in persons older than 40 years of age. Lattice degeneration was found in 33.3% of the eyes with pigment dispersion syndrome.

Correlation between Octopus perimetry and fluorescein angiography after strontium-90 plaque brachytherapy for subfoveal exudative age related macular degeneration.

AIM: To evaluate the correlation between the central visual field and changes in fluorescein angiography and fundus photography in patients treated with strontium plaque radiotherapy for subfoveal exudative age related macular degeneration (AMD). METHODS: Octopus program 34 automated static perimetry, fluorescein angiography, and colour fundus photography were performed on 19 patients at baseline and at 12 months after strontium-90 plaque therapy. A schematic picture outlining the areas of hyperfluorescent neovascular membranes and subretinal blood was drawn of a projected 30 degrees fundus fluorescein angiogram. This drawing was superimposed on the size adjusted Octopus visual field. The changes in retinal sensitivity were calculated and related to angiographic changes. RESULTS: Three of the 19 patients had a reliability factor (RF) > 15% and were excluded from further analysis. In the remaining 16 patients the mean defect (MD) and loss variance (LV) values remained unchanged in patients showing regression of the choroidal neovascular membrane (CNVM) to irradiation at 12 months. MD was 7.7 (SD 1.7) at baseline and 7.6 (1.9) at 12 months (p = 0.86), and LV was 32.6 (13.9) at baseline and 32.4 (15.7) at 12 months (p = 0.94). However, in patients with progression of the CNVM at 12 months, both the MD and LV increased significantly during the 12 month follow up (MD from 7.3 (2.9) to 13.1 (3.6) (p = 0.05) and LV from 31.0 (22.9) to 71.8 (24.1) (p = 0.017)). When comparing the mean retinal sensitivity in the area of the primary CNVM (including classic, occult, and haemorrhagic components), the results were analogous: in patients with a regression of the CNVM after irradiation the mean sensitivity remained almost unchanged. It was 10.3 (6.4) dB at baseline and 9.4 (7.3) dB at 12 months (p = 0.58). In five out of 11 patients (45%) with regression of the CNVM, the mean retinal sensitivity even improved by 2.0-5.0 dB in the area of the original lesion during follow up. Instead, in patients showing progression of the CNVM at 12 months, there was a significant loss in mean retinal sensitivity--from 9.9 (4.6) dB at baseline to 1.0 (1.1) dB at 12 months (p = 0.019). The mean retinal sensitivity in the area of the irradiated but clinically normal retina during follow up was not significantly altered (21.5 dB at baseline, 19.7 dB at 12 months (p = 0.10)). CONCLUSIONS: Regression of subfoveal choroidal membranes in AMD after focal strontium irradiation is connected with stabilisation or even improvement of retinal sensitivity in central visual field measured by automated perimetry. Strontium plaque irradiation does not change the sensitivity in clinically normal paramacular retina during a 12 month follow up.

A review of the outcome of trabeculectomy in open-angle glaucoma.

BACKGROUND AND OBJECTIVE: The outcome of trabeculectomy in the treatment of primary open-angle glaucoma and exfoliative glaucoma was reviewed. PATIENTS AND METHODS: The study included 87 consecutive eyes of 87 patients with open-angle glaucoma. The outcome of trabeculectomy was correlated with a biomicroscopic appearance of the filtering bleb. Visual acuity, myopic shift in refraction, and lens opacity measurements were used as indicators for cataract progression. The effect of viscoelastics on complications and short-term outcome was studied in a randomized series of 107 eyes. RESULTS: In a series of 87 eyes, 61% had intraocular pressure (IOP) of less than 22 mm Hg without glaucoma medication 1 year after surgery. After 3 years, the corresponding success rate was 74% in a series of 85 eyes that had preoperative pupillary dilation of 4 mm or more. CONCLUSION: The diffuse filtering bleb type was associated with the greatest decrease in IOP. Unfavorable flap-sized blebs and bleb failures were associated with preoperative treatment with miotics, anterior fistulation, and postoperative hypotony. These patients also tended to be younger. In a randomized, prospective study of 107 eyes, the use of sodium hyaluronate had no significant effect on the incidence of complications or on the short-term outcome. Age 61 years or older, exfoliative glaucoma, postoperative hypotony, and IOP peaks were identified as risk factors for accelerated cataract progression after trabeculectomy.

Diabetes can alter the interpretation of visual dysfunction in ocular hypertension.

PURPOSE: The authors examined the influences of diabetes on the results of visual function testing in patients with ocular hypertension (OHT). METHODS: Color vision (desaturated D-15), contrast sensitivity together with both transient and steady-state pattern electroretinogram (PERG) findings from patients with documented OHT were examined in a historic cohort study. All patients were examined at least four times (mean, 7.8 examinations) during a follow-up period that ranged from 1.5 to 4 years. Only individuals who maintained normal visual fields throughout the follow-up period were included in this analysis. The sample included 158 patients with OHT. Of these patients, 32 were African-American and 23 had a history of noninsulin-dependent diabetes with no evidence of retinopathy (by ophthalmoscopy). Normative data were obtained from a control group that included 65 white subjects with normal vision who did not have diabetes and who were similar in age to the patients in the OHT group. RESULTS: Color vision, contrast sensitivity, and PERG results were reduced significantly in patients with diabetes and OHT relative to control subjects. Patients with OHT who did not have diabetes did not have similar abnormalities. Color vision and PERG results also were reduced significantly in patients with diabetes and OHT relative to those with OHT who did not have diabetes. Only the steady-state PERG was reduced in African-American patients with OHT (relative to both control subjects and white patients with OHT). CONCLUSIONS: Patients with diabetes and OHT have significantly greater color vision, contrast sensitivity and PERG abnormalities than patients with OHT without diabetes. Race factors do not play a major role in these differences. Screening for diabetes is recommended before drawing conclusions from the results of these types of functional tests in patients with OHT.

Identification of individual microaneurysms: a comparison between fluorescein angiograms and red-free and colour photographs.

PURPOSE: To evaluate how often a microaneurysm (MA) seen in a fluorescein angiogram (FAG) is visualized in colour or red-free photographs, and conversely how often a red dot seen in a colour photograph or a red-free photograph is found in an FAG as an MA. METHOD: Sixty-degree FAGs, colour photographs and red free fundus photographs of 24 patients with mild background retinopathy were analysed using a computer-assisted fundus lesion localization system. Only lesions identified similarly in two separate sessions were processed further. The presence of lesions identified by their position was compared in FAGs and colour and red-free photographs. RESULTS: In the whole material 394 MAs were detected in FAGs, 95 in red-free and 62 in colour photographs. Of the MAs in FAGs 26 (6.6%) were seen as a red dot in a colour photograph and 52 (13%) were found in red-free photographs. Of the 95 MAs found in red-free images 52 (55%) were detected in FAGs. Of the 62 MAs in colour photographs, 26 (42%) were seen as a MA in a FAG. A significant correlation existed between MA counts in FAGs and red dot counts in colour or red-free photographs of individual patients. CONCLUSIONS: Although MAs in FAG and red spots in colour or red-free photographs all reflect the degree of retinopathy, about half of the red dots in photographs do not represent open MAs in FAGs.

Optic disc topography before and after trabeculectomy in advanced glaucoma.

BACKGROUND AND OBJECTIVE: To analyze changes in the optic disc topography after filtration surgery. PATIENTS AND METHODS: Laser scanning tomography was performed in 10 eyes of 9 patients (mean age 65.6 +/- 8.1 years; age range 55 to 75 years) after a mean follow-up of 3.7 months, and in 8 eyes of 7 patients (mean age 63.1 +/- 7.6 years; age range 55 to 75 years) after a mean follow-up of 13.1 months. RESULTS: Preoperatively, the mean intraocular pressure (IOP) was 24.4 +/- 6.9 mm Hg with maximal medication. Postoperatively at 3.7 months it was 11.0 +/- 2.2 mm Hg, and at l2.1 months it was l3.6 +/- 2.8 mm Hg. An initial reduction in IOP of more than 30 percent at 3.7 months was achieved without medication in all but 1 eye. After 12.1 months, an IOP reduction of more than 30 percent was achieved in 6 of 8 eyes (1 with medication), while 2 eyes had IOP reductions of less than 15 percent (< or = 3 mm Hg) despite medication. In the 6 eyes, the optic disc cup volume showed a decrease of more than 30 percent, while the 2 eyes without marked IOP reductions had slight increases in cup volume. Of the 2 eyes without marked decreases in cup size, 1 had normal-tension glaucoma and 1 experienced an increase in IOP of more than 25 mm Hg during the first postoperative week. CONCLUSION: The postoperative IOP should be kept low enough to permit reversal of optic disc changes.