Methods: A prospective, randomized, comparative study was performed involving patients undergoing trabeculectomy who were randomly assigned to either 0.2 mg/ml MMC for 4 minutes or 0.4 mg/ml for 2 minutes. The IOP, bleb characteristics, and occurrence of complications were compared. Age and gender of the patients, preoperative IOP, MMC concentration, bleb characteristics, angle status, and age of the surgery were analyzed to determine if they are predictive factors of the postoperative IOP using univariate and multivariate analyses. Results Seventy-four eyes of 68 patients underwent trabeculectomy: 36 eyes were treated with 0.2 mg/ml MMC for 4 minutes and 38 eyes with 0.4 mg/ml MMC for 2 minutes. There was no statistically significant difference in the mean preoperative IOP and postoperative IOP, as well as in the mean percent change in IOP (p = 0.87) between the 2 groups. Univariate and multivariate analyses showed the preoperative IOP (p = 0.02) and the type of filtering bleb (cystic p < 0.001; diffuse p = 0.045) as predictive factors of postoperative IOP. KaplanMeier survival curves showed no significant difference between the 2 groups at an average follow-up of 20 weeks. Conclusion: There is no significant difference in the outcomes of trabeculectomies using 0.2 mg/ml and 0.4 mg/ml MMC. Preoperative IOP and bleb characteristics are factors predictive of successful filtration surgery.
Male ; Female ; Middle Aged ; TRABECULECTOMY ; MITOMYCIN ; INTRAOCULAR PRESSURE ;

Methods: A prospective, randomized, controlled trial was performed involving patients requiring laser iridotomy who were randomized either to Nd:YAG laser or sequential argon-Nd:YAG laser iridotomy. Iris-perforation success rate, the average number of laser shots and amount of laser energy used, the intraocular pressure (IOP) after laser treatment, and the rate of complications were compared. The prelaser pupil size was correlated with the iris perforation success rate. Results: Forty-one eyes underwent laser iridotomy (23 Nd:YAG and 18 sequential). All eyes had patent iridotomies. There was no difference between the two groups in terms of the number of Nd:YAG laser shots delivered (p=0.97) and amount of Nd:YAG energy used (p=0.64). The total amount of laser energy used was higher in the sequential group (p=0.003). There was no significant difference in the IOP and complication rates after treatment. A positive correlation was seen between prelaser pupil size and number of Nd:YAG shots needed to enlarge (r=0.38, P=0.01). Conclusion: Nd:YAG laser alone and sequential argon-Nd:YAG have comparable success in attaining patency of laser iridotomy, IOP control, and rate of complications in dark irides of Filipinos.
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; GLAUCOMA ; LASERS, SOLID-STATE ; NEODYMIUM ;

OBJECTIVE:To determine the current leading causes of new patient consults at the out-patient general clinic of the Department of Ophthalmology and Visual Sciences (DOVS), Sentro Oftalmologico Jose Rizal (SOJR).
METHODS: The data were gathered from the DOVS out-patient general clinic monthly census. Compilation and tabulation of the diagnoses of all new patients from January to December 2009 were done.
RESULTS: The leading causes of new patient consults were cataract (30.8%), error of refraction (20.1%), pterygium (6.1%), conjunctivitis (4.9%), dysfunctional tear syndrome (4.5%), glaucoma (4.3%), diabetic retinopathy (3.7%), and hypertensive retinopathy (3.4%).
CONCLUSION: Cataract and error of refraction comprise the majority of all causes of consultation among new patients.

Human ; Cataract ; Censuses ; Conjunctivitis ; Diabetic Retinopathy ; Glaucoma ; Hypertensive Retinopathy ; Ophthalmology ; Outpatients ; Pterygium ; Referral And Consultation ; Vision Tests

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.
GLAUCOMA ; OPTIC NERVE ; VISUAL FIELDS ; VISUAL FIELD TESTS ; OPTIC DISK

Objective: This study investigated the effect of brimonidine on the anterior-chamber angle in eyes with narrow angles using noncontact three-dimensional anterior-segment analyzer Pentacam. Methods: Nine eyes with narrow angles were distributed to one of three treatment groups—single topical dose of 0.15% brimonidine tartrate, 0.5% timolol maleate (positive control), or balanced salt solution (negative control)—in a prospective, single-masked, crossover, comparative trial. The primary outcome measure was anterior-chamber angle at baseline, and 2 and 4 hours after instillation of the treatment drug. Secondary outcome measures were pupil diameter, intraocular pressure (IOP), and anterior-chamber depth and volume. After a two-week washout period, eyes were crossed over to the other treatment modes. All baseline and posttreatment measurements were taken. Repeated analysis of variance (ANOVA) was used for statistical analysis. Results: Anterior-chamber angle, depth, and volume did not differ significantly for all treatment groups. Brimonidine caused a significant decrease in pupil diameter, most notably 2 hours after instillation, from baseline of 2.36 ± 0.37 mm to 2.17 ± 0.35 mm. (p = 0.03). There was a significant decrease in IOP from baseline to hour 4 after treatment for both brimonidine (11.4 ± 2.2 to 9 ± 1.8 mm Hg, p < 0.001) and timolol (11.9 ± 2.3 to 9.4 ± 2.1 mm Hg, p = 0.003). Conclusions Brimonidine produced a miotic trend with no significant opening of the anterior-chamber angle in patients with narrow angles.
Brimonidine Tartrate ; Miosis ; Intraocular Pressure

Objective: This study compared the rates of aqueous-humor flow and trabecular outflow in eyes that had undergone YAG laser iridotomy (LI) for primary-acute-angleclosure (PAC) attack and primary-angle-closure suspect (PACS). Methods: Patients who had PAC attack in one eye and narrow occludable angles (PACS) in the other eye that had undergone YAG LI were recruited. All underwent complete ophthalmologic examination including gonioscopy, ultrasonic pachymetry, A scan, and fluorophotometry to determine the rate of aqueous-humor flow. The Goldmann equation was used to compute the outflow facility using the values of aqueous flow and intraocular pressure (IOP). Results: Fifty eyes of 25 patients were included, 25 of which had PAC attack and 25 were PACS. The central corneal thickness (CCT), anterior-chamber depth, and anterior-chamber volume of the 2 groups were comparable. PAC-attack eyes had significantly higher IOP (18.4 mm Hg) than the PACS (14.12 mm Hg) (p = 0.001). The mean rate of aqueous flow was 2.50 ± 0.94 µL/min and 2.89 ± 1.17 µL/min in the PAC and PACS respectively (p = 0.20). The mean aqueous-outflow facility was 0.29 ± 0.18 µL/min and 0.59 ± 0.37 µL/min respectively (p = 0.0008). Conclusion A significantly lower aqueous-outflow facility was demonstrated by fluorophotometry among eyes with PAC. Despite the anatomically open angles, they continued to have higher IOPs.
Fluorophotometry ; Intraocular Pressure

Objective: To evaluate and compare the effects of bevacizumab, mitoinycin-C (MMC), 5-fluorouracil (5-FU), and triamcinolone acetonide (TA) on the viability of cultured human Tenon's capsule fibroblasts (cHTF) in vitro.

Methods: Human Tenon's fibroblasts (HTF) were harvested and cultured in a Roswell-Park-Memorial 1-Institute (RPMI) media. MMC, 5-FU, bevaciz. umab, and TA were administered to the cHTF at 3-fold decreasing concentrations starting from 20 ug, 5 mg, 25 mg, and 4 mg respectively. A negative control/untreated group containing RPMI media only was included in the study. Fibroblast cell viability was assessed using resazurin fluorim etric assay. Half¬maximal inhibitory concentration (IC50) was computed for agents which showed significant decrease in cHTF viability compared to the untreated group.

Results: There was no significant difference in cH IF viability between the untreated control group compared to 5-FU (p=0.97), bevacizumab (p=0.10), and TA (p=0.06) groups. Mitomycin-C showed a significant decrease in cHTF viability (p<0.001) which was dose dependent. The IC50 of MMC was computed at 12.16 ug using the prism software.

Conclusion: Mitomycin-C demonstrated dose-dependent decrease in viability of cultured human Tenon's fibroblasts. 5-FU, bevacizumab, and triamcinolone did not show this effect.

Key Words: Mitomycin-C, 5-fluorouracil, Bevaciz. umab, Tria. mcinolone acetonide, Fibroblast, Trabeculectomy

Human ; Male ; Female ; .humans ; Mitomycin ; Triamcinolone Acetonide ; Trabeculectomy ; Resazurin ; Bevacizumab ; Fluorouracil ; Cell Survival ; Control Groups ; Inhibitory Concentration 50 ; Tenon Capsule ; Xanthenes ; Oxazines ; Antibodies, Monoclonal, Humanized ; Fibroblasts ; Software