OBJECTIVE: Since cataract and glaucoma often coexist, and there is no agreement as to their optimal management, a review of the surgical strategies for coexisting I cataract and glaucoma is necessary. The latest evidence-based findings from various studies are presented. METHODS: A literature search of the latest full articles (up to September 2006) was conducted on the surgical management of coexisting cataract and glaucoma. The results of the 2001 Johns Hopkins milestone study were also included for analysis and comparison. RESULTS: Evidence is strong that trabeculectomy is associated with increased risk of postoperative cataract. Though cataract surgery alone may be appropriate for some glaucoma patients, combined cataract and glaucoma surgery lower long-term intraocular pressure (IOP) more than cataract extraction alone. Use of intraoperative mitomycin-C is beneficial in combined surgery. Limbu and fornix-based conjunctival flaps are equally effective for lowering IOP combined surgery. Trabeculectomy alone lowers long-term IOP more tha combined extracapsular cataract extraction (ECCE) and trabeculectomy. Evidence is weak that combined surgery with phacoemulsification rather than ECCE results in lower long-term IOP, as does two-site compared to single-site combined surgery. CONCLUSION: The literature does not point to an optimal strategy for controlling in patients with coexisting cataract and glaucoma needing surgery. There is a continued need for high-quality studies of longer duration and more information on the optic nerve and visual field.
GLAUCOMA ; CATARACT ; INTRAOCULAR PRESSURE ; OCULAR HYPERTENSION ; OCULAR HYPOTENSION ; SURGERY ; PHACOEMULSIFICATION ; TRABECULECTOMY

PURPOSE: To report the effectiveness of selective laser trabeculoplasty (SLT) in patients with intraocular hypertension refractory to maximum tolerated medical therapy after intravitreal triamcinolone acetonide (IVTA). CASE SUMMARY: The records of 3 patients with steroid-induced intraocular hypertension that did not respond to maximum tolerated medical therapy were retrospectively reviewed. The patients received SLT instead of filtering surgery or Argon laser trabeculoplasty. The mean intraocular pressure (IOP) of 13.7 mm Hg increased to 30.7 mm Hg within 13 days of IVTA. IOP was uncontrolled despite maximum tolerated medical therapy. Patients underwent SLT 15.3 weeks after IVTA. Mean IOP decreased to 16 +/- 3.0 mm Hg after 1 day, 19.7 +/- 8.0 mm Hg after 1 week, 17 +/- 8.0 mm Hg after 1 month, 12.3 +/- 2.9 mm Hg after 3 months and 12.3 +/- 0.6 mm Hg after 4 to 6 months. The number of IOP lowering drugs were decreased to 1 from 4.3 after 6 months of SLT. CONCLUSIONS: SLT may be effective and safe for the treatment of steroid-induced intraocular hypertension refractory to maximum tolerated medical therapy.
Argon ; Filtering Surgery ; Humans ; Hypertension ; Intraocular Pressure ; Ocular Hypertension ; Retrospective Studies ; Trabeculectomy ; Triamcinolone Acetonide

Adenosine deaminase(ADA)has been used for the diagnosis of localized tuberculosis.The titer of ADA was measured from the ocular fluid of the patients who had undergone vitreoretinal surgery due to non-tuberculous vitreoretinal disease. Forty five patients were included and twenty patients were male. Mean age was 51.9 years. Four patients had diabetes mellitus and two had essential hypertension. The most frequent cause of vitreoretinal surgery was proliferative vitreoretinopathy(12 eyes). For the analysis of ADA titer, vitreous fluid(group I)was aspirated in 36 patients undergoing pars plana vitrectomy and subretinal fluid(group II)in 9 patients undergoing scleral encircling. Mean titer of ADA was 9.01+/-15.69 IU/L, and there was no significant difference on the statistics between group I(6.06+/-13.75 IU/L)and group II(20.83+/-18.17 IU/L). All 45 eyes showed negative reaction to polymerase chain againt tuberculosis, and 25 of 29 patients had positive reaction to tuberculin skin test. There was no statistically significant relationship between ADA titer and tuberculin skin test. This result suggests that ADA may be used for the diagnosis of posterior ocular tuberculosis, since the normal concentration in the posterior ocular fluid was compatible with the one in other body fluids where it has been used for the diagnosis of localized tuberculosis.
Adenosine Deaminase* ; Adenosine* ; Body Fluids ; Diabetes Mellitus ; Diagnosis ; Humans ; Hypertension ; Male ; Skin Tests ; Tuberculin ; Tuberculosis ; Tuberculosis, Ocular ; Vitrectomy ; Vitreoretinal Surgery

We report a case of Descemet's membrane detachment, a rare complication of viscocanalostomy. During the operation, the injection cannula was directed slightly oblique to the Schlemm's canal rather than parallel to it. Localized corneal whitening developed adjacent to the injection site during viscoelastic injection. One week postoperatively, corneal edema decreased and Descemet's membrane detachment was noted. Nine months after surgery, the cornea was clear while the Descemet's membrane detachment remained. And IOP was 19 mmHg without any medications. We think that improper cannula positioning during viscoelastic injection may cause Descemet's membrane detachment, a rare complication of viscocanalostomy.
Aged ; Case Report ; Corneal Diseases/*etiology ; *Descemet's Membrane ; Human ; Hyaluronic Acid/administration & dosage ; Injections/adverse effects ; Intraoperative Complications ; Male ; Ocular Hypertension/*surgery

INTRODUCTIONPrimary angle-closure glaucoma (PACG) is a major cause of blindness among Asians. A better understanding of the disease will improve the treatment and outcome of this condition.

METHODSA literature review of all recent publications on PACG was carried out. Articles were retrieved using a key word search of MEDLINE, PubMed and Science Citation Index databases.

RESULTSFollowing laser peripheral iritodomy for acute angle-closure, Asians were found to have a higher tendency to develop a subsequent rise in intraocular pressure compared to Caucasians. Furthermore, the extent and severity of visual field damage was more severe in Asians than Caucasians, particularly in eyes that presented insidiously with chronic PACG. Prophylactic laser iridotomy in the contralateral eye was found to be highly effective in preventing acute angle-closure attacks.

CONCLUSIONPACG is more difficult to manage and is associated with more severe long-term visual morbidity in Asians than Caucasians. Regular follow-up of patients with PACG is important for the early detection of progression of the disease and visual field deterioration.

Asian Continental Ancestry Group ; European Continental Ancestry Group ; Glaucoma, Angle-Closure ; complications ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Iridectomy ; adverse effects ; Ocular Hypertension ; etiology ; Visual Fields

PURPOSE: To report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP). METHODS: A 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done. RESULTS: Surgery was successful in both eyes. CONCLUSIONS: This is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.
*Anterior Chamber ; Cataract/complications/diagnosis ; Cataract Extraction ; Electroretinography ; Follow-Up Studies ; Humans ; Iris/surgery ; Laser Therapy/adverse effects ; Lens Implantation, Intraocular/methods ; Lens Subluxation/diagnosis/*etiology/surgery ; Male ; Middle Aged ; Ocular Hypertension/complications/physiopathology/surgery ; Retinitis Pigmentosa/*complications/diagnosis/surgery ; Sclera/surgery ; Suture Techniques ; Visual Fields ; Vitrectomy

PURPOSE: To investigate the rate and the degree of the ocular hypertensive response to dexamethasone ointment in children undergoing eyelid surgery. METHODS: Dexamethasone ointment (Dexcosil(R)) was applied three times a day for the first week and twice a day for the second to third week postoperatively to children undergoing epiblepharon surgery. Intraocular pressure (IOP) was measured on the day before surgery, postoperative day 1, 7, 14, 21, 28 and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase and time to reach a peak IOP were analyzed. Dexamethasone ointment was discontinued if the IOP was 25 mmHg or more. RESULTS: A total of 96 children (mean age, 6.5+/-2.7 years) were included. Preoperative mean IOP was 13.6+/-2.9 mmHg (range 7-19). After dexamethasone ointment treatment, the children showed a significant rise in IOP as compared with the preoperative values. The peak IOP was 20.6+/-4.9 mmHg (range 11-39) and the time to reach peak IOP was 8.5+/-5.9 days. The low responders (delta IOP< or =5 mmHg) of our group comprised 35.4% (34/96) of patients, intermediate responders (delta IOP 6-15 mmHg) comprised 56.3% (54/96) of patients and high responders (delta IOP> or =16) comprised 8.3% (8/96) of patients. A net increase in IOP was significantly higher in children 5 years old or less as compared with those older than 5 years (age< or =5, 9.4+/-7.5 mmHg vs age>5, 6.3+/-4.4 mmHg; p=0.015, unpaired t-test). CONCLUSIONS: Ocular hypertensive response after dexamethasone ointment to the eyelids occurred frequently in children, especially those 5 years old or younger.
Prospective Studies ; Prognosis ; Postoperative Period ; Ointments ; Ocular Hypertension/*chemically induced/physiopathology ; Male ; Intraocular Pressure/*drug effects ; Humans ; Glucocorticoids/administration & dosage/*adverse effects ; Follow-Up Studies ; Female ; Eyelid Diseases/surgery ; Dexamethasone/administration & dosage/*adverse effects ; Child, Preschool ; Child ; Adult ; Adolescent ; Administration, Topical