Search

We studied the histopathologic changes of three eyes enucleated two weeks, eight weeks, and 17 months, respectively, after noncontact Nd:YAG cyclophotocoagulation. The histologic findings at two weeks were destruction of the nonpigmented and pigmented ciliary body epithelium, occlusion of the capillaries of the ciliary processes, and ciliary body stromal necrosis in the region of the processes. Hyperplasia of the pigmented and nonpigmented epithelium, fibrosis and near total atrophy of the ciliary processes, and partial atrophy of the ciliary muscles were present at eight weeks and 17 months. We concluded that application of treatment 1.0 to 1.5 mm posterior to the corneoscleral limbus selectively destroys the pars plicata, and that, histologically, the mechanism for reducing intraocular pressure appears to be destruction of ciliary processes with reduction of aqueous formation.

Purpose To determine the glaucoma phenotype of an American pedigree with the myocilin Asp380His. Design An observational case series study. Methods An observational case series study was used to examine a family in which an Asp380His myocilin mutation was segregating. Thirteen family members were examined and medical records were obtained on the remaining two individuals. Blood samples were collected from all 15 participants following the tenets of the Helsinki declaration under the auspices of the Oregon Health & Sciences University Institutional Review Board and screened for myocilin variants by denaturing high-performance liquid chromatography (dHPLC). Any DNA samples with dHPLC data different from the control sample were sequenced for base pair analysis. Results An Asp380His myocilin mutation was identified in eight members, seven of whom had primary open-angle glaucoma (POAG). The eighth individual had high intraocular pressures (IOPs). The disease presents in this family with extremely high IOPs requiring trabeculectomies to control the pressure. The age at diagnosis ranged from 30 to 45. Conclusions This family with an Asp380His myocilin mutation presents with an intermediate phenotype between juvenile- and adult-onset glaucoma. The Asp380 amino acid residue appears to be important in myocilin function based on the finding that substitution of this amino acid with four different amino acids (His, Ala, Asn, or Gly) all result in a similar presentation of POAG that is intermediate between the more severe clinical presentations observed in individuals with the Pro370Leu or Lys423Glu variant and the milder findings in patients with the Gln368Stop mutation.

Evaluate Humphrey visual field (VF) analyzer central 30-2 foveal threshold test for best-corrected visual acuity.Consecutive case series.Both eyes (n = 117) of 59 patients with diseased and healthy eyes presenting for VF analysis were evaluated to determine foveal threshold. This was compared with uncorrected visual acuity converted to logMAR, determined by manifest refraction, or estimated from Snellen visual acuity with pinhole.Foveal threshold correlated with logMAR uncorrected visual acuity for right (P.0001) and left eyes (P.0001) and logMAR best-corrected visual acuity for right (P.0001) and left eyes (P.0001). Sixty-eight percent of eyes with visual acuity20/50 had foveal threshold of 0 to 30; 47% with visual acuity of20/20 had foveal threshold better than 37.Foveal threshold measurement appears to provide a reliable estimate of best-corrected visual acuity. This method may usefully predict visual acuity in eyes with possible nonorganic visual acuity loss.

Purpose To compare the safety and intraocular pressure (IOP)-lowering efficacy of travoprost 0.004%/timolol 0.5% fixed combination ophthalmic solution (Trav/Tim) to its components travoprost 0.004% ophthalmic solution, TRAVATAN, (Trav) and timolol 0.5% ophthalmic solution (Tim) in patients with open-angle glaucoma or ocular hypertension. Design Randomized multicenter, double-masked, active-controlled, parallel group study. Methods Two hundred sixty-three patients with open-angle glaucoma or ocular hypertension were randomized to receive Trav/Tim once daily AM (and vehicle PM), Trav once daily PM (and vehicle AM), or Tim twice daily (AM and PM). Efficacy and safety were compared across treatment groups over 3 months. Results Trav/Tim produced a mean IOP decrease from baseline of 1.9 mm Hg to 3.3 mm Hg more than Tim, with a significant decrease in mean IOP at each of the nine study visits ( P ≤ .003). Trav/Tim decreased mean IOP by 0.9 mm Hg to 2.4 mm Hg more than Trav, with a significant decrease in mean IOP at seven of the nine study visits ( P ≤ .05). The adverse event profile for Trav/Tim was comparable to Trav or Tim alone. Conclusions Over the 3 months of treatment, Trav/Tim produced clinically relevant IOP reductions in patients with open-angle glaucoma or ocular hypertension that were greater than those produced by either Trav or Tim alone. The clinical results that Trav/Tim was safe and well tolerated with an incidence of adverse events was comparable to the results of Trav or Tim alone. Trav/Tim provides both more effective IOP reduction than its components and the benefits of once-daily dosing.

Purpose To report a case of Bartonella henselae infection. Design Observational case report Methods Review of the clinical, laboratory, photographic, and angiographic records of a patient with cat scratch disease associated with central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss. Results A 21-year-old man had no light perception in the left eye secondary to concurrent central retinal artery and vein occlusion believed to have resulted from infection with Bartonella henselae . Forty days later, he developed neovascular glaucoma in the left eye. Conclusion Ocular complications associated with Bartonella henselae infection may include central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss.

Purpose To report the magnetic resonance appearance of hypotonus maculopathy. Design Observational case report. Methods A 48-year-old man with a long history of glaucoma and subsequent trabeculectomy in the right eye developed hypotonus maculopathy. Visual acuity continued to decrease in both eyes of a relatively young individual with severe primary open angle glaucoma. A magnetic resonance image was requested to look for a compressive optic neuropathy. Results Magnetic resonance imaging showed an abnormal plaquelike thickening of the macula and flattening of the posterior globe. Conclusion To our knowledge, this is the first case report of the magnetic resonance appearance of hypotonus maculopathy.

Inquiries to Steven Ofner, M.D., Eugene Eye Care Associates, P.C., 1415 Pearl St., Eugene, OR 97401. Congenital glaucoma in identical twins has been observed, as has primary open-angle glaucoma in monozygotic twin pairs, but lowtension glaucoma in identical twins has not been well documented. In a large study of twins with chronic open-angle glaucoma, 29 monozygotic and 79 dizygotic pairs were studied. In another large study of the incidence of ocular disease in twins, low-tension glaucoma was not described. However, intraocular pressure criteria were probably part of the study. An autosomal dominant form of low-tension glaucoma has been previously described. We managed a case of low-tension glaucoma in identical twins. A 44-year-old woman was referred for examination after routine automated perimetry disclosed an abnormality in the visual field. Her ocular and medical history were noncontributory. Her identical twin sister was also healthy. Ocular examination showed a visual acuity of 20/20 in both eyes. The left eye had an afferent pupillary defect. There were inferior iris transillumination defects in both eyes without Krukenberg's spindles. Gonioscopy showed the iridocorneal angle to be open 360 degrees to the scierai spur with mild trabecular pigmentation. The optic disk had a cup/disk ratio of 0.7 in both eyes, with a splinter hemorrhage at the disk margin in the superotemporal portion of the left eye. Static threshold perimetry disclosed a dense inferonasal step in the left eye that corresponded with the disk hemorrhage. The visual field in the right eye showed an inferonasal depression of retinal sensitivity. The highest intraocular pressure measured was 21 mm Hg in both eyes during an all-day diurnal curve study. The lowest intraocular pressures were 16 mm Hg in the right eye and 17 mm Hg in the left eye. Intraocular pressure decreased to 13 mm Hg in the right eye and 15 mm Hg in the left eye while the patient was instilling timolol 0.5% twice a day in both eyes. Subsequently, the patient's asymptomatic, identical twin sister was examined. Results of her ocular examination were similar to those of her twin sister, except her pupillary responses were normal. No iris transillumination defects were noted. The optic disk showed a cup/disk ratio of 0.7, with some sloping temporally in both eyes. A large splinter hemorrhage was present superotemporally in the right eye, which was contralateral to the eye of her twin sister. Results of static threshold perimetry were normal in the left eye, but showed an inferonasal defect in the right eye. Results of magnetic resonance imaging of the brain and orbits with gadolinium contrast were within normal limits as were results of a complete physical examination and carotid artery duplex scanning for each twin sister. The highest intraocular pressures measured were 21 mm Hg in the right eye and 19 mm Hg in the left eye during an all-day diurnal curve study. The lowest intraocular pressures were 18 mm Hg in the right eye and 15 mm Hg in the left eye. The

Six cases of glaucoma associated with pigment dispersion syndrome occurred after the implantation of posterior chamber intraocular lenses. All six patients had iris transillumination defects associated with the intraocular lens haptics, increased intraocular pressure, and pigment deposition in the trabecular meshwork and the anterior chamber. Medication controlled the glaucoma and none of the patients required further surgery.

A select population of patients received repeat laser trabeculoplasties of 40 to 100 burns over 180 to 360 degrees. These eyes had shown an excellent prolonged response to initial laser trabeculoplasty. Eight of 11 eyes with greater than one year follow-up showed a sustained hypotensive response to repeat laser trabeculoplasty. No significant posttreatment intraocular pressure increases were observed. Repeat argon laser trabeculoplasty was effective for these patients who had shown a prolonged response to their initial treatment.

We used the mode-locked neodymium-YAG laser to reopen filtration fistulas in nine eyes in which the fistula had become occluded internally by a variably pigmented membrane, vitreous, or, in one case, capsular lens material. In five eyes filtration was successfully reestablished, reducing the intraocular pressure to less than 21 mm Hg (range, 10 to 20 mm Hg). The remaining four eyes had fistulas thought to be open internally after laser treatment; however, filtration was not established because of external subconjunctival scarring of the bleb. As with needling or argon laser fistular reopening, successful filtration followed Nd-YAG laser fistular surgery only when the fistula was occluded by an identifiable membrane and when the eye already had had a well-established bleb.

Using computer assisted morphologic analysis of central corneal endothelial specular micrographs, we prospectively examined the effects of glaucoma laser procedures on the corneal endothelium. Argon laser trabeculoplasty was performed in 22 eyes of 17 patients. Argon laser iridotomy was performed in 14 eyes of seven patients. Untreated fellow eyes in ten patients undergoing laser trabeculoplasty were used as controls. After one year, no statistically significant difference in cell area, percent hexagonal cells, or shape factor was observed. Our results suggest that argon laser procedures do not pose any long-term hazard to the corneal endothelium.

l3-lipoproteins during the course of the therapy. Any systemic or ocular toxicity of miconazole was not disclosed in this case. Miconazole is active in vitro against a large number of fungi including some ocular pathogens." Foster and Stefanyszyn! reported that miconazole had good intraocular penetration in rabbits. It has been successfully used intravenously in the treatment of human mycosis and produced no side effects, although we found no reports of successfully treating human keratomycosis by intravenous miconazole monotherapy. Our patient was apparently cured by miconazole therapy and this limited experience suggests that intravenous miconazole is a useful treatment for human fungal keratitis. This agent warrants further evaluation for ophthalmic use. Rebell and Forster'' documented that miconazole was only incompletely fungistatic to B. theobromae, although our strain was sensitive to this drug (minimum inhibiting concentration is 0.9 lJog/ml), whereas it was not sensitive to ketoconazole (minimum inhibiting concentration is 15.6 IJog/ml).

We studied the diagnostic features of vitreous humor filling the anterior chamber in open-angle glaucoma in one patient who developed this phenomenon several years after an intracapsular cataract extraction. In two other patients, vitreous filled the anterior chamber after ocular trauma. These patients had markedly increased intraocular pressures that responded poorly to medical therapy. Follow-up of at least one year with each of our patients suggests that with vitrectomy they have done well.

Editor's Note: With this issue the journal launches a new section in which periodically a particular topic will be reviewed by an expert or experts in a field with emphasis upon their personal views. We hope these views will be fresh, thought-provoking, and a stimulus to further studies. This section will be concerned mainly with the state-of-the-art and will relate to a particular viewpoint as of this time.

To study further the transient increase in trabecular cell division within the first two days after laser trabeculoplasty in human corneoscleral explant organ cultures, we used a pulse-chase protocol in which immediately after laser treatment 3H-thymidine was added to the culture medium for 48 hours (the pulse period). Fresh medium without radiolabel was then added for variable times (the chase period) before termination of the experiment. Autoradiography was used to follow changes in the regional distribution of the cells that divided during the pulse period and had 3H-thymidine-labeled DNA. Laser-treated explants, evaluated after a pulse with no chase, showed a fourfold increase in cell division (P less than .001) over nontreated controls. Nearly 60% of this cell division was localized to the anterior, nonfiltering region of the trabecular meshwork where it inserts into the cornea beneath Schwalbe's line. Trabecular cell division in other regions of the meshwork was not increased over controls at this time. After seven or 14 days of chase without radiolabel, the regional distribution of radiolabeled cells changed in laser-treated explants but not in controls. By 14 days, only 26% of the labeled cells remained in this anterior insert region, while 60% were found in the region of the burn sites. Macroautoradiography of whole explants corroborated these observations. Our data support the hypothesis that laser trabeculoplasty causes early cell division by a population of cells in the anterior meshwork; these new cells then migrate and repopulate the burn sites over the next few weeks.