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Background: Neurilemomas (schwannomas) rarely occur intraocularly. When present, they pose a diagnostic dilemma for the physician and often are mistaken as a malignant lesion, resulting in enucleation. Methods: The authors report the clinical findings of a 46-year-old man with a slowly progressive growing mass of the anterior chamber, associated with glaucoma and the development of cataract. To further delineate the tumor's features, ancillary techniques, including ultrasonography, computed tomography, and magnetic resonance imaging, were conducted. A definitive anterior chamber biopsy of the tumor was performed with histoogc examination and electron microscopy. Results: Ultrasonography, high-resolution computed tomography and magnetic resonance imaging showed a well-delineated mass of the inferior ciliary body involving nearly 5 clock hours of the angle. Two clinical features that suggested a longstanding tumor were brilliant transillumination of the mass (leading to the impression of a "cystic mass," not corroborated by ultrasonography) and retrodisplacement of the involved iris root. The histology, and particularly the electron microscopic features, confirmed the diagnosis of a neurilemoma, a benign tumor of the anterior segment. Conclusion: Intraocular neurilemomas are extremely rare tumors. Few are well documented with modern ancillary techniques. Clinical findings in conjunction with radiographic and ultrasonic features may support the diagnosis of a benign tumor. For this patient, confirmation via biopsy permitted combined cataract and glaucoma surgery to rehabilitate the eye, which retains 20/20 visual acuity 3 years after the procedure.

Purpose: Argon laser trabeculoplasty (ALT) is commonly used in the treatment of open-angle glaucoma. Varying success rates in lowering intraocular pressure (IOP) and controlling glaucoma are reported in studies with follow-up periods from 1 to 5 years, and few reports are available with follow-up to 10 years. The authors retrospectively reviewed the efficacy of ALT in patients followed up to 10 years. Methods: Ninety-three patients with open-angle glaucoma underwent 360° ALT. Mean follow-up was 52 ± 43 months (mean ± standard deviation; range, 1–132 months). Successful treatment at the time of final follow-up was defined as a decrease in IOP of 3 mmHg or greater from pretreatment level, IOP of 19 mmHg or less, stable visual field, stable optic nerve, and no further laser or surgical intervention. Results: The decrease in IOP was 8.9 ± 5.4 mmHg at 1 year, 10.0 ± 4.2 mmHg at 5 years, and 8.9 ± 5.2 mmHg at 10 years. The probability of success at 1 year was 77%, at 5 years 49%, and at 10 years 32%. Failure was most common in the first year after treatment (23%), and thereafter failure occurred at a rate of 5% to 9% per year. The mean decrease in IOP for all 93 eyes at time of maximum follow-up was 6.1 ± 7.1 mmHg. Conclusion: Argon laser trabeculoplasty is an effective means for reducing IOP in many patients followed for an extended time. However, up to one half of eyes within 5 years of ALT and two thirds of eyes within 10 years may require additional laser or surgical intervention for glaucoma control.

Purpose: To investigate the safety and efficacy of holmium YAG laser sclerectomy, a new laser filtration procedure. Methods: The authors performed holmium YAG laser sclerectomy on 49 eyes of 46 patients (mean follow-up, 12.3 ± 1.1 months). Results: Mean preoperative intraocular pressure (IOP) was 26.9 ± 1.3 mmHg; postoperative mean IOP on last follow-up visit was 19.7 ± 1.6 mmHg. Thirty (61%) of 49 eyes achieved a final IOP of 5 to 22 mmHg, 29 (59%) of 49 had a final IOP of 5 to 19 mmHg, and 21 (43%) of 49 had a final IOP of 5 to 15 mmHg. Sixteen (73%) of 22 eyes treated postoperatively with 5-fluorouracil (5-FU) had a final IOP of 21 mmHg or less. Twenty-seven percent of eyes lost one or more lines of vision, and 36% of eyes gained one or more lines of vision; there was no median change in visual acuity. Complications included suprachoroidal hemorrhage in 7 (14%) of 49 eyes and intraoperative vitreous hemorrhage in 2. Seventeen (35%) of 49 eyes required a second IOP-lowering procedure. Conclusion: Holmium YAG laser sclerectomy is an effective means to perform glaucoma filtration surgery. This is a full-thickness filtering procedure, with all of the risks attendant.

Background: Early reports of both contact and noncontact transscleral Nd:YAG laser cyclophotocoagulation have been encouraging; however, recent evidence indicates a significant incidence of hypotony, visual loss, and phthisis with the noncontact technique with more than 6 months of follow-up. The authors sought to determine the intermediate term effects of contact transscleral Nd:YAG laser cyclophotocoagulation (CYC). Methods: The authors followed 116 eyes of 114 patients for a minimum of 1 year after treatment of advanced glaucoma with CYC. Results: The mean preoperative intraocular pressure (IOP) of 35.0 ± 1.0 mmHg decreased to 18.6 ± 1.1 mmHg ( P Conclusion: Midterm results of CYC continue to be encouraging but are tempered by a nearly 10% incidence of hypotony or phthisis and the progression of visual loss.

Advanced glaucoma in 140 eyes of 136 patients was treated with contact transscleral continuous wave neodymium:YAG (Nd:YAG) laser cyclophotocoagulation (CYC) with a sapphire-tipped probe. The anterior edge of the probe was placed 0.5 to 1.5 mm posterior to the limbus, using 7 to 9 W of power for 0.7 seconds with 32 to 40 applications, sparing the 3 and 9 o'clock meridians. Patients were studied prospectively. The mean preoperative intraocular pressure (IOP) of 36.7 ± 0.97 mmHg decreased to 21.2 ± 0.99 mmHg (P = 0.004) after treatment (mean follow-up, 3.2 ± 0.35 months) for a mean decrease in IOP of 15.5 ± 1.21 mmHg and a mean percent decrease of 39%. Forty-one eyes were followed 6 or more months (mean, 6.7 ± 0.25 months). The CYC reduced IOP to 25 mmHg or less in 71 % of eyes, to 22 mmHg or less in 62% of eyes, and to 19 mmHg or less in 49% of eyes. Maximum lowering of IOP occurred 1 week to 1 month after treatment and remained at that level through 6 months of follow-up. Retreatment was required in 11% of patients; only one patient was retreated more than once. Four patients treated with 9 W of power developed IOPs below 5 mmHg; two of these patients had an IOP of 0 mmHg. Other complications of therapy were minimal, and patients had little pain. There was no significant change in visual acuity. Early results of this newly available therapy are encouraging.

Fifteen patients with synechial angle-closure glaucoma uncontrolled by medical and laser therapy were treated with surgical goniosynechialysis. Five patients were treated with goniosynechialysis alone, and ten were treated with goniosynechialysis in combination with other surgical procedures. The procedure was successful, in terms of reducing synechiae, in 14 eyes (93%). The extent of angle closure was reduced from 340 degrees +/- 45 degrees (mean +/- standard deviation) preoperatively to 80 degrees +/- 70 degrees postoperatively; the mean reduction was 260 degrees +/- 95 degrees (P less than 0.0001) for the group overall and 280 degrees +/- 80 degrees (P less than 0.0007) for the subgroup treated with goniosynechialysis alone. The mean preoperative intraocular pressure (IOP) was 40 +/- 4 mmHg. The mean postoperative IOP was 14 +/- 4 mmHg. The mean reduction in IOP was 26 +/- 15 mmHg (P less than 0.0001) for the group overall and 27 +/- 18 mmHg (P less than 0.015) for the subgroup treated with goniosynechialysis alone. Glaucoma medications were reduced from a mean of 2.6 +/- 1.0 preoperatively to 1.1 +/- 1.2 postoperatively for the group overall and to 1.4 +/- 1.5 for the subgroup treated with goniosynechialysis alone. Complications consisted of two eyes with intraoperative bleeding. One of these required intraoperative conversion to surgical trabeculectomy. The other was associated with a transient postoperative IOP elevation to 40 mmHg. Surgical goniosynechialysis may be an effective means of reducing synechiae and lowering IOP, either alone or in conjunction with other surgical procedures, in patients with angle closures of less than 6 months' duration.

Increased intraocular pressure (IOP) in encapsulated filtration blebs was evaluated in 49 eyes of 49 patients followed for 6 to 48 months (mean +/- standard deviation, 19.7 +/- 12.6 months). Intraocular pressure increased from 10.2 +/- 7.5 mmHg at 1 week postfiltration surgery to a peak of 26.1 +/- 10.7 mmHg at 3 weeks postoperatively and then decreased to 16.2 +/- 5.0 mmHg at 16 weeks and remained stable through the follow-up period. Thirty-nine eyes had a final IOP of 19 mmHg or less; 35 eyes required medical therapy alone (antiglaucoma drops, oral carbonic anhydrase inhibitors, and/or digital massage) with a final IOP of 14.1 +/- 3.8 mmHg; and 14 eyes required surgical reintervention for medically uncontrolled IOP elevation, and five of these eyes required two or more surgical reoperative procedures. Vigorous medical therapy, including glaucoma medications, topical steroids, and digital massage, is particularly important for encapsulated blebs during the first 2 months after surgery. After this period, IOP decreases and often remains sufficiently reduced to avoid further surgical intervention.

The authors present four cases of the dural shunt syndrome in which shallowing of the anterior chamber or rubeosis developed. All patients were female, ranging in age from 66 to 79 years, exhibiting elevated intraocular pressure (IOP), decreased extraocular movements, injected tortuous episcleral vessels, and proptosis. The authors managed these four cases with laser iridotomy, gonioplasty, panretinal photocoagulation, or medical treatment. It is important to recognize associated findings in patients with shallow anterior chambers and elevated IOPs so that a diagnosis of a dural shunt is considered and appropriately treated. Theories on the mechanisms of increased IOP in the dural shunt syndrome and the management of various types of glaucoma in four different cases are reviewed.

Background: The authors report the postoperative development of iris retraction syndrome in two individuals. This is a rare syndrome that can present with pupillary block after an unrepaired rhegmatogenous retinal detachment. Patients: The authors report two patients who had the iris retraction syndrome shortly after intraocular surgery. One patient had pupillary block that developed 6 months after cataract extraction and posterior chamber intraocular lens implantation. A second patient had uveitis, hypotony, and pupillary seclusion 4 weeks after pars plana vitrectomy. Results: Both patients were treated successfully with a scleral buckling procedure and peripheral iridectomy. Conclusion: Postoperative uveitis that occurs with iris retraction and pupillary seclusion should alert the physician of an occult retinal detachment and warrant a thorough dilated funduscopic examination. Features unique to this report include the development of iris retraction syndrome in the presence of a pseudophakos, the rapidity of onset of this disorder after retinal detachment, and its masquerade as a persistent postoperative uveitis.

Purpose To report the surgical management of leaking filtering blebs occurring after blebitis or persistent hypotony. Design Retrospective, noncomparative case series. Participants Twenty-two eyes of 20 patients with late bleb leak, blebitis or endophthalmitis, hypotony maculopathy, or bleb dysesthesia on presentation to the glaucoma service who required surgical bleb revision from 1990 through 1999. Intervention Pedicle flap, partial excision, and advancement or free conjunctival autologous graft techniques for surgical bleb revision. Type of bleb revision was dependent on the dimensions of the bleb and quality of surrounding conjunctiva. Main outcome measures Preoperative and postoperative intraocular pressure (IOP), status of bleb leak, reoperation for glaucoma, or requirement for postrevision glaucoma medical therapy, with success defined as the need for two or fewer glaucoma medications after revision. Results Eighty-six percent (19/22) of eyes that underwent surgical bleb revision had resolution of leak and IOP control using two or fewer medications after one or more bleb revisions. The preoperative IOP (mean ± standard deviation) was 3.7 ± 2.6 mmHg (range, 0–8 mmHg). After an average follow-up of 21 months (range, 8–108 months), the IOP was 11.0 ± 4.4 mmHg for patients taking 0.6 ± 1.0 glaucoma medications. Eighteen percent (4/22) of eyes required two or more bleb revisions. In one eye, an IOP spike of 36 mmHg developed after revision, which required laser suture lysis on two occasions before the IOP was significantly lowered. The three failures were: one eye that required three or more medications for IOP control, a patient whose eye had a persistent leak after revision and who was not mentally competent to undergo repeat revision, and one eye that required combined glaucoma and cataract surgery after revision. Conclusions Surgical bleb revision has a high success rate of closing late bleb leaks, maintaining glaucoma control, and preserving vision, with few postoperative complications. The appropriate surgical procedure for revision must be based on the individual clinical situation and can result in successful bleb revision.

Neurilemomas (schwannomas) rarely occur intraocularly. When present, they pose a diagnostic dilemma for the physician and often are mistaken as a malignant lesion, resulting in enucleation.The authors report the clinical findings of a 46-year-old man with a slowly progressive growing mass of the anterior chamber, associated with glaucoma and the development of cataract. To further delineate the tumor's features, ancillary techniques, including ultrasonography, computed tomography, and magnetic resonance imaging, were conducted. A definitive anterior chamber biopsy of the tumor was performed with histologic examination and electron microscopy.Ultrasonography, high-resolution computed tomography and magnetic resonance imaging showed a well-delineated mass of the inferior ciliary body involving nearly 5 clock hours of the angle. Two clinical features that suggested a longstanding tumor were brilliant transillumination of the mass (leading to the impression of a "cystic mass," not corroborated by ultrasonography) and retrodisplacement of the involved iris root. The histology, and particularly the electron microscopic features, confirmed the diagnosis of a neurilemoma, a benign tumor of the anterior segment.Intraocular neurilemomas are extremely rare tumors. Few are well documented with modern ancillary techniques. Clinical findings in conjunction with radiographic and ultrasonic features may support the diagnosis of a benign tumor. For this patient, confirmation via biopsy permitted combined cataract and glaucoma surgery to rehabilitate the eye, which retains 20/20 visual acuity 3 years after the procedure.

Argon laser trabeculoplasty (ALT) is commonly used in the treatment of open-angle glaucoma. Varying success rates in lowering intraocular pressure (IOP) and controlling glaucoma are reported in studies with follow-up periods from 1 to 5 years, and few reports are available with follow-up to 10 years. The authors retrospectively reviewed the efficacy of ALT in patients followed up to 10 years.Ninety-three patients with open-angle glaucoma underwent 360 degrees ALT. Mean follow-up was 52 +/- 43 months (mean +/- standard deviation; range, 1-132 months). Successful treatment at the time of final follow-up was defined as a decrease in IOP of 3 mmHg or greater from pretreatment level, IOP of 19 mmHg or less, stable visual field, stable optic nerve, and no further laser or surgical intervention.The decrease in IOP was 8.9 +/- 5.4 mmHg at 1 year, 10.0 +/- 4.2 mmHg at 5 years, and 8.9 +/- 5.2 mmHg at 10 years. The probability of success at 1 year was 77%, at 5 years 49%, and at 10 years 32%. Failure was most common in the first year after treatment (23%), and thereafter failure occurred at a rate of 5% to 9% per year. The mean decrease in IOP for all 93 eyes at time of maximum follow-up was 6.1 +/- 7.1 mmHg.Argon laser trabeculoplasty is an effective means for reducing IOP in many patients followed for an extended time. However, up to one half of eyes within 5 years of ALT and two thirds of eyes within 10 years may require additional laser or surgical intervention for glaucoma control.

To investigate the safety and efficacy of holmium YAG laser sclerectomy, a new laser filtration procedure.The authors performed holmium YAG laser sclerectomy on 49 eyes of 46 patients (mean follow-up, 12.3 +/- 1.1 months).Mean preoperative intraocular pressure (IOP) was 26.9 +/- 1.3 mmHg; postoperative mean IOP on last follow-up visit was 19.7 +/- 1.6 mmHg. Thirty (61%) of 49 eyes achieved a final IOP of 5 to 22 mmHg, 29 (59%) of 49 had a final IOP of 5 to 19 mmHg, and 21 (43%) of 49 had a final IOP of 5 to 15 mmHg. Sixteen (73%) of 22 eyes treated postoperatively with 5-fluorouracil (5-FU) had a final IOP of 21 mmHg or less. Twenty-seven percent of eyes lost one or more lines of vision, and 36% of eyes gained one or more lines of vision; there was no median change in visual acuity. Complications included suprachoroidal hemorrhage in 7 (14%) of 49 eyes and intraoperative vitreous hemorrhage in 2. Seventeen (35%) of 49 eyes required a second IOP-lowering procedure.Holmium YAG laser sclerectomy is an effective means to perform glaucoma filtration surgery. This is a full-thickness filtering procedure, with all of the risks attendant.

Early reports of both contact and noncontact transscleral Nd:YAG laser cyclophotocoagulation have been encouraging; however, recent evidence indicates a significant incidence of hypotony, visual loss, and phthisis with the noncontact technique with more than 6 months of follow-up. The authors sought to determine the intermediate term effects of contact transscleral Nd:YAG laser cyclophotocoagulation (CYC).The authors followed 116 eyes of 114 patients for a minimum of 1 year after treatment of advanced glaucoma with CYC.The mean preoperative intraocular pressure (IOP) of 35.0 +/- 1.0 mmHg decreased to 18.6 +/- 1.1 mmHg (P less than 0.0001) during the average follow-up of 19.0 +/- 0.6 months (range, 12 to 36 months). Intraocular pressure control of 3 to 25 mmHg was achieved in 72%, 3 to 22 mmHg in 65%, and 3 to 19 mmHg in 56% of eyes. Retreatment was required in 31 of the 116 eyes (27%). Intraocular pressure decreased to less than 3 mmHg in 9 eyes and to 0 mmHg in 6 of these 9 eyes. Nineteen eyes, all with initial visual acuity of counting fingers or worse, progressed to no light perception; 17 of 36 eyes (47%) with visual acuity of 20/200 or better lost 2 or more Snellen lines.Midterm results of CYC continue to be encouraging but are tempered by a nearly 10% incidence of hypotony or phthisis and the progression of visual loss.

The authors present four cases of the dural shunt syndrome in which shallowing of the anterior chamber or rubeosis developed. All patients were female, ranging in age from 66 to 79 years, exhibiting elevated intraocular pressure (IOP), decreased extraocular movements, injected tortuous episcleral vessels, and proptosis. The authors managed these four cases with laser iridotomy, gonioplasty, panretinal photocoagulation, or medical treatment. It is important to recognize associated findings in patients with shallow anterior chambers and elevated IOPs so that a diagnosis of a dural shunt is considered and appropriately treated. Theories on the mechanisms of increased IOP in the dural shunt syndrome and the management of various types of glaucoma in four different cases are reviewed.

One hundred and twelve eyes of 103 patients were analyzed during a 9½-year period after surgical drainage of a choroidal (ciliochoroidal) detachment (CD). Choroidal detachment in five groups of postoperative patients was studied. CD after surgery for cataract, for cataract and glaucoma, and for glaucoma alone had different time courses, but in all of these, there were similar amounts of protein (67% of plasma protein concentration) in the suprachoroidal fluid (SCF). In marked contrast was a group of patients with intraoperative choroidal effusions and very little protein (18% of plasma concentration) in the SCF. Identified also was a chronic recurrent form of CD that usually persisted for more than three months. Three distinct mechanisms by which choroidal effusion is formed were recognized, (1) one with evidence for the effusion occurring through an intact isoporous membrane (groups 1–3) ; (2) a second in which hemorrhagic SCF appeared acutely or subacutely (groups 1 and 2) through a disrupted isoporous membrane; and (3) a third form, an intraoperative choroidal effusion in patients with elevated episcleral venous pressure. Increased filtration rate of serum through an intact choriocapillary membrane caused molecular sieving of serum proteins. Inflammation, infection, cataract formation, and corneal edema were uncommonly encountered. Indications for surgery and recommended surgical technique are outlined in detail.

In a long-term study of 252 eyes that had initial glaucoma filtration surgery, there was an overall success rate of 85%. Rigid criteria for success included an intraocular pressure equal to or less than 19 mmHg, no further visual field loss or disc damage, and no glaucomatous etiology for a decrease in visual acuity. The success rate was evaluated over an extended postoperative period with a range of 2 to 14 years and a mean follow-up of five years (61 months). Full thickness procedures had a higher success rate for a greater length of time, 88% (6 years) than did trabeculectomy, 76% (4 years). If an eye was considered successful at two years, the probability of success at five years was 94.5% for full thickness procedures and only 82% for trabeculectomies. Choroidal effusion associated with hypotony and shallow anterior chamber was the most frequent postoperative complication. There was no difference in the incidence between full thickness procedures and trabeculectomies. Cataract extraction was indicated more often following full thickness procedures, 34%, than trabeculectomies, 21%. However, the performance of a choroidal tap or subsequent cataract extraction did not appear to influence the success of the filtration operation. Bleb leaks and bleb infection occurred only after full thickness operations and were associated with a high 5/8 (62%) rate of bleb failure and loss of glaucoma control. Full thickness filtering operations appeared to insure a lower pressure from a longer period of time than does trabeculectomy.

The surgical management of glaucoma in aphakia has been limited by poor success in the control of intraocular pressure and serious postoperative complications that threaten vision. A consecutive series of trabeculectomy filtering procedures in aphakic eyes with a mean preoperative intraocular pressure of 38 mmHg was followed for an average of 26 months and revealed a 62% control of intraocular pressure at 21 mmHg or less. Five additional patients (24%) had pressures lower than 21 mmHg following digital massage. The complication of decreased visual acuity following surgery was significant but not directly related to the surgical procedure. Another patient population with glaucoma and aphakia with a mean preoperative pressure of 25 mmHg was treated with laser trabeculoplasty. In 12 of 15 patients (80%) intraocular pressure was lower than 22 mmHg for an average of eight months and did not require glaucoma surgery. There were no significant complications following this therapy and all patients retained preoperative level of visual acuity. In aphakic patients who have uncontrolled glaucoma on maximal medical therapy, surgery is indicated. We recommend the following approach to surgical management: (1) Laser treatment to the trabecular meshwork if the angle is open; (2) if this fails, or the angle is extensively closed, a trabeculectomy filtering procedure is suggested; (3) cyclocryotherapy has been effective in controlling pressure but the unpredictable loss of vision has prompted caution in seeing eyes; (4) cyclodialysis; and (5) transpupillary or transscleral treatment of the ciliary processes are additional modes of therapy. Improved results of surgical treatment for glaucoma and aphakia have been encouraging and should be used when maximal medical therapy is ineffective.

Chronic and recurrent choroidal (ciliochoroidal) detachments developed following glaucoma filtration surgery in 14 eyes of 13 patients during a 9-year period. Three specific subgroups were identified: recurrent, inflammatory, and chronic (present for more than 6 months). The factors that may be related to the development of chronic and recurrent choroidal detachments included patient age (mean, 68.8 years), systemic hypertension or atherosclerotic heart disease, hyperopia, aqueous suppressant therapy, ocular inflammation, and full-thickness filtration surgery. A total of 46 choroidal detachments in 14 eyes were recorded and required drainage of suprachoroidal fluid on 34 occasions. All eyes developed visually significant cataracts, and complete resolution of the recurrent or chronic choroidal detachment occurred following cataract extraction in six eyes. Treatment of chronic and recurrent choroidal detachments should include intense therapy of ocular inflammation, discontinuation of medications that can incite ocular inflammation, discontinuation of topical and systemic aqueous suppressant therapy, and when a visually significant cataract is present, cataract extraction combined with a choroidal tap should be performed.

The development of an encapsulated filtering bleb (Tenon's cyst) complicated 56 of 409 consecutive filtering operations (13.7%) performed during a 40-month period after January 1983. Fifteen eyes (27.8% of encapsulated blebs) required surgical revision. The recognition of bleb encapsulation occurred 20.4 +/- 12.7 days (mean +/- standard deviation) postoperatively. Prolonged duration of beta-adrenergic antagonist therapy was associated with an increased frequency of bleb encapsulation (180.6 +/- 128.5 weeks without encapsulation, 229.0 +/- 129.3 weeks with encapsulation, P less than 0.009). Bleb encapsulation occurred in 42 of 272 eyes with previous argon laser trabeculoplasty, but in only 4 of 85 eyes without any previous anterior segment laser (P less than 0.01). Encapsulated filtering blebs developed in 4 of 12 (33.3%) eyes with congenital glaucoma and 4 of 9 (44.4%) eyes with juvenile glaucoma (P less than 0.0002). The intraocular pressures (IOPs) in the eyes with encapsulated filtering blebs were significantly elevated at 1, 2, and 3 postoperative weeks, and at final follow-up compared with eyes without bleb encapsulation.

The disappointing visual acuity results following cyclocryotherapy for neovascular glaucoma have prompted us to consider filtration surgery as a reasonable alternative in the treatment of selected patients. All cases of surgically treated neovascular glaucoma were reviewed. There were 26 operations in 24 eyes with a follow-up ranging from six months to seven years and a mean of 22.8 months. Adequate pressure control was obtained in 16 of the 24 eyes (67%). In the eyes with successful control of intraocular pressure, vision was 20/400 or better in eight of the 16 eyes (50%). Four patients (17%) lost light perception. Approximately one half of the operations were trabeculectomies, and the others were posterior lip sclerectomies. There seemed to be no significant difference in the final intraocular pressure levels, number or degree of complications, or successes within the two subgroups. Panretinal photocoagulation, topical steroids, cycloplegics, and time for these measures to have their effect are important preoperative adjuncts to surgical treatment. We are encouraged by the long-term preservation of vision and control of intraocular pressure in many of these eyes.

Four female patients with known unplanned filtering blebs following cataract surgery developed endophthalmitis, two weeks to 30 months after being fit with corneal contact lenses. Three patients were wearing hard contact lenses and one wore a soft lens. Significant blepharoconjunctivitis was present and treated in two patients, but intraocular infection was not averted. When endophthalmitis was diagnosed, all patients had clinical evidence of a bleb infection as well as hypopyon. Despite aggressive medical therapy, two eyes required enucleation while two eyes survived with good vision. We recommend that eyes that have unplanned filtering blebs following cataract surgery should not have a contact lens inserted until the blebs have been closed.

Forty eyes in 37 patients that had previously successful 360 degrees argon laser trabeculoplasty were again found to have uncontrolled intraocular pressure (IOP) on maximally tolerated medical therapy and were retreated with argon laser trabeculoplasty to 180 degrees of the trabecular circumference. Successful retreatment was considered a decrease in IOP of 3 mmHg or more and sufficient to avoid further laser therapy or invasive glaucoma surgery. Laser trabeculoplasty retreatment was successful in 13 of the eyes treated (32%). Retreatment failed to control IOP in 27 of the retreated eyes (68%): either the IOP was not lowered by at least 3 mmHg (4 eyes) or the eyes required further laser therapy or surgery (23 eyes). The probability of successful IOP control 1 year after retreatment was 33% and only 14% after 1.75 years. No IOP elevations greater than 6 mmHg were recognized in the postlaser period. Although retreatment with argon laser trabeculoplasty can safely be used to control the IOP in some glaucomatous eyes, the likelihood of success is low.

One hundred and twelve eyes of 103 patients were analyzed during a 9 1/2-year period after surgical drainage of a choroidal (ciliochoroidal) detachment (CD). Choroidal detachment in five groups of postoperative patients was studied. CD after surgery for cataract, for cataract and glaucoma, and for glaucoma alone had different time courses, but in all of these, there were similar amounts of protein (67% of plasma protein concentration) in the suprachoroidal fluid (SCF). In marked contrast was a group of patients with intraoperative choroidal effusions and very little protein (18% of plasma concentration) in the SCF. Identified also was a chronic recurrent form of CD that usually persisted for more than three months. Three distinct mechanisms by which choroidal effusion is formed were recognized, (1) one with evidence for the effusion occurring through an intact isoporous membrane (groups 1-3); (2) a second in which hemorrhagic SCF appeared acutely or subacutely (groups 1 and 2) through a disrupted isoporous membrane; and (3) a third form, an intraoperative choroidal effusion in patients with elevated episcleral venous pressure. Increased filtration rate of serum through an intact choriocapillary membrane caused molecular sieving of serum proteins. Inflammation, infection, cataract formation, and corneal edema were uncommonly encountered. Indications for surgery and recommended surgical technique are outlined in detail.