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Objectives: The European Glaucoma Prevention Study seeks to evaluate the efficacy of reducing intraocular pressure (IOP), with dorzolamide to prevent or delay patients affected by ocular hypertension from developing primary open-angle glaucoma. Design: Randomized, double-blinded, controlled clinical trial. Participants: Patients (age ≥ 30 years) were enrolled from 18 European centers. The patients fulfilled a series of inclusion criteria including the measurements of IOP (22-29 mmHg), two normal and reliable visual fields (VFs) (on the basis of mean defect and corrected pattern standard deviation/corrected loss of variance of standard 30/11 Humphrey or Octopus perimetry), and normal optic disc as determined by the Optic Disc Reading Center (vertical and horizontal cup-to-disc ratios; asymmetry between the two eyes ≤ 0.4). Intervention: Patients were randomized to the treatment with dorzolamide or a placebo. Main Outcome Measures: End points are VF and/or optic disc changes. A VF change during the follow-up must be confirmed by two further positive tests. Optic disc change is defined by the agreement of two out of three independent observers evaluating optic disc stereo-slides. Results: One thousand seventy-seven subjects were randomized between January 1, 1997 and May 31, 1999. The mean age was 57.03 ± 10.3 years; 54.41% were women and 99.9% were Caucasian. Mean IOP was 23.6 ± 1.6 mmHg in both eyes. Mean visual acuity was 0.97 ± 0.11 in both eyes; mean refraction was 0.23 ± 1.76 diopters in the right eye and 0.18 ± 1.79 diopters in the left eye. Previous use of medication for ocular hypertension was reported by 38.4% of the patients, systemic hypertension by 28.1%, cardiovascular diseases by 12.9%, and diabetes mellitus by 4.7%. The qualifying VFs were normal and reliable according to protocol criteria. Conclusions: The mean IOP of the patients enrolled in the European Glaucoma Prevention Study is consistent with the estimated mean IOP (within the range of 22-29 mmH

PURPOSE: Prospective, comparative, randomised study aiming at assessing the safety and the intraocular pressure (IOP) lowering effect of Micropulse Diode Laser Trabeculoplasty (810nm)(MDLT) and Argon Laser Trabeculoplasty in patients with open angle glaucoma. METHODS: 26 patients (mean age=67 years) were randomly assigned to undergo either MDLT (16 eyes) (66 applications, 100 msec, 0.6 mJ/pulse, 300 microm) or ALT (15 eyes) over 180 degrees. In 5 patients, MDLT was done in one eye and ALT in the other eye. Patients were followed for early IOP spikes and anterior segment inflammation. IOP was recorded at 1 day, 1 week, 1 and 3 months and 3 month intervals thereafter. RESULTS: Both groups were well-matched for age, glaucoma type, previous laser or surgical procedure, pre-treatment meds. Mean follow-up was 5.2 +/- 1.7 months for MDLT and 5.5 +/- 2.3 in ALT (p>0.05). Mean pre-treatment IOP was 20.7 +/- 3.8 mmHg and 21.6 +/- 4.2 mmHg in ALT respectively (p>0.05). Mean IOP was significantly reduced compared to the pre-treatment level in both groups at the different visits (p <0.05). At 3 months, the mean IOP was not significantly different in MDLT (18.6 +/- 5.1 mmHg) vs. ALT(16.7 +/- 3.3 mmHg) (p=0.26) while the mean IOP decrease was significantly less in MDLT (2.5 +/- 2.6 mmHg) than in ALT (4.9 +/- 3.4 mmHg) (p= 0.04). This corresponded to a mean percentage of IOP reduction of 12.2 +/- 11.9% in MDLT and 21.8 +/- 11.1% in ALT respectively (p=0.03), as well as an IOP drop > or =20% compared to the baseline IOP observed in 35.7% in MDLT versus 50% in ALT (p=0.03). At 3 months, the mean number of meds was significantly lower in MDLT (2.1 +/- 0.8) than in ALT (2.8 +/- 0.7) (p=0.03). MDLT was uneventful in 100% of patients with no thermal pain and no uncomfortable laser flashes. Anterior segment inflammation was absent or mild in both procedures. MDLT was associated with early moderate IOP spike in one eye with POAG. CONCLUSION: At 3 months, Micropulse diode laser trabeculopla

Over the past decade, results from prospective, randomized, clinical trials have confirmed the value of reducing intraocular pressure (IOP) in patients with ocular hypertension or primary open-angle glaucoma and have outlined the need to consider a target IOP in an individual glaucomatous patient and not an arbitrary value of 21 mm Hg as classically believed. The target IOP corresponds to an estimation of the mean IOP obtained with treatment that is expected to prevent further glaucomatous damage. Target IOP is difficult to assess accurately in advance in every individual patient and eye. Moreover, no degree of IOP is proven to be safe for every patient. This paper will deal with the criteria that can be used to approach as closely as possible and periodically re-assess the range of the target IOP in an individual. Although IOP has been found to be more variable in glaucomatous than in healthy eyes, the potential role of diurnal IOP fluctuations in the development or progression of glaucomatous damage is still unclear. It has been strongly suggested in a recent past that abnormal 24-hour IOP fluctuation could be a significant risk factor for glaucomatous damage. There is still currently insufficient evidence to support that both 24-hour IOP fluctuation and IOP variation over periods longer than 24 hours are an independent and separate risk factor for glaucomatous damage. Until further confirmation on their exact role in glaucoma development and progression, the goal of detecting and reducing abnormal 24-hour IOP fluctuation is warranted in all newly diagnosed glaucomatous patients as well as in patients who continue to progress at lower pressures.

The Pascal dynamic contour tonometer (PDCT) is designed to measure intraocular pressure (IOP) largely independent of the corneal properties. It is equipped with a digital LCD screen that displays the IOP, the ocular pulse amplitude (OPA) and the quality score (Q) of the measurements [range 1 (excellent) to 5 (poor)]. The manufacturer has recommended discarding the IOP and OPA values of Q4 and Q5. The aim of our study was to assess if IOP and OPA measurements with Q3 are acceptable for clinical and research purposes. This is a prospective, observational study in which both patients with ocular hypertension or glaucoma and healthy subjects were enrolled; three consecutive PDCT IOP measurements were performed on all participants. Only patients and subjects with Q1, Q2 and Q3 recorded together were eligible. Only one eye per subject was considered for statistical analysis. The mean PDCT IOP and OPA were taken for statistical analyses. An ANOVA test for repeated measures was used to compare the differences between PDCT IOP and OPA Q1, Q2, and Q3 scores. A total of 87 subjects met the inclusion criteria. Mean PDCT (+/-SD) IOP were 17.5 +/- 3.4 mmHg for Q1, 17.6 +/- 3.3 mmHg for Q2 and 17.9 +/- 3.3 mmHg for Q3 (P > 0.05). Mean OPA Q1, Q2 and Q3 were 2.5 +/- 0.9, 2.5 +/- 1.0 and 2.5 +/- 1.0 mmHg, respectively, and were not statistically different. Based on these results, we concluded that the IOP and OPA values with Q1, Q2 or Q3 measured by PDCT are not significantly different and can therefore be taken into account indiscriminately for clinical and research purposes.

The Proview phosphene (eye-pressure) tonometer and the Rebound tonometer ICare are relatively new devices basically different from the Goldmann applanation tonometry (GAT). Both technologies will be presented in this review with respect to their principle, their technique, their advantages and limits, as well as their accuracy, the IOP measurements agreement with GAT, and the influence of central corneal thickness on the reliability of these measurements. Because the current data base for the interpretation of glaucoma disease course and its management are still relatively small, the development of a continuous, accurate, reliable and harmless monitoring of IOP over 24 hours is strongly desirable in the future. Approaches for self-tonometry and devices such as smart contact lenses which can take the IOP from the corneal surface have been developed with this goal. The future will probably confirm whether telemetric IOP monitoring with an implantable active microsystem allows a reliable IOP monitoring or not. In any case, active implants will open new and important perspectives in the diagnosis and the treatment of glaucomatous optic neuropathy.

Due to the recent rapid increase in the aging population, glaucoma in the over-eighties population will become a significant problem of ocular health in the coming decades. It is important to determine the natural effects of aging on the optic nerve head and aqueous humor dynamics in these patients for early diagnosis and monitoring of glaucoma. Its characteristics, context, management, and treatment are very perceptibly different from those of the younger glaucomatous patient. For many reasons, such as its frequent association with macular age-related degeneration, diagnosis of glaucoma in the over-eighties may be difficult. Management of the over-eighties glaucoma is frequently difficult and time-consuming. Less aggressive than in a younger patient and based on topical medications in most cases, it must be discussed case by case and will be based on the general context, the quality of compliance, and especially on the potential consequences of the glaucomatous visual-field defects on the patient's quality of life. In any case, overtreatment as well as treatments that are too complex must be avoided. Given the reduced metabolism in the very elderly, the safest medications must also be selected. It is important to always consider glaucoma medications as part of the patient's medicine regimen. Associated risk factors, especially concomitant systemic hypotension, will be simultaneously treated. Laser trabeculoplasties probably have broader indications than in younger patients. Except for phacoextraction, which is very frequently helpful in controlling IOP, incisional filtering procedures or laser diode cyclophotocoagulations remain infrequently indicated in over-eighties glaucoma patients.

PURPOSE: 1) To summarize the literature on compliance (the extent to which the patient's behaviors correspond with the provider's recommendations) and persistence (total time on therapy) in patients with open-angle glaucoma or ocular hypertension. 2) To suggest guidelines to improve these two parameters, which are both essential and integral elements of optimizing patient care. METHODS: Compliance-related research published between 1980 and March 2005. RESULTS: Medication compliance has mostly been investigated and measured using patient self-reports, electronic monitoring, and medication possession ratio. Noncompliance-related problems are underestimated, complex, unpredictable and frequent. Noncompliance rates of at least 25% have been reported. The main obstacles to medication compliance are situational/environmental or related to the side effects or complexity of the medication regimen. Persistence with glaucoma medications has also been proven to be poor. Based on retrospective studies using survival analyses, fewer than 25% of patients may be persistent over 12 months. Persistence rates differ from one treatment to another and may fluctuate with time in the same patient. CONCLUSIONS: Improving the quality of information, the patient-physician relationship, and educating patients are all crucial. Simplification of the treatment regimen and selection of medications with the fewest systemic and ocular side effects must be a priority. Accurately assessing patient compliance and persistence are indispensable to reducing mistakes from either medication noncompliance or lack of persistence with poor efficacy and to avoid unnecessary changes in a patient's therapeutic regimen or surgery.

PURPOSE: To assess the long-term safety and effectiveness of non penetrating deep sclerectomy (DS) and to compare the incidence and the severity of postoperative complications and the IOP results according to surgical adjuvants (implant device, antimetabolite or both) were used or not. MATERIAL-METHODS: Retrospective non randomised study including 171 eyes (136 patients), mean age: 63.9 years) with medically uncontrolled open-angle glaucoma and without previous filtering surgery. 81 eyes (48.2%) had severe glaucomatous damage. All procedures were performed according to the Kozlov's and Memoud's technique. Except for 8 eyes, they were associated with the placement of an implant device (SKGEL or T-FUX) and/or intra-operative application of low dose antimetabolite (5-FU in 58 eyes and mitomycine C in 53 eyes). RESULTS: Mean follow-up was 39.6 +/- 18.3 months. According to surgery, DS were categorized in 4 groups: Group 1: DS with Healon GV (n=8)(4.7%); Group 2: DS with antimetabolite application (n=26) (15.2%); Group 3: DS with placement of an implant (n=53) (31%). Group 4: intraoperative antimetabolite +implant device (n=84 eyes) (49.1%). Peroperative microperforations without iris hernia occurred in 35 eyes (21%). 1st month postoperative complications were observed in 90 eyes (52.6%) with mild to moderate hyperfiltration in 27 eyes, excessive scarring of filtration bleb in 38 eyes, and iris incarceration in 10 eyes. 5-FU injections were given in 58 eyes (34%). YAG gonioperforation was needed in 107/171 eyes (63%) and was complicated by iris incarceration in 9 eyes. Early and late spontaneous iris incarceration was observed in 10 eyes. A second filtering procedure was needed in 10 eyes.

PURPOSE: To compare the incidence and the severity of short-and medium-term complications following "modern" trabeculectomy (mTRAB) with non-penetrating deep sclerectomy (NPDS). MATERIALS AND METHODS: Comparative retrospective nonrandomized study including 65 eyes (55 patients) (mean age: 68.6 years) with medically uncontrolled glaucoma. mTRAB was performed in 43 eyes, NPDS in 22 eyes. mTRAB was performed according to a slightly modified P.T.Khaw protocol. NPDS procedures were done according to Kozlov's and Mermoud's technique with SKGEL implant in 18/22 eyes. Intraoperative antimetabolites (AMETAB) were given in 25 eyes (58%) in the mTRAB and 17 (77%) in the NPDS (p>0.05). RESULTS: Mean follow-up was longer in NPDS (10.7+/-5.5 months) than in mTRAB (8.5+/-3.4 months) (p<0.05). Preoperatively, the two groups were comparable in respect of age, type of glaucoma, mean IOP, severity of VF defects and bleb failure risk factors (p>0.05). Peroperatively, mTRAB were uneventful in 86% vs 90% of NPDS. 1st month postop complications occurred in 60.4% in mTRAB and 77.2% in NPDS (P>0.05). Most of them were minor and transient in both surgeries. Postop early anterior chamber inflammation was mild to moderate in all cases. The incidence of wound leaks (21% in the mTRAB group and 18% in the NPDS group) and hyperfiltration related complications (14% and 13.6% respectively in the mTRAB and NPDS group) were comparable between the two procedures (p > 0.05). Intraoperative antimetabolite application was not associated with an increased rate of postoperative hyperfiltration related complications. Scarring of filtration blebs had concerned a lower percentage of mTRAB eyes (19%) than the NPDS (36%). The number for 5-FU injections was less - although not significantly - in the mTRAB than in the other group (18.6% in mTRAB versus 41% in NPDS (p=0.05). Late complications were not observed in the mTRAB group. Iris prolapse associated with increased IOP occurred in 3 of the 22 NPDS procedures (

PURPOSE: The Icare dynamic tonometer (impact or Rebound tonometry) is a new tonometer based on making a moving object collide with an eye and on monitoring the motion parameters of this object following contact. The purpose of this study was to assess intra- and interobserver variability of IOP measurements with the Icare and their correlations with Goldmann applanation tonometry (GAT) and central corneal thickness (CCT). MATERIAL AND METHODS: A prospective study including three groups of patients: group 1 (50 normal subjects), group 2 (50 patients with OHT or POAG and GAT IOP>22 mmHg), and group 3 (38 glaucomatous patients with GAT IOP< or =22 mmHg). In group 1, three consecutive IOP measurements were taken by three distinct observers with Icare followed by three GAT measurements by the same clinician. In group 2, the same procedure was followed from patients 1 to 25 and the reverse sequence from patients 25 to 50 after a 10-min break. In group 3, only one clinician took three GAT measurements followed by three Icare measurements after a 10-min break to exclude a tonographic effect in eyes with statistically normal-range IOPs. RESULTS:: In group 1, intraobserver variability was about 6% for each observer (NS). There was no learning curve effect. The interobserver variation coefficient was 6.4%. Icare overestimated IOP compared to GAT (mean difference, 1.5-2.2 mmHg) (p<0.001). Icare IOP was 23.4 mmHg for observer 1 when GAT was 22 mmHg (95% individual CI, 18-28.9 mmHg). In group 2, intraobserver variation coefficients of the IOP ranged from 5% to 5.4% (NS). Icare overestimated IOP by mean 0.84 mmHg compared with GAT. In group 3, mean IOP was not different between Icare and GAT. Icare IOP of 20.7 mmHg corresponded to a value of 22 mmHg using GAT. In this group, correlations between CCT and IOP measurements were higher for Icare than for GAT (p=0.062). CONCLUSION: Icare measures IOP in an unanesthetized sitting patient in a very brief time. Patient's minimal cooperati

PURPOSE: Owing to its technical refinements, "modern" trabeculectomy aims to reduce the incidence and severity of early postoperative complications while increasing postop IOP success. The purpose of our study was to evaluate namely the safety of "modern" trabeculectomy, the quality of the filtration blebs, the influence on the quality of life and secondarily IOP reduction according to the surgical procedure whether augmented with peroperative application of antimetabolites or not. MATERIAL-METHODS: Retrospective study including our 45 first consecutive procedures in 38 patients (mean age: 61.1 years) with medically uncontrolled various glaucomas. All procedures were performed according to a modified P. Khaw's protocol. Antimetabolites were applied peroperatively in 28/45 eyes (62.2%) with a history of previous filtering surgery (12/28 eyes) and/or advanced glaucomatous damage (22/28 eyes). Antimetabolites were not used in the 17/45 other eyes with lower surgical risk factors and higher target IOP, surgical procedure was not augmented with antimetabolites. Postoperative management included laser suture lysis, withdrawal of adjustable sutures and 5-FU injections when needed. Complete ocular examination was carried out preoperatively and postoperatively at day 1, 7, at 1, 2 and 3 months and every 3 months thereafter. All patients were questioned for symptoms associated with filtration bleb dysesthesia at the last visit. RESULTS: The mean follow-up was 7.9 +/- 3.3 in the group without antimetbolites and 5.3 +/- 2.2 months in the group with antimetabolites (p < 0.05). Final mean IOP (+/-SD) was significantly lower in the group augmented with antimetabolites (11.2 +/- 4.5 mmHg) compared with the group without antimetabolites (14.9 +/- 3.7 mm Hg) (p < 0.05). Complete and qualified success were respectively 64.3% and 89.3% in the group with antimetabolites and 70.6% and 82.4% in the subgroup without antimetabolites (p > 0.05). 1st month postoperative complications were tra

PURPOSE: The aim of this study was to evaluate the efficacy and the safety of bimatoprost in an outpatient glaucoma practice and to correlate the responsiveness to this treatment with the central corneal thickness. MATERIALS AND METHODS: Our retrospective analysis included 55 consecutive patients (mean age, 66 years). Bimatoprost was administered in monotherapy in 32 patients and in combined treatment in 23. Mean follow-up was 5.5 months. In bilateral treatments (33/55 patients), only one eye (with the more severe defect and/or the higher IOP) was included in the analysis. The patients were considered as responders to bimatoprost when the observed reduction of IOP was > or = 20% and/or at least 3 mmHg compared with the pretreatment IOP. The mean central corneal thickness (CCT) was extrapolated from five consecutive measurements with the ultrasonic pachymeter Pachette. RESULTS: Overall, the mean IOP was reduced from a pretreatment value of 21.1 mmHg to 17.3 mmHg at the last visit (mean IOP decrease, 3.6 mmHg, or 17%) (p < 0.05). Except for four patients (7.3%) who discontinued bimatoprost secondary to local or systemic adverse effects, ocular tolerance of bimatoprost was excellent in 62%. Moderate conjunctival hyperemia was present in 18%. The mean IOP reduction was 19% in monotherapy and 15% in combined treatments. Concomitantly, the percentage of responders was slightly higher in patients only receiving bimatoprost than in patients receiving bimatoprost associated with other medication (s). In monotherapy, bimatoprost induced a further IOP decrease of 12% compared with a previous association of two medications that did not include a prostaglandin (10 patients). In the 20 patients in whom bimatoprost had replaced another prostaglandin, a further mean IOP reduction of 11% was observed. The frequency of distribution of the responders to bimatoprost was not correlated with CCT (chi2, p > 0.05). CONCLUSIONS: Considering the limits of this study, our results suggested th

PURPOSE: To evaluate the usefulness of non-mydriatic fundus camera (NMFu-camera) and frequency doubling perimeter (FDP) for detecting glaucoma in a general population. METHODS: This prospective observational multicenter study consisted in screening for glaucoma in the populations of three Belgian cities. Intraocular pressure (IOP) was measured with non-contact pneumo-tonometer (NCT) and applanation tonometry (AT) if NCT IOP was > or = 17 mmHg. Visual field was screened with FDP (C-20-5) and digitized optic disc photographs (ODPs) were taken with NMFu-camera. FDP was considered abnormal if at least one defective point was found. ODPs were graded as normal or glaucomatous by consensus of three glaucoma specialists. Optic disc and visual field results were matched per eye. Subjects with known ocular hypertension and/or treated primary open angle glaucoma were excluded from the analysis. RESULTS: A total of 1620 subjects were included in the study. Their mean age was 63.2 years. AT IOP was > 21 mmHg in 8.2%. A total of 98.1% of ODPs could be interpreted. Glaucomatous optic discs were detected in 3.5% of the subjects. In this group only 24% had an AT IOP > or = 22 mmHg. FDP was abnormal in 44.5%. The sensitivity and specificity of FDP to identify patients with an optic disc graded as glaucomatous were 58.6% and 64.3% respectively. CONCLUSIONS: The combined use of the NMFu-camera and the FDP is a feasible method for an initial glaucoma mass screening. NMFu-camera may be a useful and quick method to screen for glaucomatous damage in a community. FDP in screening strategy was revealed to be not sensitive enough when setting the cut-off value at one defective test location. IOP measurements were confirmed to be a poor tool to detect glaucomatous damage.

Among the numerous corneal variables that may influence the determination of the "true" intraocular pressure (IOP) from applanation tonometry measurements and considering the still non conclusive scientific data on all the different aspects of this topic, the measurement of the central corneal thickness (CCT) may be an interesting diagnosis tool in hypertensive and glaucomatous patients. As far as the physiologic variability of the corneal thickness is considered, the measurement of CCT can potentially become an important confounding variable when measuring applanation tonometry in patients with ocular hypertension. It could also improve the management of patients with normal tension glaucoma and patients with suspicious optic discs. In these three groups, the measurement of CCT may be useful in determining if there is an artefactual error in the IOP measurement due to a thicker (too high) cornea or thinner (too low) cornea. Therefore the IOP corrected by CCT may change or influence a decision to initiate or modify treatment. CCT measurement has also proved to be crucial in patients who have undergone laser refractive surgery.

Visual function is crucial in driving and is one of the links which determine the medical aptitude to this activity. The ophthalmologist has important medical and moral responsibilities and has more than one mission in the determination of the aptitude to driving. The evaluation of the aptitude of the (future) driver is based on different legal criteria (Belgian Royal Orders dated on 23-03-1998 and 05-09-2002) whose requirements are in accordance with EC reglementation and are different according as the motor vehicles are used for private or professional purposes. Social and psychological consequences of driving incapacity may be important as far as the real impact of vision alterations on the incidence of motor vehicle crashes is still to be clearly determined. The knowledge of the repercussions of different diseases such as ametropia, age related effects, loss of vision in one eye, cataract, glaucomatous neuropathy, laser treatments,... on car driving can help the ophthalmologist to improve his judgment on the patient's real driving aptitude and the quality of his counselling if needed.

PURPOSE: to report a case of severe ocular hypertension occurring as a complication after a single intravitreal injection of triamcinolone acetonide for the treatment of a diabetic cystoid macular edema. METHODS: interventional case report. RESULTS: a 63-year-old pseudophakic diabetic woman developed a severe and relatively sudden IOP increase to 50 mm Hg one month after receiving a single 4-mg intravitreal injection of triamcinolone acetonide for a chronic progressive macular cystoid edema. Previously the patient who did not develop corticosteroid-induced glaucoma secondary to her cataract surgery was treated with topical beta-blockers for a mild chronic bilateral ocular hypertension. A deep sclerectomy had to be performed in emergency to avoid optic nerve damage and allowed to successfully control the IOP with a 5 month follow-up. Concomitantly visual acuity could be increased from 0.05 before the intravitreal injection to 0.4. CONCLUSIONS: Although unfrequent in the literature, this observation confirms the risk of occurrence of a severe ocular hypertension after intravitreal injection of triamcinolone. A close monitoring of IOP is mandatory after intravitreal injection, especially in patients with altered trabecular function. This potentially devastating complication has to be weighed up with the benefices of intravitreal injection of triamcinolone for improving visual acuity in patients with clinically significant diabetic macular edema.

PURPOSE: To assess the effectiveness and the safety of deep sclerectomy (DS) with reticulated hyaluronic acid implant (SKGEL) and/or 5-Fluorouracile (5-FU). MATERIAL-METHODS: 42 phakic eyes (42 patients) (mean age: 61.0 +/- 11.5 years) with medically uncontrolled open angle glaucoma and without history of previous filtering procedure were included in this non-randomized retrospective study. According to the peroperative protocol, the patients were categorized into 3 groups: DS + SKGEL (7 eyes), DS + 5-FU (50/mg/ml during 3 minutes) (13 eyes) and group C with SKGEL and 5-FU simultaneously (22 eyes). RESULTS: The mean follow up was 30.6 +/- 9.2 months and was significantly shorter in group C. The 3 groups were comparable with respect to the age of the patients, the severity of glaucomatous defects, the distribution of the target IOP, the mean number and duration of preoperative medications as well as to the mean preoperative visual acuity and IOP. The mean IOP was significantly decreased from 27.3 +/- 3.2 mm Hg to 16.1 +/- 3.7 3.7 mm Hg (p < 0.0001) and was not significantly different between the 3 groups at 24 months follow up (p > 0.05). Mean visual acuity was not significantly altered in the 3 groups (p > 0.05). Complete (target IOP reached without medication or YAG laser goniopuncture) and qualified (target IOP reached with medication and/or YAG laser goniopuncture) final success rates were respectively 33.3% and 83.3%. The frequency of distribution of success was not significantly different between the 3 groups but the percentage of success was 100% in group A, 84.6% in group B and 77.2% in group C. Subconjunctival injections were needed in 33% in the first postoperative month. (group A: 28.5%; group B: 46.2%; group C: 27.2%) (X2 p > 0.05). Postoperative complications were relatively minor and were observed in 66% (P > 0.05 between the 3 groups). YAG laser goniopunctures were performed in 38% (group A: 16.6%; group B: 61.5%; group: 33.3%, X2 p > 0.05). Complete a

With laser iridotomy, argon laser trabeculoplasties, cyclophotocoagulations with diode laser and Nd:YAG goniopunctures after deep sclerectomy, among other procedures, the laser has offered a very wide range of treatments for managing glaucomatous patients for roughly twenty years. In this paper we provide a general review of the present applications of lasers in the treatment of glaucoma, focusing on the indications, results and complications of the most frequently used procedures in daily clinical practice.

Congenital glaucoma is a rare and very polymorphous condition. Recent major advances in the pathogenesis, the genetics, the clinical diagnosis and the treatment of the disease have contributed to radically improve its prognosis. The diagnosis and the monitoring of a child with a congenital glaucoma are part of a multidisciplinary care approach where surgery is predominant and which must aim both to normalize the intraocular pressure in the long term and to attempt to improve the development of the visual function through a careful and lasting treatment of the associated functional amblyopia.

PURPOSE: To assess effectiveness and safety of DS with reticulated hyaluronic acid implant (SKGEL) and/or 5-Fluorouracile (5-FU). MATERIAL-METHODS: 61 eyes (48 patients) (mean age: 64.5 +/- 10.5 years) with medically uncontrolled open angle glaucoma and comparable surgical risk failure were included in this retrospective non randomized study and were categorized into DS + SKGEL (10 eyes), DS + 5-FU (25 eyes) and DS + SKGEL + 5-FU simultaneously (26 eyes). The 3 groups were comparable in respect of age of patients, diagnosis, severity of VF defects, and bleb failure risk factors. All procedures were performed according to the Kozlov's and Mermoud's technique. Complete ocular examination was carried out preoperatively and at day 1, 7, at 1, 2 and 3 months and every three months thereafter. RESULTS: Mean follow up was 11 +/- 4.9 months and was significantly shorter in group C. For all 61 eyes, mean IOP was significantly decreased from 27.8 +/- 8.6 mm Hg to 15.1 +/- 3.5 mm Hg. Complete (target IOP reached without medication or YAG laser goniopuncture) and qualified (target IOP reached with medication and/or YAG laser goniopuncture) final success rates were respectively of 54% and 90%. Complete success probability was 95% at 6 months and 72% at 12 months. Qualified success probability increased to 89.5% at 12 months. The IOP results, the distribution of success rates and complications were similar within the first postoperative year whatever using SKGEL or intra-operative 5-FU application or both. The need for additional glaucoma medication and the percentage of YAG goniopuncture appeared to be lower in the SKGEL group. Success probability appeared to be improved in SKGEL group comparatively with the other 2 groups. CONCLUSIONS: NPDS is a valid, effective and relatively safe alternative to trabeculectomy although adjunctive medications and/or Nd:YAG goniopuncture are frequently needed. Considering the limitations of our study, we can conclude that the IOP results, succes

PURPOSE: The main purpose of our study was to assess the systemic safety of brimonidine tartrate 0.2%, an alpha 2 highly selective agonist in patients with glaucoma or ocular hypertension Material-Methods: Brimonidine was administered alone or in combination in 128 patients suffering from glaucoma or ocular hypertension in order to improve the IOP effect and/or to replace a drug which prescription was limited due to its secondary effects. In addition to the standard follow up and IOP reduction evaluation, our study was focused on the appreciation of the systemic tolerance to brimonidine. RESULTS: The average age of our patients was 65.2 +/- 13.8 years and the mean follow up was 4.5 +/- 3.4 months. Brimondine was administered in monotherapy in 15 patients (7.8%) and in combination with another drug in the others (92.2%), the combination with a beta-blocking agent being the most frequent combination. 113 among the 128 patients suffered from POAG. 51.6% of patients described systemic side effects at various degrees (drowsiness, fatigue, general uneasiness, mouth dryness.). All these systemic side effects were significantly more frequent in patients older than 60 years (p<0.05). They did not seem to be influenced by an intercurrent illness or a systemic concurrent treatment with drugs potentially acting with the noradrenergic transmission (monoamine oxydase inhibitors, tricyclic antidepressants, mianserine, alpha-sympatholytics.). Brimonidine was interrupted in 82 patients (64.1%) secondary to a systemic intolerance in 21 patients, an allergic blepharo-conjunctivitis in 12 patients, and a non optimal IOP reduction in 42 patients. Considering the all patients and treatments, IOP dropped from 20.5 +/- 3.6mmHg to 19.8 +/- 4.6mmHg at the last examination (p<0.05). In bitherapies, the observed IOP reduction was not significantly different from the one achieved with the previous association. CONCLUSION: Our medium-term results have shown that brimonidine was an efficient ocul

Purpose: The main purpose of our study was to assess the systemic safety of brimonidine tartrate 0.2 %, an alpha 2 highly selective agonist in patients with glaucoma or ocular hypertension Material-Methods: Brimonidine was administered alone or in combination in 128 patients suffering from glaucoma or ocular hypertension in order to improve the IOP effect and/or to replace a drug which prescription was limited due to its secondary effects. in addition to the standard follow up and IOP reduction evaluation, our study was focused on the appreciation of the systemic tolerance to brimonidine. Results: The average age of our patients was 65.2 +/- 13.8 years and the mean follow up was 4.5 +/- 3.4 months. Brimondine was administered in monotherapy in 15 patients (7.8%) and in combination with another drug in the others (92.2%), the combination with a beta-blocking agent being the most frequent combination. 113 among the 128 patients suffered from POAG. 51.6% of patients described systemic side effects at various degrees (drowsiness. fatigue, general uneasiness, mouth dryness...). All these systemic side effects were significantly more frequent in patients older than 60 years (p < 0.05). They did not seem to be influenced by an intercurrent illness or a systemic concurrent treatment with drugs potentially acting with the noradrenergic transmission (monoamine oxydase inhibitors, tricyclic antidepressants, mianserine, alpha-sympatholytics...). Brimonidine was interrupted in 82 patients (64.1%) secondary to a systemic intolerance in 21 patients, an allergic blepharo-conjunctivitis in 12 patients, and a non optimal IOP reduction in 42 patients. Considering the all patients and treatments, IOP dropped from 20.5 +/- 3.6mmHg to 19.8 +/- 4.6mmHg at the last examination (p < 0.05). in bitherapies, the observed IOP reduction was not significantly different from the one achieved with the previous association. Conclusion: Our medium-term results have shown that brimonidine was an effic

A 40 year-old woman receiving alpha interferon therapy for chronic active hepatitis C presented transient bilateral visual obscurations with associated visual field defects and headaches, with elevated cryoglobulin levels. These manifestations mimicked the clinical picture of migraine and were associated with worsening of previous moderate Raynaud's syndrome and diffuse paraventricular lesions of the white matter seen in cerebral MRI. Bilateral posterior cerebral transient ischemic episodes rather than an anterior visual pathway lesion were thought to be responsible for the clinical symptoms though the exact role of interferon in these vasospastic-like disorders remains speculative. Their possible relationship with increased cryoglobulinemia is uncertain. We suggest that Raynaud's phenomenon may have a predisposing role for these manifestations.

[Controversies Over the Pathogenesis and Medical-treatment of Thyroid-associated Ophthalmology]