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PURPOSE: To determine the effect of acute and chronic primary angle closure glaucoma (PACG) on the trabecular meshwork. METHODS: Trabecular specimens of 16 consecutive patients with primary angle closure glaucoma (PACG)--6 acute PACG eyes, and 10 chronic PACG eyes without an acute attack--were studied by light and electron microscopy. RESULTS: Acute PACG: The trabecular meshwork revealed a generalised oedema and an accumulation of pigment in the widened trabecular spaces and Schlemm′s canal. Attenuated trabecular endothelial cells appeared to be devoid of subcellular components. Chronic PACG: In chronic PACG eyes the trabecular architecture had lost its regular arrangement, with fewer and narrower trabecular spaces and fusion of the trabecular beams in areas. There were numerous electron-dense bodies in the trabecular tissues, both within the trabecular beams and in the extracellular spaces, which had a banded fibrillar structure. An overall loss of endothelial cells was noted; the remaining cells were crowded together and were polymorphic. Melanin pigment was present both within the stroma and in the endothelial cells. CONCLUSIONS: Pigment accumulation in the trabecular spaces and within the cells and a noninflammatory degeneration appeared to be the primary changes in the trabecular meshwork after acute angle closure glaucoma. In chronic PACG eyes, there was evidence of loss of endothelial cells and reactive repair processes. These changes were present in areas away from visible peripheral anterior synechiae. A gonioscopic evaluation of the extent of peripheral anterior synechiae alone may not reflect the extent of trabecular meshwork damage in acute and chronic PACG. Patients experiencing an acute attack of PACG require a long-term follow up, because the intraocular pressure (IOP) may rise later, due to ongoing changes compromising the outflow facility, or due to the effects of aging in the trabecular meshwork.

All the presently available antiglaucoma medications have either local or systemic adverse effects. Combinations of drugs are being used not only to increase the effectivity and compliance but also to decrease the incidence and magnitude of side effects. The single dose response of open angle glaucoma eyes to pilocarpine 1%, clonidine 0.125%, a combination of pilocarpine 1% and clonidine 0.125%, and timolol 0.5% was studied in a double blind, masked, cross over study. Over a period of twelve hours the effectivity of the combination of pilocarpine 1% and clonidine 0.125% was significantly more than that of either drug alone and was found to be similar to that of timolol 0.5%. No local or systemic adverse effects were seen.

A comparative retrospective study of 164 cases of juvenile secondary gla as presenting to the glaucoma service in 1984 and 100 cases in 1988, to the changes brought about by health education and innovations in ophthalmic care is undertaken.

Clinically observed complicated cataracts, generally do not have a definite causal factor. We studied the effects of E. coli toxin injected suprachoroidally, to simulate the effect of toxins released by extraocular organisms on the lens. 79.2% of eyes had a definable cataract at the end of the 6th week of observation. The biochemical changes portrayed an increased oxidative activity in the lens, evidenced by a fall in glutathione concentration, and the consequent tertiary reorientation of proteins to increase insoluble proteins, forming a cataract.

Traumatic cataracts can nor be adequately managed with cutting aspiration systems by an anterior or pars planes approach 20 cases were randomly assured to these two approaches Pars plana lensectomy caused a more frequent uveitis and secondary glaucoma, though the visual acuity achieved post-operatively was similar in the two groups. We recommend an anterior lensectomy for patients who do not require simultaneous posterior segment surgery, because the retained posterior capsule decreases the indicence of complications.

Aims: To study the efficacy of argon laser trabeculoplasty (ALT) as a primary and secondary therapy in Indian patients with primary open angle glaucoma (POAG). Methods: ALT was performed as [...]

Purpose: To study ultrastructural changes of the trabecular meshwork in acute and chronic primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG) eyes by scanning electron microscopy.Materials and Methods: Twenty-one trabecular meshwork surgical specimens from consecutive glaucomatous eyes after a trabeculectomy and five postmortem corneoscleral specimens were fixed immediately in Karnovsky solution. The tissues were washed in 0.1 M phosphate buffer saline, post-fixed in 1% osmium tetraoxide, dehydrated in acetone series (30-100%), dried and mounted.Results: Normal trabecular tissue showed well-defined, thin, cylindrical uveal trabecular beams with many large spaces, overlying flatter corneoscleral beams and numerous smaller spaces. In acute PACG eyes, the trabecular meshwork showed grossly swollen, irregular trabecular endothelial cells with intercellular and occasional basal separation with few spaces. Numerous activated macrophages, leucocytes and amorphous debris were present. Chronic PACG eyes had a few, thickened posterior uveal trabecular beams visible. A homogenous deposit covered the anterior uveal trabeculae and spaces. Converging, fan-shaped trabecular beam configuration corresponded to gonioscopic areas of peripheral anterior synechiae. In POAG eyes, anterior uveal trabecular beams were thin and strap-like, while those posteriorly were wide, with a homogenous deposit covering and bridging intertrabecular spaces, especially posteriorly. Underlying corneoscleral trabecular layers and spaces were visualized in some areas.Conclusions: In acute PACG a marked edema of the endothelium probably contributes for the acute and marked intraocular pressure (IOP) elevation. Chronically raised IOP in chronic PACG and POAG probably results, at least in part, from decreased aqueous outflow secondary to widening and fusion of adjacent trabecular beams, together with the homogenous deposit enmeshing trabecular beams and spaces. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the efficacy of cyclodialysis-enhanced Mitomycin c (MMC) trabeculectomy in post-keratoplasty glaucoma.DesignProspective, non-comparative, interventional case series.MethodsA total of 45 eyes of 45 consecutive patients with refractory glaucoma after penetrating glaucoma underwent a cyclodialysis-augmented trabeculectomy with MMC. The visual acuity, intraocular pressure (IOP), corneal clarity, and graft failure were evaluated over a minimum follow-up of 2 years.ResultsThe mean age of the patients was 55.4±9.4 years. The cyclodialysis-augmented MMC trabeculectomy procedure resulted in a mean reduction of IOP from 38.9±3.9mmHg (95% confidence interval (CI) 35.9–42.2) at baseline to 11.3±2.8mmHg (95% CI 9.5–12.9), at final follow up (P=0.002). Blebs were avascular, diffuse, and extended posteriorly. Postoperative UBMs revealed the presence of a cyclodialysis with a small associated suprachoroidal effusion and a subconjunctival filtering bleb in all cases.ConclusionsCyclodialysis-augmented MMC trabeculectomy provides a safe and effective method of lowering IOP in intractable glaucoma following penetrating keratoplasty, without compromising the corneal graft survival and clarity. [ABSTRACT FROM AUTHOR]

ObjectivesTo measure ocular biometric parameters in all possible untreated family members of index primary angle closure glaucoma (PACG) patients and to correlate these values among affected, unaffected, and suspected family members.MethodsAnterior chamber depth (ACD), axial length (AL), lens thickness (LT), relative lens position, and central corneal thickness (CCT) were measured in first- and second-degree relatives of index patients. These biometric parameters were compared among the relatives and index patients as well as among affected, unaffected, and suspected family members.ResultsOf the 108 family members included in the study, 34 (31.6%) were affected with primary angle closure, 19 (17.6%) were suspect, and 55 (50.7%) were unaffected family members. In comparison to index cases, ACD was 14.56% more in affected, 21.7% more in primary angle closure suspects and 34.92% more in unaffected family members. LT was 10.73, 11.1, 16% less and AL was 0.11, 3.53 and 5.37% more in affected, suspected, and unaffected family members, respectively. Lens position and CCT were not statistically different in the various subgroups.ConclusionsACD is narrowest, lens thickest, and AL shortest in family members affected with PACG compared to suspected and unaffected members. Although LT and ACD could change with advancing age, AL appears to be a marker to identify members at risk of angle closure glaucoma.Eye (2008) 22, 521–527; doi:10.1038/sj.eye.6702687; published online 16 February 2007 [ABSTRACT FROM AUTHOR]