Average Preoperative Intraocular Pressure Research Articles

Long-term Efficacy of Trabeculectomy on Chinese Patients with Pigmentary Glaucoma: A Prospective Case Series Observational Study.

Background:Though trabeculectomy is often performed on patients with medically refractive pigmentary glaucoma (PG), the clinical outcomes of surgical treatment on PG remain unknown. The aim of this study was to summarize the long-term efficacy and safety of trabeculectomy on PG.Methods:This was a prospective case series observational study. Eighteen consecutive PG patients were followed up for 8 years after trabeculectomy from May 2006 to April 2007. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, intraocular pressure (IOP) measurement, Humphrey visual field analysis (VFA), and stereoscopic funduscopy were performed on admission and every 6 months after the surgery. Postoperative IOP, VA, BCVA, VFA, adjunctive anti-glaucoma medication, treatment-related side-effects, changes in blebs, and main clinical findings in the anterior segment of PG were recorded and compared with the baseline.Results:Eighteen PG eyes from 18 patients, with average preoperative IOP of 34.5 ± 4.7 mmHg (range: 21–47 mmHg, 1 mmHg=0.133 kPa) were enrolled in this study. All enrolled patients completed the follow-up visits and required examinations. Eight years after trabeculectomy, all surgical eyes (18/18) had satisfactory IOP control with an average of 13.7 ± 2.5 mmHg (range: 9–19 mmHg), which was significantly lower than baseline (P = 0.001). Majority (15/18) of the PG eyes had stable VA, BCVA, VFA, and optic disc cupping parameters. Functional blebs still existed in 12/18 of the PG eyes at the last follow-up visit. Unanimously, pigmentation in the anterior segment attenuated with time after surgical treatment. No severe side-effects were recorded in any of the surgical eyes.Conclusions:All surgical PG eyes in this study had satisfactory IOP control 8 years after the surgery with well-preserved visual function. The long-term efficacy and safety of trabeculectomy are promising in PG patients.

Postoperative refractive error following cataract surgery after the first attack of acute primary angle closure

To investigate differences between preoperative target refraction and postoperative spherical equivalent refraction in eyes with the first attack of acute angle closure glaucoma before and after surgery. We retrospectively examined eyes of 36 patients who suffered the first attack of acute primary angle closure after undergoing cataract extraction and intraocular lens implant. We measured keratometric values (K1, K2) due to medical therapy for high ocular tension and the mean time interval until surgery. We compared the axial length, expected diopter, logMAR visual acuity, K1, K2, refractive spherical equivalent, and intraocular pressure (IOP) before and 6 months after surgery. The average preoperative IOP was 51.3 ± 9.0 mmHg, but it decreased to 14.8 ± 3.6 mmHg after surgery. No corneal edema was observed after surgery. The average axial length was 22.12 ± 1.03 mm and there was no significant change in keratometric values, which were 7.72 ± 0.33 mm (K1) and 7.51 ± 0.31 mm (K2) before surgery and 7.67 ± 0.33 mm (K1) and 7.49 ± 0.29 mm (K2) after surgery. Similarly, no significant difference was observed in average preoperative target refractive error (-0.57 ± 0.53 D) and average postoperative refractive spherical equivalent (-0.67 ± 0.97 D). The inability to accurately determine preoperative refractive error due to corneal edema or other complications is a concern during the first attack of acute angle closure glaucoma. However, our results indicate that no differences should be expected between preoperative refractive error and postoperative refractive spherical equivalent.

The Effect of Phacoemulsification on Intraocular Pressure in Medically Controlled Open-Angle Glaucoma Patients

To evaluate intraocular pressure (IOP) after phacoemulsification in patients with medically controlled open-angle glaucoma (OAG), and examine the association of biometric variables to IOP changes. Retrospective case series. Open-angle glaucoma patients without prior incisional glaucoma surgery undergoing phacoemulsification by a single surgeon between January 1997 and October 2011 were evaluated. Patient charts were reviewed to obtain demographic information, preoperative glaucoma medications, severity and treatment measures, and preoperative and postoperative IOP. A total of 157 eyes (157 patients) were included in the study. The average preoperative IOP of 16.3 ± 3.6 mm Hg decreased to 14.5 ± 3.4 mm Hg at 1 year (P < .001). Sixty eyes (38%) required additional medications or laser for IOP control within the first year postoperatively, or had a higher IOP at postoperative year 1 without medication change. Among eyes without postoperative medication changes (n = 102), higher preoperative IOP (P < .001), older age (P = .006), and deeper anterior chamber depth (P = .015) were associated with lower postoperative IOP. Phacoemulsification resulted in a small average decrease in IOP in patients with OAG. A sizeable proportion of medically controlled glaucoma patients with open angles undergoing phacoemulsification experienced an increase in IOP or required more aggressive treatment to control IOP postoperatively.

The influence of surgical and medical interventions upon optic disc structure in patients with primary open angle glaucoma.

To evaluate the changes of optic disc parameters in primary open angle glaucoma (POAG) patients after surgical and medical treatment, and analyze the determinants of these changes. A total of 67 patients were enrolled in this study. Thirty nine patients (40 eyes) underwent trabeculectomy and 28 patients (32 eyes) received intra-ocular pressure (IOP) lowering medical therapy. All subjects underwent bilateral routine ocular examination and Heidelberg retina tomography (HRT) before treatment and 2 weeks, 1 month, 3 months, 6 months and 1 year after treatment. Changes in optic disc parameters in both the surgical and medical groups were analyzed, as was the influence of disease severity and IOP reduction on these changes. In the surgical group, the average preoperative IOP was 32.8±8.64 mmHg, which showed a significant decline at each post-operative visit. Most optic disc parameters measured by HRT were significantly improved after trabeculectomy (P=0.001~0.01), though the amount of improvement declined gradually during the post-operative period. Rim volume (RV), cup shape measure (CSM ), mean RNFL (mRNFL), RNFL cross sectional area (RNFLA) and vertical cup-to-disc ratio (C/D) still remained significantly below the pre-operative mean one year after surgery. In the medical group, the mean IOP before treatment was 24.8±4.32 mmHg and remained <21 mmHg on all subsequent post-treatment visits. However, no significant changes in optic disc parameters were found after initiation of medical treatment (F=0.52~2.21, P=0.75~0.07). In the surgical group, the extent of reduction of IOP was positively correlated with the improvement in RV, CSM and vertical C/D (r=0.41~0.58, P=0.001~0.04) at one year after trabeculectomy. The absolute value of the mean deviation on visual field testing was negatively correlated with the improvement of RV and CSM (r=-0.43~-0.62, P=0.03~0.001). Improvement in optic disc parameters occurred more commonly after surgical than medical treatment in POAG patients. The amount of reduction of IOP was correlated with the extent of this improvement, which may be more limited in more severe glaucoma.

Microdevice for aqueous humor drainage Maldonado Bas - Pförtner

A microdevice for the treatment of refractory glaucoma is presented. The underlying concepts, its mechanisms of action and the surgical technique for implanting are explained and the results are analyzed. The microdevice was developed and the surgeries were performed at the Maldonado-Bas Eye Clinic (Cordoba, Argentina), under the rules established in the protocol approved by the provisions of the National Administration of Drugs, Food and Medical Technology 430/7. File No.:1-47-25-649-07-1. In a prospective study, following the protocol, 16 eyes with refractory glaucoma were included and operated. Intraocular pressure <21mmHg with or without additional medication was considered successful. The follow-up was one year. Averages, percentages and their 95% confidence bands were calculated. Analysis of variance for repeated measures was used to compare averages. The average preoperative intraocular pressure was 32.81 mmHg, SD ± 10.94 mmHg in a range of 14 to 50 mmHg. The average post-surgical intraocular pressure at one year was 12.43 mmHg, SD ± 2.85 mmHg in a range of 7 to 19 mmHg. The difference between the pre-and post-surgery average intraocular pressure was 20.38 mmHg. The number of successes was 14 eyes (87.5%, confidence interval (CI) 95% 61.6% - 98.6%). The number of failures was two eyes (12.5%, CI 95% 1.43% - 38.4%). The results show that the microdevice is successful for the treatment of refractory glaucoma.

Trabeculotomy combined with phacoemulsification, intraocular lens implantation and sinusotomy for exfoliation glaucoma

To verify the advantages of trabeculotomy combined with phacoemulsification, intraocular lens implantation and sinusotomy (PTOS) in eyes with exfoliation glaucoma (XFG) and a coexisting cataract. Sixty-six eyes of 62 Japanese XFG patients that received either PTOS, phacotrabeculectomy (PTE) or MMC trabeculectomy (LEC) were followed for up to 36 months at Niigata University Medical and Dental Hospital. The outcomes of postoperative intraocular pressure (IOP) and visual acuity as well as complications were compared among the patients who underwent the three surgical procedures. The average preoperative IOP in the PTOS cases was 22.4 ± 5.13 mmHg, but decreased to 12.3 ± 2.33 mmHg at 12 months post-surgery and was maintained for up to 36 months. The preoperative IOPs, which were 21.9 ± 4.18 mmHg in the PTE group and 26.6 ± 7.57 mmHg in the LEC group, decreased to 13.3 ± 2.79 mmHg in the PTE group and 12.6 ± 6.00 mmHg in the LEC group at 12 months. There were no statistical differences among the three groups at any time point after 3 months. While the postoperative corrected visual acuities were similar between the PTOS and PTE groups, the average time in which the best postoperative visual acuity was reached was significantly shorter in the PTOS group (1.37 ± 1.74 months) than in the PTE group (4.92 ± 4.36 months). PTOS can be recommended as an initial glaucoma surgery for XFG eyes with coexisting cataracts, because PTOS is not a filtering surgery, but can obtain similar IOP effects as PTE for XFG eyes.

Internal Reflectivity of Filtering Blebs versus Intraocular Pressure in Patients with Recent Trabeculectomy

The authors conducted a morphology analysis of filtering blebs with anterior segment optical coherence tomography (AS-OCT) in patients shortly after trabeculectomy to find further criteria for success or failure of a filtering bleb. Thirty-seven patients (43 eyes) who had recently (<2 years) undergone trabeculectomy were measured 1 to 4 times with AS-OCT. In contrast to ultrasound biomicroscopy, AS-OCT eliminates the need for a water bath in contact with the globe. This is of particular value in a study of morphologic parameters that may be altered by contact and in the postoperative period when concerns of infection are paramount. In this study, the internal reflectivity of the fluid-filled cavity of the filtering bleb was compared with the intraocular pressure (IOP). Mean age of the patients was 69.5 years (range, 27-84 years). Average preoperative IOP of the 43 eyes was 20.6 mm Hg (range, 10-42 mm Hg), average postoperative IOP at the time of AS-OCT measurement was 10.6 mm Hg (range, 2-40 mm Hg), and mean IOP reduction was 10.0 mm Hg (48.5%). Internal reflectivity of the fluid-filled cavity of the filtering bleb correlated very well to the IOP (R(2) = 0.3762, n = 61, P < 0.0001). AS-OCT is a promising tool with which to analyze the morphology of the filtering bleb after trabeculectomy. A highly significant correlation between the internal reflectivity of the fluid-filled cavity of the filtering bleb and the IOP could be shown that may have future impact in evaluating the postoperative success or failure of filtering blebs.

253 Sclerothalamotomy (STT) ab interno, une nouvelle méthode minimale invasive chirurgical du glaucome, 4 ans de “follow-up”

Aim The aim of this study is to demonstrate the efficacy and safety of a new surgical procedure termed sclerothalamotomy ab interno (STT ab interno ) for the treatment of primary open-angle glaucoma and juvenile glaucoma. Aim and Methods 58 non penetrating glaucoma procedures called “sclerothalamotomies ab interno ” were performed with radiofrequency in 53 patients with primary open-angle glaucoma and 5 patients with juvenile glaucoma between April 2002 and June 2003. The average preoperative intraocular pressure (IOP) in the 53 primary open-angle glaucoma respectively 5 juvenile glaucoma patients was 25.6 ± 2.3 mmHg respectively 41.0 ± 6.4 mmHg. The sclerothalamotomies ab interno were carried out with a custom made high-frequency dissection 19G probe (tip 0.3 × 1 mm) applying bipolar current with a frequency of 500 kHz. Discussion After a follow-up period of 48 months, the average IOP dropped to 14.6 ± 1.7 mmHg respectively to 12.0 ± 2.6 mmHg, an outcome which is in both groups statistically (p Conclusion Sclerothalamotomy ab interno is a minimally invasive, safe and efficacious surgical technique for lowering IOP in open-angle and juvenile glaucoma.

A novel technique of ab interno glaucoma surgery: follow-up results after 24 months

It was the aim of this study to investigate the efficacy, longevity, and safety of a new ab interno intervention for the treatment of primary open-angle glaucoma (POAG). The previously described method of radiofrequency-mediated "sclerothalamotomy ab interno" was applied in 53 eyes of consecutive patients with POAG between April 2002 and July 2002. Average preoperative intraocular pressure (IOP) was 25.6+/-2.3 mmHg (range 18-48 mmHg). Sclerothalamotomies were carried out with a custom-made high-frequency dissection 19 G probe (tip 0.3 x 1 mm) applying bipolar current with a frequency of 500 kHz (tip temperature 130 degrees C). After a follow-up period of 24 months, the average IOP was 15.0+/-1.6 mmHg (range 11-20 mmHg) (p<0.005). The average number of topical agents was 2.6+/-1.0 (range 1-5) preoperatively. Twenty-four months after surgery such agents were used in only five (9.6%) eyes and the average was 0.21+/-0.53 (range 0-2). Transient IOP elevation was observed in 12 of 53 eyes (22.6%) postoperatively. In all cases elevated IOP could efficiently be controlled with topical medication. In general, IOP dropped continuously over the course of the 6 months following surgery and then remained constant. This study indicates that sclerothalamotomy ab interno is a safe and efficient surgical method for the treatment of POAG. Long-term results clearly demonstrate the longevity of IOP reduction.

One-Year Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma

Background: Selective laser trabeculoplasty (SLT) targets the pigmented trabecular meshwork (TM) cells without damage to the adjacent non-pigmented tissue. A study was conducted to evaluate the efficacy and safety of SLT in the treatment of uncontrolled open-angle glaucoma. Methods: In a prospective non-randomized study 44 eyes of 31 patients with uncontrolled open-angle glaucoma were treated with a frequency-doubled, Q-switched Nd:YAG laser. A total of approximately 50 spots were placed over 180° of the TM at energy levels ranging from 0.7 to 0.9 mJ. Intraocular pressure (IOP) was measured 1, 2, and 24 h, 1 and 2 weeks and 1, 2, 3, 6, 9, and 12 months after treatment. Results: The average pre-operative IOP was 25.6 (SD 2.6) mm Hg (range 22–34). The mean IOP reduction from baseline at 24 h, 3, 6 and 12 months was 7.1 mm Hg (SD 3.5) or 27.6%; 4.2 mm Hg (SD 3.5) or 16.4%; 4.7 mm Hg (SD 4.2) or 18.6%, and 4.4 mm Hg (SD 3.8) or 17.1%, respectively. The percent of eyes with IOP reduction of 3 mm Hg or more at 3, 6 and 12 months was 66, 78 and 62%. A pressure spike of 8 mm Hg or more was detected in 4 eyes (9.1%). Anterior chamber reaction was seen 1 h after SLT and was mild to moderate in 16 eyes (40.4%) and marked in 3 eyes (6.8%). Conclusions: SLT has shown reasonable efficacy in lowering IOP over 1-year follow-up, but there was a tendency for IOP to increase with a longer follow-up. Long-term follow-up studies with a large sample size are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT.

Intraocular pressure after phacoemulsification with posterior chamber lens implantation in open-angle glaucoma.

To evaluate changes in intraocular pressure (IOP) after phacoemulsification (Phaco) with posterior chamber lens (PC IOL) implantation in eyes with primary open-angle glaucoma (POAG) at least 2 years after surgery. 19 eyes of 13 POAG patients who underwent uneventful clear cornea Phaco with PC IOL implantation and with follow-up of at least 2 years after surgery were included in this retrospective study. None of them had previous intraocular surgery or argon laser trabeculoplasty. The average preoperative IOP was 16.9 +/- 2.02 mm Hg. The average follow-up of was 36 +/- 11.8 months. 1 week after surgery a significant decrease in average IOP was observed (13.8 +/- 3.0 mm Hg; P = 0.000). 1 and 4 months after surgery IOP was still significantly lower than preoperatively. 8 months after surgery IOP significantly increased to 15.9 mm Hg (+/- 2.9 mm Hg; P = 0.022) with respect to 1 week postoperatively, but then again significantly decreased to 15.5 mm Hg (+/- 2.6 mm Hg; P = 0.020) 1 year after surgery and stayed approximately the same at 2 and 3 years after surgery. After 4 years the average IOP was 15.0 mm Hg (+/- 3.1 mm Hg; P = 0.216), that was statistically insignificant because of the small number of patients. In 79% (15 eyes) of our cases medical antiglaucoma treatment was unchanged, in 21% (4 eyes) the therapy was reduced. Uneventful Phaco with PC IOL implantation in good medically controlled POAG eyes was associated with a statistically significant long-term decrease in IOP, allowing the reduction of postoperative antiglaucoma medications in more than 20% of the eyes.

Outcome of Combined Phacoemulsification, Intraocular Lens Implantation and Viscocanalostomy

To assess the pressure-lowering effect, visual acuity, and intra- and postoperative complications of combined cataract surgery, intraocular lens(IOL) implantation and viscocanalostomy. Combined viscocanalostomy, phacoemulsification, and IOL implantation was performed on 45 eyes, which were followed for more than 6 months after surgery. The average preoperative intraocular pressure(IOP) was 20.2 +/- 3.1(mean +/- standard deviation) mmHg, and the average medication number was 1.7. A prospective study of these cases was performed. IOP was significantly reduced after surgery, being 13.6 mmHg at 3 months and 15.1 mmHg at 6 months postoperatively. The visual acuity was improved more than 2 lines in 38 eyes. Disruption of Descemet's membrane was noted in 5 eyes and microperforation in 9 eyes as intraoperative complications. Postoperative complications were not vision threatening and included short term hyphema in 34 eyes, fibrin deposition in 5 eyes and IOP spike(> 5 mmHg) in 5 eyes. There were no cases of hypotony, choroidal detachment, or endophthalmitis. Combined viscocanalostomy, cataract extraction, and IOL implantation was a safe and efficacious way to reduce IOP.

Clinical Results of Selective Laser Trabeculoplasty

Purpose: Selective laser trabeculoplasty (SLT) is a new laser procedure using a frequency-doubled Q-switched Nd:YAG laser (wavelength: 532 mm). The laser parameters are set to selectively target pigmented trabecular meshwork (TM) cells without coagulative damage to the TM structure or non-pigmented cells. We investigated the safety and efficacy of SLT in lowering intraocular pressure (IOP). Subjects and Methods: Sixty-seven eyes of 67 patients with uncontrolled open angle glaucoma were treated with the Coherent Selecta 7000 ® (Coherent Inc., Palo Alto, CA). Nineteen of 67 patients had previously received argon laser trabeculoplasty. A total of approximately 60 non-overlapping spots were placed over 180 degrees of the TM ranging from 0.5 to 1.0 mJ per pulse. The maximum energy level at which no bubble formation was observed determined choice. Results: The average preoperative IOP was 22.4 mm Hg. Six months after the operation, mean IOP reduction was 4.4 mm Hg, and mean outflow pressure (OP) reduction was 38.1%. One month after the operation 68.7% of patients responded to treatment with an OP reduction of at least 20% (“responders”). Transient IOP elevation of 5 mm Hg or greater was seen in 25.4% of patients. The success rate at 6 months after operation was 64.6% for all patients (67 eyes) and 78.2% for the responders (46 eyes). An analysis using a Cox proportional hazard model showed that a low preoperative IOP was the significant determinant for success, and the hazard ratio for the IOP increase of 5 mm Hg was 2.12. Other factors such as age, gender, past history of ALT, and goniopigment were not significantly related to success. Conclusion: SLT appears to be a safe and effective way to lower IOP.

Initial experience with pneumatically stented baerveldt implant modified for pars plana insertion for complicated glaucoma

ObjectiveTo assess the efficacy of pneumatically stented drainage tube implants specially modified for pars plana insertion in the treatment of complicated glaucoma. DesignRetrospective, non-comparative case series. Participants50 consecutive patients with refractory complicated glaucoma nonresponsive to medical treatment. InterventionBaerveldt glaucoma implants modified by Hofmann for pars plana insertion were placed following pars plana vitrectomy and gas–fluid exchange (pneumatically stented implant, or PSI procedure). Main outcome measureReduction of intraocular pressure (IOP) to 21 mmHg or less. Results31 neovascular and 19 complicated non-neovascular glaucoma eyes in 48 patients referred to a vitreoretinal subspecialty practice, average age 69 years (range 29–91), were followed an average of 18 months (range 3–41). The average preoperative IOP was 44 mmHg (14–78) on an average 3.2 glaucoma medications (range 2–6). The average final postoperative IOP was 14 mmHg (range 5–31) on an average 0.6 glaucoma medications (range 0–3, median 0). The final intraocular pressure was 21 mmHg or less in 47 of 50 (94%) operated eyes. Serious complications related to the procedure occurred in five eyes (10%). ConclusionsPneumatically stented Baerveldt glaucoma implants modified with the Hofmann elbow to facilitate pars plana insertion are effective in the treatment of complicated glaucoma.

Immediate intraocular pressure response to selective laser trabeculoplasty

BACKGROUND/AIMSSelective laser trabeculoplasty targets the pigmented trabecular meshwork cells without damage to the trabecular meshwork architecture in vitro. A study was conducted in vivo of eight eyes with uncontrolled open...

Management of Coexisting Corneal Disease and Glaucoma by Combined Penetrating Keratoplasty and Trabeculectomy With Mitomycin-C

The management of coexistent corneal disease and uncontrolled glaucoma continues to be a challenging clinical situation. The purpose of this study is to evaluate the results of combined penetrating keratoplasty and trabeculectomy with mitomycin-C. A retrospective study was undertaken to review the records of nine patients who had corneal edema and high intraocular pressure managed by simultaneous penetrating keratoplasty and trabeculectomy with mitomycin-C. The nine patients had an average pre-operative intraocular pressure of 26 mm Hg (range 17 to 41 mm Hg) and associated corneal edema. The average postoperative intraocular pressure at last follow-up was 19 mm Hg (range 5 to 53 mm Hg). Three patients needed additional procedures. Six of nine patients had intraocular pressures judged to be adequately controlled (11 +/- 5 mm Hg, range 5 to 18 mm Hg) throughout the postoperative period (average follow-up 16 months). Grafts remained clear in seven patients. The grafts failed in two cases in which additional glaucoma surgery was necessary. Combined penetrating keratoplasty and trabeculectomy with mitomycin-C should be considered for selected patients with uncontrolled glaucoma and corneal disease who have sufficient conjunctiva for a filtering procedure.

Holmium laser sclerostomy: a clinical study.

A prospective study of 30 glaucoma patients (one eye in each patient) treated by an ab externo holmium laser sclerostomy is presented. An average of 40.2 pulses with an energy of 100 mJ was necessary to produce a filtering bleb. The average pre-operative intraocular pressure was 25.5 +/- 7.4 mmHg, with an average of 14.06 +/- 5.7 mmHg post-operatively at the final follow-up. The mean follow-up was 7.5 months (range 5-12 months) and the mean age of the patients was 71.4 years. Using strict criteria 70% of sclerostomies were considered successful at the final follow-up visit. The main post-operative complication was iris plugging of the sclerostomy. This was dealt with successfully with a 'Q'-switched neodymium:YAG laser in 80% of cases. Our early experience with the laser suggests that it is an easy, quick method of producing a filtering bleb, and may be carried out as an office procedure. As the technique evolves its long-term success remains to be evaluated; however, it shows promise both as an alternative to trabeculectomy as a primary procedure and as an additional technique for more complicated cases of glaucoma.

Drainage Tube Implants in the Treatment of Glaucoma Following Penetrating Keratoplasty

ABSTRACT A retrospective review was undertaken to compare outcomes in 26 eyes that underwent penetrating keratoplasty (PKP) and drainage tube surgery (Morteno double-plate implant or Schocket procedure). Drainage tube surgery was performed either before PKP (10 eyes), after PKP (7 eyes), or at the same time as PKP (9 eyes). Mean follow up was 22 months. The average preoperative intraocular pressure (IOP) for all of the eyes was 31 mm Hg; 96% of them achieved a final IOP of less than 18 mm Hg (average, 14 mm Hg on a mean of 0.8 medications). Graft failure occurred in 11/26 (42%). Eight of these eyes were regrafted, and six of these eight have remained clear at a mean follow up of 22 months after grafting. The overall PKP success rate, including the eyes that underwent repeat PKP, was 81%. Visual acuity remained stable or improved in 70% of the eyes.

Transscleral Neodymium:YAG Thermal Cyclophotocoagulation in Refractory Glaucoma: A Preliminary Report

Thirty patients treated with transscleral neodymium:YAG laser cyclophotocoagulation (TSYLC) are reported. All patients had advanced glaucoma and had previously undergone one or more surgical procedures that failed, or were unsuitable for surgery. The average preoperative intraocular pressure (IOP) for the group was 43 ± 12 mmHg. The average follow-up time was 6 months. The average energy level used was 3.8 J (range, 3.5–4.5 J). The patients were divided into two groups. Group 1 consisted of 20 patients in whom laser lesions were applied 3 mm from the limbus. Group 2 consisted of ten patients in whom laser lesions were applied 2 mm from the limbus. Success was defined as an IOP between 22 and 5 mmHg, regardless of the number of treatments required. The overall success rate was 86%. However, group 2 required significantly more retreatment than did group 1. Complications were moderate and transient.

Anterior Chamber Tube Shunt to an Encircling Band in the Treatment of Neovascular Glaucoma and other Refractory Glaucomas: A Long-term Study

Long-term follow-up results of the anterior chamber tube shunt to an encircling band (ACTSEB) procedure are reported. Thirty eyes of 28 patients with neovascular glaucoma (Group I) and five eyes with nonneovascular refractory glaucoma (Group II) underwent this procedure. In Group I, the average preoperative intraocular pressure (IOP) was 57.1 mmHg. After surgery and average followup of 25 months 96% of eyes had a successful outcome with an average IOP of 15.8 mmHg (P < 0.001). In Group II, despite multiple glaucoma surgical procedures, the average preoperative IOP was 54 mmHg. After surgery and average followup of 20 months 80% of eyes had a successful outcome with an average IOP of 19.8 mmHg (P < 0.01). Revisions in our surgical technique utilizing a small entry with a 25-gauge needle into the anterior chamber and use of Healon® resulted in a fully formed anterior chamber by two days. Clinical and experimental evidence is presented which suggest that aqueous filters through the tube to a reservoir around the encircling band.