Postoperative Intraocular Pressure Spikes Research Articles

Risk factors for a postoperative intraocular pressure spike after phacoemulsification

Risk factors for a postoperative intraocular pressure spike after phacoemulsification

Endoscopic Cyclophotocoagulation Using Iris Hooks Versus Viscoelastic Devices

Endoscopic cyclophotocoagulation utilizes a diode laser to ablate ciliary body epithelium, resulting in decreased intraocular pressure. Viscoelastic devices are often used to elevate the iris for improved exposure and efficient treatment of targeted tissue. Occasionally, early postoperative intraocular pressure spikes may occur due to retained viscoelastic material. Iris hooks may provide a safe alternative for elevation of the iris during endoscopic cyclophotocoagulation treatment and may be particularly advantageous in cases of aphakia or posterior capsule compromise in which viscoelastic removal is made more difficult.

Risk factors for a postoperative intraocular pressure spike after phacoemulsification

Risk factors for a postoperative intraocular pressure spike after phacoemulsification

Phaco-viscocanalostomy versus Phaco-trabeculotomy

To compare the surgical outcomes between phaco-viscocanalostomy and phaco-trabeculotomy in open-angle glaucoma. In a nonrandomized, retrospective clinical study, 110 eyes underwent phaco-viscocanalostomy (VCS group), and 110 eyes underwent phaco-trabeculotomy (LOT group). The mean follow-up was 857+/-409 (+/-SD) days (P=0.4777). The mean preoperative treated intraocular pressure (IOP) values were 20.2+/-3.5 mm Hg in the VCS group and 20.9+/-3.5 mm Hg in the LOT group (P=0.3377). The postoperative IOPs in the VCS group were 15.0+/-3.0 and 16.1+/-3.0 mm Hg at 1 and 3 years, and in the LOT group 16.3+/-2.9 mm Hg (P=0.0088) and 16.5+/-3.3 mm Hg (P=0.4993), respectively. The number of medications used in the VCS group was significantly lower than in the LOT group during the observation periods (P< or =0.0130). The probabilities of achieving IOPs< or =21 mm Hg at 3 years in the VCS group were 92.0% with or without mediations and 58.2% without medications, and were significantly better than those of the LOT group (84.7% and 36.0%, P=0.0334 and P<0.0001 by log-rank test, respectively). The probabilities of achieving IOPs< or =16 mm Hg at 3 years in the VCS group were 30.5% with or without mediations and 30.3% without medications, whereas those in the LOT group were 27.5% (P=0.1799) and 19.4% (P=0.0010), respectively. The visual outcome was similar between the groups. Postoperative hyphema (> or =2 mm) and IOP spikes (> or =30 mm Hg) occurred significantly less in the VCS group (2.7 and 3.6%, respectively) than in the LOT group (26.4 and 28.2%, respectively; P<0.0001). In 13 eyes (11.8%) of the LOT group, the highest IOP level was recorded 40 mm Hg or higher. Vitreous hemorrhage and central visual loss occurred in 1 case each in the LOT group. After a middle-term observation, phaco-viscocanalostomy provides better IOP control and a lower incidence of vision-threatening complications than phaco-trabeculotomy.

The effect of elective phacofragmentation on central corneal thickness in the dog

To characterize the short- and intermediate-term effects of elective phacofragmentation on central corneal thickness (CCT) in the dog. Forty-three dogs (66 eyes) undergoing elective phacofragmentation cataract surgery over an 8-month period at a single private ophthalmology referral clinic were enrolled in the study. Central corneal thickness was measured by ultrasonic pachymetry just prior to surgery, 1 day following surgery, 1 week postoperatively, 1 month postoperatively, and more than 2 months postoperatively. Statistical comparisons were made using descriptive and inferential statistical methods with a level of significance set at P < 0.05. The initial mean CCT of 611 microm increased dramatically to 741 microm 1 day postphacofragmentation. Mean CCT remained slightly elevated (666 microm) at 1 week postoperatively, but became indistinguishable from preoperative measurements by 1 month postsurgery (626 microm) and remained so at the > 2-month time period (618 microm). The change over time and trends remained statistically significant and remarkably similar, even when adjusted separately for age, gender, surgeon status, diabetic status, cataract type, and total surgery time (all P < 0.0001). Corneas of diabetic dogs were thicker than those of nondiabetic dogs at all time periods, and the overall effect of diabetic status was significant (P = 0.016). There was a sharper increase from the preoperative to 1-day postoperative CCT in the diabetic group compared to the nondiabetic group. The mean CCT of the pseudophakic group took longer to return to baseline than the aphakic group. The mean CCT of the foldable intraocular lens (IOL) group took longer to return to baseline than both the rigid IOL and aphakic groups. Dogs with documented in-hospital postoperative intraocular pressure spikes (> 25 mmHg) developed a greater 1-day postsurgical increase in CCT. It appears that there was a sharper decrease in mean CCT from 1 month to more than 2 months postoperatively in the postoperative hypertension group. Elective phacofragmentation cataract surgery results in an increase in CCT in dogs, but this increase is transient. Particular care may be indicated to protect the endothelium of diabetic patients undergoing phacofragmentation. These data do not clearly support an advantage of the small-incision cataract surgery made possible by the use of foldable IOLs.

Change in intraocular pressure within 1 week of phacoemulsification and intraocular lens implantation using Adatocel

To examine the change in intraocular pressure (IOP) within 1 week of phacoemulsification and foldable posterior chamber intraocular lens (PC IOL) implantation using Adatocel (hydroxypropyl methylcellulose 2% [HPMC]). Department of Ophthalmology, University of Sciences, Faculty of Medicine, Pécs, Hungary. In this prospective study, the IOP in 118 eyes of 118 patients (57 men, 61 women, mean age 68 years +/- 7.8 [SD]) with no history of glaucoma was assessed by Goldmann applanation tonometry 2 to 3, 6 to 8, and 22 to 24 hours and 1 week after uneventful phacoemulsification and PC IOL implantation. The effect of the removal of Adatocel ("partial removal" from the anterior chamber [AC] only versus "complete removal" from behind of the IOL as well), the lens type (Medicontur 601 HP versus Bausch & Lomb Hydroview), and the type of anesthesia (topical versus parabulbar) were compared. Statistical analysis was performed using the Student t test, and P< or =.05 was considered statistically significant. The mean preoperative IOP was 13.83 +/- 2.5 mmHg. There were no significant differences at any time in postoperative IOP measurements between the 2 IOL types and the 2 modes of anesthesia. At 2 to 3 hours, 6 to 8 hours, and 22 to 24 hours, the IOP was significantly higher in the 30 eyes in which the Adatocel was partially removed (from the AC only) than in the 88 eyes in which it was completely removed (from behind the PC IOL as well) (P< or =.05, P< or =.01, and P< or =.001, respectively). Severe postoperative IOP spikes in nonglaucomatous patients after uneventful phacoemulsification cataract surgery are rare. The type of implanted PC IOL and the mode of anesthesia had no significant effect on postoperative IOP. Total removal of the ophthalmic viscosurgical device, even when using HPMCs such as Adatocel, is necessary to prevent postoperative IOP spikes.

Postoperative intraocular pressure spikes: the need to treat.

Raised intraocular pressure (IOP) still holds pride of place as the principal risk factor for developing glaucoma. The detrimental effects of chronically elevated IOP on the optic disc are well known. However, the clinical significance of acutely raised IOP is less certain. Transient acute elevations of intraocular pressure (IOP spikes) occur following many surgical and laser procedures. Cataract extraction, glaucoma surgery, pars plana vitrectomy with fluid air exchange, Nd-YAG capsulotomy, or peripheral iridotomy, and laser trabeculoplasty all have been reported to be associated with variable IOP spikes in the early postoperative period. There is considerable diversity of opinion concerning how these IOP spikes should best be managed. We have reviewed the nature and quality of the available experimental and clinical data relating to IOP spikes and we offer some broad, general guidelines for their clinical management.

Intraocular pressure after bilateral cataract surgery using Healon, Healon5, and Healon GV

Purpose: To determine whether there is a difference in frequency or severity of postoperative intraocular pressure (IOP) spikes after bilateral phacoemulsification with complete ophthalmic viscosurgical device (OVD) removal when Healon®5 (sodium hyaluronate 2.3%), Healon® (sodium hyaluronate 1%), or Healon GV® (sodium hyaluronate 1.4%) is used. Setting: York Finch Eye Associates and Humber River Regional Hospital, Toronto, Ontario, Canada. Methods: Bilateral cataract surgery was performed in 99 patients; 50 were randomly assigned to receive Healon5 in 1 eye and Healon GV in the fellow eye and 49, Healon in 1 eye and Healon GV in the fellow eye. The IOP was measured preoperatively as well as 5 and 24 hours and 7 days postoperatively. The mean IOP and standard deviation at each time interval were calculated for each OVD. The results were compared among the OVDs using Student t tests for each time at which IOP was assessed. Results: There were no significant differences in postoperative IOP spikes among the Healon5, Healon, and Healon GV groups; however, patients receiving lower viscosity OVDs had a lower mean IOP at 24 hours. All groups had increased IOP at 5 and 24 hours and reduced IOP at 7 days. Conclusions: Within a family of molecularly similar OVDs, lower viscosity OVDs appear to cause slightly lower mean elevations in IOP in normal patients at 24 hours. However, if the OVD is removed, postoperative IOP spikes above 21 mm Hg appear related more to patient factors (eg, predisposition in glaucoma patients) and surgically induced trauma than to the specific long-chain non-cross-linked hyaluronan OVD used.

Factors leading to reduced intraocular pressure after combined trabeculotomy and cataract surgery.

To determine the factors that control intraocular pressure (IOP) after trabeculotomy combined with phacoemulsification and intraocular lens implantation as an initial procedure in adults with primary open-angle glaucoma (POAG). A consecutive series of 141 eyes with POAG or ocular hypertension was prospectively recruited. One hundred five eyes were treated by combined trabeculotomy and cataract surgery (TPI group) and 36 eyes were treated by cataract surgery alone (PI group). The prognostic factors that correlate with successful IOP control after surgery were screened using the Cox multivariate analyses based on three definitions of success: IOP <21 mm Hg, <17 mm Hg, and <15 mm Hg, with or without eye drops. The factors examined were types of procedure (TPI or PI), age, sex, preoperative IOP level, number of preoperative antiglaucoma medications, eyes with high myopia (>-10 diopters), postoperative hyphema lasting longer than 4 days, and postoperative transient IOP spike (>30 mm Hg). TPI was a significant factor for IOP reduction in the three definition-based multivariate analyses. Other factors included patient age, preoperative IOP level, and postoperative IOP spike. The statistical significance of age was further confirmed using linear regression analysis and the Spearman correlation coefficient (Rs) between age and IOP level 3 months after surgery (R(2)=0.13, P = 0.0002 and Rs=-0.44, P < 0.0001, respectively in the TPI group). The success rates for IOP control <17 mm Hg and <15 mm Hg were significantly higher in patients 70 years and older than in younger patients, as determined using the Kaplan-Meier life table analysis with the Mantel-Cox logrank test in both TPI and PI groups. IOP reduction was significantly greater in older patients than in younger patients at every follow-up visit for up to 1.5 years for the TPI group and up to 1 year for the PI group. Advanced age is a favorable prognostic factor for successful control of IOP after combined trabeculotomy and cataract surgery. Older patients with POAG and visually significant cataract are good candidates for combined trabeculotomy and cataract surgery.

Revisiting early postoperative follow-up after phacoemulsification

Purpose: To determine whether postoperative evaluation of routine phacoemulsification can be safely and effectively performed on the day of surgery and 4 days postoperatively and evaluate the incidence and management of early intraocular pressure (IOP) elevations 3 to 7 hours postoperatively in patients with or without glaucoma. Setting: Community-based hospital. Methods: This retrospective series comprised 465 consecutive patients who had phacoemulsification and intraocular lens implantation. All patients had postoperative follow-up on the day of surgery (3 to 7 hours postoperatively) and at 4 days. Patients were classified into 2 groups: nonglaucoma (NG), 396 patients; and glaucoma (GL), 69 patients. The main outcome measures were the incidence and management of postoperative complications including IOP spikes, wound leaks, uveitis, and endophthalmitis. Results: Three to 7 hours postoperatively, 73 NG (18.4%) and 32 GL (46.4%) patients had IOP elevations greater than 28 mm Hg, a significant change from baseline ( P < .0001). Fourteen NG (3.6%) and 13 GL (18.8%) patients had IOP elevations greater than 40 mm Hg ( P < .0001). Significant IOP elevations were effectively managed with a paracentesis with or without short-term antiglaucoma medications on the day of surgery, with 75 NG (18.9%) and 39 GL (56.5%) patients requiring IOP intervention. There were no IOP elevations greater than 21 mm Hg on the next day or at 4 days. There were no complications that were missed at the same-day evaluation that may have been identified at the 1-day postoperative visit. Conclusions: The results indicate that after routine phacoemulsification, patients can be safely and effectively reviewed on the day of surgery and 4 days postoperatively to identify and manage early postoperative IOP spikes. A significant number of patients, particularly those with preexisting glaucoma, had potentially harmful IOP spikes 3 to 7 hours postoperatively.

Surgical Outcomes of Trabeculotomy Combined with Sinusotomy for Juvenile Glaucoma

Purpose: To evaluate the outcome of trabeculotomy combined with sinusotomy for juvenile glaucoma. Methods: We studied 16 patients (25 eyes) (age range, 11–50 years) with juvenile glaucoma for a minimum follow-up period of 1 year. We performed combined trabeculotomy and sinusotomy surgery in 13 juvenile glaucoma patients (18 eyes), and trabeculotomy alone in 6 patients (7 eyes). Results: The intraocular pressure (IOP) of the combined surgery group was 29.8 ± 7.8 mm Hg before surgery and 15.6 ± 3.0 mm Hg 1 year after surgery. The IOP of the trabeculotomy-alone group was 29.1 ± 6.4 mm Hg before surgery and 15.4 ± 2.4 mm Hg 1 year after surgery. A postoperative IOP spike that was higher than the preoperative IOP was recorded in 2 eyes of the combined surgery group and in 2 eyes of the trabeculotomy group. The combined surgery group consisted of 7 eyes with a previously failed glaucoma surgery, and 11 eyes having a first glaucoma surgery. The postoperative IOP in these 11 eyes was 15.5 ± 2.8 mm Hg. Conclusion: Trabeculotomy is very effective in lowering the IOP in patients with juvenile glaucoma. Sinusotomy does not play an important role in tension control.

SURGICAL MANAGEMENT OF COEXISTING GLAUCOMA AND CATARACT

As longevity increases among the elderly, the challenge of managing coexisting glaucoma and cataract is becoming ever more frequent. Modern surgical techniques for cataract removal (e.g., small incision phacoemulsification and temporal clear corneal incision) spare conjunctiva and minimize disruption of the anterior chamber angle. Postoperative bleb titration with releasable scleral flap sutures and antifibrotic medications increases the chance for successful aqueous filtration. These advances have made us reconsider the choice for performing cataract extraction and trabeculectomy together or in sequential steps (staged surgery) for eyes with coexisting cataract and glaucoma. There are many issues (Table 1) to consider in the surgical treatment of coexisting glaucoma and cataract including medication compliance, side effects, and cost. The severity of glaucomatous visual field loss and optic nerve damage and the level of intraocular pressure (IOP) influence the surgical decision. The possibility of further optic nerve damage from a postoperative IOP spike must be addressed. The type of glaucoma and the preoperative state of the conjunctiva and anterior segment also influence the decision-making process. Cataract extraction presents extra hazards in the glaucomatous eye relating to poor pupillary dilation caused by miotic use and diminished zonular integrity in eyes with exfoliation syndrome. The surgical approach for cataract extraction is also important. Large incision extracapsular cataract extraction (ECCE) or scleral tunnel phacoemulsification cause limbal and conjunctival scarring that may have an impact on the success of future glaucoma surgery. This can be avoided by using a clear corneal incision for removal of the cataract. In previous years, combined cataract and filtration surgery has gained favor over procedures. Combined surgery is convenient for the patient because two procedures are done during a single operation. It also diminishes the likelihood of a postoperative IOP spike, which is common when cataract surgery is performed alone. 18 This trend has resulted in more eyes with glaucoma who are destined for cataract extraction having a trabeculectomy added secondarily. Nevertheless, combined surgery risks more intraoperative and postoperative complications than either operation separately, slower visual recovery than cataract surgery alone, and lower chance of developing a filtration bleb. In this article we review the available information on the surgical management of eyes with coexisting cataract and glaucoma and present a rationale for a return to sequential or staged surgery. We approach each patient with glaucoma and cataract by considering the status of the patient's glaucoma and the patient's need for improved vision. Whatever procedures are selected, the ultimate goals should be an adequate IOP and improved quality of life by improving vision and decreasing the need for antiglaucoma medications.

Phacotrabeculectomy With "Smile" Incision, Punch, and Single Releasable Suture

To describe and prospectively evaluate a technique of phacotrabeculectomy consisting of a "smile" wound, corneal punch, and tight closure of the scleral flap with a single releasable suture. A cohort of 25 patients underwent this procedure performed by a single surgeon. The surgical technique is described and the first year of follow-up is evaluated. Mean intraocular pressure (IOP) was 25.4 mm Hg preoperatively and 16.2 mm Hg at a mean follow-up of 10.2 months (a fall of 36%). Incidence of immediate postoperative complications was low, especially those related to hypotony (wound leak, shallow anterior chamber, fibrinous uveitis). There was a 50% incidence of postoperative IOP spikes of greater than 26 mm Hg. Three cases were deemed partial failures at 1 year (IOP < 21 mm Hg on medical treatment), and three cases were complete failures (IOP > 21 mm Hg or further surgery required). The tight scleral flap and routine release of the releasable suture on the third postoperative day reduce immediate postoperative complications compared with other studies, with the exception of IOP spikes. The lack of aqueous flow in the immediate postoperative phase may be a factor in the failure rate, which is higher than expected.

Development and use of brimonidine in treating acute and chronic elevations of intraocular pressure: A review of safety, efficacy, dose response, and dosing studies

Clinical trials were conducted to evaluate brimonidine tartrate, an α 2-adrenoceptor agonist, for treating chronically elevated intraocular pressure (IOP) and the prophylactic treatment of acute pressure rises. In normal volunteers, brimonidine administered twice daily for five days at concentrations ranging from 0.08–0.5% lowered IOP 16–22% and was well-tolerated ocularly and systemically. In a 28-day study in 186 patients with glaucoma or ocular hypertension, maximum IOP lowering was 27.2% and 30.1% for brimonidine 0.2% and 0.5%, respectively. The most common adverse events were dry mouth, fatigue/drowsiness, and blurring, which occurred significantly more frequently with brimonidine 0.5% than 0.2%. Brimonidine 0.5% was tested in 471 patients undergoing argon laser trabeculoplasty (ALT). One drop administered preoperatively, postoperatively or both pre- and postoperatively significantly reduced the number of postoperative IOP spikes (1–2% of patients compared to 23% receiving only vehicle). Systemic hypotension, dry mouth, lid retraction and conjunctival blanching occurred more frequently in patients who received the drug twice. Brimonidine 0.2% twice daily was compared with three times daily in 101 patients. No significant differences were seen between the two regimens in mean change from baseline IOP with mean decreases ranging from 3.4 ± 3.23 to 5.2 ± 3.77 mm Hg (standard deviation) with twice daily dosing, and from 2.8 ± 3.26 to 4.9 ± 3.70 mm Hg with three times daily dosing. The most common complaints were blurring and oral dryness. Based upon results of these and other early studies, brimonidine 0.5% was selected for acute therapy for the prevention of postoperative intraocular pressure spikes and brimonidine 0.2% for chronic use in glaucoma and ocular hypertension.

Combined phacoemulsification and trabeculectomy with mitomycin-C

Purpose: To examine the safety and efficacy of primary combined phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and trabeculectomy with mitomycin-C (0.4 mg/ml) in patients with open-angle glaucoma and visually significant cataract.Setting: University-hospital-based glaucoma referral practice.Methods: In this study, data of 43 patients of a single surgeon were retrospectively analyzed. These consecutive patients had combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with mitomycin-C.Results: Thirty-eight patients (88%) had open-angle glaucoma and 5 (12%) pseudoexfoliative glaucoma. Thirty-eight patients (88%) had 12 months of follow-up; all had at least 6 months follow-up. Mean preoperative intraocular pressure (IOP) was 21.6 mm Hg ± 6.8 (SD) (range 12.0 to 41.0 mm Hg) with 2.5 ± 1.0 glaucoma medications. At last follow-up, mean IOP had decreased to 14.2 ± 6.2 mm Hg (range 3.0 to 40.0 mm Hg) with 0.5 ± 0.5 glaucoma medications. Twenty-one patients (55%) had an IOP of 15 mm Hg or less at 12 months. Best corrected visual acuity was 20/40 or better in 31 of 43 patients (72%) at last follow-up. A filtration bleb was noted in 33 of 40 patients (83%) at their last visit. Postoperative IOP spikes occurred in 17 patients (40%), transient hyphema in 12 (28%), transient wound leaks in 11 (26%), and superficial punctate keratopathy in 11 (26%). Three cases of persistent hypotony (IOP less than 5 mm Hg) and 1 case of epithelial downgrowth were also noted.Conclusion: Phacoemulsification with IOL implantation and combined trabeculectomy with mitomycin-C produced good visual acuity and excellent IOP control but resulted in some complications. The use of mitomycin-C in combined procedures does not appear to confer a significant benefit.

Practice Trends

To identify risk factors for surgical failure after gonioscopy-assisted transluminal trabeculotomy (GATT) in juvenile open-angle glaucoma (JOAG).Prospective, interventional case series.GATT was the initial surgery in 70 eyes of 70 patients with JOAG. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤21 mm Hg with at least a 20% reduction from preoperative IOP, with or without the use of antiglaucoma medication (qualified and complete success, respectively) at each postoperative visit. IOP spike was defined as IOP >30 mm Hg and an increase of at least 10 mm Hg from IOP before the spike, and then reduced to ≤21 mm Hg.The median age at the time of surgery was 19.3 years (range, 4.9-37.5 years) with a visual field mean deviation of −17.4 ± 10.6 dB. Mean IOP decreased from 31.3 ± 9.5 mm Hg preoperatively to 15.8 ± 2.7 at 12 months postoperatively. The complete and qualified success rates were 74.3% and 91.4%, respectively. An IOP spike occurred in 52 eyes (74%), with a median spike duration of 3.5 days (range, 1-21 days). Longer duration of IOP spike (P = .009) and older age at the time of surgery (P = .025) were both associated with worse surgical outcomes. Advanced disease was associated with prolonged IOP spike (P = .007).GATT provided excellent outcomes in patients with severe JOAG. Older age and longer duration of postoperative IOP spike are risk factors for failure. Severe cases are more likely to have longer durations of IOP spike. Frequent IOP monitoring during the early postoperative period is needed to detect IOP spikes in these patients.

Effectiveness of apraclonidine and acetazolamide in preventing postoperative intraocular pressure spikes after extracapsular cataract extraction

We studied the effectiveness of two prophylactic agents in controlling early postoperative intraocular pressure (IOP) increases after cataract surgery. Fifty-four nonglaucomatous patients received either topical 1 % apraclonidine, one drop before and after surgery, or sustained-release acetazolamide, 500 mg, or no medication at the completion of planned extracapsular cataract extraction (ECCE). Mean baseline IOPs were similar among patients randomized to the apraclonidine, acetazolamide, and control groups: 15.29 mm Hg, 15.33 mm Hg, and 14.26 mm Hg, respectively. At 3 hours postoperatively, IOPs were significantly lower in the apraclonidine group (11.13 mm Hg, P = .035), nonsignificantly lower in the acetazolamide group (13.3 mm Hg, P = .17), and significantly increased in the control group (21.32 mm Hg, P = .003). One eye in the apraclonidine group and six in the control group had IOPs greater than 30 mm Hg. At 24 hours, the only statistically significant difference was in the control group, whose mean IOPs remained elevated (21.83 mm Hg, P = .0008). One eye in the apraclonidine group, two in the acetazolamide group, and five in the control group had IOPs greater than 30 mm Hg. We found a significant early IOP reduction with apraclonidine given topically preoperatively and at the completion of planned ECCE.

The Triple Procedure of ECCE, IOL Implantation and Trabeculectomy, Long-term Results and Complications

OBJECTIVE: To assess the safety and efficacy of the triple procedure of extracapsular cataract extraction (ECCE), lens implant and trabeculectomy in cataract and glaucoma patients. STUDY DESIGN: Retrospective study of postoperative results with a minimum follow-up of 14 months. SETTING: Ophthalmic Department, Treviso Hospital, Italy. PATIENTS: One hundred and five eyes of 82 patients suffering from cataract and glaucoma. MAIN OUTCOME MEASURES: Best corrected visual acuity, keratometry, intraocular pressure, visual field, number of medications, complications. RESULTS: Intraocular pressure (IOP) decreased from 25.26 ± 6.12 (m ± DS) mmHg to 16.72 ± 4.08 (m ± DS) mmHg and visual field stabilization was obtained in 89 eyes. Visual acuity of 0.5 or better was obtained in 59% of eyes. Visual significant postoperative complications occurred in only seven eyes. CONCLUSION: The triple procedure of ECCE, lens implantation and trabeculectomy provided satisfying visual rehabilitation and IOP control, in a single operation, avoiding dangerous postoperative IOP spikes. Visually significant complications appeared minimal.

Peripheral Iridotomy Using Nd:YLF Laser

We used the Nd:YLF Oscillator/Regenerative Amplifier Laser (ISL, San Diego, Calif) at 1053 nm to perform peripheral iridotomies in three eyes. The total amount of energy required was greater than the usual amount needed in Nd:YAG peripheral iridotomies. However, each laser pulse uses a much smaller quantity of laser energy and produces a smaller and more refined optical breakdown. The postoperative courses for these patients were uneventful, without postoperative intraocular-pressure spike or increasing anterior-chamber reactions.