Glaucoma

PURPOSE:
To evaluate the effect of substituting topical cyclosporin A 0.5% for topical corticosteroids in patients with postkeratoplasty glaucoma.

METHODS:
Topical cyclosporin A 0.5% was prospectively substituted for topical corticosteroids to treat 25 patients with postkeratoplasty glaucoma.

RESULTS:
Twenty-one (84%) of 25 patients showed a reduction in intraocular pressure (IOP) (range, 1-22 mm Hg; mean, 8.7 mm Hg). Follow-up ranged from 3 to 12 months (mean, 5.8). Graft clarity was maintained in all patients, with one allograft rejection episode. Thirteen patients were able to discontinue one or more glaucoma medication(s).

CONCLUSION:
Topical cyclosporin A 0.5% may be substituted for topical corticosteroids to aid in the management of postkeratoplasty patients with glaucoma. However, the resultant decrease in IOP may be associated with an increased risk for immune rejections.

Authors' abstract, Cornea
Department of Ophthalmology,
North Shore University Hospital,
Manhasset, New York

Glaucoma

Objective:
To determine the hemodynamic abnormalities that result in visual acuity loss because of retinal or choroidal dysfunction associated with arteriovenous shunts (avs) that involve the cavernous sinus.

Methods:
Retrospective study of the records of 250 patients with either a carotid cavernous fistula or dural arteriovenous malformation revealed a total of 10 patients with vision loss secondary to retinopathy (group I) or choroidal effusion (group ii). The cerebral angiograms of these 10 patients and 10 additional patients with visual dysfunction due to elevated intraocular pressure (group iii) were evaluated to determine whether the three groups could be distinguished by a specific vasculopathic pattern. Particular attention was given to the extent of thrombosis in the ophthalmic venous system and cavernous sinus.

Results:
There were angiographic signs of severe thrombosis in the ophthalmic vein in nine patients and in the cavernous sinus in seven patients ipsilateral to the retinal or choroidal lesion. In contrast, in group iii, severe thrombosis in the ipsilateral ophthalmic vein and in the cavernous sinus occurred in one and two patients, respectively. Closure of the avs improved the visual acuity in 1 of 4 patients in group I and in 4 of 5 patients in group ii, and normalized the intraocular pressure in all patients.

Conclusions:
Ophthalmic vein thrombosis, rather than arterialization of the venous system or an arterial ''steal,'' is the principal cause of retinal or choroidal dysfunction associated with avs to the cavernous sinus. Following avs closure, visual recovery is more frequent with choroidal effusion or detachment rather than with retinopathy.

Authors's abstract, JNO
New York, NY

Glaucoma

PURPOSE AND METHODS:

A commercially available tissue glue has been used to effect conjunctival wound closure after trabeculectomy. In four cases it was used in conjunction with sutures and in two cases alone to achieve watertight closure of the conjunctiva. A small transient leak was noted postoperatively in one case, and no case of flat anterior chamber occurred.

RESULTS AND CONCLUSION:
Intraocular pressure was controlled in all cases 3 months postoperatively. Tissue glue can be an effective method of achieving conjunctival wound closure in glaucoma surgery.

Authors' abstract, J Glauc
London, England

Glaucoma

PURPOSE:
To investigate practice patterns among glaucoma subspecialists in the American Glaucoma Society (AGS) and the Japanese Glaucoma Society (JGS), regarding use of antifibrosis agents and glaucoma drainage devices.

METHODS:
An anonymous survey incorporating 10 clinical situations was mailed to all AGS and JGS members in December 1995.

RESULTS:
Half of the AGS (105 of 210), and JGS (25 of 50) members returned surveys. Most respondents (51-87%) preferred trabeculectomy with adjunctive mitomycin for all 10 clinical situations. Mitomycin concentrations varied from 0.1 to 0.8 mg/ml (range of means for 10 situations 0.31-0.39 mg/ml) and intraoperative application times ranged from 5 s to 7 min (range of means for 10 situations 2.5-4.6 min). Preferences for either no antifibrosis agent (up to 39%) or 5-fluorouracil (up to 29%) were highest in primary trabeculectomy. Thirty-seven percent to 64% of AGS members used glaucoma drainage devices, especially after complicated postsurgical glaucomas (after penetrating keratoplasty, scleral buckling, or pars plana vitrectomy) and in neovascular glaucoma, but few JGS members used them. Large differences between university- and private practice-based AGS members were found only in mitomycin use for primary trabeculectomy (33% vs. 52%, respectively; p = 0.07) and for complicated postsurgical glaucomas (46% vs. 70%, respectively; p = 0.03).

CONCLUSIONS:
Trabeculectomy with mitomycin was the preferred surgical procedure among AGS and JGS members in the clinical situations surveyed. Mitomycin concentration and time of application varied widely. Many respondents used 5-fluorouracil or no antimetabolite in primary trabeculectomy. Glaucoma drainage devices were widely used for complicated glaucomas in the United States.

authors abstract, J Glauc
Miami, FL

Glaucoma

Purpose:
To determine whether microorganisms are able to survive in a solution of 50 mg/ml of 5-fluorouracil (5-FU) and, therefore, whether there is a risk of vial contamination with multiple use.

Methods:
Ten common nosocomial pathogens were tested. Minimal inhibitory concentrations (MICs) of 5-FU were determined for each organism. Organisms were then inoculated into 1 ml of 5-FU (50 mg/ml) and, after timed periods of exposure, were plated onto blood agar and incubated at 37 degrees C. Plates were checked daily for the presence or absence of growth.

Results:
The MICs of Klebsiella pneumoniae and Pseudomonas cepacia were within one log unit of the 10 mg/ml concentration of 5-FU used by some clinics. After incubation in 5-FU for 1 h, all species survived; after 24h of exposure, five of the 10 species-Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, K. pneumoniae, and Proteus mirabilis-were still viable.

Conclusion:
5-FU has limited bactericidal activity, and there is a risk of contamination if 5-FU vials are used in multiple dose fashion.

Authors' abstract, JGlauc
San Francisco, CA