David W. Richards

Clinical Experience with the Baerveldt Glaucoma Drainage Implant

PURPOSE To assess clinical outcomes in patients who were treated with the Baerveldt glaucoma drainage implant. METHODS The authors performed a retrospective multicenter study of 100 patients (103 eyes) with medically uncontrollable glaucomas who underwent a one-stage implantation with either the 200-, 250-, 350-, or 500-mm2 Baerveldt implant. The authors defined surgical success as 5 mmHg less than intraocular pressure less than 22 mmHg without additional glaucoma surgery and without loss of light perception. RESULTS With a mean follow-up of 13.6 +/- 0.9 months (range, 4-37 months), 74 eyes (71.8%) had successful outcomes. Cumulative life-table success rates were 90.3% at 3 months (n = 103), 72.6% at 6 months (n = 84), and 60.3% at 24 months (n = 34). Intraocular pressure (IOP) was reduced from a mean of 38.5 +/- 1.4 mmHg with 2.2 +/- 0.1 antiglaucoma medications to 15.1 +/- 0.8 mmHg (P < 0.0005) with 0.5 +/- 0.1 antiglaucoma medications (P < 0.0005). Visual acuity was improved or remained within one line of the preoperative visual acuity in 90 eyes (87.4%). Complications occurred in 74 eyes (71.8%). A significant portion of these complications (45%) was transient, resolving without any intervention. Only 8% were serious sight-threatening complications. The most common complications included shallow anterior chamber or hypotony (32%), choroidal effusion or hemorrhage (20.4%), corneal decompensation or edema (17.5%), hyphema (14.1%), and tube obstruction (12.6%). CONCLUSION The Baerveldt implant is effective in lowering the IOP in patients with intractable glaucomas. Hypotony and other complications are common, which also have been reported in other nonvalved glaucoma drainage implants. However, the majority of these complications did not affect surgical outcome.

Cystoid macular edema associated with latanoprost in aphakic and pseudophakic eyes

PURPOSE To describe four patients who developed cystoid macular edema shortly after onset of treatment with latanoprost. METHOD Retrospective review of medical records of patients with open-angle glaucoma who developed cystoid macular edema shortly after starting latanoprost. RESULTS The use of topical latanoprost was temporally related to the development of cystoid macular edema in four patients (six eyes; two aphakic eyes and four pseudophakic eyes). Cystoid macular edema resolved in all patients after latanoprost was discontinued. CONCLUSIONS Cystoid macular edema is a potential complication of latanoprost therapy. Further observations are needed to determine if the risk of cystoid macular edema is limited to or greatest in patients who are pseudophakic or aphakic.

Detection of intraocular pressure change in the eye using sonoelastic Doppler ultrasound

We report the first use of sonoelastic Doppler ultrasound for in vivo and in vitro clinical studies of intraocular pressure (IOP). The method involves low-amplitude and low-frequency sonic excitation of the eye, and detection of the resulting vibration using Doppler ultrasound. A dependence of the frequency of resonance of the eye on the IOP has been observed in both in vitro and in vivo experiments. Preliminary in vitro experiments have been performed using eviscerated and enucleated human and pig eyes. As little as 4 mm Hg change in IOP has been found detectable in these experiments. Preliminary in vivo experiments also showed promising results in this regard. We present a simple model for the resonances of the eye, a method to detect the amplitude of vibration using Doppler ultrasound and results from the in vitro and in vivo experiments.

Detection of intraocular pressure change in a human eye model using sonoelastic Doppler ultrasound

Sonoelasticity is proposed for clinical measurement of intraocular pressure (IOP). It is postulated that the change of fluid pressure in a fluid-filled elastic shell, such as the eye, would change the apparent elasticity of the shell, which in turn would change its frequency of resonance. If a standardized normal range of resonance for the human eye can be found, any abnormality in the resonance can then be used to detect abnormalities in the IOP. Preliminary experiments are performed using eviscerated and enucleated human and pig eyes. IOP is varied by insertion of a saline fluid filled catheter with a hydrostatic pressure. Doppler ultrasound is used to find the amplitude of vibration of the sclera. As little as 4 mm Hg change in IOP is detected.<<ETX>>

Enhanced detection of normal retinal nerve-fiber striations using a charge-coupled device and digital filtering

We used a 1024 × 1024 pixel, 15-μm, 16-bitencoding, multi-pin-phase charge-coupled device (CCD) to obtain images of the normal human retinal nerve fiber layer. This device, which operates at room temperature, offers significantly better signal-to-noise ratio, linearity, and dynamic range than do photographic film, video imaging techniques, or commercially available CCDs. We demonstrate the use of a nonlinear digital filter, together with filter windows, that enhances fine detail of NFL striations, while suppressing noise, in limited areas of the CCD images. High-sensitivity imaging of this type, together with appropriate digital processing, may prove useful in diagnosing and following nerve-fiber-layer damage due to glaucoma.

In vitro imaging of ophthalmic tissue by digital interference holography

We used digital interference holography (DIH) for in vitro imaging of human optic nerve head and retina. Samples of peripheral retina, macula, and optic nerve head from two formaldehyde-preserved human eyes were dissected and mounted onto slides. Holograms were captured by a monochrome CCD camera (Sony XC-ST50, with 780 × 640 pixels and pixel size of ∼9 µm). Light source was a solid-state pumped dye laser with tunable wavelength range of 560–605 nm. Using about 50 wavelengths in this band, holograms were obtained and numerically reconstructed using custom software based on NI LabView. Tomographic images were produced by superposition of holograms. Holograms of all tissue samples were obtained with a signal-to-noise ratio of approximately 50 dB. Optic nerve head characteristics (shape, diameter, cup depth, and cup width) were quantified with a few micron resolution (4.06–4.8 µm). Multiple layers were distinguishable in cross-sectional images of the macula. To our knowledge, this is the first report of DIH use to image human macular and optic nerve tissue. DIH has the potential to become a useful tool for researchers and clinicians in the diagnosis and treatment of many ocular diseases, including glaucoma and a variety of macular diseases.