Donald J. Cinotti

The Efficacy of Brimonidine in Decreasing Elevations in Intraocular Pressure after Laser Trabeculoplasty

PURPOSE The authors explored the empirical dosing requirement for administration of an alpha 2-adrenoceptor agonist, brimonidine, and determined its efficacy in decreasing elevations in intraocular pressure (IOP) after 360 degrees argon laser trabeculoplasty (ALT). METHODS This vehicle-controlled, double-masked, multicenter trial evaluated three dosing regimens of brimonidine. Two hundred thirty-two patients for whom 360 degrees ALT was indicated were randomized into one of four treatment groups: 0.5% brimonidine both before and after ALT; brimonidine before but vehicle after ALT; vehicle before but brimonidine after ALT; or vehicle at both times. RESULTS During the first 3 hours after 360 degrees ALT, the overall incidence of IOP elevations of 5 mmHg or greater was 38% (23 of 60 eyes) in the group receiving vehicle only, and it ranged from 3% to 9% (2 of 62 to 5 of 53 eyes) in the groups receiving any brimonidine treatment. There was little difference in efficacy between the three dosing regimens of brimonidine. Brimonidine was well tolerated by the patients. CONCLUSION Based on this large, controlled, multicenter study, 0.5% brimonidine was an effective agent for reducing elevations in IOP after 360 degrees ALT. Only one dose, administered either before or after 360 degrees ALT, was required.

Levobunolol vs timolol for open-angle glaucoma and ocular hypertension.

A group of 162 patients with chronic open-angle glaucoma or ocular hypertension were treated twice daily for up to 15 months with one of the following topical ophthalmic solutions: 0.5% levobunolol, 1% levobunolol, or 0.5% timolol. Overall mean reductions in intraocular pressure were 8 mm Hg for patients receiving 0.5% levobunolol or timolol and 8.2 mm Hg for patients receiving 1% levobunolol. There were no significant differences between levobunolol and timolol in mean reductions in intraocular pressure, percent of patients with adequately controlled intraocular pressure, or life-table estimates of the probability of successful treatment.

Control of intraocular pressure in glaucomatous eyes after extracapsular cataract extraction with intraocular lens implantation

ABSTRACT Two hundred sixty eyes of 195 patients having extracapsular cataract extraction (ECCE) with insertion of a posterior chamber intraocular lens were studied retrospectively. Of these cases, 160 eyes had preexisting glaucoma while 100 had no ocular pathology except for cataract. Intraocularpressure decreased significantly after ECCE in both groups and slowly returned to baseline within two years. The average postoperative visual acuity was better in the control group than in the glaucoma group. Patients with glaucoma were controlled with less medication after surgery. We believe that ECCE with insertion of a posterior chamber intraocular lens can be safely performed in glaucoma patients and has a beneficial effect on the control of glaucoma.

Use of Split-Thickness Dermal Graft in the Surgical Treatment of Corneal and Scleral Defects

We used split-thickness dermal grafts for the surgical treatment of corneal and scleral perforations in two patients and obtained excellent results. Patient 1 had severe lye burns and bilateral corneal perforations and Patient 2 had scleromalacia perforans. The dermal graft self-epithelializes and, thus, does not need to be covered by conjunctiva; is supple, without the bulkiness of other materials, particularly cartilage and periosteum; is hearty and flourishes on avascular surfaces such as cornea and sclera; has good tensile strength; and is autogenous.

Pseudotumor cerebri—A complication of tetracycline treatment of acne

A female adolescent on tetracycline therapy for a dermatologic condition developed pseudotumor cerebri resulting in impaired visual acuity and papilledema. The therapy of pseudotumor cerebri is discussed.

Neodymium:YAG laser therapy for pseudophakic pupillary block

ABSTRACT Pupillary block occurred in six patients with anterior chamber intraocular lens implants. After medical therapy failed, the Nd:YAG laser was used to break the hyaloid face in the pupillary and iridectomy apertures. Iridotomies were also produced at the sites of bulging iris. Following laser treatment the anterior chambers deepened and there were no further signs or symptoms of pupillary block. The Nd:YAG laser proved to be a useful treatment for pseudophakic pupillary block.

Combined intraocular lens and strabismus surgery.

ABSTRACT Ten cases of combined strabismus surgery and intraocular lens implantation were reviewed to determine if there were increased risks and complications. A review of these cases revealed the contrary was true; i.e., there were no complications arising from the combined surgery and there were benefits in the decreased hospitalization and operative time, less mental trauma, and improved muscle surgical outcome. From these results, we conclude that combined intraocular lens and strabismus surgery is efficacious and indicated in patients with strabismus and cataracts or aphakia.

Estimates of primary implant power using an intraocular lens table

ABSTRACT Intraocular lens (IOL) power data have been compiled in tabular format as a function of axial length measurements, corneal powers, and desired refractive errors. The table is presented to assist the clinician in performing IOL power estimates and as an independent source for checking preoperative IOL power calculations. Ophthalmologists who do not own a personal computer will find the lens power table a valuable adjunct to their present repertoire of analytical skills.

An intraocular lens power calculator for the IBM PC and PCjr computers using input variable selection

A BASIC program to calculate intraocular lens power and refractive errors using previously derived equations is presented. The program was written for the IBM PC and PCjr computers with an emphasis on clinical usefulness. Program features include a comparison of refractive and axial length predictions of secondary implant power and velocity compensation for axial length measurements made on aphakic patients. Equation specification by input variable selection and automatic averaging of keratometer readings make the program highly efficient.