Gesa A. Stroman

Clinical Presentation and Initial Treatment Patterns in Patients With Exfoliation Glaucoma Versus Primary Open-Angle Glaucoma

BACKGROUND AND OBJECTIVE The presentation and initial response to treatment of consecutive patients with exfoliation glaucoma (PXE) and primary open-angle glaucoma (POAG) were evaluated prospectively. PATIENTS AND METHODS Forty-six consecutive newly diagnosed patients with POAG and PXE were included in a prospective study that evaluated the initial clinical course and treatment results. The two groups were age- and race-matched. RESULTS This study found no difference in optic disc parameters at presentation between patients with POAG (n = 22) and those with PXE (n = 24) (P > .05). However, the presenting mean defect was significantly worse in patients with PXE versus those with POAG (P = .0038), although the loss variance was similar (P > .90). The mean presenting intraocular pressure (IOP) for patients with PXE (32.0 +/- 5.2 mm Hg) was greater than that for patients with POAG (27.1 +/- 4.4 mm Hg) (P= .0025). Additionally, patients with PXE required more treatment steps to control IOP (P = .005). Thirteen of 24 patients with PXE versus 3 of 22 patients with POAG (P = .016) required either laser or conventional surgical techniques to reduce IOP. CONCLUSION This study shows that patients with PXE have greater visual field loss and have more difficulty gaining control of IOP on presentation than patients with POAG.

Magnetic resonance imaging in patients with unexplained optic neuropathy.

PURPOSE To investigate the anatomic relation between the optic nerve and the adjacent intracranial internal carotid artery (ICA) in patients with unexplained optic neuropathy. METHODS Coronal magnetic resonance images (MRIs) of 20 patients with unexplained optic neuropathy and 20 age-matched controls were evaluated with digitizing software. RESULTS The distance between the optic nerve and ICA was significantly less on the side ipsilateral to the atrophic optic nerve than either the study groups contralateral optic nerve-ICA distance (P<0.001) or the control groups optic nerve-ICA distance (P<0.001). The diameter of the atrophic optic nerves was significantly less than either the diameter of the study groups contralateral normal nerves (P=0.008) or the control groups nerves (P<0.001). There was no significant difference between the diameters of the ICA flow voids adjacent to the atrophic optic nerves versus either the study groups contralateral ICA flow voids (P=0.91) or the control groups ICA flow voids (P=0.74). CONCLUSIONS The authors speculate that the intimate relation between the optic nerve and adjacent ICA may be important in the development of unexplained optic neuropathy. The ICA need not appear abnormal in MRIs.

Ultrastructural Features of Filtration Blebs With Different Clinical Appearances

The authors studied two functioning filtration blebs to evaluate a possible transconjunctival route of aqueous humor flow and describe potential differences between thin cystic and thick opaque functioning filtration blebs. The specimens were prepared for light and electron microscopy immediately after surgical excision because of filtration bleb discomfort. Both blebs had normal collagen in the substantia propria. The collagen, however, was widely spaced and subepithelial connective tissue loosely arranged. Clear spaces were seen in the superficial substantia propria. Epithelial cells were focally acantholytic, separated by clear spaces. Consequently, clinically distinct blebs demonstrated similar histologic and ultrastructural features. The epithelial intercellular spaces observed in this study provide anatomic evidence that aqueous could move transconjunctivally as a mechanism for filtration bleb function.

Contact Versus Noncontact Diode Laser Transscleral Cyclophotocoagulation in Cadaver Eyes

BACKGROUND AND OBJECTIVE The optimal placement and laser energy levels of a new contact probe with a variable focus used for transscleral diode cyclophotocoagulation were compared with the diode laser noncontact technique. MATERIALS AND METHODS Fresh cadaver eyes were evaluated by a modified posterior Miyake view using videotape, light microscopy, and scanning electron microscopy. RESULTS The noncontact diode technique at maximum energy (1.2 J) and contact diode applications at similar energy levels failed to produce obvious gross tissue ciliary body change and mild alterations by histology. Consistent gross, histologic, and scanning electron microscopic damage was noted at 3.0 J or more with the contact probe placed at the surgical limbus and defocused 0.5 to 1.5 mm posteriorly. CONCLUSIONS This study indicates that the Multilase contact diode laser causes transscleral ciliary body destruction in a cadaver eye model and may have potential clinical usefulness.