Hugh L. Hennis

Semiconductor diode laser transscleral cyclophotocoagulation in patients with glaucoma.

We used the semiconductor diode laser to perform transscleral cyclophotocoagulation in 14 patients with glaucoma. Laser settings used for this procedure were 990 milliseconds, 100-microns spot size, and 1,200 mW of power. Applications were placed 1 mm posterior to the surgical corneoscleral limbus and 1 mm defocused toward the ciliary body. The mean preoperative intraocular pressure was 34.8 +/- 13 mm Hg, and the mean intraocular pressure six months after a single treatment session was 24.3 +/- 18 mm Hg (P greater than .001, paired t-test). The mean number of glaucoma medications decreased from 2.2 preoperatively to 1.4 postoperatively. Complications included conjunctival burns and uveitis in 14 patients, and pain in one patient. These results suggested that semiconductor diode transscleral cyclophotocoagulation may be useful as a treatment to reduce the intraocular pressure in patients with glaucoma.

The Use of 5-Fluorouracil in Patients Following Combined Trabeculectomy and Cataract Extraction

We studied the effect of postoperative administration of subconjunctival 5-fluorouracil in maintaining postoperative filtration following combined trabeculectomy and extracapsular cataract extraction with posterior chamber lens implantation. Three months postoperatively, the mean intraocular pressure in 15 patients who had received 5-fluorouracil was 13.1 +/- 3.2 mm Hg; in 17 control patients, it was 13.0 +/- 3.0 mm Hg (P greater than .05). The mean number of postoperative medicines in the study patients was 0.7; in the control patients, 0.8 (P greater than .05). Bleb appearance and improvement in visual acuity were similar in the two groups. This study does not support the routine use of 5-fluorouracil in patients who have undergone combined trabeculectomy and extracapsular cataract extraction.

Use of the argon laser to close filtering bleb leaks

We attempted to seal 15 consecutive filtering bleb leaks in 11 patients using argon laser energy. Eight leaks were at the conjunctival-corneal interface associated with a fornix-based flap, 4 leaks resulted from suture scissoring of the conjunctiva, and 3 leaks were button-holes in the conjunctiva. Thirteen leaks occurred within 2 weeks after filtering surgery, while 2 were of late onset. Argon laser parameters used were a 500-μm spot size, 0.1-s time interval, and between 500 and 1800 mW of power. Thirteen leaks were sealed after one or two laser sessions, while 2 leaks required other treatment modalities. Complications included conjunctival fenestration and transient corneal stromal opacities. This study suggests that the argon laser can be used to seal filtering bleb leaks in many patients following filtering surgery.

Transscleral cyclophotocoagulation using a semiconductor diode laser in cadaver eyes.

We studied the effectiveness of semiconductor diode laser transscleral cyclophotocoagulation in cadaver eyes using the Miyake technique and light microscopy. Thermal lesions in the ciliary processes were induced with 0.7-second, 1200-mW, and 100- to 500-microns applications, 0.5 mm from the surgical limbus and defocused 1 mm posteriorly. An effective ciliary body reaction was observed grossly as tissue blanching, shrinkage, and pigment dispersion; and histologically, as coagulation necrosis and epithelial cell disruption. No damage to crystalline or intraocular lenses was evident. This successful application of diode laser transscleral cyclophotocoagulation in cadaver eyes suggests that it may prove useful in treating patients with glaucoma.

Unscheduled DNA synthesis in cells of different shape in fibroblast cultures from donors of various ages

Human fibroblast cultures derived from normal donors of different ages were examined for the proportion of spindle-shaped, sail-shaped, and large pleomorphic cells which constitute the cultures, and the capacities of these cells for unscheduled DNA synthesis (UDS). The large pleomorphic cells were most abundant in all cultures, followed in abundance by the sail-shaped and spindle-shaped cells. Major changes in the occurrence of the cells of different shape with increased donor age were not apparent, although the abundance of spindle-shaped cells decreased slightly with donor age. The large pleomorphic and sail-shaped cells exhibited similar UDS which was consistently greater than that of the spindle-shaped cells. No major changes in UDS were observed for either type of cell with increased donor age.

Conjunctival Structure and Cell Counts and the Results of Filtering Surgery

We evaluated perioperative conjunctival biopsy specimens in 28 consecutive patients with primary open-angle glaucoma undergoing trabeculectomy who had not undergone previous intraocular surgery. We found six months postoperatively that the number of goblet cells was significantly greater (6.40 +/- 5.40 vs 1.68 +/- 1.60 per field of view; P = .004, Students t-test) in patients with easier postoperative intraocular pressure control (intraocular pressure < or = 15 mm Hg with zero to two glaucoma medications) than in patients with more difficult intraocular pressure control (> 15 mm Hg with three or more glaucoma medications). No statistical differences between groups were observed in mast cells, neutrophils, eosinophils, macrophages, plasma cells, lymphocytes, or fibroblasts (P > .05). Also, no statistical difference between groups existed in conjunctival structure, including mucopolysaccharide and collagen composition, vascular density, or epithelial thickness (P > .05). This study suggests that the number of conjunctival goblet cells may be related to intraocular pressure control after trabeculectomy.

Carcinoma arising in an odontogenic keratocyst with orbital invasion

A 54-year-old black female presented with proptosis and reduced visual acuity of the left eye. Computerized tomography (CT) revealed tumor involvement of the left cavernous sinus and posterior orbit. The patient had a nineteen year history of a left-sided jaw tumor which recurred despite surgical and radiation therapy. Biopsy demonstrated a parakeratinized odontogenic keratocyst with areas of transformation into an invasive squamous cell carcinoma. Although a parakeratinized odontogenic keratocyst may be locally invasive, to our knowledge, no case of a parakeratinized odontogenic keratocyst involving the orbit or cavernous sinus previously has been reported.

THE INFLUENCE OF AGE UPON INFLAMMATORY CELL COUNTS AND STRUCTURE OF CONJUNCTIVA IN CHRONIC OPEN-ANGLE GLAUCOMA

Abstract. We evaluated the influence of age upon conjunctival structure and number of inflammatory cells by studying perioperative conjunctival biopsies from 54 consecutive primary open‐angle glaucoma patients undergoing initial filtering surgery (trabeculectomy alone or combined cataract extraction and trabeculectomy). All patients had received chronic topical glaucoma therapy for >1 year. We divided the patients into three age groups for analysis: 40–60 (n = 10), 61–74 (n = 28), and > 75 (n = 16) years. We found no statistical difference (p > 0.05, chi‐square) in cell counts of neutrophils, eosinophils, mast cells, macrophages, fibroblasts, lymphocytes, plasma cells and goblet cells across the three age groups. In addition, no statistical differences were observed between age groups in vascular density, epithelial thickness as well as mucopolysaccharide and collagen composition (p > 0.05, chi square). This study suggests that conjunctival structure and inflammatory cell counts change little with advancing age in primary open‐angle glaucoma patients.

Histologic differences in the conjunctiva of black and white glaucoma patients.

We compared perioperative conjunctival biopsy specimens from 31 consecutive trabeculectomy patients to determine if there were any histologic differences between black and white glaucoma patients. We found a statistically significantly greater mean and distribution of mast cells and neutrophils in the white patients. No significant difference was found in the mean number of goblet cells, eosinophiles, macrophages, fibroblasts, plasma cells, or lymphocytes; or in thickness of the epithelium, vascular density, or collagen or mucopolysaccharide staining. We conclude that histological conjunctival factors that could be evaluated preoperatively probably are not related to the poor results in black patients of filtration surgery noted by some investigators.

The association of conjunctival inflammatory cells with the results of combined cataract extraction and filtration surgery.

We studied conjunctival biopsy specimens from 30 consecutive patients undergoing combined cataract extraction with posterior chamber lens implantation and trabeculectomy to determine if inflammatory cell counts and tissue structure are predictive for postoperative intraocular pressure control. We classified intraocular pressure control postoperatively by grouping patients in three ways: first, by ease of intraocular pressure control (patients with < 16 mm Hg receiving from no medicine to two glaucoma medicines vs. those with ≥ 16 mm Hg or receiving three glaucoma medicines); second, by those who had improved versus worsened intraocular pressure control postoperatively compared to before surgery; and third, by those who had bleb elevation versus no bleb formation. With all three classifications no statistical difference existed between groups of patients in the number of goblet cells, mast cells, neutrophils, eosinophils, macrophages, plasma cells, lymphocytes, or fibroblasts, as well as in epithelium thickness or vascular density (p > 0.05, Students t test). Also, no statistical difference existed in mucopolysaccharide or collagen staining between groups of patients (p > 0.05, Mann-Whitney U test). This study suggests that conjunctival inflammatory cell counts or tissue structure, which can be evaluated histologically, are not associated with postoperative intraocular pressure control following combined cataract extraction and trabeculectomy.