John Hetherington

Adverse Effects Experienced by Patients Taking Timolol

Adverse effects involving one or more organ systems occurred in 38 of 165 patients with various types of glaucoma when timolol was added to their glaucoma therapy. It was necessary to discontinue timolol because of these side effects in 15 (9%) of the patients. Double-masked studies will be necessary to clarify the relationship of these adverse effects to the use of timolol.

Complications of laser trabeculoplasty.

Laser trabeculoplasty (LTP) is a relatively new procedure requiring evaluation for long-term effectiveness and associated complications. The authors review some 300 LTPs and identify complications. Among the most serious are transient or persistent rise in intraocular pressure, iritis, and progression of visual field loss. The authors recommend LTP as an alternative to glaucoma surgery in selected patients not controlled by medications.

Side effects of timolol

Timolol maleate, a nonselective beta blocker, has been associated with adverse reactions when administered topically or systemically. The current literature pertaining to timolol-related side effects and reports to the National Registry of Drug Induced Ocular Side Effects are reviewed. Knowing what side effects are associated with the systemic administration of timolol is helpful in predicting systemic side effects that may be encountered when timolol is administered topically.

Timolol and Pediatric Glaucomas

Thirty-eight eyes were treated by adding timolol to the medical regimen. After a suitable trial, attempts were made to reduce other glaucoma medications. Fifteen eyes with infantile glaucoma treated surgically at birth, experienced elevated intraocular pressure later in life. Another 15 eyes had glaucoma associated with congenital anomalies such as aniridia, Sturge-Weber syndrome, and mesodermal malformations. The group with infantile glaucoma demonstrated an average drop in pressure of 24% and 22% after one and three months, respectively. Six of the 15 eyes were controlled at 22 mm Hg or less. In the other group, intraocular pressure fell 30% after one month and 12% after three months. Five of the 15 eyes were controlled. Adverse effects occurred in five patients, timolol therapy was discontinued in two (7%). The IOP was not controlled in any of the eyes with timolol alone.

Laser Trabeculoplasty and the Glaucomas

A standard 100-spot laser trabeculoplasty was applied to 137 eyes of 109 presurgical patients with a variety of primary, secondary, and postsurgical glaucomas. Average follow-up was 15.3 months. Laser therapy was most successful in eyes without prior surgery (chronic open-angle glaucoma (COAG), pseudoexfoliation, pigmentary dispersion) or with only one prior operation (iridectomy, trabeculectomy, or intracapsular cataract extraction). The mean range for pressure reduction was 6 to 12 mmHg. Failures were frequently seen in eyes with angle recession, uveitis, or more than one operation. Visual field deterioration was seen in 11% of successful COAG eyes. Asymmetric responses in bilaterally treated COAG patients were seen half the time. A drift downward of 5 mmHg or more at six months after laser reversed itself by 12 months in approximately one out of eight eyes from various categories.

Congenital ectropion uveae with glaucoma.

Congenital ectropion uveae (CEU) is a rare, nonprogressive anomaly characterized by the presence of iris pigment epithelium on the anterior surface of the iris stroma, often associated with neurofibromatosis and occasionally with other ocular anomalies. We present eight patients with unilateral CEU. Seven patients had glaucoma in the involved eye, while the eighth was a 10-week-old infant. In the two patients with bilateral glaucoma, the second eye was similar to the first, but without CEU. Three patients had neurofibromatosis, two had facial hemihypertrophy, one had Riegers anomaly, one had Prader-Willi syndrome, and one had no systemic anomalies. Two had initially been misdiagnosed as having a large pupil in the involved eye and one as having a Horners syndrome in the uninvolved eye. The finding of CEU in an infant warrants continued observation for the development of glaucoma and disorders of neural crest origin.

Long-term follow-up of initially successful trabeculectomy with 5-fluorouracil injections

PURPOSEnTo study the long-term results (1-14 years) of trabeculectomies with 5-fluorouracil injections that were successful at 1 year.nnnDESIGNnA retrospective noncomparative case series. INTERVENTION/PARTICIPANTS: We identified 87 patients (87 eyes) who had trabeculectomies with 5-fluorouracil injections from 1984 to 1989 that were successful at 1 year and had a follow-up range of 1.0 to 14.7 years (mean, 8.1, standard deviation of 4.4 years). All patients had previously failed glaucoma surgery (66.7%), cataract surgery (47.1%), or other diagnoses making them at high risk for failure.nnnMAIN OUTCOME MEASURESnSuccessful control of intraocular pressure (IOP) was defined as IOP less than 21 mmHg or a reduction of 33% if preoperative pressure was less than 21 mmHg. Statistical analysis was performed using Kaplan-Meier life table analysis.nnnRESULTSnIf an eye is considered successful by IOP at 1 year, the probability of successful control is 61% at 5 years, 44% at 10 years, and 41% at 14 years.nnnCONCLUSIONSnDespite successful IOP control at 1 year, trabeculectomies with 5-fluorouracil injections show a continual loss of IOP control over time.

The Spectrum of Chandler's Syndrome

Summary This presentation supports many of the findings described by Dr Chandler. Pathologic findings with light microscopy have led us toward some understanding of the damage produced by proliferating tissues. Transmission and scanning electron microscopy may help us to further understand the pathogenesis. At this stage, we believe the specular microscope may be useful in cases of unexplained unilateral glaucoma with subtle endothelial abnormalities undetected by slitlamp examination. It may, in the future, facilitate the differentiation of these interesting endothelial dystrophies with their accompanying glaucomas.

Glaucomatous Cupping of the Optic Disk by Ultrasonography

B-scan ultrasonography was used to evaluate advance glaucomatous cupping of the optic disk (0.7 cup/disk ratio or greater) in one normal subject and six patients with glaucoma. The normal eye emitted a continuous echo from the posterior pole, which conformed to its mild degree of concavity. The glaucomatous eyes emitted echos from the posterior pole, demonstrating the more extreme concavity of the optic cup. Ultrasonographic evaluation of an acrylic plate containing holes of known diameter demonstrated the limits of resolution and artifacts that resulted from this examination.

Becker-Shafferʼs Diagnosis and Therapy of the Glaucomas, Third Edition

contents n1. Introduction, n2. aqueous humor dynamics, n3. clinical examination of the eye, n4. clinical entities, n5. management, n6. medical treatment, n7. laser therapy, n8. surgical principles and procedures, n9. conclusion.