Robert N. Shaffer

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.

Ciliary block (malignant) glaucoma.

A review of the history, recognition, mechanisms, and therapy of ciliary block glaucoma has been given. Cycloplegic therapy is stressed in the susceptible eye.

Long-term Analysis of Pigmentary Dispersion Syndrome and Piegmentary Glaucoma

Abstract A retrospective, longitudinal study of 129 eyes in 65 patients with pigmentary dispersion syndrome and either ocular hypertension or glaucoma was undertaken. The mean follow-up period was 17 years (range, 5-35 years). Visual acuity, intraocular pressure (IOP), visual field loss, pigment grade, Krukenberg spindle, iris transillumination, medications, and surgeries were analyzed for each patient at 5-year intervals from 1960 through 1983. Disc and field changes developed in 35% of patients with pigment dispersion syndrome and ocular hypertension during the study period. The long-term prognosis of the medical and surgical management of pigmentary glaucoma is discussed.

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.

ANALYSIS OF SURGICAL AND MEDICAL MANAGEMENT OF GLAUCOMA IN STURGE-WEBER SYNDROME

Management of glaucoma associated with Sturge-Weber syndrome (SWS) is difficult. The authors reviewed 36 eyes of 30 SWS patients with either early or late-onset glaucoma with a mean follow-up of 122 months (range, 24-253 months). Intervals between required surgical or medical interventions were analyzed. Intervention was attributed to elevated intraocular pressure (IOP) in 55% of cases and disc change in 45%. Median stable postoperative interval with goniotomy was 12 months; with trabeculotomy, 21 months; with trabeculectomy, 34 months; with argon laser trabeculoplasty, 25 months; and with medications, 57 months. Survival analysis shows statistically significant differences between goniotomy and medications. Intraoperative choroidal expansions developed in 24% of cases receiving a trabeculectomy, and none developed with either goniotomy or trabeculotomy.

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.

Discussion of Presentation by Dr Helen Mintz Hittner, Et Al

THE diseases discussed in the papers by Dr Hittner et al and by Dr Luntz have infancy as a common denominator, but the causes of their glaucoma are poles apart. The authors experience with retrolental fibroplasia patients has largely been limited to cases with grade 4 or 5 retinopathy and angle-closure glaucoma. Therapy has been limited to lens extraction to deepen the shallow anterior chambers and to avoid the necessity of enucleation in end-stage glaucoma. The present paper stresses that the retinopathy of prematurity is accompanied by similar vascular and cicatricial changes in the anterior segment and that the less severely damaged eyes can retain useful vision.