Japanese Journal of Ophthalmology

To study the mode of intraocular pressure (IOP) reduction based on correlation with the preoperative IOP after filtering and nonfiltering surgeries. Pre- and postsurgical IOPs at 6 months were compared in one eye of each of 789 subjects with primary open-angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension who underwent trabeculectomy with adjunctive mitomycin C alone (Lectomy-MMC) (n = 145), phaco-viscocanalostomy (Phaco-VCS) (n = 320), phaco-trabeculotomy ab externo (Phaco-lotomy) (n = 116), or phacoemulsification aspiration and intraocular lens implantation alone (PEA+IOL) (n = 208). The correlation between the preoperative and 6-month postoperative IOP was not significant in eyes that underwent Lectomy MMC (r = −0.026, P = 0.7552, IOP reduction 51.9%), but was significant in eyes treated by Phaco-VCS (r = 0.409; IOP reduction, 24.8%) or PEA+IOL alone (r = 0.294; IOP reduction, 9.9%), and was marginal in eyes treated by Phaco-lotomy (P = 0.062; r = 0.174; IOP reduction, 24.1%). Among the four cohorts studied, the variation in the 6-month postoperative IOP was the largest after Lectomy-MMC. After glaucoma surgery, there are two modes of IOP reduction. The postoperative IOP after Lectomy MMC did not correlate with the preoperative IOP, whereas the postoperative IOP levels after Phaco-VCS, Phaco-Lotomy, and PEA+IOL correlated with preoperative IOP levels. We may be able to predict postsurgical IOP after nonfiltering surgery.

Although useful for reducing intraocular pressure (IOP), bimatoprost (BIM) can cause deepening of the upper eyelid sulcus (DUES), one of the symptoms of prostaglandin-associated periorbitopathy (PAP). We investigated recovery from BIM-induced DUES after switching treatment to latanoprost (LAT). Prospective, observer-masked, open-label study. Twenty-five Japanese patients suffering from primary open-angle glaucoma treated with LAT in both eyes for longer than 6 months and requiring further IOP reduction were prospectively enrolled in the study. During the first 6 months after the switch to BIM, 15 of the 25 patients (60 %) developed DUES. Among these patients, 13 were switched back to LAT and re-examined for DUES at 2-month intervals for an additional 6 months. Two months after the switch back to LAT, for 11 of the 13 patients (85 %) the DUES symptoms had either decreased or disappeared, and this was maintained for at least 6 months. During this time, 6 of 8 patients (75 %) subjectively positive for DUES self-reported a decrease in DUES. Although DUES is a frequent side effect of treatment with BIM, switching to LAT may reverse the condition for most patients.

Purpose: To shorten the duration of prone positioning after macular hole surgery from 1 week to 1 day, and to evaluate preoperative factors and the initial hole closure rate. Methods: The subjects were 33 patients (34 eyes) who underwent macular hole surgery between April 1998 and August 1999, and maintained the prone position for 1 week (1-week group) and 21 patients (21 eyes) who underwent this operation between September 1999 and March 2000, and maintained the prone position for only 1 day (1-day group). The criteria for macular hole surgery were no more than 6 months since symptom development and no flattening of the fluid cuff. Eyes treated by removal of the retinal pigment epithelium (RPE) or internal limiting membrane (ILM) were excluded. In all phakic eyes, cataract surgery was combined with macular hole surgery. In the 1-day group, the patients maintained the prone position for 1 day and were instructed to avoid only the supine position for the subsequent 1 week. Results: Preoperative factors possibly affecting the hole closure rate did not differ significantly between the two groups. Initial hole closure rates were similar in the 1-week (91.2%) and 1-day (90.5%) groups. Conclusion: In eyes without symptoms of long duration, the duration of prone positioning after macular hole surgery may be shortened to 1 day even without using special techniques, such as removal of the RPE or ILM, in combination with macular hole surgery.

To evaluate functional progression in preperimetric glaucoma (PPG) with disc hemorrhage (DH) and to determine the time interval between the first-detected DH and development of glaucomatous visual field (VF) defect. A total of 87 patients who had been first diagnosed with PPG were enrolled. The medical records of PPG patients without DH (Group 1) and with DH (Group 2) were reviewed. When glaucomatous VF defect appeared, the time interval from the diagnosis of PPG to the development of VF defect was calculated and compared between the two groups. In group 2, the time intervals from the first-detected DH to VF defect of the single- and recurrent-DH were compared. Of the enrolled patients, 45 had DH in the preperimetric stage. The median time interval from the diagnosis of PPG to the development of VF defect was 73.3 months in Group 1, versus 45.4 months in Group 2 (P = 0.042). The cumulative probability of development of VF defect after diagnosis of PPG was significantly greater in Group 2 than in Group 1. The median time interval from first-detected DH to the development of VF defect was 37.8 months. The median time interval from DH to VF defect and cumulative probability of VF defect after DH did not show a statistical difference between single and recurrent-DH patients. The median time interval between the diagnosis of PPG and the development of VF defect was significantly shorter in PPG with DH. The VF defect appeared 37.8 months after the first-detected DH in PPG.

The correct fi gure is shown on the right.