- Email: [email protected]
Earlier trabeculectomy
CURRENT
3xs
OPHTHALMOLOGY
Topographical Analysis of the Cornea: Ten Caveats in Keratorefractive Surgery, byJ .J . Rowsc~),. Inl O~h~hnlmol Clinic 2(l): 1-32, 1983 The, alrtllor pwsrnts 111~ fitllowing 10 observations ahout kcratorcfractivc surg:rr!-: ( 1 ) tlw normal c‘r~Ixf3 flattens O\YI‘ all); incision: (2) radial incisions flatten the ad,jaccnt cornea and the cornea W a\vay: (:<) the corncal fbttetiing eflicct increases as incisions approach the ;%xtal asis: (1-l the cornea tlattvti dirc~c~tl~ o\‘cr an\ sutured incision: (5) the liml~l cornea flattens adjacent to loose sutures, flattens 180” awn!~ and stwfwns 9C? away: (6) the cornea stccf~etis adjacent to tight sutures, steefwns 180” away, and fl;rttt~ns IW awil\‘: i 7) the corned flattms over any \vcd,qe resection or cortical tuck; (8) th(* cortit’a stcrpetis anterior to \\-cylgt* rcscclion or corncal tucks; (9) tissue rcmo\~al, whether traumatic or surgicall\~ ittducvd, produws corncal flattcnin~ over the site ol‘tissuc‘ removal: and ( 10) full thickness corncal tissue addition products cc~rncal stcqwnitl~ o\.cxr thts site 01‘ tht. tissue addition and flattens the adjacent cornea.
Comment The dcwlopmrnt of r&-active cornea1 surgical procedures. including radial keratotomy , has slimulatcd renewed interest in understanding the topography of the cornea. In his article, Dr. Kous~~~ provides IIS with a superb o\m\riew of the current techniques used to assess corncal ccJIitOUr. hsd on his lahorator)~ a~td c,linical investigations, \vc are then provided with ten “caveats” \vhich arc designed to help us understand how thtx cot-ma reacts to various incisions, sutures and wound healing. Dr. Ro\L.sc). supports his tunclusic~ns 1,) anal~ sis of cyc bank q’cs and clinical cases. primarily using the corncascopc. which mwsurcs Ci.5(0 IL?‘%, of the cnrncal SUI hw. ‘The caveats qualitati\.clJ. provide thr changes Lvhich occur in 111~c-rntral and pcriphcral cornea. ()nct understood. thcsc principles can he applied in the everyday practicr of cataract sttryr!‘. ‘IItc I~JIII. cx\cIts relating to wcdgc rcswtions or rclasing krratotomics are usc+uI onl) 10 those sttr~cotis pcdimniilg cx)rne;tl tr;~nsplatit;ttioti. IIt-. ROM.SC~sho~.s quantitative mwsurrmcnts in sonic‘ of his clinical photo,qraphs. hut thils to mc.ntion the potential itia&~racies of‘ measurcmcnt using the prcsctitl~ a\2ilahle tcctttiiqucs ti,r anal) zing corticascolx photcqraphs. .Mthough he dots pro\?de us \vith a fjirly good rcvi~w ol‘tltr history ofcornc~al topograph). Itt f‘ailcd to cite (tits tiurncrous rcfb-cnccs relating to astigmatism fi~lfowitig cataract suryr! whiclt h;tvc sttl,stantiat4 manv ofhis caveats. In spitr ofthesc shorrcomings. this is an c~cc’llrnt rcvitv artirlc ii)r an\ one intcwstcd in uncicrstattdingthe topography of the normal and alJnorma1 cornea. .;\s WC twonlc more scq~lt’istic~rrcd in our ahilit!, to ntcasurc the cffi~ts ofwhat WCdo on the cornea, WC w,ill no doubt hc al~lr ((1 fjrovidc ntort~ f~txdictahlc rcsults tiJllowitig all t!‘pt5 ofcortieal surgety. including kcratot.c’lr;t~.(i\.c. sutyqcr\.. Dr. Ro\~w~~‘~ c~sc~~ll~~~~l rc,\,icw articlt, will certainly hc one of thaw cited in littuw discussion 01‘ wrnwl cofxqraf)lt! Pl.liI<\- s. BI\I,I:lr I,\,JOI.I.\.
(1 \1.1101<~1
\
Earlier Trabeculectomy, by J.L. Jay. T rms Ophthalmol Sot I:k’ 10.7:35-38, 1983 In tllc fxrst drcadc thctx- l1a1.c hccn considcral~lc ad\wlcc\ in 111~‘ sut@cal and mctlical trcatmcnts a\Glahlt rcclucc the intraocular prcssurc in eves with primary opctl-angle ,qlaucoma. Tli(~ ititroduclion aid asscsstiiuir ol‘nv~v dry+ has ahsorlml so much of the research intcrrst that there has twcti littfc vlli)r1 to rlIakc direct ~~omparisons 01‘ the fxriiJrtnancc 01‘ medical versus surgical (rcatmcnt. and the rc(xw1 intio\~arioti of‘ lawtt.~t~~c~c.t~lo~,l~~st). ma)’ fitrthcr divert intcrcst fi-om this inlp(Jt?:ttlt and fundamental thcralwutic. c1toic.c. This is a prcliminar). report of‘ a collahora~i\~e, prospecti\xs, randomized trial 01‘ tliallagcmrnt 01‘ I)rimar) usin g medical therapy f0llobw~ 1)~ tr~tt~c~crtlct~tot~~~. 0Iwti angle ,glaucoma wticrc conventional management only in unaucctxful casts ~vas compared with trat~eculcctoni~~ as lhc primary fijrm oftrc~ttmcnt j sitpplcmcatitcd \vhcrca nwcssarv t,!. mcadical thcrapv). Usin
384
Srlrv Ophthahnol
29(5) hlarch-April
1985
CURRENT
OPHTHALMOLOGY
first year, and two of the 18 eyes in the group receiving surgery primarily required supplementary medical therapy in the same period. The author concludes that traheculectomy was more efFective in lowering intraocular pressure than medical treatment. ,L\lthough no statistically significant diffrcnces in \,isual fi~nction or disc appearance is yet dctectahle, there is a trend in ljvor of traheculrctomy as the primary procedure of choice in the management of‘ these patients.
Comment The author has reported on early results with relatitrely shortterm fhllow-up of a small group of’paticnts, showing that the patients subject to early traheculcctomy fared better than a comparable group treated with medications. He further stresses the rclatii-e saf‘cty of* traheculectomy. There is little doubt about the greater safety of‘ trahrrulectomy over unprotected filtering procedures f‘or Icns opacities and probably ciliary block (malignant) glaucoma is glaucoma. The incidence of hypotony, significantly reduced. This greater safiaty is at the cost ofa slightly higher success rate for pressure control and a slightly higher mean postoperative pressure in the controlled traheculectomized patient. Serious complications fi-om
Endothelial Cell Loss in Herpes Zoster Keratouveitis, Jukka. Br J O~~t~~~mQl67:751-754, 1983
by A.A.
FI<.\x(:Ix:o,
Reijo,
C:.\r,lbx)I
V. Antti,
and
M.
The authors report a series of 14 patients followed up with slit-lamp, noncontact and wide-field specular microscopical examination for anterior segment changes during unilateral attacks of keratouveitis due to the Their affected eyes presented nonreflecting varicella zoster virus. 10 patients had severe keratouveitis. endothelial changes in the diflerent phases of the disease. The first nonreflecting changes suggesting virus endotheliitis were observed at the onset of the keratouveitis. These changes later recurred in several months. When the cornea1 edema had subsided, the mean endothelial cell density of the aflected eye was an average of 15% lower than in the healthy fellow eyes. During early uveitis, transient high intraocular pressure developed in five patients. Patients with severe disease and an episode of high intraocular pressure had a 20% lower cell count in the diseased eye than in the healthy fellow eye. During the followup, interstitital keratitis developed in two cases and focal iris atrophy in another two. Four patients presented with mild keratouveitis. The posterior cornea and the endothelial density in this group remained unchanged. The authors summarize the present study by emphasizing that herpes zoster keratouveitis may be a longthreatens the visual integrity. Some of the complications, lasting disease which, with its complications,
3xs
OPHTHALMOLOGY
Topographical Analysis of the Cornea: Ten Caveats in Keratorefractive Surgery, byJ .J . Rowsc~),. Inl O~h~hnlmol Clinic 2(l): 1-32, 1983 The, alrtllor pwsrnts 111~ fitllowing 10 observations ahout kcratorcfractivc surg:rr!-: ( 1 ) tlw normal c‘r~Ixf3 flattens O\YI‘ all); incision: (2) radial incisions flatten the ad,jaccnt cornea and the cornea W a\vay: (:<) the corncal fbttetiing eflicct increases as incisions approach the ;%xtal asis: (1-l the cornea tlattvti dirc~c~tl~ o\‘cr an\ sutured incision: (5) the liml~l cornea flattens adjacent to loose sutures, flattens 180” awn!~ and stwfwns 9C? away: (6) the cornea stccf~etis adjacent to tight sutures, steefwns 180” away, and fl;rttt~ns IW awil\‘: i 7) the corned flattms over any \vcd,qe resection or cortical tuck; (8) th(* cortit’a stcrpetis anterior to \\-cylgt* rcscclion or corncal tucks; (9) tissue rcmo\~al, whether traumatic or surgicall\~ ittducvd, produws corncal flattcnin~ over the site ol‘tissuc‘ removal: and ( 10) full thickness corncal tissue addition products cc~rncal stcqwnitl~ o\.cxr thts site 01‘ tht. tissue addition and flattens the adjacent cornea.
Comment The dcwlopmrnt of r&-active cornea1 surgical procedures. including radial keratotomy , has slimulatcd renewed interest in understanding the topography of the cornea. In his article, Dr. Kous~~~ provides IIS with a superb o\m\riew of the current techniques used to assess corncal ccJIitOUr. hsd on his lahorator)~ a~td c,linical investigations, \vc are then provided with ten “caveats” \vhich arc designed to help us understand how thtx cot-ma reacts to various incisions, sutures and wound healing. Dr. Ro\L.sc). supports his tunclusic~ns 1,) anal~ sis of cyc bank q’cs and clinical cases. primarily using the corncascopc. which mwsurcs Ci.5(0 IL?‘%, of the cnrncal SUI hw. ‘The caveats qualitati\.clJ. provide thr changes Lvhich occur in 111~c-rntral and pcriphcral cornea. ()nct understood. thcsc principles can he applied in the everyday practicr of cataract sttryr!‘. ‘IItc I~JIII. cx\cIts relating to wcdgc rcswtions or rclasing krratotomics are usc+uI onl) 10 those sttr~cotis pcdimniilg cx)rne;tl tr;~nsplatit;ttioti. IIt-. ROM.SC~sho~.s quantitative mwsurrmcnts in sonic‘ of his clinical photo,qraphs. hut thils to mc.ntion the potential itia&~racies of‘ measurcmcnt using the prcsctitl~ a\2ilahle tcctttiiqucs ti,r anal) zing corticascolx photcqraphs. .Mthough he dots pro\?de us \vith a fjirly good rcvi~w ol‘tltr history ofcornc~al topograph). Itt f‘ailcd to cite (tits tiurncrous rcfb-cnccs relating to astigmatism fi~lfowitig cataract suryr! whiclt h;tvc sttl,stantiat4 manv ofhis caveats. In spitr ofthesc shorrcomings. this is an c~cc’llrnt rcvitv artirlc ii)r an\ one intcwstcd in uncicrstattdingthe topography of the normal and alJnorma1 cornea. .;\s WC twonlc more scq~lt’istic~rrcd in our ahilit!, to ntcasurc the cffi~ts ofwhat WCdo on the cornea, WC w,ill no doubt hc al~lr ((1 fjrovidc ntort~ f~txdictahlc rcsults tiJllowitig all t!‘pt5 ofcortieal surgety. including kcratot.c’lr;t~.(i\.c. sutyqcr\.. Dr. Ro\~w~~‘~ c~sc~~ll~~~~l rc,\,icw articlt, will certainly hc one of thaw cited in littuw discussion 01‘ wrnwl cofxqraf)lt! Pl.liI<\- s. BI\I,I:lr I,\,JOI.I.\.
(1 \1.1101<~1
\
Earlier Trabeculectomy, by J.L. Jay. T rms Ophthalmol Sot I:k’ 10.7:35-38, 1983 In tllc fxrst drcadc thctx- l1a1.c hccn considcral~lc ad\wlcc\ in 111~‘ sut@cal and mctlical trcatmcnts a\Glahlt rcclucc the intraocular prcssurc in eves with primary opctl-angle ,qlaucoma. Tli(~ ititroduclion aid asscsstiiuir ol‘nv~v dry+ has ahsorlml so much of the research intcrrst that there has twcti littfc vlli)r1 to rlIakc direct ~~omparisons 01‘ the fxriiJrtnancc 01‘ medical versus surgical (rcatmcnt. and the rc(xw1 intio\~arioti of‘ lawtt.~t~~c~c.t~lo~,l~~st). ma)’ fitrthcr divert intcrcst fi-om this inlp(Jt?:ttlt and fundamental thcralwutic. c1toic.c. This is a prcliminar). report of‘ a collahora~i\~e, prospecti\xs, randomized trial 01‘ tliallagcmrnt 01‘ I)rimar) usin g medical therapy f0llobw~ 1)~ tr~tt~c~crtlct~tot~~~. 0Iwti angle ,glaucoma wticrc conventional management only in unaucctxful casts ~vas compared with trat~eculcctoni~~ as lhc primary fijrm oftrc~ttmcnt j sitpplcmcatitcd \vhcrca nwcssarv t,!. mcadical thcrapv). Usin
384
Srlrv Ophthahnol
29(5) hlarch-April
1985
CURRENT
OPHTHALMOLOGY
first year, and two of the 18 eyes in the group receiving surgery primarily required supplementary medical therapy in the same period. The author concludes that traheculectomy was more efFective in lowering intraocular pressure than medical treatment. ,L\lthough no statistically significant diffrcnces in \,isual fi~nction or disc appearance is yet dctectahle, there is a trend in ljvor of traheculrctomy as the primary procedure of choice in the management of‘ these patients.
Comment The author has reported on early results with relatitrely shortterm fhllow-up of a small group of’paticnts, showing that the patients subject to early traheculcctomy fared better than a comparable group treated with medications. He further stresses the rclatii-e saf‘cty of* traheculectomy. There is little doubt about the greater safety of‘ trahrrulectomy over unprotected filtering procedures f‘or Icns opacities and probably ciliary block (malignant) glaucoma is glaucoma. The incidence of hypotony, significantly reduced. This greater safiaty is at the cost ofa slightly higher success rate for pressure control and a slightly higher mean postoperative pressure in the controlled traheculectomized patient. Serious complications fi-om
Endothelial Cell Loss in Herpes Zoster Keratouveitis, Jukka. Br J O~~t~~~mQl67:751-754, 1983
by A.A.
FI<.\x(:Ix:o,
Reijo,
C:.\r,lbx)I
V. Antti,
and
M.
The authors report a series of 14 patients followed up with slit-lamp, noncontact and wide-field specular microscopical examination for anterior segment changes during unilateral attacks of keratouveitis due to the Their affected eyes presented nonreflecting varicella zoster virus. 10 patients had severe keratouveitis. endothelial changes in the diflerent phases of the disease. The first nonreflecting changes suggesting virus endotheliitis were observed at the onset of the keratouveitis. These changes later recurred in several months. When the cornea1 edema had subsided, the mean endothelial cell density of the aflected eye was an average of 15% lower than in the healthy fellow eyes. During early uveitis, transient high intraocular pressure developed in five patients. Patients with severe disease and an episode of high intraocular pressure had a 20% lower cell count in the diseased eye than in the healthy fellow eye. During the followup, interstitital keratitis developed in two cases and focal iris atrophy in another two. Four patients presented with mild keratouveitis. The posterior cornea and the endothelial density in this group remained unchanged. The authors summarize the present study by emphasizing that herpes zoster keratouveitis may be a longthreatens the visual integrity. Some of the complications, lasting disease which, with its complications,