. Purpose:  To investigate how prophylactic anterior chamber paracentesis affects the intraocular pressure (IOP) after intravitreal pegaptanib injections. Methods:  In this prospective study, 41 eyes of 41 patients receiving intravitreal pegaptanib injections were randomly assigned either to receive anterior chamber paracentesis prior to the injection (Group A, 20 patients, n = 35 injections) or not (Group B, 21 patients, n = 38 injections). IOP was measured before the pegaptanib injection (T0) and 2 min (T1), 30 min (T2) and 1 week (T3) after the injection. A four‐point scale was used to evaluate the subjective pain experienced during the procedure. Results:  The mean IOP at T1 was 15.3 ± 7.5 mmHg in group A and 47.1 ± 24.1 mmHg in group B (difference −31.85 mmHg, 95% Confidence interval −40.13 to −23.56; p < 0.0001). In 45% of the injections without paracentesis, IOP was higher than 50 mmHg 2 min after the pegaptanib injection. No significant difference in IOP was observed at T0, T2 and T3 between the two study groups. The mean pain scores did not differ significantly (0.97 in group A versus 1.32 in group B; p = 0.08). Conclusions:  The results suggest that prophylactic anterior chamber paracentesis helps to prevent the high postoperative IOP spike without causing patients any additional pain.

Abstract.Purpose:  To evaluate the outcome of 180° micropulse diode laser trabeculoplasty (MDLT) in patients with open‐angle glaucoma.Methods:  A retrospective review of 40 eyes of 29 MDLT‐treated patients with a minimum follow‐up time of 6 months. Successful outcome was defined as follows: (i) a ≥20% or (ii) a ≥3‐mmHg decrease of intraocular pressure (IOP), no further need for laser‐ or incisional surgery and the number of glaucoma medication was the same or less than preoperative. These definitions will from now on be referred to as definition one and definition two.Results:  Life‐table analysis showed an overall success rate of 2.5% (1/40) and 7.5% (3/40) (according to definitions one and two, respectively) after up to 19 months of follow‐up. The average time for failure was by definition one 2.9 months (standard deviation, SD ± 3.5, range 1–12 months) and by definition two 3.3 months (SD ± 3.9, range 1–16 months). There were no intra‐ or postoperative complications caused by MDLT. Postoperative inflammatory reaction, cells and flare, was scanty.Conclusion:  Our results suggest that 180° MDLT is a safe but ineffective treatment in patients with open‐angle glaucoma.

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ABSTRACT.Purpose: To analyze the results of 87 consecutive one-stage Molteno implantations in 87 patients and evaluate the factors influencing the surgical outcome, especially the effect of intraoperative partial and total occlusion of the tube. Methods: Successful outcome was defined as final intraocular pressure (IOP) between 6 and 22 mmHg with less or equal amount of glaucoma medication than preoperatively without loss of light perception. Results: After a mean (∫SD) follow-up of 24∫17 months, the mean IOP was 18.1∫16.0 mmHg compared to the preoperative mean of 42.4∫11.1 mmHg (p∞.0001). One-, 2-and 4.5-year life-table success rates were 90%, 75% and 50%, respectively. There was no statistically significant difference in the success rate between the eyes with total and partial tube occlusion (pΩ0.703). Postoperative hyphema, suprachoroidal hemorrhage and the number of systemic medications were the only factors significantly associated with failure. Conclusions: Molteno implantation is warranted in patients with refractory glaucoma who have undergone numerous previous surgical procedures.

ABSTRACT.Purpose: To detect by immunohistochemical means the changes in bleb capsules at the cellular level between functioning and non-functioning glaucoma drainage implants (GDIs). Methods: Three samples each of functioning (1 Baerveldt and 2 Molteno implants) and non-functioning filtration blebs (1 Molteno and 2 Ahmed implants) were studied. A non-functioning bleb was defined as an intra-ocular pressure (IOP) >21 mmHg or a <20% reduction in IOP from baseline on three consecutive follow-up visits with maximal tolerated medication. The capsules were obtained between 6 and 108 months after GDI insertion for medical reasons only. Primary antibodies were used to stain fibronectin, tenascin, laminin, collagen IV and smooth muscle actin (SMA). The samples were graded on the basis of the intensity and quantity of immunohistochemical staining into four categories as follows: no staining or a mild, moderate or marked staining. Results: The non-functioning blebs expressed more fibronectin, tenascin and SMA through the whole capsule wall than the functioning blebs. In the functioning blebs, tenascin was found mainly in the inner layer of the capsule. More type IV collagen and laminin were also found in the non-functioning bleb capsules than in the functioning blebs. No difference was found between the bleb capsules irrespective of whether they had been perfused with aqueous humour immediately after surgery (Ahmed) or after a delay (Molteno, Baerveldt). Conclusion: Accumulation of extracellular matrix components and activated fibroblasts in the bleb capsules of non-functioning GDI indicates the presence of an active wound healing process, suggesting a possible reduction in filtration through the bleb wall.