A retrospective cohort study of the case notes of 295 patients referred to the glaucoma clinic at the Royal Infirmary of Edinburgh between October 1993 and March 1994 was performed. The purpose of the study was to determine the diagnostic outcome of new referrals suspected of having glaucoma, all of whom were examined by a single glaucoma specialist. The largest diagnostic group was ocular hypertension (113, 42%), just over half of which were started on treatment. A new diagnosis of glaucoma was confirmed in 46 patients (17%). In total, 107 patients (39%), required treatment (46 glaucoma and 61 ocular hypertension). Thirty-six percent of new referrals were either discharged (80, 29%) or had other ocular conditions unrelated to glaucoma (19, 7%). A proportionately high number of new glaucoma cases (15 out of 46) had normal intraocular pressures, which emphasises the important role of ophthalmoscopy and perimetry in case detection. In conclusion, the number of newly diagnosed cases of glaucoma (17%) is considerably less than previous reports (22-39%), with a high proportion of referrals (2 in every 5) having ocular hypertension.

We retrospectively evaluated a consecutive series of 45 patients (45 eyes) who underwent trabeculectomy augmented with a single intra-operative 5 minute application of 5-fluorouracil (5-FU; 25 mg/ml). All patients were at an increased risk of subconjunctival fibrosis and surgical failure. The mean follow-up period was 24 months (range 12-42, SD 6.9). The mean pre-operative intraocular pressure (IOP) was 29.1 mmHg (SD 6.1) and the mean IOP at the last post-operative visit was 16.6 mmHg (SD 6.4) (p < 0.0001) with a mean IOP reduction of 42%. The number of medications reduced from a mean of 2.3 (SD 0.7) pre-operatively, to 0.8 (SD 0.7) post-operatively (p < 0.0001) and 22 eyes (49%) required no topical treatment for IOP control. An IOP of 21 mmHg or less with or without medications was achieved in 80% of cases. There was no significant difference in final IOP or success rate over time between low- and high-risk patients, although the low-risk patients did better in the first 12-18 months. Complications included hypotony maculopathy in 2 cases (4%), leaking bleb in 5 cases (11%) and giant bleb in 1 case (2%), giving a total of 8 cases (18%) with bleb-related sequelae. In the short to medium term, a single per-operative application of 5-FU is a useful adjunctive treatment during glaucoma filtering surgery for low- to moderate-risk cases, although a steady increase in the failure rate was associated with increasing length of follow-up.

Aims-To study the efficacy oflaser suture lysis in the promotion of filtration and bleb formation during the early postoperative period after trabeculectomy. Methods-This was a prospective study of 20 eyes from 20 patients undergoing trabeculectomy. Patients were entered into the study if, after a trial period of ocular massage, the intraocular pressure (LOP) Patients and methods This is a consecutive series of 20 eyes from 20 patients with a mean follow up of 6 months (range 3-10 months). There were 13 females and seven males with a mean age of 67 years. Fourteen patients had chronic open angle glaucoma, four had chronic angle closure glaucoma, two had pseudoexfoliative glaucoma, one had secondary glaucoma following anterior uveitis, and there was one case of secondary glaucoma following penetrating keratoplasty for acanthamoeba keratitis.All patients underwent trabeculectomy surgery by one of three surgeons. Fornix based conjunctival flaps were created followed by diathermy to the sclera before a rectangular scleral flap measuring 3 x 3 or 4 x 4 mm was dissected to clear cornea. Fourteen cases had a paracentesis created before a block of corneoscleral tissue was excised. A peripheral iridectomy was performed and the scleral flap was sutured with two or three 10/0 nylon stitches. The conjunctiva was closed with buried nylon sutures. A subconjunctival injection of 20 mg gentamicin was given at the end of the procedure. There were three patients who had their drainage surgery augmented with peroperative administration of 5-fluorouracil (5-FU): these included the two cases of secondary glaucoma (one due to uveitis and one following corneal graft for acanthamoeba keratitis) and one case of combined extracapsular cataract extraction with trabeculectomy during which there was vitreous loss. In these cases a limbal based conjunctival flap was utilised and 5-FU soaked in a sponge was applied to the scleral bed, covered with the conjunctival flap, and left in place for 5 minutes, during which time the sponge was replenished with 5-FU at 1 minute intervals.

The accuracy of referral to the glaucoma clinic in Edinburgh was evaluated retrospectively by case note analysis. Two hundred and ninety-five patients suspected of having glaucoma were referred during a 6 month period. Optometrists accounted for 96% of referrals with the remainder being referred directly by the GP. The highest overall detection rates (glaucoma + glaucoma suspects) were amongst those optometrists who combined tonometry with either a field assessment, ophthalmoscopy or both (66-78%). Despite this there was a high false positive rate with 36% of referrals being discharged or having conditions unrelated to glaucoma. To improve referral efficiency it is recommended that optometrists should routinely combine tonometry with ophthalmoscopy and perimetry, and tests should preferably be repeated prior to referral if an abnormality is suspected. The accuracy of referrals could be improved by the use of Goldmann applanation tonometry and by better interpretation of perimetric findings.