Faculty Bibliography

Eighty-four eyes received 107 argon laser trabeculoplasty treatments at Beth Israel Medical Center between 1982 and 1984 for advanced primary and secondary glaucoma. The prelaser mean pressure was 20.25 mmHg. Pressures taken 1 1/2 hours postoperatively varied widely: the pressure rose after 47 treatments and fell or remained the same after 60. Significant increases in pressure occurred in 10 eyes, after 12 treatments; 42% of these had received burns of 0.8 watts or greater. Pressure changes were correlated with laser burn energy level. Both patients who had significant increases in pressure initially were retreated again--in the same eye--at another time had similar increases in postoperative pressure again, even with lower energy levels. Comparison with the results of previous reports highlights the advantages of limited treatment to the anterior trabeculum with low energy levels

The term 'malignant glaucoma' referred originally to a rare and highly feared form of glaucoma occurring in certain postoperative patients. Over time the concept of the disease was expanded to include a group of angle closure glaucomas unresponsive to traditional miotic or filtering therapy. The haphazard lumping of many disease entities under such an umbrella term has caused confusion, which we attempt to resolve through a mechanistic approach to elucidating the pathogenesis of malignant glaucoma based on the anatomical location of obstruction to normal aqueous flow; surgical treatments are suggested based on the pathogenesis. Attention is drawn to the role of the vitreous and anterior hyaloid in combination with a block to normal aqueous circulation, redirection of its flow, high intraocular pressure and vitreous swelling in precipitating malignant glaucoma and creating a vicious circle to maintain it. Surgical management is directed to correcting the obstruction to normal aqueous flow and removing aqueous accumulated in the posterior chamber, vitreous or suprachoroidal space

The subscleral Scheie procedure is most effective in advanced glaucoma patients with IOP of 35 mm Hg or more and in those patients in need of a secondary or tertiary procedure. The surgical technique is described

Two homosexual males with the 'gay bowel syndrome' experienced an acute unilateral loss of vision. Both patients had white intraretinal lesions, which became confluent. One of the cases had a depressed cell-mediated immunity; both patients ultimately died after a prolonged illness. In one patient cytomegalovirus was cultured from a vitreous biopsy. Autopsy revealed disseminated cytomegalovirus in both patients. Widespread retinal necrosis was evident, with typical nuclear and cytoplasmic inclusions of cytomegalovirus. Electron microscopy showed herpes virus, while immunoperoxidase techniques showed cytomegalovirus. The altered cell-mediated response present in homosexual patients may be responsible for the clinical syndromes of Kaposi's sarcoma and opportunistic infection by Pneumocystis carinii, herpes simplex, or cytomegalovirus