Effect of brimonidine tartrate 0.15% on scotopic pupil size and upper eyelid position: controlled trial

BACKGROUND: To evaluate the effect of brimonidine tartrate 0.15% ophthalmic solution on pupil size under scotopic condition and upper eyelid position. METHODS: This study comprised 72 eyes of 36 healthy subjects. A single drop of brimonidine tartrate 0.15% ophthalmic solution was instilled in the right eye and artificial tear was instilled in the left eye. Pupil size was measured using an infra-red pupillometer under scotopic condition before and at 30 min, 2, 4, 6, 8 and 10 h after instillation. Measurement of margin reflex distance 1 (MRD1) was performed using a millimetre ruler before and after at 10 min after instillation. RESULTS: The mean age of the subjects was 32.19 ± 11.43 years (range 10–52 years), 17 were female and 19 were male. Before brimonidine instillation, the mean pupil size was 6.09 ± 1.03 mm in the brimonidine eyes and 6.06 ± 1.04 mm in the control eyes. There was a significant decrease in mean pupil size at 30 min (4.45 ± 1.04), 2 h (4.49 ± 1.06), 4 h (4.59 ± 1.06), 6 h (4.89 ± 1.06) and 8 h (5.38 ± 1.02) after instillation compared to before in brimonidine eyes (p < 0.001 for all). There was a significant miosis continued for at least 6 h (5.95 ± 1.03) in control eyes (p < 0.001). There was no significant change in MRD1, before and after instillation both in brimonidine and control eyes. CONCLUSIONS: Brimonidine tartrate 0.15% had a significant miosis under scotopic condition for at least 8 h after instillation and had a significant miosis on the untreated eye for at least 6 h

Enucleation and Techniques of Orbital Implant Placement

Enucleation is a surgical procedure that involves removal of the eye and anterior optic nerve, most commonly with retention of the extraocular muscles which are then sewn to the implant. Meticulous surgical technique is essential to prevent long-term complications and ensure optimal long-term function and cosmesis of the anophthalmic socket. When appropriate surgical technique is used, the patient often has a significant improvement in both function and cosmesis after an enucleation, and is quite grateful for the relief of pain they can achieve. It is critical that the surgeon approach this surgery keeping the long term view of the anophthalmic socket in mind. Generally, this involves providing the patient with the largest implant that will fit the socket without undue tension during Tenon’s capsule and conjunctival closure, thereby minimizing socket and eyelid asymmetry and preventing future forniceal and eyelid issues. This chapter reviews basics of enucleation surgery, with a focus on methods to achieve optimal results. Also, the chapter discusses implant placement techniques and provides a brief review of enucleation implants. Additionally, it describes how enucleation implants have evolved and improved over time

Antimetabolite-Augmented Trabeculectomy Combined with Cataract Extraction for the Treatment of Cataract and Glaucoma

Cairns first described glaucoma filtration surgery for the treatment of glaucoma in 1968.1 The main aim of the operation, as he described it, was to improve the drainage of aqueous into the canal of Schlemm, hence the name trabeculectomy. Interestingly, the formation of a drainage bleb following the surgery was initially regarded as a failure. It was not until subsequent studies showed improved effectiveness in the presence of a drainage bleb 2 that the idea of surgically creating a diversion of aqueous to the sub-Tenon's space became the goal of the procedure. © 2009 Springer-Verlag New York