ABSTRACT.In most patients, chronic open-angle glaucoma is a slowly progressive disease. Eyes with very high intraocular pressure (IOP > 30 mmHg) represent an exception to this and should be treated and followed extremely intensively. As lowering IOP is, so far, the only means of treating glaucoma, the majority of research reports deal with the IOP-lowering effect of the treatment. The primary goal of treatment, however, is to prevent glaucomatous damage to the structures and function of the eye. The effectiveness of treatment is monitored with optic disc and retinal nerve fibre layer imaging and with visual field examinations. If the glaucomatous changes are progressing, more effective treatment should be given. In the course of follow-up, it should be noted that the changes in the optic nerve structure and function appear and progress at different time-points with delays of up to several years. The assessment of abnormalities is dependent on the examination method and requires a great deal of experience on the part of the examiner. The important risk factors in glaucoma are elevated IOP (even if IOP is within normal range in half of patients ), age, positive family history, exfoliation, race and myopia.

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.

The autofluorescence profile of the lens was measured from 84 eyes of 84 patients with cortical, nuclear, posterior subcapsular, or mixed lens opacities. Measurements were performed with a fluorometer in the blue-green autofluorescence range (495 nm/520 nm). The mean maximum autofluorescence value differed in every cataract group statistically significantly from that of the age matched controls (p < or = 0.0058). The highest autofluorescence values were measured in nuclear and mixed cataract groups (p < 0.0001) with high and narrow autofluorescence profile. In cortical cataracts the curve was low and flattened and the mean maximum autofluorescence value was lower than in the control eyes (p < 0.0001). The maximum autofluorescence was related to lens coloration as well as to visual acuity only in nuclear cataract. The regression between maximum autofluorescence and light scatter was statistically significant only in the nuclear cataract group (p = 0.0004). Since the autofluorescence profiles differed not only in height but also in width between the cataract groups, various width/maximum autofluorescence ratios were measured. In nuclear and mixed cataract groups the ratio 75% width/maximum autofluorescence was statistically significantly lower than in other groups (p < 0.0001). In cortical cataracts the ratio (50% width - 75% width)/maximum autofluorescence was statistically significantly higher than in other groups (p < 0.0001).

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The Humphrey 30-2 visual field was examined 9 times before and after an 8-km jog in one subject, whose contrast sensitivity had been found to improve after jogging. The mean deviation improved statistically significantly suggesting better sensitivity of the visual system after jogging. Our results suggest that in some individuals physical exercise influences the factors which lie behind the visual field long-term fluctuation.