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SUMMARY Three commonly used injection anesthetics, bupivacaine .75%, mepivacaine 2%, and lidocaine 2% were evaluated for onset, completeness and duration of akinesia following modified O'Brien facial nerve block, using a new force-sensitive lid speculum. All three agents provided facial akinesia that was profound within six minutes of the time of injection. The onset and the depth of anesthesia were roughly the same with all three agents. However, bupivacaine induced akinesia of greatest duration, lasting up to six hours, the time of final measurement in this study. Akinesia produced by mepivacaine was adequate for about 90 minutes, and lidocaine for 15-30 minutes. A newly-described force-sensitive speculum was utilized in this study. It is an effective instrument for measuring completeness of akinesia, and may have clinical usefulness.

Laser peripheral iridectomies were performed on both eyes of 38 patients with acute or chronic primary angle-closure glaucoma or with narrow angles capable of closure. The right eye was treated with the neodymium YAG laser (Nd:YAG) and the left eye with the argon laser. Patients were followed for a minimum of eight months. The mean number of applications to produce iris penetration was six with the Nd:YAG laser and 73 with the argon laser. Visual acuity, postoperative intraocular pressure (IOP), corneal changes, and pigment dispersion were similar in the two groups. Microhyphema was more prevalent in the Nd:YAG iridectomy group. Pupillary distortion, iritis, and late failure of patency were more frequent in the argon laser group. Nd:YAG laser iridectomies require fewer applications and produce less inflammation. This controlled study demonstrates that when properly and carefully performed, the Nd:YAG laser is at least as effective and appears to be as safe as the argon laser for performing peripheral iridectomies.

In 15 patients with primary open-angle glaucoma who required surgery in both eyes because of progressive glaucomatous disease a peripheral iridectomy with thermal sclerostomy was performed in one eye and a trabeculectomy in the other eye, the choice of procedure being determined randomly. In all 15 cases at one year and 13 cases at 5 years after operation the immediate complication rate was higher in patients receiving peripheral iridectomy with thermal sclerostomy. The average final level of intraocular pressure (on no treatment) was 16 mmHg in patients receiving peripheral iridectomy with thermal sclerostomy and 22 mmHg in those in whom a trabeculectomy was performed. The control of disease was the same in both groups, there being an improvement in the visual field in approximately one-third of all cases and stability of the visual field in all other cases except for one. However, twice as many patients after trabeculectomy required additional medical therapy to maintain the intraocular pressure in a range that was considered satisfactory. Stability of intraocular pressure was virtually the same in both groups. The mechanism of control of intraocular pressure in patients receiving peripheral iridectomy with thermal sclerostomy appeared to be gross filtration in all cases, whereas such gross filtration was observed in only 2 eyes in which a trabeculectomy had been performed.

A review of our first 200 neodymium-YAG laser iridectomies performed over a two-year period in various forms of glaucoma showed patent iridectomies in 180 of 182 eyes (99% success) at the last examination (one to 26 months postoperatively). Both failures had preexisting chronic uveitis. Eighteen eyes were lost to follow-up. Complications included intraocular pressure increased more than 10 mm Hg in 54 eyes (30%), hemorrhage in 36 eyes (20%), iritis in 21 eyes (11.5%), posterior synechiae in 13 eyes (7%), corneal changes in seven eyes (4%), and pupillary distortion in six eyes (3%). With experience, fewer applications are required to penetrate the iris, and retreatment to obtain patency is less likely to be needed.

Argon laser trabeculoplasty (ALT) was performed in 232 eyes of 180 patients affected by uncontrolled primary open-angle glaucoma (POAG), exfoliation syndrome glaucoma (ESG) or pigment dispersion syndrome glaucoma (PDSG). Mean follow-up was 9 months (3-22). Mean IOP change was -21.6% (±19) from the initial value. The effect of IOP was larger in patients with ESG, PDSG, and in POAG cases with more pigmented trabecular meshwork. No relationship was found between IOP changes and age or refraction of patients; the association with iridoplasty did not influence final results. An Octopus computerized perimeter was used for pre and post-treatment visual field tests. In 113 eyes Octopus exams met the requirements for quantitative analysis. In this group 17% of visual field improved, 64% remained stable and 19% worsened. A good functional response was more frequent among the eyes with less advanced disease.

All patients with primary open-angle or primary angle-closure glaucoma requiring trabeculectomy between January 1982 and January 1983 were entered into a randomized prospective study to evaluate the effect of postoperative corticosteroids. Twenty-three eyes in Group 1 received a cycloplegic and topical antibiotic. Twenty-nine eyes in Group 2 received the same treatment, with the addition of topical 1% prednisolone acetate. Twenty-three eyes in Group 3 received the same treatment as Group 2, with the addition of systemic prednisone. Success rate was significantly improved with the use of topical corticosteroids. Systemic steroids did not prove to be of any added benefit over topical use alone.