Influence of Nifedipine on the Visual Fields of Patients with Optic-Nerve-Head Diseases

Calcium-channel blockers have long been employed in coronary disease, and recent investigations have indicated their efficacy in improving the visual field in low-tension glaucoma or presumed vasospasm, possibly by enhancing ocular circulation. We evaluated the short-term influence of a typical calcium-channel blocker, nifedipine, on 59 patients with visual-field defects, some with optic-nerve-head pathology (n = 38) and some with normal-appearing optic nerve heads (n = 21). On the average, a statistically significant improvement of 1.2 dB was observed. Different types of patients, however, behaved quite differently. The younger the patient, the greater the improvement. Patients with normal optic nerve heads improved by 1.54 dB, whereas patients with optic-nerve-head excavation improved by only 0.66 dB. No response was observed in patients with anterior ischemic neuropathy. Marked deterioration was noted in one glaucoma patient with low systemic blood pressure. The visual-field changes were observed in the scotomatous and non-scotomatous areas. Thus, the calcium-channel blocker nifedipine can be effective in some selected diseases whose pathogenesis probably involves vascular dysregulation though it may even be contraindicated in others

Regression of rubeosis iridis after trabeculectomy combined with mitomycin-C

The authors report two cases in which severe rubeosis iridis regressed after trabeculectomy with intraoperative application of mitomycin-C. Several days after the operation, the vessels were no longer perfused. Only white, empty, "ghost" vessels were visible. This phenomenon was observed in one case with well-controlled intraocular pressure (IOP) after surgery, as well as in a case in which IOP rose again to high preoperative values. The authors conclude that the regression of the rubeosis may be caused by a local, intraocular pharmacologic side effect of mitomycin-C, not by the drop in IOP alone.

The influence of magnesium on visual field and peripheral vasospasm in glaucoma

Previous studies indicated calcium channel blockers to be of some help for normal-tension glaucoma patients. The present study evaluates the effect of magnesium, a 'physiological calcium blocker', in 10 glaucoma patients (6 with primary open-angle glaucoma, 4 with normal-tension glaucoma). All patients had a digital cold-induced vasospasm. Magnesium (121.5 mg) was administered twice a day for a month. After 4 weeks of treatment, the visual fields tended to improve. All three video-nailfold-capillaroscopic parameters [blood cell velocity (in mm/s) before and after cooling, cold-induced blood flow cessation (in seconds) as well as the number of capillaries per microscopic field which showed such a blood flow cessation] as well as digital temperature improved significantly. Systemic blood pressure and pulse rate remained stable. In conclusion, magnesium improves the peripheral circulation and seems to have a beneficial effect on the visual field in glaucoma patients with vasospasm.

[Experiences with mitomycin C]

BACKGROUND

Recently, encouraging results with the use of Mitomycin C in trabeculectomy have been reported.

PATIENTS

We used Mitomycin C (0.028%) during trabeculectomy in 72 eyes of 68 patients. Forty-one eyes have already been controlled during 6 months and 19 eyes during 9 months after the surgery.

RESULTS

The mean intraocular pressure after 6 and 9 months was respectively 13 +/- 8 mm Hg and 13 +/- 10 mm Hg. The difference between these results and the preoperative values (27 +/- 9 mm Hg) were statistically significant after 6 and 9 months (p < 0.001). Despite frequent choroidal detachments (20 eyes), the visual acuity recovered during the follow-up to the preoperative values.

CONCLUSIONS

In patients with uncertain prognosis for the intraocular pressure after trabeculectomy, the intraoperative application of Mitomycin C seems to improve considerably the operative success rate.

Comparison of the severity of normal-tension glaucoma in men and women

To determine whether damage in normal-tension glaucoma is more pronounced in men or in women, we analyzed visual-field damage, intraocular pressure, age, frequency of acral vasospastic reaction on local cooling, and frequency of headache in 28 consecutive patients with newly diagnosed normal-tension glaucoma. The difference between genders with regard to mean visual-field defect was significant (9.4 +/- 1.3 dB in men and 6.7 +/- 1.0 dB in women; p = 0.034). This difference could not be explained by other variables. Because the population tested was relatively young, this study suggests normal-tension glaucoma to be more severe in men, in an earlier stage of the condition.