Gonioscopic findings after filtering surgery for glaucoma.
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A valve implant for glaucoma incorporated upper and lower intraocular pressure limits for outflow. The device consisted of an open Supramid tube sealed to a Silastic tube with a slit valve. The valve implants had opening pressures of 11 to 16 mm Hg and closing pressures 1 to 3 mm Hg lower. A surgical technique was developed in monkey eyes and applied later in modified form to three patients with glaucoma. In four of seven monkey eyes the implants remained in place and were patent for over one year. Follow-up studies were carried out for over six months in the three patients. In two patients the valve implants were functioning with controlled intraocular pressures. In one patient the implant migrated posteriorly. This was replaced by using a new valve and a buried fixation suture and has since functioned without problem. The valve implants were well tolerated and offered possibilities for predictable intraocular pressures after glaucoma surgery.
We studied aqueous humor of rhesus and owl monkeys for its effect on the growth of subconjunctival fibroblasts in tissue culture. Aqueous humor samples obtained before glaucoma surgery inhibited the initiation of growth of fibroblasts. However, postoperative aqueous humor samples supported growth of fibroblasts. The change in aqueous humor physiology lasted for up to two months after glaucoma surgery. Our study indicated that possibly material added to the postoperative aqueous humor inactivates an inhibitor normally present in primary aqueous humor. An alternative explanation would be that primary aqueous humor, in contrast to secondary aqueous humor, lacks sufficient nutrient material to support fibroblast growth in tissue culture.
Filtration surgery was performed with a pressure-sensitive, unidirectional valve implant in 79 eyes with neovascular glaucoma. The device consisted of an open Supramid tube (outside diameter 0.58 mm) sealed to a Silastic tube with a slit valve. The Supramid tube was inserted at the corneoscleral limbus 1 to 4 mm into the anterior chamber. The Silastic portion was located under a scleral flap. Of the 79 eyes, 53 had postoperative intraocular pressures less than or equal to 24 mm Hg after a mean follow-up period of 23.7 +/- 10.9 months. Bleb revision for external scarring was required in ten of these 53 eyes and postoperative medical therapy was required in 26. The valve implant failed to control intraocular pressure in 26 of the 79 eyes. Failure was secondary to scarring of the external bleb in 18 eyes and to closure of the internal Supramid tube in five eyes. Mortality during the follow-up period was high: 12 of the 53 successfully treated patients and five of the unsuccessfully treated patients died.
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PURPOSE: To evaluate pupil dilation from intracameral injection of nonpreserved 1% lidocaine. DESIGN: Observational case series of 25 consecutive phakic trabeculectomies. METHOD: Patients were evaluated in the operating room setting and given one drop of topical tetracaine preoperatively. Nonpreserved 1% lidocaine (0.1 cc) was injected intracameraly into the anterior chamber through a paracentesis site at the corneal limbus. Pupil diameter was measured after instillation of topical tetracaine, before injection of intracameral lidocaine. Postinjection measurements were made at 1, 3, and 5 minutes. RESULTS: The mean male pupil diameter was significantly greater than female dilation at every time point. The mean blue iris diameter was greater than brown at 1 and 3 minutes, but there was no difference at 5 minutes or more. There was no racial difference in the pupil dilation response to intracameral lidocaine. CONCLUSIONS: Nonpreserved intracameral 1% lidocaine produces immediate pupil dilation in previously undilated phakic patients during trabeculectomy surgery.
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We evaluated perioperative conjunctival biopsy specimens in 28 consecutive patients with primary open-angle glaucoma undergoing trabeculectomy who had not undergone previous intraocular surgery. We found six months postoperatively that the number of goblet cells was significantly greater (6.40 +/- 5.40 vs 1.68 +/- 1.60 per field of view; P = .004, Student's t-test) in patients with easier postoperative intraocular pressure control (intraocular pressure < or = 15 mm Hg with zero to two glaucoma medications) than in patients with more difficult intraocular pressure control (> 15 mm Hg with three or more glaucoma medications). No statistical differences between groups were observed in mast cells, neutrophils, eosinophils, macrophages, plasma cells, lymphocytes, or fibroblasts (P > .05). Also, no statistical difference between groups existed in conjunctival structure, including mucopolysaccharide and collagen composition, vascular density, or epithelial thickness (P > .05). This study suggests that the number of conjunctival goblet cells may be related to intraocular pressure control after trabeculectomy.
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We operated on 59 eyes with advanced neovascular glaucoma (37 eyes in diabetic patients and 22 eyes in patients with central retinal vein occlusion) using a trabeculectomy technique that includes a simple silicone tube as the draining element. Mean (+/- 1 S.D.) intraocular pressure preoperatively was 57 +/- 8.7 mm Hg. During follow-up periods ranging from one to five years, the mean intraocular pressure decreased to 27 +/- 16.5 mm Hg. Adequate control of intraocular pressure (24 mm Hg or less) was achieved in 37 eyes (63%). Only four eyes required enucleation. Nine silicone tubes had to be removed because of necrosis of the scleral flap and conjunctival perforation or because they were expulsed. Surgery relieved the severe ocular pain even when intraocular pressure was not satisfactorily controlled.
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