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At least 217 records · Page 12Linked to original sources
PubMed2005

[Changes of blood-aqueous barrier after phacoemulsification in patients with previous glaucoma filtering surgery].

OBJECTIVE: To evaluate the effect of trabeculectomy and/or phacoemulsification surgery on blood-aqueous barrier function. METHODS: Phacoemulsification with implantation of intraocular lens was performed on 46 cataract eyes of 40 glaucoma patients following previous trabeculectomy (group 1), and 64 cataract eyes of 60 patients (group 2). The aqueous flare and cells were examined preoperatively and on days 1, 7, 30, 90 postoperatively using a laser flare-cell meter (LFCM). RESULTS: The mean aqueous flare values were (15.12 +/- 2.87), (40.24 +/- 3.75), (24.33 +/- 3.38), (21.18 +/- 1.77), (16.51 +/- 1.70) photon counts/ms in group 1 preoperatively and on days 1, 7, 30, 90 after surgery (P < 0.05) respectively; and were (6.94 +/- 2.34), (26.27 +/- 10.21), (13.96 +/- 6.44), (9.07 +/- 2.67), (7.16 +/- 1.89) photon counts/ms in group 2 (P < 0.05) respectively. CONCLUSIONS: Trabeculectomy can breakdown blood-aqueous barrier permanently while phacoemulsification damage the blood-aqueous barrier transiently. Phacoemulsification combined with a previous trabeculectomy can enhance this damage.

Aged↗
PubMed2005

Choroidal detachment after filtering surgery.

BACKGROUND: The purpose of this study is to report the treatment and outcome of eight cases of choroidal detachment, which occurred several days to many years after trabeculectomy. METHODS: This is a retrospective study of eight cases of choroidal detachment after trabeculectomy with or without cataract extraction reviewed at CGMH, Keelung, from 2002 to 2004. One eye with idiopathic scleromalacia with chronic uveitis and secondary glaucoma, five eyes with primary open angle glaucoma and two eyes with chronic angle closure glaucoma after trabeculectomy were reported. Six of the eight cases developed acute onset choroidal detachment within two weeks after surgery. The other two cases suffered from choroidal detachment many years after trabeculectomy for different reasons. Regarding the types of operation, combined glaucoma and cataract surgery was performed in five cases and intraoperative application of adjunctive mitomycin C was used in two cases. Decrease in vision acuity and varying degrees of eye pain with a flat or shallow chamber were noted in all cases. Associated hypotony was found in six of the eight cases. The treatment included topical cycloplegic corticosteroid and oral corticosteroid. RESULTS: Choroidal detachments were improved or complete resolution obtained after medical treatment for about three weeks to one month in all cases. But persistent poor control of intraocular pressure was found in two cases. Ultrasonography was used as a reliable tool to confirm the diagnosis and resolution of choroidal etachment in cases of blurred fundus examination and synechiae miotic pupil. CONCLUSIONS: Choroidal detachment is one of the complications after trabeculectomy. The diagnosis of choroidal detachment can be confirmed most reliably by ultrasonography. Medical therapy is effective for resolution.

Adult↗
PubMed1984

Filtering surgery in childhood glaucoma.

A review of 38 eyes of 24 patients receiving filtration surgery for childhood glaucoma is presented. A total of 54 procedures were performed, including both thermal sclerostomies and trabeculectomies. Successful control of intraocular pressure was obtained in 20 eyes (52%). Average follow-up time was four years, two months. Filtration surgery is seen as a useful technique in the treatment of childhood glaucoma when goniotomy fails. It also is useful in those conditions where the success rate of goniotomy is expected to be low.

Adolescent↗
PubMed1993

[Mitomycin C in glaucoma surgery].

Glaucoma filtering surgery fails because of scarring of the filtering bleb. Fibroblasts proliferation from the episclera and Tenon capsule play an important role in the scarring process. The use of antimetabolites in glaucoma filtering surgery have a beneficial effect on the lowering of intraocular pressure especially in eye at poor surgery prognosis. They inhibit the fibroblasts proliferation and subsequent scarring of filtering bleb. 5 fluorouracil improves chance of success with filtering surgery but the necessity of multiple subconjunctival injections has many disadvantages including discomfort for the patient and ocular surface problems such as corneal defect and conjunctival wound leak. Mitomycin C with its focal applications limits the toxic effects to tissue directly exposed to the drug. A single intra-operative application leads to a more hypotensive effect with less corneal complications which are two major advantages of this treatment (Kitazawa and al.): Success rate at one year without medical treatment: 88% with MMC-40% with 5 FU. Different tissue culture studies as well as clinical studies demonstrate that the antiproliferative effect of MMC is 100 times more powerful than 5 fluorouracil. Mitomycin C might probably interfere with other steps in the wound healing process. Mitomycin C seems to be a better treatment than 5 fluorouracil. Nevertheless long term randomized prospective human studies are necessary to confirm it.

Adult↗
PubMed2006

Clinical efficacy and biocompatibility of three different leukocyte and fat removal filters during cardiac surgery.

Activated leukocytes and fat particles are associated with organ injury after a cardiac surgery. Filters are currently used to remove either leukocytes or fat particles. A novel approach with a filter that combines leukocyte and fat removal might be clinically useful. As it is not known which type of filter has a good and safe performance in both leukocyte and fat removal, we measured in this study the leukocyte and fat removal properties and the biocompatibility of three different filters. We used six Pall RS1 (Pall, Portsmouth, England) leukocyte removal filters, six Pall LipiGuard fat removal filters, and six Fresenius Biofil 02 (Fresenius, Emmer-Compascuum, The Netherlands) leukocyte removal filters and measured the passage times of 500 and 1000 mL of residual heart-lung machine blood. We determined the circulating leukocyte and platelet counts, and total hemoglobin, triglyceride, and free fatty acid concentration after the filters. In addition, we measured free hemoglobin, plasma elastase (Merck, Darmstadt, Germany), and complement C5-9 (Quidel, San Diego, CA, U.S.A.) to assess the biocompatibility of the filters. The circulating fat particles were calculated with an automated hematology analyzer. The passage time for the blood was shortest for the Biofil filter (P = 0.02, analysis of variance). The total leukocyte counts (P = 0.04) and fat particles (P = 0.02) were higher after the LipiGuard filter. This filter also had a higher increase in free hemoglobin concentration (P = 0.03). We conclude that the leukocyte removal filters were superior to the fat removal filter both in leukocyte and fat removal.

Aged↗
PubMed1996

The use of bioerodible polymers and daunorubicin in glaucoma filtration surgery.

PURPOSE: Glaucoma filtering surgery usually fails from postoperative fibroblast proliferation, collagen deposition, and subsequent sclerostomy or bleb scarring. Daunorubicin inhibits fibroblast proliferation in vivo and in vitro. The authors studied the effect of a sustained subconjunctival release of daunorubicin by way of a bioerodible polymer on the success of glaucoma filtration surgery in a rabbit model. METHODS: Daunorubicin was incorporated into the copolymer by compression molding. The resultant implant measured 3.0 mm in diameter, 1.0 mm in thickness, and 8.0 mg in weight. A posterior lip sclerectomy was performed in both eyes of 23 rabbits by the same surgeon. One eye was randomized to receive the disc with daunorubicin, whereas the fellow eye received a blank disk as a control. The appropriate polymer disk then was placed on the scleral surface immediately posterior to the sclerostomy site and the conjunctiva was closed. Intraocular pressures and slit-lamp biomicroscopy were recorded preoperatively, then every other day after surgery for 31 days. Intraocular pressure, bleb survival, and complications were evaluated. RESULTS: The decrease in intraocular pressure from baseline was significantly greater in the daunorubicin eyes than in the control eyes during postoperative days 5 through 25. Bleb survival was significantly longer in the daunorubicin eyes than in the control eyes (bleb failure in 91% of control eyes versus 22% of treatment eyes by day 13). There were no statistically significant differences between the daunorubicin-treated and control eyes regarding corneal clouding, lens clarity, cataract formation, or conjunctival injection. However, conjunctival erosions occurred in four daunorubicin-treated eyes. Histopathologic examination was performed 2 weeks after surgery on the eyes of three randomly selected rabbits. CONCLUSION: Daunorubicin in a bioerodible delivery system may potentially be a useful adjunct to glaucoma filtering surgery and requires further evaluation.

Animals↗
PubMed2005

[The outcome of phacoemulsification in eyes after filtering glaucoma surgery].

BACKGROUND: Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery. PATIENTS AND METHODS: Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery. RESULTS: The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %. CONCLUSION: Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.

Aged↗
PubMedDate not supplied

[5-fluorouracil in the treatment of postoperative glaucoma].

INTRODUCTION: Standard filtering surgery in postoperative glaucoma in aphakic and pseudophakic eyes and eyes after failed filtering surgery is successful in 50% cases. The main cause of failure filtering surgery is scarring of the filtering bleb-fibroblastic proliferation at the subconjunctival episcleral interface [1, 2]. The use of antimetabolites such as 5-fluorouracil and Mitomycin C inhibits fibroblast proliferation and increases the success rate of filtering surgery, especially in postoperative glaucoma [3-6]. The exact dosage and frequency of administration to maximize success and minimize complications of treatment has not yet been determined [7]. METHODS: Fifteen patients (15 eyes) with medically uncontrolled postoperative glaucomas were included in the study. Clinical data are summarised in Table 1. All patients after standard trabeculectomy received 5 mg of 0.3 ml 5-fluorouracil subconjunctivally each day for 7 days. The mean 5-fluorouracil dose was 25.1 mg. Topical corticosteroid and cycloplegic eye drops were also instilled in all 15 eyes for 4 weeks after surgery. RESULTS: Successful control of IOP was achieved after a 5-fluorouracil filtering procedure in 13 of 15 eyes (86.6%), with a mean follow-up of 11.4 months. Two patients (13.4%) with uncontrolled glaucoma required cyclokryocoagulation in addition to antiglaucoma medications. Transscleral fibrosa and internal occlusive membrane were the primary cause of failure of filtration fistulas. Only one patient in the group of successful control of IOP required topical 0.5% Timolol (Table 1). Mean value of postoperative IOP was 13.53 mmHg. Most of the early complications such as corneal epitheliopathy, corneal epithelial defects and shallow anterior chamber, resolved without irreversible damage. Two eyes had transient maculopathy and choroidal detachment. There were no late complications, except progression of cataracta in one eye (Table 2). DISCUSSION: Our success rate in 5-fluorouracil treatment in postoperative glaucoma was 86.6%. The results of Fluorouracil Filtering Surgery Study Group revealed failure in 28% of eyes with 5-fluorouracil treatment compared to 60% of eyes in standard group without fluorouracil. We achieved better results in shorter follow-up. Short term complications related to 5-fluorouracil treatment such as corneal epithelipathy, recovered well with time. Long term complications caused by thin and cystic blebs: endophthalmitis, iridocyclitis, late bleb leaks, bleb encapsulated, were not recorded in our series. By comparing the results reported here with those previously reported [8-10] it looks like that certain long term complications can be reduced by adjusting the dose according to the clinical response. Weinrab et al. [10] reported similar successful surgical outcomes in refractory glaucoma, but these results cannot be compared directly, because of likely differences in such factors, as are the indications of surgical criteria for selection of specific surgical procedures, surgical technique and postoperative care. Some clinical reports have shown that Mitomycin C contributes to the increased success of filtering surgery in high risk glaucoma [11, 12], but 5-fluorouracil is still the golden standard among other antimetabolites.

Adult↗