SEARCH · PubMed Health

Results for “Filtering Surgery”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources

PubMed1998

New patterns of infecting organisms in late bleb-related endophthalmitis: a ten year review.

PURPOSE: To report the risk factors, causative organisms and visual outcomes in patients with late-onset bleb-related endophthalmitis. METHODS: Medical records of all patients with the clinical diagnosis of late-onset bleb-related endophthalmitis undergoing vitreous aspirates for culture at our institution from January 1987 to July 1996 were reviewed. Late-onset bleb-related endophthalmitis was defined as conjunctival injection, bleb purulence and intraocular inflammation developing at least 1 month following filtering surgery. RESULTS: Forty-nine cases of bleb-related endophthalmitis developed in 42 patients (23 men, 19 women). Mean patient age was 62.1 +/- 19.3 years (range 5-94 years). Thirty-nine patients underwent prior filtering surgery (superior trabeculectomy, 24 eyes; inferior trabeculectomy, 10 eyes; combined superior trabeculectomy/cataract extraction, 4 eyes; posterior lip sclerectomy, 1 eye) and 3 had inadvertent blebs following cataract extraction. Endophthalmitis developed an average of 25.4 +/- 23.5 months (range 1-96 months) post-operatively. Antifibrosis agents were used in 25 of 39 eyes undergoing filtering surgery (mitomycin C, 13 eyes; 5-fluorouracil, 12 eyes). Bleb leaks were documented in a total of 32 of 49 (65%) cases either before or at the time of endophthalmitis diagnosis. Vitreous cultures were positive in 42 of 49 (86%) cases. The most frequently cultured organisms were Staphylococcus aureus (13), Staphylococcus epidermidis (12), Streptococcus species (8) and Haemophilus influenzae (2). A final visual acuity of 20/400 or better was achieved in 32 of 49 (65%) cases. CONCLUSIONS: Staphylococcal species were the most frequently cultured organisms in this series and may be associated with better visual outcomes. Although a causal relationship cannot be established, these results suggest a strong association between bleb leaks and endophthalmitis.

Adolescent↗

PubMed1987

Ten year results of laser trabeculoplasty. Does the laser avoid glaucoma surgery or merely defer it?

The first 150 consecutive phakic eyes from 113 patients aged 40 years or more treated with laser trabeculoplasty were evaluated. Twenty-four patients (37 eyes) have died, two eyes developed spontaneous rubeosis, and one patient (one eye) was not available, leaving 110 eyes with a 6 to 10 years follow-up. Of the 37 eyes of dead patients (average age 80 years), only one eye had filtering surgery, and 33 of the other 36 eyes had a last recorded intraocular pressure of less than 21 mm Hg. Of the 110 eyes of living patients followed for 6 years, 33 had filtering surgery and 62 eyes (56 per cent) had an intraocular pressure of less than 21 mm Hg. Of 10 eyes followed for 10 years, eight had intraocular pressures less than 23 mm Hg, seven had pressures less than 21 mm Hg, and two had had filtering surgery. Eyes with advanced disc damage at the time of trabeculoplasty had a 51 per cent rate of later glaucoma surgery, while eyes with a cup/disc ratio less than 0.9 at trabeculoplasty had a glaucoma surgery rate of 16 per cent. Eyes of non-white patients did as well as eyes of white patients. Computer analysis of over 1,700 eyes with two-year follow-up indicated better long-term control when 100 or more laser burns were used for trabeculoplasty. Laser trabeculoplasty can defer surgery for the remaining lifespan in elderly patients, and has controlled primary open-angle glaucoma for over 10 years, but later glaucoma surgery is often required in eyes with far advanced glaucoma damage.

Adult↗

PubMed2001

Filtering glaucoma surgery using an excimer laser.

PURPOSE: To evaluate the results of excimer laser trabecular ablation in the treatment of open-angle glaucoma. SETTING: Clínica de Ojos Maldonado Bas Privada, Córdoba, Argentina. METHODS: This study comprised 32 eyes that had surgery for open-angle glaucoma between May 1997 and May 2000. The surgical procedure included topical anesthesia, a conjunctival incision, a lamellar scleral flap, and ablation of Schlemm's canal and the trabeculum with a scanning or diaphragm excimer laser system until a microperforation was produced in the underlying corneotrabecular tissue. The microperforation had no effect on the treatment and was used only as a sign that the ablation was deep enough and should be stopped. Schlemm's canal was unroofed, and its inner wall and the trabeculum were partially ablated. The scleral flap and conjunctiva were sutured. No antimetabolites were used. RESULTS: The mean intraocular pressure was 28.06 mm Hg +/- 9.82 (SD) preoperatively and 13.09 +/- 2.67 mm Hg postoperatively. Complications included hyphema (n = 3), choroidal detachment (n = 5), posterior synechias (n = 1), and posterior synechias and cataract (n = 1). CONCLUSION: Excimer laser ablation appears to be an effective option for the treatment of glaucoma that may be easier to perform than other procedures for many surgeons.

Adolescent↗

PubMed2002

Efficacy of indomethacin 0.1% and fluorometholone 0.1% on conjunctival inflammation following chronic application of antiglaucomatous drugs.

BACKGROUND: Subclinical conjunctival inflammation has been shown to have a deleterious effect on the outcome of filtering surgery. The study was designed to assess the efficacy and safety of a non-steroidal anti-inflammatory ophthalmic solution (preservative-free indomethacin 0.1%) on conjunctival inflammation following chronic application of antiglaucomatous drugs, in comparison with a steroidal ophthalmic solution (preserved fluorometholone). METHODS: Eighty-nine glaucomatous patients were included in a randomised, multicentre study comparing two parallel groups of treatment given on the basis of 1 drop 4 times daily for 1 month before filtering surgery. Patients had been treated with one or more antiglaucomatous drugs for at least 3 years. The routine antiglaucomatous treatment was continued during the study. Evaluations were carried out at baseline and after 30 days of treatment. Conjunctival inflammation was assessed under masked conditions by means of conjunctival impression analysis which determined the percentage of cells expressing HLA-DR. The ocular surface was also examined using the fluorescein test and lissamine green staining. RESULTS: Paired conjunctival impression specimens available both on day 0 (D0) and day 30 (D30) involved 49 patients. Among them, 34 eyes had a positive expression of HLA-DR at inclusion. On D30, in patients positive to HLA-DR on D0, the percentage of cells expressing HLA-DR had significantly decreased in both treatment groups: the mean reduction was 29.7% from a baseline value of 51.4% in the indomethacin group ( P=0.019) and 32.5% from a baseline value of 48.7% in the fluorometholone group ( P<0.001). There was no significant difference between groups. Seven cases of drug-related superficial punctate keratitis were observed on D30 by means of a fluorescein test: one in the indomethacin group and six in the fluorometholone group. CONCLUSION: Both anti-inflammatory eyedrops were effective in reducing subclinical conjunctival inflammation before filtering surgery. Regarding superficial punctate keratitis, the corneal tolerance of preservative-free indomethacin 0.1% eyedrops seemed to be better than that of preserved fluorometholone eyedrops.

Aged↗

PubMed2000

Sinusotomy and deep sclerectomy.

Non-penetrating filtering surgery (NPFS) started in 1962 with the first sinusotomy performed by Kraznov. At that time, the author of this new technique believed that the outflow resistance in the majority of cases of primary open-angle glaucoma was located at the level of scleral aqueous drainage veins and not in the trabeculum. He therefore developed a safe NPFS technique, leaving in place the trabeculum and the inner wall of Schlemm's canal. Because of difficulties with the microsurgical technique and the small reduction in intraocular pressure (IOP) compared with trabeculectomy, sinusotomy was abandoned. In the last decade, with the widespread use of operating microscopes, NPFS has been the subject of renewed interest. IOP reduction with the new NPFS techniques is comparable to that obtained with trabeculectomy, with significantly lower pre- and post-operative complications. The new NPFS techniques such as deep sclerectomy, ab externo trabeculectomy and viscocanalostomy present definitively different mechanisms of filtration compared with early sinusotomy. This article will review the history of NPFS as well as describing the different new non-penetrating filtering surgeries.

Filtering Surgery↗

PubMed2000

[Histopathological evaluation of vitamin E derivatives effects on the healing process of a model of filtration surgery].

PURPOSE: To describe the effect of alpha-tocopherol derivatives (acetate and acid succinate) on the histopathological characteristics of the surgical fistulae in an experimental model of filtering surgery. METHODS: 30 pigmented rabbits were randomly divided into 3 study groups. Twenty-four hours before surgery the animals were injected subconjunctivally with 0.5 ml of solution: group I (n=10) 0.75% ethanol in balanced saline solution (BSS), group II (n=10) 100 microgrs alpha-tocopherol acetate (AT) in 0.75% ethanol in BSS, group III (n=10) 100 microgrs alphatocopherol acid succinate (ST) in 0.75% ethanol in BSS. Histological findings were evaluated 30 days after surgery. RESULTS: The groups treated with alpha-tocopherol derivatives showed a higher percentage of fistular persistence and smaller wound healing areas. There was a subconjunctival cellular infiltrate of mononuclear and eosinophilic cells. CONCLUSIONS: Histological findings support the clinical use of alpha tocopherol derivatives, AT and ST. to inhibit the wound healing processes associated to filtering surgery failure.

Animals↗

PubMed2004

Reducing intraocular pressure: is surgery better than drugs?

Reducing IOP is presently the evidence based, most accepted and most practised therapeutical approach for glaucoma patients. Currently topical ocular hypotensive medications, with its different classes, as well as filtering surgery (trabeculectomy and non-penetrating glaucoma surgery) are in the forefront of therapeutic modalities for IOP reduction. This article looks at the potential advantages and disadvantages of topical medications versus filtering surgery. It does not directly address the question of initial treatment of glaucoma, or what is the better treatment of glaucoma, as other review articles had, but rather looks in a more specific on the pros and the cons of each in relation to IOP reduction. In other words this article deals with the situation once the decision has been made to reduce IOP.

Antihypertensive Agents↗

PubMed1989

Low-dose 5-fluorouracil and glaucoma filtration surgery.

We show that a 40-mg total dose of subconjunctival 5-fluorouracil after glaucoma filtering surgery can provide a success rate comparable to that demonstrated in prior studies employing a higher dose. Sixty-four eyes with poor prognoses underwent filtering surgery with postoperative subconjunctival injections of 5 mg of 5-fluorouracil daily for seven days followed by one injection 1 week later. In 75% percent of the eyes intraocular pressure stabilized at 21 mm Hg or less regardless of medications used. The majority of failures occurred within 6 months of treatment. Postoperative corneal epithelial defects occurred in 30% of the cases, conjunctival wound leaks in 6.3%. A 40-mg dose of subconjunctival 5-fluorouracil appears to be effective and may be associated with a lower incidence of postoperative complications than higher doses.

Adolescent↗

PubMed1986

Prevention and management of delayed suprachoroidal hemorrhage after filtration surgery.

We report two new cases of massive delayed nonexpulsive suprachoroidal hemorrhage (DNSH) following a filtering operation in the aphakic eyes of elderly patients with glaucoma. A timely surgical drainage resulted in full recovery of preoperative visual acuity in both of our patients. As we combine our cases with a series of 18 similar cases of others in the literature, the following conclusions emerge. Limited DNSH does not require surgical intervention for a favorable visual outcome. Massive DNSH, however, requires timely and appropriate surgical intervention to achieve a favorable visual outcome and to avoid persistent hypotony. The most effective surgical intervention is drainage of the suprachoroidal hemorrhage and re-formation of the anterior chamber, but without concomitant vitrectomy. In both limited and massive DNSH, the final visual outcome is not determined by the worst vision at the time of DNSH. Some of the known and suspected risk factors of DNSH following filtering surgery are old age, aphakia, postoperative hypotony, a history of vitreous manipulation or complication, general anesthesia, increased venous pressure, use of fluorouracil, and high myopia. In view of these risk factors, we recommend several preventive measures for decreasing the incidence of DNSH following filtering surgery.

Aged↗

PubMed2000

Paired parallel locking forceps.

We describe an instrument used to prevent contact between an antimetabolite and the conjunctiva-Tenon's wound edge in filtering surgery. Paired parallel locking forceps were used to keep the everted conjunctival-Tenon's wound edge from touching the antimetabolite sponge during limbal-based filtering surgery while enabling manipulation of the antimetabolite sponge. This allows the surgeon to more easily avoid the conjunctival edge, making antimetabolite touch easier and safer.

Alkylating Agents↗

PubMed2005

Filtering bleb function after clear cornea phacoemulsification: a prospective study.

AIM: To evaluate the influence of clear cornea phacoemulsification on filtering bleb morphology, function, and intraocular pressure (IOP) in glaucomatous eyes with previously successful filtering surgery. METHODS: The clinical course of 30 patients (30 eyes) who underwent clear cornea phacoemulsification after successful filtering glaucoma surgery was prospectively evaluated. Mean IOP and filtering bleb morphology (standardised assessment criteria and score 0-12, 12 = optimum) were determined before surgery, and 3 days, 6 months, and 12 months after surgery. The control group consisted of 36 patients with glaucoma after clear cornea phacoemulsification without previous filtering surgery. RESULTS: Mean IOP increased after phacoemulsification by about 2 mm Hg (preoperatively 14.28 (SD 3.71) mm Hg, 12 months postoperatively 16.33 (3.31) mm Hg, p = 0.006). 15 patients (50%) showed an IOP increase of >2 mm Hg, 11 patients (36.7%) had no IOP difference (within 2 mm Hg), and in four patients (13.3%) IOP decreased >2 mm Hg. Mean score of filtering bleb morphology 1 year after surgery decreased from 9.5 to 9.0 (p = 0.154). In three of 30 preoperatively IOP regulated eyes the postoperative IOP was 21 mm Hg. The control group showed an average IOP decrease of 2.01 mm Hg (p = 0.014) 12 months after cataract surgery. CONCLUSION: An increase in IOP was found 1 year after phacoemulsification in half of the filtered glaucomatous eyes. IOP in glaucomatous eyes without previous filtering surgery decreased in the same period. Cataract extraction using clear cornea phacoemulsification may be associated with a partial loss of the previously functioning filter and with an impairment of filtering bleb morphology.

Aged↗

PubMed2004

Surgically induced corneal refractive change following glaucoma surgery: nonpenetrating trabecular surgeries versus trabeculectomy.

PURPOSE: To compare surgically induced corneal refractive change following trabeculectomy with the nonpenetrating trabecular filtering surgeries with and without implant. SETTING: Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey. METHODS: A consecutive series of 34 patients (34 eyes) with uncontrolled open-angle glaucoma had trabecular filtering surgery. Patients were assigned randomly to receive viscocanalostomy (12 patients), nonpenetrating deep sclerectomy (NPDS) with T-flux implant (10 patients), and trabeculectomy (12 patients). Autokeratometry and computerized corneal videokeratoscopy with the Topcon KR-7000P autokeratorefractometer were performed preoperatively and 1 day and 1, 3, and 6 months postoperatively to analyze surgically induced keratometric and topographic astigmatism. RESULTS: Thirty patients (11 trabeculectomy, 11 viscocanalostomy, and 8 NPDS with nonabsorbable implant) completed the study. Mean patient age was 61.7 years +/- 10.9 (SD) (range 37 to 81) and did not differ among groups. Postoperative intraocular pressure (IOP) levels and visual acuity (logMAR values) did not differ among groups compared with preoperative levels. Average induced astigmatism was lower in the NPDS group than the trabeculectomy group at postoperative month 3 and 6 based on autokeratometry values (P =.023 and.042, respectively). Nonpenetrating surgeries resulted in less induced astigmatism in the early postoperative period and less against-the-rule shift over 6 months. CONCLUSION: Despite larger flap size and surgical area, nonpenetrating trabecular surgeries induced less astigmatism than trabeculectomy.

Adult↗

PubMed2002

[Antimetabolites in glaucoma surgery--long-term results].

PURPOSE: To observe the long term success of antimetabolites used in glaucoma filtering surgery in eyes with high risc of failure. MATERIAL AND METHOD: Two groups of patients undergone trabeculectomy with the use of antimetabolites 5-Fluorouracil (5-FU) and Mitomycin C (MMC) are included in this retrospective study. 5-FU was administered postoperatively 1-10 times in the dose of 5 mg/ml in subconjunctival injection on 32 eyes. Follow up time ranged from 8 months to 9 years. Mitomycin C was administered intraoperatively in the dose of 0.2 mg/ml, on subconjunctival sponge with application time from 3 to 5 minutes on 15 eyes. Follow up time ranged from 7 month to 4.5 years. RESULTS: Intraocular pressure (IOP) before operation with the use of 5-FU was in average 28.8 mmHg (22-50 mmHg) at the end of therapy with 5-FU was 17.6 mmHg (10-30 mmHg) and in the last examination was on average 19.5 mmHg (14-28 mmHg). IOP before operation with the use of MMC was in average 30.3 mmHg (22-40 mmHg), the seventh day after administration of MMC 12.7 mmHg (6-20 mmHg) and in the last examination was in average 18 mmHg (9-28 mmHg). During the long term observation of IOP values in the 5-FU group there was 79.2% success and in the MMC group there was 83.3% success (IOP up to 20 mmHg with or without therapy). Decrease of IOP was statistically significant. CONCLUSION: Antimetabolites improve the success of filtering surgery in high risc glaucomas. The long term follow up shows that failure of filtration in these types of glaucomas is still a serious clinical problem.

Adult↗

PubMed1976

Modified trabeculectomy incision for c ataract extraction.

Preservation of the fistula site from previous filtering surgery for glaucoma at the time of cataract surgery is difficult. A modified trabeculectomy incision for cataract extraction following successful filtering surgery for glaucoma is described.

Aged↗

PubMed1991

Regulating the dose of 5-fluorouracil to prevent filtering bleb scarring.

Repeated doses of 5mg of 5-fluorouracil (5-FU) were injected subconjunctivally in 25 poor-prognosis glaucomatous eyes after filtering surgery to prevent filtering bleb scarring. The frequency (1-2 times a day) and duration (minimum, 7 days) of injections were determined by the degree of the anterior chamber reaction and/or conjunctival hyperemia at the filtering bleb site. Punctate corneal erosions or filaments were not considered a contraindication to continuation of 5-FU treatment. After 12 months, intraocular pressure (IOP) of 16 mmHg or less without medical treatment was found in 19 (76%) eyes. In 16 of these (64%), the IOP was 12 mmHg or less. In two (8%) other eyes, it was 20 mmHg or less with medication. We believe that the comparatively low IOP levels achieved without medical treatment in 76% of the eyes in our study can be attributed in part to our therapeutic approach with 5-FU.

Adolescent↗

PubMed1993

Trabeculotomy in juvenile primary open-angle glaucoma.

Long-term results of trabeculotomy in juvenile primary open-angle glaucoma (JPOAG) were investigated based on a follow-up study of 16 eyes in 11 patients, diagnosed when they were between 10 and 45 years old. Preoperative visual field defects were found in 75% (12/16) of the eyes. After a mean follow up of 7 years (range, 1 to 18 years), 88% (14/16) of the eyes had an intraocular pressure (IOP) of 21 mm Hg or less (peak pressure at diurnal curves). Nine of these were receiving no medical treatment and five were being treated with beta-blockers and/or dipivefrin. The best results were in the younger patients; the success rate of those under age 40 years was 100%. After normalization of IOP, visual field testing showed no progression in defects. We conclude that trabeculotomy rather than filtering surgery should be used to treat JPOAG, because the success rate of filtering surgery decreases with decreasing age. Also, the good functional results achieved in these patients after normalization of IOP may indicate that ocular hypertension is the only risk factor in JPOAG.

Adolescent↗

PubMed2004

[The influence of cataract surgery on the efficacy of trabeculectomy in patients with open-angle glaucoma].

PURPOSE: To study the influence of cataract surgery on the intraocular pressure decreasing effect of trabeculectomy in patients with open angle glaucoma. METHOD: Retrospective study that included two groups: --32 patients with open angle glaucoma, their intraocular pressure being controlled after filtering surgery; they were subject to cataract surgery at least 6 months after the trabeculectomy (the CT group)--44 patients with open angle glaucoma (primary or secondary) with intraocular pressure controlled after trabeculectomy (the T group). The evaluation included: preoperative intraocular pressure, early (at 2 months) and late (at 18 months) postoperative intraocular pressure, intra- and postoperative complications of the cataract surgery, the need for antiglaucoma medication. RESULTS: The cataract surgery in patients with trabeculectomy increases the intraocular pressure (initial mean IOP = 15.31 mmHg, final mean IOP = 18.53 mmHg, mean IOP = 3.22 mmHg). The intraocular pressure increase is more important after extracapsular extraction than after phacoemulsification (3.7 vs. 2.01 mmHg). Qualified therapeutical success was obtained in 81.25% of CT patients. In the T group the postoperative intraocular pressure maintained constant throughout the entire follow-up period. The number of additional antiglaucoma drugs was larger in the T group (0.7 versus 0.5). The patients that suffered intra and postoperative complications had increased intraocular pressure when compared to those without complications (mean IOP early = 3.1 mmHg, mean IOP late = 1.1 mmHg). CONCLUSIONS: Cataract surgery in patients with previous filtering surgery increases the intraocular pressure and the need for antiglaucoma drugs. The intraocular pressure rise was more important after extracapsular extraction than after phacoemulsification. Intra and postoperative complications result in a more important increase in intraocular pressure, in the first months after the cataract operation.

Aged↗

PubMed1998

The effects of RGD (Arg-Gly-Asp) peptides on glaucoma filtration surgery in rabbits.

BACKGROUND AND OBJECTIVE: Integrins are the main mediators of the interaction between fibroblasts and extracellular matrix (ECM) during scar formation. The adhesion motive RGD (Arg-Gly-Asp) is contained in the ECM and is recognized by the integrin receptor. Soluble peptides containing the RGD sequence can compete with -RGD- contained in the ECM for binding to the integrin receptor and thus prevent cell adhesion and scar formation. MATERIALS AND METHODS: The peptides RGD (p602), GRGDSP (p603), GRGDSPCA (p604), and GGRGDSPCA (p605) were used in 25 glaucoma filtering surgeries in rabbits (five eyes per peptide and five with saline). RESULTS: Postoperative subconjunctival injections of peptides were given at days 0, 4, 8, 12, and 16. Bleb size, bleb survival, and signs of toxicity were examined. The GRGDSPCA and GGRGDSPCA showed an increase in bleb formation, size, and survival with no clinical signs of toxicity compared with controls (P < .008). Histopathologic evaluation confirmed inhibitory effects in scar formation with bleb formation, and transmission electron microscopy demonstrated that there was no toxicity to the ciliary body. CONCLUSION: These peptides were effective in controlling scar formation in glaucoma filtering surgery.

Animals↗