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Results for “Filtering Surgery”

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At least 289 records · Page 16Linked to original sources

PubMed1995

[Posterior chamber intraocular lens implantation in filtered glaucoma eyes].

PURPOSE: To investigate the method of cataract extraction with posterior chamber intraocular lens implantation in eyes that had undergone glaucoma filtering surgery and its effect on filtering bleb. METHODS: Extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed in 21 eyes with a preexisting filtration bleb, in which a lateral and inferior lateral limbal incison was selected, the pupil sphinctor was cut and the iris was sew for the small and fixed pupil. RESULTS: the postoperative visual acuity of all patients was improved in different degrees, with 0.5 or better in 76.19% of the eyes. The postoperative IOP increased by 0.41 kPa. The functional filtering bleb was not apparently cicatrized. CONCLUSIONS: Filtered glaucoma eyes with cataract can improve visual acuity and maintain the functional filtered bleb by extracapsular cataract extraction with posterior chamber intraocular lens implantation with lateral or inferior lateral limbal incision.

Aged↗

PubMed1999

Clinical phenotype of juvenile open-angle glaucoma linked to chromosome 1q in a Danish family.

PURPOSE: To describe in a Danish family the phenotype of members with autosomal dominant juvenile open-angle glaucoma linked to chromosome 1q, GLCA1, and to assess possible biometric differences between the eyes of affected and unaffected subjects. METHODS: Thirty-five subjects in a six generation family were examined. The records of five additional affected family members were available. Records from former examinations and treatments were also obtained. In 18 affected subjects and 13 unaffected subjects above 24 years biometric parameters were assessed and compared between the groups. RESULTS: The age at diagnosis of glaucoma was on average 18 years (range 8 to 33 years). Bilateral intraocular pressure was high at the time of diagnosis (mean 37 mmHg, range 28-69 mmHg). All subjects except two needed filtering surgery shortly after diagnosis (mean 1 year, range 0-8 years). Gonioscopy displayed open chamber angle and goniodysgenesis in all affected subjects, but no dysgenesis in unaffected subjects. A comparison of biometric parameters of affected and unaffected subjects showed a deeper anterior chamber, but no other differences were found. CONCLUSION: The phenotype of the affected family members is characterized by juvenile onset of glaucoma, open chamber angle with goniodysgenesis, high initial intraocular pressure, and the need for filtering surgery to control pressure. The deeper anterior chamber in affected subjects could indicate more extensive maldevelopment in affected subjects.

Adolescent↗

PubMed2002

Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes.

OBJECTIVE: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. MAIN OUTCOME MEASURES: Visual acuity outcomes and intraocular pressure control after endophthalmitis. RESULTS: An antifibrotic agent was used in 40 (82%) of the 49 eyes identified, including mitomycin-C in 33 (67%) and 5-fluorouracil (5-FU) in 7 (14%). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27%) eyes, bleb manipulations in 15 (31%) (needling in 3 [6%], compression sutures in 2 [4%], laser suture lysis in 6 [12%], bleb revision in 5 [10%], and autologous blood injection in 2 [4%]), bleb defects in 6 (12%), inferior bleb location 6 (12%), and nasolacrimal duct obstruction in 1 (2%). The most common causative organisms were Streptococcus species in 15 eyes (31%) and Staphylococcus species in 11 eyes (22%). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: > or = 20/40 (5% versus 15%), 20/50 to 20/400 (32% versus 54%), and < 5/200 (64% versus 31%). Eleven (22%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11%) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. CONCLUSIONS: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.

Adult↗

PubMed2003

Conversion from trabeculectomy to deep sclerectomy. Prospective study of the first 44 cases.

PURPOSE: To evaluate the outcomes of conversion from trabeculectomy to deep sclerectomy with placement of a drainage implant. SETTING: Department of Ophthalmology, Hospital of Buskerud, Drammen, Norway. METHODS: Deep sclerectomy was performed in 41 patients (44 eyes) from November 1999 to January 2002. An absorbable implant (AquaFlow((R)), Staar Surgical) and a nonabsorbable implant (T.Flux((R)), IOLTech Laboratories) were used in 75% and 25% of eyes, respectively. Patients with open-angle glaucoma who needed filtering surgery were enrolled consecutively in a prospective study. Patients with 2 or more previous filtering surgeries or neovascular glaucoma were excluded, as were children. Of the original 48 eyes, accidental perforation of the trabeculo-Descemet's membrane occurred in 8.3%; these eyes were excluded from the study. The severity of optic nerve damage was considered in the decision to start therapy. An intraocular pressure (IOP) above 22 mm Hg was always treated. RESULTS: After a mean follow-up of 12.9 months +/- 7.1 (SD), 61.4% of eyes were controlled without therapy. When eyes with previous surgery were excluded, the rate increased to 66.7% after a mean follow-up of 13.8 +/- 7.2 months. The mean IOP preoperatively and after 12 months was 27.9 +/- 6.9 mm Hg and 14.6 +/- 3.5 mm Hg, respectively (P<.001). The mean number of medications decreased from 3.4 +/- 1.0 preoperatively to 0.6 +/- 1.1 12 months postoperatively (P<.001). A reoperation was required in 2 cases (4.5%). There were no complications related to hypotony or other significant complications. CONCLUSIONS: This study shows that conversion from trabeculectomy to deep sclerectomy with placement of an implant is safe. The postoperative IOP reduction was acceptable, and no significant complications occurred.

Adult↗

PubMed1987

Adjusting the dose of 5-fluorouracil after filtration surgery to minimize side effects.

The antimetabolite 5-fluorouracil (5-FU) was used as adjunctive treatment in glaucomatous eyes with poor prognoses undergoing filtering surgery. By adjusting the frequency of postoperative 5-FU subconjunctival injections according to the clinical response, the author thought it might be possible to reduce episcleral fibroproliferation and maintain a patent filter while reducing complications. Sixty-three eyes underwent filtering surgery with subsequent subconjunctival injections of 5.0 to 7.5 mg 5-FU for 14 days. The antimetabolite was not administered if there was evidence of corneal toxicity as demonstrated by epithelial defects or filaments, flat anterior chamber, or a conjunctival wound leak. By adjusting the injections in this fashion, the total amount of 5-FU administered ranged between 17.5 and 62.5 mg (34.4 +/- 11.6 mg). After 1 year, successful surgical outcomes were observed in 13/15 eyes with aphakia (87%), 11/17 eyes with neovascular glaucoma (65%), 11/12 eyes with at least two previous failed filters (92%), and 5/6 eyes with inflammatory glaucoma (83%). Eyes with epithelial downgrowth and cicatrizing diseases of the conjunctiva also were treated. Overall, conjunctival wound leaks were observed in 24% of the eyes and 29% had detectable changes in their corneal epithelium with corneal defects and filaments. Although adjusting the dose of 5-FU appears to be safe and effective, this can be determined clearly only by a controlled randomized clinical trial.

Adult↗

PubMed2004

[Frequency of reoperations after amniotic membrane transplantation].

BACKGROUND: Retrospective evaluation of the frequency of reoperations after amniotic membrane transplantation for different pathologic entities. MATERIAL AND METHODS: We included 81 cases of amniotic membrane transplantation (AMT), which were operated on at the university eye clinic Tübingen since 1997 and which had been followed up for at least 12 months. Patient diagnoses were subdivided as follows: conjunctival defects after tumour excision (N = 2), bullous keratopathy (N = 5), external fistula after glaucoma filtering surgery (N = 3), recurrent pterygium (N = 5), symblepharon (N = 6), corneal ulcer with descemetocele (N = 3), non-perforated corneal ulcer (N = 51), perforated corneal ulcer (N = 1), other (n = 5). RESULTS: The overall reoperation rate was determined to be 42 % after a follow-up period of one year. Most frequently, a second AMT (N = 16) and a perforating keratoplasty (N = 16) were performed after the initial AMT. The following reoperation rates were determined for the subgroups: Conjunctival defects after tumour excision (0 %), Bullous keratopathy (60 %), External fistula after glaucoma filtering surgery (67 %), Recurrent pterygium (60 %), Symblepharon (67 %), Corneal ulcer with descemetocele (67 %), Non-perforated corneal ulcer (49 %), Perforated corneal ulcer (100 %). CONCLUSIONS: Particularly in patients with conjunctival defects after tumour excision and with non-perforated corneal ulcers, stabilisation of the ocular surface homeostasis can be achieved with a single amniotic membrane transplantation for at least one year.

Biological Dressings↗

PubMedDate not supplied

Effect of cytokines on regulation of the production of transforming growth factor beta-1 in cultured human Tenon's capsule fibroblasts.

PURPOSE: Transforming growth factor-beta1 (TGF-beta1) is thought to play a pivotal role in the regulation of the wound healing process after glaucoma filtering surgery. The aim of the present study was to investigate whether platelet-derived growth factor isoforms (PDGF-AA, PDGF-BB), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), interleukin-1beta (IL-1beta) and transforming growth factor-beta1 (TGF-beta1) modulate the production of latent and/or active TGF-beta1 by cultured human Tenon's capsule fibroblasts (HTF). METHODS: Human Tenon's capsule fibroblasts were seeded at two different densities (30 cells/mm2 and 150 cells/mm2) and stimulated for five days with PDGF-AA, PDGF-BB, bFGF, EGF, IL-1beta and TGF-beta1. Control cells were treated with serum-free medium (WM/F12). The concentrations of latent and active TGF-beta1 in the medium were determined using an immunoassay before and after activation of TGF-beta1 by transient acidification. RESULTS: The concentration of latent TGF-beta1 in conditioned media from HTF seeded at high density (150 cells/mm2) significantly increased after stimulation with 5 ng/ml TGF-beta1 (151.5 +/-41.7 pg/ml) or 10 ng/ml IL-1beta (45.7+/-8.1 pg/ml). The concentration of active TGF-beta1 in conditioned media also significantly increased after stimulation of HTF with 5 ng/ml TGF-beta1 (48.4+/-27.5 pg/ml). CONCLUSIONS: The present results indicate that TGF-beta1 is the most potent inducer of its own synthesis in HTF. Activation of an autocrine TGF-beta1 loop may play a role in the wound healing response after glaucoma filtering surgery.

Cells, Cultured↗

PubMed1996

Effect of fibrostatin C, an inhibitor of prolyl 4-hydroxylase, on collagen secretion by human Tenon's capsule fibroblasts in vitro.

PURPOSE: To investigate the effect of fibrostatin C, a prolyl 4-hydroxylase (PH) inhibitor produced by Streptomyces catenulae subsp. griseospora, on type I collagen secretion by human Tenon's capsule fibroblasts (TCFs) in vitro, as an indication of the potential therapeutic efficacy of this compound in antifibrotic therapy after glaucoma filtering surgery. METHODS: The concentrations of type II procollagen COOH-terminal peptide (PIP) in culture medium or cell lysate were determined by immunoassays. For comparison with its effect on PIP secretion, we determined the effects of the agent on the secretion of other peptides, including laminin, vitronectin receptor, and a metalloproteinase inhibitor. The expression of collagens I and III, fibronectin, and PH by TCFs was examined by immunohistochemistry, and cellular ultrastructure was evaluated by transmission electron microscopy. RESULTS: Fibrostatin C (50 microM) significantly reduced the concentration of PIP in culture medium and increased its concentration in the cell lysate in a dose-dependent manner, but it had no effect on the secretion of other peptides. Cell viability and proliferation were not affected by fibrostatin C. Fibrostatin C also increased the number of cytoplasmic granules immunoreactive with antibodies to collagen I or III, but had no effect on fibronectin or PH immunoreactivity. Ultrastructurally, cisternae of the endoplasmic reticulum were dilated in fibrostatin C-treated TCFs, consistent with the retention of underhydroxylated collagen precursors in this organelle. CONCLUSIONS: Fibrostatin C inhibits the secretion of type I collagen by cultured TCFs. This agent may thus prove therapeutically beneficial for inhibiting the excess fibrosis in the wound of filtering surgery.

Aged↗

PubMed1983

Early and late failures of argon laser trabeculoplasty.

Sixty-five eyes in 52 patients with open-angle glaucoma were treated with argon laser trabeculoplasty (ALT). Although a majority of the eyes showed a decrease in intraocular pressure (IOP) of 5 mm Hg or more, eight eyes required filtering surgery within one year of treatment, and extensive peripheral anterior synechiae and persistent elevation of IOP developed in an additional two eyes that did not undergo surgery. In four of six eyes with juvenile glaucoma that were treated with ALT, complications developed and/or filtering surgery was required. A rise in IOP more than a year after treatment was noted in two eyes that had shown an initial satisfactory response to ALT. Although ALT seems to be a valuable addition to glaucoma therapy, the potential exists for both early and late complications and failures.

Glaucoma, Open-Angle↗

PubMed2002

Effects of tranilast on filtering blebs: a pilot study.

PURPOSE: To investigate the effects of topical instillation of 0.5% tranilast eye drops on intraocular pressure (IOP) and bleb formation after glaucoma filtering surgery. PATIENTS AND METHODS: This was a prospective, randomized, double-masked, and controlled clinical trial. A total of 52 eyes of 52 patients were randomly assigned to receive either 0.5% tranilast eye drops (24 eyes) or vehicle saline solution (28 eyes) 4 times daily for 3 months after trabeculectomy. Features of the bleb, such as vascularization and size, and intraocular pressure were studied. RESULTS: The incidence of vascularized bleb and "pseudopod" formation 6 months post treatment were more common in tranilast-treated eyes than control eyes (P = 0.019 and P = 0.043, respectively). The bleb was significantly larger at 6 and 12 months (P = 0.024 and P = 0.049, respectively), and reduction of the IOP was more significant for 2 years postoperatively (P = 0.002 to P = 0.032) in tranilast-treated eyes than control eyes. No vision-threatening side reactions were associated with tranilast. CONCLUSIONS: The use of topical tranilast after filtering surgery alleviates ischemia of the filtering bleb, reduces IOP, and increases the size of the bleb.

Administration, Topical↗

PubMed2005

Intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

PURPOSE: This study investigated firstly the change of intraocular pressure (IOP) after injection of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema and secondly the factors that influence these changes. METHODS: A prospective, non-comparative study was performed in 60 patients at Kangnam Sacred Heart Hospital from October 2003 to September 2004. All the patients received 4-mg IVTA injection. RESULTS: Mean IOP was elevated from the day after injection and peaked at 20.5 mmHg after 2 months (p=0.000). Twenty-six eyes (43.3%) showed significant IOP elevation. IOP was not controlled despite full glaucoma medication in 7 (11.7%) eyes. Two eyes underwent filtering surgery. Younger age was a statistically significant predictive factor for IOP elevation (p=0.009). CONCLUSIONS: In this study, patients who needed filtering surgery developed an IOP spike within one week after the injection. Therefore, clinicians should consider checking IOP at the end of the first week. Furthermore, greater cautions is mandatory with relatively younger patients.

Adult↗

PubMed2002

Individual factors influencing trabecular morphology in glaucoma patients undergoing filtration surgery.

PURPOSE: Epidemiologic studies have shown that various lifestyle characteristics are statistically associated with the chronic open-angle glaucomas. This study was designed to investigate the influence of individual factors on the light-microscopic morphology of the trabecular meshwork in open-angle glaucomas. METHODS: Quantitative computer-assisted topographic analysis of the trabecular meshwork was performed in meridional sections of 80 trabeculectomy specimens from patients with primary open-angle (n = 36), exfoliative (n = 30) and pigment-dispersion (n = 14) glaucoma. Measurements included inner wall length of the, central thickness of the trabecular meshwork, and compactness of the Schlemm canal and trabecular meshwork. Morphologic data were correlated with individual patient data including age, duration of the disease, maximum intraocular pressure, cup-disc ratio, refraction, height, weight, body mass index, a simple morbidity index, previous surgery, and number of topical antiglaucomatous medications used. RESULTS: Inner wall length of the Schlemm canal was significantly lower in eyes with previous filtering surgery (P = 0.03), but not in eyes with a high number of topical medications (P = 0.17). There was a significant tendency for the inner wall length of the Schlemm canal to be shortened in patients where high maximum intraocular pressure was combined with long-term glaucoma (P = 0.027). Body mass index did not differ significantly between patients with primary open-angle, exfoliative, and pigment-dispersion glaucoma and showed no correlation with the quantitative data of the meshwork. The morbidity index correlated well with body mass index (0.0006) and age (P < 0.0001). CONCLUSION: Contrary to findings of experimental mice studies, we found no indication that glaucoma patients with lower body mass index have a larger lumen of the Schlemm canal than patients with a higher body mass index. Although caution should be used when interpreting data from trabeculectomy studies, there is a certain probability that a history of previous filtering surgery and of a long-term high intraocular pressure will be associated with a shortening of the Schlemm canal.

Adult↗

PubMed1999

[The use of antimetabolites in the treatment of glaucoma].

Many adjunctive therapies have been proposed to increase the success and prevent or reduce the incidence of complications associated with filtering surgery. Intraoperative or postoperative use of an antimetabolite has found a place as adjunctive therapy for eyes with otherwise pour prognosis following glaucoma filtering surgery.

Antimetabolites↗

PubMed1998

The contribution of phacoemulsification to combined cataract and glaucoma surgery.

The refinements of small incision cataract surgery by phacoemulsification with foldable intraocular lens implantation and the pharmacologic modulation of wound healing have brought new options for the combined procedure. Phacoemulsification combined with filtering surgery has the potential advantage of requiring a smaller conjunctival and scleral incision, which may reduce inflammation and bleb scarring with the possibility of enhanced bleb formation and long-term intraocular pressure control. The smaller phacoemulsification incision also helps to reduce postoperative astigmatism and improve visual results. Following combined phacoemulsification and filtering surgery, a larger area of undisturbed or virginal tissue in the conjunctiva and at the limbus is spared for further glaucoma surgeries or revision if the initial procedure fails. The risk of suprachoroidal hemorrhage during phacoemulsification in this susceptible group of patients is minimized by maintaining a closed chamber during the procedure.

Antimetabolites↗

PubMed2002

A prospective randomized trial of viscocanalostomy versus trabeculectomy in open-angle glaucoma: a 1-year follow-up study.

PURPOSE: To assess the intraocular pressure-lowering efficacy and the postoperative complication profile of viscocanalostomy versus trabeculectomy. PATIENTS AND METHODS: Sixty eyes of 60 patients with medically uncontrolled open-angle glaucoma were randomized either to the viscocanalostomy or to the trabeculectomy group of the trial. Viscocanalostomy was performed according to Stegmann's technique using high-molecular-weight sodium hyaluronate to fill the ostia of the Schlemm canal. For trabeculectomy, a modified Cairns-trabeculectomy was performed. Examinations were performed before surgery and postoperatively daily for 1 week. Follow-up visits were scheduled 1, 6, and 12 months after surgery. RESULTS: The mean (SD) preoperative intraocular pressure was 27.1 (7.1) mm Hg for all patients enrolled. One day after surgery, mean (SD) intraocular pressure was 15.9 (5.2) for the trabeculectomy group (P <0.001) and 15.7 (3.6) for the viscocanalostomy group (P <0.001), respectively. The success rate, defined as an intraocular pressure lower than 22 mm Hg without medication, was 56.7% in the trabeculectomy group and 30% in the viscocanalostomy group at 12 months postoperatively (P = 0.041). The number of postoperative complications was lower in the viscocanalostomy group than in the trabeculectomy group. CONCLUSIONS: In eyes with open-angle glaucoma, viscocanalostomy is less effective in reducing intraocular pressure than standard filtering surgery. However, postoperative complications are more frequent after filtering surgery.

Conjunctiva↗

PubMed1991

Risk factors associated with late infection of filtering blebs and endophthalmitis.

Late infection of filtering blebs and endophthalmitis are hazardous complications of glaucoma filtering surgery frequently associated with bleb failure and loss of functional vision. To determine possible risk factors for the development of these complications, characteristics of nine eyes of nine patients after filtering surgery in whom late endophthalmitis developed were compared with those in patients who had received a comparable operation at the same time in whom endophthalmitis did not develop. An average of 7.7 +/- 6.2 years (range, 6 months to 18 years) elapsed between the time of the filtering procedure and the initial appearance of endophthalmitis. Factors associated with increased risk were: increased axial length, thin and leaky bleb, conjunctivitis, upper respiratory infection, and the winter season.

Adolescent↗

PubMed2003

[The refractory glaucomas].

Refractory types of glaucoma continue to present a therapeutic challenge to ophthalmologists. Approaches toward the management of these difficult glaucomas are addressed in this paper. The first part devotes special attention to understand the cause(s) of the failure of previous filtering surgery(ies). The next part emphasizes filtration surgery with intraoperative application of antimetabolites: 5-fluorouracil or mitomycin C and the surgical and pharmacological management of failing filtration. In case of failure of multiple filtering surgery with application of antimetabolites, surgeons have to consider cyclodestructive procedures (transscleral diode laser or endoscopic cyclophotocoagulation) to reduce aqueous production, or fistulizing procedures with tube implants or other drainage devices (valves).

Glaucoma↗

PubMed2001

[Laser flare in combined cataract and glaucoma surgery].

BACKGROUND: We used a laser-flare meter to compare inflammation of the anterior chamber in combined cataract and glaucoma surgery with that in pure filtering surgery. MATERIALS AND METHODS: In 34 consecutive patients with primary chronic open-angle glaucoma (PCOG) we combined glaucoma surgery and cataract extraction with phacoemulsification and implantation of a foldable intraocular lens via the same incision. We compared the results with those in 32 PCOG patients receiving a single goniotrephination and in 45 PCOG patients receiving cataract extraction via clear cornea with implantation of a foldable lens. RESULTS: The increase in the flare in the first 2 days was significant in those receiving combined cataract and glaucoma surgery and in those receiving single goniotrephination but not in those receiving a single cataract extraction. After 3 weeks there was no significant difference to the preoperative value in any of the groups. The highest flare values were in patients after combined surgery, significantly higher than after cataract extraction in the first days and higher than in the goniotrephination patients 3 weeks after the operation. CONCLUSION: The highest flare on the first day was in combined cataract and glaucoma surgery. This may explain the more frequent scarring of the filtering bleb in combined surgery. Postoperatively the intraocular pressure and number of drugs used for glaucoma did not differ in patients with combined and single goniotrephination.

Aged↗