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At least 37 records · Page 2Linked to original sources
PubMed1997

Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment.

PURPOSE: Hypotony maculopathy after glaucoma filtering surgery with adjunctive mitomycin C has been reported to occur in 3% to 14% of cases. The authors evaluated its incidence when using a corneal safety-valve incisior intended to reduce its occurrence. The authors also evaluated a technique for reversing hypotony maculopathy by reoperation using two sets of stitches in the scleral flap, with one set tied tightly to temporarily raise the intraocular pressure, stretch the sclera, and flatten chorioretinal folds. METHODS: The authors reviewed the results of 699 procedures performed between April 1991 and October 1994. All were performed or supervised by one surgeon (PFP). RESULTS: Hypotony maculopathy developed in 9 (1.3%) of 699 eyes. There was a statistically significant higher incidence in primary filters (4%) as compared to secondary filters or combined procedures. After revision, eight (89%) of nine recovered visual acuity of greater than or equal to 20/30 and the mean intraocular pressure was 14.5 +/- 4 mmHg at a mean follow-up of 15 months. CONCLUSION: The incidence of hypotony maculopathy after glaucoma filtering surgery with mitomycin C using a corneal safety-valve incision is less than that reported in the literature without this incision. There is an increased risk in myopes, young patients, and primary filters. Early intervention with the described scleral flap revision technique usually allows restoration of prefiltration visual acuity without compromise of bleb function.

Adult↗
PubMed1997

Use of a special device for the treatment of overfiltration after glaucoma filtering surgery.

BACKGROUND: standardized A and B scan echography were used to look for the possible presence of ciliochoroidal detachment in patients with flat anterior chamber following glaucoma filtering surgery. For this purpose, a scleral shell filled with saline solution was inserted between the lids. As a deepening of the anterior chamber was found in some patients, we planned to utilize these devices for the treatment of flat anterior chambers after glaucoma filtering surgery. METHODS: 16 patients with flat anterior chambers after glaucoma filtering surgery underwent the insertion of a scleral shell filled with saline solution between the lids. The shell was left in place for 15 min. RESULTS: In all of our patients a deepening of the anterior chamber was achieved. In 5 patients 1 application, in 6 patients 2 applications, in 4 patients 3 applications were needed. CONCLUSIONS: The advantages of using this procedures are: the procedure is quick; it does not disturb the corneal epithelium; it is cheap; it does not require suturing the conjunctiva; it can be part of the examination of the anterior segment with echography to look for any ciliary body detachment.

Anterior Chamber↗
PubMed1995

5-Fluorouracil filtering surgery and neovascular glaucoma. Long-term follow-up of the original pilot study.

BACKGROUND: The long-term efficacy and safety of filtering surgery with 5-fluorouracil (5-FU) in eyes with neovascular glaucoma are unknown. METHODS: Kaplan-Meier survival curve analysis of surgical outcome was performed on all 34 patients (34 eyes) enrolled from May 1982 through April 1986 in the original pilot study of filtering surgery with 5-FU. RESULTS: Success rates at the 1-, 2-, 3-, 4-, and 5-year intervals were 71%, 67%, 61%, 41%, and 28%, respectively. The median filter survival time was 38.7 months (95% confidence interval: 32-45 months). Twelve (35%) of 34 patients lost light perception vision, and phthisis bulbi developed in 8 (24%) of 34 patients. Age of 50 years or younger (P < 0.0001) and type 1 diabetes (P = 0.0004) were significant risk factors for surgical failure. The 1-year success rate for patients no older than 50 years of age was 23% compared with a 95% success rate in patients older than 50 years of age. After adjustment for age, type 1 diabetes was a borderline risk factor (P = 0.06). CONCLUSION: There is a high risk of long-term failure of filtering surgery with 5-FU in neovascular glaucoma. Patients 50 years of age or younger have an extremely poor prognosis. Patients older than 50 years of age have initial short-term success with an accelerated failure rate after 3 years.

Adolescent↗
PubMed1991

Tissue plasminogen activator modifies healing of glaucoma filtering surgery in rabbits.

The healing response after glaucoma filtering surgery was analyzed immunohistochemically in rabbit eyes that had been treated with tissue plasminogen activator immediately after surgery and in the fellow eyes that had not been so treated. In the untreated eyes, at 1 day after surgery, fibronectin-like immunoreactivity was seen in the scleral fistula tract but not in the subconjunctival space of the filtering bleb. At 3 days immunoreactivity for fibronectin, collagen III, and collagen I could be seen in the bleb and fistula tract. By 14 days staining for collagen I and collagen III filled the surgical site, but fibronectin could only be seen in the fistula tract. In the eyes treated with tissue plasminogen activator immediately after surgery, the deposition of fibronectin and collagen III in the subconjunctival space and fistula tract was apparently delayed and diminished. This delayed and reduced deposition was correlated with the delayed clinical failure of surgery in these eyes. These results suggest that alteration of the biochemical changes in the extracellular matrix occurring after filtering surgery may influence the success of this surgery.

Animals↗
PubMed1994

The effects of intraoperative mitomycin-C or 5-fluorouracil on glaucoma filtering surgery.

We compared the success rate of filtering surgery of a single 5-minute intraoperative application of mitomycin-C (MMC) or 5-fluorouracil (5-FU). Animal experiment and clinical study were done. In animal study, thirty pigmented rabbits (60 eyes) weighing 2.0 to 2.5 Kg were enrolled. We divided into 4 groups, such as BSS, 5-FU 50 mg/ml, MMC 0.2 mg/ml and MMC 0.4 mg/ml subconjunctival soaked group. Each group consisted of 15 eyes. In each group, 10 eyes was for examination of bleb survival and complications, 3 eyes for light microscopic examination and 2 eyes for electron microscopic examination. Bleb was survived 6.1 days (3 to 13 days) for BSS treated group, 16.3 days (9 to 23 days) for 5-FU 50mg/ml treated group, 32.7 days (17 to 55 days) in MMC 0.2 mg/ml treated group, and 64.4 days (49 to 84 days) in MMC 0.4 mg/ml treated group. Duration of bleb survival was significantly prolonged in 5-FU, MMC 0.2 mg/ml and MMC 0.4 mg/ml group respectively. In clinical study, fifty-five eyes of 40 patients were enrolled. 29 eyes of 21 patients were treated with MMC 0.2 mg/ml and 26 eyes of 19 patients were treated with 5-FU 50 mg/ml. The success rate was 89.7% in MMC 0.2 mg/ml treated group and 84.6% in 5-FU 50 mg/ml treated group at postoperative 3 months, and postoperative 6 months 89.7% in MMC 0.2 mg/ml treated group and 76.9% in 5-FU 50 mg/ml treated group. There was no statistical significance at postoperative 3 months (P > 0.05), but statistical significance at postoperative 6 months (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Intraocular lens implantation after glaucoma filtering surgery--time course of changes in intraocular pressure control and filtering blebs].

Cataract extraction and intraocular lens (IOL) implantation were carried out in 45 glaucomatous eyes that had undergone glaucoma filtering surgery. Of these, 37 eyes had primary glaucoma, 2 eyes capsular glaucoma, and 6 eyes secondary glaucoma. The visual acuity after IOL implantation was 0.5 or more in 29 eyes (64%) but in 10 eyes (22%) acuity was 0.1 or less because of advanced optic nerve head damage. To analyze affects of IOL implantation on intraocular pressure (IOP) control and functioning of the filtration bleb in 39 eyes of primary or capsular glaucoma, a life-table analysis with the Kaplan-Meier method was performed. The probability that IOP control does not worsen at 2 years was 43 +/- 7% (SE) in 21 eyes without pre-operative ocular hypotensive medication, 56 +/- 16% in 18 eyes with pre-operative ocular hypotensive medication, 47 +/- 12% in 26 eyes where functioning filtering bleb existed pre-operatively. The probability that the filtering bleb survives 2 years post-operatively was 44 +/- 11%. The present results imply that intensive management of post-operative inflammation and careful IOP follow up are imperative in eyes in which IOL implantation was indicated after undergoing filtration surgery.

Aged↗
PubMed1994

Krupin eye valve with disk for filtration surgery. The Krupin Eye Valve Filtering Surgery Study Group.

PURPOSE: The authors evaluate a long posterior tube shunt device with a pressure sensitive valve for filtration surgery in eyes with recalcitrant glaucoma. METHODS: The device consisted of an anterior chamber tube connected to an oval (13 x 18 mm) episcleral explant. The explant was designed to maximize the area of surrounding encapsulation while still allowing implantation within one quadrant. A pressure-sensitive and unidirectional slit valve in the tube provided resistance to aqueous humor flow. One-stage implantation without the use of restrictive sutures was performed in 50 eyes with various types of glaucoma unresponsive to prior glaucoma surgery. RESULTS: Mean (+/- standard error of the mean) preoperative intraocular pressure (IOP) of 36.4 +/- 1.6 mmHg was reduced significantly (P < 0.001) to 8.3 +/- 1.3 mmHg on the first postoperative day. Mean anterior chamber depth (scale, 0-4+) was 3.4 +/- 0.1. Mean IOP 1 month after surgery was 14.1 +/- 1.3 mmHg. The implant was removed from four eyes due to IOP failure (1 eye), external erosion (2 eyes), or endophthalmitis (1 eye). A suprachoroidal hemorrhage occurred in one eye on the first postoperative day. Diplopia developed in one eye after surgery. Mean IOP at last follow-up examination (mean, 25.4 +/- 2.4 months; range, 16-36 months) was 13.1 +/- 1.3 mmHg. Intraocular pressure was 19 mmHg or lower in 80% of the eyes, 59% of which were without adjunctive antiglaucoma medications. CONCLUSIONS: Design features of the Krupin Eye Valve with Disk result in a large area of encapsulation in a single ocular quadrant which functions as an external reservoir for passage of aqueous humor. The valve portion facilitates maintenance of anterior chamber depth during the early postoperative interval. This new therapeutic device can be effective in the long-term control of IOP in glaucomatous eyes not responsive to prior filtration surgery with adjunctive antimetabolite therapy.

Female↗
PubMed1995

The Tübingen Glaucoma Study. Glaucoma filtering surgery--a retrospective long-term follow-up of 254 eyes with glaucoma.

A major focus of our study was the ability to predict the long-term success of filtering surgery. The results of glaucoma filtering surgery (trabeculectomy) as performed by the staff of the University Eye Hospital of Tübingen from 1988 through 1994 on 254 eyes of 214 patients are presented, with particular emphasis being placed not only on intraocular pressure (IOP) control but also the progression of glaucomatous damage (visual field loss or disc damage) and the etiology of visual acuity losses. There was an overall success rate of 64%. Rigid criteria for success included an IOP of less than 30 mmHg, no further visual field loss or disc damage, and no glaucomatous etiology for a decrease in visual acuity. A total of 35 eyes (13.8%) showed a loss of visual acuity after 6 months amounting to 2 or more Snellen lines, caused mainly by lens opacification, hypotony maculopathy, and "wipeout" (loss of the central visual field in the absence of another explanation). We found that there is a considerable risk for sudden loss of visual acuity after operation on older patients with small residual visual fields and severe hypotony on the 1st postoperative day. There was a 13% incidence of failure of blebs. A total of 34 eyes had an early IOP rise of more than 30 mmHg after surgery. A postoperative hypotony of less than 3 mmHg was more significantly seen in patients treated with 5-fluorouracil. Moreover, the results show that in some instances, a long-term use of topically applied glaucoma medication can adversely affect the results of fistulizing surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Wound healing after filtering surgery in owl monkeys.

We performed posterior lip sclerectomies in 29 owl monkey eyes to determine the natural history of wound healing after filtering surgery without adjunctive antimetabolite therapy. We noted three phases of wound healing during clinical and histologic examination: early healing (days 2 to 6), intermediate healing (days 7 to 9), and late healing (days 10 to 14). In the early healing phase, all limbal fistulas except one remained open gonioscopically, but by day 6, fibroblasts had proliferated along the walls of the opening. Proliferation and migration of fibroblasts continued during the intermediate healing phase to completely occlude four and to partially occlude two of the ten fistulas in the eyes studied during this time. In the late healing phase, the limbal fistula was completely closed by granulation tissue in four of five eyes and was slitlike open in one eye. In this model of filtering surgery, wound healing at the sclerectomy site with obliteration of the limbal opening by proliferating fibroblasts occurred within the first 14 postoperative days. We believe that the short-term effects of newer treatments designed to alter wound healing after filtering surgery may be assessed in this model, which is characterized by predictable and prompt wound healing.

Animals↗
PubMed1994

New lid speculum for glaucoma filtering surgery.

Successful bleb formation in glaucoma filtering surgery depends on adequate intraoperative visualization and atraumatic handling and preservation of normal conjunctiva and Tenon's capsule in order to avoid unnecessary stimulation and fibrous tissue formation. With these requirements in mind, we designed a new lid speculum that offers the following advantages: (1) wide surgical field exposure; (2) simultaneous globe fixation; (3) obviation of placing a bridle suture; (4) minimal damage to the superior rectus muscle, conjunctiva, and Tenon's capsule; (5) conjunctival incision placement far from the limbus; and (6) reduced operating time.

Eyelids↗
PubMed1984

Malignant glaucoma occurring 16 years after successful filtering surgery.

Malignant (ciliary block) glaucoma occurred in a patient 16 years after successful filtering surgery for glaucoma. Initially a moderate rise in intraocular pressure (IOP) occurred despite a functional filtering bleb. Pilocarpine treatment was started and exaggerated the attack of malignant glaucoma. The possibility that malignant glaucoma had occurred 16 years after successful filtering surgery was not appreciated until the anterior chamber deepened and a fall in IOP occurred with instillation of cycloplegic drops into the eye.

Female↗
PubMed1986

Dexamethasone, D-penicillamine, and glaucoma filter surgery in rabbits.

A study was made in rabbits of the effect of topical dexamethasone ointment, .05%, and either subconjunctival or intraperitoneal D-penicillamine on the duration of function of glaucoma filtering surgery. The drugs were tested alone and in combination. Intraperitoneal D-penicillamine was not effective, either alone or combined with topical dexamethasone. Topical dexamethasone ointment alone and subconjunctival D-penicillamine alone significantly prolonged the duration of function of the filter surgery; however, when combined, no additional effect was observed. It was concluded that the institution of therapy with both drugs immediately after glaucoma filtering surgery was not the optimal temporal sequence for combining the two modes of therapy.

Administration, Topical↗
PubMed1993

Filtering surgery with 5-fluorouracil subsequent to Molteno implant.

In cases of refractory glaucoma, when Molteno shunt implantation has been performed and resulted in failure, the best surgical option has not yet been established. Filtering surgery with 5-fluorouracil (5-FU) as one option for the above was performed in four non-neovascular glaucomatous eyes (four patients) after failure of Molteno shunt implantation. Injections of 5 mg 5-FU were administered once daily for 9-14 days. After follow-up of 6-18 months in 3 eyes, intraocular pressure ranged from 10 to 16 mm Hg. In the fourth eye, in which bleb scarring ensued, a second filtering surgery with 5-FU was performed after 4 months, and resulted in a successful outcome as recorded 26 months later. These preliminary results suggest that filtering surgery with 5-FU might be an acceptable surgical option in non-neovascular refractory glaucoma subsequent to failure of Molteno shunt implantation.

Adolescent↗
PubMed1984

5-fluorouracil and glaucoma filtering surgery. II. A pilot study.

5-Fluorouracil (5-FU) was injected subconjunctivally after glaucoma filtering surgery in a pilot study of eyes with poor surgical prognoses. Twenty-seven (79%) of the 34 aphakic eyes with glaucoma achieved an intraocular pressure (IOP) of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 91 -468 days). Nine (69%) of 13 eyes with neovascular glaucoma achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 120-379 days). Eight (89%) of nine phakic eyes with glaucoma following unsuccessful filtering procedures achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 134-394 days). Visual acuities remained within one line of their preoperative levels or improved in 32 (94%) of the 34 aphakic eyes with glaucoma, eight (62%) of the 13 eyes with neovascular glaucoma, and six (67%) of the nine phakic eyes with glaucoma following unsuccessful filtering procedures. Postoperative corneal epithelial defects occurred in 45% of the cases. Conjunctival wound and conjunctival needle tract leaks were observed in 41% of the cases, but only one eye required wound revision. No other serious side effects that we attributed to 5-FU were observed. It seems that postoperative subconjunctival 5-FU increases the likelihood of achieving IOP control following filtering surgery in eyes with poor surgical prognoses; however, a randomized clinical trial is necessary to confirm this.

Adolescent↗
PubMed1995

[An analysis of causes of post-operative shallow anterior chamber in glaucoma filtering surgery].

131 eyes of 103 cases having undertaken glaucoma filtering surgeries were randomly selected to analyze retrospectively the causes of the post-operative shallow anterior chamber. The causes are choroidal detachment accounting for 75.6%, excessive filtration 13.3% and malignant glaucoma 11.1%. As the rate of discovery of the choroidal detachment under a direct ophthalmoscope was quite low, the definite diagnosis depended primarily on B-ultrasonography. It is discovered that in the analysis of the possible factors leading to choroidal detachment, the plasma level of fibronectin is correlated to the development of the post-operative choroidal detachment of a glaucoma filtering operation, suggesting the impairment of microcirculatory function be investigated to approach the causes of the choroidal detachment following anti-glaucoma and other intraocular surgeries.

Adult↗
PubMed1977

The incidence of sickle trait in Blacks requiring filtering surgery.

Open-angle glaucoma in the blacks is generally thought to be a more malignant disease than in whites in terms of response to therapy and subsequent visual loss. An increased incidence of unsuspected sickle trait and undetected sickling may have contributed to these patients' optic nerve ischemia, progressive field loss and need for surgery. A homoglobin electrophoresis was done on 40 black patients who required filtering surgery for uncontrolled open-angle glaucoma. Only 2 of the 40 patients (5%) had sickle trait as determined by the hemoglobin electrophoresis. In a matched group of 40 controls, only 3 patients (7.5%) had sickle trait. Therefore, there does not appear to be an increased incidence of sickle trait in black patients requireing filtering surgery.

Adult↗
PubMed1992

Late-onset Moraxella catarrhalis endophthalmitis after filtering surgery.

We describe a young man in whom endophthalmitis caused by Moraxella catarrhalis developed 5 years after glaucoma filtering surgery. The infection responded to treatment with broad-spectrum antibiotics, and 2 months after presentation the visual acuity had returned to 20/50. To our knowledge this is the first report of late-onset endophthalmitis due to M. catarrhalis complicating glaucoma filtering surgery.

Adult↗