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At least 361 records · Page 20Linked to original sources
PubMed2002

[Perspectives in glaucoma surgery].

Trabeculectomy is still considered to be the gold standard in the surgical treatment of the open-angle glaucomas. The additional application of local antimetabolites has reduced the rate of early filtering bled fibrosis, but increased the rate of essential late-postoperative complications. Growth factor inhibition and photodynamic therapy may be an alternative local treatment to enhance the results in filtering surgery. Non-penetrating glaucoma surgery and ab-interno trabecular surgery have several conceptual advantages, e.g. the lack of overfiltration or the untouched conjunctiva in the ab-interno approach. Clinical studies of these and other new procedures including antiglaucomatous retinectomy and subchoroidal shunt systems are currently performed in order to evaluate their potential and limits in the clinical management of glaucoma.

Filtering Surgery↗
PubMed2000

[Vitrectomy for the treatment of expulsive hemorrhage].

PURPOSE: To evaluate the surgical outcome of vitrectomy in the treatment of expulsive hemorrhage associated with intraocular surgery. METHODS: We reviewed 12 eyes from 12 patients with expulsive hemorrhage, occurring after or during cataract extraction (4 eyes), phacoemulsification (2 eyes), glaucoma filtering surgery (4 eyes), or vitrectomy (2 eyes). Mean follow-up period was 21 months. RESULTS: The retina was reattached in 6 eyes (50%) after the initial surgery and ultimately in 9 eyes (75%). Three eyes, which failed to achieve retinal reattachment, resulted in phthisis bulbi. Final visual acuity was 0.1 or belter in 4 eyes and 0.01 to 0.09 in 4 eyes. The incidence of expulsive hemorrhage was 0% for cataract surgery, 0.57% for trabeculectomy, and 0.09% for vitrectomy at Toho University Sakura Hospital. CONCLUSION: In the treatment of expulsive hemorrhage, vitrectomy is an effective surgical procedure to improve the visual function.

Adolescent↗
PubMedDate not supplied

Management of delayed massive suprachoroidal hemorrhage: a clinical retrospective study.

Suprachoroidal hemorrhages, both expulsive and delayed non-expulsive, are among the most devastating complications of intraocular surgery. We reviewed the charts of 13 patients with a delayed non-expulsive suprachoroidal hemorrhage (DNSCH) after cataract extraction (3 patients), glaucoma filtering surgery (6 patients), penetrating keratoplasty (3 patients), or vitrectomy (1 patient). All had large hemorrhagic choroidal detachments with nine eyes presenting kissing choroidal detachment, five eyes with associated retinal detachment, and one eye with intravitreous hemorrhage. All patients were treated with systemic corticosteroids before surgery. Eleven eyes underwent anterior drainage sclerotomy, followed by SF6 gas injection in eight eyes, and pars plana vitrectomy with silicon oil tamponade in three eyes. Mean follow-up was 22 months. These procedures gave good anatomical results in eleven cases and good visual results in nine. The results suggest that not all DNSCH need to be drained surgically but that, when surgical drainage is indicated, the use of gas to maintain internal tamponade appears to be beneficial.

Adolescent↗
PubMed2006

[Needle revision of late failing filtering blebs after glaucoma surgery].

PURPOSE: To evaluate the results of bleb needling in eyes subjected to filtering surgery six months or more previously. METHODS: A retrospective study of 23 eyes in 21 patients subjected to bleb needling performed by means of a 25G needle, 6 months to 23 years after failed filtering surgery (mean 67.3 months). The mean number of bleb needlings was 1.2 and the mean number of 5-fluorouracil subconjunctival injections was 3.9. RESULTS: The mean intraocular pressure (IOP) before needling was 26 mmHg and the mean anti-glaucoma medications was 1.3 per eye. The mean postoperative IOP was 16.3 mmHg and mean anti-glaucoma medications 0.7. A diffuse filtering bleb was evident in 12 eyes (54.5%). The results of needling were worse in eyes subjected to previous surgery for glaucoma or other failed bleb needling procedures (75% failure). CONCLUSION: Needle revision of the filtering bleb is a simple and safe technique that offers good results even years after a filtering surgery had been performed. It should be considered before other medical or surgical treatments in patients with a previously functioning bleb and a permeable sclerectomy site at gonioscopy.

Aged↗
PubMed2001

Management of the late leaking filtration blebs. A report of seven cases and a selective review of the literature.

PURPOSE: To describe the outcome of various treatment modalities in the management of late bleb leaks after glaucoma filtering surgery (GFS). MATERIALS AND METHODS: Seven consecutive patients treated for late bleb leaks (Seidel's positive) between July 1990 and June 1999 were were enrolled in the study. The management strategy consisted of initial conservative therapy, and tailored surgery, if necessary. The surgical technique employed was either conjunctival-Tenon's advancement flap, hinged scleral flap, or fistulectomy with direct suturing. The main outcome measures were bleb characteristics and postoperative intraocular pressure (IOP). The secondary outcome measure was visual acuity. RESULTS: One patient responded to conservative therapy (aqueous suppressants, bandage contact lens) and six patients needed surgery. The successful surgical technique was conjunctivo-Tenon's advancement flap in three, hinged scleral flap in two, and fistulectomy-direct suturing to the wound (combined with cataract surgery and intraocular lens implantation) in one patient. The bleb leak stopped in all cases and 5 of the 6 surgical patients sustained functioning filtering blebs. Follow-up ranged from 8 to 56 months (mean = 20.4 +/- 16.2 months). Visual acuity improved to 6/12 or better in 4 cases, 6/36 in 2 cases and it remained at light perception in one case. None of the patients had any intraoperative or postoperative complications. CONCLUSIONS: Late leaking blebs after GFS can be treated successfully. The management decision and selection of surgical technique should be based on the clinical condition.

Aged↗
PubMed2005

[Computer program for antiglaucomatous surgeries analysis].

Computer analysis of long-term results of the surgical treatment of glaucoma needs suitable program for database data download retrospectively and prospectively as well. We composed a universal database program Glaucoma Access 97 for patients' follow-up in glaucoma surgery centers. Data about 1073 antiglaucomatous filtering surgeries from the period 1990-2000 were downloaded. The program permits to download data about the patients before the surgery, details about the operation procedure, and from the follow-up visits into the database using special software questionnaire sheets. Outcome from the database may be data about long-term IOP compensation, visual acuity changes, and treatment after the surgery. Evaluation of the data allows to follow up the successfulness of the treatment of specified groups of patients and to compare results of surgeons and individual departments as well.

Databases as Topic↗
PubMed1997

Lack of corneal toxicity of interferon Alpha-2b administered subconjunctivally after sclerectomy.

PURPOSE: To evaluate the corneal toxicity of subconjunctival injection interferon alpha-2b at filtering bleb after sclerectomy in white rabbits. METHODS: Eight rabbits which had been performed sclerectomy were randomly divided into two groups. Each group consisted of four rabbits. Eight eyes in group 1 were subconjunctivally received interferon alpha-2b 5 x 10(5) IU/0.2 ml into filtering bleb from the edge of the filtering site immediately after operation and every postoperative day. The other eight eyes in group 2 were injected with 0.2 ml normal saline. All of the eyes underwent daily examination by slip-lamp microscopy and direct ophthalmoloscopy. Sodium fluorescein was used to assess corneal epithelial integrity. On day 3, 4, 7 and 14, every two rabbits (group 1 and 2 each, respectively) were killed and removed cornea immediately to take examination of the viability of corneal endothelium by dual staining with typan blue and alizanin red S. RESULTS: No sign of toxicity in corneal epithelium and endothelium were found following continuously injection interferon alpha-2b at filtering bleb 3-14 days totally for selected doses. CONCLUSION: Subconjunctivally administered interferon alpha-2b at filtering bleb after glaucoma filtering surgery may be a safe drug-applied method.

Animals↗
PubMed2001

[Glaucoma after extremely severe chemical and thermal eye burns. Surgical possibilities].

BACKGROUND: Late secondary glaucomas after severe chemical or thermal eye burns are associated with diagnostic and surgical difficulties. Routine filtering surgery (trabeculectomy) has a low success rate. In these eyes aqueous shunt implantation and cyclophotocoagulation are alternative procedures. PATIENTS: In our retrospective study, the records of 12 patients with 14 severe eye burns (grade IV) were analyzed. Nine eyes were treated with an aqueous shunt device (six von Denffer and three Ahmed implants). Diode laser cyclophotocoagulation (Iris Medical Instruments) was performed in five eyes. The mean time interval between surgery and accident was 88.3 months (aqueous shunt) and 32.8 months (cyclophotocoagulation). RESULTS: The mean follow-up was 45 +/- 36 months (von Denffer implant), 38 +/- 5 months (Ahmed implant), and 11 +/- 8 months (cyclophotocoagulation). Intraocular pressure (IOP) was reduced from 39 +/- 7 to 23 +/- 6 (von Denffer implants) and from 38 +/- 3 to 8 +/- 10 (Ahmed implants). Mean IOP before treatment with cyclophotocoagulation was 33 +/- 8 and 18 +/- 2 after treatment. Systemic carbonic anhydrase inhibitors were stopped in all patients. Visual acuity deteriorated in five of nine eyes treated with aqueous shunt devices and was unchanged or better in all eyes treated with cyclophotocoagulation. Multiple re-operations were necessary after aqueous shunt implantation. Severe complications leading to failure in these eyes were encapsulated bleb in four eyes, expulsive hemorrhage in one eye, and phthisis in one eye. Cyclophotocoagulation was repeated in two eyes. Severe complications were not observed. CONCLUSION: IOP reduction was effective and comparable in both procedures. Because of the high incidence of severe complications after shunt surgery, we prefer cyclophotocoagulation for the treatment of intractable glaucoma after severe eye burns.

Adult↗
PubMed1999

Effect of the cytostatic agent idarubicin on fibroblasts of the human Tenon's capsule compared with mitomycin C.

BACKGROUND/AIMS: To investigate the in vitro effect of a short time exposure to the anthracycline idarubicin on proliferation, protein synthesis, and motility of human Tenon's capsule fibroblasts in comparison with the antitumour antibiotic mitomycin C. METHODS: After determination of effective concentrations of idarubicin, fibroblasts of the human Tenon's capsule were exposed to idarubicin or mitomycin C at concentrations ranging from 0.1 microg/ml to 1 microg/ml or from 2.5 microg/ml to 250 microg/ml, respectively, for 0.5, 2, or 5 minutes and cultured for 60 days. Cell death by apoptosis caused by idarubicin treatment was confirmed by Hoechst 33258 staining. Further proliferation was explored by cell counting and by (3)H-thymidine uptake. Protein synthesis was measured by (3)H-proline uptake and motility was assessed by agarose droplet motility assay. RESULTS: Idarubicin is able to exert toxicity and to induce apoptosis during a short time exposure of 0.5 minutes at concentrations of 0.3-1 microg/ml resulting in a significant reduction in cell number compared with the control after 60 days. For mitomycin C, higher concentrations and longer expositions were necessary. Even after treatment with 1 microg/ml idarubicin or 250 microg/ml mitomycin C a few cells were able to incorporate (3)H-thymidine. (3)H-proline uptake up to 10 days after exposure to 0.3 microg/ml idarubicin was found not to be decreased. Cell motility was reduced after treatment with 1 microg/ml idarubicin for 5 minutes or with 250 microg/ml mitomycin C for 2 or 5 minutes. For low mitomycin C concentrations, an increase in motility was found during the first 10 days. CONCLUSION: Idarubicin reduces proliferation of human Tenons's capsule fibroblasts after incubation for 0.5 minutes at concentrations as low as 0.3-1 microg/ml. In comparison, mitomycin C requires longer exposure times and higher doses for equal results. Therefore, idarubicin may be useful in the prevention of glaucoma filtering surgery failure.

Antibiotics, Antineoplastic↗
PubMed2006

[Dosage and kinetics of MMC release of a collagen implant used as a delivery device in glaucoma surgery in the rabbit eye].

PURPOSE: To determine the absorption and the release of mitomycin-C from a collagen implant and tissue impregnation in the anterior structures of the rabbit eye. METHODS: Determining the quantity of mitomycin-C that a collagen implant can absorb with the difference between dry and soaked weight. Mitomycin-C release was measured in vitro using spectrophotometry. The measurement was repeated using a bioassay. Ocular tissue impregnation was determined in 12 eyes of six rabbits. Sclera, implant, aqueous, and ciliary body specimens were collected for concentration measurement using HPLC from 1 to 6 h after surgery. RESULTS: The mean mitomycin-C quantity absorbed in the implant was 3.22+/-0.2 microg. In vitro release was 0.13 mg/ml after 10 min and 0.05 microg/ml at 6 h. The bioassay showed almost no antifibrotic activity in sclera. In vivo release of mitomycin-C was high from the first to the sixth hour. CONCLUSION: After filtering surgery, mitomycin-C in the collagen implant is clearly released and ocular tissues are effectively impregnated.

Animals↗
PubMed2003

Five year results of viscocanalostomy.

AIM: To prospectively study the success rate and complications of viscocanalostomy, a non-penetrating glaucoma surgery. METHODS: Prospective non-randomised consecutive case series of 57 eyes (57 patients) with medically uncontrolled primary and secondary open angle glaucoma. Viscocanalostomy was performed on all participants with injection of viscoelastic in the surgically created ostia of Schlemm's canal as well as in the scleral bed, the superficial scleral flap was loosely sutured. Intraocular pressure, visual acuity, and number of goniopunctures were measured. RESULTS: The mean follow up period was 34.1 months. The mean preoperative intraocular pressure (IOP) was 24.6 mm Hg; while the mean postoperative IOP was 5.6 mm Hg at day 1 and 13.9 mm Hg at 36 month. Patients who achieved IOP below 21 mm Hg with or without medication were 90% at 60 months, complete success rate (IOP<21 mm Hg without medication) was 60% at 60 months. 21 patients (37%) needed Nd:YAG goniopuncture postoperatively to control raised IOP, mean time for goniopuncture application was 9.4 months, mean pre-goniopuncture IOP was 20.4 mm Hg and mean postgoniopuncture IOP was 12.6 mm Hg (p <0.0001). CONCLUSION: Viscocanalostomy appears to be a promising modification of filtering surgery.

Aged↗
PubMedDate not supplied

[Experimental study of cytokines complex inhibitory effect on wound healing after glaucoma filtering operations: histopathological and immunochemical findings].

Experiments on a model of glaucoma filtering operation in 25 rabbits showed that the natural cytokine complex inhibited the operation wound healing in comparison with the control. The complex was prepared by an original method (culturing peripheral blood leukocytes) at Immunology Department of the Russian State Medical University. Histopathological study revealed delayed formation of cicatricial tissue under the effect of cytokines. Decreased proliferation of fibroblasts and their decreased functional activity (decreased synthetic activity of glycosaminoglycanes and collagen) was detected in cicatricial tissue. Immunohistochemical studies showed that in remote periods (after 3-8 months) type IV membrane collagen formed in new cicatricial tissue, while in the control, types III and I collagens predominated in cicatricial tissue. Immunohistochemical structure of the cicatrix in experiment correlated with fine fibrous structure of cicatricial tissue, characterized by high permeability. Possible mechanisms of the inhibitory effect of the natural cytokine complex on the course of operation wound healing after glaucoma-filtering surgery are discussed.

Animals↗
PubMed2000

Risk factors for glaucoma filtering bleb infections.

OBJECTIVE: To determine risk factors for bleb-related ocular infection after glaucoma filtering surgery. METHODS: A case-control study comparing all consecutive cases of glaucoma filtering bleb-related infections (55 eyes of 55 patients) with matched control eyes between January 1, 1990, and June 30, 1998, was performed. Bleb-related infection was classified as blebitis when a mucopurulent infiltrate was identified within the bleb and associated with mild to moderate anterior segment inflammation. Eyes with endophthalmitis had hypopyon, cells in the anterior vitreous cavity, or a positive vitreous biopsy sampling result. A control was selected for each case based on matching of the surgeon, date and type of glaucoma surgery, and type of antifibrotic agent used. Multivariate, matched, case-control logistic regression analysis was performed using age, race, sex, diagnosis, number of previous incisional operations, filtering bleb location, and presence of bleb leak to determine which variables were associated with bleb-related infection. RESULTS: The odds of an eye with a bleb-related infection being seen with a concomitant late-onset bleb leak are 25.8 times the odds of a noninfected eye having a late-onset bleb leak at any time in the postoperative period (P<.001; 95% confidence interval, 2.3-294.1). Other risk factors for bleb-related infection included younger age (P = .05), black race (P = .03), diagnosis of primary open-angle glaucoma (P = .03), and inferior location of the filtering bleb (P = .04). CONCLUSIONS: Late-onset bleb leakage is a significant risk factor for bleb-related infection. The risk of infection may warrant closure of late-onset bleb leaks in selected eyes.

Aged↗
PubMed1998

[Ocular tissue concentrations and results of filtration surgery after topical use of mitomycin C in rabbits].

We measured mitomycin C (MMC) concentrations in rabbit ocular tissues, using high-performance liquid chromatography, after the subconjunctival application of surgical sponges which had absorbed various doses (0.1, 0.2 or 0.4 mg) of MMC and with varying duration of application (1, 3, or 5 minutes). MMC concentrations at the administered site showed a significant correlation with the dose and duration of application. In multiple regression analysis the MMC concentration (microgram/g) in the conjunctiva was -6.73 + 67.4 x dose (mg) + 1.66 x time (minutes) (R-square 0.65); in the sclera, -1.85 + 38.2 x dose + 0.927 x time (R-square 0.63); and in the corena, -0.727 + 8.44 x dose (R-square 0.46). We also compared the results of filtering surgery on rabbits using 0.2 mg MMC intraoperative exposure of 1, 3, 5 minutes or 5-minute application of distilled water (control). The duration of maintained intraocular pressure reduction and filtering bleb was significantly longer in MMC-treated group (1 minute; 15 +/- 7.1, 3 minutes; 27 +/- 14.3, 5 minutes; 29 +/- 18.6 days, mean +/- standard deviation) than in the control group (7 +/- 3.7 days). Among the MMC-treated groups, good results were maintained significantly longer in the 3- or 5-minute application groups than in the 1-minute group. There was no difference between the 3-minute group and the 5-minute group.

Animals↗
PubMedDate not supplied

Trabeculectomy in the management of Posner-Schlossman syndrome.

Posner-Schlossman syndrome (glaucomatocyclitic crisis) is a condition of unknown etiology. Patients present with blurred vision, show minimal anterior chamber activity, and raised intraocular pressure (IOP). Corneal edema may cause colored halos. The condition tends to be recurrent, usually responding to a topical steroid and ocular hypotensives. The eyes appear normal between attacks. We present a patient who had bilateral Posner-Schlossman syndrome and underwent filtering surgery to control raised intraocular pressure in both eyes. During the follow up of more than 4 years, the control of IOP was good and he had no further attacks.

Adult↗
PubMed2001

Effect of cataract surgery on intraocular pressure in eyes with previous trabeculectomy.

PURPOSE: To determine the course of the intraocular pressure in eyes in which cataract surgery was performed after trabeculectomy. METHODS: This was a retrospective study of consecutive patients who were scheduled for routine cataract surgery. The patients had previously undergone glaucoma filtering surgery. Pre- and postoperative data were evaluated. Both the status of glaucoma and the increase in visual acuity were monitored. RESULTS: Patients operated on over a six-year period were enrolled. The mean interval between glaucoma surgery and cataract surgery was 58.1 months. The mean duration of follow-up after cataract surgery was 31.4 months, with a minimum of 12 months. The mean central visual acuity increased by 4 lines. Before cataract surgery, 53% of the eyes had complete success (group 1), while 28% had qualified success (group 2) and the remaining 19% were failures (group 3). From group 1, 61% remained a complete success until the last visit. No eye of group 1 developed a failure. In group 2, 23% were a complete success at the final follow-up, while 4% failed. In group 3, only 35% were failures while the remaining 65% were a complete or qualified success. CONCLUSIONS: Eyes with a well-controlled intraocular pressure following trabeculectomy seem to have a favorable prognosis after subsequent cataract surgery. Eyes with qualified success or failure before cataract surgery have a slight chance of improvement in intraocular pressure control. Cataract surgery had no markedly negative effect on the intraocular pressure overall. Performing trabeculectomy and cataract surgery at different times may still be a feasible option as opposed to combined procedures.

Adult↗
PubMed1991

Cytokines, fibrosis and the failure of glaucoma filtration surgery.

Current therapies for the prevention of fibrosis after glaucoma filtering surgery can be effective but often produce unwanted side effects. An understanding of the cellular basis of the fibrotic reaction may lead to better treatments. Wound repair revolves around angiogenesis and the activation of fibroblasts by cytokines. These peptides, a number of which have been described, act together in intricately complicated networks to encourage fibroblast chemotaxis, proliferation and contractility, as well as to stimulate the production of glycosaminoglycans and collagen. Since interferons seem to inhibit many of these responses, they deserve further evaluation in the treatment of ocular fibrosis.

Cytokines↗