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PubMedDate not supplied

[Early postoperative campimetric outcome after trabecular surgery of chronic advanced glaucoma].

The authors report about the results of a preliminary study concerning the changes of glaucomatous visual field just after glaucoma filtering surgery in patients with advanced glaucoma. The visual field was established preoperatively, then 7 and 30 days in post operative period. Mesopic campimetry had been selected because of its precision for central field defects. The results appear to be favourable with 13 improvements 14 stabilizations, and 7 aggravations without loss of central vision. The authors have tried to determine predictive risk factors. The most important one are preoperative campimetric shape, angle anatomy, refraction and cardiovascular diseases.

Adult↗

PubMedDate not supplied

Thrombocytopenia and the risks of intraocular surgery.

BACKGROUND AND OBJECTIVE: In thrombocytopenia, a hemorrhagic diathesis is usually present due to a low platelet count and has been related to the development of cataracts and retinopathy. The concomitant administration of nonsteroidal anti-inflammatory drugs can increase the hemorrhagic diathesis. The purpose of this study was to investigate the impact of thrombocytopenia during and after intraocular surgery. PATIENTS AND METHODS: A retrospective study of medical files of patients who had undergone cataract and glaucoma filtering surgery and were diagnosed as having thrombocytopenia between 1994--1995 and 1998--1999 was conducted. Eight patients with a total of 11 surgical procedures were included in this study. RESULTS: Hemorrhagic complications occurred in 2 of the 11 procedures, for an incidence of 18%. These 2 cases are described in detail. CONCLUSIONS: The current study confirms that thrombocytopenia is a significant risk factor for perioperative bleeding in ocular surgery. A routine questionnaire should be completed before ocular surgery and a complete blood cell count obtained in suspect cases. Consultation with a hematologist is warranted in cases of thrombocytopenia.

Aged↗

PubMed1990

Visual field behavior after intra-ocular surgery in glaucoma patients with advanced defects.

Fifty advanced glaucoma patients with central visual field islands were evaluated before and after intra-ocular surgery with respect to visual acuity and visual field behavior. Thirteen patients underwent a cataract extraction, and 37 a filtering procedure. Visual acuity generally improved to a certain extent after lens extraction, and deteriorated after filtering surgery. For both groups the visual field island became somewhat larger with respect to the surface area, but the foveal value was usually lower after the operation. There was no clear relationship between visual acuity and foveal values or the surface area of the central island. One patient suffered unexplained loss of central vision.

Aged↗

PubMed1984

Complications of extracapsular cataract surgery. The indications and risks of peripheral iridectomy.

With the increased popularity of extracapsular cataract surgery, the need for a peripheral iridectomy has been questioned. Some surgeons feel that the risks involved in performing the iridectomy are greater than when leaving the iris untouched. The indications and risks of iridectomy with cataract surgery are discussed. Four case reports are presented. In three cases, iridectomy was not performed with cataract surgery, and a pupillary block developed. In one of these three, a congenital cataract, secondary angle closure, developed requiring filtering surgery. In the fourth case, an iridectomy prevented serious complications from an unusual degree of postoperative inflammation with complete posterior synechia following uneventful cataract surgery.

Aged↗

PubMed1992

[Treatment of anterior uveitis with 5-fluorouracil].

Filtering surgery with use of 5-fluorouracil (5FU) was performed in 5 eyes (4 patients) with inflammatory glaucoma to prevent filtering bleb scarring. Postoperative injections of 5FU were given once or twice a day, according to the degree of anterior chamber inflammation. Complete remission of the uveitis was achieved in all 5 eyes after 7-14 days of postoperative injections of 5FU. There were no recurrences of uveitis during a minimum of 8 months of follow-up.

Fluorouracil↗

PubMed2005

[Modulation of cell proliferation and collagen synthesis of porcine Tenon's fibroblasts by extracts of lens and vitreous with treatment of dexamethasone].

OBJECTIVE: To demonstrate the effects of lens extract (LE), vitreous extract (VE) and dexamethasone on the modulating of the proliferation and collagen synthesis of Tenon's capsule fibroblast. METHODS: Cell proliferation and collagen synthesis of Tenon's fibroblast were measured using MTT and reverse transcription polymerase chain reaction techniques in the presence or absence of LE, VE, or dexamethasone, respectively. RESULTS: The growth of Tenon's fibroblasts was stimulated by LE and VE in dose and time-dependent manners. Dexamethasone significantly inhibited the proliferation of the cells either in the presence or absence of LE and VE. Similarly, LE and VE significantly stimulated the collagen synthesis of the cells. However, dexamethasone showed no significant effect on the LE or VE-enhanced collagen synthesis of the cells. CONCLUSION: These results suggested that there might be some ingredients in LE or VE that could stimulate the cell proliferation and collagen synthesis of Tenon's capsule fibroblasts. These ingredients, if released, may affect the success rate of filtration surgery for glaucoma. The application of glucocorticoid itself might not be sufficient to retard the scar formation following the filtering surgery in refractory glaucoma after cataract surgery or vitrectomy.

Animals↗

PubMed2005

Intraocular pressure changes in the contralateral eye after trabeculectomy with mitomycin C.

AIM: To assess intraocular pressure (IOP) changes of the contralateral eyes of eyes undergoing trabeculectomy with mitomycin C (MMC). METHODS: Non-comparative retrospective study of 24 consecutive patients who underwent trabeculectomy with MMC that led to more than 45% reduction in IOP. In the contralateral eyes, IOP before surgery was compared with IOP 1 day and 1 month after surgery. 11 fellow eyes were under topical hypotensive therapy while 13 contralateral eyes were not (12 contralateral eyes had previous filtering surgery and one had normal tension glaucoma). No patients had systemic ocular hypotensive therapy. RESULTS: Mean IOP in all contralateral eyes decreased from 15.5 (SD 5.5) mm Hg to 12.5 (3.8) mm Hg (p<0.01), and 13.0 (4.7) mm Hg (p<0.001) 1 day and 1 month after surgery, respectively. In the 11 fellow eyes under topical ocular hypotensive therapy mean IOP was reduced from 19.5 (4.0) mm Hg to 13.5 (2.2) mm Hg (p<0.01), and 16.5 (2.8) mm Hg (p<0.05) 1 day and 1 month after surgery, respectively. In the 13 fellow eyes not under topical ocular hypotensive therapy mean IOP was reduced from 12.1 (4.2) mm Hg to 11.6 (4.7) mm Hg (p not significant) and 9.8 (3.8) mm Hg (p0.01) 1 day and 1 month after surgery, respectively. CONCLUSIONS: In the present population, a month after trabeculectomy, mean IOP in the contralateral eyes decreased independently of whether these contralateral eyes were undergoing topical ocular hypotensive therapy or not.

Administration, Topical↗

PubMed1991

Internal sclerostomy with laser: a new approach to glaucoma surgery.

The creation of a fistula that permits controlled flow of aqueous from the anterior chamber to the subconjunctival space has been and remains the main technical goal of glaucoma filtering surgery. Currently, most complications are secondary to the surgical manipulation of the conjunctiva (mainly leakage from bleb and conjunctival fibrosis) or flattening of the anterior chamber. To overcome this problem, new methods are evolving in which the fistula is created from within the eye, with no conjunctival dissection. The performing of the sclerostomy by means of externally delivered laser energy is a further step in the same direction.

Glaucoma↗

PubMed1997

[Cataract-glaucoma combined surgery: comparison between phacoemulsification combined with deep sclerectomy, or trabeculectomy].

PURPOSE: To study the success rate of combined phaco-intraocular lens (IOL)-deep sclerectomy (P-DS), a new perforating filtering surgery, versus phaco-IOL-trabeculectomy (P-T). METHODS: Of 38 patients, 39 eyes with cataract and different types of glaucoma, 19 eyes underwent P-DS, and 20 eyes underwent P-T. Patients were prospectively studied. RESULTS: The follow-up of both groups was 11 +/- 6 months. The intraocular pressure (IOP) decrease in both groups was similar (from a mean preoperative IOP of 26.5 +/- 6.8 mmHg, to a mean postoperative IOP of 14.8 +/- 1.3 mmHg in the P-DS group, vs 25.9 +/- 7.7 mmHg preoperative and 14.8 +/- 2.7 mmHg postoperative in the P-T group). The visual acuity outcome was similar in both groups. The complication rate was significantly lower in the P-DS group. CONCLUSIONS: Deep sclerectomy associated with cataract surgery offers the same IOP reduction and visual acuity outcome. However, the complication rate is significantly lower and allows easier ambulatory care.

Aged↗

PubMed1997

Small incision trabeculectomy avoiding Tenon's capsule. A new procedure for glaucoma surgery.

BACKGROUND AND PURPOSE: Wound healing at the level of Tenon's capsule is a common cause of trabeculectomy failure. The purpose of this study is to present a new technique for glaucoma filtering surgery in which an injury to Tenon's capsule is minimized. METHODS: A 2.5-mm conjunctival peritomy was performed without cutting Tenon's capsule. A partial-thickness incision was made at the limbus and a scleral pocket was dissected 2 to 3 mm posteriorly. The subconjunctival space was entered with a cystotome passed through the scleral pocket, and balanced salt solution (BSS, Alcon Laboratories, Ft. Worth, TX) was injected, forming a subconjunctival bleb. In patients considered high risk, 5-fluorouracil (5 mg) was mixed with the BSS injected. The anterior chamber was entered at the initial limbal incision. A 1.5- by 1-mm fragment of the floor of the pocket was excised, followed by a peripheral iridectomy. The scleral wound, as well as the conjunctiva, was closed with separate 10-0 nylon sutures. This procedure was performed in 30 glaucomatous eyes. Seven high-risk eyes received four to seven postoperative injections of 5 mg of 5-fluorouracil. RESULTS: Preoperative intraocular pressure (IOP) was 34.5 +/- 8.1 mmHg. Postoperative IOP was 13.2 +/- 4.1 at 6 months (P < 0.01), and 90% of the eyes had IOP less than or equal to 18 mmHg without medication. Mean follow-up was 7.6 months (range, 6-14 months). Blebs were low-lying and diffuse. No serious complications were encountered. CONCLUSIONS: This new technique is a safe procedure that effectively reduces IOP. It is done through a small incision without sophisticated instruments. More cases and a prospective trial are needed to ascertain its potential advantages over those of conventional trabeculectomy.

Adult↗

PubMed2006

Comparison of two clinical Bleb grading systems.

PURPOSE: To evaluate 2 recently described grading systems for clinical grading of filtering surgery blebs: the Moorfields Bleb Grading System (MBGS) and the Indiana Bleb Appearance Grading Scale (IBAGS). DESIGN: Observational comparative study. PARTICIPANTS: Twenty-four glaucoma filtering blebs in 24 eyes of 17 patients. METHODS: Three observers in a prospective agreement study compared MBGS with IBAGS during slit-lamp examination. MAIN OUTCOME MEASURES: Comparison analyses were performed, including agreement, repeatability, and intraclass correlation coefficient (ICC). RESULTS: A wide range of bleb characteristics was represented in the cohort. Acceptable levels of intrasystem agreement were found in both systems: for IBAGS, overall agreement at the 0.5- and 1.0-unit levels were 80.6% and 97.6%, respectively, and for MBGS, these were 78.4% and 97.4% for morphologic and vascularity indices. Repeatability coefficients ranged from 0.5 to 1.4 for MBGS and 0.8 to 1.2 for IBAGS. The ICC values in the MBGS ranged from 0.18 to 0.72 for single measures and 0.39 to 0.88 for average measures. For IBAGS, the single-measure ICC values were between 0.06 and 0.53, and the average-measure ICC values were between 0.16 and 0.77. The MBGS ICC values for bleb size were higher than for IBAGS. CONCLUSIONS: Both methods are reproducible clinically and had generally high levels of interobserver agreement. Both have minor deficiencies that should be amenable to improvement. The MBGS performed similarly to the IBAGS for reproducibility, had higher ICC values for morphologic features, and captured extra vascularity data with probable clinical implications.

Blister↗

PubMed1989

Glaucoma and its relationship to intraocular lens implantation.

The management of glaucoma and cataract is a complex subject that has remained controversial until recently. Extracapsular cataract surgery with posterior chamber lens implantation has made the procedure safe to perform in most eyes with glaucoma controlled medically, by laser trabeculoplasty or after filtering surgery. This paper will review the literature to establish rational guidelines for this particular group of patients.

Cataract↗

PubMed2001

[Ahmed valve in high-risk glaucoma surgery].

We used the Ahmed valve for the treatment of 142 eyes with high-risk glaucoma. The glaucoma was neovascular in 74 cases, aphakic or pseudophakic in 19 eyes and occurred after previous faliure of filtering surgery in 49 eyes. Preoperative mean IOP was 31.6+/-10.4 mmHg under topical and/or systemic treatment. The success rate (IOP<22 mmHg with only topical treatment) was 56.3% with a mean follow-up of 32.4 months. Complications were fewer and milder compared with those reported for other types of drainage implants and for other types of antiglaucoma procedures.

Aphakia↗

PubMedDate not supplied

Preliminary clinical experience with the Gunther temporary inferior vena cava filter.

PURPOSE: The authors describe their preliminary clinical experience with the Gunther temporary inferior vena cava (IVC) filter. PATIENTS AND METHODS: Seven women and 10 men, mean age 52 years (range, 19-85 years), were treated with the temporary IVC filter. Indications for filter placement were pulmonary embolism (PE) in four patients and iliofemoral deep venous thrombosis in six. In these patients anticoagulation was contraindicated because of planned major surgery. Filters were placed in four patients following massive PE and in three for prophylaxis following cranial trauma. Four patients had underlying malignant disease. Filters were introduced through the right common femoral vein in 14 patients, the left common femoral vein in two, and the left internal jugular vein in one. RESULTS: No patient developed recurrent PE with the filter in place. All filters were removed without complication 3-14 days (mean, 7 days) after placement. Two of the patients with underlying malignant disease required placement of a permanent filter. Two patients developed IVC thrombosis with the filter in place, and both developed recurrent PE after filter removal. Two patients developed insertion vein thrombosis. One patient developed a bleeding disorder that caused a massive hematoma at the insertion vein site, which may have contributed to her death. CONCLUSION: The Gunther temporary filter can be used in selected patients; however, patients with underlying malignant disease may be more appropriately treated with a permanent filter. The temporary filter does not appear to reduce the rate of insertion vein and IVC thrombosis.

Adult↗

PubMed2006

Non-penetrating deep sclerectomy for glaucoma associated with Sturge-Weber syndrome.

PURPOSE: To report the results of non-penetrating deep sclerectomy (NPDS) in the treatment of glaucoma associated with Sturge-Weber syndrome (SWS). METHODS: We carried out a retrospective case series analysis of patients who underwent NPDS for glaucoma associated with SWS between 1998 and 2003. The control of glaucoma after NPDS, the results of surgery on intraocular pressure, the need for additional medical treatment and surgical complications were studied. RESULTS: Twelve eyes of nine patients, aged 11 days to 24 years, underwent filtering surgery: nine NPDS procedures were performed and three surgical procedures had to be converted to trabeculectomy because NPDS was not technically achievable. The mean follow-up after surgery was 26.3 months (range 6-48 months). Two trabeculectomies were complicated by choroidal effusion, which resolved in both cases. Good control of glaucoma was obtained during follow-up. CONCLUSIONS: Non-penetrating deep sclerectomy is transiently efficient in the treatment of SWS-associated glaucoma. Further studies of NPDS for the treatment of glaucoma associated with SWS are warranted.

Adolescent↗

PubMed1992

Antimetabolites in the surgical treatment of glaucomas.

Fibroblast proliferation with scarring at the surgical site plays an important role in the failure of filtration surgery. Several antimetabolites inhibit fibroblast proliferation in vitro. These observations have lead to the widespread clinical use in humans of 5-fluorouracil and more recently mitomycin-C in glaucoma filtering surgery.

Animals↗

PubMed1998

[Combined interventions: cataract and glaucoma review of the literature].

The combined surgical treatment of cataract and glaucoma has a long and controversial history. It changed dramatically over these two last decades with the technologic advances of both cataract and glaucoma surgery which have enabled to minimize the incidence and severity of complications and greatly influenced indications for combined surgery. During the 80's, extensive studies have shown the efficacy of combined trabeculectomy with extracapsular cataract extraction (ECCE) and posterior chamber lens implantation in patients with coexisting cataract and glaucoma. Small-incision cataract surgery by phacoemulsification with foldable introcular lenses have shortly replaced the ECCE in the beginning of the 1990's and have been, with pharmacologic modulation of wound healing for glaucoma filtering surgery, the most important factors which have contributed to a higher success rate and the actual relative safety of combined procedures. As compared to cataract extraction alone, the combined procedures offer better protection against the risk of early postoperative intraocular pressure increase, as well as the hope of better long-term intraocular pressure control. Although long-term intraocular pressure control has not been as predictable with combined surgery as in the two-stage approach, the recent use of antimetabolites (such as Mitomycin C) appeared to have improved early filtration success significantly. Conversely, combined operations tend to have a larger postoperative rate of complications than in cataract extraction alone. Having regard to the large variations in methods of patients selection, procedures evaluation, and criteria for success among the different authors, we will summarize the functional results, short and long-term intraocular pressure control and complications following combined procedures.

Cataract↗

PubMed2005

Bullous keratopathy as a complication of trabeculectomy with mitomycin C.

BACKGROUND: The routine use of mitomycin C to enhance glaucomatous filtering surgery has found wide acceptance. Complications of the application of mitomycin C have been repeatedly noticed. We now report a previously undescribed complication showing a toxic effect of mitomycin C to the corneal endothelium. METHODS: Patients underwent routine trabeculectomy with mitomycin C. Following surgery, the eyes were examined by biomicroscopy and specular microscopy of the corneal endothelium. RESULTS: In two cases, we observed a partial decompensation of the corneal endothelium resulting in a well-demarcated clear zone of the cornea and a second zone with thickening of the cornea and a bullous keratopathy adjacent to the filtering bleb. The specular microscopy showed marked irregularities of the endothelial cells and areas of necrosis in those parts of the cornea close to the filtering bleb. CONCLUSIONS: The two cases described here demonstrate that if the corneal endothelium is already compromised before surgery, the application of mitomycin C may have an additional toxic effect on the endothelium and may result in a partial bullous keratopathy. Surgeons should be aware of this complication.

Adult↗