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PubMed1992

Injectable microspheres with controlled drug release for glaucoma filtering surgery.

The authors evaluated the effects of biodegradable poly (lactic acid) microspheres that provided the controlled release of the antimetabolic agent adriamycin (ADR) to prevent post surgical fibrosis after glaucoma filtering surgery. Fifty six eyes of 28 rabbits underwent posterior lip sclerotomy and received a 0.2 ml subconjunctival injection that contained microspheres 90 degrees from the filtering site immediately after surgery. Microspheres containing ADR (100 or 200 micrograms) were randomly administered to one eye. The fellow eyes served as controls and received microspheres without the drug. Intraocular pressure in the eyes treated with the microspheres that contained the drug was significantly lower than that in the control eyes from days 7-12 in the 100 micrograms group and from days 6-16 in the 200 micrograms group (P < .05). Eyes that received ADR had a significantly longer patent filtering bleb compared with the control eyes (P < .05). No corneal complications were observed in the eyes treated with 100 micrograms of ADR and the control eyes. Peripheral corneal opacities (25%) and epithelial erosion (17%) were observed in the eyes that received the 200 micrograms dose, but the cornea returned to normal after 4 wk. These results suggest that controlled-drug-release microspheres with an antimetabolic agent may be promising for preventing fibrosis after surgery.

Animals↗

PubMed1975

Unsuccessful eccentric perilimbal suction after filtering surgery.

Eccentric suction was applied over the surgical site in 47 eyes thought to have unsuccessful external filtering procedures. Referrals for suction were made either because the postoperative intraocular pressure was uncontrolled or because blebs were becoming progressively flatter. Patients had an average of seven such treatment sessions. No discernible benefit from eccentric suction in failing filtering surgery was noted one year postoperatively.

Epinephrine↗

PubMed1987

Serious corneal complications of glaucoma filtering surgery with postoperative 5-fluorouracil.

We studied four patients who, having received postoperative 5-fluorouracil after glaucoma filtering operations, developed serious corneal complications. All four patients had preexisting corneal abnormalities including keratoconjunctivitis sicca, exposure keratopathy, and bullous keratopathy. All of the patients developed epithelial defects in the postoperative period. The complications included bacterial corneal ulceration (two patients), sterile corneal ulceration and corneal perforation (one patient), and a keratinized corneal plaque with underlying sterile stromal infiltrate (one patient). The use of 5-fluorouracil, which is an antimetabolite with considerable corneal epithelial toxicity, after glaucoma filtering surgery frequently causes corneal epithelial defects that may lead to secondary complications. Patients receiving this drug should have their corneal status closely monitored. In patients with corneal epithelial disease, 5-fluorouracil should be used with caution.

Aged↗

PubMed2003

Postoperative 5-fluorouracil versus intraoperative mitomycin C in high-risk glaucoma filtering surgery: extended follow up.

PURPOSE: To compare the long-term efficacy and safety of postoperative subconjunctival 5-fluorouracil (5-FU) injections with that of intraoperative mitomycin C (MMC) in eyes at high risk for failure of trabeculectomy. METHODS: In a retrospective, non-randomized comparative trial, 36 eyes of 36 consecutive patients at high risk for failure of trabeculectomy underwent glaucoma filtering surgery with either postoperative subconjunctival 5-FU injections (19 eyes) or intraoperative application of MMC (17 eyes). Intraocular pressure, number of postoperative antiglaucoma medications, postoperative visual acuity, interventions, and complications were evaluated. RESULTS: Overall success (intraocular pressure </=21 mmHg) at 1 year was 73.6% in the 5-FU group and 82.3% in the MMC group. The cumulative 4-year success was 52.6% in the 5-FU group and 60.5% in the MMC group (P = 0.6). At 4-year follow up, mean +/- SD intraocular pressures were 17.58 +/- 4.01 mmHg in the 5-FU group and 13.33 +/- 3.36 mmHg in the MMC group (P = 0.01). There was no significant difference in the number of post-operative medications (P = 0.84), appearance of blebs (P = 0.20), final visual acuity (P = 1.00), and complications (P > 0.05) between the groups. CONCLUSIONS: These results suggest that both postoperative 5-FU injections and intraoperative MMC application have long-term success in high-risk patients. However, MMC results in a greater decrease in intraocular pressure than 5-FU.

Adult↗

PubMed2004

Outcomes of bleb excision and conjunctival advancement for leaking or hypotonous eyes after glaucoma filtering surgery.

AIM: To determine outcomes of bleb excision and conjunctival advancement for leaking or hypotonous eyes after glaucoma filtering surgery. METHODS: In a retrospective case series the medical records of all patients who underwent bleb excision and conjunctival advancement surgery for bleb leaks or hypotony (defined as IOP less than 6 mm Hg, associated with reduced vision) at the Jules Stein Eye Institute and the Yale University Eye Center between January 1993 and June 2002 were reviewed. Only patients with more than 6 months of follow up were included. Complete success was defined as resolution of the pre-existing leak or hypotony, with maintenance of IOP > or =6 and < or =21 mm Hg, in the absence of further glaucoma surgery and without any glaucoma medication. Qualified success met the above criteria with or without the use of glaucoma medications. Success rates were analysed with Kaplan-Meier survival curves. RESULTS: 49 eyes were included in the study; 13 eyes had overt bleb leaks, 27 eyes had hypotony. Nineteen patients underwent resuturing of sclera and/or placement of a pericardial graft in addition to bleb excision and conjunctival advancement. Mean preoperative IOP increased from 3.2 (SD 2.4) mm Hg (range 0-10 mm Hg) to 13.8 (4.8) mm Hg (range 6-29 mm Hg) at last follow up (p<0.0001). Mean preoperative visual acuity improved from 0.6 (0.3) logMAR (range 0-2) to 0.3 (0.3) logMAR (range 0-2) at final follow up (p<0.0001). 16 eyes (40%) were classified as complete success and 17 additional eyes achieved qualified success, for a total of 33 eyes (83%) achieving at least qualified success. There was no significant difference in the rate of complete success (p = 0.95) or qualified success (p = 0.88) between the group of patients who underwent bleb excision and conjunctival advancement alone versus those who also had resuturing of sclera and/or placement of a pericardial graft. Failures included three eyes that had persistent hypotony without leak, requiring additional bleb revision, and four with uncontrolled IOP, two of whom underwent additional glaucoma surgery. CONCLUSION: Bleb excision with conjunctival advancement is a successful procedure for bleb repair. This technique provides successful resolution of leaks and hypotony, maintains glaucoma control with or without medication, and preserves vision with minimal postoperative complications in a majority of eyes.

Adult↗

PubMed1991

Infectious crystalline keratopathy occurring in an eye subsequent to glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil.

We present a case of infectious crystalline keratopathy occurring after 5-fluorouracil filtering surgery. The patient had discrete, branching, white crystalline lesions in the anterior corneal stroma. Cultures grew Streptococcus viridans, and gram-positive cocci were demonstrated in corneal tissue biopsy specimens. Toxic and immunosuppressive properties of 5-fluorouracil may have participated in the pathogenesis of the infectious crystalline keratitis.

Chronic Disease↗

PubMed1999

[Effect of mitomycin C dissolved in a reversible thermosetting gel on outcome of filtering surgery in the rabbit].

PURPOSE: Based on our previous report that showed enhanced transfer of mitomycin C to the sclera and the conjunctiva by dissolving the antiproliferative in a reversible thermo-setting gel, we conducted a study to investigate the efficacy of the mitomycin C-gel in the rabbit. METHODS: We subconjunctivally injected 0.1 ml of the mitomycin C-gel solution containing several amounts of the drug. Trephination was performed in the injected region 24 hours later. Intraocular pressure measurement, and photography and ultrasound biomicroscopic examination of the filtering bleb were done 1, 2, and 4 weeks postoperatively. RESULTS: The gel containing 3.0 micrograms or more mitomycin C significantly enhanced bleb formation in addition to reducing the intraocular pressure. CONCLUSION: The reversible thermo-setting gel seems to facilitate filtration following glaucoma filtering surgery in the rabbit and deserves further investigation as a new method of mitomycin C application.

Animals↗

PubMed1990

Combined cataract implant and filtering surgery with 5-fluorouracil.

In this preliminary retrospective study, results of combined extracapsular cataract extraction, intraocular lens implantation, and filtering surgery with subconjunctival 5-fluorouracil (5-FU) injections in 22 eyes were compared with those obtained in a similar group without 5-FU injections. Five to 35 mg (mean, 17.3 mg) of 5-FU were administered to each eye in the 5-FU group. Intraocular pressure (IOP) was controlled with fewer medications postoperatively than preoperatively in both the 5-FU group and the control group. However, the 5-FU group demonstrated statistically significant greater improvement in IOP control than the control group (P = .043).

Aged↗

PubMed1983

Late hyphema after filtering surgery for glaucoma.

Four eyes of three patients developed spontaneous hyphemas eight months to three years after uncomplicated glaucoma filtering surgery. In two of the four eyes abnormal vessels could be seen at the internal margin of the trabeculectomy opening. Argon laser photocoagulation was successfully used to treat the bleeding, although one eye required multiple sessions.

Adult↗

PubMed1996

Histology of conjunctival vascular endothelium after filtering surgery with mitomycin C in rabbits.

OBJECTIVE: To examine histologic changes in conjunctival vasculature during the first 72 hours following filtering surgery with adjunctive mitomycin C in rabbits. DESIGN: Thirty-six New Zealand white rabbits underwent unilateral posterior lip sclerectomy. In 18 rabbits mitomycin C (0.5 mg/mL) was applied subconjunctivally for 5 minutes. The remaining 18 animals were treated with the phosphate-buffered saline vehicle for 5 minutes. Three rabbits from either group were killed at 0, 4, 12, 24, 48 and 72 hours postoperatively. OUTCOME MEASURES: Degree of vascularity of filtering blebs on gross examination and appearance of conjunctival vascular specimens on light and transmission electron microscopy, as assessed by three masked observers. RESULTS: On gross examination the filtering blebs in the mitomycin C group were slightly less hyperemic than those in the control group at 12, 24 and 48 hours and were markedly less hyperemic at 72 hours. Light microscopy showed tightly packed erythrocytes within the conjunctival vessels of the experimental blebs and an almost total absence of endothelium within many of the vascular channels by 72 hours. Transmission electron microscopy showed focal loss of vascular endothelial cells and thrombus formation in the experimental blebs, as early as 12 hours postoperatively. CONCLUSIONS: Our findings suggest that the decreased vascularity of filtering blebs observed after trabeculectomy with adjunctive mitomycin C is at least partially due to a toxic effect of the agent on the endothelial cells of the conjunctival vessels.

Animals↗

PubMed1996

Long-term results of Krupin-Denver valve implants in filtering surgery for neovascular glaucoma.

The long-term results obtained with the Krupin eye short valve shut in 28 eyes with neovascular glaucoma were retrospectively analyzed by means of Kaplan-Meier survival curve. The preoperative intraocular pressures (IOPs) ranged from 28 to 62 mm Hg (mean, 36.8 +/- 5.8 mm Hg). Success was considered an IOP of less than 22 mm Hg and greater than 5 mm Hg without medication (complete success) or with medication (qualified success) without additional glaucoma filtering surgery or devastating complications. Postoperative success was obtained in 10 out of 28 eyes after a mean follow-up period of 58.4 +/- 23.02 months (range, 10-108 months). The 3- and 6-year life table success rates were 66 and 34%, respectively. Early complications were: shallow or flat anterior chamber (15 patients, 53.6%), hypotony (16 patients, 57.1%), hypertony (7 patients, 25%), serous choroidal effusion (7 patients, 25%), fibrinous uveitis (5 patients, 17.9%), blockage of the intracameral portion of the tube by fibrin (5 patients, 17.9%), choroidal hemorrhage (2 patients, 7.1%). Late complications were: external conjunctival bleb failure (12 patients, 42.9%), blockage of the intracameral portion of the tube by fibrovascular tissue (5 patients, 17.9%), cataract (2 patients, 7.1%), bullous keratopathy (2 patients, 7.1%), external erosion of the Silastic valve (2 patients, 7.1%), phthisis bulbi (2 patients, 7.1%). Mortality during long-term follow-up was high in our series. The complications of an underlying diabetes mellitus were the most common cause of death (15 out of 22 patients). The high mortality of patients subjected to valve implantation makes it difficult to interpret the results of long-term studies. However, the valve implant is still today an alternative surgical procedure for controlling IOP in eyes with neovascular glaucoma that have visual potential.

Aged↗

PubMed1987

D-penicillamine and beta-aminopropionitrile effects on experimental filtering surgery.

We studied the effect of two compounds, beta-aminopropionitrile (BAPN) and D-penicillamine on the success of experimental glaucoma filtering surgery in cynomolgus monkeys. All animals had laser-induced glaucoma and underwent punch sclerectomy operations. Eyes treated with BAPN or D-penicillamine maintained successful filtration for at least 3 days longer than nondrug-treated controls. This effect, while statistically significant (P less than 0.05), was temporary. The lack of more substantial improvement in prolonging filtering patency may have resulted from an inadequate effective drug concentration. Alternatively, these drugs may have limited potency because their action on new collagen synthesis affects only a minor component of the healing process that causes filter failure.

Aminopropionitrile↗

PubMed2002

Chymase and angiotensin converting enzyme activities in a hamster model of glaucoma filtering surgery.

PURPOSE: Two pathways for the formation of angiotensin II (Ang II) in local tissues are known to exist, one involving angiotensin-converting enzyme (ACE), and the other in which chymase plays a role. It has been shown that chymase activity is present in monkey, dog, and hamster eyes. Because chymase activates various cytokines by increasing Ang II formation, thereby promoting the production of extracellular matrix, the role of Ang II in wound healing has attracted much interest. In this work, we created sclerocorneal wounds in hamster eyes and measured the levels of ACE and chymase activities in the eye during the wound healing process. METHODS: Sclerocorneal wounds were made at 6 locations on the corneal limbus of one eye in each of 36 hamsters. Using the contralateral eyes as controls, we measured levels of chymase and ACE activities in the overall eye at 3, 7, and 21 days postoperatively. Histopathological evaluations of the sclerocorneal wounds in the treated eyes were also carried out for samples stained with toluidine blue. RESULTS: Chymase activity in the treated eyes tended to be higher than that in the control at 21 days. ACE activity in the treated eyes was significantly higher than that in the control at 3, 7, and 21 days postoperatively. Histopathological examination revealed increased mast cells in the subconjunctival tissue and around the tunnel opening in the sclerocornea. CONCLUSIONS: These findings show that not only ACE but also chymase contributes to the formation of Ang II in the healing of sclerocorneal wounds in hamster eyes. This leads to the suggestion that ACE inhibitors or chymase inhibitors could potentially inhibit scarring in glaucoma filtering surgery.

Animals↗

PubMed1994

[A comparative study of homoharringtonine with 5-fluorouracil in filtering surgery].

With a prospective, randomized and double-masked control method, homoharringtonine(H.H) and 5-Fluorouracil (5-FU) were used in filtering surgery. We compared the effect and side effect of H.H with those of 5-FU. 24 eyes were in H.H group and 23 eyes in 5-FU group. An average follow-up of 18 months revealed: (1) the cumulative percentage of functioning bleb in H.H group (84.9%) was significantly higher than that in 5-FU group (62.2%) (P < 0.05); (2) the cumulative surgical success rate in H.H group (85.7%) was significantly higher than that in 5-FU group (61.1%) (P < 0.05); (3) the rate of corneal erosion in H.H group (20.8%) was significantly lower than that in 5-FU group (52.2%) (P < 0.05), the difference of other complications between H.H group and 5-FU group was not significant.

Adolescent↗

PubMed1991

The effect of glaucoma filtering surgery on corneal endothelial cell density.

Corneal endothelial cell counts were obtained preoperatively and 3 months postoperatively in 46 eyes undergoing glaucoma filtering surgery. Average central endothelial cell loss in eyes without postoperative iridocorneal touch was 1.6%. In eyes with iridocorneal touch (Spaeth's grades 1 and 2), the average cell counts decreased by 7.1% and 9.3%, respectively. The average loss for combined grades 1 and 2 (8.1%) approached statistical significance (P +/- .06). The average loss in two patients with corneolenticular touch (Spaeth's grade 3) was greater than 50%. These findings suggest that early postoperative iridocorneal touch is unlikely to lead to corneal compromise in most eyes, but that corneolenticular touch can result in severe endothelial cell loss.

Aged↗

PubMed1990

[Changes in the visual fields following filtering surgery in advanced glaucoma].

The authors report about the results of a preliminary study concerning the changes of glaucomatous field after glaucoma filtering surgery in patients with advanced glaucoma. Mesopic campimetry had been selected because of its precision for central field defects. The first results appear to be favourable. No patient lost central vision suddenly after surgery. The authors have tried to research predictive risk factors. The factors that seem to be the most important to consider are the preoperative campimetric shape and the angle anatomy.

Aged↗

PubMed1990

Serous retinal detachment following glaucoma filtering surgery.

We report the occurrence of serous retinal detachment in association with choroidal effusion and hypotony in six eyes that had undergone glaucoma filtering surgery. Hypotony with choroidal effusion was documented in five patients before the onset of serous retinal detachment. While one patient underwent vitrectomy, treatment was conservative in the other patients. Serous retinal detachment and choroidal effusions resolved spontaneously as the intraocular pressure normalized. Although one patient regained preoperative visual acuity, all other patients lost at least one line of Snellen acuity.

Adolescent↗

PubMed2006

Potential role of tissue transglutaminase in glaucoma filtering surgery.

PURPOSE: Scarring of the filtering bleb site is the main cause of failure in glaucoma filtration surgery. In the present study, the role of tissue transglutaminase (tTgase) in the accumulation of extracellular matrix (ECM) proteins in these scars was investigated. Transglutaminases are enzymes capable of cross-linking ECM proteins to proteolysis-resistant complexes. METHODS: Expression of tTgase, its reaction product epsilon-(gamma-glutamyl)-lysine, and fibronectin and their colocalization were investigated immunohistochemically in failed blebs and in an in vitro trabeculectomy model. Failed blebs were analyzed by RT-PCR for the presence of tTgase mRNA. Human Tenon fibroblasts (HTFs) were treated with transforming growth factor-beta2 (TGF-beta2). The effect was studied with immunohistochemistry, Northern blot analysis, and Western blot analysis. tTgase activity was assayed by incorporation of biotinylated cadaverine into fibronectin. RESULTS: Expression of tTgase and epsilon-(gamma-glutamyl)-lysine was present in all failed blebs. Staining was most prominent at the rim of the Tenon cyst. In the in vitro trabeculectomy model, tTgase and epsilon-(gamma-glutamyl)-lysine were barely present at the incision side of the flap but were perspicuously increased by TGF-beta2 treatment. Enzyme and its reaction product were colocalized with fibronectin. Cultured HTFs contained a basal level of tTgase mRNA. After treatment with TGF-beta2, expression and activity of tTgase significantly increased. CONCLUSIONS: The findings demonstrated that tTgase is present and functionally active in failed blebs. Expression and activity of tTgase appeared to be stimulated by TGF-beta2, a growth factor known to be increased in primary open angle glaucoma. Intervention at this pathway might open a new approach to prevent scarring after glaucoma filtration surgery.

Adult↗