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PubMedDate not supplied

Effect of mitomycin C dissolved in reversible thermo-setting gel on the 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 agent into a reversible thermo-setting gel, we conducted a study to investigate the efficacy of mitomycin C gel in the rabbit. METHODS: We subconjunctivally injected 0.1 mL of the mitomycin C gel solution containing several different amounts of the agent. Trephination was performed in the injected region 24 hours later. Intraocular pressure measurement, photography, and ultrasound biomicroscopic examination of the filtering bleb were conducted 1, 2, and 4 weeks postoperatively. RESULTS: The gel containing 3.0 microg or more mitomycin C significantly enhanced bleb formation and reduction in the intraocular pressure. CONCLUSIONS: The reversible thermo-setting gel seems to help the filtering bleb to survive in the rabbit and deserves further investigation as a new method of mitomycin C application.

Animals↗

PubMed1998

Synthetic meshwork implant for glaucoma filtering surgery: effect of adjunct heparin and sodium hyaluronate in rabbits.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of a novel filtering implant, a synthetic meshwork (MESH), with or without heparin or sodium hyaluronate amendment. MATERIALS AND METHODS: Eighteen eyes of 18 rabbits received MESH surgery. The eyes were divided into three subgroups. Six eyes received the MESH implant with no modification (group 1), 6 eyes received MESH saturated with heparin (group 2), and 6 eyes received MESH with sodium hyaluronate administration into the anterior chamber during surgery (group 3). Intraocular pressure (IOP) and outflow facility were measured during a period of 6 months. RESULTS: The MESH-implanted eyes showed lower IOP and higher outflow facility than control eyes up to postoperative days 119 and 49, respectively (P > .05). Earliest functional failure was seen in group 3 and latest in group 2. CONCLUSION: MESH implant surgery showed a long-term efficacy in reducing IOP. The beneficial effects of added heparin were limited. Sodium hyaluronate administration reduced the efficacy of the implant device.

Animals↗

PubMed1997

Blebitis, early endophthalmitis, and late endophthalmitis after glaucoma-filtering surgery.

PURPOSE: The differentiating characteristics in blebitis and early and late endophthalmitis after glaucoma filtration surgery are reviewed. METHODS: All admission records and operative reports, as well as available office notes, on patients with blebitis or bleb-associated endophthalmitis admitted to a large referral eye center from 1985 to 1995 were reviewed retrospectively. RESULTS: Ten cases of blebitis and 33 cases of bleb-associated endophthalmitis were identified. One patient with blebitis progressed to culture-positive endophthalmitis. Of the 33 cases of bleb-associated endophthalmitis, there were 6 cases of early endophthalmitis (before postoperative week 6) and 27 cases of late endophthalmitis. In early endophthalmitis, Staphylococcus epidermidis was isolated on vitreous culture in 4 (67%) of 6 cases, whereas in late endophthalmitis, this organism was isolated in only 1 (4%) of 27 cases. In the 27 late cases, Streptococcus species and gram-negative organisms comprised 48% of isolates; of 33 cases of endophthalmitis, 15 (45%) demonstrated no growth on vitreous culture. Patients with endophthalmitis fared more poorly than those with blebitis in terms of visual outcome. CONCLUSIONS: Because blebitis may be prodromal to endophthalmitis, aggressive antimicrobial therapy, perhaps with oral quinolones, is warranted. In addition, patients with blebitis should be observed closely to identify extension into the vitreous cavity so that intravitreous antibiotics can be administered in a timely fashion. Finally, clinicians should not extrapolate the results of the Endophthalmitis Vitrectomy Study to the postfiltration surgery endophthalmitis given the differing pathogenesis and unique spectrum of organisms.

Adult↗

PubMed1995

Preoperative mitomycin-C subconjunctival injection and glaucoma filtering surgery.

Intraoperative mitomycin-C application has been well accepted recently as a useful adjunctive procedure to enhance the filtering effect in glaucoma surgery. However, the exact dose of mitomycin-C left after such a procedure in the ocular tissue is variable and unclear. It is important to determine such residual because of potential long-term toxicity of mitomycin-C to the eye. Based on previous successful experience using preoperative mitomycin-C subconjunctival injection in the THC-YAG laser sclerostomy on rabbits, the effect of intraocular pressure (IOP) control and its clinical observation was studied in six eyes of six refractory and high risk glaucoma patients by subconjunctival 1.2 micrograms to 3.6 micrograms mitomycin-C injection 24 to 72 hours prior to classic, routine, limbal-based trabeculectomy surgery. After 18 months of satisfactory clinical observation of the first eye for IOP, functioning bleb appearance and smooth clinical course, the same procedure was used on an additional five eyes, with a follow-up period of more than five months. Average IOP was reduced from 27.8 mm Hg (range 24 to 34 mm Hg) preoperatively to 9.5 mm Hg (range 5 to 14 mm Hg) postoperatively, with a smooth clinical course. The advantages of such preoperative subconjunctival mitomycin-C injection are emphasized here.

Adolescent↗

PubMed1998

A novel method for controlling the quantity of mitomycin-C applied during filtering surgery for glaucoma.

The use of a sponge impregnated with mitomycin-C is an increasingly common practice in glaucoma surgery. The appropriate antibiotic concentration and exposure time have been considered in the literature, but not the exact amount to be used or the size of the sponge. The purpose of this study was to estimate the quantity of mitomycin-C contained in sponges prepared by different surgeons as compared to that in applicators of the type used in Schirmer's test graduation (5 x 5 mm). Four surgeons each cut and prepared 10 sponges for intraoperative use according to their usual method. The same procedure was performed with 10 Schirmer's test graduations. Each sponge and each graduation was immersed in a solution of mitomycin-C 0.2 mg/ml, and the quantity of antibiotic (microg) in each was calculated as the difference between wet and dry weight. The mean quantity (+/- SEM) of mitomycin-C contained in cut sponges was 9.6 +/- 4.4 microg (range 1.9-17.3), and the differences between surgeons were statistically significant (p<0.0001). The mean quantity of antibiotic in Schirmer's test graduation was 1.7 +/- 0.3 microg (range 1.1-2.5), and the differences between surgeons were not statistically significant (p=0.79). The quantities of mitomycin-C contained in sponges prepared for glaucoma surgery differed for a given surgeon and between surgeons. Thus, variations in the doses applied to the sclera could account for certain complications due to mitomycin-C. The use of a Schirmer's test graduation improves predictability for the quantity of mitomycin-C applied to the sclera.

Antibiotics, Antineoplastic↗

PubMed1997

[Does the dosage of mitomycin-C applied during filtering surgery of glaucoma vary with the individual surgeon?].

PURPOSE: The purpose of this study was to estimate the quantity of mitomycin-C contained in sponges prepared by different surgeons as compared to that in applicators of the type used in Schirmer's test graduation (5 x 5 mm). MATERIALS AND METHODS: Four surgeons each cut and prepared 10 sponges for intraoperative use according to their usual method. The same procedure was performed with 10 Schirmer's test graduations. Each sponge and each graduation was immersed in a solution of mitomycin-C 0.2 mg/ml, and the quantity of antibiotic (microgram) in each was calculated as the difference between wet and dry weight. RESULTS: The mean quantity (+/-SEM) of mitomycin-C contained in cut sponges was 9.6 +/- 4.4 micrograms (range 1.9-17.3), and differences between surgeons were statistically significant (p < 0.0001). The mean quantity of antibiotic in Schirmer's test graduation was 1.7 +/- 0.3 micrograms (range 1.1-2.5), and the differences between surgeons were not statistically significant (p = 0.79). CONCLUSION: The quantities of mitomycin-C contained in sponges prepared for glaucoma surgery differed for a given surgeon and between surgeons. Thus, variations in the doses applied to the sclera could account for certain complications due to mitomycin-C. The use of a Schirmer's test graduation improves predictability for the quantity of mitomycin-C applied to the sclera.

Antimetabolites↗

PubMed1994

The effects of glaucoma filtering surgery on the variability of diurnal intraocular pressure.

The results of this study indicate that filtration surgery reduces the mean diurnal IOP, the range of diurnal variation, and the day-to-day variability. The effect on the range is proportionally greater than on the other two parameters. Further study will be required to determine whether this selective effect makes surgical reduction of IOP any more effective in the prevention of further glaucomatous visual field damage than other therapeutic methods that lower mean IOP to the same degree.

Circadian Rhythm↗

PubMed2004

[Intraoperative use of mitomycin C in glaucoma filtering surgery--indications, results and complications].

PURPOSE: The influence of MMC on the cornea, especially on the corneal endothelium and thickness, were checked. MATERIAL AND METHODS: In one-year-follow up patients after trabeculectomies with or without topical use of mitomycin C were controlled for early and late complications, and levels of intraocular pressure. The progression of glaucomatous neuropathy was obtained by comparing the cup to disc ratio and some parameters of static visual field testing (MD, PSD) progressions, after one year observations. RESULTS: Intraocular pressures were stable and at lower levels in the group of patients after primary trabeculectomies (group C) than in the control group (group A). We obtained good, statistically significant decrease in IOP in all groups during one year follow-up. CONCLUSIONS: We didn't find any toxic effects of MMC, given on a sponge during trabeculectomy, on the morphology and physiology of the corneal endothelium and the central corneal thickness. We also didn't note any differences between groups in the progression of glaucomatous optic nerve damaged and cataract after 1 year follow up.

Adult↗

PubMed2002

Free conjunctival autologous graft for bleb repair and bleb reduction after trabeculectomy and nonpenetrating filtering surgery.

PURPOSE: To describe methods and outcomes of excisional revision of a filtering bleb (bleb revision) using free conjunctival autologous graft either for bleb repair or for bleb reduction after trabeculectomy and deep sclerectomy with an implant. METHODS: Retrospective medical records were reviewed for a consecutive non-comparative case series comprising patients who underwent excisional revision of a filtering bleb between May 1998-January 2001. Excisional revision using free conjunctival autologous graft (bleb revision) was performed either for bleb repair, to treat early and late leaks and hypotony with maculopathy, or for bleb reduction, to improve ocular pain, discomfort, burning, foreign body sensation, tearing, and fluctuations of visual acuity. The revision consisted of bleb excision and free conjunctival autologous graft. The bleb histopathology was analyzed in patients who underwent bleb repair. RESULTS: Sixteen patients were included in the study, consisting of nine patients who had a trabeculectomy and seven patients who had a deep sclerectomy with an implant. Bleb revision was necessary in 14 patients due to leaking filtering bleb (bleb repair), and in 2 patients due to bleb dysesthesia (bleb reduction). After a follow-up of 15.1 +/- 8.4 months, the mean intraocular pressure (IOP) rose from 7.8 +/- 6.3 mm Hg to 14.3 +/- 6.5 mm Hg, and the visual acuity from 0.4 +/- 0.3 to 0.7 +/- 0.3, with a P value of 0.008 and 0.03, respectively. The complete success rate at 32 months, according to the Kaplan-Meier survival curve, was 38.3%, and the qualified success rate was 83.3%. Four patients (25%) required additional suturing for persistent bleb leak. To control IOP, antiglaucoma medical therapy was needed for six patients (37.5%) and repeated glaucoma surgery was needed for one patient. CONCLUSION: Free conjunctival autologous graft is a safe and successful procedure for bleb repair and bleb reduction. However, patients should be aware of the postoperative possibility of requiring medical or surgical intervention for IOP control after revision.

Adult↗

PubMed1998

Is the single use of intraoperative 5-fluorouracil in filtering surgery for high-risk cases enough?

PURPOSE: To study the efficacy of the adjunctive use of a single intraoperative application of 5-fluorouracil (5FU) in eyes with poor prognoses for a successful outcome with a trabeculectomy. METHOD: Twenty-four patients (25 eyes) with a mean age of 63.7 +/- 14.7 years (range 27-86 years) and a history of one or more risk factors (age < 50 years, more than 3 years on topical medication, a previous failed filter, previous cataract surgery, uveitis, neovascular glaucoma) underwent trabeculectomy with the intraoperative application of 5FU on a sponge (25 mg/ml) for 5 min. The average follow-up was 10.1 +/- 5.5 months. RESULTS: The mean pre-operative intraocular pressure (IOP) was 24.7 +/- 6.2 mmHg and the mean post-operative IOP was 13.9 +/- 3.5 mmHg. Success, defined as an IOP within desired target levels for a particular eye, in the presence of a functioning filter, without supplementary medical therapy, was achieved in 56.5% of cases. CONCLUSIONS: Our results of successful filters in this group of patients with moderate- to high-risk characteristics approach similar figures quoted for trabeculectomies without the adjunctive use of intraoperative 5FU in eyes with poor prognoses with a similar length of follow-up. Though the numbers are small there is a trend that indicates that the intraoperative application of a single dose of 5FU alone may not be sufficient in eyes with moderate- to high-risk characteristics of failure of a trabeculectomy.

Adult↗

PubMed1997

Effects of mitomycin C on the expression of proliferating cell nuclear antigen after filtering surgery in rabbits.

BACKGROUND: The aim of the study was to evaluate the effects of mitomycin C on the cell replication activity in wound healing following experimental filtration surgery. METHODS: Trabeculectomy with or without application of mitomycin C was performed on albino rabbit eyes. At 1, 4, 7, 14, and 28 days after surgery, the expression of proliferating cell nuclear antigen, a marker of cell proliferation, in the filtering site was examined immunohistochemically using a streptavidin-biotin complex method. RESULTS: In control eyes that underwent trabeculectomy but did not receive mitomycin C, the number of immunoreactive cells increased 4-7 days after operation and decreased markedly at around 14 days. The filtering site was obstructed histologically at 4-7 days after operation. In the mitomycin C-treated eyes, immunoreactive cells appeared 4 days after surgery but disappeared by 7 days at the surgical site. The number of immunoreactive cells in the treated eyes was much lower than that in control eyes. CONCLUSION: The cell replication activity was markedly inhibited by administration of mitomycin C. The filtering site remained open for 28 days after surgery, whereas it was completely obstructed within 7 days in control eyes. Immunocytochemistry for proliferating cell nuclear antigen, as used in this study, is a simple and reliable method for detection of cell replication activity.

Animals↗

PubMed1987

Internal sclerectomy for glaucoma filtering surgery with an automated trephine.

A technique is described for performing full-thickness glaucoma filtering operation from within the anterior chamber. The procedure utilizes an automated trephine, designated the "trabecuphine," that is capable of simultaneous cutting and irrigation. The trabecuphine is brought into the anterior chamber through a limbal incision 180 degrees away from the planned filter site. The trephine is passed across the anterior chamber, above the iris, and into the angle to perform the sclerotomy. This procedure was performed successfully in 13 eyes of seven cynomolgus monkeys. Complications included two small hyphemas that cleared completely. Other complications such as flat anterior chamber, corneal damage, iridodialysis, conjunctival buttonhole, and cataract formation did not occur. Internal scleral trephination may offer another alternative in the surgical management of patients with intractable glaucoma.

Animals↗

PubMed1986

Temporary visual loss with ciliary body detachment and hypotony after attempted YAG laser repair of failed filtering surgery.

Ciliary body detachment, hypotony, and visual loss developed within one month after an attempt to reopen a closed filtering bleb with YAG laser treatment. The patient was a 68-year-old black woman who had a previously functioning thermal sclerostomy. YAG laser energy delivered to the sclerosed filtering site ab interno was unsuccessful in restoring patency to the filtering site as judged by clinical examination. Because of hypotony, all glaucoma medications were discontinued. Resolution of the ciliary body detachment with return of vision and stable intraocular pressures occurred after three weeks of intensive topical and systemic corticosteroid treatment.

Aged↗

PubMed1992

Recurrent choroidal detachment following timolol therapy in previously filtered eye. Choroidal detachment post filtering surgery.

A 64-year-old patient with open-angle glaucoma was treated with timolol following two unsuccessful filtering procedures. While on timolol therapy, she developed three episodes of choroidal detachment, hypotony and shallow anterior chamber. These findings resolved upon cessation of timolol and reappeared on 3 occasions shortly after reinstitution of the beta blocker therapy.

Choroid Diseases↗

PubMed1991

Reducing corneal toxicity of 5-fluorouracil in the early postoperative period following glaucoma filtering surgery.

To gain a better understanding of the relationship between postoperative 5-fluorouracil administration and corneal complications associated with its use, we analysed 43 consecutive filtering procedures in which it had been employed. Nine of the 43 eyes had corneal complications during that period. At the end of the three-month period, these corneal complications had all resolved. There was no correlation between postoperative intraocular pressure lowering and incidence of corneal complications. A low dose of 5-fluorouracil, and early recognition and treatment of corneal toxicity associated with its use may reduce corneal complications while maintaining filtration in eyes with poor surgical prognosis.

Aged↗

PubMed1995

[Intraocular pressure after filtering operation or combined filter-cataract operation].

BACKGROUND: The prevalence of glaucoma is 2% and of cataract 25% in patients at the age of 65 to 75 years. To this moment the discussion is open about the optimal therapy when there is simultaneous cataract and glaucoma. We evaluated and compared the intraocular pressure and the visual acuity in patients with filtering-surgery and combined surgery (= filtering surgery plus simultaneous cataract surgery). METHOD: In a retrospective study 56 eyes of 45 patients operated by filtering surgery and 46 eyes of 40 patients operated by combined surgery were examined. RESULTS: Patients with combined surgery showed significant higher frequency of fibrin in the anterior chamber compared to patients with filtering-surgery. After 12 months there was no significant difference in intraocular pressure between both groups. The IOP of the last examination was 16 +/- 4 mm Hg in eyes with combined surgery and 14 +/- 4 mm Hg in eyes with filtering surgery. Eyes with combined surgery showed an increase of visual acuity from 0.2 +/- 0.2 to 0.4 +/- 0.3, eyes with filtering surgery a decrease of visual acuity from 0.7 +/- 0.3 to 0.6 +/- 0.3. CONCLUSION: Combined surgery is perioperatively associated with a higher frequency of complications, but showed 12 months postoperatively equal values of regulated intraocular pressure.

Aged↗

PubMed1994

[Initial experience with the use of mitomycin C in anti-glaucoma filtering surgery].

The authors report on their initial experience with the use of peroperative administration of mitomycin C (0.5 mg/ml for a period of 5 mins.) in complicated cases of glaucoma. In 14 eyes of 15 with a mean observation period of 8 months compensation of the intraocular pressure was achieved. In one eye 5 months after a filtering operation transplantation of the cornea was performed with secondary implantation of the posterior-chamber intraocular lens, decompensation of the intraocular pressure was treated 11 months after the filtering operation by cyclocryotherapy. Mitomycin C is a promising substance which improves substantially the prognosis of complicated cases of glaucoma.

Adult↗

PubMed1979

Filtering surgery in children: barriers to success.

The use of trabeculectomy in advanced pediatric glaucoma is reviewed. Intraocular pressure was controlled in only 50% of the patients, and the best visual results was 20/200. Complications of vitreous loss, scleral collapse, ectasia, retinal detachment, and endophthalmitis were encountered. No evidence was found to support the claim that in the seriously compromised buphthalmic eyes, trabeculectomy is safer than other filtering operations since it filters under a scleral flap.

Adolescent↗