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At least 19 recordsLinked to original sources

PubMed1992

Risk factors for suprachoroidal hemorrhage after filtering surgery. The Fluorouracil Filtering Surgery Study Group.

In the Fluorouracil Filtering Surgery Study, ten of 162 eyes (6.2%) that had undergone previous cataract extraction developed a nonexpulsive suprachoroidal hemorrhage after filtering surgery. Of the previously reported risk factors, including age, myopia, history of vitrectomy, history of 5-fluorouracil injections, postoperative hypotony, and high preoperative intraocular pressure, only high preoperative intraocular pressure was statistically significant (P = .002). The risk of suprachoroidal hemorrhage was strongly associated with the level of the preoperative intraocular pressure. None of the 63 patients with a preoperative intraocular pressure less than 30 mm Hg, three of the 47 patients (6%) with a preoperative intraocular pressure between 30 and 39 mm Hg, four of the 36 patients (11%) with a preoperative intraocular pressure between 40 and 49 mm Hg, two of the 12 patients (17%) with a preoperative intraocular pressure between 50 and 59 mm Hg, and one of four patients with an intraocular pressure more than 60 mm Hg developed a suprachoroidal hemorrhage. Because the preoperative intraocular pressure was highly correlated with the difference between the preoperative and the postoperative intraocular pressure, it was not possible to distinguish which factor was clinically more important.

Aged↗

PubMed1996

Five-year follow-up of the Fluorouracil Filtering Surgery Study. The Fluorouracil Filtering Surgery Study Group.

PURPOSE: To determine the efficacy and safety of subconjunctival 5- fluorouracil injections after trabeculectomy in patients with poor prognoses, to determine risk factors for surgical failure and to examine the relationship of intraocular pressure and visual function. METHODS: In this multicenter clinical trial, 213 patients with previous cataract surgery or previous failed filtering surgery were randomly assigned to receive either trabeculectomy alone or trabeculectomy with postoperative subconjunctival 5-fluorouracil injections. Measurements of intraocular pressure, visual acuity, and visual fields were performed throughout the five years, with the clinician masked to the treatment group. Failure was defined as a reoperation to control intraocular pressure or an intraocular pressure greater than 21 mm Hg at or after the first-year examination. RESULTS: Fifty-four (51%) of the 105 eyes in the 5-fluorouracil group and 80 (74%) of the 108 eyes in the standard filtering surgery group were classified as failures (P < .001, Mantel-Cox survival analysis). Risk factors for failure include high intraocular pressure, a short time interval after the last procedure involving a conjunctival incision, the number of procedures with conjunctival incisions, and Hispanic ethnicity. Patients in both treatment groups with controlled intraocular pressures were more likely to maintain visual acuity. Patients in the 5-fluorouracil group had a higher risk of late-onset bleb leaks (9% nine of 105) than those in the standard filtering surgery group (2% two of 108) (P = .032, Fisher's exact test). CONCLUSIONS: We recommend the use of subconjunctival 5-fluorouracil after trabeculectomy in eyes after previous cataract surgery or unsuccessful filtering surgery, but caution against its routine use in patients with good prognoses.

Cataract Extraction↗

PubMed1989

Fluorouracil Filtering Surgery Study one-year follow-up. The Fluorouracil Filtering Surgery Study Group.

Two hundred thirteen patients participated in the Fluorouracil Filtering Surgery Study, a randomized clinical trial, to determine the efficacy and safety of subconjunctivally injected 5-fluorouracil after filtering surgery in eyes with poor prognoses. Twenty-eight (27%) of the 105 eyes in the 5-fluorouracil group and 54 (50%) of the 108 eyes in the standard group were classified as failures, defined by reoperation for control of intraocular pressure during the first year or an intraocular pressure greater than 21 mm Hg at the one-year visit (P = .0007, Mantel-Haenszel chi-square). Corneal epithelial toxicity and transient visual acuity loss were more common in the 5-fluorouracil group (P less than .001, chi-square); however, the visual acuities and the mean visual field sensitivities were not significantly different at one year. We recommend the use of subconjunctivally injected 5-fluorouracil after trabeculectomy in eyes with uncontrolled glaucoma and poor prognoses, specifically after previous cataract extraction or unsuccessful filtering surgery.

Adult↗

PubMed1977

Anterior chamber after intrascleral filtering surgery.

Intrascleral filtering surgery was performed in 58 eyes and the anterior chamber (AC) depth was estimated postoperatively by recording the equivalent number of corneal thicknesses (CT) of central AC depth (lens-cornea distance). Lens-cornea touch occurred in 3 of 28 eyes with chronic simple glaucoma and was highly correlated with cataract formation. Lens-cornea touch did not develop in any of 11 eyes with other types of phakic glaucoma. Lens-cornea touch did not occur in any eye if the postoperative AC depth was ever 2 CT or greater and all three instances of lens-cornea touch occurred on or by the fifth postoperative day. Nineteen aphakic eyes were operated and all had normal AC depth from the first postoperative day. The data do not support the common belief that filtering procedures done beneath a scleral flap result in faster AC depth reformation than filtering procedures not done beneath a scleral flap.

Anterior Chamber↗

PubMedDate not supplied

Wound healing in glaucoma filtering surgery.

Successful glaucoma filtering surgery is characterized by the passage of aqueous humor from the anterior chamber to the subconjunctival space, which results in the formation of a filtering bleb. Aqueous in the subconjunctival space may then exit by multiple pathways. Bleb failure most often results from fibroblast proliferation and subconjunctival fibrosis. Factors associated with an increased risk of bleb failure include youth, aphakia, active anterior segment neovascularization, inflammation, previously failed glaucoma filtering surgery, and, possibly, race. Several surgical and pharmacologic techniques have recently been introduced to enhance success in eyes with poor surgical prognoses. To elucidate the scientific rationale of these methods, we summarize the process of wound healing after glaucoma filtering surgery and describe postoperative clinical and histopathologic features, factors which may affect success, and specific methods to improve surgical success.

Adrenal Cortex Hormones↗

PubMed2006

[What should be done when surgery fails? Managing the flat bleb after filtering surgery].

Approaches to treatment of the flat bleb after filtering surgery depends on the IOP, bleb appearance and absence or presence of a leak, anterior chamber depth, and the time since surgery. Treatment modalities include simple watching and waiting, reinstituting medical therapy, digital massage, laser suture lysis, YAG goniopuncture, or reoperation.

Filtering Surgery↗

PubMed2002

Descemet membrane detachment after nonpenetrating filtering surgery.

PURPOSE: To make surgeons performing nonpenetrating filtering surgery aware of an unusual complication namely Descemet membrane detachment. METHODS: We retrospectively reviewed nine eyes of nine patients seen in our hospital with Descemet membrane detachment occurring after nonpenetrating filtering surgery from January 1994 to December 2000. RESULTS: Both planar and nonplanar detachments were reported. Neither scrolls nor tears in the Descemet membrane were observed in any patient. After viscocanalostomy (four patients), the detachment was generally noticed shortly after the procedure and the cornea maintained its clarity. After deep sclerectomy with a collagen implant (five patients), it developed weeks to months postoperatively with adjacent corneal edema. Four patients had descemetopexy. None required more than one procedure. However, at the last visit, two detachments persisted although they had diminished in size: one after viscocanalostomy and conservative treatment and one after descemetopexy after deep sclerectomy with a collagen implant. To date otherwise, no signs of significant corneal damage could be observed clinically nor by specular microscopy and pachymetry. CONCLUSIONS: The diagnosis of Descemet membrane detachment can be easily overlooked or misdiagnosed. The clinical presentation, clinical course, and pathogenesis depend on the type of nonpenetrating filtering surgery performed. Ophthalmologists should be aware of this unusual complication, which is likely to be more common after nonpenetrating filtering surgery than after trabeculectomy. A period of observation before attempting descemetopexy is recommended.

Adult↗

PubMed2000

Results of filtering surgery in young patients with aniridia.

To evaluate whether filtering surgery is effective in controlling the intraocular pressure of young aniridic patients with glaucoma, we retrospectively reviewed the charts of aniridic patients with glaucoma under the age of 40 years. We defined a good intraocular pressure control period as the time from surgery until IOP exceeded 20 mm Hg, with or without glaucoma medication. Twenty filtering surgeries (17 trabeculectomies and 3 trabeculectomies with mitomycin C) were performed on 10 eyes in 6 patients for more than 20 years. The mean good intraocular pressure control period after the filtering surgery was 14.6 months (range, 2 to 54 months). Aside from mild choroidal detachment, no other serious complications were encountered. We believe that filtering surgery is efficacious for control of intraocular pressure of young aniridic patients with glaucoma.

Adult↗

PubMedDate not supplied

Morphometric study of wound healing in a model of filtering surgery with mitomycin-C.

BACKGROUND: Failure of filtering surgery may be related to excessive wound healing in the surgical area. This effect diminishes with the use of antimetabolic agents. Mitomycin-C (MMC) has proved to be the most effective drug to reduce myofibroblastic proliferation in experimental in vivo and in vitro models. To our knowledge, the objective changes induced by mitomycin-C in the size of wound healing areas have not been investigated. METHODS: Filtering surgery was performed on both eyes of 40 pigmented rabbits. Preoperatively one of the eyes received MMC (0.5 mg/ml), and the fellow eye received balance salt solution as placebo. Animals were killed on days 6, 15, 30 and 58. Microscopic healing areas were measured by digital procedures. The areas of target and fellow control eyes were compared by the Wilcoxon test. RESULTS: This study showed significant differences (p < 0.05) between treated and untreated groups, the healing are a gradually becoming smaller. CONCLUSIONS: Objective methods to quantify the microscopic effects of MMC can be useful to improve our knowledge about the action on this antimetabolite and to enable us to adjust more accurately the timing and dosage when applying the drug in glaucoma filtering surgery.

Animals↗

PubMed1993

Three-year follow-up of the Fluorouracil Filtering Surgery Study.

Patients who participated in the Fluorouracil Filtering Surgery Study, a clinical trial in which patients were randomly assigned to treatment to determine the efficacy and safety of subconjunctivally injected 5-fluorouracil after filtering surgery in eyes with poor prognoses, were followed up for three years. Treatments in 49 of the 100 eyes in the 5-fluorouracil group and 73 of the 99 eyes (74%) in the standard treatment group were classified as failures, defined by reoperation for control of intraocular pressure or intraocular pressure greater than 21 mm Hg during the first three years postoperatively (P < .001, chi-square). Late-onset leakage of aqueous through the filtering bleb occurred more frequently in the 5-fluorouracil group (seven of 105 eyes, 7%) than in the standard treatment group (none of 108 eyes, 0%) (P = .006, Fisher's exact test). We recommend the use of 5-fluorouracil after trabeculectomy in eyes after previous cataract extraction or unsuccessful filtering surgery. The increased risk of late-onset conjunctival filtering bleb leaks associated with 5-fluorouracil cautions against its routine use in patients with good prognoses.

Fluorouracil↗

PubMed1997

Electroporation and bleomycin in glaucoma-filtering surgery.

PURPOSE: To develop a new treatment in glaucoma-filtering surgery using combined treatment with electroporation and the antiproliferative drug bleomycin. METHODS: Pigmented rabbits were treated with both bleomycin (10 micrograms/ml) and localized electric pulses (EP) using a special probe (5 V/cm, 100 msec, 8 pulses) (n = 10; group A). After EP treatment, bleomycin was washed out with 50 ml balanced salt solution, and then a posterior lip sclerectomy was performed on the same area. We also studied rabbits undergoing a posterior lip sclerectomy with bleomycin treatment alone (n = 10; group B), a posterior lip sclerectomy with EP treatment alone (n = 5; group C) and a posterior lip sclerectomy alone using the same operation (n = 5; group D, negative control). The intraocular pressure (IOP) was measured before and 1, 3, 5, 7, 10, 15, and 20 days after surgery. The formation of blebs, the conjunctiva, and the cornea were periodically examined by slit-lamp biomicrography. RESULTS: In every group, the IOP decreased until day 7, and no significant difference was observed among the four groups. In groups B, C, and D (control), the IOP increased gradually from day 10 and thereafter returned to the preoperative level after 15 days. However, in group A, the IOP remained lower than the preoperative level for 20 days; it was also significantly lower than each of the other three groups (P < 0.01). The survival rate of a filtering bleb was significantly higher in group A than in groups B, C, or D, but the survival rate in group B was not higher than groups C or D. No adverse effects were clinically observed in the ocular tissue, such as the cornea and conjunctiva. CONCLUSIONS: The combined treatment with EP and bleomycin was found to decrease IOP more prominently than EP or bleomycin treatment alone in filtering surgery. This treatment thus makes filtering surgery effective by decreasing the dose of the antiproliferative drug and by possibly localizing the drug delivery.

Animals↗

PubMed2000

Nonpenetrating filtering surgery in glaucoma.

Since 1967, trabeculectomy has been the standard drainage operation for most cases of medically uncontrolled glaucoma. It is associated with significant risk of hypotony, hyphema, choroidal effusion or hemorrhage, and bleb failure. Toward the goal of a safer and more reproducible glaucoma filtering surgery, nonperforating filtering surgeries are now performed in primary open-angle glaucoma, normal-pressure glaucoma, and most cases of secondary glaucoma. The site of highest resistance to outflow, the juxtacanalicular trabecular meshwork, is bypassed with avoidance of penetration into the anterior chamber. Different techniques of nonpenetrating filtering surgeries are discussed here.

Anterior Chamber↗

PubMedDate not supplied

Semiconductor diode laser transscleral cyclophotocoagulation versus filtering surgery with Mitomycin-C.

Both filtering surgery with Mitomycin-C and diode laser cyclophotocoagulation have proved to be effective alternatives in cases of glaucoma with poor surgical prognosis. The right eyes of 40 pigmented rabbits were randomly divided into 2 groups: Mitomycin-C group underwent filtering surgery with application of 0.4 mg/ml of Mitomycin-C whereas the diode laser (DL) group received 15 applications of 1.8 J (1800 mW. 1000 ms) distributed in 270 degrees. Mean IOP showed statistical differences in two periods between days 3-13 and 45-60-Mann-Whitney U test -with a higher IOP lowering in the DL group. The comparison of IOP survival curves (Log-Rank test) was not significant p = 0.070809. Ocular hypertension, hyphema and inflammatory signs were higher in the DL group, both in short and long term, but in terms of statistical significance only ocular hypertension showed differences p = 0.00011717-Fisher exact test. Microscopic examination revealed patent sclerostomies in 60% of the MMC group eyes with different grades of fibroblastic proliferation. In the DL group we observed necrosis of the scleral stroma and of the pigmented and unpigmented ciliary epithelium, with signs of thermal coagulation of the ciliary stroma and of the stromal vasculature. We must point out that the treatment with laser has proved to be more effective although both treatments showed very acceptable IOP lowering until 2 months after the surgery.

Administration, Topical↗

PubMed1990

Management of cornea-lens touch after filtering surgery for glaucoma.

The success of filtering surgery for glaucoma may be compromised by a postoperative flat anterior chamber associated with cornea-lens touch, hypotony, and absence of wound leakage. The clinical course of eight patients with this complication was reviewed. Six patients had chronic angle-closure glaucoma. Only one patient responded to medical therapy which included frequent topical application of atropine sulfate 3.0% for 1 hour. Reformation of the anterior chamber with air and drainage of any suprachoroidal fluid was immediately performed in the remaining seven. At the time of follow-up (mean, 16 months), the glaucoma was controlled in all eyes except one. The mean intraocular pressure (IOP) was 14 mmHg in those eyes not requiring reoperation. Six (75%) of eight eyes had diffuse, succulent filter blebs. Five eyes (63%) required no antiglaucoma medications, one eye (12%) required one, one eye (12%) required two, and one eye (12%) underwent repeat filtering surgery. The results suggest that, once medical therapy is not immediately successful, prompt surgical reformation of the anterior chamber along with drainage of any suprachoroidal fluid may preserve the filter blebs in these eyes.

Adult↗

PubMed2000

Characteristics and risk factors of infections after glaucoma filtering surgery.

PURPOSE: To define characteristics and potential risk factors of endophthalmitis and blebitis after glaucoma filtering surgery in adults. METHODS: A chart review of all cases of endophthalmitis or blebitis treated at the Duke University Eye Center for 6 years (January 1993 to December 1998) was performed to identify patients with a history of incisional glaucoma surgery. RESULTS: Twenty patients were identified. The filtering bleb was located superiorly in all patients. Blebitis but not endophthalmitis developed in 3 (15%) of 20 patients, and all had visual outcomes of at least 20/25. Endophthalmitis (blebitis and vitritis) occurred in 17 (85%) of 20 patients. Cases of blebitis were treated with topical antibiotics. All cases of endophthalmitis were treated with intravitreal antibiotics, and 3 (18%) of 17 patients also underwent immediate vitrectomy. Initial visual acuity was less than hand motions in 5 (29%) of 17. Final visual acuity was less than 20/200 in only one case of endophthalmitis. In 15 (75%) of 20 patients, the bleb was noted to be thin, avascular, or both. On presentation, 11 (55%) of 20 blebs had Seidel-positive leaks with hypotony. A history of recurrent bleb leaks was documented in 7 (33%) of 20 patients. Pseudophakia was present in 13 (65%) of 20 eyes, and 7 (35%) of 20 had undergone combined cataract and filtering surgery. A prodrome, such as a browache, headache, or external eye inflammation or infection, was documented in previous physician visits in 7 (35%) of 20 patients. No cases occurred in eyes with glaucoma implants. CONCLUSIONS: Patients in whom endophthalmitis develops after trabeculectomy do poorly, even with aggressive medical and surgical intervention. As expected, several patients had thin, avascular, leaking blebs. In addition, hypotony, recurrent bleb leaks, pseudophakia, and more than one filtering surgery may also be associated with blebitis or endophthalmitis after glaucoma filtering surgery. In a surprising number of patients, prodromal signs or symptoms were documented by ophthalmologists days or weeks before the diagnosis of blebitis or endophthalmitis was made.

Adolescent↗

PubMedDate not supplied

Glaucoma filtering surgery, a retrospective study of 300 operations.

The results of 300 consecutive glaucoma filtering procedures, which were performed in our clinic between January 1982 and September 1985, are described. The overall combined success rate (complete + qualified) was 66.5% (Heuer's classification). This is in good agreement with other glaucoma referral centers. The peak of the age distribution curve at the time of operation was between 70 and 75 years. Nevertheless, 30% of operations was performed on patients under 50 years of age. Relatively poor success rates were obtained in operations following prior unsuccessful filtering surgery (50.5%) or other surgery (47%), in patients under 50 years of age (61%) and in some types of secondary glaucoma. In aphakia/pseudophakia the success rate was 33%. The posterior capsule was intact only 13% of this category at the time of surgery, in 56% previously unsuccessful filtering surgery had been performed, and the age at operation was relatively young (53 yr). These factors have an unfavorable influence on the results of filtering surgery. The success rate in phakic primary open angle glaucoma was 85% and in phakic primary angle closure glaucoma 73%. The combination with a cataract extraction (in 28%) and a peripheral iridectomy, if this had not been performed previously, (in 31%) may have contributed to the relatively favorable surgical results in phakic primary angle closure glaucoma. Relatively high intraocular pressures were found in the early postoperative period; the peak of the pressure-curve was between 20 and 25 mm Hg, 10 mm Hg higher than at the end of follow-up. Postoperative progression of glaucomatous visual field defects was noted in 7%. The most disturbing complication was flat anterior chamber, causing or enhancing cataract formation (in 4 out of 8 phakic patients) and corneal dystrophy (in 2 out of 12 patients). A review of literature is given concerning methods of improving filtration, when the surgical prognosis is poor.

Evaluation Studies as Topic↗

PubMed1999

[Prognostic value of anterior chamber hemorrhage following glaucoma filtering surgery].

PURPOSE: Evaluation of the prognostic significance of a postoperative anterior chamber hemorrhage (ACH) after glaucoma filtering surgery. PATIENTS AND METHODS: Records of 332 patients, who had undergone filtering surgery between 1/1993 and 2/1997, were analyzed retrospectively with particular concern on epidemiologic data, pre- and postoperative regulation of intra-ocular pressure (IOP), complications including ACH, postoperative 5-fluouracil (5-FU) therapy and postoperative IOP lowering therapy. Surgical success was defined as (1) IOP reduction below 21 mm Hg, (2) relative IOP reduction at least 20% and (3) no reoperation to control IOP until the first-year examination. RESULTS: 60 out of 332 patients (18.1%) suffered from ACH after glaucoma filtering surgery. 24 patients with ACH were treated with 5-FU, postoperatively. When all patients with ACH were considered in the evaluation, the difference between the success rate of patients with ACH and the success rate of patients without ACH was not statistically significant. In contrast, when ACH was the only complication in patients, who were not treated with 5-FU, the success rate was significantly worse (38%), when compared with the control group (patients, who did not have ACH or who had other complications in addition to ACH) (67%) (p = 0.008). When patients with these criteria received 5-FU postoperatively, the difference between success rates of both groups was not any longer statistically significant (p = 0.99). DISCUSSION: The postoperative occurrence of anterior chamber hemorrhage is associated with a higher failure rate of filtering surgery. Early administration of 5-FU is recommended in these cases.

Aged↗

PubMed2005

In vivo confocal microscopy study of blebs after filtering surgery.

OBJECTIVE: To analyze bleb structure after filtering surgery at the cellular level using a new generation in vivo confocal microscope. DESIGN: Observational case series. PARTICIPANTS: We retrospectively evaluated 17 filtering blebs of 13 patients after trabeculectomy. METHODS: Ophthalmologic examinations included slit-lamp examination, applanation tonometry, and in vivo confocal microscopy (Heidelberg Retina Tomograph II, Rostock Cornea Module). Eyes were classified into 3 groups: (1) functioning blebs (6 eyes), (2) nonfunctioning blebs (6 eyes), and (3) functioning blebs after application of mitomycin C (5 eyes). Cellular patterns, morphologic appearance, and functional aspects of functioning and nonfunctioning blebs were compared in a masked manner. MAIN OUTCOME MEASURES: In vivo confocal microscopy images were analyzed for number of intraepithelial microcysts, density of subepithelial connective tissue, presence of blood vessels, or encapsulation. RESULTS: All functioning blebs had numerous intraepithelial optically-empty microcysts, whereas all nonfunctioning blebs had none or few. Subepithelial connective tissue was widely spaced in all functioning blebs, whereas the tissue was dense in 83.3% of nonfunctioning blebs. Functioning blebs with mitomycin C had numerous microcysts and loosely arranged subepithelial connective tissue as compared with nonfunctioning blebs. CONCLUSIONS: In vivo confocal microscopy study of blebs is an original method that agrees well with ex vivo histologic examination. The number of microcysts and the density of the subepithelial connective tissue observed with in vivo confocal microscopy are correlated with bleb function. By providing details of the structures of filtering blebs at the cellular level, in vivo confocal microscopy constitutes a new promising way to understand wound healing mechanisms after filtering surgery.

Adult↗