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At least 235 records · Page 13Linked to original sources
PubMed1983

Early and late failures of argon laser trabeculoplasty.

Sixty-five eyes in 52 patients with open-angle glaucoma were treated with argon laser trabeculoplasty (ALT). Although a majority of the eyes showed a decrease in intraocular pressure (IOP) of 5 mm Hg or more, eight eyes required filtering surgery within one year of treatment, and extensive peripheral anterior synechiae and persistent elevation of IOP developed in an additional two eyes that did not undergo surgery. In four of six eyes with juvenile glaucoma that were treated with ALT, complications developed and/or filtering surgery was required. A rise in IOP more than a year after treatment was noted in two eyes that had shown an initial satisfactory response to ALT. Although ALT seems to be a valuable addition to glaucoma therapy, the potential exists for both early and late complications and failures.

Glaucoma, Open-Angle↗
PubMed2002

Effects of tranilast on filtering blebs: a pilot study.

PURPOSE: To investigate the effects of topical instillation of 0.5% tranilast eye drops on intraocular pressure (IOP) and bleb formation after glaucoma filtering surgery. PATIENTS AND METHODS: This was a prospective, randomized, double-masked, and controlled clinical trial. A total of 52 eyes of 52 patients were randomly assigned to receive either 0.5% tranilast eye drops (24 eyes) or vehicle saline solution (28 eyes) 4 times daily for 3 months after trabeculectomy. Features of the bleb, such as vascularization and size, and intraocular pressure were studied. RESULTS: The incidence of vascularized bleb and "pseudopod" formation 6 months post treatment were more common in tranilast-treated eyes than control eyes (P = 0.019 and P = 0.043, respectively). The bleb was significantly larger at 6 and 12 months (P = 0.024 and P = 0.049, respectively), and reduction of the IOP was more significant for 2 years postoperatively (P = 0.002 to P = 0.032) in tranilast-treated eyes than control eyes. No vision-threatening side reactions were associated with tranilast. CONCLUSIONS: The use of topical tranilast after filtering surgery alleviates ischemia of the filtering bleb, reduces IOP, and increases the size of the bleb.

Administration, Topical↗
PubMed1999

[The use of antimetabolites in the treatment of glaucoma].

Many adjunctive therapies have been proposed to increase the success and prevent or reduce the incidence of complications associated with filtering surgery. Intraoperative or postoperative use of an antimetabolite has found a place as adjunctive therapy for eyes with otherwise pour prognosis following glaucoma filtering surgery.

Antimetabolites↗
PubMed1998

The contribution of phacoemulsification to combined cataract and glaucoma surgery.

The refinements of small incision cataract surgery by phacoemulsification with foldable intraocular lens implantation and the pharmacologic modulation of wound healing have brought new options for the combined procedure. Phacoemulsification combined with filtering surgery has the potential advantage of requiring a smaller conjunctival and scleral incision, which may reduce inflammation and bleb scarring with the possibility of enhanced bleb formation and long-term intraocular pressure control. The smaller phacoemulsification incision also helps to reduce postoperative astigmatism and improve visual results. Following combined phacoemulsification and filtering surgery, a larger area of undisturbed or virginal tissue in the conjunctiva and at the limbus is spared for further glaucoma surgeries or revision if the initial procedure fails. The risk of suprachoroidal hemorrhage during phacoemulsification in this susceptible group of patients is minimized by maintaining a closed chamber during the procedure.

Antimetabolites↗
PubMed1991

Risk factors associated with late infection of filtering blebs and endophthalmitis.

Late infection of filtering blebs and endophthalmitis are hazardous complications of glaucoma filtering surgery frequently associated with bleb failure and loss of functional vision. To determine possible risk factors for the development of these complications, characteristics of nine eyes of nine patients after filtering surgery in whom late endophthalmitis developed were compared with those in patients who had received a comparable operation at the same time in whom endophthalmitis did not develop. An average of 7.7 +/- 6.2 years (range, 6 months to 18 years) elapsed between the time of the filtering procedure and the initial appearance of endophthalmitis. Factors associated with increased risk were: increased axial length, thin and leaky bleb, conjunctivitis, upper respiratory infection, and the winter season.

Adolescent↗
PubMed2001

[Laser flare in combined cataract and glaucoma surgery].

BACKGROUND: We used a laser-flare meter to compare inflammation of the anterior chamber in combined cataract and glaucoma surgery with that in pure filtering surgery. MATERIALS AND METHODS: In 34 consecutive patients with primary chronic open-angle glaucoma (PCOG) we combined glaucoma surgery and cataract extraction with phacoemulsification and implantation of a foldable intraocular lens via the same incision. We compared the results with those in 32 PCOG patients receiving a single goniotrephination and in 45 PCOG patients receiving cataract extraction via clear cornea with implantation of a foldable lens. RESULTS: The increase in the flare in the first 2 days was significant in those receiving combined cataract and glaucoma surgery and in those receiving single goniotrephination but not in those receiving a single cataract extraction. After 3 weeks there was no significant difference to the preoperative value in any of the groups. The highest flare values were in patients after combined surgery, significantly higher than after cataract extraction in the first days and higher than in the goniotrephination patients 3 weeks after the operation. CONCLUSION: The highest flare on the first day was in combined cataract and glaucoma surgery. This may explain the more frequent scarring of the filtering bleb in combined surgery. Postoperatively the intraocular pressure and number of drugs used for glaucoma did not differ in patients with combined and single goniotrephination.

Aged↗
PubMed1997

[Surgical revision for hypotonia after glaucoma operation with mitomycin C].

PURPOSE: Persistent hypotony with maculopathy is a severe complication of mitomycin C when used during filtration surgery. We wanted to know whether this complication can be controlled by a surgical reintervention yielding tight closure of the initial sclerostomy. METHOD: In our clinic, 52 eyes underwent filtering surgery with intraoperative application of mitomycin C. Seven of them required a reoperation owing to persistent hypotony with maculopathy. During this reoperation, the scleral flap was tightly sutured (5x) or, if necessary, was closed with dehydrated human dura mater (2x). RESULTS: In all cases the intraocular pressure increased immediately (i.e., within less than 24 h) after reoperation. This intraocular pressure increase was accompanied by a simultaneous regression of the maculopathy. Further details: mean intraocular pressure (mmHg): before initial operation with mitomycin C: 38.5 +/- 2.9; after initial operation: 3.7 +/- 0.6; before reoperation (= 8 months after initial operation): 3.3 +/- 0.7; 24 h after reoperation: 22.0 +/- 2.9; 9 months after reoperation: 16.7 +/- 1.7. Mean visual acuity: before initial operation with mitomycin C: 0.72 +/- 0.1; after initial operation: 0.34 +/- 0.1; before reoperation (= 8 months after initial operation): 0.17 +/- 0.05; 24 h after reoperation: 0.28 +/- 0.05; 9 months after reoperation: 0.55 +/- 0.1. CONCLUSIONS: (1) Since the interval between reoperation and intraocular pressure increase was very short in all cases, overfiltration is at least one major reason for hypotony, not only ciliary body failure; (2) in cases of persistent hypotony after filtering surgery with mitomycin C, surgical reintervation can be recommended. During this reoperation, the initial sclerostomy should be closed tightly.

Adult↗
PubMed1997

Intraoperative prediction of intraocular pressure for the first postoperative day following glaucoma filtration surgery.

The goal of glaucoma filtering surgery is to achieve adequate control of intraocular pressure (IOP). This prospective study evaluates the authors' accuracy in predicting IOP for the first postoperative day (POD 1) through digital palpation of the globe and evaluation of the achieved leakage at the end of trabeculectomy. Fifty patients underwent trabeculectomy with or without the use of an antimetabolite. At the conclusion of the procedure, an IOP prediction for POD 1 was given by the surgeon. The recorded IOP readings on POD 1 were compared with this prediction. The results were evaluated by linear regression analysis. The IOP predictions were within +/- 3 mm Hg of the forecasted value for 31 patients (62%), within +/- 6 mm Hg for 44 patients (88%) and outside of +/- 6 mm Hg for 6 patients (12%). Short-term postoperative IOP control is reasonably predictable and may be adjusted for individual care.

Aqueous Humor↗
PubMed1999

Prevention and management of hypotony after glaucoma surgery.

Postoperative hypotony is a common complication of glaucoma filtering surgery, particularly with adjunctive use of antifibrotic agents. Associated structural sequelae and reduced visual function may occur in some eyes, resulting in the low-pressure syndrome. Precautions may be taken intraoperatively and postoperatively to decrease the likelihood of hypotony. Sometimes, despite these measures, the low-pressure syndrome still can occur, the management of which can be difficult. When simple observation does not result in spontaneous resolution, several noninvasive and invasive techniques are available, targeted at the cause of low IOP.

Anterior Chamber↗
PubMed1986

Management of large filtering blebs with the argon laser.

Complications attributable to large conjunctival blebs after glaucoma filtering surgery range from annoying foreign-body sensation to devastating endophthalmitis. We used the argon laser to shrink large complicated blebs in four eyes of four patients who had previously undergone glaucoma filtering surgery. The eye is first anesthetized with a topical agent. The bleb surface is lightly abraded with a sterile cotton swab and then "painted" with a tissue-staining dye. Diffuse laser burns applied over the surface resulted in sufficient shrinkage to allow resolution of the respective symptoms or secondary complications in all four cases. The first two patients developed small leaks that we attribute to delivering laser burns to extremely thin areas of conjunctiva. In both cases the leaks gradually sealed over several weeks. None of the eyes developed increases in intraocular pressure or anterior segment inflammation. In each case, filtering capability was maintained.

Aged↗
PubMed1997

Conjunctival impression cytology of the filtering bleb.

Impression cytology was used to evaluate the conjunctival surface change after filtering surgery and its association with bleb type and mitomycin C. Impression cytology were obtained at least ten (mean, 20.4) months after surgery from 22 eyes of 19 patients who had undergone trabeculectomy, and were graded according to a previously described system. Blebs were divided into thin cystic and thick diffuse types. Abnormal impressions, demonstrated as disturbed epithelial and goblet cell morphology and a decrease in the numbers of both cells, were found in nine eyes (40.9%). With regard to the prevalence of abnormal impressions, there were statistically significant differences between bleb type and between the use or non-use of mitomycin C (p = 0.040, 0.013); these related more to the use of mitomycin C than to bleb type. This study reveals that filtering surgery causes long-term damage to the conjunctival epithelium overlying a filtering bleb, especially in a patient with a thin cystic bleb or one has been treated with mitomycin C. This change in the conjunctival surface may lead to the occurrence of late hypotony and bleb-related infection.

Adult↗
PubMed1993

[Goniotrepanation combined with sinus surgery as a transitional measure in spontaneous carotid artery-cavernous sinus fistulas].

Two patients with spontaneous, angiographically proven fistulas showed progressive ocular symptoms which precluded waiting for spontaneous occlusion of the fistulas. On the other hand, endovascular therapy of the carotid-cavernous fistulas was not possible because the arterial supply of the fistulas came from both internal carotids. Therefore filtering surgery was performed in the affected eyes. Postoperatively, intraocular pressure decreased to normal values in both patients and the symptoms resolved. The visual acuity increased in one patient and remained the same in the other. In conclusion, filtering surgery is an important therapeutic tool to preserve visual function in eyes with carotid-cavernous fistulas that display progressive ocular symptoms but cannot be treated by embolization.

Aged↗
PubMed1977

Progression of glaucomatous field defects despite successful filtration.

It is generally assumed that successful filtering surgery, by maintaining intraocular pressure at a low level, will protect a glaucoma patient's remaining visual field. We present three patients with chronic open angle glaucoma and typical visual field changes. In each case, filtering surgery was performed because of progressive loss of visual filed and inadequate pressure control. Despite excellent pressure levels after operation, field loss continued in the operated eye. Certain genetic and systemic factors may contribute to further loss of visual field in the presence of normal intraocular pressures. We stress the importance of careful and continuous examination of the visual fields in all glaucoma patients regardless of the response of pressure to treatment.

Adult↗
PubMed1991

Subconjunctival 5-fluorouracil and herpes simplex keratitis.

We present a case of herpes simplex keratitis that appeared during a period following filtering surgery in which subconjunctival 5-FU was being administered. Although the 5-FU treatment was not halted, 4 days later the keratitis healed. The typical practice of discontinuing 5-FU treatment when these kinds of inflammation occur following filtering surgery may be unwarranted.

Eye Diseases↗
PubMed1989

Long-term evaluation of timolol.

Maintenance effect of the topical beta-blocker timolol on intraocular pressure (IOP) was investigated for a mean follow-up of 31.6 months in a group of 155 patients (275 eyes) with glaucoma or ocular hypertension. The mean IOP-value was calculated from 3 readings of the daytime IOP curve, and the mean eye pressure of the right and left eye in the respective individual was used. The medical therapy was carried out with our ranking order of drugs of choice: timolol, timolol combined with adjunctive drug therapy, laser trabeculoplasty and/or filtering surgery. Intraocular pressure was controlled with timolol alone in 98 of 155 patients (63.2%, Group 1). In 36 patients, timolol plus adjunctive medication was required to control IOP (23.2%, Group 2). Twenty-one (13.6%, Group 3) required either laser trabeculoplasty or filtering surgery in addition to timolol. Sufficient IOP-lowering effect was more frequently maintained in patients with ocular hypertension than those with glaucoma simplex or capsular glaucoma. Failures in timolol treatment occurred mostly within 6 months from the start of the therapy and correlated well with higher initial IOP. Transient adverse effects were observed in 11.2% of cases. In three cases (1.9%) local and systemic side effects were serious enough to require discontinuation of the drug therapy. One patient (0.7%) was a non-responder and was withdrawn from the study for that reason. Sixteen patients (10.3%) were lost to follow-up during the 4 year study.

Adult↗
PubMed1992

Encapsulated filtering bleb. A selective review--new deductions.

Filtering bleb encapsulation may, in some cases, be a severe complication following filtering surgery. The cause and mechanism of its development are not known. A selective review of data that might shed some light on these dilemmas, is presented. Based on these data, it is suggested that: (a) non-contractile collagen-producing fibroblasts play a major role in the process of bleb encapsulation, while in wound healing following filtering surgery, contractile fibroblasts are the major components; (b) the process of bleb encapsulation is less sensitive to the toxic effect of 5-Fluorouracil than would healing; (c) collagen-producing fibroblasts may be less sensitive to the destructive effect of 5-Fluorouracil than contractile fibroblasts; (d) inflammatory mediators are important triggers of bleb encapsulation.

Animals↗
PubMed2001

Surgical outcomes of deep sclerectomy with collagen implant.

We evaulated the effectiveness and adverse effects of deep sclerectomy with collagen implant (DSCI), which is a kind of nonpenetrating filtering surgery. In this retrospective study, DSCI was performed in 15 eyes of 11 glaucoma patients. An trabeculo-Descemet's membrane (TDM) window is created by a deep sclerokeratectomy, and the collagen implant is placed in the sclera bed under a superficial flap (deep sclerectomy with collagen implant). In 3 of 15 eyes the DSCI was intraoperatively converted to conventional filtering surgery for a large perforation of the TDM. These eyes were not included in the results of the surgical outcomes. The mean age of the patients was 50.3 +/- 14.4 years, and the mean follow-up period was 11.1 +/- 5.9 months. A diagnosis of chronic open angle glaucoma was made in 7 eyes and a diagnosis of secondary glaucoma in 5 eyes. The mean preoperative IOP was 25.8 +/- 11.9 mmHg, the immediate postoperative IOP was 6.4 +/- 2.9 mmHg, and at the final follow-up, the IOP was 11.9 +/- 2.5 mmHg. The IOP in 5 eyes was under 6 mmHg temporarily. However, there was no serious complication such as shallow anterior chamber. DSCI is considered to be a good surgical procedure that has similar surgical outcomes to a conventional trabeculectomy without serious complications.

Adult↗
PubMed1992

High incidence of sympathetic ophthalmia after contact and noncontact neodymium:YAG cyclotherapy.

BACKGROUND: Two cases of sympathetic ophthalmia occurring after noncontact neodymium:YAG (Nd:YAG) cyclotherapy have previously been reported. In each case, the patient had undergone filtering surgery in the exciting eye. Although in each case Nd:YAG cyclotherapy was the last surgery performed, the inciting event of sympathetic ophthalmia was unclear. METHODS: The authors studied three additional patients who developed sympathetic ophthalmia after Nd:YAG cyclotherapy for glaucoma. RESULTS: Two patients developed sympathetic ophthalmia 4 months after noncontact Nd:YAG cyclotherapy, and 1 patient developed sympathetic ophthalmia 18 months after contact Nd:YAG cyclotherapy. All patients had previous cataract extractions but no filtering surgery in the exciting eye. Clinical features included chronic iridocyclitis, choroidal folds, Dalen-Fuchs nodules, and optic disc edema. Combining these cases with the two previously reported cases, the incidence of sympathetic ophthalmia at our institution thus far is 5.8% (4 of 69) and 0.67% (1 of 150) after noncontact and contact Nd:YAG cyclotherapy, respectively. CONCLUSIONS: The incidence of sympathetic ophthalmia after Nd:YAG cyclotherapy is high compared with other ocular procedures. The clinician should vigilantly monitor patients after Nd:YAG cyclotherapy and report additional cases that may have occurred at other institutions.

Aged↗