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At least 253 records · Page 14Linked to original sources
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 One patient (0.7%) was a non-responder and was withdrawn from the study for that reason.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↗
PubMed1999

Mitomycin C in higher risk trabeculectomy: a prospective comparison of 0.2- to 0.4-mg/cc doses.

PURPOSE: This randomized, masked, prospective study was conducted to compare the outcome of filtering surgery using doses of 0.2 mg/cc or 0.4 mg/cc of mitomycin C (MMC) in eyes that were at higher risk from previous conjunctival incisional surgery. METHODS: Eyes of 50 consecutive patients with primary open-angle, pseudoexfoliation, or pigmentary glaucoma requiring trabeculectomy who had previously undergone either limbal cataract surgery or trabeculectomy were enrolled. Patients received an intraoperative dose of either 0.2 or 0.4 mg/cc MMC for 2 minutes (n = 25 in each study group). Intraocular pressure (IOP), logMAR visual acuity, and complications were monitored at regular intervals for 1 year. Unpaired student t tests were used to compare percent decrease in IOP in both study groups at each interval. RESULTS: The percent decrease in IOP was not significantly different between groups at 1 day, 1 week, 1 month, 3 months, 6 months, or 1 year after surgery. LogMAR visual acuity was not significantly different between groups at 1 month, 6 months, or 1 year. Treatment failure occurred in seven patients in the 0.2 mg/cc group (28%) and seven patients in the 0.4 mg/cc group (29.2%). Postoperative hypotony, choroidal effusions and hemorrhages, and wound leaks occurred in both groups, but occurred more often in the group receiving 0.4 mg/cc MMC. CONCLUSION: Filtering surgery performed on higher risk eyes was as effective using a lower dose (0.2 mg/cc) of MMC as that using a higher dose (0.4 mg/cc). Incidence of complications and treatment failures was slightly higher in the group receiving high-dose MMC.

Adult↗
PubMed1992

Use of the argon laser to close filtering bleb leaks.

We attempted to seal 15 consecutive filtering bleb leaks in 11 patients using argon laser energy. Eight leaks were at the conjunctival-corneal interface associated with a fornix-based flap, 4 leaks resulted from suture scissoring of the conjunctiva, and 3 leaks were button-holes in the conjunctiva. Thirteen leaks occurred within 2 weeks after filtering surgery, while 2 were of late onset. Argon laser parameters used were a 500-microns spot size, 0.1-s time interval, and between 500 and 1800 mW of power. Thirteen leaks were sealed after one or two laser sessions, while 2 leaks required other treatment modalities. Complications included conjunctival fenestration and transient corneal stromal opacities. This study suggests that the argon laser can be used to seal filtering bleb leaks in many patients following filtering surgery.

Adult↗
PubMed1994

Glaucoma drainage implants.

Glaucoma drainage implants provide a useful option in the management of complicated glaucomas for which the risk of failure of conventional filtering surgery is high. The basic design of these devices is similar; a silicone tube shunts aqueous humor from the anterior chamber to a fibrous capsule surrounding a synthetic plate or band positioned at the equatorial region of the globe. The capsule serves as a reservoir for aqueous drainage. Drainage implants have been used in the treatment of various refractory glaucomas, including those associated with aphakia and pseudophakia, prior unsuccessful filtering surgery, anterior segment neovascularization, trauma, youth, uveitis, epithelial downgrowth, iridocorneal endothelial syndrome, vitreoretinal disorders, and penetrating keratoplasty. Modifications in implant design and surgical technique have been developed to limit the occurrence of postoperative complications such as hypotony and its related sequelae, and strabismus.

Child↗
PubMed1988

Clinical experience with the single-plate Molteno implant in complicated glaucomas.

Ninety patients with medically uncontrollable glaucomas and poor surgical prognoses received single-plate Molteno implants (Optomat Supplies, Dunedin, New Zealand) without postoperative adjunctive systemic antifibrosis therapy. Eleven patients had insufficient follow-up for assessment of intraocular pressure (IOP) or visual acuity outcome. The initial Molteno implant procedures in the remaining 79 patients were successful (IOP less than or equal to 21 mmHg with at least 6 months' follow-up) in 26 (63%) of the 41 patients older than 12 years of age with non-neovascular glaucomas in aphakia/pseudophakia; 7 (70%) of the 10 patients older than 12 years of age with non-neovascular glaucomas in phakic eyes after failed filtering surgery; 7 (47%) of the 15 patients with neovascular glaucomas; and 7 (54%) of the 13 patients younger than 13 years of age with non-neovascular glaucomas. The visual acuities remained within one line of their preoperative levels or improved in 31 (76%) of the 41 aphakic or pseudophakic eyes with non-neovascular glaucomas; 3 (30%) of the 10 phakic eyes with non-neovascular glaucomas after failed filtering surgery; 10 (67%) of the 15 eyes with neovascular glaucomas; and 9 (100%) of the 9 eyes with non-neovascular glaucomas in patients younger than 13 years of age on whom Snellen acuity was available.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

A review of surgical alternatives to medical therapy for glaucoma.

Results of four uncontrolled studies, with short-term follow-up, of argon laser trabeculoplasty (ALT) as initial treatment for various open-angle glaucomas indicate short-term success varies from 65 to 90 percent. The success rates are less impressive when the definition of success, usually intraocular pressure 22 mmHg or less, and the short follow-up, usually limited to months, are considered. The ongoing, multicenter, random-assignment, controlled Glaucoma Laser Trial in the United States will provide additional information about short- and long-term follow-up of primary ALT that will clarify the accuracy of the results of these preliminary trials.Results of another study suggest that initial filtering surgery is as effective at controlling intraocular pressure and preserving visual function as medical treatment for newly diagnosed glaucoma. All these clinical studies are difficult to interpret and suffer from the lack of data analysis using the life-table method. The comparatively low rate of long-term success of ALT for open-angle glaucoma performed after failure of medical management, particularly in blacks, cautions that ALT may not be a good substitute for medications or filtering surgery in newly diagnosed glaucoma.

Glaucoma, Open-Angle↗
PubMed1992

The effect of trabeculectomy on corneal topography.

Trabeculectomy is increasingly being performed earlier in the treatment of primary open-angle glaucoma (POAG). Surgically-induced alterations in corneal curvature resulting from filtering surgery may have a significant impact on patients, especially younger ones, whose vision may already be compromised by visual-field loss. Using data obtained by computer-assisted topographic analysis performed preoperatively and at 12 weeks postoperatively, we longitudinally studied the corneal surface changes induced by primary trabeculectomy in eight eyes undergoing surgery for POAG or normal-tension glaucoma. Additional data collected included refraction, keratometry, axial length, intraocular pressure, and pachometry. Five of eight eyes developed 1.50 to 2.50 diopters of steepening in the 90-degree meridian. One patient developed flattening in the 180-degree meridian without vertical steepening. Two patients had little change in the central optical zone. Of the six eyes with induced with-the-rule astigmatism, keratometry was less sensitive than topographic analysis in detecting the changes induced by trabeculectomy. Our data indicate that changes in corneal curvature are induced by filtering surgery, but may be undetectable without topographic analysis.

Astigmatism↗
PubMed1991

Interferon-gamma inhibits collagen synthesis by human Tenon's capsule fibroblasts in vitro.

Collagen deposition is largely responsible for scar information, an undesirable outcome of glaucoma filtering surgery. Because interferon-gamma (IFN-gamma) has been reported to inhibit collagen synthesis in a variety of cells, the authors examined its effect on collagen synthesis by Tenon's capsule fibroblasts cultured from three patients. In addition, the authors studied the effects of IFN-gamma on fibroblast proliferation. IFN-gamma inhibited collagen synthesis at dosages of 1-10,000 U/ml. The average median effective dose (ED50) was 6.60 U/ml. In contrast, IFN-gamma had no significant effect on cell proliferation in dosages of 0.001-10,000 U/ml. These results suggest that IFN-gamma may be a useful agent for modifying the wound healing response, particularly after glaucoma filtering surgery.

Adult↗
PubMed1993

Incidence of complications following 5-fluorouracil with trabeculectomies.

To investigate the incidence of complications reportedly caused by the use of 5-fluorouracil (5-FU) in glaucoma filtering surgery, we performed trabeculectomy with 5-FU on 57 eyes of 56 patients with advanced glaucoma. The mean preoperative intraocular pressure was 34.8 mm Hg. The most frequent complication encountered was superficial punctate keratopathy (26%), followed by shallowing of the anterior chamber (12%), choroidal detachment (9%), and flap retraction (7%). We, however, did not encounter any cases of confluent corneal epithelial defect, subepithelial scarring, or striate melanokeratosis which are usually described with the use of 5-FU. With a mean follow-up of 7.1 months, an intraocular pressure less than 16 mm Hg without hypotensive therapy were achieved in 73.7% of cases, and less than 21 mm Hg without hypotensive therapy in 86%. Considering the low incidence of complications and the high success rate, we recommend the use of 5-FU in routine glaucoma filtering surgery.

Combined Modality Therapy↗
PubMed1987

The effect of beta irradiation on monkey Tenon's capsule fibroblasts in tissue culture.

Fibroblast proliferation with subsequent bleb scarring is a major cause of filtering surgery failure. To investigate possible antiproliferative effects of beta radiation, owl monkey Tenon's capsule fibroblasts in tissue culture were irradiated to doses of 30, 100, 300, 1,000, and 3,000 rads with a linear accelerator and to doses of 95,285, and 950 rads with a Strontium-90 applicator. The irradiated cell proliferation expressed as the percentage of the non-irradiated control growth on the third and seventh days, respectively, after beta irradiation was: 97% and 96% after 30 rads; 72% and 90% after 100 rads; 48% and 44% after 300 rads; 39% and 14% after 1,000 rads; and 39% and 14% after 3,000 rads. Similar effects on cell proliferation were observed with the Strontium-90 applicator. The inhibitory effect of beta irradiation on fibroblast proliferation in tissue culture suggests that beta irradiation after filtering surgery may reduce postoperative bleb scarring.

Animals↗
PubMed2000

Outcome of trabeculectomy with mitomycin-C in the iridocorneal endothelial syndrome.

PURPOSE: Eyes with iridocorneal endothelial (ICE) syndrome have a high risk of failure in glaucoma filtering surgery failing. We investigated the efficacy of trabeculectomy with intraoperative mitomycin-C application in these patients. DESIGN: Retrospective nonrandomized comparative trial with historical controls. PARTICIPANTS AND CONTROLS: Ten patients with unilateral iridocorneal endothelial (ICE) syndrome were reviewed. Their intraocular pressures could not be controlled medically. In five eyes, this was the primary surgery performed. Five of the patients had undergone prior intraocular pressure-(IOP) lowering surgery that had failed at the time enrolled. Results were compared with previously published case series of similar patients treated with trabeculectomy alone or trabeculectomy and subconjunctival 5-fluorouracil injections. INTERVENTION: Intervention consisted of trabeculectomy with a limbus-based conjunctival flap and mitomycin-C application. The dosage of mitomycin-C was 0.4 mg/ml for 1 to 4 minutes (mean, 1.9 min). MAIN OUTCOME MEASURES: Adequate control of IOP (without medication lower than 21 mm Hg). RESULTS: In eight eyes the IOP remained well controlled (mean IOP, 12.1 mm Hg) over the entire length of available of follow-up (mean, 14.9 months). Two eyes required implantation of an aqueous tube shunt at 4 and 11 months, respectively, after trabeculectomy with mitomycin-C. One eye experienced visual loss of 3 Snellen lines because of hypotony maculopathy. CONCLUSIONS: Trabeculectomy with mitomycin-C application offers a reasonable intermediate-term success rate in ICE patients, who are otherwise at high risk for failure of filtering surgery.

Adult↗
PubMed1996

A novel MMC-loaded pHEMA drainage device for the treatment of glaucoma: in vitro and in vivo studies.

Administration of subconjunctival 5-fluorouracil (5-FU) and topical mitomycin-C (MMC) has been shown to improve the success rate of glaucoma-filtering surgery. However, corneal toxicity and administrative problems remain. To overcome this limitation, drainage devices for the sustained release of 5-FU and MMC were designed and tested in vitro and in vivo. This paper presents only the results of our studies which were carried out on MMC-loaded devices. Here, the drainage devices were prepared from MMC-loaded poly(hydroxyethyl methacrylate) (pHEMA) matrices in different cross-linking ratios and in different drug loading capacities, i.e. 0.2, 0.5, and 2.0 mg MMC per device. These devices released MMC at approximately 6.0-90.0 micrograms day-1 for over 2 months depending on cross-linking density and initial drug loading. The diffusional release of MMC from glassy and swollen copolymers showed that diffusion mechanism is Fickian in both cases. The usability of the pHEMA implants were investigated by in vivo experiments which were done on eight dog's eye. In the treatment eyes, intraocular pressures remained significantly lower than the control eyes throughout the experimental period (4 months). Subconjunctival implantations revealed no clinical and histological evidence for toxicity. The results of in vitro and in vivo studies indicate that an implantable release system delivering MMC for over 2 months can improve the prognosis for filtering surgery by preventing postoperative fibrosis.

Administration, Topical↗
PubMed1997

In vitro effects of doxorubicin and mitomycin C on human Tenon's capsule fibroblasts.

Doxorubicin is an antiproliferative agent, that also inhibits prolyl 4-hydroxylase in vitro. We evaluated the effects of doxorubicin and mitomycin C (MMC) on the proliferation of human Tenon's capsule fibroblasts and the secretion of type I collagen in these cells to explore the potential use of doxorubicin as an antifibrotic agent after glaucoma filtering surgery. Standard immunoassays were used to determine the concentrations of type I procollagen COOH-terminal peptide (PIP), laminin and vitronectin receptor in conditioned media and cell lysates in the presence or absence of doxorubicin or MMC. The mitotic activity and viability of these cells were also determined. Cellular ultrastructure was evaluated by transmission electron microscopy. Doxorubicin and MMC decreased the cellular viability, the mitotic activity, and the production of the peptides measured. The inhibition of PIP secretion into the culture medium was higher in doxorubicin-treated cultures than in MMC-treated cultures at the tested concentrations (5-100 microM). The decrease in PIP levels in cell lysates was less in doxorubicin-treated culture (25 microM) than in MMC-treated culture (25 microM), suggesting that procollagen synthesis and secretion might be attenuated by doxorubicin. Ultrastructural studies revealed increased numbers of lysosomes in the cytoplasm of doxorubicin-treated cells relative to MMC-treated cells. Doxorubicin and MMC reduced cell viability and inhibited the proliferation and synthesis of PIP, laminin, and vitronectin receptor peptide. Inhibitory effects of doxorubicin on PIP secretion were more potent than those of MMC. Doxorubicin may be useful for inhibiting the fibrotic response at the site of ocular filtering surgery.

Adult↗
PubMed1994

Transcriptional control of human Tenon's capsule fibroblast collagen synthesis in vitro by gamma-interferon.

PURPOSE: Gamma-interferon (gamma-IFN) has been shown to be a potent inhibitor of collagenous protein production independent of its effects on noncollagenous protein production and cell proliferation in vitro. To understand further the processes controlling tissue fibrosis and the potential use of gamma-IFN as an antifibrotic treatment after glaucoma filtering surgery, the in vitro effects of recombinant gamma-IFN on procollagen mRNA production were studied. METHODS: Subconfluent human Tenon's capsule fibroblast cultures were exposed to 10, 50, 500, and 1000 U/ml of human recombinant gamma-IFN for 48 hours and to 500 U/ml for 12, 24, and 72 hours. After the incubation period, polyA+ mRNAs were isolated by oligo (dT) cellulose columns, separated according to size by electrophoresis through a denaturing agarose gel, and transferred to an activated nylon membrane for Northern blot analysis. The levels of type III (alpha 1) procollagen, type I (alpha 1) procollagen, and fibronectin (noncollagenous protein) mRNA were determined by hybridization with radiolabeled cDNA probes specific for these components followed by autoradiography. RESULTS: Densitometric analysis showed gamma-IFN selectively inhibited type III and type I procollagen mRNA synthesis from 24% (10 U/ml) to 99% (1000 U/ml) while leaving fibronectin mRNA synthesis unaffected. The degree of inhibition was also time dependent; more inhibition occurred with increasing incubation time. CONCLUSIONS: These results indicate that gamma-IFN is able to regulate collagen synthesis at the transcriptional level and that its inhibition is relatively specific. Gamma-interferon's specific inhibitory effects may offer advantages over current therapies in modulating the fibrotic response after glaucoma filtering surgery.

Cell Line↗
PubMed2002

Antiproliferative effect of mycophenolate mofetil on cultured human Tenon fibroblasts.

BACKGROUND: Wound healing after glaucoma filtering surgery is often complicated by exaggerated scarring of the subconjunctival Tenon's layer. Therefore, antiproliferatives are commonly employed. The immunosuppressive drug mycophenolate mofetil (MMF) is used to prevent graft rejection after kidney or liver transplantation. The effect is mediated by inhibition of lymphocyte proliferation. In this study we investigated the effect of MMF on human Tenon fibroblast proliferation in cell culture. METHODS: Human Tenon fibroblasts (HTF) were cultivated with 10% fetal calf serum. Cells were incubated with MMF concentrations of 0.1 microM to 3000 microM for up to 20 days. In a second set of experiments HTF were incubated for 10 min only in MMF solutions. Cell counts were performed to evaluate the proliferation rate. The proliferation was also assessed by Ki67 staining. Morphological changes were documented by vimentin staining. RESULTS: Growth inhibition of HTF by MMF was concentration dependent. IC(50) was 0.85+/-0.05 microM for 6 days of incubation. Brief exposure to MMF leads to a reversible growth arrest for up to 14 days with concentrations of 1000 microM or higher. Ki67 staining confirmed the concentration dependent proliferation rate. CONCLUSION: MMF has a concentration-dependent antiproliferative effect on HTF without any detected cytotoxicity in the applied concentration range. Brief incubation also leads to a growth arrest; therefore, intraoperative MMF application might prevent exaggerated scarring after glaucoma filtering surgery.

Aged↗