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At least 343 records · Page 19Linked to original sources
PubMed1987

[Use of 5-fluorouracil in the surgery of glaucoma].

63 eyes (46 patients) with different types of glaucoma have been operated by filtering surgery with subconjunctival 5 fluoro-uracil (5-FU) injections. The mean follow up is 7 months. Two groups of patients have been studied: In the 33 eyes with previous unsuccessful glaucoma surgery, the result was very good: 73% of complete success (IOP less than or = 20 mmHg without additional therapy) 18% of qualified success (IOP less than or = 20 mmHg with additional therapy) 8% of failure. The other group included 30 eyes without previous glaucoma surgery, but with a bad surgical prognosis. In all the cases, the result was good, only one eye required additional therapy. The corneal complications are the most frequent, but do not last long. The other complications depend upon the indications, there are many in the aphakic patients. The durable flat anterior chamber must also be quoted.

Conjunctiva↗
PubMedDate not supplied

Internal sclerostomy with the Er:YAG laser using a gradient-index (GRIN) endoscope.

BACKGROUND AND OBJECTIVE: To show that sclerostomy, a glaucoma filtering surgery, can be performed using an Er:YAG laser. Scarring at the filtering site, a recurrent problem, may be reduced through proper positioning of the sclerostomy by using an intraocular endoscope. MATERIALS AND METHODS: Ab interno full-thickness sclerostomies were performed on eye bank eyes with an Er:YAG laser through a custom made optical delivery system. The intraocular laser probe consisted of a low OH silica fiber inserted in a metallic tapered sheathing. A rigid intraocular endoscope based on gradient-index lenses allowed visualization of the filtration site. RESULTS: A clear view of the anterior chamber angle was obtained through the endoscope, allowing for precise location of the sclerostomy. Full-thickness sclerostomies could then be performed at the desired location. Histologic sections showed thermal necrosis less than 50 microm thick in tissue adjacent to the sclerostomy. CONCLUSIONS: A sclerostomy performed with a combined procedure using an Er:YAG laser and intraocular endoscopy increases the speed of the procedure. The use of a high-resolution intraocular endoscope may increase the success rate of ab interno laser glaucoma surgeries.

Endoscopy↗
PubMed1981

Vision-threatening glaucoma following cataract surgery.

In four patients, vision-threatening acute glaucoma occurred following routine uncomplicated cataract surgery. Intraocular pressure remained elevated despite maximum tolerated medical therapy, requiring glaucoma filtering surgery in all four cases. Enzyme zonulolysis, water-tight wound closure, and compression of angle structures by wound sutures are discussed as contributing factors in the development of this postoperative acute glaucoma.

Cataract Extraction↗
PubMed1996

[Biodegradable controlled-release 5-FU implant in the surgery for glaucoma. Experimental study].

BACKGROUND: 5-Fluorouracil (5-FU) is useful as an adjunct treatment for glaucoma filtering surgery. However, efficacy depends upon maintaining sustained drug levels, currently achieved by repeated daily injections of the drug for several days. To overcome this limitation, we designed a biodegradable implant for the sustained release of 5-FU. MATERIAL AND METHODS: The implant (0.79 mm diameter, 6 mm long, 2.2 mg weight) contains 0.66 mg of 5-FU and is loaded in a needle coupled to a custom-made instrument to permit subconjonctival insertion of the implant through a 2 mm wide snip incision. The in vitro and in vivo pharmacokinetics as well as the biocompatibility studies of the implants were assessed in the rabbit. RESULTS: No infection, inflammatory reaction or extrusion occurred. The implant released the drug at a constant rate of 1.20 micrograms/hr for over 18 days and totally biodegraded in less than 86 days. CONCLUSION: Implantation of the device, after laser sclerostomy or conventional trabeculectomy shows great potential for the treatment of glaucoma. To determine the implant's efficacy, additional studies in the cat are underway.

Animals↗
PubMed1979

Recurrent orbital and metastatic melanoma in a patient undergoing previous glaucoma surgery.

A 61-year-old woman had unilateral acute angle-closure glaucoma and subsequently underwent a Scheie filtering operation. After a two-week interval, a large choroidal and ciliary body melanoma in the glaucomatous eye was found. No evidence of metastatic disease was found and the eye was enucleated. Histopathologic sections did not show extrascleral extension. Two and one-half years later the patient developed local orbital recurrence of the melanoma and fatal metastatic disease. We hypothesized a possible causal relationship between the filtering surgery and the local and systemic recurrence of the tumor.

Choroid Neoplasms↗
PubMed1997

Phacotrabeculectomy with or without punch: preliminary results comparing the two techniques.

The authors report their experience in the combined surgery, for glaucoma and cataract, by using the Crozafon-De Laage punch. 24 patients affected by open-angle glaucoma and cataract have been enrolled in the study. 12 underwent a combined operation of phacoemulsification and trabeculectomy according to Cairns, and 12 underwent phacoemulsification and protective filtering surgery executed with the Crozafon-De Laage punch. Comparing the two methods we noted as advantage of the punch its easiness of use, through the sclerocorneal tunnel of the phacoemulsification, to create a filtering fistula; this shortened the duration of surgery. As a disadvantage of punch use we noted a lower filtering gradability as opposed to Cairns' trabeculectomy.

Adult↗
PubMed2000

[Surgical indications in coexisting cataracts and glaucoma].

Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery.

Cataract↗
PubMed1979

Choroidal effusion during glaucoma surgery in patients with prominent episcleral vessels.

Rapid intraoperative choroidal effusion and flattening of the anterior chamber occurred during glaucoma filtering surgery in four young patients with prominent episcleral vessels, elevated episcleral venous pressure, and advanced open-angle glaucoma. Two of these four patients had Sturge-Weber syndrome. Intraoperative release of suprachoroidal fluid (SCF) through a posterior sclerotomy facilitated reformation of the anterior chamber and repositioning of the iris and ciliary body. Posterior sclerostomy performed prior to opening the anterior chamber minimized the above-mentioned untoward series of events. Analysis of SCF and serum demonstrated considerable differences in total protein and individual immunoglobulin levels; this appears to be a manifestation of molecular sieving at the level of the choriocapillaris. Choroidal detachment and postoperative serous retinal detachment are manifestation of this phenomenon.

Adult↗
PubMed1990

Combined exfoliation and pigment dispersion syndrome.

Both exfoliation syndrome and pigmentary dispersion syndrome can lead to secondary glaucoma. We treated five patients who had pigmentary dispersion and who subsequently developed exfoliation. In one patient who had bilateral pigment dispersion syndrome, the presence of exfoliation increased the difficulty of controlling intraocular pressure in the affected eye. In a monocular patient, exfoliation and pigmentary dispersion were concurrently present with characteristic defects of both pigmentary dispersion and exfoliation as seen by transillumination defects of the iris. A third patient had bilateral pigmentary dispersion and uncontrollable intraocular pressure in an eye with exfoliation. Despite argon laser trabeculoplasty, the pressure remained uncontrolled. Another patient had a filtering operation in the left eye, with gradually increasing intraocular pressure in the right eye. Exfoliation material complicated the pressure control in the unoperated on eye. Another patient had an eight-year history of glaucoma in the left eye for which filtering surgery was performed. Exfoliation was present in both eyes with controlled pressure in the filtered eye but uncontrolled pressure in the nonfiltered eye.

Anterior Eye Segment↗
PubMed1981

Argon laser trabecular surgery in uncontrolled phakic open angle glaucoma.

Thirty-five phakic eyes from a predominantly black population with clinically uncontrolled open angle glaucoma underwent argon laser treatment to 360 degrees of the trabecular meshwork. The intraocular pressure in the untreated eye was used as a control whenever possible. The mean pressure change in the treated eye at four months showed a decrease of 10.0 mm Hg (P less than 0.001). This effect was maintained throughout the 18-month follow-up period. Thirty-four of the 35 eyes (97%) were clinically controlled with pressures averaging less than 20 mm Hg. The procedure appears to function by improving outflow facility as manifested by a statistically significant increase in outflow for six months post-treatment. The major complication was the formation of peripheral anterior synechiae. These synechiae were localized and did not affect the success of the procedure. Argon laser trabecular surgery appears to be effective in lowering intraocular pressure with many advantages over standard filtering surgery.

Adult↗
PubMed2002

Intraoperative episcleral versus postoperative topical application of mitomycin-C for trabeculectomies.

OBJECTIVE: To assess the efficacy of a new application technique of mitomycin-C to enhance the outcome of filtering surgery in cases of complicated glaucoma. DESIGN: Randomized clinical trial. PARTICIPANTS: Fifty consecutive patients scheduled for glaucoma surgery in one large surgical center. INTERVENTION: Patients underwent routine trabeculectomy. In group 1, mitomycin-C (0.05 mg/ml) was applied topically to the filtering bleb on days 1, 2, and 3 after surgery (postoperative application). In group 2, mitomycin-C (0.2 mg/ml) was applied by means of to a sponge during surgery (intraoperative application). MAIN OUTCOME MEASURES: Preoperative and postoperative intraocular pressure (IOP) values, visual acuity, the need for antiglaucoma medication, previous surgical procedures, and the need for further surgical interventions were monitored. RESULTS: Sufficient follow-up data were available from 24 of 25 patients in each of the two groups. The follow-up ranged from 12 to 28 months and was evaluated at 12 months for all patients. The mean IOP decreased from 27.3 to 15.5 mmHg in group 1 and from 29.0 to 17.5 mmHg in group 2. The average number of medications decreased from 2.3 and 2.4 to 0.9 and 0.8 (P = 0.68; t test) in groups 1 and 2, respectively, at the 12-month visit. Hypotony was more frequent in group 2, in which the only case of hypotony maculopathy occurred. There was a tendency of more eyes with lower IOP values in this group. The rate of loss of visual acuity of more than 2 lines was higher in group 2. Failures were more frequent in group 2 (7 of 24) compared with group 1 (1 of 24) (P = 0.04, chi-square test). CONCLUSIONS: To our knowledge, this is the first prospective, randomized clinical study to evaluate the efficacy of this different technique of mitomycin-C application. The postoperative application of mitomycin-C was effective, having few failures. This application of mitomycin-C may be associated with a lower rate of complications when used in eyes with complicated forms of glaucoma.

Administration, Topical↗
PubMed1995

[Lymphatic congestion of the conjunctiva after pre-auricular lymph node excision].

PATIENT: A 68-year-old woman presented with massive congestion of lymphatic vessels of temporal inferior conjunctiva two months after extirpation of the parotic gland for an aciniform epithelioma on the same side. Clinical findings of the right and left eye were unremarkable otherwise. The congestion resolved spontaneously. METHODS: Patent Blue 2.5% was injected into the subconjunctiva in 5 mm distance of the limbus. The superior conjunctiva revealed a normal circular pattern of lymphatic vessels. In the temporal inferior conjunctiva massively congested lymphtic vessels could be demonstrated. This area is normally drained by the regional lymphnodes now interrupted by the surgery. CONCLUSION: The individual anatomy of the lymphatic vessels may be of significance also in filtering surgery. Especially radial conjunctival cuts may interrupt the lymphatic vessels. The regional lymphatic drainage from the temporal inferior conjunctiva is blocked by massive surgery of the parotic gland.

Aged↗
PubMed1985

Surgical management of encapsulated filtering blebs.

Encapsulated filtering blebs associated with elevated intraocular pressure or symptomatic dellen formation, unresponsive to conservative therapy, developed in 24 of 222 eyes following glaucoma filtering surgery over a five-year period, an incidence of 11%. Nine of 13 eyes were treated successfully with primary needling of the bleb. Ten of 11 eyes were successfully treated with primary bleb revision. Four eyes were successfully treated with a combination of needling and surgical revision and one eye required cyclocryotherapy. The overall success rate of needling or bleb revision was 96% after an average follow-up of 20 months. Thus, encapsulation of the filtering bleb, although requiring additional surgery in many cases, carries a favorable long-term prognosis.

Cicatrix↗
PubMed1997

Late onset of sequential multifocal bleb leaks after glaucoma filtration surgery with 5-fluorouracil and mitomycin C.

PURPOSE: To describe the late onset of sequential multifocal bleb leaks as a postoperative complication after filtering surgery with antimetabolites. MATERIALS: Retrospectively, 385 consecutive eyes (304 patients) undergoing trabeculectomy with 5-flurouracil (5-FU) or mitomycin C (MMC) from 1989 to 1994 were reviewed. Eyes with filtration bleb leak occurring 6 months or more after trabeculectomy were analyzed, and clinical characteristics of the filtration bleb, response to treatment, and bleb histopathology from eyes undergoing bleb excision were analyzed. RESULTS: In seven (1.8%) of 385 consecutive eyes from 304 patients undergoing glaucoma filtration surgery with 5-FU or MMC, repetitive bleb leaks in different locations of the bleb were observed from 9 to 44 months (mean, 20.4 months) after the procedure. One hundred ninety-three eyes (50%) were treated with 5-FU and the remaining eyes, with MMC. All eyes had transparent, avascular, lobular, cystic blebs. Bleb leaks occurred in five eyes treated postoperatively with subconjunctival 5-FU and in two eyes in which MMC was used intraoperatively. Three eyes (all treated with 5-FU) required surgical excision, and four eyes healed with soft contact lens, cyanoacrylate glue, or intrableb injection of autologous blood. Histopathology of the bleb leak sites demonstrated focal epithelial thinning and interruption with subjacent hypocellularity and stromal collagen degeneration. CONCLUSION: Late sequential multifocal bleb leaks may occur after glaucoma filtration surgery with administration of antimetabolites (5-FU or MMC) and are associated with epithelial break-down, hypocellularity, and stromal collagen necrosis in the filtration bleb.

Aged↗
PubMed1993

Long-term effects of mitomycin on filtering blebs. Lack of fibrovascular proliferative response following severe inflammation.

BACKGROUND AND OBJECTIVE: The use of antimetabolites, such as fluorouracil and mitomycin, enhances the success rate of filtering surgery, especially in eyes at high risk for failure, and increases the likelihood of a thin, avascular filtering bleb. In addition, mitomycin may cause long-term inhibition of the fibroblast's ability to proliferate in the conjunctiva and Tenon's capsule. Preoperative and postoperative inflammation frequently contributes to scarring of filtering blebs. The purpose of this study is to evaluate the effect of intraoperative mitomycin use on the survival of filtering blebs after severe inflammation. DESIGN: We retrospectively studied three eyes that had undergone trabeculectomy with intraoperative mitomycin. Two eyes had concomitant intraocular lens implantation. All three eyes had blebs that functioned well postoperatively. PATIENTS: These eyes sustained episodes of intense inflammation in the form of herpes zoster ophthalmicus, endophthalmitis, or purulent infection of the bleb postoperatively. RESULTS: Following treatment of the inflammation, no change in the appearance or function of the bleb could be detected. CONCLUSION: Either the indirect effect of mitomycin in producing a thin, avascular bleb or a long-term effect of mitomycin on the ability of conjunctival and Tenon's capsule fibroblasts to proliferate may have contributed to bleb survival.

Aged↗
PubMedDate not supplied

[Early postoperative campimetric outcome after trabecular surgery of chronic advanced glaucoma].

The authors report about the results of a preliminary study concerning the changes of glaucomatous visual field just after glaucoma filtering surgery in patients with advanced glaucoma. The visual field was established preoperatively, then 7 and 30 days in post operative period. Mesopic campimetry had been selected because of its precision for central field defects. The results appear to be favourable with 13 improvements 14 stabilizations, and 7 aggravations without loss of central vision. The authors have tried to determine predictive risk factors. The most important one are preoperative campimetric shape, angle anatomy, refraction and cardiovascular diseases.

Adult↗
PubMed1990

Visual field behavior after intra-ocular surgery in glaucoma patients with advanced defects.

Fifty advanced glaucoma patients with central visual field islands were evaluated before and after intra-ocular surgery with respect to visual acuity and visual field behavior. Thirteen patients underwent a cataract extraction, and 37 a filtering procedure. Visual acuity generally improved to a certain extent after lens extraction, and deteriorated after filtering surgery. For both groups the visual field island became somewhat larger with respect to the surface area, but the foveal value was usually lower after the operation. There was no clear relationship between visual acuity and foveal values or the surface area of the central island. One patient suffered unexplained loss of central vision.

Aged↗