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PubMed1984

Complications of extracapsular cataract surgery. The indications and risks of peripheral iridectomy.

With the increased popularity of extracapsular cataract surgery, the need for a peripheral iridectomy has been questioned. Some surgeons feel that the risks involved in performing the iridectomy are greater than when leaving the iris untouched. The indications and risks of iridectomy with cataract surgery are discussed. Four case reports are presented. In three cases, iridectomy was not performed with cataract surgery, and a pupillary block developed. In one of these three, a congenital cataract, secondary angle closure, developed requiring filtering surgery. In the fourth case, an iridectomy prevented serious complications from an unusual degree of postoperative inflammation with complete posterior synechia following uneventful cataract surgery.

Aged↗

PubMed1992

[Treatment of anterior uveitis with 5-fluorouracil].

Filtering surgery with use of 5-fluorouracil (5FU) was performed in 5 eyes (4 patients) with inflammatory glaucoma to prevent filtering bleb scarring. Postoperative injections of 5FU were given once or twice a day, according to the degree of anterior chamber inflammation. Complete remission of the uveitis was achieved in all 5 eyes after 7-14 days of postoperative injections of 5FU. There were no recurrences of uveitis during a minimum of 8 months of follow-up.

Fluorouracil↗

PubMed1991

Internal sclerostomy with laser: a new approach to glaucoma surgery.

The creation of a fistula that permits controlled flow of aqueous from the anterior chamber to the subconjunctival space has been and remains the main technical goal of glaucoma filtering surgery. Currently, most complications are secondary to the surgical manipulation of the conjunctiva (mainly leakage from bleb and conjunctival fibrosis) or flattening of the anterior chamber. To overcome this problem, new methods are evolving in which the fistula is created from within the eye, with no conjunctival dissection. The performing of the sclerostomy by means of externally delivered laser energy is a further step in the same direction.

Glaucoma↗

PubMed1997

[Cataract-glaucoma combined surgery: comparison between phacoemulsification combined with deep sclerectomy, or trabeculectomy].

PURPOSE: To study the success rate of combined phaco-intraocular lens (IOL)-deep sclerectomy (P-DS), a new perforating filtering surgery, versus phaco-IOL-trabeculectomy (P-T). METHODS: Of 38 patients, 39 eyes with cataract and different types of glaucoma, 19 eyes underwent P-DS, and 20 eyes underwent P-T. Patients were prospectively studied. RESULTS: The follow-up of both groups was 11 +/- 6 months. The intraocular pressure (IOP) decrease in both groups was similar (from a mean preoperative IOP of 26.5 +/- 6.8 mmHg, to a mean postoperative IOP of 14.8 +/- 1.3 mmHg in the P-DS group, vs 25.9 +/- 7.7 mmHg preoperative and 14.8 +/- 2.7 mmHg postoperative in the P-T group). The visual acuity outcome was similar in both groups. The complication rate was significantly lower in the P-DS group. CONCLUSIONS: Deep sclerectomy associated with cataract surgery offers the same IOP reduction and visual acuity outcome. However, the complication rate is significantly lower and allows easier ambulatory care.

Aged↗

PubMed1997

Small incision trabeculectomy avoiding Tenon's capsule. A new procedure for glaucoma surgery.

BACKGROUND AND PURPOSE: Wound healing at the level of Tenon's capsule is a common cause of trabeculectomy failure. The purpose of this study is to present a new technique for glaucoma filtering surgery in which an injury to Tenon's capsule is minimized. METHODS: A 2.5-mm conjunctival peritomy was performed without cutting Tenon's capsule. A partial-thickness incision was made at the limbus and a scleral pocket was dissected 2 to 3 mm posteriorly. The subconjunctival space was entered with a cystotome passed through the scleral pocket, and balanced salt solution (BSS, Alcon Laboratories, Ft. Worth, TX) was injected, forming a subconjunctival bleb. In patients considered high risk, 5-fluorouracil (5 mg) was mixed with the BSS injected. The anterior chamber was entered at the initial limbal incision. A 1.5- by 1-mm fragment of the floor of the pocket was excised, followed by a peripheral iridectomy. The scleral wound, as well as the conjunctiva, was closed with separate 10-0 nylon sutures. This procedure was performed in 30 glaucomatous eyes. Seven high-risk eyes received four to seven postoperative injections of 5 mg of 5-fluorouracil. RESULTS: Preoperative intraocular pressure (IOP) was 34.5 +/- 8.1 mmHg. Postoperative IOP was 13.2 +/- 4.1 at 6 months (P < 0.01), and 90% of the eyes had IOP less than or equal to 18 mmHg without medication. Mean follow-up was 7.6 months (range, 6-14 months). Blebs were low-lying and diffuse. No serious complications were encountered. CONCLUSIONS: This new technique is a safe procedure that effectively reduces IOP. It is done through a small incision without sophisticated instruments. More cases and a prospective trial are needed to ascertain its potential advantages over those of conventional trabeculectomy.

Adult↗

PubMed1989

Glaucoma and its relationship to intraocular lens implantation.

The management of glaucoma and cataract is a complex subject that has remained controversial until recently. Extracapsular cataract surgery with posterior chamber lens implantation has made the procedure safe to perform in most eyes with glaucoma controlled medically, by laser trabeculoplasty or after filtering surgery. This paper will review the literature to establish rational guidelines for this particular group of patients.

Cataract↗

PubMed2001

[Ahmed valve in high-risk glaucoma surgery].

We used the Ahmed valve for the treatment of 142 eyes with high-risk glaucoma. The glaucoma was neovascular in 74 cases, aphakic or pseudophakic in 19 eyes and occurred after previous faliure of filtering surgery in 49 eyes. Preoperative mean IOP was 31.6+/-10.4 mmHg under topical and/or systemic treatment. The success rate (IOP<22 mmHg with only topical treatment) was 56.3% with a mean follow-up of 32.4 months. Complications were fewer and milder compared with those reported for other types of drainage implants and for other types of antiglaucoma procedures.

Aphakia↗

PubMedDate not supplied

Preliminary clinical experience with the Gunther temporary inferior vena cava filter.

PURPOSE: The authors describe their preliminary clinical experience with the Gunther temporary inferior vena cava (IVC) filter. PATIENTS AND METHODS: Seven women and 10 men, mean age 52 years (range, 19-85 years), were treated with the temporary IVC filter. Indications for filter placement were pulmonary embolism (PE) in four patients and iliofemoral deep venous thrombosis in six. In these patients anticoagulation was contraindicated because of planned major surgery. Filters were placed in four patients following massive PE and in three for prophylaxis following cranial trauma. Four patients had underlying malignant disease. Filters were introduced through the right common femoral vein in 14 patients, the left common femoral vein in two, and the left internal jugular vein in one. RESULTS: No patient developed recurrent PE with the filter in place. All filters were removed without complication 3-14 days (mean, 7 days) after placement. Two of the patients with underlying malignant disease required placement of a permanent filter. Two patients developed IVC thrombosis with the filter in place, and both developed recurrent PE after filter removal. Two patients developed insertion vein thrombosis. One patient developed a bleeding disorder that caused a massive hematoma at the insertion vein site, which may have contributed to her death. CONCLUSION: The Gunther temporary filter can be used in selected patients; however, patients with underlying malignant disease may be more appropriately treated with a permanent filter. The temporary filter does not appear to reduce the rate of insertion vein and IVC thrombosis.

Adult↗

PubMed1992

Antimetabolites in the surgical treatment of glaucomas.

Fibroblast proliferation with scarring at the surgical site plays an important role in the failure of filtration surgery. Several antimetabolites inhibit fibroblast proliferation in vitro. These observations have lead to the widespread clinical use in humans of 5-fluorouracil and more recently mitomycin-C in glaucoma filtering surgery.

Animals↗

PubMed1998

[Combined interventions: cataract and glaucoma review of the literature].

The combined surgical treatment of cataract and glaucoma has a long and controversial history. It changed dramatically over these two last decades with the technologic advances of both cataract and glaucoma surgery which have enabled to minimize the incidence and severity of complications and greatly influenced indications for combined surgery. During the 80's, extensive studies have shown the efficacy of combined trabeculectomy with extracapsular cataract extraction (ECCE) and posterior chamber lens implantation in patients with coexisting cataract and glaucoma. Small-incision cataract surgery by phacoemulsification with foldable introcular lenses have shortly replaced the ECCE in the beginning of the 1990's and have been, with pharmacologic modulation of wound healing for glaucoma filtering surgery, the most important factors which have contributed to a higher success rate and the actual relative safety of combined procedures. As compared to cataract extraction alone, the combined procedures offer better protection against the risk of early postoperative intraocular pressure increase, as well as the hope of better long-term intraocular pressure control. Although long-term intraocular pressure control has not been as predictable with combined surgery as in the two-stage approach, the recent use of antimetabolites (such as Mitomycin C) appeared to have improved early filtration success significantly. Conversely, combined operations tend to have a larger postoperative rate of complications than in cataract extraction alone. Having regard to the large variations in methods of patients selection, procedures evaluation, and criteria for success among the different authors, we will summarize the functional results, short and long-term intraocular pressure control and complications following combined procedures.

Cataract↗

PubMed2002

[Weill-Marchesani syndrome. Late athalamia following antiglaucomatous surgery].

PURPOSE/METHOD: A case of a patient with Weill-Marchesani syndrome who developed a secondary glaucoma due to synechiae in both eyes is described. As intraocular pressure (IOP) could not be controlled with medical treatment in the left eye (LE), the patient underwent glaucoma filtering surgery. IOP was controlled and no complications occurred. However, 15 months later, athalamia stage 1 was diagnosed in the LE, without any alterations in the posterior pole. To solve this complication, a vitrectomy with lens extraction and intraocular lens implantation in the LE was performed. Currently, IOP is 12 mmHg and the anterior chamber remains deep. RESULTS/CONCLUSIONS: The association of vitrectomy and lens surgery in those cases where there is a predisposition to forward movement of the lens, might reduce intra and postoperative complications.

Abnormalities, Multiple↗

PubMed1997

Effects of different formulations of mitoxantrone (solutions, nanospheres, liposomes) on glaucoma surgery in rabbits.

Pharmacological blockade of fibroblastic proliferation after glaucoma filtration surgery by using antimitotic agents in different formulations (liposomes, nanospheres) is of great clinical interest. However, only limited comparative data are available on the effect of encapsulated drugs on intraocular pressure (IOP) after filtering surgery. Therefore we have studied the effect on IOP of liposomes, nanospheres and a solution of mitoxantrone (MTO), a well-known antimitotic, in rabbits before and after sclerectomy. MTO in solution form, as well as in a liposome formulation, improved the outcome of the surgery by reducing IOP when administered subconjunctivally just following surgery. This effect was similar to mitomycin-C application. In contrast, neither prior administration nor subconjunctival nanosphere injections induced a reduction in IOP. Liposome administration demonstrated no delayed action or promoting effect but reduced the occurrence of corneal opacity observed in groups treated with MTO in solution.

Animals↗

PubMed1982

Combined cataract extraction and glaucoma surgery.

An approach to the surgical management of eyes with concomitant cataract and glaucoma is outlined, and the author's experience in 73 consecutive cases is described. Cataract extraction alone is recommended when glaucomatous damage is minimal, and the intraocular pressure is controlled with a low-dose, well-tolerated medical regimen. When the glaucoma is uncontrolled on maximum tolerable medical therapy and poses an immediate threat to vision, a two-stage procedure of filtering surgery with subsequent cataract extraction is preferred. Between these two extremes of glaucoma control are those cases for which a combined operation is felt to be indicated, especially when cataract surgery is planned in an eye with borderline glaucoma control and/or moderate to advanced glaucomatous damage. The preferred combined approach is cataract extraction with a guarded filtering procedure, and a simplified technique to accomplish this is described.

Cataract↗

PubMed2000

[Non-penetrating deep sclerectomy without collagen implant for glaucoma, as single or combined surgery].

Deep sclerectomy (DS) can be used in glaucoma with increased intraocular pressure when medical treatment fails. It involves removing part of the ocular drainage apparatus. Resistance to intraocular fluid drainage is decreased, improving drainage and decreasing intraocular pressure. By avoiding anterior chamber penetration, DS diminishes frequency of the complications of filtering surgery. 24 eyes of 23 patients underwent DS for primary or secondary open angle glaucoma with elevated intraocular pressure not controlled medically. It included preparation of a 4.0 x 4.0 mm limbal-based external scleral flap, dissecting and removing most of an internal scleral flap (leaving it 1 mm smaller than the external flap), unroofing Schlemm's canal and removing fine endothelial tissue lining its inner walls. The external scleral flap was then repositioned and sutured. Collagen implants were not used. In some cases DS was combined with extracapsular cataract extraction and intraocular lens implantation. Mean intraocular pressure decreased from 24.8 +/- 3.9 mmHg initially to 12.8 +/- 4.4 mmHg 6 months after operation (p < 0.0001). There was no difference in postoperative intraocular pressure between DS as a single procedure or as part of a combined operation. Complications were mild and of short duration. If long-term follow-up shows that lowered intraocular pressures are maintained, DS should be a surgical option in earlier stages of glaucoma.

Cataract Extraction↗

PubMedDate not supplied

Use of gas permeable contact lenses following trabeculectomy.

Some patients require a contact lens after glaucoma filtering surgery. The visual rehabilitation of such eyes can be challenging. We report on a total of eight eyes (seven patients) fit with lenticular-design, rigid gas permeable (RGP) contact lenses after the successful establishment of a filtering bleb. In follow-up (mean: 40 months), all patients have successfully worn lenses without adverse effects. We believe that, with careful fitting, close monitoring, and appropriate patient selection, the presence of a filtering bleb need not be a contraindication to contact lens wear, particularly when a smooth-edged, rigid gas permeable (RGP) daily wear lens is used.

Adult↗

PubMed1999

Novel synthetic meshwork for glaucoma treatment. I. Design and preliminary in vitro and in vivo evaluation of various expanded poly(tetrafluoroethylene) materials.

A novel drainage implant for glaucoma filtering surgery (MESH) is proposed. After various expanded poly(tetrafluoroethylene) (e-PFTE) materials were evaluated, the feasibility and the short-term safety of the technique were assessed in this first pilot study in the rabbit. The porous structure and the in vitro resistance to aqueous flow of seven different e-PTFE membranes (5-80 microm average pore size) were compared. Eight Dutch pigmented rabbits were implanted with the T-shaped MESH implants made from either 20- or 50-microm average pore size e-PTFE membranes. Clinical examination, intraocular pressure (IOP) measurements, and histology analyses were performed over a period of 3 months. The contralateral nonoperated eyes served as controls. MESH implantation took less than 7 min. No postoperative hypotony, migration, or extrusion of the implant and no intraocular inflammation or infection occurred. A significant IOP reduction in the implanted eyes was obtained past postoperative day 21 with the 20-microm material implant. The drainage efficacy was correlated with the degree of colonization of the porous materials and the inner spacing of the implant as observed by histology. With a filtering patency 3 times longer than conventional trabeculectomy and laser sclerectomy, MESH surgery is a promising technique for glaucoma treatment. Further studies are underway to enhance the device efficacy and understand the mechanism of filtration.

Animals↗

PubMed1994

Posterior chamber intraocular lens implantation in filtered or nonfiltered glaucoma eyes.

Cataract extraction and posterior chamber intraocular lens (PC-IOL) implantation was carried out in 45 glaucoma eyes that had undergone glaucoma filtering surgery (Group A), and in 47 glaucoma eyes in which intraocular pressure (IOP) was well controlled with medication (Group B). To analyze the effects of PC-IOL implantation on the control of IOP and the functioning of the filtering bleb, a life-table analysis using the Kaplan-Meier method was carried out. In Group A the probability that IOP control will not worsen at 2 years was 56 +/- 12 (SE)% in eyes where a functioning filtering bleb had existed preoperatively. The probability that the filtering bleb was not cicatrized at 2 years postoperatively was 44 +/- 11 (SE)%. In Group B the postoperative IOP on the first postoperative day was significantly higher than the preoperative level in primary open angle glaucoma (POAG) eyes, while no such difference was seen in primary angle closure glaucoma (PACG) eyes. The postoperative IOP was significantly lower than the preoperative level from 3 to 6 months postoperatively in POAG eyes and from 1 to 12 months postoperatively in PACG eyes. Medication did not differ significantly pre- and postoperatively. In 64 +/- 11 (SE)% of POAG and 63 +/- 15% of PACG eyes the IOP control did not worsen at 2 years. In 70% of the eyes the IOP control improved postoperatively, and was maintained for 2 years with the probability of 44 +/- 12 (SE)%.

Aged↗

PubMed1978

The long-term effects of iridectomy for primary acute angle-closure glaucoma.

Forty-nine eyes were treated with iridectomy for primary acute angle-closure glaucoma. Forty asymptomatic, normotensive fellow eyes were similarly treated. The duration of follow-up after surgery was 52.3 +/- 3.6 months. Thirty-seven (76%) of the eyes with acute attacks were cured by iridectomy alone and required no medical therapy. Twelve eyes (24%) developed increased intraocular pressure following iridectomy, but only one eye (2%) required filtering surgery. Eighty-eight percent of the asymptomatic, normotensive fellow eyes required no subsequent therapy, and none developed visual field defects. Visual acuity was unchanged in 22 of 49 (45%) of the acutely involved eyes and decreased more than six lines in 11 (22%) eyes. In the 40 fellow eyes, visual acuity was unchanged in 63% and decreased more than six lines in only one (2%) eye.

Aged↗