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Permeability of uveal vessels after experimental filtering surgery in rabbits.

In adult albino rabbits, an opening wound was made in the central area of the cornea in one eye and the anterior chamber was made flat for 48 hours. Fluorescein-labeled dextran with a molecular weight of 70,000 was injected intravenously, and the uveal tissues were examined by fluorescence microscopy. A marked leakage of fluorescein-dextran was seen to occur from the vessels of the iris, ciliary body, anterior choroid and also even in the posterior choroid. The degree of leakage was similar during the period from 30 minutes to 48 hours after the surgery. In the fellow normal eyes, the leakage was minimal. In some eyes, the aqueous humor was aspirated and subsequently the anterior chamber was reformed spontaneously; the leakage of fluorescein-dextran determined 6 hours later was much less than after the filtering surgery. Some eyes were pretreated by topical 0.3% flurbiprofen solution or 0.3% indomethacin oil drop before the filtering surgery was performed. The pretreatment significantly reduced leakage of fluorescein-dextran from the uveal vessels, but the pretreatment with topical 0.1% betamethasone had only a slight effect.

Animals

The effect of reducing the exposure time of mitomycin C in glaucoma filtering surgery.

BACKGROUND: The use of adjunctive intraoperative mitomycin C has considerably improved the success rate of glaucoma filtering surgery. However, the ideal concentration and exposure time of mitomycin C is unknown. The purpose of this study is to determine whether a satisfactory surgical outcome can be achieved with a lower incidence of adverse side effects by using a shorter exposure time of mitomycin C than has been recommended previously. METHODS: Twenty-five eyes of 25 consecutive patients who were considered to be at high risk for surgical failure because of their age (< 55 years), previous failure of trabeculectomy, previous cataract surgery, or traumatic glaucoma received a single intraoperative application of mitomycin C (0.2 mg/ml for 2 minutes). They were case-matched with a group of 48 consecutive patients who received a single intraoperative application of mitomycin C (0.2 mg/ml for 5 minutes) by using age, race, type of refractory glaucoma, and preoperative intraocular pressure (IOP) as variables. RESULTS: Eighteen months after surgery, 22 (88%) patients in the 2-minute group and 21 (84%) patients in the 5-minute group had an IOP less than 21 mmHg with or without treatment. No significant differences were found in the complication rate: in 2 (8%) of 25 eyes of the 2-minute group, chronic hypotony developed compared with 3 (12%) of 25 eyes in the 5-minute group. Hypotony-related maculopathy developed in one eye in the 5-minute group. A cystic bleb was found in 15 (60%) eyes in the 2-minute group compared with 19 (76%) eyes in the 5-minute group, although this difference was not statistically significant. Two (8%) eyes in the 2-minute group and one eye (4%) in the 5-minute group had a bleb-related infection. In one (4%) patient in each group, late severe endophthalmitis developed. CONCLUSION: These results suggest that a 2-minute intraoperative application of 0.2 mg/ml mitomycin C is as effective as a 5-minute exposure, but the complication rate remains unaltered.

Adult

Glaucoma filtering surgery with postoperative 5-fluorouracil in patients with intraocular inflammatory disease.

Twenty-one eyes of 18 patients with uncontrolled glaucoma and intraocular inflammatory disease had glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil (5-FU). Follow-up for eyes in which intraocular pressure was controlled ranged from 6 to 53 months (mean, 34 months; median, 35 months). Fifteen of 21 eyes (71%) had controlled intraocular pressure (21 mmHg or less). Control was achieved in 9 of 10 (90%) phakic eyes and in 6 of 11 (55%) aphakic or pseudophakic eyes with or without glaucoma medication. Four of six filter failures had a second filtering procedure with 5-FU, and of these four procedures, three were successful. Cataract progression occurred in 9 of 10 phakic eyes, leading to cataract surgery in 7 eyes. Other complications included corneal epithelial defects in 13 eyes, bleb leaks in 3 eyes, choroidal effusions in 13 eyes, 1 choroidal hemorrhage, 1 serous retinal detachment and macular retinal pigment epithelial disturbance associated with hypotony and choroidal effusion. Filtering surgery with postoperative subconjunctival 5-FU can successfully control intraocular pressure in eyes with ocular inflammatory disease.

Adolescent

Glaucoma filtering surgery: factors that determine pressure control.

Factors that determine pressure control after filtering surgery were studied in 194 eyes of 158 patients in a retrospective study. Emphasis was placed on the cumulative probability method of Kaplan and Meier and multiple regression analysis. Aphakia and the presence of a surgical bleb were the most important factors. Age and type of surgical procedure were next. Race and race-sex interaction were the least important. The above factors accounted for only 6% to 16% of the total variance. The difference between eyes of the same patient was less than that between paired eyes of different patients but the former was surprisingly high. In the selected group of successful cases without medication the postoperative pressure was independent of the baseline pressure and choice of surgical procedure.

Adolescent

Glaucoma filtering surgery factors that determine pressure control.

Factors that determine pressure control after filtering surgery were studied in 194 eyes of 158 patients in a retrospective study. Emphasis was placed on the cumulative probability method of Kaplan and Meier and multiple regression analysis. Aphakic and the presence of a surgical bleb were the most important factors. Age and type of surgical procedure were next. Race and race-sex interaction were the least important factors. The above factors accounted for only 6% to 16% of the total variance. The difference between eyes of the same patient was less than that between paired eyes of different patients but the former was surprisingly high. In the selected group of successful cases without medication the postoperative pressure was independent of the baseline pressure and choice of surgical procedure.

Cornea

Limbus-based versus Fornix-based conjunctival flap in filtering surgery. A randomized prospective study.

A randomized prospective study was performed to compare the results of filtering surgery using a Limbus-based versus a Fornix-based conjunctival flap. The wound closure of the Fornix-based flap was performed using a running 10/0 nylon suture at the limbus. No statistical significant difference of IOP regulation was found between the two groups. There was a tendency of reduced occurrence of shallow anterior chamber and of less vascularized filtering blebs in the Fornix-based technique.

Conjunctiva

Injectable microspheres with controlled drug release for glaucoma filtering surgery.

The authors evaluated the effects of biodegradable poly (lactic acid) microspheres that provided the controlled release of the antimetabolic agent adriamycin (ADR) to prevent post surgical fibrosis after glaucoma filtering surgery. Fifty six eyes of 28 rabbits underwent posterior lip sclerotomy and received a 0.2 ml subconjunctival injection that contained microspheres 90 degrees from the filtering site immediately after surgery. Microspheres containing ADR (100 or 200 micrograms) were randomly administered to one eye. The fellow eyes served as controls and received microspheres without the drug. Intraocular pressure in the eyes treated with the microspheres that contained the drug was significantly lower than that in the control eyes from days 7-12 in the 100 micrograms group and from days 6-16 in the 200 micrograms group (P < .05). Eyes that received ADR had a significantly longer patent filtering bleb compared with the control eyes (P < .05). No corneal complications were observed in the eyes treated with 100 micrograms of ADR and the control eyes. Peripheral corneal opacities (25%) and epithelial erosion (17%) were observed in the eyes that received the 200 micrograms dose, but the cornea returned to normal after 4 wk. These results suggest that controlled-drug-release microspheres with an antimetabolic agent may be promising for preventing fibrosis after surgery.

Animals

Unsuccessful eccentric perilimbal suction after filtering surgery.

Eccentric suction was applied over the surgical site in 47 eyes thought to have unsuccessful external filtering procedures. Referrals for suction were made either because the postoperative intraocular pressure was uncontrolled or because blebs were becoming progressively flatter. Patients had an average of seven such treatment sessions. No discernible benefit from eccentric suction in failing filtering surgery was noted one year postoperatively.

Epinephrine

Serious corneal complications of glaucoma filtering surgery with postoperative 5-fluorouracil.

We studied four patients who, having received postoperative 5-fluorouracil after glaucoma filtering operations, developed serious corneal complications. All four patients had preexisting corneal abnormalities including keratoconjunctivitis sicca, exposure keratopathy, and bullous keratopathy. All of the patients developed epithelial defects in the postoperative period. The complications included bacterial corneal ulceration (two patients), sterile corneal ulceration and corneal perforation (one patient), and a keratinized corneal plaque with underlying sterile stromal infiltrate (one patient). The use of 5-fluorouracil, which is an antimetabolite with considerable corneal epithelial toxicity, after glaucoma filtering surgery frequently causes corneal epithelial defects that may lead to secondary complications. Patients receiving this drug should have their corneal status closely monitored. In patients with corneal epithelial disease, 5-fluorouracil should be used with caution.

Aged

Infectious crystalline keratopathy occurring in an eye subsequent to glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil.

We present a case of infectious crystalline keratopathy occurring after 5-fluorouracil filtering surgery. The patient had discrete, branching, white crystalline lesions in the anterior corneal stroma. Cultures grew Streptococcus viridans, and gram-positive cocci were demonstrated in corneal tissue biopsy specimens. Toxic and immunosuppressive properties of 5-fluorouracil may have participated in the pathogenesis of the infectious crystalline keratitis.

Chronic Disease

Combined cataract implant and filtering surgery with 5-fluorouracil.

In this preliminary retrospective study, results of combined extracapsular cataract extraction, intraocular lens implantation, and filtering surgery with subconjunctival 5-fluorouracil (5-FU) injections in 22 eyes were compared with those obtained in a similar group without 5-FU injections. Five to 35 mg (mean, 17.3 mg) of 5-FU were administered to each eye in the 5-FU group. Intraocular pressure (IOP) was controlled with fewer medications postoperatively than preoperatively in both the 5-FU group and the control group. However, the 5-FU group demonstrated statistically significant greater improvement in IOP control than the control group (P = .043).

Aged

Late hyphema after filtering surgery for glaucoma.

Four eyes of three patients developed spontaneous hyphemas eight months to three years after uncomplicated glaucoma filtering surgery. In two of the four eyes abnormal vessels could be seen at the internal margin of the trabeculectomy opening. Argon laser photocoagulation was successfully used to treat the bleeding, although one eye required multiple sessions.

Adult

D-penicillamine and beta-aminopropionitrile effects on experimental filtering surgery.

We studied the effect of two compounds, beta-aminopropionitrile (BAPN) and D-penicillamine on the success of experimental glaucoma filtering surgery in cynomolgus monkeys. All animals had laser-induced glaucoma and underwent punch sclerectomy operations. Eyes treated with BAPN or D-penicillamine maintained successful filtration for at least 3 days longer than nondrug-treated controls. This effect, while statistically significant (P less than 0.05), was temporary. The lack of more substantial improvement in prolonging filtering patency may have resulted from an inadequate effective drug concentration. Alternatively, these drugs may have limited potency because their action on new collagen synthesis affects only a minor component of the healing process that causes filter failure.

Aminopropionitrile

[A comparative study of homoharringtonine with 5-fluorouracil in filtering surgery].

With a prospective, randomized and double-masked control method, homoharringtonine(H.H) and 5-Fluorouracil (5-FU) were used in filtering surgery. We compared the effect and side effect of H.H with those of 5-FU. 24 eyes were in H.H group and 23 eyes in 5-FU group. An average follow-up of 18 months revealed: (1) the cumulative percentage of functioning bleb in H.H group (84.9%) was significantly higher than that in 5-FU group (62.2%) (P < 0.05); (2) the cumulative surgical success rate in H.H group (85.7%) was significantly higher than that in 5-FU group (61.1%) (P < 0.05); (3) the rate of corneal erosion in H.H group (20.8%) was significantly lower than that in 5-FU group (52.2%) (P < 0.05), the difference of other complications between H.H group and 5-FU group was not significant.

Adolescent

The effect of glaucoma filtering surgery on corneal endothelial cell density.

Corneal endothelial cell counts were obtained preoperatively and 3 months postoperatively in 46 eyes undergoing glaucoma filtering surgery. Average central endothelial cell loss in eyes without postoperative iridocorneal touch was 1.6%. In eyes with iridocorneal touch (Spaeth's grades 1 and 2), the average cell counts decreased by 7.1% and 9.3%, respectively. The average loss for combined grades 1 and 2 (8.1%) approached statistical significance (P +/- .06). The average loss in two patients with corneolenticular touch (Spaeth's grade 3) was greater than 50%. These findings suggest that early postoperative iridocorneal touch is unlikely to lead to corneal compromise in most eyes, but that corneolenticular touch can result in severe endothelial cell loss.

Aged

[Changes in the visual fields following filtering surgery in advanced glaucoma].

The authors report about the results of a preliminary study concerning the changes of glaucomatous field after glaucoma filtering surgery in patients with advanced glaucoma. Mesopic campimetry had been selected because of its precision for central field defects. The first results appear to be favourable. No patient lost central vision suddenly after surgery. The authors have tried to research predictive risk factors. The factors that seem to be the most important to consider are the preoperative campimetric shape and the angle anatomy.

Aged

Serous retinal detachment following glaucoma filtering surgery.

We report the occurrence of serous retinal detachment in association with choroidal effusion and hypotony in six eyes that had undergone glaucoma filtering surgery. Hypotony with choroidal effusion was documented in five patients before the onset of serous retinal detachment. While one patient underwent vitrectomy, treatment was conservative in the other patients. Serous retinal detachment and choroidal effusions resolved spontaneously as the intraocular pressure normalized. Although one patient regained preoperative visual acuity, all other patients lost at least one line of Snellen acuity.

Adolescent

Filtering surgery with mitomycin-C in uncomplicated (primary open angle) glaucoma.

Mitomycin is an antibiotic with antineoplastic activity which inhibits fibroblast proliferation in the operative field in glaucoma filtering surgery. The authors retrospectively evaluated the effectiveness of trabeculectomy with mitomycin-C as an initial surgical procedure in uncomplicated (primary open angle) glaucoma in 17 eyes of 17 patients; 12 eyes of 12 patients that received standard trabeculectomy constituted the control group. Mitomycin was applied at a concentration of 0.5 mg/ml for 3 min to the episclera and 2 min under the scleral flap. Median values for preoperative intraocular pressure was 43 mmHg (range 26-65) in the control group and 40 mmHg (range 30-60) in the mitomycin group (p > 0.05, Mann-Whitney U-test). After an average follow-up of 17 months, median postoperative IOP was 10 mmHg (range 3-18) in the control group and 4 mmHg (range 1.1-20) in the mitomycin group (p < 0.05, Mann-Whitney U-test). Percentage IOP drop was 75.6% in the control group (range 30.8-93.5%) and 89.6% (range 54.2-98%) in the mitomycin group (p < 0.05, Mann-Whitney U-test). The postoperative visual acuities of the two groups did not differ significantly (p > 0.05, Fisher exact test). Although there was not a statistically significant difference between complications, such as elevated intraocular pressure, wound leakage or bleb ulceration in both groups (p > 0.05, Fisher exact test), the number of hypotonous eyes (having an average IOP < or = 5 mmHg) was significantly higher in the mitomycin-C group compared to the controls (p < 0.05, Fisher exact test). Mitomycin established a well formed bleb and reduced the IOP more effectively than did the standard filtering procedure (p < 0.05, Mann-Whitney U-test); however, further work is necessary to evaluate the long-term complications of mitomycin-C surgery such as hypotony. This would help clear any doubts about the safety of this procedure on long-term.

Adult