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At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

A comparative clinical trial of mitomycin C and cyclosporin A in trabeculectomy.

This prospective, randomized clinical trial assessed the effects of mitomycin C and cyclosporin A used as antimetabolites in trabeculectomy on the post-operative IOP and success rate. Eighty-six consecutive patients were randomly allocated to three treatment groups. There were 30 patients in the mitomycin C group, 28 in the cyclosporin A group and 28 in the control group. The follow-up periods were different for the three groups and ranged from 6 to 30 months. The treatment groups consisted of primary open-angle glaucoma, closed-angle glaucoma, various secondary glaucomas and prior failed trabeculectomy. There were no significant differences pre-operatively with respect to IOP and number of medications used (p > 0.05). Postoperative IOP was considered to be successfully reduced when it was reduced by more than 25% from baseline or when it was lower than 20 mmHg. According to these criteria, IOP was under control in 90% of the mitomycin C treated eyes, 85.7% of cyclosporin A treated eyes and 71.4% of the control eyes. Postoperatively there was a significant decrease in IOP (p < 0.01) and in the number of medications need to control IOP (p < 0.01) in the mitomycin C and cyclosporin A groups. Post-operative IOP and number of medications in the mitomycin C and cyclosporin A group were similar. Complications encountered in the three groups were similar. There were no serious complications like hypotonus maculopathy. Our study highlights the utility of mitomycin C as an adjunct in glaucoma filtering surgery and indicated that cyclosporin A may also be used as an antimetabolite.

Adolescent↗
PubMed1989

Correlation of tonography and constant pressure perfusion measurements of outflow facility in the rabbit.

The values of aqueous outflow facility, determined using tonography and constant pressure perfusion, were compared in the New Zealand white rabbit. Four-minute indentation tonography was followed by multi-level constant pressure perfusion lasting 60 minutes in one randomly chosen eye of each animal. Mean outflow facility was 0.26 +/- 0.07 microliter/(min) (mmHg) using tonography and 0.26 +/- 0.6 microliter/(min) (mmHg) using constant pressure perfusion. These values are similar (p greater than 0.6) and show significant correlation (r = 0.914, p less than 0.001). Constant pressure perfusion was associated with a time-dependent facility increase, and with increased flow and stable resistance at higher infusion pressures. These results suggest that tonography may represent a repeatable, reproducible, and valid noninvasive technique to monitor outflow facility in this animal. This may be important in the evaluation of medications which alter wound healing after glaucoma filter surgery.

Animals↗
PubMed1992

The effects of 5-fluorouracil and mitomycin C on the corneal endothelium.

5-Fluorouracil (5-FU) and Mitomycin C (MMC) are used as adjunct chemotherapy during glaucoma filtering surgery to suppress conjunctival fibroblast proliferation. Since part of these agents may gain access to the anterior chamber and cause cytotoxicity to the corneal endothelium we set up an in vitro system to establish a dose-response effect. Cytotoxicity of MMC and 5-FU was quantified using Mosmann's colorimetric assay in a bovine endothelial cell culture system. In this assay the respiratory activity of the cells is used as a marker for cell viability. After incubation for 5 minutes the 3.0 mg/ml concentration of MMC showed endothelial cytotoxicity, whereas no endothelial toxicity of 5-FU was noted in concentrations up to 50 mg/ml. After incubation for 30 minutes endothelial cytotoxicity was demonstrated for 50 mg/ml of 5-FU and 1 mg/ml of MMC. After an exposure-time of 60 minutes the toxicity level remained 50 mg/ml for 5-FU but decreased to 0.5 mg/ml for MMC. We conclude that with respect to the clinically used concentrations and methods of application of 5-FU and MMC in vivo endothelial toxicity is not to be expected. However, in cases of accidental access of MMC to the anterior eye chamber and following a reduction of aqueous turnover rate the safety of MMC is unwarranted.

Animals↗
PubMed1999

Midterm follow-up of necrotic bleb excision and advancement of the fornical conjunctiva.

Mitomycin C has improved the success rate of glaucoma filtering surgery in patients at high risk for surgical failure. However chronic hypotony is marked by decreased vision and a late-onset leaking bleb after filtration surgery using mitomycin C. Bleb excision and conjunctival advancement is the method of choice to repair bleb leakage and chronic hypotony. Five eyes from five patients were received glaucoma filtration surgery with topical mitomycin C. All of the patients' blebs were avascular and transparent. The reasons for bleb excision were two spontaneous bleb leaks, two traumatic bleb leaks and one case of severe irritation. The mean follow-up period was 18.4 +/- 8.3 months (ten to 29 months). Cataract surgery was combined in one eye. Postoperative intraocular pressure (IOP) increased from 2.3 +/- 1.5 mmHg to 9.5 +/- 3.7 mmHg at nine months postoperatively in four eyes. It went from 28 mmHg to 40 mmHg in one patient with uveitis, for whom a second trabeculectomy with mitomycin C; 0.4 mg/ml for 3 minutes, was performed. After surgery, IOP decreased to 4 mmHg in three months. Postoperative visual acuity improved four snellen lines in three eyes. A partially avascular bleb recurred in three eyes, a corneal bleb in one eye and blepharoptosis, which disappeared spontaneously at four months postoperatively, in one eye. Necrotic bleb excision and advancement of fornical conjunctiva were useful methods to increase IOP and to improve visual acuity for the patient experiencing irritation symptoms, and for leaking blebs, and hypotonic maculopathy.

Adult↗
PubMed2006

Multiple retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma.

PURPOSE: We describe the occurrence of a massive retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma. METHODS: A 33-year-old man who suffered from uveitic glaucoma was transferred to our hospital. The lOP in both his eyes was documented to vary between 11 mmHg and 43 mmHg and remained at a continuously high level for 7 months despite maximally tolerable medical treatment. A paracentesis was performed bilaterally to lower the IOP. RESULTS: Immediately after the paracentesis, massive retinal hemorrhages occurred in the left eye. Multiple round blot retinal hemorrhages with white centers occurred in the equator and peripheral retina, and small slit hemorrhages were observed in the peripapillary area. A fluorescence angiography(FAG) showed no obstruction of retinal vessels but a slightly delayed arteriovenous time in the left eye. CONCLUSIONS: It is important to be aware that patients who have a persistent relatively high IOP are at an increased risk of developing decompression retinopathy due to paracentesis and filtering surgery.

Adult↗
PubMed1999

Nd:Yag goniopuncture after deep sclerectomy with collagen implant.

BACKGROUND AND OBJECTIVE: To study the need, the safety and the success rate of Nd:Yag goniopuncture in eyes that underwent deep sclerectomy with collagen implant. PATIENTS AND METHODS: The first 100 patients that underwent deep sclerectomy with collagen implant were prospectively followed. Deep sclerectomy with collagen implant is a non-penetrating filtering surgery which allows filtration of aqueous from the anterior chamber to the subconjunctival space through a remaining trabeculo-Descemet's membrane without opening the anterior chamber. Goniopunctures with Nd:Yag laser were performed at the site of surgery when the filtration through the trabeculo-Descemet's membrane was considered to be insufficient with elevated intraocular pressure. The laser treatment was performed using a Lasag 15 gonioscopy contact lens (CGA1). Goniopunctures were performed using the free-running Q-switched mode with an energy ranging from 2 to 4 mJ. RESULTS: Of 100 patients who underwent deep sclerectomy with collagen implant, goniopunctures with Nd:Yag laser were performed in 41 patients (41%). The mean time between deep sclerectomy with collagen implant and goniopuncture was 9.9 months +/-1.2 months (+/-SE). The mean IOP before laser treatment was 22.2 mm +/-7.0 mm Hg and decreased to 12.5 mm +/-5.8 mm Hg immediately after laser treatment and remained stable for the next 2 years of follow-up. The immediate success rate of goniopuncture was 83%. Choroidal detachment occurred in two patients (5%). CONCLUSION: Nd:Yag goniopuncture is an efficient and safe treatment for low filtration through the trabeculo-Descemet's membrane after deep sclerectomy with collagen implant.

Aged↗
PubMed1993

Laser sclerostomy for the management of glaucoma.

Laser sclerostomy can be performed in a less invasive manner than standard filtering surgery. Recent studies have explored the use of laser energy of varying wavelengths, properties, and tissue interaction to create thermal sclerostomies. Several methods deliver laser energy by mirrored contact lenses to the internal face of the filtration angle or by fiberoptic cables for ab interno or ab externo sclerostomy formation. Certain laser techniques can be performed outside the standard operating room, in a clinic or minor surgery room. This article reviews the various laser sclerostomy techniques currently being investigated.

Animals↗
PubMed1999

[The effects of single mitomycin C application on the expression of matrix metalloproteinase in the sclera and aqueous of albino rabbits].

BACKGROUND: Topically applied mitomycin C, which is used to prevent scar formation after filtering surgery for glaucoma, is known to cause reduction in scleral cells and abnormal remodelling of scleral extracellular matrices. I examined in this study the effects of mitomycin C on the expression of matrix metalloproteinase in the sclera and aqueous humor. METHOD: Mytomycin C was applied for 5 minutes to the bared sclera of 14 albino rabbit eyes. The sclera was organ cultured after 1 week, 2 weeks, and 1 month. The culture medium was subjected to zymography to quantitate the gelatinase activity. In situ zymography was performed on the sclera obtained 1 month after mitomycin C application. The aqueous was also subjected to zymography. FINDINGS: The scleral tissue and its cultured media showed enhanced gelatinase activity. The aqueous showed no changes in gelatinase activity. CONCLUSION: Increased activity in matrix metalloproteinase may be involved in the abnormal remodelling of scleral extracellular matrices after application of mitomycin C.

Administration, Topical↗
PubMed1999

A false-positive Seidel test after Ahmed valve insertion.

An 80-year-old monocular man with long-standing primary open angle glaucoma underwent successful filtering surgery in his sighted right eye in 1980. He subsequently developed a cataract and had an uncomplicated clear cornea phacoemulsification with posterior chamber intraocular lens in 1996. Post-operatively, the filtration bleb remained very avascular but shallowed; the intraocular pressure increased and remained uncontrolled despite maximally tolerated medical therapy. His vision improved to 6/7.5 and automated perimetry revealed a less than 5 degrees small central island of vision. His left eye was phthisical with no light perception.

Aged↗
PubMedDate not supplied

Primary trabeculectomy in young adults: long-term clinical results and factors influencing the outcome.

OBJECTIVE: To assess the long-term clinical outcome of primary trabeculectomy in young adults, and evaluate potential risk factors contributing to failure of filtering surgery. MATERIAL AND METHODS: A retrospective review was carried out of the charts of all glaucomatous patients between the age of 15 to 45 years. These patients had no history of previous extra- or intraocular surgery and had undergone primary trabeculectomy without the use of antimetabolites from January 1988 to January 1995 at the University Eye Hospital of Cologne. A total of 51 eyes of 45 patients fulfilled the inclusion criteria. There were no drop-outs from follow-up. Mean follow-up was 5.2 years (range, 2.5 to 9.5 years). Outcome was defined as a success when postoperative intraocular pressure (IOP) was 21 mm Hg or lower. If further glaucoma medication was required the outcome was described as a qualified success, and when the patient was free of medication the outcome was considered a complete success. RESULTS: Using the Kaplan-Meier survival curve, cumulative life-table success rates were 88% at 1 year (n = 51), 82% at 3 years (n = 47), 76% at 5 years (n = 26), and 70% at 7 years (n = 22). At final visit 71% (n = 36) were classified as successes, with 54% (n=30) being successful without adjunct medication. Seventeen percent (n = 6) required additional topical medication. Previous laser trabeculoplasty and an IOP greater than 40 mm Hg during the course of the disease was found to adversely affect the outcome. Eyes with iridocorneal epithelialopathy (ICE) syndrome, Rieger's anomaly, and uveitic glaucoma failed more frequently than those with juvenile, pigmentary, and primary open-angle glaucoma (POAG). Younger age (< 30 years) was not associated with a lower success rate after controlling for glaucoma category. CONCLUSION: The success rate of the uncomplicated group compares favorably with the 75% to 90% success rates of trabeculectomy commonly cited for primary glaucomas in older adults. Primary trabeculectomy in young patients may have a favorable outcome even without antimetabolite therapy.

Adolescent↗
PubMed1999

Low-dose postoperative transconjunctival application of mitomycin C in rabbit trabeculectomy.

PURPOSE: Mitomycin C (MMC) is commonly administered during filtering surgery to enhance the success of the procedure. Unfortunately, the increased success rate is associated with complications, including late bleb leaks, endophthalmitis, and ciliary epithelial toxicity. The purpose of this study was to investigate a safe and effective dose regimen for MMC to reduce incidence of those complications. METHODS: Trabeculectomy was performed in 36 rabbits. MMC was applied only during surgery, only one day after surgery, or once daily after surgery for 3 days at lower concentrations. Balanced salt solution (BSS) was administered during surgery to one group as a placebo. The time to bleb failure was determined and the eyes were evaluated histopathologically. Success and toxicity were compared for the different treatment groups. RESULTS: The mean time until trabeculectomy failure was 2.83 days for the placebo group, 6.33 days with administration of MMC 0.5 mg/mL during surgery, 7.83 days with administration of MMC 0.5 mg/mL once after surgery, and 11, 9, and 4.83 days with administration of MMC 0.1 mg/mL, 0.05 mg/mL, or 0.025 mg/mL, respectively, once a day for 3 consecutive days. On electron microscopic examination of the ciliary epithelium, toxic effects were greatest with MMC concentrations of 0.5 mg/mL and were less with lower concentrations. CONCLUSION: The effect of MMC on trabeculectomy survival was dependent on both the concentration and the method of administration. Lower concentrations with multiple postoperative administrations were as effective as but caused less ciliary body toxicity than intraoperative administration of higher concentrations.

Alkylating Agents↗
PubMed1999

[Ocular hypertension and uveitis. Study of 374 cases of uveitis].

OBJECTIVES: To study the frequency of ocular hypertension in uveitis and its correlations with the characteristics of uveitis. To analyze the mechanisms of hypertension and the influence of different etiologies. To evaluate the prognosis of increased intraocular pressure secondary to uveitis. MATERIAL AND METHODS: Retrospective, single-center, mono-observer study of 374 consecutive cases of uveitis. RESULTS: Ocular hypertension was observed in 45 of 374 cases (12%). Hypertension was observed only in 2 cases without any sign of anterior chamber inflammation. Increased intraocular pressure was more frequently observed in granulomatous uveitis [15 of 33 cases (45.4%)] than in non granulomatous uveitis [30 of 341 cases (8.9%)] (p < 0.001). There were 2 cases of Posner-Schlossman syndrome. Herpetic uveitis was otherwise the most frequent etiology of uveitis associated with secondary ocular hypertension [8 of 22 cases (36.3%)]. The ocular hypertension was most often in phase with intraocular inflammation [17 of 45 cases (37.8%)], suggesting a mechanism of trabecular obstruction. Corticosteroid-induced hypertension was only noted in 2 cases. In 12 cases the mechanisms of ocular hypertension could not be determined. Glaucomatous optic neuropathy was only observed in 3 patients. Filtering surgery was performed in 4 cases. CONCLUSIONS: Among uveitis cases, findings linked to a higher frequency of ocular hypertension were identified. There was a discrepancy between the low frequency of corticosteroid induced hypertension and the broad use of topical corticosteroids in cases of uveitis. The analysis of the mechanisms involved is necessary for an adequate treatment. The prognosis of hypertensive uveitis was more frequently linked to the consequences of intraocular inflammation than to hypertension.

Adrenal Cortex Hormones↗
PubMed1999

[Argon laser trabeculoplasty--the possibility for antiglaucoma treatment].

The current role of argon laser trabeculoplasty in the treatment of open angle glaucoma is still open discussion. To evaluate the effectiveness of ALT we performed a study on 36 patients followed for 2 years. We noted a success rate of 61.11% after 2 years and noticed that the success rate decreased in time. ALT should be considered as an intermediate therapy in the management of open angle glaucoma, after drug therapy has failed and before filtering surgery is performed.

Adult↗
PubMed1999

[Hypotony after trabeculectomy in a case of pigmentary glaucoma].

In the following we present the evolution of a case of pigmentary glaucoma and the efficient solution of rare complication in the filtering surgery--hypotonia. We also made some modern pathogenetic considerations about the appearance of ocular hypertension.

Adult↗
PubMed1999

[Valve implants of glaucoma pressure regulator for refractory glaucoma: own experience].

PURPOSE: To present our experiences in valve implantation for refractory glaucoma. MATERIAL AND METHODS: From October 1993 to December 1996 implantations of Glaucoma Pressure Regulator Optimed were performed in 7 eyes of 7 patients. There were 4 men and 3 women aged from 32 to 65 years. There were 3 eyes with neovascular glaucoma due to diabetes mellitus, 2 eyes with posttraumatic glaucoma, including 1 case after keratoplasty, 1 eye with postkeratoplasty glaucoma and 1 eye with aphakic glaucoma. Preoperative IOPs ranged from 33 to 61 mm Hg (mean 37.6 +/- 7.2 mm Hg). RESULTS: Success was considered an IOP of less than 22 mm Hg without medication (complete success) or with medication (qualified success) without additional filtering surgery. Postoperative success was obtained in 4 out of 7 eyes after follow-up period of 37.4 +/- 17.08 months (range 16-39 months). Early complications were hyphema (1 patient, 14.3%), blockage of intracameral portion of the tube (1 patient, 14.3%), hypertony (1 patient, 14.3%). Late complications were: external conjunctival bleb failure (2 patients, 28.6%), blockage of intracameral portion of tube by fibrovascular tissue (1 patient, 14.3%). CONCLUSION: Our experiences confirm that the valve implant is still today an alternative surgical procedure for controlling IOP in eyes with refractory glaucoma that have visual potential.

Adult↗
PubMed2000

[Administration of autologous blood to a patient via intrableb injection as a method for treating hypotony after trabeculectomy].

Hypotony is a common complication of glaucoma filtering surgery. The aim of this paper is to evaluate the treatment of this complication by intrableb injection of autologous blood. This procedure was performed in 9 patients with hypotony after trabeculectomy. Normalization of intraocular pressure was noted in 8 patients. No complications were observed. Intrableb injection of autologous blood can be used as an effective method in the treatment of hypotony following filtration surgery.

Aged↗
PubMed2001

Histological effects in the iris after 3 months of latanoprost therapy: the Mainz 1 study.

OBJECTIVE: To determine whether 3 months of topical latanoprost treatment caused proliferative or degenerative effects on the peripheral iris of patients with glaucoma. METHODS: Seventeen patients requiring filtering surgery for primary open-angle glaucoma or pseudoexfoliation glaucoma were randomized to receive topical latanoprost for 3 months (n = 8) or alternative medication (n = 9) before surgery. A trabeculectomy and a peripheral iridectomy specimen was obtained from each patient during surgery. The tissue was subjected to histological and immunohistochemical evaluation using 2 cell cycle markers: proliferating cell nuclear antigen and nuclear-associated protein (Ki-67). RESULTS: No degenerative or pathological changes were seen in the latanoprost-treated irides, including the one specimen in this series in which there was an eye color change. Proliferating cell nuclear antigen and nuclear-associated protein markers were negative for changes in all the test specimens. CONCLUSION: Short-term treatment with latanoprost does not produce morphological changes or cellular proliferation changes in the iris.

Administration, Topical↗
PubMed2001

[Cyclosporin A eyedrops: manufacturing, toxicity, pharmacokinetics and indications in 2000].

INTRODUCTION: Cyclosporin eye-drops allow local immunoregulation without systemic side effects and is an alternate to local steroids. In this article we review specific problems of product setup and clinical studies published over the past 20 years. PRODUCT SETUP: The main problems in eye-drop preparation are sterility, pH, particles, and its lipophilic properties. Numerous excipients have been tested including oil solvents, alphacyclodextrin, collagen shields, liposomes, polyester nanocapsules, but documentation on stability of the molecule is inadequate. TOXICITY: Epithelial toxicity is well known and is probably mainly due to the excipient. No endothelial toxicity has been described in vivo. Repeated doses lead to uveal reactions in animals, which could limit the indications for intraocular diseases. PHARMACOKINETICS: Bioavailability is mainly limited by the lipophilic properties. Oil excipients, the most widely used, lead to good corneal penetration but low intraocular concentrations. Cyclosporin bioavailability is improved when using hydrophilic excipients. INDICATIONS: Every ocular surface disease that involves cytokines is a potential indication for cyclosporine eyedrops: keratoconjunctivitis sicca, vernal keratitis, adjuvant therapy of filtering surgery, stromal herpes keratitis, immunity limbal keratitis, and Thygeson's keratitis. There is biological evidence of efficacy, and encouraging results from many studies, yet few have tested a large number of patients. A large multicenter study on dry eye is currently in progress.

Biological Availability↗