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PubMedDate not supplied

Repair of a late-onset filtering bleb leak using a corneal graft shaped with an excimer laser.

A new method for repairing an area of late scleral necrosis and bleb leak after glaucoma-filtering surgery using mitomycin C (MMC) is described. In a 33-year-old female patient diagnosed with bilateral juvenile glaucoma, a bleb leak occurred 41 months after trabeculectomy with MMC in the left eye. A corneal stromal patch-graft shaped to the desired size using an excimer laser (Excimer-Laser-Corneal-Shaping-System, ELCS-S) was used to cover the scleral defect. This step was followed by water-tight closure of the conjunctiva. During the follow-up period of 12 months the leak remained successfully repaired and the intraocular pressure stayed between 8 and 14 mm Hg without medication. This technique that uses lamellar grafts of very large size should be considered when a surgical repair of a large leaking bleb is required, especially in cases with scleral tissue necrosis.

Adult↗
PubMed2001

Tentative surgical repair of leaking filtering bleb with amniotic membrane transplantation--a case report.

To repair a traumatic leaking cystic bleb in a 50-year-old male patient who had received multiple glaucoma filtering surgeries with the application of mitomycin-C, an amniotic membrane covered over the leaking bleb and sutured it to the adjacent conjunctiva with 10-0 nylon was done. The anterior chamber gradually formed after the amniotic membrane transplantation (AMT) and intraocular pressure returned to the level before trauma. Three weeks after the operation, the amniotic membrane was removed. No more leakage from the bleb was observed during four months follow-up. However, another bleb revision surgery was performed later to repair recurrent bleb leakage. Although conjunctival advancement or free conjunctival autograft have been reported to repair leaking bleb successfully, the simple primary method of using AMT is still encouraged in repair of a ruptured bleb with tentative maintenance of adequate filtration.

Amnion↗
PubMed2001

[How to prevent and treat glaucoma surgical failures?].

Although many improvements have been made to filtering surgery in glaucoma, some post operative complications do occur quite often. Patients need careful and frequent follow-up to assess and treat the early complications that may occur after glaucoma surgery. Over the medium and long term, insufficient verification of the intra ocular pressure signals the failure of the initial surgery. In this article, we review the diagnostic tools useful for detecting the early and late failures of glaucoma surgery and we provide recommendations for their treatment.

Glaucoma↗
PubMed2002

[Ocular decompression retinopathy after trabeculectomy].

PURPOSE: Two cases of ocular decompression retinopathy associated with glaucoma filtering surgery are described. CONCLUSIONS: Both patients were young males, intraocular pressures were 35 and 40 mm Hg before surgery. The retinal haemorrhages resolved, and in the only case where it was possible to estimate the visual acuity, it had improved significantly. In the few cases that were reported, most involve young males with markedly high intraocular pressures before surgery and occasionally myopic.

Adolescent↗
PubMedDate not supplied

Partial excision with a conjunctival advancement flap after a relaxing incision for a dissecting glaucoma filtering bleb.

A 65-year-old male patient developed dissecting glaucoma filtration bleb following trabeculectomy with mitomycin-C (MMC). Surgical partial excision of the bleb was performed and the tissue was subjected to histopathological evaluation. The bleb area was covered by a conjunctival flap that was advanced with the help of a relaxing incision in the superior conjunctiva fornix. The dissecting bleb was successfully managed by controlling intraocular pressure, and the patient became asymptomatic without any medication. The light microscopic examination of the bleb showed irregularly arranged collagen bundles and hypocellularity of the subconjunctival tissue with places of nodular configuration of the fibroblast in the periphery. Surgical partial excision of the dissecting glaucoma filtering bleb is a reliable, simple, and precise method. Advancing the conjunctival flap by a superior conjunctival relaxing incision facilitates easy mobilization of the flap, ensures healthy resurfacing of the bleb, and prevents postoperative transconjunctival leakage. Histopathology of the bleb is compatible with the use of MMC during original filtering surgery.

Aged↗
PubMed2002

[Filtering bleb failure of open angle glaucoma].

PURPOSE: To analyze the frequency and the causes of trabeculectomy failure in primary and secondary open angle glaucoma and the results of the individual treatment in these cases. METHOD: Retrospective study that includes 69 trabeculectomy failures. Filtering bleb failure was recorded in 49 cases of primary open glaucoma and 21 cases of secondary open angle glaucoma. The slit lamp examination and the gonioscopy clarify the causing mechanism of the failure. The treatment has been established in an individual manner in order to achieve stable control of intraocular pressure (under 21 mmHg) RESULTS: The cause of the early failure (15 cases) was the obstruction of the internal ostium of the trabeculectomy in 10 cases, episcleral and conjunctival fibrosis in 4 cases and encapsulated bleb in 1 case. Episcleral and conjunctival fibrosis in 46 cases and encapsulated bleb in 6 cases have caused the late failure. The most effective option in early failure of trabeculectomy was internal de-sobstruction. In late failures, additional medical therapy and a second filtering surgery combined with antifibrotic agents were the most effective and commonly techniques. CONCLUSIONS: Immediate recognition of the failure, the ascertaining of the etiology and of the appropriate treatment allows a high rate therapeutic success achievement.

Computer Graphics↗
PubMed2000

[The Ahmed glaucoma valve implantation for refractory glaucoma].

OBJECTIVE: To evaluate the efficacy of the Ahmed Glaucoma Valve implant in the treatment of refractory glaucoma. METHODS: 28 cases(29 eyes) of refractory glacucoma were treated by the Ahmed glaucoma Valve implant, including 10 cases (10 eyes) of neovascula glaucoma, 5 cases (6 eyes) of juvenile glaucoma and 13 cases (13 eyes) of other causes glaucoma. RESULTS: Post-operative follow-up time was 3-12 months. The intraocular pressure (IOP) was lowered from preoperative 40.9 +/- 7.32 mmHg (1 mmHg = 0.133 kPa) to postoperative 20.63 +/- 2.75 mmHg in Neovascular glaucoma; from preoperative 41 +/- 5.66 to postoperative 18.00 +/- 2.12 mmHg in glaucoma after IOL implant combined with vitrectomy operation; from preoperative 33.65 +/- 5.28 to postoperative 16.45 +/- 1.48 mmHg in juvenile glaucoma; from preoperative 31.43 +/- 4.13 to postoperative 18.13 +/- 1.25 mmHg in the failure conventional filtering surgery of glaucoma. The postoperative complicatons were flat anterior chamber, hyphema, anterior iritis and so on. CONCLUSION: The Ahmed glaucoma valve implant is a useful method in lowing IOP of refractory glaucoma.

Female↗
PubMed1992

Neovascular glaucoma and intraocular pressure: I. Pathogenesis of increased intraocular pressure and therapy (a review of historical and current therapeutic modalities).

The pathogenesis of neovascular glaucoma is summarized. Elevation of intraocular pressure is mostly associated with mechanical obstruction of the anterior chamber angle by the fibrovascular membrane, as well as with an enhanced ultrafiltration from the newly formed vessels. Drug therapy is insufficient. Standard filtering surgery is unsatisfactory with regard to the control of intraocular pressure and hemorrhagic complications. The drainage implants appear to be promising. Panretinal photocoagulation is unfavorable due to turbidity of the optical media. Favorable therapeutical results were achieved with cryosurgical techniques, namely panretinal cryocoagulation, combined with cyclocryocoagulation. Cyclocryocoagulation alone accounts for a high percentage of complications and therapeutical results are not convincing.

Cryosurgery↗
PubMed1992

Effect of steroids and nonsteroidal antiinflammatory agents on human ocular fibroblast.

5-fluorouracil and steroids have been used to suppress excessive scar formation after glaucoma filtering surgery (GFS). Steroidal and nonsteroidal antiinflammatory drugs (NSAIDs), which are inhibitors of arachidonic acid (AA) pathway, both limit fibroblast activity and reduce inflammation. In this experiment, the ability of corticosteroid (dexamethasone sodium phosphate), cyclooxygenase inhibitor (piroxicam), lipoxygenase inhibitor (ferulic acid), and dual cyclo/lipoxygenase inhibitor (phenidone) to inhibit human Tenon's fibroblast proliferation was evaluated in culture. After human Tenon's fibroblast cell lines were established, a complete dose-response curve was done for the representative compounds for 8 days. Fibroblast attachment and proliferation were quantified by Coulter counter, hexosaminidase, and tritiated thymidine uptake assays. All four drugs inhibited attachment and proliferation at high concentrations. Phenidone was the most effective, with inhibition occurring within the 0.001-0.1 mmol/l range. It also was the only drug that showed inhibition at the antiinflammatory range in vivo. Dexamethasone, piroxicam, and ferulic acid did not inhibit fibroblast attachment and proliferation until doses well above those required to inhibit AA biosynthesis were attained. Only dexamethasone showed increased potency with incubation time. Overall, the NSAIDs showed antiproliferative activity comparable to or better than that of the steroids. Because the potency of steroids increases over time, these drugs may be more beneficial if given prior to initiation of inflammation. These results suggest that NSAIDs may be useful as both antiinflammatory and antiproliferative agents in preventing bleb failure after GFS.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

[Postoperative results of non-penetrating trabeculectomy for primary open-angle glaucoma].

PURPOSE: To estimate the postoperative results of non-penetrating trabeculectomy(NPT), the success rate of postoperative intraocular pressure(IOP) and the clinical factors affecting postoperative IOP were evaluated. SUBJECTS AND METHODS: 32 eyes of 32 primary open-angle glaucoma(POAG) patients who underwent NPT as the first filtering surgery were enrolled in the study. We evaluated postoperative IOP using the Kaplan-Meier method, a proportional hazard model, and multiple logistic analysis. RESULTS: 53.2% of all patients had an IOP of less than 16 mmHg without antiglaucoma medication, and 63.8% had an IOP of less than 16 mmHg with antiglaucoma medication 36 months postoperatively. The performance of Nd:YAG trabeculopuncture(YLT) was indicated as a significant factor affecting postoperative IOP by the proportional hazard model(p = 0.037). 72.2% of patients who did not undergo YLT had an IOP of less than 16 mmHg without antiglaucoma medication, and 36.5% who underwent YLT had a postoperative IOP of less than 16 mmHg. There was significant difference between the both groups(log rank test, p = 0.045). Preoperative IOP with antiglaucoma medication was indicated as a significant factor affecting performance of YLT by multiple logistic analysis. CONCLUSION: These results suggest that NPT may be useful to reduce the use of antiglaucoma medication in patients with POAG whose preoperative IOP is controllable with antiglaucoma medication.

Adult↗
PubMed2004

Incidence of acute angle-closure glaucoma in Dalmatia, southern Croatia.

AIM: To investigate the incidence of acute angle-closure glaucoma among residents of Dalmatia, southern part of Croatia. METHODS: We reviewed hospital records of 176 patients with acute angle-closure glaucoma treated between January 1995 and December 2001 at the Departments of Ophthalmology at four hospitals in Dalmatia. There were 122 women, aged between 29 and 89 years (median age; 68 years), and 54 men, aged between 33 and 88 years (median age, 70 years). RESULTS: The unadjusted crude incidence was 2.9/100,000 (95% confidence interval [CI], 1.6-4.5). The unadjusted crude incidence among men and women was 1.9 (95% CI, 0.3-3.8) and 3.9 (95% CI, 1.7-6.1) cases/100,000 per year, respectively. The relative risk (RR) of developing acute angle-closure glaucoma was 2.1 (95% CI, 1.5-2.9) times higher for women as compared to men. The RR of acute angle-closure glaucoma was 1.9 (95% CI, 0.6-6.2) in the 40-49 years group, 6.5 (95% CI, 2.3-18.8) in the 50-59 years group, 17 (95% CI, 6.3-47.8) in the 60-69 years group, and 28 (95% CI, 10.4-77.3) in the over 69 years group. The median time from the onset of symptoms to presentation at the hospital was 2 days (range, 1-15 days). In 87 (48%) patients intraocular pressure control was achieved by medical treatment, 41 (23%) patients underwent peripheral iridectomy, and 48 (27%) patients required a trabeculectomy. In 35 (73%) out of 48 patients managed by filtering surgery, the delay in treatment was 3 or more days. In 34 (19%) eyes with final visual acuity 0.1 or worse, the delay in presentation was 3 days or more. No statistically significant association was found between acute angle-closure glaucoma and seasonal variation (chi-square=0.85; p=0.8). CONCLUSION: Earlier recognition of the patients with acute angle-closure glaucoma and a shorter time of delay in presentation could have saved many patients from surgery and vision loss each decade.

Acute Disease↗
PubMed2004

[Secondary glaucoma due to progressive iris atrophy--a century after the first description. Case report].

The iridocorneal endothelial syndrome (ICE) consists of some disorders, like: progressive essential iris atrophy, Chandler disease and the iris nevus syndrome that are characterized by corneal endothelium proliferation and migration, iris atrophy, corneal oedema and/or pigmentary iris nevi. Secondary, refractory glaucoma affects about 50% of patients with progressive essential iris atrophy. Medication of glaucoma is only initially effective. Some conventional filtering surgeries, to control glaucoma are often unsuccessful. Presented case of our patient with primary essential iris atrophy, with secondary glaucoma shows surgical problems. Multiple filtration surgery with or without antiproliferative agents turn out not to be sufficient. In conclusion, intraocular pressure was effectively lowered with iridocleisis technique.

Adult↗
PubMed2004

Intravitreal triamcinolone injection for macular edema secondary to increased retinal vascular permeability.

BACKGROUND AND PURPOSE: Macular edema is an important cause of visual loss in various retinal diseases, and may be refractory to conventional treatment. We investigated the efficacy of intravitreal injection of triamcinolone acetonide for the treatment of intractable macular edema. METHODS: A prospective study was conducted in 17 patients (18 eyes) with a diagnosis of macular edema unresponsive to conventional treatment, resulting from inflammatory or retinal vascular diseases. The underlying diseases associated with the development of macular edema were: diabetic retinopathy (6 eyes), branch retinal vein occlusion (5 eyes), Irvine-Gass syndrome (3 eyes), and central retinal vein occlusion (4 eyes). Triamcinolone acetonide 4 mg was injected intravitreally. Ophthalmological examinations, fundus photography, fluorescein angiography, and optical coherence tomography were performed before treatment, 3 months and 6 months after treatment. During the follow-up period, recurrent macular edema was retreated with the same dosage and followed for another 6 months. RESULTS: Sixteen eyes received a single injection and 2 others (11%) underwent reinjection after the 3-month follow-up examination. Among the eyes that received a single injection, 10 (63%) showed visual acuity gain of 2 or more Snellen lines at the 6-month follow-up. The pretreatment central macular thickness averaged 581 microm [corrected] and reduced to 215 microm [corrected] at the 6-month follow-up. In the 2 eyes that received reinjection, macular edema also showed significant reduction 6 months after retreatment. Sterile endophthalmitis was noted in 3 eyes (17%). Two eyes (11%) developed significant cataract. Three eyes (17%) developed high intraocular pressure; 1 of them (5.5%) ultimately required filtering surgery. CONCLUSIONS: Intravitreal injection of triamcinolone temporarily reduced refractory macular edema. Potential complications should be monitored after treatment.

Aged↗
PubMed1992

Surgically-induced astigmatism in combined ECCE with filtering procedures compared to ECCE alone.

Extracapsular cataract extraction with implantation of a posterior chamber lens combined with filtering surgery (glaucoma triple procedure) is frequently employed in the co-management of cataract and glaucoma. Nineteen triple procedures with a minimum of six months follow up were compared to 19 cases of extracapsular cataract extraction with lens implant matched for age, sex, and surgeon with regard to surgically induced astigmatism as determined by vector analysis. Follow up averaged 10 months for the triple group and 14 months for the controls. There was no statistically significant difference in preoperative astigmatism between the two groups nor in the mean number of sutures cut. Postoperatively, the keratometric cylinder averaged 2.55 +/- 1.54 diopters for the cases and 1.20 +/- 1.11 D for the controls; the difference of 1.36 D was statistically significant (P = .004). The postoperative refractive cylinder was 2.34 +/- 1.54 D for the cases and 1.29 +/- 1.07 D for the controls; the difference of 1.05 D was statistically significant (P = .017). With regard to surgically-induced astigmatism, vector analysis showed that the cases averaged 2.18 +/- 1.25 D and the controls 1.23 +/- 0.81 D; the difference of 0.95 D was statistically significant (P = .006). With regard to surgically-induced astigmatism, vector analysis showed that the cases averaged 2.18 +/- 1.25 D and the controls 1.23 +/- 0.81 D; the difference of 0.95 D was statistically significant (P = .006). When analyzed for change along the vertical meridian, the cases averaged 1.12 +/- 1.57 D surgically-induced against-the-rule astigmatism, as compared with 0.30 +/- 1.16 D for the controls (difference, 0.83 D; P = .062). The glaucoma triple procedures induced approximately 1.00 D more cylinder than the controls.

Aged↗
PubMed2002

[Trabeculetomy combined with implantation of silicon rubber slice for intractable glaucoma].

PURPOSE: To investigate the lowering-pressure outcome and postoperative complications of trabeculectomy with implantation of silicon rubber slice for intractable glaucoma. METHODS: Sixty eyes with intractable glaucoma, including 12 eyes with neovascular glaucoma, 14 eyes with aphakic or pseudophakic glaucoma, 4 eyes with congenital glaucoma, 18 eyes with failed filtering surgery glaucoma and 12 eyes with glaucoma secondary to trauma, were performed trabeculectomy with implantation of silicon rubber slice. The postoperative lowering-pressure outcome and complications also were observed. RESULTS: All patients were follow-up for 5 to approximately 34 months ( mean, 18.3 months) . The postoperative intraocular pressure of patients was 17.30 to approximately 37.19 mmHg [mean, (23.36 +/- 4.06) mmHg] at the last visit. Of 60 eyes, the postoperative intraocular pressure was below 21 mmHg in 38 eyes (63.3%), between 21 to 30 mmHg in 18 eyes (30%) and higher than 30 mmHg only in 4 eyes (6.7%). No serious complications and rejection related to implantation of silicon rubber slice occurred in this group during the follow-up period. CONCLUSION: Trabeculectomy combined with implantation of silicon rubber slice seems to be an ideal procedure for treatment of intractable glaucoma in developing countries, especially in vast country hospital in China, this surgery also can replace the expensive import drainage device implant (Molteno tube implant) therapy for intractable glaucoma.

Adolescent↗
PubMed1992

Recurrent hemorrhagic choroidal detachment associated with disseminated intravascular coagulation.

We report the case of a patient with recurrent hemorrhagic choroidal detachments after combined cataract and filtering surgery associated with exacerbation of chronic disseminated intravascular coagulation (DIC). It was postulated that the formation and drainage of the hemorrhagic choroidal detachments induced thrombin generation and consequently coagulation factor and platelet consumption. Fibrinolysis resulted in the release of fibrin-degradation products (FDP). Consumption of clotting factors and platelets combined with FDP release may result in decompensation of a chronic DIC state and cause a bleeding diathesis. This case shows the need for complete hematologic evaluation of patients with hemostatic abnormalities.

Aged↗
PubMed2005

Short term experience with "modern" trabeculectomy augmented with intraoperative antimetabolites.

PURPOSE: Owing to its technical refinements, "modern" trabeculectomy aims to reduce the incidence and severity of early postoperative complications while increasing postop IOP success. The purpose of our study was to evaluate namely the safety of "modern" trabeculectomy, the quality of the filtration blebs, the influence on the quality of life and secondarily IOP reduction according to the surgical procedure whether augmented with peroperative application of antimetabolites or not. MATERIAL-METHODS: Retrospective study including our 45 first consecutive procedures in 38 patients (mean age: 61.1 years) with medically uncontrolled various glaucomas. All procedures were performed according to a modified P. Khaw's protocol. Antimetabolites were applied peroperatively in 28/45 eyes (62.2%) with a history of previous filtering surgery (12/28 eyes) and/or advanced glaucomatous damage (22/28 eyes). Antimetabolites were not used in the 17/45 other eyes with lower surgical risk factors and higher target IOP, surgical procedure was not augmented with antimetabolites. Postoperative management included laser suture lysis, withdrawal of adjustable sutures and 5-FU injections when needed. Complete ocular examination was carried out preoperatively and postoperatively at day 1, 7, at 1, 2 and 3 months and every 3 months thereafter. All patients were questioned for symptoms associated with filtration bleb dysesthesia at the last visit. RESULTS: The mean follow-up was 7.9 +/- 3.3 in the group without antimetbolites and 5.3 +/- 2.2 months in the group with antimetabolites (p < 0.05). Final mean IOP (+/-SD) was significantly lower in the group augmented with antimetabolites (11.2 +/- 4.5 mmHg) compared with the group without antimetabolites (14.9 +/- 3.7 mm Hg) (p < 0.05). Complete and qualified success were respectively 64.3% and 89.3% in the group with antimetabolites and 70.6% and 82.4% in the subgroup without antimetabolites (p > 0.05). 1st month postoperative complications were transient and minor. They occurred in 59% in the group without antimetabolites and in 68% in the subgroup augmented with antimetabolites. Complications had comparable frequency of distribution between the 2 subgroups (p > 0.05). 84% of the filtration blebs (30/45) were diffuse and mildly vascularized. Avascular blebs were noticed in 7 eyes (15.5%) and were not related with the intraoperative application of mitomycin C (p > 0.05). Subjective comfort was good to excellent in 42/45 eyes (93.3%). Mean final visual acuity was not altered compared with preop level (p > 0.05). CONCLUSIONS: Our short term results suggest that the safety of "modern" trabeculectomy augmented with antimetabolites is comparable to those without intraoperative antimetabolites. Filtration blebs were very well tolerated in most patients. The peroperative use of antimetabolites precludes to appreciate if the success rates are due to the use of antimetabolites and/or the technique per se.

Adolescent↗
PubMed1992

Effects of timolol, betaxolol, and levobunolol on human tenon's fibroblasts in tissue culture.

Evidence has been found suggesting that long-term therapy with topical antiglaucoma medications may decrease the success of glaucoma filtering surgery. To investigate this question further, the antiproliferative effects of the preservative benzalkonium chloride and three pure and commercially available beta-adrenergic antagonist preparations (timolol, betaxolol, and levobunolol) were studied on tissue cultures of human Tenon's capsule fibroblasts. Each drug preparation was tested on three different cell lines. Fibroblast growth was measured with tritiated thymidine uptake and hexosaminidase assays. Trypan blue uptake was used to assess cell viability microscopically. The commercially available preparations containing benzalkonium chloride and those of betaxolol and levobunolol without the preservative had similar inhibitory doses for 50% of cells. The timolol preparation without preservative was significantly less toxic than its commercially available one. The three tested beta-adrenergic blockers did not stimulate fibroblast proliferation directly in this in vitro model. Even when the cultures were washed free of the drugs, growth continued to be suppressed, suggesting that the inhibition was not reversible. An increase in fibroblasts and inflammatory cells after long-term antiglaucoma medical therapy thus may be caused not by a direct stimulation of cell proliferation but by chronic inflammation from the irritating effects of antiglaucoma medications and/or their preservatives.

Benzalkonium Compounds↗