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PubMedDate not supplied

Scleral free auto-implant plug with mitomycin as limitation of trepanosclerectomy flow in glaucoma filtering surgery.

UNLABELLED: The purpose of this study is to evaluate the effect of trephination with free scleral auto-implant plug exposed to Mitomycin-C out of the eye, in surgical treatment of primary open-angle glaucoma (POAG), in comparison with efficacy of trabeculectomy with MMC (32 eyes with POAG of patients, younger than 55 years-group 1). Trephination with scleral auto-implant plug with MMC was done on 35 eyes of patients, younger than 55 years, with POAG (group 2). The postoperative follow-up was 28.52 +/- 8.78 months. SURGICAL PROCEDURE: A limbal 1.0 mm diameter trephination is made beneath the limbus-based conjunctival flap, a small iridectomy is performed. From the external layers of the trephine button one third of the corneoscleral thickness, in the form of a thin disc, is excised. The scleral disc, a free auto-implant, is dipped into liquid containing MMC with concentration 0.2 mg/ml for 5 minutes, outside the eye. Afterwards the scleral disc soaked with MMC is carefully irrigated with 150 ml of BSS and placed in the external part of the trephine fistula in primary position and stabilized with two interrupted 10-0 nylon sutures. The operation is ended as a typical trabeculectomy. The final success rate in terms of IOP (IOP < 14 mmHg) was 100%, without or with antiglaucoma medication, in both groups, but the number of postoperative complications was significantly lower in group 2. Trephination with free scleral auto-implant plug soaked with MMC may represent a viable alternative to trabeculectomy with MMC; the scleral plug may be taken out of the eye and exposed to antimetabolite outside the eye to minimize toxicity.

Antibiotics, Antineoplastic↗

PubMed1995

Long-term results of non-filtering surgery for the treatment of primary angle-closure glaucoma.

BACKGROUND: We previously reported the effectiveness of goniosynechialysis and trabeculotomy ab externo for adult-onset glaucoma. In this study, we performed non-filtering surgery on patients with primary angle-closure glaucoma and studied the long-term outcome of this treatment. METHODS: Included in this study were 35 eyes of 25 patients with primary angle-closure glaucoma, each of which had an intraocular pressure greater than 20 mmHg with maximal tolerated antiglaucoma medication, even after laser iridotomy or surgical iridectomy. Of these 35 eyes, 22 underwent trabeculotomy and 13 underwent goniosynechialysis. All patients were followed up for at least 18 months. RESULTS: In 21 (95%) of 22 eyes after trabeculotomy, and in 12 (92%) of 13 eyes after goniosynechialysis, intraocular pressures were well controlled at or below 21 mmHg at the final examination. However, in two of the 21 eyes in which trabeculotomy was a success, and in four of the 12 eyes in which goniosynechialysis was successful, the procedure had to be repeated before adequate control of pressure was achieved. CONCLUSION: Our results show that intraocular pressure in most cases of primary angle-closure glaucoma can be controlled by restructuring of the physiologic aqueous outflow route by means of goniosynechialysis or trabeculotomy, and that filtering surgery is not necessary.

Aged↗

PubMed1977

Exfoliation material in different sections of the eye.

Nine trabeculectomy samples, five iridectomy samples and one lens of an exfoliation syndrom were examined. Next to typical exfoliation syndrome fibrils, the alteration of endothelial membranes and similar structures has been pointed out. Concerning the glaucoma genesis, it is being discussed whether a participation of the trabecular network in the disease course might be a preliminary condition for the development of glaucoma and, thus, mere infiltration of exfoliation material into the trabecular network alone could be responsible for developing a glaucoma.

Basement Membrane↗

PubMed1977

[Dominantly inherited cleavage of the pigment layer of the iris and the ciliary body (author's transl)].

A dominantly inherited cleavage of the pigment layer of the iris has been observed throughout three generations. In the two elder generations, luxation and rapidly progressing opacification of the lenses occurred; after cataract extraction, a cleavage of the pigment layer of the ciliary body could also be seen through the iridectomy. The lenses had reduced sagital and spherical diameters (4X7 mm). Furthermore, a peculiar form of glaucoma and a peripheral retinal detachment has been observed in the eldest generation.

Adolescent↗

PubMed1993

Laser iridoplasty in the treatment of severe acute angle closure glaucoma.

Twenty eyes of 19 patients presenting with acute angle closure glaucoma (AACG) which failed to respond to medical treatment were treated with laser iridoplasty. In all 20 eyes, laser peripheral iridectomy (PI) was prevented by a hazy cornea. In all cases, iridoplasty resulted in a rapid and significant reduction in intraocular pressure. Laser iridoplasty appears to have a useful role in the management of medically unresponsive AACG, particularly in those cases where laser peripheral iridotomy (PI) has failed or is not possible to perform.

Acute Disease↗

PubMed1995

Jaeger, about glaucoma.

E. Jaeger published the first illustration of the glaucomatous cup. Throughout his clinical career he published multiple observations about findings in glaucoma. In his book Ueber Glaucoma he praised and advocated A. von Graefe's iridectomy but contradicted Graefe's concept of the etiology being a localized choroiditis in favor of systemic gout.

Austria↗

PubMed1994

No-stitch combined glaucoma cataract-surgery.

A new method of small incision cataract surgery is presented which allows sutureless wound closure with a fistulating aperature for regulating IOP. After in-the-bag pcIOL implantation, a triangular opening is made into the posterior scleral valve and combined with a peripheral iridectomy. Sufficient regularization of the IOP and good visual results could be observed in the majority of all 61 eyes operated on using this method.

Aged↗

PubMed1982

The ONG capsular lens, report of 100 implantations.

This Capsular Lens (ONG, type IV, to be called 'O.C.L.') has been developed for routinely performed extracapsular cataract extraction with lens implantation. The fundamental surgical procedure was based on continuing experience with the bimanual aspiration-irrigation technique and system developed by the author in 1971. The biomechanical properties of the asymmetric partly flexible, haptic loops are designed to give tensionfree fixation in two capsular pockets. The plano-anterior position of the lens ensures well-defined irido-lenticular clearance and proper alignment of the convex side with the posterior capsule. Consequently no iridectomy or iridotomy is needed for proper aqueous flow.

Cataract Extraction↗

PubMed1989

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: 5 years follow-up.

A series of 64 eyes, in 64 patients with giant retinal tears, treated by vitrectomy and fluid/silicone-oil exchange, has been reviewed after 5 years. Anatomical success was achieved in 73% of cases and visual function in successful cases ranged from 6/6 to NPL; 66% achieved acuities of 6/60 or better and 32% had vision of 6/18 or better. These results compare favourably with those in a previous series reported after 6 months and 18 months. Epiretinal membrane proliferation and shortening accounted for the majority of retinal redetachments while macular abnormalities, especially pucker, were responsible for a poor visual outcome. Glaucoma is the most serious long-term complication of the surgical method and occurs most frequently in aphakic eyes. Retention of the crystalline lens, whenever possible, the creation of a 6 o'clock iridectomy in aphakic eyes, early removal of silicone oil and a conservative approach to the use of scleral buckles are recommended.

Adolescent↗

PubMed1989

Fine structural defects in a case of congenital microcoria.

A case of congenital miosis associated with myopia and cataract is described. Tissue obtained at iridectomy was examined with the electron microscope and compared with a specimen of normal iris. The miotic iris was found to be hypoplastic and to display differences in the cellular density of the stroma. The contractile processes of the dilator myoepithelium were conspicuously absent from the underlying stroma, and the existing myofibrils were much disarranged.

Adult↗

PubMed1982

Argon laser lesions of the rabbit iris: quantitative aspects.

The destructive effect of nonperforating argon laser coagulations in the brown irides of rabbits was studied with quantitative histological methods. Power, spot size, and exposure time were systematically varied. The lateral and axial extensions of the crater and the denaturation of the adjacent tissue were studied. The main conclusions are: (1) the extent of tissue damage is significantly correlated with power and spot size, though the correlation is not proportional; (2) the lateral extension of the tissue reaction is far more pronounced than the axial extension; (3) increase in exposure time is effective up to 0.2 s, though a further increase up to 0.5 s does not enhance the tissue reaction. It is discussed that for conventionally switched lasers the main determinant for the final extension of the lesion is the density and distribution of the pigment granules within the iris. The radial distribution of the protrusions of the melanocytes in brown irides of the rabbits used in this study favors the lateralization of the tissue reaction. The nonlinearity of the tissue reaction and exposure time might be due to the fact that after initial damage in early phases of irradiation (e.g., up to 50 or 100 ms, the absorbed laser energy is dissipated in already destroyed tissue. Some practical aspects for iridectomy are discussed.

Animals↗

PubMed1987

Pars plana vitrectomy in the management of subluxed and posteriorly dislocated intraocular lenses.

The results of pars plana vitreous microsurgery in a series of nine patients with subluxed or posteriorly dislocated intraocular lenses (IOL) are described. Two posterior chamber intraocular lenses were repositioned in the ciliary sulcus anterior to the zonular ring. One posteriorly dislocated anterior chamber IOL was retrieved from the vitreous gel and repositioned into the anterior chamber angle. In three cases, stable repositioning of the dislocated posterior chamber IOL could not be achieved and the lens was exchanged by way of a limbal incision for an appropriate anterior chamber IOL. In three cases, and anterior chamber IOL subluxed into a large basal iridectomy was successfully repositioned using similar instrumentation.

Aged↗

PubMed1996

Spherophakia, nanophthalmia, hypoplastic ciliary body and glaucoma in brachydactyly-associated syndromes.

Three juvenile patients showing a systemic disorder associated with small stature, brachydactyly and glaucoma were discovered to have spherophakia and a nanophthalmic axial length of the eye between 20.29 and 21.26 mm. According to clinical and radiological criteria only one patient was classified as having Marchesani syndrome; one patient suffered from an acrofacial disorder, and the third displayed typical ocular signs of Rieger syndrome. Pupillary block mechanism had led to glaucoma in all three patients. Despite iridectomy and trabeculotomy, two of them had unregulated intraocular pressure (IOP) and showed partial angleblock by progressive anterior synechiae after surgery. Ultrasonographic biomicroscopy revealed in all cases considerable hypoplasia of the ciliary body. We conclude that the clinical combination of spherophakia and brachydactyly is not necessarily limited to Marchesani syndrome. In the wide range of brachydactyly-associated syndromes an ophthalmic examination should always be performed in order to rule out ocular complications such as spherophakia and secondary glaucoma. We could not confirm Marchesani's hypothesis of a hyperplastic ciliary body in the spherophakia-brachydactyly syndrome, considering our nanophthalmic eyes. Pressure-reducing surgery in eyes with spherophakia and nanophthalmia seems to run a high risk of inducing an extensive formation of anterior synechiae.

Abnormalities, Multiple↗

PubMed1976

[Fuchs's heterochromic cyclitis. Electron-microscopic study of nine iris biopsies (author's transl)].

The irises of 9 cases of Fuchs's heterochromic cyclitis, obtained by iridectomy during cataract surgery, were examined pathohistologically and electron microscopically. There is a chronic type of iridocyclitis with infiltration of mainly plasma cells and with a marked degenerative and atrophic component. The main feature of the fine structure is the presence of isolated organelles, mainly mitochondria, with intact structure, a result of a process which seems to destroy first the endoplasmatic reticulum and leads to cytolysis. This phenomenon, however, is present too in cases of types chronic iridocyclitis, but to a lesser extent. Thus, the extent of the atrophic process seems to be the only pathognomonic criteria for Fuchs's heterochromic cyclitis. The electron microscope cannot reveal pathognomonic criteria for Fuchs's heterochromic cyclitis, and, furthermore, we could not demonstrate any findings which could establish or confirm the etiology. The theory of a dysfunction of the sympathetic innervation and the theory of a vascular pathogenesis could not be confirmed. The question is discussed whether Fuchs's heterochromic cyclitis is a autoimmune-disease which attacks the endoplasmatic reticulum first.

Atrophy↗

PubMed2004

[Clinical and genetic results with reference to corneal alterations in Lowe-syndrome].

BACKGROUND: The Lowe oculo-cerebro-renal syndrome (OCRL1) is a rare X-linked disease which causes impairment of visual acuity. The situation may be further complicated by corneal alterations. PATIENTS AND METHODS: In total seven patients from different families were clinically examined by slit-lamp examination, funduscopy, measurement of the intraocular pressure and ultrasound sonography. Molecular genetic analysis was performed in six patients by sequencing large PCR amplicons with a DNA sequencer and the ABI PRISM Sequence navigator software. RESULT: All affected boys were aphakic. Due to high intraocular pressure, iridectomy, goniotomy, cyclo-cryo treatment or trabeculectomy were performed. All patients showed opacity or pannus-like alterations of the cornea. Molecular genetic analysis revealed four novel and two known mutations. CONCLUSION: Reduced visual acuity was partly explained by morphological changes due to the underlying genetic defect and the development of cataract and glaucoma. Opacity of the cornea as well as alterations of the cornea seem to be a major problem in the course of the disease.

Adult↗

PubMed2005

[Malignant glaucoma following blunt trauma of the eye].

PURPOSE: Ciliary block glaucoma most commonly occurs after intraocular surgery. We report a case of malignant glaucoma following blunt trauma of the eye with no previous surgery or laser. PATIENT: A 54-year-old female suffered from acute elevation of intraocular pressure on her right eye after blunt trauma 2 months earlier. As a variety of topical and systemic antiglaucomatous drugs and the presence of a patent iridotomy could not control intraocular pressure (IOP) and the anterior chamber remained flattened, ciliary block glaucoma was diagnosed. Subsequent surgical treatment included pars plana vitrectomy (PPV), phacoemulsification with implantation of an intraocular lens, a second PPV with trabeculectomy and mitomycin-C, eccentric YAG-laser capsulotomy, and a third PPV with zonulo-iridectomy and endolaser-induced zonular shrinkage. After this variety of surgical approaches, a stable and deep anterior chamber could be achieved with an average IOP of 10 mmHg. CONCLUSIONS: Ciliary block glaucoma may occur after blunt trauma of the eye even without a history of intraocular surgery or laser. In addition, our case demonstrates the uncertainty of surgical success in affected patients.

Eye Injuries↗

PubMed2004

Translocation of iris pigment epithelium in patients with exudative age-related macular degeneration: long-term results.

PURPOSE: To report the practicability and efficacy of autologous iris pigment epithelium (IPE) translocation in exudative age-related macular degeneration (ARMD) over 1 year. METHODS: The consecutive interventional case series included 56 patients with exudative ARMD. During vitrectomy the submacular neovascular membrane (CNV) was removed and IPE cells, harvested from a peripheral iridectomy, were injected into the submacular space. Included were patients with subfoveal occult CNV (11 eyes), classic CNV (10 eyes), mixed CNV (17 eyes), CNV with a pigment epithelial detachment (13 eyes) or CNV with a hemorrhage (5 eyes). Outcome measures were visual acuity, foveal fixation, size of CNV and rate of recurrence based on fluorescence angiographic imaging. RESULTS: All patients underwent successful surgical removal of the CNV with consecutive subretinal IPE injection. Visual acuity was better than 20/100 in 19 patients preoperatively and in 18 patients postoperatively. A visual acuity of 20/100 or less was found in 37 patients preoperatively and in 38 patients postoperatively. Mean preoperative visual acuity (1.0+/-0.3 logMAR units) did not change significantly after 1 year (1.0+/-0.3 logMAR units). Ten eyes (18%) developed a recurrence. Fixation within the surgically denuded area could be demonstrated in 25 eyes (45%). CONCLUSIONS: Autologous IPE translocation for ARMD over one year can preserve foveal function on a low level, but cannot improve visual acuity. IPE translocation is technically feasible with a low rate of complications. Continued research seems justified to improve functional outcome.

Aged↗

PubMed2000

Iris pigment epithelial cell translocation in exudative age-related macular degeneration. A pilot study in patients.

BACKGROUND: This prospective, non-controlled pilot study investigates the practicability of IPE translocation and functional outcome in ARMD patients. Removal of submacular choroidal neovascularization (CNV) in age-related macular degeneration (ARMD) is usually associated with RPE damage and poor visual prognosis. Homologous RPE transplants fail to preserve macular function, possibly due to immune rejection. Instead of homologous RPE, we suggest translocating autologous iris pigment epithelium (IPE), building on earlier evidence from animal and in vitro investigations that IPE can substitute RPE functions in the experimental animal. Immunological cell rejection is avoided. METHODS: Four eyes with well-defined and eight eyes with ill-defined subfoveal CNV were submitted to operation and followed up for a minimum of 6 months. IPE cells were harvested from a peripheral iridectomy. A vitrectomy was performed. Submacular membranes were removed, and isolated IPE cells were injected into the subretinal space. Examinations included ETDRS visual acuity, fluorescein angiography, and SLO microperimetry. RESULTS: All patients underwent successful surgical removal of CNV and subretinal IPE injection. Compared to preoperative visual acuity (20/400-20/100) no significant change was observed after 6 months (20/320-16/80). A change of more than two ETDRS chart lines was defined as significant. One eye with preoperative ill-defined CNV developed a recurrence, leading to reduced visual acuity. In all patients, postoperative fluorescence angiography revealed early hyperfluorescence (window defect) in the surgically denuded area. Central fixation was demonstrated in 50% of eyes. CONCLUSIONS: Preliminary data suggests that IPE translocation in submacular surgery for ARMD can preserve but not improve preoperative visual acuity over 6 months. Functional results are promising compared to submacular membrane extraction alone and RPE transplantation. Continued research on improvement of IPE translocation seems justified.

Aged↗