Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Filtering Surgery”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMed1987

Trifluorothymidine and 5-fluorouracil: antiproliferative activity in tissue culture.

The antiproliferative activity of trifluorothymidine (F3TDR) and 5-fluorouracil (5-FU), two cell-cycle-phase-specific antimetabolites, was compared in a tissue culture model of human scleral fibroblasts and rabbit corneal epithelial cells. The mean concentrations required to inhibit human scleral fibroblast proliferation to 50% of the control rate (ID50) after 5 days of exposure were 8.50 micrograms/mL for F3TDR and 0.43 microgram/mL for 5-FU. The corresponding ID50 levels for rabbit corneal epithelial cells were 0.24 microgram/mL and 0.42 microgram/mL. The ID50 of F3TDR was significantly higher than that of 5-FU in human scleral fibroblasts (p less than 0.001) but not in rabbit corneal epithelial cells. F3TDR appears to have no clinical advantage over 5-FU in minimizing corneal epithelial toxicity when given to prevent fibroblast proliferation after glaucoma filtering surgery.

Animals↗
PubMed1987

Management of leaking filtration blebs.

This study describes 11 patients, in whom filtering surgery was performed, who developed a leaking filtration bleb postoperatively. Average follow-up time was 3 1/2 years. In three patients, suturing of the conjunctiva was performed. In two, anterior chamber reformation and choroidal tap were required, and, in both cases, the leak sealed spontaneously without surgical repair. In two, the glaucoma shell tamponade technique was used to facilitate anterior chamber reformation. These reformed in both cases, and no subsequent shallow anterior chambers have been noted. In four cases, conservative therapy, which consisted of antibiotics, glaucoma medication with or without patching, and careful patient observation, was used to manage the leaking blebs. Complications observed were: iritis (1 case), early infection of the bleb (1), flat anterior chamber (1), and failure of the bleb to allow sufficient aqueous humor outflow (2).

Aged↗
PubMed1988

The effects of D-penicillamine and daunorubicin on conjunctival fibroblast proliferation and collagen synthesis.

Two drugs, D-penicillamine and daunorubicin, were tested for their effect on proliferation and collagen synthesis of cultured conjunctival fibroblasts. This cell type is likely responsible for scar formation and ultimate filter surgery failure in glaucoma patients. Both drugs were antiproliferative; however, D-penicillamine required 2000 times the concentration of daunorubicin to achieve a similar degree of inhibition. D-penicillamine had a more consistent effect on intracellular collagen synthesis than daunorubicin at the doses tested. In contrast, at concentrations of daunorubicin where all proliferation ceased, intracellular production and extracellular transport of collagen were maintained.

Animals↗
PubMed1988

Inhibition of human scleral fibroblast proliferation with heparin.

Proliferation of fibroblasts is a serious problem in ocular trauma and surgical wound healing. Depending on the location of the injury, the growth of fibroblasts can lead to different problems. In glaucoma filtering surgery, fibroblast proliferation may contribute to scar tissue formation and premature wound closure. Fibroblastic growth in proliferative vitreoretinopathy may lead to the formation of preretinal membranes, which can contract, causing retinal detachment. In an effort to find a more effective method of inhibiting ocular fibroblast proliferation, we have investigated the effect of heparin, a sulfated polysaccharide, on the proliferation of fibroblasts obtained from the sclera of donor eyes. Heparin inhibits the incorporation of 3H-thymidine in a dose-dependent manner in the presence of fetal bovine serum (FBS). This inhibition is partially reversed by endothelial cell growth factor (ECGF). The heparin antagonist protamine sulfate causes a reversal of heparin inhibition and, in some instances, a significant increase in 3H-thymidine incorporation compared to serum controls. Heparin was equally effective in inhibiting cell proliferation in control and heparin-protamine sulfate-pretreated medium. These results were apparently unrelated to a direct toxic effect on cells, as a Trypan Blue exclusion assay showed no significant difference in viability when heparin treated cells were compared to control cells. Direct cell counts showed that heparin was effective in inhibiting cell proliferation over a long time period, but only if it was reinstilled every 2 days. Heparin treatment shows promise as a method for controlling fibroblast proliferation in the eye.

Cell Division↗
PubMed1987

Visual field improvement after neodymium: YAG laser puncture of miotic cysts.

This case report describes the use of a Q-switched neodymium:YAG laser to puncture miotic cysts. Fifteen shots of 0.06 mJ were needed. The pupil dilated more widely following this procedure, resulting in an improvement in the patient's visual field. Intraocular pressure (IOP) was not able to be controlled medically, however, and filtering surgery 20 days post laser treatment was required. IOP control had been poor prior to the laser-treatment, and did not appear to be more following treatment.

Adult↗
PubMed1986

In vitro inhibition of ocular cell proliferation with ara-C: blockage of the antiproliferative effect with 2'-deoxycytidine.

Cytosine arabinoside (ara-C), a cell cycle-phase specific antimetabolite, was tested in a tissue culture model of human scleral fibroblasts (HSCF), and human retinal pigmented epithelium cells (HRPE), to investigate possible applications in the modulation of wound healing after glaucoma filtering surgery and in the postoperative management of proliferative vitreoretinopathy. Cell proliferation after a 72 hr incubation in the presence of ara-C was inhibited to 50% of the control growth rate (ID50) with calculated doses of 60 ng/ml in HSCF and 4 and 5 ng/ml in HRPE cultures. 2'-deoxycytidine, a competitive inhibitor of ara-C action, completely eliminated the cell growth retardation of both cell types produced by ara-C after 72 hr incubation.

Cell Division↗
PubMed1986

Sodium hyaluronate (Healon) in glaucoma filtering procedures.

Healon (sodium hyaluronate) has been used in a prospective study designed to investigate its possible usefulness in promoting effective bleb formation and preventing cleft closure in trabeculectomy for glaucoma. One hundred fourteen patients with open-angle glaucoma were randomly assigned to one of two groups. In one group (55 patients), filtering surgery was performed without the use of Healon. In the remaining 59 patients, Healon was used to separate the iris from the cleft, the sclera from the sclera and the conjunctiva from the sclera. The surgical procedure used was the Stallard-Worst triangular modification of Cairns' method, combined with removal of the Tenon's capsule. The patients whose operations were performed with the aid of Healon had a higher success rate, as manifested by better and more permanent bleb formation and maintenance, more open clefts, less scarring, less peripheral anterior synechiae formation, and significantly lower long-term intraocular pressure. Moreover, the number of patients requiring supplemental postoperative timolol therapy was significantly smaller in the Healon group (5/59 patients: 8.5%) than in the control group (33/55 patients: 60%). There was a transient delay in the reduction of intraocular pressure following trabeculectomy in the Healon patients which was not observed in control patients. Apart from this, no adverse effects were associated with the use of Healon.

Aged↗
PubMed1984

Argon laser trabeculoplasty in progressive low-tension glaucoma.

Twenty-two phakic eyes with progressive low-tension glaucoma had a 360-degree argon laser trabeculoplasty (ALT). Seven of these eyes had diurnal curves performed pre- and two months postlaser treatment to measure the effect of ALT on diurnal pressure variation. Sixteen of the 22 eyes (73%) were clinical successes with a 4.9 mm Hg decrease at 12 months in the successful group. However there was a decreasing pressure lowering effect with time with a mean follow-up of 21.6 months. The diurnal curve data showed a 6.2 mm Hg decrease between the mean pressure pretreatment and two months postlaser treatment. The mean peak pressure posttreatment was 13.29 mm Hg, a 6.17 mm Hg decrease from the prelaser mean peak pressure. The finding of 24-hour pressure control and a reduction in the mean peak pressure confirms the usefulness of ALT in progressive low-tension glaucoma and we recommend that it be utilized as the step in between maximally tolerated medical therapy and filtering surgery.

Circadian Rhythm↗
PubMed1995

Retinal hemodynamics in patients with chronic open-angle glaucoma.

Recently it has been demonstrated that retinal hemodynamics are disturbed in patients with chronic open-angle glaucoma. As the underlying cause a reduction in perfusion pressure due to increased intraocular pressure (IOP) and deficiencies of retinal autoregulation has been discussed. The present study was undertaken to clarify the influence of filtering surgery on retinal hemodynamics in patients with chronic open-angle glaucoma. A total of 17 patients with chronic open-angle glaucoma aged between 37 and 86 years were included in this prospective study. All patients underwent digital fluorescein angiography before and 10 days after fistulating procedures. From the angiograms the arteriovenous passage time (AVP) and arterial mean dye-bolus velocity (MDV) were quantified by means of digital picture analysis. At baseline the AVP was significantly prolonged in the patients as compared with reference values (AVP, 2.5 +/- 0.8 versus 1.6 +/- 0.4 s; P < 0.01). After the fistulating procedure (IOP: before, 29 +/- 5 mmHg; after, 16 +/- 4 mmHg) the AVP was significantly reduced as compared with baseline values (AVP, 2.5 +/- 0.8 versus 2.0 +/- 0.4 s; P < 0.05), whereas the MDV showed only a slight increase (MDV, 5.70 +/- 0.89 versus 5.99 +/- 0.92 mm/s; P > 0.05). This study confirms a disturbance of retinal hemodynamics in patients with chronic open-angle glaucoma. The significant reduction in AVP observed after lowering of the IOP by fistulating procedures demonstrates the positive influence of IOP reduction on the retinal circulation. The improvement in retinal circulation may prevent the occurrence of further glaucomatous damage after fistulating procedures.

Adult↗
PubMed1995

[Trabeculectomy with mitomycin C. Study apropos of 30 cases].

UNLABELLED: Standard trabeculectomy with adjunct Mitomycin C application was performed in 30 eyes of 26 patients with refractory glaucoma to study the efficacy and safety of this technique. The results were analyzed for each aetiology and number of ocular risk factors for failure of filtering procedure and compared with those of other series, including those using 5-fluorouracil. METHODS: The surgical procedure was similar to that described by Cairns, except that a fornix-based conjunctival flap was used. A 0.4 mg/ml solution of Mitomycin C was applied at the filtration site for three minutes. The mean follow-up was 6.4 months; the thirty eyes were followed for 4 to 11 months. RESULTS: At 6 months, the intraocular pressure was less than 21 mmHg in 65.2% of cases without postoperative glaucoma medication, and the overall success rate was 86.9%. No remarkable complications occurred. CONCLUSION: Intraoperative Mitomycin C may be a helpful adjunct in achieving low final intraocular pressure after trabeculectomy in high-risk glaucoma filtering surgery, and Mitomycin C may be a viable alternative to postoperative 5-Fluorouracil. But further studies regarding late complications due to mitomycin are required.

Adolescent↗
PubMed1994

Noncontact transscleral Nd:YAG cyclophotocoagulation: a long-term follow-up of 500 patients.

Long-term experience with transscleral cyclophotocoagulation in 500 patients suggests that this operation is the cyclodestructive procedure of choice. It offers a reasonable surgical option in the high-risk glaucoma population, which includes patients with neovascular glaucoma, glaucomas with active uveitis, glaucomas in aphakia or pseudophakia, and other cases in which filtering surgery has failed or is felt to have a low chance for success. Satisfactory intraocular pressure reduction was achieved in 62% of the patients with one treatment session. After one or more repeated procedures in 21% of the study group, the final intraocular pressure was below baseline in 94%, with a mean final reduction of 24 mm Hg, which was judged to be adequate for 87% of the patients. However, visual loss remains a significant postoperative complication, with some degree of reduced vision occurring in 39% of the study population. Patients with neovascular glaucoma had the greatest percentage of visual loss at 46%, compared with 34% and 38% for patients with glaucomas in pseudophakia and aphakia, respectively. While it is hard to know how many of these cases of visual loss were a direct result of the cyclophotocoagulation, the procedure should be used with caution in eyes with a potential for good central vision. Further study is needed to determine the relative indications for transcleral cyclophotocoagulation and the various operations to increase aqueous outflow in the management of patients in the high-risk glaucoma population.

Adolescent↗
PubMed1993

[Postoperative follow-up after goniotrepanation with fornix-based conjunctival flap].

Goniotrephination with a fornix-based conjunctival flap was performed in 60 glaucomatous eyes. The postoperative course was monitored with special reference to intraocular pressure, anterior chamber depth, choroidal detachment and external fistulation. Some degree of choroidal detachment was observed in 1/3 of cases, extending centrally to the equator in only 11% and centrally to the vessel arcade in none. The anterior chamber was found to have become shallow in 16%, but this persisted longer than 3 days in only 6.7%. In 13.3% a external fistula arising from the conjunctival wound persisted for more than 1 day. The described technique with a fornix-based conjunctival flap and meander-like suture at the limbus further reduces the frequency and severity of complications in filtering surgery.

Choroid↗
PubMed1994

Evaluation of a tapered, blunt, bipolar cautery tip for trabeculectomy.

A bipolar cautery instrument with a tapered, blunt tip has been developed for glaucoma filtering surgery. Evaluated in 30 consecutive trabeculectomy procedures, the instrument proved suitable for all aspects of the operation. The narrow, 23-gauge shaft and tapered, blunt tip allowed gentle, pin-point coagulation of individual bleeders, as well as cauterization of tracks of tissue in a continuous motion. The unit was effective for external cauterization of conjunctival and scleral vessels, as well as for internal cauterization of anterior uveal tissue.

Conjunctiva↗
PubMed1994

[Ten-year results of argon laser trabeculoplasty].

One hundred and forty-seven eyes of 107 primary open angle glaucoma (POAG) patients and 39 eyes of 31 capsular glaucoma patients who were followed up for a minimum of 5 years after argon laser trabeculoplasty were reviewed. The mean preoperative intraocular pressure (IOP) was 23.6 mmHg. The follow-up periods ranged from 5 to 13 years with an average of 8.8 years. Using a life-table method, the probability of success was calculated, as defined by IOP at 21 mmHg or lower with same or less preoperative medical regimen, no deterioration of visual field defect and no requirement of filtering surgery. The success rate at 5 postoperative years was 40.3% for the POAG and 65.7% for the capsular glaucoma, and at 10 postoperative years it was 26. 8% for POAG and 26.9% for capsular glaucoma. An analysis using Cox proportional hazard model showed that preoperative lower IOP, male sex and higher age were the significant determinants for success.

Adolescent↗
PubMed1993

The role of 5-fluorouracil in complicated glaucomas.

The long-term efficacy of trabeculectomy in controlling intraocular pressure (IOP) has been found unsatisfactory in various complicated and refractory glaucomas. The most common cause for failure is excessive scarring at the filtering site. Several wound modulating agents which reduce scarring have been tested. In this study, 5-Fluorouracil (5-FU), a halogenated pyrimidine analogue and a potent anti-mitotic agent, was applied for seven days after trabeculectomy in eighteen complicated and unsuccessful filtering glaucomas, at a daily dosage of 5 mg in the form of 0.5 ml subconjunctival injections. The common postoperative complications encountered were corneal epithelial erosion (38%), wound leakage (16%), subconjunctival haemorrhage (32%) and hyphaema (10%), all during the first 7 to 10 days. Monitoring at regular intervals up to six months showed adequate control of IOP (less than 22mm Hg.) in 88% of the cases. Cases of aphakic glaucoma and neovascular glaucoma showed poor response. Use of 5-FU as an adjuvant to filtering surgery in various complicated glaucomas improves the long-term results.

Adult↗
PubMed1993

Intraoperative mitomycin C in complicated glaucomas.

Filtering surgery has been found to be less successful in certain types of glaucoma. These include young patients, those with pigmentary glaucoma, secondary glaucoma, angle recession glaucoma, aphakic or pseudophakic glaucoma, and patients requiring reoperation. This study describes the authors' attempt to evaluate the effectiveness of conventional trabeculectomy with intraoperative application of mitomycin C in such patients. Ten eyes of 8 patients were evaluated in this study. Of these cases 4 eyes (2 bilateral cases) were from the primary juvenile open angle group; 2 eyes each had pseudophakic glaucoma and previous anti-glaucoma surgery which had failed; one eye had aphakic glaucoma and the last suffered from angle recession glaucoma. The intraocular pressure was successfully controlled in all the ten eyes. The preoperative IOP ranged from 28 to 50 mm Hg and the postoperative IOP ranged from 7 to 16 mm Hg. The postoperative complications were minimal.

Adult↗
PubMed1993

Intraocular pressure and visual field decay in chronic glaucoma.

A total of 41 eyes of 28 patients with primary open-angle glaucoma and low-tension glaucoma (group 1) were followed for 12-72 months with tonometry and automated perimetry. A second group consisting of 13 eyes (9 patients) with secondary glaucoma (pigment dispersion, goniodysgenesis, ciliolenticular block and chronic angle closure) was followed for 13-60 months. None of the eyes had undergone filtering surgery during the follow-up period. The visual field decay was calculated by means of regression analysis of the mean defect. There was a significant correlation between visual field decay and both mean intraocular pressure (IOP, P > 95%) and maximal IOP (P > 98%) in the secondary glaucomas, which was not found in group 1. IOP oscillation expressed by the standard deviation of IOP was significantly correlated with progressive visual field loss in both groups. The slope of visual field decay was independent of the functional damage at the initial examination. Even if the influence of IOP level on the course of primary chronic glaucoma may have been masked by other factors that have a great interindividual variation, the oscillation of IOP seems to be at least as important as the level of IOP.

Adult↗
PubMed1993

Subconjunctival THC:YAG ("holmium") laser thermal sclerostomy ab externo. A one-year report.

BACKGROUND: Laser sclerostomy can be performed in a less-invasive manner than standard filtering surgery. Longer wavelengths in the infrared range have water-absorptive characteristics that facilitate perforation of the sclera. The goal was to perform laser sclerostomy ab externo to avoid intraocular instrumentation and minimize conjunctival trauma. METHODS: A thulium, holmium, chromium-doped:YAG (THC:YAG) crystal laser was used to create thermal sclerostomies in 49 glaucomatous eyes of 46 patients. The laser is a long-pulsed (300-microsecond), compact, self-contained, solid-state laser operating in the near infrared (2.1 microns). Energy was delivered via a specially designed 22-gauge (712-microns) optic probe that emits energy at a right angle to the long axis of the fiber. Pulse energies of 80 to 120 mJ were used. Total energy levels to produce full-thickness sclerostomies ranged from 1.4 to 7.2 J. Subconjunctival 5-fluorouracil (5-FU) injections were administered in 46 eyes. Success was defined as an intraocular pressure (IOP) of less than or equal to 22 mmHg with or without medications. For eyes in which preoperative IOP was less than or equal to 22 mmHg, success was defined as a decrease in IOP of greater than or equal to 30%. RESULTS: Estimated probability of success allowing for one retreatment was 0.75 at 6 months and 0.68 at 12 months. Mean IOP of successful cases was 13.3 mmHg at both 6 and 12 months. Twelve cases failed within the initial 6 months, and two additional cases failed by 12 months. CONCLUSION: THC:YAG ("holmium") laser thermal sclerostomy is an alternative to other full-thickness filtration procedures. Further evaluation and understanding will define its ultimate role in glaucoma management.

Adolescent↗