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PubMed1999

A slit-lamp needling filtration procedure for uncontrolled glaucoma in pseudophakic and aphakic eyes.

In one aphakic and one pseudophakic patient without previous filtration surgery, a transconjunctival needling procedure similar to that used for failed filtration procedures was performed to create a filtering bleb. In both cases, intraocular pressure was successfully lowered for 6 months until the occurrence of bleb encapsulation, which was relieved by transconjunctival needling. There were no complications. In selected cases, this minimally invasive slit-lamp needling procedure provides successful filtration.

Aged↗
PubMed1998

The effect of cardiopulmonary bypass on blood cell filterability in children undergoing cardiac surgery.

BACKGROUND: The extended use of cardiopulmonary bypass (CPB) in cardiac surgery is limited because of damage to blood which in adults has been assessed by alterations in blood cell rheology. Blood trauma assessment in children is difficult because of the restrictions in sample volume and frequency but needs to be established from time to time in order to study the tolerance to new surgical and extracorporeal techniques. MATERIALS AND METHODS: Fourteen pediatric patients undergoing cardiac surgery with CPB for congenital heart disease corrections were studied. Whole blood, red blood cell and white blood cell rheology (filterability) were monitored before, during and after CPB using the St. George filtrometer that used small amounts of blood. RESULTS: The results showed that all the rheologic parameters were altered during the blood trauma of CPB and were outside the reference values before, during and after CPB. CONCLUSIONS: This suggested that blood cell rheologic disturbances did not recover soon after CPB and this may be of interest in long term follow-up to understand responses and recovery patterns to disease and interventions associated with pediatric heart surgery using CPB.

Blood Cell Count↗
PubMed2005

Inadvertent filtering bleb following sutureless cataract surgery.

The case history of a sixty-two-year-old lady, who presented with a bleb in the upper part of her left eye following cataract surgery was studied. The patient had no prior history of any glaucoma surgery. Gonioscopy revealed fishmouthing of the internal aspect of the scleral tunnel incision. The diagnosis of post-cataract filtering bleb was made which was managed by resuturing the wound. This case highlights the use of gonioscopy to visualise and evaluate the internal wound and discusses intraoperative recognition of internal leak and its management with horizontal sutures.

Cataract Extraction↗
PubMed1997

[The effect of heterogeneous scleral transplantation on hypotony after filtration surgery of glaucoma with mitomycin C].

OBJECTIVE: The study was designed to observe the effect of heterogeneous scleral transplantation in treatment of hypotony after filtration surgery of glaucoma with mitomycin C. METHOD: 7 patients (8 eyes) with hypotony after filtration surgery of glaucoma with mitomycin C were treated by heterogeneous scleral transplantation. RESULTS: The post-operative follow-up periods ranged from 3 to 19 months (mean 7.75 +/- 5.37 months). Postoperatively, the visual acuity was increased in 5 eyes, and the intraocular pressure was increased to normal level in all eight eyes. CONCLUSION: Heterogeneous scleral transplantation has therapeutic effects in the treatment of hypotonic eyes after filtration surgery of glaucoma.

Adolescent↗
PubMed2004

Efficacy of non-penetrating trabecular surgery for open angle glaucoma: a meta-analysis.

BACKGROUND: Non-penetrating trabecular surgery is a new filtrating surgery without opening in ternal trabecular structures. This study was to estimate the overall efficacy of non-penetrating trabecular surgery for open angle glaucoma. METHODS: The published articles selected for this study were obtained by a computerised Medline and China Biological Medicine Disk search of the literature and a manual search of the bibliographies of relevant articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis. RESULTS: A total of 37 articles were included in the meta-analysis. The pooled complete success rates of non-penetrating trabecular surgery with different techniques were: deep sclerectomy single, 69.7% (95% CI: 58.5% - 81.0%); deep sclerectomy with collagen implant, 59.4% (95% CI: 47.0% - 71.8%); deep sclerectomy with reticulated hyaluronic acid implant, 71.1% (95% CI: 56.8% - 85.3%); and viscocanalostomy, 72.0% (95% CI: 57.6% - 86.4%). The overall weighted complete success rate of non-penetrating trabecular surgery was 67.8% (95% CI: 61.4% - 74.3%). CONCLUSIONS: Non-penetrating trabecular surgery is the best available therapy method for medically uncontrolled open angle glaucoma with a complete success rate of over 60%. But the different techniques cannot belie the complete success rate of non-penetrating trabecular surgery.

Filtering Surgery↗
PubMed1992

Laboratory evaluation of the Pall LG6 leukocyte depleting arterial line filter.

The Pall LG6 arterial line filter has been designed to remove free circulating leukocytes from the arterial line of the extracorporeal circuit employed in openheart surgery. The filter was evaluated and compared to a control filter (Pall Stat-Prime) in terms of its general blood handling characteristics, particularly with regard to the associated level of leukocyte removal. The gross air handling characteristics of the filters were also assessed together with pressure drop. It was found that the filters differed little in terms of all factors studied other than the level of leukocyte depletion. The LG6 filter was associated with substantial levels of leukocyte depletion, particularly the depletion of neutrophils. Over the 90 minute perfusion period the LG6 filter was found to be associated with a neutrophil depletion rate of around 70% while preferentially sparing lymphocytes. This compared to a 10-20% depletion rate in the control filter. This was achieved without apparently compromising the performance of the filter in terms of the other factors studied.

Animals↗
PubMed2006

Options in pediatric glaucoma after angle surgery has failed.

PURPOSE OF REVIEW: Congenital glaucoma is primarily a surgical disease with medical management serving as a temporizing measure before surgery or as postoperative adjunctive treatment. First-line surgery for congenital glaucoma consists of incisional procedures on the anterior chamber angle: goniotomy and trabeculotomy. Angle surgery has a high success rate with few complications. Despite the high initial success rate, almost 20% of angle procedures eventually fail, and surgeons are confronted with a choice of what procedure to do next: a trabeculectomy with or without adjunctive antifibrosis therapy, glaucoma drainage surgery, or cyclodestructive procedures. This review will discuss and compare these procedures as reported in recent studies and how variables such as age, number of prior procedures, and type of glaucoma have clarified the order in which these procedures might be performed after failed angle surgery. RECENT FINDINGS: Clinical reports in refractory pediatric glaucoma consist solely of retrospective studies of varying size and quality. Recent studies of trabeculectomy in this population suggest mitomycin C is associated with increased risk of late infectious complications. Trabeculectomy has worse outcome among younger patients Glaucoma drainage devices have a success rate approaching 80% at 1 year, but less with longer follow-up. Cyclodestructive procedures are generally reserved for advanced cases, but low-dose cyclodiode therapy and endocyclophotocoagulation may prove useful earlier in the disease (< 2 years). SUMMARY: Refractory pediatric glaucoma remains a challenge. Glaucoma drainage devices appear to be the most predictable and possibly safest procedure to consider after failed conventional angle surgery.

Aqueous Humor↗
PubMed2001

[Phacoemulsification in patients with cataract and overfiltering bleb after antiglaucoma surgery].

PURPOSE: To evaluate the effect of phacoemulsification in patients with cataract, overfiltering bleb, and low-tension after antiglaucoma surgery. METHODS: Phacoemulsification and implantation of a foldable intraocular len was performed in six patients(7 eyes) with overfiltering bleb, low-tension, and cataract. The complications, blebs, intraocular pressures(IOP), and visual acuity were observed postoperatively. RESULTS: No severe complication was found. The overfiltering blebs constricted and their walls became thicker three months after the operation. The visual acuity and IOP were improved (P < 0.05). CONCLUSION: Phacoemulsification may be another way to treat the patients with cataract and overfiltering bleb, low-tension after antiglaucoma surgery.

Aged↗
PubMed1997

A full-thickness scleral graft for the surgical management of a late filtration bleb leak.

BACKGROUND AND OBJECTIVES: Late bleb leak may follow months to years after filtration surgery. This article describes the surgical repair of eight leaking blebs using a full-thickness scleral graft and analyzes the efficacy of the procedure and its effect on intraocular pressure (IOP) control. PATIENTS AND METHODS: The indications for surgical bleb revision were hypotony maculopathy (2 eyes), endophthalmitis (2 eyes), bleb infection (2 eyes), and chronic epiphora and blurring of vision (2 eyes). All eyes were treated surgically through bleb excision and repair of the scleral defect with a full-thickness scleral graft. Conjunctival closure was performed either by its advancement to the limbus or by free conjunctival autograft. Follow-up ranged from 4 months to 7 years. RESULTS: Surgery stopped the leak in all cases, and hypotony was relieved without loss of long-term IOP control. However, early postoperative IOP rises (> 30 mm Hg) occurred in 2 eyes and a pressure-lowering medication was necessary to achieve long-term IOP control (IOP < 22 mm Hg) in 3 eyes. CONCLUSIONS: The technique described is an effective procedure for the treatment of late bleb leaks and is especially useful for the treatment of leaks found in association with full-thickness scleral defects. IOP spikes in the early postoperative period may occur, but long-term IOP control can be expected without the need for further filtration surgery.

Aged↗
PubMed2004

Elimination of proinflammatory cytokines in pediatric cardiac surgery: analysis of ultrafiltration method and filter type.

OBJECTIVE: This study was undertaken to assess whether different filter types or ultrafiltration methods influence inflammatory markers in pediatric cardiac surgery. METHODS: Forty-one children younger than 5 years were prospectively randomized to groups A (polyamid filter with conventional ultrafiltration), B (polyamid filter with modified ultrafiltration), C (polysulfon filter with conventional ultrafiltration), and D (polysulfon filter with modified ultrafiltration). Interleukin 6, interleukin 10, tumor necrosis factor, terminal complement complex, and lactoferrin were measured before the operation (T0), before rewarming (T1), after ultrafiltration (T2), at 6 (T3) and 18 hours (T4) after the operation, and in the ultrafiltrate. RESULTS: All markers changed with both ultrafiltration methods, both filter types, and in all groups (except tumor necrosis factor) along the T0 to T4 observation time (P <.0001). Their patterns of changes were different for terminal complement complex, with less decrease after use of the polysulfon filter (P <.05), and among groups A through D for interleukin 6 (P =.01), with more decrease in group C than group A (P <.02). Interleukin 10 decreased with the polyamid filter (P <.001) but not with the polysulfon filter. In the ultrafiltrate, tumor necrosis factor was higher with the polysulfon filter than the polyamid filter (6.8 +/- 5 pg/mL vs 4.0 +/- 3.7 pg/mL, P <.05). The ultrafiltrate/plasma ratio of interleukin 6 was higher with conventional ultrafiltration than modified ultrafiltration (0.018 +/- 0.017 vs 0.004 +/- 0.007, P <.005). CONCLUSIONS: The polysulfon filter showed a filtration profile for inflammatory mediators superior to that of the polyamid filter for interleukin 6, tumor necrosis factor, and interleukin 10. Interleukin 6 was most efficiently removed by conventional ultrafiltration with a polysulfon filter, and tumor necrosis factor was best removed by modified ultrafiltration with a polysulfon filter, whereas other inflammatory mediators were not influenced by filter type or ultrafiltration method. Therefore combined conventional and modified ultrafiltration with a polysulfon filter may currently be the most effective strategy for removing inflammatory mediators in pediatric heart surgery.

Biomarkers↗
PubMed2000

Complications of glaucoma drainage implant surgery.

Glaucoma drainage implants play an important role in the management of refractory glaucoma. It may be considered as a primary procedure in eyes with severe scarring of the conjunctiva and the limbus, neovascularization, multiple previous, failed filtering procedures, and severely glaucomatous eyes for which corneal graft is planned. Recommendations have been made regarding improving the biocompatibility of the materials used in the manufacture of these implants. The current state of development of glaucoma drainage implants is likened to that of intraocular lenses in the 1970s. Further development of devices and techniques will only serve to improve our armamentarium and success against glaucoma, specifically refractory glaucoma. Glaucoma posterior tube shunts have proved to be safe, with the majority of complications either nonsight-threatening, spontaneously resolving, or reversible. Considered primarily in the most severe cases of refractory glaucoma, it has otherwise changed the outlook for such patients.

Filtering Surgery↗
PubMed2005

Current indications for preoperative inferior vena cava filter insertion in patients undergoing surgery for morbid obesity.

BACKGROUND: Pulmonary embolus is a potentially lethal complication in patients undergoing surgery for morbid obesity. In a select group of patients at high risk for venous thromboembolic events (VTE), we have chosen to prophylactically insert inferior vena cava filters via a jugular percutaneous approach. We propose guidelines for preoperative insertion of inferior vena cava filters in patients with clinically significant obesity. METHODS: All patients who underwent preoperative insertion of inferior vena cava (IVC) filters as prophylaxis for pulmonary emboli were reviewed. Data regarding body mass index (BMI), prior history of venous thromboembolism, current anticoagulant usage, as well as other patient data were compiled and analyzed. Additionally, all operative notes were reviewed, and operative data were analyzed and compared. RESULTS: 14 patients underwent preoperative IVC filter placement before gastric bypass. Mean patient age was 49.1 +/- 1.52 years and mean BMI was 56.5 +/- 4.45 kg/m2. No complications occurred due to preoperative filter placement, and no pulmonary emboli occurred in this group. Indications for preoperative IVC filter insertion included prior pulmonary embolus (6), prior deep venous thrombosis (7), and lower extremity venous stasis (1). CONCLUSIONS: Vena caval filter placement in the preoperative period can be undertaken safely in bariatric patients. We recommend that routine preoperative vena caval filter placement should be undertaken in all bariatric patients with prior pulmonary embolus, prior deep venous thrombosis, evidence of venous stasis, or known hypercoagulable state. Possible roles for IVC filter placement in this patient population are expanding as more data is acquired.

Bariatrics↗
PubMed2005

Wound healing after glaucoma surgery: how to manage it?

Agents such as the antimetabolites 5-fluorouracil (5FU) and mitomycin-C (MMC) have revolutionised glaucoma surgery in patients with a high risk of surgical failure. However, vision threatening complications can be associated with the use of these agents. Changes in antimetabolites application during and after the surgery can increase the safety and reduce the complications while maintaining effectiveness.

Adult↗
PubMed2002

[The evaluation of incidence of massive suprachoroidal hemorrhage n the material of the Department of Ophthalmology, Medical Academy in Bialystok from 1990 to 2000].

PURPOSE: Massive suprachoroidal hemorrhage is a well-known, possibly serious complication of many surgical procedures, including cataract extraction, glaucoma-filtering procedures, penetrating keratoplasty, retinal detachment surgery and pars plana vitrectomy. The aim of our study is evaluation of the incidence of massive suprachoroidal hemorrhage among patients operated in Department of Ophthalmology, Medical Academy in Białystok from 1990 to 2000. MATERIAL AND METHODS: From 1990 to 2000, 6225 intraocular operations, including 5541 cataract extractions, 195 glaucoma-filtering surgeries, 438 retinal detachment surgeries and 51 multiprocedure surgeries were performed. The criteria for diagnosis were the intraoperative signs of suprachoroidal hemorrhage (shallowing of the anterior chamber, increasing of the intraocular pressure, iris prolapse, expulsion of the lens and vitreous, retinal and choroidal elevation and loss of the red reflex) and postoperative ultrasonic examination. RESULTS: 18 eyes were identified with massive suprachoroidal hemorrhage, including 16 eyes during cataract extraction and 2 eyes during filtering procedures. The incidence of suprachoroidal hemorrhage for all intraoperative surgeries was 0.29%. It occurred in 0.28% of cataract surgeries and 1.02% of glaucoma filtering procedures. There were no incidence of suprachoroidal hemorrhage during retinal detachment surgeries. CONCLUSION: A massive suprachoroidal hemorrhage is a relatively rare complication of intraocular operations. Most frequently it is associated with glaucoma filtering surgery.

Aged↗
PubMed1995

Treatment of postfiltration bleb leaks with autologous blood.

BACKGROUND: Managing filtration surgery bleb leaks can be difficult as well as frustrating. Treatment options traditionally have included aqueous suppressants, patching, and bleb compression devices. Previously, if conservative management failed, surgical revision was considered. METHODS: Six patients with thin avascular blebs and discrete leaking holes (2 had had full-thickness procedures, 4 had had trabeculectomy with mitomycin C) underwent subconjunctival injection of approximately 1 ml of whole autologous blood. Injections were made just lateral and just medial to the domed cystic elevation of the blebs. RESULTS: Five of six eyes were leak-free by the second day after the procedure. No complications occurred. After 4 to 12 months of follow-up, four eyes are currently leak-free. In these eyes, intraocular pressure is between 8 and 12 mmHg. CONCLUSION: Subconjunctival peribleb injection of autologous blood may be a safe and helpful adjunct in treating selected postfiltration surgery bleb leaks.

Aged↗