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At least 775 records · Page 43Linked to original sources
PubMed2003

Clinical experience of e-PTFE membrane implant surgery for refractory glaucoma.

AIMS: To evaluate the clinical efficacy of membrane tube implant made of expanded polytetrafluoroethylene (e-PTFE, Gore-Tex) membrane and silicone tube in treating refractory glaucoma. METHODS: A retrospective chart review was performed on 43 eyes of 40 patients who underwent glaucoma tube shunt implant surgery using double layered e-PTFE membrane and silicone tube to treat refractory glaucoma. The surgeries were performed from May 1991 to September 1995, and the subjects were patients with terminal glaucoma without useful vision on the study eye. RESULTS: The mean follow up period was 32.9 months. The Kaplan-Meier survival for intraocular pressure (IOP) control (IOP between 6 and 21mm Hg without significant complication) was 80.9% at 1 year, 73.9% at 2 years, and 62.2% at 3 years after surgery. After excluding three eyes of three patients who were dropped within 3 months after surgery and did not have any serious complication or problem in IOP control, the average preoperative IOP was 42.5 (SD 14.6) mm Hg and IOP on the last visit was 17.3 (10.2) mm Hg (p = 0.000, n = 40). The number of antiglaucoma medications before surgery (2.2 (0.6)) was reduced to 0.5 (0.8) on the last visit (p = 0.000). The IOP was controlled within the range of 6-21 mm Hg in 26 eyes (65.0%). In the remaining 14 eyes (35%), we could not control the IOP or additional surgery was needed to control the IOP or to treat severe complications. Two cases of endophthalmitis and three of phthisis were found as serious complications. The other complications were similar to those of other commercially available glaucoma implants. CONCLUSION: A comparable clinical result was obtained with this new implant as with the other commercially available implants. This implant with a thin and non-rigid reservoir has a potential to reduce some complications associated with the large volume and rigid consistency of the other implants, although it is not yet proved. This membrane tube implant may be considered as another substitute in the surgery of refractory glaucoma.

Adult↗
PubMed1997

Different opening techniques in cataract surgery.

A retrospective study on the different opening techniques in cataract surgery at our Department in 1996 was carried out. In our everyday practice fornix based conjunctival flap and sclerocorneal oblique or vertical-oblique approach with a center at 12 o'clock was performed. In the case of hemorrhagic diathesis and secondary ACL implantation the corneal approach was preferred. After glaucomatous filtration surgery the incision was made temporally in some cases.

Cataract Extraction↗
PubMed1998

The effect of paclitaxel powder on glaucoma filtration surgery in rabbits.

OBJECTIVE: The authors determine if the intraoperative placement of paclitaxel powder in the subconjunctival space improves the outcome of glaucoma filtration surgery in rabbits. METHODS: A posterior lip sclerectomy was performed in the right eye of 24 New Zealand white rabbits. Before the conjunctiva was fully sutured, 8 mg of mannitol powder alone, or 8 mg of mannitol powder containing either 10 micrograms or 250 micrograms of paclitaxel, was placed in the subconjunctival space of six eyes each in masked fashion. An additional six animals were treated with episcleral application of a sponge soaked in a solution of 0.5 mg/ml of mitomycin C (MMC) for 5 minutes before the sclerectomy was performed. Intraocular pressure and bleb size were measured until the operation had failed or until the 7 weeks of observation had concluded. RESULTS: Both paclitaxel powder and MMC solution improved the outcome of filtration surgery in this model as measured by magnitude of intraocular pressure (IOP) lowering and duration of surgical success. No toxic effect of either drug was observed, although endophthalmitis was observed in eight animals followed for more than 3 weeks. CONCLUSION: The introduction of paclitaxel into the subconjunctival space at the conclusion of filtration surgery has an effect comparable to intraoperative MMC.

Animals↗
PubMed2006

[Postoperative care after glaucoma filtration surgery].

Scarring of the filtering bleb is the main complication after glaucoma filtration surgery. Postoperative care most importantly determines success or failure of the operation. Both, preoperative antiinflammatory treatment and reduction or discontinuation of topical medication have a positive effect on postoperative conjunctival wound healing. After conventional postoperative care only about 40% of patients reach target pressures in the long-term without topical medication. Intensified postoperative care (IPC) increases the success rate by 25% after 5 years. Central to the concept of IPC is a wound modulating therapy which is adapted to the phases of wound healing of the filtering bleb. Evaluation of filtering bleb morphology is a prerequisite for the application of topical steroids and 5-fluorouracil. In addition, dedicated counseling of the patient and close follow-up are mandatory. In order to further increase the success rate of penetrating glaucoma surgery and decrease the side effects of the current antimetabolite therapy more research on wound healing as well as specific therapy to prevent scarring are necessary.

Administration, Topical↗
PubMed2000

Cellular photoablation to control postoperative fibrosis in filtration surgery: in vitro studies.

The purpose of this study was to evaluate the feasibility of cellular photoablation using fluorescence-generated photoreaction products as a method to control postoperative fibrosis in filtration surgery. The fluorescent probe, 2', 7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein, acetoxymethyl ester (BCECF-AM) is a cell membrane permeable compound rendered membrane-impermeable and fluorescent upon cleavage by intracellular esterases. Human scleral and Tenon's capsule fibroblasts were cultured and used as the target cells. Uptake and retention of the probe were determined with a fluorescence multi-well plate reader. Fibroblasts with or without intracellular probe were irradiated under conditions of fluorescence microscopy with diffuse blue light (450-490 nm, 1.68x10(2)mW m(2-1)). The viability of cells was examined by trypan blue exclusion and crystal violet test. To better mimic a wound healing process the effect of cellular photoablation was verified in artificial lesions produced in cultured monolayers loaded with different concentrations of the probe. Uptake and retention of BCECF-AM is dependent on ambient concentration. When incorporated the probe is lethal to those cells exposed to the appropriate photo-irradiation. Cells exposed to BCECF-AM (for 45 min) at a concentration of approximately 10 microm and irradiated for 1 min resulted in 100% cell death. Cellular photoablation in contrast to chemotherapeutic agents acts only on the targeted cells. This method shall be pursued as an alternative therapy to control postoperative fibrosis in filtration surgery.

Dose-Response Relationship, Drug↗
PubMed2003

Ciliary body toxicity of cyclosporin A and octreotide acetate in rabbit eyes: a comparison with mitomycin C and 5-fluorouracil.

PURPOSE: To compare the toxicities of cyclosporin A, octreotide acetate, mitomycin C and 5-fluorouracil to the ciliary body. METHOD: We applied sponges soaked in these compounds to the open scleras of rabbit eyes. Histopathological specimens were obtained from the operation site and at 180 degrees from it on the 14th day after surgery. RESULTS: Mean ciliary epithelial thickness in the study groups was as follows: 12.29 +/- 2.69 microm in group 1 (mitomycin C), 13.85 +/- 4.56 microm in group 2 (5-fluorouracil), 17.71 +/- 3.09 microm in group 3 (cyclosporin A), 11.64 +/- 2.92 microm in group 4 (octreotide acetate), 11.92 +/- 2.89 microm in group 5 (topically applied octreotide acetate) and 21.85 +/- 4.29 microm in group 6 (control). The ciliary epithelial thickness in groups 1, 2, 4 and 5 was statistically different from that in the control group. Intracellular vacuolisation and degenerative changes of the non-pigmented epithelium, and pigment loss of the pigmented epithelium, were found mostly in group 1 and moderately in group 2 and 3. CONCLUSION: Octreotide acetate and cyclosporin A are less toxic alternatives to mitomycin C and 5-fluorouracil in glaucoma filtration surgery.

Animals↗
PubMed2005

Orbital complications after aqueous drainage device procedures.

A retrospective case series of 2 patients with orbital complications after tube shunt placement for glaucoma is reported. The first patient presented with limited motility and conjunctival injection in the setting of intraocular gas leakage in the superior orbit after previous vitreoretinal surgery. The second patient presented with multiple signs of orbital cellulitis. Both patients improved with intravenous antibiotics. Although rare, orbital complications may occur after glaucoma tube shunt surgery.

Adolescent↗
PubMed1997

Long-term effects of tube-shunt procedures on management of refractory childhood glaucoma.

PURPOSE: The authors evaluated the long-term results of tube-shunt surgery in management of childhood glaucoma. METHODS: The results of tube-shunt surgery in children who had glaucoma refractory to medical or alternative surgical treatment in the Glaucoma Service of Wills Eye Hospital during the period 1986 through 1993 were reviewed. Eighteen eyes of 15 patients were included in the analysis. Follow-up ranged from 14 to 80 months (mean +/- standard deviation, 47.3 +/- 25.1 months). RESULTS: In the early postoperative course (6 months after surgery), the intraocular pressure (IOP) was between 6 and 21 mmHg in 13 eyes (72.2%) with or without glaucoma medication. Two or more years later, IOP was between 6 and 21 mmHg in four eyes without further glaucoma medication (22.2%) and four eyes (22.2%) with the addition of antihypertensive therapy. Five eyes (27.8%) lost light perception, whereas seven (38.9%) remained within one line of preoperative vision or improved. Twelve eyes underwent 28 additional surgical procedures after the tube-shunt operation, mostly to control IOP or manage tube-related complications. CONCLUSION: The limited success rate, relatively high complication rate, and need for frequent surgical intervention suggest caution regarding the prognosis of tube-shunt surgery in children with glaucoma.

Adolescent↗
PubMed1999

[A study of interferon alpha-2b as an accessory drug after glaucoma filtration surgery].

OBJECTIVE: To elucidate the inhibitory action of interferon alpha-2b (IFN alpha-2b) on the cicatrization under conjunctiva and the best way to use it after glaucoma filtration surgery. METHODS: Immunohistochemical PAP method and image biological system 2000 (IBAS 2000) were utilized to quantitatively analyze the inhibitory effect of IFN alpha-2b on the expression of epidermal growth factor receptor (EGFR) of cultured calf fibroblasts; the effects of IFN alpha-2b on collagen contents in suture-caused cicatrization under conjunctiva and changes of aqueous humor protein after trabeculectomy performed on rabbits have also been observed. RESULTS: IFN alpha-2b reduced the expression of EGFR of cultured bovine fibroblasts at a dose-dependent manner. The relationship between the EGFR and the dosage of IFN alpha-2b is Y = 2953.8 - 554.5 lgx (r = -0.98, P < 0.01). With 4.67 x 10(-5) micromol/L IFN alpha-2b not only reduced about 50% of the collagen in suture-caused cicatrization, but also significantly decreased the protein concentration of aqueous humour 3 and 72 hours after trabeculectomy. CONCLUSION: It is promising that IFN alpha-2b can be used after glaucoma filtration surgery to reduce excessive cicatrization with many advantages compared with antimetabolites.

Animals↗
PubMed2001

[Influence on tear film of postoperative 5-fluourouracil and intraoperative mitomycin C in glaucoma filtration surgery].

OBJECTIVE: To investigate the changes of tear film functions due to the use of postoperative 5-fluourouracil (5-Fu) and intraoperative mitomycin C (MMC) in glaucoma filtration surgery. METHODS: 71 eyes of 71 refractory glaucoma patients were followed up after filtration surgery. They were divided into 3 groups. The 5-Fu and MMC groups consisted of 24 and 17 eyes respectively. The other 30 eyes that underwent the surgery without any use of antimetabolic agents were in the control group. The observed symptoms included ocular foreign body sensation, dryness, photophobia, itching and discharge. The available criteria were conjunctival congestion, fluorescein and rose bengal staining on the cornea and conjunctiva, break-up time of tear film and Schirmer's test. RESULTS: The ocular symptoms and signs were manifest and tear film functions were significantly decreased in 5-Fu group (P < 0.05). No significant difference between MMC and the control was seen, except that the dry feeling was significantly intensive in MMC group (P < 0.05). CONCLUSION: The postoperative use of 5-Fu after glaucoma filtration surgery leads to tear film abnormalities apparently.

Adult↗
PubMed1999

[A comparison on postoperative shallow anterior chambers with different kinds of glaucoma surgery].

PURPOSE: Comparing the rate of postoperative shallow anterior chambers with three kinds of filtration surgery to find the most effective way of reducing the complication. METHODS: The 120 cases (154 eyes) with primary angle-closure glaucoma or primary open-angle glaucoma were enrolled in this study. The patients were divided into three groups, group 1 (12 cases, 14 eyes) treated by deep sclecatony and group two (66 cases, 82 eyes) treated by trobeculecotomy and group three (42 cases, 58 eyes) treated by trobeculecotomy combining with scleral flaps tightly sutured with releasable sutures. RESULTS: The rate of shallow anterior chambers was following: group one 21.4%, group two 19.5%, group three 5.1%. The rate of this complication between group 1 and group 2 was not different in statistics (P > 0.05), but group 3 was significantly reduced in comparing with that of the other two groups (P < 0.05). CONCLUSION: The results indicate that this kind of suture may decrease the occurrence of the complication of shallow anterior chamber in filtration surgery and it is simple to operate and the curative result is reliable.

Adult↗
PubMed1996

[Long-term surgical effects of trabeculotomy combined with sinusotomy].

We retrospectively analyzed long-term effects of trabeculotomy combined with sinusotomy. We reviewed 29 eyes with primary open angle glaucoma and 6 eyes with psuedexfoliation glaucoma. The preoperative intraocular pressure was equal to or over 21 mmHg. All cases had been subjected to initial trabeculotomy combined with sinusotomy. The had been followed up for at least 3 years after surgery. The mean age was 57.8 years and the mean follow-up period was 40.5 months. The preoperative intraocular pressure was 24.3 +/- 5.9 mmHg (Mean +/- standard deviation) and the postoperative intraocular pressure was 15.8 +/- 3.8 mmHg. There was statistically significant difference between preoperative and postoperative intraocular pressure. The Kaplan-Meier life table method indicated a success rate at 50 months after surgery of 0.63 +/- 0.15, as defined by intraocular pressure of 20 mmHg or lower, and of 0.35 +/- 0.08 as defined by intraocular pressure equal to or lower than 14 mmHg. The success rate of filtering blebs was 0.10 +/- 0.05 at 50 months. Eleven of 35 eyes (37%) were controlled at equal to or below 14 mmHg and 20 of 35 (67%) eyes were controlled at equal to or lower than 16 mmHg at final postoperative intraocular pressure. The surgical results of trabeculotomy combined with sinusotomy remain effective in controlling intraocular pressure levels for long periods.

Adult↗
PubMed2000

Variability of dissection depth in deep sclerectomy: morphological analysis of the deep scleral flap.

BACKGROUND: Deep sclerectomy and similar procedures including a deroofing of Schlemm's canal are meeting with increasing interest owing to the limited risk profile of non-perforating glaucoma surgery. The aim of our study was to investigate how often the outer wall of Schlemm's canal or parts of the trabecular meshwork were incorporated in the excised tissue on deep scleral flap dissection by an experienced glaucoma surgeon. METHODS: The excised deep scleral flap was prepared for light microscopy after performing deep sclerectomy in 7 children and 22 adult patients suffering from glaucoma. Meridional serial sections were checked for the presence of fragments of trabecular beams and collector channels and parts of the endothelial wall of Schlemm's canal. Morphology was compared with the intraoperative appearance of the operated tissue. RESULTS: In 15 patients (52%) the deep scleral flap contained at least some tissue from the outer wall of Schlemm's canal; in 5 of these 15 patients noticeable remnants of the juxtacanalicular trabecular meshwork were also found, although only in one patient was this obvious during surgery. In 14 patients (48%) no evidence of the deroofing of Schlemm's canal was found within the excised deep scleral flap, although intraoperatively the dissection seemed to have been too superficial in only 5 patients. CONCLUSION: Even when performed by an experienced glaucoma surgeon, deep sclerectomy produces biopsy material of remarkable morphological variability that does not always correspond to the intraoperative appearance of the site of operation. More than in conventional trabeculectomy this variability may be of importance for the outcome of surgery.

Adult↗
PubMed1997

Effect of topical aclacinomycin on glaucoma filtration surgery in rabbits.

A prospective, randomized, double-masked and placebo-controlled study was performed to compare the effects of a single 5-minute intraoperative exposure to aclacinomycin (AMC) 0.4 mg/ml or 0.8 mg/ml with control eyes treated with saline solution on the success of glaucoma filtration surgery in 26 rabbits. Intraocular pressure (IOP), bleb survival, fistula patency and complications were evaluated. The results showed that IOP in the eyes treated with AMC was significantly lower than that in the control eyes from days 5-40 in the 0.4 mg/ml group and from days 5-20 in the 0.8 mg/ml group. The bleb survival lasted significantly longer in the two treated groups than in the control group and in the AMC 0.4 mg/ml group than in the AMC 0.8 mg/ml group. At 40 days, the rate of sclera fistula occlusion was 0% in the AMC 0.4 mg/ml eyes, 43.8% in the AMC 0.8 mg/ml eyes, and 100% in the control eyes. Significant complications, such as anterior chamber inflammation, hyphema, moderate and severe corneal haze, dense corneal neovascularization and mild cataract occurred only in the eyes treated with AMC 0.8 mg/ml. The results indicated that intraocular treatment with AMC at a dose of 0.4 mg/ml had a markedly beneficial effect on IOP, bleb appearance and fistula patency after experimental filtration surgery in rabbits.

Aclarubicin↗
PubMed2006

[A case of severe glaucoma with pseudopemphigoid successfully treated by filtration surgery using amniotic membrane].

BACKGROUND: It is necessary to decrease topical anti-glaucoma medication for severe glaucoma with pseudopemphigoid caused by anti-glaucoma eye drops. Glaucoma filtrating surgery is often needed instead of medication, but the prognosis is poor because it induces scar fomation and makes the filtrating bleb vanish. CASE: An 85-year-old male patient with exfoliation syndrome had twice undergone glaucoma surgery about ten years previously. His intra-ocular pressure (IOP) was high despite topical anti-glaucoma medication. At the first examination in our hospital, he had severe superficial punctate keratopathy, blephariticshortening and symblepharon, and we therefore diagnosed severe pseudopemphigoid induced by anti-glaucoma eye drops. Because his IOP could not be controlled by topical and general medication, we conducted a glaucoma filtrating operation using amniotic membrane. CONCLUSION: The administration of oral anti-inflammatory drugs before and after surgery and the use of amniotic membrane prevented post-operative scar formation and the progress of symblepharon, resulting in the successful control of IOP after surgery.

Aged, 80 and over↗
PubMed1999

Probability of filtration surgery in patients with open-angle glaucoma.

OBJECTIVE: To investigate the probability of undergoing filtration surgery in either 1 or both eyes in patients in whom open-angle glaucoma was newly diagnosed. METHODS AND DESIGN: A retrospective community-based study of 295 residents of Olmsted County, Minnesota, in whom open-angle glaucoma was newly diagnosed between January 1, 1965, and December 31, 1980, was performed. Kaplan-Meier methods were used to estimate the cumulative probability of undergoing filtration surgery during a 20-year period. RESULTS: At 20 years of follow-up, the Kaplan-Meier cumulative probability of undergoing filtration surgery in at least 1 eye was estimated to be 23% (95% confidence interval, 16%-30%), and in both eyes the estimate was 12% (95% confidence interval, 6%-17%). Patients with optic nerve damage at the time of diagnosis were more likely to undergo surgery than patients with elevated intraocular pressure but no damage (1 eye, 39% vs 15%; both eyes, 27% vs 5%). CONCLUSION: This retrospective study of a white population newly diagnosed as having and treated for open-angle glaucoma indicates that while most patients did not undergo filtration surgery in the course of glaucoma therapy, at least one third of those with glaucomatous damage at the time of diagnosis underwent filtration surgery.

Aged↗
PubMed2005

[Intraocular penetration of cefotiam hydrochloride, a kind of cephalosporin after filtration surgery in rabbit eyes].

PURPOSE: In this study, we measured the cefotiam dihydrochloride (CTM) concentration in ocular tissue after filtration surgery in rabbit eyes. METHODS: CTM (20 mg/kg body weight) was administered intravenously 30 min before filtration surgery which was performed by double flap procedure on the right eyes of white rabbits. The aqueous humor and serum were extracted at 10 min after surgery and at 30 min, 60 min, and 120 min. Drug concentration in all of the specimens was measured by high performance liquid chromatography (HP-LC). RESULT: The CTM concentrations of aqueous humor in the nonoperated eyes were 0.44 +/- 0.16(mean +/- standard deviation) microg/ml (n = 4) (40 min after intravenous dosage), 0.36 +/- 0.17microg/ml (n = 4) (60 min after intravenous dosage), 0.38 +/- 0.34, microg/ml(n = 3) (90min after intravenous dosage) and 0.27 +/- 0.10 microg/ml (n = 5) (150 min after intravenous dosage). In contrast, CTM concentration in the aqueous humor of the operated eyes was 2.4 +/- 0.95 microg/ml (n = 4) at 10 min after surgery (40 min after intravenous dosage), 2.11 +/- 1.10 microg/ml (n = 4) at 30 min after surgery (60 min after intravenous dosage), 1.18 +/- 0.78 microg/ml (n = 4) at 60 min after surgery (90 min after intravenous dosage) and 0.47 +/- 0.1 microg/ml (n = 5) at 120 min after surgery (150 min after intravenous dosage). The intraocular penetration of CTM at 10 min and at 120 min after filtration surgery was significantly higher in comparison with the drug concentration in the nonoperated eyes (p < 0.05). CONCLUSION: The intraocular penetration of CTM after filtration surgery was much higher in comparison with the drug concentration in the nonoperated eyes. These results may be useful to predict the intraocular penetration of CTM in human eyes after filtration surgery.

Animals↗