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At least 811 records · Page 45Linked to original sources
PubMed2002

Effects of viscoelastic injection into Schlemm's canal in primate and human eyes: potential relevance to viscocanalostomy.

OBJECTIVE: To study possible initial mechanisms of alterations in aqueous outflow that may result from the injection of viscoelastic into Schlemm's canal (SC) during viscocanalostomy. DESIGN: Experimental animal (Macaca nemestrina) and human autopsy study. METHODS: Eyes were dissected into a limbal ring and hemisected or quartered. Uncannulated segments served as controls. In treated segments, SC was cannulated and viscoelastic injected. Segments were fixed and sectioned into continuous 500 to 1000 microm pieces, examined at the dissecting microscope, and photomicrographs were taken. Representative tissue was further prepared for scanning electron microscopy or sectioned at 1 microm. MAIN OUTCOME MEASURES: Tissue sections were examined to determine the extent of dilation and disruption of SC and related structures. SC dimensions were measured in segments from controls, cannulated regions, and regions of viscoelastic injection beyond the cannula insertion. In the hemisected segments, the circumferential extent of SC dilation was determined, and structures within the canal were described and counted. RESULTS: SC was dilated with increased anteroposterior length and height in cannulated and viscoelastic-injected segments in both primate and human eyes relative to untreated controls. The walls of SC were disrupted in both regions of cannulation and of viscoelastic injection, and the collector channels were widely dilated by viscoelastic. With decreasing effectiveness, the injected viscoelastic circumferentially dilated SC as far as 14 mm and 16 mm in primate and human hemisections, respectively. Structures that bridged between the walls of SC were often disrupted. CONCLUSIONS: Cannulation of SC and injection of viscoelastic beyond the cannula resulted in marked dilation of SC and associated collector channels. Lateral walls, inner wall endothelium, and bridging structures of SC were frequently disrupted by cannulation and sometimes by injected viscoelastic. These findings suggest that viscocanalostomy may acutely cause a direct communication between SC and the juxtacanalicular space, and so may initially enhance conventional aqueous outflow. Controlled clinical trials will be necessary to determine the long-term outcomes of this procedure.

Aged↗
PubMed1995

An ultrasound biomicroscopic study of filtering blebs after mitomycin C trabeculectomy.

PURPOSES: To investigate the relation between filtering bleb function and ultrasound biomicroscopic images, and to establish a new classification system for filtering blebs according to these images. METHODS: After trabeculectomy with mitomycin C, the filtering blebs of 117 eyes from 117 patients with various types of glaucoma were examined using ultrasound biomicroscopy. Four parameters of the images-intrableb reflectivity, visibility of the route under the scleral flap, formation of a cavernous fluid-filled space, and bleb height-were correlated with the level of intraocular pressure (IOP). RESULTS: Reflectivity inside the bleb and visibility of a route under the scleral flap were highly associated with IOP control. Blebs were classified into four categories according to the four measured parameters: type L (low-reflective), type H (high-reflective), type E (encapsulated), and type F (flattened). Eyes with good IOP control had mainly type L blebs. Type E and type F blebs were seen mostly in eyes requiring additional medication. CONCLUSION: The structure inside a filtering bleb is visible by ultrasound biomicroscopy, and bleb function is significantly associated with its ultrasound biomicroscopic image in eyes trabeculectomized with adjunctive mitomycin C.

Adolescent↗
PubMed1996

Bleb-related endophthalmitis after trabeculectomy with mitomycin C.

PURPOSE: To determine whether filtering blebs resulting from adjunctive use of mitomycin C (MMC) leads to an increased risk of endophthalmitis. METHODS: The authors retrospectively reviewed the records of 232 consecutive trabeculectomies performed at the W. K. Kellogg Eye Center with adjunctive use of MMC from May 1990 through June 1993. Data obtained from the records included patient age, sex, race, type of glaucoma, site of filtration surgery, concentration and duration of exposure to MMC, presence of early or late bleb leakage, and the occurrence of endophthalmitis. RESULTS: Three patients were lost to follow-up less than 1 month after surgery. A total of 229 eyes of 192 patients (11 women and 82 men) were included in the study. Mean follow-up of patients remaining free of infection was 18.5 +/- 10.8 months (range, 1-44 months). The overall incidence of bleb-related endophthalmitis was 2.6%. Endophthalmitis developed in 8% of patients (4 or 50) in whom an inferior approach was used and in 1.1% (2 or 179) in whom a superior approach was used (P = 0.02, Fisher's exact test). The estimated odds ratio for the development of endophthalmitis after trabeculectomy with adjunctive MMC for inferior versus superior filtration sites was 7.7. CONCLUSION: Short-term follow-up of trabeculectomies performed with adjunctive use of MMC demonstrates an overall incidence of endophthalmitis comparable to filtrationprocedures performed with 5-fluorouracil or without antifibrotic agents. However, inferior trabeculectomy performed with adjunctive MMC carries a significantly increased risk of bleb-related endophthalmitis compared with filters performed superiorly.

Aged↗
PubMed1996

Tissue plasminogen activator for preserving inferior peripheral iridectomy patency in eyes with silicone oil.

PURPOSE: An inferior peripheral iridectomy (IPI) was used to prevent forward migration of silicone oil in vitrectomized eyes; however, in approximately one third of eyes, the IPI closed spontaneously. Occlusion of the IPI by fibrin is believed to be an early event in permanent IPI closure by scar tissue. The authors determined whether intraocular tissue plasminogen activator (tPA) would restore and maintain IPI patency in eyes that had early occlusion of the IPI by fibrin. METHODS: Between November 1993 and January 1995, 12 patients who underwent vitrectomy with silicone tamponade and IPI for complicated retinal detachment received an anterior chamber injection of tPA (6.25 or 12.5 microgram) for occlusion of the IPI by fibrin. RESULTS: All 12 patients had lysis of fibrin and maintained a patent IPI at the last follow-up (124+/-95 days). One patient required multiple tPA injections for recurrent fibrin formation. In another patient, a small hyphema developed after the tPA injection, which did not occlude the IPI. When compared with the natural course in a very similar group of patients previously reported, tPA had a statistically significant beneficial effect in the maintenance of IPI patency (P = 0.040). CONCLUSIONS: Intraocular tPA can be safely used to lyse postoperative fibrin occluding the IPI in eyes with silicone oil tamponade. Early lysis of this fibrin maintains IPI patency.

Adult↗
PubMed1997

Bleb-related ocular infection in children after trabeculectomy with mitomycin C.

OBJECTIVE: The purpose of the study is to report the clinical course of bleb-related ocular infection in children after trabeculectomy with adjunctive mitomycin C. DESIGN: The study design was a retrospective review of all patients with a diagnosis of bleb-related ocular infection after trabeculectomy with adjunctive mitomycin C. PARTICIPANTS: Three children were identified in whom late postoperative bleb-related ocular infection developed. INTERVENTION: Treatment consisted of vitreous biopsy with intravitreous antibiotic and corticosteroid injection and/or bleb culture with topical and intravenous antibiotic administration. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure were measured. RESULTS: Bleb-related ocular infection developed an average of 16.7 +/- 10.9 months after trabeculectomy (range, 4-23 months). The mean age at presentation was 7.0 +/- 2.6 years (range, 4-10 years). Vitreous cultures were positive for staphylococci in two cases. A bleb culture from the third case also grew staphylococcus. All of the children recovered their initial vision after treatment of infection. However, one lost six lines of vision after a subsequent retinal detachment. Additional glaucoma surgery was required in one patient. CONCLUSIONS: Late bleb-related ocular infection may occur in children after trabeculectomy with mitomycin C and is characterized by abrupt onset, bleb infiltration, and rapid progression. Despite early preservation of vision after treatment of infection, significant late visual loss can occur.

Anti-Bacterial Agents↗
PubMed1997

Dacryocystorhinostomy with intraoperative mitomycin C.

PURPOSE: To observe the effect of intraoperative mitomycin C on the size of the osteotomy site after dacryocystorhinostomy.: METHODS: A total of 15 eyes of 14 patients diagnosed with primary acquired nasolacrimal duct obstruction were assigned randomly to either a mitomycin C group or a control group. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site and then after 30 minutes was removed transnasally. Nasoendoscopic findings were recorded at the completion of the surgery and at 1 month, 3 months, and 6 months after surgery for the two groups. A computer-aided digitizer was used to calculate the surface area of the osteotomy site, and a Student's t test was used to compare the difference between the two groups. RESULTS: All patients in the mitomycin C group remained symptom free after removal of their silicone tube (100% success), and there was one patient in the control group who had recurrent epiphora (87.5% success). Septo-osteotomy adhesion was found in two patients in the control group (25%), but there was no such adhesion found in the patients in the mitomycin C group. In the mitomycin C group, the average final surface area of the osteotomy at the end of the sixth postoperative month was 27.10 +/- 5.78 mm2, whereas that of the control group was only 10.83 +/- 3.37 mm2. Although the immediate postoperative surface area of the osteotomy showed no significant difference between the two groups, a statistically significant difference was noted at 6 months. CONCLUSION: Intraoperative mitomycin C is effective in maintaining a larger osteotomy size. This modification may possibly improve success rates over the traditional dacryocystorhinostomy procedure.

Chemotherapy, Adjuvant↗
PubMed1998

Management of large, leaking, and inadvertent filtering blebs with the neodymium:YAG laser.

OBJECTIVE: The purpose of the study was to test the efficacy of the neodymium:YAG (Nd:YAG) laser for repairing filtering blebs. DESIGN: The study design was a prospective study. PARTICIPANTS: Five eyes of five patients with leaking blebs (group 1), five eyes of five patients with large irritating blebs (group 2), and four eyes of four patients with inadvertent filtering blebs in the surgical wound after cataract surgery (group 3) were studied. INTERVENTION: The thermal mode of the Lasag Microrupter II Nd:YAG laser was used to treat the filtering blebs. The area of the bleb targeted for treatment was "painted" with methylene blue and then exposed to Nd:YAG laser treatment with an energy level of 2.5 to 3.75 J in a grid pattern. The aiming beam was focused on the conjunctiva, but the laser beam was offset according to the height of the bleb (offset of 0.9-1.5 mm, 4-5 on the Lasag) to selectively treat the internal surface of the bleb. MAIN OUTCOME MEASURES: Symptomatology, intraocular pressure (IOP), and complications were measured. RESULTS: After the laser treatment, all the leaks in group 1 were healed, all the patients in group 2 reported relief of their symptoms, and all blebs in group 3 shrank considerably. The IOP increased significantly (P < 0.001) after laser treatment in all three groups. This elevation appeared to diminish over time, with the major increase in IOP being recorded within the first month after the laser treatment. However, satisfactory IOP control was maintained in nearly all patients (13 to 14) who received none or one antiglaucoma medication. The visual acuity of one patient decreased significantly because of cataract formation. Complications included transient pressure rise (1 eye), bleb failure (1 eye), pupillary retraction toward the bleb (6 eyes), iatrogenic bleb leak (6 eyes), and cataract (1 eye). CONCLUSION: The continuous wave Nd:YAG laser is an effective tool for repairing bleb-related problems while maintaining successful filtration.

Aged↗
PubMed2002

Perineal urethrostomy.

Perineal urethrostomy can be used successfully in male cats to help manage certain lower urinary tract diseases. Indications and surgical technique are discussed and illustrated. Potential complications encountered with the surgical technique along with methods for preventing and managing are elaborated. With experience, perineal urethrostomy can be performed successfully and with minimal complications.

Animals↗
PubMed2001

Dilation of Schlemm's canal in viscocanalostomy: comparison of 2 viscoelastic substances.

PURPOSE: To study the injection of viscoelastic material into Schlemm's canal adjacent to and 6.0 mm from the scleral flap during viscocanalostomy in an autopsy eye model. SETTING: Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Viscocanalostomy was performed in 8 postmortem human globes. Sodium hyaluronate (Healon GV or Healon5) was injected into 1 side of Schlemm's canal, with the other side serving as a control in some eyes. The eyes were prepared for light microscopic analysis, and serial pathologic sections were taken adjacent to the flap and 6.0 mm circumferentially from the flap. The area of Schlemm's canal was calculated and compared using t tests. RESULTS: Injecting viscoelastic material enlarged the area of Schlemm's canal adjacent to and 6.0 mm from the flap significantly more than not injecting viscoelastic material. While there was no difference between the viscoelastic materials in dilating Schlemm's canal at the flap, with Healon5 there was a small but statistically significantly greater dilation 6.0 mm from the flap. No full-thickness breaks in the trabecular meshwork were noted adjacent to or 6.0 mm from the flap. CONCLUSION: Injecting viscoelastic material significantly increased the cross-sectional area of Schlemm's canal and may play a role in the success of viscocanalostomy. Further study is needed to elucidate the mechanism of this procedure.

Anterior Eye Segment↗
PubMed2002

Imaging and intervention in the gastrointestinal tract in children.

Vascular and interventional techniques have become an integral component of modern pediatric healthcare. Minimally invasive procedures of the gastrointestinal tract now comprise a large part of any active pediatric interventional practice. Magnetic resonance cholangiopancreatography offers a reliable, non-invasive means to evaluate patients with possible pancreatic or biliary pathology. This article reviews treatment of esophageal strictures and placement of gastronomy and gastrojejunostomy tubes and discusses new developments. Placement of percutaneous cecostomy tubes is a relatively new procedure that creatively uses the techniques developed for placement of percutaneous gastronomy tubes. This procedure offers significant benefits and lasting positive lifestyle changes for patients suffering from fecal incontinence. Liver biopsy in high-risk patients can be performed safely using measures designed to significantly decrease the risk of post-biopsy hemorrhage, such as track embolization or the transjugular approach.

Angioplasty, Balloon↗
PubMed1989

Cricothyroidotomy, a useful alternative to tracheostomy in maxillofacial surgery.

Tracheostomy and prolonged intubation are traditionally used in maintaining the airway, particularly after extensive maxillofacial surgery. The literature reports significant morbidity and mortality from both these procedures. Cricothyroidotomy is proposed as a useful alternative in certain circumstances. Recent documentation suggests that traditional fears of subglottic stenosis after cricothyroidotomy are ill-founded. Cricothyroidotomy may also benefit the patient by quicker rehabilitation and in early mobilisation, compared with prolonged intubation. The surgical procedure is quick and easily performed, making it suitable for emergency airway control. Cricothyroidotomy is not appropriate in children or in patients with inflammation to the trachea, since these may predispose to subglottic stenosis.

Cricoid Cartilage↗