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At least 865 records · Page 48Linked to original sources
PubMed2005

Decorin modulates wound healing in experimental glaucoma filtration surgery: a pilot study.

PURPOSE: To analyze the effect of perioperative decorin in an experimental setting of glaucoma filtration surgery. METHODS: Glaucoma filtration surgery, similar to that performed in clinical practice, was performed on 35 chinchilla rabbits (ChBB:CH). The animals received a unilateral subconjunctival injection of decorin (40-100 microg) or the vehicle alone before surgery and at different time intervals thereafter. Antifibrotic efficacy was established by clinical response and histologic examination. The animals were killed on day 14, and the eyes processed for histology. RESULTS: Both the vehicle and the decorin solution were well tolerated. No adverse effects such as inflammation or blurring of the optical media were observed. Conjunctival scarification occurred within 1 week in the control groups but was suppressed in the experimental groups. The intraocular pressure correlated with the fibrotic process and reached normal levels within 7 days after surgery in control animals, but remained significantly (P <0.001) reduced in the experimental groups. Histologic examination of the surgical area 14 days after surgery disclosed massive fibrosis in the control animals, but little deposition of extracellular matrix in the experimental groups. CONCLUSIONS: The data of this pilot study suggest that perioperative subconjunctival decorin applications significantly affect conjunctival scarring and surgical outcome of glaucoma filtration treatments in rabbits.

Animals↗
PubMed2005

Prospective survey of adverse reactions to topical antiglaucoma medications in a hospital population.

AIM: To identify the relative incidence and profile of adverse drug reaction (ADR) to various topical ocular hypotensives in a hospital setting. METHODS: All the patients presenting in outpatients clinic and accident and emergency with an ADR to topical hypotensive agent from August 2000 to January 2001 were included in the study. Details regarding the type date of commencing the treatment, the date of developing ADR, time to resolution of the ADR were noted. RESULTS: Over the period of 6 months, 66 patients presented with 73 ADRs. Brimonidine was the most frequent offending agent. In total, 23 (34.8%) presented with ADR after being commenced on treatment for more than 12 months. In all, 16 (24%) patients had IOP > 21 on presentation, eight (12%) patients underwent filtration surgery following the development of ADR. CONCLUSION: Adverse drug reaction to ocular hypotensive agents is not uncommon and can have a major impact on glaucoma management. Delayed presentation and association with raised intraocular pressure presentation emphasise the need for effective patient education to encourage prompt reporting of ADR.

Adrenergic alpha-Agonists↗
PubMed1994

Cellulose sponge punch for controlled mitomycin application.

We describe a new punch for cellulose sponges that helps to standardize the application of mitomycin during glaucoma filtration surgery. The punch was used to create 40 cellulose application disks. The height, diameter, and weight were measured in both wet and dry states. The disk dimensions and weights were reproducible, with a coefficient of variation less than 5 for all categories. The punch has been very useful in our clinical practice and research.

Animals↗
PubMed1997

The trabeculum as a drain in aphakic glaucoma.

Glaucoma of the aphakic patient is often difficult to treat. The authors present a new surgical technique which uses a portion of the trabeculum as a drain placed in the anterior chamber. Thirty eyes (19 aphakic and 11 pseudophakic) in 28 patients presenting refractory glaucoma were operated on by the same surgeon. Sixteen eyes had already undergone glaucoma surgery, 17 presented vitreous in the anterior chamber. The average postoperative follow-up was 18 months. Eighteen eyes (60%) needed no further treatment, 6 eyes (20%) were stabilized with a local treatment, 6 eyes (20%) remained hypertonic. This new surgical technique, which uses a portion of the trabeculum as a drain, allows for long-lasting filtration in the aphakic or pseudophakic patient with refractory glaucoma.

Aphakia, Postcataract↗
PubMed2006

Comparative safety profile between "modern" trabeculectomy and non-penetrationg deep sclerectomy.

PURPOSE: To compare the incidence and the severity of short-and medium-term complications following "modern" trabeculectomy (mTRAB) with non-penetrating deep sclerectomy (NPDS). MATERIALS AND METHODS: Comparative retrospective nonrandomized study including 65 eyes (55 patients) (mean age: 68.6 years) with medically uncontrolled glaucoma. mTRAB was performed in 43 eyes, NPDS in 22 eyes. mTRAB was performed according to a slightly modified P.T. Khaw protocol. NPDS procedures were done according to Kozlov's and Mermoud's technique with SKGEL implant in 18/22 eyes. Intraoperative antimetabolites (AMETAB) were given in 25 eyes (58%) in the mTRAB and 17 (77%) in the NPDS (p>0.05). RESULTS: Mean follow-up was longer in NPDS (10.7+/-5.5 months) than in mTRAB (8.5+/-3.4 months) (p<0.05). Preoperatively, the two groups were comparable in respect of age, type of glaucoma, mean IOP, severity of VF defects and bleb failure risk factors (p>0.05). Peroperatively, mTRAB were uneventful in 86% vs 90% of NPDS. 1st month postop complications occurred in 60.4% in mTRAB and 77.2% in NPDS (P>0.05). Most of them were minor and transient in both surgeries. Postop early anterior chamber inflammation was mild to moderate in all cases. The incidence of wound leaks (21% in the mTRAB group and 18% in the NPDS group) and hyperfiltration related complications (14% and 13.6% respectively in the mTRAB and NPDS group) were comparable between the two procedures (p > 0.05). Intraoperative antimetabolite application was not associated with an increased rate of postoperative hyperfiltration related complications. Scarring of filtration blebs had concerned a lower percentage of mTRAB eyes (19%) than the NPDS (36%). The number for 5-FU injections was less - although not significantly - in the mTRAB than in the other group (18.6% in mTRAB versus 41% in NPDS (p=0.05). Late complications were not observed in the mTRAB group. Iris prolapse associated with increased IOP occurred in 3 of the 22 NPDS procedures (13.6%). Final mean visual acuity was unchanged compared with preop value and was similar between the 2 groups (p>0.05). Diffuse, mildly vascularized filtration blebs were observed in 84% in mTRAB and 64% in DS (p>0.05). Mean IOP significantly decreased from 24.8+/-8.3 mm Hg to 13.4+/-4,3 mm Hg in mTRAB and from 25.1+/-6.5 mm Hg to 14.7+/-4.6 mm Hg in DS (p> 0.05). It was not different between the 2 groups with and without AMETAB augmentation. 70% of the mTRAB achieved a final IOP < or = 15 mmHg vs 41% in NPDS (p<0.05). The mean number of postop medications was 0.49 in mTRAB and 0.96 in NPDS (p<0.05). Complete (target IOP reached without meds) and qualified (target IOP reached with and without meds) final success rates were 60% and 88% in mTRAB and 36.4% and 68.2% in NPDS (p>0.05). CONCLUSIONS: Whether surgery was augmented with intraoperative antimetabolite or not, mTRAB revealed as a priority to be associated with comparable and even less complications than deep sclerectomy. Owing to the limitations of our study and until further confirmation, our results have suggested that mTRAB was associated with a slightly more important IOP reduction as well as higher success rates than NPDS.

Adolescent↗
PubMed1996

[Trabeculo-intendation. A new surgical treatment of glaucoma of the aphakic eye].

INTRODUCTION: Glaucoma of the aphakic patient is often difficult to treat. Classical surgical management is limited by poor quality conjunctiva and by the presence of the vitreous gel opposite the fistula. We present a new surgical technique which uses a portion of the trabeculum as a drain placed in the anterior chamber. MATERIAL AND METHODS: Thirty eyes (19 aphakic and 11 pseudophakic) in 28 patients presenting refractory glaucoma were operated on by the same surgeon. Sixteen eyes had already undergone glaucoma surgery, 17 presented vitreous in the anterior chamber. Average post-operative follow-up was 18 months. RESULTS: Eighteen eyes (60%) needed no further treatment, 6 eyes (20%) were stabilized with a local treatment, 6 eyes (20%) remained hypertonic. CONCLUSION: This new surgical technique, which uses a portion of the trabeculum as a drain, allows for long lasting filtration in the aphakic or pseudophakic patient with refractory glaucoma.

Aphakia↗
PubMed2006

Topical ocular hypotensive medication and lens opacification: evidence from the ocular hypertension treatment study.

PURPOSE: To determine whether topical ocular hypotensive medication is associated with refractive changes, visual symptoms, decreased visual function, or increased lens opacification. DESIGN: Multi-center clinical trial. METHODS: We compared the medication and observation groups of the Ocular Hypertension Treatment Study (OHTS) during 6.3 years of follow-up with regard to the rate of cataract and combined cataract/filtering surgery, and change from baseline in visual function, refraction, and visual symptoms. A one-time assessment of lens opacification was done using the Lens Opacities Classification System III (LOCS III) grading system. RESULTS: An increased rate of cataract extraction and cataract/filtering surgery was found in the medication group (7.6%) compared with the observation group (5.6%) (hazard ratio [HR] 1.56; 95% confidence interval [CI] 1.05 to 2.29). The medication and observation groups did not differ with regard to changes from baseline to June 2002 in Humphrey visual field mean deviation, Humphrey visual field foveal sensitivity, Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, refraction, and visual symptoms. For the medication and observation groups, LOCS III readings were similar for nuclear color, nuclear opalescence, and cortical opacification. There was a borderline higher mean grade for posterior subcapsular opacity in the medication group (0.43 +/- 0.6 SD) compared with the observation group (0.36 +/- 0.6 SD) (P = .07). CONCLUSIONS: We noted an increased rate of cataract extraction and cataract/filtering surgery in the medication group as well as a borderline higher grade of posterior subcapsular opacification in the medication group on LOCS III readings. We found no evidence for a general effect of topical ocular hypotensive medication on lens opacification or visual function.

Administration, Topical↗
PubMed1999

Acquired Pseudo-Brown's syndrome immediately following Ahmed valve glaucoma implant.

A 76-year-old woman noted vertical and horizontal diplopia one day following placement of an Ahmed valve in the superonasal quadrant of her left eye. She was unable to elevate her left eye, especially in adduction. She refused implant removal and strabismus surgery alone failed to satisfactorily resolve her problem. On forced duction testing, the implant became wedged between the globe and orbit superonasally. Subsequent repositioning of the valve resulted in resolution of her motility problem. Implant-orbital disproportion can produce a pseudo-Brown's syndrome. Surgeons are encouraged to perform forced duction testing at the time of glaucoma implant placement to detect and prevent this complication.

Aged↗
PubMed1999

New management of malignant glaucoma by phacoemulsification with posterior chamber foldable intraocular lens implantation.

OBJECTIVE: To investigate the feasibility of phacoemulsification with posterior chamber foldable intraocular lens implantation in the management of malignant glaucoma. PATIENTS AND METHODS: Fourteen patients with malignant glaucoma diagnosed in the Department of Glaucoma were enrolled in the study. 12 patients developed malignant glaucoma after filtration surgery. 1 developed after peripheral iridectomy. 1 patient developed malignant glaucoma without any clear cause. Cataract phacoemulsification was performed. Posterior chamber intraocular foldable lens was implanted in 10 cases of patients. RESULTS: All 14 patients were cured with normal intraocular pressure, normal anterior chamber depth and increased visual acuity. CONCLUSION: Phacoemulsification with posterior chamber foldable intraocular lens implantation is a good alternative in treating malignant glaucoma.

Aged↗
PubMedDate not supplied

Mid-term follow-up of Nd:YAG laser iridotomy in Asian eyes.

BACKGROUND AND OBJECTIVE: To assess the long-term results of Nd:YAG laser iridotomy in the treatment of patients with primary angle-closure glaucoma and occludable angles to evaluate the risk-benefit ratio and the role of gonioscopy in predicting the outcome after Nd:YAG laser iridotomy. PATIENTS AND METHODS: The records of 138 consecutive patients (231 eyes) who underwent Nd:YAG laser iridotomy in one hospital during 3 years (from 1989 to 1991) were reviewed. The mean follow-up period was 51 months. RESULTS: Of all eyes, 25.1% were treated for chronic angle-closure glaucoma and 10.8% were treated for acute angle-closure glaucoma; most eyes (64.1%) underwent prophylactic iridotomy for occludable angles. Decreased intraocular pressure (IOP) was noted in most eyes after Nd:YAG laser iridotomy; only 10 eyes required further filtration surgery. Visual acuity was unchanged or improved in 97.9% of all eyes at the 6-month visit. Cataract progression was primarily responsible for those eyes with decreased acuity. Ninety-seven percent of eyes had quantitatively wider angles after laser treatment; 8 of 14 eyes with peripheral anterior synechiae of more than 270 degrees underwent further surgery to control IOP. Transient elevated IOP and iris bleeding occurred in 23.5% and 12.2% of the eyes, respectively; other complications were rare. CONCLUSION: Nd:YAG laser iridotomy is a safe and effective procedure for the treatment and prevention of angle-closure glaucoma. Gonioscopy is useful to predict the outcome after Nd:YAG laser iridotomy.

Adult↗
PubMed1999

Medical treatment patterns of ASCRS members for primary open-angle glaucoma--1998 survey.

A survey of medical treatment patterns for primary open-angle glaucoma (POAG) was mailed to all United States members of the American Society of Cataract and Refractive Surgery (ASCRS) in March 1998; 21.2% responded. Demographic information pertinent to glaucoma care was also obtained. The use of diagnostic ancillary tests, as well as the sequential order of preferred therapy, in 3 hypothetical patient populations was analyzed: patients with mild, moderate, and advanced POAG. Preferred medical therapy was cross-tabulated with number of years in practice, fellowship training in glaucoma, and geographic location.

Adult↗
PubMed2006

[The place of filtration surgery in the treatment of adult onsets of primary glaucoma].

The author presents contemporary opinion on the place of filtration surgery in the treatment of adult onsets of primary glaucoma. Increasing age and greater IOP fluctuation increase the odds of VF progression after surgical intervention. Retinal ganglion cell function, optic disc morphology as well as VF parameters, can be at least partially restored after surgical IOP reduction in early glaucoma. It is the most important, to choose the critical time for surgical intervention in the aim to achieve reversal of field loss.

Adult↗
PubMed2002

Management of refractory glaucoma in childhood.

Glaucoma in children is characterized by marked intraocular pressure (IOP) elevation with resultant atrophy of the optic nerve and loss of retinal ganglion cells. In very young children, secondary expansion of the globe with damage to anterior segment structures, such as the cornea and zonule, often occurs. Permanent, severe visual dysfunction may result from optic nerve damage as well as from amblyopia arising from anisometropia and corneal opacification. The treatment of childhood glaucoma often involves surgery. Goniotomy and trabeculotomy remain the first line surgical procedures for open-angle glaucoma in children. Trabeculectomy with adjunctive antifibrosis therapy, aqueous shunt surgery, and cyclodestructive procedures are undertaken when angle surgery fails to control the IOP or is unlikely to succeed. The choice of surgical procedure is individualized according to factors such as the age of the patient, the specific type of glaucoma, the number of prior surgical procedures, and the visual potential of the eye. Achieving and maintaining an adequate IOP to prevent progressive optic nerve damage, avoiding complications, and preserving vision are the goals that must be considered in deciding on a surgical plan.

Child↗
PubMed2002

[The risk factors for massive suprachoroidal hemorrhage in the material of the Department of Ophthalmology, Medical Academy in Bialystok from 1990 to 2000].

PURPOSE: The aim of our study is evaluation of the risk factors for development of expulsive hemorrhage among patients operated in Department of Ophthalmology, Medical Academy in Białystok from 1990 to 2000. MATERIAL AND METHODS: This was a retrospective study of 18 patients with massive suprachoroidal hemorrhage occurring in association with cataract and glaucoma surgery. RESULTS: The mean age of patients with expulsive hemorrhage was 69.5 years. There were 10 women (55.6%) and 8 men (44.4%). In the population of patients in whom the suprachoroidal hemorrhage occurred hypertension was present in 5 (27.7%) and diabetes in 3 (16.6%). 8 patients (44.4%) had reported atherosclerotic cardiovascular disease. 7 patients (38.8%) had a history of glaucoma, 6 (33.3%) had high myopia. 1 patient had posterior synechiae after uveitis. All surgeries, except one, were performed under local anesthesia. There were no associations between suprachoroidal hemorrhage development and season. CONCLUSION: The results of our study suggest, that the risk factors for the development of massive intraoperative suprachoroidal hemorrhage are: high myopia, glaucoma and systemic cardiovascular diseases. A knowledge of these risk factors can help the physician in identifying patients, who are at a greater risk of having massive suprachoroidal hemorrhage.

Aged↗
PubMed1998

A mouse model to study the wound healing response following filtration surgery.

BACKGROUND: Failure of trabeculectomy is attributed to an exaggerated wound healing response at the episcleral level. We have developed a simple technique in mice that creates corneoscleral wounds and used it to study the role of growth factors in wound healing associated with loss of fistular patency. In addition, the effect of suramin on the wound healing response has been investigated. MATERIALS AND METHODS: Using black C57B1/6 mice, we created a fistula from the subconjunctival space to the anterior chamber by external penetration with a 25-gauge needle through the bulbur conjunctiva. Eyes were examined by light microscopy at different times following surgery and evaluated for the presence of growth factors in the sclerosing wound by immunohistochemistry. In an additional group, suramin (1.0 mg/ml) was applied topically five times. RESULTS: The limbal/scleral wounds closed rapidly. Granulation tissue consisting mostly of fibroblasts developed within the first 2 days, and the collagen component increased over time. By 4 weeks, the wound was completely healed. We found that within 1 day after surgery GF beta 2 reached high intensity. TGF beta 1 and PDGF A reached maximal intensity by day 2 and remained elevated for about a week, PDGF B was present at moderate intensity even before surgery. Myofibroblastic differentiation was observed from days 2 to 7. Suramin-treated wounds showed a decrease of cells and delay in fibroblast maturation. TGF beta 1 and TGF beta 2 levels persisted longer than in the controls, while PDGF A and PDGF B levels were lower than in the controls at all time points. CONCLUSIONS: The mouse corneoscleral wound model that we have developed mimics the process of wound healing and fistulizing surgery that takes place in other animal models and in human eyes in which the outcome of the surgery is poor. Our analysis of the appearance of growth factors associated with wound healing demonstrates that PDGF A as well as TGF beta 1 and TGF beta 2 appear early in the process at high levels and are potential targets for interventive strategies to ensure channel patency. Suramin has a distinct effect on the wound healing process and expression of growth factors and may be a promising substance for clinical use.

Animals↗
PubMed2000

Wound healing modulation after glaucoma surgery.

Recent developments in molecular and cell biology have made a major impact on our understanding of the wound healing process and its modification. In this article, the spectrum of therapies that are either currently available or have potential application as modulators of the scarring response following glaucoma surgery are reviewed. Refinement of existing antimetabolite regimens can improve surgical results, especially in carefully selected patient groups. However, the most promising new approach appears to be using molecular-based therapies, such as fully human neutralizing monoclonal antibodies, designed to target specific molecules in the scarring response. Such strategies ultimately offer the potential of safer, more specific, focal, and titratable treatment, with far-reaching clinical applications.

Animals↗
PubMed1997

Needling versus medical treatment in encapsulated blebs. A randomized, prospective study.

OBJECTIVE: The purpose of the study is to compare the efficacy and safety of transconjunctival needling and medical treatment in eyes with encapsulated blebs. DESIGN: A randomized, prospective study. PARTICIPANTS: Two hundred eighty-two eyes that underwent a guarded filtration procedure between January 1994 and January 1996 at the Glaucoma Service of University of Campinas. INTERVENTION: Encapsulated blebs developed in 25 (8.9%) of 282 eyes and were randomized to either needling (n = 14) or medical treatment with aqueous humor suppressants (n = 11). If one treatment failed to maintain intraocular pressures (IOPs) below 20 mmHg, the other treatment was initiated. If both methods failed, surgical revision or further glaucoma surgery was performed. Complete success was defined as IOP less than 20 mmHg after one treatment method. Qualified success was defined when IOPs less than 20 mmHg were obtained with both treatment methods, whereas failure was defined when IOP greater than 20 mmHg or when further surgery was indicated. MAIN OUTCOME MEASURES: Intraocular pressure, vision, and number of antiglaucoma medications. RESULTS: After a mean follow-up of 9.6 months, medical treatment alone was successful in ten patients (90.9%), whereas needling alone was successful in one patient (7.1%) (P = 0.00003). In the needling group, 92.9% of the eyes required aqueous humor suppressants, and 57.1% were considered qualified successes at the last follow-up (mean = 10.1 months). At the last follow-up examination, there was no statistically significant difference between the mean number of medications in both groups (P = 0.797). Further glaucoma surgery was performed in five patients (35.7%) undergoing needling and one patient (9.1%) receiving medical treatment (P = 0.162). CONCLUSIONS: Medical treatment with digital pressure should be used as the initial treatment in eyes with encapsulated blebs. Needling procedures or surgical revision, methods that are more invasive and potentially associated with severe complications, should be limited to the small percentage of eyes that do not respond to medical treatment.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Treatment of solitary subconjunctival cysts of filtration pad after fistulizing surgery of glaucoma].

The clinical picture and cytostatic treatment of solitary subconjunctival cysts of filtration pad after fistula-forming antiglaucoma surgery are described. Twenty-seven eyes with hypertension which developed as a result of subconjunctival cysts formed in the early postoperative period in 7% of patients operated on for open-angle glaucoma. Probable mechanisms of the pathogenesis of the formation of solitary cysts are discussed and 3-staged therapy proposed, including beta-blockers, perforation of the cyst wall by YAG laser, and, in 10% of cases with rigid cysts, microsurgical revision of filtration pad.

Adrenergic beta-Antagonists↗