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At least 883 records · Page 49Linked to original sources
PubMed1996

[Subconjunctival 5-fluorouracil polyphase liposome interference with scar formation in experimental filtration surgery].

OBJECTIVE: A comparative study was made to determine the effect of 5-fluorouracil (5-Fu) polyphase liposome and 5-Fu solution on the prevention of scar formation in filtration surgery. METHOD: 20 New Zealand white rabbits that underwent a standard trabeculectomy in both eyes were divided into two groups and each group consisted of 10 rabbits. Postoperatively, according to randomized fashion, in the first group, one eye received daily subconjunctival injection of 5 mg (0.2 ml) 5-Fu solution and the fellow eye received equal subconjunctival amount of normal saline serving as the control, in the second group, one eye received once subconjunctival injection of 5 mg (0.2 ml) of 5-Fu ployphase liposome with every 3 days apart and the fellow eye received the equal amount of subconjunctival injection of polyphase liposome serving as the control. RESULTS: Two weeks after the surgery, the eyes treated with 5-Fu solution in the first group and 5-Fu polyphase liposome in the second group showed marked reduction of intraocular pressure (IOP, P < 0.05) and the control eyes of both groups did not reveal any marked reduction of IOP as compared with preoperative IOP respectively. Morphometric analysis of the areas of fibrosis in histologic section demonstrated a significant decrease (P < 0.002) in episcleral fibrosis in the eyes treated with 5-Fu solution and 5-Fu polyphase liposome as compared with their control eyes respectively. Superficial punctate keratopathy occurred in two of the 5-Fu solution-treated eyes (20%) and no toxic reaction was noted in the 5-Fu polyphase liposome-treated eyes. CONCLUSION: Postoperatively, subconjunctival 5-Fu polyphase liposome instead of 5-Fu solution inhibits the scar formation at filtering site, and the therapy is safe and effective, leading to a higher success rate.

Animals↗
PubMed2005

What do glaucoma specialists know about their patients?

BACKGROUND: Although interaction between doctor and patient is undoubtedly influenced by their mutual expectations, little information is available about the knowledge and expectations of glaucoma doctors concerning their patients' attitudes and treatment patterns. The aim of our prospective study was to compare the actual responses of glaucoma patients concerning various issues related to their disease and the responses the glaucoma doctors expected their patients to give. METHODS: Glaucoma patients consecutively sent to our glaucoma centre were asked to complete a standardised questionnaire about their glaucoma history, treatment routines and opinions on issues related to glaucoma. Ophthalmologists at the glaucoma centre were asked to predict patients' answers. RESULTS: One hundred and twenty-eight consecutive glaucoma patients completed the patients' questionnaire and 12 glaucoma specialists completed the corresponding questionnaire for doctors. Frequency of intraocular pressure (IOP) measurements and visual field testing, as well as the number of topical medications, were relatively accurately predicted by the glaucoma doctors. Differences between the doctors' predictions and patients' responses were found concerning discomfort after surgery and the influence of stress or environmental factors on IOP. The largest range of doctors' predictions (0-100%) was observed concerning the portion of patients claiming a 100% adherence to glaucoma medication. CONCLUSION: Glaucoma specialists are familiar with the treatment patterns of their patients. The knowledge of glaucoma specialists of their patients' subjective attitudes to glaucoma-related issues deserves further investigation, as discrepancies between doctors' and patients' responses were observed in this area.

Adult↗
PubMed1999

Postoperative systemic corticosteroid treatment and Molteno implant surgery: a randomized clinical trial.

PURPOSE: To determine whether it is possible to improve the surgical success of Molteno implantation by causing a general suppression of collagen synthesis with postoperative oral prednisolone. METHODS: Twenty-two patients requiring single stage, single-plate Molteno implantation were randomized into two study groups: the control group A and the systemic prednisolone treatment group B. Serum markers of collagen metabolism were monitored. RESULTS: A successful outcome at the end of the 6-month follow-up, defined as final IOP > or =6 mmHg and < or =22 mmHg with less or equal number of antiglaucoma medication as preoperatively and no additional surgery was achieved in 9 of 11 (82 %) patients of group A and in 5 of 10 (50 %) patients of group B (p= 0.18). There was a statistically significant decrease in serum markers of collagen synthesis in the group B but not in the group A. CONCLUSION: The serum markers indicated a systemic effect of oral prednisolone on collagen synthesis in group B but it did not improve the surgical outcome as compared to the controls.

Administration, Oral↗
PubMed2006

Considerations in developing model-based economic evaluations of glaucoma treatment.

PURPOSE: To facilitate future glaucoma model development and to provide guidance for decision-makers evaluating them, we provide an overview of an innovative glaucoma model and highlight important modeling considerations. CONSIDERATIONS: The considerations that were addressed include: disease outcome that is both relevant and meaningful to current clinical practice; diversity in treatment options and practices; incorporation of therapy discontinuation; and consideration of the variability in patient response to treatment. MODEL SCOPE: A state-transition, Monte Carlo simulation model was developed to simulate the management and treatment of patients with glaucoma and/or ocular hypertension. The model examines strategies involving sequential use of up to 6 pharmacologic interventions. Transitions are based on the monthly probability that a patient is no longer "successfully maintained" on therapy, which can be a consequence of lack of intraocular pressure control, adverse events, lack of compliance, or lack of persistence. Outputs of the model include months on each treatment, frequency of therapy switches, days of intraocular pressure control, frequency of ophthalmologist visits, frequency of surgery, and glaucoma-related costs. The model allows the user to specify country-specific treatment strategies, survival on therapy, surgical rates, practice patterns, and costs. CONCEPT APPLICATION: The model presented offers insights into accommodating patient and clinician variability through the use of persistence distributions. It will facilitate future glaucoma model development and provide insight for decision-makers who must evaluate model-based analyses of the economic value of glaucoma interventions.

Antihypertensive Agents↗
PubMed2004

Concave trabeculo-Descemet's membrane as an early sign of viscocanalostomy failure.

PURPOSE: To correlate trabeculo-Descemet's membrane (TDM) changes with a late rise in intraocular pressure (IOP) in patients with successful viscocanalostomy. SETTING: Consultores Oftalmológicos, Hospital Oftalmológico Santa Lucía, and Centro de Estudios Médicos e Investigación, Buenos Aires, Argentina. METHODS: Patients who had a viscocanalostomy between July 1998 and September 2001 were retrospectively studied. Gonioscopy was performed in all patients. A subgroup of patients who had a late increase in IOP and were successfully treated with neodymium:YAG (Nd:YAG) laser goniopuncture were studied to correlate gonioscopic findings. Ultrasound biomicroscopy was performed in 10 cases. Intraocular pressure measurements were taken before viscocanalostomy and before and after Nd:YAG treatment. RESULTS: Sixty-eight eyes of 48 patients had a viscocanalostomy to control IOP. Twenty-six eyes had a late increase in IOP and were successfully treated with Nd:YAG laser goniopuncture. Before goniopuncture, 17 eyes (65.30%) had a concave TDM. The mean IOP in these patients increased from 14.27 mm Hg to 18.73 mm Hg (range 14 to 27 mm Hg). Goniopuncture was performed a mean of 10.7 months (range 1 to 36 months) after surgery. After Nd:YAG treatment, the TDM was flat in all patients who had a concave TDM before treatment. At the last examination, the mean IOP was 13.8 mm Hg, a mean decrease of 52.24% from the baseline preoperative IOP; 61.5% of eyes had a final IOP of 14.0 mm Hg or lower. CONCLUSIONS: A concave TDM was associated with a late IOP rise. The TDM was flat after laser goniopuncture and normalization of IOP.

Aged↗
PubMed2002

Beyond Mitomycin: TGF-beta and wound healing.

The introduction of the anti-cancer drugs Mitomycin and 5-fluorouracil as anti-scarring agents within the last decade, has greatly improved surgical results of glaucoma filtration surgery. However, a number of problems associated with their use have emerged. At the same time, the transforming growth factor-beta (TGF-beta) has been identified as an important component of wound healing, particularly in the conjunctival scarring response. Recent developments in molecular therapy offer exciting prospects for the modulation of wound healing, specifically those targeting TGF-beta. As TGF-beta is such a potent stimulant of scarring, this review examines its biology and role in ocular wound healing and repair, and discusses promising new approaches to modifying its activity.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

[Laser surgery for some forms of secondary posttraumatic glaucoma].

Zeiss Visulas YAG I Nd:YAG laser (Opton, Germany) was used in the treatment of 70 patients with three forms of secondary posttraumatic glaucoma (adhesive glaucoma with anterior-chamber adhesions and goniosynechias, adhesive glaucoma with aphakia-aniridia symptom complex, and aphakic malignant glaucoma). Laser synechiolysis was highly effective in patients with the first of the listed forms of glaucoma if the operation was performed as early as possible. The efficacy of hyaloidotomy, particularly peripheral, is confirmed; this modality in combination with drug therapy helps normalize intraocular pressure. The place of transpupillary laser hyaloidotomy in the treatment of aphakic malignant glaucoma is defined.

Anterior Eye Segment↗
PubMed1996

Anterior chamber maintenance during drainage of a suprachoroidal hemorrhage in two phakic eyes.

BACKGROUND AND OBJECTIVES: The authors describe a technique for hemorrhage drainage following glaucoma surgery that uses an anterior chamber maintainer to minimize risk to the anterior lens capsule. PATIENTS AND METHODS: Two patients had suprachoroidal hemorrhages following filtration surgery. Because their eyes were phakic, an anterior chamber maintainer, as opposed to a 23-gauge butterfly needle, was used for aqueous replacement during hemorrhage drainage. RESULTS: The maintainer provided a stable anterior chamber environment during both drainage procedures. No damage to anterior chamber structures occurred, and the postoperative course was unremarkable in both patients. CONCLUSIONS: The use of a sharp-tipped infusion cannula may be contraindicated for the phakic patient who has a suprachoroidal hemorrhage. The anterior chamber maintainer is a useful alternative instrument in such cases.

Adult↗
PubMedDate not supplied

Transcript expression of matrix metalloproteinases in the conjunctiva following glaucoma filtration surgery in rabbits.

PURPOSE: To determine the changes in the expression of transcripts of matrix metalloproteinases (MMPs) and their tissue inhibitor (TIMP) in the conjunctiva following glaucoma filtration surgery (GFS). METHODS: The reverse transcription-polymerase chain reaction method was performed on tissue specimens obtained from adult rabbits undergoing GFS at various postoperative time points. RESULTS: MMP 1 decreased more than 7-fold from its baseline level during the first 2 weeks following surgery. MMP 2 decreased on the 1st postoperative day, but increased on day 2, and remained elevated for 2 weeks. The postoperative level of MMP 14 did not change much from baseline except that noted on day 9. The TIMP 1 expression showed an early biphasic pattern. MMP 3 and MMP 9 were not detected in all the specimens. CONCLUSIONS: The transcript expression of MMPs and TIMP 1 in the conjunctiva is altered following GFS, with each gene product demonstrating a unique temporal pattern.

Animals↗
PubMed2000

Modulating conjunctival wound healing.

Advances in molecular and cell biology have led to an expansion in our knowledge and understanding of the processes involved in wound healing. We review existing and potential therapies modulating the conjunctival scarring response, with particular reference to glaucoma filtration surgery. We discuss how the refinement of present antimetabolite regimens can minimise complications and improve surgical results, and advocate their use in carefully selected patient groups. Perhaps the most promising approach is targeting biological molecules. Hence, use of fully human neutralising monoclonal antibodies to the growth factor TGF beta has potential as a useful strategy for modifying conjunctival scarring. Combination therapies may also afford an improved therapeutic index. It is hoped that future therapies can offer safer, more specific, focal and titratable treatment, with far-reaching clinical applications.

Antimetabolites↗
PubMed2000

Efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucoma.

AIMS: To evaluate the efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucomas. METHODS: This retrospective study reviewed the final intraocular pressure, visual outcome, and incidence of complications in all patients with the Ahmed glaucoma valve implant performed at the Prince of Wales Hospital, Hong Kong, between June 1996 and November 1998. RESULTS: A total of 65 eyes from 60 patients were treated with the Ahmed glaucoma implant. At a mean follow up (SD, median) of 21.8 (9.2, 28. 0) months (range 6-37 months), the mean intraocular pressure was reduced from 37.0 (SD 12.1) mm Hg before the implant surgery to 16.1 (12.4) mm Hg at the last follow up after surgery. The success rate of intraocular pressure control of <22 mm Hg was achieved in 73.8% of operated eyes. Transient postoperative hypotony with shallow anterior chamber occurred in 10.8% of cases. The most common postoperative complication was the formation of encapsulated bleb (24.6%). CONCLUSIONS: The Ahmed glaucoma valve implant appears to be effective and relatively safe for treating complicated glaucomas in Chinese eyes. The success rate is comparable with those reported in non-Asian eyes. Formation of postoperative encapsulated bleb is, however, more commonly encountered.

Adolescent↗
PubMed2002

Viscocanalostomy and phacoviscocanalostomy: long-term results.

PURPOSE: To determine the safety and efficacy of viscocanalostomy and cataract extraction by phacoemulsification combined with viscocanalostomy (phacoviscocanalostomy) in the management of medically uncontrolled glaucoma. SETTING: Department of Ophthalmic Surgery, Warrington Hospital, Warrington, England. METHODS: This prospective nonrandomized study comprised 101 consecutive eyes of 73 patients with medically uncontrolled glaucoma having viscocanalostomy or phacoviscocanalostomy. Outcomes measured were intraocular pressure (IOP) control, visual acuity, gonioscopy, bleb morphology, and complications associated with surgery. Examinations were performed preoperatively and 1 and 7 days and 1, 3, 6, 9, and 12 months postoperatively and then at 6-month intervals. The mean follow-up was 23.9 months +/- 11 (SD) (range 6 months to 3.5 years). RESULTS: The mean preoperative IOP was 24.9 +/- 5.7 mm Hg on 2.27 +/- 0.8 medications and the mean postoperative IOP at last follow-up, 16.14 +/- 2.9 mm Hg on 0.1 medications. A postoperative IOP of 21 mm Hg or less was achieved in 93% of eyes. In the remaining 7%, an addition of a mean of 1.4 medications achieved an IOP less than 21 mm Hg. No case required further glaucoma surgery. The mean percentage of IOP reduction in eyes having viscocanalostomy alone was 37% and in eyes having phacoviscocanalostomy, 33%. Complications were minor and included 4 small hyphemas, 5 small choroidal detachments, 1 iris prolapse through the phaco incision, and 10 intraoperative microperforations of the trabeculo-Descemet's window. Transient postoperative pressure elevations secondary to topical steroids occurred in 18% of eyes. CONCLUSIONS: Viscocanalostomy and phacoviscocanalostomy were safe and effective in the surgical management of glaucoma and combined glaucoma and cataract. There was a low incidence of complications postoperatively and throughout the long-term follow-up.

Aged↗
PubMed2000

Secondary glaucoma in patients with juvenile rheumatoid arthritis-associated iridocyclitis.

PURPOSE: The prevalence and management of glaucoma were evaluated in patients with juvenile rheumatoid arthritis (JRA)-associated iridocyclitis. METHODS: The records of 69 patients with JRA-associated iridocyclitis were reviewed. RESULTS: Twenty-nine (42%) of these patients had secondary glaucoma or ocular hypertension. Glaucoma was controlled with topical treatment in only 7 of the 41 affected eyes (17%); systemic carbonic anhydrase inhibitor therapy resulted in control of another 8 eyes. Surgery controlled all but one of the remainder. CONCLUSION: Glaucoma is a common complication of JRA-associated iridocyclitis. It results from prolonged, inadequately treated intraocular inflammation and in some instances, from steroid use. Medical and surgical therapy for the glaucoma associated with JRA-uveitis is challenging and incompletely effective. We suspect that a more aggressive approach to the treatment of JRA-associated uveitis, earlier in the course of the disease may reduce this vision robbing contribution to the process.

Adolescent↗
PubMed2002

Fungal keratitis after nonpenetrating glaucoma surgery.

PURPOSE: The purpose was to report a case of fungal keratitis that occurred following viscocanalostomy. METHODS: A 63-year-old man who underwent viscocanalostomy in his left eye presented with pain, redness, watering, and a decrease in visual acuity. Slit lamp examination showed teardrop-like stromal infiltration of the superior cornea. Corneal and conjunctival scrapings were obtained and a corneal biopsy was performed. RESULTS: Microscopic examination of smears demonstrated no bacteria and fungi. Corneal biopsy revealed dichotomously branching, septate hyphae suggestive of Aspergillus species. Culture identified no microorganism. The patient responded to amphotericin B treatment and the corneal infiltration resolved, leaving a plaquelike corneal scar. CONCLUSION: Fungal keratitis may occur after viscocanalostomy, but prompt diagnosis and treatment can preserve the eye.

Amphotericin B↗
PubMed1999

Contact transscleral diode cyclophotocoagulation for refractory glaucoma.

PURPOSE: To evaluate the effect of contact transscleral diode cyclophotocoagulation on intraocular pressure (IOP), vision, number of medications, and complications in a heterogenous population of patients with refractory glaucoma. METHODS: Clinical data for all patients undergoing contact transscleral diode cyclophotocoagulation for refractory glaucoma at the Medical College of Georgia between November 1994 and November 1996 were reviewed. Forty-seven eyes of forty-seven patients followed for at least one month were included. Visual acuity, IOP, number of medications, and complications were noted for follow-up periods as long as 24 months. RESULTS: At final follow-up examination (range 1-24 months, median 9 months), the average decrease in IOP was 21+/-16 mmHg. Thirty-one (66%) patients had final IOP between 7 and 21 mmHg. Medications were decreased by an average of 1.1. Twenty-six (62%) of 42 patients with vision before surgery had stable or improved visual acuity at the final follow-up visit; 16 (38%) had a deterioration in visual acuity. Neovascular glaucoma was associated with a posttreatment IOP less than 7 mmHg. CONCLUSION: Contact transscleral diode cyclophotocoagulation is effective in lowering IOP in eyes with refractory glaucoma. It also serves to reduce the number of medications required for appropriate IOP control. Loss of visual acuity remains an important concern. Acute complications tend to be transient. Further study is needed to identify patients at risk for markedly reduced IOP after this procedure and for modulation of the protocol to decrease such risk.

Adolescent↗
PubMed1995

Effects of topically applied mitomycin-C on intraocular pressure, facility of outflow, and fibrosis after glaucoma filtration surgery in clinically normal dogs.

The effects of mitomycin-C on intraocular pressure (IOP), facility of outflow (C), and Tenon's capsule fibrosis were studied over 60 days in 10 clinically normal dogs. A-1-piece, silicone glaucoma implant was surgically implanted into both eyes; the filtration site of one eye was treated with a single, 5-minute intraoperative application of mitomycin (0.5 mg/ml), and the fellow eye was treated in a similar manner with balanced salt solution. There were no significant differences in preoperative IOP or C-values between treatment groups. Mean IOP in eyes of both groups initially decreased from the preoperative value, but returned to the baseline value by day 21. Mean facility of aqueous outflow (C-value) increased in all eyes during the first 14 days (mitomycin-C-value = 2.26 +/- 0.72; control C-value = 2.38 +/- 0.81), then reached a plateau that was significantly higher than the baseline value in mitomycin (P = 0.039) and control (P = 0.041) eyes. Histologic evaluation revealed all implants surrounded by a connective tissue capsule composed of regular dense collagen and fibroblasts that was significantly (P = 0.003) thinner in the mitomycin-treated (scleral side = 167 +/- 62 microns; conjunctival side = 122 +/- 41 microns) than the control (scleral side = 261 +/- 92 microns; conjunctival side = 180 +/- 48 microns) group. There were, however, no significant differences in IOP or C-values between groups at any postoperative time interval. Results of this study indicate that intraoperative treatment with mitomycin suppresses, but does not prevent fibrosis around silicone filtering implants.

Animals↗
PubMedDate not supplied

The role of the immune system in conjunctival wound healing after glaucoma surgery.

The immune system has a fundamental role in the development and regulation of ocular healing, which plays an important role in the pathogenesis of most blinding diseases. This review discusses the mechanisms of normal wound healing, describing the animal and fetal wound healing models used to provide further insight into normal wound repair. In particular, conjunctival wound repair after glaucoma filtration surgery will be used to illustrate the contributions that the different components of the immune system make to the healing process. The potential role of macrophages, the possible regulatory effect of lymphocytes, and the important role of growth factors and cytokines in the wound healing reaction are discussed. The significance of the immune system in the pathogenesis of aggressive conjunctival scarring is addressed, particularly assessing the predisposing factors, including drugs, age, and ethnicity. The rationale behind the pharmacological agents currently used to modulate the wound healing response and the effects these drugs have on the function of the immune system are described. Finally, potential new therapeutic approaches to regulating the wound healing response are reported.

Animals↗
PubMed1995

The morphology of conjunctiva after long-term topical anti-glaucoma treatment. A quantitative analysis.

On biopsy material, differences in the degree of conjunctival inflammation and fibrosis between topically treated glaucoma patients and age matched controls, were examined histologically. Eighteen patients with primary glaucoma underwent goniotrephinations, because maximal medical therapy had failed. The patients had received at least two types of topical anti-glaucoma drugs for at least 12 months (mean 46 months). The control group consisted of 18 age-matched control patients without glaucoma, who had received no topical therapy. These patients underwent cataract surgery or squint surgery. Biopsies were taken from the infero-temporal bulbar quadrant with a biopsy forceps. The specimens were fixed while stabilized on a rubber support to exclude any major shrinkage. Specimens were analyzed by light microscopy for the content of inflammatory cells (plasma cells, lymphocytes, polymorphs, macrophages and mast cells), goblet cells and fibroblasts. No significant difference in the histologic parameters between the two groups could be demonstrated. The study suggests that topical treatment for periods up to 4 years with anti-glaucoma drugs does not induce morphological signs of inflammation and fibrosis of the conjunctiva.

Administration, Topical↗