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PubMed1999

The effect of hydroxyurea on rabbit subconjunctival fibroblast culture and use of hydroxyurea in rabbits after glaucoma filtration surgery.

In an in vitro study, rabbit subconjunctival fibroblasts were cultured and the effects of an antineoplastic drug, hydroxyurea (HU), on fibroblast proliferation and fibroblast attachment was investigated. The effects of HU were compared with those of mitomycin C (MMC). Different concentrations of HU and MMC were added to culture medium. The HU doses which led to 50% of inhibition (ID(50)) and the dose which led to about 90% of inhibition (subtoxic high dose, STHD) were determined to be 8 and 1,000 microg/ml, respectively. ID(50) of MMC and its STHD which led to about 100% inhibition were found to be 0.01 and 1 microg/ml, respectively. Reversibility studies revealed that inhibition disappeared depending on the dose and incubation period of both HU and MMC. In an in vivo study, glaucoma filtration surgery (GFS) was performed in rabbits which were treated with HU (treatment group) and distilled water (control group). Tissue samples were taken from the subconjunctival area treated at 1 h, 1 day, 5 days and 30 days postoperatively. The biopsy specimens were then placed in tissue culture media. Fibroblast outgrowth rates detected in the HU group were found to be significantly lower than those in the control group in the specimens taken at the end of the first hour. The difference was significant on culture days 9-15 in the biopsy specimens taken on day 1 while it was not significant in those taken on days 5 and 30.

Animals↗
PubMed2006

Seven-year follow-up of combined cataract extraction and viscocanalostomy.

PURPOSE: To investigate the long-term success and complications of phacoemulsification combined with viscocanalostomy (phacoviscocanalostomy) in eyes with coexisting cataract and medically uncontrolled glaucoma. SETTING: Department of Ophthalmology, Warrington Hospital, Warrington, United Kingdom. METHODS: A prospective nonrandomized study evaluated 165 consecutive eyes (114 patients) that had phacoviscocanalostomy. The main outcome measures were intraocular pressure (IOP), visual acuity, requirement for topical antiglaucoma medication, and the presence or absence of drainage blebs or bleb complications. RESULTS: The mean follow-up was 38.7 months +/- 19.3 (SD) (range 12 to 90 months). There was a statistically significant decrease in IOP, from 24.1 +/- 5.1 mm Hg preoperatively to 13.8 +/- 8.1 mm Hg 1 day after surgery (P<.001), 16.0 +/- 4.1 mm Hg at 5 years (P<.001), and at all evaluations to the last follow-up. The mean number of medications per eye decreased significantly from 2.5 +/- 0.9 before surgery to 0.1 +/- 0.5 at last follow-up (P<.001). At the final follow-up, IOP was reduced by 33.2% (16.2 mm Hg versus 24.1 mm Hg). Complete success, defined as an IOP reduction of more than 30% from preoperative level without medications, was achieved in 48.5% of eyes, with 42% of eyes having an IOP of less than 16 mm Hg. The percentage fall in IOP was linearly related to the preoperative IOP level (P<.001). No eye developed a trabeculectomy-type bleb, and there were no bleb-related complications. CONCLUSIONS: Phacoviscocanalostomy was safe and effective for the management of eyes with coexisting cataract and medically uncontrolled glaucoma. It provided a stable and sustained reduction in IOP with a minimum requirement for topical medication.

Aged↗
PubMedDate not supplied

Results of trabeculotomy and guarded filtration procedure for glaucoma associated with Sturge-Weber syndrome.

PURPOSE: To assess the efficacy of trabeculotomy and guarded filtration procedure in the management of glaucoma associated with the Sturge-Weber syndrome. METHODS: Six patients (seven eyes) with Sturge-Weber syndrome who underwent glaucoma surgery were retrospectively reviewed. One patient had bilateral glaucoma. Age at the time of operation ranged between 23 days and 9 years. The mean preoperative intraocular pressure was 30.6 mmHg (range 25-38 mmHg). Trabeculotomy and guarded filtration procedure were performed in three eyes each and both techniques were used in one eye. RESULTS: The mean follow-up was 6.3 (range 2-11) years. A single procedure lowered the intraocular pressure and arrested the progression of the disease in five eyes. Two patients required topical antiglaucoma medication. No patient needed reoperation. Two eyes suffered intra- and post-operative temporary choroidal effusions. CONCLUSIONS: Trabeculotomy in infancy and guarded filtration procedure in older children effectively stabilized the eyes and prevented further glaucomatous damage in our patients with Sturge-Weber syndrome.

Child↗
PubMedDate not supplied

Surgical results of bleb revision with scleral patch graft for late-onset bleb complications.

BACKGROUND AND OBJECTIVE: To describe the results of bleb revision with scleral patch graft for late-onset bleb-related complications. PATIENTS AND METHODS: A retrospective case series between October 1996 and March 2003. RESULTS: Fourteen patients had surgery for bleb leak, hypotonous maculopathy, dysesthesia, or bleb-associated infections after initial trabeculectomy or thermal sclerostomy. The preoperative intraocular pressure was 3.3 +/- 2.6 mm Hg, and the final intraocular pressure was 11.6 +/- 3.4 mm Hg after 10.1 +/- 6.8 months. Seven eyes required no further bleb revision or glaucoma medications. Visual acuity improved in 10 of 14 eyes. A second scleral patch graft revision was necessary in 3 eyes, but bleb leaks and hypotony resolved in all 14 eyes at last follow-up. Complications included bleb failure, bullous keratopathy progression, cataract progression, and ptosis. CONCLUSION: Bleb revision with scleral patch graft is effective for treating late-onset bleb complications, resulting in improvement in visual acuity and resolution of hypotonous maculopathy, bleb leaks, and dysesthesia.

Adult↗
PubMed1997

[Mitomycin C concentrations in rabbit ocular tissues after topical administration during glaucoma filtration surgery].

Using high-performance liquid chromatography, we measured Mitomycin C (MMC) concentrations in conjunctiva, sclera and aqueous of 22 rabbit eyes after single topical administration of 0.2 mg.ml-1 MMC during glaucoma filtration surgery. The peaks of MMC concentrations in conjunctiva, sclera, aqueous were 2.01 micrograms.g-1, 2.95 micrograms.g-1 and 0.16 microgram.ml-1 with half life of 0.63, 0.35 and 0.84 hours respectively. Irrigating the ocular surface with 20 ml of normal saline after MMC application reduced the peak drug concentration to 1/8 in conjunctiva, to 1/5 in sclera and to 1/3 in aqueous. The results showed that the MMC concentrations in conjunctiva and sclera were well above the ID50 of rabbit subconjunctival fibroblast (0.1 microgram.ml-1), and the concentration in aqueous was well below the level known to cause endothelium toxicity (approximately 0.2 mg.ml-1) and retinal toxicity (> 1.3 micrograms.ml-1). Therefore, 0.2 mg.ml-1 MMC can inhibit subconjunctival fibroblast effectively and has no side effect on visual function.

Administration, Topical↗
PubMed2006

[What should be done when surgery fails? Intraocular pressure remains too low after filtrating surgery].

The definition of postoperative hypotony should be based on intraocular pressure (<5 mmHg) but should also take into account the associated anatomical risk, risk factors as well as the mechanisms involved, which vary depending on whether the anterior or posterior segment is concerned (presence or absence of the Seidel sign, primary or secondary ciliary body and choroidal detachment, etc.). The course to follow is based on evaluating the urgency of the situation so as to provide an adapted response. The choice and delay of the therapeutic response depends on the degree of inflammation of the bleb, the degree of athalamia (3 stages), and the aspect of the posterior pole. In case one or the other chosen technique fails (simple surveillance, bandage, protective eye shield, contact lens, laser, etc.), surgical revision of the operative site may be necessary. The anterior chamber must be reinflated using viscoelastic in certain situations. Much rarer is the need for intervention on the posterior pole after UBM, B ultrasound, and gonioscopy. Cases of severe and delayed secondary hypotonia with conjunctiva-scleral necrosis require rapid reoperation.

Filtering Surgery↗
PubMed2005

Clinical features and course of patients with glaucoma with the E50K mutation in the optineurin gene.

PURPOSE: To investigate the clinical features of subjects with glaucoma with the E50K mutation in the optineurin (OPTN) gene and to compare the onset, severity, and clinical course of these patients with a control group of subjects with glaucoma without this mutation. METHODS: The phenotype of well-characterized subjects from Moorfields Eye Hospital, London, who had been identified as carrying the OPTN E50K mutation was examined. A wide range of structural, psychophysical, and demographic factors were then compared with those in a control group of subjects with glaucoma without this mutation. RESULTS: Eleven subjects with glaucoma with the E50K mutation (nine in two families and two sporadic cases) were studied. All 11 subjects had normal tension glaucoma (NTG), with presenting and highest IOP of 15.3 +/- 3.0 and 16.5 +/- 2.5 mm Hg (+/-SD) on diurnal testing. Compared with 87 NTG control subjects who did not have this mutation, subjects with E50K presented at a younger age (40.8 +/- 15 years, P = 0.0001) and had more advanced optic disc cupping (mean cup-disc ratio +/- SD 0.86 +/- 0.1, P = 0.001) and smaller neuroretinal rim area (+/-SD; 0.5 +/- 0.28 mm2, P = 0.001) at diagnosis. The rate of filtration surgery performed for progressive visual field loss in those with and without the E50K mutation was 72.7% and 25.3%, respectively (P = 0.003), and all subjects with E50K were found to have progressing visual fields. In addition, seven E50K mutation-carrying individuals in two families (age range, 23-58 years) presented with normal optic discs and visual fields and, as yet, no signs of glaucoma. CONCLUSIONS: In this study, subjects with glaucoma who had the OPTN E50K mutation were found to have NTG that appeared to be more severe than that in a control group of subjects with NTG without this mutation. The findings emphasize the importance of early detection and treatment of glaucoma in such individuals, to minimize visual loss.

Adult↗
PubMed2001

The impact of glaucoma on the quality of life of patients in Norway. I. Results from a self-administered questionnaire.

PURPOSE: To evaluate the feelings and experiences of patients living with glaucoma. METHODS: A questionnaire was delivered to patients willing to take part, at a regular visit to their ophthalmologist, for filling in anonymously at home. A total of 589 questionnaires were returned. RESULTS: More than 80% reported negative emotions on learning that they had glaucoma, one-third were afraid of going blind. Half the patients had no visual problem at all, 14% complained of poor or very poor vision. This proportion increased with age. One-fourth of the patients on topical medication experienced adverse effects of moderate or high degree. About half the patients being treated with laser or surgery felt their situation had improved afterwards. Nine-tenths of the individuals were satisfied with the information and care given, although their knowledge about glaucoma was rather incomplete. One-fifth missed information, mainly on causes, treatment and prognosis of the disease. The younger patients were more anxious and inquiring, reported more side effects and were less satisfied than the older patients. The women were in general more dissatisfied than the men. CONCLUSION: Giving a patient a diagnosis of glaucoma influences his quality of life negatively. Only half of our patients experienced any visual difficulties, whereas one-fourth reported adverse reactions due to the therapy. Most of the patients were very satisfied with the information and care given. Ophthalmologists in private practice are quite central in the management and care of the glaucoma patients in a medical setting like ours.

Adult↗
PubMed2003

Optical coherence tomography in malignant glaucoma following filtration surgery.

AIM: To assess the value of slit lamp adapted optical coherence tomography (OCT) for the management of malignant glaucoma following filtration surgery. METHODS: Two patients (three eyes) developed malignant glaucoma following filtration surgery for primary open angle glaucoma (POAG). With slit lamp adapted OCT it was possible to image non-invasively the anterior chamber angle structures during the malignant glaucoma episode, and after pars plana vitrectomy (PPV) with anterior chamber reformation. RESULTS: OCT revealed in both patients a markedly decreased anterior chamber angle with extreme shallowing of the anterior chamber depth during the acute malignant glaucoma phase. This critical closure of the anterior chamber angle resolved after PPV and deepening of the anterior chamber with viscoelastic. After PPV the quantitative values of the anterior chamber angle (ACA) and the anterior chamber opening distance (AOD) increased from 0 to an ACA of 35 degrees (SD 14 degrees ) and an AOD of 426 (SD 162) micro m. CONCLUSIONS: Non-contact slit lamp adapted OCT was helpful to evaluate the anterior chamber structures in malignant glaucoma, and thus could improve management of this serious clinical disorder.

Aged↗
PubMedDate not supplied

Glaucoma filtration surgery and antimetabolites.

Two studies compared the success of filtration surgery in high-risk eyes using postoperative 5-FU and mitomycin-C, and found that IOPs are lower, and fewer postoperative glaucoma medications are required for control in eyes treated with mitomycin. A similar number of complications occurred in both groups except for a higher incidence of corneal toxicity in the 5-FU treated eyes. Mitomycin-C offers the additional convenience of a single intraoperative application. 5-FU also may be used as an intraoperative application, but no studies have been published regarding its comparable efficacy or safety compared with mitomycin-C. 5-FU has the advantage of being able to use it at any time in the early postoperative course when bleb inflammation arises. 5-FU has known complications, while mitomycin-C, although it appears relatively safe, has been used in fewer patients so far. The advantage of greater surgical success, with lower intraocular pressures, puts antimetabolites into the armamentarium of every surgeon who performs glaucoma procedures.

Antimetabolites↗
PubMed1998

Preoperative features of patients with exfoliation glaucoma and primary open-angle glaucoma. The AHEPA study.

PURPOSE: To describe and compare the preoperative characteristics of Greek patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG). METHODS: We prospectively investigated the preoperative features of 100 consecutive patients undergoing filtration surgery for either EXG, or POAG. We compared 74 patients with EXG and 26 with POAG. RESULTS: EXG patients were older (68.2 vs 62.4 years; p<0.05) and more often from the countryside (73%). Both glaucomas showed a preponderance for males, similar frequencies of positive family history and systemic disorders, with the exception of diabetes which was more common in POAG (19.2% vs 5.4%). The first IOP measurement, before treatment, was significantly higher in EXG (40.4 mm Hg) compared with POAG (33.9 mm Hg). Despite a shorter duration of medical therapy (25 vs 65 months) and more topical drugs EXG patients exhibited higher mean preoperative IOP (36 vs 27.8 mm Hg for POAG; p<0.05). EXG patients had significantly worse visual acuity than POAG (0.4 vs 0.6; p<0.05) and worse compliance to medical therapy (48%) compared to POAG (33%). CONCLUSION: Significant differences in preoperative features distinguish EXG from POAG.

Age Distribution↗
PubMed1998

Laser-cured fibrinogen glue to repair bleb leaks in rabbits.

OBJECTIVE: To determine whether laser-cured fibrinogen glue can close bleb leaks in rabbits. METHODS: Full-thickness filtration surgery with intraoperative mitomycin and a sutured limbus-based conjunctival flap was performed in 1 eye each of 19 New Zealand albino rabbits. On the second postoperative day, a 2- to 3-mm hole was made in the bleb. In 9 rabbits, the hole was glued using fibrinogen glue with indocyanine green dye added. The glue was "cured" with a diode laser. Eyes that had been glued and developed a subsequent leak had the glue reapplied on the day the leak was detected. RESULTS: The glue remained on the conjunctiva for an average (mean+/-SD) of 1.9+/-1.8 days (range, 0-5 days). The last day of bleb leak for the rabbits with glued eyes was 1.6+/-2.4 days; for the control rabbits, it was 8.0+/-4.4 days (P=.001, Mann-Whitney U test). CONCLUSION: Laser-cured fibrinogen glue is effective in closing bleb leaks in rabbits.

Animals↗
PubMed2005

Cyclosporin as an adjunct to glaucoma filtration surgery.

PURPOSE: Current adjunctive therapies to glaucoma surgery have unreliable effects, are toxic, and have numerous late complications associated with their use. This study examined whether topical cyclosporin (CsA) prolongs bleb survival after glaucoma filtration surgery. METHODS: Anesthetized white New Zealand rabbits underwent glaucoma filtration surgery with a drainage tube. Cyclosporin (2%), applied intraoperatively or as topical treatment following glaucoma filtration surgery, was compared with intraoperative mitomycin C (MMC) and an untreated control group. RESULTS: The bleb remained elevated for 15.1 +/- 3.2 days in the untreated control group, 12.2 +/- 2.1 days after intraoperative cyclosporin, and 27.5 +/- 1.7 days after intraoperative mitomycin C (P < 0.001). When topical treatment with cyclosporin followed intraoperative mitomycin C, bleb survival significantly decreased to 19.2 +/- 4.6 days (P = 0.003). Intraocular pressure (IOP) remained significantly reduced in the mitomycin C-treated group longer than in either the control or cyclosporine-treated groups. CONCLUSIONS: In comparison with mitomycin C, neither intraoperative nor postoperative treatment with cyclosporin was associated with a decrease in intraocular pressure or prolonged bleb survival. Contrary to the initial hypothesis, topical treatment with cyclosporin actually mitigated the beneficial effects of mitomycin C on bleb survival. Clinical implications of these findings for patients with functioning blebs deserve further study.

Administration, Topical↗
PubMed1996

Reversal of topical antiglaucoma medication effects on the conjunctiva.

OBJECTIVE: To determine whether the adverse effects of antiglaucoma medications could be reversed before filtration surgery, potentially reducing the risk of subsequent failure. METHODS: One month before surgery, 30 patients who were receiving multiple antiglaucoma medications underwent an inferior bulbar conjunctival biopsy, ceased using sympathomimetic drops, and began treatment with topical corticosteroid, (1% fluorometholone four times daily). At the time of surgery two conjunctival biopsy specimens were obtained, one from the operation site (superior bulbar region), and one from the inferior bulbar region. The biopsy specimens were quantitatively analyzed by light microscopy. In addition, the outcome of first trabeculectomy for 16 of these patients was compared with that of 16 matched patients who had not undergone an altered preoperative regimen of topical therapy. RESULTS: During a 1-month period a notable decrease occurred in the number of fibroblasts and inflammatory cells throughout the conjunctiva. Inferior bulbar conjunctiva was found to be representative of superior bulbar conjunctiva with respect to these changes. Furthermore, evidence comparing the matched patients suggested that the altered preoperative regimen may have improved the success rate of trabeculectomy. CONCLUSIONS: The preoperative regimen used reversed the adverse conjunctival effect of topical medication. The regimen may be of clinical benefit in improving the success rate of trabeculectomy.

Administration, Topical↗
PubMed2004

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial.

PURPOSE: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). SETTING: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. METHODS: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. RESULTS: At 3 years, the mean IOP was 16.0 mmHg +/- 7.07 (SD) in the trabeculectomy group and 17.8 +/- 4.6 mmHg in the viscocanalostomy group (P=.694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mmHg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P=.002). CONCLUSIONS: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.

Adult↗
PubMed1998

Pericardial patch grafts in glaucoma implant surgery.

PURPOSE: The authors determine the safety and effectiveness of pericardial patch grafts in glaucoma implant surgery. METHODS: A retrospective chart review was conducted on all patients who underwent a glaucoma implant procedure with the use of a pericardial patch graft to cover the subconjunctival portion of the tube at The New York Eye and Ear Infirmary between September 1, 1995 and June 30, 1996. Charts were assessed for evidence of delle formation, graft rejection, graft-related infection, graft thinning, or tube erosion. RESULTS: Forty-four eyes of 44 patients were enrolled. Mean follow-up was 10.2 +/- 4.0 months (range, 2.3 to 18.6 months). Infection, tube erosion, graft rejection, and graft-related inflammation did not occur. Five eyes were noted to have asymptomatic thinning of the patch without evidence of tube erosion. CONCLUSIONS: Preserved human cadaveric pericardial patch grafts appear to be well-tolerated for use with glaucoma drainage devices. As with other grafting material, potential for graft thinning is possible and further long-term experience is needed.

Adolescent↗
PubMed2000

The role of glaucoma therapy in the need for repeat penetrating keratoplasty.

PURPOSE: To evaluate the effects of medical and surgical therapy for glaucoma in patients requiring repeat penetrating keratoplasty (PK) for endothelial failure. METHODS: Retrospective review of the charts of all patients undergoing repeat PK at the Cornea Service at Wills Eye Hospital between January 1, 1989 and December 31, 1995. Study end-points were time to first rejection episode, number of rejection episodes, time to endothelial failure, and time to regraft. RESULTS: During the study period, 156 patients underwent repeat PK for irreversible endothelial failure. Ninety-four (60.3%) patients had a concomitant diagnosis of glaucoma. Of these 94, 27 (28.7%) underwent glaucoma surgery. The surgically treated group had a significantly higher percentage of patients with at least one rejection episode (55.6%) than those without glaucoma (32.8%; p = 0.04). Similarly, a significant difference existed in the percentage of both medically and surgically treated glaucoma patients having at least one rejection episode (50%) when compared with patients without glaucoma (32.8%; p = 0.04). Rejection episodes occurred sooner in the glaucoma patients than in the nonglaucoma group (18 months vs. 32 months; p = 0.01), irrespective of glaucoma therapy. Grafts in glaucoma patients failed 12 months earlier than those in patients without glaucoma. CONCLUSION: In a selected group of patients who required repeat PK for endothelial graft failure, a majority of patients were found to have a history of glaucoma. Among regraft patients, surgical therapy for glaucoma was found to increase the risk of rejection episodes when compared to patients without glaucoma. The patients with glaucoma were found to be at increased risk for early rejection and failure compared to patients without glaucoma.

Corneal Diseases↗
PubMed1997

Gonioscopic laser sclerostomy versus filtration surgery in a rabbit model.

In a prospective and randomised study, we compared the course of pulsed dye laser ab interno sclerostomy with the course of posterior lip sclerectomy in 25 rabbits. One eye of each rabbit was randomly selected to be treated with laser; the fellow eye underwent posterior lip sclerectomy. Intraocular pressure (IOP) determinations and slit lamp examinations were recorded pre-operatively, then every other day for 3 weeks on 21 of the rabbits. Histological examination was performed on the eyes of 3 randomly selected rabbits that were killed 72 hours post-operatively. Laser sclerostomy resulted in an average maximal drop in IOP of 9.5 mmHg on post-operative day 1, and posterior lip sclerectomy resulted in a similar drop of 10.5 mmHg (p = 0.43, t-test). By life-table analysis, 88% of eyes returned to within 2 mmHg of pre-operative IOP values within 7 days following either laser internal sclerostomy or posterior lip sclerectomy. There was no significant difference between laser internal sclerostomy and posterior lip sclerectomy eyes with respect to the number of days needed to return to within 2 mmHg of preoperative IOP values (p = 0.26, sign test of the life-table analysis). Pulsed dye laser internal sclerostomy appears to be as effective as posterior lip sclerectomy in lowering IOP in the rabbit model.

Animals↗