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PubMed1992

Transoesophageal echocardiography in neonates, infants and children: applicability and diagnostic value in everyday practice of a cardiothoracic unit.

OBJECTIVE: To determine the applicability of and information obtained by transoesophageal echocardiography in neonates, infants, and children in every day practice of a cardiothoracic unit. DESIGN: Four month prospective study. SETTING: Supraregional centre for paediatric cardiothoracic services. PATIENTS AND METHODS: 58 patients aged between four days and 16 years with a wide range of cardiovascular disease underwent transoesophageal echocardiography under sedation or general anaesthetic. One of two paediatric probes (6 or 7 mm diameter), or an adult probe (13 mm in diameter) was used. Whenever possible the investigation was immediately preceded by precordial echocardiography. MAIN OUTCOME MEASURES: Success, failure, technical difficulties, and complications of probe introduction and, when possible, comparison of the information obtained with that obtained from precordial echocardiography. RESULTS: Introduction of the probe was successful in 57 of the 58 patients. The only complication encountered was transient bradycardia during manipulation of the probe in a 2.2 kg baby. The adult (13 mm) probe was successfully used in children as small as 7.0 kg. Below this weight a smaller paediatric probe was required. In 56% of cases transoesophageal ultrasound provided information not obtained from the precordial approach. The technique was of particular value perioperatively and in the immediate postoperative period in neonates and infants and in the presence of valve prostheses and the investigation of mediastinal tumours in older children. CONCLUSIONS: Transoesophageal echocardiography is a valuable additional investigative tool for children of all ages. It is of particular value when acquisition of precordial image is impaired around the time of and after operation and in children with prosthetic valves or mediastinal tumour. Image quality was superior with the adult probe and we recommend the use of this probe unless the patient's weight is below 7 kg, when a paediatric probe allows this technique to be used usefully and safely in babies as small as 2.2 kg.

Adolescent↗
PubMed1987

Temporary vascular occlusion during aneurysm surgery.

Premature rupture of a cerebral aneurysm during operation is a serious hazard. Direct pressure and suction may not always be effective in controlling the hemorrhage, and hasty dissection under such circumstances can cause serious injury to vital structures. In facing this risk, elective temporary arterial occlusion of parent vessels can be an advantage. Temporary clipping also may be helpful in the case of a giant aneurysm when the lesion must be opened and evacuated, or in the case of a thin-walled fundus tightly adherent to perforating vessels. Reduction of tension in the aneurysmal sac can be a valuable aid to safe dissection. The authors reviewed a total of 185 cases of intracranial aneurysm operated upon (L.S.) in the 5-year period between January 1980 and January 1985. Sixty-six patients (35.7%) underwent temporary arterial occlusion during the operations. Clinical outcome was excellent in 65.2% of the patients, good in 13.6%, fair in 12.1%, and poor in 3%. The mortality rate was 6.1%. No significant difference was found by comparing the 66 patients with temporary arterial occlusion with the 119 patients without occlusion. The longest occlusion time for the patients with excellent outcome was 23 minutes for bilateral A1 segments, 40 minutes for middle cerebral artery, 27 minutes 44 seconds for internal carotid artery, and 13 minutes 30 seconds for basilar artery. This study suggests that temporary arterial occlusion does not necessarily increase the overall mortality and morbidity in aneurysm surgery. When justified and used with caution it can be a valuable adjunct for the neurosurgeon.

Adolescent↗
PubMed1999

Comparison of phacotrabeculectomy with 5-fluorouracil, mitomycin-C, and without antifibrotic agents.

BACKGROUND AND OBJECTIVE: To evaluate the potential benefits, complications, and prognostic risk factors for failure of phacotrabeculectomy performed with or without 5-fluorouracil (5-FU) and mitomycin-C (MMC). PATIENTS AND METHODS: Retrospective chart review of 78 patients who underwent phacotrabeculectomy during a 2-year period. Patients were divided into 3 groups, those who received 5-FU (N = 28). MMC (N = 29), or no antifibrotic agent (N = 21). RESULTS: All 3 groups had statistically significant lower intraocular pressures (IOP) on fewer antiglaucomatous medications at 6-month, 12-month, and last follow-up compared to preoperative levels (P < .05). Intraocular pressures were lower in the group that received MMC compared to the 5-FU group, but not in the group that did not receive antimetabolites, at all time intervals measured (P < .05). Black race was a strong predictor of failure of trabeculectomy (P = 009). No differences in final visual acuity or complications were found between groups. CONCLUSIONS: Phacotrabeculectomy is effective regardless of antimetabolite use. Race is a strong predictor of failure.

Aged↗
PubMed1999

Transmyocardial laser revascularization: experimental and clinical results.

BACKGROUND: Transmyocardial laser revascularization (TMR) is an emerging therapy for the treatment of coronary artery disease not amenable to percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery (CABG). OBJECTIVE: To summarize the experimental and clinical experience to date with TMR. Specifically, the history of the technique, preclinical and clinical data, patient selection and perioperative management, as well as future applications of TMR are discussed. DATA SOURCES: All English language articles pertaining to TMR published through March 1999. MEDLINE was searched with the key words 'myocardial revascularization', 'lasers' and 'laser surgery', as well as the text terms 'transmyocardial laser revascularization', 'TMR' and 'TMLR'. Reference lists of articles obtained from MEDLINE were studied for additional references not discovered in computer searches. Pertinent abstracts published within the past two years were reviewed as well. STUDY SELECTION: Studies that produced original experimental or clinical data were selected. DATA SYNTHESIS: Experimental studies demonstrate that TMR channels become occluded in the early postoperative period. However, experimental data indicate that laser injury appears to promote neovascularization with secondary improvements in perfusion in treated regions. Human clinical studies confirm the efficacy of the procedure, with significant improvements in anginal class up to at least one year postoperatively, although documented improvements in myocardial perfusion have been less consistent. Perioperative morbidity and mortality appear to be increased in patients with unstable angina or reduced left ventricular function. CONCLUSIONS: With careful patient selection and peri- operative management, TMR is a safe and effective therapy for severe angina pectoris secondary to end-stage coronary artery disease. Additional studies are required to define the role of TMR in combination with PTCA, CABG and angiogenic growth factors, as well as the safety and efficacy of catheter-based TMR.

Angina Pectoris↗
PubMed1989

[Changes in serum pancreatic secretory trypsin inhibitor (PSTI) during and after heart surgery].

Serum pancreatic secretory trypsin inhibitor (PSTI) is considered to be one of the acute phase reactants which increase after tissue injuries like surgery or major trauma. 25 patients were studied to investigate the changes in serum PSTI during and after heart surgery. 18 patients underwent the operation with the aid of cardiopulmonary bypass (CPB)-CPB group, and the other 7 patients, all pediatric cases, were treated under simple deep hypothermia by surface cooling without CPB-simple hypothermia group. Serum amylase, serum C reactive protein (CRP), cardiac index and A-aDO2 after surgery were examined, and the duration of CPB or circulatory arrest were recorded. The correlation between serum level of PSTI after surgery and these parameters were also studied. During surgery, a transient elevation of serum PSTI was noticed in the period of CPB, but no significant change of serum PSTI was seen under simple deep hypothermia and circulatory arrest. On the first post operative day, a slight but significant increase of serum PSTI was seen in CPB group, on the other hand no significant increase was seen in simple hypothermia group. Postoperative increase of serum PSTI was correlated to circulatory arrest time in simple hypothermia group, and was inversely correlated to cardiac index determined immediately after the operation in CPB group. No correlation was seen between serum level of PSTI after surgery and serum amylase, CRP, A-aDO2 or duration of CPB. The magnitude of increase of serum PSTI after heart surgery was small, and did not seem to be well correlated to the extent of surgical insults.

Adult↗
PubMedDate not supplied

[Compensation for bleeding in a surgical milieu. Importance of normovolemic hemodilution. Apropos of 25 cases].

In order to get round blood supply difficulties, 25 patients undergoing hemorrhagic interventions (blood loss average of 1,500 ml) were subjected to the techniques of normovolemic hemodilution. Preoperatively a volume of 1,080 ml of blood was taken in every patient (a total of 271 in all patients together); the blood was simultaneously replaced by 1,300 ml of macromolecules (modified fluid gelatin polymer and/or low molecular weight dextran according to disponibility). Two thirds of the taken amount are transfused to the patients preoperatively immediately after surgical hemostasis has been achieved or when the hematocrit is about 20%; the last third is administered in the immediate postoperative period. The economy of blood realised by this technique is considerable (119 units of homologous blood). The rationale depends on two essential particularities: on one hand, the diminution of blood loss since at a hematocrit of 25% the loss is only 50% of the globular mass which would have disappeared at normal hematocrit; on the other hand, the compensation of hemorrhage by transfusion of fresh autologous blood, eliminating homotransfusion reactions. The main hematocrit obtained 24 hours after transfusion is about 34%. Thus, economy of blood and rheological advantages (amelioration of microcirculation, increase of capacity of oxygen transport, increase of tissular oxygenation) must induce physicians to reexamine their behaviour in transfusion strategy and compensation of hemorrhage because the optimal hematocrit in normovolemy is of about 30%.

Adult↗
PubMed1985

Quality of use of parenteral metronidazole therapy in a teaching hospital.

The recent release, relatively high cost and potential adverse effects of parenterally administered metronidazole prompted a quality-of-use audit at a 1000-bed teaching hospital. Ninety-two courses of treatment in 81 inpatients during a 6-week period were studied. Appropriateness of therapy was assessed on the basis of published indications. Parenterally administered metronidazole was prescribed primarily in anaerobic and anaerobic-aerobic infections. It was used as frequently for prophylaxis as for therapy. Surgical services accounted for 95% of the treatment courses. Inappropriate use was noted in 27 (29%) of the courses: agents other than parenterally administered metronidazole were indicated in 12 (13%), while the dose, dosing interval or duration of treatment was suboptimal in 15 (16%). Substantial savings would be achieved if oral or rectal metronidazole therapy were substituted for intravenous therapy for perioperative prophylaxis in elective colorectal surgery. Written justification for use and automatic stop orders are recommended to improve the cost effectiveness of both prophylactic and therapeutic use of selected antimicrobial agents.

Bacterial Infections↗
PubMed1991

[Contribution of somatosensory evoked potentials in the surveillance of the spinal cord during spinal surgery].

This study shows the results obtained in 51 patients, children and adolescents by monitoring somatosensory evoked potentials during spinal surgery: Cotrel-Dubousset instrumentation, surgical anterior correction by plating, spondylolisthesis and hemivertebra surgery. The recordings were made in preoperative, peroperative and postoperative periods; the electro-physiological and anaesthetic conditions allowed us to obtain reliable recordings. Analysis of the peroperative somatosensory evoked potentials showed significant differences in latencies, but also in amplitudes and morphology during distraction in scoliosis or spondylolisthesis. These impairments gradually improved and recovered their normal values at the end of the operation. The impairments were, with equal correction, 4 times more important in Cotrel-Dubousset instrumentation than in surgical anterior correction by plating. In 3 cases, the modifications observed during instrumentation led the surgeon to change his operative behavior avoiding certainly a postoperative neurological disorder. The correlation between the neurological troubles and the impairments of the potentials allowed us to define alarm criteria, and if they persist the wake-test becomes necessary.

Adolescent↗
PubMed2005

Laparoscopic vs open total colectomy: a case-matched comparative study.

BACKGROUND: Open total colectomy and ileorectal anastomosis (OTC) is a major colorectal procedure which would preclude laparoscopy in many centers because of technical difficulty and the fact that laparoscopic total colectomy (LTC) takes much longer than standard laparoscopic proctosigmoidectomy (LPS). This study compares OTC with LTC and LPS. METHODS: In this study, 34 LTC patients (May 1999 to August 2003) were matched for age, diagnosis, operative period, and procedure with patients undergoing OTC. Patients with a previous major laparotomy were excluded from the open group. Groups were compared for gender, American Society of Anesthesiology (ASA) classification, operating time, estimated blood loss, length of hospital stay (LOS), complications including readmissions, and costs. The LPS cases were picked randomly from the laparoscopic database (every eighth patient), and the OT and LOS were noted. RESULTS: The LTC and OTC groups were matched for age (mean, 31 vs 34 years; p = 0.2), sex (14 vs 13 females; p = 0.8), ASA (8/23/3/0 vs 8/22/4/0, class 1/2/3/4). The body mass index was higher in the open group (23.8 vs 27.9; p = 0.04). The operating time was significantly longer (187 vs 126 min; p = 0.0001) and the median LOS shorter in the LTC group (3 days [IQR, 2.5-5 days] vs 6 days [IQR 4-8 days]; p = 0.0001). The estimated blood loss was significantly less in the LTC group (168 [50-700] ml) vs 238 [50-800] ml); p = 0.001, but there was no significant difference in the complication (26.5% vs 38.2%; p = 0.4) readmission (11.8% vs 14.7%; p = 1.0), reoperative rates (8.8% vs 11.8%; p = 1.0), or direct costs ($4,578 vs $4,562; p = 0.3). One LTC patient died expired on postoperative day 2 of a cardiac event. Four patients (11.8%) required conversion for obesity (n = 2), adhesions (n = 1), or intraoperative hemorrhage (n = 1). The operating times were 36 min longer in the LTC group than in the LPS group (151 vs 187 min; p = 0.02), but there was no significant difference in the LOS. (3 vs 3 days, p = 0.2). CONCLUSIONS: The findings show that LTC provides a significant decrease in the LOS over OTC, with increased operating time, but without any change in other parameters. A laparoscopic approach to subtotal colectomy is recommended for suitable patients when an experienced team is available.

Adult↗
PubMed1999

Role of the surgical trainee in upper gastrointestinal resectional surgery.

The 'New Deal' set out by the Department of Health in 1991, together with the introduction of specialist 6-year training grades by Calman in 1993, has resulted in a decrease in available training time for surgeons in the UK. There is also an emerging belief that surgical procedures performed by trainees might compromise patient outcome. This study examines the level of trainee experience in a specialist gastrointestinal unit and whether operation by a trainee surgeon adversely affects patient outcome. All patients in the University Department of Surgery, Royal Infirmary, Edinburgh, undergoing oesophagogastric, hepatic or pancreatic resection between January 1994 and December 1996 were entered into the study. The early clinical outcome (in-hospital mortality and morbidity, considered in three groups: anastomotic leak, other technique-related complications and non-technique-related complications) was evaluated with regard to the grade of surgeon (consultant or trainee) performing the operation. Of the 222 patients undergoing major upper gastrointestinal resection during the study period, 100 (45%) were operated on by trainees. Trainees were assisted and closely supervised by consultants in all but six resections. There was no major difference in mortality rate (consultant, 4.1% vs trainee, 5%), incidence of non-technique-related complications (consultant, 6.7% vs trainee, 7.1%), anastomotic leaks (consultant, 10.7% vs trainee, 5%) or technique-related complications (consultant, 18.9% vs trainee, 15%) between the two grades of surgeon. In a specialist unit, the early clinical outcome of patients undergoing major upper gastrointestinal resection by supervised trainees is no worse than in those operated on by consultants. Participation of trainees in such complex procedures enhances surgical training and does not jeopardise patient care.

Adolescent↗
PubMed1998

Prediction of the immediate outcome of femoropopliteal saphenous vein bypass by angiographic runoff score.

OBJECTIVES: To determine the value of the Ad Hoc scoring system (SVS/ISCVS) in predicting the immediate outcome of femoropopliteal saphenous vein grafts. DESIGN: Retrospective study. MATERIALS: One hundred and twenty patients underwent 132 primary femoropopliteal vein bypass procedures, 32 for claudication and 100 for critical leg ischemia (CLI). METHODS: The outflow arteries were graded according to the Ad Hoc scoring system (SVS/ISCVS). Postoperative immediate graft patency and leg salvage to the period of the first 30 days after surgery. RESULTS: Ninety-one per cent of claudicants and 83% of CLI patients had immediate patency. The overall 30-day patency rate was 85%. Leg salvage rate was 91% for the patients with CLI. Patients with score in the highest quartile were found to have a 8.7 times higher risk for immediate graft occlusion (p = 0.005). Multivariate analysis showed that the Ad Hoc score was predictive of immediate patency (p = 0.0006) and leg salvage (p = 0.0004). In patients with a score < or = 7.5 and in those with a score > 7.5, the patency rates were 95% and 66% (p = 0.001), and the leg salvage rates were 97% and 80%, (p = 0.004), respectively. CONCLUSIONS: The Ad Hoc scoring system is useful in predicting the immediate outcome of femoropopliteal saphenous vein grafts.

Aged↗
PubMed1992

[Immediate and long-term results of 790 mitral valve replacements].

A total of 790 patients underwent isolated (N = 520) or mitral valve replacement associated with a tricuspid valve procedure for lesions excluding post-myocardial infarction mitral regurgitation. The mean age was 54 years: the sex ratio was 1.9 +/- 1.1, female/male. Three hundred and four patients (38.5%) were in the NYHA functional class II and 406 patients (61.5%) were in classes III or IV. The operative mortality was 9.7% (77 patients). The factors associated with a high operative risk were, on multifactorial analysis: double valve replacement, age over 70 years, NYHA class IV, aortic clamp time over 68 minutes and the presence of mitral regurgitation. Seven hundred and four of the 713 survivors were contacted (98.7% follow-up). The average follow-up period was 5.05 years (range 11 to 219 months) giving a total of 3,997 patient-years. The 5 and 10 year actuarial survival rates were 74.7% and 64.7% respectively. The presence of a tricuspid lesion requiring surgical correction, a high NYHA classification and the presence of mitral regurgitation were poor prognostic factors of long-term survival. Three hundred and sixteen of the 533 survivors at the time of the inquiry were in NYHA class I (59.3%), 188 in NYHA class II (35.3%) and 29 in NYHA class III or IV (5.4%). Mitral valve replacement should be considered early as the immediate and long-term results are closely related to the preoperative myocardial function.

Actuarial Analysis↗
PubMed1997

The use of music during the immediate postoperative recovery period.

The most effective approach to managing patients' pain in the immediate postoperative period may include a combination of pharmacologic agents and noninvasive, nonpharmacologic interventions. In this study, nurse researchers evaluated the effect of music on pain and anxiety levels and selected physiologic parameters of two groups of patients who were emerging and recovering from anesthesia. Patients in the treatment group listened to music through head-phones during the last 30 minutes of their surgical procedures and during the first hour in the postanesthesia care unit (PACU). Patients in the control group had identical surgical procedures, received the same preoperative medications, and were managed with the same anesthesia protocol but did not listen to music in the OR or PACU. No differences existed between the two patient groups in the variables measured; however, patients in the treatment group stated that music helped them relax and functioned as a distracter.

Adult↗
PubMed2000

[S-(+)-ketamine versus ketamine racemic mixture: hemodynamic studies].

OBJECTIVE: Evaluation of hemodynamic effects of S-(+)-ketamine versus ketamine-racemic mixture during induction of anesthesia, during steady-state of a fentanyl-midazolam-anesthesia and in the period of aortic cross-clamping during extracorporeal circulation. METHODS PATIENTS: 80 patients scheduled for coronary revascularization. STUDY DESIGN: double-blind, randomized. STUDY 1: Induction of anesthesia with ketamine-racemic mixture (3 mg/kg) or S-(+)-ketamine (1.5 mg/kg) plus midazolam 0.15 mg/kg. PARAMETERS: invasive hemodynamic monitoring including right ventricular volumes and pressure. STUDY 2: Bolus of ketamine-racemic mixture (3 mg/kg), S-(+)-ketamine (1.5 mg/kg) or placebo during steady-state anesthesia with fentanyl and midazolam. PARAMETERS: see study 1, additionally left ventricular systolic and end-diastolic pressure and maximum speed of left ventricular pressure increase (dp/dt). STUDY 3: Bolus of ketamine-racemic mixture (3 mg/kg), S-(+)-ketamine (1.5 mg/kg) or placebo in the period of aortic cross clamping during ECC. PARAMETERS: mean systemic pressure, central venous pressure, reservoir volume. RESULTS STUDY 1: Heart rate and systemic blond pressure remained unchanged until intubation, which caused significant increases of these parameters. Stroke volume Index and cardiac index decreased in the S-(+)-group compared with racemic mixture, right- and left ventricular filling parameters remained unchanged throughout the study. STUDY 2: There were no significant hemodynamic changes with time or between the groups. STUDY 3: Significant arterial vasodilation was observed in the racemic mixture group, venous parameters remained unchanged. CONCLUSION: There were no major differences in the hemodynamic profiles of S-(+)-ketamine and the racemic mixture. S(+)-ketamine did not provide hemodynamic advantages. The use of both preparations should be limited to selected clinical situations in patients with reduced coronary reserve.

Aged↗
PubMed1986

Comparison of measurements of cardiac output by bioimpedance and thermodilution in severely ill surgical patients.

In order to evaluate a new thoracic electrical bioimpedance (TEB) system for measurement of stroke volume based on the Sramek-Bernstein equation, 391 paired values of cardiac output were measured simultaneously with the standard thermodilution method. These values were obtained from 16 patients selected for having the most severe illness during a 6-month period; the intent was to evaluate the bioimpedance method in the worst possible situations. The correlation coefficient (r) was 0.83, slope was 0.87, intercept was 1.53, and the mean difference between the two methods was 16.2 +/- 11.8 (SD)% in the total series. In 285 paired samples where satisfactory conditions were met, r was 0.90, slope was 0.98, intercept was 0.34, and the mean difference was 11.8 +/- 8.9%. The data indicate satisfactory correlations between these two methods. When the TEB waveform is satisfactory, the agreement between TEB and thermodilution is as good as the agreement between serial thermodilution methods. Difficulties may arise with dysrhythmias, tachycardia (heart rate greater than 150 beat/min), metal in the chest or chest wall, sepsis, hypertension, and extremely oily skin. Mechanical ventilation did not appear to be a problem.

Cardiac Output↗
PubMed1996

[Intra-operative management during laparotomy for patients under hemodialysis].

We evaluated retrospectively 31 patients under hemodialysis who underwent scheduled laparotomy with a purpose to determine the optimal intra-operative water balance. The patients fell into two different periods according to the difference of the principle of anesthesia. Anesthesia method employed for the former eleven patients (1987.6-1990.12) was NLA with pancuronium for muscle relaxation and they were ventilated mechanically in ICU. More recent twenty patients (1991-1995) had epidural block plus nitrous oxide-oxygen-isoflurane with vecuronium and they were extubated early. These latter patients, compared with the preoperative values, did not show any significant changes in mean arterial pressure or systemic vascular resistance after the operation. Intra-operative water balance showed a positive correlation with PADP (r = 0.57) and a negative correlation with SVR (r = 0.36) at the end of operation. The adequate fluid infusion is necessary to maintain PADP, and the water balance of +3-5 ml x kg-1 x hr-1 is recommended during laparotomy for the patients under hemodialysis.

Anesthesia, General↗
PubMed1998

Adenosine induced transient cardiac standstill in catheter interventional procedures for congenital heart disease.

OBJECTIVE: To describe the use of intravenous adenosine to create transient cardiac standstill during balloon dilatation procedures for congenital heart defects. SETTING: A tertiary paediatric cardiac centre. DESIGN AND PATIENTS: This was a prospective pilot study. Thirteen patients born with congenital heart disease and who had stenotic lesions requiring relief were considered for the technique. All were suitable for balloon dilatation. Their ages ranged from 2 months to 30 years, mean (SD) 9.9 (9.8) years. The dose of adenosine varied from 0.125 mg/kg to 0.555 mg/kg, mean 0.33 (0.127). RESULTS: Two patients only developed sinus bradycardia in response to adenosine, which may have been related to the technique of administration. The other 11 experienced a period of asystole, which ranged from 2.4 to 10.8 seconds, mean 4.99 (2.27), and a total atrioventricular block period of 5.0 to 21.2 seconds, mean 9.47 (4.64). The interval between adenosine injection and the onset of asystole varied from 2.4 to 15.8 seconds, mean 8.05 (3.6), depending on cannula size, site of administration, and cardiac output. The peak gradient across the stenotic lesions fell from 52.3 (23.7) to 17.8 (11.9) mm Hg (p < 0.001). Apart from one short episode of atrial fibrillation there were no complications. CONCLUSIONS: Intravenous adenosine is a safe and effective agent for creating transient cardiac standstill during balloon dilatation procedures for congenital heart disease. This achieves stability which is likely to improve results and reduce complications. It may have applications in other fields of cardiac intervention where an immobile heart is desirable during the critical phase of a procedure.

Adenosine↗
PubMed1999

Midterm follow-up of necrotic bleb excision and advancement of the fornical conjunctiva.

Mitomycin C has improved the success rate of glaucoma filtering surgery in patients at high risk for surgical failure. However chronic hypotony is marked by decreased vision and a late-onset leaking bleb after filtration surgery using mitomycin C. Bleb excision and conjunctival advancement is the method of choice to repair bleb leakage and chronic hypotony. Five eyes from five patients were received glaucoma filtration surgery with topical mitomycin C. All of the patients' blebs were avascular and transparent. The reasons for bleb excision were two spontaneous bleb leaks, two traumatic bleb leaks and one case of severe irritation. The mean follow-up period was 18.4 +/- 8.3 months (ten to 29 months). Cataract surgery was combined in one eye. Postoperative intraocular pressure (IOP) increased from 2.3 +/- 1.5 mmHg to 9.5 +/- 3.7 mmHg at nine months postoperatively in four eyes. It went from 28 mmHg to 40 mmHg in one patient with uveitis, for whom a second trabeculectomy with mitomycin C; 0.4 mg/ml for 3 minutes, was performed. After surgery, IOP decreased to 4 mmHg in three months. Postoperative visual acuity improved four snellen lines in three eyes. A partially avascular bleb recurred in three eyes, a corneal bleb in one eye and blepharoptosis, which disappeared spontaneously at four months postoperatively, in one eye. Necrotic bleb excision and advancement of fornical conjunctiva were useful methods to increase IOP and to improve visual acuity for the patient experiencing irritation symptoms, and for leaking blebs, and hypotonic maculopathy.

Adult↗