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PubMed2004

Needling for encapsulated trabeculectomy filtering blebs.

BACKGROUND: Encapsulation of a filtering bleb following trabeculectomy may lead to elevation of intraocular pressure, prompting further medical or surgical intervention. It has been suggested that needling of an encapsulated bleb may be effective in re-establishing drainage and lowering intraocular pressure. OBJECTIVES: The objective of this review is to assess the effects of needling encapsulated blebs on intraocular pressure. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group trials register) on The Cochrane Library (Issue 2 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to May 2003) and LILACS (Latin American and Caribbean Health Sciences ) (June 2003). There were no language or date restrictions in the searches. SELECTION CRITERIA: We included randomised and quasi-randomised in which bleb needling was compared with any form of antiglaucoma medication in people with encapsulated trabeculectomy blebs. The primary outcome was mean intraocular pressure measured in millimetres of mercury at day one, one week, one month and at last available follow-up. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: One trial, which randomised 25 eyes to either needling or medical treatment, met the inclusion criteria. At one day post-treatment, mean intraocular pressure was lower in the needling group (16.28 mm Hg, standard deviation 5.9) than the medical group (19.45 mm Hg, standard deviation 3.75). The difference was not statistically significant. At all other follow-up points, mean intraocular pressure was consistently higher in the needling group than the medical group, although the differences were not statistically significant. However, only one needled bleb remained successful at the end of follow-up compared to 10 out of the 11 blebs managed conservatively. This difference was statistically highly significant. REVIEWERS' CONCLUSIONS: Evidence from one small trial suggests that needling of encapsulated trabeculectomy blebs is not better than medical treatment in reducing intraocular pressure.

Blister↗
PubMed1997

Erbium: YAG laser trabecular ablation with a sapphire optical fiber.

The purpose of the study was to evaluate the effect of erbium (Er): yttrium aluminum garnet (YAG) laser trabecular ablation with a sapphire optical fiber on outflow facility. After obtaining baseline outflow facility using a computerized differential pressure perfusion system, human cadaver eyes were subjected to Er: YAG laser trabecular ablation using a sapphire optical fiber. Single pulses at varying energy levels (10 to 20 mJ pulse-1) were applied in a nearly contiguous fashion over four clock hours of meshwork. Post-laser outflow facility was then determined utilizing the same perfusion system and histopathologic analysis performed. Of the ten eyes, nine were perfused to steady baseline facility. One eye was excluded from the study because of a leak in our system during the initial perfusion. The mean baseline facility was 0.283+/-0.08 microl min-1 mmHg-1. There was a significant increase in outflow facility after trabecular ablation, with a mean post-laser facility of 0.62+/-0.15 microl min-1 mmHg-1 (P=0.01). Eyes which received a sham treatment showed no increase or a minimal increase in facility. Histopathologic analysis revealed ablation into Schlemm's canal with some thermal damage to the outer wall at all energy levels. Er: YAG laser trabecular ablation with a sapphire fiber is capable of increasing outflow facility in human cadaver eyes.

Erbium↗
PubMed2000

The effect of integrin antibodies on the attachment and proliferation of human Tenon's capsule fibroblasts.

The integrins are protein heterodimers consisting of noncovalently associated alpha and beta subunits. The adhesive interactions mediated by integrins are necessary for cellular survival and proliferation. In this study we investigated the effects of three different integrin antibodies on the proliferation of human Tenon's capsule fibroblasts in tissue culture. Human Tenon's capsule fibroblasts were cultured into 96 well plates and treated with different concentrations (ranging from 10(-6) to 1 microg ml(-1)) of three different integrin antibodies: human integrin alpha-2 antibody, human integrin alpha-3 antibody and human integrin alpha-5/FnR (fibronectin receptor) antibody. Coulter counter, hexosaminidase, and 3H-thymidine assays were used to determine the inhibitory effects of these integrin antibodies on ocular fibroblasts on days 0 (attachment), 1,3 and 7 following antibody treatment. The concentration of each antibody required to produce a proliferation 50% less than the control (ID50) was calculated for each assay. With respect to attachment, all three antibodies studied displayed some inhibitory activity. All three antibodies also displayed dose-dependent antiproliferative properties, especially at the highest concentration tested after 7 days of exposure. The integrin alpha-2 antibody was the most potent of the inhibitors, followed by the integrin alpha-3 antibody, with the integrin alpha-5 antibody being the least potent antibody tested. In addition, the anti-proliferative activities of the integrin alpha-2 and integrin alpha-3 antibodies increased with increasing incubation time. In conclusion, these integrin antibodies demonstrated some inhibitory effects on the attachment and proliferation of human Tenon's capsule fibroblasts in culture. Further investigation will be required to determine whether integrin antibodies can significantly limit scar formation in vivo without significant toxicity.

Antibodies↗
PubMed2004

Inhibitory mechanism of inteferon-gamma on human fibroblasts from Tenon's capsule.

The inhibitory mechanism of interferon-gamma (IFN-gamma) on the fibroblasts from Tenon's capsule was studied. By using immunohistochemical SP method and pathological image system, the inhibitory effects of IFN-gamma on the expression of transforming growth factor beta receptor I in the in vitro cultured fibroblasts from Tenon's capsule were quantitatively analyzed. The results showed that IFN-gamma could reduce the expression of transforming growth factor beta receptor I in the fibroblasts with the following dose-effect relationship: Y = 1937.5-134.2 Igx (r=-0.971, P<0.01). It was concluded that IFN-gamma could inhibit the expression of transforming growth factor beta receptor I in the fibroblasts from Tenon's capsule. The modulation of the transforming growth factor beta receptor I expression by IFN-gamma may be beneficial to the alleviation of the hyperplasia of scar after trabeculectomy.

Conjunctiva↗
PubMed2002

[Filtering bleb revision. Techniques and outcome].

BACKGROUND: The surgical management and outcome of bleb-related complications such as leaking blebs,overfiltration and blebitis are reported. METHODS: A retrospective analysis was carried out of 35 patients who underwent surgical repair of the filtering bleb in our hospital between 1991 and 2000. RESULTS: Surgical techniques used were autologous blood injection, fibrin glue injection, conjunctival suturing, resuturing of the trabeculectomy flap, bleb excision, conjunctival advancement, lyodura and tenon patching. In the eyes with leaking blebs the mean preoperative intraocular pressure (IOP) was 11.6+/-10.3 mmHg. After an average followup of 12 months the IOP was 11.9+/-3.3 mmHg. In the eyes with overfiltration the mean IOP was 2.4+/-1.5 mmHg and after an average follow-up of 18 months the mean IOP increased to 13.5+/-3.7 mmHg. In 77.1% the IOP was regulated between 8 and 21 mmHg without glaucoma medication. Mean visual acuity improved by 3.6+/-5.9 lines postoperatively. CONCLUSION: Surgical bleb revision has a high success rate with regard to maintaining a functioning filtering bleb and to preserving vision.

Adolescent↗
PubMed2003

[Nd-YAG laser iridotomy in pigment dispersion syndrome and pigment dispersion glaucoma].

Pigment dispersion syndrome is characterized by iris transillumination defects, Krukenberg spindels, and dense trabecular pigmentation. Additional features are bilaterality, myopia, concavity of the peripheral iris, a higher incidence in men than in woman,and young age of onset. A mechanism of reverse pupillary block causes iridozonular friction. Laser iridotomy is recommended as treatment to prevent further pigment dispersion and pigmentary glaucoma.

Accommodation, Ocular↗
PubMed2006

Outflow mechanisms after deep sclerectomy with two different designs of collagen implant in an animal model.

BACKGROUND: To study experimentally two different shapes of collagen implants (CI) used in deep sclerectomy (DS). The ability to promote drainage vessels, outflow mechanisms, success rates, and biodegradability, were studied prospectively in an animal model. MATERIALS AND METHODS: DS was performed in 20 eyes of ten rabbits. Each rabbit randomly received a cylindrical CI in one eye, while the other eye received a flat CI. Intraocular pressure (IOP) measurement, ultrasound biomicroscopy (UBM) examination of DS site and simultaneous fluorescein and indocyanin green anterior-segment angiography were performed preoperatively, at 1 and 2 weeks, 1, 2, 3, 6 and 9 months for each eye. At the end of the follow-up period, outflow facility (OF) was measured and histological examinations of the filtration site were performed. RESULTS: In the cylindrical implant group, IOP significantly dropped from a mean pre-operative value of 14.8+/-2.2 mmHg to a mean postoperative values of 10.9+/-3.3, 12.5+/-2.2, 11.8+/-2.6, 11.2+/-2.3, 10.7+/-1.9, 14.0+/- 3.2, 12.6+/-2.4 mmHg at 1, 2 weeks, and 1, 2, 3, 6, and 9 months, respectively. In the flat CI group, IOP significantly dropped from a mean preoperative value of 14.1+/-1.8 mmHg to a mean postoperative values of 10.4+/-2.7, 12.7+/-1.9, 12.5+/-3.2, 11.2+/-1.6, 11.6+/-1.8, 11.5+/-2.3, 11.0+/-2.2 mmHg at 1, 2 weeks, and at 1, 2, 3, 6, and 9 months, respectively. UBM images showed a gradual resorption of both type of CI during the first 3 months, and angiographies showed progressive growth of drainage vessels around the filtration site in both groups. The mean OF 9 months postoperatively for the cylindrical CI was 0.53 (SD +/- 0.23) ml/ min per mmHg and was 0.56 (SD+/-0.17) ml/min per mmHg for the flat CI (P=0.6). Histological examination revealed excellent biocompatibilty and a high density of drainage vessels in the sclera around the operative site in both groups. CONCLUSION: Using IOP and OF measurements, UBM, angiography, and histology, we were able to compare two types of CI used as space maintainer in DS. Both CIs showed efficient IOP lowering effect and outflow facility increase, possibly explained by stimulation of drainage vessels growth. Both implants showed excellent biocompatibility. The flat CI showed a slight tendency towards better overall performances.

Animals↗
PubMed2005

Viscocanalostomy versus trabeculectomy in patients with bilateral high-tension glaucoma.

Results of trabeculectomy (TE) and viscocanalostomy (VCO) were compared in a prospective randomised study in two fellow eyes of 22 consecutive patients with bilateral symmetrical high-tension glaucoma. Rates of overall surgical success with intraocular pressures (IOP) < or = 18 mm Hg with or without medications were 91 for the TE, and 95 for the VCO group after a mean follow-up of 18 months. Complete success rates without medications were 64 and 59 for TE and VCO groups, respectively (p = 0.750). Both procedures significantly reduced IOP, however, IOP course following trabeculectomy was significantly lower (p = 0.026). Rates of complications were not found to be different between the two groups of eyes, except for an apparent--though not significant (p = 0.066)--increase in cataract progression with TE. Various types of conjunctival blebs were detected in all eyes with surgical success in both groups, however, diffuse, elevated or multi-cystic functional blebs appeared to be more predominant in eyes with TE, compared to the VCO group in which low-lying, localised blebs had a higher incidence (p = 0.015). Viscocanalostomy was found to be a safe and effective filtration technique in patients with uncomplicated high-tension glaucoma, though IOP decrease was more pronounced with trabeculectomy.

Adult↗
PubMed1966

Cyclodialysis implants in human eyes.

In 34 eyes with various types of glaucoma, cyclodialysis implants were used to produce reduction of intraocular pressure. The average reduction of pressure in the 14 eyes with chronic simple glaucoma (phakic and aphakic) was from 36 mm Hg preoperatively to 15 mm Hg postoperatively. Six of the 14 have since required some medication. The average facility of outflow preoperatively was 0.17 and postoperatively was 0.22. The principal mode of action of the cyclodialysis implants was found to be decreased aqueous formation. A long-term follow-up of these patients has been undertaken.

Filtering Surgery↗
PubMed2005

Primary viscocanalostomy for juvenile open-angle glaucoma.

PURPOSE: To evaluate the efficacy and safety of primary viscocanalostomy for medically uncontrolled juvenile open-angle glaucoma (JOAG). DESIGN: Prospective, noncomparative, interventional case-series study. METHODS: The study included 20 eyes of 20 consecutive patients with medically uncontrolled JOAG who were treated by viscocanalostomy at one institution. No surgical or laser procedure preceded viscocanalostomy. Surgical outcome was defined as an overall success by the following criteria: no visual field deterioration, no optic-neuropathy progression, postoperative intraocular pressure IOP < or =20 mm Hg, and IOP reduction > or =30% compared with baseline values with or without medication. When medications were not required, success was defined as complete. Cases that did not fulfill the aforementioned criteria and cases in which a surgical revision or further goniopuncture was performed were defined as a failure. RESULTS: Gender distribution was similar. Fourteen eyes belonged to the white race; five eyes belonged to the black race, and one eye belonged to Arab ethnicity. Mean age (+/-SD) at operation was 33.77 +/- 6.16 years, with the mean preoperative IOP (+/-SD) at 22.9 +/- 4.77 mm Hg. Thirty-six months after operation, 16 cases (80%) were considered an overall success. In 11 cases (55%), success was complete. Four cases (20%) were considered failures. No serious complications were documented either during or after operation. In two cases (10%), we documented a spontaneously reabsorbed microhyphema. Trabeculo-Descemet-membrane microperforation occurred in two cases (10%). In two other cases (10%), Trabeculo-Descemet-membrane perforation occurred and was accompanied by iris prolapse that needed peripheral iridectomy. CONCLUSION: Primary viscocanalostomy can efficiently and safely reduce intraocular pressure in cases of medically uncontrolled JOAG and provide a rational alternative to conventional surgical modalities.

Adolescent↗
PubMed2006

Rescue of failed filtering blebs with ab interno trephination.

We evaluated the effectiveness of ab interno automated trephination as a technique for rescuing failed mature filtering blebs. A retrospective chart review of 40 failed blebs of 38 patients who had a posttrephination follow-up period of at least 3 months was done. With success defined as intraocular pressure (IOP) <21 mm Hg and at least a 20% reduction from baseline on the same or fewer number of pretrephination medications, 30/40 eyes (75%) fit these criteria over the entire course of follow-up. Among all 40 eyes, there was a significant reduction of IOP from pretrephination to 3 months (P<.001). The percentage of patients requiring 2 or more medications declined from 90% pretrephination to 21% at 3 months (P<.0001), and was stable thereafter. Some patients were able to eliminate all medications. Patients who did not meet the criteria of success regained successful IOP control with other modalities of management. Complications were few. We believe that ab interno trephination is an excellent option for rescuing selected failed filtering blebs.

Adult↗
PubMed1997

Exogenous Neisseria meningitidis endophthalmitis.

PURPOSE: To report a case of Neisseria meningitidis endophthalmitis in association with a leaking filtering bleb and to consider antibiotic prophylaxis of those people with whom the patient had contact. METHOD: We treated an 81-year-old man who had a chronic, leaking filtering bleb and who developed exogenous N meningitidis endophthalmitis. RESULT: N meningitidis endophthalmitis was controlled with antibiotic therapy. Antibiotic prophylaxis for those with whom the patient had contact was not recommended. CONCLUSION: In this case, the N meningitidis strain was not considered invasive because the bacteria apparently entered the eye through a leaky filtering bleb and not through the bloodstream. Recovery of noninvasive N meningitidis does not require prophylaxis for patient contacts. In cases of endogenous or idiopathic N meningitidis endophthalmitis, antibiotic prophylaxis of close patient contacts may be warranted.

Aged↗