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At least 991 records · Page 55Linked to original sources
PubMed2001

Dilation of Schlemm's canal in viscocanalostomy: comparison of 2 viscoelastic substances.

PURPOSE: To study the injection of viscoelastic material into Schlemm's canal adjacent to and 6.0 mm from the scleral flap during viscocanalostomy in an autopsy eye model. SETTING: Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Viscocanalostomy was performed in 8 postmortem human globes. Sodium hyaluronate (Healon GV or Healon5) was injected into 1 side of Schlemm's canal, with the other side serving as a control in some eyes. The eyes were prepared for light microscopic analysis, and serial pathologic sections were taken adjacent to the flap and 6.0 mm circumferentially from the flap. The area of Schlemm's canal was calculated and compared using t tests. RESULTS: Injecting viscoelastic material enlarged the area of Schlemm's canal adjacent to and 6.0 mm from the flap significantly more than not injecting viscoelastic material. While there was no difference between the viscoelastic materials in dilating Schlemm's canal at the flap, with Healon5 there was a small but statistically significantly greater dilation 6.0 mm from the flap. No full-thickness breaks in the trabecular meshwork were noted adjacent to or 6.0 mm from the flap. CONCLUSION: Injecting viscoelastic material significantly increased the cross-sectional area of Schlemm's canal and may play a role in the success of viscocanalostomy. Further study is needed to elucidate the mechanism of this procedure.

Anterior Eye Segment↗
PubMed2002

Midterm ultrasound biomicroscopy findings in eyes with successful viscocanalostomy.

PURPOSE: To show tissue changes using ultrasound biomicroscopy (UBM) in eyes with controlled intraocular pressure (IOP) after viscocanalostomy. SETTING: Consultores Oftalmológicos, Fundación Oftalmológica Argentina Jorge Malbran and Hospital Santa Lucía, Buenos Aires, Argentina. METHODS: This retrospective noncomparative case series comprised 23 eyes of 19 patients with uncontrolled open-angle glaucoma who had viscocanalostomy and UBM and a mean follow-up of 20 months +/- 5.9 (SD) (range 12 to 30 months). The UBM measurements were taken a mean of 6.8 +/- 5.9 months (range 3 to 14 months) after the viscocanalostomy. In 7 eyes, UBM was again performed a mean of 7.8 +/- 4.6 months (range 7 to 9 months) after the first study. All patients had preoperative and postoperative IOP measurements. RESULTS: The mean IOP at last examination was 13.3 +/- 2 mm Hg (range 8 to 17 mm Hg). One eye had evidence of a subconjunctival bleb. All eyes had a nonreflective scleral chamber and posterior to it, a hyporeflective zone. In 7 eyes in which 2 UBMs were performed, the scleral chamber was unchanged 7 to 9 months after the first study. CONCLUSIONS: The presence of a scleral chamber and absence of a subconjunctival filtering bleb are the usual UBM findings in eyes with adequate control of IOP several months after viscocanalostomy. These findings suggest that viscocanalostomy is successful when a continuous aqueous flow through the trabeculo-Descemet's membrane is present, maintaining a scleral chamber.

Aged↗
PubMed2002

Iris synechia after laser goniopuncture in a patient having deep sclerectomy with a collagen implant.

Neodymium:YAG (Nd:YAG) goniopuncture is an efficient and safe treatment for low filtration through the trabeculo-Descemet's membrane after deep sclerectomy with a collagen implant (DSCI). The only reported complication of this procedure is choroidal detachment. However, we found an iris synechia in a patient whose intraocular pressure (IOP) was elevated again 1 month after Nd:YAG goniopuncture. Synechiolysis and peripheral iridectomy with Nd:YAG and argon lasers effectively removed the iris synechia, and IOP immediately dropped to the normal range. We believe that iris synechia is a potential complication that may cause elevated IOP after laser goniopuncture in patients having DSCI.

Adult↗
PubMed1998

Permanent glaucomatous visual loss after photorefractive keratectomy.

A 41-year-old man who had photorefractive keratectomy (PRK) for myopia developed corneal haze. After intensive treatment with topical corticosteroids, he developed elevated intraocular pressure and optic nerve damage. Because of an inadequate response to steroid discontinuation and medical treatment, the patient required a glaucoma filtering procedure. Corticosteroid-induced glaucoma is a possible complication of the treatment often associated with PRK. Careful patient screening and disclosure of this risk are imperative.

Administration, Topical↗
PubMed1999

Viscocanalostomy for open-angle glaucoma in black African patients.

PURPOSE: To study the clinical effectiveness of viscocanalostomy in a population of black African patients with open-angle glaucoma that was uncontrolled on medical treatment. SETTING: Department of Ophthalmology, Medical University of Southern Africa, Medunsa, South Africa. METHODS: In this prospective study viscocanalostomy was performed in 214 eyes of 157 black African patients with open-angle glaucoma that was poorly controlled by medical therapy. The procedure involves the production of superficial and deep scleral flaps. The deep flap is disserted to the plane of Schlemm's canal. From this plane, an intact window in Descemet's membrane is created by gentle pressure at the level of Schwalbe's line using a cellulose sponge. Aqueous humor diffuses through this window into a subscleral space (lake). Reflection of the inner flap unroofs Schlemm's canal, creating a trough leading to 2 entrances into Schlemm's canal (surgical ostia). A delicate cannula is introduced into the entrance of Schlemm's canal left and right and high-viscosity sodium hyaluronate is gently injected into the canal for 4 to 6 mm. The deeper scleral flap is excised (deep sclerectomy) and the superficial flap is sutured securely using 5, 11-0 polyester fiber (Mersilene) sutures. High-viscosity sodium hyaluronate is then injected into the subscleral lake to act as a physical barrier to fibrinogen migration postoperatively. RESULTS: Postoperative intraocular pressure (IOP) of 22 mm Hg or less was achieved without medical therapy in 82.7% of eyes. If a beta blocker was added to the cases not achieving 22 mm Hg or less postoperatively, the success rate increased to 89.0%. The average follow-up was 35 months (range 6 to 64 months). CONCLUSION: Viscocanalostomy produced an encouraging long-term reduction in the IOP of black African patients with glaucoma who would otherwise have had a poor prognosis.

Adolescent↗
PubMed2003

Viscocanalostomy and deep sclerectomy for the surgical treatment of glaucoma: a longterm follow-up.

PURPOSE: To study the outcome of viscocanalostomy (VC) and deep sclerectomy (DS) for the surgical management of medically uncontrolled glaucoma. PATIENTS AND METHODS: A non-randomized, prospective study of all consecutive non-penetrating glaucoma filtering procedures was carried out in two centres. In the first centre, one surgeon (MSW) performed VC in 105 eyes (27 VC and 78 phaco VC). In the second centre, one surgeon (PKW) performed DS in 87 eyes (52 DS and 35 phaco DS). RESULTS: The mean follow-up was 36 months (range 9-60 months). At final follow-up the complete success rate (intraocular pressure < or = 21 Hg without medication) was 92.6% for VC eyes, 96% for phaco VC eyes, 77% for DS eyes and 94% for phaco DS eyes. Kaplan-Meier survival analysis for complete success showed no significant difference between DS and VC nor between phaco VC and phaco DS (p > 0.05). By 36 months postoperatively, mean IOP was 16.8 mmHg (SD 3) in VC eyes, 16.6 mmHg (SD 3.1) in phaco VC eyes, 16.7 mmHg (SD 5.7) in DS eyes and 15 mmHg (SD 3.2) in phaco DS eyes. Postoperative Nd:YAG laser goniopuncture was necessary in 10 eyes in the DS group. Large or cystic drainage blebs occurred only in the DS eyes. CONCLUSIONS: Viscocanalostomy and DS are effective and safe methods of achieving sustained IOP reduction in glaucomatous eyes and both techniques can be successfully combined with cataract extraction.

Adult↗
PubMed2005

Topical application of autologous serum for the treatment of late-onset aqueous oozing or point-leak through filtering bleb.

PURPOSE: To evaluate the efficacy of topical autologous serum application to stop aqueous oozing or point-leak through filtering bleb after trabeculectomy. PATIENTS AND METHODS: A total of 21 consecutive eyes with oozing and 21 eyes with a point-leak through a functional bleb after trabeculectomy with 5-fluorouracil or mitomycin C were enrolled in this randomized, case-control study. In eyes randomly assigned to the serum group, an antibiotic and the autologous serum, which was sterilely diluted to 20% with physiological saline, were topically applied four times a day for up to 12 weeks. In eyes assigned to the control group, the antibiotic alone was applied according to the same protocol. Intraocular pressure (IOP) and the presence of oozing or a point-leak were tested before and every 2 weeks after starting the treatments. RESULTS: In the serum and control groups, oozing stopped in 62.5 and 0% of eyes, respectively (P=0.003), and point-leaks stopped in 27.3 and 18.2%, respectively (P>0.9). IOP significantly increased from 10.0+/-3.2 (mean+/-standard deviation) to 11.8+/-3.3 mmHg in eyes in which oozing stopped (P=0.066), and from 11.4+/-2.7 to 15.4+/-2.3 mmHg in eyes in which a point-leak stopped (P=0.042). CONCLUSIONS: Autologous serum application was significantly effective to stop aqueous oozing but not point-leaks. Stopping oozing or point-leaks was significantly associated with an increase in IOP.

Administration, Topical↗
PubMed2004

Whither the blade?

Explore the source record for details and available documents.

Anti-Inflammatory Agents↗
PubMed2001

[Formation of a descemetic bleb after deep sclerectomy and visco-canalostomy: apropos of 2 cases].

BACKGROUND: Deep sclerectomy with visco-canalostomy is a new non perforating method for the surgical treatment of glaucoma. PATIENTS AND METHODS: We report 2 patients who developed a descemetic bleb after this surgical procedure. RESULTS: The cornea remained clear for more than ten months, as long as the bleb was not ruptured. In case of rupture, one should inject air into the anterior chamber to fix the descemetic membrane, otherwise the cornea will become quickly cloudy. CONCLUSIONS: Descemetic bleb formation after visco-canalostomy is a new complication which has to be recognized and treated in order to avoid corneal edema.

Aged↗
PubMed2002

[Measurement of intraocular pressure using the Tono-Pen in comparison with Goldmann applanation tonometry - a clinical study in 100 eyes].

BACKGROUND: In clinical practice ophthalmologists often need a tonometer which is independent of a slit lamp. Such a hand-held device is the Tono-Pen. We compared the precision of two equal Tono-Pens with Goldmann applanation tonometry. MATERIAL AND METHODS: Measurement of intraocular pressure (IOP) was done in 100 eyes of 51 patients (mean age 63 +/- 15 years) suffering from ocular hypertension or glaucoma. According to a random table either the right or left eye was measured using Goldmann tonometer first and the Tono-Pen second. For the other eye the measurement was reversed. One of the two equal Tono-Pens (Solan/USA) was used according to a second random table. Three measurements were obtained with each instrument on both eyes within 15 minutes subsequently. Patients were placed in an upright position for all measurements. RESULTS: Even for well-trained ophthalmologists a learning curve of approximately 10 measurements was observed using the Tono-Pen. The Tono-Pen measured an average IOP of 16.9 mm Hg in all 100 eyes. The Goldmann tonometer measured an average IOP of 17.7 mm Hg. The difference was not statistically significant. The standard deviation for all measurements was better for the Tono-Pen (4.7 mm Hg vs 5.8 mm Hg for Goldmann tonometer). No reduction of the IOP after Tono-Pen measurement was observed (in contrast to the Goldmann tonometer). The reproducibility of the Tono-Pen on the same eye was inferior to the Goldmann tonometer by a factor of 2. There was an almost significant difference in reproducibility between two equal Tono-Pens. CONCLUSIONS: Measurement of IOP with the Tono-Pen is comparable to Goldmann applanation tonometry if an average of 3 measurements is used. The difference between two equal Tono-Pens indicates the need for improvement of the quality check during production.

Aged↗
PubMed2004

[First experience with amniotic membrane transplantation].

BACKGROUND: The purpose of this retrospective study was to analyze the outcome of amniotic membrane transplantation (AMT) performed at the University Eye Clinic Bern during the last 12 months. PATIENTS AND METHODS: Nine men (62.4 +/- 16.7 yrs.) and four women (78.3 +/- 22.3 yrs.) were treated with an AMT and grouped according to the ophthalmologic diagnosis: Group A, chronic corneal surface defect without limbal stem cell deficiency (n = 8); Group B, conjunctival fornix reconstruction (n = 7); Group C, filtering bleb defect (n = 2). RESULTS: 11/17 (65 %) AMT's performed in 14 eyes of 13 patients showed a favorable postoperative result after a mean follow-up time of 8.7 (+/- 2.9) months. In Group A (chronic corneal surface defect) 4/8, in Group B (conjunctival fornix defect) 7/7 and in Group C (filtering bleb defect) 0/2 showed an improvement of the basic ocular problem. 4/8 patients from Group A and 7/7 patients of Group B showed postoperatively a strong reduction of the ocular inflammation. CONCLUSIONS: In the present small study, favorable results were achieved in patients with chronic corneal surface defects without limbal stem cell deficiency and conjunctival fornix defects following AMT. In patients with fornix defects, the AMT seemed to be a valuable alternative to the more complicated transplantation of mouth- or nose mucous membrane. The two eyes with filtering defects failed.

Adult↗
PubMed2005

[Differentiation between pupillary and ciliary block by means of the Orbscan II in a patient with angle block glaucoma].

BACKGROUND: A ciliary block is the rarer cause of angle block glaucoma. In order to choose the appropriate therapy, however, it is crucial to make the correct diagnosis. We report on a patient who suffered from recurrent increases of intraocular pressure while having renal dialysis. In his case the use of the Orbscan II made the differentiation between a pupillary and a ciliary block easier. CASE REPORT: In addition to basic ophthalmological examinations we performed a topographic analysis using Orbscan II before and after renal dialysis. Since intraocular pressure rise during renal dialysis had been proven, iridotomies on both eyes and an iridectomy on the left one had been performed before the patient was referred to us. In spite of these open shunts we measured an increase of intraocular pressure values of 10 to 12 mmHg directly after renal dialysis had been completed. The anterior chamber became shallower both at its centre and the periphery, thus its volume diminished analogously. Measurements by the Orbscan II showed that the lens swelled up and was displaced anteriorly as well, so that a ciliary block mechanism had to be assumed. CONCLUSIONS: Since the Orbscan II is capable of collecting topometric data of the cornea, anterior chamber and also lens, it is helpful in differentiating a pupillary from a ciliary block in angle block glaucoma.

Aged↗
PubMed1998

[Evaluation of the filtering bleb using ultrasound biomicroscopy].

BACKGROUND: Sometimes in glaucomatous patients treated with trabeculectomy there is not a correlation between bleb shape and intraocular pressure. So we studied the functional anatomy of the filtering bleb by a ultrasound biomicroscope, using high frequency (50 Mhz) probe, which provides high resolution images of filtering blebs. MATERIALS AND METHODS: A total of 46 filtering blebs of 46 patients after trabeculectomy were analyzed by ultrasound biomicroscopy (50 Mhz). Dimensions, shapes and structure of blebs were evaluated in 2 groups of patients. RESULTS: It was possible to obtain longitudinal or transverse images of filtering blebs, to measure the height, to evaluate the reflectivity inside and to follow the route under the scleral flap. Blebs with lower reflectivity and a visible route under the scleral flap had a lower intraocular pressure while the height was not important for a good intraocular pressure. CONCLUSIONS: So ultrasound biomicroscopy can be a useful method to study filtering blebs and also to explain the mechanisms of filtering structures in patients who underwent trabeculectomy.

Aged↗
PubMedDate not supplied

Formulation factors for preparing ocular biodegradable delivery system of 5-fluorouracil microparticles.

Microparticles containing 5-fluorouracil (5-FU) were prepared using poly(DL-lactide-co-glycolide) with an oil-in-oil emulsion/solvent extraction technique. Particle characteristics including size distribution, 5-FU loading efficiencies, in vitro release and degradation were investigated. The dispersed phase was composed of PLG dissolved in dichloromethane, and the continuous phase was paraffin oil containing lecithin. 5-FU was successfully entrapped in the microparticles with trapping efficiencies up to 76%, loading level 10% w/v, and particle size 3 microm. Release profiles of 5-FU loaded microparticles were determined to follow a first-order-time relationship. An optimized preparation of 5-FU microparticles was achieved and was capable of controlling the release of 5-FU over 21 days with an in vitro delivery rate of 0.4 microg 5-FU/mg particles/day in the study. Preliminary animal studies indicated that the 5-FU loaded microparticles as an ocular delivery system showed no ocular toxicity and no significant inflammatory response in rabbits for 2 months. The 5-FU loaded microparticles approach, with PLG, might be a potential for the application of long-term delivery of hydrophilic drugs in the eye.

Animals↗
PubMed1994

Review: implants.

An implantable sustained release device has been developed to treat chronic disorders of the eye. The device, consisting of a central core of drug encased in layers of permeable and impermeable polymers, can be implanted subconjunctivally or intravitreally. This technique was used to develop a ganciclovir device which, when implanted into the vitreous, maintains therapeutic vitreous levels of drug for 8 months. Initial studies in patients with cytomegalovirus (CMV) retinitis indicate that this treatment may offer better control of the disease and fewer side effects than existing therapies. Cyclosporine A devices were prepared for the treatment of uveitis. Early data suggests that these devices maintain therapeutic levels in the vitreous for approximately 3 years. Work on efficacy and toxicity is continuing. Although clinical applications of these devices are likely to be restricted to diseases requiring chronic drug therapy, they can be used to investigate optimal delivery rates. Subconjunctivally implanted devices releasing 5-FU for 12 days maintained filters in cynomolgus monkeys for 3 months. Similar devices maintained low intraocular pressure in 75% of high risk filter patients.

Animals↗
PubMed1995

Treatment of failing glaucoma filtering cystic blebs with tissue plasminogen activator (tPA).

Tissue plasminogen activator (tPA) is a clot-specific fibrinolytic agent shown to be effective in decreasing postsurgical fibrin formation and enhancing filtration after trabeculectomy. To evaluate the efficacy of tPA on blebs showing clinical evidence of failure, a retrospective analysis was performed on 20 eyes of 20 glaucoma patients with failing or failed cystic filtering bleb treated with tPA intrableb and/or intracameral injection. The average pre-tPA intraocular pressure (IOP) was 18.0 +/- 7.2 mmHg and post-tPA was 12.9 +/- 6.2 mmHg. Fifteen of 20 eyes (75%) were able to maintain their IOP at or below target level, in the follow-up period of 3 to 7 months. Eight of the 15 eyes with successful outcome were free of glaucoma medication. Patients experienced no pain or irritation during and after the injection of tPA. No adverse effects on visual acuity or major complications were encountered. Transient mild complications related to tPA injections were subconjunctival hemorrhage (2 eyes), hyphema (1 eye) and hypotony (6 eyes). The revision of failing cystic bleb by tPA intrableb and/or intracameral injection may be considered as a useful adjunct with low risk in management of failing cystic blebs. A well designed clinical trial would provide needed information pertaining to the nature of cystic bleb formation as well as the efficacy, safety and clinical implication on the tPA treatment.

Aged↗
PubMed2000

Intracorneal inclusion of high-molecular-weight sodium hyaluronate following detachment of Descemet's membrane during viscocanalostomy.

PURPOSE: Viscocanalostomy in accordance with Stegmann's technique is a new surgical option in the treatment of glaucoma. There are few reports available describing the specific complications of viscocanalostomy. We report a case of intracorneal inclusion of high-molecular-weight sodium hyaluronate following viscocanalostomy. CASE REPORT: A 66-year-old man with uncontrolled primary open angle glaucoma of his right eye and a history of argon laser trabeculoplasty underwent viscocanalostomy in accordance with Stegmann's technique. During the filling of Schlemm's canal, a limited lysis of Descemet's membrane advanced centrally in the clear cornea adjacent to the site of canalostomy forming an intracorneal bubble of high-molecular-weight sodium hyaluronate. Postsurgical slit-lamp biomicroscopy showed an intracorneal clear bubble within the corneal periphery without evidence of adjacent corneal edema and with no contact between the corneal endothelium and the iris. Follow-up examinations determined that the appearance of the corneal inclusion, essentially, was unchanged, with only a slight tendency of resorption. No signs of corneal scarring or endothelial decompensation could be noted. CONCLUSION: To date, we could not determine a significant corneal damage in conjunction with the described complication. However, it is difficult to predict the long-term clinical course of our patient. Corneal decompensation as a result of possible endothelial toxicity of high-molecular weight sodium hyaluronate as well as spontaneous absorption seem possible.

Aged↗