Memantine and progressive glaucoma.
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Aged↗
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Results for “Filtering Surgery”
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Correlation between finger blood flow and changes in optic nerve head blood flow following therapeutic intraocular pressure reduction.
PURPOSE: To correlate finger blood flow and changes in optic nerve head (ONH) blood flow following therapeutic intraocular pressure (IOP) reduction in open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS: Seventeen open-angle glaucoma patients and nineteen ocular hypertension patients underwent therapeutic IOP reduction followed by a minimum of 4 weeks of follow-up. Optic nerve head blood flow measurements were obtained by scanning laser Doppler flowmetry using full-field perfusion image analysis. Finger blood flow was measured using the Transonic laser Doppler Flowmeter. Finger blood flow was measured at baseline, after immersion in warm water (40 degrees C) for 2 minutes (Flow Max), and after immersion in cold water (4 degrees C) for 10 seconds (Flow Min). Patients were identified as vasospastic if their Flow Max/Flow Min >7. Statistical comparisons were performed using two-tailed distribution paired T-test and Pearson's correlation factor. RESULTS: For similar mean percentage intraocular pressure reduction, vasospastic patients had greater improvements in rim blood flow than did non-vasospastic patients [+35% versus +13%] (P = 0.01). While there was no difference in rim blood flow changes in the vasospastic versus the non-vasospastic OAG group, the vasospastic ocular hypertension group showed 18% increase in rim blood flow whereas the non-vasospastic ocular hypertension group showed an 8% decrease. A significant negative correlation was also found in the open-angle glaucoma group between rim blood flow change and Flow Max (-0.681, P = 0.003). In contrast, no such correlation was found in the ocular hypertension group (+0.144, P = 0.556). CONCLUSION: OAG patients had a significant negative correlation between changes in rim blood flow and maximum finger Doppler flow. Among ocular hypertension patients, increased rim blood flow was only found in the vasospastic group, though this increase was not statistically significant. These results suggest that open-angle glaucoma and ocular hypertension patients with the most severe vasospastic disease may show the greatest improvements in rim blood flow after sustained intraocular pressure reduction.
Aged↗
Donor scleral patch for treating hypotony due to leaking and/or overfiltering blebs.
OBJECTIVE: To report a modified technique of bleb revision with the use of a donor scleral patch in cases in which scleral melting did not allow effective suturing and closure of the aqueous leak. The suturing technique ensures tight adaptation of the scleral patch over the leaky region, and allows better-controlled aqueous flow with loose suturing of the posterior edge of the scleral patch. METHODS: Records of patients who underwent bleb revision with donor scleral graft from 1997 to 2003 were reviewed retrospectively. Chart information including demographic and clinical data was recorded preoperatively and 1 day, 1 week, 1 month, 6 months, and at final follow-up. RESULTS: Fifteen patients underwent this surgical procedure for bleb revision. The mean follow-up time was 22.0 +/- 24.0 months (median = 8.0 months). The mean preoperative visual acuity was 20/50 and the mean intraocular pressure (IOP) was 2.9 +/- 2.3 mm Hg, which improved to 20/30 and 14.1 +/- 3.3 mm Hg respectively, on last follow-up. CONCLUSIONS: The scleral patch with 4-nylon sutures should be proposed in cases in which a macerated scleral bed is revealed during the revision. The loose suturing of the scleral patch at its posterior border was found to prevent intraocular pressure spikes.
Adolescent↗
Phaco-viscocanalostomy versus phaco-trabeculotomy: a middle-term study.
PURPOSE: To compare the surgical outcomes between phaco-viscocanalostomy and phaco-trabeculotomy in open-angle glaucoma. PATIENTS AND METHODS: In a nonrandomized, retrospective clinical study, 110 eyes underwent phaco-viscocanalostomy (VCS group), and 110 eyes underwent phaco-trabeculotomy (LOT group). The mean follow-up was 857+/-409 (+/-SD) days (P=0.4777). RESULTS: The mean preoperative treated intraocular pressure (IOP) values were 20.2+/-3.5 mm Hg in the VCS group and 20.9+/-3.5 mm Hg in the LOT group (P=0.3377). The postoperative IOPs in the VCS group were 15.0+/-3.0 and 16.1+/-3.0 mm Hg at 1 and 3 years, and in the LOT group 16.3+/-2.9 mm Hg (P=0.0088) and 16.5+/-3.3 mm Hg (P=0.4993), respectively. The number of medications used in the VCS group was significantly lower than in the LOT group during the observation periods (P< or =0.0130). The probabilities of achieving IOPs< or =21 mm Hg at 3 years in the VCS group were 92.0% with or without mediations and 58.2% without medications, and were significantly better than those of the LOT group (84.7% and 36.0%, P=0.0334 and P<0.0001 by log-rank test, respectively). The probabilities of achieving IOPs< or =16 mm Hg at 3 years in the VCS group were 30.5% with or without mediations and 30.3% without medications, whereas those in the LOT group were 27.5% (P=0.1799) and 19.4% (P=0.0010), respectively. The visual outcome was similar between the groups. Postoperative hyphema (> or =2 mm) and IOP spikes (> or =30 mm Hg) occurred significantly less in the VCS group (2.7 and 3.6%, respectively) than in the LOT group (26.4 and 28.2%, respectively; P<0.0001). In 13 eyes (11.8%) of the LOT group, the highest IOP level was recorded 40 mm Hg or higher. Vitreous hemorrhage and central visual loss occurred in 1 case each in the LOT group. CONCLUSIONS: After a middle-term observation, phaco-viscocanalostomy provides better IOP control and a lower incidence of vision-threatening complications than phaco-trabeculotomy.
Aged↗
Intrastromal diathermal keratostomy: a new micropenetrating clear-cornea glaucoma procedure.
PURPOSE: The filtering intrastromal diathermal keratostomy (IDK) was developed to comply with the call for a low postoperative intraocular pressure (IOP) and a bleb morphology without a thin, cystic appearance. PATIENTS AND METHODS: A diathermal microkeratostomy (150 to 200 microm) was created into the anterior chamber, anterior to the Schwalbe line through the floor of a surgical corneoscleral tunnel incision into the subconjunctival space. A newly developed, bipolar diathermal microneedle was used to create the keratostomy, replacing the Holmium laser used previously. Subconjunctival injections of 3 microg mitomycin C were used in each eye 1 week before the IDK to obtain maximum antiproliferative effect at the time of the operation. Nine patients (10 eyes) with complicated, refractory primary and secondary open-angle glaucoma are discussed. RESULTS: Histologic examination of the IDK and clinical postoperative ultrasound biomicroscopy showed an optimal appearance of the diathermal microkeratostomy. After 34 months (range 24 to 42 mo) the mean IOP was 11 mm Hg (SD+/-3, range 6 to 16) without medication in all 10 eyes. IDK revision with internal needling of postoperative subconjunctival fibrosis through the tunnel incision was performed in 5 eyes after an average of 3 months (range 0.2 to 7 mo). After 33 months (range 19 to 38 mo), the postrevision mean IOP was 10 mm Hg (SD+/-2, range 8 to 14) without medication in all 5 eyes. All 10 eyes showed noncystic diffuse blebs with optimal spongy subepithelial morphology: in 2 eyes the blebs were totally avascular and in 8 eyes they were relatively avascular. CONCLUSIONS: The preliminary results of the new clear-cornea IDK seem promising because of postoperative IOP of about 10 mm Hg despite a low dose of mitomycin C and noncystic bleb morphology.
Adult↗
Operative revision of non-functioning filtering blebs with 5-fluorouracil to regain intraocular pressure control.
PURPOSE: To determine the efficacy of extensive microsurgical needling revision of failed filtering blebs followed by serial 5-fluorouracil subconjunctival injections. METHODS: Thirty-six eyes of 34 consecutive patients with progressive open-angle glaucoma refractory to topical therapy submitted to needling revision as a major procedure. All patients required multiple antiglaucoma medications preoperatively, and had completely flat or densely encapsulated filtering blebs. All patients underwent elaborate needling revision (limbus to superior rectus >8 mm diameter, >3 mm elevation, entry-site sutured with 8-0 vicryl and bleb reformed via paracentesis with viscoelastic) in the operating room, followed by serial 5-fluorouracil. The patients were followed for up to 6 months postoperatively. The main outcome measures were intraocular pressure (IOP) and the number of antiglaucoma medications used. RESULTS: Thirty-one eyes (86%) maintained mean IOP below 15 mmHg postneedling without medication. Overall the mean IOP postneedling was >9 mmHg lower than medicated preoperative levels (P < 0.0001). IOP reduction in encapsulated blebs was marginally superior to that in flat blebs. CONCLUSIONS: Extensive needling revision in the operating room is safe, straightforward, and produces reproducible restoration of filtering function.
Adult↗
Comment on 'What is the direct cost of treatment of acute primary angle closure glaucoma? The Singapore model'.
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Acute Disease↗
A randomised, prospective study comparing trabeculectomy with viscocanalostomy with adjunctive antimetabolite usage for the management of open angle glaucoma uncontrolled by medical therapy.
AIMS: To compare trabeculectomy with viscocanalostomy augmented with adjunctive antimetabolite use for the control of intraocular pressure (IOP) in open angle glaucoma (OAG). METHODS: 45 patients (50 eyes) with uncontrolled OAG were randomised to either trabeculectomy (25 eyes) or a viscocanalostomy technique (25 eyes). Preoperatively, all eyes were graded in terms of risk factors for drainage failure and were given intraoperative antimetabolites (5-fluorouracil 25 mg/ml (5-FU), mitomycin C (MMC) 0.2 mg/ml and 0.4 mg/ml) according to a standard protocol. RESULTS: There were no significant differences between the groups in age, sex, type of OAG, preoperative medications, risk factors for drainage failure, and preoperative IOP. Mean follow up was 20 months (range 3-24 months). It was 12 months or longer in all eyes, except two lost to follow up at 3 months. At 12 months, complete success (IOP<21 mm Hg without antiglaucoma medications) was seen in 91% of eyes undergoing trabeculectomy, but in only 60% of eyes undergoing viscocanalostomy (p<0.02). Similarly, at the last follow up visit (mean 20 months) complete success was seen in 68% of eyes undergoing trabeculectomy and 34% with viscocanalostomy (p<0.05). In terms of qualified success (IOP<21 mm Hg with or without glaucoma medications) and mean IOP measurements postoperatively there were no difference between the groups, although the mean number of antiglaucomatous medications required postoperatively was less with trabeculectomy (0.39) than viscocanalostomy (1.04) (p<0.05). Needling procedures were more commonly required after trabeculectomy (p<0.02). YAG goniotomy was required in three eyes (13%) after viscocanalostomy. Early transient complications such as anterior chamber shallowing and encysted blebs were more common in the trabeculectomy group (p<0.05). Late postoperative cataract formation was similar between the two groups. CONCLUSION: In terms of complete success and number of antiglaucomatous medications required postoperatively, IOP control appears to be better with trabeculectomy. Viscocanalostomy is associated with fewer early transient postoperative complications.
Adult↗
Glaucoma drainage devices; past, present, and future.
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Filtering Surgery↗
A year is a short time in glaucoma.
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Child↗
Bilateral angle closure glaucoma and visual loss precipitated by antidepressant and antianxiety agents in a patient with depression.
A 71-year-old woman with depression had been treated with an antidepressant (maprotiline) and antianxiety agents (clotiazepam and alprazolam). She had previously complained of ocular pain and blurred vision. However, thorough ocular examination was not performed at those times. On examination, visual acuity was no light perception OD and hand motion OS. Intraocular pressures were 33 mm Hg OU. Moderately dilated pupils, atrophic irises, shallow anterior chambers and closed angles were seen in both eyes. Despite treatment, her visual acuity decreased to no light perception bilaterally. Psychiatrists and ophthalmologists should be aware that antidepressants and antianxiety agents can precipitate angle closure glaucoma in susceptible eyes.
Adrenergic beta-Antagonists↗
Ocular hypertension and glaucoma associated with scleritis and uveitis. Aspects of epidemiology, pathogenesis and therapy.
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Antihypertensive Agents↗
Genotype-phenotype correlations in Axenfeld-Rieger malformation and glaucoma patients with FOXC1 and PITX2 mutations.
PURPOSE: To improve the understanding of Axenfeld-Rieger Malformation (ARM)-associated glaucoma and to determine the best glaucoma treatment for patients with ARM who have known genetic defects in FOXC1 or PITX2. METHODS: Clinical data were collected from patients with diagnosed ARM, in whom we had previously identified disease-causing mutations in either the FOXC1 or PITX2 genes, by examination of patient records and use of clinical questionnaires. One hundred twenty-six patients with ARM, representing 20 different probands, with FOXC1 and PITX2 alterations were included in the study. RESULTS: ARM-associated glaucoma is a bilateral anterior segment dysgenesis disease that affects males and females equally. Seventy-five percent of the patients with ARM who participated in this study had glaucoma that had developed in adolescence or early adulthood. Of note, the patients with nonocular findings were more likely to have PITX2 defects than FOXC1 defects. Glaucoma in only 18% of patients with either PITX2 or FOXC1 genetic defects responded to medical or surgical treatment (used solely or in combination). CONCLUSIONS: Patients with FOXC1 mutations have the mildest prognosis for glaucoma development, whereas patients with PITX2 defects and patients with FOXC1 duplication have a more severe prognosis for glaucoma development than do patients with FOXC1 mutations. In the present study, current medical therapies do not successfully lower intraocular pressure or prevent progression of glaucoma in patients with ARM who have FOXC1 or PITX2 alterations. This clinical study also provides useful diagnostic criteria to identify the gene responsible for ARM.
Anterior Eye Segment↗
Characterization of iris pigment epithelial cell for auto cell transplantation.
To establish auto iris pigment epithelial (IPE) transplantation, we characterized the properties of IPE cells and the method of culture using auto serum. Monkey and human IPE cells were obtained and cultured in several conditions, using auto, mouse, rabbit, bovine, or human serum. Immunocytochemical study was performed to confirm that the cells were epithelial in origin. The proliferation rate of the IPE was also calculated from fresh human IPE cells, which were obtained during filtering glaucoma surgery. Proliferation rate was also compared to that of retinal pigment epithelial (RPE) cells. Reverse-transcriptase and polymerase chain reaction for melanogenesis was performed, and the amount of pigment in the IPE cells was also calculated. Mouse and rabbit sera were not effective for the monkey IPE cell culture. Conversely, the cells grew well in the medium with auto, bovine, or human serum. Human IPE cells grew exponentially by the described methods and reached to 60,000 cells after about 4-5 weeks. When we compared them by proliferation rate, IPE cells were less proliferative than RPE cells. The gene expression for melanogenesis and the amount of pigment in the IPE gradually decreased through successive passages. Transplantation has been tried for the treatment of age-related macular degeneration using RPE from fetus or from eye bank eyes. However, focal rejection may play an important role in the clinical results. The establishment of auto IPE cell transplantation may improve the problem of rejection. In the present study, we established auto IPE cell culture using auto serum. The cultured IPE cell showed pigment epithelial cell properties until around five passages in both human and monkey.
Animals↗
Viscocanalostomy with mitomycin-C: a preliminary study.
PURPOSE: To compare the results of viscocanalostomy with and without mitomycin-C (MMC). METHODS: Retrospective results of 15 standard viscocanalostomy (VCO) operations (Group 1) were compared with the prospective results of 15 VCO operations performed with intraoperative adjunctive MMC (Group 2). MMC (0.2 mg/mL) was applied over and under the superficial scleral flap for 3 minutes in Group 2 before the deep flap was prepared. Each patient was followed up for at least 1 year, and results of examinations in the first 12 months were used in the statistical comparison of the two groups. Surgical success was defined as intraocular pressure (IOP) < or = 18 mmHg. RESULTS: Preoperative mean intraocular pressures (IOP) in Group 1 and Group 2 were 35.3+/-11.0 and 39.1+/-8.9, respectively. Mean IOP levels at the 12th month were 14.4+/-2.6 and 11.9+/-4.0, respectively, showing a significant decrease in both groups (p<0.001). Postoperative IOP course appeared to be lower in the MMC group, however, the difference was not statistically significant (p=0.554). Complete success rates without medications were 40% in Group 1 and 67% in Group 2. No significant difference was found between the two groups in terms of early and late postoperative complications, pre- and postoperative number of antiglaucoma medications, and surgical success rates at the end of the study period (p>0.05 for all). A significant difference was verified between the two groups of eyes considering the conjunctival bleb types, as low-lying, localized blebs were the most frequent type in Group 1 and thin-walled, avascular blebs were more predominant in the MMC group (p=0.004). CONCLUSIONS: Intraoperative adjunctive MMC use might improve the long-term results of viscocanalostomy by facilitating subconjunctival filtration and might widen the indication range of the technique.
Adult↗
Low-dosage mitomycin C as an adjunct to trabeculectomy. A prospective controlled study.
PURPOSE: To assess the advantages and adverse effects of intraoperative low-dose Mitomycin C in filtering glaucoma surgery. METHODS: Sixty eyes of 48 patients undergoing surgery for uncontrolled glaucoma were randomized to two groups: one underwent standard trabeculectomy, the other had trabeculectomy with intraoperative application of 0.1 mg/ml mitomycin C. Follow-up was at least one year. RESULTS: The success rate (IOP < 18 mmHg) was 96.6% in the mitomycin C group and 73.3% in the control group. Mean IOP at one year of successful cases was 11.1 +/- 3.1 mmHg in the mitomycin C group and 16.4 +/- 6.1 mmHg in controls (p < 0.0001). Two patients in the mitomycin C group (6.6%) and six (20%) in the control group needed antiglaucomatous drugs to keep IOP below 18 mmHg. CONCLUSIONS: Mitomycin C is a useful adjunct to glaucoma surgery. Adverse effects at the dosage used are mainly due to hypotony and are preventable with two-layer suture. Low-dose mitomycin C may be useful in standard primary trabeculectomy.
Administration, Topical↗