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PubMedDate not supplied

Clinical evaluation of the effect of mitomycin-C in re-operation for primary open angle glaucoma.

The aim of the study was to evaluate the effect of mitomycin-C (MMC) in a second antiglaucoma operation after failure of the first operation. We assessed 46 patients (26 male, 20 female, mean age 64.2 years) with high intraocular pressure (IOP) (mean 32.4 +/- 5.2 mmHg) despite previous trabeculectomy (Tr-Ec) one to three years earlier and topical or systemic medical treatment. All patients underwent a second Tr-Ec and were randomly divided into two groups: group A, 24 patients, underwent a second Tr-Ec with MMC and group B, 22 patients, also underwent a second Tr-Ec but without MMC. Postoperative complications included: shallow anterior chamber (duration > 1 week), group A 29.2%, group B 13.6%; chroidal effusion, group A 8.3%, group B 0%; cystic degeneration of conjunctiva, group A 16.6%, group B 4.5%; transient maculopathy, group A 12.5%, group B 0%. IOP control (< or = 20 mmHg after 18 months) was: group A 20 patients (83.3%) with mean 12.5 +/- 3.2 mmHg and group B 13 patients (63.6%) with mean 19.6 +/- 6.1 mmHg. In conclusion, the use of MMC in re-operation for primary open-angle glaucoma is associated with a higher rate of and more severe postoperative complications than Tr-Ec alone. However, it achieves significantly lower IOP in a larger number of patients.

Administration, Topical↗
PubMed2006

Recurrent intraocular pressure elevation during hemodialysis in a patient with neovascular glaucoma.

PURPOSE: To report a patient with symptomatic intraocular pressure (lOP) elevation in an eye with neovascular glaucoma (NVG) during hemodialysis. METHODS: Case report. RESULTS: Recurrent episodes of severe ocular pain and elevated IOP in the NVG eye were noted during hemodialysis in a 29-year-old man. The patient was recently diagnosed at our ophthalmology clinic with NVG due to central retinal vein occlusion. IOP was temporarily controlled after the Ahmed valve implantation. However, after the fibrous membrane developed and occluded the tip of the Ahmed valve, IOP elevation during hemodialysis recurred. Further treatments with intravenous mannitol, oral carbonic anhydrase inhibitor, topical antiglaumatic agents and subconjunctival 5-fluorouracil (5-FU) injections all failed to control relapsing pain and IOP elevation. Eventually, evisceration and hydroxyappatite implantation were performed. CONCLUSIONS: Physicians must be alert to the possibility of IOP elevation in glaucomatous eyes during hemodialysis.

Adult↗
PubMed1999

Oral prednisone in guarded filtration procedures supplemented with antimetabolites.

BACKGROUND AND OBJECTIVE: To evaluate whether a three-day course of oral prednisone perioperatively improves the surgical outcome of guarded filtering procedures supplemented with antifibrosis agents. DESIGN, MATERIALS AND METHODS: A prospective, randomized, double-masked, placebo-controlled, clinical trial was designed. Adult patients with non-inflammatory glaucoma undergoing a guarded filtration procedure supplemented with antimetabolite were enrolled. Patients received a three-day course of prednisone (50 mg BID) or placebo perioperatively. The main outcome measures were intraocular pressure (IOP) and number of antiglaucoma medications. Surgical success was defined before data collection according to two different criteria: "success-I": IOP level < or = 15 mmHg with no more than one anti-glaucoma medication, and "success-II": IOP reduction of at least 20% of baseline level with no more than one antiglaucoma medication. RESULTS: Thirty-five subjects were enrolled. Seventeen patients were treated with prednisone and eighteen with placebo. Mean follow-up was 9.2 months +/-6.2 months. The probability of success-I at 9 months was 63.0% in the study group and 65.6% in the control groups (p>0.05). The probability of success-II at 9 months was 60.2% in the study group and 55.0% in the control groups, (p>0.05). The difference in frequency of postoperative complications between groups was not statistically significant. The most common complication was choroidal detachment (n=2) in the prednisone-treated group and bleb leak (n=2) in the control group. CONCLUSION: The perioperative use of oral prednisone did not alter the surgical outcome of filtering procedures associated with antifibrosis agents in this population of glaucoma patients.

Administration, Oral↗
PubMed1997

Surgical management of coincident cataract and glaucoma.

Surgical management of coincident cataract and glaucoma has become very common for ophthalmic surgeons. As the medical options continue to improve, many patients with glaucoma do not require surgical intervention until the time of cataract extraction. Therefore, combined glaucoma procedures are becoming increasingly common. With the advent of small-incision phacoemulsification and trabeculectomy with releasable sutures and antimetabolites, techniques have improved considerably in the recent decade. This article discusses many of the important topics as they relate to this subject. It is not a comprehensive review, but rather discusses the literature over the scanning period of this periodical.

Cataract↗
PubMedDate not supplied

[Refractory glaucoma: peculiarities of treatment].

Refractory glaucoma is a clinical variety of glaucoma remarkable for its resistance to therapy. This determined special approaches to choice of drugs and methods ensuring a stable hypotensive effect as one of the conditions of preserving the visual functions. Original methods for surgical treatment of refractory glaucoma are proposed. New effective operations prevent excessive cicatrices at the site of intervention, one of the major causes of failure of antiglaucoma operations. Ultrasonic cyclodialysis is an effective method for surgical treatment of glaucoma in an aphakic eye. A principally new approach to treatment of refractory glaucoma is based on the use of high-frequency focussed ultrasound, a noninvasive method (sclerocyclodestruction) for attaining the hypotensive effect. The efficiency of the natural cytokine complex in the treatment of refractory glaucoma is due to effects of immunopeptides on repair processes at the site of intervention, which inhibit cell growth and prevent excessive development of cicatricial tissue round newly created routes of humor discharge.

Cicatrix↗
PubMed1998

[Studies of mechanism of malignant glaucoma using ultrasound biomicroscope].

OBJECTIVE: To study the mechanism of malignant glaucoma using ultrasound biomicroscope (UBM) combined with general A scan and to observe the conditions of cilio-lens block in living eyes at the realtime when malignant glaucoma is occurring. METHODS: 31 eyes from 27 patients with malignant glaucoma were evaluated and 54 normal eyes and 72 eyes of primary angle-closure glaucoma were studied as the controls. RESULTS: Of the 31 eyes, close attachments between the ciliary body and the lens were found in 18 eyes (58.1%) and slits between them were found in 13 eyes (41.9%) during the onset of malignant glaucoma. Ciliary body thickness increased significantly (P < 0.05). Fluid in the supraciliary space was found in 11 eyes. CONCLUSIONS: The mechanism of malignant glaucoma is associated with the abnormal relationship among anterior vitreous, ciliary process and lens periphery. Fluid in the supraciliary space makes the ciliary process closer to the lens periphery. It is one of the factors causing cilio-lens block. The ultrasound biomicroscopic image is a new better practicable method to diagnose malignant glaucoma during its onset compared with other methods at present used in the clinical work. It is much more valuable to differentiate the pupillary block glaucoma from malignant glaucoma by using ultrasound biomicroscopy.

Adult↗
PubMedDate not supplied

Filtering bleb modification with a THC:YAG (Holmium) laser.

OBJECTIVE: To present a method for remodeling oversized blebs using the THC:YAG laser and describe its use in treating hypotony and bleb leaks. METHODS: Retrospective medical record review of 13 patients who underwent holmium laser bleb revision. RESULTS: Thirteen eyes of 13 patients were analyzed. All the patients had an oversized bleb and 2 patients presented an associated late-onset leaking bleb. Mean preoperative IOP was 4.1 mm Hg. THC:YAG laser energy was applied to the bleb to remodel and/or close the leak. After a mean follow up of 17.3 months, the mean IOP was 7.84 mm Hg +/- 2.3. Postsurgery complications included hyphema and the inadvertent rupture of a conjunctival microcyst. Visual acuity improved in 9 of the eyes and remained stable in 4 of the eyes. CONCLUSION: The THC:YAG laser can be used effectively to sculpt large blebs, reduce symptoms associated with large blebs, increase IOP in hypotonous eyes, and under specific circumstances, close bleb leaks.

Adult↗