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PubMed1995

Preoperative mitomycin-C subconjunctival injection and glaucoma filtering surgery.

Intraoperative mitomycin-C application has been well accepted recently as a useful adjunctive procedure to enhance the filtering effect in glaucoma surgery. However, the exact dose of mitomycin-C left after such a procedure in the ocular tissue is variable and unclear. It is important to determine such residual because of potential long-term toxicity of mitomycin-C to the eye. Based on previous successful experience using preoperative mitomycin-C subconjunctival injection in the THC-YAG laser sclerostomy on rabbits, the effect of intraocular pressure (IOP) control and its clinical observation was studied in six eyes of six refractory and high risk glaucoma patients by subconjunctival 1.2 micrograms to 3.6 micrograms mitomycin-C injection 24 to 72 hours prior to classic, routine, limbal-based trabeculectomy surgery. After 18 months of satisfactory clinical observation of the first eye for IOP, functioning bleb appearance and smooth clinical course, the same procedure was used on an additional five eyes, with a follow-up period of more than five months. Average IOP was reduced from 27.8 mm Hg (range 24 to 34 mm Hg) preoperatively to 9.5 mm Hg (range 5 to 14 mm Hg) postoperatively, with a smooth clinical course. The advantages of such preoperative subconjunctival mitomycin-C injection are emphasized here.

Adolescent↗
PubMed1998

A novel method for controlling the quantity of mitomycin-C applied during filtering surgery for glaucoma.

The use of a sponge impregnated with mitomycin-C is an increasingly common practice in glaucoma surgery. The appropriate antibiotic concentration and exposure time have been considered in the literature, but not the exact amount to be used or the size of the sponge. The purpose of this study was to estimate the quantity of mitomycin-C contained in sponges prepared by different surgeons as compared to that in applicators of the type used in Schirmer's test graduation (5 x 5 mm). Four surgeons each cut and prepared 10 sponges for intraoperative use according to their usual method. The same procedure was performed with 10 Schirmer's test graduations. Each sponge and each graduation was immersed in a solution of mitomycin-C 0.2 mg/ml, and the quantity of antibiotic (microg) in each was calculated as the difference between wet and dry weight. The mean quantity (+/- SEM) of mitomycin-C contained in cut sponges was 9.6 +/- 4.4 microg (range 1.9-17.3), and the differences between surgeons were statistically significant (p<0.0001). The mean quantity of antibiotic in Schirmer's test graduation was 1.7 +/- 0.3 microg (range 1.1-2.5), and the differences between surgeons were not statistically significant (p=0.79). The quantities of mitomycin-C contained in sponges prepared for glaucoma surgery differed for a given surgeon and between surgeons. Thus, variations in the doses applied to the sclera could account for certain complications due to mitomycin-C. The use of a Schirmer's test graduation improves predictability for the quantity of mitomycin-C applied to the sclera.

Antibiotics, Antineoplastic↗
PubMed1997

[Does the dosage of mitomycin-C applied during filtering surgery of glaucoma vary with the individual surgeon?].

PURPOSE: The purpose of this study was to estimate the quantity of mitomycin-C contained in sponges prepared by different surgeons as compared to that in applicators of the type used in Schirmer's test graduation (5 x 5 mm). MATERIALS AND METHODS: Four surgeons each cut and prepared 10 sponges for intraoperative use according to their usual method. The same procedure was performed with 10 Schirmer's test graduations. Each sponge and each graduation was immersed in a solution of mitomycin-C 0.2 mg/ml, and the quantity of antibiotic (microgram) in each was calculated as the difference between wet and dry weight. RESULTS: The mean quantity (+/-SEM) of mitomycin-C contained in cut sponges was 9.6 +/- 4.4 micrograms (range 1.9-17.3), and differences between surgeons were statistically significant (p < 0.0001). The mean quantity of antibiotic in Schirmer's test graduation was 1.7 +/- 0.3 micrograms (range 1.1-2.5), and the differences between surgeons were not statistically significant (p = 0.79). CONCLUSION: The quantities of mitomycin-C contained in sponges prepared for glaucoma surgery differed for a given surgeon and between surgeons. Thus, variations in the doses applied to the sclera could account for certain complications due to mitomycin-C. The use of a Schirmer's test graduation improves predictability for the quantity of mitomycin-C applied to the sclera.

Antimetabolites↗
PubMed1994

The effects of glaucoma filtering surgery on the variability of diurnal intraocular pressure.

The results of this study indicate that filtration surgery reduces the mean diurnal IOP, the range of diurnal variation, and the day-to-day variability. The effect on the range is proportionally greater than on the other two parameters. Further study will be required to determine whether this selective effect makes surgical reduction of IOP any more effective in the prevention of further glaucomatous visual field damage than other therapeutic methods that lower mean IOP to the same degree.

Circadian Rhythm↗
PubMed1998

Is the single use of intraoperative 5-fluorouracil in filtering surgery for high-risk cases enough?

PURPOSE: To study the efficacy of the adjunctive use of a single intraoperative application of 5-fluorouracil (5FU) in eyes with poor prognoses for a successful outcome with a trabeculectomy. METHOD: Twenty-four patients (25 eyes) with a mean age of 63.7 +/- 14.7 years (range 27-86 years) and a history of one or more risk factors (age < 50 years, more than 3 years on topical medication, a previous failed filter, previous cataract surgery, uveitis, neovascular glaucoma) underwent trabeculectomy with the intraoperative application of 5FU on a sponge (25 mg/ml) for 5 min. The average follow-up was 10.1 +/- 5.5 months. RESULTS: The mean pre-operative intraocular pressure (IOP) was 24.7 +/- 6.2 mmHg and the mean post-operative IOP was 13.9 +/- 3.5 mmHg. Success, defined as an IOP within desired target levels for a particular eye, in the presence of a functioning filter, without supplementary medical therapy, was achieved in 56.5% of cases. CONCLUSIONS: Our results of successful filters in this group of patients with moderate- to high-risk characteristics approach similar figures quoted for trabeculectomies without the adjunctive use of intraoperative 5FU in eyes with poor prognoses with a similar length of follow-up. Though the numbers are small there is a trend that indicates that the intraoperative application of a single dose of 5FU alone may not be sufficient in eyes with moderate- to high-risk characteristics of failure of a trabeculectomy.

Adult↗
PubMed1997

Effects of mitomycin C on the expression of proliferating cell nuclear antigen after filtering surgery in rabbits.

BACKGROUND: The aim of the study was to evaluate the effects of mitomycin C on the cell replication activity in wound healing following experimental filtration surgery. METHODS: Trabeculectomy with or without application of mitomycin C was performed on albino rabbit eyes. At 1, 4, 7, 14, and 28 days after surgery, the expression of proliferating cell nuclear antigen, a marker of cell proliferation, in the filtering site was examined immunohistochemically using a streptavidin-biotin complex method. RESULTS: In control eyes that underwent trabeculectomy but did not receive mitomycin C, the number of immunoreactive cells increased 4-7 days after operation and decreased markedly at around 14 days. The filtering site was obstructed histologically at 4-7 days after operation. In the mitomycin C-treated eyes, immunoreactive cells appeared 4 days after surgery but disappeared by 7 days at the surgical site. The number of immunoreactive cells in the treated eyes was much lower than that in control eyes. CONCLUSION: The cell replication activity was markedly inhibited by administration of mitomycin C. The filtering site remained open for 28 days after surgery, whereas it was completely obstructed within 7 days in control eyes. Immunocytochemistry for proliferating cell nuclear antigen, as used in this study, is a simple and reliable method for detection of cell replication activity.

Animals↗
PubMed1987

Internal sclerectomy for glaucoma filtering surgery with an automated trephine.

A technique is described for performing full-thickness glaucoma filtering operation from within the anterior chamber. The procedure utilizes an automated trephine, designated the "trabecuphine," that is capable of simultaneous cutting and irrigation. The trabecuphine is brought into the anterior chamber through a limbal incision 180 degrees away from the planned filter site. The trephine is passed across the anterior chamber, above the iris, and into the angle to perform the sclerotomy. This procedure was performed successfully in 13 eyes of seven cynomolgus monkeys. Complications included two small hyphemas that cleared completely. Other complications such as flat anterior chamber, corneal damage, iridodialysis, conjunctival buttonhole, and cataract formation did not occur. Internal scleral trephination may offer another alternative in the surgical management of patients with intractable glaucoma.

Animals↗
PubMed1986

Temporary visual loss with ciliary body detachment and hypotony after attempted YAG laser repair of failed filtering surgery.

Ciliary body detachment, hypotony, and visual loss developed within one month after an attempt to reopen a closed filtering bleb with YAG laser treatment. The patient was a 68-year-old black woman who had a previously functioning thermal sclerostomy. YAG laser energy delivered to the sclerosed filtering site ab interno was unsuccessful in restoring patency to the filtering site as judged by clinical examination. Because of hypotony, all glaucoma medications were discontinued. Resolution of the ciliary body detachment with return of vision and stable intraocular pressures occurred after three weeks of intensive topical and systemic corticosteroid treatment.

Aged↗
PubMed1992

Recurrent choroidal detachment following timolol therapy in previously filtered eye. Choroidal detachment post filtering surgery.

A 64-year-old patient with open-angle glaucoma was treated with timolol following two unsuccessful filtering procedures. While on timolol therapy, she developed three episodes of choroidal detachment, hypotony and shallow anterior chamber. These findings resolved upon cessation of timolol and reappeared on 3 occasions shortly after reinstitution of the beta blocker therapy.

Choroid Diseases↗
PubMed1991

Reducing corneal toxicity of 5-fluorouracil in the early postoperative period following glaucoma filtering surgery.

To gain a better understanding of the relationship between postoperative 5-fluorouracil administration and corneal complications associated with its use, we analysed 43 consecutive filtering procedures in which it had been employed. Nine of the 43 eyes had corneal complications during that period. At the end of the three-month period, these corneal complications had all resolved. There was no correlation between postoperative intraocular pressure lowering and incidence of corneal complications. A low dose of 5-fluorouracil, and early recognition and treatment of corneal toxicity associated with its use may reduce corneal complications while maintaining filtration in eyes with poor surgical prognosis.

Aged↗
PubMed1995

[Intraocular pressure after filtering operation or combined filter-cataract operation].

BACKGROUND: The prevalence of glaucoma is 2% and of cataract 25% in patients at the age of 65 to 75 years. To this moment the discussion is open about the optimal therapy when there is simultaneous cataract and glaucoma. We evaluated and compared the intraocular pressure and the visual acuity in patients with filtering-surgery and combined surgery (= filtering surgery plus simultaneous cataract surgery). METHOD: In a retrospective study 56 eyes of 45 patients operated by filtering surgery and 46 eyes of 40 patients operated by combined surgery were examined. RESULTS: Patients with combined surgery showed significant higher frequency of fibrin in the anterior chamber compared to patients with filtering-surgery. After 12 months there was no significant difference in intraocular pressure between both groups. The IOP of the last examination was 16 +/- 4 mm Hg in eyes with combined surgery and 14 +/- 4 mm Hg in eyes with filtering surgery. Eyes with combined surgery showed an increase of visual acuity from 0.2 +/- 0.2 to 0.4 +/- 0.3, eyes with filtering surgery a decrease of visual acuity from 0.7 +/- 0.3 to 0.6 +/- 0.3. CONCLUSION: Combined surgery is perioperatively associated with a higher frequency of complications, but showed 12 months postoperatively equal values of regulated intraocular pressure.

Aged↗
PubMed1994

[Initial experience with the use of mitomycin C in anti-glaucoma filtering surgery].

The authors report on their initial experience with the use of peroperative administration of mitomycin C (0.5 mg/ml for a period of 5 mins.) in complicated cases of glaucoma. In 14 eyes of 15 with a mean observation period of 8 months compensation of the intraocular pressure was achieved. In one eye 5 months after a filtering operation transplantation of the cornea was performed with secondary implantation of the posterior-chamber intraocular lens, decompensation of the intraocular pressure was treated 11 months after the filtering operation by cyclocryotherapy. Mitomycin C is a promising substance which improves substantially the prognosis of complicated cases of glaucoma.

Adult↗
PubMed1979

Filtering surgery in children: barriers to success.

The use of trabeculectomy in advanced pediatric glaucoma is reviewed. Intraocular pressure was controlled in only 50% of the patients, and the best visual results was 20/200. Complications of vitreous loss, scleral collapse, ectasia, retinal detachment, and endophthalmitis were encountered. No evidence was found to support the claim that in the seriously compromised buphthalmic eyes, trabeculectomy is safer than other filtering operations since it filters under a scleral flap.

Adolescent↗
PubMed1986

Topical fluorouracil. II. Postoperative administration in an animal model of glaucoma filtering surgery.

Unilateral posterior lip sclerectomies were performed in ten owl monkeys. Five milligrams of fluorouracil was injected subconjunctivally in each operated eye immediately after surgery. Three drops (approximately 2.4 mg/drop) of fluorouracil were instilled ten minutes apart in each operated eye twice daily on postoperative days 1 through 7 and once daily on postoperative days 8 through 15, 17, 19, and 21. One monkey died on the seventh postoperative day; its death could not be attributed to systemic fluorouracil toxicity. All of the operated eyes had filtering blebs after the full course of fluorouracil, but seven also had corneal epithelial defects. By the seventh postoperative week, two of the operated eyes manifested moderately severe corneal opacification. Ten weeks postoperatively, the electroretinographic a- and b-wave amplitudes averaged 17% and 12% less, respectively, in the seven operated eyes without clinically significant corneal opacification than in the unoperated fellow eyes. Only two eyes had blebs after the 12th postoperative week. Histopathologic examination was performed on five eyes, of which only two revealed patent sclerostomies. Although topical fluorouracil appears to delay bleb scarring, the corneal findings suggest that it may be more toxic than subconjunctival fluorouracil.

Administration, Topical↗
PubMed1987

Complications of subconjunctival 5-fluorouracil following glaucoma filtering surgery.

The antimetabolite 5-fluorouracil (5-FU) has been used to inhibit fibroblastic growth to increase the success rate in glaucoma filtration surgery. Subconjunctival 5-FU can have adverse side effects. This paper describes two cases in detail of the ocular side effects of 5-FU. The first case is representative of the ocular surface problems. The second case deals with bleb leaks. Relative contraindications to 5-FU treatment are pre-existing ocular surface problems, early postoperative bleb leaks and fornix-based conjunctival flaps in filtering procedures. New drug delivery methods are presently being investigated to help decrease the adverse side effects and increase the efficacy of 5-FU.

Aged↗
PubMedDate not supplied

Scleral free auto-implant plug with mitomycin as limitation of trepanosclerectomy flow in glaucoma filtering surgery.

UNLABELLED: The purpose of this study is to evaluate the effect of trephination with free scleral auto-implant plug exposed to Mitomycin-C out of the eye, in surgical treatment of primary open-angle glaucoma (POAG), in comparison with efficacy of trabeculectomy with MMC (32 eyes with POAG of patients, younger than 55 years-group 1). Trephination with scleral auto-implant plug with MMC was done on 35 eyes of patients, younger than 55 years, with POAG (group 2). The postoperative follow-up was 28.52 +/- 8.78 months. SURGICAL PROCEDURE: A limbal 1.0 mm diameter trephination is made beneath the limbus-based conjunctival flap, a small iridectomy is performed. From the external layers of the trephine button one third of the corneoscleral thickness, in the form of a thin disc, is excised. The scleral disc, a free auto-implant, is dipped into liquid containing MMC with concentration 0.2 mg/ml for 5 minutes, outside the eye. Afterwards the scleral disc soaked with MMC is carefully irrigated with 150 ml of BSS and placed in the external part of the trephine fistula in primary position and stabilized with two interrupted 10-0 nylon sutures. The operation is ended as a typical trabeculectomy. The final success rate in terms of IOP (IOP < 14 mmHg) was 100%, without or with antiglaucoma medication, in both groups, but the number of postoperative complications was significantly lower in group 2. Trephination with free scleral auto-implant plug soaked with MMC may represent a viable alternative to trabeculectomy with MMC; the scleral plug may be taken out of the eye and exposed to antimetabolite outside the eye to minimize toxicity.

Antibiotics, Antineoplastic↗