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PubMed1997

Clinicopathologic features and surgical management of dissecting glaucoma filtering blebs.

Three patients are described in whom full-thickness glaucoma filtering procedures were complicated by marked extension of the bleb over the cornea, with subsequent symptoms that required surgical intervention. The surgical management in each case involved blunt dissection of the bleb from the cornea, with revision of the remaining portion of the bleb differing in each case according to the intraoperative findings. Light microscopic examination of one surgical specimen revealed a markedly attenuated epithelium covering hydropic corneal stroma. The authors postulate that the mechanism of formation involves aqueous humor dissection between corneal epithelium and stroma, leading to abnormal hydration of the superficial lamellae.

Aged↗
PubMed1997

[Surgical revision of failed filtering bleb with mitomycin C].

The revision of a failed filtering bleb using mitomycin C was performed in 40 eyes (28 eyes with primary open angle glaucoma and 12 eyes with secondary open angle glaucoma) in which the previous trabeculectomy using 5-fluorouracil had failed to control intraocular pressure (IOP). Presurgical IOP ranged from 21 approximately 36 mm Hg (average: 24.7 mmHg) with the maximum tolerable antiglaucoma medication. The follow-up period was at least 2 years (24 approximately 60, mean: 39.8 months). Mitomycin C (0.04%, 5 ml, 5 min) was applied under the subconjunctival space. After rinsing, the wall of the scarred bleb was incised in cases with a localized bleb, or the margin of the scleral flap was incised in cases without a filtering bleb. The conjunctival wound was closed with 10-0 Nylon sutures. IOP control under 21 mmHg was achieved in 53.4% without medication and in 60.2% with or without medication at 60 months. After repeating the same procedure, IOP control was obtained in 82.2% with or without medication at 60 months. The success rate in secondary open angle glaucoma was less than in primary open angle glaucoma. Complications such as flattening of the anterior chamber requiring reformation (8%), choroidal detachment (8%), hyphema (5%), and hypotonic maculopathy (5%) were less than after trabeculectomy but conjunctival wound separation (5%) occurred little more frequently.

Adult↗
PubMed1997

Primary valve malfunction of the Krupin eye valve with disk.

PURPOSE: To examine the management and possible causes of primary valve malfunction of the Krupin eye valve with disk. METHODS: The authors reviewed the results of 113 patients undergoing implantation of the Krupin eye valve with disk and identified eight patients with primary valve malfunction requiring surgical revision. RESULTS: Valve revision involved manipulation (n = 1 case), explantation of the malfunctioning valve and implantation of a new valve (n = 2), and amputation of the valve (n = 5). Six of eight patients had final intraocular pressures of < 21 mmHg on one or no medications at a mean interval of 15.9 months (range 5-36) after surgical revision. Transient postoperative hypotony was noted in three patients and chronic hypotony with loss of light perception in one patient. One explanted valve was examined and found to have partially fused leaflets. CONCLUSIONS: Surgical revision in cases of primary valve malfunction of the Krupin eye valve with disk may be accomplished relatively safely with an acceptable level of postoperative complications. The etiology of primary valve malfunction may be related to the sterilization process and prolonged storage before implantation.

Filtering Surgery↗
PubMed1997

Treatment of bleb leaks with transforming growth factor-beta in the rabbit model.

PURPOSE: The mechanism through which peribleb injection of autologous blood results in resolution of bleb leak in the rabbit model remains unclear. This study evaluates the clinical and histologic effects of peribleb injection of transforming growth factor-beta (TGF-beta) after leak induction in mitomycin-C-treated blebs. METHOD: Posterior lip sclerectomies treated with mitomycin-C were created in New Zealand White rabbits. On postoperative day 7, a standardized stab incision was performed on all blebs, and the eyes were randomized to receive a peribleb injection of either TGF-beta or of a balanced salt solution. RESULTS: Injection of TGF-beta was associated with the resolution of bleb leak and maintenance of a functioning bleb in 50% (4 of 8) of treated eyes. The remaining TGF-beta-treated eyes and control eyes demonstrated continued bleb leaks or bleb failures with intraocular pressure returning to preoperative levels. Histologic examination revealed increased peribleb cellularity and denser collagen deposition in the TGF-beta-treated eyes compared with that observed in control eyes. CONCLUSIONS: Peribleb TGF-beta injections may contribute to healing bleb leaks, but the injections do not appear in this model to be as useful as whole-blood injections.

Animals↗
PubMed1997

[The progression of primary operated glaucoma].

OBJECTIVE: Study of the causes responsible for glaucoma progression in patients operated for glaucoma. MATERIAL AND METHOD: A series of 185 patients operated for primary open angle glaucoma were followed up for a mean period of 3.2 years. 46 patients had evidence of glaucoma progression: insufficient filtration was recognized as the cause in 23 patients, while blockage of the filtering bleb was responsible for the rest of 23 cases. RESULTS: Progression of glaucoma was detected in 19.32% of patients with functional filtering bleb; 44.1% of patients with intraocular pressure between 16 and 21 mmHg did not show disease progression; 8 out of 23 patients needed a new trabeculectomy; internal obstruction of the bleb was demonstrated in 8 cases; 4 patients needed additional medical therapy; internal revision of the bleb (3 cases) and a new trabeculectomy gave the best results; external obstruction of the bleb was found in 15 patients; 7 had a diffuse fibrovascular proliferation and 8 had an encapsulated bleb. We used a new trabeculectomy for diffuse fibrovascular proliferation and a cystotomy or a cystectomy for encapsulated bleb. The results were good in almost all cases. CONCLUSIONS: Glaucoma progression appears even with postoperative intraocular pressures within statistical normality; identification of the causes responsible for glaucoma progression insures individualized treatment with constant good results.

Combined Modality Therapy↗
PubMed1997

Simultaneous use of mitomycin-C with Baerveldt implantation.

BACKGROUND AND OBJECTIVE: To evaluate the outcome of Baerveldt implantation with adjunctive mitomycin-C in cases of complicated glaucoma. PATIENTS AND METHODS: The authors reviewed the charts of all patients who had undergone Baerveldt implantation with mitomycin-C between January 1993 and March 1995. Success was defined before data collection as an intraocular pressure (IOP) between 5 and 21 mm Hg, with or without medications. The success rate was calculated using the Kaplan-Meier actuarial method. RESULTS: Twenty-nine patients were identified. The mean preoperative IOP was 33.6 mm Hg, with an average of 2.0 antiglaucoma medications. The probability of success at 6 and 12 months for patients who received mitomycin-C during Baerveldt implantation was 82.4% and 73.3%, respectively. Choroidal effusion with a flat anterior chamber (10.3%), corneal edema (6.8%), and conjunctival erosion (6.8%) were the most frequent complications. CONCLUSION: In this retrospective series of complicated glaucoma, the implantation of a Baerveldt drainage device with adjunctive mitomycin-C had a satisfactory outcome. The complications encountered and the clinical efficacy were comparable to those of previously reported series in which mitomycin-C was not used.

Antibiotics, Antineoplastic↗
PubMed1997

The effect of intraoperative injection of hyaluronan under a one-piece glaucoma filtration implant in the rabbit eye.

The effect of a single intraoperative injection of hyaluronan on intraocular pressure (IOP) and postsurgical tissue healing was evaluated on 18 rabbits with an aqueous drainage implant. During the follow-up period IOP was recorded and analysed. Furthermore, inflammatory reaction and appearance of the fibrous tissue around the implants were studied in histological sections. In both the hyaluronan and control groups the operation lowered the average IOP statistically significantly for the whole follow-up period when compared with preoperative values. From days 7 to 60 the mean IOP values of the hyaluronan injected eyes stayed at a lower level than in the control eyes, but with no statistical difference between the 2 groups. The connective tissue layer around the implants appeared less dense during the first 17 postoperative days in the sodium-hyaluronate group; in addition, the inflammatory cell reaction showed a tendency to remain acute longer.

Animals↗
PubMed1998

Bolstering Sisyphus.

Explore the source record for details and available documents.

Antihypertensive Agents↗
PubMed1998

Molteno implant with mitomycin C: intermediate-term results.

PURPOSE: The authors examine the intermediate-term effects of adjunctive intraoperative mitomycin C (MMC) in a cohort of patients who received double-plate Molteno implants for complicated glaucomas. METHODS: A consecutive series of 21 patients who received MMC 0.5 mg/ml for 5 minutes as an adjunct to a double-plate Molteno implant was compared by life-table analysis to a historical control group of 18 patients who received either no adjunct or 5-fluorouracil (5-FU) but no MMC. RESULTS: At three years follow-up, 35% (95% confidence interval (CI), 15-57%) of patients who received MMC avoided failure criteria of intraocular pressure (IOP) less than 6 mm Hg or more than 21 mm Hg, addition of glaucoma medication, reoperation for glaucoma, or tube removal. Seventeen percent (95% CI, 4-37%) of patients in the control group at three years follow-up met similar criteria (p = 0.039). No late complications of tube erosion were seen in the MMC group. CONCLUSION: Intraoperative MMC offers an increased likelihood of a two- to three-year period of medication-free IOP control in patients undergoing double-plate Molteno implants, compared to similar patients receiving 5-FU or no adjunctive antimetabolite therapy.

Adult↗
PubMed1998

Costs of treating primary open-angle glaucoma and ocular hypertension: a retrospective, observational two-year chart review of newly diagnosed patients in Sweden and the United States.

PURPOSE: The objective of this study was to investigate what treatment strategies prevail in different countries for patients newly diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH) only and initiated on treatment with beta-blockers, and to estimate the total direct cost of treatment for two years. In addition, differences in costs between and within the countries and the determinants of variations in costs across patients were examined. MATERIALS AND METHODS: The authors performed a retrospective medical record analysis in several academic and office-based study centers in Sweden and the United States. Standard costs for each resource item were determined and applied to all centers within the country. Differences in treatment costs within the countries are thus the effect of differences in treatment strategies, not of differences in prices. RESULTS: There was considerable variation between the centers of each country. Sweden had a higher number of surgical interventions, which may be explained by the fact that the Swedish cohort had a higher mean intraocular pressure (IOP) at baseline and a higher proportion of patients with definite POAG and exfoliation glaucoma. However, in both countries the mean IOP at study end was approximately 18 mm Hg. Total direct costs for two years were 15,119 SEK (US$2,160; $1US = 7 SEK) and $2,109, respectively. In a multiple regression analysis, the estimated effects of baseline IOP and of IOP change after treatment initiation on treatment costs were positively and negatively significant, respectively, in both countries. CONCLUSION: Despite differences in baseline diagnosis and in treatment strategies, mean IOP was decreased to 18 mm Hg in both countries. Baseline IOP was positively correlated with treatment costs, while the initial IOP-lowering effect of treatment was negatively correlated with two-year costs.

Adrenergic beta-Antagonists↗
PubMed1998

Use of autologous Tenon's capsule and scleral patch grafts for repair of excessively draining fistulas with leaking filtering blebs.

PURPOSE: To report the use of autologous Tenon's and partial-thickness scleral tissues for patch graft revisions of excessively draining fistulas associated with leaking filtering blebs. METHODS: Appropriate sized pieces of autologous Tenon's tissue and partial-thickness scleral tissue were dissected near the surgical sites and used as patch grafts to effectively repair excessively draining fistulas with leaking filtering blebs. RESULTS: Both Tenon's and partial-thickness scleral patch grafts were useful in adequately closing the excessively draining fistulas. CONCLUSION: Autologous Tenon's and scleral tissue patch grafts appear to be safe and effective for the repair of excessively draining fistulas, and are useful when patch grafts are unexpectedly needed.

Aged↗