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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↗
PubMed1976

Valve implants in filtering surgery.

A valve implant for glaucoma incorporated upper and lower intraocular pressure limits for outflow. The device consisted of an open Supramid tube sealed to a Silastic tube with a slit valve. The valve implants had opening pressures of 11 to 16 mm Hg and closing pressures 1 to 3 mm Hg lower. A surgical technique was developed in monkey eyes and applied later in modified form to three patients with glaucoma. In four of seven monkey eyes the implants remained in place and were patent for over one year. Follow-up studies were carried out for over six months in the three patients. In two patients the valve implants were functioning with controlled intraocular pressures. In one patient the implant migrated posteriorly. This was replaced by using a new valve and a buried fixation suture and has since functioned without problem. The valve implants were well tolerated and offered possibilities for predictable intraocular pressures after glaucoma surgery.

Adolescent↗
PubMed1980

Aqueous humor changes after experimental filtering surgery.

We studied aqueous humor of rhesus and owl monkeys for its effect on the growth of subconjunctival fibroblasts in tissue culture. Aqueous humor samples obtained before glaucoma surgery inhibited the initiation of growth of fibroblasts. However, postoperative aqueous humor samples supported growth of fibroblasts. The change in aqueous humor physiology lasted for up to two months after glaucoma surgery. Our study indicated that possibly material added to the postoperative aqueous humor inactivates an inhibitor normally present in primary aqueous humor. An alternative explanation would be that primary aqueous humor, in contrast to secondary aqueous humor, lacks sufficient nutrient material to support fibroblast growth in tissue culture.

Animals↗
PubMed1983

Long-term results of valve implants in filtering surgery for eyes with neovascular glaucoma.

Filtration surgery was performed with a pressure-sensitive, unidirectional valve implant in 79 eyes with neovascular glaucoma. The device consisted of an open Supramid tube (outside diameter 0.58 mm) sealed to a Silastic tube with a slit valve. The Supramid tube was inserted at the corneoscleral limbus 1 to 4 mm into the anterior chamber. The Silastic portion was located under a scleral flap. Of the 79 eyes, 53 had postoperative intraocular pressures less than or equal to 24 mm Hg after a mean follow-up period of 23.7 +/- 10.9 months. Bleb revision for external scarring was required in ten of these 53 eyes and postoperative medical therapy was required in 26. The valve implant failed to control intraocular pressure in 26 of the 79 eyes. Failure was secondary to scarring of the external bleb in 18 eyes and to closure of the internal Supramid tube in five eyes. Mortality during the follow-up period was high: 12 of the 53 successfully treated patients and five of the unsuccessfully treated patients died.

Adolescent↗
PubMed1993

Conjunctival structure and cell counts and the results of filtering surgery.

We evaluated perioperative conjunctival biopsy specimens in 28 consecutive patients with primary open-angle glaucoma undergoing trabeculectomy who had not undergone previous intraocular surgery. We found six months postoperatively that the number of goblet cells was significantly greater (6.40 +/- 5.40 vs 1.68 +/- 1.60 per field of view; P = .004, Student's t-test) in patients with easier postoperative intraocular pressure control (intraocular pressure < or = 15 mm Hg with zero to two glaucoma medications) than in patients with more difficult intraocular pressure control (> 15 mm Hg with three or more glaucoma medications). No statistical differences between groups were observed in mast cells, neutrophils, eosinophils, macrophages, plasma cells, lymphocytes, or fibroblasts (P > .05). Also, no statistical difference between groups existed in conjunctival structure, including mucopolysaccharide and collagen composition, vascular density, or epithelial thickness (P > .05). This study suggests that the number of conjunctival goblet cells may be related to intraocular pressure control after trabeculectomy.

Adrenergic beta-Antagonists↗
PubMed1984

Long-term results of silicone tube in filtering surgery for eyes with neovascular glaucoma.

We operated on 59 eyes with advanced neovascular glaucoma (37 eyes in diabetic patients and 22 eyes in patients with central retinal vein occlusion) using a trabeculectomy technique that includes a simple silicone tube as the draining element. Mean (+/- 1 S.D.) intraocular pressure preoperatively was 57 +/- 8.7 mm Hg. During follow-up periods ranging from one to five years, the mean intraocular pressure decreased to 27 +/- 16.5 mm Hg. Adequate control of intraocular pressure (24 mm Hg or less) was achieved in 37 eyes (63%). Only four eyes required enucleation. Nine silicone tubes had to be removed because of necrosis of the scleral flap and conjunctival perforation or because they were expulsed. Surgery relieved the severe ocular pain even when intraocular pressure was not satisfactorily controlled.

Adult↗
PubMed1987

Chronic and recurrent choroidal detachment after glaucoma filtering surgery.

Chronic and recurrent choroidal (ciliochoroidal) detachments developed following glaucoma filtration surgery in 14 eyes of 13 patients during a 9-year period. Three specific subgroups were identified: recurrent, inflammatory, and chronic (present for more than 6 months). The factors that may be related to the development of chronic and recurrent choroidal detachments included patient age (mean, 68.8 years), systemic hypertension or atherosclerotic heart disease, hyperopia, aqueous suppressant therapy, ocular inflammation, and full-thickness filtration surgery. A total of 46 choroidal detachments in 14 eyes were recorded and required drainage of suprachoroidal fluid on 34 occasions. All eyes developed visually significant cataracts, and complete resolution of the recurrent or chronic choroidal detachment occurred following cataract extraction in six eyes. Treatment of chronic and recurrent choroidal detachments should include intense therapy of ocular inflammation, discontinuation of medications that can incite ocular inflammation, discontinuation of topical and systemic aqueous suppressant therapy, and when a visually significant cataract is present, cataract extraction combined with a choroidal tap should be performed.

Acetazolamide↗