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PubMed2003

[The failure causes of non-penetrating trabecular surgery and reoperation].

OBJECTIVE: To study the failure causes of non-penetrating trabecular surgery (NPTS) with SKGeL (a hyaluronic acid biological gel) implant and the surgical method of reoperation. METHODS: Repeated operation with mitomycin (MMC) through the initial surgical site was performed on 13 failure cases (13 eyes) that had undergone NPTS with SKGeL implant. The blockage of filtration tract was removed and the anterior chamber was intact during the surgery. All of these cases were open-angle glaucoma. Before the repeated surgery ultrasound biomicroscopic (UBM) examination was performed on the primary filtering bleb, and the intraocular pressure (IOP) examination was followed after the repeated operation. RESULTS: The mean follow-up period was (14.0 +/- 5.8) months (6 to 24 months). The examination of UBM showed that the filtering bleb disappeared and there was a liquid chamber under the superficial scleral flap in every failure case. The filtration failure due to the scarring at conjunctiva-Tenon's capsule-superficial scleral flap interface in 9 cases, proliferative membrane formation on the trabecular surface in 3 cases, micro-penetration of the trabecula in 1 case. At the end of follow-up, the IOP of 10 cases was lower than 21 mmHg without medication, the mean IOP level was (14.1 +/- 3.7) mm Hg, the IOP of 1 cases was 15 mmHg with Betagen, another 2 cases failed again 6 months after the repeated surgery and underwent the trabeculectomy at last. The complications included hyphema in one case and micro-penetration of the tabecula in one case. CONCLUSIONS: The scarring at conjunctiva-Tenon's capsule-superficial scleral flap interface was the most important cause of NPTS with SKGeL implant failure. A repeated surgery with MMC through the initial surgical site may be a choice for the failure cases.

Adult↗
PubMed1999

[A preliminary report of a new technique: non-penetrating trabecular surgery].

OBJECTIVE: To evaluate the clinical effect of nonpenetrating trabecular surgery with sodium hyaluronate gel implant in Primary Open-Angle Glaucoma(POAG). METHODS: Twenty-four eyes of 22 patients with medically uncontrolled POAG were underwent nonpenetrating trabecular surgery with hyaluronate gel implant. The procedure was performed involing excising a deep-sclera tissue that flush with innerwall of Schlemm' s canal without opening the anterior chamber, then placing a 3 mm x 4.5 mm x 0.5 mm or 3.5 mm x 3.5 mm x 3.5 mm sodium hyaluronate gel implant under the scleral flap respectively. The postoperative Intraocular Pressure (IOP), Inflammation and fitering bleb were analysised. All of patients were undertaken ultrasound biomicroscopy (UBM) to evaluate the surgery site on postoperative 1-3 months. Mean follow-up was 3.9 +/- 2.2 months. RESULTS: The IOP decreased from a mean preoperative value of 24.4 +/- 9.1 mmHg to a mean postoperative value of 15.1 +/- 3.7 mmHg (P < 0.01). The number of anti-glaucomatous medications by topically or systemically was reduced from preoperative sorts of 2.8 +/- 1.4 to postoperative sorts of 0.7 +/- 1.0 (P < 0.01). The visual acuity remained stable, 6 eyes had IOP elevated and 2 eyes had occured hyphema. The complications such as flat chamber, inflammation and detachment of choroid were not observed. The UBM showed that the hyaluronate gel implant wasn't degraded and a transparent liquid space was formed under the scleral flap in all of patients on postoperatively 1-3 month. The filtering blebs were formed in some patients. CONCLUSION: Nonpenetrating trabecular surgery with hyaluronate gel implant can effectively lower IOP and reduce the number of anti-glaucomatous medications. No severe complications occured. With a simple postoperative nursing, it can be performed in clinic. It is proved to be a promising and new special technique to treat glaucoma.

Adolescent↗
PubMed2001

Diplopia after limited macular translocation surgery.

PURPOSE: Full macular translocation surgery relocates the fovea away from choroidal neovascularization, inducing significant postoperative torsional diplopia. In "limited macular translocation," a saline-induced retinal detachment is followed by scleral imbrication with mattress sutures and spontaneous retinal reattachment. In this study, diplopia was characterized in patients treated with limited macular translocation. METHODS: Two surgeons performed retinal translocation surgery on 250 patients over an 18-month time span. The extent and direction of the retinal translocation, and the amount and location of scleral imbrication, were recorded. All patients complaining of diplopia were referred for ocular motility evaluation and treatment. RESULTS: Thirteen (5.2%) patients complained of occasional or constant diplopia. Imbricating sutures were placed supero-temporally in all cases. Inferior foveal translocation ranged from 200 to 2115 microm (median, 1750 microm). Visual acuity ranged from 20/40 to 20/400 in the operated eye. Prism-and-cover testing underestimated the strabismus when compared with subjective testing. In 3 patients, there was no shift on alternate-cover testing despite binocular diplopia. Excyclotorsion ranged from 0 degrees to 16 degrees. Diplopia resolved in 10 cases with prism; 3 required an occlusive filter for distortion or aniseikonia. One patient underwent successful strabismus surgery to eliminate dependence on prism glasses. CONCLUSIONS: Limited macular translocation only rarely produces symptomatic diplopia. Suprisingly, traditional prism-and-cover testing does not reliably quantify the misalignment. This may result from the combination of a persistent macular scotoma and a repositioned fovea relative to the peripheral retina. Prism therapy is generally satisfactory in the absence of retinal distortion or aniseikonia.

Aged↗
PubMed1994

The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning.

BACKGROUND AND PURPOSE: Microemboli have been implicated in the etiology of neuropsychological deficits after cardiopulmonary bypass. This study examined the incidence of high-intensity transcranial signals (microemboli) and their relation to changes in neuropsychological performance after surgery. METHODS: Transcranial Doppler ultrasonography was used to measure middle cerebral artery blood flow velocity and detect microemboli. The number of high-intensity transcranial signals was determined and related to a neurological examination and absolute changes in neuropsychological performance as well as the number of patients considered to exhibit a neuropsychological deficit. Data were available on 100 consenting patients undergoing routine cardiopulmonary bypass. Fifty of the patients were randomly assigned to a procedure that included a 40-microns arterial line filter, and 50 had the procedure without any arterial line filter. RESULTS: Significantly more patients were found to have neuropsychological deficits in the group without the arterial line filter at both 8 days (P < .05) and 8 weeks (P < .03) after surgery. In addition, more "soft" neurological signs were found in the nonfiltered group 24 hours after surgery (P < .05). More high-intensity transcranial signals were found in the nonfiltered group, and the number of high-intensity transcranial signals was found to be related to the likelihood of a patient having a neuropsychological deficit at 8 weeks. CONCLUSIONS: These data suggest that neuropsychological deficits after routine cardiopulmonary bypass are related to the number of microemboli delivered during surgery. Furthermore, the numbers of microemboli may be reduced by including a 40-microns filter on the arterial line.

Cardiopulmonary Bypass↗
PubMed1999

Digital radiography of interproximal bone loss; validity of different filters.

The aim of the present study was to compare linear measurements of interproximal bone loss on digitized radiographic images after application of different filters to the gold standard of intrasurgical measurements. Immediately before surgery, 50 radiographs of 50 periodontally-diseased teeth exhibiting interproximal bone loss, were obtained by a standardized technique in 33 patients. Intrasurgically, the distances from the cementoenamel junction (CEJ) to the alveolar crest (AC) and from the CEJ to the deepest extension of the bony defect (BD) were assessed. All radiographs were digitized with a flatbed scanner (resolution: 600x1200 dpi). Using the FRIACOM-soft-ware, the linear distances CEJ to AC and CEJ to BD were measured at 50 interproximal lesions from the digitized but unchanged radiographic images and also after use of 7 different basic image-processing modes (enhancement of contrast [dynamics], inversion, high-pass, enhancement of gray-level differences, mean value, histogram correction, spreading of grey values) with 11-fold magnification. Neither the measurement of the distance CEJ to AC on the unchanged images nor assessments with any of the filters revealed significant differences from the gold standard. Multivariate analysis of variance showed the respective filter (p=0.009), intrasurgical and radiographic assessments (p<0.0001), to statistically significantly, influence the difference between intrasurgical and radiographic measurements of the distance CEJ to BD. The underestimation of the intra-surgically assessed distance CEJ to BD by radiographic measurements ranged from 0.3+/-2.0 to 0.8+/-1.9 mm. The filter "mean value" underestimated interproximal bone loss statistically significantly more than the digitized but unchanged radiograph (p=0.05). In this study, basic digital manipulations (filters) of radiographic images failed to result in statistically significantly more valid measurements of interproximal bone loss when compared to the unchanged but digitized images. All radiographic assessments on the digitized images except for use of one filter (mean value) came close to the intrasurgical gold standard.

Adult↗
PubMed2002

Optimal flattening filter shape of a surface brachytherapy applicator.

As an alternative to standard treatment of superficial lesions with surgery and/or superficial/orthovoltage x-ray irradiation, radioactive moulds can be used. However, close proximity of the source to the treatment region leads to significant dose inhomogeneities in the tissue. Analytical and fast numerical methods have been developed that can calculate a corresponding flattening filter that evens out the dose distribution at the surface. Monte Carlo transport calculations were used to enable accurate treatment of the transport through the geometry. It was found that the use of pre-calculated transport parameters like dependence of the attenuation coefficient and scattering with depth is required for fast calculation of the flattening filter shape. Only 1-2 iterations were needed for a successful convergence to the filter shape that flattens out the dose distribution at the surface to within 1%. The developed methods are very general and could be applied with some minor modifications to other problems, where shaping of the irradiation field is required.

Algorithms↗
PubMed1998

Erbium: YAG laser trabecular ablation (LTA) in the surgical treatment of glaucoma.

BACKGROUND AND OBJECTIVE: Laser trabecular ablation (LTA) aims to remove trabecular tissue and to open Schlemm's canal in order to improve outflow facility in glaucomatous eyes. The purpose of our study was to investigate the pressure-reducing effect of LTA in chronic open-angle glaucoma 1 year following laser surgery. STUDY DESIGN/MATERIALS AND METHODS: Eleven eyes of 11 patients with chronic open-angle glaucoma were treated by circumscribed laser ablation of the trabecular meshwork. We used an Erbium:YAG laser (2.94 microm) with a quartz fiber contact endoprobe (320 microm core-diameter, 385 microm coating-diameter) applying 11-30 single neighbouring laser pulses (5-7 mJ) to the trabecular meshwork by an ab-interno approach. Laser procedure was gonioscopically visualized. RESULTS: Mean maximum intraocular pressure (IOP) of all 11 patients before LTA was 36 mmHg and dropped down to 22 mmHg after a mean follow-up of 12 months following LTA; this represents an IOP decrease of 38% (P=0.008). The average number of medications per eye dropped from 2.8 to 1.5 per eye (P=0.021). CONCLUSION: Although IOP lowering effect of Erbium:YAG laser trabecular ablation did not prove as effective as in filtering procedures, LTA might be a valuable alternative in glaucoma surgery especially in order to avoid conjunctival scarring and postoperative hypotony.

Aged↗
PubMed1997

Subconjunctival retention of C3F8 gas increased the success rates of trabeculectomy in young people.

In this study, the effect of subconjunctival retention of perfluoropropane (C3F8) gas on trabeculectomy was evaluated to determine if this maneuver would increase the success rate of the surgery. Thirty-two patients (under 35 years old) with a diagnosis of primary open-angle glaucoma or steroid-induced glaucoma were randomized into two groups to receive trabeculectomy: Group A (trabeculectomy alone, 16 eyes) and Group B (trabeculectomy with subconjunctival retention of 0.5 mL pure C3F8 gas, 16 eyes). The results showed that the typical appearance of a subconjunctivally retained C3F8 filtering bleb is highly distended in the first two weeks after surgery, followed by flattening and diffusing gradually. The average retention time of C3F8 gas within the subconjunctival space is 28 +/- 6 days. A higher success rate was noted in Group B than in Group A (94% versus 50%, p = 0.016) at a mean follow-up time of 12 months. However, there were no differences in complication rates and results of final visual acuity between the two groups (both groups had two patients lose more than two lines of vision, p = 1.0). Our study suggests that subconjunctival retention of C3F8 gas increases the success rate of trabeculectomy in young people in the intermediate-term (12 months) follow-up period.

Adult↗
PubMed1996

A placebo-controlled, double-masked evaluation of mitomycin C in combined glaucoma and cataract procedures.

PURPOSE: This study was performed to determine if adjunctive use of mitomycin C (MMC) would increase the success of combined phacoemulsification, intraocular lens implantation, and trabeculectomy surgery with releasable sutures. METHODS: Seventy-two eyes with cataract and glaucoma, requiring surgery for decreased vision, uncontrolled intraocular pressure, or to obtain a better view of the optic nerve, were randomized to receive a 2.5-minute subconjunctival exposure to either MMC (0.5 mg/ml) or placebo balanced salt solution. Postoperative evaluations at 3, 6, and 12 months were performed by a masked observer who recorded visual acuity, intraocular pressure, glaucoma medications, presence of filtering blebs, and complications. Endothelial cell counts were measured before and 3 months after surgery. RESULTS: The MMC group had significantly greater reduction in mean intraocular pressure through the first 12 months of follow-up (7.05-7.65 mmHg versus 2.62-3.84 mmHg; P = 0.001-0.028). In addition, through the first 6 months of follow-up, the MMC group required significantly fewer medications (0.4-0.5 versus 1.1-1.2; P = 0.002-0.004). Requirements for additional glaucoma surgery were less in the MMC group (4/ 36) than in the placebo group (7/35) (P = 0.301). Filtering blebs were significantly larger at 6 and 12 months (P = 0.002 and P = 0.001, respectively), and would leaks were more common (P = 0.101) in the MMC group. The mean decrease in endothelial cell count at month 3 was slightly, although not significantly, greater in the MMC treatment group (206.9 versus 91.3 cells/mm2* P = 0.377). CONCLUSION: The increased success of the glaucoma procedure in the MMC group together with relatively minor toxicity, suggests its use is beneficial in combined glaucoma-cataract surgery.

Aged↗
PubMed1997

Serum S-100 protein concentration after cardiac surgery: a randomized trial of arterial line filtration.

INTRODUCTION: Embolization of gaseous and particulate matter is incriminated in the neuropsychological morbidity of CPB and can be reduced by membrane oxygenators and arterial line filtration. It is not known if the use of arterial line filtration in conjunction with membrane oxygenators might have an additive effect in reducing cerebral injury. METHODS: Forty patients undergoing elective coronary artery surgery were prospectively randomized to a 43 microns heparin coated arterial line filter (Cobe Sentry) or to no filtration (control group). All operations were performed by one surgeon (DPT) using intermittent ischaemia with nonpulsatile CPB, a COBE CML membrane oxygenator and alpha-stat paCO2 management. Flow rates were maintained between 2.0 and 2.4 l-1 m2 per min with a perfusion pressure of 50-80 mmHg and a systemic temperature of 34 degrees C. Cerebral injury was defined by careful neurological examination and serial measurement of the serum concentration of S-100 protein (a highly specific astroglial cell derivative, elevated serum levels of which correlate with proven cerebral injury). RESULTS: There was no difference [mean (S.D.)] in the control and filter groups with respect to age [61(9) vs. 62(9) years], ejection fraction, number of grafts [2.8(0.6) vs. 2.6(0.7)] or CPB times [55(19) vs. 57(18) min]. Preoperatively, no patient had detectable S-100. In the postoperative period 23 of 40 patients (58%) showed elevated S-100 levels. At 1, 5 and 24 h the respective number of patients in the control and filter groups with elevated S-100 was (14 vs. 9), (4 vs. 0), (4 vs. 0)) (P < 0.05). No patient had overt cerebral injury. CONCLUSIONS: This study suggests that (i) subclinical cerebral injury is common (58% of patients in this study) even after apparently uncomplicated surgery with short CPB times; (ii) serum S-100 protein is a valuable marker for investigating potentially cerebral protective innovations during CPB; and (iii) arterial line filtration significantly reduces but does not eliminate cerebral injury.

Aged↗
PubMed1997

Delayed-onset endophthalmitis associated with conjunctival filtering blebs.

OBJECTIVE: The purpose of the study is to evaluate the causative organisms, treatment methods, and visual acuity outcomes of patients treated for delayed-onset endophthalmitis associated with conjunctival filtering blebs. METHODS: The medical records of 32 patients with conjunctival filtering bleb-associated endophthalmitis treated at the Bascom Palmer Eye Institute between 1989 and 1995 were reviewed retrospectively. Bleb-associated endophthalmitis was diagnosed at 1 month or more after surgery in all patients. Patients with bleb infections only but without, signs of intraocular infection were excluded from this series. RESULTS: Previous antimetabolite therapy was used in 20 patients, including mitomycin C in 14 and 5-fluorouracil in 6. Streptococcal species were the most frequently cultured organisms occurring in 15 (47%) of 32 eyes. Of the 32 patients, 30 received intraocular antibiotics. The initial treatment included a pars plana vitrectomy in 18 patients and a vitreous tap without vitrectomy in 12 patients. Two of three patients who presented with no light perception vision were treated by evisceration. Overall, 15 (47%) of 32 patients achieved a final visual acuity of 20/400 or better. Of those patients with Streptococcal species cultured from the eye, 6 (40%) of 15 had a visual acuity of 20/400 or better compared to 9 (52%) of 17 in patients with non-Streptococcal species. CONCLUSIONS: Delayed-onset endophthalmitis associated with conjunctival filtering blebs is a current and future concern, especially with increasing use of mitomycin C. The Streptococcal species are a common causative organism. Despite current treatment of these patients, the visual acuity outcomes generally are worse than in patients with acute-onset endophthalmitis after cataract surgery.

Adult↗
PubMed1998

[An experimental study on effects of biomembrane on prevention of filtering bleb adhesion in trabeculectomy].

OBJECTIVE: The study was designed to investigate the effects of biomembrane on experimental trabeculectomy. METHODS: A biomembrane was implanted under the scleral flap and the conjunctival flap in trabeculectomy in one eye of rabbits, while the fellow eye of the same rabbit without biomembrane implantation was the control. RESULTS: (1) The wound healing of the procedure reached its peak at 2-3 weeks after surgery, while the absorption of the biomembrane began at 6 weeks after surgery, and there was no tight adhesion between the biomembrane and the scar tissue, thus the filtering fistula was prevented from obstruction. (2) From the 2nd to the 7th week after surgery, the percentage of existing functional bleb in the experimental group was significantly higher than that in the control group (P < 0.05). (3) From the 1st to the 5th postoperative week, the decreasing of intraocular pressure in the experimental group was significantly greater than that in the control group (P < 0.05). CONCLUSION: The use of biomembrane in trabeculectomy can prevent the adhesion of filtering bleb and decrease intraocular pressure more effectively, and this study can provide experimental reference for the clinical use of biomembrane.

Animals↗
PubMed2001

Stereotactic lesional surgery for the treatment of tremor in multiple sclerosis: a prospective case-controlled study.

The effect of stereotactic lesional surgery for the treatment of tremor in multiple sclerosis was examined in a prospective case-controlled study. Surgery was not undertaken in 33 patients (72% of 46 cases referred for stereotactic surgery), two of whom died within 4 months of referral. Twenty-four multiple sclerosis patients were included in the study; 13 underwent surgery and were matched against 11 controls on the basis of age, sex, expanded disability system scores (EDSS) and disease duration. Assessments were carried out at baseline/preoperatively, and then 3 and 12 months later; these included accelerometric and clinical ratings of tremor, spirography, handwriting, a finger-tapping test, nine-hole peg test, tremor-related disability, general neurological examination, Barthel Activities of Daily Living (ADL) Index of general disability, EDSS, a 0-4 ataxia scale, Mini-Mental State (MMS) examination, speech and swallowing assessments and grip strength. Postoperative MRI scans demonstrated that tremor could be attenuated by lesions centred on the thalamus in seven cases, on the zona incerta in five cases and in the subthalamic nucleus in one case. Two patients developed hemiparesis and in two cases epilepsy recurred. Two surgical patients and one control patient died between the 3 and 6 months assessments. Both groups had a significant deterioration in EDSS but not Barthel ADL Index scores at 1 year, but the difference between the groups was not significant. Similarly, no differences between the groups' rates of deterioration of speech or swallowing or MMS were found. Significant improvements in contralateral upper limb postural (P2) and kinetic tremors, spiral scores and head tremor were detected at 3 and 12 months after surgery (but not handwriting or nine-hole peg test performance). Tremor-related disability and finger-tapping speed were also significantly better 12 months after surgery, the latter having significantly worsened for the control group. A 3 Hz 'filter' for postural (P2) upper limb tremor was detected by accelerometry/spectral analysis above which tremor was always abolished and at or below which some residual tremor invariably remained. Criteria for selecting multiple sclerosis patients for this form of surgery are discussed.

Activities of Daily Living↗
PubMed2006

Phacoemulsification in patients with previous trabeculectomy: role of 5-fluorouracil.

UNLABELLED: Cataract surgery in a patient with previous trabeculectomy is considered to have an adverse effect on the long-term survival of the filtering bleb. 5-Fluorouracil (5-FU) has been used in patients with a pre-existing bleb, undergoing cataract surgery, but there are no published reports for or against its use in such cases. This study was carried out to evaluate the protective role of subconjunctival 5-FU on the pre-existing bleb from trabeculectomy in patients undergoing phacoemulsification. METHODS: This retrospective study was carried out on patients with pre-existing filtering bleb from trabeculectomy for primary open-angle glaucoma who then underwent phacoemulsification at least 12 months after trabeculectomy. Data were collected for two groups of patients. Group 1 (22 patients) received 5-FU at the end of successful phacoemulsification, whereas group 2 (25 patients) did not receive it. The two groups were comparable with respect to age, gender, intraocular pressure (IOP), type of glaucoma, number of adverse risk factors present, and duration of follow-up. Any worsening of IOP control was analysed using mean IOP and mean change in the treatment for glaucoma. RESULTS: Mean IOP was comparable in the two groups, but there was a significant difference in mean change in glaucoma treatment between the two groups at 12 months postoperatively. Worsening of IOP control was seen in 13.6% of the patients in group 1 and in 36.4% in group 2 (P-value=0.03). CONCLUSION: Our study suggests that 5-FU has a protective effect on the functioning bleb and may be used routinely at the end of phacoemulsification in such cases.

Aged↗
PubMed1996

Hypotensive reactions to white cell-reduced plasma in a patient undergoing angiotensin-converting enzyme inhibitor therapy.

BACKGROUND: Hypotensive reactions to platelet transfusions performed with white cell (WBC)-reduction filters with negatively charged surfaces have been reported recently in patients taking angiotensin-converting enzyme (ACE) inhibitors. Experimental studies have shown that the filter material can activate bradykinin, which may cause symptoms in patients with reduced bradykinin catabolism. Symptomatic adverse reactions after the administration of fresh-frozen plasma (FFP) through a WBC-reduction filter have not been reported in a patient on ACE Inhibitor medication. CASE REPORT: A 58-year-old man with congenital coagulation factor V deficiency and hypertension treated with an ACE inhibitor was admitted for rehabilitation after orthopedic surgery. On 3 consecutive days, he received FFP through a WBC-reduction filter; within minutes of the beginning of each infusion, he experienced a drop in blood pressure, facial erythema, abdominal pain, and anxiety. When the infusions were stopped, symptoms quickly abated without treatment. Multiple prior transfusions of unfiltered FFP and FFP filtered through a WBC-reduction filter made by a different manufacturer, as well as subsequent transfusions of unfiltered FFP, had not produced such reactions. CONCLUSION: Facial flushing, hypotension, and abdominal pain after FFP administration in a patient on ACE inhibitor medication appeared to be associated with a specific type of WBC-reduction filter. This association and other reported studies suggest that special caution is warranted when patients who are treated with ACE inhibitors receive blood components administered through WBC-reduction filters capable of generating bradykinin.

Abdominal Pain↗
PubMed1999

Prognosis of primary ab externo surgery for primary congenital glaucoma.

BACKGROUND: The strategy of pressure reducing surgery in primary congenital glaucoma has changed over the last decade. Ab externo filtering procedures--for example, trabeculectomy or trabeculotomy combined with trabeculectomy, have now been accepted even as primary intervention. METHODS: The authors reviewed 61 eyes in 35 consecutive patients with primary congenital glaucoma, who underwent different types of initial ab externo surgery between 1988 and 1996 (median follow up 36 months) to determine the efficacy of different surgical techniques and the influence of various risk factors. RESULTS: Trabeculotomy was performed in 17 eyes (27.9%), trabeculotomy with trabeculectomy in 15 eyes (24.6%), and trabeculectomy in 29 eyes (47.5%). Regarding age, preoperative intraocular pressure, corneal diameter, ocular axial length, and incidence of corneal haze the subgroups were comparable. Success rates of trabeculotomy, trabeculectomy, and a combined procedure did not significantly differ when assessed by life table analysis. Patient age under 3 months (p = 0.014) and an ocular axial length of 24 mm or more (p = 0.016) proved to be major risk factors for primary ab externo surgery failure. A second operation was necessary in 20 of 61 eyes (32.8%) during follow up. CONCLUSION: Prognosis of primary ab externo glaucoma surgery in primary congenital glaucoma seems to be governed more by the individual course and severity of the disease than by modification of surgical techniques.

Age Factors↗
PubMed2002

Ultrasound biomicroscopy and its value in predicting the long term outcome of viscocanalostomy.

AIMS: To examine whether the early postoperative morphology at the site of sclerectomy, as visualised by ultrasound biomicroscopy (UBM), is an indicator of the mechanisms that lower intraocular pressure (IOP) and/or predictors of the long term outcome of viscocanalostomy. METHODS: 15 eyes of 14 patients with medically uncontrolled open angle glaucoma and no history of surgery underwent viscocanalostomy according to Stegmann's technique. Ultrasound biomicroscopy was performed during the first month after surgery. The following parameters were assessed: dimensions of the intrascleral "lake," presence of a filtering bleb, presence of a subconjunctival cavity or a suprachoroidal hypoechoic area, and the thickness of the residual trabeculocorneal membrane. A complete ophthalmological examination was performed the day before and the day after surgery. Follow up visits were scheduled 1 week, 4 weeks, 6 months, and 12 months after surgery. RESULTS: At 1 year successful control of IOP (<20 mm Hg) was achieved without further manipulation or medication in six of 15 eyes. The size of the intrascleral "lake" (average 0.62 mm(3)) did not correlate with later IOP; however, a visible route under the scleral flap and accidental perforation of the trabeculocorneal membrane were associated with long term lowering of IOP. Normal thickness of the trabeculocorneal membrane (0.10-0.15 mm) was indicative of IOP control with and without medication. When UBM showed an early collapse of the intrascleral cavity, control of IOP was not achieved. Other UBM findings did not predict long term function. CONCLUSION: In accordance with previous studies, the authors found that UBM examination is a useful method to evaluate outflow mechanisms after glaucoma surgery. This study shows that UBM imaging of external filtration during the early postoperative period can be used to predict the success of viscocanalostomy. However, to establish conclusively what parameters of UBM predict successful viscocanalostomy a larger number of patients must be studied.

Adult↗
PubMed1984

[Krupin's valve. Remarks on the surgery of glaucoma. Personal results apropos of 20 Krupin-Denver valves].

The literature concerning different kinds of draining implants used since the beginning of this century to increase the reliability of filtering operations to relieve glaucoma has been reviewed. The Krupin-Denver valve implant, which allows a filtration surgery with a pressure sensitive, unidirectional valve implant function drew the author's attention. This device consists in an open supramid tube sealed to a silastic tube ending with a slit valve which opens under a 11 to 14 mmHg intra ocular pressure. The supramid tube is inserted 1 to 4 mm long into the anterior chamber from the corneoscleral limbus, and the silastic tube is set under a scleral flap. Personal results are exposed from february 1981 to december 1983, 15 eyes have been treated (5 neovascular glaucomas, 5 glaucomas in aphakia, 4 congenital glaucomas and one chronic glaucoma). After mean follow up time of 13 months (1 to 34 months), the Krupin valve insertion controls the intraocular pressure in 14 eyes, without antiglaucoma medication in 5, and 7 cases are controlled with an additional local therapy, and further 2 cases with a general treatment. In the discussion, the improvements brought by this valve implant are studied facing the three great reasons of failure in the filtering operations as defined in 1980 by Molteno and Cairns: immediate post surgical hypotony, blockage of the internal end of the draining fistula, blockage of the external end of the draining fistula.

Adult↗