Slit-lamp needle revision of failed filtering blebs using high-dose mitomycin C

PURPOSE: To investigate the efficacy of bleb needle revision with high-dose mitomycin C in reviving failed filtering blebs after 1 year. PATIENTS AND METHODS: We reviewed the charts of 44 patients with one eye that had undergone bleb needle revision with a mixture of 0.1 mL of mitomycin (0.4 mg/mL) mixed with 0.1 mL of non-preserved 1% lidocaine. At least 12 months of follow-up were required. A successful bleb needle revision was defined as one that did not require a subsequent needling, glaucoma surgery, or medication to reach an intraocular pressure (IOP) greater than 4 mm Hg but less than 22 mm Hg. A qualified success was defined as a successful bleb needle revision that required subsequent needling or medication. RESULTS: The bleb needle revision with high-dose mitomycin was a success or qualified success after 12 months in 28 patients or 64% (95% confidence interval, 50% to 78%). The baseline IOP in these patients was 26.7 +/- 8.2 mm Hg (range 15 to 48 mm Hg) using an average of 1.5 +/- 1.5 glaucoma medications. The IOP after 1 year was 13.6 +/- 4.0 (range 6 to 21 mm Hg) with an average of 0.5 +/- 0.8 medications. Of 44 patients, 17 (39%) were successes and 11 (25%) were qualified successes. CONCLUSION: Bleb needle revision with high-dose MMC was effective in reducing the IOP in 64% of eyes with a failed filtering bleb with minimal long-term complications.     

Prospective evaluation of preoperative factors associated with successful mitomycin C needling of failed filtration blebs

PURPOSE: To study the long-term effectiveness and factors involved in successful needling of failed filtration blebs with mitomycin C (MMC). MATERIALS AND METHODS: We conducted a prospective, nonrandomized comparative trial that included 34 consecutive patients (34 eyes) who underwent mitomycin C needling of a failed filtering bleb after trabeculectomy followed by a 0.01 mL injection of mitomycin C (0.2 mg/ml). The success of the needling revision was defined as absolute if the intraocular pressure (IOP) was < 21 mm Hg without antiglaucoma medications and qualified if the IOP was < 21 mm Hg with antiglaucoma medications. Preoperative and perioperative factors were evaluated for an association with postoperative success using Kaplan-Meier survival analysis. RESULTS: The mean follow-up was 14.2 +/- 9.8 months. The mean preoperative IOP was 25.5 +/- 4.4 mm Hg, which decreased to 11.1, 13.4, 15.8, 16.7, 14.9, 14.1, 13.9, and 13 on postoperative day 1, postoperative week 1, and after 1, 3, 6, 9, 12, and 24 months, respectively (P = 0.001 for each comparison). At the final visit, success was absolute in 15 eyes (44.1%) and qualified in 14 eyes (41.2%). The success rates were 90% and 75% at 1 and 2 years, respectively. The success of the needling procedure was highly correlated with glaucoma filtration surgery performed less than 4 months previously (Kaplan-Meier analysis, log-rank test P = 0.006). CONCLUSIONS: Mitomycin C needling revision appears to have a high long-term success rate. Surgery performed less than 4 months previously contributes to the success of the initial mitomycin C needling procedure.     

Intermediate-term outcome of Baerveldt glaucoma implants in Asian eyes

PURPOSE: To determine the intermediate-term efficacy and safety of Baerveldt glaucoma implants in Asian eyes with complicated glaucoma. DESIGN: Retrospective, nonrandomized, comparative trial. PARTICIPANTS: One hundred twenty-four Asian patients (124 eyes) with complicated glaucoma. INTERVENTION: Implantation of 54 250-mm(2) and 70 350-mm(2) Baerveldt glaucoma drainage implants at Singapore National Eye Center from 1994 through 1999. MAIN OUTCOME MEASURES: Intraocular pressure, number of glaucoma medications, and complications. RESULTS: The mean follow-up period was 33.4 +/- 14.4 months (mean +/- SD; range, 12-72 months). Intraocular pressure (IOP) was reduced from a mean preoperative IOP of 36.5 +/- 10.7 mmHg (range, 21-80 mmHg) to 15.3 +/- 6.0 mmHg (range, 1-34 mmHg), and the number of glaucoma medications decreased from 2.6 +/- 0.6 (range, 1-5) before the time of surgery to 0.5 +/- 0.9 (range, 0-4) medications at last follow-up. Overall, there were 67 eyes (54%) that were classified as complete successes, 27 eyes (22%) that were qualified successes, and 30 eyes that failed (24%). Postoperative complications occurred in 43 eyes (34.7%), and 21 eyes (17%) required further surgical intervention and revision. There was no statistically significant difference between the 250-mm(2) and 350-mm(2) type of implants in terms of success rates, final IOP, number of medications, and rates of complications. After adjusting for gender, preoperative IOP, and length of follow-up, increasing age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.09; P = 0.02) and the number of previous operations performed before implant surgery (OR, 1.57; 95% CI, 1.07-2.31; P = 0.01) were found to be correlated positively with failure. CONCLUSIONS: In Asian eyes with complicated glaucoma, Baerveldt glaucoma implants achieve stable and satisfactory IOP reduction with low incidence of complications in the intermediate term after surgery.     

The filtering, clear-cornea diathermal keratostomy: a minor Danish multicenter study

PURPOSE: Is the new micropenetrating, clear-cornea procedure, intrastromal diathermal keratostomy (IDK), an alternative to the intricate "modern trabeculectomy"? METHODS: Prospective multicenter study. Four surgeons from 4 Danish eye departments attended an IDK course and subsequently decided when to start their consecutive IDK series. The data were analyzed centrally. Injection of preoperative, subconjunctival doses of mitomycin C (MMC) was recommended according to risk-of-failure. A total of 54 eyes from 48 patients with advanced and complicated glaucomas (mean age 65 y) and preoperative mean intraocular pressure (IOP) of 29 mm Hg were studied. RESULTS: At 10 months (range: 3 to 34 mo) the total success rate, employing traditional IOP success criteria (IOP< or =18 mm Hg and postoperative IOP decrease > or =30%), was 87% (47 of 54 eyes). In the 69% (37 of 54 eyes) without medication, the final IOP+/-SD was 11+/-3.5 mm Hg. Employing new IOP success criteria (IOP< or =15 mm Hg and postoperative IOP decrease> or =30%) for severe glaucoma (cup/disc ratio> or =0.8) and traditional criteria for moderate glaucoma (cup/disc ratio< or =0.7) the success rates were 76% and 80% and the mean postoperative IOP+/-SD were 10+/-2.5 mm Hg and 13+/-2.5 mm Hg, respectively. No serious complications (malignant glaucoma, endophthalmitis) were seen. The success rate for the most experienced and the less experienced surgeons, with risk-of-failure factors per eye of 1.3 and 1.2, was similar at 88% and 86%, respectively. The "knife time" for the experienced surgeon averaged 15 minutes (range: 10 to 20 min). The success rate (traditional criteria) after IDK revision with internal needling was 69%. CONCLUSIONS: MMC IDK seems to be simpler and quicker than the modern trabeculectomy, and with similar success rate and safety. Revision by internal needling is easy and efficient. Thus, MMC IDK may be a valid alternative and may also be recommended after failed MMC trabeculectomy, replacing shunting. Randomized, controlled studies are indicated.     

Operative revision of non-functioning filtering blebs with 5-fluorouracil to regain intraocular pressure control

PURPOSE: To determine the efficacy of extensive microsurgical needling revision of failed filtering blebs followed by serial 5-fluorouracil subconjunctival injections. METHODS: Thirty-six eyes of 34 consecutive patients with progressive open-angle glaucoma refractory to topical therapy submitted to needling revision as a major procedure. All patients required multiple antiglaucoma medications preoperatively, and had completely flat or densely encapsulated filtering blebs. All patients underwent elaborate needling revision (limbus to superior rectus >8 mm diameter, >3 mm elevation, entry-site sutured with 8-0 vicryl and bleb reformed via paracentesis with viscoelastic) in the operating room, followed by serial 5-fluorouracil. The patients were followed for up to 6 months postoperatively. The main outcome measures were intraocular pressure (IOP) and the number of antiglaucoma medications used. RESULTS: Thirty-one eyes (86%) maintained mean IOP below 15 mmHg postneedling without medication. Overall the mean IOP postneedling was >9 mmHg lower than medicated preoperative levels (P < 0.0001). IOP reduction in encapsulated blebs was marginally superior to that in flat blebs. CONCLUSIONS: Extensive needling revision in the operating room is safe, straightforward, and produces reproducible restoration of filtering function.     

Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis

PURPOSE: To report the outcome of 5-fluorouracil (5-FU)-augmented bleb needling revision of failed and failing filtration blebs and to identify risk factors for failure, indicators for success, and any complications of the procedure. DESIGN: Prospective, observational, noncomparative, interventional case series with survival analysis. METHODS: The results of 101 bleb needling procedures augmented with subconjunctival 5-FU injection were determined after a minimum follow-up of 9 months. Kaplan-Meier plots were constructed and a Cox proportional hazards regression analysis was performed to assess the association between study factors and time to failure. MAIN OUTCOME MEASURES: Reduction in intraocular pressure (IOP) by 2 criteria (<22 mmHg, >30%), glaucoma medications, complications, and factors associated with outcome. RESULTS: At the time of their last follow-up visit, 60 eyes had an IOP <22 mmHg, mean IOP being reduced from 26.5 mmHg to 15 mmHg [corrected] after a median of 1 needling procedure (mean, 1.6). The median interval between the "index" filtration surgery and the first (or only) needling procedure was 3.1 months, with a range of 10 days to 11 years. There was a reduction in mean number of topical antiglaucoma agents from 0.7 to 0.2 per successful eye and a median follow-up duration of 18.7 months (range, 9.3-52.8 months [corrected]). Thus, the overall cross-sectional success rate of the procedure at the time of the last visit was 59.4%. Strong evidence was found for an association between the immediate attainment of a low IOP (<11 mmHg) and longer survival times. None of the other proposed factors that may have affected outcome were identified as having a statistically significant effect; however, this may have been the result of the low statistical power for some of the factors in this study. CONCLUSIONS: These data suggest that bleb needling augmented with 5-FU is a safe and effective method by which a significant number of failed or failing filtration blebs can be rescued from failure. Attaining an immediate reduction in IOP to <11 mmHg seems to be a favorable factor with respect to reasonably long-term efficacy .     

The role of needle revision and 5-fluorouracil application over the filtration site in the management of bleb failure after trabeculectomy: a prospective study

Fifty-three eyes of 49 consecutive patients with an intraocular pressure (IOP) over 21 mmHg; without bleb or with a thick, flat bleb after the second postoperative week following trabeculectomy were included in the study. Needle revision was performed with a 26-gauge tuberculin syringe containing 5 mg (0.2 ml) 5-FU in a period of 2 weeks to 10 months postoperatively after unsuccessful digital massage and/or laser suture-lysis. 5-FU injection was not performed when a bleb formation was observed during needling. In case of no bleb formation, 5-FU was injected subconjunctivally over the scleral flap area and repeated a maximum of six times until a functioning bleb was maintained. Needle revision was successful in 14 of 53 eyes (26.4%) as an initial procedure and nine (16.9%) eyes maintained success. Forty-four eyes (83.1%) had 5-FU injection since needle revision did not provide bleb formation (39 eyes) or did not maintain initial success (five eyes). Mean IOP was 27.8±4.7 mmHg (range, 22–41) before any intervention and decreased to 20.5±4.8 mmHg (range, 8–35) after a mean follow-up of 25.1 months and the difference was statistically significant (p<0.001). Mean IOP after needle revision in 14 patients was 18.9±4.9 mmHg (range, 8–29) and 16.3±3.7 mmHg in nine out of 14 patients that maintaned success. Mean IOP after the last 5-FU injection was 21.4±4.6 mmHg (range, 1335 mmHg). The mean number of 5-FU injections was 2.4 (range, 1 – 6). During a mean follow-up of 25.1 months (range, 1–48 months), three eyes (5.7%) had diffuse corneal punctate epitheliopathy lasting for 3–4 weeks and subconjunctival hemorrhage was seen in nine eyes (17%). Needle revision and/or subconjunctival injection of 5-FU over the bleb area is a safe, relatively efficient approach with a low rate of complications to overcome the early and mid term bleb failure after trabeculectomy.     

Results of combined phacoemulsification and viscocanalostomy in patients with cataract and pseudoexfoliative glaucoma

PURPOSE: Coexisting pseudoexfoliation glaucoma (PEXG) and cataract represents a special challenge. Although phacotrabeculectomy is an effective procedure, it combines the risks of phacoemulsification and trabeculectomy. This study evaluates phacoviscocanalostomy to manage eyes with PEXG and cataract. METHODS: We conducted a prospective noncomparative study that included 30 consecutive eyes of 22 patients with uncontrolled PEXG and cataract. Phacoviscocanalostomy was performed in all. Success rate based on postoperative intraocular pressure (IOP) reduction and requirement for topical antiglaucoma medication was evaluated as the main outcome measure. Visual acuity and complication rates were secondary outcomes. RESULTS: The mean follow-up was 18.6 months +/-6.2 (SD) (range 12 to 36 months). There was statistically significant decrease in mean IOP from 25.3+/-5.2 mmHg preoperatively to 13.5+/-6.0 mmHg 1 day after surgery (p< .05), 12.3+/-3.1 mmHg at the final follow-up (p< .05), and at all evaluations to the last postoperative visit. Only three eyes (10%) required a single antiglaucoma medication to achieve the target IOP. A complete surgical success (IOP <21 mmHg without medication) was achieved in 90%, while a qualified success (IOP <21 mmHg with or without glaucoma medication) was achieved in 100% of cases. Complications included Descemet membrane microperforations (13.3%), macroperforation (3.3%), zonular dehiscence (6.6%), and transient postoperative IOP spike (3.3%). CONCLUSIONS: Phacoviscocanalostomy achieved excellent IOP control and visual acuity improvement in pseudoexfoliation patients with coexisting cataract and glaucoma. Complication rate was low and did not affect the surgical outcome.     

Deep sclerectomy with mitomycin C in failed trabeculectomy

AIM: To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. METHODS: This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS: The mean preoperative IOP was 25.8+/-7.3 mmHg; the IOP significantly decreased to 14.6+/-3.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P=0.000). At 1 year, the complete success rate (IOP相似文献   

Surgical repair of leaking filtering blebs

PURPOSE: To report the surgical management of leaking filtering blebs occurring after blebitis or persistent hypotony. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-two eyes of 20 patients with late bleb leak, blebitis or endophthalmitis, hypotony maculopathy, or bleb dysesthesia on presentation to the glaucoma service who required surgical bleb revision from 1990 through 1999. INTERVENTION: Pedicle flap, partial excision, and advancement or free conjunctival autologous graft techniques for surgical bleb revision. Type of bleb revision was dependent on the dimensions of the bleb and quality of surrounding conjunctiva. MAIN OUTCOME MEASURES: Preoperative and postoperative intraocular pressure (IOP), status of bleb leak, reoperation for glaucoma, or requirement for postrevision glaucoma medical therapy, with success defined as the need for two or fewer glaucoma medications after revision. RESULTS: Eighty-six percent (19/22) of eyes that underwent surgical bleb revision had resolution of leak and IOP control using two or fewer medications after one or more bleb revisions. The preoperative IOP (mean +/- standard deviation) was 3.7 +/- 2.6 mmHg (range, 0-8 mmHg). After an average follow-up of 21 months (range, 8-108 months), the IOP was 11.0 +/- 4.4 mmHg for patients taking 0.6 +/- 1.0 glaucoma medications. Eighteen percent (4/22) of eyes required two or more bleb revisions. In one eye, an IOP spike of 36 mmHg developed after revision, which required laser suture lysis on two occasions before the IOP was significantly lowered. The three failures were: one eye that required three or more medications for IOP control, a patient whose eye had a persistent leak after revision and who was not mentally competent to undergo repeat revision, and one eye that required combined glaucoma and cataract surgery after revision. CONCLUSIONS: Surgical bleb revision has a high success rate of closing late bleb leaks, maintaining glaucoma control, and preserving vision, with few postoperative complications. The appropriate surgical procedure for revision must be based on the individual clinical situation and can result in successful bleb revision.     

Methods of argon laser trabeculoplasty, complications and long-term follow-up of the results

Argon laser trabeculoplasty (ALT) was performed on 125 eyes with primary open-angle glaucoma (POAG) and 32 eyes with capsular glaucoma; all eyes were surgical candidates where maximum tolerable medication had failed to control the intraocular pressure (IOP) below 20 mmHg. There were 93 eyes of men and 64 eyes of women, in the age range from 20 to 84 years. Three methods were used: Group 1, 36 eyes treated with about 100 laser shots to the trabecular pigment band over 360 degrees; Group 2, 84 eyes with about 50 shots to the pigment band over 180 degrees; and Group 3, 37 eyes with similar treatment to the anterior part of the trabecular band. The frequency of the initial IOP rise and the maximum postoperative IOP level were in the order of Groups 1, 2 and 3. Other complications, iritis, hemorrhage and peripheral anterior synechiae, were most frequent in Group 1. The success rate of the postoperative IOP control below 20 mmHg with continued medication was analyzed by the life-table method: It was 39 +/- 8% over the period averaging 39 months in Group 1, 66.5 +/- 6% over 17.3 months in Group 2, and 33.7 +/- 15% over 8.1 months in Group 3. The ALT over 180 degrees aimed at the pigment band gave better IOP control with less complications than 360 degrees ALT. The success rate in the eyes of Group 2 was 57 +/- 6% and 94 +/- 6% in POAG and capsular glaucoma, respectively. The IOP distribution after the ALT had a peak at 16-17 mmHg; the IOP was lower than 15 mmHg in about 21% of the eyes. Concurrent IOP measurement and tomography revealed that the IOP reduction after ALT was due largely to a reduction of the outflow resistance in the aqueous outflow channel.     

Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results

PURPOSE: To investigate the long-term efficacy and safety of non-penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5-fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery. METHODS: Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP)or=20% drop in IOP or a reduction of at least two medications. RESULTS: Twenty-three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8+/-7.8 to 15.4+/-4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long-term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery. CONCLUSION: NPGS augmented with small-volume MMC/5FU provides good long-term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.     

Refractory glaucoma – tube or diode?

BACKGROUND: The aim of the present study was to assess the relative effectiveness of tube surgery and cyclodiode laser in terms of achieving intraocular pressure control. METHODS: A retrospective study was undertaken to compare patients undergoing double plate Molteno tube implantation with patients undergoing diode cyclophotocoagulation. Intraocular pressure (IOP) was documented at 7 days prior to surgery and postoperatively at various time points. Surgical success was defined as a final IOP between 6 (inclusive) and 21 mmHg (inclusive), without the use of topical medication, while 'qualified' success was defined as IOP within the same range with the use of topical medication. RESULTS: Twenty-eight diode patients and 26 tube patients were included for the study. An average follow up of 150 weeks (range = 21-322 weeks) was available. Mean preoperative IOP was 37 +/- 12 mmHg for the tube group and 39 +/- 16 mmHg for the diode group (t = 0.51, P = 0.61). The final IOP was 17 +/- 12 mmHg for the tube group and 21 +/- 13 mmHg for the diode group (t = 0.35, P = 0.73). Surgical success was achieved in 46% of tube eyes and 11% of diode eyes, while qualified success was achieved in 81% of tube eyes compared with 64% of eyes in the diode group. Two eyes which underwent diode became phthisical. CONCLUSIONS: IOP control may be achieved in a greater number of patients with tube surgery. The possible benefits of IOP control in diode patients need to be weighed against the risks of long-term visual loss and the need for multiple re-treatments in this group.     

Trans-scleral diode laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma

PURPOSE: To evaluate the success rate of contact diode transscleral cyclophotocoagulation (TSCPC) in pediatric refractory glaucoma. PATIENTS: and method: Twenty-eight eyes of 28 patients (age range 5 months to 26 years) with medical and surgical refractory pediatric glaucoma due to primary congenital glaucoma (group 1, 20 eyes) or aphakic congenital glaucoma (group 2: 8 eyes), were included in this retrospective study. All eyes underwent one or more TSCPC with the diode laser (Oculight SLX, Iris Medical) with a minimal follow-up of 2 months. Success was defined as intraocular pressure (IOP) between 6 and 20 mmHg after one or more procedures, with no increase in medical hypotensive therapy, and no progression to another hypotensive procedure. RESULTS: Mean baseline IOP was 29.4 +/- 7.8 mmHg (range 25 to 60 mmHg) and mean follow-up was 10.3 +/- 6.9 months (range 2 to 26 months). Success rates evaluated at 6 and 12 months (Kaplan Meier survival curves) were 54.4% and 27.7% respectively, with one-third of the eyes retreated once or more. These success rates were similar in both groups with a mean baseline IOP decrease of 38.9 +/- 15.9%. Postoperative uncontrolled hypertony occurred in the first 3 months in 6 (21.4%) eyes, leading to surgical IOP management. Other complications were decrease in visual acuity (14.3%), inflammation (25.5%) and phthisis (3.5%). CONCLUSION: TSCPC with the diode laser is a disappointing procedure for the management of refractory pediatric glaucoma, with poor mid-term IOP control and high incidence of complications including severe uncontrolled IOP increase. For these reasons, this cyclodestructive procedure should be considered as a last resort therapy for patients with refractory pediatric glaucoma.     

Outcome of cataract extraction and posterior chamber intraocular lens implantation following glaucoma filtration surgery

PURPOSE: To evaluate the outcome of cataract extraction (CE) after glaucoma filtering surgery (GFS). METHODS: A total of 77 eyes (77 patients) who underwent CE with posterior chamber intraocular lens (PCIOL) implantation following GFS by a single surgeon were reviewed. Main outcome measures were preoperative and postoperative intraocular pressures (IOPs), visual acuities, medications, astigmatism, bleb survival, time of surgical failure, complications, and success rate. RESULTS: Mean time interval between GFS and CE was 46.8+/-50.9 months (range, 2-348 months). The mean preoperative IOP was 13.9+/-4.7 mmHg (range 3-27 mmHg) and mean postoperative IOP at 3 weeks was 13.6+/-5.5 mmHg (range, 6-44 mmHg). The mean follow-up was 19.5+/-20.1 months (range, 1.4-73 months; median 10.6 months). Complete success was achieved in 59 eyes (76.7%). The cumulative probability of complete success was 91.3+/-3.7, 82.0+/-5.6 and 78.1+/-6.5% at the end of 6 months, 1, and 2 years, respectively. Visual acuity before CE was < or =20/50 in all eyes (100%). Visual acuity at last visit was > or =20/40 in 33 eyes (42.8 %), 20/50-20/80 in 30 eyes (39.0%), < or =20/100 in 14 eyes (18.2%). Risk factors identified for qualified success included age at CE>60 years, interval of < or =5 months between GFS and CE, use of preoperative glaucoma medications, and postoperative IOP >19 mmHg within 2 weeks. CONCLUSIONS: IOP and bleb function was maintained after CE with PCIOL implantation following successful GFS with good visual recovery.     

Filtering bleb revision. Techniques and outcome

BACKGROUND: The surgical management and outcome of bleb-related complications such as leaking blebs,overfiltration and blebitis are reported. METHODS: A retrospective analysis was carried out of 35 patients who underwent surgical repair of the filtering bleb in our hospital between 1991 and 2000. RESULTS: Surgical techniques used were autologous blood injection, fibrin glue injection, conjunctival suturing, resuturing of the trabeculectomy flap, bleb excision, conjunctival advancement, lyodura and tenon patching. In the eyes with leaking blebs the mean preoperative intraocular pressure (IOP) was 11.6+/-10.3 mmHg.After an average followup of 12 months the IOP was 11.9+/-3.3 mmHg. In the eyes with overfiltration the mean IOP was 2.4+/-1.5 mmHg and after an average follow-up of 18 months the mean IOP increased to 13.5+/-3.7 mmHg. In 77.1% the IOP was regulated between 8 and 21 mmHg without glaucoma medication. Mean visual acuity improved by 3.6+/-5.9 lines postoperatively. CONCLUSION: Surgical bleb revision has a high success rate with regard to maintaining a functioning filtering bleb and to preserving vision.     

Initial 5-fluorouracil trabeculectomy in young patients.

The effectiveness of initial trabeculectomy with adjunctive 5-fluorouracil (5-FU) for uncomplicated glaucoma in patients age 40 years or younger at the time of surgery was evaluated retrospectively in a consecutive series of 20 eyes of 20 patients. Fifteen patients had juvenile primary open-angle glaucoma, 4 had pigmentary glaucoma, and 1 had glaucoma associated with angle recession. Mean patient age was 26.8 +/- 9.7 years (range, 13 to 40 years) at the time of surgery. The mean total 5-FU dose administered was 27.8 +/- 8.8 mg (range, 15 to 45 mg). The intraocular pressure (IOP) decreased from 34.4 +/- 11.5 mmHg preoperatively to 10.5 +/- 4.0 mmHg postoperatively after a mean follow-up of 31.1 +/- 17.3 months (range, 11.5 to 70 months). Nineteen eyes (95%) had a postoperative IOP of 20 mmHg or less without pressure-lowering medications. One patient required additional medical therapy to control the IOP. Complications included bleb-related endophthalmitis (2 eyes) and hypotony maculopathy (1 eye).     

Long-term results of noncontact neodymium:yttrium-aluminum-garnet cyclophotocoagulation in neovascular glaucoma

PURPOSE: To determine the long-term efficacy and safety of noncontact transscleral neodymium:yttrium-aluminum-garnet (Nd:YAG) cyclophotocoagulation (CP) for the treatment of neovascular glaucoma (NVG). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: One hundred fifteen eyes of 111 subjects treated from December 1987 to January 2001. METHODS: Eyes with uncontrolled NVG underwent noncontact Nd:YAG CP. Treatment parameters and pretreatment and posttreatment intraocular pressures (IOP) were reviewed. Preoperative and postoperative IOP were compared using a paired Student's t test. Success was defined as an IOP 相似文献   

Combined phacoemulsification and nonpenetrating deep sclerectomy in the treatment of chronic angle-closure glaucoma with cataract

PURPOSE: To review the result of nonpenetrating deep sclerectomy (NPDS) combined with phacoemulsification in the treatment of chronic angle-closure glaucoma (CACG) with coexisting cataract. METHODS: This is a retrospective review of 29 eyes of 26 patients who had undergone combined NPDS and phacoemulsification for cataract and CACG between January 2001 and June 2003. The visual acuity, intraocular pressure (IOP), and complications were analyzed. RESULTS: The mean follow-up period was 33.8 months (range 23.3 to 54.0 months). Postoperative visual acuity improved in 21 eyes (72%) and remained the same in 6 eyes (21%). The IOP was reduced significantly from 20.3+/-3.9 mmHg (mean +/- SD) preoperatively to 15.9+/-3.1 mmHg postoperatively at last follow-up visit (p<0.001). The number of antiglaucoma medications was also reduced significantly from 2.9+/-0.8 (mean +/- SD) preoperatively to 1.0+/-1.2 at last follow-up (p<0.001). Fifteen eyes (52%) achieved complete success with IOP < or = 21 mmHg without antiglaucoma medications and 25 eyes (86%) achieved qualified success with IOP < or = 21 mmHg with or without medications at the last follow-up visit. Of the 25 eyes achieving qualified success, 24 (96%) had a reduction in the number of medications. There were 4 failures, defined as uncontrolled IOP requiring further filtering operation or oral drug treatment. Intraoperative complications included one accidental anterior chamber puncture and one iris plug intraoperatively. Postoperative complications included one choroidal effusion, three wound leaks requiring repair, and two punctate epithelial erosions. There was no shallowing of the anterior chamber, hyphema, hypotony, or infection encountered. CONCLUSIONS: Combined NPDS and phacoemulsification could be a safe and effective surgical option for the management of CACG with cataract.     

Surgical revision of failed filtration surgery with mitomycin C augmentation

AIM: The aim of the study was to assess the outcomes of surgical revision with reopening of the scleral flap in eyes with failed glaucoma surgery and adjunctive mitomycin C (MMC). METHODS: Retrospective, noncomparative, interventional case series. Fifty-four eyes of 54 consecutive patients with previously failed trabeculectomy or deep sclerectomy who underwent formal surgical revision (23 with concurrent phacoemulsification) were included. MMC, 0.2 mg/mL for 2 to 3 minutes, was applied under a fornix-based conjunctival flap. The preexisting scleral flap was dissected open to reestablish filtration. RESULTS: Mean follow-up was 39.5+/-10 months. Kaplan-Meier survival analysis showed that the probability (with 95% confidence intervals) of maintaining an intraocular pressure (IOP) between 5 and 18 mm Hg and 20% decrease from preoperative IOP was 64% (47% to 76%) with medications and/or needle revision and 38% (26% to 53%) without, 3 years after surgery. Mean IOP before surgery was 23.6+/-7.2 mm Hg and 14.4+/-6.0 three years after surgery (last IOP before further glaucoma procedure carried forward). Needle revision for bleb failure or high IOP was carried out in 23 eyes (42.5%) and further glaucoma surgery in 5 eyes (9.3%). Patients were on an average of 2+/-1.1 glaucoma medications before surgery. At last follow-up, the number of medications had decreased to 0.8+/-1.2 (P<0.000), with 23 eyes (42.5%) requiring medications to control IOP. Significant complications included delayed suprachoroidal hemorrhage (3 eyes, 5.6%), delayed bleb leaks (5 eyes, 9.3%), hypotony (2 eyes, 3.7%), and blebitis (2 eyes, 3.7%). CONCLUSIONS: There is a progressive increase in IOP with time after surgical revision of failed glaucoma surgery with adjunctive MMC. A significant proportion of eyes will eventually require a needle revision procedure and/or glaucoma medications to further lower IOP. Also, there is a significant incidence of complications associated with this procedure.