Recurrent anterior uveitis after trabeculectomy with mitomycin C

Objective: To report 4 cases of recurrent anterior uveitis occurring 1–11 months after trabeculectomy with mitomycin C.Design: Observational case series.Participants: Four patients in whom recurrent uveitis developed after trabeculectomy with mitomycin C, followed at Maisonneuve-Rosemont Hospital in Montreal, Quebec. Methods: Retrospective review of the medical records.Results: One to 11 months after trabeculectomy with mitomycin C, noninfectious, recurrent anterior uveitis developed in 4 patients with no prior history of uveitis. Topical and intravitreal corticosteroids were effective in reducing acute inflammation, yet 2 patients went on to have chronic anterior uveitis.Conclusions: Recurrent anterior uveitis presenting later than 3 weeks postoperatively may be associated with trabeculectomy with mitomycin C. It should be included in the differential diagnosis of a nonresolving blebitis.     

Mid-term outcome of trabeculectomy with adjunctive mitomycin C in glaucoma patients

PurposeTo quantify the 2-year success rate and complications of trabeculectomy with adjunctive mitomycin C (MMC).MethodsA retrospective chart review was undertaken of 147 eyes that had undergone trabeculectomy with adjunctive MMC (concentration from 0.1 to 0.27 mg/mL) and at least 2 years' follow-up between January 2001 and March 2010. Demographic and clinical data were collected from all patients at the time of surgery and subsequent follow-up visits. Complete success was defined as intraocular pressure (IOP) ≤ 21 mmHg without any additional medication, whereas qualified success was defined as IOP ≤21 mmHg with or without medication.ResultsAt 24 months, mean IOP was 16.4 ± 10.6 mmHg, with a mean IOP decrease of 19.8 ± 14.2 mmHg. In primary glaucoma patients (n = 66), 60.6% and 95.4% of eyes achieved complete success and qualified success, respectively, at 2-year follow-up. Sub-group analysis of the initial trabeculectomy in primary glaucoma patients (n = 49) showed that complete and qualified success increased to 65.3% and 98.0%, respectively. The success rate was lower in secondary glaucoma patients (n = 74), with complete success at 41.9% and qualified success at 67.6% at 2-year follow-up. Eighty-six eyes (58.5%) developed one or more complications, from mild, such as hyphema, to severe, such as bleb leakage, which could necessitate surgical intervention. Twenty-six eyes developed severe complications, such as wound gap after 5 postoperative days, hypotony, hypotony maculopathy, choroidal detachment, overhanging bleb, bleb leakage, and endophthalmitis. A comparison between eyes with severe complications and other eyes in relation to different MMC amount, defined as MMC concentration multiplied by application duration, revealed no significant difference (p = 0.136). Further glaucoma surgery was performed in 27 eyes (18.4%).ConclusionThe outcome of trabeculectomy with low-dose intraoperative MMC is favorable in primary glaucoma patients at 2-year follow-up. Severe complications are not significantly related to MMC amount. Factors associated with severe complications require further study. Careful selection of MMC concentration and application time based on preoperative and intraoperative risk factors may further improve surgical results.     

Comparison of single-drop mitomycin C regime with other mitomycin C regimes in pterygium surgery

PURPOSE: To evaluate the safety and efficacy of single-drop instillation of mitomycin C (MMC) in pterygium surgery and to compare the results with both postoperative and intraoperative application of MMC. METHODS: Eighty eyes of 72 patients with pterygium were randomised into 4 equal groups: group 1--control--bare scleral excision (BSE); group 2--BSE with single-drop instillation of mitomycin C (MMC) 0.02% at the end of the surgery; group 3--BSE with postoperative MMC 0.02% drops twice a day for 5 days; and group 4--BSE with intraoperative MMC 0.02%. RESULTS: The recurrence of pterygium was observed in 14 (70%), 4 (20%), 4 (20%) and 3 (15%) eyes of group 1, 2, 3, and 4 respectively. The recurrence rate after BSE with single drop MMC regime (group 2) was significantly lower than group 1 recurrence (P=0.001) and was statistically comparable to that of group 3 and 4. Scleral defects in the bare area occurred in 4 (20%), 16 (80%) and 16 (80%) eyes of group 2, 3, and 4 respectively. The incidence of scleral defects was significantly lower in group 2 compared to group 3 (P=0.0001) and group 4 (P=0.0001). Compared to group 1 and 2, a significant delay in wound epithelialisation occurred in group 3 (P=0.003) and 4 (P=0.004). An ischaemic area in the bare sclera developed in 8 (40%) and 6 (30%) eyes of group 3 and 4 respectively, while ischaemic area did not develop in group 1 and 2. CONCLUSION: Single-drop instillation of 0.02% mitomycin C following pterygium excision appears both safe and efficacious.     

Trabeculectomy with mitomycin C for treatment of neovascular glaucoma in diabetic patients

BACKGROUND: To assess the efficacy and to determine the risk factors of trabeculectomy with mitomycin C (MMC) in eyes with neovascular glaucoma (NVG) secondary to diabetic retinopathy. METHODS: Kaplan-Meier survival analysis of the surgical outcome was performed on 35 eyes with NVG. Age, extent of peripheral anterior synechia, surgical history (cataract, glaucoma, vitrectomy), and concurrent retinal cryotherapy were evaluated to determine factors influencing the surgical outcome. The main criterion for success was a postoperative intraocular pressure (IOP) of < or = 21 mm Hg. RESULTS: The cumulative probability of success was 67.0% at 1 year and 61.8% after 2 to 3 years. The surgical outcome was significantly better in patients without a previous vitrectomy (p = 0.03). Extensive preoperative peripheral anterior synechia was also a risk factor for surgical failure (p = 0.013). CONCLUSIONS: Trabeculectomy with MMC can effectively reduce the elevated IOP associated with NVG. The extent of peripheral anterior synechia and a history of vitrectomy are significant negative predictors of surgical outcome.     

晶状体乳化治疗葡萄膜炎并发白内障的研究

目的 探讨晶状休乳化吸出（phacoemulsification and aspiralion）治疗葡萄膜炎并发白内障的疗效。方法 18例（28眼）葡萄膜炎并发白内障伴有虹膜后粘连和小瞳孔，手术中先用撕囊镊撕除瞳孔区机化膜，做连续环形撕囊，囊袋内植入人工晶状体，观察手术并发疝和术后视力，观察时间为术后3月。结果 术后视力明显提高，术后瞳孔直径增大。部分瞳孔恢复对光反应，无严事并发症发生。结论 本手术方法对葡萄膜炎并发白内障有良好的疗效，手术损伤小，不伤及虹膜，术后前段反应轻。     

超声乳化吸出联合小梁切除术治疗青光眼合并白内障

目的评价晶状体超声乳化吸出折叠式人工晶状体植入联合小梁切除术的效果和安全性以及手术技术的进步。方法对47例(53眼)青光眼合并白内障手术进行回顾性临床分析。随访12~18个月。手术技术的改进包括抗代谢药物的使用;双切口法;可调节缝线及以穹隆为基底的结膜瓣等4方面。结果53眼中49眼(92.45%)眼压控制在21mmHg以下(1mmHg=0.133kPa),其中28眼(52.83%)在15mmHg以下。眼压由术前平均(25.17±3.70)mmHg降至术后(16.79±2.78)mmHg,(t=21.60,P=0.000);使用抗青光眼药物由术前平均(1.89±0.49)种减少到术后仅8眼(15.09%)需1种。39眼(73.58%)获得≥0.5校正视力,术后视力较术前明显提高(z=-5.845,P<0.001)。术后早期发生纤维素性葡萄膜炎9眼,浅前房2眼,低眼压黄斑水肿2眼,脉络膜脱离1眼。结论超声乳化白内障吸出人工晶状体植入联合小梁切除术可以在降低眼压的同时恢复视力,减少抗青光眼药物的使用。改良的联合手术技术提高了效果和安全性。     

Results of trabeculectomy with adjunctive intraoperative mitomycin C in Chinese patients with glaucoma.

BACKGROUND AND OBJECTIVE: To report the results of trabeculectomy with adjunctive intraoperative mitomycin C in Chinese patients with glaucoma. PATIENTS AND METHODS: The medical records of Chinese patients who received trabeculectomy with intraoperative mitomycin C from 1992 to 1998 were retrospectively reviewed. A "successful" trabeculectomy was defined as one after which the intraocular pressure (IOP) could be controlled to between 5 and 21 mm Hg, inclusive, with no more than 3 glaucoma medications. RESULTS: One hundred fourteen trabeculectomies in 105 eyes of 90 patients were retrospectively reviewed. Mean age +/- standard deviation was 48.1 +/- 21.9 years. Primary open-angle glaucoma (43.0%) and angle-closure glaucoma (27.2%) were the most common diagnoses leading to trabeculectomy. The mean follow-up +/- standard deviation was 29.6 +/- 18.6 months (range, 6 to 92 months). The overall success rate at the last follow-up was 73.7% (84 of 114 trabeculectomies). CONCLUSIONS: Trabeculectomy with mitomycin C is a safe and effective procedure for the control of IOP in Chinese patients with glaucoma.     

小梁切除术中应用丝裂霉素C致前房出血

为探讨小梁切除术中应用丝裂霉素Ｃ（ＭＭＣ）致前房出血的原因。方法：回顾性分析９９例１４２眼原发性青光眼小梁切除术后前房出血的情况,对术中未应用ＭＭＣ与术中巩膜瓣上及巩膜瓣下放置０．３～０．４ｍｇ／ｍｌＭＭＣ４～５分钟,术后前房出血的发生率进行了比较。结果：未应用ＭＭＣ组前房出血的发生率为４．１７％,巩膜瓣上置ＭＭＣ组前房出血的发生率为６．０６％,巩膜瓣下置ＭＭＣ组前房出血的发生率为３７．８４％,明显高于前两组,Ｐ＜０．０１。结论：巩膜瓣下置ＭＭＣ组前房出血的发生率明显增高,可能是ＭＭＣ对睫状体血管内皮细胞损伤的结果。     

Deep sclerectomy augmented with mitomycin C

AIMS: To investigate the comparative efficacy and safety of deep sclerectomy with and without intraoperative mitomycin C (MMC) application for lowering the intraocular pressure (IOP). METHODS: A total of 71 eyes of 71 consecutive patients who had routine deep sclerectomy (DS), nonaugmented (DS-noMMC) or with mitomycin C (DS-MMC) augmentation (0.2 mg/ml for 2 min) and follow-up of 4 months or more were identified from an ongoing prospective database on glaucoma surgery. Indications for MMC use were the presence of risk factors for subconjunctival scarring and low target IOPs. MMC 0.2 mg/ml was applied in the sub-Tenons space for 2 min. RESULTS: There were 19 eyes in the DS-noMMC group and 52 eyes in the DS-MMC group. In 11 eyes (15.5%), the procedure was complicated by intraoperative perforation of the trabeculo-Descemet's window. Eyes in the DS-MMC group had significantly lower IOPs (MANOVA, P = 0.04). Kaplan-Meier survival curve analysis showed that the probability of maintaining IOP below target IOP level, below 18 mmHg and below 14 mmHg at 1 year was 51, 67, and 35% for the DS-noMMC group and 80, 86, and 74% for the DS-MMC group. The survival rates of the DS-MMC group were not statistically significant (P = 0.06) when the success criterion was maintaining an IOP less than 18 mmHg but were significant for the other criteria, namely IOP less than target levels (P = 0.03) and less than 14 mmHg (P = 0.03). Nd:YAG goniopuncture to lower IOP to target levels was done more frequently in the DS-noMMC group (13 eyes, 81%) than the DS-MMC group (20 eyes, 45%) and this difference was significant (P = 0.03). The prevalence of avascular areas within filtration blebs and transconjunctival oozing of aqueous was significantly higher in the DS-MMC group (P < 0.01). CONCLUSIONS: The use of intraoperative MMC during deep sclerectomy has a significant effect on the postoperative IOP and increases the probability of achieving target IOPs. However, our current technique of MMC application is associated with a higher incidence of avascular blebs and transconjunctival oozing.     

丝裂霉素C在慢性闭角型青光眼合并白内障手术中的价值

目的:探讨丝裂霉素C(MMC)在慢性闭角型青光眼患者行青光眼白内障联合手术中的价值,为青光眼合并白内障的临床治疗提供参考。方法:将40例慢性闭角型青光眼合并白内障患者随机分为观察组(使用MMC组)和对照组(未使用MMC组),均行晶状体超声乳化联合小梁切除术治疗,比较治疗效果。结果:观察组治疗后患者远视力(矫正)、周围前房深度、眼压及降眼压药物使用数量与种类均优于对照组,且与对照组比较,均P<0.05,具有统计学差异。观察组功能性滤过泡的比例与对照组比较,两组差异无统计学意义(P>0.05)。两组治疗主要并发症为术后浅前房,其中,观察组1例(5%),对照组2例(10%),两组比较差异无统计学意义(P>0.05)。结论:MMC能改善慢性闭角型青光眼患者行青光眼白内障联合手术后的眼压、视力,建议推广使用。     

Cataract surgery in patients with uveitis

Although cataract surgery for senile cataract is routine and easily performed, the decision to remove the cataract in a patient with a history of uveitis is considerably more complex and usually involves multiple considerations, related not only to the cause of the uveitis but also to the appropriate surgical procedures. The problems confronting the ophthalmologist caring for the patient with uveitis begin with the first visit. Establishing a diagnosis and controlling the inflammation are the critical elements in the treatment of the patient; these two factors will determine the incidence of cataract formation and other complications, the appropriate time for cataract removal, and the surgical strategy, as well as determine the visual outcome long before surgery occurs. Diagnosis, control of inflammation, preoperative management, particularities of the surgical techniques, and postoperative complications in patients with a history of uveitis have been reviewed previously in this section. Our aims in this article are to review the literature on this subject over the past year and to reemphasize the idea of a model of zero tolerance for inflammation to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision.     

术中应用丝裂霉素治疗不同类型原发性翼状胬肉的疗效观察

目的:探讨丝裂霉素在不同类型原发性翼状胬肉术中局部应用的疗效。方法:选择翼状胬肉组织侵入角膜内>2mm的原发性翼状胬肉患者259例279眼,在显微镜下,按常规方法切除翼状胬肉的头颈体部,用0.2mg/mL的丝裂霉素溶液在巩膜上作用3min,生理盐水充分冲洗,缝合结膜,术后滴复方妥布霉素眼液,4次/d,涂复方妥布霉素眼膏,1次/晚,第7d拆线。随访12～18mo。结果:术后,271眼达到治愈标准,治愈率97.1%;8眼复发,复发率为2.9%。单眼单侧、双眼单侧、单眼双侧的复发率分别为1.8%,2.5%,14.3%。结论:术中局部应用丝裂霉素治疗原发性单眼单侧翼状胬肉效果良好,复发率明显降低,且未见明显副作用;而单眼双侧的翼状胬肉患者治疗后复发率仍较高。     

Cataract surgery in patients with uveitis

Until recently, cataract surgery in a patient with uveitis was regarded as a hazardous procedure that yielded unpredictable and often disappointing results. With an increasing number of ophthalmologists recognizing the consequences of chronic low-grade inflammation and therefore treating uveitis patients more aggressively, with a better selection of cases for surgery, and with better surgical techniques, more patients with a history of uveitis who need cataract surgery enjoy a successful outcome than ever before. Careful management and control of inflammation preoperatively and after surgery is critical to success. An in-the-bag posterior chamber lens implant can be part of the surgical plan in selected cases. The aims of the authors in this article are to emphasize the ideas of, intolerance to inflammation, a limited tolerance for steroids to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision, and strict criteria for selection and management of those patients with uveitis who need cataract surgery.