The effect of photodynamic therapy with rose bengal on posterior capsule opacification in rabbit eyes

We investigated the in vivo effect of photodynamic therapy (PDT) using rose bengal on the development of posterior capsule opacification (PCO). Endocapsular phacoemulsification was performed on white rabbits, which were divided into 4 groups: control group; group 1, treated with visible light only; group 2, treated with rose bengal only, and group 3, treated with PDT. In the case of the PDT group, rose bengal dissolved in sodium hyaluronate was injected into the empty capsular bag and treated with visible light. Three months after surgery, the rabbits were sacrificed and the eyeballs enucleated. The obstruction rate of visible light caused by PCO was measured with an optical powermeter. The mean obstruction rate was 30.6% in the control group, 28.3% in group 1, 19.3% in group 2, and 14.3% in group 3. Group 3 showed a statistically significant decrease in PCO compared with the control group and group 1 (p = 0.0014). Our results suggest that PDT using rose bengal effectively decreased PCO in rabbit eyes.     

Effects of viscoelastic material on the corneal endothelial cells in trabeculectomy with adjunctive mitomycin-C

We evaluated the change of corneal endothelium after trabeculectomy with mitomycin-C soaking (0.2 mg/ml, 2.4 +/- 1.2 minutes) and the effect of viscoelastic material in reducing this change. In randomly selected cases, 0.05 ml of sodium hyaluronate(Healon) was injected into anterior chamber (Healon group, n = 20), and same amount of balanced salt solution was injected in the other eyes (Control, n = 18) at the beginning of surgery. There were no differences in clinical variables and specular microscopy result between 2 groups before surgery. After surgery, the change of endothelial cells were significantly reduced in Healon group (cell density; -2.5 +/- 1.6%, variability of cell area; 5.8 +/- 2.5%, and percentage of hexagonal cell; -2.2 +/- 0.7%) compared to control group (-7.7 +/- 6.0%, 8.9 +/- 4.4%, and -4.8 +/- 3.5% respectively, p < 0.01). In trabeculectomy with mitomycin-C, the damage to the corneal endothelium was reduced significantly by injecting the viscoelastic material without significant complication.     

眼内应用丝裂霉素C抑制后囊膜混浊的组织病理学研究

目的：研究兔晶状体超声乳化术中眼内应用0．2mg／ml的丝裂霉素C(mitomycin-C，MMC)对术后后囊膜混浊的抑制作用，并比较不同给药方式对眼毒性的差异。方法：将32只新西兰白化兔随机分为A、B、C、D4组，进行晶状体超声乳化摘除术。A组为空白对照组，B组用0．2mg／ml的MMC溶液在环形撕囊后作水分离，C组在术中将混有MMC(0．2mg／ml)的粘弹剂注入空的囊袋中，D组将MMC(0．2mg／ml)溶于配好的灌注液中，在手术中应用。术后1个月对术眼进行组织病理学检查。结果：术后1个月时光镜下A组中赤道部及中央后囊膜均可见晶状体上皮细胞的明显增生、移行及大量排列紊乱的成纤维细胞和胶原纤维。B、C、D三组中可见赤道部少量残留的晶状体上皮细胞及皮质，中央后囊的表面未见品状体上皮细胞、成纤维细胞或珍珠样小体。透射电镜下，D组中虹膜上皮、睫状体上皮及视网膜各层均发生了不同程度超微结构的损伤，A、B、C三组间未见明显异常。结论：眼内应用0．2mg／ml的MMC明显抑制后囊膜混浊的发展。尽管眼内应用0．2mg／ml的MMC可以导致眼内组织的毒性，但通过改进用药方法和加强保护措施，可有效地避免或减少药物的眼毒性。在应用于临床之前，仍需进一步动物实验研究。     

Viscoelastic protection from endothelial damage by air bubbles

PURPOSE: To determine whether viscoelastic materials effectively protect the corneal endothelium from air bubbles. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. METHODS: Human eye-bank and rabbit eyes had a standardized phacoemulsification procedure with or without viscoelastic material (Healon [sodium hyaluronate 1.0%], Healon GV [sodium hyaluronate 1.4%], or Viscoat [chondroitin sulfate 4.0%-sodium hyaluronate 3.0%]). The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy. Rabbit eyes with and without viscoelastic material (Healon or Viscoat) had a standardized irrigation/aspiration (I/A) procedure. The mucinous layer of the endothelium was examined after the procedure with transmission electron microscopy. RESULTS: In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of human and rabbit corneas had many areas of cell loss in a pattern consistent with air-bubble damage. With Viscoat, endothelial cells remained intact. In the I/A experiment, the mucinous layer of Viscoat-exposed rabbit endothelium appeared thinner. In the same experiments without viscoelastic material or with Healon, the mucinous layer of the endothelium appeared normal. CONCLUSIONS: Viscoat effectively protected the endothelium from air-bubble damage. Viscoat appears to protect the endothelium by acting as a physical barrier. Its adherence is probably related to the way it interacts with the mucinous layer of the endothelium.     

Efficacy of various drugs in the prevention of posterior capsule opacification: experimental study of rabbit eyes

PURPOSE: To assess the efficacy of various drugs in the prevention of posterior capsule opacification (PCO) in a closed capsular bag technique. SETTING: Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA. METHODS: Lens material was removed using phacoaspiration or phacoemulsification through a microcapsulorhexis according to the hardness of the crystalline lens correlated with the weight and age of the rabbits. A mixture of an ophthalmic viscosurgical device (sodium hyaluronate 1.4% [SHA]) and a drug was injected into the empty capsular bag, allowed to remain inside for 3 minutes, and removed. The capsular bag was rinsed with balanced salt solution (BSS) and refilled with SHA. In a group of rabbits, the capsulorhexis was sealed with a minicapsulorhexis valve (MCV). Rabbits were treated with 1 of the following: SHA (control), BSS, mitomycin-C (MMC, 0.2 mg/mL), ethylenediaminetetraacetic acid (EDTA) (10 mM and 15 mM), 5-fluorouracil (5-FU, 33 mg/mL), acetic acid (3%, 0.3%, and 0.003%), and distilled water. RESULTS: Upon completion of the study, the control and treated eyes had PCO and new lens material (not residual). Anterior capsule proliferation was observed in eyes treated with 5-FU. The order of PCO appearance (earliest to latest) was as follows: 15 mM EDTA, SHA, MMC, acetic acid 0.3%, acetic acid 3%, BSS, distilled water (small animals; no MCV), acetic acid 0.003%, 5-FU, 10 mM EDTA, and distilled water (large animals; MCV). The earliest appearance was day 1 postoperatively and the latest, day 47. CONCLUSIONS: Distilled water and 10 mM EDTA treatments were the most efficient in retarding the appearance of PCO.     

人工晶体植入后房水中透明质酸钠残留量的测定

目的测定人工晶体植入后房水中透明质酸钠的残留量。方法用岛津ＵＶ３１０１型紫外分光光度仪测量２３例（２５只眼）人工晶体植入后,注吸前及注吸２ｍｌ、５ｍｌ、８ｍｌ时房水中透明质酸钠（ｓｏｄｉｕｍｈｙａｌｕｒｏｎａｔｅ）的百分比浓度。结果注吸前、后不同的相对百分比浓度分别为６５５０％±１８１２％、１０２０％±４８０％、２１９％±１８３％及０７０％±０９１％。结论房水置换２ｍｌ可清除房水中大部分透明质酸钠,而置换８ｍｌ可使透明质酸钠残留减至微量,保持术后眼压正常。     

Sodium hyaluronate eye drops prevent late-onset bleb leakage after trabeculectomy with mitomycin C

PURPOSE: To evaluate the efficacy of sodium hyaluronate eye drops for prevention of late-onset bleb leakage after trabeculectomy with mitomycin C (MMC). METHODS: Sixty-eight patients (68 eyes) who had trabeculectomy with MMC from March 1995 to February 2002 at the Marui Eye Clinic or the Department of Ophthalmology, Fukushima Medical University Hospital were examined in this study. Twenty-two were treated postoperatively with sodium hyaluronate eye drops (sodium hyaluronate group) and 46 eyes were not treated postoperatively (control group). The blebs were classified according to the avascular area, epithelial defect and degree of bleb wall leakage. Both groups were assigned classes (0, avascular or partial avascular bleb; 1, avascular or partial avascular bleb with an epithelial defect; 2, avascular or partial avascular bleb with oozing; 3, avascular or partial avascular bleb with a point of leakage). RESULTS: Follow-up duration ranged from 10 to 116 months (mean+/-SD, 57.6+/-30.5). The incidence of reclassification from class 1 to class 0 was significantly greater in the sodium hyaluronate group (four of six class 1 eyes improved to class 0 after application of sodium hyaluronate eye drops) than in the control group (zero of 10 eyes) (P=0.008). And, the incidence of reclassification from class 1 to class 2 or class 3 was significantly smaller in the sodium hyaluronate group (one of six eyes) than in the control group (nine of 10 eyes) (P=0.008). CONCLUSIONS: Sodium hyaluronate eye drops may prevent late-onset bleb leakage after trabeculectomy with MMC.     

Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy

PURPOSE: To evaluate the results of the prophylactic use of mitomycin-C to inhibit haze formation after excimer laser photorefractive keratectomy (PRK) for medium and high myopia in eyes that were not good candidates for laser in situ keratomileusis (LASIK). SETTING: Carones Ophthalmology Center, Milan, Italy. METHODS: This prospective randomized masked study comprised 60 consecutive eyes (60 patients). The inclusion criteria were a spherical equivalent correction between -6.00 and -10.00 diopters (D) and inadequate corneal thickness to allow a LASIK procedure with a residual stromal thickness of more than 250 microm. The eyes were divided into 2 groups according to the randomization protocol. After PRK, the study group eyes were treated with a single intraoperative dose of mitomycin-C (0.2 mg/mL), applied topically with a soaked microsponge placed over the ablated area and maintained for 2 minutes. The control eyes did not receive this treatment. Refraction, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and slitlamp evidence of corneal opacity (haze) or other visible complications were evaluated. RESULTS: No toxic or side effects were encountered postoperatively. No study group eye had a haze rate higher than 1 during the 6-month follow-up; 19 eyes (63%) in the control group did (P =.01). At 6 months, the between-group difference in the refractive outcome was statistically significant (P =.05), with 26 study group eyes (87%) and 14 control eyes (47%) within +/-0.50 D of the attempted correction. No study group eye had a BCVA loss during the follow-up; 7 control eyes had lost 1 to 3 lines at 6 months (P =.0006). CONCLUSIONS: The prophylactic use of a diluted mitomycin-C 0.02% solution applied intraoperatively in a single dose after PRK produced lower haze rates, better UCVA and BCVA results, and more accurate refractive outcomes than those achieved in the control group.     

Effect of topical brimonidine on intraocular pressure after small incision cataract surgery

PURPOSE: To evaluate the effect of brimonidine 0.2% on intraocular pressure (IOP) after small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 80 eyes of 40 patients scheduled for small incision cataract surgery in both eyes. In each patient, 1 eye was randomly assigned to receive 1 drop of brimonidine 0.2% or no treatment (control) immediately after surgery. The fellow eye received the other assigned treatment. All patients had standardized surgery by the same surgeon with sodium hyaluronate 1%, a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. RESULTS: Six hours after surgery, the mean increase in IOP was 4.7 mm Hg +/- 6.1 (SD) in the brimonidine group and 4.6 +/- 5.3 mm Hg in the control group. In each group, 17 eyes (43%) had an IOP increase of 5 mm Hg or more. Twenty to 24 hours after surgery, the mean increase in IOP was 1.5 +/- 4.2 mm Hg in the brimonidine group and 1.6 +/- 4.4 mm Hg in the control group. There were no statistically significant between-group differences at any measurement. CONCLUSIONS: In both groups, IOP significantly increased 6 hours and 20 to 24 hours after small incision cataract surgery. Brimonidine 0.2% failed to reduce the IOP increase observed after small incision cataract surgery.     

Transconjunctival mitomycin-C in needle revisions of failing filtering blebs

PURPOSE: To report the efficacy and safety of transconjunctival mitomycin-C as an adjunct to needle revision of failing filtering blebs. DESIGN: Retrospective, consecutive, noncomparative interventional case series. PARTICIPANTS: Forty-one patients (42 eyes) undergoing bleb revisions by a single surgeon at a single institution from May 1997 to January 2001. METHODS: The authors retrospectively reviewed charts of 42 eyes that underwent needle revision of the failing filtering bleb using transconjunctival application of mitomycin-C. Needling of the bleb was performed with a 25-gauge needle. The site of the needle puncture was sutured and followed by application of transconjunctival mitomycin-C (0.5 mg/ml) by means of a sponge left in contact with the conjunctival epithelium for 6 minutes. A group of patients received additional subconjunctival injections of 5-fluorouracil in the postoperative period. Success was defined as a reduction in intraocular pressure of 30% without the use of antiglaucoma medications and no further surgical procedures to control intraocular pressure. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, complications, number of glaucoma medications used at the final visit. RESULTS: Mean preoperative intraocular pressure was 22.1 +/- 8.0 mmHg, which was reduced by 9.6 +/- 7.9 mmHg to a mean postoperative intraocular pressure of 12.5 +/- 6.1 mmHg. Mean follow-up was 17.6 +/- 13.5 months. Kaplan-Meier survival analysis showed a probability of continued success at 12 months of 76.1%, and at 24 months of 71.6%. The most common complication was hyphema in 7.1% of patients. Twenty-six eyes also received postoperative injections of 5-fluorouracil. CONCLUSIONS: Transconjunctival mitomycin-C may enhance success of the needling procedure in failing filtering blebs.     

Corneal endothelial cell protection during phacoemulsification: low- versus high-molecular-weight sodium hyaluronate

PURPOSE: To compare the efficacy of low- and high-molecular-weight sodium hyaluronate in protecting corneal endothelial cells during phacoemulsification. SETTING: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. METHODS: One hundred forty-nine eyes of 136 cataract patients were randomly assigned to have cataract surgery using sodium hyaluronate 1% with a low molecular weight (0.6 to 1.2 million d, Opegan) or sodium hyaluronate 1% with a high molecular weight (4 million d, Healon) during phacoemulsification. Each group was divided into 2 subgroups depending on the amount of ultrasound (% min) used during phacoemulsification, which was defined as the mean phacoemulsification energy (%) multiplied by phacoemulsification time (minutes). Corneal endothelial cell density was examined preoperatively and 3 months after surgery. The rate of cell loss was compared between the subgroups in the Opegan group and the Healon group. RESULTS: In the subgroups with ultrasound of 50% min or less, the mean rate of endothelial cell loss 3 months after surgery was 3.2% +/- 4.1% (SD) in the Opegan group and 5.9% +/- 5.3% in the Healon group (P =.0214). In the subgroups with ultrasound over 50% min, the mean rate of endothelial cell loss 3 months after surgery was 7.5% +/- 10.6% in the Opegan group and 14.8 +/- 9.0% in the Healon group (P =.0029). CONCLUSIONS: The results suggest that Opegan is more effective than Healon in protecting corneal endothelial cells during phacoemulsification regardless of the amount of ultrasound energy used.     

Evaluation of ophthalmic visicoelastic devices in rabbit penetrating keratoplasty--the protective effect for corneal endothelial cells after autokeratoplasty and the effect of intraocular pressure after aqueous exchange

PURPOSE: To investigate the effect of sodium hyaluronate molecular weight on corneal endothelial cells and intraocular pressure after penetrating keratoplasty in rabbits. MATERIAL AND METHOD: Rotating autokeratoplasty was carried out on rabbits using six groups of sodium hyaluronate in which the molecular weight differed. Then the endothelial cell density, hexagonal cell rate, corneal thickness, and intraocular pressure were measured. The intraocular pressure in the rabbit eyes after aqueous exchange with six groups of sodium hyaluronate was also measured. RESULTS: The endothelial cell density and hexagonal cell rate in the hyaluronate group of molecular weight 1.53-2.13 million and 1.9-3.9 million were the same as in the eye groups receiving no manipulation. As for the intraocular pressure after aqueous exchange, the highest intraocular pressure was more than 40 mmHg in the group treated with hyaluronate over 1.9 million and the group treated with hyaluronate and chondroitin sulfate compounding agent. CONCLUSION: Endothelial protection was considered to be superior when hyaluronate with a molecular weight of 1.5-3.9 million was used in rabbits. However, it is grossible that leaving a large amount of hyaluronate with a molecular weight over 1.9 million in the eye may lead to a remarkable increase in the early postoperative intraocular pressure.     

Viscoanesthesia. Part I: toxicity to corneal endothelial cells in a rabbit model

PURPOSE: To evaluate the toxicity of a solution combining sodium hyaluronate 1.5% with lidocaine (0.5%, 1.0%, or 1.65%) to the rabbit corneal endothelium. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Each rabbit cornea was excised, and the endothelium was exposed to 1 of the following solutions for 20 minutes: viscoanesthetic solution (0.5%, 1.0%, or 1.65% lidocaine in sodium hyaluronate 1.5%; 5 corneas each), sodium hyaluronate 1.5% (n = 5), balanced salt solution (BSS(R)) (n = 5), mitomycin-C 0.02% (n = 2), dextran 15% (n = 2), or distilled water (n = 2). The endothelium was then stained with trypan blue and alizarin red. Two corneas were stained immediately after excision. Cell morphology and damage to the corneal endothelium were analyzed by microscopic examination. RESULTS: The endothelium in the corneas of the viscoanesthetic groups was comparable to that in the sodium hyaluronate 1.5% and the BSS groups and to the corneas not exposed to any solution. In some areas of the 1.0% and the 1.65% viscoanesthesia groups, the corneal endothelial cells presented irregular intercellular borders. Staining with trypan blue, which indicates cellular damage, was observed in some linear areas corresponding to corneal folds in all groups. The folds were probably caused during manipulation for corneal excision and staining. The corneal endothelium was destroyed in the mitomycin group. In the dextran and distilled-water groups, morphological alterations probably resulting from osmotic changes were observed. CONCLUSIONS: The 3 concentrations of viscoanesthetic solutions appeared to be safe to rabbit corneal endothelium.     

Evaluation of posterior capsule opacification using a new posterior view method in rabbits: single-piece acrylic versus 3-piece acrylic intraocular lens

PURPOSE: To introduce a new procedure for evaluating posterior capsule opacification (PCO) in rabbit eyes and to perform a comparative study of the single-piece and 3-piece acrylic intraocular lenses (IOLs) on PCO using the new evaluation method. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: A single-piece or 3-piece acrylic IOL was implanted in 1 eye and the other in the contralateral eye of 5 rabbits. Three weeks after surgery, PCO was scored by Evaluation of Posterior Capsule Opacification (EPCO) in posterior view. Before the posterior view was photographed, the anterior capsule was removed from the whole optic area to eliminate disturbing anterior capsule opacification (ACO) for the PCO evaluation. RESULTS: Posterior capsule opacification could be well observed and viewed in the posterior view so that it could be scored by EPCO without confusion with ACO. The mean PCO score of the single-piece and 3-piece acrylic IOLs was 3.12 +/- 0.19 and 2.41 +/- 0.70, respectively (P < .05 and P = .03, respectively). CONCLUSION: The removal of ACO allowed scoring of PCO by EPCO in rabbit eyes. The single-piece acrylic IOL showed significantly more PCO than the 3-piece acrylic IOL at least 3 weeks after surgery in rabbits.     

Comparison of posterior capsule opacification in rabbits receiving either mitomycin-C or distilled water for sealed-capsule irrigation during cataract surgery

PURPOSE: To compare posterior capsule opacification (PCO) in rabbits who undergo cataract surgery and receive either mitomycin-C (MMC) or distilled water (DW) during sealed-capsule irrigation (SCI). In addition, we examined the toxicity of DW and MMC. METHODS: Twenty-four eyes from 12 rabbits were divided into three groups. Balanced salt solution (BSS), DW, MMC 0.4 mg/mL was injected into the capsular bag for 2 min after endocapsular phacoemulsification and insertion of a SCI device. The degree of PCO was assessed by POCOman software at 3 months post surgery. Central corneal thickness, anterior chamber inflammation were assessed 1 day, 1 week, 2 weeks, 3 weeks, 1 month and 3 months postoperatively. RESULTS: A statistically significant difference in PCO scores was noted between the control and study groups (P < 0.05). The PCO scores of the MMC group were significantly lower than those of the DW group (P < 0.05). The MMC and DW groups did not show significant toxicity compared with the BSS group. CONCLUSIONS: MMC is more effective in reducing PCO than DW; the SCI device can protect the surrounding ocular tissue from MMC toxicity in rabbit eyes.     

Pentacam tomograms: a novel method for quantification of posterior capsule opacification

PURPOSE: To develop and validate a method to quantify posterior capsule opacification (PCO) in eyes after cataract surgery and intraocular lens implantation using Scheimpflug Pentacam tomograms and compare its validity with slit lamp retroillumination image analysis. METHODS: One hundred twenty-four pseudophakic eyes of 124 patients were divided into two groups. Group 1 consisted of 40 eyes with visually significant PCO, and group 2 consisted of 84 eyes without visually significant PCO. Pentacam Imaging was performed after full mydriasis using the 50-scan acquisition protocol, and high-resolution tomograms were reconstructed and analyzed using ImageJ freeware. Retroillumination photographs were captured for group 1 eyes using the Topcon digital slit lamp, and these were analyzed using POCOman software to calculate an aggregate severity grade and percentage PCO value. Correlation coefficients were calculated for PCO values obtained using POCOman and ImageJ. RESULTS: Mean PCO percentage value obtained using POCOman software was 23.34 +/- 6.25 U, mean aggregate PCO severity grade was 0.46 +/- 0.28 U, and mean pixel-intensity value using ImageJ was 31.071 +/- 8.26 U. There was a significant positive correlation between the percentage PCO (P = 0.000; r = 0.864) and PCO severity grade (P = 0.001; r = 0.490) obtained for group 1 eyes using slit lamp retroillumination images and PCO pixel intensity obtained using Pentacam tomograms. CONCLUSIONS: Retroillumination photographs are the standard for quantifying PCO. Pentacam tomograms are easier to obtain and are free of flash reflections, and they allow for a more objective analysis. The correlation between the two methods demonstrates that ImageJ analysis of Pentacam tomograms is a viable tool for PCO analysis.     

补肾丸合明目五子治疗干眼症的临床疗效

目的:观察补肾丸合明目五子治疗蒸发过强型干眼症的治疗效果.方法:本研究采用阳性药物对照、前瞻性研究、随机数余数分组法,将65例门诊确诊为蒸发过强型干眼症的患者分为治疗组32例64眼和对照组33例66眼.治疗组口服补肾丸合明目五子汤剂治疗,联合使用玻璃酸钠滴眼液,对照组单纯使用玻璃酸钠滴眼液点眼,两组患者均以4wk为1个疗程.观察两组患者治疗前后泪膜稳定性、中医临床症状评分的变化,并进行疗效评价.结果:治疗组较对照组泪膜稳定性增加,中医临床症状评分下降.治疗组疗效优于对照组,差异有统计学意义(z=-3.149,P<0.05).结论:补肾丸合明目五子联合玻璃酸钠滴眼液治疗蒸发过强型干眼症的疗效优于单纯使用玻璃酸钠滴眼液.     

Photorefractive keratectomy with intraoperative mitomycin-C application

PURPOSE: To evaluate the efficacy and safety of photorefractive keratectomy (PRK) with intraoperative application of mitomycin-C (MMC). SETTING: Yonsei Eye Center, Seoul, South Korea. METHODS: This retrospective noncomparative case series included 536 patients (1011 eyes) who had had PRK with intraoperative application of MMC using the Nidek EC-5000 excimer laser. Preoperative and postoperative best spectacle-corrected and uncorrected visual acuities, spherical equivalent (SE) refraction, corneal haze graded by slitlamp biomicroscopy, and endothelial cell density measured by specular microscopy were evaluated. RESULTS: The mean preoperative SE was -7.82 diopters (D) +/- 2.64 (SD); 72% of eyes (732) were more than -6.00 D, and 28% (287) were more than -9.00 D. The mean follow-up was 13 months (range 6 to 27 months). Six months postoperatively, the mean postoperative SE was -0.14 +/- 0.62 D; 86% were within +/-0.50 D and 93% were within +/-1.00 D of desired refraction. Eighty-six percent had 20/20 or better visual acuity, and 98% were 20/40 or better. Regression of more than 1.00 D occurred in 78 eyes (7.6%), and it was more common in eyes with a preoperative SE of -9.00 D or worse (18%). Haze occurred in 32 eyes (3.17%), but in most cases it was limited to grade 1. Grades 2 and 3 haze occurred in 3 eyes and 2 eyes, respectively. The postoperative endothelial cell density measured by specular microscopy did not show a significant difference from preoperative measurements. Delayed epithelial healing was observed in 2 eyes. CONCLUSION: Photorefractive keratectomy with intraoperative application of MMC was a safe procedure that produced excellent visual outcomes with few complications.     

Effects of thick Tenon's capsule on primary trabeculectomy with mitomycin-C

PURPOSE: To investigate the effects of thick Tenon's capsule on primary trabeculectomy with adjunctive mitomycin-C. METHODS: In this prospective interventional case series of 45 consecutive uncomplicated glaucoma patients, 45 eyes with thick Tenon's capsule underwent primary trabeculectomy with intraoperative mitomycin-C (0.4 mg/ml for 3 min). Success was defined as intraocular pressure (IOP) 相似文献   

Sodium hyaluronate in trabeculectomy: effect on early complications

PURPOSE: To evaluate the effect of sodium hyaluronate on the early complications of trabeculectomy. METHODS: In this prospective study, trabeculectomy was performed in 51 eyes of 51 patients with different types of glaucoma. Patients were divided into two groups randomly. In 24 eyes (study group) sodium hyaluronate was injected into the anterior chamber after suturing the scleral flap. In the remaining 27 eyes (control group) only balanced salt solution was injected. Visual acuities, intraocular pressures and early complications were evaluated. RESULTS: Preoperative mean intraocular pressures were similar in the two groups (34.5 +/- 18.7 mmHg in the study group and 37.2 +/- 18.1 mmHg in the control group). In the first postoperative day mean intraocular pressure difference was significant (16.8 +/- 7.1 mmHg in the study group and 9.0 +/- 6.6 mmHg in the control group, P < 0.01). There was significant difference in occurrence of hypotony (8.3% study vs. 40.7% control), anterior chamber shallowing (8.3% study vs. 37% control) and choroidal detachment (none in study vs. 33.3% control) between the two groups (P < 0.01). Early intraocular pressure peak, occurred more common in the study group (20.8%) than in the control group (11.1%), but the difference was not significant (P > 0.01). Hyphema occurred in two (8.3%) eyes in the study group, and three (11.1%) in the control group. This was not significant (P > 0.01). The clearance time of blood from the anterior chamber (less than 1 week) was also similar in the two groups. CONCLUSION: Sodium hyaluronate-assisted trabeculectomy decreased the incidence of early postoperative complications like anterior chamber shallowing, choroidal detachment and hypotony, but it did not have any effect on hyphema or its clearance.