Prevention of hypotony after trabeculectomies with mitomycine

Hypotony with reduced a reduced visual acuity is often seen after trabeculectomy with mitomycine. In this study we describe measures such as reattaching the sleral flap with at least seven nylon sutures and the controlled and delayed use of argon laser suture lysis. With these preventative measures the percentage of hypotonies (IOP 6 mmHg) three months after surgery was reduced from 38 to 15% and chronically reduced visual acuity was reduced from 38 to 5%. With these adaptations in the surgical technique the complication rate of trabeculectomies with mitomycine can be markedly reduced without affecting the mean IOP (10.9 mmHg versus 10.8 mmHg) three months after surgery and the percentage of eyes with IOP 18 mmHg or less without medication (94 versus 91%).     

Retroprosthetic membrane: A complication of keratoprosthesis with broad consequences

Keratoprosthesis (KPro) devices have the remarkable ability to restore vision in patients suffering from corneal blindness who are poor candidates for traditional penetrating keratoplasty. However, eyes with KPro can experience various complications, including the development of retroprosthetic membrane (RPM). RPMs reduce visual acuity in patients due to physical obstruction of the visual axis, but studies have shown that RPM can also lead to a variety of other consequences, from melting of the corneal carrier graft to precipitating retinal detachments. Histopathologic studies have shown that RPMs are composed of elements from both the recipient and donor. The presence of myofibroblasts in RPMs imparts them with contractile properties, which can contribute to their downstream complications, including angle closure, hypotony, and retinal detachment. At present, there are limited treatments to combat the growth of RPM. Future therapies could include anti-metabolites and targeted anti-inflammatory treatments, as well as device coatings or textured device surfaces that can hinder RPM proliferation. The long-term success of KPro depends on devising an effective solution for preventing RPM growth.     

臀肌张力减退在腰椎间盘突出症诊断中的意义

目的:探讨腰椎间盘突出症患者出现臀肌张力减退、萎缩与椎间盘突出的部位、发病机制之间的关系及临床意义。方法 自1989～1998年对我院44例腰椎间盘突出症患者行手术探查治疗,其中男28例,女16例,年龄20～80岁,起病时间3个月～10年不等,随访时间3个月～2年,33例术前有臀肌张力减退,萎缩;同时对4例成人尸体进行解剖观察。结果:手术探查44例中阳性率为75％。结论:臀肌张力减退、萎缩是腰椎间盘突出症的诊断体征之一,其阳性率与突出物的大小、部位以及发病时间长短相关。     

Suturas transconjuntivales del tapete escleral en maculopatía hipotónica tardía tras esclerectomía profunda no perforante

Clinical case

A 63-year-old man presents with late hypotony maculopathy after non-penetrating deep sclerectomy. Hypotonia and visual acuity are improved after transconjunctival suturing of the scleral flap.

先天性白内障术后视网膜脱离合并睫状体环形纤维增生1例并文献复习

目的 报道1例先天性白内障术后视网膜脱离合并睫状体环形纤维增生病例的临床特征及治疗要点,分析其形成的病理机制。 方法 回顾该病例的诊断和治疗过程,结合病例资料及相关文献进行分析讨论。 结果 术中取出人工晶状体,行玻璃体切除术,剥离并切除睫状体环形增殖物后,复位视网膜,填充硅油。3个月后取出硅油并悬吊人工晶状体,术后患者视网膜平伏,眼压恢复至正常。 结论 视网膜脱离是先天性白内障术后严重的并发症之一,形成睫状体环形纤维增生的患者可表现为慢性低眼压和角膜带状变性,手术治疗应以保证眼压的维持并提高视力为目标。     

Effect of Excision of Avascular Bleb and Advancement of Adjacent Conjunctiva for Treatment of Hypotony

Purpose

To evaluate the efficacy of excision of avascular bleb and advancement of adjacent conjunctiva (EBAC) for treatment of hypotony after trabeculectomy with mitomycin C (MMC).

Methods

Fifteen patients (17 eyes) who received EBAC for correction of hypotony between September 1996 and October 2008 were reviewed retrospectively. The main outcomes were intraocular pressure (IOP) and postoperative complications.

Results

Hypotony (IOP <6 mmHg) of eight eyes (47.1%, seven patients) was caused by bleb perforation. Of these, two eyes (two patients) had a history of trauma. Hypotony appeared at 33.9±30.8 months, and EBAC was performed at 48.2±35.3 months after trabeculectomy with MMC. The mean follow-up period was 38.3±29.8 months. The qualified success rate of EBAC was 100% at 51 months after EBAC, and the complete success rate of EBAC was 76.5% at six months and 70.6% at 51 months, as determined by Kaplan-Meier analysis. Post-EBAC complications included blepharoptosis in four eyes (23.5%) and bleb perforation in one (5.9%). The blepharoptosis resolved within one month after EBAC in two patients. However, in the other patients, mild blepharoptosis remained at 17 and 22 months postoperatively.

Conclusions

EBAC was found to be an effective method for treatment of hypotony after trabeculectomy with MMC, and postoperative blepharoptosis was a major complication.     

Manejo de la hendidura de ciclodiálisis con crioterapia transescleral

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.     

外伤性低眼压视网膜电图的改变

目的 观察外伤性低眼压后视网膜电图 (ERG)的变化，探讨可能的改变机制。 方法 兔眼40只，伤前测量眼压后20只实验眼制作外伤性低眼压的兔眼模型，20只对照眼行晶状体囊外摘除术，伤后分别于2、4、8、16周测量眼压。进行暗适应ERG检查。 结果 伤后2周，实验组ERG b波的振幅高于伤前，约为伤前的2.5倍，到伤后16周下降至伤前1.5倍。 结 论 外伤性低眼压后ERG b波振幅高于正常，可能与低眼压造成视网膜血液循环淤滞，代谢产物淤积有关。 （中华眼底病杂志，2004，20：189-191）