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Trabeculectomy

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Trabeculectomy

  • primary trabeculectomy
    		•

    Selected Abstracts

    Trabeculectomy postponed due to volume of sub-Tenon local anaesthetic

    ANAESTHESIA, Issue 1 2009
    O. T. Sykes
    No abstract is available for this article. [source]

    Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot study

    ACTA OPHTHALMOLOGICA, Issue 1 2010
    Dimitris Papaconstantinou
    Abstract. Purpose:, To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP). Methods:, Forty eyes of 40 patients were assigned randomly to undergo trabeculectomy either with OloGen implant (study group) or without implant (control group). Preoperative data included age, gender, type of glaucoma, IOP and number of preoperative glaucoma medications. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Each patient was followed up for at least 6 months. Results:, There were no significant differences between the groups in terms of age, gender, type of glaucoma, preoperative IOP and number of antiglaucoma medications. Mean IOPs for both groups were significantly lower than preoperative levels at all intervals (P < 0.05) The number of glaucoma medications used dropped from a preoperative mean of 3.5 ± 0.7 to a 6-month postoperative mean of 0.3 ± 0.7 (P < 0.001) in the study group and from 3.7 ± 0.4 to 0.5 ± 1.1 (P < 0.001) in the control group. No statistically significant differences between the two groups were observed in terms of postoperative complications. Conclusion:, In this pilot study it appears that trabeculectomy with OloGen does not seem to offer any significant advantages compared with trabeculectomy alone. Additionally, even though there were no statistical differences between the two groups as far as complications were concerned, one eye from the study group developed endophthalmitis 10 days after surgery and two eyes presented with positive Seidel test and flat anterior chamber and required additional suturing. Studies with larger numbers of patients and longer follow-ups are required to confirm these findings and to examine the safety and long-term outcomes of trabeculectomy with OloGen. [source]

    Tight orbit syndrome: a previously unrecognized cause of open-angle glaucoma

    ACTA OPHTHALMOLOGICA, Issue 1 2010
    Graham A. Lee
    ABSTRACT. Purpose:, To describe a new syndrome of tight orbit and intractable glaucoma with a poor visual prognosis. Methods:, A retrospective observational case series of six patients seen at two centres between 2001 and 2007 assessing intraocular pressure (IOP), best-corrected visual acuity and visual field. Results:, Three men and three women, ranging in age at diagnosis from 14 to 53 years, demonstrated similar orbital features and progressive visual field loss despite intensive management with medication and laser and operative surgery. Highest IOPs ranged from 30 to 50 mmHg. Trabeculectomy and/or glaucoma drainage devices were attempted in five patients but all failed. One patient underwent orbital decompression with achievement of IOP control. Final IOP at last follow-up was variable; only two patients achieved IOP in the normal range, with the rest ranging from 25 to 40 mmHg. All patients had advanced visual field loss. Conclusion:, Tight orbit syndrome presents a serious clinical challenge. Despite maximum medical therapy and surgical intervention IOP is difficult to control, resulting in progressive visual field loss. [source]

    Cataract, loss of visual acuity, infection after trabeculectomy

    ACTA OPHTHALMOLOGICA, Issue 2009
    AM BRON
    Purpose Trabeculectomy is the most popular surgery for glaucoma, however some complications may impair the success of the procedure. Moreover without impacting the overall efficacy of trabeculectomy, the quality of life of the patients could be affected in a certain number of cases. Methods In this session we will give some tips to prevent and to treat these complications. Results Cataract is frequent after trabeculectomy and is mainly related to postoperative hypotony. In most recent clinical studies cataract has been shown to occur in half of the eyes 3 years after trabeculectomy. This has led H Jampel to write a provocative editorial; Trabeculectomy: more effective at causing cataract surgery than lowering intraocular pressure (Ophthalmology 2009;116:173-174). In advanced cases, severe sight-threatening complications such as the wipe-out syndrome, even uncommon may definitely lead the patient to blindness. The two more frequent presentations of infection after trabeculectomy are blebitis and endophthalmitis. Both can occur several years after trabeculectomy and Streptococci which are frequently found are devastating strains. Antimetabolites greatly increase the prevalence of endophthalmitis after trabeculectomy. Other less severe complications such as bleb dysesthesia may alter the quality of life of the patients. Conclusion The information of the patients and the quality of the follow-up are of paramount importance when a trabeculectomy is considered. [source]

    Trabeculectomy with an active postoperative regimen: results and resource utilization

    ACTA OPHTHALMOLOGICA, Issue 5 2009
    Amelie B. Taube
    Abstract. Purpose:, To evaluate intraocular pressure (IOP) and resource utilization after trabeculectomy, using an active postoperative regimen, in a Swedish population. Methods:, A retrospective analysis was performed on the patient charts of all patients who underwent trabeculectomy in a Swedish university hospital during 1 year (November 2000,December 2001). Trabeculectomy was performed in 34 eyes and trabeculectomy in combination with phacoemulsification in 10 eyes. Intraocular pressure, visual acuity, complications and numbers of injections of 5-fluorouracil, suture removal, needling procedures and visits to ophthalmologists were recorded for 2 years. Results:, Mean IOP before surgery was 30.4 mmHg (standard deviation [SD] 9.5) in eyes with capsular glaucoma and 28.7 mmHg (SD 9.3) in eyes with primary open-angle glaucoma. Mean IOP after 2 years was 15.3 mmHg (SD 3.9) in all eyes. Intraocular pressure of < 18 mmHg was achieved in 65% of the eyes after 2 years, as was IOP , 13 mmHg in 37%. Flap or suture manipulation was performed in 41 of 44 eyes. Needling procedures were carried out a mean of 2.3 times in 31 eyes. The mean number of visits to an ophthalmologist was 14.1 during the first postoperative year and 4.4 during the second. Conclusions:, The results were encouraging, with few complications and modest resource utilization. [source]

    Trabeculectomy and Mitomycin C (Trab-MMC) for uveitic glaucoma: post surgical interventions

    ACTA OPHTHALMOLOGICA, Issue 2007
    A LOCKWOOD
    Purpose: To examine the outcome of patients at who underwent trabeculectomy and MMC for refractory uveitic glaucoma and determine the post operative interventions required Methods: The Birmingham ReGAE (Research into Glaucoma and Ethinicity) Project is an open, prospective, consecutive series of patients who had undergone trabeculectomy with MMC. The surgery was performed by a single surgical team at the Birmingham and Midland Eye Centre Results: Twenty eyes of 25 patients with uveitic glaucoma underwent Trab-MMC for uncontrolled IOP despite maximally tolerated medical treatment. Mean follow-up was 650 days. Mean pre-op IOP was 26.7 mmHg and post-op was 11.5 mmHg. 92 % of trabeculectomies reached complete success (IOP , 21 mmHg without medication). Subconjunctival injections of 5-fluorouracil were performed on 10 eyes (36 %). Bleb needling revision was performed on 5 eyes (18 %).Visual loss > 2 lines occurred in 1 case (3.8%) due to delayed hypotony maculopathy Conclusions: Trabeculectomy and Mitomycin C is effective in this complex series of patients but do require considerable post surgery manipulation [source]

    Autologous blood injection for marked overfiltration early after trabeculectomy with mitomycin C

    ACTA OPHTHALMOLOGICA, Issue 3 2001
    Koji Okada
    ABSTRACT. Purpose: After trabeculectomy with mitomycin C, extremely low intraocular pressure (IOP) with excess filtration may cause hypotonous maculopathy in the early postoperative period. We evaluated the effect of injecting autologous blood on reversing early postoperative marked hypotony after trabeculectomy with mitomycin C. Methods: Trabeculectomy with mitomycin C was performed in 258 eyes between 1994 and 1998. Peribleb autologous blood injection was performed in five eyes in which pressure patches were ineffective in reversing excess filtration. Approximately 0.1 to 0.3 ml of whole unclotted blood was slowly injected at least 3 mm from the edge of the flap using a sterile 27-gauge needle. Results: None of these eyes developed hypotonous maculopathy after injection. After a mean 31-month follow-up, all eyes had well-controlled IOP and visual acuity in three eyes was much improved. Postoperative complications included mild IOP elevation in one eye treated with laser suturelysis, and fibrinous pupillary membrane in one eye. Conclusion: In the early postoperative period, autologous blood injection is effective in reversing excess filtration. [source]

    Trabeculectomy and Mitomycin C (Trab-MMC) for uveitic glaucoma: post surgical interventions

    ACTA OPHTHALMOLOGICA, Issue 2007
    A LOCKWOOD
    Purpose: To examine the outcome of patients at who underwent trabeculectomy and MMC for refractory uveitic glaucoma and determine the post operative interventions required Methods: The Birmingham ReGAE (Research into Glaucoma and Ethinicity) Project is an open, prospective, consecutive series of patients who had undergone trabeculectomy with MMC. The surgery was performed by a single surgical team at the Birmingham and Midland Eye Centre Results: Twenty eyes of 25 patients with uveitic glaucoma underwent Trab-MMC for uncontrolled IOP despite maximally tolerated medical treatment. Mean follow-up was 650 days. Mean pre-op IOP was 26.7 mmHg and post-op was 11.5 mmHg. 92 % of trabeculectomies reached complete success (IOP , 21 mmHg without medication). Subconjunctival injections of 5-fluorouracil were performed on 10 eyes (36 %). Bleb needling revision was performed on 5 eyes (18 %).Visual loss > 2 lines occurred in 1 case (3.8%) due to delayed hypotony maculopathy Conclusions: Trabeculectomy and Mitomycin C is effective in this complex series of patients but do require considerable post surgery manipulation [source]

    Long term outcome of bleb needling revisions following mitomycin C trabeculectomy in Afro-Caribbean eyes

    ACTA OPHTHALMOLOGICA, Issue 2007
    TA WILLIAMS
    Purpose: To assess the frequency, risk factors and outcome of patients requiring bleb needling revisions (BNR)following Mitomycin-C (MMC) augmented trabeculectomies in Afro-Caribbean eyes in Birmingham, United Kingdom. Methods: ReGAE (Research in Glaucoma and Ethinicity) is a UK based multidisciplinary based research group whose research is aimed at preventing glaucomatous blindness in the diverse ethnic population of the West Midlands. A prospective study of consecutive Afro-Caribbean patients with refractory advanced glaucoma who had undergone Mitomycin C augmented trabeculectomy (modified Cairns type trabeculectomy with fornix based conjunctival flap mitomycin C 0.1-0.4mg/ml) was completed. Bleb needling revisions in the operating theatre with subconjunctival 5 fluro-uracil (5FU) 0.1ml 25mg/ml) were required in a subset of eyes. The frequency, timing, complications and outcome of BNRs was studied. Results: 38 eyes (35 patients) were included in the study; mean age 52 years (range 11-77 years); male:female 21:14. 9 of 38 eyes (24%)required BNR. Aetiology of glaucoma POAG 44%; JOAG 23%; traumatic 11%; fuchs 11%; pseudoexfoliation 11%. Of the patients requring BNR 6 eyes required BNR within 1 month of MMC- trabeculectomy. BNRs were performed 1-48 months postopereratively. Number of BNRs required 1.7 per eye (range 1-4) over a 2 year post operative follow up period. No complications occurred during BNR. Conclusions: Afro-Caribbean patients have a significant risk of requiring BNR following MMC trabeculectomy. Although such bleb manipulations are most commonly required during the early postoperative period, late subtenon's fibrosis may necessitate late BNR in this ethnic group. [source]

    Protocol for mitomycin C use in glaucoma surgery

    ACTA OPHTHALMOLOGICA, Issue 2 2005
    J. A. Maquet
    Abstract. Purpose:,To evaluate the results of a protocol described for mitomycin C (MMC) use in trabeculectomy or combined surgery (phacoemulsification and trabeculectomy). Methods:,A total of 143 eyes (60 trabeculectomies and 83 combined surgeries) of 124 patients were divided into four groups: group 1 (without MMC); group 2 (with 0.1 mg/ml MMC); group 3 (with 0.2 mg/ml MMC), and group 4 (with 0.4 mg/ml MMC). Two-minute MMC was used in every case in groups 2, 3 and 4. The results were analysed after 1 year of follow-up. Intraocular pressure (IOP) and complications were evaluated. Successful IOP control was defined when IOP was <21 mmHg and <16 mmHg if advanced glaucoma was present, always without additional medical treatment. Results:,Mean preoperative IOP decreased from 24.60 mmHg (SD 1.40 mmHg) to 13.47 mmHg (SD 0.37 mmHg) (p < 0.00001), 12 months postoperatively. Control in IOP was achieved in 79.02% of eyes. No significant differences were found in final mean IOP values (p > 0.196) or in postoperative complications (p > 0.120) in groups 2, 3 and 4. Conclusion:,With the protocol described, a selection of concentration of MMC has been made in different clinical forms of glaucoma. No significant differences in IOP control and postoperative complications were noticed among the groups. [source]

    Systemic anti-inflammatory fibrosis suppression in threatened trabeculectomy failure

    CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2004
    Brendan Vote FRANZCO
    Abstract Purpose:,To provide a rationale for the use of systemic anti-inflammatory fibrosis suppression in the postoperative management of threatened early trabeculectomy bleb failure. Methods:,A review of the literature and of the authors' own experiences was conducted. Results:,The most important cause of persistent elevation of intraocular pressure after trabeculectomy is unduly marked or persistent inflammation with deposition of fibrous tissue, which prevents the formation of an adequately draining bleb. It was found that a clinically useful degree of suppression of bleb inflammation and fibrosis can be obtained with a 4,6 week course of the combined systemic administration of prednisone (10 mg t.i.d.), a non-steroidal anti-inflammatory agent (e.g. diclofenac 100 mg SR daily) and colchicine (0.25 mg or 0.3 mg t.i.d.), which was termed anti-inflammatory fibrosis suppression. Topical atropine 1% t.i.d. and adrenaline 1% t.i.d. eye drops can also be considered in addition to routine postoperative topical steroids. Conclusions:,Despite advances in surgical techniques and methods to control fibrosis, anti-inflammatory fibrosis suppression is a valuable tool to have available in the post­operative period for management of trabeculectomies that threaten failure. This regime produces a diffuse bleb, which has a very low risk of late infection or bleb perforation. It is recommend that this regime be added to the list of therapies that are considered when clinical features suggestive of a failing bleb are confronted early in the post­operative course. [source]

    Serious complications of cosmetic NewColorIris implantation

    ACTA OPHTHALMOLOGICA, Issue 6 2010
    Justin E. Anderson
    Acta Ophthalmol. 2010: 88: 700,704 Abstract. Purpose:, This case report describes serious postoperative complications and markedly elevated intraocular pressure (IOP) associated with the NewColorIris cosmetic implant. Methods:, We report an interventional case series of two patients who suffered multiple complications after NewColorIris implantation carried out in Panama. Assessment included visual acuity, photography, endothelial cell count and anterior segment optical coherence tomography (OCT) when possible. Results:, Both patients presented with endothelial cell loss, uveitis, pigment dispersion and elevated IOP. Anterior segment OCT demonstrated irregularities in the position and configuration of the implants within the anterior chamber with resultant areas of implant,iris and implant,endothelial contact. One patient had acute postoperative hyphaema that resolved with anterior chamber tissue plasminogen activator injection. Both patients required explantation OU, one eye has required trabeculectomy, and one eye with bullous keratopathy is being evaluated for Descemet's stripping endothelial keratoplasty. Conclusions:, Implantation of the NewColorIris cosmetic implant can lead to serious complications including hyphaema, uncontrolled IOP, severe endothelial cell loss, bullous keratopathy and anterior uveitis. Explantation may lead to improvement, but permanent damage to the trabecular meshwork and corneal endothelium persists. [source]

    3415: Treatment of postoperative macular edema

    ACTA OPHTHALMOLOGICA, Issue 2010
    I PETROPOULOS
    Purpose Cystoid macular edema (CME) is a frequent complication of a number of interventions in ophthalmology, such as cataract surgery (Irvine-Gass syndrome), laser procedures, and trabeculectomy. The purpose of this talk is to present the latest bibliographic data regarding the appropriate treatment of postoperative CME. Methods A review of the existing literature concerning the treatment of postoperative CME is performed. Characteristic personal cases are presented. Results In more than two-thirds of the cases, postoperative CME resolves spontaneously within weeks or months. Prophylactic topical treatment with indomethacin or flurbiprofen seems to reduce the frequency of clinical and angiographic CME, but its beneficial effect on final visual acuity is not established. Curative therapy includes topical corticosteroids; topical non-steroidal anti-inflammatory drugs (e.g. ketorolac); oral acetazolamide; sub-Tenon or intravitreal injection of triamcinolone acetonide; intravitreal injection of anti-VEGF drugs; and pars plana vitrectomy. The indications, role, and efficacy of each of the above treatment modalities are discussed, based on the latest bibliographic data. Conclusion Most cases of postoperative CME are mild and resolve spontaneously. In refractory cases, sub-Tenon or intravitreal injection of triamcinolone acetonide can be effective, but the risk of ocular hypertony is high. Intravitreal injection of anti-VEGF drugs offers promising results, yet large-scale randomized studies are necessary to validate their utility. Finally, pars plana vitrectomy is the treatment of choice when vitreomacular traction and/or epiretinal membrane is present. [source]

    2165: Microplasmin as an antiscarring agent for glaucoma surgery: translation into clinical application

    ACTA OPHTHALMOLOGICA, Issue 2010
    E VANDEWALLEArticle first published online: 23 SEP 2010
    Purpose Previously Microplasmin was investigated in a rabbit model for trabeculectomy. The combination of intracameral injections and topical drops of Microplasmin improved surgical outcome. The aqueous solution of Microplasmin used, was not optimized for use as drops or injections. Microplasmin is an autocatalytic enzyme which has a short half life when it is brought in conditions of 37°C and physiological pH. Therefore there is need for a more stable and longer acting formulation. Methods Firstly we will do pharmacological experiments to determine the rheological characterization of drug carriers with Carrier-med rheometer. Then we will define the purity of Microplasmin bulk drug substance by RP-HPLC. Finally, we will check the Microplasmin activity in the new obtained solutions by spectrophotometer. Secondly we will perform trabeculectomy in a rabbit model and administer the most qualified and optimized formulations. Postoperative clinical evaluation of IOP, bleb area, conjunctival vascularity and anterior chamber assessment will be performed. The eyes will be immunohistological investigated for collagen and inflammation. Conclusion Our previous data learned that the combination therapy of Microplasmin improved surgical outcome in a rabbit model, despite the fact that the formulation of Microplasmin was not optimized for use as drops or injections. Our proposed research project will optimize the formulation of Microplasmin for extended drug delivery and determine the optimal administration route and regimen. We believe that this project will allow us to further improve the positive animal data, translate this novel antifibrotic adjunctive therapy into clinical application, and thus improve the outcome after trabeculectomy in patients. [source]

    Central retinal vein occlusion following trabeculectomy with OloGen in patients with advanced glaucoma: a possible side-effect?

    ACTA OPHTHALMOLOGICA, Issue 5 2010
    Paris Tranos
    No abstract is available for this article. [source]

    Stratus optical coherence tomography study of filtering blebs after primary trabeculectomy with a fornix-based conjunctival flap

    ACTA OPHTHALMOLOGICA, Issue 1 2010
    Kazuyuki Hirooka
    Abstract. Purpose:, To investigate the relationship between filtering bleb function and Stratus optical coherence tomography (OCT) images. Methods:, We studied 72 eyes of 65 consecutive patients who had a fornix-based conjunctival flap in primary trabeculectomy with mitomycin C (MMC). Filtering blebs with various types of glaucoma were examined using Stratus OCT. Success rates were defined as intraocular pressure (IOP) , 15 mmHg and IOP reduction , 25% without medication or additional surgery. Success rates among classified groups were compared using Kaplan,Meier survival curves and the log-rank test. Results:, Blebs were classified into three different categories on the basis of the following Stratus OCT patterns: cystoid type (multiple cysts inside the bleb; 17 eyes), diffuse type (low to high reflective areas that were mixed inside the bleb; 31 eyes) and layer type (medium to high reflective layer inside the bleb; 24 eyes). Success rates in the cystoid-, diffuse- and layer-type blebs were 94%, 97% and 75% (P = 0.02), respectively. Conclusion:, In trabeculectomy with MMC and a fornix-based conjunctival flap, there is a significant association between the success rates and the postoperative Stratus OCT findings of filtering blebs. [source]

    Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot study

    ACTA OPHTHALMOLOGICA, Issue 1 2010
    Dimitris Papaconstantinou
    Abstract. Purpose:, To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP). Methods:, Forty eyes of 40 patients were assigned randomly to undergo trabeculectomy either with OloGen implant (study group) or without implant (control group). Preoperative data included age, gender, type of glaucoma, IOP and number of preoperative glaucoma medications. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Each patient was followed up for at least 6 months. Results:, There were no significant differences between the groups in terms of age, gender, type of glaucoma, preoperative IOP and number of antiglaucoma medications. Mean IOPs for both groups were significantly lower than preoperative levels at all intervals (P < 0.05) The number of glaucoma medications used dropped from a preoperative mean of 3.5 ± 0.7 to a 6-month postoperative mean of 0.3 ± 0.7 (P < 0.001) in the study group and from 3.7 ± 0.4 to 0.5 ± 1.1 (P < 0.001) in the control group. No statistically significant differences between the two groups were observed in terms of postoperative complications. Conclusion:, In this pilot study it appears that trabeculectomy with OloGen does not seem to offer any significant advantages compared with trabeculectomy alone. Additionally, even though there were no statistical differences between the two groups as far as complications were concerned, one eye from the study group developed endophthalmitis 10 days after surgery and two eyes presented with positive Seidel test and flat anterior chamber and required additional suturing. Studies with larger numbers of patients and longer follow-ups are required to confirm these findings and to examine the safety and long-term outcomes of trabeculectomy with OloGen. [source]

    Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucoma

    ACTA OPHTHALMOLOGICA, Issue 1 2010
    Yoshiaki Saito
    Abstract. Purpose:, This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG). Methods:, Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were , 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 ± 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan,Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups. Results:, Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group. Conclusions:, This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG. [source]

    Evaluation of choroidal blood flow after treatment of retinal diseases

    ACTA OPHTHALMOLOGICA, Issue 2009
    C CHIQUET
    Purpose this review aims to summarize studies which assessed the effect of treatment on choroidal blood flow. Methods this presentation will focus on studies using the laser Doppler flowmeter for the analysis of choroidal blood flow parameters (velocity, volume and flow) before and after treatment. Therapies have been assessed in different ocular disease, such as age-related macular degeneration (laser photocoagulation therapy, photodynamic therapy, transpupillary thermotherapy, sildenafil citrate, niacin, pentoxifylline), diabetes mellitus (panretinal photocoagulation, intravenous C-peptide infusion), retinal vein occlusions (isovolemic hemodilution), macular edema (diclofenac), inflammation (corticosteroid), retinal detachment (surgery) or glaucoma (nimodipine, endothelin receptor antagonist, bimatoprost, timolol, trabeculectomy). Results this paper will give insight to the effects of laser treatment (laser photocoagulation, photodynamic therapy), surgery (scleral buckling, trabeculectomy, ocular anesthesia) or systemic drugs on the choroidal blood flow. Methodological considerations will be analyzed, such as the calculation of the sensitivity of the experiments, the comparisons of different groups with or without randomization. Conclusion laser Doppler flowmetry is a useful and a non invasive technique to study the effect of treatment on choroidal blood flow. In ocular disease, investigators should be aware of the tissue scattering changes associated with a retinal or choroidal disease and the necessity of a controlled foveal fixation. [source]

    We're still under pressure: postoperative hypertony

    ACTA OPHTHALMOLOGICA, Issue 2009
    I STALMANS
    Purpose Postoperative hypertony is a frequent complication after trabeculectomy. This problem may occur from the early, to the late stages, and may be an acute or chronic situation. The aim of this lecture is to review the various causes with their clinical presentation and therapeutic strategy. Methods An overview will be provided on the different mechanisms that may cause hypertony after trabeculectomy, ranging from tight flap sutures or blocking of the constructed channel by various substances, over encapsulation and failing bleb to steroid response. For each of these situations, the clinical presentation and differential diagnosis will be discussed. Finally, the therapeutic options will be reviewed. Photographic and video material will be used to illustrate the various clinical presentations and therapeutic interventions. Conclusion This lecture will provide the audience with a practically oriented overview of the clinical management of hypertony after trabeculectomy. [source]

    Help, I've been too successful: postoperative hypotony

    ACTA OPHTHALMOLOGICA, Issue 2009
    T ZEYEN
    Purpose To give an overview of the etiology and treatment of hypotony post-trabeculectomy. Methods Postoperative hypotony is most commonly caused by either overfiltration or bleb leakage. This condition can lead to a flat anterior chamber, hypotony maculopathy, choroidal detachment, and cataract. Results Possible strategies to decrease overfiltration and heal bleb leaks will be highlighted. We will review when and how to refill the anterior chamber, and discuss the proper timing and technique to treat choroidal detachments. Finally, the indications, pros and cons of cataract surgery after trabeculectomy will be discussed. Conclusion This presentation will give guidance on how to diagnose and treat hypotony after trabeculectomy. [source]

    Cataract, loss of visual acuity, infection after trabeculectomy

    ACTA OPHTHALMOLOGICA, Issue 2009
    AM BRON
    Purpose Trabeculectomy is the most popular surgery for glaucoma, however some complications may impair the success of the procedure. Moreover without impacting the overall efficacy of trabeculectomy, the quality of life of the patients could be affected in a certain number of cases. Methods In this session we will give some tips to prevent and to treat these complications. Results Cataract is frequent after trabeculectomy and is mainly related to postoperative hypotony. In most recent clinical studies cataract has been shown to occur in half of the eyes 3 years after trabeculectomy. This has led H Jampel to write a provocative editorial; Trabeculectomy: more effective at causing cataract surgery than lowering intraocular pressure (Ophthalmology 2009;116:173-174). In advanced cases, severe sight-threatening complications such as the wipe-out syndrome, even uncommon may definitely lead the patient to blindness. The two more frequent presentations of infection after trabeculectomy are blebitis and endophthalmitis. Both can occur several years after trabeculectomy and Streptococci which are frequently found are devastating strains. Antimetabolites greatly increase the prevalence of endophthalmitis after trabeculectomy. Other less severe complications such as bleb dysesthesia may alter the quality of life of the patients. Conclusion The information of the patients and the quality of the follow-up are of paramount importance when a trabeculectomy is considered. [source]

    Ocular rigidity and ocular response analyzer

    ACTA OPHTHALMOLOGICA, Issue 2009
    E IOMDINA
    Purpose To study ocular rigidity and sclera crosslinking level at diferent stages of primary open angle glaucoma (POAG). Methods Biomechanical parameters of the eye especially corneal hysteresis (CH, mm Hg) were measured in 238 patients (311 eyes) aged 40-84 (median age 67.4 yrs) at various stages of compensated primary open-angle glaucoma using Reichert Ocular Response Analyzer (ORA). Besides, scleral samples obtained during sinus trabeculectomy combined with sclera trephination in the inferio-exterior quadrant of 28 patients (28 eyes) with various stages of POAG were studied using differential scanning calorimetry (Mettler TA 4000 with DSC20 cell). Results Average value (median) of CH gradually decreased from 10.1 mm Hg in the initial glaucoma stage (I) to 9.1 mm Hg in the developed (II) and 8.6 mm Hg in the advanced (III) glaucoma stage. The decrease of this clinical parameter is caused by structural and biochemical damage of the corneoscleral coat. In stage I, endothermic scleral collagen transition occurred at the median thermal peak Tm=60.3 grad.C, while in stages II and III the median peaks of scleral collagen melting emerge at higher temperatures: Tm=62.0 grad.C and Tm=64.5 grad.C, respectively (p<0,05). This testifies to a significant increase of scleral cross-linking and ocular rigidity during glaucoma development. Conclusion Biomechanical and biochemical disorders of glaucomatous sclera may cause clinical changes of ocular rigidity of eyes with POAG. This may be an important link of POAG pathogenesis requiring special therapy. [source]

    Ocular pulse amplitude under pressure: what happens to OPA in glaucoma before and after surgery?

    ACTA OPHTHALMOLOGICA, Issue 2009
    I STALMANS
    Purpose To investigate whether trabeculectomy, besides its intraocular pressure (IOP) - lowering effect, has an effect on the ocular pulse amplitude (OPA). To determine if OPA changes are influenced by IOP changes. Methods Forty-eight glaucoma patients (48 eyes) scheduled for unilateral first-time trabeculectomy were prospectively enrolled from October 2007 to April 2008. The eye undergoing trabeculectomy was considered as study eye, whereas the non-operated fellow eye was used as control eye. OPA, IOP, blood pressure and heart rate were measured prior to and 4 weeks following trabeculectomy by means of Pascal dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT) and sphygmomanometry. A regression model for repeated measures was used. Results Preoperative GAT, DCT and OPA were 20.92 ±8.55 mmHg, 21.33 ±7.06 mmHg and 3.23 ±1.58 mmHg, respectively. One month following trabeculectomy, GAT, DCT and OPA were 11.23 ±5.03 mmHg, 14.45 ±4.79 mmHg and 2.12 ±1.07 mmHg, respectively. There was a significant decrease in OPA after filtering surgery in the study eye compared to the control eye (P<0.0001). Changes in OPA were correlated with changes in IOP (Spearman rho = 0.49, P=0.0004). When the IOP change caused by filtering surgery was taken into account, no significant difference in effect on the OPA following trabeculectomy could be demonstrated in the study eye compared to the control eye (P=0.18). Conclusion OPA changes were strongly correlated with IOP changes. There was no evidence for an effect of filtering surgery on the OPA when the concomitant IOP decrease after trabeculectomy was taken into account. [source]

    The effect of microplamin on wound healing after glaucoma filtration surgery

    ACTA OPHTHALMOLOGICA, Issue 2009
    T VAN BERGEN
    Purpose The outcome of trabeculectomy can be diminished due to a decreased bleb function secondary to blood/ fibrin clot in the aqueous outflow pathway. The aim of this study is to investigate whether the administration of Microplasmin (ThromboGenics), a recombinant protein that dissolves clot and fibrin, could lead to a better maintenance of the constructed channel, and thus improve surgical outcome after trabeculectomy. Methods The effect of Microplasmin will be investigated in vivo in a mouse model for conjunctival fibrosis and in a rabbit model for glaucoma surgery. Postoperative follow up of the animals will take place daily during the first week and two-daily until they are scarified. On specific time points animals will be sacrificed and both eyes will be enucleated. Seven-µm thin slides will be (immuno-)stained for CD45 to evaluate inflammation and for Sirius red and Trichrome to evaluate fibrosis. Results Preliminary results showed that Microplasmin significantly improved glaucoma surgery outcome in the rabbit model of aggressive scarring compared to control. Conclusion Our proposed research project will elucidate the potential role of Microplasmin in the improvement of filtration surgery outcome, and will highlight any anti-clotting, anti-inflammatory, and/or anti-fibrotic effects of this molecule. Microplasmin as an adjuvant therapy in glaucoma surgery might open new perspectives for more efficient surgery. [source]

    Can preoperative bevacizumab improve trabeculectomy outcome?

    ACTA OPHTHALMOLOGICA, Issue 2009
    Avastin-Trab study
    Purpose The aim of this project is to study whether peroperative intracameral bevacizumab (Avastin®) might improve the outcome of filtration surgery. Methods This study will be carried out in a prospective, placebo-controlled, double-blinded experimental setup. The effect of peroperative administration of bevacizumab on intraocular pressure, bleb characteristics and post-operative medication and surgical intervention will be investigated. The risk of systemic side-effects will minimalized by using local anti-Vascular Endothelial Growth Factor treatment. The study patients will be divided into two major groups: A) Patients with primary open angele glaucoma and B) Patients with normotensive glaucoma, in which very low IOPs are targeted. Both groups of patients will undergo a trabeculectomy. Patients in group A will not be given the antimetabolite Mitomycin C (MMC), while patients in group B will receive MMC to obtain sufficiently low IOPs. This strategy adheres to standard operating procedures for filtration surgery. Results will follow Conclusion Our study will potentially shed new light on a plausible and simple method to improve the prognosis of glaucoma filtration surgery. Since this study will provide direct data on the effectiveness of a one-time treatment that might reduce the risk of bleb failure after filtration surgery, avoiding or reducing the need for long-term medication use or secondary surgical intervention, the potential clinical implications of this study are clear. Thus, our project opens exciting new perspectives for the treatment and prognosis of the blinding condition of glaucoma [source]

    Is inhibition of VEGF165 sufficient to inhibit scar formation after trabeculectomy?

    ACTA OPHTHALMOLOGICA, Issue 2009
    T VAN BERGEN
    Purpose We have previously shown that VEGF plays a role in scar formation after glaucoma surgery and that inhibition of all VEGF-isoforms by bevacizumab is able to reduce scar formation. This study was designed to elucidate the exact role of VEGF165 in scar formation after trabeculectomy. The effect of pegaptanib (Pfizer), which specifically blocks VEGF165, was investigated in vitro and in vivo. Methods The effect of pegaptanib on Tenon fibroblasts and HUVEC in vitro was determined using a WST-1 proliferation assay. The effect of the aptamer was also investigated in vivo in a rabbit model for glaucoma surgery by studying angiogenesis, inflammation and collagen deposition. Results A dose-dependent reduction of HUVEC proliferation was seen after pegaptanib administration in vitro (P<0.05 with a dose of at least 0,3 mg/ml). A concentration of 2 mg/ml pegaptanib was necessary to inhibit the proliferation of Tenon fibroblasts. The aptamer also significantly reduced blood vessel density 3 days after surgery in a rabbit model of trabeculectomy (P=0.001). There were no significant differences in inflammation and collagen deposition in the treated eyes compared to control. Conclusion Whereas HUVEC cells were inhibited by pegaptanib in a dose-dependent way, Tenon fibroblasts were only inhibited at the highest dose. A single administration of pegaptanib at the time of trabeculectomy reduced postoperative angiogenesis, but not inflammation or collagen deposition. Further studies using repeated pegaptanib injections are necessary to investigate whether the lack of effect of pegaptanib on scarring was due to a shorter working time of pegaptanib compared to bevacizumab, or due to the difference in their effect on the various VEGF isoforms. [source]

    Preoperative topical non-steroidal anti-inflammatory drug or steroid and clinical outcomes after trabeculectomy

    ACTA OPHTHALMOLOGICA, Issue 2009
    I STALMANS
    Purpose To investigate the benefit of preoperative topical non-steroidal anti-inflammatory drug (NSAID) or steroid after trabeculectomy. Methods In this prospective randomized placebo-controlled trial, 61 patients scheduled for trabeculectomy were randomized to one of 3 study medication groups: NSAID (ketorolac), steroid (fluorometholone) or placebo (artificial tears). Patients instilled one drop 4x daily for 1 month preoperatively and were examined on day 1, 2, at weeks 1, 2, and 4, and at months 3, 6, 12, 18 and 24 following trabeculectomy. Main outcome measures were incidence of postoperative interventions and IOP-lowering medications; complete and qualified success rate; final IOP and relative IOP reduction. Results Fifty-four eyes were entered for analysis. The percentage of patients requiring needling within the first year was 41% in the placebo, 6% in the NSAID and 5% in the steroid group (P = 0.006). The percentage of patients requiring IOP-lowering medication at one year was 24% in the placebo, 18% in the NSAID and 0% in the steroid group (P = 0.054 overall; P = 0.038 for steroids versus others). Log-rank test showed a significant (P = 0.019) difference in medication-free survival curves between the different groups; patients in the steroid group needed significantly less medication (P = 0.007). The inter-group differences in one-year IOP, relative IOP reduction and success rates were not significant. Conclusion Topical ketorolac or fluorometholone for one month preoperatively was associated with improved trabeculectomy outcomes in terms of likelihood of postoperative needling. Within the steroid group, there was a significant reduced need for postoperative IOP-lowering medication. [source]

    Microplasmin improves surgical outcome in a rabbit model for trabeculectomy

    ACTA OPHTHALMOLOGICA, Issue 2009
    E VANDEWALLE
    Purpose This study was designed to study the efficacy and safety of Microplasmin as an anti-scarring agent after trabeculectomy in a rabbit model. Methods The effect of Microplasmin was investigated in vivo in a rabbit model for glaucoma surgery. Clinical outcome measures were intra-ocular pressure, bleb area and survival, side effects on slit lamp examination. Moreover, (immuno-) histochemical analysis of the eyes was performed, with quantification of inflammation (CD 45) and collagen deposition (Trichrome and Sirius Red). In the first experiment (n=10), Microplasmin anterior chamber injection was compared to placebo injection. In the second experiment (n=3), topical Microplasmin drops were compared to placebo drops. In the third experiment (n=5) the combination of Microplasmin anterior chamber injection and topical drops was compared to placebo injection and drops. All experiments were conducted in a masked observator way. Results Microplasmin significantly augmented the bleb area and survival in a rabbit model of trabeculectomy after a single anterior chamber injection or combination therapy (injection combined with drops) compared to control. Collagen deposition was borderline reduced after Microplasmin administration compared to control. No significant changes in inflammation were noticed in the anterior chamber or in the conjunctiva. Conclusion Microplasmin single injection or combination with postoperative drops improved the outcome after trabeculectomy. In a rabbit model, larger blebs were produced for a longer period compared to control, and collagen deposition tended to decrease in this small series. [source]

    Do patients with normal tension glaucoma have a thinner conjunctiva?

    ACTA OPHTHALMOLOGICA, Issue 2009
    R VAN GINDERDEUREN
    Purpose The central cornea is thinner in patients with normal tension glaucoma (NTG). We had developed the surgical impression of thinner conjunctivas in patients with NTG. The purpose of this study was to determine whether there is a difference between the conjunctival thickness of patients with NTG and those with high tension primary open-angle glaucoma (POAG). Methods In this prospective study, 40 patients scheduled for trabeculectomy were categorized into NTG and POAG based on maximum intraocular pressure (IOP) as measured by Goldmann applanation tonometry. Ten (10) patients with NTG (max. IOP,21mmHg) and 30 patients with high tension POAG (max IOP>21mmHg) were included in the study. Conjunctival biopsies taken from the inferior fornix one month prior to trabeculectomy were fixed in formalin and embedded in Historesin. The conjunctival thickness was measured on a standardised way and compared between the two groups. Non-paired Student T test for two-tailed groups with equal variance was used for statistical analysis. Results The difference in mean conjunctival thickness between patients with NTG (66.4,±21.1) and patients with high tension POAG (104.6,±44.3) was statistically significant (P=0.045). The mean CCT in NTG (537,6±19.6) was lower than in POAG (548.3±38.0), but did not reach significancy in this study. Conclusion Patients with NTG have a thinner conjunctiva than those with high tension POAG [source]