No Abstract Available.
Filtering Surgery* ; Genistein* ; Glaucoma*

PURPOSE: To evaluate the histopathologic changes after insertion of polymer made of poly- glycolic acid(PGA) and poly(lactic acid-co-glycolic acid)(PLGA)/5-FU following filtering surgery in the rabbit. METHOD: A polymer with 0.3 mm thickness made of PGA and PLGA/5-Fluorouracil(5-FU, 10% by weight) composite were made in a size of 3 x 7 mm. After full-thickness filtration surgery performed, PGA was inserted under the conjunctiva in group I, PLGA/5-FU was inserted in group II and none in control group. Twelve rabbit eyes were enrolled in each group. RESULT: Postoperatively, no serious complication was found in anterior segment. In the control eyes inflammatory cell reaction was minimal at 2 weeks after surgery and decreased thereafter. While severe fibrovascular tissue reaction with loss of conjunctival filtration space was noted at 2 and 4 weeks after surgery in group I, the filtration space was well maintained without fibrovascular tissue reaction until 4 weeks after surgery in group II. At 8 weeks after surgery, fibrous tissue reaction was observed in group I, but not in group II and contol. The polymer was not found and the filtration space was obliterated at 8 weeks after surgery in group I and II. CONCLUSION: PLGA/5-FU may be used as an effective adjunct to improve the success rate of the filtration surgery, without inducing serious fibrous tissue reaction. PGA was not suitable.
Conjunctiva ; Filtering Surgery* ; Filtration ; Polymers*

Among the complication of filtering surgery for glaucoma, late bacterial endophthalmitis is relatively uncommon, but very disatrous and so requires a prompt and vigorous treatment. Recently, authors experienced 2 cases of late onset endophthalmitis, each developed 13 years and 15 years after filtering surgery. And we performed pars plana vitrectomy as well as medical treatment. These cases had a good response to our medical and surgical treatment with no loss of vision.
Endophthalmitis* ; Filtering Surgery* ; Glaucoma ; Vitrectomy

Objective: To assess the safety and incidence of subconjunctival fibrosis in rabbits eyes with and without intraoperative application of Seprafilm Bioresorbable Membrane (Genzyme Corp., Cambridge, MA) Methodology: A fornix based conjunctival peritomy was made on 20 eyes of10 rabbits. Ten eyes were randomly assigned to receive Seprafilm on the subconjunctival area while the opposite eye had no intraoperative application of the membrane. Two orbits (one rabbit) were exenterated each week for ten weeks and gross and histologic evaluation for signs of morbidity and scarring were performed Results: Seprafilm did not show any adverse effect on the rabbits eyes. All eyes with Seprafilm (100 percent) were a vascular while 5 eyes (50 percent) without Seprafilm showed the presence of conjunctival vascularity. Conjunctival mobility was normal in eyes with Seprafilm (100 percent) while the conjunctiva was immobile in 6 eyes (60 percent) without Seprafilm. Histologic sections on eyes without Seprafilm showed presence of fibrosis and inflammatory infiltrates in 7 eyes (70 percent) while only 2 (20 percent) and 3 eyes (30 percent) with Seprafilm showed the presence of fibrosis and inflammatory infiltrates, respectively. Failed "blebs" were evident in 6 eyes (60 percent) while only 4 eyes (40 percent) without Seprafilm were considered as functioning "blebs". All eyes with Seprafilm (100 percent) were considered as functioning "blebs" (p.005) and is statistically significant Conclusion: Pre-clinical evaluation has shown that Seprafilm is safe and effective in preventing postoperative subconjunctival fibrosis.
Animal ; FILTERING SURGERY ; MOLTENO IMPLANTS ; GLAUCOMA SURGERY ; SURGERY, FILTRATION ; SURGERY, FILTERING

Intraoperative mitomycin c has been popularized for use as an adjuvant to increase the success rate of trabeculectomy because of its antifibroblastic effects. Basically it has a potent antifibroblastic effect and its use presents many potential problems and side effects. As a result, many surgeons concentrate on method to gain the optimal surgical results with the minimal complications with MMC. But the long-term effects of MMC have not been determined because of its short history of clinical applications. So, we evaluated the surgical results and complications of MMC in a long-term follow-up study (more than 30 months) , which was divided into 4 groups by the use of MMC and the high-risk characteristics. A total of 135 eyes were studied. Each group included: A, 40 eyes; B, 17 eyes; C, 52 eyes; D, 26 eyes. Failed filtering surgery and young age were major factors in high-risk groups. In high-risk groups (A, B), the difference in success rates was statistically significant A(M+), 88.5%; B(M-), 52.9% (p=0.010), but in non-high risk groups (C, D), it was not: C(M+), 75%; D(M-), 76.9% (p=0.852). The difference in isual acuity (more than 3 lines in a snellen chart) between each groups was not shown. And in non-high risk groups (C, D), the difference in the hypotony rate was statistically significant C(M+), 21%; D(M-), 49% (p=0.046), but in high-risk groups, it was not: A(M+), 15%; B(M-), 11% (p=0.748). Regardless of the preoperative IOP level, postoperative IOP was less in cases where MMC was used than in cases where MMC was not used. In conclusion, MMC increased the success rate in high-risk groups but it aggravated complications, especially in non-high risk groups. To get optimal results with minimal complications, discreet use of MMC in selected cases is highly recorninended.
Filtering Surgery ; Follow-Up Studies* ; Mitomycin* ; Trabeculectomy*

The purpose of this study was to determine whether preoperative topical antiglaucomatous therapy influences the outcome of subsequent trabeculectomy. We investigated 50 eyes of 36 patients with primary open anlge glaucoma(POAG)and 86 eyes of 77 patients with primary angle closure glaucoma (PACG), who had undergone trabeculectomy. All the patients had received topical antiglaucomatous therapy preoperatively and had been followed up for at least 6 months postoperatively. Both groups, POAG and PACG were divided into two subgroups according to the duration of preoperative antiglaucomatous therapy: (a)for less than 1 month and (b)for more than 6 months. The criterion for success was maintenance of postoperative intraocular pressure(IOP)below 21 mmHg without medication. The rates of success were compared at 1 week, 1 month, 3 months, and 6 months postoperatively. In POAG patients, the overall success rate was clinically significantly higher in subgroup (a)than in subgroup (b)(P<0.05). The success rate in subgroup (a)of POAG patients remained higher irrespective of class of antiglaucomatous medications(P<0.05). In PACG patients, the success rate was also higher in subgroup A, but it failed to reach clinical significance. Postoperative mean IOP was slightly lower in subgroup (a)of all the participants, but it was not clinically significant. Our study suggests that long-term use topical antiglaucoma medications can affect adversely the result of filtering surgery in POAG.
Filtering Surgery ; Glaucoma, Angle-Closure ; Humans ; Trabeculectomy*

PURPOSE: We investigated the anti-inflammatory and anti-fibrotic effects of amniotic membrane(AM) ointment in filtering surgery of rabbits. METHODS: After filtering surgery was performed on both eyes of 10 rabbits, the AM ointment was applied over and under the scleral flap on one eye whereas base ointment excluding AM element was applied to the other as a control. The shapes of blebs were observed under slit-lamp biomicroscopy at postoperative 3 days, 1 week, 2 weeks and 4 weeks, and the tissues were excised for histologic studies. RESULTS: Serial changes of intraocular pressures had no significant difference. Slit-lamp biomicroscopy demonstrated that conjunctival blebs of AM ointment group were more elevated and cystic at 1 and 2 weeks. The heights of conjunctival blebs were significantly higher at 1, 2 and 4 weeks, and the width of scleral tracks was significantly wider at 1 and 2 weeks in AM ointment group. The number of inflammatory cells in the scleral track was significantly less at 3 days and 1 week, the number of fibroblasts in scleral track was significantly less at 2 and 3 weeks in AM ointment group. Masson s trichrome stain was less positive in AM ointment and the stain area of alpha-smooth muscle actin-positive fibroblasts was insignificant with image analysis system. Collagen type 3 appeared in scleral track from postoperative 1 week in control group, however, in AM ointment group, from 4 weeks. CONCLUSIONS: AM ointment is beneficial to suppress fibroblast differentiation, proliferation and inflam-matory reaction in filtering surgery and might be safe and effective adjunctive for enhancement of success in filtering surgery.
Amnion* ; Blister ; Collagen ; Fibroblasts ; Filtering Surgery* ; Humans* ; Intraocular Pressure ; Rabbits*

The study was carried out to investigate the efficacy of subconjunctivally injected mitomycin-C (MMC) on glaucoma filtration surgery(GFS) in rabbit eyes. Each of 0.05mg, 0.1mg and 0.2mg MMC were injected subconjunctivally into the rabbit eye according to groups I, II, III respectively following GFS. The IOP were returned to preoperative level at postoperative 2 weeks in control group, and at postoperative 12 weeks in group I and II. Histologically the fibrotic reaction appears less intensively in the order of group III, II, I and control group at 2 weeks after GFS. At postoperative 12th week, fibroblasts are more frequently oberved in group I and II than control group. But the proliferation of collagenous and reticulin fibers are less in group I and II than control group. The least amount of fibroblasts, collagenous and reticulin fibers are found in group III. It is suggested that subconjunctival injection of lower concentration of MMC would be effective approval as an adjunctive method to improve more success rate of GFS from this study.
Collagen ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Mitomycin* ; Rabbits* ; Reticulin

PURPOSE: To investigate the effects of varying the time of Mitomycin-C (MMC) subconjunctival injection before, during and after operation. METHOD: We divided rabbits into 3 groups according to injection time. Subconjunctival injections of 0.01% MMC 0.05 ml were given to the preoperative group at 6, 12 and 24 hours before operation, and to the postoperative group at 6, 12 and 24 hours after operation. The control group was given the injections during operation. Bleb formation and histologic analyses were studied for 4 weeks after operation. RESULTS For gross findings, the blebs of the preoperative and control groups were seen on the fourth day and completely formed at one week after operation, and were larger than those of the postoperative group. On the other hand, the blebs of the postoperative group were seen to have poor formation, displaying hypervascularity on the fourth day and disappearing one week after operation. For histologic findings, the proliferation of collagen fibers and the undifferentiation of fibroblasts observed in the preoperative and control groups were almost identical. But, the proliferation of collagen fibers and well-differentiated fibroblasts were seen to increase in the postoperative group, so aqueous flow was obstructed at week 3. CONCLUSIONS: Subconjunctival injections within 24 hours before or during glaucoma filtration surgery were better for bleb formation and preservation than those administerd after surgery.
Blister ; Collagen ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Hand ; Mitomycin* ; Rabbits*

PURPOSE: To investigate the effects of varying the time of Mitomycin-C (MMC) subconjunctival injection before, during and after operation. METHOD: We divided rabbits into 3 groups according to injection time. Subconjunctival injections of 0.01% MMC 0.05 ml were given to the preoperative group at 6, 12 and 24 hours before operation, and to the postoperative group at 6, 12 and 24 hours after operation. The control group was given the injections during operation. Bleb formation and histologic analyses were studied for 4 weeks after operation. RESULTS For gross findings, the blebs of the preoperative and control groups were seen on the fourth day and completely formed at one week after operation, and were larger than those of the postoperative group. On the other hand, the blebs of the postoperative group were seen to have poor formation, displaying hypervascularity on the fourth day and disappearing one week after operation. For histologic findings, the proliferation of collagen fibers and the undifferentiation of fibroblasts observed in the preoperative and control groups were almost identical. But, the proliferation of collagen fibers and well-differentiated fibroblasts were seen to increase in the postoperative group, so aqueous flow was obstructed at week 3. CONCLUSIONS: Subconjunctival injections within 24 hours before or during glaucoma filtration surgery were better for bleb formation and preservation than those administerd after surgery.
Blister ; Collagen ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Hand ; Mitomycin* ; Rabbits*