In glaucoma filtering surgery, we conducted subconjunctival injection of Mitomycin-C(MMC) 12 hours before and after surgery, and examined histologic findings of the filtering bleb, and condition of the anterior chamber which ensued after the injection. We divided 15 full-grown rabbits into three groups, and for each group, administered subconjunctivally 0.1cc of 0.002%, 0.004%, and 0.008% MMC, respectively. The subconjunctival injection of MMC before surgery was given to the right eye and post-surgical injection to the left, and we examined the results 1, 2, 4, 7, and 14 days after the administration.In conclusion, subconjunctival injection of MMC 12 hours before glaucoma filtering surgery is shown to be more effective than the injection after the surgery.
Anterior Chamber ; Blister* ; Filtering Surgery* ; Glaucoma* ; Mitomycin* ; Rabbits

Usual managements of flat anterior chamber following filtering surgery are deepening of anterior chamber using cycloplegics and mydriatics, and pressure patch technique compressing the fistula. But the pressure patch technique may worsen chamber depth problem because exact compression on the filtering area is difficult by pressure patching. Prolonged pressure patching may also cause deterioration of filtering function. The tampon with glaucoma shell provides enough resistance to excessive outflow, allows the anterior chamber to reform promptly, and can prevent choroidal separation. We treated the flat anterior chamber following trabeculectomy using glaucoma shell in 7 eyes. The anterior chamber in each eye was restored promptly within 2-4 days after the placement of glaucoma shell. Glaucoma shell is easy to handle, gives minimal discomfort to patient, and may need less time to restore flat anterior chamber than pressure patching.
Anterior Chamber* ; Choroid ; Filtering Surgery ; Fistula ; Glaucoma* ; Humans ; Mydriatics ; Trabeculectomy*

PURPOSE: To compare the axial lengths, anterior chamber depths, and keratometric measurements and to predict postoperative refractions of AL-Scan(R), IOL master(R), and ultrasound. METHODS: A total of 40 eyes in 30 patients who received cataract surgery were included in the present study. The axial length, anterior chamber depth, and keratometry were measured by 2 types of partial coherence interferometry (AL-Scan(R) and IOL master(R)) and ultrasound. The SRK/T formula was used to calculate IOL power, and the predictive error which subtracts predictive refraction from postoperative refraction was compared among the ocular biometry devices. RESULTS: Axial lengths were 23.08 +/- 0.62 mm, 23.09 +/- 0.62 mm, and 22.99 +/- 0.62 mm measured by AL scan(R), IOL master(R), and ultrasound, respectively. Axial length measured by ultrasound was statistically significantly shorter than AL scan(R) and IOL master(R) (p < 0.001, p < 0.001, respectively). The anterior chamber depth and keratometry were 3.11 +/- 0.06 mm and 44.82 +/- 1.34 D measured by AL scan(R), and 3.13 +/- 0.06 mm and 44.85 +/- 1.26 D measured by IOL master(R), respectively. The differences of anterior chamber depth and keratometry between the 2 devices were not statistically significant (p = 0.226, p = 0.331, respectively). The mean absolute prediction errors were 0.44 +/- 0.35 D, 0.40 +/- 0.34 D, and 0.39 +/- 0.30 D in AL-Scan(R), IOL master(R) and ultrasound, respectively, and were not statistically significantly different (p = 0.843, p = 0.847, p = 1.000, respectively). CONCLUSIONS: The ocular biometric measurements and prediction of postoperative refraction using AL-Scan(R) were as accurate as IOL master(R) and ultrasound.
Anterior Chamber ; Biometry* ; Cataract* ; General Surgery ; Humans ; Interferometry ; Ultrasonography

14 eyes of 11 patients with chronic angle-closure glaucoma(CACG) undergoing extracapsular cataract extraction(ECCE) with posterior chamber intraocular lens(PCIOL) implantation(group 1) and 14 eyes of 12 patients without glaucoma undergoing ECCE/PCIOL(group 2) were studied to assess the effect on anterior chamber depth, anterior chamber angle, and intraocular pressure (IOP). We measured the anterior chamber depth and angle using the EAS-1000 Scheimpflug camera. Following ECCE/PCIOL in group 1, the anterior chamber depth increased 1.00 +/- 0.25mm(p=0.0001), the anterior chamber angle widened 15.36 +/- 5.61 degrees(p=0.0001), and the postoperative IOP drop of 4.7mmHg(23.9%) showed statistical significance. Group 2 showed the increase of anterior chamber depth 0.22 +/- 0.44mm(p=0.0964), the widening of anterior chamber angle 2.51 +/- 2.65 degrees(p=0.0047), and the decrease of IOP 0.9mmHg(6.2%, p=0.0933). The effects on anterior chamber depth, anterior chamber angle, and rap were statistically significant between the two groups. Based on these results, we recommend that eyes with cataract and CACG may be considered for ECCE/PCIOL implantation as a first procedure rather than combined cataract and filtering surgery.
Anterior Chamber ; Cataract Extraction* ; Cataract* ; Filtering Surgery ; Glaucoma ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure

We examined the differences of the glaucoma filtering blebs according to the application methods of mitomycin C (subconjunctival injection and soaking). We performed filtering surgery from the anterior chamber to the subconjunctival space with the silicone tube, in both eyes of 12 grey rabbits. In one eye, subconjunctival injection of the mitomycin-C 0.05ml after filtering surgery (concentration 0.004, 0.008, 0.012, 0.016%) was performed and on the other eye, Weck-Cel sponge soaked with the 0.04% mitomycin-C was applied for 3 minutes and the wound was washed with copious amount of balanced salt solution before the closure of wound. We examined the size, shape, vascular distribution of the filtering blebs and status of the anterior chamber after filtering surgery. We obtained the tissues of the filtering bleb at 7days, 14days and 21days after surgery and microscopic examinations were performed. In subconjunctival injection with the 0.004% of mitomycin-C, bleb size and its duration was small and short than those eyes with the soaking. In eyes with subconjunctival injection with the 0.008% of mitomycin-C, bleb size and its duration showed similiar blebs to soaking cases and anterior chamber was shallow in one eye. In case of 0.012% subconjunctival injection, bleb size and duration were greater than those with soaking and slightly shallow anterior chamber was shown in all cases. In cases of subconjunctival injection with 0.016% mitomycin-C, shallow anterior chamber and hypotony were common. In histological examination, there was similiar findings of fibroblast activity between 0.008% subconjunctival injection and 0.004% soaking cases. Therefore we conclude that the concentration of mitomycin-c in subconjunctival injection for glaucoma filtering surgery should not be higher than 0.008%.
Anterior Chamber ; Blister ; Fibroblasts ; Filtering Surgery ; Glaucoma ; Mitomycin* ; Porifera ; Rabbits ; Silicones ; Wounds and Injuries

The effect of mitomycin on the corneal endothelial cell density was evaluated between the mitomycin group of 23 eyes who underwent trabeculectomy with mitomycin and the control group of 20 eyes who underwent trabeculectomy. The mitomycin(0.2 mg/ml) was applied under the scleral flap, Tenon's capsule or conjunctiva during trabeculectomy for 2-5 minutes(average: 4 minutes) and was irrigated with 50ml of balanced salt solution. Average central endothelial cell loss in the mitomycin group was 10.1 +/- 7.1% and 8.4 +/- 8.3% in the control group(P>0.05, t-test). A shallow anterior chamber with iridocorneal touch(Spaeth's grade 1 and 2) was developed in 12(52%) of 23 eyes in the mitomycin group and 9(45%) of 20 eyes in the control group(P>0.05, chi-square). The average central endothelial cell loss was 12.7 +/- 8.3% in 21 eyes with iridocorneal touch and 5.9 +/- 5.4% in 22 eyes that maintained their anterior chamber(P<0.05, t-test). In 21 eyes with iridocorneal touch average central endothelial cell loss was 12.6 +/- 7.8% in the mitomycin group, and 12.8 +/- 9.5% in the control group(P>0.05, t-test). In 22 eyes that maintained their anterior chamber, average loss was 7.1 +/- 5.4% in the mitomycin group, and 4.8 +/- 5.4% in the control group(P>0.05, t-test). These findings suggest that intraoperative use of mitomycin(0.2 mg/ml) during trabeculectomy is unlikely to cause profound corneal endothelial cell loss and iridocorneal touch after the filtering surgery is associated with greater loss of endothelial cells.
Anterior Chamber ; Conjunctiva ; Corneal Endothelial Cell Loss ; Endothelial Cells* ; Filtering Surgery ; Mitomycin* ; Tenon Capsule ; Trabeculectomy*

The adjunctive use of 5-fluorouracil and mitomycin C remarkably improves the success rate of glaucoma filtering surgery, but these antiproliferative agents may be toxic to other ocular tissues. The authors evaluated the effect of 5-FU and MMC on the blood-aqueous barrier. Sixteen pigmented rabbits were used, 7 for 5-FU group and 9 for MMC group. Five milligrams of 5-FU(0.1ml) was injected subconjunctivally in one eye of each animal in 5-FU group. In MMC group, we made limbus-based conjunctival flap on superotemporal area and applied MMC(0.4 mg/ml) soaked Week-cell sponge on subconjunctival-scleral space for 5 minutes and irrigated with 200 ml of normal saline. The contralateral eyes of each animal in both groups were used for control. We measured protein concentration in anterior chamber with the laser flare-cell meter(Kowa, FM-500). At 7 hours after operation, protein concentration in anterior chamber was significantly higher in 5-FU injected eyes(11.22 +/- 1.98 photons/msec, mean +/- S.D.) than control eyes(7.78 +/- 0.96 photons/msec) in the 5-FU group. There was no difference between MMC treated eyes and control eyes. MMC soaking is thought to be less harmful on the blood-aqueous barrier than 5-FU subconjunctival injection.
Animals ; Anterior Chamber ; Blood-Aqueous Barrier* ; Filtering Surgery ; Fluorouracil* ; Glaucoma ; Mitomycin* ; Porifera ; Rabbits

PURPOSE: To investigate the efficacy and postoperative complications of nonpenetrating deep sclerectomy(NDS) with 0.02% Mitomycin C(MMC) in primary open-angle glaucoma(POAG). METHODS: After 5 x 5 mm scleral flap was made externally, 0.02% MMC was applied under and above the scleral flap for 2 to 5 minutes. A rectangular internal scleral flap was dissected down to remove Schlemm's canal and juxtacanalicular trabecula. RESULTS: Eleven patients(16 eyes) with POAG underwent the filtering surgery of NDS. The mean follow-up was 10.7(range 6 to 12) months. The mean preoperative intraocular pressure(IOP) was 25.6+/-1.7mmHg(SEM, standard error of mean). The mean postoperative IOP was 12.3+/-1.4, 15.8+/-1.8, 15.5+/-0.9, 16.3+/-1.3, and 18.3+/-1.7 mmHg(SEM) at 1, 3, 6, 9, and 12 months, respectively. Success rate defined as an IOP lower than 21 mmHg without medication was 93.8%, 87.5% and 80.8% at 3, 6 and 12 months, respectively. Complications included two shallow anterior chambers, three wound leakages, two hypotonies and two iris adhesions to sclerectomy site. CONCLUSION: Deep sclerectomy with 0.02% MMC may contribute to a satisfactory result of effect of IOP reduction with fewer complication in management of POAG but has tendency to increase the IOP gradually as time elapsed.
Anterior Chamber ; Filtering Surgery ; Follow-Up Studies ; Iris ; Mitomycin* ; Postoperative Complications ; Wounds and Injuries

During filtration surgery for glaucoma, the conjunctival incision site is sutured watertightly with a suture material like 10-0 nylon. However, this suture material may cause the infiltration of inflammatory cells, and the proliferation and migration of fibroblasts and collagen fibers at the junction of the conjunctiva and episclera. Subsequently, the arrangement of collagen fiber in episclera would be disrupted and the outflow of aqueous humor could be occluded. In the search for a more suitable suture material, the fibrin glue(Tisseel(R)) was introduced recently. It is claimed to be simple to use and safe, causes less damage and less inflammatory reaction than nylon. The authors used 10-0 nylon(control group) on the right eye and fibrin glue(Tisseel(R))(experimental group) on the left eye of a white rabbit's conjunctival suture. We compared and evaluated the clinical and histological effects of the suture material on the suture site as well as on the intraocular region. The results were as follows; 1. In the experimental group, conjunctival injection and chemosis were mild and disappeared rapidly. 2. The filtering bleb was macroscopically well formed and maintained from the third postoperative day in both groups, but, thereafter, it decreased in size in two cases of the control group. 3. There was no difference in the inflammatory reaction in anterior chamber in both groups postoperatively. 4. In the experimental group, there was loosening of the fibroblasts proliferation and lesser infiltration of inflammatory cells at the postoperative second and fourth week. And the arrangement of collagen fibers in episclera was intact. The above findings strongly suggest fibrin glue(Tisseel(R)) as a suture material in the filtration surgery of glaucoma is clinically promising.
Anterior Chamber ; Aqueous Humor ; Blister ; Collagen ; Conjunctiva ; Fibrin* ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma ; Nylons ; Rabbits* ; Sutures

We performed a new technique described by Schocket et al. in 6 cases of advanred, uncontrolled glaucoma and 2 cases of neovascular glaucoma. A silicone tube was inserted into the anterior chamber and aqueous was shunted through the tube to a reservoir around the encircling band. After a mean follow up of 103 days, 8 eyes (100 %) had a sucoessful outcome with the intraocular pressure below 20 mm Hg. Thus we recommend this procedure rather than destructive surgery in the treatment of advanced, uncontrolled glaucoma and neovascular glaucoma.
Adolescent ; Adult ; Anterior Chamber/*surgery ; Child ; Female ; Glaucoma/*surgery ; Glaucoma, Neovascular/surgery ; Humans ; *Intubation ; Male ; Middle Aged ; *Silicones