It has been known that subconjunctival injections of 5-fluorouracil (5-FU) may enhance the surgical outcome of glaucomatous eyes with poor prognosis after filtering surgery. The authors reviewed 24 eyes of 23 patients who had received subconjunctival injections of 5-FU after filtering surgery, and all of them were followed up at least 6 months. The average follow-up period was 12 months, and the average total dosage of 5-FU was 17.4mg per eye. Successful surgical outcomes were observed in 7 of 10 eyes with glaucoma after unsuccessful filtering surgery (70%), 7 of 9 eyes with neovascular glaucoma (78%), and 4 of 5 eyes with aphakic glaucoma (80%). The complications of filtering surgery and 5-FU injections were corneal epithelial defects (17%), hyphema (12%), conjunctival wound leakage (4%), and filtering site obstruction (4%). Therefore, we think that postoperative subconjuntival 5-FU injection increase the success rate of filtering surgery in refractory glaucoma.
Filtering Surgery* ; Fluorouracil* ; Follow-Up Studies ; Glaucoma* ; Glaucoma, Neovascular ; Humans ; Hyphema ; Prognosis ; Wounds and Injuries

A potent antiproliferative agent, Mitomcin-C, has been known to improve the surgical outcom of glaucomatous eyes with poor prognosis after filtering surgery. Twenty one eyes of 21 patients underwent trabeculectomy with Mitomyc-C. Overall success rate is 81%: 2 of 3 eyes with glaucoma after unsuccessful filtering surgery, 3 of 4 eyes with neovascular glaucoma, 2 of 3 eyes with secondary glaucoma, 1 of 2 eyes with aphakic glaucoma and all of 9 eyes with advanced glaucoma. Postoperative complications were prolonged conjuntival wound leakage in two eyes, conjuntibval wound leakage and corneo-lenticular touch in one eye, choroidal detachment in one eye, progression of cataract in one eye, hyphema in 3 eyes.
Cataract ; Choroid ; Filtering Surgery* ; Glaucoma* ; Glaucoma, Neovascular ; Humans ; Hyphema ; Mitomycin* ; Postoperative Complications ; Prognosis ; Trabeculectomy ; Wounds and Injuries

A potent antiproliferative agent, Mitomcin-C, has been known to improve the surgical outcom of glaucomatous eyes with poor prognosis after filtering surgery. Twenty one eyes of 21 patients underwent trabeculectomy with Mitomyc-C. Overall success rate is 81%: 2 of 3 eyes with glaucoma after unsuccessful filtering surgery, 3 of 4 eyes with neovascular glaucoma, 2 of 3 eyes with secondary glaucoma, 1 of 2 eyes with aphakic glaucoma and all of 9 eyes with advanced glaucoma. Postoperative complications were prolonged conjuntival wound leakage in two eyes, conjuntibval wound leakage and corneo-lenticular touch in one eye, choroidal detachment in one eye, progression of cataract in one eye, hyphema in 3 eyes.
Cataract ; Choroid ; Filtering Surgery* ; Glaucoma* ; Glaucoma, Neovascular ; Humans ; Hyphema ; Mitomycin* ; Postoperative Complications ; Prognosis ; Trabeculectomy ; Wounds and Injuries

An antimetabolite, 5-fluorouracil(5-FU) has a property of inhibiting fibroblast proliferahon and is known to increase success rate of glaucoma filtering surgery in patients at risk by preventing postoperative scarring of a filtering bleb. Thirteen eyes of 13 patients with uncontrolled glaucoma at high risk for failures of standard filteration underwent trabeculectomy with post-operative 5-FU subconjunctival injections. The mean follow-up time was 7.3 months. The intraocular pressure was controlled in 77% of the over-all study patients after 1 month, 69% after 2 months and 54% after 6months, respectively. In patients with neovascular glaucoma, the intraocular pressure was controlled in 80% of the patients after 1 month and 60% after 2 months and 40% after 6 months. A corneal epithelial defect was the most common complicatio. No other severe complications were observed.
Blister ; Cicatrix ; Fibroblasts ; Filtering Surgery* ; Fluorouracil ; Follow-Up Studies ; Glaucoma ; Glaucoma, Neovascular ; Humans ; Intraocular Pressure ; Trabeculectomy

BACKGROUNDNeovascular glaucoma is a refractory disease, and difficult to manage. The aim of this study was to evaluate the clinical outcomes of Ahmed glaucoma valve implantation (AGVI) in neovascular glaucoma (NVG) and non-NVG patients.

METHODSThis prospective, non-randomized study included 55 eyes of 55 patients with refractory glaucoma; 27 had NVG (NVG group) and 28 had non-NVG (non-NVG group). All of the patients underwent AGVI. The NVG group was adjunctively injected with intravitreal ranibizumab/bevacizumab (IVR/IVB) before AGVI. Intraocular pressure (IOP) was the primary outcome measure in this study. Surgical success rate, number of antiglaucoma medications used, best corrected visual acuity (BCVA), and postoperative complications were analyzed between the groups.

RESULTSAll of the patients completed the study (follow-up of 12 months). Kaplan-Meier survival curve analysis indicated that the qualified success rates in the NVG and non-NVG groups at 12 months were 70.5% and 92.9%, respectively; this difference was significant (P = 0.036). The complete success rates in the NVG and non-NVG groups at 12 months were 66.7% and 89.3%, respectively (P = 0.049). Compared with preoperative examinations, the postoperative mean IOP and use of medications were significantly lower at all follow-up time points in both groups (all P < 0.05). There were significant differences in BCVA between the two groups at the 12-month follow-up (χ(2) = 9.86, P = 0.020). Cox proportional hazards regression showed NVG as a risk factor for surgical failure (RR = 15.08, P = 0.033). Postoperative complications were similar between the two groups.

CONCLUSIONSAGVI is a safe and effective procedure in refractory glaucoma, but the success rate of surgery was related to the type of refractory glaucoma. The complete and qualified success rates of NVG patient adjunctive anti-vascular endothelial growth factor treatment are still lower than those of non-NVG patients.

Adult ; Aged ; Female ; Glaucoma ; surgery ; Glaucoma Drainage Implants ; Glaucoma, Neovascular ; surgery ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies

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

Glaucoma, Neovascular ; drug therapy ; epidemiology ; surgery ; Humans ; Retinal Diseases ; drug therapy ; epidemiology ; surgery

Neovascular glaucoma is considered to be one of the most difficult forms of glaucoma to control. In neovascular glaucoma fibrovascular tissue grows over the surface of the iris and trabecular meshwork. Many modified filtering surgery with artificial drainage devices have been tried in attempts to maintain openings for aqueous humor to leave the eye. Modified trabeculectomy was performed with inexpensive easily available simple silicone tube in 8 eyes with neovascular glaucma. Of the 8 eyes, 6 had postopeoative intraocular pressures lower rhan 25mmHg through a mean follow-up period of 6 months.
Aqueous Humor ; Drainage ; Filtering Surgery ; Follow-Up Studies ; Glaucoma ; Glaucoma, Neovascular* ; Intraocular Pressure ; Iris ; Silicones ; Trabecular Meshwork ; Trabeculectomy*

BACKGROUND: Neovascular glaucoma is common secondary glaucoma at high risk for failure of glaucoma filtering surgery. Recently, trabeculectomy with adjunctive mitomycin C trabeculectomy has been tried to improve the surgical success rate of conventional trabeculectomy. But, the long-term effects of mitomycin C trabeculectomy for neovascular glaucoma are unknown. Thus, we evaluated the long-term effects of mitomycin C trabeculectomy and its prognostic factors influencing the outcome. MATERIALS AND METHODS: Medical records of 62 eyes of 55 neovascular glaucoma who had undergone mitomycin C trabeculectomy were retrospectively reviewed. Surgical success was defined as intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: Postoperative success was obtained in 37 (60%) out of 62 eyes after mean follow- up period of 23.9+/-16.2 months. Using Kaplan-Meier survival analysis, cumulative success rate at the 6-, 12-, 24- and 36-month intervals were 85%, 71%, 57% and 52%, respectively. Success rate was greater in eyes with diabetic retinopathy than other causes(p=0.005) and in eyes with preoperative panretinal photocoagulation(PRP) than without PRP(p=0.015). However, Cox proportional hazard regression analysis revealed that preoperative PRP was not a significant risk factor for surgical failure. CONCLUSION: Prognosis of neovascular glaucoma caused by diabetic retinopathy was better than that caused by the other disorders following mitomycin C trabeculectomy. The author would suggest that mitomycin C trabeculectomy could be effective and relatively safe as the first procedure of choice before performing glaucoma drainage device implantation or cyclodestructive procedure.
Diabetic Retinopathy ; Drainage ; Filtering Surgery ; Glaucoma ; Glaucoma, Neovascular* ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin* ; Prognosis ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

We analyzed the clinical result of trabeculectomy with amniotic membrane transplantation which has antifibrotic and antiinflammatory action in risky glaucoma patients. Subjects were included four eyes of four patients with neovascular glaucoma, one eye of one patient with primary open angle glaucoma and four eyes of three patients with congenital glaucoma. After limbal based scleral flap was made in triangular shape with 5x4 mm sized, amniotic membrane, sized by 6x6 mm with epithelial side up, was placed on the scleral flap and then sutured to medial and lateral portion at 3 mm superior to base of scleral flap base with 10-0 nylon(2 points). The state of bleb, intraocular pressure and complications were observed at postoperative 1st, 3rd, 6th and 9th week. The IOP was reduced from 33.6+/-11.1 mmHg, to 15.5+/-6.5 mmHg at postoperative one week, 17.0+/-8.3 mmHg at three weeks, 16.9+/-8.1 mmHg at six weeks, 17.1+/-6.4 mmHg at nine weeks. 6 eyes(77.7%)had controlled IOP under 21 mmHg without antiglaucomatous agents at last follow up. Avascular blebs were observed throughout postoperative period in all subjects. Postoperative complications were shallow anterior chamber in one eye at 1st week and low intraocular pressue in one eye at 1st, 3rd week, that resolved at six weeks. Trabeculectomy with amniotic membrane transplantation on the scleral flap appeared to be effective as an augment therapy for filtering surgery in risky glaucoma.
Amnion ; Anterior Chamber ; Blister ; Filtering Surgery ; Follow-Up Studies ; Glaucoma ; Glaucoma, Neovascular ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Membranes* ; Postoperative Complications ; Postoperative Period ; Trabeculectomy