To evaluate the efficacy of amniotic membrane in the management of painful bullous keratopathy secondary to the intractable glaucoma and in preventing exposure of drainage devices, we inserted Ahmed valve with amniotic membrane patch graft over the implant itself, and debrided corneal epithelium with amniotic membrane graft over the exposed stroma as a single operation. During the follow-up periods, we monitored vision, intraocular pressure (IOP), presence of ocular pain, and postoperative complications associated with the implants. The mean follow up period was 8.4+/-3.2 months. IOP was well controlled after the intervention. The preoperative mean IOP was measured as 43.9+/-9.0 mmHg and lowered to 16.1+/-1.8 mmHg at the last visit and no complications associated with the implants were noted. Even though the improvement in vision was not prominent, the ocular surface stabilized rapidly and ocular pain associated with bullous keratopathy disappeared soon after surgery. Conclusively the use of amniotic membrane in conjunction with Ahmed valve implantation is an effective way to relieve ocular pain and lessen the chances of complications associated with the implant in patients with intractable glaucoma and bullous keratopathy.
Retrospective Studies ; Middle Aged ; Male ; Humans ; *Glaucoma Drainage Implants ; Glaucoma/complications/surgery ; Female ; Epithelium, Corneal/pathology/surgery ; Corneal Transplantation/*methods ; Corneal Diseases/etiology/pathology/*surgery ; Amnion/*transplantation ; Aged

This experiment used 30 rabbits (40 normal eyes) to determine the applicability of an expanded polytetrafluoroethylene (e-PTFE) surgical membrane as a glaucoma seton. The e-PTFE membrane had 0.1 mm thickness and was cut into T-shaped pieces measuring about 2x7 mm. One end of the implant was introduced into the anterior chamber through a sclerectomy opening and the other ends were allowed to extend from the Iamellar scleral flap into the subconjunctival space. During the follew-up at the end of 8 weeks, all the eyes with an implant showed an apparent filtering bleb, while only one of 6 eyes that had undergone a trabeculectomy alone did. The location of the created filtering blebs depended on the implant position. Pestoperative inflammatory changes were unremarkable. Histologic examinations reyealed a tissue-free cystic space surrounding the e-PTFE implants which maintained their original color, thickness, pliability and size. Transmission electron microscopy showed few myofibroblast-like cells in the fibrous wall containing the implant. With scanning electron microscopy, the internal end of the implant strip had a clean surface and no adhesions to adjacent structures of the anterior chamber angle. The corneal endothelial cells were intact in the area close to the tip of the implant. Considering the clinical and histologic findings, it appeared that the e-PTFE was acceptably innocuous in the anterior segment of the eye and a convenient material as a glaucoma seton.
Animals ; Drainage/*methods ; Glaucoma/pathology/*surgery ; Polytetrafluoroethylene ; *Prostheses and Implants ; Rabbits ; Trabeculectomy

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.
Blister/pathology/*surgery ; Blood Transfusion, Autologous/*methods ; Conjunctiva/pathology/surgery ; Glaucoma/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*surgery ; *Suture Techniques ; Trabeculectomy/*adverse effects

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.
Blister/pathology/*surgery ; Blood Transfusion, Autologous/*methods ; Conjunctiva/pathology/surgery ; Glaucoma/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*surgery ; *Suture Techniques ; Trabeculectomy/*adverse effects

To increase the success rate of intraocular pressure control in recalcitrant glaucoma, anterior chamber tube shunt to a surgical membrane (ACTSSM) surgery using silicone tube and expanded polytetrafluoroethylene (e-PTFE) can be performed. Applying mitomycin C (MMC) during ACTSSM surgery may increase the success rate by decreasing the fibroblast proliferation and collagen in the fibrous capsule. To evaluate the effects of MMC on the fibrous capsule formed after ACTSSM surgery, operations were performed on 18 white rabbits. Nine rabbits were treated with 0.04% MMC solution on the episclera for 5 minutes before ACTSSM (group A) and the others were not treated (group B). At postoperative 2, 4 and 8 weeks successively, 6 eyes of the 3 rabbits were enucleated from each group. Light microscopic examinations were performed after hematoxylin
Animals ; Anterior Chamber/pathology/*surgery ; Glaucoma/*surgery ; Intraocular Pressure/drug effects ; Mitomycin/*therapeutic use ; Polytetrafluoroethylene ; *Prostheses and Implants ; Rabbits ; Silicone Elastomers

The inhibitory mechanism of interferon-gamma (IFN-gamma) on the fibroblasts from Tenon's capsule was studied. By using immunohistochemical SP method and pathological image system, the inhibitory effects of IFN-gamma on the expression of transforming growth factor beta receptor I in the in vitro cultured fibroblasts from Tenon's capsule were quantitatively analyzed. The results showed that IFN-gamma could reduce the expression of transforming growth factor beta receptor I in the fibroblasts with the following dose-effect relationship: Y = 1937.5-134.2 Igx (r=-0.971, P<0.01). It was concluded that IFN-gamma could inhibit the expression of transforming growth factor beta receptor I in the fibroblasts from Tenon's capsule. The modulation of the transforming growth factor beta receptor I expression by IFN-gamma may be beneficial to the alleviation of the hyperplasia of scar after trabeculectomy.
Conjunctiva ; metabolism ; pathology ; Connective Tissue ; drug effects ; Fibroblasts ; metabolism ; pathology ; Filtering Surgery ; Glaucoma ; pathology ; surgery ; Humans ; Interferon-gamma ; biosynthesis ; genetics ; Receptors, Transforming Growth Factor beta ; analysis

Since the anterior chamber tube shunt to an encircling band(ACTSEB) is not a simple procedure, an extended polytetrafluoroethylene (e-PTFE)-silicone tube (anterior chamber tube shunt to a surgical membrane; ACTSSM) was attempted as a new glaucoma drainage implant. To see whether the newly-modified, two-fold e-PTFE-silicone tube implant could prevent early hypotony and to compare the tissue response to each implant, ACTSEB and ACTSSM procedures were done in normal colored rabbit eyes. It was found the ACTSSM kept the depth of the postoperative anterior chamber normal. And in general, foreign body responses were light microscopically similar. The fibrous capsule lining the e-PTFE was composed of thicker, less dense fibroblasts, as well as less collagen than that lining the silicone encircling band. These findings seemed to be related to the difference in the pressure-lowering capacity between ACTSEB and ACTSSM.
Animals ; Anterior Chamber/pathology/*surgery ; Cell Adhesion ; Drainage/*instrumentation ; Fibroblasts ; Foreign-Body Reaction/pathology ; Glaucoma/*surgery ; Intraocular Pressure ; *Polytetrafluoroethylene ; Postoperative Complications/prevention & control ; *Prostheses and Implants ; Rabbits ; *Silicone Elastomers

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Adult ; Conjunctiva/*blood supply/*surgery ; Female ; Glaucoma, Open-Angle/*etiology/pathology ; Gonioscopy ; Humans ; *Intraocular Pressure ; Postoperative Complications/*etiology/pathology ; Surgery, Plastic/adverse effects

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Adult ; Conjunctiva/*blood supply/*surgery ; Female ; Glaucoma, Open-Angle/*etiology/pathology ; Gonioscopy ; Humans ; *Intraocular Pressure ; Postoperative Complications/*etiology/pathology ; Surgery, Plastic/adverse effects

We compared the success rate of filtering surgery of a single 5-minute intraoperative application of mitomycin-C (MMC) or 5-fluorouracil (5-FU). Animal experiment and clinical study were done. In animal study, thirty pigmented rabbits (60 eyes) weighing 2.0 to 2.5 Kg were enrolled. We divided into 4 groups, such as BSS, 5-FU 50 mg/ml, MMC 0.2 mg/ml and MMC 0.4 mg/ml subconjunctival soaked group. Each group consisted of 15 eyes. In each group, 10 eyes was for examination of bleb survival and complications, 3 eyes for light microscopic examination and 2 eyes for electron microscopic examination. Bleb was survived 6.1 days (3 to 13 days) for BSS treated group, 16.3 days (9 to 23 days) for 5-FU 50mg/ml treated group, 32.7 days (17 to 55 days) in MMC 0.2 mg/ml treated group, and 64.4 days (49 to 84 days) in MMC 0.4 mg/ml treated group. Duration of bleb survival was significantly prolonged in 5-FU, MMC 0.2 mg/ml and MMC 0.4 mg/ml group respectively. In clinical study, fifty-five eyes of 40 patients were enrolled. 29 eyes of 21 patients were treated with MMC 0.2 mg/ml and 26 eyes of 19 patients were treated with 5-FU 50 mg/ml. The success rate was 89.7% in MMC 0.2 mg/ml treated group and 84.6% in 5-FU 50 mg/ml treated group at postoperative 3 months, and postoperative 6 months 89.7% in MMC 0.2 mg/ml treated group and 76.9% in 5-FU 50 mg/ml treated group. There was no statistical significance at postoperative 3 months (P > 0.05), but statistical significance at postoperative 6 months (P < 0.05). There was no serious complications using a MMC 0.2 mg/ml or 5-FU 50mg/ml.
Adult ; Aged ; Animals ; *Filtering Surgery ; Fluorouracil/*administration & dosage/pharmacology ; Glaucoma, Angle-Closure/*surgery ; Glaucoma, Open-Angle/*surgery ; Humans ; Intraoperative Care ; Middle Aged ; Mitomycin/*administration & dosage/pharmacology ; Ostomy ; Rabbits ; Sclera/pathology ; Sclerostomy