Glaucoma ; congenital ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Trabeculectomy ; methods

Six patients with exfoliation syndrome were seen in our glaucoma clinic. Four patients presented unilateral ocular involvement and the other 2 patients were bilaterally involved. Eight eyes had exfoliation material on the anterior surface of the lens and pupillary border, and 7 eyes exhibited it on the anterior chamber angle. Sampaolesi`s line was detected in 4 eyes. Five patients (6 eyes) of 6 patients (8 eyes) with exfoliation exhbited an elevated intraocular pressure (IOP) exceeding 21 mmHg. Among them, 3 patients (3 eyes) had an extremely high maximum IOP over 47 mmHg, and 2 patients (3 eyes) had a slightly elevated IOP less than 26 mmHg during the follow-up period. Argon laser trabeculoplasty (ALT) was performed twice on each unilateral eye of the 2 patients on whom the inital trabeculectomy failed. However, longterm IOP control after laser treatment was not obtained in either case, which might be due to the extremely high prelaser lOP level, in exoess of 40 mmHg.
Aged ; Anterior Eye Segment/*physiopathology/surgery ; Eye Diseases/diagnosis/*physiopathology/surgery ; Female ; Glaucoma/physiopathology/surgery ; Humans ; Intraocular Pressure ; Korea ; Laser Therapy ; Male ; Middle Aged ; Trabeculectomy

PURPOSE: Ahmed glaucoma valves were implanted into the ciliary sulcus of two patients diagnosed with neovascular glaucoma with favorable outcomes. METHODS: The study patients presented to our hospital with ocular pain caused by increased intraocular pressure (IOP). A thorough history was taken, and an ophthalmic examination was performed. RESULTS: A 71-year-old male patient and a 57-year-old female patient visited our hospital for ocular pain and persistent, elevated IOP. Each were diagnosed with neovascular glaucoma and underwent an Ahmed glaucoma valve implantation to the sulcus. After surgery, the patients maintained stable IOPs without major complications. CONCLUSIONS: The method of Ahmed glaucoma valve implantation into the ciliary sulcus could reduce complications caused by implantation to the anterior chamber. It is thought to be an efficient method for the maintenance of appropriate IOP after surgery.
Aged ; Ciliary Body/*surgery ; Female ; Follow-Up Studies ; *Glaucoma Drainage Implants ; Glaucoma, Neovascular/physiopathology/*surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Prosthesis Design ; Prosthesis Implantation/*instrumentation ; Visual Acuity

PURPOSE: To compare the histopathologic and morphologic findings of encapsulated blebs following Ahmed glaucoma valve implantation and primary standard trabeculectomy with mitomycin-C. METHODS: We reviewed the records of patients with otherwise uncontrollable glaucoma who had undergone Ahmed glaucoma valve implantation or trabeculectomy with mitomycin-C. Five eyes that underwent Ahmed valve implantation and three eyes that underwent trabeculectomy needed surgical revision of the initial surgery due to encapsulated bleb development with total loss of function. The surgically removed encapsulated blebs were analyzed macroscopically and microscopically. RESULTS: Removal of the encapsulated bleb was performed at a mean follow-up time of 26.6 +/- 19.4 weeks in the Ahmed valve implantation group and 12.0 +/- 11.4 weeks in the trabeculectomy group. The fibrotic wall of the encapsulated blebs had an overall thickness of 2.48 +/- 0.42 mm in the Ahmed valve implantation group and 1.62 +/- 0.37 mm in the trabeculectomy group. Macroscopically, the coconut flesh-like smooth surface was split into two layers, and the wall of the capsule was thicker in the Ahmed valve implantation group than in the trabeculectomy group. Histopathologically, the fibrotic capsule was composed of an inner fibrodegenerative layer and an outer fibrovascular layer, and there were no histopathological differences between the two groups. CONCLUSIONS: The fibrotic capsule wall was thicker in the Ahmed valve group, but there were no differences in histological findings between the two groups.
Adult ; Blister/*surgery ; Female ; Glaucoma/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Humans ; Infant ; Male ; Middle Aged ; Mitomycin/*therapeutic use ; Nucleic Acid Synthesis Inhibitors/*therapeutic use ; Reoperation ; *Trabeculectomy ; Treatment Outcome

PURPOSE: We explored the performance of and pressure elevation caused by small-diameter microtubes used to reduce overfiltration. METHODS: Using a syringe pump-driven constant-flow setting (2 µL/min), pressures were measured for polytetrafluoroethylene (PTFE) microtubes 5 mm in length with inner diameters of 51, 64, and 76 µm and for polyether block amide (PEBAX) microtubes with an inner diameter of 76 µm. Experiments (using microtubes only) were initially performed in air, water, and enucleated pig eyes and were repeated under the same conditions using intraluminal 9/0 nylon stents. RESULTS: The pressures measured in air in 51-, 64-, and 76-µm-diameter PTFE microtubes differed significantly (22.1, 16.9, and 12.2 mmHg, respectively; p < 0.001), and that of the 76-µm-diameter PEBAX microtube was 15.8 mmHg (p < 0.001 compared to the 12.2 mmHg of the 76-µm-diameter PTFE microtube). The pressures measured in water also differed significantly among the three microtubes at 3.9, 3.0, and 1.4 mmHg, respectively, while that in the PEBAX microtube was 2.6 mmHg (all p < 0.001). Using the intraluminal stent, the pressure in water of the three different PTFE microtubes increased to 22.6, 18.0, and 4.1 mmHg, respectively, and that in the PEBAX microtube increased to 10.5 mmHg (all p < 0.001). Similar trends were evident when measurements were performed in pig eyes. CONCLUSIONS: Although microtubes of smaller diameter experienced higher pressure in air, reduction of the inner diameter to 51 µm did not adequately increase the pressure attained in water or pig eyes. Insertion of an intraluminal stent effectively elevated the latter pressures. PEBAX microtubes created higher pressures than did PTFE microtubes.
Animals ; Disease Models, Animal ; Glaucoma/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Intraocular Pressure/*physiology ; Ophthalmologic Surgical Procedures/*instrumentation ; *Polytetrafluoroethylene ; Prosthesis Design ; Swine

PURPOSE: To compare the success rates, complications, and visual outcomes between silicone Ahmed glaucoma valve (AGV) implantation with 96 mm2 (FP8) or 184 mm2 (FP7) surface areas. METHODS: This study is a retrospective review of the records from 132 adult patients (134 eyes) that underwent silicone AGV implant surgery. Among them, the outcomes of 24 eyes from 24 patients with refractory glaucoma who underwent FP8 AGV implantation were compared with 76 eyes from 76 patients who underwent FP7 AGV implantation. Preoperative and postoperative data, including intraocular pressure (IOP), visual acuity, number of medications, and complications were compared between the 2 groups. RESULTS: There were no significant differences in baseline characteristics between the 2 groups (p > 0.05). The postoperative visual acuity of the patients in the FP8 group was better than that of the patients in the FP7 group in some early postoperative periods (p < 0.05); however, after 10 postoperative months, visual acuity was not significantly different through the 3-year follow-up period (p > 0.05). Postoperative IOP was not significantly different between the 2 groups (p > 0.05) except for IOP on postoperative day 1 (11.42 mmHg for the FP7 group and 7.42 mmHg for the FP8 group; p = 0.031). There was no statistical difference in success rates, final IOP, number of medications, or complication rates between the 2 groups (p > 0.05). CONCLUSIONS: The FP7 and FP8 AGV implants showed no difference in terms of vision preservation, IOP reduction, and number of glaucoma medications required.
Adult ; Female ; Glaucoma/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Humans ; Intraocular Pressure/*physiology ; Male ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; *Silicone Elastomers ; Tonometry, Ocular ; Treatment Outcome ; Visual Acuity

OBJECTIVETo investigate the progression of visual field loss and to explore the prognosis of glaucomatous optic neuropathy in patients with chronic angle-closure glaucoma (CACG) after their intraocular pressures were well controlled under 21 mmHg.

METHODSForty-seven eyes of 29 patients in the Department of Ophthalmology in PUMC Hospital were included. All the patients had at least two separate tests of visual fields using the 24-2 program of the Humphery Visual Field Analyzer after their intraocular pressure were well controlled under 21 mmHg after sugery. The visual fields of patients were followed routinely for at least 1 year. In addition, all patients were divided into 2 groups according to follow-up period: 1-2 years group and over 2 years group. Visual field scores were calculated with the Advanced Glaucoma Intervention Study (AGIS) method. The visual fields were divided 5 sections and the sensitivity and defect depth of each section were calculated.

RESULTNo statistically significant differences were found in terms of AGIS scores, localized sensitivities and localized defects within the time interval of the observation.

CONCLUSIONGlaucomatous optic neuropathy is not likely to progressively deteriorate in CACG cases once their intraocular pressure are well controlled under 21 mmHg.

Aged ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Optic Disk ; physiopathology ; Optic Nerve Diseases ; physiopathology ; Retrospective Studies ; Visual Fields

BACKGROUNDMany studies indicated that short-term and long-term intraocular pressure (IOP) fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evaluated the long-term fluctuation of IOP in primary chronic angle closure diseases. The objective of this study was to investigate the long-term IOP fluctuation of primary angle closure diseases and its associations following laser peripheral iridotomy (LPI) with or without laser peripheral iridoplasty.

METHODSA total of 158 patients with primary angle closure suspect (PACS, n = 21), primary angle closure (PAC, n = 81) and primary angle closure glaucoma (PACG, n = 55) had been treated by LPI with or without laser peripheral iridoplasty and followed up for more than 12 months. IOP was measured with Goldman applanation tonometer. Multivariate linear regression with generalized estimating equation (GEE) regression models was used to evaluate the association of long-term IOP fluctuation (maximum IOP minus minimum IOP) with gender, age, baseline IOP, baseline peripheral anterior synechia (PAS), baseline vertical cup/disc ratio (VCDR), baseline mean deviation (MD), need for IOP-lowering medications.

RESULTSIOP fluctuation during follow-up in PACS, PAC and PACG groups were (4.83 ± 2.90), (5.67 ± 3.35), and (9.40 ± 7.14) mmHg, respectively. IOP fluctuation was strongly correlated with baseline IOP (r = 0.356, P < 0.001), PAS (r = 0.374, P < 0.001). IOP fluctuation was higher in patients with higher baseline IOP (0.18 mmHg per unit increase, 95%CI: 0.05 - 0.31 mmHg).

CONCLUSIONSLong-term IOP fluctuation in PACG group was larger than that in PACS or PAC group. Eyes with higher baseline IOP were observed to have larger long-term IOP fluctuation.

Follow-Up Studies ; Glaucoma, Angle-Closure ; physiopathology ; therapy ; Humans ; Intraocular Pressure ; Iridectomy ; Iris ; surgery ; Laser Therapy ; Middle Aged

Many surgeons have noted that when the visual field is markedly constricted, immediate and permanent loss of central vision may follow otherwise successful glaucoma surgery. The present study was undertaken to assess the relative risk of surgical therapy in the loss of central vision in patients with advanced glaucoma. We reviewed the records of 44 eyes (including 8 macular split eyes) of 36 patients who had undergone trabeculectomy for intraocular pressure (IOP) control. The patients were followed for a minimum of 4 months with an average follow-up of 4.1 years. None of the patient suddenly lost visual field following surgery when central vision was spared at the time of operation. There was good preservation of preoperative visual acuity except in 3 eyes which developed lens opacity. There was no progression of visual field loss when the IOP was controlled below 21 mmHg. There was good control of IOP of 43 eyes in 44 eyes operated. However, in one of the 2 reoperated eyes, we could not control the IOP below 21 mmHg.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Glaucoma/physiopathology/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/physiopathology ; Prognosis ; Trabeculectomy ; *Visual Acuity

OBJECTIVETo evaluate the therapeutic effect of laser photocoagulation of ciliary processes after pars plana vitrectomy in aphakic glaucoma.

METHODSTwenty patients (20 eyes) of aphakic glaucoma underwent vitrectomy plus laser treatment. During the surgery, after conventional 3-incision pars plana vitrectomy, a probe of semi-conductor diode laser (532 nm) was inserted through the sclera incision, the ciliary processes were then photocoagulated under direct visualization for 180 degree range. Before and after the surgery, the visual acuity, the intraocular pressure (IOP) as well as the outer appearance of the anterior segment were evaluated. The mean follow-up period was 13 months.

RESULTSThe IOP at the last visit was (21.35 +/-2.52) mmHg, which was significantly lower than that before the surgery [(39.75 +/-6.27) mmHg, P=0.000]. Atrophy of the ciliary processes was observed 1-3 months after the surgery.

CONCLUSIONPars plana vitrectomy combined with laser coagulation of ciliary processes reduces the IOP in patients with aphakic glaucoma effectively.

Adult ; Aphakia ; complications ; Ciliary Body ; surgery ; Female ; Glaucoma ; complications ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Laser Coagulation ; methods ; Male ; Middle Aged ; Treatment Outcome ; Visual Acuity ; Vitrectomy ; methods