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

Mitomycin-C(MMC) has been increasingly used as adjunct chemotherapy during glaucoma filtering surgery in order to increase the success rate, because of its ability to inhibit the proliferation of fibroblast. Although MMC demonstrates toxic effects in the anterior segment of the eye, few studies on its retinal toxicity have been reported. Therefore, this study was performed to investigate the retinal toxicity of MMC in the rabbit after intra cameral irrigation. After anesthesia, 1 ml of MMC(40 mg/ml) was intracamerally irrigated in right eye and 1ml of balanced salt solution(BSS) was used as control in the left eye. The electroretinogram was checked before, 2 and 7 days after intracameral MMC irrigation. The fundus examination and histopathology by light microscopy and transmission electron microscopy were performed at 7days after MMC irrigation. On electroretinogram, scotopic b-wave amplitude in MMC irrigated eye was significantly decreased 7 days after irrigation as compared with BSS irrigated eye. The retina in MMC irrigated eye was normal on the fundus findings and histopathology by light microscopy and transmission electron microscopy 7 days after irrigation. This findings suggest that intracameral irrigation of MMC may induce the functional disturbance rather than structural alteration of retina.
Anesthesia ; Drug Therapy ; Fibroblasts ; Filtering Surgery ; Glaucoma ; Microscopy ; Microscopy, Electron, Transmission ; Mitomycin* ; Retina ; Retinaldehyde

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

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: To report a patient with symptomatic intraocular pressure (IOP) elevation in an eye with neovascular glaucoma (NVG) during hemodialysis. METHODS: Case report. RESULTS: Recurrent episodes of severe ocular pain and elevated IOP in the NVG eye were noted during hemodialysis in a 29-year-old man. The patient was recently diagnosed at our ophthalmology clinic with NVG due to central retinal vein occlusion. IOP was temporarily controlled after the Ahmed valve implantation. However, after the fibrous membrane developed and occluded the tip of the Ahmed valve, IOP elevation during hemodialysis recurred. Further treatments with intravenous mannitol, oral carbonic anhydrase inhibitor, topical antiglaumatic agents and subconjunctival 5-fluorouracil (5-FU) injections all failed to control relapsing pain and IOP elevation. Eventually, evisceration and hydroxyappatite implantation were performed. CONCLUSIONS: Physicians must be alert to the possibility of IOP elevation in glaucomatous eyes during hemodialysis.
Renal Dialysis/*adverse effects ; Recurrence ; Male ; Kidney Failure, Chronic/complications/*therapy ; Intraocular Pressure/*physiology ; Humans ; Glaucoma, Neovascular/complications/*physiopathology/surgery ; Glaucoma Drainage Implants ; Follow-Up Studies ; Filtering Surgery/instrumentation ; Adult

We report on a case of cholesterosis bulbi concurrent with secondary glaucoma. A 36-year-old man, with a history of long-standing retinal detachment in his right eye after the irrigation and aspiration of a congenital cataract, presented with a clinical picture of elevated intraocular pressure and ocular pain. Upon slit-lamp examination, we found a ciliary injection and a pseudohypopyon of polychromatic crystals. Gonioscopic examination revealed a large amount of crystals deposited on the trabecular meshwork and mild rubeosis iridis, but the neovascularization of the angle could not be clearly confirmed due to the presence of so many crystals. Pars plana vitrectomy was performed to remove clusters of crystals and bevacizumab was injected intravitreally to treat iris neovascularization. Aqueous aspirate was examined by light microscopy and the typical highly refringent cholesterol crystals were identified. Intraocular pressure returned to a normal level after the bevacizumab injection, although severe cholesterosis was still evident in the anterior chamber. To our knowledge, this would be the first Korean case of cholesterosis bulbi combined with chronic retinal detachment and presumed neovascular glaucoma, which was treated by pars plana vitrectomy and intravitreal bevacizumab injection.
Adult ; Angiogenesis Inhibitors/therapeutic use ; Anterior Chamber/*metabolism ; Antibodies, Monoclonal, Humanized/*therapeutic use ; *Cholesterol ; Eye Diseases/complications/metabolism ; Follow-Up Studies ; Glaucoma/surgery ; Glaucoma, Neovascular/drug therapy/*etiology/surgery ; Humans ; Intraocular Pressure ; Male ; Vitrectomy/*methods

BACKGROUNDArgon laser peripheral iridoplasty (ALPI) is proved to be effective in lowering intraocular pressure (IOP) of patients with mild acute primary angle closure (APAC). It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed to evaluate the IOP-lowering efficacy of ALPI and laser peripheral iridotomy (LPI) on patients with refractory APAC, who have previously responded poorly to intensive medical therapy.

METHODSThirty-six patients (8 men and 28 women) were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber (AC) angle, and IOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity (VA), best corrected VA (BCVA), IOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes.

RESULTSAll patients were affected unilaterally, with average age of (54.6 ± 11.7) (range, 37.0 - 75.0) years old. The mean IOP value of the affected eyes dropped from (31.6 ± 7.7) (range, 21.0 - 39.0) mmHg at enrollment to (18.4 ± 8.7) (range, 10.0 - 27.0) mmHg 2 hours after ALPI. At follow-up day 7, the mean IOP value maintained at (14.8 ± 4.2) (range, 9.0 - 21.0) mmHg, which was significantly different (P = 0.000) compared with baseline. The average decrease of IOP in the APAC eyes was (16.8 ± 7.4) (range, 12.0 - 21.0) mmHg. At follow-up three years later, the mean IOP of the APAC eyes stabilized at (16.3 ± 3.2) (range, 9.0 - 20.0) mmHg with at least 180° of AC angle opened.

CONCLUSIONALPI and LPI lower the IOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.

Adult ; Aged ; Female ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Iridectomy ; methods ; Iris ; surgery ; Laser Therapy ; Male ; Middle Aged ; Treatment Outcome

BACKGROUNDGlaucoma filtering surgery (GFS) is the most common procedure performed in the treatment of glaucoma. Although antiscarring agents help prevent postsurgical scarring and improve glaucoma surgical outcomes, they may be associated with an increased incidence of severe and potentially blinding complications. Poly(DL-lactide-co-glycolide) (PDLLA/GA) is a bioresorbable polymer, which can be prepared with a large range of physical, mechanical, and biological properties and has been widely used in medicine, including as an absorbable suture and a drug carrier and especially as a scaffold in tissue engineering. This study aimed to evaluate the effect of PDLLA/GA on scar formation after glaucoma filtration surgery (GFS).

METHODSForty-eight New Zealand white rabbits were divided into two groups randomly and GFS was performed on the right eye of each. PDLLA/GA membranes were put under the sclera flap for evaluation. GFS with no membrane inserted served as control. Clinical evaluations of intraocular pressure (IOP) and the presence of a filtration bleb were performed at intervals (3 days, 1, 2, 4, 8, 12, 20, and 24 weeks) postoperatively. At each time point, three eyes per group were excised to observe histological changes such as inflammation and scar formation and the expression of collagen type IV, proliferating cell nuclear antigen (PCNA), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1). The expression of connective tissue growth factor (CTGF) mRNA was determined by reverse transcription-polymerase chain reaction.

RESULTSThe lower IOP level and an effective bleb were maintained for a long time after GFS in the PDLLA/GA group. The histological analysis showed less inflammation and scar formation, weaker expression of collagen type IV and PCNA, more intense MMP-9 and TIMP-1, slightly elevated ratio of MMP-9 and TIMP-1, and a smaller increase in CTGF mRNA postoperatively in the PDLLA/GA group but less than the control group (P < 0.05).

CONCLUSIONPDLLA/GA membranes may be promising for preventing fibrosis after GFS.

Animals ; Biocompatible Materials ; therapeutic use ; Cicatrix ; prevention & control ; Filtering Surgery ; Glaucoma ; drug therapy ; surgery ; Lactic Acid ; therapeutic use ; Polyglycolic Acid ; therapeutic use ; Rabbits

No abstract available.
Adult ; Female ; Glaucoma, Angle-Closure/*surgery ; Humans ; Intraocular Pressure/physiology ; *Iridectomy ; Iris/*surgery ; Laser Therapy/*methods ; Lens, Crystalline/*physiology ; Middle Aged ; Suture Techniques ; Tonometry, Ocular ; Viscosupplements/administration & dosage

We studied the efficacy and safety of using topical mitomycin C (MMC) as an adjunct to glaucoma filtration surgery. Trabeculectomy was performed in 23 eyes of 19 patients with poor surgical prognosis. After the preparation of a scleral flap, 0.2 mg or 0.4 mg/ml MMC was applied to the exposed tissue for 5 minutes. The wound was then irrigated with 250ml of normal saline. The mean follow-up period was 7.8 months. Preoperative mean intraocular pressure (IOP) was 33.8mmHg, and the mean IOPs on 1, 3, 6, and 12 months after operation were 10.3, 12.5, 12.4 and 12.3mmHg, respectively. At postoperative 12 months, 74.7% achieved an IOP of less than or equal to 20mmHg without any antiglaucoma medication. There were early postoperative complications of aqueous leaking from conjunctival wounds in 3 eyes (13.0%), shallow anterior chamber in 2 eyes, and hyphema in one eye and one eye had long-term hypotony lasting more than 3 months. Although MMC is simple to use, it is a potent adjunct to glaucoma filtration surgery, more work should follow to determine the mechanism of action, indications, dosage and optimal exposure time of MMC.
Administration, Topical ; Adolescent ; Adult ; Aged ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Glaucoma/surgery/*therapy ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Mitomycin/*administration & dosage ; Ophthalmic Solutions ; Prognosis ; *Trabeculectomy