24 eyes of 20 patients with increased intraocular pressure(IOP) or glaucoma that were not medically controlled or those who failed with previous glaucoma surgeries underwent Ahmed glaucoma valve implantation with intraoperative mitomycin C application. Mean follow-up period was 4.5 months (2-9 months) and mean preoperative IOP was 38.0 +/- 11.5mmHg. Mean IOP at last visit was 16.5 +/- 6.2mmHg and it was significantly lower compared to preoperative IOP (p<0.0001). One eye (4.2%) showed IOP less than 5mmHg at first postoperative day. When surgical success was defined as IOP less than 22mmHg and greater than 4 mmHg for 2 months or longer, IOP lowered by at least 20% from preoperative values (in eyes with preoperative IOP less than 22mmHg), and no additional glaucoma surgery or visually devastating complications, cumulative probability of success at 7 months was 69.1%. Qualified success (defined as lOP less than 22mmHg and greater than 4mmHg at last visit) rate was 83.3%. Complete success (IOP controlled as above without medication) rate was 66.7%. The complications included temporary shallow anterior chamber in 3 eyes, choroidal detachment in 3 eyes, fibrous membrane formation in anterior chamber in 3 eyes, hyphema in 2 eyes, tube malposition in 1 eye, corneal decompensation in 1 eye and tube blockage in 1 eye. This study suggests that Ahmed glaucoma implant provides good IOP control without significant postoperative complications including immediate postoperative period, and its success rate is comparable to the other seton implants.
Anterior Chamber ; Choroid ; Follow-Up Studies ; Glaucoma* ; Humans ; Hyphema ; Membranes ; Mitomycin ; Postoperative Complications ; Postoperative Period

We evaluated the sensitivity and specificity of Frequency doubling perimetry[FDP]with fourty-nine normal subjects and twenty-six patients of early glaucomatous field change. We regarded Humphrey field analyzer[HFA]30-2 GHT as gold standard. 'True positive 'was regarded as 'outside normal limit 'or P-value of MD or PSD below 0.05 at HFA, 'abnormal 'at FDP P-value of MD or PSD below 0.05. MD of early glaucoma was -5.4 decibel at HFA and -6.61 decibel at FDP, Sensitivity of early glaucoma was 96.1%with FDP and 84.6%with HFA;specificity, 89.7%with FDP and 83.6%with HFA. We could confirm FDP threshold test showed good sensitivity in detecting early glaucoma. Especially, use of PSD increased efficiency of the test.
Glaucoma* ; Humans ; Sensitivity and Specificity* ; Visual Field Tests*

We compared the results of phacoemulsification, intraocular lens(IOL) insertion, and trabeculectomy with mitomycin(MMC) in patients receiving either 3.2mm or 5.5mm incision. Our study revealed that the surgicalresults were comparable between the 3.2 and 5.5mm incision groups in terms of number of glaucoma medicatins, intraocular pressure(IOP) control, visual acuity except visual recovery in early period. The 3.2mm incision group showed stastically significant advantage in early visual recovery than the comparison group(P<0.05, Wilcox rank test). The incidence of anterior capsular opacity was significantly higher in 3.2mm incision group, requiring YAG capsulectomy for better vision than in 5.5mm group. This study suggests that both 3.2 and 5.5mm incision glaucoma triple procedures combined with Mitomycin C(MMC) may provide excellent postoperative IOP control and visual recovery without significant complication I intermediate follow-up period.
Follow-Up Studies ; Glaucoma ; Humans ; Incidence ; Lenses, Intraocular* ; Mitomycin* ; Phacoemulsification* ; Trabeculectomy* ; Visual Acuity

PURPOSE: To compare quantitative polarimetric measurements in eyes with NTG and HTG using GDx-VCC. Both groups were matched by age and glaucoma stage based on the Humphrey visual field test. METHODS: We retrospectively reviewed the records of 146 patients who underwent Humphrey field analysis (HFA) and GDx-VCC. We compared outcomes of retinal nerve fiber layer (RNFL) parameters among the three groups by ANOVA and between each pair of groups using the Tukey-Kramer Post-Hoc test. We also evaluated the sensitivity and specificity of GDx-VCC in detecting glaucoma in each group. RESULTS: The mean age and HFA mean deviation (MD) were 55.6+/-9.5 years and -0.8+/-1.5 dB in 47 control patients, 59.4+/-9.0 years and -5.77+/-4.38 dB in 49 NTG patients, and 59.4+/-11.7 years and -8.09+/-6.77 dB in 51 HTG patients, respectively. All thickness parameters were lower in HTG patients compared to NTG patients, but there were no significant differences in ratio parameters between age-matched early HTG and NTG patients. The sensitivity of GDx-VCC was significantly higher in both early and total HTG patients compared to the respective groups of NTG patients. CONCLUSIONS: Compared to eyes with NTG, eyes with HTG showed reduced RNFL thickness and ratio parameters when patients were age and visual field matched. GDx-VCC appeared to be more sensitive in detecting RNFL damage in HTG patients.
Visual Fields ; Severity of Illness Index ; Retrospective Studies ; Retinal Ganglion Cells/*pathology ; Perimetry/*methods ; Nerve Fibers/*pathology ; Middle Aged ; Lasers/*diagnostic use ; Intraocular Pressure/*physiology ; Humans ; Glaucoma, Open-Angle/*pathology/physiopathology ; Follow-Up Studies ; Aged

We investigated the ability of the GDx-Nerve Fiber Analyzer (NFA) to discriminate between normal and early glaucomatous eyes among Korean individuals by reviewing the medical records of 217 consecutive subjects: 61 early glaucoma patients, 68 ocular hypertensive patients, and 88 normal subjects. GDx parameters were compared using ANOVA. The Receiver Operating Characteristics (ROC) curve for each GDx-NFA variable was used to diagnose each parameter, and Pearson correlation coefficients were calculated to assess the association between GDx-NFA parameters and visual field indices in early glaucoma. The best GDx parameters to discriminate between early glaucomatous and normal subjects were the number, maximum modulation, ellipse modulation and inferior ratio (i.e. area under the ROC curve > 0.8). A value for the Number of equal to or greater than 27 was optimal for detecting early glaucoma, with a sensitivity of 80.3% and specificity of 80.7%. In addition, symmetry was positively correlated with the corrected pattern standard deviation (CPSD) among visual field indices in early glaucoma.
*Diagnostic Techniques, Ophthalmological ; Female ; Glaucoma, Open-Angle/*diagnosis/ethnology ; Humans ; Intraocular Pressure ; Korea/epidemiology ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Ocular Hypertension/diagnosis/ethnology ; Optic Nerve Diseases/*diagnosis/ethnology ; ROC Curve ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Sensitivity and Specificity ; Visual Fields

To increase the success rate of intraocular pressure control in recalcitrant glaucoma, Ahmed glaucoma shunt has been used recently. Application of mitomycin C(MMC) during Ahmed implantation may be speculated to increase the success rate by decreasing the fibroblast proliferation and colagen deposition in the filtering capsule. To find out histological change with the use of MMC in the capsule of seton implant, a rabbit model of the Ahmed implant was created to obtain a serial histological specimens over 6 months. Ahmed S1 implant were implanted in 10 normal white rabbits. Five rabbits were treated with 0.04% MMC solution during the implantation under subtenon space(group 1) and the remaining ones were not(group 2). The rabbits were sacrificed at 1, 3, and 6 months to obtain histological specimen of the bleb capsules in each group. Light microscopic examinations were performed after hematoxylin and eosin staining. In group 1(MMC application group), the thickness of fibrous capsule was 0.6mm at 1 month, 0.48mm at 3 months, and 0.4mm at 6 months serially. The number of fibroblasts was 139/mm3 at 1 month, and 82/mm3 at 6 months. In group 2, the capsule thickness was not significantly different compared with roup 1 at 6 months. IN conclusion, during the period over 6 months period, there was no significant difference in thickness of bleb capsule in the two groups although the number of fibroblasts was 3 times denser in group 2 than in group 1.
Blister ; Capsules ; Eosine Yellowish-(YS) ; Fibroblasts ; Glaucoma ; Hematoxylin ; Intraocular Pressure ; Mitomycin* ; Rabbits

To evaluate the effect of superior oblique tenotomy on horizontal deviation at primary position in A-pattern exotropia with bilateral superior oblique overaction.We performed adjustable strabismus surgeries under topical anesthesia in 6 patients with A-pattern exotropia. After adjusting horizontal deviation to orthotropia in primary position by horizontal muscle surgery, we measured angle deviation in up, primary, downgaze position and added bilateral superior oblique tenotomy, and remeasured the angle deviation at same positions. We analyzed the angle deviation at postoperative one day, one month, and three month in comparison with the preoperative value. There were no change of horizontal deviation in primary position in 2 patients, qhile 3 to 8 prism diopter(PD) esotropic shift occurred in 4 patients(average 3.3PD) after bilateral superior oblique tenotomy at last follow-up of 3 month. At 3 month postoperatively, there was a tendency of exotropic shift from esotropia noted at immediate postoperative period. When combined surgeries of superior oblique and horizontal muscle are considered and intraoperative adjustable surgery is not permitted, horizontal muscle surgery can be performed with disregarding the effect of bilateral superior oblique tenotomy on primary position horizontal alignment.
Anesthesia ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Postoperative Period ; Strabismus ; Tenotomy*

To determine the safety and efficacy of using subconjunctival 5- fluorouracil(5-FU) injection on high risk eyes for filtration failure who had undergone trabeculectomy with intraoperative mitomycin C(MMC), we conducted a retrospective analysis of 17 eyes of 17 consecutive patients. Intraoperative MMC exposure (0.4mg/ml) was followed by supplemental postoperative 5-FU injection as necessary to titrate bleb vascularity and intraocular pressure (IOP). Exposure time to MMC was 2 to 5 minutes based on multiple preoperative and intraoperative risk factors. Postoperative 5-FU was administered by subconjunctival injection(5mg) adjacent to or into the bleb in a weekly interval(mean 4 injections, range 2-5 injections). Mean follow-up time was 8.6 months. Overall mean preoperative IOP was 27.1+/-7.2mmHg compared with mean postoperative IOP of 12.3+/-7.4mmHg. Fifteen eyes(88%) achieved a final IOP < OR =21mmHg without medicatio and 11 eyes(64%) achieved a final IOP< OR =12mmHg. Complications developed after 5-FU injections included corneal epithelial defect in 2 eyes (12%), hypotony (IOP< OR =5, at least 2 visits) in 2 eyes(12%), and bleb leakage in 1 eye(6%). No patient had a hypotony induced maculopathy, hyphema or choroidal effusion. Our data suggest that postoperative 5-FU may be safely used adjunctively following MMC trabeculectomy in carefully selected patients, and may improve the overall success rate with high risk trabeculectomy.
Blister ; Choroid ; Filtration ; Fluorouracil* ; Follow-Up Studies ; Humans ; Hyphema ; Intraocular Pressure ; Mitomycin* ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

PURPOSE: To evaluate the structure-function relationships between retinal sensitivity measured by Humphrey visual field analyzer (HVFA) and the retinal nerve fiber layer (RNFL) thickness measured by scanning laser polarimetry (SLP) with variable corneal compensation (VCC) and enhanced corneal compensation (ECC) in glaucomatous and healthy eyes. METHODS: Fifty-three eyes with an atypical birefringence pattern (ABP) based on SLP-VCC (28 glaucomatous eyes and 25 normal healthy eyes) were enrolled in this cross-sectional study. RNFL thickness was measured by both VCC and ECC techniques, and the visual field was examined by HVFA with 24-2 full-threshold program. The relationships between RNFL measurements in superior and inferior sectors and corresponding retinal mean sensitivity were sought globally and regionally with linear regression analysis in each group. Coefficients of the determination were calculated and compared between VCC and ECC techniques. RESULTS: In eyes with ABP, R2 values for the association between SLP parameters and retinal sensitivity were 0.06-0.16 with VCC, whereas they were 0.21-0.48 with ECC. The association of RNFL thickness with retinal sensitivity was significantly better with ECC than with VCC in 5 out of 8 regression models between SLP parameters and HVF parameters (P<0.05). CONCLUSIONS: The strength of the structure-function association was higher with ECC than with VCC in eyes with ABP, which suggests that the ECC algorithm is a better approach for evaluating the structure-function relationship in eyes with ABP.
Algorithms ; Birefringence ; Cornea/physiology ; Cross-Sectional Studies ; *Diagnostic Techniques, Ophthalmological ; Female ; Glaucoma/*diagnosis ; Humans ; Intraocular Pressure ; Lasers/diagnostic use ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Optic Nerve Diseases/*diagnosis ; Prospective Studies ; Retinal Ganglion Cells/*pathology ; Vision Disorders/*diagnosis ; *Visual Fields

The aim of this study was to determine the relationship between the frequency doubling technology (FDT) screening algorithm and parapapillary retinal nerve fiber layer (RNFL) thickness in the eyes of glaucoma suspects and patients with open angle glaucoma. FDT C20-1 screening program and a scanning laser polarimetry (SLP) system (GDx-NFA) was used to assess 53 glaucomatous eyes, 53 glaucoma suspects and 36 normal control eyes. In glaucomatous eyes, there were correlations between the FDT the screening algorithm and RNFL retardation values in several polarimetric indices, most significantly "inferior thickness" (r = -0.321, P = 0.029). In the eyes of glaucoma suspects, however, we observed no correlation between the FDT results and RNFL retardation values (r = 0.080, P > 0.05, "inferior thickness"). In glaucomatous eyes, the abnormal scores obtained with FDT screening program correlated negatively with RNFL retardation values, as measured by SLP. Despite poor correlation between the FDT abnormal score and RNFL retardation value in glaucoma suspects, detection of abnormality using the FDT screening protocol may aid in the assessment of early glaucomatous structural damage.
Comparative Study ; Glaucoma, Open-Angle/*diagnosis/physiopathology ; Humans ; Intraocular Pressure ; Lasers/diagnostic use ; Microscopy, Confocal ; Middle Aged ; Nerve Fibers/*pathology ; Ocular Hypertension/diagnosis/physiopathology ; Optic Nerve/*pathology ; Perimetry/*methods ; Retinal Ganglion Cells/*pathology