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 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

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*

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

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

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

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 investigate the relationship between the SLP-VCC parameters and the SLP-ECC parameters in the eyes with typical retardation pattern (TRP) and atypical retardation pattern (ARP), and the sensitivities and specificities of the SLP-VCC parameters and the SLP-ECC parameters in the eye with TRP and ARP. METHODS: In this prospective study, 72 eyes with TRP images (30 glaucomatous and 42 normal eyes) and 53 eyes with ARP images (28 glaucomatous and 25 normal eyes) were recruited. For each group, we analyzed relationship between each parameters of GDx-VCC and GDx-ECC and the diagnostic ability of GDx-ECC by using the ROC curve. RESULTS: In the eyes with TRP, TSNIT average was significantly lower by GDx-ECC than GDx-VCC in the control group. Inferior average was significantly higher by GDx-ECC than GDx-VCC in both glaucomatous and normal group. TSNIT standard deviation was significantly higher by GDx-ECC than GDx-VCC in both groups. NFI was significantly lower by GDx-ECC than GDx-VCC in both groups. TSS (typical scan score) was significantly higher by GDx-ECC than GDx-VCC in both groups. In the eyes with ARP, TSNIT average was significantly lower by GDx-ECC than GDx-VCC in both groups. Superior and Inferior average was not different between GDx-ECC and GDx-VCC. TSNIT standard deviation was significantly higher by GDx-ECC than GDx-VCC in both groups. NFI was not different between groups. TSS was significantly higher by GDx-ECC than GDx-VCC in both groups. Comparison of ROC curve for the SLP parameters revealed no difference between VCC and ECC. TSNIT standard deviation, however, showed relatively high value in GDx-ECC compared with GDx-VCC. CONCLUSIONS: GDx-ECC has comparable diagnostic ability in discriminating glaucomatous and normal eyes with GDx-VCC and TSNIT standard deviation by the GDx-ECC algorithm could be a useful parameter in discriminating glaucomatous and normal eyes.
Compensation and Redress* ; Prospective Studies ; ROC Curve ; Scanning Laser Polarimetry*

Eyes with neovascular glaucoma often times present with vitreous hemorrhage which makes subsequent panretinal photocoagulation difficult to impossible. These eyes can benefit from pars plana vitrectomy combined with glaucoma shunt procedure. Other candidates are those refractory galucomatous eyes with severe vitreoretinal diseases that require surgical intervention. We performed standard pars plana vitrectomies in combination with Ahmed Glaucoma Valve implant and analyzed the surgical outcome in 11 eyes of 11 patiens with severe refractory galucoma. With the surgical success defined as an achievement of intraocular pressure(IOP) less or equal to 21 mmHg with anatomical reattatchment of retina, nine eyes(81.8%) became qualified in the success group. Complications included hyphema and/or severe fibrinous reaction (3 eyes), temporary IOP increase (3 eyes), recurrent vitreous hemorrhage (1 eye) and loss of light perception (1 eye). No eye showed postoperative hypotony, choroidal effusion or hemorrhage. In conclusion, in those eyes with refractory glaucoma accompanied with severe vitreoretinal disease that do not respond to the conventional IOP lowering procedures, combined pars plana vitrectomy with Ahmed Glaucoma Valve implantation may serve as a useful surgical alternative.
Choroid ; Fibrin ; Glaucoma* ; Glaucoma, Neovascular ; Hemorrhage ; Hyphema ; Light Coagulation ; Retina ; Vitrectomy* ; Vitreous Hemorrhage