The use of intraoperative application of Mitomycin C at the filtration site has been known to improve the surgical outcome in glaucomatous eyes with high risk for failure of trabeculectomy. The author performed trabeculectomies with intraoperative Mitomycin C on 25 eyes of 20 patients with poor surgical prognosis to study the efficacy and safety of this technique in glaucomatous patients with high risk for failure of trabeculectomy. After the preparation of a scleral flap, 0.2mg/ml sulution of Mitomycin C was applied between Tenon's capsule and the sclera for 2 minutes. The exposed area was then irrigated with 200 ml of balanced salt solution. The follow-up period was from 1 to 7 months (mean 3.8 months). The mean preoperative intraocular pressure (IOP) was 38.6±6.6mmHg. The mean final postoperative IOP was 11.7±3.8mmHg. Twenty three (88%) of the 25 eyes were successfully controlled with the IOP of less than or equal to 20 mmHg wthout glaucoma medication. There were early postoperative complications of hyphema in 5 eyes (20%), shallow anterior chamber in 4 eyes(16%), punctate keratopathy in 3 eyes (12%), aqueous leaking from conjunctival wound in 2 eyes (8%), encapsulated bled in 1 eye (4%) and choroidal detachment in 1 eye (4%), and 4 eyes had long term hypotony lasting more than 2 months. Although Mitomycin C is simple to use and effective adjunct to trabeculectomy, further study will be needed to determine the mechanism of action, indication, dosage and optimal exposure time of Mitomycin C.
Anterior Chamber ; Choroid ; Filtration ; Follow-Up Studies ; Glaucoma ; Humans ; Hyphema ; Intraocular Pressure ; Mitomycin* ; Postoperative Complications ; Prognosis ; Sclera ; Tenon Capsule ; Trabeculectomy* ; Wounds and Injuries

We studied the change in intraocular pressure (IOP) in 15 consecutive cataract patients who underwent extracapsular cataract extraction and posterior chamber lens implantation between Feb. 1993 and Apr. 1993 to evaluate the effect of this surgery on postoperative IOP. To evaluate the clinical usefulness of non-contact tonometer, the intraocular pressures were measured with Kowa non-contact tonometer (TM-2000, Japan) as well as Goldmann applanation tonometer. There was a decrease in IOP of 3.4±2.9mmHg (p<0.001) 3 months after this surgery and the intraocular pressure differences between pseudophakic eyes and contralateral phakin eyes at 3 months postoperatively were 2.4±3.8mmHg (p<0.05). The correlation coefficient between non-contact tonometer and Goldmann tonometer was 0.8876 (p=0.001) in the postoperative 76 eyes. Therefore, out results suggest that extracapsular cataract extraction and posterior chamber lens implantation alone can be a useful surgical method in cataract patient with ocular hypertension, and non-contact tonometer was relatively accurate in measuring the postoperative intraocular pressure.
Cataract Extraction* ; Cataract* ; Humans ; Intraocular Pressure* ; Methods ; Ocular Hypertension

BACKGROUND: Neovascular glaucoma is common secondary glaucoma at high risk for failure of glaucoma filtering surgery. Recently, trabeculectomy with adjunctive mitomycin C trabeculectomy has been tried to improve the surgical success rate of conventional trabeculectomy. But, the long-term effects of mitomycin C trabeculectomy for neovascular glaucoma are unknown. Thus, we evaluated the long-term effects of mitomycin C trabeculectomy and its prognostic factors influencing the outcome. MATERIALS AND METHODS: Medical records of 62 eyes of 55 neovascular glaucoma who had undergone mitomycin C trabeculectomy were retrospectively reviewed. Surgical success was defined as intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: Postoperative success was obtained in 37 (60%) out of 62 eyes after mean follow- up period of 23.9+/-16.2 months. Using Kaplan-Meier survival analysis, cumulative success rate at the 6-, 12-, 24- and 36-month intervals were 85%, 71%, 57% and 52%, respectively. Success rate was greater in eyes with diabetic retinopathy than other causes(p=0.005) and in eyes with preoperative panretinal photocoagulation(PRP) than without PRP(p=0.015). However, Cox proportional hazard regression analysis revealed that preoperative PRP was not a significant risk factor for surgical failure. CONCLUSION: Prognosis of neovascular glaucoma caused by diabetic retinopathy was better than that caused by the other disorders following mitomycin C trabeculectomy. The author would suggest that mitomycin C trabeculectomy could be effective and relatively safe as the first procedure of choice before performing glaucoma drainage device implantation or cyclodestructive procedure.
Diabetic Retinopathy ; Drainage ; Filtering Surgery ; Glaucoma ; Glaucoma, Neovascular* ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin* ; Prognosis ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

Even though phototherapy is an effective means of treating hyperbilirubinemia, adequate binocular shields are essential to prevent light hazard of retina during phototherapy. The phototherapy to young albino rabbits was performed under various conditions; exposured for 12, 24, and 48 hours, continuity or intermittence of irradiation, and use of shields. Although there was no definite pathologic change in indirect ophthalmoscopic examination, severe damage was seen at electron microscopic level. In all experimental groups, swelling and edema of photoreceptor were seen. at right after phototherapy. Futhermore, more severe damage was seen in case of intermittent irradiated group and prolong exposed group. In mydriatic eyes, severity of damage was similiar to non mydi iatic eyes, but area of retinal damage was more extensive than non-mydriatic eves.. In control group which was protected by binocular shields during phototherapy, no significant abnormality was found.
Dermatitis, Phototoxic* ; Edema ; Hyperbilirubinemia ; Phototherapy ; Rabbits ; Retina ; Retinaldehyde* ; Telescopes

Fifty-four marginal rotation procedures for cicatrical entropion and marginal entropion were performed in twenty-eight patients (8 males, 20 females). The age ranged from 4 to 74 years old (meant 51.1 years old). After the follow up periods of 6 to 48 months, excellent correction of the eyelid margin and good cosmetic appearance were noticed in most cases, but nine cases combined with severe trichiasis showed recurred trichiasis requiring reoperation.
Entropion ; Eyelids ; Follow-Up Studies ; Humans ; Male ; Reoperation ; Trichiasis

PURPOSE: Young age is controversial risk factor for filtration failure following trabeculectomy with adjunctive mitomycin C (MMC). This study aimed at investigating whether juvenile-onset primary open angle glaucoma (JPOAG) patients have worse long-term outcome than adult-onset primary open angle glaucom (APOAG) patients following primary trabeculectomy with adjunctive MMC. METHODS: Medical records of 162 eyes of 113 primary open angle glaucoma patients who had undergone primary trabeculectomy with MMC and minimum follow up of 12 months were retrospectively reviewed. All the patients were free of other known risk factors except young age for surgical failure following trabeculectomy. The patients were divided into two groups; juvenile group (68 eyes of 42 patients, 10~35 years of age) and adult group (51 eyes of 41 patients, age 50 years or older). Forty-three eyes of 30 patients, aged 36~49 years, were excluded from the analysis for the study purpose. Demographic, preoperative and postoperative data were collected for up to 96 months. Kaplan-Meier survival analysis was used for probability of cumulative success estimations according to success criterion (defined as postoperative intraocular pressure of 20 mmHg or less without glaucoma medications). RESULTS: Cumulative life-table success rates of juvenile group were 98.5% at 12 months, 84.6% at 48 months, and 71.2% at 96 months. Those of adult group were 98.0%, 77.0%, and 68.5% respectively. There was no statistically significant difference in overall filtration success rates between juvenile and adult groups (p=0.52). Using a Cox proportional hazard regression analysis of potential risk factors, young age was not found to significantly affect the surgical failure (p=0.97). CONCLUSIONS: Young age itself was not associated with the poor surgical outcome following primary trabeculectomy with adjunctive MMC in this study. The present results suggest that the success rate of the JPOAG compares favorably with that of the APOAG. Primary trabeculectomy with MMC in juvenile glaucoma without other concomitant risk factors may have a favorable long-term clinical outcome as adult glaucoma.
Adult ; Filtration ; Follow-Up Studies ; Glaucoma ; Glaucoma, Open-Angle* ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin* ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

The management of coincident glaucoma and cataract is not only a common clinical challenge but also an important research topic in the ophthalmic surgical field. The purpose of this article is to compare the different surgical options on the basis of their achievable postoperative intraocular pressure (IOP) control, success rates, and complication rates reported in the related literature, and to give advice on how to manage typical situations of patients with both glaucoma and cataract. Main topics were focused on indications and rationale of 3 surgical options (only cataract surgery first and later trabeculectomy, only trabeculectomy first and later cataract surgery, or simultaneous combined surgery). Modern clear corneal cataract extraction techniques resulted in a modest intermediate-term reduction of IOP and has considerably improved the success rates of combined glaucoma and cataract surgery. It also enabled future trabeculectomy to be successfully performed at a later date if necessary. Trabeculectomy alone achieved better IOP regulation than phacotrabeculectomy (combined surgery), but subsequent cataract surgery may compromise preexisting filtering bleb. Combined surgery augmented with mitomycin C achieved a lower IOP than combined surgery alone but had a higher complication rate. In conclusion, the choice of the preferred surgical method should be determined according to the target pressure, the amount of glaucomatous damage, and the grade of visual disturbance caused by the cataract. Phacotrabeculectomy with adjunctive mitomycin C offers visual improvement and achieves the best IOP lowering of all types of combined glaucoma and cataract surgery currently used but is associated with potentially sight-threatening complications.
Blister ; Cataract Extraction ; Cataract* ; Glaucoma* ; Humans ; Intraocular Pressure ; Mitomycin ; Phacoemulsification ; Trabeculectomy

PURPOSE: This study was conducted to assess the surgical outcomes of limbal lensectomy with or without anterior vitrectomy for the management of lens subluxation. MATERIALS AND METHODS: The medical records of 20 consecutive patients (33 eyes) with lens subluxation who had undergone limbal lensectomy with or without anterior vitrectomy from February 1999 to January 2004 were retrospectively reviewed. RESULTS: All the patients, except one high axial myopic patient, were implanted with scleral sutured posterior chamber intraocular lens. We evaluated the preoperative, postoperative visual acuity and postoperative complications and compared the results in group I (limbal lensectomy with anterior vitrectomy, 27 eyes) to those in group II (limbal lensectomy without anterior vitrectomy, 6 eyes). The preoperative best-corrected visual acuity was 0.21 and postoperative best-corrected visual acuity was improved by 2 lines or more in all 27 eyes in group I, and in 5 eyes in group II (p>0.05). The most frequent postoperative complication was intraocular lens dislocation in four eyes (14.8%) in group I alone. No retinal detachment occurred in either group, even in patients with high myopia. CONCLUSION: Limbal lensectomy without anterior vitrectomy improved visual acuity similarly to limbal lensectomy with anterior vitrectomy without significant increase of postoperative complications. This results of this study suggest that anterior vitrectomy is not necessarily required for the management of lens subluxation.
Dislocations ; Humans ; Lens Subluxation* ; Lenses, Intraocular ; Medical Records ; Myopia ; Postoperative Complications ; Retinal Detachment ; Retrospective Studies ; Visual Acuity ; Vitrectomy*

BACKGROUND: The safety and efficacy of trabeculectomy with Mitomycin C (MMC) for surgical treatment in aphakic and pseudophaic eyes were retrospectively evaluated. MATERIALS AND METHODS: The authors reviewed 51 eyes of 45 patients who had been followed up for at least 6 months after trabeculectomy using MMC for aphakic and pseudophakic eyes. The success rate and complications were analyzed. The success criteria included intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as a postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: The average follow up period was 27.7 months and the intraocular pressure was controlled under 21 mmHg in 36 eyes of 51 (70.6%) after the procedure with or without medication for glaucoma. Using the Kaplan-Meier survival analysis, the cumulative success rate at the 3-, 6-, 12-, 24- and 36-month intervals were 98.0%, 94.1%, 91.9%, 83.4% and 75.5%, respectively. The complications observed were hyphema (4 eyes), serous choroidal detachment (4 eyes), hypotony (3 eyes), and endophthalmitis (1 eye). CONCLUSION: Trabeculectomy using Mitomycin C for the treatment of aphakic and pseudophaic eyes was safe and effective.
Aphakia ; Choroid ; Endophthalmitis ; Follow-Up Studies ; Glaucoma ; Humans ; Hyphema ; Intraocular Pressure ; Mitomycin* ; Pseudophakia ; Retrospective Studies ; Trabeculectomy*

Exfoliation syndrome(XFS)has rarely been reported in Korea even though its worldwide distribution. The purpose of this study is to report clinical manifestations of XFS in Korea and to determine its relationship to the development of glaucoma in patients with XFS. We retrospectively reviewed the medical records of 31 patients with XFS presenting over a 6-year period at Yeungnam university hospital. Patients were considered to have XFS if characteristic fibrillar exfoliative materials were visualized on the anterior lens capsule. We investigated clinical features such as gender, age, combined systemic disease, laterality, presence of cataract or glaucoma, methods of treatment and complications. We could identify 24 males and 7 females with XFS. All the cases were aged 60 years or more except one case, with the peak in the eighth decade(mean 71.5, range from 37 to 92 years). In 11 patients(35%), XFS was bilateral. Cataract was associated in 28 eyes(67%)out of the total 42 eyes and cataract extractions were performed in 8 eyes. Glaucoma developed in 17(55%)out of the total 31 patients, with the predilection toward the case with bilateral involvement(73%)of XFS, and 44%of glaucomatous eyes required trabeculectomy. The clinical features of XFS in Korea were similar to previous reports from other parts of the world, but interestingly male predominance was a unique finding in this study. Our study suggests that XFS occurs not uncommonly among the Korean population.
Cataract ; Cataract Extraction ; Exfoliation Syndrome* ; Female ; Glaucoma ; Humans ; Korea* ; Male ; Medical Records ; Retrospective Studies ; Trabeculectomy