PURPOSE: To describe the long-term results of deep sclerectomy with collagen implant (DSCI) with or without adjuvant mitomycin C in Korean patients with primary or secondary open-angle glaucoma (OAG). METHODS: This retrospective review was comprised of 65 Korean patients who received DSCI with or without adjuvant mitomycin C due to primary or secondary OAG. Patients were followed for 72 months after surgery. Complete success was defined as intraocular pressure (IOP) <21 mmHg without medication and qualified success was defined as IOP <21 mmHg with or without medication. RESULTS: Mean postoperative follow-up period was 53.0 +/- 16.2 months. Mean IOP was 30.5 +/- 11.7 mmHg preoperatively, 8.4 +/- 4.3 mmHg at postoperative day one and 13.4 +/- 3.8 mmHg 60 months after surgery. The mean number of glaucoma medications was decreased from 3.6 +/- 1.1 to 1.6 +/- 1.3 at 60 months after the operation. Complete and qualified success rates were 36.7% and 79.6% at postoperative 60 months, respectively (Kaplan-Meier survival curve). No shallow or flat anterior chamber, endophthalmitis, or surgery-induced significant cataract was observed. CONCLUSIONS: The results of DSCI in Korean patients presented here seem reasonably excellent with qualified success rates of over 70% at six years with negligible complications.
Adult ; Anterior Chamber/*surgery ; Collagen/*administration & dosage ; Drug Implants/*administration & dosage ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle/physiopathology/*surgery ; Humans ; Incidence ; Intraocular Pressure ; Male ; Postoperative Complications/epidemiology ; Postoperative Period ; Republic of Korea/epidemiology ; Retrospective Studies ; Sclera/*surgery ; Sclerostomy/*methods ; Time Factors ; Treatment Outcome ; Visual Acuity

PURPOSE: To report the case of a 36-year-old patient with nanophthalmic uveal effusion was treated with scleral window surgery and topical administration of mitomycin C (MMC). CASE SUMMARY: A 36-year-old woman presented with decreased visual acuity and blurred vision in the both eyes during 3 months. Fundus examination revealed choroidal effusion and retinal detachment with thickend sclera wall and short axial lengh. Partial-thickness sclera flap with deep sclerostomy was performed and topical MMC was administered to one quadrant of the equatorial sclera. The subretinal fluid resorbed gradually and visual acuity improved. CONCLUSIONS: Scleral window surgery and topical mitomycin C might relieve the blocked transscleral outflow of intraocular fluid in the small area of a sclerostomy in young patient with nanophthlamos.
Administration, Topical ; Adult ; Aqueous Humor ; Choroid ; Eye ; Female ; Humans ; Mitomycin ; Retinal Detachment ; Sclera ; Sclerostomy ; Subretinal Fluid ; Vision, Ocular ; Visual Acuity

BACKGROUNDNon-penetrating trabecular surgery is a new filtrating surgery without opening in ternal trabecular structures. This study was to estimate the overall efficacy of non-penetrating trabecular surgery for open angle glaucoma.

METHODSThe published articles selected for this study were obtained by a computerised Medline and China Biological Medicine Disk search of the literature and a manual search of the bibliographies of relevant articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis.

RESULTSA total of 37 articles were included in the meta-analysis. The pooled complete success rates of non-penetrating trabecular surgery with different techniques were: deep sclerectomy single, 69.7% (95% CI: 58.5% - 81.0%); deep sclerectomy with collagen implant, 59.4% (95% CI: 47.0% - 71.8%); deep sclerectomy with reticulated hyaluronic acid implant, 71.1% (95% CI: 56.8% - 85.3%); and viscocanalostomy, 72.0% (95% CI: 57.6% - 86.4%). The overall weighted complete success rate of non-penetrating trabecular surgery was 67.8% (95% CI: 61.4% - 74.3%).

CONCLUSIONSNon-penetrating trabecular surgery is the best available therapy method for medically uncontrolled open angle glaucoma with a complete success rate of over 60%. But the different techniques cannot belie the complete success rate of non-penetrating trabecular surgery.

Human ; Adult ; GLAUCOMA-OPEN-ANGLE ; GLAUCOMA,SIMPLEX ; GLAUCOMA, COMPENSATED ; IRIDOCORNEAL ENDOTHELIAL SYNDROME ; FILTERING SURGERY ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY

Chronic primary glaucoma affects sight very quietly - until such time that the progression of the disease is considerably advanced. The search for the ideal therapeutic approach to the disease can only provide, at best, for the arrest of the damage to the optic nerve head by bringing down the intraocular pressure to a level low enough to elude harm. Patients afflicted with the disease are bound to a therapy of a lifetime. This has implications of understated proportions in the economic scenario of a developing country. This study is conceived to determine the cost-effectiveness of chronic primary glaucoma management. A cross-sectional study design is employed to answer this objective. Medical records of 290 study eyes of 148 patients with chronic primary glaucoma (aged 14 - 88 years) are evaluated for cost-effectiveness of therapy. Results have shown that on one hand, medical therapy has a mean annual cost of PhP 5,830.00 + 278.00. On the other hand, surgical therapy has a one-time mean annual cost of PhP 8,100.00 + 359.00.Comparing cost-effectiveness using analysis of covariance (ANCOVA), one finds that filtering surgery is at least twice more cost effective than medical management (p0.001). Surgical complications, however, may hamper the effectiveness of filtering surgery. The study recommends that young patients with advanced disease and with higher IOP at the time of consult could be served more efficiently with a filter, whereas elderly patients approaching their life expectancy who can comply with the demands of effective medical management may not benefit much from it.
Human ; Aged ; Middle Aged ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY ; FILTERING SURGERY

In deep sclerectomy, collagen implant has been used to maintain space under the scleral flap. However, the effect of other implants has not been studied. In this retrospective study, we compared surgical outcomes between small collagen and chromic catgut used as implants in deep sclerectomy. Deep sclerectomy was performed on 23 patients (25 eyes) who either had an open angle and a high intraocular pressure (IOP) (> 22 mmHg) in spite of receiving the maximal tolerable medical treatment, or who were intolerant to medications. Our study consisted of 14 patients (15 eyes) in the small collagen group and 8 (9 eyes) in the chromic catgut group. The mean follow-up period was 8.6 +/- 3.3 months in the small collagen group and 4.4 +/- 1.2 months in the chromic catgut group. The mean preoperative IOP was not significantly different between the two groups. The complete success rate of the small collagen group was significantly better than that of the chromic catgut group at the final follow-up when data were analyzed using the Kaplan-Meier survival curve (87% versus 30%; P = .01). As for the qualified success rate, the small collagen group showed significantly better results at the final follow-up (93% versus 80%; P = .046). The mean number of postoperative medications was significantly lower in the small collagen group (0.26 versus 1.10; P < .05). These results confirmed that the use of small collagen implant in deep sclerectomy produced a higher success rate and a lowered need for postoperative medication compared to the use of chromic catgut implant. Because equal sized implants were used, the difference in biochemical properties, particularly the severity of inflammation caused by the implant, is presumed to be the cause of the different surgical outcomes.
*Absorbable Implants ; Adolescent ; Adult ; Aged ; *Catgut ; *Collagen ; Comparative Study ; Female ; Glaucoma, Open-Angle/*surgery ; Human ; Male ; Middle Aged ; *Postoperative Complications ; Retrospective Studies ; Sclerostomy/*methods ; Treatment Outcome

Silicone oil has been used successfully in vitreoretinal surgery for many years. But complications from the use of silicone oil as a long-acting internal tamponade may develop. They include glaucoma, keratopathy, oil emulsification, and cataract. For patients requiring silicone oil removal and cataract surgery, both operations can be performed in a combined procedure. After phacoemulsification, a posterior continuous curvilinear capsulorhexis(PCCC) is performed, followed by irrigation of balanced salt solution(BSS)into vitreous cavity allowing flow out of silicone oil through the PCCC and intraocular lens(IOL)is implanted into remaining capsular bag. This technique offers faster visual rehabilitation, shorter operation time and reduces the risk of peripheral retinal defect, vitreous hemorrhage that may be caused by traditional oil removal through sclerostomy.
Capsulorhexis* ; Cataract ; Glaucoma ; Humans ; Phacoemulsification* ; Rehabilitation ; Retinaldehyde ; Sclerostomy ; Silicone Oils* ; Vitreoretinal Surgery ; Vitreous Hemorrhage

Congenital glaucoma is the disease that requires operation and its prognosis is not good. In our study, we estimated the operative results of congenital glaucoma. We retrospectively reviewed the medical records of 39 patients(65 eyes) who were diagnosed with and operated for congenital glaucoma since 1986 and followed at least 6 months thereafter. Operation included goniotomy, trabeculotomy, trabeculectomy, Holmium laser sclerostomy, and Seton operation. Twenty five patients were male and fourteen were female, and the mean age at diagnosis was 18.7 months. Mean operation number ws 2.5. Success rate after only one operation without further medication was 20.0%. Sucess rate after only one operation with or without medical treatment was 32.3%. Success rate after more than two operations was 50.8%, and overall success rate was 83.1%. First operation before 3 years of age and preoperative intraocular pressure below 25mmHg had the higher success rate. And initial cup to disc ratio has no influence on the success rate. In congenital glaucoma, they need mean 2.5 operations on the average for success.
Diagnosis ; Female ; Glaucoma* ; Humans ; Intraocular Pressure ; Lasers, Solid-State ; Male ; Medical Records ; Prognosis ; Retrospective Studies ; Sclerostomy ; Trabeculectomy

The present study investigates the effects of the new Erbium:YAG(yttrium aluminum garnet) laser sclerostomy in eight rabbits eyes. The energy was set at 10mJ per pulse with the frequeny of 10Hz, and the total energy for the full thickness sclerostomy procedure was rated at 90 to 150ml. Following the procedure, the mean intraocualar pressure was significantly reduced for up to 7 days, and the histopathological observation at day 7 revealed clearly demarcated wound margins at the resected sites. The sesults suggest that te Erbium:YAG laser sclerostomy may be a good supportive procedures to conventional treatment of glaucoma.
Aluminum ; Erbium* ; Glaucoma ; Lasers, Solid-State* ; Rabbits* ; Sclerostomy* ; Wounds and Injuries

Mitomycin C is an antibiotic isolated from the broth of Streptomyces caespitosus which has been used as the adjunctive drug to reduce the fibroblast proliferation. Holmium laser sclerostomy can minimize conjunctival damage. We examined pharmacokinetics of mitomycin C following topical administration. Holmium laser sclerostomy was performed on one eye of each 15 rabbits and the other eye was served as a control. Next day, mitomycin C solution(0.4mg/ml) was administered by topical drops in both eyes of each rabbit. The concentrations of mitomycin C in the aqueous and the vitreous compartments of operated and control eyes were determined by HPLC at 0.5, 1, 2, 3, 6 hours after topical administration. The peak aqueous concentration was 0.07 microgram/ml in operated eyes and 0.06 microgram/ml in control eyes. The peak vitreous concentration was 0.10 microgram/ml in operated eyes and 0.09 microgram/ml in control eyes. The levels of detected mitomycin C at all time intervals were higher than the IC50(0.002 microgram/ml) for the inhibition of conjunctival fibroblast proliferation. These results suggest that topical mitomycin C easily crosses the intact and minimally damaged conjunctiva and therefore increases the success rate of Holmium laser sclerostomy.
Administration, Topical ; Chromatography, High Pressure Liquid ; Conjunctiva ; Fibroblasts ; Holmium* ; Lasers, Solid-State* ; Mitomycin* ; Pharmacokinetics ; Rabbits* ; Sclerostomy* ; Streptomyces