Previous studies have suggested that there are racial differences in the outcome of conventional filtration surgery. This study aims to evaluate the outcome of glaucoma drainage implants in Asian ...eyes with complicated glaucoma and to determine whether there are racial differences in the results of such implant surgery compared to previous reports in non-Asian patients.
The study design was a retrospective review of all patients with more than 6-months’ follow-up after glaucoma implant surgery at the Singapore National Eye Centre between January 1993 and August 1996.
A Total of 83 Asian patients with uncontrolled complicated glaucoma participated.
A total of 29 patients received Molteno implants and 54 received Baerveldt implants.
The surgical outcome was assessed in terms of final intraocular pressure (IOP), visual acuity outcome, and incidence of complications. Success was defined as final IOP less than 22 mmHg with no medications and qualified success as an IOP less than 22 mmHg with medication.
With mean follow-up of 13.41 months, success in IOP control was achieved in 73.5% of patients and qualified success in 12%. Visual acuity remained stable or improved in 85.5%. There were no patients who encountered intraoperative complications, and the incidence of serious postoperative complications was low. The most frequently observed short- and long-term postoperative complication was hyphema in 14 eyes (16.9%) and bullous keratopathy in 7 eyes (8.4%), respectively.
Glaucoma drainage implants have good outcome and visual stabilization in Asian eyes with success rates for IOP control comparable to those reported in previous studies in non-Asian eyes.
Cataract surgery after trabeculectomy Seah, S K; Jap, A; Prata, Jr, J A ...
Ophthalmic surgery and lasers,
07/1996, Letnik:
27, Številka:
7
Journal Article
To determine the effect of cataract surgery on glaucomatous eyes with good intraocular pressure (IOP) control after trabeculectomy.
Twenty-two eyes with functional blebs that underwent cataract ...extraction were retrospectively analyzed.
The mean (+/- SD) preoperative IOP was 11.0 +/- 4.3 mm Hg. The mean (+/- SD) postoperative IOPs at 1, 2, 6, and 9 months were 15.5 +/- 4.9, 12.6 +/- 4.7, 14.6 +/- 5.6, and 19.0 +/- 7.9 mm Hg, respectively. At each interval except for the second month, the mean IOP was statistically significantly higher than the preoperative value (P = .0003, .24, .02, and .0009, respectively). The total number of medications was also higher (3 preoperatively versus 27 postoperatively). The interval between the two surgeries had no influence on IOP control. Intraoperative complications during cataract surgery, particularly vitreous loss, were associated with poor IOP control. Phacoemulsification had less of an effect on the postoperative IOP control than did extracapsular cataract extraction.
Eyes with previous successful trabeculectomies had higher IOPs and required more medications after subsequent cataract surgeries.
To evaluate the use of perfluoropropane (C3F8) gas bubble in the augmentation of glaucoma-filtering blebs.
Experimental animal study and a pilot clinical study.
Twenty rabbits in the animal study and ...20 humans in the pilot study participated.
Twenty patients underwent trabeculectomy for medically uncontrolled glaucoma. Surgical techniques were similar to those used in standard limbus-based trabeculectomies. The Tenon’s capsule and conjunctival wound were closed separately using continuous sutures. Before the final knots were tied, 0.1 to 0.2 ml of 15%:85%–C3F8:air mixture gas bubble was introduced into the subconjunctival space with a silicone tube attached to a 27-gauge Rycrof cannula. The sutures were immediately knotted on withdrawal of the tube. The patients were reviewed after surgery for the appearance, size, and location of the gas bubble. The bleb morphology and intraocular pressures were also monitored.
The parameters measured were intraocular pressure control, Snellen visual acuity, appearance of the bleb in relation to its elevation and degree of inflammation of the subconjunctival tissue, and characteristics of the gas bubble (e.g., size, number, and position).
The gas bubbles stayed in the conjunctival bleb for an average duration of 17 days (range, 13–27 days). In all cases, the gas bubbles helped to maintain the filtering bleb until their complete resolution. No excessive inflammation was noted in the filtering blebs. The mean preoperative intraocular pressure was 27.3 ± 5.5 millimeters of mercury (mmHg), and the mean postoperative intraocular pressure was 14.5 ± 2.3 mmHg, with only two patients requiring supplementary topical medication. All cases resulted in good filtering blebs with satisfactory intraocular pressures after 16 months of follow-up.
Subconjunctival C3F8 gas bubbles, via a “spacer” effect, aid the maintenance of filtering blebs in the early postoperative period. This technique may be useful in augmenting or salvaging blebs at risk of failure.
To assess visibility of the scleral spur in anterior segment optical coherence tomography (AS-OCT) images. This cross-sectional observational study included 502 participants aged 50 years or older ...who had no previous ophthalmic problems and were recruited from a community clinic in Singapore. All participants underwent gonioscopy and AS-OCT (Visante; Carl Zeiss Meditec, Dublin, California). Scleral spur location was assessed in AS-OCT images by 2 examiners with glaucoma subspecialty training and was defined as the point where there was an inward protrusion of the sclera with a change in curvature of its inner surface. Scleral spur location could be determined in 72% of the images of the right Its location on AS-OCT images was less detectable in quadrants with a closed angle on gonioscopy and also in images obtained in the superior and inferior compared with the nasal and temporal quadrants (64%, 75%, and 80%, respectively; P <.001). The inability to detect the scleral spur may hamper quantitative analysis of anterior chamber angle parameters that are dependent on the location of this anatomical structure, particularly in the superior and inferior quadrants. New parameters independent of the scleral spur may be useful for detecting eyes at risk of angle closure.
To investigate the results of combined phacoemulsification, intraocular lens implantation and trabeculectomy in Asian patients with chronic angle closure glaucoma (CACG).
This was a retrospective ...non-comparative case series of 55 consecutive patients (57 eyes) who underwent phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy for CACG at the Singapore National Eye Centre between 1997-1998. The surgical outcome was assessed in terms of intraocular pressure (IOP), the incidence of complications and the visual acuity at last follow-up. Success was defined as final IOP < or = 21 mmHg without medication and qualified success as final IOP < or = 21 mmHg with medication. Patients with final IOP > 21 mmHg who required further glaucoma surgery, lost light perception or became pthisical, were classified as failures. The eyes were further categorized into two groups according to whether single-site or separate-site surgery was performed. The outcome was also compared among eyes in which per-operative antimetabolites were applied to the trabeculectomy site and those without antimetabolites.
The mean follow up was 22.0 +/- 5.6 months (mean +/- SD). Success was achieved in 46 (81%) eyes, qualified success in 10 (17%) eyes, and failure in 1 (2%) eye. In terms of IOP outcome, the success rate was similar in the two surgical groups (single-site or separate-site). There was no significant difference in IOP outcome among eyes in which per-operative antimetabolites were used and eyes with no per-operative antimetabolites use. Forty-one eyes (72%) had 6/12 or better vision. There were no cases of intraoperative complications and the incidence of postoperative complications was low.
Combined phacoemulsification, intraocular lens implantation and trabeculectomy is associated with good intraocular pressure control and visual outcome in patients with CACG.
A prospective study was performed to compare argon laser iridotomy and sequential argon laser and Nd:YAG laser iridotomy in dark irides.
Twenty-four eyes of 17 patients underwent laser iridotomies; ...13 underwent argon laser iridotomies and 11 underwent sequential argon laser and Nd:YAG laser iridotomies. The argon laser settings were standardized at 1.2 W, 50-mum spot size, and 0.1-second duration. The Nd:YAG laser was set at 2.5 mJ and single-pulse shots were used.
All of the iridotomies were patent at the end of one treatment session. The mean total energy used for argon laser iridotomy was 8.28 J. For sequential iridotomy, 3.12 J was used for the argon laser stage and 7.5 mJ for the Nd:YAG laser stage.
The total argon laser energy used can be reduced by 2.65 times by using the sequential laser iridotomy technique.
Mitomycin C (MMC) is used in the treatment of disseminated adenocarcinoma of the stomach and pancreas and is used in ophthalmology as adjunctive therapy in trabeculectomy. Since only small volumes of ...aqueous humor are available for analysis, a sensitive method requiring limited sample preparation was developed. An internal standard, 4-aminoacetophenone, was added to aqueous humor specimens, and the solution was directly injected into the high-performance liquid chromatographic (HPLC) column. The use of a short 50-mm C18 reversed-phase column gave adequate resolution of peaks with improved sensitivity. The method was applicable for determination of MMC in serum, although solid-phase extraction for sample clean-up was required prior to injection into the HPLC column, and analytical columns of 150-250 mm were necessary for adequate resolution of peaks. The method has been validated and is linear from 6.25 to 50 ng/ml in aqueous humor and from 10 to 500 ng/ml in serum.
