To assess clinical outcomes and establish the incidence and management of a hypertensive phase (HP) (defined as intraocular pressure IOP > 21 mmHg in the first 6 postoperative months) in patients ...with Ahmed glaucoma valve implant.
Retrospective noncomparative case series.
A total of 85 patients were included in the current study, including consecutive patients who had intractable glaucoma and underwent Ahmed valve implant insertion at the University Glaucoma Center, Tampa, Florida (DWR and WEL) and the Massachusetts Eye and Ear Infirmary (PAN) between January 1993 and June 1997. Only patients with a minimum of 6 months’ follow-up were included.
Ahmed glaucoma valve implant insertion to control intractable glaucoma was performed.
Success was defined as IOP less than 22 mmHg and greater than 4 mmHg on the last two visits, a decrease of no more than two lines in the visual acuity and no additional surgical interventions to control IOP.
The cumulative probability of success at 12 months was 77%. A total of 26 patients (30.6%) failed during the study period, and 70 patients (82%) exhibited HP. Hypertensive phase peaked at 1 month after the operation and stabilized at 6 months. There were 34 patients (48%) with HP who were controlled with additional medications: 14 (20%) with needling and 5-fluorouracil injections and 20 (28%) who needed secondary surgical intervention. There were 8 patients (9.4%) who exhibited hypotony (<5 mmHg) on postoperative day 1 and 3 (3.5%) at 3 months. Visual acuity returned to baseline between 3 and 6 months after the operation. The major complications associated with the valve were hyphema in 14 cases (16.5%), suprachoroidal hemorrhage in 4 cases (4.7%), end-plate exposure in 10 cases (11.7%), tube exposure in 6 cases (7%), tube block in 4 cases (4.7%), loss of vision in 5 cases (5.8%), and corneal graft failure in 4 (30%) of 13 cases with clear grafts.
The overall success rate is comparable to that of prior studies using different implants. The majority of the patients exhibit an HP that peaks at 1 month, with gradual stabilization over 6 months. One third of the patients needed secondary surgical intervention to control the HP. The incidence of postoperative hypotony and flat or shallow anterior chambers is very low after Ahmed glaucoma valve insertion.
Aqueous shunts for glaucoma Minckler, D S; Vedula, S S; Li, T J ...
Cochrane Database of Systematic Reviews,
04/2006
2
Journal Article
Recenzirano
Odprti dostop
Aqueous shunts are employed for intraocular pressure (IOP) control in primary and secondary glaucomas that fail medical, laser, and other surgical therapies.
This review compares aqueous shunts for ...IOP control and safety.
We searched CENTRAL, MEDLINE, PubMed, EMBASE, NRR all in January 2006, LILACS to February 2004 and reference lists of included trials.
We included all randomized and quasi-randomized trials in which one arm of the study involved shunts.
Two authors independently extracted data for included studies and a third adjudicated discrepancies. We contacted investigators for missing information. We used fixed-effect models and summarized continuous outcomes using mean differences.
We included fifteen trials with a total of 1153 participants with mixed diagnoses. Five studies reported details sufficient to verify the method of randomization but only two had adequate allocation concealment. Data collection and follow-up times were variable.Meta-analysis of two trials comparing Ahmed implant with trabeculectomy found trabeculectomy resulted in lower mean IOPs 11 to 13 months later (mean difference 3.81 mm Hg, 95% CI 1.94 to 5.69 mm Hg). Meta-analysis of two trials comparing double-plate Molteno implant with the Schocket shunt was not done due to substantial heterogeneity. One study comparing ridged with standard double-plate Molteno implants found no clinically significant differences in outcome. Two trials investigating the effectiveness of adjunctive mitomycin (MMC) with the Molteno and Ahmed implants found no evidence of benefit with MMC. Two trials that investigated surgical technique variations with the Ahmed found no benefit with partial tube ligation or excision of Tenon's capsule. One study concluded there were outcome advantages with a double versus a single-plate Molteno implant and one trial comparing the 350 mm(2) and 500 mm(2) Baerveldt shunts found no clinically significant advantage of the larger device but neither of these trials included all patients randomized. One study suggested improved clinical outcome when MMC was employed with a newly described shunt including ultrasound supporting the conclusion. One small study did not demonstrate an outcome advantage to systemic steroid use postoperatively with single-plate Molteno shunts. One study comparing endocyclophotocoagulation (ECP) with Ahmed implant in complicated glaucomas found no evidence of better IOP control with Ahmed implant over ECP.
Relatively few randomized trials have been published on aqueous shunts and methodology and data quality among them is poor. To date there is no evidence of superiority of one shunt over another.
Glaucoma remains the leading cause of blindness after penetrating keratoplasty. Post-keratoplasty glaucoma was originally described in 1969, and its management is still controversial. Recent ...developments in management include newer classes of drugs, surgical procedures, such as trabeculectomy with mitomycin-C, implantation of glaucoma drainage devices, and cyclodestructive procedures with Nd: YAG and diode lasers. However, the risk of graft failure continues to be high with all surgical procedures.
Fenofibrate, a well-known normolipidemic drug, has been shown to exert strong anticancer effects against tumors of neuroectodermal origin including glioblastoma. Although some pharmacokinetic studies ...were performed in the past, data are still needed about the detailed subcellular and tissue distribution of fenofibrate (FF) and its active metabolite, fenofibric acid (FA), especially in respect to the treatment of intracranial tumors. We used high performance liquid chromatography (HPLC) to elucidate the intracellular, tissue and body fluid distribution of FF and FA after oral administration of the drug to mice bearing intracranial glioblastoma. Following the treatment, FF was quickly cleaved to FA by blood esterases and FA was detected in the blood, urine, liver, kidney, spleen and lungs. We have also detected small amounts of FA in the brains of two out of six mice, but not in the brain tumor tissue. The lack of FF and FA in the intracranial tumors prompted us to develop a new method for intracranial delivery of FF. We have prepared and tested in vitro biodegradable poly-lactic-co-glycolic acid (PLGA) polymer wafers containing FF, which could ultimately be inserted into the brain cavity following resection of the brain tumor. HPLC-based analysis demonstrated a slow and constant diffusion of FF from the wafer, and the released FF abolished clonogenic growth of glioblastoma cells. On the intracellular level, FF and FA were both present in the cytosolic fraction. Surprisingly, we also detected FF, but not FA in the cell membrane fraction. Electron paramagnetic resonance spectroscopy applied to spin-labeled phospholipid model-membranes revealed broadening of lipid phase transitions and decrease of membrane polarity induced by fenofibrate. Our results indicate that the membrane-bound FF could contribute to its exceptional anticancer potential in comparison to other lipid-lowering drugs, and advocate for intracranial delivery of FF in the combined pharmacotherapy against glioblastoma.
To compare surgical outcomes following implantation of the polypropylene plate Ahmed glaucoma valve (AGV) (S-2) and the newer silicone plate AGV (FP-7) with minimum 12 months follow-up in patients ...with intractable glaucoma.
Retrospective chart review of 25 eyes of 22 patients who underwent FP-7 and 26 eyes of 22 patients who underwent S-2 AGV implantation by a single surgeon. Main outcome measures included surgical outcomes in terms of intraocular pressure (IOP) control, hypertensive phase, and postoperative complications.
There were no significant differences in diagnoses, pre-and postoperative IOP, pre- and postoperative visual acuities at all time points, and in the number of pre- and postoperative medications between the groups. Significant IOP reductions occurred after FP-7 implantation (29.6 +/- 13.1 to 12.1 +/- 3.4, p < 0.001) and S-2 implantation (31.4 +/- 11.7 to 16.1 +/- 5.7, p < 0.001). The FP-7 group had a statistically lower IOP compared to the S-2 group at 6 (p<0.05), 9 (p<0.01), and 12 months (p<0.01). There was no significant difference in the hypertensive phase between the two groups (p=0.41).
FP-7 model silicone plate AGV resulted in lower IOP compared to the older S-2 polypropylene plate AGV at 1 year. This may suggest that the plate material may influence clinical outcome.
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