Final Postoperative Intraocular Pressure Research Articles

A Review of Scleral Flap Shape on Trabeculectomy Outcomes

Introduction : Trabeculectomies are amongst the most common surgical procedures to lower intraocular pressure (IOP). Scleral flap dimensions are a key factor in influencing aqueous outflow and subsequent IOP reduction, especially in the early postoperative period. Despite the substantial diversity of scleral flap shapes that is used in practice, there is little information comparing outcomes between them. In this study, we review the literature on the uses and outcomes of various scleral flap shapes. Methods: A literature review was performed using the databases: MEDLINE, SCOPUS, and Web of Science. Search terms for relevant studies included the following: trabeculectomy AND (square OR triang* OR rectang* OR polygon* OR arc OR shape) AND flap. Results: Our initial literature search revealed 71 unique articles, six of which met our inclusion and exclusion criteria and were reviewed. Four articles reported the use of triangular flaps, one rectangular flap, one square flap, and two arc-shaped flaps. The data from each article were reviewed for the following: Surgical technique Early postoperative intraocular pressure reduction Final postoperative intraocular pressure reduction Postoperative complications Conclusions: A myriad of scleral flap shapes is utilized in surgical practice. Essentially all of the trabeculectomy procedures, regardless of scleral flap shape, achieved substantial reductions in IOP with similar success rates. However, due to the variability in surgical technique and lack of direct comparison, we cannot definitively conclude or deny that one flap shape is superior to another. We believe our review provides the most comprehensive analysis of scleral flap shape to date and highlights its importance in regulating aqueous flow, especially in the early postoperative period.

Safety and efficacy of collagen matrix implantation in infantile glaucoma.

To evaluate the preliminary results of biodegradable collagen matrix implant (Ologen) designed to improve outcome in patients with infantile glaucoma undergoing combined trabeculotomy and trabeculectomy. A biodegradable collagen matrix (OculusGen) was placed in the subconjunctival space, partially over the scleral flap and the sclera in 20 eyes of 11 patients with infantile glaucoma who underwent combined trabeculotomy and trabeculectomy. Patients were examined preoperatively and on the first postoperative day with multiple postoperative follow-up visits within 12 months after surgery. Examination included measurements of intraocular pressure (IOP), corneal diameter, and axial length, bleb evaluation, and funduscopy. Ultrasound biomicroscopy of bleb (bleb presence, wall reflectivity, and scleral route visibility) was done at 1, 3, and 6 months and the last follow-up visit. Any complication was recorded. Data analysis was performed using paired-samples t test. Mean patient age was 5.7 ± 5.69 months. Mean duration of follow-up was 10.05 ± 1.15 months. Mean preoperative IOP was 25.9 ± 3.08 mm Hg with 1.75 ± 0.55 IOP-lowering medications and mean final postoperative IOP was 17.7 ± 3.51 mm Hg with 0.55 ± 0.69 IOP-lowering medications. Overall success at last follow-up was 80%. None of the patients experienced systemic or ocular complication related to OculusGen. By the 6th month, complete Ologen degradation was evident in all cases. The short-term preliminary results of this study indicate that the combined trabeculotomy and trabeculectomy with Ologen implantation could potentially provide a safe and effective procedure in the infantile age group but longer duration of follow-up in larger number of patients is needed.

Short-term effect of diode laser cyclophotocoagulation on intraocular pressure: a prospective study.

This aims to determine the immediate and short-term risk of intraocular pressure spikes following diode laser cyclophotocoagulation. This study is a prospective, consecutive cohort study in a UK teaching hospital. Fifty-three consecutive patients undergoing cyclophotocoagulation were invited to participate in this study. Intraocular pressure (IOP) measurements were taken immediately prior to cyclodiode laser, hourly for the first 3 h after laser, on the first and seventh postoperative days, and at three months following laser. Eyes experiencing intraocular pressure elevation defined at two levels (≥3 mm Hg and ≥10 mm Hg from the pretreatment level) were identified. Seventeen eyes (34%) had an elevation in intraocular pressure (≥3 mmHg) during the first 3 h postoperatively with a mean increase of 10.3 mmHg. No preoperative or perioperative associations were found for a postcyclodiode spike within the first 3 postoperative hours.No association was found between pressure spikes and visual acuity, reduction of glaucoma medication or final postoperative intraocular pressure at 3 months. Eyes that did not have an IOP spike during the first 3 h postoperatively had a greater reduction in IOP at 3 months (15.2 mmHg vs. 10.2 mmHg; P = 0.184). IOP spikes are common in the immediate period after cyclophotocoagulation. An elevation in IOP is noted after the first hour in the vast majority who experience a spike in the first 3 h post-procedure.

Surgical Results in the Management of Advanced Primary Congenital Glaucoma in a Rural Pediatric Population

To present the anatomic and functional results of surgical treatment for advanced primary congenital glaucoma (PCG) in a rural setting. Retrospective, observational case series. Forty eyes of 22 consecutive patients diagnosed with PCG and who underwent surgical treatment. All eyes underwent surgical treatment for PCG. Type of surgery and postoperative complications were noted. We examined anatomic and functional indices before and after the operation. Visual acuity (VA), intraocular pressure (IOP), refractive spherical error, cup-to-disc ratio (CDR), and horizontal corneal diameter (HCD). Average age at the time of surgery was 3.3 years (range, 0.4-10) and the mean follow-up was 6 months (range, 1-11). 15% showed marked lens dislocation owing to the severe buphthalmos at presentation. Preoperative IOP was 54 ± 2 mmHg, HCD was 15.1 ± 0.3 mm, and CDR (when visible) was 0.8 ± 0.02. Surgical intervention included 31 trabeculotomies, 6 Ahmed Glaucoma Valve implants, 1 goniotomy, and 2 eviscerations. Serious complications were noted in 4 eyes. Final postoperative IOP was 23 ± 2 mmHg (P < 0.0001). Patients were significantly more likely to have ambulatory VA (following objects or better) after operation (18% vs 64%; P < 0.0001). Our surgical outcomes in children with advanced PCG demonstrated moderate overall improvement in IOP and modest improvement of VA. Deep deprivation amblyopia, severe disease manifestation at presentation, opaque corneas, and frequent lens dislocation limited the possible success. These data further signify the need for effective, timely screening of children and prompt recognition by health care workers to reduce the rate of avoidable blindness in developing countries.

Pars Plana Baerveldt Implantation for Refractory Childhood Glaucomas

To evaluate the effectiveness and associated complications of Baerveldt glaucoma implant (BGI) surgery with pars plana tube insertion in aphakic and pseudophakic children. The medical records of 30 patients (30 eyes) younger than 18 years old with uncontrolled glaucoma associated with aphakia or pseudophakia who underwent pars plana BGI surgery were retrospectively reviewed. Clinical outcome assessment included the measurement of intraocular pressure (IOP) and visual acuity and the identification of complications. Success was defined as 5 mm Hg<final postoperative IOP < or =21 mm Hg with or without glaucoma medications and without visually devastating complications or further glaucoma surgery. Outcomes were evaluated using Kaplan-Meier life-table analysis. Mean follow-up after BGI surgery was 29.8+/-26.4 months. Twelve, 24, and 36-month life-table rates for successful IOP control were 85%, 81%, and 72%, respectively. Six of 30 patients were considered failures. Complications included hypotony (5 patients, with 1 developing hemorrhagic choroidals which required surgical intervention and a second progressing to phthisis), retinal detachment (4 patients), tube obstruction (2 patients), pupillary membrane (1 patient), worsening esotropia (1 patient), focal scleral ectasia (1 patient), and loss of light perception (1 patient). Visually devastating complications were observed in 3 patients (hemorrhagic choroidals 1 patient, phthisis 1 patient, loss of light perception 1 patient). BGI surgery with pars plana tube insertion is a reasonable option for managing aphakic and pseudophakic children with uncontrolled glaucoma. Complications of BGI surgery related to anterior chamber tube placement, such as tube-cornea touch, are minimized with this approach. The incidence of posterior segment complications, although possibly higher compared with limbal tube insertion, was not excessive.

Long-term results of anterior chamber tube shunt to an encircling band in the treatment of refractory glaucomas.

We performed the anterior chamber tube shunt to an encircling band procedure in 34 patients (36 eyes) with refractory glaucoma, and evaluated the long-term outcome. The preoperative mean intraocular pressure (IOP) was 36.8 +/- 9.6 mmHg, the postoperative mean IOP was 21.6 +/- 13.6 mmHg, a statistically significant (p < 0.01) reduction of IOP following this procedure. The final postoperative IOP was under 21 mmHg in 23 (63.9%) of the 36 eyes. The success rate of IOP control 36 months after the operation without any elevation of post-operative IOP was 30.3% (life-table method). Complications of this procedure included flattening of the anterior chamber (61.1%), damage to the corneal endothelium (25%), hyphema (25%), and a transient IOP elevation (25%). As filtering surgery with 5-fluorouracil is more effective and simple to perform, we conclude that the anterior chamber tube shunt to an encircling band procedure should be reserved for those with refractory glaucoma who have had multiple surgical interventions.

Glaucome congénital et sclérectomie profonde : résultats d’une étude sur plus de 3 années

To assess the outcome of deep sclerectomy surgery with intraoperative antimitotic application in children with primary and secondary congenital glaucomas. Thirty-seven eyes of 22 children aged from 1 day to 14 years were included in this study; 30 eyes had primary congenital glaucoma and were divided into two groups according to the management delay. Eighteen eyes were managed early (group 1) and 12 eyes were diagnosed late (group 2). Finally, seven eyes had a more complex dysgenic glaucoma (group 3). All the eyes had a deep sclerectomy with antimitotic intraoperative application (5 FU). Pre- and postoperative intraocular pressures, success rate, preoperative corneal transparency, corneal diameter, and surgical complications were assessed. Total success was defined by final postoperative intraocular pressure lower than 16 mmHG without combined medical treatment; partial success was defined by lower than 16 mmHG with a combined medical treatment. The mean follow-up was 38.2 months. Total success was 34% and partial was 82%: 56% and 89%, respectively, for group 1, 33% and 100% for group 2, and 14% and 57% for group 3. No severe complications occurred after surgery. The probability of success was significantly lower for secondary congenital glaucomas and for primary congenital glaucomas with late management. Management delay and the type of glaucoma seem to be capital in the prognosis of high intraocular pressure. Deep sclerectomy with antimitotic application (5 FU) is a good alternative to trabeculectomy in primary glaucomas.

Pars plana insertion of glaucoma drainage devices for refractory glaucoma

Glaucoma drainage devices are more commonly inserted into the anterior chamber because of the relative ease of this method of insertion. However, in certain cases, posterior placement of the tube may be necessary or may be more desirable. The outcome of a series of patients with glaucoma drainage devices inserted into the pars plana was examined. Retrospective chart review of patients who underwent pars plana implantation of Molteno and Baerveldt glaucoma drainage devices at the Sydney Eye Hospital. There were 33 cases reviewed. The mean follow-up period was 30.2 months. The mean final postoperative intraocular pressure was reduced to 13.4 +/- 4.4 mmHg (SD) from 33.06 +/- 8.47 mmHg preoperatively. The mean number of intraocular pressure-lowering medications in use postoperatively was 0.6 +/- 0.8, reduced from 3.6 +/- 1.27 medications in use preoperatively. Sixteen (48.5%) eyes were classified as complete successes, 14 (42.4%) eyes as qualified successes and three eyes (9%) as failures. Kaplan-Meier survival analysis for cumulative success (absence of failure) predicted 61.1% survival at 60 months. Complications included five cases of decompensation of corneas or corneal grafts, one case each of conjunctival wound dehiscence, large choroidal effusion, epiretinal membrane, Molteno plate extrusion and intraocular pressure unresponsive to medical therapy, and three cases of tube blockage. In this series of patients, pars plana insertion of glaucoma drainage devices has been shown to be an effective alternative for selected cases where anterior chamber tube insertion is not possible or is not ideal.

Long-Term Results of Trabeculectomy With Different Concentrations of Mitomycin C in Refractory Developmental Glaucoma

To evaluate the long-term results of trabeculectomy with two different concentrations of mitomycin C in refractory developmental glaucoma. A total of 48 eyes of 37 patients with previous failure of congenital glaucoma surgery underwent mitomycin C-augmented trabeculectomy. Data were analyzed retrospectively, and patients were divided into two groups. Group 1 consisted of 18 patients (25 eyes) who underwent trabeculectomy with a 0.4 mg/mL mitomycin C solution and group 2 consisted of 19 patients (23 eyes) who underwent trabeculectomy with a 0.2 mg/mL mitomycin C solution. Pre- and postoperative intraocular pressure (IOP), best-corrected visual acuity, bleb characteristics, success rate, and complications were compared for both groups. Mean time between primary surgery and mitomycin C-augmented trabeculectomy was 19.3 months (range, 11 months to 7 years). Mean preoperative IOP was 28.4 +/- 2.9 mm Hg in group 1 and 29.0 +/- 2.4 mm Hg in group 2. Final postoperative IOP was 17.0 +/- 1.6 for group 1 and 17.1 +/- 1.4 mm Hg for group 2. There were no significant differences between the groups for IOP, success rate, and complications (P > .05). The most common postoperative complication was shallow anterior chamber (11 [22.9%] of 48 eyes). A 0.4 or 0.2 mg/mL mitomycin C solution for 4 minutes may be used during trabeculectomy in refractory developmental glaucoma.

Deep Sclerectomy with Various Implants: An Experimental and Histopathologic Study in a Rabbit Model

Background and Objective: To investigate the effectiveness of various implants used in experimental deep sclerectomy and to report tissue reactions developed to these implants histopathologically. Materials and Methods: Forty eyes of 40 New Zealand white albino rabbits underwent deep sclerectomy with various implants. The rabbits were divided into four groups; each consisted of 10 eyes. Deep sclerectomy was performed using copolymer materials in group 1, silicone materials in group 2 and chromic catgut suture in group 3. No implants were used in the control group (group 4). Clinical and histopathological examinations were performed to investigate the effectiveness of implants. Results: Mean preoperative intraocular pressure (IOP) was 14.4 ± 1.6 mm Hg in group 1, 14.5 ± 1.8 mm Hg in group 2, 13.8 ± 1.5 mm Hg in group 3 and 14.5 ± 1.2 mm Hg in group 4. The final postoperative IOPs were 10.7 ± 0.9, 10.6 ± 0.8, 13.5 ± 1.0, and 14.5 ± 1.4 mm Hg, respectively. At 2 months, the decrease in IOPs from baseline and the persistence of the filtering bleb were significantly marked in group 1 and group 2 (p < 0.001). Histopathological evaluation revealed that copolymer and silicone materials formed a smooth and regular intrascleral space. There were no foreign body reaction, tissue destruction or fibrosis in group 1 and group 2, but chromic catgut sutures caused severe fibrosis and inflammatory reaction in group 3. Mean histopathologic score of group 1, group 2, group 3 and group 4 was 0.7 ± 0.5, 0.8 ± 0.5, 2.4 ± 0.6, and 0.1 ± 0.3, respectively. Conclusion: Copolymer or silicone materials may increase the success rate of surgery by maintenance of a large and regular intrascleral space after deep sclerectomy and prevention of collapse of the flap.

Results of phacoemulsification in eyes with preexisting glaucoma filters

A retrospective analysis was performed on 58 eyes that had temporal phacoemulsification via a clear corneal (32 eyes) or scleral tunnel (26 eyes) approach after previous filtration surgery with a minimum follow-up of 12 months. The study analyzed best-corrected visual acuity (BCVA), changes in intraocular pressure (IOP), and changes in glaucoma medication requirements. There were no statistically significant differences between the two groups in BCVA, IOP, and postoperative glaucoma medication requirements or between patients who received mitomycin C at the time of the original filter and those who did not. The mean preoperative logarithm of the minimal angle of resolution (logMAR) equivalent BCVA for all eyes was 0.8 + 0.4, which improved to a mean of 0.4 + 0.4 postoperatively (P < .0000002). The mean preoperative IOP in all eyes was 11.8 + 4.2 mm Hg and the mean final postoperative IOP was 13. 7 + 4.6 mm Hg (P < .022). The mean preoperative number of glaucoma medications for all eyes was 0.6 + 1.1 and the mean final postoperative number of glaucoma medications was 0.5 + 0.9 (not significant). Clear corneal or scleral tunnel phacoemulsification in the setting of a preexisting glaucoma filter was associated with improved BCVA, a small but statistically significant increase in IOP, and stability in the number of glaucoma medications required for IOP control over a minimum follow-up of 1 year.—Michael D. Wagoner

Results of phacoemulsification in eyes with preexisting glaucoma filters

Purpose To evaluate the intraocular pressure (IOP), best corrected visual acuity (BCVA), and glaucoma medication requirements in patients having phacoemulsification after preexisting glaucoma filters. Setting Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. Methods A retrospective analysis of 58 eyes that had temporal phacoemulsification via a clear corneal (32 eyes) or a scleral tunnel (26 eyes) approach after filtration surgery was performed with a minimum follow-up of 12 months. Two-tailed homoscedastic t tests were used for statistical analysis. Results The mean preoperative IOP in all eyes was 11.8 mm Hg ± 4.2 (SD), and the mean final postoperative IOP was 13.7 ± 4.6 mm Hg ( P<.022). The mean preoperative logMAR equivalent BCVA was 0.8 ± 0.4, which improved to a mean of 0.4 ± 0.4 postoperatively ( P<.0000002). There was no statistically significant change in glaucoma medication requirements postoperatively. The differences in IOP, BCVA, and postoperative glaucoma medication requirements were not statistically significant between the clear corneal group and the scleral tunnel group or between patients who received mitomycin at the time of filtration surgery and those who did not. There were no intraoperative complications; 1 patient required additional glaucoma surgery. Conclusion Clear corneal or scleral tunnel phacoemulsification in the setting of a preexisting glaucoma filter was associated with improved BCVA, a small but statistically significant increase in IOP, and stability in the number of glaucoma medicines required for IOP control over a minimum follow-up of 1 year.

Endocyclophotocoagulation for management of difficult pediatric glaucomas

Introduction: Experience with endoscopic diode laser cyclophotocoagulation remains limited. We report the efficacy and safety profile of this glaucoma surgery technique in the pediatric population. Methods: Retrospective review of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Surgery was performed by using the Microprobe (Endo Optiks, Little Silver, NJ) integrated laser endoscope system. Patients were followed-up for a minimum of 6 months or until declared treatment failures. Treatment success is defined as a postoperative intraocular pressure of ≤ 21 mm Hg, with or without adjunctive glaucoma medications. Results: Baseline mean pretreatment intraocular pressure was 35.06 ± 8.55 mm Hg. Final postoperative intraocular pressure was 23.63 ± 11.07 mm Hg (30% decrease) after an average of 1.42 ± 0.87 endolaser procedures and 19.25 ± 19.36 months of follow-up. Success rate of the initial procedure at last follow-up was 34%. Nine eyes (25%) were retreated at least once. Cumulative success rate after all procedures at last follow-up was 43%. Mean cumulative arc of treatment was 260° ± 58° of ciliary processes. Postoperative complications included retinal detachment in 2 patients, hypotony in 1 patient, and progression of vision loss from hand motion to no light perception in 1 patient. All 4 complications occurred in aphakic patients. Conclusions: Endoscopic diode laser cyclophotocoagulation is a moderately effective procedure for the management of difficult pediatric glaucomas. Aphakic patients may have an increased risk of significant postoperative complications, such as retinal detachment. (J AAPOS 2001;5:221-9)

Pars Plana Filtration with Multiple Laser Perforation of the Uvea for Neovascular Glaucoma Following Proliferative Diabetic Retinopathy

Purpose: To evaluate the effect of pars plana filtration with multiple laser perforation of the uvea in neovascular glaucoma patients following proliferative diabetic retinopathy. Methods: In 18 eyes of 13 patients, after a fornix-based conjunctival incision, two 9 × 3 mm, thin, rectangular scleral flaps were created 3–6 mm posterior to the limbus. The remaining layers of sclera under each flap were removed. The exposed uvea was irradiated at a mean of 60.6 spots with an argon laser just to the point of perforation. After the posterior chamber fluid escaped, the flaps were sutured. Results: The mean preoperative intraocular pressure (IOP) was 36.4 ± 9.0 mm Hg. After an average follow-up of 16.6 ± 5.9 months, the mean final postoperative IOP was 16.6 ± 4.4 mm Hg. The postoperative IOP was below 21 mm Hg in 3 (16.7%) of the 18 eyes without medication, in 14 (77.8%) on anti-glaucoma eye drops, and in 16 (88.9%) on anti-glaucoma eye drops and an oral carbonic anhydrase inhibitor. Snellen visual acuity improved by more than 2 lines in 7 of the 18 eyes, worsened by this amount in 3, and remained within baseline ± 2 lines in 8. Conclusion: This procedure is an effective treatment for neovascular glaucoma patients following proliferative diabetic retinopathy.

Initial experience with pneumatically stented baerveldt implant modified for pars plana insertion for complicated glaucoma

ObjectiveTo assess the efficacy of pneumatically stented drainage tube implants specially modified for pars plana insertion in the treatment of complicated glaucoma. DesignRetrospective, non-comparative case series. Participants50 consecutive patients with refractory complicated glaucoma nonresponsive to medical treatment. InterventionBaerveldt glaucoma implants modified by Hofmann for pars plana insertion were placed following pars plana vitrectomy and gas–fluid exchange (pneumatically stented implant, or PSI procedure). Main outcome measureReduction of intraocular pressure (IOP) to 21 mmHg or less. Results31 neovascular and 19 complicated non-neovascular glaucoma eyes in 48 patients referred to a vitreoretinal subspecialty practice, average age 69 years (range 29–91), were followed an average of 18 months (range 3–41). The average preoperative IOP was 44 mmHg (14–78) on an average 3.2 glaucoma medications (range 2–6). The average final postoperative IOP was 14 mmHg (range 5–31) on an average 0.6 glaucoma medications (range 0–3, median 0). The final intraocular pressure was 21 mmHg or less in 47 of 50 (94%) operated eyes. Serious complications related to the procedure occurred in five eyes (10%). ConclusionsPneumatically stented Baerveldt glaucoma implants modified with the Hofmann elbow to facilitate pars plana insertion are effective in the treatment of complicated glaucoma.

Modification of trabeculectomy with single-dose intraoperative 5-Fluorouracil application.

To assess the outcome of trabeculectomy supplemented with intraoperative 5-Fluorouracil (5 FU) application in glaucoma patients. A prospective non-randomized case series of 76 eyes of 76 consecutive patients who underwent trabeculectomy with intraoperative sponge 5 FU (25 mg/ml). Minimum follow-up was 6 months. There were 31 eyes in the low-risk group and 45 eyes in the high-risk group. The reduction in intraocular pressure (IOP) and any treatment complications were noted. The mean preoperative IOP was 28+/-7.72 mm Hg. The mean final postoperative IOP was 16.8+/-6.1 mm Hg. The average number of glaucoma medications required dropped from 1.8+/-0.8 preoperatively to 0.4+/-0.8 after the operation (p<0.001). Cumulative success rates (IOP less than 21 mm Hg) for all eyes were 93% and 81% at 6 and 12 months, respectively. There was no difference in outcome between the low- and high-risk groups if criteria for success were an IOP of less than 21 mm Hg or an IOP of less than 21 mm Hg and an IOP reduction of 30%. However, if success is defined as an IOP of 15 mm Hg or less and a 30% fall in IOP, then the low-risk group had significantly longer survival times than the high-risk group (p=0.033, log-rank test). Transient punctate keratitis and corneal epithelial defect were each observed in only 1 eye. Other serious complications include rapid progression of cataract in 2 eyes, endophthalmitis in 1 eye and hypotonic maculopathy after subsequent cataract extraction in 1 eye. Single dose intraoperative 5 FU appears to be a safe and useful adjunct to trabeculectomy. IOPs in the low teens were achieved in a greater proportion of low-risk eyes than high-risk eyes.

Mitomycin-C in Congenital Glaucoma

To evaluate the adjunctive use of mitomycin-C (MMC) during trabeculotomy and trabeculectomy for eyes with high-risk congenital glaucoma. A prospective, randomized, double-blind study was performed to compare the effect of a single, 4-minute intraoperative exposure to 0.2 mg/ml (group 1) or 0.4 mg/ml (group 2) of MMC on trabeculotomy with trabeculectomy in 16 high-risk cases (30 eyes) of congenital glaucoma. The preoperative and final postoperative intraocular pressures (IOPs) of the two groups did not differ significantly. At the final follow-up, IOP control (< 21 mm Hg) without medications was achieved in 60% of the eyes in group 1 and in 86.67% of the eyes in group 2 (P = 21). With medication, IOP control was achieved in 86.7% of the eyes of each group. In both groups, the rate of surgical failure was 13.3%. Avascular, thin, sharply demarcated blebs were noted in 33.3% of the eyes from group 1 and in 66.67% of those from group 2 (P = .14). Intraoperative and postoperative hyphema and postoperative hypotony were the complications encountered in both groups, whereas serous choroidal detachment and wound leakage were seen only in group 2. Intraoperative MMC applied at a concentration of 0.2 mg/ml controlled postoperative IOP as effectively as a 0.4-mg/ml concentration in high-risk cases of congenital glaucoma, but with a lower incidence of complications and thin-walled blebs.

Pars plana implant and vitrectomy for treatment of neovascular glaucoma.

To evaluate the effectiveness of pars plana implants in the treatment of neovascular glaucoma. Twenty-two consecutive pars plana implant procedures performed for neovascular glaucoma were retrospectively reviewed. Preoperative intraocular pressures ranged from 22 to 80 mmHg (mean 46 mmHg) on a mean of three glaucoma medications. With a mean follow-up interval of 16 months, final postoperative intraocular pressures ranged 9-21 mmHg (mean 16) on a mean 0.7 medications. One patient required a second implant to achieve final intraocular pressure control. Visual acuity was stabilized or improved in 19 of 22 cases (86%). Complications included retinal detachment in two cases (9%). Macular pucker, vitreous hemorrhage, hyphema, choroidal hemorrhage, diplopia, and loss of light perception occurred in one case (5%) each. None developed phthisis bulbi. Pars plana drainage tube implants are effective in the treatment of neovascular glaucoma.

Retinectomy Lowers Intraocular Pressure in Otherwise Intractable Glaucoma: Preliminary Results / COMMENT

Surgery for glaucomas unresponsive to conventional surgical strategies has always been frustrating and puzzling. I present preliminary results achieved by partial retinectomy in nine eyes that had complete synechial closure of the chamber angle accompanied by very high intraocular pressure (IOP), debilitating pain, and poor vision. The aim of this surgical procedure was to lower IOP by rerouting aqueous humor to the absorbing compartment of the choriocapillaris through a large retinal hole. Since a retinal wound will not heal, this "filtration site" will remain open and functional. Follow up ranged from 2 to 12 months. Preoperative IOPs ranged from 38 to 70 mm Hg; final postoperative IOPs, from 2 to 50 mm Hg. IOP decreased in all of the nine patients. Phthisis developed in two eyes and hypotony in three; the latter three eyes were not phthisical. The procedure was complicated by retinal detachment in one eye. A technique for determining the optimum size of the retinectomy for specific patients remains to be developed.

Cliniclal Experiences of Trabeculectomy with Mitomycin C

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 solution 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 . The mean final postoperative IOP was . Twenty three (88%) of the 25 eyes were successfully controlled with the IOP of less than or equal to 20 mmHg without 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 bleb 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.