Success Rate Of Filtration Surgery Research Articles

Modified Cortex Mori Capsules improving the successful rate of functional filtering blebs after reclinical glaucoma filtering surgery.

BACKGROUNDThe major reason for filtering bleb failure or scarring of the bleb site is due to excessive scarring after glaucoma filtration surgery in the clinic. Traditional Chinese medicine has preeminence in the prevention of fibrosis formation through the regulation of systemic circulation and improvement of the properties of the inflammatory cells in the blood.AIMTo examine the clinical efficacy of using the Modified Cortex Mori Capsules (MCMC; Chinese name: Jiawei Sangbaipi Capsules) in the success rate of functional filtering blebs after glaucoma filtering surgery in clinical patients.METHODSSixty resurgery glaucoma patients were randomly divided into two groups: 30 patients in surgery with the placebo group and 30 patients in surgery with the MCMC group. Patients took either the placebo or the MCMC 2 wk before and after surgery. Postoperative morphology and function filtering bleb, visual acuity, intraocular pressure, postoperative complications, the success rate of filtration surgery and clinical efficacy were observed.RESULTSFifty patients completed the study. The percentage of functional filtering blebs in the surgery plus MCMC group was 84% at 6 mo after surgery, which was higher than surgery plus placebo group (64%, P < 0.05). The surgical success rate in the MCMC and placebo groups were 79% ± 8.3% and 57% ± 10.6% respectively (P < 0.05). The visual acuity, intraocular pressure and the postoperative complications in the two groups had no significant differences.CONCLUSIONGlaucoma filtering surgery while taking MCMC not only reduced excessive scar formation and increased the success rate of functional filtering blebs but also improved the success of glaucoma filtration operations.

Outcome improvement of glaucoma filtration surgery through the effect of local rock‐inhibition on wound healing

AbstractPurpose The aim of this study was to investigate the efficacy of a local ROCK‐inhibitor; AMA0076 (Amakem NV) for improving surgical outcome, after glaucoma filtration surgery in a rabbit model.Methods The in vivo effects of local ROCK‐inhibition were investigated in a rabbit model of glaucoma filtration surgery (n=5 per histological analysis group). Topical treatment with AMA0076 (study eye) and vehicle (control eye) was administered every day 3x/day (9h/13h/17h) from day 1 after surgery. Treatment outcome was studied by clinical investigation (IOP; intraocular pressure, bleb area and bleb survival) as well as immunohistological analyses for inflammation (CD45), angiogenesis (CD31) and collagen deposition (Sirius Red) at day 3, 8 and 14 after surgery.Results Bleb survival showed no difference between treated and non‐treated eyes however, there a trend (p=0,09) can be distinguished. Topical treatment of AMA0076 reduced inflammation on day 3 (p=0.036) and day 8 (p=0.044) as well as angiogenesis on day 8 (p=0.04). There were no differences in collagen deposition.Conclusion Targeting ROCK with a local ROCK inhibitor, AMA0076, is efficacious in reducing inflammation and angiogenesis on several time points in a rabbit model of glaucoma surgery. These results render ROCK an interesting target to increase the success rate of filtration surgery and point to potential therapeutic benefits of the local ROCK inhibitor, AMA0076.

The medical and surgical treatment of glaucoma.

Ongoing demographic changes in Europe are heightening the importance of adequate treatment for glaucoma, a disorder that is markedly more common in the elderly. A selective search for relevant literature, including Cochrane Reviews and the guidelines of the European Glaucoma Society, regarding the topical and surgical treatment of glaucoma. It is recommended that the intraocular pressure (IOP) should be lowered by 20% to 50% from its baseline value, depending on the extent of already existing damage, the rate of progression, the baseline IOP, and the age of the patient. Topical monotherapy can lower the IOP by 15% to 30%. The success rate of filtration surgery has risen because of the intraoperative application of topical antimetabolites and currently ranges from 50% to 90%, depending on the study. The goal of glaucoma treatment is to protect the patient from blindness and visual impairment while keeping the treatment-related decline in quality of life to a minimum. Any type of glaucoma treatment, be it medical or surgical, must further this aim in consideration of the situation of the individual patient.

Modulation of cell proliferation and collagen synthesis of porcine Tenon's fibroblasts by extracts of lens and vitreous with treatment of dexamethasone

To demonstrate the effects of lens extract (LE), vitreous extract (VE) and dexamethasone on the modulating of the proliferation and collagen synthesis of Tenon's capsule fibroblast. Cell proliferation and collagen synthesis of Tenon's fibroblast were measured using MTT and reverse transcription polymerase chain reaction techniques in the presence or absence of LE, VE, or dexamethasone, respectively. The growth of Tenon's fibroblasts was stimulated by LE and VE in dose and time-dependent manners. Dexamethasone significantly inhibited the proliferation of the cells either in the presence or absence of LE and VE. Similarly, LE and VE significantly stimulated the collagen synthesis of the cells. However, dexamethasone showed no significant effect on the LE or VE-enhanced collagen synthesis of the cells. These results suggested that there might be some ingredients in LE or VE that could stimulate the cell proliferation and collagen synthesis of Tenon's capsule fibroblasts. These ingredients, if released, may affect the success rate of filtration surgery for glaucoma. The application of glucocorticoid itself might not be sufficient to retard the scar formation following the filtering surgery in refractory glaucoma after cataract surgery or vitrectomy.

Randomized controlled clinical trial of beta irradiation as an adjunct to trabeculectomy in open-angle glaucoma

Objective To assess the effect of a single intraoperative application of 750 cGy of beta irradiation on the outcome of trabeculectomy for uncontrolled open-angle glaucoma. Design A prospective, randomized, double-blind, placebo-controlled clinical trial. Participants Sixty-one eyes of 61 Caucasian patients at low risk of filtering surgery failure, with poorly controlled primary or secondary open-angle glaucoma undergoing routine trabeculectomy. Method Patients were randomly assigned to control or beta irradiation groups. All patients underwent standard trabeculectomy with fornix-based conjunctival incision. Eyes assigned to beta irradiation received 750 cGy of beta irradiation directly over the sclerostomy site on completion of conjunctival suturing. An identical but inactive applicator was applied to control eyes, delivering no radiation. Both operator and patient remained masked to the assignment for the 12-month follow-up period. Main outcome measures The main outcome measure was intraocular pressure (IOP) control. Complete success of IOP control was defined as an IOP less than 21 mmHg at 12 months without need for additional medication. Qualified success was defined as an IOP less than 21 mmHg at 12 months where additional medication was required. Results Complete success of IOP control was achieved in 19 (86%) control eyes and 35 (90%) irradiated eyes ( P = 1.0). Qualified success of IOP control was achieved in 21 (95%) control eyes and 39 (100%) irradiated eyes at 12 months follow-up ( P = 1.0) Conclusions We experienced a very high success rate of filtration surgery in this select population without adjunctive irradiation. Our sample size was too small to show any improvement in success with use of beta irradiation in this group. Other studies would have to be done to determine whether it may have measurable benefit in cases with a high risk of filtration failure.

The effects of antiglaucomatous agents on conjunctiva used for various durations.

Purpose: The effect of antiglaucomatous agents on conjunctiva used for various durations evaluated histopatho-logically. Methods: Conjunctiva biopsies were taken in 19 Mayis University Faculty of Medicine Ophthalmology Department from 31 eyes of 30 patients who underwent filtration surgery after a period of antiglaucomatous agent use and examined under light microscope. The results were compared with the results of conjunctival biopsies from 10 similar aged patients undergoing retinal detachment of cataract surgery and with no other ocular pathology. Results: Five of the cases were using antiglaucomatous treatment for two months (Group A), four cases for two to 12 months (Group B) and 22 cases for more than 12 months (Group C) before the surgery. Four cases were using a beta blocker only, eight cases beta blocker + sympathomimetic or beta blocker + myotic and the remaining 19 cases were using a combination of beta blocker + sympathomimetic + myotic. Histopathologic evaluation with light microscope showed no pathologic change in group A, but, subepithelial increase of lymphocytes, mast cells, macrophages and fibroblasts in group C. Conclusion: It was detected that subconjunctival inflammatory reaction increases as the number of antiglaucomatous agents and the treatment duration increase. These changes might be considered as risk factors that decrease the success rate of filtration surgery.

5-fluorouracil and Mitomycin C in Pseudophakic Patients

Purpose: Previous studies have shown that 5-fluorouracil (5-FU) and mitomycin C enhance the success rate of filtration surgery in aphakic eyes. However, eyes with posterior chamber implants have not been specifically studied. This study was performed to compare the safety and efficacy of 5-FU with that of mitomycin C in eyes that have posterior chamber implants and undergo filtration surgery for uncontrolled glaucoma.Methods: Eighty eyes of 74 patients who had previous cataract surgery with posterior chamber implants and who subsequently required trabeculectomy for uncontrolled open-angle glaucoma were randomized to receive either subconjunctival postoperative 5-FU or intraoperative mitomycin C.Results: Twelve months after surgery, intraocular pressures (IOPs) averaged 12.8 ± 5.5 mmHg (mean ± standard deviation) in the mitomycin C group and 14.8 ± 3.8 mmHg in the 5-FU group (P = 0.001). Mitomycin C-treated eyes received an average of 0.6 medications for IOP control, and 5-FU-treated eyes received an average of 1.05 medications (P = 0.03). There was no significant difference in complications between the two groups.Conclusion: Mitomycin C appears be a viable alternative to 5-FU in patients with posterior chamber implants with uncontrolled glaucoma who require filtration surgery.

Effects of Postoperative Mitomycin C on Glaucoma Filtration Surgery in Rabbits Treated Preoperatively With Antiglaucoma Medications

In a rabbit model, we evaluated the effects of topically applied postoperative mitomycin C (MMC) on the success rate of glaucoma filtration surgery in animals treated preoperatively with pilocarpine hydrochloride 4% and levobunolol hydrochloride (Betagan) for 16 weeks. Full-thickness filtration surgery was performed with a single 5-minute intraoperative exposure to a sponge soaked with 0.4 mg/mL MMC of one eye in nine rabbits in one group (group A) and to both eyes in 13 rabbits in a second group (group B). In addition, one eye of each rabbit in group B received a daily drop of 0.4 mg/mL MMC for 13 days after the operation. All of the eyes were then followed for 80 days. The intraoperatively applied MMC enhanced the success rate of the filtration surgery in the group A eyes. However, the eyes that also received postoperative drops of MMC (group B) had longer periods of reduced intraocular pressure (IOP) (P [chi-squared = 5.94] < .025), fewer bleb failures (P [chi-squared = 8.09] < .005), and more complications than the eyes that received only intraoperative MMC.

Racial differences in the results of glaucoma filtration surgery: are racial differences in the conjunctival cell profile important?

Conjunctival biopsies were obtained at the time of filtration surgery from 90 patients with glaucoma; 45 of these patients were black and 45 white. Forty nine of the patients (25 black, 24 white) had undergone a primary trabeculectomy. Comparisons between black and white patients were made with respect to the results of surgery and differences in conjunctival cell profile. In agreement with many authors, trabeculectomy was found to be less successful in black patients (67% compared with 80%), although this finding was not statistically significant by survival analysis. In addition, conjunctiva from black patients was found to contain a greater number of macrophages and a smaller number of both mast cells and goblet cells in comparison with white patients. There was a tendency for conjunctiva from black patients to contain more fibroblasts. Conjunctiva obtained from the patients whose filtration surgery subsequently failed was found to contain more fibroblasts, macrophages, and basal epithelial pale cells. A greater number of conjunctival macrophages and possibly fibroblasts in black patients may partially explain the tendency for a lower success rate of filtration surgery in this group of patients.

Results of Intraoperative 5-Fluorouracil Supplementation on Trabeculectomy for Open-angle Glaucoma

The success rate of filtration surgery has been increased by the postoperative subconjunctival injection of 5-fluorouracil, a potent antimetabolite. However, the optimal route of administration has not been determined. Trabeculectomy was performed on one eye each of 14 patients. Topical 5-fluorouracil was applied intraoperatively (50 mg/ml for five minutes) and subconjunctival 5-fluorouracil was injected postoperatively (an average of 5.8 injections) (mean total dose, 29 mg). Seven of the 14 eyes had primary open-angle glaucoma, and seven eyes had open-angle glaucoma with either uveitis, aphakia, or previous failed trabeculectomy. Mean preoperative intraocular pressure was 24.7 mm Hg during treatment with an average of three antiglaucoma medications, and mean final intraocular pressure was 11.9 mm Hg during treatment with an average of 0.2 medication. Thirteen of 14 eyes (93%) had final intraocular pressure of 18 mm Hg or less. Mean follow-up was 6.4 months (range, four to nine months). No remarkable complications occurred. Visual acuity remained stable in 13 of 14 eyes (93%). Intraoperative 5-fluorouracil may be a helpful adjunct in achieving low final intraocular pressure after trabeculectomy.

Failed Laser Trabeculoplasty Requiring Surgery in Open-Angle Glaucoma

Argon laser trabeculoplasty (ALT) has been successful in controlling open-angle glaucoma, but a significant number of patients still require filtration surgery. Concern that post-laser inflammatory changes or alterations of structural anatomy with damage to the trabecular meshwork may adversely affect the outcome of filtration surgery prompted a retrospective review of 87 consecutive eyes with open-angle glaucoma that required filtration surgery following failed ALT. The follow-up period was at least 6 months, with a mean of 18 months (6 to 38 months). Posterior lip sclerectomy was chosen for 69 eyes and trabeculectomy for 18 eyes. The overall success rate of filtration surgery during the follow-up period was 92%. There was no recognized difference in the response to filtration surgery following ALT.

The Effect of Total Vitrectomy on Filtration Surgery in the Aphakic Eye

The influence of total vitrectomy on the success rate of filtration surgery was investigated, with 47 operations (6 reoperations) being performed on 41 patients. At six months postoperatively, successful control (IOP less than 21 mm Hg) was achieved in 32 of 41 patients (78%). Twenty-four patients had filtration blebs present. Total vitrectomy favorably influences the result of filtration surgery. However, the morbidity rate (two retinal detachments and two cases of cystoid macular edema) is higher than in standard filtration procedures.