Aims/background-The introduction of the adjunctive use of antiproliferatives to trabeculectomy has greatly improved the success rate of this operation. Trabeculectomy with antiproliferative treatment, however, is usually associated with a cystic and thin walled filtering bleb, which may be more susceptible to infection. The objective of this study was to evaluate the incidence, clinical findings, and risk fac- 1%). Five eyes developed blebitis; six eyes developed endophthalmitis. Bleb related infection developed an average of 3.1 (1.6) (range 0.4 to 6.0) years after trabeculectomy. All eyes had avascular or hypovascular blebs that were cystic in shape before infection and all eyes had reduced intraocular pressure. Early wound leaks and chronic, intermittent bleb leaks were identified to be risk factors for the bleb related infection. Conclusion-The incidence of delayed onset, bleb related infection after trabeculectomy with antiproliferative treatment is similar to that after trabeculectomy without antiproliferatives. (Br J Ophthalmol 1997;81:877-883) Antiproliferative agents, 5-fluorouracil (5-FU) and mitomycin C (MMC), have markedly improved the success rate of glaucoma filtering surgery and are widely used to treat glaucomatous eyes with a poor surgical prognosis.

* BACKGROUND AND OBJECTIVE: To compare the outcome of transscleral cyclophotocoaguiation (TSCPC) using a diode laser with that of TSCPC using an Nd: YAG laser in neovascular glaucoma. * PATIENTS AND METHODS: The surgical outcome of diode laser TSCPC was retrospectively compared with that of free-running mode Nd: YAG laser (FR-YAG) TSCPC and continuo us -wave mode Nd:YAG laser (CW-YAG) TSCPC. Twenty-one eyes of 2 1 patients in the diode laser group, 9 eyes of 9 patients in the FR-YAG group, and 9 eyes of 9 patients in the CW-YAG group were treated. * RESULTS: The Kaplan-Meier life-table analysis revealed that the probability (mean ± standard error) of successful intraocular pressure control with diode laser TSCPC at 3 years postoperatively was 47-2 ± 12.6% per operation and 55.9 ± 16.3% per eye. Compared with the CW-YAG TSCPC, the diode laser TSCPC had a significantly higher probability of success throughout the follow-up period. Diode laser TSCPC was associated with improvement or preservation of visual acuity in 16 of 21 eyes (76%), and was the best of the three laser sources. Postoperative complications were minor following diode laser TSCPC. * CONCLUSION: Diode laser TSCPC appears to be as effective as FR-YAG TSCPC and better than CWYAG TSCPC for treating neovascular glaucoma. [Ophthalmic Surg Lasers 1998;29:722-727.]

Ab externo thermal sclerostomy was performed with the holmium YAG (thulium, holmium, chromium-doped YAG crystal) laser in 21 eyes of 20 patients with refractory glaucoma. We used either the 5-fluorouracil (5-FU) or mitomycin C (MMC) antimetabolites in all cases. The rate of intraocular pressure (lOP) control defined as lOP < 21 mmHg regardless of whether antiglaucoma medication was applied postoperatively) was estimated by the life-table methods of Kaplan-Meier. The postoperative lOP control rate was 47.1% in the MMC-treated group at 57 months, and 14.3% in the 5-FU-treated group at 52 months. There were statistically significant differences in success rates between the MMC-and 5-FU-treated groups. We observed no clinically significant complications except excess filtration associated with a shallow anterior chamber in one case. This procedure is thought to have several advantages over more conventional filtration surgery; the operation time is shorter, and there is no need for intraocular manipulation, which means conjunctival trauma is minimal. However, the IOP control rate was substantially lower than that achieved via conventional trabeculectomy. Our results suggest that the selection of patients and the use of MMC is an important factor in maintaining successful filtration.

We measured aqueous flare in 16 glaucomatous eyes after trabeculectomy in which 5-fluorouracil (5-FU) or mitomycin C (MMC) had been used as an adjunctive therapy. The eyes were divided into a 5-FU and an MMC group, matched for factors that might influence the postoperative inflammatory response to intraocular surgery. Seven eyes of seven patients received subconjunctival injections of 5-FU (50 mg in 2 weeks) and nine eyes of nine patients were given 0.2 mg/0.5 mL MMC intraoperatively. The aqueous flare converted to an albumin concentration mg/dLj was significantly higher in the 5-FU group than in the MMC group (359.6 ± 113.8 mg/dL and 143.2 ± 46.7 mg/dL, respectively; Mann-Whitney U test, P < .05) on the second postoperative day. Intraoperative MMC appears to be no more harmful to the blood-aqueous barrier than 5-FU.

To determine an appropriate setting for the THC-YAG laser (chromium-sensitized, thulium, and holmiumdoped YAG laser), we performed sclerostomy ab externo on 24 pigmented rabbits. The laser energy was delivered via a subconjunctivally-inserted fiberoptic probe that was placed at the limbus through a small conjunctival incision. We used four pulseenergy levels to perform the sclerostomies: 80 mJ, 120 mJ, 160 mJ, and 200 mJ. At all these levels, a new outflow pathway was easily created, a filtering bleb was formed, and intraocular pressure (IOP) was immediately reduced. Severe tissue damage around the sclerostomy site occurred with the 160-millijoule and 200-millijoule pulses. The 80-millijoule pulse created a relatively small patent sclerostomy, providing only relatively brief IOP reduction. We conclude that 120-millijoule is the most appropriate laser-pulse energy for use in pigmented rabbits.