Anterior chamber flare after trabeculectomy and after phacoemulsification

Siriwardena, Dilani

doi:10.1136/bjo.84.9.1056

Cited by 114 publications

(78 citation statements)

References 5 publications

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“…23 Cataract surgery causes prolonged breakdown of the blood aqueous barrier compared with eyes with trabeculectomy alone. 24 This persistent breakdown with serum-like components in the aqueous may upregulate fibrogenic cytokines production and has been shown to reduce mitomycin c cytotoxicity to fibroblasts. 25 In such cases, combined phacoemulsification with cyclodiode may be a more attractive option in temporarily controlling the IOP while delaying filtration surgery until anterior chamber inflammation has settled.…”

Section: Discussionmentioning

confidence: 99%

The UK National Cyclodiode Laser Survey

Agrawal

Dulku

Nolan

et al. 2010

Eye

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Purpose To evaluate current practice of transscleral diode laser cyclophotocoagulation (cyclodiode) laser treatment among consultant ophthalmologists in the United Kingdom. Methods A 31-question survey was emailed to all practising consultant ophthalmologists who were members of the Royal College of Ophthalmologists. All non-responders were sent a postal version of the questionnaire. This paper looked at cyclodiode practice patterns and consisted of questions on demographic data, transillumination, and power settings, factors influencing practice, post-operative care, and repeat treatment. Results A total of 510 participants (53.6%) responded. A total of 180 (35.3%) responders reported performing cyclodiode laser treatment, of which 84 (46.7%) were glaucoma subspecialists (GSS). Initial median power settings used were 1500 mW and 2000 ms. The average number of applications delivered per sitting was 25.5 ± 1.2 applications for GSS vs 20.6 ± 2.0 for non-GSS in a seeing eye (P ¼ 0.0013). In all, 65% routinely transilluminated the globe of which 78% were GSS and 52.3% were non-GSS (P ¼ 0.0009). In all, 43% of the GSS vs 17% of the non-GSS lowered power settings in uveitic glaucoma (P ¼ 0.013). In blind eyes, 30% of the GSS vs 12% of the non-GSS increased energy levels (P ¼ 0.0014). In all, 60% of the responders performed cyclodiode at any visual acuity, whereas 22% performed combined cyclodiode and cataract surgery. Conclusions This survey highlights a wide variation in the use of cyclodiode laser treatment amongst GSS and non-GSS. However, the most frequently used practice may not be the optimal practice. A more individualised parameter according to the condition of the eyes may optimise the outcome.

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Section: Discussionmentioning

confidence: 99%

The UK National Cyclodiode Laser Survey

Agrawal

Dulku

Nolan

et al. 2010

Eye

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“…The stimulus for wound healing is thought to be very different in eyes having combined procedures. 15 In addition, the construction of the internal sclerostomy and stresses placed on the scleral flap and tunnel during the combined procedure will inevitably be different.…”

Section: Discussionmentioning

confidence: 99%

Fornix vs limbal-based trabeculectomy with mitomycin C

Alwitry

Patel

King

2004

Eye

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Purpose To compare the effectiveness of limbus-and fornix-based conjunctival flaps in patients undergoing trabeculectomy with mitomycin-C augmentation. Methods A retrospective review of the records of 71 consecutive eyes of 59 patients who underwent trabeculectomy with mitomycin C. All the patients had at least 6 months of follow-up. The first 35 eyes underwent surgery with a limbal-based flap, whereas all subsequent surgeries were by fornix-based procedures. Results No significant difference was detected between the groups with regard to patient demographics, preoperative visual field and intraocular pressure parameters, postoperative intraocular pressures at day 1, months 1, 3, and 6 postoperatively, need for intervention, need for supplementary glaucoma medication, and final visual acuity. There were four cases of overdrainage and hypotony in the limbal-based group, whereas none occurred in the fornix-based group. In all 83% percent of eyes in the limbal-based group achieved intraocular pressures off medication of less than 18 mmHg, whereas 94% of the fornix based group obtained such IOP control. One patient in the limbal-based group developed late postoperative endophthalmitis. Conclusion Trabeculectomy with MMC augmentation is a safe and effective procedure for reduction of IOP and visual rehabilitation whether a fornix-or a limbal-based conjunctival flap is utilised. In this series, there was a greater risk of excessive drainage with subsequent hypotonous complications when surgery was undertaken by a limbal-based procedure.

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“…Trabeculectomy is associated with an increase in anterior chamber (AC) inflammation, which may compromise bleb survival. 36 AC activity, as measured by a flare-meter, is significantly lower after DS than trabeculectomy and this may be advantageous for bleb survival in high-risk eyes. 37 Excessive flow in the early postoperative period may result in a number of complications with trabeculectomy.…”

Section: Eyementioning

confidence: 99%

Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

Anand

Wechsler²

2011

Eye

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Purpose To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE). Patients and methods Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) 418 mm Hg. MMC (0.2 mg/ml) was applied for 2-3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure. Results Mean follow-up was 57.7±22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3-25.6, 95% confidence intervals) to 13.4 mm Hg (12.0-14.2) at 3 years after surgery (Po0.001). There was a significant decrease in the number of glaucoma medications from 2.0±1 preoperatively, to 0.3±0.7, 3 years after surgery. Kaplan-Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained o19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP o6 mm Hg) was the commonest complication in five eyes (6.1%). Conclusion DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.

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Anterior chamber flare after trabeculectomy and after phacoemulsification

Cited by 114 publications

References 5 publications

The UK National Cyclodiode Laser Survey

The UK National Cyclodiode Laser Survey

Fornix vs limbal-based trabeculectomy with mitomycin C

Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

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