Bleb reconstruction using donor scleral patch graft for late bleb leak and hypotony

2020 ◽  
pp. 112067212092434
Author(s):  
Michael O’Rourke ◽  
Sarah Moran ◽  
Niamh Collins ◽  
Aoife Doyle
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Standard Deviation ◽  
Late Complication ◽  
Case Series ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Operative Care ◽  
Patch Graft ◽  
Bleb Leak

Purpose Bleb dysfunction may occur as a late complication following glaucoma filtration surgery. Over-filtering, thinning and cystic blebs can lead to hypotony, leak and corneal dellen. We report our surgical management and outcomes of this specific entity using donor scleral patch grafts. Methods This is a 10-year non-comparative, retrospective interventional case series. Bleb reconstruction involved excision of encysted conjunctiva and sclera to identify the original fistula. A functioning donor scleral patch graft was sited over this with fixed and releasable sutures and the conjunctiva advanced. Intraocular pressure, visual acuity and post-operative issues were assessed. Results A total of 18 eyes of 17 patients with mean age 65 years (standard deviation 13.5) were included. Trabeculectomy was the primary procedure in 72% ( n = 13) and deep sclerectomy in 28% ( n = 5). Bleb leak accounted for 61% ( n = 11), hypotony 33% ( n = 6) and corneal dellen 6% ( n = 1). Mean pre-operative intraocular pressure was 7 mm Hg (standard deviation 4.6) which increased to 18.5 mm Hg (standard deviation 12) at day 1 ( p < 0.001), 11.8 mm Hg (standard deviation 4.6) at 3 months ( p < 0.05), 12.1 mm Hg (standard deviation 4.2) at 1 year ( p < 0.01) which was maintained at 12.1 mm Hg (standard deviation 5.3) at last follow-up ( p < 0.001). Post-operative interventions included bleb needling, re-suturing, suture removal, further glaucoma management, bleb leak and cataract surgery. Visual acuity also improved post-operatively and was maintained. Conclusion Reconstruction of the filtering bleb architecture with donor sclera results in improved intraocular pressure while maintaining visual acuity. Post-operative care is required to support the restored bleb function. Our findings support the use of scleral patch graft as an effective and safe method for the long-term management of hypotony and bleb leak as a late complication of glaucoma filtration surgery.

scholarly journals The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension

2018 ◽  
Vol 29 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Marta Misiuk-Hojlo ◽  
Maria Pomorska ◽  
Malgorzata Mulak ◽  
Marek Rekas ◽  
Joanna Wierzbowska ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Standard Deviation ◽  
Ocular Hypertension ◽  
Benzalkonium Chloride ◽  
Tear Film ◽  
Corrected Visual Acuity ◽  
Break Up ◽  
Preservative Free ◽  
Best Corrected Visual Acuity

Purpose: To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension. Methods: A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability. Results: Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001). Conclusion: Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.

scholarly journals Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

2013 ◽  
Vol 5 ◽  
pp. OED.S12672
Author(s):  
Kagmeni Giles ◽  
Moukouri Ernest ◽  
Domngang Christelle ◽  
Nguefack-Tsague Georges ◽  
Cheuteu Raoul ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Teaching Hospital ◽  
Case Series ◽  
University Teaching ◽  
Case Series Study ◽  
The Mean ◽  
The University

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.

scholarly journals Avoiding BAK in postoperative eye drops reduces the need for subconjunctival 5-FU injections post-trabeculectomy

2020 ◽  
Vol 17 (1) ◽  
pp. 128-131
Author(s):  
Keith Ong ◽  
Leonard Ong
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
T Test ◽  
Topical Steroids ◽  
Eye Drops ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Group A ◽  
Group B ◽  
Causes Of Failure

Purpose: Subconjunctival fibrosis is one of the main causes of failure of glaucoma filtration surgery. It can result in absence of a filtration bleb, a small scarred bleb, or a cystic bleb. 5-Fluorouracil (5-FU), mitomycin C (MMC), and topical steroids have been used to suppress subconjunctival fibrosis. Method: A study was done analyzing the number of postoperative subconjunctival 5-FU injections for trabeculectomy on pseudophakic eyes prior to and following the change to a BAK-free regimen. The cohort consisted of 16 consecutive cases undergoing primary trabeculectomy without intraoperative MMC or 5-FU. The trabeculectomy surgery included a groove sclerectomy procedure. Group A were 8 eyes of patients who had the author’s standard Chlorsig, Maxidex, and Prednefrin Forte eye drops tds. Group B were 8 eyes who had Chlorsig-dexamethasone and Optive-dexamethasone tds eye drops postoperatively. Results: Group B (BAK-free) patients required fewer postoperative 5-FU subconjunctival injections (average: 2.9, range: 1-5 injections) compared to Group A (BAK) patients (average: 7.3, range: 4-18 injections). This difference was statistically significant (P = 0.02, unpaired t-test). All patients had functioning blebs and did not require glaucoma medications to maintain target intraocular pressure. The Group B (BAK-free) patients had more diffuse blebs than the Group A (BAK) patients. Conclusion: The results demonstrated that when BAK was eliminated from postoperative eye drops in trabeculectomy, the number of postoperative 5-FU injections was reduced.

Visual Acuity, Intraocular Pressure, and Macular Thickness in Patients Undergoing Dialysis

2021 ◽  
Vol 19 (6) ◽  
pp. 98-106
Author(s):  
Monawar Muhsin Jabr ◽  
Hussain S. Hasan ◽  
Hind Ahmed Mahdi
Keyword(s):  
Chronic Kidney Disease ◽  
Visual Acuity ◽  
Intraocular Pressure ◽  
Standard Deviation ◽  
Kidney Disease ◽  
Refractive Error ◽  
Average Thickness ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
The Right

Background: Chronic kidney disease (CKD) is a public health problem over all the world. CKD may also be defined by the presence of kidney damage or a reduced glomerular filtration rate (GFR), which is the best overall indicator or index of kidney function. CKD patients are usually treated using kidney dialysis (hemodialysis) that uses a blood filtration mechanism (HD). Several metabolic parameters, such as blood urea, sodium, potassium, and glucose levels, can alter during HD. Osmotic alterations in blood, aqueous and vitreous humor, and other extracellular fluids arise from these fluctuations. That also can affect visual acuity, intraocular pressure (IOP), and retinal thickness. Aim of the Study: To evaluate some of the ocular findings undergoing HD to keep prevent the loss of patient vision such as visual acuity (VA), intraocular pressure (IOP), central corneal thickness (CCT), central Foveal Thickness (CFT), retinal nerve fiber layer (RNFL). Patient& Methods: This is a cohort (prospective) design study. This study including Seventy nine patients divided into two groups the first group from one week to six month (9 femal & 18 males) another group over than six month (36 female & 16 male) the average age between (12 to 70 years). This research performed in the three places department of the eye in Al-Hussein hospital in Samawah city, Al-Haboby hospital, Al-Hussein hospital in Dhi Qar city finally in Al-Shaheed Gazy hospital and Baghdad teaching hospital in Baghdad. Examining Visual Acuity by Snellen chart & auto refractometer, IOP& CCT by (CT.1 Computerized Tonometer TOPCON), RNLF and Central Foveal Thickness by OCT (Carl ZEISS, TOPCON). The inclusion criteria were as follows: all the patients undergoing dialysis from one week to over six months. Exclusion criteria were as follows: the patients have diabetic, any patients have a hereditary disease or glaucoma history or laser therapy, or intraocular injection in the eye before dialysis, the patients have a problem in the eye before dialysis such as cataracts or opacity leads to does surgery, the patients who have a refractive error or wear glass had been also excluded. Result: Includes the results of seventy-nine patients (45 females and 34 males) with chronic kidney disease examined ocular findings before a session of dialysis divided into two groups based on their duration of dialysis. Group one with twenty-seven patients (9 female & 18 male) under dialysis from one week to six months with mean & standard deviation (3.2037, ± 1.89259), group tow with fifty tow patients (36 female & 16 male) under dialysis from the duration over than six months with mean & standard deviation (44.2308, ± 26.24367) respectively. Patients aged (12 to 70 years) had mean age & ± standard deviation (35.1481, ± 12.88918), (44.4038, ± 15.42249) for two groups respectively. Patients in two groups had IOP (Right eye), its mean & standard deviation (15, ± 2.34), (15.69, ± 2.56) for group one & group tow respectively. Also, patients had CCT (Right eye) with mean & standard deviation (5.3467E2, ± 39.00296), (5.2312E2, ± 30.44162) for group one & group tow respectively. Patients had CCT (Left) with mean & standard deviation (5.2878E2, ± 37.55748), (5.2179E2, ± 29.58957) for group one & group tow respectively. Patients in two groups had average thickness RNFL (Right eye) with mean & standard deviation (1.0604E2, ± 25.17551), (95.6154, ± 21.27150) for group one & group tow respectively. Also, patients had average thickness RNFL (left eye) with mean & standard deviation (1.0930E2, ±23.80177), (98.7500, ± 23.77334) for group one & group tow respectively. Conclusions: This study found CCT effective with dialysis tend to be thin (53 patient,18 patient in group one &35 in group two) and that will be had a threefold higher risk of developing glaucoma when compared with thick average because of the IOP value affected by it. Refractive error effective with dialysis & become was more prominent that can be shown in the group two have (40 patient from 52) while (15 patient from27) in the group one although a lot of them corrected to the BCVA. In conclusion high value of the C/D ratio formed about (45.57%, 53.16%) to the right &left eye respectively this value will be form important sign of risk factor to progressive of glaucomatous need to be alert in the future. Also our research reveals CFT effective undergoing dialysis the thick value was (56 in the right eye, 55 in the left eye) high compared with the thin (9 in the right&9 in the left eye) & normal (14 in the right eye, 15 in the left eye). All the two groups of patients will be effected by the duration of dialysis with a time.

scholarly journals Initial hypotensive therapy of primary glaucoma with the domestic latanoprost generic: efficacy and safety

2022 ◽  
Vol 14 (4) ◽  
pp. 7-14
Author(s):  
S. Yu. Petrov ◽  
O. M. Kalinina ◽  
L. V. Yakubova ◽  
S. M. Kosakyan ◽  
L. V. Vasilenkova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Standard Deviation ◽  
Adverse Events ◽  
Nerve Fiber ◽  
Retinal Nerve Fiber Layer ◽  
Control Group ◽  
Efficacy And Safety ◽  
Fiber Layer ◽  
Nerve Fiber Layer

Purpose: a comparative study of the efficacy and safety of the Latanoprost-Optic drug and the original latanoprost drug administered to previously untreated patients with primary open-angle glaucoma (POAG). Material and methods. A double-blind, randomized, parallel-group study involved 60 patients (70 eyes) with newly diagnosed POAG, who were randomly divided into 2 groups of equal size. The patients of the main group (34 eyes) received Latanoprost-Optic, whilst the control group received the original preparation of latanoprost, 1 instillation in the evening. The reference points were the values of intraocular pressure, visual acuity, perimetric indices (standard deviation, standard deviation pattern), the average thickness of the retinal nerve fiber layer, the minimum width of the neuroretinal girdle, the thickness of the retinal nerve fiber layer in the macula, the thickness of the ganglion cell layer in the macula, the thickness of the inner plexiform layer, and the safety (adverse events). The observation period was 12 weeks. Results. After 2 weeks, both groups showed a statistically significant decrease in intraocular pressure, which remained stable after 6 and 12 weeks. The average decrease in intraocular pressure of those receiving Latanoprost-Optic was 30% and at no control point a statistically significant difference from the original drug was revealed. A positive dynamic of visual acuity, static perimetry indices and optical coherence tomography was registered, showing n significant intergroup differences. This may indicate that the drugs have an indirect neuroprotective effect. The adverse events included discomfort and redness of the bulbar conjunctiva, which were recorded in 7 out of 30 patients in the study group and in 6 out of 30 patients in the control group. All of them were mild and completely reversible. No serious or systemic adverse events were reported. Conclusion. Latanoprost-Optic has an efficacy comparable to that of the original latanoprost drug and has a comparable favorable safety profile.

scholarly journals AR12286 Alleviates TGF-β-Related Myofibroblast Transdifferentiation and Reduces Fibrosis after Glaucoma Filtration Surgery

Molecules ◽  
2020 ◽  
Vol 25 (19) ◽  
pp. 4422
Author(s):  
Wen-Sheng Cheng ◽  
Ching-Long Chen ◽  
Jiann-Torng Chen ◽  
Le-Tien Lin ◽  
Shu-I Pao ◽  
...  
Keyword(s):  
Cell Migration ◽  
Intraocular Pressure ◽  
Kinase Inhibitor ◽  
Control Group ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Collagen Contraction ◽  
Β Receptor ◽  
Tgf Β1

Scar formation can cause the failure of glaucoma filtration surgery. We investigated the effect of AR12286, a selective Rho-associated kinase inhibitor, on myofibroblast transdifferentiation and intraocular pressure assessment in rabbit glaucoma filtration surgery models. Cell migration and collagen contraction were used to demonstrate the functionality of AR12286-modulated human conjunctival fibroblasts (HConFs). Polymerase chain reaction quantitative analysis was used to determine the effect of AR12286 on the production of collagen Type 1A1 and fibronectin 1. Cell migration and collagen contraction in HConFs were activated by TGF-β1. However, compared with the control group, rabbit models treated with AR12286 exhibited higher reduction in intraocular pressure after filtration surgery, and decreased collagen levels at the wound site in vivo. Therefore, increased α-SMA expression in HConFs induced by TGF-β1 could be inhibited by AR12286, and the production of Type 1A1 collagen and fibronectin 1 in TGF-β1-treated HConFs was inhibited by AR12286. Overall, the stimulation of HConFs by TGF-β1 was alleviated by AR12286, and this effect was mediated by the downregulation of TGF-β receptor-related SMAD signaling pathways. In vivo results indicated that AR12286 thus improves the outcome of filtration surgery as a result of its antifibrotic action in the bleb tissue because AR12286 inhibited the TGF-β receptor-related signaling pathway, suppressing several downstream reactions in myofibroblast transdifferentiation.

scholarly journals Late-Onset Glaucoma-Filtrating Bleb Leak in a Penetrating Keratoplasty Patient: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Zuleyha Yalniz-Akkaya ◽  
Ayse Burcu ◽  
Firdevs Ornek
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Penetrating Keratoplasty ◽  
Late Onset ◽  
Corneal Graft ◽  
Case Presentation ◽  
Bleb Leak ◽  
One Year ◽  
Human Pericardium

Introduction. Late-onset bleb leaks occur more frequently after the use of adjunctive antimetabolites and require surgical management to seal and preserve filtrating bleb.Case Presentation. A 48-year-old female presented with decreased visual acuity for five days in her left eye. She had a left penetrating keratoplasty one year earlier and two trabeculectomies 7 years earlier. Visual acuity was hand motions, intraocular pressure was 3 mmHg, corneal graft was clear, mature cataract was present, and axial length was 30.48 mm. The conjunctiva covering the superotemporal sclerotomy was avascular, flat, and partially lost. After heavily painting the bleb with a fluorescein, late-onset point leak was revealed. Overlying conjunctiva was excised. The atrophic, irregular, and partially absent scleral flap was covered by a processed human pericardium graft and conjunctival advancement. Postoperatively, intraocular pressure stabilized around 16 mmHg. After four months, phacoemulsification and intraocular lens implantation were performed. Visual acuity did not exceed 0.1 (in decimal notation) due to degenerative myopia-related macular atrophy. Corneal graft remained clear at her 6-month followup period.Conclusion. Surgical bleb revision using a pericardium graft and conjunctival advancement seems to be an effective method for treating late bleb leaks. However, careful follow-up is required for detecting recurrent leaks and elevated intraocular pressure.

scholarly journals One Year Outcomes and Stability of a Novel Scleral Anchored Intraocular Lens

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Edoardo Abed ◽  
Matteo Forlini ◽  
Edlira Bendo ◽  
Aurelio Imburgia ◽  
Alessandro Mularoni ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Anterior Segment ◽  
Case Series ◽  
Specular Microscopy ◽  
Iop Measurement ◽  
Prospective Case Series ◽  
One Year

Purpose. To assess one year results and stability of the implantation of a scleral anchored intraocular lens (IOL). Design. Interventional prospective case series. Methods. Sixty eyes of 60 patients affected by either aphakia or IOL dislocation were included in this study. Patients underwent vitrectomy, scleral fixation of the IOL, and, if present, dislocated IOL removal. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months after surgery by best-corrected distance visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, corneal specular microscopy, and optical coherence tomography (OCT) of both the macula and anterior segment. Results. At twelve months, mean BCVA significantly improved ( p < 0.0001 ), and none of the patients experienced a decrease of visual acuity. A 10% decrease of endothelial cell count occurred after surgery. Cystoid macular edema occurred in three patients (5%). A transient increase of intraocular pressure was noted in 7 cases (12%). At one month, horizontal and vertical IOL tilt was 1.04 ± 0.87 and 0.74 ± 0.71 degrees, respectively, and did not significantly change in the follow-up ( p > 0.05 ). None of the patients had decentration or dislocation of scleral-fixated IOL during the follow-up. Conclusion. Implantations of scleral plug fixated IOL provide good visual results, low complication rate, and excellent stability of the lens until one-year follow-up.

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