The Efficacy of Nonpenetrating Deep Sclerectomy with 0.02% Mitomycin C

PURPOSE: To investigate the efficacy and postoperative complications of nonpenetrating deep sclerectomy(NDS) with 0.02% Mitomycin C(MMC) in primary open-angle glaucoma(POAG). METHODS: After 5 x 5 mm scleral flap was made externally, 0.02% MMC was applied under and above the scleral flap for 2 to 5 minutes. A rectangular internal scleral flap was dissected down to remove Schlemm's canal and juxtacanalicular trabecula. RESULTS: Eleven patients(16 eyes) with POAG underwent the filtering surgery of NDS. The mean follow-up was 10.7(range 6 to 12) months. The mean preoperative intraocular pressure(IOP) was 25.6+/-1.7mmHg(SEM, standard error of mean). The mean postoperative IOP was 12.3+/-1.4, 15.8+/-1.8, 15.5+/-0.9, 16.3+/-1.3, and 18.3+/-1.7 mmHg(SEM) at 1, 3, 6, 9, and 12 months, respectively. Success rate defined as an IOP lower than 21 mmHg without medication was 93.8%, 87.5% and 80.8% at 3, 6 and 12 months, respectively. Complications included two shallow anterior chambers, three wound leakages, two hypotonies and two iris adhesions to sclerectomy site. CONCLUSION: Deep sclerectomy with 0.02% MMC may contribute to a satisfactory result of effect of IOP reduction with fewer complication in management of POAG but has tendency to increase the IOP gradually as time elapsed.

Use of Gore-Tex in Bleb Revision after Trabeculectomy with Mitomycin

Trabeculectomy, as a surgical intervention in the treatment of glaucoma, has become most popular. The most common cause of filtration failure is obstruction of aqueous outflow due to bleb fibrosis. Adjunctive intraoperative mitomycin-C has been reported to improve the success of filtration surgery in eyes of high risk for failure. But its use increases the rate of complications after filtering surgery: especially postoperative hypotony, wound leakage, and scleral necrosis. We have experienced two patients whose scleral flaps were necrotized after trabeculectomy with mitomycin-C in uncomplicated glaucoma. We report successful results in revision of filtering bleb by using Gore-Tex as a patch graft.

The Effect of Cataract Operation on Ocular Hypotony after Trabeculectomy with Mitomycin C

Cataract operation was carried out in 7 glaucomatous eyes with prolonged ocular hypotony after trageculectomy with intraoperative mitomycin C. In all cases, The postoperative intraocular pressure(IOP) rose and the postopeative average IOP was 6.0+/-2.0mmHg higher than their preoperative average IOP. The preexisting bleb was reduced in size eyes that underwent phacoemulsification and posterior chamber intraocular lens(PC-IOL) implantation. But. It was not changed in extracapsular cataract extraction and IOL implantation. In our study, cataract operation in eyes that had lens opacity with prolonged hypotony induced IOP rise and was beneficial to hypotony.

Effect of Positive End-Expiratory Pressure on Intraocular Pressure in the Critically Ill and Mechanically Ventilated Patients / 대한구급학회지

BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation. METHODS: Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order. RESULTS: IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed. CONCLUSIONS: The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.

Corneal Incision Phacoemulsification and Trabeculectomy: combined Surgery at Separated site

We reviewed 9 eyes which underwent combined phacoemulsification and trabeculectomy at separate site. Phacoemulsification was performed using corneal incision and trabeculectomy was performed at one superior quadrant using a limbus-based conjunctival flap with mitomycin C(0.2mg/ml, 3-5 minutes). Six eyes received 3-piece folable silicone lenses and 3 eyes received 1-picec PMMA(diameter 5.5mm) lenses. Mean preoperatie intraocular pressure (IOP) was 23.4+/-8.7mmHg. Mean follow-up period was 12.7(range 6-21)months. The mean postoperative IOP at 1, 6, 12 months were 14.6+/-4.8mmHg, 13.8+/-4.4mmHg, 16.6+/-6.8mmHg, respectively. Seven eyes achieved a final fisual acuity of 0.7 or better. One patient developed vision-impairing complications; flat anterior chambe and anterior dislocation of silicone lens. Other complications include posteror synechiae(4 eyes), capsular opacities (3 eyes), lens decentration with capsular contracture(1 eye). These rusults suggest that combined corneal incision phacoemulsification and trabeculectomy at separate site offers an effective technique to control postoperative intraocular pressure in patients with coexsisting cataract and glaucoma, though this procedure is not devoid of complications.

Serous Retinal Detachment Following Trabeculectomy in a Case of Sturge-Weber Syndrome with Glaucoma

A trabeculectomy with mitomycin (0.2mg/ml, 5 minutes) was performed in a 28-year-old man with glaucoma associated with Sturge-Weber syndrome. Two prophylactic posterior sclerotomies were made in an attempt to prevent sudden uveal effusion. The surgery was uncomplicated. On the first postoperative day, however, the anterior chamber became shallow with hypotony (<4mmHg). A 360 degrees choroidal detachment with serous retinal detachment encroaching upon macula was recognized. On the third postoperative day, evacuation of the suprachoroidal space was performed. However, the eye remained hypotonus and choroidal expansion with overlying retinal detachment occured again. The bleb decreased in size with time and the intraocular pressures(IOPs) rose gradually (10-14mmHg). The choroidal and retinal detachment resolved spontaneously with the increased IOP in 40 days. Twenty seven monthes after trabeculectomy, he has a small localized. bleb. The IOP is maintained in the high-teens(15-20mmHg) without any medication.

Comparison between CT-HRP and Bartha Strain of Pseudorabies Virus as a Neurotracer in the Rat Visual System

To investigate the applicability of the Bartha strain of pseudorabies virus(PRV-Ba) as a neurotracer in the visual system, we performed immunohistochemical study of the rat brain after intravitreal injection of the PRV-Ba. Cholera toxin-horseradish peroxidase(CT-HRP), a well known neurotracer, was also injected into the vitreous cavity for comparison. After given survival time the brain was removed and processed immunohistochemical stain for PRV-Ba and neurohistochemical stain for CT-HRP. The CT-HRP positive reactions were observed almost contralaterally in optic chiasm, optic tract, suprachiasmatic nucleus(SCN), olivary pretectal nucleus(OPT), all three subdivision of lateral geniculate body, superficial gray layer and optic layer of superior colliculus and medial, lateral, dorsal terminal nucleus of accessory optic tract. PRV-Ba immunopositive reaction was observed in SCN and OPT, but not in nerve fiber system and dorsal lateral geniculate body. Also PRV-Ba positive cells were distributed mainly in intermediate layer and weakly distributed in superficial layer of the superior colliculus. This study suggests that PRV-Ba is not a useful neurotracer in studying the visual system of the rat.

A Study on Mitomycin C Induced Damage to the Iris and Ciliary Body of Cats

This study was performed to investigate the toxicity of mitomycin C(MMC) on the iris and ciliary body of the cat. After anesthesia, MMC in 0.1, 0.2, or 0.4 mg/ml concenration was injected intracamerally and the equal volume of balanced salt solution(BSS) was injected intracamerally to the contralateral eye as a control. There were no significant difference between 0.1 mg/ml of MMC and BBS injection except for the enlargement of endoplasmic reticulum and destruction of cristae of ciliary body 14 days after MMC injection. Iris vessel was congested and mitochondria of ciliary body was enlarged and cristae was disrupted 7 days after 0.4 mg/ml of MMC injection. There were infiltration of inflammatory cell on the iris and increased cellular damage at the nonpigmented epithelium of ciliary body 21 days after 0.4 mg/ml of MMC injection. These results suggest that the caution is necessary to prevent high concentration of MMC from getting into the anterior chamber at the time of glaucoma filtering surgery in human.

Corneal Central Endothelial Cell Loss after Trabeculectomy with Mitomycin C

The effect of mitomycin on the corneal endothelial cell density was evaluated between the mitomycin group of 23 eyes who underwent trabeculectomy with mitomycin and the control group of 20 eyes who underwent trabeculectomy. The mitomycin(0.2 mg/ml) was applied under the scleral flap, Tenon's capsule or conjunctiva during trabeculectomy for 2-5 minutes(average: 4 minutes) and was irrigated with 50ml of balanced salt solution. Average central endothelial cell loss in the mitomycin group was 10.1 +/- 7.1% and 8.4 +/- 8.3% in the control group(P>0.05, t-test). A shallow anterior chamber with iridocorneal touch(Spaeth's grade 1 and 2) was developed in 12(52%) of 23 eyes in the mitomycin group and 9(45%) of 20 eyes in the control group(P>0.05, chi-square). The average central endothelial cell loss was 12.7 +/- 8.3% in 21 eyes with iridocorneal touch and 5.9 +/- 5.4% in 22 eyes that maintained their anterior chamber(P0.05, t-test). In 22 eyes that maintained their anterior chamber, average loss was 7.1 +/- 5.4% in the mitomycin group, and 4.8 +/- 5.4% in the control group(P>0.05, t-test). These findings suggest that intraoperative use of mitomycin(0.2 mg/ml) during trabeculectomy is unlikely to cause profound corneal endothelial cell loss and iridocorneal touch after the filtering surgery is associated with greater loss of endothelial cells.

Study on neural axis of rat uterus using pseudorabies virus / 대한해부학회지

No abstract available.

Effect of Intraoperative Mitomycin C in High-risk Glaucoma Filtering Surgery

A potent antiproliferative agent, Mitomcin-C, has been known to improve the surgical outcom of glaucomatous eyes with poor prognosis after filtering surgery. Twenty one eyes of 21 patients underwent trabeculectomy with Mitomyc-C. Overall success rate is 81%: 2 of 3 eyes with glaucoma after unsuccessful filtering surgery, 3 of 4 eyes with neovascular glaucoma, 2 of 3 eyes with secondary glaucoma, 1 of 2 eyes with aphakic glaucoma and all of 9 eyes with advanced glaucoma. Postoperative complications were prolonged conjuntival wound leakage in two eyes, conjuntibval wound leakage and corneo-lenticular touch in one eye, choroidal detachment in one eye, progression of cataract in one eye, hyphema in 3 eyes.

Effect of Intraoperative Mitomycin C in High-risk Glaucoma Filtering Surgery

A potent antiproliferative agent, Mitomcin-C, has been known to improve the surgical outcom of glaucomatous eyes with poor prognosis after filtering surgery. Twenty one eyes of 21 patients underwent trabeculectomy with Mitomyc-C. Overall success rate is 81%: 2 of 3 eyes with glaucoma after unsuccessful filtering surgery, 3 of 4 eyes with neovascular glaucoma, 2 of 3 eyes with secondary glaucoma, 1 of 2 eyes with aphakic glaucoma and all of 9 eyes with advanced glaucoma. Postoperative complications were prolonged conjuntival wound leakage in two eyes, conjuntibval wound leakage and corneo-lenticular touch in one eye, choroidal detachment in one eye, progression of cataract in one eye, hyphema in 3 eyes.

A Clinical Study on Rhegmatogenous Retinal Detachment

Authors analysed the clinical characteristics and the surgical results of rhegmatogenous retinal detachment in 70 patients(71 eyes) who were operated GNUH from Feb. 1990 to Feb. 1992. The clinical characteristics of rhegmatogenous retinal detachment were as follows. The result was myopia(39.4%) as the most common associated ocular finding, one break(57.7%) as the number of break, two quadrants(33.8%) as the extent of retinal detachmenthole(53.5%) as the type of break and superior temporal portion(56.3%) and anterior portion including equator(83.1%) as the location of break. The success rate of first operation was 87.3% and the overall success rate of rhegmatogenous retinal detachment maintained anatomical attachment above 6 months and exeluded 3 cases of refused reoperation was 92.3%. The type of break extent of detachment and duration of detachment were not influenced to surgical success rate statistically(P>0.05). The most common cause of first operative failure was proliferative vitreoretinopathy(57%).

Mesenchymal Chondrosarcoma of the Orbit: A case report and review of the literature

The mesenchymal chondrosarcoma of the orbit is so rare that only a few cases have been reported in Korea and world-wide. We experienced that a patient whose complaints were proptosis and diplopia caused by orbital tumor. After tumor removal, it was histologically diagnosed as mesenchymal chondrosarcoma. So we report a case of mesenchymal chonrosarcoma of the orbit with a review of the literature.

Posterior Capsular Rupture in Planned ECCE for Posterior Chamber Intraocular Lens Implantation

The incidence of inadvertent posterior capsular rupture at each stage of planned ECCE and posterior chamber intraocular lens implantation was studied. From June 1985 to Dec. 1986, 133 cases of planned ECCE for posterior chamber intraocular lens implantation were performed. Posterior capsular rupture with or without vitreous loss was developed in 11 cases(8.2%) out of 133. The rupture occurred during nuclear expression in 2 cases(1.5%), during cortical clean-up in 6 cases(4.5%), during remval removal of anterior capsular flaps in 2 cases(1.5%), during posterior chamber intraocular lens implantation in 1 case(0.7%), but during posterior capsule polishing in nocase(0%). Vitreous loss was combined with posterior capsular rupture in 6 cases(4.5%), but the other 5 cases were not associated with vitreous loss(3.7%). After management of vitreous loss by automated anterior vitrectomy in 10 cases, anterior chamber intraocular lens was implanted. But in the other 1 cases with mid posterior capsular rupture without vitreous loss, anterior chamber intraocular lens was implanted without anterior vitrectomy. A final visual acuity of 0.5 or better by 2 months postoperatively was observed in 10 cases out of 11(91%).

Surgical Treatment of Congenital Nystagmus

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular position of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture. But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm-5.5mm and 6.5mm-7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.

Surgical Treatment of Congenital Nystagmus

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular position of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture. But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm-5.5mm and 6.5mm-7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.

Surgical Treatment of Congenital Nystagmus

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular pasition of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture, But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm - 5.5mm and 6.5mm - 7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.

Clinical Results on Intraocular Lens Implantation

A clinical study of the refractive and visual results with 104 consecutive implantations of the intraocular lens was performed between July 1984 and April 1986. Postoperative refraction of myopia was observed in 56.7% of patients, and emmetropia in 21.1%, hyperopia in 22.2%. Visual acuity of 0.5 or better at 2 month after operation was revealed in 88.9% of cases studied; 90.3% in 62 cases of posterior chamber lens implantations and 85.7% in 28 cases of anterior chamber lens implantations. There was no statistically significant difference between visual results after anterior chamber lerts and posterior chamber lens implantation.