Comparison of Mitomycin C Trabeculectomy and Ahmed Valve Implant Surgery for Neovascular Glaucoma

PURPOSE: To compare the results of mitomycin C trabeculectomy and Ahmed valve implant surgery for neovascular glaucoma (NVG). METHODS: We reviewed the medical records of 58 patients (66 eyes) with NVG who had undergone mitomycin C trabeculectomy or Ahmed valve implant surgery in the previous 5 years. Trabeculectomy (A group) was performed in 27 eyes of 24 patients and valve implant surgery (B group) in 39 eyes of 34 patients. Intraocular pressure (IOP), visual acuity, complications and the rate of surgical success of the two groups were compared. IOP under 21 mmHg without medication was considered as complete success (CS), under 21 mmHg with medication as qualified success (QS), and IOP over 22 mmHg despite medication as failure (F). RESULTS: IOP at postoperative 2 months was lower in the trabeculectomy group than in the drainage implant surgery group (16.4 +/- 11.3 mmHg, 20.9 +/- 8.7 mmHg, P=.087), but at 12 months, there was no statistically significant difference (18.4 +/- 11.5 mmHg, 17.0 +/- 6.4 mmHg, P=.608). Visual acuity also showed no significant difference. The respective rate of success between A and B groups was 66.7% and 38.5% (CS), 25.9% and 33.3% (QS), and 7.4% and 28.2% (F), at postoperative 2 months, and 47.8% and 42.3% (CS), 30.4% and 46.2% (QS), and 21.7% and 11.5% (F), at 12 months. The most common postoperative complication was hyphema in both groups, while other complications were shallow anterior chamber, valve problems, etc. CONCLUSIONS: The type of surgery had no significant effect on the success rate of neovascular glaucoma treatment at postoperative 12 months.

Effects of Hyaluronic Acid on the Polymorphonuclear Leukocyte (PMN) Release of Active Oxygen and Protection of Bovine Corneal Endothelial Cells from Activated PMNs

The goal of this study was to evaluate the function of hyaluronic acid (HA) on the active oxygen release from polymorphonuclear leukocytes (PMNs) and the protective effect of bovine corneal endothelial cells (BCEC) from activated PMNs. We used HA with three different molecular weights (MW 700, 000, 2, 000, 000, and 4, 000, 000) and five different concentrations (0, 0.1, 1, 2, and 3 mg/ml). We evaluated the amount of released superoxide from activated PMNs by using dismutase-inhibitable ferricytochrome C reduction. To compare the property and protective effect of HA with those of other viscoelastic substances, we used the same concentration of methylcellulose. HA suppressed superoxide release from PMNs and protected BCEC from activated PMNs in a dose-dependent, rather than a molecular weight-dependent, manner. The effect of HA reached almost a plateau at concentration above 2 mg/ml. However, methylcellulose, another viscoelastic substance, showed a similar effect. Therefore, it seems that the suppression of superoxide released from PMNs is not a property that is unique to HA, but is a general property of viscoelastic substances. Our results indicate that the action mechanism of HA proceeds not only through cell surface HA-receptor. We think that HA also acts as a physical barrier and/or a scavenger of superoxide.

A Case of Subfoveal Choroidal Neovascularization following Multiple Evanescent White-Dot Syndrome

PURPOSE: We report a case of subfoveal choroidal neovascularization following multiple evanescent white dot syndrome (MEWDS). METHODS: A 28-year-old female patient with vitreous floater and scotoma of her right eye was diagnosed with MEWDS. Fundus examination revealed multiple white dots at midperipheral retina, and a granular appearance of macular, which were nearly subsided at 1 month after her first visit. She complained of a sudden decrease in visual acuity of right eye at 3 months after her initial episode of MEWDS. Fundus examination showed macular hemorrhage with edema. Typical subfoveal choroidal neovascularization with leakage was confirmed by Indocyanine Green Angiography (ICGA), which was treated by photodynamic therapy (PDT). RESULTS: Subfoveal choroidal neovascularization following MEWDS is rare, and this is the first Korean case report.