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Background: Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow?ups and management of the blebs play a critical role in the long?term success. This video is aimed at showing the real?world management of blebs postoperatively. Purpose: This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation. Synopsis: This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed. Highlights: We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture?related complications and their management have been shown along with practical examples
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We present a case of post-trabeculectomy encapsulated dysesthetic bleb with scleral fistula, managed successfully with autograft. The child was operated on twice before for trabeculectomy, and intraocular pressure (IOP) recorded was in the normal range for the initial few years. This time child presented with a large encapsulated dysesthetic bleb with borderline IOP. As the IOP was on the lower side, an underlying scleral fistula was suspected and planned for bleb revision with a donor patch graft. We describe the novel technique of bleb revision along with the repair of the scleral fistula with an autologous free fibrotic Tenon’s tissue graft instead of a donor patch graft with a successful outcome.
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Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti?glaucoma medication use and compare it with the age?matched normal population. Methods: Objective clinical evaluation was done by tear film break?up time (TBUT) and Schirmer’s test (ST) in the three groups– trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ?10), chronic anti?glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty?six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.
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The purpose of this article is to evaluate the effectiveness of collagen crosslinking of filtering blebs with 0.1% riboflavin stimulated with ultraviolet A radiation in a case of a thin-walled filtering bleb with leakage following an episode of late blebitis. The time to cessation of the bleb leakage was studied, as well as the intraocular pressure, the visual acuity, and the presence of adverse effects during 4 years of follow-up after treatment. A single session of crosslinking was effective in resolving the leakage of the filtering bleb. There were no adverse effects. The intraocular pressure and the visual acuity remained stable after 4 years of follow-up. Collagen crosslinking with 0.1% riboflavin stimulated with ultraviolet A radiation may prove to be a simple, painless, non-invasive, and repeatable treatment of the leaking bleb with the aim of strengthening the collagen fibers of the conjunctiva and avoiding more invasive surgical treatments.
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AIM: To investigate the expression level of inflammatory factors of aqueous humor before trabeculectomy in binocular chronic primary angle-closure glaucoma(CPACG)and its correlation with postoperative filtration bleb and intraocular pressure.METHODS: A total of 15 cases(30 eyes)with binocular CPACG who admitted to the Affiliated Eye Hospital of Nanjing Medical University from September to December 2021 and received trabeculectomy were selected. The surgery interval between two eyes was 7d, and the preoperative expression levels of monocyte chemoattractant protein-1(MCP-1), interleukin-17(IL-17), transforming growth factor-β(TGF-β), and interferon-γ(IFN-γ)of the aqueous humor in both eyes were respectively detected by enzyme-linked immunosorbent assay(ELISA). Furthermore, the intraocular pressure(IOP)and the morphology of filtering blebs at 1mo after surgery were measured.RESULTS: The concentrations of MCP-1, IL-17, TGF-β, and IFN-γ in aqueous humor from the first eye before surgery were 330.4±46.2, 357.3±46.9, 2347.5±363.8 and 527.7±101.6pg/mL respectively, and those concentrations in aqueous humor from the fellow eye were 298.2±40.7, 309.1±53.5, 1938.3±426.0 and 628.2±104.9pg/mL respectively. The preoperative expression levels of inflammatory factors of aqueous humor in both eyes were statistically significant(P≤0.05). Furthermore, the expression levels of IL-17 and TGF-β in the aqueous humor of patients with CPACG correlated with IOP and the height of filtering blebs at 1mo after surgery(P<0.05).CONCLUSION: There may be changes in the expression levels of inflammatory factors of aqueous humor in the fellow eye after surgery of the first eye. Moreover, the preoperative expression level of IL-17 and TGF-β in aqueous humor possibly related to postoperative IOP and the height of filtering bleb.
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Purpose: This study was conducted to assess the outcomes of bleb needling for the treatment of failure of filtration surgeries in primary glaucoma with a follow?up of six months. Methods: This prospective interventional study included patients with primary glaucoma who underwent trabeculectomy or combined glaucoma and cataract surgery with failed or failing bleb after six weeks of surgery and less than two years. A comprehensive examination including best?corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, gonioscopy, slit?lamp examination, and bleb morphology grading was done. Selected patients underwent a subconjunctival bleb needling with mitomycin C (MMC) (dose 0.2 mg/ml). Postoperatively, patients were followed up on the first, third, and sixth months and were assessed with respect to IOP, need for antiglaucoma medication (AGM), and complications. Results: Sixty eyes of 59 patients were included. Preoperatively, 33.3% of patients were on one AGM, whereas postoperatively at the third month 51.7% and at the sixth month 50% of patients were on no AGM. There was a statistically significant decrease in IOP (P < 0.001) from preoperative (mean: 23.8 ± 7.86 mmHg) to postoperative first month (mean: 19.8 ± 9.08 mmHg), third month (mean: 17.4 ± 5.4 mmHg) and sixth month (mean 16.6 ± 4.39). According to the defined criteria in the current study, we achieved 22 (37.9%) successes, 31 qualified successes (53.4%), and 5 (8.6%) failures. Univariate regression analysis showed a higher failure rate among younger age groups. Gender, laterality, and intraoperative complications were not significant statistically. Conclusion: Bleb needling is a safe and effective procedure for the treatment of failed filtration surgeries
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Background: Trabeculectomy is associated with several complications. One of the common complications with mitomycin assisted trabeculectomy is thin cystic bleb leading to bleb leak, hypotony and infections. Various technique of bleb repair and reconstruction have been described, such as conjunctival advancement, or scleral, pericardial or corneal patch graft. Purpose: To demonstrate bleb revision by bleborhexis and clear corneal lamellar patch graft for a patient with thin cystic leaking bleb leading to hypotony and decreased vision. Synopsis: This was a 75-year-old one-eyed lady, diagnosed with primary angle-closure glaucoma in both eyes with absent light perception in the left eye, had undergone a combined trabeculectomy and cataract surgery in the right eye 6 years ago. She presented with diminution of vision (6/18p), introacular pressure (IOP) of of 6 mmHg, thin cystic leaking overhanging bleb, and dysesthesia. Bleb repair by bleborhexis with lamellar corneal patch graft was performed. Bleborhexis is a technique in which the overhanging fibrosed thin cystic conjunctival bleb is peeled off the cornea smoothly to leave a uniform clear corneal surface. Clear cornea, uniform diffuse bleb, well-formed anterior chamber with and IOP of 15 mmHg was noted on the first post-operative day, with a vision of 6/12p. This procedure helped meticulous reconstruction of the bleb, early recovery of vision, maintanance of normotensive eye, and save the eye from potential infections. Highlights: Bleborhexis with lamellar corneal patch graft provides for an easy and a elegant surgical technique with minimal corneal tissue damage, faster healing and patient comfort. It could be the favored technique in patients with thin overhanging clebs.
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Purpose: To comparatively evaluate in Indian eyes with coexisting cataract and primary open?angle glaucoma the outcome of mitomycin C (MMC) and Ologen implant as adjunctives in combined phacoemulsification with trabeculectomy. Methods: Eyes with primary open?angle glaucoma that underwent trabeculectomy and phacoemulsification with IOL implantation with either MMC application or Ologen implant between June 2019 and February 2020 were followed up for 12 months. Thirty?four eyes of 34 participants were studied. The primary outcome was intraocular pressure (IOP), and the secondary outcomes were the number of ocular hypotensives, best distance visual acuity (BDVA), and bleb morphology. Results: In 16 eyes treated with MMC and 18 eyes treated with Ologen implant, it was observed that the mean postoperative IOP (14.62 � 2.89 mm Hg with MMC and 14.56 � 4.14 mm Hg with Ologen implant) was not significantly different in both groups (P = 0.47). Number of ocular hypotensives and BDVA were also comparable between the two groups. However, bleb morphology was better with Ologen implantation. One eye in the MMC group developed hypotony which was conservatively managed. Conclusion: MMC and Ologen are both effective adjunctives in combined phaco?trabeculectomy. However, the Ologen implant provides better bleb health and safety
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Animal models are useful in glaucoma research to study tissue response to wound healing. Smaller animals such as rats offer additional advantages in terms of availability of detection antibodies and microarrays with cheaper maintenance costs. In this study, we describe a glaucoma filtering surgery (GFS) model in adult Sprague–Dawley rats by performing a sclerostomy using a 26?G needle and additionally placing a silicone tube (27 G) connecting the anterior chamber to the subconjunctival space to maintain a patent fistula for the flow of aqueous humor, thus providing a more definitive bleb. This technique will be useful in identifying and modifying newer targets in the wound healing process in order to improve surgical outcomes following GFS
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Objective:To investigate the inhibitory effect of CLC-2 chloride channel targeted blocking on fibrosis of human conjunctival fibroblasts (HConF).Methods:HConF were divided into blank control group, lipofectamine 2000 (Lipo2000) group, nonsense small interfering RNA (siRNA) group, and CLC-2 siRNA transfected group.The HConF were cultured in medium containing the corresponding transfection reagents according to grouping.No intervention was given to blank control group.The expression level of CLC-2 mRNA of HConF was detected by real-time fluorescence quantitative PCR; absorbance ( A) value indicating the proliferative ability of HConF was determined by CCK-8 kit; the apoptosis ratio of HConF was tested by flow cytometry; the migration ability of HConF was identified by cell scratch test and Transwell migration assay; the contraction rate of HConF was assayed by collagen contraction test; the expression levels of collagenⅠ, collagen Ⅲ, PI3K, Akt, p-PI3K and p-Akt proteins were measured by Western blot. Results:Significant differences were found in relative expression levels of CLC-2 mRNA and A value among four groups ( F=90.110, 198.680; both at P<0.001). The relative expression level of CLC-2 mRNA and A value were significantly lower in CLC-2 siRNA transfected group than nonsense siRNA group, showing statistically significant differences (both at P<0.001). The proportion of apoptotic HConF in blank control group, Lipo2000 group, nonsense siRNA group, and CLC-2 siRNA transfected group was (4.78±1.10)%, (4.54±1.51)%, (4.82±0.88)% and (28.90±0.91)%, respectively, and a statistically significant difference was found ( F=363.260, P<0.001). The proportion of apoptotic HConF was significantly higher in CLC-2 siRNA transfected group than nonsense siRNA group, with a statistically significant difference ( P<0.001). Statistically significant differences were found in cell migration rate and the number of migrating cells among four groups ( F=74.493, 1 625.431; both at P<0.01). The cell migration rate of HConF in CLC-2 siRNA transfected group was significantly lower and the number of migrating cells was significantly smaller than those of nonsense siRNA group, with statistically significant differences (both at P<0.001). A statistically significant difference in contraction rate was found among four groups ( F=104.692, P<0.001). The contraction rate of HConF was significantly lower in CLC-2 siRNA transfected group than nonsense siRNA group, and the difference was statistically significant ( P<0.001). Statistically significant differences were found in relative expression levels of collagen Ⅰ and collagen Ⅲ proteins, p-PI3K/PI3K ratio, and p-Akt/Akt ratio among four groups ( F=112.073, 456.931, 340.889, 43.021; all at P<0.001). The relative expression levels of collagen Ⅰ and collagen Ⅲ proteins, p-PI3K/PI3K ratio and p-Akt/Akt ratio in CLC-2 siRNA transfected group were significantly lower than those of nonsense siRNA group, showing statistically significant differences (all at P<0.05). Conclusions:Targeted blocking of CLC-2 chloride channel gene expression can inhibit fibrosis of HConF by promoting apoptosis of HConF through PI3K/Akt signaling pathway and inhibit fibrotic processes such as cell migration, collagen synthesis and collagen contraction.
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Se realizó una búsqueda sobre la evaluación cualitativa de la ampolla de filtración. La ampolla conjuntival es la parte visible de la cirugía filtrante, y su morfología es un indicador de factores que pueden determinar el resultado hipotensor de la cirugía y las posibles complicaciones posoperatorias. Se han desarrollado diversos estudios que relacionan la evaluación clínica de su morfología y el control de la presión intraocular, y se han establecido varios sistemas de puntuación, entre ellas: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale y métodos de imagen para evaluar el segmento anterior (biomicroscopia ultrasónica, Tomografía retinal de Heidenberg y tomografía de coherencia óptica). Estos métodos proporcionan una herramienta útil para el seguimiento de la cirugía filtrante y su documentación(AU)
A review was conducted on the qualitative evaluation of the filtering bleb. The conjunctival bleb is the visible part of filtration surgery, and its morphology is an indicator of factors which may determine the hypotensive result of surgery and the possible postoperative complications. Various studies have been conducted which relate the clinical evaluation of its morphology and intraocular pressure control. Several grading systems have thus been established: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale and imaging methods to evaluate the anterior segment (ultrasound biomicroscopy, Heidenberg retinal tomography and optical coherence tomography). These methods are a useful tool for the follow-up of filtration surgery and its documentation(AU)
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Humans , Glaucoma/surgery , Filtering Surgery/adverse effects , Tomography, Optical Coherence/methods , Evaluation Studies as TopicABSTRACT
@#AIM: To observe the intraocular pressure(IOP)control and bleb function after phacoemulsification in patients with previous history of successful/qualified success mitomycin-C augmented trabeculectomy.<p>METHODS: This was a retrospective cohort study. Data of patients who had undergone trabeculectomy between 1st January 2013 to 31st Dec 2015 with subsequent cataract surgery were extracted from server. All patients had previous either success/qualified success trabeculectomy done. They went through uncomplicated phacoemulsification <i>via</i> clear corneal incision. Postoperative follow-up, review of bleb and IOP readings using Goldmann tonometer were taken. Details that were investigated include postoperative IOP control, visual improvement, number of anti-glaucoma medications, as well as the timing from trabeculectomy to phacoemulsification. Comparison with control group was made.<p>RESULTS: Fifteen eyes from thirteen patients fulfilled the criteria for study and had undergone uncomplicated phacoemulsification on a post-trabeculectomy eye. Two of the eyes had secondary glaucoma while the other thirteen had primary glaucoma. All phacoemulsifications were done at least 6mo after trabeculectomy(mean 14.7±4.3mo). There was only 1 eye(6.7%)requiring anti-glaucoma medications before the cataract surgery. This number increased to 4(26.7%)at 1-year post-phacoemulsification. The number further increased to eight(53.3%)at 2y post-phacoemulsification. The number of anti-glaucoma drops needed after surgery at 2y ranged from 2-4. In all the 15 eyes, there was no statistically significant change in IOP control between pre-cataract surgery(mean 13.4±2.9 mmHg)compared to 1y(mean 14.1±3.2 mmHg, <i>P</i>=0.357)and 2y(mean 15.1±3.3 mmHg, <i>P</i>=0.212)post-phacoemulsification. Visual improvement after phacoemulsification however is significant, from a preoperative average visual acuity of LogMAR 1.52±1.00 to a postoperative average visual acuity of 0.53±0.54(<i>P</i>=0.000, paired <i>t</i>-test). <p>CONCLUSION: This analysis shows significant visual improvement following cataract surgery in post-trabeculectomy patients without compromising IOP control. However, a reduced bleb function is noted following the surgery evidenced by the increase in number of anti-glaucoma drops used after surgery especially two years after the cataract surgery. Patients should be counselled regarding the possibility of restarting on anti-glaucoma medications post-phacoemulsification. The timing and sequence of cataract and glaucoma surgery should be optimized for best outcome.
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?AIM:To observe the intraocular pressure ( IOP) control and bleb function after phacoemulsification in patients with previous history of successful/qualified success mitomycin-C augmented trabeculectomy.?METHODS:This was a retrospective cohort study. Data of patients who had undergone trabeculectomy between 1st January 2013 to 31st Dec 2015 with subsequent cataract surgery were extracted from server. All patients had previous either success/qualified success trabeculectomy done. phacoemulsification via clear corneal incision. Postoperative follow-up, review of bleb and IOP readings using Goldmann tonometer were taken. Details that were investigated include postoperative IOP control, visual improvement, number of anti-glaucoma medications, as well as the timing from trabeculectomy to phacoemulsification. Comparison with control group was made.?RESULTS: Fifteen eyes from thirteen patients fulfilled the criteria for study and had undergone uncomplicated phacoemulsification on a post-trabeculectomy eye. Two of the eyes had secondary glaucoma while the other thirteen had primary glaucoma. All phacoemulsifications were done at least 6mo after trabeculectomy (mean 14.7± 4.3mo ) . There was only 1 eye ( 6. 7％) requiring anti-glaucoma medications before the cataract surgery. This number increased to 4 ( 26. 7％) at 1 - year post -phacoemulsification. The number further increased to eight ( 53. 3％) at 2y post - phacoemulsification. The number of anti-glaucoma drops needed after surgery at 2y ranged from 2-4. In all the 15 eyes, there was no statistically significant change in IOP control between pre-cataract surgery (mean 13.4±2.9 mmHg) compared to 1y (mean 14.1±3.2 mmHg, P=0.357) and 2y (mean 15.1±3.3 mmHg, P = 0. 212 ) post - phacoemulsification. Visual improvement after phacoemulsification however is significant, from a preoperative average visual acuity of LogMAR 1.52± 1.00 to a postoperative average visual acuity of 0.53± 0.54 ( P=0. 000, paired t-test) .?CONCLUSION: This analysis shows significant visual improvement following cataract surgery in post -trabeculectomy patients without compromising IOP control. However, a reduced bleb function is noted following the surgery evidenced by the increase in number of anti - glaucoma drops used after surgery especially two years after the cataract surgery. Patients should be counselled regarding the possibility of restarting on anti - glaucoma medications post -phacoemulsification. The timing and sequence of cataract and glaucoma surgery should be optimized for best outcome.
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@#AIM: To evaluate the expression level of transforming growth factor β2(TGF-β2)in the aqueous humor and trabecular tissue of patients with primary angle-closure glaucoma(PACG)of Han and Kazakh ethnic groups and the formation of filter bleb after trabeculectomy.<p>METHODS: Prospective research. Between July 2018 to April 2019, 46 PAGG patients(49 eyes)underwent trabeculectomy in our hospital, including 25 Han nationality(26 eyes)and 21 Kazak nationality(23 eyes). Aqueous humor and trabecular tissue were obtained through trabeculectomy. ELISA method was used to detect the content of total aqueous TGF-β2(tTGF-β2)and activated TGF-β2(aTGF-β2). And the expression of TGF-β2 in trabecular tissue was detected by immunohistochemistry and immunofluorescence.<p>RESULTS:Immunohistochemical staining and immunofluorescence staining showed that the expression of TGF-β2 in the trabecular meshwork of Han patients was significantly higher than that of Kazakh patients. ELISA quantitative analysis showed that the aTGF-β2 content of Han and Kazak patients were 172.015±79.367pg/mL and 83.436±41.743pg/mL, respectively, the difference was statistically significant(<i>t</i>=4.794, <i>P</i><0.001). In patients ≥70 years old, the content of tTGF-β2 in the aqueous humor of patients of the two nationalities was 480.124±152.997 and 338.858±72.497pg/mL, respectively, the difference was statistically significant(<i>t</i>=2.421, <i>P</i>=0.026). In the comparison between preoperative and postoperative, there were time differences and interaction effects in intraocular pressure between Han and Kazak patients. At 6mo postoperatively, the formation of type Ⅰ and Ⅱ filter blebs in Han and Kazak patients was different, and the difference was statistically significant(50% <i>vs</i> 78%; χ2=4.841, <i>P</i>=0.028).<p>CONCLUSION: The expression of TGF-β2 in the aqueous humor and trabecular meshwork of patients with PACG in the two ethnic groups is different. The expression of TGF-β2 in the aqueous humor and trabecular meshwork of Kazakh patients is significantly lower, which reduces the promotion of postoperative filtering scar Functional filtration filtration bleb.
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@#AIM: To observe the intraocular pressure(IOP)control and bleb function after phacoemulsification in patients with previous history of successful/qualified success mitomycin-C augmented trabeculectomy.<p>METHODS: This was a retrospective cohort study. Data of patients who had undergone trabeculectomy between 1st January 2013 to 31st Dec 2015 with subsequent cataract surgery were extracted from server. All patients had previous either success/qualified success trabeculectomy done. They went through uncomplicated phacoemulsification <i>via</i> clear corneal incision. Postoperative follow-up, review of bleb and IOP readings using Goldmann tonometer were taken. Details that were investigated include postoperative IOP control, visual improvement, number of anti-glaucoma medications, as well as the timing from trabeculectomy to phacoemulsification. Comparison with control group was made.<p>RESULTS: Fifteen eyes from thirteen patients fulfilled the criteria for study and had undergone uncomplicated phacoemulsification on a post-trabeculectomy eye. Two of the eyes had secondary glaucoma while the other thirteen had primary glaucoma. All phacoemulsifications were done at least 6mo after trabeculectomy(mean 14.7±4.3mo). There was only 1 eye(6.7%)requiring anti-glaucoma medications before the cataract surgery. This number increased to 4(26.7%)at 1-year post-phacoemulsification. The number further increased to eight(53.3%)at 2y post-phacoemulsification. The number of anti-glaucoma drops needed after surgery at 2y ranged from 2-4. In all the 15 eyes, there was no statistically significant change in IOP control between pre-cataract surgery(mean 13.4±2.9 mmHg)compared to 1y(mean 14.1±3.2 mmHg, <i>P</i>=0.357)and 2y(mean 15.1±3.3 mmHg, <i>P</i>=0.212)post-phacoemulsification. Visual improvement after phacoemulsification however is significant, from a preoperative average visual acuity of LogMAR 1.52±1.00 to a postoperative average visual acuity of 0.53±0.54(<i>P</i>=0.000, paired <i>t</i>-test). <p>CONCLUSION: This analysis shows significant visual improvement following cataract surgery in post-trabeculectomy patients without compromising IOP control. However, a reduced bleb function is noted following the surgery evidenced by the increase in number of anti-glaucoma drops used after surgery especially two years after the cataract surgery. Patients should be counselled regarding the possibility of restarting on anti-glaucoma medications post-phacoemulsification. The timing and sequence of cataract and glaucoma surgery should be optimized for best outcome.
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Purpose: We investigated the factors influencing the morphology of filtration blebs after Ex-PRESS® surgery. We analyzed the thickness of the bleb wall and the height and the volume of blebs. Methods: This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, we analyzed the cases of 145 consecutive patients (180 eyes) who underwent trabeculectomy with Ex-PRESS® for the first time at Toyama University Hospital and were followed for >1 year. We used anterior segment optical coherence tomography to analyze the morphology of the blebs after Ex-PRESS surgery. We also examined potential influencing factors including age, central corneal thickness, type of glaucoma (primary open-angle glaucoma [POAG] or pseudo-exfoliation glaucoma [PEXG]), preoperative intraocular pressure (IOP), postoperative IOP, history of trabeculotomy, and operation method: Ex-PRESS surgery only, or simultaneous cataract surgery. Results: Ex-PRESS surgeries significantly decreased the IOP from 24.5 ± 8.8 mmHg to 11.1 ± 3.4 mmHg after 1 year (P < 0.001). The cases with higher blebs, larger volume of blebs, and thinner bleb wall had better surgical outcomes. Conclusion: Advanced age, higher postoperative IOP, PEXG, and simultaneous cataract surgeries were found to decrease the volume and height of blebs. Younger age, higher postoperative IOP, POAG, and simultaneous cataract surgeries were found to thicken the wall of blebs. Among the younger patients, there were many cases in which surgery was unsuccessful in spite the large volume of blebs. The reason for this may be that the wall of the bleb is thick.
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Blue rubber bleb nevus syndrome (BRBNS) is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.
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PURPOSE: To investigate the clinical features and surgical outcomes of encapsulated bleb excision with collagen matrix implantation performed in patients with failed Ahmed glaucoma valve (AGV) implantation. METHODS: Eighteen eyes of 18 patients underwent encapsulated bleb excision and collagen matrix implantation. Patients were divided into two groups by reference to intraocular pressure (IOP) after preoperative ocular massage: group 1, patients who exhibited substantial IOP reductions; and group 2, patients who did not show substantial changes in IOP. Needling was conducted in group 2. The clinical features of the two groups were compared, including IOP changes after ocular massage and needling, AGV status, and surgical outcomes 6 months after surgery. RESULTS: The mean preoperative IOP among the 18 patients was 30.6 ± 5.7 mmHg. After ocular massage, the IOPs decreased by 22 and 26 mmHg in the two patients in group 1 and the 16 patients in group 2 showed a mean IOP reduction of 1.6 ± 2.2 mmHg (p = 0.013). IOPs decreased after needling in group 2 (range, 6 to 30 mmHg; p < 0.001). Fibrovascular tissue ingrowth into the AGV was observed in the two patients in group 1 and the same ingrowth was observed in 10 of the 16 patients in group 2. Six months after surgery the mean IOP among the 18 patients decreased significantly (19.1 ± 3.2 mmHg, p < 0.001). There was no significant difference in the mean postoperative IOP at 6 months between group 1 (14.0 ± 2.8 mmHg) and group 2 (19.8 ± 2.6 mmHg, p = 0.052). CONCLUSIONS: Encapsulated bleb excision with collagen matrix implantation resulted in a significant IOP-lowering effect 6 months after surgery. Fibrovascular ingrowth into the AGV was common but did not seem to be a major cause of AGV implantation failure.
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Humans , Blister , Collagen , Glaucoma , Intraocular Pressure , MassageABSTRACT
Blue rubber bleb nevus syndrome(BRBNS)is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.