Prospective evaluation of wipe-out after glaucoma filtration surgery in eyes with split fixation

Purpose: To assess the incidence and cause of idiopathic, irreversible loss of vision (“wipe?out”) in the early post?operative period after glaucoma?filtration surgery in advanced glaucoma. Methods: It was a prospective, interventional cohort study. Patients with advanced glaucoma and macular split fixation underwent either only trabeculectomy (group A) or combined phaco?emulsification with trabeculectomy (group B). The incidence and cause of visual loss, changes in intra?ocular pressure, visual acuity, and visual field indices during 2 months post surgery were assessed. Results: Thirty patients (30 eyes) were divided in two groups. No significant difference was noted between the pre?operative and post?operative mean deviations in both groups (P = 0.41, P = 0.65). Two eyes in group A and one eye in group B had visual loss of two lines or more at the end of 2 months because of cataract and choroidal detachment. None of the eyes showed “wipe?out”. Conclusion: “Wipe?out” is a rare phenomenon after surgery in advanced glaucoma

A modified model of glaucoma filtering surgery in Sprague-Dawley rats

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

Research progress on pathobiology of myofibroblast in wound healing after glaucoma filtering surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#Glaucoma filtering surgery is the main treatment for the glaucomatous patients. Typically, surgery failed mary due to wound fibrosis and contracture at the post-surgical site.Myofibroblasts transdifferentiated from other cells via a process known as epithelial-mesenchymal transition(EMT)is a common feature of the fibrotic filtering channel, which can produce excessive amounts of the extracellular matrix(ECM), and then exert tractional forces, resulting in the disruption of tissue architecture and obstruction of filtering channel. In this review, we explain the pathological function of myofibroblast in the wound healing process after glaucoma filtering surgery.

Effect of Breviscapine on Visual Function of Patients with Primary Open-angle Glaucoma at Middle and Late Stage after Filtration Surgery / 中国药师

Objective:To study the effect of breviscapine on visual function of the patients with primary open-angle glaucoma after filtration surgery. Methods:Twenty-nine cases (42 eyes) of patients with primary open-angle glaucoma at middle and late stage after filtration surgery were selected and randomly divided into the experimental group and the control group according to the defect degree of visual field. The 15 patients (21 eyes) in the experimengtal group ( TG) were intravenously injected 250ml saline containing 50mg breviscapine, while the 14 patients (21 eyes) in the control group (CG) were intravenously injected 250ml saline containing 1g vita-min C. The treatment course was 2 weeks followed by one-week withdrawal. After three treatment courses, the visual function in the two groups was investigated and compared before and after the treatment. Results:After the treatment, the visual field defect value and the thickness of retinal nerve fiber layer of the patients in TG were both better than those before the treatment (P<0. 01,P<0. 05). The values of visual acuity and visual field defect of the patients in TG were significantly better than those of the patients in CG ( P<0. 05, P<0. 01). Conclusion:After intraocular pressure is controlled, breviscapine injection can reduce the vision damage of patients with primary open-angle glaucoma at middle and late stage after filtration surgery and improve the visual field defect.

Clinical Effect of Interferon α-2 b on Scar Formation after Glaucoma Filtering Surgery / 中国药师

Objective:To investigate the preventive efficacy of interferon α -2b on scar formation after glaucoma filtering opera-tion. Methods:Totally 62 patients with primary glaucoma(68 eyes)were randomly divided into the observation group(31 cases with 36 eyes)and the control group(31 cases with 32 eyes). The patients in the observation group were given wet compress with a piece of cotton infiltrated by interferonα-2b,while the control group was given wet compress with a piece of cotton infiltrated by mitomycin C. After 4-month postoperative follow-up,the type of filtering bleb,complications and the changes of intraocular pressure were compared between the two groups. Results:The observation group was mainly with type II bleb(58. 33%),while the control group was mainly with type I bleb(53. 13%),and there was significant difference in the filtering bleb type between the two groups(P0. 05). The percentage of visual invariableness or improvement in the observation group was significantly higher than that in the control group(P<0. 05),and the occurrence of complications after the operation in the observation group was significantly lower than that in the control group( P<0. 05). Conclusion:Interferon α-2b is an ideal drug for anti-scarring formation after glaucoma filtration surgery.

A Case of Central Serous Chorioretinopathy after Glaucoma Filtering Surgery

PURPOSE: To report a case of central serous chorioretinopathy development after glaucoma filtering surgery and spontaneous resolution in a patient with a history of central serous chorioretinopathy in the contralateral eye. CASE SUMMARY: A 46-year-old male with a history of chronic uveitis in both eyes presented with uncontrolled intraocular pressure (IOP) in his left eye. Initial IOP was 34 mm Hg in his left eye. On preoperative evaluation, central serous chorioretinopathy, which was diagnosed in another clinic 1 month prior, was observed in his right eye. Slightly pale optic disc and retinal nerve fiber layer defects were noted in the left eye. However, macular abnormalities were not observed in the left eye. Trabeculectomy and peripheral iridectomy using mitomycin C were performed in the left eye. The patient was prescribed triamcinolone 8 mg daily for 4 days to reduce the post-surgical inflammation. On postoperative day 4, IOP in the left eye was 7 mm Hg and newly developed central serous chorioretinopathy was noted. On follow-up, IOP was maintained at 7-10 mm Hg and central serous chorioretinopathy disappeared 7 months postoperatively. CONCLUSIONS: When clinicians consider performing an ophthalmological procedure in a patient with a history of central serous chorioretinopathy in the contralateral eye, careful observation of central serous chorioretinopathy development is recommended.

Effects of transforming growth factor-β2 on human Tenon fibroblasts transformation and scarring after glaucoma filtration surgery / 中华实验眼科杂志

Background Research showed that transforming growth factor-β2 (TGF-β2) promotes scar formation.But its mechanism in scarring after glaucoma filtration surgery is worthy of studying.Objective This study was to investigate the effect of TGF-β2 on myofibroblast transition of human Tenon fibroblasts (HTFs) and scarring after glaucoma filtration surgery.Methods Tenon capsular tissue was obtained from 3 patients with strabismus during the surgery and was incubated in DMEM with 10％ fetal bovine serum (FBS).The cells were collected and passaged in the free-serum medium for 24 hours,and then 1,2,5,10,20 μg/L TGF-β2 was added into the medium respectively,to induce the transformation of HTFs,and 2 μg/L or 5 μg/L TGF-β2 was used to treat the HTFs for 6,24,48 and 72 hours.The control group was not treated with TGF-β2.The expressions of α-smooth muscle actin (α-SMA) and phosphorylation of the signaling proteins (pSmad2) in HTFs were detected by Western blot assay.The expressions of α-SMA and F-actin were located by cell immunofluorescine technique under the confocal immunofluorescence microscopy.Cell contractility was determined by collagen gel contraction assays.This study was approved by Ethic Committee of Institute of Surgery Research of Daping Hospital,and informed consent was obtained from each patient or custodian initial of the study.Results The expression of α-SMA protein in the HTFs was increased significantly after the treatment of TGF-β2 in comparison with the control group and reached a peak at 24-48 hours.The α-SMA expression was gradually weakened in the 10 μg/L TGF-β2 groups.Little of α-SMA and F-actin were expressed in the control group.However,strong staining for α-SMA and F-actin were observed in the 1,2 and 5 μg/L TGF-β2 groups and then the staining weakened at the concentration of 10 μg/L.In addition,pSmad2 showed a stronger expression in the 2 μg/L TGF-β2 group than that in the PBS group and FBS group,with the strongest expression in 30 minutes through 2 hours.The untreated gel contracted (78.00±3.13)％ from its initial size,and contraction in the 1,2,5,10 μg/L TGF-β2 group were (63.88±1.78)％,(20.69±0.65)％,(19.49-±0.54)％,(16.24±0.84) ％,respectively,TGF-β2 increased HTFs contraction significantly (Fgroup =859.400,P =0.000).Conclusions TGF-β2 can induce transdifferentiation of Tenon fibroblast into myofibroblast and increase cell contractility,with a concentration-dependent and time-dependent pattern to an extent.It may be the mechanism of scar formation after glaucoma filter surgery.

Glaucoma Filtering Surgery With Low Concentration of Cyclosporin A in Rabbits: A Pilot Study

PURPOSE: The effect of 0.2% cyclosporin A (CsA) as an adjuvant therapy after glaucoma-filtering surgery was the focus of this study. METHODS: A posterior lip sclerotomy was performed in 16 eyes of 8 rabbits, and 0.2% CsA was administered into the right eyes. The left eyes served as controls. The intraocular pressure (IOP) was measured 1, 3, 5, 7, 14, and 28 days after surgery. Hematoxylin-eosin (HE) and anti-bromodeoxyuridine (BrdU) immunocytochemical staining were performed at 1, 2, 4, and 8 weeks. RESULTS: The IOP at 7 and 14 days after surgery was lower in the 0.2% CsA group and statistically significant (P=0.047, P=0.48; respectively). HE staining did not show any difference between experimental and control eyes, but anti-BrdU staining showed a lower number of positive cells in the experimental eyes at 1 week. The fibroblast proliferation rate was significantly lower 1 week after surgery in the 0.2% CsA group (P=0.003). CONCLUSIONS: An effect of 0.2% CsA on early wound healing was observed. The data suggest that a low concentration of CsA can be useful when employed as adjuvant therapy in glaucoma filtering surgery.

Multiple Retinal Hemorrhage following Anterior Chamber Paracentesis in Uveitic Glaucoma

PURPOSE: We describe the occurrence of a massive retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma. METHODS: A 33-year-old man who suffered from uveitic glaucoma was transferred to our hospital. The IOP in both his eyes was documented to vary between 11 mmHg and 43 mmHg and remained at a continuously high level for 7 months despite maximally tolerable medical treatment. A paracentesis was performed bilaterally to lower the IOP. RESULTS: Immediately after the paracentesis, massive retinal hemorrhages occurred in the left eye. Multiple round blot retinal hemorrhages with white centers occurred in the equator and peripheral retina, and small slit hemorrhages were observed in the peripapillary area. A fluorescence angiography(FAG) showed no obstruction of retinal vessels but a slightly delayed arteriovenous time in the left eye. CONCLUSIONS: It is important to be aware that patients who have a persistent relatively high IOP are at an increased risk of developing decompression retinopathy due to paracentesis and filtering surgery.

Effect of filtering surgery on glaucoma / 中国康复理论与实践

@#ObjectiveTo investigate the effect of filtering surgery on glaucoma.Methods50 glaucoma cases (60 eyes) were underwent trabeculectomy, including paracentesis in advance, suturing of sclera flap and conjunctiva flap, using mitomycin (MMC) and forming anterior chamber as soon as finished operation. All cases were followed up 1 year.ResultsPostoperative IOP was lower than 21 mmHg in 54 eyes, 6 eyes were <30 mmHg when treated with drugs. After operation, there were only 2 eyes had lower vision, the others had higher vision. Two eyes had conjunctiva filtering, two eyes had choroidal separation, but they recovered after non surgical therapy.ConclusionFiltering surgery can decrease common complications, increase vision of early stage, and make IOP recovered to normal.

Related factors of choroidal detachment after glaucoma filtering surgery and the preventive measures / 第三军医大学学报

Objective To investigate the related factors and the preventive measures of choroidal detachment after glaucoma filtering surgery. Methods The clinical data of 8 patients (10 eyes) with choroidal detachment out of 337 patients (378 eyes) undergoing glaucoma filtering surgery were analyzed retrospectively. Results Of the 8 patients (10 eyes) with choroidal detachment, acute angle closure glaucoma was found in 3 patients (3 eyes), chronic angle closure glaucoma in 4 patients (6 eyes), and neovascular glaucoma in 1 patient (1 eye). The youngest was 51 years old and the oldest was 73 years old with an average age of (65.25?5.58) years old. Of the 8 patients, primary hypertension was found in 1 patient, type Ⅱ diabetes in 4 patients (diabetes patients combined with hypertension in 3 out of the 4 patients). Intraocular pressure of 3 patients (4 eyes) was regulated to the normal level [(22.38-24.38) mmHg] by medicine before operation. The remaining 5 patients (6 eyes) underwent operation at high intraocular pressure [(35.76-50.10) mmHg]. Choroidal detachment occurred at 1-11 d, (5.25?2.2) d in average. Shallow anterior chambers of 6 eyes treated by medicine therapy recovered within 5-10 d, (7.5?1.04) d in average. Shallow anterior chamber of 4 eyes treated by surgery recovered within 1-6 d, (3.65?1.45) d in average. Conclusion Occurrence of the choroidal detachment after glaucoma filtering surgery is associated with many factors, such as high intraocular pressure before operation, diabetes, hypertension, and arteriosclerosis. The preventive measures of choroidal detachment after glaucoma filtering surgery include: controlling intraocular pressure as low as possible before operation, avoiding sudden reduced intraoculer pressure during operation, forming anterior chamber at the end of operation, using releasable scleral flap sutures, adopting corticosteroid and ciliary muscle anaesthetics after operation, and avoiding mental stress.

The Effects of Genistein on the Proliferation of Subconjunctival Fibroblasts in Rabbit

Failure of glaucoma filtering surgery most commonly results from excessive fibrosis and occlusion of the filtration site. Many drugs have been investigated to improve surgical results, but drugs that effectively suppress fibroblast activity with less side effects have not been found yet. Genistein, an isoflavonoid phytoestrogen found in soya bean and other legumes, has been reported as a potent inhibitor of tyrosine kinase and suppresses the receptor activation of many growth factors. In this study, the effect of genistein on the proliferation of subconjunctival fibroblast in rabbits were investigated. Cell proliferation was assayed after bFGF (10ng/ml), TGF-beta1 (10ng/ml), EGF (5ng /ml), PDGF (20ng/ml) in cultured rabbit fibroblasts and the effects of genistein on them were analyzed. Each growth factors stimulated fibroblast proliferation effectively. bFGF, TGF-beta1, EGF and PDGF stimulated cell growth by 183%, 163%, 134%, and 182% after 24 hours, respect- ively, and cell growths were increased up to 72 hours. Genistein 50 micrometer suppressed stimulated fibroblast growth by 36%, 46%, 65% and 43%in bFGF, TGF-beta1, EGF and PDGF stimulated samples 24 hours later respectively. Therefore, we speculate that genistein suppresses the proliferating activity of growth factor-induced fibroblasts in rabbit.

The Effects of Minoxidil Versus Mitomycin C on the Filteing Surgery for Glaucoma in Rabbits

We compared the effect of topical minoxidil after filtering surgery with that of mitomycin C (MMC) application in rabbits. Fourty-nine eyes were divided into the minoxidil-treated eyes, MMC_treated eyes and control eyes. Intraocular pressure (IOP) in minoxidil-treated eyes and MMC-soaked eyes were significantly lower than that of the control eyes at postoperative 1 and 3 days. MMC-soaked eyes had lower IOPs than the minoxidil-treated and control eyes, but IOPs in the minoxidil- and control eyes were similar at days 5 to 21. IOP survival in the MMC-treated eyes was significantly longer than in both the minoxidil-treated and control eyes. These results suggest that topical minoxidil can cause reduction of IOP at the early postoperative period. Howver, the IOP lowering effect of Minoxidil did not last as long as that of MMC soaking. Further study is necessary to enhance the efect of topical minoxidil including its method of application and optimal concentration.

Trabeculectomy with Adjunctive Mitomycin-C: Compariative Study of Subconjunctival Injection and Soaking of Mitomycin-C (I)

We conducted retrospective study to compare MMC subconjunctival injection with MMC soaking for surgical outcome and postoperative complications as an adjunct to trabeculectomy in eyes with primary glaucoma. Thirty-two eyes of 27 patients with primary glaucoma who ahd undergone primary trabeculectomy with adjunctive subconjunctival mitomycin-C injection (Group I, 0.04mg/ml, 0.05ml) were compared with subconjunctival mitomycin-C soaking group (Group II, 0.4mg/ml, 3 min) of 30 eyes of 25 patietns with primary glaucoma who had undergone primary trabeculectomy. Minimal follow-up period was 3 months and mean follow-up period was 14.5 months in group I, 15.7 months in group II. Preoperative mean IOP was 33.9+/-9.3mmHg in group I, 28.3+/-10.1mmHg in group II and there was no statistical significance. Postoperative mean IOP in 1, 3, 5 months were 16.4+/-7.0, 16.1+/-7.5, 16.9+/-5.8mmHg in group I, 13.2+/-4.4, 14.2+/-4.1, 15.1+/-4.7 mmHg in group II, respectively. Twenty-six eyes(81%) in group I and twenty-three eyes (77%) in group II achieved an intraocular pressure of less than 21 mmHg and good bleb formation. Postoperative complications were hyphema(9% in group I, 10% in group II), shallow anterior chamber (6% in group I, 3% in group II), bleb leaking (3% in group I, 0% in group II), hypotony maculopathy (3% in group I, 3% in group II), avascular cystic bleb(13% in group I, 25% in group II) and belb fibrosis (18% in group I, 25% in group II). There was no statistical significance. The rates of surgical success and postoperative compliations were similar in the two groups. Subconjunctival injection is another useful adjunctive application method of MMC. The method is able to control accurate amount and to improve surgical outcome in trabeculectomy.

Risk Factors for Glaucoma Filtering Surgery and Mitomycin C

To determine the factors which can increase the failure after glaucoma filtering surgery and to evaluate the affect of Mitomycin C(MMC) on filtering surgery. We evaluated 249 eyes who underwent glaucoma filtering surgery consecutively during last 2 years in Catholic University Medical College hospitals. 129 eyes had risk factors and 68 eyes of them were treated with MMC during operation. The success rate of the group with risk factors was significantly lower (P=0.001) than that of the group without risk factors. In the risk group, MMC has increased the sucess rate (P=0.07). Previous cataract surgery, neovascularization of iris (NVI) , re-trabeculectomy, young age under 40, uveitis and diabetes were significant risk factors for surgical failure. After adjustment of each factors, previous cataract surgery, NVI, retrabeculectomy and young age still increased the failure rate significantly. Among them we were able to make reduse the effect of re-trabeculectomy and youth by using MMC during surgery. The outcome of glaucoma surgery may increase the success rate in some high risk cases.

Filtering Operation with Adjunctive Mitomycin-C in Rabbit: Comparative Study by Subconjunctival Injection and Soaking of Mitomycin-C

We examined the differences of the glaucoma filtering blebs according to the application methods of mitomycin C (subconjunctival injection and soaking). We performed filtering surgery from the anterior chamber to the subconjunctival space with the silicone tube, in both eyes of 12 grey rabbits. In one eye, subconjunctival injection of the mitomycin-C 0.05ml after filtering surgery (concentration 0.004, 0.008, 0.012, 0.016%) was performed and on the other eye, Weck-Cel sponge soaked with the 0.04% mitomycin-C was applied for 3 minutes and the wound was washed with copious amount of balanced salt solution before the closure of wound. We examined the size, shape, vascular distribution of the filtering blebs and status of the anterior chamber after filtering surgery. We obtained the tissues of the filtering bleb at 7days, 14days and 21days after surgery and microscopic examinations were performed. In subconjunctival injection with the 0.004% of mitomycin-C, bleb size and its duration was small and short than those eyes with the soaking. In eyes with subconjunctival injection with the 0.008% of mitomycin-C, bleb size and its duration showed similiar blebs to soaking cases and anterior chamber was shallow in one eye. In case of 0.012% subconjunctival injection, bleb size and duration were greater than those with soaking and slightly shallow anterior chamber was shown in all cases. In cases of subconjunctival injection with 0.016% mitomycin-C, shallow anterior chamber and hypotony were common. In histological examination, there was similiar findings of fibroblast activity between 0.008% subconjunctival injection and 0.004% soaking cases. Therefore we conclude that the concentration of mitomycin-c in subconjunctival injection for glaucoma filtering surgery should not be higher than 0.008%.

Diode Laser Ab Externo Sclerostomy in Rabbits

Sclerostomy is preferable full-thickness filtration surgery, if very low pressure are desired or if guard filtration surgery had failed. Laser sclerostomy can be performed in a less invasive manner than standard procedure, so it reduces scar formation and minimizes postoperative complications. The objective of this investigation was to determine the feasibility and parameters of laser sclerostomy using a diode laser. The diode laser with a fiberoptic delivery system is lightweight, portable and utilizes a 100 Volt outlet. Eighteen eyes of pigmented rabbits underwent a diode laser ab externo sclerostomy with energy 2 W, duration 1-2 seconds by applying endolaser probe, 0.5 mm from the limbus. Gross and histopathologic examination were done at 1 hour and 7 days after treatment. A patent fistula with formation of filtering bleb was achieved in all cases. There was a flattening of the filtration bleb at 3.3 postoperative days.

Ultrastructural Changes of The Scleral Fibroblasts after Glaucoma Filtering Surgery with Intraoperative Mitomycin-C in Rabbit Eyes

We investigated the long-term scleral toxicity after single intraoperative exposure to mitomycin-C(MMC) at 2 different exposure length of time and with or without profuse irrigation after the MMC applications during glaucoma filtering surgery(GFS) in rabbit eyes. Albino rabbits undergoing GFS received a single exposure to MMC 0.5 mg/ml for 1 or 5 minutes with placing MMC-soaked sponges between the conjunctival flap and the scleral bed. A subsequent irrigation of the exposed tissue with 250 ml of balanced salt solution(BSS) was done in one group but not in the other groups. Six months after GFS, the eyes were enucleated and fixed in glutaraldehyde for transmission electron microscopy(TEM). TEM revealed degenerative changes of the fibroblasts at the middle portion of sclera in all MMC treated groups. There were some differences between the groups with 1 minute and 5 minutes exposure to MMC. No discernible differences existed in the ultrastructural findings of the scleral fibroblasts between the groups with or without BSS irrgation after 5-minutes exposure to MMC. Our observation suggest that an exposure to MMC 0.5 mg/ml can cause longterm scleral fibroblast toxicity. There was no discernible differences in scleral fibroblast toxicity between the groups with and without profuse BSS irrigation.

The Effect of Mitomycin C on the Holmium Laser Sclerostomy in Rabbits

This experiment is to evaluate the effects of subconjunctival mitorrycin injection on the holmium laser sclerostomy in rabbits. Three hours before laser sclerostomy, subconjunctival injection of normal saline(in control group, n=10 yes) or 0.04% mitomycinGn experiment group, n=10 eyes) was performed. After laser sclerostomy, change of intraocular pressure and appearance of filtering bleb were observed in each group. The duration of success with low intraocular pressure and presence of filtering blebs were evaluated. The duration of success was 5.1 +/- 2.5 days in control group and 29.8 +/- 12.6 days in experiment group. In the former, mean intraocular pressure was not significantly low compared with preoperative one five days after sclerostomy, but latter showed significantly low intraocular pressure 35 days after operation. These results suggest that subconjunctival injection of 0.04% mitomycin C three hours before operation was effective to the success of holmium laser sclerostomy.

The Effects of Mitomycin C and Ascorbic Acid on the Holmium Laser Sclerostomy in Rabbits

Several methods of mitomycin administration or subconjunctival injection of ascorbic acid was combined with holmium laser scleorstomy for the evaluation of their effects in the sclerostomy. Thirty rabbits(60 eyes) were divided into 6 groups. Group 1 received topical application of 0.04% mitomycin for 2 weeks ostoperatively. Group 2 received subconjunctival injection of 0.04% mitomycin 3 hours before sclerostomy combined with postoperative topical use of mitomycin. Group 3 received subconjunctival injection of 0.04% mitomycin just before operation. Suconjunctival injection of 0.004% mitomycin was underwent 3 hours before surgery in group 4 and just before scierostomy in group 5. After subconjuctival injection of 25mg ascorbic acid, sclerotomy was performed on group 6. We evaluated duration of success and complication, mean duration of success was 7.4 days, in group 1, 35 days in group 2, 11.9 days in group 3, 7.2 day in group 4, 10.1 days in group 5, and 10.7 days in group 6. All methods were less effective than Subconjunctival mitomycin injection 3 hours before surgery. Corneal erosion, corneal, opacity, hyphema, and early hypotony were found in mitomycin use. Ascorbic acid injection did not develop complications. In these results, the subconjunctival injection of 0.04% mitomycin C 3 hours before the holmium laser sclerostomy was regarded as the most effective to holmium laser sclerostomy without complications. Subconjunctival injection of ascorbic acid was helpful for sclerostomy but less effective than mitomycin use.