Glaucoma drainage devices / Dispositivos de drenagem para glaucoma

ABSTRACT Glaucoma drainage devices are important therapeutic options for cases of refractory glaucoma, in which trabeculectomy with antimetabolites has shown high risk of failure. There are devices with different sizes, designs and materials, and several studies have been conducted to test their safety and effectiveness. Despite known complications, their use has progressively increased in recent years, and they are the primary surgical option, in some situations. The aim of this review is to discuss the importance, mechanisms, biomaterials, results and complications of glaucoma drainage devices.

RESUMO Os dispositivos de drenagem para glaucoma são importante opção terapêutica em casos de glaucomas refratários, nos quais a trabeculectomia com antimetabólitos tem alta chance de falência. Há dispositivos com diferentes tamanhos, desenhos e materiais, e muitos estudos foram realizados para testar sua segurança e eficácia. Apesar de suas conhecidas complicações, seu uso tem aumentado progressivamente nos últimos anos, inclusive como primeira opção cirúrgica, em algumas situações. O objetivo desta revisão foi discutir a importância, os mecanismos, os biomateriais, os resultados e as complicações dos dispositivos de drenagem para glaucoma.

Retinosquise peripapilar e descolamento seroso de retina neuro-sensorial após esclerectomia profunda não penetrante / Peripapillary retinoschisis and serous detachment of neurosensory retina after a non-penetrating deep sclerectomy

Resumo Relato de caso de um paciente de 46 anos com glaucoma juvenil de controle clínico insatisfatório, portador de retinosquise peripapilar que, após ser submetido à esclerectomia profunda não penetrante, evoluiu com descolamento seroso da retina neuro-sensorial. A associação entre retinosquise peripapilar e o descolamento seroso pós cirurgia filtrante é de ocorrência rara, tendo sido descrito apenas um caso na literatura. A partir deste relato temos por objetivo, além de enfatizar a raridade da associação, mostrar a importância de investigar retinosquise peripapilar em pacientes glaucomatosos, em especial se associada a camada de fibras nervosas, e a importância da explanação adequada aos pacientes de um possível descolamento seroso de retina no pós-operatório de cirurgia filtrante.

Abstract Case report of a 46-year-old patient with unsatisfactory clinical controlled juvenile glaucoma and peripapillary retinoschisis who, after being submitted to non-penetrating deep sclerectomy, evolved with serous detachment of the neurosensory retina. The association between peripapillary retinoschisis and serous detachment after filtering surgery is rare and only one case has been described in the literature. The purpose of this report is, besides to emphasize the rarity of the association, to show the importance of investigating peripapillary retinoschisis in glaucomatous patients, especially if associated with retinal nerve fiber layer, and the importance of adequate explanation to patients of possible serous detachment of retina in the postoperative of filtering surgery.

Resultados a corto plazo de la facotrabeculectomía por una vía en el Instituto Cubano de Oftalmología Ramón Pando Ferrer / Short-term outcomes of one-site phacotrabeculectomy at Ramón Pando Ferrer Cuban Institute of Ophthalmology

Objetivos: describir los resultados a corto plazo de la facotrabeculectomía por una vía. Métodos: se realizó un estudio descriptivo de series de casos en 19 ojos de 18 pacientes tratados con facotrabeculectomía por una vía y por un mismo cirujano del Departamento de Glaucoma del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre los meses de febrero y octubre del año 2016. Se controlaron las siguientes variables: edad, sexo, color de piel (blanco o negro), número de fármacos hipotensores, agudeza visual mejor corregida, presión intraocular, estadio de daño glaucomatoso, tipo de glaucoma y complicaciones posquirúrgicas con seguimiento durante tres meses. Resultados: la edad promedio de la muestra fue 69 ± 12 años, igual número de masculinos y femeninos. Predominó el glaucoma primario de ángulo abierto y el color de piel negra. En el preoperatorio la presión intraocular media fue 22,5 ± 5,9 mmHg; la agudeza visual mejor corregida 51,77 ± 31,89 VAR y el número de fármacos hipotensores 3,2 ± 0,5. A los tres meses posoperatorios la presión intraocular media fue 15,6 ± 4,3 mmHg (p< 0,05); la agudeza visual mejor corregida 71,15 ± 33,05 VAR y el número de fármacos hipotensores 0,7 ± 1 (p< 0,05). Las complicaciones posquirúrgicas fueron atalamia, desprendimiento coroideo y quiste de Tenon. Conclusiones: la facotrabeculectomía por una vía constituye una alternativa quirúrgica que ofrece a pacientes con glaucoma y catarata el control de la presión intraocular, la recuperación visual, la reducción del número de fármacos hipotensores oculares y mínimas complicaciones(AU)

Objectives: describe the short-term outcomes of one-site phacotrabeculectomy. Methods: a descriptive case-series study was conducted of 19 eyes of 18 patients treated with one-site phacotrabeculectomy by the same surgeon at the Glaucoma Department of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February to October 2016. The variables evaluated were age, sex, skin color (black or white), number of hypotensive drugs, best corrected visual acuity, intraocular pressure, glaucomatous damage, glaucoma type and postsurgical complications during a three-month follow-up. Results: mean age of the sample was 69 ± 12 years, with an equal number of males and females. There was a predominance of primary open-angle glaucoma and black skin color. In the preoperative period mean intraocular pressure was 22.5 ± 5.9 mmHg, best corrected visual acuity was 51.77 ± 31.89 VAR, and the number of hypotensive drugs was 3.2 ± 0.5. Three months after surgery mean intraocular pressure was 15.6 ± 4.3 mmHg (p< 0.05), best corrected visual acuity was 71.15 ± 33.05 VAR and the number of hypotensive drugs was 0.7 ± 1 (p< 0.05). The postoperative complications were athalamia, choroidal detachment and Tenon cyst. Conclusions: one-site phacotrabeculectomy is a surgical alternative offering patients with glaucoma and cataract intraocular pressure control, visual recovery, a reduction in the number of hypotensive drugs, and minimal complications(AU)

Biomicroscopia ultrassônica na viscocanalostomia / Ultrasound biomicroscopy in viscocanalostomy

OBJETIVO: Estudar por biomicroscopia ultrassônica (UBM) de alta frequência as características anatômicas da viscocanalostomia, e a relação dessas características com a redução da pressão intraocular. MÉTODOS: Estudo transversal, que incluiu nove olhos (sete pacientes) submetidos à viscocanalostomia, e posteriormente examinados por UBM de alta frequência (80 MHz). Os parâmetros da UBM avaliados após um follow-up mínimo de seis meses foram: presença de espaço intraescleral, comprimento e altura máximos do espaço intraescleral, e a espessura mínima da membrana trabéculo-descemética (MTD) residual. O sucesso cirúrgico definiu-se como pressão intraocular (PIO) <22mmHg ou redução de 20% da PIO sem medicação tópica. Possíveis associações entre as variáveis da UBM e o resultado cirúrgico foram avaliados. RESULTADOS: O tempo médio entre a cirurgia e a realização da UBM foi de 15,5 ± 8,8 meses (6 - 29 meses). Verificou-se uma redução da PIO de 23,5 ± 6,9 mmHg (13,7-32,0) pré-operatória para 14,5 ± 2,4 mmHg (10,7-17,3) pós-operatória (p<0,05). Identificou-se a presença de espaço intraescleral em todos os olhos. A média do comprimento máximo do espaço intraescleral era 1,83 ± 0,51mm; a média da altura máxima do espaço intraescleral era 0,36 ± 0,17mm; e a média da espessura mínima da MTD era 0,14 ± 0,07mm. Não foram encontradas correlações significativas entre o valor da PIO pós-operatória e o comprimento do espaço intraescleral (r²=0,359), a altura do espaço intraescleral (r²=0,017) e a espessura da MTD (r²=0,003). CONCLUSÃO: Em pacientes submetidos à viscocanalostomia, a UBM após um follow-up mínimo de seis meses identificou o espaço intraescleral em todos os olhos. Não se encontrou qualquer correlação estatisticamente significativa entre os valores de PIO pós-operatória e as características anatômicas do espaço intraescleral.

PURPOSE: To evaluate by high frequency ultrasound biomicroscopy (UBM) the anatomical characteristics of viscocanalostomy and their relationship with the intraocular pressure (IOP) lowering. METHODS: A transversal study which included 9 eyes (7 patients) undergoing viscocanalostomy and examined by high frequency UBM (80 MHz). Several UBM variables were evaluated, including the presence of the intrascleral space, the maximum length and height of the intrascleral space and the minimum thickness of residual trabeculo-Descemet membrane (TDM). Surgical success was considered to be achieved when IOP was <22mmHg or the IOP was lowered 20% or more without the use of any medication. The possible association between UBM variables and the surgical outcome was determined. RESULTS: The mean time between surgery and the UBM examination was 15.5 ± 8.8 months (range 6-29). The mean IOP decreased from a preoperative value of 23.5 ± 6.9 mmHg (range 13.7-32.0) to 14.5 ± 2.4 mmHg (range 10.7-17.3) postoperative (p<0.05). The presence of an intrascleral space was a constant finding. The mean length of the intrascleral space was 1.83 ± 0.51mm, the mean height was 0,36 ± 0,17mm; and the mean TDM thickness was 0.14 ± 0.07mm. There were a poor correlation between the level of IOP at the time of UBM and the lenght of the intrascleral space (r²=0.359), the height of the intrascleral space (r²=0.017) or the thickness of the remaining TDM (r²=0.003). CONCLUSION: In patients undergoing viscocanalostomy, UBM examination after a minimum of 6-month follow-up period showed the presence of an intrascleral space in all patients. There was no statiscally significant relationship between the level of IOP and the anatomical characteristics of the intrascleral space.

Surgical Outcomes of Different Ahmed Glaucoma Valve Implantation Methods between Scleral Graft and Scleral Flap

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

Surgical Outcomes of Different Ahmed Glaucoma Valve Implantation Methods between Scleral Graft and Scleral Flap

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

Prognostic Factors for the Success of Laser Iridotomy for Acute Primary Angle Closure Glaucoma

PURPOSE: To identify the prognostic factors for successful laser iridotomy for acute angle-closure glaucoma (AACG). METHODS: We retrospectively reviewed the medical records of 77 eyes of 77 patients with AACG with initial intraocular pressure (IOP) above 40 mmHg. All of the patients received maximum tolerable medical therapy (MTMT) followed by laser iridotomy. In order to comparatively analyze the factors affecting successful laser iridotomy, an increase in IOP on follow-up was defined as increase in IOP greater than 21 mmHg requiring medical or surgical treatment. RESULTS: Successful laser iridotomy was achieved in 59.7% (46/77 eyes). Thirty-one eyes (40.3%) exhibited increased IOP on follow-up, and of these, 30 eyes developed an increase in IOP within six months after the first attack. The success rate was higher (92.9%) in 42 patients who had greater than 30% IOP reduction by MTMT at the first attack compared to the 35 patients whose IOP reduction was less than 30%, of which 24 eyes (72.7%) showed more than 30% IOP reduction after intravenous hyperosmotic agent treatment (p=0.012). The success rate was higher in patients treated within seven days after the development of symptoms than in those treated after seven days (Odds ratio, 4.51; 95% confidence interval, 1.38 to 14.75). CONCLUSIONS: Our data suggest that we can expect successful IOP control after laser iridotomy in eyes with AACG if the patient can be treated within seven days after the development of symptoms and if the IOP reduction was more than 30% by MTMT.

Tonometria, paquimetria e comprimento axial ocular em cães glaucomatosos submetidos à ablação uveal intravítrea / Tonometry, pachymetry and globe axial lenght in glaucomatous dogs submitted to intravitreal uveal ablation

Estudaram-se as alterações tonométricas, paquimétricas e de comprimento axial em cães com glaucoma submetidos à ablação uveal intravítrea. Foram avaliados 13 olhos irreversivelmente cegos de cães que apresentavam glaucoma crônico unilateral, nos quais realizou-se a ablação uveal intra-vítrea, por meio de injeção na câmara vítrea de 0,5ml de sulfato de gentamicina (40mg/ml) associado a 0,3ml de fosfato de dexametasona (4mg/ml). As mensurações da pressão intra-ocular (Po), espessura corneana e eixo axial com tonometria de aplanação, paquimetria ultra-sônica e ultra-sonografias modos A e B foram realizadas no dia da ablação (M0) e após uma (M1), quatro (M4), oito (M8), 12 (M12), 24 (M24) e 48 semanas (M48). A Po diminuiu significativamente em todos os momentos em relação ao M0, com aumento da espessura corneana ao longo do experimento. Nas avaliações ultra-sonográficas notou-se diminuição significativa do bulbo ocular a partir de M4, com medidas ultra-sonográficas modo A significativamente maiores que as do modo B. O procedimento foi efetivo na redução da Po e na diminuição do eixo axial, demonstrando ser viável no controle do glaucoma crônico em olhos irreversivelmente cegos, e ser uma alternativa à enucleação e inserção de prótese ocular

Changes in tonometry, pachymetry and globe axial length in glaucomatous dogs submitted to intravitreal uveal ablation were studied. Thirteen irreversible blind canine eyes were evaluated. They presented unilateral chronic glaucoma, in which intravitreal uveal ablation was performed, through vitreous chamber injection of 0.5ml of gentamicin sulfate solution (40mg/ml) with 0.3ml of dexametazon dissodic phosphate (4mg/ml). The measurements of intraocular pressure (IOP), corneal thickness and globe axial length with aplanation tonometry, ultrasound pachymetry and A and B-mode ultrasound scan were made on the day of the procedure (M0), and on the next day (M1), four (M4), eight (M8), 12 (M12), 24 (M24) and 48 weeks (M48) after. The IOP decreased on all moments in relation to M0, with corneal thickness increasing throughout the experiment. The ultrasonographic evaluations revealed significant globe decrease from M4, with A-scan measurements significantly higher than B-scan. The procedure was effective on intraocular pressure reduction and in shortening the axial length, showing to be feasible to control chronic glaucoma in irreversible blind eyes, as well as an alternative to enucleation and intraocular prothesis

[Efficacy of the Ahmed glaucoma valve implant in eyes with refractory glaucoma]

Implantation of glaucoma drainage devices is currently considered as a good alternative to the traditional treatment of refractory glaucoma. To evaluate the efficacy and safety of the Ahmed glaucoma valve implant in eyes with refractory glaucoma. This retrospective study included 27 eyes from 27 patients with refractory glaucoma treated with the Ahmed glaucoma valve implant between February 1995 and January 2000. We reviewed the final intraocular pressure and incidence of complications in all patients. The most common aetiology of refractory glaucoma was open-angle glaucoma [48.1%] followed by neovascular glaucoma [29.6%]. After a mean follow-up of 35.74 months [range 9-52 months], the mean intraocular pressure decreased from 35.66 mm Hg before surgery to 14 mm Hg on the last follow-up visit after surgery. Thus, the procedure was successful in 69.23%of cases. Nine patients [33.33%] achieved reduced intraocular pressure without additional antiglaucomatous medication. Transient postoperative hypotony of<5 mm Hg occurred in 14.8%of patients. This was, with transient hyphaema, the most common postoperative complication. The Ahmed glaucoma valve implant seems to be effective and safe for the management of refractory glaucoma. However, it is less effective in case of neovascular glaucoma

Cirurgia filtrante não penetrante: conceito, técnicas e resultados / Non-penetrating filtering surgery: concept, technique and results

A cirurgia filtrante não penetrante tem sido alvo de muita discussão nos últimos anos. As duas técnicas mais praticadas são a viscocanalostomia e a esclerectomia profunda não penetrante com trabeculectomia externa. Elas têm por objetivo abaixar a pressão intra-ocular, diminuindo a resistência ao escoamento do humor aquoso. Os pontos em comum destas duas técnicas são: a retirada de um retalho escleral profundo, pré-ciliar e pré-coroidiano; abertura e retirada da parede externa do canal de Schlemm; além da retirada do estroma corneano, situado à frente do trabeculado anterior e da membrana de Descemet. Ambas as técnicas levam à formação de um espaço denominado câmara de descompressão. O humor aquoso deixa a câmara anterior, atravessando a fina membrana trabecular residual e permanece na câmara de descompressão até ser absorvido por diferentes maneiras. Na viscocanalostomia, há a injeção de um produto viscoelástico nas duas extremidades abertas do canal de Schlemm, a fim de abrir a luz do canal e seus eferentes, para que o humor aquoso drene mais facilmente. Já na esclerectomia profunda com trabeculectomia externa, o ponto essencial é a retirada da membrana trabecular externa (trabeculado juxtacanalicular e parede interna do canal de Schlemm). Os estudos retrospectivos e prospectivos de ambas as técnicas, que as comparam à trabeculectomia, relatam taxas de sucesso similares, com menor incidência de complicações pós-operatórias e recuperação visual mais rápida com a cirurgia não penetrante. O objetivo deste artigo é expor e descrever as diferentes técnicas, seus mecanismos de ação, seus resultados através da análise da literatura.

Recently, many discussions occurred concerning non-penetrating filtering surgery. Viscocanalostomy and deep sclerectomy with external trabeculectomy are the most practiced techniques. Their goal is to reduce intraocular pressure by enhancing the natural aqueous outflow, while reducing its resistance. Both techniques involve the removal of a deep scleral flap, the external wall of Schlemm's canal and corneal stroma behind the anterior trabecular meshwork and Descemet membrane, thus creating a scleral lake, where the aqueous humor remains until it is absorbed in many different ways. In viscocanalostomy, a high-molecular viscoelastic substance is injected into the ostia of Schlemm's canal in order to enlarge it and its collectors channels. In deep sclerectomy with external trabeculectomy, the inner wall of Schlemm's canal is removed with adjacent trabecular layers. Studies, both retrospective and prospective, demonstrated similar tensional results when compared to classical trabeculectomy, with fewer complications and better visual recovery after non-penetrating procedure. The aim of this study is to expose the non-penetrating surgery techniques, mechanism of action and results based on the analysis of published literature.

Inducción de cambio en el patrón topográfico en la cirugía filtrante de glaucoma / Induced changes in topographic pattern after filterin glaucoma surgery

Conocer el cambio inducido y poder refractivo en la superficie anterior y posterior de la córnea en pacientes operados de cirugía filtrante de glaucoma. Estudio prospectivo, longitudinal, experimental y comparativo. Se escogieron aleatoriamente 33 ojos sometidos a trabeculectomías y colocación de valvulas de Ahmed. Se valoraron con el sistema Orbscan II, (Bausch & Lomb Surgical, Inc. (USA) los patrones de elevación de la superficie anterior, posterior y determinación, comparación de astigmatismos inducidos en el preoperatorio y postoperatorio (primer, tercer y sexto mes); se aplicaron pruebas no paramétricas de Friedman y de Mann-Whitney. Todos los pacientes incluidos no tenían cirugías oculares previas ni combinadas para el momento del estudio. 33 ojos de 33 pacientes, 21 ojos operados (63,6 por ciento) con trabeculectomía y 12 ojos (36.4 por ciento) con válvula de Ahmed. La edad promedio era de 64.29 ± 4.77 (trabeculectomía) y de 50 ± 26.50 operados con válvula de Ahmed (IVA). Al comparar los cambios en la superficie posterior entre los grupos se observó en el preoperatorio una p de 0.864 y en el postoperatorio de 0.011 (primer mes), 0.061 (tercer mes) y de 0.007 (sexto mes), mostrando una diferencia asintótica (bilateral). Los cambios pueden deberse no solamente a la técnica quirúrgica sino también a la presión intraocular, cicatrización, poder queratométrico, a la experiencia quirúrgica del cirujano, entre otros factores.

Comparación de cirugía filtrante en glaucoma congénito / Comparative filtering surgery for congenital glaucoma

El glaucoma congénito primario es una enfermedad de tratamiento esencialmente quirúrgico. La trabeculectomía con mitomicina-C ha sido utilizada tanto como primera elección o como segunda cirugía cuando ha fallado algún otro procedimiento quirúrgico. En esta revisión se analizaron de manera retrospectiva los casos presentados en nuestro hospital en los últimos 10 años y se compararon con los casos en donde se realizó trabeculectomía simple o esclerectomía, valorando la agudeza visual, la presión intraocular, el diámetro corneal y la excavación papilar tanto pre como postquirúrgica, así como la formación de la vesícula filtrante. Se encontró mayor éxito en la trabeculectomía con mitomicina-C comparada con las otras 2 técnicas, además de que las complicaciones no fueron mucho mayores a lo reportado en la literatura. Concluimos que la técnica de trabeculectomía con mitomicina-C puede ser segura pero sugerimos un estudio prospectivo para poder tener suficiente poder estadístico, mejorar la calidad de las mediciones y controlar las variables adecuadamente.

Minoxidil tópico en la cirugía filtrante experimental de glaucoma / Topical minoxidil in the glaucoma experimental filtration surgery

Este estudio evaluó los efectos clínicos e histopatológicos del Minoxidil 120 mM tópico en la cirugía filtrante de glaucoma en un modelo animal. A conejos albinos de Nueva Zelanda se les realizó una cirugía filtrante y fueron tratados tópicamente con Minoxidil 120 mM o vehículo (placebo). Los conejos en forma aleatoria se asignaron a los diferentes grupos de tratamientos. Grupo A (10 conejos) recibieron Minoxidil 120 mM por 5 días, grupo B (10 conejos) por 14 días y grupo C por 21 días. El ojo contralateral fue el control. La presión intraocular (PIO) y la apariencia de la ampolla fue monitoreada. Después de los períodos de tratamiento, los ojos se removieron cuidadosamente y procesados para miscroscopia de luz. Minoxidil a 120 mM, disminuyó significativamente la PIO (p=0,01). El promedio de la PIO postoperatoria en el grupo Minoxidil 120mM vs. control fue de 10,42 ñ 1,68 vs. 13,63 ñ 1,78 mm de Hg, 10,72ñ 231 vs. 13,86 ñ 1,79mm de Hg y 10,00 ñ 2,00 vs. 11,5 ñ 1,97 mm de Hg (XñDS), para los días 5, 14 y 21 del postoperatorio, respectivamente. La presencia de ampolla, en el grupo minoxidil vs. control, se observó en un 93,33 por ciento vs. 56,66 por ciento, 95 por ciento vs. 35 por ciento y 100 por ciento vs. 30 por ciento, para los días 5, 14 y 21 del postoperatorio, respectivamente (P<0,05). Hubo una disminución significativa en el contaje de fibroblastos en el grupo minoxidil vs. control de 32,5 ñ13,77 vs. 83,9ñ32,47, 34,8ñ33,44vs 79,8ñ40,45 y 45,6ñ24,67 vs. 102,4ñ54,51 (XñDS), para los días 5, 14 y 21 del postoperatorio, respectivamente (p<0,0001); correspondiendo a un 61,26 por ciento, 56,39 por ciento y 55,47 por ciento de reducción respecto al control. El examen histológico en los ojos tratados con Minoxidil, mostraron esclerectomías permeables y ampollas con cavidades bien formadas e hipocelulares. El minoxidil fue bien tolerado y parece seguro y no tóxico. Minoxidil retarda la cicatrización de la herida, prolongando la sobrevida de la cirugía filtrante. En concentración 120 mM, Minoxidil inhibe la proliferación fibroblástica en el punto máximo de la fase proliferativa de la cicatrización de la herida, aumentando la longevidad de la ampolla y causando una disminución significativa de la presión intraocular

Experiencia en cirugía filtrante y uso de Mitomicina en el Servicio de Oftalmología del Hospital Militar "Dr. Carlos Arvelo" / Experience in filtering surgery and use of mitomicyn in the Ophthalmology Service of the Hospital Militar \"Dr. Carlos Arvelo\"

En el Servicio de Oftalmología del Hospital Militar "Dr. Carlos Arvelo", realizamos un estudio retrospectivo en pacientes glaucomatosos intervenidos de cirugía filtrante con complicación intraoperatoria de Mitomicina en dosis de 0.3 mgr/cc durante 3 minutos. Desde marzo 1996 a marzo 1997. Se incluyeron 24 pacientes con un total de 31 ojos, 61 por ciento eran pacientes con glaucoma de ángulo abierto, todos sin cirugía antiglaucomatosa previa, 60 por ciento tenían más de 2 años de tratamiento con dos o más drogas, 2,5 por ciento tenían daño avanzado del nervio óptico y campo visual. Definimos el éxito quirúrgico en presiones menores de15 mmHg sin alteración de la agudeza visual preoperatoria, alcanzándose en más del 85 por ciento de los casos. Tomamos como referencia la agudeza visual y presión intraocular existentes a los 6 meses de la operación. La agudeza visual postoperatoria se mantuvo a pesar del discreto deterioro menor a dos optotipos de Snellen. Se presentaron complicaciones en 75 por ciento de los casos, de los cuales el desprendimiento coroideo seroso, cámara plana e hifema representaron la mayoría y cedieron favorablemente con tratamiento medico. Se analizan los resultados obtenidos, recomendando la aplicación de Mitomicina C en cirugía filtrante

Uso intraopertaorio de Mitomicina C en cirugía filtrante de glaucoma / Intraoperative use of mitomycin C in glaucoma filtering surgery

Evaluamos de forma retrospectiva los resultados y complicaciones de 17 trabeculectomías con el uso de Mitomicina C (MMC) con concentraciones de 0,2 y 0,4 mg/ml, aplicada durante 4 minutos en 16 pacientes con diferentes tipos de glaucoma entre enero de 1995 y junio de 1996. Definimos "exito completo" como el logro de presiones intraoculares postoperatorias (PIO) < o = 21 mm de Hg sin uso de medicación y "éxito parcial" como el logro de las mismas presiones pero con medicación coadyuvante. La edad media de los pacientes fue de 55,18 años, con una PIO media preoperatoria de 29,4 ñ 10,6 mm de Hg. Durante el seguimiento de 17,9 semanas se obtuvo un 94 por ciento de "éxito completo", con una PIO postoperatoria de 10.7 ñ 3,4 mm de Hg. Se observó un 24 por ciento de complicaciones relacionadas al uso de MMC. El uso de MMC durante la cirugía filtrante de glaucoma se asocia a una alta tasa de éxito. Las complicaciones relacionadas al uso de MMC si son adecuadamente manejadas no parecen afectar el éxito de la cirugía

Cirugía filtrante ajustable: nueva técnica antiglaucomatosa / Adjustable filtering surgery: technique new in antiglaucomatous surgery

Ofrecer una técnica quirúrgica en pacientes con glaucoma de ángulo abierto, que hemos denominado cirugía filtrante ajustable, de fácil realización, cuyo objetivo fundamental es impedir el cierre de la fístula por el proceso de fibrosis de la herida. Seis pacientes entre 44 y 75 años, con diagnóstico de glaucoma de ángulo abierto avanzado no controlado con terapia máxima, fueron sometidos a esta técnica quirúrgica una vez obtenido su consentimiento, con excavaciones entre 0,6 y 0,7 y presión intraocular mínima de 28 mmHg y máxima de 32mmHg. En 5 de 6 pacientes se obtuvieron niveles de presión intraocular entre 14 y 17 mmHg. Cuando se movilizaba el flap se obtenía una disminución de presión intraocular de 3-4 mmHg. En 1 paciente el nivel de presión persistió elevado y se añadió terapia médica. El mecanismo de acción de nuestro procedimiento consiste en interrumpir el ciclo de formación de la fibrosis subconjuntival mediante un efecto mecánico provocado por la tracción del flap en el lecho filtrante, durante los días de máxima proliferación fibroblástica, pero se necesitan futuros estudios clínicos e histopatológicos para determinar la eficiencia de este procedimiento