Résumé
Las modificaciones en la técnica de la cirugía filtrante están encaminadas a que los resultados sean cada vez más efectivos. La trabeculectomía con suturas liberales tiene por objeto lograr un mejor control de la presión intraocular (PIO) y diminuir las complicaciones postoperatorias. Se estudió la evolución de 42 ojos de 32 pacientes sometidos a trabeculectomía con suturas liberales. La PIO preoperatoria promedio, que era de 32.3 ñ 10.4 mmHg., disminuyó a 14.3 ñ 6.9 mmHg., (p<.001) después de un periodo de seguimiento de 6 a 30 meses (x 13.6 ñ 7.7). La única complicación considerable fue un desprendimiento coroide hemorrágico. La trabeculectomía con suturas liberales combina las ventajas de la trabeculectomía y las de la cirugía filtrante no protegida, manteniendo un cierre hermético inicial del colgajo escleral para evitar la hipotonía en el postoperatorio inmediato y permitiendo posteriomente obtener una mayor filtración conforme las suturas van siendo liberadas.
Sujets)
Adolescent , Adulte , Adulte d'âge moyen , Humains , Mâle , Femelle , Complications postopératoires/prévention et contrôle , Sclère/chirurgie , Procédures de chirurgie ophtalmologique , Procédures de chirurgie opératoire , Trabéculectomie , Glaucome/chirurgie , Bupivacaïne/administration et posologie , Hypotension oculaire/prévention et contrôle , Pression intraoculaire/physiologie , Techniques de sutureRésumé
An attempt was made to observe the possibility of controlling intraocular pressure (IOP) without hypotony and ocular motility disorder by installing an experimentally designed glaucoma implant through a small conjunctival incision with the aid of a stylet and maintaining the aqueous reservoir using mitomycin C (MMC). The implant was made of silicone tube, of which one end was occluded by glue and on the same end 4 check-valve-like slits were made. Thirty-five healthy white rabbits were used and subdivided into 4 groups. In groups I to III, implants having 2.0, 2.5, 3.0 mm slit lengths, respectively, were installed with MMC application in one eye of each of the 10 rabbits. In group IV, a 2 mm slit-length implant was installed without MMC in one eye of each of the 5 rabbits. Pneumatonometry and ultrasonography were performed to check the IOP and the formation of aqueous reservoir in the implanted eyes for 8 weeks. In group I through III, there was a statistically significant 4-5 mmHg pressure-lowering effect in the implanted eyes compared to the contralateral control eyes for 8 weeks. The aqueous reservoirs were observed throughout the follow-up period. In group IV, we could observe neither a pressure-lowering effect nor aqueous reservoir formation in the implanted eyes after 2 weeks postoperatively. Hypotony did not occur in implanted eyes in any of the groups. This study shows the possibility of IOP control by installing a specially designed glaucoma implant with application of MMC.
Sujets)
Animaux , Lapins , Pôle antérieur du bulbe oculaire/imagerie diagnostique , Antibiotiques antinéoplasiques/usage thérapeutique , Humeur aqueuse/métabolisme , Traitement médicamenteux adjuvant , Glaucome/thérapie , Pression intraoculaire , Mitomycine/usage thérapeutique , Hypotension oculaire/prévention et contrôle , Troubles de la motilité oculaire/prévention et contrôle , Prothèses et implants , Siloxane élastomère , Tonométrie oculaireRésumé
Sodium hyaluronate can be used during a trabeculectomy to prevent early postoperative hypotony and shallow anterior chamber. To determine its long-term effect on the outcome of filtration surgery, fifteen rabbits underwent a osterior-lip sclerectomy in both eyes. Into their right eyes 0.2ml sodium hyaluronate, and into left eyes 0.2ml balanced salt solution were injected intracamerally. Gross and histopathological differences of bleb were observed. There was no statistically significant difference in longevity of the filtration bleb.