Efficacy and safety of trabeculectomy with mitomycin C for childhood glaucoma: a study of results with long-term follow-up

OBJECTIVE: To evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma. INTRODUCTION: The use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children. METHODS: A retrospective chart review (1991-2001) of 114 patients (114 eyes) from 0-14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent. RESULTS: The mean patient age was 57.36 51.14 months (range: 0.5-168 months). Treatment was considered successful in 63 eyes (55.26 percent), with a mean intraocular pressure of 12.11 3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16 26.13 months (range 12-113 months). A post-surgical intraocular pressure of < 16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2 percent, 78.7 percent, 60.7 percent and 50.8 percent, respectively. The cumulative probability of failure was 40.8 percent at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88 percent) after an average 36.96 months (range: 1.7-106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak. DISCUSSION: It has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30 percent to 50 percent of cases. In our study, treatment was considered successful in 63 eyes (55.26 percent) within 61.16 26.13 months of follow-up. CONCLUSIONS: Trabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults.

Influência da terapia hormonal sobre a pressão ocular de mulheres na pós-menopausa / The influence of hormonal therapy on intraocular pressure in post-menopausal women

Casuística e métodos: estudo prospectivo, randomizado, com amostra constituída por 58 olhos de 58 mulheres na pós-menopausa, com indicação clínica de terapia hormonal, divididas em dois grupos: terapia hormonal (n=32) e grupo controle placebo (n=26). As pacientes foram avaliadas quanto à pressão ocular, paquimetria, ceratometria e dosagens dos hormônios sexuais. Resultados: a pressão ocular média do grupo com terapia hormonal foi de 14,08  1,96 mmHg no pré- tratamento, e 13,22  2,16 mmHg (30 dias), 13,22  2,35 mmHg (60 dias) e 13,12 2,34 mmHg (90 dias) no pós-tratamento (p=0,0009); no grupo placebo a pressão ocular média variou de 13,81  3,28 mmHg (pré-tratamento), para 13,30  3,58 mmHg (30 dias),13,05 3,52 mmHg (60 dias) e 13,12  3,02 mmHg ( 90 dias) (p = 0,108). Conclusões: As pressões oculares médias foram semelhantes entre os grupos terapia hormonal e placebo. O grupo terapia hormonal apresentou redução significativa da pressão ocular. Houve correlação direta entre as pressões oculares médias e níveis hormonais de LH e FSH, e correlação inversa com níveis hormonais de estradiol / Subject and Methods: A prospective, randomized, controlled study on 58 women at least 1 year after spontaneous menopause. Thirty two women were treated with noretisterone acetate (1 mg/day) and estradiol (2 mg/day). Twenty six women were treated with placebo. All participants underwent eye examination at the beginning of the study and after one, two and three months of therapy, with IOP measure, corneal thickness and corneal curvature. Serum levels were measured for estradiol, luteinizing hormone, follicle stimulating hormone (FSH) and progesterone. Results: The mean IOP of hormone therapy group was 14,08  1,96 mmHg before therapy and 13,22  2,16 mmHg (1 month), 13,22  2,35 mmHg (2 months) e 13,12 2,34 mmHg (3 months) (p=0,0009); placebo group the mean IOP was 13,81  3,28 mmHg (before), 13,30  3,58 mmHg (1 month),13,05 3,52 mmHg (2 months) e 13,12  3,02 mmHg ( 3 months) (p = 0,108). . No significant differences were observed between the two groups at all visits (before and 1,2,3 months after treatment)...