Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas.

PURPOSE: To evaluate the effectiveness and safety of trabeculectomy with mitomycin-C (MMC) in the management of childhood glaucomas. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: All patients less than 18 years of age who underwent trabeculectomy with MMC from June 1991 through October 1997 were included. METHODS: The medical records of 29 consecutive patients (29 eyes) were reviewed. Data collected during routine patient follow-up were analyzed. Surgical outcome was evaluated using Kaplan-Meier life-table analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment included intraocular pressure (IOP) control, visual acuity, and identification of complications. Successful IOP control was defined as 5 mmHg < or = final IOP < or = 21 mmHg, with or without antiglaucoma medications and without further glaucoma surgery or loss of light perception. Outcomes for the group of patients with primary infantile glaucoma were compared with those for the group with secondary glaucomas. RESULTS: Mean patient age was 6.4 +/- 4.4 years (range, 0.2-15.3 years). A variety of primary and secondary glaucomas were represented. Mitomycin-C (0.5 mg/ml) on a surgical sponge was applied to the episcleral surface for an average of 3.8 +/- 1.0 minutes (range, 1.5-5.0 minutes). Mean follow-up time for patients categorized as successes was 25.1 +/- 16.0 months (range, 5.5-59.7 months). The 12-, 24-, and 36-month life-table success rates for IOP control were 82%, 59%, and 59% respectively. There was no difference between the primary infantile glaucoma group and the secondary glaucoma group with respect to length of follow-up, rate of successful IOP control, and incidence of complications. Five patients (17%) experienced late bleb-related infection (BRI) at an average of 27.9 +/- 18.1 months (range, 5.4-55.5 months) after surgery. Other complications included hyphema, retinal detachment, late-onset bleb leak, flat anterior chamber, chronic hypotony, decompression retinopathy, suture abscess, and phthisis. CONCLUSIONS: Trabeculectomy with MMC may be useful in the management of childhood glaucomas in which goniotomy, trabeculotomy, or both have failed. However, the high incidence of BRI in this series over an extended follow-up interval dictates caution in using MMC as an adjunct in pediatric trabeculectomy.

Free and conjugated chlorin E6 in the photodynamic therapy of human bladder carcinoma cells.

Photodynamic therapy is an experimental modality for treatment of superficial bladder cancer, and consists of the administration of a photosensitizer and subsequent tumor-irradiation with light. Presently hematoporphyrin derivative (HPD) is the only photosensitizer in experimental clinical use in the United States. Because of the high nonspecific phototoxicity of HPD, new methods of photosensitization have been sought. In this study we compared chlorin e6, free and conjugated to 1-micron.-diameter latex microspheres. Phototoxicity was evaluated on MGH-U1 cells derived from a human bladder carcinoma. MGH-U1 cells were preincubated for 18 hours either with free Ce6 (0.43 microM) or Ce6-microspheres (0.43 microM equivalent in Ce6) and irradiated with an argon-laser-pumped dye laser emitting at 659 nm., over the radiant-exposure range of 5-50 J/cm. At 24 hours after light exposure the cells were observed microscopically for morphological alteration and evaluated for cell death by trypan blue exclusion. Cultures incubated with Ce6-microspheres and subsequently irradiated showed morphologic evidence of cell damage, apparent after irradiation with five J/cm. and a light dose dependent decrease in cell survival. In contrast, cells incubated with free Ce6 at the same concentration of 0.43 microM and subsequently irradiated demonstrated neither detectable morphologic alteration nor change in cell survival. Only cells preincubated with free Ce6 at higher concentration showed morphologic changes. Thus, Ce6-microsphere conjugate was much more efficient at inducing photodynamic destruction of bladder carcinoma cells than was free Ce6.

Gamma-interferon effects on human fibroblasts from Tenon's capsule.

Gamma-interferon (G-IFN) exhibits antiproliferative effects, inhibits collagen synthesis by fibroblasts, and may help to regulate the turnover of fibrous tissue. Fibroblasts from Tenon's capsule are cellular components that contribute to unsuccessful glaucoma filtration surgery. Therefore, the authors studied the effects of G-IFN on growth, wound closure, collagen synthesis, and extracellular matrix in cultured human Tenon's capsule fibroblasts (HTCF). HTCF incubated with G-IFN at doses of 1 to 1000 U/ml showed cellular heterogeneity, with some cells showing morphologic changes characteristic of senescence, and a dose-dependent inhibition of wound closure. At 1000 U/ml, G-IFN reduced collagen synthesis by 57%, reduced immunofluorescent staining of collagen type I and fibronectin network, and altered the organization of actin microfilaments into large cable-like structures. Cell proliferation and viability were not affected at any concentration of G-IFN. These results suggest that G-IFN may be useful to modulate wound healing after filtration surgery.

Asymmetric breast tissue.

A prospective study was undertaken to evaluate the significance of asymmetric breast tissue (asymmetric volume of breast tissue, asymmetrically dense breast tissue with preserved architecture, or asymmetrically prominent ducts) on mammograms. Of 8,408 mammograms obtained in 1985, 221 (3%) demonstrated asymmetric breast tissue. Follow-up was 36-42 months after the initial mammographic study. During this time none of the patients underwent biopsy on the basis of mammographic findings, although 20 underwent excisional biopsy because of clinical findings. Breast cancer was diagnosed in two patients and breast lymphoma in one patient. Biopsy specimens from the remaining 17 patients were benign. At mammography, all three malignant lesions had a palpable abnormality associated with the asymmetric tissue. Breast cancer was not found in any of the remaining 201 patients. Therefore, an asymmetric volume of breast tissue, asymmetrically dense breast tissue, or asymmetrically prominent ducts that do not form a mass, do not contain microcalcifications, or do not produce architectural distortion should be viewed with concern only when associated with a palpable asymmetry and are otherwise normal variations.