ABSTRACT
PURPOSE: To compare surgical outcomes in neovascular glaucoma patients who underwent trabeculectomy with mitomycin C versus Ahmed Glaucoma Valve implantation. PATIENTS AND METHODS: This was a retrospective comparative case series. We reviewed 40 eyes of 39 patients with underlying diagnosis of neovascular glaucoma, divided into two groups: Ahmed Glaucoma Valve (N = 20) and trabeculectomy with mitomycin C (N = 20). Surgical success was defined as 6 mm Hg ≤ intraocular pressure ≤21 mm Hg, with or without the use of glaucoma medications, with no further glaucoma surgery, and light perception or better vision. Early postoperative hypotony was defined as intraocular pressure <5 mm Hg during the first postoperative week. RESULTS: The average follow-up was 31 months (range 6-87 months) for the Ahmed Glaucoma Valve group and 25 months (6-77 months) for the trabeculectomy group. Although the mean number of postoperative intraocular pressure-lowering medications was significantly higher in the trabeculectomy group compared with the Ahmed Glaucoma Valve group at 3 and 6 month time points, there was no statistically significant difference at any other time point. There was no statistically significant difference between both groups in postoperative visual acuity and intraocular pressure. Success was 70% and 65% at 1 year and 60% and 55% at 2 years after Ahmed Glaucoma Valve and trabeculectomy, respectively. Kaplan-Meier survival curve analysis showed no significant difference in success between the two groups (P = 0.815). Hyphema was the most common complication in both groups. CONCLUSION: We found similar results after trabeculectomy with mitomycin C and Ahmed Glaucoma Valve implantation in eyes with neovascular glaucoma.
ABSTRACT
A 48-year-old woman with a history of chronic intranasal cocaine abuse presented with unilateral proptosis associated with severe visual loss from optic neuropathy in the right eye. Imaging showed extensive bone and soft tissue destruction in the paranasal region and an orbital mass. Initial biopsies suggested a low-grade neoplasm. The correct diagnosis was established only on repeat biopsy, which revealed marked pleomorphism and nonspecific chronic inflammation with irregular collagen bundles containing thick-walled blood vessels. This case emphasizes that intranasal cocaine abuse may clinically, radiographically, and histopathologically mimic a neoplasm or a necrotizing vasculitis.
Subject(s)
Cocaine-Related Disorders/complications , Optic Nerve Diseases/etiology , Orbital Diseases/etiology , Paranasal Sinus Diseases/etiology , Administration, Intranasal , Blindness/diagnosis , Blindness/etiology , Cellulitis/diagnosis , Cellulitis/etiology , Chronic Disease , Cocaine/adverse effects , Exophthalmos/diagnosis , Exophthalmos/etiology , Female , Fibrosis/pathology , Humans , Middle Aged , Nasal Cavity/pathology , Optic Nerve Diseases/diagnosis , Orbit/pathology , Orbital Diseases/diagnostic imaging , Paranasal Sinus Diseases/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
PURPOSE: Previously reported clinical outcomes after treatment of congenital iris cysts have been poor, complicated by cyst recurrence and vision loss. Our purpose was to evaluate the outcomes of surgical excision and microdiathermy of congenital iris cysts. DESIGN: Interventional retrospective case series. METHODS: Four patients (3 children, 1 adult) were treated for a congenital iris cyst based on history and clinical presentation. After cyst excision with caution to avoid cyst rupture, the base of the cyst was treated with microdiathermy. MAIN OUTCOME MEASURE: Presence or absence of a residual cyst after surgical intervention. RESULTS: In all 4 patients, histopathological findings confirmed the diagnosis of a congenital iris cyst. Follow-up periods ranged from 1.4 to 6.2 years (mean +/- standard deviation, 4+/-2). Vision loss did not occur in any of the treated eyes. No cyst recurrence was noted after initial surgical treatment. CONCLUSION: A modern microsurgical technique with adjunctive use of microdiathermy provides improved outcomes in the surgical management of congenital iris cysts. We believe that microdiathermy applied to the base of the cyst removes residual epithelial tissue that accounted for the recurrences documented in previous reports.
Subject(s)
Cysts/surgery , Diathermy/methods , Iris Diseases/surgery , Ophthalmologic Surgical Procedures , Pigment Epithelium of Eye/surgery , Child , Child, Preschool , Combined Modality Therapy , Cysts/congenital , Female , Humans , Iris Diseases/congenital , Male , Middle Aged , Pigment Epithelium of Eye/pathology , Retrospective Studies , Visual AcuityABSTRACT
Altered mucosal integrity and increased cytokine production, including tumor necrosis factor (TNF), are the hallmarks of inflammatory bowel disease (IBD). In this study, we addressed the role of TNF receptors (TNFR) on intestinal epithelial cell migration in an in vitro wound closure model. With mouse TNFR1 or TNFR2 knockout intestinal epithelial cells, gene transfection, and pharmacological inhibitors, we show a concentration-dependent receptor-mediated regulation of intestinal cell migration by TNF. A physiological TNF level (1 ng/ml) enhances migration through TNFR2, whereas a pathological level (100 ng/ml) inhibits wound closure through TNFR1. Increased rate of wound closure by TNFR2 or inhibition by TNFR1 cannot be explained by either increased proliferation or apoptosis, respectively. Furthermore, inhibiting Src tyrosine kinase decreases TNF-induced focal adhesion kinase (FAK) tyrosine phosphorylation and cellular migration. We therefore conclude that TNFR2 activates a novel Src-regulated pathway involving FAK tyrosine phosphorylation that enhances migration of intestinal epithelial cells.
