RESUMO
PURPOSE: This study was performed to determine if adjunctive use of mitomycin C (MMC) would increase the success of combined phacoemulsification, intraocular lens implantation, and trabeculectomy surgery with releasable sutures. METHODS: Seventy-two eyes with cataract and glaucoma, requiring surgery for decreased vision, uncontrolled intraocular pressure, or to obtain a better view of the optic nerve, were randomized to receive a 2.5-minute subconjunctival exposure to either MMC (0.5 mg/ml) or placebo balanced salt solution. Postoperative evaluations at 3, 6, and 12 months were performed by a masked observer who recorded visual acuity, intraocular pressure, glaucoma medications, presence of filtering blebs, and complications. Endothelial cell counts were measured before and 3 months after surgery. RESULTS: The MMC group had significantly greater reduction in mean intraocular pressure through the first 12 months of follow-up (7.05-7.65 mmHg versus 2.62-3.84 mmHg; P = 0.001-0.028). In addition, through the first 6 months of follow-up, the MMC group required significantly fewer medications (0.4-0.5 versus 1.1-1.2; P = 0.002-0.004). Requirements for additional glaucoma surgery were less in the MMC group (4/ 36) than in the placebo group (7/35) (P = 0.301). Filtering blebs were significantly larger at 6 and 12 months (P = 0.002 and P = 0.001, respectively), and would leaks were more common (P = 0.101) in the MMC group. The mean decrease in endothelial cell count at month 3 was slightly, although not significantly, greater in the MMC treatment group (206.9 versus 91.3 cells/mm2* P = 0.377). CONCLUSION: The increased success of the glaucoma procedure in the MMC group together with relatively minor toxicity, suggests its use is beneficial in combined glaucoma-cataract surgery.
Assuntos
Glaucoma/cirurgia , Lentes Intraoculares , Mitomicina/uso terapêutico , Inibidores da Síntese de Ácido Nucleico/uso terapêutico , Facoemulsificação , Trabeculectomia , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Quimioterapia Adjuvante , Método Duplo-Cego , Endotélio Corneano/citologia , Feminino , Seguimentos , Glaucoma/tratamento farmacológico , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Acuidade VisualRESUMO
Rieger syndrome is a genetically and phenotypically heterogeneous disorder typically characterized by malformations of the eyes, teeth, and umbilicus. The syndrome is inherited as an autosomal dominant trait and exhibits significant variable expressivity. One locus associated with this disorder has been mapped to 4q25. Using a large four-generation pedigree, we have identified a second locus for Rieger syndrome located on chromosome 13q14.
Assuntos
Anormalidades Múltiplas/genética , Mapeamento Cromossômico , Cromossomos Humanos Par 13/genética , Oftalmopatias Hereditárias/genética , Adolescente , Anormalidades do Olho/genética , Genes Dominantes/genética , Glaucoma/genética , Humanos , Masculino , Linhagem , Síndrome , Anormalidades Dentárias/genética , Umbigo/anormalidadesRESUMO
The use of 5-Fluorouracil (5-FU) to inhibit scarring following filtration surgery has been hampered by corneal epithelial defects and their accompanying inflammation. This toxicity, which occurs during the crucial period in which the risk of bleb failure is highest, has previously been a relative contraindication to further 5-FU use. We have found the early placement of a therapeutic bandage contact lens permits extended administration of 5-FU during this period, minimizing discomfort and inflammation as well as enhancing bleb survival.
