[Follow-up of trabeculectomy. Complications and therapeutic consequences]. / Nachbetreuung von Trabekulektomien. Komplikationen und therapeutische Konsequenzen.

BACKGROUND: Intensive follow-up after trabeculectomy is important for long-term success. In the postoperative period, complications must be detected early in order to initiate adequate therapeutic measures. PATIENTS AND METHODS: In a retrospective study 113 eyes from 113 consecutive patients were followed-up for a period of 6 months after trabeculectomy with regard to postoperative complications and therapeutic decisions (invasive and conservative). Criteria of success were defined as an intraocular pressure (IOP) < 21 mmHg without antiglaucomatous treatment as well as an IOP reduction > 20% compared to the preoperatively treated IOP. RESULTS: Most of the postoperative complications occurred within the first 3 weeks: scarring of the filtering bleb (47.6%), choroidal detachment (18.6%), shallowing of the anterior chamber (8%), fibrinous reaction (5.3%), overfiltration (4.4%), reduced flow under the scleral flap (4.4%), corneal dellen (3.5%), prolapse of the iris (3.5%), external fistulation (2.7%), increase of the IOP due to steroids (1.8%), detachment of the ciliary body (1.8%) and malignant glaucoma (0.9%). In the postoperative period, 45.1% of the eyes needed further interventions such as 5-fluorouracil (5-FU) injections (28.3%), needling and 5-FU-injections (14.2%), laser suturolysis (6.2%). Repositioning of the iris, YAG-laser iridotomy, laser treatment of the filtering bleb, autologous blood injection and cyclocryoapplication were needed only in rare cases and 36.3% received other conservative treatment (i.e. modification of topical steroids, increase of cycloplegic treatment). After 6 months the success rate without antiglaucoma medication was 88.5%. CONCLUSIONS: An intensive follow-up after trabeculectomy is mandatory to avoid postoperative failure. In about half of the patients postoperative additional therapeutic measures became necessary, particularly if scarring of the filtering bleb occurred. Paying attention to these factors yields in a high success rate after filtering surgery.

[Bone growth after finger replantation in childhood]. / Das Knochenwachstum nach Fingerreplantationen im Kindesalter.

Following replantation in childhood, growth disorders of the affected epiphysis can influence function and aesthetic appearance of the hand. In a retrospective study long-term results of replantation in the upper limb in childhood were analysed with respect to factors influencing further growth. 22 patients with 29 replanted fingers were reviewed clinically and radiologically after an average interval of ten years. An average bone growth of 93% compared to the contralateral non-injured side was found. With the epiphysis affected, bone growth was reduced to 86% of the contralateral side. Analysis of single phalanges showed a growth rate of 71 to 100% in phalanges distal to the amputation and also in phalanges initially severed. Potential factors influencing bone growth were assessed separately. Best results were achieved in straight injuries without epiphyseal affection. An influence of anoxia time or number of anastomosed vessels could not be found. Even though replantation in childhood affects growing bone, almost normal bone growth can be expected afterwards.

Success criteria and success rates in trabeculectomy with and without intraoperative antimetabolites using intensified postoperative care (IPC).

PURPOSE: To define the success rate of trabeculectomy for surgical treatment of glaucoma under intensified postoperative care (IPC) conditions in cases of severe visual field damage or progression of visual field loss. METHODS: In a retrospective study, we evaluated the outcome of trabeculectomy in 99 eyes of 99 patients from October 1995 to June 1997. In 23 eyes, antimetabolites were used intraoperatively. Regarding intraocular pressure (IOP), success was defined as lowering the preoperative, maximally treated IOP by more than 20% in addition to a postoperative IOP level lower than 21 mmHg without using further glaucoma medication. Success rate was defined by stabilisation of visual acuity and visual field in addition to IOP reduction. RESULTS: The postoperative IOP was 14.7 mmHg (+/- 3.4 mmHg) following standard trabeculectomy (preoperative IOP 24.3 +/- 6.7 mmHg) and 15.8 mmHg (+/- 4.9 mmHg) following trabeculectomy with intraoperative antimetabolites (preoperative IOP 27.0 +/- 9.5 mmHg). The success rate concerning the IOP was 83% in standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. The visual acuity showed stabilisation in 93% of cases following standard trabeculectomy and in 100% following trabeculectomy with intraoperative antimetabolites. The visual field showed stabilisation according to the Aulhorn criteria in 95% and 94% of cases following standard trabeculectomy and trabeculectomy with intraoperative antimetabolites, respectively. The total success rate using all criteria together was 76% following standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. CONCLUSION: The overall outcome after trabeculectomy is good with appropriate follow-up and timely decisions for after-treatment to ensure good development of the filtering bleb.

Ocular ochronosis in alkaptonuria patients carrying mutations in the homogentisate 1,2-dioxygenase gene.

AIMS: To assess the involvement of the recently identified human homogentisate 1,2-dioxygenase gene (HGO) in alkaptonuria (AKU) in two unrelated patients with ochronosis of the conjunctiva, sclera, and cornea. METHODS: A mutation screen of the entire coding region of the HGO gene was performed using single stranded conformational analysis after polymerase chain reaction with oligonucleotide primers flanking all 14 exons of the HGO gene. Fragments showing aberrant mobility were directly sequenced. RESULTS: Two homozygous missense mutations, L25P and M368V, were identified, each of which leads to the replacement of a highly conserved amino acid in the HGO protein. CONCLUSIONS: The authors describe a novel mutation, L25P, in the German population and bring to 18 the total number of known HGO mutations.