Background: We assessed bleb morphology and the intraocular pressure (IOP)-lowering effect of trabeculectomy with ologen compared to mitomycin C (MMC) in juvenile open-angle glaucoma (JOAG). Methods: This is a prospective interventional comparative study conducted on 40 eyes (20 patients) with medically uncontrolled JOAG, randomly operating one eye for trabeculectomy with ologen (group A: 20 eyes) and the other with MMC (group B: 20 eyes). IOP measurement, SITA standard perimetry, and spectral domain optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness were all done pre- and postoperatively. Postoperative blebs were assessed clinically using the Moorfields bleb grading system (MBGS) and anterior segment OCT (AS-OCT). All patients were examined for up to 1 year postoperatively. Results: The mean postoperative IOP was statistically significantly lower than the mean preoperative IOP at each follow-up in each group. At 1 year, the mean postoperative IOP was significantly lower in group A. According to the MBGS, blebs with an ologen implant showed significantly better scoring than those with MMC. AS-OCT showed that ologen-induced blebs had significantly more fluid-filled spaces, cleavage planes, and less fibrosis. Conclusion: Ologen resulted in a lower long-term postoperative IOP, a better bleb morphology, and fewer complications. Our results suggest that ologen may be a useful alternative to MMC in JOAG.
One hundred fifty-one unilateral cataract patients were randomly assigned to receive either a one-piece Staar AA-4203 silicone intraocular lens inserted through a 3.5 mm incision, an loptex 5 mm x 6 mm oval optic lens inserted through a 5.5 mm incision, or an AMO three-piece modified C-loop 6.0 round optic poly(methyl methacrylate) lens inserted through a 6.5 mm incision. Follow-up was 97% at two days postoperatively and 84% at one week and two months postoperatively. At one week postoperatively, 62% of 3.5 mm incision cases had uncorrected visual acuity of 20/40 or better compared with 33% of 5.5 mm (P < .01) and 43% of 6.5 mm incision cases. At two months postoperatively, 85% of 3.5 mm incision cases had uncorrected visual acuity of 20/40 or better compared with 64% of 6.5 mm (P < .05) and 71% of 5.5 mm incision cases. The 3.5 mm incision cases had significantly less total keratometric cylinder than other cases at all postoperative examinations (P < or = .001) and less surgically induced cylinder at two days and one week post-operatively (P < or = .02). The 5.5 mm and 6.5 mm incision cases did not differ significantly in visual acuity or astigmatism at any examination.
The combined procedure appeared to be a sound method of providing visual rehabilitation and adequate IOP control. The use of the capsular wick seemed to help maintain glaucoma filtration.
We used releasable sutures to minimize immediate postoperative hypotony and flat anterior chamber in 19 cases of refractory glaucoma requiring insertion of a single-plate Molteno implant in a one-stage procedure. A slip knot using 7-0 nylon suture was fashioned around the Molteno tube under a lamellar scleral flap. In 18 of the 19 eyes, anterior chamber depth was normal immediately after surgery.
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