Purpose:To prospectively investigate the incidence of postoperative ptosis following trabeculectomy by comparing preoperative and postoperative margin reflex distance (MRD), and to analyze the clinical factors associated with ptosis.Patients and Methods:Patients who underwent trabeculectomy with mitomycin C in unilateral eye between 2010 and 2012 were enrolled. MRD was measured before and 3 and 6 months after trabeculectomy. The MRD is the distance between the light reflex at central cornea and the upper eyelid margin when the patient gazed at a pen light placed 50 cm away straightly. Postoperative ptosis was defined as a decrease in MRD≥2 mm from preoperative level. The correlation among ΔMRD (difference between preoperative and 6 mo postoperative MRD) and clinical factors comprising age, spherical equivalent, preoperative MRD, 6-month postoperative intraocular pressure (IOP), and IOP reduction (difference between preoperative and 6 mo postoperative IOP) was analyzed.Results:Thirty-six patients (36 eyes) were analyzed. Preoperative median MRD was not different between the operated eye and nonoperated fellow eye (both 4.0 mm, P=0.65). The 3- and 6-month postoperative MRD in the operated eye were significantly reduced compared with preoperative MRD (3.0 mm, P=0.04 and 2.5 mm, P=0.01, respectively). The 3- and 6-month postoperative MRD in the nonoperated eye were not different from preoperative MRD (4.0 mm, P=0.81 and 4.0 mm, P=0.85, respectively). The incidence of ptosis at 6 months after operation was 19% (7 of 36 eyes). The IOP was significantly decreased at 3 and 6 months after operation (both P<0.01). No correlation was observed between ΔMRD and all the factors analyzed.Conclusions:Ptosis is a major complication following trabeculectomy with mitomycin C, with an incidence of 19% at 6 months after operation.
Ovarian developmental stages and serum steroid hormone levels were examined at six different times of day (0100, 0600, 1000, 1300, 1600, 2000 h) in a marine teleost, the Japanese whiting Sillago japonica, which has an asynchronous-type ovary containing oocytes at various stages of development and spawns every day during a period ranging up to three months. The largest oocytes in the ovaries at the active vitellogenic or post-vitellogenic stages were found between 0100 and 1300 h. Oocyte maturation indicated by germinal vesicle breakdown (GVBD) occurred at 1600 h, and ovulated oocytes were observed in the ovaries collected at 2000 h. These processes were accompanied by a significant daily change in serum steroid hormone levels. The serum level of estradiol-17β showed a peak in fish with mature oocytes sampled at 1600 h. In these fish, the second-largest oocytes in the ovaries were at the initial stage of vigorous vitellogenesis, the secondary yolk stage. Therefore the highest level of serum estradiol-17β was considered to be due to the second-largest oocytes. Testosterone levels remained low and constant throughout the experimental period. The serum levels of 17α,20β-dihydroxy-4-pregnen-3-one (17α,20β-diOHprog) peaked at 1600 h at which time all fish had mature oocytes. These results indicate that the Japanese whiting possesses a diurnal rhythm of oocyte development including vitellogenesis, oocyte maturation and ovulation, and further suggest that daily cycles in oocyte growth and maturation which simultaneously take place in an ovary are regulated by diurnal secretions of estradiol-17β and the maturation-inducing steroid, 17α,20β-diOHprog.
Even though additional treatments such as repeated suture, suture removal, and needle revison were necessary in some cases, transconjunctival scleral flap resuturing is a simple and minimally invasive procedure that improves hypotony after glaucoma filtering surgery, with no serious complication.
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