ABSTRACT.Purpose: To study the epidemiology and risk factors of early-and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy. Methods: Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared. Results: The joint rate of infection was 0.46% or 34 incidents in 7402 procedures. The frequency of early (occurring <6 weeks after surgery) onset PE was 0.19%, late PE was 0.19% and severe blebitis was 0.08%. Dominating aetiologies were staphylococci and streptococci. Overall, the infection severely impaired the visual function. Combined cataract and fistulating operations were less prone to develop late infections, p = 0.04, but no other decisive factors were identified in the case-control study. Data collection for all trabeculectomy surgeries from 1998 and onward identified an increased rate for late infection with the use of mitomycin C (MMC), 8 in 1171 surgeries or 0.7%, versus no such use, 0 case of late PE in 2136 surgeries, p < 0.001. Conclusions: Postoperative endophthalmitis is a devastating complication after trabeculectomy. The use of MMC increases the risk for delayed infection. Early PE after trabeculectomy is clearly more common than PE after cataract surgery. Developing efficacious prophylactic antibiotic regimens to reduce early PE after penetrating filtering procedures should be a major priority in ophthalmic surgery.
In order to determine the risk for bilateral blindness from glaucoma and to which extent other diseases are responsible for the disability, the registers of low vision clinics were surveyed. All registered patients still alive in 1991 with the diagnosis of glaucoma were included. Eighteen hundred and ninety-five patients fulfilled these criteria. Blindness was defined as bilateral visual acuity < or = 0.1. The majority of the patients (68%) had a visual acuity better than 0.1. The remaining 590 patients had a visual acuity < or = 0.1. In this latter group glaucoma was the reason for the low visual acuity in 20%, glaucoma in combination with other eye diseases in 35% and other eye diseases in 44%. Macular degeneration and cataracts were the main causes of the low vision in the latter group. The prevalence of glaucoma blindness in the Stockholm region was found to be 0.007% for glaucoma and 0.020% for glaucoma in combination with other eye diseases.
ABSTRACT.Purpose: To histochemically analyze if the glycoseaminoglycan component of pseudoexfoliation material consists of hyaluronan. Methods: The hyaluronan binding region of cartilage proteoglycans was utilized in a staining specific for hyaluronan. The technique has been described and employed previously. Human donor eyes with and without the presence of visible pseudoexfoliations were analyzed. Results: Hyaluronan was found to coat the fibrillar exfoliation material on the lens, the zonules, the iris epithelium and the ciliary body. It was also found on a capsular bag following cataract surgery. Conclusion: In the anterior chamber hyaluronan constitutes one part of the exfoliation material. Abnormal findings of hyaluronan could be found in the cornea.
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