Long-term Outcomes of Needle Revision of Trabeculectomy Blebs With Mitomycin C and 5-Fluorouracil

Anand, Nitin; Khan, Aldrin

doi:10.1097/ijg.0b013e3181911271

Cited by 79 publications

(92 citation statements)

References 29 publications

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“…It is possible that the laser application promoted holes in the scleral flap, which had been weakened by the use of mitomycin C. Success rates (of varying definitions) of 7% to 69% have been reported for needling alone and of 75% to 94% for nee- tiple needlings are frequently necessary, and complications such as hyphema and shallow anterior chamber may occur. 6,8,9 Serous choroidal detachment, bleb leakage, encapsulated bleb, mild vitreous hemorrhage, punctate keratopathy, corneal edema, blebitis, suprachoroidal hemorrhage, and endophthalmitis have also been reported. 8,9,27,28,[30][31][32][33] In contrast, goniopuncture is noninvasive and has been widely used after deep sclerectomy, with low complication rates.…”

Section: 22mentioning

confidence: 94%

Nd:YAG Laser Goniopuncture for Late Bleb Failure After Trabeculectomy With Adjunctive Mitomycin C

Susanna

Moraes²,

Alencar

et al. 2014

JAMA Ophthalmol

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IMPORTANCEThere is an increasing need to prolong trabeculectomy success rates with minimally invasive procedures.OBJECTIVE To investigate the safety and efficacy of Nd:YAG laser goniopuncture (LGP) in lowering intraocular pressure (IOP) in eyes having late bleb failure following trabeculectomy with mitomycin C administration. DESIGN, SETTING, AND PARTICIPANTS Prospective, noncomparative, interventional cohort at a referral glaucoma practice, including 19 eyes of 19 patients with uncontrolled glaucoma after failed trabeculectomy.INTERVENTIONS All eyes had ischemic nonfunctioning blebs with patent internal ostia and underwent Nd:YAG LGP, followed by a 5-fluorouracil injection. MAIN OUTCOMES AND MEASURESThe IOP and the number of antiglaucoma medications before and after the procedure, as well as presurgical and postsurgical appearance of the blebs, using the Indiana Bleb Appearance Grading Scale classification. RESULTSThe mean (SD) time of LGP after trabeculectomy was 35.7 (32.3) months, and the mean (SD) follow-up period after LGP was 6.0 (1.1) months (range, 4.4-8.4 months). The mean (SD) IOP had decreased from 20.9 (4.5) mm Hg (range, 15.5-29.0 mm Hg) to 11.9 (4.1) mm Hg (range, 5.0-21.0 mm Hg) (P < .001). The only complications observed after LGP were 2 cases of hypotony, which resolved spontaneously. Compared with baseline Indiana Bleb Appearance Grading Scale classifications, 2 eyes showed an increase in bleb height and 10 eyes showed an increase in bleb extension. None of the eyes had a positive Seidel test result. The mean (SD) number of hypotensive agents per eye had decreased from 0.7 (1.1) to 0.3 (0.7) after the procedure. At the last follow-up visit, 15 eyes (79%) had achieved an IOP of 15 mm Hg or less, with a minimum IOP reduction of 20% from baseline without medication use. CONCLUSIONS AND RELEVANCEThe Nd:YAG LGP is a safe and effective procedure for lowering IOP in eyes with ischemic nonfunctioning blebs and patent trabeculectomy ostia. This is a promising solution to rescue failed trabeculectomies and can potentially prolong trabeculectomy success rates.

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Section: 22mentioning

confidence: 94%

Nd:YAG Laser Goniopuncture for Late Bleb Failure After Trabeculectomy With Adjunctive Mitomycin C

Susanna

Moraes²,

Alencar

et al. 2014

JAMA Ophthalmol

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“…Like 5-FU, mitomycin-C is a potent antibacterial agent and inhibits vascularization (Tomasz 1995). There is some evidence that mitomycin-C is longer acting and better suited for topical application than 5-FU (Anand and Khan 2009;Kim et al 2008). However, we have not made any direct comparisons of the two agents.…”

Section: Discussionmentioning

confidence: 99%

A watertight acrylic-free titanium recording chamber for electrophysiology in behaving monkeys

Adams¹,

Economides²,

Jocson³

et al. 2011

Journal of Neurophysiology

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Neurophysiological recording in alert monkeys requires the creation of a permanent aperture in the skull for repeated insertion of microelectrodes. Most laboratories use polymethyl methacrylate to attach a recording chamber over the skull opening. Here, we describe a titanium chamber that fastens to the skull with screws, using no polymethyl methacrylate. The gap between the base of the chamber and the skull is filled with hydroxyapatite, forming a watertight gasket. As the chamber base osseointegates with the skull, the hydroxyapatite is replaced with bone. Rather than having a finite lifetime, the recording chamber becomes more firmly anchored the longer it is in place. It has a small footprint, low profile, and needs little maintenance to control infection. Toilette consists of occasional application of betadine to clean the scalp margin, followed by application of neomycin, polymyxin, and bacitracin ointment. Antibiotic is also placed inside the chamber to suppress bacterial proliferation. Thickening of the dura within the chamber can be prevented by regular application of mitocycin C and/or bevacizumab, an antibody against vascular endothelial growth factor. By conducting an e-mail survey, this protocol for chamber maintenance was compared with procedures used in 37 other vision research laboratories. Refinement of appliances and techniques used for recordings in awake monkeys promises to increase the pace of scientific discovery and to benefit animal welfare.

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“…Antiproliferative agents have the potential to cause other complications such as corneal epithelial defects with 5-FU, late bleb leaks and bleb-related endophthalmitis with MMC [93]. To minimize these complications and risk of failure from excessive scarring and fibrosis, shunting devices have been used as a primary surgical procedure for IOP control in uveitic patients.…”

Section: Reviewmentioning

confidence: 99%

Intraocular pressure elevation in uveitis

Din

Isa

Taylor

et al. 2012

Expert Review of Ophthalmology

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Long-term Outcomes of Needle Revision of Trabeculectomy Blebs With Mitomycin C and 5-Fluorouracil

Abstract: This study suggests that MMC is more effective than 5-FU for needle revision of failed trabeculectomy blebs.

Cited by 79 publications

References 29 publications

Nd:YAG Laser Goniopuncture for Late Bleb Failure After Trabeculectomy With Adjunctive Mitomycin C

Nd:YAG Laser Goniopuncture for Late Bleb Failure After Trabeculectomy With Adjunctive Mitomycin C

A watertight acrylic-free titanium recording chamber for electrophysiology in behaving monkeys

Intraocular pressure elevation in uveitis

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