RESUMEN
Se realizó una búsqueda sobre la evaluación cualitativa de la ampolla de filtración. La ampolla conjuntival es la parte visible de la cirugía filtrante, y su morfología es un indicador de factores que pueden determinar el resultado hipotensor de la cirugía y las posibles complicaciones posoperatorias. Se han desarrollado diversos estudios que relacionan la evaluación clínica de su morfología y el control de la presión intraocular, y se han establecido varios sistemas de puntuación, entre ellas: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale y métodos de imagen para evaluar el segmento anterior (biomicroscopia ultrasónica, Tomografía retinal de Heidenberg y tomografía de coherencia óptica). Estos métodos proporcionan una herramienta útil para el seguimiento de la cirugía filtrante y su documentación(AU)
A review was conducted on the qualitative evaluation of the filtering bleb. The conjunctival bleb is the visible part of filtration surgery, and its morphology is an indicator of factors which may determine the hypotensive result of surgery and the possible postoperative complications. Various studies have been conducted which relate the clinical evaluation of its morphology and intraocular pressure control. Several grading systems have thus been established: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale and imaging methods to evaluate the anterior segment (ultrasound biomicroscopy, Heidenberg retinal tomography and optical coherence tomography). These methods are a useful tool for the follow-up of filtration surgery and its documentation(AU)
Asunto(s)
Humanos , Glaucoma/cirugía , Cirugía Filtrante/efectos adversos , Tomografía de Coherencia Óptica/métodos , Estudios de Evaluación como AsuntoRESUMEN
La cirugía filtrante es una opción de tratamiento encaminada a disminuir la presión intraocular una vez que no hay respuesta a las alternativas no quirúrgicas. En los últimos años ha experimentado una evolución sorprendente. Aparecen nuevos dispositivos que buscan obtener un control tensional con las mínimas complicaciones; entre estos, el implante Ex-PRESS ha demostrado una efectividad similar a la trabeculectomía, mientras que la variante técnica para su implantación, descrita por Richard Hoffmann, posibilita excelentes resultados con menos dificultades. Se presenta un paciente masculino de 51 años de edad, de raza blanca, con antecedente de glaucoma, con agudeza visual mejor corregida de 100 VAR y presión intraocular de 32 mmHg. Se realizó implante de dispositivo Ex-PRESS (modelo P-50) mediante la técnica modificada de Richard Hoffmann, asociada al uso de mitomicina C al 0,2 por ciento en el transoperatorio. A los dos años se lograron tensiones oculares de 17 mmHg y agudeza visual mejor corregida de 100 VAR(AU)
Filtration surgery is a therapeutic option aimed at reducing intraocular pressure when there is no response to non-surgical alternatives. Filtration surgery has developed remarkably in recent years. New devices have emerged geared to achieving pressure control with minimum complications. Among them, Ex-PRESS implantation has shown to be as effective as trabeculectomy, and the technique described by Richard Hoffman provides excellent results with fewer difficulties. A case is presented of a male white 51-year-old patient with a history of glaucoma, best corrected visual acuity 100 VAR, and intraocular pressure 32 mmHg. Implantation was performed of an Ex-PRESS (model P-50) device by modified Richard Hoffman's technique associated to 0.2 percent mitomycin C in the perioperative period. Two years after surgery, ocular tensions of 17 mmHg and a best corrected visual acuity of 100 VAR had been achieved(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Trabeculectomía/métodos , Glaucoma/diagnóstico , Mitomicina/efectos adversos , Cirugía Filtrante/efectos adversos , Presión IntraocularRESUMEN
Resumo Relato de caso de um paciente de 46 anos com glaucoma juvenil de controle clínico insatisfatório, portador de retinosquise peripapilar que, após ser submetido à esclerectomia profunda não penetrante, evoluiu com descolamento seroso da retina neuro-sensorial. A associação entre retinosquise peripapilar e o descolamento seroso pós cirurgia filtrante é de ocorrência rara, tendo sido descrito apenas um caso na literatura. A partir deste relato temos por objetivo, além de enfatizar a raridade da associação, mostrar a importância de investigar retinosquise peripapilar em pacientes glaucomatosos, em especial se associada a camada de fibras nervosas, e a importância da explanação adequada aos pacientes de um possível descolamento seroso de retina no pós-operatório de cirurgia filtrante.
Abstract Case report of a 46-year-old patient with unsatisfactory clinical controlled juvenile glaucoma and peripapillary retinoschisis who, after being submitted to non-penetrating deep sclerectomy, evolved with serous detachment of the neurosensory retina. The association between peripapillary retinoschisis and serous detachment after filtering surgery is rare and only one case has been described in the literature. The purpose of this report is, besides to emphasize the rarity of the association, to show the importance of investigating peripapillary retinoschisis in glaucomatous patients, especially if associated with retinal nerve fiber layer, and the importance of adequate explanation to patients of possible serous detachment of retina in the postoperative of filtering surgery.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Desprendimiento de Retina/etiología , Glaucoma/cirugía , Cirugía Filtrante/efectos adversos , Retinosquisis/complicaciones , Disco Óptico , Retina/diagnóstico por imagen , Esclerótica/cirugía , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Desprendimiento de Retina/diagnóstico , Cirugía Filtrante/métodos , Tomografía de Coherencia Óptica , Presión Intraocular , Fibras NerviosasRESUMEN
Abstract Purpose: To describe the use of compressive suture (CS) in the prevention and management of adverse events associated with glaucoma surgery. Methods: This was a descriptive, retrospective study based on information retrieved from the records of patients submitted to glaucoma surgery between 1999 and 2012 at a regional main public hospital and at a private ophthalmology clinic belonging to one of the authors. Only cases with adverse events treated with CS were eligible. Results: Compressive suture was successfully used to improve the closure of the anterior and/or lateral edge of the conjunctival flap, to limit the downward extension of filtering blebs, to prevent excessive filtration from the scleral flap edge in cases of difficult closure with conventional suture, and in patients submitted to trabeculotomy-trabeculectomy. Conclusion: Safe, low-cost and easy to perform, compressive suture is a useful tool for the prevention and management of adverse events associated with glaucoma surgery.
Resumo Objetivo: Descrever o uso de sutura compressiva (SC) na prevenção e no manejo de complicações associadas à cirurgia antiglaucomatosa. Métodos: Trata-se de um estudo descritivo, retrospectivo, baseado em informações obtidas dos registros de pacientes submetidos à cirurgia de glaucoma entre 1999 e 2012 em um hospital público de referência regional e em uma clínica oftalmológica privada de um dos autores. Somente casos com eventos adversos tratados com SC foram selecionados. Resultados: A SC foi usada com sucesso para proporcionar melhor vedação nas bordas anterior e/ou lateral do retalho conjuntival, para limitar a extensão descendente das bolhas filtrantes, para evitar a filtração excessiva da borda do retalho escleral em casos de fechamento difícil pela sutura convencional, e em pacientes submetidos à trabeculotomia - trabeculectomia. Conclusão: Trata-se de um procedimento de fácil realização, seguro e de baixo custo, bastante útil na abordagem de intercorrências e complicações durante a cirurgia antiglaucomatosa.
Asunto(s)
Humanos , Trabeculectomía/efectos adversos , Glaucoma/cirugía , Técnicas de Sutura , Cirugía Filtrante/efectos adversos , Trabeculectomía/métodos , Registros Médicos , Estudios Retrospectivos , Complicaciones Intraoperatorias/prevención & controlRESUMEN
PURPOSE: Vascular endothelial growth factor (VEGF) may contribute to the scarring process resulting from glaucoma filtration surgery, since this cytokine may stimulate fibroblast proliferation. The aim of this study was to describe a new bevacizumab-loaded polyurethane implant (BPUI) and to evaluate its effectiveness as a new drug delivery system of anti-VEGF antibody in a rabbit model of glaucoma filtration surgery. METHODS: An aqueous dispersion of polyurethane was obtained via the conventional process. Bevacizumab (1.5 mg) was then incorporated into the dispersion and was subsequently dried to form the polymeric films. Films with dimensions of 3×3×1 mm that either did (group BPUI, n=10) or did not contain bevacizumab (group PUI, n=10) were implanted in the subconjunctival space, at the surgical site in 1 eye of each rabbit. The in vitro bevacizumab release was evaluated using size-exclusion high-performance liquid chromatography (HPLC), and the in vivo effects of the drug were investigated in a rabbit experimental trabeculectomy model by examining the bleb characteristics and collagen accumulation, and by performing immunohistological analyses of VEGF expression. RESULTS: HPLC showed that only 10% of the bevacizumab in the implants had been released by postoperative day 5. In vivo studies demonstrated that the drug had no adverse effects; however, no significant differences in either the bleb area score or the collagen deposit intensity between the group PUI and the group that BPUI were observed. Moreover, the group BPUI presented a significantly lower proportion of VEGF-expressing fibroblasts than group PUI (0.17±0.03 vs. 0.35±0.05 cells/field, P=0.005). CONCLUSIONS: This study demonstrated that bevacizumab release from the BPUIs only occurred for a short time probably from the surface of the films. Nevertheless, they were well tolerated in rabbit eyes and reduced the number of VEGF-expressing fibroblasts.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Portadores de Fármacos/química , Cirugía Filtrante , Glaucoma/cirugía , Poliuretanos/química , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Animales , Anticuerpos Monoclonales Humanizados/uso terapéutico , Bevacizumab , Cromatografía en Gel , Cicatriz/etiología , Cicatriz/metabolismo , Cicatriz/patología , Cicatriz/prevención & control , Conjuntiva/cirugía , Implantes de Medicamentos , Femenino , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Fibroblastos/patología , Cirugía Filtrante/efectos adversos , Conejos , Propiedades de SuperficieRESUMEN
Las infecciones relacionadas con la cirugía filtrante del glaucoma son graves, de difícil pronóstico visual y se consideran una complicación después de esta cirugía. Se realizó una revisión bibliográfica actualizada con el objetivo de describir los principales factores de riesgos, gérmenes causales, cuadro clínico, conducta terapéutica y pronóstico de la blebitis y endoftalmitis asociada a la cirugía filtrante del glaucoma. El diagnóstico temprano y el tratamiento adecuado de las blebitis previenen la aparición de endoftalmitis y la consecuente pérdida visual(AU)
The bleb-associated infections are severe complications after glaucoma filtering surgery, with poor visual prognosis. An update literature review was made to describe the main risks factors, causal germs, clinical manifestations, treatment and the prognosis of the blebitis and bleb-associated endophthalmitis. The early diagnosis and appropriate treatment of blebitis prevent the occurrence of endophthalmitis and consequent visual loss(AU)
Asunto(s)
Humanos , Glaucoma/cirugía , Cirugía Filtrante/efectos adversos , Infecciones del Ojo/etiología , Endoftalmitis/etiologíaRESUMEN
BACKGROUND AND OBJECTIVE: Integrins are the main mediators of the interaction between fibroblasts and extracellular matrix (ECM) during scar formation. The adhesion motive RGD (Arg-Gly-Asp) is contained in the ECM and is recognized by the integrin receptor. Soluble peptides containing the RGD sequence can compete with -RGD- contained in the ECM for binding to the integrin receptor and thus prevent cell adhesion and scar formation. MATERIALS AND METHODS: The peptides RGD (p602), GRGDSP (p603), GRGDSPCA (p604), and GGRGDSPCA (p605) were used in 25 glaucoma filtering surgeries in rabbits (five eyes per peptide and five with saline). RESULTS: Postoperative subconjunctival injections of peptides were given at days 0, 4, 8, 12, and 16. Bleb size, bleb survival, and signs of toxicity were examined. The GRGDSPCA and GGRGDSPCA showed an increase in bleb formation, size, and survival with no clinical signs of toxicity compared with controls (P < .008). Histopathologic evaluation confirmed inhibitory effects in scar formation with bleb formation, and transmission electron microscopy demonstrated that there was no toxicity to the ciliary body. CONCLUSION: These peptides were effective in controlling scar formation in glaucoma filtering surgery.
Asunto(s)
Cirugía Filtrante/efectos adversos , Glaucoma/cirugía , Oligopéptidos/farmacología , Complicaciones Posoperatorias/prevención & control , Animales , Adhesión Celular/efectos de los fármacos , Cuerpo Ciliar/efectos de los fármacos , Cuerpo Ciliar/ultraestructura , Conjuntiva/efectos de los fármacos , Femenino , Fibrosis/prevención & control , Estudios de Seguimiento , Glaucoma/tratamiento farmacológico , Oligopéptidos/toxicidad , Conejos , Esclerótica/efectos de los fármacos , Esclerótica/patologíaAsunto(s)
Humanos , Adolescente , Masculino , Glaucoma , Glaucoma/complicaciones , Glaucoma/diagnóstico , Glaucoma/metabolismo , Glaucoma/patología , Corticoesteroides , Corticoesteroides/efectos adversos , Corticoesteroides/toxicidad , Corticoesteroides/uso terapéutico , Corticoesteroides/farmacología , Cirugía Filtrante/efectos adversos , Cirugía Filtrante/métodos , Cirugía Filtrante/rehabilitación , Cirugía FiltranteRESUMEN
Analisamos o papel do retalho conjuntival na incidência de bolsa filtrante encapsulada em pacientes portadores de glaucoma primário de ângulo aberto. Em 22 trabeculectomias foi utilizado o retalho conjuntival de base fórnice; estes resultados foram comparados com 23 olhos submetidos à trabeculectomia utilizando o retalho conjuntival de base límbica. Foi encontrada maior incidência de bolsa encapsulada nos casos com retalho conjuntival de base límbica: 7/23 (30,4 por cento), quando comparados com os de base fórnice: 1/22 (4,5 por cento) (p<0,02).