Joji Watanabe

Nd:YAG laser trabeculopuncture (YLT) for glaucoma with traumatic angle recession

Traumatic angle recession caused by blunt trauma often induces uncontrollable glaucoma despite the maximum medical therapy tolerated, such as argon laser trabeculoplasty (ALT), with no or little benefit. Therefore, instead of ALT, we tried Nd:YAG laser trabeculopuncture (YLT) on 11 patients with this type of glaucoma. The intraocular pressure of these patients was followed up for 15 ± 7 months (average ± SD). In 6 of 7 eyes treated initially with YLT, the IOP was significantly reduced, so medication was discontinued. Four other cases with uncontrollable IOP after failed ALT were treated with YLT. The IOP of 3 cases was successfully controlled by medication after YLT. These YLT results were then compared with those of ALT in 11 glaucoma patients with traumatic angle recession. Seven of 11 cases treated initially with ALT failed in less than 3 months, and surgical intervention or additional laser treatments were required. The probability of success from the time-series analysis at 12 months after each laser application was 0.909 in YLT, 0.273 in ALT. YLT offers significant advantages over ALT for the treatment of glaucoma with traumatic angle recession after blunt trauma and thus merits further study.

Effects of mitomycin C on the expression of proliferating cell nuclear antigen after filtering surgery in rabbits

Abstract• Background: The aim of the study was to evaluate the effects of mitomycin C on the cell replication activity in wound healing following experimental filtration surgery. • Methods: Trabeculectomy with or without application of mitomycin C was performed on albino rabbit eyes. At 1, 4, 7, 14, and 28 days after surgery, the expression of proliferating cell nuclear antigen, a marker of cell proliferation, in the filtering site was examined immunohistochemically using a streptavidin-biotin complex method. • Results: In control eyes that underwent trabeculectomy but did not receive mitomycin C, the number of immunoreactive cells increased 4–7 days after operation and decreased markedly at around 14 days. The filtering site was obstructed histologically at 4–7 days after operation. In the mitomycin C-treated eyes, immunoreactive cells appeared 4 days after surgery but disappeared by 7 days at the surgical site. The number of immunoreactive cells in the treated eyes was much lower than that in control eyes. • Conclusion: The cell replication activity was markedly inhibited by administration of mitomycin C. The filtering site remained open for 28 days after surgery, whereas it was completely obstructed within 7 days in control eyes. Immunocytochemistry for proliferating cell nuclear antigen, as used in this study, is a simple and reliable method for detection of cell replication activity.

Trabeculectomy with 5-fluorouracil

Abstract The effect of subconjunctival injection of 5‐fluorouracil (5‐FU) after trabeculectomy was studied retrospectively in 205 eyes of 168 patients. A life table analysis of the surgical outcome was based on the type of glaucoma and age related differences, and a comparison was made with patients who had trabeculectomy without subconjunctival 5‐FU. The success rate at 30 months after trabeculectomy with 5‐FU therapy was considerably higher in primary open‐angle glaucoma at 93.6% (72.7%), secondary glaucoma at 88.9% (72.4%), and refractory glaucoma at 72.2% (32.5%) with (or without) the use of ocular hypotensive drops when compared with historical control groups treated without 5‐FU (60.0% (41.7%), 35.5% (24.0%), and 18.0% (8.0%), respectively). In patients aged over 70 years, no statistically significant improvement could be demonstrated with the use of 5‐FU after trabeculectomy in primary open‐angle glaucoma. Our study may provide data on the appropriate dosage and indications for the use of this drug after glaucoma surgery.

Posterior Iris Bowing after accomodation—Elucidation of the etiology of pigment dispersion syndrome

Recent advancements in imaging the anterior segment structures using the ultrasound biomicro scope (UBM) have proven the involvement of posterior iris bowing due to reverse pupillary block as the cause of pigment dispersion syndrome. In this report, we examined whether the posterior iris bowing occurs even in normal eyes following accommodation, and whether the degree of iris concavity tends to be greater in myopic eyes than in emmetropic eyes. The subjects were normal eyes with sufficient accommodation power, i.e. 5 myopic eyes with less than-5 diopter reflection, 5 emmetropic eyes within +/- 1 dioptor reflection, respectively. We obtained UBM images of the iris at 4 portions before and after accommodation, and measured the degree of posterior iris bowing. We found that almost all data shift posteriorly after accommodation, and that the iris concavity is more distinct in myopic eyes than in emmetropic eyes both before and after accommodation (before: p = 0.0004, after: p < 0.0001). From these results, we confirmed that iris concavity after accommodation occurs in normal eyes but not enough for iridozonular contact, and that pigment dispersion syndrome results from augmented iris concavity owing to pre-existing factors such as iris flexibility, myopia, and sufficient accommodation power.

Long-term results of anterior chamber tube shunt to an encircling band in the treatment of refractory glaucomas

Abstract We performed the anterior chamber tube shunt to an encircling band procedure in 34 patients (36 eyes) with refractory glaucoma, and evaluated the long‐term outcome. The preoperative mean intraocular pressure (IOP) was 36.8 ± 9.6 mmHg, the postoperative mean IOP was 21.6 ± 13.6 mmHg, a statistically significant (p < 0.01) reduction of IOP following this procedure. The final postoperative IOP was under 21 mmHg in 23 (63.9%) of the 36 eyes. The success rate of IOP control 36 months after the operation without any elevation of postoperative IOP was 30.3% (life‐table method). Complications of this procedure included flattening of the anterior chamber (61.1%), damage to the corneal endothelium (25%), hyphema (25%), and a transient IOP elevation (25%). As filtering surgery with 5‐fluorouracil is more effective and simple to perform, we conclude that the anterior chamber tube shunt to an encircling band procedure should be reserved for those with refractory glaucoma who have had multiple surgical interventions.