Early results of suprachoroidal drainage tube implantation for the surgical treatment of glaucoma.

PURPOSE: To evaluate the efficacy and safety of suprachoroidal silicone tube shunt implantation in glaucoma. PATIENTS AND METHODS: Twenty-four glaucomatous eyes unresponsive to medical treatment were included, 7 of them had earlier trabeculectomy. After preparation of a limbus-based scleral flap, 1.5 mm deep sclerotomy was made adjacent to scleral flap opening. Posterior end of the silicone tube was placed posteriorly in suprachoroidal space, anterior end was placed into anterior chamber. Intraocular pressure (IOP) and best corrected visual acuities (BCVA) were measured preoperatively and postoperatively on the first day, at the first week, in the first, third, sixth, twelfth, and eighteenth months. Postoperative IOP >21 mm Hg, <5 mm Hg (after 3 months), or additional glaucoma surgery were accepted as failure. Eyes not failed and not on supplemental medical therapy are considered as complete success. Eyes that have not failed, with or without supplemental medical therapy, are considered as qualified success. Hypotony was defined as early, when IOP below 5 mm Hg was observed within 4 weeks. RESULTS: Mean postoperative follow-up period was 34.4±23.7 weeks (range 4 to 78 wk). Complete success rates were 95.8%±4.1 at the first week, 79.2%±8.3 in the first and the third month, 63.3%±12.0 for the sixth and twelfth month. Qualified success rates were 95.8%±4.1 in the first week, 87.5%±6.8 in the first, third, sixth, twelfth months. Mean postoperative IOP's (8.5±4.9mm Hg, 12.9±5.6 mm Hg, 17.0±7.9 mm Hg, 15.3±3.6 mm Hg, 18.3±6.0, 15.1±6.0 mm Hg, respectively for the first week, first, third, sixth and twelfth mo) were significantly lower than preoperative mean IOP's. The success rates in cases without earlier trabeculectomy were significantly higher than in cases with earlier trabeculectomy (P=0.035). Postoperative first day mean±SD BCVA value was significantly lower than preoperative value (P=0.004). Failure was seen in 7 eyes of which 3 of them underwent reoperation for glaucoma. Early hypotony was seen in 6 eyes. No infection, choroidal, or retinal detachment was seen. There was a fibrin reaction in the anterior chamber in 3 patients. Two patients had intracameral bleeding, 1 of them underwent anterior chamber lavage. CONCLUSIONS: Suprachoroidal tube drainage of aqueous humor from the anterior chamber to the suprachoroidal space is effective in reducing IOP in glaucoma patients, with lower serious complication rates, and may be preferred as initial surgery in cases without earlier trabeculectomy.

Effect of doxycycline on postoperative scarring after trabeculectomy in an experimental rabbit model.

PURPOSE: To investigate effectiveness of doxycycline after trabeculectomy in rabbits by evaluating bleb appearance, intraocular pressure, and levels of matrix metalloproteinase-1, -2, -3, and -9 and tissue inhibitors of metalloproteinase (TIMP)-1 and -2 in the subconjunctival (sc) area. METHODS: Twenty-nine New Zealand White rabbits were assigned into 1 of 6 groups as follows: topical doxycycline (0.1%), postoperative sc injection of doxycycline (100 mg/2 mL), and intraoperative mitomycin-C (MMC) (0.2 mg/mL) and their respective control groups. RESULTS: There was significant difference between intraocular pressure in the case groups, but there was no significant difference in topical doxycycline and MMC groups during the follow up. In the topical doxycycline group, levels of TIMP-1 and perifericTIMP-1 were higher and levels of perifericMMP-2 and inflammation were lower than their controls. In the sc doxycycline group, peripheral inflammation was higher than in the corresponding control. Only peripheral inflammation was significantly different between case groups, with the highest level in sc and the lowest level in MMC groups. Further, topical doxycycline group showed no significant difference in bleb appearance or peripheral inflammation compared with MMC group. Conjunctival burn and corneal vascularization were detected only in the sc doxycycline group. CONCLUSIONS: Topical doxycycline is more effective than sc doxycycline but is similar to MMC, and it can be an alternative to MMC in trabeculectomy in rabbits.

Effect of chronic topical glaucoma medications on aerobic conjunctival bacterial flora.

PURPOSE: To investigate whether the chronic topical medications affect aerobic conjunctival bacterial flora of patients with glaucoma and to compare their findings with the findings of the controls. METHODS: Eighty-one patients and 67 healthy control subjects participated in this case-control study. Duplicate conjunctival swab specimens were collected from each patient at the microbiology laboratory and were investigated for the presence of aerobic bacteria. All bacterial species from isolated colonies were identified. RESULTS: Thirty seven (45.7%) of the 81 patients and 25 (37.3%) of 67 controls had positive conjunctival cultures. Coagulase-negative Staphylococcus was the most commonly isolated bacterial species in both groups. There were no statistically significant differences between the prevalence of other conjunctival cultures testing positive for any of the isolated organisms. The patients were also evaluated with respect to the presence of a systemic illness. Age, sex, presence of diabetes and asthma, duration of antiglaucomatous medication, and number of medications used did not have an effect on culture positivity in both groups when evaluated by logistic regression model. CONCLUSIONS: The conjunctival culture positivity was higher in patients with glaucoma than in the healthy controls and in patients with diabetes than in patients without diabetes, although both were statistically insignificant. Aerobic conjunctival flora of the patients using topical glaucoma medications and the controls did not differ. Further studies are needed to comment on the clinical importance of these findings.

Comparison of the effects of latanoprost and bimatoprost on central corneal thickness.

PURPOSE: To compare the effects of latanoprost and bimatoprost on central corneal thickness (CCT). MATERIALS AND METHODS: A total of 188 eyes of 94 patients who were being followed in our hospital's glaucoma clinic and were receiving either latanoprost (55.3%) or bimatoprost (44.7%) monotherapy were recruited for the study. The data were collected prospectively from the patients, who were medicated with bimatoprost or latanoprost, at the initial diagnosis of glaucoma. Measurements were performed at the initial diagnosis, 6th, 12th, and 24th months. All the measurements were carried out by the same doctor between 9 AM and 11 AM, using Goldmann applanation tonometer for intraocular pressure (IOP) and ultrasound biopachymeter for CCT. RESULTS: There were no significant differences between the patient groups receiving latanoprost or bimatoprost for sex, age, baseline IOP, and CCT. The mean baseline CCT values were 559.5+/-35.3 mum for latanoprost group and 553.4+/-31.7 mum for bimatoprost group. CCT of both groups at 6, 12, and 24 months were significantly thinner when compared with baseline CCT. The percent reduction rates were 1.9+/-2.4% for latanoprost and 2.8+/-1.8% for bimatoprost in the 24th month. CONCLUSION: A significant reduction in CCT was observed at the 6th, 12th, and 24th months with latanoprost and bimatoprost. Serial CCT measurements in determining the IOP values may be helpful in the follow-up of prostaglandin analogs.