Successful goniosynechialysis for angle-closure glaucoma after vitreoretinal surgery.

PURPOSE: To describe 2 cases of long-term successful clinical outcome after goniosynechialysis for secondary angle-closure glaucoma after vitreoretinal surgery. METHODS: Case reports. Goniosynechialysis was performed bilaterally in 1 patient and unilaterally in another for uncontrolled angle-closure glaucoma after vitreoretinal surgery. RESULTS: Angle reopening was performed 2 to 4 months after initial closure. After follow-up of between 3 and 5 years, intraocular pressure has remained below 21 mm Hg without medication in all three eyes. CONCLUSION: Goniosynechialysis should be considered a viable therapeutic alternative to filtration surgery in selected patients with a recent history of angle-closure glaucoma after vitreoretinal surgery.

Antinociceptive effects of the neuroactive steroid, 3alpha-hydroxy-5alpha-pregnan-20-one and progesterone in the land snail, Cepaea nemoralis.

Results of investigations with vertebrates have implicated neuroactive steroids and in particular 5alpha-reduced metabolites of progesterone such as 3alpha-hydroxy-5alpha-pregnan-20-one (3alpha,5alpha-THP/3A5P and originally allopregnanolone) in the rapid modulation of diverse functions including that of nociceptive sensitivity. These effects have been indicated to involve modulation of GABA receptors. Results of recent phylogenetic studies have revealed the presence of GABA receptors in invertebrates that may also be subject to modulation by steroids and neuroactive steroids. The present study examined the effects of the neuroactive steroid, 3alpha-hydroxy-5alpha-pregnan-20-one, as well as progesterone on aversive thermal (nociceptive) responses in a mollusc, the land snail, Cepaea nemoralis. 3alpha-Hydroxy-5alpha-pregnan-20-one had significant dose-related (0.01-1.0 microg) antinociceptive effects in Cepaea increasing the latency of response to a 40 degrees C surface, with maximum effects being evident 15-30 min after administration. These effects of 3alpha-hydroxy-5alpha-pregnan-20-one were stereospecific, with the stereoisomer 3beta-hydroxy-5alpha-pregnan-20-one (3B5P) failing to affect nociceptive responses. Progesterone also had significant dose-related (0.10-10 microg) antinociceptive effects that, however, were delayed in onset and relatively prolonged (60-120 min), suggestive of the formation of active metabolites. The presence of endogenous progesterone (12.36+/-0.17 ng/g tissue) was ascertained by a radioimmunoassay further supporting a functional role for steroids in Cepaea. The antinociceptive effects of 3alpha-hydroxy-5alpha-pregnan-20-one and progesterone were blocked by the GABA antagonists, bicuculline and picrotoxin, while being relatively insensitive to opioid and N-methyl-D-aspartate antagonists. These results suggest an early evolutionary development and phylogenetic continuity of neuroactive steroid and GABA involvement in the mediation of nociception.

Wound healing after filtering surgery in owl monkeys.

We performed posterior lip sclerectomies in 29 owl monkey eyes to determine the natural history of wound healing after filtering surgery without adjunctive antimetabolite therapy. We noted three phases of wound healing during clinical and histologic examination: early healing (days 2 to 6), intermediate healing (days 7 to 9), and late healing (days 10 to 14). In the early healing phase, all limbal fistulas except one remained open gonioscopically, but by day 6, fibroblasts had proliferated along the walls of the opening. Proliferation and migration of fibroblasts continued during the intermediate healing phase to completely occlude four and to partially occlude two of the ten fistulas in the eyes studied during this time. In the late healing phase, the limbal fistula was completely closed by granulation tissue in four of five eyes and was slitlike open in one eye. In this model of filtering surgery, wound healing at the sclerectomy site with obliteration of the limbal opening by proliferating fibroblasts occurred within the first 14 postoperative days. We believe that the short-term effects of newer treatments designed to alter wound healing after filtering surgery may be assessed in this model, which is characterized by predictable and prompt wound healing.

5-Fluorouracil and glaucoma filtering surgery. III. Intermediate follow-up of a pilot study.

Ninety-five patients (104 eyes) were enrolled in a pilot study of subconjunctival 5-fluorouracil (5-FU) injections after filtering surgery in eyes with poor surgical prognoses. At least a six-month follow-up was available on 84 patients, of whom four were excluded from the analysis of surgical outcome because they suffered retinal detachments within six months of their filtering surgery. The initial 5-FU procedures on the remaining 80 patients were successful (no further glaucoma surgical procedures were either performed or recommended, and the intraocular pressures [IOPs] were either 21 mmHg or lower with ocular hypotensive medication[s] or 25 mmHg or lower without ocular hypotensive medication) in 33 (68%) of the 48 aphakic eyes with non-neovascular glaucomas, 13 (81%) of the 16 phakic eyes with non-neovascular glaucomas after unsuccessful filtering surgery, and 12 (75%) of the 16 eyes with neovascular glaucoma (NVG). The follow-up on the successful eyes ranged from 6 to 34 months (mean +/- SD = 18.5 +/- 7.5). The visual acuities remained within one line of their preoperative levels or improved in 38 (79%) of the 48 aphakic eyes with non-neovascular glaucoma, 11 (69%) of the 16 phakic eyes with non-neovascular glaucoma after unsuccessful filtering surgery, and 12 (75%) of the 16 eyes with NVG. The initial 5-FU procedures on the 104 eyes were complicated by the following: corneal epithelial defects (50%); conjunctival wound and suture tract leaks (36%; 2% underwent surgical repair); suprachoroidal hemorrhages (9%); retinal detachments (3%); subepithelial corneal scarring (3%); endophthalmitis (2%); and malignant glaucoma (1%). It is the authors' impression that postoperative subconjunctival 5-FU increases the likelihood of achieving IOP control after filtering surgery in eyes with poor surgical prognoses; however, a randomized clinical trial is necessary to confirm this impression.