Historical Considerations and Innovations in the Perioperative Use of Mitomycin C for Glaucoma Filtration Surgery and Bleb Revisions.

Although there is a currently a revolution in angle-based procedures, subconjunctival filtration surgery with mitomycin C (MMC) wound modification remains a vital skill for glaucoma surgeons. MMC is a potent antifibrotic agent that has been an invaluable adjunct for successful glaucoma filtration surgery for over 20 years, but it must be used judiciously to avoid serious complications, including hypotony, corneal decompensation, bleb avascularity, bleb leaks, blebitis, and endophthalmitis. The purpose of this report is to describe the historical lessons learned from MMC use, along with updated methods of MMC delivery during primary trabeculectomy, bleb needling at the slit lamp, bleb revisions in the operating room, and newer and less invasive ab-interno filtering procedures. Information for the review was gathered using an extensive search on PubMed, a review of all available peer-reviewed literature, and the authors' personal clinical judgment and experience.

Is Newer Necessarily Better? The Evolution of Incisional Glaucoma Surgery Over the Last 100 Years.

PURPOSE: To examine the progress made in glaucoma incisional surgery and determine if there has been sufficient progress to meet the needs of glaucoma patients. DESIGN: Perspective (literature review). METHODS: This is a retrospective assessment of key milestones in the evolution of glaucoma incisional surgery and an evaluation of the risks and the benefits of these procedures. Benefits are defined as effective reduction in intraocular pressure (IOP) and protecting visual function, while risks are defined as safety and complications for our patients. Quality of life is also considered. RESULTS: Although advances have been made in the last 100 years, the trabeculectomy, a procedure that was described more than 50 years ago, remains the optimal choice for reducing IOP among those patients who require pressures in the teens, who do not respond to medications and prior laser therapy. CONCLUSIONS: Appropriate patient selection, careful attention to surgical technique, and intensive follow-up of patients will optimize the results of a trabeculectomy. Newer procedures must be carefully studied in well-designed clinical trials to determine comparative levels of safety and efficacy to this gold standard. Advances in drug delivery and minimally invasive glaucoma surgery may ultimately produce the best outcome for glaucoma patients in the future.

Vladimir Petrovich Filatov, uno de los padres del trasplante corneal / Vladimir Petrovich Filatov, one of the fathers of corneal transplant

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[The Origin of the Disorder Named "Ryoku-naisho (Glaucoma)"].

It is said that the description of an ocular disorder related to the color of the sea in the Hippocratic Corpus is the oldest medical reference to glaucoma. In the early Edo period in Japan, the Books of Secrets of the Majima school, describe a disorder called aosokohi. This nomenclature is believed to be based upon the Five Elements' Theory (Wu-Xing Thought)in ancient China, which assigned five colors for intraocular disorders ("naisho/sokohi" in Japanese), blue ("ao" in Japanese), red, yellow, white and black. In Japanese literature, in late Edo period, "ryokunaisho (glaucoma)" appeared after the publication of Dutch-Japanese translation by Dutch scholars. The Japanese name is thought to derive trom "Glaukos" which means green in ancient Greek. Since the Meiji period, "ryoku-naisho (glaucoma)" has been used inmost textbooks including those by foreign teachers and the works of Jujiro Komoto, the first Professor at the Department of Ophthalmology of (Tokyo)Imperial University.

Historia de la cirugía del glaucoma (I): desde Graefe a las primeras cirugías filtrantes / History of glaucoma surgery (I): From Graefe to the first steps of filtering surgeries

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Historia de la cirugía del glaucoma (II): de la goniotomía a la primera cirugía no perforante / History of glaucoma surgery (II): From goniotomy to the first non-penetrating surgery

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Glaucoma and the Origins of Its Name.

PURPOSE: To identify the origins of the name of the disease Glaucoma. METHODS: Ancient Greek medical literature, Homeric poems, and ancient Greek religion and art were examined. RESULTS: The roots of the name Glaucoma could be traced back to Homeric times. Ancient Greek physicians following the Hippocratic tradition preferred the use of the terms Hypochysis or Hypochyma for the same disease. This fact indicates that the older term Glaucoma did not fulfill strict medical criteria, but had a long history connected to superstition, which the rational ancient Greek physician tried to overcome using terms derived from their fundamental principal of humoral pathology. CONCLUSIONS: In ancient Greek medical literature, Glaucoma had a significant place among ocular diseases. The origin of its name could be traced back to Homeric times and could be connected to the ancient belief of a primitive folk about the apotropaic role of animals against diseases, which in this case is represented by the superstitious role of the owl.

The invention of gonioscopy by Alexios Trantas and his contribution to ophthalmology.

Gonioscopy is a technique used to examine structures in the anterior chamber angle (the fluid filled space inside the eye between the iris and the innermost layer of the cornea, the endothelium). It is an essential tool in ophthalmic practice, particularly in the diagnosis of glaucoma. In 1899, the Greek ophthalmologist Alexios Trantas was the first to visualise the angle in vivo and coined the term 'gonioscopy'. He made a number of other important contributions to ophthalmology.

Sympathectomy for glaucoma: Its rise and fall (1898-1910).

The influence of the sympathetic nervous system upon intraocular pressure (IOP) has been a subject of great interest since 1727, when the first experimental ocular sympathetic paralysis was produced in dogs. By the middle of the 19th century, it was known that excision of the superior cervical sympathetic ganglion lowered, and that electrical stimulation of the sympathetic nerve trunk raised IOP in various animals. From these observations, it was thought that excision of this ganglion could replace or supplement the available operations for glaucoma of which iridectomy was the most popular. Iridectomy was acknowledged to be of great value in acute and subacute glaucoma, but less useful in chronic glaucoma. Iridectomy, however, was associated with major surgical complications and long-term failure, so that there was considerable appeal of an extraocular operation that avoided the risks of intraocular surgery. Beginning in 1898, cervical sympathectomy became a widely performed operation around the world, with most surgeons enthusiastic about its results, at least initially, and many publications from 1898 to 1905 claimed excellent results for various types of glaucoma. Opponents of the procedure emphasized that the effect on IOP was transient, and that the published reports of successful results were poorly documented. The popularity of sympathectomy gradually diminished and by 1910 it was abandoned. I discuss the reasons why cervical sympathectomy received such initial enthusiasm but was then questioned and discarded. These included bias from the surgeons promoting this surgery; the placebo effect; short follow-up; inaccurate, subjective, and variable measures of the surgical results; and the development of more effective procedures such as filtering surgery and cyclodialysis.

Herbert Herbert: his corneal pits and scleral slits.

PURPOSE: To evaluate the life and professional work of the English ophthalmologist Herbert Herbert (1865-1942). DESIGN: Historical study. METHODS: The main sources for this investigation are Herbert's approximately 65 published papers and 3 monographs. Other sources are contemporary publications by other ophthalmologists and secondary historical reviews of this period. Written communications with some of Herbert's descendants revealed previously unknown information about his life. RESULTS: Herbert is now remembered for his description of the eponymously named limbal corneal pits as a sign of trachoma. This finding is essentially pathognomic of trachoma and was welcomed as a sign that could reliably diagnose trachoma from other external diseases. He also described the sinuous outline of the upper lid margin, sometimes called Herbert's sign, as a diagnostic finding of trachomatous infection. His diagnostic acumen in the field of trachoma has justly stood the test of time. However, his interest in trachoma was peripheral to his main professional work, which was the study of glaucoma filtration surgery, then in its early development from 1900 to 1920. He was among the major pioneers in the development of original techniques for this surgery. He emphasized the use of small incision sclerotomy to produce an even and diffuse filtration bleb, rather than the large incision sclerectomy proposed by other surgeons, which he felt produced too large and thin a filtering bleb subject to complications. This point has also stood the test of time. However, he erred in developing and championing the use of deliberate iris inclusion into the filtering sclerotomy (iridencleisis) to prevent closure of the sclerotomy, a technique that was questioned at that time and eventually discredited. The iris-free procedure of corneoscleral trephination developed by his contemporary Robert H. Elliot became the preferred glaucoma filtering procedure until the introduction of peripheral iridectomy with scleral cautery (thermal sclerostomy) in the 1950s and then trabeculectomy in the 1970s. CONCLUSIONS: Herbert should be remembered as an astute and original observer and as an innovative surgeon who developed some of the pioneering techniques in glaucoma filtering surgery.

Blindness of Johann Sebastian Bach.

Johann Sebastian Bach (1685-1750) was one of the greatest composers of all time. Apart from performing as a brilliant organist, he composed over 1.100 works in almost every musical genre. He was known as a hardworking, deeply Christian person, who had to support his family of 20 children and many students staying at his home. At the age of 64 years, his vision started to decline. Old biographies claim that it was the result of overstressing his vision in poor illumination. By persuasion of his friends, he had his both eyes operated by a travelling British eye surgeon. A cataract couching was performed. After surgery, Bach was totally blind and unable to play an organ, compose or direct choirs and orchestras. He was confined to bed and suffering from immense pain of the eyes and the body. He died <4 months after surgery. In this paper, as the plausible diagnosis, intractable glaucoma because of pupillary block or secondary to phacoanaphylactic endophthalmitis is suggested.

Count sir Luigi Preziosi and his glaucoma operation: the development of early glaucoma filtering surgery.

Count Sir Luigi Preziosi (1888-1965) was a famous ophthalmologist from the island Republic of Malta. He received his ophthalmic training in Rome and the United Kingdom. He practiced ophthalmology in Malta for 45 years and was a professor at the University of Malta. Like many physicians in Malta, he was active in the politics and governance of his country, serving as president of the Senate, president of the National Congress to draft a new constitution, and, finally, as president of the National Assembly of Malta. His most important ophthalmologic contribution was the development of the thermal sclerostomy filtering operation for glaucoma, which he first described in 1924. He referred to this operation initially as electro-cautery puncture and later simply as Preziosi's operation. Many surgeons considered this procedure an advance over the other available filtering operations such as sclerectomy, iridencleisis, and trephination. The operation was then further developed in 1957 by Harold G. Scheie of the University of Pennsylvania. Scheie referred to his procedure as peripheral iridectomy with scleral cautery, and it was a standard filtering operation for glaucoma for many years until the development of trabeculectomy.