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Background: It is necessary to decrease topical anti-glaucoma medication for severe glaucoma with pseudopemphigoid caused by anti-glaucoma eye drops. Glaucoma filtrating surgery is often needed instead of medication, but the prognosis is poor because it induces scar fomation and makes the filtrating bleb vanish., Case: An 85-year-old male patient with exfoliation syndrome had twice undergone glaucoma surgery about ten years previously. His intra-ocular pressure (IOP) was high despite topical anti-glaucoma medication. At the first examination in our hospital, he had severe superficial punctate keratopathy, blephariticshortening and symblepharon, and we therefore diagnosed severe pseudopemphigoid induced by anti-glaucoma eye drops. Because his IOP could not be controlled by topical and general medication, we conducted a glaucoma filtrating operation using amniotic membrane., Conclusion: The administration of oral anti-inflammatory drugs before and after surgery and the use of amniotic membrane prevented post-operative scar formation and the progress of symblepharon, resulting in the successful control of IOP after surgery.

Purpose: We treated an adult patient with traumatic glaucoma who exhibited dramatic elasticity in the topography of the optic nerve head, as shown in a Heidelberg Retina Tomograph (HRT) examination after filtering surgery., Case: A 41-year-old man came to us with a right eye injury following an external blow. At the first examination, visual acuity was 0.4 (1.2) and intraocular pressure (IOP) was 11 mmHg in both eyes. Cells in the anterior chamber and angle dialysis were noted in all quadrants of the right eye, but there was no hyphema. Two weeks later, the patient returned to our hospital with pain in the right eye and a headache. Visual acuity in the right eye had decreased to 0.06 (0.1) and IOP was 50mmHg. A cilioconjunctival injection and corneal edema were observed. The patient was treated with medications, but IOP was uncontrollable and the optic disc cupping in the right eye was enlarged. Further, values for Cup Disc Area Ratio (C/D; 0.553) and Cup Volume (CV; 0.548) in the right eye were larger than those of the left (0.287 and 0.168, respectively) in an HRT examination. We performed a non-penetrating trabeculectomy 5 weeks after the injury. Two weeks after surgery, IOP was lowered to 7 mmHg, and C/D 0.122) and CV (0.062) were improved. Six months after the procedure, C/D (0.304) and CV (0.202) were nearly the same as those of the left eye (0.292 and 0.144)., Conclusion: Although the duration of high IOP was short, high elasticity in the optic disc morphology of this adult case was shown quantitatively in an HRT examination.

Purpose: In this study, we measured the cefotiam dihydrochloride (CTM) concentration in ocular tissue after filtration surgery in rabbit eyes., Methods: CTM (20 mg/kg body weight) was administered intravenously 30 min before filtration surgery which was performed by double flap procedure on the right eyes of white rabbits. The aqueous humor and serum were extracted at 10 min after surgery and at 30 min, 60 min, and 120 min. Drug concentration in all of the specimens was measured by high performance liquid chromatography (HP-LC)., Result: The CTM concentrations of aqueous humor in the nonoperated eyes were 0.44 +/- 0.16(mean +/- standard deviation) microg/ml (n = 4) (40 min after intravenous dosage), 0.36 +/- 0.17microg/ml (n = 4) (60 min after intravenous dosage), 0.38 +/- 0.34, microg/ml(n = 3) (90min after intravenous dosage) and 0.27 +/- 0.10 microg/ml (n = 5) (150 min after intravenous dosage). In contrast, CTM concentration in the aqueous humor of the operated eyes was 2.4 +/- 0.95 microg/ml (n = 4) at 10 min after surgery (40 min after intravenous dosage), 2.11 +/- 1.10 microg/ml (n = 4) at 30 min after surgery (60 min after intravenous dosage), 1.18 +/- 0.78 microg/ml (n = 4) at 60 min after surgery (90 min after intravenous dosage) and 0.47 +/- 0.1 microg/ml (n = 5) at 120 min after surgery (150 min after intravenous dosage). The intraocular penetration of CTM at 10 min and at 120 min after filtration surgery was significantly higher in comparison with the drug concentration in the nonoperated eyes (p < 0.05)., Conclusion: The intraocular penetration of CTM after filtration surgery was much higher in comparison with the drug concentration in the nonoperated eyes. These results may be useful to predict the intraocular penetration of CTM in human eyes after filtration surgery.

Purpose: To examine whether tranilast and ketotifen fumarate inhibit the growth of human Tenon's capsule fibroblasts and maintain experimental filtering blebs on rabbit eyes., Methods: Human Tenon's capsule fibroblasts were grown in Dulbecco's modified Eagle's medium with 10% fetal calf serum and growth was measured with 3-[4,5-dimethylthiazole-2-yl]-2,5-diphenyltetrazolium bromide (MTT) and direct counting of cell number. Production of collagen and transforming growth factor-beta 1 (TGF-beta 1) was measured with corresponding enzyme-linked immunosorbent assay (ELISA). In experimental filtering surgery performed on rabbit eyes, the effects of the topical drugs on intraocular pressure and on maintenance of the filtering blebs were observed., Results: Both tranilast and ketotifen inhibited the growth of the fibroblasts and half-inhibitory concentrations were 200 microM and 70 microM, respectively. Low concentration (10 microM) of tranilast and ketotifen decreased the synthesis of collagen but neither drug had any obvious effect on TGF-beta 1 production. Both drugs prolonged the life of the experimental filtering bleb significantly [12.5 +/- 3.2 (mean +/- standard deviation) days, 13.9 +/- 3.4 days, respectively; control, 10.5 +/- 2.4 days]., Conclusion: Tranilast and ketotifen inhibited the growth of human Tenon's capsule proliferation and are capable of maintaining experimental filtering blebs in rabbit eyes.

Purpose: To evaluate the surgical outcome of vitrectomy in the treatment of expulsive hemorrhage associated with intraocular surgery., Methods: We reviewed 12 eyes from 12 patients with expulsive hemorrhage, occurring after or during cataract extraction (4 eyes), phacoemulsification (2 eyes), glaucoma filtering surgery (4 eyes), or vitrectomy (2 eyes). Mean follow-up period was 21 months., Results: The retina was reattached in 6 eyes (50%) after the initial surgery and ultimately in 9 eyes (75%). Three eyes, which failed to achieve retinal reattachment, resulted in phthisis bulbi. Final visual acuity was 0.1 or belter in 4 eyes and 0.01 to 0.09 in 4 eyes. The incidence of expulsive hemorrhage was 0% for cataract surgery, 0.57% for trabeculectomy, and 0.09% for vitrectomy at Toho University Sakura Hospital., Conclusion: In the treatment of expulsive hemorrhage, vitrectomy is an effective surgical procedure to improve the visual function.

Purpose: Based on our previous report that showed enhanced transfer of mitomycin C to the sclera and the conjunctiva by dissolving the antiproliferative in a reversible thermo-setting gel, we conducted a study to investigate the efficacy of the mitomycin C-gel in the rabbit., Methods: We subconjunctivally injected 0.1 ml of the mitomycin C-gel solution containing several amounts of the drug. Trephination was performed in the injected region 24 hours later. Intraocular pressure measurement, and photography and ultrasound biomicroscopic examination of the filtering bleb were done 1, 2, and 4 weeks postoperatively., Results: The gel containing 3.0 micrograms or more mitomycin C significantly enhanced bleb formation in addition to reducing the intraocular pressure., Conclusion: The reversible thermo-setting gel seems to facilitate filtration following glaucoma filtering surgery in the rabbit and deserves further investigation as a new method of mitomycin C application.

We measured mitomycin C (MMC) concentrations in rabbit ocular tissues, using high-performance liquid chromatography, after the subconjunctival application of surgical sponges which had absorbed various doses (0.1, 0.2 or 0.4 mg) of MMC and with varying duration of application (1, 3, or 5 minutes). MMC concentrations at the administered site showed a significant correlation with the dose and duration of application. In multiple regression analysis the MMC concentration (microgram/g) in the conjunctiva was -6.73 + 67.4 x dose (mg) + 1.66 x time (minutes) (R-square 0.65); in the sclera, -1.85 + 38.2 x dose + 0.927 x time (R-square 0.63); and in the corena, -0.727 + 8.44 x dose (R-square 0.46). We also compared the results of filtering surgery on rabbits using 0.2 mg MMC intraoperative exposure of 1, 3, 5 minutes or 5-minute application of distilled water (control). The duration of maintained intraocular pressure reduction and filtering bleb was significantly longer in MMC-treated group (1 minute; 15 +/- 7.1, 3 minutes; 27 +/- 14.3, 5 minutes; 29 +/- 18.6 days, mean +/- standard deviation) than in the control group (7 +/- 3.7 days). Among the MMC-treated groups, good results were maintained significantly longer in the 3- or 5-minute application groups than in the 1-minute group. There was no difference between the 3-minute group and the 5-minute group.

The revision of a failed filtering bleb using mitomycin C was performed in 40 eyes (28 eyes with primary open angle glaucoma and 12 eyes with secondary open angle glaucoma) in which the previous trabeculectomy using 5-fluorouracil had failed to control intraocular pressure (IOP). Presurgical IOP ranged from 21 approximately 36 mm Hg (average: 24.7 mmHg) with the maximum tolerable antiglaucoma medication. The follow-up period was at least 2 years (24 approximately 60, mean: 39.8 months). Mitomycin C (0.04%, 5 ml, 5 min) was applied under the subconjunctival space. After rinsing, the wall of the scarred bleb was incised in cases with a localized bleb, or the margin of the scleral flap was incised in cases without a filtering bleb. The conjunctival wound was closed with 10-0 Nylon sutures. IOP control under 21 mmHg was achieved in 53.4% without medication and in 60.2% with or without medication at 60 months. After repeating the same procedure, IOP control was obtained in 82.2% with or without medication at 60 months. The success rate in secondary open angle glaucoma was less than in primary open angle glaucoma. Complications such as flattening of the anterior chamber requiring reformation (8%), choroidal detachment (8%), hyphema (5%), and hypotonic maculopathy (5%) were less than after trabeculectomy but conjunctival wound separation (5%) occurred little more frequently.

We evaluated collagen synthetic activity, which plays an important role in wound healing, following experimental filtration surgery in rabbits. Collagen synthetic activity was measured by immunohistochemistry for prolyl 4-hydroxylase beta-subunit and type I procollagen. Trabeculectomy was performed on albino rabbit eyes, with the filtering site harvested on postoperative days 1, 4, 7, 14, and 28. Samples were fixed with 10% buffered formalin for 12 hours and prepared for paraffin section, and each antigen was detected in filtering site tissue using avidin-biotinylated peroxidase complex. Immunoreaction of prolyl 4-hydroxylase beta-subunit or type I procollagen increased from day 4 to 14 and markedly decreased at day 28. These findings show that prolyl 4-hydroxylase and type I procollagen are markedly produced almost simultaneously, and collagen synthetic activity following filtration surgery continues for over 14 days in the process of wound healing.