ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The long-term success of filtering surgery is not dependent on surgical technique alone. The development of the filtering bleb in the postoperative period, in particular with regard to wound healing and subconjunctival scarring, is equally important. Morphologic changes of the developing filtering bleb after trabeculectomy can predict early failure even if the intraocular pressure is still normal. A basic understanding of wound healing processes and histologic changes of the developing filtering bleb are mandatory to interpret correctly the morphologic appearance of the developing filtering bleb. In clinical practice, follow-up of the filtering bleb according to a standardized morphologic classification may help to predict outcome and provide clues for the necessity and timing of further treatment.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The efficacy of combined surgery for the treatment of concurrent glaucoma and cataract has long been under scrutiny. Comparisons between sequential surgery and combined procedures have shown mixed results, and current guidelines have been drawn for the indication of combined surgery. The evolution of combined triple surgery–cataract extraction, intraocular lens implantation, and filtering procedure–has evolved from planned extracapsular cataract extraction to small-incision phacoemulsification. The improvements of phacoemulsification over extracapsular surgery have naturally given rise to improvements in the results of combined procedures; good outcomes in both intraocular pressure control and visual acuity have been reported along with low complication rates. The techniques of combined phacoemulsification-trabeculectomy are under continual development as new sutureless incisions, filtration procedures, and antimetabolite use are studied. The results of numerous studies show that the combined procedure is an effective method of treatment of glaucoma and cataract. This review examines various recent aspects of the combined procedure, phacoemulsification-trabeculectomy, antimetabolites, results and complications, as well as current developments of new techniques. In addition, we review studies on combined cataract extraction and trabeculectomy, including older literature on planned extracapsular extraction plus trabeculectomy as well as newer studies on phacoemulsification-trabeculectomy.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Important advances have been made within the past year in the area of glaucoma genetics, including the identification of the TIGR gene for adult as well as juvenileGLC1Aglaucoma, a P450 gene forGLC3Acongenital glaucoma, and a bicoidhomeobox transcription factor geneRIEGfor developmental glaucoma. The cloning of TIGR as a candidate gene for glaucoma is based on its distinctive induction in human trabecular meshwork cells and tissues, its induction profile, and the expressed molecule's putative biologic properties. Results from several laboratories showing defects in the olfactomedin homology domain of the TIGR gene have generated particular interest concerning potential pathogenic mechanisms. Recent progress in glaucoma genetics has also included the identification of new loci in familial adult open-angle glaucoma, the identification of a locus associated with pigment dispersion syndrome, and the collection of new families for linkage analyses and clinical assessments. Taken together, these findings offer future prospects for improving diagnostic criteria, for understanding disease etiologies, and for developing improved therapeutic strategies.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Evidence that vascular factors contribute to the pathogenesis and development of glaucomatous optic neuropathy continues to accumulate. A higher than expected prevalence of systemic vascular disorders in individuals with glaucoma has been documented. New sophisticatedin vivoanalysis techniques, such as ultrasound color Doppler imaging, suggest that decreased blood flow velocity and increased vascular resistance are present in the vessels serving the optic nerve of human subjects with glaucoma, implying the presence of either organic or functional vascular disorders in these individuals. Recognizing that different analysis techniques have led to conflicting observations, experimental models have been developed to provide an additional tool with which to interpret the effects of compromised optic nerve perfusion

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Clonidine hydrochloride, apraclonidine hydrochloride, and brimonidine tartrate constitute the three topical α agonists that are used in the treatment of elevated intraocular pressure. All the α agonists have prejunctional (α2) as well as postjunctional (α1) effects. Within the past year, questions have arisen about their local and systemic effects, and their effects upon the optic nerve. We will, therefore, attempt to clarify these points, to provide a greater understanding of the role of α agonists in glaucoma therapy.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The pathogenesis of the diseases termedopen-angle glaucomaremains elusive but progress is being made in understanding more clearly the optic nerve head, vascular, and cellular mechanisms that are associated with them. Even though the greatest risk factors remain intraocular pressure, age, race and refractive error, the association with vascular disease continues to unfold in the literature. Clinical and laboratory studies, although not addressing mechanisms directly as far as we know, continue to probe potential pathways that will ultimately lead to subsets of open-angle glaucoma. Only when this is accomplished will we be able to focus therapy at pathogenesis rather than at risks.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Ultrasound biomicroscopy has allowed us to elucidate the anatomic variations and underlying mechanisms in angle-closure glaucoma. Four levels of anatomic block can be distinguished, and a specific approach to treatment exists for each level to correct the abnormal forces leading to closure of the angle. As more quantitative approaches are developed, our understanding of these disorders will become increasingly sophisticated.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Our new hypothesis for the regulation of aqueous humor outflow suggests that the trabecular meshwork is not a passive filter but an active contractile element contributing to the ciliary muscle traction affecting it. The trabecular meshwork contains contractile smooth-muscle-specific α-actin filaments, and its cells exhibit electrical properties typical for smooth muscle cells. Contractility measurements performed for the first time in isolated trabecular meshwork enable a functional comparison with ciliary muscle. Pharmacologic outflow regulation has been determined in isolated perfused anterior segments with intact trabecular meshwork and total absence of ciliary muscle. Substances that contracted isolated trabecular meshwork (eg, pilocarpine) decreased the outflow rate, whereas relaxants (eg, low-dose epinephrine) increased it. The concept of a functional antagonism between the trabecular meshwork and the ciliary muscle has to be considered.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Many risk factors associated with glaucoma have been identified recently. The best known of these is increased intraocular pressure (IOP). Among the others, however, vascular risk factors play a major role. Although such vascular factors were already postulated more than 100 years ago, only recent technical developments have afforded systematic investigations of associated microcirculatory disturbances and basic principles of blood flow regulation. In glaucoma, besides IOP, vascular dysregulation (such as local vasospasm and systemic hypotension, resulting in impaired autoregulation of blood flow in the optic nerve head, the choroid, and other ocular tissues) seems to be a major risk factor. However, multiple coacting factors, which are not limited to the eye but are, rather, symptoms of a systemic disease, seem to be involved in the damaging process.

ISSN:1040-8738    

出版商:OVID    

年代:1998

数据来源: OVID