The surgical management of glaucoma in aphakia has been limited by poor success in the control of intraocular pressure and serious postoperative complications that threaten vision. A consecutive series of trabeculectomy filtering procedures in aphakic eyes with a mean preoperative intraocular pressure of 38 mmHg was followed for an average of 26 months and revealed a 62% control of intraocular pressure at 21 mmHg or less. Five additional patients (24%) had pressures lower than 21 mmHg following digital massage.
Four eyes underwent cicatricial closure of the filtering bleb within the 6 weeks postoperatively. They failed to respond to digital massage and conventional therapy, resulting in loss of bleb and elevated intraocular pressure. The average pre-YAG laser treatment intraocular pressure was 34.5 mmHg. Three hundred to five hundred applications from the mode-locked Neodymium:YAG laser ( Meditec ) delivered at 3.5 mJ were directed through a goniocontact prism to the surgical area. Prompt vaporization of scar tissue and sclera resulted in a dramatic reversal of the pathology.
Food and Chemical Toxicology: An International Journal Published for the British Industrial Biological Research Association
Elevated intraocular pressure (IOP) constitutes the best characterized risk for primary open-angle glaucoma (POAG). Elevated IOP is believed to result from an increase in aqueous humor outflow resistance at the level of the trabecular meshwork (TM)/Schlemm's canal. Malfunction of the TM in POAG is associated with the expression of markers for inflammation, cellular senescence, oxidative damage, and decreased cellularity. Current POAG treatments rely on lowering IOP, but there is no therapeutic approach available to delay the loss of function of the TM in POAG patients.