Efficacy and safety of trabeculectomy with mitomycin C for childhood glaucoma: a study of results with long-term follow-up

OBJECTIVE: To evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma. INTRODUCTION: The use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children. METHODS: A retrospective chart review (1991-2001) of 114 patients (114 eyes) from 0-14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent. RESULTS: The mean patient age was 57.36 51.14 months (range: 0.5-168 months). Treatment was considered successful in 63 eyes (55.26%), with a mean intraocular pressure of 12.11 3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16 26.13 months (range 12-113 months). A post-surgical intraocular pressure of < 16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2%, 78.7%, 60.7% and 50.8%, respectively. The cumulative probability of failure was 40.8% at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88%) after an average 36.96 months (range: 1.7-106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak. DISCUSSION: It has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30% to 50% of cases. In our study, treatment was considered successful in 63 eyes (55.26%) within 61.16 26.13 months of follow-up. CONCLUSIONS: Trabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults

Partial Tenon´s capsule resection with adjunctive mitomycin C in Ahmed valve implant surgery among neovascular glaucoma patients

Este estudo teve por objetivo avaliar a eficácia e a segurança da cirurgia de implante de Ahmed, associada à ressecção parcial da cápsula de Tenon e ao uso da mitomicina C, em portadores de glaucoma neovascular. A amostra foi constituída por 31 olhos de trinta pacientes portadores de glaucoma neovascular, secundário à retinopatia diabética proliferativa ou à oclusão da veia central da retina, com acuidade visual maior ou igual à percepção luminosa. Os olhos foram randomizados para formarem dois grupos: implante de Ahmed convencional, associado ao uso da mitomicina C (n=15), e implante de Ahmed de alta resistência, associado à ressecção parcial da cápsula de Tenon e ao uso da mitomicina C (n=16). Controlaram-se as variáveis procurando homogeneizar os grupos a fim de prevenir vieses nas avaliações dos desfechos. Definiram-se como sucesso cirúrgico simples os casos com pressões oculares maiores ou iguais a 5 mm Hg e menores ou iguais a 21 mm Hg. A média de idade foi de 58,06 anos ± 13,02 , sendo de 62,63 anos ± 10,23 no grupo com e de 53,20 anos ± 14,22 no grupo sem ressecção parcial da cápsula de Tenon (p = 0,109). Não houve diferença estatisticamente significativa entre os grupos com relação ao sexo (p = 0,722), olho operado (p = 1,0), causa do glaucoma neovascular (p = 1,0), existência de panfotocoagulação prévia (p = 1,0) e acuidade visual pré-operatória (p = 0,154). A pressão ocular média pré-operatória foi de 51,00 ± 10,05 mm Hg no grupo com ressecção parcial da cápsula de Tenon e de 51,20 ± 11,58 mm Hg no grupo sem ressecção da cápsula de Tenon (p = 0,889). Houve redução significativa da pressão ocular em ambos os grupos a partir do primeiro dia do pós-operatório. A pressão ocular média dos grupos com e sem ressecção parcial da cápsula de Tenon aos 24 meses de seguimento foi de, respectivamente, 17,00 ± 12,77 mm Hg e 19,78 ± 15,71 mm Hg (p = 0,820). O seguimento médio foi de 23,44 meses ± 9,63 no grupo com ressecção parcial da cápsula de Tenon e de 23,40 meses ± 9,62 no grupo sem ressecção parcial da cápsula de Tenon (p = 0,952). Registraram-se diferenças estatisticamente significativas entre as pressões médias nos grupos com e sem ressecção parcial da cápsula de Tenon apenas no primeiro dia, terceiro e sétimo meses do pós-operatório. Houve redução mais intensa da acuidade visual no grupo sem ressecção parcial da cápsula de Tenon do que no grupo com exérese da cápsula de Tenon (p = 0,023*). O sucesso simples foi de 62,5% (dez olhos) no grupo com e de 53,3% (oito olhos) no grupo sem ressecção parcial da cápsula de Tenon (p = 0,722). Não se verificaram bolhas transparentes, pálidas ou isquêmicas em fase alguma do pós-operatório, em ambos os grupos. As freqüências das complicações foram semelhantes em ambos os grupos, exceto por uma freqüência quase quatro vezes maior de exposição do implante no grupo com ressecção parcial da cápsula de Tenon. Em resumo, os índices de sucesso cirúrgico foram semelhantes entre os grupos com e sem ressecção parcial da cápsula de Tenon, após um seguimento médio de 23,42 meses. Houve redução significativa da acuidade visual nos dois grupos, a qual foi mais intensa naquele sem ressecção parcial da cápsula de Tenon. A exposição do implante de drenagem foi quase quatro vezes mais freqüente no grupo submetido à ressecção parcial da cápsula de TenonThe objective of the study was to evaluate the safety and efficacy of Ahmed glaucoma valve implant surgery combined with partial Tenon\'s capsule resection and mitomycin C administration in neovascular glaucoma patients. Our sample comprised 31 eyes of 30 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion. The 30 patients all had visual acuity equal to or greater than their perception of light. The eyes were randomized into two groups: conventional Ahmed valve implant combined with mitomycin C administration (n = 15); and high-resistance Ahmed implant combined with partial Tenon\'s capsule resection and mitomycin C administration (n = 16). Variables were controlled in an attempt to homogenize the groups and thereby avoid any bias in the evaluation of the results. Simple surgical success was defined as ocular pressure equal to or greater than 5 mmHg but less than or equal to 21 mmHg. Median age was 58.06 ± 13.02 (53.20 ± 14.22 in the group not submitted to resection and 62.63 ± 10.23 in the group submitted to partial Tenon\'s capsule resection; p = 0.109). No statistically significant difference between the groups was found related to gender (p = 0.722), operated eye (p = 1.0), cause of neovascular glaucoma (p = 1.0), previous panphotocoagulation (p = 1.0), or preoperative visual acuity (p = 0.154). Mean preoperative ocular pressure was 51.20 ± 11.58 mmHg in the group not submitted to resection and 51 ± 10.05 mmHg in the group submitted to partial Tenon\'s capsule resection (p = 0.889). From the first preoperative day, there was a significant reduction in ocular pressure in both groups. At 24 months after surgery, mean ocular pressure of subjects not submitted and submitted to partial Tenon\'s capsule resection was 19.78 ± 15.71 mmHg and 17.00 ± 12.77 mmHg, respectively (p = 0.820). Mean length of the follow-up period was 23.40 ± 9.62 months in those not submitted to resection and 23.44 ± 9.63 months in the group submitted to partial Tenon\'s capsule resection (p = 0.952). Statistically significant differences in ocular pressure were found between the two groups only on postoperative day 1 and at 3 and 7 months after surgery. In the group not submitted to resection, there was a more marked reduction in visual acuity (p = 0.023*). Simple surgical success was achieved in 53.3% (8) of the eyes in the group not submitted to resection and in 62.5% (10) of the eyes in the group submitted to partial Tenon\'s capsule resection (p = 0.722). There were no pale or transparent blebs in either group during the postoperative phase. The incidence of complications was similar between the two groups, with the exception of the incidence of implant tube exposure, which was four times greater in the group submitted to partial Tenon\'s capsule resection. In conclusion, after a mean follow-up period of 23.42 months, the measures of surgical success were comparable between the two groups. There was significant reduction in visual acuity in both groups, more markedly in the group not submitted to resection. The implant drainage tube became exposed four times more frequently in the group submitted to partial Tenon\'s capsule resectio

Update on angle-closure glaucoma: diagnosis

L’année 2004 célèbre le cinquantième anniversaire du déclenchement de la guerre d’indépendance algérienne avec l’insurrection du 1er novembre 1954, date fondatrice pour la naissance de l’État algérien. À l’occasion de cette célébration, ce numéro d’Insaniyat, revue algérienne d’anthropologie et de sciences sociales, a l’ambition d’offrir un large panorama historiographique sur plusieurs périodes de l’histoire de l’Algérie. Ambition chronologique (période coloniale, période du mouvement nation..

Identification of mTOR and AGO1 IRES trans-acting factors

Cancer is the second leading cause of death globally; therefore, its study is crucial to discover new therapies. Under stress, the regular process of protein synthesis (canonical translation) is impaired, while a back-up mechanism mediated by internal ribosome entry sites (IRES) continues to function, allowing the synthesis of proteins that maintain cellular viability. This also happens in cancer cells, contributing for their survival and consequent tumorigenesis. IRES-mediated translation and its regulation by IRES trans-acting factors (ITAFs) has been correlated to metastasis and chemotherapeutic drug resistance. Therefore, our main goal was to validate ITAFs and assess their significance in cancer onset, thus becoming candidates as novel therapeutic targets. A bicistronic reporter system, which contains a first cistron translated via canonical translation and a second one translated by IRES of mTOR1 and AGO12 was used to test IRES-driven translation initiation activity. Experiments were carried out in which several proteins (hnRNPs) were silenced by specific siRNAs to analyse their function as ITAFs of mTOR and AGO1 IRESs. Also, distinct drugs were applied to simulate endoplasmic reticulum (ER) or hypoxia stress, to evaluate their effect on IRES activity. The relative IRES activity was assessed by luminescence tests and the protein levels by Western blot. In general, knockdown of hnRNPK and hnRNPU seems to decrease the IRES activity by ~60% and ~30% respectively, while hnRNPC knockdown does not show a significant effect. Regarding the ER stress, hnRNPK knockdown seems to decrease even more the IRES activity, while hnRNPU depletion induces a significant increase. On the other hand, in hypoxia, the hnRNPs knockdowns do not significantly affect IRES activity. These results indicate that hnRNPK and hnRNPU may function as ITAFs of mTOR and AGO1 IRES activity in cells under ER stress. Our data can be decisive for a better understanding of carcinogenesis and suggest new therapeutic targets for cancer treatment. 1. Marques-Ramos, A., et.al. 2017. RNA. 23, 1712-1728 2. Lacerda, R. 2016. Faculdade de Ciências e Tecnologia da Universidade NOVA de LisboaWork partially supported by UID/MULTI/04046/2019 Research Unit grant from FCT, Portugal (to BioISI)info:eu-repo/semantics/publishedVersio