Success and complication rates of trabeculectomies augmented with MMC in the management of glaucoma

Glaucoma unresponsive to medical treatment is managed by surgery. Augmentation with mitomycin C (MMC) is considered in patients at high risk of surgery failure. Aim: In this paper we assess and compare the success and complications of this procedure performed in the local state hospital with those of larger international centres. Methods: A retrospective study of the surgery performed between 2003 and 2007 at St. Luke's Hospital by one surgeon (FM) was conducted. The total number of eyes considered in this analysis was 32. Intraocular pressures and complications up to one year post-operatively were recorded. Results: The mean intraocular pressure decreased from 30mmHg pre-operatively to 18mmHg post-operatively. The mean IOP drop registered was 42%. Of the 32 eyes that underwent trabeculectomy augmented by MMC, 23 were classified as a complete success with IOP remaining below 21mmHg at 1 year post-surgery. Six eyes were considered as a partial success since they had an IOP under 21mmHg but this had to be kept under control with the administration of medications. Failure of surgery was classified as uncontrollable UOP, although also on medications. This was seen in 3 eyes. Using the central limit theorem, the significance of the difference in means and difference in percentages of IOP drop and complication rates, between the local state hospital procedures and international centres were calculated. Conclusions: Incidences obtained from this analysis compare very favourably with results from international studies showing no significant differences.peer-reviewe

Sudden bilateral loss of vision in a 19-year-old man

Introduction: Posterior Reversible Leukoencephalopathy Syndrome (PRES) is caused by ischaemia commonly affecting the posterior cerebral vasculature. It presents with sudden decreased vision, headaches, nausea, vomiting, seizures, and altered mental status. Case presentation: A 19-year-old male presented to the ophthalmic emergency complaining of sudden bilateral loss of vision, which was down to light perception He reported headaches, nausea, and drowsiness since the previous day. He was a known case of hypertension secondary to IgA nephropathy. Magnetic resonance imaging (MRI) with STIR and FLAIR sequences showed foci of hyperintensity within the occipital lobes bilaterally. This confirmed the suspected diagnosis of PRES. Discussion: Aetiological factors of PRES include sudden increase in blood pressure, eclampsia, porphyria, renal disease, and Cushing syndrome. These lead to blood-brain barrier injury either by hyper- or hypoperfusion, endothelial dysfunction, changes in blood vessel morphology, hypocapnea, or immune system activation. Histopathological changes in PRES include activated astrocytes, scattered macrophages and lymphocytes, often in the absence of inflammation or neuronal damage. Conclusion: PRES is usually a reversible neuroophthalmological condition, however prompt recognition and appropriate management is important to prevent permanent brain injury or even death.peer-reviewe

Can pterygium excision with mitomycin C leaving bare sclera be salvaged?

Purpose The aim of this study was to analyze the recurrence rate of pterygium following excision with intra-operative mitomycin C (MMC) and post-operative scraping of the perilimbal conjunctival defect, and the patients’ satisfaction with this technique. Methods This is a retrospective analysis of a cohort of 33 eyes of 28 patients with primary or recurrent pterygium who underwent simple excision with MMC. They were followed up after a mean of 27.8 months. The main outcomes considered were the recurrence rate and patient satisfaction. A recurrence was defined as any regrowth of conjunctiva over the limbus and any complications were considered significant. The patients were interviewed with a standard questionnaire and examined. Results An objective recurrence was noted in 55% (18 out of 33 eyes). The recurrence rate after excision of primary pterygia was 46% (13 out of 28 eyes), and for recurrent pterygia it was 80% (four out of five eyes). In this study the complications included: six eyes that developed a granuloma, one case of bleeding which persisted for three days post-op, and one eye in which there was a suspected scleral melt at five weeks. 79% of the procedures resulted in a good patient satisfaction (26 out of 33 eyes), and only in 15% (five eyes) was there a subjective recurrence. Conclusions This technique in our study resulted in an unacceptably high recurrence rate, especially in the case of recurrent pterygia. However patients still tended to be satisfied with the outcome.peer-reviewe