A pilot study of a system for grading of drainage blebs after glaucoma surgery.

Purpose: To develop and evaluate a novel bleb grading scheme for clinical and photographic evaluation.

Method: A system for grading bleb photographs using widely applicable parameters was designed, and reference color photographs printed. A prospective masked agreement study was undertaken comparing slit lamp examination with mono and stereo photographs; 36 eyes of 28 patients with previous glaucoma surgery were graded according to defined parameters on a 1 to 10 scale clinically at the slit lamp by four ophthalmologists and two optometrists.

Silicone oil concentrates fibrogenic growth factors in the retro-oil fluid.

Aim: To determine whether silicone oil concentrates protein and growth factors in the retro-oil fluid.

Methods: A laboratory analysis of intraocular fluid and vitreous specimens obtained from patients undergoing removal of silicone oil, revision vitrectomy, or primary vitrectomy for macular hole, proliferative vitreoretinopathy (PVR), or retinal detachment. Patients were prospectively recruited from routine vitreoretinal operating lists.

Flap and suture manipulation after trabeculectomy with adjustable sutures: titration of flow and intraocular pressure in guarded filtration surgery.

Purpose: To describe the intraocular pressure (IOP) changes resulting from scleral flap suture and scleral flap manipulation in an experimental model of conventional guarded filtration surgery.

Design: Experimental study.

Methods: Trabeculectomy operations were performed with adjustable sutures on 5 donor human eyes connected to a constant flow infusion and a real-time IOP monitoring system.

Matrix metalloproteinase distribution during early corneal wound healing.

Aim: To compare matrix metalloproteinase (MMP) localisation in anterior keratectomy (AK) and lamellar keratectomy (LK) wounds.

Methods: Wounds were produced in one eye of 24 rabbits. The AK wounds were made to approximately 120 microm in depth and then allowed to re-epithelialise.

A review of trabeculectomy in East Asian people--the influence of race.

Glaucoma is the leading cause of irreversible blindness worldwide. East Asians account for approximately half of all glaucoma sufferers. It is likely that trabeculectomy will be needed for many of these people as the intraocular pressure is to be maintained at a satisfactorily low level.

Polyvalent dendrimer glucosamine conjugates prevent scar tissue formation.

Dendrimers are hyperbranched macromolecules that can be chemically synthesized to have precise structural characteristics. We used anionic, polyamidoamine, generation 3.5 dendrimers to make novel water-soluble conjugates of D(+)-glucosamine and D(+)-glucosamine 6-sulfate with immuno-modulatory and antiangiogenic properties respectively.

National survey of antimetabolite use in glaucoma surgery in the United Kingdom.

Aims: To assess the pattern of use of antimetabolites in trabeculectomy surgery by all consultant ophthalmologists in the United Kingdom.

Methods: A postal questionnaire of 12 questions regarding antimetabolite use in trabeculectomy surgery was sent to all 749 consultant ophthalmologists in the United Kingdom. The consultants were asked to estimate the number of trabeculectomies they performed per year, how often they used 5-fluorouracil (5-FU) in primary and redo surgery, their usual method of administration of 5-FU, how often they used mitomycin (MMC) in primary and redo surgery, and their usual dosage regimen of MMC.

MMP inhibition prevents human lens epithelial cell migration and contraction of the lens capsule.

Purpose: The development of posterior capsule contraction following cataract surgery is caused by the activity of residual lens epithelial cells. Matrix metalloproteinases (MMPs) are a group of proteolytic enzymes, which are essential for cell migration and cell mediated contraction following wound healing. The authors investigated whether inhibiting MMP activity can reduce lens epithelial cell migration and as a result, lead to a reduction in cell mediated capsule contraction.

Spontaneous inferior subconjunctival haemorrhages in association with circumferential drainage blebs.

Aim: To describe an association of spontaneous inferior subconjunctival haemorrhages in eyes with circumferential drainage blebs following trabeculectomy.

Methods: Observational case series. Patients with multiple episodes of spontaneous inferior subconjunctival haemorrhage following trabeculectomy (with or without antimetabolite) and circumferential blebs are presented.

Primary open-angle glaucoma.

Primary open-angle glaucoma is a progressive optic neuropathy and, perhaps, the most common form of glaucoma. Because the disease is treatable, and because the visual impairment caused by glaucoma is irreversible, early detection is essential. Early diagnosis depends on examination of the optic disc, retinal nerve fibre layer, and visual field.

Interocular asymmetry of visual field defects in primary open angle glaucoma and primary angle-closure glaucoma.

Aim: To compare the interocular asymmetry in visual field loss of patients with primary open-angle (POAG) and primary angle-closure glaucoma (PACG).

Methods: Subjects entering a prospective, randomised, controlled trial of intraoperative 5-fluorouracil in glaucoma surgery in Singapore were included. Preoperative visual field testing was performed using automated white-on-white perimetry (24-2 test pattern, threshold program, Mk II, Model 750, Zeiss-Humphrey, San Leandro, CA, USA).

Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis.

Purpose: To report the outcome of 5-fluorouracil (5-FU)-augmented bleb needling revision of failed and failing filtration blebs and to identify risk factors for failure, indicators for success, and any complications of the procedure.

Design: Prospective, observational, noncomparative, interventional case series with survival analysis.

Methods: The results of 101 bleb needling procedures augmented with subconjunctival 5-FU injection were determined after a minimum follow-up of 9 months.

Involvement of CTGF in TGF-beta1-stimulation of myofibroblast differentiation and collagen matrix contraction in the presence of mechanical stress.

Purpose: This study was undertaken to investigate the role of connective tissue growth factor (CTGF) in fibroblast-to-myofibroblast differentiation and fibroblast-mediated collagen matrix contraction in the presence of mechanical stress.

Methods: An in vitro three-dimensional contraction model of human corneal-fibroblast-seeded collagen lattices (FSCLs) in the presence of mechanical stress generated by attaching the lattices to the culture well was used to measure FSCL contraction. FSCLs were treated with CTGF; TGF-beta1; serum-free (SF) control medium; or TGF-beta1 plus antisense oligodeoxynucleotides to CTGF; TGF-beta1 plus scrambled-sequence oligodeoxynucleotide to CTGF; or TGF-beta antibody.

Defining "occludable" angles in population surveys: drainage angle width, peripheral anterior synechiae, and glaucomatous optic neuropathy in east Asian people.

Background: /aim: A current consensus in epidemiological studies of primary angle closure (PAC) is to diagnose the condition only if the posterior (usually pigmented) trabecular meshwork is seen for less than 90 degrees of the angle circumference, termed an "occludable angle." The authors sought to assess the validity of this epidemiological classification by exploring the relation between drainage angle width, peripheral anterior synechiae (PAS) and glaucomatous optic neuropathy (GON).

Methods: 918 Mongolians and 995 Chinese Singaporeans, both groups aged 40 years and older were examined in two population based surveys.

T lymphocyte mediated lysis of mitomycin C treated Tenon's capsule fibroblasts.

Aims: To evaluate the effect of T cell co-culture on mitomycin C treated and untreated Tenon's capsule fibroblasts.

Methods: IL-2 dependent allogeneic T cells were incubated over a monolayer of mitomycin C treated or control fibroblasts. Fibroblast numbers were evaluated by direct counts using phase contrast microscopy.

Effect of cataract extraction and intraocular lens implantation on nerve fibre layer thickness measurements by scanning laser polarimeter (GDx) in glaucoma patients.

Purpose: To assess the influence of visually significant cataract on the measurement of nerve fibre layer thickness by scanning laser polarimetry (GDx) in glaucoma patients undergoing phacoemulsification cataract extraction.

Method And Subjects: All subjects with primary glaucoma participating in a prospective trial of glaucoma surgery who subsequently underwent cataract extraction were eligible. A single trained observer using the GDx nerve fibre layer analyser (LDT) performed pre- and post-operative measurements of nerve fibre layer thickness (NFLT).

The effects of single doses of beta radiation on the wound healing behaviour of human Tenon's capsule fibroblasts.

Aim: To determine the effects of single doses of beta radiation on the wound healing functions of human Tenon's capsule fibroblasts (hTf).

Methods: hTf were grown in tissue culture and irradiated with beta radiation using a strontium 90 source. The effects of beta radiation on fibroblast migration was studied using microporous transwell membranes.

Temporal and spatial expression of matrix metalloproteinases during wound healing of human corneal tissue.

Our understanding of MMP expression during corneal repair has previously relied upon animal models, isolated human biopsy specimens and cell culture studies. The aim of this study was to determine the temporal and spatial expression of matrix metalloproteinases following wounding of cultured human corneal tissue. Human corneas were cultured and cut into six pieces.

Cystic bleb formation and related complications in limbus- versus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C.

Objective: Comparison of fornix- and limbus-based conjunctival flaps with respect to cystic bleb-related complications of trabeculectomy with high-dose mitomycin C (MMC) in pediatric and young adult glaucoma.

Design: Retrospective nonrandomized comparative interventional case series.

Participants: Thirty-seven patients.

Mediation of transforming growth factor-beta(1)-stimulated matrix contraction by fibroblasts: a role for connective tissue growth factor in contractile scarring.

Excessive cell-mediated tissue contraction after injury can lead to morbid contractile scarring in the body. In the eye this can cause blindness because of posterior capsule opacification, proliferative vitroretinopathy, failure of glaucoma filtration surgery, and corneal haze. During repair, transforming growth factor (TGF)-beta and connective tissue growth factor (CTGF) genes are co-ordinately expressed.

Determinants of intraocular pressure and its association with glaucomatous optic neuropathy in Chinese Singaporeans: the Tanjong Pagar Study.

Purpose: To examine the relationship between intraocular pressure (IOP), anthropomorphic, demographic, socioeconomic, systemic, and ocular factors and glaucomatous optic neuropathy (GON) in Chinese people.

Methods: Chinese people (n = 2000), aged 40 to 79 years, were selected from the Singapore electoral register. Of the 1717 considered eligible for examination, 1232 participated, representing a response rate of 71.

Problem of dural scarring in recording from awake, behaving monkeys: a solution using 5-fluorouracil.

In studies using single neuron recordings from awake, behaving monkeys, it is necessary to make repeated transdural penetrations using fragile microelectrodes. The tough connective tissue that accumulates after the dura mater is first exposed is often problematic because of electrode breakage and the mechanical stress to the underlying brain tissue caused by excessive dimpling during penetration. We describe the use of an antimitotic compound, 5-fluorouracil (5FU) to control the growth of this connective tissue.