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Surgical revision of failed filtering bleb with mitomycin C
447
ABSTRACTS
visual acuity of 0.6 or better and that of 0.2 or worse. The poor visual outcome resulted from macular degeneration, and risk factors for its development were small birth weight (Mann-Whitney U test, P = 0.03) retinopathy plus disease (x2 test, P = 0.041), treatment of a large area of the fundus (Mann-Whitney U test, P = 0.035) and the inside of the vascular arcade (Mann-Whitney U test, P = 0.0034), and treatment by cryocautery (x2 test, P = 0.032). Macular degeneration occurred either as an isolated small focus extending circumferentially around the fovea or as a result of extension from the temporal degeneration caused by photocoagulation. These results suggest that intensive treatment for retinopathy of prematurity, in addition to the prematurity by itself, caused the development of macular degeneration. Overtreatment should be carefully avoided in retinopathy of prematurity complicated by disease in which photocoagulation needs to be done in the area posterior to the ridge. (J Jpn Ophthalmol Sot 101:503-509,1997) Miki Noso Department of Ophthalmology, Okayama University MtJdical School
Immunohistochemical and Immunogenetic Analysis of Ocular Adenexal Lymphoid Proliferations We examined 20 cases (21 specimens) of ocular adnexal lymphoid proliferations, using the histological, immunohistochemical, and molecular genetic methods. The latter two protocols were performed to detect the light chain restriction of immunoglobulin with peroxidase-antiperoxidase (PAP) methods and the clonality of immunoglobulin heavy chain gene with the hemi-nested polymerase chain reaction (PCR) method, respectively. Although in eight cases it could not be morphologically determined whether they were neoplastic or not, clonality was revealed in one case with immunohistochemistry and in four cases with PCR. Two cases showed discordant results between immunohistochemistry and PCR probably due to somatic mutation of the framework region of the immunoglobulin heavy chain gene. Therefore, we concluded that examination with these methods contributes to a better understanding of the nature of the ocular adnexal lymphoid proliferations. Furthermore, the immunoglobulin gene PCR method is very useful in practical examination, as it can be used with formalin-fixed paraffin-embedded specimens. (J Jpn Opthalmol Sot 101:510-515,1997)
Toshinobu Kubota,* Yasushi Yatabe: Shinobu Awaya,* Junpei Asai’ and Naoyoshi Mori” *Department of Ophthalmology, Nagoya University School of Medicine; ‘Department of Pathology and Clinical Laboratories, Aichi Cancer Hospital; ‘First Department of Pathology, Nagoya University School of Medicine
Surgical Revision of Failed Filtering Bleb with Mitomycin C The revision of a failed filtering bleb using mitomycin C was performed in 40 eyes (28 eyes with primary open angle glaucoma and 12 eyes with secondary open angle glaucoma) in which the previous trabeculectomy using 5-fluorouracil had failed to control intraocular pressure (IOP). Presurgical IOP ranged from 21-36 mmHg (average: 24.7 mmHg) with the maximum tolerable antiglaucoma medication. The follow-up period was at least 2 years (24-60, mean: 39.8 months). Mitomycin C (0.04%, 5 mL, 5 min) was applied under the subconjunctival space. After rinsing, the wall of the scarred bleb was incised in cases with a localized bleb, or the margin of the scleral flap was incised in cases without a filtering bleb. The conjunctival wound was closed with 10-O Nylon sutures. IOP control under 21 mmHg was achieved in 53.4% without medication and in 60.2% with or without medication at 60 months. After repeating the same procedure, IOP control was obtained in 82.2% with or without medication at 60 months. The success rate in secondary open angle glaucoma was less than in primary open angle glaucoma. Complications such as flattening of the anterior chamber requiring reformation (8%) choroidal detachment (8%), hyphema (5%) and hypotonic maculopathy (5%) were less than after trabeculectomy, but conjunctival wound separation (5%) occurred little more frequently. (J Jpn Ophthalmol Sot 101:516-519,1997) Takeshi Hara and Shiroaki Shirato Department of Ophthalmology, The University of Tokyo School of Medicine
Four Cases of Late Infection Following Scleral Buckling Procedure We report four cases with late infection following a scleral buckling procedure. These cases were a 44-
ABSTRACTS
visual acuity of 0.6 or better and that of 0.2 or worse. The poor visual outcome resulted from macular degeneration, and risk factors for its development were small birth weight (Mann-Whitney U test, P = 0.03) retinopathy plus disease (x2 test, P = 0.041), treatment of a large area of the fundus (Mann-Whitney U test, P = 0.035) and the inside of the vascular arcade (Mann-Whitney U test, P = 0.0034), and treatment by cryocautery (x2 test, P = 0.032). Macular degeneration occurred either as an isolated small focus extending circumferentially around the fovea or as a result of extension from the temporal degeneration caused by photocoagulation. These results suggest that intensive treatment for retinopathy of prematurity, in addition to the prematurity by itself, caused the development of macular degeneration. Overtreatment should be carefully avoided in retinopathy of prematurity complicated by disease in which photocoagulation needs to be done in the area posterior to the ridge. (J Jpn Ophthalmol Sot 101:503-509,1997) Miki Noso Department of Ophthalmology, Okayama University MtJdical School
Immunohistochemical and Immunogenetic Analysis of Ocular Adenexal Lymphoid Proliferations We examined 20 cases (21 specimens) of ocular adnexal lymphoid proliferations, using the histological, immunohistochemical, and molecular genetic methods. The latter two protocols were performed to detect the light chain restriction of immunoglobulin with peroxidase-antiperoxidase (PAP) methods and the clonality of immunoglobulin heavy chain gene with the hemi-nested polymerase chain reaction (PCR) method, respectively. Although in eight cases it could not be morphologically determined whether they were neoplastic or not, clonality was revealed in one case with immunohistochemistry and in four cases with PCR. Two cases showed discordant results between immunohistochemistry and PCR probably due to somatic mutation of the framework region of the immunoglobulin heavy chain gene. Therefore, we concluded that examination with these methods contributes to a better understanding of the nature of the ocular adnexal lymphoid proliferations. Furthermore, the immunoglobulin gene PCR method is very useful in practical examination, as it can be used with formalin-fixed paraffin-embedded specimens. (J Jpn Opthalmol Sot 101:510-515,1997)
Toshinobu Kubota,* Yasushi Yatabe: Shinobu Awaya,* Junpei Asai’ and Naoyoshi Mori” *Department of Ophthalmology, Nagoya University School of Medicine; ‘Department of Pathology and Clinical Laboratories, Aichi Cancer Hospital; ‘First Department of Pathology, Nagoya University School of Medicine
Surgical Revision of Failed Filtering Bleb with Mitomycin C The revision of a failed filtering bleb using mitomycin C was performed in 40 eyes (28 eyes with primary open angle glaucoma and 12 eyes with secondary open angle glaucoma) in which the previous trabeculectomy using 5-fluorouracil had failed to control intraocular pressure (IOP). Presurgical IOP ranged from 21-36 mmHg (average: 24.7 mmHg) with the maximum tolerable antiglaucoma medication. The follow-up period was at least 2 years (24-60, mean: 39.8 months). Mitomycin C (0.04%, 5 mL, 5 min) was applied under the subconjunctival space. After rinsing, the wall of the scarred bleb was incised in cases with a localized bleb, or the margin of the scleral flap was incised in cases without a filtering bleb. The conjunctival wound was closed with 10-O Nylon sutures. IOP control under 21 mmHg was achieved in 53.4% without medication and in 60.2% with or without medication at 60 months. After repeating the same procedure, IOP control was obtained in 82.2% with or without medication at 60 months. The success rate in secondary open angle glaucoma was less than in primary open angle glaucoma. Complications such as flattening of the anterior chamber requiring reformation (8%) choroidal detachment (8%), hyphema (5%) and hypotonic maculopathy (5%) were less than after trabeculectomy, but conjunctival wound separation (5%) occurred little more frequently. (J Jpn Ophthalmol Sot 101:516-519,1997) Takeshi Hara and Shiroaki Shirato Department of Ophthalmology, The University of Tokyo School of Medicine
Four Cases of Late Infection Following Scleral Buckling Procedure We report four cases with late infection following a scleral buckling procedure. These cases were a 44-