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Sebbag L, Pe’er O. Role of Inflammation in Canine Primary Glaucoma. Animals (Basel) 2023; 14:110. [PMID: 38200841 PMCID: PMC10777923 DOI: 10.3390/ani14010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Primary glaucoma is a painful, progressive, and blinding disease reported in many canine breeds, characterized by intraocular pressure (IOP) elevation in the absence of antecedent intraocular disease. Clinical observations of dogs with primary glaucoma suggest that many affected eyes develop concurrent intraocular inflammation in addition to elevated IOP. In this work, we summarize the current knowledge that relates inflammation to primary glaucoma in dogs, reviewing studies focused on genetics, physiology, histopathology, bioanalysis of ocular fluids, therapeutics, and clinical outcomes of glaucomatous patients. Through disruption of the blood-aqueous and blood-retinal barriers, pigment dispersion, and biochemical changes to the aqueous humor and tear film, the pathogenesis of canine primary glaucoma appears to involve inflammatory changes to various extents and with various consequences from the front to the back of the eye. Among others, inflammation further impacts IOP by reducing aqueous humor outflow at the level of the iridocorneal angle and accelerates vision loss by promoting neuronal degeneration. As such, the vicious cycle of ocular inflammation and IOP elevation might warrant the use of anti-inflammatory medications as a core component of the treatment regime for dogs with primary glaucoma, either therapeutically (i.e., actively glaucomatous eye) or prophylactically in the yet unaffected contralateral eye.
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Affiliation(s)
- Lionel Sebbag
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot 76100, Israel
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Dias DT, Almeida I, Ushida M, Lopes FS, Kanadani FN, Gracitelli CPB, Prata TS. Subtenon triamcinolone as an adjuvant in mitomycin-C-enhanced trabeculectomy in non-inflammatory glaucomas: A randomized clinical trial. PLoS One 2022; 17:e0268623. [PMID: 35617211 PMCID: PMC9135266 DOI: 10.1371/journal.pone.0268623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
This unicentric randomized clinical trial was designed to compare the surgical outcomes of mitomycin C-enhanced trabeculectomy (MMC-TRAB) with and without subtenon triamcinolone acetonide (TAAC) injection in patients with non-inflammatory glaucomas. This trial is registered at the Brazilian Registry of Clinical Trials (ReBEC) under the register number RBR-53f8nh. Consecutive non-inflammatory glaucoma patients requiring surgical intervention were randomized into two groups. In the control group, eyes underwent standard MMC-TRAB, while in the intervention group, besides the standard MMC-TRAB, these eyes also received a subtenon TAAC injection (4mg) close to the bleb site at the end of the surgery. The main outcomes of the study were surgical success rates, intraocular pressure (IOP) and number of medications at all timepoints. Success was defined as IOP ≤ 15 mmHg and subdivided in complete or qualified according to the need of medication. A total of 75 eyes of 63 different patients were included (intervention group = 39 eyes; control group = 36 eyes). There was no difference between groups at baseline (p>0.11). Multivariable regression analysis indicated that IOP levels were significantly lower in the intervention group at 18 and 24 months of follow-up when number of medications was considered as a covariate (P<0.001). Complete success rates were higher in the intervention group at 06 (90.9% vs 68.7%; p = 0.03), 12 (87.2% vs 66.7%; p = 0.02) and 18 months (87.2% vs 66.7%; p = 0.02). Additionally, although success rates at 24 months were higher in the intervention group (82.0% vs 66.7%; p = 0.09), this difference did not reach statistical significance. Qualified success rates did not significantly differ between groups at all timepoints. In conclusion, this study found significantly lower IOPs levels at 18 and 24 months of follow-up and higher complete success rates until 18 months of follow-up, with the use of subtenon TAAC as an adjuvant to standard MMC-TRABs in non-inflammatory glaucoma patients.
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Affiliation(s)
- Diego T. Dias
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Department, Hospital de Olhos de Sergipe, Aracaju, Sergipe, Brazil
- * E-mail:
| | - Izabela Almeida
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Flavio S. Lopes
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio N. Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Tiago S. Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
- Department of Ophthalmology, Hospital Oftalmológico de Sorocaba, Sorocaba, São Paulo, Brazil
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Huang W, Li X, Gao K, Zhang X. Combined subconjunctival injection of dexamethasone for the management of acute primary angle closure: a randomised controlled trial. Br J Ophthalmol 2019; 104:87-91. [PMID: 31000508 DOI: 10.1136/bjophthalmol-2018-313473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/19/2019] [Accepted: 03/17/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate whether the combined subconjunctival injection of dexamethasone can accelerate the decrease in intraocular pressure (IOP) in acute primary angle closure (APAC)-affected eyes. METHODS 42 patients with APAC were recruited for a randomised controlled trial. These patients were separated into two groups: the injection group (21 patients) and the control group (21 patients). The injection group was subjected to a subconjunctival injection with 2.5 mg dexamethasone. Other drug treatments were the same with the control group. The follow-up was at 0, 3, 6, 12 and 24 hours after injection. The outcome measures include IOP and intraocular inflammation variables. RESULTS The IOP was significantly decreased in both groups after treatment. However, 24 hours after the initial treatment, the IOP of the injection group was significantly lower compared with the control group (p = 0.017). Kaplan-Meier survival curve analysis showed that the total success rate of the injection group and the control group were 79.7% and 54.9% at 24 hours after treatment (p = 0.027), respectively. For the comparison of anterior chamber inflammation, the severity of conjunctival erythema, ciliary flush and pain in the injection group was also lower than that in the control group at 24 hours after treatment(p = 0.012, p = 0.048 and p = 0.013, respectively). No statistical significance was found between the two groups regarding the anterior chamber cells, anterior chamber flare and photophobia. CONCLUSION The combined subconjunctival injection of dexamethasone for the management of APAC eyes can significantly accelerate the relief of high IOP, and therefore, improve the success rate of treatment.
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Affiliation(s)
- Wenbin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Xingyi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Kai Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
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Eine neue Operationstechnik für die Behandlung von sekundären refraktären posttraumatischen Glaucomen nach Trabekulektomie mit PRECLUDE® Pericardial Membrane – eine Fallbeschreibung. SPEKTRUM DER AUGENHEILKUNDE 2019. [DOI: 10.1007/s00717-019-0428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rangel HMDA, Rolim HT, Vidigal P, Araújo IDD, Cronemberger S. Healing modulation in glaucoma surgery after application of subconjunctival triamcinolone acetate alone or combined with mitomycin C: an experimetal study. Rev Col Bras Cir 2018; 45:e1861. [PMID: 30066737 DOI: 10.1590/0100-6991e-20181861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/10/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to study the efficacy and safety of the use of subconjunctival triamcinolone acetate alone or in combination with mitomycin C as a modulator of trabeculectomy healing in rabbits. METHODS we submitted thirty male, albino, New Zealand rabbits to bilateral trabeculectomy. We divided the animals into four experimental groups with 15 eyes per group: control, mitomycin C, triamcinolone acetate and triamcinolone acetate + mitomycin C. We performed aplanation tonometry and clinical analysis of the bleb through the Moorfields Graduation System in the postoperative period. For the evaluation of healing, we carried out the quantitative analysis of the inflammatory infiltrate (polymorphonuclear) through Hematoxylin & Eosin staining, and vascular proliferation, through immunohistochemistry. RESULTS we observed a significant decrease in postoperative intraocular pressure in all groups compared with the preoperative pressure (p<0.001). However, there was no difference between groups (p=0.186). The triamcinolone + mitomycin C acetate group presented better indices as for the maximum bleb height and vascularization of the bleb central area (p=0.001); in addition, there was a lower inflammatory response (p=0.001) and lower vascular proliferation (p=0.001) in the intermediate phase of the study compared with the monotherapies. CONCLUSION the combination of mitomycin C and triamcinolone acetate resulted in a synergistic action between these agents, with broader and more diffuse blebs, less inflammatory infiltrate and less vascular proliferation in the intermediate stages of follow-up in this animal model.
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Affiliation(s)
- Hayana Marques do Aragão Rangel
- Universidade Federal de Minas Gerais, Departamento de Oftalmologia, Belo Horizonte, MG, Brasil
- Santa Casa de Misericórdia de Belo Horizonte, Centro de Referência em Glaucoma e Catarata, Belo Horizonte, MG, Brasil
| | - Hévila Tamar Rolim
- Santa Casa de Misericórdia de Belo Horizonte, Centro de Referência em Glaucoma e Catarata, Belo Horizonte, MG, Brasil
- Universidade Federal de Rondônia, Departamento de Medicina, Porto Velho, RO, Brasil
| | - Paula Vidigal
- Universidade Federal de Minas Gerais, Departamento de Patologia, Belo Horizonte, MG, Brasil
| | - Ivana Duval de Araújo
- Universidade Federal de Minas Gerais, Departamento de Cirurgia, Belo Horizonte, MG, Brasil
| | - Sebastião Cronemberger
- Universidade Federal de Minas Gerais, Departamento de Oftalmologia, Belo Horizonte, MG, Brasil
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Alagöz N, Alagöz C, Yıldırım Y, Yeşilkaya C, Altan Ç, Bozkurt E, Şatana B, Başarır B, Taşkapılı M. The Effect of Adjuvant Intracameral Triamcinolone Acetonide on the Surgical Results of Trabeculectomy with Mitomycin C. Turk J Ophthalmol 2017; 46:169-174. [PMID: 28058152 PMCID: PMC5200822 DOI: 10.4274/tjo.88785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/22/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To evaluate the effect of adjuvant intracameral triamcinolone acetonide (TA) on the surgical results of trabeculectomy with mitomycin C. MATERIALS AND METHODS All consecutive trabeculectomy cases performed in the glaucoma clinic between July 2012 and December 2013 were retrospectively reviewed from the patient charts. Only those with follow-up of 12 months or longer were included. Patients with intraoperative intracameral TA (study group, n=19) were compared to those without TA (control group, n=21) in terms of surgical success, intraocular pressure (IOP) change, medication use and complications. RESULTS Forty eyes of 31 patients (21 male/10 female, mean age 64.2±13.8 years) were included in the study. The mean follow-up period was 20.9±5.1 months and 20.7±6.7 months in the study and control groups, respectively (p=0.830). Baseline IOP was 26.4±9.9 and 25.2±7.6 mmHg (p=0.979), and final IOP was 12.7±2.6 and 13.6±3 mmHg in both groups respectively (p=0.226). At the final follow-up, complete success was observed in 68.4% and 52.4% of the study and control groups (p=0.349) and anti-glaucoma medication was used by 31.6% (mean number of medications: 0.79±1.2) and 47.6% (mean number of medications: 1.33±1.7), respectively (p>0.05). Bleb encapsulation, leakage, suture-lysis and hypotony rates were similar in both groups (for all, p>0.05). Cataract progression was noted in six (35.3%) and in five (26.3%) of the phakic eyes in the study and control groups, respectively (p=0.720). CONCLUSION When used intracamerally, TA did not increase the complication rate in trabeculectomy surgery. Although the group that received TA showed lower IOP levels, use of fewer medications and fewer eyes requiring medication, the differences did not reach significance.
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Affiliation(s)
- Neşe Alagöz
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Cengiz Alagöz
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Yıldırım
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Ceren Yeşilkaya
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Çiğdem Altan
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | | | - Banu Şatana
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Berna Başarır
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
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Angiogenesis in glaucoma filtration surgery and neovascular glaucoma: A review. Surv Ophthalmol 2015; 60:524-35. [PMID: 25980779 DOI: 10.1016/j.survophthal.2015.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 12/25/2022]
Abstract
Angiogenesis may pose a clinical challenge in glaucoma, for example, during the wound healing phase after glaucoma filtration surgery and in the severe secondary glaucoma called neovascular glaucoma (NVG). Upregulation of vascular endothelial growth factor (VEGF), a key mediator of angiogenesis, occurs in eyes that have undergone glaucoma filtration surgery, as well as those with NVG. This has led investigation of the ability of anti-vascular endothelial growth factor therapy to improve outcomes, and we examine the findings with respect to the safety and efficacy of anti-vascular endothelial growth factor agents, mainly bevacizumab and ranibizumab, in eyes that have undergone glaucoma filtration surgery or have NVG. Combining conventional therapies-such as antimetabolites after filtration surgery and panretinal photocoagulation in NVG-and anti-vascular endothelial growth factor drugs may produce a synergetic effect, although further studies are required to evaluate the long-term efficacy of combination treatments.
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