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Park J, Rittiphairoj T, Wang X, E JY, Bicket AK. Device-modified trabeculectomy for glaucoma. Cochrane Database Syst Rev 2023; 3:CD010472. [PMID: 36912740 PMCID: PMC10010250 DOI: 10.1002/14651858.cd010472.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Glaucoma is an optic neuropathy that leads to visual field defects and vision loss. It is the second leading cause of irreversible blindness in the world. Treatment for glaucoma aims to reduce intraocular pressure (IOP) to slow or prevent further vision loss. IOP can be lowered with medications, laser, or incisional surgery. Trabeculectomy is a surgical approach which lowers IOP by shunting aqueous humor to a subconjunctival bleb. Device-modified trabeculectomy techniques are intended to improve the durability and safety of this bleb-forming surgery. Trabeculectomy-modifying devices include the Ex-PRESS, the XEN Gel Stent, the PreserFlo MicroShunt, as well as antifibrotic materials such as Ologen, amniotic membrane, expanded polytetrafluoroethylene (ePTFE) membrane, Gelfilm and others. However, the comparative effectiveness and safety of these devices are uncertain. OBJECTIVES To evaluate the benefits and harms of different devices as adjuncts to trabeculectomy on IOP control in eyes with glaucoma compared to standard trabeculectomy. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was August 2021. SELECTION CRITERIA We included randomized controlled trials in participants with glaucoma comparing device-modified trabeculectomy techniques with standard trabeculectomy. We included studies that used antimetabolites in either or both treatment groups. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. change in IOP and 2. mean postoperative IOP at one year. Our secondary outcomes were 3. mean change in IOP from baseline, 4. mean postoperative IOP at any time point, 5. mean best-corrected visual acuity (BCVA), 6. visual field change, 7. quality of life, 8. proportion of participants who are drop-free at one year, 9. mean number of IOP lowering medications at one year, and 10. proportion of participants with complications. MAIN RESULTS Eight studies met our inclusion criteria, of which seven were full-length journal articles and one was a conference abstract. The eight studies included 961 participants with glaucoma, and compared two types of devices implanted during trabeculectomy versus standard trabeculectomy. Seven studies (462 eyes, 434 participants) used the Ex-PRESS, and one study (527 eyes, 527 participants) used the PreserFlo MicroShunt. No studies using the XEN Gel Stent implantation met our criteria. The studies were conducted in North America, Europe, and Africa. Planned follow-up periods ranged from six months to five years. The studies were reported poorly, which limited our ability to judge risk of bias for many domains. None of the studies explicitly masked outcome assessment. We rated seven studies at high risk of detection bias. Low-certainty of evidence from five studies showed that using the Ex-PRESS plus trabeculectomy compared with standard trabeculectomy may be associated with a slightly lower IOP at one year (mean difference (MD) -1.76 mmHg, 95% confidence interval (CI) -2.81 to -0.70; 213 eyes). Moderate-certainty of evidence from one study showed that using the PreserFlo MicroShunt may be associated with a slightly higher IOP than standard trabeculectomy at one year (MD 3.20 mmHg, 95% CI 2.29 to 4.11). Participants who received standard trabeculectomy may have a higher risk of hypotony compared with those who received device-modified trabeculectomy, but the evidence is uncertain (RR 0.73, 95% CI 0.46 to 1.17; I² = 38%; P = 0.14). In the subgroup of participants who received the PreserFlo MicroShunt, there was a lower risk of developing hypotony or shallow anterior chamber compared with those receiving standard trabeculectomy (RR 0.44, 95% CI 0.25 to 0.79; 526 eyes). Device-modified trabeculectomy may lead to less subsequent cataract surgery within one year (RR 0.46, 95% CI 0.27 to 0.80; I² = 0%). AUTHORS' CONCLUSIONS Use of an Ex-PRESS plus trabeculectomy may produce greater IOP reduction at one-year follow-up than standard trabeculectomy; however, due to potential biases and imprecision in effect estimates, the certainty of evidence is low. PreserFlo MicroShunt may be inferior to standard trabeculectomy in lowering IOP. However, PreserFlo MicroShunt may prevent postoperative hypotony and bleb leakage. Overall, device-modified trabeculectomy appears associated with a lower risk of cataract surgery within five years compared with standard trabeculectomy. Due to various limitations in the design and conduct of the included studies, the applicability of this evidence synthesis to other populations or settings is uncertain. Further research is needed to determine the effectiveness and safety of other devices in subgroup populations, such as people with different types of glaucoma, of various races and ethnicity, and with different lens types (e.g. phakic, pseudophakic).
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Affiliation(s)
- Junghyun Park
- Department of Ophthalmology, Inje University Seoul Paik Hospital, Seoul, Korea, South
| | - Thanitsara Rittiphairoj
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Xue Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jian-Yu E
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amanda K Bicket
- Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Helmers G, Munteanu C, Löw U, Seitz B. [Trabeculectomy with mitomycin C and Ologen® implant in comparison to classical trabeculectomy]. DIE OPHTHALMOLOGIE 2023; 120:20-26. [PMID: 35925352 DOI: 10.1007/s00347-022-01686-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Trabeculectomy (TE) with mitomycin C (MMC) is considered the gold standard in glaucoma surgery. A new modification is the use of an Ologen® implant (AEON Astron Europe B.V., Leiden, Netherlands) during TE, which was analyzed and compared to the standard TE in this retrospective study. PATIENTS AND METHODS On 70 eyes Ologen® was applied during surgery (group 2), whereas 98 eyes were operated on without the implant (group 1). Both surgical procedures were compared regarding the efficiency of lowering the intraocular pressure (IOP), the number of glaucoma medications, the rate of complications and follow-up treatment. Data were collected up to 24 months after surgery. RESULTS In group 1 the IOP was lowered from 28.0 mmHg (95% confidence interval, CI 26.6-29.4 mmHg) to 16.0 mmHg (14.0-18.1) after 24 months. In group 2, the pressure dropped from 28.5 mmHg (26.8-30.1) to 14.3 mmHg (11.7-17.0). The IOP reduction was significant in both groups (p < 0.001), there was no significant difference between the groups (p > 0.05). Glaucoma-related follow-up treatments were performed more often in group 1 but the difference was not significant. CONCLUSION Both procedures significantly lower the IOP and the number of glaucoma medications. For our cases, TE with Ologen® and MMC is considered to be superior to TE with MMC regarding the lower rates of follow-up treatments as it is less time-consuming for the patients and the clinic.
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Affiliation(s)
- Gloria Helmers
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße 100, Gebäude 22, 66424, Homburg/Saar, Deutschland.
| | - Cristian Munteanu
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße 100, Gebäude 22, 66424, Homburg/Saar, Deutschland
| | - Ursula Löw
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße 100, Gebäude 22, 66424, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße 100, Gebäude 22, 66424, Homburg/Saar, Deutschland
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Shin J, Hur J, Lee JE, Kang YJ, Kim SJ, Kim S, Choi HY. The Efficacy of Atelocollagen to Inhibit Fibrotic Proliferation in Tenon Tissue: In vitro Study. Ophthalmic Res 2022; 66:86-98. [PMID: 35952635 DOI: 10.1159/000525762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the safety and efficacy of atelocollagen in preventing the fibrotic change of human tenon tissue induced by transforming growth factor β1 (TGFβ1). METHODS Primary cultured human Tenon's fibroblasts (HTFs) were incubated with TGFβ1 alone and with various concentrations of atelocollagen, respectively. Cell viability was measured by Cell Counting Kit-8 (CCK-8). The mRNA levels of α-smooth muscle actin (α-SMA), vimentin, fibronectin, zonular occludens scaffolding protein (ZO-1), cellular communication network factor 2 (CCN2), and interleukin 6 (IL-6) were measured by quantitative reverse transcription polymerase chain reaction, Western blot, and immunofluorescence analysis. Wound healing assay and collagen contraction assay were additionally evaluated for identifying the inhibitory effect of atelocollagen in HTFs. To elucidate the mechanism by which atelocollagen affects HTF proliferation, the phospho-extracellular-signal-regulated kinases (pERK)/total-extracellular-signal-regulated kinases (tERK), phospho-focal adhesion kinase (pFAK)/total-focal adhesion kinase (tFAK), and pSmad3/tSmad3 protein expression ratios were measured by Western blot. RESULTS The safety of atelocollagen in HTF was identified by CCK-8 analysis. The expression of α-SMA and vimentin in HTFs treated with 0.023% and 0.046% atelocollagen significantly decreased at both mRNA and protein levels, while that of ZO-1 in 0.046% atelocollagen increased compared with TGFβ1-treated cells. The protein expression of fibronectin, CCN2, and IL-6 in HTFs treated with 0.023% and 0.046% atelocollagen significantly decreased. The immunofluorescence microscopy of α-SMA and ZO-1 showed results similar to those of the Western blot. In the wound-scratch assays, cell migration was significantly attenuated in HTFs treated with 0.005% atelocollagen. Atelocollagen at 0.005, 0.011, and 0.023% significantly inhibited the gel contraction induced by TGFβ1 at both 24 h and 48 h. The increase in pERK/tERK and pSmad3/tSmad3 protein expression ratios in TGFβ1-treated HTFs significantly decreased after treatment with 0.023 and 0.046% atelocollagen. CONCLUSION Since atelocollagen gel effectively suppresses the proliferation of HTFs in TGFβ1-induced transdifferentiation, it may be a potential therapeutic agent in glaucoma surgery.
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Affiliation(s)
- Jonghoon Shin
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin Hur
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
- PNU GRAND Convergence Medical Science Education Research Center, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yoon Jeong Kang
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Soo Jin Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sangyoon Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hee-Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Republic of Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Anton N, Doroftei B, Ilie OD, Ciuntu RE, Bogdănici CM, Nechita-Dumitriu I. A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes. Diagnostics (Basel) 2021; 11:1329. [PMID: 34441264 PMCID: PMC8394444 DOI: 10.3390/diagnostics11081329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022] Open
Abstract
Pregnancy is a condition often characterized by changes that occur in different parts of the body. Generally, the eyes suffer several changes during pregnancy that are usually transient but may become permanent at times. This may occur due to the release of placental hormones and those of maternal endocrine glands and fetal adrenal glands. Due to hormonal influences, physiological ocular changes during pregnancy have been shown in Caucasian women, so corneal sensitivity, refractive status, intraocular pressure, and visual acuity may change during pregnancy. Within this review, all studies that referred to physiological aspects and to changes of ocular pathology of pregnancy, the effect of the pregnancy on pre-existing (diabetic retinopathy, neuro-ophthalmic disorders) eye disorders, postpartum ocular changes, the intraocular pressure and the effect of hypotensive ophthalmic medicine during pregnancy, the connection between pregnancy and the neuro-ophthalmic pathology, as well as the role of anesthesia were analyzed.
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Affiliation(s)
- Nicoleta Anton
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Bogdan Doroftei
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No. 20A, 700505 Iasi, Romania;
| | - Roxana-Elena Ciuntu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Camelia Margareta Bogdănici
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Ionela Nechita-Dumitriu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
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Abstract
How to cite this article: Dada T, Ramesh P, Sethi A, et al. Ethics of Glaucoma Widgets. J Curr Glaucoma Pract 2020;14(3):77–80.
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Affiliation(s)
- Tanuj Dada
- Department of Ophthalmology, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Ramesh
- Department of Ophthalmology, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anin Sethi
- Department of Ophthalmology, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shibal Bhartiya
- Glaucoma Services, Department of Ophthalmology, Fortis Memorial Research Institute, Gurugram, Haryana, India
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Chiu HI, Su HI, Ko YC, Liu CJL. Outcomes and risk factors for failure after trabeculectomy in Taiwanese patients: medical chart reviews from 2006 to 2017. Br J Ophthalmol 2020; 106:362-367. [PMID: 33229342 DOI: 10.1136/bjophthalmol-2020-317303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/02/2020] [Accepted: 11/04/2020] [Indexed: 11/03/2022]
Abstract
AIMS To determine long-term outcomes and risk factors for failure after mitomycin C (MMC)-augmented initial trabeculectomy (IT) in Taiwanese patients. METHODS We reviewed medical records of patients with glaucoma undergoing IT during December 2006-December 2016. We defined complete success as an intraocular pressure (IOP) of >5 or ≤21 mm Hg or IOP reduction of ≥20% from baseline without supplemental medications and qualified success as the aforementioned IOP levels with or without supplemental medications. Kaplan-Meier survival and Cox proportional analyses evaluated success rates and risk factors for failure, respectively. RESULTS We enrolled 190 patients (237 eyes; mean age: 54.0±15.3 years; mean postoperative follow-up period: 68.4±35.1 months). Mean IOP and glaucoma medications decreased from 22.2±10.8 to 14.4±5.2 mm Hg (p<0.001) and 3.0±0.7 to 1.8±1.2 (p=0.015), respectively, at the last visit. Cumulative qualified success rates were 93.9%, 93.0%, 86.5% and 67.1% at the 1, 2, 5 and 10 years follow-up, respectively; however, only 7.7% of the eyes reached complete success at the last visit. Eyes with poor preoperative visual acuity were associated with low qualified success rates (HR=1.689, p=0.027); patients aged >70 years had higher complete success rates than did those aged ≤70 years. Five cases (2.11%) exhibited bleb-associated complications. CONCLUSION Despite satisfactory long-term success rates, most eyes needed medication for IOP control, supporting the notion of predisposed scarring vitality in patients of Chinese ethnicity following MMC-augmented trabeculectomy.
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Affiliation(s)
- Hsun-I Chiu
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Huan-I Su
- Department of Ophthalmology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan .,Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan .,Medicine, National Yang-Ming University, Taipei, Taiwan
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Abstract
PURPOSE OF REVIEW Glaucoma management during pregnancy is a complex challenge, which requires balancing the clinical disease of the mother with the potential risks of therapy to the developing child. Because systematic studies are lacking in the pregnant population, this review aims to collect the array of available data from observational studies and case reports to provide the reader with guidance and context for the safety of glaucoma interventions during pregnancy. RECENT FINDINGS Surgical glaucoma is a rapidly expanding field with many new technologies and procedures. We review the surgical options for the gravid patient with reference to traditional procedures like trabeculectomy and tube-shunts, and newer MIGS procedures. When indicated, orphan trabeculectomy, or with collagen matrix implant may be a viable solution for severe glaucoma during pregnancy. Newer MIGS procedures such as the gelatin stent may also provide minimally invasive options for pregnant patients. Two new medications, Vyzulta and Rhopressa, were recently released in 2018 and have limited data to support their safety for use during pregnancy. SUMMARY The careful consideration of fetal health in the management of glaucoma during pregnancy is best done as a part of a multidisciplinary team including obstetrics and neonatology. When medication is necessary, steps to minimize systemic absorption should be employed. Surgical management should not be excluded for pregnant patients and may be considered before medical management in some cases to prevent fetal exposures and maternal harm.
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Wang D, Jampel HD. Imprecision Medicine: The Use of Mitomycin C in Trabeculectomy Surgery. ACTA ACUST UNITED AC 2018; 1:149-151. [DOI: 10.1016/j.ogla.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/05/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
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