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Agnifili L, Figus M, Sacchi M, Oddone F, Villani E, Ferrari G, Posarelli C, Carnevale C, Nucci P, Nubile M, Mastropasqua L. Managing the ocular surface after glaucoma filtration surgery: an orphan topic. Graefes Arch Clin Exp Ophthalmol 2024; 262:2039-2056. [PMID: 38091058 DOI: 10.1007/s00417-023-06333-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Ocular surface (OS) disorders before glaucoma filtration surgery (GFS) have been considered to play a crucial role influencing the surgical outcome. Conversely, the impact of surgery itself on the OS is almost completely overlooked, though evidence suggest that ocular surface disease (OSD) may be induced in patients by GFS. This review analyzes the determinants involved in the OSD development after GFS, the clinical features and related consequences, the main diagnostic hallmarks, as well as the therapeutic strategies for its management. METHODS The PubMed database was utilized for the literature examination. Keywords that were searched included ocular surface disease, glaucoma filtration surgery, filtration bleb, post-surgical management, and quality of life. RESULTS After GFS, OSD is promoted by peri- and post-operative factors, such as the filtration bleb (FB) development, combined surgical approach with phacoemulsification, the use of antifibrotic agents and the reintroduction of antiglaucoma medications. This particular form of OSD that present similar clinical features to mild to moderate dry eye, can be named as post-glaucoma surgery-OSD (PGS-OSD). PGS-OSD may negatively affect the FB functionality, thus potentially hindering the disease control, and significantly worsen the patient quality of life (QOL). CONCLUSIONS Clinicians are encouraged to routinely include the OS evaluation after GFS and to consider proper management when the occurrence of PGS-OSD worsen the patient's QOL or exert negative effects to the FB functionality. An outline summarizing the main risk factors and the most appropriate therapeutic options to mitigate the PGS-OSD was proposed to support the routine practice.
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Affiliation(s)
- Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Michele Figus
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | | | - Edoardo Villani
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Giulio Ferrari
- IRCCS San Raffaele Scientific Institute, Division of Neuroscience, Cornea and Ocular Surface Disease Unit, Eye Repair Lab, Milan, Italy
- Vita-Salute San Raffaele University, Department of Ophthalmology, Milan, Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
| | | | - Paolo Nucci
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Mario Nubile
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
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Cui S, Zhang J, Zhang S, Li J, Li Q. Effect of mitomycin C and 5-fluorouracil on wound healing in patients undergoing glaucoma surgery: A meta-analysis. Int Wound J 2024; 21:e14500. [PMID: 37990074 PMCID: PMC10898392 DOI: 10.1111/iwj.14500] [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: 10/18/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
Increased intraocular pressure (IOP) is a risk factor for glaucoma. One treatment option is trabeculectomy. Antimetabolic agents are used in the operation to decrease the post-operative scarring of the wound. The two most common medicines are Mitomycin C (MMC) and 5-Fluorouracil (5-FU). The aim of this research is to assess the effect of MMC on post-operation wound healing in comparison with 5-FU in addition to trabeculectomy. Well, we went through four common databases. Our language was limited to English during the study. The last time we looked at the e-databases was August 2023. Case control studies were performed where MMC resulted in better wound healing than 5-FU. Researchers selected a total of 1023 trials and eventually selected six trials for data analysis. Four hundred and ninety one cases of glaucoma were treated with trabeculectomy. Among them, 246 were given MMC and 245 were given 5-FU during operation. Six trials showed that there was no statistical difference between MMC and 5-FU in the incidence of post-operative wound leak in glaucoma patients who received trabeculectomy (OR, 1.21; 95% CI, 0.63-2.30 p = 0.57); Five trials demonstrated that MMC was associated with a reduced risk of post-operative corneal damage compared to 5-FU injection (OR, 0.18; 95% CI, 0.06-0.56 p = 0.003); In both trials, the incidence of post-operative bleeding was not significantly different from that of 5-FU injected in the MMC group (OR, 0.33; 95% CI, 0.05-2.16 p = 0.25). Our results indicate that MMC is superior to 5-FU in the reduction of post-operative corneal injury. Additional comparisons between MMC and 5-FU are required in order to increase the reliability and effectiveness of these findings.
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Affiliation(s)
- Sha Cui
- Department of Ophthalmology, Xiangyang Central HospitalAffiliated Hospital of Hubei University of Arts and ScienceXiangyangChina
| | - Juntao Zhang
- Department of Ophthalmology, Xiangyang Central HospitalAffiliated Hospital of Hubei University of Arts and ScienceXiangyangChina
| | - Shaowei Zhang
- Department of Ophthalmology, Xiangyang Central HospitalAffiliated Hospital of Hubei University of Arts and ScienceXiangyangChina
| | - Jinrong Li
- Department of Ophthalmology, Xiangyang Central HospitalAffiliated Hospital of Hubei University of Arts and ScienceXiangyangChina
| | - Qin Li
- Department of Ophthalmology, Xiangyang Central HospitalAffiliated Hospital of Hubei University of Arts and ScienceXiangyangChina
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Seresirikachorn K, Thiamthat W, Annopawong K, Wanichwecharungruang B, Friedman DS, Vu DM. Treatment Outcomes for Juvenile Open Angle Glaucoma in Thailand. J Glaucoma 2023; 32:976-982. [PMID: 37725790 DOI: 10.1097/ijg.0000000000002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PRCIS Juvenile open angle glaucoma (JOAG) patients with thick central corneas and negative family history were more likely to undergo surgery, mainly trabeculectomy with half requiring additional surgery within 10 years. PURPOSE To assess the characteristics and treatment outcomes of patients with JOAG in Thailand. PATIENTS AND METHODS This retrospective, multicenter study included all patients diagnosed with JOAG over 12 years from 2 tertiary hospitals in Bangkok, Thailand. RESULTS A total of 200 eyes from 104 patients were included in this study. The mean age of onset was 24.0±10.1 years (range: 5-40 y), with male predominance (60.5%). Over 90% of patients had bilateral JOAG and 25% had a positive family history. Negative family history (adjusted odds ratio=4.59, P =0.02) and thick central corneal thickness were surgical predictors (every 10 µm adjusted odds ratio=1.29, P =0.01). Over 70% of cases needed glaucoma surgery. Trabeculectomy with Mitomycin-C was performed on 131 eyes (65.5%) with a cumulative probability of complete success of 71.0%, 57.8%, 39.2%, and 26.9% and qualified success of 86.3%, 73.6%, 64.8%, and 45.7% at 1, 3, 5, and 10 years, respectively. The mean follow-up after surgery was 94.9 ± 69.8 months (range: 13-153 mo). There were no serious postoperative complications. Myopia and the number of baseline glaucoma medications were significantly associated with surgical failure. CONCLUSIONS Trabeculectomy with mitomycin C was the most common primary surgery performed in Thai patients with JOAG, and successfully reduced intraocular pressure without significant complications. Patients with thicker corneas were more likely to undergo surgery. By 10 years, half of the patients required additional surgery and risk factors for failure included myopia and the number of medications.
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Affiliation(s)
- Kasem Seresirikachorn
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Warakorn Thiamthat
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Kornkamol Annopawong
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital
| | | | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School
| | - Daniel M Vu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Luo M, Xiao H, Huang J, Jin L, Li Z, Tu S, Huang H, Zhu Y, Li Y, Zhuo Y. Multi-Quantitative Assessment of AS-OCTA Complemented AS-OCT for Monitoring Filtering Bleb Function After Trabeculectomy. Transl Vis Sci Technol 2023; 12:18. [PMID: 37471100 PMCID: PMC10365142 DOI: 10.1167/tvst.12.7.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Purpose The purpose of this study was to explore a quantitative grading system of the filtering bleb combined anterior segment optical coherence tomography angiography (AS-OCTA) vascular features and optical coherence tomography (OCT) morphological features. Methods One hundred three eyes of 103 patients diagnosed with primary open-angle glaucoma and undergone trabeculectomy over 6 months were divided into success and failure groups according to postoperative intraocular pressure (IOP) level. Vessel density (VD) and vessel diameter index (VDI) were examined by AS-OCTA. Bleb's morphology, including bleb height (BH), and microcyst-structure (MCS) were detected by AS-OCT. Multi-vascular model score (MVMS) was calculated by comprehensive factor analysis, and the comprehensive grading system (MVMS-MCS-BH) was analyzed by linear regression. The efficiency our method was verified by receiver operating characteristic (ROC) analysis. Results The VD and VDI were higher in the failure group and closely related to post-trabeculectomy IOP (all P = 0.000). The MVMS was mostly consisted of VD in all regions, and VDIs of nasal, central, and temporal positions in sequence. MVMS ≥0, BH <1.33, and non-MCS were significantly associated with IOP increasing (coefficient = -3.23, -3.69, and 8.10, all P = 0.000). MVMS-BH-MCS got a higher area under curve (AUC), sensitivity, and specificity (0.92, 100%, and 80.30%) than the slit-lamp method (0.62, 72.20%, and 46.43%, respectively). Conclusions The quantitative vascular characteristics detected by AS-OCTA were significant for the bleb monitor. The MVMS-BH-MCS grading system had achieved outstanding accuracy in reflecting the surgical results. Translational Relevance The multi-vascular biomarker and comprehensive evaluation combined vascular and morphological parameters yield useful information on surgical outcomes, and help ophthalmologists to monitor patients effectively.
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Affiliation(s)
- Man Luo
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
- Center on Frontiers of Computing Studies, School of Computer Science, Peking University, Beijing, China
| | - Hui Xiao
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Shu Tu
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Haishun Huang
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Yiqing Li
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology; Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases Guangzhou, China
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Tu S, Luo Z, Yang R, Hu D, Xian B, Zhao F, Ge J. Mitomycin C-loaded PTMC15-F127-PTMC15 hydrogel maintained better bleb function after filtering glaucoma surgery in monkeys with intraocular hypertension. RSC Adv 2023; 13:13604-13615. [PMID: 37152569 PMCID: PMC10155495 DOI: 10.1039/d3ra01002c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023] Open
Abstract
There is an unmet need for a safer and more effective approach for antimetabolite application to prevent bleb fibrosis after glaucoma filtering surgery. Here, we utilized our previously developed thermosensitive sustained-release agent, mitomycin C-loaded poly(trimethylene carbonate)15-F127-poly(trimethylene carbonate)15 (MMC-hydrogel), aiming to further evaluate the efficacy and safety of MMC-hydrogel in high intraocular pressure (IOP) primate eyes. Twelve primate eyes after high IOP induction were randomly divided into three groups, which respectively received phosphate-buffered saline (PBS)-hydrogel, MMC-hydrogel, and MMC treatment during trabeculectomy. IOP and bleb volume were measured using a Tonopen and anterior segment optical coherence tomography over 28 days. At the end of the experiment, all experimental primate eyes were enucleated. Histopathology and immunohistochemistry were performed to reveal myofibroblast cells and collagen deposition of filtering blebs. The MMC-hydrogel group had satisfactory IOP control (9.25 ± 4.80 mmHg) and maintained well-functioning blebs for a longer time. Fibrosis and scarring were significantly alleviated in this MMC-hydrogel group. There was no obvious toxicity to ocular surfaces or intraocular structures. Taken together, these data suggest that PTMC15-F127-PTMC15-loaded MMC-hydrogel plays a role in functional maintenance and scarring inhibition, showing high efficacy in reducing post-filtering surgery bleb fibrosis. This MMC-hydrogel may offer a new solution for filtering bleb management after glaucoma surgery.
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Affiliation(s)
- Shu Tu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University 7 Jinsui Road, Tianhe District Guangzhou 510000 China +86 20 66615460
| | - Ziming Luo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University 7 Jinsui Road, Tianhe District Guangzhou 510000 China +86 20 66615460
| | - Runcai Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University 7 Jinsui Road, Tianhe District Guangzhou 510000 China +86 20 66615460
| | - Dongpeng Hu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University 7 Jinsui Road, Tianhe District Guangzhou 510000 China +86 20 66615460
| | - Bikun Xian
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University 7 Jinsui Road, Tianhe District Guangzhou 510000 China +86 20 66615460
| | - Feng Zhao
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University 7 Jinsui Road, Tianhe District Guangzhou 510000 China +86 20 66615460
| | - Jian Ge
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University 7 Jinsui Road, Tianhe District Guangzhou 510000 China +86 20 66615460
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Luo M, Xu Z, Ye Z, Liang Z, Xiao H, Li Y, Li Z, Zhu Y, He Y, Zhuo Y. Deep learning for anterior segment OCT angiography automated denoising and vascular quantitative measurement. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Luo N, Liu M, Hao M, Xu R, Wang F, Zhang W. Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis. BMJ Open 2023; 13:e065921. [PMID: 37080625 DOI: 10.1136/bmjopen-2022-065921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of tube shunt implantation with trabeculectomy in the treatment of patients with glaucoma. METHODS A systematic literature search was performed for studies comparing tube with trabeculectomy in patients with glaucoma (final search date: 27 February 2022). Comparisons between tube and trabeculectomy were grouped by the type of tube (Ahmed, Baerveldt, Ex-PRESS and XEN). The primary endpoints included intraocular pressure (IOP), IOP reduction (IOPR), IOPR percentage (IOPR%), complete success rate (CSR), qualified success rate (QSR) and adverse events (AEs). RESULTS Forty-nine studies were included in this meta-analysis and presented data for 3795 eyes (Ahmed: 670, Baerveldt: 561, Ex-PRESS: 473, XEN: 199, trabeculectomy: 1892). Ahmed and Ex-PRESS were similar to trabeculectomy in terms of IOP outcomes and success rate (Ahmed vs trabeculectomy: IOPR%: mean difference (MD)=1.34 (-5.35, 8.02), p=0.69; Ex-PRESS vs trabeculectomy: IOPR%: MD=0.12 (-3.07, 3.31), p=0.94). The IOP outcomes for Baerveldt were worse than those for trabeculectomy (IOPR%: MD=-7.51 (-10.68, -4.35), p<0.00001), but the QSR was higher. No significant difference was shown for the CSR. XEN was worse than trabeculectomy in terms of IOP outcomes (IOPR%: MD=-7.87 (-13.55, -2.18), p=0.007), while the success rate was similar. Ahmed and Ex-PRESS had a lower incidence of AEs than trabeculectomy. Baerveldt had a lower incidence of bleb leakage/wound leakage, hyphaema and hypotonic maculopathy than trabeculectomy but a higher incidence of concurrent cataracts, diplopia/strabismus and tube erosion. The incidence of AEs was similar for the XEN and trabeculectomy procedures. CONCLUSION Compared with trabeculectomy, both Ahmed and Ex-PRESS appear to be associated with similar ocular hypotensive effects and lower incidences of AEs. However, Baerveldt and XEN cannot achieve sufficient reductions in IOP outcomes similar to those of trabeculectomy. PROSPERO REGISTRATION NUMBER CRD42021257852.
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Affiliation(s)
- Nachuan Luo
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Miaowen Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Meiqi Hao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ruoxin Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fei Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
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Nagar AM, Maghsoudlou P, Wormald R, Barton K, Hysi P, Lim KS. Differences in the Surgical Outcomes of Glaucoma Surgery in Patients of African Caribbean Descent. Curr Eye Res 2022; 47:1567-1577. [PMID: 36214781 DOI: 10.1080/02713683.2022.2126859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE People of African Caribbean Descent (ACD) have a higher prevalence of glaucoma compared to people of European Descent (ED) and there is uncertainty if treatment outcomes are equivalent between the two groups. To assess surgical failure rates comparing ACD with ED focusing on trabeculectomy, aqueous shunt implantation, non-penetrating filtering surgery (NPFS), and minimally invasive glaucoma surgery (MIGS) by performing a systematic review in accordance with the PRISMA guidelines and to determine whether there is any evidence in to show a difference in success rates based on race. METHODS A systematic review of articles using the CENTRAL, Ovid MEDLINE, PubMed, EMBASE, and ClinicalTrials.gov databases was completed. Additional studies were identified by contacting clinical experts and searching bibliographies. All retrospective and prospective studies on trabeculectomy, aqueous shunt implantation, NPFS, and MIGS that included at least 20% ACD were included. Two review authors independently screened search results for eligibility and inclusion and extracted the data using pre-determined fields. RESULTS A total of 76 studies were identified for inclusion in the review. Glaucoma surgical outcomes in ACD appear to be poorer compared to ED overall, particularly for trabeculectomy. Data on NPFS are limited, but the studies completed thus far demonstrate surprisingly good results for ACD, particularly when compared to ED, who have significantly lower pre-operative IOPs. Evidence from studies investigating aqueous shunts does not suggest that ACD have poorer outcomes than ED. There is not enough data on MIGS to provide a significant conclusion. CONCLUSION In a population where trabeculectomy may no longer be the gold standard, sufficiently powered studies assessing surgical outcomes in aqueous shunts, NPFS, and MIGS are needed to guide clinicians.
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Affiliation(s)
- A M Nagar
- Department of Ophthalmology, St Thomas' Hospital, London, UK.,King's College London, London, UK
| | | | - R Wormald
- International Centre for Eye Health at the LSHTM and Institute of Ophthalmology UCL, London, UK
| | - K Barton
- Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P Hysi
- King's College London, London, UK
| | - K S Lim
- Department of Ophthalmology, St Thomas' Hospital, London, UK.,King's College London, London, UK
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Kontic M, Todorovic D, Zecevic R, Vulovic TS. High-Frequency Deep Sclerotomy as Adjunctive Therapy in Open-Angle Glaucoma Patients. Ophthalmic Res 2022; 66:339-344. [PMID: 36380636 DOI: 10.1159/000527677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 10/09/2022] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Glaucoma is a chronic, progressive disease of the optic nerve that can cause vision loss and blindness. High-frequency deep sclerotomy (HFDS) is a novel ab interno procedure used to lower intraocular pressure (IOP). This study aims at examining hypotensive effects of HFDS in patients with medically uncontrolled primary open-angle glaucoma (POAG). METHODS 23 patients (23 eyes) participated in this study. They were all affected by POAG and used maximum prescribed medical therapy. It is important to note that the target IOP was not detected in any study participant. The target IOP is the highest IOP value at which no new damages of the optic nerve occur. The procedure was performed with a custom-made, high-frequency dissection probe by applying bipolar current of 500 kHz. Six pockets (1 mm deep, 0.3 mm high, and 6 mm wide) were made ab interno in nasal sclera (through trabecular meshwork and Schlemm's canal). Tobramycin/dexamethasone and pilocarpine eye drops were administered postoperatively for a month. RESULTS The mean value of the base IOP had been 25.6 mm Hg before the procedure. Significant complications were not recorded either during the surgery or in a postoperative follow-up period. The average IOP for our patients reduced by 8.6 mm Hg (33.6%) after a year. The mean value of the instilled anti-glaucoma eye drops had been 2.78 (SD = 0.45) before the HFDS and 0.61 (SD = 1.04) at the end of the research. The target IOP was not achieved in five cases (21.7% of our sample). DISCUSSION/CONCLUSION This study presents the data on our first surgical experience with HFDS that was conducted on 23 patients who had medically uncontrolled POAG. The results indicate that HFDS is safe and efficient in reducing IOP.
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Affiliation(s)
- Marko Kontic
- Special Ophthalmology Hospital "Belgrade Ophthalmological Center", Belgrade, Serbia
| | - Dusan Todorovic
- Clinic of Ophthalmology, Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Rada Zecevic
- Special Ophthalmology Hospital "Belgrade Ophthalmological Center", Belgrade, Serbia
| | - Tatjana Sarenac Vulovic
- Clinic of Ophthalmology, Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Lee JY, Wu J, Liu Y, Saraswathy S, Zhou L, Bu Q, Su Y, Choi D, Park E, Strohmaier CA, Weinreb RN, Hong YK, Pan X, Huang AS. Subconjunctival Lymphatics Respond to VEGFC and Anti-Metabolites in Rabbit and Mouse Eyes. Invest Ophthalmol Vis Sci 2022; 63:16. [PMID: 36166215 PMCID: PMC9526361 DOI: 10.1167/iovs.63.10.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To characterize and pharmacologically influence subconjunctival lymphatics in rabbit and mouse eyes. Methods Rabbits received subconjunctival injections of trypan blue or fixable fluorescent dextrans. Bleb-related outflow pathways were quantified. Immunofluorescence for vessel-specific markers (lymphatics [podoplanin and LYVE-1] and blood vessels [CD31]) were performed in native rabbit conjunctiva and after fixable fluorescent dextran injection. Vascular endothelial cell growth factor-C (VEGFC) was injected subconjunctivally in rabbits. mRNA and protein were assessed for the above markers using RT-PCR and Western blot. Alternatively, mouse studies used Prox1-tdTomato transgenic reporter mice. Subconjunctival injection conditions included: no injection, balanced salt solution (BSS), VEGFC, 5-fluorouracil (5FU) and two concentrations of mitomycin-C (MMC). Two mouse injection protocols (short and long) with different follow-up times and number of injections were performed. Mouse eyes were enucleated, flat mounts created, and subconjunctival branching and length assessed. Results Rabbit eyes demonstrated clear bleb-related subconjunctival outflow pathways that were distinct from blood vessels and were without nasal/temporal predilection. Immunofluorescence against vessel-specific markers showed lymphatics and blood vessels in rabbit conjunctiva, and these lymphatics overlapped with bleb-related subconjunctival outflow pathways. Subconjunctival VEGFC increased lymphatic (P = 0.004-0.04) but not blood vessel (P = 0.77-0.84) mRNA or protein in rabbits. Prox1-tdTomato transgenic reporter mice demonstrated natively fluorescent lymphatics. Subconjunctival VEGFC increased murine lymphatic branching and length (P ≤ 0.001-0.004) while antimetabolites (P ≤ 0.001-0.043) did the opposite for the long protocol. Discussion Subconjunctival lymphatics are pharmacologically responsive to both VEGFC and antimetabolites in two animal models studied using different methodologies. These results may be important for bleb-forming glaucoma surgeries or ocular drug delivery.
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Affiliation(s)
- Jong Yeon Lee
- Department of Ophthalmology, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Jingyi Wu
- Weifang Medical University, Weifang, Shandong Province, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Yameng Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Sindhu Saraswathy
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Longfang Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Qianwen Bu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Ying Su
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Dongwon Choi
- Department of Surgery, Norris Comprehensive Cancer Center Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Eunkyung Park
- Department of Surgery, Norris Comprehensive Cancer Center Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Clemens A Strohmaier
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria.,Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, United States
| | - Young-Kwon Hong
- Department of Surgery, Norris Comprehensive Cancer Center Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Xiaojing Pan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Alex S Huang
- Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, United States
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11
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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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12
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Marolo P, Reibaldi M, Fallico M, Maugeri A, Barchitta M, Agodi A, Parisi G, Caselgrandi P, Ventre L, Ahmed IIK. Reintervention rate in glaucoma filtering surgery: A systematic review and meta-analysis. Eur J Ophthalmol 2022; 32:2515-2531. [PMID: 35473447 DOI: 10.1177/11206721221093828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Reintervention rate is an important factor impacting on patients, surgeons, and society. To date, only a few studies have focused on this topic. For this reason, a systematic review and meta-analysis was undertaken to assess the reintervention rate after glaucoma filtering surgery. MATERIALS AND METHODS Prospective studies reporting the reintervention rate after glaucoma filtering surgery and with at least 12 months of follow-up were systematically searched on PubMed, Medline and Embase databases. The primary outcome was the total reintervention rate following surgery. Secondary outcomes were: the rate of manipulation, in-clinic and in-operating room reintervention; the reintervention rate for intraocular pressure (IOP) control and for complications; demographic, clinical and surgical variables associated with reintervention rate. RESULTS Ninety-three studies with a total of 8345 eyes were eligible. The total reintervention rate was 1.84 (95% CI 1.57-2.13), with a lower rate for Baerveldt (0.53, 95% CI 0.29-0.83) and Preserflo (0.60, 95% CI 0.15-1.29), and a higher rate for Xen (4.26, 95% CI 2.59-6.31). The manipulation rate was 0.99 (95% CI 0.77-1.23), the in-clinic reintervention rate was 0.08 (95% CI 0.05-0.12) and the in-operating room reintervention rate was 0.28 (95% CI 0.22-0.35). The reintervention rate for IOP control was 1.26 (95% CI 1.04-1.51) and the reintervention rate for complications was 0.27 (95% CI 0.21-0.35). CONCLUSIONS All types of surgery presented a total reintervention rate similar to the overall findings, except studies on Baerveldt and Preserflo Microshunt, with a lower rate, and Xen, with a higher rate. None of the variables evaluated were found to be directly associated with the explored outcomes.
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Affiliation(s)
- Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Matteo Fallico
- Department of Ophthalmology, 9298University of Catania, Catania, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Paolo Caselgrandi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Luca Ventre
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology & Vision Sciences, 7938University of Toronto, Toronto, Ontario, Canada
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13
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Luo M, Zhu Y, Xiao H, Huang J, Ling J, Huang H, Li Y, Zhuo Y. Characteristic Assessment of Angiographies at Different Depths with AS-OCTA: Implication for Functions of Post-Trabeculectomy Filtering Bleb. J Clin Med 2022; 11:jcm11061661. [PMID: 35329987 PMCID: PMC8949979 DOI: 10.3390/jcm11061661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to analyze the quantitative vascular biomarkers of filtering bleb function at different depths using anterior segment optical coherence tomography angiography (AS-OCTA). This cross-sectional study is registered on Clinicaltrails.gov (NCT 04515017). Forty-six eyes with primary open-angle glaucoma that had undergone trabeculectomy with mitomycin-C for more than six months were included. Vessel density (VD) and vessel diameter index (VDI) in the superficial layer (SL), Tenon’s layer (TL), and deep layer (DL) of the bleb were obtained. The VD and VDI were higher in the failure group (both p = 0.000). Significant correlations were found between the SL, TL, DL’s VDI, and IOP in the success group (p = 0.013, 0.016, 0.031, respectively). The VD of the TL and DL were related to IOP in the failure group (p = 0.012, 0.009). Tenon’s VD (TVD) and Tenon’s VDI (TVDI) correlated with IOP adjusting for TVD, TVDI, and the Indiana Bleb Appearance Grading Scale (IBAGS) (p = 0.009, 0.043) or Kenfeld grading system (KGS) (p = 0.011, 0.016). The area under curve (AUC) of the TVD, TVDI, IBAGS, and KGS to predict surgery failure were 0.960, 0.925, 0.770, and 0.850. AS-OCTA realized the quantitative evaluation of vessels, especially the invisible vascularity beneath the conjunctiva. TVD and TVDI as detected by AS-OCTA better reflected bleb function than conventional grading systems.
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Affiliation(s)
- Man Luo
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Hui Xiao
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Jin Ling
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Haishun Huang
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Yiqing Li
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
- Correspondence: (Y.L.); (Y.Z.)
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Guangzhou 510060, China; (M.L.); (Y.Z.); (H.X.); (J.H.); (J.L.); (H.H.)
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
- Correspondence: (Y.L.); (Y.Z.)
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14
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Malyugin BE, Sidorova AV, Starostina AV, Zhuravlev AS, Khaletskaya AA, Eliseeva MA, Smirnova EA. [Pharmacological modulation of wound healing in glaucoma surgery]. Vestn Oftalmol 2022; 138:136-143. [PMID: 36004602 DOI: 10.17116/oftalma2022138041136] [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] [Indexed: 06/15/2023]
Abstract
Despite the well-known effectiveness of pharmacological glaucoma therapy, surgical approach remains one of the main treatment options for some forms and stages of the disease. The long-term success of glaucoma surgery depends on the intensity of local wound healing processes at the surgical site. The most common way to influence healing processes in surgical treatment of glaucoma is the use of antimetabolites. However, given the high risk of serious complications associated with their use, the search for new drugs devoid of these disadvantages continues. The aim of this review is to describe the efficacy and safety of both currently used and upcoming pharmacological ways to influence the wound healing process after glaucoma surgery in order to improve the stability of hypotensive effect.
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Affiliation(s)
- B E Malyugin
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Sidorova
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A V Starostina
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A S Zhuravlev
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A A Khaletskaya
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - M A Eliseeva
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - E A Smirnova
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
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15
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Mattout HK, Fouda SM, Al-Nashar HY. Evaluation of Topical Mitomycin-C Eye Drops After Reconstructive Surgery for Anophthalmic Contracted Socket. Clin Ophthalmol 2021; 15:4621-4627. [PMID: 34916774 PMCID: PMC8667192 DOI: 10.2147/opth.s343550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery for contracted socket and to compare the results with those of the conventional postoperative treatment. Patients and Methods The medical records of patients who underwent reconstructive surgery for contracted anophthalmic socket were retrospectively reviewed. Based on the postoperative treatment protocol, two groups of patients were identified; group I (15 patients) who received topical MMC drops (0.02%) 4 times daily for 6 weeks and group II (15 patients) who received the conventional treatment (topical antibiotic-steroid combination). Preoperative data were extracted for age, gender, cause and timing of anophthalmia, history of previous surgeries, preoperative forniceal depth and socket volume (SV). The main postoperative outcome measures were superior fornix depth (SFD), inferior fornix depth (IFD) and SV at the end of 6th postoperative month. Prosthesis fitting and complications were also considered for analysis. Results The mean preoperative IFD was 1.67±0.04 mm in group I and 1.58±0.37 mm in group II, by the end of the 6th postoperative month it increased to 6.1 ±0.27 mm and 5.12 ±0.25mm, respectively. The mean preoperative SFD in group I was 8.3±0.9 mm and 8.9±1.1 mm in group II, by the end of the 6th postoperative month SFD became 13.4±1.2 mm and 10.2±1.4 mm in groups I and II, respectively. The mean SV measured six months postoperatively was 1.9±0.2 mL and 1.3±0.09 mL in groups I and II, respectively. These differences in the postoperative SFD, IFD and SV between both groups were statistically significant. More cases reported successful fitting in group I than in group II but this difference was not statistically significant. Conclusion Postoperative use of topical MMC is associated with higher forniceal depth and greater SV when compared to the conventional treatment in socket reconstructive surgeries with amniotic membrane graft (AMG).
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Affiliation(s)
- Hala K Mattout
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh M Fouda
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Haitham Y Al-Nashar
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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16
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Steplewski A, Fertala J, Tomlinson RE, Wang ML, Donahue A, Arnold WV, Rivlin M, Beredjiklian PK, Abboud JA, Namdari S, Fertala A. Mechanisms of reducing joint stiffness by blocking collagen fibrillogenesis in a rabbit model of posttraumatic arthrofibrosis. PLoS One 2021; 16:e0257147. [PMID: 34492074 PMCID: PMC8423260 DOI: 10.1371/journal.pone.0257147] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
Posttraumatic fibrotic scarring is a significant medical problem that alters the proper functioning of injured tissues. Current methods to reduce posttraumatic fibrosis rely on anti-inflammatory and anti-proliferative agents with broad intracellular targets. As a result, their use is not fully effective and may cause unwanted side effects. Our group previously demonstrated that extracellular collagen fibrillogenesis is a valid and specific target to reduce collagen-rich scar buildup. Our previous studies showed that a rationally designed antibody that binds the C-terminal telopeptide of the α2(I) chain involved in the aggregation of collagen molecules limits fibril assembly in vitro and reduces scar formation in vivo. Here, we have utilized a clinically relevant arthrofibrosis model to study the broad mechanisms of the anti-scarring activity of this antibody. Moreover, we analyzed the effects of targeting collagen fibril formation on the quality of healed joint tissues, including the posterior capsule, patellar tendon, and subchondral bone. Our results show that blocking collagen fibrillogenesis not only reduces collagen content in the scar, but also accelerates the remodeling of healing tissues and changes the collagen fibrils’ cross-linking. In total, this study demonstrated that targeting collagen fibrillogenesis to limit arthrofibrosis affects neither the quality of healing of the joint tissues nor disturbs vital tissues and organs.
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Affiliation(s)
- Andrzej Steplewski
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Jolanta Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Ryan E. Tomlinson
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Mark L. Wang
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Allison Donahue
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - William V. Arnold
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Michael Rivlin
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Pedro K. Beredjiklian
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Joseph A. Abboud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Surena Namdari
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Andrzej Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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17
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Fellman RL, Mattox C, Singh K, Flowers B, Francis BA, Robin AL, Butler MR, Shah MM, Giaconi JA, Sheybani A, Song BJ, Stein JD. American Glaucoma Society Position Paper: Microinvasive Glaucoma Surgery. Ophthalmol Glaucoma 2021; 3:1-6. [PMID: 32672638 DOI: 10.1016/j.ogla.2019.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022]
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18
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Combined Trabeculotomy-Trabeculectomy Versus Trabeculectomy for Treatment of Silicone Oil-induced Ocular Hypertension. J Glaucoma 2021; 30:134-139. [PMID: 33031185 DOI: 10.1097/ijg.0000000000001702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022]
Abstract
PRCIS Combined trabeculotomy-trabeculectomy (CTT) has a significantly better hypotensive effect than trabeculectomy and a higher success rate in cases of silicone oil-induced ocular hypertension. PURPOSE To compare the ocular hypotensive effect of CTT with mitomycin-C (MMC) to that of trabeculectomy with MMC in cases of silicone oil-induced ocular hypertension. PATIENTS AND METHODS Thirty eyes of 30 patients with high intraocular pressure (IOP) after vitrectomy and silicone oil injection (followed by silicone oil removal) were randomly allocated to 2 groups in this randomized trial. Group A was composed of 15 cases who underwent combined CTT with MMC while group B cases contained 15 cases undergoing trabeculectomy with MMC. Patients were followed up for 12 months. We included patients above 18 years old, having performed vitrectomy and silicone oil injection followed by oil removal, and having IOP >21 mm Hg uncontrollable by antiglaucoma medications. RESULTS The postoperative IOP drop was significantly greater in group A than in group B at all follow up visits (P<0.05). Compared with preoperative IOP, both surgeries produced a significantly lower postoperative IOP at all follow-up visits (P<0.05). For group A, complete success rates (IOP≤21 mm Hg without ocular hypotensive medications) and qualified success rates (IOP≤21 mm Hg with or without ocular hypotensive medications) were both higher than for group B. CONCLUSION Both surgeries effectively reduce IOP in cases of silicone oil-induced ocular hypertension, but CTT has a significantly better hypotensive effect and a higher success rate on the long-term.
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Shalaby HS, Hashem NH. Trabeculectomy with OloGen versus Mitomycin C for the Treatment of Silicone Oil-Induced Glaucoma. Klin Monbl Augenheilkd 2021; 239:1147-1154. [PMID: 34198351 DOI: 10.1055/a-1500-8230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To compare the intraocular pressure-lowering effect and success rate of trabeculectomy with OloGen to that of trabeculectomy with mitomycin C (MMC) in cases of silicone oil-induced glaucoma. MATERIALS AND METHODS Forty eyes of forty patients with elevated intraocular pressure (IOP) after vitrectomy and silicone oil injection (followed by silicone oil removal) were assigned to two groups. Group A included 20 cases who underwent trabeculectomy with OloGen, while group B cases contained 20 cases undergoing trabeculectomy with MMC. The follow-up period was 24 months. Patients enrolled had IOP > 21 mmHg despite being on antiglaucoma medications. RESULTS The mean postoperative IOP reduction was lower in group A than in group B at all follow-up visits, but this difference was not statistically significant (p > 0.05). Moreover, group A and B patients were found to be similar as regards the need for postoperative antiglaucoma medications on all follow-up visits. The Kaplan-Meier survival analysis curves for the two groups revealed slightly higher success rates in group B than in group A. However, these differences were not statistically significant for both qualified success (IOP ≤ 21 mmHg with or without antiglaucoma medications) and complete success (IOP ≤ 21 mmHg without antiglaucoma medications). There was no significant difference in the postoperative complication rate between the two groups. CONCLUSION OloGen implant lowers IOP to a similar extent as MMC when combined with trabeculectomy for the treatment of silicone oil-induced glaucoma, and with comparable success rates. The rate of postoperative complications is similar for OloGen implantation and MMC.
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Dwivedi R, Somerville T, Cheeseman R, Rogers C, Batterbury M, Choudhary A. Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes. Graefes Arch Clin Exp Ophthalmol 2021; 259:1965-1974. [PMID: 33683432 PMCID: PMC7938885 DOI: 10.1007/s00417-021-05144-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/19/2021] [Accepted: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Two-year post-operative outcomes of both deep sclerectomy (DS) and trabeculectomy surgery (Trab) augmented with Mitomycin C (MMC) at a single tertiary eye centre. Methods Retrospective review of DS + MMC and trabeculectomy + MMC at a single centre between February 2015 and March 2018. Patients with a minimum of 12-month follow-up were included. Post-operative follow-up: day 1, week 1, months 1/3/6/12/18/24. Primary outcomes: changes in intraocular pressure (IOP) and changes in LogMAR visual acuity (BCVA) pre- and post-procedure. Secondary outcomes: changes in number of eye drops, number of follow-up clinic visits, post-operative complications and further surgical interventions. Complete success: IOP ≤ 21 mmHg off all IOP-lowering medications. Qualified success: IOP ≤ 21 mmHg on medication. Failure: IOP > 21 mmHg at 24 months or ≤ 5 mmHg on 2 consecutive follow-up visits after 3 months +/− additional incisional glaucoma surgery +/− loss of light perception. Statistical analysis performed using Microsoft Excel + SPSS. Results 90 eyes: DS + MMC = 46 eyes, Trab + MMC = 44 eyes. DS + MMC v Trab + MMC: mean pre-op IOP = 19.57 mmHg v 18.89 mmHg, significantly reduced at all post-operative time-points for both groups (p < 0.001). Mean IOP reduction from baseline = 33.94% v 38.39%; > 30% IOP reduction = 54.35% v 68.18%. IOP ≤ 16 mmHg = 82.61% (38/46) v 95.46% (42/44), IOP ≤ 12 mmHg = 52.17% (24/46) v 72.72% (32/44). Complete success = 67.39% v 61.36%, qualified success = 26.09% v 29.55%, failure = 6.52% v 9.09%. Post-op BCVA: no statistically significant differences between two groups (p = 0.09). Mean pre-op drops v post-op drops = 2.98 v 0.38 (DS + MMC; p < 0.001); 2.68 v 0.39 (Trab + MMC; p < 0.001). Further surgical intervention = 13% v 29.55%. Mean number of post-op clinic visits DS + MMC v Trab + MMC = 10.09 v 13.02 (p = 0.005). Conclusion Both procedures achieve sustained intraocular pressure and drop reduction at 2 years post-op. DS + MMC has lower complication rates requiring less intervention and significantly fewer clinic visits, which may be an important factor for deciding surgical management of glaucoma patients in the era of Covid-19 to reduce patient/clinician exposure to the virus.
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Affiliation(s)
- Rahul Dwivedi
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
| | - Tobi Somerville
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert Cheeseman
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Clare Rogers
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Mark Batterbury
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Anshoo Choudhary
- St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
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21
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Kim SJ, Moon SW, Lee JW. One-year Result of Trabeculectomy Following a Failed Trabecular Micro-bypass Stent. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.2.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sayed KM. Common and rare complications following filtering surgery for children with congenital glaucoma; a5 years study. Eur J Ophthalmol 2021; 31:3034-3041. [PMID: 33426914 DOI: 10.1177/1120672120986375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the incidence of postoperative complications following combined trabeculotomy trabeculectomy with mitomycin C (CTTM) for congenital glaucoma (CG), in addition to documentation of some unusual complications and possible ways to manage these complications safely with minimal morbidity. METHODS A retrospective observational study was performed on 190 eyes with CG had a CTTM procedure.Included eyes were operated upon between February 2015 and February 2020 in Sohag University Hospitals. Medical records were reviewed and postoperative complications were reported. Incidence of postoperative complications and their management were the main outcome measures. RESULTS Early complications developed the form of shallow anterior chamber (AC) (16.3%), hyphema (10.5%), serous choroidal detachment (2%), hemorrhagic choroidal detachment (2%). Unusual and rare complications occurred in the form of iatrogenic Cushing syndrome, unilateral toxic keratopathy developed, vitreous hemorrhage (VH), intercalary staphyloma and decompression retinopathyLate complications included: high postoperative intraocular pressure (IOP) (16.5%), thin cystic blebs (13.1%), hypotony disc edema (2%), cataract (3.2%), one eye developed blebitis and one eye developed endophthalmitis. CONCLUSION Surgical management of CG is full of complications in early and late postoperative periods such as shallow AC, hyphema and thin cystic blebs. Some unusual and rare complications developed such as iatrogenic Cushing syndrome, unilateral toxic keratopathy, vitreous hemorrhage, intercalary staphyloma and decompression retinopathy. If identified early; all these complications could be managed properly leading to a successful and favorable outcome.
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Affiliation(s)
- Khulood Muhammad Sayed
- The Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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23
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Swogger J, Conner IP, Happ-Smith C, Kemmerer MC, Julian DR, Davis R, Wells A, Schuman JS, Yates CC. Novel combination therapy reduces subconjunctival fibrosis after glaucoma filtration surgery in the rabbit model. Clin Exp Ophthalmol 2021; 49:60-69. [PMID: 33426793 DOI: 10.1111/ceo.13884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/08/2020] [Accepted: 11/06/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Glaucoma filtration surgery (GFS) is limited by subconjunctival, episcleral and scleral fibrosis sealing the trabeculectomy and scarring the filtering bleb. Mitomycin-C (MMC) is commonly applied intraoperatively to the subconjunctival and/or intrascleral space to reduce scarring and promotes GFS success but is associated with postoperative scleral melting and bleb leaks. IP-10 peptide (IP-10p), an ELR-negative CXC chemokine mimetic and inhibitor of fibroblast function, may be an alternative or adjunct to current postoperative GFS treatments. This study sought to determine if IP-10p produces histological changes in tissue remodelling, vascularity and fibrosis that enhance bleb survival after GFS. METHODS Rabbits underwent tube-assisted filtration surgery on the right eye with either: (a) IP-10p injected into bleb at time of surgery and postoperative days 2, 4 and 7, (b) intraoperative MMC or (c) intraoperative MMC plus IP-10p injected into bleb at time of surgery and postoperative days 2, 4 and 7. Left contralateral eyes were treated with balanced salt solution (BSS). RESULTS IP-10p-treated blebs demonstrated reduced collagen deposition, cellularity and overall reduction of scar formation compared to BSS-control. Bleb vascularity was reduced compared to BSS-control and MMC treatment groups. Additionally, IP-10p/MMC treated eyes demonstrated an increased number of conjunctival goblet cells in bleb histology compared to the dramatic loss seen with MMC treatment alone. CONCLUSIONS This study demonstrates that IP-10p significantly reduces histological scarring compared to BSS or MMC alone, does not damage the conjunctiva to the extent of current standards, and may be an alternative or adjunct to MMC for those undergoing GFS.
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Affiliation(s)
- John Swogger
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ian P Conner
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carrie Happ-Smith
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Megan C Kemmerer
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Dana R Julian
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Rachel Davis
- Department of Ophthalmology, UNM Eye Center, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Alan Wells
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joel S Schuman
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, New York, USA
| | - Cecelia C Yates
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Yamamoto Y, Mukai A, Ikushima T, Urata Y, Kinoshita S, Hamuro J, Ueno M, Sotozono C. Pluripotent epigenetic regulator OBP-801 maintains filtering blebs in glaucoma filtration surgery model. Sci Rep 2020; 10:20936. [PMID: 33262357 PMCID: PMC7708845 DOI: 10.1038/s41598-020-77811-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023] Open
Abstract
Inhibition of fibrosis is indispensable for maintaining filtering blebs after glaucoma filtration surgery (GFS). The purpose of this study was to investigate the ability of a pluripotent epigenetic regulator OBP-801 (OBP) to ameliorate extracellular matrix formation in a rabbit model of GFS. Rabbits that underwent GFS were treated with OBP. The gene expression profiles and intraocular pressure (IOP) were monitored until 30 postoperative days. The bleb tissues were evaluated for tissue fibrosis at 30 postoperative days. In in vitro models, OBP interfered the functions of diverse genes during the wound-healing process. In in vivo GFS models, the expressions of TGF-β3, MMP-2, TIMP-2 and 3, LOX, COL1A and SERPINH1 were significantly inhibited at 30 postoperative days in the OBP group compared with those in the vehicle control group. OBP treatment involving subconjunctival injection or eye drops showed no adverse effects, and reduced levels of α-SMA and collagen deposition at the surgical wound site. OBP maintained the long-lived bleb without scar formation, and IOP was lower at 30 postoperative days compared with the vehicle control group. These findings suggest that OBP is an effective and useful candidate low-molecular-weight agent for improving wound healing and surgical outcomes in a rabbit model of GFS.
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Affiliation(s)
- Yuji Yamamoto
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsushi Mukai
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toru Ikushima
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yasuo Urata
- Oncolys BioPharma, Inc., Tokyo, 106-0032, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Junji Hamuro
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-8566, Japan
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Results of fluorouracil-augmented Xen45 implantation in primary open-angle and pseudoexfoliation glaucoma. Int Ophthalmol 2020; 41:945-955. [PMID: 33180281 DOI: 10.1007/s10792-020-01650-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To report the effectiveness and safety of 5-fluorouracil (5-FU)-augmented Xen45 implantation in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). METHODS This single-center, retrospective chart review study included 29 eyes that underwent 5-FU-augmented Xen45 implantation. Main outcome measures were intraocular pressure (IOP) levels and number of glaucoma medications. Surgical success was defined as IOP ≤ 21 mmHg and ≥ 20% reduction from preoperative levels without (complete success) or with (qualified success) glaucoma medications and without further glaucoma surgery at last follow-up. All postoperative interventions and complications were also noted. RESULTS The mean age of the patients was 67.5 ± 10.3 years, and the mean follow-up time was 23.2 ± 12.6 months. Mean IOP was 24.5 ± 8.7 mmHg and decreased by 30.2% at 12 months, 24.9% at 24 months, and 31.7% at final visit (p < 0.001, p = 0.006, p > 0.001, respectively). Mean number of glaucoma medications decreased from 2.83 preoperatively to 0.71 at 12 months, 0.87 at 24 months, and 0.86 at final visit (p < 0.001). At final visit, the complete success rate was 48.3%, qualified success rate was 69%, and 62.1% of the eyes were free of glaucoma medications. Needling was performed in 7 eyes (24%). Adverse events included choroidal detachment in 5 eyes, hyphema in 2 eyes, and endophthalmitis in 1 eye. CONCLUSION 5-FU-augmented Xen45 implantation in POAG and PEXG patients provided safe and effective IOP lowering with significant reduction of glaucoma medications up to 3 years.
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Aslan F, Öktem Ç. Does adjuvant intracameral triamcinolone acetonide increase the effectiveness of phacotrabeculectomy? A Case-Control Study. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2020; 76:68-76. [PMID: 33126801 DOI: 10.31348/2020/14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the effect of intracameral triamcinolone acetonide (TA) on surgical success in 5-fluorouracil (5-FU) supported primary phacotrabeculectomy (PT) cases. MATERIAL AND METHODS This retrospective study included 23 eyes (study group) of 23 patients who underwent TA during PT and 26 eyes (control group) of 26 patients without TA. PT patients in the study group received 1 mg TA intraoperatively at the end of surgery. Pre- and postoperative visual acuity, intraocular pressure (IOP), and number of antiglaucoma drugs used were compared. Postoperative complications and need for 5-FU injection were evaluated for both groups. RESULTS Mean age was 64.1 2 ± 1.91 (48-86) years in the control group and 66.52 ± 2.02 (52-86) years in the study group (p = 0.824). Comparison of pre- and postoperative IOP values showed significant decreases in postoperative IOP levels at all-time points in both the control and study groups (p < 0.001). The only significant difference between groups was on postoperative first day (study group: 9.22 ± 1.41 mmHg; control group: 6.35 ± 2.17 mmHg, p < 0.001). Need for postoperative 5-FU injection was significantly more common in the control group (p = 0.023). CONCLUSION Intracameral injection of 1 mg TA at the end of PT surgery did not yield superior results in postoperative IOP compared to PT alone, and the two groups showed similar IOP reduction. When given as an adjunct to PT, 1 mg TA suppresses anterior segment inflammation and reduces the need for 5-FU injection.
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Costagliola C, Sbordone M, Gandolfi S, Cesari L, Furneri G, Fea AM. Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change? Clin Ophthalmol 2020; 14:2639-2655. [PMID: 32982157 PMCID: PMC7500840 DOI: 10.2147/opth.s264839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.
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Affiliation(s)
- Ciro Costagliola
- Department of Medicine & Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Mario Sbordone
- Ophthalmology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Stefano Gandolfi
- Ophthalmology Unit, Department of Biological, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Luca Cesari
- UOC Ophthalmology - Area 5, Ascoli Piceno, San Benedetto del Tronto, Italy
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Xu L, Asaoka R, Murata H, Kiwaki T, Zheng Y, Matsuura M, Fujino Y, Tanito M, Mori K, Ikeda Y, Kanamoto T, Yamanishi K. Improving Visual Field Trend Analysis with OCT and Deeply Regularized Latent-Space Linear Regression. Ophthalmol Glaucoma 2020; 4:78-88. [PMID: 32791238 DOI: 10.1016/j.ogla.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate whether OCT measurements can improve visual field (VF) trend analyses in glaucoma patients using the deeply regularized latent-space linear regression (DLLR) model. DESIGN Retrospective cohort study. PARTICIPANTS Training and testing datasets included 7984 VF results from 998 eyes of 592 patients and 1184 VF results from 148 eyes of 84 patients with open-angle glaucoma, respectively. Each eye underwent a series of 8 VF tests with the Humphrey Field Analyzer OCT series obtained within the same observation period. METHODS Using pointwise linear regression (PLR), the threshold values of a patient's eighth VF results were predicted using values from shorter VF series (first to second VF tests [VF1-2], first to third VF tests, . . . , to first to seventh VF tests [VF1-7]), and the root mean square error (RMSE) was calculated. With DLLR, OCT measurements (macular retinal nerve fiber layer thickness, the thickness of macular ganglion cell layer and inner plexiform layer, and the thickness of the outer segment and retinal pigment epithelium) that were obtained within the period of shorter VF series were incorporated into the model to predict the eighth VF. MAIN OUTCOME MEASURES Prediction accuracy of VF trend analyses. RESULTS The mean ± standard deviation RMSE resulting from PLR averaged 27.48 ± 16.14 dB for VF1-2 and 3.98 ± 2.25 dB for VF1-7. Significantly (P < 0.001) smaller RMSEs were obtained from DLLR: 4.57 ± 2.71 dB (VF1-2) and 3.65 ± 2.27 dB (VF1-7). CONCLUSIONS It is useful to include OCT measurements when predicting future VF progression in glaucoma patients, especially with short VF series.
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Affiliation(s)
- Linchuan Xu
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan; Department of Computing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan; Seirei Christopher University, Shizuoka, Hamamatsu, Japan; Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hiroshi Murata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Kiwaki
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yuhui Zheng
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Department of Ophthalmology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Yuri Fujino
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan; Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoko Ikeda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; Oike-Ikeda Eye Clinic, Kyoto, Japan
| | - Takashi Kanamoto
- Department of Ophthalmology, Hiroshima Memorial Hospital, Hiroshima, Japan; Department of Ophthalmology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kenji Yamanishi
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan.
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Wang J, Jiang C, Jing Q, Jiang Y, Shao T. Differential Effects of TGF-β2 on the Low-Density Lipoprotein Receptor Expression in Three Types of Human Subconjunctival Fibroblasts. Curr Eye Res 2020; 46:35-44. [PMID: 32633666 DOI: 10.1080/02713683.2020.1789174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To investigate whether TGF-β2 had a different effect on the expression levels of low-density lipoprotein receptor (LDLr) in the subconjunctival fibroblasts from glaucoma patients who underwent a reoperation (RGSFs) compared with those from glaucoma patients who underwent first filtering surgery (GSFs) and control patients with cataracts (HSFs). Methods: Human subconjunctival fibroblasts were obtained from the three groups of patients. Different concentrations of TGF-β2 were added to the fibroblasts for 1, 3, and 5 days. The proliferation of the fibroblasts was determined by CCK-8 assays. Real-time PCR and western blotting were performed to analyze the mRNA and protein levels of LDLr. The uptake of DiI-labeled LDL was determined by confocal microscopy. Results: The results revealed that under TGF-β2 exposure, fibroblast proliferation was positively correlated with LDLr expression (all p < .001). The LDLr mRNA and protein levels were affected by TGF-β2 in a concentration-dependent and time-dependent manner in the RGSFs, GSFs and HSFs. The maximal expression of LDLr after TGF-β2 stimulation was consistent with the peak uptake of DiI-LDL, which was obviously highest in the RGSFs, followed by the GSFs, and then the HSFs (all p < .05). All 3 groups took up DiI-LDL in a similar time-dependent manner, with maximal uptake at 6 h following DiI-LDL incubation (all p < .05). In addition, there were significant differences in the LDLr protein levels in the subconjunctival tissues isolated from the glaucoma patients during reoperation, the glaucoma patients during first filtering surgery and the control patients at day 3 (p < .05). The highest protein expression of LDLr was observed in the RG group. Conclusion: These data suggested that the RGSFs had the highest LDLr expression and the highest peak uptake of LDL among three groups. The LDLr-drug-LDL delivery system could potentially be used for targeted delivery of antimetabolite agents in anti-scarring therapy for glaucoma patients after filtering surgery.
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Affiliation(s)
- Jiajian Wang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University , Shanghai, China
| | - Chao Jiang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University , Shanghai, China
| | - Qinghe Jing
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University , Shanghai, China
| | - Yongxiang Jiang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University , Shanghai, China
| | - Tingting Shao
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University , Shanghai, China
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Akiyama G, Saraswathy S, Bogarin T, Pan X, Barron E, Wong TT, Kaneko MK, Kato Y, Hong Y, Huang AS. Functional, structural, and molecular identification of lymphatic outflow from subconjunctival blebs. Exp Eye Res 2020; 196:108049. [PMID: 32387381 PMCID: PMC7328765 DOI: 10.1016/j.exer.2020.108049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/05/2020] [Accepted: 04/27/2020] [Indexed: 01/26/2023]
Abstract
The purpose of this study is to evaluate outflow pathways from subconjunctival blebs and to identify their identity. Post-mortem porcine (n = 20), human (n = 1), and bovine (n = 1) eyes were acquired, and tracers (fluorescein, indocyanine green, or fixable/fluorescent dextrans) were injected into the subconjunctival space to create raised blebs where outflow pathways were visualized qualitatively and quantitatively. Rodents with fluorescent reporter transgenes were imaged for structural comparison. Concurrent optical coherence tomography (OCT) was obtained to study the structural nature of these pathways. Using fixable/fluorescent dextrans, tracers were trapped to the bleb outflow pathway lumen walls for histological visualization and molecular identification using immunofluorescence against lymphatic and blood vessel markers. Bleb outflow pathways could be observed using all tracers in all species. Quantitative analysis showed that the nasal quadrant had more bleb-related outflow pathways compared to the temporal quadrant (nasal: 1.9±0.3 pathways vs. temporal: 0.7±0.2 pathways; p = 0.003). However, not all blebs resulted in an outflow pathway (0-pathways = 18.2%; 1-pathway = 36.4%; 2-pathways = 38.6%; and 3-pathways = 6.8%). Outflow signal was validated as true luminal pathways using optical coherence tomography and histology. Bicuspid valves were identified in the direction of flow in porcine eyes. Immunofluorescence of labeled pathways demonstrated a lymphatic (Prox-1 and podoplanin) but not a blood vessel (CD31) identity. Therefore, subconjunctival bleb outflow occurs in discrete luminal pathways. They are lymphatic as assessed by structural identification of valves and molecular identification of lymphatic markers. Better understanding of lymphatic outflow may lead to improved eye care for glaucoma surgery and ocular drug delivery.
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Affiliation(s)
- Goichi Akiyama
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Jikei School of Medicine, Tokyo, Japan
| | - Sindhu Saraswathy
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thania Bogarin
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Xiaojing Pan
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong First Medical University, Qingdao, China
| | - Ernesto Barron
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tina T Wong
- Singapore National Eye Center and Singapore Research Institute, Singapore, Singapore
| | - Mika K Kaneko
- Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yukinari Kato
- Tohoku University Graduate School of Medicine, Miyagi, Japan; New Industry Creation Hatchery Center, Tohoku University, Miyagi, Japan
| | - Young Hong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Norris Comprehensive Cancer Center Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alex S Huang
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Combined Phacoemulsification With Goniosynechialysis Under Ophthalmic Endoscope for Primary Angle-closure Glaucoma After Failed Trabeculectomy. J Glaucoma 2020; 29:941-947. [DOI: 10.1097/ijg.0000000000001579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SPARC Levels Modulate the Capacity of Mitomycin to Inhibit the Proliferation of Human Tenon's Capsule Fibroblasts. J Ophthalmol 2020; 2020:5703286. [PMID: 32104594 PMCID: PMC7035548 DOI: 10.1155/2020/5703286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/01/2020] [Accepted: 01/13/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the role of SPARC in the antiproliferation effect of MMC on human Tenon's fibroblasts (HTF). Method Sixteen PACG patients aged 59 ± 10 years (31-72 years), including 6 males and 10 females, were recruited. Tenon tissue was harvested during filtering surgery. Cell density was evaluated after MMC application with different concentrations and application times, by which the optimized MMC application modality was determined. MMC, si-SPARC, or SPARC protein was used when needed to evaluate the cell densities under different conditions, by which the role of SPARC in MMC-mediated antifibrotic process was identified. Results Considering that the cell densities, as well as SPARC expression on mRNA and protein levels, are relatively stable when the MMC concentration is higher than 0.02% and exposure time longer than 90 s, we chose the MMC application pattern with 0.02% and 90 s as an optimized pattern for the downstream work. Compared to control, the si-SPARC and MMC downregulated the SPARC protein by 91% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (. Conclusion This study demonstrates that in HTF, (1) MMC downregulates the expression of SPARC in protein and mRNA levels; (2) SPARC depletion has synergistic effect on the antifibrotic effect of MMC; and (3) reactive oxygen species are the possible mediator in the antifibrotic effect of MMC and si-SPARC.
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Fang A, Nie L, Wang P, Zheng J, Chan YK, Zhang Q, Liang Y, Qu J. Silicone Tube Miniature Drainage Device Implanted under Scleral Flap for the Surgical Treatment of Glaucoma. Curr Eye Res 2020; 45:820-826. [PMID: 32090623 DOI: 10.1080/02713683.2019.1701687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of a silicone tube miniature drainage device implanted under scleral flap for the surgical treatment of primary open-angle glaucoma (POAG). METHODS This is a non-randomized prospective study. Patients with a minimum follow-up of 12 months were analyzed. Demographic information, preoperative and postoperative data including intraocular pressure (IOP), number of medications and complications were recorded. RESULTS A total of 33 eyes of 33 patients were included in the analysis. Mean postoperative follow-up was 29.5 ± 6.9 months (range 18-50 months). The mean preoperative IOP was 25.8 ± 7.3 mmHg and decreased to 14.9 ± 4.3, 14.2 ± 3.4 and 14.9 ± 3.3 mmHg at 1 year, 2 years and last follow-up after surgery. The number of medications was decreased from 3.1 ± 1.3 preoperatively to 0.2 ± 0.7, 0.4 ± 0.9 and 0.4 ± 1.0 at 1 year, 2 years and last follow-up, respectively, after surgery. Only six (18.2%) patients used glaucoma medications at last visit. The complete success rates were 87.9% and 78.6%, respectively, at 1 and 2 years postoperatively. The operation-related complications were rare. CONCLUSIONS The silicone tube miniature drainage device implanted under the scleral flap was found to be a relatively safe and effective surgery for the treatment of POAG. Longer follow-up periods and larger sample sizes are expected.
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Affiliation(s)
- Aiwu Fang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University , Wenzhou, China
| | - Li Nie
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University , Wenzhou, China
| | - Peijuan Wang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University , Wenzhou, China
| | - Jingwei Zheng
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University , Wenzhou, China
| | - Yau Kei Chan
- Department of Ophthalmology, University of Hong Kong , Hong Kong, China
| | - Qi Zhang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University , Wenzhou, China
| | - Yuanbo Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University , Wenzhou, China
| | - Jia Qu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University , Wenzhou, China
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Liang L, Zhu MN, Chen BJ, Wang Z, He LY, Zhang R. Inhibitive effect of TAK-242 on Tenon's capsule fibroblasts proliferation in rat eyes. Int J Ophthalmol 2019; 12:1699-1707. [PMID: 31741857 DOI: 10.18240/ijo.2019.11.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
AIM To study the inhibition effect of TAK-242 on the proliferation of rat eye Tenon's capsule fibroblasts via the toll-like receptor 4 (TLR4) signaling pathway. METHODS SD rat Tenon's capsule fibroblasts were extracted and cultured, then the cells were divided into normal control group, lipopolysaccharide (LPS) group (10 g/mL LPS) and TAK-242 group (1 µmol/L TAK-242, and 10 µg/mL LPS after 30min). The expressions of TLR4, transforming growth factor-β1 (TGF-β1) and interleukin-6 (IL-6) in each group were detected by Western blot and reverse transcriptase-polymerase chain reaction (RT-PCR). Cell proliferation was detected by cell counting kit-8 (CCK-8). RESULTS Double immunofluorescent labeling in the extracted cells showed negative keratin staining and positive vimentin staining. Western blot showed that the LPS group had the highest expression of TLR4 and TGF-β1 (P<0.01). Enzyme linked immunosorbent assay (ELISA) also showed that the secretion of IL-6 was the highest in LPS group (P<0.01). But there was no significant difference in TLR4 and TGF-1, as well as IL-6 expressions between the TAK-242 group and the normal control group (P>0.05). RT-PCR showed that the IL-6 mRNA expression in LPS group was the highest in the three groups (P<0.01). CONCLUSION TAK-242 inhibits the proliferation of LPS-induced Tenon's capsule fibroblasts and the release of inflammatory factors by regulating the TLR4 signaling pathway, providing a new idea for reducing the scarring of the filter passage after glaucoma filtration surgery.
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Affiliation(s)
- Liang Liang
- Department of Ophthalmology, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443003, Hubei Province, China.,Department of Ophthalmology, Yichang Central People's Hospital, Yichang 443003, Hubei Province, China
| | - Meng-Nan Zhu
- Department of Ophthalmology, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443003, Hubei Province, China.,Department of Ophthalmology, Yichang Central People's Hospital, Yichang 443003, Hubei Province, China.,Department of Ophthalmology, Xianning Central Hospital, Xianning 437100, Hubei Province, China
| | - Bao-Ji Chen
- Department of Ophthalmology, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443003, Hubei Province, China.,Department of Ophthalmology, Yichang Central People's Hospital, Yichang 443003, Hubei Province, China
| | - Zheng Wang
- Department of Ophthalmology, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443003, Hubei Province, China.,Department of Ophthalmology, Yichang Central People's Hospital, Yichang 443003, Hubei Province, China
| | - Li-Ye He
- Department of Ophthalmology, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443003, Hubei Province, China.,Department of Ophthalmology, Yichang Central People's Hospital, Yichang 443003, Hubei Province, China
| | - Rang Zhang
- Department of Ophthalmology, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443003, Hubei Province, China.,Department of Ophthalmology, Yichang Central People's Hospital, Yichang 443003, Hubei Province, China
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Collar B, Simón G, Yuan Q, Shen S, Irazoqui P. Semi-permanent transcorneal filter support and in vivo surgical implantation technique for open-angle glaucoma treatment. Biomed Microdevices 2019; 21:92. [PMID: 31686233 DOI: 10.1007/s10544-019-0440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Primary open-angle glaucoma is a progressive disease affecting nearly 60 million people worldwide which, if left untreated, can lead to optic nerve head damage and complete loss of sight. Current interventions include: pharmaceutical drops, laser surgery, shunts, and bleb; however, these methods provide insufficient long-term efficacy in intraocular pressure management. We developed a semi-permanent, implantable transcorneal duct as a new aid in the treatment of this disease. The duct, composed of an intracorneal stabilizing washer and hollow screw, creates an interface between the anterior chamber and the external environment, allowing for the outflow of excess aqueous humor. We discuss the fluid mechanics behind designing and implementing a filter material capable of preventing the ingress of bacteria and viruses while modifying aqueous humor outflow resistances to pre-glaucomatous levels, finding the effective radius of such a material to be 10.44 μm. After performing surgical implantation in four rabbit eyes, subsequent testing showed successful integration between the screw and washer. Colored saline injections highlighted fluid flow progression out of the eye through the duct, suggesting that the device may be a viable approach to treating high intraocular pressure created by open-angle glaucoma.
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Affiliation(s)
- Brett Collar
- Department of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive, West Lafayette, IN, 47907, USA. .,Department of Electrical and Computer Engineering, Purdue University, 465 Northwestern Ave, West Lafayette, IN, 47907, USA.
| | - Gabriel Simón
- Department of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive, West Lafayette, IN, 47907, USA.,Ophthalmological Institute of Gabriel Simón, Calle de Fuencarral, 7, 28004, Madrid, Spain
| | - Quan Yuan
- Department of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive, West Lafayette, IN, 47907, USA
| | - Sui Shen
- Department of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive, West Lafayette, IN, 47907, USA
| | - Pedro Irazoqui
- Department of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive, West Lafayette, IN, 47907, USA.,Department of Electrical and Computer Engineering, Purdue University, 465 Northwestern Ave, West Lafayette, IN, 47907, USA
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Anterior Chamber Sulfur Hexafluoride (SF6) Injection for the Management of Postsurgery Hypotony in Glaucoma Patients. J Glaucoma 2019; 27:476-479. [PMID: 29613979 DOI: 10.1097/ijg.0000000000000958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article was to describe a new technique involving the injection of sulfur hexafluoride (SF6) gas in the anterior chamber (A/C) for the management of hypotony in patients with previous glaucoma surgery. MATERIALS AND METHODS Seven patients were included in this prospective case series. All patients had advanced glaucoma that was managed surgically either by trabeculectomy (6 patients) or Ahmed valve (1 patient). All patients presented with intraocular pressure (IOP) <7 mm Ηg, shallow A/C, and ultrasound images of choroidal detachment and ciliary body detachment. Patients' hypotony was treated by 0.4 to 0.6 mL of 100% pure SF6 injection in the A/C followed by supine posture. The purpose of this injection was dual: to displace the ciliary body to its normal position and restore aqueous humor normal production, and to block aqueous humor outflow through bubble formation, causing an increase in IOP. RESULTS Surgical technique was successful in all 7 patients with IOP normalization (>10 mm Hg) and A/C depth increase within the first week after surgery. CONCLUSION A new surgical technique of SF6 injection in the A/C for patients with choroidal detachment and hypotony shows promising results.
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Abstract
AIM To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant. METHODS Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications. RESULTS A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was -3.69 (95% CI: -6.70 to -0.68) at 1 month, -2.69 (-5.17 to -0.21) at 3 months, -3.67 (-6.09 to -1.25)at 6 months, -3.24 (-6.08 to -0.41) at 12 months, 1.24 (-9.43 to 11.90) at 24 months, and 1.10 (-10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10-0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications.Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01). CONCLUSION Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.
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Arnljots TS, Economou MA. XEN Gel Stent exposure 7mo after primary implantation: a case report. Int J Ophthalmol 2019; 12:689-691. [PMID: 31024828 DOI: 10.18240/ijo.2019.04.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/02/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Mario A Economou
- Anterior Segment Department, St. Erik Eye Hospital, Stockholm 11282, Sweden.,Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden
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HDAC Inhibitors: Therapeutic Potential in Fibrosis-Associated Human Diseases. Int J Mol Sci 2019; 20:ijms20061329. [PMID: 30884785 PMCID: PMC6471162 DOI: 10.3390/ijms20061329] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 02/07/2023] Open
Abstract
Fibrosis is characterized by excessive deposition of the extracellular matrix and develops because of fibroblast differentiation during the process of inflammation. Various cytokines stimulate resident fibroblasts, which differentiate into myofibroblasts. Myofibroblasts actively synthesize an excessive amount of extracellular matrix, which indicates pathologic fibrosis. Although initial fibrosis is a physiologic response, the accumulated fibrous material causes failure of normal organ function. Cardiac fibrosis interferes with proper diastole, whereas pulmonary fibrosis results in chronic hypoxia; liver cirrhosis induces portal hypertension, and overgrowth of fibroblasts in the conjunctiva is a major cause of glaucoma surgical failure. Recently, several reports have clearly demonstrated the functional relevance of certain types of histone deacetylases (HDACs) in various kinds of fibrosis and the successful alleviation of the condition in animal models using HDAC inhibitors. In this review, we discuss the therapeutic potential of HDAC inhibitors in fibrosis-associated human diseases using results obtained from animal models.
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Asano S, Murata H, Matsuura M, Fujino Y, Asaoka R. Early Detection of Glaucomatous Visual Field Progression Using Pointwise Linear Regression With Binomial Test in the Central 10 Degrees. Am J Ophthalmol 2019; 199:140-149. [PMID: 30465746 DOI: 10.1016/j.ajo.2018.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We previously reported that it was beneficial to apply binomial pointwise linear regression (PLR) to detect 24-2 glaucomatous visual field (VF) progression, compared to mean deviation (MD) trend analysis and permutation analysis of PLR (PoPLR). The purpose of the current study was to validate the usefulness of the binomial PLR method to detect VF progression in the central 10 degrees in glaucoma patients. DESIGN Reliability assessment. METHODS A series of 15 VFs (Humphrey Field Analyzer 10-2 SITA-standard) from 97 eyes in 69 primary open-angle glaucoma patients, obtained over 8.5 ± 1.3 years (mean ± SD), were investigated. PLR was performed by regressing the total deviation of all test points on the series of 15 VFs. VF progression was determined from the analyses of VF test points using the binomial test (1-sided, P < .025). The time needed to detect VF progression was also investigated. The results were compared with PoPLR and MD trend analyses. RESULTS The binomial PLR was comparable to PoPLR and MD trend analyses in the positive predictive value (0.19 to 0.80), the negative predictive value (0.86 to 1.0), and the false positive rate (0.0 to 0.13) to evaluate glaucomatous VF progression. The time needed to detect VF progression (4.2 ± 1.8 years) was significantly shorter with the binomial PLR method compared with PoPLR and MD trend analysis (P = .04, P = .012, respectively). CONCLUSIONS The binomial PLR method detected glaucomatous VF progression in the central 10 degrees significantly earlier than PoPLR and MD trend analyses.
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Canaloplasty in the Treatment of Open-Angle Glaucoma: A Review of Patient Selection and Outcomes. Adv Ther 2019; 36:31-43. [PMID: 30488337 PMCID: PMC6318242 DOI: 10.1007/s12325-018-0842-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 11/24/2022]
Abstract
Canaloplasty is a relatively new non-penetrating surgery for the reduction of intraocular pressure in patients affected by glaucoma. The technique uses a microcatheter to perform a 360 º cannulation of Schlemm’s canal and leaves in place a tension suture providing an inward distension. It aims to restore the physiological outflow pathways of the aqueous humour and is independent of external wound healing. Several studies have shown that canaloplasty is effective in reducing intraocular pressure and has a low rate of complications, especially compared with trabeculectomy, the gold standard for glaucoma surgery. Currently, canaloplasty is indicated in patients with open-angle glaucoma, having a mild to moderate disease, and the combination with cataract phacoemulsification may provide further intraocular pressure reduction. This article reviews canaloplasty indications, results and complications and analyses its outcomes compared with traditional penetrating and non-penetrating techniques.
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Kobat SG, Celiker FU, Dagli AF, Kasar K. The effect on wound healing of pazopanib and bevacizumab compared with corticosteroid in experimental glaucoma filtration surgery. Int J Ophthalmol 2018; 11:1909-1915. [PMID: 30588421 DOI: 10.18240/ijo.2018.12.05] [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: 07/16/2018] [Accepted: 08/09/2018] [Indexed: 12/15/2022] Open
Abstract
AIM To compare the effects of bevacizumab and pazopanib with corticosteroids on wound healing after trabeculectomy. METHODS In the study, 35 New Zealand white rabbits were randomly divided into five groups. Apart from the first group, limbus-based trabeculectomy was performed for the eyes of rabbits. No postoperative treatment was administered for group I. Topically administered saline, prednisolone acetate (1%), bevacizumab 5 mg/mL, pazopanib 5 mg/mL for group II, III, IV and V respectively were applied for groups 6h daily for 28d. On day 28 of the experiment, eyes were enucleated and histologically and immunohistochemically analyzed. RESULTS The fibroblast counts of groups IV and V were determined to be lower than those of groups II and III (P<0.05). In the mononuclear cell (MNC) count evaluation, no statistically significant difference was determined between the treatment groups (P>0.05). The immunohistochemical staining intensity of fibroblast growth factor β (FGF-β) and vascular endothelial growth factor (VEGF) was determined to be lower in groups IV and V than in groups II and III (P<0.05). No statistically significant difference was determined between groups IV and V in respect of fibroblast count, MNC count, FGF-β and VEGF staining intensity (P>0.05). The platelet derived growth factor β (PDGF-β) intensity was lower in group V than in groups II, III and IV (P<0.05). While the PDGF-β staining intensity was significantly lower in group IV than in group II, the difference compared with group III was not statistically significant (P>0.05). CONCLUSION Bevacizumab and pazopanib might be good alternatives of corticosteroid treatment on delaying wound healing in glaucoma surgery.
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Affiliation(s)
- Sabiha Gungor Kobat
- Department of Ophthalmology, Elazig Health Sciences University, Elazig 23000, Turkey
| | - Fatma Ulku Celiker
- Department of Ophthalmology, School of Medicine, Firat University, Elazig 23119, Turkey
| | - Adile Ferda Dagli
- Department of Pathology, School of Medicine, Firat University, Elazig 23119, Turkey
| | - Kader Kasar
- Department of Ophthalmology, Ordu State Hospital, Ordu 52100, Turkey
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Mamikonyan VR, Fisenko NV. [Glaucoma surgery: from traditional filtration techniques to modern principles of bioengineering]. Vestn Oftalmol 2018; 134:111-117. [PMID: 30499548 DOI: 10.17116/oftalma2018134051111] [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] [Indexed: 11/17/2022]
Abstract
The article reviews the history of glaucoma surgery and analyses the connection between the accumulation of knowledge on glaucoma progression and the emergence of effective surgical treatment methods based on glaucoma pathogenesis. It also describes modern principles of preventing filtering bleb scarring. Particular attention is devoted to biodegradable collagen matrix implants.
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Affiliation(s)
- V R Mamikonyan
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N V Fisenko
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Mercieca K, Perumal D, Darcy K, Anand N. Cataract extraction after deep sclerectomy and its effect on intraocular pressure control. Eye (Lond) 2018; 33:557-563. [PMID: 30382238 DOI: 10.1038/s41433-018-0262-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To estimate the incidence and predisposing factors for cataract extraction (CE) after Deep Sclerectomy (DS) with Mitomycin-C (MMC) and its effect on intraocular pressure (IOP) control. METHODS Retrospective study of phakic eyes which had DS with MMC performed over a 5-year period. 179 eyes of 179 patients were included. RESULTS Mean age at time of DS was 68.6 ± 9.7 years and mean follow-up was 89.4 ± 29.4 months. 63 eyes had CE and the probability of CE following DS was 0% at 1, 11.6% at 3, 21.0% at 5 and 33.2% at 7 years, with a 50% probability (median survival time) of 10 years. Age was association with increased risk for CE (Hazard ratio 1.05, 95% CI: 1.03-1.08, p < 0.0001). Mean IOP had increased from 11 mmHg to 15 mmHg in the first 3 months and remained higher up to a year (p < 0.001). There was no difference in the probability of maintaining an IOP < 16 mmHg without additional medications or needle revision (p = 0.05,Log-rank test). 20/47 eyes that failed were from the CE group, of which 14 (22.2%) failed prior to CE. Number of eyes on glaucoma medications before CE was 6 (mean edications 0.2 ± 0.5 m) and by last follow-up, 9 eyes were on medications (mean medications 0.2 ± 0.7). Post-CE needle revision was performed on 4 eyes. CONCLUSIONS The probability of CE after DS is low, with a gradual increase with time. Increasing age was found to be a statistically significant risk factor. There was a modest increase in IOP after CE and increase use of glaucoma medications.
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Affiliation(s)
- Karl Mercieca
- Manchester University Hospitals NHS Trust, Manchester, UK
| | - Divya Perumal
- Manchester University Hospitals NHS Trust, Manchester, UK
| | - Kieren Darcy
- University Hospital Bristol NHS Trust, Bristol, UK
| | - Nitin Anand
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK. .,Calderdale and Huddersfield NHS Trust, Huddersfield, UK.
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Yin X, Cai Q, Song R, He X, Lu P. Relationship between filtering bleb vascularization and surgical outcomes after trabeculectomy: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 2018; 256:2399-2405. [PMID: 30209568 DOI: 10.1007/s00417-018-4136-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/13/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To explore the relationship between the bleb vasculature and surgical outcome after trabeculectomy (TRAB) using optical coherence tomography angiography (OCT-A). METHODS A prospective study was conducted, which included 26 eyes of 26 primary glaucoma patients in the final analysis. Thereinto, six patients underwent TRAB combined 5-FU and 12 patients received subconjunctival 5-FU injection postoperation. The bleb vessel was evaluated using OCT-A 1 week, 2 weeks, 1 month, 3 months, and 6 months after TRAB. Intraocular pressure (IOP), filtering bleb height, and bleb wall thickness were recorded at the same time. Pearson's correlation analysis and linear regression analysis were performed to determine the correlation of the vessel area data with other parameters. RESULTS Compared with vessel area 1 week after surgery, there was significant increase of the vessel area (△vessel area) 2 weeks (11.13 ± 11.91%, p < 0.05) and 1 month (16.91 ± 14.85%, p < 0.0001) after surgery in all patients. The △vessel area was significantly greater in acute angle closure (AAC) and primary angle closure glaucoma (PACG) 1-month post-TRAB as compared with that 1 week (p < 0.05). The results indicated that the △vessel area 1-month post-TRAB was positive correlated with IOP 6-month post-TRAB (β = 3.88, p = 0.042). CONCLUSIONS Filtering bleb vascularization evaluation using OCT-A could potentially predict IOP 6-month post-TRAB. Surgery effect predicted by filtering bleb vascularization detection is conducive to the select specific postoperative intervention to improve the success rate of TRAB.
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Affiliation(s)
- Xue Yin
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Qinhua Cai
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Run Song
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Xuefei He
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Peirong Lu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China.
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Esfandiari H, Pakravan M, Yazdani S, Doozandeh A, Yaseri M, Conner IP. Treatment Outcomes of Mitomycin C-Augmented Trabeculectomy, Sub-Tenon Injection versus Soaked Sponges, after 3 Years of Follow-up: A Randomized Clinical Trial. Ophthalmol Glaucoma 2018; 1:66-74. [PMID: 32672635 DOI: 10.1016/j.ogla.2018.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the 3-year outcome of trabeculectomy with mitomycin C (MMC)-soaked sponges versus intra-Tenon injection of MMC in eyes with uncontrolled primary open-angle glaucoma. DESIGN Randomized clinical trial. PARTICIPANTS Eighty-two consecutive patients with uncontrolled primary open-angle glaucoma. METHODS Participants were randomized either to intra-Tenon injection of 0.1 ml of 0.01% MMC (TI group) or 0.02% subconjunctival application of MMC-soaked sponges (TS group). Patients were followed up for 3 years after surgery. The data for 73 eyes were included in the final analysis. MAIN OUTCOME MEASURES The primary outcome measure was the surgical success, defined as intraocular pressure (IOP) more than 5 mmHg and <21 mmHg, and IOP reduction of 20% or more from baseline, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures were IOP, glaucoma medications, best-corrected visual acuity (VA), bleb morphologic features according to the Indiana Bleb Appearance Grading Scale, complications, and endothelial cell count changes. RESULTS The cumulative probability of success at 3-year follow-up was 72.2% in the TI group and 65.1% in the TS group (P = 0.30). Uncontrolled IOP was the most common reason for failure. The mean preoperative IOP was 22.4±4.6 mmHg with an average of 3.1±1.0 medications. At 3 years, final IOP was 15.3±3.7 mmHg in the TI group and 16.4±3.5 mmHg in the TS group (P = 0.55). Mean glaucoma number of medications was 0.9±1.1 and 1.1±1.1 in the TI and TS groups, respectively (P = 0.54). Blebs tended to be more diffuse (P = 0.032), less vascularized (P = 0.013), and more shallow (P = 0.012) after intra-Tenon injection. Visual outcomes and endothelial cell changes were similar in both groups (P = 0.47 and P = 0.94, respectively). CONCLUSIONS Although the success rate and IOP reduction were comparable with both techniques, bleb morphologic parameters were more favorable after intra-Tenon injection of 0.1 ml of 0.01% MMC.
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Affiliation(s)
- Hamed Esfandiari
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mohammad Pakravan
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Doozandeh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ian P Conner
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Sung MS, Eom GH, Kim SJ, Kim SY, Heo H, Park SW. Trichostatin A Ameliorates Conjunctival Fibrosis in a Rat Trabeculectomy Model. ACTA ACUST UNITED AC 2018; 59:3115-3123. [DOI: 10.1167/iovs.18-23826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mi Sun Sung
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Gwang Hyeon Eom
- Department of Pharmacology, Chonnam National University Medical School, Hwasungun, South Korea
| | - Soo Jin Kim
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - So Young Kim
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hwan Heo
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Sang Woo Park
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, South Korea
- Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, South Korea
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Gedde SJ, Chen PP, Heuer DK, Singh K, Wright MM, Feuer WJ, Schiffman JC, Shi W. The Primary Tube Versus Trabeculectomy Study. Ophthalmology 2018; 125:774-781. [DOI: 10.1016/j.ophtha.2017.10.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
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Abbas A, Agrawal P, King AJ. Exploring literature-based definitions of hypotony following glaucoma filtration surgery and the impact on clinical outcomes. Acta Ophthalmol 2018; 96:e285-e289. [PMID: 29193812 DOI: 10.1111/aos.13601] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To highlight the variations in published definitions of hypotony and their impact on reported clinical outcomes. To propose a revised definition, focusing on clinically significant hypotony (CH). METHODS Literature review of hypotony definitions published between January 2010 and December 2015 was carried out. Numerical definitions for hypotony, its onset, duration and associated clinical signs were recorded. Each definition was applied to surgical outcomes data collected prospectively from a cohort of 300 glaucoma patients treated at a single centre. The sensitivity and specificity of each definition in identifying CH [defined as low intraocular pressure (IOP) with signs of maculopathy hypotony and choroidal detachment] were calculated. RESULTS A total of 128 eligible papers were identified, and 14 different definitions for hypotony were extracted. In 53 (41.4%), hypotony was not defined. In the remaining 75 (58.6%), the numerical definitions varied between 4 and 8 mmHg, and of these, 24 (32%) included the onset and duration of hypotony as part of the definition. Definition-dependent hypotony rates within the cohort varied between 1% and 59.3%. No statistical differences were found between the groups based on corneal thickness or axial length. Clinically significant hypotony (CH) was identified in 37 (12.3%), with large differences in the sensitivity and specificity among published definition. CONCLUSION Variations in defining postoperative hypotony can have a large impact on the reported success and failure rates among studies. There is a need for a more robust universal definition, focusing on clinically important signs, to allow better comparison between different treatment modalities.
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Affiliation(s)
- Ali Abbas
- Glaucoma Unit; Moorfields Eye Hospital; London UK
| | - Pavi Agrawal
- Department of Ophthalmology; Nottingham University Hospital; Nottingham UK
| | - Anthony J. King
- Department of Ophthalmology; Nottingham University Hospital; Nottingham UK
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Abstract
Introduction: The concept of canaloplasty is to increase aqueous egress through all structures that control the aqueous outflow, such as the trabecular meshwork, Schlemm’s canal, and collector channels, by viscomodulation and by placing of a suture stent into the canal. Clinical studies show canaloplasty to be safe and efficient in lowering the intraocular pressure; however, proper knotting of the tensioning suture is technically challenging and even impossible if circumferential cannulation cannot be achieved; furthermore, protrusion of the suture stent is a potential lifelong risk. Methods: The specific design of the Stegmann Canal Expander allows a permanent expansion of the canal and distension of the trabecular meshwork. Two expanders are implanted on either side of the surgically created ostium of Schlemm’s canal to treat half of the circumferential outflow system. This article describes the technique step by step, provides the clinician with surgical pearls, and highlights the management of adverse events. Results: Technically, implantation of the Stegmann Canal Expander is simple and does not require a long learning curve, compared to placing and knotting a tensioning suture. Most issues are related to the two-flap dissection technique (deep sclerectomy technique) and not to implantation of the Stegmann Canal Expander. Intraocular pressure reduction without medications to the low teens can be achieved. Conclusions: The Stegmann Canal Expander is a novel micro-device that has the potential to make canaloplasty a simplified, more controlled, and reproducible surgical procedure.
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Affiliation(s)
- Matthias C Grieshaber
- Department of Ophthalmology, Glaucoma Service, University Hospital of Basel, Basel, Switzerland
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