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Hasan SM, Theilig T, Lehmann T, Meller D. Factors Correlated With Mid-Term Morphology of Functional Blebs Following Implantation of Preserflo MicroShunt Using AS-OCT. Transl Vis Sci Technol 2023; 12:4. [PMID: 37917087 PMCID: PMC10627305 DOI: 10.1167/tvst.12.11.4] [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: 06/27/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose Evaluating bleb morphology is crucial after glaucoma filtering surgery. Advances in anterior segment optical coherence tomography (AS-OCT) allow for objective assessment. While various parameters differentiate functional from failed blebs, limited information exists regarding variations within functional blebs. This study aimed to identify factors influencing morphology of functional blebs following implantation of Preserflo MicroShunt. Methods Eyes with functional blebs after Preserflo were retrospectively included. Age, gender, lens status, preoperative intraocular pressure (pre-IOP) and number of glaucoma medications were documented along with biometric measurements as axial length (AL), white-to-white distance, and anterior chamber depth. Postoperative data included time elapsed since surgery (TaS) and postoperative IOP (post-IOP). Bleb dimensions were measured using AS-OCT including maximal bleb height (MBH), width, length (MBL), bleb wall thickness (BWT), and bleb distance to limbus (DtL) along with dimensions of episcleral lake (maximal height, width [MLW], and length). Linear regression models were applied to correlate these parameters with bleb dimensions. Results Included were 50 eyes from 50 patients. Mean IOP decreased from 25.3 ± 10.0 to 11.9 ± 3.0 mm Hg after 278.5 ± 221.9 days after surgery. MBH correlated negatively with age (unstandardized coefficients [uSC] = -0.012) and TaS (uSC = -0.001, P = 0.008 for both). BWT correlated negatively with age (uSC = -0.013, P = 0.02), MBL with AL (uSC = -0.566, P = 0.01) and MLW with pre-IOP (uSC = -0.073, P = 0.02). DtL exhibited a positive correlation with post-IOP (uCS = 0.136, P = 0.02). Conclusions Morphology of functional blebs might be influenced by multiple factors such as age, TaS, AL, and pre- and post-IOP. Translational Relevance Age, time after surgery, axial length, and preoperative and postoperative IOP could affect the morphology of a functional bleb; hence, these factors should be taken into consideration when making treatment decisions.
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Affiliation(s)
- Somar M. Hasan
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Theresa Theilig
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Daniel Meller
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
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Hasan SM, Theilig T, Tarhan M, Papadimitriou M, Meller D. [Bleb morphology using optical coherence tomography : After primary implantation of XEN gel stent and open conjunctival revision]. DIE OPHTHALMOLOGIE 2023; 120:529-537. [PMID: 36445475 DOI: 10.1007/s00347-022-01764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND The implantation of a XEN gel stent is an innovative method for filtration surgery using an ab interno approach. The morphological evaluation of the resulting bleb is decisive for surgical success. Bleb revision is frequently needed after XEN implantation and might affect the bleb morphology. Aim of this study was to examine bleb morphology using anterior segment OCT (AS-OCT) and analyze the morphological differences of blebs after primary XEN implantation and after bleb revision. MATERIAL AND METHODS Included were eyes that underwent XEN implantation (Pr-X) or bleb revision after XEN (Re‑X group). An AS-OCT of blebs was performed and images were classified using a novel classification system (the Jenaer bleb grading system, JBGS). Frequency of different tomographic patterns (M) and their correlation with intraocular pressure (IOP) were analyzed. RESULTS AND DISCUSSION A total of 69 eyes (40 in the Pr‑X and 29 in the Re‑X groups) were included. At the conjunctival level, the most common M in both groups was subconjunctival spaces (M-C2) followed by intraconjunctival cysts (C1) and no conjunctival changes (C0). No differences of frequencies between the two groups or of IOP between the three Ms were seen. At the tenon level, the most commonly seen Ms in the Pr‑X group were hyporeflective and cavernous changes (M-T2, T3) followed by no changes (M0) and hyperflective changes (T1). In the Re‑X group, the M‑T1 and T2 were most commonly seen followed by T3 and T0. The M‑T2 and T3 in the Pr‑X group and the M‑T1 and T2 in the Re‑X group correlated with lower IOP. An episcleral lake (M-ES1) was seen significantly less frequently in the Pr‑X group compared with Re‑X group where it correlated with lower IOP CONCLUSION: The hyperreflective changes at the tenon level and the presence of an episcleral lake were seen more frequently following bleb revision compared with primary XEN implantation and correlated with lower IOP. The interpretation of bleb morphology using AS-OCT should only be done considering the surgical approach used.
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Affiliation(s)
- Somar M Hasan
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Theresa Theilig
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Melih Tarhan
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Menelaos Papadimitriou
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Daniel Meller
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
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Jang YK, Choi EJ, Son DO, Ahn BH, Han JC. Filtering Bleb Size in the Early Postoperative Period Affects the Long-term Surgical Outcome after Trabeculectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:53-61. [PMID: 36549333 PMCID: PMC9935064 DOI: 10.3341/kjo.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To investigate whether postoperative filtering bleb size affects the surgical outcome after trabeculectomy. METHODS In this study, we retrospectively reviewed 145 medically uncontrolled glaucoma patients with intraocular pressure (IOP) values >21 mmHg before surgery and data from ≥2 years of follow-up. Postoperative IOP, filtering bleb size including extent and height, and other clinical factors were measured after trabeculectomy. We divided bleb extent into quadrants and bleb height by 0.5 intervals of corneal thickness. The main outcome measure was surgical success. We confirmed complete success when the IOP was ≤21 mmHg and decreased by >20% from baseline without medication or additional procedures. Qualified success used the same criteria but allowed for medication or additional procedures. Cases with reoperation or two consecutive IOP measurements <6 mmHg were considered failures. RESULTS A total of 145 eyes of 145 patients was included. The average observation period was 30.8 ± 10.9 months. During multivariate Cox regression analysis, a larger extent of filtering bleb revealed significantly low hazard ratios in both complete and surgical success (0.509 and 0.494, respectively); however, there was no significant relationship between bleb height and surgical outcome. CONCLUSIONS The extent of the filtering bleb was associated with surgical outcomes of trabeculectomy in glaucoma patients.
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Affiliation(s)
- Yoon Kyung Jang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Eui Jun Choi
- Department of Statistics and Data Science, Yonsei University, Seoul,
Korea
| | - Dong Ook Son
- Department of Statistics and Data Science, Yonsei University, Seoul,
Korea
| | - Byung Heon Ahn
- Department of Ophthalmology, Myung-Gok Eye Research Institute, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul,
Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
- Department of Medical Device, Management and Research, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul,
Korea
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Novel Bleb Classification Following Ab Interno Implantation of Gel-Stent Using Anterior Segment Optical Coherence Tomography. J Glaucoma 2023; 32:117-126. [PMID: 35980859 DOI: 10.1097/ijg.0000000000002096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/21/2022] [Indexed: 01/28/2023]
Abstract
PRCIS A novel qualitative tomographical classification for bleb after implantation of XEN-Gel-Stent using ab interno approach is presented. Association of anatomic patterns to intraocular pressure (IOP) and success rates (SR) illustrates that anterior segment optical coherence tomography can be useful tool in clinical guidance. PURPOSE To present a novel classification of bleb resulting from ab interno implantation of XEN-Gel-Stent and report association of tomographical patterns with IOP and SR. MATERIALS AND METHODS A cross-sectional 1-armed study of patients receiving XEN-Gel-Stent. Tomographical changes in the bleb area were studied using swept-source optical coherence tomography in an early (d 29-90 postsurgery) and late (starting from d 91 postsurgery) phase. Frequency of patterns and their association with IOP and SR (defined as IOP<18 mmHg without medications) were studied. RESULTS One hundred eleven examinations of 49 blebs (49 patients) were included. Three tomographical patterns at conjunctival, 4 at tenons capsule, and 2 at episcleral level were characterized. Most frequent conjunctival pattern was subconjunctival spaces (56.3% and 53.2% in the early and late phase, respectively) and associated with lower IOP (13.0±6.0 mmHg) and higher SR (89%) but only in the early phase compared with other conjunctival patterns ( P <0.05). At tenons capsule level, the hyporeflective pattern was most frequent (50% and 51.9% in early and late phase) followed by the cavernous pattern. Both patterns associated with lower IOP and higher SR compared with hyper-reflective or loss of tenon changes ( P <0.005). Most blebs showed no episcleral lake (87.5% and 89.9% in early and late phase). No difference of IOP and SR was noted compared with those showing an episcleral lake. CONCLUSION A practical and clinically relevant novel classification system is proposed to tomographically describe and classify blebs after implantation of XEN-Gel-Stent. Certain patterns were associated with lower IOP and higher SR.
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Makashova NV, Kolosova OY. [Studying the condition of filtering bleb after glaucoma surgery using optical coherence tomography]. Vestn Oftalmol 2021; 137:68-73. [PMID: 34965070 DOI: 10.17116/oftalma202113706168] [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: 11/17/2022]
Abstract
PURPOSE To compare the optical coherence tomography (OCT) findings on the condition of filtering bleb (FB) in patients with primary open-angle glaucoma (POAG) who used different local therapy before glaucoma surgery. MATERIAL AND METHODS The study included a total of 82 patients (82 eyes) followed up after glaucoma surgery: 50 patients (50 eyes) who received preservatives-containing drugs before glaucoma surgery; 32 patients (32 eyes) - who were on preservative-free drug treatment before glaucoma surgery. The examinations were carried out 7 days, 1 and 3 months after micro-invasive sinus trabeculectomy. The condition of filtering bleb was studied using the Visante AS-OCT device, as well as with a slit lamp for clinical observation. Corneal-compensated intraocular pressure (IOPcc) was determined by bi-directional pneumatic applanation of the cornea using the Ocular Response Analyzer (ORA). RESULTS After 3 months post-op, a functioning FB and intraocular pressure below 15.0 mm Hg were observed in 38 eyes out of 50 (76%) in group 1, in 12 eyes (24%) the FB was nonfuncitonal. In Group 2, 25 eyes out of 32 (78%) had functioning FB and intraocular pressure lower than 15.0 mm Hg; in 7 eyes (22%) the FB was nonfuncitonal. Needling was needed 3 months after the operation in 7 eyes out of 32 (22%) in group 2. The need for needling according to OCT findings in patients of group 1 occurred already one week after surgery for 4 eyes out of 50 (8%), after one month - for 14 eyes (28%). CONCLUSION In patients on pre-operative drug therapy with preservative-containing medications, the process of scarring in the FB is faster. The OCT method allows early detection of the initial signs of scarring, as well as determining the need for needling.
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Carnevale C, Riva I, Roberti G, Michelessi M, Tanga L, Verticchio Vercellin AC, Agnifili L, Manni G, Harris A, Quaranta L, Oddone F. Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review. Pharmaceuticals (Basel) 2021; 14:581. [PMID: 34207162 PMCID: PMC8234834 DOI: 10.3390/ph14060581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023] Open
Abstract
Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.
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Affiliation(s)
- Carmela Carnevale
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Ivano Riva
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Gloria Roberti
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Manuele Michelessi
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Lucia Tanga
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Alice C. Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d’Annunzio of Chieti—Pescara, 66100 Chieti, Italy;
| | - Gianluca Manni
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Francesco Oddone
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
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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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Makashova NV, Kolosova OY. [Methods of assessing the condition of filtering bleb after glaucoma surgery]. Vestn Oftalmol 2020; 136:93-99. [PMID: 33084285 DOI: 10.17116/oftalma202013606193] [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: 11/17/2022]
Abstract
Currently, there is a need to assess the condition of structures at the surgery site after glaucoma intervention due to the necessity to decide further treatment tactics after performed operations, as well as the possibility of developing more advanced methods of surgical treatment of glaucoma. Despite the fact that there are several methods of examining the filtration bleb (FB), some of them have both clear advantages and significant disadvantages. This article reviews the possibilities of using optical coherence tomography (OCT), ultrasound biomicroscopy (UBM), thermography, confocal microscopy, and the Hyperemia-3 program for assessing the structural and functional state of the FB.
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Kosugi M, Kokubun T, Tsuda S, Yamanari M, Nakazawa T. Usefulness of Polarization-sensitive Optical Coherence Tomography-derived Attenuation-coefficient Images to Visualize the Internal Structure of the Filtering Bleb. Curr Eye Res 2020; 46:606-609. [PMID: 33016140 DOI: 10.1080/02713683.2020.1825749] [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: 10/23/2022]
Abstract
PURPOSE/AIM OF THE STUDY Polarization-sensitive anterior-segmental optical coherence tomography (PS-OCT) is useful to evaluate the filtering blebs after trabeculectomy. However, the attenuation phenomenon of OCT signal disturbs the visibility of intra-bleb's structure and distribution of birefringence; a specific parameter of PS-OCT. This study aimed to evaluate the effectiveness of the attenuation-coefficient image of the filtering blebs. MATERIALS AND METHODS This study included 25 eyes 6 months after TLE. The attenuation-coefficient image of blebs was calculated from OCT intensity signal information. The contrast level of the image (reflectivity of bleb's surface wall/reflectivity of scleral flap) in both attenuation-coefficient image and intensity image and the height of the bleb's wall were calculated. The improvement extent of contrast was defined as the ratio of contrast (attenuation-coefficient image's contrast/intensity image's contrast). We compared the contrast of attenuation-coefficient image and intensity image and investigated the relationship between improvement extent of contrast and height of bleb's wall. RESULTS The contrast of the attenuation-coefficient image (317.7 ± 255.4%) was significantly higher than that of the intensity image (39.1 ± 24.5%) (P < .01) and the improvement extent of contrast was 9.5 ± 4.6 times. Furthermore, there was a positive correlation between the improvement extent of contrast and the height of the bleb's wall (r = 0.44, P = .03). CONCLUSIONS The contrast of the image at depth of filtering blebs was improved by attenuation-coefficient image. It is suggested that the attenuation-coefficient image may improve the visibility of the structure and distribution of birefringence in the blebs compared to the intensity image.
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Affiliation(s)
- Mayo Kosugi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taiki Kokubun
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Yamanari
- Department of Technological Development, Tomey Corporation, Nagoya, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Retinal Disease Control, Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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AR12286 Alleviates TGF-β-Related Myofibroblast Transdifferentiation and Reduces Fibrosis after Glaucoma Filtration Surgery. Molecules 2020; 25:molecules25194422. [PMID: 32993110 PMCID: PMC7583051 DOI: 10.3390/molecules25194422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022] Open
Abstract
Scar formation can cause the failure of glaucoma filtration surgery. We investigated the effect of AR12286, a selective Rho-associated kinase inhibitor, on myofibroblast transdifferentiation and intraocular pressure assessment in rabbit glaucoma filtration surgery models. Cell migration and collagen contraction were used to demonstrate the functionality of AR12286-modulated human conjunctival fibroblasts (HConFs). Polymerase chain reaction quantitative analysis was used to determine the effect of AR12286 on the production of collagen Type 1A1 and fibronectin 1. Cell migration and collagen contraction in HConFs were activated by TGF-β1. However, compared with the control group, rabbit models treated with AR12286 exhibited higher reduction in intraocular pressure after filtration surgery, and decreased collagen levels at the wound site in vivo. Therefore, increased α-SMA expression in HConFs induced by TGF-β1 could be inhibited by AR12286, and the production of Type 1A1 collagen and fibronectin 1 in TGF-β1-treated HConFs was inhibited by AR12286. Overall, the stimulation of HConFs by TGF-β1 was alleviated by AR12286, and this effect was mediated by the downregulation of TGF-β receptor-related SMAD signaling pathways. In vivo results indicated that AR12286 thus improves the outcome of filtration surgery as a result of its antifibrotic action in the bleb tissue because AR12286 inhibited the TGF-β receptor-related signaling pathway, suppressing several downstream reactions in myofibroblast transdifferentiation.
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Moon S, Lee J. Clinical Outcomes of Trabeculectomy with Amniotic Membrane Transplantation and Mitomycin C in Primary Open-Angle Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.8.929] [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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12
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Structural imaging of conjunctival filtering blebs in XEN gel implantation and trabeculectomy: a confocal and anterior segment optical coherence tomography study. Graefes Arch Clin Exp Ophthalmol 2020; 258:1763-1770. [PMID: 32415535 DOI: 10.1007/s00417-020-04671-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To describe and compare the conjunctival filtering bleb features after XEN gel implantation and trabeculectomy using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). METHODS Fifty-two patients who underwent completely successful trabeculectomy (24 eyes) or completely successful XEN gel implantation (28 eyes) were consecutively enrolled. At the sixth-month follow-up, filtering blebs were analyzed with AS-OCT and IVCM. The main outcomes were the following: (i) bleb-wall epithelium cyst-like structure density and area (BECSD, BSCSA), (ii) bleb-wall sub-epithelium cyst-like structure density and area (BSCSD, BSCSA,), (iii) bleb-wall thickness (BT), (iv) bleb-wall epithelial thickness (BET), (v) bleb-wall reflectivity (BR), and (vi) bleb height (BH), for AS-OCT. Mean microcyst density (MMD) and area (MMA) and stromal meshwork reflectivity (SMR) were the IVCM outcomes. RESULTS Six-month intraocular pressure was 11.46 ± 3.09 and 10.06 ± 3.39 mmHg in the XEN gel implantation and trabeculectomy, respectively (p > 0.05). At AS-OCT, XEN gel blebs showed lower BH, BT, BET, BR, (p < 0.001), and BECSA values (p < 0.005), and a higher BECSD (p < 0.05) compared with trabeculectomy blebs. At IVCM, MMA and SMR values were lower in the XEN gel implantation, compared with trabeculectomy (p < 0.05). BECSD and BSCSD negatively correlated with BR (p < 0.01; r = - 0.110; p < 0.01; r = - 0.249), whereas BR strongly correlated with SMR (p < 0.001; r = 0.819). CONCLUSION Successful filtering blebs after XEN gel implantation appeared flatter and thinner, with a higher number of epithelial cysts and a hypo-reflective bleb wall compared with trabeculectomy. These aspects may depend on the different intra-operative tissue manipulation and/or on different aqueous humor dynamics in the sub-conjunctiva between surgeries.
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Yamamoto K, Kokubun T, Sato K, Akaishi T, Shimazaki A, Nakamura M, Shiga Y, Tsuda S, Omodaka K, Saya H, Nakazawa T. The DNA topoisomerase II inhibitor amsacrine as a novel candidate adjuvant in a model of glaucoma filtration surgery. Sci Rep 2019; 9:19288. [PMID: 31848363 PMCID: PMC6917768 DOI: 10.1038/s41598-019-55365-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/06/2019] [Indexed: 12/22/2022] Open
Abstract
Treatments for refractory glaucoma include trabeculectomy, in which a filtering bleb is created to reduce aqueous pressure. Mitomycin C (MMC) is often used as an adjuvant to reduce post-trabeculectomy bleb scarring and consequent failure. However, scarring sometimes still occurs. Thus, we searched for more effective trabeculectomy adjuvants with high-throughput screening (HTS) of a library of 1,165 off-patent drug compounds. This revealed that amsacrine (AMSA), a DNA topoisomerase II (TOP2) inhibitor, was the top candidate. Compared to MMC, rabbits that underwent trabeculectomy with 10% AMSA had lower IOP at 42, 56, and 70 days (P < 0.01 at all measurement points) and a higher bleb score at 28, 42, 56, and 70 days (P = < 0.01, 0.04, 0.04, and < 0.01, respectively). Compared to saline, rabbits that received 1% AMSA also had lower IOP and better bleb score at all time points, without a sharp drop in IOP just after surgery (all P < 0.01). Both effects were milder than MMC at 7 days (P = 0.02 and <0.01, respectively). Thus, this study showed that HTS may help identify new, promising uses for off-patent drugs. Furthermore, trabeculectomy with AMSA at a suitable concentration may improve the prognosis after trabeculectomy compared to MMC.
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Affiliation(s)
- Kotaro Yamamoto
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Taiki Kokubun
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Kota Sato
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
- Department of Collaborative Program for Ophthalmic Drug Discovery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takahiro Akaishi
- Research and Development Division, Santen Pharmaceutical Co. Ltd., Ikoma, Nara, 630-0101, Japan
| | - Atsushi Shimazaki
- Research and Development Division, Santen Pharmaceutical Co. Ltd., Ikoma, Nara, 630-0101, Japan
| | - Masatsugu Nakamura
- Research and Development Division, Santen Pharmaceutical Co. Ltd., Ikoma, Nara, 630-0101, Japan
| | - Yukihiro Shiga
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan.
- Department of Collaborative Program for Ophthalmic Drug Discovery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan.
- Department of Retinal Disease Control, Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan.
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan.
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The effectiveness of colchicine combined with mitomycin C to prolong bleb function in trabeculectomy in rabbits. PLoS One 2019; 14:e0213811. [PMID: 30889194 PMCID: PMC6424470 DOI: 10.1371/journal.pone.0213811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/28/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the potential of colchicine to improve bleb function after trabeculectomy. Methods To find the maximum usable colchicine concentration, an ocular irritation study was performed with the Draize test at concentrations of 0.001%, 0.01% and 0.1%. Additionally, the synergistic effect of topical colchicine instillation and MMC application to surgical site was evaluated in a rabbit model by measuring changes after trabeculectomy in intraocular pressure (IOP) and bleb morphology score at 3, 7, 14, 21, 28, 35, 42, and 49 days. Results Experiments with a rabbit model of trabeculectomy showed that 0.04% MMC plus 0.01% colchicine was more effective than saline and 0.04% MMC alone in maintaining IOP reduction at days 7–49 (P < 0.01 at all time points) and day 49 (P < 0.05), respectively, while 0.04% MMC alone was more effective than saline only at days 7–35 (P < 0.05 at all time points). 0.04% MMC plus 0.01% colchicine and 0.04% MMC alone were more effective than saline at preserving bleb score at days 7–21 and 35–49 (P < 0.05 at all time points) and at days 7–35 (P < 0.05 at all time points), respectively. Conclusion Colchicine may be a promising adjuvant for strengthening the effect of MMC and improving the survival of the filtering bleb in trabeculectomy.
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