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Schneider S, Kallab M, Murauer O, Reisinger AS, Strohmaier S, Huang AS, Bolz M, Strohmaier CA. Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation. Acta Ophthalmol 2024; 102:e797-e804. [PMID: 38306110 DOI: 10.1111/aos.16642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Bleb failure is a common complication after glaucoma filtration surgery. Different bleb classification schemes incorporating filtration bleb vascularization have been proposed, but the reported correlation with intraocular pressure (IOP) has been variable, possibly because of subjective vascularization grading. The purpose of the present study was to evaluate bleb vascularization after Preserflo Microshunt (PM) implantation using anterior segment OCT-angiography (AS-OCTA) as a biomarker for bleb failure. METHODS Twenty-three eyes of twenty-three patients underwent PM implantation. Up to 12 months after surgery PM scleral passage-centred AS-OCTA measurements (PLEX Elite 9000) for bleb-vessel density (BVD) determination were performed and IOP as well as necessity for surgical revisions (needling and open revision) were documented. After multi-step image analysis (region of interest definition, artefact removal, binarization, BVD calculation), the predictive value of early postoperative BVD for surgical revisions was assessed using logistic regression modelling. RESULTS Baseline IOP (23.57 ± 7.75 mmHg) decreased significantly to 8.30 ± 2.12, 9.17 ± 2.33 and 11.70 ± 4.40 mmHg after 1, 2 and 4 week(s), and 13.48 ± 5.83, 11.87 ± 4.49, 12.30 ± 6.65, 11.87 ± 3.11 and 13.05 ± 4.12 mmHg after 2, 3, 6, 9 and 12 month(s), respectively (p < 0.001). Nine patients (39%) needed surgical revisions after a median time of 2 months. Bleb vessel densities at 2 and 4 weeks were significantly associated with future surgical revisions upon logistic regression analysis (2 W/4 W likelihood-ratio test p-value: 0.0244/0.0098; 2 W/4 W area under the receiver operating characteristics curve: 0.796/0.909). CONCLUSION Filtration bleb vessel density can be determined using AS-OCTA in the early postoperative period and is predictive for bleb failure after PM implantation.
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Affiliation(s)
- Sophie Schneider
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Martin Kallab
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Olivia Murauer
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Anna-Sophie Reisinger
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Susanne Strohmaier
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Alex S Huang
- Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Matthias Bolz
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Clemens A Strohmaier
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria
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Ge LY, Wu TH, Liu YQ, Jiang C, Yin X. Management of experimental trabeculectomy filtering blebs via crosslinking of the scleral flap inhibited vascularization. Graefes Arch Clin Exp Ophthalmol 2024; 262:1507-1517. [PMID: 37943331 DOI: 10.1007/s00417-023-06306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate whether UVA-light-activated riboflavin-induced collagen crosslinking (UVA-CXL) can maintain the function of filtering blebs after trabeculectomy (TRAB) in rabbits. METHODS Thirty-six healthy rabbits were randomized to one of the following groups with 12 rabbits in each group: Trabeculectomy group (TRAB group), trabeculectomy combined with CXL group (CXL group), and trabeculectomy combined with MMC group (MMC group). Six rabbits of each group were performed with intraocular pressure (IOP), optical coherence tomography (OCT), and OCT angiography (OCTA). Bleb structure was observed via hematoxylin & eosin (H&E) and Masson staining. Immunohistochemistry, proteomic study, western blot, and tensile test were performed between CXL group and the control. In vitro, cell viability was evaluated by CCK-8 and Calcein/PI staining. TRPV4 and VEGF-a expression levels were measured by Q-PCR. Ca2+ concentration was observed with Fluo-4 AM. RESULTS The IOP and bleb median survival day were significantly modified in CXL (5.92 ± 0.32 mmHg and 15.5 days) than TRAB group (7.50 ± 0.43 mmHg and 9 days). The bleb area and height increased. CXL inhibited vascularization, and vascularization peaked at postoperative day (POD) 14 and then decreased gradually. In proteomic analyses, Z disc, actin filament binding, and sarcomere organization were significantly enriched. CXL inhibited scleral stress‒strain in tensile tests. Compared with TRAB group, TRPV4 expression was significantly increased, but VEGF-a and TGF-β1 levels were reduced in the CXL group in western blot. Meanwhile, TRPV4 expression colocalized with CD31. In vitro, CXL inhibited HUVECs cell viability. After CXL, expression level of TRPV4 was increased and calcium influx was activated, but VEGF-a was decreased in HUVECs. CONCLUSIONS This study demonstrates that intraoperative UV-RF CXL can significantly improve the success rate of TRAB via inhibiting filtering bleb vascularization. CXL increased sclera stiffness, in turn, induced TRPV4 activation, thus contributing to vascular endothelial cells suppression.
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Affiliation(s)
- Ling Ying Ge
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Tian Hong Wu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Yue Qi Liu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Chun Jiang
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China
| | - Xue Yin
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 21006, Jiangsu Province, China.
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Wen Y, Jiang D, Tang K, Chen W. Current clinical applications of anterior segment optical coherence tomography angiography: a review. Graefes Arch Clin Exp Ophthalmol 2023; 261:2729-2741. [PMID: 36862203 DOI: 10.1007/s00417-023-05997-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 03/03/2023] Open
Abstract
Optical coherence tomography (OCT) is a revolutionary in vivo imaging technology that presents real-time information on ocular structures. Angiography based on OCT, known as optical coherence tomography angiography (OCTA), is a noninvasive and time-saving technique originally utilized for visualizing retinal vasculature. As devices and built-in systems have evolved, high-resolution images with depth-resolved analysis have assisted ophthalmologists in accurately localizing pathology and monitoring disease progression. With the aforementioned advantages, application of OCTA has extended from the posterior to anterior segment. This nascent adaptation showed good delineation of the vasculature in the cornea, conjunctiva, sclera, and iris. Thus, neovascularization of the avascular cornea and hyperemia or ischemic changes involving the conjunctiva, sclera, and iris has become prospective applications for AS-OCTA. Although traditional dye-based angiography is regarded as the gold standard in demonstrating vasculature in the anterior segment, AS-OCTA is expected to be a comparable but more patient-friendly alternative. In its initial stage, AS-OCTA has exhibited great potential in pathology diagnosis, therapeutic evaluation, presurgical planning, and prognosis assessments in anterior segment disorders. In this review of AS-OCTA, we aim to summarize scanning protocols, relevant parameters, and clinical applications as well as limitations and future directions. We are sanguine about its wide application in the future with the development of technology and refinement in built-in systems.
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Affiliation(s)
- Yajing Wen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Dan Jiang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Kexin Tang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wei Chen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Figus M, Sacchi M, Rossi GC, Babighian S, Del Castillo JMB, de Polo L, Melchionda E, Posarelli C. Ocular surface and glaucoma, a mutual relationship. Practical suggestions for classification and management. Eur J Ophthalmol 2023:11206721231199157. [PMID: 37649335 DOI: 10.1177/11206721231199157] [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: 09/01/2023]
Abstract
The chronic use of glaucoma medications could improve the development of an ocular comorbidity, the glaucoma therapy-related ocular surface disease. This could be related to the exposure of the conjunctiva to preservatives, but also active compounds such as prostaglandin analogues may improve the risk of ocular surface inflammation. Inflammation has a negative impact on tolerability and adherence to eyedrops and to the outcome of filtration surgery as well. A stratification of glaucoma patients based not only on visual field progression but also on glaucoma therapy-related ocular surface disease would be desirable for a strategic management. Early diagnosis, individualized treatment, and safe surgical management should be the hallmarks of glaucoma treatment. One of the main issues for the proper and successful management of patients is the right timing, effectiveness and safety for both medical and surgical treatment options leading to a precision medicine in glaucoma disease as the best modern treatment.
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Affiliation(s)
- Michele Figus
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Matteo Sacchi
- Eye clinic, San Giuseppe Hospital - IRCCS Multimedica, Milan, Italy
| | - Gemma Caterina Rossi
- Department of Surgical Science, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- ASST Bergamo Est, Ambulatorio di Oculistica, Ospedale MO A.Locatelli, Piario, Italy
| | - Silvia Babighian
- Department Ophthalmology, Sant'Antonio Hospital, Azienda Ospedaliera Padova, Padova, Italy
| | - José Manuel Benitez Del Castillo
- Hospital Clinico San Carlos de Madrid Department of Ophthalmology, Madrid, Spain
- Universidad Complutense de Madrid, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Madrid, Spain
| | | | - Eugenio Melchionda
- UOC Chirurgica Oftalmologica e di Urgenza, Presidio Ospedaliero Oftalmico, ASL ROMA1, Roma, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Anterior Segment-Optical Coherence Tomography Bleb Morphology Comparison in Minimally Invasive Glaucoma Surgery: XEN Gel Stent vs. PreserFlo MicroShunt. Diagnostics (Basel) 2022; 12:diagnostics12051250. [PMID: 35626405 PMCID: PMC9141468 DOI: 10.3390/diagnostics12051250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The purpose of this study is to compare the morphology of six-month follow-up blebs created by a subconjunctival glaucoma surgical device (XEN45) to those created by a PreserFlo MicroShunt with a sub-Tenon insertion, utilizing AS-OCT. Methods: A retrospective study of 29 eyes who underwent XEN45 implantation and 29 eyes who underwent PreserFlo MicroShunt implantation. The patients were analyzed at 24 h, 1 week, 1 month, 3 months and 6 months. At each visit, the maturation and morphological alterations of the blebs were observed, as well as connections with the IOP. Results: In both groups, IOP showed significant reduction at all follow ups (p < 0.0001). In XEN group, the most common bleb morphology in the immediate postoperative was the subconjuntival separation type (42%) followed by the uniform type (34%), with a trend inversion at 6 month follow up (51% of uniform type). On the contrary, the most common morphology after PreserFlo was the multiple internal layer (55%), which showed a tendency to reduce over time and was substituted by the microcystic multiform, whose percentage increased over time (17% at day 1 vs. 44% at month 6). Uniform appearance was associated by the posterior episcleral fluid (PEF) lake presence. Both horizontal and vertical diameters significantly increased over time. Conclusion: XEN and PreserFlo implantation resulted in the production of diffuse blebs with different characteristics, which may influence IOP lowering capacity and bleb revisions necessity over time.
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Kan JT, Betzler BK, Lim SY, Ang BCH. Anterior segment imaging in minimally invasive glaucoma surgery - A systematic review. Acta Ophthalmol 2022; 100:e617-e634. [PMID: 34250742 DOI: 10.1111/aos.14962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st-generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle-based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post-implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology.
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Affiliation(s)
- John Tsia‐Chuen Kan
- Department of Ophthalmology Tan Tock Seng Hospital National Healthcare Group Eye Institute Singapore Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Sheng Yang Lim
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology Tan Tock Seng Hospital National Healthcare Group Eye Institute Singapore Singapore
- Department of Ophthalmology Woodlands Health Campus National Healthcare Group Eye Institute Singapore Singapore
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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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Agnifili L, Sacchi M, Figus M, Posarelli C, Lizzio RAU, Nucci P, Mastropasqua L. Preparing the ocular surface for glaucoma filtration surgery: an unmet clinical need. Acta Ophthalmol 2022; 100:740-751. [PMID: 35088941 DOI: 10.1111/aos.15098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022]
Abstract
The mutual relationship among medical therapy, ocular surface (OS) and filtration surgery (FS) represents one of the most crucial issues in glaucoma management. As the long-term use of intraocular pressure-lowering medications significantly affect the OS health, patients with an uncontrolled disease frequently undergo glaucoma surgery in less-than-ideal conditions. As we known, OS changes strongly affect the post-operative bleb filtration capability. Therefore, improving the OS conditions before proceeding with FS is needed. Currently, given the rapid diffusion of new surgical procedures, this need is even more perceived. Nevertheless, despite surgeons retain the OS preparation of primary importance, and recognize the OS disease (OSD) as the only modifiable risk factor for filtration failure, there is no agreement on which strategies should be preferred to prepare patients. This is largely due to the lack of validated guidelines, which forces clinicians to adopt personal approaches based on evidence derived from low-quality studies. In this review, we provided an overview of risk factors involved in the FS failure, with particular attention to those depending on OS changes, and how OSD negatively affects the aqueous humor resorption after surgery. Moreover, we reported the most exploited measures to mitigate the OSD before surgery, the possible reasons underlying the absence of shared approaches, and the upcoming area of intervention to preserve the OS health during glaucoma management. Finally, based on the current evidence, we proposed a pre-operative outline reporting the main risk factors that should be considered before surgery, and the therapeutical options available to improve the OS.
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Affiliation(s)
- Luca Agnifili
- Department of Medicine and Ageing Science, Ophthalmology Clinic University ‘G. D'Annunzio’ of Chieti‐Pescara Pescara Italy
| | - Matteo Sacchi
- San Giuseppe Hospital, University Eye Clinic IRCCS Multimedica Milan Italy
| | - Michele Figus
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency University of Pisa Pisa Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency University of Pisa Pisa Italy
| | | | - Paolo Nucci
- Department of Clinical Science and Community Health University of Milan Milan Italy
| | - Leonardo Mastropasqua
- Department of Medicine and Ageing Science, Ophthalmology Clinic University ‘G. D'Annunzio’ of Chieti‐Pescara Pescara Italy
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Luo M, Li Y, Zhuo Y. Advances and Current Clinical Applications of Anterior Segment Optical Coherence Tomography Angiography. Front Med (Lausanne) 2021; 8:721442. [PMID: 34888319 PMCID: PMC8649770 DOI: 10.3389/fmed.2021.721442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is the most relevant evolution based on optical coherence tomography (OCT). OCTA can present ocular vasculature, show detailed morphology for assessment, and quantify vessel parameters without intravenous dye agent. Research on the anterior segment OCTA (AS-OCTA) is only in its initial phase, and its advances in clinical diagnosis and treatment efficacy evaluations require a detailed comparison to traditional imaging methods. In this review of AS-OCTA, we summarize its technical features, imaging advances, current clinical applications in various eye diseases, as well as its limitations and potential future directions. AS-OCTA offers potential advantages in ophthalmic imaging, and with further development it could become a common tool in the near future.
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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, 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, 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, Guangzhou, China
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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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