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Finger PT. High-Dose-Rate Yttrium-90 ( 90Y) Episcleral Plaque Brachytherapy for Iris and Iridociliary Melanoma. OPHTHALMOLOGY SCIENCE 2024; 4:100513. [PMID: 38840779 PMCID: PMC11152663 DOI: 10.1016/j.xops.2024.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 06/07/2024]
Abstract
Purpose To describe a pilot study on the use of single-session, high-dose-rate, Food and Drug Administration-cleared, yttrium-90 (Y90) plaque brachytherapy for iris and iridociliary melanoma. Design A single-center, clinical case series. Participants Six consecutive patients were included in this study. Each was diagnosed with an iris or iridociliary melanoma based on clinical examination with or without biopsy. Methods Each tumor was staged according to the American Joint Committee on Cancer criteria and received Y90 eye plaque brachytherapy. The main variables were tumor size, patient age, sex, and method of diagnosis (clinical or biopsy). Surgical techniques, treatment durations, and ocular side effects were recorded. Local control was defined as a lack of tumor growth or regression determined by clinical examinations, including slit-lamp and gonio photography, as well as high-frequency ultrasound measurements. Toxicity parameters included acute and short-term corneal/scleral change, anterior segment inflammation, and cataract progression. Main Outcome Measures Local and systemic cancer control, tumor regression, visual acuity, as well as radiation-related normal tissue toxicity. Results High-dose-rate Y90 plaque brachytherapy was used to treat small (American Joint Committee on Cancer cT1) category melanomas. Single-surgery high-dose-rate irradiations were performed under anesthesia. Because of short treatment durations, high-dose-rate Y90 did not require the additional procedures used for low-dose-rate plaque (e.g., sutures, amniotic membrane epicorneal buffering, Gunderson flaps, and second surgeries for plaque removal). Only conjunctival recession was used to avoid normal tissue irradiation. High-dose-rate Y90 treatment durations averaged 8.8 minutes (median, 7.9; range, 5.8-12.9). High-dose-rate Y90 brachytherapy was associated with no periorbital, corneal (Descemet folds), or conjunctival edema. There was no acute or short-term anterior uveitis, secondary cataract, scleropathy, radiation retinopathy, maculopathy, or optic neuropathy. The follow-up was a mean of 16.0 (range 12-24) months. Evidence of local control included a lack of expansion of tumor borders (n = 6, 100%), darkening with or without atrophy of the tumor surface (n = 5/6, 83%), and a mean 24.5% reduction in ultrasonographically measured tumor thickness. There were no cases of metastatic disease. Conclusions High-dose-rate Y90 brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of iris and iridociliary melanomas. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Paul T. Finger
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, New York
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Finger PT. Yttrium-90 Episcleral Plaque Brachytherapy for Choroidal Melanoma. JOURNAL OF VITREORETINAL DISEASES 2024; 8:210-214. [PMID: 38465362 PMCID: PMC10924596 DOI: 10.1177/24741264241227684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To describe the first use of high-dose-rate yttrium-90 disc brachytherapy for choroidal melanoma. Methods: A 72-year-old patient had a cT1-category choroidal melanoma characterized by the presence of orange pigment, increasing subretinal fluid (SRF), and enlarging tumor thickness. It was treated with single-session, light-guided, light-defined yttrium-90-disc brachytherapy. Results: A specialized handheld applicator provided with 4 encircling lights was used to guide plaque placement and localize treatment. Unlike low-dose-rate plaques, high-dose-rate yttrium-90 required only 3 minutes 39 seconds. In this case, treatment did not require episcleral sutures, muscle relocation, outpatient dwell time, or a second surgery. High-dose-rate treatment improved radiation safety by eliminating perioperative exposure to health care personnel, the community, and the family. At the 13-month follow-up, the SRF and tumor thickness were diminished. There was no secondary cataract, radiation retinopathy, maculopathy, or optic neuropathy, and the visual acuity was 20/20. Conclusions: Yttrium-90 brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of a choroidal melanoma.
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Thong KX, Andriesei P, Luo J, Qin M, Ng J, Tagalakis AD, Hysi P, Yu-Wai-Man C. Adrenaline blocks key cell cycle genes and exhibits antifibrotic and vasoconstrictor effects in glaucoma surgery. Exp Eye Res 2023; 233:109561. [PMID: 37429521 DOI: 10.1016/j.exer.2023.109561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
Adrenaline is a sympathomimetic drug used to maintain pupil dilation and to decrease the risk of bleeding. The aim of this study was to demonstrate if adrenaline could exert antifibrotic effects in glaucoma surgery. Adrenaline was tested in fibroblast-populated collagen contraction assays and there was a dose-response decrease in fibroblast contractility: matrices decreased to 47.4% (P = 0.0002) and 86.6% (P = 0.0036) with adrenaline 0.0005% and 0.01%, respectively. There was no significant decrease in cell viability even at high concentrations. Human Tenon's fibroblasts were also treated with adrenaline (0%, 0.0005%, 0.01%) for 24 h and RNA-Sequencing was performed on the Illumina NextSeq 2000. We carried out detailed gene ontology, pathway, disease and drug enrichment analyses. Adrenaline 0.01% upregulated 26 G1/S and 11 S-phase genes, and downregulated 23 G2 and 17 M-phase genes (P < 0.05). Adrenaline demonstrated similar pathway enrichment to mitosis and spindle checkpoint regulation. Adrenaline 0.05% was also injected subconjunctivally during trabeculectomy, PreserFlo Microshunt and Baerveldt 350 tube surgeries, and patients did not experience any adverse effects. Adrenaline is a safe and cheap antifibrotic drug that significantly blocks key cell cycle genes when used at high concentrations. Unless contraindicated, we recommend subconjunctival injections of adrenaline (0.05%) in all glaucoma bleb-forming surgeries.
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Affiliation(s)
- Kai Xin Thong
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Petru Andriesei
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Jinyuan Luo
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Mengqi Qin
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Jia Ng
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | | | - Pirro Hysi
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK
| | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK; Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
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Finger PT, Stewart R, Rivard MJ, Beers RJ, Kamen J, Lama S, Chin KJ, Mohney K, Welles TS, Sauerwein WAG, Rosenzweig K. First clinical implementation of Yttrium-90 Disc Brachytherapy after FDA clearance. Brachytherapy 2023; 22:416-427. [PMID: 36948988 DOI: 10.1016/j.brachy.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/04/2023] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Herein, we study if high-dose-rate (HDR) yttrium-90 (90Y) brachytherapy could be utilized by medical physicists, radiation oncologists, and ophthalmic surgeons. METHODS AND MATERIALS Yttrium-90 (90Y) beta-emitting brachytherapy sources received United States Food and Drug Administration clearance for episcleral treatment of ocular tumors and benign growths. Dose calibration traceable to the National Institute of Standards and Technology as well as treatment planning and target delineation methods were established. Single-use systems included a 90Y-disc affixed within specialized, multifunction, handheld applicator. Low-dose-rate to high-dose-rate prescription conversions and depth-dose determinations were performed. Radiation safety was evaluated based on live exposure rates during assembly and surgeries. Clinical data for radiation safety, treatment tolerability, and local control was collected. RESULTS Practice parameters for the medical physicist, radiation oncologist, and ophthalmic surgeon were defined. Device sterilizations, calibrations, assemblies, surgical methods, and disposals were reproducible and effective. Treated tumors included iris melanoma, iridociliary melanoma, choroidal melanoma, and a locally invasive squamous carcinoma. Mean calculated 90Y disc activity was 14.33 mCi (range 8.8-16.6), prescription dose 27.8 Gy (range 22-30), delivered to depth of 2.3 mm (range 1.6-2.6), at treatment durations of 420 s (7.0 min, range 219 s-773 s). Both insertion and removal were performed during one surgical session. After surgery, each disc-applicator- system was contained for decay in storage. Treatments were well-tolerated. CONCLUSIONS HDR 90Y episcleral brachytherapy devices were created, implementation methods developed, and treatments performed on 6 patients. Treatments were single-surgery, rapid, and well-tolerated with short-term follow up.
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Affiliation(s)
- Paul T Finger
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, NY; The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY; Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH.
| | - Robert Stewart
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mark J Rivard
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Raymond J Beers
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob Kamen
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shyam Lama
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kimberly J Chin
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, NY; Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Kyle Mohney
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Toby S Welles
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | | | - Kenneth Rosenzweig
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
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Murdoch I, Puertas R, Hamedani M, Khaw PT. Long-Term Safety and Outcomes of β-radiation for Trabeculectomy. J Glaucoma 2023; 32:171-177. [PMID: 36375094 DOI: 10.1097/ijg.0000000000002144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022]
Abstract
PRCIS β-radiation is a neglected antiscarring therapy with past concerns for safety. This report found it safe and efficacious when used as an adjuvant to trabeculectomy surgery in 101 people (135 eyes) over 20 years. PURPOSE β-radiation has been used as an adjunct to prevent scarring in trabeculectomy surgery for many decades. Safety concerns were raised with the use of high doses on the bare sclera. Moorfields Eye Hospital has a large cohort of patients who have received β-radiation therapy. We report a review of the long-term safety and efficacy. METHODS Cases undertaken between August 1992 and August 1996 were reviewed. Those with records available for postoperative review of more than 5 years were included. Failure (reintervention/>21 mm Hg on 2 successive occasions) and any complication previously reported in association with β-radiation were the primary outcomes. RESULTS In total, 292 operations using β-radiation were recorded and 101 people (135 eyes) with trabeculectomy surgery and postoperative follow-up for over 4.5 years were included. The median follow-up period was 22.5 years. At the final follow-up, 48 (48%) single eyes per person had failed and 20/51 (51%) eyes with primary open angle glaucoma had cataract surgery. Other complications were rare and associated with copathology. CONCLUSION In glaucoma patients at risk of scarring and failure after trabeculectomy, as an antiscarring adjuvant, a 750 cGY dose of β-radiation was found to be safe and efficacious in the long term.
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Affiliation(s)
- Ian Murdoch
- UCL Institute of Ophthalmology
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust
| | - Renata Puertas
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust
| | | | - Peng Tee Khaw
- UCL Institute of Ophthalmology
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Augmented Subscleral Trabeculectomy With Beta Radiation and Mitomycin C in Egyptian Glaucoma Patients. J Glaucoma 2020; 28:637-642. [PMID: 30925575 DOI: 10.1097/ijg.0000000000001255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Subscleral trabeculectomy is the most common surgical treatment for glaucoma. However, wound healing and scar formation may result in bleb fibrosis, leading to bleb failure. The healing response of the wound is reported to be the single most important risk factor in determining the final intraocular pressure (IOP) after glaucoma filtration surgery. Thus, we aimed to evaluate the effect of preoperative beta irradiation and intraoperative mitomycin C (MMC) treatment as combined adjuncts to subscleral trabeculectomy in the management of glaucoma in Egyptian patients. PATIENTS AND METHODS This prospective, interventional, comparative masked clinical study was performed between October 2016 and January 2018. This study included 50 subjects, 25 of whom underwent trabeculectomy augmented by MMC intraoperatively and beta radiation preoperatively at the bleb area (patient group #1). The remaining 25 subjects underwent trabeculectomy with MMC alone (control group #2). Beta radiation was administered 5 to 7 days before the surgery as a single dose (1000 cGy) using a strontium-90 probe. MMC (0.2 mg/mL) was administered for 2 minutes. RESULTS There was a statistically significant difference in postoperative IOP between the groups from the second week. Intraoperative hyphema occurred in 6 cases in the control group #2, whereas no intraoperative hyphema was observed in patient group #1; this difference was statistically significant. CONCLUSIONS Subscleral trabeculectomy augmented by beta radiation and MMC gives greater control over IOP. Therefore, we recommend using beta radiation before trabeculectomy in patients who may have a high risk of developing conjunctival fibrosis.
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de Oliveira CM, Ferreira JDLM. Overview of cicatricial modulators in glaucoma fistulizing surgery. Int Ophthalmol 2020; 40:2789-2796. [DOI: 10.1007/s10792-020-01454-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
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Hamada N, Azizova TV, Little MP. Glaucomagenesis following ionizing radiation exposure. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2019; 779:36-44. [PMID: 31097150 PMCID: PMC10654893 DOI: 10.1016/j.mrrev.2019.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 12/31/2022]
Abstract
Glaucoma is a group of optic neuropathies causing optic nerve damage and visual field defects, and is one of the leading causes of blindness. Nearly a century has passed since the first report of glaucoma manifested following ionizing radiation therapy of cancers. Nevertheless, associations between glaucoma and radiation exposures, a dose response relationship, and the mechanistic underpinnings remain incompletely understood. Here we review the current knowledge on manifestations and mechanisms of radiogenic glaucoma. There is some evidence that neovascular glaucoma is manifest relatively quickly, within a few years after high-dose and high dose-rate radiotherapeutic exposure, but little evidence of excess risks of glaucoma after exposure to much lower doses or dose rates. As such, glaucoma appears to have some of the characteristics of a tissue reaction effect, with a threshold of at least 5 Gy but possibly much higher.
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Affiliation(s)
- Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo, 201-8511, Japan.
| | - Tamara V Azizova
- Clinical Department, Southern Urals Biophysics Institute, Ozyorskoe Shosse 19, Ozyorsk Chelyabinsk Region, 456780, Russia.
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, MSC 9778, Bethesda, MD, 20892-9778, USA.
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Choi JA, Song LD, Choi S, Park SM, Kwon JW, Jee D. The cost-effectiveness of medication, laser trabeculoplasty, and trabeculectomy for treatment of open-angle glaucoma in South Korea. Medicine (Baltimore) 2019; 98:e14026. [PMID: 30633194 PMCID: PMC6336655 DOI: 10.1097/md.0000000000014026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Open-angle glaucoma (OAG) imposes high disease burden in South Korea. Although various effective interventions are available to manage the progression of OAG, there is limited data on the cost-effectiveness of these treatment strategies in South Korea. METHODS Using a Markov cohort model, we evaluated the cost-effectiveness of 3 major treatment strategies (medication, laser trabeculoplasty, and trabeculectomy) for South Korean patients with OAG. We projected a 25-year time horizon to study a hypothetical cohort of 10,000 patients of age 40 with mild OAG. The outcome measures were quality-adjusted life-years (QALYs) gained, cost from the societal perspective, and the incremental cost-effectiveness ratio (ICER) of medication, laser trabeculoplasty, and trabeculectomy. Interventions were evaluated at a willingness-to-pay (WTP) threshold of 30,000,000 KRW ($29,152) per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to address the model uncertainty. RESULTS The mean costs for medication, laser trabeculoplasty, and trabeculectomy were 29,661,740 KRW, 17,34,1342 KRW, and 22,275,438 KRW, respectively. The mean QALYs gained were 15.7, 15.3, and 14.8 for medication, laser trabeculoplasty, and trabeculectomy, respectively. Surgery was strongly dominated because it generated fewer expected QALYs but incurred greater expected cost than laser. The ICER was 30,885,179 KRW per QALY for medication versus laser trabeculoplasty. Laser was cost-effective, however, at a lower WTP threshold of 21,000,000 KRW per QALY gained or below. The results were most sensitive to the progression rates from mild to moderate glaucoma under laser treatment. CONCLUSION Under the WTP threshold of 30,000,000 KRW per QALY, medication was cost-effective compared with laser trabeculoplasty and trabeculectomy for treating mild OAG in South Korean population. Laser, however, can be a cost-effective alternative in more resource-limited settings.
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Affiliation(s)
- Jin A. Choi
- Department of Ophthalmology and Visual Science, St Vincent's Hospital College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Lina D. Song
- PhD Program in Health Policy, Harvard University, Cambridge, MA
| | - Seulggie Choi
- Seoul National University Graduate School, Department of Biomedical Sciences
| | - Sang Min Park
- Seoul National University Graduate School, Department of Biomedical Sciences
- Seoul National University Hospital, Department of Family Medicine, Seoul, South Korea
| | - Jin Woo Kwon
- Department of Ophthalmology and Visual Science, St Vincent's Hospital College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, St Vincent's Hospital College of Medicine, Catholic University of Korea, Seoul, South Korea
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Smith AF, Negretti G, Mascaro A, Bokre D, Baker H, Dhalla K, Murdoch IE. Glaucoma Control Strategies in Sub-Saharan Africa: A Review of the Clinical and Health Economic Evidence. Ophthalmic Epidemiol 2018; 25:419-435. [DOI: 10.1080/09286586.2018.1501499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Andrew F. Smith
- Department of Ophthalmology, King’s College London, London, UK
- MedMetrics Inc., Ottawa, Canada
| | - Guy Negretti
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital, London, UK
| | - Aaron Mascaro
- MedMetrics Inc., Ottawa, Canada
- McGill University, Montreal, Canada
| | - Desta Bokre
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Helen Baker
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Kazim Dhalla
- Dr. Agarwal’s Eye Hospital with Abu Baseer Specialist Eye Clinic, Dar Es Salaam, Tanzania
| | - Ian E. Murdoch
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital, London, UK
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Abdull MM, Broadway DC, Evans J, Kyari F, Muazu F, Gilbert C. Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria. Clin Exp Ophthalmol 2018; 46:1041-1047. [PMID: 29808573 PMCID: PMC6585748 DOI: 10.1111/ceo.13328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/10/2018] [Accepted: 05/20/2018] [Indexed: 12/01/2022]
Abstract
Importance To investigate the safety, effectiveness and follow‐up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria. Background There is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance of surgery are poor. Design Prospective case series. Participants New glaucoma patients where surgical intervention was recommended. Methods A diode 810 nm laser G‐probe was used under retrobulbar anaesthesia to deliver approximately 20 shots for 2000 ms, titrating the power. If both eyes were treated the first was the study eye. Repeat treatment offered if the intraocular pressure (IOP) was >21 mmHg on two consecutive visits. Main Outcome Measures IOP < 22 mmHg, change in ≥2 lines of Snellen visual acuity (VA), and complications. Results 201 out of 204 eyes with complete data analysed. Mean age 52 years, 17 (8.3%) eyes were re‐treated. Mean pre‐treatment IOP was 39 (SD 11) mmHg. 106 (53%) attended at 12 months when the mean IOP was 19 (7–45) mmHg; 77 (73%) had IOP < 22 mmHg. VAs were better in 13 (12.3%) and worse in 23 (21.7%) eyes. Postoperative complications included mild uveitis (5.5%), corneal oedema (2.5%), severe uveitis (0.5%) and transient hypotony (2.0%). No hypotony at 12 months. Conclusions and Relevance Transscleral diode laser cyclophotocoagulation controlled IOP in almost three quarters of eyes at 12 months with short‐term preservation of vision and minimal complications. Poor follow‐up in this setting highlights the need for an effective, safe and acceptable treatment where regular follow‐up is less critical.
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Affiliation(s)
- Mohammed M Abdull
- Ophthalmology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David C Broadway
- Directorate of Ophthalmology, Norwich and Norfolk University Hospital NHS Foundation Trust, Norwich, UK
| | - Jennifer Evans
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Fatima Kyari
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Baze University, Abuja, Nigeria
| | - Fatima Muazu
- Ophthalmology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Fonseca EC, Rocha EM, Arruda GV. Comparison among adjuvant treatments for primary pterygium: a network meta-analysis. Br J Ophthalmol 2017; 102:748-756. [PMID: 29146761 DOI: 10.1136/bjophthalmol-2017-310288] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/23/2017] [Accepted: 08/13/2017] [Indexed: 11/03/2022]
Abstract
PURPOSE Pterygium is a frequent ocular disease, where the major challenge is the high level of recurrence after its surgical removal. We performed a network meta-analysis to identify, among several adjuvant treatments for primary pterygium, which is the best to prevent recurrence. METHODS A search was conducted using PubMed, Scientific Electronic Library Online, Latin American and Caribbean Centre on Health Sciences and Cochrane Eyes and Vision Group Trials Register between 1993 and 2015 for randomisedclinical trials (RCTs) comparing adjuvant treatments following primary pterygium surgery. RESULTS 24 RCTs that studied 1815 eyes of 1668 patients were included and allowed direct and indirect comparison among 14 interventions through network meta-analysis. The rank from the best to worse treatment to prevent recurrence is: conjunctival autograft + ciclosporin 0.05% eye drops, bare sclera + intraoperativemitomycin C (MMC) <0.02%, bare sclera + beta therapy (2500 cGy single dose), conjunctival autograft + beta therapy (1000 cGy single dose), bare sclera + MMC 0.02% eye drops, conjunctival autograft, bare sclera + intraoperative MMC >0.02%, bare sclera + ciclosporin 0.05% eye drops, bare sclera + intraoperative 5-fluorouracil 5%, amniotic membrane transplantation, bare sclera + intraoperative MMC 0.02%, conjunctival autograft + bevacizumab 0.05% eye drops, bare sclera + bevacizumab 0.05% eye drops and bare sclera alone. CONCLUSION The best adjuvant treatment to prevent recurrence after primary pterygium surgery is the association of conjunctival autograft and ciclosporin 0.05% eye drops. Bare sclera technique alone should be discontinued since it is associated with high recurrence rates.
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Affiliation(s)
- Ellen Carrara Fonseca
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Eduardo Melani Rocha
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Viani Arruda
- Department of Radiotherapy, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Olawoye OO, Ashaye AO. LONG TERM OUTCOMES OF AUGMENTED TRABECULECTOMY WITH 5-FLUOROURACIL IN NIGERIA. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2017; 7:92-112. [PMID: 29951457 PMCID: PMC6018030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Glaucoma in sub-Saharan Africa has been described as a surgical disease because of the high cost of medical treatment, poor compliance and unavailability of medications. AIM This study reports the long-term outcomes and complication rates following trabeculectomy with 5-fluorouracil in a case series of Nigerians. DESIGN OF STUDY This was a retrospective, observational, non-comparative case series. SETTING University College Hospital, Ibadan, Nigeria. METHODOLOGY Each patient had complete ophthalmic evaluation. The post-operative intraocular pressure (IOP), visual acuity outcomes and post operative complications were assessed. The World Glaucoma Association consensus on surgical outcome was used to evaluate surgical outcome. RESULTS Of the 292 patients who presented with glaucoma during this period, a total of 47 eyes of 31 patients (10.6%) had trabeculectomy with 5-FU. The mean presenting intraocular pressure (IOP) was 31.8±12.2mmHg. At three years post-operatively, 48.5% achieved complete success without medications while 90.9% achieved success with or without medications at an IOP cut off of ≤21mmHg. At the same time point of 3 years and an IOP cut off of ≤15mmHg, 63.6% achieved success with or without medications. At a mean post-operative period of 43± 19.6 months, (range 12-86 months), mean IOP had reduced from a preoperative mean of 31.8±12.2mmHg to 15.4±4.7mmHg (P<0.001). CONCLUSION Trabeculectomy with 5-Fluorouracil is effective in the long term in reducing IOP with minimal complications in this population of Nigerians.
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Affiliation(s)
- O O Olawoye
- Department of Ophthalmology, College of Medicine University of Ibadan, Ibadan, Nigeria
| | - A O Ashaye
- Department of Ophthalmology, College of Medicine University of Ibadan, Ibadan, Nigeria
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Dhalla K, Cousens S, Bowman R, Wood M, Murdoch I. Is Beta Radiation Better than 5 Flurouracil as an Adjunct for Trabeculectomy Surgery When Combined with Cataract Surgery? A Randomised Controlled Trial. PLoS One 2016; 11:e0161674. [PMID: 27606611 PMCID: PMC5015865 DOI: 10.1371/journal.pone.0161674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/30/2016] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION In an African setting surgery is generally accepted as the treatment of first choice for glaucoma. A problem with trabeculectomy surgery for the glaucomas is the frequent co-existence and exacerbation of cataract. We report a randomized controlled trial to compare the use of beta radiation with 5FU in combined cataract and glaucoma surgery. PARTICIPANTS AND METHODS Consenting adults aged >40 years with glaucoma, an IOP>21mmHG and cataract were enrolled and randomised to receive either 1000cG β radiation application or sub-conjunctival 5fluorouracil (5FU) at the time of combined trabeculectomy and phaco-emulsification with lens implant surgery. RESULTS 385 individuals were eligible for inclusion of whom 301 consented to inclusion in the study (one eye per patient). 150 were randomised to the 5FU arm and 151 received β radiation. In the 12 months following surgery there were 40 failures (IOP>21mmHg) in the 5FU arm and 34 failures in the beta arm. The hazard ratio for the beta radiation arm compared to the 5FU arm, adjusted for IOP at baseline, was 0.83 (95% c.i. 0.54 to 1.28; P = 0.40). The improvement from mean presenting visual acuities of 0.91 and 0.86 logMAR to 0.62 and 0.54 in the 5FU and beta arms respectively was comparable between groups (P = 0.4 adjusting for baseline VA). Incidence of complications did not differ between the two groups. DISCUSSION This study highlights several important issues in the quest for a therapeutic strategy for the glaucomas in an African context. Firstly, there is no evidence of an important difference between the use of 5FU and beta radiation as an anti-metabolite in phacotrabeculectomy. Secondly phacotrabeculectomy is a successful operation that improves visual acuity as well as controlling IOP in a majority of patients. Although the success of trabeculectomy in lowering IOP is reduced when combined with phacoemulsification compared with trabeculectomy alone, this finding has to be set against the possible need for subsequent cataract surgery following trabeculectomy alone, which represents a second trip and expense for the patient and results in 10-61% failure of the trabeculectomy at one year post-cataract surgery. TRIAL REGISTRATION ISRCTN Registry ISRCTN36436933.
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Affiliation(s)
- Kazim Dhalla
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation Hospital in Tanzania (CCBRT), Dar Es Salaam, Tanzania
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Mark Wood
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation Hospital in Tanzania (CCBRT), Dar Es Salaam, Tanzania
| | - Ian Murdoch
- Institute of Ophthalmology, University College of London, London, United Kingdom
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Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study. Eye (Lond) 2016; 30:1126-34. [PMID: 27256305 DOI: 10.1038/eye.2016.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/20/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeWe aimed to assess the IOP-lowering effect of trabeculectomy with ologen in refractory secondary glaucoma following failed trabeculectomy with mitomycin C (MMC), and to compare its surgical outcome between open angle (SOAG) and angle closure (SACG) cases.MethodsThis is a prospective interventional comparative study conducted on 40 eyes (40 patients) with medically uncontrolled secondary glaucoma. Patients were divided into group A: 18 eyes (18 patients) with SOAG, and group B: 22 eyes (22 patients) with SACG. All patients underwent trabeculectomy with insertion of ologen implant. Intraocular pressure (IOP) measurement, SITA standard perimetry (Central 24-2), spectral domain optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness, and anterior segment OCT for bleb morphology, were all done pre- and postoperatively. Primary outcome measures were comparing preoperative to postoperative measurements and also comparing these measurements between SOAG and SACG. All patients were examined up to 1 year.ResultsWhen preoperative IOP was compared with postoperative IOP, in each group, there was a statistically significant difference (P<0.001). IOP percentage difference was statistically insignificantly different between both groups except at 1 month. According to Moorfields bleb grading system; postoperative bleb was better than the bleb of the previously failed trabeculectomy (P<0.001), and there was a significant difference between group A and B regarding bleb area. Total success rate was 100%; in group A, complete success was 100%, while in group B it was 72.7% (P=0.016).ConclusionOur results suggest that Ologen may be a useful alternative to MMC in repeat trabeculectomy.
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Abdull MM, Chandler C, Gilbert C. Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria. BMC Ophthalmol 2016; 16:44. [PMID: 27102524 PMCID: PMC4839108 DOI: 10.1186/s12886-016-0220-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/13/2016] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment. METHOD Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management. RESULTS Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up. CONCLUSION Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial.
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Affiliation(s)
- Mohammed Mahdi Abdull
- />Ophthalmology Department, Abubakar Tafawa Balewa University Teaching Hospital, PMB 0117, Bauchi, Bauchi State Nigeria
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Chandler
- />Department of Global Health and Development London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Gilbert
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Masoumpour MB, Nowroozzadeh MH, Razeghinejad MR. Current and Future Techniques in Wound Healing Modulation after Glaucoma Filtering Surgeries. Open Ophthalmol J 2016; 10:68-85. [PMID: 27014389 PMCID: PMC4780518 DOI: 10.2174/1874364101610010068] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 12/21/2022] Open
Abstract
Filtering surgeries are frequently used for controlling intraocular pressure in glaucoma patients. The long-term success of operation is intimately influenced by the process of wound healing at the site of surgery. Indeed, if has not been anticipated and managed accordingly, filtering surgery in high-risk patients could end up in bleb failure. Several strategies have been developed so far to overcome excessive scarring after filtering surgery. The principal step involves meticulous tissue handling and modification of surgical technique, which can minimize the severity of wound healing response at the first place. However, this is usually insufficient, especially in those with high-risk criteria. Thus, several adjuvants have been tried to stifle the exuberant scarring after filtration surgery. Conventionally, corticosteroids and anti-fibrotic agents (including 5-fluorouracil and Mitomycin-C) have been used for over three decades with semi-acceptable outcomes. Blebs and bleb associated complications are catastrophic side effects of anti-fibrotic agents, which occasionally are encountered in a subset of patients. Therefore, research continues to find a safer, yet effective adjuvant for filtering surgery. Recent efforts have primarily focused on selective inhibition of growth factors that promote scarring during wound healing process. Currently, only anti-VEGF agents have gained widespread acceptance to be translated into routine clinical practice. Robust evidence for other agents is still lacking and future confirmative studies are warranted. In this review, we explain the importance of wound healing process during filtering surgery, and describe the conventional as well as potential future adjuvants for filtration surgeries.
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Affiliation(s)
| | | | - M Reza Razeghinejad
- Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, USA
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Ting NS, Li Yim JF, Ng JY. Different strategies and cost-effectiveness in the treatment of primary open angle glaucoma. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:523-30. [PMID: 25506233 PMCID: PMC4259865 DOI: 10.2147/ceor.s30697] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Glaucoma is the second highest cause of blindness worldwide with an estimated half of the glaucoma population unaware of their disease. To date, intraocular pressure is the most important modifiable risk factor and lowering it has been proven to reduce progression of visual field loss associated with glaucoma. Different strategies are available to lower intraocular pressure and include medical, laser, or surgical treatment in the form of topical or systemic medications, argon or selective laser trabeculoplasty, and glaucoma drainage surgery such as trabeculectomy, deep sclerectomy, or other drainage devices. The effectiveness of these treatments has been well documented however their cost-effectiveness between the developed world and third world remains unclear.
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Affiliation(s)
| | - James Ft Li Yim
- Department of Ophthalmology, University Hospital Ayr, South Ayrshire, UK
| | - Jia Y Ng
- Department of Ophthalmology, University Hospital Ayr, South Ayrshire, UK ; Faculty of Medicine, University of Glasgow, Glasgow, UK
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Ji QS, Qi B, Liu L, Lao W, Yang ZH, Wang GF, Yu GC, Zhong JX. Comparison of trabeculectomy and trabeculectomy with amniotic membrane transplantation in the same patient with bilateral glaucoma. Int J Ophthalmol 2013; 6:448-51. [PMID: 23991376 DOI: 10.3980/j.issn.2222-3959.2013.04.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/24/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To observe effects of trabeculectomy with amniotic membrane transplantation (AMT) in controlling postoperative intraocular pressure (IOP) in patients with medically uncontrolled glaucoma. METHODS This study included adult patients with requiring bilateral glaucoma surgery. Each patient underwent trabeculectomy (Non-AMT group) in one eye and with AMT (AMT group) in the other eye according to randomized principle. Success was defined as intraocular pressure (IOP)<21mmHg without any anti-glaucoma medications at 24 months follow-up. The two groups were compared in terms of IOP, complications and success rate. RESULTS Thirty-four eyes of 17 patients were investigated in this study. There was no statistically signifcant difference in pre-operative IOP between the two groups. The mean IOP was lower in AMT group compared with Non-AMT group on follow up months 12, 18, and 24.Postoperative complications were more frequent in Non-AMT group (35.3%, 6/17) compared with AMT group (5.9%, 1/17). The success rate of surgery was 88.2% (15/17) in Non-AMT group and 100% (17/17) in AMT group. CONCLUSION Trabeculectomy with AMT is an effective procedure to reduce IOP and complications, thereby improving surgical success rates.
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Affiliation(s)
- Qing-Shan Ji
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
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Seibold LK, Sherwood MB, Kahook MY. Wound modulation after filtration surgery. Surv Ophthalmol 2013; 57:530-50. [PMID: 23068975 DOI: 10.1016/j.survophthal.2012.01.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 01/02/2012] [Accepted: 01/19/2012] [Indexed: 01/26/2023]
Abstract
Filtration surgery is the standard invasive procedure for the management of intraocular pressure in advanced glaucoma. The key to a successful outcome is to modulate the normal wound healing cascade that leads to closure of the newly created aqueous outflow pathway. Antifibrotic agents such as mitomycin C and 5-fluorouracil have been increasingly used to modulate the wound healing process and increase surgical success. Although these agents have proven efficacy, they also increase the risk of complications. Efforts have centered on the identification of novel agents and techniques that can influence wound modulation without these complications. We detail new agents and methods under investigation to control wound healing after filtration surgery.
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Affiliation(s)
- Leonard K Seibold
- Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado at Denver, Aurora, Colorado, USA
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Abstract
BACKGROUND The outcome of glaucoma surgery can be affected by the rate at which the surgical wound heals. Beta radiation has been proposed as a rapid and simple treatment to slow down the healing response. OBJECTIVES To assess the effectiveness of beta radiation during glaucoma surgery (trabeculectomy). SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 3), MEDLINE (January 1950 to March 2012), EMBASE (January 1980 to March 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 26 March 2012. SELECTION CRITERIA We included randomised controlled trials comparing trabeculectomy with beta radiation to trabeculectomy without beta radiation. DATA COLLECTION AND ANALYSIS We collected data on surgical failure (intraocular pressure > 21 mmHg), intraocular pressure and adverse effects of glaucoma surgery. We pooled data using a fixed-effect model. MAIN RESULTS We found four trials that randomised 551 people to trabeculectomy with beta irradiation versus trabeculectomy alone. Two trials were in Caucasian people (126 people), one trial in black African people (320 people) and one trial in Chinese people (105 people). People who had trabeculectomy with beta irradiation had a lower risk of surgical failure compared to people who had trabeculectomy alone (pooled risk ratio (RR) 0.23 (95% CI 0.14 to 0.40). Beta irradiation was associated with an increased risk of cataract (RR 2.89, 95% CI 1.39 to 6.0). AUTHORS' CONCLUSIONS Trabeculectomy with beta irradiation has a lower risk of surgical failure compared to trabeculectomy alone. A trial of beta irradiation versus anti-metabolite is warranted.
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Affiliation(s)
- James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK.
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The Changing Conceptual Basis of Trabeculectomy: A Review of Past and Current Surgical Techniques. Surv Ophthalmol 2012; 57:1-25. [DOI: 10.1016/j.survophthal.2011.07.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 07/13/2011] [Accepted: 07/19/2011] [Indexed: 11/24/2022]
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Abstract
Purpose To evaluate to what extent contemporary glaucoma abstracts offer complete information and to suggest a new manner of pressure results reporting. Materials, methods, and results Most of the 36 relevant surgical glaucoma abstracts found in one issue of International Glaucoma Review contain insufficient data-supported statements. Such abstracts cannot offer a clear picture of the study essence if economic, linguistic, or political barriers prevent access to the full text. In order to enrich abstract content and to avoid typographic space waste, a formula is suggested to provide, in one single line of symbols and figures, all the necessary data for statistical interpretation at two evolution moments: the first significative control (6 months) and the final one. Conclusion The current manner of results reporting in surgical glaucoma abstracts is subject to too little standardization, allowing insufficiently data-supported statements. Abstracts, especially those printed in small-circulation language journals, should be conceived and standardized in such a manner that any abstract review reader is capable of grasping the essence of the study at first glance. The suggested manner of reporting results would bring satisfaction to all areas of the process. Publishers would save typographic space, readers would find all the necessary data for statistical analysis and comparison with other studies, and authors would be convinced that the essence of their work would penetrate in spite of any economic, linguistic, or political barriers.
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Omoti AE, Enock ME, Iyasele ET. Surgical management of primary open-angle glaucoma in Africans. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.09.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes. Eye (Lond) 2009; 24:573-7. [DOI: 10.1038/eye.2009.132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Abstract
BACKGROUND The outcome of glaucoma surgery can be affected by the rate at which the surgical wound heals. Beta radiation has been proposed as a rapid and simple treatment to slow down the healing response. OBJECTIVES To assess the effectiveness of beta radiation during glaucoma surgery (trabeculectomy). SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (which includes the Cochrane Eyes and Vision Group Trials Register) (Issue 4 2008), MEDLINE (January 1966 to October 2008) and EMBASE (January 1980 to October 2008). The databases were last searched on 24 October 2008. SELECTION CRITERIA We included randomised controlled trials comparing trabeculectomy with beta radiation to trabeculectomy without beta radiation. DATA COLLECTION AND ANALYSIS We collected data on surgical failure (intraocular pressure > 21 mmHg), intraocular pressure and adverse effects of glaucoma surgery. We pooled data using a fixed-effect model. MAIN RESULTS We found four trials that randomised 551 people to trabeculectomy with beta irradiation versus trabeculectomy alone. Two trials were in Caucasian people (126 people), one trial in black African people (320 people) and one trial in Chinese people (105 people). People who had trabeculectomy with beta irradiation had a lower risk of surgical failure compared to people who had trabeculectomy alone (pooled risk ratio (RR) 0.23 (95% CI 0.14 to 0.40). Beta irradiation was associated with an increased risk of cataract (RR 2.89, 95% CI 1.39 to 6.0). AUTHORS' CONCLUSIONS Trabeculectomy with beta irradiation has a lower risk of surgical failure compared to trabeculectomy alone. A trial of beta irradiation versus anti-metabolite is warranted.
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Affiliation(s)
- James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK, PO6 3LY.
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Park YK, Ye SJ, Kim IH, Wee WR, Kim MK, Han HS, Son KJ, Park UJ. Potential use of P-32 ophthalmic applicator: Monte Carlo simulations for design and dosimetry. Med Phys 2008; 35:1854-8. [DOI: 10.1118/1.2896076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Georgoulas S, Dahlmann-Noor A, Brocchini S, Khaw PT. Modulation of wound healing during and after glaucoma surgery. PROGRESS IN BRAIN RESEARCH 2008; 173:237-54. [PMID: 18929113 DOI: 10.1016/s0079-6123(08)01117-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Following all types of glaucoma filtration surgery (GFS), scarring still poses the major threat to long-term success. The healing and scarring determine the percentage of patients achieving low final intraocular pressures (IOPs) that are associated with virtually no glaucoma progression. The use of antifibrotic agents to inhibit scarring of trabeculectomy blebs is now a well-established clinical practice. Unfortunately, severe complications such as leakage, infection, hypotony, and endophthalmitis with complete loss of vision may occur. In addition, surgery still fails in some individuals despite maximal doses of current antifibrotics. Better therapeutic agents are needed. Many promising new agents are being evaluated clinically and in vitro. In this chapter, we will discuss our current understanding of the wound healing process after glaucoma surgery and promising new treatment modalities.
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Affiliation(s)
- Stelios Georgoulas
- Ocular Repair and Regeneration Biology Research Unit, National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 9EL, UK
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Mendrinos E, Shaarawy T. Glaucoma surgery: toward a new global vision. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.2.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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