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Gambini G, Carlà MM, Giannuzzi F, Savastano A, Caporossi T, Baldascino A, Iannetta D, Vielmo L, Rizzo S. Evaluation of ocular surface following PreserFlo Microshunt implantation: Functional outcomes and quality of life. Clin Exp Ophthalmol 2024; 52:42-53. [PMID: 37983671 DOI: 10.1111/ceo.14320] [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: 06/11/2023] [Revised: 09/29/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This study aimed to evaluate the impact of PreserFlo Microshunt on the ocular surface, focusing on both objective and subjective parameters. METHODS Prospective-observational study on 48 eyes undergoing PreserFlo Microshunt implantation, standalone or combined with phacoemulsification. At baseline, 1-month, 6-months and 12-months post-operative follow-ups, we performed Ocular Surface Disease Index (OSDI) questionnaire, Schirmer's test (ST), Tear-film break-up time (TBUT), fluoresceine staining (FS), tear osmolarity and minimum corneal epithelial thickness (Epi-ThkMIN. ) measurements. RESULTS OSDI score improved from 37.43 ± 17.49 at baseline, to 24.13 ± 12.55 at 1-month (p = 0.003) and to 12.89 ± 8.54 and 13.09 ± 10.22 at 6-months and 12-months (p < 0.0001). TBUT and ST, in a similar way, non-significantly increased at 1-month, but then improved at 6-months and 12-months (p < 0.05 for both). Tear osmolarity significantly decreased from 308.2 ± 7.3 mOsm/L at baseline, to 303.3 ± 8.2 mOsm/L, 295.6.2 ± 7.0 mOsm/L and 297.6 ± 6.8 mOsm/L at 1-month, 6-months and 12-months (p < 0.05 for all). Epi-ThkMIN was stable when comparing baseline (44.9 ± 5.7 μm) and 1-month (p = 0.28), and successively increased in 6-months (47.8 ± 5.5 μm, p = 0.02) and 12-months (48.0 ± 3.6 μm, p = 0.01). In subgroup analysis, OSDI score and tear osmolarity were significantly higher at 1-month in combined group compared to standalone group (p = 0.03 and p = 0.02, respectively), but reaching comparable values in successive follow-ups. Further, Oxford scale grades for FS were significantly improved when comparing baseline-6-months and baseline-12-months. CONCLUSION PreserFlo implantation improved ocular surface subjective symptoms, increased TBUT and ST, and reduced FS, highlighting the potential benefits of this surgical intervention. Moreover, we reported significant improvements of tear osmolarity and corneal epithelium.
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Affiliation(s)
- Gloria Gambini
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Alfonso Savastano
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Danilo Iannetta
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Vielmo
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
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Sen E, Elgin U, Ozen O, Ozturk FG. The Efficacy and Safety of Trehalose in Primary Trabeculectomy with Mitomycin C: A Report of Early Findings. Clin Ophthalmol 2021; 15:2301-2306. [PMID: 34103893 PMCID: PMC8180299 DOI: 10.2147/opth.s311524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Objective To compare bleb morphology and tear tests of glaucoma patients who used trehalose and those who did not use after primary trabeculectomy with mitomycin C (MMC) during the early post-operative period. Methods This retrospective study included two groups: Group 1 using Trehalose + hyaluronic acid (THA) after primary trabeculectomy with MMC (n = 19) and Group 2 undergoing primary trabeculectomy with MMC (n = 16). The preoperative and postoperative intraocular pressure (IOP), the results of Schirmer, and tear break-up time tests were analyzed. Postoperative bleb morphology was also evaluated at the 1st day, and 1st and 2nd weeks, and 1st and 2nd months. Results There was no statistically significant difference in preoperative IOP, Schirmer test or tear break-up time between groups. The mean horizontal extent of the blebs was significantly wider in Group 1 at the first week (p= 0.02). Bleb vascularization was also found to be lower in Group 1 at the second week (p= 0.001). The mean bleb height and horizontal extent were significantly higher in Group 1 at the first month (p=0.02, p= 0.03, respectively). The mean bleb horizontal extent was significantly higher in Group 1 at the second month (p= 0.03). Conclusion The use of trehalose improved surgical success of primary trabeculectomy with MMC in terms of IOP control, post-operative complications, and bleb morphology during the early postoperative period. Trehalose might contribute to wound healing which led to an ideal bleb.
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Affiliation(s)
- Emine Sen
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Glaucoma Department, Ankara, Turkey
| | - Ufuk Elgin
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Glaucoma Department, Ankara, Turkey
| | - Osman Ozen
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Gomes JÁP, Milhomens Filho JAP. Iatrogenic corneal diseases or conditions. Exp Eye Res 2020; 203:108376. [PMID: 33279524 DOI: 10.1016/j.exer.2020.108376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
Any prescribed or self-administered therapy carries inherent risks of secondary adverse events. While the volume of treatments being administered through healthcare systems has been increasing, scientific advancements in our understanding of the mechanisms of pharmaceutical side effects and complications from procedures now allow us to reduce the risk of non-intentional damage to ocular health. This review summarizes the most common and leading causes of iatrogenic visual impairment, corneal diseases, and conditions that present in a general ophthalmologic practice, including a comprehensive analysis of their pathophysiology and recommendations for management and prophylaxis.Iatrogenic corneal diseases and conditions can arise from topical drugs, contact lens use, eye surgeries and procedures, systemic drugs, non-ophthalmological events, and cosmetic procedures. Topical and systemic drugs may disturb tear film homeostasis or result in ocular surface deposits. The use of ill-fitted contact lenses can trigger eye discomfort and poor hygiene conditions that can predispose to severe infections. Procedures to the eye may result in a variety of anatomical and functional complications that ophthalmologists should be aware of how to avoid or at least be prepared to manage if they occur. Even non-ophthalmological events such as non-invasive ventilation, radiation therapies and, immune-based conditions, or cosmetic procedures such as eyelash growth and fillers, can result in unwanted damage to the ocular surface.
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Affiliation(s)
- José Álvaro Pereira Gomes
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - José Arthur Pinto Milhomens Filho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Swogger J, Conner IP, Rosano M, Kemmerer M, Happ-Smith C, Wells A, Schuman JS, Yates CC. Injected Versus Sponge-Applied Mitomycin C (MMC) During Modified Trabeculectomy in New Zealand White Rabbit Model. Transl Vis Sci Technol 2020; 9:23. [PMID: 33150049 PMCID: PMC7585388 DOI: 10.1167/tvst.9.11.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 08/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Mitomycin C is routinely applied during trabeculectomy surgeries to enhance bleb survival after glaucoma filtration surgery. The current approach involves placing cellulose sponges soaked in mitomycin C at a standard concentration onto bare sclera for a predetermined duration, which varies among surgeons. The purpose of this study was to compare the effects of sponge-applied versus intra-Tenon injection of mitomycin C during modified trabeculectomy. Methods Two groups of five New Zealand White rabbits underwent glaucoma filtration surgery with either preoperative intra-Tenon injection of mitomycin C or intraoperative application of mitomycin C using a cellulose sponge. Postoperative intraocular pressure was recorded weekly, and eyes were enucleated and sent for pathological examination and histological analysis. Results An intra-Tenon injection of mitomycin C resulted in decreased intraocular pressure measurements and bleb vascularity compared to the controls but increased levels compared to the sponge-applied group. Collagen deposition and cellularity were reduced and the goblet cell population was increased in the intra-Tenon injection group. Conclusions This study shows that an intra-Tenon injection can be an effective method for administering mitomycin C compared to the standard-of-care approach of mitomycin C being sponge applied onto bare sclera. Mitomycin C injection led to a greater reduction in intraocular pressure and inhibition of fibroblasts. The associated goblet cell population that can lead to increased mitomycin C toxicity-related morbidity was minimized with the intra-Tenon injection compared to the sponge-applied MMC treatment. Therefore, patients with ocular surface disease may benefit from an intra-Tenon injection. Translational Relevance This project provides a direct, qualitative assessment in an animal model of common techniques within glaucoma filtration surgery for drug delivery to improve surgical success.
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Affiliation(s)
- John Swogger
- Department of Ophthalmology, UPMC Eye Center, Eye & Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ian P Conner
- Department of Ophthalmology, UPMC Eye Center, Eye & Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maranda Rosano
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Megan Kemmerer
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Carrie Happ-Smith
- Department of Ophthalmology, UPMC Eye Center, Eye & Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alan Wells
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel S Schuman
- Department of Ophthalmology, UPMC Eye Center, Eye & Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cecelia C Yates
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Reduction in Ocular Hypotensive Eyedrops by Ab Interno Trabeculotomy Improves Not Only Ocular Surface Condition But Also Quality of Vision. J Ophthalmol 2018; 2018:8165476. [PMID: 30034863 PMCID: PMC6032976 DOI: 10.1155/2018/8165476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the effect of ab interno trabeculotomy using the Trabectome surgical system on tear film stability and functional visual acuity (FVA). Patients and Methods Adult glaucoma patients who underwent Trabectome surgery alone or Trabectome surgery combined with phacoemulsification with intraocular lens insertion were included in this study. Corneal epithelial defects, tear film breakup time (TBUT), tear meniscus height, tear film spreading grade, tear interferometry grade, and FVA were assessed before and after surgery in addition to routine ophthalmic examinations. Changes in ocular surface conditions and visual acuity as a result of the Trabectome surgery were investigated. Results Thirty eyes of 22 patients with a mean age of 72.2 ± 7.9 years, including 8 males and 14 females, were enrolled. The Trabectome surgery significantly reduced the intraocular pressure (IOP) from 20.3 ± 5.2 to 15.0 ± 3.3 mmHg (P < 0.001) and the number of different types of ocular hypotensive eyedrops used from 3.2 ± 0.7 to 1.1 ± 0.7 types (P < 0.001). The surgery significantly improved corneal epithelial defects, the tear spreading grade, the tear interferometry grade, and FVA. The surgery also improved the visual maintenance ratio among all enrolled patients, including those who underwent Trabectome surgery only. Conclusion Trabectome surgery may be beneficial not only for IOP reduction but also for improving ocular surface conditions and FVA.
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Iyer JV, Zhao Y, Lim FPM, Tong L, Wong TTL. Ocular lubricant use in medically and surgically treated glaucoma: a retrospective longitudinal analysis. Clin Ophthalmol 2017; 11:1191-1196. [PMID: 28706441 PMCID: PMC5495090 DOI: 10.2147/opth.s134570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Chronic use of intraocular pressure-lowering medications is associated with ocular surface disease (OSD). In this study, we assess the incidence of topical lubricant use as a surrogate marker for underlying OSD, in medically and surgically treated glaucoma patients. Methods Retrospective chart review was performed for newly diagnosed glaucoma patients who were started on topical medications in 2007 and followed up over a 5-year period. Primary outcome measure was the incidence of topical lubricant use in these patients and a subset of these patients who required glaucoma or cataract surgery during follow-up. Results Charts of 505 newly diagnosed glaucoma patients with no prior history of ocular lubricant use were analyzed. Mean age was 63.9 years (SD 11.1), 42.8% were women. One hundred one (20.0%) patients underwent phacoemulsification surgery, 80 underwent mitomycin C (MMC) augmented phacotrabeculectomy, 16 underwent MMC-augmented trabeculectomy and 3 underwent tube surgery during the course of follow-up as their only type of surgery. Five-year incidence of lubricant use was 59% in all glaucoma subjects; 54.1% of patients were on medical treatment and 74.0% of patients who underwent phacotrabeculectomy or trabeculectomy were started on lubricants, respectively (P=0.0011); 60.4% of glaucoma subjects who underwent phacoemulsification surgery were started on lubricants. Incidence of lubricant use increased from 17.7% preoperatively to 74.0% postoperatively in subjects who required trabeculectomy or phacotrabeculectomy. Incidence of lubricant use was similar in patients on one or multiple glaucoma medications, with the mean onset of lubricant use being 10 months after starting glaucoma medication in both groups. Females were more likely to use artificial tears compared with males (P=0.002). Conclusion Both medical and surgical management of glaucoma have an adverse effect on the ocular surface. Chronic use of glaucoma medications was associated with a high incidence of ocular lubricant use. MMC-augmented trabeculectomy was associated with an even higher incidence of ocular lubricant use.
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Affiliation(s)
- Jayant Venkatramani Iyer
- Glaucoma, Singapore National Eye Centre.,Singapore Eye Research Institute.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Yang Zhao
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Fiona Pin Miao Lim
- Glaucoma, Singapore National Eye Centre.,Singapore Eye Research Institute
| | - Louis Tong
- Glaucoma, Singapore National Eye Centre.,Singapore Eye Research Institute.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Tina Tzee Ling Wong
- Glaucoma, Singapore National Eye Centre.,Singapore Eye Research Institute.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
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