1
|
Szymanska M, Normando E, Cordeiro MF. Delayed follow‐up of glaucoma patients due to COVID‐19 pandemic – impact on disease progression. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
| | - Eduardo Normando
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
- Imperial College Healthcare NHS Trust (ICHNT) The Western Eye Hospital London UK
| | - Maria F. Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
- Imperial College Healthcare NHS Trust (ICHNT) The Western Eye Hospital London UK
- Glaucoma and Retinal Neurodegeneration Group Department of Visual Neuroscience UCL Institute of Ophthalmology London UK
| |
Collapse
|
2
|
Szymanska M, Capellan P, Yap T, Cordeiro MF. Neuroimaging in normal tension glaucoma: to scan or not to scan? Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
| | | | - Timothy Yap
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
| | - Maria F. Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
- Glaucoma and Retinal Neurodegeneration Group Department of Visual Neuroscience UCL Institute of Ophthalmology London UK
- Imperial College Healthcare NHS Trust (ICHNT) The Western Eye Hospital London UK
| |
Collapse
|
3
|
Szymanska M, Mahmood D, Yap TE, Cordeiro MF. Recent Advancements in the Medical Treatment of Diabetic Retinal Disease. Int J Mol Sci 2021; 22:ijms22179441. [PMID: 34502350 PMCID: PMC8430918 DOI: 10.3390/ijms22179441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic retinal disease remains one of the most common complications of diabetes mellitus (DM) and a leading cause of preventable blindness. The mainstay of management involves glycemic control, intravitreal, and laser therapy. However, intravitreal therapy commonly requires frequent hospital visits and some patients fail to achieve a significant improvement in vision. Novel and long-acting therapies targeting a range of pathways are warranted, while evidence to support optimal combinations of treatments is currently insufficient. Improved understanding of the molecular pathways involved in pathogenesis is driving the development of therapeutic agents not only targeting visible microvascular disease and metabolic derangements, but also inflammation and accelerated retinal neurodegeneration. This review summarizes the current and emerging treatments of diabetic retinal diseases and provides an insight into the future of managing this important condition.
Collapse
Affiliation(s)
- Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK; (M.S.); (D.M.); (T.E.Y.)
| | - Daanyaal Mahmood
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK; (M.S.); (D.M.); (T.E.Y.)
| | - Timothy E. Yap
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK; (M.S.); (D.M.); (T.E.Y.)
| | - Maria F. Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK; (M.S.); (D.M.); (T.E.Y.)
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, UK
- Correspondence:
| |
Collapse
|
4
|
Cordeiro MF, Nunes TRS, Bezerra FG, Damasco PKM, Silva WAV, Ferreira MRA, Magalhães OMC, Soares LAL, Cavalcanti IMF, Pitta MGR, Rêgo MJBM. Phytochemical characterization and biological activities of Plectranthus barbatus Andrews. BRAZ J BIOL 2021; 82:e236297. [PMID: 33787716 DOI: 10.1590/1519-6984.236297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 11/22/2022] Open
Abstract
Plectranthus barbatus Andrews (Lamiaceae) is widely distributed in the world and has a range of popular therapeutic indications. This work aimed to evaluate the phytochemical characterization of two leaf extracts of P. barbatus, and their antimicrobial, antineoplastic and immunomodulatory potential. After collection, herborization and obtainment of the P. barbatus aqueous extract (PBA) and acetone:water 7:3 P. barbatus organic extract (PBO), the phytochemical characterization was performed by high-performance liquid chromatography (HPLC). The antimicrobial activity was performed to determine the minimum inhibitory concentration (MIC) against eight bacterial strains using the microdilution test and the fungus Trichophyton rubrum by disc diffusion assay and microdilution test. Cytotoxicity was assessed by MTT and trypan blue methods in normal peripheral blood mononuclear cells (PBMCs) at concentrations ranged between 0.1 to 100 µg.mL-1 and in neoplastic cell lines Toledo, K562, DU-145 and PANC-1 at 1, 10 and 100 µg.mL-1 . Immunomodulatory activity, was evaluated by sandwich ELISA of proinflammatory cytokines at BALB/c mice splenocytes cultures supernatant. Both extracts presented flavonoids, cinnamic derivatives, steroids and ellagic acid. PBO showed bacteriostatic activity against Acinetobacter baumannii (MIC = 250 µg.mL-1) clinical isolate and PBA fungistatic activity against Trichophyton rubrum (MIC = 800 µg.mL-1). The extracts did not exhibit toxicity to PBMCs and neoplastic cells (IC50 > 100 µg.mL-1). Additionally, PBO at 100 µg.mL-1 significantly inhibited IFN-γ and IL-17A cytokines (p = 0.03). Plectranthus barbatus is a potential candidate for therapeutic use due to its low toxicity in healthy human cells and exhibits biological activities of medical interest as bacteriostatic, fungistatic and immunomodulatory.
Collapse
Affiliation(s)
- M F Cordeiro
- Universidade Federal de Pernambuco - UFPE, Research Centre for Therapeutic Innovation - Suely Galdino - NUPIT-SG, Laboratory of Immunomodulation and New Therapeutical Approaches, Recife, PE, Brasil.,Universidade Federal do Vale do São Francisco - UNIVASF, Medicine Collegiate, Paulo Afonso, BA, Brasil
| | - T R S Nunes
- Universidade Federal de Pernambuco - UFPE, Research Centre for Therapeutic Innovation - Suely Galdino - NUPIT-SG, Laboratory of Immunomodulation and New Therapeutical Approaches, Recife, PE, Brasil
| | - F G Bezerra
- Universidade Federal de Pernambuco - UFPE, Research Centre for Therapeutic Innovation - Suely Galdino - NUPIT-SG, Laboratory of Immunomodulation and New Therapeutical Approaches, Recife, PE, Brasil
| | - P K M Damasco
- Universidade Federal de Pernambuco - UFPE, Micology Department, Recife, PE, Brasil
| | - W A V Silva
- Universidade Federal de Pernambuco - UFPE, Pharmacy Department, Recife, PE, Brasil
| | - M R A Ferreira
- Universidade Federal de Pernambuco - UFPE, Pharmacy Department, Recife, PE, Brasil
| | - O M C Magalhães
- Universidade Federal de Pernambuco - UFPE, Micology Department, Recife, PE, Brasil
| | - L A L Soares
- Universidade Federal de Pernambuco - UFPE, Pharmacy Department, Recife, PE, Brasil
| | - I M F Cavalcanti
- Universidade Federal de Pernambuco - UFPE, Laboratory of Immunopathology Keizo Asami, Recife, PE, Brasil
| | - M G R Pitta
- Universidade Federal de Pernambuco - UFPE, Research Centre for Therapeutic Innovation - Suely Galdino - NUPIT-SG, Laboratory of Immunomodulation and New Therapeutical Approaches, Recife, PE, Brasil
| | - M J B M Rêgo
- Universidade Federal de Pernambuco - UFPE, Research Centre for Therapeutic Innovation - Suely Galdino - NUPIT-SG, Laboratory of Immunomodulation and New Therapeutical Approaches, Recife, PE, Brasil
| |
Collapse
|
5
|
Moreddu R, Elsherif M, Adams H, Moschou D, Cordeiro MF, Wolffsohn JS, Vigolo D, Butt H, Cooper JM, Yetisen AK. Integration of paper microfluidic sensors into contact lenses for tear fluid analysis. Lab Chip 2020; 20:3970-3979. [PMID: 32944726 DOI: 10.1039/d0lc00438c] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this article, using the integration of paper microfluidics within laser-inscribed commercial contact lenses, we demonstrate the multiplexed detection of clinically relevant analytes including hydrogen ions, proteins, glucose, nitrites and l-ascorbic acid, all sampled directly from model tears. In vitro measurements involved the optimization of colorimetric assays, with readouts collected, stored and analyzed using a bespoke Tears Diagnostics smartphone application prototype. We demonstrate the potential of the device to perform discrete measurements either for medical diagnosis or disease screening in the clinic or at the point-of-care (PoC), with future applications including monitoring of ocular infections, uveitis, diabetes, keratopathies and assessing oxidative stress.
Collapse
Affiliation(s)
- Rosalia Moreddu
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Yetisen AK, Jiang N, Castaneda Gonzalez CM, Erenoglu ZI, Dong J, Dong X, Stößer S, Brischwein M, Butt H, Cordeiro MF, Jakobi M, Hayden O, Koch AW. Scleral Lens Sensor for Ocular Electrolyte Analysis. Adv Mater 2020; 32:e1906762. [PMID: 31834667 DOI: 10.1002/adma.201906762] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/13/2019] [Indexed: 06/10/2023]
Abstract
The quantitative analysis of tear analytes in point-of-care settings can enable early diagnosis of ocular diseases. Here, a fluorescent scleral lens sensor is developed to quantitatively measure physiological levels of pH, Na+ , K+ , Ca2+ , Mg2+ , and Zn2+ ions. Benzenedicarboxylic acid, a pH probe, displays a sensitivity of 0.12 pH units within pH 7.0-8.0. Crown ether derivatives exhibit selectivity to Na+ and K+ ions within detection ranges of 0-100 and 0-50 mmol L-1 , and selectivities of 15.6 and 8.1 mmol L-1 , respectively. A 1,2 bis(o-aminophenoxy)ethane-N,N,-N',N'-tetraacetic-acid-based probe allows Ca2+ ion sensing with 0.02-0.05 mmol L-1 sensitivity within 0.50-1.25 mmol L-1 detection range. 5-Oxazolecarboxylic acid senses Mg2+ ions, exhibiting a sensitivity of 0.10-0.44 mmol L-1 within the range of 0.5-0.8 mmol L-1 . The N-(2-methoxyphenyl)iminodiacetate Zn2+ ion sensor has a sensitivity of 1 µmol L-1 within the range of 10-20 µmol L-1 . The fluorescent sensors are subsequently multiplexed in the concavities of an engraved scleral lens. A handheld ophthalmic readout device comprising light-emitting diodes (LEDs) and bandpass filters is fabricated to excite as well as read the scleral sensor. A smartphone camera application and an user interface are developed to deliver quantitative measurements with data deconvolution. The ophthalmic system enables the assessment of dry eye severity stages and the differentiation of its subtypes.
Collapse
Affiliation(s)
- Ali K Yetisen
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| | - Nan Jiang
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Carmen M Castaneda Gonzalez
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| | - Zeynep Izlen Erenoglu
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| | - Jie Dong
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| | - Xingchen Dong
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| | - Simon Stößer
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| | - Martin Brischwein
- Department of Electrical and Computer Engineering, TranslaTUM Campus, Technical University of Munich, Munich, D-80290, Germany
| | - Haider Butt
- Department of Mechanical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
| | - Maria F Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, NW1 5QH, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Martin Jakobi
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| | - Oliver Hayden
- Department of Electrical and Computer Engineering, TranslaTUM Campus, Technical University of Munich, Munich, D-80290, Germany
| | - Alexander W Koch
- Institute for Measurement Systems and Sensor Technology, Technical University of Munich, Munich, D-80290, Germany
| |
Collapse
|
7
|
Yang E, Al-Mugheiry TS, Normando EM, Cordeiro MF. Real-Time Imaging of Retinal Cell Apoptosis by Confocal Scanning Laser Ophthalmoscopy and Its Role in Glaucoma. Front Neurol 2018; 9:338. [PMID: 29867744 PMCID: PMC5962659 DOI: 10.3389/fneur.2018.00338] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/27/2018] [Indexed: 12/31/2022] Open
Abstract
Glaucoma is one of the leading causes of irreversible blindness in the world. It is characterized by the progressive loss of retinal ganglion cells (RGCs), mainly through the process of apoptosis. Glaucoma patients often come to clinical attention when irreversible loss of visual function has been already established; therefore, early recognition of RGC apoptosis is inordinately important in disease prevention. The novel technology called Detection of Apoptosing Retinal Cells (DARC) allows real-time in vivo quantification of apoptosing cells through the use of a fluorescent biomarker and a confocal scanning ophthalmoscope. A recent Phase I clinical trial has evaluated the safety of DARC and its ability to detect retinal apoptosis in glaucoma patients and healthy volunteers. Results suggest that DARC may have potential in the early detection of glaucoma, which could help alleviate the medical, social, and economic burden associated with this blinding condition.
Collapse
Affiliation(s)
- Elizabeth Yang
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Toby S Al-Mugheiry
- Queen Elizabeth Hospital, King's Lynn NHS Foundation Trust, Norfolk, United Kingdom
| | - Eduardo M Normando
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom.,Insitute of Ophthalmology, University College London, London, United Kingdom
| | - Maria F Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom.,Insitute of Ophthalmology, University College London, London, United Kingdom
| |
Collapse
|
8
|
Affiliation(s)
- T Fayers
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - G K Loh
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M F Cordeiro
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - V Lee
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - R Jain
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P M Fayers
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
9
|
Abstract
BACKGROUND Glaucoma comprises a group of neurodegenerative diseases resulting in retinal ganglion cell death within the optic nerve head. It is projected to affect almost 80 million people worldwide by 2020. The condition's asymptomatic nature translates to over half of glaucoma sufferers being unaware of their condition. By the time of diagnosis, irreversible blindness is likely to have occurred. Prime areas of glaucoma research therefore include identification and optimization of risk factors for the disease, accurate and early diagnostic tools and novel therapeutic methods. METHODS The goal of this review was to summarize main areas of latest glaucoma research into risk factors of glaucoma, diagnostic tools and treatments. PubMed was used to search for terms including glaucoma risk factors, glaucoma diagnostics, glaucoma treatment, glaucoma drug delivery and glaucoma IOP. RESULTS The evidence for risk factors of low CSF pressure, IOP, smoking, vascular risk factors and light toxicity is described. Latest diagnostic and monitoring techniques for glaucoma include SD-OCT, DARC and IOP telemetry. Current and emerging medical and surgical treatments in glaucoma are discussed. Rho kinase inhibitors have the potential to both lower IOP and also provide neuroprotection, several of which are in clinical trials. Several other new medical treatments such as calcium channel blockers and neurotrophic agents also have the capacity to provide neuroprotection. Minimally Invasive Glaucoma Surgery (MIGS) devices provide an improved safety profile compared to traditional trabeculectomy; the latest ab interno and ab externo devices are described. Novel drug delivery methods, including punctual plugs and contact lenses, help overcome the challenges with patient adherence. CONCLUSION The ultimate goals are to reduce the individual patient risk factors associated with glaucoma, diagnose the condition early and to find treatments that not only reduce IOP but also reverse neurodegeneration of RGCs. The usage of combinations of novel medical and surgical treatments may help maximize IOP reduction and neuroprotection.
Collapse
Affiliation(s)
- Shiama I Balendra
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London. United Kingdom
| | - Parth Arvind Shah
- Department of Ophthalmology, The Princess Alexandra Eye Pavilion, Chalmers St, Edinburgh EH3 9HA. United Kingdom
| | - Mishank Jain
- Department of Ophthalmology, Central Middlesex Hospital, Acton Lane, Park Royal, London, NE10 7NS. United Kingdom
| | | | - Maria F Cordeiro
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London. United Kingdom
| |
Collapse
|
10
|
Cordeiro MF, Normando EM, Cardoso MJ, Miodragovic S, Jeylani S, Davis BM, Guo L, Ourselin S, A'Hern R, Bloom PA. Real-time imaging of single neuronal cell apoptosis in patients with glaucoma. Brain 2017; 140:1757-1767. [PMID: 28449038 PMCID: PMC5445254 DOI: 10.1093/brain/awx088] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/13/2017] [Indexed: 11/13/2022] Open
Abstract
See Herms and Schön (doi10.1093/brain/awx100) for a scientific commentary on this article.
Collapse
Affiliation(s)
- Maria F Cordeiro
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, UK.,The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK.,The Imperial College Ophthalmic Research Group (ICORG), Imperial College London NW1 5QH, UK
| | - Eduardo M Normando
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK.,The Imperial College Ophthalmic Research Group (ICORG), Imperial College London NW1 5QH, UK
| | - M Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing, University College London, Wolfson House, Stephenson Way, London, NW1 2HE London, UK
| | - Serge Miodragovic
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK
| | - Seham Jeylani
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK
| | - Benjamin M Davis
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Li Guo
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, University College London, Wolfson House, Stephenson Way, London, NW1 2HE London, UK
| | | | - Philip A Bloom
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK.,The Imperial College Ophthalmic Research Group (ICORG), Imperial College London NW1 5QH, UK
| |
Collapse
|
11
|
Kang S, Luk S, Han H, Cordeiro MF, Ahmed F, Bloom P, Crawley L. Refractive outcome of combined phacoemulsification and endoscopic cyclophotocoagulation. Int Ophthalmol 2016; 37:1311-1317. [PMID: 27990622 DOI: 10.1007/s10792-016-0411-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the refractive outcome of eyes that underwent phacoemulsification combined with endoscopic cyclophotocoagulation (phaco-ECP) with the eyes that underwent phacoemulsification alone. METHODS A retrospective case series review of 103 consecutive eyes that underwent phaco-ECP and 62 eyes that underwent phacoemulsification between January 2006 and August 2012 was conducted. Post-operative refractive outcomes were obtained by subjective refraction or autorefraction. Demographic data, best corrected visual acuity, intraocular pressure, number of glaucoma agents and mean deviation of the Humphrey visual field test (MD) were also analysed. RESULTS The total number of eyes included in the study was 62 eyes for the phaco-ECP group and 62 eyes for the control group who underwent phacoemulsification alone. More than 90% of eyes (n = 56) in phaco-ECP group achieved post-operative refraction within ±1 dioptre (D) of the target refraction. In the control group, 100% of eyes achieved post-operative refraction within ±1D of the target refraction. When comparing the difference between the target and the actual refractive outcome between the phaco-ECP and the control group, there was no statistically significant difference. CONCLUSIONS Refractive outcome after phaco-ECP is comparable to phacoemulsification alone. This study suggests that the intraocular lens power can be selected for cataract surgery alone and that ECP does not change the effective lens position significantly; therefore, no modification of biometry formulae is required. Phaco-ECP should be considered as an effective, safe and predictable surgical treatment option for glaucoma patients with co-existing cataract.
Collapse
Affiliation(s)
- S Kang
- Imperial College Healthcare NHS Trust, The Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.
| | - S Luk
- Imperial College Healthcare NHS Trust, The Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK
| | - H Han
- Imperial College Healthcare NHS Trust, The Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK
| | - M F Cordeiro
- Imperial College Healthcare NHS Trust, The Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.,Imperial College London, London, UK.,Glaucoma and Retinal Neuro-degeneration Research Group, UCL Institute of Ophthalmology, London, UK
| | - F Ahmed
- Imperial College Healthcare NHS Trust, The Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.,Imperial College London, London, UK
| | - P Bloom
- Imperial College Healthcare NHS Trust, The Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.,Imperial College London, London, UK
| | - L Crawley
- Imperial College Healthcare NHS Trust, The Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.,Imperial College London, London, UK
| |
Collapse
|
12
|
Affiliation(s)
- B M Davis
- Glaucoma and Retinal Neurodegeneration Research, Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - L Guo
- Glaucoma and Retinal Neurodegeneration Research, Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - J Brenton
- Glaucoma and Retinal Neurodegeneration Research, Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - L Langley
- Glaucoma and Retinal Neurodegeneration Research, Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - E M Normando
- Western Eye Hospital, Imperial College Healthcare Trust, London, UK
| | - M F Cordeiro
- Glaucoma and Retinal Neurodegeneration Research, Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
- Western Eye Hospital, Imperial College Healthcare Trust, London, UK
| |
Collapse
|
13
|
Galho AR, Cordeiro MF, Ribeiro SA, Marques MS, Antunes MFD, Luz DC, Hädrich G, Muccillo-Baisch AL, Barros DM, Lima JV, Dora CL, Horn AP. Protective role of free and quercetin-loaded nanoemulsion against damage induced by intracerebral haemorrhage in rats. Nanotechnology 2016; 27:175101. [PMID: 26965041 DOI: 10.1088/0957-4484/27/17/175101] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intracerebral haemorrhage (ICH) is a worldwide public health problem. Experimental studies have shown that oxidative stress plays an important role in the pathogenesis of ICH and could represent a target for its treatment. However, the blood-brain barrier is an obstacle to be overcome, as it hampers the administration of compounds to the central nervous system. In this study, we compared the effects of a quercetin-loaded nanoemulsion (QU-N) with the free form of the drug (QU-SP) in a collagenase-induced ICH rat model. Quercetin (QU) is a polyphenol that has an antioxidant effect in vitro, but due to its high lipophilicity, it has low bioavailability in vivo. In this study, animals submitted or not to ICH were treated with a single intraperitoneal QU dose (free or nanoemulsion) of 30 mg kg(-1). Motor assessment was evaluated by the open field, foot fault and beam walking behavioural tests. 72 h after surgery the haematoma size was evaluated and biochemical measurements were performed. Animals treated with QU-N had a significant improvement in the beam walking and open field tests. Also, QU-N was able to reduce the size of the haematoma, preserving the activity of glutathione S-transferase (GST), increasing GSH content, and the total antioxidant capacity. QU-SP recovered locomotor activity and increased the GSH content and the total antioxidant capacity. Thus, it can be observed that QU presented antioxidant activity in both formulations, but the incorporation into nanoemulsions increased its antioxidant effect, which was reflected in the improvement of the motor skills and in the haematoma size decrement. These results suggest that the nanoemulsion containing QU developed in this study could be promising for future studies on treatments for ICH.
Collapse
Affiliation(s)
- A R Galho
- Programa de Pós-graduação em Ciências Fisiológicas - Fisiologia Animal Comparada, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, 96210-900, Brazil
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Javaid FZ, Brenton J, Guo L, Cordeiro MF. Visual and Ocular Manifestations of Alzheimer's Disease and Their Use as Biomarkers for Diagnosis and Progression. Front Neurol 2016; 7:55. [PMID: 27148157 PMCID: PMC4836138 DOI: 10.3389/fneur.2016.00055] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/29/2016] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia affecting the growing aging population today, with prevalence expected to rise over the next 35 years. Clinically, patients exhibit a progressive decline in cognition, memory, and social functioning due to deposition of amyloid β (Aβ) protein and intracellular hyperphosphorylated tau protein. These pathological hallmarks of AD are measured either through neuroimaging, cerebrospinal fluid analysis, or diagnosed post-mortem. Importantly, neuropathological progression occurs in the eye as well as the brain, and multiple visual changes have been noted in both human and animal models of AD. The eye offers itself as a transparent medium to cerebral pathology and has thus potentiated the development of ocular biomarkers for AD. The use of non-invasive screening, such as retinal imaging and visual testing, may enable earlier diagnosis in the clinical setting, minimizing invasive and expensive investigations. It also potentially improves disease management and quality of life for AD patients, as an earlier diagnosis allows initiation of medication and treatment. In this review, we explore the evidence surrounding ocular changes in AD and consider the biomarkers currently in development for early diagnosis.
Collapse
Affiliation(s)
- Fatimah Zara Javaid
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Jonathan Brenton
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Li Guo
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Maria F. Cordeiro
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
15
|
Heaton GR, Davis BM, Turner LA, Cordeiro MF. Ocular biomarkers of Alzheimer's disease. Cent Nerv Syst Agents Med Chem 2016; 15:117-25. [PMID: 25788142 DOI: 10.2174/1871524915666150319123015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 11/22/2022]
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease characterised clinically by a progressive decline in executive functions, memory and cognition. Classic neuropathological hallmarks of AD include intracellular hyper-phosphorylated tau protein which forms neurofibrillary tangles (NFT), and extracellular deposits of amyloid β (Aβ) protein, the primary constituent of senile plaques (SP). The gradual process of pathogenic amyloid accumulation is thought to occur 10-20 years prior to symptomatic manifestation. Advance detection of these deposits therefore offers a highly promising avenue for prodromal AD diagnosis. Currently, the most sophisticated method of 'probable AD' diagnosis is via neuroimaging or cerebral spinal fluid (CSF) biomarker analysis. Whilst these methods have reported a high degree of diagnostic specificity and accuracy, they fall significantly short in terms of practicality; they are often highly invasive, expensive or unsuitable for large-scale population screening. In recent years, ocular screening has received substantial attention from the scientific community due to its potential for non-invasive and inexpensive central nervous system (CNS) imaging. In this appraisal we build upon our previous reviews detailing ocular structural and functional changes in AD (Retinal manifestations of Alzheimer's disease, Alzheimer's disease and Retinal Neurodegeneration) and consider their use as biomarkers. In addition, we present an overview of current advances in the use of fluorescent reporters to detect AD pathology through non-invasive retinal imaging.
Collapse
Affiliation(s)
| | | | | | - Maria F Cordeiro
- Glaucoma & Retinal Degeneration Research Group, UCL Institute of Ophthalmology, Bath Street, London, EC1V 9EL, UK.
| |
Collapse
|
16
|
|
17
|
Abstract
Elevated IOP in clinical practice is usually seen in glaucoma or ocular hypertension. Glaucoma affects 60 million people worldwide and 8.4 million are bilaterally blind from this chronic disease.1 Options for reducing IOP rely on pharmacological agents, laser treatments and surgery which may be penetrating or non-penetrating. The last twenty years has seen significant changes in all of these strategies. This review aims to cover these clinical options and introduce some of the new technologies currently in development for the clinical lowering of IOP.
Collapse
Affiliation(s)
- Laura Crawley
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Maria F. Cordeiro
- Glaucoma and Retinal Neurodegeneration Research Group, Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Li Guo
- Glaucoma and Retinal Neurodegeneration Research Group, Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom
| |
Collapse
|
18
|
Georgiou AL, Guo L, Cordeiro MF, Salt TE. Changes in NMDA receptor contribution to synaptic transmission in the brain in a rat model of glaucoma. Neurobiol Dis 2010; 39:344-51. [PMID: 20451613 PMCID: PMC2917788 DOI: 10.1016/j.nbd.2010.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/22/2010] [Accepted: 04/26/2010] [Indexed: 01/18/2023] Open
Abstract
In the age-related, blinding disease glaucoma, retinal ganglion cells (RGCs) degenerate, possibly affecting glutamatergic retinofugal transmission to the brain. The superior colliculus (SC) is a major central target of retinofugal axons in the rodent, a much used disease model. We investigated the contribution of NMDA-type glutamate receptors to retinocollicular transmission in a rat glaucoma model, using a SC brain slice preparation to determine the sensitivity of synaptic responses to the NMDAR antagonist D-AP5. At 32 weeks after induction of experimental glaucoma, but not earlier, there was an increase in NMDAR contribution to SC synaptic responses in slices receiving input from glaucomatous eyes. This suggests that there are changes in NMDAR function after RGC degeneration in experimental glaucoma, which may represent functional SC compensation through plasticity via NMDARs. This has implications for studies carried out using rodent glaucoma models, especially those evaluating potential treatment strategies, as it suggests that functional changes in the central visual system need to be considered in addition to those in the eye. Furthermore, the data underline the need for early therapeutic intervention in order to pre-empt subsequent central functional changes.
Collapse
Affiliation(s)
- A L Georgiou
- Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | | | | | | |
Collapse
|
19
|
Cordeiro MF, Guo L, Coxon KM, Duggan J, Nizari S, Normando EM, Sensi SL, Sillito AM, Fitzke FW, Salt TE, Moss SE. Imaging multiple phases of neurodegeneration: a novel approach to assessing cell death in vivo. Cell Death Dis 2010; 1:e3. [PMID: 21364622 PMCID: PMC3032512 DOI: 10.1038/cddis.2009.3] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 10/02/2009] [Accepted: 10/02/2009] [Indexed: 11/29/2022]
Abstract
Nerve cell death is the key event in all neurodegenerative disorders, with apoptosis and necrosis being central to both acute and chronic degenerative processes. However, until now, it has not been possible to study these dynamically and in real time. In this study, we use spectrally distinct, well-recognised fluorescent cell death markers to enable the temporal resolution and quantification of the early and late phases of apoptosis and necrosis of single nerve cells in different disease models. The tracking of single-cell death profiles in the same living eye over hours, days, weeks and months is a significant advancement on currently available techniques. We identified a numerical preponderance of late-phase versus early-phase apoptotic cells in chronic models, reinforcing the commonalities between cellular mechanisms in different disease models. We showed that MK801 effectively inhibited both apoptosis and necrosis, but our findings support the use of our technique to investigate more specific anti-apoptotic and anti-necrotic strategies with well-defined targets, with potentially greater clinical application. The optical properties of the eye provide compelling opportunities for the quantitative monitoring of disease mechanisms and dynamics in experimental neurodegeneration. Our findings also help to directly observe retinal nerve cell death in patients as an adjunct to refining diagnosis, tracking disease status and assessing therapeutic intervention.
Collapse
Affiliation(s)
- M F Cordeiro
- UCL Institute of Ophthalmology, University College London, London, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Guo L, Tsatourian V, Luong V, Podoleanu AG, Podolean AG, Jackson DA, Fitzke FW, Cordeiro MF. En face optical coherence tomography: a new method to analyse structural changes of the optic nerve head in rat glaucoma. Br J Ophthalmol 2005; 89:1210-6. [PMID: 16113384 PMCID: PMC1772813 DOI: 10.1136/bjo.2004.058941] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate en face optical coherence tomography (eOCT) and its use as an effective objective technique for assessing changes in the glaucomatous rat optic nerve head (ONH) in vivo, and compare it with confocal scanning laser ophthalmoscopy (cSLO). METHODS 18 Dark Agouti (DA) rats with surgically induced ocular hypertension were imaged with eOCT and cSLO at regular intervals. Assessment included three dimensional (3D) topographic reconstructions, intensity z-profile plots, a new method of depth analysis to define a "multilayered" structure, and scleral canal measurements, in relation to the degree of intraocular pressure (IOP) exposure. RESULTS The increased depth resolution of the eOCT compared to the cSLO was apparent in all methods of analysis, with better discrimination of tissue planes. This was validated histologically. eOCT demonstrated several significant changes in imaged rat ONH which correlated with IOP exposure, including the area of ONH (p<0.01), separation between retinal vessel and scleral layers (p<0.05), and anterior scleral canal opening expansion (p<0.05). CONCLUSION eOCT appears to be effective in assessing rat ONH, allowing detailed structural analysis of the multilayered ONH structure. As far as the authors are aware, this is the first report of scleral canal expansion in a rat model. They suggest eOCT as a novel method for the detection of early changes in the ONH in glaucoma.
Collapse
Affiliation(s)
- L Guo
- Institute of Ophthalmology, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Freitas VJF, Serova IA, Andreeva LE, Júnior ESL, Teixeira DIA, Cordeiro MF, Rondina D, Paula NRO, Arruda IJ, Verde JBL, Dvoriantchikov G, Serov O. Birth of normal kids after microinjection of pronuclear embryos in a transgenic goat (Capra hircus) production program in Brazil. Genet Mol Res 2003; 2:200-5. [PMID: 14966685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
This pilot project was designed to determine if normal kids could be produced after microinjection in pronuclear embryos and subsequent transfer to recipients in a transgenic goat program in Brazil. Twelve donors of the Saanen breed and 17 recipients of an undefined breed were used. The estrus of both donors and recipients was synchronized by a standard progestagen treatment and superovulation obtained by six pFSH injections. Donors in estrus were mated with fertile Saanen bucks. Zygotes were recovered surgically by flushing oviducts. The recovered zygotes with visible pronuclei were microinjected with 500 to 1000 copies of the human G-CSF gene. Two or four embryos were surgically transferred into the oviducts of recipients. One recipient became pregnant and two kids were born. No transgenic goat was identified after PCR analysis. Even though transgenic goats were not obtained, this experiment establishes the basis of a synchronization and superovulation regimen for use in goats raised in Brazil, for the purpose of collecting and manipulating the pronuclear embryos. This project also showed that microinjected one-cell goat embryos can survive to produce live young following surgical transfer.
Collapse
Affiliation(s)
- V J F Freitas
- Laboratory of Physiology and Control of Reproduction, State University of Ceará, Av. Paranjana, 1700, 60740-000 Fortaleza, CE, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Cordeiro MF, Mead A, Ali RR, Alexander RA, Murray S, Chen C, York-Defalco C, Dean NM, Schultz GS, Khaw PT. Novel antisense oligonucleotides targeting TGF-beta inhibit in vivo scarring and improve surgical outcome. Gene Ther 2003; 10:59-71. [PMID: 12525838 DOI: 10.1038/sj.gt.3301865] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The scarring response is an important factor in many diseases throughout the body. In addition, it is a major problem in influencing results of surgery. In the eye, for example, post-operative scarring can determine the outcome of surgery. This is particularly the case in the blinding disease glaucoma, where several anti-scarring regimens are currently used to improve glaucoma surgery results, but are of limited use clinically because of severe complications. We have recently identified transforming growth factor-beta (TGF-beta) as a target for post-operative anti-scarring therapy in glaucoma, and now report the first study of novel second-generation antisense phosphorothioate oligonucleotides against TGF-beta in vivo. Single applications of a TGF-beta OGN at the time of surgery in two different animal models closely related to the surgical procedure performed in glaucoma patients, significantly reduced post-operative scarring (P<0.05) and improved surgical outcome. Our findings suggest that TGF-beta antisense oligonucleotides have potential as a new therapy for reducing post-surgical scarring. Its long-lasting effects after only a single administration at the time of surgery make it particularly attractive clinically. Furthermore, although we have shown this agent to be useful in the eye, it could have widespread applications anywhere in the body where the wound-healing response requires modulation.
Collapse
|
25
|
Abstract
The healing process after glaucoma filtration is the main determinant of surgical failure and, even more important, the final intraocular pressure. The ability to fully control wound healing may ultimately give us the ability to set the intraocular pressure in the low teens for all patients undergoing glaucoma filtration surgery. The authors review the changes in how to use antimetabolites to improve safety, and many of the exciting new areas of progress, including growth factor neutralization and future molecular therapies to control wound healing.
Collapse
Affiliation(s)
- P T Khaw
- Wound Healing Research Unit, Department of Pathology, Institute of Ophthalmology and Moorfields Eye Hospital, London, England
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
The immune system has a fundamental role in the development and regulation of ocular healing, which plays an important role in the pathogenesis of most blinding diseases. This review discusses the mechanisms of normal wound healing, describing the animal and fetal wound healing models used to provide further insight into normal wound repair. In particular, conjunctival wound repair after glaucoma filtration surgery will be used to illustrate the contributions that the different components of the immune system make to the healing process. The potential role of macrophages, the possible regulatory effect of lymphocytes, and the important role of growth factors and cytokines in the wound healing reaction are discussed. The significance of the immune system in the pathogenesis of aggressive conjunctival scarring is addressed, particularly assessing the predisposing factors, including drugs, age, and ethnicity. The rationale behind the pharmacological agents currently used to modulate the wound healing response and the effects these drugs have on the function of the immune system are described. Finally, potential new therapeutic approaches to regulating the wound healing response are reported.
Collapse
Affiliation(s)
- L Chang
- Wound Healing Research and Glaucoma Units, Institute of Ophthalmology, London, United Kingdom
| | | | | | | | | |
Collapse
|
27
|
|
28
|
Abstract
Advances in molecular and cell biology have led to an expansion in our knowledge and understanding of the processes involved in wound healing. We review existing and potential therapies modulating the conjunctival scarring response, with particular reference to glaucoma filtration surgery. We discuss how the refinement of present antimetabolite regimens can minimise complications and improve surgical results, and advocate their use in carefully selected patient groups. Perhaps the most promising approach is targeting biological molecules. Hence, use of fully human neutralising monoclonal antibodies to the growth factor TGF beta has potential as a useful strategy for modifying conjunctival scarring. Combination therapies may also afford an improved therapeutic index. It is hoped that future therapies can offer safer, more specific, focal and titratable treatment, with far-reaching clinical applications.
Collapse
Affiliation(s)
- M F Cordeiro
- Department of Pathology & Glaucoma, Moorfields Eye Hospital, London, UK
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Recent developments in molecular and cell biology have made a major impact on our understanding of the wound healing process and its modification. In this article, the spectrum of therapies that are either currently available or have potential application as modulators of the scarring response following glaucoma surgery are reviewed. Refinement of existing antimetabolite regimens can improve surgical results, especially in carefully selected patient groups. However, the most promising new approach appears to be using molecular-based therapies, such as fully human neutralizing monoclonal antibodies, designed to target specific molecules in the scarring response. Such strategies ultimately offer the potential of safer, more specific, focal, and titratable treatment, with far-reaching clinical applications.
Collapse
Affiliation(s)
- M F Cordeiro
- Department of Pathology, Moorfields Eye Hospital, London, UK
| | | | | | | |
Collapse
|
30
|
Cordeiro MF, Bhattacharya SS, Schultz GS, Khaw PT. TGF-beta1, -beta2, and -beta3 in vitro: biphasic effects on Tenon's fibroblast contraction, proliferation, and migration. Invest Ophthalmol Vis Sci 2000; 41:756-63. [PMID: 10711691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
PURPOSE To compare the effects of the three human transforming growth factor-beta (TGF-beta) isoforms and different concentrations of TGF-beta on human Tenon's capsule fibroblasts (HTF), with a view to delineating the role of this growth factor in the subconjunctival scarring response after glaucoma filtration surgery. METHODS Application of recombinant human TGF-beta1, -beta2, and -beta3 (range 0-10(-8) M) was assessed using several assays of HTF function: fibroblast-mediated collagen contraction, proliferation, and migration. RESULTS All three isoforms of TGF-beta behaved in a similar manner in vitro. They each stimulated HTF-mediated collagen contraction, proliferation, and migration with a characteristic concentration-dependent response, with peak activities at 10(-9), 10(-12), and 10(-9) M, respectively, that were significantly different from control (P<0.05). At concentrations above and below peak activities, HTF activity was reduced, demonstrating biphasic effects of TGF-beta. CONCLUSIONS TGF-beta1, -beta2, and -beta3 have similar actions in vitro; this is demonstrated by their effects on several HTF-mediated functions. TGF-beta induces a response in HTF that is concentration-dependent, with different functions being maximally stimulated at different concentrations. This biphasic response highlights the significance of the concentration profile of TGF-beta at the wound site. These findings are important in filtration surgery, where constant changes in the local environment occur due to the passage of aqueous and the wound healing process. The varying levels of TGF-beta in the aqueous and subconjunctival tissues may thus significantly modify the conjunctival scarring response.
Collapse
Affiliation(s)
- M F Cordeiro
- Department of Pathology, Moorfields Eye Hospital & Institute of Ophthalmology, London, United Kingdom.
| | | | | | | |
Collapse
|
31
|
Affiliation(s)
- M F Cordeiro
- Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
| | | | | | | | | |
Collapse
|
32
|
Cordeiro MF, Plant GT, Child A, Jones B, Khaw PT. Visual loss after primary trabeculotomy with mitomycin C in Ehlers-Danlos syndrome. Br J Ophthalmol 1999; 83:1202-4. [PMID: 10636654 PMCID: PMC1722818 DOI: 10.1136/bjo.83.10.i1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Cordeiro MF, Gay JA, Khaw PT. Human anti-transforming growth factor-beta2 antibody: a new glaucoma anti-scarring agent. Invest Ophthalmol Vis Sci 1999; 40:2225-34. [PMID: 10476787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
PURPOSE Currently available anti-scarring regimens for glaucoma filtration surgery have potentially blinding complications and thus the need for alternative and safer agents. The effects of a new antibody to transforming growth factor (TGF)-beta2 on in vitro and in vivo conjunctival scarring and after glaucoma filtration surgery were investigated. METHODS The activity of a novel recombinant monoclonal neutralizing antibody (mAb) to human TGF-2 (rhAnti-TGF-beta2 mAb) was studied in conjunctival fibroblast-mediated proliferation, migration, and collagen contraction. Its safety in subconjunctival administration was assessed in vivo, and, in a rabbit model of glaucoma filtration surgery, its effects on conjunctival scarring and filtration surgery outcome were investigated. RESULTS The rhAnti-TGF-beta2 mAb effectively inhibited TGF-beta2-mediated conjunctival scarring activity in vitro, at 50% inhibitory concentrations (IC50) of less than 1 nM. It significantly improved glaucoma filtration surgery outcome in an animal model of aggressive conjunctival scarring compared with control (P = 0.0291) and was clinically safe, nontoxic, and well tolerated after subconjunctival administration. CONCLUSIONS Subconjunctival rhAnti-TGF-beta2 mAb treatment significantly affects surgical outcome and effectively reduces conjunctival scarring both in vitro and in vivo. It appears safe for subconjunctival administration and when compared with mitomycin-C treatment histologically, much less destructive to local tissue. rhAnti-TGF-beta2 mAb may have potential as a new anti-scarring agent for use in glaucoma filtration surgery.
Collapse
Affiliation(s)
- M F Cordeiro
- Wound Healing Research Unit, Moorfields Eye Hospital and Institute of Ophthalmology, London, United Kingdom
| | | | | |
Collapse
|
34
|
Cordeiro MF, Reichel MB, Gay JA, D'Esposita F, Alexander RA, Khaw PT. Transforming growth factor-beta1, -beta2, and -beta3 in vivo: effects on normal and mitomycin C-modulated conjunctival scarring. Invest Ophthalmol Vis Sci 1999; 40:1975-82. [PMID: 10440251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
PURPOSE To compare the effects of the three human isoforms of transforming growth factor (TGF)-beta in vivo using a mouse model of conjunctival scarring, both in normal eyes and after treatment with MMC, with a view to delineating the role of this growth factor in glaucoma filtration surgery. METHODS Application of recombinant human TGF-beta was assessed in a prospective, randomized study of mouse conjunctival scarring, in which subconjunctival TGF-beta1, -beta2, and -beta3 (all 10(-9) M) were compared with control (phosphate-buffered saline [PBS] carrier) and mitomycin C (MMC; 0.4 mg/ml) treatment at 6 hours, and 1, 3, and 7 days after surgery (six eyes/treatment/time point). Effects of TGF-beta2 on eyes previously treated with MMC were also assessed. Histologic studies of enucleated eyes were performed to analyze development of the scarring response, extracellular matrix deposition, and the inflammatory cell profile. RESULTS All three isoforms of TGF-beta behaved in a similar manner in vivo, being associated with a rapid-onset and exaggerated scarring response compared with control and MMC treatment. TGF-beta-treated eyes showed evidence of an earlier peak in inflammatory cell activity (P < 0.05) and increased collagen type III deposition (P < 0.05). TGF-beta2 treatment significantly stimulated scarring after MMC application (P < 0.05). CONCLUSIONS TGF-beta1, -beta2, and -beta3 appear to have similar actions in vivo and stimulate the conjunctival scarring response. Application of TGF-beta2 modified the effects of MMC. All TGF-beta isoforms may be potent modulators of the conjunctival scarring response. These studies indicate that TGF-beta2 may naturally modify the antiscarring effects of antimetabolites such as MMC in glaucoma filtration surgery.
Collapse
Affiliation(s)
- M F Cordeiro
- Department of Pathology, Moorfields Eye Hospital and Institute of Ophthalmology, London, United Kingdom
| | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Abstract
AIMS To establish a simple model of conjunctival wound healing in the mouse eye. METHODS 4 week old BABL/c mouse eyes were studied over a 14 day period. Surgical procedure under general anaesthesia involved a blunt dissection of the conjunctiva performed by injection of 25 microliters of PBS via a 27 gauge needle into one eye, while the contralateral eye was used as control. Mice were assessed clinically and sacrificed at 1, 2, 3, 7, and 14 days after surgery. Enucleated eyes were prepared for histological analysis. Development of scar tissue was studied with haematoxylin and eosin, oxidation aldehyde fuchsin, and van Gieson stains, with assessment of cellularity, extracellular matrix formation, and wound characterisation. RESULTS Histological analysis revealed a marked and characteristic healing response initiated by a predominantly granulocytic inflammatory reaction at day 1 with peak fibroblast activity 3 days after surgery. Oxytalan fibres and newly laid collagen fibres were detected early in the subconjunctival wound area and up to 7 days after surgery. Remodelling and complete organisation of scar tissue was evident by day 14. CONCLUSION A single subconjunctival injection in the mouse eye results in a marked and consistent healing response. This represents a simple, inexpensive, and reliable animal model of conjunctival scarring. The mouse is a biologically well characterised animal model and allows the use of a wide variety of molecular tools. There are potentially significant clinical applications, in particular in investigating the effects of modulating agents such as antimetabolites, growth factors, and their antagonists on conjunctival scarring.
Collapse
Affiliation(s)
- M B Reichel
- Department of Molecular Genetics, Institute of Ophthalmology, London
| | | | | | | | | | | |
Collapse
|
37
|
Daniels JT, Occleston NL, Crowston JG, Cordeiro MF, Alexander RA, Wilkins M, Porter R, Brown R, Khaw PT. Understanding and controlling the scarring response: the contribution of histology and microscopy. Microsc Res Tech 1998; 42:317-33. [PMID: 9766427 DOI: 10.1002/(sici)1097-0029(19980901)42:5<317::aid-jemt3>3.0.co;2-m] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In response to injury, the body usually initiates a full and swift wound healing response resulting in reconstructed, repaired tissue. In certain instances, due to a variety of factors, this may not happen, an example being chronic granulating venous leg ulcers. At the other extreme, the wound may heal excessively, producing disabling hypertrophic scarring such as can occur following large, deep burn injuries. Our group is interested in the surgical treatment of the eye disease glaucoma. As will be explained, the successful surgical treatment of this disease depends on a reduced scarring response at the end of wound healing. The purpose of this article is to give an overview of our microscopic and histological experimental work which has furthered our understanding of tissue repair, particularly the scarring response and its potential modification for successful glaucoma surgery.
Collapse
Affiliation(s)
- J T Daniels
- Wound Healing Research Unit, Institute of Ophthalmology and Moorfields Eye Hospital, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Constable PH, Crowston JG, Occleston NL, Cordeiro MF, Khaw PT. Long term growth arrest of human Tenon's fibroblasts following single applications of beta radiation. Br J Ophthalmol 1998; 82:448-52. [PMID: 9640199 PMCID: PMC1722552 DOI: 10.1136/bjo.82.4.448] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS/BACKGROUND Antimetabolites are increasingly used to manipulate the healing response after filtration surgery, but problems with thin cystic blebs have been encountered with the liquid agents commonly used such as 5-fluorouracil and mitomycin C. beta Radiation appears to be a useful adjuvant treatment for preventing scarring after trabeculectomy, resulting in diffuse rather than cystic bleb formation, but much of the basic cell biology of the ocular fibroblast response to beta radiation remains unclear. The effects of beta radiation on ocular fibroblast proliferation and cell cycling were investigated to determine the nature and duration of these effects on these cells. METHODS In vitro cell culture techniques were used to investigate fibroblast proliferation. Cell viability was studied using trypan blue dye exclusion. The effect of radiation on cell cycling was investigated using bromodeoxyuridine uptake. p53 expression was demonstrated using immunocytochemistry. RESULTS beta Radiation inhibited fibroblast proliferation in a dose dependent manner. Early cell death was not a prominent feature, but irradiated fibroblasts demonstrated a rapid onset and sustained period of growth arrest. p53 expression was found to be increased in irradiated cells. CONCLUSIONS Single doses of beta radiation significantly inhibit Tenon's capsule fibroblast proliferation in vitro over a 28 day period. This inhibition is the result of a rapid onset and sustained period of growth arrest in irradiated cells. Irradiated fibroblasts show an increase in p53 expression, a nuclear phosphoprotein which has been associated with control of the cell cycle. Single applications of beta radiation may be an effective treatment for the prevention of bleb failure as a result of prolonged growth arrest of Tenon's capsule fibroblasts.
Collapse
Affiliation(s)
- P H Constable
- Department of Pathology, Institute of Ophthalmology, Moorfields Eye Hospital, London
| | | | | | | | | |
Collapse
|
39
|
Cordeiro MF, Stanford MR, Phillips PM, Shilling JS. Relationship of diabetic microvascular complications to outcome in panretinal photocoagulation treatment of proliferative diabetic retinopathy. Eye (Lond) 1998; 11 ( Pt 4):531-6. [PMID: 9425420 DOI: 10.1038/eye.1997.139] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Argon laser panretinal photocoagulation for proliferative diabetic retinopathy was shown in the Diabetic Retinopathy Study and Early Treatment Diabetic Retinopathy Study to reduce the incidence of blindness by 50% with relatively small amounts of treatment. However, some diabetics require much more extensive photocoagulation for control of proliferative disease. We attempted to determine risk factors for poor response to treatment with panretinal photocoagulation (PRP) by studying outcome in relation to the argon laser burn count and the presence of diabetic vascular complications. Sixty-six consecutively treated eyes undergoing PRP were studied, of which 57% showed resolution of new vessels 6 weeks after treatment. This was significantly related to the total amount of laser treatment given (mean no. in regressed eyes 5800 burns, non-regressed 3510 burns; p < 0.05). Renal disease and age (< 50 years) were identified as risk factors for non-regression (p < 0.05); hypertension, neuropathy, duration of disease and insulin dependence had no significant effect on outcome. We conclude that regression of proliferative disease is significantly related to the cumulative total number of laser burns applied and that successful laser photocoagulation in patients with diabetic renal disease requires considerably more treatment than that suggested by earlier studies.
Collapse
Affiliation(s)
- M F Cordeiro
- Department of Ophthalmology, Greenwich District Hospital, London, UK
| | | | | | | |
Collapse
|
40
|
Affiliation(s)
- M F Cordeiro
- Wound Healing Group, Institute of Ophthalmology, London, UK
| | | | | |
Collapse
|
41
|
Cordeiro MF, Constable PH, Alexander RA, Bhattacharya SS, Khaw PT. Effect of varying the mitomycin-C treatment area in glaucoma filtration surgery in the rabbit. Invest Ophthalmol Vis Sci 1997; 38:1639-46. [PMID: 9224294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To investigate the effect of varying the treatment area of subconjunctival mitomycin-C (MMC) using an adapted rabbit model of filtration surgery. METHODS Twenty-four New Zealand White rabbits underwent filtration surgery, with random allocation to one of three treatments: 5-minute subconjunctival applications of MMC (0.4 mg/ml) with either a large (8 x 10 mm) or small (4 x 2 mm) sponge or no treatment (control). Drainage was achieved by placing an intravenous cannula through a scleral tunnel into the anterior chamber. Rabbits were examined at set intervals for up to 30 days after surgery. Measurements of appearance, size, height, and vascularity of blebs and of intraocular pressure and anterior chamber depth were made by a masked observer. Histologic analysis of eyes was performed at 3, 14, and 30 days. RESULTS Statistical analysis showed a significant difference in bleb survival among all groups (log rank P = 0.0054, with 100% survival with large areas of MMC treatment). Comparison between large and small treatment area groups revealed significant differences in bleb survival (log rank P = 0.0388); bleb area (between-subject analysis, P = 0.009), and bleb height (between-subject analysis, P = 0.005). These differences were seen clinically, with large areas of MMC treatment producing diffuse and elevated blebs, small areas of treatment producing thin-walled and localized blebs with scarring at 21 days, and no treatment resulting in comparatively vascularized and scarred blebs before 14 days. Histologic analysis revealed clear differences among groups, with an increase in subconjunctival cellularity and scar tissue in eyes with failed blebs. CONCLUSIONS The size of the area of subconjunctival MMC treatment significantly affects surgical outcome. Histologic features mirror differences observed clinically. Alteration of the size of the MMC treatment area may provide an alternative and more controllable approach to modulating the wound-healing response after drainage surgery and, more important in the clinical context, to modifying bleb morphology.
Collapse
Affiliation(s)
- M F Cordeiro
- Wound Healing Group, Institute of Opthalmology, London, England
| | | | | | | | | |
Collapse
|
42
|
Cordeiro MF, Stanford M, Shilling JS, Holder GE. Electroretinogram as indicator of prognosis of central retinal vein occlusion. Br J Ophthalmol 1995; 79:507. [PMID: 7612574 PMCID: PMC505151 DOI: 10.1136/bjo.79.5.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
43
|
Cordeiro MF, Lloyd ME, Spalton DJ, Hughes GR. Ischaemic optic neuropathy, transverse myelitis, and epilepsy in an anti-phospholipid positive patient with systemic lupus erythematosus. J Neurol Neurosurg Psychiatry 1994; 57:1142-3. [PMID: 8089695 PMCID: PMC1073153 DOI: 10.1136/jnnp.57.9.1142] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
44
|
Cordeiro MF, Graham EM. Retinal infections. Br J Hosp Med (Lond) 1994; 51:402-8. [PMID: 8081577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Retinal infections may occur as part of a multisystem disease or as a distinct clinical entity. Early recognition of such infections and prompt treatment may prevent permanent visual loss, and can provide important diagnostic information.
Collapse
|
45
|
Abstract
Ophthalmoscopy is an essential part of a complete clinical examination of a patient. However specific formal instruction in fundoscopy is rarely given to medical students. We decided to determine the value of explicit teaching of ophthalmoscopy and devised and validated a rating scale for assessing performance which was used to evaluate 29 first year clinical medical student volunteers at St. Bartholomew's Hospital Medical College, before and after formal instruction in fundoscopy. The competence of this group at ophthalmoscopy was then compared to the rest of their year (109 medical students) during the objective structured clinical end-of-year examination. Students formally instructed in ophthalmoscopy showed an improved score after instruction (from 53% to 77%). They also performed better at fundoscopy than the rest of their year (mean average score 64%), when tested 2 months later, suggesting persistence of the training effect. However as a group they performed no better than their peers at clinical skills other than ophthalmoscopy. We suggest that as fundoscopy is such an important clinical skill, medical students should be given specific teaching, preferably in their ophthalmology firm attachment, as we have shown that it results in a persistent improvement in performance.
Collapse
Affiliation(s)
- M F Cordeiro
- Department of Ophthalmology, St. Bartholomew's Medical College, London
| | | | | |
Collapse
|
46
|
|