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?AIM: To evaluate the effect for refractory glaucoma by using Ex - Press miniature implantation with deep sclerectomy.?METHODS: Thirty eyes in 24 patients with refractory glaucoma were treated by Ex- Press miniature ( P50 ) implantation with deep sclerectomy. The patients’ symptom, intraocular pressure ( IOP ) , visual acuity and complications were analyzed in a 12mo follow-up period.?RESULTS: During the follow-up period, all patients’ ocular pain was reduced. The mean IOP before operation and at the last follow-up time were 51. 15 ± 2. 60mmHg (1kPa=7. 5mmHg) and 15. 11 ± 2. 51mmHg, respectively, there was significant difference (P<0. 05). Postoperative visual acuity was improved in 8 eyes, had no significant change in 22 eyes. After operation, hyphema of anterior chamber appeared in 2 eye ( 7%) , which were obsorbed after 1wk.? CONCLUSION: Ex - Press miniature implantation combined with deep sclerectomy surgery is a relatively effective and safe treatment for the patients with refractory glaucoma. This method can significantly degrade the IOP, lessen ocular pain and reduce the complications risk.
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AIM: To investigate the clinical therapeutic effects of human umbilical vein (HUV)implantation and mitomycin C (MMC) in non-penetrating trabecular surgery (NPTS). METHODS:A total of 32 patients (46 eyes) with uncontrolled primary open angle glaucoma (POAG) were divided into two groups: HUV+MMC group (n=25), SKGEL+MMC group (n=21). The procedure commenced with the creation of a limbus based conjunctival flap. After the dissection of a superficial limbus based rectangular scleral flap, MMC(0.4mg/mL) was used superior and inferior surface of the superficial scleral flap for three minutes. A second limbus based scleral flap was carefully dissected beneath the previous one towards the choroid. Schlemm's canal was deroofed during the extension of the deep scleral flap toits limbal edges. HUV or SKGEL fixed on the bed of sclera in experimental group. Postoperative examinations were performed at 1 week,2,4 weeks;2,6,12 months. IOP,best-corrected visual acuity(BCVA), functional blebs and success rate were examined. RESULTS: There were no statistically differences with postoperative IOP in HUV+MMC group and SKGEL+MMC group (P>0.05) during 1 week to 12 months. There was no difference with postoperative function blebs and the change of BCVA during 1 week to 12 months between HUV+MMC group and SKGEL+MMC group (P>0.05).At 12 months after surgery, the success rate was 84% in HUV+MMC group,86% in SKGEL+MMC group. CONCLUSION: The application of HUV in NPTS can prevent the adhesion of filtering channel and it can improve the success rate of NPTS. Compared with SKGEL, HUV has lower price. So it is a better implant.
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AIM:To compare one-site vs two-site phacotrabe-culectomy in chronic angle-closure glaucoma (CACG) coexisting with cataract.METHODS:This prospective, randomized study included 41 eyes with CACG. One-site approach was performed in 21 eyes and two-site procedure in 20 eyes. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), the number of antiglaucoma medications and complications were observed. All patients were followed up for 9 months.RESULTS:There were no significant differences between the two groups preoperatively. IOP decreased from 22.7±4.9mmHg and 23.7±4.7mmHg preoperatively in one-and two-site groups to 18.0±1.2mmHg and 16.7±1.1mmHg 9 months after operation respectively(P<0.05). There were no significant differences in mean IOP between the two groups at any time (P>0.05). Decrease of the number of antiglaucoma medications and BCVA improvement were similar in both groups 9 months after surgery (P>0.05).There were no significant differences in complications between the two surgical procedures.CONCLUSION:There were no significant differences between the two groups in clinical efficacy and complications.
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Background TLR-4 is a natural immunity receptors in immunity,and it plays an important role in the repair of central nervous system damage.But its effect in glaucoma optic nerve injury is unclear.Objective This study was to investigate the expression of TLR-4 in retina with high intraocular pressure(IOP)in genetic and Drotein level and therefore explore the mechanism of TLR-4 on retinal ganglion cells(RGCs)injury. Methods Chronic ocular hypertension models were established in the right eyes of 150 clean purebred Sprague-Dawley rats by cauterizing the 3 sallow sclera veins.IOP was measured before and after 2 h,1 day,3,7,14,28,56 days after operation by PEN Ⅱ TONO-type pen tonometer.The expression of TLR-4 protein in rat retina was detected by immunohistochemistry and Western blot,and expression of TLR-4 mRNA was assayed by real time-PCR.This experimental procedure foliowed the Statement of Association for Research in Vision and Ophthalmology. Results The IOP was elevated in various time points after operation in experimental group,showing significant differences in comparison with control group(P<0.01).The immunohistochemistry revealed that the expression of TLR-4 protein in rat retina with chronic hypertension in 2 h,1 day,3,7,14,28,56 days after operation with the high A298 values in comparison with control eyes(P<0.05-0.01).Increased levels of TLR-4 mRNA in rat retinas were detected by RTPCR in high IOP eyes compared with control eyes in all time points after operation,presenting statistically significant differences between two groups(P<0.05-0.01).Western blot detection displayed the high expression of TLR-4 in retina in high IOP eyes early after operation with statistically significant results between model group and control group (P<0.05-0. 01). Conclusion TLR-4 is up-regulated in rat retina with chronic high IOP,suggesting that TLR-4 plays an immunoregulatory effect in glaucomatous eye.
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Background Neovascular glaucoma is a type of refractory glaucoma.Biological amnion combined with glaucoma valve implantation is a primary therapy and its long-term effectiveness is noticeable. Objective The goal of this Survey was to evaluate the effectiveness of biological amnion combined with glaucoma valve implantation for neovascular glaucoma and compare the clinical outcome with simple glaucoma valve implantation. Methods This was a retrospective observational case series.The clinical data of 44 eyes of 44 patients received biological amnion combined with glaucoma valve implantation for neovascular glaucoma and 43 eyes of 43 patients received simple glaucoma valve implantation for neovascular glaucoma were retrospectively analyzed and compared.The age,sex and disease-cause were matched between these two groups.Patients were followed-up for 24 months after operation.Surgery success was identified as the intraocular pressure(IOP)<21 mmHg after operation.Written informed consent was obtained from each patient prior to the operation.Results The IOP was<21 mmHg throughout the follow-up duration in both groups.No significant difierence was found in the IOP value in 1 week after operation between two groups(t=-5.34,P=0.60).However,IOP values were lower in biological amnion combined with glaucoma valve implantation group in 3,12 and 24 months after operation than those of simple glaucoma valve implantation(t=6.64,t=5.00,t=7.81,P<0.01).Operation successful rates in biological amnion combined with glaucoma valve implantation group were 97.73％.93.18％。90.24％and 82.05％in 1 week,3 months,12 months and 24 months respectively after operation.and those in simple glaucoma valve implantation were 95.35％,71.43％,65.00％and 60.53％in corresponding time points,showing considerably significant differences between two groups (χ2=7.06,χ2=7.47,χ2=4.37,P<0.05).There was no significant difference in Ihe number of eyes with complication between the two groups(P>0.05). Conclusion The biological amnion combined with glaucoma valve implantation surgery may be more effective and safe for the treatment of neovascular glaucoma than with glaucoma va]ve only.
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·AIM: To study the expressive variation of Nogo-A on rat retina in the process of chronic ocular hypertension. · METHODS: Thirty-six healthy adult male Wistars were randomly divided into control group (6 rats) and chronic hypertension group (30 rats). Chronic hypertension was created by cauterizing the superficial scleral veins. Immunohistochemistry technique was used to evaluate the expressive varieties of Nogo-A at different time points during the course of chronic ocular hypertension. · RESULTS: The success of the model was indicated by over 40% of increase in the IOP as compared with normal rats. Compared with control group, as time passed chronic hypertension group gradually had detectable morphology changes in the retina. At the 21st day of chronic ocular hypertension, retinas became thinner and the quantity of retinal ganglion cell (RGC) decreased (P<0.05). Assoicated with the morphological changes, the expression of Nogo-A was strongly increased (P<0.05).CONCLUSION: Myelin associated protein Nogo-A plays a part in the process of chronic ocular hypertension.
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AIM: To investigate the effect of PEDF on retinal neovascularization in mice. METHODS: 40 7-day-old C57BL/6J mice was exposed to 750mL/L oxygen for 5 days and then to normal situation to produce the murine model of oxygen-induced retinopathy(OIR). One eye of the mouse was regarded as experimental one and the other served as control. Eyes in experimental group received intravitreal injection of PEDF and eyes in control group received intravitreal injection of PBS at postnatal day 12. All mice were executed at postnatal day 17. The changes of retinal vessels of mice were observed by ADPase histochemical technique. The inhibitory effect of PEDF on retinal neovascularization was evaluated by counting the endotheliocyte nuclei of new vessels which extended from retina to vitreous in the tissue slice of HE staining. RESULTS: Neovascularization was reduced, retinal blood vessels distributed regularly and non-perfusion areas were not found in eyes of experimental group compared with control group. The number of endotheliocyte nuclei of new vessels extending from retina to vitreous was significantly less in the eyes of experimental group (10.18±1.74) than that in control group (38.89±2.98) (P<0.01). Retinal toxicity and inflammatory reactions were not found in tissue slice.CONCLUSION: PEDF inhibits retinal angiogenesis in OIR and the feasibility should be determined for use of PEDF in ocular angiogenesis treatment.
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AIM: To study caspase-9 expression on rat retina in the process of chronic elevation of IOP and the changes with the application of amino guanidine (AG), thus to investigate potential protective function of AG to rat retina with chronic elevation of IOP.METHODS: Immunohistochemistry, RT-PCR and Western blot were used to observe retinal morphology and expression of caspase-9 at different time points of rat with chronic IOP elevation, both affected or not affected by the application of AG.RESULTS: Compared with control group, as time passed retina of experimental group gradually had detectable morphological changes. On 21st day of chronic IOP elevation, retinas became thinner and the quantity of retinal ganglion cells (RGCs) decreased; caspase-9 expression increased, consistent with the morphological changes. The group using AG presented relatively smaller morphology changes and less expression of caspase-9.CONCLUSION: Apoptosis-related gene caspase-9 played a part in the process of chronic IOP elevation; AG protects retina by down-regulating expression of caspase-9.
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Objective To explore the effect of adenovirus carrying pigment epithelium-derived factor(ADV-PEDF)gene treatment on retinal neovascularization of mice with retinopathy of prematurity (ROP).Methods Sixty 7 d C57BL/6J mice were put into the environment with (750?5)mL/L oxygen for 5 days and returned to normal environment to establish animal models of ROP.The eyes in experimental group received an intravitreal injection of 1 ?L of ADV-PEDF,and the same volume of ADV-LacZ was injected into the eyes of mice in control group.The ADPase histochemical staining was used for retinal flatmount to observe changes of retinal vessels.The inhibitory effects of PEDF on retinal neovascularization were evaluated by counting the endotheliocyte nuclei of new vessels extending from retina to vitreous in the tissue-slice.The expression of PEDF in retina were detected by Western blotting.Results The vessels from optic disc were very thin and distorted in eyes of control group in retinal flatmount.There were avascular area around optic disc and neovascular trufts beside avascular area.Compared with control group,regular distributions and no conspicuous avascular area were found in eyes of experiment group in retinal flatmount.The number of the endotheliocyte nuclei of new vessels extending from retina to vitreous was less in the eyes of the experiment group than that in control group (P