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@#AIM: To compare the safety and effectiveness of pars plane filtering(PPF)and trabeculectomy(TRA)on neovascular glaucoma(NVG). <p>METHODS: This retrospective comparison was done in 12 patients(one eye with NVG in each)who were treated with PPF surgery and 15 patients who were treated during the same period with TRA, one eye was treated in each patient. Intraocular pressure(IOP), complete surgical success rate, peripheral anterior chamber depth(PACD), postoperative anterior chamber morphology, visual acuity and complications were observed and compared between the two groups.<p>RESULTS: The IOP was significantly reduced at each time point after the surgery 1, 3d, 1wk, 1, 3mo after operation(P<0.05), and there was no significant between-group difference at any time point(P >0.05). The rate of complete success observed 3mo after operation was superior in PPF group(92% vs 53%, P<0.05). PACD was found to be deeper at 1wk after the operation in PPF group as compared with the values before the operation and was deeper than that in TRA group(P<0.05); while this comparison in TRA group showed no significant change(P>0.05). After the operation, the anterior chamber angle was open and the anterior chamber was deepened in PPF group. No significant changes in visual acuity before and after the operation within each group and between groups were observed 3mo after the surgery(P>0.05). The incidence of postoperative hemorrhage in anterior chamber was lower in PPF group(8% vs 47%, P<0.05). <p>CONCLUSION: Both PPF and TRA surgery can successfully control IOP of NVG. However, PPF surgery appeared to be superior as having a higher complete success rate. In addition, PPF surgery makes the anterior chamber deeper and wider, and result in fewer severe postoperative complications.
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At present, the mechanism of scar formation in filtering area after glaucoma filtering surgery has not been fully understood.It is believed that stimulation of cytokines and growth factors during postoperative wound healing causes excessive activation of fibroblasts in the Tenon capsule, resulting in the deposition of extracellular matrix and scar formation.Long non-coding RNA (lncRNA) is a kind of RNA sequence that does not encode proteins.It can regulate cell proliferation, apoptosis and become a precursor of microRNA, and its specific expression has been proved and plays an important regulatory role in various fibrotic tissue.With the deepening of research, lncRNA has also been found to be involved in the formation and development of filtering bleb scarring after glaucoma filtering surgery.Previous studies have shown that lncRNA is specifically expressed in Tenon capsule tissues after glaucoma filtering surgery, and different lncRNAs can affect the proliferation of fibroblasts in Tenon capsule or the synthesis of extracellular matrix through different ways, which can affect the formation of fibroblasts scarring.In this article, the role of different lncRNAs in the proliferation of Tenon fibroblasts and its potential in treating bleb scarring were summarized so as to provide a new direction for the treatment of postsurgical scarring.
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Objective:To investigate the effect of long-term application of prostaglandin analog drops on bulbar conjunctival thickness in rabbits.Methods:Twenty-four healthy New Zealand white rabbits were randomly divided into latanoprost group, carteolol group and blank control group using the random number table method, with 8 rabbits in each group.The left eyes of rabbits were taken as experimental eyes.The rabbits in the latanoprost group and carteolol group were given latanoprost eye drops or carteolol eye drops once a day for 2 months according to grouping.The bulbar conjunctival thickness of left eyes of the latanoprost group and carteolol group were measured by optical coherence tomography (OCT) at baseline and two months after administration, respectively.The conjunctival tissue of the three groups were extracted to investigate the protein and mRNA expression level of matrix metalloproteinases-1 (MMP-1) and MMP-3 by Western blot and real-time fluorescence quantitative polymerase chain reaction (PCR). The study protocol was approved by an Ethics Committee of Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (No.2017-0014). The use and care of the experimental animals complied with the ARVO Statement.Results:In the latanoprost group, the conjunctival thickness was significantly reduced from baseline (178.88±5.23)μm to (124.19±11.29)μm at 2 months after administration ( P<0.01). In the carteolol group, there existed no significant difference in the conjunctival thickness between baseline (184.94±11.85)μm and (183.31±8.71)μm at 2 months after administration ( P>0.05). The conjunctival thickness at 2 months after administration of the latanoprost group was significantly thinner than that of the carteolol group ( P<0.01). The protein and mRNA expression levels of MMP-1 and MMP-3 in conjunctival tissue of the latanoprost group were significantly higher than those of the blank control group and carteolol group (all at P<0.01). Conclusions:The long-term topical use of prostaglandin analog drops can significantly reduce the bulbar conjunctival thickness in rabbits.The mechanism may be related to the elevated expression levels of MMP-1 and MMP-3 in the bulbar conjunctival tissue.
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Se realizó una búsqueda sobre la evaluación cualitativa de la ampolla de filtración. La ampolla conjuntival es la parte visible de la cirugía filtrante, y su morfología es un indicador de factores que pueden determinar el resultado hipotensor de la cirugía y las posibles complicaciones posoperatorias. Se han desarrollado diversos estudios que relacionan la evaluación clínica de su morfología y el control de la presión intraocular, y se han establecido varios sistemas de puntuación, entre ellas: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale y métodos de imagen para evaluar el segmento anterior (biomicroscopia ultrasónica, Tomografía retinal de Heidenberg y tomografía de coherencia óptica). Estos métodos proporcionan una herramienta útil para el seguimiento de la cirugía filtrante y su documentación(AU)
A review was conducted on the qualitative evaluation of the filtering bleb. The conjunctival bleb is the visible part of filtration surgery, and its morphology is an indicator of factors which may determine the hypotensive result of surgery and the possible postoperative complications. Various studies have been conducted which relate the clinical evaluation of its morphology and intraocular pressure control. Several grading systems have thus been established: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale and imaging methods to evaluate the anterior segment (ultrasound biomicroscopy, Heidenberg retinal tomography and optical coherence tomography). These methods are a useful tool for the follow-up of filtration surgery and its documentation(AU)
Subject(s)
Humans , Glaucoma/surgery , Filtering Surgery/adverse effects , Tomography, Optical Coherence/methods , Evaluation Studies as TopicABSTRACT
Irido-Corneal Endothelial (ICE) syndrome is an uncommon clinical entity which includes corneal endothelial damage, obstruction of anterior chamber angle, iris atrophy, and polycoria.ICE syndrome is a spectrum of clinical entities namely Progressive Iris Atrophy (PIA), Cogan Reese Syndrome (CRS), and Chandler Syndrome (CS). It is considered to be sporadic, usually unilateral and diagnosed in young adults, females and occasionally in children. Corneal decompensation and glaucoma are the commonest causes of vision loss in patients with ICE syndrome.Medical management of this condition is usually with topical antiglaucoma medication. In most cases medical therapy fails and requires Glaucoma Filtration surgery. Glaucoma drainage devices are the mainstay of treatment and many patients require keratoplasty. We wanted to study the clinical profile of ICE syndrome patients, its association with glaucoma in Indian population and compare the findings with those of previous studies. METHODSIn this retrospective study, data of 50 consecutive patients having ICE syndrome at a tertiary eye care centre was collected. RESULTSOut of 50 patients, 28 (56%) were females, aged 7 to 65 years (median - 40.72 years). 49 patients (98%) had unilateral presentation, and one had bilateral involvement (2%). Progressive Iris Atrophy (PIA) was seen in 20 (40%), Chandlers Syndrome (CS) in 20 (40%) and 10 eyes (20%) had Cogan-Reese Syndrome (CRS). 46 (92%) eyes had glaucoma. Mean Intra-Ocular Pressure (IOP) was 23.70 ± 11.7 mm of Hg. Mean AGM used was 2.44 ± 1.3. 44 (88%) eyes were diagnosed to have glaucoma at presentation, 1 (2%) eye was diagnosed with glaucoma during follow up. 20 (40%) eyes were managed medically for IOP control. 8 (16%) eyes had undergone previous glaucoma surgery. 20 (40%) eyes underwent glaucoma surgery for IOP control. 15 (30%) eyes had Trabeculectomy with Mitomycin C, 5 (10%) had Ahmed glaucoma valve. 4 (8%) eyes underwent diode cyclophotocoagulation. 6 (12%) eyes required more than 1 surgery for IOP control. 6 (12%) eyes underwent penetrating keratoplasty (PK) for corneal oedema. Mean period of follow up was 8.4 ± 6.4 months. There were no cases of sight threatening complications like suprachoroidal haemorrhage, blindness or endophthalmitis. CONCLUSIONSGlaucoma is strongly associated with ICE syndrome. ICE patients may require more than 1 surgery for IOP control. They are commonly associated with corneal complications which may require penetrating keratoplasty.
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@#The lens plays a crucial part in the etiology of primary angle-closure glaucoma(PACG). The changes in the thickness and position of the lens have been related to common structural deviations observed in PACG eyes such as: shallow anterior chamber, pupillary block and crowded anterior chamber angle. Lens extraction has long been used to treat PACG, which combined with anti-glaucoma surgeries remains a commonly employed therapy. This article aims to summarize the medical outcome and role of phacoemulsification with or without anti-glaucoma surgeries in the treatment of PACG.
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Filtering bleb scarring is the main cause of glaucoma filtration surgery failure. Subconjunctival injection of antimetabolites, such as mitomycin and 5-fluorouracil, is widely used clinically to reduce the incidence of scarring, which improves the success rate of the surgery. However, accompanied side effects such as cytotoxicity should not be ignored. Secreted protein acidic and rich in cysteine (SPARC) as a matricellular protein is widely distributed in the eyes, which plays an important role in the process of wound repairing and tissue remodeling. The expression of SPARC is significantly elevated in the mouse model of subconjunctival scarring. Researches suggest that SPARC participates in and regulate the formation of bleb scarring through multiple pathways, therefore it may become a specific new target in the anti-scarring therapy.
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@#Filtering channels carring and subsequent obstruction are the main cause of operation failure after glaucoma filtration surgery. During the process of scarring, human Tenon fibroblasts are transformed into myofibroblasts and secrete a large amount of extracellular matrixproteins. The derangement of the collagen fiber is also observed. A large number of studies have been carried out by domestic and foreign researchers on the treatment of postoperative filtering channel scarring. In this review we summarize the mechanisms of scar formation after glaucoma filtration surgery and corresponding research progress in recent years.
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OBJECTIVE@#To study the anti- scarring effect of rapamycin in rabbits receiving glaucoma filtering surgery.@*METHODS@#Ninety-six Chinchilla rabbits were randomized equally into 3 rapamycin treatment groups and one control group. All the rabbits underwent trabeculectomy, after which the rabbits in the 3 rapamycin groups were treated with eye drops containing 1%, 3%, or 5% rapamycin in the operated eyes, and those in the control groups were given castor oil 4 times a day. The intraocular pressure (IOP) and inflammatory reaction in the treated eyes were observed, and the PCNA-positive cells in the filtering bleb were detected using immunohistochemistry. RTFs isolated from the Tenon's capsule of the rabbits were cultured , and the expressions of caspase-3, caspase-8, and caspase-9 in the fibroblasts were detected after treatment with different concentrations of rapamycin.@*RESULTS@#The IOP was significantly lower in rapamycin-treated group than in the control group after the surgery ( < 0.05). The counts of the PCNA-positive cells were significantly lower in rapamycin-treated rabbits than in the control group ( < 0.05). Rapamycin treatment dose-dependently increased the expressions of caspase-3 and caspase- 9 at both the mRNA ( < 0.001) and protein ( < 0.001) levels without causing significant changes in the expressions of caspase-8.@*CONCLUSIONS@#Rapamycin can inhibit excessive proliferation of the fibroblasts in the filtering bleb to reduce scar formation after glaucoma filtration surgery in rabbits. Rapamycin also increases the expressions of caspase-3 and caspase-9 to induce apoptosis of the RTFs.
Subject(s)
Animals , Rabbits , Caspase 3 , Metabolism , Caspase 9 , Metabolism , Cell Proliferation , Cicatrix , Filtering Surgery , Glaucoma , General Surgery , Intraocular Pressure , Postoperative Complications , Proliferating Cell Nuclear Antigen , Random Allocation , Sirolimus , Therapeutic Uses , TrabeculectomyABSTRACT
Objective To evaluate the effect of two polymer membranes, polyhydroxyalkanoates(PHA)and polylactic acid(PLA)during glaucoma filtration surgery(GFS),and to evaluate the morphology of membranous PHA after interlamellar implantation. Methods Twenty-eight New Zealand white rabbits were chosen and twenty-four of them were randomly divided into 6 groups(n=4):the PHA-low group,PHA-high group,PLA-low group,PLA-high group,positive control group(MMC group)and blank control group. The rabbits in each group received GFS. The corresponding polymer membranes were implanted under the scleral flap,while the MMC group was treated with 0.2 mg/mL mitomycin C(MMC) for 3 minutes,and the blank control group was treated without extra drugs. The intraocular pressure(IOP)was examined at 0 d,1 d, 3 d, 7 d, 14 d, 28 d and 84 d after GFS. The corneal layers of four rabbits were implanted with PHA membranes and the corneal morphological changes were observed after 84 d. Results The IOP of the PHA-low and PLA-high groups was lower than that of the blank control group at 84 d after GFS(P < 0.05),and was similar with that of the MMC group(P> 0.05). Morphological studies showed that there were no collagenous fibers filling in the duct, and the collagenous fibers around the membranes were generally arranged in parallel. There were no obvious changes in the peripheral collagen structure after implantation of PHA membranes between the corneal layers. Conclusions Application of PHA and PLA membranes during GFS in rabbits may maintain the level of IOP,and the effect is similar with MMC. The mechanism may be achieved through the mechanical blocking of fibrous tissue.
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·Glaucoma filtration surgery is currently the preferred method for patients in whom anti-glaucoma medication and laser treatment can not control intraocular pressure, and its postoperative filtering bleb scar formation is the leading cause of surgical failure. At present, there are some progresses in the basic and clinical studies of postoperative anti-glaucoma scar. However, it is still a problem to seek for an effective, safe and stable treatment of scarring after glaucoma filtration surgery. Those articles published in the past three years on the glaucoma filtration after anti-scarring related drugs are reviewed.
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Se describen dos casos clínicos (hermanos), con el objetivo de mostrar diferentes opciones terapéuticas en el glaucoma por cierre angular primario por iris en meseta. El primer caso representa una paciente femenina con antecedentes de iris en meseta e iridectomía periférica quirúrgica, quien presentaba cifras de tensión intraocular elevadas y progresión del daño glaucomatoso, por lo que se decidió realizar trabeculectomía en ambos ojos, con evolución satisfactoria. El segundo caso se trata de un paciente masculino, con antecedentes de salud, quien acudió por molestias oculares. Tras examen físico oftalmológico se constató glaucoma por cierre angular por iris en meseta, con presión intraocular elevada y opacidad del cristalino asociada, por lo que se realizó trabeculectomía en ojo derecho más extracción del cristalino en ambos ojos. Como complicaciones posoperatorias presentó desprendimiento coroideo y edema macular, resueltos con tratamiento médico. La trabeculectomía luego de la extracción del cristalino en ojo derecho falló, por lo que actualmente se encuentra compensado con tratamiento médico. La elección de la terapéutica adecuada debe tener en cuenta los factores fisiopatológicos involucrados y la forma de presentación(AU)
Different therapeutic options for the primary angle closure glaucoma by plateau iris were described in two clinical cases. The first one was a female patient with a a history of plateau iris and peripheral iridectomy. Elevation of intraocular pressure and progression to glaucoma was confirmed, so it was decided to perform trabeculectomy in both eyes and the result was satisfactory. The second case was a male patient with history of health problems, who suffered with eye disturbances. After ophthalmological exam, a primary angle closure glaucoma caused by plateau iris was confirmed with marked eye hypertension and associated crystalline lens opacity. Trabeculectomy of right eye and lens extraction in both eyes was applied. Choroidal detachment and macular edema were the postoperative complications, but the medical treatment managed to solve this situation. After the lens extraction, trabeculectomy in the right eye failed and today it is compensated with medical treatment. The right therapeutic choice should take into consideration the physiopathologic factors and the form of presentation(AU)
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Humans , Male , Female , Middle Aged , Glaucoma, Angle-Closure/diagnosis , Iridectomy/methods , Trabeculectomy/statistics & numerical data , Macular Edema/drug therapy , Pseudophakia/therapyABSTRACT
Glaucoma filtration surgery is a challenge for any glaucoma surgeon, because of its variable results and numerous complications. The Ex-PRESS glaucoma shunt, when used along with trabeculectomy gives a controlled drainage of aqueous and hence most of the complications due to over filtration like hypotony, choroidal detachment could be avoided. Tissue erosion and migration of device were initially noted, but later became rare due to modifications in techniques, like use under a sclera flap. The Ex-PRESS glaucoma shunt implant is a promising device in glaucoma filtration surgery, if used judiciously.
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·To improve the effect of glaucoma filtration operation in reducing intraocular pressure ( lOP ) , it’s important to prevent and inhibit fibrotic scar formation during and after operation.This paper focuses on the current and future possible means for modulation of wound healing after glaucoma filtration surgery, mainly including series of medications ( antimetabolites, anti-inflammation drugs, antigrowth factor drugs, drugs acting on cell signal pathways, etc.) , new drug delivery system and other technologies. This article also discusses the future orientation in this field.
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Abstract?AlM: To observe the clinical efficacy and safety of glaucoma filtration surgery combined with the application of 5 - fluorouracil for clinical treatment to offer the reference.?METHODS:A total of 91 cases of patients with glaucoma treated in our hospital were randomly divided into three groups, 30 cases of group A were given mitomycin in surgery, 31 cases of group B were given 5-fluorouracil, 30 cases of group C were given cyclosporine. They were given 12 -month-follow-up after operation, the operation success rate were recorded, the incidence of 1 -year-adverse reactions, visual acuity, intraocular pressure, low intraocular pressure, shallow anterior chamber, corneal damage index were recorded.?RESULTS: lntraocular pressure ofgroups A, B, C were respectively (20.5±8.6)mmHg,(15.2±5.5)mmHg,(20.0± 8. 1 ) mmHg, by the analysis of variance, group B was significantly lower than other two groups,P<0. 05;patients of groups A, B, C whose visual acuity increased ratios after 1y were respectively 22. 5%, 38. 1%,and 23. 1% , by the Chi. square test, the increased ratio of group B was higher than other two groups , P<0. 05; The operation success rates after 1y of operation of groups A, B, C were respectively 67. 5%,88. 1%,71. 8%,by the Chi square test, the increased ratio of group B was higher than other two groups, P<0. 05;The general incidence of adverse reaction were respectively 22. 5%,9. 5%,20. 5%,by the Chi square test , the increased ratio of group B was lower than other two groups, P<0. 05.?CONCLUSlON:Glaucoma filtration surgery combined with the application of 5-fluorouracil can improve the operation success rate, decrease the occurrence rate of adverse reaction, and safety can be improved.
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AIM: To observe the morphologic changes of of filtration blebs after trichostatin A treatment in an experimental glaucoma filtration surgery ( GFS) . METHODS:Subconjunctival injection TSA, mitomycin C ( MMC) and PBS during the filtering surgery in rabbits. The morphologic changes of filtration blebs were evaluated by Krofeld score method postoperatively days 3, 7, 14, 21, and 28. RESULTS: TSA induced filteation bleds were elevated diffusely within 14d and cystic blebs formed 28d, filtration bleb score was significantly higher in TSA group than that in PBS group. CONCLUSION: TSA can keep the aqueous humor outflow by inhibiting scar formation and prolong the existence of the filtration bleb.
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At present, filtration surgery remains an important treatment of glaucoma, and filtering bleb fibrosis is the main cause for treatment failure. Filtering bleb fibrosis is a common fiber hyperplastic disease, and it relates to the activation and proliferation of fibroblasts and the excessive production of extracellular matrix ( ECM) such as collagen protein. The most frequently-used drugs for filtering bleb fibrosis in clinic are 5-fluoro-2,4 (1h, 3h) pyrimidinedione ( 5 - Fu ) and mitomycin ( MMC ) . Although they are effective in some degree, they also have some serious side effects which restrict their clinical use. Triptolide ( TPL) is a major active component of the medicinal plant, tripterygium wilfordii hook. f. ( TWHF) . TPL has multiple pharmacological activities including immunosuppressive, anti- inflammatory, anti- cancer and anti-fertility activity. Reviewing related literatures published in recent ten years, we confirmed that TPL seemed to possess a pharmacological activity in treating filtering bleb fibrosis. Since it has three major functions:1. inhibit the activation and proliferation of fibroblasts and the excessive production of collagen protein; 2. alleviate the inflammatory reaction after surgical wound to suppress fibrous scar formation; 3. TPL has a protective effect on retinal ganglion cells ( RGCs ) . We further find that TPL's anti-fibrosis activity mainly results from that it inhibits TGF-β/Smad,NF-κB and PI3K/AKT signal transduction pathway. This comprehensive analysis about the feasibility of Triptolide's role in treating filtering bleb fibrosis after the filtration surgery of glaucoma can help us develop new drugs for filtering bleb fibrosis and exploit TPL's clinical value on some level.
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Background Scarring of the filtering bleb is a main cause of filtering surgical failure in glaucoma.It has been reposed that tetrandrine could suppress the proliferation of cultured human fibroblast of Tenons capsule in vitro and thus has the potential effect to prevent scarring after the filtering surgery. Objective Present study was to investigate the anti-cicatricial effect of tetrandrine drug delivery system(Tet DDS)during filtration surgery. Methods Filtration surgery was performed in bilateral eyes of 18 New Zealand white rabbits.The Tet DDS with 0.3 mg Tet,0.2 mg Tet or free-Tet were implanted subcunjunctially during the surgery.The filtering blebs were scored in 1 day,4,7,10,14 days after referring to the corneal thickness and bleb range under the slit-lamp biomicroscopy.The morphology of filtering bleb was assessed by in vivo confocal microscopy in 7 and 14 days after operation.The filtering bleb specimen was prepared in 7 and 14 days for the histopathological examination. Results The filtering bleb scores in Tet DDS implantation groups were significantly higher than those in free-Tet DDS group from 4 days through 14 days after trabeculectomy(P＜0.01),and the scores showed a considerably increase in 0.3 mg Tet DDS group compared with 0.2 mg Tet DDS group from 7 days through 14 days after trabeculectomy(P＜0.05).The filtering blebs of Tet DDS implantation groups were found with distinct subepithelial cystic spaces under the light microscopy and in vivo confocal microscopy on the 7th day and 14th day after surgery.Compared with free-Tet DDS group,the numbers of subepithelial mierocysts were much more(P＜0.01)and the area of microcysts was larger(P＜0.01)in Tet DDS group.The filtering tissue presented with more subepithelial microcysts and larger microcysts range in 0.3 mg Tet DDS group than 0.2 mg Tet DDS group in 7 and 14 days after operation(P＜0.05).The inflammatory cell infiltration wag milder in 0.3 mg Tet DDS group in comparison with 0.2 mg Tet DDS group and free-Ted DDS group.Conclusion Tet DDS has strong inhibitory effects on inflammatory cells activity and fibroblagt activity the early stage after filtering surgery and therefore improve the surgery success rate.
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AIM: To investigate the influence of He-Ne laser on connective tissue growth factor (CTGF) expression and collagen formation of fibroblast in filtration site after trabeculectomy in rabbit, and to discuss the mechanism for preventing scar formation with He-Ne laserin vivo.METHODS: The upper nasal limbus area next to the upper rectus muscle in right eyes Received 10 minutes He-Ne laser irradiation (200mW/cm2) every day for three days, the left eyes served as control. Twenty-four hours after the last irradiation, both eyes of the rabbits were took trabeculectomy surgery. The expressions of CTGF in the filtration area were tested on the 7th, 14th and 28th day after surgery and collagen density was tested on the 14th and 28th day after surgery. Each of the time point had 7 rabbits. RESULTS: The expression of CTGF was lower than that of the control group's on the 7th and 14th day after trabeculectomy surgery (P=0.01, P=0.005). When examined on the 14th and 28th day, the collagen density of irradiation group were significantly lower than that of the control group's (P=0.013, P=0.01).CONCLUSION: Pretreating the filtration area with 200mW/cm2 He-Ne laser may be helpful in preventing scar formation after trabeculectomy in rabbit, possibly due to downregulation of the expression of CTGF and collagen synthesis in fibroblasts. He-Ne laser may be developed into a new scar preventing method in filtration surgery.