ABSTRACT
AIM: To evaluate the efficacy and safety of trabeculectomy at the inferior limbus for patients of intraocular pressure(IOP)after failed glaucoma filtration.METHODS: A retrospective analysis was conducted to identify 51 glaucoma patients with 61 eyes that had undergone trabeculectomy at the inferior limbus for patients of IOP after failed glaucoma filtration. The preoperative and postoperative IOP, visual acuity and number of IOP-lowering drugs, as well as intraoperative and postoperative complications were extracted. Surgical success rates were calculated using Kaplan-Meier survival analysis.RESULTS: The postoperative follow-up time ranged from 6-76(mean 30.15±14.10)mo. The preoperative IOP of 61 eyes was 35.98±10.01mmHg, the IOP after the surgery at 1wk, 1, 3, 6mo, 1a and the IOP of last follow-up visit were 9.62±4.90, 13.15±4.51, 16.05±7.37, 16.48±6.81, 16.68±6.42, 16.77±7.56 mmHg respectively, all of these were different compared to the preoperative IOP(P<0.001). The postoperative complete success rates at 6mo, 1 and 2a were 62%, 49% and 36%, respectively and the partial success rates were 93%, 85% and 81%, respectively. There were 34 eyes(56%)formed functional filtration blebs. There were 3.33±0.77 kinds of IOP-lowering eye drops used before surgery, and it was decreased to 1.41±1.44 kinds of eye drops(t=9.86, P<0.001)at 3mo after surgery. There was no severe complication observed such as filtering bleb infection and endophthalmitis.CONCLUSION: Trabeculectomy at the inferior limbus offers the opportunity for patients with uncontrolled IOP after failed glaucoma filtration, and it can still be used as a safe and effective treatment for patients, although it is relatively difficult to operate.
ABSTRACT
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.
ABSTRACT
@#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.
ABSTRACT
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.
ABSTRACT
@#AIM:To evaluate the efficacy of EX-PRESS glaucoma filtration device combined with phacoemulsification and intraocular lens implantation for refractory glaucoma complicated with cataract.<p>METHODS: Totally 60 patients(60 eyes)of refractory glaucoma were chosen as the research objects between January 2013 and January 2016 in our hospital, who were divided into research group and the control group according to the operation method. Research group(29 patients 29 eyes)was given EX-PRESS glaucoma drainage device combined with phacoemulsification and intraocular lens implantation; control group(31 patients 31 eyes)was given trabeculectomy combined with phacoemulsification and intraocular lens implantation. The visual acuity, intraocular pressure(IOP), the successful rate and other clinical indicators were observed and analyzed. <p>RESULTS: The surgery of all the 60 patients achieved success.The successful rate of research group was 93%, that of control group was 81%, while the difference was not significant(<i>P</i>=0.26). The best corrected visual acuity(BCVA)of both groups was better than before treatment at 6mo after surgery without statistically significant. The postoperative BCVA was not different between the two groups. The IOP between the two groups was significantly different(<i>P</i><0.05). The IOP of research group at 1d, 1 and 3mo was significantly lower than control group(<i>P</i><0.05). The IOP at 6mo after surgery was not significantly between the two groups. The IOP at different time was significantly different(<i>P</i><0.05). The IOP at 1d after surgery was significantly different compared to that at 6mo(<i>P</i>=0.007). <p>CONCLUSION:It has good clinical effect that EX-PRESS glaucoma filtration device combined with phacoemulsification for refractory glaucoma complicated with cataract. It is a treatment with high feasibility, safety and effectiveness.
ABSTRACT
AIM: To observe the clinical effect of Ex - press glaucoma filtration device implantation under scleral flap for traumatic glaucoma. METHODS: Totally 19 eyes of 19 patients with traumatic glaucoma were implanted with Ex - press glaucoma filtration device under the scleral flap from December 2012 to May 2013. The postoperative visual acuity, anterior chamber depth and hyphema,intraocular pressure(IOP), filtering bleb and other complications were observed and summarized. RESULTS: Ex - press glaucoma filtration device were implanted successfully in 19 patients. At 1d postoperatively shallow anterior chamber was occurred in 2 eyes and hyphema was occurred in 3 eyes. At 3mo postoperatively increased vision was occurred in 9 eyes (47%),functional filtering bleb was occurred in 18 eyes ( 95%), and IOP was 12. 1 ± 6. 1mmHg. At 6mo postoperatively increased vision was occurred in 11 eyes (58%),functional filtering bleb was occurred in 18 eyes (95%),and IOP was 13. 3±6. 9mmHg. Compared with the preoperative IOP ( 29. 8 ± 6. 7mmHg), the difference was significant(PCONCLUSION: Ex - press glaucoma filtration device implantationfor traumatic glaucoma can improve the postoperative vision and control the postoperative IOP stably with fewer complications and high safety.
ABSTRACT
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.
ABSTRACT
34 patients who suffered from NVG, excluding patients with shallow anterior chamber.All patients were assigned to groups A and B according the different therapy.Group A ( 15 eyes ) was treated with Ex -PRESS glaucoma filtration device implantation. Group B ( 19 eyes ) underwent a trabeculectomy combined with mitomycin C. All the patients were followed up to 1a.The results of best-corrected visual acuity ( BCVA ) , intraocular pressure ( lOP ) , the combination of lOP lowering medications, complications were recorded statistically analyzed preoperative and 1d, 1, 4wk, 6 and 12mo after operation. · RESULTS: Mean lOP decreased significantly frompreoperative values in both groups ( P=0.01 ) .The both group had similar lOP values changes after 1, 4wk, 6, 12mo, and there were no significant difference in statistics (P=0.451).There was no significant difference in BCVA changes after operation in both groups ( P =0.832).Success rate was 66.7%and 63.1%at 1a after Ex-PRESS glaucoma filtration device and trabeculectomy, respectively. Anterior chamber bleeding occurred to 8 cases after trabeculectomy in group B and to 3 cases with Ex-PRESS glaucoma filtration device implantation in group A.Choroidal detachment occurred to 3 cases in group A and 6 cases in group B. No other ocular or systemic adverse events were found during the follow-up duration. ·CONCLUSlON:ln the short-term, Ex-PRESS glaucoma filtration device implantation has the advantages of simpleness, safety, minimally invasive, short learning curve for neovascular glaucoma, which provides us an available strategy to conquer NVG by simply operation and less suffering.
ABSTRACT
AIM:To discuss the application effect of adjustable sutures in glaucoma filtering operation after trabecular resection. METHODS: Seventy-eight cases ( 101 eyes ) suffered from glaucoma were randomly divided into two groups, observation group and control group. Thirty-nine cases ( 51 eyes ) in the observation group underwent trabeculectomy with adjustable sutures, the control group (39 cases, 50 eyes) only adopted trabeculectomy.RESULTS: Compared Preoperative IOP in two groups, the difference was not statistically significant (P>0. 05). After 6mo, IOP were decreased compared with preoperative in two groups, and that in observation group was lower than control group, the difference was statistically significant ( P CONCLUSION: The adjustable sutures combined with trabeculectomy for glaucoma can significantly reduce the postoperative complications. The curative effect is exact and clinically applicable.
ABSTRACT
Generally, the postoperative failure of glaucoma filtrationsurgery(GFS) is caused by scarring of filtering site. Mitomycin C(MMC) has been commonly used for preventing the scarring of filtering site. Though the antifibroblastic effect of this drug is approved clinically, its cytotoxic side effect cannot be overlooked,. alpha-tocopherol is known to inhibit proliferation of fibroblast without cytotoxic complications. In this study, we used alpha-tocopherol in GFS of rabbits and investigated the maintenance of bleb formation, complications and inhibition of fibroblast proliferation compared with MMC. Thirty six rabbits were divided into 6 groups Negative control groups were the balanced salt solution soaked group and the 19% ethanol soaked group and positive control group was soaked with 0.2mg/ml MMC during GFS. As experimental groups, group I, II, III were soaked with 100micrometer, 1mM and 10mM alpha-tocopherol. The results were as follows: For the maintenance of bleb formation, at postoperative 2 weeks, all extinguished in negative control groups and each experimental groups from I to III showed 16.7%, 33.3%, 50%, with highest rate of 66.7% in MMC soaked group, but at 2 months, group III and MMC soaked group showed 33.3% equally. Various complications were present in MMC soaked group but rare in alpha-tocopherol soaked groups. On histologic examinations, proliferation of fibroblast and infiltration of lymphocyte in group II, III and MMC soaked group except group I were much less than those of negative control groups and the degree of inhibition was proportional to concentration of tocopherol. There was no statistic difference(P>0.05) in area of reticulin fibers between group III and MMC soaked group and antifibroblastic effects were also similar between these two groups. These result suggest when directlyconcentration(1mM<) as much as MMC. Moreover, it is expected to be used more safely during GFS withous serious cytotoxic complications. However, application method, dosageand possible long term complications.
Subject(s)
Rabbits , alpha-Tocopherol , Blister , Cicatrix , Ethanol , Fibroblasts , Filtering Surgery , Filtration , Glaucoma , Lymphocytes , Mitomycin , Reticulin , TocopherolsABSTRACT
The main cause of failure in glaucoma filtering surgery is obstruction of aqueous outflow due to subconjunctival fibrosis. Transforming growth factor-beta(TGF-beta) is known to be a growth factor for subconjunctival fibroblast. Recently, mannose-6-phosphate(M-6-P) is reported to be an inhibitor of TGF-beta activity. In this study, we evaluated the effects of TGF-betas and M-6-P on the proliferation of cultured subconjunctival fibroblast of white rabbit in vitro. Cell proliferation was determined by 3H-thymidine DNA incorporation method. TGF-beta1, 2, 3 all promoted proliferation of subconjunctival fibroblast in a concentration dependent fashion and the effect of TGF-beta1 was most prominent among 3 types. Low concentration (0.01mM) of M-6-P paradoxically increased cell proliferation, but with the concentration of 1.0mM, the inhibitory effects were varied in the range of 45% to 7%.
Subject(s)
Cell Proliferation , DNA , Fibroblasts , Fibrosis , Filtering Surgery , Glaucoma , Transforming Growth Factor beta , Transforming Growth Factor beta1ABSTRACT
The authors investigated the toxicity of two antimetabolites. 5-fluorouracil(5-FU) and mitomycin-C(MMC) on the rabbit cornea and sclera following glaucoma filtration surgery(GFS). Forty rabbits were divided into four groups; the first control group(I) was the balanced salt solution soaked group(BSS) during GFS, the second(II) was the 5-FU subconjunctival injected group(5-FU SC) after GFS, the third(III) was the 5-FU soaked group(5-FU) during GFS, and the fourth(IV) was the MMC soaked group(MMC) during GFS. At the fifth day after GFS, scanning electron microscopic findings showed that corneal epithelial cells were most seriously damaged in 5-FU SC group, slightly damaged in 5-FU group, and no change in MMC and BSS group. At six months after GFS, transmission electron microscopic observation on sclera revealed the most profound degenerative changes in 5-FU group, and followed by an order of MMC, 5-FU SC, and BSS group. These results suggest that the dosage and application method of antimetabolites should be selected with great caution to prevent ocular toxicity.
Subject(s)
Rabbits , Antimetabolites , Cornea , Epithelial Cells , Filtering Surgery , Filtration , Fluorouracil , Glaucoma , Mitomycin , ScleraABSTRACT
Antimetabolites, 5-fluorouracil(5-FU) and mitomycin-C(MMC), are used to promote the success rate of the glaucoma filtration surgery(GFS). The authors observed and compared the duration of bleb formation and complications by slit-lamp biomicroscopy, and the inhibition of fibroblast proliferation and of fibrosis by light microscopy following GFS in 4 group rabbits. One hundred and twenty rabbits comprised in this study were divided into four groups; the first control group(I) was the balanced salt solution soaked group(BSS) during GFS, the second(II) was the 5-FU subconjunctival injected group(5-FU SC) after GFS, the third(III) was the 5-FU soaked group(5-FU) during GFS, and the fourth(IV) was the MMC soaked group(MMC) during GFS. For the maintenance of bleb formation, MMC, 5-FU SC, 5-FU and BSS group showed 0%, 26.7%, 16.7%, 100% at the 1 month after GFS, and 0%, 0%, 0%, 73.3% at the 2 months after GFS, respectively, which suggested that MMC group lasted longest. The inhibition of fibrosis and fibroblast proliferation became higher in the order of MMC, 5-FU, 5-FU SC, BSS group at 2 weeks after the surgery. At 3 months after GFS, there was no conspicuous statistic difference(P>0.05) between 5-FU SC and 5-FU group, but some differences(P<0.001) in the rest groups. From these results, we concluded that antimetabolites such as 5-FU and MMC could be used effectively in cases of poor prognosis of GFS. However, the dosage and application method of antimetabolites should be considered very carefully and further research will be necessary to find out the optimal dosage with minimum toxicity.
Subject(s)
Rabbits , Antimetabolites , Blister , Fibroblasts , Fibrosis , Filtering Surgery , Filtration , Fluorouracil , Glaucoma , Microscopy , Mitomycin , PrognosisABSTRACT
The most common cause of the postoperative failure of glaucoma filtration surgery(GFS) is scarring secondary to fibroblast proliferation and fibrosis at the interface of the episclera and conjunctive. To inhibit this process, mitomycin C(MMC) has been studied experimentally, both in vivo and in vitro. In evaluating the toxicity of MMC, we observed the inhibition of fibroblast proliferation and of fibrosis by light microscope, and the ultrastructual changes of the sclera by transmission electron microscope following the soaking of MMC during GFS in rabbit eyes. The sixty rabbits which comprised this study were divided into four groups; the first control group(I) was soaked with the BSS during GFS, the second(II), the third(III), and the fourth(IV) group were soaked with the 0.2 mg/ml, 0.5 mg/ml, and 0.5 mg/ml MMC soaked groups, respectively, during GFS as experimental groups. On histologic examination, the degree of proliferation of fibroblasts with fibrosis and infiltration of lymphocytes in MMC soaked groups was less than those of BSS soaked group at 2 weeks and 2 months after GFS. At six months after GFS, there was ultrastructural evidence of degenerative changes of scleral fibroblasts such as clumping of nuclear chromatin, wrinkling of nuclear membrane, and cystic dilatation of rough endoplasmic reticulum in MMC soaked groups. Higher concentration of MMC caused more degenerative changes in cellular structures. These results surggested that the scar formation after GFS could be significantly suppressed by a single application of MMC during surgery, and MMC could be0 used effectively in cases of poor prognosis of GFS. Further experiments need to be conducted to determine the optimal concentration, exposure time, and application method of MMC.
Subject(s)
Rabbits , Cellular Structures , Chromatin , Cicatrix , Dilatation , Endoplasmic Reticulum, Rough , Fibroblasts , Fibrosis , Filtering Surgery , Filtration , Glaucoma , Lymphocytes , Mitomycin , Nuclear Envelope , Prognosis , ScleraABSTRACT
To investigate the safety of subconjunctivally injected mitomycin-C(MMC) as an adjunctive therapy following the glaucoma filtration surgery(GFS), various amounts of MMC have been given to rabbit eyes after the surgery. To the control group, balanced salt solution(BSS) was injected subconjunctivally and 0.05mg MMC dissolved in BSS was given to the I experimental group I, 0.1mg to the group II, and 0.2mg to the group III. When the concentration of MMC in aqueous humor and cornea were measured at 30 min after the administration of MMC by high performance liquid chromatography, while no MMC was detected in aqueous humor, 1.2 +/- 0.5 micro gram of MMC/g of corneal tissue was detected for group III and 0.3 +/- 0.1 micro gram/g was found in group II. No MMC could be detected in corneal tissues of group I. The scanning electron microscopy which was done on the third day after surgery, revealed the most serious destructive changes of corneal endothelium in group III, while slight changes in group II, and no alteration in group I and control group. Based on these observations, subconjunctival injection of low dose(0.05mg) of MMC may be safe as an adjunctive method to enhance the success rate of GFS.