Evolução atípica de cisto de tenon após implante de válvula de Ahmed / Atypical evolution of tenon cyst after Ahmed valve implantation

Resumo Descrevemos o caso de um paciente portador de glaucoma secundário que evoluiu com cisto de tenon após implante de válvula de Ahmed. A despeito da conduta expectante inicial e das intervenções cirúrgicas posteriores, apenas com a utilização da ciclofotocoagulação transescleral com laser micropulsado a pressão intraocular atingiu valores aceitáveis.

Abstract We describe the case of a patient with secondary glaucoma who developed tenon cyst after Ahmed valve implantation. Despite the initial expectant management and subsequent surgical interventions, only with the micropulse transecleral cyclophotocoagulation did the intraocular pressure reach acceptable values.

Anti-fibrotic effects of rosmarinic acid on Tenon's capsule fibroblasts stimulated with TGF-ß: therapeutic potential in ocular surgery / Efeito antifibrótico do Ácido Rosmarínico sobre os fibroblastos da Cápsula de Tenon estimulados com TGF-beta2: potencial terapêutico na cirurgia ocular

ABSTRACT Purpose: Collagen deposition and myofibroblast differentiation are critical factors related to excessive scarring in ocular surgeries. This study evaluated the anti-fibrotic activity of rosmarinic acid on rabbit Tenon's capsule fibroblasts stimulated with transforming growth factor- β2. Methods: Primary cultures of rabbit Tenon's capsule fibroblasts were treated with various concentrations of rosmarinic acid for 12 h, in the presence and absence of transforming growth factor-β2. After 48 h, the proliferation index of rabbit Tenon's capsule fibroblasts and the differentiation of myofibroblasts were investigated through immunofluorescence staining for proliferating cell nuclear antigen and alpha smooth muscle actin. An automated cell counter and colorimetric metabolic activity assay were used to evaluate cell number and viability. Collagen expression and production were determined by quantitative real-time polymerase chain reaction and hydroxyproline assay, respectively. Results: Unstimulated rabbit Tenon's capsule fibroblasts treated with any concentration of rosmarinic acid exhibited diminished collagen expression (p<0.01) but showed no differences in proliferation index. Transforming growth factor-β2 exposure induced myofibroblast differentiation and increased collagen production. Exposure to rosmarinic acid at 1.0 and 3.0 µM concentrations reduced the proliferation index (p<0.02), as well as the collagen expression and hydroxyproline content (p<0.05). Exposure to 3.0 µM rosmarinic acid reduced viability (p=0.035) in unstimulated rabbit Tenon's capsule fibroblasts and cell numbers (p=0.001) in both stimulated and unstimulated rabbit Tenon's capsule fibroblast cultures. Conclusions: Exposure to 1.0 µM rosmarinic acid was noncytotoxic and led to reduced collagen expression and proliferation of stimulated rabbit Tenon's capsule fibroblasts. These findings suggest that rosmarinic acid is a relatively non-injurious anti-fibrotic compound to rabbit Tenon's capsule fibroblasts, with potential application as an adjunctive agent in ocular procedures, particularly in glaucoma surgeries.

RESUMO Objetivo: A deposição de colágeno e a diferenciação de miofibroblastos são fatores chaves relacionados à cicatrização excessiva em cirurgias oculares. Este estudo avaliou a atividade anti-fibrótica do ácido rosmarínico nos fibroblastos da cápsula de Tenon de coelhos estimulados com o fator de crescimento transformador-β2. Métodos: Culturas primárias de fibroblastos da cápsula de Tenon de coelhos foram tratadas com várias concentrações de ácido rosmarínico por 12h, na presença e na ausência do fator de crescimento transformador-β2. Após 48h, o índice de proliferação dos fibroblastos da cápsula de Tenon de coelhos e a diferenciação dos miofibroblastos foram investigados por coloração por imunofluorescência para proliferação de antígeno nuclear celular e α-actina de músculo liso, respectivamente. Um contador automático de células e um ensaio de atividade metabólica colorimétrica foram utilizados para avaliar o número e a viabilidade das células. A expressão e produção do colágeno foram determinadas por reação quantitativa em cadeia da polimerase em tempo real e ensaio de hidroxiprolina, respectivamente. Resultados: Fibroblastos da cápsula de Tenon de coelhos não estimulados tratados com qualquer concentração de ácido rosmarínico exibiram diminuição de colágeno (p<0,01), mas não mostraram diferenças no índice de proliferação. A exposição ao fator de crescimento transformador-β2 induziu a diferenciação de miofibroblastos e aumentou a produção de colágeno. A exposição ao ácido rosmarínico nas concentrações de 1,0 e 3,0 µM reduziu o índice de proliferação (p<0,02), bem como a expressão de colágeno e a quantificação de hidroxiprolina (p<0.05). A exposição a 3,0 µM de ácido rosmarínico reduziu a viabilidade (p=0,035) de fibroblastos da cápsula de Tenon de coelhos não estimulados e o número de células (p=0,001) em culturas de fibroblastos da cápsula de Tenon de coelhos estimuladas e não estimuladas. Conclusões: A exposição ao ácido rosmarínico 1,0 µM foi não citotóxica e levou à expressão reduzida de colágeno e menor proliferação de fibroblastos da cápsula de Tenon estimulados pelo fator de crescimento transformador-β2. Esses achados sugerem que o ácido rosmarínico é um composto antifibrótico relativamente não lesivo aos fibroblastos da cápsula de Tenon de coelhos, com potencial aplicação como agente adjuvante em procedimentos oculares, particularmente em cirurgias de glaucoma.

Intravitreal and posterior subtenon triamcinolone acetonide for severe acute posterior multifocal placoid pigment epitheliopathy / Triancinolona intravítrea e sub-tenoniana para epiteliopatia pigmentar placóide multifocal posterior aguda grave

ABSTRACT A 21-year-old man presented with visual acuity of 20/200 in both eyes. The fundus picture, fluorescein angiography, and optical coherence tomography revealed severe bilateral acute posterior multifocal placoid pigment epitheliopathy and serous macular detachments. We treated the patient with triamcinolone acetonide, an intravitreal injection (4 mg/0.1 mL) in one eye and a posterior subtenon injection (40 mg/1 mL) in the other eye. Within 2 weeks the visual acuity was 20/80 in both eyes. At the 8-week follow-up visit his vision was 20/63 bilaterally. One year later the vision remained 20/63 in both eyes. In this patient, the triamcinolone acetonide injections, whether administered intravitreally or via the posterior subtenon route, achieved similar anatomic and functional recovery results.

RESUMO Um homem de 21 anos apresentou acuidade visual de 20/200 em ambos os olhos. O quadro de fundo de olho, angiofluoresceinografia e a tomografia de coerência óptica revelaram epiteliopatia pigmentar placóide multifocal posterior aguda e descolamento macular seroso. Tratamos o paciente com triancinolona acetonida, uma injeção intravítrea (4 mg/0,1 ml) em um olho e uma injeção subtenoniana posterior (40 mg/1 ml) no outro olho. Após 2 semanas, a acuidade visual foi de 20/80 em ambos os olhos. Na visita de acompanhamento de 8 semanas, sua visão foi de 20/63 bilateralmente. Um ano depois, a visão permaneceu 20/63 em ambos os olhos. Neste paciente, as injeções de triancinolona, administradas por via intravítrea ou por via subtenoniana posterior, obtiveram resultados semelhantes na recuperação anatômica e funcional.

Effect of cytoglobin overexpression on extracellular matrix component synthesis in human tenon fibroblasts

BACKGROUND: Conjunctival filtering bleb scar formation is the main reason for the failure of glaucoma filtration surgery. Cytoglobin (Cygb) has been reported to play an important role in extracellular matrix (ECM) remodeling, fibrosis and tissue damage repairing. This study aimed to investigate the role of Cygb in anti-scarring during excessive conjunctival wound healing after glaucoma filtration surgery. METHODS: Cygb was overexpressed in human tenon fibroblasts (hTFs) by transfecting hTFs with lentiviral particles encoding pLenti6.2-FLAG-Cygb. Changes in the mRNA and protein levels of fibronectin, collagen I, collagen III, TGF-ß1, and HIF1α were determined by RT-PCR and western blotting respectively. RESULTS: After Cygb overexpression, hTFs displayed no significant changes in visual appearance and cell counts compared to controls. Whereas, Cygb overexpression significantly decreased the mRNA and protein expression levels of collagen I, collagen III and fibronectin compared with control (p < 0.01). There was also a statistically significant decrease in the mRNA and protein levels of TGF-ß1 and HIF-1α in hTFs with overexpressed Cygb compared with control group (p < 0.05). CONCLUSION: Our study provided evidence that overexpression of Cygb decreased the expression levels of fibronectin, collagen I, collagen III, TGF-ß1 and HIF-1α in hTFs. Therefore, therapies targeting Cygb expression in hTFs may pave a new way for clinicians to solve the problem of post-glaucoma surgery scarring.

Éxito y seguridad de la resección de quiste encapsulado en implante valvular de Ahmed. Serie de casos / Success and safety of encapsulated cyst resection in Ahmed valve implant: case series

Introducción: el encapsulamiento de la ampolla o también llamado "quiste de Tenon" alrededor del dispositivo puede comprometer el funcionamiento valvular, aumentando la presión intraocular y así requiriendo procedimientos quirúrgicos adicionales. Objetivo: describir la eficacia y seguridad de la resección de quiste encapsulado en implante valvular de Ahmed en el control de la presión intraocular. Diseño de estudio: estudio observacional, retrospectivo, serie de casos. Método: se hizo un análisis de los pacientes a los que se les realizó resección de quiste encapsulado con un seguimiento a 6 meses, se excluyeron pacientes con antecedente de procedimiento ciclodestructivo, agudeza visual no percepción de luz, alteración del estado de conciencia, cirugía combinada y /o seguimiento postoperatorio menor de 3 meses. Resultados: se analizaron 14 ojos de los cuales 9 (64.3%) eran mujeres. El promedio de edad fue 56.1 con un rango entre 14 ­ 83 años. La presión intraocular preoperatoria promedio fue 26.7± 6.6 mmHg con una reducción estadísticamente significativa desde el primer día posoperatorio 9.8 ± 0.93 mmHg y al sexto mes 13.7 ± 0.94 mmHg (p 0.005). En el primer mes posoperatorio se logró reducción significativa en el número de medicamentos hipotensores (p 0.003), el cual se estabilizó al tercer mes y al sexto mes no presentó diferencia estadísticamente significativa (p 0.078). Conclusión: la resección de quiste encapsulado es un procedimiento efectivo para lograr el control de la presión intraocular en pacientes con glaucomas refractarios y/o no controlados con pocas complicaciones asociadas.

Background: the encapsulation of the bleb or so-called (Tenon cyst) around the device can compromise valve function, increasing intraocular pressure and thus requiring additional surgical procedures. Objective: to describe the efficacy and safety of encapsulated cyst resection in Ahmed valve implant for the control of intraocular pressure. Study design: observational study, retrospective cases series. Method: an analysis was made of the patients who underwent encapsulated cyst resection between January 2016 and August 2017 with a 6-month follow-up, patients with a history of cyclodestructive procedure, visual acuity of no light perception, altered state of consciousness, combined surgery and / or postoperative follow-up of less than 3 months were excluded. Results: 14 eyes were analyzed, of which 9 (64.3%) were women. The average age was 56.1 with a range between 14 - 83 years. he average preoperative intraocular pressure was 26.7 ± 6.6 mmHg with a statistically significant reduction from the first postoperative day 9.8 ± 0.93 mmHg and at the sixth month 13.7 ± 0.94 mmHg (p 0.005). In the fi rst postoperative month there was a significant reduction in the number of hypotensive drugs (p 0.003), which stabilized at the third month and at the sixth month did not present a statistically significant difference (p 0.078). Conclusion: encapsulated cyst resection is an effective procedure to achieve control of intraocular pressure in patients with refractory and / or uncontrolled glaucoma with few associated complications.

Role of Hydrogen Sulfide in the Survival of Fibroblasts and Fibroblast-mediated Contraction of Collagen Gel

PURPOSE: To investigate the role of hydrogen sulfide in the survival and collagen gel contraction of cultured human Tenon's capsule fibroblasts (HTCFs). METHODS: Primarily cultured HTCFs were exposed to 0, 100, 200, or 300 µM hydrogen sulfide (sodium hydrogen sulfide, NaHS) for 2 days. Cellular survival was assessed by MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide) assay. Degree of apoptosis was assessed with flow cytometry using annexin-V/propidium iodide double staining. To evaluate the effect of NaHS on cellular transdifferentiation, HTCFs were stimulated with 5 ng/mL TGF-β1 and the level of expression of α-smooth muscle actin (SMA) mRNA was assessed using reverse-transcription polymerase chain reaction. The cells were embedded in collagen gel, and the amount of gel contraction was measured. RESULTS: NaHS at 300 µM reduced HTCF survival (p = 0.013); NaHS at both 200 and 300 µM increased apoptosis in a dose-dependent manner (p = 0.013 and p = 0.016). TGF-β1 increased the expression of α-SMA mRNA (p = 0.041); co-treatment with 100 µM NaHS decreased TGF-β1-induced α-SMA mRNA expression (p = 0.039) and inhibited collagen gel contraction. CONCLUSIONS: NaHS at high concentration reduced cellular survival and increased HTCF apoptosis. NaHS decreased TGF-β 1-induced increases in α-SMA mRNA expression and collagen gel contraction. Thus, hydrogen sulfide may suppress scar formation by inhibiting HTCF transdifferentiation and contraction of collagen gels.

The Anti-fibrotic Effect of Nilotinib on Tenon's Capsule Fibroblasts in Vitro

PURPOSE: To evaluate the anti-fibrotic effects of nilotinib on the survival of cultured human Tenon's capsule fibroblasts (HTFs). METHODS: HTF primary cultures were obtained from samples following glaucoma surgery. Primarily cultured HTFs were exposed to 1, 5, 10, and 20 µM nilotinib for 24 hours. The effects of nilotinib on HTF proliferation and cell viability were determined using the 3-(4,5-dimethylthiazone-2-yl)-2,5-diphenyl tetrazolium (MTT) assay, and apoptosis was determined by flow cytometry using annexin-V/propidium iodide (PI) double staining. Apoptosis-related proteins were detected by western blotting. RESULTS: The MTT assay showed that nilotinib induced an inhibition of HTF proliferation at concentrations of 10 and 20 µM (p < 0.001 and p < 0.001, respectively). Annexin V/PI double staining showed significantly increased apoptosis in cells treated with nilotinib. Nilotinib activated caspase-3, -9, and poly adenosine diphosphate ribose polymerase cleavage, and downregulated the expression of B-cell lymphoma-extra large and Bax, which indicated that nilotinib-induced apoptosis was partly mediated through the mitochondrial pathway. In addition, treatment with nilotinib decreased the expression of α-smooth muscle actin and transforming growth factor-β. CONCLUSIONS: Nilotinib decreased cell survival of cultured HTFs and induced mitochondria-mediated apoptosis. The results suggested that nilotinib may exert antiproliferative effects on HTFs, making it a possible agent to control postoperative fibrosis in patients undergoing glaucoma surgery.

Effects of Valproic Acid on the Survival of Human Tennon's Capsule Fibroblasts

PURPOSE: To investigate the effects of valproic acid on the survival of cultured human Tenon's capsule fibroblasts (HTFBs). METHODS: Primary cultured HTFBs were exposed to 0, 0.25, 0.5, and 1.0 mM valproic acid with or without 0, 1.0, 2.5 µg/mL mitomycin C, and incubated for 5 days. Cell survival was assessed using an MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide) assay and the degree of apoptosis was assessed by flow cytometry using annexin-V/propidium iodide double staining. RESULTS: Valproic acid decreased the survival of HTFBs in a dose-dependent manner, and survival was further decreased by adding mitomycin C to valproic acid. Both valproic acid and mitomycin C induced apoptosis of HTFBs. Valproic acid induced less apoptosis than mitomycin C. CONCLUSIONS: Valproic acid decreased the cellular survival of HTFBs and induced apoptosis. The antiproliferative effects of valproic acid were further enhanced by the addition of mitomycin C.

A Case of Immediate Surgical Repair in Traumatic Isolated Inferior Rectus Muscle Rupture

PURPOSE: We report a case of infraduction limitation improvement and orthotropia at primary position in a patient with traumatic isolated inferior rectus muscle rupture after immediate repair surgery of the ruptured muscle. CASE SUMMARY: A 47-year-old man came to our emergency department complaining of right eyelid contusion and conjunctival laceration after trauma due to the metal part of a high pressure hose. Right hypertropia of 20 prism diopters was observed at primary gaze and right hypertropia of 30 prism diopters was observed at down gaze. The right eye showed a -4 infraduction limitation. We sutured the distal part of the ruptured inferior rectus muscle with surrounding tissue, including the Tenon's capsule and the part of the muscle stump, to its original insertion. Orthotropia at primary position and 8-prism-diopters of right hypertropia on down gaze was observed one day after surgery. At 40 days after surgery, the patient had orthotropia at primary position and 4-prism-diopter right hypertropia on down gaze. Infraduction limitation of the right eye improved to -1. CONCLUSIONS: Immediate repair of complete traumatic isolated inferior rectus muscle rupture can correct the limitation of extraocular movement and achieve orthotropia at primary position.

Pseudotumor esclerosante de órbita / Sclerosing orbital pseudotumor

RESUMO O pseudotumor esclerosante de órbita é um subtipo raro de pseudotumor inflamatório idiopático de órbita. É mais comum em adultos e apresenta diagnóstico de exclusão. A primeira linha de tratamento são os esteroides. O subtipo esclerosante apresenta resposta moderada aos esteroides devido à predominância de fibrose e colágeno na histologia. Relatamos o caso de um paciente com diagnóstico histológico de pseudotumor esclerosante de órbita que teve boa resposta ao tratamento com corticoide associado à azatioprina.

ABSTRACT Sclerosing orbital pseudotumor is a rare subtype of idiopathic orbital inflammatory pseudotumor. It's more common in adults and presents diagnosis of exclusion. Steroids represent the first option of treatment. The sclerosing orbital pseudotumor subtype shows moderate response to steroids due to the predominance of fibrosis and collagen in its histology. We report on a case of a patient with histologic diagnosis of sclerosing orbital pseudotumor successfully treated with corticosteroid associated with azathioprine.

Effect of Posterior Subtenon Triamcinolone Acetonide Injection on Diabetic Macular Edema Refractory to Intravitreal Bevacizumab Injection

PURPOSE: To evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure. METHODS: Patients with DME and central subfield thickness (CST) >300 microm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after > or =3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography. RESULTS: Forty eyes of 34 patients were included. The average baseline CST was 476 microm. The average CST decreased to 368 microm at 2 months, 374 microm at 4 months, and 427 microm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected. CONCLUSIONS: Posterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.

Posterior sub-tenon's bevacizumab injection in diabetic macular edema; a pilot study

Purpose: To evaluate the short-term results of sub-tenon's injection of bevacizumab in patients with clinically significant macular edema [CSME]

Methods: In this prospective non comparative interventional case series, sub-tenon's injection of 2.5 mg/0.1 ml bevacizumab was performed for eyes with CSME. Macular thickness and best corrected visual acuity measurements were performed before and one month after injections

Results: Nineteen eyes of twelve patients with a mean age of 59.8 +/- 5.7 years were evaluated. Thirteen eyes [68.4%] had center-involving macular edema. No significant difference was observed between pre- and post-injection central subfield retinal thickness measurements [P = 0.3]. Central subfield thickness measurements improved or remained unchanged in 13 eyes [68.4%]. Baseline BCVA of 0.48 +/- 0.35 LogMAR improved to 0.36 +/- 0.26 LogMAR after injection [P = 0.01]. Improvement of >2 lines in BCVA was found in 5 eyes [26.3%], and no eye lost >2 lines of BCVA. No complication associated with sub-tenon's injection was observed

Conclusion: Sub-tenon's injection of bevacizumab resulted in significant short-term visual improvement in eyes with CSME. Retinal thickness changes were not significant

Flow Cytometric Analysis of the Effects of Resveratrol on the Survival of Human Tennon's Capsule Fibroblasts

PURPOSE: Resveratrol exerts cytoprotective or cytotoxic effects according to cell type. This study was performed to evaluate the effects of resveratrol on the survival of cultured human Tenon's capsule fibroblasts (HTFBs). METHODS: Primarily cultured HTFBs were exposed to 0, 10, or 100 microM resveratrol for 3 days. Cellular survival was assessed using the MTT assay and degree of apoptosis was analyzed with flow cytometry using annexin-V/propidium iodide double staining. RESULTS: Resveratrol decreased the survival of HTFBs after exposure to 10 microM (p = 0.04). In flow cytometric analysis, 10 microM resveratrol did not affect the degree of apoptosis (p = 0.89), but 100 microM resveratrol increased the degree of apoptosis (p = 0.003). Both 10 and 100 microM resveratrol did not affect the degree of necrosis (p = 0.74, 0.33). CONCLUSIONS: Resveratrol decreased cellular survival of cultured HTFBs and induced apoptosis. Thus, resveratrol may exert antiproliferative effects on HTFBs.

Sealing the gap between conjunctiva and Tenon's capsule in primary pterygium surgery / Adição do selamento entre conjuntiva e cápsula de Tenon em cirurgia de pterígio primário

Objetive: To assess the results of an alternative surgical approach in the excision of primary pterygium by analyzing the rates of recurrence and of intraoperative and postoperative complications. Methods: Retrospective cross-sectional study based reviewing the clinical records of individuals subjected to surgery for pterygium, with conjunctival autograft transplantation, fibrin glue and intraoperative application of mitomycin C. In addition, sealing was performed by suturing the gap between the conjunctiva and Tenon’s capsule. A total of 36 eyes from 35 individuals were subjected to the assessed techniques. The study variables were complications of surgery and recurrence rates during a minimun follow-up period of 6 months. Results: No recurrence occurred during the follow-up period. One graft (2.8%) exhibited partial retraction, but pterygium did not recur. The intraocular pressure increased in one eye (2.8%) and was controlled by clinical methods. Conclusion: Eyes in which a barrier was established between the conjunctiva and Tenon’s capsule by sealing the gap between them showed an absence of recurrence in the sample studied. However, there is the need of a random prospective study with a control group for a more accurate conclusion on the efficacy of the technique .

Objetivo: Avaliar os resultados de uma abordagem cirúrgica alternativa na excisão de pterígio primário por meio da observação das taxas de recidiva e de complicações intraoperatórias e pós-operatórias Métodos: Estudo retrospectivo e transversal realizado a partir da revisão de prontuários de pacientes submetidos à cirurgia de pterígio com transplante autólogo de conjuntiva, cola de fibrina e aplicação intraoperatória de mitomicina C. Além disso, foi realizado através de sutura, o selamento da lacuna entre a conjuntiva e cápsula de Tenon. No total, 36 olhos de 35 pacientes foram submetidos à técnica. As variáveis do estudo foram complicações da cirurgia e taxas de recidiva durante um período mínimo de 6 meses de seguimento. Resultados: Não foram constatadas recidivas durante o tempo de seguimento. Um enxerto (2,8%) desenvolveu retração parcial, sem posterior recorrência do pterígio, e um olho (2,8%) apresentou aumento da pressão intraocular, que foi controlada clinicamente. Conclusão: A criação de uma barreira entre a conjuntiva e cápsula de Tenon, por meio do selamento da lacuna, mostrou ausência de recidiva na amostra estudada. Necessita-se, no entanto, de um estudo prospectivo randomizado com grupo controle para uma conclusão mais precisa da eficácia da técnica. .

Comparison of the in-vitro effects of bevacizumab, mitomycin-C, 5-fluorouracil,and triamcinolone acetonide on the viability of cultured human tenon's fibroblasts

@#<p style="text-align: justify;"><strong>Objective:</strong> To evaluate and compare the effects of bevacizumab, mitoinycin-C (MMC), 5-fluorouracil (5-FU), and triamcinolone acetonide (TA) on the viability of cultured human Tenon's capsule fibroblasts (cHTF) in vitro.</p> <p style="text-align: justify;"><strong>Methods:</strong> Human Tenon's fibroblasts (HTF) were harvested and cultured in a Roswell-Park-Memorial 1-Institute (RPMI) media. MMC, 5-FU, bevaciz. umab, and TA were administered to the cHTF at 3-fold decreasing concentrations starting from 20 ug, 5 mg, 25 mg, and 4 mg respectively. A negative control/untreated group containing RPMI media only was included in the study. Fibroblast cell viability was assessed using resazurin fluorim etric assay. Half¬maximal inhibitory concentration (IC50) was computed for agents which showed significant decrease in cHTF viability compared to the untreated group.</p> <p style="text-align: justify;"><strong>Results:</strong> There was no significant difference in cH IF viability between the untreated control group compared to 5-FU (p=0.97), bevacizumab (p=0.10), and TA (p=0.06) groups. Mitomycin-C showed a significant decrease in cHTF viability (p<0.001) which was dose dependent. The IC50 of MMC was computed at 12.16 ug using the prism software.</p> <p style="text-align: justify;"><strong>Conclusion:</strong> Mitomycin-C demonstrated dose-dependent decrease in viability of cultured human Tenon's fibroblasts. 5-FU, bevacizumab, and triamcinolone did not show this effect.</p> <p style="text-align: justify;"><strong>Key Words:</strong> Mitomycin-C, 5-fluorouracil, Bevaciz. umab, Tria. mcinolone acetonide, Fibroblast, Trabeculectomy</p>

Effects of Prednisolone and Loteprednol Eyedrops on the Proliferation of Human Tenon's Capsule Fibroblasts

PURPOSE: To compare the effect of loteprednol etabonate (LE) with prednisolone acetate (PDA) drops on the proliferation of human Tenon's capsule fibroblasts (HTFBs). METHODS: Primarily cultured HTFBs were treated with serially diluted PDA and LE for 3 days. Cellular survival was determined by a rapid colorimetric assay using MTT. RT-PCR was performed to determine the relative expression of TGF-beta mRNA in response to LE and PDA. RESULTS: PDA inhibited proliferation of HTCF in a dose-dependent manner and LE inhibited significantly the proliferation of HTCF at the higher concentration of 50 microg/ml (p < 0.05). Compared to LE, PDA inhibited proliferation of HTCF significantly at each diluted concentration (p < 0.05). Expressions of TGF-beta were decreased as the concentration of both PDA and LE increased. PDA decreased expression of TGF-beta more significantly compared to LE at each concentration (p < 0.05). CONCLUSIONS: Although LE has offered promising anti-inflammatory efficacy with decreased impact on intraocular pressure, LE may be less effective than PDA in inhibiting fibroblast proliferation and may be not comparable to PDA in preventing excessive scarring after glaucoma filtering surgery.

Posterior Subtenon Triamcinolone Acetonide in Gas-filled Eyes as an Adjunctive Treatment for Complicated Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the effect of adjunctive subtenon injection of triamcinolone acetonide (TA) in gas-filled eyes after vitrectomy for complicated proliferative diabetic retinopathy (PDR). METHODS: This nonrandomized comparative study included 27 patients (27 eyes) who underwent pars plana vitrectomy and gas tamponade for treatment of PDR with tractional or combined tractional-rhegmatogenous retinal detachment and who received subtenon injection of TA (40 mg) at the end of surgery. The study group was compared with the control group (29 eyes), which was matched with the study group for preoperative and intraoperative parameters, but underwent pars plana vitrectomy and gas tamponade without a subtenon injection of TA. RESULTS: Retinal reattachments without reoperation were achieved in 25 eyes (92.6%) and 26 eyes (89.7%) at 6 months (p = 1.000) in the study and control groups, respectively. The study group and the control group did not differ significantly in the frequency of postoperative proliferative vitreoretinopathy, retinal redetachment rate, reoperation rate, macular pucker formation, postoperative vitreous hemorrhage, gain in visual acuity, intraocular pressure, and intraocular inflammation (p > 0.05). CONCLUSIONS: The clinical results of pars plana vitrectomy for complicated PDR are not improved significantly by an adjunctive subtenon TA injection in gas-filled eyes.

Exposição de fibroblastos de pterígios recidivados e da cápsula de Tenon normal à triancinolona / Exposure of recurrent pterygium and normal Tenon's capsule fibroblasts to triamcinolone

OBJETIVO: Avaliar a taxa de proliferação de fibroblastos provenientes de pterígios recidivados e da cápsula de Tenon normal, quando expostos in vitro à triancinolona. MÉTODOS: Foram realizadas culturas primárias de explantes de pterígios recidivados e da cápsula de Tenon normal do mesmo portador do pterígio. Os fibroblastos foram cultivados e subcultivados até a terceira passagem e posteriormente expostos à triancinolona, com avaliação da taxa de proliferação celular após três, seis, 12 e 18 dias. RESULTADOS: Os fibroblastos expostos à triancinolona apresentaram taxa de proliferação significativamente menor (P<0,05) se comparados aos não expostos quando a avaliação foi feita após três, seis e 12 dias. Na avaliação do 18º dia houve retomada da taxa de proliferação, com significância estatística, somente nos fibroblastos provenientes de pterígios. CONCLUSÃO: Tanto os fibroblastos provenientes da cápsula de Tenon normal, quanto os de pterígios recidivados, apresentaram taxa de proliferação significativamente menor após a exposição à triancinolona. Os fibroblastos de pterígio retomaram a proliferação após 18 dias da exposição. Os resultados apontaram que a triancinolona pode ser útil como adjuvante no tratamento do pterígio.

PURPOSE: To evaluate the proliferation rate of recurrent pterygium and normal Tenon's capsule fibroblasts after exposure to triamcinolone. METHODS: Explants of recurrent pterygia and normal Tenon's capsule of the same carrier were cultured. The fibroblasts were cultured and subcultured until the third passage and subsequently exposed to triamcinolone. The cell proliferation rate was evaluated 3, 6, 12 and 18 days after the exposure. RESULTS: Fibroblasts exposed to triamcinolone had significantly lower proliferation rate (P <0.05) compared to those not exposed, when the evaluation was performed 3, 6 and 12 days later. In the 18th day after exposure, there was a return in the proliferation rate, with statistical significance, only in the pterigyum fibroblasts. CONCLUSION: Both the fibroblasts from normal Tenon's capsule as from recurrent pterygia showed significantly lower proliferation rate after exposure to triamcinolone. After 18 days from the exposition, pterygium fibroblasts recovered the proliferation. The results suggested the triamcinolone might be useful as adjuvant in pterygium treatment.

Effect of tetrandrine on bax, bcl-2 and TGF-β2 mRNA expressions in cultured human Tenon's capsule fibroblasts / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of tetrandrine (Tet) on the expression of bax, bcl-2, and transforming growth factor-β2 (TGF-β2) mRNA in cultured human fibroblasts of Tenon's capsules (TCFS) and explore its possible mechanism.</p><p><b>METHODS</b>The third passage of TCFS cultured in vitro were exposed to 1×10(-5) mol/L Tet for 24 h, and real-time fluorescence quantitative PCR was used to detect the changes in the expressions of bax, bcl-2, and TGF-β2 mRNA.</p><p><b>RESULTS</b>The expression level of bax mRNA was obviously higher, while bcl-2 and TGF-β2 mRNA levels were significantly lower in Tet-treated TCFS than those in the control cells (P<0.05).</p><p><b>CONCLUSION</b>Tet can inhibit the proliferation of TCFS possibly by reducing the expressions of bcl-2 and TGF-β2 mRNA, enhancing the expression of bax mRNA and inducing cell apoptosis, suggesting its potential in preventing fibrous scar formation after glaucoma filtration surgery.</p>