A nonrandomized controlled study of inflammatory response between uveitic glaucoma and other refractory glaucoma following Ahmed glaucoma valve implantation / 中华实验眼科杂志

Background The aqueous flare is obvious in uveitic glaucomatous eye due to the damage of blood-aqueous barrier,especially following intraocular surgery.How to quantitatively determine the aqueous flare is important for us to understand the severity of inflammatory response.Objective This study was to assess inflammatory response following Ahmed glaucoma valve implantation in uveitic glaucomatous eye.Methods A nonrandomized controlled study was carried out under the approval of Ethic Committee of Zhongshan Ophthalmic Center of Sun Yat-sen University.Twenty-nine eyes of 29 subjects with refractory glaucoma were enrolled this hospital from October 2011 through July 2012.The patients were divided into the uveitic glaucoma group (10 eyes) and the other refractory glaucoma group (19 eyes) with the matched demography,and Ahmed glaucoma valve implantation was performed on all the eyes under the informed consent of each patient.The aqueous flare value was determined with FC-2000 flare-cell photometry and intraocular pressure (IOP) was measured with Goldmann tonometer before surgery and 1 day,3 days,1 week,2 weeks,1 month and 3 months after surgery.The outcomes were compared between the two groups,and the correlation of aqueous flare value with IOP was analyzed.Results In the uveitic glaucoma group,the aqueous flare values were 21.10 (10.50,38.58) photoparticles/ms,88.00 (23.55,168.63) photoparticles/ms and 29.90 (8.90,65.18)photoparticles/ms 1 day,3 days and 1 week after surgery,which were significantly higher than 13.53 (7.60,24.00) photoparticles/ms before surgery (all at P＜0.01).The same trend was found in the other refractory glaucoma group.In addition,the aqueous flare value was higher in the uveitic glaucoma group than that in the other refractory glaucoma group in 3 months after surgery (q=-3.445,P＜0.01).No significant differences were seen in IOP between the two groups at various time points (all at P＞0.05).Also,no significant correlations were seen between IOP and aqueous flare value in all patients at various time points (preoperation:rs =0.136,P =0.481; postoperative 1 day:rs =0.019,P =0.922 ; postoperative 3 days:rs =-0.035,P =0.858 ; postoperative 1 week:rs =0.317,P=0.094; postoperative 2 weeks:rs =0.034,P =0.861 ; postoperative 1 month:rs =-0.094,P =0.628 ; postoperative 3 months:rs =0.065,P =0.738).Conclusions FC-2000 flare-cell photometry can reflect the inflammatory reaction of the anterior chamber following Ahmed glaucoma valve implantation in various types of refractory glaucomatous eyes.The postoperative inflammatory response is more serious and lasting in uveitic glaucomatous eye.

Rat model of blood-ocular barrier breakdown induced by anterior segment intraocular analogic surgery / 中华眼底病杂志

Objective To establish a rat model of blood ocular barrier breakdown induced by anterior segment intraocular analogic surgery. Methods One hundred and fifty healthy adult male rats were randomly divided into control group and model group,75 rats in each group.The rats were anesthetized with 1 ml/kg ketamine hydrochloride/xylazine hydrochloride solution.Three way pipes were attached to a phosphate buffer infusion bag and two intravenous catheters. One catheter was inserted 30° obliquelythrough the transparent cornea anterior to the limbus into the rat's anterior chamber.Then the needle was withdrawn and the sheath was indwelling.Another catheter was connected with a manometer.Intraocular pressure was varied from 0 to 12 mm Hg (1 mm Hg=0.133 kPa) 60 times,30 times per min.The catheter was removed.The eyes were treated with ofloxacin ophthalmic solution after surgery.The 1st,2nd,3rd,5th and 7th day after surgery,the integrity of the blood ocular barrier was assessed by immunohistochemical staining for albumin and quantitative measurement using Evan's blue as a tracer. Results Albumin immunohistochemical staining of the control group was confined to the iris and retinal blood vessels.The choroid was stained at each time point after surgery.Albumin immunohistochemical staining of the model group was abundant around the iris and the retinal vasculature on the 1st day after surgery.The albumin diffused throughout the iris and the retina on the 2nd and the 3rd day after surgery.The albumin reached the retinal vessels on the 5th and 7th day after surgery.The aqueous humor Evans blue leakages of the model group were higher than those of the control group on the 1st,2nd,3rd and 5th day after surgery.The differences were statistically significant (t=25.781,37.433,25.150,19.171; P＜0.01).The Evans blue leakage of the model group was close to that of the control group on the 7th day after surgery. The difference was no statistical significant(t=1.303,P=0.209).The retinal Evans blue leakages of the model group were higher than those of the control group on the 1st,the 2nd and the 3rd day after surgery.The differences were statistically significant (t=11.997,14.622,23.014; P＜0.01).The Evans blue leakage of the model group was close to those of the control group on the 5th and 7th day after surgery. The differences were not statistically significant(t=2.027,0.756 ； P=0.058,0.459).Conclusion This study establishes a rat model of blood ocular barrier breakdown induced by imitating the injury to the anterior segment during intraocular surgery.

Dynamic observation of function of blood-aqueous barrier in Vogt-Koyanagi-Harada syndrome / 中华眼底病杂志

Objective To detect the changes of function of blood-aqueous barrier in different Syndrome stages of patients with Vogt-Koyanagi-Harada (VKH) syndrome in order to provide the appropriate therapy. Methods According to clinical manifestation, 77 patients (144 eyes) with VKH syndrome were divided into 4 groups: 10 cases in posterior uvietis stage group (20 eyes), 27 in anterior uveal involvement stage group (50 eyes), 23 in recurrent anterior uvitis stage group (41 eyes), and 17 in convalescent stage group (33 eyes). The other 50 cases (100 eyes) were in the control group. Flare and cells of anterior chamber in patient with VKH Syndrome at different stages were graded and measured by laser flare and cell meter (LFCM) and slitlamp microscope. Results According to the results of slitlamp biomicroscopy, anterior chamber flare and cells were at the 0 grade in the patients at posterior uvietis stage (20 eyes). The results of LFCM examination revealed that the flare value and cells were (9.7?3.4) pc/ms and (0.9?0.6)/0.5 mm3 in posterior uvietis stage group, and (5.3?2.3) pc/ms and (0.8? 0.6)/0.5 mm3 in the control group. The differences between the two groups were significant (P

Observation of Damage to the Blood-Aqueous Barrier after Trabeculectomy with Mitomycin C

We observed the breakdown of the blood-aqueous barrier after trabeculectomy with mitomycin C by using laser flaremeter. There were 20 patients (25 eyes) of which 9 patients(11 eyes) were applied 0.02% MMC for 3minutes during the trabeculectomy and 11 patients (14 eyes) were not applied MMC. All patients were diagnosed as primary open angle glaucoma and underwent trabeculectomy. The preoperative, postoperative 1 day and 3 months aqueous flare intensity were 10.8+/- 5.05, 15.6+/- 5.32, 10.1+/- 4.55(photon count/msec)in group with MMC and 10.6+/-4.04,15.9+/-3.30, 9.2+/-3.94(photon count/msec) in group without MMC Anterior chamber flares were highest on the first postoperative day, declining rapidly in the first week with more gradual recovery to preoperative level by 1 month postoperatively, which shows the breakdown of blood-aqueous barrier by surgery. There was no statistically significant difference between the two groups in postsurgical aqueous flare intensity. 0.02% MMC does not appear.

Effect of 5-fluorouracil and Mitomycin-C on Blood Aqueous Barrier

The adjunctive use of 5-fluorouracil and mitomycin C remarkably improves the success rate of glaucoma filtering surgery, but these antiproliferative agents may be toxic to other ocular tissues. The authors evaluated the effect of 5-FU and MMC on the blood-aqueous barrier. Sixteen pigmented rabbits were used, 7 for 5-FU group and 9 for MMC group. Five milligrams of 5-FU(0.1ml) was injected subconjunctivally in one eye of each animal in 5-FU group. In MMC group, we made limbus-based conjunctival flap on superotemporal area and applied MMC(0.4 mg/ml) soaked Week-cell sponge on subconjunctival-scleral space for 5 minutes and irrigated with 200 ml of normal saline. The contralateral eyes of each animal in both groups were used for control. We measured protein concentration in anterior chamber with the laser flare-cell meter(Kowa, FM-500). At 7 hours after operation, protein concentration in anterior chamber was significantly higher in 5-FU injected eyes(11.22 +/- 1.98 photons/msec, mean +/- S.D.) than control eyes(7.78 +/- 0.96 photons/msec) in the 5-FU group. There was no difference between MMC treated eyes and control eyes. MMC soaking is thought to be less harmful on the blood-aqueous barrier than 5-FU subconjunctival injection.

Prostaglandin E in rabbit aqueous humor after Nd-YAG laser photodisruption of the iris and the effect of topical indomethacin pretreatment

Rabbit eyes were irradiated with a neodymium-yttrium-aluminum-garnet (Nd-YAG) laser and the changes in prostaglandin E and protein levels in the aqueous humor were measured. Intraocular pressure and pupil diameter were also determined in the same rabbits. Prostaglandin E and protein in the aqueous humor were increased depending upon the number of laser lesions. The increase in intraorular pressure and the decrease in pupil diameter occurred at similar dosages of laser irradiation. The response of the iris to the photodisruption was rapid. Changes in prostaglandin and protein contents and pupil diameter were already prominent 15 min after laser irradiation. Indomethacin pretreatment abolished most of these responses, suggesting that acute reactions following photodisruption were largely dependent on prostaglandin synthesis in iris tissue