Efficacy and Safety of the Subtenon Injection of 0.01% Mitomycin C-augmented Trabeculectomy.

Background Trabeculectomy, with the application of mitomycin C (MMC), has been the gold standard glaucoma-filtering surgery. The conventional method of applying MMC using soaked sponges does not ensure a controlled amount of delivery of MMC, and incidences of blebitis are reported to be associated with leftover sponges. This study aims to assess the safety and efficacy of a low dose (0.1 mg/ml) of MMC administered through subtenon injection during trabeculectomy combined with cataract extraction, addressing existing research gaps. Methods It is a prospective interventional study on patients who underwent trabeculectomy with a subtenon injection of 0.1 mg/ml of MMC combined with cataract extraction and were followed up over six months. Efficacy was determined in terms of intraocular pressure (IOP) reduction; bleb architecture was graded using the Indiana Bleb Appearance Grading System (IBAGS) and success rate, and safety was commented upon in terms of complications. Results Thirty patients were enrolled, with the majority having primary open-angle glaucoma (63.33%), while 36.67% had primary angle-closure glaucoma. Baseline IOP was 31.40(±10.38) mmHg. It significantly reduced to 14.60(±3.75) mmHg on the first postoperative day, decreasing to 9.55(±1.57) mmHg by the sixth postoperative month (p=0.001). The percentage reduction in IOP was substantial, 69.57%, by the sixth postoperative visit. Bleb morphology assessment using IBAGS revealed significant improvements in bleb height and extent and a reduction in vascularity over the six-month follow-up (p=0.001), and no eyes had bleb encapsulation. Out of the total patients, 93.33% achieved controlled IOP without anti-glaucoma medications, while 6.67% required one medication for IOP control. Complications were minimal, with transient corneal edema in six patients and manageable postoperative hypotony in one case. Conclusion A subtenon injection of MMC during trabeculectomy effectively reduces IOP and promotes favorable bleb architecture, offering an effective and safer alternative to the conventional approach.

Intraoperative challenges and outcomes of pediatric cataract surgery following glaucoma filtering surgery.

PURPOSE: To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. METHODS: This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019. RESULTS: We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5 months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2 years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. CONCLUSION: Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.

Qingguang'an-induced autophagy in TFs inhibits scar formation: A follow-up in vivo mechanistic investigation.

Purpose: To investigate the mechanism by which Qingguang'an inhibits scar formation in rabbits administered glaucoma filtering surgery (GFS). Methods: Combined trabeculectomy was performed in 100 rabbits diagnosed with glaucoma, which were assigned to five groups, including the no surgery, surgery only, mitomycin C (MMC; positive control), Qingguang'an (experimental) and PBS (negative control) groups. The animals were followed up at postoperative days 1-28. Ultrastructure was observed under a transmission electron microscope (TEM). Real-Time Polymerase Chain Reaction (RT-PCR), Western blot, Hematoxylin and Eosin (H&E) staining, Masson's trichrome staining and Immuno-histochemistry (IHC) were performed to assess the harvested blocks. Results: In the Qingguang'an group, intraocular pressure (IOP) on postoperative D28 was significantly lower than values in the no surgery, surgery only and PBS groups (P < 0.05). Its blebs kept better filtering function and less complications in follow-up, which be detected to have less fibroblasts and collagen deposition histologically. Compared with the PBS group, ATG5, Beclin1 and LC3-II mRNA levels were significantly increased while P62 was downregulated in the Qingguang'an group (P < 0.05). Correspondingly, ATG5 and Beclin1 protein amounts in the Qingguang'an group were increased while P62 was downregulated. The LC3-II/Ⅰ ratio tended to rise to the process of autophagy. Abundant autophagosomes were captured under TEM in this condition. Conclusions: Qingguang'an granules can inhibit scar formation in rabbits after GFS and restrain IOP increase by inducing autophagy in TFs.

Surgical Outcomes in Uveitic Glaucoma: Long-Term Evaluation of Trabeculectomy, Non-Penetrating Deep Sclerectomy, Ex-PRESS Shunt and Ahmed Glaucoma Valve. A 3-Year Follow-Up Study.

PURPOSE: Uveitis can lead to secondary glaucoma, a condition with challenging management that can carry irreversible visual loss. Filtering surgery has demonstrated a higher failure rate, increased incidence of postoperative complications and reinterventions in uveitic patients. There is no consensus on the optimal surgical approach for uveitic glaucoma (UG) due to limited data comparing various intraocular pressure (IOP)-lowering surgeries. This retrospective cohort aims to assess the clinical outcomes of trabeculectomy (TBT), non-penetrating deep sclerectomy (NPDS), Ex-PRESS shunt and Ahmed glaucoma valve, providing additional insights into the long-term IOP control and safety of filtering surgeries in UG. METHODS: The filtering surgery was performed on 32 eyes of 27 UG patients. Complete success was defined as IOP ≤ 18 mmHg or a 30% reduction. Qualified success allowed topical hypotensive treatment. RESULTS: Complete success was 40.63% (13/32) at 12 months and 36.67% (11/30) at 36 months. Qualified success was 84.38% (27/32) at 12 months and 63.33% (19/30) at 36 months. In the survival analysis, both NPDS and Ex-PRESS demonstrated decreased failure rates compared to TBT (NPDS vs TBT: HR = 0.20, p = 0.049; Ex-PRESS vs TBT: HR = 0.28, p = 0.13). One or more reinterventions were required in 34.38% (11/32) of the eyes. NPDS had the lowest incidence of hypotony. Secondary cataract was a common complication in all groups. CONCLUSION: Various filtering surgeries are safe and effective procedures for lowering IOP and reducing the requirement of topical antihypertensives in UG at 36 months. However, one-third of the patients will require another IOP-lowering procedure.

A Comparative Analysis of Morphology and Dimensions of Functional Blebs following PRESERFLO-Microshunt and XEN-Gel-Stent, a Study Using Anterior Segment OCT.

Evaluation of bleb morphology is a vital part of successful filtration glaucoma surgery. The PRESERFLO-MicroShunt (PRESERFLO) and XEN-Gel-Stent (XEN) are drainage devices implanted using different surgical approaches (ab externo and ab interno, respectively), potentially resulting in distinct bleb morphology. Understanding these morphological differences is essential for postoperative care. In this study, we retrospectively examined functioning blebs following PRESERFLO and XEN implantation using high-resolution anterior segment OCT imaging. Qualitative assessment utilizing the Jenaer Bleb Grading System and quantitative assessment measuring 12 parameters representing bleb dimensions were conducted, and the results were compared between the two groups. A total of 80 eyes from 80 patients were included (41 after PRESERFLO, 39 after XEN). Functioning blebs following PRESERFLO exhibited a higher frequency of hyperreflective tenon changes compared to XEN (31.7% vs. 10.3%, respectively, p = 0.02) and a lower frequency of cavernous changes (17.1% vs. 35.9%, p = 0.05). Additionally, PRESERFLO blebs showed a higher frequency of visible episcleral lakes (92.7% vs. 30.8%, p < 0.001). Furthermore, PRESERFLO blebs demonstrated larger height (2.13 ± 0.5 vs. 1.85 ± 0.6 mm, p = 0.03), width (10.31 ± 2.3 vs. 9.1 ± 2.3 mm, p = 0.02), length (9.13 ± 1.8 vs. 8.24 ± 1.9 mm, p = 0.04), posterior location relative to the limbus (6.21 ± 1.2 vs. 5.21 ± 1.8 mm, p = 0.005), and a thicker bleb wall (1.60 ± 0.5 vs. 1.1 ± 0.4 mm, p = 0.004). Functioning blebs following PRESERFLO and XEN displayed morphological distinctions, likely attributed to variations in surgical techniques (ab externo vs. ab interno) and stent dimensions. These morphological differences should be taken into consideration when evaluating blebs, as they could impact assessments of bleb functionality and influence decisions regarding postoperative interventions.

Late-Onset Bleb-Related Endophthalmitis Caused by Moraxella nonliquefaciens: A Case Report.

Moraxella species are Gram-negative coccobacilli that typically colonize the flora of the human upper respiratory tract and have low pathogenic potential. There are limited case reports implicating the organisms as the cause of endocarditis, bacteremia, septic arthritis, ocular infection, and meningitis. In cases of keratitis and conjunctivitis, Moraxella nonliquefaciens is not commonly isolated from the ocular surface. We present a case of a diabetic patient who developed late-onset bleb-related endophthalmitis caused by M. nonliquefaciens 4 years after glaucoma filtering surgery. Within one day, the patient presented with an acutely fulminant course with sudden visual loss, redness, and ocular pain. Appropriate antibiotic treatment and early vitrectomy resulted in a favorable final visual acuity of 20/100, which was his vision prior to infection. The use of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass spectrometry (MALDI-TOF MS) enabled the rapid identification of the organism. Endophthalmitis caused by M. nonliquefaciens should be considered in patients who underwent glaucoma filtering surgery with antifibrotic agents.

Zinc Oxide Tetrapods Modulate Wound Healing and Cytokine Release In Vitro-A New Antiproliferative Substance in Glaucoma Filtering Surgery.

Glaucoma filtering surgery is applied to reduce intraocular pressure (IOP) in cases of uncontrolled glaucoma. However, postoperative fibrosis reduces the long-term success of both standard trabeculectomy and microstents. The aim of this study was to test the antiproliferative and anti-inflammatory potential of ZnO-tetrapods (ZnO-T) on human Tenon's fibroblasts (HTFs) for glaucoma surgery. The toxicity of ZnO-T on HTFs was determined using an MTT test. For analysis of fibroblast proliferation, migration, and transdifferentiation, cultures were stained for Ki67, alpha-smooth muscle actin (α-SMA), and p-SMAD. A fully quantitative multiplex ELISA was used to determine the concentrations of different cytokines, platelet-derived growth factor (PDGF), and hepatocyte growth factor (HGF) in culture supernatants with and without previous ZnO-T treatment. Treatment with higher concentrations (10 and 20 µg/mL) was associated with HTF toxicity, as shown in the wound healing assay. Furthermore, the number of Ki67, α-SMA-positive, and pSMAD-positive cells, as well as IL-6 and HGF in supernatants, were significantly reduced following incubation with ZnO-T. In conclusion, we were able to show the antiproliferative and anti-inflammatory potentials of ZnO-T. Therefore, the use of ZnO-T may provide a new approach to reducing postoperative fibrosis in glaucoma filtering surgery.

In Vitro Evaluation of Zinc Oxide Tetrapods as a New Material Component for Glaucoma Implants.

In our previous study we were able to show that zinc oxide (ZnO) tetrapods inhibit wound healing processes. Therefore, the aim of this study was to test the antiproliferative effect of two types of porous polydimethylsiloxane (PDMS)/ tetrapodal zinc oxide (ZnO-T) materials, as well as their usability for glaucoma implants. To find the best implant material, two different porous PDMS/ZnO-T materials were examined. One consisted of 3D interconnected PDMS coarse-pored foams with protruding ZnO-T particles; the other consisted of fine-pored 3D interconnected ZnO-T networks homogeneously coated by a thin PDMS film in the nanometer range. Fibroblast cell viability was investigated for both materials via MTT dye, and some implant material samples were further processed for electron microscopy. Both PDMS/ZnO-T materials showed reduced cell viability in the MTT staining. Furthermore, the electron microscopy revealed barely any fibroblasts growing on the implant materials. At the surface of the fine-pored implant material, however, fibroblasts could not be observed in the etched control samples without ZnO-T. It was found that post-processing of the material to the final stent diameter was highly challenging and that the fabrication method, therefore, had to be adapted. In conclusion, we were able to demonstrate the antiproliferative potential of the two different PDMS/ZnO-T materials. Furthermore, smaller pore size (in the range of tens of micrometers) in the implant material seems to be preferable.

Prospective evaluation of wipe-out after glaucoma filtration surgery in eyes with split fixation.

Purpose: To assess the incidence and cause of idiopathic, irreversible loss of vision ("wipe-out") in the early post-operative period after glaucoma-filtration surgery in advanced glaucoma. Methods: It was a prospective, interventional cohort study. Patients with advanced glaucoma and macular split fixation underwent either only trabeculectomy (group A) or combined phaco-emulsification with trabeculectomy (group B). The incidence and cause of visual loss, changes in intra-ocular pressure, visual acuity, and visual field indices during 2 months post surgery were assessed. Results: Thirty patients (30 eyes) were divided in two groups. No significant difference was noted between the pre-operative and post-operative mean deviations in both groups (P = 0.41, P = 0.65). Two eyes in group A and one eye in group B had visual loss of two lines or more at the end of 2 months because of cataract and choroidal detachment. None of the eyes showed "wipe-out". Conclusion: "Wipe-out" is a rare phenomenon after surgery in advanced glaucoma.

Coughing-induced retinal pigment epithelial tear after trabeculectomy combined with pars plana vitrectomy.

Purpose: To report a case of retinal pigment epithelial (RPE) tear after trabeculectomy combined with pars plana vitrectomy (PPV). Observations: A 65-year-old man with neovascular glaucoma due to proliferative diabetic retinopathy presented with visual impairment and elevated intraocular pressure (IOP) in the right eye and underwent trabeculectomy combined with PPV. Three weeks after surgery, the best-corrected visual acuity (logarithm of minimal angle of resolution) improved from 3.0 to 0.30, and the IOP was controlled within normal limits. Four weeks after the surgery, he noticed visual impairment and ocular pain in the right eye after continuous coughing associated with asthma. Fundus examination revealed bullous retinal detachment, choroidal detachment, and submacular hemorrhage (SMH) due to a giant RPE tear at the posterior pole. Visual acuity worsened considerably to 1.7, while IOP was not elevated (6 mmHg). The patient received PPV with recombinant tissue plasminogen activator (rt-PA) and fluid/air exchange for internal tamponade and achieved anatomic retinal and choroidal attachments. Conclusions and importance: The acute increase in hydrostatic pressure in the choroidal interstitium due to continuous coughing induces an RPE tear. Vitrectomy with rt-PA and fluid/air exchange may be a favorable treatment for exudative retinal detachment and SMH due to RPE tears.

A modified model of glaucoma filtering surgery in Sprague-Dawley rats.

Animal models are useful in glaucoma research to study tissue response to wound healing. Smaller animals such as rats offer additional advantages in terms of availability of detection antibodies and microarrays with cheaper maintenance costs. In this study, we describe a glaucoma filtering surgery (GFS) model in adult Sprague-Dawley rats by performing a sclerostomy using a 26-G needle and additionally placing a silicone tube (27 G) connecting the anterior chamber to the subconjunctival space to maintain a patent fistula for the flow of aqueous humor, thus providing a more definitive bleb. This technique will be useful in identifying and modifying newer targets in the wound healing process in order to improve surgical outcomes following GFS.

Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital.

AIM AND OBJECTIVE: This study aimed to evaluate the performance of and indication for different surgical techniques in the management of uveitic glaucoma (UG). MATERIALS AND METHODS: A retrospective audit of records of all patients with UG who underwent ≥1 glaucoma surgery, between January 2007 and December 2016. The main outcomes were intraocular pressure (IOP) and the need for antihypertensive medication at each follow-up visit. The total number of surgical interventions needed to control IOP was recorded. Postoperative interventions and complications were analyzed. RESULTS: Forty eyes from 34 patients were assessed. Overall, baseline IOP was 30.7 ± 8.2 mm Hg, and postoperative mean IOP at the last visit was 16.4 ± 2.0 mm Hg, with a mean follow-up of 28 months. Antihypertensive medications were reduced from 2.8 ± 0.8 to 0.8 ± 1.2. During the follow-up, 61.8% of the eyes required only one glaucoma surgery. There was no correlation between the location of uveitis and the total number of glaucoma surgeries required. The greatest IOP reductions were in cases treated with non-penetrating deep sclerectomy (21%), Ahmed valve (23%), and cyclophotocoagulation (CPC) (51%); in cases where an Ahmed implant was the first surgical option, a 43% reduction was achieved. CONCLUSION: Filtering procedures, glaucoma drainage devices, and CPC are all good options for IOP control in UG, but all are prone to failure over time. With respect to IOP reduction, the safety profile, and postoperative care, Ahmed implants and CPC might be the best first surgical option. CLINICAL SIGNIFICANCE: The article highlights the versatility of the surgical techniques required to treat UG, which is one of the most difficult types of glaucoma to manage. HOW TO CITE THIS ARTICLE: Ventura-Abreu N, Mendes-Pereira J, Pazos M, et al. Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital. J Curr Glaucoma Pract 2021;15(2):52-57.

Acute Glaucoma Filtering Surgery Failure following Herpes Zoster Ophthalmicus Infection.

Herein, we report a case of acute failure of a previously successful trabeculectomy, following an infection with herpes zoster ophthalmicus (HZO). HZO remains a common infection, especially among elderly and immunocompromised patients. There is a strong link between HZO infection, the incidence of secondary glaucoma, and the need for glaucoma filtering surgery. Though, to our knowledge, there are no cases reporting on the effect that a concomitant infection may have on a previously successful trabeculectomy. In our case, a 76-year-old immunocompetent male with primary open-angle glaucoma in both eyes and a history of a successful right eye trabeculectomy 1 year earlier presented with acute primary HZO involving the ophthalmic branch of the right trigeminal nerve. Appropriate topical and systemic treatment was immediately initiated. Three days later, the trabeculectomy bleb showed hyperemia and flattening and concomitant rise of intraocular pressure was noted. A week later, the cutaneous signs were improving yet the trabeculectomy had failed and high intraocular pressure was established, requiring both topical and systemic antiglaucoma medications. Our study suggests that a previously successful trabeculectomy may manifest signs of compromise and subsequent failure following a HZO infection.

Pars Planectomy: Preliminary Report of a New Glaucoma Filtering Technique in Vitrectomized Eyes.

PURPOSE: To propose a new filtering technique in vitrectomized eyes with glaucoma and report its clinical results and safety. METHODS: The medical records of 13 eyes that developed glaucoma following pars plana vitrectomy and underwent pars planectomy, from 2011 to 2018, at Songklanagarind hospital, Hatyai, Songkhla, Thailand were retrospectively reviewed. The main outcome measures were visual acuity (VA), intraocular pressure (IOP), number of glaucoma medications, and postoperative complications. Surgical success was defined as IOP value at the last visit of 6-21 mmHg, regardless of anti-glaucoma medication usage, and without further glaucoma surgery. RESULTS: The mean follow-up duration was 47.7 ± 32.1 months (range, 0.3-101.1 months). Preoperative BCVA increased from LogMAR 1.01 ± 0.85 to 1.2 ± 0.91 at the last visit (p = 0.233). The mean preoperative IOP was 28.15 ± 9.17 mmHg with an average of 3.46 ± 0.52 anti-glaucoma medications. At the final visit, the mean IOP was 14.08 ± 4.89 mmHg (p = 0.006) and the mean number of anti-glaucoma medications decreased to 1.31 ± 1.38 (p = 0.000). The probability of surgical success was 58.3%, 50%, and 37.5% at 1, 2, and 6 years after pars planectomy, respectively. Postoperative complications included vitreous hemorrhage in 1 eye (7.7%). No retina and pars plicata associated complications were found. CONCLUSION: Pars planectomy is efficient and safe as well as requires a short learning curve. It should be considered as an alternative filtering surgery in glaucoma after vitrectomy, especially with an extensive limbal scar that might be a limitation in trabeculectomy and GDDs techniques and outcomes.

Local peribulbar anesthesia before glaucoma filtering surgery in a patient with Brugada syndrome.

We report anesthetic management in a patient with Brugada syndrome, an inherited syndrome characterized by normal QT interval, typical ST-segment-elevation in the right precordial leads, and increased risk of sudden cardiac death in the absence of myocardial ischemia or structural heart disease. A 69-year-old man scheduled for glaucoma filtering surgery underwent local peribulbar anesthesia using 5 mL of lidocaine 20 mg/mL solution that was slowly injected into two different sites approximately 10 min prior to the surgical procedure. The surgery proceeded uneventful and data of patient's blood pressure, heart rate, oxygen saturation were collected. Continuous electrocardiography monitoring before, during, and up to 6 h after surgery did not reveal any arrhythmia or tachycardia. A certain number of drugs should be avoided in patients with Brugada syndrome because of their potential risk to trigger an arrhythmia. Among them there are some anesthetics and in particular those that are sodium channel blockers. Ropivacaine and bupivacaine, commonly used for peribulbar block, have been associated with onset of severe arrhythmias. Contrarily, the use of class IB drugs mexiletine and lidocaine is generally considered safe. Local anesthetic agent should be carefully chosen, and anesthesia should be obtained using the minimal necessary drug dose.

Retinal detachment with retinal pigment epithelial tear under hypotony after trabeculectomy: A case report.

PURPOSE: To report a case of retinal detachment with retinal pigment epithelium (RPE) tear, under hypotony after trabeculectomy, which immediately resolved upon elevation of intraocular pressure. OBSERVATIONS: A 67-year-old man who had undergone trabeculectomy presented for treatment of a visual field defect in his left eye. His glaucoma surgery was uneventful. At his first visit to our clinic, the patient's visual acuity was 15/20 in the right eye and 20/40 in the left; intraocular pressure was 18 mmHg in the right and 5 mmHg in the left. Fundus examination of the left eye revealed a retinal detachment, overlying a choroidal detachment, and an RPE tear. The retinal detachment did not resolve with systemic steroid pulse therapy or vitrectomy. The patient was then diagnosed with an exudative retinal detachment with RPE tear under hypotony, and transconjunctival sutures were applied to tighten the scleral flap, to elevate intraocular pressure. After the transconjunctival sutures were applied, intraocular pressure increased to 10 mmHg and the exudative retinal detachment immediately resolved. There was no recurrence of retinal detachment after the intervention. CONCLUSIONS AND IMPORTANCE: Because there have been few case reports of retinal detachment with an RPE tear after glaucoma filtering surgery, no therapeutic strategy has yet been proposed. The findings in this case indicate that intraocular pressure elevation is effective for treating exudative retinal detachment with RPE tear in cases of hypotony after glaucoma filtering surgery.

Surgical outcomes following Muller Muscle-Conjunctival Resection in patients with glaucoma filtering surgery.

PURPOSE: Muller muscle-conjunctiva resection (MMCR) has been often considered to be relatively contraindicated in patients with previous glaucoma surgery. We investigate the glaucoma and ptosis outcomes in patients with glaucoma filtering blebs undergoing MMCR surgery. METHODS: Retrospective cross-sectional case-control study at a single institution over a 15-year period on eyes of patients > 18 years of age who underwent MMCR surgery were included. Eyes were separated into 2 groups: 1) Ptosis with glaucoma filtering bleb(s) (case group); 2) Ptosis without a glaucoma filtering bleb (control group). The primary outcome measure was bleb failure. Secondary outcome measures were postoperative marginal reflex distance (MRD)1 and change in MRD1. RESULTS: 87 eyes from 80 patients met the inclusion criteria, with 29 eyes from 25 patients in the case group and 58 eyes from 55 patients in the control group. The mean (SD) length of MMCR follow-up and glaucoma follow-up after MMCR surgery were 7.3 (15.2) months and 16.4(9.3) respectively. Preoperatively, there were no significant differences between groups in terms of mean (SD) age [73 (13.2) vs 73.4 (13.1) years; p = .79] nor preoperative MRD1 [1.3 (0.2) vs. 1.4 (0.1) mm; p = .90]. There were no bleb-related complications. Three eyes (10.3%) were characterized as postoperative bleb failure. No significant differences in mean postoperative MRD1 nor mean change in MRD1 were noted (p= .34 and p = .15). CONCLUSIONS: Muller muscle-conjunctiva resection (MMCR) is an apparently safe and effective tool for the management of ptosis in patients with glaucoma filtering blebs.

Recommendations for the management of elevated intraocular pressure due to bleb fibrosis after XEN gel stent implantation.

Surgical management of glaucoma offers a means of effective disease control. A gel stent that facilitates drainage to the subconjunctival space offers intraocular pressure (IOP) reduction similar to traditional glaucoma filtering surgeries in a less invasive manner. However, like all subconjunctival filtering procedures that result in a bleb, fibrosis can present as a cause of elevated IOP. The following proposed techniques and recommendations for managing elevated IOP due to bleb fibrosis after gel stent implantation are based on the clinical experience of the authors. The goal of this paper is to improve outcomes following gel stent surgery by providing guidance on assessment of bleb function and strategies for bleb enhancement.

Research progress on pathobiology of myofibroblast in wound healing after glaucoma filtering surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#Glaucoma filtering surgery is the main treatment for the glaucomatous patients. Typically, surgery failed mary due to wound fibrosis and contracture at the post-surgical site.Myofibroblasts transdifferentiated from other cells via a process known as epithelial-mesenchymal transition(EMT)is a common feature of the fibrotic filtering channel, which can produce excessive amounts of the extracellular matrix(ECM), and then exert tractional forces, resulting in the disruption of tissue architecture and obstruction of filtering channel. In this review, we explain the pathological function of myofibroblast in the wound healing process after glaucoma filtering surgery.

Pirfenidone Induces G1 Arrest in Human Tenon's Fibroblasts In Vitro Involving AKT and MAPK Signaling Pathways.

PURPOSE: To investigate the underlying mechanism by which pirfenidone blocks the transition from the G1 to S phase in primary human Tenon's fibroblasts. METHODS: Primary human Tenon's fibroblasts were characterized by immunocytofluorescence staining with vimentin, fibroblast surface protein, and cytokeratin. After treating Tenon's fibroblasts with pirfenidone under proliferation conditions (10% fetal bovine serum), cell proliferation was measured using a WST-1 assay. Progression through the cell cycle was analyzed by flow cytometry. The expression of CDK2, CDK6, cyclinD1, cyclinD3, and cyclinE and the phosphorylation of AKT, ERK1/2/MAPK, JNK/MAPK, and p38 MAPK were estimated using western blot analysis. RESULTS: Under proliferative conditions, pirfenidone inhibited Tenon's fibroblasts proliferation and arrested the cell cycle at the G1 phase; decreased the phosphorylation of AKT, GSK3ß, ERK1/2/MAPK, and JNK/MAPK; increased the phosphorylation of p38 MAPK; and inhibited CDK2, CDK6, cyclin D1, cyclin D3, and cyclin E in a dose-dependent manner. Inhibitors of AKT (LY294002), ERK1/2 (U0126), and JNK (SP600125) arrested the G1/S transition, similar to the effect of pirfenidone. The p38 inhibitor (SB202190) decreased the G1-blocking effect of pirfenidone. The expression of CDK2, CDK6, cyclin D1, and cyclin D3 were inhibited by LY294002, U0126, and SP600125. SB202190 attenuated the pirfenidone-induced reduction of CDK2, CDK6, cyclin D1, cyclin D3, and cyclin E. CONCLUSIONS: Pirfenidone inhibited HTFs proliferation and induced G1 arrest by downregulating CDKs and cyclins involving the AKT/GSK3ß and MAPK signaling pathways.