Effect of Novel Design Modifications on Fibrotic Encapsulation: An In Vivo Glaucoma Drainage Device Study in a Rabbit Model.

PURPOSE: To quantify the effects of modified Ahmed glaucoma valves® (AGV) with anti-fibrotic plate coatings or a plate surface micro-pattern on outflow resistance and tissue response. METHODS: Twelve New Zealand rabbits were divided into four groups: commercially available AGV implants (n = 3), AGV with hydrophilic coating (n = 3), AGV with heparin coating (n = 3), and AGV with a plate surface micro-pattern (n = 3). After 6 weeks, the anterior chamber silicone tube was cannulated in situ and perfused with 2.5 µL/min of saline. The pressures were recorded with a perfusion system to measure outflow resistance. The rabbits were then euthanized followed by enucleation of all eyes for bleb histological analyses. RESULTS: Hydrostatic pressures were significantly lower in AGVs with the hydrophilic plate coating (mean difference -9.6 mm Hg; p < 0.001), heparin-coated plates (mean difference -4.4 mm Hg; p < 0.001), and micro-patterned plates (mean difference -18.6 mm Hg, p < 0.001), indicating lower outflow resistance compared to control AGV models. Fibrotic encapsulation was lower in hydrophilic plate coating (84.2 µm; mean difference -6.2 µm, p = 0.425), micro-patterned surface (63.7 µm; mean difference -26.7 µm, p = 0.003), and heparin plate coating (49.3 µm; mean difference -41.1 µm, p = 0.006) when compared to control AGV models. CONCLUSIONS: Modified AGVs with plate coatings and AGVs with micro-patterned plates both appear to reduce postoperative fibrotic encapsulation and aqueous outflow resistance by altering the tissue response to implanted materials. Further studies are needed to characterize the safety and role of plate surface modifications on glaucoma drainage devices.

Goniotomy with a single-use dual blade: Short-term results.

PURPOSE: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a single-use dual blade (Kahook) in patients with mild to end-stage glaucoma. SETTING: International multicenter ophthalmic care centers. DESIGN: Prospective interventional case series. METHODS: Consecutive patients with glaucoma who had phacoemulsification plus goniotomy with the single-use dual blade were enrolled in this study. Each center collected deidentified clinical data, including preoperative and postoperative IOP, medication use, adverse events, and whether additional surgery was required during a 6-month follow-up. RESULTS: Of the 71 eyes included in this study, 70% had primary open-angle glaucoma. Other diagnoses included angle-closure, pigmentary, pseudoexfoliative, and normal-tension glaucoma. Sixty-five percent of eyes were classified as having mild to moderate glaucoma and 35%, severe glaucoma. The mean baseline IOP decreased from 17.4 mm Hg ± 5.2 (SD) to 12.8 ± 2.6 mm Hg 6 months postoperatively and the hypotensive medication use decreased from 1.6 ± 1.3 to 0.9 ± 1.0, respectively (P < .001 and P = .005, respectively). The most common observation was blood reflux during surgery (39.4%). CONCLUSION: Single-use dual blade goniotomy plus phacoemulsification resulted in a significant and sustained reduction in IOP and a decrease in glaucoma medications after 6 months of follow-up.

Spinal cord compression following traditional confinement massage.

We describe a case of tetraparesis in a 33-year-old woman following neck manipulation performed by a traditional confinement mid-wife. An MRI of the cervical spine revealed a fracture of the second cervical vertebra with atlanto-axial subluxation that resulted in cord compression.

Palm vitamin E and glucosamine sulphate in the treatment of osteoarthritis of the knee.

OBJECTIVE: To assess the efficacy of oral palm vitamin E in reducing symptoms of patients with osteoarthritis (OA) of the knee compared to oral glucosamine sulphate. METHODS: This open study was carried out at the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia between March 2006 and November 2007. Seventy-nine patients were recruited to receive either 1.5 g oral glucosamine sulphate or 400 mg oral palm vitamin E for 6 months. Symptoms were assessed using the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and visual analogue scale (VAS). RESULTS: Sixty-four patients completed the trial (vitamin E n=33, glucosamine sulfate n=31). After 6 months of treatment, both groups showed a significant improvement in WOMAC scale and significant reduction in the VAS score during standing and walking. There was no significant difference in WOMAC scale and VAS score between the 2 groups. Except for mild allergic reaction and abdominal discomfort in one patient, there were no other serious adverse effects reported. Serum malondialdehyde was significantly higher in the glucosamine group compared to palm vitamin E treated group at the end of the study. Serum of vitamin E was significantly higher in the palm vitamin E group compared to glucosamine. CONCLUSION: The finding of this study suggests that oral palm vitamin E in a dose of 400 mg taken daily has a potential role in reducing symptoms of patients with OA of the knee. It may be just as effective as glucosamine sulphate in reducing the symptoms and free from serious side effects. Further study is required to ascertain the mechanism of action beside its antioxidant effect.