Migration of glaucoma drainage device extender into anterior chamber after trauma.

PURPOSE: Glaucoma drainage devices, on rare occasions, need repositioned and the intraocular portion of the implant tube is found to be "too short" to do so. Previously, a technique was described for "extending" the tube with angiocatheter material (rather than replacing the entire apparatus), and had been performed successfully without complication for 7 years. This case describes the first known complication: trauma causing anterior chamber migration of the tube extension requiring retrieval and reconstruction of the tube extension apparatus. PATIENT AND METHODS: One eye of 1 patient (age 8) with a prior glaucoma drainage device and tube extension with angiocatheter material with elevated intraocular pressure after direct trauma to the eye from a pencil. Office examination revealed inferior corneal edema and no tube segment visible in the anterior chamber on limited examination due to age-related compliance. Gonioscopy under anesthesia revealed the tube extender in the inferior anterior chamber. The tube extender was retrieved from the anterior chamber. The glaucoma drainage device was surgically exposed and the tube extension was reconstructed, including securing the tube extension with a suture placed through the lumens of both the angiocatheter extender and the tube extension. RESULTS: The reconstructed tube extension maintained good draining function with the secured extension and no further migration of the tube extension into the anterior chamber was seen. CONCLUSIONS: Tube extension using angiocatheter material continues to be a viable, cost-effective option in difficult cases. Placing a securing suture in patients prone to eye trauma can be considered.

The use of rabbit polyclonal antibodies to assess neoantigenicity following viral reduction of an alpha-1-proteinase inhibitor preparation.

The objective of this study was to determine whether the viral reduction processes of nanofiltration and solvent/detergent treatment used in the manufacture of alpha-1 proteinase inhibitor (API) cause neoantigenic changes. Polyclonal antibodies were raised in rabbits against the treated API and quantitatively absorbed with an affinity column containing API that had not undergone viral reduction treatment. Antibodies before and after absorption were measured in a validated ELISA using the immunogen for antibody capture. Antibodies against novel API epitopes were not found after antiserum from rabbits inoculated with treated API was absorbed with untreated API. A positive control, consisting of serum obtained from rabbits inoculated with trinitrophenylated API, showed substantial amounts of measurable antibody following absorption with untreated API. The results suggest that the viral reduction process used does not result in the creation of API neoantigens.

Structural design of the dry fibrin sealant dressing and its impact on the hemostatic efficacy of the product.

We compared the hemostatic efficacy of a production version of a dry fibrin sealant dressing (DFSD) to a prototype that was previously successful in large animal studies. The results were used to improve manufacturing processes. Grade-V liver injuries were induced in swine and treated with gauze sponges (GAU), the prototype dressings (DFSD-1), or the scaled-up production version dressings (DFSD-2 in experiment 1 and DFSD-3 in experiment 2). Blood loss, hemostasis, resuscitation volume, and 60-min survival were quantified. In experiment 1, the DFSD-1 treatment reduced blood loss (p < 0.01), increased hemostasis at 4 min (p < 0.05), and improved survival (p < 0.05) compared with GAU. The DFSHD-2 decreased blood loss (p < 0.05) but did not increase hemostasis or survival significantly. Based on these results, manufacturing processes were altered, producing DFSD-3. In experiment 2, the DFSD-1 and DFSD-3 were equally effective in reducing blood loss (p < 0.01) and resuscitation volume (p < 0.05) compared with GAU. Hemostasis occurred more frequently in both the DFSD-1 and DFSD-3 groups (p < 0.01) compared with GAU. The structural design of DFSD-2 did not meet the efficacy requirement for release of the product. The subsequent change incorporated in DFSD-3 improved all hemostatic parameters of the dressings equal to those of the prototype product.