Safety and Efficacy of Second Ahmed Valve Implant in Refractory Glaucoma.

BACKGROUND: Refractory glaucoma still represents a challenge for ophthalmologists to manage intraocular pressure. The present study aimed to evaluate long term efficacy and safety of a second Ahmed valve implantation after the failure of a first implant in patients with refractory glaucoma and elevated intraocular pressure (IOP). METHODS: Retrospective, multicenter non-comparative case series. Twenty-eight patients were retrospectively recruited between January 2011 and December 2017. Demographic data, glaucoma type, visual acuity, intraocular pressure, medical therapy, and complications were registered. Three criteria of success were established: Type 1 surgical success: IOP ≤ 15 mmHg and a reduction of IOP ≥ 40% from baseline; Type 2 surgical success: IOP ≤ 18 mmHg and a reduction of IOP ≥ 30% from baseline; and Type 3 surgical success: IOP ≤ 21 mmHg and a reduction of IOP ≥ 20% from baseline. Surgical failure has been established as IOP less than 5 mmHg or over 21 mmHg and less than a 20% reduction of IOP from baseline despite medications in two consecutive visits, light perception loss referable to glaucoma, and the necessity for further glaucoma surgery. Failure was observed in six (21%) patients. (3) Results: Mean IOP and mean glaucoma medication number significantly reduced from baseline after the second implantation, and the surgical success rate at 72 months ranged from 10% to 78% based on the different criteria of success. Failure was observed in six (21%) patients. CONCLUSIONS: This study confirmed the safety and efficacy of a second Ahmed valve implantation in patients with refractory glaucoma and elevated IOP at baseline.

The era of anti-vascular endothelial growth factor (VEGF) drugs in ophthalmology, VEGF and anti-VEGF therapy.

Angiogenesis is a clue process for tissue development and function, both in normal and pathological conditions. This process is regulated by multiple molecular systems. One of the most potent is vascular endothelial growth factor (VEGF) and its receptor (VEGFR) system. Members of this family are involved in new vessel formation in embryogenesis and maturation, as well as in reparative or pathological reactions in later stages. They play a substantial role in regeneration, inflammation, wound healing, as well as in cancer pathology. Nowadays it is possible to modulate VEGF-VEGFR interactions in many pathological conditions using anti-VEGF therapy. This therapy has already achieved a grounded position in the management of rheumatological disorders, tumour progression, and metastasis. Such drugs as bevacizumab, ranibizumab, aflibercept, and pegaptanib have also proven to be very effective in the treatment of several ocular diseases, such as age-related macular degeneration (AMD), macular oedema, or proliferative retinopathies and iris neovascularisation. The indications for the application of this therapy in ophthalmology are becoming wider and wider. It may also be used for corneal pathologies and in anti-glaucoma procedures.

[Uveitis in patients with multiple sclerosis]. / Zapalenie blony naczyniowej u chorych na stwardnienie rozsiane.

UNLABELLED: Multiple sclerosis (SM) is an idiopathic, demyelinating CNS disease, with often ocular manifestations. Besides the most common SM ocular manifestation-optic neuritis, particular attention should be paid to uveitis. It is estimated that uveitis is ten times more frequent in population with SM than on population without it. PURPOSE: The aim of this study is to present our own observation of clinical course of the uveitis in SM patients. MATERIAL AND METHODS: We studied 9 patients (7 women and 2 men), who had been treated in 2nd Department of Ophthalmology Lublin Medical School in 1993-2006. In I group (2 persons) uveitis was casually diagnosed during an ophthalmic examination in patients with SM. In II group (2 persons), first event of the uveitis was observed in patients with already diagnosed SM. In III group (2 persons), initial diagnose was uveitis, and subsequently SM was diagnosed. Group IV consisted of patients with uveitis, who developed SM several years later (3 persons). RESULTS: Clinical course of inflammatory process was bilateral, severe and chronic with exacerbation. Panuveitis, cystoid macular oedema, cataract formation, and glaucoma were the most often findings. All of patients were treated with corticosteroids. Therapy with corticosteroids caused improvement in all patients. CONCLUSIONS: The possibility of co-existence of SM and uveitis should be emphasized. Corticosteroids are efficient in the treatment of ocular complications in patients with SM.

Benzalkonium chloride (BAK) induces apoptosis or necrosis, but has no major influence on the cell cycle of Jurkat cells.

Benzalkonium chloride (BAK) is a cationic detergent with a very slow turnover. Because of its strong antibacterial activities, BAK is widely used especially in dentistry and ophthalmology. It is the most commonly used preservative in topical ophthalmic medications. Due to chronicity and widespread use of such treatments, BAK's side effects are of great importance. BAK toxicity for adherent cells, probably related to its pro-oxidative activities, is time- and dose-dependent. Although lymphocytes often infiltrate superficial eye tissues, the BAK influence on them is yet to be established. The aim of this study was to check BAK cytotoxicity on T lymphocytic Jurkat line cells and to verify the suggestion that BAK can induce G2M cell blocks. A dose- and time-dependent cytotoxic effect of BAK on lymphoid cells in relatively low concentrations was shown in this study. In lower concentrations, it shows a moderate apoptotic and minimal antiproliferative effect on Jurkat cells, while in higher concentrations it shows a rapid necrotic effect. No G2M cell blocks were observed. Our findings could suggest lymphoid dysfunction during intensive, prolonged topical BAK treatment, even at dosages relatively non-toxic to epithelial eye cells.

Safety and tolerability of tafluprost in treatment of elevated intraocular pressure in open-angle glaucoma and ocular hypertension.

Glaucoma is one of the most common neuropathies of the optic nerve. An elevated intraocular pressure (IOP) is a well documented risk factor for the development and progression of this disease. Until now, IOP reduction is the only well documented successful method of glaucoma treatment. Among the many hypotensive drugs, prostaglandin analogs are proved to be the most potent antiglaucoma agents, with very few systemic side effects. A new prostanoid FP receptor analog, tafluprost, has been introduced into the medical treatment of glaucoma and ocular hypertension. Many studies have shown that it is an efficient IOP-lowering drug, and that it is safe and well tolerated. A preservative-free tafluprost formulation is as potent as a preserved one, but it has fewer and milder toxic effects on the eye.

Cytometric assessment of cytostatic and cytotoxic effects of topical glaucoma medications on human epithelial corneal line cells.

BACKGROUND: The long-term-treatment of glaucoma with topical medications is associated with side effects involving cornea damage. We examined the effect of glaucoma topical medications (bimatoprost, travoprost, latanoprost, timolol, betaxolol, dorzolamide, brinzolamide, brimonidine) on growth of cells of three human epithelial corneal lines. METHODS: The cells were cultured in 8-chamber slides, treated with different concentrations of the medications, and fixed at 24, 48, and 72 h. Cell number on slides to estimate viability and growth curves, frequency of apoptosis (FLICA and caspase-3 activation probes), and proliferation (BrdU incorporation assay) were measured by laser scanning cytometry (LSC). RESULTS: Depending on concentration all examined medications induced cell necrosis or apoptosis and suppressed proliferation. Significant variability in proliferation and apoptosis was observed within the same cultures depending on local cell density, with cells in high density areas being more resistant. The data indicate that commonly used topical medications exert cytostatic and cytotoxic effects in cultures of corneal cells and suggest that caution should be exercised in their use, particularly, when the corneal diseases are accompanied by cell proliferation and regeneration, in long-term-treatment. CONCLUSIONS: The present approach of using LSC makes it possible to assess and compare cytostatic and cytotoxic effects of different topical medications on the respective target cells.

TH1/TH2 balance in the subretinal fluid of patients with rhegmatogenous retinal detachment.

BACKGROUND: The pathogenesis of rhegmatogenous retinal detachments remains unclear, but some data suggest immune system involvement. Cytokines are substances secreted by cells in order to modulate the function of other cells. They exert primarily local effects. Because the TH1/TH2 balance is crucial in the immune response, the predominance of one cytokine profile in subretinal fluid may be of particular importance in understanding its pathogenesis. MATERIAL/METHODS: We measured the titres of IL-10 and tIL-12 in the subretinal fluid of 36 rhegmatogenous retinal detachment patients using ELISA assays. RESULTS: The mean level of IL-10 and tIL-12 in the subretinal fluid was 4.75 pg/ml and 106.5 pg/ml, respectively. CONCLUSIONS: It would appear that IL-10 and IL-12 are produced by cells in subretinal fluid, and their presence may be evidence for an existing inflammatory process. Despite the tendency to decreased cytokine concentration over time and the tendency to higher concentrations of IL-10 and tIL-12 when the detachment of the retina is more extensive, no predominance of TH1- or TH2-type response was observed.