RESUMO
The precise mechanism by which oral infection contributes to the pathogenesis of extra-oral diseases remains unclear. Here, we report that periodontal inflammation exacerbates gut inflammation in vivo. Periodontitis leads to expansion of oral pathobionts, including Klebsiella and Enterobacter species, in the oral cavity. Amassed oral pathobionts are ingested and translocate to the gut, where they activate the inflammasome in colonic mononuclear phagocytes, triggering inflammation. In parallel, periodontitis results in generation of oral pathobiont-reactive Th17 cells in the oral cavity. Oral pathobiont-reactive Th17 cells are imprinted with gut tropism and migrate to the inflamed gut. When in the gut, Th17 cells of oral origin can be activated by translocated oral pathobionts and cause development of colitis, but they are not activated by gut-resident microbes. Thus, oral inflammation, such as periodontitis, exacerbates gut inflammation by supplying the gut with both colitogenic pathobionts and pathogenic T cells.
Assuntos
Colite/patologia , Enterobacter/fisiologia , Microbioma Gastrointestinal , Klebsiella/fisiologia , Boca/microbiologia , Animais , Colite/microbiologia , Colo/microbiologia , Colo/patologia , Modelos Animais de Doenças , Enterobacter/isolamento & purificação , Feminino , Inflamassomos/metabolismo , Interleucina-10/deficiência , Interleucina-10/genética , Interleucina-1beta/metabolismo , Klebsiella/isolamento & purificação , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Periodontite/microbiologia , Periodontite/patologia , Células Th17/citologia , Células Th17/imunologia , Células Th17/metabolismoRESUMO
Colonization with a mixture of Clostridium species has been shown to induce accumulation of induced regulatory T (iTreg) cells in the colon. Transforming growth factor-ß (TGF-ß) is an essential factor for iTreg cell induction; however, the relationship between Clostridium species and TGF-ß remains to be clarified. Here we demonstrated that a gram-positive probiotic bacterial strain, Clostridium butyricum (C. butyricum), promoted iTreg cell generation in the intestine through induction of TGF-ß1 from lamina propria dendritic cells (LPDCs). C. butyricum-mediated TGF-ß1 induction was mainly Toll-like receptor 2 (TLR2) dependent, and the ERK-AP-1 kinase pathway played an important role. In addition, the autocrine TGF-ß-Smad3 transcription factor signal was necessary for robust TGF-ß expression in DCs, whereas Smad2 negatively regulated TGF-ß expression. Smad2-deficient DCs expressed higher concentrations of TGF-ß and were tolerogenic for colitis models. This study reveals a novel mechanism of TGF-ß induction by Clostridia through a cooperation between TLR2-AP-1 and TGF-ß-Smad signaling pathways.
Assuntos
Clostridium butyricum/imunologia , Células Dendríticas/imunologia , Proteína Smad2/genética , Proteína Smad3/genética , Fator de Crescimento Transformador beta1/biossíntese , Animais , Infecções por Clostridium/imunologia , Infecções por Clostridium/microbiologia , Colite/imunologia , MAP Quinases Reguladas por Sinal Extracelular/imunologia , Intestinos/imunologia , Intestinos/microbiologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Mucosa/citologia , Mucosa/imunologia , Regiões Promotoras Genéticas/genética , Linfócitos T Reguladores/imunologia , Receptor 2 Toll-Like/imunologia , Fator de Transcrição AP-1/imunologia , Fator de Crescimento Transformador beta1/genéticaRESUMO
PURPOSE: To investigate the inhibitory effect of hydrogen gas inhalation on retinal ischemia reperfusion (I/R) injury using a rat model. METHODS: Six-week-old male Sprague-Dawley rats were used. A 27G needle connected by a tube to a saline bottle placed 200 cm above the eye was inserted into the anterior eye chamber to create a rat retinal I/R model. In the ischemia-plus-hydrogen-gas group (H2( +) group), the ischemia time was set to 90 min, and 1.8% hydrogen was added to the air delivered by the anesthesia mask simultaneously with the start of ischemia. In the non-hydrogen-treatment ischemia group (H2( -) group), I/R injury was created similarly, but only air was inhaled. ERGs were measured; after removal of the eyes, the retina was examined for histological, immunostaining, and molecular biological analyses. RESULTS: The mean thickness of the inner retinal layer in the H2( +) group was 107.2 ± 16.0 µm (n = 5), significantly greater than that in the H2( -) group (60.8 ± 6.7 µm). Immunostaining for Iba1 in the H2( -) group showed increased numbers of microglia and microglial infiltration into the subretinal space, while there was no increase in microglia in the H2( +) group. B-wave amplitudes in the H2( +) group were significantly higher than in the H2( -) group. In the membrane antibody array, levels of interleukin-6, monocyte chemotactic protein 1, and tumor necrosis factor alpha were significantly lower in the H2( +) group than in the H2( -) group. CONCLUSION: Inhalation of 1.8% hydrogen gas inhibited the induction of inflammation, morphological/structural changes, and glial cell increase caused by retinal I/R injury.
Assuntos
Hidrogênio , Traumatismo por Reperfusão , Ratos , Masculino , Animais , Ratos Sprague-Dawley , Hidrogênio/metabolismo , Hidrogênio/farmacologia , Retina/patologia , Traumatismo por Reperfusão/prevenção & controle , IsquemiaRESUMO
PURPOSE: To evaluate the efficacy of vitrectomy with epiretinal proliferation (EP) sparing for full-thickness macular hole (FTMH) accompanied by EP. METHODS: A multicenter, retrospective study. Eyes were divided into two groups: the sparing group (Group S) included eyes in which the EP around the hole was peeled and preserved, whereas the removal group (Group R) included eyes in which the EP was partially or completely removed. The internal limiting membrane was peeling in all eyes. RESULTS: Forty-six eyes were included. Twenty-five eyes were in Group S, and 21 eyes were in Group R, with no difference in preoperative best-corrected visual acuity (BCVA) (P = 0.96). After primary surgery, MHs were closed in all eyes, and there were no complications in either group. Postoperative 12-month BCVA significantly improved in both groups (both P < 0.01), while Group S had better 12-month BCVA than Group R (P = 0.016). In the multivariable analysis, EP sparing was associated with better BCVA at 12 months (P = 0.006) after accounting for the minimal macular hole size and preoperative BCVA. CONCLUSIONS: EP sparing and removal were both safe and effective techniques, while EP sparing may provide a favorable outcome for eyes with FTMH and EP.
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PURPOSE: To investigate the incidence of intraocular inflammation (IOI) and its risk factors following intravitreal injections of brolucizumab for neovascular age-related macular degeneration in Japan. METHODS: A total of 1,351 Japanese consecutive patients with neovascular age-related macular degeneration who were treated with brolucizumab from May 2020 to May 2022 at 14 institutions were examined. The variables analyzed were the number of brolucizumab injections, time to onset of IOI, and risk factors. RESULTS: Intraocular inflammation developed in 152 eyes (11.3%). Retinal vasculitis and/or retinal occlusion occurred in 53 eyes (3.9%). Ninety-four patients received bilaterally, bilateral IOI occurred in five patients (5.3%). Sixteen eyes (1.2%) had irreversible visual acuity loss and nine eyes (0.67%) had visual loss of three lines or more due to retinal vasculitis and/or retinal occlusion. The cumulative IOI incidence was 4.5%, 10.3%, and 12.2% at 30, 180, and 365 days (1-year), respectively. History of IOI (including retinal vasculitis) and/or retinal occlusion (odds ratio [OR], 5.41; P = 0.0075) and female sex (OR, 1.99; P = 0.0004) were significantly associated with IOI onset. CONCLUSION: The 1-year cumulative incidence of IOI in Japanese neovascular age-related macular degeneration patients treated with brolucizumab was 12.2%. History of IOI (including retinal vasculitis) and/or retinal occlusion and female sex were significant risk factors.
Assuntos
Anticorpos Monoclonais Humanizados , Degeneração Macular , Vasculite Retiniana , Uveíte , Feminino , Humanos , Inibidores da Angiogênese , Incidência , Inflamação , Injeções Intravítreas , Japão , Retina , Fatores de Risco , Transtornos da Visão , MasculinoRESUMO
PURPOSE: This study aimed to examine the changes in lower eyelid position after blepharoptosis surgery and the factors that influence the outcome. METHODS: We conducted a retrospective study of 155 eyes of 89 patients who underwent blepharoptosis surgery between June 2019 and October 2022. The margin reflex distance (MRD)-1 and MRD-2 were examined preoperatively and 3 months postoperatively in two groups: one with lower scleral show (LSS) (n = 37) and one without LSS (n = 118). The clinical characteristics of the two groups were compared. RESULTS: Both the LSS and non-LSS groups showed significant postoperative improvement in MRD-1 scores (p < .01, p < .01, respectively). MRD-2 was significantly reduced in the LSS group, while it remained unchanged in the non-LSS group (p < .01, p = .27, respectively). There were no significant differences between the two groups in age, sex, history of hard contact lens use, preoperative levator function, use of topical steroids, history of endophthalmic surgery, or history of filtration surgery; however, the LSS group significantly used prostaglandin analogs (PGAs) (p = .03). Postoperatively, MRD-2 decreased in 13 eyes (35.1%) and was maintained in 24 eyes (64.9%) in the LSS group and was maintained in all eyes in the non-LSS group. In the LSS group, we also examined the association between postoperative MRD-2 reduction and the use of PGAs and found that more patients with MRD-2 reduction used PGAs (p = .02). CONCLUSION: Lower scleral show in PGAs-associated blepharoptosis is expected to improve after blepharoptosis surgery.
Assuntos
Blefaroplastia , Blefaroptose , Pálpebras , Humanos , Blefaroptose/cirurgia , Blefaroptose/fisiopatologia , Estudos Retrospectivos , Feminino , Masculino , Pálpebras/cirurgia , Blefaroplastia/métodos , Pessoa de Meia-Idade , Idoso , Adulto , Músculos Oculomotores/cirurgia , Músculos Oculomotores/fisiopatologia , Idoso de 80 Anos ou mais , Adolescente , Adulto JovemRESUMO
PURPOSE: We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). PATIENTS AND METHODS: This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3 years. We measured the CED before and after (at 12, 24, and 36 months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. RESULTS: We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm2 after 3 years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm2 after 3 years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. CONCLUSIONS: EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients.
Assuntos
Perda de Células Endoteliais da Córnea , Endotélio Corneano , Síndrome de Exfoliação , Glaucoma de Ângulo Aberto , Pressão Intraocular , Humanos , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/fisiopatologia , Estudos Retrospectivos , Masculino , Feminino , Idoso , Endotélio Corneano/patologia , Perda de Células Endoteliais da Córnea/etiologia , Perda de Células Endoteliais da Córnea/diagnóstico , Contagem de Células , Pressão Intraocular/fisiologia , Seguimentos , Pessoa de Meia-Idade , Síndrome de Exfoliação/cirurgia , Fatores de Tempo , Trabeculectomia/métodos , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: It is not known whether clopidogrel use in cytochrome P450 (CYP) 2C19 loss-of-function (LOF) carriers with high bleeding risk (HBR) contributes to adverse outcomes after percutaneous coronary intervention (PCI).MethodsâandâResults: This retrospective observational study included 618 consecutive patients with available CYP2C19 polymorphism information who underwent PCI between September 2014 and August 2021. Patients with HBR (319 [52%] met the Academic Research Consortium definition) were divided into 2 groups according to P2Y12inhibitor action, namely decreased (i.e., clopidogrel in CYP2C19 LOF carriers) and retained (i.e., clopidogrel in CYP2C19 LOF non-carriers or prasugrel regardless of CYP2C19 polymorphisms), and clinical outcomes at 1 year were compared using inverse probability-weighted Cox proportional hazard regression. The primary ischemic outcome (a composite of cardiovascular death, myocardial infarction, or ischemic stroke) was significantly higher in the decreased than retained group (10.2% vs. 3.0%; adjusted hazard ratio [aHR] 2.78; 95% confidence interval [CI] 1.40-5.52; P=0.004). The primary bleeding outcome (Bleeding Academic Research Consortium 3 or 5) did not differ significantly between the decreased and retained groups (3.4% vs. 6.9%, respectively; aHR 0.48; 95% CI 0.22-1.01; P=0.054). There were no interactions between the treatment groups and HBR status in primary ischemic and bleeding outcomes. CONCLUSIONS: Among patients with HBR, clopidogrel use in CYP2C19 LOF carriers was significantly associated with increased ischemic events after PCI.
Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Humanos , Clopidogrel/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Citocromo P-450 CYP2C19/genética , Hemorragia/induzido quimicamenteRESUMO
Short-chain fatty acids, such as butyrate, are major gut microbial metabolites that are beneficial for gastrointestinal health. Clostridium butyricum MIYAIRI588 (CBM588) is a bacterium that produces a robust amount of butyrate and therefore has been used as a live biotherapeutic probiotic in clinical settings. Clostridioides difficile causes life-threatening diarrhea and colitis. The gut resident microbiota plays a critical role in the prevention of C. difficile infection (CDI), as the disruption of the healthy microbiota by antibiotics greatly increases the risk for CDI. We report that CBM588 treatment in mice significantly improved clinical symptoms associated with CDI and increased the number of neutrophils and Th1 and Th17 cells in the colonic lamina propria in the early phase of CDI. The protective effect of CBM588 was abolished when neutrophils, IFN-γ, or IL-17A were depleted, suggesting that induction of the immune reactants is required to elicit the protective effect of the probiotic. The administration of tributyrin, which elevates the concentration of butyrate in the colon, also increased the number of neutrophils in the colonic lamina propria, indicating that butyrate is a potent booster of neutrophil activity during infection. However, GPR43 and GPR109a, two G protein-coupled receptors activated by butyrate, were dispensable for the protective effect of CBM588. These results indicate that CBM588 and butyrate suppress CDI, in part by boosting antimicrobial innate and cytokine-mediated immunity.
Assuntos
Clostridioides difficile/imunologia , Infecções por Clostridium/imunologia , Clostridium butyricum/fisiologia , Colo/imunologia , Neutrófilos/imunologia , Receptores Acoplados a Proteínas G/metabolismo , Animais , Butiratos/metabolismo , Interferon gama/metabolismo , Interleucina-17/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Receptores Acoplados a Proteínas G/genética , alfa-Defensinas/metabolismoRESUMO
PURPOSE: To assess the effect of switching to brolucizumab from aflibercept on eyes with type 1 macular neovascularization (MNV) and polypoidal choroidal vasculopathy (PCV) at 18 months. METHODS: This study was a retrospective, observational case series that included 19 eyes of 19 patients with type 1MNV and 23 eyes of 22 patients with PCV. We compared the injection intervals, visual acuity, total lesion size, and the number of polypoidal lesions between baseline and 18 months. The correlations between the data including treatment interval, total lesion size, and the number of polyps were also assessed. RESULTS: Treatment intervals were significantly extended; from 7.4 ± 1.4 weeks to 11.6 ± 2.6 weeks for type 1 MNV, p < 0.001; from 6.9 ± 1.3 to 11.7 ± 3.1 weeks for PCV, p < 0.001. In type 1 MNV eyes, strong correlation was found between total lesion size and brolucizumab injection intervals (r = - 0.81; p = 0.0002) and moderate correlation was found between treatment frequency with aflibercept and that with brolucizumab (r = 0.76; p = 0.040). In PCV eyes, we found strong correlation between the number of polyps and brolucizumab treatment frequency (r = - 0.81; p = 0.0016) and moderate correlation between total lesion size and brolucizumab treatment interval (r = - 0.48; p = 0.034). Intraocular inflammation occurred in 2 of 19 eyes (10.3%) with type 1 MNV and 5 of 23 eyes (21.7%) with PCV. CONCLUSION: The properties to extend brolucizumab injection intervals might be the smaller lesion size and lower aflibercept frequency for type 1 MNV and the smaller number of polyps and the smaller size of lesion for PCV.
Assuntos
Neovascularização de Coroide , Degeneração Macular , Humanos , Seguimentos , Inibidores da Angiogênese , Vasculopatia Polipoidal da Coroide , Estudos Retrospectivos , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/patologia , Corioide/patologia , Degeneração Macular/tratamento farmacológico , Injeções Intravítreas , Tomografia de Coerência Óptica , AngiofluoresceinografiaRESUMO
PURPOSE: For the treatment of lamellar macular hole, the recent development of a lamellar hole-associated epiretinal proliferation (LHEP) embedding technique is likely to improve functional and anatomical results. However, the peeling of LHEP is often technically challenging. We have developed a new technique using a backflush needle with a silicone tip cannula that seems safer and more effective for use in LHEP embedding. METHODS: A 25-gauge vitrectomy system with an enhancing visual acuity system (D.O.R.C., Zuidland, Netherlands) was used in all cases. After core vitrectomy, triamcinolone acetonide (Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) was used to visualize the membrane. A 25-gauge backflush needle with a silicone tip cannula was used to remove the thin preretinal membrane centripetally, leaving an LHEP on the edge of the hole. Brilliant Blue G (internal limiting membrane Blue; D.O.R.C.) was then used to stain the internal limiting membrane. RESULTS: This technique was used in six eyes with lamellar macular holes. In all cases, peeling and embedding of the LHEP was effectively performed without damaging the internal limiting membrane or causing retinal hemorrhage. No other intraoperative or postoperative complications were experienced. CONCLUSION: Using a silicone-tipped backflush needle with passive aspiration was a simple and effective technique for peeling and embedding of LHEPs in this small series.
Assuntos
Membrana Epirretiniana , Perfurações Retinianas , Humanos , Cânula/efeitos adversos , Acuidade Visual , Tomografia de Coerência Óptica/métodos , Estudos Retrospectivos , Membrana Epirretiniana/etiologia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Proliferação de CélulasRESUMO
PURPOSE: To investigate the incidence of postoperative blepharoptosis and clinical risk factors for blepharoptosis after pars plana Baerveldt 350 glaucoma implantation (BGI) by a single surgeon for refractory glaucoma. METHODS: Twenty-four patients (30 eyes) who underwent pars plana BGI for refractory glaucoma at Toyama University Hospital between November 2019 and February 2021 were included. Patients with a preoperative margin reflex distance-1 (MRD-1) of ≥2 mm were included in the study, and a decrease in MRD-1 of ≥2 mm at 6 months postoperatively was defined as blepharoptosis. RESULTS: The mean MRD-1 decreased significantly from 3.2 ± 0.6 mm preoperatively to 2.4 ± 1.1 postoperatively ( p < 0.01). Postoperative ptosis developed in 8 eyes (26.7%). A comparison of the ptosis (n = 8) and nonptosis (n = 22) groups showed a significant difference in the history and number of previous filtration surgeries ( p = 0.02 and p = 0.03, respectively). Those with previous filtration surgery had a higher risk of blepharoptosis after pars plana BGI compared with those without previous filtration surgery (OR: 6.43; 95% confidence interval: 1.03-40.26; p = 0.04). CONCLUSION: Pars plana BGI is a risk factor for postoperative blepharoptosis. Particular attention should be paid to eyes that have undergone previous filtration surgery.
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Blefaroptose , Implantes para Drenagem de Glaucoma , Glaucoma , Cirurgiões , Humanos , Pressão Intraocular , Implantes para Drenagem de Glaucoma/efeitos adversos , Blefaroptose/epidemiologia , Blefaroptose/etiologia , Blefaroptose/cirurgia , Incidência , Implantação de Prótese , Glaucoma/epidemiologia , Glaucoma/etiologia , Glaucoma/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: This study aimed to analyze saccades in patients with orbital-wall fractures with little or no ocular motor impairment. METHODS: We included 7 eyes of 7 patients with unoperated orbital-wall fractures (3 cases of orbital-floor fractures and 4 cases of medial orbital-wall fractures) with mild or no diplopia who presented to our hospital between August 2019 and March 2021. Eye movements were assessed at the first visit and after 1 month using the Hess area ratio according to the Hess screen test, binocular single vision (BSV) scores (total 59 points) obtained using Goldman perimetry, and maximum velocity and amplitude of saccades within 15 degrees obtained using an eye tracker system. RESULTS: Hess area ratio and BSV scores at the first visit and after 1 month were 88.6±8.2% and 97.4±3.6% and 49.6±8.5 points and 53.5±6.6 points, respectively, with no significant change (Hess area ratio, P =0.06; BSV, P =0.44). Next, the authors compared the velocity and amplitude of the saccades between the first visit and 1 month later and found no significant changes in any of the 4 directions (adduction, abduction, upgaze, and downgaze). Similarly, no significant differences were observed between the velocity and amplitude of the saccades between the injured and noninjured eyes, both at the first visit and after 1 month. CONCLUSIONS: In patients with orbital-wall fractures with little or no eye movement impairment, eye tracker-based saccade analysis showed that the saccade velocity and amplitude did not change during the natural course of healing of the fracture.
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Fraturas Orbitárias , Movimentos Sacádicos , Humanos , Diplopia , Movimentos Oculares , Fraturas Orbitárias/complicações , Fraturas Orbitárias/cirurgia , Órbita/cirurgia , Estudos RetrospectivosRESUMO
Three-dimensional measurement is a high-throughput method that can record a large amount of information. Three-dimensional modelling of plants has the possibility to not only automate dimensional measurement, but to also enable visual assessment to be quantified, eliminating ambiguity in human judgment. In this study, we have developed new methods that could be used for the morphological analysis of plants from the information contained in 3D data. Specifically, we investigated characteristics that can be measured by scale (dimension) and/or visual assessment by humans. The latter is particularly novel in this paper. The characteristics that can be measured on a scale-related dimension were tested based on the bounding box, convex hull, column solid, and voxel. Furthermore, for characteristics that can be evaluated by visual assessment, we propose a new method using normal vectors and local curvature (LC) data. For these examinations, we used our highly accurate all-around 3D plant modelling system. The coefficient of determination between manual measurements and the scale-related methods were all above 0.9. Furthermore, the differences in LC calculated from the normal vector data allowed us to visualise and quantify the concavity and convexity of leaves. This technique revealed that there were differences in the time point at which leaf blistering began to develop among the varieties. The precise 3D model made it possible to perform quantitative measurements of lettuce size and morphological characteristics. In addition, the newly proposed LC-based analysis method made it possible to quantify the characteristics that rely on visual assessment. This research paper was able to demonstrate the following possibilities as outcomes: (1) the automation of conventional manual measurements, and (2) the elimination of variability caused by human subjectivity, thereby rendering evaluations by skilled experts unnecessary.
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Imageamento Tridimensional , Lactuca , Lactuca/crescimento & desenvolvimento , Simulação por ComputadorRESUMO
PURPOSE: To investigate the risk factors for Ex-Press® (EXP) surgery failure. PATIENTS AND METHODS: This was a retrospective non-randomized study of 98 patients who had undergone EXP and were followed up ≥ 5 years. We investigated the following nine risk factors: age, gender, hypertension, diabetes mellitus (DM), previous glaucoma surgery, type of glaucoma (primary open-angle glaucoma vs. pseudo-exfoliation glaucoma), surgical methods (EXP alone vs. EXP + cataract surgery simultaneously), central corneal thickness (CCT), and preoperative intraocular pressure (IOP). We defined a successful surgery as a postoperative reduction in the IOP ≥ 20% from the preoperative IOP and ≤ 18 mmHg. We determined the risk factors using multivariate cox regression models. RESULTS: Performing EXP significantly decreased the IOP (preoperative: 25.2 ± 8.7, at 5 years: 11.1 ± 4.1). The success ratio of EXP was 67.4% at 5 years. We found no significant risk factors for EXP surgery failure. The p values of the factors were age (p = 0.936), gender (p = 0.0587), hypertension (p = 0.409), DM (p = 0.967), previous glaucoma surgery (p = 0.940), type of glaucoma (p = 0.435) surgical methods (p = 0.521), CCT (p = 0.091), and preoperative IOP (p = 0.082). CONCLUSIONS: No preoperative factors that could be used to predict the failure of EXP surgery were identified. EXP can be safely performed for primary open-angle glaucoma and pseudo-exfoliation glaucoma.
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Síndrome de Exfoliação , Glaucoma de Ângulo Aberto , Glaucoma , Hipertensão , Trabeculectomia , Humanos , Glaucoma de Ângulo Aberto/cirurgia , Síndrome de Exfoliação/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Seguimentos , Pressão Intraocular , Fatores de RiscoRESUMO
PURPOSE: Previously, we reported that the Ex-press® shunt (EXP) was associated with more rapid reduction in corneal endothelial cells when inserted into the cornea rather than the trabecular meshwork (TM). We compared the reduction rate of corneal endothelial cells between the corneal insertion group and TM insertion group. METHODS: This was a retrospective study. We included patients who had undergone EXP surgery and were followed for > 5 years. We analyzed the corneal endothelial cell density (ECD) before and after EXP implantation. RESULTS: We included 25 patients in the corneal insertion group and 53 patients in the TM insertion group. One patient in the corneal insertion group developed bullous keratopathy. The ECD decreased significantly more rapidly in the corneal insertion group (p < 0.0001), in whom the mean ECD decreased from 2227 ± 443 to 1415 ± 573 cells/mm2 at 5 years with a mean 5-year survival rate of 64.9 ± 21.9%. By contrast, in the TM insertion group, the mean ECD decreased from 2356 ± 364 to 2124 ± 579 cells/mm2 at 5 years, and the mean 5-year survival rate was 89.3 ± 18.0%. The decrease rate of ECD was calculated as 8.3%/year in the corneal insertion group and 2.2%/year in the TM insertion group. CONCLUSIONS: Insertion into cornea is a risk factor for rapid ECD loss. The EXP should be inserted into the TM to preserve the corneal endothelial cells.
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Perda de Células Endoteliais da Córnea , Implantes para Drenagem de Glaucoma , Humanos , Perda de Células Endoteliais da Córnea/diagnóstico , Perda de Células Endoteliais da Córnea/etiologia , Endotélio Corneano , Malha Trabecular/cirurgia , Células Endoteliais , Estudos Retrospectivos , Implantes para Drenagem de Glaucoma/efeitos adversos , Córnea , Contagem de CélulasRESUMO
BACKGROUND: By the time patients with keratoconus are referred to specialists for treatment, the disease-related thinning of their corneas has already made them ineligible (< 400 µm) for corneal crosslinking (CXL). PURPOSE: To find basic ophthalmic examination parameters that can ensure proper timing of referral for CXL. METHODS: We reviewed cases referred to Toyama University Hospital for the treatment of keratoconus from August 2011 to May 2021 to identify the frequency of contraindication due to minimal corneal thickness (MCT) < 400 µm at first visit. We performed a receiver operator characteristic (ROC) analysis of basic exam parameters (uncorrected distance visual acuity, corrected distance visual acuity, corrected distance visual acuity with hard contact lens, sphericity, cylindricity, and/or corneal astigmatism) potentially predicting eligibility for CXL. For those with an area under the curve (AUC) > 0.8, we determined cut-off values and calculated sensitivity and specificity. RESULTS: Analyses included 66 eyes of 38 Japanese patients aged 25.0 ± 7.1 yrs (range 12-38 yrs) (56 male eyes and 10 female eyes). Thirty percent of the patients had an MCT < 400 µm. The AUC for uncorrected distance visual acuity (UCDVA) was 0.85. A cut-off value of 1.22 (converted to decimal visual acuity: ≥ 0.06) yielded 87% sensitivity and 75% specificity. The AUC for corrected distance visual acuity (CDVA) was 0.90. A cut-off of 0.52 (converted to decimal visual acuity: ≥ 0.3) yielded 89% sensitivity and 75% specificity. CONCLUSIONS: It is advisable to refer patients with keratoconus to a specialized facility for CXL when either of the following conditions is present: (i) UCDVA (decimal visual acuity) ≥ 0.06 or (ii) CDVA (decimal visual acuity) ≥ 0.3.
Assuntos
Ceratocone , Humanos , Masculino , Feminino , Ceratocone/diagnóstico , Ceratocone/tratamento farmacológico , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Raios Ultravioleta , Substância Própria , Córnea , Reagentes de Ligações Cruzadas/uso terapêutico , Topografia da CórneaRESUMO
PURPOSE: To analyze the relationship between tear meniscus dimensions and higher-order aberrations (HOAs) in patients with lacrimal passage obstruction using anterior segment optical coherence tomography (AS-OCT). METHODS: This study was a retrospective observational study of 71 eyes of 49 patients with lacrimal passage obstruction. These patients received sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) at Toyama University Hospital between August 2020 and October 2021. Using AS-OCT, tear meniscus height (TMH), tear meniscus area (TMA), and total corneal HOAs values were measured before and after surgery. RESULTS: Surgical success was achieved in 69 eyes (97.1%). At the final observation, 62 eyes showed lacrimal patency (89.8%). The preoperative TMH, TMA, and HOAs values were 1.55 ± 0.96 mm, 0.11 ± 0.14 mm2, and 0.37 ± 0.27 µm, respectively, and the final postoperative TMH, TMA, and HOAs values were 0.97 ± 0.74 mm (p < 0.0001), 0.06 ± 0.11 mm2 (p = 0.02), and 0.29 ± 0.16 µm (p = 0.001), respectively. The results showed a significant improvement. The changes in HOAs before and after surgery were positively correlated with the changes in TMH (r = 0.3476, p = 0.0241) and TMA (r = 0.3653, p = 0.0174). CONCLUSION: SG-BCI for lacrimal passage obstruction resulted in a significant decrease in measured HOAs. The decrease in HOAs was correlated with decreases in tear meniscus dimensions.
Assuntos
Síndromes do Olho Seco , Aparelho Lacrimal , Menisco , Humanos , Lágrimas , Córnea , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: To compare surgical outcomes of Ex-PRESS® (EXP) surgery for primary open-angle glaucoma (POAG) between low preoperative intraocular pressure (IOP) and high preoperative IOP. METHODS: This was a retrospective non-randomized study. Seventy-nine POAG patients who underwent EXP surgery and were followed for > 3 years were included. Patients with a preoperative IOP of ⦠16 mmHg and > 16 mmHg with tolerant glaucoma medications were defined as the low IOP group and the high IOP group, respectively. We compared the surgical outcomes, postoperative IOP and number of glaucoma medications. Success was defined as a postoperative IOP of ⦠15 mmHg and a reduction of > 20% from the preoperative IOP to the postoperative IOP. RESULTS: EXP surgeries significantly decreased IOPs from 13.2 ± 2.0 to 9.1 ± 2.9 mmHg in the low IOP group (p < 0.001), and from 22.5 ± 4.8 to 12.5 ± 4.0 mmHg in the high IOP group (p < 0.001). The mean postoperative IOP was significantly low in the low IOP group at 3 years (p = 0.0008). Success rates compared using the Kaplan-Meier survival curve were not significantly different (p = 0.449). CONCLUSIONS: EXP surgery was useful for POAG patients with a low preoperative IOP.
Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Trabeculectomia , Humanos , Pressão Intraocular , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Estudos Retrospectivos , Glaucoma/cirurgia , Período Pós-Operatório , Trabeculectomia/métodos , Resultado do TratamentoRESUMO
PURPOSE: It has been reported that corneal endothelial cells (CEC) decrease faster when the tip of the Baerveldt glaucoma implant (BGI) tube is inserted into the anterior chamber than into the vitreous cavity. We investigated whether surgically relocating the tip of the BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss. PATIENTS AND METHODS: This was a single facility retrospective cohort study. The inclusion criteria were the CEC density less than 1500 cells/mm2 and the CEC reduction ratio was greater than 10%/year. The subjects were 11 consecutive patients that could be followed > 12 months after relocation surgery. All patients were undergone vitrectomy, and the tip of tube was inserted into the vitreous cavity from the anterior chamber. We compared the intraocular pressure (IOP), reduction slope of CEC density and annual reduction rate of CEC density before and after relocation surgery. We calculated the annual reduction ratio in comparison with the preoperative CEC density (%/year). RESULTS: The mean of period between the Baeveldt with anterior chamber insertion surgery and the relocation surgery was 33.8 ± 15.0 months. The mean of follow-up after relocation surgery was 21.8 ± 9.8 months. The relocation surgery did not significantly change IOP (p = 0.974). The mean preoperative and postoperative IOP were 13.1 ± 4.5 and 13.6 ± 4.3 mmHg. The reduction ratio of the CEC density was 15.4 ± 6.7 (%/year) before relocation surgery and significantly slower at 8.3 ± 6.5 (%/year) after relocation surgery (p = 0.024). Two patients resulted in bullous keratopathy after relocation surgery. CONCLUSIONS: Relocating the tip of BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss.