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AIM: To investigate the expression level of inflammatory factors of aqueous humor before trabeculectomy in binocular chronic primary angle-closure glaucoma(CPACG)and its correlation with postoperative filtration bleb and intraocular pressure.METHODS: A total of 15 cases(30 eyes)with binocular CPACG who admitted to the Affiliated Eye Hospital of Nanjing Medical University from September to December 2021 and received trabeculectomy were selected. The surgery interval between two eyes was 7d, and the preoperative expression levels of monocyte chemoattractant protein-1(MCP-1), interleukin-17(IL-17), transforming growth factor-β(TGF-β), and interferon-γ(IFN-γ)of the aqueous humor in both eyes were respectively detected by enzyme-linked immunosorbent assay(ELISA). Furthermore, the intraocular pressure(IOP)and the morphology of filtering blebs at 1mo after surgery were measured.RESULTS: The concentrations of MCP-1, IL-17, TGF-β, and IFN-γ in aqueous humor from the first eye before surgery were 330.4±46.2, 357.3±46.9, 2347.5±363.8 and 527.7±101.6pg/mL respectively, and those concentrations in aqueous humor from the fellow eye were 298.2±40.7, 309.1±53.5, 1938.3±426.0 and 628.2±104.9pg/mL respectively. The preoperative expression levels of inflammatory factors of aqueous humor in both eyes were statistically significant(P≤0.05). Furthermore, the expression levels of IL-17 and TGF-β in the aqueous humor of patients with CPACG correlated with IOP and the height of filtering blebs at 1mo after surgery(P<0.05).CONCLUSION: There may be changes in the expression levels of inflammatory factors of aqueous humor in the fellow eye after surgery of the first eye. Moreover, the preoperative expression level of IL-17 and TGF-β in aqueous humor possibly related to postoperative IOP and the height of filtering bleb.
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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
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Objective:To investigate the inhibitory effect of CLC-2 chloride channel targeted blocking on fibrosis of human conjunctival fibroblasts (HConF).Methods:HConF were divided into blank control group, lipofectamine 2000 (Lipo2000) group, nonsense small interfering RNA (siRNA) group, and CLC-2 siRNA transfected group.The HConF were cultured in medium containing the corresponding transfection reagents according to grouping.No intervention was given to blank control group.The expression level of CLC-2 mRNA of HConF was detected by real-time fluorescence quantitative PCR; absorbance ( A) value indicating the proliferative ability of HConF was determined by CCK-8 kit; the apoptosis ratio of HConF was tested by flow cytometry; the migration ability of HConF was identified by cell scratch test and Transwell migration assay; the contraction rate of HConF was assayed by collagen contraction test; the expression levels of collagenⅠ, collagen Ⅲ, PI3K, Akt, p-PI3K and p-Akt proteins were measured by Western blot. Results:Significant differences were found in relative expression levels of CLC-2 mRNA and A value among four groups ( F=90.110, 198.680; both at P<0.001). The relative expression level of CLC-2 mRNA and A value were significantly lower in CLC-2 siRNA transfected group than nonsense siRNA group, showing statistically significant differences (both at P<0.001). The proportion of apoptotic HConF in blank control group, Lipo2000 group, nonsense siRNA group, and CLC-2 siRNA transfected group was (4.78±1.10)%, (4.54±1.51)%, (4.82±0.88)% and (28.90±0.91)%, respectively, and a statistically significant difference was found ( F=363.260, P<0.001). The proportion of apoptotic HConF was significantly higher in CLC-2 siRNA transfected group than nonsense siRNA group, with a statistically significant difference ( P<0.001). Statistically significant differences were found in cell migration rate and the number of migrating cells among four groups ( F=74.493, 1 625.431; both at P<0.01). The cell migration rate of HConF in CLC-2 siRNA transfected group was significantly lower and the number of migrating cells was significantly smaller than those of nonsense siRNA group, with statistically significant differences (both at P<0.001). A statistically significant difference in contraction rate was found among four groups ( F=104.692, P<0.001). The contraction rate of HConF was significantly lower in CLC-2 siRNA transfected group than nonsense siRNA group, and the difference was statistically significant ( P<0.001). Statistically significant differences were found in relative expression levels of collagen Ⅰ and collagen Ⅲ proteins, p-PI3K/PI3K ratio, and p-Akt/Akt ratio among four groups ( F=112.073, 456.931, 340.889, 43.021; all at P<0.001). The relative expression levels of collagen Ⅰ and collagen Ⅲ proteins, p-PI3K/PI3K ratio and p-Akt/Akt ratio in CLC-2 siRNA transfected group were significantly lower than those of nonsense siRNA group, showing statistically significant differences (all at P<0.05). Conclusions:Targeted blocking of CLC-2 chloride channel gene expression can inhibit fibrosis of HConF by promoting apoptosis of HConF through PI3K/Akt signaling pathway and inhibit fibrotic processes such as cell migration, collagen synthesis and collagen contraction.
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Se realizó una búsqueda sobre la evaluación cualitativa de la ampolla de filtración. La ampolla conjuntival es la parte visible de la cirugía filtrante, y su morfología es un indicador de factores que pueden determinar el resultado hipotensor de la cirugía y las posibles complicaciones posoperatorias. Se han desarrollado diversos estudios que relacionan la evaluación clínica de su morfología y el control de la presión intraocular, y se han establecido varios sistemas de puntuación, entre ellas: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale y métodos de imagen para evaluar el segmento anterior (biomicroscopia ultrasónica, Tomografía retinal de Heidenberg y tomografía de coherencia óptica). Estos métodos proporcionan una herramienta útil para el seguimiento de la cirugía filtrante y su documentación(AU)
A review was conducted on the qualitative evaluation of the filtering bleb. The conjunctival bleb is the visible part of filtration surgery, and its morphology is an indicator of factors which may determine the hypotensive result of surgery and the possible postoperative complications. Various studies have been conducted which relate the clinical evaluation of its morphology and intraocular pressure control. Several grading systems have thus been established: Wuerzburg Bleb Classification Score, Moorfields Bleb Grading System, Indiana Bleb Appearance Grading Scale and imaging methods to evaluate the anterior segment (ultrasound biomicroscopy, Heidenberg retinal tomography and optical coherence tomography). These methods are a useful tool for the follow-up of filtration surgery and its documentation(AU)
الموضوعات
Humans , Glaucoma/surgery , Filtering Surgery/adverse effects , Tomography, Optical Coherence/methods , Evaluation Studies as Topicالملخص
Filtering bleb scarring is the main cause of glaucoma filtration surgery failure. Subconjunctival injection of antimetabolites, such as mitomycin and 5-fluorouracil, is widely used clinically to reduce the incidence of scarring, which improves the success rate of the surgery. However, accompanied side effects such as cytotoxicity should not be ignored. Secreted protein acidic and rich in cysteine (SPARC) as a matricellular protein is widely distributed in the eyes, which plays an important role in the process of wound repairing and tissue remodeling. The expression of SPARC is significantly elevated in the mouse model of subconjunctival scarring. Researches suggest that SPARC participates in and regulate the formation of bleb scarring through multiple pathways, therefore it may become a specific new target in the anti-scarring therapy.
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Objective To study the effect and mechanisms of chloride channel blocker 5-Nitro-2-(3-phenylpropylamino) benzoic acid (NPPB) on thansforming growth factor β1 (TGF-β1) induced human conjunctival fibroblasts (HConF) fibrosis.Methods Cell counting kit (CCK-8) was used to screen out the optimal TGF-β1 treatment time and the optimal NPPB concentration.The cells were divided into control group,TGF-β1 treatment group and TGF-β1+NPPB group.Cell proliferation and cell cycle were detected by CCK-8 and flow cytometer,respectively.Cell migration ability were observed by scratch and transwell migration assays.Western blot and Real time-PCR were used to detect the expression of collagen Ⅰ (COL-Ⅰ),fibronectin (FN) and α-smooth muscle actin (α-SMA).The phosphorylation level of PI3K and Akt were measured by Western blot.Results TGF-β1 promotes cell proliferation in a time-dependent manner.There was no statistically significant difference in A values between 48 hours and 72 hours after TGF-β1 treatment (P =0.064).Forty-eight hours was selected as the most appropriate time for TGF-β1 treatment.NPPB inhibited HConF cell proliferation in a concentration-dependent manner.Compared with the control group,the proliferation A values of cells in the 50 mol/L and 100 mol/L NPPB groups were significantly reduced (P =0.020,0.000),and 100 mol/L was selected as the optimal concentration of NPPB.The cell proliferation A value,migration area and migration cell number of TGF-β1 +NPPB group were significantly lower than those of TGF-β1 treatment group (all at P＜0.05).Compared with the control group and TGF-β1 +NPPB group,the proportion of G1 phase cells in the TGF-β1 treatment group was reduced,and the proportion of cells in the S phase and G2/M phase were increased,with statistically significant differences between them (all at P ＜ 0.05).The protein and mRNA expression of α-SMA,COL-Ⅰ and FN in the TGF-β1 treatment group were higher than those in the control group and TGF-β1+NPPB group,with statistically significant differences between them(all at P＜0.05);the ratios of p-PI3K/PI3K and p-Akt/Akt in the TGF-β1 treatment group were significantly higher than those in the control group and TGF-β1 +NPPB group,with statistically significant differences between them (all at P＜0.05).Conclusions NPPB may inhibit TGF-β1 induced HConF fibrosis process by inhibiting phosphorylation of PI3K and Akt.
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A 26-year-old male presented with superior filtering bleb with scleral thinning, dislocated lens, and hypotony in both the eyes. His cornea was normal without any sign of ectasia, and there was no history of recurrent redness, trauma, or surgery in either eye. Anterior segment optical coherence tomography did not reveal communicating fistula between the anterior chamber and subconjunctival space. Physical examination and blood investigations did not reveal any systemic association. He was diagnosed to have spontaneous filtering bleb, which is a rare condition observed with ocular or systemic abnormalities.
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Objective To investigate the clinical effects of microinvasive revision surgery on the patients of the fibrotic filtering bleb with the guidance of ultrasound biomicroscopy (UBM).Methods A prospective,nonrandomized clinical controlled trial was conducted,which had 2 groups according to the results from UBM during the same period in our hospital,including the patients with the microinvasive revision surgery (28 patients of 28 eyes,group A) and the in-situ traditional revision surgery of larger incision (27 patients of 27 eyes,group B).The clinical data of the patients were collected and the main observation targets were the change of the postoperative visual acuity (VA),intraocular pressure (IOP),the operation success rate and the complications.Results There were no significant differences in the gender,age,glaucoma types,primary operation modes,postoperative follow-up time and preoperative VA (all P ＞0.05).The average duration of hospital stay,postoperative VA and the postoperative complications of group A were better than those of group B and the differences were statistically significant (all P ＜ 0.05).There was no significant difference in IOP at different time points between the two groups (all P ＞ 0.05).The operative successful rates of the two groups were 64.3％ and 66.6％,respectively(P ＞ 0.05).Conclusion The in-situ microinvasive revision surgery on the basis of the UBM examination is a good choice for patients with the fibrotic filtering bleb of the unlocked inner passageway in the filter aisle and a latent liquid dark cavity that is interlinked with the anterior chamber under the scleral flap or the liquid dark cavity of the capsule.
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Objective To report a postoperative complication of corneal invasion of filtering bleb (CIFB) and the analysis of its diagnosis and treatment.Methods A retrospective analysis was conducted in 17 patients with CIFB collected from March 2006 to April 2017.They were treated according to the classification standards.Patients suffering the mild type with no obvious conjunctival post-adhesion received conservative observation;but patients with obvious adhesion were given acupuncture separation combined with 5-Fluorouracil filter follicular subconjunctival injection and eye massage.The moderate type with no progress was treated with the mild and mediumpartial filtration and amniotic membrane transplantation.For the severe ones,the conjunctiva filtering bleb was excised with lamellar keratoplasty and filtering bleb reconstruction.Finally,the clinical features,classification standards and the follow-up results were summarized.Results As for the clinical features,17 patients were treated with domeas the basement of the conjunctival incision,and received intraoperative mitomycin administration.For the patients with CIFB growing rapidly,the posterior synechiae of their filtering blebs had occurred and timely actions could slow down or stop its development.As for the classification standards,according to the degree of corneal invasion,there were 11 patients being mild type,5 patients being moderate types,and only 1 patients being severe type.After treatment,the progress stopped in all mild patients,while the moderate and severe types were not relapsed after treatment.Conclusion CIFB is different from overhanging filtering bleb.As a less common kind of filtering bleb complication,timely identification and appropriate treatments can effectively delay or even stop the progress of corneal damage to maintain the filtering surgery effects.
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Objective To study the inhibitive effects of matrine on the formation of glaucoma filtration bleb scar.Methods A total of 40 New Zealand white rabbit were chosen and randomly divided into four groups(group A,B,C and D).Both eyes in four groups were treated with glaucoma filtration surgery.The cotton pieces under the sclera flap were made:1.0 g · L-1 matrine cotton piece in group A,0.4 g · L-1 matrine cotton piece in group B,0.2 mg · L-1 mitomycin cotton piece in group C and PBS cotton piece in group D.The intraocular pressure,filtering bleb,anterior chamber reaction and complications were observed at preoperative and postoperative 1 day,3 days,7 days,14 days,28 days in all groups.Two rabbits selected randomly from every group were killed at 1 day,3 days,7 days,14 days and 28 days after surgery.Tissue was harvested from the bleb area and made into pathological section,immunestaining and Masson trichromatic dyeing were used to observe the inflammatory cells,collagen,fibroblasts,the change of muscle fibroblasts and new collagen fibers under light microscope.The cornea was observed at 7 days under transmission electron microscope for drug toxic reaction,Results At postoperative 7 days,14 days,28 days,there were statistical difference in IOP between group A,B,C and group D group (P ＜ 0.05),and there were statistical difference between group A and group B (P ＜ 0.05).At postoperative 7 days,14 days,28 days,there were statistical difference in fibroblasts counting between group A,B,C and group D group (P ＜0.01),and there were statistical differences between group A and group B (P ＜ 0.05).Conclusion Matrine can inhibit fibroblasts hyperplasia,reduce the scar of filtration area and has no side effects on eye tissues.
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Recent researches showed the incidence of filtering blebs leakage after anti-glaucoma surgery was 3％-25％.The affecting factors include the usage of antimetabolite medicine.Pathogenesis of filtering blebs leakage is the basement membrane of conjunctival cells fracture,reduced conjunctival cells and subconjunctival cells.It may cause hypotony,bleb infection and even endoophthalmitis.The treatments mainly include conservative therapy and surgery.Conservative therapy methods include package,autoserum or fibrin injection or eye drops and tissue glue.Surgery methods include conjunctival transposition,repair with conjunctival,corneal,scleral,amniotic membrane and biomechanical materials.Filtering blebs leakage may induce severve complications without timely treatments.Conservative therapy and surgery have their own limitations,which need to be considered intently and followed up closely.
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Aim: The aim of the study is to assess the outcomes of transconjunctival mitomycin C (MMC)‑augmented revision in eyes with failed trabeculectomy. Materials and Methods: This is a retrospective, noncomparative case series. One hundred and twenty‑one eyes of 113 consecutive glaucoma patients with previously failed trabeculectomy who underwent transconjunctival revision with at least 12 months of follow‑up were initially included in the study. The success was determined on the basis of intraocular pressure (IOP) alone. The main outcome measures were IOP, best‑corrected distance visual acuity, complications, bleb appearance, lens status, visual field progression, and time between primary trabeculectomy and MMC revision. The main purpose of the study was to determine the efficacy of a single MMC‑augmented needle revision. Results: Mean follow‑up was 2.3 years. Twelve months after revision, IOP had declined from 26.1 ± 8.4 mmHg to 14.1 ± 4.8 mmHg (P < 0.05) and remained 16.0 ± 5.6 mmHg at 24 months, 15.7 ± 5.8 mmHg at 48 months, and 15.2 ± 4.0 mmHg at 60 months. Complete success was achieved in 53% of cases, 84% achieved qualified success, and 16% were classified as failures 12 months after revision. Early complications developed in 45 of the initial 121 eyes (37.2%). Conclusions: Transconjunctival MMC‑augmented revision appears to be a safe and useful tool in reducing IOP and re‑establishing filtration after trabeculectomy failure. This simple procedure has a high rate of success and helps avoid other surgical interventions which are more destructive for the conjunctiva.
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AIM: To explorethe therapeutic efficacy of treating cataract phacoemulsification remove combined with trabeculectomy early postoperative failure with open sclera flap recanalization by phacoemulsification auxiliary hook interred the anterior chamber. METHODS:Twenty-seven cases ( 27 eyes ) of glaucoma combined cataract surgery(3mo) in the early failure were treated with that the phacoemulsification auxiliary hook into anterior chamber under the original sclera flap, open from the inside have adhesion of the sclera flap. Postoperative follow-up 12mo, the intraocular pressure and best corrected visual acuity were observed. RESULTS: The postoperative follow- up was 12mo. There were functional filtering bleb in 14(52%) eyes; and the IOP was below 21mmHg in 17 eyes(63%) without any anti- glaucoma drug, and in 7 eyes ( 26%) with 1 - 2 categories of lower intraocular pressure( IOP) drugs, and 3 eyes(11%), failure and the success rate was 89% after 12mo. Average intraocular pressure after 1wk, 1mo, 3mo, 6mo and 12mo were(7. 1±4. 3) mmHg,(10. 5±5. 1) mmHg,(15. 1±4. 8 ) mmHg, ( 16. 8±5. 2 ) mmHg, ( 17. 3±5.1 ) mmHg, significantly lower than the IOP preoperatively(30. 2±6. 8) mmHg (PCONCLUSION: It is a safe and effective method thattreating phacoemulsification cataract remove combined with trabeculectomy early postoperative failure with open sclera flap recanalization by phacoemulsification auxiliary hook interred the anterior chamber.
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Background Dynamic observation in morphology and histology of conjunctival filtering bleb in rats can contribute to form ideal filtering blebs by interferencing the process of scarring.Objective This study was designed to observe the survival time,morphological and histopathological changes of conjunctival filtering bleb after filtering surgery.Methods Filtering surgeries were performed on 60 male adult Sprague-Dawley rats by implanting drainage tubes into the anterior chamber.The shape of filtering blebs was examined by slit lamp microscope 1 day,3,5,7,14,28 days after surgery.The filtering was typed according to the criteria of Kronfeld.Areas of the filtering bleb were measured and compared at various time points after surgery.Conjunctival and subconjunctival tissues at filtering zone were obtained 1 day,3,5,7,14,28 days after surgery,respectively,and hematoxylin and eosin staining was used for the histopathological evaluation.Results Well-elevated filtering blebs formed on the first day after surgery in 60 rat eyes.The survival time of filtering bleb was 7-17 days with the mean time of (11.93±2.23) days.Survival rate of the filtering blebs was 100％ in 1-5 days,77％ in 7 days,20％ in 14 days and 0 in 28 days after operation.The filtering blebs were functional (Ⅰ type) in 1-5 days after operation,23 eyes were functional in 7 days after operation (13 eyes were Ⅰ type,10 eyes were Ⅱ type),4 eyes were functional in 14 days after operation (2 eyes were Ⅰ type,2 eyes wereⅡtype).The filtering area shrunken from (7.50±1.08) mm2 to (1.83±0.35) mm2during the observational duration.The filtering blebs area of different days after surgery were statistically significant (F =180.056,P=0.000),and significant differences were found between any two timepionts after surgery (all at P =0.000).Histological examination showed that inflammatory finding was dominant in postoperative day 1-3,such as infiltration of inflammatory cells,vasodilatation and edema of tissue.However,proliferating manifestation became the main signs 5 days later,showing the increase of fibroblasts,neovascularization and collagen formation.Conclusions The model of conjunctival filtering blebs in rats can be successfully established by implanting silicone tube into anterior chamber.The inflammatory response,proliferation of fibroblasts and the accumulation of collagen fibers are involved in the scarring process of filtering blebs.
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At present, filtration surgery remains an important treatment of glaucoma, and filtering bleb fibrosis is the main cause for treatment failure. Filtering bleb fibrosis is a common fiber hyperplastic disease, and it relates to the activation and proliferation of fibroblasts and the excessive production of extracellular matrix ( ECM) such as collagen protein. The most frequently-used drugs for filtering bleb fibrosis in clinic are 5-fluoro-2,4 (1h, 3h) pyrimidinedione ( 5 - Fu ) and mitomycin ( MMC ) . Although they are effective in some degree, they also have some serious side effects which restrict their clinical use. Triptolide ( TPL) is a major active component of the medicinal plant, tripterygium wilfordii hook. f. ( TWHF) . TPL has multiple pharmacological activities including immunosuppressive, anti- inflammatory, anti- cancer and anti-fertility activity. Reviewing related literatures published in recent ten years, we confirmed that TPL seemed to possess a pharmacological activity in treating filtering bleb fibrosis. Since it has three major functions:1. inhibit the activation and proliferation of fibroblasts and the excessive production of collagen protein; 2. alleviate the inflammatory reaction after surgical wound to suppress fibrous scar formation; 3. TPL has a protective effect on retinal ganglion cells ( RGCs ) . We further find that TPL's anti-fibrosis activity mainly results from that it inhibits TGF-β/Smad,NF-κB and PI3K/AKT signal transduction pathway. This comprehensive analysis about the feasibility of Triptolide's role in treating filtering bleb fibrosis after the filtration surgery of glaucoma can help us develop new drugs for filtering bleb fibrosis and exploit TPL's clinical value on some level.
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PURPOSE: To evaluate clinical results of combined phacotrabeculectomy (PHACO-TRAB) and trabeculectomy (TRAB) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS: Forty-two eyes of 42 patients with POAG and 60 eyes of 60 patients with PACG were studied retrospectively. Fifty-two patients underwent PHACO-TRAB and 50 patients underwent TRAB. The IOP, number of anti-glaucoma medications, and duration of filtering bleb survival for 3 years after surgery were compared. RESULTS: For 12 months after surgery, the TRAB group maintained significantly lower IOP than the PHACO-TRAB group (p < 0.05, t-test), and there was no significant difference thereafter. The filtering bleb survival rate was significantly higher in the TRAB group during the study period. In patients with POAG, the TRAB group showed higher filtering bleb survival rate for 3 years (p = 0.016, log-rank test). However, in patients with PACG, there was no significant difference in filtering bleb survival between the 2 groups. In patients with POAG, the TRAB group maintained significantly lower IOP for 12 months after surgery, and there was no significant difference afterwards. In patients with PACG, the TRAB group maintained lower IOP only at 1, 3, and 6 months after surgery. However, the PHACO-TRAB group showed significantly lower IOP at 18 months and 36 months after surgery. CONCLUSIONS: In patients with POAG, TRAB was more effective in lowering IOP and maintaining filtering bleb. However in patients with PACG, there was no difference in filtering bleb survival between the 2 groups. TRAB was more effective in maintaining IOP during the early period after surgery, but PHACO-TRAB was superior to TRAB beyond 1 year after surgery in patients with PACG.
الموضوعات
Humans , Blister , Eye , Glaucoma , Glaucoma, Angle-Closure , Glaucoma, Open-Angle , Intraocular Pressure , Retrospective Studies , Survival Rate , Trabeculectomyالملخص
PURPOSE: To evaluate clinical results of combined phacotrabeculectomy (PHACO-TRAB) and trabeculectomy (TRAB) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS: Forty-two eyes of 42 patients with POAG and 60 eyes of 60 patients with PACG were studied retrospectively. Fifty-two patients underwent PHACO-TRAB and 50 patients underwent TRAB. The IOP, number of anti-glaucoma medications, and duration of filtering bleb survival for 3 years after surgery were compared. RESULTS: For 12 months after surgery, the TRAB group maintained significantly lower IOP than the PHACO-TRAB group (p < 0.05, t-test), and there was no significant difference thereafter. The filtering bleb survival rate was significantly higher in the TRAB group during the study period. In patients with POAG, the TRAB group showed higher filtering bleb survival rate for 3 years (p = 0.016, log-rank test). However, in patients with PACG, there was no significant difference in filtering bleb survival between the 2 groups. In patients with POAG, the TRAB group maintained significantly lower IOP for 12 months after surgery, and there was no significant difference afterwards. In patients with PACG, the TRAB group maintained lower IOP only at 1, 3, and 6 months after surgery. However, the PHACO-TRAB group showed significantly lower IOP at 18 months and 36 months after surgery. CONCLUSIONS: In patients with POAG, TRAB was more effective in lowering IOP and maintaining filtering bleb. However in patients with PACG, there was no difference in filtering bleb survival between the 2 groups. TRAB was more effective in maintaining IOP during the early period after surgery, but PHACO-TRAB was superior to TRAB beyond 1 year after surgery in patients with PACG.
الموضوعات
Humans , Blister , Eye , Glaucoma , Glaucoma, Angle-Closure , Glaucoma, Open-Angle , Intraocular Pressure , Retrospective Studies , Survival Rate , Trabeculectomyالملخص
La trabeculectomía es generalmente un procedimiento exitoso para reducir la presión intraocular en pacientes con glaucoma. Sin embargo, el fallo de la ampolla de filtración puede ocurrir y provocar un incremento de la presión intraocular. Esto conllevaría a una intervención médica o quirúrgica adicional. Se realiza una revisión bibliográfica sobre la cistitomía transconjuntival, asociada al uso de antimetabolitos (mitomicina C o 5-fluorouracilo) o no. Se demuestra que es mínimamente invasiva, con escasas complicaciones y que constituye un método eficaz, fácil y barato para restablecer el drenaje acuoso y disminuir la presión intraocular
Trabeculectomy is usually a successful procedure to reduce intraocular pressure in glaucoma patients. However, the failure of the filtering bleb can occur, leading to increased intraocular pressure and to a further medical or surgical intervention. A literature review on transconjunctival cystotomy, with or without the use of mitomycin C or 5-fluorouracil, was made. It was demonstrated that this method is minimally invasive with few complications, effective, easy-to-apply and inexpensive to restore aqueous drainage and lowering intraocular pressure
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La trabeculectomía es uno de los tratamientos de elección en los pacientes con glaucoma. La causa más común de fallo de esta cirugía en su primer trimestre es la bula de filtración encapsulada. Usualmente es resultado de la proliferación fibrótica subconjuntival que lleva a fallo de la bula, como por ejemplo en los glaucomas traumáticos. La revisión con agujas y la mitomicina C constituyen una opción efectiva y relativamente segura para restaurar la función de la cirugía de filtración. Se presenta un paciente donde se restableció el flujo de humor acuso con este proceder
Trabeculectomy is the surgical treatment of choice for many patients with glaucoma. The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb. Generally, that results from scarring in the subconjunctival space with a resultant intrableb fibrosis and the development of a failed bleb, for example in traumatic glaucoma. Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive the function of the filtration surgery. This was the case report of a patient whose aqueous humor flow was reestablished with this treatment
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Background The filtering surgery is the main method of treating glaucoma.Fibrosis of filtering bleb is a key cause of failure of operation.The study about application of anti-scaring drug in filtering surgery is a hotspot.Objective Present study was to investigate the anti-scaring effect of paclitaxel aher trabeculectomy.Methods Thirty-two adult clean domestic rabbits underwent standardized trabeculectomy and randomly divided into 4 groups.Normal saline solution was used beneath the scleral flap during trabeculectomy for 3 minutes in 16 eyes of 8 rabbits as controls.0.3 g/L mitomycin C,0.2 g/L paclitaxel or 0.3 g/L paclitaxel was administered at the same way respectively in other 3 groups.Intraocular pressure (IOP) was measured,and eye numbers with function blebs were compared among 4 groups at the 4th,7th,14th and 28th day after surgery.The opening of filtration tunnel and the number of inflammatory cells were observed by hematoxylin and eosin staining,and proliferation of new collagen fibers was evaluated by Masson trichrome method.This study complied with the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission(version 1988). Results No significant differences were found in the change of lOP among 4 groups before operation(F=0.54,P=0.83)and the 4th day aher operation(F=0.57,P=0.87).The IOP value was statistically lower in 0.3 g/L mitomycin C group,0.2 g/L paclitaxel group and 0.3 s/L paelitaxel group than the normal saline solution group(P＜0.05)with the lowest value in 0.3 s/L paclitaxel group in 7,14,28 days after operation(P＜0.05).Functional filtering bleb was seen in all the rabbit eyes in the 4th day after operation.In 7,14,28 days after operation,the number of eyes with functional bleb wag evidently more in 0.3 g/L mitomycin C group,0.2 g/L paclitaxel group and 0.3 g/L paclitaxel group compared with normal saline group(P＜0.05).The histological examination showed that the infiltration of inflammatory cells in filtering tunnel was much more obvious in normal saline solution group than the other groups with the most mild response in 0.3 g/L paclitaxel group.Masson trichrome revealed that proliferation of new collagen fibers in 0.3 g/L paclitaxel group was significantly decreased in comparison with those in other three groups at the 4th,7th,14th and 28th day after surgery(all P＜0.05). Conclusion Paclitaxel can inhibit the inflammatory response and collagen fibrosis and therefore open the filtering tunnel after it be used topically during the glaucoma trabeculectomy.