ABSTRACT
AIM: To compare the surgical outcomes of glaucoma drainage device implantation (GDI) and trans-scleral neodymium:YAG cyclophotocoagulation (CPC) in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty (DSAEK). METHODS: This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery (15 with GDI and 14 with CPC). The main outcome measures were intraocular pressure (IOP), glaucoma surgery success rate (defined as IOP of 6-21 mm Hg without additional anti-glaucoma operation), number of glaucoma medications, endothelial graft status, and best-corrected visual acuity (BCVA). RESULTS: The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries, both for the GDI and CPC groups. Both groups showed significant IOP reduction after glaucoma surgery. The GDI group presented a significantly higher success rate in IOP control than the CPC group (60% vs 21.4%, P=0.03). Both procedures significantly decreased the number of glaucoma medications (P=0.03). Forty percent and 57% of cases in the GDI and the CPC group, respectively, experienced endothelial graft failure during follow-up (P=0.36). Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group. CONCLUSION: Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK. GDI is preferable to CPC in refractory glaucoma cases after DSAEK, as it manifests a significantly higher success rate for IOP control, similar endothelial graft failure rate, and relatively preserves BCVA than CPC.
ABSTRACT
OBJECTIVE: To measure the number of glucocorticoid receptors (GR) in the trabecular meshwork and peripheral blood lymphocytes of rabbits, and to explore their relationship with steroid-induced glaucoma. METHODS: Steroid-induced glaucoma model was induced by subconjunctival injection of 0.5 mg dexamethasone in the right eyes every two days for a month. Before the injection, GR concentration was measured in peripheral blood lymphocytes and trabecular meshwork of rabbits using the radio-ligand binding assay. GR concentration was measured again 30 days after the injection. The data was analyzed with SPSS software. RESULTS: The GR concentration in the peripheral blood lymphocytes and the trabecular meshwork of rabbits was (3642 +/- 947) site/cell and (2437.85 +/- 733.93) dmp/mg, respectively. The expression level in lymphocytes was significantly correlated with that in the trabecular (r = 0.862, P < 0.01). After treated with dexamethasone, the intraocular pressure of rabbits increased significantly, and the GR concentration in peripheral blood lymphocytes decreased significantly. Elevating level of IOP correlated positively with the primary and decreasing level of GR (r = 0.78, 0.79, P < 0.01). CONCLUSIONS: GR concentration in the peripheral blood lymphocytes of rabbits can reflect directly the GR number in the trabecular meshwork. There may be a close relationship between the GR number in peripheral blood lymphocytes and steroid-induced glaucoma.