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Glaucoma Surgery (glaucoma + surgery)
Selected AbstractsGlaucoma Surgery: Lest we forgetACTA OPHTHALMOLOGICA, Issue 6 2003Tarek Shaarawy No abstract is available for this article. [source] Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Yoshiaki Saito Abstract. Purpose:, This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG). Methods:, Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were , 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 ± 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan,Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups. Results:, Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group. Conclusions:, This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG. [source] Hyaluronidase allergy: A rare cause of periorbital inflammationAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2010Kate Borchard ABSTRACT Hyaluronidase is a bovine or ovine testicular protein that is used as an adjunct to co-administered medicaments and fluids to enhance their dispersion and absorption through the degradation of hyaluronan. While it is a known potential allergen, there are few reports of hyaluronidase hypersensitivity. A 56-year-old lady presented 8 hours post glaucoma surgery with ipsilateral lacriminorrhoea, periorbital erythema, oedema, proptosis, pruritis and conjunctival chemosis. Right ocular motility was restricted and visual acuity was reduced. The reaction settled with oral corticosteroids and antihistamines. Hyaluronidase allergy was confirmed on skin prick testing. Hyaluronidase allergy is rare. In the few cases reported, reactions occurred at various doses and were acute (intraoperative), early (within hours), intermediate (within days) or delayed (within weeks). Anaphylaxis has also been described. Primary sensitization appears to be a prerequisite for most reactions. The variability in onset of symptoms and the response to skin testing would suggest that type I and type IV hypersensitivity may both contribute to this response. In this case, the timing fitted with a late phase type 1 reaction. This case shows that despite being less common than haemorrhage for acute reactions and infection for delayed reactions, allergy can account for orbital inflammation following ophthalmic surgery. [source] 1315: Cataract, refractive and glaucoma surgery: anterior eye segment photo, clinical details, TD OCT, SD OCT and SS OCT scans, diagnosis and conclusionACTA OPHTHALMOLOGICA, Issue 2010D JANISZEWSKA [source] 2164: Role of placental growth factor (PIGF) in wound healing after glaucoma filtration surgeryACTA OPHTHALMOLOGICA, Issue 2010T VAN BERGENArticle first published online: 23 SEP 2010 Purpose Failing filtering surgery due to excessive wound healing is a considerable challenge in ophthalmology, and largely contributes to progressive vision loss in glaucoma patients. Anti-VEGF therapy helps to prevent post-surgical scarring by inhibiting angiogenesis and collagen deposition, but does not influence inflammation (which is also an important player in postoperative wound healing). We will check the hypothesis that placental growth factor (PlGF) plays a role in scar formation after glaucoma filtration surgery, and that it may be a(n) (additional) target for improvement of the outcome of this surgery through its known anti-angiogenic and anti-inflammatory, and possibly anti-fibrotic properties. Methods The effect of an anti-PlGF antibody (ThromboGenics) will be investigated in vitro on the proliferation of endothelial cells (HUVEC), inflammatory cells (Jurkat cells) and of Tenon fibroblasts (TF). The effect of the antibody will also be investigated in vivo in a rabbit model for glaucoma surgery by measuring intra-ocular pressure (IOP), filtration bleb function and survival, and by (immuno-)histological analysis of angiogenesis (CD31), inflammation (CD45) and fibrosis (Sirius Red). Conclusion Our proposed research project will elucidate the potential role of PlGF-inhibition in the improvement of filtration surgery outcome, and will highlight any angiostatic, anti-inflammatory, and/or anti-fibrotic effects. PlGF-inhibition as an adjuvant anti-inflammatory therapy to anti-VEGF treatment in glaucoma surgery might open new perspectives for more efficient surgery. In conclusion, our project opens exciting perspectives for the treatment of the blinding condition of glaucoma, and thus might improve the visual prognosis of glaucoma patients. [source] 2165: Microplasmin as an antiscarring agent for glaucoma surgery: translation into clinical applicationACTA OPHTHALMOLOGICA, Issue 2010E VANDEWALLEArticle first published online: 23 SEP 2010 Purpose Previously Microplasmin was investigated in a rabbit model for trabeculectomy. The combination of intracameral injections and topical drops of Microplasmin improved surgical outcome. The aqueous solution of Microplasmin used, was not optimized for use as drops or injections. Microplasmin is an autocatalytic enzyme which has a short half life when it is brought in conditions of 37°C and physiological pH. Therefore there is need for a more stable and longer acting formulation. Methods Firstly we will do pharmacological experiments to determine the rheological characterization of drug carriers with Carrier-med rheometer. Then we will define the purity of Microplasmin bulk drug substance by RP-HPLC. Finally, we will check the Microplasmin activity in the new obtained solutions by spectrophotometer. Secondly we will perform trabeculectomy in a rabbit model and administer the most qualified and optimized formulations. Postoperative clinical evaluation of IOP, bleb area, conjunctival vascularity and anterior chamber assessment will be performed. The eyes will be immunohistological investigated for collagen and inflammation. Conclusion Our previous data learned that the combination therapy of Microplasmin improved surgical outcome in a rabbit model, despite the fact that the formulation of Microplasmin was not optimized for use as drops or injections. Our proposed research project will optimize the formulation of Microplasmin for extended drug delivery and determine the optimal administration route and regimen. We believe that this project will allow us to further improve the positive animal data, translate this novel antifibrotic adjunctive therapy into clinical application, and thus improve the outcome after trabeculectomy in patients. [source] 2127: Ghrelin concentration in the aqueous humour and plasma in open angle glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2010A KATSANOS Purpose Ghrelin is a peptide hormone that exerts metabolic and smooth muscle-relaxant effects in ocular tissues. The aim of this study was to compare aqueous humor and plasma levels of ghrelin in patients with open angle glaucoma (OAG) and controls. Methods Twenty four OAG, including 7 pseudoexfoliation (PXG) and 17 primary open-angle glaucoma (POAG) patients, and 30 controls were included. All participants were patients scheduled for cataract or glaucoma surgery. Patients with other concomitant ocular disease, previous ocular surgery or diabetes were excluded. Blood samples were collected before cataract surgery. Aqueous humor was aspirated from the anterior chamber through a paracentesis with a 27 G needle under sterile conditions. Ghrelin levels in both samples were measured quantitatively with commercially available Radioimmunoassay (RIA) kits. Results Mean±SD age was 71.0±9.3 and 69.6±6.6 years in the OAG and control groups, respectively (p=0.6). Plasma levels of ghrelin were 495.6±157.7 pg/ml in the OAG and 482.2±125.4 pg/ml in the control group, respectively (Mann-Whitney test, p=0.9). Aqueous humor levels of ghrelin were 85.5±15.4 pg/ml and 123.4 ±25.5 pg/ml in the OAG and control groups, respectively (Mann-Whitney test, p<0.01). The ratio of plasma/aqueous concentration in ghrelin was higher in the OAG versus the control group (5.82± 1.94 versus 4.00±1.04, Mann-Whitney test, p<0.01). There was no difference neither in plasma nor in aqueous humor levels of ghrelin between POAG and PXG patients (p>0.5). Conclusion Aqueous humor levels of ghrelin were significantly lower in OAG patients. This difference may manifest a role of ghrelin in the disease process or a consequence of antiglaucoma treatment. [source] Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot studyACTA OPHTHALMOLOGICA, Issue 1 2010Dimitris Papaconstantinou Abstract. Purpose:, To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP). Methods:, Forty eyes of 40 patients were assigned randomly to undergo trabeculectomy either with OloGen implant (study group) or without implant (control group). Preoperative data included age, gender, type of glaucoma, IOP and number of preoperative glaucoma medications. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Each patient was followed up for at least 6 months. Results:, There were no significant differences between the groups in terms of age, gender, type of glaucoma, preoperative IOP and number of antiglaucoma medications. Mean IOPs for both groups were significantly lower than preoperative levels at all intervals (P < 0.05) The number of glaucoma medications used dropped from a preoperative mean of 3.5 ± 0.7 to a 6-month postoperative mean of 0.3 ± 0.7 (P < 0.001) in the study group and from 3.7 ± 0.4 to 0.5 ± 1.1 (P < 0.001) in the control group. No statistically significant differences between the two groups were observed in terms of postoperative complications. Conclusion:, In this pilot study it appears that trabeculectomy with OloGen does not seem to offer any significant advantages compared with trabeculectomy alone. Additionally, even though there were no statistical differences between the two groups as far as complications were concerned, one eye from the study group developed endophthalmitis 10 days after surgery and two eyes presented with positive Seidel test and flat anterior chamber and required additional suturing. Studies with larger numbers of patients and longer follow-ups are required to confirm these findings and to examine the safety and long-term outcomes of trabeculectomy with OloGen. [source] The effect of microplamin on wound healing after glaucoma filtration surgeryACTA OPHTHALMOLOGICA, Issue 2009T VAN BERGEN Purpose The outcome of trabeculectomy can be diminished due to a decreased bleb function secondary to blood/ fibrin clot in the aqueous outflow pathway. The aim of this study is to investigate whether the administration of Microplasmin (ThromboGenics), a recombinant protein that dissolves clot and fibrin, could lead to a better maintenance of the constructed channel, and thus improve surgical outcome after trabeculectomy. Methods The effect of Microplasmin will be investigated in vivo in a mouse model for conjunctival fibrosis and in a rabbit model for glaucoma surgery. Postoperative follow up of the animals will take place daily during the first week and two-daily until they are scarified. On specific time points animals will be sacrificed and both eyes will be enucleated. Seven-µm thin slides will be (immuno-)stained for CD45 to evaluate inflammation and for Sirius red and Trichrome to evaluate fibrosis. Results Preliminary results showed that Microplasmin significantly improved glaucoma surgery outcome in the rabbit model of aggressive scarring compared to control. Conclusion Our proposed research project will elucidate the potential role of Microplasmin in the improvement of filtration surgery outcome, and will highlight any anti-clotting, anti-inflammatory, and/or anti-fibrotic effects of this molecule. Microplasmin as an adjuvant therapy in glaucoma surgery might open new perspectives for more efficient surgery. [source] The retinal nerve fiber layer and the optic nerve head morphology after glaucoma surgeryACTA OPHTHALMOLOGICA, Issue 2009T GRACNER Purpose To detect and quantify changes in the retinal nerve fiber layer (RNFL) and the optic nerve head (ONH) morphology after glaucoma surgery. Methods 13 eyes of 13 patients with open-angle glaucoma in which goniotrephining with scleral flap without intraoperative antimetabolites for progressive glaucoma damage was done were included in this prospective study. Before and 6 months after the surgery: the intraocular pressure (IOP) was measured, the thicknes of the RNFL was measured with a scanning laser polarimeter (GDx VCC), the confocal scanning laser ophthalmoscopy measurements of ONH with Heidelberg retina tomograph (HRT 3) were performed and the visual field was tested with Humphrey Field Analyser. Results The mean IOP before surgery was 24.5 ? 2.3 mmHg decreasing 6 months after to a mean of 13.9 ? 3.0 mmHg (p<0.05). The RNFL measurements with GDx VCC revealed no differences between the mean TSNIT Avarage (p=0.383), mean Superior Avarage (p=0.756) and mean Inferior Avarage (p=0.269) before and after surgery. The ONH measurements with HRT 3 revealed postoperatively a significant increase in the mean Rim Area, Rim Volume and Cup Shape Measure, whereas Cup Area, Cup Volume and Linear Cup/Disc Ratio decreased (p<0.05). There were no differences between the mean Height Variation Contour (p=0.678) and Mean RNFL Thickness (p=0.064) before and after surgery. Preoperatively the mean value of the Mean Deviation on automated perimetry was ,18.82 ? 8.5 dB improving 6 months postoperatively to a mean of ,16.63 ? 7.9 dB (p<0.05). Conclusion Our study demonstrated the beneficial effect of IOP reduction obtained with glaucoma surgery on visual field indices and ONH parameters evaluated by HRT 3. [source] Is inhibition of VEGF165 sufficient to inhibit scar formation after trabeculectomy?ACTA OPHTHALMOLOGICA, Issue 2009T VAN BERGEN Purpose We have previously shown that VEGF plays a role in scar formation after glaucoma surgery and that inhibition of all VEGF-isoforms by bevacizumab is able to reduce scar formation. This study was designed to elucidate the exact role of VEGF165 in scar formation after trabeculectomy. The effect of pegaptanib (Pfizer), which specifically blocks VEGF165, was investigated in vitro and in vivo. Methods The effect of pegaptanib on Tenon fibroblasts and HUVEC in vitro was determined using a WST-1 proliferation assay. The effect of the aptamer was also investigated in vivo in a rabbit model for glaucoma surgery by studying angiogenesis, inflammation and collagen deposition. Results A dose-dependent reduction of HUVEC proliferation was seen after pegaptanib administration in vitro (P<0.05 with a dose of at least 0,3 mg/ml). A concentration of 2 mg/ml pegaptanib was necessary to inhibit the proliferation of Tenon fibroblasts. The aptamer also significantly reduced blood vessel density 3 days after surgery in a rabbit model of trabeculectomy (P=0.001). There were no significant differences in inflammation and collagen deposition in the treated eyes compared to control. Conclusion Whereas HUVEC cells were inhibited by pegaptanib in a dose-dependent way, Tenon fibroblasts were only inhibited at the highest dose. A single administration of pegaptanib at the time of trabeculectomy reduced postoperative angiogenesis, but not inflammation or collagen deposition. Further studies using repeated pegaptanib injections are necessary to investigate whether the lack of effect of pegaptanib on scarring was due to a shorter working time of pegaptanib compared to bevacizumab, or due to the difference in their effect on the various VEGF isoforms. [source] Microplasmin improves surgical outcome in a rabbit model for trabeculectomyACTA OPHTHALMOLOGICA, Issue 2009E VANDEWALLE Purpose This study was designed to study the efficacy and safety of Microplasmin as an anti-scarring agent after trabeculectomy in a rabbit model. Methods The effect of Microplasmin was investigated in vivo in a rabbit model for glaucoma surgery. Clinical outcome measures were intra-ocular pressure, bleb area and survival, side effects on slit lamp examination. Moreover, (immuno-) histochemical analysis of the eyes was performed, with quantification of inflammation (CD 45) and collagen deposition (Trichrome and Sirius Red). In the first experiment (n=10), Microplasmin anterior chamber injection was compared to placebo injection. In the second experiment (n=3), topical Microplasmin drops were compared to placebo drops. In the third experiment (n=5) the combination of Microplasmin anterior chamber injection and topical drops was compared to placebo injection and drops. All experiments were conducted in a masked observator way. Results Microplasmin significantly augmented the bleb area and survival in a rabbit model of trabeculectomy after a single anterior chamber injection or combination therapy (injection combined with drops) compared to control. Collagen deposition was borderline reduced after Microplasmin administration compared to control. No significant changes in inflammation were noticed in the anterior chamber or in the conjunctiva. Conclusion Microplasmin single injection or combination with postoperative drops improved the outcome after trabeculectomy. In a rabbit model, larger blebs were produced for a longer period compared to control, and collagen deposition tended to decrease in this small series. [source] Sodium hyaluronate gels as a drug-release system for corticosteroids: release kinetics and antiproliferative potential for glaucoma surgeryACTA OPHTHALMOLOGICA, Issue 8 2008Martin S. Spitzer Abstract. Purpose:, To evaluate the release kinetics, biocompatibility and antiproliferative potential of a concentrated hydrophilic steroid formulation from commercially available sodium hyaluronate gels as a potential adjunct in glaucoma surgery. Methods:, Dexamethasone and sodium hyaluronate 1% (Healon) and sodium hyaluronate 2.3% (Healon 5) were mixed to yield sodium hyaluronate formulations containing dexamethasone in concentrations of 4,20 mg/ml (7.7,38 mm). Non-cumulative and cumulative release into balanced salt solution (BSS) or phosphate buffered saline (PBS) was measured spectrophotometrically over 2,6 days. For cytotoxicity assays, human tenon fibroblasts (HTFB) and human retinal pigment epithelium cells (ARPE19) were cultured in a serum-deficient medium to ensure a static milieu; 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazoliumbromide (MTT) assay and Live/DeadÔ cell-mediated cytotoxicity assay were used to exclude cytotoxicity. Cellular proliferative activity was monitored by 5,-bromo-2,-deoxyuridine (BrdU)-incorporation into cellular DNA. Results:, The release kinetics from sodium hyaluronate 1% and 2.3% were almost identical. Steady state was achieved after approximately 44 hrs in non-cumulative measurements. The release plotted as a function of the square root of time was consistent with a largely diffusion-controlled release system. No cytotoxicity could be observed. Dexamethasone-loaded sodium hyaluronate showed a significant antiproliferative effect on HTFB and ARPE19 cells. Conclusion:, Dexamethasone-loaded sodium hyaluronate shows extended release of steroid over almost 2 days in concentrations high enough to inhibit the proliferation of HTFB and RPE cells without evoking cytotoxic effects. Thus, this formulation may be an easy-to-prepare adjunct in glaucoma surgery or other procedures in which cellular growth inhibition is desired. [source] The role of non-penetrating filtering procedures in glaucoma surgeryACTA OPHTHALMOLOGICA, Issue 2 2007Liv Drolsum No abstract is available for this article. [source] Protocol for mitomycin C use in glaucoma surgeryACTA OPHTHALMOLOGICA, Issue 2 2005J. A. Maquet Abstract. Purpose:,To evaluate the results of a protocol described for mitomycin C (MMC) use in trabeculectomy or combined surgery (phacoemulsification and trabeculectomy). Methods:,A total of 143 eyes (60 trabeculectomies and 83 combined surgeries) of 124 patients were divided into four groups: group 1 (without MMC); group 2 (with 0.1 mg/ml MMC); group 3 (with 0.2 mg/ml MMC), and group 4 (with 0.4 mg/ml MMC). Two-minute MMC was used in every case in groups 2, 3 and 4. The results were analysed after 1 year of follow-up. Intraocular pressure (IOP) and complications were evaluated. Successful IOP control was defined when IOP was <21 mmHg and <16 mmHg if advanced glaucoma was present, always without additional medical treatment. Results:,Mean preoperative IOP decreased from 24.60 mmHg (SD 1.40 mmHg) to 13.47 mmHg (SD 0.37 mmHg) (p < 0.00001), 12 months postoperatively. Control in IOP was achieved in 79.02% of eyes. No significant differences were found in final mean IOP values (p > 0.196) or in postoperative complications (p > 0.120) in groups 2, 3 and 4. Conclusion:,With the protocol described, a selection of concentration of MMC has been made in different clinical forms of glaucoma. No significant differences in IOP control and postoperative complications were noticed among the groups. [source] Recurrent retinal haemorrhages after glaucoma surgeryACTA OPHTHALMOLOGICA, Issue 3p1 2004Kyung-Chul Yoon No abstract is available for this article. [source] | ||||||||||