Modified Cortex Mori Capsules improving the successful rate of functional filtering blebs after reclinical glaucoma filtering surgery

BACKGROUND The major reason for filtering bleb failure or scarring of the bleb site is due to excessive scarring after glaucoma filtration surgery in the clinic.Traditional Chinese medicine has preeminence in the prevention of fibrosis formation through the regulation of systemic circulation and improvement of the properties of the inflammatory cells in the blood.AIM To examine the clinical efficacy of using the Modified Cortex Mori Capsules(MCMC;Chinese name:Jiawei Sangbaipi Capsules)in the success rate of functional filtering blebs after glaucoma filtering surgery in clinical patients.METHODS Sixty resurgery glaucoma patients were randomly divided into two groups:30 patients in surgery with the placebo group and 30 patients in surgery with the MCMC group.Patients took either the placebo or the MCMC 2 wk before and after surgery.Postoperative morphology and function filtering bleb,visual acuity,intraocular pressure,postoperative complications,the success rate of filtration surgery and clinical efficacy were observed.RESULTS Fifty patients completed the study.The percentage of functional filtering blebs in the surgery plus MCMC group was 84%at 6 mo after surgery,which was higher than surgery plus placebo group(64%,P<0.05).The surgical success rate in the MCMC and placebo groups were 79%±8.3%and 57%±10.6%respectively(P<0.05).The visual acuity,intraocular pressure and the postoperative complications in the two groups had no significant differences.CONCLUSION Glaucoma filtering surgery while taking MCMC not only reduced excessive scar formation and increased the success rate of functional filtering blebs but also improved the success of glaucoma filtration operations.

Bleb needling outcomes for failed trabeculectomy blebs in Asian eyes: a 2-year follow up

·AIM: To describe the outcomes of bleb needling in primary glaucoma in an Asian tertiary eye centre over a2 y period. To compare the success rates between primary angle-closure glaucoma(PACG) and primary open angle glaucoma(POAG). Lastly, to identify factors associated with success of bleb needling.·METHODS: This was a retrospective review of 227 patients who underwent bleb needling between June2009 and June 2011 in Singapore National Eye Centre.The 5-fluorouracil(5-FU) augmented bleb needling was performed either at the slit lamp or in the operating theatre. Repeat bleb needlings were performed as necessary. Complete success was defined as maintenance of intraocular pressure(IOP) ≥6 mm Hg and ≤21 mm Hg, in the absence of further surgery or use of antiglaucoma medication. Qualified success met the above criteria with or without use of antiglaucoma medications.· RESULTS: One hundred and seventy-five eyes completed the two-year follow up. Sixty-nine percent of participants had POAG and 31% had PACG. The mean interval between filtering surgery and bleb needling was299.9 ±616.4d for POAG and 167.1 ±272.2d for PACG.Mean needling attempts were 1.9±1.4 and 2±1.6 for POAG and PACG respectively. In general, there was a statistically significant reduction of IOP ranging from21.9% to 26.8% from month 1 through to month 24. The complete success rates at month 6 were 70.0% for POAG and 65.7% for PACG. At month 12, this decreased to62.2% for POAG and PACG and at month 24, 57.9% for POAG and 63.0% for PACG respectively. The qualified success rates at month 6 for POAG and PACG were23.8% and 29.9% respectively, 32.2% and 29.2% at month12, and 34.7% and 29.6% at month 24. The success ratesbetween POAG and PACG were not significantly different(P 】0.05 for complete and qualified success at months 6,12 and 24). An increased number of needlings and higher pre-needling IOP were associated with failure.·CONCLUSION: The 5-FU augmented bleb needling within one year of trabeculectomy in Asian eyes can provide clinically significant IOP lowering of more than20% for 2y. POAG and PACG had similar complete success rates(58% and 63% respectively). Factors associated with greater risk of procedure failure included increased number of needlings and higher pre-needling IOP. Asian eyes have a greater propensity for scarring but bleb needling, if performed in a timely manner can rescue bleb function.

Alginate core-shell microcapsule reduces the DMSO addition-induced osmotic damage to cells by inhibiting cellular blebs

In cryopreservation,the addition of cryoprotectant can change the intra-and extra-cellular osmotic pressure,affect the cell morphology,and induce blebs on the plasma membrane.In this study,the blebs of cells microencapsulated in the alginate microsphere induced by osmotic shock were studied,and the effects of microencapsulation on bleb size and cell viability were determined.Firstly,a coaxial co-flow focusing device was applied to generate cell-laden microcapsules using alginate hydrogel in this paper.Then,cellular blebs induced by DMSO with various concentrations under microencapsulation were compared with that when non-encapsulated,and the dynamic process of cellular bleb was investigated.Finally,the qualitative relationship between bleb size and cell viability in the presence of DMSO was built,and thus the effects of microencapsulation on bleb size and viability were evaluated.The results show that the bleb size is smaller and the cell viability is higher,and cell microencapsulation can significantly inhibit the excessively large blebs generated on the cell membrane and reduce the osmotic damage to cells when loading cryoprotectant and then to improve cell viability during cryopreservation.This work can provide insights for optimizing cryoprotectant-loading protocols,offer a new avenue to study cell blebbing,and advance future research on cryopreservation of rare cells and biomaterials.

Posterior scleral application of a mitomycin C-soaked sponge during trabeculectomy

AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

Effectiveness of conjunctival bleb scarring by knockdown of heat shock protein 47 in rat model

AIM:To evaluate the effectiveness of knock-down of heat shock protein 47(HSP47)on conjunctival bleb scarring in a rat model and its possible mechanism.METHODS:Male Sprague–Dawley rats were used for glaucoma filtration surgery(GFS)and were treated with either phosphate buffered solution,shControl,mitomycin C,or sh-HSP47 using a microsyringe immediately after GFS.The morphology of filtering blebs was observed postoperatively.The levels of HSP47 were analyzed at 2,5,8,and 11d after GFS via real‑time quantitative polymerase chain reaction(PCR)and Western blot.The silencing effect of HSP47,the expression of collagen I and III,and the potential signaling pathways of HSP47 during scarification were explored 11d post GFS.The protein levels of transforming growth factor-β1(TGF-β1),phospho-Smad2(pSmad2),phospho-Smad3(p-Smad3),and phospho-p38(p-p38)were also analyzed using Western blot.RESULTS:Sh-HSP47 treatment significantly prolonged the functional filtration bleb retention.The levels of HSP47 were increased significantly at 5,8,and 11d postoperatively compared to the control group(P<0.05,P<0.01,and P<0.001).The levels of HSP47 protein at day 11 postoperatively were significantly down-regulated after HSP47 silencing using sh-HSP47 adenovirus transfection(P<0.01).Expression levels of collagen I and III within the blebs were significantly reduced in the absence of HSP47(P<0.01).Moreover,the protein levels of TGF-β1,p-Smad2/3,and p-p38 were dramatically inhibited after treatment with sh-HSP47(P<0.01).CONCLUSION:The inhibitory effects of HSP47 knockdown on scarring after GFS have the potential to be an efficacious therapeutic option for the treatment of conjunctival bleb scarring.

Fungal corneal ulcer after repair of an overhanging filtering bleb:A case report

BACKGROUND Overhanging filtering bleb is a common complication after trabeculectomy and surgical repair is an effective treatment when the patient presents with apparent symptoms.Filtering bleb relevant infection including in the filtering bleb itself and even endophthalmitis in some severe cases has been reported.However,corneal fungal infection after filtering bleb repair is rarely reported.CASE SUMMARY A 57-year-old Chinese man who had sensations of redness and foreign body sensations in the left eye 3 wk after repair of overhanging filtering bleb.3 wk ago,due to sensations of a foreign body in the left eye for 3 years with worsening for 3 mo.The patient was diagnosed as overhanging filtering bleb and underwent a repair of overhanging filtering bleb.Postoperative,the filtering bleb formed well and the intraocular pressure is normal.But the patient gradually develop redness,pain and a grey infiltrate of the cornea in the eye.Finally it developed into fungal corneal ulcer.Through asking the medical history,we found the patient had irregularly self-medicated for years with glucocorticoid eye drops for years to relieve the foreign body sensation in the eye caused by filtering bleb overhanging.Because the glucocorticoid eye drops he used years ago had provide normal sensation to the eye.After 3 mo of anti-fungal treatment,the inflammation was controlled.CONCLUSION In addition to avoiding the development of overhanging filtering bleb after trabeculectomy,the present case report also suggests that clinicians should pay more attention to the patient’s ocular self-medication history.Particularly in patients with a history of glaucoma or eye surgery.Because these patients may be exposed to more types of eye drops than other individuals,they may select the wrong medi-cations for long-term use,based on their previous experience.

瘤颈栓塞治疗颅内动脉瘤破裂的单臂研究

目的探讨动脉瘤颈部血管内弹簧圈栓塞术(ECE)治疗具有血泡形成颅内动脉瘤破裂(RICABF)的有效性和安全性。方法回顾性分析86例RICABF患者临床资料,包括继发性破裂/出血率,颈内动脉瘤栓塞率,残余/复发性动脉瘤,术中事件和栓塞后并发症,以及格拉斯哥结局量表(扩展)(GOS-E)的改善。结果动脉瘤完全闭塞72个(72/86,83.7%),颈部残留12个(12/86,14.0%),残留动脉瘤2个(2/86,2.3%)。术后GOS-E评分3分3例(3.5%),4分10例(11.6%),5分73例(84.9%)。所有患者行随访血管造影(平均9.0个月)。复发3例(3/86,3.5%)。没有报告提示动脉瘤破裂或出血。结论瘤颈部ECE是RICABF的有效且安全的治疗方式,其长期有效性和安全性需要在前瞻性和比较性研究中进行调查。

Incidental finding of esophageal pneumatosis

Pneumatosis of the gastrointestinal tract is a rare condition characterized by the presence of air filled cavities in the gastrointestinal tract wall.Its occurrence has been described throughout the gastrointestinal tract from the esophagus to the rectum,however it is most commonly reported in the small intestine.Despite multiple case reports in literature,its pathogenesis still remains unclear.Pneumatosis may be idiopathic or associated with a variety of disorders namely peptic ulcer disease,jejunoileal bypass,intestinal obstruction and non-gastrointestinal disorders like asthma,chronic obstructive pulmonary disease,systemic lupus erythematosus,infectious enteritis,etc.We here present a rare case of pneumatosis of the esophagus diagnosed incidentally at an esophagogastroduodenoscopy(EGD).A 78-year-old asymptomatic woman underwent EGD and colonoscopy at our hospital for evaluation of anemia.Few months prior to EGD,she had undergone excision of laryngocele at our hospital.EGD revealed extensive submucosal blebs distributed throughout the esophagus,otherwise unremarkable stomach and duodenum.Colonoscopy showed a tubular adenomatous polyp.Since our patient was asymptomatic she did not require any surgical intervention.Management of pneumatosis depends on the underlying cause.

Blue rubber bleb nevus syndrome:A case report and literature review

Blue rubber bleb nevus syndrome(BRBNS)is a rare disease characterized by multiple venous malformations and hemangiomas in the skin and visceral organs.The lesions often involve the cutaneous and gastrointestinal systems.Other organs can also be involved,such as the central nervous system,liver,and muscles.The most common symptoms are gastrointestinal bleeding and secondary iron deficiency anemia.The syndrome may also present with severe complications such as rupture,intestinal torsion,and intussusception,and can even cause death.Cutaneous malformations are usually asymptomatic and do not require treatment.The treatment of gastrointestinal lesions is determined by the extent of intestinal involvement and severity of the disease.Most patients respond to supportive therapy,such as iron supplementation and blood transfusion.For more significant hemorrhages or severe complications,surgical resection,endoscopic sclerosis,and laser photocoagulation have been proposed.Here we present a case of BRBNS in a 45-year-old woman involving 16sites including the scalp,eyelid,orbit,lip,tongue,face,back,upper and lower limbs,buttocks,root of neck,clavicle area,superior mediastinum,glottis,esophagus,colon,and anus,with secondary severe anemia.In addition,we summarize the epidemiology,clinical manifestations,diagnosis,differential diagnosis and therapies of this disease by analyzing all previously reported cases to enhance the awareness of this syndrome.

Postoperative adjunctive bevacizumab versus placebo in primary trabeculectomy surgery for glaucoma

AIM: To compare the effectiveness of postoperative adjunctive use of subconjunctival bevacizumab in altering the outcome of primary trabeculectomy in terms of sustained lowering of intraocular pressure(IOP) and reduction of postoperative bleb vascularization and fibrosis.METHODS: A prospective, one center, randomized, placebo-control study. Fifty-nine patients(59 eyes) with uncontrolled IOP under maximal tolerated medical treatment(MTMT) were recruited. A primary trabeculectomy with mitomycin C(MMC) was done and the patients were randomized to either postoperative subconjunctival injection of bevacizumab(1.25 mg/0.05 mL) or balanced salt solution(BSS). Forty-seven patients(47 eyes) completed at least one year of follow up and were included in the study. The main outcome measure was the IOP, and secondary outcome measures include bleb morphology, vascularization, and fibrosis, as well as the need for glaucoma medications and 5-fluorouracil(5-FU) needling.RESULTS: At 1-year follow up, there was no significant difference between groups for IOP(P=0.65), bleb morphology(P=0.65), and the need for glaucoma medications(P=0.65) or 5-FU needling requirements(P=0.11). However, the bevacizumab group had a higher rate of success results, lower use of glaucoma medications after surgery, and optimal bleb aspect in more patients, but more 5-FU needling procedures required. CONCLUSION: A bigger sample size is needed in order to determine whether the differences found in the bevacizumab group are statistically significant.

Protective effect of prednisolone on ischemia-induced liver injury in rats

AIM: To investigate the effects of prednisolone on cell membrane bleb formation, calpain μ activation and talin degradation during hepatic ischemia-reperfusion injury in rats. METHODS: The hilar area of the left lateral and median lobes of rat liver (68%) was clamped for 60 min and followed by 120 min reperfusion. Prednisolone was administered at 1.0, 3.0, or 10 mg/kg at 30 min before ischemia. In addition to biochemical and microscopic analyses, activation of calpain μ was determined using specific antibodies against the intermediate (activated) form of calpain μ. Degradation of talin was also studied by Western blotting. RESULTS: In the control and prednisolone (1.0 mg/kg) groups, serum aspartate transaminase (AST) and alanine transaminase (ALT) level were elevated, and cell membrane bleb formation was observed after 120 min of reperfusion. Moreover, calpain μ activation and talin degradation were detected. Infusion of prednisolone at 3.0 or 10 mg/kg significantly suppressed serum AST and ALT, and prevented cell membrane bleb formation. At 10 mg/kg, prednisolone markedly suppressed calpain μ activation and talin degradation. CONCLUSION: Prednisolone can suppress ischemia- reperfusion injury of the rat liver. Its cytoprotective effect is closely associated with the suppression of calpain μ activation and talin degradation.

Endoscopic therapy for esophageal hematoma with blue rubber bleb nevus syndrome

A 57-year-old woman previously diagnosed with blue rubber bleb nevus syndrome(BRBNS) reported hematemesis. BRBNS is a rare vascular anomaly syndrome consisting of multifocal hemangiomas of the skin and gastrointestinal(GI) tract but her GI tract had never been examined. An upper gastrointestinal endoscopy revealed a large bleeding esophageal hematoma positioned between the thoracic esophagus and the gastric cardia. An endoscopic injection of polidocanol was used to stop the hematoma from bleeding. The hematoma was incised using the injectionneedle to reduce the pressure within it. Finally, argon plasma coagulation(APC) was applied to the edge of the incision. The esophageal hematoma disappeared seven days later. Two months after the endoscopic the rapy, the eso phage alulcerhealed and the hemangioma did not relapse. This rare case of a large esophageal hematoma originating from a hemangioma with BRBNS was treated using a combination of endoscopic therapy with polidocanol injection, incision, and APC.

Filtering bleb area and intraocular pressure following subconjunctival injection of CTGF antibody after glaucoma filtration surgery in rabbits

AIM: To study the role of connective tissue growth factor (CTGF) antibody in inhibiting bleb scarring after glaucoma filtration surgery (GFS) in rabbit model. METHODS: GFS was performed on both eyes in five rabbits. One eye of each rabbit was chosen randomly as antibody group and received subconjunctival injection of 0.1mL CTGF antibody (50mg/L) immediately after GFS applied and on the 5 th day after GFS. The other eye of each rabbit as control group was received subconjunctival injection of 0.1mL PBS at the same time as antibody group. On postoperative days 1, 3, 5, 7, 10, and 14, the appearance of filtrating blebs was observed under slit lamp, the area and the intraocular pressure (IOP) were measured with micrometer and applanation tonometer, respectively. RESULTS: On postoperative days 1, 3, 5, 7, 10, and 14, areas of filtrating blebs in antibody group were all larger comparing with the control group (P<0.05) and IOPs of antibody group were lower than the control group(P<0.05). CONCLUSION: Subconjunctival injection of CTGF antibody can maintain larger bleb area and lower IOP after GFS in rabbit.

Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up:A case report

BACKGROUND Blue rubber bleb nevus syndrome(BRBNS)is a rare vascular disease,difficult to diagnose and choose a treatment method,especially in young children.There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients,in general.The literature on BRBNS cases is limited and presents various therapeutic approaches.CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female,whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam.Skin lesions,typical for BRBNS,appeared on the 8th d of the child’s life and their number increased over the next several months.The child also experienced episodes of critical decrease in hemoglobin level(by as much as 52 g/L)for several years,requiring iron supplementation and several blood transfusions.Video capsule endoscopy revealed numerous vascular formations in the small bowel.The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis.Single-balloon enteroscopy was used to perform sclerotherapy,with aethoxysklerol foam.A positive effect was observed within 19 mo of follow-up.We continue to monitor the patient’s hemoglobin level,every 2 wk,and it has remained satisfactory(>120 g/L).CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.

Functional evaluation of the filtering bleb by ultrasound biomicroscopy after trabeculectomy with mitomycin C

AIM： To study the role of ultrasound biomicroscopy（UBM） in the assessment of the bleb function after trabeculectomy with mitomycin C（MMC）. METHODS： This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3 min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure（IOP） was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mmHg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36 mo after trabeculectomy（13.6±9.7 m o）. RESULTS： This study included 33 trabeculectomy filtering blebs of 25 patients（9 males and 16 females）. The mean age of patients was 53.2±14.2 y（range 25-71y）. We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs（IOP ≤18 mmHg without antiglaucoma medications）, others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings（intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts） and cases with different grades of clinical functional success（P〈0.01）.CONCLUSION： UBM is an objective tool in the functional assessment of the post-trabeculectomy filtering bleb through a significant correlation between certain UBM parameters and the different grades of clinical functional success.

Efficacy of autologous conjunctival flap on repairing the late-onset filtering bleb leakage

AIM： To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy.METHODS： This study retrospectively reviewed 106 eyes from 106 patients with late-onset filtering bleb leakage after trabeculectomy who received autologous conjunctival flap surgery at the Zhongshan Ophthalmic Centre from 2005 to 2015. The basic information was recorded, and the interval time between trabeculectomy and autologous conjunctival flap surgery as well as related risk factors, intraocular pressure（IOP）, anterior chamber depth（ACD） and best corrected visual acuity（BCVA） were analysed. Moreover, 41 patients who completed the 1-year follow up were analysed to determine the IOP and BCVA changes and long-term success rates.RESULTS： The 50 male and 56 female subjects（average age 39.13±17.96 y） included 47（44.34%） and 33（31.13%） cases of primary open angle and primary angle-closure glaucoma. The mean interval between trabeculectomy and repair surgery was 60.60±56.92（3-264）mo. The mean mitomycin（MMC） concentration during trabeculectomy was 0.27±0.04（0.12-0.4） mg/m L in the fornix-based conjunctival flap group（68 patients） and 0.28±0.04（0.20-0.33） mg/m L in the limbal-based conjunctival flap group（11 patients）. After bleb leakage, the patients＇ vision remained stable while the IOP decreased from 10.25±4.76（3-20.86） to 9.44±4.33（2-21） mm Hg（P〈0.01）. In the 41 analysed patients, the IOP was controlled at 15.68±5.11（7-40） mm Hg in the 1^（st） year after autologous conjunctival flap surgery and recurrence was not observed, for a long-term success rate of 100%. CONCLUSION： Autologous conjunctival flap repairing surgery is an effective technique for sealing filtering bleb leakages and controlling IOP postoperatively.

Short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy for failed Ahmed glaucoma valve

AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy(ERC) after Ahmed glaucoma valve(AGV) failure.METHODS: Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval.The number of anti-glaucoma medications(AGMs),intraocular pressure(IOP) and best corrected visual acuity(BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d.Intra-and postoperative complications were also recorded.Positive outcome was defined as IOP≤21 mm Hg with or without AGMs.RESULTS: Fourteen eyes [14 patients, median age 69.5y, interquartile range(IQR) 61.3-80] were included.Pseudoexfoliative glaucoma(n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo(IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0(IQR 3.0-4.0)to 2.0(IQR 1.5-3), the median IOP decreased from 26 mm Hg(IQR 22-29) to 16.5 mm Hg(IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1,3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes(36%), which were resolved spontaneously during the first week following ERC.CONCLUSION: ERC has a high success rate for shortterm management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.

An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy(SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb.METHODS: This randomized prospective study included 28 eyes from 28 patients(age range: 42-55 y) with primary open angle glaucoma(POAG) presented with elevated intraocular pressure(IOP) with fibrotic bleb despite previous SST for more than 4 mo. The eyes enrolled in the study were divided into two groups: group I(subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C(MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity(VA), visual field(VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg(P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg(P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF.CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4 mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.

Sirolimus treatment for neonate with blue rubber bleb nevus syndrome:A case report

BACKGROUND Blue rubber bleb naevus syndrome(BRBNS)is a rare disease that usually presents with multiple venous malformations in the skin and gastrointestinal tract.Lesions located in the gastrointestinal tract always result in chronic gastrointestinal bleeding and severe anemia.The successful management of BRBNS with sirolimus had been reported in many institutions,due to its impact on signaling pathways of angiogenesis.However,the experience in treatment of neonates with BRBNS was limited.CASE SUMMARY A 38-day-old premature female infant born with multiple skin lesions,presented to our center complaining of severe anemia and hematochezia.Laboratory examination demonstrated that hemoglobin was 5.3 g/dL and contrast-enhanced abdominal computed tomography showed multiple low-density space-occupying lesions in the right lobe of the liver.She was diagnosed as having BRBNS based on typical clinical and examination findings.The patient was treated by transfusions twice and hemostatic drugs but symptoms of anemia were difficult to alleviate.A review of BRBNS case reports found that patients had been successfully treated with sirolimus.Then the patient was treated with sirolimus at an average dose of 0.95 mg/m2/d with a target drug level of 10-15 ng/mL.During 28 mo of treatment,the lesion was reduced,hemoglobin returned to normal,and there were no adverse drug reactions.CONCLUSION This case highlights the dosing regimen and plasma concentration in neonates,for the current common empiric dose is high.

Overhanging glaucoma filtration bleb related to cataract surgery

A 74-year-old man presented with a three-year history of foreign body sensation in the right eye after cataract surgery.He underwent uneventful trabeculectomy with mitomycin C(MMC) in the right eye seven years ago.Slit-lamp examination revealed a large avascular filtration bleb overhanging on the cornea with a thin base connected to the conjunctiva.Preoperative ultrasound biomicroscopy(UBM) impressions were confirmed by leakage of aqueous from the incision intraoperatively.Surgical dissection and revision of the bleb was performed with satisfactory outcome.Histopathologic evaluation showed proliferation of fibrous tissue under the conjunctival epithelia with irregular cystoids change.The current case may be the first report of a post-trabeculectomy overhanging filtration bleb related to cataract surgery.The possible mechanism may be related to microleakage of the surgical wound after phacoemulsification which initiated the healing and scarring process.