Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty

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 Descemetstripping 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.

Binocular disturbance after glaucoma drainage device implantation

Binocular vision disturbance is a well-described complication of glaucoma drainage device(GDD) implantation. The pathophysiology is not well-understood, but may involve bulk effects from the implant and surrounding bleb, as well as modulation of muscle function due to surgical trauma and post-operative inflammation, resulting in a combined resection/posterior fixation effect. Retrospective studies have found the risks of motility disorder and diplopia vary widely, estimated to be 56%-86% and 57%-75%, respectively. More recently, cross-sectional studies and prospective trials estimate post-GDD incidence to be approximately 1%-44%, with the incidence in newer generation of implants designed to limit bleb size likely lower at 1%-5%. Suggested methods of management strategies include prismatic spectacles, monocular occlusion, extreme monovision, and strabismus surgery.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

A feasibility study of using biodegradable magnesium alloy in glaucoma drainage device

Technological advances in glaucoma have challenged the traditional treatment paradigm. Historically incisional surgery has been used in cases of advanced disease and/or uncontrolled intraocular pressures resistant to medical or laser interventions. More recently, perhaps due to advancements in imaging, surgery has been suggested to be beneficial earlier in the treatment paradigm. Despite these trends, surgical manipulation of the tissues and unpredictability of wound healing continue to result in surgical failure. Magnesium is an essential element for human body and plays a critically important role in maintaining the functional and structural integrity of several tissues, including the eye. Due to several of its advantageous properties such as non-toxicity, biodegradability, and high biological compatibility, magnesium alloy has attracted great attention as a novel biomaterial. Biodegradable cardiovascular stents made of magnesium alloy have already been introduced into clinical practice. The purpose of this review is to determine if bioabsorbable magnesium alloys can be utilized as a promising candidate for the development of a new generation of glaucoma surgical assistive devices.

Dellen-like keratopathy associated with glaucoma drainage devices

To report the first case of dellen-like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. A 70-year-old male with a history of primary open angle glaucoma and dry eye disease underwent placement of glaucoma drainage devices with antimetabolite application in both eyes. Prior to placement, minimal refractive error was noted on manifest refraction. Several years later, the patient was referred for decreased vision and corneal irregularity. Examination showed pathologic corneal curvature, superior corneal thinning, and epithelial demarcation lines immediately anterior to the glaucoma drainage devices in both eyes. The epithelium remained intact with no evidence of limbal stem cell deficiency. Manifest refraction revealed a large change in both eyes. Topography was used to confirm the presence of irregular corneal curvature anterior to the glaucoma drainage devices. Dellen-like keratopathy with superior thinning is a rare sequela after implantation of a glaucoma drainage device that must be considered in elderly patients who undergo glaucoma surgery. It is likely related to a combination of tear film alteration related to previously large anterior blebs, antimetabolite application, and aqueous humor flow patterns around the drainage devices. Treatment should focus on lubrication.

Long-term Outcomes of Domestic Hunan Aqueous-Drainage Implantation in Refractory Glaucoma

Purpose:To evaluate the long-term outcomes of a non-valved,.Chinese-made Hunan aqueous drainage device(HAD) in patients with refractory glaucoma,.compared to trabeculectomy.Methods:This was a retrospective observational case series,including 27 patients with refractory glaucoma who either underwent HAD implantation (n=11) or trabeculectomy (n=16).The mean follow-up was 27.9±13.5 (mean±SD) months.Intraocular pressure(IOP),visual acuity and postoperative complications were measured.Results:IOP was significantly lower at the last follow-up in both two groups compared with the baseline IOP (HAD:58.4 to 19.0 mmHg,P<0.001;trabeculectomy:58.4 to 23.7 mmHg,P<0.001).One week,1 month and 1 year after the operation,the average IOP of the HAD group was significantly lower than that of trabeculectomy group(P<0.05 at all time points).However,the IOP did not differ significantly between the two groups at the time of last follow-up.Conclusion:HAD implantation serves as a good option to control IOP in refractory glaucoma.

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

AIM：To evaluate the efficacy and safety of intravitreal ranibizumab（IVR）with panretinal photocoagulation（PRP）followed by trabeculectomy compared with Ahmed glaucoma valve（AGV）implantation in neovascular glaucoma（NVG）.METHODS：This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included：diabetic retinopathy（25 eyes）,and retinal vein occlusion（20 eyes）.All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities（BCVA）were converted to the logarithms of the minimum angle of resolution（log MAR）for the statisitical analyses.Intraocular pressure（IOP）,the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS：A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery（F=545.468,P〈0.05）,and the mean postoperative log MAR BCVA was also significantly improved（F=10.964,P〈0.05）with no significant difference between two groups.CONCLUSION：It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR＋AGV implantation＋PRP and IVR＋trabeculectomy＋PRP in eyes with NVG.

Comparison of FP-7 and S-2 Ahmed glaucoma valve implantation in refractory glaucoma patients for short-term follow-up

Background Ahmed glaucoma valves （AGV） has been used for decades, but there is no detailed report about the efficacy of AGV in Chinese glaucoma patients. This study aimed to compare the intraocular pressure （IOP） lowering efficacy and side effects of S-2 polypropylene and PF-7 silicone AGV implantation in Chinese refractory glaucoma patients.Methods Patients were divided into S-2 model AGV group and FP-7 model AGV group. The complete and qualified surgical success rate, change of IOP, number of anti-glaucoma medications used and postoperative complications were recorded and analyzed.Results Average follow-up time was comparable between two groups. IOP was reduced from （37.9±12.7） mmHg preoperatively to （17.3±5.3） mmHg at the last follow-up in S-2 group and reduced from （39.9±14.4） mmHg to （17.7±4.9）mmHg in FP-7 group. Anti-glaucoma medications were reduced from 3.8±0.2 to 1.5±0.2 in S-2 group, and 3.5±0.2 to 0.7±0.2 in FP-7 groups. The cumulative success rates were comparable in two groups, which were 61.2% and 72.1% in S-2 group and FP-7 group respectively. When IOP reduction criteria was used, complete success rates were 30.6% and 51.2% for S-2 and FP-7 groups, and qualified success rates were 86.1% and 92.7% separately. In both groups, the major complication was hypotony, and the previous trabeculectomy of patients was the major risk factor for surgery failure.Conclusions In this short-term retrospective study, S-2 AGV is showed at least as effective as FP-7 AGV in IOP reduction, but associated with higher rate of complications. Previous trabeculectomy is a principle risk factor for AGV implantation failure. These clinical outcomes are important for converting use of the FP-7 silicon AGV in Chinese refractory glaucoma patients.

Hydrus microstent implantation for surgical management of glaucoma: a review of design, efficacy and safety

With the advent of microinvasive glaucoma surgery(MIGS),the spectrum of modalities available to manage patients with this chronic and heterogeneous condition has broadened.Despite its novelty however,there has been a rapid evolution in the development of a multitude of devices,each targeting a structure along the aqueous drainage pathway.A growing body of evidence has demonstrated IOP and medication burden reduction,and a more favorable safety profile with MIGS procedures in contrast to traditional incisional surgeries.Among the array of MIGS,the Hydrus®Microstent(Ivantis,Inc.,Irvine,CA)is a recent FDA approved device,designed to bypass the trabecular meshwork and provide a scaffold for Schlemm’s canal.The objective of this article is to review the Hydrus from conception to clinical use,and present data on its efficacy and safety to date.The available literature has shown promise,however inherent to all novel devices,only longterm monitoring will ensure sustained IOP control and an acceptable safety profile.Surgical advancements in glaucoma have revolutionized the field,and continued research and development will establish these approaches in clinical treatment algorithms.

Glaucoma drainage implants

Glaucoma drainage devices have traditionally been reserved for refractory glaucoma.However,there is an increasing body of evidence to suggest the use of these implants at an earlier stage in the surgical management of glaucoma.We describe the mechanics behind their function as well as the various implants available.The implants vary in size,surface area and composition and hence the surgical implantation of these devices are described in detail.The knowledge of such devices and their potential complications is fundamental for the successful management of patients who undergo aqueous-shunt surgery.Careful patient selection and optimal postoperative management is critical to the successful patient outcomes.

难治性青光眼伴白内障应用FLACS和CPCS分别联合引流阀植入术的疗效观察

目的探讨难治性青光眼伴白内障应用飞秒激光辅助白内障超声乳化(FLACS)和常规白内障超声乳化(CPCS)联合引流阀植入术的临床疗效。方法回顾性选取2020年1月至2023年4月在自贡市第四人民医院治疗的难治性青光眼伴白内障患者92例,根据最终选取的治疗方案分为FLACS组(n=40)和CPCS组(n=52)。比较两组术前、术后1 d、1周、1个月、3个月和6个月的眼压、最佳矫正视力(BCVA)、角膜内皮细胞密度、中央前房深度等差异,并比较两组术后6个月时手术效果和并发症情况。结果FLACS组和CPCS组术后1 d、1周、1个月、3个月和6个月眼压比较,差异均无统计学意义(P>0.05);FLACS组术后1 d和1周BCVA分别为(0.22±0.09)、(0.20±0.08)LogMAR,优于CPCS组[(0.45±0.10)、(0.38±0.10)LogMAR](P<0.05);FLACS组和CPCS组术后1个月、3个月和6个月BCVA比较,差异均无统计学意义(P>0.05)。FLACS组和CPCS组术后1 d、1周、1个月、3个月和6个月中央前房深度比较,差异均无统计学意义(P>0.05);FLACS组术后1 d、1周、1个月、3个月和6个月角膜内皮细胞密度分别为(2102.32±103.34)、(2088.34±101.21)、(2091.12±100.45)、(2101.43±104.45)和(2095.54±101.44)个/mm^(2),均高于CPCS组[(1720.23±100.20)、(1705.54±98.28)、(1743.34±102.23)、(1802.21±103.32)和(1810.23±102.22)个/mm^(2)],差异均有统计学意义(P<0.05)。FLACS组术后6个月的手术效果优于CPCS组,差异有统计学意义(P<0.05),其完全成功率达到77.50%。FLACS组术后总并发症发生率为15.00%,明显低于CPCS组(34.62%),差异有统计学意义(P<0.05)。结论相较于CPCS,FLACS联合引流阀植入术治疗难治性青光眼伴白内障有较好的临床疗效,值得临床使用。

HMGB1在类青光眼引流阀植入术后瘢痕化中的作用机制

目的:探究高迁移率族蛋白1(HMGB1)在类青光眼引流阀植入术后瘢痕组织中的动态表达,揭示HMGB1在青光眼术后瘢痕化中的作用及其可能的作用机制。方法:将60只新西兰大白兔随机分为空白对照组(n=20)、模型组(n=20,结膜囊下硅胶植入)、模型给药组(n=20,硅胶植入联合5-氟尿嘧啶注射)。分别于术后4、8 wk取球结膜组织,采用HE染色和Masson染色检测结膜组织中成纤维细胞和胶原纤维增生及分布情况;免疫组织化学染色检测结膜组织中HMGB1、转化生长因子(TGF)-β1、Smad3、α-平滑肌肌动蛋白(α-SMA)的分布及变化情况;RT-PCR和Western blot检测结膜组织中HMGB1、TGF-β1、Smad3、α-SMA mRNA及蛋白的表达。结果:HE染色和Masson染色结果显示,4、8 wk模型组较空白对照组结膜组织中炎症细胞、成纤维细胞及胶原纤维增生明显,而4、8 wk模型给药组结膜组织中成纤维细胞及胶原纤维增生相对于同时期模型组明显减少。免疫组织化学染色结果显示,4、8 wk模型组结膜组织中可见HMGB1、TGF-β1、Smad3、α-SMA蛋白表达,呈棕褐色染色,8 wk模型组染色更深,而4、8 wk模型给药组较同时期模型组阳性染色程度下降。4、8 wk模型组结膜组织中HE染色成纤维细胞数与免疫组织化学染色HMGB1的表达水平均呈正相关(r=0.602、0.703,均P<0.05)。RT-PCR和Western blot结果显示,4、8 wk模型组结膜组织中HMGB1、TGF-β1、Smad3、α-SMA mRNA及蛋白表达量显著高于空白对照组(均P<0.05),4、8 wk模型给药组结膜组织中HMGB1、TGF-β1、Smad3、α-SMA mRNA及蛋白表达量显著低于同时期模型组(均P<0.05)。模型组和模型给药组中HMGB1与TGF-β1、Smad3的mRNA表达水平具有正相关性(均P<0.05)。结论:类青光眼引流阀植入术后随时间延长HMGB1表达升高,HMGB1在青光眼术后具有致瘢痕形成的作用,并可能通过TGF-β/Smad信号通路参与瘢痕化的发生发展。

XEN引流管植入联合丝裂霉素C治疗开角型青光眼

目的:探讨XEN引流管植入联合丝裂霉素C(MMC)治疗开角型青光眼(OAG)的临床疗效和安全性。方法:回顾性纳入OAG患者37例37眼,按初始接受抗青光眼手术治疗与否分为初次青光眼手术组17例17眼,多次青光眼手术组20例20眼,记录各随访时间点眼压、降眼压药物种类及并发症,术后随访时间大于1 a。结果:术后1 a,初次与多次青光眼手术组眼压分别从术前27.56±9.94、28.43±14.18 mmHg降至15.16±3.65、17.18±5.83 mmHg,分别下降55.01%和60.43%(t=4.863,P<0.001;t=3.255,P=0.004)。术后不同时间点两组眼压均较术前降低,时间有差异(F_(时间)=6.876,P_(时间)<0.001),组间及交互均无差异(F_(组间)=0.242,P_(组间)=0.626;F_(时间×组间)=0.959,P_(时间×组间)=0.458)。两组手术完全成功率分别为47%、45%,条件成功率为76%、75%(Z=-0.115,P=0.909),完全成功与条件成功累积生存率分析均无差异(χ^(2)=0.042,P=0.838;χ^(2)=0.004,P=0.949)。术后1 a随访时两组降眼压药物均由术前的3(2,3)种减少为1(0,2)种(Z=-3.289、-3.796,均P<0.001),组间无差异(Z=-0.581,P=0.561)。术后短期并发症以低眼压为主,前房出血次之,远期并发症以滤过泡包裹为主,除外引流管暴露及脱落各1眼,无其他严重并发症发生。结论:XEN引流管植入联合MMC治疗初次与多次青光眼手术OAG患眼均安全有效,但多次青光眼手术组滤过泡包裹发生率高。

HA-Mg引流片兔眼前房植入对眼压控制的有效性和安全性

目的评估羟基磷灰石涂层镁基(HA-Mg)青光眼引流片植入兔眼后的安全性和有效性。方法使用配对比较法将12只SPF级3~4月龄新西兰白兔随机分为HA-Mg引流片植入组和小梁切除术组,每组6只,均取右眼进行相应操作;12只左眼均不行任何操作,作为正常对照组。术后1、3、5个月,采用裂隙灯显微镜及前置镜观察术后各组眼部情况;采用超声生物显微镜检查引流片于前房与结膜下间隙固定情况。术后5个月,采用角膜内皮细胞计数仪测量HA-Mg引流片植入组角膜内皮细胞数量;术前和术后每周采用Tonopen眼压计测量眼压,连续监测21周;采用锥虫蓝前房注入法验证房水引流通道通畅性;采用苏木精-伊红染色法评估HA-Mg引流片完全降解后房水引流通道与周围组织情况。结果术后实验兔均未出现全身及眼部异常或不良反应,6枚HA-Mg引流片均于术后约4个月完全降解,4枚引流片位置固定良好,2枚引流片出现少量旋转移位,无引流片落入前房;术后5个月,HA-Mg引流片植入组和正常对照组角膜内皮细胞数量分别为(2535.2±274.4)和(2521.0±175.8)个,差异无统计学意义(t=0.073,P=0.857)。手术前后不同时间点各组眼压总体比较,差异均有统计学意义(F组别=26.409,P<0.001;F时间=7.843,P<0.001),其中小梁切除术组和正常对照组术后不同时间点眼压均高于HA-Mg引流片植入组,HA-Mg引流片植入组术后不同时间点眼压均低于术前,差异均有统计学意义(均P<0.05)。引流通道通畅性实验发现,HA-Mg引流片植入术后5个月,蓝色染色剂仍可从前房引流到结膜下。术后6个月引流片已完全降解,巩膜层间可见线状房水引流通道及虹膜前粘连,各组织均未见明显炎性细胞浸润。结论HA-Mg引流片植入兔眼后可有效降低眼压,安全性较好。

XEN凝胶引流管植入术在青光眼治疗中的应用研究进展

XEN凝胶引流管植入术是一种新型微创青光眼手术(MIGS),通过一种新型交联材料制成的微型引流管构建房水流出的结膜下外引流新通路。引流管可应用内、外入路2种方法植入,二者各有优劣。目前,XEN凝胶引流管已在多种类型的青光眼及白内障超声乳化联合手术中证实了其长、短期良好的有效性及安全性,并与其他抗青光眼滤过性手术展开对比研究。术后滤过泡相关的并发症常见,针刺分离和开放性滤过泡修复常用于其术后干预。该术式是MIGS的典型代表,具有操作较简单、组织损伤小、手术时间短、降眼压效果良好、安全性好等优点,明显扩大了MIGS适应证的范围,在青光眼治疗中具有良好的临床应用前景。本文就XEN凝胶引流管的材料及其特性、手术操作技巧、适应证及禁忌证、临床应用、并发症等研究进展进行综述。

抑制Ahmed青光眼引流阀植入术后滤过区瘢痕化相关研究进展

Ahmed青光眼引流阀(AGV)植入术是治疗难治性青光眼的主要手段之一,其相对于常规滤过性手术具有更高的手术成功率。但AGV作为异物常会引起滤过区瘢痕组织增生,包裹引流盘,从而抑制房水外流,引起眼压重新升高,导致手术失败。尽管AGV植入术中和术后多次注射抗代谢药物可抑制术后滤过区瘢痕化,但术后多次结膜下注射不仅会引起患者的不适,而且会引起相应并发症,因此需要对AGV进行改进,避免反复注射药物,使药物在局部缓慢释放,同时减轻AGV的异物反应。最近,Ologen胶原蛋白、聚2-羟基甲基丙烯酸乙酯凝胶、聚乳酸-羟基乙酸共聚物和天然蛋白页岩等新型材料及技术的应用为抑制AGV植入术后滤过区瘢痕化提供了新的治疗方法选择。本文从AGV引流盘材料的发展、AGV联合新型材料药物缓释系统的构建、AGV引流盘结构的改进等方面对抑制滤过区瘢痕化的方法和研究进展进行综述。

青光眼滤过术中植入物的应用现状

滤过性手术是目前治疗青光眼的主要手术方式,滤过泡瘢痕化是导致手术失败的主要原因。术中及术后应用抗代谢药物如丝裂霉素C(MMC)和5-氟尿嘧啶能够提高手术成功率,但相关并发症难以避免。动物实验与临床应用证实植入物的应用能有效保持滤过道通畅,将植入物赋予缓释抗代谢或抗瘢痕化的能力将会增强青光眼滤过手术的效果。该研究将对各种植入物在青光眼滤过手术中的应用作一综述。

Combined pars plana vitrectomy and Baerveldt glaucoma implant placement for refractory glaucoma

AIMTo evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant (PPV-BGI) placement for refractory glaucoma.METHODSThe medical records of 92 eyes (89 patients) that underwent PPV-BGI were retrospectively reviewed, including 43 eyes with neovascular glaucoma (NVG) and 49 eyes with other types of glaucoma (non-NVG).RESULTSOutcome measures were visual acuity (VA), intraocular pressure (IOP), glaucoma medical therapy, complications, and success [VA&#x0003e;hand motions (HM), IOP&#x02265;6 mm Hg and &#x02264;21 mm Hg, no subsequent glaucoma surgery]. Cumulative success rates for the non-NVG group and NVG group were 79% and 40% at 1y, respectively (P=0.038). No difference in the rates of surgical success were found between pars plana and anterior chamber tube placement. Preoperative IOP (mean&#x000b1;SD) was 30.3&#x000b1;11.7 mm Hg in the Non-NVG group and 40.0&#x000b1;10.6 mm Hg in the NVG group, and IOP was reduced to 15&#x000b1;9.5 mm Hg in the non-NVG group and 15&#x000b1;10.5 mm Hg in the NVG at 1y. Number of glaucoma medications (mean&#x000b1;SD) decreased from 2.7&#x000b1;1.3 in the non-NVG group and 2.8&#x000b1;1.3 in the NVG group preoperatively to 0.76&#x000b1;1.18 in the non-NVG group and 0.51&#x000b1;1.00 in the NVG group at 1y. Improvement in VA of &#x02265;2 Snellen lines was observed in 25 (27%) eyes, although only 33% of non-NVG eyes and 2.3% of NVG eyes maintained VA better than 20/200 at 1y. Nonclearing vitreous hemorrhage was the most common postoperative complication occurring in 16 (17%) eyes, and postoperative suprachoroidal hemorrhages developed in 5 (5.4%) eyes.CONCLUSIONPPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities, especially in eyes with NVG. The location of tube placement does not influence surgical outcome and should be left to the discretion of the surgeon.

Glaucomatous optic neuropathy treatment options:the promise of novel therapeutics,techniques and tools to help preserve vision

Peripheral vision loss followed by ＂tunnel vision＂ and eventual irreversible blindness is the fate of patients afflicted by various forms of glaucoma including primary open-angle glaucoma（POAG） and normotensive glaucoma（NTG）.These complex and heterogeneous diseases are characterized by extensive death of retinal ganglion cells（RGCs） accompanied by retraction and severance of their axonal connections to the brain and thus damage to and thinning of the optic nerve.Since patients suffering from this glaucomatous optic neuropathy（GON） first notice visual impairment when they have lost 〉 40% of their RGCs,early diagnosis is the key to retard the progression of glaucoma.Elevated intraocular pressure（IOP）,low cerebrospinal and/or low intracranial fluid pressure,advancing age,and ethnicity are major risk factors associated with POAG.However,retinal vascular abnormalities and a high sensitivity of RGCs and optic nerve head components to neurotoxic,inflammatory,oxidative and mechanical insults also contribute to vision loss in POAG/GON.Current treatment modalities for POAG and NTG involve lowering IOP using topical ocular drugs,combination drug products,and surgical interventions.Two recently approved multi-pharmacophoric drugs（e.g.,rho kinase inhibitor,Netarsudil;a drug conjugate,Latanoprostene Bunod） and novel aqueous humor drainage devices（i Stent and Cy Pass） are also gaining acceptance for treating POAG/NTG.Neuroprotective and regenerative agents,coupled with electroceutical,mechanical support systems,stem cell transplantation and gene therapy are emerging therapeutics on the horizon to help combat GON.The latter techniques and approaches hope to rejuvenate RGCs and repair the optic nerve structures,thereby providing a gain of function of the visual system for the glaucoma patients.

Bio-modulation of scaring Glaucoma Filtration Surgery using a novel application of coated magnesium

Filtration surgery still plays a mainstream role of treatment for glaucoma.Postoperative scarring is the main cause of surgical failure.This study evaluated the biocompatibility and anti-proliferative properties of pure magnesium with three different coatings,which are hydroxyapatite(HA),dicalcium phosphate dihydrate(DCPD)and DCPD+stearic acid(SA),in a primary culture of human tenon's capsule fibroblasts(HTCFs)and in rabbit Glaucoma Filtration Surgery.Titanium and glass were used as controls in vitro,and trabeculectomy was used as control in vivo.The results show the number and shape of HTCFs seeded on different coatings showed less quantity and poor cell morphology.Each type of coated magnesium demonstrated significantly decreased metabolic activity of HTCFs.DCPD+SA showed higher cytotoxicity than the other coatings.Significant inhibition of proliferation was observed with the DCPD+SA coating.The expression ofα-SMA was decreased in the cells when seeded on all of the coated magnesium disks.In vivo,no obvious adverse effects were observed after operation.No significant difference existed for any of the different samples regarding different ion concentrations in the aqueous humor.The inflammatory response in the titanium,DCPD and DCPD+SA treated eyes was more intense than in the trabeculectomy alone and HA groups.Western Blot analysis showed that collagen-1 andα-SMA expression was significantly lower in the titanium,HA,DCPD and DCPD+SA groups compared with the control.Different coatings on magnesium were able to affect the corrosive properties,which in turn,influenced the morphology and function of HTCFs.HA coated magnesium may be considered a very promising biodegradable material for the next generation of glaucoma drainage devices.