AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had ...AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had been diagnosed with glaucoma and received antiglaucoma surgery between January 1,2015 and December 31,2021 was conducted.The glaucoma diagnosis in this study included primary open angle glaucoma,primary angleclosure glaucoma,secondary glaucoma,and paediatric glaucoma.The types of surgeries were categorised as internal filtration,external filtration,and cyclodestruction surgery based on the pathway of aqueous humor outflow.The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed.RESULTS:The number of patients hospitalised for glaucoma surgery increased yearly,from 752 in 2015 to 1373 in 2021,at the Eye Hospital of Wenzhou Medical University.Regarding the patients diagnosed with primary open angle glaucoma,internal filtration surgery increased from 27.40%of the sample to 54.40%of the sample,while external filtration surgery decreased from 71.50%to 44.20%between 2015 and 2021.For paediatric glaucoma,internal filtration surgery increased from 37.50%in 2015 to 88.20%in 2021.Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma,the proportion of internal filtration surgery also showed an increase from 18.20%in 2015 to 40.90%in 2021.Meanwhile,internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00%in 2015,and showed a small increase by 2021.CONCLUSION:As surgical technology and surgical experience continue to elevate and improve,the range of glaucoma surgeries are correspondingly evolving.This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.展开更多
AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil(5-FU) for open angle glaucoma(OAG) patients after filtration surgery. METHODS: As a prospective randomized interv...AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil(5-FU) for open angle glaucoma(OAG) patients after filtration surgery. METHODS: As a prospective randomized interventional trial, 36 eyes from 36 patients after OAG surgery were collected and divided randomly into conbercept and 5-FU groups. All patients were subconjunctivally injected with either conbercept(0.2 mL) or 5-FU(0.2 mL) on the 5th day post-operatively. The intraocular pressure(IOP), number of medications used, type of conjunctival bleb, and complications were recorded and analyzed pre-operatively and 1d, 1wk, 1, 3 and 6mo post-injection. RESULTS: There were significant differences in IOP between the conbercept and 5-FU groups 1mo(conbercept group: 12.17±1.04 mm Hg; 5-FU group: 13.50±2.33 mm Hg, t=2.214, P=0.037), 3mo(conbercept group: 13.00±1.88 mm Hg; 5-FU group: 14.50±2.28 mm Hg, t=2.153, P=0.039), and 6mo post-injection(conbercept group: 13.28±2.95 mm Hg; 5-FU group: 15.22±2.49 mm Hg, t=2.140, P=0.040); however, in the number of medications, a prominent difference was not shown between groups on post-injection 6mo(t=1.312, P=0.200). Moreover, there was mild vascularity observed in the conbecept group than the 5-FU group 1d(3a, 3b, 3c: t=8.497, 6.693, 4.515, P=0.000), 1wk(3a, 3b, 3c: t=3.431, 6.408, 3.984, P=0.002, 0.000, 0.000), and 1mo post-injection(3a, 3b, 3c: t=2.466, 2.466, 2.503, P=0.019, 0.019, 0.017). Simultaneously, differences from other indicators between the two groups were not demonstrated. Also, there was a lower probability of corneal epithelial stripping in the conbercept group than the 5-FU group(χ2=4.500, P=0.034). CONCLUSION: Subconjunctival injection of conbercept has a safe, effective, and tolerable profile for open angle glaucoma patients with distinct conjunctival congestion after filtration surgery.展开更多
AIM： To investigate the incidence rate and risk factors for grade Ⅲ flat anterior chamber（FAC） after glaucoma filtration surgery based on 5-year data.METHODS： Patients who underwent glaucoma filtration surgery in...AIM： To investigate the incidence rate and risk factors for grade Ⅲ flat anterior chamber（FAC） after glaucoma filtration surgery based on 5-year data.METHODS： Patients who underwent glaucoma filtration surgery in Daping hospital from January 2009 to December 2013 were enrolled in this retrospective study. The incidence of grade Ⅲ FAC following glaucoma filtration surgery was determined. Regression analysis was performed to investigate the influence of glaucoma type, surgical approach, age, and preoperative intraocular pressure（IOP） on the risk of postoperative FAC.RESULTS： A total of 2179 eyes receiving anti-glaucoma surgery were included. Ninety-one eyes suffered from postoperative FAC, with an overall incidence rate of 4.18%. Of 471 eyes with primary open angle glaucoma（POAG）, grade Ⅲ FAC occurred in only 3 eyes（0.64%）. Primary angleclosure glaucoma（PACG） was diagnosed in 1076 eyes, 39（3.62%） of which developed grade Ⅲ FAC, including 12 eyes（12/300, 4%） with acute PACG（aP ACG） and 27 eyes（27/776, 3.48%） with chronic PACG（c PACG）. Six of 259 eyes（2.32%） with secondary glaucoma, 28 of 186 eyes（15.05%） with neovasular glaucoma, 1 of 66 eyes（1.52%） with congenital glaucoma, and 14 of 115 eyes（12.17%） with remnant glaucoma suffered from grade Ⅲ FAC. Of 6 eyes with mixed glaucoma, none developed grade Ⅲ FAC after surgery. When stratified by surgical approach, 24 of 766 eyes（3.13%） undergoing trabeculectomy, 21 of 924 eyes（2.27%） treated by trabeculectomy plus mitomycin C（MMC）, 18 of 109 eyes（16.51%） undergoing Ahmed glaucoma valve implantation, 23 of 201 eyes（11.44%） managed by Ahmed implantation plus MMC, and 5 of 133 eyes（3.76%） treated by Ahmed implantation plus lens extraction or vitrectomy developed grade Ⅲ FAC. Logistic regression analysis revealed that factors including neovasular glaucoma, remnant glaucoma, glaucoma valve implantation, glaucoma valve implantation＋MMC, glaucoma valve implantation＋vitrectomy, age〉60 y, and IOP at admission 〉50 mm Hg were significantly associated with an increased risk for grade Ⅲ FAC.CONCLUSION： The overall incidence of grade Ⅲ FAC after glaucoma filtration surgery is 4.18%. Patients with neovasular glaucoma and remnant glaucoma are at a higher risk of developing FAC. Ahmed glaucoma valve implantation is associated with a higher risk for grade Ⅲ FAC compared with trabeculectomy. No significant correlation was observed between the use of MMC in glaucoma filtration surgery and the risk of postoperative FAC. Higher IOP at admission（〉50 mm Hg） and old age（〉60 y） are risk factors for grade Ⅲ FAC.展开更多
Purpose: To investigate postoperative inhibition of cell proliferation in animals treated with exogenous p27Kip1 during an experimental glaucoma filtration surgery (GFS) by histological and ultrastructural examination...Purpose: To investigate postoperative inhibition of cell proliferation in animals treated with exogenous p27Kip1 during an experimental glaucoma filtration surgery (GFS) by histological and ultrastructural examinations. Methods:The primer was designed according to p27Kip1 gene sequence of GenBank..The p27Kip1-expressing adenovirus-mediated Ad-p27 was constructed according to standard techniques..Gene therapy was performed by subconjunctival delivery of Ad-p27,mitomycin C(MMC) and PBS served as controls..Histological and ultastructural changes at surgical sites were observed for 28 days postoperatively. Results: Histologically, evident cellular proliferation induced by Ad-p27 was observed on day 7,.with appreciable filtering cavity. However, thin conjunctival layers were noted, and the number of fibroblasts decreased in the Tenon's capsule on day 14. On day 28, the filtering cavity partially disappeared. The histological features of the animals with MMC delivery were similar to those treated by Ad-p27..In contrast,.in the PBS treatment group, thick conjunctival layers were observed, and the number of goblet cells and fibroblasts, increased markedly..The filtering cavity disappeared at postoperative day 21. Twenty eight day postoperatively,.ultrastructural findings showed that most conjunctival epithelial cells in the Ad-p27 treatment group were under static state,.and that organelles were inactive. The number of goblet cells,.and the secretion of mucin,.were decreased..The amount of fibroblasts also decreased with partial apoptotic cells. The ultrastructural features presented by rabbits with the MMC delivery resembled those treated with Ad-p27. In the PBS treatment group, the number of conjunctival epithelial cells increased; the amount of goblet cells increased as the secretion of mucin was strengthened, and a substantial amount of fibroblasts were observed with active and productive organelles. Conclusion: Ad-p27 inhibits the proliferation of Tenon's capsule fibroblasts at surgical sites, and suppresses the formation of scars, thereby promoting surgical efficacy.展开更多
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.Sli...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.展开更多
Purpose: To observe the inhibitory action of homoharringtonine liposome during the healing process of wounds in the filtering sitesMethods: posterior sclerectomies were performed in 14 rabbits. Postoperatively one eye...Purpose: To observe the inhibitory action of homoharringtonine liposome during the healing process of wounds in the filtering sitesMethods: posterior sclerectomies were performed in 14 rabbits. Postoperatively one eye of each rabbit received subconjunctival injections of HH liposome and fellow eye received saline injection in a randomized masked fashion.Results; Fourteen days after operation the IOP of experimental eyes reduced significantly (P < 0.01) as compared with the controlled eyes, and the number of remaining filtering blebs increased noticeably (P< 0.05). Pathohistological examination revealed that the number of fibroblasts per square micron in the filtering sites and the thickness of the scars in the center of the filtering sites of the experimental eyes were less than those of the controlled eyes. No serious ocular toxic and side effects were found.Conclusion : This experiment suggests that homoharringtonine liposome can markedly inhibit the scar formation of filtering sites after glaucoma展开更多
Scarring is one of the biggest areas of unmet need in the long-term success of glaucoma filtration surgery.Quantitative evaluation of the scar tissue and the post-operative structure with micron scale resolution facil...Scarring is one of the biggest areas of unmet need in the long-term success of glaucoma filtration surgery.Quantitative evaluation of the scar tissue and the post-operative structure with micron scale resolution facilitates development of anti-fibrosis techniques.However,the distinguishment of conjunctiva,sclera and the scar tissue in the surgical area still relies on pathologists'experience.Since polarized light imaging is sensitive to anisotropic properties of the media,it is ideal for discrimination of scar in the subconjunctival and episcleral area by characterizing small differences between proportion,organization and the orientation of the fibers.In this paper,we defined the conjunctiva,sclera,and the scar tissue as three target tissues after glaucoma filtration surgery and obtained their polarization characteristics from the tissue sections by a Mueller matrix microscope.Discrimination score based on parameters derived from Mueller matrix and machine learning was calculated and tested as a diagnostic index.As a result,the discrimination score of three target tissues showed significant difference between each other(p<0.001).The visualization of the discrimination results showed significant contrast between target tissues.This study proved that Mueller matrix imaging is effective in ocular scar discrimination and paves the way for its application on other forms of ocular fibrosis as a substitute or supplementary for clinical practice.展开更多
Background Glaucoma filtering surgery （GFS） is the most common procedure performed in the treatment of glaucoma.Although antiscarring agents help prevent postsurgical scarring and improve glaucoma surgical outcomes,...Background Glaucoma filtering surgery （GFS） is the most common procedure performed in the treatment of glaucoma.Although antiscarring agents help prevent postsurgical scarring and improve glaucoma surgical outcomes,they may be associated with an increased incidence of severe and potentially blinding complications.Poly（DL-lactide-co-glycolide） （PDLLA/GA） is a bioresorbable polymer,which can be prepared with a large range of physical,mechanical,and biological properties and has been widely used in medicine,including as an absorbable suture and a drug carrier and especially as a scaffold in tissue engineering.This study aimed to evaluate the effect of PDLLA/GA on scar formation after glaucoma filtration surgery （GFS）.Methods Forty-eight New Zealand white rabbits were divided into two groups randomly and GFS was performed on the right eye of each.PDLLA/GA membranes were put under the sclera flap for evaluation.GFS with no membrane inserted served as control.Clinical evaluations of intraocular pressure （lOP） and the presence of a filtration bleb were performed at intervals （3 days,1,2,4,8,12,20,and 24 weeks） postoperatively.At each time point,three eyes per group were excised to observe histological changes such as inflammation and scar formation and the expression of collagen type Ⅳ,proliferating cell nuclear antigen （PCNA）,matrix metalloproteinase-9 （MMP-9）,and tissue inhibitor of metalloproteinase-1 （TIMP-1）.The expression of connective tissue growth factor （CTGF） mRNA was determined by reverse transcription-polymerase chain reaction.Results The lower lOP level and an effective bleb were maintained for a long time after GFS in the PDLLA/GA group.The histological analysis showed less inflammation and scar formation,weaker expression of collagen type Ⅳ and PCNA,more intense MMP-9 and TIMP-1,slightly elevated ratio of MMP-9 and TIMP-1,and a smaller increase in CTGF mRNA postoperatively in the PDLLA/GA group but less than the control group （P ＜0.05）.Conclusion PDLLA/GA membranes may be promising for preventing fibrosis after GFS.展开更多
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 filtratio...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.展开更多
基金Supported by the National Key Research and Development Project of China(No.2020YFC2008200)the Program for Zhejiang Leading Talent of S&T Innovation(No.2021R52012)+1 种基金Key Research and Development Projects of Zhejiang Province(No.2022C03112)the Zhejiang Provincial Program for the Cultivation of Leading Talents in Colleges and Universities(No.2020099)。
文摘AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had been diagnosed with glaucoma and received antiglaucoma surgery between January 1,2015 and December 31,2021 was conducted.The glaucoma diagnosis in this study included primary open angle glaucoma,primary angleclosure glaucoma,secondary glaucoma,and paediatric glaucoma.The types of surgeries were categorised as internal filtration,external filtration,and cyclodestruction surgery based on the pathway of aqueous humor outflow.The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed.RESULTS:The number of patients hospitalised for glaucoma surgery increased yearly,from 752 in 2015 to 1373 in 2021,at the Eye Hospital of Wenzhou Medical University.Regarding the patients diagnosed with primary open angle glaucoma,internal filtration surgery increased from 27.40%of the sample to 54.40%of the sample,while external filtration surgery decreased from 71.50%to 44.20%between 2015 and 2021.For paediatric glaucoma,internal filtration surgery increased from 37.50%in 2015 to 88.20%in 2021.Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma,the proportion of internal filtration surgery also showed an increase from 18.20%in 2015 to 40.90%in 2021.Meanwhile,internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00%in 2015,and showed a small increase by 2021.CONCLUSION:As surgical technology and surgical experience continue to elevate and improve,the range of glaucoma surgeries are correspondingly evolving.This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.
文摘AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil(5-FU) for open angle glaucoma(OAG) patients after filtration surgery. METHODS: As a prospective randomized interventional trial, 36 eyes from 36 patients after OAG surgery were collected and divided randomly into conbercept and 5-FU groups. All patients were subconjunctivally injected with either conbercept(0.2 mL) or 5-FU(0.2 mL) on the 5th day post-operatively. The intraocular pressure(IOP), number of medications used, type of conjunctival bleb, and complications were recorded and analyzed pre-operatively and 1d, 1wk, 1, 3 and 6mo post-injection. RESULTS: There were significant differences in IOP between the conbercept and 5-FU groups 1mo(conbercept group: 12.17±1.04 mm Hg; 5-FU group: 13.50±2.33 mm Hg, t=2.214, P=0.037), 3mo(conbercept group: 13.00±1.88 mm Hg; 5-FU group: 14.50±2.28 mm Hg, t=2.153, P=0.039), and 6mo post-injection(conbercept group: 13.28±2.95 mm Hg; 5-FU group: 15.22±2.49 mm Hg, t=2.140, P=0.040); however, in the number of medications, a prominent difference was not shown between groups on post-injection 6mo(t=1.312, P=0.200). Moreover, there was mild vascularity observed in the conbecept group than the 5-FU group 1d(3a, 3b, 3c: t=8.497, 6.693, 4.515, P=0.000), 1wk(3a, 3b, 3c: t=3.431, 6.408, 3.984, P=0.002, 0.000, 0.000), and 1mo post-injection(3a, 3b, 3c: t=2.466, 2.466, 2.503, P=0.019, 0.019, 0.017). Simultaneously, differences from other indicators between the two groups were not demonstrated. Also, there was a lower probability of corneal epithelial stripping in the conbercept group than the 5-FU group(χ2=4.500, P=0.034). CONCLUSION: Subconjunctival injection of conbercept has a safe, effective, and tolerable profile for open angle glaucoma patients with distinct conjunctival congestion after filtration surgery.
文摘AIM： To investigate the incidence rate and risk factors for grade Ⅲ flat anterior chamber（FAC） after glaucoma filtration surgery based on 5-year data.METHODS： Patients who underwent glaucoma filtration surgery in Daping hospital from January 2009 to December 2013 were enrolled in this retrospective study. The incidence of grade Ⅲ FAC following glaucoma filtration surgery was determined. Regression analysis was performed to investigate the influence of glaucoma type, surgical approach, age, and preoperative intraocular pressure（IOP） on the risk of postoperative FAC.RESULTS： A total of 2179 eyes receiving anti-glaucoma surgery were included. Ninety-one eyes suffered from postoperative FAC, with an overall incidence rate of 4.18%. Of 471 eyes with primary open angle glaucoma（POAG）, grade Ⅲ FAC occurred in only 3 eyes（0.64%）. Primary angleclosure glaucoma（PACG） was diagnosed in 1076 eyes, 39（3.62%） of which developed grade Ⅲ FAC, including 12 eyes（12/300, 4%） with acute PACG（aP ACG） and 27 eyes（27/776, 3.48%） with chronic PACG（c PACG）. Six of 259 eyes（2.32%） with secondary glaucoma, 28 of 186 eyes（15.05%） with neovasular glaucoma, 1 of 66 eyes（1.52%） with congenital glaucoma, and 14 of 115 eyes（12.17%） with remnant glaucoma suffered from grade Ⅲ FAC. Of 6 eyes with mixed glaucoma, none developed grade Ⅲ FAC after surgery. When stratified by surgical approach, 24 of 766 eyes（3.13%） undergoing trabeculectomy, 21 of 924 eyes（2.27%） treated by trabeculectomy plus mitomycin C（MMC）, 18 of 109 eyes（16.51%） undergoing Ahmed glaucoma valve implantation, 23 of 201 eyes（11.44%） managed by Ahmed implantation plus MMC, and 5 of 133 eyes（3.76%） treated by Ahmed implantation plus lens extraction or vitrectomy developed grade Ⅲ FAC. Logistic regression analysis revealed that factors including neovasular glaucoma, remnant glaucoma, glaucoma valve implantation, glaucoma valve implantation＋MMC, glaucoma valve implantation＋vitrectomy, age〉60 y, and IOP at admission 〉50 mm Hg were significantly associated with an increased risk for grade Ⅲ FAC.CONCLUSION： The overall incidence of grade Ⅲ FAC after glaucoma filtration surgery is 4.18%. Patients with neovasular glaucoma and remnant glaucoma are at a higher risk of developing FAC. Ahmed glaucoma valve implantation is associated with a higher risk for grade Ⅲ FAC compared with trabeculectomy. No significant correlation was observed between the use of MMC in glaucoma filtration surgery and the risk of postoperative FAC. Higher IOP at admission（〉50 mm Hg） and old age（〉60 y） are risk factors for grade Ⅲ FAC.
基金Supported by the Key Science and Technology Program of Shaanxi Province(Grant No.2009K17-02)Scientific Research Foundation of the Education Department of Shaanxi Province.(Grant No.11JK0705)
文摘Purpose: To investigate postoperative inhibition of cell proliferation in animals treated with exogenous p27Kip1 during an experimental glaucoma filtration surgery (GFS) by histological and ultrastructural examinations. Methods:The primer was designed according to p27Kip1 gene sequence of GenBank..The p27Kip1-expressing adenovirus-mediated Ad-p27 was constructed according to standard techniques..Gene therapy was performed by subconjunctival delivery of Ad-p27,mitomycin C(MMC) and PBS served as controls..Histological and ultastructural changes at surgical sites were observed for 28 days postoperatively. Results: Histologically, evident cellular proliferation induced by Ad-p27 was observed on day 7,.with appreciable filtering cavity. However, thin conjunctival layers were noted, and the number of fibroblasts decreased in the Tenon's capsule on day 14. On day 28, the filtering cavity partially disappeared. The histological features of the animals with MMC delivery were similar to those treated by Ad-p27..In contrast,.in the PBS treatment group, thick conjunctival layers were observed, and the number of goblet cells and fibroblasts, increased markedly..The filtering cavity disappeared at postoperative day 21. Twenty eight day postoperatively,.ultrastructural findings showed that most conjunctival epithelial cells in the Ad-p27 treatment group were under static state,.and that organelles were inactive. The number of goblet cells,.and the secretion of mucin,.were decreased..The amount of fibroblasts also decreased with partial apoptotic cells. The ultrastructural features presented by rabbits with the MMC delivery resembled those treated with Ad-p27. In the PBS treatment group, the number of conjunctival epithelial cells increased; the amount of goblet cells increased as the secretion of mucin was strengthened, and a substantial amount of fibroblasts were observed with active and productive organelles. Conclusion: Ad-p27 inhibits the proliferation of Tenon's capsule fibroblasts at surgical sites, and suppresses the formation of scars, thereby promoting surgical efficacy.
基金supported by the Natural Science Foundation of Guangdong Province in China(grant No.2015A030313052)
文摘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.
基金Supported by grants from the National Health Ministry(0557309)
文摘Purpose: To observe the inhibitory action of homoharringtonine liposome during the healing process of wounds in the filtering sitesMethods: posterior sclerectomies were performed in 14 rabbits. Postoperatively one eye of each rabbit received subconjunctival injections of HH liposome and fellow eye received saline injection in a randomized masked fashion.Results; Fourteen days after operation the IOP of experimental eyes reduced significantly (P < 0.01) as compared with the controlled eyes, and the number of remaining filtering blebs increased noticeably (P< 0.05). Pathohistological examination revealed that the number of fibroblasts per square micron in the filtering sites and the thickness of the scars in the center of the filtering sites of the experimental eyes were less than those of the controlled eyes. No serious ocular toxic and side effects were found.Conclusion : This experiment suggests that homoharringtonine liposome can markedly inhibit the scar formation of filtering sites after glaucoma
基金supported by the Natural Science Foundation of Beijing(No.7194266)Beijing Municipal Administration of Hospitals'Youth Program(No.QML20191206)+1 种基金Fundamental Research Funds for the Central Public Welfare Research Institutes(No.XTCX2021002)Scientific and technological innovation project of China Academy of Chinese Medical Sciences(No.CI2021A00601).
文摘Scarring is one of the biggest areas of unmet need in the long-term success of glaucoma filtration surgery.Quantitative evaluation of the scar tissue and the post-operative structure with micron scale resolution facilitates development of anti-fibrosis techniques.However,the distinguishment of conjunctiva,sclera and the scar tissue in the surgical area still relies on pathologists'experience.Since polarized light imaging is sensitive to anisotropic properties of the media,it is ideal for discrimination of scar in the subconjunctival and episcleral area by characterizing small differences between proportion,organization and the orientation of the fibers.In this paper,we defined the conjunctiva,sclera,and the scar tissue as three target tissues after glaucoma filtration surgery and obtained their polarization characteristics from the tissue sections by a Mueller matrix microscope.Discrimination score based on parameters derived from Mueller matrix and machine learning was calculated and tested as a diagnostic index.As a result,the discrimination score of three target tissues showed significant difference between each other(p<0.001).The visualization of the discrimination results showed significant contrast between target tissues.This study proved that Mueller matrix imaging is effective in ocular scar discrimination and paves the way for its application on other forms of ocular fibrosis as a substitute or supplementary for clinical practice.
文摘Background Glaucoma filtering surgery （GFS） is the most common procedure performed in the treatment of glaucoma.Although antiscarring agents help prevent postsurgical scarring and improve glaucoma surgical outcomes,they may be associated with an increased incidence of severe and potentially blinding complications.Poly（DL-lactide-co-glycolide） （PDLLA/GA） is a bioresorbable polymer,which can be prepared with a large range of physical,mechanical,and biological properties and has been widely used in medicine,including as an absorbable suture and a drug carrier and especially as a scaffold in tissue engineering.This study aimed to evaluate the effect of PDLLA/GA on scar formation after glaucoma filtration surgery （GFS）.Methods Forty-eight New Zealand white rabbits were divided into two groups randomly and GFS was performed on the right eye of each.PDLLA/GA membranes were put under the sclera flap for evaluation.GFS with no membrane inserted served as control.Clinical evaluations of intraocular pressure （lOP） and the presence of a filtration bleb were performed at intervals （3 days,1,2,4,8,12,20,and 24 weeks） postoperatively.At each time point,three eyes per group were excised to observe histological changes such as inflammation and scar formation and the expression of collagen type Ⅳ,proliferating cell nuclear antigen （PCNA）,matrix metalloproteinase-9 （MMP-9）,and tissue inhibitor of metalloproteinase-1 （TIMP-1）.The expression of connective tissue growth factor （CTGF） mRNA was determined by reverse transcription-polymerase chain reaction.Results The lower lOP level and an effective bleb were maintained for a long time after GFS in the PDLLA/GA group.The histological analysis showed less inflammation and scar formation,weaker expression of collagen type Ⅳ and PCNA,more intense MMP-9 and TIMP-1,slightly elevated ratio of MMP-9 and TIMP-1,and a smaller increase in CTGF mRNA postoperatively in the PDLLA/GA group but less than the control group （P ＜0.05）.Conclusion PDLLA/GA membranes may be promising for preventing fibrosis after GFS.
基金Supported by the National Natural Science Foundation of China(No.81500719)Shaanxi Science and Technology Project(No.2022SF-434)Xi’an Science and Technology Project(No.21YXYJ0044).
文摘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.
