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Singh A, Singh K, Singh A. Bleb resuscitation of failing, leaking and dysfunctional blebs: A review. Indian J Ophthalmol 2025; 73:S197-S206. [PMID: 39982080 PMCID: PMC12013292 DOI: 10.4103/ijo.ijo_1233_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 11/09/2024] [Accepted: 12/18/2024] [Indexed: 02/22/2025] Open
Abstract
The success of trabeculectomy surgery depends on the longevity of the filtering bleb. Bleb failure can be categorized into two types: the scarred bleb with high intraocular pressure or the over-filtering and leaking bleb with low intraocular pressure. Bleb scarring is an insidious process over time as a consequence of excessive subconjunctival fibrosis. Timely recognition and early intervention utilizing a stepped-up approach are important for resuscitating the bleb and salvaging the trabeculectomy. Over-filtration and leaky bleb on the other end of the spectrum lead to failure of optimal bleb function and require a different management approach. This review discusses in detail various surgical techniques to revive dysfunctional blebs with a special focus on bleb needling. Timely identification and multifaceted management of bleb-related complications is the key to ultimately improving long-term success rates and patient outcomes.
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Affiliation(s)
- Arshi Singh
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Kirti Singh
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Aastha Singh
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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2
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Sharma R, Nappi V, Empeslidis T. The developments in amniotic membrane transplantation in glaucoma and vitreoretinal procedures. Int Ophthalmol 2023; 43:1771-1783. [PMID: 36715957 PMCID: PMC10149474 DOI: 10.1007/s10792-022-02570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/12/2022] [Indexed: 01/31/2023]
Abstract
The main reasons why Amniotic Membrane (AM) is transplanted in Ophthalmology are: to provide a substrate for cellular growth and to provide tectonic support or as a biological bandage and barrier that protects the wound to facilitate an environment for wound healing. The application of AM is well-documented in corneal disorders of various aetiologies [1], however, research within the field has highlighted how it can be used in conjunctival disorders and most recently, in glaucoma and vitreoretinal procedures. This review explores the preservation modalities of AM and summarises the current literature regarding AM transplantation in Glaucoma and Vitreoretinal conditions. AM transplantation in conjunction with trabeculectomy was reported to be used in two different surgical techniques. They differ in relation to the position of the implant: below the scleral flap or over the entire exposed sclera. The results of these studies suggest that AM transplant is a safe procedure that helps in the improvement of the intraocular pressure when associated with trabeculectomies. Moreover, it enhances trabeculectomies success rates when used along with mitomycin C [2]. The use of AM is also described for managing leaking blebs. It is mentioned to be a suitable alternative to conjunctival advancement. Regarding AM transplantation in glaucoma shunt or valve surgeries, the current literature is relatively limited. However, AM has been described as a good tectonic support for shunt procedures [3]. Successful results are described in the literature for surgical treatments using AM plug for vitreoretinal procedures. In particular macular hole closure and rhegmatogenous retinal detachment. In conclusion, AM transplant is a very promising and versatile adjutant therapy. However, further studies are also required for a better understanding and refinement of surgical techniques.
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Affiliation(s)
- Rohit Sharma
- Eye Department, University Hospitals Derby & Burton NHS trust, Burton, UK. .,School of Medicine, University of Nottingham, Nottingham, UK.
| | - Vivian Nappi
- Ophthalmology Department, Nottingham University Hospital NHS Trust, Nottingham, UK
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3
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Abstract
PURPOSE The purpose of this work was to report a new method for the repair of ischemic bleb leaks. Bleb leakage is a serious complication of glaucoma filtering surgery with mitomycin C. Many surgical methods have been proposed to seal the leakage from a bleb; however, this novel plication method is effective, relatively easy to perform, and safe. METHODS We describe the case reports of 2 patients with leakage from a bleb who were treated with the new method. The conjunctiva was lifted away from the sclera as extensively as possible around the ischemic conjunctiva toward the fornix using a bleb knife. Thereafter, 10-0 nylon sutures were applied between the nonischemic conjunctiva located just outside the ischemic conjunctiva and the corneal limbus. The ischemic conjunctiva was not removed, but covered with the nonischemic conjunctiva that was advanced toward the corneal limbus by these sutures. RESULTS After treatment, no recurrence of bleb leakage was observed. Moreover, no ischemic changes were observed in the advanced nonischemic conjunctiva or plicated conjunctiva. CONCLUSION This new method of bleb plication was effective for sealing bleb leakage.
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Sugimoto K, Murata H, Yamashita T, Asaoka R. Bleb plication: a minimally invasive repair method for a leaking ischemic bleb after trabeculectomy. Sci Rep 2020; 10:14978. [PMID: 32917919 PMCID: PMC7486366 DOI: 10.1038/s41598-020-72056-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/21/2020] [Indexed: 11/09/2022] Open
Abstract
Bleb leakage is a serious complication of glaucoma filtering surgery. This study describes the method and the results of a new repair method for ischemic bleb leaks. The subjects were consecutive eleven eyes of 11 patients with bleb leakage who underwent the bleb plication surgery. The bleb plication surgery consisted of two steps: 1) bleb needle redirection to float the conjunctiva away from the sclera as extensively as possible around the ischemic conjunctiva; and 2) multiple “O-shaped” sutures were applied between the non-ischemic conjunctiva just outside the ischemic conjunctiva and corneal limbus. The ischemic conjunctiva was not removed, but undermined beneath the advanced non-ischemic conjunctiva. This bleb plication method was repeated until the leakage was sealed. All patients were followed up for at least 6 months after final bleb plication. After final bleb plication, no recurrence of bleb leakage was observed. Moreover, ischemic changes were no longer observed in the advanced non-ischemic conjunctiva. Pre-operative and final intraocular pressure was 3.2 ± 4.1 and 11.9 ± 2.8 mmHg, respectively. This new repair method of bleb plication was safe and effective in sealing the leakage. The conjunctiva is not excised, and hence it does not run out.
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Affiliation(s)
- Koichiro Sugimoto
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan. .,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan. .,Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
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Walkden A. Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective. Clin Ophthalmol 2020; 14:2057-2072. [PMID: 32801614 PMCID: PMC7383023 DOI: 10.2147/opth.s208008] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/22/2020] [Indexed: 01/23/2023] Open
Abstract
Aim The aim of this paper is to provide a succinct literature review of the different clinical applications for AMT usage in an ophthalmic setting, ranging from commonly used applications to less mainstream approaches. The hope is that this review enables the reader to have a better understanding of the biological properties of amnion as well as the indications and scenarios in which AMT can be used, whilst presenting relevant evidence from within the literature which may be of interest. We also provide an update on the methods of preservation of amniotic membrane and the application methodologies. Methods Literature search. A PubMed search was performed using the search terms “amniotic membrane transplant”, “amnion AND cornea”, amnion AND ophthalmology”, “amnion AND ocular surface” and “Amnion AND eye”. A full review of the literature using the PubMed database was conducted up until 01/05/20. The articles used were written in English, with all articles accessed in full. Both review articles and original articles were used for this review. All full publications related to ophthalmology were considered.
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Affiliation(s)
- Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK.,University of Manchester Faculty of Medical and Human Sciences, Manchester, Greater Manchester, UK
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Mercieca KJ, Fenerty CH, Steeples LR, Drury B, Bhargava A. Precipitants of 5-Fluorouracil in Trabeculectomy Bleb Management: A Comparative Laboratory Study. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Aquino MC, Lim D, Chew PTK. Micropulse P3™ (MP3) Laser for Glaucoma: An Innovative Therapy. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Shah S, Rana M, Pandey P, Masood I. Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet\'s Stripping Automated Endothelial Keratoplasty. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Elbably A, Othman TM, Mousa A, Elridy M, Badawy W, Elbably M. Deep Sclerectomy with Porous Collagen in Open-angle Glaucoma, Short-term Study. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Albis-Donado O, Bhartiya S, Gil-Reyes M, Casale-Vargas G, Arreguin-Rebollar N, Kahook MY. Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude. J Curr Glaucoma Pract 2018; 12:40-44. [PMID: 29861581 PMCID: PMC5981092 DOI: 10.5005/jp-journals-10028-1242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/09/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction To ascertain differences in intraocular pressure (IOP) measurement and their repeatability between dynamic contour tonometry (DCT) and Goldmann/Perkins applanation tonometry (GAT) at two different atmospheric pressures. Materials and methods Forty-one eyes of 41 healthy consenting subjects were enrolled for this observational, cross-sectional study. Pachymetry and IOP measurements with DCT and GAT for both eyes of each subject at Acapulco (0 m from sea level) and at Mexico City (2,234 m from sea level) were done by the same observer. The IOP was compared between tonometers at each of the altitudes, and also for repeatability of each tonometer at different altitudes. Pearson's correlation coefficient and Bland-Altman plots were used to assess reliability of measurements and their differences at the two altitudes. Results The mean age of patients was 41.7 (28-66 years); 22 were females. Mean IOP with DCT was 16.1 ± 2.2 mm Hg at sea level and 15.9 ± 2.1 mm Hg at 2,234 m above sea level, not a significant difference. Mean GAT IOP at the two altitudes was 13.1 ± 1.8 and 11.5 ± 1.7 mm Hg respectively, a statistically sig -nificant difference. In contrast, central corneal thickness (CCT) was not significantly changed (548.3 to 549.4 μm, p = 0.496). Conclusion Repeatability of single-observer measurements with GAT remains clinically acceptable, but not at different altitudes. The DCT seems to more consistently measure a similar IOP at different altitudes in the same subjects. The two tonometers may not be used interchangeably in the serial follow-up of patients at any of the altitudes.How to cite this article: Albis-Donado O, Bhartiya S, Gil-Reyes M, Casale-Vargas G, Arreguin-Rebollar N, Kahook MY. Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude. J Curr Glaucoma Pract 2018;12(1):40-44.
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Affiliation(s)
- Oscar Albis-Donado
- Associate Professor, Department of Ophthalmology, Instituto Mexicano de Oftalmologia, Queretaro, Mexico and Omesvi Diagnostic Group Mexico City, Mexico
| | - Shibal Bhartiya
- Senior Consultant, Department of Ophthalmology, Glaucoma Facility, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Marina Gil-Reyes
- Ophthalmologist, Department of Cornea and Uveitis Section, Omesvi Diagnostic Group, Mexico City, Mexico
| | - Giovanna Casale-Vargas
- Ophthalmologist, Department of Cornea and Uveitis Section, Omesvi Diagnostic Group, Mexico City, Mexico
| | - Nancy Arreguin-Rebollar
- Ophthalmologist, Department of Cornea and Uveitis Section, Omesvi Diagnostic Group, Mexico City, Mexico
| | - Malik Y Kahook
- Professor, Department of Ophthalmology, School of Medicine, University of Colorado, Denver, Colorado, USA
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Alaghband P, Rodrigues IA, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract 2018; 12:45-49. [PMID: 29861582 PMCID: PMC5981093 DOI: 10.5005/jp-journals-10028-1243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022] Open
Abstract
Primary angle closure glaucoma (PACG) is more blinding (1 in 4 cases) than primary open angle glaucoma (1 in 10 cases). Cataract surgery is an effective initial treatment for majority of cases of PACG. However, cataract surgery alone may not be enough to control intraocular pressure (IOP) in cases with extensive synechial angle closure glaucoma. It is reported that glaucoma drainage surgery is needed in 12% of PACG cases after cataract surgery. Some experts combine cataract surgery with either goniosynechialysis (GSL) or endocyclophotocoagulation (ECP) to enhance IOP control. However, neither combination ensures complete success. We report three subjects with extensive synechia! angle closure in whom we facilitated a technique that combines lens extraction with ECP and endoscopic-GSL (PIECES). We demonstrated that this combined technique was a more effective and efficient method of achieving lower IOP in the presence of extensive synechial PACG. We believe that it addresses both the inflow and outflow of the aqueous humor simultaneously. Two out of three patients had good IOP control without medication and one patient needed one drop after a minimum 12 months of follow up. Furthermore, it may reduce the need for medical therapy and future more invasive glaucoma drainage surgery. How to cite this article: Alaghband P, Rodrigues IAS, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract 2018;12(1):45-49.
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Affiliation(s)
- Pouya Alaghband
- Registrar, Department of Ophthalmology, St Thomas Hospital, London United Kingdom
| | - Ian As Rodrigues
- Consultant, Department of Ophthalmology, St Thomas Hospital, London United Kingdom
| | - Saurabh Goyal
- Consultant, Department of Ophthalmology, St Thomas Hospital, London United Kingdom
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12
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Aoun G, Berberi A, Yared G, Diab HA. Antibiotic Therapy and Bacterial Odontogenic Infections: An Overview. WORLD JOURNAL OF DENTISTRY 2018; 9:154-161. [DOI: 10.5005/jp-journals-10015-1526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Sheng Lim K, Garg A, Cheng J, Muthusamy K, Beltran-Agullo L, Barton K. Comparison of Short-term Postoperative Hypotony Rates of 23-gauge vs 25-gauge Needles in Formation of the Scleral Tract for Baerveldt Tube Insertion into the Anterior Chamber. J Curr Glaucoma Pract 2018; 12:36-39. [PMID: 29861580 PMCID: PMC5981091 DOI: 10.5005/jp-journals-10028-1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction To compare the early postoperative hypotony rates and intraocular pressure (IOP) in two groups of eyes using either 23-gauge (23G) or 25-gauge (25G) needle in the creation of the anterior chamber entry tract for Baerveldt tube. The primary outcome measure was incidence of hypotony, and secondary outcome measures included comparison of mean IOP and other early complications. Materials and methods Ours was a retrospective case review of consecutive patients who underwent 350 mm2 Baerveldt implantation in two units over a 2-year period. Data including IOP and complications were collected at 1 day, 1 week, and 1 month following surgery from patients’ notes. Statistical analysis between groups was determined using the unpaired 2-tailed f-test for continuous variables and chi-squared test for categorical variables. Statistical significance was defined at the 0.05 level. Results A total of 58 eyes of 58 patients were included in this study. Preoperative mean IOP in the 25G group was significantly higher (26.4 ± 6.8 mm Hg) when compared with the 23G group (21.6 ± 4.0 mm Hg) (p = 0.002). The mean postoperative IOP remained significantly higher in the 25G group at day 1 (p=0.004), week 1 (p = 0.008), but not at month 1 (p = 0.744). Four patients in the 23G group had hypotony within 1 month postsurgery compared with no cases in the 25G group (chi-squared test p = 0.038). Conclusion There was a significantly higher risk of early hypotony and lower IOP in the larger 23G group at days 1 and 7, although the IOP was similar in both groups by 1 month. Clinical significance After all glaucoma drainage device (GDD) tube implantation, regardless of which needle is used to create the tract, the entry site should always be checked with 2% fluorescein drop and 10.0 nylon suture is used with or without autologous Tenon’s tissue to close any leakage. How to cite this article: Lim KS, Garg A, Cheng J, Muthusamy K, Beltran-Agullo L, Barton K. Comparison of Short-term Postoperative Hypotony Rates of 23-gauge vs 25-gauge Needles in Formation of the Scleral Tract for Baerveldt Tube Insertion into the Anterior Chamber. J Curr Glaucoma Pract 2018;12(1):36-39.
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Affiliation(s)
- Kin Sheng Lim
- Consultant, Department of Ophthalmology, Guys & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anurag Garg
- Specialist Registrar, Department of Ophthalmology, Glaucoma Service, St Thomas' Hospital, London, United Kingdom
| | - Jason Cheng
- Fellow, Department of Ophthalmology, Glaucoma Service, St Thomas' Hospital, London, United Kingdom
| | - Kirithika Muthusamy
- Specialist Registrar, Department of Ophthalmology, Moorfields Eye Hospital London, United Kingdom
| | - Laura Beltran-Agullo
- Fellow, Department of Ophthalmology, Glaucoma Service, St Thomas' Hospital, London, United Kingdom
| | - Keith Barton
- Consultant, Department of Ophthalmology, Moorfields Eye Hospital London, United Kingdom
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Trevino R, Sponsel WE, Majcher CE, Allen J, Rabin J. Association of Diopsys® Short-duration Transient Visual Evoked Potential Latency with Visual Field Progression in Chronic Glaucoma. J Curr Glaucoma Pract 2018; 12:29-35. [PMID: 29861579 PMCID: PMC5981090 DOI: 10.5005/jp-journals-10028-1240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/16/2017] [Indexed: 11/23/2022] Open
Abstract
Aim To determine the association of Diopsys® NOVA-LX amplitude and latency abnormality scores with perimetric staging of chronic glaucoma, and to explore potential single-visit short-duration transient visual evoked potential (SD-tVEP) trend detection ability utilizing Humphrey 30-2 field progression data. Materials and methods Setting: Glaucoma subspecialty clinic. Participants: Treated adult chronic glaucoma patients undergoing SD-tVEP evaluation. Main outcome measures: (1) Proportion of eyes designated as suspect or abnormal by the NOVA-LX multifactorial algorithm were determined as a function of glaucoma severity using the most recent Humphrey visual field analyzer (HVFA) 30-2 field. (2) Association between long-term HVFA-guided progression analysis (GPA) annual slopes and SD-tVEP abnormality was assessed to determine whether a single VEP test might help to identify eyes more prone to progressive visual field (VF) loss. Results One hundred and thirty-three eyes of 84 patients (mean age 68 years) were analyzed. The SD-tVEP abnormality increased proportionately with severity of VF loss under high-contrast (Hc) test conditions for both latency (p = 0.001) and amplitude (p < 0.01). The HVFA progression analysis printouts existed for 91 eyes (mean 12.3 fields per eye/range 5-18). Nearly three-quarters (72.5%) of eyes with mean annual HVFA progression >0.7 dB/year (n = 29) had single-visit VEP latency abnormalities. Fewer than half (46.7%) of the remainder (n = 62) showed latency abnormality. Mean progression for eyes with abnormal vs normal VEP latency was -0.87 ± 0.3 dB/year vs -0.32 ± 0.4 dB/year. Conclusion Diopsys NOVA-LX Hc latency abnormality shows strong association with VF loss among a diverse population of clinical patients undergoing active treatment for chronic glaucoma, and appears likely to afford clinically useful trend-detecting test. Clinical significance The SD-tVEP has the potential to serve as a single-visit clinical indicator to identify glaucoma patients at high risk for VF progression. How to cite this article: Trevino R, Sponsel WE, Majcher CE, Allen J, Rabin J. Association of Diopsys® Short-duration Transient Visual Evoked Potential Latency with Visual Field Progression in Chronic Glaucoma. J Curr Glaucoma Pract 2018;12(1):29-35.
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Affiliation(s)
- Richard Trevino
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - William E Sponsel
- Director, Professor and Consultant, Department of Ophthalmology, CLI Eyes of Africa Clinic and Surgery Center, Malawi, Africa; WESMDPA Baptist Medical Center Glaucoma Service, San Antonio, Texas; Department of Biomedical Engineering, University of Texas San Antonio, San Antonio, Texas; Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - Carolyn E Majcher
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - Joey Allen
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - Jeffery Rabin
- Optometrist, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
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Singh K, Mutreja A, Bhattacharyya M, Dangda S, Jaisingh K. Bilateral Phacomatosis Pigmentovascularis in a Young Male with Developmental Glaucoma and Varicose Veins. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Popovic M, Campos-Möller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1248] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Thangamathesvaran L, Crane E, Modi K, Khouri AS. Outcomes of Resident-versus attending-performed Tube Shunt Surgeries in a United States Residency Program. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Arora V, Arora P, Soliman M. Evaluation of Coronal Leakage of Preheated Nanohybrid and Bulk Fill Composites in Endodontically Treated Teeth: An in vitro Study. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10015-1534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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J Lu L, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018; 12:19-28. [PMID: 29861578 PMCID: PMC5981089 DOI: 10.5005/jp-journals-10028-1239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/09/2017] [Indexed: 11/23/2022] Open
Abstract
Conventional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device (GDD) surgery, have been enhanced by surgeons to improve outcome and decrease complications. Over the last two decades, adjuncts, such as collagen matrix implants, fibrin adhesives, and amniotic membrane transplantation (AMT) have been found to be effective in modulating fibrosis and scarring during the wound-healing process, reducing postoperative inflammation, and repairing bleb leakage or conjunctival erosion. The use of these tools provides several advantages when used in trabeculectomy, GDD surgery, and surface reconstruction associated with glaucoma surgery complications. Their use will be discussed in this review. How to cite this article: Lu LJ, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018;12(1):19-28.
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Affiliation(s)
- Louise J Lu
- Medical Student, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
| | - Laura Hall
- Ophthalmologist, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
| | - Ji Liu
- Ophthalmologist, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
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Dong J, Syed ZA, Fan K, Yahya AF, Melki SA. Potential Savings from Visit Reduction of Continuous Intraocular Pressure Monitoring. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ali A, Almaroof A, Festy F, Banerjee A, Mannocci F. In vitro Remineralization of Caries-affected Dentin after Selective Carious Tissue Removal. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10015-1529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Adjunctive Mitomycin C or Amniotic Membrane Transplantation for Ahmed Glaucoma Valve Implantation: A Randomized Clinical Trial. J Glaucoma 2017; 25:415-21. [PMID: 25967528 DOI: 10.1097/ijg.0000000000000256] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether adjunctive mitomycin C (MMC) or amniotic membrane transplantation (AMT) improve the outcomes of Ahmed glaucoma valve (AGV) implantation. METHODS This double-blind, stratified, 3-armed randomized clinical trial includes 75 eyes of 75 patients aged 7 to 75 years with refractory glaucoma. Eligible subjects underwent stratified block randomization; eyes were first stratified to surgery in the superior or inferior quadrants based on feasibility; in each subgroup, eyes were randomly assigned to the study arms using random blocks: conventional AGV implantation (group A, 25 eyes), AGV with MMC (group B, 25 eyes), and AGV with AMT (group C, 25 eyes). RESULTS The 3 study groups were comparable regarding baseline characteristics and mean follow-up (P=0.288). A total of 68 patients including 23 eyes in group A, 25 eyes in group B, and 20 eyes group C completed the follow-up period and were analyzed. Intraocular pressure was lower in the MMC group only 3 weeks postoperatively (P=0.04) but comparable at other time intervals. Overall success rate was comparable in the 3 groups at 12 months (P=0.217). The number of eyes requiring medications (P=0.30), time to initiation of medications (P=0.13), and number of medications (P=0.22) were comparable. Hypertensive phase was slightly but insignificantly more common with standard surgery (82%) as compared with MMC-augmented (60%) and AMT-augmented (70%) procedures (P=0.23). Complications were comparable over 1 year (P=0.28). CONCLUSIONS Although adjunctive MMC and AMT were safe during AGV implantation, they did not influence success rates or intraocular pressure outcomes. Complications, including hypertensive phase, were also comparable.
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Conjunctival Advancement With Subconjunctival Amniotic Membrane Draping Technique for Leaking Cystic Blebs. J Glaucoma 2016; 25:188-92. [PMID: 25203661 DOI: 10.1097/ijg.0000000000000098] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the successful use of a technique involving amniotic membrane graft for the repair of leaking cystic blebs following mitomycin C (MMC) trabeculectomy. PATIENTS AND METHODS A retrospective review of 17 eyes of 16 patients who had undergone trabeculectomy with MMC or combined cataract phacoemulsification and trabeculectomy with MMC and presented with leaky cystic blebs with or without hypotony was conducted. All patients were treated with amniotic membrane graft over the leaking area with conjunctival advancement without excision of the cystic bleb and had a minimum of 1-year follow-up. Success was defined as a final intraocular pressure (IOP) ≥ 6 and ≤ 21 mm Hg without glaucoma medications. Qualified success that met the above criteria, however, required the use of glaucoma medication for optimal IOP control. Failure was defined as any patient with persistent bleb leak requiring additional procedures and/or the presence of hypotony (IOP<6 mm Hg ± clinical evidence of hypotony maculopathy). RESULTS Seventeen of the 17 eyes had complete resolution of bleb leak at last follow-up. Total success rate was 15 of the 17 patients, or 88%. Eleven eyes (64.7%) met criteria for complete success. Four eyes (23.5%) required glaucoma medications after the procedure and met criteria for qualified success. Two eyes (11.8%) met criteria for failure, as they presented with a pinpoint limbal leak requiring a suture at the slit lamp in the postoperative period. Mean IOP increased from 5.7 ± 2.8 mm Hg preoperatively to 13.1 ± 3.4 mm Hg at most recent follow-up (P<0.000007). LogMAR visual acuity likewise improved from 0.7 ± 0.8 preoperatively to 0.1 ± 0.1 LogMAR units at most recent follow-up (P<0.030). Mean follow-up time was 21.4 ± 7.3 months. CONCLUSIONS The technique of amniotic membrane bleb draping with conjunctival advancement successfully restored bleb function, while facilitating fast resolution and stabilization of IOP and visual acuity.
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Malhotra C, Jain AK. Human amniotic membrane transplantation: Different modalities of its use in ophthalmology. World J Transplant 2014; 4:111-21. [PMID: 25032100 PMCID: PMC4094946 DOI: 10.5500/wjt.v4.i2.111] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 03/01/2014] [Accepted: 05/08/2014] [Indexed: 02/05/2023] Open
Abstract
The amniotic membrane (AM) is the inner layer of the fetal membranes and consist of 3 different layers: the epithelium, basement membrane and stroma which further consists of three contiguous but distinct layers: the inner compact layer, middle fibroblast layer and the outermost spongy layer. The AM has been shown to have anti-inflammatory, anti-fibrotic, anti-angiogenic as well as anti-microbial properties. Also because of its transparent structure, lack of immunogenicity and the ability to provide an excellent substrate for growth, migration and adhesion of epithelial corneal and conjunctival cells, it is being used increasingly for ocular surface reconstruction in a variety of ocular pathologies including corneal disorders associated with limbal stem cell deficiency, surgeries for conjunctival reconstruction, as a carrier for ex vivo expansion of limbal epithelial cells, glaucoma surgeries and sceral melts and perforations. However indiscriminate use of human AM needs to be discouraged as complications though infrequent can occur. These include risk of transmission of bacterial, viral or fungal infections to the recipient if the donors are not adequately screened for communicable diseases, if the membrane is not processed under sterile conditions or if storage is improper. Optimal outcomes can be achieved only with meticulous case selection. This review explores the ever expanding ophthalmological indications for the use of human AM.
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Frangouli O, Adams GG. The Use of Amniotic Membrane for the Management of Fibrosis in Complex Strabismus Surgery. Strabismus 2013; 21:13-22. [DOI: 10.3109/09273972.2012.762531] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Nakamura M, Naka M, Tatsumi Y, Nagai-Kusuhara A, Kanamori A, Yamada Y, Negi A. Filtering Bleb Structure Associated with Long-Term Intraocular Pressure Control after Amniotic Membrane-Assisted Trabeculectomy. Curr Eye Res 2012; 37:239-50. [DOI: 10.3109/02713683.2011.635403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Li M, Han B, Liu W. Preparation and properties of a drug release membrane of mitomycin C with N-succinyl-hydroxyethyl chitosan. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:2745-2755. [PMID: 22095446 DOI: 10.1007/s10856-011-4455-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 10/01/2011] [Indexed: 05/31/2023]
Abstract
A novel drug loaded membrane made of N-succinyl-hydroxyethyl chitosan and mitomycin C was used as an implant for glaucoma filtering surgery. The characteristics of the membrane, such as FTIR, equilibrium water content, swelling ratio, permeability, and drug release in vitro were determined. The L929 fibroblast inhibition of drug loaded membranes was compared to hydroxyethyl chitosan film and blank control, detecting by MTT. The biodegradability and biocompatibility were evaluated by implanting membranes into the subcutaneous tissue and muscle of rats. FTIR indicated mitomycin C was introduced. The experimental results indicated the drug loaded membrane was effective on the swelling property, permeability, and drug release in vitro. Cell culture experimental results demonstrated that the destination membrane inhibited fibroblast proliferation. In vivo, the membranes showed bioabsorption and biocompatibility. The experimental results provide a theoretical basis for the future development of the drug loaded membrane as an implant for increasing the success rate of filtering surgery.
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Affiliation(s)
- Minyu Li
- College of Marine Life Sciences, Ocean University of China, Qingdao, People's Republic of China
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Abstract
Cryopreserved amniotic membrane modulates adult wound healing by promoting epithelialization while suppressing stromal inflammation, angiogenesis and scarring. Such clinical efficacies of amniotic membrane transplantation have been reported in several hundred publications for a wide spectrum of ophthalmic indications. The success of the aforementioned therapeutic actions prompts investigators to use amniotic membrane as a surrogate niche to achieve ex vivo expansion of ocular surface epithelial progenitor cells. Further investigation into the molecular mechanism whereby amniotic membrane exerts its actions will undoubtedly reveal additional applications in the burgeoning field of regenerative medicine. This article will focus on recent advances in amniotic membrane transplantation and expand to cover its clinical uses beyond the ocular surface.
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Affiliation(s)
- Jingbo Liu
- Ocular Surface Center, 7000 SW, 97 Avenue, Suite 213, Miami, FL 33173, USA
- Eye Hospital, Wenzhou Medical College, Wenzhou, 325000, China
| | - Hosam Sheha
- Ocular Surface Center, 7000 SW, 97 Avenue, Suite 213, Miami, FL 33173, USA
- Research Institute of Ophthalmology, Cairo, Egypt
| | - Yao Fu
- Ocular Surface Center, 7000 SW, 97 Avenue, Suite 213, Miami, FL 33173, USA
- Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Scheffer CG Tseng
- Ocular Surface Center, 7000 SW, 97 Avenue, Suite 213, Miami, FL 33173, USA
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Kiuchi Y, Yanagi M, Nakamura T. Efficacy of amniotic membrane-assisted bleb revision for elevated intraocular pressure after filtering surgery. Clin Ophthalmol 2010; 4:839-43. [PMID: 20689739 PMCID: PMC2915873 DOI: 10.2147/opth.s12311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Indexed: 12/05/2022] Open
Abstract
Purpose: To compare the effectiveness of standard revision surgery using mitomycin C (MMC) with revision using amniotic membrane transplantation and MMC for elevated intraocular pressure (IOP) after trabeculectomy. Patients and methods: A retrospective, nonrandomized comparative study of 36 eyes of 36 patients with a failed trabeculectomy. Patients were divided into two groups, ie, a nonamnion-transplanted group and an amnion-transplanted group. The amniotic membrane was placed on the scleral flap under the conjunctiva in the amnion-transplanted group. Both groups recovered filtration of aqueous humor from the surgical site with the adjunctive use of MMC. The changes in IOP and cumulative survival rate were compared for the two groups. Success was defined as a 30% reduction in IOP from the preoperative IOP and maintenance below 21 mmHg with or without the use of antiglaucomatous agents. Results: The mean preoperative IOP was not significantly different in the two groups. The mean postoperative IOP in the nonamnion group, 12.1 ± 5.5 mmHg, was significantly lower than the IOP in the amnion group, 16.0 ± 3.7 mmHg. Survival curves in the two groups did not reach significantly different levels. Conclusions: Conventional surgical bleb revision with MMC can significantly reduce the elevated IOP associated with a failed filtration bleb. The use of an amniotic membrane transplant did not improve the surgical outcome in our cases.
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Affiliation(s)
- Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Sciences, Hiroshima University, Hiroshima, Japan.
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Buccal Mucous Membrane for the Reconstruction of Complicated Leaking Trabeculectomy Blebs. J Glaucoma 2010; 19:270-4. [PMID: 19730123 DOI: 10.1097/ijg.0b013e3181aff448] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee GA, Holcombe DJ. Surgical revision of dysfunctional filtration blebs with bleb preservation, sliding conjunctival flap and fibrin glue. Eye (Lond) 2009; 24:947-53. [PMID: 19942939 DOI: 10.1038/eye.2009.279] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The introduction of anti-metabolite regimens to glaucoma filtration surgery has improved post-operative intraocular pressure (IOP) control; however, it has also increased the frequency of dysfunctional blebs. In this study, we report a surgical technique for the repair of trabeculectomy blebs using bleb preservation, a sliding conjunctival flap, and fibrin glue. METHODS This study is a retrospective, non-comparative, consecutive case series involving 10 eye samples collected from 10 patients (6 M : 4 F) with one or a combination of bleb overfiltration, dysesthesia, thinning, leak, or blebitis, in which a conjunctival flap was advanced over the failing bleb and secured in place using fibrin glue and sutures. RESULTS All patient eyes had symptom resolution post-operatively. There were no bleb leaks or hypotonous eyes after an average follow-up of 15.2 months (range: 6-31 months). Three patients required needling augmented with 5-fluorouracil needling to maintain IOP control. IOP decreased from a mean of 13.6+/-1.8 mm Hg (with a mean of 0.7 glaucoma medications) pre-operatively to 11.7+/-0.9 mm Hg (with a mean of 0.9 glaucoma medications). CONCLUSION Conjunctival flap advancement with bleb preservation and adjunctive fibrin glue is a successful technique used for the treatment of bleb dysfunction. The major advantages compared with other techniques are preservation of IOP control and reduced post-operative complications, such as wound leak and the need for re-suturing.
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Affiliation(s)
- G A Lee
- City Eye Centre, Department of Ophthalmology, Royal Brisbane and Women's Hospital, Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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Bresson-Dumont H, Lehoux A, Foucher J. Réfection de bulle de filtration après chirurgie du glaucome. Résultats tonométriques à moyen terme. J Fr Ophtalmol 2009; 32:241-6. [DOI: 10.1016/j.jfo.2009.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The amniotic membrane remains a useful tool in the treatment of several ophthalmic conditions, especially those related to the ocular surface. However, the 'success' reported in individual case reports and case series is not substantiated in the few published randomised controlled trials. More often than not, it is not as good as existing alternative options and, at best, is as good but with probably an increased cost. The variable outcomes could be related to inter and intra donor variations in the membrane and the depletion or alterations in its constituents subsequent to processing and storage. The membrane thus is a fairly 'non-standardised product' making comparisons of different applications and indications difficult. The potential for 'epidemic' infections, such as HIV, hepatitis B and C, is a serious issue as, in many parts of the world, fresh unquarantined membrane, at times with no tests for the above infectious agents, is being used. The exact mechanism of action of the membrane is not known but the consensus is that it acts as a substrate or scaffold for host cells to populate and thus facilitate healing and repair. The development of a standard 'synthetic membrane' using collagen or polymer matrices impregnated with putative beneficial ingredients, such as growth factors and antimicrobials, is being considered and may prove to be a step in the right direction.
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