Deep Sclerectomy With Mitomycin C and Injectable Cross-linked Hyaluronic Acid Implant: Long-term Results

Bettin, Paolo; Matteo, Federico Di; Rabiolo, Alessandro; Fiori, Marina; Ciampi, Carlo; Bandello, Francesco

doi:10.1097/ijg.0000000000000309

Cited by 20 publications

(15 citation statements)

References 24 publications

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“…Goniopuncture was needed in 33 of 35 eyes in our study. The frequency is higher than previously reported (Shaarawy et al 2001;Ollikainen et al 2011;Bettin et al 2016). However, Anand & Pilling (2010) followed 258 patients after deep sclerectomy for a mean of 40 months.…”

Section: Discussioncontrasting

confidence: 71%

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Long‐term results of deep sclerectomy in normal‐tension glaucoma

Harju

Suominen

Allinen

et al. 2017

Acta Ophthalmologica

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Section: Discussioncontrasting

confidence: 71%

“…; Bettin et al. ). However, Anand & Pilling () followed 258 patients after deep sclerectomy for a mean of 40 months.…”

Section: Discussionmentioning

confidence: 98%

Long‐term results of deep sclerectomy in normal‐tension glaucoma

Harju

Suominen

Allinen

et al. 2017

Acta Ophthalmologica

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“…Healaflow® (Aptissen S.A., Plan Les Ouates, Switzerland) is a transparent hydrogel, developed and marketed for use in glaucoma filtering surgery, where its purpose is to maintain the bleb and limit postoperative fibrosis [32][33][34]. In this application, the gel is retained for 3-6 months [33], whereas it was retained in the vitreous space for at least a few weeks when evaluated as an experimental vitreous substitute [26].…”

Section: Vitreous Substitutesmentioning

confidence: 99%

Inflammatory responses after vitrectomy with vitreous substitutes in a rabbit model

Barth

Crafoord

Arnér

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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Purpose To investigate the inflammatory response of current and future potential vitreous substitutes in an experimental in vivo vitrectomy model. Methods Twenty-five gauge pars plana vitrectomy was performed in the right eye of 60 pigmented rabbits, with subsequent injection of 0.5-1.0 ml of Healaflow® (cross-linked hyaluronic acid, n = 12), Bio-Alcamid® (polyalkylimide, n = 8), silicone oil (n = 12), or balanced saline solution (BSS, n = 28). Postoperative clinical evaluation was performed; and the rabbits were sacrificed at 1 day, 1 week, or 1 month. The eyecups were then examined macroscopically; the retinas sectioned and stained with hematoxylin and eosin (Htx), and immunohistochemically labeled for glial fibrillary acidic protein (GFAP), CD45, galectin-3, CD68, and CD20. Unoperated left eyes from treated animals as well as eyes from untreated animals were used as controls. Results Vitrectomy without major complications was achieved in 46/60 eyes. The remaining 14 eyes were analyzed separately. One eye developed endophthalmitis after 1 week and was excluded. Eyes treated with Healaflow®, silicone oil, and BSS had a comparable appearance macroscopically and in Htx-stained sections, whereas Bio-Alcamid®-injected eyes exhibited increased macroscopic inflammation and severely affected retinas. GFAP upregulation was present in all treatment groups, most prominent in eyes treated with Bio-Alcamid® and silicone oil. Upregulation of CD45 and CD68 in the inner retina and vitreous space was most prominent with Bio-Alcamid® treatment, and these eyes together with their silicone oil-treated counterparts also displayed a stronger upregulation of CD20-labeled cells compared with remaining groups. General upregulation of galectin-3, mainly in the inner retina, was found in all groups. In eyes with perioperative complications, labeling of CD45, CD68, and especially GFAP was comparably high. Conclusions We here describe differences in the postsurgery inflammatory profiles of existing and potential vitreous substitutes. Bio-Alcamid® and silicone oil display severe signs of gliosis and inflammation, whereas Healaflow® elicits minimal reactions comparable with BSS, highlighting its potential application as a vitreous substitute in a future clinical setting.

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“…[ 24 25 ] Recent studies suggested that the injection of cross-linked sodium hyaluronate gel under scleral flap and conjunctiva could inhibit the process of local fibrosis and vascularization and reduce the possibility of bleb failure, maintaining an effective filtration, and improving the long-term success rate of penetrating and nonpenetrating glaucoma surgeries. [ 15 20 26 27 ] In this prospective study, we compared the safety and efficiency of trabeculectomy with cross-linked sodium hyaluronate gel injection for Chinese glaucoma patients and followed up for 5 years. Our data indicated that both trabeculectomy alone and trabeculectomy with cross-linked sodium hyaluronate gel injection group witnessed efficient lowering of IOP, while the patients in the cross-linked sodium hyaluronate gel injection group achieved more IOP reduction at 1, 3, and 5 years after operation.…”

Section: Discussionmentioning

confidence: 99%

“…[ 13 14 15 16 ] Other studies have also suggested that intraoperative implantation of sodium hyaluronate gel may prevent bleb scarring, fibrosis, adhesion and improve IOP. [ 17 18 19 20 ] However, limited randomized and case-controlled studies have been conducted to investigate the long-term outcomes of cross-linked sodium hyaluronate gel applied in trabeculectomy in patients with glaucoma.…”

Section: Introductionmentioning

confidence: 99%

Five Years' Outcomes of Trabeculectomy with Cross-linked Sodium Hyaluronate Gel Implantation for Chinese Glaucoma Patients

Wang

Dai

Dang

et al. 2018

Chinese Medical Journal

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Background:Trabeculectomy is the most efficient surgical treatment. Prevention failure of bleb cicatrix would lead to unsatisfactory postoperative intraocular pressure (IOP) controlling and unsatisfactory success rate. The aim of this study was to evaluate the 5-year outcomes of trabeculectomy with a cross-linked sodium hyaluronate gel implantation for Chinese glaucoma patients.Methods:This is a prospective, case-controlled study. Patients who were to be applied first-time trabeculectomy in the Department of Ophthalmology of Peking University Third Hospital between 2010 and 2012 were included in the study. Totally, 60 eyes were randomly assigned to the trabeculectomy group (TA group) or the trabeculectomy with cross-linked sodium hyaluronate gel implantation group (TH group). Follow-up was finished at 1 week, 1 month, 3 months, 1 year, 3 years, and 5 years after the operation. The statistical index of demographic data, IOP, bleb shape, and any complications or medications or surgical procedures were recorded and assessed by SPSS 19.0 software through independent t-test, one-way analysis of variance (ANOVA) and Pearson's Chi-square test, respectively.Results:The baseline IOP was comparable between the two groups (t= −1.00, P= 0.32) while the postoperative IOP was significantly lower in the TH group at 1, 3 and 5 years' time points (P = 0.00, P= 0.01 and P = 0.01, respectively). According to the Indiana Bleb Appearance Grading Scale, the height and extent of bleb were better in the TH group at all follow-up time points (P < 0.05), however, the comparison of bleb vascularity showed no statistical difference (P > 0.05). TA group had a higher percentage of complications (13% vs. 3%) compared to TH group; however, there was no statistical difference in the comparison of each statistical item (P > 0.05, respectively). The complete success at 5 years was higher in the TH group than that in the TA group (78% vs. 54%, P = 0.03).Conclusion:Our results suggested that implantation of cross-linked sodium hyaluronate gel with trabeculectomy was more efficient and would improve the prognosis of glaucoma patients.

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Deep Sclerectomy With Mitomycin C and Injectable Cross-linked Hyaluronic Acid Implant: Long-term Results

Abstract: DS with Healaflow and MMC seems to be an effective and safe technique to lower IOP in patients affected by open-angle glaucoma, with few postoperative complications.

Cited by 20 publications

References 24 publications

Long‐term results of deep sclerectomy in normal‐tension glaucoma

Long‐term results of deep sclerectomy in normal‐tension glaucoma

Inflammatory responses after vitrectomy with vitreous substitutes in a rabbit model

Five Years' Outcomes of Trabeculectomy with Cross-linked Sodium Hyaluronate Gel Implantation for Chinese Glaucoma Patients

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