Early flap dislocation with perioperative brimonidine use in laser in situ keratomileusis

Nowroozzadeh, Mohammad Hossein

doi:10.1016/j.jcrs.2009.09.017

Cited by 6 publications

(5 citation statements)

References 4 publications

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“…Some previous reports dealt with the adverse effects of perioperative use of brimonidine for laser in situ keratomileusis (LASIK) [ 8 – 10 ]. Topical administration of brimonidine was found to raise the incidence of corneal flap dislocation after LASIK and Walter and Gilbert [ 8 ] suggested the following possible mechanisms: (1) brimonidine itself or brimonidine-containing eyedrops may act as a lubricant and cause the flap to slide from the corneal bed, (2) brimonidine may cause vasoconstriction of the anterior ocular vessels and decrease the corneal endothelial function to maintain proper flap adherence, and (3) brimonidine itself may be directly toxic to the corneal endothelial cells and reduce their metabolic activity.…”

Section: Introductionmentioning

confidence: 99%

Brimonidine reduces TGF-beta-induced extracellular matrix synthesis in human Tenon’s fibroblasts

et al. 2015

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BackgroundBrimonidine is a highly selective α2 adrenergic agonist that has been widely used in anti-glaucoma eyedrops. The aim of this study was to investigate its putative anti-fibrotic role in the fibrosis caused by activated Tenon’s fibroblasts.MethodsPrimary cultured human Tenon’s fibroblasts were exposed to 2.0 ng/mL of transforming growth factor-β1 (TGF-β1) for up to 48 h. In the presence of various concentrations of brimonidine (from 0.0 to 10.0 μM), the expression levels of fibronectin, collagen types I and III, and β-actin were determined by Western immunoblots. The expression of phosphorylated SMAD2/3 (p-SMAD2/3) was then evaluated using immunofluorescence.ResultsTGF-β1 significantly increased the synthesis of fibronectin and collagens in human Tenon’s fibroblasts; however brimonidine treatment distinctly attenuated the TGF-β1-induced production of extracellular matrix (ECM) proteins. TGF-β1 also changed the cellular morphology to be plump, while brimonidine treatment returned the cells to a spindle shape, similar to control fibroblasts. Regarding p-SMAD2/3, brimonidine treatment did not show any apparent changes in its expression.ConclusionsOur data revealed that brimonidine reduces TGF-β-induced ECM synthesis in human Tenon’s fibroblasts in vitro. This finding implies that topical administration of brimonidine may be helpful in reducing the fibrosis caused by the long-term use of topical anti-glaucoma medications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-015-0045-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Brimonidine reduces TGF-beta-induced extracellular matrix synthesis in human Tenon’s fibroblasts

et al. 2015

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“…It is believed that brimonidine can destabilize fl ap adherence by adversely affecting corneal reepithe- Dilute Brimonidine for LASIK Patients/Pasquali et al lialization and endothelial cell function (the latter disrupting the negative intrastromal corneal pressure gradient responsible for early fl ap adherence). 18 Some studies have found no increase in the risk of fl ap complications with use of brimonidine, 6,7 whereas other studies have reported an incidence of fl ap dislocation varying from 10% to 36%. 5,8 We did not encounter any frank fl ap dislocations in 120 eyes treated with dilute brimonidine.…”

Section: Discussionmentioning

confidence: 99%

“…Refl oats for mildfl ap edge wrinkling were required in 3 brimonidine eyes (2.5%), 1 naphazoline/pheniramine eye (0.8%), and no control eyes, but this difference did not reach statistical signifi cance (P = . 18). There was no signifi cant difference between eyes at 3 months in terms of visual acuity, refractive error, corrected distance visual acuity, or rate of enhancement.…”

mentioning

confidence: 99%

Dilute Brimonidine to Improve Patient Comfort and Subconjunctival Hemorrhage After LASIK

Pasquali¹,

Aufderheide²,

Brinton³

et al. 2013

J Refract Surg

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“…Theories for the mechanism of early flap adhesion include osmotic pressure due to endothelial pump activity [ 36 , 37 ], electrostatic interactions in the stroma [ 38 ], and epithelial bridging at the edge of the flap [ 37 ]. Multiple studies have found brimonidine to reduce flap adherence and increase the risk of dislocation and cite its effects on endothelial pump activity as a possible cause [ 39 , 40 , 41 ]. Endothelial cell density and endothelial pump activity both decrease with age and could be related to an increased incidence of flap dislocation in older patients if osmotic pressure is indeed the mechanism for early flap adhesion [ 18 , 19 , 20 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK

Moshirfar

West

Miller

et al. 2021

JCM

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Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes.

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Early flap dislocation with perioperative brimonidine use in laser in situ keratomileusis

Cited by 6 publications

References 4 publications

Brimonidine reduces TGF-beta-induced extracellular matrix synthesis in human Tenon’s fibroblasts

Brimonidine reduces TGF-beta-induced extracellular matrix synthesis in human Tenon’s fibroblasts

Dilute Brimonidine to Improve Patient Comfort and Subconjunctival Hemorrhage After LASIK

Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK

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