Effects of Intraoperative Mitomycin-C on the Function of Baerveldt Glaucoma Drainage Implants in Rabbits

Prata, João Antônio; Minckler, Don S.; Mermoud, André; Baerveldt, George

doi:10.1097/00061198-199602000-00006

Cited by 30 publications

(22 citation statements)

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“…The ligature was released 1 week after surgery, and postoperative management was the same for all procedures, depot Medrol to reduce inflammation and topical Gentamycin 0.3% to prevent infection. Sagittal sections of eyes with cylindrical implants (n = 9) [14] were compared to specimens from 25 eyes implanted with different size Baerveldt implants (n = 5 for each size, 50, 100 and 200 mm 2 ) [4, 5], 14 rabbit eyes with Ahmed VS-1 implants with and without functional blebs [Fucik and Heuer, 1996, unpublished], and 2 monkey eyes with experimental ocular hypertension and different size Molteno implants [2]. Although collagen fibrils are smaller than the wavelength of light, their presence and orientation can be measured using polarization microscopy.…”

Section: Methodsmentioning

confidence: 99%

“…Glaucoma shunt devices vent aqueous by passive filtration through a fibrous accessory capsule deposited onto the plate [1,2,3,4,5]. The capsule consists of collagen, and its formation is assumed to be a cicatricial process [1,2,3,4,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…The capsule consists of collagen, and its formation is assumed to be a cicatricial process [1,2,3,4,5,6,7]. We tested this hypothesis by examining the capsule using polarization microscopy.…”

Section: Introductionmentioning

confidence: 99%

“…As in trabeculectomy, collagen deposition (fibrosis) reduces aqueous filtration by decreasing hydraulic conductivity until the capsule fails as a filtration membrane. Therefore, an aggressive adjunct antifibrotic regimen is recommended but remains controversial [5,6,7,8,9,10,11,12,13]. Controlling collagen deposition is essential because a continuous deposition model suggests all shunt devices will eventually fail.…”

Section: Introductionmentioning

confidence: 99%

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Force and Geometry Determine Structure and Function of Glaucoma Filtration Capsules

Wilcox

Kadri²

2007

Ophthalmologica

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Background/Aims: Glaucoma shunts vent aqueous humor to orbital tissue across a fibrous capsule. The capsule consists of collagen and fibroblasts, and its formation was assumed to be a cicatricial process. Capsule fibrosis remains the leading cause of device failure. We tested the wound healing hypothesis using morphometry and polarization microscopy and found the capsule consists not of scar tissue but rather highly organized extracellular matrix. Methods: Polarization microscopy reveals collagen orientation within the extracellular matrix. Rotation of the specimen in the plane of polarized light reveals collagen bundle orientation with respect to capsule surface geometry. Capsule thickness was measured and correlated with device dimension. Results: Capsule collagen is highly organized and not scar tissue. Relative orientation is predictable from simple engineering principles and shows tissue deposits reinforcing collagen parallel to its principle stress axes along the capsule surface. Capsule thickness and collagen orientation correlate with device dimension and surface geometry. Conclusion: The corollary is true. Geometry can be used to manage the amount, distribution and orientation of collagen and thus control hydraulic conductivity and surface area of the filtration capsule.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Force and Geometry Determine Structure and Function of Glaucoma Filtration Capsules

Wilcox

Kadri²

2007

Ophthalmologica

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“…24 There have been contradictory reports about the effect of antifibrotic agents on glaucoma implant surgeries. [25][26][27][28][29][30] In this study, when the subjects were divided into two groups, the mitomycin C treated group and the untreated group, there was no difference not only in preoperative variables such as age, sex, preoperative intraocular pressure, and number of preoperative antiglaucoma medications but also in the intraocular pressure at the last visit. The success rate was higher in the mitomycin C group, but it was not significant statistically.…”

Section: -6 23mentioning

confidence: 91%

Clinical experience of e-PTFE membrane implant surgery for refractory glaucoma

Kim

Kim²,

Choi³

et al. 2003

British Journal of Ophthalmology

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Aims: To evaluate the clinical efficacy of membrane tube implant made of expanded polytetrafluoroethylene (e-PTFE, Gore-Tex) membrane and silicone tube in treating refractory glaucoma. Methods: A retrospective chart review was performed on 43 eyes of 40 patients who underwent glaucoma tube shunt implant surgery using double layered e-PTFE membrane and silicone tube to treat refractory glaucoma. The surgeries were performed from May 1991 to September 1995, and the subjects were patients with terminal glaucoma without useful vision on the study eye. Results: The mean follow up period was 32.9 months. The Kaplan-Meier survival for intraocular pressure (IOP) control (IOP between 6 and 21mm Hg without significant complication) was 80.9% at 1 year, 73.9% at 2 years, and 62.2% at 3 years after surgery. After excluding three eyes of three patients who were dropped within 3 months after surgery and did not have any serious complication or problem in IOP control, the average preoperative IOP was 42.5 (SD 14.6) mm Hg and IOP on the last visit was 17.3 (10.2) mm Hg (p = 0.000, n = 40). The number of antiglaucoma medications before surgery (2.2 (0.6)) was reduced to 0.5 (0.8) on the last visit (p = 0.000). The IOP was controlled within the range of 6-21 mm Hg in 26 eyes (65.0%). In the remaining 14 eyes (35%), we could not control the IOP or additional surgery was needed to control the IOP or to treat severe complications. Two cases of endophthalmitis and three of phthisis were found as serious complications. The other complications were similar to those of other commercially available glaucoma implants. Conclusion: A comparable clinical result was obtained with this new implant as with the other commercially available implants. This implant with a thin and non-rigid reservoir has a potential to reduce some complications associated with the large volume and rigid consistency of the other implants, although it is not yet proved. This membrane tube implant may be considered as another substitute in the surgery of refractory glaucoma.

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