Excision of Tenon Capsule in Pediatric Trabeculectomy

Awadein, Ahmed; Sayed, Yasmine M. El

doi:10.1097/ijg.0000000000000220

Cited by 15 publications

(10 citation statements)

References 23 publications

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“… 31 Since a small portion of Tenon's was removed at the location of the stent, with blunt posterior dissection of both the subconjunctival and sub-Tenon's spaces, MMC injection can reach the inner conjunctival surface, both sides of the remaining Tenon's and the outer scleral surface, inhibiting fibroblast proliferation and scarring from all of these potential sources. Finally, a partial tenectomy was performed, which has been shown to reduce the frequency of encapsulated blebs following trabeculectomy in pediatric patients 33 and may reduce the risk of early stent obstruction. 27 These modifications likely promoted the formation of excellent diffuse, posterior, and avascular bleb morphologies.…”

Section: Discussionmentioning

confidence: 99%

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Harris

Valle

2020

American Journal of Ophthalmology Case Reports

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Purpose To provide the first report of effective use of bilateral XEN Gel Stent implantation using an ab externo open-conjunctival approach designed to improve bleb function and meet the uniquely low intraocular pressure requirements of a Japanese patient with normal-tension glaucoma refractory to topical medical therapy. Observations A 54-year-old phakic Japanese woman with severe normal-tension glaucoma on maximally tolerated medical therapy of four topical agents presented with above-goal intraocular pressures and new medication intolerances. She underwent bilateral ab externo open-conjunctival XEN Gel Stent implantation with tenectomy and sub-Tenon's injection of 40μg of mitomycin-C, which resulted in reduction of intraocular pressures by 41.2 and 28.6% to 10 and 10 mmHg in the right and left eyes, respectively at the most recent visit. Postoperatively, a diffuse filtering bleb with good morphology developed in both eyes. The procedure has so far allowed for complete cessation of all four topical medications for up to eight months following surgery without any serious complications. Conclusions This case illustrates the potential of Xen Gel Stent implantation through an ab externo, open-conjunctival approach to be an effective, simple alternative to trabeculectomy to meet the unique low-pressure requirements of normal-tension glaucoma patients with practical and safety benefits of a micro-invasive approach.

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Section: Discussionmentioning

confidence: 99%

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Harris

Valle

2020

American Journal of Ophthalmology Case Reports

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“…Most cases of failure following glaucoma filtering surgeries are related to the proliferation of fibroblasts, synthesis of extracellular matrix, and subsequent development of subconjunctival fibrosis [ 6 ]. Research has been carried out to investigate the potential for excising Tenon’s capsule [ 7 , 8 ], placing valve implants above Tenon’s [ 9 ], and locating filtering blebs under Tenon’s [ 10 ]. However, it seems that the most important element to a successful glaucoma filtering surgery is the use of antimetabolites [ 1 , 11 , 12 ].…”

Section: Peri-operative/adjunctive Use Of Antifibrotic Agentsmentioning

confidence: 99%

XEN Gel Stent Open Conjunctiva Technique: A Practical Approach Paper

Panarelli

Yan²,

Francis

et al. 2020

Adv Ther

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The Xen Gel Stent lowers intraocular pressure by shunting aqueous humor to the subconjunctival space. While published studies include both open conjunctiva and closed conjunctiva approaches, most publications feature a closed conjunctiva, ab interno approach. While this approach is widely used, other approaches may be preferred for some patients. This paper provides details on surgical steps and tips for enhancing outcomes for an open conjunctiva technique for the implantation of the Xen Gel Stent, as well as reasoning as to when this approach should be used.

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“…Therefore, these studies showed the potential influence on scar formation by interfering with conjunctiva and Tenon’s capsule and inspired us to study whether dissecting subconjunctival tissues at different depths influences subconjunctival fibrosis. Furthermore, excision of Tenon’s capsule during trabeculectomy helps in preventing fibrosis and enhances the chances of success [4]. Tenon’s capsule needs to be excised during filtration surgery to alleviate fibroblastic response, especially for the thick and active Tenon’s capsule [23].…”

Section: Discussionmentioning

confidence: 99%

“…Minimally invasive external mini-glaucoma shunt implantation with less conjunctival dissection potentially causes less conjunctival scarring [3]. Moreover, tenonectomy in trabeculectomy may help reduce fibrosis and therefore improves the success rate [4]. These results inspired us to explore whether dissecting subconjunctival tissues at different depths influences scar formation.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Subconjunctival Wound Healing between Different Methods of Dissecting Subconjunctival Tissues

Gong

Chen

et al. 2020

Ophthalmic Res

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Objective: To compare different methods for dissecting subconjunctival tissues by developing subconjunctival wound healing models. Methods: New Zealand white rabbits were separated into 3 groups based on the method by which the rabbit subconjunctival wound healing model was generated: subconjunctival tissues were dissected episclerally (EPI) or subepithelially (SUB), with a corresponding blank control (CON). All the cases in the experimental groups were surgically prepared with conjunctival flaps, and they were sacrificed on the third postoperative day. At the surgical sites, the protein levels of hypoxia-inducible factor-1 (HIF-1)-α, vascular endothelial growth factor (VEGF)-A, and matrix metalloproteinase (MMP)-2 were detected by Western blot, morphological vascularity was measured by Adobe Photoshop, and subconjunctival fibrosis was assessed by histology. Results: Compared with the CON group, both the EPI and SUB groups showed significantly upregulated protein levels of HIF-1α, VEGF-A, and MMP-2. In addition, the protein levels of HIF-1α, VEGF-A, and MMP-2 were higher in the EPI group than in the SUB group. Morphological vascularity was significantly elevated in the EPI group compared with the SUB and CON groups. Collagen content was markedly increased in the EPI group compared with the SUB and CON groups. Conclusions: Dissecting subconjunctival tissues subepithelially inhibits subconjunctival fibrosis, which may be instructive in tenonectomy in filtration surgery.

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Excision of Tenon Capsule in Pediatric Trabeculectomy

Abstract: Excision of the Tenon capsule could help achieve better IOP control in pediatric glaucoma surgery.

Cited by 15 publications

References 23 publications

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

XEN Gel Stent Open Conjunctiva Technique: A Practical Approach Paper

A Comparison of Subconjunctival Wound Healing between Different Methods of Dissecting Subconjunctival Tissues

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