Histopathologic Study of the Molteno Glaucoma Implant in Three Patients

Rubin, Betty L.; Chan, Chi‐Chao; Burnier, M.; Munion, Lucille; Freedman, Jeffrey

doi:10.1016/s0002-9394(14)77017-5

Cited by 33 publications

(9 citation statements)

References 16 publications

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“…The available literature is scant and the few concerned studies have investigated histological changes in encapsulation related valve failure. Most of the studies are based on small sample sets (eg, n = 1, 3, 5, 6, 9, 10) and also not always uniform for the implants used [11–13,27–30]. Nevertheless, these studies have provided valuable histopathological insight.…”

Section: Discussionmentioning

confidence: 99%

Altered Expression of Fibrosis Genes in Capsules of Failed Ahmed Glaucoma Valve Implants

et al. 2015

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PurposeAhmed glaucoma valve (AGV) implant is an aqueous shunt device used to control intraocular pressure in glaucoma. Implant failure results from impervious encapsulation of the shunt plate causing increased hydraulic resistance and raised intraocular pressure. We hypothesized that deregulation of fibrosis pathway contributes to capsular resistance. We tested this by studying fibrosis related gene expression in failed AGV implants.MethodsDifferential gene expression was examined in failed AGV capsules and compared to normal control tenon. Following total RNA extraction, 84 key genes in fibrosis pathway were examined by real-time PCR using RT2 Profiler PCR Array. Relative gene expression was calculated using ΔΔCt method. Gene specific TaqMan assays were used to validate select genes with ≥2 fold differential expression in the array expression profile.ResultsWe observed differential expression in several genes in the fibrosis pathway. Almost half (39/84) of examined genes showed ≥2 fold differential expression in majority of capsules examined on the array. TaqMan assays for select genes including CCN2 (CTGF), THBS1, SERPINE1, THBS2, COL3A1, MMP3, and IL1A in an increased validation sample set showed significant changes in expression (p value from <0.001 to 0.022) at a high frequency in concurrence with our array results.ConclusionsPathway-focused analyses identified candidate genes with altered expression providing molecular evidence for deregulation of the fibrosis pathway in AGV failure.

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Section: Discussionmentioning

confidence: 99%

Altered Expression of Fibrosis Genes in Capsules of Failed Ahmed Glaucoma Valve Implants

et al. 2015

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“…10,11 A consistent histological pattern has been observed in bleb capsules around Molteno implants and has led the authors to hypothesize that 2 opposing processes occur, which have been described elsewhere. [12][13][14][15][16][17] These observations have led to modification of the standard single-and double-plate Molteno implants (surface area, 137 and 274 mm 2 , respectively) in recent years, resulting in 2 single-plate Molteno3 implants (surface areas, 175 and 230 mm 2 ) (Figure 1). Although made from the same materials, the Molteno3 implants differ from earlier models in that they have a thinner, more flexible episcleral plate, the height of the outer ridge has been reduced, and the pressure ridge outline has been modified from triangular to elliptical.…”

Section: O L T E N O I M P L a N T Smentioning

confidence: 99%

Otago Glaucoma Surgery Outcome Study

Thompson¹,

Molteno²,

Bevin³

et al. 2013

JAMA Ophthalmol

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To evaluate the efficacy of the 175-mm 2 Molteno3 implant in patients with nonneovascular glaucoma.Methods: A hospital-based, retrospective historical control comparative case series comparing results in the first 87 eyes to receive the 175-mm 2 Molteno3 implant with those in a control group of 115 eyes receiving the 274mm 2 double-plate Molteno implant.Results: Successwasdefinedasanintraocularpressure(IOP) of at least 6 mm Hg but not more than 21 mm Hg with or without hypotensive medication. The mean postoperative follow-up was 3.0 years (range, 13 days to 5.6 years) in the Molteno3 implant group and 6.2 years (range, 1 day to 13.9 years) in the double-plate Molteno implant group. The mean (SD) preoperative IOP was 25.6 (7.1) mm Hg in the Mol-teno3 implant group in eyes treated with a mean of 2.3 ocular hypotensive medications, and 25.7 (8.0) mm Hg in the double-plate Molteno implant group in eyes treated with a mean of 2.2 medications. The mean (SD) postoperative IOP at 36 months was 13.9 (3.2) mm Hg in the Molteno3 implant group in eyes treated with a mean of 0.9 ocular hypotensive medications, and 14.5 (3.4) mm Hg in the doubleplate group in eyes treated with a mean of 0.7 medications. The probability of IOP control at 3 years was 0.79 in both groups.Therewassignificantlymorepostoperativehypotony in eyes without a polyglactin 910 tie in the Molteno3 implant group (P=.04); however, significantly more eyes with flat anterior chambers in the double-plate group required anterior chamber reformation (P=.03). Conclusion:The 175-mm 2 Molteno3 implant provided intermediate-term successful treatment of nonneovascular glaucoma comparable to that provided by the double-plate Molteno implant.

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“…Due to increases in fibroblast activity, which impairs the formation of filtering blebs and reduces aqueous humor outflow, the failure rate of this surgery can reach 15–30% [2,3]. Conjunctival inflammation is an important contributor to the development of fibrosis.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Dry Eye Disease on Scar Formation in Rabbit Glaucoma Filtration Surgery

Hong¹,

Zhu²,

Zhang³

et al. 2017

IJMS

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The success rate of glaucoma filtration surgery is closely related to conjunctival inflammation, and the main mechanism of dry eye disease (DED) is inflammation. The aim of this study was to evaluate the effect of DED on bleb scar formation after rabbit glaucoma filtration surgery. Sixteen New Zealand white rabbits were randomly divided into control and DED groups. A DED model was induced by twice-daily topical administration of 0.1% benzalkonium chloride (BAC) drops for three weeks. Ocular examinations were performed to verify the DED model. Surgical effects were assessed, and histologic assessments were performed on the 28th postoperative day. Higher fluorescein staining scores, lower basal tear secretion levels and goblet cell counts, and increased interleukin 1β (IL-1β) levels were observed in the DED group. The DED eyes displayed significantly higher intraocular pressure (IOP)% on the 14th postoperative day; a smaller bleb area on days 14, 21 and 28; and a shorter bleb survival time. Moreover, proliferating cell nuclear antigen (PCNA) and alpha-smooth muscle actin (α-SMA) levels were significantly increased in the DED group. These results demonstrate that DED promotes filtering bleb scar formation and shortens bleb survival time; these effects may be mediated via IL-1β.

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Histopathologic Study of the Molteno Glaucoma Implant in Three Patients

Cited by 33 publications

References 16 publications

Altered Expression of Fibrosis Genes in Capsules of Failed Ahmed Glaucoma Valve Implants

Altered Expression of Fibrosis Genes in Capsules of Failed Ahmed Glaucoma Valve Implants

Otago Glaucoma Surgery Outcome Study

The Effect of Dry Eye Disease on Scar Formation in Rabbit Glaucoma Filtration Surgery

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