Long-term Morphologic Effects of Antiglaucoma Drugs on the Conjunctiva and Tenon's Capsule in Glaucomatous Patients

Sherwood, Mark B.; Grierson, Ian; Millar, Lynn; Hitchings, Roger A.

doi:10.1016/s0161-6420(89)32888-0

Cited by 334 publications

(191 citation statements)

References 7 publications

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“…II This has been linked to the effects of prolonged topical therapy,1O which has been shown to increase the number of tissue inflammatory cells. 12 In a study of factors affecting lOP control after three different drainage procedures (posterior lip sclerectomy, trabeculectomy and 'guarded keratostomy') in 194 eyes of 158 patients, Levene dismissed diabetes as a factor in pressure control. 13 However, there were only 17 eyes from patients with diabetes in his study and there is no mention…”

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confidence: 99%

Trabeculectomy in diabetic patients with glaucoma

Hugkulstone¹,

Smith²,

Vernon³

1993

Eye

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SUMMARYForty-one eyes of 41 patients with diabetes mellitus who underwent trabeculectomy over a 4-year period were compared with 41 age-and sex-matched controls, who were also matched for date of operation and surgical technique. The two groups were comparable for glau coma diagnoses, duration of glaucoma before admission and number of ocular hypotensive medications. The intraocular pressures at diagnosis and on admission were similar. Post-operative complications were equally fre quent. The mean intraocular pressure at 6 months was significantly lower in the control group, and fewer dia betic patients achieved either an intraocular pressure <21 mmHg or successful drainage (defined as an intra ocular pressure <21 mmHg on no treatment) at 6 months and at the final visit, after similar periods of follow-up.Trabeculectomy in diabetic patients with pre-existing retinopathy resulted in a significantly higher intraocular pressure at 6 months than when no retinopathy was present.Since its introduction in 1968,1 trabeculectomy has become the procedure of choice for glaucoma. Subsequent reports have documented its success in the control of intra ocular pressure (IOP),2-8 and it has been shown to offer better control of glaucoma, in terms of lOP and progres sive field loss, when used as primary treatment.9, I O How ever, failure does occur, and is characterised by a marked inflammatory response in the conjunctival dermis and Tenon's capsule in early (less than 6 months) failure. II This has been linked to the effects of prolonged topical therapy,1O which has been shown to increase the number of tissue inflammatory cells.12 In a study of factors affecting lOP control after three different drainage procedures (posterior lip sclerectomy, trabeculectomy and 'guarded keratostomy') in 194 eyes of 158 patients, Levene dismissed diabetes as a factor in pressure control. 13 However, there were only 17 eyes from patients with diabetes in his study and there is no mention of their distribution between the three surgical procedures, which were performed consecutively without random allocation. There is very little in the literature on trabecu lectomy in diabetic patients. We present here the first such study and compare the results with a matched, non-dia betic control group. METHODSPatients with diabetes mellitus who had undergone trabec ulectomy between 1 April 1987 and 31 March 1991 were identified from theatre records. These were age-and sex matched (again from the theatre registers) with non-dia betic patients who had had trabeculectomy at the same time. They were also matched for surgical technique (lim bus-or fornix-based conjunctival flaps being the only major difference).The notes for these two groups were then reviewed. Glaucoma diagnosis and date, duration of disease before admission (in months) and treatment on admission were recorded. Anaesthetic technique and post-operative com plications were noted. lOPs were recorded at diagnosis, on admission, at the first post-operative visit, at 6 months fol lowing surgery and at t...

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confidence: 99%

Trabeculectomy in diabetic patients with glaucoma

Hugkulstone¹,

Smith²,

Vernon³

1993

Eye

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“…However, several investigators have suggested that the prolonged medical treatment may prejudice the success of surgical treatment priming the conjunctival cellular population for an excessive response to surgical wounding. Prolonged medical treatment has been reported to stimulate increased conjunctival cell expression of the inflammatory cell marker HLA-DR. 14, 15 Sherwood et al 16 (using toluidine blue staining and cell morphology techniques) reported a significant increase in macrophages, lymphocytes, mast cells, and fibroblasts in the group of glaucoma patients who had received more than two types of drops for at least 1 year compared with glaucoma patients who underwent filtration surgery as a primary treatment. Broadway et al 17 reported that glaucoma patients who had received multiple topical treatments have a lower success rate after filtration surgery compared with those who undergo primary trabeculectomy.…”

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Increased mast cell numbers in the conjunctiva of glaucoma patients: a possible indicator of preoperative glaucoma surgery inflammation

Chang

Wong

Ohbayashi³

et al. 2008

Eye

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“…Кроме того, в ходе ряда иссле-дований установлено, что частота глазной сим-птоматики зависит от наличия в составе капель консерванта [29,36] и количества используемых препаратов [32], а прекращение инстилляций существенно снижает выраженность клиниче-ских проявлений [36,45]. Опубликованы данные о развитии субконъюнктивального фиброза у па-циентов, длительное время находящихся на мест-ной терапии, что обусловлено увеличением коли-чества фибробластов в субэпителиальной строме вследствие повышения числа провоспалительных клеток [16,22,41]. Показано, что продолжитель-ные инстилляции гипотензивных препаратов мо-гут провоцировать укорочение сводов конъюн-ктивы [40], способное привести к выраженному рубцеванию конъюнктивы и помутнениям рого-вицы [44].…”

Section: The Influence Of Local Iop-lowering Therapy On the Anterior unclassified

“…М. Sherwood et al (1989) сравнили две группы пациентов -после пер-вичной хирургии глаукомы и после длительной местной терапии, показав существенное уве-личение численности макрофагов, лимфоцитов, тучных клеток и фибробластов в конъюнктиве и теноновой капсуле и существенное сниже-ние численности эпителиальных бокаловидных клеток во второй группе [41]. Согласно ряду отечественных исследований глаукомный про-цесс может коррелировать с провоспалитель-ными процессами деградации и апоптоза тканей переднего отрезка глаза [7,8].…”

Section: The Influence Of Local Iop-lowering Therapy On the Anterior unclassified

The influence of local IOP-lowering therapy on the anterior segment tissues and outcome of glaucoma filtering surgery

Petrov

Юрьевич²,

Lovpache

et al. 2017

Ophthalmology Reports

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Nowadays, a wide choice of local IOP-lowering medications allows ensuring a successful intraocular pressure compensation and primary open angle glaucoma stabilization. However, taking into consideration a long term action of drugs on the ocular surface, even without clinical manifestations there is a direct inflammatory cells’ activation with mixed toxic and allergic changes, which is confirmed by histology, immune-histology, and impression cytology methods. Such chronic sub-clinical inflammation represent a potential risk of excessive fibroblast proliferation with subsequent rapid postoperative scarring of new outflow pathways and atypical filtration bleb formation. It is shown that there is a clear relationship between number of glaucoma drugs used, treatment duration, intensity of conjunctival infiltration with inflammatory cells and fibroblasts, and risk of episcleral fibrosis and subconjunctival scarring during post-op period. (For citation: Petrov SYu, Lovpache DzhN, Loskutov IA, Safronova DM. The influence of local IOP-lowering therapy on the anterior segment tissues and outcome of glaucoma filtering surgery. Ophthalmology Journal. 2017;10(4):41-47. doi: 10.17816/OV10441-47).

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Long-term Morphologic Effects of Antiglaucoma Drugs on the Conjunctiva and Tenon's Capsule in Glaucomatous Patients

Cited by 334 publications

References 7 publications

Trabeculectomy in diabetic patients with glaucoma

Trabeculectomy in diabetic patients with glaucoma

Increased mast cell numbers in the conjunctiva of glaucoma patients: a possible indicator of preoperative glaucoma surgery inflammation

The influence of local IOP-lowering therapy on the anterior segment tissues and outcome of glaucoma filtering surgery

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