Prognose von Korneatransplantationen nach Bulbusperforation

Suleiman, Yusuf; Amm, Marita; Duncker, G.; Nölle, Bernhard

doi:10.1055/s-2004-813536

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…The magnitude of this secondary glaucomatous complication has most likely been underestimated in the past due to its frequently delayed manifestation, sometimes many years (“time bomb”). Epidemiological studies on secondary glaucoma are therefore limited and numbers citing incidence and outcomes vary substantially with geography and level of economy of the area ( Dana et al, 1995 ; Doren et al, 1990 ; Dubey et al, 2019 ; Gong et al, 2021 ; Li et al, 2022 ; Suleiman et al, 2004 ; Thylefors & Négrel, 1994 ). One source estimated that about six million patients in the world have secondary glaucoma compared with 67 million with the primary glaucoma ( Quigley & Broman, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

The prophylactic value of TNF‐α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

Paschalis,

Zhou,

Sharma

et al. 2023

Acta Ophthalmologica

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Background and PurposeLate secondary glaucoma is an often‐severe complication after acute events like anterior segment surgery, trauma and infection. TNF‐α is a major mediator that is rapidly upregulated, diffusing also to the retina and causes apoptosis of the ganglion cells and degeneration of their optic nerve axons (mediating steps to glaucomatous damage). Anti‐TNF‐α antibodies are in animals very effective in protecting the retinal cells and the optic nerve—and might therefore be useful prophylactically against secondary glaucoma in future such patients. Here we evaluate (1) toxicity and (2) efficacy of two TNF‐α inhibitors (adalimumab and infliximab), in rabbits by subconjunctival administration.MethodsFor drug toxicity, animals with normal, unburned corneas were injected with adalimumab (0.4, 4, or 40 mg), or infliximab (1, 10, or 100 mg). For drug efficacy, other animals were subjected to alkali burn before such injection, or steroids (for control). The rabbits were evaluated clinically with slit lamp and photography, electroretinography, optical coherence tomography, and intraocular pressure manometry. A sub‐set of eyes were stained ex vivo after 3 days for retinal cell apoptosis (TUNEL). In other experiments the optic nerves were evaluated by paraphenylenediamine staining after 50 or 90 days. Loss of retinal cells and optic nerve degeneration were quantified.ResultsSubconjunctival administration of 0.4 mg or 4.0 mg adalimumab were well tolerated, whereas 40.0 mg was toxic to the retina. 1, 10, or 100 mg infliximab were also well tolerated. Analysis of the optic nerve axons after 50 days confirmed the safety of 4.0 mg adalimumab and of 100 mg infliximab. For efficacy, 4.0 mg adalimumab subconjunctivally in 0.08 mL provided practically full protection against retinal cell apoptosis 3 days following alkali burn, and infliximab 100 mg only slightly less. At 90 days following burn injury, control optic nerves showed about 50% axon loss as compared to 8% in the adalimumab treatment group.ConclusionsSubconjunctival injection of 4.0 mg adalimumab in rabbits shows no eye toxicity and provides excellent neuroprotection, both short (3 days) and long‐term (90 days). Our total. accumulated data from several of our studies, combined with the present paper, suggest that corneal injuries, including surgery, might benefit from routine administration of anti‐TNF‐α biologics to reduce inflammation and future secondary glaucoma.

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Section: Introductionmentioning

confidence: 99%

The prophylactic value of TNF‐α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

Paschalis,

Zhou,

Sharma

et al. 2023

Acta Ophthalmologica

View full text Add to dashboard Cite

show abstract

“…The magnitude of this secondary glaucomatous complication has most likely been underestimated in the past due to its frequently delayed manifestation, sometimes many years (“time bomb”). Epidemiological studies on secondary glaucoma are therefore limited and numbers citing incidence and outcomes vary substantially with geography and level of economy of the area (Doren et al, 1990; Thylefors & Négrel 1994; Dana et al, 1995; Suleiman et al, 2004; Dubey et al, 2019; Gong et al, 2021; Li et al, 2021;). One source estimated that about 6 million patients in the world have secondary glaucoma compared with 67 million with the primary glaucoma (Quigley & Broman 2006).…”

Section: Introductionmentioning

confidence: 99%

The prophylactic value of TNF-α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

Paschalis

Zhou

Sharma

et al. 2022

Preprint

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Background and Purpose: Late secondary glaucoma is an often severe complication after acute events like anterior segment surgery, trauma, infection, etc. TNF-α is a major mediator that is rapidly upregulated, diffusing also to the retina and causes apoptosis of the ganglion cells and degeneration of their optic nerve axons (mediating steps to glaucomatous damage). Anti-TNF-α antibodies are in animals very effective in protecting the ganglion cells and the optic nerve - and might therefore be useful prophylactically against secondary glaucoma in patients. Here we evaluate 1) toxicity and 2) efficacy of two TNF-α inhibitors (adalimumab and infliximab), in rabbits by subconjunctival administration. Methods: For drug toxicity, animals with normal, unburned corneas were injected with adalimumab (0.4, 4, or 40 mg), or infliximab (1, 10, or 100 mg). For drug efficacy, other animals were subjected to alkali burn before such injection, or steroids. The rabbits were evaluated clinically with slit lamp and photography, electroretinography, optical coherence tomography, and intraocular pressure manometry. Some eyes were stained ex vivo after 3 days for retinal ganglion cell apoptosis (TUNEL). In other experiments the optic nerves were evaluated with paraphenylenediamine staining after 50 or 90 days. Loss of retinal ganglion cells and optic nerve degeneration were quantified. Results: Subconjunctival administration of 0.4 mg or 4.0 mg adalimumab were well tolerated, whereas 40.0 mg was toxic to the retina. 1, 10, or 100 mg infliximab were also well tolerated. Analysis of the optic nerve axons after 50 days confirmed the safety of 4.0 mg adalimumab or of 100 mg infliximab. For efficacy, 4.0 mg adalimumab subconjunctivally in 0.08 mL provided practically full protection against ganglion cell apoptosis 3 days following alkali burn, and infliximab 100 mg only slightly less. At 90 days following a burn, the control optic nerve showed about 50% axon loss but only about 8% if protected with adalimumab. Conclusions: Subconjunctival injection of 4.0 mg adalimumab in rabbits shows no eye toxicity and provides excellent neuroprotection, short (3 days) and long-term (90 days). Our total accumulated data from several studies,z combined with the present paper, suggest that corneal injuries, including surgery, might benefit from routine administration of anti-TNF-α biologics to reduce inflammation and future secondary glaucoma.

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“…6,7 The literature suggests that final VA is often poor, graft survival is low, and frequent postoperative complications occur compared with non–trauma-related transplants. 8–11 In the past 2 decades, improvement in surgical techniques and careful preoperative selection of patients have improved surgical outcomes in keratoplasty after OGI. 12 To optimize patient selection, preoperative counseling, and postoperative care, it is necessary to determine the preoperative characteristics that put patients at risk for graft failure and poor VA after transplantation.…”

mentioning

confidence: 99%

Outcomes of Penetrating Keratoplasty After Open Globe Injury

Durrani

Zhou

et al. 2021

Cornea

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The purpose of this study was to investigate the clinical features, surgical outcomes, and prognostic factors of penetrating keratoplasty (PKP) after open globe injury (OGI).Methods: A retrospective review of all patients treated for OGI between January 2000 and July 2017 was conducted. Demographic, preoperative, perioperative, and postoperative data were collected for those who underwent PKP after OGI. The predictive value of each preoperative variable on graft failure was assessed using univariate and multivariable Cox proportional hazards models, and the predictive value of variables on post-PKP visual outcome was assessed using both univariate and multivariable logistic regression models. All eyes that underwent PKP after OGI were included unless they had less than 365 days of follow-up.Results: Forty-six eyes that underwent PKP met inclusion criteria.The median age was 46 years (interquartile range = 23.00-61.25), median follow-up was 78.5 months (interquartile range = 38.63-122.02), and 37 of 46 subjects (80.4%) were male. The observed 1-and 5-year graft survival estimates were 80.4% and 41.7%, respectively. Factors statistically associated with graft failure in multivariable analyses were rejection episode, hazard ratio (HR) = 3.29; retinal detachment (RD), HR = 3.47; and endophthalmitis, HR = 6.27. Fifteen of 42 eyes (35.7%) regained ambulatory vision (20/200 or better). The strongest predictors of vision worse than 20/200 at the last follow-up were RD, odds ratio (OR) = 43.88; graft rejection, OR = 12.42; and injury outside the workplace, OR = 25.05.Conclusions: Despite a high graft survival at 1 year, most of the patients did not regain ambulatory vision. Graft rejection, RD, and endophthalmitis were risk factors for graft failure. These factors should be considered when counseling patients regarding PKP after OGI.

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Prognose von Korneatransplantationen nach Bulbusperforation

Abstract: Compared to patients with Fuchs' dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary glaucoma and graft rejection.

Cited by 7 publications

References 22 publications

The prophylactic value of TNF‐α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

The prophylactic value of TNF‐α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

The prophylactic value of TNF-α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma

Outcomes of Penetrating Keratoplasty After Open Globe Injury

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