The surgical management of chronic hypotony due to uveitis

Smet, Marc D. de; Gunning, Frans P.; Feenstra, R

doi:10.1038/sj.eye.6701425

Cited by 40 publications

(12 citation statements)

References 20 publications

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“…Neither injection of saline solution nor lymphocytes could decrease IOP, indicating that IOP drop did not result from nonspecific medium or cell injections. In addition, lymphocytes being particularly prone to induce immune reactivity, the fact that their administration failed to decrease IOP suggests that the decreased pressure did not result from an increased inflammatory response to the graft [47–49]. Interestingly, MSC injected in the anterior ocular chamber persisted only for a few days, far less than the 5 weeks persistence in the retina observed after MSC injection in the vitreous in a similar glaucoma model [50].…”

Section: Discussionmentioning

confidence: 99%

Transplantation of Mesenchymal Stem Cells Promotes Tissue Regeneration in a Glaucoma Model Through Laser-Induced Paracrine Factor Secretion and Progenitor Cell Recruitment

et al. 2013

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Among bone marrow cells, hematopoietic and mesenchymal components can contribute to repair damaged organs. Such cells are usually used in acute diseases but few options are available for the treatment of chronic disorders. In this study, we have used a laser-induced model of open angle glaucoma (OAG) to evaluate the potential of bone marrow cell populations and the mechanisms involved in tissue repair. In addition, we investigated laser-induced tissue remodeling as a method of targeting effector cells into damaged tissues. We demonstrate that among bone marrow cells, mesenchymal stem cells (MSC) induce trabecular meshwork regeneration. MSC injection into the ocular anterior chamber leads to far more efficient decrease in intraocular pressure (IOP) (p < .001) and healing than hematopoietic cells. This robust effect was attributable to paracrine factors from stressed MSC, as injection of conditioned medium from MSC exposed to low but not to normal oxygen levels resulted in an immediate decrease in IOP. Moreover, MSC and their secreted factors induced reactivation of a progenitor cell pool found in the ciliary body and increased cellular proliferation. Proliferating cells were observed within the chamber angle for at least 1 month. Laser-induced remodeling was able to target MSC to damaged areas with ensuing specific increases in ocular progenitor cells. Thus, our results identify MSC and their secretum as crucial mediators of tissue repair in OAG through reactivation of local neural progenitors. In addition, laser treatment could represent an appealing strategy to promote MSC-mediated progenitor cell recruitment and tissue repair in chronic diseases. STEM

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Section: Discussionmentioning

confidence: 99%

Transplantation of Mesenchymal Stem Cells Promotes Tissue Regeneration in a Glaucoma Model Through Laser-Induced Paracrine Factor Secretion and Progenitor Cell Recruitment

et al. 2013

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Section: Aetiology Histopathology and Mechanismsmentioning

confidence: 99%

“…Choroidal fluid is believed to accumulate as a result of enhanced uveoscleral outflow and decreased aqueous humour production, a cycle that is often perpetuated once choroidal effusion develops. A ring of anterior choroidal fluid can rotate the ciliary body forward, impairing its ability to produce aqueous humour (Weekers & Delmarcelle 1953;de Smet et al 2005). Dellaporta (1954) believed that, in hypotonic eyes, the protruding nerve head pulled the nerve-fibre layer causing friction between the retina and the pigment epithelium of the retina along the nerve fibres.…”

Section: Aetiology Histopathology and Mechanismsmentioning

confidence: 99%

Hypotony maculopathy

Costa

Arcieri

2007

Acta Ophthalmologica Scandinavica

128

112

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ABSTRACT. Hypotony maculopathy, first described in 1954 by Dellaporta, usually occurs after antiglaucomatous surgery or after perforating eye injuries; it is characterized by hypotony associated with fundus abnormalities, including papilloedema, vascular tortuosity and chorioretinal folds. In hypotony maculopathy, the scleral wall collapses inward, resulting in redundancy of the choroid and retina, leading to chorioretinal wrinkling. As the antero-posterior diameter of the vitreous cavity decreases, the very thick perivofeal retina surrounding the very thin foveal retina is thrown into radial folds around the fovea. It has been reported that hypotony maculopathy occurs in up to 20% of cases of glaucoma filtering surgery and has become more common after the introduction of antimetabolites. Young age, myopia, primary filtering surgery, systemic illnesses and elevated preoperative intraocular pressure (IOP) have been found to be associated with hypotony maculopathy. Hypotony maculopathy is treated with procedures designed to elevate IOP, which may reverse the inward scleral bowing and improve visual acuity. The successful treatment of hypotony maculopathy depends on the correct identification of its cause. Once the cause is detected, treatment should be employed as soon as possible because delayed normalization of the IOP may result in permanent macular chorioretinal changes and poor vision. This review will explore the definition, mechanisms, clinical findings and treatment of hypotony maculopathy.

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“…It allows direct localization and observation of the tear with its associated vitreous traction, allowing one to decide on the most expedient means of re-attaching the retina, thus avoiding unnecessary surgery. 16,17 By-passing the anterior segment opacities shortens the surgical intervention and avoids extensive eye surgery. This allows for a more rapid recovery, as it minimizes trauma to ocular structures.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery—endoscopic retinal detachment repair in patients with media opacities

Smet

Mura

2007

Eye

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Purpose Evaluate the use of an ophthalmic endoscope in patients with a retinal detachment and anterior media opacity. Materials and methods A retrospective interventional case series. Search of a comprehensive database of retinal detachment patients with pre-operatively impaired anterior segments such that lens extraction, a keratoprosthesis, or extensive anterior segment manipulation was required for adequate repair. Pars plana vitrectomy was carried out with an endoscope without manipulation of the anterior segment. Characteristics of the detachment were recorded, as were complications/subsequent surgeries, pre-operative, 3-month post-operative, and final follow-up visual acuities. Results Before surgery, five patients had a gas-induced cataract after a failed pneumatic retinopexy; one patient had a Reis-Buckler's dystrophy and corneal ulcer; three patients had synechiae around iris-fixed lenses. One patient had proliferative vitreoretinopathy. The median pre-operative vision was hand motion (20/30 to light perception). The median final visual acuity was 20/30 (20/20-20/200). Two patients required a subsequent lens extraction, one patient had a recurrent detachment. Conclusion In appropriate retinal detachment patients, endoscopy can be safe and effective, while limiting the scope of the surgical intervention.

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The surgical management of chronic hypotony due to uveitis

Cited by 40 publications

References 20 publications

Transplantation of Mesenchymal Stem Cells Promotes Tissue Regeneration in a Glaucoma Model Through Laser-Induced Paracrine Factor Secretion and Progenitor Cell Recruitment

Transplantation of Mesenchymal Stem Cells Promotes Tissue Regeneration in a Glaucoma Model Through Laser-Induced Paracrine Factor Secretion and Progenitor Cell Recruitment

Hypotony maculopathy

Minimally invasive surgery—endoscopic retinal detachment repair in patients with media opacities

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