Long‐term result of combined ab externo Schlemm’s canal surgery and phacoemulsification in management of open angle glaucoma in cataract patients

We evaluated the effects of ripasudil on the distal aqueous outflow tract in patients with open-angle glaucoma (OAG) who underwent a 360° suture trabeculotomy ab interno followed by ripasudil treatment beginning 1 month postoperatively. We compared 27 of these patients, by using propensity score analysis, with 27 patients in a matched control group who had no ripasudil treatment. We assessed the changes in the mean intraocular pressure (IOP) and the relationship between the IOP changes and background factors. All eyes had a complete 360° Schlemm’s canal incision and phacoemulsification. The mean IOP at 1 and 3 months after ripasudil administration were significantly reduced by −1.7 ± 1.9 mmHg (p < 0.0001) and −1.3 ± 2.3 mmHg (p = 0.0081) in the ripasudil group, respectively, but IOP in the control group was not significantly reduced. The IOP reduction was significantly associated with the IOP before ripasudil treatment (p < 0.001). In conclusion, the use of ripasudil for patients with OAG after circumferential incision of the Schlemm’s canal produced significant IOP reductions. Ripasudil may affect the distal outflow tract, thereby leading to the IOP reduction.

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Role of the Blockade of Schlemm's Canal in Pathogenesis of Primary Open-Angle Glaucoma

American Journal of Ophthalmology ◽

10.1016/0002-9394(70)90484-8 ◽

1970 ◽

Vol 70 (5) ◽

pp. 691-696 ◽

Cited By ~ 53

Author(s):

A.P. Nesterov

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Schlemm’S Canal ◽

Schlemm's Canal

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Positive correlation between blood reflux in Schlemm's canal and the decrease of intraocular pressure after selective laser trabeculoplasty in primary open‑angle glaucoma

Experimental and Therapeutic Medicine ◽

10.3892/etm.2018.6051 ◽

2018 ◽

Cited By ~ 1

Author(s):

Jie‑Ling Gong ◽

Samer Al‑Wesabi ◽

Yin Zhao ◽

Hong Zhang

Keyword(s):

Intraocular Pressure ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Selective Laser Trabeculoplasty ◽

Schlemm’S Canal ◽

Positive Correlation ◽

Schlemm's Canal ◽

Laser Trabeculoplasty

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A Randomized Trial of a Schlemm's Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open-Angle Glaucoma

Ophthalmology ◽

10.1016/j.ophtha.2015.03.031 ◽

2015 ◽

Vol 122 (7) ◽

pp. 1283-1293 ◽

Cited By ~ 96

Author(s):

Norbert Pfeiffer ◽

Julian Garcia-Feijoo ◽

Jose M. Martinez-de-la-Casa ◽

Jose M. Larrosa ◽

Antonio Fea ◽

...

Keyword(s):

Intraocular Pressure ◽

Randomized Trial ◽

Open Angle Glaucoma ◽

Open Angle ◽

Schlemm’S Canal ◽

Schlemm's Canal

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12-month interim results of a prospective study of patients with mild to moderate open-angle glaucoma undergoing combined viscodilation of Schlemm’s canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery

European Journal of Ophthalmology ◽

10.1177/1120672121998234 ◽

2021 ◽

pp. 112067212199823

Author(s):

Iwona Grabska-Liberek ◽

Patrycja Duda ◽

Monika Rogowska ◽

Julita Majszyk- Ionescu ◽

Agnieszka Skowyra ◽

...

Keyword(s):

Cataract Surgery ◽

Open Angle Glaucoma ◽

Case Series ◽

Open Angle ◽

Schlemm’S Canal ◽

Schlemm's Canal ◽

Prospective Case Series ◽

A Prospective Study ◽

Time Point

Purpose: To characterize clinical outcomes of combined viscodilation of Schlemm’s canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery in eyes with mild to moderate open-angle glaucoma (OAG). Methods: In this prospective case series, the OMNI glaucoma surgical platform (Sight Sciences, Menlo Park, CA) was utilized to perform the procedure either combined with phacoemulsification or as a standalone procedure. Changes from baseline in intraocular pressure (IOP) and IOP-lowering medications were evaluated through the first 12 months of a planned 24-month follow-up period. Results: Among 17 eyes of 15 subjects, mean IOP was reduced from 20.4 mmHg to 12.7–13.7 mmHg through 12 months of follow-up ( p < 0.001 at every time point) and mean medications reduced from 2.5 to 0.1–0.6 ( p < 0.001 at every time point). IOP reductions in eyes undergoing standalone surgery were approximately 2–4 mmHg greater at each time point compared to eyes undergoing surgery combined with phacoemulsification; this may be related to a higher baseline IOP in the former eyes (22.1 vs 18.5 mmHg). Six eyes developed hyphema, of which three required washout for elevated IOP on the first postoperative day; six additional eyes had IOP elevations that resolved with medical management. Conclusion: Viscodilation of Schlemm’s canal and collector channels paired with ab interno trabeculotomy performed with a single integrated instrument (OMNI), whether as standalone or combined with phacoemulsification, effectively lowers both IOP and the need for IOP-lowering medications through 12 months of follow-up.

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Reduction in trabecular meshwork stem cell content in donor eyes with primary open angle glaucoma

Scientific Reports ◽

10.1038/s41598-021-03345-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yogapriya Sundaresan ◽

Lakshmi Priya Manivannan ◽

Shanthi Radhakrishnan ◽

Krishnadas Subbiah Ramasamy ◽

Muthukkaruppan Veerappan ◽

...

Keyword(s):

Stem Cell ◽

Trabecular Meshwork ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Stem Cell Marker ◽

Histopathological Analysis ◽

Open Angle ◽

Cell Marker ◽

Schlemm’S Canal ◽

Schlemm's Canal

AbstractWe previously identified and characterized human trabecular meshwork stem cells (TMSCs) based on high expression of ABCG2/p75 positivity and high nucleus to cytoplasmic ratio. These TMSCs expressing high ABCG2 and p75 were located to the insert region of the human TM. Additionally, we demonstrated an age-related reduction in the TMSC content which was significantly associated with TM cell loss. In continuation, this study was aimed to determine the TMSC content in glaucomatous donor eyes wherein a drastic reduction in TM cellularity has already been reported. Anterior segments from known glaucomatous (n = 6) and age-matched normal (n = 8) donors were dissected into four quadrants. A minimum of three sections from each quadrant were used for histopathological analysis as well as immunostaining. Analysis of hematoxylin and eosin-stained sections from glaucomatous tissues revealed a decrease in total TM cellularity, thickening of trabecular beams, fusion of trabeculae, absence of patent Schlemm’s canal compared to age-matched controls. In addition, the TM thickness at various positions of the meshwork and the coronal as well as the meridional diameters of the Schlemm’s canal were observed to be significantly reduced in glaucomatous eyes. Further, sections from both the groups were immunostained for universal stem cell marker ABCG2 and neural crest derived stem cell marker p75. The images were acquired using Leica SP8 confocal microscope. Quantification of total TM cellularity based on nuclear counterstain (mean ± SD) using ImageJ identified 69.33 ± 12.77 cells/section in control eyes. In glaucomatous donors, the TM cellularity was found to be reduced significantly to 41.83 ± 9.0 (p = 0.0007). In addition, a reduction in the percentage of TMSCs (cells with high ABCG2 expression and p75 positivity) was evident in glaucomatous donors (0.14 ± 0.17%) compared to age-matched controls (4.73 ± 5.46%) (p = 0.064). Thus, the present study confirmed the significant decline in TM cellularity and a reducing trend in the TMSC content, though this reduction was non-significant in glaucomatous donor eyes. Further studies are essential to elucidate the role of TMSCs in the pathogenesis of primary open angle glaucoma.

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