scholarly journals Bleb-Independent Glaucoma Surgery to Activate the Uveolymphatic Route of Non-Trabecular Aqueous Humor Outflow: Short-Term Clinical and OCT Results

Vision ◽  
2022 ◽  
Vol 6 (1) ◽  
pp. 4
Author(s):  
Vinod Kumar ◽  
Kamal Abdulmuhsen Abu Zaalan ◽  
Andrey Igorevich Bezzabotnov ◽  
Galina Nikolaevna Dushina ◽  
Ahmad Saleh Soliman Shradqa ◽  
...  
Keyword(s):  
Aqueous Humor ◽  
Distal Part ◽  
Lymphatic Vessels ◽  
Glaucoma Surgery ◽  
Proximal Part ◽  
Deep Sclerectomy ◽  
Aqueous Humor Outflow ◽  
Collagen Implant ◽  
The Mean ◽  
Partial Success

The deep sclerectomy technique was modified to enhance aqueous humor (AH) outflow via the non-trabecular pathway. A pilot study was carried out to assess its safety and effectiveness. Thirty-eight patients were under observation. After superficial scleral flap (4 × 4 mm), deep scleral layers were divided into three parts by three parallel-to-limbus incisions. Deep sclerectomy without creating a window in the Descemetes’ membrane was carried out in the distal part. A collagen implant was placed under the sclera of the remaining two parts with one end in the intrascleral pool. The third proximal part was excised to expose the uvea and implant. A Nd:YAG laser trabeculotomy at the surgery site was made on postoperative days 7–10. Outcome measures were IOP change, use of hypotensive medication(s), complications, and the need for a second surgery. At six months, the mean IOP decreased from 29.1 ± 9.2 mm Hg to 14.0 ± 4.3 mm Hg (p = 1.4 × 10−9); hypotensive medication use reduced from 2.9 ± 0.9 to 0.6 ± 1.0 (p = 1.3 × 10−10); complete success was achieved in 68.4% of cases and partial success was achieved in 31.6% of cases. Intraoperative and postoperative complications were rare and manageable. The OCT of the surgery site revealed the absence of bleb in all cases. Lymphatic vessels with characteristic bicuspid valves in their lumen were detected in conjunctiva near the operation site and over it in 32 patients. IOP decrease in the proposed technique was achieved by activation of the uveolymphatic route of AH outflow.

scholarly journals Activation of uveolymphatic outflow pathway after non-penetrating glaucoma surgery without filtering bleb: case reports

2021 ◽  
Vol 21 (2) ◽  
pp. 108-115
Author(s):  
V. Kumar ◽  
◽  
K.A. Abu Zaalan ◽  
M.A. Frolov ◽  
A.S. Shradqa ◽  
...  
Keyword(s):  
Open Angle Glaucoma ◽  
Case Reports ◽  
Lymphatic Vessels ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Modified Technique ◽  
Filtering Bleb ◽  
Aqueous Humor Outflow ◽  
Collagen Implant ◽  
Outflow Pathway

The authors propose a modified technique of non-penetrating filtering glaucoma surgery for primary open-angle glaucoma (POAG) to improve the uveoscleral outflow. The study enrolled 11 patients with POAG. A novel surgical technique included two steps. The first step was modified deep sclerectomy and cyclodyalysis with collagen implant placed into the supraciliary space. The second step (after 7–10 days) was YAG laser trabeculotomy. Surgical site and adjacent areas were examined by optical coherence tomography (OCT). After 6 months, mean IOP significantly reduced by 52% (from 30.0±10.3 mm Hg to 14.6±5.0 mm Hg, р=0.0004) while the number of IOP-lowering medications reduced by 79% (from 2.9±1.0 to 0.6±0.4, р=0.000001). The aqueous humor outflow occurred through conjunctival lymphatic vessels without filtering bleb formation, as illustrated by OCT. Postoperative complications were minor and easy-to-treat. Three case reports are discussed. Keywords: open-angle glaucoma, glaucoma surgery, conjunctival lymphatics, filtering bleb, non-penetrating glaucoma surgery, uveolymphatic outflow pathway. For citation: Kumar V., Abu Zaalan K.A., Frolov M.A. et al. Activation of uveolymphatic outflow pathway after non-penetrating glaucoma surgery without filtering bleb: case reports. Russian Journal of Clinical Ophthalmology. 2021;21(2):108–115. DOI: 10.32364/2311-7729-2021- 21-2-108-115.

Regional differences in potassium content of smooth muscle from opossum esophagus.

1978 ◽  
Vol 235 (6) ◽  
pp. E709
Author(s):  
K Schulze ◽  
J J Hajjar ◽  
J Christensen
Keyword(s):  
Smooth Muscle ◽  
Distal Part ◽  
Proximal Part ◽  
Distal Segment ◽  
Intracellular Concentration ◽  
Potassium Content ◽  
Intracellular Potassium ◽  
The Mean ◽  
Intracellular Potassium Concentration ◽  
Space Volume

Strips from the proximal part of the smooth muscle segment of opossum esophagus have a significantly higher potassium content (50 +/- 3 meq/kg) than those from the distal part (38 +/- 3 meq/kg). There are no significant differences between the two regions in content of sodium (65 +/- 4 meq/kg in proximal, 71 +/- 3 meq/kg in distal) or chloride (48 +/- 10 meq/kg in proximal, 42 +/- 5 meq/ kg in distal). The mean [14C]inulin uptake is 240 +/- 10 ml/kg in both proximal and distal strips. [14C]polyethylene glycol uptake is smaller and [14C]sucrose and [14C]mannitol uptake in both areas are larger than that of inulin. Intracellular potassium concentration (based on the inulin uptake as an estimate of the extracellular space volume) is significantly higher proximally (71 +/- 3 mM) than distally (52 +/- mM). Ouabain, 10(-4) M, increases the intracellular concentration of sodium and decreases the intracellular concentration of potassium in both the proximal and distal segment. The efflux of 86Rb, measured by a washout technique, is higher in the distal than in the proximal smooth muscle segment. A difference in membrane permeability to rubidium and hence, potassium between proximal and distal smooth muscle segments may account in part for the different intracellular potassium concentrations.

scholarly journals Deep Sclerectomy with Goniosynechiolysis Ab Interno for Chronic Glaucoma Associated with Peripheral Anterior Synechiae

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Alireza Mirshahi ◽  
Peter Raak ◽  
Katharina Ponto ◽  
Bernhard Stoffelns ◽  
Katrin Lorenz ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Covariance Structure ◽  
Glaucoma Surgery ◽  
Deep Sclerectomy ◽  
Chronic Glaucoma ◽  
Target Pressure ◽  
The Mean ◽  
One Year ◽  
Ab Interno

Purpose. To report one-year results of phacoemulsification combined with deep sclerectomy and goniosynechiolysis ab interno for chronic glaucoma associated with peripheral anterior synechiae (PAS).Methods. We retrospectively analyzed medical charts of 16 patients (20 eyes) treated by one-site combined phacoemulsification and deep sclerectomy with goniosynechiolysis ab interno. PAS were transected by a spatula introduced into the anterior chamber through a paracentesis. To account for the correlation of right and left eyes a linear mixed model with unstructured covariance structure was calculated.Results. The mean preoperative intraocular pressure (IOP) was20.3±5.2 mmHg with2.4±1.0medications. One year postoperatively, the mean IOP was15.3±3.3 mmHg (P=0.004, pairedt-test) with0.6±1.0medications. A postoperative IOP of ≤21 mmHg without medication was achieved in 17 of 19 eyes (89.5%) and in 12/19 eyes (63.2%) at 3 and 12 months after surgery, respectively. In the remaining eyes (10.5% at 3 months and 36.8% at 12 months), additional medication led to an IOP ≤21 mmHg or the target pressure. No case required further glaucoma surgery. In one eye, conversion of the surgery to trabeculectomy was necessary due to Descemet’s window rupture.Conclusions. With goniosynechiolysis ab interno, effective and safe nonpenetrating glaucoma surgery is possible in presence of PAS.

scholarly journals A Variant of Micro-Invasive Glaucoma Surgery: Calibrated Reverse Meridional Cyclodialysis ab interno Involving Implantation of a Non-Absorbable Collagen Implant

2021 ◽  
Vol 18 (1) ◽  
pp. 61-69
Author(s):  
V. Kumar ◽  
A.S. S. Shradqa ◽  
K. A. Abo Zaalan
Keyword(s):  
Medication Use ◽  
Glaucoma Surgery ◽  
Intraoperative Complication ◽  
Surgery Outcome ◽  
Collagen Implant ◽  
Second Surgery ◽  
Partial Success ◽  
Cyclodialysis Ab Interno ◽  
Ab Interno ◽  
Cyclodialysis Cleft

Purpose. To assess safety and effectiveness of calibrated cyclodialysis ab interno involving implantation of a non-absorbable collagen implant in the suprauveal space in decreasing IOP in glaucoma patients.Methods. Forty-three patients (43 eyes; 16 male and 27 females; average age — 70.4 ± 10.0 years) were included in this pilot study. A 6 mm long and 2.0 mm wide cyclodialysis cleft was created ab interno in one of the lower quadrants of the eye using a specially designed spatula followed by insertion of a strip of implant in the cleft. In 19 eyes (44.3 %) the procedure was performed as standalone procedure and in 24 eyes (55.7 %) along with cataract surgery. Outcome measures were IOP change, use of hypotensive medication(s), complications, and need for a second surgery. Decrease in IOP by >20 % and IOP between 6 and 21 mmHg without hypotensive medication(s) constituted complete success; similar changes in IOP with medication(s) constituted partial success. Need for second surgery constituted failure.Results. At 6 months, baseline IOP decreased from 20.6 ± 7.4 mmHg to 12.9 ± 4.9 mmHg (a decrease by 37.4 %; р < 0.001) and hypotensive medication use reduced from 2.6 ± 0.8 to 1.0 ± 1.1 (a reduction by 57.7 %; р < 0.001). Complete success was achieved in 19 eyes (44.2 %), partial in — 15 eyes (34.9 %). Nine eyes had unsuccessful outcomes (20.9 %); among these, seven eyes (78 %) had severe glaucoma and five eyes (55 %) had undergone previously glaucoma surgeries. Hemorrhaging at the cleft site was the most common intraoperative complication — 18 eyes (41.9 %). Postoperative complications included hyphema, which was completely resorbed within one week.Conclusion. Calibrated cyclodialysis ab interno procedure involving implantation of a non-absorbable collagen implant in the suprauveal is safe and easy to perform. It effectively decreases IOP in patients with moderate glaucoma but is less effective in patients with severe glaucoma and in patients with previously failed glaucoma surgeries. Complications were found to be minimal.

scholarly journals The Role of Biologically Active Aqueous Humor Molecules of the Anterior Chamber and Lacrimal Fluid in the Implementation of the Hypotensive Effect of Non-Penetrating Deep Sclerectomy

2021 ◽  
Vol 6 (2) ◽  
pp. 126-132
Author(s):  
N. V. Volkova ◽  
Ju. V. Malysheva ◽  
T. N. Iureva ◽  
S. I. Kolesnikov
Keyword(s):  
Anterior Chamber ◽  
Aqueous Humor ◽  
Hypotensive Effect ◽  
Biologically Active ◽  
Control Group ◽  
Formation Mechanisms ◽  
Deep Sclerectomy ◽  
Lacrimal Fluid ◽  
Aqueous Humor Outflow

To date, the factors affecting the course of the reparative process after non-penetrating deep sclerectomy (NPDS) have not been fully determined. There is no systematic information about the regulatory role of the cytokines TGF-β, IL-6, IL-8 and MMP-9, VEGF A 121 and 165 in the formation mechanisms of the newly created pathways consistency of intraocular aqueous humor outflow.Purpose. To determine possible ways of impact of biologically active aqueous humor molecules of the anterior chamber and lacrimal fluid on the hypotensive effect of non-penetrating deep sclerectomy.Methods. A prospective study of 65 patients with open-angle glaucoma before and 12 months after NPDS and 22 patients without eye hydrodynamic disorders with the determination of the initial concentrations of biologically active molecules in the lacrimal fluid and aqueous humor of the anterior chamber. Twelve months after NPDS all patients were divided into three groups, depending on the hypotensive effect of the operation, according to the criteria.Results. Multivariate discriminant analysis showed the greatest inter-group differences, calculated by the square of the Mahalanobis distance, between group 3 with no hypotensive effect of NPDS and the control group (R2 = 8.48, p = 0.001). The most informative features that determine the differences between the 4 groups in the total population, calculated according to the Fischer F-test, were MMP-9 (F = 14.7, p = 0.001) and TGF-β (F = 7.08, p = 0.001) in the aqueous humor of the anterior chamber. In pairwise comparison of groups 1 and 2, the maximum level of significance according to the F-criterion was characteristic of the level of tear IL-6 (F = 21.25, p = 0.001), with approximately equal degree – IL-8 (F = 7.85, p = 0.001) and VEGF (F = 7.12, p = 0.001), to a lesser extent TGF of aqueous humor (F = 4.43, p = 0.001) and MMR-9 (F = 2.23, p = 0.001). Between groups 1–3, the maximum differences according to the Fisher criterion were observed in the IL-8 (F = 20.99, p = 0.001), TGF (F = 8.75, p = 0.001) and to a lesser extent – TGF (F = 5.83, p = 0.001).Conclusion. The analysis of the obtained data showed the decisive role of the imbalance of proinflammatory cytokines, signaling proteins with prolymphoangiogenic activity, and MMP-9 in the aqueous humor of the anterior chamber, as well as in the initial state of the lacrimal fluid in the postoperative healing processes after NPDS. 

scholarly journals Organogenesis and Distribution of the Ocular Lymphatic Vessels in the Anterior Eye: Implication to Glaucoma Surgery Site Selection

2019 ◽  
Author(s):  
Yifan Wu ◽  
Young Jin Seong ◽  
Kin Li ◽  
Dongwon Choi ◽  
Eunkyung Park ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Lymphatic Vessel ◽  
Vision Loss ◽  
Current Knowledge ◽  
Lymphatic Vessels ◽  
Front Surface ◽  
Glaucoma Surgery ◽  
Distribution Patterns ◽  
Aqueous Humor Outflow ◽  
Nasal Side

ABSTRACTGlaucoma surgeries, such as trabeculectomy, are performed to lower the intraocular pressure to reduce the risk of vision loss. The surgeries create a new passage in the eye that reroutes the aqueous humor outflow to the subconjunctival space, where the fluid is presumably absorbed by the conjunctival lymphatics. However, the current knowledge of these ocular surface lymphatics remains limited. Here, we characterized the biology and function of the ocular lymphatics using transgenic lymphatic reporter mice and rats. We found that the limbal and conjunctival lymphatic networks are progressively formed by a primary lymphatic vessel that grows out from the nasal-side medial canthus region at the time of birth. This primary lymphatic vessel immediately branches out and invades the limbus and conjunctiva, and then simultaneously encircles the cornea in a bidirectional manner. As a result, the distribution of the ocular lymphatic is significantly polarized toward the nasal side, and the limbal lymphatics are directly connected to the conjunctival lymphatics. New lymphatic spouts are mainly produced from the nasal-side limbal lymphatics, posing the nasal side of the eye more responsive to fluid drainage and inflammatory stimuli. Consistently, when a fluorescent tracer was injected, fluid clearance was much more efficient in the nasal side than the temporal side of the eyes. In comparison, blood vessels are evenly distributed on the front surface of the eyes. We found that these distinct vascular distribution patterns were also conserved in human eyes. Together, our study demonstrated that the ocular surface lymphatics are more densely present in the nasal side and uncovered the potential clinical benefits in selecting the nasal side as a surgical site for glaucoma surgeries to improve the fluid drainage.

scholarly journals Lymphatics in Eye Fluid Homeostasis: Minor Contributors or Significant Actors?

Biology ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 582
Author(s):  
Mariela Subileau ◽  
Daniel Vittet
Keyword(s):  
Aqueous Humor ◽  
Molecular Mechanisms ◽  
Immune Cell ◽  
Three Dimensional ◽  
Lymphatic Vessels ◽  
Lipid Absorption ◽  
Cell Trafficking ◽  
Glymphatic System ◽  
Fluid Homeostasis ◽  
Aqueous Humor Outflow

Lymphatic vessels exert major effects on the maintenance of interstitial fluid homeostasis, immune cell trafficking, lipid absorption, tumor progression and metastasis. Recently, novel functional roles for the lymphatic vasculature have emerged, which can be associated with pathological situations. Among them, lymphatics have been proposed to participate in eye aqueous humor drainage, with potential consequences on intraocular pressure, a main risk factor for progression of glaucoma disease. In this review, after the description of eye fluid dynamics, we provide an update on the data concerning the distribution of ocular lymphatics. Particular attention is given to the results of investigations allowing the three dimensional visualization of the ocular surface vasculature, and to the molecular mechanisms that have been characterized to regulate ocular lymphatic vessel development. The studies concerning the potential role of lymphatics in aqueous humor outflow are reported and discussed. We also considered the novel studies mentioning the existence of an ocular glymphatic system which may have, in connection with lymphatics, important repercussions in retinal clearance and in diseases affecting the eye posterior segment. Some remaining unsolved questions and new directions to explore are proposed to improve the knowledge about both lymphatic and glymphatic system interactions with eye fluid homeostasis.

500 THE PATHOLOGICAL GASTROESOPHAGEAL REFLUX IN PATIENTS WITH CYSTIC FIBROSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Dmitry Bordin ◽  
Elen Valitova ◽  
Gulsara Baymakanova ◽  
Stanislav Krasovskiy ◽  
Olga Berezina
Keyword(s):  
Cystic Fibrosis ◽  
Gastroesophageal Reflux ◽  
Lung Transplantation ◽  
Distal Part ◽  
Proximal Part ◽  
Distal Esophagus ◽  
Upper Endoscopy ◽  
Proximal Esophagus ◽  
Impedance Monitoring ◽  
The Mean

Abstract   The presence of gastroesophageal reflux in patients after lung transplantation rises the risk of posttransplantant complications. The aim of our study was to evaluate the severity of gastroesophageal reflux (GER) in patients with cystic fibrosis before lung transplantation. Methods 14 patients with cystic fibrosis, who refferred to our Centre, were included in this study, mean age 28,86 ± 2,5 (6 males and 8 females). The diagnosis of cystic fibrosis was established at the age of 1–5 y.o. according to clinic, sweet test and genetic tests. All patients were performed upper endoscopy, X-ray, esophageal manometry and 24 h impedance monitoring. PPI treatment was excluded for 7 days before monitoring. Pathologic GER was established when total number of refluxes in distal esophagus was more than 75, the total number of refluxes in proximal esophagus was more than 20% of those in the distal part. Results According to endoscopy, none of patients had erosions of the esophagus. Five patients had ineffective motility and one—diffuse esophageal spazm. 56% of patients had pathologic number of refluxes in distal esophagus. 80% subjects had pathologic refluxes in proximal esophagus. The mean number of total refluxes in distal part was 54,93 ± 5,7, in proximal part—27,64 ± 2,6 (it is 40% of those in distal part). The distribution of acid and non-acid refluxes in patients with pathologic refluxes was 2:1. We didn’t reveal any correlation between number of refluxes, ineffective motility and gastric emptying. Conclusion despite normal upper endoscopy, 56% of patients with cystic fibrosis have pathologic gastroesophageal reflux. Besides, the study showed high propagation of GER to proximal esophagus in 80% of subjects, which may play role in posttransplantation period.

scholarly journals Immunohistochemical identification of lymphatic outflow in filtering blebs after non-penetrating deep sclerectomy (NPDS)

2021 ◽  
pp. 48-54
Author(s):  
T.N. Iureva ◽  
◽  
J.V. Malysheva ◽  
I.V. Klimenkov ◽  
N.P. Sudakov ◽  
...  
Keyword(s):  
Moisture Absorption ◽  
Open Angle Glaucoma ◽  
Anterior Segment ◽  
Lymphatic Vessels ◽  
Glaucoma Surgery ◽  
Deep Sclerectomy ◽  
Open Angle ◽  
Podoplanin Expression ◽  
Group 2 ◽  
Immunohistochemical Studies

Relevance. One of the conditions for the functional outflow pathways' formation after filtering glaucoma surgeries is the uniform moisture absorption from the filtering blebs, which is provided by the blood and, possibly, lymphatic vessels of the conjunctiva. Purpose. To conduct a structural and molecular assessment of filtering blebs in patients with open-angle glaucoma (OAG) after non-penetrating deep sclerectomy (NPDS) according to OCT data, as well as ultrastructural and immunohistochemical studies. Material and methods. A clinical study of 12 patients with primary open-angle glaucoma (POAG) after NPDS was conducted. In the long-term postoperative period (12–18 months), the level of intraocular pressure (IOP) was determined, the structure of the filtering blebs using biomicroscopy and OCT of the anterior segment of the eye was evaluated, the immunohistochemical study of the filtering blebs' tissue for the expression of podoplanin and ultrastructural analysis of the samples obtained using a laser confocal microscope LSM 710 (Zeiss) was performed. In 8 cases (group 1), these were non-functional scarred filtering blebs, IOP 24.12± 2.24 mm Hg, in 4 cases (group 2) – functional filtering blebs, IOP 15.31± 4.08 mm Hg. Results. During the immunohistochemical examination of the first group patients' conjunctival samples, no vessels with characteristics of the lymphatic system were detected in any case. In each sample of the second group patients' filtering blebs, from 5 to 7 vessels with different variants of podoplanin expression were determined. Conclusion. The aqueous outflow entering the subconjunctival space through the newly created outflow pathway during glaucoma surgery is carried out at the expense of conjunctival lymphatic structures, the condition of which to a certain extent determines the success or failure of the surgery. Key words: non-penetrating deep sclerectomy; open-angle glaucoma; lymphatic outflow; filtering blebs

scholarly journals Magnetically Actuated Glaucoma Drainage Device with Adjustable Flow Properties after Implantation

2021 ◽  
Vol 4 (1) ◽  
pp. 3
Author(s):  
Inês C. F. Pereira ◽  
Hans M. Wyss ◽  
Henny J. M. Beckers ◽  
Jaap M. J. den Toonder
Keyword(s):  
Aqueous Humor ◽  
Alternative Pathway ◽  
Glaucoma Surgery ◽  
Glaucoma Drainage Device ◽  
Hydrodynamic Resistance ◽  
Aqueous Humor Outflow ◽  
Non Invasive ◽  
Magnetically Actuated ◽  
Magnetic Stimulus ◽  
Glaucoma Drainage Devices

Glaucoma is the second leading cause of preventable blindness worldwide, following cataract formation. A rise in the intraocular pressure (IOP) is a major risk factor for this disease, and results from an elevated resistance to aqueous humor outflow from the anterior chamber of the eye. Glaucoma drainage devices provide an alternative pathway through which the aqueous humor can effectively exit the eye, thereby lowering the IOP. However, post-operative IOP is unpredictable and current implants are deficient in maintaining IOP at optimal levels. To address this deficiency, we are developing an innovative, non-invasive magnetically actuated glaucoma implant with a hydrodynamic resistance that can be adjusted following surgery. This adjustment is achieved by integrating a magnetically actuated microvalve into the implant, which can open or close fluidic channels using an external magnetic stimulus. This microvalve was fabricated from poly(styrene–block–isobutylene–block–styrene), or ‘SIBS’, containing homogeneously dispersed magnetic microparticles. “Micro-pencil” valves of this material were fabricated using a combination of femtosecond laser machining with hot embossing. The glaucoma implant is comprised of a drainage tube and a housing element fabricated from two thermally bonded SIBS layers with the microvalve positioned in between. Microfluidic experiments involving actuating the magnetic micro-pencil with a moving external magnet confirmed the valving function. A pressure difference of around 6 mmHg was achieved, which is sufficient to overcome hypotony (i.e., too low IOP)—one of the most common post-operative complications following glaucoma surgery.

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