Bleb-related Porcine Lymphatic Outflow Is Greater from Subconjunctival compared to Subtenon Blebs

Lee, Jong Yeon; Strohmaier, Clemens; Akiyama, Goichi; Saraswathy, Sindhu; Yoo, Chungkwon; Kim, Yong Yeon; Hong, Young‐Kwon; Huang, Alex S.

doi:10.5005/jp-journals-10078-1382

Cited by 3 publications

(2 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to some of the above‐mentioned studies, we did not correlate BVD with IOP but evaluated its early predictive value regarding surgical revisions which is a clinically highly relevant endpoint and combines various aspects of bleb dysfunction. Early predictive factors for FB function are needed to broaden our understanding of FB (patho)physiology, which is still limited and has only recently been expanded by the concept of lymphatic FB drainage (Lee et al., 2022). In a socio‐economic environment where limited resources have to be wisely allocated to an ever‐increasing elderly population, early predictive factors are also vital for postoperative patient stratification and identification of high‐risk patients requiring higher frequency follow‐up visits.…”

Section: Discussionmentioning

confidence: 99%

Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation

Schneider,

Kallab,

Murauer

et al. 2024

Acta Ophthalmologica

View full text Add to dashboard Cite

PurposeBleb failure is a common complication after glaucoma filtration surgery. Different bleb classification schemes incorporating filtration bleb vascularization have been proposed, but the reported correlation with intraocular pressure (IOP) has been variable, possibly because of subjective vascularization grading. The purpose of the present study was to evaluate bleb vascularization after Preserflo Microshunt (PM) implantation using anterior segment OCT‐angiography (AS‐OCTA) as a biomarker for bleb failure.MethodsTwenty‐three eyes of twenty‐three patients underwent PM implantation. Up to 12 months after surgery PM scleral passage‐centred AS‐OCTA measurements (PLEX Elite 9000) for bleb‐vessel density (BVD) determination were performed and IOP as well as necessity for surgical revisions (needling and open revision) were documented. After multi‐step image analysis (region of interest definition, artefact removal, binarization, BVD calculation), the predictive value of early postoperative BVD for surgical revisions was assessed using logistic regression modelling.ResultsBaseline IOP (23.57 ± 7.75 mmHg) decreased significantly to 8.30 ± 2.12, 9.17 ± 2.33 and 11.70 ± 4.40 mmHg after 1, 2 and 4 week(s), and 13.48 ± 5.83, 11.87 ± 4.49, 12.30 ± 6.65, 11.87 ± 3.11 and 13.05 ± 4.12 mmHg after 2, 3, 6, 9 and 12 month(s), respectively (p < 0.001). Nine patients (39%) needed surgical revisions after a median time of 2 months. Bleb vessel densities at 2 and 4 weeks were significantly associated with future surgical revisions upon logistic regression analysis (2 W/4 W likelihood‐ratio test p‐value: 0.0244/0.0098; 2 W/4 W area under the receiver operating characteristics curve: 0.796/0.909).ConclusionFiltration bleb vessel density can be determined using AS‐OCTA in the early postoperative period and is predictive for bleb failure after PM implantation.

show abstract

Section: Discussionmentioning

confidence: 99%

Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation

Schneider,

Kallab,

Murauer

et al. 2024

Acta Ophthalmologica

View full text Add to dashboard Cite

show abstract

“…From blebs, AH filters through conjunctival vessels and lymphatics [ 6 , 7 , 28 , 29 , 30 , 31 , 32 ]. Benedikt O.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics

Kumar,

Bezzabotnov,

Rustamova

et al. 2023

Vision

View full text Add to dashboard Cite

A surgical technique was developed to enhance aqueous humor (AH) flow through the non-trabecular outflow pathway by rerouting it from the anterior chamber (AC) to the suprachoroidal space (SCS) without detaching the ciliary body from the scleral spur. Medium- and long-term surgical outcomes were retrospectively analyzed in a case series of 58 glaucoma patients. At 6, 12, and 24 months, the mean IOP decreased from 27.8 ± 8.3 to 14.9 ± 5.0 mmHg, median 15.0 (25th percentile (p25)13.0; 75th percentile (p75) 18.0) and 15.2 ± 3.3 mmHg, and hypotensive medication use reduced from a median (p25; p75) of 3 (2; 3) to 0 (0; 2), 0 (0; 2), and 0 (0; 1.5), respectively. Intra- and postoperative complications were few and manageable. Following surgery, no bleb formation occurred in any of the cases (as confirmed by optical coherence tomography). Conjunctival lymphatic vessels (CLVs) developed in 50% of eyes (29/58). Clinically, they developed directly from sclera and had no connection to the surgical site. Analysis further showed that the development of CLVs and their longer visibility period had poor prognostic value for IOP control. If the fluid flow from the SCS to CLVs was resistance-free, no CLV development was evident. However, if any resistance existed in the flow, the fluid accumulated in lymphatics, resulting in their engorgement. The proposed technique was safe and effective in decreasing IOP in glaucoma patients by enhancing AH flow from the SCS to CLVs via connecting intrascleral microchannels.

show abstract

VEGF-C and 5-Fluorouracil Improve Bleb Survival in a Rabbit Glaucoma Surgery Trabeculectomy Model

Wu,

Zhou,

Liu

et al. 2024

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

Purpose To evaluate VEGF-C–induced lymphoproliferation in conjunction with 5-fluorouracil (5-FU) antimetabolite treatment in a rabbit glaucoma filtration surgery (GFS) model. Methods Thirty-two rabbits underwent GFS and were assigned to four groups ( n = 8 each) defined by subconjunctival drug treatment: (a) VEGF-C combined with 5-FU, (b) 5-FU, (c) VEGF-C, (d) and control. Bleb survival, bleb measurements, and IOP were evaluated over 30 days. At the end, histology and anterior segment OCT were performed on some eyes. mRNA was isolated from the remaining eyes for RT-PCR evaluation of vessel-specific markers (lymphatics, podoplanin and LYVE-1; and blood vessels, CD31). Results Qualitatively and quantitatively, VEGF-C combined with 5-FU resulted in blebs which were posteriorly longer and wider than the other conditions: vs. 5-FU ( P = 0.043 for longer, P = 0.046 for wider), vs. VEGF-C ( P < 0.001, P < 0.001) and vs. control ( P < 0.001, P < 0.001). After 30 days, the VEGF-C combined with 5-FU condition resulted in longer bleb survival compared with 5-FU ( P = 0.025), VEGF-C ( P < 0.001), and control ( P < 0.001). Only the VEGF-C combined with 5-FU condition showed a negative correlation between IOP and time that was statistically significant (r = −0.533; P = 0.034). Anterior segment OCT and histology demonstrated larger blebs for the VEGF-C combined with 5-FU condition. Only conditions including VEGF-C led to increased expression of lymphatic markers (LYVE-1, P < 0.001–0.008 and podoplanin, P = 0.002–0.011). Expression of CD31 was not different between the groups ( P = 0.978). Conclusions Adding VEGF-C lymphoproliferation to standard antimetabolite treatment improved rabbit GFS success and may suggest a future strategy to improve human GFSs.

show abstract

Bleb-related Porcine Lymphatic Outflow Is Greater from Subconjunctival compared to Subtenon Blebs

Cited by 3 publications

References 41 publications

Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation

Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation

Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics

VEGF-C and 5-Fluorouracil Improve Bleb Survival in a Rabbit Glaucoma Surgery Trabeculectomy Model

Contact Info

Product

Resources

About