Conjunctival Inflammatory Cells and Their Predictive Role For Deep Sclerectomy in Primary Open-angle Glaucoma and Exfoliation Glaucoma

Helin, Minna; Rönkkö, Seppo; Puustjärvi, Tuomo; Teräsvirta, Markku; Ollikainen, Minna; Uusitalo, Hannu

doi:10.1097/ijg.0b013e3181d9ccb0

Cited by 29 publications

(29 citation statements)

References 25 publications

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“…Interestingly, we found slightly higher levels of MMP staining in ExG patients. We have also established differences in the inflammatory status between POAG and ExG in our previous study (Helin et al 2011). Our hypothesis is that there are probably multiple, at least partly yet unknown, factors influencing surgery outcome in ExG patients.…”

Section: Discussionmentioning

confidence: 99%

“…The study protocol was approved by the Ethical Committee of Kuopio University Hospital. The clinical data of glaucoma patients are presented in our previously published study (Helin et al 2011). …”

Section: Samplesmentioning

confidence: 99%

“…Detailed data of demographics are listed in our previously published study (Helin et al 2011). The ages of POAG patients, ExG patients and controls were 68.6 AE 10.5 years, 70.5 AE 7.8 years and 63.1 AE 13.3 years, respectively.…”

Section: Demographic and Clinical Datamentioning

confidence: 99%

“…The state of the conjunctiva is known to be an important factor for the success of trabeculectomy (Broadway et al 1994b) and deep sclerectomy (DS) (Helin et al 2011). Therefore, the effects of chronic topical treatment and other factors that may interfere with the normal function and structure of the conjunctiva during the course of glaucoma are of vital importance.…”

Section: Introductionmentioning

confidence: 99%

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Conjunctival matrix metalloproteinases and their inhibitors in glaucoma patients

Helin-Toiviainen

Rönkkö

Puustjärvi

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: Chronic conjunctival inflammation, caused by various reasons, for example long-term use of topical drugs and/or their preservatives, affects the outcome of glaucoma surgery by interfering with wound healing. Matrix metalloproteinases (MMPs) remodel extracellular matrix (ECM) and are involved in the wound healing process. This study was designed to evaluate the conjunctival expression of MMPs and their tissue inhibitors (TIMPs) in the normal eye, primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) and whether there is an association between staining intensities and deep sclerectomy outcome. Methods: Immunohistochemical procedures were performed on conjunctival samples which were obtained from POAG (n = 11) and ExG (n = 14) patients as well as normal (n = 7) subjects. Antibodies against MMPs (MMP-1, -2, -3 and -9) and TIMPs (TIMP-1, -2 and -3) were used. Results: In conjunctival stroma, expression levels of MMP-2 (p = 0.047), MMP-3 (p = 0.009), MMP-9 (p < 0.001), TIMP-1 (p = 0.003), TIMP-2 (p < 0.001) and TIMP-3 (p < 0.001) in ExG and MMP-9 (p = 0.008), TIMP-2 (p = 0.02) and TIMP-3 (p = 0.002) in POAG were significantly increased compared to control. We further found correlations between expression of MMP-1 and MMP-3 and the length of pilocarpine treatment. Conclusion: The expression of MMPs and TIMPs is increased in the conjunctiva of POAG and ExG patients having a long history of topical antiglaucoma drops. Antiglaucoma agents and/or their preservatives alter the remodelling balance of ECM in conjunctiva of POAG and ExG eyes. The balance between MMPs and TIMPs may play a crucial role in the conjunctival wound healing process and the outcome of glaucoma surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Samplesmentioning

confidence: 99%

Section: Demographic and Clinical Datamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conjunctival matrix metalloproteinases and their inhibitors in glaucoma patients

Helin-Toiviainen

Rönkkö

Puustjärvi

et al. 2014

Acta Ophthalmologica

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“…Despite significant progress made in glaucoma therapy, filtration surgery success rates thus do not appear to have been improved in the recent years [38]. Indeed, the same mechanisms are still involved, as very recently Helin et al [39] consistently found that densities of inflammatory cells, namely T-lymphocytes, T-helper lymphocytes, T-cytotoxic lymphocytes, B cells, plasma cells, and macrophages, measured at time of surgery, were significantly higher in patients in whom surgery failed than those with surgical success, during a long follow-up of 2.5 years.…”

Section: Increased Rate Of Glaucoma Surgery Failurementioning

confidence: 93%

Ocular Surface and External Filtration Surgery: Mutual Relationships

Baudouin¹

2012

Developments in Ophthalmology

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There is a large body of evidence from clinical and experimental studies that the long-term use of topical drugs may induce ocular surface changes, causing ocular discomfort, dry eye, conjunctival inflammation, subconjunctival fibrosis, corneal surface impairment, and, as a consequence of chronic ocular surface changes, the potential risk of failure for further glaucoma surgery. Subclinical inflammation has also been widely described in patients receiving antiglaucoma treatments for long periods of time, with inflammatory cell infiltration and fibroblast activation in the conjunctiva and subconjunctival space. The preservative, especially benzalkonium chloride, which has consistently demonstrated its toxic effects in laboratory, experimental, and clinical studies, could induce or enhance such inflammatory changes. As a quaternary ammonium, this compound causes tear film instability, loss of goblet cells, conjunctival squamous metaplasia and apoptosis, disruption of the corneal epithelium barrier, corneal nerve impairment, chronic inflammation and potential damage to deeper ocular tissues. Drug-induced adverse effects are therefore far from being restricted to only allergic reactions, but they are often very difficult to identify because they mostly occur in a delayed or poorly specific manner, and result from complex and multifactorial interactions between the drugs and the ocular surface. Postoperatively, the ocular surface also plays an important role, as the conjunctiva interacts with aqueous humor and subconjunctival fibrosis may block aqueous outflow and cause surgical failure. As preoperative inflammation underlies postoperative fibrosis and therefore surgical outcome, a better knowledge of ocular surface changes with appropriate evaluation and management should thus become a new paradigm in glaucoma care over the long term.

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Nicht penetrierende Glaukomchirurgie

2012

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Patients at high risk of developing complications (e.g. high myopia, aphakia, advanced visual field defects) benefit from non-penetrating glaucoma surgery (NPGS). Neovascular glaucoma, traumatic glaucoma or patients with a narrow angle (a scleral spur must at least be visible) are not suitable for NPGS. The aim of deep sclerectomy (DS) is mainly external subconjunctival drainage. Modified with mitomycin C and intrascleral implants, intraocular pressure (IOP) and success of DS are comparable to trabeculectomy. Viscocanalostomy and the further development to canaloplasty aim for blebless IOP control. Viscocanalostomy has an extremely low complication profile but only a slight reduction in IOP. Canaloplasty creates much more favourable results. Combined with phacoemulsification canaloplasty appears to lower IOP comparable to phacotrabeculectomy and demonstrates a more sustainable success compared to canaloplasty alone.

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Conjunctival Inflammatory Cells and Their Predictive Role For Deep Sclerectomy in Primary Open-angle Glaucoma and Exfoliation Glaucoma

Cited by 29 publications

References 25 publications

Conjunctival matrix metalloproteinases and their inhibitors in glaucoma patients

Conjunctival matrix metalloproteinases and their inhibitors in glaucoma patients

Ocular Surface and External Filtration Surgery: Mutual Relationships

Nicht penetrierende Glaukomchirurgie

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