Epitheliopathy of the bleb (EoB) - identifying attrition: A new model for failure of glaucoma surgery

Setten, G.‐B. van

doi:10.15761/nfo.1000199

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Any impairment of the lubrication capacity, such as in DED, increases the shear stress by decreasing the viscoelastic separation between the lid to and ocular surface, leading to friction [25]. This friction is naturally enhanced by the increased tectonic exposure of the ocular surface, such as is suggested for the result of glaucoma surgery [1]. In the presence of local surface elevations, otherwise normal moving forces of the lid create enhanced attrition, summarizing all the effects of pressure and friction [1].…”

Section: Characterizing Attritionmentioning

confidence: 99%

“…This friction is naturally enhanced by the increased tectonic exposure of the ocular surface, such as is suggested for the result of glaucoma surgery [1]. In the presence of local surface elevations, otherwise normal moving forces of the lid create enhanced attrition, summarizing all the effects of pressure and friction [1]. Moreover, minor, local protrusions of the ocular surface decreasing viscoelastic separation between lid to and ocular surface, leading to enhanced friction, such as in the anatomical dry eye [26], can lead to very specific and localized pain sensations.…”

Section: Characterizing Attritionmentioning

confidence: 99%

“…Attrition is defined as a decrease or reduction in numbers, size, or strength: a process of making something weaker by repeatedly attacking or exerting processes leading to weakening of resistance. In ophthalmology, attrition has been used as a term for the description of a process involving the constant or repeated challenge of ocular surface tissues by mechanical forces in association with glaucoma surgery [1]. In medicine, the term attrition has been used by dentists in order to describe the effects of bruxism (a specific form of tooth wear) [2].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Attrition, Intercellular Shear in Dry Eye Disease: When Cells are Challenged and Neurons are Triggered

Setten

2020

IJMS

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The mechanical component in the pathophysiology of dry eye disease (DED) deserves attention as an important factor. The lubrication deficit induced impaired mechano-transduction of lid pressure to the ocular surfaces may lead to the dysregulation of homeostasis in the epithelium, with sensations of pain and secondary inflammation. Ocular pain is possibly the first sign of attrition and may occur in the absence of visible epithelial damage. Attrition is a process which involves the constant or repeated challenge of ocular surface tissues by mechanical shear forces; it is enhanced by the thinning of corneal epithelium in severe DED. As a highly dynamic process leading to pain and neurogenic inflammation, the identification of the impact of attrition and its potential pathogenic role could add a new perspective to the current more tear film-oriented models of ocular surface disease. Treatment of DED addressing lubrication deficiencies and inflammation should also consider the decrease of attrition in order to stimulate epithelial recovery and neural regeneration. The importance of hyaluronic acid, its molecular characteristics, the extracellular matrix and autoregulative mechanisms in this process is outlined. The identification of the attrition and recognition of its impact in dry eye pathophysiology could contribute to a better understanding of the disease and optimized treatment regimens.

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Section: Characterizing Attritionmentioning

confidence: 99%

Section: Characterizing Attritionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Attrition, Intercellular Shear in Dry Eye Disease: When Cells are Challenged and Neurons are Triggered

Setten

2020

IJMS

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“…While the influence of repeated mechanical stress on biological materials has been studied in the past mainly in dentistry and orthopedics, its influence on soft tissues with a high rate of turnover like the epithelia covering the ocular cornea and conjunctiva has only recently caught attention. Van Setten coined the term "attrition" for the cyclic mechanical stress by friction exercised by the lid to the underlying epithelial tissues during blinking and identified attrition as a potential cause for ophthalmic surgery failure [63]. Al-Aqaba and colleagues described the potential role of attrition of corneal nerves in neurotrophic keratopathy, post-penetrating keratoplasty, laser refractive surgery and chronic corneal edema, and concluded that attrition might also explain the observed lack of correlation between corneal epithelial nerve density and corneal sensitivity [64].…”

Section: Ocular Surface Homeostasismentioning

confidence: 99%

Why Chain Length of Hyaluronan in Eye Drops Matters

Müller-Lierheim¹

2020

Diagnostics

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The chain length of hyaluronan (HA) determines its physical as well as its physiological properties. Results of clinical research on HA eye drops are not comparable without this parameter. In this article methods for the assessment of the average molecular weight of HA in eye drops and a terminology for molecular weight ranges are proposed. The classification of HA eye drops according to their zero shear viscosity and viscosity at 1000 s−1 shear rate is presented. Based on the gradient of mucin MUC5AC concentration within the mucoaqueous layer of the tear film a hypothesis on the consequences of this gradient on the rheological properties of the tear film is provided. The mucoadhesive properties of HA and their dependence on chain length are explained. The ability of HA to bind to receptors on the ocular epithelial cells, and in particular the potential consequences of the interaction between HA and the receptor HARE, responsible for HA endocytosis by corneal epithelial cells is discussed. The physiological function of HA in the framework of ocular surface homeostasis and wound healing are outlined, and the influence of the chain length of HA on the clinical performance of HA eye drops is illustrated. The use of very high molecular weight HA (hylan A) eye drops as drug vehicle for the next generation of ophthalmic drugs with minimized side effects is proposed and its advantages elucidated. Consequences of the diagnosis and treatment of ocular surface disease are discussed.

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“…Other clinical situations resulting in increased friction between lids and the ocular globe are anatomical irregularities of the ocular surface 25 . These may be caused by tissue-related changes, like in keratoconus, as a consequence of infection or burns, or, frequently, as a consequence of ocular surgery 26 . Unless controlled, increased friction may be a major cause of tissue scarring.…”

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confidence: 99%