Late-Onset Bleb Leaks After Glaucoma Filtering Surgery

Greenfield, David S.

doi:10.1001/archopht.116.4.443

Cited by 238 publications

(143 citation statements)

References 40 publications

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“…Second, it is a known fact that the use of trabeculectomy without anti-metabolites in adults with glaucoma of African descent is associated with poor outcome, 22,23 a fact that is also demonstrated in adult Ghanaians, 23,24 suggesting a possibility of failure in children of same racial descent. These facts, coupled with the poor result of trabeculectomy in children because of the aggressive wound-healing response, presence of a thick Tenon's capsule and low scleral rigidity, 25 the mild to serious ocular complications that tend to be associated with adjunctive anti-fibrotic drug use, even though the latter on the average improves trabeculectomy outcome, [25][26][27][28][29] all informed our quest to try the CTT alone as an alternate procedure.…”

Section: Eyementioning

confidence: 99%

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Essuman

Braimah

Ndanu

et al. 2010

Eye

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Section: Eyementioning

confidence: 99%

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Essuman

Braimah

Ndanu

et al. 2010

Eye

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“…[56][57][58][59] However, both treatments result in the production of thin avascular blebs which can leak 60,61 and lead to the development of blinding infections 11 and hypotony. 10, 62 The complications associated with their use can be partly attributed to the non-selective manner in which these agents work causing widespread cellular destruction.…”

Section: ----------------------------------------------------mentioning

confidence: 99%

Novel antisense oligonucleotides targeting TGF-β inhibit in vivo scarring and improve surgical outcome

Cordeiro¹,

Mead²,

Ali

et al. 2003

Gene Ther

158

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The scarring response is an important factor in many diseases throughout the body. In addition, it is a major problem in influencing results of surgery. In the eye, for example, post-operative scarring can determine the outcome of surgery. This is particularly the case in the blinding disease glaucoma, where several anti-scarring regimens are currently used to improve glaucoma surgery results, but are of limited use clinically because of severe complications. We have recently identified transforming growth factor-b (TGF-b) as a target for post-operative anti-scarring therapy in glaucoma, and now report the first study of novel secondgeneration antisense phosphorothioate oligonucleotides against TGF-b in vivo. Single applications of a TGF-b OGN at the time of surgery in two different animal models closely related to the surgical procedure performed in glaucoma patients, significantly reduced post-operative scarring (Po0.05) and improved surgical outcome. Our findings suggest that TGF-b antisense oligonucleotides have potential as a new therapy for reducing post-surgical scarring. Its long-lasting effects after only a single administration at the time of surgery make it particularly attractive clinically. Furthermore, although we have shown this agent to be useful in the eye, it could have widespread applications anywhere in the body where the wound-healing response requires modulation.

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“…Spontaneous late bleb leaks occur more frequently in glaucoma filtering surgery following adjunctive use of antimetabolites. 15,16 These leaks may be uncomplicated and self-limiting or may be associated with sight-threatening complications. The plethora of treatment options for management of bleb leaks described in the literature [17][18][19][20][21][22] reflects the widespread nature of this problem.…”

Section: Introductionmentioning

confidence: 99%

Early bleb leak after trabeculectomy and prognosis for bleb failure

Alwitry

Rotchford

Patel

et al. 2008

Eye

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Aim To determine whether early bleb leak after MMC trabeculectomy affects intermediate intraocular pressure (IOP) outcome. Methods Retrospective case note review. All cases of MMC trabeculectomy with at least 1-year follow-up were included. Cases where a bleb leak occurred within the first month were identified. All cases without an early bleb leak formed the control group. Patient demographics and clinical factors were analysed to determine any factors predisposing to bleb leakage. IOPs were compared for 1 year postoperatively and final follow-up. Results A total of 119 trabeculectomies were included. Of these 27 (22.7%) had an early bleb leak. The remaining 92 cases formed the control group. Mean age of cases was 70.7 years. Mean follow-up time was 19.5 months. Mean time of detection of the bleb leak was 9 days (range 1-21 days). Four cases (14.8%) were managed by primary resuturing. Thirteen cases (48.1%) were managed conservatively with a bandage contact lens. Ten cases (37.0%) resolved with expectant management. There was no statistically significant difference between the two groups with regards to IOP measurement at any time point. Intervention rates were similar with regards to bleb massage, 5-fluorouracil injection, and needling revision. No factors were identified between the two groups that predisposed to bleb leaks occurring. Conclusion Our data suggest that early bleb leak is not a poor prognostic indicator for intermediate bleb survival and IOP control in patients undergoing MMC trabeculectomy. No additional bleb manipulations compared with the control group were required to achieve a satisfactory IOP outcome.

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Late-Onset Bleb Leaks After Glaucoma Filtering Surgery

Cited by 238 publications

References 40 publications

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Novel antisense oligonucleotides targeting TGF-β inhibit in vivo scarring and improve surgical outcome

Early bleb leak after trabeculectomy and prognosis for bleb failure

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