- Rutgers New Jersey Medical School, Ophthalmology and Visual Science, Graduate StudentTufts Medical Center, Ophthalmology, AlumnusUniversity of Pittsburgh Medical Center, Ophthalmology, Graduate Studentadd
- Comprehensive and Glaucoma-trained Ophthalmologistedit
Purpose: To compare the safety and efficacy of two different techniques for implantation of the XEN Gel Stent, a minimally invasive surgical device for the treatment of refractory glaucoma. Methods: A retrospective chart review of eyes... more
Purpose: To compare the safety and efficacy of two different techniques for implantation of the XEN Gel Stent, a minimally invasive surgical device for the treatment of refractory glaucoma. Methods: A retrospective chart review of eyes that received ab interno or ab externo XEN Gel Stent placement from February 2017 to October 2019 was conducted. A single surgeon (NMR) performed all operations. Eyes that received the XEN implant concomitant with a glaucoma drainage device insertion or that were lost to 6-month follow-up were excluded. Intraocular pressure (IOP) change, change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes compared between groups. Results: Fifty eyes that underwent ab interno placement and 30 eyes that underwent ab externo placement were studied. The ab interno cohort demonstrated a mean IOP reduction of 8.4 ± 1.7 mmHg (28.6% decrease) by 12 months, compared to a mean reduction of 12.8 ± 3.0 mmHg (40.1% decrease) in the ab externo group (p = 0.208). Mean reduction in medication use was 1.81 ± 0.29 medications in the ab interno group and 1.86 ± 0.37 in the ab externo group (p = 0.913). By 12 months, 58% of ab interno eyes had required 5-fluorouracil injection compared to 36.7% of ab externos (p = 0.105). Bleb needling was applied to 42% and 26.7% of the eyes, respectively (p = 0.231). A second glaucoma surgery was necessary for 20% of the ab interno cohort and 10% of the ab externo cohort (p = 0.351). Conclusion: There were no differences in outcomes between ab interno and ab externo placement of the XEN Gel Stent. Both approaches are safe and effective for lowering IOP.
It may be time to extend the benefits of this practice to the masses.
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Purpose This review will provide an update on surgical techniques, outcomes, and complications for two new translimbal bleb-forming surgical glaucoma devices. Recent findings The XEN Gel Microstent and PreserFlo MicroShunt comprise a... more
Purpose This review will provide an update on surgical techniques, outcomes, and complications for two new translimbal bleb-forming surgical glaucoma devices. Recent findings The XEN Gel Microstent and PreserFlo MicroShunt comprise a category of subconjunctival microinvasive glaucoma surgery developed with the aim of improving the predictability and safety profile of bleb-forming procedures. Both devices are made of noninflammatory material which limits postsurgical inflammation and scarring and have a valve-less intrinsic flow-limiting design, which decreases the risk of hypotony. There are various techniques of implantation for the XEN Gel Microstent each with their own advantages and disadvantages. Summary These devices have demonstrated promising outcomes in early experimental literature with similar intraocular pressure-lowering effects to traditional incisional surgery such as trabeculectomy or tube shunt surgery, but with fewer risks. Future randomized, prospective studies should be done to compare these gel stents and microshunts both to each other and to other traditional glaucoma surgeries.
Recently introduced microincisional glaucoma surgeries that enhance conventional outflow offer a favorable risk profile over traditional surgeries, but can be unpredictable. Two paramount challenges are the lack of an adequate training... more
Recently introduced microincisional glaucoma surgeries that enhance conventional outflow offer a favorable risk profile over traditional surgeries, but can be unpredictable. Two paramount challenges are the lack of an adequate training model for angle surgeries and the absence of an intraoperative quantification of surgical success. To address both, we developed an ex vivo training system and a differential, quantitative canalography method that uses slope adjusted fluorescence intensities of two different chromophores to avoid quenching. We assessed outflow enhancement by trabecular microbypass (TMB) implantation or by ab interno trabeculectomy (AIT). In this porcine model, TMB resulted in an insignificant (p>0.05) outflow increase of 13±5%, 14±8%, 9±3%, and 24±9% in the inferonasal, superonasal, superotemporal, and inferotemporal quadrant, respectively. AIT caused a 100±50% (p=0.002), 75±28% (p=0.002), 19±8%, and 40±21% increase in those quadrants. The direct gonioscopy and tactile feedback provided a surgical experience that was very similar to that in human patients. Despite the more narrow and discontinuous circumferential drainage elements in the pig with
potential for underperformance or partial stent obstruction, unequivocal patterns of focal outflow enhancement by TMB were seen in this training model. AIT achieved extensive access to outflow pathways beyond the surgical site itself.
potential for underperformance or partial stent obstruction, unequivocal patterns of focal outflow enhancement by TMB were seen in this training model. AIT achieved extensive access to outflow pathways beyond the surgical site itself.
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d espite the various roles of regulator of G protein signaling (rGs) protein in the G protein signaling pathway that have been defined, the function of rGs has not been characterized in longevity signaling pathways. we found that reduced... more
d espite the various roles of regulator of G protein signaling (rGs) protein in the G protein signaling pathway that have been defined, the function of rGs has not been characterized in longevity signaling pathways. we found that reduced expression of loco, a drosophila rGs protein, resulted in a longer lifespan of flies with stronger resistance to stress, higher mnsod activity and increased fat content. in contrast, overexpression of the loco gene shortened the fly lifespan significantly, lowered stress resistance and reduced fat content, also indicating that the rGs domain containing Gtpase-activating protein (Gap) activity is related to the regulation of longevity. interestingly, expressional changes of yeast rGs2 and rat rGs14, homologs to the fly loco, also affected oxidative stress resistance and longevity in the respective species. it is known that loco inactivates inhibi-tory Gαi • GTP protein to reduce activity of adenylate cyclase (ac) and rGs14 interacts with activated h-ras and raf-1 kinases, which subsequently inhibits ErK phosphorylation. we propose that loco/rGs14 protein may regulate stress resistance and longevity as an activator in ac-camp-pKa pathway and/or as a molecular scaffold that sequesters active Ras and Raf from Ras • GTP-Raf-MEK-ErK signaling pathway. consistently, our data showed that downregulation of loco significantly diminishes camp amounts and increases pErK levels with higher resistance to the oxidative stress.
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To describe the characteristics, demographics, anatomic and functional outcomes, and complications of diabetic eyes with traction retinal detachment (TRD) or combined traction/rhegmatogenous retinal detachment that underwent pars plana... more
To describe the characteristics, demographics, anatomic and functional outcomes, and complications of diabetic eyes with traction retinal detachment (TRD) or combined traction/rhegmatogenous retinal detachment that underwent pars plana vitrectomy (PPV) silicone oil (SO) tamponade. In this retrospective chart review, exclusion criteria included previous PPV. Forty eyes were identified. The mean preoperative complexity score (CS) of the TRDs was 5.95 (range 4-8). In patients with ≥6 months of follow-up (33; 82.5%), eyes with lower CSs had a better mean final visual acuity (VA): ~20/400 for CS 4, and hand motions (HM)-1/200 for CS >5. Eyes with macula-sparing TRDs had better final VA (~20/400) than those with a detached macula (~HM). Eyes with >3 panretinal photocoagulation sessions attained better mean final VA (20/400) than eyes without any history of laser treatment (~HM). The most frequent complications were cataract (46%), preretinal fibrosis (33%), recurrent TRD (15%), oil migration to the anterior chamber (12%), corneal edema (12%), and oil emulsification (9%). Eleven (27.5%) eyes underwent SO removal. The average complexity score was high in this series. Use of SO tamponade for diabetic TRDs is not without complications, but may be beneficial in stabilizing vision in eyes with otherwise poor prognosis.