| OBJECTION: Glaucoma is a common complication of uveitis,and surgery is an important part of the treatment of uveitis glaucoma(UG).Glaucoma drainage implants(GDIs)is currently considered as a better surgical option for glaucoma,and Ahmed glaucoma valve(AGV)is the most widely used one in clinical practice.This research reported the long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve(AGV)implantation in a series of patients.METHODS: The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation.Success of the treatment was defined as patients achieving intraocular pressure(IOP)levels between 6 and 21 mmhg,or a minimum of 20% reduction from baseline IOP,without any additional surgery and with or without additional anti-glaucoma medications.The main outcome measurements included IOP,the number of glaucoma medications at 1,3,6,12,24,36,48 and 60 mo after surgery,surgical complications,final best-corrected vision acuity(BCVA),visual field(VF)and retinal nerve fiber layer(RNFL).RESULTS: The mean follow-up was 53.3±8.5(range 48 to 60)mo.The cumulative probability of success rate was 98.5%,95.5%,89.6%,83.6%,76.1%,70.1%,65.7% and61.2% at 1,3,6,12,24,36,48 and 60 mo respectively.IOP was reduced from a baseline of 30.8±6.8mmhg to 9.9±4.1,10.1±4.2,10.9±3.7,12.9±4.6,13.8±3.9,13.2±4.6,12.3±3.5 and 13.1±3.7 mmhg at 1,3,6,12,24,36,48 and 60 mo respectively,IOP at each follow-up time point was significantly lower than that at baseline(P<0.01).The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period(P<0.05).There was no significant difference between preoperative and postoperative BCVA.The VF and RNFL of the patients were stable after the surgery.The most common early postoperative complications(<3mo)were temporary low intraocular pressure(12 eyes)and corneal edema(10 eyes),which could be resolved spontaneously.The late complications(>3mo)included AVG tube occlusion(5 eyes),bleb fibrosis(15 eyes),and uveitis recurrence(6 eyes).CONCLUSION: AGV implantation is safe and effect in terms of reducing IOP,decreasing the number of glaucoma medications,and preserving vision for patients with uveitic glaucoma.Bleb fibrosis is the major cause of failure in a small number of patients,and anti-metabolic drugs may be considered as an adjunct to achieve a better long-term success rate.Objective: Glaucoma drainage implant has been widely used in clinical practice,and it is an effective method to treat various refractory glaucoma.In this study,relevant models were constructed and inflammatory factors were predicted to play a role in promoting scarring,which was proved by detecting the correlation between inflammatory factors and collagen expression.An anti-metabolic drug(MMC)may play a role in scarring after drainage implantation by inhibiting inflammation.The changes in the expression of inflammatory factors after MMC intervention were tested to prove and explore the mechanism,so as to find the basis for clinical use of such drugs,and to find possible ways to improve the success rate of such operations.Methods: 60 New Zealand white rabbits were randomly divided into 4 groups: silicone group(group A),0.2mg/ml MMC treatment group(group B),0.4mg/ml MMC treatment group(group C),and control group(group D).In group A,silicone blocks were implanted in the superior temporal bulb subconjunctiva;Group B was treated with0.2mg/ml MMC at the surgical site during implantation.The operative site of group C was treated with 0.4mg/ml MMC at the time of implantation.Surgical operation was performed in group D without silicone implant.After modeling,5 rabbits selected from each group were draw materials at 2,4 and 8weeks for corresponding research.Collagen content and expression levels of inflammatory factors(IL-1β,IL-10)in subconjunctival tissues at different stages were detected by HE staining,ELISA and immunohistochemistry.Protein phosphorylation levels in the JAK signaling pathway in each group were detected by western-blot.Results: At 2 weeks,the expression of IL-1β was widely expressed in group A,B and C,and the expression of IL-1β was A>B>C=D.IL-10 was widely expressed in groups B,C and D,and the expression of IL-10 was A<B<C=D.At week 4,the expression of IL-1β was widely expressed in group A,B and C,which was significantly lower than that at week 2.The expression of IL-1β was A>B>C=D.IL-10 was widely expressed in groups A,B,C and D,and the expression of IL-10 was A<B<C=D.At week 8,the expression of IL-1β was significantly lower than that at week 4.The expression of IL-1β was A>B=C=D.IL-10 was widely expressed in groups A,B,C and D,and the expression of IL-10 was A<B=C=D.The expression of IL-1β was consistent with collagen,while the expression of IL-10 was negative.JAK signaling pathway protein phosphorylation level was A>B>C=D.Conclusion: The fibrosis test of the model after the drainage valve implantation showed a typical inflammatory repair process,and MMC could inhibit this process.MMC affects the expression of these inflammatory factors and ultimately affects the process of scar fibrosis.The JAK signaling pathway should play an important role in scarring after valve implantation. |
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