センイ チュウタイ セツジョ ジュツ ゴ ト セクスプレス チューブ シャント ソウニュウ ジュツゴ ノ ゼンボウ スイチュウ MCP-1 ノウド ヘンカ ト ロカホウ コウゾウ

熊本大

センイ チュウタイ セツジョ ジュツ ゴ ト セクスプレス チューブ シャント ソウニュウ ジュツゴ ノ ゼンボウ スイチュウ MCP-1 ノウド ヘンカ ト ロカホウ コウゾウ

博士(医学)熊本大

Efficacy and safety of Ex-PRESS® mini shunt surgery versus trabeculectomy for neovascular glaucoma: a retrospective comparative study

Abstract Background The objective of this study is to evaluate and compare the short-term efficacy and safety of Ex-PRESS® mini shunt surgery and trabeculectomy for neovascular glaucoma (NVG). Methods Patients with NVG who underwent Ex-PRESS® mini shunt surgery or trabeculectomy as a primary glaucoma surgery between March 2013 and October 2015 were included in the study, and their medical charts were retrospectively reviewed. The Ex-PRESS® and trabeculectomy groups included 14 eyes and 30 eyes, respectively. Surgical failure was defined by an intraocular pressure (IOP) of ≥21 mmHg (condition A) or ≥ 18 mmHg (condition B); Kaplan–Meier survival analyses and the multivariable Cox proportional hazards model were used to assess efficacies. Results Kaplan–Meier survival analyses indicated that the probabilities of success at 1 year for the Ex-PRESS® group were 25.7 and 31.8% based on complete and qualified success under condition A, respectively. The corresponding values for the trabeculectomy group were 47.8 and 69.3%, and there was a significant difference in qualified success with condition A (Fig. 1; P = 0.018), while there were no significant differences in the other criteria. Ex-PRESS® mini shunt surgery and higher intraocular pressure were independent prognostic factors using Cox proportional hazards model analyses in qualified success as in condition A (P = 0.012 and 0.0495, respectively). The occurrences of postsurgical hyphema and bleb leaks were significantly higher in the trabeculectomy group (P = 0.005 and 0.008, respectively). Conclusion During a 1 year follow-up, Ex-PRESS® mini shunt surgery was a less effective, but safer treatment for NVG compared with trabeculectomy

Postoperative Changes in Aqueous Monocyte Chemotactic Protein-1 Levels and Bleb Morphology after Trabeculectomy vs. Ex-PRESS Shunt Surgery.

To evaluate the postoperative changes in blebs and levels of aqueous monocyte chemotactic protein-1 (MCP-1) after trabeculectomy vs. Ex-PRESS tube shunt surgery.Rabbits were subjected to trabeculectomy or Ex-PRESS tube shunt surgery and observed for up to 3 months. Intraocular pressure (IOP) was measured using a rebound tonometer. The MCP-1 level was measured by enzyme-linked immunosorbent assay (ELISA). Bleb morphology was evaluated using photos and anterior-segment optical coherence tomography (OCT).There were no differences in bleb appearance or IOP at any time between the groups. Bleb wall density in the anterior-segment OCT image was significantly lower 1 week after surgery in the Ex-PRESS group than the trabeculectomy group. The MCP-1 level in control eyes was 304.1 ± 45.2 pg/mL. In the trabeculectomy group, the mean aqueous MCP-1 level was 1444.9, 1914.3, 1899.8, 516.4, 398.3, 427.3, 609.5, 1612.7, 386.2, and 167.9 pg/mL at 3, 6, and 12 h, and 1, 2, 5, 7, 14, 30, and 90 days after surgery, respectively. In the Ex-PRESS group, the corresponding values were 1744.0, 1372.0, 932.5, 711.7, 396.1, 487.3, 799.5, 1327.9, 293.6, and 184.0 pg/mL. There were no significant differences in the aqueous MCP-1 level between the groups at any time point.The postoperative changes were similar in the Ex-PRESS and trabeculectomy groups, except for bleb wall density in the anterior-segment OCT image. The postoperative aqueous MCP-1 level had bimodal peaks in both groups

Immunohistochemical analysis.

<p>α-SMA-positive cells were detected as brown cells in the bleb after trabeculectomy (A, C) and Ex-PRESS tube shunt surgery (B, D). The red squares in A and B outline C and D (higher magnification), respectively. Scale bar, 1 mm (A, B) and 200 μm (C, D).</p

Time course of bleb appearance.

<p>(A) Representative photos after trabeculectomy (top) and Ex-PRESS tube shunt surgery (bottom). (B, C) Blebs were scored using the Moorfields Bleb Grading System. Open circles with dotted line, trabeculectomy group; closed circles with solid line, Ex-PRESS tube shunt surgery group. Mean ± standard error.</p

Time course of aqueous MCP-1 (A) and IOP level (B).

<p>Open circles with dotted line, trabeculectomy group; closed circles with solid line, Ex-PRESS tube shunt surgery group. Mean ± standard error. *P < 0.05, **P < 0.01, Dunnett’s test compared to non-operated eyes.</p

Intensity of the bleb wall measured using anterior-segment optical coherence tomography.

<p>Representative images in a horizontal scan 1 week after trabeculectomy (A) and Ex-PRESS tube shunt surgery (B). Time course of intensity. Open circles with dotted line, trabeculectomy group; closed circles with solid line, Ex-PRESS tube shunt surgery group. Mean ± standard error. *P < 0.05 by Wilcoxon rank-sum test.</p