fibrin and Glaucoma--Open-Angle

The amount of aqueous humor that is constantly produced by the ciliary processes and the equal amount that flows out through the trabecular meshwork via the drainage angle or through the uveoscleral route is very small (2-3 μg/min each), representing approximately 1% of the content of the anterior chamber; therefore, it is challenging to visualize its flow.. A 69-year-old man who had high intraocular pressure (IOP) (>20 mm Hg) with the maximum glaucoma eyedrop dose and presented with severe visual field loss (Humphrey Field Analyzer 30-2: -26.32 dB) had been implanted with a 350-mm2 Baerveldt tube of the aqueous chamber type for refractory open-angle glaucoma. The IOP ultimately decreased (<15 mm Hg) with no need for glaucoma eyedrops.. After the procedures, a fibrin membrane repeatedly formed on the anterior surface of the intraocular lens.. This issue was resolved by two rounds of neodymium-doped yttrium aluminum granet (Nd:YAG) laser surgery and prescription steroidal eyedrops.. During the laser surgery, an unusual and unintended fibrin flap appeared at the opening of the Baerveldt tube; this flap moved synchronously with the heartbeat, as verified by checking the pulse at the radial artery of the wrist. The fibrin flap mimicked the behavior of a cardiac valve, and the aqueous humor and stray fibrin particles mimicked the blood in the chambers of the heart. Although the Baerveldt tube itself is an artificial instrument that is not present in normal human eyes, we hypothesize that our observation shows the fundamental mechanism of aqueous humor drainage.. This novel, vividly descriptive observation highlights the important role of the heartbeat as a drainage pump in aqueous humor flow dynamics and IOP homeostasis, which are treatment targets for glaucoma, the leading cause of blindness.

Topics: Aged; Aqueous Humor; Fibrin; Glaucoma Drainage Implants; Glaucoma, Open-Angle; Heart Rate; Humans; Intraocular Pressure; Laser Therapy; Lasers, Solid-State; Male; Surgical Flaps; Trabeculectomy; Visual Acuity

To evaluate the potential role of the autologous PRGF (plasma rich in growth factors) fibrin membrane in tissue regeneration after glaucoma filtering surgery.. Ten patients with medically uncontrolled primary open-angle glaucoma underwent nonpenetrating deep sclerectomy and were treated with PRGF fibrin membrane as adjuvant. Intraocular pressure reduction was the primary outcome. This variable was measured preoperatively and also at each follow-up visit. Secondary outcomes included the number of antiglaucoma medications, anterior segment optical coherence tomography bleb examination, photographic bleb evaluation, and subjective clinical symptomatology evaluation.. The surgical technique showed a significant reduction (p < 0.05) in intraocular pressure in relation to preoperative values at each time of the study, decreasing from 23.3 ± 6.4 to 15.2 ± 4.6 mm Hg at 2 years. Furthermore, the number of antiglaucoma medications consumed showed a significant reduction at the end point of the study compared with the preoperative situation. Optical coherence tomography and photographic filtering bleb variables experienced a progressive reduction during the follow-up. Subjective symptoms showed a reduction from 8.3 ± 4.5 to 4.2 ± 5.3 at 2 years.. PRGF-Endoret treatment could promote ocular surface regeneration after glaucoma surgery, enhancing the surgery success rates and reducing the need for postoperative medications. It is important to highlight that this is a preliminary study and some large clinical studies are necessary to verify these results.

Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Chemotherapy, Adjuvant; Female; Fibrin; Glaucoma, Open-Angle; Humans; Intercellular Signaling Peptides and Proteins; Intraocular Pressure; Male; Middle Aged; Pilot Projects; Platelet-Rich Fibrin; Sclera; Sclerostomy

The aim of this study was to report a case of severe bilateral fibrinous anterior uveitis following pamidronate therapy in a patient on latanoprost.. This study is presented as an interventional case report.. Clinical examination showed bilateral severe fibrinous uveitis following an intravenous infusion of disodium pamidronate. Ocular signs and symptoms responded to stopping latanoprost and treatment with oral prednisolone (60 mg) and hourly topical prednisolone acetate 1%. The reintroduction of latanoprost resulted in a recurrence, which was stopped with subsequent improvement.. Mild anterior uveitis is an unfamiliar adverse effect of pamidronate therapy. However, severe fibrinous uveitis has not been previously described. This may be due to the compounding effect of latanoprost. This case highlights the importance of history taking and awareness of the otherwise uncommon side effect of this commonly prescribed medication.

Topics: Acute Disease; Administration, Topical; Aged, 80 and over; Anti-Inflammatory Agents; Bone Density Conservation Agents; Diphosphonates; Drug Interactions; Female; Fibrin; Glaucoma, Open-Angle; Humans; Infusions, Intravenous; Latanoprost; Osteoporosis, Postmenopausal; Pamidronate; Prednisolone; Prostaglandins F, Synthetic; Recurrence; Uveitis, Anterior

We report the use of intracameral tissue plasminogen activator to dissolve a fibrin clot occluding a Molteno tube in the immediate postoperative period. This technique is an effective alternative to awaiting clot lysis or reoperation with minimal risk. The only complication was a small, layering hyphema.

Topics: Aged; Blood Coagulation; Cataract Extraction; Female; Fibrin; Fibrinolysis; Glaucoma, Open-Angle; Humans; Lens Subluxation; Ocular Hypertension; Postoperative Complications; Prostheses and Implants; Recombinant Proteins; Silicone Elastomers; Tissue Plasminogen Activator

Transscleral cyclophotocoagulation was performed with a neodymium: YAG laser on five patients 24-72 hr before enucleation for a blind, painful eye. The thermal mode at 20 ms and a maximum offset between aiming and therapeutic beams were kept constant. Variable parameters evaluated were energy levels between 2 and 8 J and distance from the limbus of 0.5-3.0 mm. Because of the underlying distortion in three of the eyes, meaningful interpretation by light microscopic evaluation was possible only in the other two. This suggested that the early histologic hallmark of the procedure is similar to that previously observed in human autopsy eyes with ciliary epithelial damage and elevation from underlying tissue. In addition, fibrin and scant inflammatory cells were seen in the space between ciliary epithelium and stroma. Minimal damage was observed in the ciliary muscle. These findings suggest that direct damage to the ciliary epithelium is the most likely mechanism of reduced aqueous production by this cyclodestructive procedure. The findings also support the concept that an anterior placement of approximately 1.0-1.5 mm posterior to the limbus is most likely to damage the ciliary epithelium of the pars plicata.

Topics: Ciliary Body; Diabetic Retinopathy; Epithelium; Eye Enucleation; Fibrin; Glaucoma, Neovascular; Glaucoma, Open-Angle; Humans; Inflammation; Leukocytes; Light Coagulation; Sclera