tag:blogger.com,1999:blog-87928022100253871522024-03-29T08:59:53.901+05:30GLAUCOMA SPECIALIST BLOG: "THE GLOG"A blog on glaucoma by ophthalmologists for ophthalmologistsEditor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.comBlogger271125tag:blogger.com,1999:blog-8792802210025387152.post-6868990659260087242024-03-26T14:34:00.001+05:302024-03-26T14:34:35.257+05:30PERIPAPILLARY RETINOSCHISIS IN GLAUCOMA<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8ajuasmdzHld0vcg4RcXWpnmcgG5Ga1Pt_9-aOmZ-8P7tnV9rao_E7jld4-9EWPg1WnYQHsn6E9M1sCMpVdt4piejy0rvrXFfjV3evO4QgZXvop3qT8O7EWb6Q0Hgm-bj7kuXAgEH8MzTZ5T4SlBDSHC6T1VpP18VldmlUh1aNFRmtZ5rkSx39RZ9BZxS/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8ajuasmdzHld0vcg4RcXWpnmcgG5Ga1Pt_9-aOmZ-8P7tnV9rao_E7jld4-9EWPg1WnYQHsn6E9M1sCMpVdt4piejy0rvrXFfjV3evO4QgZXvop3qT8O7EWb6Q0Hgm-bj7kuXAgEH8MzTZ5T4SlBDSHC6T1VpP18VldmlUh1aNFRmtZ5rkSx39RZ9BZxS/w200-h176/logo2.png" width="200" /></a></div><br /> <p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Peripapillary changes on OCT scans are
being increasingly reported in glaucoma patients. This could be due to better
awareness of these changes or improvement in the instrumentation.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Peripapillary retinoschisis (PPRS) is more
than 10 times commoner in glaucoma patients, compared to healthy controls.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">This condition is defined as the visible
splitting of the inner or outer neurosensory retinal layers. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4SHdbtgrrVTJVtlH8QQaBCCUmke6U3YyOJiO6tfWCKTcIIi5w_QaT6LpmOHLDoFGfYwlxMbaio_977pmbUHuQFWfuomkJFgZOMCbKK5dv7LQXC8tceEq2e32ioujG6sXp6vyfujymwzh6CE_2ovmTkGdr55HnyeN2wl3HCLjGGxPrUKisGX6Zsd_wcDH4/s1004/pprs1.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="613" data-original-width="1004" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4SHdbtgrrVTJVtlH8QQaBCCUmke6U3YyOJiO6tfWCKTcIIi5w_QaT6LpmOHLDoFGfYwlxMbaio_977pmbUHuQFWfuomkJFgZOMCbKK5dv7LQXC8tceEq2e32ioujG6sXp6vyfujymwzh6CE_2ovmTkGdr55HnyeN2wl3HCLjGGxPrUKisGX6Zsd_wcDH4/w400-h244/pprs1.jpg" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The condition is often seen along an
existing RNFL bundle defect.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7S9RP_BxFT2DoEIRd1fwOvb5YFHgtF9ySAlJ-b5sSVqsJhgiuWzLFiHzNULRGh99wN9WMIE8o86-u1i0DTx2OZSNOZetWvuEIbZezFGov0n6KNFtUQt7qJ0ZlAxbRVUgQ3hJL2Jv8DPPlG2yVjacEo_AH7raTkaA4yxJAwXhOwCxG5Uf1Pdy-JZE4fBKM/s332/pprs0.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="296" data-original-width="332" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7S9RP_BxFT2DoEIRd1fwOvb5YFHgtF9ySAlJ-b5sSVqsJhgiuWzLFiHzNULRGh99wN9WMIE8o86-u1i0DTx2OZSNOZetWvuEIbZezFGov0n6KNFtUQt7qJ0ZlAxbRVUgQ3hJL2Jv8DPPlG2yVjacEo_AH7raTkaA4yxJAwXhOwCxG5Uf1Pdy-JZE4fBKM/s320/pprs0.jpg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In a study by Sung et. al, the schisis
appeared on OCT cross-sections as splitting of the superficial prelaminar
tissue. It is usually accompanied with floating retinal vessels which are
cleaved from the underlying prelaminar structures.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixzekgxgCHvAh_E-FLySfMmJ-H16kuNa0ffiSBNcIxLiHaYWp1J0OtqEdPDsM6fJi_VTRSg4Vr6InkPRhcQszeQlHur3ComMqdiKx61QQpl6fB9GwEyym8yBvbNNErZnqFBrczMxPfnS0d0LR8kqNvcc8RhqOroc7vK2WLkC54k42MWVi4HiEXSA3mZkuh/s685/pprs2.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="383" data-original-width="685" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixzekgxgCHvAh_E-FLySfMmJ-H16kuNa0ffiSBNcIxLiHaYWp1J0OtqEdPDsM6fJi_VTRSg4Vr6InkPRhcQszeQlHur3ComMqdiKx61QQpl6fB9GwEyym8yBvbNNErZnqFBrczMxPfnS0d0LR8kqNvcc8RhqOroc7vK2WLkC54k42MWVi4HiEXSA3mZkuh/w400-h224/pprs2.jpg" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">PPRS is attributed to differential shear forces
exerted by lateral tension, causing deformation and remodeling of the
load-bearing tissues in the ONH. It also impacts distant tissues through the retinal
vessels, internal limiting membrane (ILM) and macroglia (Muller cells).<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzZ1xhWg5C7BDKztlF1xeWi6hCb3RrOHHfV5-06rI4l3lULTtQFuW3wIRBuOo8cvEdXWgX-8_Jgo59P7lVJfHLwlH8eHhPbyyn1HRsdbVMz3VubtYsT4zP79wGT59t3ueFYCdc5E0s4Dwz2TCYcXhqdu57s1YIxy1bxrwy2yRFh3NCJ6GWMjZ7l_VI5A6M/s960/PPRS-Case-2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzZ1xhWg5C7BDKztlF1xeWi6hCb3RrOHHfV5-06rI4l3lULTtQFuW3wIRBuOo8cvEdXWgX-8_Jgo59P7lVJfHLwlH8eHhPbyyn1HRsdbVMz3VubtYsT4zP79wGT59t3ueFYCdc5E0s4Dwz2TCYcXhqdu57s1YIxy1bxrwy2yRFh3NCJ6GWMjZ7l_VI5A6M/w400-h300/PPRS-Case-2.png" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Lowry found PPRS was commoner in eyes with
thinner minimum rim width and a deeper cup.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">This condition is regarded as a possible
risk factor for further glaucomatous damage. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">PPRS can cause artifacts in OCT image
segmentation and diagnostic metrics, leading to overestimation of the rim
tissue thickness and underestimation of the cup depth.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u>REFERENCES:</u></b></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;">Lowry EA, Mansberger SL, Gardiner SK, Yang H, Sanchez F, Reynaud J, Demirel S, Burgoyne CF, Fortune B. Association of Optic Nerve Head Prelaminar Schisis With Glaucoma. Am J Ophthalmol. 2021 Mar;223:246-258. doi: 10.1016/j.ajo.2020.10.021. Epub 2020 Nov 6. PMID: 33166501; PMCID: PMC7979447.</span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;">Fortune B. Pulling and Tugging on the Retina: Mechanical Impact of Glaucoma Beyond the Optic Nerve Head. Invest Ophthalmol Vis Sci. 2019 Jan 2;60(1):26-35. doi: 10.1167/iovs.18-25837. PMID: 30601928.</span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;">Sung: </span><span style="font-family: Georgia, serif;"> </span><a href="https://www.ajo.com/article/S0002-9394(21)00329-9/abstract" style="font-family: Georgia, serif;" target="_blank">https://www.ajo.com/article/S0002-9394(21)00329-9/abstract</a></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Steven L. Mansberger: <a href="https://ark.meetingfiles.com/my-ark/view-session/?sid=5ae8ad13-a6c4-4c45-9865-547a51e0c811" target="_blank">https://ark.meetingfiles.com/my-ark/view-session/?sid=5ae8ad13-a6c4-4c45-9865-547a51e0c811</a><br /></span></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwgVOW3NxOzcz6RVwdpLXtL2Tgry0Q7eWp60jGTP-nDcZ7kdhokZmHgQRcN8vtqVMVObWDBu-eR5_xWz6PynyB_ErewC7PU2H1IGWV0js1D6BeO_9HMQWEQkY_R18viJETup36Slgw2MX9ljfzmgP-VIotn4UakV_15vRKb3Ob3s6fWXkNKnh1hqNpC1E3/s1024/DALL%C2%B7E%202023-12-18%2012.46.16%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwgVOW3NxOzcz6RVwdpLXtL2Tgry0Q7eWp60jGTP-nDcZ7kdhokZmHgQRcN8vtqVMVObWDBu-eR5_xWz6PynyB_ErewC7PU2H1IGWV0js1D6BeO_9HMQWEQkY_R18viJETup36Slgw2MX9ljfzmgP-VIotn4UakV_15vRKb3Ob3s6fWXkNKnh1hqNpC1E3/s320/DALL%C2%B7E%202023-12-18%2012.46.16%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" width="320" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-14089062857326936422024-03-23T13:19:00.002+05:302024-03-23T13:22:30.573+05:30HERPES & CMV ASSOCIATED GLAUCOMA<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCxl6XDXNwUxr35YWNgMQtZI69LifEe6X7KffxSdMx0rcNFfwOkCTGLcMb-fDxeJOZfCalrI-C0njVsd0tIOLW6ookOSyhU5-0kmNgdagy_zFXb7qhyphenhyphen3XUoUrfQCOzBsGOV5Q45Sm_6S2OqLlBFQBBIzIRHwHBJQ17gbw8EySt6XMTk6p6I4HlesMlvbrZ/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCxl6XDXNwUxr35YWNgMQtZI69LifEe6X7KffxSdMx0rcNFfwOkCTGLcMb-fDxeJOZfCalrI-C0njVsd0tIOLW6ookOSyhU5-0kmNgdagy_zFXb7qhyphenhyphen3XUoUrfQCOzBsGOV5Q45Sm_6S2OqLlBFQBBIzIRHwHBJQ17gbw8EySt6XMTk6p6I4HlesMlvbrZ/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In a study reported from Sankara Eye
Hospital, Bengaluru, India, patients with viral keratouveitis (VKU) were
analyzed for their clinical features and treatment options.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2PshypcW3ASWW1tdJiNzGAcZzMHlZl2egGtHZ0KJp4QghrQJfM-i6XdfGJXSWtt3Vj8ougluR9zv4mRHWL6PZ9knrqwZH54A1dvQOVPp9Ji488edn_dSoU3UoOxZoUJY2_2f-6VRGFJ9A2qwaOBopMVPkUjkbyhup_TTEGXKIcI4A-vnSpAbBdziYyp9B/s600/uveitis.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="431" data-original-width="600" height="144" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2PshypcW3ASWW1tdJiNzGAcZzMHlZl2egGtHZ0KJp4QghrQJfM-i6XdfGJXSWtt3Vj8ougluR9zv4mRHWL6PZ9knrqwZH54A1dvQOVPp9Ji488edn_dSoU3UoOxZoUJY2_2f-6VRGFJ9A2qwaOBopMVPkUjkbyhup_TTEGXKIcI4A-vnSpAbBdziYyp9B/w200-h144/uveitis.jpg" width="200" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The retrospective study involved 53 eyes of
55 patients diagnosed with VKU.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">64% were males, with the mean age of onset
being 45.4 years.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;">
<tbody><tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td colspan="2" style="border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 467.5pt;" valign="top" width="623">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><b><span style="font-family: "Georgia",serif;">ETIOLOGY OF VKU<o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">84%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">Herpes simplex virus (HSV) <o:p></o:p></span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">16%<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">Herpes zoster virus (HZV) <o:p></o:p></span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">4% <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">Cytomegalovirus (CMV) <o:p></o:p></span></p>
</td>
</tr>
</tbody></table>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;">Common clinical features of VKU induced
glaucoma patients:</span></p>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;">
<tbody><tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><b><span style="font-family: "Georgia",serif;">CLINICAL FEATURES<o:p></o:p></span></b></p>
</td>
<td style="border-left: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><b><span style="font-family: "Georgia",serif;">EYES (%)<o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">Keratic precipitates<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">70.4%<o:p></o:p></span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">Corneal edema<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">66.7%<o:p></o:p></span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">Elevated IOP (within 24
hours)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">44%<o:p></o:p></span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">Glaucomatous damage<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid windowtext; border-left: none; border-right: 1pt solid windowtext; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 233.75pt;" valign="top" width="312">
<p class="MsoNormal" style="line-height: 150%; margin-bottom: 0in; text-align: justify;"><span style="font-family: "Georgia",serif;">20%<o:p></o:p></span></p>
</td>
</tr>
</tbody></table>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Patients with more than 2 episodes of VKU
had a significantly higher risk of developing glaucoma (p<0.09).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Most patients were treated with steroids,
acyclovir and with medical management of glaucoma. However, 7.2% eyes required
glaucoma surgery.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u>REFERENCE:</u></b></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="background-color: white; color: #212121; font-size: 17px; text-align: start;"><span style="font-family: georgia;">Sudhakar P, Menon M, Ck M, Balasubramaniam A. Glaucoma in Viral Keratouveitis: A Retrospective Review at a Tertiary Eye Hospital. J Curr Glaucoma Pract. 2022 Jan-Apr;16(1):65-70. doi: 10.5005/jp-journals-10078-1359. PMID: 36060041; PMCID: PMC9385385.</span></span></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiio2mVXyFMDrOuP4GPImMn6nmbuzNolYjkPZl7eSckOsUuVDj2NLo_NF7jh8o54xID_4vvV6YEjiBPH-bPQsAP9YT9jHHRE2RdMOwl2hJ0k66MUui56Jqkwxk4DmX1hZQ8iaEBr8s1RniB-RYPgZCr1UD6Y5NmlTXvOcwwUA5ejHj3087GUV-0wmQK8fBR/s1024/IMG_20240225_114635.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiio2mVXyFMDrOuP4GPImMn6nmbuzNolYjkPZl7eSckOsUuVDj2NLo_NF7jh8o54xID_4vvV6YEjiBPH-bPQsAP9YT9jHHRE2RdMOwl2hJ0k66MUui56Jqkwxk4DmX1hZQ8iaEBr8s1RniB-RYPgZCr1UD6Y5NmlTXvOcwwUA5ejHj3087GUV-0wmQK8fBR/s320/IMG_20240225_114635.png" width="320" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-343885727984730792024-03-19T13:11:00.001+05:302024-03-19T13:38:09.583+05:30MENTAL HEALTH AND GLAUCOMA<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2V7CUJD-ms561AkWVz_iwCjfrRC-sNXgFTz3zYmz63DX9TYRU1B1zUZUFE78NVBHeGFyOKKPAEkSfC7bpzXnW1tbdH8aA5YWs4tfCIj4dp3JSlvr1C_wGqwlixBeIYGhBxBTGR3a89ODHG96iuhIZL5ocMud5wVVpDr_0aYmQaQEcTkRPYHnno5jiianb/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2V7CUJD-ms561AkWVz_iwCjfrRC-sNXgFTz3zYmz63DX9TYRU1B1zUZUFE78NVBHeGFyOKKPAEkSfC7bpzXnW1tbdH8aA5YWs4tfCIj4dp3JSlvr1C_wGqwlixBeIYGhBxBTGR3a89ODHG96iuhIZL5ocMud5wVVpDr_0aYmQaQEcTkRPYHnno5jiianb/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Memory and cognitive impairment, as well as
other mental health problems (e.g., depression and anxiety) are conditions
which could significantly reduce a glaucoma patient's ability to adhere to the treatment regime. Poor
adherence to treatment may lead to preventable vision loss.</span></p><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Cognitive impairment may prevent one from
adhering to treatment, regardless of the complexity of the treatment regimen. In
a study, 12% of patients reported difficulty remembering to take their
medications [<i>Sleath B, Robin AL, Covert D, et al. Patient-reported behavior
and problems in using glaucoma medications. Ophthalmology. 2006;113(suppl
3):431–436</i>]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Another study has shown that the patients
who were nonadherent to the treatment protocol had more frequent memory
problems than participants classified as adherent. Such memory problems
included forgetting when to take their medication and forgetting appointments.
[<i>Stryker JO, Beck AD, Primo SA, et al. An exploratory study of factors
influencing glaucoma treatment adherence. J Glaucoma. 2010;19:66–72]</i><o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><i><br /></i></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: "Georgia",serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB7ndBeN0ZHXZx6PB6aeJET-SLDku_8GyVXijGLZ-fXp4NvD9Nc-YILudMWjgaIaSdW3hReOyHaBdv_M-SqzIgKYPQi-MLehafx20DsW-DGKxr1Z7U7PkGcWhj1c_SJ55eZzgsduZWOOkjaOZSdVDcVz7QauHV05ojrLardomEXJOtLBDj5zGfb3nN1tyX/s1024/DALL%C2%B7E%202024-03-19%2011.24.00%20-%20old%20man%20putting%20eye%20drops.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB7ndBeN0ZHXZx6PB6aeJET-SLDku_8GyVXijGLZ-fXp4NvD9Nc-YILudMWjgaIaSdW3hReOyHaBdv_M-SqzIgKYPQi-MLehafx20DsW-DGKxr1Z7U7PkGcWhj1c_SJ55eZzgsduZWOOkjaOZSdVDcVz7QauHV05ojrLardomEXJOtLBDj5zGfb3nN1tyX/s320/DALL%C2%B7E%202024-03-19%2011.24.00%20-%20old%20man%20putting%20eye%20drops.png" width="320" /></a></span></div><span style="font-family: "Georgia",serif;"><br /><i><br /></i></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In a study by Yochim and colleagues, controlling
for age, in subjects above 50 years of age, memory impairment was found in
approximately 20% of the sample, and impaired executive functioning was found
in approximately 22% of the sample. Mild-to-moderate depressive symptoms were
found in 12.2% of participants, and 1 person reported clinically significant
anxiety. [<i>Yochim, Brian P. PhD, ABPP*; Mueller, Anne E. MA*; Kane, Katherine
D. MA*; Kahook, Malik Y. MD†. Prevalence of Cognitive Impairment, Depression,
and Anxiety Symptoms Among Older Adults With Glaucoma. Journal of Glaucoma
21(4):p 250-254, April/May 2012. | DOI: 10.1097/IJG.0b013e3182071b7e</i>]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The results from Yochim’s study indicate
that cognitive impairment may be common in older patients with glaucoma. This
has implications for treatment adherence, as difficulties in remembering
information may significantly impede the ability to follow instructions from a
physician. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Care-givers for glaucoma patients are usually
focused on compliance to treatment but overlook the mental health issues of the
patients which could be driving the poor adherence to protocols.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Since these care-givers are often the first
to interact with such patients, it is imperative that they are able to pick the
signs and symptoms providing clues to the presence of mental health issues in
these patients. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Appropriate interventions can achieve
better quality of life in these patients in the long run.</span></p><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-61124622793756573852024-03-16T16:21:00.002+05:302024-03-16T16:21:42.625+05:30NANO-CARRIERS FOR GLAUCOMA<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYQmkg8FgUMMW9Bo-ooYWLFKpM24Jj9JW4OAVxVYNyvrY_RXpVDHLGECdK9-2jvAB8hUm3r2t7fE_9jKe5v7JEWZshNPKFwqmuoZfUa6wsMQ5VYzD2RvdIArwmzwQskv94X3iCsLVwlM-Lp7hjyLao9j5uV9-RLl1qWlptfH4nYfo2bjquBpiyjafEYsbs/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYQmkg8FgUMMW9Bo-ooYWLFKpM24Jj9JW4OAVxVYNyvrY_RXpVDHLGECdK9-2jvAB8hUm3r2t7fE_9jKe5v7JEWZshNPKFwqmuoZfUa6wsMQ5VYzD2RvdIArwmzwQskv94X3iCsLVwlM-Lp7hjyLao9j5uV9-RLl1qWlptfH4nYfo2bjquBpiyjafEYsbs/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The conjunctiva forms an important obstacle
that does not allow drugs between 20 and 40 kDa to pass through it. The
permeability of the sclera is under debate. However, studies have shown that it
is not strictly a barrier, because molecules with a molar mass up to 150 kDa
are able to penetrate it. An important pharmacological requirement for topical
medications for glaucoma is to overcome these anatomical obstacles.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Various periocular, extraocular and
intraocular nano/micro-drug delivery systems (DDSs) have been engineered. A
number of them have been found to be safe and efficacious as anti-glaucoma
hypotensive agents. These DDSs include topical formulations, ocular inserts,
drug-eluting contact lenses, ocular ring inserts, intracameral, intravitreal,
subconjunctival and suprachoroidal injectable formulation/implants. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvCBvEnAxR_nHXIdCx4NMRFEnkP5W9tQjO1Tx1-RR2AH4JE66ptpvaZZdS5de5SxxushHDPySTBRoKc1SsiPQHNHnKUMBeSwJsJhk5Jxsk6tKEb5SY6MBGmEdkpyqoG9XmYuoMo5iVs77UqS3LXQRy4ofik37gKRuxzMT-0rbB38xT1rO0yvL0VufxcWdC/s711/nanopic1.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="711" data-original-width="457" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvCBvEnAxR_nHXIdCx4NMRFEnkP5W9tQjO1Tx1-RR2AH4JE66ptpvaZZdS5de5SxxushHDPySTBRoKc1SsiPQHNHnKUMBeSwJsJhk5Jxsk6tKEb5SY6MBGmEdkpyqoG9XmYuoMo5iVs77UqS3LXQRy4ofik37gKRuxzMT-0rbB38xT1rO0yvL0VufxcWdC/w258-h400/nanopic1.jpeg" width="258" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">According to the size, drug carriers can be
classified as implants (>1 mm), microparticles (MPs, particles with a size
ranging from 1 to 1000 µm) and nanoparticles (NPs, particles with a size less
than 1000 nm). Currently, NPs remain the most intensively used form due to
their small size, easily modified surface, ability to adsorb, attach and
encapsulate various substances, and favorable biocompatibility.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Nanocarriers can be prepared in a variety
of forms, such as polymeric nanomicelles (self-assembled suspension of
amphiphilic block copolymers with hydrophobic cores and hydrophilic shells) and
nanoemulsions (a mixture of two immiscible liquids with surfactants). <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The incorporation of drugs into
nanocarriers may surpass the limitations of current treatment regimens by
enhancing drug penetration, achieving targeted delivery, prolonging contact of
drugs with ocular tissues, and sustaining in vivo release.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Unlike other agents, nanocarriers are
equally effective in delivering lipophilic drugs, proteins, and even genes,
which are difficult with conventional solvents. Nanocarriers are also able to
protect the integrity of drug cargo before reaching the target sites. This
property is particularly intriguing when transporting molecules such as
neurotrophin and antibodies because these proteins easily degrade in vivo.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Based on their physical structures, drug
carriers can be divided into reservoir-type and matrix-type drug delivery
systems. In reservoir-type carriers, drug agents are trapped in an inner core,
surrounded by a polymer wall that controls the rate of drug release. In
matrix-type carriers, the agents are buried within and uniformly distributed
throughout the polymer matrix.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCCFeZemDb0KDQCf-HaEhs192M2JQBg43qFmOrm1Sg1hXHcnv-EH7T72iQqDafxToVDTUbnocCC8ThrjdoR1nppmB_jZV2gveuluJ2lTSXjz8rLUR1tx9fsqDj7J1uUEqsKFEJJU7bRxOWiwOjVWxF3IQdLFoDKFhf33zlslu1scaE_Kd4oWpmnZptV_nV/s467/nanopic2.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="449" data-original-width="467" height="308" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCCFeZemDb0KDQCf-HaEhs192M2JQBg43qFmOrm1Sg1hXHcnv-EH7T72iQqDafxToVDTUbnocCC8ThrjdoR1nppmB_jZV2gveuluJ2lTSXjz8rLUR1tx9fsqDj7J1uUEqsKFEJJU7bRxOWiwOjVWxF3IQdLFoDKFhf33zlslu1scaE_Kd4oWpmnZptV_nV/s320/nanopic2.jpeg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In order to improve biocompatibility or
optimize the drug release patterns different forms of materials or additives
are often incorporated into one hybrid system.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMV9p-b9uv6A4Z8V762ylW_WN0xFtGPphzcxAwovvEwVQRvYzgJXMPolcJD0-lPWsVBkT1kiAD4uPRpqqfvuTRGiWdIe7egp2Pd7sWIxsfHtsjA7ehyP5oxNKGZej9Dpjy-_DD9vpjtUaHL7i0_o2r_RgfWETVzhPBsKFLkMoOTRAz-XGpClqtWLid59vS/s1024/DALL%C2%B7E%202024-01-21%2018.39.44%20-%20picture%20of%20robotic%20eye%20with%20matrix%20numbers%20and%20rays.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMV9p-b9uv6A4Z8V762ylW_WN0xFtGPphzcxAwovvEwVQRvYzgJXMPolcJD0-lPWsVBkT1kiAD4uPRpqqfvuTRGiWdIe7egp2Pd7sWIxsfHtsjA7ehyP5oxNKGZej9Dpjy-_DD9vpjtUaHL7i0_o2r_RgfWETVzhPBsKFLkMoOTRAz-XGpClqtWLid59vS/s320/DALL%C2%B7E%202024-01-21%2018.39.44%20-%20picture%20of%20robotic%20eye%20with%20matrix%20numbers%20and%20rays.png" width="320" /></a></div><br /><p></p><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-23088860792797459922024-03-13T16:09:00.002+05:302024-03-13T16:09:58.372+05:30GLAUCOMA WEEK 2024<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiif3aOr4scQxGgD9nfEW3sI3zJyJJZ1nl6NQblZdCUp7Luq6NsLGEBKhLIlXtgcdmKmuMw0GY4uEkun6Vftk2VyKszC78cRo2apG6cA1OpHDI1-6BJ5-lr-k1jmzlscKXXgtSF5EIYa_v8a0L8nWT12uQFUYg2xHnzx3IVVUNUpHt0y1D1uOwxPjN_lBa4/s3120/IMG_20240313_142944.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2876" data-original-width="3120" height="295" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiif3aOr4scQxGgD9nfEW3sI3zJyJJZ1nl6NQblZdCUp7Luq6NsLGEBKhLIlXtgcdmKmuMw0GY4uEkun6Vftk2VyKszC78cRo2apG6cA1OpHDI1-6BJ5-lr-k1jmzlscKXXgtSF5EIYa_v8a0L8nWT12uQFUYg2xHnzx3IVVUNUpHt0y1D1uOwxPjN_lBa4/s320/IMG_20240313_142944.jpg" width="320" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;">The
glaucoma week is an important reminder of our commitment to glaucoma care. The
general population is still in the dark regarding the complexities of this
condition. As Shields mentioned in his classical text, there are more than 70
types of glaucoma known. The common denominator being damage to the retinal
ganglion cells and their axons. More horizontal and vertical screenings are
required to detect this disease and try to slow down the progressive decline.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;">The first
step in the management of glaucoma is to find the root cause of this world-wide
problem.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;">Dr. Syed
Shoeb Ahmad<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;">MBBS, MS,
FAEH, FCLI<o:p></o:p></span></p><br /><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-62394289666694167552024-03-09T12:08:00.004+05:302024-03-09T12:08:59.988+05:30COAST TRIAL (Clarifying the Optimal Application of SLT Therapy)<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz41QOSJCOaxInosM0LaK1UJg93XBpxWiD-iKs37XBnT2pGSLz3j6u-436zwgJm0T8-e8vmesriDNRdBurXB_9BKS0hkMVZMBr5-sHuHPwxVnovW8kDcnue_qXpJ5RyGcfoBKniCYy6F0up97Tra7RYV69XZo_Tqo2wFrTzoHH_XSrKLGW6B4Lu19eUkcj/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz41QOSJCOaxInosM0LaK1UJg93XBpxWiD-iKs37XBnT2pGSLz3j6u-436zwgJm0T8-e8vmesriDNRdBurXB_9BKS0hkMVZMBr5-sHuHPwxVnovW8kDcnue_qXpJ5RyGcfoBKniCYy6F0up97Tra7RYV69XZo_Tqo2wFrTzoHH_XSrKLGW6B4Lu19eUkcj/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The <b><u style="background-color: white;">COAST trial</u></b> seeks to compare the
efficacy and safety of standard versus low energy primary selective laser
trabeculoplasty (SLT) in eyes with mild-moderate primary open-angle glaucoma
(POAG) or high-risk ocular hypertension (OHTN) and to determine the optimal
interval and energy for repeat SLT.</span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIdAL0chQLJmBJF8YRWmdGMnAFPEv3vELMOpjzdzcn22KnLkNSmpM0aAs2PAdmX8NqmexQEKqL-TSIVMedpQnN6u9OUP2OGK4dtC-6Nc3XrUSlzKps0WyOVFfoMpKZYCpiaMK5o2W-mjrrIEIVO5N1j6_4vU2PL7_Qgo3iTmXUv_gnnGyDREqv9e2bJ31V/s464/IMG_20240309_103630.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="464" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIdAL0chQLJmBJF8YRWmdGMnAFPEv3vELMOpjzdzcn22KnLkNSmpM0aAs2PAdmX8NqmexQEKqL-TSIVMedpQnN6u9OUP2OGK4dtC-6Nc3XrUSlzKps0WyOVFfoMpKZYCpiaMK5o2W-mjrrIEIVO5N1j6_4vU2PL7_Qgo3iTmXUv_gnnGyDREqv9e2bJ31V/w200-h173/IMG_20240309_103630.png" width="200" /></a></div><span style="font-family: Georgia, serif;"><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;"><br /></span></p>At the 2018 annual meeting of the
Association for Research in Vision and Ophthalmology (ARVO), Stephano Gandolfi
presented a retrospective study of his patients at the University of Parma,
Italy, in which a regimen of low-energy SLT repeated annually irrespective of
intraocular pressure (IOP) produced significantly longer medication-free
survival than standard SLT repeated as needed, in patients with POAG or OHTN.</span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In Gandolfi’s study, newly-diagnosed POAG
eyes were treated primarily either with ALT 360° performed once, standard SLT
360° repeated as needed at standard energy, and low-energy 360° SLT (0.4
mJ/spot x 50-60 spots) repeated annually at low energy regardless of IOP. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">After 10 years of follow-up,
medication-free rates were 22.6% in the ALT group, 25.0% in the standard SLT
group, and 58.3% in the low-energy SLT group (p<0.001).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Gandolfi’s data suggested that the
long-term utility of SLT in glaucoma management can be improved by altering the
energy level and frequency at which SLT is performed.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The National Eye Institute (NEI) is
conducting randomized multicenter trials based on the above observations. These
trials—collectively named the Clarifying the Optimal Application of SLT Therapy
(COAST) trial—were funded in late 2020 by NEI to compare standard versus
low-energy primary SLT and annual versus <i>pro re nata</i> (PRN) repeat SLT and are
currently in the pre-enrollment phase.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The COAST Trial- based on Gandolfi’s
proof-of-concept study and evidence-based biological plausibility—that low
energy SLT, repeated annually irrespective of IOP, may reduce both SLT-related
and glaucoma-related cumulative TM damage, thus preserving TM responsivity to
SLT and extending the duration of which SLT can maintain glaucoma control and
prevent or delay the need for medications or surgery.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">This trial can bring a paradigm shift in
the management of such cases, reducing the burden of medications and still
preserving IOP levels.<o:p></o:p></span></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYnDs66RMhXf9HNzKcn94S7Iut-akEfxaOSE9nfGs0-3jmNw0Buvj4RRaz2zJotQGw4x-pUV2BG0tFwZjbannvrNRFHW9oh1TTcbnCdMrBS-6sW6OdZwpncgIrGjj0L_qNkEpH7b9eQgpeSQOZpmi7LwjpGXjlFZ9EtJqZnciUo3ZnyGUFIJdvt7HsdS6D/s1024/DALL%C2%B7E%202024-01-21%2018.39.58%20-%20picture%20of%20robotic%20eye%20with%20matrix%20numbers%20and%20rays.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="919" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYnDs66RMhXf9HNzKcn94S7Iut-akEfxaOSE9nfGs0-3jmNw0Buvj4RRaz2zJotQGw4x-pUV2BG0tFwZjbannvrNRFHW9oh1TTcbnCdMrBS-6sW6OdZwpncgIrGjj0L_qNkEpH7b9eQgpeSQOZpmi7LwjpGXjlFZ9EtJqZnciUo3ZnyGUFIJdvt7HsdS6D/s320/DALL%C2%B7E%202024-01-21%2018.39.58%20-%20picture%20of%20robotic%20eye%20with%20matrix%20numbers%20and%20rays.png" width="287" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-18383335796352583712024-03-05T12:19:00.001+05:302024-03-05T12:19:29.726+05:30EYEMATE IMPLANTABLE TONOMETER<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOH1APMkicueXo7ohL6nEMDbPoQdGM7Lcm92V6_dZNSa3SuWmUOScm-1QAOqJ7AStRGbCONrwTwNKapQ0nbqQv4H8pmFgvq6wQfkFY7Ibpyx7XViHtIefQk9h3sc6Ri1hmfWrtLHWzFAzRII9VK3oYKZPWLUrIGLTvWK5ebhngzhg3iq_eRPqpIibLli73/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOH1APMkicueXo7ohL6nEMDbPoQdGM7Lcm92V6_dZNSa3SuWmUOScm-1QAOqJ7AStRGbCONrwTwNKapQ0nbqQv4H8pmFgvq6wQfkFY7Ibpyx7XViHtIefQk9h3sc6Ri1hmfWrtLHWzFAzRII9VK3oYKZPWLUrIGLTvWK5ebhngzhg3iq_eRPqpIibLli73/w200-h176/logo2.png" width="200" /></a></div><br /> <p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The Eyemate system consists of a permanent
implantable and biocompatible micro sensor, which provides continuous
intraocular pressure (IOP) measurements. The Eyemate-SC, developed by the German
company Implandata Ophthalmic Products, is inserted into the suprachoroidal
space. The Eyemate-IO is implanted in the ciliary sulcus.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN_fBc1u-PsT1y1Qw0QK3ACtI-r4kuO5CElufKIpbmkbjdFjmKf3PUjJlBUUKCgwSbhM2sWWv2TGH8KZiy90d9CXHtitOmvkGa76C7xe6wdSGUz8_vitHbtvMDzc69kXKZwdnwFD5xrPEK12UCzbRPklU-h72f_37Xsv0d1c6AaqJ2MMuSxuNQPMcVnIlj/s753/001.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="535" data-original-width="753" height="284" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN_fBc1u-PsT1y1Qw0QK3ACtI-r4kuO5CElufKIpbmkbjdFjmKf3PUjJlBUUKCgwSbhM2sWWv2TGH8KZiy90d9CXHtitOmvkGa76C7xe6wdSGUz8_vitHbtvMDzc69kXKZwdnwFD5xrPEK12UCzbRPklU-h72f_37Xsv0d1c6AaqJ2MMuSxuNQPMcVnIlj/w400-h284/001.png" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Sulcus implanted wireless telemetric
sensors were shown to be generally safe and to provide long-term reliable IOP
measurements. However, ciliary sulcus implantation has numerous disadvantages
such as iris chafing and atrophy, pupillary distortion and pigment dispersion.
The implants are reserved for pseudophakic or cataract patients, which excludes
younger patients for whom long-term IOP monitoring is particularly important. Furthermore,
the bulky sensor ring needs a large corneo-scleral incision and causes
excessive manipulation during sulcus implantation. The ARGOS and ARGOS-02
trials for the Eyemate-IO did show good patient tolerability and provided
measurements that closely agreed with manometric pressure measurements.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The Eyemate device consists of eight
pressure- and temperature-sensitive capacitors attached to a gold circular
antenna, and readings are transmitted through an external handheld device which
also charges the Eyemate through electromagnetic coupling.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiehewFfg6gHkFJmvg1o8TYVnGCopnj0y4dz9eq9G8WjFslg4heTHANwHAbYbp6xoKDfn8hOXQoGmbGXKModuDLoDBtoHAYjsMo_mIQV0b-7etolXufeJ1AxD68Bh13WvNGOW9lPfUfhwRVGPiR6b_d5Bdq6YEHwSvGzbTMihkSvd9MQdpFh7gBGXrxgiZ2/s699/eyematepic1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="556" data-original-width="699" height="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiehewFfg6gHkFJmvg1o8TYVnGCopnj0y4dz9eq9G8WjFslg4heTHANwHAbYbp6xoKDfn8hOXQoGmbGXKModuDLoDBtoHAYjsMo_mIQV0b-7etolXufeJ1AxD68Bh13WvNGOW9lPfUfhwRVGPiR6b_d5Bdq6YEHwSvGzbTMihkSvd9MQdpFh7gBGXrxgiZ2/w400-h319/eyematepic1.png" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA3Wm4EMMkQez7RVXpngHXKC9cCvMOXywzRwih-0U7S4TMmwxWWVGcPI5AhYo49LCdv4yMg5aev_RkED-L_RKGj3hq6TmUexJZqUMmHwyQQcdoHZllGSo1KOp5lMgzE4HVmqCt1j8lp9G83igyxZC6MzRRVqyilIiM8j_Q7Xj5-ILG4kAVjSQs6XHjWmuU/s1052/eyemate%20pic2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="683" data-original-width="1052" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA3Wm4EMMkQez7RVXpngHXKC9cCvMOXywzRwih-0U7S4TMmwxWWVGcPI5AhYo49LCdv4yMg5aev_RkED-L_RKGj3hq6TmUexJZqUMmHwyQQcdoHZllGSo1KOp5lMgzE4HVmqCt1j8lp9G83igyxZC6MzRRVqyilIiM8j_Q7Xj5-ILG4kAVjSQs6XHjWmuU/w400-h260/eyemate%20pic2.png" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The IOP measurements are transmitted via a
wireless data connection to a secure internet-based database. This enables the
treating physician to monitor the IOP and then decide the adjustment of the
glaucoma medications. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqGxJq0THBXYZludVaUDz_1ASa2Jnw9Qoyty5vwjHmqJdnVU37yxzjzrerOsR9FcFqYxFe3bZYNOOJhN83TqsI9U8rbso1S9whsjVoRINbWag8u8tKRWodzZ8nPCeh6ixGvuSpsamYGQ74n045k6GgxQj_kTlJrrbdTeNWWhH68uFz8mm56E-yv8npOEhP/s945/eyematepic3.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="711" data-original-width="945" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqGxJq0THBXYZludVaUDz_1ASa2Jnw9Qoyty5vwjHmqJdnVU37yxzjzrerOsR9FcFqYxFe3bZYNOOJhN83TqsI9U8rbso1S9whsjVoRINbWag8u8tKRWodzZ8nPCeh6ixGvuSpsamYGQ74n045k6GgxQj_kTlJrrbdTeNWWhH68uFz8mm56E-yv8npOEhP/s320/eyematepic3.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYWJ94EyScPySk6tLSlAh7HbGigXjnyYcTl-_7OMT9_SBqliau-7cksdhbQWKOy1YCdaxNeK8GgjJGosCpSk51JdF6k-ThcuLkYuAbiES2538xQyG-ng4DPsipv1p2G0m0-A5VXDBZMf77Ww6eyjeFVQ9Q2F-SxOeDvQPTfZVyEGthF1toE1IspzCLP_zG/s1257/eyemate%20pic4.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="707" data-original-width="1257" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYWJ94EyScPySk6tLSlAh7HbGigXjnyYcTl-_7OMT9_SBqliau-7cksdhbQWKOy1YCdaxNeK8GgjJGosCpSk51JdF6k-ThcuLkYuAbiES2538xQyG-ng4DPsipv1p2G0m0-A5VXDBZMf77Ww6eyjeFVQ9Q2F-SxOeDvQPTfZVyEGthF1toE1IspzCLP_zG/s320/eyemate%20pic4.png" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The Eyemate smartphone app will provide
helpful information about the disease status and the therapy success to the
patient and a medication schedule can be established, which reminds the patient
automatically when he/her has to apply his/her glaucoma medication.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">One of the main advantages of IOP sensors
is that they are independent of corneal biomechanics. While corneal-surface-based
tonometry techniques only measure relative dimensional changes of the eye with
questionable validity, intraocular sensors directly measure the absolute IOP.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u>SURGICAL TECHNIQUE:</u></b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">To implant the sensor, the suprachoroidal
space is accessed either through the window (100% thickness technique) or
through a 5mm incision in the remaining scleral lamella (90% thickness
technique). The choroid is separated from the sclera by means of OVD, and the
EYEMATE-SC implant is carefully inserted into the suprachoroidal space using
padded implantation forceps and avoiding contact with the sensor’s ASIC.
Afterward, the superficial scleral flap and the conjunctiva are closed and
sutured.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJVYkhOrpvj_jcEHpxLYDdJji2SJTEGDDC2MzziVUdeuTICqHhxC0MKWE11p3a9QDF_GgXnOU7t65Tw2WHoEhmLf7rhc-cPiSAassnMRRpNA1i69fO5Z4m_GyZG1M5jT0RRffbXbe5Vs17m0BYrOazTD40lUj0sl0Nol53zWqTHAgWt7UWyCfEhbnKmEGu/s3516/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2587" data-original-width="3516" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJVYkhOrpvj_jcEHpxLYDdJji2SJTEGDDC2MzziVUdeuTICqHhxC0MKWE11p3a9QDF_GgXnOU7t65Tw2WHoEhmLf7rhc-cPiSAassnMRRpNA1i69fO5Z4m_GyZG1M5jT0RRffbXbe5Vs17m0BYrOazTD40lUj0sl0Nol53zWqTHAgWt7UWyCfEhbnKmEGu/s320/1.png" width="320" /></a></div><span style="font-family: Georgia, serif;"><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;"><br /></span></p><b><u>COMPLICATIONS:</u></b></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The most frequent postoperative
complication after Eyemate implantation is hyphema. Other complications
reported are: superficial punctate keratitis, postoperative leakage, choroidal
detachment and hypotony, postoperative photopsia, touch sensitivity, slight
pain in the operative area, and intermittent headaches. No serious AEs related
to the EYEMATE-SC sensor have been reported.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u>REFERENCES:</u></b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><ol><li><span style="font-family: "Georgia",serif;">Szurman P, Gillmann K, Seuthe AM, Dick HB,
Hoffmann EM, Mermoud A, Mackert MJ, Weinreb RN, Rao HL, Mansouri K; EYEMATE-SC
Study Group. EYEMATE-SC Trial: Twelve-Month Safety, Performance, and Accuracy
of a Suprachoroidal Sensor for Telemetric Measurement of Intraocular Pressure.
Ophthalmology. 2023 Mar;130(3):304-312. doi: 10.1016/j.ophtha.2022.09.021. Epub
2022 Oct 3. PMID: 36202141.</span></li><li><span style="font-family: "Georgia",serif;">Szurman P, Mansouri K, Dick HB, Mermoud A,
Hoffmann EM, Mackert M, Weinreb RN, Rao HL, Seuthe AM; EYEMATE-SC study group.
Safety and performance of a suprachoroidal sensor for telemetric measurement of
intraocular pressure in the EYEMATE-SC trial. Br J Ophthalmol. 2023
Apr;107(4):518-524. doi: 10.1136/bjophthalmol-2021-320023. Epub 2021 Nov 12.
PMID: 34772665; PMCID: PMC10086291.</span></li><li><span style="font-family: "Georgia",serif;">Koutsonas A, Walter P, Roessler G, Plange
N. Implantation of a novel telemetric intraocular pressure sensor in patients
with glaucoma (ARGOS study): 1-year results. Invest Ophthalmol Vis Sci. 2015
Jan 22;56(2):1063-9. doi: 10.1167/iovs.14-14925. PMID: 25613949.</span></li><li><span style="font-family: "Georgia",serif;">Choritz L, Mansouri K, van den Bosch J,
Weigel M, Dick HB, Wagner M, Thieme H; ARGOS study group. Telemetric
Measurement of Intraocular Pressure via an Implantable Pressure Sensor-12-Month
Results from the ARGOS-02 Trial. Am J Ophthalmol. 2020 Jan;209:187-196. doi:
10.1016/j.ajo.2019.09.011. Epub 2019 Sep 20. PMID: 31545953.</span></li></ol><p></p>
<br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgI6BBBFME6ffZmj6mNkONF5itYD2PqqHu-hT2yyvo-oQBaFRCVfqoRsvJgZwiwmM2cK1I9_oM2zb7AVGIWD1CKmpACsFLIkGh5juA-kQAhLbdwZkPNVdmmJCXsXAXYO3hhoPa1Cgwk1FNNrQ28bEzcADSvYO1w-gS2oksZj2kJ7mUBAw63tuwQhCYy8aJd/s1024/DALL%C2%B7E%202024-02-06%2019.46.57%20-%20a%20blind%20doctor%20doing%20surgery%20digital%20art.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgI6BBBFME6ffZmj6mNkONF5itYD2PqqHu-hT2yyvo-oQBaFRCVfqoRsvJgZwiwmM2cK1I9_oM2zb7AVGIWD1CKmpACsFLIkGh5juA-kQAhLbdwZkPNVdmmJCXsXAXYO3hhoPa1Cgwk1FNNrQ28bEzcADSvYO1w-gS2oksZj2kJ7mUBAw63tuwQhCYy8aJd/s320/DALL%C2%B7E%202024-02-06%2019.46.57%20-%20a%20blind%20doctor%20doing%20surgery%20digital%20art.png" width="320" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-22554774662689811392024-03-02T13:19:00.001+05:302024-03-02T13:19:12.297+05:30TAFLUTAN<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNaX27__pYtj2Ta3x_K4t-KwIVd6bGuU1ouT1e1GBq1G3NH65y0UPSqP9cA1-jy6Mdzye61hrmmThlyRaB_tddfqdhBPkDN-sLfEkaS5CD3sYK-ysmmanvC-afNhET4gqLRYokdy9b3zc3N_qQBIWmIbD87E4C5mEW2Vndz4hNpOS9BxztoAz3WWFf8xHp/s312/logo2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNaX27__pYtj2Ta3x_K4t-KwIVd6bGuU1ouT1e1GBq1G3NH65y0UPSqP9cA1-jy6Mdzye61hrmmThlyRaB_tddfqdhBPkDN-sLfEkaS5CD3sYK-ysmmanvC-afNhET4gqLRYokdy9b3zc3N_qQBIWmIbD87E4C5mEW2Vndz4hNpOS9BxztoAz3WWFf8xHp/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u style="background-color: #b6d7a8;">Tafluprost 0.0015%</u></b> is a prostaglandin
analogue which was co-developed by Santen with Asahi Glass Co., Ltd (Tokyo,
Japan)</span><span style="font-family: "Georgia",serif; mso-bidi-font-family: "MS Gothic"; mso-fareast-font-family: "MS Gothic";"> </span><span style="font-family: "Georgia",serif;">for the treatment of glaucoma and elevated intraocular
pressure (IOP). Unit-dose, preservative- free eyedrops and in combination with
timolol are now also available. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The recommended dose is one drop of tafluprost
in the conjunctival sac of the affected eye(s) once daily in the evening.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfCTmHrsugpfRoPwQU3k1h2W92r4GQAfQfXYuAP8azea5WN-G-vqc6XFW1Szrmcz8evAacK9ynvVw7DkUAvIdut5fHfJK3lQnyZm8F0Om4LmLWnyQCEfX8CwcJq71Z48IvpqwR2Xn5EoFCByj1Mw0oxraYN7JUTCwOOI7jqm3K9_ZUGcUzTUKyzTTvzqEk/s525/Taflotan6001PPS0.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="525" data-original-width="444" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfCTmHrsugpfRoPwQU3k1h2W92r4GQAfQfXYuAP8azea5WN-G-vqc6XFW1Szrmcz8evAacK9ynvVw7DkUAvIdut5fHfJK3lQnyZm8F0Om4LmLWnyQCEfX8CwcJq71Z48IvpqwR2Xn5EoFCByj1Mw0oxraYN7JUTCwOOI7jqm3K9_ZUGcUzTUKyzTTvzqEk/s320/Taflotan6001PPS0.jpg" width="271" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">PHARMACOLOGY:<o:p></o:p></span></u></b></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><u><span style="font-family: "Georgia",serif;">Mechanism of action=<o:p></o:p></span></u></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Tafluprost acid is a fluorinated prostaglandin
F2α (PGF2α) analogue. Tafluprost is a prodrug of the active substance,
tafluprost acid, a structural and functional analogue of PGF2α. Tafluprost acid
is a selective agonist at the prostaglandin F-receptor, increasing outflow of
aqueous humor via the uveoscleral pathway and thus lowering IOP.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Other PGF2α analogues with the same
mechanism of action include latanoprost and travoprost.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmxhyeP3yItmMiYLjnXDG3j9m4gQBg2H4UT9KrOfAChf6XWHlleLHtla6cvdQYysyE9o0hWWn_tNwYozs1T-38wZ6UB1Ffssl3Fzz1Nw6DarF4yg6oJyVUy4VsnOAuPV2bcON0H-ifQAJ5-BA_WR7-jGMaJENKUiEB9MydPKqkpVAaZS8MdC9Chx88ybOl/s331/Tafluprost-chemical-structure.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="331" data-original-width="331" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmxhyeP3yItmMiYLjnXDG3j9m4gQBg2H4UT9KrOfAChf6XWHlleLHtla6cvdQYysyE9o0hWWn_tNwYozs1T-38wZ6UB1Ffssl3Fzz1Nw6DarF4yg6oJyVUy4VsnOAuPV2bcON0H-ifQAJ5-BA_WR7-jGMaJENKUiEB9MydPKqkpVAaZS8MdC9Chx88ybOl/s320/Tafluprost-chemical-structure.gif" width="320" /></a></div><u><span style="font-family: "Georgia",serif;">Pharmacokinetics=</span></u><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Tafluprost is a prodrug ester prostaglandin
F2α-analog designed to expedite the corneal penetration of the drug, which is
then hydrolyzed by corneal esterases to produce the carboxylic acid active
metabolite. The product, tafluprost acid, can then be taken up by the aqueous
humor to therapeutically relevant levels.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Onset of action is 2 to 4 hours after
application, the maximal effect is reached after 12 hours, and ocular pressure
remains lowered for at least 24 hours.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Tafluprost acid is inactivated by beta
oxidation to 1,2-dinortafluprost acid, 1,2,3,4-tetranortafluprost acid, and its
lactone, which are subsequently glucuronidated or hydroxylated. The cytochrome
P450 liver enzymes play no role in the metabolism.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">ADVERSE EFFECTS:<o:p></o:p></span></u></b></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The most common side effect of tafluprost
is conjunctival hyperemia, which occurs in 4 to 20% of patients. Less common
side effects include stinging of the eyes, headache, and respiratory
infections. Rare side effects are dyspnea (breathing difficulties), worsening
of asthma, and macular oedema.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Tafluprost causes changes to pigmented
tissues, leading to increased pigmentation of the iris, periorbital tissue
(eyelid) and eyelashes. Before treatment is initiated, patients should be
informed of the possibility of eyelash growth, darkening of the eyelid skin and
increased iris pigmentation. Some of these changes may be permanent, and may
lead to differences in appearance between the eyes when only one eye is
treated.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Usually, the eyelash and pigmentary changes
resolve after discontinuation of the drug.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">To reduce the risk of darkening of the
eyelid skin patients should blot off any excess solution from the skin. Nasolacrimal
outflow occlusion or gently closing the eyelid after administration may reduce
the systemic absorption of products administered via the ocular route.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Contact lenses should be removed prior to
the administration of tafluprost, and may be reinserted 15 minutes following
administration.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Caution is recommended in patients with
known risk factors for iritis/uveitis and should generally not be used in
patients with active intraocular inflammation.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Macular edema, including cystoid macular
edema, has been reported during treatment with prostaglandin F2α analogues.
These side-effects usually occur in aphakic patients, pseudophakic patients
with a torn posterior lens capsule or anterior chamber lenses, or in patients
with known risk factors for macular edema. Therefore, caution is recommended
when using tafluprost in these patients.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">STUDIES:<o:p></o:p></span></u></b></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In a review performed by Keating, tafluprost
was at least as effective as latanoprost ophthalmic solution 0.005 % in Asian
patients with primary open-angle glaucoma or ocular hypertension. The efficacy
of tafluprost ophthalmic solution 0.0015 % was maintained in the longer term.
[1]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A study by the Tafluprost Multi-center
Study Group and others, found the agent to be effective in lowering IOP in
normal-tension glaucoma (NTG) patients. Mean IOP changes from baseline were
-4.0 +/- 1.7 mmHg in tafluprost administered patients and -1.4 +/- 1.8 mmHg in
Placebo administered patients at 4 weeks, with a statistically significant
difference (p<0.001). [2]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A study by Nakano et al., to evaluate the efficacy
and safety of tafluprost in NTG with IOP of 16 mmHg or less, found the IOP in
the study eyes versus fellow eyes were 10.2 ± 1.6 versus 12.1 ± 1.5 mmHg at
week 12 of treatment. The IOP difference between the study eyes and the fellow
eyes was statistically significant (P < 0.0001, Student's t test). [3]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Hoy has reported good IOP control with the
tafluprost/timolol combination (Taptiqom). [4]<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSWRTWM0oBdaSPZa9SM9GBm-pppvmFUY73c5PnQFqMFV0j4bEb9kVKRZer89_Zi62ncnq5wW_Y1aj7TgesAnGbt5-FQfgd7U2aEoKKVnSxZTMpwdVX-PENTtXuA5Odglu9qTZnR_UNXoeK8Hd7NnzDG0fiHrfHHDhCPCpxm9ZfFKR-UKsUvJCAKbOPrBWV/s383/TAFTIMO.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="383" data-original-width="280" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSWRTWM0oBdaSPZa9SM9GBm-pppvmFUY73c5PnQFqMFV0j4bEb9kVKRZer89_Zi62ncnq5wW_Y1aj7TgesAnGbt5-FQfgd7U2aEoKKVnSxZTMpwdVX-PENTtXuA5Odglu9qTZnR_UNXoeK8Hd7NnzDG0fiHrfHHDhCPCpxm9ZfFKR-UKsUvJCAKbOPrBWV/s320/TAFTIMO.png" width="234" /></a></div><b><u><span style="font-family: "Georgia",serif;">REFERENCES:</span></u></b><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><ol><li><span style="font-family: "Georgia",serif;">Keating GM. Tafluprost Ophthalmic Solution
0.0015 %: A Review in Glaucoma and Ocular Hypertension. Clin Drug
Investig. 2016 Jun;36(6):499-508. doi: 10.1007/s40261-016-0413-z. PMID:
27225879.</span></li><li><span style="font-family: "Georgia",serif;">Kuwayama Y, Komemushi S; <a name="_Hlk159841202">Tafluprost Multi-center Study Group</a>. [Intraocular
pressure lowering effect of 0.0015% tafluprost as compared to placebo in
patients with normal tension glaucoma: randomized, double-blind, multicenter,
phase III study]. Nippon Ganka Gakkai Zasshi. 2010 May;114(5):436-43. Japanese.
PMID: 20545217.</span></li><li><span style="font-family: "Georgia",serif;">Nakano T, Yoshikawa K, Kimura T, Suzumura
H, Nanno M, Noro T. <a name="_Hlk159844654">Efficacy and safety of tafluprost
in normal-tension glaucoma with intraocular pressure of 16 mmHg or less</a>.
Jpn J Ophthalmol. 2011 Nov;55(6):605-13. doi: 10.1007/s10384-011-0082-7. Epub
2011 Aug 27. PMID: 21874307.</span></li><li><span style="font-family: "Georgia",serif;">Hoy SM. Tafluprost/Timolol: A Review in
Open-Angle Glaucoma or Ocular Hypertension. Drugs. 2015 Oct;75(15):1807-13.
doi: 10.1007/s40265-015-0476-9. PMID: 26431840.</span></li></ol><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFLxlXvVl5_2t1JSbmlpWrywGNGHOGM1vKJ7Txj7KMAmzYl35PvVN2h1TjDAN_2lOacl3AcUHmqD9AhFLZy8wP6j8iUla45z6BMp-aee8ShdgJI1DUAMlIirkoVDl1UA67FfgOoHwuaE5gVUR1wjJqWDYqta6K2cgNNwql-CKjm3_p7sjPECikzNSn25vx/s1024/DALL%C2%B7E%202023-12-12%2012.53.50%20-%20many%20eyes%20floating%20in%20the%20sky%20digital%20art.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFLxlXvVl5_2t1JSbmlpWrywGNGHOGM1vKJ7Txj7KMAmzYl35PvVN2h1TjDAN_2lOacl3AcUHmqD9AhFLZy8wP6j8iUla45z6BMp-aee8ShdgJI1DUAMlIirkoVDl1UA67FfgOoHwuaE5gVUR1wjJqWDYqta6K2cgNNwql-CKjm3_p7sjPECikzNSn25vx/s320/DALL%C2%B7E%202023-12-12%2012.53.50%20-%20many%20eyes%20floating%20in%20the%20sky%20digital%20art.png" width="320" /></a></div><br /><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-43633226937763701542024-02-27T13:06:00.000+05:302024-02-27T13:06:10.019+05:30AXONAL REGENERATION<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQTOfkKNK4QQJAvJbabFp5NY4SBlZy_Nys1P4WKTK3GbzGhPHaPTiv95bGMFYtzHMGrX-tvT8fH0QGCujT3iMlHkjHSD6ztYpYXHAK5P-KZSylAkXujt4mwKEK1E8GFf_tThnHF5F_F3Ka_V2AXM6HUsos9BYFyKj4dT7vJOEmDhWngM9kS6v7tutrEo6s/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQTOfkKNK4QQJAvJbabFp5NY4SBlZy_Nys1P4WKTK3GbzGhPHaPTiv95bGMFYtzHMGrX-tvT8fH0QGCujT3iMlHkjHSD6ztYpYXHAK5P-KZSylAkXujt4mwKEK1E8GFf_tThnHF5F_F3Ka_V2AXM6HUsos9BYFyKj4dT7vJOEmDhWngM9kS6v7tutrEo6s/w200-h176/logo2.png" width="200" /></a></div><br /> <p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">A few
days after axonal injury, the associated retinal ganglion cells (RGCs) begin to
degenerate. This is especially so if the injury is close to the eye. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">The death
of RGCs can be prevented almost completely by overexpression of the
antiapoptotic Bcl family proteins, such as, Bcl-2 and Bcl-xL.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">However,
the regeneration and survival of axons is also dependent on numerous
intracellular signaling pathways. This is seen when RGCs overexpressing Bcl-2
or Bcl-xL fail to regenerate axons, unless provided with additional growth
factors. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZZdxKCUarbY4pflqYU0NcGXVh5SLy0aW2aNp7RWAVs1z3EuYYR8fTCUiDP_MvSOEeJfaQL6xa47ZM35kdXtULPq9yJ_j3Y2KKdMfhWr85zjGs99bNQN4I3l54_PKwgHUW6QfRGLmRVLNgCoKR2gu7VQPJuvA5o0Ys4M9BIzZ1U_2amlG4nhRw3339Gi55/s850/Stages-of-axon-degeneration-A-acute-injury-responses-B-acute-axonal-degeneration.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="610" data-original-width="850" height="288" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZZdxKCUarbY4pflqYU0NcGXVh5SLy0aW2aNp7RWAVs1z3EuYYR8fTCUiDP_MvSOEeJfaQL6xa47ZM35kdXtULPq9yJ_j3Y2KKdMfhWr85zjGs99bNQN4I3l54_PKwgHUW6QfRGLmRVLNgCoKR2gu7VQPJuvA5o0Ys4M9BIzZ1U_2amlG4nhRw3339Gi55/w400-h288/Stages-of-axon-degeneration-A-acute-injury-responses-B-acute-axonal-degeneration.png" width="400" /></a></div><br /><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">A number
of trophic factors can slow, but not completely stop, the death of RGCs. These
factors include ciliary neurotrophic factor (CNTF), brain derived
neurotrophic factor (BDNF), neurotrophin 4/5 nerve growth
factor, insulin-like growth factor-1, granulocyte colony-stimulating
factor, glial-derived neurotrophic factor, and neurturin. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">The death
of axotomized RGCs is also slowed by preventing caspase cleavage, blocking
the nuclear enzyme poly (adenosine diphosphate–ribose) polymerase (a substrate
for caspases), blocking nitric oxide synthase, introducing reducing
agents, or inhibiting cell death via caspase-independent
pathways. Long-term prevention of RGC death after axotomy may require the
development of long-term delivery systems or a combination of treatments.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Fibroblast
growth factor 2 stimulates some axon regeneration through the optic nerve.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Two
molecules present in the eye were found to stimulate mature RGCs to regenerate
their axons. One is mannose, a simple sugar that is abundant in the vitreous.
Mannose stimulates RGCs to extend moderately long axons if cells have
sufficiently high levels of intracellular cyclic adenosine monophosphate
(cAMP). The second growth factor is oncomodulin (Ocm), a 12-kDa,
calcium-binding protein secreted by macrophages. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">The
advances during the past few years give hope for the possibility that at least
some RGCs will be able to regenerate their axons all the way to their central
targets. The future challenges will include finding ways to optimize this
regeneration and testing whether they restore functionally meaningful levels of
vision.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><b><u>REFERENCE:</u></b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Benowitz
LI, Yin Y. Optic Nerve Regeneration. <i>Arch Ophthalmol.</i> 2010;128(8):1059–1064.
doi:10.1001/archophthalmol.2010.152<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYcy-nGP1R1KKEqjvMlVhyphenhyphen5GU-uXeBBRPLXhrQjeAgVOnzfMUNGVruPjdQnirMrYuBxYLFMnKHBso7mJCkqarg0gKkM1HF09iLeu5WmaOjGq_-e1wkO9P_GX3mEDkozS1vo5nTMv0SpCEi-22mPQoEbmI0B-ZcnU5kCCTZr37A3VwcCr3EroTWXBxxukaB/s1024/IMG_20240225_114743.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYcy-nGP1R1KKEqjvMlVhyphenhyphen5GU-uXeBBRPLXhrQjeAgVOnzfMUNGVruPjdQnirMrYuBxYLFMnKHBso7mJCkqarg0gKkM1HF09iLeu5WmaOjGq_-e1wkO9P_GX3mEDkozS1vo5nTMv0SpCEi-22mPQoEbmI0B-ZcnU5kCCTZr37A3VwcCr3EroTWXBxxukaB/s320/IMG_20240225_114743.png" width="320" /></a></div><br /><p></p><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-11770092127041242752024-02-24T12:45:00.001+05:302024-02-24T14:47:21.077+05:30AXONAL RESPONSE TO INJURY<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq7Y1At_OyZNRLfd6bLmKYCNgFaEkej-lG5b81lS_n5M7zg5jctjC7Fuy8C9Z-0SeZT_mKDX-l02hgqQBxNy6gFFVlC7VuOdKhG7ZjpIR1-dWYrtalezu8f5P1PHWXDGra4zPfoQHGfqE5pfcnrnRPCcTShiHV6hna6tBmaYyiAmyaP-qaehsACLXIURes/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq7Y1At_OyZNRLfd6bLmKYCNgFaEkej-lG5b81lS_n5M7zg5jctjC7Fuy8C9Z-0SeZT_mKDX-l02hgqQBxNy6gFFVlC7VuOdKhG7ZjpIR1-dWYrtalezu8f5P1PHWXDGra4zPfoQHGfqE5pfcnrnRPCcTShiHV6hna6tBmaYyiAmyaP-qaehsACLXIURes/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The optic nerve is regarded as an extension
of the brain. It is usually recognized that once damaged, the optic nerve does
not regenerate, leading to visual loss lasting the lifetime of the individual. The
degeneration of the optic nerve follows a timeline of events, starting
milliseconds to hours after the initiating event, such as trauma or ischemia. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6myamtAD24XAu72tdVqwrmpxFhLhQAwdAcc5PpT72Su_dv2Xs02yM9V7OewWcfYOwUGwEEuUsQVdF5ComRTr1lh3jsUcVJuuaBGyyOyLVzhbgrGFftFqxzAykIJ4iDWiZhBzSPk7-clZsPG2FfCxZxeTR6mVYAo3GVOUQHwNZqpRawnBsYshy_hutDmG5/s475/48cf27923d22933da370114c2a75d3b3.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="454" data-original-width="475" height="306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6myamtAD24XAu72tdVqwrmpxFhLhQAwdAcc5PpT72Su_dv2Xs02yM9V7OewWcfYOwUGwEEuUsQVdF5ComRTr1lh3jsUcVJuuaBGyyOyLVzhbgrGFftFqxzAykIJ4iDWiZhBzSPk7-clZsPG2FfCxZxeTR6mVYAo3GVOUQHwNZqpRawnBsYshy_hutDmG5/s320/48cf27923d22933da370114c2a75d3b3.jpg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">One of the earliest effects is the entry of
calcium ions (Ca<sup>++</sup>) into the site, through voltage-gated calcium channels,
as well as, possibly from the endoplasmic reticulum. This increased Ca<sup>++</sup>
activates calpains, which are commonly occurring cysteine proteases,
mechanistically linking injury-induced calcium signaling to subsequent axonal
degeneration by the process of cytoskeletal degradation. Following this, the
axons swell and fragment on both sides of the injury. In murine spinal cord,
the same fragmentation process can be completely blocked by calpain inhibitors.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A few days later, the <b>distal</b> axon
segments fragment through a process called Wallerian degeneration in which the
cytoskeleton is degenerated. The axon first forms swellings and then fragments
into self-enclosed units, and the myelin disintegrates into elliptical
structures.</span> <span style="font-family: "Georgia",serif;">The <b>proximal</b>
axonal segment forms a retraction bulb, elliptical in shape and several times
the axonal diameter. This bulb grows progressively larger over weeks as the
axonal cytoskeleton depolymerizes and the axon dies back towards the soma. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><span style="mso-spacerun: yes;"><br /></span></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: "Georgia",serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdfbD4Glkx7SxkRdVbU3Oe6NzDL_V9pVs1zHGaPKwebSEkkeqqsrLlVcTl0lnQGvrXQEY9IwYrgzkLyYIFDsL2CSlKEUN2ifPr5sv40YHHwq-90zoppw1H4xfIM9Az6OFZU3xioaDnWHjo0EUdjblhBvXwNNbf17CwEdoi0Jeh5FOVtV67IKDpa6fPYdBN/s438/3-s2.0-B9780123851574006722-f00672-03-9780123851574.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="438" data-original-width="328" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdfbD4Glkx7SxkRdVbU3Oe6NzDL_V9pVs1zHGaPKwebSEkkeqqsrLlVcTl0lnQGvrXQEY9IwYrgzkLyYIFDsL2CSlKEUN2ifPr5sv40YHHwq-90zoppw1H4xfIM9Az6OFZU3xioaDnWHjo0EUdjblhBvXwNNbf17CwEdoi0Jeh5FOVtV67IKDpa6fPYdBN/s320/3-s2.0-B9780123851574006722-f00672-03-9780123851574.jpg" width="240" /></a></span></div><span style="font-family: "Georgia",serif;"><br /><span style="mso-spacerun: yes;"><br /></span></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The first week following the event is
critical as the inflammatory response reaches its peak. Infiltrating
monocyte-derived macrophages arrive at the optic nerve after the first day. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Astrocytes at the injury site in the optic
nerve degenerate within 3 days and begin to repopulate by day 7. Optic nerve
head astrocytes become reactive, losing many fine processes and shrinking in
total area covered, but thickening both their soma and primary processes.
Retinal microglia increase in number, presumably through proliferation. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The retinal ganglion cell soma receives the
signal that it has been damaged within the first week, and many stress
responses are subsequently activated. Whether the RGC will die or regenerate is
determined in that first week after injury, and this fate depends on various
intrinsic and extrinsic factors.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">REFERENCE:</span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Fague L, Liu YA, Marsh-Armstrong N. The
basic science of optic nerve regeneration. Ann Transl Med. 2021 Aug;9(15):1276.
doi: 10.21037/atm-20-5351. PMID: 34532413; PMCID: PMC8421956.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie_e6CO4W1WTEWRCCBMGWbRZwO_FQgeL2S4KzDzfd39VJpzpWL5sVjC_WjPfqVNjVSqUxwale8d74WG9hbyijlQBuRzKHXKUoRDEXffU4DbVyHCfCCIx4FXSbvOJserziIV7JrKZsVM2afx2Aa45OTq1x14IR10L6p5Ufec3Jf55h42sT0k77sMyFNHQQs/s1024/DALL%C2%B7E%202023-12-18%2012.46.09%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie_e6CO4W1WTEWRCCBMGWbRZwO_FQgeL2S4KzDzfd39VJpzpWL5sVjC_WjPfqVNjVSqUxwale8d74WG9hbyijlQBuRzKHXKUoRDEXffU4DbVyHCfCCIx4FXSbvOJserziIV7JrKZsVM2afx2Aa45OTq1x14IR10L6p5Ufec3Jf55h42sT0k77sMyFNHQQs/s320/DALL%C2%B7E%202023-12-18%2012.46.09%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" width="320" /></a></div><br /><p></p><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-35107946895214555762024-02-20T12:22:00.000+05:302024-02-20T12:22:33.140+05:30ORAL CANNABINOID (PEA) FOR GLAUCOMA TREATMENT<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXdjc1rnPHnsqJ9AhxxzpbdKCGgd3mWjg5m3cg9kbbNWSTCsjbGXtWygqa84FFFvDdZ9zF_t72hQhnVMDIyMHJwNMGHX3vMQCW4AlDQ6IMj78fDI4T1tt4PKpql6w0Ua19pZAUwVQee3cx2H8jpO0tovf1t4DMb8V0dkTqNGIWSeNpEVDhyphenhyphen50VQouji-Ms/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXdjc1rnPHnsqJ9AhxxzpbdKCGgd3mWjg5m3cg9kbbNWSTCsjbGXtWygqa84FFFvDdZ9zF_t72hQhnVMDIyMHJwNMGHX3vMQCW4AlDQ6IMj78fDI4T1tt4PKpql6w0Ua19pZAUwVQee3cx2H8jpO0tovf1t4DMb8V0dkTqNGIWSeNpEVDhyphenhyphen50VQouji-Ms/w200-h176/logo2.png" width="200" /></a></div><br /> <p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A cannabinoid system composed of several
receptors and endogenous cannabinoids, including anandamide (AEA) and
2-arachidonylglycerol (2-AG), has been identified in the brain, the peripheral
tissue, and the eye. Two principal cannabinoid receptors have been described
(CB1, which is predominant in neurons, and CB2, which is localized in immune
cells and peripheral tissue cells). <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In the human eye, CB1 receptors have been
reported from the trabecular meshwork (TM) and Schlemm canal cells. Also, CB2
receptors have been demonstrated in porcine TM cells in culture.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">AEA and the CB1- and CB2-selective agonists
enhance aqueous humor outflow through the conventional pathway and
significantly decrease intra-ocular pressure (IOP) in rabbits, primates, and humans after topical
application. Conversely, CB1 antagonists elevate IOP. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">AEA, the most investigated endo-cannabinoid,
acts as a partial CB1 agonist and a weak CB2 agonist and activates the vanilloid
type 1 receptor. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="background-color: #fcff01; font-family: Georgia, serif;"><b><u>Palmitoyl-ethanol-amide (</u></b></span><span style="font-family: "Georgia",serif;"><b><u style="background-color: #fcff01;">PEA)</u></b> is an endogenous congener of AEA that
is co-synthesized with AEA by most cell types. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhICuPu5hyphenhyphenrKch0R0RoTJA1KgHmtaQBLCEY3Jn1GBx3QIjeprJgg2PUdG7BiOnibaMM86CdjwOEdHWS4sythyjtMWhwHNPByK90m1wNrImr-WQG5sSWAqJSFBMnXKkLdbO4RPQbCXNjAtvW3svRWNCvKM__1W48MS-yW_HasRFxO6_F07_ThiKNOwqpDmqj/s3016/pea2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1846" data-original-width="3016" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhICuPu5hyphenhyphenrKch0R0RoTJA1KgHmtaQBLCEY3Jn1GBx3QIjeprJgg2PUdG7BiOnibaMM86CdjwOEdHWS4sythyjtMWhwHNPByK90m1wNrImr-WQG5sSWAqJSFBMnXKkLdbO4RPQbCXNjAtvW3svRWNCvKM__1W48MS-yW_HasRFxO6_F07_ThiKNOwqpDmqj/w400-h245/pea2.jpg" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">PEA does not bind to CB1 or CB2 receptors,
but it is a competing substrate with AEA for the enzyme fatty acid amide
hydrolase (FAAH) active site, and it has been hypothesized to increase or
prolong the effect of AEA (entourage effect) without the systemic side effects
of cannabinoids.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A study was reported by Gagliano et al., to
assess the effect of oral PEA administration on IOP in primary open angle glaucoma (POAG) and ocular hypertension (OH). In the
study, 42 patients with POAG or OH who were treated with timolol 0.5% and whose
IOP was between 19- and 24-mm Hg received oral PEA (300-mg tablets twice a day)
or placebo (PEA vehicle tablets twice a day) for 2 months (period 1), and,
after a 2-month washout, received the other treatment for 1 month (period 2).
<b>[1]</b><o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7uUfp7YDeGfWiySfmHseU6hfhfIQgO9BAKmRsQNDyVMeHfzKQD5rPtfvDOnZt946sINY-xSUOvpWY68zAuQDy3oumkcHpx9JR1ry9tbmSW-RXbmHFpLZAd6R5wpt498wSnNHFovNfCt7NbdXsfwzo34OkGZLCWEXy7fg7xA0U0IURApTy7hU75MJsGv6T/s1000/peapix.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="598" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7uUfp7YDeGfWiySfmHseU6hfhfIQgO9BAKmRsQNDyVMeHfzKQD5rPtfvDOnZt946sINY-xSUOvpWY68zAuQDy3oumkcHpx9JR1ry9tbmSW-RXbmHFpLZAd6R5wpt498wSnNHFovNfCt7NbdXsfwzo34OkGZLCWEXy7fg7xA0U0IURApTy7hU75MJsGv6T/s320/peapix.jpg" width="191" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">After PEA treatment (mean baseline IOP,
21.6 </span><span style="font-family: "Georgia",serif; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">±</span><span style="font-family: "Georgia",serif;">
1.7 mm Hg), IOP was reduced by 3.2 </span><span style="font-family: "Georgia",serif; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">±</span><span style="font-family: "Georgia",serif;"> 1.3 mm Hg at 1 month and by 3.5 </span><span style="font-family: "Georgia",serif; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">±</span><span style="font-family: "Georgia",serif;"> 1.2 mm Hg
(15.9% </span><span style="font-family: "Georgia",serif; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">±</span><span style="font-family: "Georgia",serif;">
5.1%) at 2 months (ANOVA, P < 0.001; both Tukey-Kramer, P < 0.01 vs.
baseline).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Conversely, after placebo (mean baseline
IOP, 21.5 </span><span style="font-family: "Georgia",serif; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">±</span><span style="font-family: "Georgia",serif;">
1.5 mm Hg), IOP was reduced by 0.4 </span><span style="font-family: "Georgia",serif; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">±</span><span style="font-family: "Georgia",serif;"> 1.2 mm Hg at 1 month and by 0.3 </span><span style="font-family: "Georgia",serif; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">±</span><span style="font-family: "Georgia",serif;"> 1.3 mm Hg at 2
months (t-test at both time points, P < 0.001 vs. PEA). No statistically
significant vital signs, visual field, visual acuity changes, or adverse events
were detected in either group.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">No specific side effects were reported with
PEA, and no contraindications have been defined.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The study found no significant changes in
systemic blood pressure. Although, cannabinoids reduce blood pressure, with an
effect particularly involving CB1 receptors.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The decrease in IOP was 16% of the baseline
level, which was comparable to the levels achieved with other currently used
anti-hypertensive medications, such as topical Carbonic Anhydrase Inhibitors
and alpha agonists. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Kumar et al., have also performed a study
to analyze the effect of PEA on aqueous humor outflow facility. According to
them PEA caused a concentration-dependent enhancement of outflow facility
through the trabecular meshwork. These effects are mediated by GPR55 and PPARα
receptors through activation of p42/44 MAPK. <b>[2]</b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Another novel and significant effect of PEA
is neuroprotection. We know that glaucoma is a neuropathy affecting the nervous
tissue of the retina and the optic nerve. It is presumed that this neuropathy
has an inflammatory component, especially in the glia (neuroinflammation). It
is known that PEA has significant anti-inflammatory effects and this property
could contribute to neuroprotection by reducing the inflammatory component of
glaucoma. <b>[3]</b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Strobbe et al., have found that PEA
improves the endothelium-dependent flow-mediated vasodilation (FMD)
characteristics in OH patients. These patients have elevated plasma and aqueous
levels of endothelin-1 (ET-1), causing chronic impairment of ocular blood flow,
especially of the optic nerve head. <b>[4]</b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Therefore, PEA, a drug of a class that has
been proposed for the treatment of glaucoma but that is not used because of
concerns about side effects, could be a valuable tool in the treatment of such
diseases.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><span style="background-color: #fcff01;">FOR MORE INFORMATION ON THE ROLE OF MARIJUANA IN GLAUCOMA, CLICK THIS LINK</span>: <a href="https://ourgsc.blogspot.com/search?q=marijuana" target="_blank">https://ourgsc.blogspot.com/search?q=marijuana</a></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">REFERENCES:<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -0.25in;"></p><ol><li><span style="font-family: "Georgia",serif; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;"><span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Georgia",serif;">Gagliano
C, Ortisi E, Pulvirenti L, Reibaldi M, Scollo D, Amato R, Avitabile T, Longo A.
Ocular hypotensive effect of oral palmitoyl-ethanolamide: a clinical trial.
Invest Ophthalmol Vis Sci. 2011 Aug 3;52(9):6096-100. doi:
10.1167/iovs.10-7057. PMID: 21705689.<o:p></o:p></span></li><li><span style="font-family: "Georgia",serif;">Kumar
A, Qiao Z, Kumar P, Song ZH. Effects of palmitoylethanolamide on aqueous humor
outflow. Invest Ophthalmol Vis Sci. 2012 Jul 3;53(8):4416-25. doi:
10.1167/iovs.11-9294. PMID: 22589443; PMCID: PMC4625824.<o:p></o:p></span></li><li><span style="font-family: "Georgia",serif;">https://areaoftalmologica.com/en/blog/glaucoma/palmitoylethanolamide-pea-a-new-focus-on-the-treatment-of-glaucoma/</span></li><li><span style="font-family: "Georgia",serif;">Strobbe
E, Cellini M, Campos EC. Effectiveness of palmitoylethanolamide on endothelial
dysfunction in ocular hypertensive patients: a randomized, placebo-controlled
cross-over study. Invest Ophthalmol Vis Sci. 2013 Feb 1;54(2):968-73. doi:
10.1167/iovs.12-10899. PMID: 23307959.<o:p></o:p></span></li></ol><!--[if !supportLists]--><p></p>
<br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5FF2Omg2a1I1fNvz4WBJUUjryj9aZBEvgOyJwDdOGgYz0xKLtC7jE2CnfkNiDdbRRaoV4OAx3r_F8u4T8MPgYXrCD_NpeCbv4drlR9tnTS8xKM61CA0xLeNxo5Kyz5XV6KitmG4hUsmCtE4r320xXox4XO9BHZ7Y-qkYS9Th1i1e2efDr_ypv606U95ue/s1024/DALL%C2%B7E%202023-12-28%2009.42.14%20-%20river%20eyes%20sunrise%20pixel%20art.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5FF2Omg2a1I1fNvz4WBJUUjryj9aZBEvgOyJwDdOGgYz0xKLtC7jE2CnfkNiDdbRRaoV4OAx3r_F8u4T8MPgYXrCD_NpeCbv4drlR9tnTS8xKM61CA0xLeNxo5Kyz5XV6KitmG4hUsmCtE4r320xXox4XO9BHZ7Y-qkYS9Th1i1e2efDr_ypv606U95ue/s320/DALL%C2%B7E%202023-12-28%2009.42.14%20-%20river%20eyes%20sunrise%20pixel%20art.png" width="320" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-84685846784148167472024-02-17T12:38:00.002+05:302024-02-17T12:38:18.347+05:30COMPASS PERIMETER<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgm8sDLEs0f9i3PLpq6_AlUNSlQ5cE_6Xr-qdTFNt0ysBZXhPVZUfOKid4d0AUDx8SXsvJfWP_y_8d-YOI0943zIzTgJUNwCBmG_vXZy1hzx1XAbYOEVDmBH8eFJlyrRLfWOMw5kFUqXKAbt-w5o6oqlMc9PMwg3O-LGV83c4Fb3_iamclmDbJtbJFD21X/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgm8sDLEs0f9i3PLpq6_AlUNSlQ5cE_6Xr-qdTFNt0ysBZXhPVZUfOKid4d0AUDx8SXsvJfWP_y_8d-YOI0943zIzTgJUNwCBmG_vXZy1hzx1XAbYOEVDmBH8eFJlyrRLfWOMw5kFUqXKAbt-w5o6oqlMc9PMwg3O-LGV83c4Fb3_iamclmDbJtbJFD21X/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u style="background-color: #fcff01;">iCare COMPASS</u></b> is an automatic perimeter which
also combines an active retinal tracker and a scanning ophthalmoscope. This
technology provides retinal threshold sensitivity as well as TrueColor confocal
images of the retina and fixation analysis, which is eye movement artefact-free.
<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKsIfHZjT-ckc8ogr51iqzG_iY-JAaouGoM87QtZhgfB0t5MPihjWUhZ2UXnhe5H398sQI_5-6OdF4CSHH0bHi3miH3y_rhmLdNiJXcVhUO_syVcDqpGkJJ7udhmtIF8c3GjZPW8voCCVFwghZ0lXwROl07B1qykstAKBABnMKMAAM1-YoEAZz5IyOAFbh/s600/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKsIfHZjT-ckc8ogr51iqzG_iY-JAaouGoM87QtZhgfB0t5MPihjWUhZ2UXnhe5H398sQI_5-6OdF4CSHH0bHi3miH3y_rhmLdNiJXcVhUO_syVcDqpGkJJ7udhmtIF8c3GjZPW8voCCVFwghZ0lXwROl07B1qykstAKBABnMKMAAM1-YoEAZz5IyOAFbh/s320/1.jpg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The COMPASS is compatible with SAP and
offers full range of 24-2, 30-2 and 10-2 visual field-testing programs, containing
age-matched databases of retinal sensitivity in normal subjects.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The COMPASS supra-threshold testing is used
to perform fast screening for visual field (VF) loss.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The iCare COMPASS measures sensitivity at
specific retinal locations with high topographic accuracy due to the retinal
tracking technology which compensates for any eye movements during VF
examination, providing higher accuracy of the test results.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Continuous, automated, tracking of eye
movements yields to active compensation of fixation losses, with perimetric
stimuli being automatically re-positioned prior to and during projection based
on the current eye position. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">This mechanism is critical to ensure
accurate correlation between function (i.e. retinal threshold values) and
structure (fundus image). In the absence of this mechanism, any shift in eye
position occurring at the time of stimuli projection would easily produce
artifacts in VF results, with an inaccurate sensitivity being reported. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The COMPASS superimposes the threshold map
over a 60° image of the fundus. This allows simultaneous assessment of retinal
function and structure. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhunmmJgAC-aXZfHMbGyp6Gyh_ws9AFjh7SbwKFipXmbdtP3s9AYIkTXJK3yppshq6tBooEvp41lVdfN9zvjkztN73k8znbIZVDU3vkTqkE1_eIKCUmauDpATysuIU5HNl-1iaOPH7t-AePwniANZjWlvZAOOYqeU0IDqoNe8YX4kV_AnmYMKXE9us8hIJi/s800/3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="800" data-original-width="800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhunmmJgAC-aXZfHMbGyp6Gyh_ws9AFjh7SbwKFipXmbdtP3s9AYIkTXJK3yppshq6tBooEvp41lVdfN9zvjkztN73k8znbIZVDU3vkTqkE1_eIKCUmauDpATysuIU5HNl-1iaOPH7t-AePwniANZjWlvZAOOYqeU0IDqoNe8YX4kV_AnmYMKXE9us8hIJi/s320/3.jpg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The COMPASS is equipped with an automatic
refractive correction system, thus, eliminating the need for trial lenses. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The unique 3D Stereo View technology of
COMPASS captures automatically two separate photos of the nasal field, at
different angles and different focal planes (bifocal), creating outstanding 3D
perception of the disc.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUq5lH2QJeWBrtBevig4RLxJGyP2iwpo5jB8EoeyxB1QImX8k4V_5qs5Zp4nlWhl1nk_0-r0hc61DKhLMBkkBbyD3xvnVhNlI129TjghneNi4oqOTmQ6EQwgFrKA5PPGyoETmMlbYIClUwjkzh1L0_pPsZYmJWCKuB1J1uDdHhob_DnDod7DGBb2_pGwQN/s1280/4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUq5lH2QJeWBrtBevig4RLxJGyP2iwpo5jB8EoeyxB1QImX8k4V_5qs5Zp4nlWhl1nk_0-r0hc61DKhLMBkkBbyD3xvnVhNlI129TjghneNi4oqOTmQ6EQwgFrKA5PPGyoETmMlbYIClUwjkzh1L0_pPsZYmJWCKuB1J1uDdHhob_DnDod7DGBb2_pGwQN/w400-h225/4.jpg" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The COMPASS provides 60° confocal images of
the retina in different modalities: TrueColor, Infrared and Red-free, enhancing
diagnostic and prognostic capabilities in glaucoma management. The true color
confocal imaging system, allows the visualization of the retina in real color,
with outstanding details of the Optic Nerve Head (ONH). <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;">The COMPASS offers embedded capabilities
for network connectivity, for both remote data review and data backup. The
COMPASS Remote Viewer is a browser-based software that allows for reviewing
from any network computer on the same local area network (LAN), with password
protection. The Remote Viewer provides image comparison tools, anatomic
measurements, post-processing tools and more. Images taken at different times
can be registered and displayed as rapidly alternating to facilitate detection
of morphologic changes over time. Cup to disc calculation – ratios can be
measured and stored.</span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrhZxQkde_qX7aqCccijDYIYqhmRFe8PraG2OTRIEeVz-D7edNxWRNdK_GbAjLV2NY2iz9Nzf-29RfBRx_w40tNEtKI807Q9MriByqrZoOfwfKQscfiFnk_xKgOFJko98TvAoysk8XqL83p3fEKzmDQ6ysboDUCgKmwZq9evrRSVxio6GhW9fMJlypOsq-/s1280/2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrhZxQkde_qX7aqCccijDYIYqhmRFe8PraG2OTRIEeVz-D7edNxWRNdK_GbAjLV2NY2iz9Nzf-29RfBRx_w40tNEtKI807Q9MriByqrZoOfwfKQscfiFnk_xKgOFJko98TvAoysk8XqL83p3fEKzmDQ6ysboDUCgKmwZq9evrRSVxio6GhW9fMJlypOsq-/w400-h225/2.jpg" width="400" /></a></div><br /><span style="font-family: Georgia, serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The iCare COMPASS is marketed as relatively
more patient friendly because the test is straight forward, relatively fast,
and can be discontinued at any time and continued again without data loss. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiftEEkgP6ceJCqR5qCai2uM4zdvP-7O34uOh2DF1Mi7Y0xtfAxeoy1VaGToxmvc63lcS1hUpJ1Uf5masjVdWmCOedY0wVTx9WpS3hUfqbvk2JYNhjFAPxYAt74YFpDE6DtWnHsoccRDT16V5nITaKXlabf0_id3amD9_a_P1THFDKeSEc4w0UoWSIaJQGN/s1024/DALL%C2%B7E%202023-12-12%2012.53.59%20-%20many%20eyes%20floating%20in%20the%20sky%20digital%20art.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiftEEkgP6ceJCqR5qCai2uM4zdvP-7O34uOh2DF1Mi7Y0xtfAxeoy1VaGToxmvc63lcS1hUpJ1Uf5masjVdWmCOedY0wVTx9WpS3hUfqbvk2JYNhjFAPxYAt74YFpDE6DtWnHsoccRDT16V5nITaKXlabf0_id3amD9_a_P1THFDKeSEc4w0UoWSIaJQGN/s320/DALL%C2%B7E%202023-12-12%2012.53.59%20-%20many%20eyes%20floating%20in%20the%20sky%20digital%20art.png" width="320" /></a></div><br /><p></p><br /><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-75586584233035143902024-02-11T19:00:00.002+05:302024-02-11T19:00:26.207+05:30EXOSOME TREATMENT OF RGCs<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK2MZkGQNAFAe95pepM7x68EMmRA_7gpTrg0c2FSF_kqzC0rd8Wt1HaAtO-WWyt9LlcZ_rKpijnygP1neL-trSkiq87YmnzulA6w2TrioFUBxhJcBQPu8P28MPG-apSygjq_AcciV0bya6NUOM4pzlu3u1-oY4hRdAAVSmidYVRkf-q5yM9rnbWSfHt76I/s312/logo2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK2MZkGQNAFAe95pepM7x68EMmRA_7gpTrg0c2FSF_kqzC0rd8Wt1HaAtO-WWyt9LlcZ_rKpijnygP1neL-trSkiq87YmnzulA6w2TrioFUBxhJcBQPu8P28MPG-apSygjq_AcciV0bya6NUOM4pzlu3u1-oY4hRdAAVSmidYVRkf-q5yM9rnbWSfHt76I/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Mesenchymal stem cells (MSC) are
self-replicating multipotent stromal cells isolated from mesenchymal tissues
such as bone marrow (BMSC), adipose tissues, dental pulp and umbilical cord
blood as well as other tissues. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">MSCs promote the protection and
regeneration of central nervous system (CNS) neurons, which lack the capacity
to regenerate, or be replaced following their loss. The retina is an outgrowth
of the brain and is thus part of the CNS and subject to the same regenerative
limitations. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiByLKcRTmWVsl1b1MzfX_lzLNFQ0HuMAhtLa1VRHMrl4eD6VhitRi8Z0km13cmcIdFdasoQkk0wei4jM94-ip4U-4qbQB6kCdoOQu88w6KfuwnKEjzJVcF879Q0g3J4n67-ccfHKJIa4wNjYwiuqJKC0GpVNqyOmPhgxJ8jg6m-ahc8zAxgio_c1PiB0Jt/s750/1.29.24%20Optical%20tract%20from%20eye%20to%20brain.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="500" data-original-width="750" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiByLKcRTmWVsl1b1MzfX_lzLNFQ0HuMAhtLa1VRHMrl4eD6VhitRi8Z0km13cmcIdFdasoQkk0wei4jM94-ip4U-4qbQB6kCdoOQu88w6KfuwnKEjzJVcF879Q0g3J4n67-ccfHKJIa4wNjYwiuqJKC0GpVNqyOmPhgxJ8jg6m-ahc8zAxgio_c1PiB0Jt/s320/1.29.24%20Optical%20tract%20from%20eye%20to%20brain.jpg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">MSCs secrete <b><u style="background-color: #fcff01;">exosomes</u></b>, which are
endocytic-derived structures composed of proteins, lipids, and mRNA surrounded
by a phospholipid bi-layer that are secreted into the extracellular space.
Their size ranges from 30 to 100 nm. Exosomes contain mRNA and miRNA, which are
both functional and, when delivered to another cell via fusion with the cell
membrane, lead to the translation of new proteins.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYLIghj4KW_zcoFEeG7wpvdGhqQi4m2yy4L6bc_dZ6fAVy1AoFyqs6rX60_n1rdlSOOOKtcr26WHbEUq09VHnfEAGPKe5vgJRpCsTLRvNSvUFTxsXVTuNuW_FuYpdv0kLHdvAsbqYrb5PaHd8JmHYLjqq6-k445AI6D7IWIyQtHpbqLso04F46QIfRIv3g/s2867/exo1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2085" data-original-width="2867" height="233" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYLIghj4KW_zcoFEeG7wpvdGhqQi4m2yy4L6bc_dZ6fAVy1AoFyqs6rX60_n1rdlSOOOKtcr26WHbEUq09VHnfEAGPKe5vgJRpCsTLRvNSvUFTxsXVTuNuW_FuYpdv0kLHdvAsbqYrb5PaHd8JmHYLjqq6-k445AI6D7IWIyQtHpbqLso04F46QIfRIv3g/s320/exo1.jpg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">They can be easily stored and do not
proliferate, making the application of specific doses easier. Due to their
smaller size, they are also capable of migrating into the ganglion cell layer (GCL)
from the vitreous (unlike transplanted cells) and delivering their content to
the retinal ganglion cells (RGC). The surrounding phospholipid bilayer of
exosomes protects the contents against degradation and makes them
immunologically inert, qualities important for a therapeutic delivery system.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Treatment of primary retinal cultures with
BMSC-exosomes demonstrated significant neuroprotective and neuritogenic
effects. BMSC-derived exosomes promoted statistically significant survival of
RGCs and regeneration of their axons while partially preventing RGC axonal loss
and RGC dysfunction.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ7hYO_uBLQjWOxGo5b0sjYrmVn75HNAKn7PZNseOyBYyh6zaMEf4QJjELYCvfZx_f9Mq_-t2qOI-ZDWotqowuqIt2Yte8sVYyhSox0oVMynoUm8Dtq2W60ReHjRpUDyYpHTtEzTRMxTaE-gxvNL6I10iL6cwZ3AqnwMDbS2ZcLRJepy6Eb-lFwH6L53is/s3764/cells-08-00467-g005.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1676" data-original-width="3764" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ7hYO_uBLQjWOxGo5b0sjYrmVn75HNAKn7PZNseOyBYyh6zaMEf4QJjELYCvfZx_f9Mq_-t2qOI-ZDWotqowuqIt2Yte8sVYyhSox0oVMynoUm8Dtq2W60ReHjRpUDyYpHTtEzTRMxTaE-gxvNL6I10iL6cwZ3AqnwMDbS2ZcLRJepy6Eb-lFwH6L53is/w400-h178/cells-08-00467-g005.webp" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">After optic nerve crush injury, MSCs
transplanted into the vitreous are able to promote significant neuroprotection
of RGCs and moderate regeneration of their axons. In animal models of glaucoma,
MSCs promote the survival of RGCs and their axons and preserve their function.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The mechanism of exosome-derived
neuroprotection is apparently through a paracrine-mediated effect with secreted
factors being necessary. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxSeRd5iwmYbggNSuMTuzvV6ziRMiwHtNeoF8a-1ows9T3M3P9yISC8LgKyfwlUdno80c1hgmnQA7ZfMkT6Hd3XMrmqZOu4Ys7X1D1zAI1-0JHrMrrURQyngFtYujlrAFWkajZJmLJIG8DDDmQ_EKQquc0-TnFfD63NzgxuAYxWybQyheivtTiBVkqJm8c/s678/1-s2.0-S0753332220304297-gr2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="323" data-original-width="678" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxSeRd5iwmYbggNSuMTuzvV6ziRMiwHtNeoF8a-1ows9T3M3P9yISC8LgKyfwlUdno80c1hgmnQA7ZfMkT6Hd3XMrmqZOu4Ys7X1D1zAI1-0JHrMrrURQyngFtYujlrAFWkajZJmLJIG8DDDmQ_EKQquc0-TnFfD63NzgxuAYxWybQyheivtTiBVkqJm8c/w400-h190/1-s2.0-S0753332220304297-gr2.jpg" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In culture, MSC are efficacious when
cocultured (yet physically separated) from the injured retinal cells. The
assumption that neurotrophic growth factors (NTF) are important is corroborated
both by the expansive NTF rich secretome of MSC and by the attenuated
neuroprotective and neuritogenic effects when particular NTF receptors are
inhibited. Secreted NTF such as platelet-derived growth factor and
brain-derived neurotrophic factor have been shown to be important to the
neuroprotection of RGCs whereas MSC mediated-neuritogenesis depended more on
nerve growth factor. Other secreted factors, such as Wnt3a have been implicated
in the neuroprotective effect of MSC on CNS neurons. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Transplantation into the vitreous of
healthy and diseased eyes yields no evidence of differentiation or
migration/integration into retinal tissue, strongly implicating paracrine over
cell replacement as the dominant mechanism. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Exosomes offer a cell-free alternative to
BMSC therapy, which can be easily isolated, purified and stored. They lack the
risk of complications associated with transplanting live cells into the
vitreous (immune rejection, unwanted proliferation/differentiation).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A limitation of exosome-related treatment
is that regeneration is only significant at short distances from the lesion
site (<1 mm) limiting its potential at promoting functional reconnection of
the visual pathway. It is currently unknown what the ideal timeframe for
treatment is, whether a single injection of exosomes is sufficient or
weekly/bi-weekly/monthly injections are required.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiMSDzFb8LQKq8-MHMLhMqnN-WXnQqgo9UUDhtTgzimcmfo1ciNp3IIWiUb0nLJq-onJVxMknrALdUHgLQ6ijKSeCXPgatAFc1RUr70s38ee0Wu-3NkHDYh6xnAQtlhvwf7X6zzgnLOioXoCXqpHGel1S0N8pY7z1VPsWYkk5zcRK4tcACXBoVRDqcx_F1/s1650/fcell-09-643680-g002.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="596" data-original-width="1650" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiMSDzFb8LQKq8-MHMLhMqnN-WXnQqgo9UUDhtTgzimcmfo1ciNp3IIWiUb0nLJq-onJVxMknrALdUHgLQ6ijKSeCXPgatAFc1RUr70s38ee0Wu-3NkHDYh6xnAQtlhvwf7X6zzgnLOioXoCXqpHGel1S0N8pY7z1VPsWYkk5zcRK4tcACXBoVRDqcx_F1/w400-h145/fcell-09-643680-g002.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOTLKlSFMSNwjMZSkbWNPX1mlvrYnduiXDxV5OV98AKh1CYye5ScyaeterqosSvudZwZXCsXojWIham-RYVaEDwlOUzL6ADR0ax8jSLAbbKR0nRQvLPuMaLs4FwuOChBM7ZG5WZzZxwZvw8eLJN-mOc79gArPXQFZTmi21G7gr5EdWCzvMB8ezWtg-mCR_/s1024/DALL%C2%B7E%202023-12-18%2012.45.08.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOTLKlSFMSNwjMZSkbWNPX1mlvrYnduiXDxV5OV98AKh1CYye5ScyaeterqosSvudZwZXCsXojWIham-RYVaEDwlOUzL6ADR0ax8jSLAbbKR0nRQvLPuMaLs4FwuOChBM7ZG5WZzZxwZvw8eLJN-mOc79gArPXQFZTmi21G7gr5EdWCzvMB8ezWtg-mCR_/s320/DALL%C2%B7E%202023-12-18%2012.45.08.png" width="320" /></a></div><br /><p></p><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-22436915962032407412024-02-05T12:01:00.003+05:302024-02-05T12:01:32.812+05:30PRESERFLO MICROSHUNT DEVICE<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1IurwJ2vNOHtWzive2kxDckpgEX7SB5jg3078dO6o9SbUCW_B5AeGhorbXCOZuJwGw2w3QfFrMY5MCMwzMDzHX8axahWrxc7VDNPnAOidpZVNdYt2Kl6sfeSBb9Zx3eNJonTvvVhAQ377ShDwcFSX5ZkwDkTV4sdFvf2MzehsDZxi93oGz_OK_GbUBfqX/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1IurwJ2vNOHtWzive2kxDckpgEX7SB5jg3078dO6o9SbUCW_B5AeGhorbXCOZuJwGw2w3QfFrMY5MCMwzMDzHX8axahWrxc7VDNPnAOidpZVNdYt2Kl6sfeSBb9Zx3eNJonTvvVhAQ377ShDwcFSX5ZkwDkTV4sdFvf2MzehsDZxi93oGz_OK_GbUBfqX/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p><br /></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The <b style="background-color: #fcff01;">PRESERFLO MicroShunt</b> is an ab externo <b>glaucoma drainage device</b> made of an extremely flexible SIBS [poly (Styrene-block-IsoButylene-block-Styrene)]
polymer with a tube of 350 μm outer diameter and a lumen of 70 μm. </span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6dI4vg3HkORflPgInsjvs1O6G7Bnv0pJzkLYKH_IHQXjhMtQ5KbE9eViklczs2GL2Kc1PJJv-t7_hJYEUulO18e4y_s4bQV5sh3v3PzF7pwGulVF5zycWRkatBFhuHWKCqFs_IRAqLxFsrdckEC-9hBn5FeMga-O2BQH3Q0anq2dj18v2iW7KB7q7i7Oq/s1319/preserflo.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="561" data-original-width="1319" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6dI4vg3HkORflPgInsjvs1O6G7Bnv0pJzkLYKH_IHQXjhMtQ5KbE9eViklczs2GL2Kc1PJJv-t7_hJYEUulO18e4y_s4bQV5sh3v3PzF7pwGulVF5zycWRkatBFhuHWKCqFs_IRAqLxFsrdckEC-9hBn5FeMga-O2BQH3Q0anq2dj18v2iW7KB7q7i7Oq/w400-h170/preserflo.png" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">It has
triangular fins that prevent migration of the tube into the AC. The device is
designed to be implanted under the subconjunctival/Tenon space.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaXJWHHXvFt73Twh95-MPFYYFMiqajSHecPBlklv9IUcBlGIQiH4vtJosolqRb1Ykdv6hMvi_J1b86i77aX5XEWS6j9PYRWJAdqaIv9Wtw-fHzz4OfqZ2Z4llI0h_MCV3P9XOYJ4uuf_MwxfaZk0MiPDymwqVkqz9sgM3l-9UZYMpx7MOVNEmhjX3XR9hB/s1420/eye-diagram-desktop.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="903" data-original-width="1420" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaXJWHHXvFt73Twh95-MPFYYFMiqajSHecPBlklv9IUcBlGIQiH4vtJosolqRb1Ykdv6hMvi_J1b86i77aX5XEWS6j9PYRWJAdqaIv9Wtw-fHzz4OfqZ2Z4llI0h_MCV3P9XOYJ4uuf_MwxfaZk0MiPDymwqVkqz9sgM3l-9UZYMpx7MOVNEmhjX3XR9hB/s320/eye-diagram-desktop.png" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">SIBS
(Poly(styrene-block-isobutylene-block-styrene)) is a uniquely biocompatible,
degradation-resistant material proven to minimize inflammation, scarring, and
encapsulation.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5Fd7n9FDsIFTWG9lUX3dQ3K-yqWv6haTzw-5mtQ7ERS4uaAcUW46Jt9xkWu4xnwfhw8SiOMGeMefb70EjNvkUv2q_WV_Fm0jLzq-DHmdjdYd2pZL12ROcAhEu-7Znoi21iZSPQhJte9sJZyA5Xu2gLnkFqz4qktBovXhPmwS1Fc4k34TWbVchxXNxjy17/s800/PRESERFLO_MicroShunt_surgery.webp" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="457" data-original-width="800" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5Fd7n9FDsIFTWG9lUX3dQ3K-yqWv6haTzw-5mtQ7ERS4uaAcUW46Jt9xkWu4xnwfhw8SiOMGeMefb70EjNvkUv2q_WV_Fm0jLzq-DHmdjdYd2pZL12ROcAhEu-7Znoi21iZSPQhJte9sJZyA5Xu2gLnkFqz4qktBovXhPmwS1Fc4k34TWbVchxXNxjy17/w400-h229/PRESERFLO_MicroShunt_surgery.webp" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b style="background-color: #fcff01;">Contraindications</b> to implantation of the <a name="_Hlk157612595">PRESERFLO</a> Microshunt may include cases of shallow
anterior chamber, inability of the patient to adhere to postoperative visits
and/or medications, and/or intolerance or allergy to Mitomycin-C (MMC).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u style="background-color: #fcff01;">SURGICAL TECHNIQUE:</u></b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A 3 to 4 clock-hour fornix-based
conjunctival peritomy is created – typically in the superonasal or
superotemporal quadrants. Mitomycin-C soaked sponges are then applied to the
scleral bed. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Mitomycin-C concentration and duration of
applications are left to the surgeon’s discretion based on judgment of risk for
postoperative fibrosis. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">After removal of the sponges, the scleral
bed is rinsed with balanced salt solution. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The sclera is then marked 3 mm posterior
the limbus. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A scleral tunnel is initiated at this point
along the curvature of the globe, followed by change trajectory at the level of
the trabecular meshwork before entering the anterior chamber parallel to the
iris plane. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The device is then inserted through this
tract using non-toothed forceps, with care to maintain the proximal tip in a
bevel-up position. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The device is advanced until the fins are
just tucked within the distal end of the scleral tunnel. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In this position, 2 to 3 mm of the proximal
end of the device should extend into the mid-anterior chamber and parallel to
iris plane.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">When properly positioned and unobstructed,
aqueous flow should be visible at the distal end of the device. If no flow is
visible and an obvious proximal obstruction is not visualized, the distal end
may be “primed” using an anterior chamber cannula and balanced salt solution. A
corneal paracentesis may be created at surgeon discretion for additional
control of the anterior chamber or to test device patency via injection of
balanced salt solution. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Once the device has been placed and flow
has been verified, conjunctiva and Tenon capsule are repositioned over the
device, taking care to avoid distal obstruction of implant. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The distal end of the implant should lie
flush with the sclera and a second instrument may be used to direct it in this
manner. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The conjunctiva and Tenon capsule are then
closed using the surgeon’s preferred technique. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A fluorescein strip is used to confirm
adequate wound closure and the eye is protected according to the surgeon’s
usual protocol.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u style="background-color: #fcff01;">RESULTS:</u></b><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Studies have largely shown positive
outcomes with the PRESERFLO Microshunt device. The success rates with this device
are comparable to trabeculectomy success rates. However, higher doses of MMC
are associated with better results.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipuJA97ZLLSbG4WjNXGIpcxcK8h2gsfiLzgMCq0aTbn_5hFWuaRYJ6Q0-L20s1B_Z426WO-2g0di2lfUMXYceiRdKKZrv8-WEgcAL5gUEOlTTdLo7yNG1dgBOiX9Qh4ng6cEK5oO3SYqsR8aHEQUGTwR364TNZoYH9TkZLjkIw_oOtQHyOSiXRBlUq4RKK/s1024/DALL%C2%B7E%202023-12-28%2009.42.30%20-%20river%20eyes%20sunrise%20pixel%20art.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipuJA97ZLLSbG4WjNXGIpcxcK8h2gsfiLzgMCq0aTbn_5hFWuaRYJ6Q0-L20s1B_Z426WO-2g0di2lfUMXYceiRdKKZrv8-WEgcAL5gUEOlTTdLo7yNG1dgBOiX9Qh4ng6cEK5oO3SYqsR8aHEQUGTwR364TNZoYH9TkZLjkIw_oOtQHyOSiXRBlUq4RKK/s320/DALL%C2%B7E%202023-12-28%2009.42.30%20-%20river%20eyes%20sunrise%20pixel%20art.png" width="320" /></a></div><br /><p></p><br /><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-72538080992873109162024-01-30T12:28:00.001+05:302024-01-30T13:29:16.690+05:30YELLOW-TINTED IOLs IN GLAUCOMA<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8iETGECRXhYfbKDtcTEaUfJ0dq9MCIawqsXkvOoqKkWObi1tPALVx1xLomCxKQOGVfwSte3EizhljKnbmeBaw83wywS5iq2VsKqxqEzUmxt62zzHSt4tnCvJ23LENVKMxl8Mtfcgwp9PrBgJ9l_DlijlV7mGpHEbHeo6rrI9GeiONPrhOBHGrsYm5pTqm/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8iETGECRXhYfbKDtcTEaUfJ0dq9MCIawqsXkvOoqKkWObi1tPALVx1xLomCxKQOGVfwSte3EizhljKnbmeBaw83wywS5iq2VsKqxqEzUmxt62zzHSt4tnCvJ23LENVKMxl8Mtfcgwp9PrBgJ9l_DlijlV7mGpHEbHeo6rrI9GeiONPrhOBHGrsYm5pTqm/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p><br /></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Yellow-tinted intraocular lenses (IOLs) for
cataract surgery are being marketed for their ability to block deleterious blue
light entering the eye.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Short-wavelength automated perimetry (SWAP)
has the ability to detect functional changes in patients with early glaucoma
and without visually significant cataracts. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Cataracts have been reported to cause a
generalized reduction in sensitivity for standard automated perimetry (SAP) and
SWAP tests in normal subjects, and this generalized reduction is more prominent
on SWAP testing compared with SAP testing.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">SWAP testing uses a blue stimulus of 440 nm
on a bright yellow background of 100 candela/m2. (Blue On Yellow= BOY)<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Yellow-tinted IOLs contain a yellow
chromophore with the ability to absorb the high-energetic visible blue light
between 380 and 500 nm.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqDRHKSwPBAFSQ2Xi-BzmI3dCRy2rHpmeOzWlR5_hNI9eR-V9nJWxjeI6VPD5T0Q5JlnFCNV_mW7ih7LUCoBmQdhsuRd_fFghZ0rX2sMZVeKH140aTtGZuxhqGlNYBOjBkGRVFpSxqtWO-nrf6EGJuWy7Eb8DA-vkshOeaDgJDs1gA7rp2nNhfLmpCCH55/s269/iol.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="215" data-original-width="269" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqDRHKSwPBAFSQ2Xi-BzmI3dCRy2rHpmeOzWlR5_hNI9eR-V9nJWxjeI6VPD5T0Q5JlnFCNV_mW7ih7LUCoBmQdhsuRd_fFghZ0rX2sMZVeKH140aTtGZuxhqGlNYBOjBkGRVFpSxqtWO-nrf6EGJuWy7Eb8DA-vkshOeaDgJDs1gA7rp2nNhfLmpCCH55/s1600/iol.jpg" width="269" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">It is hypothesized that blue-light–filtering
IOLs may negatively affect contrast acuity and blue/yellow foveal threshold
when compared with UV-only–filtering IOLs in patients without concomitant eye
diseases. Just like nuclear sclerotic cataracts, mentioned above, these IOLs
may affect the quality of SWAP visual field testing. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The koniocellular pathway which uses the
spectrum for blue-yellow light processing has been reported to be damaged in
early glaucoma and yellow-tinted IOLs can affect SWAP significantly.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="background: white; color: #212121; font-family: "Georgia",serif;">A number of
studies have been performed to assess the effect of yellow-tinted IOLs on SWAP
testing. Nilofurshan et al., have reported improved </span><span style="font-family: "Georgia",serif;">MD and FT on SWAP testing in
mild-to-moderate glaucoma patients who underwent cataract extraction and
implantation of yellow-tinted IOLs. Kara-Júnior et al., compared the effect of
clear and yellow-tinted IOLs on SWAP indices in 46 normal subjects (mean age:
68.5 years old) and did not detect any statistically significant differences
between these two IOLs in postoperative values. Espindola also reported blue-on-yellow
perimetry did not appear to be affected by aspherical or yellow tinted IOLs.
Ueda, as well as, Kim have reported no significant influence of yellow-tinted
IOLs on FDT perimetry.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">However, Jang et al., reported a statistically
significant difference in MD and PSD values between yellow-tinted and
non-tinted IOLs on SWAP testing. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In view of these studies, it appears that the
presence of glaucoma is not a contra-indication for implantation of yellow-tinted
IOLs .<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">REFERENCES:</span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123272/#:~:text=Conclusions%3A,testing%20than%20visually%20significant%20cataracts." target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123272/#:~:text=Conclusions%3A,testing%20than%20visually%20significant%20cataracts.</a><br /></span></p><a href="https://www.scielo.br/j/abo/a/9CGyzBgWSfHtpTLGgknnVpr/" target="_blank">https://www.scielo.br/j/abo/a/9CGyzBgWSfHtpTLGgknnVpr/</a><br /><p></p><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039191/" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039191/</a><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaJ4g16bsm8PQmiCR5MbOHT2CcdNVtw2V0quTKHtAc_S84VlqTYJSCh2O2DpyqplYgjk_R2D3LrOXNkWaSE9dKqLn81OhMP87xDHogGNjNGfGs6a668TiutSBwFcBWVClhMIxfWkv5yHihu-yjgaLBHQwcIeUnQTA6LJ8A4HLkeL4pDmGVqEEGm-pkpVgm/s1024/DALL%C2%B7E%202024-01-21%2018.39.56%20-%20picture%20of%20robotic%20eye%20with%20matrix%20numbers%20and%20rays.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaJ4g16bsm8PQmiCR5MbOHT2CcdNVtw2V0quTKHtAc_S84VlqTYJSCh2O2DpyqplYgjk_R2D3LrOXNkWaSE9dKqLn81OhMP87xDHogGNjNGfGs6a668TiutSBwFcBWVClhMIxfWkv5yHihu-yjgaLBHQwcIeUnQTA6LJ8A4HLkeL4pDmGVqEEGm-pkpVgm/s320/DALL%C2%B7E%202024-01-21%2018.39.56%20-%20picture%20of%20robotic%20eye%20with%20matrix%20numbers%20and%20rays.png" width="320" /></a></div><br /><p><br /></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-54294323489079865912024-01-24T18:41:00.008+05:302024-01-27T19:06:55.938+05:30SOLAR RADIATION & GLAUCOMA<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWm841RmwPIrCsXypHK32gw5_mIqfvYDiOUdAl43TPwfc58FwbqmOb5Z-Evtb41oMyZqOE7fZUcJ0r9CjpXYznJpu_sqqHEOIb8RBPShV7q0frUz-FSQ1QE3wht4LdzCFW87tONLnZKE1crfzUOk_3TydcgrD0-VM-J2sDW3cX505x7Iz920WEi3F2Eztp/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWm841RmwPIrCsXypHK32gw5_mIqfvYDiOUdAl43TPwfc58FwbqmOb5Z-Evtb41oMyZqOE7fZUcJ0r9CjpXYznJpu_sqqHEOIb8RBPShV7q0frUz-FSQ1QE3wht4LdzCFW87tONLnZKE1crfzUOk_3TydcgrD0-VM-J2sDW3cX505x7Iz920WEi3F2Eztp/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">There are some reports suggesting that solar radiation, especially ultraviolet (UV) radiation and blue light may play an important role in the causation of
glaucoma. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0Svl22rV7w1s4-_c4ZKeIXeu0PsIkpTWPW6fy0SZZ8S0H76Vv_ODienoFAjO94iheflolWFeGpltitEKFs55c5dC2F7RXklCQc42BtP1fkj_S9dTNLetXaDna7_sbl654cBX3v0QgdCyvTNGvo-dTi8tUrN4YYYybe5LyV0sDjlcH52_CnFgleRYb2TXc/s600/UV-absorption-within-an-eye..webp" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0Svl22rV7w1s4-_c4ZKeIXeu0PsIkpTWPW6fy0SZZ8S0H76Vv_ODienoFAjO94iheflolWFeGpltitEKFs55c5dC2F7RXklCQc42BtP1fkj_S9dTNLetXaDna7_sbl654cBX3v0QgdCyvTNGvo-dTi8tUrN4YYYybe5LyV0sDjlcH52_CnFgleRYb2TXc/w400-h320/UV-absorption-within-an-eye..webp" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Effect of UV radiation at different ages</td></tr></tbody></table><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The International Commission on
Non-Ionizing Radiation Protection (ICNIRP) defines several subgroups of
ultraviolet or invisible radiation classified into UVA (315-400</span><span style="font-family: "Times New Roman",serif;"> </span><span style="font-family: "Georgia",serif;">nm), UVB (280-315</span><span style="font-family: "Times New Roman",serif;"> </span><span style="font-family: "Georgia",serif;">nm) and UVC (100-280</span><span style="font-family: "Times New Roman",serif;"> </span><span style="font-family: "Georgia",serif;">nm). Infrared (IR) radiation has also been subdivided into three
groups depending on the wavelength: IRA (700-1400</span><span style="font-family: "Times New Roman",serif;"> </span><span style="font-family: "Georgia",serif;">nm),
IRB (1400-3000</span><span style="font-family: "Times New Roman",serif;"> </span><span style="font-family: "Georgia",serif;">nm) and IRC (3000-10,000</span><span style="font-family: "Times New Roman",serif;"> </span><span style="font-family: "Georgia",serif;">nm). [1]<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWqYq2YgSkAQI74Hp4OegJLvlWq7phCN_L8yCqN49P7gBWGtoz8wM2Ksbqc8Jk8jS4v9lP1yDB2g32LdmhLHA-g4f5iB1kzWtTeZM_xUl3fB0NgMfU2DpBVuBqXEQfqXe2Dx8uye8YzDusUJg-5638-QyNkJd1xCvE9D-_dQcye1Ydj6fS3fquLBvKgGk0/s662/image-asset.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="362" data-original-width="662" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWqYq2YgSkAQI74Hp4OegJLvlWq7phCN_L8yCqN49P7gBWGtoz8wM2Ksbqc8Jk8jS4v9lP1yDB2g32LdmhLHA-g4f5iB1kzWtTeZM_xUl3fB0NgMfU2DpBVuBqXEQfqXe2Dx8uye8YzDusUJg-5638-QyNkJd1xCvE9D-_dQcye1Ydj6fS3fquLBvKgGk0/w400-h219/image-asset.jpeg" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Although the exact mechanism of UV-light
induced glaucomatous degeneration is not known, yet, there are certain pointers
to its probable association. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Osborne et al. have shown that blue light, also called high-energy visible light, which has higher wavelength than UV light (450-490 nm), adversely affects the mitochondria of retinal ganglion cells (RGCs). Moreover,
there is evidence that the mitochondrial electron transport chain-related
enzymes flavin and cytochrome-C oxidase are damaged by blue light, resulting in
the generation of photochemical effects and reactive oxygen species (ROS). [2]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">ROS are normally regulated by antioxidants,
but in eyes deformed by ischemia or myopia, blue light leads to excessive
production of ROS and mitochondrial DNA damage. Ultimately, this results in the
loss of the visual field owing to a cascade of events leading to cell death. When
the retina is exposed to blue light under ischemic conditions, it produces
relatively low levels of ATP, the RGCs get damaged, and mitochondrial energy
metabolism is inhibited. [3]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Apoptosis is induced when the
apoptosis-inducing factor (AIF), which exists in the spaces between the
mitochondrial membranes of retinal epithelial cells, splits into two molecules,
gets activated, and enters the nucleus of the cell. In contrast, necroptosis is
programmed necrosis within the cell, in which receptor-interacting protein
kinase 1 (RIP1) and receptor-interacting protein kinase 3 (RIP3) form a complex
and perform their functions. In addition to activating AIF in retinal cells,
blue light also stimulates RIP1 and RIP3 activation in RGCs. [3]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Osborne et al. demonstrated that while AIF
was expressed intact in retinal cells cultured under dark conditions, it was
expressed as two fragments under blue light conditions. Furthermore, RGCs
exposed to blue light reportedly showed a lower survival rate than those
exposed to dark illumination, and the survival rate increased significantly
when the expression of RIP1 and RIP3 proteins was inhibited through small
interfering RNA (siRNA) technology. It is evident that blue light activates
both apoptosis and apoptotic necrosis in retinal cells, which may contribute to
the onset or exacerbation of glaucoma. [4]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Pasquale et al., have shown that UV light
could also contribute to the development of pseudo-exfoliative glaucoma (PXG).
Their study showed that every hour per week spent outdoors during the summer,
averaged over a lifetime, was associated with a 4% increased odds of
exfoliation syndrome (pooled odds ratio = 1.04; 95% CI: 1.00-1.07; p = .03).
For every 1% of average lifetime summer time between 10 a.m. and 4 p.m. that
sunglasses were worn, the odds of exfoliation syndrome decreased by 2% (odds
ratio = 0.98; 95% CI: 0.97-0.99; p < .001). [5]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">After controlling for important
environmental covariates, history of work over water or snow was associated
with increased odds of exfoliation syndrome (odds ratio = 3.86; 95% CI:
1.36-10.9). There is considerable evidence that climatic factors contribute to the
pseudo-exfoliative changes. For example, aboriginal Australians who spend
substantial time outdoors have a higher prevalence of pseudo-exfoliative
syndrome (PEX). <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Dai et al., have shown that both genetic
predispositions to using sun/UV protection and having an ease of skin tanning
response are associated with a decreased risk of PXG in the European
population. According to them, one possible explanation for this association is
that UV radiation may influence the expression of nonpigmented ciliary
epithelial cells (NPE) in humans through an aryl hydrocarbon receptor
(AHR)-associated pathway, thereby contributing to the development of PXG. [6]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Clusterin, produced by NPE, serves as an
effective extracellular chaperone, its deficiency in the anterior segment can
promote stress-induced aggregation and the stable deposition of pathologic
extracellular matrix products—hallmarks of PXG. Zenkel et al. have observed an
oxidative milieu in the anterior chamber of PEX eyes, potentially leading to
stress-induced protein modifications and misfolding. [7] However, whether
oxidation of the UV radiation contributes to this process remains uncertain.
TGF-β1, oxidation and UV radiation can induce a significant upregulation in
LOXL1 gene expression in human tenon fibroblasts and PEX. UVB has been
associated with the increased levels of TGF-beta 1 mRNA, and UVA exposure can
induce oxidative damage. Nevertheless, it remains uncertain whether UV
radiation affects LOXL1 through direct DNA damage, TGF-β1 mediation, or
oxidative stress. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Oxidative stress has also been linked to
POAG by increasing flow resistance of aqueous humor through the trabecular
meshwork in the presence of high levels of hydrogen peroxide. [1]<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">TREATMENT OF GLAUCOMA WITH INFRA-RED LIGHT:<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Red light increases cytochrome-c oxidase
activity in the electron transport system, reducing inflammation and increasing
antioxidant reactions to promote cell regeneration. PBM (Photobiomodulation)
therapy, which is emerging as a new treatment for glaucoma, induces the
inhibition of nitric oxide in the electron transport system and promotes an
increase in the activity of cytochrome-C oxidase, reduces oxidative stress and
inflammatory reactions in the eye, and increases energy production in the
cells. A study by Dr. Galina has shown IOP reduction after 15 minutes of
infrared-light exposure to healthy subjects. [7]<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><span style="background-color: #fcff01;">SEE POST ON IRL TREATMENT HERE</span>: </span><a href="https://ourgsc.blogspot.com/search?q=Galina" style="font-family: Georgia, serif;" target="_blank">https://ourgsc.blogspot.com/search?q=Galina</a></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Therefore, the minimization of UV and blue light
exposure and the general application of red-light treatment strategies are
anticipated to show synergistic effects with existing treatments for glaucoma
and should be considered a necessary prospect for the future. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u>REFERENCES:</u></b></span></p>
<p class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify;"></p><ol><li><span style="font-family: "Georgia",serif;">Ivanov IV, Mappes T, Schaupp P,
Lappe C, Wahl S. Ultraviolet radiation oxidative stress affects eye health. J.
Biophotonics. 2018; 11:e201700377</span></li><li><span style="font-family: "Georgia",serif;">Osborne N.N., Lascaratos G.,
Bron A.J., Chidlow G., Wood J.P.M. A Hypothesis to Suggest That Light Is a Risk
Factor in Glaucoma and the Mitochondrial Optic Neuropathies. Br. J. Ophthalmol.
2006;90:237–241.</span></li><li><span style="font-family: "Georgia",serif;">Ahn SH, Suh JS, Lim GH, Kim TJ.
The Potential Effects of Light Irradiance in Glaucoma and Photobiomodulation
Therapy. Bioengineering (Basel). 2023 Feb 7;10(2):223.</span></li><li><span style="font-family: "Georgia",serif;">Osborne N.N., Núñez-Álvarez C.,
del Olmo-Aguado S., Merrayo-Lloves J. Visual Light Effects on Mitochondria: The
Potential Implications in Relation to Glaucoma. Mitochondrion. 2017;36:29–35.</span></li><li><span style="font-family: "Georgia",serif;">Pasquale LR, Jiwani AZ,
Zehavi-Dorin T, Majd A, Rhee DJ, Chen T, Turalba A, Shen L, Brauner S,
Grosskreutz C, Gardiner M, Chen S, Borboli-Gerogiannis S, Greenstein SH, Chang
K, Ritch R, Loomis S, Kang JH, Wiggs JL, Levkovitch-Verbin H. Solar exposure
and residential geographic history in relation to exfoliation syndrome in the
United States and Israel. JAMA Ophthalmol. 2014 Dec;132(12):1439-45. doi:
10.1001/jamaophthalmol.2014.3326. PMID: 25188364; PMCID: PMC4268013.</span></li><li><span style="font-family: "Georgia",serif;">Jinyue Dai, Lingge Suo,
Haocheng Xian, Zhe Pan, Chun Zhang; Investigating the Impact of Sun/UV
Protection and Ease of Skin Tanning on the Risk of Pseudoexfoliation Glaucoma:
A Mendelian Randomization Study. Invest. Ophthalmol. Vis. Sci. 2023;64(13):4. </span><a href="https://doi.org/10.1167/iovs.64.13.4"><span style="font-family: "Georgia",serif;">https://doi.org/10.1167/iovs.64.13.4</span></a><span style="font-family: "Georgia",serif;">.<o:p></o:p></span></li><li><span style="font-family: "Georgia",serif;">Zenkel M, Kruse FE, Jünemann
AG, Naumann GO, Schlötzer-Schrehardt U. Clusterin deficiency in eyes with
pseudoexfoliation syndrome may be implicated in the aggregation and deposition
of pseudoexfoliative material. Invest Ophthalmol Vis Sci. 2006
May;47(5):1982-90. doi: 10.1167/iovs.05-1580. PMID: 16639006.</span></li><li><span style="font-family: "Georgia",serif;">Dimitrova, Galina &
Gjorgjioska, Ana & Ilievska, Tatjana & Grkova-Mishkovska, Emilija &
Ljubic, Antonela & Purelku, Merjem & Andonovski, Dragan & Stojcev,
Sasho. (2019). The effect of infra-red light on intraocular pressure. Arquivos
Brasileiros de Oftalmologia. 82. 10.5935/0004-2749.20190017</span></li></ol><p></p>
<br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHywNY7yFavzCMdoN86s-iqHwk_zrOeOuK60ow9BfKLzzIeorUaZH1J4k9Dw9R_BmNutAcslDtOMVjOtV5S7BnP_iT6TnAIYBRkC1RTSLbA6Nw3M6kpNmh-wJJINjv0Ead7V289YZ39rQ9srrHlYMchfJfaSihuiEEyu7NWOPw4w84-c8i01Plt6F055JN/s1024/DALL%C2%B7E%202024-01-24%2011.16.28%20-%20sunglasses%20infront%20of%20eyeball%20anatomy%20and%20optic%20nerve.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHywNY7yFavzCMdoN86s-iqHwk_zrOeOuK60ow9BfKLzzIeorUaZH1J4k9Dw9R_BmNutAcslDtOMVjOtV5S7BnP_iT6TnAIYBRkC1RTSLbA6Nw3M6kpNmh-wJJINjv0Ead7V289YZ39rQ9srrHlYMchfJfaSihuiEEyu7NWOPw4w84-c8i01Plt6F055JN/s320/DALL%C2%B7E%202024-01-24%2011.16.28%20-%20sunglasses%20infront%20of%20eyeball%20anatomy%20and%20optic%20nerve.png" width="320" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-74088320935341768132024-01-21T13:36:00.003+05:302024-01-21T13:37:44.442+05:30INTRAOPERATIVE OCT<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiLFn4mXV7ls8PBdko637HFPkgwX8bjWPGOazHbRPyuhmaHP2HPeVtHJc_1WySBbb3Kjn0tYQEHlWujX6m0-hup9Sany8y-WRc1AV59CxU5BraZyUX0QerJ4nf6VVHTWRynR5M6cGkK4vPraXpw4Dz5BX8SuLYEYsQMsDfN9vsYYoq2pA1lmFZ_scGBXf_/s312/logo2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiLFn4mXV7ls8PBdko637HFPkgwX8bjWPGOazHbRPyuhmaHP2HPeVtHJc_1WySBbb3Kjn0tYQEHlWujX6m0-hup9Sany8y-WRc1AV59CxU5BraZyUX0QerJ4nf6VVHTWRynR5M6cGkK4vPraXpw4Dz5BX8SuLYEYsQMsDfN9vsYYoq2pA1lmFZ_scGBXf_/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p><br /></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><b><u>Intra-operative optical coherence
tomography (iOCT)</u></b> has the ability to enhance visualization and depth
appreciation during glaucoma surgery, especially with the gaining popularity of
Minimally Invasive Glaucoma Surgery (MIGS)—to facilitate targeted device
placement and fine surgical maneuvers in the angles, the sub-conjunctival layer
and the suprachoroidal space.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3JQ_-CbdEIck89NCxU1LLrGJj68jufay-_m-37fAHJRCdmK5jNj7FeXXlIrQWqa9V3WW_fFfAZXf2iK95t3zw4FYnXHxViXmBOU0Jj6iDRcd_pqAHm9sSvNMoVaqiZr38HSeiuPeNWnlxdlKS5L-EJYUiIOhvn22dBmQSe22NPjuNoi6dNg6jXoWnPQ8D/s900/intraoperative_OCT.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="489" data-original-width="900" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3JQ_-CbdEIck89NCxU1LLrGJj68jufay-_m-37fAHJRCdmK5jNj7FeXXlIrQWqa9V3WW_fFfAZXf2iK95t3zw4FYnXHxViXmBOU0Jj6iDRcd_pqAHm9sSvNMoVaqiZr38HSeiuPeNWnlxdlKS5L-EJYUiIOhvn22dBmQSe22NPjuNoi6dNg6jXoWnPQ8D/w400-h217/intraoperative_OCT.webp" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The iOCT allows the surgeon during trabeculectomy,
to ascertain the depth of the initial scleral incision, as well as to visualize
the regularity of the dissection and thickness of the scleral flap. While the
current state of technology does not allow precise depth identification, iOCT alters
the nature of the procedure from a ‘blind’ approach to a ‘visually guided’
approach. This is particularly important in eyes with high axial myopia, where
the thin sclera increases the risk of full-thickness dissection as well as
subsequent scarring, contributing to a higher rate of failure. The iOCT also
allows more accurate visualization of the sclerostomy and iridectomy during
trabeculectomy. iOCT may also be used as a tool for training residents to
perform glaucoma filtering surgery.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The iOCT allows the surgeon to perform
goniosynechiolysis without the use of intra-operative gonioscopy.
Post-synechiolysis, the iOCT may enable the surgeon to more objectively assess
the adequacy of synechiolysis and the effectiveness of the procedure in opening
the angle. However, in eyes with hazy corneas, the iOCT may be of limited
advantage, given that it shares similar limitations as a table-top SDOCT in
these scenarios.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The iOCT may be useful in bleb needling by
allowing the visualization of deeper tissue and structures within the bleb,
demonstrating the extent and location of adhesions and loculations, thereby
allowing targeted release of these areas of fibrosis. The iOCT further allows
objective assessment of surgical success, by identifying multiple cystic spaces
within a rising bleb. The iOCT also allows visualization of the often
concomitantly performed flap lift, which could be obscured by significant
encapsulation and tenon’s proliferation.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-gEzUsp7kQxzoxqnPIh9L3-2KEmPTApdrrF5zdnlmXKq00D5zBZZUCHw6WD0l7-SwufBKWfenppGmRy0qr1dCXz2me_oTf3UFlxXpAJbqKAteCoqI8KhKZcEO4de3_ys8_ss2CEdnEAse0Jv3Y3eUDgZAU-MGch_fDujfNxbz_J9XrLLFIJqEpCCDc1lE/s1322/BLEBNEEDLING.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="418" data-original-width="1322" height="126" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-gEzUsp7kQxzoxqnPIh9L3-2KEmPTApdrrF5zdnlmXKq00D5zBZZUCHw6WD0l7-SwufBKWfenppGmRy0qr1dCXz2me_oTf3UFlxXpAJbqKAteCoqI8KhKZcEO4de3_ys8_ss2CEdnEAse0Jv3Y3eUDgZAU-MGch_fDujfNxbz_J9XrLLFIJqEpCCDc1lE/w400-h126/BLEBNEEDLING.webp" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Swaminathan et al. described the use of
iOCT in guiding the GDD tube into the eye during surgery, demonstrating its
particular usefulness in the sulcus-placement of tubes. The direct visualization
of the tunnelling needle into the anterior chamber (AC) provides the surgeon
certainty of its entry into the AC. Conversely, the anterior movement of the
iris over the needle on iOCT indicates the entrance of the needle into the
sulcus. iOCT visualization may aid in reducing the risk of tube erosion after
GDD implantation by ensuring adequate coverage of conjunctiva and
partial-thickness sclera or donor tissue over the tube.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Siebelmann et al. reported the use of iOCT
as an adjunct to ab-externo canaloplasty surgery. The iOCT allows the visualization
of intra-operative structures, facilitating precise microcatheter passage
through the Schlemm’s canal. The iOCT may also allow direct visualization of
the suture tightening against the Schlemm’s canal—altering the shape of the AC,
from a concave, to an M-shape. The appreciation of the degree between the AC
and Schlemm’s canal upon suture tightening may allow the surgeon to titrate the
tension of the suture. Furthermore, the iOCT may help the surgeon minimize the
risk of complications from this procedure by reducing the risk of complete
penetration during dissection and minimizing the incidence of DM detachments. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3TdTSsXtAEXzU7MT8MDEz-Wg826wIiqNNYydDq2i4BDfk6MHYi2KMebcj0G0fbUmxkzbb9sESCnV_3NPFfJ2lVFtx-HtLuYstfc3mQ39iego3TKRVhRPfGxERriBdIB-nto39rfmCmQgsvk5hgOK0Bj9vN2whb9QEoh_iwNLM45U5NKWqYzmu9PfI5fAi/s1497/CANALOPLASTY.webp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="312" data-original-width="1497" height="84" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3TdTSsXtAEXzU7MT8MDEz-Wg826wIiqNNYydDq2i4BDfk6MHYi2KMebcj0G0fbUmxkzbb9sESCnV_3NPFfJ2lVFtx-HtLuYstfc3mQ39iego3TKRVhRPfGxERriBdIB-nto39rfmCmQgsvk5hgOK0Bj9vN2whb9QEoh_iwNLM45U5NKWqYzmu9PfI5fAi/w400-h84/CANALOPLASTY.webp" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Trabecular aspiration is an angle-based
MIGS which acts by clearing the inter-trabecular spaces of extracellular
debris, thereby improving aqueous drainage through the angle. iOCT-use would
theoretically facilitate more accurate siting of the aspiration cannula.
However, Heindl et al. has reported the limitations of the iOCT in its
application here—given the 840-nm wavelength of the iOCT, visibility of the
angle remains limited. In addition, the iOCT scans only vertically or
horizontally and may not allow precise imaging of the aspirator tip in relation
to the TM. OCT-guided trabecular aspiration using 1310</span><span style="font-family: "Times New Roman",serif;"> </span><span style="font-family: "Georgia",serif;">nm wavelengths has also been attempted in porcine eyes.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The ab-interno trabectome is another
angle-based MIGS device which may benefit from adjunct iOCT use, involving the
removal of trabecular tissue to increase aqueous outflow. The concurrent use of
a gonioprism or Swan–Jacobs gonioscopy lens and the iOCT has been shown to aid
the surgeon in visualizing the angle and in identifying the opening of the
inner wall of Schlemm’s canal. Tilting the microscope and the iOCT from the
regular 60° to a more horizontal position may provide better visualization for
the surgeon.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The iOCT may be useful during XEN45
implantation as it may help determine the final placement of the implant during
surgery. The use of iOCT may decrease intra-operative risks and optimize
placement of the implant. The iOCT may also be useful in visualizing the XEN45
implant in the event of sub-conjunctival hemorrhage, which obscures the
surgical field and hinders accurate placement of the implant, at times
requiring the surgeon to abort the procedure entirely.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">Limitations of iOCT:<o:p></o:p></span></u></b></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Firstly, as both stand-alone iOCTs and
microscope-integrated iOCT systems are expensive, therefore, cost and
accessibility remain a limitation in the use of this technology. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Secondly, adopting iOCT in one’s surgical
practice may involve a steep initial learning curve. The microscope-integrated
iOCT platforms require simultaneous viewing of both the surgical field and the
OCT image during surgery, through both oculars of the microscope. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Thirdly, the scanning raster of current
iOCT platforms has a restricted scanning area and this may require the surgeon
to constantly move the scanning zone during surgery to visualize the instrument
tip or area of interest. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Fourthly, optimal iOCT images may be
difficult to obtain. Current iOCT platforms do not respond well to movements of
the eye during surgery—motion artefacts are generated, and there is a
noticeable time lag in between real-time movement and the displaying of images.
A dry corneal surface, incorrect magnification and improper focus may also
compromise image quality. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Fifthly, structures posterior to metallic
instruments may not be visualized due to impedance of OCT light source
wavelength.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p><a href="https://www.nature.com/articles/s41433-019-0689-3" target="_blank">https://www.nature.com/articles/s41433-019-0689-3</a> </o:p></span></p>
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8M_hN6pU5vwldV6wiXWdenWIQZfRI_9mpPHT6eADQaFp_V_W3AriwUHWhyDynstCRR0wVnAvfUXM5LZveESh0sMGGHwCamW0sZzAopc1cRRn5EqO_precnX0iS1FmeA-uTfvmKAG4lzwHO0D5yj-eI3KGSVyLorW8_lA7w7RhMyEF9o0njKkeBdCVREDR/s1024/DALL%C2%B7E%202023-12-28%2009.42.22%20-%20river%20eyes%20sunrise%20pixel%20art.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8M_hN6pU5vwldV6wiXWdenWIQZfRI_9mpPHT6eADQaFp_V_W3AriwUHWhyDynstCRR0wVnAvfUXM5LZveESh0sMGGHwCamW0sZzAopc1cRRn5EqO_precnX0iS1FmeA-uTfvmKAG4lzwHO0D5yj-eI3KGSVyLorW8_lA7w7RhMyEF9o0njKkeBdCVREDR/w320-h320/DALL%C2%B7E%202023-12-28%2009.42.22%20-%20river%20eyes%20sunrise%20pixel%20art.png" width="320" /></a></div><br /><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><br /></p><br /><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-31422722474529080932024-01-17T12:05:00.002+05:302024-01-18T15:33:38.581+05:30SION GONIOTOMY DEVICE<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgImvHGArxmpNR5ikPrRcwTxFkA8b9QJyGs1H8UF821tAdMlueg155oEB-7GI7oOjZwJiYKwFdTto81oqec7GOc5lX0wCNGSPdKqPZHTbeDkkPPgZX_3j7Uf_HNv5yYTUAeA3bTDzJ59EtdNfotfceOp1SB0aeCDya_DF2Dvuibd1X69Ai6lcRjfIr1IqlC/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgImvHGArxmpNR5ikPrRcwTxFkA8b9QJyGs1H8UF821tAdMlueg155oEB-7GI7oOjZwJiYKwFdTto81oqec7GOc5lX0wCNGSPdKqPZHTbeDkkPPgZX_3j7Uf_HNv5yYTUAeA3bTDzJ59EtdNfotfceOp1SB0aeCDya_DF2Dvuibd1X69Ai6lcRjfIr1IqlC/w200-h176/logo2.png" width="200" /></a></div><br /><p><br /></p><p><br /></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Sight Sciences Inc., is a US-based company involved
in eye care technology. The company has announced the development of a
blade-less device for goniotomy. The procedure can be performed as a
stand-alone or in combination with cataract surgery.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The device consists of an upper foot which
helps guide the trabecular meshwork into the trap and tissue collection window.
The lower foot guides the device along the Schlemm’s canal. The toe gently
punctures the trabecular meshwork and facilitates access into the Schlemm’s
canal. The device has a trap in which excised trabecular meshwork tissue is
grasped and accumulates during the goniotomy procedure. A tissue collection window
permits visualization of the trabecular meshwork collected in the trap. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Trabecular meshwork tissue is excised over
several clock hours to permit aqueous flow through the Schlemm’s canal.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijA3fe-ujgrKZFQhOfWSnaOq4xZxyKMMfPDeY7jj8771wypLraHKPmWNlFbvWsmB8suYWMyn7cd5c535dBNnB25qywwYIOGmj4q8deVo7lZ231tuUUmvxBJQbHnVsUpJG3Njgsn1kdvO-rjDZxKXwy05NYFjuT-xEX3GEPk8XSsB8l0b002KDJODXV63g4/s1111/sion5.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="583" data-original-width="1111" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijA3fe-ujgrKZFQhOfWSnaOq4xZxyKMMfPDeY7jj8771wypLraHKPmWNlFbvWsmB8suYWMyn7cd5c535dBNnB25qywwYIOGmj4q8deVo7lZ231tuUUmvxBJQbHnVsUpJG3Njgsn1kdvO-rjDZxKXwy05NYFjuT-xEX3GEPk8XSsB8l0b002KDJODXV63g4/w400-h210/sion5.png" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL4g0z3uJ5L9eB-DuYQXqAJCSo1xJUR3CqfOmIAGmJ72vEdJ9IS-pk8OsqM1rXVinMrTPgt9QEekB8UGCkMyu4aXwjZBRe32Xk56KEToVBHeV0tS6bjw8I34Z4Exz_kbOJE7nZyHGSnJM-gPWzL2JgF5SFFfUuVyEOKgfWIKDns6fZC4wJNkCUBS0yKz0j/s866/sion1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="455" data-original-width="866" height="168" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL4g0z3uJ5L9eB-DuYQXqAJCSo1xJUR3CqfOmIAGmJ72vEdJ9IS-pk8OsqM1rXVinMrTPgt9QEekB8UGCkMyu4aXwjZBRe32Xk56KEToVBHeV0tS6bjw8I34Z4Exz_kbOJE7nZyHGSnJM-gPWzL2JgF5SFFfUuVyEOKgfWIKDns6fZC4wJNkCUBS0yKz0j/s320/sion1.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinRWTHl4ffDz6uoaRRYZnEzeaKW8umEuPAOqO1z5cpr8px7vdjH2pRQmsblwDnxkX3HQjaYhG7gY1Ha86g4YTFAUvZlZAonVqrvqKTVM388SkNtZ-WV2ReQcJ0UyLRAuORbsUSncG8CyT-ArHlVYUPmPfQIR2qL85kZjyupgttzf4K4fvCgSQgQnhnwrSk/s860/sion2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="450" data-original-width="860" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinRWTHl4ffDz6uoaRRYZnEzeaKW8umEuPAOqO1z5cpr8px7vdjH2pRQmsblwDnxkX3HQjaYhG7gY1Ha86g4YTFAUvZlZAonVqrvqKTVM388SkNtZ-WV2ReQcJ0UyLRAuORbsUSncG8CyT-ArHlVYUPmPfQIR2qL85kZjyupgttzf4K4fvCgSQgQnhnwrSk/s320/sion2.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYNgAkKwc8qnI7NZPE9Le-_lC1fJzWwKzwzqO_eAyVB39BO_Qdtsk4dOQqOqhKPer2wsPOArEefLO2AkrKj3zIMe9Z5iRz29zb5m9M-vSmt-39OyxElH96P2imbJnrT9jQGxIjb87jFJVNNrk0gzw6gZzIPAYtBs4ZCSmfQFtpld2RC10joLg-9JBW_mOU/s864/sion3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="444" data-original-width="864" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYNgAkKwc8qnI7NZPE9Le-_lC1fJzWwKzwzqO_eAyVB39BO_Qdtsk4dOQqOqhKPer2wsPOArEefLO2AkrKj3zIMe9Z5iRz29zb5m9M-vSmt-39OyxElH96P2imbJnrT9jQGxIjb87jFJVNNrk0gzw6gZzIPAYtBs4ZCSmfQFtpld2RC10joLg-9JBW_mOU/s320/sion3.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><span style="background-color: #fff2cc;">WEBSITE LINK</span>: <a href="https://sionsurgical.com/" target="_blank">https://sionsurgical.com/</a><br /></span></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOAFUDcLT9ia-JGHb6cnJXO0R4KbcbycwHgP0QyCkT5gh23zy-cMEfy7uzpH8Lu2DGTk76Dr39Bn9Pt6XAUqHcxE1hk6X88V1krYGuK-TK2NNj_yIiL3wlSi2OvPC5xEyAHzaw2n6SmRUWL6wNvpV8bbfj8TkIqB1-sjflJjdkZRaleHD4c_Fm7tjs7Laj/s1024/DALL%C2%B7E%202023-12-12%2012.52.04%20-%20many%20eyes%20floating%20in%20the%20sky%20digital%20art.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOAFUDcLT9ia-JGHb6cnJXO0R4KbcbycwHgP0QyCkT5gh23zy-cMEfy7uzpH8Lu2DGTk76Dr39Bn9Pt6XAUqHcxE1hk6X88V1krYGuK-TK2NNj_yIiL3wlSi2OvPC5xEyAHzaw2n6SmRUWL6wNvpV8bbfj8TkIqB1-sjflJjdkZRaleHD4c_Fm7tjs7Laj/s320/DALL%C2%B7E%202023-12-12%2012.52.04%20-%20many%20eyes%20floating%20in%20the%20sky%20digital%20art.png" width="320" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-59690476981774640472024-01-11T21:52:00.002+05:302024-01-12T11:41:49.000+05:30BETA-AMYLOID TEST FOR GLAUCOMA<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5NaXswWPQtxFIGTnYMNVi4uu0O3ss6Jl5KkbVp00cSDb59izXcS3HxGPlBuWkZ-ZSGwvZOmKOEOnGX_wjlD7aD24BPrEIJBawBYMzP5Y8XgNlEQ9joKg1eIO8TX6F3HuvLeQh80rvpy_virq2o-cG9OuRrjf_cDQyOzlL7-7K-5BImLjvAavIBsGEPXbC/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5NaXswWPQtxFIGTnYMNVi4uu0O3ss6Jl5KkbVp00cSDb59izXcS3HxGPlBuWkZ-ZSGwvZOmKOEOnGX_wjlD7aD24BPrEIJBawBYMzP5Y8XgNlEQ9joKg1eIO8TX6F3HuvLeQh80rvpy_virq2o-cG9OuRrjf_cDQyOzlL7-7K-5BImLjvAavIBsGEPXbC/w200-h176/logo2.png" width="200" /></a></div><br /> <p></p><p><br /></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Amydis Inc., is a company devoted to the
development of ocular biomarkers for the detection of diseases of the eye,
heart and brain. In the end of last year, the company announced the launch of
its Phase 2 clinical program for the study of a novel retinal tracer,
AMDX-2011P, which can detect amyloid-beta in glaucoma patients. This biomarker
can detect molecular changes in the retina, which can add to the
structural-functional changes seen in glaucoma patients. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">There are reports suggesting amyloid-beta
is a key factor in the pathogenesis of glaucoma. Amyloid beta is also
associated with the development of Alzheimer’s disease, suggesting glaucoma is
an “ocular Alzheimer’s disease”.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The patented retinal tracer, AMDX-2011P, is
a small molecule which can be used to detect and quantify amyloid beta deposits
in the retina using currently available imaging devices. Therefore, the
procedure claims to increase the capture rate of glaucoma and improving
clinical management. This is achieved through earlier intervention and
potentially, facilitate amyloid beta targeted neuroprotective therapies. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgckRufGoa6yN-tQQ7Qgi2sffRpqkO1UOPtxw8kkoabe2b33giPJWgMwWYM8x-kCvDbr5ABS8BJz7PwN7dPqKGlMNYcoJcJiduLnmT0-LasEsVRHr2q0IubLiltLXqGMGXzwn0rzrROKmsD9cfWFiAjIqRW_yLjIZvHK2YZbF26Mcb198uj-jsiSpjhR_9w/s1207/amy.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="564" data-original-width="1207" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgckRufGoa6yN-tQQ7Qgi2sffRpqkO1UOPtxw8kkoabe2b33giPJWgMwWYM8x-kCvDbr5ABS8BJz7PwN7dPqKGlMNYcoJcJiduLnmT0-LasEsVRHr2q0IubLiltLXqGMGXzwn0rzrROKmsD9cfWFiAjIqRW_yLjIZvHK2YZbF26Mcb198uj-jsiSpjhR_9w/w400-h188/amy.png" width="400" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In collaboration with the University of
California-San Diego (UCSD), Amydis completed proof-of-concept studies
demonstrating the Amydis tracers detect amyloid beta in post-mortem human eyes
of glaucoma patients, but not healthy subjects. The results have been submitted
for publication.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Dr. Stella Sarraf, Amydis founder and chief
executive officer was quoted, “We are thrilled to launch a new clinical program
for an eye disease. Enabling micron-level in-vivo tracking of retinal amyloid
beta formation in glaucoma patients will add a gain-of-function test to current
loss-of-function testing, empowering doctors to deliver better patient care,” “Our
goal is to also facilitate the development of neuroprotective agents to help
provide more therapeutics for patients.”<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">“If successful, the creation of a molecular
endpoint with the Amydis technology has the potential to enhance standard of
care for glaucoma patients by enabling improved diagnostic and prognostic
evaluation, as well as being used as an endpoint to develop neuroprotective
therapies,” said Dr. Robert N. Weinreb, Chair of the Amydis Scientific Advisory
Board, Chair and Distinguished Professor of Ophthalmology at UCSD and Director
of Shiley Eye Institute.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Amydis has launched a phase 2 open label,
blinded endpoint assessment study of AMDX-2011P as a retinal tracer in subjects
with primary open angle glaucoma. This trial is being conducted at three sites
in Southern California to collect multi-modal retinal imaging data on 40
subjects. This multi-modal data will include optical coherence tomography (OCT)
and OCT Angiography (OCT-A), enabling Amydis to map retinal amyloid beta,
retinal structure (OCT), and retinal vascular (OCT-A) signatures and monitor
their relative changes to better understand the pathophysiology of glaucoma.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Much like DARC technology, this technique
also relies on intravenous injection of the tracer. That is an impractical
technique for most patients visiting OPD clinics. Such diagnostic methods need
to develop drops or use other routes for the tracer to reach the retina.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdzfEYf1ZpKsm4rBMmW7A4l5f3J8Jmfh_AHvoxBprzxb1m-wyyjZ8jKK9glH5C7bbR4JwNRpg0_JsXMKPLJgGtgFbtNXqNx9Yhb23SXRdWr7MrhVjthUYdxPvbYpnLANLbGau6Y_Rco6WZjfXrPL1Gs9R16R0Zo1r65ZavVoECGzU5qFRVcuxZlCyZAz61/s1024/DALL%C2%B7E%202023-12-28%2009.42.38%20-%20river%20eyes%20sunrise%20pixel%20art.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdzfEYf1ZpKsm4rBMmW7A4l5f3J8Jmfh_AHvoxBprzxb1m-wyyjZ8jKK9glH5C7bbR4JwNRpg0_JsXMKPLJgGtgFbtNXqNx9Yhb23SXRdWr7MrhVjthUYdxPvbYpnLANLbGau6Y_Rco6WZjfXrPL1Gs9R16R0Zo1r65ZavVoECGzU5qFRVcuxZlCyZAz61/w320-h320/DALL%C2%B7E%202023-12-28%2009.42.38%20-%20river%20eyes%20sunrise%20pixel%20art.png" width="320" /></a></div><br /><p></p><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-25539807768801444462024-01-06T21:02:00.003+05:302024-01-06T21:02:34.930+05:30MicroMT GLAUCOMA IMPLANT<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd9kTvO3aJfC9QnLzfP3UB5c4Nz3nwdU7Dj2QblX4etwLNtK6ebqqYqPIbaCaesQjNjDJYEf9kXh9hXsVLy7bk1fB_IxmVNbEXUdKL5dv5hnL5Q98rh8_Oul7TzEjYf2cr9p1622553-ewNpIMowbDt1QspIL-YqkNAtKjWXltBu-4Z4tflzZW6WBCRlqC/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd9kTvO3aJfC9QnLzfP3UB5c4Nz3nwdU7Dj2QblX4etwLNtK6ebqqYqPIbaCaesQjNjDJYEf9kXh9hXsVLy7bk1fB_IxmVNbEXUdKL5dv5hnL5Q98rh8_Oul7TzEjYf2cr9p1622553-ewNpIMowbDt1QspIL-YqkNAtKjWXltBu-4Z4tflzZW6WBCRlqC/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The MicroMT is a novel membrane-tube (MT) type
glaucoma shunt device developed by Ahn and colleagues in Korea.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The MicroMT consists of an expanded
polytetrafluoroethylene (e-PTFE) membrane and a silicone tube with an
intraluminal stent, which allows aqueous drainage from the anterior chamber through
a lamellar scleral flap</span> <span style="font-family: "Georgia",serif;">in a
similar fashion as conventional trabeculectomy surgery. The intraluminal stent
prevents excessive aqueous drainage and allows additional IOP reduction through
retraction or removal of the stent.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The MicroMT consists of (1) a 2 × 2-mm
area, 0.2 mm thick e-PTFE membrane, by which the tube is anchored to the
scleral flap bed using a suture, and (2) a silicone microtube with an external
diameter of 200 μm and an internal diameter of 100 μm, which is attached to the
membrane using silicone adhesive. The tube is 6 mm long, and is trimmed during
the operation.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The silicone tube has an intraluminal
stent, which is a 7-0 nylon suture. The more the stent (suture) is pulled out
of the silicone tube, the more is the aqueous outflow. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;"><o:p> </o:p></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwp5yN50PQyADadfQu7x_OGw9FfcuN_b6vrx49HgH5eS8oDz0M1GdTnEwb0ZWAt8GBSKtoI1dxdF_s0UCs5nGTJDC60_5yBEwxYgnidK8r1l8PHcietcsPp1kHz4Rc2N1-cJP6UsEPgwtKvb8wvd9N_CrKYmAc-bsdOviEgN5qxDVCy6ePJ4ggWFokpFA-/s436/MICROMT1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="436" data-original-width="364" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwp5yN50PQyADadfQu7x_OGw9FfcuN_b6vrx49HgH5eS8oDz0M1GdTnEwb0ZWAt8GBSKtoI1dxdF_s0UCs5nGTJDC60_5yBEwxYgnidK8r1l8PHcietcsPp1kHz4Rc2N1-cJP6UsEPgwtKvb8wvd9N_CrKYmAc-bsdOviEgN5qxDVCy6ePJ4ggWFokpFA-/w334-h400/MICROMT1.png" width="334" /></a></div><br /><p></p>
<p class="MsoNormal" style="text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">SURGICAL TECHNIQUE:<o:p></o:p></span></u></b></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">A
fornix-based conjunctival incision is made, Tenon’s capsule is dissected, a
partial-thickness lamellar scleral flap is formed, eyes are treated using
either 0.02% or 0.04% mitomycin-C for 2–4 min, and a sclerostomy is performed
into the anterior chamber using a 30-gauge needle. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">The
tube’s length is adjusted, and is placed in the anterior chamber; aqueous
drainage is confirmed when droplets appeared at the end of the microtube. The
MicroMT membrane is anchored to the scleral flap bed using a 10-0 nylon suture.
The scleral flap is sufficiently closed to prevent exposure of the MicroMT, and
the post-luminal part of the stent is fixed with a suture to restrict its
movement. After the conjunctival incision is closed, the distal end of the
stent is placed on the conjunctival surface and fixed using a 10-0 nylon suture.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">During
the early postoperative period (<4 weeks), if the amount of aqueous drainage
through the tube needs to be increased, the post-luminal part of the stent,
which is located on the conjunctival surface, is retracted using forceps under
a slit-lamp biomicroscope in an outpatient clinic. To further reduce IOP in a
stepwise fashion, all intraluminal stents are completely removed 4 weeks after
surgery.<o:p></o:p></span></p><p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirH5tIPDHZmGinxVsrEumk9yKjE3xAzkWIAyFzjzdaOlmdCP5LYUDdByoMfm1rzucV16Kch_Y372Ds499D-CSN-3kxmkFzAFj9FDx4o-3JOrjC-wxR_ZuV6memAwED7pGyO_gwVjcDS3rwttOPZAXTp4cM5y4cx4a5ClbYFyEsOy06iAgI6Y3arT8r2-qf/s536/MICROMT2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="536" data-original-width="488" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirH5tIPDHZmGinxVsrEumk9yKjE3xAzkWIAyFzjzdaOlmdCP5LYUDdByoMfm1rzucV16Kch_Y372Ds499D-CSN-3kxmkFzAFj9FDx4o-3JOrjC-wxR_ZuV6memAwED7pGyO_gwVjcDS3rwttOPZAXTp4cM5y4cx4a5ClbYFyEsOy06iAgI6Y3arT8r2-qf/w364-h400/MICROMT2.png" width="364" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">CLINICAL STUDY:<o:p></o:p></span></u></b></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">In
a study reported by Ahn and colleagues, the MicroMT was implanted in 43 eyes of
43 subjects (11 female and 32 male). <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">The
mean (SD) follow-up period after the surgery was 27.9 (13.7) months (range,
7–47 months). The mean (SD) IOP before the operation was 22.5 (6.9) mmHg. After
the surgery, the mean IOP decreased to 14.8 (9.0) mmHg, 12.6 (4.8) mmHg, and
11.1 (3.6) mmHg at 1, 2 and 3 years, respectively, after the operation (34.2%,
44.0%, and 50.7% reduction, respectively, from baseline; P<0.01).<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">Complete
removal of the stent 4 weeks after the operation reduced mean IOP from 17.9
(6.3) to 12.2 (4.9) mmHg (an additional 40.2% reduction, P<0.01). <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">The
mean (SD) number of IOP-lowering medications decreased from a preoperative
value of 2.6 (0.6) to 0.5 (0.9), 0.5 (0.8) and 0.4 (0.8) at 1, 2 and 3 years,
respectively, after the operation (P0.05; Table 2). The cumulative survival
rate (standard error) was 89.5% (5%) 3 years after the surgery (Fig. 4).
Failure was observed in four eyes at 7, 9, 10, and 20 months after the
operation.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">When
visual acuity was compared between before and after the surgery, no significant
change was observed at any of the postoperative visits (P>0.05).<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">The
only observed complication was conjunctival wound leakage, which was found in
one (2.3%) eye with avascular bleb 7 months after the operation; this was
successfully resolved by conjunctival suturing.<o:p></o:p></span></p><p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;"><span style="background-color: #fcff01;">WEBLINK</span>: </span><a href="https://onlinelibrary.wiley.com/doi/10.1111/ceo.12772" style="font-family: Georgia, serif;" target="_blank">https://onlinelibrary.wiley.com/doi/10.1111/ceo.12772</a></p><p class="MsoNormal" style="text-align: justify;"><br /></p>
<p class="MsoNormal" style="text-align: justify;"><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijCAybiwGv9i2_xvA5Q2bxv5K5Z8qyvS1bJ72yfPZonmkfF9kQGolMoiC2h5qbMm0pzW5LavrRNuvv2CtmU-YEHn32mNuAJS3-aHG2QtZYxB39CPW_NGLKJ6sHNt6c3JxCYBbHLunH8LxIDuGd8DT8kMzIQmZyfOH-uhfZ2Z7JEI76ELizrEI-3dB5MYBk/s1024/IMG_20231108_191543.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijCAybiwGv9i2_xvA5Q2bxv5K5Z8qyvS1bJ72yfPZonmkfF9kQGolMoiC2h5qbMm0pzW5LavrRNuvv2CtmU-YEHn32mNuAJS3-aHG2QtZYxB39CPW_NGLKJ6sHNt6c3JxCYBbHLunH8LxIDuGd8DT8kMzIQmZyfOH-uhfZ2Z7JEI76ELizrEI-3dB5MYBk/w200-h200/IMG_20231108_191543.png" width="200" /></a></div><br /> <p></p><br /><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-13683405569620628372024-01-01T11:23:00.001+05:302024-01-01T11:23:25.050+05:30Structural and Functional Brain Changes beyond Visual System in Patients with Advanced Glaucoma<p style="text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5sX57oO2ftjUJsj03tjaCkDZZ7R1znisR0NVfQSENEp5e3dBFzZqU0ICYfQ59vJgHDHn97uIO1gdw-Jh_btZAKNuoK6tyP2ykL-LxfMI-Azw0O9NPWCIveZt4fVPnYBBRfO4nvLqLsovMoN0lsn-fFtbSq3VaYn_kjOE4SYwGPFmVEV3H7yqpZjp2KXD7/s312/logo2.png" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5sX57oO2ftjUJsj03tjaCkDZZ7R1znisR0NVfQSENEp5e3dBFzZqU0ICYfQ59vJgHDHn97uIO1gdw-Jh_btZAKNuoK6tyP2ykL-LxfMI-Azw0O9NPWCIveZt4fVPnYBBRfO4nvLqLsovMoN0lsn-fFtbSq3VaYn_kjOE4SYwGPFmVEV3H7yqpZjp2KXD7/w200-h176/logo2.png" width="200" /></a></p><br /><p></p><p><br /></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">A major characteristic of glaucomatous
degeneration is the loss of RGCs and their axons, which leads to progressive
blindness. However, some MRI studies show that neural abnormalities in glaucoma
are not limited to the RGCs and are more extensive, extending to the entire
visual pathway.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqoyZpkdF06b2811TSSb2tPdz9Zx-XLr6lRH2VAZMa3Zdqc5_b5skY-Doncn85ZmwOZxYojwfRBWRSLI5xex0G0AYHnPPIRMXzsD2BTIZwirX8tQz2t5eWLLNT_6Z16ml7OCvq2fu546H93Do_f_ynpscwqrjovnBl3OaxcgEn4bCju2NzR2iDu1saxgzT/s624/Picture1%20brain.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="299" data-original-width="624" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqoyZpkdF06b2811TSSb2tPdz9Zx-XLr6lRH2VAZMa3Zdqc5_b5skY-Doncn85ZmwOZxYojwfRBWRSLI5xex0G0AYHnPPIRMXzsD2BTIZwirX8tQz2t5eWLLNT_6Z16ml7OCvq2fu546H93Do_f_ynpscwqrjovnBl3OaxcgEn4bCju2NzR2iDu1saxgzT/w400-h191/Picture1%20brain.png" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Histological evidence of neurodegeneration
of the visual system in experimental glaucoma supports in-vivo MRI data and
suggests that MRI-derived findings could reflect the extent of neuroaxonal
damage along the entire visual system.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><a name="_Hlk154503539"><span style="font-family: "Georgia",serif;">Frezzotti </span></a><span style="font-family: "Georgia",serif;">et al., have performed MRI studies and
assessed across the whole brain: i) changes in microstructural integrity of
white matter (WM) tracts by tract-based spatial statistics (TBSS) of diffusion
tensor imaging (DTI) measures, ii) structural changes in grey matter (GM)
volume by VBM-style analysis, iii) functional connectivity (FC) changes of
brain networks by resting-fMRI, and iv) how brain changes could be related to
visual impairment. The study found changes such as reduced microstructural
integrity of the optic radiations, decreased volume of the visual cortex, and
altered FC of the visual network.</span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">TBSS analysis of DTI diffusivities
confirmed the presence of an altered integrity of the WM tracts in POAG
patients with respect to normal controls (NC). Such abnormalities were present along
the visual pathway, but also beyond the visual pathway, namely in the middle
cerebellar peduncle, posterior limb of the internal capsule mapping on the
corticospinal tract, anterior thalamic radiation on the right, and superior
longitudinal fascicle (SLF).<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3g0ouocHNjEjbiAWYEJPNpmYQVp4A8vZNNmWUQHw7HeMUYe26YoJUxaHcUDs9C-J8VZSpjsgI-Z4GoJ122KZwsXtc3jfxuYZA8jfURePRQ6FuIKW1IYSGaIvZ8u4fXsVAhPfGTMTcHZA5mOea8NF8o6rgLXQSpEAuUS6YpEHA1LIoGLr0igla_46bcDFi/s624/Picture2%20brain.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="266" data-original-width="624" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3g0ouocHNjEjbiAWYEJPNpmYQVp4A8vZNNmWUQHw7HeMUYe26YoJUxaHcUDs9C-J8VZSpjsgI-Z4GoJ122KZwsXtc3jfxuYZA8jfURePRQ6FuIKW1IYSGaIvZ8u4fXsVAhPfGTMTcHZA5mOea8NF8o6rgLXQSpEAuUS6YpEHA1LIoGLr0igla_46bcDFi/w400-h170/Picture2%20brain.png" width="400" /></a></div><span style="font-family: Georgia, serif;"><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif;"><br /></span></p>In several distinct brain regions GM volume
was lower in POAG patients than in NC. Patients also showed GM volume decrease
in the cerebellum on the left, temporal lobe (hippocampus bilaterally), frontal
lobe (fronto-orbital cortex, subcallosal cortex and frontal pole on the left)
and parietal lobe (superior parietal lobule on the right, postcentral gyrus on
the left).</span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">POAG patients had lower FC in an
extrastriate region of the visual network (lingual gyrus on the right) in the
working memory network (superior frontal gyrus on the left supramarginal gyrus
and LOC on the right) and in the dorsal attention network (LOC bilaterally, pre-
and postcentral gyrus on the left).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">POAG patients had higher FC than NC in the
visual network (LOC bilaterally and temporo-occipital fusiform cortex on the
left) and in the medial part of the executive network (superior frontal gyrus,
parancigulate gyrus and anterior cingulate).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">GM atrophy was found in the most anterior
and medial parts of the visual cortex (anterior lingual gyrus), and also in the
most posterior and lateral regions (LOC). Another recent study has found
reduced cortical thickness in primary and secondary visual cortex in a
heterogeneous group of POAG patients.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Other WM tracts and cortical GM regions
that are not part of the typical visual pathway, such as the anterior thalamic
radiation, corticospinal tract and middle cerebellar peduncle were also found altered
in POAG patients in Frezzotti’s study.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">POAG patients showed GM atrophy in regions
involved in cognitive processing such as the hippocampus (memory), fronto-orbital
cortex (decision-making) and superior parietal lobule (spatial orientation).<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In addition to brain structural
abnormalities, POAG patients also had functional connectivity changes in
different resting state networks (RSNs). In patients with severe impairment of
visual field, decreased FC in visual and working memory networks could be
interpreted as due to maladaptation, thus contributing to clinical deficits.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The findings of widespread brain
abnormalities observed in the present study delineate POAG as a more complex
disorder than classically thought, capable of involving, at least in advanced
stages, unanticipated brain structures and functions.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Therefore, glaucoma could be interpreted as
the expression of a complex neurodegenerative process at cerebral level. The
diffuse involvement of different distinct structures and functions could be an expression
of the spread of neurodegeneration, similarly to what is found in typical
neurodegenerative conditions such as Alzheimer disease, amyotrophic lateral
sclerosis and Parkinson disease.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">There is evidence indicating a close link
between glaucoma and neurodegenerative conditions on the basis of the
similarities in the loss of selective neuron populations, in the trans-synaptic
disease spreading from injured neurons to connected and distant neurons, and in
the common mechanisms of apoptosis, including oxidative injury, glutamate
excitotoxicity and abnormal protein accumulation.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The prevalence of glaucoma was found to be
much higher in different cohorts of patients with Alzheimer disease than in NC
and this was independent from the IOP values.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">By using a multimodal MRI approach, this
exploratory study demonstrates that patients with advanced POAG have structural
and functional changes that go well beyond the visual system, suggesting that
POAG can be considered a vision disorder falling within the group of
neurodegenerative disorders and, as such, spreading throughout the brain.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;"><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105931" target="_blank">https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105931</a><br /></span></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7dHSQx7PrhEt2K2UxDi0Lr05Lb5zjIj3hpCTBlHAmtRWs93DzYU6ikY-diD9p1NFIDIJ6XqjN7XL8yarCVDTQjyYsF4UHwu3vpxKuENypYSsiC7xIuyXB7OHhSV2fo8ZBxqXac9OuHws1VxU8lxiKlOVptjHR91lewgnnZ2sxomCF7hOsDT1XKYj13SEx/s1024/DALL%C2%B7E%202023-12-18%2012.46.23%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7dHSQx7PrhEt2K2UxDi0Lr05Lb5zjIj3hpCTBlHAmtRWs93DzYU6ikY-diD9p1NFIDIJ6XqjN7XL8yarCVDTQjyYsF4UHwu3vpxKuENypYSsiC7xIuyXB7OHhSV2fo8ZBxqXac9OuHws1VxU8lxiKlOVptjHR91lewgnnZ2sxomCF7hOsDT1XKYj13SEx/s320/DALL%C2%B7E%202023-12-18%2012.46.23%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" width="320" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-65909500544722162692023-12-28T10:49:00.002+05:302023-12-28T10:49:39.347+05:30NOVEL BI-LAYERED EXPANDED POLYTETRAFLUOROETHYLENE GLAUCOMA IMPLANT <p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhhrQwmjjEAkv8LYmWPA8ilwZDZ6mVZ_Anx8zFNclS4grIdqzGPORtkJ91ljD60S4c_mTUnATFfIv9rP99A5w7L2SQ-QipjKrRrlhAYnyHoBPSWk5aos7lICMzZ7P9UgAzHtKM-lVpr-JogtyZN1cB3lqbzMMZptQqyC4QNJjol2ytNtERT020m_KRjzMC/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhhrQwmjjEAkv8LYmWPA8ilwZDZ6mVZ_Anx8zFNclS4grIdqzGPORtkJ91ljD60S4c_mTUnATFfIv9rP99A5w7L2SQ-QipjKrRrlhAYnyHoBPSWk5aos7lICMzZ7P9UgAzHtKM-lVpr-JogtyZN1cB3lqbzMMZptQqyC4QNJjol2ytNtERT020m_KRjzMC/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">A
promising and incompletely explored approach to fibrosis control utilizes
biomaterials that modulate healing. Expanded polytetrafluoroethylene (ePTFE) is
a highly stable polymer of tetrafluoroethylene that was patented by Gore. </span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Due
to its biocompatibility, biostability, and high compliance, ePTFE incorporates
well into many tissues and is approved for use in numerous biomedical implants,
including: vascular grafts, bypass grafts, hernia membranes, and sutures. ePTFE
has a porous surface comprised of nodes and fibrils which can structurally
permit or prevent cellular integration. </span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif; font-size: 12pt;">Implants
of matching footprints were fabricated from silicone (Control) and novel,
bi-layered ePTFE.</span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">ePTFE
implants included: (a) one that inflated with aqueous humor (AH) (High), (b)
one that inflated with a lower profile (Low), (c) an uninflated implant not
connected to the anterior chamber (Flat), and (d) one filled with material that
did not allow AH flow (Filled). <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPdayonGZdR99-PIU5i5SGwwZs_MO0iTl8l62RGGyiZdjFuk4ysvuNy28mO1BPJBbPk_ATuH32GD5AVSn9-aLvG7EZNpoCPyxKWybvvd6lWjsSxD8TaEJ0vDkMZnNXZLaaBe0QpjFlJFywq0jDAIko5U_mrg2dHsPESY-2r0PwyF3PZcl3AgAvUpNj-Elj/s500/btm210179-fig-0001-m.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="336" data-original-width="500" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPdayonGZdR99-PIU5i5SGwwZs_MO0iTl8l62RGGyiZdjFuk4ysvuNy28mO1BPJBbPk_ATuH32GD5AVSn9-aLvG7EZNpoCPyxKWybvvd6lWjsSxD8TaEJ0vDkMZnNXZLaaBe0QpjFlJFywq0jDAIko5U_mrg2dHsPESY-2r0PwyF3PZcl3AgAvUpNj-Elj/s320/btm210179-fig-0001-m.png" width="320" /></a></div><br /><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Georgia, serif; font-size: 12pt; text-align: justify;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Georgia, serif; font-size: 12pt; text-align: justify;">All
implants were placed in adult New Zealand White rabbits and followed over 1–3
months.</span></div>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><ul><li><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">The
permeability of tissue capsules surrounding GDIs was assessed using
constant-flow perfusion with fluoresceinated saline at physiologic flow rates. </span></li><li><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">After
sacrifice, quantitative histopathological measures of capsule thickness were
compared among devices, along with qualitative assessment of cellular
infiltration and inflammation. </span></li><li><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Capsular
thickness was significantly reduced in blebs over ePTFE (61.4 ±</span><span style="font-family: "Times New Roman",serif; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">53</span><span style="font-family: "Times New Roman",serif; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Georgia;">μ</span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">m) versus silicone implants (193.6 </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Georgia;">±</span><span style="font-family: "Times New Roman",serif; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">53</span><span style="font-family: "Times New Roman",serif; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Georgia;">μ</span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">m,</span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Georgia;"> </span><i><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">p</span></i><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"> =</span><span style="font-family: "Times New Roman",serif; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">.0086). <o:p></o:p></span></li><li><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">AH
exposure did not significantly alter capsular thickness, as there was no
significant difference between High and Filled (50.9 </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Georgia;">±</span><span style="font-family: "Times New Roman",serif; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">29,</span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Georgia;"> </span><i><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">p</span></i><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"> =</span><span style="font-family: "Times New Roman",serif; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">.34)
implants. <o:p></o:p></span></li><li><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Capsules
around ePTFE implants demonstrated permeability with steady-state pressure:
flow relationships at physiologic flow rates and rapid pressure decay with flow
cessation, while pressure in control blebs increased even at low flow rates and
showed little decay. </span></li><li><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Perfused
fluorescein dye appeared beyond the plate border only in ePTFE implants. </span></li></ul><div><span style="font-family: Georgia, serif;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6AWzDim6YfWb_grOQ7I4Z7yi5GfHp4eVIDM_wfD6VnnaL7sUyt5HbDIo5WalKt-gsD31DqtszZOaw36FSQsbvWPlMRoLbVVc1V2yozM8OSSowR49RvamfrefiBt9D3iL0svGoOKUfmcugS8yQZxlxiW_0zgFg7rbVVwp6xo8aQZ7TvJblStLxcGaYEHsw/s500/btm210179-fig-0002-m.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="174" data-original-width="500" height="139" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6AWzDim6YfWb_grOQ7I4Z7yi5GfHp4eVIDM_wfD6VnnaL7sUyt5HbDIo5WalKt-gsD31DqtszZOaw36FSQsbvWPlMRoLbVVc1V2yozM8OSSowR49RvamfrefiBt9D3iL0svGoOKUfmcugS8yQZxlxiW_0zgFg7rbVVwp6xo8aQZ7TvJblStLxcGaYEHsw/w400-h139/btm210179-fig-0002-m.png" width="400" /></a></div><br /><span style="font-family: Georgia, serif;"><br /></span></div><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEgmzCw0ggMqEVVZdZozPQb_88bSfW_S_cS59rWDvxJ6M06LYVgPBamjNvvqpI-0VTb7-n1SKuQPZBMrygHe_L6u2DAvnbnQRAWiwhpuY8dLsoAT7Uoqa7UfDoylG6xxatAeeNPs2ETn4kwpnCrdILEj9UmKqKOKubkPQ_xdWqRSCQRsmcCkftK8aksmAg/s590/eptfe2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="393" data-original-width="590" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEgmzCw0ggMqEVVZdZozPQb_88bSfW_S_cS59rWDvxJ6M06LYVgPBamjNvvqpI-0VTb7-n1SKuQPZBMrygHe_L6u2DAvnbnQRAWiwhpuY8dLsoAT7Uoqa7UfDoylG6xxatAeeNPs2ETn4kwpnCrdILEj9UmKqKOKubkPQ_xdWqRSCQRsmcCkftK8aksmAg/s320/eptfe2.jpg" width="320" /></a></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIFSGhIYxKXjNpqRvsul4s6loy3mOfkwnFR4Ipk-yp_7xT0tWr4ulNSDxkruFUQUKG-pwiMoB3PfuWNc1evQrhuY4CBq5VklAJS_UQSBnjO-f_lEgd9N-5P-mQSh6UzeZRqLn65Ti2fH1Hgnz65y2sTJJ6WF1Q378WuESbIvhEelJtA490MgaB9F0dHXNJ/s464/ePTFE.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="179" data-original-width="464" height="123" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIFSGhIYxKXjNpqRvsul4s6loy3mOfkwnFR4Ipk-yp_7xT0tWr4ulNSDxkruFUQUKG-pwiMoB3PfuWNc1evQrhuY4CBq5VklAJS_UQSBnjO-f_lEgd9N-5P-mQSh6UzeZRqLn65Ti2fH1Hgnz65y2sTJJ6WF1Q378WuESbIvhEelJtA490MgaB9F0dHXNJ/s320/ePTFE.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Steady fluorescein outflow beyond the ePTFE implant </td></tr></tbody></table><br /><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">In
conclusion, ePTFE implants are associated with thinner, more permeable capsules
compared to silicone implants simulating presently used devices.</span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif; font-size: 12pt;"><span style="background-color: #fcff01;">ARTICLE LINK:</span> <a href="https://aiche.onlinelibrary.wiley.com/doi/full/10.1002/btm2.10179" style="background-color: red;" target="_blank">https://aiche.onlinelibrary.wiley.com/doi/full/10.1002/btm2.10179</a></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcckVnn1JoyJzX7yS9boqrxn1cwr1_AdsxF_PzHYFyJODSXfYVIBS_sh_CtcjxJ1WE82q-Jfn4RnHNZZhy5Bd29nm8O2QD2unIsoT5OtNlN7rLblJrbpNxpZ3llEWnRNoaLho45qLPFI2z9bSOx3GGy78Qd7RNSF_1DbJiD4eYRZGE1fHIuIK484iEjkQE/s1024/IMG_20231108_191543.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcckVnn1JoyJzX7yS9boqrxn1cwr1_AdsxF_PzHYFyJODSXfYVIBS_sh_CtcjxJ1WE82q-Jfn4RnHNZZhy5Bd29nm8O2QD2unIsoT5OtNlN7rLblJrbpNxpZ3llEWnRNoaLho45qLPFI2z9bSOx3GGy78Qd7RNSF_1DbJiD4eYRZGE1fHIuIK484iEjkQE/w200-h200/IMG_20231108_191543.png" width="200" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p><br /><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-74537817043778136072023-12-24T14:52:00.005+05:302023-12-24T14:52:52.863+05:30The mechanical theory of glaucoma in terms of prelaminar, laminar, and postlaminar factors<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUTZq0kG158SH_758-lACT0IipZ5Ixx4cTNKc-VDy_LtbnWorIKa1AIp5_EW2ZQ9VGRaYcVYGf3TfDn1-CMY4Ls1sPqVxB14-K8QLtC7Xh7uUPX3fMDWo3xvjYbW8z6XquUZnOOdA5viDYOAG1tpCT-lxnRuhCpuw5XSMIxTIFlLi3H73scgoDgf9BhUqq/s312/logo2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUTZq0kG158SH_758-lACT0IipZ5Ixx4cTNKc-VDy_LtbnWorIKa1AIp5_EW2ZQ9VGRaYcVYGf3TfDn1-CMY4Ls1sPqVxB14-K8QLtC7Xh7uUPX3fMDWo3xvjYbW8z6XquUZnOOdA5viDYOAG1tpCT-lxnRuhCpuw5XSMIxTIFlLi3H73scgoDgf9BhUqq/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p style="text-align: justify;"></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;">The
mechanical theory is one of the oldest concepts regarding the development of
glaucomatous neural degeneration. However, after a prolonged period of relative
monopoly among the various theories explaining the pathogenesis of glaucoma,
this concept gradually faded away from discourse. </span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsVgbxVNY3JSpvrEg_D44cVA-jqO3a2HiaeDJCU9hk3HBHBSNp8Dcqud4EX1oM0RGJGeHTrM09akvhngLLFi2-0n6JT_z1shwv8grTZDVFEdcKP4tGa2Pfk2l_SoCQMqMNW-9C1ToVzxNEd6fx9cUelBc4GLgK2O4wYN0_oS7bvG-5YFEIP9YTxKHQINVf/s1024/DALL%C2%B7E%202023-12-18%2012.45.03.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsVgbxVNY3JSpvrEg_D44cVA-jqO3a2HiaeDJCU9hk3HBHBSNp8Dcqud4EX1oM0RGJGeHTrM09akvhngLLFi2-0n6JT_z1shwv8grTZDVFEdcKP4tGa2Pfk2l_SoCQMqMNW-9C1ToVzxNEd6fx9cUelBc4GLgK2O4wYN0_oS7bvG-5YFEIP9YTxKHQINVf/w200-h200/DALL%C2%B7E%202023-12-18%2012.45.03.png" width="200" /></a></div><br /><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;"><br /></span><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12.0pt; line-height: 150%;">Several developments in the
recent past have rekindled interest in the mechanical theory of glaucoma. Now
we know a lot more about the biomechanics of the eye, prelaminar changes,
mechanisms of retinal ganglion cell death, biomechanical features of the optic
nerve head and sclera, extracellular matrix composition and its role,
astrocytic changes, axoplasmic flow, and postlaminar factors such as
translaminar pressure difference. These factors and others can be categorized
into prelaminar, laminar, and postlaminar elements. </span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: Georgia, serif; font-size: 16px;">The objective of this review was to present a concise analysis of these recent developments. </span><o:p style="font-family: Georgia, serif; font-size: 16px;"></o:p></p><div><span style="font-family: Georgia, serif; font-size: 16px;">The review has been published as a pre-print (Ahead of publication) in the Taiwan Journal of Ophthalmology.</span></div><div><span style="font-family: Georgia, serif; font-size: 16px;"><br /></span></div><div><span style="font-family: Georgia, serif; font-size: 16px;"><a href="https://journals.lww.com/tjop/fulltext/9900/the_mechanical_theory_of_glaucoma_in_terms_of.12.aspx" target="_blank">https://journals.lww.com/tjop/fulltext/9900/the_mechanical_theory_of_glaucoma_in_terms_of.12.aspx</a><br /></span></div><div><br /></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN4dEciDdp_0X2xXvCBFlFXgGBiYYzRcpnpxddAD4ZiR_4EN2CwH07hfuHCrn4jha7gWy_X2jmcpnHTgUSWo2IceFn226SqN7yLkXeblATZ_HJLazpeDop5lLTVSYtIPUeyVU_6rNOxoEnl3265Ct0JaLdMu-NvEcJtFEI305d1VOJ3AZRCPbnsXS2Xkex/s1024/DALL%C2%B7E%202023-12-18%2012.46.32%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN4dEciDdp_0X2xXvCBFlFXgGBiYYzRcpnpxddAD4ZiR_4EN2CwH07hfuHCrn4jha7gWy_X2jmcpnHTgUSWo2IceFn226SqN7yLkXeblATZ_HJLazpeDop5lLTVSYtIPUeyVU_6rNOxoEnl3265Ct0JaLdMu-NvEcJtFEI305d1VOJ3AZRCPbnsXS2Xkex/s320/DALL%C2%B7E%202023-12-18%2012.46.32%20-%20Optic%20nerve%20with%20water%20flowing%20over%20it.%20Digital%20art.png" width="320" /></a></div><br /><div><br /></div><p></p>Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-73041835480088863592023-12-18T12:10:00.005+05:302023-12-19T11:09:23.675+05:30iDose TR Travoprost intracameral implant<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ1y5iz38ZUkVDWxTgtTnphlXNA2L6y8-A9mXFG0cFCd_bfgc5UhahpvMj_JxqA4BaNx1bB0H4ugWOtKwt97xTNkzmnvjNkSMN12sxM8lBcfuzI6bVSuh9blzbJAVe0eomvwL2aAWPefXyCxRNnEHHd_sSk9d9-xvBsH13eUyvmJMiKse-z7m1gusQ8Tad/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ1y5iz38ZUkVDWxTgtTnphlXNA2L6y8-A9mXFG0cFCd_bfgc5UhahpvMj_JxqA4BaNx1bB0H4ugWOtKwt97xTNkzmnvjNkSMN12sxM8lBcfuzI6bVSuh9blzbJAVe0eomvwL2aAWPefXyCxRNnEHHd_sSk9d9-xvBsH13eUyvmJMiKse-z7m1gusQ8Tad/w200-h176/logo2.png" width="200" /></a></div><br /><p></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">Glaukos Corporation, the company which developed
the iStent device, has announced the FDA approval of their single
administration <a name="_Hlk153787148">iDose TR travoprost intracameral implant</a>.
<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The device is made from medical-grade
titanium and measures 1.8 mm × 0.5 mm. It is implanted using a technique
similar to many MIGS procedures. A gonioprism is used to identify the anterior
chamber (AC) angle, a 2.2 mm incision is made in clear cornea, the AC is filled
with a cohesive viscoelastic and the device is implanted through the trabecular
meshwork and the back of the Schlemm’s canal directly into the scleral tissue. The
device is held in place by a scleral anchor. After the end of the specified period, the device is replaced by a new one. According to some, the device can be used for 4-5 years.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihwC0tu2_-fH9XpmAUuDKqSBziOHvYIrdpm06daT7UEcSi87AuuA4kI-6FbomPyWw9sRFRbVoWepqC70dHOE8ObuBlI6dF5DP3OS_LTbg7IYX1F-UZlauzYo3OBDMRo57vUAuAGAiuLvCtylLzbrhEfOzpAriuxuVP-SEJNyzl8DjEiStZ21ZCCyrt0bhQ/s1366/iDose0.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1366" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihwC0tu2_-fH9XpmAUuDKqSBziOHvYIrdpm06daT7UEcSi87AuuA4kI-6FbomPyWw9sRFRbVoWepqC70dHOE8ObuBlI6dF5DP3OS_LTbg7IYX1F-UZlauzYo3OBDMRo57vUAuAGAiuLvCtylLzbrhEfOzpAriuxuVP-SEJNyzl8DjEiStZ21ZCCyrt0bhQ/w640-h360/iDose0.png" width="640" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">The device has a membrane-bound reservoir
of 75 mcg travoprost which diffuses continuously into the anterior chamber.
There are two iDose TR models available, which have two different rates of drug
elution (referred to as fast- and slow-release iDose TR models). This
drug-delivery platform circumvents the patient compliance issue which plagues
many glaucoma patients.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiV0g1k5JDCohuzEmZVOIr5_oBnBUODAnBDor7qovsqhKMIAwmygpibWAwjHfbo6yhHxLBeNKBJBnXtMaQNQAna8EqXTbmchlkGXnSIuOSF0fQSZPiMcX8vNcOP3XMtt6hUovreC54Zlfv9Lu2EI_CJW1VhtjBWyS4tnUdc0vvSX_NuJ7AwdNvTakAJ-tlW/s569/iDose2.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="265" data-original-width="569" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiV0g1k5JDCohuzEmZVOIr5_oBnBUODAnBDor7qovsqhKMIAwmygpibWAwjHfbo6yhHxLBeNKBJBnXtMaQNQAna8EqXTbmchlkGXnSIuOSF0fQSZPiMcX8vNcOP3XMtt6hUovreC54Zlfv9Lu2EI_CJW1VhtjBWyS4tnUdc0vvSX_NuJ7AwdNvTakAJ-tlW/s320/iDose2.jpg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7j7GDOYX_vOjlHHzc-QEwof9wvcPNLjXHFSeHeY5qcdDNJuBvGOOHOEpMFLF6UByaTO2KepuGt7SyTNRVkI2N-BGkJh8F-6aVeErmHzJ6D7XVH5cCJmtz_ML8SaevplLw2FKWyrovPi6sLFaO94EiVOTsW5OUmgjH5MphBJmdbKo0cuR420o3JW9HGOrm/s600/iDose3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="388" data-original-width="600" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7j7GDOYX_vOjlHHzc-QEwof9wvcPNLjXHFSeHeY5qcdDNJuBvGOOHOEpMFLF6UByaTO2KepuGt7SyTNRVkI2N-BGkJh8F-6aVeErmHzJ6D7XVH5cCJmtz_ML8SaevplLw2FKWyrovPi6sLFaO94EiVOTsW5OUmgjH5MphBJmdbKo0cuR420o3JW9HGOrm/s320/iDose3.png" width="320" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">Contraindications:</span></u></b><u><span style="font-family: "Georgia",serif;"><o:p></o:p></span></u></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">iDose TR is contraindicated in patients
with active or suspected ocular or periocular infections, patients with corneal
endothelial cell dystrophy (e.g., Fuch’s Dystrophy, corneal guttatae), patients
with prior corneal transplantation, or endothelial cell transplants (e.g.,
Descemet’s Stripping Automated Endothelial Keratoplasty [DSAEK]), patients with
hypersensitivity to travoprost or to any other components of the product.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">Warnings and Precautions:</span></u></b><u><span style="font-family: "Georgia",serif;"><o:p></o:p></span></u></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">iDose TR should be used with caution in
patients with narrow angles or other angle abnormalities. Monitor patients
routinely to confirm the location of the iDose TR at the site of
administration. Increased pigmentation of the iris can occur. Iris pigmentation
is likely to be permanent.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">Adverse Reactions:</span></u></b><u><span style="font-family: "Georgia",serif;"><o:p></o:p></span></u></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif;">In controlled studies, the most common
ocular adverse reactions reported in 2% to 6% of patients were increases in
intraocular pressure, iritis, dry eye, visual field defects, eye pain, ocular
hyperaemia, and reduced visual acuity.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Georgia",serif;">Studies:<o:p></o:p></span></u></b></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">The
FDA approval is based on results from two prospective, randomized, multicenter,
double-masked, Phase 3 pivotal trials (GC-010 and GC-012) designed to compare
the safety and efficacy of a single administration of one of two <i>iDose
TR</i> models with different travoprost release rates (referred to as the
fast- and slow-release <i>iDose TR</i> models, respectively) to
topical timolol ophthalmic solution, 0.5% BID (twice a day), in reducing IOP in
subjects with open-angle glaucoma or ocular hypertension. In total, the Phase 3
trials randomized 1,150 subjects across 89 clinical sites. The FDA approval and
Phase 3 data referenced below is for the slow-release <i>iDose TR</i> model,
consistent with the company’s NDA submission and commercialization plans.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">Both
Phase 3 trials successfully achieved the pre-specified primary efficacy
endpoints through 3 months and demonstrated a favorable tolerability and safety
profile through 12 months. IOP reductions from baseline over the first 3 months
were 6.6-8.4 mmHg in the <i>iDose TR</i> arm, versus 6.5-7.7 mmHg in
the timolol control arm.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;"> <i>iDose
TR</i> demonstrated non-inferiority to timolol ophthalmic solution in IOP
reduction during the first 3 months. The FDA also noted that subsequently <i>iDose
TR </i>did not demonstrate non-inferiority over the next 9 months.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Georgia",serif;">At
12 months, 81% of <i>iDose TR</i> subjects were completely free of
IOP-lowering topical medications across both trials. In both trials,<i> iDose
TR</i> demonstrated excellent tolerability and subject retention with 98%
of <i>iDose TR</i> subjects continuing in the trial at 12 months,
versus 95% of timolol control subjects. In controlled studies, the most common
ocular adverse reactions reported in 2% to 6% of <i>iDose TR</i> patients
were increases in intraocular pressure, iritis, dry eye, and visual field
defects, most of which were mild and transient in nature.<o:p></o:p></span></p><p class="MsoNormal" style="text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1yC68pwkDVtgutscQrs5u2KF12tKKVW0gDKGfs7kHmbvBmpVzjpy1qNuxuccLcGK44tDc8b9pQVXgZpLX3ywBuGZn8D6dNKhb_hav10Lt0Ry5hqWo-xWCCPSA5AK_4tKkWG8VEzTlM7euC67XNJ_0ePsiNHZcj5_1LF5x2EIzPENp1359ZVGWZS12lhUD/s1366/idose5.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1366" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1yC68pwkDVtgutscQrs5u2KF12tKKVW0gDKGfs7kHmbvBmpVzjpy1qNuxuccLcGK44tDc8b9pQVXgZpLX3ywBuGZn8D6dNKhb_hav10Lt0Ry5hqWo-xWCCPSA5AK_4tKkWG8VEzTlM7euC67XNJ_0ePsiNHZcj5_1LF5x2EIzPENp1359ZVGWZS12lhUD/w640-h360/idose5.png" width="640" /></a></div><br /><span style="font-family: "Georgia",serif;"><br /></span><p></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdNADxImhHK5JyWgR137mhCgj4zoYGSS_V7BxjxS0hm1cTtnGs-AOH7fGvxGZRBUH2gETuCqP4BpoJIzezdzYzke8G0BAM_cz6YCS-aZwy7hez7W806RAynbZgcJVlkBwUvpR0WrIwGMuSLrZDTQvPLjNApYQWZlLKXOlGKIqTX0k5U7qsc1HT4oXnxIJJ/s1024/IMG_20231118_183902.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdNADxImhHK5JyWgR137mhCgj4zoYGSS_V7BxjxS0hm1cTtnGs-AOH7fGvxGZRBUH2gETuCqP4BpoJIzezdzYzke8G0BAM_cz6YCS-aZwy7hez7W806RAynbZgcJVlkBwUvpR0WrIwGMuSLrZDTQvPLjNApYQWZlLKXOlGKIqTX0k5U7qsc1HT4oXnxIJJ/w200-h200/IMG_20231118_183902.png" width="200" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0tag:blogger.com,1999:blog-8792802210025387152.post-89426565559488355992023-12-14T11:11:00.004+05:302023-12-19T11:10:02.632+05:30OPTICAL COHERENCE ELASTOGRAPHY (OCE)<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQVpLqSzP3gSGMHAsevffM1hCUsxaKflgaWxpKjYQ1ckVkaQPh5V5WvLh1rLDKZ9ySaxztgIa_KTNG2h3cSx2fGqbSKzKENjs_ZbCFUNV8I8i3_fzesk5sUe8xiNk0YGbNvbKdzbdcrLwQN3kv5uU2ZYyVS2e1Kv_vpqqwOVxMhYnHNrOm34TAAvKXh9x-/s312/logo2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="312" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQVpLqSzP3gSGMHAsevffM1hCUsxaKflgaWxpKjYQ1ckVkaQPh5V5WvLh1rLDKZ9ySaxztgIa_KTNG2h3cSx2fGqbSKzKENjs_ZbCFUNV8I8i3_fzesk5sUe8xiNk0YGbNvbKdzbdcrLwQN3kv5uU2ZYyVS2e1Kv_vpqqwOVxMhYnHNrOm34TAAvKXh9x-/w200-h176/logo2.png" width="200" /></a></div><br /> <p></p><p><br /></p><p></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Optical
coherence elastography (OCE) is an emerging biomedical imaging technique used
to produce images of biological tissue in micron and submicron level and map
the biomechanical property of tissues. This technology is based on the
currently popular optical coherence tomography (OCT) technique. In theory, OCT
generates a structural image based on light scattering determined by minute
changes in the refractive index of different tissue and cell types, while OCE
utilizes local tissue motion as a function of an applied stress to infer tissue
stiffness (i.e., elasticity).<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxtUWEgBlYOzZn5Aamkj0uI_HzxVGeX_8KMQLAlxEoHxp-P9PFIvvrflsIV8qwz3GYx5e8bpl8qhTljy2Udo14vpjOm9yM1FZaPs4b4GchN4F6Seii-pZJtEKeXdYdAms01-wipdWlLXK-jfQuWVJSkPjlWELAL7obM6dLDfrkqC_bQWf41FJhOwft4_KX/s422/Web%20capture_13-12-2023_12427_.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="308" data-original-width="422" height="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxtUWEgBlYOzZn5Aamkj0uI_HzxVGeX_8KMQLAlxEoHxp-P9PFIvvrflsIV8qwz3GYx5e8bpl8qhTljy2Udo14vpjOm9yM1FZaPs4b4GchN4F6Seii-pZJtEKeXdYdAms01-wipdWlLXK-jfQuWVJSkPjlWELAL7obM6dLDfrkqC_bQWf41FJhOwft4_KX/s320/Web%20capture_13-12-2023_12427_.jpeg" width="320" /></a></div><br /><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Many diseases
affect the structural organization and function of human cells, collagen
fibers, and extracellular matrix. Therefore, changes in local elastic moduli
may be used to diagnose and help manage treatment of diseased tissue within the
cornea, sclera, lens, and retina. Biomechanical testing can be comparatively
advantageous to probe structural characteristics in both diseased and healthy
tissues that are difficult to contrast using classical OCT methods.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">The goal
of OCE is to produce images of tissue elastic and viscoelastic properties, and
ultimately quantitative maps of the static (i.e., low-frequency) Young’s
modulus from maps of tissue displacements and strains detected with OCT.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">An OCE
system uses three steps to obtain information related to tissue elasticity: (1)
mechanical loading, (2) tissue response, and (3) motion detection. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7k0BESXJyMx5agTv2xHF-DjtM0aoxe7qO4FZcATtvkzI0KAHpDYBuknYUOpbNN3wCLajOJhME_4VJR8kibHB86oErSXr5LUusJF0ZDy-nYXhnZqX7KJu52zPpLu5H10YOEoFKghPAymtMEf1PDwYniN7FgFVwJZwciHOIo1wVU5fUrYBJZP-ySohD5G_A/s700/oce1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="676" data-original-width="700" height="309" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7k0BESXJyMx5agTv2xHF-DjtM0aoxe7qO4FZcATtvkzI0KAHpDYBuknYUOpbNN3wCLajOJhME_4VJR8kibHB86oErSXr5LUusJF0ZDy-nYXhnZqX7KJu52zPpLu5H10YOEoFKghPAymtMEf1PDwYniN7FgFVwJZwciHOIo1wVU5fUrYBJZP-ySohD5G_A/s320/oce1.png" width="320" /></a></div><br /><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Elasticity
imaging requires a physical stress to deform (displace) tissue. Resulting
displacements are measured with OCT to compute strains, detect vibrations, or
track the propagation of a mechanical wave. The stress–strain response of
tissue, local vibration behavior, or mechanical wave content, can each be
mapped spatially to solve for metrics such as the Young’s (or shear) modulus.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzbZN91zoGzw8D_V74R_2BDd5kmUB9RU2rvvRaXPl60hvt23iL0GeMTM4NonLdeRsUJySfqOFZdLxOvC9gxEGWydGU6eB1WuJypvPXH9WWnTXQ80IvhYsx6xCxJyD5cNIBpNiX_1pI7O_4uGcAQzuJfNyC1csdRFII6Z4iSBl5ZjcZTuA5E52hfONkpPzO/s550/photonics-08-00111-g001-550.webp" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="498" data-original-width="550" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzbZN91zoGzw8D_V74R_2BDd5kmUB9RU2rvvRaXPl60hvt23iL0GeMTM4NonLdeRsUJySfqOFZdLxOvC9gxEGWydGU6eB1WuJypvPXH9WWnTXQ80IvhYsx6xCxJyD5cNIBpNiX_1pI7O_4uGcAQzuJfNyC1csdRFII6Z4iSBl5ZjcZTuA5E52hfONkpPzO/s320/photonics-08-00111-g001-550.webp" width="320" /></a></div><br /><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Mechanical
loading methods are static and dynamic using both contact and noncontact
approaches. For clinical applications in the anterior segment of the eye, it
appears that dynamic, noncontact methods are the most translatable. Current
noncontact methods include air-puff excitation, optical excitation, and acoustic
microtapping (AμT) using air-coupled ultrasound. For measurements in the cornea
(and sclera), optical excitation and AμT provide high bandwidth and spatially
precise excitation well-matched to mechanical wave analysis.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Soft
tissue responds to dynamic loading by launching mechanical waves. Broadband
excitations produce mechanical waves, which in bulk materials exhibit wave
speed and attenuation directly related to tissue viscoelastic parameters. Using
these methods, robust, quantitative elasticity maps of structures within the
anterior segment of the eye, especially the cornea, are possible.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Precise
knowledge of corneal biomechanics is critical for early diagnosis, optimal
management of diseased corneas (e.g., keratoconus) and predicting the risks of
surgical intervention of healthy corneas, such as post-LASIK ectasia. In
addition, traditional IOP measurements using direct contact are often con
founded by the elastic properties of the cornea. Instruments such as the ORA
and DSA attempt to account for these properties by monitoring the corneal
response to a dynamic mechanical stimulus as part of IOP measurement. Dynamic
tonometry is being considered as a potential screening tool for glaucoma and
myopia, where there is recent evidence that corneal elasticity is linked to
disease progress 70% of the population. However, it is clear that these measurements
are highly susceptible to experimental conditions and cannot be used to map
fundamental corneal viscoelastic parameters at high spatial resolution.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Therapeutic
interventions, such as UV cross linking, have been monitored with OCE to
measure the progression and retardation of collagen degradation.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Current
refractive surgery planning uses a population-based average of corneal
biomechanics rather than a customized treatment plan, which occasionally produces
unpredictable treatment outcomes even with the most conservative selection
criteria. The availability of an accurate, personalized corneal biomechanical
map of individual cornea from high-resolution OCE may enable a customized
treatment plan for each patient, with the biomechanical response adequately
predicted for the long term.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Current
clinical IOP measurements rely on indirect techniques with limited accuracy
because ocular biomechanics cannot be taken into account on a
patient-by-patient basis. Available systems used to measure IOP in vivo, such
as Goldmann applanation, ORA, and dynamic contour and non-contact tonometry,
may be improved by calibration methods that account for corneal mechanical
properties. Additionally, it is difficult for conventional (not OCE based)
tonometry systems to directly visualize the distribution of local corneal
mechanical properties in addition to providing robust estimates of quantitative
modulus values. As current clinical gold standards struggle to accurately
estimate the influence of corneal mechanical properties on IOP, approaches
utilizing available systems may lead to misinformed clinical decision making, a
niche where OCE may find great utility.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">OCE has
also shown utility in lens analysis. With aging, the natural crystalline lens
becomes less pliable causing reduced accommodation. This can be directly
measurable using OCE methods, as demonstrated using acoustic radiation force (ARF-OCE)
to detect age-related stiffness in rabbit lens. It has, however, also been
reported that increased IOP affects the shear wave speed in the lens, implying
a less understood IOP dependence on lens mechanical moduli.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">ARF-OCE
has also been demonstrated as a method to assess elasticity within the retina,
potentially providing additional information regarding cellular degradation
from measurements of retinal and choroidal stiffness, as well as providing
further insight into how IOP affects ocular function.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbekE7nUFEjWi_cbQOOxbiOSQ6BBRLeIG52IYK7swHZmqZhTGQMHf8u2sJRA47qXJcPNVmj79xiwb2JQVnzbBVaZvDPk1ZssyIBWON4GUPd8BNv9GLeuyLhOuKQ_Sy1I4keelcpRDozrvOXJEUhVOoZ5eWETlUWrd6kjNQV-TfCDjf8wekABAHJ-_7sF7Z/s300/w300.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="227" data-original-width="300" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbekE7nUFEjWi_cbQOOxbiOSQ6BBRLeIG52IYK7swHZmqZhTGQMHf8u2sJRA47qXJcPNVmj79xiwb2JQVnzbBVaZvDPk1ZssyIBWON4GUPd8BNv9GLeuyLhOuKQ_Sy1I4keelcpRDozrvOXJEUhVOoZ5eWETlUWrd6kjNQV-TfCDjf8wekABAHJ-_7sF7Z/s1600/w300.png" width="300" /></a></div><br /><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;"><br /></span><p></p>
<p class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Georgia",serif; font-size: 12pt; line-height: 150%;">Once
reliable and robust measurements of elastic modulus become possible in a
noninvasive manner, the micro- and macrostructure of tissue may be used to
infer vast amounts of pathophysiological data.<o:p></o:p></span></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3GrFuIE8MbLbO5MwbOWFHk_9R6C7qMQAXait7_K4MVQFB0AQEOT2sT0SWCC-NSZuBKFiMn-gQ0BSZu_5LxxkHTgR66tcZX85fVF4a-19_cAZ13geEOYgPkLaXExvJFDdCv4gbRoB3vOig24Bc2_MJZeENA-0GHA3aHJR79wEFLmSK4QT1tIS0LyPI95TP/s1024/IMG_20231108_191516.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3GrFuIE8MbLbO5MwbOWFHk_9R6C7qMQAXait7_K4MVQFB0AQEOT2sT0SWCC-NSZuBKFiMn-gQ0BSZu_5LxxkHTgR66tcZX85fVF4a-19_cAZ13geEOYgPkLaXExvJFDdCv4gbRoB3vOig24Bc2_MJZeENA-0GHA3aHJR79wEFLmSK4QT1tIS0LyPI95TP/w200-h200/IMG_20231108_191516.png" width="200" /></a></div><br />Editor: Syed Shoeb Ahmadhttp://www.blogger.com/profile/14393637475189657745noreply@blogger.com0