Dai Zhaoxing, Yu Xiaobo, Sun Jianguo, Sun Xinghuai
Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China 2Key Laboratory of Myopia, NHFPC, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
Key Laboratory of Myopia, NHFPC, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China 3Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China 4State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, China.
Invest Ophthalmol Vis Sci. 2017 Mar 1;58(3):1692-1701. doi: 10.1167/iovs.16-21065.
To study the functional outcomes of filtration surgery by implanting improved glaucoma drainage devices (GDDs) comprising surface grooves and a composite coating of cyclosporine A (CsA) and PLGA in experimental rabbit eyes.
Improved GDDs were designed and prepared by modifying normal GDD with surface grooves and a CsA-PLGA composite coating. Normal GDDs, grooved GDDs (G-GDDs), and G-GDDs with a CsA-PLGA composite coating (CsA@G-GDD) were implanted into 18 rabbit eyes (six eyes per group). The intraocular pressure (IOP), bleb survival time, bleb morphology, and anterior chamber reactions were assessed for up to 12 weeks after GDD implantation. The IOPs were compared statistically among the three groups. Bleb morphology was quantified using the Indiana Bleb Appearance Grading Scale. Anterior chamber radiography was performed to check whether the filtrating pathway was blocked, and determine the drainage time and diffusion area of the contrast agent. Hematoxylin and eosin staining and immunohistochemistry were conducted to assess how the GDDs slowed or prevented scar formation.
The improved GDDs were successfully prepared and implanted in 18 rabbit eyes without severe surgical complications. Bleb survival time was significantly longer and IOP was significantly lower in the G-GDD and CsA@G-GDD groups compared with the GDD group (all, P < 0.001). Blebs were significantly higher in the CsA@G-GDD group than in the GDD and G-GDD groups (P = 0.003). Anterior chamber radiography revealed more unobstructed filtration channels in the CsA@G-GDD group than in the GDD group (P = 0.032). Postsurgical scar formation was less extensive in the G-GDD and CsA@G-GDD groups than in the GDD group.
Compared with the normal GDDs, G-GDDs with a CsA-PLGA coating inhibited postsurgical scar formation and improved the surgical success rate, and might represent an alternative to existing glaucoma filtration devices.
通过在实验兔眼中植入改良型青光眼引流装置（GDD），该装置包括表面凹槽以及环孢素A（CsA）和聚乳酸-羟基乙酸共聚物（PLGA）的复合涂层，研究滤过手术的功能结果。
通过用表面凹槽和CsA-PLGA复合涂层对普通GDD进行改良，设计并制备改良型GDD。将普通GDD、带凹槽的GDD（G-GDD）和带有CsA-PLGA复合涂层的G-GDD（CsA@G-GDD）植入18只兔眼（每组6只眼）。在GDD植入后长达12周的时间里，评估眼压（IOP）、滤过泡存活时间、滤过泡形态和前房反应。对三组的IOP进行统计学比较。使用印第安纳滤过泡外观分级量表对滤过泡形态进行量化。进行前房造影以检查滤过通道是否阻塞，并确定造影剂的引流时间和扩散面积。进行苏木精-伊红染色和免疫组织化学以评估GDD如何减缓或防止瘢痕形成。
改良型GDD成功制备并植入18只兔眼，无严重手术并发症。与GDD组相比，G-GDD组和CsA@G-GDD组的滤过泡存活时间显著更长，IOP显著更低（均为P < 0.001）。CsA@G-GDD组中的滤过泡显著高于GDD组和G-GDD组（P = 0.003）。前房造影显示，CsA@G-GDD组中的滤过通道比GDD组更通畅（P = 0.032）。G-GDD组和CsA@G-GDD组术后瘢痕形成的范围小于GDD组。
与普通GDD相比，带有CsA-PLGA涂层的G-GDD可抑制术后瘢痕形成并提高手术成功率，可能代表现有青光眼滤过装置的一种替代方案。
