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P. Szurman, S. Grisanti, F. Ziemssen, M. Warga, K.U. Bartz-Schmidt; Adjuvant Decorin Therapy for Wound Healing Suppression after Filtrating Glaucoma Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1202.
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Purpose: To evaluate the antifibrotic capacity of subconjunctival Decorin as adjuvant therapy in trabeculectomy in rabbit eyes. Methods: Trabeculectomy was performed in 15 rabbit eyes divided into three subgroups of 5 eyes: trabeculectomy (1) without adjuvant therapy, (2) with 0.04 mg Decorin, (3) with 0.1 mg Decorin. In the Decorin groups subconjunctival injection was applied 15 min before operation and the four successive postoperative days. Operative procedure comprised a limbus based conjunctival approach, preparation of a 2.5 x 2.5 mm scleral flap, trepanation with a 1.5 mm trephine and subsequent iridectomy. Postoperatively, intraocular pressure was monitored by indentation tonometry in both eyes. After 2 weeks, the eyes were enucleated and processed for histological examination. Clinical success was defined as intraocular pressure ratio smaller than 0.8 compared to the non-operated eye. Results: In the control group intraocular pressure exceeded a ratio of 0.8 after 7 days postoperatively, while the Decorin groups maintained a pressure ratio less than 0.8 during the follow up time of 2 weeks. Eyes with 0.04 mg Decorin disclosed a mean ratio of 0.75 ± 0.09, eyes with 0.1 mg Decorin showed a more pronounced effect with 0.58 ± 0.11. Histology in control eyes disclosed a marked tenon proliferation with subconjunctival deposition of extracellular matrix and scleral flap scarring. Eyes with adjuvant Decorin showed a significantly reduced fibrosis and deposition of collagen material being more distinctive in the 0.1 mg Decorin group. Conclusions: Decorin in the applied concentrations might be an effective antifibrotic adjuvant in trabeculectomy, showing significant reduction of extracellular matrix deposition and subsequently a beneficial effect on postoperative scarring and intraocular pressure reduction.
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