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Alastair Lockwood, Abeer Mohamed Ahmed, Ashkan Khalili, Sahar Awwad, Garima Sharma, Steve Brocchini, Peng Khaw; The effect of steroid and matrix metalloproteinase inhibitor on bleb survival in an experimental animal model. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4480.
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The perioperative application of a sustained release matrix metalloproteinase inhibitor (MMPi) is a potential non-toxic alternative to mitomycin C (MMC) for prolonging bleb survival in glaucoma surgery. Steroids are another class of anti-inflammatory that may enhance anti-scarring efficacy. We aimed to determine whether the combination of dexamethasone and ilomastat were able to prolong bleb survival in an experimental animal model.
A randomised, prospective, masked, single observer in vivo study over 30 days was conducted. Glaucoma filtration surgery was performed on 18 New Zealand White rabbits. The rabbits received perioperatively one of three potential subconjunctival treatments, randomised according to a Latin Square design: one dexamethasone implant 2 mm diameter (1 mg) and one ilomastat implant 2 mm (1 mg), MMC soaked sponges 0.2 mg/mL for 3 minutes (positive control) and sterile water group, water applied as per MMC (negative control). Success was determined according to a clinical observation of bleb survival.
Four of the six rabbits treated with ilomastat / dexamethasone combination maintained the appearance of a bleb until day 30. Of those that did not, one developed an endophthalmitis in the first week post surgery and the other failed on day 27. The sterile water treated group failed at a median of 18 days (range 12 -21). Of the MMC treated group one animal had a bleb that failed at day 27.
Dexamethasone / ilomastat implants do appear to prolong bleb survival in this animal model.
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