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Azra Idrizovic, Jeffrey Freedman, Pavel Iserovich; The Effect of Removing Pro-inflammatory Cytokines from Molteno Implant Blebs with Elevated Intraocular Pressure.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3193.
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A previous study determined that removal of aqueous from hypertensive Molteno blebs resulted in greater survival of blebs.1 As a result thereof, this study was done to determine whether high levels of pro inflammatory cytokines obtained from hypertensive Molteno implant blebs are associated with the eventual success or failure of the bleb.
A retrospective chart review was undertaken of 15 eyes of 15 patients, with primary open angle glaucoma, following Molteno implant surgery. Surgical implant success was compared to the level of Transforming Growth Factor beta-2 (TGFβ−2) found in the aqueous, removed from the blebs during a period of increased IOP, following implant insertion. Success was defined as intraocular pressure between 5 mmHg and 18 mmHg.
Success occurred in 7 eyes and failure in 8 eyes. TGFβ−2 levels were 7782 ± 2660 (pg/ml) in the successful group and 14047 ± 1608 (pg/ml)(p=0.03) in the failure group. The average follow up after implant insertion was 39 months (Range 3 to 84 months). Average IOP at time of failure was 33 mmHg (Range 20 to 44).
A recent study revealed that elevated IOP is associated with increased levels of cytokines. 2 Our study shows that elevated levels of the pro-inflammatory cytokine, TGFβ−2, in Molteno implant blebs may be associated with eventual failure of the bleb. Lowering of IOP is thought to reduce cytokine formation. This was accomplished by removal of aqueous from the bleb, which resulted in lower levels of pro inflammatory cytokines and most importantly successful IOP control. We therefore recommend the removal of aqueous from the hypertensive bleb as the method of choice for both decreasing IOP and reducing cytokine content leading to a more successful bleb outcome. References: 1. Freedman J, Rubin B. Molteno implants as a treatment for refractory glaucoma in black patients. Arch Ophthalmol. 1991;109:1417-1420. 2. Freedman J, Iserovich P. Pro-inflammatory cytokines in glaucomatous aqueous and encysted Molteno implant blebs and their relationship to pressure. Invest Ophthalmol Vis Sci. 2013;54:4851-4855.
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