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M. S. Klocek, I. S. Zagon, J. W. Sassani, P. J. McLaughlin; The Role of Opioid Growth Factor in Enhancing the Success of Trabeculectomy: In vivo Studies. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3911.
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Over 2.2 million people have glaucoma in the U.S. Trabeculectomy is commonly used to prevent complications of glaucoma, and the success of this procedure depends on the reaction of Tenon's capsule fibroblasts (TCFs) to the surgical trauma. A serious detriment of this filtration surgery is the hyperproliferation of TCFs. Current adjuvant therapies used to reduce cell proliferation and fibrosis such as 5-fluorouracil and mitomycin-C (MMC) have serious side effects such as toxicity and bleb leakage. This study examined the efficacy of OGF as a potential non-toxic, antifibrotic adjuvant treatment to trabeculectomy.
A modified Scheie procedure was performed on 23 New Zealand White (NZW) rabbits. Animals were treated intraoperatively with PBS (control), OGF (5 mg), or MMC (0.4mg/ml). Intraocular pressure (IOP) of both the operated and unoperated eyes was measured daily by a tonometer (Tonopen XL). Daily measurements of bleb height, area, and vascularity were assessed via a slit lamp microscope to evaluate overall bleb health. Bleb failure was described as a bleb that had become flattened, scarred, and vascularized in appearance.
A Kaplan-Meier survival curve showed a mean bleb survival of 19.5 days for OGF treated animals compared to 21 days for MMC treated animals. Both OGF and MMC treated animals had blebs that functioned significantly longer than controls (9 days) (p=0.0005, log rank). Bleb area and height of MMC treated animals were larger and higher than controls starting at post-operative days 4 and 8 respectively (p<0.01). Most importantly, MMC and OGF treated groups were comparable to each other in bleb area and height.
Post-operative bleb assessment reveals that OGF is comparable to MMC in prolonging bleb function in NZW rabbits. These data suggest that OGF could serve as a new non-toxic treatment to reduce the resultant fibrosis of filtration surgery for glaucoma.
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