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Hayana Rangel, Hevila Rolim, Ivana Duval de Araujo, Paula Vidigal, Sebastiao Cronemberger; Would healing modulation in glaucoma surgery: an experimental study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4952.
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© ARVO (1962-2015); The Authors (2016-present)
This study investigates the effect of the use of Bevacizumab, Mitomycin C (MMC) and Triamcinolone (isolated and in association) on postoperative scarring after experimental glaucoma filtration surgery (GFS) in rabbits.
Forty-five New Zealand White rabbits underwent bilateral GFS and received different treatments: Saline (group 1-control); MMC (group 2); Triamcinolone (group 3); Triamcinolone and MMC (group 4); Bevacizumab (group 5); Bevacizumab and MMC (group 6). The MMC and saline were used below the scleral flap; Triamcinolone and Bevacizumab were used after GFS in subconjunctival injection(isolated and in association wiht MMC). The rabbits were evaluated on different days after GFS; intraocular pressure (IOP) was measured and the bleb’s analysis was based on Moorfields Bleb Grading System. The animals were killed on postoperative day: PD3, PD14, and PD30. Histology and immunohistochemistry were performed to examine the scarring after GFS.
Postoperative IOP in all groups was lower than preoperative IOP and remained stable throughout the study, with no significant differences between groups. Group 6 presented better clinical parameters in the maximum bubble height, central bubble area and maximum bubble area (P<0.05); the results of these parameters were better in group 4 than in the MMC group (P<0.05). Vascularization analysis of the central area and maximum area bubble showed in PD14 and PD30 lower results in the groups 2, 4 and 6 (P<0.05).In the evaluation of cellularity, in the PD14 the groups of MMC, MMC associated with Triamcinolone and Bevacizumab showed less inflammation than the other groups. In the PD30, the group of Triamcinolone in association with MMC showed the lowest cellularity (Fig. 1)(P<0.001). In the immunohistochemical evaluation, in the PD3 the group of the Saline presented greater marking of angiogenesis. In PD14, group 6 presented lower response to angiogenesis (P<0.05). In the PD30, the MMC group presented lower angiogenesis (Fig. 2)(P<0.05).
The healing cascade is a complex process, and for its modulation it is necessary the use of different agents. Our results suggest a synergistic effect of Bevacizumab and Triamcinolone when used in association with MMC, reducing the cicatricial response in GFS.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Hematoxylin-eosin staining. Presence of inflammatory cells (arrows) Group 4, PD30
Angiogenesis marking (arrows) Group 2, PD30
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