Anti-inflammatory medication after corneal trauma or surgery to prevent subsequent late glaucoma.

Abstract

Purpose : Since late glaucoma is the most damaging complication after acute corneal events such as surgery or trauma, our aim has been to develop effective prophylaxis. We have administered antibody against TNF-α for the purpose of protecting the retinal ganglion cell against apoptosis (the hallmark of glaucoma)—and to compare with the effect of corticosteroids.

Methods : Rabbits with normal corneas or with alkali-burned corneas were injected subconjunctivally with the biologics. They were evaluated clinically and with dark- and light-adapted ERG, OCT, and IOP manometrically. The tissues were stained ex vivo in 3 days experiments with TUNEL, DAPI, and H&E. The optic nerves was evaluated after 50 days with paraphenylenediamine staining.

Results : Subconjunctival administration of 0.4 mg or 4.0 mg of adalimumab, and 1.0 mg, 10.0 or 100 mg infliximab were all well tolerated. 40 mg adalimumab showed toxicity. 4.0 mg of adalimumab suppressed apoptosis the most. Local subconjunctival injection, compared to systemic infusion, resulted in substantially higher retinal bioavailability which should reduce systemic side effects. Analysis of the optic nerve axons confirmed the safety of 100 mg infliximab and the 4.0 mg adalimumab.

Conclusions : A subconjunctival injection of 4.0 mg adalimumab has excellent protective effect against retinal ganglion cell apoptosis and no observed toxicity. Corticosteroids, especially triamcinolone 20 – 40 mg sub-Tenon or subconjunctivally, are also having a suppressive effect against apoptosis, but limited applicability because of their side effects. A clinical study for anti-glaucoma prophylaxis after corneal surgery or trauma is proposed.

This is a 2021 ARVO Annual Meeting abstract.