Medical Hypothesis, Discovery & Innovation (MEHDI) Journals
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The PEG-PCL-PEG Hydrogel as an Implanted Ophthalmic Delivery System after Glaucoma Filtration Surgery; a Pilot Study
No full textCurrently, filtration surgery has been considered as the most effective therapy for glaucoma; however, the scar formation in the surgical area may often lead to failure to the procedure. An implanted drug delivery system may provide localized and sustained release of a drug over an extended period. Poly (ethylene glycol)-poly (ε-caprolactone)-poly (ethylene glycol) (PEG-PCL-PEG, PECE) hydrogel has been successfully synthesized and determined as thermosensitive and biocompatible. In order to overcome the limitations of common local ophthalmic medications, we investigated the function of a self-assembled PECE hydrogel as an intracameral injection-implanted drug carrier to inhibit the formation of postoperative scarring. Following intraoperative administration bevacizumab-loaded hydrogel intracameral was injected into rabbit eyes; the status of the bleb and filtration fistula formed following the filtering surgery were also examined through pathologic evaluation. Due to the sustained release of bevacizumab from the hydrogel, neovascularization and scar formation were inhibited; moreover, there were no corneal abnormalities and other ocular tissue damage found in the rabbits. This suggests that the PECE hydrogel may be considered as the novel biomaterial with potential as a sustained release system in glaucoma filtering surgery. Further studies require in shedding the light on the subject
The Management of Patients with Cataracts and Medically Uncontrolled Glaucoma
Full text linkTrabeculectomy surgery has been shown to lower intraocular pressure and is the most commonly performed glaucoma procedure worldwide. However, giving a patient a ‘bleb for life’ is not without consequences and the failure of trabeculectomy to control IOP in the long term is well documented. In some instances, such as in patients with exfoliative glaucoma or primary angle closure glaucoma, cataract surgery alone can often lower IOP to acceptable levels. Cataract surgery in these instances can sometimes be combined with procedures such as goniosynechialysis or endoscopic cyclophotocoagulation which may provide additional IOP lowering. Such surgery has the distinct advantage of avoiding conjunctival incisions, so that subsequent trabeculectomy, if required, is more likely to be successful. In any case, it is preferable to perform trabeculectomy in a pseudophakic eye for several reasons. If trabeculectomy is performed in a phakic eye, patients should be warned that subsequent cataract is likely and if cataract surgery is performed it is preferable to wait at least a year or more after the trabeculectomy to reduce the risk of bleb failure. Combined phacotrabeculectomy should be reserved for end-stage glaucoma in most cases, in order to reduce the risk of ‘wipe-out’
The Protective Effect of Phaseolus Vulgaris on Cataract in Type 2 Diabetes: A Profitable Hypothesis
Full text linkThe pathophysiology of major ocular complications in type 2 diabetes mellitus (T2DM) among Bantu is not well understood. Several studies have been conducted to determine the basic reasons of visual deficiencies (VD) (blindness, visual impairment, and ocular eye diseases) in T2DM among Bantu from Central Africa. The quality of dietary intake was assessed in patients along with other ophthalmological assessments for diabetic retinopathy, cataract, glaucoma, and macular edema. Beans (Phaseolus vulgaris) and leafy vegetables are rich in antioxidants. The consumption of at least 3 ladles per meal, 3 times or more per week, has been identified as a potential protective factor against cataract. The anti-radical activity of beans is well known in the literature. Beans are considered to have a comparatively higher antioxidant activity than in many other vegetables. Our findings from previous epidemiologic studies establish that the antioxidant activity of P. vulgaris helps control blood glucose. We, therefore, hypothesize that the dietary supplements of bean can be a low-cost prevention approach to reduce cataract and much other visual comorbidity associated with T2DM. However, further epidemiological studies combined with molecular research need to be conducted to prove this hypothesis
Topical Nepafenac in Treatment of Acute Central Serous Chorioretinopathy
Full text linkThis study had been performed to investigate the anatomic and functional outcomes of nepafenac 0.1% therapy in acute central serous chorioretinopathy (CSC). The medical records of 30 patients with acute CSC were reviewed for a total of 31 eye charts. Seventeen eye records of 16 patients who were treated with topical nepafenac 0.1% three times daily for four weeks and continued until complete resolution of subretinal fluid were appraised. Fourteen patients with acute CSC (a total of 14 eye records) who did not receive treatment served as the control group also had been recorded. The proportion of eyes with complete resolution of subretinal fluid, serial changes in the mean best corrected visual acuity (BCVA), and the mean central foveal thickness (CFT) at 6 months of therapy were the outcomes measured. Mean age was 42.6±8.2 years in the treatment group and 41.1±7.1 years in the control group (p=0.85). At 6 months, 14 eyes (82.3%) in the treatment group and 6 eyes (42.8%) in the control group revealed a complete resolution in the subretinal fluid (p=0.02). In the treatment group, mean BCVA (LogMAR) significantly improved from 0.19±0.17 at baseline to 0.09±0.12 at 6 months (p=0.01). In the control group, mean BCVA (LogMAR) was 0.13±0.14 at baseline and decreased to 0.1±0.11 at 6 months (p=0.28). In the treatment group, mean CFT was 349±115 µm at baseline and significantly improved to 221±95 µm at 6 months (p<0.01). In the control group, mean CFT declined from 391±138 µm at baseline to 301±125 µm at 6 months (p=0.06). No treatment-related ocular or systemic side effects were observed. In conclusion, nepafenac 0.1% has the potential to treatment acute CSC. Further trials are warranted to study its safety and efficacy for this disease
Ginsenoside-Rb1 Inhibition of VEGF Release – Structure and Activity Relations (SAR) Perspective
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Acetazolamide and Thyroid-Associated Ophthalmopathy; a Preliminary Tested Hypothesis in a TertiaryReferral Center
Full text linkThis study evaluated the effect of acetazolamide on thyroid-associated ophthalmopathy (TAO). Patients with a VISA classification index equal to or more than four were enrolled in the study and were randomly assigned into two groups. In both groups, treatment was initiated using prednisolone. Patients in the case group received acetazolamide tablets 250 mg daily in addition to prednisolone. Three months later, the VISA inflammatory score of patients in both groups were determined. Subsequent to intervention with acetazolamide, the VISA inflammatory score of patients in the case group were reduced as follows; orbital pain (57.1% versus 41.7%, P=0.736), eyelid edema (42.8% versus 27.1%, P=0.67), chemosis (53.3% versus 33%, P=0.31), injection of the eyelids (60% versus 41.6%, P=0.342), and conjunctival injection (50% versus 46.13%, P=0.73). However, these reductions were not statistically significant when compared with those observed in the control group (P=0.246). In conclusion, the effect of acetazolamide on all the parameters of the VISA inflammatory score was examined independently. All patients in the case group revealed a reduction in VISA inflammatory score following intervention. However, these reductions were not statistically significant. Further studies with large sample sizes are required
A Simple Test to Demonstrate the Implausibility of the Vitreous Traction Hypothesis
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Aspirin and Age Related Macular Degeneration; the Possible Relationship
Full text linkAge-related macular degeneration (AMD) is becoming the leading cause of blindness in developed countries. The exact etiology and pathophysiology of AMD is still unclear. A number of risk factors of AMD have been recognized, such as cigarette smoking, a family history of AMD and being Caucasian. On the other hand, aspirin is a widespread medication, which is thought to be associated with the prevalence or the survival of myocardial infarction and cancers. However, the evidence from the epidemiological studies has been contradictory and no persuasive conclusions have been made. Several problems, such as the parameters of aspirin use, the inclusion and exclusion of the participants and the required long-term follow-up, made it hard to conclude a definite relationship between aspirin use and AMD. Aspirin, as an anti-inflammatory agent, could prevent the inflammation and decrease the inflammatory damage, and might act as a deterrent for the progression of AMD. However, aspirin is an anticoagulant which might increase the risk of ocular hemorrhage in AMD patients. Decades ago, the use of aspirin was reported associated with decreased rates of CNV among AMD patients nevertheless recently, the association between aspirin use and increased risk of neovascular AMD was identified. Therefore, these current results should be challenged and acknowledged by well-designed, large-scale and long term follow-up studies. A consultation might be needed when aspirin is used in the neovascular AMD patients. To Download this article online, scan this QR code with your Smartphon