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Glaucoma: HELP
Articles by Peng Tee Khaw
Based on 50 articles published since 2008
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Between 2008 and 2019, P. Khaw wrote the following 50 articles about Glaucoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Neuroprotection and other novel therapies for glaucoma. 2013

Nucci, Carlo / Strouthidis, Nicholas G / Khaw, Peng Tee. · ·Curr Opin Pharmacol · Pubmed #23142029.

ABSTRACT: -- No abstract --

2 Review Enhanced Trabeculectomy: The Moorfields Safer Surgery System. 2017

Khaw, Peng Tee / Chiang, Mark / Shah, Peter / Sii, Freda / Lockwood, Alastair / Khalili, Ashkan. · ·Dev Ophthalmol · Pubmed #28442684.

ABSTRACT: Trabeculectomy with antifibrotic treatment is still the most popular incisional procedure for glaucoma filtration surgery (GFS) worldwide. The advent of antifibrotic agents reduced failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimise the risk of: (1) complications and (2) surgical failure. This chapter covers preoperative, intraoperative, and postoperative strategies, which improve the outcome of GFS. Strategies to reduce the risk of complications centre on the prevention of postoperative hypotony by minimising the risk of overdrainage, postoperative wound leaks, and poor bleb morphology. Surgical techniques to reduce the risk of postoperative fibrosis by the use of antifibrotic agents (including mitomycin C) are discussed in detail. These techniques are based on a combination of considerable clinical experience, observation, and laboratory research. The need to address pre-, intra-, and postoperative issues in each individual patient is emphasised. These changes are embodied in the system we call the "Moorfields Safer Surgery System." The use of these strategies has considerably reduced the incidence of major complications, including hypotony, cystic blebs, and endophthalmitis in practices around the world. Most of these techniques are simple, require minimal equipment, and can be easily mastered. They are associated with an improvement in overall outcome and it is hoped that this chapter will help the reader benefit from these advances.

3 Review Primary congenital glaucoma. 2015

Ko, Fang / Papadopoulos, Maria / Khaw, Peng T. ·National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. · National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. Electronic address: p.khaw@ucl.ac.uk. ·Prog Brain Res · Pubmed #26518078.

ABSTRACT: Primary congenital glaucoma (PCG) is the most common nonsyndromic glaucoma in infancy, which can lead to blindness, or a lifetime of vision when diagnosed and treated properly. PCG is more common in populations with a higher prevalence of consanguinity and is associated with CYP1B1 gene mutations which show variable expressivity and phenotypes. The immature angle appearance of PCG likely results from arrested development of tissues of neural crest origin in the third trimester, with the severity of abnormality varying according to the stage at which arrested development occurred. Classic symptoms at presentation include tearing, photophobia, blepharospasm, eye rubbing, and irritability. Examination may reveal elevated intraocular pressure, corneal edema, increased corneal diameter, Haab striae, or enlarged axial length. Angle surgery remains the first line treatment for PCG with a recent advance being circumferential trabeculotomy with the potential to incise the whole angle during one operation as oppose to an incremental approach and the associated multiple anesthetics. Once angle surgery fails, either trabeculectomy or glaucoma drainage device surgery may be appropriate.

4 Review Childhood glaucoma surgery in the 21st century. 2014

Papadopoulos, M / Edmunds, B / Fenerty, C / Khaw, P T. ·Glaucoma Service, Moorfields Eye Hospital, London, UK. · Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA. · Manchester Royal Eye Hospital, University of Manchester, Manchester, UK. · NIHR Biomedical Research Centre and Glaucoma Service, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK. ·Eye (Lond) · Pubmed #24924446.

ABSTRACT: Most children with glaucoma will require surgery in their lifetime, often in their childhood years. The surgical management of childhood glaucoma is however challenging, largely because of its greater potential for failure and complications as compared with surgery in adults. The available surgical repertoire for childhood glaucoma has remained relatively unchanged for many years with most progress owing to modifications to existing surgery. Although the surgical approach to childhood glaucoma varies around the world, angle surgery remains the preferred initial surgery for primary congenital glaucoma and a major advance has been the concept of incising the whole of the angle (circumferential trabeculotomy). Simple modifications to the trabeculectomy technique have been shown to considerably minimise complications. Glaucoma drainage devices maintain a vital role for certain types of glaucoma including those refractory to other surgery. Cyclodestruction continues to have a role mainly for patients following failed drainage/filtering surgery. Although the prognosis for childhood glaucoma has improved significantly since the introduction of angle surgery, there is still considerable progress to be made to ensure a sighted lifetime for children with glaucoma all over the world. Collaborative approaches to researching and delivering this care are required, and this paper highlights the need for more high-quality prospective surgical trials in the management of the childhood glaucoma.

5 Review New developments in the pharmacological modulation of wound healing after glaucoma filtration surgery. 2013

Lockwood, Alastair / Brocchini, Stephen / Khaw, Peng Tee. ·National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK. ·Curr Opin Pharmacol · Pubmed #23153547.

ABSTRACT: Despite the advent of many new devices for glaucoma surgery, scarring is the main cause of suboptimal pressure control and surgical failure in all forms of surgery. The cytotoxic antimetabolites, 5-flurouracil and mitomycin C both prolong success but with the increased risk of blinding complications. A greater understanding of the cellular mechanisms of the wound healing response has led to the identification and modulation of potential therapeutic targets. These include transforming factor β, inflammatory mediators, the acute phase protein serum amyloid P, vascular endothelial growth factor and the matrix metallaproteinases. While optimal drug delivery is still a major challenge, modulating these effects either directly or through downstream signalling promises to yield anti-scarring efficacy, while minimising side effects.

6 Review Enhanced trabeculectomy: the Moorfields Safer Surgery System. 2012

Khaw, Peng Tee / Chiang, Mark / Shah, Peter / Sii, Freda / Lockwood, Alastair / Khalili, Ashkan. ·National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK. ·Dev Ophthalmol · Pubmed #22517170.

ABSTRACT: Trabeculectomy with anti-fibrotic treatment is still the most popular incisional procedure for glaucoma filtration surgery (GFS) worldwide. The advent of anti-fibrotic agents reduced failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimise the risk of: (1) complications and (2) surgical failure. This chapter covers preoperative, intraoperative and postoperative strategies, which improve the outcome of GFS. Strategies to reduce the risk of complications centre on the prevention of postoperative hypotony by minimising the risk of overdrainage, postoperative wound leaks and poor bleb morphology. Surgical techniques to reduce the risk of postoperative fibrosis by the use of anti-fibrotic agents (including mitomycin C) are discussed in detail. These techniques are based on a combination of considerable clinical experience, observation and laboratory research. The need to address pre-, intra- and postoperative issues in each individual patient is emphasised. These changes are embodied in the system we call the 'Moorfields Safer Surgery System'. The use of these strategies has considerably reduced the incidence of major complications including hypotony, cystic blebs and endophthalmitis in practices around the world. Most of these techniques are simple, require minimal equipment and can be easily mastered. They are associated with an improvement in overall outcome and it is hoped that this chapter will help the reader benefit from these advances.

7 Review Current approaches and future prospects for stem cell rescue and regeneration of the retina and optic nerve. 2010

Dahlmann-Noor, Annegret / Vijay, Sauparnika / Jayaram, Hari / Limb, Astrid / Khaw, Peng Tee. ·UCL Partners AHSC, London, United Kingdom. ·Can J Ophthalmol · Pubmed #20648090.

ABSTRACT: The 3 most common causes of visual impairment and legal blindness in developed countries (age-related macular degeneration, glaucoma, and diabetic retinopathy) share 1 end point: the loss of neural cells of the eye. Although recent treatment advances can slow down the progression of these conditions, many individuals still suffer irreversible loss of vision. Research is aimed at developing new treatment strategies to rescue damaged photoreceptors and retinal ganglion cells (RGC) and to replace lost cells by transplant. The neuroprotective and regenerative potential of stem and progenitor cells from a variety of sources has been explored in models of retinal disease and ganglion cell loss. Continuous intraocular delivery of neurotrophic factors via stem cells (SC) slows down photoreceptor cells and RGC loss in experimental models. Following intraocular transplantation, SC are capable of expressing proteins and of developing a morphology characteristic of photoreceptors or RGC. Recently, recovery of vision has been achieved for the first time in a rodent model of retinal dystrophy, using embryonic SC differentiated into photoreceptors prior to transplant. This indicates that clinically significant synapse formation and acquisition of the functional properties of retinal neurons, and restoration of vision, are distinct future possibilities.

8 Review Strategies for optic nerve rescue and regeneration in glaucoma and other optic neuropathies. 2010

Dahlmann-Noor, A H / Vijay, S / Limb, G Astrid / Khaw, P T. ·NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK. ·Drug Discov Today · Pubmed #20197108.

ABSTRACT: Glaucoma is the most common age-related optic nerve disease and also the most common neuropathy, affecting approximately 60 million people worldwide in its most common forms. This figure is expected to rise to 80 million by 2020. Glaucoma is a neurodegenerative disease in which various triggers induce cascades of secondary events, which ultimately lead to apoptotic retinal ganglion cell (RGC) death. The main risk factor for glaucomatous nerve damage is raised pressure in the eye. Understanding the cascades mediating optic nerve damage enables the development of new, neuroprotective treatment strategies that might not only target the initial insult but also prevent or delay secondary neurodegeneration. Furthermore, neuroregeneration and repopulation of the visual pathway by stem or neural precursor cells is becoming possible. Increasing understanding of the pathways involved in directed axon growth and manipulation of stem and progenitor cells towards an RGC fate have facilitated first successes in animal models of glaucoma.

9 Review Modulation of wound healing during and after glaucoma surgery. 2008

Georgoulas, Stelios / Dahlmann-Noor, Annegret / Brocchini, Stephen / Khaw, Peng Tee. ·Ocular Repair and Regeneration Biology Research Unit, National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 9EL, UK. ·Prog Brain Res · Pubmed #18929113.

ABSTRACT: Following all types of glaucoma filtration surgery (GFS), scarring still poses the major threat to long-term success. The healing and scarring determine the percentage of patients achieving low final intraocular pressures (IOPs) that are associated with virtually no glaucoma progression. The use of antifibrotic agents to inhibit scarring of trabeculectomy blebs is now a well-established clinical practice. Unfortunately, severe complications such as leakage, infection, hypotony, and endophthalmitis with complete loss of vision may occur. In addition, surgery still fails in some individuals despite maximal doses of current antifibrotics. Better therapeutic agents are needed. Many promising new agents are being evaluated clinically and in vitro. In this chapter, we will discuss our current understanding of the wound healing process after glaucoma surgery and promising new treatment modalities.

10 Clinical Trial Comparison of latanoprost and timolol in pediatric glaucoma: a phase 3, 12-week, randomized, double-masked multicenter study. 2011

Maeda-Chubachi, Tomoko / Chi-Burris, Katherine / Simons, Brad D / Freedman, Sharon F / Khaw, Peng T / Wirostko, Barbara / Yan, Eric / Anonymous18800697. ·Pfizer Inc, New London, Connecticut, USA. ·Ophthalmology · Pubmed #21680022.

ABSTRACT: OBJECTIVE: To compare the efficacy and safety of latanoprost versus timolol in pediatric patients with glaucoma. DESIGN: Prospective, randomized, double-masked, 12-week, multicenter study. PARTICIPANTS: Individuals aged ≤18 years with glaucoma. METHODS: Stratified by age, diagnosis, and intraocular pressure (IOP) level, subjects were randomized (1:1) to latanoprost vehicle at 8 am and latanoprost 0.005% at 8 pm or timolol 0.5% (0.25% for those aged <3 years) twice daily (8 am, 8 pm). At baseline and weeks 1, 4, and 12, IOP and ocular safety were assessed and adverse events were recorded. Therapy was switched to open-label latanoprost pm and timolol am and pm for uncontrolled IOP. MAIN OUTCOME MEASURES: Mean IOP reduction from baseline to week 12. Latanoprost was considered noninferior to timolol if the lower limit of the 95% confidence interval (CI) of the difference was >-3 mmHg. A proportion of responders (subjects with ≥15% IOP reduction at weeks 4 and 12) were evaluated. Analyses were performed in diagnosis subgroups: primary congenital glaucoma (PCG) and non-PCG. RESULTS: In total, 137 subjects were treated (safety population; 12-18 years, n=48; 3-<12 years, n=55; 0-<3 years, n=34). Mean age was 8.8±5.5 years, and mean baseline IOP was 27.7±6.17 mmHg; 125 subjects completed the study, and 107 subjects were in the per protocol population. Mean IOP reductions for latanoprost and timolol at week 12 were 7.2 and 5.7 mmHg, respectively, with a difference of 1.5 mmHg (95% CI, -0.8 to 3.7; P=0.21). Responder rates were 60% for latanoprost and 52% for timolol (P=0.33). Between-treatment differences in mean IOP reduction for PCG and non-PCG subgroups were 0.6 mmHg (95% CI, -2.3 to 3.4) and 2.6 mmHg (95% CI, -0.8 to 6.1), respectively. Responder rates for latanoprost versus timolol were 50% versus 46% for the PCG group and 72% versus 57% for the non-PCG group. Both therapies were well tolerated. CONCLUSIONS: Latanoprost 0.005% is not inferior (i.e., is either more or similarly effective) to timolol and produces clinically relevant IOP reductions across pediatric patients with and without PCG. Both latanoprost and timolol had favorable safety profiles over the duration of this 3-month trial. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

11 Article Primary congenital glaucoma including next-generation sequencing-based approaches: clinical utility gene card. 2018

Yu-Wai-Man, Cynthia / Arno, Gavin / Brookes, John / Garcia-Feijoo, Julian / Khaw, Peng Tee / Moosajee, Mariya. ·National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK. c.yu-wai-man@ucl.ac.uk. · Moorfields Eye Hospital, London, EC1V 2PD, UK. c.yu-wai-man@ucl.ac.uk. · National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK. · Moorfields Eye Hospital, London, EC1V 2PD, UK. · Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. · Ophthalmology Department and Instituto de Investigacion Sanitaria, Clinico San Carlos University Hospital and Universidad Complutense. Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain. ·Eur J Hum Genet · Pubmed #30089822.

ABSTRACT: 1. NAME OF THE DISEASE (SYNONYMS): Primary congenital glaucoma (PCG). Glaucoma, congenital (GLC). 2. OMIM# OF THE DISEASE: 231300- GLC3A. 600975- GLC3B. 613085- GLC3C. 613086- GLC3D. 617272- GLC3E. 3. NAME OF THE ANALYSED GENES OR DNA/CHROMOSOME SEGMENTS: CYP1B1. LTBP2. MYOC. FOXC1. TEK. 4. OMIM# OF THE GENE(S): CYP1B1 MIM# 601771. LTBP2 MIM# 602091. MYOC MIM# 601652. FOXC1 MIM# 601090. TEK MIM# 600221. Review of the analytical and clinical validity, as well as of the clinical utility of DNA-based testing for variants in the CYP1B1, LTBP2 and MYOC gene(s) in ⊠ diagnostic, ⊠ predictive and ⊠ prenatal settings and for ⊠ risk assessment in relatives.

12 Article Genome-wide analyses identify 68 new loci associated with intraocular pressure and improve risk prediction for primary open-angle glaucoma. 2018

Khawaja, Anthony P / Cooke Bailey, Jessica N / Wareham, Nicholas J / Scott, Robert A / Simcoe, Mark / Igo, Robert P / Song, Yeunjoo E / Wojciechowski, Robert / Cheng, Ching-Yu / Khaw, Peng T / Pasquale, Louis R / Haines, Jonathan L / Foster, Paul J / Wiggs, Janey L / Hammond, Chris J / Hysi, Pirro G / Anonymous1621138 / Anonymous1631138. ·NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. · Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK. · Department of Population and Quantitative Health Sciences, Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA. · MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK. · Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, UK. · Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, UK. · Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. · Department of Ophthalmology, National University of Singapore and National University Health System, Singapore, Singapore. · Ophthalmology & Visual Sciences Academic Clinical Program (Eye-ACP), Duke-NUS Medical School, Singapore, Singapore. · Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. · Division of Genetics and Epidemiology, UCL Institute of Ophthalmology, London, UK. · Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. janey_wiggs@meei.harvard.edu. · Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, UK. chris.hammond@kcl.ac.uk. · Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, UK. pirro.hysi@kcl.ac.uk. · Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, UK. pirro.hysi@kcl.ac.uk. ·Nat Genet · Pubmed #29785010.

ABSTRACT: Glaucoma is the leading cause of irreversible blindness globally

13 Article LC-MS analysis to determine the biodistribution of a polymer coated ilomastat ocular implant. 2018

Mohamed-Ahmed, Abeer H A / Lockwood, Alastair / Fadda, Hala / Madaan, Shivam / Khaw, Peng T / Brocchini, Steve / Karu, Kersti. ·UCL School of Pharmacy, 29/39 Brunswick Square, London, WC1N 1AX, UK. Electronic address: abeer.ahmed@ucl.ac.uk. · National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, EC1V 2PD, UK. · Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA. · UCL School of Pharmacy, 29/39 Brunswick Square, London, WC1N 1AX, UK. · UCL School of Pharmacy, 29/39 Brunswick Square, London, WC1N 1AX, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, EC1V 2PD, UK. · UCL Chemistry Mass Spectrometry Facility, Department of Chemistry, Christopher Ignold Building, 20 Gordon Street, London, WC1H 0AJ, UK. ·J Pharm Biomed Anal · Pubmed #29777984.

ABSTRACT: Ilomastat is a matrix metalloproteinase inhibitor (MMPi) that has shown the potential to inhibit scarring (fibrosis) by mediating healing after injury or surgery. A long lasting ocular implantable pharmaceutical formulation of ilomastat is being developed to mediate the healing process to prevent scarring after glaucoma filtration surgery. The ilomastat implant was coated with water permeable and biocompatible phosphoryl choline polymer (PC1059) displayed extended slow release of ilomastat in vitro and in vivo. The ocular distribution of ilomastat from the implant in rabbits at day 30 post surgery was determined by the extraction of ilomastat and its internal standard marimastat from the ocular tissues, plasma, aqueous humour and vitreous fluid followed by capillary-flow liquid chromatography (cap-LC), the column effluent was directed into a triple quadrupole mass spectrometer operating in product scan mode. The lower limits of quantification (LLOQs) were 0.3 pg/μL for ocular fluids and plasma, and 3 pg/mg for ocular tissues. The extraction recoveries were 90-95% for ilomastat and its internal standard from ocular tissues. Ilomastat was found in ocular fluids and tissues at day 30 after surgery. The level of ilomastat was 18 times higher in the aqueous humour than vitreous humour. The concentration ranking of ilomastat in the ocular tissues was sclera > bleb conjunctiva > conjunctiva (rest of the eye) > cornea. Mass spectrometry analysis to confirm the presence of ilomastat in the ocular tissues and fluids at day 30 post-surgery establishes the extended release of ilomastat can be achieved in vivo, which is crucial information for optimisation of the ilomastat coated implant.

14 Article Genotype-Phenotype Associations of IL6 and PRG4 With Conjunctival Fibrosis After Glaucoma Surgery. 2017

Yu-Wai-Man, Cynthia / Tagalakis, Aristides D / Meng, Jinhong / Bouremel, Yann / Lee, Richard M H / Virasami, Alex / Hart, Stephen L / Khaw, Peng T. ·National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, England. · Experimental and Personalised Medicine Section, University College London Great Ormond Street Institute of Child Health, London, England. · Department of Mechanical Engineering, University College London, London, England. · Department of Histopathology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England. ·JAMA Ophthalmol · Pubmed #28975281.

ABSTRACT: Importance: Postsurgical fibrosis is a critical determinant of the long-term success of glaucoma surgery, but no reliable biomarkers are currently available to stratify the risk of scarring. Objective: To compare the clinical phenotype of patients with conjunctival fibrosis after glaucoma surgery with candidate gene expression tissue biomarkers of fibrosis. Design, Setting, and Participants: In this cross-sectional study, 42 patients were recruited at the time of glaucoma surgery at the Moorfields Eye Hospital from September 1, 2014, to September 1, 2016. The participants were divided into those with fibrosis and those without fibrosis. Main Outcomes and Measures: Genotype-phenotype correlations of the IL6 or PRG4 gene and detailed clinical phenotype. The IL6 and PRG4 protein expression in conjunctival tissues was also assessed using in situ immunohistochemical analysis. Central bleb area, maximal bleb area, and bleb height were graded on a scale of 1 to 5 (1 indicating 0%; 2, 25%; 3, 50%; 4, 75%; and 5, 100%). Bleb vascularity was graded on a scale of 1 to 5 (1 indicating avascularity; 2, normal; 3, mild; 4, moderate; and 5, severe hyperemia). Results: A total of 42 patients were recruited during the study period; 28 participants (67%) had previously undergone glaucoma surgery (fibrotic group) (mean [SD] age, 43.8 [3.6 years]; 16 [57%] female; 22 [79%] white), and 14 participants (33%) had not previously undergone glaucoma surgery (nonfibrotic group) (mean [SD] age, 47.7 [6.9] years; 4 [29%] female; 9 [64%] white). The fibrotic group had marked bleb scarring and vascularization and worse logMAR visual acuity. The mean (SD) grades were 1.4 (0.1) for central bleb area, 1.4 (0.1) for bleb height, and 3.4 (0.2) for bleb vascularity. The IL6 gene was upregulated in fibrotic cell lines (mean, 0.040) compared with nonfibrotic cell lines (mean, 0.011) (difference, 0.029; 95% CI, 0.015-0.043; P = .003). The PRG4 gene was also downregulated in fibrotic cell lines (0.002) compared with nonfibrotic cell lines (mean, 0.109; difference, 0.107; 95% CI, 0.104-0.110; P = .03). The study found a strong correlation between the IL6 gene and the number of glaucoma operations (r = 0.94, P < .001) and logMAR visual acuity (r = 0.64, P = .03). A moderate correlation was found between the PRG4 gene and the number of glaucoma operations (r = -0.72, P = .005) and logMAR visual acuity (r = -0.62, P = .03). Conclusions and Relevance: IL6 and PRG4 represent potential novel tissue biomarkers of disease severity and prognosis in conjunctival fibrosis after glaucoma surgery. Future longitudinal studies with multiple postoperative measures are needed to validate the effect of these potential biomarkers of fibrosis.

15 Article Genome-wide RNA-Sequencing analysis identifies a distinct fibrosis gene signature in the conjunctiva after glaucoma surgery. 2017

Yu-Wai-Man, Cynthia / Owen, Nicholas / Lees, Jonathan / Tagalakis, Aristides D / Hart, Stephen L / Webster, Andrew R / Orengo, Christine A / Khaw, Peng T. ·National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom. c.yu-wai-man@ucl.ac.uk. · UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom. c.yu-wai-man@ucl.ac.uk. · UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom. · Bioinformatics Research Group, UCL Institute of Structural and Molecular Biology, London, WC1E 6BT, United Kingdom. · Experimental and Personalised Medicine Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, United Kingdom. · National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom. ·Sci Rep · Pubmed #28717200.

ABSTRACT: Fibrosis-related events play a part in most blinding diseases worldwide. However, little is known about the mechanisms driving this complex multifactorial disease. Here we have carried out the first genome-wide RNA-Sequencing study in human conjunctival fibrosis. We isolated 10 primary fibrotic and 7 non-fibrotic conjunctival fibroblast cell lines from patients with and without previous glaucoma surgery, respectively. The patients were matched for ethnicity and age. We identified 246 genes that were differentially expressed by over two-fold and p < 0.05, of which 46 genes were upregulated and 200 genes were downregulated in the fibrotic cell lines compared to the non-fibrotic cell lines. We also carried out detailed gene ontology, KEGG, disease association, pathway commons, WikiPathways and protein network analyses, and identified distinct pathways linked to smooth muscle contraction, inflammatory cytokines, immune mediators, extracellular matrix proteins and oncogene expression. We further validated 11 genes that were highly upregulated or downregulated using real-time quantitative PCR and found a strong correlation between the RNA-Seq and qPCR results. Our study demonstrates that there is a distinct fibrosis gene signature in the conjunctiva after glaucoma surgery and provides new insights into the mechanistic pathways driving the complex fibrotic process in the eye and other tissues.

16 Article Quality of Life and Functional Vision in Children with Glaucoma. 2017

Dahlmann-Noor, Annegret / Tailor, Vijay / Bunce, Catey / Abou-Rayyah, Yassir / Adams, Gillian / Brookes, John / Khaw, Peng T / Papadopoulos, Maria. ·National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Paediatric Service, Moorfields Eye Hospital, London, United Kingdom. Electronic address: annegret.dahlmann-noor@moorfields.nhs.uk. · National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom. · National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; London School of Hygiene & Tropical Medicine, London, United Kingdom; Primary Care & Public Health Sciences, King's College London, London, United Kingdom. · National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Adnexal Service, Moorfields Eye Hospital, London, United Kingdom. · National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Paediatric Service, Moorfields Eye Hospital, London, United Kingdom. · National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom. ·Ophthalmology · Pubmed #28385300.

ABSTRACT: PURPOSE: To evaluate the effect of glaucoma on functional vision and on vision-related (VR) and health-related (HR) quality of life (QoL) in children up to 16 years of age. DESIGN: Cross-sectional observational study. PARTICIPANTS: One hundred nineteen children 2 to 16 years of age (mean age, 9.4 years; standard deviation [SD], 4.56 years) with glaucoma and their parents. METHODS: Completion of 3 validated instruments for children to assess (1) functional visual ability (FVA) with the Cardiff Visual Ability Questionnaire for Children (CVAQC), (2) VR QoL with the Impact of Vision Impairment for Children (IVI-C), and (3) HR QoL with the Pediatric Quality of Life Inventory (PedsQL) version 4.0. MAIN OUTCOME MEASURES: Cardiff Visual Ability Questionnaire for Children, IVI-C, and PedsQL scores. RESULTS: Scores for FVA, VR QoL, and HR QoL were reduced in children with glaucoma: median CVAQC score, -1.24 (interquartile range [IQR], -2.2 to -0.11; range, -3.00 higher visual ability to +2.80 lower visual ability); mean IVI-C score, 67.3 (SD, 14.4; normal VR QoL, 96); median PedsQL self-report, 78.8 (IQR, 67.4-90.2); parent report, 71.2 (IQR, 55.7-85.8); and family impact score, 74.3 (IQR, 56.9-88.5; normal HR QoL, 100). Psychosocial subscores were lower than physical subscores on the PedsQL. Older children reported less impairment on CVAQC, IVI-C, and PedsQL than younger children. Parents reported greater impact on their child's HR QoL than children reported themselves. CONCLUSIONS: Glaucoma and its management have a marked impact on a child's FVA and QoL. Children with glaucoma report HR QoL scores similar to those described by children with severe congenital cardiac defects, who have undergone liver transplants, or who have acute lymphoblastic leukemia.

17 Article A Novel Method of Extending Glaucoma Drainage Tube: "Tube-in-Tube" Technique. 2017

Chiang, Mark Yu-Ming / Camuglia, Jayne E / Khaw, Peng Tee. ·*Queensland Eye Institute †Lady Cilento Children's Hospital, Brisbane, Qld, Australia ‡NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK. ·J Glaucoma · Pubmed #27755350.

ABSTRACT: PURPOSE: To describe a new and simple technique of glaucoma tube extension that carries several advantages over previously described techniques. PATIENTS AND METHODS: A retrospective noncomparative case series of 3 patients (1 adult and 2 pediatric cases) with glaucoma tube retraction managed by the "tube-in-tube" technique. The follow-up duration ranges from 1 month to 3 years. RESULTS: Adequate tube position and length were seen in all cases throughout the follow-up period. No tube migration was seen. The intraocular pressures were significantly reduced and maintained in all cases. There was no visual loss as a result of the procedure. CONCLUSIONS: This new "tube-in-tube" glaucoma drainage device tube extension technique is safe and simple to perform, and has many advantages over previously reported techniques. It can be used in both the adult and pediatric glaucoma population, and is not limited to the type of drainage implants.

18 Article Geographical variation in glaucoma prescribing trends in England 2008-2012: an observational ecological study. 2016

Heng, Jacob S / Wormald, Richard / Khaw, Peng Tee. ·The Solomon H Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Imperial College London Faculty of Medicine, London, UK. · National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. ·BMJ Open · Pubmed #27188806.

ABSTRACT: OBJECTIVES: To explore (1) the national trend in population-adjusted prescription rates for glaucoma and ocular hypertension (OHT) in England and (2) any geographical variation in glaucoma/OHT prescribing trends and its association with established risk factors for primary open-angle glaucoma (POAG) at the population level. DESIGN: Observational ecological study. SETTING: Primary care in England 2008-2012. PARTICIPANTS: All patients who received 1 or more of the 37 778 660 glaucoma/OHT prescription items between 2008 and 2012. PRIMARY AND SECONDARY OUTCOME MEASURE METHODS: Glaucoma/OHT prescription statistics for England and its constituent primary care trusts (PCTs) between 2008 and 2012 were divided by annual population estimates to give prescription rates per 100 000 population aged ≥40 years. To examine regional differences, prescription rates and the change in prescription rates between 2008 and 2012 for PCTs were separately entered into multivariable linear regression models with the population proportion aged ≥60 years; the proportion of males; the proportion of West African Diaspora (WAD) ethnicity; PCT funding per capita; Index of Multiple Deprivation 2010 score and its domains. RESULTS: Between 2008 and 2012, glaucoma/OHT prescriptions increased from 28 029 to 31 309 items per 100 000 population aged ≥40 years. Between PCTs, nearly a quarter of the variation in prescription rates in 2008 and 2012 could be attributed to age, WAD ethnicity and male gender. The change in prescription rates between 2008 and 2012 was only modestly correlated with age (p=0.003, β=0.234), and income deprivation (p=0.035, β=-0.168). CONCLUSIONS: Increased population-adjusted glaucoma/OHT prescription rates in the study period were likely due to increased detection of POAG and OHT cases at risk of POAG. Between PCTs, regional variation in overall prescription rates was partly attributable to demographic risk factors for POAG, although the change in prescription rates was only modestly correlated with the same risk factors, suggesting potential variation in practice.

19 Article The Influence of Scleral Flap Thickness, Shape, and Sutures on Intraocular Pressure (IOP) and Aqueous Humor Flow Direction in a Trabeculectomy Model. 2016

Samsudin, Amir / Eames, Ian / Brocchini, Steve / Khaw, Peng Tee. ·*Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia †UCL Department of Mechanical Engineering ‡NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology §UCL School of Pharmacy, London, UK. ·J Glaucoma · Pubmed #26561421.

ABSTRACT: PURPOSE: Intraocular pressure and aqueous humor flow direction determined by the scleral flap immediately after trabeculectomy are critical determinants of the surgical outcome. We used a large-scale model to objectively measure the influence of flap thickness and shape, and suture number and position on pressure difference across the flap and flow of fluid underneath it. METHODS: The model exploits the principle of dynamic and geometric similarity, so while dimensions were up to 30× greater than actual, the flow had similar properties. Scleral flaps were represented by transparent 0.8- and 1.6-mm-thick silicone sheets on an acrylic plate. Dyed 98% glycerin, representing the aqueous humor was pumped between the sheet and plate, and the equilibrium pressure measured with a pressure transducer. Image analysis based on the principle of dye dilution was performed using MATLAB software. RESULTS: The pressure drop across the flap was larger with thinner flaps, due to reduced rigidity and resistance. Doubling the surface area of flaps and reducing the number of sutures from 5 to 3 or 2 also resulted in larger pressure drops. Flow direction was affected mainly by suture number and position, it was less toward the sutures and more toward the nearest free edge of the flap. Posterior flow of aqueous humor was promoted by placing sutures along the sides while leaving the posterior edge free. CONCLUSION: We demonstrate a new physical model which shows how changes in scleral flap thickness and shape, and suture number and position affect pressure and flow in a trabeculectomy.

20 Article Evaluation of Dimensional and Flow Properties of ExPress Glaucoma Drainage Devices. 2016

Samsudin, Amir / Eames, Ian / Brocchini, Steve / Khaw, Peng Tee. ·*Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia †UCL Department of Mechanical Engineering §UCL School of Pharmacy ‡NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. ·J Glaucoma · Pubmed #25719236.

ABSTRACT: PURPOSE: ExPress devices are available as P50 and P200 models, the numbers related to their luminal diameters in μm. We compared their Poiseuille's Law-based theoretical resistance values with experimental values and correlated these with their luminal dimensions derived from electron microscopy. METHODS: Scanning electron microscopy was performed on P50 and P200 devices. Bench-top flow studies were performed to find the resistances of the devices. Devices were also incorporated into a perfused, ex vivo porcine sclera model to test and compare their control of pressure, with and without overlying scleral flaps, and with trabeculectomies. RESULTS: The luminal dimensions of the P200 device were 206.4±3.3 and 204.5±0.9 μm at the subconjunctival space and anterior chamber ends, respectively. Those of the P50 device were 205.0±5.8 and 206.9±3.7 μm, respectively. There were no significant differences between the P200 and P50 devices (all P>0.05). The resistances of the P200 and P50 devices were 0.010±0.001 and 0.054±0.002 mm Hg/μL/min, respectively (P<0.05). Equilibrium pressures with overlying scleral flaps were 17.81±3.30 mm Hg for the P50, 17.31±4.24 mm Hg for the P200, and 16.28±6.67 mm Hg for trabeculectomies (P=0.850). CONCLUSIONS: The luminal diameters of both devices are externally similar. The effective luminal diameter of the P50 is much larger than 50 μm. Both devices have low resistance values, making them unlikely to prevent hypotony on their own. They lead to similar equilibrium pressures as the trabeculectomy procedure when inserted under the scleral flap.

21 Article Measures of socioeconomic status and self-reported glaucoma in the U.K. Biobank cohort. 2015

Shweikh, Y / Ko, F / Chan, M P Y / Patel, P J / Muthy, Z / Khaw, P T / Yip, J / Strouthidis, N / Foster, P J / Anonymous6890840. ·Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK. · Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. · Singapore Eye Research Institute, Singapore, Singapore. · Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia. ·Eye (Lond) · Pubmed #26315700.

ABSTRACT: PURPOSE: To determine ocular, demographic, and socioeconomic associations with self-reported glaucoma in the U.K. Biobank. METHODS: Biobank is a study of U.K. residents aged 40-69 years registered with the National Health Service. Data were collected on visual acuity, intraocular pressure (IOP), corneal biomechanics, and questionnaire from 112,690 participants. Relationships between ocular, demographic, and socioeconomic variables with reported diagnosis of glaucoma were examined. RESULTS: In all, 1916 (1.7%) people in U.K. Biobank reported glaucoma diagnosis. Participants reporting glaucoma were more likely to be older (mean 61.4 vs. 56.7 years, P<0.001) and male (2.1% vs. 1.4%, P=0.001). The rate of reported glaucoma was significantly higher in Black (3.28%, P<0.001) and Asian (2.14%, P=0.009) participants compared with White participants (1.62%, reference). Cases of reported glaucoma had a higher mean IOP (18 mm Hg both eyes, P<0.001), lower corneal hysteresis (9.96 right eye, 9.89 left eye, P<0.001), and lower visual acuity (0.09 logMAR right eye, 0.08 logMAR left eye, P<0.001) compared with those without (16 mm Hg both eyes, hysteresis 10.67 right eye, 10.63 left eye, 0.03 logMAR right eye, 0.02 logMAR left eye). The mean Townsend deprivation index was -0.72 for those reporting glaucoma and -0.95 for those without (P<0.001), indicating greater relative deprivation in those reporting glaucoma. Multivariable logistic regression showed that people in the lowest income group (<£18,000/year) were significantly more likely to report a diagnosis of glaucoma compared with any other income level (P<0.01). We observed increasing glaucoma risk across the full range of income categories, with highest risk among those of lowest income, and no evidence of a threshold effect. CONCLUSIONS: In a large U.K. cohort, individuals reporting glaucoma had more adverse socioeconomic characteristics. Study of the mechanisms explaining these effects may aid our understanding of health inequality and will help inform public health interventions.

22 Article Long-Term Outcomes of Trabeculectomy Augmented with Mitomycin C Undertaken within the First 2 Years of Life. 2015

Jayaram, Hari / Scawn, Richard / Pooley, Francisco / Chiang, Mark / Bunce, Catey / Strouthidis, Nicholas G / Khaw, Peng Tee / Papadopoulos, Maria. ·Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. · Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom. · Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; Glaucoma Department, Fundación Oftalmológica Los Andes, Santiago, Chile. · Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Glaucoma Department, Queensland Eye Institute and City Eye Centre, Brisbane, Australia. · National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; London School of Hygiene & Tropical Medicine, London, United Kingdom. · Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Singapore Eye Research Institute, Singapore, Republic of Singapore; Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia. · Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom. · Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom; National Institute of Health Research Biomedical Research Centre for Ophthalmology, University College London Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom. Electronic address: maria.papadopoulos@moorfields.nhs.uk. ·Ophthalmology · Pubmed #26315044.

ABSTRACT: PURPOSE: To evaluate the long-term effectiveness and safety of mitomycin C (MMC)-augmented trabeculectomy undertaken within the first 2 years of life for the surgical management of glaucoma. DESIGN: Retrospective, consecutive, noncomparative case series. PARTICIPANTS: All children who underwent MMC-augmented trabeculectomy within 2 years of birth between May 2002 and November 2012. METHODS: The medical records of 40 consecutive eyes of 26 children who underwent surgery by a single surgeon were reviewed. Data collected during routine clinical care were analyzed. MAIN OUTCOME MEASURES: Assessment of clinical outcomes included intraocular pressure (IOP), final visual acuity, bleb morphology, surgical complications (early and late), postoperative interventions, and further glaucoma surgery performed. Surgical success was defined as final IOP of 5 mmHg or more and of 21 mmHg or less, with anti-glaucoma medications (qualified success) and without (complete success), stable ocular dimensions and optic disc cupping, and no further glaucoma surgery (including needling) or loss of light perception. Surgical outcomes were evaluated using Kaplan-Meier life table analysis. RESULTS: Forty eyes of 26 children were studied over a mean follow-up period of 62.8 months. Most cases (80%) were of primary congenital glaucoma after failed goniotomy surgery. Cumulative probabilities of survival at 1, 5, and 7 years were 78%, 67%, and 60%, respectively. Of eyes regarded as successful, 96% (25/26 eyes) had controlled IOP without topical medication and 44% achieved visual acuity of 20/40 or better. In only 1 of the 40 eyes did a cystic avascular bleb develop, with all the other eyes being non-cystic in nature (diffuse and elevated or flat) at final follow-up. Sixty-four percent (9/14 eyes) of cases regarded as failures ultimately underwent glaucoma drainage device implantation. CONCLUSIONS: A contemporary pediatric trabeculectomy technique augmented with MMC is an effective procedure in the management of glaucoma within the first 2 years of life, as shown by the successful long-term outcomes and low incidence of sight-threatening complications. Trabeculectomy after failed goniotomy surgery or as a primary surgical intervention may offer a phakic infant with glaucoma an excellent opportunity to achieve long-term control of IOP without medications and may be associated with optimal visual outcomes.

23 Article An energy theory of glaucoma. 2015

Li, Ying / Li, Daqing / Ying, Xi / Khaw, Peng T / Raisman, Geoffrey. ·Department of Brain Repair and Rehabilitation, Spinal Research Unit, UCL Institute of Neurology, London, United Kingdom. · Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing, China. · NIHR Biomedical Research Centre Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK. ·Glia · Pubmed #25808326.

ABSTRACT: A radial array of fortified astrocytes (FASTs) is the load bearing structure of the rat optic nerve head (ONH). At the retinal end the ONH is suspended on a fluid filled extracellular space occupied by modified pigment cells which generate a glomerular-like formation of villi. We propose that regulation of fluid in and out of this space may contribute to buffering the normal fluctuations of intraocular pressure. The energy requirement for the fluid transfer process is provided by the dense vascularity of the ONH and is reflected in the giant mitochondria of the FASTs. We propose that glaucoma occurs when a maintained rise in pressure overwhelms the capacity of this regulatory system. Under these circumstances the FAST array becomes detached from its anchorage in the surrounding ONH sheath. Progressively driven backwards by the pressure, the FASTs degenerate. We propose that the degeneration of the FASTs is associated with ischemic damage caused by the backward stretching of their blood supply. Retraction of the FAST processes deprives the retinal ganglion cell axons of their energy support, resulting in axotomy. We consider that our previously observed rescue of axons and FASTs by transplantation of olfactory ensheathing cells is due to replacement of this lost energy source.

24 Article Experimental glaucoma induced by ocular injection of magnetic microspheres. 2015

Bunker, Shannon / Holeniewska, Joanna / Vijay, Sauparnika / Dahlmann-Noor, Annegret / Khaw, Peng / Ng, Yin-Shan / Shima, David / Foxton, Richard. ·Ocular Biology and Therapeutics, University College London Institute of Ophthalmology. · University College London Institue of Ophthalmology. · University College London Institue of Ophthalmology; Moorfields Eye Hospital. · University College London Institue of Ophthalmology; NIHR Biomedical Research Centre, Moorfields Eye Hospital. · Schepens Eye Research Institute, Harvard Medical School. · Ocular Biology and Therapeutics, University College London Institute of Ophthalmology; Hoffman-La Roche. · Ocular Biology and Therapeutics, University College London Institute of Ophthalmology; richard.foxton@ucl.ac.uk. ·J Vis Exp · Pubmed #25742031.

ABSTRACT: Progress in understanding the pathophysiology, and providing novel treatments for glaucoma is dependent on good animal models of the disease. We present here a protocol for elevating intraocular pressure (IOP) in the rat, by injecting magnetic microspheres into the anterior chamber of the eye. The use of magnetic particles allows the user to manipulate the beads into the iridocorneal angle, thus providing a very effective blockade of fluid outflow from the trabecular meshwork. This leads to long-lasting IOP rises, and eventually neuronal death in the ganglion cell layer (GCL) as well as optic nerve pathology, as seen in patients with the disease. This method is simple to perform, as it does not require machinery, specialist surgical skills, or many hours of practice to perfect. Furthermore, the pressure elevations are very robust, and reinjection of the magnetic microspheres is not usually required unlike in some other models using plastic beads. Additionally, we believe this method is suitable for adaptation for the mouse eye.

25 Article A comparison between tube surgery, ND:YAG laser and diode laser cyclophotocoagulation in the management of refractory glaucoma. 2013

Bloom, Philip A / Clement, Colin I / King, Anthony / Noureddin, Baha / Sharma, Kamal / Hitchings, Roger A / Khaw, Peng T. ·Western Eye Hospital, 153-173 Marylebone Road, London NW1 5QH, UK. ·Biomed Res Int · Pubmed #24222905.

ABSTRACT: PURPOSE: To compare the results of intraocular pressure (IOP) reduction by 3 treatment modalities, (a) glaucoma tube implants, (b) noncontact YAG laser cyclophotocoagulation (cycloYAG), and (c) contact transscleral diode laser cyclophotocoagulation (cyclodiode), in cases of advanced glaucoma refractory to alternative treatments. METHODS: A consecutive group of 45 eyes that received cycloYAG were matched against two control groups of patients who had received tube surgery or cyclodiode, each control group having been derived from a database of patients. RESULTS: Mean pretreatment IOP improved from 41.3, 38.6, and 32.0 mmHg for the tube, cycloYAG, and cyclodiode groups, respectively, to 16.4, 22.1, and 19.3 mmHg, respectively. Treatment success was achieved in 78%, 69%, and 71% of the tube, cycloYAG, and cyclodiode groups, respectively. Visual acuity deteriorated 2 or more Snellen lines in 16%, 7%, and 9% of the patients in the tube, cycloYAG, and cyclodiode groups, respectively. Complications included retinal detachment, hypotony, and phthisis. CONCLUSIONS: All 3 methods provided acceptable IOP lowering in the short and medium term. Control of IOP was best in patients receiving tube surgery. Cyclodiode and cycloYAG treatments were similarly effective in lowering IOP. Tube surgery was associated with a greater incidence of sight threatening complications.

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