人眼Tenon's囊成纤维细胞原代培养的研究

目的探讨体外培养原代人眼Tenon’s囊成纤维细胞的方法及其生长特性,为抗纤维化研究提供靶细胞模型。方法取翼状胬肉及斜视手术患者的Tenon’s囊组织,用组织块法培养原代成纤维细胞。用免疫荧光方法鉴定细胞。对细胞进行传代、冻存和复苏的观察。对复苏后的细胞行MTT法检测其活力并绘制生长曲线。结果人眼Tenon’s囊成纤维细胞可以在体外用组织块方法培养出来,呈典型的长梭形。免疫荧光鉴定细胞波形蛋白染色阳性。细胞多次传代后依然生长迅速,3 d即可长满瓶底。复苏后细胞2~6 d处生长对数期,增殖能力良好。结论人眼Tenon’s囊成纤维细胞体外生长状态良好,可以液氮冻存,复苏后细胞活力较强,可以用于抗纤维化增生的基础研究。     

结缔组织生长因子对人Tenon囊成纤维细胞中E-cadherin蛋白表达的促进作用

背景 青光眼滤过手术后滤过通道的瘢痕化是手术失败的主要原因,其主要病理机制是成纤维细胞的异常增生、间质-上皮转分化及细胞外基质的重塑.结缔组织生长因子(CTGF)是促进瘢痕形成的关键因子,而CTGF是否能促进人Tenon囊成纤维细胞(HTFs)的间质-上皮转分化尚不清楚.目的 观察CTGF对HTFs间质-上皮转分化的影响.方法 用体积分数10％胎牛血清的DMEM高糖型培养液进行HTFs体外常规培养和传代,取3～6代细胞用于实验.将培养的HTFs分为空白对照组和CTGF处理组,空白对照组用DMEM完全培养液培养细胞,CTGF处理组在培养液中加入CTGF,使终质量浓度为50 ng/ml.细胞培养后48 h,采用细胞免疫荧光染色技术鉴定HTFs中上皮钙黏素(E-cadherin)蛋白的表达,采用Western blot法对HTFs中E-cadherin蛋白的表达量进行检测.结果 空白对照组及CTGF处理组HTFs均生长良好,呈长梭形,漩涡状排列.细胞免疫荧光染色显示,CTGF处理组HTFs细胞质呈红色荧光,细胞核呈蓝色荧光;空白对照组HTFs仅见DAPI蓝染的细胞核,无E-cadherin表达的红色荧光.Western blot法检测结果显示,空白对照组HTFs中E-cadherin蛋白无表达,而CTGF处理组HTFs中E-cadherin蛋白的相对表达量为0.63±0.08.结论 间叶组织来源的成纤维细胞本身不表达E-cadherin,在CTGF的刺激下成纤维细胞能够表达E-cadherin,CTGF促进HTFs的间质-上皮转分化.     

精氨酸-甘氨酸-天门冬氨酸-丝氨酸肽对人Tenon囊成纤维细胞的贴壁抑制试验观察

目的：研究精氨酸-甘氨酸-天门冬氨酸-丝氨酸（Arg-Gly-Asp-Ser，RGDS）肽对人Tenon囊成纤维细胞与纤维连接蛋白（FN）粘附、增殖的影响。方法：在传代培养的人Tenon囊成纤维细胞中加入不同浓度的RGDS（1、0.1、0.001g/L），用未贴壁细胞记数法及MTT法测定RGDS肽对人Tenon囊成纤维细胞粘附、增殖的影响。结果：RGDS肽能抑制成纤维细胞在FN上的粘附，呈浓度效应特点，能抑制成纤维细胞的增殖，呈浓度及时间效应特点。结论：在细胞水平上证实RGDS肽可阻止人Tenon囊成纤维细胞对FN的粘附和增殖，具有避免青光眼滤过术后瘢痕化形成的应用前景。     

曲古抑菌素A对人Tenon囊成纤维细胞作用的研究

目的：研究曲古抑菌素A( trichostatin A,TSA)对体外培养的人Tenon囊成纤维细胞( human Tenon capsule fibroblast, HTF)增殖能力以及组蛋白去乙酰化酶1( histone deacetylase 1,HDAC1)和HDAC2蛋白表达的影响。
　　方法：取青光眼滤过术中Tenon囊组织进行HTF体外培养。选取第3~6代细胞进行实验。设置空白对照组及TSA组(600nmol/L TSA加入培养液中),分别于培养后1,2,3 d应用 MTT法检测细胞活力变化;以600 nmol/L TSA处理 HTF 2 d 后, Western blot 法检测细胞中 HDAC1和HDAC2蛋白的表达。
　　结果：与对照组比较,TSA作用1d后HTF活力下降,呈时间依赖性,具有统计学差异( P<0.05)。 TSA处理HTF后2d,Western blot法检测HDAC1和HDAC2蛋白表达受到明显抑制。
　　结论：TSA可以通过抑制HDAC1和HDAC2的表达量,抑制人Tenon囊成纤维细胞增殖,从而减少术后结膜瘢痕形成可能。     

青光眼滤过术后瘢痕形成机制及抗瘢痕化研究进展

青光眼滤过性手术失败最主要的原因是瘢痕化造成的滤过通道堵塞。增生的瘢痕中,Tenon囊成纤维细胞转化为肌成纤维细胞持续存在,并且分泌大量的细胞外基质,胶原纤维排列紊乱。国内外学者对青光眼滤过性手术后抗瘢痕治疗进行了大量的研究,现将青光眼滤过手术后瘢痕形成机制及对应的研究进展进行综述。     

K-115增强自噬调控TGF-β1诱导的人Tenon囊成纤维细胞活化

目的:研究K-115对人Tenon囊成纤维细胞(HTFs)增殖和迁移的影响,并探讨其相关作用机制,为青光眼术后抗瘢痕治疗提供新思路。方法:选取2018-09/2019-09于河北省人民医院行青光眼手术患者的Tenon囊组织,采用组织块法进行HTFs原代培养,应用转化生长因子-β1(TGF-β1)诱导HTFs模拟青光眼滤过性手术后的细胞活化模型,并采用K-115处理细胞。将细胞分为4组：对照组采用溶剂二甲基亚砜(DMSO)处理;TGF-β1组采用10μg/L TGF-β1处理24h; TGF-β1+5 K-115组采用5μmol/L K-115预处理2h后加入10μg/L TGF-β1处理24h; TGF-β1+10 K-115组采用10μmol/L K-115预处理2h后加入10μg/L TGF-β1处理24h。通过细胞增殖实验观察细胞的增殖能力;划痕试验检测细胞的迁移能力;透射电子显微镜观察细胞内自噬小体的形成;Hoechst 33342/PI染色观察细胞凋亡情况。结果:细胞增殖实验结果提示K-115可以抑制TGF-β1诱导的HTFs增殖;划痕试验提示K-115可以抑制TGF-β1诱...     

苏拉明抑制体外培养的Tenon囊成纤维细胞增殖的实验研究

目的观察苏拉明对体外培养的Tenon囊成纤维细胞增殖的影响,探讨其作为青光眼滤过术辅助用药的可能性。方法通过体外培养青光眼患者Tenon囊成纤维细胞,采用四甲基偶氮唑盐(MTT)比色法检测不同作用时间及不同浓度的苏拉明对细胞增殖的抑制作用,并用流式细胞术分析细胞周期。结果MTT法显示苏拉明作用24h、48h及72h后,浓度分别为500mg·L-1、400mg·L-1、300mg·L-1以上的各实验组与对照组吸光度值A均数间比较有显著性差异;流式细胞术显示苏拉明将细胞阻抑于G2/M期,实验组G2/M期的细胞比对照组增加了15.8%.结论苏拉明能抑制体外培养的Tenon囊成纤维细胞增殖,并呈现剂量、时间依赖性,提示其有望成为青光眼滤过术后抗瘢痕增生的辅助用药。     

抗青光眼术后滤过泡瘢痕化组织人Tenon囊成纤维细胞的生长特性

背景 抗青光眼滤过术后瘢痕组织中的主要细胞成分是人Tenon囊成纤维细胞（HTFs）,探讨滤过泡瘢痕组织中HTFs的生长特性可为抗青光眼滤过术后预防瘢痕形成的研究提供实验基础. 目的 研究抗青光眼滤过术后滤过泡瘢痕化组织中HTFs的体外生长特性. 方法 收集因抗青光眼小梁切除术后滤过泡瘢痕化行二次手术的患者8例8眼的Tenon囊组织（4 mm＆#215;5 mm）,同期以同样的取材方法收集行斜视矫正术患者8例8眼的正常Tenon囊组织.采用组织块贴壁法将Tenon囊组织进行原代培养,用鼠抗人波形蛋白细胞免疫荧光法鉴定培养的HTFs,并用巢式PCR法检测培养的HTFs中是否受到支原体的污染.分别于第0、4、7、11、14天以发光法细胞活力检测HTFs,并绘制各组细胞的生长曲线,计算细胞群体倍增时间（PDT）.比较瘢痕组和正常组HTFs形态学和PDT的差异;将瘢痕组第5代与第15代HTFs的形态及PDT进行比较,评价细胞传代生长特性的稳定性. 结果 HTFs原代培养1～2周达到融合,呈长梭形,形态符合HTFs,传代细胞4～6 d达到融合.瘢痕组与正常组HTFs的生长特性相近,对鼠抗人波形蛋白抗体呈阳性反应,PCR检测未见支原体反应条带.瘢痕组和正常组HTFs的PDT分别为（20.54±3.51）h和（18.86±2.91）h,差异无统计学意义（t=0.634,P=0.561）.细胞培养后第4、7、11和14天,瘢痕组HTFs的细胞数与正常组比较差异均无统计学意义（t=2.663,P=0.081;t=0.194,P=0.863;t=3.338,P=0.053;t=0.627,P=0.565）,2个组的HTFs随培养时间的延长显示出一致的增生曲线.瘢痕组第5代和第15代细胞PDT分别为（20.54±3.51）h及（22.84±4.15）h,差异无统计学意义（t=0.733,P=0.505）;第5代与第15代间细胞生长曲线可见其增生能力均稳定,两代间HTFs在各时间点的细胞数差异均无统计学意义（t=1.528,P=0.235;t=0.269,P=0.786;t=1.954,P=0.139;t=0.730,P=0.506）.结论 抗青光眼术后滤过泡瘢痕化患者的HTFs体外培养生长状态良好,增生能力稳定,是进行青光眼术后滤过区抗纤维化研究的良好靶细胞.     

miR-200a对结膜成纤维细胞增生和迁移的调控作用及其机制

背景 青光眼滤过性手术后手术区域瘢痕化是导致抗青光眼手术失败的主要因素,因此越来越多的研究关注瘢痕形成的原因和过程. 目的 比较青光眼滤过术后滤过区人瘢痕组织来源成纤维细胞(HSFs)与人正常Tenon囊来源成纤维细胞(HTFs)增生迁移能力的差异以及微小RNA200a(miR-200a)对结膜成纤维细胞生物学行为的抑制作用,并探讨产生这种差异的可能机制. 方法 收集斜视手术过程中切取的正常Tenon囊组织和青光眼滤过术后手术区瘢痕组织,对成纤维细胞进行原代培养,采用细胞计数试剂盒8(CCK8)法检测不同来源成纤维细胞的增生能力;采用细胞划痕试验检测细胞的相对迁移距离;采用实时荧光定量PCR法检测不同来源成纤维细胞中转化生长因子-B1(TGF-β1)mRNA和miR-200a mRNA的表达.于HTFs培养基中分别加入0、1、2和5 ng/ml TGF-β1拟似物,于HSFs培养基中分别加入0.00、0.25、0.50、1.00μs/mlTGF-β1抑制剂,细胞处理24 h,采用CCK8法检测细胞增生能力;用2 ng/ml TGF-β1拟似物处理HTFs,用1.00 μg/ml TGF-β1抑制剂处理HSFs,分别采用划痕法检测不同处理组细胞的相对迁移距离,采用实时荧光定量PCR法检测不同处理组细胞中miR-200a mRNA的相对表达量. 结果 原代培养的细胞胞体较大,呈纺锤形或星形,细胞核呈卵圆形,对角蛋白抗体呈弱阳性反应,对波形蛋白抗体呈阳性反应.HSFs的增生值(A值)为1.476±0.110,明显高于HTFs的0.958±0.074,差异有统计学意义(t=24.900,P=0.016);HSFs中TGF-β1 mRNA相对表达量高于HTFs,是HTFs的(1.739±0.205)倍,差异有统计学意义(t=6.358,P=0.024);HSFs中miR-200a mRNA的相对表达量明显低于HTFs,是HTFs的(46.23±10.78)％,差异有统计学意义(t=7.394,P=0.018).与添加2 ng/ml TGF-β1拟似物的HTFs相比,添加TGF-β1拟似物的HSFs相对迁移距离增加了(3.533±0.402)倍,miR-200a mRNA相对表达量低至(45.4±7.3)％,差异均有统计学意义(均P＜0.05);与添加1.00 μg/ml TGF-β1抑制剂的HTFs相比,培养基中添加TGF-β1抑制剂后,HSFs的相对迁移距离幅度降低至(64.3±6.5)％,miR-200a mRNA相对表达量明显增加(3.106±0.415)倍,差异均有统计学意义(均P＜0.05).结论 HSFs的增生及迁移能力均明显强于HTFs,可能与HSFs中miR-200a表达量低有关.MiR-200a与TGF-β1在调控成纤维细胞的增生和迁移能力方面发挥相反的作用.     

汉防己甲素对体外人眼Tenon囊成纤维细胞的抑制效应

目的:研究汉防己甲素(tetrandrine,Tet)对人眼Tenon囊成纤维细胞(Tenon’s capsule fibroblasts,TCFs)的抑制效应。方法:用组织块和混合消化液培养法体外培养人眼Tenon囊成纤维细胞,并对培养的传代细胞进行形态学的鉴定。采用MTT法检测不同浓度的汉防己甲素(10-4,10-5,10-6,10-7mol/L)及0.2g/L丝裂霉素(MMC)对人眼Tenon囊成纤维细胞的抑制作用。结果:人眼Tenon成纤维细胞体外生长良好,经光镜和免疫组化观察证明该细胞为成纤维细胞。MTT法证实,随着Tet药物浓度的增大,TCFs增生活性降低,对应的TCFs抑制率升高。结论:Tet对人眼Tenon囊成纤维细胞的增殖具有明显的抑制作用。     

青蒿琥酯对人Tenon囊成纤维细胞增殖与凋亡的影响

目的 观察青蒿琥酯(artesunate,Art)对人Tenon囊成纤维(human Tenon's capsule fibroblasts,HTFs)细胞增殖与凋亡的影响,探讨青光眼术后滤过泡瘢痕化的治疗对策.方法体外培养HTFs细胞,应用不同浓度(50 μg·mL-1、100 μg·mL-1、150 μg·mL-1、200 μg· mL-1)的Art处理细胞,采用MTT法检测Art对细胞增殖的影响,流式细胞仪检测Art对细胞凋亡的影响,Western blot检测Art对凋亡相关蛋白Bax、Bcl-2表达的影响.结果 Art作用细胞48 h后,MTT结果显示:与空白对照组比较,不同浓度的Art处理组对HTFs细胞的增殖均有抑制作用,且呈浓度依赖性抑制(均为P＜0.05).流式细胞仪结果显示:与空白对照组比较,50 μg·mL-1、100μg·mL-1、150 μg· mL-1、200 μg·mL-1Art作用后细胞凋亡率逐渐增加(均为P＜0.05),分别为8.80％±0.88％、11.60％±0.56％、16.30％±1.03％、23.40％±1.62％.Western blot检测结果显示:与空白对照组比较,不同浓度Art处理组Bax蛋白表达明显增加,Bcl-2蛋白表达明显降低,且均呈浓度依赖性(均为P ＜0.05).结论 Art可抑制HTFs细胞增殖并诱导其凋亡,其机制可能是通过调节凋亡相关蛋白Bax、Bcl-2的表达而实现的.Art可能成为一种潜在的抗青光眼术后滤过泡瘢痕化的药物.     

Potential role of Rho-associated protein kinase inhibitor Y-27632 in glaucoma filtration surgery

PURPOSE: To investigate the role of Y-27632, a specific inhibitor of Rho-associated protein kinase (ROCK) in regulating human Tenon fibroblast (HTF) activities including proliferation, adhesion, contraction, migratory response, and myofibroblast transdifferentiation. Effects of Y-27632 on prevention of postoperative scar formation were also examined in a rabbit model of glaucoma filtration surgery. METHODS: After treatment of HTFs with Y-27632, cell toxicity, proliferation, migration, adhesion, and contraction were studied. The cytoskeleton and alpha-smooth muscle actin (alpha-SMA) expression were examined via immunohistochemistry. In vivo studies in Japanese white rabbits consisted of a full-thickness sclerostomy followed in the 7-day postoperative period by topical application of Y-27632. Intraocular pressure, morphologic changes in bleb features, and histology of surgical sites were evaluated. RESULTS: Y-27632 had no direct toxicity or significant effects on cell proliferation of HTF. The cell adhesion assay showed that Y-27632 promoted adhesiveness to both fibronectin and collagen type I. Use of Y-27632 significantly inhibited collagen gel contraction and alpha-SMA expression in HTFs. Y-27632 also increased HTF motility. In vivo, Y-27632 inhibited wound healing and fibroproliferation after filtration surgery and significantly improved surgical outcome compared with the vehicle. Histologic examination revealed that blebs in the Y-27632-treated group differed from those in the vehicle-treated group in that they lacked significant collagen deposition in the sclerostomy area. CONCLUSIONS: Y-27632 had profound effects on activities of HTFs and was effective in preventing fibroproliferation and scar formation in a rabbit model of glaucoma surgery. A ROCK inhibitor may be an effective anti-scarring agent after glaucoma filtering surgery.     

阿昔洛韦对体外培养人眼Tenon囊成纤维细胞增殖迁移的影响

目的:探索阿昔洛韦(ACV)对体外培养人眼Tenon囊成纤维细胞(HTFs)的增殖和凋亡的影响以及作用机制。方法:将HTFs分为ACV处理组和空白组;CCK8检测不同浓度梯度下的细胞增殖速率,划痕实验检测HTFs迁移能力,流式细胞术检测HTFs凋亡以及细胞周期。结果:与空白组相比,ACV处理组(终浓度分别为1.125、2.25、3.375、4.5mmol/L)HTFs增殖速率显著降低(P<0.05),且呈浓度依赖性。4.5mmol/L ACV处理组划痕细胞迁移率显著降低(P<0.05),细胞凋亡率显著增加(P=0.0005),细胞周期G0/G1期峰值升高(P=0.0011),S期下降(P=0.0006),细胞周期被阻滞在G0/G1期。结论:阿昔洛韦可以通过阻滞HTFs周期促进细胞凋亡,抑制HTFs的增殖和迁移。     

Bleb vascularity following post‐trabeculectomy subconjunctival bevacizumab: a pilot study

Background: To determine whether postoperative subconjunctival bevacizumab significantly alters bleb vascularity. Design: A randomized, prospective interventional study. Participants: Forty‐three eyes from 39 patients were recruited, with 21 eyes randomized to subconjunctival injections of 5‐fluorouracil, and 22 eyes to combined 5‐fluorouracil/bevacizumab. Methods: All patients who underwent uncomplicated primary antimetabolite augmented trabeculectomy who subsequently required postoperative subconjunctival 5‐fluorouracil injection within 4 weeks of surgery were eligible. Patients were randomized to receive subconjunctival 5‐fluorouracil only (7.5 mg/0.15 mL) or 5‐fluorouracil plus bevacizumab (1.25 mg/0.05 mL). Main Outcome Measures: Primary outcome was bleb vascularity with secondary endpoints including visual acuity, intraocular pressure, bleb morphology, complications and total numbers of 5‐fluorouracil injections were recorded at baseline, week 12 and 18 months. Results: At week 12, there was no significant difference between groups for visual acuity, intraocular pressure, bleb vascularity and morphology, or total number of 5‐fluorouracil injections. By 18 months, 47.4% of the 5‐fluorouracil/bevacizumab group exhibited central bleb avascularity compared with 21.1% of the 5‐fluorouracil group (Fisher's exact test, P = 0.17). Two bleb complications (one blebitis; one suture abscess) recorded in the 5‐fluorouracil/bevacizumab group. Conclusions: After a single combined injection, a trend for increased central bleb avascularity was observed, although this effect was not sufficient to reach statistical significance. This, in addition to the occurrence of two bleb‐related complications in the bevacizumab group, suggests the need for a larger clinical trial to further evaluate the safety and efficacy of bevacizumab as a modulating agent in glaucoma filtration surgery.     

TGF-β2刺激人Tenon囊成纤维细胞生物学行为改变及表达整合素连接激酶(ILK)的研究

目的 探讨转化生长因子β2(transforming growth factor beta 2,TGF-β2)对体外培养的人Tenon囊成纤维细胞(human Tenon fibroblasts,HTFs)生物学行为及表达整合素连接激酶(integrin-linked kinase,ILK)的影响.方法 组织块贴壁法培养原代HTFs,免疫荧光染色鉴定波形蛋白和角蛋白.MTT法检测不同浓度TGF-β2对HTFs细胞的促增殖作用,RT-PCR检测TGF-β2作用前后α-平滑肌肌动蛋白(smooth muscle actin,SMA)、ILK mRNA的表达,Western Blot检测α-SMA、ILK、E-cadherin蛋白的表达,细胞免疫荧光染色检测α-SMA、E-cadherin蛋白的表达.结果 MTT检测结果显示,TGF-β2作用48 h、72 h,5.0 μg· L-1及10.0 μg· L-1诱导下的OD值显著高于0.1μg·L-1、1.0 μg·L-1组及空白对照组(均为P＜O.05),5.0 μg·L-1及10.0 μg·L-1作用48 h及72 h的OD值显著高于24 h(均为P＜0.05).RT-PCR检测结果显示,5.0μg·L-1TGF-β2诱导48 h后,α-SMA mRNA及ILK mRNA水平和空白对照组相比明显上调,差异均有统计学意义(均为P＜0.05).Western Blot检测结果显示,ILK、α-SMA及E-cadherin在空白对照组和5.0 μg· L-1TGF-β2处理组均有表达,但TGF-β2能够明显上调三者的表达,5.0 μg·L-TGF-β2处理48 h组与空白对照组差异均有统计学意义(均为P＜0.05).细胞免疫荧光染色结果显示,TGF-β2处理组α-SMA、E-cadherin均有荧光表达,其中oα-SMA表达在细胞质中,而E-cadherin在细胞质和细胞核中均有表达.结论TGF-β2可以诱导体外培养HTFs增殖,转分化及黏附性增强,同时促进ILK的高表达,提示ILK在青光眼术后瘢痕化过程中可能也起到一定作用.     

Bevacizumab联合Ex-press引流管治疗新生血管性青光眼

目的:探讨玻璃体腔注射贝伐单抗(bevacizumab)联合Ex-press青光眼引流管植入术治疗新生血管性青光眼的疗效和安全性。方法:对18例19眼新生血管性青光眼患者,先行玻璃体腔注射bevacizumab,待虹膜新生血管消退或萎缩后,再行Ex-press青光眼引流管(P-200)植入术,其中6例6眼联合超声乳化白内障吸除术。根据患者屈光介质情况术前或术后尽量行全视网膜光凝。Ex-press植入术后随访12mo,观察视力、眼压和手术并发症情况。结果:玻璃体腔注药后2~7d,16眼新生血管全部消退。术后平均眼压:1mo:13.05±2.46mmHg,3mo:13.80±1.88mmHg,6mo:14.30±1.38mmHg;12mo:14.60±1.43mmHg,术后1,3,6,12mo眼压与术前相比均有显著性差异(P<0.05),且术后1,3,6,12mo眼压相比均无显著性差异(P>0.05)。19眼术后视力有提高者4眼,无明显改变15眼,无视力下降眼,完全成功11眼(58%),部分成功5眼(26%),总手术成功率84%(16/19)。术后并发症:有2例术后早期短暂浅前房,散瞳1wk后前房恢复正常,1例前房少量积血,无排斥反应和严重并发症。结论:玻璃体腔注射bevacizumab可使新生血管青光眼虹膜新生血管迅速消退或萎缩,为下一步青光眼手术创造良好的条件。Ex-press青光眼引流管植入术是新的滤过性手术,该手术创伤小,不用切除虹膜,减少了术中、术后出血的风险,联合bevacizumab是治疗新生血管性青光眼的安全而有效的术式。     

The Effect of CHIR 99021, a Glycogen Synthase Kinase-3β Inhibitor,on Transforming Growth Factor β-Induced Tenon Fibrosis

PurposeThis study investigated the effect of glycogen synthase kinase-3β (GSK-3β) inhibition on the fibrosis of human Tenon''s fibroblasts (HTFs) induced by transforming growth factor-β (TGF-β).MethodsQuantitative real-time PCR and Western blot analyses were performed to determine the expression levels of molecules associated with the fibrosis of HTFs by TGF-β (fibronectin, collagen Iα, and α-smooth muscle actin) and GSK-3β. The levels of phosphorylated Smad2 and Smad3 were also analyzed in the presence of the GSK-3β inhibitor CHIR 99021. The wound healing assay was performed to determine the effect of CHIR 99021 on the migration of HTFs. All experiments were conducted using primary cultured HTFs or human tenon tissues obtained from normal subjects and patients with glaucoma.ResultsTreatment with TGF-β resulted in an increase in the levels of molecules associated with the fibrosis of HTFs. The expression levels of these molecules were higher in the tenon tissues obtained from patients with glaucoma than those from normal subjects. When the HTFs were treated with TGF-β, a significant increase in the active form of GSK-3β (Y216) was observed. A significant decrease in the active form of GSK-3β and molecules associated with fibrosis by TGF-β was noted in HTFs treated with CHIR 99021. CHIR 99021 treatment reduced the phosphorylated Smad2/Smad2 and phosphorylated Smad3/Smad3 ratios in HTFs and attenuated HTF migration.ConclusionsOur results demonstrated the effect of GSK-3β inhibition on the regulation of TGF-β–mediated fibrosis of HTFs, suggesting GSK-3β to be a potential target for maintaining bleb function after glaucoma filtration surgery.     

Comparison of the use of 5-fluorouracil and bevacizumab in primary trabeculectomy: results at 1 year

Background: The present study compared the effects of adjuvant bevacizumab and 5‐fluorouracil on the efficacy and safety of trabeculectomy. Design: A nonrandomized, prospective, interventional case study. Participants: A total of 62 patients in two groups undergoing primary trabeculectomy. Methods: In Group 1 (21 primary open‐angle glaucoma, nine pseudoexfoliative glaucoma), trabeculectomy was performed with an adjuvant 5% solution of 5‐fluorouracil administered for 4 min, intraoperatively. In Group 2 (21 primary open‐angle glaucoma, 11 pseudoexfoliative glaucoma), trabeculectomy was enhanced with 1.25 mg of bevacizumab applied subconjunctivally immediately before and after surgery and again 1 and 7 days after surgery. Main Outcome Measures: Intraocular pressure, best corrected visual acuity, visual field index, bleb morphology, cornel endothelial cell count. Results: Mean intraocular pressure was 28.0 ± 8.0 mmHg before 5‐fluorouracil‐augmented trabeculectomy and 27.8 ± 9.5 mmHg before bevacizumab‐augmented trabeculectomy. After 12 months, mean intraocular pressure was 13.6 ± 4.4 mmHg in the 5‐fluorouracil group and 14.7 ± 4.7 mmHg in the bevacizumab group. A 30% reduction of initial intraocular pressure was attained in 86.7% of patients in the 5‐fluorouracil group and 78.1% of patients in the bevacizumab group at the end of follow up. No significant differences were noted between the two studied groups with respect to corneal endothelial density, visual field indices and postoperative complications. Conclusions: The 12‐month intraocular pressure results showed no significant differences between the two groups of patients after bevacizumab or 5‐fluorouracil to augment trabeculectomy. However, to obtain successful intraocular pressure control more patients in bevacizumab group needed medical therapy.     

Postoperative adjunctive bevacizumab versus placebo in primary trabeculectomy surgery for glaucoma

AIM: To compare the effectiveness of postoperative adjunctive use of subconjunctival bevacizumab in altering the outcome of primary trabeculectomy in terms of sustained lowering of intraocular pressure (IOP) and reduction of postoperative bleb vascularization and fibrosis. METHODS: A prospective, one center, randomized, placebo-control study. Fifty-nine patients (59 eyes) with uncontrolled IOP under maximal tolerated medical treatment (MTMT) were recruited. A primary trabeculectomy with mitomycin C (MMC) was done and the patients were randomized to either postoperative subconjunctival injection of bevacizumab (1.25 mg/0.05 mL) or balanced salt solution (BSS). Forty-seven patients (47 eyes) completed at least one year of follow up and were included in the study. The main outcome measure was the IOP, and secondary outcome measures include bleb morphology, vascularization, and fibrosis, as well as the need for glaucoma medications and 5-fluorouracil (5-FU) needling. RESULTS: At 1-year follow up, there was no significant difference between groups for IOP (P=0.65), bleb morphology (P=0.65), and the need for glaucoma medications (P=0.65) or 5-FU needling requirements (P=0.11). However, the bevacizumab group had a higher rate of success results, lower use of glaucoma medications after surgery, and optimal bleb aspect in more patients, but more 5-FU needling procedures required. CONCLUSION: A bigger sample size is needed in order to determine whether the differences found in the bevacizumab group are statistically significant.