Inflammatory Molecules in Aqueous Humour and on Ocular Surface and Glaucoma Surgery Outcome

Barbara Cvenkel,Alojz Ihan,Andreja Nataša Kopitar

doi:10.1155/2010/939602

Barbara Cvenkel, Alojz Ihan + Show 1 more

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https://doi.org/10.1155/2010/939602

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Abstract

Purpose. To investigate the influence of inflammatory molecules in the aqueous humour and on the ocular surface on the outcome of glaucoma surgery. Methods. Thirty patients who needed antiglaucomatous surgery were included. The interleukin- (IL-) 8, IL-1β, IL-6, IL-10, tumour necrosis factor- (TNF-) α; and IL-12 were determined from aqueous humour preoperatively and the imprints of conjunctiva were analysed for expression of human leukocyte antigen- (HLA-)-DR after surgery by flow cytometry. The success of trabeculectomy was defined as intraocular pressure less than 21 mmHg without antiglaucoma medication. Results. Eyes with trabeculectomy failure at 3 months showed significantly higher TNF-α and IL-6 levels in the aqueous than eyes with successful surgery. Increased expression of HLA-DR on epithelial cells and antigen-presenting cells was not associated with the trabeculectomy outcome. Conclusions. Higher preoperative levels of TNF-α and IL-6 in aqueous humour may contribute to the development of inflammatory milieu and were associated with worse outcome of glaucoma surgery.

Highlights

Trabeculectomy is commonly performed in patients with uncontrolled glaucoma and with the use of antimetabolites and surgical technique modification is successful in the majority of patients [1]
We investigated the superior bulbar conjunctiva overlying the area of filtration area for the expression of human leukocyte antigen- (HLA-)DR, the markers of subclinical inflammation, on conjunctival epithelial cells and CD80 positive cells during follow-up to determine whether changes in the expression of these molecules are associated with the outcome of surgery
Mean fluorescence intensity of HLA-DR molecules on epithelial cells at 1 month and 3 months was increased in eyes with successful surgery at 12 months, but there was large scatter of the data (Figures 1 and 2)

Summary

Introduction

Trabeculectomy is commonly performed in patients with uncontrolled glaucoma and with the use of antimetabolites and surgical technique modification is successful in the majority of patients [1]. Risk factors which may influence the outcome of surgery include- previous surgery, long-term use of topical antiglaucoma medications, ocular inflammation, young age, ethnic origin, and postoperative suture lysis [2,3,4]. Changes in the number of conjunctival fibroblasts and inflammatory cells were associated with increased risk of trabeculectomy failure. Long-term use of antiglaucoma drops with preservative benzalkonium chloride (BAK) induces subclinical inflammation of conjunctiva with over expression of human leukocyte antigen- (HLA-) DR on epithelial cells. Several cytokines were found to stimulate proliferation of Tenon’s capsule fibroblasts, cells with a key role in scarring process, such as TGF-β, TNF, and IL-1 [5, 6]. Changes in the composition of this aqueous could influence the scarring process [7, 8]

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