Breakthrough treatment reduces post-surgical scarring for glaucoma patients
(Medical Xpress) -- Scientists at the Singapore Eye Research Institute (SERI) and Nanyang Technological University (NTU) have developed an innovative way to combat post-surgical scarring for glaucoma patients.
A clinical trial has shown that the use of a new drug delivery method has resulted in 40 per cent fewer injections needed by glaucoma patients to prevent scarring after surgery. This also means fewer hospital visits for these patients in future.
Glaucoma, a disease characterised by a build-up of pressure in the eye, is a major cause of blindness worldwide. It affects about 3 per cent of the population in Singapore and an estimated 30 per cent of sufferers require surgery to adequately control the disease. However, success rates for glaucoma surgery in Asian patients are considerably lower than those reported in Caucasian patients because Asians have a higher risk of scarring after such surgery. Up to one out of three operated patients requires a minor surgical procedure in the first six months in order to maintain the ideal low post-operative eye pressure.
The post-operative scarring response is the major obstacle for successful glaucoma surgery. Weve seen in our clinics that Asian patients scar earlier and more aggressively than their Caucasian counterparts, and a significant number require at least one post-operative intervention to treat this scarring response, said Associate Professor Tina Wong, Senior Consultant with SNECs Glaucoma Service, and Head of the Ocular Therapeutics and Drug Delivery Research Group at SERI. She is also the senior author of this study.
The breakthrough treatment method is made possible by Professor Subbu Venkatraman, Acting Chair of NTUs School of Materials Science and Engineering, who invented a way to make the drug, which prevents post-surgical scarring, last longer at the site of the injection. This considerably increases the interval before the drug has to be administered again.
Using a gel know as hyaluronic acid, Professor Venkatraman discovered a way to contain the drug, 5-Fluorouracil (5-FU) inside the gel. Leveraging NTUs expertise in controlled-release technology, we have found a way to deliver the drug 5-Fluorouracil gradually into the patient. This allows the drug to be time-released over several days, compared to the current effect of the drug which remains at the injected site for only a few hours. The benefit for patients who have undergone glaucoma surgery is clear fewer injections of the drug are needed. This results in less post-surgical scarring and fewer visits to the hospital.
The aim of glaucoma surgery is to create a new pathway for the aqueous fluid to flow out, thereby lowering eye pressure. During glaucoma surgery, a flap is created using the patients own tissue to regulate the outflow of aqueous fluid. A small blister, known as a conjunctival bleb, marks the new surgically created filtration site.
The flap that allows fluid to flow out can be blocked if scar tissue forms, preventing the fluid from draining effectively and causing the eye pressure to rise again. This is a particularly common problem in Asian patients. To restore outflow through the surgical flap, the obstructing scar tissue needs to be removed by injecting 5-FU which prevents further scarring. This procedure is called bleb needling.*
The clinical trial involved 49 patients, who were randomised to receive an injection of either the current 5-FU solution or the new combined formulation following bleb needling. All subjects were followed up for three months. The trial was conducted at the Singapore National Eye Centre.
The team found that the subjects who were randomised to receive the new treatment had an improved post-operative outcome. With this novel treatment, we observed a dramatically lower rate for repeat needling, with only 12 per cent requiring further intervention, whereas 50 per cent of subjects receiving the standard 5-FU solution treatment required further needlings, said Dr Arun Kumar Narayanaswamy, Senior Clinical Research Fellow, SERI, and first author of this study.
In addition, because these patients require fewer interventions, their risk of ocular infection and side effects are significantly reduced, he added.
Assoc Prof Wong, also an adjunct professor at NTUs School of Materials Science and Engineering, and Professor Subbu Venkatraman together with his team of scientists, are improving the new treatment method further using nano-encapsulation. The team aim to achieve a precise release of the correct amount of drug at a steady daily dose over a course of several weeks instead of just a few days as shown by the study.
Because the acute and most active stage of wound healing occurs in the first twelve weeks after surgery, we ideally need a sustained time release of the anti-scarring drug that can be administered as a single injection and provide the right amount of drug to continually suppress the scarring response for that crucial time frame. That way, we wont have to keep injecting patients with top-ups, often on a fortnightly or even weekly basis which is not only inconvenient for the patient but greatly increases the risk of complications with each additional injection, said Assoc Prof Wong.
In the future, this novel treatment could also be applied at the time of the glaucoma surgery to further improve surgical outcomes, as well as reduce the possible need for or frequency of bleb needling interventions after surgery.
The study, published in the journal Ophthalmology early this year, has been shortlisted for a Best Clinical Research Oral Presentation at the second SingHealth Duke-NUS Scientific Congress, which will take place on 3 and 4 August at Raffles City Convention Centre.
This research was supported in part by an Individual Research Grant awarded to Assoc Prof Wong by the Singapore Ministry of Healths National Medical Research Council.
Journal reference: Ophthalmology
Provided by Singapore Eye Research Institute
- Glaucoma stent approved Jun 26, 2012 | not rated yet | 0
- Glaucoma procedure now available at Mayo Clinic aims to prevent further eye damage Jun 25, 2008 | not rated yet | 0
- Glaucoma surgery in the blink of an eye Sep 11, 2007 | not rated yet | 0
- Mayo Clinic detective work shows possible side effect in macular degeneration drug Oct 24, 2011 | not rated yet | 0
- World-first glaucoma gene discovery May 02, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Learning curve of Electromagnetism?
3 hours ago I'm taking a first year physics course and have been having a little trouble with the basics of newtons laws and forces and whatnot, though nothing...
thin glass in liquid
3 hours ago I have one question about optics because I start interested in it. If an object is placed a distance p from a thin glass lens (index of refraction...
How many joules expended for a push up?
6 hours ago Just wondering if any of you can do the calculation that well approximates the amount of joules expended by a push up.
force to keep the folding doors
6 hours ago Hello, I would like to ask you to calculate the force F, which needed to keep the folding doors in this position. I would like to know what is the...
Confusion regarding direction of kinetic friction on inclined plane.
7 hours ago *please help! * The formula for kinetic friction acting on a sliding body is μkN When the body is sliding with constant velocity down an...
13 hours ago Alright, so in Pathfinder (like Dungeons and Dragons) there's a spell that allows you to lift/move stuff within 25 ft with 5 pounds of force. A...
- More from Physics Forums - Classical Physics
More news stories
The most common cause of failure after glaucoma surgery is scarring at the surgical site, so researchers are actively looking for ways to minimize or prevent scar formation. Previous work had suggested that vascular endothelial ...
Ophthalmology May 17, 2013 | not rated yet | 0 |
New research is emphasizing the importance of regular screenings for glaucoma, a disease that deteriorates the optic nerve over time and is a leading cause of irreversible blindness worldwide. The onset of glaucoma is associated ...
Ophthalmology May 17, 2013 | not rated yet | 0 |
The University of Nottingham and Nottingham University Hospitals NHS Trust, have been working with Sony Computer Entertainment Europe (SCEE) to develop special 3-D glasses and games to help treat children ...
Ophthalmology May 08, 2013 | not rated yet | 0
The first successful cornea transplant with donor endothelial tissue preloaded by an eye bank has been performed at Massachusetts Eye and Ear in Boston, Mass. Roberto Pineda II, M.D., Director of the Refractive Surgery Service ...
Ophthalmology May 07, 2013 | 5 / 5 (1) | 0
Adding omega-3 fatty acids did not improve a combination of nutritional supplements commonly recommended for treating age-related macular degeneration (AMD), a major cause of vision loss among older Americans, ...
Ophthalmology May 06, 2013 | 3 / 5 (2) | 0 |
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
6 hours ago | not rated yet | 0 |
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
15 hours ago | 5 / 5 (1) | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
16 hours ago | 5 / 5 (1) | 0 |
The latest makeover to a massive psychiatric tome honored by some, reviled by others and even called the "Bible" of mental disorders is being released Saturday with a host of new changes.
4 hours ago | not rated yet | 0
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.
4 hours ago | not rated yet | 0
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
6 hours ago | 5 / 5 (1) | 0