Joseph, Jeremy Paul;
(1990)
An in vitro investigation of ocular fibroblasts in relation to glaucoma filtration surgery.
Doctoral thesis (M.D), UCL (University College London).
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Abstract
The trabeculectomy is by far the most widely performed operation for chronic glaucoma. Studies of adult Caucasian patients undergoing this procedure report a success rate of about 85%. However, in children. Blacks, neovascular and aphakic glaucomas, and in patients who require re-operation, the success rate is far lower. The majority of trabeculectomies that fail, do so because of fibrosis which produces scarring at the operation site. It is unknown why certain patients are predisposed to surgical failure. The migration of fibroblasts to the wound under the influence of locally produced chemicals, and their subsequent contraction, are important in the formation of scar tissue. Fibroblast migration and contraction have not previously been studied in the context of glaucoma surgery. In addition, the role of the aqueous humour in maintaining the patency of a trabeculectomy is poorly understood. Rabbit and human ocular fibroblasts were established in tissue culture, and employed in migration assays using 48-well micro-chemotaxis chambers. Chemoattractants consisted of fibronectin, fibroblast conditioned medium, and aqueous humour. The aqueous was derived from normal rabbit and human eyes, and from patients undergoing glaucoma surgery. The fibroblasts were also investigated in contractile assays. A series of drugs were then evaluated as potential fibroblast inhibitors. Rabbit and human aqueous humour was found to be strongly chemotactic to ocular fibroblasts. Samples derived from patients who had previously undergone failed glaucoma drainage surgery were of significantly greater activity than control specimens. The presence of high aqueous chemotactic activity pre-operatively may partially explain why some patients are prone to surgical failure. A number of the drugs evaluated markedly inhibited fibroblast migration and contraction. Further testing of these compounds, particularly taxol, is indicated in animal models of glaucoma drainage surgery as some of them may be beneficial in inhibiting fibrosis in patients undergoing trabeculectomy, thereby improving the success rate of surgery.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D |
| Title: | An in vitro investigation of ocular fibroblasts in relation to glaucoma filtration surgery |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Thesis digitised by ProQuest. |
| Keywords: | Health and environmental sciences; Glaucoma |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10123753 |
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