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The use of bioerodible polymers and daunorubicin in glaucoma filtration surgery
J H Rabowsky1, A J Dukes, D A Lee
1Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, School of Medicine 90095-7004, USA.
Purpose:
Glaucoma filtering surgery usually fails from postoperative fibroblast proliferation, collagen deposition, and subsequent sclerostomy or bleb scarring. Daunorubicin inhibits fibroblast proliferation in vivo and in vitro. The authors studied the effect of a sustained subconjunctival release of daunorubicin by way of a bioerodible polymer on the success of glaucoma filtration surgery in a rabbit model.
Methods:
Daunorubicin was incorporated into the copolymer by compression molding. The resultant implant measured 3.0 mm in diameter, 1.0 mm in thickness, and 8.0 mg in weight. A posterior lip sclerectomy was performed in both eyes of 23 rabbits by the same surgeon. One eye was randomized to receive the disc with daunorubicin, whereas the fellow eye received a blank disk as a control. The appropriate polymer disk then was placed on the scleral surface immediately posterior to the sclerostomy site and the conjunctiva was closed. Intraocular pressures and slit-lamp biomicroscopy were recorded preoperatively, then every other day after surgery for 31 days. Intraocular pressure, bleb survival, and complications were evaluated.
Results:
The decrease in intraocular pressure from baseline was significantly greater in the daunorubicin eyes than in the control eyes during postoperative days 5 through 25. Bleb survival was significantly longer in the daunorubicin eyes than in the control eyes (bleb failure in 91% of control eyes versus 22% of treatment eyes by day 13). There were no statistically significant differences between the daunorubicin-treated and control eyes regarding corneal clouding, lens clarity, cataract formation, or conjunctival injection. However, conjunctival erosions occurred in four daunorubicin-treated eyes. Histopathologic examination was performed 2 weeks after surgery on the eyes of three randomly selected rabbits.
Conclusion:
Daunorubicin in a bioerodible delivery system may potentially be a useful adjunct to glaucoma filtering surgery and requires further evaluation.
Insights
This study shows that daunorubicin delivered via a bioerodible implant can improve glaucoma surgery success by reducing scarring and extending bleb survival in rabbits.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Pharmacology
Background:
- Glaucoma filtering surgery success is often limited by postoperative scarring.
- Fibroblast proliferation and collagen deposition lead to sclerostomy or bleb scarring, causing surgical failure.
- Daunorubicin is known to inhibit fibroblast proliferation.
Purpose of the Study:
- To evaluate the efficacy of a sustained subconjunctival release of daunorubicin using a bioerodible polymer.
- To determine the effect of this delivery system on the success of glaucoma filtration surgery in a rabbit model.
Main Methods:
- Daunorubicin was incorporated into a bioerodible polymer disk.
- Posterior lip sclerectomy was performed in rabbits, with one eye receiving the daunorubicin disk and the fellow eye a control disk.
- Intraocular pressure and bleb survival were monitored for 31 days.
Main Results:
- Daunorubicin treatment resulted in significantly greater intraocular pressure reduction compared to controls.
- Bleb survival was significantly longer in the daunorubicin group (22% failure) versus the control group (91% failure) by day 13.
- No significant differences in corneal clarity or lens status were observed, but conjunctival erosions occurred in four treated eyes.
Conclusions:
- Daunorubicin delivered via a bioerodible system shows potential as an adjunct to glaucoma filtering surgery.
- Further evaluation is warranted to confirm its utility in improving surgical outcomes.