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J Glaucoma. 2019 Feb 21. doi: 10.1097/IJG.0000000000001215. [Epub ahead of print]

Effect of Two Novel Sustained- Release Drug Release Systems on Bleb Fibrosis: An In Vivo Trabeculectomy Study in a Rabbit Model.

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Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Departments of Anesthesia and Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Department of Ophthalmology, University of South Florida, Tampa, Florida, USA.



Rabbit model studies suggested better morphology blebs with equal IOP efficacy as a standard MMC Trabeculectomy using a novel slow release drug delivery anti-fibrotic system delivering small quantities of MMC and 5 FU.


To evaluate two different concentrations of biodegradable poly(lactic-co-glycolic acid) (PLGA) system with 5-fluorouracil (5-FU) and mitomycin C (MMC) (ElutiGLASS) for their ability to reduce fibrosis and compare the results to standard trabeculectomy with MMC in a rabbit model.


New Zealand albino rabbits (19) were divided into 3 groups (A, B, C) and standard trabeculectomy operation was performed in the right eye of each rabbit.Group (A) had Trabeculectomy with MMC (0.4▒mg/cc) applied using a Weck cell sponge; (B) Trabeculectomy with slow release ElutiGLASS (0.23▒mg 5-FU/0.33▒μg MMC released over 23- 30▒d ); (C) Trabeculectomy with rapid release ElutiGLASS (0.45▒mg of 5-FU /0.65▒μg MMC, released over 5-7▒d). The rabbits were followed for 3 months prior to euthanasia.


Bleb morphology, vascularity, and fibrosis were less pronounced in groups B and C when compared to Group A at 3 months. Group B appears to have a lower and more diffuse bleb appearance compared to the other two groups with honeycomb appearance on both clinical examination and UBM with higher percentage of maintained bleb space (83%), less fibrosis than Group A while maintaining the same low inflammation score as the other two groups on histology. At 3 months, the PLGA polymer had completely disappeared in all rabbits. There were no statistical differences in the degree of IOP reduction or histologic inflammation, among the 3 groups.


We successfully created a sustained-release anti-fibrotic drug delivery system that delivered known dosage of the drugs at doses that are significantly lower than the current standard, and resulted in less fibrosis while maintaining a healthy bleb and equal reduction of intraocular pressure.


These results are supportive of the antifibrotic effect of the slow-release drug delivery system used in conjunction with trabeculectomy, thus paving the way for human pilot studies to improve and simplify existing surgical techniques for filtering surgeries in glaucoma.

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