Conjunctival TGF-B Level in Primary Augmented Trabeculectomy



Guan Fook Ng 1, Ishak Siti Raihan 1, Yaakub Azhany 1, Che Hussin Che Maraina 2, K. Gurusamy Banumathi3, Tajudin Liza-Sharmini*, 1
1 Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
2 Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
3 Hospital Pulau Pinang, Jalan Residensi, 10990 Georgetown, Pulau Pinang, Malaysia


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© Ng et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia; Tel: +609 767 6353; Fax: +609 765 3370; E-mail: liza@usm.my; sharminiliz@live.com


Abstract

Purpose :

To compare the levels of conjunctival transforming growth factor beta (TGF-β) between glaucoma and control patients and to determine conjunctival TGF-β levels before and 3 months after augmented primary trabeculectomy.

Methods :

Patients with primary open angle glaucoma (POAG) or primary angle closure glaucoma (PACG) admitted for mitomycin (MMC) augmented primary trabeculectomy due to failure in achieving target pressure after maximum medical therapy were selected. Age-matched non-glaucoma patients were controls. Impression cytology of the conjunctiva was obtained twice from glaucoma patients (1 week before augmented primary trabeculectomy and 3 months after surgery) and once from controls. Conjunctival cells were tagged with an anti-TGF-β antibody and analyzed by flow cytometry.

Results :

Eighteen patients (11 POAG and 7 PACG patients) and 18 age-matched control patients were included. Conjunctival TGF-β levels were significantly different between glaucoma (35.21% ± 14.12%) and control patients (14.96% ± 6.34%) (p = 0.001). There was a significant reduction in conjunctival TGF-β levels after augmented trabeculectomy (23.0% ± 13.8%) (p < 0.001). A significantly greater reduction in conjunctival TGF-β levels (61.6% ± 17.9%) was associated with complete success of trabeculectomy at 3 months (83.3%) after surgical intervention (p = 0.029).

Conclusion :

The reduction of TGF-β on the conjunctival post primary augmented trabeculectomy may suggest TGF-β as potential predicting marker of short term trabeculectomy success. However, the result may be affected by site of impression, topical pressure lowering drugs and small sample size.

Keywords: Conjunctival TGFbeta, impression cytology, trabeculectomy.