How a CAT Could Benefit From Glaucoma Patients
Even as toddlers with a "boo-boo" we learn that our bodies have the magic-like ability to heal.
With traditional glaucoma surgery, however, that healing response works against us.
Most glaucoma surgeries are what are called "penetrating.
" They require the creation of a fistula, or track from inside the eye into a reservoir (or bleb).
If this fistula closes (as occurs with healing or scarring) the surgery fails.
One way to prevent scarring is to use an "anti-metabolite" such as Mitomycin-C or 5-Fluouracil.
These agents work to inhibit the natural healing response.
The problem is that they can also cause irreversible damage to the eye resulting in long-term risk of infection (as the eye can never heal again in the area exposed to the anti-metabolite).
A novel approach to altering the healing response would be to block the healing signal in the body with an antibody.
Antibodies are natural substances created by our bodies to attack bacteria and viruses.
Scientists, however, have learned how to create antibodies that instead mop up the healing proteins in the body.
Just such an anti-healing antibody has been discovered that could help patients with glaucoma.
As reported in the journal Investigative Opthalmology and Visual Science, researchers at the Wound Healing Unit, Institute of Opthalmology in London studied a human monocolonal antibody called CAT-152 (lerdelimumab).
Professor Mead and his team found the monoclonal antibody CAT-152 can counteract the effect of transforming growth factor-beta2 (TGFb2), which stimulates scar formation.
This results in less aggressive scarring and improved eye pressure control.
When compared to use of the anti-metabolite 5-Fluouracil, the filtration reservoir (bleb) survival and surgical outcome improved by 5%.
Moreover, CAT-152 was well-tolerated and has a better safety profile compared to other agents.
Unfortunately, for those patients with glaucoma who need surgery now, monoclonal injections are not yet an option.
For the present, glaucoma patients may consider other "non-penetrating" filtering procedures like Canaloplasty which work without the use of antiproliferative agents.
Canaloplasty works by opening the eye's natural drainage system.
Because there is no "penetration" that can scar down, there is no need for modifying the body's healing response.
This surgery, which is technically more challenging than traditional surgeries requires special training.
To date, there are only a handful a surgeons in the USA performing Canaloplasty.
However, most major metropolitan area (such as Los Angeles) have at least one surgeon with the skills and patience to perform this new glaucoma surgery.
David Richardson, M.
D.
was trained at Harvard Medical School, is Board Certified, holds an active license in the State of California, and has performed thousands of eye surgeries.
As the first "interventional eye surgeon" in the San Gabriel Valley, he is certified to perform Canaloplasty.
He has been named as a "Super Doctor" by his peers (Los Angeles Magazine 2010& 2011) as well as a "Top Doc" (Pasadena Magazine 2008, 2009 & 2010).
He is currently accepting new patients (even those without cataracts or glaucoma), and is always willing to provide a second opinion for those who would like the peace-of-mind that such a consultation would provide.
With traditional glaucoma surgery, however, that healing response works against us.
Most glaucoma surgeries are what are called "penetrating.
" They require the creation of a fistula, or track from inside the eye into a reservoir (or bleb).
If this fistula closes (as occurs with healing or scarring) the surgery fails.
One way to prevent scarring is to use an "anti-metabolite" such as Mitomycin-C or 5-Fluouracil.
These agents work to inhibit the natural healing response.
The problem is that they can also cause irreversible damage to the eye resulting in long-term risk of infection (as the eye can never heal again in the area exposed to the anti-metabolite).
A novel approach to altering the healing response would be to block the healing signal in the body with an antibody.
Antibodies are natural substances created by our bodies to attack bacteria and viruses.
Scientists, however, have learned how to create antibodies that instead mop up the healing proteins in the body.
Just such an anti-healing antibody has been discovered that could help patients with glaucoma.
As reported in the journal Investigative Opthalmology and Visual Science, researchers at the Wound Healing Unit, Institute of Opthalmology in London studied a human monocolonal antibody called CAT-152 (lerdelimumab).
Professor Mead and his team found the monoclonal antibody CAT-152 can counteract the effect of transforming growth factor-beta2 (TGFb2), which stimulates scar formation.
This results in less aggressive scarring and improved eye pressure control.
When compared to use of the anti-metabolite 5-Fluouracil, the filtration reservoir (bleb) survival and surgical outcome improved by 5%.
Moreover, CAT-152 was well-tolerated and has a better safety profile compared to other agents.
Unfortunately, for those patients with glaucoma who need surgery now, monoclonal injections are not yet an option.
For the present, glaucoma patients may consider other "non-penetrating" filtering procedures like Canaloplasty which work without the use of antiproliferative agents.
Canaloplasty works by opening the eye's natural drainage system.
Because there is no "penetration" that can scar down, there is no need for modifying the body's healing response.
This surgery, which is technically more challenging than traditional surgeries requires special training.
To date, there are only a handful a surgeons in the USA performing Canaloplasty.
However, most major metropolitan area (such as Los Angeles) have at least one surgeon with the skills and patience to perform this new glaucoma surgery.
David Richardson, M.
D.
was trained at Harvard Medical School, is Board Certified, holds an active license in the State of California, and has performed thousands of eye surgeries.
As the first "interventional eye surgeon" in the San Gabriel Valley, he is certified to perform Canaloplasty.
He has been named as a "Super Doctor" by his peers (Los Angeles Magazine 2010& 2011) as well as a "Top Doc" (Pasadena Magazine 2008, 2009 & 2010).
He is currently accepting new patients (even those without cataracts or glaucoma), and is always willing to provide a second opinion for those who would like the peace-of-mind that such a consultation would provide.