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Editors Selection IGR 15-4

Surgical treatment: Ciliary tissue transplantation for prolonged hypotension

Comment by Jost Jonas on:

24841 Prolonged ocular hypotension: would ciliary tissue transplantation help, Watson PG; Jovanovik-Pandova L, Eye, 2009; 23: 1916-1925

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Germany The problem, one usually faces in glaucoma, is an intraocular pressure being too high for the pressure sensitivity of the optic nerve. The situation can be considerably more difficult if the intraocular pressure is below the threshold pressure of about 5 to 7 mmHg, which is necessary for the homeostasis of the eye. It is clinically easier to lower the intraocular pressure (the problem is just to keep at a specific level) than to increase it. The most challenging reason for chronic ocular hypotony is an insufficiency of the ciliary body to produce aqueous humour. Several procedures have been described for that situation, such as intracameral or intravitreal injection of triamcinolone and highly viscous substances, and intraocular silicone oil endotamponade, to mention only a few. In their experimental pilot study, Watson and Jovanovik-Pandova (1747) transplanted allografts of ciliary epithelium and its substrate on to the surface of the iris of normal and immunosuppressed albino rabbits. They found that these allografts of ciliary tissue survived in the normal anterior chamber of immunosuppressed rabbits and that the allografts may have produced aqueous humour. The study by Watson and Jovanovik-Pandova may be an important first step in using transplantation medicine to restore a normal intraocular pressure in eyes after severe damage to the ciliary body, and thus preventing ocular phthisis and blindness. Future studies are necessary to show that the implanted ciliary body tissue also survives in the human eye (perhaps with an intraocular immunosuppression by intraocular steroids to avoid the systemic side-effects) and whether the transplanted tissue does not undergo metaplasia but keeps its anatomy and function as an aqueous humour secreting tissue.

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