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Editors Selection IGR 12-3

Surgery: Autologus fibroblast injection

Comment by Paul Palmberg on:

13966 Injection of cultured autologous fibroblasts into the subconjunctival space of rabbits treated with mitomycin C, Hwang JM; Kee C, American Journal of Ophthalmology, 2006; 142: 259-263

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Hwang and Kee (928) have produced a rabbit model of the conjunctival changes induced by mitomycin application, and then observed the effect on conjunctival fibroblast density and collagen deposition of autologous blood injection, autologous fibroblast injection or no further treatment. Autologous fibroblast injection resulted in a thickened, less transparent conjunctiva that contained functional fibroblasts and collagen deposition, while autologous blood injection achieved lesser change.

Prior to the introduction by Peng Khaw of changes in the way mitomycin is applied in filtering surgery there was a considerable risk of late bleb leaks and infection. However, the use of thin sponges over a wide area under fornix-based flaps fortunately has markedly reduced these complications. While treatment of problematic blebs is not as important as prevention, there are still many vulnerable blebs from the prior era and better treatments than the use of autologous blood injection are still needed, since it succeeds in only a minority of cases, and better than bleb revision, which in the majority of cases results in either the need for supplemental medical therapy or bleb failure.We should be cautious about extrapolating from the present study in a rabbit model that did not involve blebs to human blebs with leaks. The flow dynamics in leaking blebs might prevent the cells from depositing where they are needed. In addition, proper facilities are needed to grow autologous fibroblasts without introducing viral or other contamination. But the approach is interesting.

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